http://doi.org/10.33698/NRF0264Pooja Bhaduriya, Smriti Arora, Parul Saini

Abstract:

Background -Anabolic steroids are synthetic variations of male sex hormone testosterone. Anabolic refers to muscle building and reduced virilising effects. Objective: To assess the knowledge, attitude and practice of adults attending selected gymnasium. Methods- A descriptive study using quantitative, descriptive survey approach, cross sectional design was conducted at Evolve Health club, Dwarka New Delhi in the month of July 2017 –February 2018. A total of 100 subjects were conveniently selected and a structured questionnaire containing MCQs, rating scale and checklist, eliciting information about the knowledge, attitude and practices of adults related to steroids use was distributed to all adults attending gymnasium The questionnaire was collected on the same day after one hour. Result –The study showed that 55% of adults had adequate knowledge and 45% of adults had moderate knowledge regarding anabolic steroids. 65% adults had moderately favourable attitude, 33% had unfavourable attitude while 3% had favourable attitude regarding anabolic steroids. Out of 100 adults, 45% were using steroids. From those who were using steroids, 80% of adults were following unsafe practices and 20% of adults were following safe practices. There is a need to organize public health programs to create awareness among people so that they can improve their knowledge, attitude and practices regarding anabolic steroids.

Key words– Anabolic steroids, adults, knowledge, attitude, practice.

Corresponding author

Dr. Smriti Arora,

Professor, Amity College of Nursing,

Amity University Haryana , Gurgaon, India,

9810840372, smritiamit@msn.com

Introduction

Anabolic steroids are derivatives of testosterone with increased anabolic effects and reduced virilising effects which include muscle building and androgenic or masculinization effects. Anabolic steroids remain a relatively easy substance to procure over internet and in many developing countries, including India. They are traditionally abused by sports person but in recent times its use has been seen in adults not involved in athletics or sports for various motives e.g. increased libido, body size and improved physical appearance. They promote protein anabolism. This is manifested clinically by increase in the muscle mass and body weight.1

The rst reports of anabolic steroids use occurred following the 1954 world weightlifting championships in the International Olympic Committee. Illegal use of anabolic steroid may involve doses 10 to 100 times higher than the normal prescription dose.2 All synthetic steroids combine the anabolic or muscle-building effects with the androgenic, or secondary male sexual characteristics. Anabolic steroids use has been linked to a higher risk of heart attack or stroke.3

The World Drug Report says that the number of users of synthetic drugs estimated at around 30 to 40 million people worldwide. It was also revealed in the survey that as much as 479,000 students worldwide or 2.9% of total student population had used one or other steroid by the last year of high school.4

The health risks surrounding steroids heavily outweigh the few benets. Steroids a r e d a m a g i n g p h y s i c a l l y a n d psychologically. Steroid use can result in long term damage to health and in some cases this can be fatal. These risks include acne or oily cysts on the skin, thinning of the hair, high blood pressure which can lead to a stroke or heart attack, paranoia and an inability to sleep, stunted growth (in adolescents), risk of infection, damaged veins or ulcers from shared needles, shrunken testicles, breast development, erection problems and risk of prostate cancer in men. Researches on anabolic steroids has not been studied much. Therefore, the researcher decided to conducted the present study to assess KAP of adults on anabolic steroids. This information is necessary to assess client needs and promote healthy lifestyles through education pertaining to steroid use. Objective: To assess the knowledge, attitude and practice of adults attending gymnasium regarding anabolic steroids.

Material and Methods:

This study followed a descriptive survey approach with cross sectional design. The study was carried out at the Evolve Health Club Dwarka New Delhi from July 2017- February2018. The study population comprised of adults including male and female aged 18-40 years. Sample size was 100 adults attending Evolve health club including males and females. The adults were selected using convenient sampling technique. Data was collected after taking written informed consent. Questionnaire was used to collect data which comprised of 27 knowledge questions, 15 attitude questions and four questions related to practices. The knowledge questionnaire, maximum score was 27 and minimum score was 0. The level of knowledge categorized as, Inadequate knowledge =0-9, Moderate k n o w l e d g e = 1 0 – 1 8 , A d e q u a t e knowledge=19-27. The reliability of structured knowledge questionnaire was checked by Kuder Richardson formula 20 (KR 20). The value of Kuder Richardson- 20 was found to be 0.94. The attitude of adults related to anabolic steroids was assessed by structured attitude scale which is three-point likert scale. Maximum score was 45 and minimum score was 15. The level of attitude categorized as, Favourable =1-21 (<50%), Moderate favourable = 22- 33 (50-75%), Unfavourable =34 – 45 (76- 100%). The reliability of structured attitude scale was assessed by Cronbach alpha. The value of Cronbach alpha was found to be 0.95. The practice of adults related to anabolic steroids was assessed by Practice Checklist. Maximum score was 4 and minimum score was 0. The level of practice was categorized as Safe practices=4, Unsafe practices=<4. The reliability of structured practice checklist was assessed by kuder Richardson formula 20 (KR 20). The  value  of  Kuder  Richardson-20  was found to be 0.92. Data was collected by administering questionnaire which was collected from them after one hour.

The collected data were analysed and organized according to the objectives of the study using SPSS version 16. Descriptive statistics like frequency, percentage, mean and SD used for describing knowledge, attitude and practice score of adults.

Results:

  1. Demographic characteristics: Table 1 shows that 64% of adults were male and 36% of adults were Mean age of

          Table 1 : Demographic characteristics of Adults attending gymnasium

N=100

Variables f/%
Gender

Male

Female

 

64

36

Level of education Up to 12th Undergraduate Postgraduate  

12

64

24

Occupation Employed Business Professionals Student  

18

26

10

46

Religion Hindu Muslim Christian Sikh  

65

24

8

3

Marital status Married Unmarried  

66

34

Availability of Trainer 100

Mean + SD:age 24.47±2.63, Self -monthly income 17670.00±18795.58, Monthly income of parents 22780.00±21644.78, Duration of using gym (months) 16.69±9.98 adults was 24.47 years. As per educational status, 64% were undergraduate and 24% were postgraduate and only 12% were in higher secondary. According to occupation, 46% of the adults were students, 26% were running their own business, 18% were employed and 10% were professionals. The mean self-monthly income of adults was Rs 17670/-. Religion of 65% adults was Hindu, 24% were Muslims, and 8% were Christians and 1% were Sikhs. As per marital status, 66% of adults were single and 34% were married, none of them were divorced or widow. Mean duration of using gymnasium was 16 months. Trainer was available at all the time. Adults spend on an average 1.42 hours in gymnasium.

b.  Assessing KAP of adults related to use of anabolic steroids

Knowledge As shown in Fig 1, none of adults had inadequate knowledge, 45(45%) of adults had moderate knowledge and 55(55%) of adults had adequate knowledge regarding anabolic steroids. Table 2 shows the knowledge of the adults related to anabolic steroids in different areas.

Figure 1: Knowledge score of adults related to use of anabolic steroids

Table 2 shows the knowledge of the adults related to anabolic steroids. Most of the adults were aware of the action i.e. protein synthesis (97%), common age of using anabolic steroids (98%), and side effects of steroids like voice changes (84%), facial hair (51%), its availability and source. 85% of the adults did not know that the routes for consuming steroids was inhalation and injection also. Only 45% of adults were aware about the correct risk factors leading to steroid use. 65% correctly mentioned that the liver can be affected by steroid use.

Figure 2 shows that 65% of adults have moderately favourable attitude regarding anabolic steroids and 33% of adult have unfavourable attitude regarding anabolic steroids, only 2% of adults have favourable attitude regarding anabolic steroids.

Attitude: As shown in table 3, 62% of  adults agreed that use of steroids is necessary for body building, 72% of adults agreed and that steroids makes muscle bigger, 55% of adults agreed that steroids makes muscle stronger, 48% of adults were unsure that risks related to steroids are exaggerated by the media ,70% of adults agreed that steroids make them look better, 67% of adults agreed that steroids help in winning competition, 38% of adults agreed that steroids boosts up their morale, 55% of adults agreed that steroids cause many

Table 2 : Knowledge of adults regarding anabolic steroids.

N=100

 

S.

No

Statememt Correct

(f)

Incorrect

(f)

1 Steroids are synthetic version of testosterone. 67 33
2 The word “anabolic” means growing. 78 22
3 Anabolic steroids started to become widely used in 1950. 67 33
4 Anabolic steroids are man-made chemicals that act like

testosterone.

85 15
5 Steroid is a hormone kind of substance. 61 39
6 A primary anabolic steroid is testosterone. 94 6
7 The common age for using anabolic steroids is 20-29 years. 98 2
8 The action of anabolic steroids is to increase protein synthesis. 97 3
9 Anabolic steroids in the brain may trigger road rage. 51 49
10 The known risk factor of steroid use is history of substance abuse 45 55
11 The routes for consuming steroids are oral, inhaled & injected. 15 85
12 The common source of anabolic steroids among students is from

the ‘trainer’ .

43 57
13 Steroids can be obtained from pharmacist. 49 51
14 Liver is most affected organ by the steroids. 65 35
15 Increase in sperm count in men is not the side effect of using

anabolic steroids.

76 24
16 Steroids can cause increased facial hair growth among females 51 49
17 Restlessness is not one of the main the psychiatric side effect of

using anabolic steroids.

57 43
18 Very high body fat is not the side effects of anabolic steroids. 98 2
19 Steroids cause voice to get deepen. 84 16
20 Anabolic steroids are used in the management of AIDS. 78 22
21 Anabolic steroids causes increased heart and respiratory rates. 64 36
22 Steroids cannot increase mental intelligence. 65 35
23 In sports, body building is most marked by anabolic steroids

scandals.

61 39
24 In sports shooting is least marked by anabolic steroid scandals. 61 39
25 WADA means World Anti-Doping Agency. 70 30
26 Stacking means Taking different steroid at a same time. 78 22
27 Taking multiple doses of steroids over a specic period of time is

called Cycling.

93 7

 health problem, 57% of adults agreed that steroids make them dependent on it, 50% of adults agreed that steroids are addictive substance. Only 33% of population believed that unauthorized seller and illegal steroid user must be punished, 36% of adults agreed that steroids make a person prone to develop mental illness, 82% of adults agreed that adults must be educated about the harmful effects of steroids, 87% of adults agreed that healthy nutrition and exercise must be used instead of steroids for body building.

S.No

.

Statement Agree f % Unsure f % Disagree f %
1. Use of steroids is necessary for body building. 62 16 22
2. Steroids makes my muscle bigger 72 10 18
3. Steroids makes my muscle stronger 50 33 17
4. The risks related to steroids are exaggerated by the media. 14 48 38
5. Steroids make me look better. 70 17 13
6. Steroids help in winning competitions. 67 15 18
7. Steroids boosts up my morale. 38 39 23
8. Steroids cause many health problems. 55 37 8
9. Steroids make me dependent on it. 57 27 16
10. Steroids are addictive substance 50 35 15
11. Unauthorized Steroids sellers must be punished. 33 43 24
12. Illegal Steroids user must be punished. 33 47 20
13. Steroids make a person prone to develop mental illness. 36 44 20
14. Adults must be educated about the harmful effects of steroids. 82 15 3
15. Healthy nutrition and exercise must be used instead of steroids for body building. 87 9 4

 

Figure 2: Attitude score of adults regarding anabolic steroids Table 3 : Adult’s attitude regarding anabolic steroids.

    N=100

 Practice: Table 4 shows that 11.11% of adults were consuming steroids on Doctor’s prescription, 44.44% of adults were monitoring their blood pressure regularly while consuming steroids, 22.22% of adults were monitoring blood cholesterol level while consuming steroids, 45% of adults w e r e n o t c o n s u m i n g s t e r o i d s i n combination of others drugs, 66.67% of adults were consuming steroids on regular b a s i s . O n f u r t h e r e n q u i r y a b o u t complications and future plans 45% of adults had planned to stop use of steroids in future, 11.1% of adults experienced male pattern baldness. No one experienced any change in sexuality during steroids consumption period.

Table 4 : Practices of adults regarding anabolic steroids.

N=45

S.no. Statements (Yes) Safe practice f(%) (No) Unsafe practice f(%)
1. Do     you consume        steroids on Doctor’s

prescription?

05(11.1) 40(88.89)
2. Do you monitor your Blood Pressure regularly

while consuming steroids?

20(44.44) 25(55.55)
3. Do you go for regular monitoring of blood cholesterol level while consuming steroids? 10(22.22) 35(7.78)
4. Do you consume steroid s in combination of

other drugs?

0 45(100)

 

Figure 3: Practice score of adults regarding anabolic steroids

It was found that only 55% of adults had adequate knowledge and 45% of adults had moderate knowledge regarding anabolic steroids. A 65% of adults had moderately favourable attitude, 33% had unfavourable attitude while 3% had favourable attitude regarding anabolic steroids. Out of 100 adults, 45% were using steroids. Amongst those who were using steroids, 80% of adults were following unsafe practices and 20% of adults were following safe practices (Figure-3). There is a need to organize public health programs to create awareness among people so that they can improve their knowledge, attitude and practices regarding anabolic steroids.

Discussion:

Use of steroids is increasing among young adults. Steroids have benecial but more deleterious effect on our health. The present study was conducted at a gymnasium at Delhi, to assess the knowledge, attitude and practices of adults with respect to use of steroids.

In the present study it was found that only 55% of the study population had only adequate knowledge about anabolic steroids and 65% had moderately favourable attitude towards anabolic steroids and 45% of adults were using anabolic steroids.

In the current study related to knowledge, 45% of the adults had moderate knowledge and 55% had adequate knowledge regarding anabolic steroid. The study ndings are consistent with the study by Al- Falasi Omar et al4 conducted in United Arab reported that more than half (59%) of the study population had inadequate knowledge about anabolic steroids. Whereas similar  study  done  by  Usman  HS  et  al5    in   steroid users. Of the users, 18 (47.4%) had used Rawalpindi Islamabad reported then more than half of the gym users (72%) had adequate knowledge regarding use of steroids. A study by Alsaeed Ibrahim, JR Akmal6 in Kuwait reported that 50% of users had inadequate knowledge and only 18.2% of them had adequate knowledge.

In the present study related to attitude, 65% of adults had moderately favourable attitude, 33% of adults had unfavourable attitude only 2% had favourable attitude. The study ndings are consistent with the study conducted by E Tamir et al9 shows that 45% of the respondents believe that steroids improves physical tness and 41% believe that most well-known athletes use steroids to look muscular, 10% of respondents agreed that steroids is popular among young people in gym centres, whereas similar study by Chebet Selina8 reported a signicant change in attitude i.e. a strong trend of negative attitude more than one anabolic androgenic steroid at a time (stacking), while 20 (52.6%) said they had never stacked anabolic-androgenic steroids A study conducted by Abrahim Cost SO et al11 reported that frequency of users were 41%, 20% of them were taking in injectable form. S Sobhanian, D Rajabian et al12 performed a cross sectional study on Frequency of the use of anabolic drugs in bodybuilding athletes, which reported that among 299 subjects studied 154 (51.5%) individuals used different types of anabolic drugs, 30 (10%) of them used testosterone, 23 (7.7%) used Somatropin, 21  (7%) used Metadianabol, and 24 (8%) of the athletes were using more than three drugs.

In the present study, there was a signicant relationship between knowledge & attitude scores ®= 0.45, p=0.01) of adults regarding anabolic steroids. Similar signicant ndings have been observed by Alsaeed Ibrahim, JR (82.3%) towards AS use by Kenyan athletes  Albkal et al6 which states that the attitudes whereas only17.7% indicated a positive attitude. Related to practice, it was observed that, most of the adults (80%) had unsafe practices and 20% of adults had safe practices while using steroids. Majority of the adults were taking steroids (88.88% orally & 11.11% injectable). The ndings are supported by Alsaeed Ibrahim,towards anabolic steroids are more strongly related with the knowledge (r=0.38, p = 0.000). In the present study, there is signicant association found between level of education with knowledge, signicant association found between adults from Muslim religion and adults who were single had favourable attitude regarding anabolic steroid. The nding are

JR Akmal6     who reported that both oral and supported by Chebet Selina8 which strongly injectable forms of Anabolic steroids -were used in approximately equal frequency, and a combination of oral and injectable Anabolic steroids was the most common practice (42.6%).  Similar  study  conducted  by  Usman HS support that there is association between knowledge and level of education (p=0.002) whereas in case of attitude, she reported that female gender had signicant association with attitude. et.al5 reported that steroids in the injectable

This study was based on self-reported form were used by 83% of the bodybuilders. About 17% of the non-users of steroids were planning to start it in future, whereas D Robert, Kersey10   conducted  a  study  on anabolic–androgenic steroid use among California community college student athlete, which shows  that  3.3%  were  anabolic-androgenic information which could be biased by the participants recall. The apparent social desirability bias, specically in subject’s responses to sensitive issues such as change in sexuality and practices is potential limitation. The honesty of some responses should also be interpreted with caution especially those that pertain to questions about sexuality and use of steroids because the data was self-reported by the adults.

It is suggested that future studies can be conducted on a large sample to generalize the ndings. Similar studies can be conducted with multi setting approach. Assessment of selected interventions can be conducted to measure the KAP of adults related to steroids. A comparative research can be done in rural as well as in the urban areas to assess knowledge, attitude and practice.

Acknowledgement: I am grateful to the adults who gladly participated in the study and the gymnasium owner for granting me permission to do the study.

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