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Report to the Committee on Oversight and Government Reform, House of 
Representatives: 

United States Government Accountability Office: 

GAO: 

October 2007: 

Anabolic Steroid Abuse: 

Federal Efforts to Prevent and Reduce Anabolic Steroid Abuse among 
Teenagers: 

Teenage Abuse of Anabolic Steroids: 

GAO-08-15: 

GAO Highlights: 

Highlights of GAO-08-15, a report to the Committee on Oversight and 
Government Reform, House of Representatives. 

Why GAO Did This Study: 

The abuse of anabolic steroids by teenagers—that is, their use without 
a prescription—is a health concern. Anabolic steroids are synthetic 
forms of the hormone testosterone that can be taken orally, injected, 
or rubbed on the skin. Although a 2006 survey funded by the National 
Institute on Drug Abuse (NIDA) found that less than 3 percent of 12th 
graders had abused anabolic steroids, it also found that about 40 
percent of 12th graders described anabolic steroids as “fairly easy” or 
“very easy” to get. The abuse of anabolic steroids can cause serious 
health effects and behavioral changes in teenagers. 

GAO was asked to examine federally funded efforts to address the abuse 
of anabolic steroids among teenagers and to review available research 
on this issue. This report describes (1) federally funded efforts that 
address teenage abuse of anabolic steroids, (2) available research on 
teenage abuse of anabolic steroids, and (3) gaps or areas in need of 
improvement that federal officials and other experts identify in 
research that addresses teenage anabolic steroid abuse. To do this 
work, GAO reviewed federal agency materials and published studies 
identified through a literature review and interviewed federal 
officials and other experts. 

What GAO Found: 

There are two categories of federally funded efforts that address 
teenage abuse of anabolic steroids. Efforts are either designed to 
focus on preventing the abuse of anabolic steroids among teenagers or 
are broader and designed to prevent substance abuse in general—which 
can include abuse of anabolic steroids among teenagers. Two programs 
that received federal funding during their development and testing, 
Athletes Training and Learning to Avoid Steroids (ATLAS) and Athletes 
Targeting Healthy Exercise & Nutrition Alternatives (ATHENA), are 
designed to focus on preventing or reducing teen abuse of anabolic 
steroids through use of gender-specific student-led curricula. In 
addition, there are various research efforts and education and outreach 
activities that focus on this issue. Two federal grant programs—the 
Office of National Drug Control Policy’s Drug-Free Communities Support 
program and the Department of Education’s School-Based Student Drug 
Testing program—are designed to support state and local efforts to 
prevent substance abuse in general and may include anabolic steroid 
abuse among teenagers as part of the programs’ substance abuse 
prevention efforts. In 2007, about one-quarter of more than 700 Drug-
Free Communities Support program grantees reported that they were 
addressing steroid abuse as one of their program’s objectives. 

Almost half of the 16 studies GAO reviewed identified certain risk 
factors and behaviors linked to the abuse of anabolic steroids among 
teenagers. Several of these studies found connections between anabolic 
steroid abuse and risk factors such as use of other drugs, risky sexual 
behaviors, and aggressive behaviors. Most of the other studies were 
assessments of the ATLAS and ATHENA prevention programs and in general 
suggested that the programs may reduce abuse of anabolic steroids and 
other drugs among high school athletes immediately following 
participation in the programs. 

Experts identified gaps in the research addressing teenage abuse of 
anabolic steroids. Experts identified a lack of conclusive evidence of 
the sustained effectiveness over time of available prevention programs, 
for example at 1 year following participants’ completion of the 
programs. Experts also identified gaps in the research on the long-term 
health effects of initiating anabolic steroid abuse as a 
teenager—including research on effects that may be particularly harmful 
in teens—and in research on psychological effects of anabolic steroid 
abuse. 

To view the full product, including the scope and methodology, click on 
[hyperlink, http://wwww.GAO-08-15]. For more information, contact 
Laurie E. Ekstrand at (202) 512-7114 or ekstrandl@gao.gov. 

[End of section] 

Contents: 

Letter: 

Results in Brief: 

Background: 

Some Federally Funded Efforts Are Designed to Focus on Preventing 
Teenage Steroid Abuse, While Other Efforts Designed to Address 
Substance Abuse in General May Include Teenagers: 

Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain Risk 
Factors and That Prevention Programs May Have Some Short-term 
Effectiveness: 

Experts Find There Are Gaps in Research on the Sustained Effectiveness 
of Prevention Programs and on the Long-term Health Effects for 
Teenagers: 

Agency Comments: 

Appendix I: Selected Federally Funded Efforts That Address or Can 
Address Anabolic Steroid Abuse among Teenagers: 

Appendix II Articles Included in GAO's Review: 

Appendix III: GAO Contact and Staff Acknowledgments: 

Table: 

Table 1: Selected Federally Funded Efforts That Address or Can Address 
Anabolic Steroid Abuse among Teenagers: 

Figures: 

Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12TH Graders, 
1991-2006: 

Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female 
Adolescents, 2002-2006: 

Abbreviations: 

ATHENA: Athletes Targeting Healthy Exercise & Nutrition Alternatives: 
ATLAS: Athletes Training and Learning to Avoid Steroids: 
CDC: Centers for Disease Control and Prevention: 
HHS: Department of Health and Human Services: 
MTF: Monitoring the Future: 
NIDA: National Institute on Drug Abuse: 
NIH: National Institutes of Health: 
ONDCP: Office of National Drug Control Policy: 
SAMHSA: Substance Abuse and Mental Health Services Administration: 
USADA: United States Anti-Doping Agency: 
YRBS: Youth Risk Behavior Survey: 

United States Government Accountability Office: 

Washington, DC 20548: 

October 31, 2007: 

The Honorable Henry A. Waxman: 
Chairman: 
The Honorable Tom Davis: 
Ranking Member: 
Committee on Oversight and Government Reform: 
House of Representatives: 

The abuse of anabolic steroids[Footnote 1] by teenagers--that is, their 
use without a prescription--is a health concern. Anabolic steroids are 
synthetic forms of the hormone testosterone that can be taken orally, 
injected, or rubbed on the skin. Although a 2006 survey funded by the 
National Institute on Drug Abuse (NIDA) showed that less than 3 percent 
of 12TH graders had abused anabolic steroids, the survey also showed 
that about 40 percent of 12TH graders described anabolic steroids as 
"fairly easy" or "very easy" to get. The abuse of anabolic steroids can 
cause serious health effects and behavioral changes in teenagers. Under 
U.S. law, anabolic steroids are controlled substances whose 
manufacture, possession, and use are regulated by the federal 
government;[Footnote 2] they also cannot be sold legally without a 
prescription. 

You asked us to examine federally funded efforts to address the abuse 
of anabolic steroids among teenagers and to review available research 
on this issue. In this report, we: 

1. describe major, federally funded efforts that address teenage abuse 
of anabolic steroids, 

2. describe the available research on teenage abuse of anabolic 
steroids, and: 

3. describe gaps or areas in need of improvement that federal officials 
and other experts identify in research that addresses anabolic steroid 
abuse among teenagers. 

We focused our review on the abuse of anabolic steroids by teenagers in 
grades 8 through 12. To describe federally funded efforts to address 
anabolic steroid abuse among teenagers, we reviewed databases of 
federal grant programs.[Footnote 3] We also obtained and reviewed 
pertinent reports and information from the Web sites of agencies within 
the Department of Health and Human Services (HHS)--the Centers for 
Disease Control and Prevention (CDC), the National Institutes of Health 
(NIH), and the Substance Abuse and Mental Health Services 
Administration (SAMHSA)--as well as the Web sites of the Department of 
Education (Education) and the Office of National Drug Control Policy 
(ONDCP). We used these resources to identify federally funded 
programs,[Footnote 4] research, and education and outreach activities 
that address--through efforts to either prevent or reduce--anabolic 
steroid abuse among teenagers. After identifying these efforts, we 
interviewed and collected information from federal officials to confirm 
that these efforts are intended to prevent or reduce anabolic steroid 
abuse among teenagers. Where available, we requested funding 
information on the federal efforts that we identified.[Footnote 5] 

To describe the available research on teenage abuse of anabolic 
steroids, we conducted a systematic review of the published literature 
on this topic. We identified 16 articles that related to teenage abuse 
of anabolic steroids and were published from January 1995 through June 
2007. To select the articles, we conducted a keyword search using the 
Dialog Database System,[Footnote 6] a system that searches numerous 
database files, and reviewed the resulting article titles and abstracts 
to identify whether the articles focused on teenage abuse of anabolic 
steroids. We did not select articles that were international works, 
based on reviews of other articles or research, position papers, policy 
statements, or federal agency program documents. The references we make 
to articles refer strictly to those that we reviewed. 

To describe the gaps or areas in need of improvement in research that 
addresses teenage abuse of anabolic steroids as identified by experts, 
we interviewed experts in anabolic steroid abuse and reviewed relevant 
literature. We interviewed federal officials from CDC, NIDA, SAMHSA, 
and Education, as well as other experts from universities and 
professional associations. We reviewed research articles identifying 
gaps or areas in need of improvement as part of our systematic review 
of the literature. We conducted the work for our review from January 
2007 through September 2007 in accordance with generally accepted 
government auditing standards. 

Results in Brief: 

There are two categories of federally funded efforts that address 
teenage abuse of anabolic steroids. Efforts are either designed to 
focus on preventing the abuse of anabolic steroids among teenagers or 
are broader and designed to prevent substance abuse in general--which 
can include abuse of anabolic steroids among teenagers. Two programs 
that received federal funding during their development and testing, 
Athletes Training and Learning to Avoid Steroids (ATLAS)[Footnote 7] 
and Athletes Targeting Healthy Exercise & Nutrition Alternatives 
(ATHENA), are designed to focus on preventing or reducing teen abuse of 
anabolic steroids. In addition, there are various research efforts and 
education and outreach activities that focus on this issue. For 
example, in addition to steroid-related research, since 2000 NIDA has 
provided nearly $500,000 in funding for a variety of education and 
outreach activities including a multimedia educational initiative 
intended to prevent anabolic steroid abuse among teenagers. Two federal 
grant programs--ONDCP's Drug-Free Communities Support program and 
Education's School-Based Student Drug Testing program--are designed to 
support state and local efforts to prevent substance abuse in general 
and may include anabolic steroid abuse among teenagers as part of the 
programs' substance abuse prevention efforts. In 2007, about one- 
quarter of more than 700 Drug-Free Communities Support program grantees 
reported that they were addressing steroid abuse as one of their 
program's objectives. 

Almost half of the 16 studies we reviewed identified certain risk 
factors and behaviors linked to the abuse of anabolic steroids among 
teenagers. Several of these studies found connections between anabolic 
steroid abuse and risk factors such as use of other drugs, risky sexual 
behaviors, and aggressive behaviors. Most of the other studies we 
reviewed were assessments of the ATLAS and ATHENA prevention programs. 
In general, these studies suggested that the programs may reduce abuse 
of anabolic steroids and other drugs among high school athletes 
immediately following participation in the programs. 

Experts identified gaps in the research that addresses anabolic steroid 
abuse among teenagers. Experts identified a lack of conclusive evidence 
of sustained effectiveness over time of available prevention programs, 
for example at 1 year following participants' completion of the 
programs. Experts also identified gaps in the research on the long-term 
heath effects of initiating anabolic steroid abuse as a teenager-- 
including research on effects that may be particularly harmful in 
teenagers--and in the research on psychological effects. 

HHS and Education provided technical comments only, which we 
incorporated into the report as appropriate. 

Background: 

The abuse of anabolic steroids differs from the abuse of other illicit 
substances. When users initially begin to abuse anabolic steroids, they 
typically are not driven by a desire to achieve an immediate euphoria 
like that which accompanies most abused drugs such as cocaine, heroin, 
and marijuana. The abuse of anabolic steroids is typically driven by 
the desire of users to improve their athletic performance and 
appearance--characteristics that are important to many teenagers. 
Anabolic steroids can increase strength and boost confidence, leading 
users to overlook the potential serious and long-term damage to their 
health that these substances can cause. In addition, the methods and 
patterns of use for anabolic steroids differ from those of other drugs. 
Anabolic steroids are most often taken orally or injected, typically in 
cycles of weeks or months (referred to as "cycling"), rather than 
continuously. Cycling involves taking multiple doses of anabolic 
steroids over a specific period of time, stopping for a period, and 
starting again. In addition, users often combine several different 
types of anabolic steroids to maximize their effectiveness (referred to 
as "stacking"). 

While anabolic steroids can enhance certain types of performance or 
appearance, when used inappropriately they can cause a host of severe, 
long-term, and in some cases, irreversible health consequences. The 
abuse of anabolic steroids can lead to heart attacks, strokes, liver 
tumors, and kidney failure. In addition, because anabolic steroids are 
often injected, users who share needles or use nonsterile injection 
techniques are at risk for contracting dangerous infections, such as 
HIV/AIDS and hepatitis B and C. There are also numerous side effects 
that are gender-specific, including reduced sperm count, infertility, 
baldness, and development of breasts among men; and growth of facial 
hair, male-pattern baldness, changes in or cessation of the menstrual 
cycle, and deepened voice among women. There is also concern that 
teenagers who abuse anabolic steroids may face the additional risk of 
halted growth resulting from premature skeletal maturation and 
accelerated puberty changes. 

The abuse of anabolic steroids may also lead to aggressive behavior and 
other psychological side effects. Many users report feeling good about 
themselves while on anabolic steroids, but for some users extreme mood 
swings also can occur, including manic-like symptoms leading to 
violence. Some users also may experience depression when the drugs are 
stopped, which may contribute to dependence on anabolic steroids. Users 
may also suffer from paranoia, jealousy, extreme irritability, 
delusions, and impaired judgment stemming from feelings of 
invincibility. 

Two national surveys showed increasing prevalence in teenage abuse of 
steroids throughout the 1990s until about 2002 and a decline since then 
(see fig. 1). One of these two national surveys, the Monitoring the 
Future (MTF) survey, is an annual survey conducted by the University of 
Michigan and supported by NIDA funding.[Footnote 8] The MTF survey 
measures drug use and attitudes among students in grades 8, 10, and 12, 
and asks several questions about the use of and attitudes towards 
anabolic steroids, such as perceived risk, disapproval, and 
availability of anabolic steroids. The survey's questions are designed 
to assess respondents' use of steroids in the last 30 days, the past 
year, and over the course of the respondent's lifetime. Questions about 
steroid use were added to the study beginning in 1989. The most recent 
results from this survey showed that in 2006, 2.7 percent of 12TH 
graders said they had used anabolic steroids without a prescription at 
least once. The second national survey, the Youth Risk Behavior Survey 
(YRBS), is a biennial survey conducted since 1991 by CDC.[Footnote 9] 
The YRBS is part of a surveillance system consisting of national, 
state, and local surveys of students in grades 9 through 12. These 
surveys collect information about a wide variety of risk behaviors, 
including sexual activity and alcohol and drug use. The most recent 
available national YRBS survey--conducted in 2005--asked one question 
related to lifetime steroid use without a prescription, which showed 
that 3.3 percent of 12TH graders had used steroids at least once. 

Figure 1: Reported Lifetime Anabolic Steroid Abuse among 12TH Graders, 
1991-2006: 

This figure is a combination line chart showing reported lifetime 
anabolic steroid abuse among 12th graders, between 1991 and 2006. The X 
axis represents the year, and the Y axis represents the percentage. One 
line represents Monitoring the Future (MTF), and the other represents 
Youth Risk Behavior Survey (YRBS). 

[See PDF for image] 

Source: GAO analysis of MTF and YRBS data. 

[End of figure] 

The MTF and YRBS surveys indicate a low abuse rate for anabolic 
steroids among teenagers[Footnote 10] when compared with the abuse 
rates for other drugs.[Footnote 11] However, the reported easy 
availability of steroids[Footnote 12] and the potential for serious 
health effects make anabolic steroid abuse a health concern for 
teenagers, particularly among males. In general, the reported rates of 
anabolic steroid abuse are higher for males than for females (see fig. 
2). Data from the 2006 MTF survey showed that 1.7 percent of teenage 
males reported abusing anabolic steroids in the past year, as compared 
with 0.6 percent of females. Data from the 2005 YRBS survey showed that 
4.8 percent of high school males reported abusing steroids in their 
lifetime, as compared with 3.2 percent of females. 

Figure 2: Reported Past Year Anabolic Steroid Abuse by Male and Female 
Adolescents, 2002-2006: 

This figure is a combination line chart showing reported past year 
anabolic steroid abuse by male and female adolescents, between 2002 and 
2006. The X axis represents the year, and the Y axis represents the 
percentage. One line represents females, and the other line represents 
males. 

[See PDF for image] 

Source: GAO analysis of MTF data. 

Note: These are combined data for 8TH, 10TH, and 12TH grade students. 

[End of figure] 

Some Federally Funded Efforts Are Designed to Focus on Preventing 
Teenage Steroid Abuse, While Other Efforts Designed to Address 
Substance Abuse in General May Include Teenagers: 

There are two categories of federally funded efforts that address 
teenage abuse of anabolic steroids. Efforts are either designed to 
focus on preventing the abuse of anabolic steroids among teenagers or 
are broader and designed to prevent substance abuse in general--which 
can include abuse of anabolic steroids among teenagers. Two programs 
that received federal research funding for their development and 
testing, ATLAS and ATHENA, are designed to focus on preventing or 
reducing teen abuse of anabolic steroids. In addition, there are 
various research efforts and education and outreach activities that 
focus on this issue. Two federal grant programs--ONDCP's Drug-Free 
Communities Support program and Education's School-Based Student Drug 
Testing program--are designed to support state and local efforts to 
prevent substance abuse in general and may include anabolic steroid 
abuse among teenagers as part of the programs' substance abuse 
prevention efforts. See appendix I for a list of the federally funded 
efforts discussed below. 

Some Federally Funded Programs, Research, and Activities Are Designed 
to Focus on Preventing Teenage Anabolic Steroid Abuse: 

There are various federally funded efforts--programs, research, and 
educational activities--that address teenage abuse of anabolic 
steroids. Some of these efforts are designed to focus on preventing or 
reducing anabolic steroid abuse among teenagers. As part of our review 
we identified two programs, the ATLAS and ATHENA programs, which 
received federal research funding during their development and testing 
and are designed to focus on preventing the abuse of anabolic steroids 
among male and female high school athletes, respectively. 

ATLAS is a student-led curriculum designed to prevent male high school 
athletes from abusing anabolic steroids and other performance-enhancing 
substances. The program's intervention strategy relies on peer pressure 
and providing information on healthy alternatives for increasing muscle 
strength and size. The ATLAS curriculum is typically delivered during a 
sport team's season in a series of 45-minute sessions scheduled at the 
coaches' discretion and integrated into the usual team practice 
activities. The athletes meet as a team in groups of six or eight 
students with one student functioning as the assigned group leader. 
Coaches, group leaders, and student athletes all work from manuals and 
workbooks, which provide brief, interactive activities that focus on 
drugs used in sports, sport supplements, strength training, sport 
nutrition, and decision making. 

The ATHENA program is designed to prevent the abuse of body-shaping 
substances such as diet pills and anabolic steroids, although abuse of 
the latter is less common in females than in males. Like ATLAS, the 
ATHENA curriculum is integrated into a sport team's usual practice 
activities and uses workbooks and student group leaders. The ATHENA 
curriculum takes into account that female athletes are less likely than 
males to abuse anabolic steroids but are more likely to have problems 
with eating disorders and to use drugs such as diet pills and tobacco. 
As a result, ATHENA's curriculum gives more attention than ATLAS's to 
addressing these behaviors. 

The ATLAS and ATHENA curricula were developed and tested with funding 
provided by NIDA.[Footnote 13] From fiscal years 1993 through 2001, 
NIDA provided more than $3.4 million to fund the research that 
developed and tested the effectiveness of the ATLAS curriculum. 
Similarly, from fiscal years 1999 through 2003 NIDA provided $4.7 
million in research funding to develop and test the effectiveness of 
the ATHENA curriculum. While ATLAS and ATHENA were developed and tested 
with federal funding, the programs are implemented at the local level. 
Schools in at least 25 states have chosen to implement the programs 
with local and private funds, and the National Football League and 
Sports Illustrated magazine together have supported the programs in 
more than 70 schools nationwide.[Footnote 14] 

In addition to the ATLAS and ATHENA programs, there are various 
federally funded research efforts that focus on preventing or reducing 
anabolic steroid abuse among teenagers. NIDA has funded several 
research projects examining the factors that influence teenagers to 
abuse anabolic steroids and the effectiveness of interventions used to 
prevent teenage steroid abuse. From fiscal years 2000 through 2006, 
NIDA awarded nearly $10.1 million in grants to support an average of 
four research projects each year related to anabolic steroid abuse with 
a specific focus on adolescents.[Footnote 15] In fiscal year 2006, for 
example, NIDA awarded a total of nearly $638,000 to three research 
projects that examined risk factors for anabolic steroid abuse among 
teenagers or the effects of steroid abuse in this population. Like 
NIDA, the United States Anti-Doping Agency (USADA)--an independent, 
nonprofit corporation funded primarily by ONDCP--supports research 
related to the abuse of anabolic steroids and other performance- 
enhancing drugs by athletes, including teenage athletes.[Footnote 16] 
In fiscal year 2006, USADA spent $1.8 million for research, and an 
ONDCP official estimated that about one-third of that research funding 
was directed to anabolic steroids and another performance-enhancing 
drug, human growth hormone. 

In addition to research, there are various education and outreach 
activities that focus on preventing anabolic steroid abuse among 
teenagers. Many of these efforts have been supported by NIDA. Since 
2000, NIDA has provided nearly $500,000 in funding for a variety of 
education and outreach efforts in support of this goal.[Footnote 17] 
For example, in April 2000, in response to an upward trend in steroid 
abuse among students, NIDA launched a multimedia educational initiative 
intended to prevent anabolic steroid abuse among teenagers. Along with 
several national partners, including the National Collegiate Athletic 
Association, the American College of Sports Medicine, and the American 
Academy of Pediatrics, the initiative produced a Web site, a research 
report on steroid abuse, and postcard-sized messages about steroids for 
placement in gyms, movie theaters, shopping malls, bookstores, and 
restaurants in selected areas. By 2007, NIDA funding for this 
particular initiative totaled about $124,000. 

In addition to NIDA, other federal agencies and organizations have 
supported educational and outreach activities that focus on preventing 
anabolic steroid abuse among teenagers, as the following examples 
illustrate. 

* ONDCP has funded six informational briefings since 2001 to encourage 
journalists, entertainment writers, and producers to accurately cover 
anabolic steroids and drug abuse among teenage athletes. ONDCP also has 
Web sites for teens and parents with information about anabolic 
steroids and links to NIDA resources. 

* Since 2003, USADA has produced written publications and annual 
reports on anabolic steroid abuse and has distributed those 
publications through high schools and state high school associations. 
In addition, some USADA public service announcements to be aired during 
televised sports events and movie trailers have targeted anabolic 
steroid abuse. 

* In fiscal years 2007 and 2008, SAMHSA expects to spend a total of 
$99,000 under a contract to develop and disseminate educational 
materials addressing the abuse of anabolic steroids by adolescent 
athletes. These materials, which are intended for use by high school 
athletic and health science departments, include brochures, a video, 
and 10 high school outreach seminars. 

Two Federal Grant Programs Designed to Address Substance Abuse May 
Address Teenage Anabolic Steroid Abuse: 

As part of our review, we identified two federal grant programs that 
are designed to support state and local efforts to prevent various 
forms of substance abuse and that may include teenagers. Grantees of 
these programs may address teenage anabolic steroid abuse as part of 
the programs' general substance abuse prevention efforts. The Drug-Free 
Communities Support program, funded by ONDCP and administered by SAMHSA 
under an interagency agreement, provides grants to community coalitions 
to address drug abuse problems identified in their 
communities.[Footnote 18] Many community coalitions choose to implement 
school-based drug prevention programs with their grant funding and are 
allowed to tailor these programs to address the drug prevention needs 
of their communities. In 2007, about one-quarter of more than 700 
grantees reported that they were addressing steroid abuse as one of 
their program's objectives.[Footnote 19] Each community coalition is 
eligible for grants of up to $125,000 per year, renewable for up to 4 
more years, and requiring dollar-for-dollar community matching 
funds.[Footnote 20] In 2007, the Drug-Free Communities Support program 
is providing about $80 million in grants to 709 community coalitions 
for drug prevention activities based on the needs of the communities. 

Another federal grant program that supports substance abuse prevention 
efforts for teenagers and that may also include efforts to address 
anabolic steroid abuse in this population is the School-Based Student 
Drug Testing program in Education's Office of Safe and Drug-Free 
Schools.[Footnote 21] Since 2003, this program has provided grants to 
school districts and public and private entities to establish school- 
based drug-testing efforts. For fiscal years 2003 through 2007, the 
Office of Safe and Drug-Free Schools awarded $32.2 million in grants to 
87 individual School-Based Student Drug Testing grantees.[Footnote 22] 
According to information provided in the grantees' grant applications, 
34 of the grantees (representing 180 middle, junior, and high schools 
and at least 70,000 students) proposed using their grant-supported drug 
testing to test for anabolic steroids in addition to other substances 
such as amphetamines, marijuana, and cocaine.[Footnote 23] Education 
officials told us that although grantees generally identify the drugs 
for which they are testing in their annual performance reports, there 
has been no independent verification by Education staff that confirms 
that the 34 grantees actually have implemented anabolic steroid testing 
or whether additional grantees have included steroid testing in their 
efforts. 

Research Shows Teenage Anabolic Steroid Abuse Is Linked to Certain Risk 
Factors and That Prevention Programs May Have Some Short-term 
Effectiveness: 

Of the 16 studies we reviewed, nearly half focused on linking certain 
risk factors and behaviors to teenagers' abuse of anabolic steroids, 
including the use of other drugs, risky sexual behaviors, and 
aggressive behaviors.[Footnote 24] Most of the other studies we 
reviewed were assessments of the ATLAS and ATHENA prevention programs 
and in general suggested that the programs may reduce abuse of anabolic 
steroids and other drugs among high school athletes immediately 
following participation in the programs. Appendix II is a list of the 
articles we reviewed. 

Almost half of the studies we reviewed identified certain risk factors 
and behaviors linked to the abuse of anabolic steroids among 
teenagers.[Footnote 25] Risk factors, such as antisocial behavior, 
family violence, and low academic achievement, are linked to youths' 
likelihood of engaging in risky behaviors, including drug abuse. 
Several studies found that the use of alcohol and other drugs--such as 
tobacco, marijuana, and cocaine--is associated with the abuse of 
anabolic steroids among teenagers, including teenage athletes and non- 
athletes. One 2005 study found that the use of other drugs was more 
likely to predict anabolic steroid abuse than participation in athletic 
activities. Several studies we reviewed found no difference between 
athletes and non-athletes in their abuse of anabolic steroids, and one 
2007 study of teenage girls found that female athletes were less likely 
than female non-athletes to abuse anabolic steroids. A few studies we 
reviewed found a positive correlation between anabolic steroid abuse 
and risky sexual behaviors such as early initiation of sexual activity 
and an increased number of sexual partners. Some studies found that 
aggressive behaviors such as fighting were related to anabolic steroid 
abuse by both males and females. Moreover, one 1997 study found that 
adolescents (both male and female) who reported abusing anabolic 
steroids in the past year were more likely to be perpetrators of sexual 
violence. However, the cause-and-effect relationships between anabolic 
steroid abuse and other risky behaviors, such as violence, have not 
been determined.[Footnote 26] 

About half of the studies we reviewed were assessments of the ATLAS and 
ATHENA prevention programs, and in general these studies suggested that 
these programs may reduce abuse of anabolic steroids and other drugs 
among high school athletes immediately following participation in the 
programs. Researchers assessing the ATLAS program reported that both 
the intention to abuse anabolic steroids and the reported abuse of 
steroids were lower among athletes who participated in the ATLAS 
program than among athletes who did not participate in the program. The 
most recent study found that although the intention to abuse anabolic 
steroids remained lower at follow-up 1 year later for athletes who 
participated in the ATLAS program, the effectiveness of the program in 
reducing reported use diminished with time. Similarly, researchers 
assessing the ATHENA program found that girls who participated in the 
program reported less ongoing and new abuse of anabolic steroids as 
well as a reduction in the abuse of other performance-enhancing and 
body-shaping substances. The authors note that these results are short 
term, and the long-term effectiveness of the ATHENA program is not 
known. 

The authors of the one study in our review that looked at student drug- 
testing programs found that the abuse of anabolic steroids and other 
illicit drugs and performance-enhancing substances was decreased among 
athletes at schools that implemented mandatory, random drug-testing 
programs. However, this group of athletes also showed an increase in 
risk factors that are generally associated with greater abuse of 
illicit drugs, including anabolic steroids. For example, athletes at 
schools with drug-testing programs were more likely to believe that 
peers and authority figures were more tolerant of drug abuse, had less 
belief in the negative consequences of drug abuse, and had less belief 
in the efficacy of drug testing. Based on these seemingly inconsistent 
findings, the study's authors called for caution in interpreting the 
findings. 

Experts Find There Are Gaps in Research on the Sustained Effectiveness 
of Prevention Programs and on the Long-term Health Effects for 
Teenagers: 

Experts identified gaps in the research that addresses anabolic steroid 
abuse among teenagers. Experts identified gaps in the current research 
on the outcomes of prevention programs that focus on anabolic steroids. 
Experts also identified gaps in the research on the long-term health 
effects of initiating the abuse of anabolic steroids as teenagers. 

According to experts, available research does not establish the extent 
to which the ATLAS and ATHENA programs are effective over time in 
preventing anabolic steroid abuse among teenage athletes. Experts 
acknowledge that both programs appear promising in their ability to 
prevent the abuse of anabolic steroids among teenage athletes 
immediately following participants' completion of the programs. 
Assessment of the effectiveness of the ATLAS program 1 year later, 
however, found that the lower incidence of anabolic steroid use was not 
sustained, although participants continued to report reduced intentions 
to use anabolic steroids. The long-term effectiveness of the ATHENA 
program has not been reported. The effectiveness of these programs has 
been assessed only in some schools in Oregon, and therefore experts 
report that the effectiveness of the programs may not be generalizable. 
In another example, experts identified the need for additional research 
to assess the effectiveness of drug-testing programs, such as those 
funded under Education's School-Based Student Drug Testing program, in 
reducing anabolic steroid abuse among teenagers.[Footnote 27] 

According to experts, there are several gaps in research on the health 
effects of teenage abuse of anabolic steroids. Experts report that 
while there is some research that has examined the health effects of 
anabolic steroid abuse among adults--for example, the harmful effects 
on the cardiovascular, hormonal, and immune systems--there is a lack of 
research on these effects among teenagers. There is also a lack of 
research on the long-term health effects of initiating anabolic steroid 
abuse during the teenage years. Some health effects of steroid abuse 
among adults, such as adverse effects on the hormonal system, have been 
shown to be reversible when the adults have stopped abusing anabolic 
steroids. Experts point out, however, that it is not known whether this 
reversibility holds true for teenagers as well. While some experts 
suggest that anabolic steroid abuse may do more lasting harm to 
teenagers, due to the complex physical changes unique to adolescence, 
according to other experts there is no conclusive evidence of 
potentially permanent health effects. Experts also report that the 
extent of the psychological effects of anabolic steroid abuse and, in 
particular, of withdrawal from steroid abuse, is unclear due to limited 
research. Some experts we consulted noted a need to better inform 
primary care physicians and pediatricians about anabolic steroid abuse 
among teenagers, so these providers would be better able to recognize 
steroid abuse in their patients and initiate early intervention and 
treatment. 

Agency Comments: 

We provided a draft of this report to HHS and Education for comment and 
received technical comments only, which we incorporated into the report 
as appropriate. 

As arranged with your offices, unless you publicly announce the 
contents of this report earlier, we plan no further distribution of it 
until 30 days after its issue date. At that time, we will send copies 
of this report to the Secretary of Health and Human Services and to the 
Secretary of Education. We will also provide copies to others upon 
request. In addition, the report is available at no charge on the GAO 
Web site at [hyperlink, http://www.gao.gov]. 

If you or your staff members have any questions regarding this report, 
please contact me at (202) 512-7114 or ekstrandl@gao.gov. Contact 
points for our Offices of Congressional Relations and Public Affairs 
may be found on the last page of this report. GAO staff members who 
made major contributions to this report are listed in appendix III. 

Signed by: 

Laurie Ekstrand: 

Director, Health Care: 

[End of section] 

Appendix I: Selected Federally Funded Efforts That Address or Can 
Address Anabolic Steroid Abuse among Teenagers: 

Table 1 lists selected federally funded efforts--including programs, 
research, and educational and outreach activities--that are designed to 
focus on preventing or reducing the abuse of anabolic steroids by 
teenagers (focused efforts), as well as other broader efforts that may 
address teenage abuse of anabolic steroids as part of the programs' 
general substance abuse prevention efforts. The list includes programs 
funded by two departments and the Office of National Drug Control 
Policy (ONDCP), in the Executive Office of the President. 

Table 1: Selected Federally Funded Efforts That Address or Can Address 
Anabolic Steroid Abuse among Teenagers: 

Program:  Department of Health and Human Services: National Institute 
on Drug Abuse (NIDA): Athletes Training and Learning to Avoid Steroids 
(ATLAS); 
Funding for fiscal year 2006: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): ---[A]; 
Program implementers or eligible applicants: Department of Health and 
Human Services: National Institute on Drug Abuse (NIDA): School 
districts, schools, behavioral health agencies, others; 
Targeted beneficiaries: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): Male high school athletes; 
Program description: Department of Health and Human Services: National 
Institute on Drug Abuse (NIDA): Focused effort: program to prevent male 
high school athletes from abusing anabolic steroids and other 
performance-enhancing drugs, and to promote healthy strength training 
and nutrition. 

Program: Department of Health and Human Services: National Institute on 
Drug Abuse (NIDA): Athletes Targeting Healthy Exercise & Nutrition 
Alternatives (ATHENA); 
Funding for fiscal year 2006: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): ---[B]; 
Program implementers or eligible applicants: Department of Health and 
Human Services: National Institute on Drug Abuse (NIDA): School 
districts, schools, behavioral health agencies, others; 
Targeted beneficiaries: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): Female high school athletes; 
Program description: Department of Health and Human Services: National 
Institute on Drug Abuse (NIDA): Focused effort: program to prevent 
female high school athletes from abusing body- shaping substances such 
as diet pills, tobacco, and anabolic steroids, and to promote healthy 
training and nutrition. 

Program: Department of Health and Human Services: National Institute on 
Drug Abuse (NIDA): Research projects; 
Funding for fiscal year 2006: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): $638,000; 
Program implementers or eligible applicants: Department of Health and 
Human Services: National Institute on Drug Abuse (NIDA): Researchers; 
Targeted beneficiaries: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): Adolescent age group; 
Program description: Department of Health and Human Services: National 
Institute on Drug Abuse (NIDA): Focused effort: funding for three 
steroid-related research projects focused on the adolescent age group 
in humans and animals. 

Program: Department of Health and Human Services: National Institute on 
Drug Abuse (NIDA): Educational and outreach activities; 
Funding for fiscal year 2006: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): $521,000; 
Program implementers or eligible applicants: Department of Health and 
Human Services: National Institute on Drug Abuse (NIDA): NIDA and its 
partners, including National Collegiate Athletic Association, American 
Academy of Pediatrics, American College of Sports Medicine, others; 
Targeted beneficiaries: Department of Health and Human Services: 
National Institute on Drug Abuse (NIDA): Teenage students, teachers, 
general public; 
Program description: Department of Health and Human Services: National 
Institute on Drug Abuse (NIDA): Focused and broad efforts: to 
distribute a research report on anabolic steroid abuse to schools; 
develop steroid abuse posters for schools; 
and support Scholastic Magazines substance abuse information to schools 
including anabolic steroids. 

Program: Substance Abuse and Mental Health Services Administration 
(SAMHSA): Center for Substance Abuse Treatment: What Steroids Can Do to 
You - The Drug-The Danger-The Deception; 
Funding for fiscal year 2006: Substance Abuse and Mental Health 
Services Administration (SAMHSA):--[C]; 
Program implementers or eligible applicants: Substance Abuse and Mental 
Health Services Administration (SAMHSA): SAMHSA contractor; 
Targeted beneficiaries: Substance Abuse and Mental Health Services 
Administration (SAMHSA): High school teachers, coaches, students; 
Program description: Substance Abuse and Mental Health Services 
Administration (SAMHSA): Focused effort: program of print materials, 
video, and high school assemblies to disseminate accurate information 
describing the health effects of anabolic steroids. 

Program: Department of Education: School-Based Student Drug Testing 
grants program; 
Funding for fiscal year 2006: Department of Education: $8.6 million; 
Program implementers or eligible applicants: Department of Education: 
School districts, public and private entities; 
Targeted beneficiaries: Department of Education: Students primarily in 
grades 6 through 12; 
Program description: Department of Education: Broad effort: as of 2006, 
72 grants to support programs that address drug prevention in schools, 
including anabolic steroid prevention efforts. 

Program: Executive Office of the President: Office of National Drug 
Control Policy (ONDCP): Drug-Free Communities Support program; 
Funding for fiscal year 2006: Executive Office of the President: Office 
of National Drug Control Policy (ONDCP): about $80 million; 
Program implementers or eligible applicants: Executive Office of the 
President: Office of National Drug Control Policy (ONDCP): Community 
coalitions; 
Targeted beneficiaries: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Various beneficiaries, including 
school-age youth, depending on community needs assessments; 
Program description: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Broad effort: as of 2006, more 
than 700 grants to communities to support coalitions and grassroots 
organizations engaged in efforts to prevent use of alcohol, tobacco, 
and illicit drugs including anabolic steroids. 

Program: Executive Office of the President: Office of National Drug 
Control Policy (ONDCP): ONDCP public information and entertainment 
industry outreach; 
Funding for fiscal year 2006: Executive Office of the President: Office 
of National Drug Control Policy (ONDCP): $5,000 for 1 event in January 
2006; 
Program implementers or eligible applicants: Executive Office of the 
President: Office of National Drug Control Policy (ONDCP): Medical 
experts, coaches, teen athletes; 
Targeted beneficiaries: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Journalists, entertainment 
writers, producers; 
Program description: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Focused and broad efforts: 6 
briefings from 2001-2007, including roundtable for a journalists' 
conference on teen athletes, briefings for magazine staffs, and media 
roundtables on teen athletes and performance- enhancing drugs. 

Program: Executive Office of the President: Office of National Drug 
Control Policy (ONDCP): United States Anti-Doping Agency (USADA) 
research projects[D]; 
Funding for fiscal year 2006: Executive Office of the President: Office 
of National Drug Control Policy (ONDCP): $1.8 million; 
Program implementers or eligible applicants: Executive Office of the 
President: Office of National Drug Control Policy (ONDCP): Researchers; 
Targeted beneficiaries: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Young athletes including 
teenagers; 
Program description: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Focused and broad efforts: grants 
for research on current and emerging drug issues; 
estimated one-third of research funding addresses anabolic steroids and 
human growth hormone. 

Program: Executive Office of the President: Office of National Drug 
Control Policy (ONDCP): USADA education and outreach activities[D]; 
Funding for fiscal year 2006: Executive Office of the President: Office 
of National Drug Control Policy (ONDCP): $1.5 million; 
Program implementers or eligible applicants: Executive Office of the 
President: Office of National Drug Control Policy (ONDCP): Public and 
private organizations; 
Targeted beneficiaries: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Teenagers, young adult athletes, 
parents, coaches; 
Program description: Executive Office of the President: Office of 
National Drug Control Policy (ONDCP): Focused and broad efforts: 
publications about anabolic steroid issues for high schools, public 
service announcements, and Web sites. 

Sources: Agency documents and program officials. 

[A] In 2006, NIDA did not provide any funding for the ATLAS program. 
From 1993 through 2001, however, NIDA funded $3.4 million in research 
related to developing and testing the ATLAS curriculum. 

[B] Similarly, NIDA did not fund research related to the ATHENA program 
in 2006, but from 1999 through 2003 the agency provided $4.7 million to 
develop and test the program. 

[C] SAMHSA officials reported that the agency expects to spend up to 
$99,000 on this project. A contract for that amount was awarded on July 
6, 2006. As of August 2007, SAMHSA reported that it had made $40,000 in 
payments under the contract and expects to pay the remaining $59,000 in 
fiscal year 2008. 

[D] USADA is not organizationally part of the Executive Office of the 
President. However, because it is an independent, nonprofit corporation 
funded primarily by ONDCP, for purposes of this report we have grouped 
USADA's activities with ONDCP's. 

[End of table] 

[End of section] 

Appendix II: Articles Included in GAO's Review: 

Borowsky, I.W., M. Hogan, and M. Ireland. "Adolescent sexual 
aggression: risk and protective factors." Pediatrics, vol. 100, no. 6 
(1997): e71-e78. 

Dukarm, C.P., R.S. Byrd, P. Auinger, and M. Weitzman. "Illicit 
substance use, gender, and the risk of violent behavior among 
adolescents." Archives of Pediatric & Adolescent Medicine, vol. 150, 
no. 8 (1996): 797-801. 

DuRant, R.H., L.G. Escobedo, and G.W. Heath, "Anabolic-steroid use, 
strength training, and multiple drug use among adolescents in the 
United States." Pediatrics, vol. 96, no. 1 (1995): 23-28. 

Elliot, D., J. Cheong, E.L. Moe, and L. Goldberg. "Cross-sectional 
study of female students reporting anabolic steroid use." Archives of 
Pediatric & Adolescent Medicine, vol. 161, no. 6 (2007): 572-577. 

Elliot, D., and L. Goldberg. "Intervention and prevention of steroid 
use in adolescents." American Journal of Sports Medicine, vol. 24, no. 
6 (1996): S46-S47. 

Elliot, D.L., L. Goldberg, E.L. Moe, C.A. DeFrancesco, M.B. Durham, and 
H. Hix-Small. "Preventing substance use and disordered eating: Initial 
outcomes of the ATHENA (Athletes Targeting Healthy Exercise and 
Nutrition Alternatives) program." Archives of Pediatric & Adolescent 
Medicine, vol. 158, no. 11 (2004): 1043-1049. 

Elliot, D.L., E.L. Moe, L. Goldberg, C.A. DeFrancesco, M.B. Durham, and 
H. Hix-Small. "Definition and outcome of a curriculum to prevent 
disordered eating and body-shaping drug use." The Journal of School 
Health, vol. 76, no. 2 (2006): 67-73. 

Fritz, M.S., D.P. MacKinnon, J. Williams, L. Goldberg, E.L. Moe, and 
D.L. Elliot. "Analysis of baseline by treatment interactions in a drug 
prevention and health promotion program for high school male athletes." 
Addictive Behaviors, vol. 30, no. 5 (2005): 1001-1005. 

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, E. Moe, L. Zoref, 
E. Greffrath, D.J. Miller, and A. Lapin. "Effects of a multidimensional 
anabolic steroid prevention intervention: the Adolescents Training and 
Learning to Avoid Steroids (ATLAS) program." JAMA, vol. 276, no. 19 
(1996): 1555-1562. 

Goldberg, L., D. Elliot, G.N. Clarke, D.P. MacKinnon, L. Zoref, E. Moe, 
C. Green, and S.L. Wolf. "The Adolescent Training and Learning to Avoid 
Steroids (ATLAS) prevention program: background and results of a model 
intervention." Archives of Pediatric & Adolescent Medicine, vol. 150 
(1996): 713-721. 

Goldberg, L., D.L. Elliot, D.P. MacKinnon, E. Moe, K.S. Kuehl, L. 
Nohre, and C.M. Lockwood. "Drug testing athletes to prevent substance 
abuse: Background and pilot study results of the SATURN (Student 
Athlete Testing Using Random Notification) study." Journal of 
Adolescent Health, vol. 32, no. 1 (2003): 16-25. 

Goldberg, L., D.P. MacKinnon, D.L. Elliot, E.L. Moe, G. Clarke, and J. 
Cheong. "The Adolescents Training and Learning to Avoid Steroids 
Program: Preventing drug use and promoting health behaviors." Archives 
of Pediatric & Adolescent Medicine, vol. 154, no. 4 (2000): 332-338. 

MacKinnon, D.P., L. Goldberg, G. Clarke, D.L. Elliot, J. Cheong, A. 
Lapin, E.L. Moe, and J.L. Krull. "Mediating mechanisms in a program to 
reduce intentions to use anabolic steroids and improve exercise self- 
efficacy and dietary behavior." Prevention Science, vol. 2, no. 1 
(2001): 15-28. 

Miller, K.E., J.H. Hoffman, G.M. Barnes, D. Sabo, M.J. Melnick, and 
M.P. Farrell. "Adolescent anabolic steroid use, gender, physical 
activity, and other problem behaviors." Substance Use & Misuse, vol. 
40, no. 11 (2005): 1637-1657. 

Naylor, A.H., D. Gardner, and L. Zaichkowsky. "Drug use patterns among 
high school athletes and nonathletes." Adolescence, vol. 36, no. 144 
(2001): 627-639. 

Rich, J.D., C.K. Foisie, C.W. Towe, B.P. Dickinson, M. McKenzie, and 
C.M. Salas. "Needle exchange program participation by anabolic steroid 
injectors." Drug and Alcohol Dependence, vol. 56, no. 2 (1999): 157- 
160. 

[End of section] 

Appendix III: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Laurie Ekstrand, at (202) 512-7114 or ekstrandl@gao.gov. 

Staff Acknowledgments: 

In addition to the contact named above, key contributors to this report 
were Christine Brudevold, Assistant Director; Ellen M. Smith; Julie 
Thomas; Rasanjali Wickrema; and Krister Friday. 

[End of section] 

Footnotes: 

[1] We use the term anabolic steroids to refer to anabolic steroids and 
their precursors, as defined in the Controlled Substances Act. See 21 
U.S.C. § 802 (23), (41). 

[2] The Crime Control Act of 1990 amended the Controlled Substances Act 
to include anabolic steroids. 21 U.S.C. § 812(c), Schedule III (e). 

[3] We searched both the Catalog of Federal Domestic Assistance, a 
database of federal grant programs maintained by the General Services 
Administration, and the Computer Retrieval of Information on Scientific 
Projects, a database of research grants funded by the National 
Institutes of Health. 

[4] We define federally funded programs as including programs that were 
developed, implemented, or tested using federal funding. 

[5] The efforts that we discuss in this report may not represent all 
federally funded activities that address anabolic steroid abuse among 
teenagers but reflect those efforts mentioned by federal officials with 
whom we consulted. We were unable to determine the extent of total 
federal funding for programs that address teenage anabolic steroid 
abuse because, in some instances, funding information covers more than 
prevention of teenage anabolic steroid abuse. 

[6] We searched using the keywords anabolic steroids, abuse, addiction, 
teen, youth, adolescent, prevent, and treat. 

[7] ATLAS--the acronym for the prevention program named Athletes 
Training and Learning to Avoid Steroids--originally stood for 
Adolescents Training and Learning to Avoid Steroids, which was the 
title of the NIDA research grants that supported the program's 
development. For this reason, some published research describing the 
program, as listed in appendix II, for example, refers to ATLAS as 
Adolescents Training and Learning to Avoid Steroids. 

[8] The MTF survey is administered to nationally representative samples 
of public and private secondary school students throughout the United 
States. In 2006, sample sizes were about 17,000, 16,600, and 14,800 in 
8th, 10th, and 12th grades, respectively. In all, about 48,500 students 
in 410 secondary schools participated in the 2006 survey. 

[9] The sampling frame for the 2005 national YRBS survey consisted of 
all public and private schools with students in at least one of grades 
9 through 12 in the 50 states and the District of Columbia. For the 
2005 national YRBS survey, 13,953 questionnaires were completed in 159 
schools by a nationally representative sample of students in grades 9 
through12. 

[10] Several researchers conducted an analysis indicating that the 
prevalence rates of teenage anabolic steroid abuse reported by MTF and 
YRBS are overestimated and that actual prevalence of teenage anabolic 
steroid abuse is even lower than these surveys report. See Gen Kanayama 
et al., "Anabolic Steroid Abuse Among Teenage Girls: An Illusory 
Problem?" Drug and Alcohol Dependence, 88 (2007): 156-162. 

[11] For example, according to the 2006 MTF survey, 42.3 percent of 
12th graders reported abusing marijuana at least once, and 8.5 percent 
reported abusing cocaine at least once. 

[12] In our previous work looking at the availability of anabolic 
steroids, we found that anabolic steroids were easily obtained without 
a prescription through the Internet. See GAO, Anabolic Steroids Are 
Easily Purchased Without a Prescription and Present Significant 
Challenges to Law Enforcement Officials, GAO-06-243R (Washington, D.C.: 
Nov. 3, 2005). 

[13] The programs originated in investigator-initiated research into 
the risk factors associated with male and female high school athletes' 
abuse of anabolic steroids. 

[14] According to NIDA officials, the principal investigators who 
developed the ATLAS and ATHENA programs signed a contract with the 
National Football League to place the programs in schools in the 
vicinity of eight National Football League teams in 2007. The contract 
was expected to support the training of about 800 coaches and 20,000 
athletes. 

[15] For fiscal years 2000 through 2006, NIDA officials reported that 
they awarded a total of 31 annual grants, many of which were 
continuation grants for previously-approved projects, for steroid- 
related research focused on the adolescent age group in humans or 
animals. Because of the continuity of the projects from year to year, 
we are reporting the average numbers of projects that were funded and 
active each year. 

[16] ONDCP officials told us that from fiscal years 2001 through 2007, 
USADA funding from ONDCP totaled nearly $46 million. In 2007, for 
example, ONDCP funding was $8.4 million or about 70 percent of USADA's 
$12 million budget, with the United States Olympic Committee providing 
the remaining 30 percent. 

[17] In addition to this funding for education and outreach activities 
specifically focused on anabolic steroid abuse among teenagers, NIDA 
has contracted with Scholastic Magazines since 2002 to provide 
information about drug abuse and addiction to students and teachers 
during the school year. This program, under which Scholastic Magazines 
receives $500,000 per year for fiscal years 2002 through 2009 for a 
total of $4 million, supports broader substance abuse prevention 
activities that have at times included anabolic steroid prevention 
articles, posters, and other materials. 

[18] Project officers in SAMHSA's Center for Substance Abuse Prevention 
work with the Drug-Free Communities Support program grantees to provide 
technical assistance and help them comply with grant requirements. 

[19] An ONDCP official told us that 189 of 702 communities (27 percent) 
provided information that they were addressing steroids in their grant 
activities along with other drugs. 

[20] Follow-on grants are also authorized. 21 U.S.C. § 1532(b)(3). 

[21] Education funds no programs specifically targeting steroid 
prevention for teens. Except for alcohol prevention efforts, the 
department addresses illegal drug abuse in schools with a comprehensive 
strategy, not drug by drug. 

[22] Total funding for the School-Based Student Drug Testing program 
for fiscal years 2003 through 2007 was about $36 million, of which 
$32.2 million (89 percent) was awarded to grantees. The remainder of 
the funding supported evaluation and peer review activities. 

[23] During a discussion of Education's program, an ONDCP official said 
that because testing for anabolic steroids is more expensive than for 
other drugs--adding $50 to $100 to the cost of a common panel of five 
drug tests--some schools add steroids to the tests for only a few of 
the students, as a deterrent. The official said that in some cases, 
federal funding helps schools afford to add steroids to their usual 
test panel. The official estimated that about 1,000 schools and school 
districts across the country were doing some sort of student drug 
testing and sometimes were including steroids. According to the 
official, New Jersey requires steroid testing for some athletic teams 
and Florida and Texas were considering similar legislation. 

[24] We reviewed 16 studies published from January 1995 through June 
2007. 

[25] These studies sought to identify a correlation between risk 
factors and behaviors and anabolic steroid abuse by teenagers. The 
studies did not identify causation. 

[26] Because aggressive behavior is one of the potential psychological 
effects of anabolic steroid abuse, anabolic steroids could predispose 
an individual to aggressive acts, including sexual violence. 

[27] Education officials told us that the agency is currently 
conducting an evaluation of the effectiveness of the student drug-
testing programs implemented by its grantees. 

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