Research Report: Health Risks and the Teen Athlete

Key findings include:

1. Athletes Were Less Likely To Use Illicit Drugs.

Playing sports was associated with reduced risk for illicit drug use. Female athletes were less likely than female nonathletes to use marijuana, cocaine, or “other” drugs (such as LSD, PCP, speed, or heroin). Male athletes were less likely than male nonathletes to use marijuana, cocaine, crack cocaine, inhalants, or “other” drugs.

2. Findings On Anabolic Steroids Were Mixed.

Male athletes overall were no more likely to use anabolic steroids than male nonathletes were. Female athletes overall, and highly involved male athletes, were both nearly one and a half times more likely than their nonathletic counterparts to use steroids; and highly involved female athletes were nearly twice as likely to do so. However, only about 2% of teenage girls used anabolic steroids overall.

3. Only Highly Involved Athletes Were More Likely To Binge Drink.

Contrary to popular belief, neither female nor male athletes were significantly more likely than nonathletes to drink alcohol overall, or to drink to excess. However, highly involved athletes of both genders were somewhat more likely to binge drink than nonathletes.

4. Athletes Were Less Likely To Smoke Cigarettes, But More Likely To Use Chewing And Dipping Tobacco.

Athletes were less likely than nonathletes ever to have smoked cigarettes regularly or to have smoked within the past month. However, both male and female athletes were more likely to use chewing/dipping tobacco; in fact, highly involved female athletes were more than three times as likely to do so as female nonathletes. Only about 2% of teenage girls used chewing/dipping tobacco overall.

5. Athletes Were Less Likely To Be Suicidal.

Both female and male athletes were less likely than their nonathletic counterparts to seriously consider or make a plan for committing suicide. Male athletes were also less likely than male nonathletes to actually attempt suicide. However, highly involved athletes of both genders who do attempt suicide were nearly twice as likely as suicidal nonathletes to require medical treatment as a result.

6. Female Athletes Had More Positive Body Images, But Were More Likely To Attempt Weight Loss.

Both female and male athletes were less likely than nonathletes to describe themselves as overweight. However, female athletes were more likely to try to lose weight; and though they were more likely than nonathletes to use dieting and exercise to do so, highly involved female athletes were also more likely to use vomiting and/or laxatives to lose weight.

7. Female Athletes Were More Likely To Wear Seatbelts, But More Likely To Drive After Drinking.

Findings regarding the relationship between athletic participation and vehicular risk were mixed. Female athletes were a third more likely than nonathletes to wear seatbelts. Female athletes overall, and highly involved athletes of both genders, were also more likely to drive an automobile after drinking than nonathletes.

Our results show that athletic participation has both positive and negative implications for adolescent health in America today. In order to guide athletes, coaches, parents, and communities to better use sports as a means of promoting adolescent health, a list of policy recommendations follows.

Policy Recommendations

The Women’s Sports Foundation developed the following policy recommendations in order to promote the health of adolescent athletes, especially girls. Given the widespread interest and involvement of American teenagers, high school and community sport are appropriate social settings in which to plan and implement community health interventions. A panel of leaders from education, government, public health, women’s health organizations, and sport was created to review the findings from this study and to identify policy goals. We gratefully acknowledge their expertise. The list of panel members and affiliations appears in the acknowledgments in the beginning of this report. The Women’s Sports Foundation Report: Health Risks and the Teen Athlete suggests that sport is a health asset in many young people’s lives, fostering wellness and reducing certain risky behaviors. Yet some findings also point to areas where the sports experience may jeopardize the health of girls and boys. The policy recommendations below, therefore, discuss the preventive aspects of high school and community sports as well as areas in need of reform.

Promoting Adolescent Health Through Sports

1. Create Federal, State, and Local Policy and Action Agendas to Support Athletics.

Educators and local, state, and federal policy officials need to evaluate the status of high school and community sports in their domains. Many school districts are experiencing the erosion of high school sports programs, a dwindling of public resources, and a decrease in athletic opportunities. In particular, poorer neighborhoods often lack the resources to support local teams.

• Create a national policy for the protection and enhancement of high school and community sports in the United States of America.
• Both public and private funds should be provided to promote health advocacy through sport.

2. Use Sport as a Gateway to Adolescent Wellness and Long-Term Health Promotion.

Families, educators, parent-teacher associations, community organizations, and health professionals must evaluate and monitor the extent to which athletic programs protect and promote the health of teen athletes. Furthermore, the lifestyle choices and health habits that teenage athletes adopt affect their health later in life, promising not only better quality of life but significant savings in health care costs.

• Proponents of adolescent health should develop health-related educational materials specifically for athletes.
• Public health departments should emphasize sport as an avenue to health (and thus as a strategy to lower cumulative health care costs).

3. Form New Partnerships to Pursue Health Advocacy through Sport.

In order to foster adolescent health through sport, new partnerships should be forged between agencies, organizations, and institutions that are both governmental and nongovernmental, health-related and nonhealth-related, public and private.

• Public health departments, schools and universities, medical centers, various sport organizations, coaches associations, and parent associations should work together to focus public attention on, and generate public and private funding for health advocacy through sport.
• Women’s health advocates and organizations, in particular, should explore policies and programs that seek to enhance girls’ health through athletic participation.
• Men’s health researchers and advocates should do likewise for boys.

4. Promote Gender Equity in Athletics.

Historically, women’s athletic participation rates mushroomed during the 1980s and 1990s, and sports are now central to many girls’ and women’s lifestyles. However, the lack of gender equity in many school athletic programs still deprives many girls of the opportunity to pursue wellness through sports participation. Athletic programs should be supported for interested girls as well as boys.

• Title IX must be vigorously enforced at all levels of education.
• Parents, coaches, and communities should monitor school and community athletic programs, and lobby their schools and local governments to enforce gender equity.
• Lawyers, educators, epidemiologists, nurses, and school administrators can ensure that the current debates around gender equity in sports include a discussion of the ways that sports can promote greater levels of wellness in both girls and boys.

5. Foster Working Relationships Between Coaches, Parents, and Health Professionals.

Information about the health needs and risks of adolescents should be included in coaching certification and education programs. Workshops, published materials, and videos can help coaches and parents better understand the preventive potentials of athletic participation.

• School districts, community-based athletic programs, and sports governance organizations should require that athletic directors, coaches, and athletic trainers learn to better assess the health risks of adolescent athletes.
• Coaches and sports officials should work closely with school nurses, physicians, and counselors to form a network of knowledgeable adults upon whom athletes can rely for guidance, support, and intervention when needed.
• Health professionals should establish dialogue with athletes and create workshops with coaches and parents, each of whom can offer valuable insights and recommendations drawn from their unique opportunities to observe and guide adolescent athletes.
• Parent Teachers Associations, school boards, and community youth programs need to ensure that the education and health are the key organizing principles for developing and evaluating athletic programs.

6. Welcome All Interested Adolescents into High School and Community Sports.

In light of the potential health benefits associated with sport, school and community sports programs should not be reserved for only the best trained and most physically mature athletes. Sports should be made an inclusive and supportive environment for all girls and boys to develop physically, mentally, and socially.

• The increasingly competitive focus of adolescent sports (as exemplified by the excessive practice of “cutting” children and adolescents from sports teams) should be de-emphasized.
• School and community leaders must ensure that adolescent health is not compromised by cultural pressures to “win at all costs.” Instead, the potential of sport to promote fitness and personal development should be exploited.

Reducing Health Risks In Adolescent Sports

1. Acknowledge the Existence of Health Risks.

The first step to reducing the risk of behaviors with negative health consequences is to recognize the frequency with which they occur. This report has explored the prevalence and likelihood of a variety of health-risk behaviors in athletes, but much more research is needed. And more information is not enough; parents, policymakers, coaches, and athletes themselves need to talk frankly about the problems associated with adolescent sports before strategies can be crafted to resolve them.

2. Increase Efforts to Detect and Prevent Health Risk Behaviors.

High schools should develop risk management procedures that allow school health officials, administrators, and coaches to identify and deal with problem behaviors among athletes. Such programs will be most effective when interested parties within and outside the school setting establish reliable lines of communication in order to coordinate efforts to promote teen health.

3. Provide Positive and Healthy Adult Role Models.

Adolescent athletes learn by observation. Respected professional and college athletes can help to make sport a safer place for girls and boys by modeling substance-free lifestyles, responsible vehicular behavior, and nonviolence off the field, track, or court. In addition, they should refuse to advertise addictive substances. Both female and male professional athletes should be recruited to participate in public service advertising campaigns that link healthy lifestyles with sports. It is particularly important for coaches to act as positive role models for the teenagers whose lives they influence. Schools can also organize mentoring programs in which “team mentors” are used to promote the concept of healthy living through sports, and offer support and encouragement to teams.

4. Let Teens Help Each Other.

Many adolescents are inclined to reject adult advice regarding health risks. In part because of this developmental tendency, teens are often strongly susceptible to peer pressure to engage in risky behavior. While parents and coaches can and should reach out to kids, teenage athletes can also be empowered by developing peer health education and support programs under the mantle of school and community sports organizations.

5. Challenge the Use of Sport Imagery to Sell Harmful Substances to Teens.

Adolescent health advocates and proponents of high school and community sports should challenge the use of sports imagery to market dangerous substances to teenage audiences. For example, corporate advertisers regularly employ glamorous images of risk sports to sell tobacco and alcohol products. The symbolic masking of addicting drugs behind the facade of athletic excitement distorts many healthful sporting values while elevating the risk of adolescent experimentation. Sports magazines and television programming with substantial teen audiences should be encouraged to eliminate tobacco and alcohol advertisements.

6. Pay Close Attention When Depressed Athletes Talk About Suicide.

Although participation in sports is associated with lower rates of considering, planning, or attempting suicide, those teen athletes who do try to kill themselves are more likely to cause serious bodily harm. No teen who expresses suicidal thoughts should be ignored, but athletes in particular should receive prompt intervention. Because athletes often grow close to their coaches and seek their advice on non-sport-related matters, coaches and health professionals can work together to supplement parental and school efforts along these lines.

Directions For Future Research

1. Most prior research, including this report, has provided only evidence of associations between athletic participation and adolescent health risks. More sophisticated longitudinal studies are needed to develop a clearer understanding of the causal mechanisms through which athletic participation influences adolescent health.

2. The organization and quality of high school and community athletic programs differ markedly from one another. Researchers should systematically evaluate how the quality and availability of athletic programs in their communities influence the health behaviors of teen athletes. This type of research is especially needed in communities where disproportionately high numbers of poor families are located.

3. Researchers need to be mindful of the unique needs and risks of girls and boys. Female and male teenage athletes share many of the same aspirations, values, physical challenges, and emotional ups and downs. Yet girls’ and boys’ experiences in sport often differ, producing unique consequences for physical and mental health.

4. Researchers should examine the extent to which some girls may be adopting health risk behaviors traditionally associated with some men’s sports, such as the use of chewing/dipping tobacco and binge drinking. Conversely, researchers need to explore the ways that the growing involvement of girls in sports may be changing boys’ health beliefs and practices.

5. It is likely that patterns of teenage alcohol use, illicit drug use, anabolic steroid use, and pathogenic weight loss behaviors vary from sport to sport and from setting to setting. Sport and health researchers need to document the risk-inducing and risk-reducing dimensions of various sports, and to compare the health consequences of participation in high school and community sports.

6. In-depth interviewing and focus group studies should be conducted to learn about the meanings and motivations that teen athletes attach to their daily decisions about risk-related health behaviors. Teen athletes should also be a part of the brainstorming process to develop strategies for reducing risky behavior.

Footnotes:

1 (For example, see Frisch, R.E., G. Wyshak, N.L. Albright, T.E. Albright, I. Schiff, K.P. Jones, J. Witschi, E. Shiang, E. Koff, and M. Marguglio. 1985. “Lower Prevalence of Breast Cancer and Cancers of the Reproductive System Among Former College Athletes Compared to Non-athletes.” British Journal of Cancer 52:885-891; see also Frisch, R.E., G. Wyshak, T.E. Albright, N.L. Albright, and I. Schiff. 1986. “Lower Prevalence of Diabetes in Female Former College Athletes Compared With Nonathletes.” Diabetes 35: 1101-1105.)

The Women’s Sports Foundation Report: Health Risks and the Teen Athlete offers a comprehensive evaluation of the linkages, both positive and negative, between sport and adolescent health risks. The Women ’s Sports Foundation presents these findings in order to foster serious dialogue over the benefits and risks of adolescent athletic participation. That sports have positive impacts on many young people ’s lives cannot be argued. The Women’s Sports Foundation promotes increased opportunities for girls and women in sports and fitness; however, the Foundation also recognizes that sport is not a perfect institution. This report analyzes some of the multifaceted connections of the sports experience to the health, safety, and fitness of American teenagers.

We explore the ways in which sports and health risks are related for both girls and boys in this study. It is clear that girls and boys have,more than ever today, a shared stake in athletics. Over the past few decades, as girls and women have flooded into what was once the exclusive purview of boys and men, a central question has arisen: Will female athletes embrace the traditional masculine sport culture, adopting risky behavior patterns previously associated with males? Or will they transform the institution of sport as we know it, making it a safer and healthier setting for both girls and boys? As the dialogue continues, this report makes a unique and necessary contribution to the debate.

The findings and conclusions of this report were derived from analysis of the 1997 Youth Risk Behavior Survey, a nationally representative survey of 16,262 public and private high school students in grades 9 through 12, developed by the Centers for Disease Control and Prevention. The Youth Risk Behavior Survey is conducted biannually to assess the prevalence of youth behaviors that influence health outcomes. It includes, but is not limited to, data on suicidal thoughts and attempts; perceptions and behaviors related to body image and weight loss; vehicular risk-taking (including seatbelt use and driving under the influence of alcohol); and substance use (tobacco, alcohol, and other illicit drug use, including anabolic steroids). We carried out logistic regression analyses to compare athletes ’and nonathletes’ odds of engaging in each of these health-risk behaviors. Where appropriate, comparisons were also made with “highly involved” athletes (that is, teenagers who reported participating in three or more sports teams over the course of the year prior to the survey).

Some specific findings documented by this study are listed below. All comparisons are made within genders; that is, they are made between athletes and nonathletes of the same gender (with some comparisons between the subgroup of highly involved athletes and nonathletes), rather than between female and male adolescents.