Clinical Pediatrics http://cpj.sagepub.com/
Human Growth Hormone: A New Substance Of Abuse Among Adolescents? Vaughn I. Rickert, Claire Pawlak-Morello, Vicki Sheppard and M. Susan Jay CLIN PEDIATR 1992 31: 723 DOI: 10.1177/000992289203101206 The online version of this article can be found at: http://cpj.sagepub.com/content/31/12/723
Published by: http://www.sagepublications.com
Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://cpj.sagepub.com/content/31/12/723.refs.html
>> Version of Record - Dec 1, 1992 What is This?
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Human Growth Hormone: A New Substance Of Abuse Among Adolescents? Vaughn I. Rickert, Psy.D.* Claire Pawlak-Morello, M.D.** Vicki Sheppard, M.D.** M. Susan Jay, M.D.**
Summary: It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were its
effects; 3)
reasons
surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31 % of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and =
nonusers
of HGH.
Introduction The
~
use
(AS)
of anabolic steroids improve athletic has been
to
performance *
**
well-documented.’1 Use of these substances has been the focus of
ment
media attention as well as the medical literature, which contains several surveys documenting use by
unpublished studies on the prevalence of AS use and its medical consequences.5 This summary
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas Department of Pediatrics, Loyola University Medical Center, Chicago, Illinois Address correspondence to: Vaughn I. Rickert, Psy.D., Department of Pediatrics, University of Arkansas for Medical Sciences, 800 Marshall Street, Little Rock, AR 72202
Presented in part at the Annual Meeting of the Society for Adolescent Medicine, Washington, DC, March 1992.
adolescents.1-4 Recently, report reviewed all
a
govern-
published
and
suggests that 5 % to 11 % of male adolescents in high school admitted to some AS use, as well as up to 2.5% of females.~ The majority of users were male athletes, especially those involved in football and wrestling.1,,, Recently, a well-known professional athlete disclosed his long-term use of AS and his moti-
Downloaded from cpj.sagepub.com at UNIV ARIZONA LIBRARY on June 19, 2014
723
vations for use; he also stated that he used human growth hormone (HGH) .6 This disclosure suggests it may be important to consider whether the AS user is also abusing HGH. Moreover, anecdotal reports suggest that HGH may actually be preferred over AS because it is not detectable with current drug-test-
ing protocols.5S Human growth hormone is secreted by the pituitary gland, and its mechanism of action is to stimulate growth throughout the body. The distribution of pituitary-extracted growth hormone was halted in 1985 after several children who had been treated with the drug developed Jakob-
items of information
on
port
gender,
these
and age. The measure used in the present study had a multiple-choice format in which several questions had more than one possible response. Adolescents were questioned concerning their sources of information about growth hormone and their knowledge of both positive and negative effects of substance use. They were asked about their personal use, use by peers, reason (s) for use, and how they had obtained growth hormone. Finally, the use of AS conjointly or alone was
as a
result of ardu-
competitive activity.’ However, perceptions have not been subjected to scientific scrutiny. Moreover, there have been no studies that examined the interaction between use of human HGH and AS use, especially among adolescents. The purpose of our study was to evaluate the prevalence of HGH use in a suburban high school population. In addition, we also sought to examine the relationship, if any, between those who report use of AS and those who concurrently use HGH. Finally, the knowledge of the therapeutic usefulness and the supportive benefits of HGH were also assessed in this
Creutzfeldt disease and died.s,7 Contamination of pituitary extracts with a slow virus is believed to have been responsible for these deaths. The introduction of re-
investigation.
combinant DNA-derived growth hormone in 1985 has increased the current available supply of the drug.5 The distribution pattern of synthetic growth hormone differs from that of AS, for which no
The present study was conducted at two suburban Chicago high schools in the same school district. The ethnic distribution of the population sampled was primarilywhite (83%) with 14% Asian and 3% black. Once permission was obtained from school superintendents, principals, and teachers and approval granted by the Institutional Review Board (University of Loyola Stritch School of Medicine), a 15-item self-report questionnaire was distributed in 18 health classes. This measure was modified from a previously used instrument which examined AS use among adolescents. After obtaining informed written consent from each participant, we asked each student to complete the questionnaire at the beginning or the end of the class period. Anonymity was guaranteed; to assure confidentiality, students were instructed not to put their names on the questionnaires and to return the consent form and questionnaire The only identifying separately.
known control exists. The manufacturers of growth hormone have voluntarily developed distribution control for their product, but the amount of growth hormone illegally sold is unknown.5 However, data suggest that the availability via this route is much less than for AS.5 Data are lacking on the prevalence
of HGH among high college students or amateur professional athletes. Anecdotal reports suggest that athletes use this hormone because they perceive it to increase body growth and strength. In addition, athletes tend to believe that HGH prevents the breakdown of muscles after AS use has been discontinued. Finally, these individuals may also believe that HGH strengthens tendons and ligaments, thereby preventing ruptures and tears or use
school and
724
that may occur ous
Methods
measure were
the self-rerace,
also evaluated. The questionnaire was administered to 432 10th-grade students, but five of the questionnaires were not used because of incomplete data. All the male students (n 224) responded; only their questionnaires were used in compiling the present results because, of the 208 female adolescents who responded, only one indicated use of growth hormone for medical =
Downloaded from cpj.sagepub.com at UNIV ARIZONA LIBRARY on June 19, 2014
Thus, only the responses of male adolescents were subjected to descriptive statistical analyses and chi-square tests to determine if differences between groups existed. reasons.
Results Of the 224 male adolescents sur-
veyed, 5% (n 11) reported past or present use of growth hormone (users) . Approximately 78% of the =
total male population had heard of hormone. Slightly more than half said that they had received their information from some media source, such as television, newspapers, or magazines. Of most importance was the lack of knowledge about positive effects of growth hormone among the male adolescents surveyed, as almost
growth
half did
provide even one corresponse on the knowledge measure. Moreover, approxicould be considered to 65% mately have poor knowledge of effects, and only two of the males in the entire sample answered all effect questions correctly. Finally, 55 (24.5%) of the males surveyed stated that they knew of someone not
rect
who had used HGH. More than half of HGH users (70%) indicated they used HGH more than one time per month. Of the 11 users, only eight reported where they obtained HGH; sources were equally distributed among peers, coaches, and others. One male student stated he had obtained this substance from a physician and that the reason for use was medically related. Of those who
provided reasons for use (n 10), all responses included increasing body size and strength, as well as strengthening tendons and liga=
ments
(n = 4). Thus, these data
suggest that probably 10 adoleswho reported use were using this substance to enhance size, strength, and/or appearance. With regard to knowledge, most users were unaware of side effects, and 50% did not indicate knowledge of one common side effect. However, knowledge between users and nonusers of HGH was not significantly different by chicents
analyses (P >.05) . significant association between HGH use and knowledge of square A
others who are users was found (P
Human Growth Hormone: A New Substance Of Abuse Among Adolescents? Vaughn I. Rickert, Claire Pawlak-Morello, Vicki Sheppard and M. Susan Jay CLIN PEDIATR 1992 31: 723 DOI: 10.1177/000992289203101206 The online version of this article can be found at: http://cpj.sagepub.com/content/31/12/723
Published by: http://www.sagepublications.com
Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://cpj.sagepub.com/content/31/12/723.refs.html
>> Version of Record - Dec 1, 1992 What is This?
Downloaded from cpj.sagepub.com at UNIV ARIZONA LIBRARY on June 19, 2014
Human Growth Hormone: A New Substance Of Abuse Among Adolescents? Vaughn I. Rickert, Psy.D.* Claire Pawlak-Morello, M.D.** Vicki Sheppard, M.D.** M. Susan Jay, M.D.**
Summary: It has been estimated that as many as 250,000 adolescents are using anabolic steroids (AS). Recently, anecdotal reports suggest that athletes may also be using human growth hormone (HGH). The purpose of the present study was to determine the following: 1) if adolescents in two suburban midwestern high schools (83% white, 14% Asian, and 3% black) were using HGH; 2) knowledge of for use; and 4) concurrent AS use. After we obtained informed written consent, 224 male and 208 female 10th-grade students were its
effects; 3)
reasons
surveyed using a 15-item questionnaire. Of male students surveyed, 5% (n 11) reported past or present use of HGH, and one female student reported use. Our data suggest that among male adolescents surveyed, a majority had heard of this substance, and 31 % of males reported knowing someone who was using HGH. Chi-square analysis found a significant association between AS and HGH use where seven AS users reported past or present use of HGH. Most HGH users were unaware of its side effects and reported first use between 14 and 15 years of age. No differences in sports activity, ethnicity, or age were found between users and =
nonusers
of HGH.
Introduction The
~
use
(AS)
of anabolic steroids improve athletic has been
to
performance *
**
well-documented.’1 Use of these substances has been the focus of
ment
media attention as well as the medical literature, which contains several surveys documenting use by
unpublished studies on the prevalence of AS use and its medical consequences.5 This summary
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas Department of Pediatrics, Loyola University Medical Center, Chicago, Illinois Address correspondence to: Vaughn I. Rickert, Psy.D., Department of Pediatrics, University of Arkansas for Medical Sciences, 800 Marshall Street, Little Rock, AR 72202
Presented in part at the Annual Meeting of the Society for Adolescent Medicine, Washington, DC, March 1992.
adolescents.1-4 Recently, report reviewed all
a
govern-
published
and
suggests that 5 % to 11 % of male adolescents in high school admitted to some AS use, as well as up to 2.5% of females.~ The majority of users were male athletes, especially those involved in football and wrestling.1,,, Recently, a well-known professional athlete disclosed his long-term use of AS and his moti-
Downloaded from cpj.sagepub.com at UNIV ARIZONA LIBRARY on June 19, 2014
723
vations for use; he also stated that he used human growth hormone (HGH) .6 This disclosure suggests it may be important to consider whether the AS user is also abusing HGH. Moreover, anecdotal reports suggest that HGH may actually be preferred over AS because it is not detectable with current drug-test-
ing protocols.5S Human growth hormone is secreted by the pituitary gland, and its mechanism of action is to stimulate growth throughout the body. The distribution of pituitary-extracted growth hormone was halted in 1985 after several children who had been treated with the drug developed Jakob-
items of information
on
port
gender,
these
and age. The measure used in the present study had a multiple-choice format in which several questions had more than one possible response. Adolescents were questioned concerning their sources of information about growth hormone and their knowledge of both positive and negative effects of substance use. They were asked about their personal use, use by peers, reason (s) for use, and how they had obtained growth hormone. Finally, the use of AS conjointly or alone was
as a
result of ardu-
competitive activity.’ However, perceptions have not been subjected to scientific scrutiny. Moreover, there have been no studies that examined the interaction between use of human HGH and AS use, especially among adolescents. The purpose of our study was to evaluate the prevalence of HGH use in a suburban high school population. In addition, we also sought to examine the relationship, if any, between those who report use of AS and those who concurrently use HGH. Finally, the knowledge of the therapeutic usefulness and the supportive benefits of HGH were also assessed in this
Creutzfeldt disease and died.s,7 Contamination of pituitary extracts with a slow virus is believed to have been responsible for these deaths. The introduction of re-
investigation.
combinant DNA-derived growth hormone in 1985 has increased the current available supply of the drug.5 The distribution pattern of synthetic growth hormone differs from that of AS, for which no
The present study was conducted at two suburban Chicago high schools in the same school district. The ethnic distribution of the population sampled was primarilywhite (83%) with 14% Asian and 3% black. Once permission was obtained from school superintendents, principals, and teachers and approval granted by the Institutional Review Board (University of Loyola Stritch School of Medicine), a 15-item self-report questionnaire was distributed in 18 health classes. This measure was modified from a previously used instrument which examined AS use among adolescents. After obtaining informed written consent from each participant, we asked each student to complete the questionnaire at the beginning or the end of the class period. Anonymity was guaranteed; to assure confidentiality, students were instructed not to put their names on the questionnaires and to return the consent form and questionnaire The only identifying separately.
known control exists. The manufacturers of growth hormone have voluntarily developed distribution control for their product, but the amount of growth hormone illegally sold is unknown.5 However, data suggest that the availability via this route is much less than for AS.5 Data are lacking on the prevalence
of HGH among high college students or amateur professional athletes. Anecdotal reports suggest that athletes use this hormone because they perceive it to increase body growth and strength. In addition, athletes tend to believe that HGH prevents the breakdown of muscles after AS use has been discontinued. Finally, these individuals may also believe that HGH strengthens tendons and ligaments, thereby preventing ruptures and tears or use
school and
724
that may occur ous
Methods
measure were
the self-rerace,
also evaluated. The questionnaire was administered to 432 10th-grade students, but five of the questionnaires were not used because of incomplete data. All the male students (n 224) responded; only their questionnaires were used in compiling the present results because, of the 208 female adolescents who responded, only one indicated use of growth hormone for medical =
Downloaded from cpj.sagepub.com at UNIV ARIZONA LIBRARY on June 19, 2014
Thus, only the responses of male adolescents were subjected to descriptive statistical analyses and chi-square tests to determine if differences between groups existed. reasons.
Results Of the 224 male adolescents sur-
veyed, 5% (n 11) reported past or present use of growth hormone (users) . Approximately 78% of the =
total male population had heard of hormone. Slightly more than half said that they had received their information from some media source, such as television, newspapers, or magazines. Of most importance was the lack of knowledge about positive effects of growth hormone among the male adolescents surveyed, as almost
growth
half did
provide even one corresponse on the knowledge measure. Moreover, approxicould be considered to 65% mately have poor knowledge of effects, and only two of the males in the entire sample answered all effect questions correctly. Finally, 55 (24.5%) of the males surveyed stated that they knew of someone not
rect
who had used HGH. More than half of HGH users (70%) indicated they used HGH more than one time per month. Of the 11 users, only eight reported where they obtained HGH; sources were equally distributed among peers, coaches, and others. One male student stated he had obtained this substance from a physician and that the reason for use was medically related. Of those who
provided reasons for use (n 10), all responses included increasing body size and strength, as well as strengthening tendons and liga=
ments
(n = 4). Thus, these data
suggest that probably 10 adoleswho reported use were using this substance to enhance size, strength, and/or appearance. With regard to knowledge, most users were unaware of side effects, and 50% did not indicate knowledge of one common side effect. However, knowledge between users and nonusers of HGH was not significantly different by chicents
analyses (P >.05) . significant association between HGH use and knowledge of square A
others who are users was found (P
