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Data investigation on the performance-enhancing drugs spread in Italy among young athletes: Prevention trough education and the fight against doping in sport

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VOLUME 16 | Proc2 | 2021 |
S705
Supplementary Issue: Autumn Conferences of Sports Science. Costa Blanca Sports Science Events, 18-19 December 2020. Alicante, Spain.
Data investigation on the performance-enhancing drugs
spread in Italy among young athletes: Prevention trough
education and the fight against doping in sport
FILOMENA MAZZEO1, STEFANIA SANTAMARIA1, VALERIA DI ONOFRIO2
1
1Department of Motor Science and Wellbeing, Interdepartmental School of Science, Engineering and Health,
University of Naples “Parthenope”, Naples, Italy
2Department of Science and Technology, Interdepartmental School of Science, Engineering and Health,
University of Naples “Parthenope”, Naples, Italy
ABSTRACT
Introduction: Substances and methods capable of improving athletic performance have been one of the
greatest concerns in elite sport community. It is a serious danger to sport and health. The teacher, coach and
educator play an important role in the "physically" training of educated people and in culture of health
promotion. Methodology: The study combines a bibliographic research about education importance in doping
prevention and the Italian data analysis in doping spread for attention among young athletes (<19). The
bibliographic sources were identified on Scopus, PubMed and ScienceDirect. The data relating about doping
spread were extrapolated by reports of the Italian Ministry of Health. The time frame considered from 2018
(latest available data) to 2013. Results: The available data show that 2014 had the highest number of
positives (58) and that, starting from that year, the doped athletes number was significantly lower up to 13 in
2018. On young people <19 an almost irrelevant positives number can be seen. Even in 2014 the positives
number was 0. Conclusion: This study shows data on the doping prevalence and the result of WADA's
identification of educational programs and research on social prevention as strategic priorities for the
development of evidence-based anti-doping education.
Keywords: Doping; Drug; Prevention; Education; Health; WADA.
1
Corresponding author. Department of Science and Technology, Interdepartmental School of Science, Engineering and Health,
University of Naples “Parthenope”, Business District, Block C4, 80143 Naples, Italy. https://orcid.org/0000-0001-9398-3496
E-mail: valeria.dionofrio@uniparthenope.it
Abstract submitted to: Autumn Conferences of Sports Science. Costa Blanca Sports Science Events, 18-19 December 2020.
Alicante, Spain.
JOURNAL OF HUMAN SPORT & EXERCISE ISSN 1988-5202
© Faculty of Education. University of Alicante
doi:10.14198/jhse.2021.16.Proc2.56
Cite this article as:
Mazzeo, F., Santamaria, S., & Di Onofrio, V. (2021). Data investigation on the performance-enhancing drugs spread
in Italy among young athletes: Prevention trough education and the fight against doping in sport. Journal of
Human Sport and Exercise, 16(2proc), S705-S715. doi:https://doi.org/10.14198/jhse.2021.16.Proc2.56
Proceeding
Mazzeo, et al. / Data investigation on the performance-enhancing drugs among athletes JOURNAL OF HUMAN SPORT & EXERCISE
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INTRODUCTION
Sport play an essential role in the life of every individual. It brings significant psychophysical and social
benefits (Mazzeo & Di Onofrio, 2019). Specifically, it allows the diffusion of important values that in particular
help young people to making the most of their abilities to control their character and to respect themselves
and others: from the opponent to the coach to the sports authorities (Montesano & Mazzeo, 2019; Wang et
al., 2020).
Moreover, sport is an essential component for the psychophysical development of people and a socially
important phenomenon (Montesano et al., 2020). According to Mauss (Mauss, 1950) it is a complex of
activities that includes different areas ranging from purely sports to politics. Sport, likewise, represents an
important educational tool for the population especially young people. It is therefore essential that society
instils the spirit of sport in the entire population (Mazzeo, 2016; Montesano, 2019b). According to 2021 Wada
Code (WADA, 2021) the spirit of sport is the celebration of the human spirit body and mind. It is the essence
of Olympism and is reflected in the vales we find and through sport including: health; ethics fair play and
honestly; athletes’ rights excellence in performance; character and education; fun and joy; teamwork;
dedication and commitment; respect for rules and laws; respect for self and other participants; courage;
community and solidarity”. The diffusion of the abovementioned values helps young people to making the
most of their abilities to control their character and to respect themselves and others: from the opponent to
the coach to the sports authorities. Moreover, athletes with excessive perfectionism, extrinsically motivated
and who have interaction with drugs have a positive attitude toward doping (Montesano et al., 2013; Zucchetti
et al., 2015; Mazzeo et al., 2019).
It is necessary for the young athlete to be well aware that only through commitment can obtain excellent
results and that defeat is not a personal failure but simply an adverse result (Mazzeo, et al., 2020).
Unfortunately, today's society and the sports world are undermining the values of sport. The culture of
perfectionism together with the pressure of sports clubs towards excellent results in order not to lose the
support of the sponsors are "forcing" athletes to seek the result at any cost (Montesano et al., 2016).
If all this is combined with the loss of the transmission of values by parents it is easy to understand how the
doping culture finds fertile ground. Indeed, especially in the digital age in which young people are completely
dependent on social media and digital communication the fake news on the effects of food and ergogenic
supplements spread rapidly negatively influencing the choices of the younger population (Montesano et al.,
2020; Mazzeo et al., 2020). Let it be clear that the search for victory and the best result has ancient origins
but the difference from the past is the exorbitant spread of the phenomenon even through substances that
are highly harmful to health. Substances and methods capable of improving athletic performance have been
one of the greatest concerns in elite sport community (Madrak et al., 2018).
Today the phenomenon is well known under the term dopinga complex phenomenon that damages the
spirit of sport and represents a serious problem of order and public health (Mazzeo & Di Onofrio, 2019).
In the study conducted by Mudrak (Mudrak, et al., 2018) on a sample of 1035 adolescents it was found that
59% intend to take drugs while 17.6% have doping behaviours. The author notes that despite the use of
doping substances is a prevalent to young athletes there is little attention to the phenomenon. A lot of drugs
are used in sport. So, non-steroidal anti-inflammatory drugs (NSAIDs) are medications that are frequently
used by athletes and the existence of an ergogenic effect of NSAIDs are discussed (Cornu et al., 2020;
Schenone et al., 2003; Motola et al., 2001; Mazzeo,2016). Anti-doping education programs during the last
Mazzeo, et al. / Data investigation on the performance-enhancing drugs among athletes JOURNAL OF HUMAN SPORT & EXERCISE
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years has increased (Codella, Glad, Luzi, & La Torre, 2019; Mazzeo et al., 2018), it is worth to have more
analysis of such studies.
Moreover, education programs continue to play a central role in WADA's overall anti-doping strategy. The
purpose of this research was to provide an overview of research focusing on anti-doping education programs
and being put on 'prevention' in the fight against doping in sport.
METHODS
The article is based on a bibliographic research going on the importance of education as doping prevention
and the analysis of data on the spread of doping in Italy for attention among young athletes (<19). The data
were collected from various sources: official documents from institutions, Scopus PubMed and ScienceDirect.
The data relating to the spread of doping were extrapolated from the reports of the Italian Ministry of Health
and published on its official website. The time frame considered for this study is 5 years from 2018 - the last
year in which the data are available to 2013.
RESULTS
The Figure 1 show total of tests and positives in Italy (Breakdown from 2013 to 2018) and in 2018, the highest
percentage of active substances detected at doping controls belonged to: cannabinoids 33.3%, anabolic
agents 26.7% and stimulants 26.7%.
Figure 1. Spread of doping substances. Breakdown from 2013 to 2018.
0
5
10
15
20
25
30
2013 2014 2015 2016 2017 2018
S1: ANABOLIC AGENTS 21 23 14 5 28 4
S2: PEPTIDE HORMONES,
GROWTH FACTORS,
RELATED SUBSTANCES, AND
MIMETICS
11 16 342
S3: BETA-2 AGONISTS 23133
S4: HORMONE AND METABOLIC
MODULATORS 1 1 2 1
S5: DIURETICS AND MASKING
AGENTS 627 655
S6: STIMULANTS 416 5 4 10 4
S7: NARCOTICS 1 1
S8: CANNABINOIDS 10 3 5 4 3 5
S9: GLUCOCORTICOIDS 68675
P1: BETA-BLOCKERS 4
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The Table 1 the athlete nationalities with the highest number of Anti-Doping Rule Violations.
Table 1. The athlete nationalities with the highest number of Anti-Doping Rule Violations. Breakdown from
2014 to 2017. Source: https://www.wada-ama.org/
Firstly, you have to consider that over the years the number of controls has varied and consequently the
number of positive athletes too. The available data shows that 2014 had the highest number of positives (58)
and that starting from that year the number of doped athletes was significantly lower up to 13 in 2018 (Figure
2).
Figure 2. Total of tests and positives in Italy. Breakdown from 2013 to 2018.
2017
Italy - 171
France - 128
USA - 103
Brazil - 84
Russian
Federation - 82
China - 62
India - 57
Belgium - 54
Spain - 52
South Africa - 43
2016
Italy - 147
France - 86
USA - 76
Australia 75
Belgium - 73
India - 69
Russia - 69
Brazil - 55
Iran 55
South Africa - 50
2015
Russian
Federation - 176
Italy - 129
India - 117
France - 84
Belgium - 67
South Africa - 59
Turkey - 59
Republic of
Korea -51
USA - 50
Iran - Republic of
Islamic - 48
2014
Russian
Federation - 148
Italy - 123
India - 96
Belgium - 91
France - 91
Turkey - 73
Australia - 73
Australia - 49
China - 49
Brazil - 46
Republic of
Korea - 43
590
1208
803 860
1427 1390
13 30 22 25 58 39
4 4 3584
926 19 20 50 35
2018 2017 2016 2015 2014 2013
Tests Positives W M
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The constant throughout the period considered was that men dope more than women. By focusing attention
on young people <19 an almost irrelevant number of positives can be seen. Even in 2014 the number of
positives was 0 (Table 2, Figure 3).
Table 2. The spread of doping among <19 athletes. Breakdown from 2013 to 2018.
Year
Checked <19
Positives <19
2018
133
1
2017
242
2
2016
143
1
2015
220
1
2014
259
0
2013
301
2
Figure 3. Doping spread in Italy to 2013 from 2018 with and a focus of age <19.
From the analysis of the data (data not shown), it is possible to observe that over the years the average age
of positive subjects has not suffered significant fluctuations, apart from a maximum value recorded in 2014
(43 years). More generally , by stratifying the sample of athletes who tested positive for controls into age
groups anti-doping, it is possible to observe the trend, over the years, to detect the highest percentage of
positive among the more mature athletes (44 years), while the lowest among the under 19, trend also
confirmed with regard to the 2013-2018 data. Furthermore, in 2018, the highest percentages of positivity in
relation to the number of athletes controlled, were recorded in athletes aged between 34 and 38 years (4.7%),
while the lowest percentage was recorded among athletes under the age of 19 (1.1%).
88% 90% 92% 94% 96% 98% 100%
1390
1427
860
802
1208
590
39
58
25
22
30
13
35
50
20
19
26
9
4
8
5
3
4
4
2
0
1
1
2
1
Total Checked 1390 1427 860 802 1208 590
Total Doped 39 58 25 22 30 13
Men 35 50 20 19 26 9
Women 485344
Age <19 201121
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Indeed, in Table 3 were indicate the studies that investigate the effects of intervention on the decision-making
process relevant to doping among elite athletes who were doping users, study on education as doping
prevention and on analysis of data on the spread of doping.
Table 3. Studies on education as doping prevention and on analysis of data on the spread of doping.
Study
Sample
Type of detection
Barkoukis et al. 2015
650 Greek athletes aged
between 14 and 20 yr.
Questionnaires
Barnes et al. -2020
Coaches
Literature review
Blank et al. 2016
1265 Austrian athletes aged
between 14 and 19 yr.
Questionnaires
Blank t al. - 2015
883 Austrian parents
Questionnaires
Blashill et al. - 2017
6248 American athletes aged
between 14 and 18 yr.
Questionnaires
Chan et al. - 2015
410 Australian elite athletes
Behaviour Analysis
Giraldi et al. - 2015
423 Italian soccer players
between 15 and 18 yr.
Questionnaires
Laure et al. - 2004
1459 French high school
students
Behaviour Analysis
Laure et al. - 2007
3564 French students between
11 and 12 yr.
Questionnaires
Lucidi et al. 2004
952 Italian athletes between 14
and 20 yr.
Questionnaires
Lucidi et al. 2008
1232 Italian high school athletes.
Questionnaires
Lucidi et al. 2013
1975 Italian athletes between 13
and 18 yr.
Questionnaires
Mazzeo et al. -2020
test controls and combined the
information on the consumption
of doping substances
Behaviour Analysis
Nicholis et al. - 2015
11 coaches from different
countries
Interviews
Turman 2007
30 parents
Interviews
DISCUSSION
There are many studies on health damage and violations of anti-doping legislation (Mazzeo et al., 2020;
Mazzeo et al., 2019; Woolf, 2020). However, to be correctly interpreted and fought - doping must also be
seen as a cultural and educational problem (Isidori, 2017) and is studied as an ethical problem that has
medical and legal riots (Mazzeo et al., 2018; Barkoukis et al., 2019). Therefore, in order to defeat this disease
of sport in addition to the controls ordered by the various sports authorities and sanctions an educational
approach is necessary as a preventive measure (Wang, et al., 2020). Indeed, Doping is closely linked to a
lack of "educational agents" such as family school religious associations federations and sports clubs
(Goldberg,2005; Wang et al., 2020).
It is therefore necessary to educate the athlete in the conscious use of their will and respect for themselves
and others (Di Onofrio et al., 2019; Woolf, 2020). Pedagogy therefore is a necessary component in doping
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prevention. It is equally necessary that anti-doping education is designed for all people involved in sports
especially the younger generations (Woolf, 2020).
But before building an educational protocol it is necessary to understand why young people have a doping
behaviour or intend to do it. Many studies show that those who have low self-esteem and constantly seek
the approval of others are more likely to use performance-enhancing drugs. These subjects classified as
ego-oriented people find the best result not for themselves but for the others and experience defeat as a
personal failure to be ashamed of (Duda et al., 1995; Mazzeo, 2019).
Moreover, Mudrak (Mudrak, et al., 2018) believes that the adolescents most prone to doping are those who
show moral disengagement from doping and feel supported by the use of doping substances by others.
Furthermore, these subjects have a poor status in the group to which they belong live the anxiety of
acceptance suffer from depression and already use substances that give a gratifying effect even if temporary.
In fact, the reward effect is an important component of drug use. It can be direct and indirect. According to
Mazzeo (Mazzeo et al.,2018; Mazzeo et al., 2019) the drugs dependence could be connected to the indirect
gratification. It consists in all situations in which the person has a social economical or psychological benefit
thanks to use drugs. For example: the direct gratification is linked to the winning of a competition and indirect
gratification in the money that the athlete receives after. If all the gratifications are connected to use of drug
maybe the athletes will use drug in the future. Another important factor that leads young people to use doping
substances is the aesthetic one. Indeed, more and more people are desperately trying to lose weight and
gain muscle in a short time and with minimal effort (Madrak et al., 2018).
For the reasons discussed above, once understood the reasons that push young athletes to take drugs it is
necessary to draw a specific educational protocol. Many scholars have pointed out that almost 50 years ago
students complained about the quality of anti-doping education due to the excessive technicality used and
inappropriate argument for the recipients (Woolf et al., 2020). Another relevant problem is the lack of
homogeneity of the educational campaigns promoted and the lack of coordination between organizations -
sporting and non - regional national and international (Mazzeo et al., 2018).
Anyway, according to scholars (Goldberg L. & Elliot, 2005) D ATLAS (Adolescents Training and Learning to
Avoid Steroids) and ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) programs are
the best educational approach. Developed at the American University of Oregon they are addressed to high
school students engaged in sports activities. The two programs have been very successful thanks to the peer
education method. But not only, they indeed focused on the reduction of the main risk factors (peer pressure
false marketing beliefs) and on the development of various protective aspects (adequate training program
nutrition confidence in one's athletic abilities).
Another important educational program is entitled Hercules” whose starting point is the awareness that drug
use depends on the environment in which the individual develops (Backhouse, 2015). The Hercules program
provides adolescents with a solid theoretical foundation on: basic principles of exercise and strength training
biomechanics of strength training nutrition and dietary supplementation sports ethics anti-doping anabolic
steroids and their adverse health effects. Its strength is the union of anti-doping education with practical
strength training (Backhouse, 2016; Mazzeo et al., 2018).
ATLAS ATHENA and Hercules’ programs are based on the observation of behavioural models their
understanding and subsequently through the imitation of positive behavioural (Woolf,2020). Similarly,
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Barkoukis (Barkoukis, 2016) designs an educational program based on the use of positive behavioural
models such as professional athletes in order to influence the choices of the younger generation of athletes.
Over the years, there have been several theories on the design of adequate educational anti-doping
programs but currently the primary source is represented by World Anti-Doping Agency (WADA) which has
elected anti-doping education as a preventive measure. Indeed, in January 2018 the Agency launched an e-
learning platform (ADeL) which offers access to all topics related to clean sport and anti-doping. Moreover, it
offers courses for athletes coaches doctors administrators and anyone interested in learning more about anti-
doping and protecting the values of clean sport (WADA, Anti-Doping E- Learning, 2020). It includes various
modules: ALPHA Coach True Parent's Guide Sport Physician's Toolkit. The ALPHA module is structured in
a series of lessons about the dangers of doping and the importance of anti-doping controls and promotes
positive attitudes to avoiding doping. It concludes with an attitude survey followed by a 12-item multiple choice
test to assess athletes' knowledge. On the other hand, Coach True Parent's Guide and Sport Physician's
Toolkit are online tutorial programs targeted at specific populations (Wolf,2020).
WADA before building anti-doping campaigns makes an important difference between information and
education (WADA 2021); the first one deals with providing knowledge while the second one has the task of
promoting behaviour. To date WADA is a reference point for the anti-doping education thanks to its
International Standard for Education (ISE) introduced in 2009 on the occasion of the World Conference on
Doping in Sport held in Katowice (Poland). According to WADA (WADA, 2020) the starting point of the ISE
is that the athlete's first anti-doping experience must be through education rather than through controls and
the education should begin early preferably in school age.
The main objective that through ISE WADA intends to pursue is the harmonization of anti-doping education
through the imposition of mandatory standards for the signatory countries.
According to Standard WADA recommends to signatories to develop and deliver an education program based
on the knowledge and dissemination of the various negative aspects related to doping and the impotence of
sporting values. The ultimate goal of the educational program is to develop an ethical awareness of the
behaviours to be assumed through the discussion of topics and issues related to clean sport.
CONCLUSION
The anti-doping fight inexorably passes through controls and eventually through sanctions. But the first
approach that athletes especially the younger ones must have with the anti-doping culture is through
information and education campaigns. They must be characterized by uniformity at every level and must be
suitable for the reference target. It is hoped that they should be of interest to school-age children in order to
influence their choices by understanding the values of sport and which models to follow and emulate.
Further research studies, especially on young athletes, and include their coaches, instructors and other
persons close to them, which examine athletes’ belief system and provoke critical thinking in athletes about
using banned substances in sport might be more effective in preventing doping as well as programs focusing
on health education.
Over the years various theories have followed one another but to date once again WADA sets itself as a
reference point in the fight against doping through its guidelines on information and education. It is therefore
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hoped that these preventive measures can over time give excellent results in order to reduce the number of
positives in every age group and in every category.
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