Final Project: Performance Enhancing Drugs-PAPM
Aaron Sweazy
Concordia University of Nebraska
Principles of Health Behavior
MPH 515
Dr. Kim Brodie
August 17, 2014
Table of Contents
Table of Contents 2
I. General Scenario 3
II. Population Threat 4
III. About Precaution Adoption Process Model 6
IV. Previous Implemented Health Programs for PEDs 8
V. Program Design 10
VI. References 11
References Continued 12
References Continued 13
FINAL PROJECT: PERFORMANCE ENHANCING DRUGS-PAPM 13
Final Project: Performance Enhancing Drugs-PAPM
I. General Scenario
Imagine if you were able to Quantum Leap into the body of a sophomore in high school. You stand there looking in the mirror as a 16 year old boy, then across the locker room at your counterparts who all look to be a mix of steel and stone. They have six packs, defined muscles and genetics in their favor. You are short, wheeze when you bend down to tie your shoes, and weigh about 40lbs more then you should. You never get much playing times in football games, so you decide lifting isn’t enough, even though you have a lot of heart in every practice and training session. So, you begin finding ways to help you “catch up” to the others in class. Using Performance Enhancing Drugs (PEDs) like steroids, you show vast improvements in strength, and appeal even to the opposite sex over the course of the next 12 months. Your junior year you find yourself a starter, muscled up and dating the star of the soccer team, life seems great, and you didn’t even have to work as hard to get the desired outcome you wanted, then it happens; side effects. You realize your testicles are shrinking, you lose your ability to sleep through the night and the pressures of keeping your physique and staying popular has put so much pressure on you to the extent you explode with rage and take it out on your girlfriend. These very real and scary side effects can happen to those who abuse steroids as indicated in Figure 1.
Figure1 (American College of Sports Medicine, 2006- Anabolic Androgenic Steroids)
II. Population Threat
Continuing on with the scenario, you have advanced onward to your senior year and it is apparent you aren’t the only person in your grade who has attempted the use of steroids. In fact 50% of your fellow seniors have admitted to using the drug prior to the completion of their freshman year. This alarming percentage documented in the MONITORING FUTURE NATIONAL SURVEY RESULTS ON DRUG USE 1975-2013 booklet is only a few paces behind the use of inhalants (66%), cigarettes (60%) and alcohol (51%) and is tied with smokeless tobacco for usage by the end of 9th grade (Johnston, O’Mally, Bachman, Schulenberg, & Miech, 2013, p. 308). To me by examination if you were to be in a graduating class of 250 individuals, there is a likelihood based on the data given, of 50% would equate to 125 members of your senior class had tried steroids (and that is just by the end of 9th grade!). Keep in mind in the scenario you tried it in your sophomore year, so the chances there are others trying it after their freshman year is great as well. Sadly the idea of getting in shape without working as hard has also put a damper on how steroids are viewed. The aforementioned booklet written by Johnston and colleagues, posed the question; “How much do you think people risk harming themselves either in a physical or other way when using steroids?” Seniors were the only class polled in the 2012 and 2013 respectively with the class of 2012 being at 58.6% of the believing people were at risk. Meanwhile the class of 2013 was met with fewer people agreeing at the tone of 54.2%, meaning the perception of a threat from one graduating class to another had a change of perceived threat of -4.4, with a .05 level of significance being used from one year to the next (Johnston et al., 2013, p. 408). With the amount of individuals decreasing in beliefs that someone on steroids could harm themselves or others, and a large portion of high school aged individuals having already taken steroids or other PEDs at some time frame during their 9th-12th grade of school. It would be safe to assume the abuse of the PEDs/Steroids would impact health outcomes negatively (because more people would think “everyone is doing it” mentality). In my opinion, public health challenges would be faced not only in trying to reverse the trend of abuse of steroids and PEDs which may have been enhanced by peer pressure. PEDs have side effects like the previous mentioning (page 2) of this document. The bad temper mentioned earlier is compulsive from the abuse of steroids and is called Roid Rage (CBS News, 2007), and along with the sleeping problems, testicular shrinkage, and other side effects not mentioned, can and usually do impact your life negatively (U.S. Anti-Doping Agency [USADA], n.d.). Dr. Shalender Bhasin who is the director of the research program in men’s health at Brigham and Women’s Hospital in Boston, Massachusetts even found a link in steroid abuse to that of depression. In 2000, Dr. Bhasin followed 34 steroid users with an astonishing 32 percent dying from suicide, which would be a full 10 individuals that killed themselves (Matthews, 2013). Human Growth Hormones (HGH) and erythropoietin(EPO) are both PEDs which have effects just as bad as steroids on many levels. HGH abuse for instance can enhance the prevalence of existing cancers and cause abnormal thyroid problems for those who use the HGHs (Johnson, n.d.). Meanwhile, EPOs can cause a decrease in blood and oxygen flow to the brain as well as increasing the chances of blood clots (Radcliffe, n.d.). The popularization PEDs from sports figures, in my opinion does not help in trying to reduce its use, as those with the aide of enhancements get high praise for their physique and their pocketbook shows a great return.
(Powell, n.d.)
III. About Precaution Adoption Process Model
If implementing a model to help remedy the issue of PED abuse the utilization of a Precaution Adoption Process Model (PAPM) as shown in Figure 2 would be a great way to help attempt to resolve the issue of PED abuse in my opinion.
Figure 2: PAPM Model (Glanz, Rimer, & Viswanath, 2008)
The PAPM is constructed with seven stages with each having a difference in the way behaviors or beliefs may be present within an individual (DiClemente, Salazar, & Crosby, 2013). First off when working with the PAPM, I would have to personally take those individuals who are unaware of the issue of the dangers of PED abuse (Stage 1), and educate them on the potential dangers of overuse of PEDs through the use of question and answer sessions and the utilization of education videos. Those unengaged on the issue of PED abuse are typically going to be aware of the risks of abuse (Stage 2), but will be naïve in thinking the risks do not point toward to them. After the first two stages an individual may hit a road bump in being undecided on whether to continue with their abuse of PEDs (Stage 3). From there a fork in the proverbial road map of the PAPM formulates in which the individual can decide to keep on taking the PEDs and cutting corners to seek a quick result by not taking action to quit (Stage 4), or by realizing they have a potentially life threating addiction and need to act on the impulse to stop before things become fatal (Stage 5). At the realization of deciding to act, the individual would need to move forward and would be steered toward action (Stage 6) of seeking therapy for addiction to help overcome the issue at hand. After action has been concluded, regularly going in for monthly follow-ups to test blood and urine samples for PEDs should be implemented. The client should also routinely report to a licensed mental health provider (LMHP) or a counselor that specializes specifically in substance type abuses. By doing the routine visits, this would throw the ball back into the court of the PED abuser, and allow them to keep maintenance (Stage 7) on keeping sober from PED abuse. By following the stages outlined in the PAPM, an individual can vastly improve their life and influence the direction of the Social Ecological Model as presented in Figure 3. Through the step by step by step process of PAPM one can embrace themselves (the individual), in order to move on to having meaningful relationships within the cohorts of interpersonal, organizational, community and public policy.
Figure 3: Social Ecological Model (Unknown, n.d.)
IV. Previous Implemented Health Programs for PEDs
The World Wrestling Entertainment (WWE) company has a Talent Wellness Program which is independently ran by Aegis Sciences Corporation(World Wrestling Entertainment [WWE], 2009) In this particular program which was started in February of 2006 there is the Substance Abuse and Drug Testing Policy in which you have to show proof of prescription medicines through a fax from a physician. Drug testing resulting in a positive result (other than Marijuana or Alcohol) will follow a “Three Strikes” layout as shown below in Figure 4:
Figure 4: Substance Abuse and Drug Testing Policy
(World Wrestling Entertainment [WWE], 2013)
1st Strike- Suspension for 30 days, fined an amount equal to 30 days, pay deducted from guarantee earnings, and public disclosure.
2nd Strike- Suspension for 60 days, fined an amount equal to 60 days, pay deducted from guarantee earnings, and public disclosure of 2nd strike.
3rd Strike-Termination with full disclosure of talent’s name with reasoning of termination being due to a 3rd strike on the policy. Prohibited from returning to the company for a full year.
If you leave the company following a 1st or 2nd strike, but return at a later date to the company, the strikes return with you. Additionally, if terminated, and The WWE later extends its hand to allow you back in the company, you are under the caveats of only having a single strike and you are out of the company, you must undergo one unannounced follow-up within a year, and lastly you are automatically enrolled in a Violation Redemption Program (WWE, 2013) which if you are compliant and pass drug tests, you can reduce the strikes assessed against you.
The Federal Bureau of Prisons (BOP) has implemented a Residential Drug Abuse Program (RDAP) which allows for all inmates to be eligible for treatment (pending funding) (Federal Bureau of Prisons [BOP], 2012). According to the BOP, “Inmates in the residential program are housed together in a treatment unit that is set apart from the general population. Consistent with drug abuse treatment research on program effectiveness, treatment is provided for a minimum of 500 hours over 9 to 12 months.” (BOP, 2012). This program is implemented to help with any form of drug abuse to include things such as PEDs. Cognitive Behavior Therapy (CBT) was used in the program and apparently worked so well the study revealed, “Male participants were 15 percent less likely to relapse than inmates who do not participate in the program.” (BOP, 2012).
A third group with success in trying to combat drug abuse is the National Institutes of Drug Abuse (NIDA). Under the umbrella of the NIDA is the Adolescents Training and Learning to Avoid Steroids (ATLAS) program National Institutes of Drug Abuse [NIDA], n.d.). ATLAS utilizes coaches and leaders on teams to educate the rest of the team on the harmful effects of steroid abuse. Program results can be seen below in Figure 5.
V. Program Design
My program I would create would be called the PEDSTOP for: Performance Enhancing Drugs and Steroids Time Out Plan. PEDSTOP would bring in 3 separate groups at 24 members in each group for 16 weeks. The idea is to have a class of heavy PED users one with frequent users, and one with rookie/occasional users which would have a facilitator (doctor/specialist) and an Assistant (a volunteer with experience in PED abuse).
Heavy Users: Groups= 6 Participants = 24 Facilitator =3 Assistant =6
Frequent Users: Groups= 4 Participants = 24 Facilitator = 2 Assistant =4
Rookie Users: Groups= 2 Participants = 24 Facilitator =1 Assistant =2
Through the PEDSTOP Groups, an awareness message on the dangers of PEDS will be brought to the participants through shared stories and photos from the assistants (Stage1 and 2). Transitioning, some folks will wish to act about doing something (Stage 3) or not acting (Stage 4). Those embracing change, will go through an 8 week rehab course with direct 1-on-1 interaction with a trained specialist which will be dubbed the title of a ‘Shoulder”. Various tasks testing the mindset of the patient will be conducted to see if they are capable making wise choices, and if they feel like they are stumbling, they have a “Shoulder” to lean on for guidance. Those wishing to stay in the group setting for little longer may do so, but will have routine checkups every 2 weeks to see if they wish to act (Stage 3). When Stage 5 (Deciding to Act) comes into effect, the patient will be assigned a specialist to deal with mental anxiety and stress that may come with the decision and will maintain their “Shoulder”. In the action stage (Stage 6) a patient must adhere to random drug tests, record a journal of well-being, and then report status to the PEDSTOP program for evaluation and recommendations on how to keep the idea of steroids being bad rooted inside the patient’s daily routine.
VI. References
American College of Sports Medicine. (2006). Anabolic Androgenic Steroids [Photograph]. Retrieved from www.medscape.com
CBS News. (2007). Facts And Myths About ’Roid Rage. Retrieved from http://www.cbsnews.com/news/facts-and-myths-about-roid-rage/
DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2013). Health Behavior THeory for Public Health: Principles, Foundations, and Applications. Burlington, MA: Jones & Bartlett Learning.
Federal Bureau of Prisons. (2012). THE FEDERAL BUREAU OF PRISONS ANNUAL REPORT ON SUBSTANCE ABUSE TREATMENTPROGRAMS FISCAL YEAR 2012 [Annual report]. Retrieved from http://www.bop.gov/inmates/custody_and_care/docs/annual_report_fy_2012.pdf