Objective: To assess the prevalence of use of anabolic-androgenic steroids and other presumed performance-enhancing drugs and the associated knowledge, attitudes, and behavior of school-aged Canadians. Design: A national survey was conducted using a self report questionnaire distributed randomly to schools within each of five Canadian regions. Setting: Canada. Subjects: The subjects were 16,119 Canadian students, in the sixth grade and above, from 107 schools drawn randomly from five Canadian regions. Main outcome measurements: The number of students reporting the use of anabolic-androgenic steroids and other performance-enhancing drugs in the year before the survey, the nature of such drug-taking activities, and the attitudes underlying the decision to take anabolic-androgenic steroids. Results: More than 83,000 young Canadians (2.8% of the respondents) are estimated to have used anabolic-androgenic steroids in the year before the survey. Of those taking such drugs, 29.4% reported that they injected them; of the latter group, 29.2% reported sharing needles in the course of injecting anabolic-androgenic steroids. Significant numbers of respondents reported using other substances (caffeine, 27%; extra protein, 27%; alcohol, 8.6%; painkillers, 9%; stimulants, 3.1%; ''doping methods,'' 2.3%; beta-blockers, 1%) in attempts to improve sport performance. Conclusions: The use of anabolic-androgenic steroids is more widespread than may have been assumed and is often accompanied by high-risk needle-sharing. Anabolic-androgenic steroid use is often intended to alter body build as opposed to accentuating sport performance. Many young Canadians use a variety of other substances in attempts to improve sport performance. Drug-taking of this kind represents a special challenge for educators, health professionals, and sport authorities.
