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Abstract. Objective: The authors designed this study to deter-mine if differences exist between male and female collegiate ath-letes’ supplement use and behaviors to modify body appearance. Participants: Collegiate athletes who participated in this study were 241 females and 210 males, aged 17 to 28 years. Method: Participants completed a questionnaire about the average number of times each week they performed specific supplementing, exer-cise, or dietary behaviors. Results: The authors found differences associated with gender for 9 of the 18 behaviors. Specifically, 2 of these 9 behaviors were dietary, 1 was supplementary, 3 were physique concerns, and 3 involved personal motivation for weight-lifting. Conclusion: Male athletes reported a higher drive for size, speed, and power, whereas female athletes were more concerned with body fat, more likely to restrict caloric intake, and more prone to consume weight loss supplements. No differences were found by gender regarding supplement use to increase body size.

Keywords: body appearance, collegiate athletes, dietary behaviors, dietary supplement use, exercise behaviors, sports performance

oday’s collegiate athletes compete in physical activi-ties for reasons that go beyond extracurricular amuse-ment, staying healthy, or a love of the game. Many

of these individuals are seeking stardom, contending for college scholarships, vying for opportunities to play on professional sports teams, or hoping to ultimately secure endorsement contracts that pay impressive salaries. To achieve such ambitious goals, some competitors have even developed a win-at-all-cost mentality to secure an advan-tage over their rivals.1,2,3

T

Enhancing Appearance and Sports Performance: Are Female Collegiate Athletes

Behaving More Like Males?

Susan M. Muller, PhD; Teena R. Gorrow, EdD; Sidney R. Schneider, PhD

It is not uncommon for modern athletes to consume performance-enhancing supplements while striving to become paramount at their sport(s). Although the supplement industry earned an estimated $1.2 to $3 billion per year during the 1990s, that figure has now soared to approximately $18 bil-lion.3 These escalating numbers point to evidence of the rising number of people using supplements on a regular basis.4

According to Kanayama et al,5 millions of men and women, categorized as commercial health club users, are currently using drugs sold over the counter as supplements. Supplementation behavior appears to begin for countless individuals during their teenage years. To examine the use rates of various performance-enhancing supplements among adolescents, an extensive cross-sectional study was conducted among 6,212 girls and 4,237 boys between 12 to 18 years of age who were enrolled in the Growing Up Today study. Of these large groups, approximately 4.7% of the boys and 1.6% of the girls reported using supplements weekly to improve physical appearance or strength.6

The use of performance-enhancing supplements also seems to be widespread among male and female athletes of all ages and levels of competition.3,4 Although supple-mentation behavior is not strictly limited to the athletic population,7 those engaged in athletic competition appear to be more likely to use supplements than nonathletes.3,8,9 The sports participation of 15,000 adolescents while in high school grades 7 to 12 was examined as a predictor of their performance-enhancing substance use 6 years after the initial survey point. Results of this study revealed that males who played a sport were 15.6% more likely to use legal performance-enhancing supplements and were 2.7% more likely to use steroids than their nonathletic peers, whereas female athletes were 1.1% more likely to use legal performance-enhancing supplements and 0.4% more likely to use steroids than female nonathletes.9

Dr Muller is with the Health, Physical Education, and Human Performance Department at Salisbury University, Salisbury, MD. Dr Gorrow is with the Teacher Education Department at Salisbury University. Dr Schneider is with the Health Sciences Department at Salisbury University.

Copyright © 2009 Heldref Publications

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Several other studies have examined supplement use rates among athletes. Specifically, in a study conducted by Schaefer et al10 to examine the use of dietary supplements containing ephedra among athletes, 7 of 311 participants reported regular use of an ephedra-containing dietary product. Furthermore, with merely 2 of the 7 users identi-fied as females, Schaefer et al concluded that males were more likely to use supplemental products.10 In another study to determine supplement use among young men and women, Kanayama and coauthors5 surveyed 511 athletes and found that 18% of males reported use of androstene-dione or other adrenal hormones, 25% reported ephedrine use, and 5% reported anabolic steroid use. However, among women, the reported use rates were lower, with 3% using androstenedione or other adrenal hormones, 13% using ephedrine, and 0% using anabolic steroids. In addition, Boyce11 found that the use of performance-enhancing supplements is probably underreported in many research studies and estimated that approximately 0% to 1% of women, 0.5% to 3% of high school girls, 1% to 5% of men, 1% to 12% of high school boys, and up to 67% of some groups of elite athletes use performance-enhancing supplements.

Although the major reason for any type of supplement use has been identified as gaining a physical advantage over an opponent, research conducted to examine performance-enhancing supplementation in the athletic population has revealed multiple reasons for this behavior among athletes, most of which are associated with winning. Besides yearn-ing to win, athletes have also reported supplementing their diets to improve performance, increase speed and endur-ance, gain energy, boost strength, assist with recovery from practices or strength training sessions, and aid in altering body composition.

In fact, altering body composition has become an espe-cially motivating factor for athletes who are not only attempting to augment performance, but also to improve their appearance. In fact, physical appearance influences one’s body image, or how one perceives it’s; one’s beliefs about body size; and how one describes, thinks about, feels, and behaves toward one’s body.12 Body image is a driving force that influences exercise and dietary behaviors, includ-ing supplementing patterns, as athletes strive to meet public expectations and the established ideals for their sport(s).

Despite the fact that men and women are quite similar genetically, society has traditionally portrayed ideal body images that promote completely different characteristics and qualities for each sex. For example, the ideal male image has traditionally embraced a tall and muscular stature that depicts power and strength. Consequently, these qualities have influ-enced the general desire by men to be muscular, especially in the chest, arms, and shoulders, with a slim waist and hips.13 Over the past couple of decades the media has elevated the pressure on males to become more muscular by portraying an increasingly lean and muscular ideal male body.14,15 Yet, the chances of attaining an ideal body decrease as the standards are raised, often to unrealistic heights.

According to leading body image researchers Cash and Pruzinsky, negative body images have become increasingly more prevalent for men and women over the past 25 years.12 In their international study on the self-image of males, Pope et al16 asked subjects to select the computerized figure best representing their own body, their ideal body, the body of an average man their age, and a body that they believed women prefer. The results indicated a wide discrepancy between the subjects’ actual muscularity and their body ideals, with men from each country choosing an ideal body approxi-mately 28 lbs more muscular than themselves. In addition, these men estimated that women preferred a male body 30 lbs more muscular than themselves.

Males are not alone in facing a changing and increasingly more unattainable ideal physique. Traditionally, the ideal body for women has differed from that of males, with the emphasis on being slim and full-breasted, rather than mus-cular.17 The ever-increasing number of women participating in exercise and sport has spurred a general desire among women to look more fit and strong. This shift in women toward a more fit physique has resulted in an increase in what may be viewed as masculine characteristics portraying strength and power, replacing the more traditional female image depicting weakness and fragility.13,18 This modified ideal body type may also influence the behavior of females, causing them to behave more like men, especially in the areas of supplementing and training for their sport. New diet and exercise trends, as well as increased desire to obtain a lean, athletic body type traditionally reserved for men, have generated a surge in dietary supplementation among women concerned with obtaining a body that more closely resembles the new ideal.6,19 Therefore, it is believed that alterations in ideal body images have influenced male and female athletes’ satisfaction with their bodies and con-sequently their dietary and exercise behaviors.

Other studies focusing on body satisfaction have sug-gested that body dissatisfaction underlies 75% to 95% of risky behavior for females and 33% to 45% for men.13 In addition, Cohane and Pope20 reported that body image dis-satisfaction is common among young males and is often associated with distress, which may lead to an increase in risky behavior, including supplementation.21,22 Male and female athletes place great emphasis on their body image, and many of them use supplements to improve how they look as well as to enhance their athletic performance. Over the past 10 to 15 years, more and more athletes are using supplements to enhance their physical appearance and strength. Additionally, athletes may be at an increased risk of having a negative body image and practicing unhealthy behaviors because of the demands of their sport23,24 and concerns about body shape or size.19,25

Several studies have examined gender differences in regard to body image and its influence on behavior among athletes.6,26,27,28 Body image is often associated with body composition, particularly among athletes concerned with meeting the physical requirements of their sports. Although neither men nor women desire to be overweight, it is also

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undesirable for men to be too small or to lack muscle. An examination of supplement behaviors among 10,449 boys and girls revealed that the reasons for taking supplements associated with altering body composition varied by gender. The boys tended to use the supplements to obtain better physiques or gain muscle, whereas the girls reported a desire to achieve a lower body weight.6

In a study which focused on self-image and related behavior in athletes, 90% of disordered eating in athletes was found to occur among women.26 These disordered eat-ing behaviors were associated with a desire to lose body fat. Selby et al27 also reported that women displayed greater body image dissatisfaction and eating psychopathology, compared with men participating in the same sports. The women in this study reported the belief that weighing less and having reduced amounts of body fat would enhance athletic performance and promote a better self-image.

Similarly, Rudd and Carter28 surveyed 1,200 athletes from 34 different sports that they classified as either non-lean (eg, basketball, football, lacrosse, softball) or lean (eg, swimming, wrestling, track and field, gymnastics). Male and female athletes in the nonlean sports were more likely to report using supplements designed to increase muscle mass, such as steroids. Men in this study were more likely to use steroids (1.2%) and muscle enhancing supplements (9.9%) than were women (0.3% and 2.8%, respectively). Rudd and Carter concluded that men are more likely than women to use supplements for sports enhancement, and that certain sports increase the tendency of athletes to use muscle-enhancing supplements.

Male athletes appear to be more concerned about gaining muscle size, power, speed, and endurance than are female athletes. The 2 most commonly used supplements reported by male athletes are creatine and anabolic steroids, which are associated with increasing lean body mass.29 Most, but not all, studies have found that the use of anabolic steroids is more common among men than women. For example, in a large cross-sectional study involving 4,746 middle and high school students, Irving et al30 observed that 5.4% of the boys and 2.9% of the girls had used steroids during the past year. They also found that steroid use among the boys was associated with participation in sports that emphasize weight or shape. Brill and Keane31 reported widespread supplement use among male and female bodybuilders. These researchers differentiated anabolic, muscle-enhancing supplements from “fat burners” and found that women in their study reported higher use of “fat burners,” whereas men were more likely to use muscle-enhancing supplements.

Consuming supplements has become quite common for male and female athletes at all levels of competition.9 Whether an athlete supplements to improve appearance, gain a competitive edge, or keep up with those who are already using these substances, it is evident that the pressure to use performance-enhancing supplements is significant.32

A review of the literature demonstrates that there are behaviors commonly associated with enhancement of per-formance and body image.33,34 These behaviors may be

categorized as involving dietary modifications or sup-plementation, exercise patterns, and those performed for physique protection. Although several studies have been conducted to examine a specific subset of these types of behaviors with a variety of populations, we have only found 1 other study that examined this group of behaviors among collegiate athletes. Thus, there is a need to establish baseline data on behaviors associated with body image and sports performance to help determine future health educa-tion and intervention programs supportive of collegiate athletes at risk. To help establish this baseline, we examined the following question: Are there differences between male and female collegiate athletes in their rates of supplementa-tion, types of supplements consumed, and behaviors used to modify physical characteristics of their bodies?

METHODWe recruited a sample of 451 athletes, aged 17 to 28

years (M = 19.48 years, SD = 1.98 years), from current varsity sport teams and intramural sports clubs at a north-eastern university to participate in this study. We recruited the 241 female participants from the women’s varsity field hockey, lacrosse, basketball, swimming, volleyball, soc-cer, and softball teams, and the bodybuilding, soccer, and lacrosse intramural sports clubs. We recruited the 210 male subjects from the men’s varsity lacrosse, basketball, swim-ming, baseball, football, and soccer sport teams, and the bodybuilding, rugby, and lacrosse intramural sports clubs.

Procedure and Instrumentation Participants completed an informed consent form,

approved in advance by the University’s Human Subjects Committee, which described the purpose of the study and assured participants that their responses would remain anonymous. Participants were then asked to complete a questionnaire that was developed for use in this study by a panel of 4 experts in the areas of health and exercise sci-ence, including 1 of the study’s authors. Items of interest to the authors, noted on the basis of their personal review of the related literature, were represented on the questionnaire and included body symmetry, physique protection behav-iors, lifting behaviors and associated objectives, body size or weight, steroid use, dietary supplement use, and altera-tions in dietary habits. Participants were asked to respond to each statement on the questionnaire by reporting the average number of times each week that they performed each of 18 behaviors. The possible responses for each item ranged from 0 to 7, with 0 indicating that the behavior was performed 0 days per week by the individual, 1 indicating that it was performed 1 day per week, 2 indicating that it was performed 2 days per week, 3 indicating that it was per-formed 3 days per week, 4 indicating that it was performed 4 days per week, 5 indicating that it was performed 5 days per week, 6 indicating that it was performed 6 days per week, and 7 indicating that the behavior was typically per-formed every day. The remaining items on the questionnaire asked participants to identify the sport(s) in which they

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were participating and to provide their age and gender. The panel of experts reviewed the questionnaire for content and face validity. All surveys were administered to the athletes in small groups (15–20 participants).

Statistical AnalysesData analyses were performed using a computerized

statistical package (SPSS 15.0 for Windows, Chicago, IL). Data were recoded by subjects’ reported responses of 0 to 7 with no or yes. Where the number 0 indicated that the athlete did not perform the behavior, no was substituted for the participant’s response of 0 days per week. All other participants’ responses of 1 through 7 indicated that the behaviors were performed and were recoded with yes. The Pearson’s chi square was used to test for the associa-tion between reported (yes or no responses) behaviors and

gender (see Table 1). Additional analyses were conducted to determine whether men and women differed in the frequency of performing specific behaviors.

Data were further analyzed using the appropriate statisti-cal measure based on distribution patterns. For responses to questions where data were found to be normally distrib-uted, an independent t test was used to test for differences between male and female reported behaviors; data only included subjects that reported performing the behavior. For responses to questions where data were found to not be nor-mally distributed, the Mann–Whitney test for independent samples was used to test for differences between male and female reported behaviors and included only subjects that reported actually performing the behavior. For all statistical analyses, a probability level of less than or equal to 0.05 was considered to show statistical significance.

TABLE 1. Association Between Performance of Behaviors and Sex

Sex

Male Female Pearson’s

Behavior n % n % N χ2 p

Dietary behaviors Take dietary supplements 89 42.4 229 99.1 317 175.53 < .001 Drink protein shakes 171 81.5 188 81.3 359 8.58 .83 Avoid high-fat foods 192 91.5 197 85.3 389 4.00 .046 Restrict food intake to decrease body fat 35 16.7 77 33.3 112 16.13 < .001 Drink meal replacement shakes 38 18.1 33 14.3 71 1.18 .28Supplementation behaviors Take supplements to decrease body fat 20 9.6 78 33.8 98 37.40 < .001 Take steroids or steroid- based substances to increase body size 9 4.3 7 3.0 16 0.48 .48 Think about or consider taking steroids 9 4.3 7 3.0 16 0.48 .48 Take supplements to increase body size 57 27.2 59 25.5 116 0.15 .70Physique concern behaviors Worry about losing mass 57 27.2 39 16.9 96 6.80 .59 Check body weight using a scale 43 20.5 77 33.3 120 9.18 .002 Check muscle size with tape measure 18 8.5 17 7.4 35 0.22 .64 Feel concern about body symmetry (having body areas proportioned) 180 85.8 156 67.5 336 20.04 < .001 Look into a mirror to check body size 157 74.8 106 45.9 263 38.10 < .001 Wear baggy clothes to hide body defects 51 24.3 62 26.8 113 0.38 .54Lifting behaviors Lift weights to become more powerful 100 47.7 68 29.4 168 15.42 < .001 Lift weights to become faster 121 57.6 83 35.9 204 20.81 < .001 Lift weights to increase body size 180 85.8 149 45.3 329 26.12 < .001

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RESULTSAnalyses of data on the basis of yes or no responses

showed a significant association between behavior and gender for 9 of the 18 behaviors (see Table 1). Spe-cifically, performance of the following behaviors were found to be associated with gender: taking dietary supplements, restricting food intake to decrease body fat, taking supplements to decrease body fat, checking body weight using a scale, feeling concern over body symmetry, looking into a mirror to check body size, lifting to become more powerful, lifting to become faster, and lifting to increase body size. The following 9 behaviors were found not to be associated with gen-der: drinking protein shakes, avoiding high-fat foods, drinking meal replacement shakes, taking steroids or steroid-based substances to increase body size, thinking

about or considering taking steroids, taking supplements to help increase body size, worrying about losing mass, checking muscle size using a tape measure, and wearing baggy clothes to hide body defects.

Further analyses of data examining reported fre-quency of performing the behaviors (analyses limited to those athletes that reported performing each behavior) showed significant gender differences for only 4 of the 18 behaviors (see Table 2). Specifically, men and women differed in the frequency of performance for the following behaviors: taking dietary supplements, avoid-ing high-fat foods, taking supplements to decrease body fat, and feeling concerned about body symmetry. No differences were found between men and women in the frequency of performing any of the remaining behaviors included in the survey.

TABLE 2. Comparison of Male and Female Collegiate Athletes’ Frequency of Reported Performance of Behaviors

Men Women

Behavior M SD n M SD n

Dietary behaviors Take dietary supplementsa 4.79 2.05 89 3.90 1.89* 229 Drink protein shakesa 4.35 1.95 171 4.24 1.85 188 Avoid high-fat foodsa 4.61 1.92 192 3.86 1.91* 197 Restrict food intake to decrease body fata 3.09 1.93 35 3.71 2.01 77 Drink meal replacement shakesb 2.89 1.73 38 2.70 1.57 33Supplementation behaviors Take supplements to decrease body fata 2.60 1.96 20 3.76 1.71* 78 Take supplements to help increase body sizeb 4.97 2.06 57 4.64 2.22 59 Think about or consider taking steroidsb 1.67 1.23 9 1.43 1.13 7 Take steroids or steroid-based substances to increase body sizeb 1.67 1.23 9 1.43 1.13 7Physique concern behaviors Look into a mirror to check body sizea 4.18 1.82 157 3.97 1.86 106 Worry about losing massa 3.81 1.96 57 3.13 2.00 39 Feel concern about body symmetrya 4.52 1.95 180 3.99 2.09* 156 Wear baggy clothes to hide body defectsa 4.00 2.14 51 3.76 2.22 62 Check body weight using a scaleb 3.44 2.20 43 2.83 1.90 77 Check muscle size with tape measureb 1.32 1.12 18 1.18 1.26 17Lifting behaviors Lift weights to become fastera 4.16 2.13 121 4.41 2.08 83 Lift weights to become more powerfula 4.10 1.94 100 4.28 1.90 68 Lift weight to increase body sizea 4.65 1.89 180 4.48 2.01 149

Note. Analyses limited to those athletes reporting that the behavior was performed at least 1 day per week. *Significant differences between men and women (p < .05)aAnalyzed by independent t test for normally distributed data.bAnalyzed by Mann–Whitney test for independent samples not normally distributed.

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DISCUSSIONThis study was designed to determine if differences exist

between male and female collegiate athletes’ appearance-modifying or sports-enhancement behaviors. Results indi-cated that 9 of the 18 behaviors examined were found to be associated with gender. Of these 9 behaviors 2 may be considered dietary, 1 is supplementary in nature, 3 are considered physique-concern behaviors, and 3 involve moti-vation for lifting.

Differences in dietary behaviors included consuming supplements and restricting food intake to decrease body fat, for which more women than men reported perform-ing these dietary modifications. In this study 99% of women, compared to 42% of men, reported taking dietary supplements. The large difference between these rates may be because of the generic nature of the term dietary supple-ment. According to Driskell et al,35 women are more likely than men to take calcium and/or iron supplements, whereas the rate of reported vitamin and mineral supplementation was similar for men (55%) and women (59%). The higher rate of reported food restriction among female athletes in this study is in agreement with the findings of Field et al,6 who examined supplement behaviors among 10,449 boys and girls, concluding that the girls were more concerned with reducing body weight, whereas the boys were more interested in size and muscle related to obtaining a better physique. Interestingly, among those athletes in the current study who reported taking dietary supplements, the men (4.79 days/week) reported taking them more frequently than the women (3.9 days/week). This finding may mean that many of these athletes are reporting somewhat erratic use of various multivitamin/minerals intended for everyday consumption or that consumption of sports bars and drinks may be included in this category.

Differences between male and female athletes’ supple-mentation behaviors were only found in reported use of products taken to help decrease body fat. Among athletes in this study, 33.8% of the women and 9.6% of the men report-ed the regular consumption of weight loss supplements. Not only did more female than male athletes report the use of weight loss supplements, but women also reported taking them at a higher frequency rate. Among those taking these weight loss supplements, women reported consuming them an average of 3.76 days per week, whereas men reported a use rate of 2.60 days per week. These rate differences indicate that female athletes are more concerned about body fat than their male counterparts and is in agreement with the findings of Brill and Keane,31 who reported higher consumption rates of supplements they classified as “fat burners” by female than male body builders.

The most surprising finding in this area was that no sig-nificant difference exists between men (27.2%) and women (25.5%) taking supplements to help increase body size. This does not support the findings of Rudd and Carter,28 who sur-veyed 1,200 athletes participating in 34 different sports and concluded that male athletes were more likely than female athletes to take supplements to increase body size. The

inclusion of female body builders in the current study may have increased the percentage of women who reported the use of size-enhancing supplements, thereby eliminating the gender differences in regards to this behavior. This finding does, however, lend support to the idea that the behavior of female athletes is changing and in many ways is becoming very similar to the behavior of male athletes.

In this study, male and female athletes reported feeling concern about physique. The men reported significantly higher rates of concern over body symmetry (85.8%) and checking body size in a mirror (74.8%) than did the women, reporting 67.5% and 45.9%, respectively, for these same behaviors. Despite this, more female than male athletes reported checking their body weight with a scale. Taken together, these findings indicate that men and women are concerned with body size issues but are likely to display this concern in different ways. Male athletes appear to worry more about symmetry and use a mirror to check on these concerns, whereas women reported more concern about their weight as evidenced by frequency of using a scale.

Differences were found between male and female athletes for each of the lifting behaviors examined. Men in this study reported higher rates than women for lifting to become more powerful (47% vs 29%), become faster (57% vs 35%), and increase body size (85% vs 45%). Despite differences in the rates of male and female athletes reporting lifting for various reasons, among those athletes lifting, there were no differences in the frequency (days per week) that they actually reported performing these behaviors. Among those athletes report-ing lifting, men and women averaged between 4 and 5 days per week. The lack of difference in frequency rates among those athletes who reported regular weight lifting is most likely because of the requirements of their sports. Modern varsity athletes participating in similar sports are often trained by strength and conditioning coaches. These coaches design programs for men and women, with differences largely occur-ring in the absolute amount of weight being lifted, rather than in the frequency or duration of each workout session.

In summary, male and female collegiate athletes in this study reported similar patterns for 9 of the 18 appearance-modifying and performance-enhancing behaviors exam-ined, lending support to the idea that female collegiate athletes are behaving in ways that are similar to their male counterparts. Gender differences were most apparent in the approach to modifying body size and shape, with women reporting higher rates of taking a general dietary supple-ment, consuming products designed to reduce body fat coupled with checking body weight using a scale, whereas male athletes were more concerned about body symmetry and lifting for speed, power, and size. Thus, it can be con-cluded that female and male collegiate athletes are often behaving in very similar ways, whereas differences occur predominantly among attempts to alter body composition.

Limitations

Despite the limitations of this study, which include sample size and use of a self-report questionnaire, the

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data do reveal a need for health education programs for collegiate athletes to address issues related to behaviors associated with enhancement of performance and body image. Although it is not unreasonable to suggest that there is a relationship between gender and behavior, more research needs to be conducted to distinguish between the performance of specific behaviors and the motivation to continue these behaviors despite potential health risks.

COMMENTBehaviors commonly performed by collegiate athletes

attempting to enhance appearance and/or sports perfor-mance are often linked to body image perceptions. This study lends support to the concept that collegiate athletes are frequently modifying their behaviors in an effort to address concerns about body image as well as sports per-formance. These findings have implications for designing health instruction for college students. The literature reveals that body dissatisfaction often underlies risky behaviors, such as eating disorders or excessive exercising patterns.13 As noted by Rudd and Carter,28 behaviors that may be considered risky are frequently encouraged despite the potential negative effect on the physical or emotional well-being of the athlete. Furthermore, because eating disorders and related risky behaviors (ie, consumption of weight loss supplements) are increasing among college students, it has become a pressing social concern to examine these behav-iors and attempt to ameliorate the trend.

Health professionals in academia are responsible for the development of instructional programs to educate col-legiate students and athletes. Quality health instruction arises from needs assessment data and review of current literature. These data indicate a need for curricular and outreach programs that address body image attitudes, perceptions, and cultural expectations. Health instruction should be designed to address the intrinsic and extrinsic factors serving as motivators of these behaviors. Health educators may play a critical role in promoting healthy behavior among this population by implementing relevant, socially responsible programs.

Future research should focus on educational program-ming to determine the impact on behavioral patterns of college aged student-athletes. A more thorough examina-tion of the social and cultural expectations for collegiate athletes may be obtained using qualitative methodology. This type of approach may lend itself to a better under-standing of the differing expectations and pressure placed on males and females because of gender and the nature of their specific sport.

NOTE

For comments and further information, address corre-spondence to Dr Susan Muller, Health, Physical Education, and Human Performance Department, Salisbury University, 1101 Camden Ave, Salisbury, MD 21801, USA (e-mail: smmuller@salisbury.edu).

REFERENCES 1. Metzl J. Strength training and nutritional supplement use in

adolescents. Curr Opin Pediatr. 1999;11:292–296. 2. King D, Lea T, Maughan R. Dietary supplements. J Sports

Sci. 2004;22:95–113. 3. Laos C, Metzl J. Performance-enhancing drug use in young

athletes. Adolesc Med. 2006;17:719–731. 4. Nissen S, Sharp R. Effect of dietary supplements on lean

mass and strength gains with resistance exercise: a meta-analysis. J Appl Physiol. 2003;94:651–659.

5. Kanayama G, Gruber A, Pope H, Boroweicki J, Hudson J. Over-the-counter drug use in gymnasiums: an underrecognized sub-stance abuse problem? Psychother Psychosom. 2001;70:137–140.

6. Field A, Austin S, Camargo C, et al. Exposure to the mass media, body shape concerns, and use of supplements to improve weight and shape among male and female adolescents. Pediatrics. 2005;116:e214–e220.

7. Faigenbaum A, Zaichowsky D, Gardner D, Micheli L. Anabolic steroid use by male and female middle school students. Pediatrics. 1998;101:e6.

8. Gershel J, Levine S, Metzel J, Small E. Creatine use among young athletes. J Am Acad Child Adolesc Psychiatry. 2004;108:421–425.

9. Dodge T, Jaccard J. The effect of high school sports partici-pation on the use of performance-enhancing substances in young adulthood. J Adolesc Health. 2006;39:367–373.

10. Schaefer M, Smith J, Dahm D, Sorenson M. Ephedra use in a select group of adolescent athletes. J Sci Med Sport. 2006;5:407–414.

11. Boyce E. Use and effectiveness of performance-enhancing substances. J Pharm Pract. 2003;16:22–36.

12. Cash T, Pruzinsky T. Body Image: A Handbook of Theory, Research, and Clinical Practice. New York, NY: Guilford Press; 2002.

13. Grogan S. Body Image: Understanding Body Dissatisfaction in Men, Women, and Children. London: Routledge; 1999.

14. Pope H, Olivardia R, Gruber A, Borowiecki J. Evolving ideals of male body image as seen through action toys. Int J Eat Disord. 1999;26:65–72.

15. Pope H, Phillips K, Olivardia R. The Adonis Complex: The Secret Crisis of Male Body Obsession. New York, NY: Free Press; 2000.

16. Pope H, Gruber A, Mangweth B, et al. Body image perception among men in three countries. Am J Psychiatry. 2000;157:1297–1301.

17. Brumberg J. The Body Project: An Intimate History of Ameri-can Girls. New York, NY: Random House; 1998.

18. Grogan S. Body image and health. J Health Psychol. 2006;11:523–530.

19. Yesalis C, Barsukiewicz C, Kopstein A, Bahrke M. Trends in anabolic-androgenic steroid use among adolescents. Arch Pedi-atr Adolesc Med. 1997;151:1197–1206.

20. Cohane G, Pope H. Body image in boys: a review of the literature. Int J Eat Disord. 2001;29:373–379.

21. Blouin A, Goldfield G. Body image and steroid use in male bodybuilders. Int J Eat Disord. 1995;18:159–65.

22. Cafri G, van den Berg P, Thompson J. Pursuit of muscularity in adolescent boys: elations among biopsychosocial variables and clini-cal outcomes. J Clin Child Adolesc Psychol. 2006;35:283–291.

23. Thompson R, Sherman R. Athletes, athletic performance and eating disorders: healthier alternatives. J Soc Issues. 1999;55:317–337.

24. Smolak L, Murnen S, Ruble A. Female athletes and eating problems: a meta-analysis. Int J Eat Disord. 2000;27:371–380.

25. Williamson D, Netemeyer R, Jackman L, Anderson D, Funsch C, Rabalais J. Structural equation modeling for risk fac-tors for the development of eating disorder symptoms in female athletes. Int J Eat Disord. 1995;17:387–393.

520 JOURNAL OF AMERICAN COLLEGE HEALTH

Muller et al

26. Dick R. Eating disorders in NCAA athletic programs. J Athl Train. 1991;26:136–140.

27. Selby R, Weinstein H, Bird T. The health of university athletes: attitudes, behaviors, and stressors. J Am Coll Health. 1990;39:11–18.

28. Rudd N, Carter J. Building positive body image among college athletes: A socially responsible approach. Clothing and Textiles R J. 2006;24:363.

29. Metzl J, Small E, Levine S, Gershel J. Creatine use among young athletes. Pediatrics. 2001;108:421–425.

30. Irving L, Wall M, Neumark-Sztainer D, Story M. Steroid use among adolescents: findings from the project EAT. J Adolesc Health. 2002;30:243–252.

31. Brill J, Keane W. Supplementation patterns of competitive male and female bodybuilders. J Int Soc Sports Nutr. 1994;4:398–412.

32. Calfee R, Fadale P. Popular ergogenic drugs and supple-ments in young athletes. Pediatrics. 2006;117:e577–e589.

33. Pope H, Gruber A, Choi P, Olivardia R, Phillips K. Muscle dysmorphia. An underrecognized form of body dysmorphic disor-der. Psychosomatics. 1997;38:548–557.

34. Lantz C, Rhea D, Mayhew J. The drive for size: a psycho-behavioral model of muscle dysmorphia. Int J Sports Med. 2001:71–84.

35. Driskell J, Krumbach C, Ellis D. Vitamin and mineral supple-ment use among college athletes. J Am Diet Assoc. 1998;98:A17.

36. Silver M. Use of ergogenic aids by athletes. J Am Acad Orthop Surg. 2001;9:61–70.