Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Recent evidence suggests that the use of drugs, primarily steroids, to enhance sports performance and physical appearance is prevalent among adolescents. From a theoretical perspective, several economic models have been developed to explore the economic incentives for steroid use among professional and adult elite athletes. These theories have not been extended to adolescents who may have different incentives, economic or not, to use performance enhancing drugs. We conduct an exploratory analysis of the economic and behavioral determinants of steroid use among adolescents using data from the Youth Risk Behavior Surveillance System from 1991 to 2005 merged with state information on college athletic scholarships and costs.

We apply predictions of theoretical models of doping as strategic or illicit behavior and hypothesize that adolescents who participate in sports have a greater economic incentive to use steroids and have different characteristics than adolescents who use steroids to experiment with illicit substances or to change physical appearance. We further hypothesize that the use of steroids by high school athletes will vary across states depending upon opportunities to secure college athletic scholarships and costs of attending college. We explore our hypotheses by estimating probit models of determinants of steroid use for the full sample and two sub-samples: heavy steroid users who participated in team sports; and infrequent steroid users who did not participate in sports.

The full sample results are similar to those reported in cross-sectional clinical literature. Steroid use declines with age; males are more likely to use steroids than females; there is little difference in steroid use across ethnic groups; steroid use is positively associated with smoking, drinking and use of marijuana and hard drugs. In the subsample of infrequent steroid users, males are still more likely to use steroids than females but the probability is far smaller than for the full sample. Steroid use is associated with the desire to change body appearance and use of other drugs. In the subsample of heavy steroid users, blacks and males are more likely to use steroids; steroid use is not associated with a desire to change body appearance; steroid use declines much less with age; and greater participation in team sports is associated with a higher probability of steroid use.

The results for the subsample of participants in sports are supportive of an economic rationale for steroid use. Among high school athletes, males, blacks and those who participate in more sports have a higher probability of heavy steroid use. These are the adolescents with the highest expected payoff from improve athletic performance in high school. Infrequent steroid use is associated with a different set of explanatory variables: the desire to change appearance; and experimentation with illicit substances. If economic factors play a role in steroid use as suggested by our results, then this might have important consequences for policy interventions aimed at reducing adolescent steroid use.