School-based prevention of anabolic-androgenic steroid use: mapping the evidence from adolescent prevention programs.

Abstract

Adolescents are vulnerable to sociocultural influences related to body image and appearance, which may increase the risk of anabolic-androgenic steroid (AAS) and other image- and performance-enhancing drug (IPED) use and subsequent adverse health outcomes. School-based prevention initiatives targeting AAS use and its associated health risks may prevent the initiation and use of these substances among adolescents by educating them about the dangers, adverse effects, and risks of AAS use while promoting healthier choices. This scoping review aimed to map the characteristics, intervention components, and reported outcomes of school-based prevention programs targeting AAS and other IPED use among adolescents. Peer-reviewed English-language studies evaluating school-based prevention programs addressing AAS and IPEDs among adolescents were included. Searches were conducted through Scopus, Embase (Elsevier), CINAHL (EBSCOhost), Web of Science, ProQuest, MEDLINE (Ovid), and PsycINFO, covering all eligible records published up to September 2025. Data were charted to map study characteristics, intervention types and delivery features, populations, and outcome domains assessed, with findings synthesised descriptively in line with scoping review methodology. Seventeen studies were included. Interventions mostly involved classroom-based education (70.6%) and sport- or exercise-integrated components (52.9%). Outcomes were predominantly evaluated by study-specific questionnaires (58.8%). Most studies examined knowledge, attitudes, intentions, and psychosocial outcomes, whereas fewer studies assessed behavioural outcomes, particularly actual AAS use (≤ 20%). Considerable variation was identified in intervention content, outcome measures, and follow-up periods. The available literature is heterogeneous and primarily focuses on knowledge, attitudinal, intentional, and psychosocial outcomes rather than behavioural outcomes. Future research should include more consistent outcome measures, longer follow-up periods, and greater attention to behavioural outcomes and psychosocial determinants of AAS and IPED use.