After adjusting for all covariates, the authors found high school boys were 70 percent more likely than other participants to use protein shakes and powders and other muscle-enhancing substances.
Asian males were more likely to use steroids compared with white males, while Asian females had around a greater chance of using steroids or other muscle-enhancing substances.
Both girls and boys who participated on a sports team were significantly more likely to engage in all muscle-enhancing behaviors besides taking steroids and, among girls, other muscle-enhancing substances.
The authors noted that the study sample from a single U.S. state may not be generalizable, and that study measures of muscle-enhancing behavior were self-reported.
Nonetheless, "pediatricians and other healthcare providers should ask their adolescent patients about muscle-enhancing behaviors," they advised. "Healthcare providers should counsel adolescent patients about appropriate exercise, general nutrition, and the lack of efficacy and potential dangers of muscle-enhancement products."
They added that future research could include more detailed assessments of participants' body composition and weight.