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Charles E. Yesalis, ScD; Nancy J. Kennedy, DrPH; Andrea N. Kopstein, MPH; Michael S. Bahrke, PhD

JAMA. 1993;270(10):1217-1221.

Abstract
Objective.
—To estimate the size of the anabolic-androgenic steroid (AAS) user population in the United States, to examine characteristics of AAS users, and to explore the association between AAS use and the use of other illicit drugs as well as self-reported aggressive behaviors.

Design.
—A cross-sectional study using data from the 1991 National Household Survey on Drug Abuse.

Study Population.
—The survey covered the population aged 12 years and older living in households in the United States. The results of the survey were based on personal interviews combined with self-administered questionnaires from 32 594 respondents. These respondents were randomly selected by means of a stratified multistage area sample of the household population.

Results.
—Estimates based on data from the National Household Survey on Drug Abuse indicated that there are more than 1 million current or former AAS users in this country, with more than half of the lifetime user population being 26 years of age or older. More than 300 000 individuals used AAS in the past year. Males had higher levels of AAS use during their lifetime than females (0.9% and 0.1%, respectively; P<.01). The median age of first use of AAS for the study population was 18 years; for 12- to 17-year-olds, the median age of initiation was 15 years. Among 12- to 34-year-olds, AAS use was significantly and positively associated with the use of other illicit drugs (P<.05), cigarettes (12- to 17-year-olds only; P<.01), and alcohol (P<.01). Furthermore, AAS use is highly correlated with self-reported aggressive behavior (P<.01) and crimes against property (P<.01).

Conclusions.
—These results indicate that AAS use impacts a large number of men and women from various racial and age groups across the nation. While causal inferences cannot be made regarding the associations between AAS use and use of other drugs as well as antisocial behavior, these findings should enhance our ability to profile the typical AAS user.

(JAMA. 1993;270:1217-1221)

Author Affiliations
From the Department of Health Policy and Administration, Pennsylvania State University, University Park (Dr Yesalis); Policy and Planning Unit, Center for Substance Abuse Prevention, Rockville, Md (Dr Kennedy); Statistics and Analysis Branch, National Institute on Drug Abuse, Rockville, Md (Ms Kopstein); and Department of Epidemiology and Biostatistics, University of Illinois at Chicago (Dr Bahrke).

Footnotes
The views expressed in this article are those of the authors and do not reflect the official position of the National Institute on Drug Abuse or the US Department of Health and Human Services.

Reprint requests to Department of Health Policy and Administration, Pennsylvania State University, 115 Henderson Bldg, University Park, PA 16802-6500 (Dr Yesalis).

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