Prevalence, determinants and trends of anabolic-androgenic steroid use among 93,437 high-school students: Repeated cross-sectional studies in Italy

OBJECTIVES: Limited information is available on anabolic-androgenic steroids (AAS) use among young people. This study aims to fill this knowledge gap using a large Italian dataset. STUDY DESIGN: Repeated representative cross-sectional study. METHODS: We used data from the ESPADItalia surveys annually conducted between 2017 and 2023 (excluding 2020) on 93,437 adolescents aged 15-19 years. Odds ratios (OR) of lifetime AAS use were estimated using unconditional multiple logistic regression models. RESULTS: Lifetime AAS use prevalence was 1.9%, current use was 0.8%. Lifetime use declined from 2.4% (2017) to 1.2% (2021), then rose to 3.3% (2023). AAS use was more frequent among males (OR = 1.94; 95% Confidence Interval, CI: 1.75-2.15), those preferring not to disclose their gender (OR = 4.18; 95% CI: 3.00-5.81), overweight/obese (OR = 1.27; 95% CI: 1.10-1.46), subjects doing daily (OR = 1.21; 95% CI: 1.02-1.45), moderate (OR = 1.22; 95% CI: 1.00-1.49), intense (OR = 1.74; 95% CI: 1.41-2.15), agonistic (OR = 1.29; 95% CI: 1.15-1.45) physical activity, users of slimming substances (OR = 15.61; 95% CI: 13.01-18.73), supplements (OR = 4.59; 95% CI: 4.07-5.19), cigarettes (OR = 2.26; 95% CI: 2.04-2.51), cannabis (OR = 3.16; 95% CI: 2.83-3.52), alcohol (OR = 1.71; 95% CI: 1.53-1.91), energy drinks (OR = 4.25; 95% CI: 3.81-4.74), gamblers (OR = 1.98; 95% CI: 1.72-2.28), with low school performance (OR = 1.49; 95% CI: 1.17-1.90) and self-satisfaction (OR = 1.57; 95% CI: 1.36-1.82), and social problems (OR = 1.61; 95% CI: 1.40-1.84). CONCLUSIONS: After a declining trend until 2021, AAS use subsequently rose among Italian teens, especially in vulnerable groups, including gender minorities, and adolescents with addictive behaviours or compromised social and psychological well-being. Awareness efforts are needed to address this emerging concern.