P3.260: Trends in Legal Performance Enhancing Substance (PES) Use in Young Athletes Over the Past Decade (2013-2024)

Background: The purpose of our study was to investigate trends of reported legal PES use in young athletes from 2013 to 2024. Secondary aims included reporting trends in legal PES use among young athletes before and after publication of major educational, advocacy, and research initiatives regarding PES use in youth sport, and trends in PES use pre and post the COVID-19 pandemic.

Methods: Our study was an observational cohort study of prospectively collected data from athletes undergoing an injury prevention evaluation (IPE) at a tertiary-level pediatric hospital-affiliated sports injury prevention center from 2013-2024. Surveys from 2020 (n=3) and 2021 (n=0) were excluded due to decreased availability of IPE data secondary to the COVID-19 pandemic. Logistic regression models were used to evaluate the trends in legal PES use over the eleven years of collected data, including comparisons from 2013-2016 and 2017-2024 to reflect time before and after release of major initiatives regarding legal PES use in youth sport released in 2016, and from 2013-2019 and 2022-2024 to reflect time before and after the COVID-19 pandemic.

Results: 1021 athletes were analyzed. Median age was 14 (range 6 to 25 years), 55.7% were female, 76.5% were white, and 71.2% were from middle to upper income households. 15.4% of athletes used legal PES (157/1021, 95% CI, 13.3-17.7%). 11.9% used caffeine (121/1021), 2.8% used creatine (29/1021), and 3.4% used nutritional weight gain supplements (35/1021). 54.8% (86/157) of athletes who used legal PES were male. Overall legal PES use and respective individual legal PES (creatine, caffeine, nutritional weight gain supplements) use were not statistically significantly different over the course of the study. In multivariate analysis, there was no significant change in PES use when comparing before and after pertinent initiatives (OR 1.26, 0.85, 1.86, p=0.251). After the COVID-19 pandemic, young athletes were more likely to use legal PES (OR 2.59, 95% CI: 1.49, 4.44, p< 0.001). Age and gender differences in legal PES use were observed as well in multivariate analyses. Males were 1.66 (95% CI: 1.19, 2.32, p=0.003) times more likely to use legal PES compared to females after controlling for the year of the survey. High-school (OR 3.58, 95% CI: 2.42, 5.38, p< 0.001) and college aged (OR 5, 95% CI: 2.61, 9.41, p< 0.001) athletes were more likely to use legal PES compared to middle school aged after controlling for year as well.

Conclusion: Legal PES use in the young athlete population, seen more predominantly in males and older athletes over the past decade, is not decreasing despite major, relevant initiatives. The impact of COVID-19 could be a contributing factor to this pattern, but we acknowledge that the pandemic may have its own separate and unique impact on young athletes and legal PES use.