2010 vol. 34 no. 5 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 531© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia

doi: 10.1111/j.1753-6405.2010.00603.x

The non-medical use of steroids in Australia: results from a general population surveyMatthew Dunn

National Drug and Alcohol Research Centre, University of New South Wales

In Australia there exists a large array of studies investigating

substance use among groups such as the general population,

regular drug users and those who come into contact with the

criminal justice system.1 Much of this research focuses upon

the use and harms associated with substances such as heroin,

methamphetamine, cocaine and MDMA (‘ecstasy’). By

comparison, the non-medical use of anabolic-androgenic steroids

(AAS, or ‘steroids’) is an under-researched area in Australia, and

little attention has been given to their use and associated harms.

There have been a number of studies investigating the use and

risks associated with steroid use in Australia, the majority of which

have made use of convenience samples. This is understandable,

given that much of the focus has been upon either blood-borne

virus risk behaviours2 or other substance use.3 Yet there has been

limited research into steroid use at a population level. Yesalis et

al.4 examined steroid use in the general population in the US;

this study aside, most large-scale studies have investigated use

among adolescents or tertiary students. While population-level

studies have inherent weaknesses, they are important for providing

population-based estimates for the general population1 and to

provide a basis for which to compare findings from targeted

samples of users.

Data from the 2007 National Drug Strategy Household Survey

(NDSHS) was used to examine the proportion of the population

who reported ever and past year use of steroids for non-medical

purposes and other drug use among users of these drugs. The

2007 NDSHS was managed by the Australian Institute of Health

and Welfare (AIHW) on behalf of the Australian Government

Department of Health and Welfare. A drop and collect method

(n=19,818) and computer assisted telephone interview (CATI)

method (n=3,538) were used. The response rate for the entire

survey was 49.3%. Ethics approval was granted by the AIHW

Health Ethics Committee.

All participants were asked “Have you ever used steroids for

non-medical purposes?” and all participants in the sample were

asked standard questions concerning demographic characteristics

and other drug use histories. Analyses in the current manuscript

focus upon those who reported affirmative to steroid use for non-

medical purposes only. All statistical analyses were conducted

using SAS Version 9.2. The sample was divided according to those

who had ever used steroids for non-medical purposes (“steroid

users”) and those who had not (“non-users”). Odds ratios (OR)

and 95% confidence intervals (95%CI) were calculated to estimate

the significant of differences between steroid users and non-users.

Less than 1% (0.3%) of Australians aged 14 years and over

had ever used steroids for non-medical purposes and 0.1% of

Australians aged 14 and over had used steroids for non-medical

purposes in the past year. Lifetime use was highest among those

aged 20-29 (0.6%) years and 30-39 years (0.5%); recent (past year)

use was highest among those aged 20-29 years (0.3%), though

the small size of the estimates meant that the 95% confidence

intervals overlapped.

There were differences between steroid users and non-users

in the prevalence of other drug use in the 12 months prior to the

survey. Steroid users were more likely to report the past-year use of

meth/amphetamine (15.6% vs. 2.1%; OR=8.5; 95%CI=4.0, 18.1),

cannabis (29.3% vs. 8.6%; OR=4.4; 95%CI=2.3, 8.2), cocaine

(13.3% vs. 1.5%; OR=9.9; 95%CI=4.4, 22.2), hallucinogens (6.4%

vs. 0.6%; OR=11.9; 95%CI=3.7, 38.3), ecstasy (15.4% vs. 3.3%;

OR=5.3; 95%CI=2.6, 10.9), ketamine (5.1% vs. 0.2%; OR=33.0;

95%CI=9.2, 117.5), GHB (3.0% vs. 0.1%; OR=36.1; 95%CI=7.4,

176.8) and inhalants (8.1% vs. 0.4%; OR=24.5; 95%CI=9.2, 65.0).

No differences were found regarding the past-year use of alcohol;

no participant from either group reported past-year heroin use.

There is limited data pertaining to the general population use

of steroid use in the literature. The present study found that the

proportion of the population reporting non-medial steroid use was

low, consistent with international findings. Lifetime and recent

use were considerably lower than for other drugs such as ecstasy,

cocaine and meth/amphetamine5 but similar to that of substances

such as heroin5 and GHB.6

The association between steroid use and other illicit drug

use is surprising; apart from their non-medical use of steroids,

users are generally portrayed as health-conscious and eschewing

‘recreational’ drugs. Substance use among steroid using groups

has tended to be confined to drugs which counter unwanted side

effects of steroid use, such as gynecomastia. The use of illicit

drugs among targeted samples of steroid users has been found

among those identifying as homo/bisexual,7 suggesting that sexual

orientation may better explain this relationship than steroid use.

There are limitations to the current study. The findings are

limited in the cross-sectional design of the NDSHS, as well as the

reliance on self-report. The response rate to the survey was also

low, which may lead to underestimates of population prevalence.

Further, this survey may fail to adequately survey users of drugs

with a low prevalence, such as steroids, and this should be taken

into account. Nonetheless, the study has several strengths, such

as the large sample size as well as the distinction of investigating

steroid use for non-medical purposes, overcoming some of the

limitations of other studies which have used inadequately worded

questions.8

AcknowledgementsThe National Drug and Alcohol Research Centre (NDARC) is

funded by the Australian Government Department of Health and

Letter

532 AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 2010 vol. 34 no. 5© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia

Ageing. The author would like to thank the Australian Institute of

Health & Welfare (AIHW) for the provision of the National Drug

Strategy Household Survey (NDSHS) data. The author would also

like to acknowledge the Australian Social Science Data Archive

for access to the NDSHS. Thanks to Ms Amanda Roxburgh and

Dr Tim Slade for their work on the weighting for the NDSHS.

References1. Shand F, Topp L, Darke S, Makkai T, Griffiths P. The monitoring of drug trends

in Australia. Drug Alcohol Rev. 2003;22: 63-74.2. Aitken C, Delalande C, Stanton K. Pumping iron, risking infection? Exposure

to hepatitis C, hepatitis B and HIV among anabolic-androgenic steroid injectors in Victoria, Australia. Drug Alcohol Depend. 2002;65:303-8.

3. Dunn M. Are anabolic-androgenic steroid users polysubstance users? J Sci Med Sport. 2009;12:e1-e2.

4. Yesalis, CE, Kennedy, NJ, Kopstein, AN, Bahrke, MS. Anabolic-androgenic steroid use in the United States. JAMA. 1993;270:1217-1221.

5. Australian Institute of Health and Welfare, 2007 National Drug Strategy Household Survey: First results. 2008, Australian Institute of Health and Welfare: Canberra.

6. Degenhardt L, Dunn M. The epidemiology of GHB and ketamine use in an Australian household survey. Int J Drug Policy. 2008;19(4):311-16.

7. Peters, R., et al., Patterns and correlates of anobolic-androgenic steroid use. 1997, National Drug and Alcohol Research Centre, University of New South Wales: Sydney, Australia.

8. Kanayama G, Boynes M, Hudson JI, Field AE, Pope HG. Anabolic steroid abuse among teenage girls: An illusory problem? Drug Alcohol Depend. 2007;88:156-62.

Correspondence to: Matthew Dunn, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052. Fax: (02) 9385 0222; e-mail: m.dunn@unsw.edu.au

doi: 10.1111/j.1753-6405.2010.00604.x

Smoke-free home status and parents’ smoking status among first-time mothersLi Ming Wen, Chris Rissel

Sydney School of Public Health, University of Sydney and Health Promotion Service, Sydney South West Area Health Service, New South Wales

Eric LeeSchool of Public Health and Community Medicine, University of New South Wales

Parental smoking can adversely affect the health of infants

through exposure to environmental tobacco smoke (ETS). A recent

study found that while newborn babies were often shielded from

ETS by parents, this protective behaviour only lasted weeks or

months and was not sustained throughout the first few years of

life.1 In Australia, approximately 17% of women smoke during

pregnancy.2 However, less is known about changes to the smoking

status of a mother’s partner and changes to smoke-free home status

during pregnancy compared with after giving birth.

To investigate parents’ smoking status and smoke-free home

status before or after the birth of their child, we analysed the

baseline data collected by the Healthy Beginnings Trial (HBT).3 As

part of the HBT, first-time mothers who attended antenatal clinics

at Liverpool or Campbelltown Hospitals located in south-west

Sydney were recruited. Four hundred and nine first-time mothers

were interviewed at 26-36 weeks of pregnancy and another 258

first-time mothers were interviewed within one month after giving

birth. The interviews took place at the mothers’ home. Mothers

were asked their smoking status, their partners’ smoking and

whether any smoking was allowed inside their home.

The study found there were no significant differences in smoking

status of the mothers or their partners before and after the child’s

birth (Table 1). Before the birth 17% of the mothers smoked

and among those mothers interviewed after the birth 14% were

smoking (p=0.36). Partner smoking status remained high before

or after their child’s birth (36% vs 37%, p=0.69). In one in 10

households both parents smoked before or after the birth of child

(p=0.62). At one month after the child’s birth there was a higher

proportion of households that were smoke-free compared with

those households where the mother was interviewed before giving

birth (96% vs 89%, p=0.001).

Smoke-free home status was significantly associated with

parents’ smoking status. Compared to homes with non-smoking

parents, the risk ratio of smoking occurring inside their home was

3.7, 95%CI 1.8-7.3 (p<0.001) for homes with a parent smoking,

and 8.1, 95%CI 3.7-17.4, (p<0.001) for homes with both parents

smoking, after adjusting for household income and maternal

education level using log-binomial regression.

High rates of partners’ smoking after the birth of a child are of

concern. Because the smoking status of a mother’s partner is a

significant predictor of continued smoking by the mother during

her pregnancy,4 maternal smoking intervention programs must

look into their partner's smoking status.

Table 1: Parents’ smoking status and smoke-free home status before and after the birth of child as reported by first-time mothers in south-west Sydney.

Variables Before giving birth After giving birth Pb n=409 n=258 na (%) na (%)

Maternal smoking 0.36

Yes 68 (17) 36 (14)

No 338 (83) 220 (86)

Partner smoking 0.69

Yes 143 (36) 94 (37)

No 260 (64) 160 (63)

Both parents smoking 0.62

Yes 46 (11) 24 (9)

No 363 (89) 234 (91)

Smoke-free home 0.001

Yes 363 (89) 249 (96) No 45 (11) 9 (4)

Notes: a) May not add to 409 or 258 due to missing data b) chi-squared test

Letter