Download A study was conducted to determine the prevalence, motives

RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
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DEEPTI TIMUNGPI
M.SC. Nursing 1st Year
Medical Surgical Nursing
Sneha College of Nursing
Bangalore – 560043
RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
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DEEPTI TIMUNGPI
1st Year M.Sc. (Nursing)
SNEHA COLLEGE OF NURSING
NO.97, 5th Main. I stage, I Block, HBR Layout, Bangalore
– 43
SNEHA COLLEGE OF NURSING
M.Sc. Nursing 1st year
MEDICAL SURGICAL NURSING
25.05.2010
“A STUDY TO ASSESS THE EFFECTIVENESS OF
SELF INSTRUCTIONAL MODULE (SIM) ON
KNOWLEDGE REGARDING THE SIDE EFFECTS OF
USING ANABOLIC ANDROGENIC STEROID (AAS)
DRUG AMONG STUDENTS STUDYING IN
SELECTED DEGREE COLLEGES AT BANGALORE”
Brief resume on intended
work
6.1: Need for the study
ENCLOSED
6.2: Review of Literature
ENCLOSED
6.3: Objectives of the study ENCLOSED
6.4: Hypothesis
ENCLOSED
Materials and Methods:
7.1: Sources of Data: Data will be collected from the students studying in
Selected degree colleges in Bangalore.
7.2: Method of Data Collection: Structured questionnaire method
7.3: Does the study require any investigation or intervention to be carried out on
the patients or human or animals?
NO
7.4: Has ethical clearance been obtained?
YES
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
“Drug misuse is not a disease; it is a decision, like the decision to step out in
front of a moving car. You would call that not a disease but an error of judgment” –
Philip K. Dick
The World Drug Report says that the number of users of synthetic drugs –
estimated at around 30 to 40 million people worldwide. Also, it was revealed in the
survey that as much as 479,000 students worldwide or 2.9% of total student population
had used one or other steroid by the last year of high school.1
Drugs commonly referred to as “steroid” are classified as Anabolic (or Anabolic
androgenic) and corticosteroids. Corticosteroids, such as cortisone are drugs that doctors
typically prescribe to help to control inflammation in the body. They are not the same as
the anabolic steroids that receive so much media attention for their use by some athletes
and body builders.2
Anabolic steroids are synthetically produced variants of the naturally occurring
male hormone testosterone. Both males and females have testosterone produced in their
bodies: males in the testes, and females in the ovaries and other tissues. The full name for
this class of drugs is androgenic (promoting masculine characteristics) anabolic (tissue
building) steroids (the class of drugs). Some of the most abused steroids include Deca-
Durabolin® , Durabolin ® , Equipoise® , and Winstrol® . The common street (slang)
names for anabolic steroids include arnolds, gym candy, pumpers, roids, stackers, weight
trainers, and juice.Anabolic steroids are usually taken orally or injected although there is
a gel version which can be rubbed onto the skin. Steroids are dangerous for two reasons:
they are illegal, and they can damage a person's health, especially if used in large doses
over time. Also, the health problems caused by steroids may not appear until years after
the steroids are taken. 3
And around three million Indians are projected victims of different kinds of drug
abuse. It was revealed that rural youth are more vulnerable to drug usage than urban
youth and 73% of drug addicts are between 16 to 35 years. A recent survey had also
indicated that at least 23% of Bangalore University students are using drugs, which also
include the use of anabolic androgenic steroids. These students are irregular and show no
interest in academics. 4
6.1: NEED FOR STUDY
The health risks surrounding steroids heavily out weigh the few benefits. Steroids
are damaging physically and psychologically. Steroids may seem to be the best and
easiest way to enhance your body, but they only work for so long. Once the side effects
start surfacing, the user will have trouble exercising or may not even be able to exercise.
Therefore, everything that they have worked for will go down the drain. And since
steroids are addictive, once the user stops taking them, their body will crave and need
steroids to function. It will take time for the body to be able to function as it once did. 5
Steroid use can result in long term damage to your health and in some cases this
can be fatal. These risks include: Acne and/or oily cysts on the skin, thinning of the hair,
High blood pressure which can lead to a stroke or heart attack, Paranoia and an inability
to sleep, Stunted growth (in adolescents), Risk of infection, damaged veins or ulcers from
shared needles, Shrunken testicles, breast development, erection problems and risk of
prostate cancer in men. Lowered sex drive and reduced sperm output. ‘Masculinisation’
in women. People who take steroids find that they are prone to aggressive behaviour and
violence - even if before taking steroids they were peaceful or mild mannered. This can
happen in both sexes and is known as ‘roid rage’.6
A research report by National Institute on Drugs (NIDA) stated that
steroids when used in high doses, increase irritability and aggression. Some steroid
abusers report that they have committed aggressive acts, such as physical fighting or
armed robbery, theft, vandalism, or burglary. Abusers who have committed aggressive
acts or property crimes generally report that they engage in these behaviors more often
when they take steroids than when they are drug free. A recent study suggests that the
mood and behavioral effects seen during anabolic-androgenic steroid abuse may result
from secondary hormonal changes. 7
Anabolic steroids are available easily these days. Legally, they can be obtained
only through prescription. But youngsters can also get these from their trainers in the
gym. Peer pressure is the beginning to fuel AS abuse among young adult in India. Boys
ape their favorite models and want bulging biceps, a washboard stomach, and six-pack
abs. Girls, on the other hand, take to steroids to get the lean muscular look which is
fashionable these days. 8
A study in India revealed that 25% of the teenagers/young adult used supplements
and other drugs to develop muscles and better body physique. There are students who
admitted that they took illegal supplements or steroids to achieve this goal. Although they
were only composed of 5.5%, this could still become a major concern for the authorities.9
India has yet to ban many of the substances that the overseas market controls have
decided are not safe for public use. There are many cases of steroids and other
performance enhancing drugs all through India from the use of athletes and soldiers to
some of Bollywoods favorite actors. Because steroids are so common in India at the
moment and because they have been for the last ten years then the Indian government
will have to deal with the problems that steroid abuse creates in the long term. This will
mean new facilities will be required to deal with all of the cases. If the legalization of
certain products is stopped the populous stays healthier and this means less government
spending overall. (10)
Steroid abuse is still on the rise, and not just among professional athletes
and bodybuilders, but also among the teenagers and young adult, as the desire to look like
models is fuelling the abuse of anabolic steroids. What most steroid users don’t realize is
that they are placing themselves at risk for something they could achieve on their own.
The best way to improve performance and increase muscle mass is to follow a welldesigned programme that challenges both your body and your mind. No drug can ever do
that. (11)
Through many articles and media I came to know that Steroid abuse is one of the
most prevalent issues in today’s society that is associated with body builders, fitness buff
and professional athletes. Even teens and youths who are not athletes also abuse steroids
in the desire of getting a six-pack body without the knowledge of their side effects which
can be life threatening. Therefore I feel this self instructional module will help the youths
in better understanding of the side effects of AAS that will keep them away from AAS
abuse.
6.2: REVIEW OF LITERATURE:
The review of literature is defined as a broad, comprehensive in depth,
systematic and critical review of scholarly publications, unpublished scholarly print
materials, audiovisual materials and personal communications.
Review of literature is divided into three parts:

Literature related to AAS.

Literature related to side effect of AAS.

Literature related to knowledge of AAS among young adult.
Literature related to AAS:
A study was conducted on the prevalence of AAS abuse among adolescent and
young adults in Poland. 3687 men (48.2%) and women (51.8%), median age 23
(interquartile range 19–20 years) participated in a survey. The result shows that the
prevalence of AAS use was 6.2% among males and 2.9% among females. Male AAS
users, compared to non-users, were more often concerned about their physical
appearance, were less educated and often engaged in some sport activity. Among female
AAS users, no significant differences concerning self-body image satisfaction or
participation in sports were found. However, compared to non-users, female AAS users
were less educated. (12)
A study conducted on future AAS use intentions with current substance use. 214
exercising males (mean age, 30 years; range, 17-61 years) recruited from 5 gymnasia.
The survey contained a structured interview schedule that included questions regarding
licit and illicit substance use, reasons for non-AAS use, and, where appropriate, reasons
for intended future AAS use. The study reveals that 16% of the sample indicated that they
would use AAS in the future. Reasons for future AAS use included increasing muscle
size (80%), improving appearance (74%), and increasing strength (57%). (13)
A study conducted reveals that most of the anabolic drug users are the middle
class heterosexual men, among the 25 years old age group. About 78.4% of steroid users
were non-competitive body builders and non-athletes. It also revealed that generally the
steroid abusers do not trust their physician which leads them to concealing the truth from
them. However about 66% of the abusers were willing to undergo medical study. And
most of the steroid abusers are most likely to suffer from muscle dysmorphia. (14)
A study conducted on the social background and current social situation of male
abusers of anabolic-androgenic steroids (AAS), age group 18 – 45 yrs, from a public
gym. The result shows that histories of a troubled childhood as well as current social
disadvantage were both more frequent among the AAS users. Users also reported poor
relationships with their parents and almost half of them had experienced physical or
mental abuse. Their current circumstance included abuse of other drugs, battering of
spouses and other criminality such as assault, illegal possession of weapons and theft. (15)
Literature related to side effect of AAS:
A study was conducted on the effects of AAS use on serious violent
behavior. Multivariate models based on data from the National Longitudinal Study of
Adolescent Health (N=6823) were used to examine the association between lifetime and
past-year self-reported anabolic-androgenic steroid use and involvement in violent acts.
Compared with individuals who did not use steroids, young adult males who used
anabolic-androgenic steroids reported greater involvement in violent behaviors. (16)
A study conducted on adverse health effects of AAS state that the adverse
side effects of AAS include sexual dysfunction, alterations of the cardiovascular system,
psyche and behavior, and liver toxicity. Occasionally, AAS abuse may be linked to
certain social and psychological traits of the user, like low self-esteem, low selfconfidence, suffered hostility, childhood conduct disorder, and tendency to high-risk
behavior. The overwhelming stereotype about AAS is that these compounds cause
aggressive behavior in males. Use of AAS in combination with alcohol largely increases
the risk of violence and aggression. (17)
A study conducted on long-term AAS use is associated with left ventricular
dysfunction. A comparison of cardiac parameters between weightlifters reporting longterm AAS use and weightlifters without prior AAS exposure participated. The result
shows that AAS users had significantly lower LV ejection fraction (50.6%) than non
users ( 59.1%) , longitudinal strain 16.9% versus 21.0%, and radial strain 38.3% versus
50.1%. Ten of the 12 AAS users showed LV ejection fractions below the accepted limit
of normal (>or=55%). AAS users also demonstrated decreased diastolic function
compared to nonusers as evidenced by a markedly lower early peak tissue velocity and
early-to-late diastolic filling ratio. (18)
Literature related to knowledge of AAS among young adult:
A study was conducted on the knowledge about AAS, the extent, main reasons
and consequences of its use among adolescents and young adult students of three types of
schools: grammar, secondary school and vocational school. 1175 students of both sexes
participated. The results shows that 9.38% males and 2.08% females were abusing AAS
or had abused them. Students from vocational schools had a higher usage rate and more
knowledge of AAS than pupils from the other two types of schools and the main reasons
for using AAS are connected with the will to change their bodies so as to improve
appearance. Over a half of the users had suffered from some side effects of AAS: acne,
hair-loss, sexual disturbances, irritability, voice deepening, depression etc. (19)
A study was conducted to determine the prevalence, motives, and knowledge of
risks of AAS. A confidential questionnaire was completed by 6,930 students. The
prevalence of AAS use was 2.7%, Prevalence was slightly higher in sport participants
than non-participants. The study shows knowledge deficits regarding potential side
effects. Users of AAS were less likely than nonusers to acknowledge the risks of AAS.(20)
A study conducted on knowledge, attitudes and practices of anabolic steroid usage
among gym users in Trinidad. Self-administered questionnaires were completed by 1062
gym-users in 14 gyms in Trinidad, 506 (52.7%) females and 502 (48.3%) males.
Individuals were in the 20 to 29 year age group. The prevalence of AS use was higher
among males than females (p < 0.001). Improvement of physical appearance was the
main reason cited for AS use. Anabolic steroid users knew more about the adverse effects
of AS than non-AS users but the therapeutic uses of AS were comparatively less well
known. This study demonstrated a general lack of knowledge concerning AS use and that
a small but significant proportion of persons using gyms admitted to abusing AS. (21)
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of self instructional module (SIM) on
knowledge regarding the side effects of using anabolic androgenic steroid (AAS) drug
among students studying in selected degree colleges at Bangalore”
6.3: OBJECTIVES OF THE STUDY
The objectives of the studies are:
1. To assess the knowledge of students regarding the side effects of using anabolic
androgenic steroid.
2. To evaluate the effectiveness of self instructional module on side effects of using
anabolic androgenic steroid use by comparing mean pretest and post test
knowledge scores.
3. To determine an association between selected demographic variables with
knowledge scores of students regarding side effects of AAS.
6.4: HYPOTHESIS
H0 – There will not be any significant difference between pretest and post test knowledge
scores on knowledge of side effects of AAS.
H1 – There will be significant difference between pretest and post test knowledge scores
on knowledge of side effects of AAS.
6.5: OPERATIONAL DEFINITION OF TERMS:-
ASSESS:
It is a way of judging the level of knowledge of students regarding side effect of
anabolic androgenic steroid.
EFFECTIVENESS:
Refers to the impact of self instructional module on knowledge of students
regarding side effects of AAS as revealed by statistically significant difference between
pre test and post test.
SELF INSTRUCTIONAL MODULE:
Refers to structured learning material prepared by the investigator regarding the
knowledge of side effects of AAS.
KNOWLEDGE:
Refers to the awareness of students regarding the side effects of AAS measured
by self administered questionnaire scores.
SIDE EFFECT OF ANABOLIC ANDROGENIC STEROID:
It refers to harmful and undesired effect resulting from the use of AAS. It ranges
from some that are physically unattractive to others that are life threatening.
STUDENTS:
A group of learners who are studying in selected degree colleges in Bangalore.
6.6: ASSUMPTIONS:
The study is based on the following assumption:
1. Students may have less knowledge regarding side effect of AAS.
2. Self instruction module regarding side effects of AAS will improve the
knowledge of students.
3. Appropriate knowledge prevents the incidence of AAS use.
6.7: DELIMITATIONS:
The study is delimited to student who are:

Available during the period of study.

Willing to participate in the study.
6.8: SIGNIFICANCE OF THE STUDY:
i.
The study helps to estimate the level of knowledge regarding side
effects of AAS among students of selected degree colleges at
Bangalore.
ii.
Administration of SIM will enhance the knowledge regarding side
effects of AAS among the students of selected degree colleges at
Bangalore.
6.9: CONCEPTUAL FRAMEWORK:
A suitable modified conceptual theory framework will be adopted for the study.
7. MATERIALS & METHOD:
7.1: SOURCE OF DATA:
The data will be collected from students studying in selected degree colleges in
Bangalore.
7.2: METHODS OF DATA COLLECTIONS:
Research method
-
Pre experimental method.
Research design
-
Single group pre test – post test design.
Group
Pre test
Intervention
Post test
Single group
01
X
02
Key:O1 – Pre test: a pre test knowledge of
degree students regarding side effect of
AAS.
X – self instructional module.
O2 – Post test: a post test on knowledge of
degree students regarding side effect of
AAS.
Sample technique
-
Convenient sampling
Population
-
Students studying in selected degree
colleges in Bangalore.
Sample
-
Students of selected degree colleges in
Bangalore who have fulfilled the inclusion
criteria.
Sample size
-
60 students in selected degree colleges in
Bangalore.
Setting of the study
-
The study will be conducted in selected
degree colleges in Bangalore.
Research variable
Dependent variable
-
Knowledge of students regarding side
effects of AAS.
Independent Variable
-
Self instructional module on side effects of
AAS.
7.2.1: CRITERIA FOR SELECTION OF SAMPLES:
INCLUSION CRITERIA:
The study includes students:

Those who are willing to participate in the study.

Those who are studying in selected degree College at Bangalore.

Those who are available at the time of data collection.
EXCLUSION CRITERIA:
The study excludes students:

Those who are not willing to participate.

Those who are not available at the time of data collection.
7.2.2: TOOL OF RESEARCH:
Self administered questionnaire will be developed into two part.
Section A – Demographic Variables
Section B – Questionnaires on knowledge regarding side effect of AAS.
7.2.3: DATA COLLECTIONS:
The investigator distributes self administered questionnaire regarding side effect
of AAS.
7.2.4: METHOD OF DATA ANALYSIS AND PRESENTATION:
i.
Descriptive statistics – It includes mean, median, mode and standard
deviation.
ii.
Inferential statistics – It includes paired t-test, chi square and correlation
co –efficient.
7.3: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENSIONS TO BE CARRIED OUT ON PATIENTS OR OTHER HUMAN
OR ANIMALS?

No.
7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes.
8. LIST OF REFERENCES:
1. Peoples’s Daily Online . UN says drug use shifting towards new drugs,
markets. 2010 June; 17-18;
http://english.peopledaily.com.cn/90001/90777/90856/7041225.html
2. Steven Dowshen. Steroids. 2010 October;
http://kidshealth.org/parent/emotions/behavior/steroids.html#
3. Drug Enforcement Administration, Office of Diversion Control,
Washington, D.C. 20537. A Guide for Understanding the Dangers of
Anabolic Steroids. March 2004;
http://www.deadiversion.usdoj.gov/pubs/brochures/steroids/public/index.h
tml
4. Chitleen K Shethi. Tackling drug menace. The Tribune, Chandigarh,
India. 2010 April;
http://www.tribuneindia.com/2010/20100509/letters.htm
5. Derek Charlebois. Taking steroid: what could it hurt. 2010;
http://www.teenbodybuilding.com/derek4.htm
6. medic8. Anabolic Steroids – Drug addiction.
http://www.medic8.com/drug-addiction/anabolic-steroids.html
7. National Institute of Drug Abuse. Research Report Series - Anabolic
Steroid Abuse. US.
http://www.nida.nih.gov/researchreports/steroids/anabolicsteroids4.html
8. Naveen Rathee. Six pack warning: supplements. India Today Magazine.
Issue 29. 2010 Jan; 29-30
9. Jarred Martin. Young Indians Depend on Anabolic Steroids to Have a
Muscular Body. 2010 July; http://www.steroidsources.com/SteroidInformation/2010/07/young-indians-depend-on-anabolic-steroids-to-havea-muscular-body/
10. Dr Chein. Famous for steroids in India. 2008 Nov.
http://www.steroids.in/category/hgh-and-steroids
11. American Council on Exercise. The Truth about Steroids. 2005;
http://www.fitfaq.com/steroids-truth-article.html
12. Rachoń D, Pokrywka L, Suchecka-Rachoń K. Prevalence and risk factors
of anabolic-androgenic steroids (AAS) abuse among adolescents and
young adults in Poland. Social and Preventive Medicine journal;
51(6);392-398
13. Dunn, Matthew, Mazanov, Jason ,Sitharthan, Gomathi. Predicting Future
Anabolic-Androgenic Steroid Use Intentions With Current Substance Use:
Findings From an Internet-Based Survey. Journal of Sport Medicine:
May 2009;19(3), 222-227
14. Stephen E. Lankenau and Michael C. Clatts. Steroid Use. Journal Urban
Health. 2004 June; 81(2): 232–248
15. Skarberg K, Engstrom I. Substance Abuse Treatment, Prevention, and
Policy 2007.
16. Kevin M. Beaver; Michael G. Vaughn; Matt DeLisi; John Paul Wright.
The effects of AAS use on serious violent behavior. American Journal of
Public Health. 2008; 98(12): 2185-2187.
17. Van Amsterdam J, Opperhuizen A, Hartgens F. Adverse health effects of
AAS. Regul Toxicol Pharmacol. 2010 Jun; 57(1): 117-23.
18. Baggish AL, Weiner RB, Kanayama G, Hudson JI Picard MH Hutter
AM Jr, Pope HG Jr. Long-term AAS use is asso ciated with left ventricular
dysfunction Circ Heart Fail. 2010 Jul 1; 3(4):472-476.
19. K. Sas-Nowosielski. The knowledge about AAS, the extent, main reasons
and consequences of its use among adolescents and young adult students.
Biology of Sport.2006;23(3); 225-235
20. Tanner SM, Miller DW, Alongi C. The prevalence, motives, and
knowledge of risks of AAS. Clin J Sport Med. 1995; 5(2):108-115.
21. Maharaj VR, Dookie T, Mohammed S, Ince S, Marsang BL, Rambocas N,
et. al. Knowledge, attitudes and practices of anabolic steroid usage among
gym users in Trinidad. West Indian Med J. 2000 Mar; 49(1): 55-58
RESEARCH WEB INTERNET:
1. www.pubmed.com
2. www.google.com
3. www.yahoo.com