“I would never go to the doctor and speak about steroids”: Anabolic androgenic steroids, stigma and harm

Background: This investigation explores the concept of stigma related to people who use anabolic-androgenic steroids (PWU-AAS) when accessing healthcare services. Anabolic-androgenic steroids (AAS) are used by subsections of the population and have been associated with various health harms. Responding to associated health risks, within the UK, harm reduction and healthcare service provisions have been established. Although these services provide essential support, various barriers, including stigma, exist which can limit engagement with them. Method: Ten qualitative interviews were conducted with PWU-AAS and have accessed healthcare and harm reduction services related to their use of AAS. Results: PWU-AAS anticipated stigma: (1) when accessing needle and syringe programs; (2) when seeking support from healthcare professionals; and (3) when experiencing specific adverse health implications. Stigma meant PWU-AAS were less likely to engage with healthcare professionals, attend harm reduction services, and were reluctant to disclose specific medial conditions. Conclusions: Interventions and messaging tackling AAS-related stigma ought to be considered for public-facing health and harm reduction services, to better support the needs and requirements of PWU-AAS

“You could try this compound, but it might send you nuts”: how steroid suppliers perceive the underground market and their ‘hybrid’ role within it

Introduction The illicit manufacture and use of image and performance enhancing drugs (IPEDs) have increased. The underground market continues to meet consumer demands amidst evolving cultural narratives around most alluring IPEDs. This qualitative study aimed to provide insights into how IPED suppliers perceive demands within the current market and their roles within it. Methods We interviewed four IPED suppliers in Australia regarding distribution challenges and market changes. Interviews were transcribed and analyzed, with immediate reflective notes taken after each interview. Inductive line-by-line analysis facilitated identification and development of themes. Results Cultural narratives were perceived to influence the demand for several drugs (e.g. trenbolone, dihydroboldenone, fluoxymesterone) due to their perceived desirability and elevated status compared to other compounds. Consumers, who appeared to demonstrate knowledge gaps, were sometimes guided in their consumption practices by IPED suppliers, who drifted into a “hybrid” role of coach-supplier. Discussion IPED suppliers highlighted a perceived demand for specific AAS, driven by cultural narratives. Consequently, IPED suppliers assumed a hybrid role whereby they provide advice to the people who purchase IPEDs at point-of-sale. Urgent action is needed to address cultural narratives and provide education and harm reduction to support people who use IPEDs

Characterising differences between self-reported and wastewater-identified drug use at two consecutive years of an Australian music festival.

BackgroundIn the context of drug prohibition, potential adulteration and variable purity pose additional health risks for people who use drugs, with these risks often compounded by the outdoor music festival environment. Ahead of the imminent implementation of drug checking services in Queensland, Australia, this study aims to characterise this problem using triangulated survey and wastewater data to understand self-reported and detected drug use among attendees of a multi-day Queensland-based music festival in 2021 and 2022.MethodsWe administered an in-situ survey focusing on drug use at the festival to two convenience samples of 136 and 140 festival attendees in 2021 and 2022 respectively. We compared survey findings to wastewater collected concurrently from the festival's site-specific wastewater treatment plant, which was analysed using Liquid Chromatography Tandem Mass Spectrometry.ResultsMost survey respondents (82 % in 2021, 92 % in 2022) reported using or intending to use an illicit drug at the festival. Some respondents reported potentially risky drug use practices such as using drugs found on the ground (2 % in 2021, 4 % in 2022). Substances detected in wastewater but not surveys include MDEA, mephedrone, methylone, 3-MMC, alpha-D2PV, etizolam, eutylone, and N,N-dimethylpentylone.ConclusionMany substances detected in wastewater but not self-reported in surveys likely represent substitutions or adulterants. These findings highlight the benefits of drug checking services to prevent harms from adulterants and provide education on safer drug use practices. These findings also provide useful information on socio-demographic characteristics and drug use patterns of potential users of Queensland's future drug checking service

Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums

Abstract Background There is good evidence to suggest that performance and image enhancing drug (PIED) use is increasing in Australia and that there is an increase in those using PIEDs who have never used another illicit substance. Peers have always been an important source of information in this group, though the rise of the Internet, and the increased use of Internet forums amongst substance consumers to share harm reduction information, means that PIED users may have access to a large array of views and opinions. The aim of this study was to explore the type of information that PIED users seek and share on these forums. Methods An online search was conducted to identify online forums that discussed PIED use. Three discussion forums were included in this study: aussiegymjunkies.com, bodybuildingforums.com.au, and brotherhoodofpain.com. The primary source of data for this study was the ‘threads’ from the online forums. Threads were thematically analysed for overall content, leading to the identification of themes. Results One hundred thirty-four threads and 1716 individual posts from 450 unique avatars were included in this analysis. Two themes were identified: (1) personal experiences and advice and (2) referral to services and referral to the scientific literature. Conclusions Internet forums are an accessible way for members of the PIED community to seek and share information to reduce the harms associated with PIED use. Forum members show concern for both their own and others’ use and, where they lack information, will recommend seeking information from medical professionals. Anecdotal evidence is given high credence though the findings from the scientific literature are used to support opinions. The engagement of health professionals within forums could prove a useful strategy for engaging with this population to provide harm reduction interventions, particularly as forum members are clearly seeking further reliable information, and peers may act as a conduit between users and the health and medical profession

Communicating aquatic safety to national parks visitors in Queensland, Australia via social media: campaign co-design and pilot evaluation

Background: Social media is a major driver of tourism to aquatic sites in national parks where increased tourist numbers and risky behaviours are leading to injuries and deaths. This study co-designed a social media safety campaign with Queensland National Parks and Wildlife Service (QPWS) to evaluate whether messages reach park visitors and impact behaviours at a known injury hotspot. Methods: Social media posts describing risks in national parks locations popular with social media users were promoted on Instagram and Facebook between January and February 2024. Quantitative analysis of in-person survey data of visitors to Curtis Falls in Tamborine National Park was conducted, as well as analysis of campaign sentiment and metrics. Results: The social media communication campaign was well received by social media users with a high number of engagements with the campaign content including four thousand link clicks, 100+ shares and 254 saves across the communication materials presented. Content analysis of comments on social media revealed that some respondents (20%) felt the tone of the organic content component of the communication campaign was patronising, while others (20%) were pleased to receive messages around safety in national parks. In-person surveys (n=50) showed that 78% of respondents use social media to find places to visit in nature, 74% often or occasionally rely on social media for information or inspiration about their national parks visit with 39% relying on national parks content on social media pages. A third (32%) recalled (prompted) at least one of the communication materials from Instagram. Almost half (48%) considered QPWS safety communications somewhat or very effective on social media. Conclusions: Results suggest that social media may be a useful way to encourage safer behaviours around aquatic hazards in National Parks among social media users. We recommend communicating with social media users more frequently with messages that have been co-designed with end-users. Influencers may also represent a useful avenue to pursue but further research is needed to find the most effective communication strategy

A novel device using the Nordic hamstring exercise to assess eccentric knee flexors strength : a reliability and retrospective injury study

STUDY DESIGN: \ud Reliability and case-control injury study. \ud \ud OBJECTIVES: \ud 1) To determine if a novel device, designed to measure eccentric knee flexors strength via the Nordic hamstring exercise (NHE), displays acceptable test-retest reliability; \ud 2) to determine normative values for eccentric knee flexors strength derived from the device in individuals without a history of hamstring strain injury (HSI) and; \ud 3) to determine if the device could detect weakness in elite athletes with a previous history of unilateral HSI. \ud \ud BACKGROUND: \ud HSIs and reinjuries are the most common cause of lost playing time in a number of sports. Eccentric knee flexors weakness is a major modifiable risk factor for future HSIs, however there is a lack of easily accessible equipment to assess this strength quality. \ud \ud METHODS: \ud Thirty recreationally active males without a history of HSI completed NHEs on the device on 2 separate occasions. Intraclass correlation coefficients (ICCs), typical error (TE), typical error as a co-efficient of variation (%TE), and minimum detectable change at a 95% confidence interval (MDC95) were calculated. Normative strength data were determined using the most reliable measurement. An additional 20 elite athletes with a unilateral history of HSI within the previous 12 months performed NHEs on the device to determine if residual eccentric muscle weakness existed in the previously injured limb. \ud \ud RESULTS: \ud The device displayed high to moderate reliability (ICC = 0.83 to 0.90; TE = 21.7 N to 27.5 N; %TE = 5.8 to 8.5; MDC95 = 76.2 to 60.1 N). Mean±SD normative eccentric flexors strength, based on the uninjured group, was 344.7 ± 61.1 N for the left and 361.2 ± 65.1 N for the right side. The previously injured limbs were 15% weaker than the contralateral uninjured limbs (mean difference = 50.3 N; 95% CI = 25.7 to 74.9N; P < .01), 15% weaker than the normative left limb data (mean difference = 50.0 N; 95% CI = 1.4 to 98.5 N; P = .04) and 18% weaker than the normative right limb data (mean difference = 66.5 N; 95% CI = 18.0 to 115.1 N; P < .01). \ud \ud CONCLUSIONS: \ud The experimental device offers a reliable method to determine eccentric knee flexors strength and strength asymmetry and revealed residual weakness in previously injured elite athletes