Programs that Work
Athletes Training and Learning to Avoid Steroids (ATLAS)
Healthy and Safe Children
Youths not using alcohol, tobacco, or illegal drugs
Age of Child
Type of Setting
Type of Service
Type of Outcome Addressed
Substance Use and Dependence
Evidence Level (What does this mean?)
Athletes Training and Learning to Avoid Steroids (ATLAS) is a drug prevention and health promotion program designed for male high school athletes. The program, which began in 1994, aims to reduce risk factors for steroid use, alcohol, and other drugs, and to promote healthy nutrition and exercise behaviors among youth. The ATLAS program addresses a variety of potential risk factors related to steroid use and substance abuse. These risk factors include social influences (such as peers, coaches, media), the perceived positive benefits of steroid use, misperceptions about the actual extent of steroid use among peers, lack of information about the negative effects of steroid use, and beliefs that one is not vulnerable to adverse effects.
The ten-week program initially was used with high school football players and currently is used with male athletes participating in a variety of sports. Within a team-based setting, coaching staff and peer leaders present the ATLAS curriculum using a hands-on, interactive approach. Program components include classroom-based educational sessions, weight-room exercise sessions, and an evening session for parents. Since ATLAS first was used, annual "booster" sessions have been added to help maintain early program gains and address risk factors not changed during the program's first year.
The ATLAS program initially was used and studied with male football players at 31 high schools in 12 cities in Washington and Oregon. The average age of these students was 15 to 16 years. Most were from middle-class backgrounds. Approximately 80 percent of study participants were white, with the remainder from African-American, Hispanic, Asian, and other ethnic backgrounds.
Thirty-one high school football teams composed of more than 3,200 athletes were studied in three successive annual cohorts (1994–1996: Year 1, Year2, and Year 3). These schools were assigned randomly either to participate in the program or to not participate, after first being matched on several demographic characteristics, including the following: school size, socio-economic status, participation in a free-lunch program, win-loss record of the school’s football team, school-wide attendance, and number of students attending college. Non-participants tended to come from families with somewhat higher incomes and educational levels; however, no analysis was done to discover why this might be the case.
Each of the 2,516 football players across the three cohorts was assigned to one of the two groups (the decrease from the original 3,200 students who were enrolled is due to regular, anticipated attrition throughout the football season): 1,145 attended schools assigned to receive the ATLAS program, and 1,371 students attended schools assigned to the comparison group and received only an anti-steroid informational pamphlet. Year 1 included players from Grades 9 through 12; Years 2 and 3 included players from all these grades but consisted primarily of ninth and tenth graders.
Participants in both the program schools and comparison schools completed self-report questionnaires at three points during the study: just prior to the first program session, immediately after the last program session (about ten weeks later), and approximately nine to ten months following program completion (one-year follow-up data is available for Year 1 and Year 2 cohorts and results are combined in the long-term follow-up assessment). Questionnaires assessed steroid, alcohol, and other drug use, risk factors for steroid and other substance use, knowledge/attitudes concerning steroids, sports nutrition and exercise knowledge/behaviors, and intentions to use steroids. Of the original 2,516 participants assessed during the preseason, 78.5 percent were present at the seasons’ end.
Key Evaluation Findings
All phases of the evaluation conducted by Goldberg, et al. (2000) found that compared with non-participants immediately after program participation and nine to ten months later, ATLAS participants:
- Reported significantly less intent to use steroids.
- Reported significantly improved sports nutrition behaviors and significantly greater use of school facilities rather than private gyms – significant, in that young athletes have been shown to have greater vulnerability to influences that encourage usage of steroids and other performance-enhancement products within the private-gym context.
- Demonstrated greater knowledge about the consequences of steroid and alcohol use, nutritional supplements, and exercise.
- Were significantly more likely to believe that their coaches were less tolerant of steroid use and had significantly greater belief in their team and peers as trusted sources of information about drugs.
- Were significantly more skeptical of media advertisements for muscle-building products.
- Had significantly greater feelings of athletic competence, ability to strength train, and ability to refuse steroids and other offers of drugs, and had increased self-esteem.
- Were significantly more likely to believe in the potential risks associated with steroid use and felt more personally vulnerable to negative effects of steroid use.
- Among those athletes who had never used alcohol or drugs, ATLAS participants were more likely to remain alcohol and drug-free at one year after completion of the program.
Compared with non-participants immediately after, and nine to ten months after, program participation, Goldberg, et al. (1996a) found that ATLAS participants reported:
- No significant decrease in actual steroid usage.
Male high school and community athletic teams.
The ATLAS program and its evaluation were funded by the National Institute on Drug Abuse.
- The ATLAS program takes place in a team setting with peers who share common goals and with coaches who have significant contact time and influence with students.
- The program is implemented during the football season (or other sports season) because this is the period during which students tend to be at greatest risk for steroid usage.
- Periodic "booster" sessions help to make the information offered in the intervention a more-integrated part of the participants’ knowledge base and behavior.
- Parents are involved in prevention efforts.
The ATLAS program is composed of a three-pronged curriculum consisting of classroom-based education, weight-room skill training, and an informational session for parents.
- Classroom Education — Led by peer leaders and coaching staff, a series of ten 45-minute educational sessions is presented that addresses sports nutrition, strength training, and the effects of steroid use and associated risk factors. Participants practice skills for refusing steroid offers by taking part in role-playing exercises, and reviewing bodybuilding magazines to learn about media portrayals of steroid use and potential negative side effects of using steroids and other performance-enhancement products.
- Weight Room Exercises — Participants are provided with printed guides that focus on sports nutrition guidelines and recommendations, and a weight-training booklet that describes strength-training techniques and flexible workout plans designed to be incorporated into any team’s exercise regime. In addition, the importance of working out as a team is emphasized and group-training sessions are implemented. (Note: In the original model of the program, weight-room sessions were presented at school gyms that were designed to help reinforce the classroom curriculum and demonstrate weight-lifting techniques.)
- Parental Involvement - Parents and guardians of participating students receive a family sports nutrition booklet, which contains information about food shopping and sports nutrition menus. Parents are asked to participate in a voluntary evening informational session that focuses on program goals and content and includes a question-and-answer session.
In the original program presentation, coaching staff received a one-day in-service training and curriculum guide with specific lesson plans. Program staff trained peer leaders during a four- to six-hour training session. Each coach and peer leader received curriculum manuals, lesson plans, and activities to use in the classroom. Today, coaches typically are trained using an instructor's manual included in the curriculum package. The package also includes materials for training peer leaders.
Issues to Consider
This program received a "promising" rating. The program was evaluated according to rigorous standards, and included an experimental-control design and a large sample size. The study team was able to follow up with 78.8 percent of the original study population. The evaluations yielded strong, quantifiable, and scientifically credible evidence of a reduction of risk factors associated with steroid usage. The program significantly reduced alcohol and other illicit drug use, and driving under the influence. However, the program was not able to show significant and sizeable changes in the actual use of steroids. While there was evidence of a change in cumulative steroid use in the desired direction, the change was not statistically significant and the effect size was small. This may be related to the fact that an extremely low percentage of young men used steroids at the start of the program/study.
Of the total study population, only 1 to 3 percent of the population indicated any steroid usage at baseline, and less than 1 percent initiated steroid use in the follow-up period. Even if the program eradicated a large portion of this usage, it would be unlikely that such a small change would be statistically significant given the sample sizes in the study. As a result, although the program was quite effective in having an impact on attitudes and risk factors, the evaluation was not able to demonstrate how or if these changes are translated into an actual shift in steroid use.
ATLAS researchers extended their study by examining how treatment outcomes varied by baseline characteristics (Fritz et al., 2005), and found that those participants that knew less about the effects of steroid use were more likely to benefit from the intervention, that is, to learn more about the harmful effects of steroids. Likewise, those participants with higher intentions to use steroids were more likely to see a decrease in their intentions to use steroids following the intervention.
In addition to the identified benchmark, the ATLAS program has been shown to generate improvements in participants’ self-esteem, peer relationships, and general health practices. These accomplishments are as much a focus and benefit of the intervention as is steroid use determent.
Portland, OR, and Vancouver, WA
For more information about the ATLAS program and its research, contact:
Linn Goldberg, M.D., FACSM
ATLAS Anabolic Steroid Prevention Program
Oregon Health Sciences University
Mail Code: CR-110
3181 SW Sam Jackson Park Rd.
Portland, OR 97201-3098
A curriculum package is available from Sunburst Communications, Inc. This package consists of an instructor's manual with background information, a 90-minute session for training peer leaders, and the ten-session curriculum. An athlete's pack also is available and includes three booklets: a workbook for the ten program sessions, a training guide, and a sports menu.
To order the ATLAS curriculum, contact:
Sunburst Communications, Inc.
101 Castleton Street
Pleasantville, NY 10570
Goldberg, Linn, David McKinnon, Diane Elliot, et al.,
The Adolescents Training and Learning to Avoid Steroids Program: Preventing Drug Use and Promoting Health Behaviors
Archives of Pediatric and Adolescent Medicine, 2000., Vol. 154, pp. 332-338.
Goldberg, Linn, Diane Elliot, Greg Clarke, et al., Effects of a Multidimensional Anabolic Steroid Prevention Intervention: The Adolescent Training and Learning to Avoid Steroids (ATLAS) Program Journal of the American Medical Association, 1996a., Vol. 276, pp. 1555-1563.
Goldberg, Linn, Diane Elliott, Greg Clarke, et al., The Adolescents Training and Learning to Avoid Steroids (ATLAS) Prevention Program: Background and Results of a Model Intervention Archives of Pediatric and Adolescent Medicine, 1996b., Vol. 150, pp. 713-721.