Cornelia Blank, University for Health Sciences, Medical Informatics and Technology, Austria

Efforts to protect athletes’ health and integrity must consider doping and its prevention. Accordingly, doping prevention is given high priority by 35 international federations questioned [1]. Considering the definition of prevention in a public health context, the focus is set on identifying risk factors and then minimizing these risk factors to decrease the incidence of an illness. In this regard, no matter if we consider doping as an illness or if we consider negative health effects of doping whose incidence we aim to decrease, the perspective is risk-factor based and identifying these was focus of most of the research in doping prevention over the last 10 years [2-3].

However, I would like to designate several boundaries of the perspective and current doping prevention research. One generally recognized criticism lies in the micro-level focus of this research, which is mainly athlete-centred and analyses doping behaviour as an intentional and volitional decision-making process. Summarizing findings from the latest FIFA 2013 consensus meeting [4] and recommendations of Backhouse et al. [5], future efforts in doping prevention should also include a) sport specific risk assessment, b) data management, c) longitudinal approaches researching doping decision-making processes, and d) a multinational focus that includes potential cultural differences.

In line with this, Stewart and Smith [6] emphasize the need to acknowledge the impact of community cultures and practices on athletes. Doping can be understood on an individual cognitive level, but the contextual-organizational level must not be ignored [7]. In summary, social ecological theory dictates that in addition to personal intrinsic factors, attitudes and behaviours could be driven by environmental influences, formed in a defined context, where situational factors, social agents and the system might play an important role.

Protective factors to doping

The single focus on risk factors can be considered another criticism regarding doping prevention efforts. Like the health promotion focus that aims to increase protective factors keeping people healthy even when facing risk factors, doping prevention might benefit from a perspective shift involving protective factors that keep athletes from doping. Even though research on protective factors is comparably scarce, findings indicate that reasons to dope are quite different from reasons not to dope [8-10]. Thus, effective prevention should target both, risk factors (to be decreased) and protective factors (to be increased).

A third criticism relates the prevention strategies currently employed by the responsible authorities. Current evidence suggests that the links between socio-cognitive variables and doping behaviour are weak [2-3], indicating a limited chance of success. Yet, many prevention programs aim at inducing change in exactly those variables or claim to address these but actually, only convey information about the prohibited list.

Lastly, aspects of national culture such as individualism, collectivism, or the amount of accepted power distance [11-12] can also affect doping vulnerability, and are included in neither risk nor protective perception approaches yet. This leads back to the call from Backhouse et al. [5] to perform multinational and multidisciplinary studies. There is a need for integrating different disciplines as well as past, current and future research findings to identify possible patterns.

In our opinion, systematic, long-term data aggregation that allows analysis of potential patterns and dynamic processes combining individual characteristics, social agents and the sporting system might not only indicate system- or culture-specific differences in doping prevention approaches, but also point out its effects on athletes’ characteristics within these systems. Our “Doping Prevention Monitoring Program (DPMP)” project, funded by the International Olympic Committee, aims to develop such a tool for long-term data aggregation. In view of the issues addressed before, we think that a significant strength of the project is the multidisciplinary approach realized with expert meetings to discuss development and implementation of this tool. Coming together for the first time in June 2017, the experts agreed on the specific goals to develop an instrument to measure indicators relevant to preventing doping behaviour and to indicate effects of doping prevention strategies on those indicators.

Results of the expert meeting comprise the necessity to include not only markers indicating risk factors to dope but also protective factors not do dope. Another common agreement of the experts was that it seems unlikely that variables or constructs that reflect values (i.e. attitudes, norms etc.) would be sensitive enough to pick up changes of current doping prevention strategies as these do not really target them; hence they have been excluded. However, based on theoretical considerations focusing on behavioural change models, it was decided to include other, new aspects such as legitimacy, trust and the advocacy of doping prevention messages and to evaluate potential effects of nation-specific doping prevention on these. Lastly, as most current prevention strategies are knowledge-centred, knowledge (perceived and objective) is a variable to be included in the instrument as well.

Identifying doping prevention measures that are effective

The long-term goal is to implement this instrument at all Youth Olympic Games to receive data over time to get the possibility to detect patterns and changes in doping prevention strategies and its impacts on the specific markers identified with questioning adolescent athletes and their support staff. The aim is a very competitive one; however, we believe it is a first step towards integrating past, current and future work on doping prevention strategies.

Summarizing, there is massive evidence in different fields and disciplines that provides ideas about the understanding of why athletes dope (and do not dope). However, one key-message of the last INDR conference was that there is no one-size-fits all solution for all sports, nations and athletes, which I completely support. Findings of this project might allow us to identify doping prevention measures that are effective as well as efficient for specific contexts.

I want to emphasize that efficiency and effectivity in the context of this project is not aimed at doping behaviour as surrogate endpoint but rather at surrogate markers that have the potential to prevent athletes from doping. These are markers that we know (or at least think) decrease athletes’ susceptibility to doping. In this context, the project might help to dilute the focus on the connotative term of “doping prevention” and change the perspective more towards personality development and strengthening protective factors in adolescent athletes. If doping is really just a coping strategy to react to pressure or situational temptations, there might be the need to shift the focus of doping prevention to a new angle. This could include providing athletes with the support they need within the specific context they are embedded.

In conclusion, facilitating an environment helping our athletes to become aware of the temptation within their specific context, to be able to make informed decisions within their specific context and to be able to deal with pressure points within their specific context might call for a new road to doping prevention.

References

1. Mountjoy M, Junge A: The role of International Sport Federations in the protection of the athlete's health and promotion of sport for health of the general population. British Journal of Sports Medicine. 2013 Nov; 47(16):1023-7.
2. Ntoumanis N, Ng JY, Barkoukis V, Backhouse S: Personal and psychosocial predictors of doping use in physical activity settings: a meta-analysis. Sports Medicine. 2014;44(11):1603-24.
3. Blank C, Kopp M, Niedermeier M, Schnitzer M, Schobersberger W: Predicting doping intentions, susceptibility, and behaviour of elite athletes – a critical meta-analytic review of the current literature. SpringerPlus. 2016;5:1333.
4. Dvorak J, Baume N, Botre F, Broseus J, Budgett R, Frey WO, et al.: Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015. British Journal of Sports Medicine. 2014;48(10):801-6.
5. Backhouse S, McKenna J, Robinson S, Atkin A. International Literature Review: Attitudes, Behaviours, Knowledge and Education - Drugs in Sport: Past, Present and Future. Montreal: World Anti-Doping Agency, 2007.
6. Stewart B, Smith ACT: Drug Use in Sport. Impliacations for Public Policy. Journal of Sport & Social Issues. 2008;32(3):278-98.
7. Copeland R, Potwarka LR: Individual and contextual factors in ethical decision making: A case study of the most significant doping scandal in Canadian university sports history. Sport Management Review. 2016;19(1):61-8.
8. Erickson K, McKenna J, Backhouse S: A qualitative analysis of the factors that protect athletes against doping in sport. Psychology of Sport and Exercise. 2015; 16 (2): 149-155.
9. Overbye M, Knudsen ML, Pfister G: To dope or not to dope: elite athletes’ perception of doping deterrents and incentives. Performance Enhancement and Health. 2013; 2:119-134.
10. Petroczi A, Norman P, Brueckner S:  Can we better integrate the role of anti-doping in sports and society? A psychological approach to contemporary value-based prevention. IN O Rabin, Y Pitsiladis (eds): Acute Topics in Anti-Doping, Medicine and Sport Science. 2017;62:160-176.
11. Hofstede G. Culture’s consequences: International differences in work-related values. Beverly Hills, CA: Sage; 1980.
12. Hofstede G. Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations. 2nd ed. Thousand Oaks, CA: Sage; 2001.