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Intervention Summary

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ATLAS (Athletes Training and Learning To Avoid Steroids)

Athletes Training and Learning To Avoid Steroids (ATLAS) is a school-based drug prevention program. ATLAS was designed for male high school athletes to deter drug use and promote healthy nutrition and exercise as alternatives to drugs. The curriculum consists of 10 45-minute interactive classroom sessions and 3 exercise training sessions facilitated by peer educators, coaches, and strength trainers. Program content includes (1) discussion of sports nutrition; (2) exercise alternatives to anabolic steroids and sports supplements; and (3) the effects of substance abuse in sports, drug refusal role-playing, and the creation of health promotion messages.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: February 2007
1: Intent to use anabolic steroids
2: Anabolic steroid use
3: Alcohol and other illicit drug use
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
Genders Male
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History ATLAS has been implemented in more than 275 sites in 43 States, Washington, DC, and Puerto Rico and has reached approximately 35,000 students.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations ATLAS materials have been translated into Spanish.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective

Quality of Research
Review Date: February 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Goldberg, L., MacKinnon, D. P., Elliot, D. L., Moe, E. L., Clarke, G., & Cheong, J. (2000). The Adolescents Training and Learning to Avoid Steroids Program: Preventing drug use and promoting health behaviors. Archives of Pediatrics and Adolescent Medicine, 154, 332-338.  Pub Med icon

Supplementary Materials

Athlete Pack, including sports menu, training guide, and 10-session curriculum workbook

Coach/Instructor Package, including background information, squad leader guide, 10-session curriculum guide, and overheads

Fidelity Rating Form

Fritz, M. S., MacKinnon, D. P., Williams, J., Goldberg, L., Moe, E. L., & Elliot, D. L. (2005). Analysis of baseline by treatment interactions in a drug prevention and health promotion program for high school male athletes. Addictive Behaviors, 30, 1001-1005.  Pub Med icon

Goldberg, L., Elliot, D., Clarke, G. N., MacKinnon, D. P., Moe, E., Zoref, L., et al. (1996). Effects of a multidimensional anabolic steroid prevention intervention. The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program. Journal of the American Medical Association, 276(19), 1555-1562.  Pub Med icon

Goldberg, L., Elliot, D. L., Clarke, G. N., MacKinnon, D. P., Zoref, L., Moe, E., et al. (1996). The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention program. Background and results of a model intervention. Archives of Pediatrics and Adolescent Medicine, 150, 713-721.  Pub Med icon

MacKinnon, D. P., Goldberg, L., Clarke, G. N., Elliot, D. L., Cheong, J., Lapin, A., et al. (2001). Mediating mechanisms in a program to reduce intentions to use anabolic steroids and improve exercise self-efficacy and dietary behavior. Prevention Science, 2(1), 15-28.  Pub Med icon

Outcomes

Outcome 1: Intent to use anabolic steroids
Description of Measures Intent to use anabolic steroids was measured by a self-report instrument using primarily 5- to 7-point agreement scales.
Key Findings Athletes participating in ATLAS were compared with athletes who were given commercially produced materials that emphasized the adverse effects of anabolic steroids and the benefits of a sports nutrition diet. Athletes in the ATLAS group were less likely than those in the comparison group to say they intended to use anabolic steroids, both at the end of the football season (p < .05) and at 1-year follow-up (p < .03).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 2: Anabolic steroid use
Description of Measures Anabolic steroid use was measured by a self-report instrument primarily using 5- to 7-point agreement scales.
Key Findings Athletes participating in ATLAS were compared with athletes who were given commercially produced materials that emphasized the adverse effects of anabolic steroids and the benefits of a sports nutrition diet. At the end of the football season, 7 new anabolic steroid users were reported in the ATLAS group, while 18 were reported in the comparison group (p < .04).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 3: Alcohol and other illicit drug use
Description of Measures Alcohol and other illicit drug use (marijuana, amphetamines, and narcotics) were measured by a self-report instrument primarily using 5- to 7-point agreement scales.
Key Findings Athletes participating in ATLAS were compared with athletes who were given commercially produced materials that emphasized the adverse effects of anabolic steroids and the benefits of a sports nutrition diet. Compared with athletes in the comparison group, athletes in the ATLAS group typically reported lower use of alcohol and illicit drugs, both at the end of the football season (p = .009) and at 1-year follow-up (p < .04).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.0 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 100% Male 79% White
7.4% Race/ethnicity unspecified
5.4% Black or African American
3.7% Asian
3.7% Hispanic or Latino
0.8% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Intent to use anabolic steroids 2.7 2.5 3.3 3.0 2.6 3.2 2.9
2: Anabolic steroid use 3.0 3.0 3.3 3.0 2.0 3.2 2.9
3: Alcohol and other illicit drug use 3.0 3.2 3.3 3.0 2.6 3.2 3.0

Study Strengths

The psychometric properties of the alcohol and drug use outcome measures, which were based on the Monitoring the Future survey, have been established by independent investigators. Intervention fidelity is clearly a strength of ATLAS. The investigators endeavored to assure fidelity by providing highly scripted materials and observing classroom sessions to confirm coach and peer-leader adherence to the protocol. Attrition among students was not unreasonably high given the relatively high student turnover (78.9% from preseason to postseason). Follow-up rates were impressive (68.7% for cohorts 1 and 2 at 1-year follow-up). There was no attrition among schools. Everyone who completed the program appears to have provided complete data. The longitudinal evaluation used a quasi-experimental design in which the schools were matched in dyads based on salient demographics, including school size, family socioeconomics, and the football team's prior win-loss record. The convergence of findings across studies and cohorts strongly supports the conclusion that ATLAS led to positive changes in participants' intentions to use anabolic steroids and reductions in their use of anabolic steroids, alcohol, and drugs. There was some evidence that the analyses may be appropriate to support outcomes seen in the short-term and 1-year follow-ups.

Study Weaknesses

More details could have been presented on questionnaire development and psychometric properties regarding anabolic steroid use. Because research staff could identify respondents through codes, students may have responded to the survey based on their awareness of what the experimenter expected to find. The authors noted that "some students who used or were considering using anabolic steroids may have been reluctant to enroll. Alternatively, these students may have enrolled in the study but not admitted to drug use." The methods used to analyze the effects of attrition, and most especially the effects of differential attrition, are unclear. One potential threat to internal validity was the significant baseline differences between the experimental and control groups. There were concerns about the selection of one-tailed rather than two-tailed significance tests, regardless of how promising the pilot data were, and the absence of alpha correction, given the number of separate regressions.

Readiness for Dissemination
Review Date: February 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

ATLAS CD-ROMs (training and implementation)

ATLAS informational DVD

ATLAS program Web site, http://www.atlasprogram.com

Goldberg, L., Elliot, D., & Center for Health Promotion Research. (n.d.). The ATLAS program athlete's guide. Portland, OR: Authors.

Goldberg, L., Elliot, D., & Center for Health Promotion Research. (n.d.). The ATLAS program coach manual. Portland, OR: Authors.

Goldberg, L., Elliot, D., & Center for Health Promotion Research. (n.d.). The ATLAS program squad leader manual. Portland, OR: Authors.

Goldberg, L., Elliot, D., & Center for Health Promotion Research. (n.d.). The ATLAS program team workbook. Portland, OR: Authors.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.8 3.3 3.0 3.3

Dissemination Strengths

Implementation materials include everything a coach might need to put this program into practice, with supplemental materials for teams and athletes that reinforce lessons. Training materials are well organized. Pre- and postintervention tests are included to assess both coaches' and athletes' knowledge gain.

Dissemination Weaknesses

No guidance is provided for interpreting pre/postintervention test data. The materials provide an implementation checklist but do not specify what tools should be used to monitor fidelity.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Coach/Instructor Package (includes Leader Training videos) $280 each Yes
Squad Leader Package $11 each Yes
Athlete Package $11 each Yes
Coach/Instructor Training Varies depending on site needs No
Replications

No replications were identified by the developer.

Contact Information

To learn more about implementation, contact:
Michelle Otis
(503) 418-4166
steinerm@ohsu.edu

To learn more about research, contact:
Linn Goldberg, M.D.
(503) 494-8051
goldberl@ohsu.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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