ADOPCIÓN DE UNA LEY MARCO
3.1.3 DISEñO DE UN PROCESO PARTICIPATIVO PARA LA ELABORACIÓN DE LEYES
3.1 Chapter overview
This chapter provides an overview of the current literature on AAS use in relation to the information and support that AAS-users access and want. The main section of this chapter is in the form of a Scoping Review published as part of this study (Harvey et al. 2019), which includes the PRISMA diagram, inclusion and exclusion criteria and databases searched (Section 2). However, due to word limitations of the published paper there are several relevant elements relating to the review process that are addressed in this preamble. The chapter ends with a redefining of the aims and objectives of this thesis based on the findings of the literature (Section 3).
Chapter 3 Section 1
3.2 Introduction
The word restrictions for the published paper did not allow for detailed
information on either the research strategy or data extraction. These are included later in this section. This chapter begins by addressing a key challenge faced by the researcher when searching the literature, that of inconsistencies in the terminology.
3.3 The search strategy
Inconsistencies in terminology
3.3.1
Inconsistency of terminology was a challenge when trying to identify literature relevant to this study. This first came to light through a review of the search strategies of a number of recent literature reviews. Several recent reviews covering different aspects of AAS use (2011 to 2018) did not give details of the search terms used. Those that did focussed on a small number of key words e.g. ‘anabolic steroid’, ‘performance enhancing drug’/“anabol*”, “steroid*,” and “doping” (Sagoe, Andreassen, et al. 2014, Sagoe, Molde, et al. 2014), whereas other reviews used a narrower lens e.g. Anabolic Androgenic Steroid (Frati et al. 2015) or ‘anabolic OR androgenic OR AAS’ (Christou et al. 2017). Other authors
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included brand names (Brennan et al. 2017) and others a completely different set of terms e.g. ‘prohormones’, ‘designer steroids’, ‘testosterone boosters’, and ‘legal steroids’ (Rahnema et al. 2015). The terminology also differed by country, for example, Australia uses PIEDS, the UK, IPEDs. Table 3-1 highlights some of the numerous different terms (and acronyms) that could include non-prescribed use of AAS in the literature.Table 3-1 Terminology to describe steroid use
Terminology Associated
acronyms
Appearance or image enhancing drugs or substances APEDs Performance or muscle enhancing drugs or substances PEDs, PESs Performance and image/appearance enhancing
drugs\agents
IPEDs, PIEDs, PEAs Anabolic steroids, Androgenic Anabolic Steroids,
Androgenic-Anabolic Steroids
AS, AAS
Ergogenic aids/substances/drugs, UES, EDs
Synthetic testosterone, testosterone boosters, synthetic steroids
Muscle developing drugs or substances Designer drugs, prohormones
Doping (agents) Black market steroid
Non-prescription steroid use, non-medical steroid use Brand names e.g. Trenbolone
Terms such as IPED (Brennan et al. 2017), PES (Karazsia et al. 2013), PIEDs (Griffiths et al. 2017) and APEDs (Nieuwoudt et al. 2015) are a ‘catch all’ to encompass all types of drugs that act on performance enhancement and can include HGH, nutritional supplements and AAS. The word ‘doping’ proves challenging as this word is normally associated with drug use in competitive sports; however, it appears to be used for studies that include recreational AAS use e.g. Sagoe and colleagues (2014, 2015) reviews. Additionally, the terms ‘drugs’ and ‘substances’ are often used interchangeably, and the terms
‘supplements’ or ‘agents’ are also widely used in the literature. The wide variation of terms used to describe this type of substance use means that searching the literature for the specifics of AAS use is fraught and could lead to confusion regarding motivations, effects and even risks of use. This could in part be due to the nature of the research as the people who use these substances do take a
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range and combination of substances, which may make it a challenge forresearchers to get a clear picture of used substances.
Development of the search strategy
3.3.2
The search strategy is briefly outlined in the following paper but again word limitations meant that some process details were not reported, so are addressed here for completeness. The search strategy followed an adapted PICO (Fineout- Overholt and Johnston 2005), as comparison was not relevant to the questions (Appendix 2). The wide variation of terms to describe AAS could have led to key studies being omitted, as the term ‘IPED’ is often used when covering a wider variety of substances than just steroids such as HGH and creatine. Therefore, in order to develop an effective search strategy, key words and number of word groupings were tested (Appendix 3) with expert support from Bournemouth University library staff to select articles on AAS. These terms were drawn together from the terms used in the recent reviews and publications in the UK public health arena. This was followed by an analysis of key words contained in the title, abstract and the index terms used to describe the article in order to broaden search terms. Searches of terms such as ‘anabolic androgenic steroids’, ‘image and performance enhancing drugs’ and associated acronyms (not including the brand names of specific AAS) were combined with the terms ‘support’ and ‘information’, and associated synonyms (Appendix 2). To try to minimise the risks of missing out key literature, several variations of search terms were trialled using a Boolean search strategy and checked through inverse searching to try to throw the net as wide as possible. Initially, the word ‘doping’ had been excluded as it is normally associated with drug use in competitive sports however, it was
reincorporated on the basis of Sagoe and colleagues (2014, 2014) reviews (section 1.31). Due to the number of articles selected, articles were excluded in the search strategy using NOT “animal* OR mice OR rats OR "guinea pig*" OR spectrometry OR bovine” to exclude non-relevant topic areas. The initial literature search was carried out in July 2017 to inform the development of the questionnaire and updated in June 2018.
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3.4 Data extraction
The data extraction process is reported in the following paper, however, it should be noted that customised data extraction forms were designed (Appendix 4) to extract key data on information on support and advice, population, substance use, study aims, recruitment methods, methodology and demographics. To help ensure the quality and consistency of the data extraction process, the data extraction sheet was piloted and the supervisory team reviewed a proportion of articles (Chapter 3, 2).
Data extraction also posed several challenges. It was difficult to ascertain which studies included AAS-users who were using for purely recreational purposes, as bodybuilding can be done competitively but is also a term used for working out to increase muscle size. Terms such as bodybuilding were often used indiscriminately to refer to either competitive or recreational motivations. The lack of granularity when related to types of AAS-user added to the lack of clarity as, although some studies included only competitors or athletes, others used the term athletes, yet also incorporated recreational use and others did not report type of use.
3.5 Quality assessment
Due to the different types of source articles, three quality assessment tools were used. The critical appraisal skills tool checklist (Public Health Resource Unit 2006) was applied to the qualitative articles. For the quantitative studies, which were a mix of methodologies, a tool was adapted from Davids and Roman (2014): Quantitative Review Methodology (Appendix 5). To assess the quality of the report, the quantitative and qualitative elements were individually assessed using the chosen assessment tools, then the criteria from the mixed-methods section of the Mixed-Methods Appraisal Tool (Pluye et al. 2011) was used, to assign an overall quality score. Only studies scoring ** or above were included ( Appendix 6). No studies were excluded based on quality.
3.6 Literature review
The next section is the scoping literature view exploring information and support accessed and wanted, and is in the form of a published paper (Harvey et al. 2019).