Pharmacy 2013, 1, 94-106; doi:10.

3390/pharmacy1020094
OPEN ACCESS

pharmacy
ISSN 2226-4787
www.mdpi.com/journal/pharmacy
Article

Exploring Knowledge, Attitudes and Abuse Concerning Doping

in Sport among Syrian Pharmacy Students
Mazen El-Hammadi 1,2,* and Bashar Hunien 2
1
Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Damascus
University, Damascus, Syrian Arab Republic
2 Department of Pharmaceutics, College of Pharmacy, International University for Science and
Technology, Dara’a, Syrian Arab Republic; E-Mail: [email protected]

* Author to whom correspondence should be addressed; E-Mail: [email protected].

Received: 12 August 2013; in revised form: 2 September 2013 / Accepted: 17 September 2013 /
Published: 27 September 2013

Abstract: This study aimed to assess pharmacy students’ knowledge about doping substances
used in sport, explore their attitudes toward doping and investigate their misuse of doping
drugs. A questionnaire was developed and employed to collect data from bachelor of
pharmacy (BPharm) students at the International University for Science and Technology
(IUST). Two-hundred and eighty students participated in this self-administrated, paper-based
survey. Around 90% of the students did not appear to know that narcotics, β-blockers and
diuretics were used in sport as doping agents. Additionally, proportions between 60% and
80% considered vitamins, energy drinks and amino acids as substances that possess
performance-enhancing effects. The main reason for doping, based on students’ response,
was to improve muscular body appearance. The vast majority of students agreed that pharmacists
should play a major role in promoting awareness about risks of doping. While students
showed negative attitudes toward doping, approximately 15% of them, primarily males,
had already tried a doping drug or might do so in the future. More than 60% of the students
believed that sports-mates and friends are the most influential in encouraging them to take a
doping agent. The study highlights the need to provide pharmacy students with advanced
theoretical background and practical training concerning doping. This can be achieved by
adopting simple, but essential, changes to the current curricula.

Keywords: doping; performance-enhancing substances; drug abuse; pharmacy students

Pharmacy 2013, 1 95

1. Introduction

The use of performance-enhancing methods in sport was reported as early as more than two
thousand years ago during the ancient Olympic Games held in 668 BC; a special diet of dried figs was
taken by Charmis, the Spartan winner of the stade race [1]. However, the emergence of doping as a
modern issue first came to prominence in the 1960s when amphetamines were widely used among
professional European cyclists and blamed for causing the tragic death of the English cyclist Tom
Simpson, during the 1967 Tour de France [1].
The sport industry has witnessed a drastic booming in the last few decades progressing from an
amateur era into highly competitive professional business that attracts billions of dollars in investment [2].
The desire to achieve superiority, glory and even wealth seems to be a driving force for athletes to try
legal and illegal performance-enhancing substances and/or methods [3]. Most dangerously, doping is
no longer restricted to elite athletes. Numerous studies have reported the use of doping agents among
young sportspeople in schools, non-competing amateurs and gymnasium clients; for many of whom
body appearance, and not in necessary competing in games, is a priority [4–10]. Estimates reveal that
between 1–3 million Americans [11] and 50,000–100,000 Swedish [12], equate to approximately 1%
of the population of both countries, have misused anabolic steroids. Likewise, it was found that up to
5% of US high-school students had used growth hormone as an anabolic aid [13]. Furthermore, in 2001 it
was estimated that 2.8 million US recreational athletes had tried ephedrine as a stimulating agent [14].
In 1999, the International Olympic Commission (IOC) issued the Olympic Movement Anti-Doping
Code in which doping was defined as “the use of an expedient (substance or method) which is
potentially harmful to athletes’ health and/or capable of enhancing their performance, or the presence
in the athlete’s body of a prohibited substance or evidence of the use thereof or evidence of the use of a
prohibited method.” A list of prohibited substances and methods of doping that are banned by the IOC
is issued and annually updated by the World Anti-Doping Agency (WADA) [15]. Beside well-known
illicit performance-enhancing substances, such as anabolic steroids, growth hormone and stimulants,
the list contains less popular doping agents, e.g., narcotics, diuretics and β-blockers. While narcotics
can reduce the sensation of pain associated with fatigue and serious injuries, diuretics are employed to
decrease an athlete’s weight and prevent detection of banned agents by depleting their concentration in
urine as a result of increased urination [16]. β-blockers, however, are beneficial in particular sports that
require mental concentration such as archery and shooting [15]. Food supplements and products that
have not yet been proved to neither enhance sport performance nor be harmful, e.g., amino acids
(AAs), vitamins and energy drinks, are not included in the WADA list. Although AAs are the
structural units that make up proteins, the major constituents of muscles, there is no evidence that these
supplements have performance-enhancing effects in sport [17]. This also applies to vitamins which are
only needed in limited amounts. Energy drinks that contain stimulant substances such as caffeine,
taurine and ginseng may provide a little, insignificant boost in performance for a very short time [18].
However, it is important to point out that large quantities of the legal substances mentioned above can
carry major health risks, such as dehydration and heart and kidney problems [17,18].
The aims of prohibiting doping in sport are not just to prevent athletes from gaining unfair
competitive advantage, preserve the honesty of sport and fair-play’s principle and set a good example
for many young people who regard sporting heroes as role models to be emulated, but also to protect
Pharmacy 2013, 1 96

athletes’ health against potential hazards of doping [19]. Many illicit performance-enhancing substances,
such as anabolic-adrenergic hormones and stimulants, are notorious for causing life-threatening health
problems including cardiac events [20,21]. Furthermore, several death incidents have been linked to
misuse of doping agents [1,22–24].
Several reports [25–29] have suggested a variety of roles for pharmacists to assist in doping control.
Pharmacists who are drug experts can be a good resource of information to the general public and
athletes on doping substances and associated hazards. Thus, they can help spreading anti-doping
awareness. Additionally, pharmacists can provide counseling to athletes to prevent them from accidentally
taking medical substances that are banned in particular sports. Furthermore, the emerging field of “sports
pharmacy” has highlighted new duties for pharmacists in sports medicine and doping control [28,29].
Sport pharmacists are responsible for dispensing, advising, prescribing and monitoring sport medications
and supplements whether they are intended for therapeutic or performance enhancement reasons.
Pharmacists’ anti-doping roles and responsibilities can be of particular interest in countries where
doping control experts and sports medicine specialists are not commonly found, such as in developing
countries. However, the major concern remains whether pharmacy programs provide adequate
education and training that allow graduates to take over these roles. A French survey [25] concluded
that pharmacists did not have the general knowledge and skills necessary to engage effectively in
doping prevention. Similarly, a study in Slovenia found that 35% of the responding pharmacists had
poor knowledge about doping in sports [26]. A more recent study [27], published whilst the current
work was in the writing up stage, revealed that pharmacy students in Japan did not have opportunities
to learn about doping and supplement intake and that the basic knowledge they had might cause
confusion. Most interestingly, pharmacy students are at an age group to which significant proportions
of doping abusers belong [4–10], hence, some of them might have a personal experience with doping
abuse. Therefore, beside good knowledge about doping it is equally important for pharmacy students,
who are the future pharmacists, to develop proper attitudes that allow them to participate efficiently in
the fight against doping when they become qualified pharmacists. Thus, our aims were to assess Syrian
pharmacy students’ knowledge about doping substances used in sport, explore their attitudes toward
doping and its control and investigate their misuse of doping drugs.

2. Methods

This cross-sectional study was carried out on a group of students enrolled in the College of
Pharmacy at International University for Science and Technology (IUST) during the 2011–2012
academic year. The school of pharmacy at IUST is a relatively new private school which was founded
in 2005. It offers a credit-based system leading to a Bachelor Degree in Pharmacy (BPharm). In 2011,
approximately 1,000 students were enrolled in the pharmacy program. The study was approved by the
Scientific Affairs Council of IUST.

2.1. Questionnaire Development

In order to perform the study, a questionnaire was designed and employed. To develop the
questionnaire 10 randomly selected individuals from the expected study population were invited for
voluntary participation in the questionnaire development. A draft of the questionnaire was constructed
Pharmacy 2013, 1 97

taking into account these individuals’ comments and responses to issues related to doping agents, their
uses and consumption and doping control. For evaluation and clarity purposes, another group of 20
randomly selected pharmacy students was requested to complete the questionnaire and to comment on
any item they did not understand or found confusing/ambiguous. Suggestions from this group were
used to improve the questionnaire.

2.2. Instruments

The questionnaire consisted of five parts (Appendix I). Items in the first part of the questionnaire
gathered personal information on gender, age and year of study. The second part collected data on
students’ knowledge of the concept of doping. This part comprised a list of nine substances known to
be used by athletes and students were asked whether they agree, disagree or not sure if each one of
these substances has a doping or performance-enhancing effect. In the third part, items were designed
as statements to investigate students’ views on reasons for using doping agents. In the fourth part, the
items were formulated to probe students’ attitudes toward consumption of doping agents. The final
(fifth) part was dedicated to explore the use of performance-enhancing drugs among students and the
role that awareness can play in preventing doping abuse. In the third, fourth and fifth parts, a 5-point
Likert scale ranging from strongly disagree (1) to strongly agree (5) was utilized to evaluate students’
responses to items in these parts.

2.3. Data Collection

Data were collected during the second semester in the 2011–2012 academic year. The questionnaires
were distributed to students in laboratory sessions and retrieved immediately after completion. A quota
sampling strategy was used to obtain similar proportions of females and males and of students from
different study years. Completion time was estimated at approximately 10 minutes. Participants were
made aware of the purpose of the study, that their participation was entirely voluntary and that all data
gathered were fully anonymous and to be handled with confidentiality. Questionnaires were distributed
to 350 pharmacy students. Two-hundred eighty students completed the questionnaire, with a response
rate of 80%. Among these individuals, males and females were almost equal (134 males (47.9%)). The
participants from each study year ranged between 37–70 students: 70 (25.0%) first year, 37 (13.2)
second year, 44 (15.7%) third year, 61 (21.8%) fourth year and 68 (24.3%) fifth year. The mean age
was 21.3 ± 2.1, the minimum age 17 and the maximum age 30.

2.4. Statistical Analysis

The Chi-square test was employed to assess the association between independent (gender and study
year) and dependent (responses) variables. The Mann-Whitney U and Kruskal Wallis tests were used
to compare the difference in mean values (ordinal data) in two (gender comparisons) or more (study
year comparisons) independent samples, respectively. The level of statistical significance for all tests
was set at a p value < 0.05.
Pharmacy 2013, 1 98

3. Results

Students’ responses concerning their understanding of doping are displayed in Table 1. More than
two thirds of the students reported that anabolic and growth hormones were used to enhance athletes’
performance. Additionally, slightly more than 50% agreed that stimulants have doping/performance-
enhancing effects. However, approximately 90% of the students did not appear to know that narcotics,
β-blockers and diuretics were used in sport as doping agents. Whereas, remarkable proportions
between nearly 60% and 80% considered vitamins, energy drinks and amino acids (AAs) as substances
that possess performance-enhancing effects.

Table1. Students’ response concerning potential doping/performance-enhancing effects of

several substances used by athletes.
Doping/performance-enhancing effects
Substance
Agree, # (%) Disagree, # (%) Not sure, # (%)
Amino acids (AAs) 218 (77.9) 23 (8.2) 39 (13.9)
Anabolic (masculine) steroids 208 (74.3) 30 (10.7) 42 (15)
Diuretics 30 (10.7) 186 (66.4) 64 (22.9)
Energy drinks 162 (57.9) 60 (21.4) 58 (20.7)
Growth hormone 192 (68.6) 34 (12.1) 54 (19.3)
Narcotics 34 (12.1) 226 (80.7) 20 (7.1)
Stimulants (such as amphetamine) 152 (54.3) 50 (17.9) 78 (27.9)
Vitamins 231 (82.5) 11 (3.9) 38 (13.6)
β-blockers 39 (13.9) 144 (51.4) 97 (34.6)

By comparing responses from study year groups, a significant difference was found only in answers
concerning anabolic steroids (p = 0.002), with greater proportions of students at advanced years giving
correct answers. No statistical difference was found between males and females.
From mean values of students’ responses concerning reasons for doping abuse (Table 2) it can be
stated that the most important reason is “to change body shape and build muscle mass” with
approximately 80% of the students agreed on this. In addition, students affirmed, but to a less extent,
that doping agents may also be used to “enhance performance at local and international sport competitions”
or as “an easy and quick approach to achieve desired physical capabilities.” To “merely imitate the
others” appeared to be the reason least favored by students. Significantly higher mean values were
observed at higher study years when comparing responses to items concerning reasons for doping
abuse including to change body shape (p = 0.003), to enhance sport performance (p = 0.038) and to
pick the easy option (p = 0.034). No statistical differences were observed between males and females.
Pharmacy 2013, 1 99

Table 2. Students’ response concerning reasons suggested for doping abuse.

Strongly Disagree, Neutral, Agree, Strongly
Reason Mean (SD)
disagree, # (%) # (%) # (%) # (%) agree, # (%)
To change body shape and
13 (4.6) 17 (6.1) 32 (11.4) 101 (36.1) 117 (41.8) 4.04 (1.093)
build muscle mass
To enhance performance
at local and international 14 (5) 18 (6.4) 60 (21.4) 132 (47.1) 55 (19.6) 3.71 (1.018)
sport competitions
An easy and quick
approach to achieve
21 (7.5) 48 (17.1) 63 (22.5) 100 (35.7) 47 (16.8) 3.37 (1.171)
desired physical
capabilities
To merely imitate the
41 (14.6) 67 (23.9) 76 (27.1) 63 (22.5) 32 (11.4) 2.92 (1.230)
others

Students’ attitudes toward the use of doping agents are displayed in Table 3. Almost half of the
students either strongly disagreed or disagreed that “taking a doping drug is an ethical deed.” A similar
proportion of the participants did not appear to show respect to individuals who take doping agents.
Interestingly, while approximately three quarters of the students were conscious about the harmful
effects of doping agents on abusers’ health, more than one third either strongly agreed or agreed that
occasional intake of a doping drug is not harmful. Statistical analysis showed no differences in terms
of gender and study year.

Table 3. Students’ response to statements concerning consumption of doping agents.

Strongly disagree, Disagree, Neutral, # Agree, Strongly
Reason Mean (SD)
# (%) # (%) (%) # (%) agree, # (%)
Taking a doping agent is an ethical
68 (24.3) 75 (26.8) 86 (30.7) 43 (15.4) 7 (2.5) 2.45 (1.094)
deed
I respect individuals who take doping
55 (19.6) 86 (30.7) 101 (36.1) 31 (11.1) 6 (2.1) 2.45 (0.998)
agents
Taking a doping agent can harm
5 (1.8) 19 (6.8) 54 (19.3) 100 (35.7) 101 (36.1) 3.98 (0.996)
user’s health
Taking a doping agent for only a
31 (11.1) 71 (25.4) 77 (27.5) 81 (28.9) 19 (6.8) 2.95 (1.124)
short period is not harmful

Table 4 demonstrates students’ response to statements concerning their anti-doping behavior and
the role of awareness in doping control. Most of the students reported they would advise individuals
not to take doping substances. Furthermore, the vast majority of students agreed that proper awareness
about potential adverse effects of doping substances can help minimizing their abuse. They also agreed
that pharmacists should play a major role in promoting doping awareness. No statistical differences
were measured when gender and study year groups were compared.
When students were asked if they had ever taken a prohibited performance-enhancing drug, only 13
(4.6%) admitted they had done so; including 12 males and only one female (p < 0.001). Furthermore,
10% of the students confessed that they might consider taking a doping drug sometime in the future.
Pharmacy 2013, 1 100

Significantly more males (19) than females (4) expressed their potential interest in trying such a
substance (p = 0.001). No statistical difference was found among study year groups.
Students were also asked about the most influential person or factor that would encourage them to
take a performance-enhancing drug and in response 34.9% stated a sports-mate, 28% a friend, 21.5 a
coach, 12.5% media and only 3.9% chose “else.” Statistical tests showed no differences between males
and females and among study year groups.

Table 4. Participants’ anti-doping behaviors and their attitudes toward doping awareness.
Strongly Strongly
Disagree, Neutra, Agree,
Statement disagree, agree, Mean (SD)
# (%) # (%) # (%)
# (%) # (%)
I advise individuals not to take doping
15 (5.4) 26 (9.3) 47 (16.8) 107 (38.4) 84 (30.1) 3.78 (1.133)
substances
Proper awareness concerning adverse effects
of doping substances can help minimizing 2 (0.7) 11 (3.9) 43 (15.4) 141 (50.4) 82 (29.4) 4.04 (0.819)
their abuse
Pharmacists should help promoting
awareness about adverse effects of doping 4 (1.4) 9 (3.2) 26 (9.3) 90 (32.3) 150 (53.4) 4.34 (0.882)
substances

4. Discussion

A major objective of the current study is to shed light on some aspects of a potential role that
pharmacists can play in doping control. Considering this, it is crucially essential for pharmacists to
have an adequate knowledge about medicines used in sport and positive attitudes toward doping and its
prevention, which can to a great extant be acquired and developed at college.
A list of various substances used by athletes was selected with the aim to assess students’
knowledge of the doping concept. Thus, beside well-known performance-enhancing substances, i.e.
anabolic steroids, growth hormone and stimulants, we incorporated less popular banned doping agents
including diuretics, narcotics and β-blockers. Furthermore, a number of non-prohibited substances and
food supplements, i.e. amino acids (AAs), vitamins as well as energy drinks were also included in this
list. Students did not appear to have a comprehensive and clear understanding of doping. While a large
number of students knew that anabolic steroids, growth hormone and stimulants were doping
substances most of them failed to identify the less popular agents, i.e. diuretics, narcotics and
β-blockers. On the other hand, non-doping substances, i.e. AAs, vitamins and energy drinks, were
considered doping agents by a large proportion of the respondents. Furthermore, there was no evidence
that students develop a better knowledge about doping agents as they progress in their course of study.
Throughout the course of a pharmacy program, students may learn about many doping agents and
their biological effects in several curricular courses, such as pharmacology, toxicology, biochemistry
and medicinal chemistry. However, in these courses doping substances are usually studied according to
their respective therapeutic or chemical groups and not in one chapter/module under the title “doping.”
Thus, although students may have some knowledge about general therapeutic uses and adverse effects
of the listed substances they did not seem to know much about the potential abuse of some of these
substances in sports.
In a similar study conducted in Japan [27], the majority of responding pharmacy students claimed to
know what doping was in detail. However, this finding is questionable as remarkable proportions of
Pharmacy 2013, 1 101

the participants did not appear to know that some OTC drugs might contain doping agents and that
supplements were originally foods [27].
The majority of students believed that doping agents were used to change body shape and build a
muscle mass. This may indicate that users of performance-enhancing substances for bodybuilding
purposes exceed those who use them in competitive sports. Most bodybuilders do not participate in
sport contests and may, therefore, have no concerns about doping control tests. As a consequence,
abusers of this group may consider taking unsafe agents, thus exposing their health to serious hazards.
This finding also stresses the fact that doping abuse is not anymore limited to competing athletes.
Similarly, other studies demonstrated that main reasons for the intake of doping drugs were to improve
muscular body appearance and secondarily to enhance performance in sports [4,6,10].
The negative attitude of students toward use of doping agents may be attributed to their perception
concerning the hazardous health effects of doping, beside the illegal and unmerited advantages that
doping offer to athletes in competitions. Likewise, it was revealed that 90% of Japanese pharmacy
students had negative images regarding doping violation [27]. Even so, a relatively considerable
proportion of the students (approximately 15%) either had tried an illegal performance-enhancing drug
in the past or might do so in the future. However, the proportion of actual users (4.6%) is in line with
percentages suggested for youth users which are between 0.6%–5% [8]. This finding might be
correlated to the significant proportion of the students (35.7%) who believe that occasional use of
doping agents is not harmful and those (17.9%) who think that taking a doping drug is an ethical deed.
An athlete may find it ethically justified to take a doping agent if, for example, he/she thinks it is for
the good of his/her team, country, etc. Therefore, ethical obligations may contribute to doping use,
especially with the absence of an effective system for doping detection and control. Interestingly, a UK
study indicated that about 7% of participating young athletes were willing to use a prohibited
substance if it would be completely undetectable and not having serious health consequences [3].Most
of the students who confessed they had tried a prohibited performance-enhancing drug (12 out of 13)
or might consider taking one in the future (19 out 23) were males. This is in agreement with previous
studies which all have demonstrated that doping is higher among males [4,6–10,14]. There may be two
main reasons for this. First, a muscular body appearance appears to a large extent a character that is
preferred by males [6]. Second, men seem far more interested in sports in comparison with women [30].
Therefore, if a doping substance is to be taken for bodybuilding purposes or performance-enhancement
in sport competitions more male abusers, compared to females, are likely to be encountered. Apart
from the number of abusers, males and females showed similar knowledge and attitudes with regard to
doping. Furthermore, there was no evidence that students’ knowledge about doping is improved as the
students progress in their study year.
In general, students valued the impact of awareness spreading and the role that pharmacists could
play in doping prevention. This is of particular importance given that those who encourage doping
abuse as identified by this study, such as sports-mates and friends, are not likely to be educated about
doping risks and may be giving misleading or incomplete information on these risks. It would be
expected that learning about these risks can have a discouraging influence on abusers’ decision to take
a doping agent. In this context, pharmacists can be a good resource of information for athletes, doping
abusers and those who seek appropriate information on adverse effects of performance-enhancing substances.
Pharmacy 2013, 1 102

The current study encompasses a number of limitations pertaining to instrument development, data
collection and study sample.
Concerning instrument development, the items included in the instrument may not adequately
represent all aspects of issues related to the studied topic. The study methodology would have
benefited from previous studies in the literature; however to our knowledge by the time the instrument
was developed, no reports on doping among pharmacy students had been published.
Self-report techniques are known to present a number of limitations because they assume that the
respondent is able to self-report and is willing to self-declare. Furthermore, doping is a highly sensitive
topic and self-reported doping attitude/behavior assessment may be subject to social desirability
bias [31]. Nonetheless, in the current study although doping misuse among students was observed, the
questionnaire was essentially designed to address students as potential future experts in medications,
including performance enhancing agents, rather than potential doping abusers.
During data collection, questionnaires were intentionally distributed to comparable numbers of
females and males and of students from each of the five years of the BPharm program at IUST. The
purpose of this was to make gender and study year comparisons possible and valid. As a consequence,
participants’ female to male ratio was less than normally seen in Syrian pharmacy schools [32,33],
however it is unlikely that this has biased the results. This is because the responses of males and
females were similar and only statistical difference was observed in proportions of doping abusers.
The current study was performed on a single population of one pharmacy school in Syria and may,
therefore, not be generalizable to all pharmacy schools in the country. Nonetheless, many of our
findings were in line with previous studies [25–27]. It is also noteworthy that the proportion of doping
abusers reported in our study may not necessarily represent the prevalence among youths in the
country. For example, it has been reported that doping was less common among students of biomedical
schools including pharmacy, compared to other schools [9].

5. Conclusions

Taking into account the rapid growth of this public health problem among non-competing athletes,
it seems vital to involve pharmacists in the anti-doping efforts. The findings of this study, and previous
studies [25–29], highlight the need to provide pharmacy students with advanced theoretical background
and practical training concerning doping. This can be achieved by adopting simple, but essential, changes
to current curricula. One chapter concerning the pharmacology of performance-enhancements in sport,
in a course of pharmacology or a similar subject, in addition to another chapter that provides appropriate
practical strategies on dispensing, advising, prescribing and monitoring sport medications, in a course
of pharmacy practice, may be adequate.
Interestingly, and in agreement with other studies [4,12], the predominantly negative attitude
toward doping and reasonable knowledge about its risks among respondents does not appear to prevent
some of them from trying doping agents. This suggests that successful doping prevention strategies
should go beyond spreading awareness and more studies in this context are required to explore doping
abusers’ behavioral and psychological characteristics and analyze their motivations. Such studies may
also help to identify and develop the optimal approaches that pharmacists can follow to effectively
deliver their message to doping drug requestors.
Pharmacy 2013, 1 103

Acknowledgements

The authors would like to thank Dr. Hiba Al-Hamidi for her useful assistance.

Conflicts of Interest

The authors declare no conflict of interest.

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Appendix I. The Questionnaire Used in the Study.

Survey on Knowledge, Attitudes and Abuse of IUST Pharmacy Students Concerning Doping
in Sport

Please take your time to frankly and carefully answer the following questions, by filling the gaps or
ticking the appropriate option – please respond to all questions:
Note: participation in this study is voluntary.

I Personal Information

1. Are you a: male female

2. How old are you? ___________________
3. Please indicate your study year: ________

II Do You Agree that the Following Substances Can Have Doping/Performance-Enhancing

Effects in Sport?

Substance  Agree  Disagree  Not sure 

4. Amino acids (AAs)       
5. Anabolic (masculine) steroids       
6. Diuretics       
7. Energy drinks       
8. Growth hormone       
9. Narcotics       
10. Stimulants (such as amphetamine)       
11. Vitamins       
12. β-blockers       

III Doping Drugs Are Used in Sport with an Aim To:

Strongly Strongly
Reason  Disagree  Neutral  Agree 
disagree  agree 
13. change body shape and build a
         
muscle mass within a short period of time 
14. enhance sport performance in local
         
and international competitions 
15. pick the easy option as a result of not
having a desire to spend enough efforts to          
achieve the desired physical capabilities 
16. merely imitate the others           
Pharmacy 2013, 1 106

IV To What Extant Do Agree with the Following Statements?

Strongly
Statement  Disagree  Neutral  Agree  Strongly agree 
disagree 
17. Taking a doping agent is an
         
ethical deed 
18. I respect individuals who take
         
doping agents 
19. Taking a doping agent can
         
harm user’s health 
20 Taking a doping agent for only
         
a short period is not harmful 

V To What Extant Do Agree with the Following Statements?

Strongly Strongly
Statement  Disagree  Neutral  Agree 
disagree  agree 
21. I may consider using a doping
         
drug (sometime in the future) 
22. I advice individuals not to
         
take doping substances 
23. Proper awareness
concerning adverse effects of
         
doping substances can help
minimizing their usage 
24. Pharmacists should help
promoting awareness about
         
adverse effects of doping
substances

25. Have you ever taken a prohibited performance-enhancing drug? yes no

26. Out of the following options, who/which is the most influential person/factor in encouraging you
to take a performance-enhancing drug?
Media friend Coach Sport mate else (please specify)

Thank you for participating in this study.

© 2013 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article
distributed under the terms and conditions of the Creative Commons Attribution license
(http://creativecommons.org/licenses/by/3.0/).