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NIDA. (2005, August 1). ATHENA Program Reduces Substance Abuse by Girls on High School Sports Teams. Retrieved from

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August 01, 2005
Patrick Zickler
Two girl basketball players

High school girl athletes who participated in a recently evaluated NIDA-supported nutritional and behavioral guidance program were less likely than nonparticipating peers to engage in substance abuse and other high-risk behaviors. Girls on teams that used ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) were less likely than girls on teams that received only printed information to use diet pills or so-called performance-enhancing substances such as steroids, amphetamines, and muscle-building supplements. The ATHENA team members also were less likely to be sexually active and more likely to wear seat belts, and they experienced fewer injuries during the sports season.

In the ATHENA program, developed at the Oregon Health & Science University in Portland by Drs. Diane Elliot and Linn Goldberg, selected team leaders receive a 90-minute orientation and then conduct discussion and activity sessions during scheduled team practices. Each team leader works with a squad of approximately six teammates, following a manual that is much like a playbook, with scripts for eight 45-minute sessions dealing with the harmful consequences of substance abuse and other unhealthy behaviors and the beneficial effects of good diet and exercise. Along with providing information, the workbook engages the girls in activities such as critiquing magazine advertising and other media influences on self-image; classifying various foods according to carbohydrate, fat, and protein content; and determining the best balance of dietary fuels for athletic training and competition. Each ATHENA athlete uses a pocket-sized nutrition and training guide to monitor diet and exercise. Coaches and other staff members receive an orientation to assist the team leaders as timekeepers and facilitators for the sessions.

ATHENA's Impact on Behavior and Nutrition

  Control Group Experimental Group
Before Intervention After Intervention Before Intervention After Intervention
Nutrition, Exercise Abilities, and Beliefs*
Tracking protein intake 2.11 2.03 2.16 2.54
Eating more protein in the last 2 months 3.95 3.92 4.19 5.10
Knowing how to lift weights to improve strength 5.48 5.61 5.15 5.92
Self-rating of skill in strength training 5.48 5.61 5.15 5.92
Believing that nutrition affects sport performance 5.75 5.64 6.06 6.01
Additional Health-Influencing Behaviors
Rode in a car with an alcohol-consuming driver** 0.44 0.42 0.41 0.26
Knowing how to turn down unhealthy weight-loss behaviors* 5.80 5.77 5.91 6.14
No. of sport injuries so could not train in the last3 months 0.32 0.36 0.32 0.26
Intentions Toward Future Disordered Eating Behaviors and Drug Use*
Diet pill use 1.74 1.79 1.87 1.62
Vomiting to lose weight 1.66 1.76 1.62 1.57
Tobacco use 1.56 1.79 1.55 1.58
Creatine (muscle-building supplement) use 1.87 1.77 1.72 1.51

Data are significant differences expressed as the mean.
*Scored using a seven-item agreement scale ranging from 1 (strongly disagree) to 7 (strongly agree).
**Scored 0 to 4 for times occurred with 0 indicating none; 1, once; 2, two or three times; 3, four or five times; or 4, six or more times.

High-school girls who participated in the ATHENA curriculum were less likely to engage in drug abuse or other unhealthy behaviors than were girls given printed information about drugs and nutrition.

To evaluate ATHENA, the researchers recruited 40 girls' sports teams in 18 public high schools in northwest Oregon and southwest Washington. Teams from half the schools followed the ATHENA program. The other teams received printed information about eating disorders, substance abuse, and sports nutrition, but did not take part in discussion or group activities. Before the first practice of their sports season and again within 2 weeks after the season ended, each girl filled out a questionnaire about her eating patterns; nutritional awareness; use of diet pills, amphetamines, anabolic steroids, and muscle-building supplements; and other health-related behaviors.

Preseason survey results were essentially the same for girls on ATHENA teams and those in the control group, but in postseason surveys the ATHENA participants reported significant decreases in risky behaviors. According to Dr. Elliot, the control athletes were three times more likely to begin using diet pills and almost twice as likely to begin using other -shaping substances, including amphetamines, anabolic steroids, and muscle-building supplements, during the season. The use of diet pills went up among control girls, while it fell to approximately half its preseason level among ATHENA girls. ATHENA athletes also were more likely to use seatbelts and less likely to ride in a car with a driver who had been drinking, to believe claims in advertising, or to agree with the statement that men find thin women most attractive.

Adolescent girls experience social and cultural pressure about image, and they look to each other for role models more than they follow the guidance offered in classrooms, research has shown. The competitive environment of athletic programs may compound the pressure, leading to disordered eating and the use of -shaping substances such as steroids, diuretics, laxatives, and even tobacco, Dr. Elliot says. However, the athletic environment can exert positive peer pressure also. The researchers modeled ATHENA's use of sports teams as a forum to promote healthy lifestyles on a similar program they developed for male high school athletes (see "Like ATHENA, ATLAS Targets High School Athletes"). "We found that the team-based approach used in ATLAS [Athletes Training and Learning to Avoid Steroids] produced greater positive change than did a more conventional classroom-style approach," Dr. Elliot says.

"Two features of the ATHENA program are striking," says Dr. Larry Seitz of NIDA's Division of Epidemiology, Services and Prevention Research. "One is the peer-based rather than classroom-based approach, and the other is the effect on a wide spectrum of linked behaviors, from vomiting to induce weight loss to believing nutritional claims in advertising. Improvements like these can help young female athletes make healthier choices throughout life, not just during the sport season."

The Oregon Health & Science University Sports Medicine Web site,, provides more information about ATHENA and ATLAS.


  • Elliot, D.L., et al. Preventing substance use and disordered eating: Initial outcomes of the ATHENA program. Archives of Pediatric and Adolescent Medicine 158(11):1043-1049, 2004. [Abstract]

Like ATHENA, ATLAS Targets High School Athletes


ATLAS (Athletes Training and Learning To Avoid Steroids), the result of 5 years of NIDA-supported development, is a program for male high school athletes to help reduce use of anabolic steroids and other sport supplements, alcohol, and other drugs. ATLAS emphasizes the immediate impact of alcohol and other drugs on athletic performance and conditioning rather than potential and abstract long-term effects. An evaluation of the program in 15 high schools showed that, compared with a control group, 1 year after completion of the program, ATLAS-trained students had:

  • Half the incidence of new use of anabolic steroids and less intention to use the drugs in the future;
  • Less use of alcohol, marijuana, amphetamines, and narcotics;
  • Less use of "athletic enhancing" supplements;
  • Less likelihood of engaging in hazardous substance abuse behaviors such as drinking and driving;
  • Reduced substance abuse risk factors; and
  • Improved substance abuse protective factors.