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Sports Medicine

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26.04.2021 | Systematic Review

Doping Prevalence in Competitive Sport: Evidence Synthesis with “Best Practice” Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence

Erschienen in: Sports Medicine | Ausgabe 9/2021

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Abstract

Background

The prevalence of doping in competitive sport, and the methods for assessing prevalence, remain poorly understood. This reduces the ability of researchers, governments, and sporting organizations to determine the extent of doping behavior and the impacts of anti-doping strategies.

Objectives

The primary aim of this subject-wide systematic review was to collate and synthesize evidence on doping prevalence from published scientific papers. Secondary aims involved reviewing the reporting accuracy and data quality as evidence for doping behavior to (1) develop quality and bias assessment criteria to facilitate future systematic reviews; and (2) establish recommendations for reporting future research on doping behavior in competitive sports to facilitate better meta-analyses of doping behavior.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. Articles were included if they contained information on doping prevalence of any kind in competitive sport, regardless of the methodology and without time limit. Through an iterative process, we simultaneously developed a set of assessment criteria; and used these to assess the studies for data quality on doping prevalence, potential bias and reporting.

Results

One-hundred and five studies, published between 1975 and 2019,were included. Doping prevalence rates in competitive sport ranged from 0 to 73% for doping behavior with most falling under 5%. To determine prevalence, 89 studies used self-reported survey data (SRP) and 17 used sample analysis data (SAP) to produce evidence for doping prevalence (one study used both SRP and SAP). In total, studies reporting athletes totaled 102,515 participants, (72.8% men and 27.2% women). Studies surveyed athletes in 35 countries with 26 involving athletes in the United States, while 12 studies examined an international population. Studies also surveyed athletes from most international sport federations and major professional sports and examined international, national, and sub-elite level athletes, including youth, masters, amateur, club, and university level athletes. However, inconsistencies in data reporting prevented meta-analysis for sport, gender, region, or competition level. Qualitative syntheses were possible and provided for study type, gender, and geographical region. The quality assessment of prevalence evidence in the studies identified 20 as “High”, 60 as “Moderate”, and 25 as “Low.” Of the 89 studies using SRP, 17 rated as “High”, 52 rated as “Moderate”, and 20 rated as “Low.” Of the 17 studies using SAP, 3 rated as “High”, 9 rated as “Moderate”, and 5 rated as “Low.” Examining ratings by year suggests that both the quality and quantity of the evidence for doping prevalence in published studies are increasing.

Conclusions

Current knowledge about doping prevalence in competitive sport relies upon weak and disparate evidence. To address this, we offer a comprehensive set of assessment criteria for studies examining doping behavior data as evidence for doping prevalence. To facilitate future evidence syntheses and meta-analyses, we also put forward “best practice” recommendations and reporting guidelines that will improve evidence quality.

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There is not a universal definition of doping. However, this study builds upon [1] definition where doping “refers to the set of prohibited substances and/or methods as identified by the ruling body of the particular sport”, which, “means that the term ‘doping’ in […] does not reflect other doping violations mentioned in the World Anti-Doping Code, such as whereabouts failures or trafficking.” We have also differentiated between therapeutic and unintentional use of prohibited substances to more clearly describe the phenomenon.

The connection between controlled substances in sport (doping) and in general is a complicated one. First of all, not all substances prohibited in sport are controlled substances for the general population, and this varies from one country to another. One example for this is anabolic steroids (AS). AS are prohibited in sport both in- and out-of-competition for all athletes around the globe under WADA regulations. However, whilst using AS is also illegal in some countries (e.g., Australia, US, Norway, Saudi Arabia), in other countries (e.g., UK, Canada, South Africa, Turkey) personal use is not illegal but production and supply without license are, regardless of who uses it. In countries where doping is a criminal offence (e.g., Austria, Germany, France, Italy, Israel), AS use is only illegal and can carry a prison sentence for athletes if they are subject to doping control, but not for the general population. AS is not a controlled substance in some countries (e.g., Japan, Bulgaria, Russia, Mexico).

Gender is the term used in official documents and reporting throughout sport governing bodies such as the International Olympic Committee, the Court of Arbitration for Sport, and the World Anti-Doping Agency to classify competition categories for men and women. As this evidence synthesis only related to competitive sport, the manuscript reflects the categorizations used by the competitive sport governing bodies.

A multitude of indirect estimation models exists. In the applied literature, these are often referred to as ‘randomized response technique’, even though not all models rely on randomization. For simplicity and to avoid confusion, we accepted this terminology for the review while noting its inaccuracy.

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Titel: Doping Prevalence in Competitive Sport: Evidence Synthesis with “Best Practice” Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence
Publikationsdatum: 26.04.2021
Erschienen in: Sports Medicine / Ausgabe 9/2021
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI: https://doi.org/10.1007/s40279-021-01477-y

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