OBJECTIVE: Media images of men and women have become increasingly muscular, and muscle-enhancing techniques are available to youth. Identifying populations at risk for unhealthy muscle-enhancingbehaviors is of considerable public health importance. The current study uses a large and diverse population-based sample of adolescents to examine the prevalence of muscle-enhancing behaviors and differences across demographic characteristics, weight status, and sports team involvement. METHODS: Survey data from 2793 diverse adolescents (mean age = 14.4) were collected at 20 urban middle and high schools. Use of 5 muscle-enhancing behaviors was assessed (changing eating, exercising, protein powders, steroids and other muscle-enhancing substances), and a summary score reflecting use of 3 or more behaviors was created. Logistic regression was used to test for differences in each behavior across age group, race/ethnicity, socioeconomic status, BMI category, and sports team participation. RESULTS: Muscle-enhancing behaviors were common in this sample for both boys and girls. For example, 34.7% used protein powders or shakes and 5.9% reported steroid use. Most behaviors were significantly more common among boys. In models mutually adjusted for all covariates, grade level, Asian race, BMI category, and sports team participation were significantly associated with the use of muscle-enhancing behaviors. For example, overweight (odds ratio = 1.45) and obese (odds ratio = 1.90) girls had significantly greater odds of using protein powders or shakes than girls of average BMI. CONCLUSIONS: The use of muscle-enhancing behaviors is substantially higher than has been previously reported and is cause for concern. Pediatricians and other health care providers should ask their adolescent patients about muscle-enhancing behaviors.

There is a paucity of research regarding the contextual factors that influence health behaviors to inform the development of programs and services for youth during the transition from adolescence to young adulthood. Researchers are thus in need of efficient strategies for surveying diverse populations of young adults. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey design (web and mailed surveys) and 2) identify demographic correlates of response mode. Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III: 2008-2009) examining factors associated with weight-related behaviors. Participants were mailed invitation letters providing the web address and a unique password for completing the survey. Nonresponders were mailed three reminder invitations; the third mailing included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Most completed surveys (82.1% of n=2,287) were returned by respondents within the first four months of fielding prior to the mailing which included the paper form. Nearly all of these early responders (92.6% of n=1,878) and 86.5% of the full respondent sample (n=1,979 of 2,287) completed the web form. Response to the web versus mailed paper form of the survey was associated with age >25 years, higher socioeconomic status, current employment, student status, and having no children. The combination of web and mailed survey modes is an effective strategy for conducting data collection in demographically diverse, young adult populations.

OBJECTIVE Despite considerable policy interest in the association between perceived public stigmatization of mental illness and use of mental health services, limited empirical evidence, particularly from longitudinal data, documents this relationship. This study used longitudinal data to estimate the association between perceived public stigmatization and subsequent mental health care seeking. METHODS A Web-based survey was used to collect data from a random sample of undergraduate and graduate students at a university at baseline and two years later (N=732). Logistic regression models assessed the association between students' perceived public stigma at baseline and measures of subsequent help seeking for mental health problems (perceived need for help and use of mental health services) at follow-up. RESULTS No significant associations were found between perceived public stigma and help-seeking behavior over the two-year period. CONCLUSIONS In this population of college students, perceived stigma did not appear to pose a substantial barrier to mental health care.