RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES

BANGALORE – KARNATAKA

Proforma synopsis for registration of subject for dissertation

Submitted by:

DEEPTI TIMUNGPI

M.SC. Nursing 1st Year

Medical Surgical Nursing

Sneha College of Nursing

Bangalore – 560043
 RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES

BANGALORE – KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 Name of the Candidate & DEEPTI TIMUNGPI

Address
2 Name of the Institution
1st Year M.Sc. (Nursing)
SNEHA COLLEGE OF NURSING
NO.97, 5th Main. I stage, I Block, HBR Layout, Bangalore
– 43
SNEHA COLLEGE OF NURSING

3 Course of study and M.Sc. Nursing 1st year

subject MEDICAL SURGICAL NURSING
4 Date of admission to 25.05.2010
course
5 Title of the topic “A STUDY TO ASSESS THE EFFECTIVENESS OF
SELF INSTRUCTIONAL MODULE (SIM) ON
KNOWLEDGE REGARDING THE SIDE EFFECTS OF
USING ANABOLIC ANDROGENIC STEROID (AAS)
DRUG AMONG STUDENTS STUDYING IN
SELECTED DEGREE COLLEGES AT BANGALORE”
6 Brief resume on intended
work
6.1: Need for the study ENCLOSED
6.2: Review of Literature ENCLOSED
6.3: Objectives of the study ENCLOSED
6.4: Hypothesis ENCLOSED
7 Materials and Methods:
7.1: Sources of Data: Data will be collected from the students studying in
Selected degree colleges in Bangalore.
7.2: Method of Data Collection: Structured questionnaire method
7.3: Does the study require any investigation or intervention to be carried out on
the patients or human or animals?
NO
7.4: Has ethical clearance been obtained?
YES
6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION:

“Drug misuse is not a disease; it is a decision, like the decision to step out in

front of a moving car. You would call that not a disease but an error of judgment” –

Philip K. Dick

The World Drug Report says that the number of users of synthetic drugs –

estimated at around 30 to 40 million people worldwide. Also, it was revealed in the

survey that as much as 479,000 students worldwide or 2.9% of total student population

had used one or other steroid by the last year of high school.1

Drugs commonly referred to as “steroid” are classified as Anabolic (or Anabolic

androgenic) and corticosteroids. Corticosteroids, such as cortisone are drugs that doctors

typically prescribe to help to control inflammation in the body. They are not the same as

the anabolic steroids that receive so much media attention for their use by some athletes

and body builders.2

Anabolic steroids are synthetically produced variants of the naturally occurring

male hormone testosterone. Both males and females have testosterone produced in their

bodies: males in the testes, and females in the ovaries and other tissues. The full name for

this class of drugs is androgenic (promoting masculine characteristics) anabolic (tissue

building) steroids (the class of drugs). Some of the most abused steroids include Deca-
Durabolin® , Durabolin ® , Equipoise® , and Winstrol® . The common street (slang)

names for anabolic steroids include arnolds, gym candy, pumpers, roids, stackers, weight

trainers, and juice.Anabolic steroids are usually taken orally or injected although there is

a gel version which can be rubbed onto the skin. Steroids are dangerous for two reasons:

they are illegal, and they can damage a person's health, especially if used in large doses

over time. Also, the health problems caused by steroids may not appear until years after

the steroids are taken. 3

And around three million Indians are projected victims of different kinds of drug

abuse. It was revealed that rural youth are more vulnerable to drug usage than urban

youth and 73% of drug addicts are between 16 to 35 years. A recent survey had also

indicated that at least 23% of Bangalore University students are using drugs, which also

include the use of anabolic androgenic steroids. These students are irregular and show no

interest in academics. 4

6.1: NEED FOR STUDY

The health risks surrounding steroids heavily out weigh the few benefits. Steroids

are damaging physically and psychologically. Steroids may seem to be the best and

easiest way to enhance your body, but they only work for so long. Once the side effects

start surfacing, the user will have trouble exercising or may not even be able to exercise.

Therefore, everything that they have worked for will go down the drain. And since

steroids are addictive, once the user stops taking them, their body will crave and need

steroids to function. It will take time for the body to be able to function as it once did. 5
 Steroid use can result in long term damage to your health and in some cases this

can be fatal. These risks include: Acne and/or oily cysts on the skin, thinning of the hair,

High blood pressure which can lead to a stroke or heart attack, Paranoia and an inability

to sleep, Stunted growth (in adolescents), Risk of infection, damaged veins or ulcers from

shared needles, Shrunken testicles, breast development, erection problems and risk of

prostate cancer in men. Lowered sex drive and reduced sperm output. ‘Masculinisation’

in women. People who take steroids find that they are prone to aggressive behaviour and

violence - even if before taking steroids they were peaceful or mild mannered. This can

happen in both sexes and is known as ‘roid rage’.6

A research report by National Institute on Drugs (NIDA) stated that

steroids when used in high doses, increase irritability and aggression. Some steroid

abusers report that they have committed aggressive acts, such as physical fighting or

armed robbery, theft, vandalism, or burglary. Abusers who have committed aggressive

acts or property crimes generally report that they engage in these behaviors more often

when they take steroids than when they are drug free. A recent study suggests that the

mood and behavioral effects seen during anabolic-androgenic steroid abuse may result

from secondary hormonal changes. 7

Anabolic steroids are available easily these days. Legally, they can be obtained

only through prescription. But youngsters can also get these from their trainers in the

gym. Peer pressure is the beginning to fuel AS abuse among young adult in India. Boys

ape their favorite models and want bulging biceps, a washboard stomach, and six-pack
abs. Girls, on the other hand, take to steroids to get the lean muscular look which is

fashionable these days. 8

A study in India revealed that 25% of the teenagers/young adult used supplements

and other drugs to develop muscles and better body physique. There are students who

admitted that they took illegal supplements or steroids to achieve this goal. Although they

were only composed of 5.5%, this could still become a major concern for the authorities.9

India has yet to ban many of the substances that the overseas market controls have

decided are not safe for public use. There are many cases of steroids and other

performance enhancing drugs all through India from the use of athletes and soldiers to

some of Bollywoods favorite actors. Because steroids are so common in India at the

moment and because they have been for the last ten years then the Indian government

will have to deal with the problems that steroid abuse creates in the long term. This will

mean new facilities will be required to deal with all of the cases. If the legalization of

certain products is stopped the populous stays healthier and this means less government

spending overall. (10)

Steroid abuse is still on the rise, and not just among professional athletes

and bodybuilders, but also among the teenagers and young adult, as the desire to look like

models is fuelling the abuse of anabolic steroids. What most steroid users don’t realize is

that they are placing themselves at risk for something they could achieve on their own.

The best way to improve performance and increase muscle mass is to follow a well-

designed programme that challenges both your body and your mind. No drug can ever do

that. (11)
 Through many articles and media I came to know that Steroid abuse is one of the

most prevalent issues in today’s society that is associated with body builders, fitness buff

and professional athletes. Even teens and youths who are not athletes also abuse steroids

in the desire of getting a six-pack body without the knowledge of their side effects which

can be life threatening. Therefore I feel this self instructional module will help the youths

in better understanding of the side effects of AAS that will keep them away from AAS

abuse.

6.2: REVIEW OF LITERATURE:

The review of literature is defined as a broad, comprehensive in depth,

systematic and critical review of scholarly publications, unpublished scholarly print

materials, audiovisual materials and personal communications.

Review of literature is divided into three parts:

 Literature related to AAS.

 Literature related to side effect of AAS.

 Literature related to knowledge of AAS among young adult.

Literature related to AAS:

A study was conducted on the prevalence of AAS abuse among adolescent and

young adults in Poland. 3687 men (48.2%) and women (51.8%), median age 23

(interquartile range 19–20 years) participated in a survey. The result shows that the

prevalence of AAS use was 6.2% among males and 2.9% among females. Male AAS
users, compared to non-users, were more often concerned about their physical

appearance, were less educated and often engaged in some sport activity. Among female

AAS users, no significant differences concerning self-body image satisfaction or

participation in sports were found. However, compared to non-users, female AAS users

were less educated. (12)

A study conducted on future AAS use intentions with current substance use. 214

exercising males (mean age, 30 years; range, 17-61 years) recruited from 5 gymnasia.

The survey contained a structured interview schedule that included questions regarding

licit and illicit substance use, reasons for non-AAS use, and, where appropriate, reasons

for intended future AAS use. The study reveals that 16% of the sample indicated that they

would use AAS in the future. Reasons for future AAS use included increasing muscle

size (80%), improving appearance (74%), and increasing strength (57%). (13)

A study conducted reveals that most of the anabolic drug users are the middle

class heterosexual men, among the 25 years old age group. About 78.4% of steroid users

were non-competitive body builders and non-athletes. It also revealed that generally the

steroid abusers do not trust their physician which leads them to concealing the truth from

them. However about 66% of the abusers were willing to undergo medical study. And

most of the steroid abusers are most likely to suffer from muscle dysmorphia. (14)

A study conducted on the social background and current social situation of male

abusers of anabolic-androgenic steroids (AAS), age group 18 – 45 yrs, from a public

gym. The result shows that histories of a troubled childhood as well as current social

disadvantage were both more frequent among the AAS users. Users also reported poor
relationships with their parents and almost half of them had experienced physical or

mental abuse. Their current circumstance included abuse of other drugs, battering of

spouses and other criminality such as assault, illegal possession of weapons and theft. (15)

Literature related to side effect of AAS:

A study was conducted on the effects of AAS use on serious violent

behavior. Multivariate models based on data from the National Longitudinal Study of

Adolescent Health (N=6823) were used to examine the association between lifetime and

past-year self-reported anabolic-androgenic steroid use and involvement in violent acts.

Compared with individuals who did not use steroids, young adult males who used

anabolic-androgenic steroids reported greater involvement in violent behaviors. (16)

A study conducted on adverse health effects of AAS state that the adverse

side effects of AAS include sexual dysfunction, alterations of the cardiovascular system,

psyche and behavior, and liver toxicity. Occasionally, AAS abuse may be linked to certain

social and psychological traits of the user, like low self-esteem, low self-confidence,

suffered hostility, childhood conduct disorder, and tendency to high-risk behavior. The

overwhelming stereotype about AAS is that these compounds cause aggressive behavior

in males. Use of AAS in combination with alcohol largely increases the risk of violence

and aggression. (17)

A study conducted on long-term AAS use is associated with left ventricular

dysfunction. A comparison of cardiac parameters between weightlifters reporting

long-term AAS use and weightlifters without prior AAS exposure participated. The
 result shows that AAS users had significantly lower LV ejection fraction (50.6%)

than non users ( 59.1%) , longitudinal strain 16.9% versus 21.0%, and radial strain

38.3% versus 50.1%. Ten of the 12 AAS users showed LV ejection fractions below

the accepted limit of normal (>or=55%). AAS users also demonstrated decreased

diastolic function compared to nonusers as evidenced by a markedly lower early

peak tissue velocity and early-to-late diastolic filling ratio. (18)

Literature related to knowledge of AAS among young adult:

A study was conducted on the knowledge about AAS, the extent, main reasons

and consequences of its use among adolescents and young adult students of three types of

schools: grammar, secondary school and vocational school. 1175 students of both sexes

participated. The results shows that 9.38% males and 2.08% females were abusing AAS

or had abused them. Students from vocational schools had a higher usage rate and more

knowledge of AAS than pupils from the other two types of schools and the main reasons

for using AAS are connected with the will to change their bodies so as to improve

appearance. Over a half of the users had suffered from some side effects of AAS: acne,

hair-loss, sexual disturbances, irritability, voice deepening, depression etc. (19)

A study was conducted to determine the prevalence, motives, and knowledge of risks

of AAS. A confidential questionnaire was completed by 6,930 students. The

prevalence of AAS use was 2.7%, Prevalence was slightly higher in sport

participants than non-participants. The study shows knowledge deficits regarding

potential side effects. Users of AAS were less likely than nonusers to acknowledge

the risks of AAS.(20)

 A study conducted on knowledge, attitudes and practices of anabolic steroid usage

among gym users in Trinidad. Self-administered questionnaires were completed by 1062

gym-users in 14 gyms in Trinidad, 506 (52.7%) females and 502 (48.3%) males.

Individuals were in the 20 to 29 year age group. The prevalence of AS use was higher

among males than females (p < 0.001). Improvement of physical appearance was the

main reason cited for AS use. Anabolic steroid users knew more about the adverse effects

of AS than non-AS users but the therapeutic uses of AS were comparatively less well

known. This study demonstrated a general lack of knowledge concerning AS use and that

a small but significant proportion of persons using gyms admitted to abusing AS. (21)

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of self instructional module (SIM) on

knowledge regarding the side effects of using anabolic androgenic steroid (AAS) drug

among students studying in selected degree colleges at Bangalore”

6.3: OBJECTIVES OF THE STUDY

The objectives of the studies are:

1. To assess the knowledge of students regarding the side effects of using anabolic

androgenic steroid.

2. To evaluate the effectiveness of self instructional module on side effects of using

anabolic androgenic steroid use by comparing mean pretest and post test

knowledge scores.

3. To determine an association between selected demographic variables with

knowledge scores of students regarding side effects of AAS.

6.4: HYPOTHESIS

H0 – There will not be any significant difference between pretest and post test knowledge

scores on knowledge of side effects of AAS.

H1 – There will be significant difference between pretest and post test knowledge scores

on knowledge of side effects of AAS.

6.5: OPERATIONAL DEFINITION OF TERMS:-

ASSESS:

It is a way of judging the level of knowledge of students regarding side effect of

anabolic androgenic steroid.

EFFECTIVENESS:

Refers to the impact of self instructional module on knowledge of students regarding

side effects of AAS as revealed by statistically significant difference between pre test

and post test.

SELF INSTRUCTIONAL MODULE:

Refers to structured learning material prepared by the investigator regarding the

knowledge of side effects of AAS.

KNOWLEDGE:

Refers to the awareness of students regarding the side effects of AAS measured by

self administered questionnaire scores.

SIDE EFFECT OF ANABOLIC ANDROGENIC STEROID:

It refers to harmful and undesired effect resulting from the use of AAS. It ranges

from some that are physically unattractive to others that are life threatening.

STUDENTS:

A group of learners who are studying in selected degree colleges in Bangalore.

6.6: ASSUMPTIONS:

The study is based on the following assumption:

1. Students may have less knowledge regarding side effect of AAS.

2. Self instruction module regarding side effects of AAS will improve the

knowledge of students.

3. Appropriate knowledge prevents the incidence of AAS use.

6.7: DELIMITATIONS:

The study is delimited to student who are:

 Available during the period of study.

 Willing to participate in the study.

6.8: SIGNIFICANCE OF THE STUDY:

i. The study helps to estimate the level of knowledge regarding side

effects of AAS among students of selected degree colleges at

Bangalore.

ii. Administration of SIM will enhance the knowledge regarding side

effects of AAS among the students of selected degree colleges at

Bangalore.

6.9: CONCEPTUAL FRAMEWORK:

A suitable modified conceptual theory framework will be adopted for the study.

7. MATERIALS & METHOD:

7.1: SOURCE OF DATA:

The data will be collected from students studying in selected degree colleges in

Bangalore.

7.2: METHODS OF DATA COLLECTIONS:

Research method - Pre experimental method.

Research design - Single group pre test – post test design.

Group Pre test Intervention Post test

Single group 01 X 02

Key:-

O1 – Pre test: a pre test knowledge of

degree students regarding side effect of

AAS.

X – self instructional module.

O2 – Post test: a post test on knowledge of

degree students regarding side effect of

AAS.

Sample technique - Convenient sampling

Population - Students studying in selected degree

colleges in Bangalore.

Sample - Students of selected degree colleges in

Bangalore who have fulfilled the inclusion

criteria.

Sample size - 60 students in selected degree colleges in

Bangalore.

Setting of the study - The study will be conducted in selected

degree colleges in Bangalore.

Research variable
Dependent variable - Knowledge of students regarding side

effects of AAS.

Independent Variable - Self instructional module on side effects of

AAS.

7.2.1: CRITERIA FOR SELECTION OF SAMPLES:

INCLUSION CRITERIA:

The study includes students:

 Those who are willing to participate in the study.

 Those who are studying in selected degree College at Bangalore.

 Those who are available at the time of data collection.

EXCLUSION CRITERIA:

The study excludes students:

 Those who are not willing to participate.

 Those who are not available at the time of data collection.

7.2.2: TOOL OF RESEARCH:

Self administered questionnaire will be developed into two part.

Section A – Demographic Variables

Section B – Questionnaires on knowledge regarding side effect of AAS.

7.2.3: DATA COLLECTIONS:

The investigator distributes self administered questionnaire regarding side effect

of AAS.

7.2.4: METHOD OF DATA ANALYSIS AND PRESENTATION:

i. Descriptive statistics – It includes mean, median, mode and standard

deviation.

ii. Inferential statistics – It includes paired t-test, chi square and correlation

co –efficient.

7.3: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENSIONS TO BE CARRIED OUT ON PATIENTS OR OTHER HUMAN

OR ANIMALS?

 No.

7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED?

 Yes.
8. LIST OF REFERENCES:

1. Peoples’s Daily Online . UN says drug use shifting towards new drugs,

markets. 2010 June; 17-18;

http://english.peopledaily.com.cn/90001/90777/90856/7041225.html

2. Steven Dowshen. Steroids. 2010 October;

http://kidshealth.org/parent/emotions/behavior/steroids.html#

3. Drug Enforcement Administration, Office of Diversion Control,

Washington, D.C. 20537. A Guide for Understanding the Dangers of

Anabolic Steroids. March 2004;

http://www.deadiversion.usdoj.gov/pubs/brochures/steroids/public/index.h

tml

4. Chitleen K Shethi. Tackling drug menace. The Tribune, Chandigarh, India.

2010 April; http://www.tribuneindia.com/2010/20100509/letters.htm

5. Derek Charlebois. Taking steroid: what could it hurt. 2010;

http://www.teenbodybuilding.com/derek4.htm

6. medic8. Anabolic Steroids – Drug addiction.

http://www.medic8.com/drug-addiction/anabolic-steroids.html

7. National Institute of Drug Abuse. Research Report Series - Anabolic

Steroid Abuse. US.

http://www.nida.nih.gov/researchreports/steroids/anabolicsteroids4.html
8. Naveen Rathee. Six pack warning: supplements. India Today Magazine.

Issue 29. 2010 Jan; 29-30

9. Jarred Martin. Young Indians Depend on Anabolic Steroids to Have a

Muscular Body. 2010 July; http://www.steroidsources.com/Steroid-

Information/2010/07/young-indians-depend-on-anabolic-steroids-to-have-

a-muscular-body/

10. Dr Chein. Famous for steroids in India. 2008 Nov.

http://www.steroids.in/category/hgh-and-steroids

11. American Council on Exercise. The Truth about Steroids. 2005;

http://www.fitfaq.com/steroids-truth-article.html

12. Rachoń D, Pokrywka L, Suchecka-Rachoń K. Prevalence and risk factors

of anabolic-androgenic steroids (AAS) abuse among adolescents and

young adults in Poland. Social and Preventive Medicine journal;

51(6);392-398

13. Dunn, Matthew, Mazanov, Jason ,Sitharthan, Gomathi. Predicting Future

Anabolic-Androgenic Steroid Use Intentions With Current Substance Use:

Findings From an Internet-Based Survey. Journal of Sport Medicine:

May 2009;19(3), 222-227

14. Stephen E. Lankenau and Michael C. Clatts. Steroid Use. Journal Urban

Health. 2004 June; 81(2): 232–248

 15. Skarberg K, Engstrom I. Substance Abuse Treatment, Prevention,

and Policy 2007.

16. Kevin M. Beaver; Michael G. Vaughn; Matt DeLisi; John Paul Wright.

The effects of AAS use on serious violent behavior. American Journal of

Public Health. 2008; 98(12): 2185-2187.

17. Van Amsterdam J, Opperhuizen A, Hartgens F. Adverse health effects

of AAS. Regul Toxicol Pharmacol. 2010 Jun; 57(1): 117-23.

18. Baggish AL, Weiner RB, Kanayama G, Hudson JI Picard MH

Hutter AM Jr, Pope HG Jr. Long-term AAS use is asso ciated with left

ventricular dysfunction Circ Heart Fail. 2010 Jul 1; 3(4):472-476.

19. K. Sas-Nowosielski. The knowledge about AAS, the extent, main reasons

and consequences of its use among adolescents and young adult students.

Biology of Sport.2006;23(3); 225-235

20. Tanner SM, Miller DW, Alongi C. The prevalence, motives, and

knowledge of risks of AAS. Clin J Sport Med. 1995; 5(2):108-115.

21. Maharaj VR, Dookie T, Mohammed S, Ince S, Marsang BL, Rambocas N,

et. al. Knowledge, attitudes and practices of anabolic steroid usage among

gym users in Trinidad. West Indian Med J. 2000 Mar; 49(1): 55-58

RESEARCH WEB INTERNET:

1. www.pubmed.com

2. www.google.com

3. www.yahoo.com