{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:56:14Z","timestamp":1772254574702,"version":"3.50.1"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T00:00:00Z","timestamp":1718755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Image and Performance-Enhancing Drugs (IPEDs) can enhance mental and physical capabilities and impact one\u2019s overall health. Initially confined in sport environments, IPEDs use has become increasingly widespread in a high-performing society. The present study was aimed at profiling IPEDs use during the COVID-19 lockdown among an international sample of young adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional observational study was carried out in eight countries (United Kingdom, Italy, Lithuania, Hungary, Portugal, Spain, Brazil, and Japan) between April and May 2020. The survey questionnaire included validated measurements such as Exercise Addiction Inventory (EAI), Appearance Anxiety Inventory (AAI), and Self-Compassion Scale (SCS) as well as questions about the type of IPEDs, purchasing methods and socio-demographic information.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 736 IPEDs users were included in the survey. Their mean age was 33.05\u2009years (\u00b1<jats:italic>SD<\/jats:italic>\u2009=\u200910.06), and 64.2% were female participants. Overall, 6.8% were found at risk of exercise addiction (EAI &amp;gt;24), 27.6% presented high levels of appearance anxiety, and 24.9% revealed low levels of emotional regulation\u2019s self-compassion. Most participants (55.6%) purchased IPEDs through pharmacies\/specialized shops, while 41.3% purchased IPEDs on the Internet. Online IPEDs buyers were mainly men who had higher scores on the Exercise Addiction Inventory. One or more IPEDs classifiable as \u201cpotentially risky\u201d were used by 66.3% of the sample. Users of \u201cpotentially risky IPEDs\u201d were younger and primarily men. They showed higher scores both on the Exercise Addiction Inventory and Appearance Anxiety Inventory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study profiled users of IPEDs when the most restrictive COVID-19 lockdown policies were implemented in all the participating countries. More targeted post-COVID 19 prevention strategies should be implemented according to the emerged socio-demographic and psychopathological traits and cross-cultural differences emerged. Longitudinal studies will also be needed to determine the long-term effect of the COVID-19 lockdown on IPEDs consumption.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1386721","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T13:08:03Z","timestamp":1718802483000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Profiling and assessing the risks of image- and performance-enhancing drugs use during the COVID-19 lockdown"],"prefix":"10.3389","volume":"12","author":[{"given":"Ilaria","family":"De Luca","sequence":"first","affiliation":[]},{"given":"Francesco","family":"Di Carlo","sequence":"additional","affiliation":[]},{"given":"Julius","family":"Burkauskas","sequence":"additional","affiliation":[]},{"given":"Artemisa R.","family":"Dores","sequence":"additional","affiliation":[]},{"given":"Irene P.","family":"Carvalho","sequence":"additional","affiliation":[]},{"given":"M. \u00c1ngeles","family":"G\u00f3mez-Mart\u00ednez","sequence":"additional","affiliation":[]},{"given":"Attila","family":"Szabo","sequence":"additional","affiliation":[]},{"given":"Hironobu","family":"Fujiwara","sequence":"additional","affiliation":[]},{"given":"Cristina Monteiro","family":"Barbosa","sequence":"additional","affiliation":[]},{"given":"Marco","family":"Di Nicola","sequence":"additional","affiliation":[]},{"given":"Marianna","family":"Mazza","sequence":"additional","affiliation":[]},{"given":"Gabriele","family":"Sani","sequence":"additional","affiliation":[]},{"given":"Debora","family":"Luciani","sequence":"additional","affiliation":[]},{"given":"Mauro","family":"Pettorruso","sequence":"additional","affiliation":[]},{"given":"Massimo","family":"di Giannantonio","sequence":"additional","affiliation":[]},{"given":"Ilaria","family":"Cataldo","sequence":"additional","affiliation":[]},{"given":"Gianluca","family":"Esposito","sequence":"additional","affiliation":[]},{"given":"Giovanni","family":"Martinotti","sequence":"additional","affiliation":[]},{"given":"Thomas","family":"Zandonai","sequence":"additional","affiliation":[]},{"given":"Olivier","family":"Rabin","sequence":"additional","affiliation":[]},{"given":"Ornella","family":"Corazza","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2024,6,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.1016\/S2215-0366(20)30077-8","article-title":"Online mental health services in China during the COVID-19 outbreak","volume":"7","author":"Liu","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"773","DOI":"10.5498\/wjp.v12.i6.773","article-title":"Contents legacy of neuropsychiatric symptoms associated with past COVID- 19","volume":"12","author":"De Berardis","year":"2022","journal-title":"World J Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1548","DOI":"10.1002\/hbm.25741","article-title":"Olfactory loss and brain connectivity after COVID-19","volume":"43","author":"Esposito","year":"2022","journal-title":"Hum Brain Mapp"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"8823","DOI":"10.3390\/ijerph19148823","article-title":"Online Behaviours during the COVID-19 pandemic and their associations with psychological factors: an international exploratory study","volume":"19","author":"Burkauskas","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/ijcp.13716","article-title":"Telepsychiatry and other cutting-edge technologies in COVID-19 pandemic: bridging the distance in mental health assistance","volume":"75","author":"Di Carlo","year":"2021","journal-title":"Int J Clin Pract"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2020.572245","article-title":"Psychopathological burden and quality of life in substance users during the COVID-19 lockdown period in Italy","volume":"11","author":"Martinotti","year":"2020","journal-title":"Front Psych"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1080\/09638237.2020.1803234","article-title":"Exercise addiction and COVID-19-associated restrictions","volume":"30","author":"Lim","year":"2021","journal-title":"J Ment Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5114\/biolsport.2020.96857","article-title":"Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study","volume":"38","author":"Ammar","year":"2021","journal-title":"Biol Sport"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fphys.2020.572718","article-title":"A preventive role of exercise across the coronavirus 2 (SARS-CoV-2) pandemic","volume":"11","author":"Wang","year":"2020","journal-title":"Front Physiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/j.jagp.2020.06.024","article-title":"The mental health benefits of physical activity in older adults survive the COVID-19 pandemic","volume":"28","author":"Callow","year":"2020","journal-title":"Am J Geriatr Psychiatr"},{"key":"ref11","volume-title":"Diagnostic and statistical manual of mental disorders - DSM V","year":"2013"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"403","DOI":"10.3109\/10826084.2011.639120","article-title":"Exercise addiction: symptoms, diagnosis, epidemiology, and etiology","volume":"47","author":"Berczik","year":"2012","journal-title":"Subst Use Misuse"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"3678","DOI":"10.1007\/s11469-022-00815-z","article-title":"Physical activity and exercise addiction during the Covid-19 pandemic in Italy","volume":"21","author":"Ceci","year":"2023","journal-title":"Int J Ment Heal Addict"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-018-5930-7","article-title":"\u201cI aspire to look and feel healthy like the posts convey\u201d: engagement with fitness inspiration on social media and perceptions of its influence on health and wellbeing","volume":"18","author":"Raggatt","year":"2018","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyg.2021.689058","article-title":"Exploring the relationship between mental well-being, exercise routines, and the intake of image and performance enhancing drugs during the coronavirus disease 2019 pandemic: a comparison across sport disciplines","volume":"12","author":"Shibata","year":"2021","journal-title":"Front Psychol"},{"key":"ref16","first-page":"1","article-title":"Does primary exercise dependence really exist?","volume-title":"Exercise addiction: Motivation for participation in sport and exercise","author":"Veale","year":"1995"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0213060","DOI":"10.1371\/journal.pone.0213060","article-title":"The emergence of exercise addiction, body dysmorphic disorder, and other image-related psychopathological correlates in fitness settings: a cross sectional study","volume":"14","author":"Corazza","year":"2019","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpsyt.2021.648501","article-title":"Exercise and use of enhancement drugs at the time of the COVID-19 pandemic: a multicultural study on coping strategies during self-isolation and related risks","volume":"12","author":"Dores","year":"2021","journal-title":"Front Psych"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jpsychires.2022.01.032","article-title":"An international cross-sectional investigation on social media, fitspiration content exposure, and related risks during the COVID-19 self-isolation period","volume":"148","author":"Cataldo","year":"2022","journal-title":"J Psychiatr Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/add.13439","article-title":"Can new psychoactive substances be regulated effectively? An assessment of the British psychoactive substances bill","volume":"112","author":"Reuter","year":"2017","journal-title":"Addiction"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e52","DOI":"10.1371\/journal.pmed.0010052","article-title":"Is it ethical to use enhancement technologies to make us better than well?","volume":"1","author":"Caplan","year":"2004","journal-title":"PLoS Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/hup.2619","article-title":"The use of supplements and performance and image enhancing drugs in fitness settings: a exploratory cross-sectional investigation in the United Kingdom","volume":"32","author":"Mooney","year":"2017","journal-title":"Hum Psychopharmacol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"100014","DOI":"10.1016\/j.etdah.2021.100014","article-title":"The market of sport supplement in the digital era: a netnographic analysis of perceived risks, side-effects and other safety issues","volume":"1","author":"Catalani","year":"2021","journal-title":"Emerg Trends Drugs Addict Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"347","DOI":"10.52586\/4948","article-title":"Smart drugs and neuroenhancement: what do we know?","volume":"26","author":"Esposito","year":"2021","journal-title":"Front Biosci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1123\/ijsnem.2017-0429","article-title":"Athletes and supplements: prevalence and perspectives","volume":"28","author":"Garthe","year":"2018","journal-title":"Int J Sport Nutr Exerc Metab"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"106470","DOI":"10.1016\/j.addbeh.2020.106470","article-title":"Estimates of caffeine use disorder, caffeine withdrawal, harm and help-seeking in New Zealand: a cross-sectional survey","volume":"109","author":"Booth","year":"2020","journal-title":"Addict Behav"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"4102","DOI":"10.2903\/j.efsa.2015.4102","article-title":"Scientific opinion on the safety of caffeine","volume":"13","author":"Panel","year":"2015","journal-title":"EFSA J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2722","DOI":"10.2174\/1381612823666170117122801","article-title":"Dietary supplements: foods, medicines, or both? A controversial designation with unspecific legislation","volume":"23","author":"Pereira","year":"2017","journal-title":"Curr Pharm Des"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/nu12113449","article-title":"Dietary supplements: are current policies adequate for promoting health?","volume":"12","author":"Shi","year":"2020","journal-title":"Nutrients"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1177\/1073191107306673","article-title":"Development and examination of the social appearance anxiety scale","volume":"15","author":"Hart","year":"2008","journal-title":"Assessment"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4296","DOI":"10.3390\/ijerph20054296","article-title":"Strong correlations between social appearance anxiety, use of social media, and feelings of loneliness in adolescents and young adults","volume":"20","author":"Papapanou","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1123\/jsep.2019-0061","article-title":"Exploring self-compassion and versions of masculinity in men athletes","volume":"41","author":"Reis","year":"2019","journal-title":"J Sport Exerc Psychol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1037\/a0025754","article-title":"Self-compassion: conceptualizations, correlates & interventions","volume":"15","author":"Barnard","year":"2011","journal-title":"Rev Gen Psychol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1080\/16066350310001637363","article-title":"The exercise addiction inventory: a new brief screening tool","volume":"12","author":"Terry","year":"2004","journal-title":"Addict Res Theory"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40798-014-0005-5","article-title":"A cross-cultural re-evaluation of the exercise addiction inventory (EAI) in five countries","volume":"1","author":"Griffiths","year":"2015","journal-title":"Sports Med Open"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1017\/S1352465813000556","article-title":"The appearance anxiety inventory: validation of a process measure in the treatment of body dysmorphic disorder","volume":"42","author":"Veale","year":"2014","journal-title":"Behav Cogn Psychother"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.jocrd.2015.12.001","article-title":"Young adolescents\u2019 appearance anxiety and body dysmorphic symptoms: social problems, self-perceptions and comorbidities","volume":"8","author":"Mastro","year":"2016","journal-title":"J Obsessive Compuls Relat Disord"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1080\/15298860309027","article-title":"The development and validation of a scale to measure self-compassion","volume":"2","author":"Neff","year":"2003","journal-title":"Self Identity"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"Ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/biomedicines10020355","article-title":"Misuse of anticholinergic medications: a systematic review","volume":"10","author":"Chiappini","year":"2022","journal-title":"Biomedicines"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1016\/S0140-6736(19)32231-7","article-title":"New psychoactive substances: challenges for drug surveillance, control, and public health responses","volume":"394","author":"Peacock","year":"2019","journal-title":"Lancet"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s12954-021-00571-8","article-title":"Investigating the impact of COVID-19 on performance and image enhancing drug use","volume":"18","author":"Dunn","year":"2021","journal-title":"Harm Reduct J"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1002\/hup.2299","article-title":"Promoting innovation and excellence to face the rapid diffusion of novel psychoactive substances in the EU: the outcomes of the ReDNet project","volume":"28","author":"Corazza","year":"2013","journal-title":"Hum Psychopharmacol Clin Exp"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.forsciint.2011.07.026","article-title":"Development of the role of national anti-doping organisations in the fight against doping: from past to future","volume":"213","author":"Kamber","year":"2011","journal-title":"Forensic Sci Int"},{"key":"ref45","first-page":"128","article-title":"Use of nutritional supplements in sports: risks, knowledge, and behavioural-related factors","volume":"24","author":"Molinero","year":"2009","journal-title":"Nutr Hosp"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1080\/0264041031000140581","article-title":"Dietary supplements","volume":"22","author":"Maughan","year":"2004","journal-title":"J Sports Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.drugpo.2016.08.012","article-title":"Exploring the social lives of image and performance enhancing drugs: an online ethnography of the Zyzz fandom of recreational bodybuilders","volume":"39","author":"Underwood","year":"2017","journal-title":"Int J Drug Policy"},{"key":"ref48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-319-60600-2","volume-title":"Novel psychoactive substances: Policy, economics and drug regulation","author":"Corazza","year":"2017"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.ad.2011.11.008","article-title":"Cult of the body beautiful: at what cost?","volume":"103","author":"Mataix","year":"2012","journal-title":"Actas Dermosifiliogr"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1136\/jme.2009.030882","article-title":"Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology","volume":"35","author":"Cakic","year":"2009","journal-title":"J Med Ethics"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1386721\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T13:08:09Z","timestamp":1718802489000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1386721\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,19]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2024.1386721"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1386721","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,19]]},"article-number":"1386721"}}