A Descriptive Cross-sectional Study of Knowledge of Doping at Grassroot Level in India

Sivakumar Kannan¹, Anup Naha¹*, Robindra Ramnarine Singh², Punit Bansal³,

Vinod C Nayak⁴, Sandeep Goud⁵, Usha Rani⁶

¹Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences,

Manipal Academy of Higher Education, Manipal, India.

²Robin Singh Sports Academy, Dubai, UAE.

³Department of Pharmacology, Manipal College of Pharmaceutical Sciences,

Manipal Academy of Higher Education, Manipal, India.

⁴Department of Forensic Medicine, Kasturba Medical College,

Manipal Academy of Higher Education, Manipal, India.

⁵University of West Indies-Bahamas.

⁶Department of Health Innovation, Prasanna School of Public Health,

Manipal Academy of Higher Education, Manipal, India.

*Corresponding Author E-mail: dranresearch@gmail.com

ABSTRACT:

Doping is termed as the use of banned drugs or methods to increase an athlete's performance and the concealment or attempted concealment of such use. Doping is a significant issue in the world of athletics. This study aims to assess doping knowledge among school physical education teachers (PET) of one sample district of Karnataka, India. Descriptive research was conducted using a cross-sectional, complete enumeration approach with 308 PET The questionnaire developed by World Anti-Doping Agency (WADA) was approved for use in testing doping knowledge. Descriptive statistics, Fisher's exact test and Kruskal-Wallis test were used to explain PET demographic variables and knowledge assessment. Out of 308, one hundred ninety-three (62.66%) are males with an average age of 45.61 ± 8.33 and One hundred fifteen (37.34%) respondents were females with a mean age of 44.69 ± 8.36 years. 268 PET has Poor knowledge (87%), 27 PET has Intermediate knowledge (9%), and 13 High knowledge (4%) of doping. The current study findings highlighted a lack of knowledge of PET in the aspect of Doping. Physical Education Teachers play a vital role to train and mentor younger children at sports in schools. Training physical education teachers in Doping will help create awareness and sustainable education about anti-doping practices among children.

KEYWORDS: Athlete, Doping, Knowledge, Physical education teachers.

1. INTRODUCTION:

The use of banned drugs or methods to increase an athlete's performance and the concealment or attempted concealment of such use is referred to as doping. There are numerous performance-enhancing substances and methods, and as science advances, they are becoming more diverse, complicated, and innovative. World Anti-Doping regulations ban such drugs and methods ¹.

World Anti-Doping Agency (WADA) has developed guidelines for athletes about the prohibited substances that should not be consumed in sports, both in competitions and out-of-competitions. Prohibited substances are anabolic beta-blockers, glucocorticoids, hormone, and metabolic modulators, stimulants, anabolic agents, beta-2 agonists, non-approved substances, diuretics, and masking agents, narcotics, cannabinoids, mimetics, growth factors, peptide hormones, and related substances ². Prohibited substance lists are maintained and published by WADA every year first of January on their official webpage in English and French language. The prohibited list contains what the substance or their molecule or methods are not for athlete usages ³.

Doping has been part of the sport since the beginning. The use of drugs to enhance performance in sports has certainly occurred since the time of the original Olympic Games from the year 776 BC to 393 BC. The word 'doping' originates from the Dutch word 'doop,' which is a viscous opium juice, the drug of choice of the ancient Greeks". Initially, Amphetamine, Cocaine, Strychnine, and Ephedrine were used as stimulants for athletics in the early 1900s ⁴. When sports started, several athletes started to use illegal components. The most common reasons cited by professional athletes for taking illegal components: achieving success in athletics by better performance, the financial benefits, enhancing recovery, and also preventing deficit of nutrition ⁵.

Various Anti-Doping organizations working together to prevent doping from sports, provide equal chances to each sportsperson, and protect athlete health. In 1928, the International Association of Athletics Federation (IAAF) became the first International Sports Federation to forbid Doping ⁶. In 1999, by 10^th of November to coordinate, supervise, and promote the battle in opposition to sports doping and its forms, an international self-governing organization WADA was created ^7,8. The National Anti-Doping Agency (NADA) was founded on November 24, 2005, as a recognized organization under the Societies Registration Act of 1860 to promote dope-free sports in India⁹. NADA was banned 1109 sportspersons in various sports due to positive doping tests from 01-01-2009 to 22-04-2021; for sports events: Athletics, Weightlifting, Basketball, Football, Boxing, Cycling, Hockey, Swimming, and other sports events ¹⁰. Before taking medications or supplements, WADA also recommends that athletes can consult a Pharmacist¹¹. The International Pharmaceutical Federation (FIP) has decided to recognize the pharmacist's role in the fight against sports doping ¹².

Many deserving athletes were banned from sports due to their lack of knowledge for using prohibited substances. In any sports, the sportsperson must go through flowing stages (Figure 1) to participate internationally. Doping must be controlled from the beginning.

Physical Education Teacher (PET) primarily works in Schools, Colleges, and Universities. The PET's primary responsibilities are to train children or students in a variety of sports events. The PET's plays a vital role to train and mentor younger children at sports in grass root level (schools). Hence, the present study was designed to determine the level of anti-doping awareness among PET.

Figure 1: Sportsperson life cycle

2. MATERIALS AND METHODS:

2.1 Study design and settings:

This cross-sectional study was intended as a questionnaire-based descriptive study. The study focused on PET's in the Udupi District, Karnataka, India. The study questionnaire was given to PET from primary and higher secondary schools in Udupi. After receiving PET consent, subjects were asked to complete the questionnaire and the same was collected.

2.2 Study sample:

By complete enumeration sampling method, the sample size was determined using a 0.20 anticipated proportion, a 5% margin of error, and a 95% confidence interval (CI). The calculated sample size was 308. The study was conducted from July 2019 to January 2020. PETs from primary and secondary schools in the Udupi District were included in the study. The data was not collected for Pre-University College and other districts.

2.3 Ethical approval:

This research was carried out under ethical guidelines. The study protocol No: IEC 96 - 2019 was approved by the Institution Ethics Committee (IEC) and The Clinical Trials Registry- India (CTRI) No: CTRI/2019/05/018872. Before the start of the study, the respondents were asked to sign a consent form.

2.4 Study Instrument:

The data was gathered using a systematic and pre-tested questionnaire derived from WADA validated questionnaire. The questionnaire was then pre-tested on a group of professionals tasked with identifying the most valuable questions in determining our goals. The questionnaire consisted of an assessment of doping knowledge. Age, gender, school, and income were among the demographic characteristics of the participants. The school was categorized as a private or Government school. A total of fifteen multiple-choice questions were used to test knowledge. For each item, a grading system was devised. If the response was "know," one point was awarded, and if the answer was "do not know," zero points were awarded. The level of knowledge was divided into three categories: low (<50%), moderate (50-75%), and excellent (>75%).

2.5 Statistical analysis:

Descriptive statistics using mean, ± standard deviation, and percentage were reported for each questionnaire. One sample T-Test was used for further data analysis. Fisher's exact test was used to compare two unpaired groups, considering the data was not normally distributed. Since data on age and knowledge score was skewed, Kruskal-Wallis Test were used to find any significant association between age and knowledge score.

3. RESULTS:

3.1 Participant demographic data:

Out of total 308 subjects, 193 (62.66%) subjects were males with a mean age of 45.61±8.33 years, and 115 (37.34%) were female with a mean age of 44.69±8.36 years. The age of participants with 21 and 60 years becoming the youngest and oldest respectively. One hundred and ninety-eighth (64.29%) were government school PET, and one hundred ten (35.71%) were private school PET.

3.2 Assessment of knowledge towards Doping:

Table 1 describes the responses of the participants towards doping knowledge. Knowledge was assessed using a WADA-validated questionnaire focusing on Doping, prohibited list, sample analysis, and supplements. If the response was "know," one point was awarded, and if the answer was "do not know," zero points were awarded. The scoring range of the questionnaire was 15 (maximum) to 0 (minimum). PET should get a 100% score, but still, we have taken 50% score for acceptable minimum requirement but considering that minimum score also there was statistically significant difference, the score pitched by the PET's is significantly less compared to expected score, one-sample proportion test were used for this analysis. Doping knowledge of 308 PET, 268 PET has Poor knowledge (87%), 27 PET has Intermediate knowledge (9%), and 13 High knowledge (4%).

Table 1: Responses to doping knowledge items

Question	Question	Correct Responses n (%)	t-statistics p-value	Female gender	Fisher's extract test
Q1	What is doping?	125 (40)	<0.0001*	76 (66)	<0.0001
Q2	Why is doping banned?	89 (29)	<0.0001*	50 (43)	<0.0001
Q3	How do I know if a substance is permitted?	88 (28)	<0.0001*	51 (44)	<0.0001
Q4	How can you tell if nutritional supplements are safe to use?	84 (27)	<0.0001*	54 (47)	<0.0001
Q5	Can I be tested?	74 (24)	<0.0001*	43 (37)	<0.0001
Q6	What are the sanctions if I get caught doping?	79 (26)	<0.0001*	44 (38)	<0.0001
Q7	Can my coach or doctor be sanctioned?	77 (25)	<0.0001*	45 (39)	<0.0001
Q8	Who is responsible when a substance is found in an athlete's body?	62 (20)	<0.0001*	36 (31)	<0.0001
Q9	What if my physician has to treat me with some medicine?	75 (24)	<0.0001*	47 (41)	<0.0001
Q10	Can my coach or someone I choose come with me to the doping control station?	60 (19)	<0.0001*	42 (37)	<0.0001
Q11	Who is allowed to perform a doping control?	60 (19)	<0.0001*	40 (35)	<0.0001
Q12	Can doping have an impact on my growth?	63 (20)	<0.0001*	38 (33)	<0.0001
Q13	Can I refuse to be tested?	62 (20)	<0.0001*	36 (31)	<0.0001
Q14	Where can I find reliable information about anti-doping?	48 (16)	<0.0001*	27 (23)	<0.01
Q15	How does doping control happen?	56 (18)	<0.0001*	21 (27)	<0.0001

The Hypothesis score was set at a minimum of 50%, a score of 7 out of 15 questions per candidate. It was (Figure 2) found to be statistically significantly different (p<0.000) with a 95% confidence level. Undoubtedly, most of the participants (87%) were significantly lesser than 50%.

Figure 2: PET knowledge score (Ho-Hypothesis)

Among the 308 participants, despite having similar mean age between the genders recruited (approx. 45 years) and being less in number (37.34%), the knowledge score was comparatively higher in female participants. It was also found to be statistically significant (p<0.0001) on Fisher's extract test with a 95% confidence level (Figure 3).

Figure 3: Gender knowledge score

It was noted that the Government school have more number physical education teachers above the age of 41 years as compared to private schools, which was found to be statistically significant (p<0.001) with a 95% confidence level (Figure 4 and Figure 5). There can be a possibility that government and Private school teachers might have different experience due to the difference in the environment, so we hunted to find any difference between their knowledge scores. However, we could not find any statistically significant difference (p>0.05) between the scores of government school teachers versus private school teachers on the Kruskal-Wallis Test.

Figure 4: PET Summary report for age

Figure 5: PET responses age by government school

The estimate for the difference between the Government and private schools is about -3.460 with 95% CI for difference: (-5.384, -1.536). The higher age group works in government schools. The difference in the mean age between the Government and private schools is statistically significant (P=0.00) with a T-Value of -3.54, and the degrees of freedom is 306. Usually, with experience, the knowledge gets better, and on the other hand, the more the age is, the better the experience is. So, we have also tried to analyze whether age impacted their knowledge score (Figure 6). Surprisingly, we found that the responder's age does not affect knowledge score (P>0.05).

Figure 6: Age>40 and knowledge score

4. DISCUSSION:

4.1 Doping Knowledge among PET's:

The purpose of this cross-sectional research was to assess PET's doping knowledge. PETs are considered powerful influencing elements in the regulation of children's attitudes and behaviors and a good source of knowledge transmission. As a result, they should be included in doping prevention educational programs. WADA questionnaires were utilized to gather responses in this investigation. 14 of the 15 questions received less than 30% of the total answer rate. Overall, the majority of PETs had a low rate of correct doping knowledge answers 87%. In terms of the specific items, Question 1 states that all PETs should be aware of what constitutes Doping, nevertheless, the accurate response score was just 40%. Dietary supplements are becoming more popular among athletes. Positive doping tests caused to the use of any supplement containing WADA prohibited component ^13,14. In Question 4, Only 27% of PETs knew about the supplement. This highlights the need to educate PETs on Doping, nutritional supplements, and anti-doping education to prevent Doping at the grassroots level.

4.2 The relationship between PET's demographics and doping knowledge:

Gender showed a statistically significant association with PET doping knowledge in this investigation. Although the number of females practicing sports is lower than males ¹⁵, Male individuals had a higher range than female participants out of 308 respondents. In contrast, female participants had a better knowledge score than male participants. Knowledge increases with experience, and on the other hand, the more experience you have, the better. As a result, we attempted to determine whether their age influenced their knowledge score. Surprisingly, we discovered that the respondent's age had no bearing on their knowledge score. We noticed that government schools had a more significant percentage of physical education teachers older than private schools; therefore, we looked for differences in their knowledge scores. However, we were unable to detect a statistically significant difference between the ratings of government and private school teachers.

5. CONCLUSION:

Results from the present study have enlightened the insufficient knowledge of PET towards Doping. Physical education teachers play a vital role in training and mentoring the young population for sports at the school level. Training physical education teachers in Doping will help create awareness and sustainable education about anti-doping practices among children.

6. STUDY LIMITATIONS:

The study was only done in one city; therefore, the findings do not apply to the entire PET of India. It is also potential that only a limited sample size cannot be generalized to the entire country. Furthermore, the study's cross-sectional design was linked to social desirability bias.

7. CONFLICT OF INTEREST:

The authors have disclosed no conflicting interests. No funding was provided for this study.

8. ACKNOWLEDGMENT:

World Anti-Doping Agency for proving the questionnaires. The authors express their gratitude to the people who took part in the research.

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Received on 15.09.2021 Modified on 23.10.2021

Research J. Pharm.and Tech 2021; 14(12):6587-6591.

DOI: 10.52711/0974-360X.2021.01139