A mediation analysis of the ATHENA intervention for female athletes: prevention of athletic-enhancing substance use and unhealthy weight loss behaviors

J Pediatr Psychol. Nov-Dec 2009;34(10):1069-83. doi: 10.1093/jpepsy/jsp025. Epub 2009 Apr 22.


Objective: To explain, through mediation analyses, the mechanisms by which ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives), a primary prevention and health promotion intervention designed to deter unhealthy body shaping behaviors among female high school athletes, produced immediate changes in intentions for unhealthy weight loss and steroid/creatine use, and to examine the link to long-term follow-up intentions and behaviors.

Methods: In a randomized trial of 1668 athletes, intervention participants completed coach-led peer-facilitated sessions during their sport season. Participants provided pre-test, immediate post-test, and 9-month follow-up assessments.

Results: ATHENA decreased intentions for steroid/creatine use and intentions for unhealthy weight loss behaviors at post-test. These effects were most strongly mediated by social norms and self-efficacy for healthy eating. Low post-test intentions were maintained 9 months later and predicted subsequent behavior.

Conclusions: ATHENA successfully modified mediators that in turn related to athletic-enhancing substance use and unhealthy weight loss practices. Mediation analyses aid in the understanding of health promotion interventions and inform program development.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Athletic Performance
  • Basketball / psychology
  • Body Image
  • Creatine
  • Doping in Sports / prevention & control*
  • Feeding and Eating Disorders / prevention & control*
  • Female
  • Health Education*
  • Humans
  • Longitudinal Studies
  • Models, Psychological
  • Outcome and Process Assessment, Health Care
  • Peer Group
  • Self Efficacy
  • Soccer / psychology
  • Social Values
  • Sports / psychology*
  • Steroids
  • Volleyball / psychology
  • Weight Loss*


  • Steroids
  • Creatine