Peer Education Reduces Risks

By Staff

Coaching Management, 13.5, April 2005,

When adolescents want information or advice, where do they turn? Although adults might wish for a different answer, it’s usually to their peers. A new program for teenage female student-athletes uses that fact to its advantage, and according to a recent study, it’s seeing great results.

A study published in the November issue of the Archives of Pediatrics and Adolescent Medicine showed that a group of high school athletes who took part in a program called ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) as part of their sport season were significantly less likely to participate in unhealthy behaviors. They were less likely to start using diet pills, amphetamines, anabolic steroids, or muscle-building supplements; drive with someone who had been drinking; become sexually active; use tobacco; or vomit to lose weight. And they were more likely to engage in healthy eating and strength training. They also proved less prone to injury during their season.

The study was conducted by ATHENA’s developers, a team of researchers at Oregon Health & Science University, on 928 athletes from 40 teams at 18 Washington and Oregon high schools. Before starting the program, student-athletes took anonymous questionnaires to assess their attitudes and behaviors. After completing the program, they took the questionnaires again—with very different results.

To develop ATHENA, the researchers started with the framework for ATLAS, a similar curriculum that has been successful in reducing anabolic steroid use among male student-athletes. However, ATHENA targets issues specifically affecting adolescent girls, such as eating disorders, diet pill use, body dissatisfaction, drug use, depression, and the media’s portrayal of women. Rather than preaching or using scare tactics, the program focuses on providing accurate information and uses improved athletic performance as motivation for encouraging healthy choices.

"When it comes to nutrition, nowhere in the program does it say, ‘Don’t take diet pills and don’t make yourself vomit,’" says Diane Elliot, a researcher with the Division of Health Promotion and Sports Medicine at Oregon Health & Science and one of the program’s creators. "Instead, we put it in performance terms: How much protein and carbohydrate do you need to fuel your engine for practice?"

To help girls deconstruct media portrayals of women, student-athletes are asked to look at specific print and television advertisements and discuss whether the women they portray have healthy, realistic body shapes and sizes. Then they are asked to re-make the ads in a way that reflects a healthy lifestyle.

To address the increased risk of depression faced by females, athletes learn a technique called "cognitive restructuring" which teaches them to make connections between their thoughts and their moods by keeping logs. "Once they make connections between their thoughts, emotions, and activities, they can avoid getting caught in a spiral of depression," Elliot says. "Again, we cast it in performance terms. We talk about how working on your own psychology can make you a better athlete and help your team."

The program consists of eight 45-minute sessions designed to be conducted once a week during a team’s season. A coach or assistant coach is in charge of the program and commits to being present for each session. However, the responsibility for running the program largely falls to the athletes themselves. Members of junior varsity and varsity squads work together, divided into small groups of about six athletes each. The coach chooses a squad leader for each group and helps the team get started and stay on track, but beyond that, athletes run the activities.

"There is no preparation required for coaches or squad leaders," says Elliot. "They open the page and they’re ready to go.

"Peer-led programs work for high schoolers because they are affected more by peers and less by teachers," Elliot continues. "Part of the developmental task of becoming an adolescent is pulling away from adults. Sports teams are a natural place to implement a program of this type because the athletes are already bonded as a team—these are the peers they already turn to for information and advice."

Annette Gaston, former Head Volleyball Coach at La Center (Wash.) High School, administered the program to her teams for four years, running the sessions after practices on Fridays. "All I did was basically oversee and lead them a little bit into their discussion," she says. "Then the student-leaders would take control and work with their group. It was really easy to do."

Gaston believes the program produced real results for her athletes. "How many times during high school do girls hear, ‘Don’t’ and ‘You can’t’?" she says. "Teenagers tend to tune that message out. This program gives them facts instead. A lot of young female athletes have never been told what diet pills and other drugs do in the body. When they do get the correct information, they are more likely to make good decisions on their own."

Conducting the program can be rewarding for coaches, too. "They get to see the kids do skits and activities and they get to know them in a whole different way," Elliot says. "Coaches told us it made them feel very positive about what they were doing."

For more information or to order ATHENA, visit: To read the text of the study, go to: