Attitudes and behavior related to performance-enhancing substance use among elite Saudi football players.

OBJECTIVE: To investigate the attitudes, beliefs and behavior related to performance enhancing substances (PES) use in elite Saudi football players. METHOD: A cross-sectional survey was conducted. Using a systematic random sample of elite Saudi male football players, the standard World Anti-doping Agency (WADA) Social Science Research Package questionnaire was distributed to 408 players. RESULTS: The overall prevalence rate of PES use was 3.9%, with the overall prevalence rate of doping susceptibility 17.1%. PES use or doping susceptibility is strongly correlated but negatively associated with morality and cheating measures (p <  0.011, the estimate is - 0.139), threat or deterrence appraisal (p <  0.001, the estimate is - 0.301) and beliefs about the reference group's endorsement (p < 0.001, the estimate is - 0.213) but not with legitimacy perceptions (p = 0.513) and beliefs about the benefits of doping (p = 0.678). The strongest relationship was found between threat or deterrence appraisal (p < 0.001), and beliefs about the reference group's endorsement of PES use (p < 0.001). CONCLUSION: Morality and cheating measures, threat or deterrence appraisal and beliefs about the reference group's endorsement are the main predictors for PES use in Saudi Arabia.