Psychosocial predictors of doping intentions and use in sport and exercise: a systematic review and meta-analysis.

OBJECTIVE: To conduct a meta-analytic review of psychosocial predictors of doping intention, doping use and inadvertent doping in sport and exercise settings. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Scopus, Medline, Embase, PsychINFO, CINAHL Plus, ProQuest Dissertations/Theses and Open Grey. ELIGIBILITY CRITERIA: Studies (of any design) that measured the outcome variables of doping intention, doping use and/or inadvertent doping and at least one psychosocial determinant of those three variables. RESULTS: We included studies from 25 experiments (N=13 586) and 186 observational samples (N=3 09 130). Experimental groups reported lower doping intentions (g=-0.21, 95% CI (-0.31 to -0.12)) and doping use (g=-0.08, 95% CI (-0.14 to -0.03), but not inadvertent doping (g=-0.70, 95% CI (-1.95 to 0.55)), relative to comparators. For observational studies, protective factors were inversely associated with doping intentions (z=-0.28, 95% CI -0.31 to -0.24), doping use (z=-0.09, 95% CI -0.13 to to -0.05) and inadvertent doping (z=-0.19, 95% CI -0.32 to -0.06). Risk factors were positively associated with doping intentions (z=0.29, 95% CI 0.26 to 0.32) and use (z=0.17, 95% CI 0.15 to 0.19), but not inadvertent doping (z=0.08, 95% CI -0.06 to 0.22). Risk factors for both doping intentions and use included prodoping norms and attitudes, supplement use, body dissatisfaction and ill-being. Protective factors for both doping intentions and use included self-efficacy and positive morality. CONCLUSION: This study identified several protective and risk factors for doping intention and use that may be viable intervention targets for antidoping programmes. Protective factors were negatively associated with inadvertent doping; however, the empirical volume is limited to draw firm conclusions.

Morality- and Norm-Based Subgroups of Disability-Sport Athletes Differ on Their Anticipated Guilt and Intentions Toward Doping.

The purpose of this study was to examine whether subgroups of disability-sport athletes exist on morality- and norm-based doping cognitions and whether these groups differ in anticipated guilt or doping intentions. A survey was completed by 186 athletes (Mage = 37.5 years, 78.0% male, 45.1% wheelchair basketball) assessing norms, doping moral disengagement, anticipated guilt, and intentions to dope. Cluster analysis revealed four distinct subgroups of athletes, including one potentially high-risk subgroup characterized by relatively high scores on doping moral disengagement, subjective norms, and descriptive norms. One-way analysis of variance revealed significantly lower anticipated guilt in two athlete subgroups characterized by relatively higher doping moral disengagement than the other two subgroups. Moreover, the potentially high-risk group had a greater proportion of athletes showing some presence of intention to dope. This study suggests there is a small subgroup of disability-sport athletes at elevated risk of doping who might benefit from targeted antidoping interventions.

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study.

BACKGROUND: This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships. METHODS: An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16-88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted. RESULTS: Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media. CONCLUSIONS: The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network.

BACKGROUND: The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. METHODS: A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK academics or within the UK were eligible, if published in the previous five years. RESULTS: In total 87 eligible outputs were identified, including 26 review articles, 25 qualitative papers and 24 quantitative papers. together with small numbers of clinical studies/case reports (6) and commentaries/correspondence (6). The most common topics of research were public health, treatment and harm reduction (41), followed by studies focusing on epidemiology, sub-groups of people using IPEDs and motivations for use (34). The studies illustrated the diverse populations of people who use a range of enhancement drugs including concomitant psychoactive drug use. A number of papers focused on blood borne viruses and associated issues, while others reported on the uptake of needle and syringe programmes. No effectiveness evaluations related to any aspect of treatment, harm reduction or other intervention were published during study period. CONCLUSION: There is a need for the development of effectiveness evaluations of current interventions and any future service provision for people using image and performance enhancing drugs. While there have been no studies of this nature to date, this review illustrates the rich data that has been gathered through diverse methodologies, that will assist in the development of future effectiveness evaluations.

"Beyond the Rink": A Multilevel Analysis of Social Identity Behaviors Captured Using the Electronically Activated Recorder.

This study used ecological sampling methods to examine associations between youth athletes' experiences receiving and engaging in behaviors indicative of in-group ties, cognitive centrality, and in-group affect (i.e., social identity) during a 3-day competitive ice hockey tournament. Forty-five youth (Mage = 12.39 years; SDage = 1.14 years; 94% male) from nine teams wore an electronically activated recorder that captured brief (50-s) audio observations throughout the tournament. Participants also completed daily diary questionnaires for each day of competition. Multilevel structural equation modeling demonstrated that athletes were more likely to engage in behaviors indicative of in-group affect and cognitive centrality on days when they received as higher-than-average frequency of behaviors indicative of cognitive centrality from teammates, coaches, and parents. The findings suggest that when team members interact in ways that demonstrate they are thinking about their team, they influence fellow members to behave in ways that promote a sense of "us."

A Longitudinal Examination of the Relations Between Moral Disengagement and Antisocial Behavior in Sport.

Moral disengagement (MD) has been positively associated with antisocial behavior (AB) in sport. However, the longitudinal associations between MD and AB are unexamined to date. Adopting a three-wave cross-lagged panel design, the authors examined the reciprocal relations between MD and two forms of AB (i.e., toward opponents and teammates) across a competitive season with a sample of 407 team-sport athletes (Mage = 15.7 years) from Canada. Using structural equation modeling, the authors found strong positive autoregressive effects for MD and both forms of AB across both time periods. They also identified strong positive synchronous correlations between MD and both types of AB at each time point. Finally, cross-lagged effects were only found between MD and AB toward opponents; effects from MD to AB toward opponents were stronger than the reciprocal effects. These findings contribute important knowledge on the regulation of AB in sport.

Perceptions of coach doping confrontation efficacy and athlete susceptibility to intentional and inadvertent doping.

OBJECTIVES: We tested a conceptually grounded model linking athlete perceptions of strength and conditioning and technical coach doping confrontation efficacy (DCE) with athletes' doping self-regulatory efficacy (SRE), doping moral disengagement (MD), and susceptibility to intentional and inadvertent doping. DESIGN: Cross-sectional, correlational. METHODS: Participants were high-level athletes (nmale  = 532; nfemale  = 290) recruited in Australia (n = 261), the UK (n = 300), and the USA (n = 261). All participants completed questionnaires assessing the variables alongside a variant of the randomized response technique to estimate the prevalence of doping. RESULTS: The estimated prevalence of intentional doping in the sample was 13.9%. Structural equation modeling established: (a) perceptions of technical and strength and conditioning coaches' DCE positively predicted doping SRE; (b) doping SRE negatively predicted doping MD; (c) doping MD positively predicted susceptibility to intentional and inadvertent doping; and (d) the predictive effects of coach perceptions on susceptibility to doping were mediated by doping SRE and doping MD. Multisample analyses demonstrated these predictive effects were invariant between males and females and across the three countries represented. CONCLUSIONS: The findings show the conceptually grounded model to offer extended understanding of how multiple individuals within the athlete support personnel network may influence athlete doping.

Sport supplement use predicts doping attitudes and likelihood via sport supplement beliefs.

The aim of this study was to examine: 1) whether sport supplement use is related to doping and 2) whether sport supplement beliefs mediated this relationship. In Study 1, athletes (N = 598), completed measures of sport supplement use, sport supplement beliefs, and doping attitudes. In Study 2, athletes (N = 475) completed measures of sport supplement use, sport supplement beliefs, and doping likelihood. In both studies, sport supplement use predicted doping outcomes indirectly via sport supplement beliefs. Our findings provide novel evidence to suggest that sport supplement users, who strongly believe that sport supplements are effective, are more likely to dope. For anti-doping organisations wishing to prevent doping, targeting an athlete's beliefs about sport supplements may improve the effectiveness of anti-doping prevention programmes.

Disentangling the Relations between Social Identity and Prosocial and Antisocial Behavior in Competitive Youth Sport.

The social identities formed through membership on extracurricular activity groups may contribute to the frequency with which youth engage in prosocial and antisocial behavior. However, researchers have yet to disentangle the individual- and group-level processes social identification effects operate through; sex and perceived norms may also moderate such effects. Thus, we investigated the hierarchical and conditional relations between three dimensions of social identity (i.e., ingroup ties, cognitive centrality, ingroup affect) and prosocial and antisocial behavior in youth ice hockey players (N = 376; 33% female). Multilevel analyses demonstrated antisocial teammate and opponent behavior were predicted by cognitive centrality at the team level. Further, prosocial teammate behavior was predicted by cognitive centrality and ingroup ties at the individual-level. Also, perceived norms for prosocial teammate behavior moderated the relations between ingroup ties, cognitive centrality, and ingroup affect and prosocial teammate behaviour. Finally, sex moderated the relations between cognitive centrality/ingroup affect and antisocial opponent behavior. This work demonstrates the multilevel and conditional nature of how social identity dimensions relate to youth prosocial and antisocial behavior.

Examining social identity and intrateam moral behaviours in competitive youth ice hockey using stimulated recall.

Social identity - identity formed through membership in groups - may play an important role in regulating intrateam moral behaviour in youth sport (Bruner, M. W., Boardley, I., & Côté, J. (2014). Social identity and prosocial and antisocial behavior in youth sport. Psychology of Sport and Exercise, 15(1), 56-64. doi:10.1016/j.psychsport.2013.09.003). The aim of this study was to qualitatively examine this potential role through stimulated recall interviews with competitive youth-ice-hockey players. Twenty-three players (Mage = 13.27 years, SD = 1.79) who reported engaging in high, median or low frequency of antisocial teammate behaviour (determined through pre-screening with the Prosocial and Antisocial Behaviour in Sport Scale [Kavussanu, M., & Boardley, I. D. (2009). The prosocial and antisocial behavior in sport scale. Journal of Sport and Exercise Psychology, 31(1), 97-117. doi:10.1123/jsep.31.1.97]) were recruited from eight youth-ice-hockey teams in Canada. Interviews involved participants recalling their thoughts during prosocial/antisocial interactions with teammates, prompted by previously recorded video sequences of such incidents. Thematic analysis of interview data revealed all athletes - regardless of reported frequency of intrateam antisocial behaviour - felt prosocial interactions with teammates enhanced social identity. In contrast, the perceived influence of antisocial teammate behaviour on social identity differed depending on athletes' reported frequency of intrateam antisocial behaviour; those reporting low and median frequencies described how such behaviour undermines social identity, whereas athletes reporting high frequency did not perceive this effect. The study findings highlight the potential importance of intrateam moral behaviour and social identity for youth-sport team functioning.

Linking Narcissism, Motivation, and Doping Attitudes in Sport: A Multilevel Investigation Involving Coaches and Athletes.

Research on coaching (Bartholomew, Ntoumanis, & Thøgersen-Ntoumani, 2009) has shown that coaches can display controlling behaviors that have detrimental effects on athletes' basic psychological needs and quality of sport experiences. The current study extends this literature by considering coach narcissism as a potential antecedent of coaches' controlling behaviors. Further, the study tests a model linking coaches' (n = 59) own reports of narcissistic tendencies with athletes' (n = 493) perceptions of coach controlling behaviors, experiences of need frustration, and attitudes toward doping. Multilevel path analysis revealed that coach narcissism was directly and positively associated with athletes' perceptions of controlling behaviors and was indirectly and positively associated with athletes' reports of needs frustration. In addition, athletes' perceptions of coach behaviors were positively associated-directly and indirectly-with attitudes toward doping. The findings advance understanding of controlling coach behaviors, their potential antecedents, and their associations with athletes' attitudes toward doping.

When do normative beliefs about aggression predict aggressive behavior? An application of I3 theory.

I(3) theory assumes that aggressive behavior is dependent on three orthogonal processes (i.e., Instigator, Impellance, and Inhibition). Previous studies showed that Impellance (trait aggressiveness, retaliation tendencies) better predicted aggression when Instigator was strong and Inhibition was weak. In the current study, we predicted that another Impellance (i.e., normative beliefs about aggression) might predict aggression when Instigator was absent and Inhibition was high (i.e., the perfect calm proposition). In two experiments, participants first completed the normative beliefs about aggression questionnaire. Two weeks later, participants' self-control resources were manipulated either using the Stroop task (study 1, N = 148) or through an "e-crossing" task (study 2, N = 180). Afterwards, with or without being provoked, participants played a game with an ostensible partner where they had a chance to aggress against them. Study 1 found that normative beliefs about aggression negatively and significantly predicted aggressive behavior only when provocation was absent and self-control resources were not depleted. In Study 2, normative beliefs about aggression negatively predicted aggressive behavior at marginal significance level only in the "no-provocation and no-depletion" condition. In conclusion, the current study provides partial support for the perfect calm proposition and I(3) theory.

Changes in task self-efficacy and emotion across competitive performances in golf.

This research aimed to investigate (a) the effect of golfers' perceptions of coach motivation efficacy on golfers' precompetition task self-efficacy, (b) the effect of performance on pre-to-postround changes in self-efficacy, (c) the effect of pre-to-postround changes in self-efficacy on pre-to-postround changes in affect and emotion, and (d) whether any effects of performance on pre-to-postcompetition changes in affect and emotion were mediated by pre-to-postcompetition changes in self-efficacy. In Study 1, a scale measuring golf self-efficacy was developed and validated using data from 197 golfers. In Study 2, 200 golfers completed this measure alongside measures of coach motivation efficacy, and positive and negative affect before a golf competition; all measures (except coach motivation efficacy) were again completed following the competition. Structural equation modeling showed that coach motivation efficacy positively predicted precompetition self-efficacy, performance positively predicted pre-to-postcompetition changes in self-efficacy, which had positive and negative effects, respectively, on pre-to-postcompetition changes in positive and negative affect; mediation analyses demonstrated that pre-to-postcompetition changes in self-efficacy mediated effects of performance on pre-to-postcompetition changes in positive and negative affect. In Study 3, the Study-2 procedures were replicated with a separate sample of 212 golfers, except measures of excitement, concentration disruption, somatic anxiety, and worry replaced those for positive and negative affect. Structural analyses showed the findings from Study 2 were largely replicated when specific emotions were investigated in place of general indices of affect. This investigation makes novel contributions regarding the potential importance of perceptions of coach efficacy for golfers' own efficacy beliefs, and the role personal efficacy beliefs may play in facilitating the effects of performance on affective outcomes.

Moral disengagement and associated processes in performance-enhancing drug use: a national qualitative investigation.

This study investigated psychosocial processes associated with avoidance of health- and morality-based deterrents to performance-enhancing drug (PED) use. In-depth semi-structured interviews were conducted with 64 English male bodybuilders with experience of doping. Resultant data were content analysed deductively using definitions for the eight mechanisms of moral disengagement (MD; Bandura, A. (1991). Social cognitive theory of moral thought and action. In W. M. Kurtines & J. L. Gewirtz (Eds.), Handbook of moral behavior and development: Theory research and applications (pp. 71-129). Hillsdale, NJ: Lawrence Erlbaum Associates.), and three further themes from Boardley and Grix (2013. Doping in bodybuilders: A qualitative investigation of facilitative psychosocial processes. Qualitative Research in Sport, Exercise, and Health. Advance online publication, doi 10.1080/2159676X.2013.766809). These analyses evidenced six MD mechanisms, and all three of the themes from Boardley and Grix (2013. Doping in bodybuilders: A qualitative investigation of facilitative psychosocial processes. Qualitative Research in Sport, Exercise, and Health. Advance online publication). Subsequent frequency analyses revealed six of the eight MD mechanisms, and two of the three additional themes, were common across the sample. Overall, the findings suggest MD may help athletes circumvent health- and morality-based deterrents to doping, describe a process linking supplement and PED use and detail how some athletes may actively avoid social censure for doping by only discussing PED use with other PED users from within their training environment.

Development and validation of dependence and craving measures specific to athletes who use anabolic-androgenic steroids.

Background: Anabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving. Methods: Data were collected from male and female strength athletes who use AAS across two samples (n sample 1 = 206; n sample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments. Results: Exploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales. Conclusion: The AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS.

Barriers and enablers in doping, anti-doping, and clean sport: A qualitative meta-synthesis informed by the theoretical domains framework and COM-B model.

To protect the integrity of sport, and the health of athletes, global anti-doping programmes seek to prevent doping, and elicit anti-doping and clean sport behaviours, through education, deterrence, detection, enforcement, and rules. To guide programme development, this meta-synthesis of qualitative research applied a behavioural science framework to identify barriers and enablers to doping, anti-doping, and clean sport. A systematic search of electronic databases up to May 2022, followed by critical appraisal, resulted in 73 included articles. Fifty-two articles reported the athlete perspective, thirteen included athletes, athlete support personnel (ASP), and other experts, and eight focused on ASP only. Rigorous methods of thematic synthesis were drawn upon to construct analytical themes in line with the theoretical domains framework (TDF) and the capability, opportunity, and motivation model of behaviour (COM-B). A wide range of barriers and enablers were identified which influenced capability, opportunity, and motivation to participate in a clean sport environment. The weight of evidence pointed to limitations in the current anti-doping education system in providing athletes and ASP with the knowledge and skills to protect against doping, as well as the significant influence of social and cultural norms in shaping doping and clean sport behaviours through a shared social identity, and risky contexts leading to moments of vulnerability to doping. We identified a need for anti-doping programmes to move beyond the current focus on athlete capability, and address the opportunity and motivation components of clean sport behaviours through a targeted and tailored focus on education, training, persuasion, modelling and environmental restructuring interventions.

The Prosocial and Antisocial Behaviour in Sport Scale: further evidence for construct validity and reliability.

The purpose of this research was to provide further evidence for the construct validity (i.e., convergent, concurrent, and discriminant validity) of the Prosocial and Antisocial Behaviour in Sport Scale (PABSS), an instrument that has four subscales measuring prosocial and antisocial behaviour toward teammates and opponents. We also investigated test-retest reliability and stability of the PABSS. We conducted three studies using athletes from a variety of team sports. In Study 1, participants (N = 129) completed the PABSS and measures of physical and verbal aggression, hostility, anger, moral identity, and empathy; a sub-sample (n = 111) also completed the PABSS one week later. In Study 2, in addition to the PABSS, participants (N = 89) completed measures of competitive aggressiveness and anger, moral attitudes, moral disengagement, goal orientation, and anxiety. In Study 3, participants (N = 307) completed the PABSS and a measure of social goals. Across the three studies, the four subscales evidenced the hypothesised relationships with a number of variables. Correlations were large between the two antisocial behaviours and small between the two prosocial behaviours. Overall, the findings supported the convergent, concurrent, and discriminant validity of the scale, provided evidence for its test-retest reliability and stability, and suggest that the instrument is a valid and reliable measure of prosocial and antisocial behaviour in sport.

Bracketed morality revisited: how do athletes behave in two contexts?

The concept of bracketed morality has received empirical support in several sport studies (e.g., Bredemeier & Shields, 1986a, 1986b). However, these studies have focused on moral reasoning. In this research, we examined bracketed morality with respect to moral behavior in sport and university contexts, in two studies. Male and female participants (Study 1: N = 331; Study 2: N = 372) completed questionnaires assessing prosocial and antisocial behavior toward teammates and opponents in sport and toward other students at university. Study 2 participants also completed measures of moral disengagement and goal orientation in both contexts. In most cases, behavior in sport was highly correlated with behavior at university. In addition, participants reported higher prosocial behavior toward teammates and higher antisocial behavior toward opponents in sport than toward other students at university. The effects of context on antisocial behavior were partially mediated by moral disengagement and ego orientation. Our findings extend the bracketed morality concept to prosocial and antisocial behavior.

Measuring sport fantasy proneness and deflated reality in sport and performance: Development and validation of two context-specific instruments.

Fantasy-prone personalities and generalized states of pessimism and hopelessness have been linked to various behavioural, cognitive, and health related outcomes in the general population. Nevertheless, to date, knowledge of sport-specific fantasy proneness and athletes' perception of deflated reality in sport is scarce, possibly due to a lack of appropriate psychometric instruments to examine these two important context-specific constructs. In this research, we developed the Sport Fantasy Proneness Scale (SFPS) and the Deflated Reality in Sport Scale (DRSS), first assessing the content validity of items for the instruments following a rigorous process. Through two cross-sectional samples (Study 1: Sample 1 N = 255, Sample 2 N = 260) and one longitudinal sample (Study 2: Sample 3 N = 118) of competitive athletes in the UK, we then examined factorial, convergent, discriminant, and concurrent validity and measurement invariance (Study 1), as well as internal consistency, and test-retest reliability (Study 2) of the two new scales. Results revealed robust construct validity and reliability of scores on the two instruments and suggested very good invariance when implementing the new scales to athletes from different sports and competitive levels and good invariance for cross-gender comparisons. The new scales fill a gap in the sport psychology literature and provide researchers and practitioners with robust psychometric instruments to examine new research questions and tackle issues relevant to athletes' sport-specific fantasy proneness and perceptions of deflated reality.

Doping in Paralympic sport: perceptions, responsibility and anti-doping education experiences from the perspective of Paralympic athletes and parasport coaches.

Introduction: Limited effort has been invested in understanding doping in Paralympic sport. The limited evidence that exists suggests that factors influencing doping in parasport are similar to Olympic sport. However, based on the design and nature of the previous studies, where methods have been mostly limited to qualitative data and prevalence numbers, further research is warranted to extend previous findings. Methods: Informed by current evidence from Paralympic and Olympic sport, we aimed to investigate (1) para-athletes' perceptions of Anti-Doping Rule Violations (ADRVs) and responsibility for them, (2) descriptive norms for doping in parasport (3) perceptions of anti-doping education and legitimacy of anti-doping authorities, and (4) coach engagement in doping prevention and levels of doping confrontation efficacy using a quantitative survey approach. Results: In total, valid survey responses from 126 Paralympic athletes and 35 coaches from four countries (Germany, Austria, Switzerland, UK) were analysed for experience with anti-doping, descriptive norms, anti-doping education, perceived legitimacy, knowledge, and doping confrontation efficacy (coaches only). Across both athletes and coaches, the level of education was generally good and doping willingness was low. Classification cheating was considered a form of doping and seems to be an important issue for athletes and coaches, especially within the UK sample. For 33.3% of the athletes, doping control was their first experience with anti-doping. Coaches' engagement with doping prevention activities and their perceived efficacy to confront doping-related matters appears to be higher compared to Olympic coaches' samples. Discussion: Sport organisations/NADOs in Paralympic sport could use synergies with those organisations in Olympic sport, adopting similar approaches to anti-doping education, also focusing on a balanced communication of doping prevalence numbers and testing figures. Efforts to ensure athletes are educated about anti-doping before they are tested should be upheld. It seems that in para sport, different compared to able-bodied coaches, anti-doping organizations do not have to convince the coaches about their roles (i.e., being responsible for anti-doping education) anymore but can directly build on these resources. Overall, it seems that there are few differences between parasport and able-bodied sports and thus responsible organisations could use the existing programmes in Olympic sport and only adapt special content (e.g., boosting) which is unique to Paralympic athletes.