It’s a new twist on the phrase, “Just Say No.” Mix health education with sports, and young female athletes will turn away from eating disorders, drug abuse, and risky living, new research shows.

A high school program — piloted in Portland, Ore., — has helped female athletes say no to diet pills, laxatives, forced vomiting, body-building steroids, alcohol, smoking, and more. It’s also helped boost their self-esteem, and shown them how to beat depression.

“We’ve helped them learn to make connections between how they feel and what they do… that’s big for girls,” researcher Diane L. Elliot, MD, a professor of health promotion and sports medicine at Oregon Health & Science University in Portland, tells WebMD.

Her report appears in the latest issue of Archives of Pediatric and Adolescent Medicine.

Some 50 percent of high school kids participate in school sports. Yet, contrary to popular belief, young female athletes are vulnerable — like any teen girl is — to eating disorders and substance abuse, including smoking, diet pills, diuretics, laxatives, amphetamines, and anabolic steroid use, writes Elliot.

A program launched in the 1990s, to turn teen boys against bodybuilding steroids, showed that teens listen to health education when sports performance is the focus, she says. It was called ATLAS (Adolescents Training and Learning to Avoid Steroids).

That highly successful effort provided the model for Elliot’s program. “But ours couldn’t be ATLAS in skirts. We had to tailor it to girls’ specific needs,” she tells WebMD.

Preventing Eating Disorders

Elliot’s program involved 18 public high schools in northwest Oregon and southwest Washington, with 928 girls participating in 40 different sports teams. All were about 15 years old.

Half participated in health education programs in addition to their regular sports training. The rest continued their regular sports training.

The eight-week program involved 45-minute health education sessions every week. The coach was an integral part, fitting the sessions into the girls’ training schedule. But the girls themselves took charge of the health education sessions.

Each week, the teams broke into small groups; one girl took the lead as teacher. “We know that peer teaching works best in teen prevention programs like this,” says Elliot. “And the all-girl format helps boost self-esteem. Starting in middle school, boys demand more of a teacher’s time, so girls become less assertive.”

Better sports performance — the natural way — was the message for these female athletes.

“We talked about healthy nutrition, how your body needs protein, calcium, carbohydrates so you can perform better, build muscles, bones, be a better team,” says Elliot. “We didn’t use calorie goals, because we recognize that girls can get fixated on calories.”

Alcohol, diet pills, and self-induced vomiting were also discussed — but in terms of their effect on muscles, hydration, heart, and stamina during performance.

The topic of depression also came up, since women and girls are more at risk. “Depression is also a big risk factor for drug use,” says Elliott. In addition, these female athletes learned about how the media represent women, “that [they are] not healthy, realistic images.”

The result: use of diet pills and bodybuilding supplements decreased among the young female athletes on the program. Girls had more knowledge of the immediate effects of drugs. Girls were also better able to control their emotions. And they had better insights into media advertising, so they were less manipulated.

Next: Female Athletes and Their Coaches

After graduation, Elliott and her colleagues mailed surveys to each of the female athletes. The majority was still using the skills it had learned — decision making, ability to control emotions, and insight into the media, she tells WebMD.

“There was less alcohol use, less marijuana use among girls in the experimental program, which was what we’d hoped for,” she says. “As far as disordered eating, there was a very low percentage in all the girls. Once they get out of school, it becomes less of an issue.”

Female Athletes and Their Coaches

Jorge E. Gomez, MD, professor of pediatrics at the University of Texas Health Science Center in San Antonio, wrote an editorial about Elliot’s study.

“It’s a dilemma that a lot of high school girls, especially female athletes, find themselves in — there’s a lot of pressure to be thin,” Gomez tells WebMD.

“Pressure comes not only from peers, from the media, but also from well-meaning coaches,” says Gomez. “There’s a myth that if you have an athlete performing at a certain level, you can put them at a higher level if you just make them thinner. That myth is wrong. There is no evidence, certainly no concrete evidence, that that’s true. But it continues to be something that high school athletes, more so than college athletes, run into.”

A young female athlete might even be threatened with losing her spot on a team if she doesn’t make a certain weight, he notes. “In a sport like softball, what does it matter how much she weighs? Sometimes it’s taken to that extreme.

“Under no circumstances should weight be a performance criterion, except in sports like wrestling where it really does make a difference,” Gomez says.

Health education in training programs — as Elliot shows — is a great idea. “A lot depends on how this information is portrayed to girls,” Gomez tells WebMD. “It’s really astonishing that these high school coaches voluntarily gave up 45 minutes of practice time. It shows that most coaches are genuinely interested in the welfare of high school athletes, and are very willing to learn about health issues. Most of these coaches are very well intentioned.”

By Jeanie Lerche Davis, reviewed by Charlotte E. Grayson, MD

SOURCES: Elliot, D. Archives of Pediatric Adolescent Medicine, Nov. 2004; vol 158: pp 1043-1049. Diane L. Elliot, MD, professor of health promotion and sports medicine, Oregon Health & Science University, Portland, Ore. Jorge E. Gomez, MD, professor of pediatrics, University of Texas Health Science Center, San Antonio.