The results of the 2001 NCAA Study of Substance Use Habits of College Student-Athletes are in, containing responses from more than 21,000 student-athletes across all three divisions and encompassing athletes competing in 36 men's and women's sports.

More than 700 institutions participated in the survey that tried to reach up to 12 percent of the student-athletes of each sport. While this survey has been performed every four years since 1985, this is by far the largest number of athletes surveyed.

While the final document is almost 50 pages in length, there are a few key points that in the report that need emphasis, including the increased number of women who are participating in NCAA sports. In the 1997 survey, 33 percent of the respondents were women, compared with 38 percent in the current survey. While the increased participation of women is encouraging, it led to some ominous findings.

Almost every women's sport reported an increase in ergogenic (performance-enhancing) drugs as compared to 1997. This was especially true with substances such as ephedrine and amphetamines.

We need to be especially aware of this type of drug use in sports where thinness is encouraged. As an example, women's gymnastics reported that the use of ephedrine went from 1.1 percent to 8.3 percent during the previous four-year period. Ephedrine is banned by the NCAA and has potentially dangerous side effects, especially when used in connection with weight-loss programs. All coaches should be aware of ephedrine use, which can be found in many over-the-counter dietary supplements.

One of the most striking findings in the survey was when most drug use begins. Except for crack/cocaine, the majority of drug use begins in high school. This is important for educators because patterns of use may already be established when an athlete enrolls in college.

The role of primary prevention -- preventing someone from using for the first time -- is minimal in college, and the focus should be on changing behavior in terms of substance use. In addition, education about substance abuse should begin in the recruiting process. It is a difficult area to approach, but it may help in the long run if it is addressed early.

For the first time, the survey looked at the use of nutritional supplements. We found that 42 percent of student-athletes had used supplements in the previous year, with creatine, protein powders and amino acids leading the way.

There was some good news from the survey, however. The use of spit or smokeless tobacco dropped to 17.4 percent, which continues a trend of diminishing use over the past 12 years.

Tobacco-education efforts have focused on spit tobacco. The NCAA bans the use of those products by athletes, coaches, officials and all personnel during competitions. Although more needs to be done, any reduction is welcome in this substance that is a leading cause of head and neck cancers.

The drug-use study is one of the more valuable tools the NCAA has at its disposal. It provides the best measure of athletes' substance use and abuse habits published anywhere in the world. Thanks to all of those who participated in this study, and to the NCAA research staff.

Gary Green is the team physician for the University of California, Los Angeles, in addition to being a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.