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21/523 Image and performance enhancing drugs commissioning brief


Prior to the advertisement of this brief, the Public Health Research (PHR) Programme ran an Application Development Award for this topic area. The aim of the award was to provide funding for underpinning development work that would add to the current knowledge base, and ultimately support and inform applications to this commissioned call. The link to the study page is here.

Research question(s)

What interventions are effective and cost effective to prevent and reduce the health harms caused by the use of image and performance enhancing drugs? Image and performance enhancing drugs (IPEDs) encompasses a wide range of substances including anabolic androgenic steroids (AAS) that are taken to alter body image and/or performance. IPEDs can be categorised based on their main reason for use. Examples include: to gain weight, to change the structure and function of muscle, to lose weight, to change the appearance of the skin, to improve sexual behaviour and function or cognitive function. Traditionally, IPED use was largely limited to participants of elite sports and body-building. However, the last decade has seen an unprecedented increase in their use across the adult population.

Significant developments in the understanding of issues in the area of IPED use (e.g., rapidly occurring changes in the types and use of IPEDs and the manner in which they are distributed) make them a key public health concern. Areas of concern (particularly related to users of anabolic androgenic steroids) include IPED use and:

  • The dangers inherent in injecting drug use
  • Multiple drug use including illegal psychoactive drug use
  • Other risk taking behaviours e.g. risky sexual behaviour
  • Uncertainty around established long-term effects including cardio-vascular, liver and brain effects

Easily available and often used alongside other medication and/or ‘traditional’ recreational drugs, recent primary research indicates that contrary to official figures, IPED use is now commonplace in the UK.

The features and nature of IPED use are complex and the IPED using population has a diverse typology. In addition, varied environmental and social factors influence IPED use in different ways and at different times. Effective interventions to prevent and reduce IPED use will require consideration of the individual user, the complex systems in which he/she operates and consideration of the full range of substances being used. Effective in this context relates not only to the size of the effect, but it also takes into account any harmful or negative side effects, including inequitable outcomes.

For this call, the Public Health Research Programme is looking for research regarding illegal drugs or the use of legal drugs for unlicensed indications. For this call, the Public Health Research Programme is looking for research regarding self-directed drug use for image and performance enhancement.

The evidence base and the understanding of the different forms of IPED use, pharmacology, harms, user population characteristics and potential interventions are at varied stages and research will need to take this into account. The PHR Programme recognises that research on anabolic androgenic steroids is at a more developed stage than other IPEDs and as a result, there may be more interventions to evaluate in this area.

For this call, the Public Health Research Programme is particularly interested in receiving applications for evaluations of interventions that seek to influence factors that operate at community, institutional and societal levels to prevent and reduce the harms from the use of IPEDs. The PHR Programme welcomes applications that include an epidemiological component to provide evidence on prevalence including hidden populations (e.g. those in prisons, armed forces, women, men who have sex with men). The PHR Programme is not interested in individual treatment services, but this may be of interest to the NIHR’s HS&DR and HTA programmes.

Research could include, but is not limited to, evaluations of interventions targeted at specific population groups (such as those using mainstream and/or body building free weight gyms), interventions that take place in particular social or work environments where IPED use may be normalised or interventions aimed at specific institutions where there are vulnerable, at-risk groups of people (such as prisons, young offenders institutions). Researchers should specify and justify their choice of intervention to evaluate and the relevance to the population being studied.

A range of study designs and outcome measures could be used. Researchers will need to identify and justify the most suitable methodological approach(es). Researchers will also need to specify key outcome measures and specify how these will be measured in short, medium and long terms. Outcomes to be researched could include (but are not limited to): physical health, mental health, changes in patterns of and/or reduction of use, changes in attitudes to use of IPEDs, uptake of needle exchange programme facilities and engagement with health services.

Researchers may wish to consider evaluating natural experiments comparing the effects of different approaches and different settings in design and delivery of programmes to prevent and reduce IPED use. Researchers might like to consider the use of online IPED discussion forums which are a rich but under-used setting for research. The Public Health Research Programme is interested in receiving applications which will increase understanding of causal factors, social and environmental influences.

Researchers should demonstrate the relevance of their proposed research to evidence users. Inclusion of evidence users as funded members of research teams is encouraged. Researchers might want to consider how they will share their findings with relevant decision makers. They will be expected to be aware of other studies in this area and ensure their proposed research is complementary.

The Public Health Research Programme would welcome the involvement of people who are current or previous users of IPEDs. We will consider inclusion of such experts as costed members of the research study team if appropriately justified.

Studies should generate evidence to inform the development or implementation of single or multi-component interventions. Studies may include evidence syntheses, studies evaluating interventions, including trials, quasi-and natural experimental evaluations, and feasibility and pilot studies for these. We welcome applications for linked studies (e.g. pilot + main evaluation, evidence syntheses + modelling). Secondary analyses of existing epidemiological data and/or impact modelling studies may also be funded. We encourage the adoption of a systems perspective where appropriate to the study context. In all cases a strong justification for the chosen design and methods must be made.

The primary outcome measure of the research, if not necessarily the intervention itself, must be health-related. The positive or negative impacts of the intervention, including inequitable outcomes should be considered. Researchers are asked to indicate how long-term impacts will be assessed. All applications should identify underlying theory and include a logic model (or equivalent) to help explain underlying context, theory and mechanisms. Proposals should ensure adequate public involvement in the research.

The impacts of public health interventions are often complex and wide-reaching. Studies should acknowledge this by adopting a broad perspective, taking account of costs and benefits to all relevant sectors of society. An appropriate health economic analysis to inform cost effectiveness, affordability or return on investment should be included where appropriate. Sustainability - health, economic and environmental - is also of interest.

For all proposals, applicants should clearly state the public health utility of the outcomes and the mechanisms by which they will inform future public health policy and practice. Details about the potential pathway to impact and scalability of interventions, if shown to have an effect, should be provided, including an indication of which organisation(s) might fund the relevant intervention(s) if widely implemented.

Remit of call

All proposals submitted under this call must fall within the remit of the NIHR Public Health Research (PHR) Programme. Please go to the PHR webpage for details. For the evaluation of time sensitive, policy driven, interventions applicants may wish to consider the fast-track work stream.

General notes

The PHR Programme funds research to generate evidence to inform the delivery of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. Our scope is multi-disciplinary and broad, covering a wide range of interventions that improve public health.

The primary aim of the programme is the evaluation of practical interventions. We will fund both primary research (mainly evaluative, but also some preparatory research) and secondary research (evidence synthesis); precise methods will need to be appropriate to the question being asked and the feasibility of the research.

Our research serves a variety of key stakeholders including: decision-makers in local government; primary care organisations and other local public services; third sector organisations; relevant national agencies (e.g. NICE) concerned with improving public health and reducing health inequalities; researchers; public health practitioners and the public.

Applicants should consider how their findings will impact upon decision making in public health practice, whether results are generalisable to other populations and affordable, setting out a clear pathway to impact. The PHR Programme recognises that there is a need for an evidence base for disinvestment and that the removal of an intervention from a population can be worthy of evaluation.

The affordability of the intervention, and at least an indication of the stakeholder(s) willing to fund the intervention, should be referenced within the stage 1 application. At the stage 2 application point, statements of support confirming stakeholder commitments to funding will be required. Applicants should be aware that the PHR Programme is unable to fund intervention costs.

The PHR Programme is open to the joint funding of research projects with other organisations such as those in the third sector. If you would like to explore the potential for joint funding, please contact us at with details of your proposal and the other funder prior to submission.

All of our funded projects are eligible for publication in the NIHR Journals Library. This open access resource is freely available online, and provides a full and permanent record of NIHR-funded research.

Notes to applicants

The PHR Programme is funded by the NIHR, with contributions from the CSO in Scotland, NISCHR in Wales, and HSC R&D, Public Health Agency, Northern Ireland. Researchers in England, Scotland, Wales and Northern Ireland are eligible to apply for funding under this programme.

Applicants are recommended to seek advice from suitable methodological support services, at an early stage in the development of their research idea and application. The NIHR Research Design Service can advise on appropriate NIHR programme choice, and developing and designing high quality research grant applications.

The NIHR Clinical Research Network (CRN) supports health and social care research taking place in NHS and non-NHS settings. The CRN provides expert advice and support to plan, set up and deliver research efficiently.

Clinical Trials Units (CTU) are regarded as an important component of many trial applications however, they are not essential for all types of studies to the PHR programme. The CTUs can advise and participate throughout the process from initial idea development through to project delivery and reporting. NIHR CTU Support Funding provides information on units receiving funding from the NIHR to collaborate on research applications to NIHR programmes and funded projects. In addition, the UKCRC CTU Network provides a searchable information resource on all registered units in the UK, and lists key interest areas and contact information.

Transparency agenda

In line with the government’s transparency agenda, any contract resulting from this tender may be published in its entirety to the general public.