Key clinical point: Legal performance-enhancing substances may be a gateway for future alcohol problems in young men and emotional or physical health problems in young women.

Major finding: Use of alcohol in adolescence was prospectively associated with use of legal performance-enhancing substances in young men (odds ratio, 1.39), and legal performance-enhancing substances use in young adulthood was associated with alcohol problems including injurious and risky behaviors (adjusted OR, 1.78).

Study details: The data come from a cross-sectional study of 12,133 young adults aged 18-26 years who were part of the National Longitudinal Study of Adolescent to Adult Health from 1994 to 2008.

Disclosures: The study was supported by the National Institutes of Health and by grants to one of the coauthors from the Pediatric Scientist Development Program funded by the American Academy of Pediatrics and the American Pediatric Society, as well as the American Heart Association Career Development Award. The researchers had no financial conflicts to disclose.