Oct 04, 2008


The Athletes Targeting Healthy Exercise & Nutrition Alternatives (ATHENA) program is a school-based, team-centered intervention aimed at reducing disordered eating and deterring the use of body-shaping substances among middle and high school female athletes. In a random assignment study of 40 female high school athletic teams, teams were assigned to either receive the intervention (experimental group) or engage in standard team practices (control group). Athletes in the experimental group consistently reported more favorable results on a wide variety of post-intervention outcomes compared to those in the control group, including knowledge, intentions, protein intake, and less use of diet pills.


Target population:Female athletes between 13 and 17 years old

The Athletes Targeting Healthy Exercise & Nutrition Alternatives (ATHENA) program is a school-based, team-centered intervention that emphasizes the consequences of substance use and other unhealthy behaviors as well as the benefits of good nutritional habits and effective exercise training. There is also a cognitive restructuring component to the program which addresses mood-related risk factors for diet pill use.

The ATHENA program is delivered by a Coach/Instructor and Squad Leader(s). It is recommended that there be one student Squad Leader for every five athletes on a team. Each Squad Leader delivers scripted lessons in small learning clusters. Each intervention consists of eight 45-minute classroom sessions. Each participant receives a workbook and a sport nutrition and training guide.

In 2007 dollars, the Coach/Instructor Package costs $280, each Squad Leader Package is $11, and each Athlete Package is $11. There is an 11% charge for shipping and handling. A $505 optional training is available for the Coach/Instructor.


Elliot, D.L., Moe, E.L., Goldberg, L., DeFrancesco, C.A., Durham, M.B., & Hix-Small, H. (2006). Definition and Outcome of a Curriculum to Prevent Disordered Eating and Body-Shaping Drug Use. Journal of School Health, 76,67-73.

Evaluated population: 40 female athletic teams from 18 different high schools were the sample for this evaluation. 20 teams from nine of the schools were randomly assigned to receive the intervention, and 20 teams from the other nine schools were assigned to the standard team practice control group. In total, 928 athletes participated in the evaluation. In the intervention group, the mean age was 15.4 years, and 93.6% were white. In the control group, the mean age was 15.3 years, and 91.4% were white.

Approach: All of the athletes participating in the evaluation completed baseline questionnaires immediately before the sports season began. The 177-item questionnaires assessed the following seven constructs: 1) Disordered eating behaviors and body-shaping drug use, 2) nutrition and exercise behaviors and abilities, 3) intentions toward future disordered eating behaviors and drug use, 4) knowledge of substance and nutrition-related topics, 5) mood, traits, and beliefs, 6) adherence to attitudes presented in the media, and 7) adherence to coach and peer pressures. In order to assess post-intervention changes in the measured constructs, the athletes were given the same set of questionnaires within two weeks of the sport season’s conclusion. Survey administration was conducted by the study’s research assistants.

Athletes in the intervention group participated in eight, 45-minute sessions during the course of their sport season. These sessions were scheduled at the coaches’ discretion and were integrated into the standard team activities. During each of these sessions, the athletes on each team were divided into small groups of six, with one athlete per group functioning as the assigned Squad Leader. Squad Leaders and coaches used manuals with scripted lesson plans, and the remaining teammates used matching workbooks. Each of the athletes received a nutrition and exercise guide. Athletes in the control group participated in their regularly scheduled, standard activities.

Results: Results indicated consistently better outcomes for athletes in the experimental group compared with athletes in the control group. Specifically, athletes receiving the intervention reported positive outcomes relative to the control group on the following indicators: a) dietary habits and strength training skills, e.g., diet pill use in the past three months, tracking of protein intake, and how to lift weights and improve strength; b) intent to engage in unhealthy behaviors, e.g., intent toward vomiting to lose weight and intent toward future tobacco use; c) knowledge of dietary needs and damaging effect of alcohol, e.g., knowledge of anabolic steroids and understanding that alcohol is a toxin that damages muscles; d) perception of social norms and peer norms about physical appearance and drug use, e.g., knowledge of how to control one’s mood, knowledge of how to turn down unhealthy weight-loss behaviors, belief that media advertisements are true, belief that thin women are most attractive to men, belief that their closest friends are against them using drugs, and belief that their closest friends use body-shaping drugs.

Results indicated that there were no differences between the experimental and control groups for the following outcomes: Knowledge of disordered eating’s effects, feelings of depression in the past week, levels of self-esteem, feeling pressure from teammates to lose weight, or perceptions of the percent of female athletes at other schools with disordered eating or body-shaping drug use.


Intervention materials may be obtained from:

Michelle Otis

Oregon Health & Science University

3181 SW Sam
Jackson Park Road, CR 110

Portland, OR 97239-3098

Phone: (503) 418-4166; Fax: (503) 494-1210


Web site:


Elliot, D.L., Moe, E.L., Goldberg, L., DeFrancesco, C.A., Durham, M.B., & Hix-Small, H. (2006). Definition and outcome of a curriculum to prevent disordered eating and body-shaping drug use. Journal of School Health, 76, 67-73.

Elliot, D.L., Moe, E.L., Goldberg, L., DeFrancesco, C.A., Durham, M.B., & Hix-Small, H. (2007). Long-term outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) program for female high school athletes. Manuscript submitted for publication.

Keywords: Adolescence (12-17), Youth, Gender-Specific (Female Only), Physical Health, Mental Health, Social/Emotional Health, Nutrition, School-Based, High School, Education and Cognitive Development, Life Skills, White or Caucasian.

Program information last updated on 10/4/08.