MLB.COM NEW YORK — Nine out of 10 Americans can tell you that illegal steroid usage is a major problem. But most of them believe that the epidemic begins and ends in professional sports without considering the rest of society. That finding, controversial though it may seem, was the main conclusion from the first survey designed to measure the public perception of illegal steroid use in the United States. The survey, conducted by Gallup and commissioned by a consortium of concerned academics, targeted 1,000 Americans and their knowledge of performance-enhancing drugs. Three major institutions — The Taylor Hooton Foundation, the National Baseball Hall of Fame and Museum and the Professional Baseball Athletic Trainers Society — teamed with the University of Massachusetts at Boston to find out what the public knows about illegal steroid use and to determine the next step in fighting what seems to be a growing national epidemic. Neil Romano, the chairman of the Taylor Hooton Foundation and former director of the White House Office of Drug Abuse Policy, on Thursday introduced the survey, titled The American Public’s Perception of Illegal Steroid Use. Romano said there weren’t many surprises in the survey, which found that less than 20 percent of people consider steroids to be a problem among American adolescents. Romano also said data has shown that perhaps as many as 25 to 45 students in every high school are using steroids, which suggests a disconnect between reality and perception. “Because the American people haven’t connected the dots between steroid use and our children, nobody has bothered to try and connect the dots between steroid abuse as it relates to what is known as ‘roid rage’ and the increase of bullying and violence in our schools,” he said. “It stands to reason that if the American people do not believe these drugs are a big problem for their children, they’ll miss the warning signs of abuse and sadly learn about those negative effects the hard way.” And that was the point of the survey: to gauge what people know before attempting to make any ground in the national discourse. Dr. Gary N. Siperstein, director of the Center for Social Development and Education at UMass-Boston, said that the survey revealed some interesting trends about what people know about steroids and how they know it. “Almost 100 percent of the people out there believe the use of steroids is cheating,” he said. “Everyone says, ‘If you take it, it’s unsafe.’ And they know that because two-thirds have taken steroids themselves legally. Over two-thirds believe it’s a big problem in professional sports and it’s a big problem at the college level. But they don’t connect the dots because it’s not a big problem in high school. … The surprise for me — or not a surprise — is when does the public think it begins? Does it begin when it’s the athlete in professional sports? I talk about pathways to a problem. The pathways begin at the high school level.” Don Hooton, the founder of the Taylor Hooton Foundation, has made this entire conversation his life’s work. Hooton’s late son Taylor passed away at the age of 17 after using anabolic steroids, and the foundation started in his honor has educated more than a half-million people in the United States, Canada and Latin America about the dangers of illegal steroid use. The elder Hooton testified at the Congressional Hearings on Steroids in Baseball in 2005, and he said he was gratified to see some of the changes that have come in the last eight years from the nation’s professional sports leagues. What hasn’t happened, according to Hooton, is an educational plan that makes sense from the federal government. “I am proud to report that Major League Baseball has stepped to the plate. It is now the number one provider of youth education on the subject of appearance and performance-enhancing drugs,” said Hooton, who also praised the NFL for embracing his message. “What’s the Congress done about this problem in the wake of these hearings? Nothing. Absolutely nothing. After all the grandstanding before the TV cameras that day, our federal government hasn’t instituted any form of education program for our children and hasn’t invested any time in raising awareness about the scope of this program nationally.” All of the panelists, to a man, clarified that they have no problem with prescribed use of steroids for ethically and medically cleared purposes. It’s the unsupervised usage, they said, that generally results in tragedy. Gene Monahan, who served as the head athletic trainer for the Yankees from 1973 to 2011, spoke to some of the specific health risks at hand. Monahan detailed about how increased muscle size can add strain to your kidneys, and he said that years of steroid use can adversely affect your reproductive system and lead to gastrointestinal problems. Steroids also increase muscle size, and when they increase the size of your heart, it leads to problems in blood flow to the rest of your body. Monahan likened the heart to a water pump when he began talking about the effects of illegal steroid usage. When the heart gets too big, he said, it doesn’t pump as much blood out and it has to start beating faster and faster. “If you pump that thing real fast, you’re not going to get more water. You’re going to get less water,” he said. “That’s what happens in the heart. If you pump real fast, it’s not getting a chance to relax and grab some more water and bring it out of the spigot. You’re getting little spurts. If you take your time and do a slow, rhythmic beat, you’ll get a good flow of water.” Education, said Monahan, is of paramount importance. Perhaps as many as 1.5 million teens and adolescents are using steroids illegally in this country, and Monahan said most people can’t tell you the hazards associated with usage. Studies have shown, in fact, that less than 50 percent of adults can describe even one negative effect of steroid usage. And the way to combat that, said Monahan, is to start with today’s youth. When kids learn about steroid usage from their health teachers, he said, more than two-thirds of them can tell you about the deleterious effects. And when they learn it from their coaches or sports counselors, said Monahan, 75 percent of them remember how it can affect their health. Siperstein brought some more interesting trends to the fore. Siperstein noted that less than a third of the survey’s respondents can define the term “roid rage,” and he said that prevalence rates for steroids are generally 4-to-6 percent. If you extrapolate that to every school in America, that basically means that every classroom has one student illegally using steroids. And if that number sounds shocking, consider this: Siperstein said that one-third of respondents 20 years old and younger knows at least one peer who has done steroids, suggesting that the phenomenon is larger than anyone can pinpoint. “Either they all know the same person — which is a little difficult because Gallup assures me this was a random sample of every region — or we have to start re-thinking the prevalence rates we’re getting,” said Siperstein. “I’ve studied children since the 1970’s, and I’ve been surveying adolescents and children from within the United States and China and Japan. One of the things that I know intuitively is that when you ask an adolescent if they’ve ever experimented with alcohol or marijuana, those are party drugs. Those are drugs that kids can say, ‘Yeah,’ because they know the kid in the seat next to them will say, ‘Yes.’ “Steroid use is secretive. And we need to really understand that, because when we ask a child who’s sitting in the classroom if they’ve ever taken steroids, what are they going to say to you? But if you ask them if they know someone? ‘Yeah, I do.’ ” And that, said Siperstein, is the point of the survey. It’s a conversation starter, if nothing else. It’s an opportunity to start measuring what we know and what we don’t know about illegal steroid usage, and it’s a chance to acknowledge that what we see on the field at stadiums across the nation is just a reflection of what’s really going on in society writ large. Jeff Idelson, president of the National Baseball Hall of Fame and Museum, spoke Thursday about B.A.S.E., the Hall’s educational initiative designed to reach children. B.A.S.E. stands for “Be A Superior Example” and focuses on healthy living and clean character, and Idelson said this survey can play a key role in educating the youth of America. “We needed some empirical data to substantiate what we all believe, which is that steroid use is more prevalent than we know at the high school level and even in middle school. It exists,” he said. “Commissioner [Bud] Selig often likes to say that baseball is a social institution. There’s nowhere that resonates stronger than at Cooperstown, where we connect the cultural side with the game of baseball. “And as a public institution, we have a social responsibility to address issues that relate to the game. The issue of PED use certainly didn’t begin with baseball, but it’s seeped into it. Our job is to help end it.” Spencer Fordin is a reporter for MLB.com.