CHICAGO — About 1 million young people aged 12 through 17 have taken performance-enhancing sports supplements, a health insurer's survey concluded.

The survey results, released Monday by the Blue Cross and Blue Shield Association, are based on random telephone interviews with 785 youths last month.

Use of performance-enhancers was reported by 5 percent of participants aged 12 through 17, or 32 of the 650 surveyed. The samples were considered nationally representative, and Blue Cross extrapolated to estimate national use.

Supplement use also was reported by 2 percent of those aged 10 to 14, but the 1.3 percentage point error margin made those results less conclusive. The error margin was 1.7 percentage points for the question on those aged 12 to 17.

Pennsylvania State University epidemiologist Charles Yesalis, who has studied supplement use, said the numbers are hardly surprising and may even underestimate the number of youths using supplements.

He said there is ample publicity about athletes using performance enhancers and "the notion that that doesn't cascade down in a negative way to our children is moronic."

The most popular substance used by survey participants was creatine, a legal, widely available amino acid-based strength-training supplement for athletes that's marketed to youngsters in cookies and candy. It was cited by about half the youths who said they had used supplements.

Creatine can cause short-term cramping and diarrhea. While less is known about long-term use, it has been linked to muscle injury and kidney problems, said Dr. Brent Bauer, a Mayo Clinic internist and supplements specialist. The benefits for anyone other than elite athletes are negligible, Bauer said.

Other supplements cited, but in small numbers, included anabolic steroids, which are illegal for strength-training, and products containing the stimulant ephedrine.

Steroids can have potentially serious side effects ranging from baldness to heart and liver problems, and ephedrine has been linked to potentially fatal cardiovascular problems.

Dr. Allan Korn, Blue Cross' chief medical officer, said the survey underscores the need for parents and coaches "to get serious about educating children" about the supplements. He said the government "should take swift action to limit marketing and sales to minors."

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"The very idea that we have Oreo-like cookies containing creatine is just dreadful, and we want it to stop," he said.

John Cordaro, president of the Council for Responsible Nutrition, a trade group for supplement makers, said the group thinks creatine is safe but that ephedrine should not be used by anyone under 18. He had not seen the survey and said the industry does not have its own estimates for performance-enhancing supplement use.

The survey was conducted for Blue Cross by C&R Research Services, Inc., a market research firm.

Blue Cross and Blue Shield is a Chicago-based national association of locally operated health plans that insure 81 million Americans.

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