Competing at top levels causes athletes to risk their health by pushing their physical and mental limits, both in training and competition. Difficulties may arise in managing potential health risks such as overtraining, malnutrition, drug abuse and playing hurt. In competitive sports, good health is the necessary foundation for developing peak athletic performance. This phenomenon of protecting and risking the athletes' health challenges the development of health promotion and protection strategies, especially for young athletes [1
Adolescents are normally hardly concerned with their health. At the same time they have to cope with substantial physical, psychological and social developments. Considering this sensitive phase of development it is therefore imperative to provide young elite athletes effective structures for promoting a healthy and successful sports career.
Based on constructivist approaches [3
], we consider individuals' representations of their social world, their behavior and biographical developments as a complex interplay between themselves and their different social systems. Against this background, we assume that subjective health concepts and theories as summarized in the expression 'lay health representations', largely influence individuals' health-related behavior and subjective health state [7
The lay health representations of athletes are generally influenced by their social networks (e.g., general conditions of their sport or their sports associations' medical treatment offers) and shaped by significant life events which may lead them to focus on specific health-related topics like prevention or nutrition. Thus, the athletes' lay health representations and the resulting health-related behavior are subject to ongoing changes over the course of their career [2
Most studies concerning the young athletes' health deal with sports specific injuries and illnesses [10
] and health-related behaviors such as disordered eating [13
], (recreational) drug use [14
] and dietary supplement use [15
]. Additionally some of these studies examine the athletes' attitudes towards specific behaviors like mouthguard use [17
], doping and drug abuse [18
], or competing in pain [19
] Yet, young elite athletes' individual health management, seen as their overall and sports-specific health-related behavior, is still not thoroughly examined. While there are a lot of representative studies dealing with subjective health state, health complaints and risky behavior in adolescents [20
], a comparison with values of young elite athletes is not possible until now.
Considering the increasing number of sociological studies address the effects of elite sports specific risk cultures on managing pain and injury [22
], almost nothing is known about the characteristics and mediation of certain risk cultures in youth elite sports and its impact on health promotion or injury prevention strategies. Explorative approaches on elite athletes' accounts on health [27
] or lay health representations [2
] show the significance of career socialization processes in developing a sports specific understanding of threats, health resources and the meaning of future well-being. Likewise, little is understood about the adolescent athletes' lay health representations, its significance for healthy behavior and its development under the influence of formal and informal support systems and social environments. Therefore, still to be thoroughly examined is the role of peers, parents, coaches, healthcare providers, sports associations, and other significant support systems within adolescent elite sports' health protection and promotion processes. Until now, there is alack of health promotion and protection strategies for adolescent elite sports, which are empirically based and developed under participation of the relevant sports associations.
Research questions and methodological approach
The German Young Olympic Athletes' Lifestyle and Health Management Study (GOAL Study; Figure ) has two central aims: First, to fill the above-mentioned research gaps and second, to develop sports-specific health protection and promotion strategies. In order to create a holistic picture of managing health in German adolescent elite sports, we carried out a nationwide mixed-method study. Combining quantitative and qualitative approaches allowed us to gather a broad range of representative information on squad athletes of all Olympic disciplines as well as in-depth information on four Olympic disciplines: artistic gymnastics, biathlon, handball and wrestling.
Within the quantitative section of the GOAL Study, we attempt to identify the impact of lay health representations (including subjective concepts about nutrition as well) of adolescent athletes, social networks and socio-demographic variables on athletes' health-related behavior and subjective health state on a representative basis.
We aim to answer the following questions within the quantitative study part:
• What kind of lay representations of health do young German Olympic athletes have, and are there any differences related to discipline, age, sex or social background?
• To what extent is the athletes' health-related behavior and subjective health state influenced by lay health representations?
• What health- and especially nutrition-related conflicts are found between young athletes and significant others of their social networks?
• To what extent do health-related behavior and subjective health state differ between adolescent elite athletes and non-athletes?
The qualitative section of the GOAL Study investigates how young athletes, depending on their biographic backgrounds, construct the meaning and relevance of health and nutrition within their sports-specific surroundings. Furthermore, the qualitative analysis allows us to identify sports-specific health cultures and helps us to reconstruct the influence of organizational structures on managing health-related aspects.
Thus, the following questions are the focus of the qualitative study section:
• How do adolescent athletes deal with health and nutrition, and how is health embodied in their everyday life?
• How do biography and social context influence health and nutrition practices within adolescent elite sports?
• Do sports disciplines differ concerning their health and risk cultures, and if yes, how do these cultures influence the young athletes' health and nutrition behavior?
The studies' results will serve as the basis for tailored health promotion strategies to be developed in cooperation with representatives of German elite sports' associations.