Background: Steroid use among adolescents is an increasing health concern. Literature examining factors related to steroid use is limited. Methods: We investigated steroid use among 9th through 12th grade adolescents in the Greater Cincinnati area. A total of 38,414 adolescents completed the PRIDE Questionnaire. Associations between demographics, school factors, parent factors, sport participation, and steroid use were examined. Results: A total of 2.6% of adolescents reported using steroids in the past year. Most prevalent was steroid use among male, Junior/Senior, African-American, and Hispanic adolescents. Rates of steroid use differed significantly based on school and parent factors, but not sport participation. Adolescents who reported attendance at schools that frequently set and enforced rules for drug use or whose parents frequently set rules for drug use were at decreased odds for steroid use. School communication about drug use was negatively associated with steroid use. Conclusions: School administration and staff, as well as parents, are uniquely positioned to deter steroid use among adolescents. Findings suggest that limiting steroid screening to student athletes might miss a substantial proportion of the population at risk. Thus, broad-based screening and prevention programs may be more effective than programs targeting student athletes alone.