Vaping Has Consequences: Just because You Can’t Smell it Doesn’t Mean it’s Harmless

By Nicole Wetsman  and Janice T. Radak

Vaping—nearly 80% of adolescents are doing it, according to the Centers for Disease Control and Prevention—that’s 8 out of 10 teenagers, which means that student athletes are not immune.

Vaping is defined as inhaling and exhaling the vapor (technically called aerosol) produced by an e-cigarette or similar battery-powered device. The devices are small, some as small as a USB drive. They use a “pod” or cartridge, each of which has as much nicotine as a full pack of traditional cigarettes. The catch, for parents and coaches alike, is that, unlike traditional cigarettes which produce smoke and leave a distinct smell in the air and on clothing, vaping is odorless. The flavored pods, which often left a candy-like smell, have been recently banned, but remain for sale on the internet.

So vaping may be happening closer to home than you realize. Indeed, vaping recently surpassed traditional cigarettes as the favored tobacco product of today’s youth—and it’s not just high schoolers who are partaking.

Sadly, where sports participation—particularly team sports—had been seen as a deterrent to tobacco use in years past, vaping is seen across all aspects of today’s teenage life, including team sports.

“Coaches believe that their athletes are already healthier than others. They believe they’re not using substances, but it’s sometimes a dirty secret in athletic communities,” said Philip Veliz, PhD, associate director of the Sport, Health, and Activity Research and Policy Center at the University of Michigan. “We can’t turn a blind eye. It’s something that has to be addressed in sports organizations.”

“If vaping interferes with the body’s ability to heal, it would interfere with the athlete’s ability to train well or reap the benefits of training.”  Jeffrey Spiegel, MD

Use Among Athletes

Vaping is still pretty new in the scheme of things, so there isn’t much medical or even sport research about what it does to an athlete’s body or which type of athlete might engage in this behavior, Veliz explained.

Older research on cigarette smoking shows that adolescents who participate in physical activities, such as sports, are less likely to smoke. Some sports, though, are less protective against cigarette smoking than others: kids who play contact sports, like football, are at a higher risk than kids who run cross country, for example.1

Veliz was able to analyze data from the 2014-2015 Monitoring the Future survey, which asks high schoolers about attitudes, drug use, and other behavioral topics.2 A subset of that year’s survey answered additional questions about e-cigarette use. Veliz compared reported sports participation with e-cigarette or cigarette use. As in earlier studies, this showed that kids who played sports—especially those who played 3 or more sports—were less likely to use traditional cigarettes. However, he found no difference between athletes and non-athletes with regards to their e-cigarette use.

Wrestlers were at the greatest risk of using all tobacco products, including e-cigarettes, followed by lacrosse players—both at risks higher than 20%. Football, baseball, softball, and volleyball players were also at higher risk of using e-cigarettes—all above 10%.

“There isn’t a protective effect of sports participation against vaping, not the way that there is for cigarette use,” Veliz said. “The idea might be that kids think vaping or e-cigarettes are safer than cigarettes. Athletes might also see that is the case, and that it wouldn’t impact their sports the same way.”

One important note for parents: The survey did not ask about Juul, a brand of e-cigarette that is particularly popular with teens and adolescents. Many young people, when asked if they vape, will say that they do not, even if they use Juul—because it’s thought of as distinct. So ask if your teen is “Juuling” and you may get a different response.

What Do Nicotine and Vaping Do?

To be clear, there is no medical use for nicotine—either through vaping or traditional cigarettes. While athletes may enjoy the immediate stimulation it can cause, many studies show that nicotine is harmful to adolescent brain growth, particularly to those areas of the brain that control attention, learning, mood, and impulse control. (See “E-Cigarette, Vaping, Terminology and Facts,” page 11.)

Vaping is simply another way to inhale nicotine, the addictive agent in tobacco: Yes, many illicit e-cigarette products also carry THC, the psychoactive ingredient in marijuana, but we’ll focus here on nicotine and the other chemicals in the vaping cartridge. There is research on what those things do to the human body and the potential impact that might be particularly harmful to and impede performance in teens participating in sports.

For example, research shows that vaping can affect blood flow and blood vessels. Blood flow, or circulation, carries oxygen and nutrients to every cell in the body and speeds up when we are active. Healthy blood vessels act as elastic tubes that widen (dilate) and constrict to push the blood throughout the body; this is called flow-mediated dilation and it is a measure of blood vessel health. One study from Italy found that nicotine, which is known to constrict blood vessels, has a negative effect on flow-mediated dilation—and that effect came from both traditional and e-cigarettes.3

And nicotine is not the only chemical in e-cigarettes that can affect how blood vessels work. Alessandra Caporale, PhD, led a study that looked at how blood vessels function after using vaping and e-cigarette products.4 “We initially thought the major effect would be nicotine. But inside the e-cigarette aerosol are other components,” said Caporale, a post-doctoral researcher in the Laboratory for Structural, Physiologic, and Functional Imaging at the University of Pennsylvania School of Medicine.

Her study found that propylene glycol and glycerol, two chemicals in the liquids vaporized in e-cigarettes, can be irritants when inhaled. They also found that e-cigarettes release tiny particles of metals, smaller than 100 nanometers. These small particles are known to cause vascular inflammation and other negative  effects that can damage blood flow. And the effects are immediate.

Additionally, Caporale looked at how blood vessels responded before and after study participants inhaled the e-cigarette vapor. After the study participants inhaled the e-cigarette vapor, dilation was reduced by nearly 34%, indicating changes to the inner linings of the vessels. “The endothelium [the lining of the blood vessel] was not functioning properly,” Caporale said.

Those effects on vessels are nearly impossible to perceive, she said, so e-cigarette users would not notice that anything was different, and the effects of a single use would most likely resolve after about 4 to 6 hours. However, when the vapor is inhaled consistently, those effects could add up to potential long-term, lingering vascular problems.

Importantly, Caporale noted that even small changes in blood vessels might affect athletes. “When you go to the gym, your muscles need a boost of oxygenated blood. They need reactive and healthy vessels to dilate as needed. If the ability of vessels is impaired, it means the whole system is down, and doesn’t work as well.”

Another chemical in the mix is diacetyl, which has been linked to “Popcorn lung,” a condition that affects the tiny air passages in the lungs, making it difficult for sufferers to get enough air. It was first identified in workers at popcorn factories, hence the name. Technically known as bronchiolitis obliterans, its symptoms can develop as early as 2 weeks after exposure. Symptoms include fatigue, dry cough, shortness of breath and/or wheezing in the absence of a cold or asthma.

In 2019, vitamin E acetate, another chemical in the cartridges came to the public’s attention. An understanding of the harmful effects of this chemical came to light when EVALI,* a potentially fatal lung disease, was formally diagnosed after 55 people died as a result of vaping. It remains unclear how EVALI develops or why, but in the most severe cases, it causes the lungs to completely stop functioning. (*EVALI stands for e-cigarette or vaping product use associated lung injury)

School coaches have noticed other health concerns around vaping. One North Carolina swim coach said she found that her swimmers who vaped tended to be sicker for longer periods of time, missing both meets and practices. “I found there seemed to be a relationship between vaping and respiratory types of illnesses,” said Nina McPherson, a high school swim coach in Waxhaw, North Carolina.5

Wound Healing and Training

Damaged blood vessels might also contribute to slowed healing in wounds as studies show that smokers have a higher chance of complications from surgeries and their wounds take longer to heal.

Over the past few years, Jeffrey Spiegel, MD, professor of otolaryngology, head and neck surgery at Boston University School of Medicine, said he started to have patients ask about vaping. “They would say, I know smoking is unsafe around surgery, but is vaping ok?” In response, he conducted a study to see if e-cigarettes affected wounds in the same way that traditional cigarettes do.6 His work showed that there was more tissue death in rats that were exposed to both traditional cigarette smoke and e-cigarette vapor, than in rats that were exposed to neither. Tissue death is a sign of impaired wound healing.

“Wound healing is a pretty good model for physical health in general,” said Spiegel. “You need good nutrition, good blood flow to heal an injury.”

If vaping impacts wound healing, that would also have repercussions for athletic performance, Spiegel noted. Sports injuries may take longer to heal, especially if they are significant, such as fractures, muscle tears, or other problems.

In addition, working to build muscle is a constant cycle of micro-injuries. Exercise causes microscopic tears in muscle fibers, which heal to regrow stronger. “If vaping interferes with the body’s ability to heal, it would interfere with the athlete’s ability to train well or reap the benefits of training,” Spiegel said. “It’s the same way for people with bad diabetes, or an autoimmune disease, or anything that interferes with their ability to heal. We can’t expect them to be able to reach the types of performance of an elite athlete.”

Schools Weigh In

Serving on school-based sports teams is viewed as a privilege and many schools have policies against smoking and/or vaping—parents and coaches would be wise to make certain that such policies have been updated to include both. And make sure students know there are consequences for breaking those policies.

NBCNews reported the case of a Massachusetts hockey player who was stripped of his team captain status when it was discovered he was vaping on school premises.5 He was also suspended from school which meant he missed college recruiters.

While benching and play-off suspensions have been common punishments, many schools, doctors, and parents are beginning to look at vaping through a different lens: addiction. Indeed, the Truth Initiative (truthinitiative.org) is working with school districts that want to explore offering cessation programs to students caught vaping, rather than suspensions.

Vaping is a definite trend among today’s youth and young athletes are not immune. Keeping young athletes informed about the negative consequences of using these types of products may help to keep them healthy…and in the game.

Nicole Wetsman is a freelance writer in New York City. Janice T. Radak is Editorial Director for MVP PARENT.

References

  1. Veliz PT, Boyd CJ, McCabe SE. Competitive sport involvement and substance use among adolescents: a nationwide study. Subst Use Misuse. 2015;50:156-65.
  2. Veliz P et al. Adolescent sports participation, e-cigarette use, and cigarette smoking. Am J Prev Med. 2017;53:e175-e183.
  3. Carnevale R, et al. Acute impact of tobacco vs electronic cigarette smoking on oxidative stress and vascular function. Chest. 2016;150:606-12.
  4. Caporale A, et al. Acute effects of electronic cigarette aerosol inhalation on vascular function detected at quantitative MRI. Radiology. 2019;293:1-10.
  5. Edwards E. Vaping is hurting teenage athletes, dashing their future in sports. Published July 10, 2019. Available at https://www.nbcnews.com/health/kidshealth/vaping-hurting-teenage-athletes-dashing-their-future-sports-n1027011. Accessed March 11, 2020.
  6. Troiano C, Jaleel Z, Spiegel JH. Association of electronic cigarette vaping and cigarette smoking with decreased random flap viability in rats. JAMA Facial Plast Surg. 2019;21:5-10.

E-Cigarette, Vaping, Terminology and Facts

What are e-cigarettes?

  • E-cigarettes are electronic devices that heat a liquid and produce an aerosol, or mix of small particles in the air. They come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.
  • Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items. Larger devices such as tank systems, or “mods,” do not look like other tobacco products.
  • E-cigarettes are known by many different names. They are sometimes called “e-cigs,” “e-hookahs,” “mods,” “vape pens,” “vapes,” “tank systems,” and “electronic nicotine delivery systems (ENDS).”
  • Using an e-cigarette is sometimes called “vaping” or “JUULing.”

How do e-cigarettes work?

  • E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine, flavorings, and other chemicals that help to make the aerosol.
  • The liquid used in e-cigarettes often contains nicotine and flavorings. This liquid is sometimes called “e-juice,” “e-liquid,” “vape juice,” or “vape liquid.”
  • Users inhale e-cigarette aerosol into their lungs. Bystanders can also breathe in this aerosol when the user exhales it into the air.

What is JUUL?

  • JUUL (pronounced “jewel”) is a brand of e-cigarette that is shaped like a USB flash drive (third from left in illustration). Like other e-cigarettes, JUUL is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled.
  • All JUUL e-cigarettes have a high level of nicotine. According to the manufacturer, a single JUUL pod contains as much nicotine as a pack of 20 regular cigarettes.2
  • JUUL is one of a few e-cigarettes that use nicotine salts, which allow particularly high levels of nicotine to be inhaled  more easily and with less irritation than the free-base nicotine that has traditionally been used in tobacco products, including e-cigarettes.
  • News outlets and social media sites report widespread use of JUUL by students in schools, including classrooms and bathrooms.
  • Approximately two-thirds of JUUL users aged 15 – 24 do not know that JUUL always contains nicotine.
  • Although JUUL is currently the top-selling e-cigarette brand in  the United States, other companies sell e-cigarettes that look like USB flash drives. Examples include the MarkTen Elite, a nicotine delivery device, and the PAX Era, a marijuana delivery device that looks like JUUL.
  • Additional information about USB-shaped e-cigarettes and actions that parents, educators, and health care providers can take to protect kids is available at cdc.gov – search for e-cigarette.

What is in e-cigarette aerosol?

  • E-cigarette aerosol is NOT harmless “water vapor.”
  • The e-cigarette aerosol that users breathe from the device and exhale can contain harmful and potentially harmful substances
  • The aerosol that users inhale and exhale from e-cigarettes can expose both themselves and bystanders to harmful substances.
  • It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine.

What do we know about heated tobacco products?

  • Heated tobacco products (HTPs) like IQOS and Eclipse, sometimes marketed as “heat-not-burn” technology, represent a diverse class of products that heat the tobacco leaf to produce an inhaled aerosol. They are different from e-cigarettes, which heat a liquid that can contain nicotine derived from tobacco.
  • HTPs are available in at least 40 countries and have several have been authorized for sale in the United States by the FDA. In 2018, few U.S. adults (2.4% of all surveyed, including 6.7% of current smokers surveyed) had ever used HTPs. Youth use of HTPs is unknown, but monitoring is underway.
  • Scientists are still learning about the short-term and long-term health effects of HTPs, but the available science shows the contain harmful and potentially harmful ingredients. Youth use of any tobacco products, including heated products, is unsafe.
  • It is important that we continue to modernize proven tobacco prevention and control strategies to include newer products entering the market such as HTPs.

Excerpted from: US Centers for Disease Control and Prevention. Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults. Updated Feb. 3, 2020. Available at https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html. Accessed Mar. 10, 2020.

 

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