The purpose of this article is to provide the school nurse with the ability to recognize performance and appearance enhancing substance use and understand treatment and prevention strategies to reduce associated health risks. The use of appearance and performance enhancing drugs and substances, also known as “doping,” has been an ethical and health issue in sports for many years. It is vital that school nurses learn to recognize performance and appearance enhancing substance use to ensure student athletes and exercisers receive the care and education they need. Commonly used performance and appearance enhancing substances include anabolic-androgenic steroids, stimulants, diuretics, growth hormone, and supplements. Signs and symptoms that may look similar to other health concerns include palpitations, stunted growth, acne, severe headaches, muscle cramps, dizziness, and dehydration, but some long-term severe complications occur as well. Doping can lead to severe and sometimes permanent organ damage, including liver, kidney, and heart disease. The school nurse can play a key role by working with parents, coaches, school counselors, and educators to foster an anti-doping culture.
BhamB. (2003). Unhealthy competition. Advances in biomedical research provide new drugs and technologies in medicine, but also new ways for athletes to illegally enhance their performance. EMBO Reports, 4(10), 927–929. https://doi.org/10.1038/sj.embor.embor948
5.
BirznieceV. (2015). Doping in sport: Effects, harm and misconceptions. Internal Medicine Journal, 45(3), 239–248. https://doi.org/10.1111/imj.12629
6.
CodellaR.GladB.LuziL.La TorreA. (2019). An Italian campaign to promote anti doping culture in high-school students. Frontiers in Psychology, 10, Article 534. https://doi.org/10.3389/fpsyg.2019.00534
7.
CuffS.LaBotzM. (2020). Legal performance-enhancing substances in children and adolescents: Why should we care?Pediatrics, 146(3), Article e2020012278. https://doi.org/10.1542/peds.2020-012278
8.
DaherJ.El KhouryD.DwyerJ. (2021). Education interventions to improve knowledge, beliefs, intentions and practices with respect to dietary supplements and doping substances: A narrative review. Nutrients, 13(11), Article 3935. https://doi.org/10.3390/nu13113935
GarzonL. S.EwaldR. E.RutledgeC. M.MeadowsT. (2006). The school nurse’s role in prevention of student use of performance-enhancing supplements. The Journal of School Health, 76(5), 159–163. https://doi.org/10.1111/j.1746-1561.2006.00088.x
14.
GansonK. T.MitchisonD.MurrayS. B.NagataJ. M. (2020). Legal performance enhancing substances and substance use problems among young adults. Pediatrics, 146(3), Article e20200409. https://doi.org/10.1542/peds.2020-0409
15.
GellerA. I.ShehabN.WeidleN. J.LovegroveM. C.WolpertB. J.TimboB. B.MozerskyR. P.BudnitzD. S. (2015). Emergency department visits for adverse events related to dietary supplements. The New England Journal of Medicine, 373(16), 1531–1540. https://doi.org/10.1056/NEJMsa1504267
16.
GreydanusD. E.PatelD. R. (2010). Sports doping in the adolescent: The Faustian conundrum of Hors de Combat. Pediatric Clinics of North America, 57(3), 729–750. https://doi.org/10.1016/j.pcl.2010.02.008
17.
HalasJ. G.GrimbergA. (2020). Dilemmas of growth hormone treatment for GH deficiency and idiopathic short stature: Defining, distinguishing, and deciding. Minerva Pediatrica, 72(3), 206–225. https://doi.org/10.23736/S0026-4946.20.05821-1
18.
HorwitzH.AndersenJ. T.DalhoffK. P. (2019). Health consequences of androgenic anabolic steroid use. Journal of Internal Medicine, 285(3), 333–340. https://doi.org/10.1111/joim.12850
19.
KanayamaG.PopeH. G.Jr. (2012). Illicit use of androgens and other hormones: Recent advances. Current Opinion in Endocrinology, Diabetes, and Obesity, 19(3), 211–219. https://doi.org/10.1097/MED.0b013e3283524008
20.
KannL.KinchenS.ShanklinS. L.FlintK. H.KawkinsJ.HarrisW. A.LowryR.OlsenE. O.McManusT.ChyenD.WhittleL.TaylorE.DemissieZ.BrenerN.ThorntonJ.MooreJ.ZazaS., & Centers for Disease Control Prevention. (2014). Youth risk behavior surveillance—United States, 2013. Morbidity and Mortality Weekly Report Supplements, 63(4), 1–168.
21.
KarazsiaB. T.CrowtherJ. H.GaliotoR. (2012). Undergraduate men’s use of performance-and appearance-enhancing substances: An examination of the gateway hypothesis. Psychology of Men & Masculinity, 14(2), 129–137. https://doi.org/10.1037/a0027810
LazurasL.BarkoukisV. (2014). Performance- and appearance-enhancing drug use in sports: A psychological perspective. In EcklundR. C.TenenbaumG. (Eds.), Encyclopedia of sport and exercise psychology (pp. 1167–1187). SAGE.
24.
LazurasL.BarkoukisV.LoukovitisA.BrandR.HudsonA.MalliaL.MichaelidesM.MuziM.PetrócziA.ZelliA. (2017). “I want it all, and I want it now”: Lifetime prevalence and reasons for using and abstaining from controlled performance and appearance enhancing substances (PAES) among young exercisers and amateur athletes in five European countries. Frontiers in Psychology, 8, Article 717. https://doi.org/10.3389/fpsyg.2017.00717
25.
LevyS.SchizerM., & Committee on Substance Abuse American Academy of Pediatrics. (2015). Adolescent drug testing policies in schools. Pediatrics, 135(4), e1107–e1112. https://doi.org/10.1542/peds.2015-0055
26.
MomayaA.FawalM.EstesR. (2015). Performance-enhancing substances in sports: A review of the literature. Sports Medicine, 45(4), 517–531. https://doi.org/10.1007/s40279-015-0308-9
NichollsA. R.CopeE.BaileyR.KoenenK.DumonD.TheodorouN. C.ChanalB.Saint LaurentD.MüllerD.AndrésM. P.KristensenA. H.ThompsonM. A.BaumannW.LaurentJ. F. (2017). Children’s first experience of taking anabolic-androgenic steroids can occur before their 10th birthday: A systematic review identifying 9 factors that predicted doping among young people. Frontiers in Psychology, 8, Article 1015. https://doi.org/10.3389/fpsyg.2017.01015
29.
OrF.KimY.SimmsJ.AustinS. B. (2019). Taking stock of dietary supplements’ harmful effects on children, adolescents, and young adults. The Journal of Adolescent Health, 65(4), 455–461. https://doi.org/10.1016/j.jadohealth.2019.03.005
30.
PoppelK. (2021). Efficient ways to combat doping in a sports education context: A Systematic review on doping prevention measures focusing on young age groups. Frontiers in Sports and Active Living, 3, Article 673452. https://doi.org/10.3389/fspor.2021.673452
31.
ShekelleP. G.HardyM. L.MortonS. C.MaglioneM.MojicaW. A.SuttorpM. J.RhodesS. L.JungvigL.GagnéJ. (2003). Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: A meta-analysis. Journal of the American Medical Association, 289(12), 1537–1545. https://doi.org/10.1001/jama.289.12.1537
32.
SigalosJ. T.PastuszakA. W. (2018). The safety and efficacy of growth hormone secretagogues. Sexual Medicine Reviews, 6(1), 45–53. https://doi.org/10.1016/j.sxmr.2017.02.004
VoronaE.NieschlagE. (2018). Adverse effects of doping with anabolic androgenic steroids in competitive athletics, recreational sports and bodybuilding. Minerva Endocrinologica, 43(4), 476–488. https://doi.org/10.23736/S0391-1977.18.02810-9
36.
WhiteN. D.NoeunJ. (2016). Performance-enhancing drug use in adolescence. American Journal of Lifestyle Medicine, 11(2), 122–124. https://doi.org/10.1177/1559827616680593
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
