Associations between energy drink consumption and alcohol use behaviors among college students

Prevalence of energy drink consumption world-wide: A systematic review and meta-analysis

BACKGROUND AND AIMS

The increasing market for energy drinks (EDs) in recent years, as well as the health risks caused by their consumption, prompt calls to estimate the prevalence of ED use among different countries. This systematic review and meta-analysis aimed to synthesize the prevalence of ED use in different continents and age groups.

METHOD

We searched two databases (i.e. PubMed and PsycInfo) on 31 March 2023 to identify studies reporting the prevalence of ED use. A total of 192 studies (196 distinct samples; n = 1 120 613; 53.37% males) from the United States, Europe, Asia, Oceania and Africa were included in the analysis. A random-effects model was applied to estimate the overall pooled prevalence at several time-periods. Subgroup analyses were performed to provide prevalence based on continent and age group. The quality of articles was assessed using Joana Brigg's Institute (JBI) critical appraisal checklist. Measurements included prevalence of ED use (i.e. life-time, past 12 months, past 30 days, past 7 days and daily use), continent and age group (i.e. children, adolescents, young adults and adults).

RESULTS

The life-time ED use world-wide-pooled prevalence was estimated to be 54.7% [95% confidence interval (CI) = 48.8-60.6; I2  = 99.80], 43.4% (95% CI = 36.1-50.6; I2  = 99.92) in the past 12 months, 32.3% (95% CI = 28.8-35.8; I2  = 99.82) in the past 30 days, 21.6% (95% CI = 18.7-24.5; I2  = 99.95) in the past 7 days and 8.82% (95% CI = 6.3-11.4; I2  = 99.95) daily ED use. Subgroups analyses showed significant differences in ED life-time use within age groups (P = 0.002) and continents (P = 0.035).

CONCLUSIONS

The world-wide prevalence of energy drink use appears to be high, particularly among adolescents and young adults.

Energy drink consumption and sleep parameters in college and university students: a national cross-sectional study

OBJECTIVES

To investigate the frequency of energy drink (ED) consumption, and the association between ED consumption and selected sleep characteristics and parameters in Norwegian college and university students. We also explored whether these associations varied based on sex.

DESIGN

Cross-sectional.

SETTING

Data were gathered from the SHOT2022 study (Students' Health and Well-being Study), a national survey.

PARTICIPANTS

53 266 students, aged 18-35 years, enrolled in higher education in Norway (2022).

MAIN OUTCOME MEASURES

Estimated marginal means were computed from general linear models investigating the association between ED consumption and continuous sleep outcomes, while log-link binomial regression analysis was used for dichotomous sleep outcomes of sleep measures. All models were adjusted for age.

RESULTS

Among the participants, 4.7% of men and 3.3% of women reported consuming ED daily. The frequency of ED consumption was inversely associated with sleep duration and sleep efficiency, while a direct association was observed with the frequency of ED consumption and sleep patterns such as sleep onset latency and wake after sleep onset across sexes. The strongest association was found between daily ED consumption and short sleep duration where men had a risk ratio (RR) of 2.07; 95% CI 1.77 to 2.42, and women had a RR of 1.87; 95% CI 1.64 to 2.14.

CONCLUSION

ED consumption was a strong determinant for negative sleep outcomes. Even small amounts of ED were associated with poorer sleep outcomes, which warrant more attention towards the consequences of consuming ED among college and university students.

Effect of various factors on energy drinks consumption, and their connection with alcohol consumption

Energy drinks (EDs) have become widely popular among adolescents and young adults. Excessive consumption of EDs can lead to ED abuse and alcohol abuse. Therefore, this study has aimed to analyse the consumption of EDs in a group of patients suffering from alcohol dependence and among young adults, considering such issues as the amounts consumed, underlying reasons and threats arising from excessive consumption of ED and their mixing with alcohol (AmED). The study included 201 men (101 patients treated due to alcohol dependence and 100 young adults/students). Each research participant responded to questions in a survey designed by the researchers (socio-demographic data, clinical data, including consumption of ED, AmED and alcohol), the MAST and SADD. The participants also had their arterial blood pressure measured. EDs were consumed by 92% of the patients and 52% of young adults. A statistically significant dependence was confirmed between consumption of ED and tobacco smoking (p < 0.001), as well as the place of residence (p = 0.044). For 22% of the patients, ED consumption had an effect on alcohol consumption, where 7% admitted to feeling an increased urge to drink alcohol, and 15% said ED consumption decreased it. A statistically significant relationship (p < 0.001) was also shown between ED consumption and the consumption of EDs mixed with alcohol (AmED). This study may implicate that widespread consumption of EDs predisposes to the consumption of alcohol mixed with ED or separate.

Consumption patterns of energy drinks in university students: A systematic review and meta-analysis

OBJECTIVES

Energy drink (ED) use is promoted to stimulate mental and/or physical activity, and their popularity has increased over the years, especially among young people. However, the use of EDs is often improper, and can induce adverse effects for human health. The purpose of this systematic review and meta-analysis was to analyze the literature to characterize the prevalence of ED consumption and motivations for use among undergraduate students. Furthermore, adverse effects and health-related behaviors associated with ED consumption were explored.

METHODS

This systematic review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and the PubMed, Scopus, and Web of Science databases were used for data research.

RESULTS

A total of 71 articles published between 2007 and 2021 met the inclusion criteria and were included in the review. The estimated overall prevalence of ED consumption was 42.9% in undergraduate students (95% confidence interval, 42.5%-43.3%), with significant heterogeneity among studies (Q test: P < 0.001; I² = 99.4%). The main reasons for use were engagement in study, projects or examinations, stay awake or alert, and physical activity/sport engagement. Sleep disturbance and increased heart rate or blood pressure were the most commonly reported adverse effects. ED consumption was frequently associated with alcohol use and smoking.

CONCLUSIONS

These findings suggest that the inappropriate use of EDs and related unhealthy behaviors should be identified early, and addressed through effective educational interventions.<END ABSTRACT>.

Factors and perceptions associated with energy drink consumption among undergraduate students attending a rural university: a descriptive study

Objectives: This study examined the prevalence, patterns, and knowledge of Energy Drink (ED) consumption among undergraduate students. Participants: Participants included students (n = 373) attending a medium-sized rural university in Texas. Methods: Students were surveyed anonymously using convenience sampling and a cross-sectional design with 15 items structured questionnaire. Results: Nearly 90% of the study participants (N = 373) were between 18-24 years. Among the consumers (n = 165), the majority were females (80%) and Caucasian (73%). About 60% of them lived on campus, 22% were engaged in some type of sports activity, and primarily represented the freshmen (42%) and sophomore (25%) population. Having apriori knowledge of the negative health effects of EDs was associated with their consumption [OR: 0.40, CI: (0.22, 0.72)]. Conclusions: Our findings highlight the need to establish programs and policies on campus to address ED consumption issues and create educational campaigns to inform the undergraduate population attending a rural university.

Alcohol Mixed with Energy Drinks (AmED) Use among University Students: A Systematic Review and Meta-Analysis

In the last decades, there has been a huge increase in the consumption of both Energy Drinks (EDs) and alcohol and, concurrently, these two trends generated the additional practice of mixing ED with alcohol, known as Alcohol mixed with Energy Drink (AmED). One of the most important group of AmED consumers is represented by young. Indeed, the study population of the researches in this field are mainly represented by college students and the results evidence a great range of negative consequences for health. The purpose of the systematic review was to explore the prevalence of AmED consumption among undergraduate students, together with motivations to their use, adverse effects and health-related behaviors associated to AmEDs use. The review was conducted according to the PRISMA Statement and PubMed, Scopus and Web of Science were interrogated. 42 articles, published from 2008 to 2021, were included in the review. An overall prevalence rate of 37% was estimated for AmEDs use in undergraduates, with geographical differences. Although a decrease in consumption was observed throughout the studied period, a continuous monitoring on this phenomenon is needed for identifying those risk groups that could develop risky behaviors related to AmEDs consumption and provide them targeted educational interventions.

Energy drink expectancies among college students

ObjectiveSince the late '90 s, energy drink consumption has increased. The purpose of this investigation was to examine energy drink expectancies of college students. Participants: The university registrar randomly selected fifty university classes to be surveyed. Methods: A cross-sectional research design was used to assess the prevalence of energy drink consumption and energy drink expectancies. Binary logistic regression analyses were conducted to ascertain which expectancies explained energy drink consumption. Results: The expectancy factors of 1,246 participants accounted for 25.8% of the variance in past 30-day energy drink consumption. Energy enhancement, anxiety/negative physical effects, withdrawal, and appetite suppression were each found to be significantly related to energy drink consumption. Conclusions: Energy enhancement and anxiety/negative effects were the strongest predictors of energy drink consumption among college students. The results from this study can be used to design interventions to challenge erroneous expectancies and reinforce others that promote moderation or abstinence.

Prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among active duty United States military personnel

Background

Although representative data on caffeine intake in Americans are available, these data do not include US service members (SMs). The few previous investigations in military personnel largely involve convenience samples. This cross-sectional study examined prevalence of caffeine consumers, daily caffeine consumption, and factors associated with caffeine use among United States active duty military service members (SMs).

Methods

A stratified random sample of SMs were asked to complete an on-line questionnaire on their personal characteristics and consumption of caffeinated products (exclusive of dietary supplements). Eighteen percent (n = 26,680) of successfully contacted SMs (n = 146,365) completed the questionnaire.

Results

Overall, 87% reported consuming caffeinated products ≥1 time/week. Mean ± standard error per-capita consumption (all participants) was 218 ± 2 and 167 ± 3 mg/day for men and women, respectively. Caffeine consumers ingested 243 ± 2 mg/day (251 ± 2 mg/day men, 195 ± 3 mg/day women). On a body-weight basis, men and women consumed respectively similar caffeine amounts (2.93 vs 2.85 mg/day/kg; p = 0.12). Among individual caffeinated products, coffee had the highest use (68%), followed by sodas (42%), teas (29%), energy drinks (29%) and gums/candy/medications (4%). In multivariable logistic regression, characteristics independently associated with caffeine use (≥1 time/week) included female gender, older age, white race/ethnicity, higher body mass index, tobacco use or former use, greater alcohol intake, and higher enlisted or officer rank.

Conclusion

Compared to National Health and Nutrition Examination Survey data, daily caffeine consumption (mg/day) by SMs was higher, perhaps reflecting higher mental and physical occupational demands on SMs.

Coffee and energy drink use patterns in college freshmen: associations with adverse health behaviors and risk factors

Background

Public health concern over college students mixing caffeine-containing energy drinks (EDs) and alcohol has contributed to an array of ED-focused research studies. One review found consistent associations between ED use and heavy/problem drinking as well as other drug use and risky behaviors (Nutr Rev 72:87–97, 2014). The extent to which similar patterns exist for other sources of caffeine is not known. The present study examined associations between coffee and ED consumption and alcohol, tobacco and other drug use; alcohol use problems; and parental substance abuse and mental health problems in a sample of college freshmen.

Methods

Subjects were N = 1986 freshmen at an urban university who completed an on-line survey about demographics; caffeine; alcohol, tobacco and other drug use; and family history. The sample was 61% female and 53% White. Chi-square analyses and multivariable binary or ordinal logistic regression were used to compare substance use, problem alcohol behavior, and familial risk measures across 3 caffeine use groups: ED (with or without Coffee) (ED + Co; N = 350); Coffee but no ED (Co; N = 761); and neither coffee nor ED (NoCE; N = 875) use.

Results

After adjusting for gender and race, the 3 caffeine use groups differed on 8 of 9 symptoms for alcohol dependence. In all cases, the ED + Co group was most likely to endorse the symptom, followed by the Co group and finally the NoCE group (all p < .002). A similar pattern was found for: use 6+ times of 5 other classes of drugs (all p < .05); extent of personal and peer smoking (all p < .001); and paternal problems with alcohol, drugs and anxiety/depression as well as maternal alcohol problems and depression/anxiety (p < .04).

Conclusions

The response pattern was ubiquitous, with ED + Co most likely, Co intermediate, and NoCE least likely to endorse a broad range of substance use, problem alcohol behaviors, and familial risk factors. The finding that the Co group differed from both the ED + Co and NoCE groups on 8 measures and from the NoCE group on one additional measure underscores the importance of looking at coffee in addition to EDs when considering associations between caffeine and other risky behaviors.

Health and safety risks affecting part-time nursing students

Background

Professional nurses who are employed full-time can study their postgraduate programmes part-time to add to the basic qualification they obtained through relevant institutions of higher education like universities or colleges. Although there are advantages for part-time study such as improvement of qualifications, enhancement of personal development and increased chance of promotion, there are disadvantages as well, which includes keeping a job, attending to family and social responsibilities, time management to ensure that studying is done after work or in-between work and other activities, attending to assignments and complying with the requirements to acquire the qualification.

Aim

This study aimed to explore health and safety risks faced by nurses who work and study part-time.

Setting

The study was conducted at a university in Gauteng province, South Africa. Nurses who undertake part-time studies at this university were the focus of study.

Method

The research design used in the study was an exploratory, quantitative method that was contextual in nature. Data were collected using a self-administered questionnaire that comprised of demographical and health and safety aspects. Data were analysed by means of descriptive statistics using the Statistics package for Social Sciences version 26.

Results

Research findings indicated that students who study part-time experience health and safety risks such as fatigue (n = 86; 49%), stress (n = 95; 54%), sleep disorders (n = 60; 34%), poor eating habits (n = 123; 70%), abuse of caffeine (n = 91; 52%) and are prone to road accidents (n = 54; 31%).

Conclusion

Nurses who work and study part-time need support from their employers and families. Employers should grant study leave as a way of support.

Association between energy drink consumption and substance use in adolescence: A systematic review of prospective cohort studies

BACKGROUND

It is unclear whether energy drink (ED) consumption is associated with substance use (SU) in adolescence. The purpose of this study is to clarify the association.

METHODS

A systematic review was conducted using a wide range of electronic bibliographic databases to search for published prospective cohort studies on the topic from inception to 14th August 2019. The risk of bias was addressed by using the Risk Of Bias In Non-randomised Studies - of Interventions; ROBINS-I. Studies targeting adolescents were collected. Additionally, we collected studies that examined an association between the extent of energy drink consumption as exposure variables and any substance use as outcome variables.

RESULTS

Five studies met the eligibility criteria. ED consumption was associated with adolescent use of alcohol, tobacco, cannabis, prescription stimulants, and analgesics. However, the overall risk of bias in the included studies was severe.

CONCLUSION

ED consumption may be associated with SU in adolescence, particularly alcohol use. The results, however, were still inconclusive due to the relatively low methodological quality in the included studies. Evidence from more well-designed trials is needed in future research.

Alcohol, nicotine, and caffeine consumption on a public U.S. university campus determined by wastewater-based epidemiology

Alcohol, nicotine, and caffeine use in at-risk populations is a public health concern that claims over 550,000 lives annually. Self-reported surveys from college students often reveal overconsumption of these substances. Unfortunately, the costs of these surveys are high, and consequently, the results from few studies are often extrapolated across the entire target population. Here we employed wastewater-based epidemiology (WBE) to directly measure the levels of these three psychotropic substances and their metabolites in sewage from a large public Southwestern U.S. university campus during the 2017-2018 academic year. Results showed per person alcohol consumption was 11.3 ± 7.5 g d^-1 person^-1 or 0.8 ± 0.5 drinks d^-1 person^-1, similar to averages of nationwide estimates from self-reporting of this subpopulation aged 18-25 years (10.1 ± 0.8 g d^-1 person^-1 or 0.7 ± 0.06 drinks d^-1 person^-1). Caffeine and nicotine consumption determined by WBE were significantly lower (p < 0.05) than nationwide estimates from self-reporting (caffeine: 114 ± 49 vs. 178 ± 19 mg d^-1 person^-1; nicotine: 627 ± 219 vs. 927 ± 243 μg d^-1 person^-1). Strong positive correlations were found for consumption of alcohol and nicotine (Spearman r_s: 0.71; p < 0.01), and nicotine and caffeine (0.59, p < 0.01), but not alcohol and caffeine (0.17). Alcohol and nicotine consumption were significantly higher on weekends compared to weekdays (p < 0.01), while caffeine consumption was higher during the week (p < 0.05). This first U.S. WBE study on alcohol, nicotine, and caffeine use among U.S. college students demonstrated the feasibility and practicality of longitudinally tracking the behavior of an entire campus population of 60,000 students directly, repeatedly, and more inexpensively (US$0.58/person) compared to conventional questionnaires (US$127/person).

Determinants of energy drink consumption in adolescents: identification of sex-specific patterns

OBJECTIVES

To investigate sex differences in sociodemographic and lifestyle correlates of frequent energy drink (ED) consumption in adolescents.

STUDY DESIGN

This study was based on data collected among French-speaking Belgian adolescents aged 11-20 years (n = 8137) within the 2018 Health Behaviour in School-aged Children study.

METHODS

Multiple logistic analyses stratified by sex were performed to estimate the associations between consuming EDs more than once a week, and various sociodemographic and lifestyle characteristics.

RESULTS

Overall, 14.0% of boys and 7.6% of girls consumed ED more than once a week. For both genders, the likelihood of consuming ED more than once a week was higher among adolescents consuming soft drinks daily (vs. < daily), alcohol weekly (vs. < weekly), spending at least 5 h/day in front of screens (vs. < 5 h/day), and going to bed later than 11:30 PM (vs. ≤ 10:00 PM). Among boys, adolescents reporting at least 1 h of moderate-to-vigorous physical activity (MVPA) daily (vs. < 1 h/day MVPA) were more likely to consume ED more than once a week (adjusted odd ratio (aOR) = 1.49 (95% confidence interval [CI] 1.11-2.01)). Among girls, adolescents from low affluence families (vs. high affluence) (aOR = 2.03 (95% CI 1.19-3.48)) and immigrants (vs. natives) (2nd generation: aOR = 1.75 (95% CI 1.31-2.32); 1st generation: aOR = 1.90 (95% CI 1.20-3.03)) were more likely to consume ED more than once a week.

CONCLUSIONS

We identified different patterns of ED consumption in boys and girls. These results suggest that sex-tailored interventions could be relevant to reduce ED consumption in adolescents.

Case report on energy drink consumption among Health Sciences University students in Gauteng Province, South Africa

Background

There are claims that energy drink (ED) consumption can bring about an improvement in mental functioning in the form of increased alertness and enhanced mental and physical energy. These claims address the lifestyle of a student of sleep deprivation and academic pressure with ED consumption becoming a popular practice amongst students. The study’s objectives were to determine the prevalence, reasons for, and patterns of ED and alcohol mixed with ED (AmED) consumption amongst university students.

Case presentation

Registered students of the Health Sciences University, Gauteng Province, South Africa, formed the study population where this quantitative cross-sectional survey conveniently collected data by means of previous validated self-administered questionnaires from 490 students representing the diverse demographics of the university. Questions on the socio-demographic profile of the participants; pattern of alcohol use; reasons, pattern, and preferred types of EDs use; and the pattern, reason, and experience of AmED use during the past 12 months were asked. Frequency and percentages of distributions were determined, and the possible factors contributing to ED consumption were computed using the chi-square test. Results indicated that a total of 58% of students were consuming EDs mainly to stay awake (31%), to be more alert (14%), and to help with concentration (15%), 69% were consuming alcohol, and 16% were consuming AmEDs.

Conclusion

There is an urgent need for an appropriate public health prevention intervention so that ED consumers can make informed choices when indulging in these health behaviors before the seemingly harmless consumption of ED amongst students becomes a public health issue.

The Effects of Goal Framing on Energy Drink Consumption: The Moderating Role of Temporal Framing

BACKGROUND

With the rapid expansion of the energy drink market, concerns associated with its adverse effects have been raised. This research examines how goal framing moderated by temporal framing affects attitude, subjective norm, and perceived behavioral control related to energy drink consumption.

METHODS

A 2 (goal framing: gain vs. loss) × 2 (temporal framing: present-oriented vs. future-oriented) randomised experiment was employed. The sample consisted of 195 college students who consume energy drinks.

RESULTS

Results showed that a future-oriented message was more effective than a present-oriented one when used in gain framing in increasing perceived behavioral control, as predicted. A future-oriented message was also more effective in increasing perceived negative subjective norms, but only when used in loss framing; this was the opposite of the predicted result.

CONCLUSIONS

The findings extend previous research on goal framing by (1) identifying an important moderator-temporal framing-in processing health promotion messages about energy drink consumption and (2) examining such moderated effects on different psychological factors. The findings of this study are expected to inform the development of more effective message strategies in health domains.

Youth consumption of alcohol mixed with energy drinks in Canada: Assessing the role of energy drinks

Consuming alcohol mixed with energy drinks (AmED) is a risk behaviour among youth, and previous research has reported a positive association between binge drinking and AmED consumption. However, limited research has examined how regular consumption of energy drinks is associated with AmED consumption among youth. The purpose of this report is to examine the role of energy drink use on AmED consumption in a Canadian youth population. Using data from the 2015-2016 COMPASS survey including 35,300 grade 9 to 12 students, two logistic regression models investigated if the inclusion of energy drink consumption in the past week altered the results of a model examining AmED consumption. In this sample, 13.2% of students reported AmED consumption in the last 12 months. Those who reported drinking energy drinks in the past week were 3.38 times more likely to consume AmED than those who did not drink energy drinks. The inclusion of past week energy drink use decreased the effect size of other associated substance use behaviours. This report demonstrates that past week energy drink use is associated with increased likelihood of AmED consumption and suggests that previous research may have missed this important contributor. These findings along with existing energy drink research highlight the importance of addressing the lack of energy drink regulations in Canada.

Food Choices of Young Adults in the United States of America: A Scoping Review

Understanding food choice is critical to developing effective health promotion efforts to counter the leading causes of morbidity and mortality in the United States. Although physiologic, environmental, and social factors influence the development of health conditions, routine decisions, such as food choice, also contribute substantially over time. Behavioral scientists believe that these routine decisions represent a key opportunity to improve population health. We conducted a scoping review of both health and business literature to identify themes in the food choices of young adults aged 19-24 y in the United States. Informed by the Joanna Briggs Institute processes for scoping reviews, we conducted a structured search of 8 health and business databases on 18 April 2017. The databases were PubMed, Business Source Complete, PsycInfo, Cochrane Library, CINAHL, Web of Science, SCOPUS, and ABI/Inform Collection. Eligible literature captured real-world dietary choices of the general population of young adults between 1 January, 2007 and 31 December, 2017. Records were screened in Covidence. Data was extracted into Excel and key findings thematically analyzed. The search returned 9085 records. Ninety-nine records met the eligibility criteria. Themes identified in the foods chosen by young adults include inadequate fruit and vegetable consumption, choosing international flavors and food formats, convenience foods, frequent snacking, the selection of healthy foods based on perceptions of what is healthy rather than the nutrient or calorie content of foods, an interest in sustainable production methods, the desire to customize/tailor foods, foods young people find interesting, and regional foods. This research identified common food choices that can help inform the tailoring of health promotion efforts; however, more research is needed to understand the underlying mechanisms and principles shaping these choices.

Energy drinks in children and adolescents: demographic data and immediate effects

Energy drinks consumption has become increasingly common in the last few years, despite evidence associating these products with vast adverse health effects. This led us to explore the phenomenon of energy drinks consumption in adolescents in the Israeli Arab population of the Nazareth area (Northern Israel), examining their awareness of risks associated with consumption of energy drinks, investigating their immediate effects on the body. Our study revealed that the consumption of energy drinks is very common in adolescents of both sexes, though more common in boys. Of 375 students who filled out the questionnaire, 206 reported that they consumed energy drinks (55%), 91 were male (44.4%), and 115 were female (55.6%). In the experimental stage of this study, we found that energy drinks significantly increased systolic blood pressure in most participants within a brief period of time after drinking.Conclusion: Given the prevalence of energy drinks consumption and their side effects, it is important to increase awareness of the risks associated with their regular use and to combat this phenomenon through the education system in schools. What is Known: • Energy drinks consumption has become popular and frequent among adolescents across the world. • The immediate effects of energy drinks in children and adolescents are poorly described. What is New: • Religious and social norms are not a barrier to ED consumption among the varied investigated population. • Our study describes the immediate effect of energy drinks during the first 2 h after consumption, revealing systolic blood pressure to be significantly increased.

Investigating associations between caffeinated beverage consumption and later alcohol consumption among early adolescents

Previous research has demonstrated that caffeinated beverage consumption predicts alcohol consumption among early adolescents. This study aimed to investigate this association in two ways: (1) by examining if this association remained significant once other established risk factors for alcohol were adjusted for statistically; and (2) by considering three possible moderators of this association: gender, sensation-seeking, and parental monitoring. Data from the Camden Youth Development Study, a longitudinal, community-based study of middle-school students, were used. Youth were initially assessed in 6th and 7th grade and followed-up 16 months later. Self-reports of frequency of energy drink, coffee, and alcohol consumption, as well as sensation-seeking, perceived peer and best friend alcohol use, alcohol expectancies, and parental monitoring, were used. Results indicated that both energy drink and coffee consumption predicted later alcohol consumption, even after adjusting for other risk factors for alcohol consumption. Parental monitoring was a significant moderator of this link, such that youth who consumed energy drinks and reported low parental monitoring were particularly at risk for later alcohol consumption. These findings indicate that the link between earlier caffeine consumption and later alcohol consumption is not simply due to the co-occurrence of caffeine consumption with other risk factors for alcohol use. In addition, risk associated with early energy drink consumption appears to be particularly pronounced for youth in families characterized by low parental monitoring.

Gender Differences in Any-Source Caffeine and Energy Drink Use and Associated Adverse Health Behaviors

Background: The majority of college students report caffeine use with many using caffeine daily. Energy drink (ED) use, in particular, is common among college students, and numerous studies link these heavily caffeinated drinks to a variety of adverse consequences including substance use and risky behaviors. However, little is known about correlations between any-source caffeine use and other substance use and problems. The purpose of this study was to evaluate patterns of caffeine use and examine the relationships between caffeine, in general, and EDs specifically, and adverse health behaviors in college students. Methods: We used data from a longitudinal study of alcohol use and health-related outcomes to assess caffeine, alcohol, nonprescription drug, and tobacco use and symptoms of alcohol dependence in 1958 freshmen from a mid-Atlantic university during Fall 2012. We compared adverse health behaviors between caffeine users and nonusers and ED users and nonusers. Data were evaluated separately in men and women. Results: While women reported significantly more caffeine use than men, men reported more ED use. EDs, regardless of frequency of use, were associated with all adverse health behaviors, but only in female students. Similarly, daily any-source caffeine use was significantly associated with alcohol, nonprescription drug, and tobacco use in female students, but in men, the association was less robust. Conclusions: This research shows that caffeine use is prevalent among college students, and, in female students, is associated with alcohol, nonprescription drug, and tobacco use and alcohol dependence symptoms. Interventions aimed at promoting healthy behaviors may be especially useful in this population.

Review: Trends, Safety, and Recommendations for Caffeine Use in Children and Adolescents

OBJECTIVE

Caffeine use is common in children and adolescents, but the recommendations for safe consumption are based on decades-old data collected exclusively in adults. Increased availability of caffeine-containing products and a concerted marketing effort aimed at children and adolescents, has increased interest in understanding the physiological, behavioral, and psychological effects of caffeine within this population. This manuscript provides a review of the literature concerning trends and safety of ingested caffeine in children and adolescents.

METHOD

A search of the National Library of Medicine database was conducted using the terms caffeine, children, adolescents, and safety, in addition to tailored searches on specific topics using combinations of search terms such as energy drinks, cardiovascular, mood, cognitive, mental health, sleep, and regulations.

RESULTS

The majority of the literature reviewed here suggests that typical, moderate caffeine consumption in children and adolescents is relatively safe, but that higher doses of caffeine consumption (>400 mg) can cause physiological, psychological, and behavioral harm, in particular in subgroups of children, such as those with psychiatric or cardiac conditions. More attention is being paid to the potential adverse effects of both acute and chronic caffeine use, and additional regulations surrounding the sale and marketing of highly caffeinated beverages are now being considered.

CONCLUSION

More research is needed to fill in gaps in our knowledge, including understanding the relationship between caffeine use and initiation of other substances, such as cigarettes, alcohol, or marijuana, identifying individuals at risk for caffeine toxicity, and developing harm-reduction strategies.

Caffeinated energy drink use by U.S. adolescents aged 13-17: A national profile

The present study examined the national prevalence and distribution of adolescent use of caffeinated energy drinks, assessing variations in sociodemographic characteristics, personality traits, lifestyles, and patterns of alcohol and caffeine use. A cross-sectional survey was conducted in May 2014, using a nationally representative sample of 1,032 U.S. early (aged 13-15; n = 602) and middle adolescents (aged 16-17; n = 430). Nearly two thirds of teens reported ever using energy drinks; 41% had done so recently, that is, in the past 3 months. Middle adolescents reported higher prevalences of both lifetime and recent use of energy drinks than early adolescents. Common situational contexts for use (e.g., compensating for lack of sleep or playing sports) differed by both gender and age cohort. In hierarchical logistic regression analyses, gender and geographic region significantly predicted both lifetime and recent use for early adolescents only, whereas age and race were significant predictors only for middle adolescents. For both age cohorts, odds of both lifetime and recent use increased with sensation-seeking score, lifetime alcohol use, and recent caffeinated soft drink use. Among early adolescents, grade point average predicted lifetime use only, whereas coffee and caffeine pill use predicted recent use only. Among middle adolescents, impulsivity and past sports participation predicted lifetime but not recent use. Our findings show that adolescent energy drink use is widespread and varies as a function of demographic, psychosocial, lifestyle, and substance use characteristics. Future research is needed to assess whether differences between early and middle adolescent use patterns are primarily developmental or cohort effects. (PsycINFO Database Record

Energy drink consumption and the perceived risk and disapproval of drugs: Monitoring the Future, 2010-2016

BACKGROUND

Energy drinks have become quite popular in recent years among adolescents, prompting a wealth of recent research examining the potential deleterious consequences of energy drink consumption among youth. The present study adds to this body of work by exploring perceptions of risk and disapproval of soft and hard drugs among adolescents and whether such attitudes are predicted by patterns of energy drink/shot consumption.

METHODS

Data were derived from the seven most recent cohorts (2010-2016) of the Monitoring the Future (MTF) study, a nationally representative survey of U.S. youth. The significance of associations between energy drink/shot consumption and drug perceptions/attitudes was tested using logistic regression techniques employing adjustments for covariates and cohort-specific fixed effects.

RESULTS

Energy drink/shot consumption was largely associated with significant increases in the odds of failing to perceive any risk of drug use and failing to disapprove of drug use among youths, regardless of whether attitudes concerning soft or hard drugs were examined. These associations were particularly robust in the case of habitual energy drink/shot consumers (relative to occasional consumers or abstainers).

CONCLUSIONS

Additional efforts should be made to heighten awareness and education concerning the potential dangers of energy drink consumption among youth, particularly as it pertains to drug attitudes and diminished perceptions of substance use risk. Policies that minimize energy drink consumption among youth as well as programs that educate parents and teachers about the drug attitudes of youths who regularly consume energy drinks and promote active monitoring of these adolescents may be worthwhile.

Energy drinks and escalation in drug use severity: An emergent hazard to adolescent health

The aim of the current study is to determine whether energy drink consumption contributes to drug use and, more specifically, an escalation in the severity of drug use. We first examine the association between energy drink use and hard drug use, and subsequently investigate whether soft drug use mediates this relationship. Potential moderating influences are also investigated by testing whether the degree of mediation varies by age, gender, and race. The current study uses a nationally representative sample of 8th (ages 13-14), 10th (ages 15-16), and 12th (ages 17-18) grade adolescents from the 2015 Monitoring the Future survey. Negative binomial regression is employed to examine associations between energy drink consumption and soft and hard drug use. Mediation results indicate that energy drink consumption is significantly associated with increased soft drug use, which is, in turn, associated with significant increases in hard drug use. This cascading effect of energy drink consumption on drug use appears to be stronger among younger females and older males. Results for the moderating effect of race are mixed. Energy drinks appear to pose an important threat to adolescent health in the form of soft and hard drug use. The United States may want to consider adopting energy drink policies similar to European countries and Canada, which require warning labels on beverages with high caffeine content.

Does early exposure to caffeine promote smoking and alcohol use behavior? A prospective analysis of middle school students

BACKGROUND AND AIMS

Despite the negative consequences associated with caffeine use among children and youth, its use is increasingly widespread among middle school students. Cross-sectional studies reveal links between caffeine and other substance use. The potential for caffeine use to confer increased vulnerability to substance use, however, has not been investigated using prospective designs. We hypothesized that caffeine use at baseline would be associated positively with increased alcohol use, drunkenness, smoking and e-cigarette use.

DESIGN

Prospective cohort study with 12 months separating baseline from follow-up.

SETTING

West Virginia, USA.

PARTICIPANTS

Middle school students (6th and 7th grades; n = 3932) in three West Virginia (WV) counties provided data at baseline and follow-up 12 months later.

MEASUREMENTS

Youth self-reported their use of caffeine from multiple sources (e.g. soda, energy drinks, coffee and tea), cigarette smoking, electronic cigarette use, alcohol use and drunkenness.

FINDINGS

Cross-lagged path models for individual substance use categories provided a good fit to the data. Controlling for demographic variables and other substance use at baseline, caffeine at time 1 (T1) was associated positively with T2 cigarette smoking (β = 0.27, P = 0.001), e-cigarette use (β = 0.21, P = 0.001), alcohol use (β = 0.17, P = 0.001) and drunkenness (β = 0.15, P = 0.001). Conversely, non-significant relations emerged between three of four substances at T1 and caffeine at T2. Positive relations were found between e-cigarette use at T1 and caffeine use at T2 (β = 0.07, P = 0.006). These findings were supported by an omnibus model with all substances included. Specifically, significant relations were observed between caffeine at T1 and all substance use outcomes at T2, whereas no significant relations were observed between substance use and caffeine over time.

CONCLUSIONS

Caffeine may promote early use of other types of substances among middle school-aged adolescents.

Is the Consumption of Energy Drinks Associated With Academic Achievement Among College Students?

Despite widely reported side effects, use of energy drinks has increased among college students, who report that they consume energy drinks to help them complete schoolwork. However, little is known about the association between energy drink use and academic performance. We explored the relationship between energy drink consumption and current academic grade point average (GPA) among first-year undergraduate students. Participants included 844 first-year undergraduates (58.1 % female; 50.7 % White). Students reported their health behaviors via an online survey. We measured energy drink consumption with two measures: past month consumption by number of drinks usually consumed in 1 month and number consumed during the last occasion of consumption. We used multiple linear regression modeling with energy drink consumption and current GPA, controlling for gender, race, weekend and weekday sleep duration, perceived stress, perceived stress management, media use, and past month alcohol use. We found that past month energy drink consumption quantity by frequency (p < 0.001), and energy drinks consumed during the last occasion (p < 0.001), were associated with a lower GPA. Energy drinks consumed during the last occasion of consumption (p = 0.01) remained significantly associated with a lower GPA when controlling for alcohol use. While students report using energy drinks for school-related reasons, our findings suggest that greater energy drink consumption is associated with a lower GPA, even after controlling for potential confounding variables. Longitudinal research is needed that addresses whether GPA declines after continued use of energy drinks or if students struggling academically turn to energy drinks to manage their schoolwork.

Energy Drink Use Among Ohio Appalachian Smokers

Caffeine-containing energy drinks have emerged as a public health concern due to their association with caffeine toxicity and alcohol use. Despite the fact that previous research has linked caffeine use in the form of coffee drinking to smoking, there is little research examining the association between energy drinks and smoking. The present study examines demographic and behavioral factors associated with energy drink use among a sample of rural Ohio Appalachian smokers. It was hypothesized that male gender, young age (21-30 years.) and alcohol use would be associated with energy drink use. A sample of adult smokers (n = 298) from Ohio Appalachian counties were interviewed regarding demographic and behavioral factors. Logistic regression analysis was used to assess the association between these factors and energy drink use. Seventy percent of Ohio Appalachian smokers studied had ever used an energy drink and 40 % had used an energy drink in the past month. Young age, male gender, and single marital status were associated with higher odds of ever having used an energy drink. Young age, and binge drinking were associated with higher odds of past 30-day use while abstinence from drinking was associated with lower odds of past 30-day use. Ohio Appalachian adult smokers had higher rates of energy drink use compared to previous estimates of ever or past month use found in other studies. The combined use of caffeine, nicotine, and alcohol warrants attention due to potential for health risk.

Energy Drinks and Binge Drinking Predict College Students' Sleep Quantity, Quality, and Tiredness

This study examines whether energy drink use and binge drinking predict sleep quantity, sleep quality, and next-day tiredness among college students. Web-based daily data on substance use and sleep were collected across four semesters in 2009 and 2010 from 667 individuals for up to 56 days each, yielding information on 25,616 person-days. Controlling for average levels of energy drink use and binge drinking (i.e., 4+ drinks for women, 5+ drinks for men), on days when students consumed energy drinks, they reported lower sleep quantity and quality that night, and greater next-day tiredness, compared to days they did not use energy drinks. Similarly, on days when students binge drank, they reported lower sleep quantity and quality that night, and greater next-day tiredness, compared to days they did not binge drink. There was no significant interaction effect between binge drinking and energy drink use on the outcomes.

Alcohol consumption and factors associated with binge drinking among female university students of health area

Abstract Objective: To evaluate the pattern of alcohol consumption and the prevalence and factors associated with binge drinking among university students of health-related courses in Aracaju, Sergipe, Brazil. Methods: A cross-sectional study was performed of 865 female students from two universities in the Brazilian Northeast. The instruments used were the AUDIT and a questionnaire used to collect sociodemographic data. The chi-square test and logistic regression were used, with statistical significance set at p-value < 0.05. Results: Risky alcohol consumption was evidenced in 16.4%, while the prevalence of binge drinking was 48.0%. Binge drinking was strongly associated with drunk driving (OR = 12.24) and living in a conflicting family environment (OR = 6.33). Binge drinking was a constant in students who engaged in fights, those who had problems with the law and among smokers. Conclusion: The high prevalence of risky alcohol consumption, binge drinking and the association of these with risky behaviors in students serve to guide future public policies on prevention.

Reasons for Energy Drink Use and Reported Adverse Effects Among Adolescent Emergency Department Patients

OBJECTIVES

There is concern of energy drink use by adolescents. The objective of this study was to evaluate the energy drink consumption use, frequency, age of first use, reasons for use, influences of choice of brand, and adverse events recorded in a predominant Latino adolescent population.

METHODS

Subjects between the ages of 13 and 19 years utilizing emergency department services for any reason at a large county hospital answered a questionnaire about energy drink usage.

RESULTS

There were 192 subjects, of which 49% were male and 51% were female. Latino adolescents were 85% of the participants, although other ethnic groups participated including African American, white, and Asian. Reasons for use include 61% to increase energy, 32% as study aide, 29% to improve sports performance, and 9% to lose weight. Twenty-four percent reported using energy drinks with ethanol or illicit drugs including marijuana, cocaine, and methamphetamine. Adverse reactions were reported in 40% of the subjects including insomnia (19%), feeling "jittery" (19%), palpitations (16%), gastrointestinal upset (11%), headache (8%), chest pain (5%), shortness of breath (4%), and seizures (1%).

CONCLUSIONS

Both brand name and packaging influenced the choice of energy drink in most subjects. Forty percent reported at least 1 adverse effect. While most adverse effects were not severe, a small number are serious. In addition, we showed intentional ingestion with ethanol and illicit drugs. Of additional concern is that both brand and packaging seem to directly affect choice of energy drink consumed.

Trajectories of energy drink consumption and subsequent drug use during young adulthood

BACKGROUND

Highly caffeinated energy drinks (EDs) are popular with adolescents and young adults, but longitudinal consumption patterns are poorly understood especially in relation to other substance use.

METHODS

ED and other substance use were assessed annually (modal ages 21-25) among a sample (n=1099) who were originally recruited as first-year college students (modal age 18). Trajectory groups were derived based on probability of past-year use during ages 21-24, and compared for possible differences in substance use outcomes at age 25, holding constant demographics, sensation-seeking, other caffeine consumption, and age 21 substance use.

RESULTS

From age 21-25, ED consumption declined in both annual prevalence [62.5%wt to 49.1%wt (wt=weighted)] and frequency of use among consumers (35.2-26.3 days/year). Yet individuals exhibiting a Persistent trajectory (51.4%) of consumption outnumbered those with Non-Use (20.6%), Intermediate (17.4%), or Desisting (10.6%) trajectories. Age 25 cocaine use, nonmedical use of prescription stimulants (NPS), and alcohol use disorder (AUD) risk were significantly associated with trajectory group membership, with Persistent and Intermediate groups exhibiting the highest risk for such outcomes, even accounting for prior substance use and other risk factors. Neither marijuana nor tobacco use were associated with group membership.

CONCLUSIONS

The typical pattern of ED consumption among this sample was sustained use throughout young adulthood. Such individuals appear to be at high risk for adverse substance use outcomes, and results suggest possible specificity regarding cocaine use and NPS, and AUD risk. More research is needed to understand the mechanisms underlying the connection between ED and substance use.

Energy Drink and Alcohol mixed Energy Drink use among high school adolescents: Association with risk taking behavior, social characteristics

PURPOSE

The aims of the study were to: a) examine the prevalence of energy drink (ED) and alcohol mixed with energy drink (AmED) consumption; b) investigate the relationships between ED and AmED with alcohol, binge drinking and drugs accounting for at risk behaviors among a representative sample of Italian adolescents.

METHODS

A representative sample of 30,588 Italian high school students, aged 15-19years, was studied. Binary and multivariate logistic regression analyses were performed to determine the independent association of the potential predictors' characteristics with the ED and AmED drinking during the last year.

RESULTS

Respectively 41.4% and 23.2% of respondents reported drinking EDs and AmEDs in the last year. Multivariate analysis revealed that consumption of EDs and AmEDs during the last year were significantly associated with daily smoking, binge drinking, use of cannabis and other psychotropic drugs. Among life habits and risky behaviors the following were positively associated: going out with friends for fun, participating in sports, experiencing physical fights/accidents or injury, engaging in sexual intercourse without protection and being involved in accidents while driving.

CONCLUSIONS

This study demonstrates the popularity of ED and AmED consumption among the Italian school population aged 15-19years old: 4 out of 10 students consumed EDs in the last year and 2 out of 10 AmED. Multivariate analysis highlighted the association with illicit drug consumption and harming behaviors, confirming that consumption of EDs and AmEDs is a compelling issue especially during adolescence, as it can effect health as well as risk taking behaviors.

Energy drinks and alcohol-related risk among young adults

BACKGROUND

Energy drink consumption, with or without concurrent alcohol use, is common among young adults. This study sought to clarify risk for negative alcohol outcomes related to the timing of energy drink use.

METHODS

The authors interviewed a community sample of 481 young adults, aged 18-25, who drank alcohol in the last month. Past-30-day energy drink use was operationalized as no-use, use without concurrent alcohol, and concurrent use of energy drinks with alcohol ("within a couple of hours"). Negative alcohol outcomes included past-30-day binge drinking, past-30-day alcohol use disorder, and drinking-related consequences.

RESULTS

Just over half (50.5%) reported no use of energy drinks,18.3% reported using energy drinks without concurrent alcohol use, and 31.2% reported concurrent use of energy drinks and alcohol. Relative to those who reported concurrent use of energy drinks with alcohol, and controlling for background characteristics and frequency of alcohol consumption, those who didn't use energy drinks and those who used without concurrent alcohol use had significantly lower binge drinking, negative consequences, and rates of alcohol use disorder (P < .05 for all outcomes). There were no significant differences between the no-use and energy drink without concurrent alcohol groups on any alcohol-related measure (P > .10 for all outcomes).

CONCLUSIONS

Concurrent energy drink and alcohol use is associated with increased risk for negative alcohol consequences in young adults. Clinicians providing care to young adults could consider asking patients about concurrent energy drink and alcohol use as a way to begin a conversation about risky alcohol consumption while addressing 2 substances commonly used by this population.

Acute impact of caffeinated alcoholic beverages on cognition: A systematic review

INTRODUCTION

Energy drinks are popular beverages that are supposed to counteract sleepiness, increase energy, maintain alertness and reduce symptoms of hangover. Cognitive enhancing seems to be related to many compounds such as caffeine, taurine and vitamins. Currently, users mostly combine psychostimulant effects of energy drinks to counteract sedative effects of alcohol. However, recent literature suggests that this combination conducts to feel less intoxicated but still impaired. The goal of the present article is to review cognitive impact and subjective awareness in case of caffeinated alcoholic beverage (CAB) intoxication.

METHOD

PubMed (January 1960 to March 2016) database was searched using the following terms: cognitive impairments, alcohol, energy drinks; cognition, alcohol, caffeine.

RESULTS

99 papers were found but only 12 randomized controlled studies which explored cognitive disorders and subjective awareness associated with acute CAB or AED (alcohol associated with energy drinks) intoxication were included.

DISCUSSION

The present literature review confirmed that energy drinks might counteract some cognitive deficits and adverse effects of alcohol i.e. dry mouth, fatigue, headache, weakness, and perception of intoxication due to alcohol alone. This effect depends on alcohol limb but disappears when the complexity of the task increases, when driving for example. Moreover, studies clearly showed that CAB/AEDs increase impulsivity which conducts to an overconsumption of alcohol and enhanced motivation to drink compared to alcohol alone, potentiating the risk of developing addictive behaviors. This is a huge problem in adolescents with high impulsivity and immature decision making processes.

CONCLUSION

Although energy drinks counteract some cognitive deficits due to alcohol alone, their association promotes the risk of developing alcohol addiction. As a consequence, it is necessary to better understand the neurobiological mechanisms underlying these interactions in order to better prevent the development of alcohol dependence.

Energy drink use frequency among an international sample of people who use drugs: Associations with other substance use and well-being

OBJECTIVE

The study aims were to identify: i.) energy drink (ED), caffeine tablet, and caffeine intranasal spray use amongst a sample who report drug use, and ii.) the association between ED use frequency and demographic profile, drug use, hazardous drinking, and wellbeing.

METHOD

Participants (n=74,864) who reported drug use completed the online 2014 Global Drug Survey. They provided data on demographics, ED use, and alcohol and drug use, completed the Alcohol Use Disorders Identification Test (AUDIT) and Personal Wellbeing Index (PWI), and reported whether they wished to reduce alcohol use.

RESULTS

Lifetime ED, caffeine tablet and intranasal caffeine spray use were reported by 69.2%, 24.5% and 4.9%. Median age of ED initiation was 16 years. For those aged 16-37, median years using EDs increased from 4 to 17 years of consumption, where it declined thereafter. Greater ED use frequency was associated with: being male; under 21 years of age; studying; and past year caffeine tablet/intranasal spray, tobacco, cannabis, amphetamine, MDMA, and cocaine use. Past year, infrequent (1-4days) and frequent (≥5days) past month ED consumers reported higher AUDIT scores and lower PWI scores than lifetime abstainers; past month consumers were less likely to report a desire to reduce alcohol use.

CONCLUSIONS

ED use is part of a complex interplay of drug use, alcohol problems, and poorer personal wellbeing, and ED use frequency may be a flag for current/future problems. Prospective research is required exploring where ED use fits within the trajectory of other alcohol and drug use.

Perceptions and Knowledge of Caffeinated Energy Drinks: Results of Focus Groups With Canadian Youth

OBJECTIVE

To examine use, knowledge, and perceptions of caffeinated energy drinks (CEDs) among youth.

DESIGN

Qualitative research using focus group discussions (n = 4).

SETTING

Two Canadian cities (Toronto and Montreal).

PARTICIPANTS

Youth aged 12-18 years (n = 41).

PHENOMENON OF INTEREST

Perceived definitions of CEDs, reasons for use, knowledge of health effects, use with alcohol, marketing perceptions, and use and understanding of cautionary statements on packaging.

ANALYSIS

Data were analyzed using a modified grounded-theory approach.

RESULTS

Youth identified CEDs as products that provide energy and contain caffeine and sugar. Compared with mainstream CED brands and energy shots, youth were less likely to perceive Gatorade, Coca-Cola, and a Starbucks beverage as energy drinks, despite some ambiguity. The majority of participants believed that CEDs, including mixed with alcohol, were not necessarily harmful in moderation and that marketing was targeted toward older youth and young adults. Awareness of cautionary statements on CEDs was low; cautionary statements were perceived as difficult to find and read owing to the design and small font.

CONCLUSIONS AND IMPLICATIONS

Findings suggest a need to increase public education regarding the potential risks of CED consumption, including enhancements to the mandated cautionary statements, with greater attention to the impact of CED marketing on youth.

Consumption of energy drinks among Québec college students

OBJECTIVES

Consumption of energy drinks (ED) raises concerns because of adverse health effects possibly linked with high levels of caffeine and sugar intake. The study looks at the scope of ED consumption as well as some of the associated characteristics.

METHODS

Thirty-six public colleges in the Canadian province of Québec agreed to participate in a descriptive cross-sectional study (n = 36). In February 2013, participating colleges invited their students to answer an online questionnaire on consumption of ED, alcoholic ED (AED), and ED in combination with other psychotropic drugs. A descriptive and correlational analysis was carried out. Logistic regressions explored associations between ED consumption and associated characteristics.

RESULTS

Of the students who successfully completed the questionnaire and participated in the study (n = 10,283), a low proportion consumed ED (9.1%; n = 935) and/or AED (1.1%; n = 109) at least once a week in the previous month. Although low in proportion, a number of participants reported having used ED with other stimulant psychoactive substances (n = 247) and ≥3 ED/day (n = 193) or ≥3 AED/occasion (n = 167), which can pose a risk for serious adverse effects. Weekly ED consumption was associated with consumption of ≥20 cups of coffee/week, smoking, excessive use of alcohol and past use of cannabis, glues or solvents and amphetamines.

CONCLUSION

A majority of respondents are not heavy users of ED, AED, or ED with drugs. Yet, the profiles of ED consumption potentially harmful to health that characterize some participants indicate that the potential health consequences of such behaviour are of concern.

Consuming energy drinks at the age of 14 predicted legal and illegal substance use at 16

AIM

This study examined whether consuming energy drinks at the age of 14 predicted substance use at 16.

METHODS

We followed 621 youths from an area of Switzerland who completed a longitudinal online survey in both 2012 and 2014 when they were 14 and 16 years of age. At 14, participants, who were divided into nonenergy drink users (n = 262), occasional users (n = 183) and regular users (n = 176), reported demographic, health-related and substance use data. Substance use at 16 was assessed through logistic regression using nonusers as the reference group and controlling for significant variables at 14.

RESULTS

At the bivariate level, energy drink consumption was associated with substance use at both 14 and 16. Energy drink consumers were also more likely to be male, older, less academic, sleep less on schooldays and live in an urban area. In the multivariate analysis, smokers, alcohol misusers and cannabis users at the age of 16 were significantly more likely to have been regular energy drink users at the age of 14.

CONCLUSION

Consuming energy drinks at 14 years of age predicted using legal and illegal substances at 16. Health providers should screen young adolescents for energy drink use and closely monitor weekly users.

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

Caffeine Use among Active Duty Navy and Marine Corps Personnel

Data from the National Health and Nutrition Examination Survey (NHANES) indicate 89% of Americans regularly consume caffeine, but these data do not include military personnel. This cross-sectional study examined caffeine use in Navy and Marine Corps personnel, including prevalence, amount of daily consumption, and factors associated with use. A random sample of Navy and Marine Corps personnel was contacted and asked to complete a detailed questionnaire describing their use of caffeine-containing substances, in addition to their demographic, military, and lifestyle characteristics. A total of 1708 service members (SMs) completed the questionnaire. Overall, 87% reported using caffeinated beverages ≥1 time/week, with caffeine users consuming a mean ± standard error of 226 ± 5 mg/day (242 ± 7 mg/day for men, 183 ± 8 mg/day for women). The most commonly consumed caffeinated beverages (% users) were coffee (65%), colas (54%), teas (40%), and energy drinks (28%). Multivariable logistic regression modeling indicated that characteristics independently associated with caffeine use (≥1 time/week) included older age, white race/ethnicity, higher alcohol consumption, and participating in less resistance training. Prevalence of caffeine use in these SMs was similar to that reported in civilian investigations, but daily consumption (mg/day) was higher.

A UK student survey investigating the effects of consuming alcohol mixed with energy drinks on overall alcohol consumption and alcohol-related negative consequences

Previous research reported positive associations between alcohol mixed with energy drink (AMED) consumption and overall alcohol consumption. However, results were largely based on between-subjects comparisons comparing AMED consumers with alcohol-only (AO) consumers, and therefore cannot sufficiently control for differences in personal characteristics between these groups. In order to determine whether AMED consumers drink more alcohol on occasions they consume AMED compared to those when they drink AO additional within-subjects comparisons are required. Therefore, this UK student survey assessed both alcohol consumption and alcohol-related negative consequences when consumed alone and when mixed with energy drinks, using a within-subject design. A total of 1873 students completed the survey, including 732 who consumed AMED. It was found that AMED consumers drank significantly less alcohol when they consumed AMED compared to when they drank AO (p < 0.001). In line with reduced alcohol consumption significantly fewer negative alcohol-related consequences were reported on AMED occasions compared to AO occasions (p < 0.001). These findings suggest that mixing alcohol with energy drinks does not increase total alcohol consumption or alcohol-related negative consequences.

Alcohol, caffeine, and nicotine consumption in adolescents: hair analysis versus self-report

BACKGROUND

Clinical reliability of self-reported data for alcohol, caffeine, and nicotine consumptions is lacking, particularly in adolescents.

OBJECTIVES

To compare a self-report questionnaire and hair analysis to assess the reliability and effectiveness of the self-report.

METHODS

A cross-sectional study on 14-15-year-old Italian students (n = 874, 38% males, 62% females) was performed comparing self-reported data to hair analysis. The latter quantified hair concentrations of caffeine, nicotine, cotinine, ethyl glucuronide (EtG), and fatty acid ethyl esters (FAEEs) using mass spectrometry.

RESULTS

Concordance between self-report and hair testing ranged from good to poor across substances and levels of use: poor for heavy alcohol intake (EtG: k = 0.36, 20 positive cases by hair analysis, false negative by self-report, 2.3% of total sample; FAEE k = 0.31, 25 positive cases, 2.9% of total sample); fair to poor for active smokers (k = 0.40, 125 positive cases, 14.3% of total sample); and moderate for caffeine (k = 0.57, 56 positive cases, 6.4% of total sample).

CONCLUSIONS

Epidemiological studies on alcohol, caffeine, and nicotine consumption in adolescents may benefit from the inclusion of toxicological analysis on hair samples to overcome the under-reporting phenomenon of questionnaires and detect more cases of problematic substance use.

Problematic Drinking Among Postgraduate Students: Binge Drinking, Prepartying, and Mixing Alcohol With Energy Drinks

BACKGROUND

Although problematic alcohol use has been studied extensively in undergraduate students, little is known about problematic drinking among postgraduate students.

OBJECTIVES

This study examined binge drinking, prepartying, and mixing alcohol with energy drinks to determine: (1) the extent to which postgraduate students engage in these drinking behaviors, (2) how postgraduate students differ from undergraduate students in these behaviors, and (3) the demographic risk factors for these behaviors in postgraduate (and undergraduate) students.

METHODS

This study utilized data from n = 695 students (n = 298 postgraduate; n = 397 undergraduate) who participated in the Healthy Minds Study at a large, public university in the Midwestern US.

RESULTS

Past-two-week binge drinking, past-year and past-30-day prepartying, and past-30-day mixing alcohol with energy drinks were reported by 26.2%, 28.6%, 14.9%, and 8.1% of postgraduate students, respectively. Multivariate analyses indicated that postgraduate status was a significant negative predictor of binge drinking and prepartying, and that status interacted with age in predicting prepartying such that the effect of age on prepartying was negative for postgraduate students and nonsignificant for undergraduates. Age was a significant negative predictor of mixing alcohol with energy drinks for all students.

CONCLUSIONS/IMPORTANCE

This study makes a unique contribution to the literature by providing information on problematic drinking in postgraduate students. Although there was evidence of "maturing out," a substantial number of postgraduate students were found to engage in binge drinking and prepartying, and a not insubstantial number of them were found to mix alcohol with energy drinks.

Weekly Energy Drink Use Is Positively Associated with Delay Discounting and Risk Behavior in a Nationwide Sample of Young Adults

Background: Energy drink use is associated with increased risk behavior among adolescents and college students. This study examined this relationship in a nationwide sample of young adults and also examined relations between energy drink use and delay discounting. Methods: Participants were 874 U.S. adults 18-28 years of age with past 30-day consumption of caffeine and alcohol. Participants completed an online survey of energy drink use, drug use, sexual activity, alcohol misuse (alcohol use disorders identification test [AUDIT]), sensation seeking (four-item Brief Sensation Seeking Scale [BSSS-4]), and delay discounting of monetary rewards and condom use. Results: Over one-third of participants (n = 303) reported consuming energy drinks at least once per week. Weekly energy drink users were more likely than less-than-weekly energy drink users to report a recent history of risk behaviors, including cigarette smoking (56% vs. 28%, p < 0.0001), illicit stimulant use (22% vs. 6%, p < 0.0001), and unprotected sex (63% vs. 45%, p < 0.0001). Covariate-adjusted analyses found that weekly energy drink users did not have significantly higher BSSS-4 scores (3.5 vs. 3.1, p = 0.098), but they had higher mean AUDIT scores (8.0 vs. 4.8, p < 0.0001), and they more steeply discounted delayed monetary rewards. Although weekly energy drink users did not show steeper discounting of delayed condom use, they showed a lower likelihood of using a condom when one was immediately available. Conclusions: This study extends findings that energy drink use is associated with risk behavior, and it is the first study to show that energy drink use is associated with monetary delay discounting.

Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical and Verbal Aggression in Bar Conflicts

BACKGROUND

Young adult use of alcohol mixed with caffeinated energy drinks (AmEDs) has been globally linked with increased odds of interpersonal aggression, compared with the use of alcohol alone. However, no prior research has linked these behaviors at the event level in bar drinking situations. The present study assessed whether AmED use is associated with the perpetration of verbal and physical aggression in bar conflicts at the event level.

METHODS

In Fall 2014, a community sample of 175 young adult AmED users (55% female) completed a web survey describing a recent conflict experienced while drinking in a bar. Use of both AmED and non-AmED alcoholic drinks in the incident were assessed, allowing calculation of our main predictor variable, the proportion of AmEDs consumed (AmED/total drinks consumed). To measure perpetration of aggression, participants reported on the occurrence of 6 verbal and 6 physical acts during the bar conflict incident.

RESULTS

Linear regression analyses showed that the proportion of AmEDs consumed predicted scores for perpetration of both verbal aggression (β = 0.16, p < 0.05) and physical aggression (β = 0.19, p < 0.01) after controlling for gender, age, sensation-seeking and aggressive personality traits, aggressive alcohol expectancies, aggressogenic physical and social bar environments, and total number of drinks.

CONCLUSIONS

Results of this study suggest that in alcohol-related bar conflicts, higher levels of young adult AmED use are associated with higher levels of aggression perpetration than alcohol use alone and that the elevated risk is not attributable to individual differences between AmED users and nonusers or to contextual differences in bar drinking settings. While future research is needed to identify motivations, dosages, and sequencing issues associated with AmED use, these beverages should be considered a potential risk factor in the escalation of aggressive bar conflicts.