An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school 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.

Soft and energy drinks consumption and associated factors in Saudi adults: a national cross-sectional study

Introduction

The consumption of soft and energy drinks poses a significant risk for non-communicable diseases, such as diabetes and heart disease. Studies in Saudi Arabia have reported elevated consumption of soft/energy drinks, but nation-wide data is not available. Therefore, this study aims to explore the prevalence of soft and energy drinks consumption and its associated factors among a representative sample of Saudi adults.

Methods

The present research is a secondary data analysis of the 2021 Sharik Diet and Health National Survey (SDHNS). Current analysis used data on socio-demographics, anthropometrics, physical activity, and soft and energy drink consumption. The frequency of soft and energy drinks consumption is assessed on a weekly basis.

Results

Of the 5,194 Saudi adults, 3,928 were analyzed. Overall, 67% consumed soft drinks weekly, while 30% consumed energy drinks weekly. In multiple logistic regression, consumption of either soft drinks or energy drinks was associated with males, a younger age, lower income, and lower physical activity. Individuals with overweight or obesity were less likely to consume energy drinks [OR (95%CI): 0.83 (0.71, 0.99) and 0.73 (0.60, 0.90), respectively] than those with healthy weight. However, education level was not associated with either soft or energy drink consumption. These findings highlight the need for targeted interventions designed to reduce soft and energy drinks consumption in Saudi adults.

Athletes Drink Gatorade: DMA Advertising Expenditures, Ad Recall, and Athletic Identity Influence Energy and Sports Drink Consumption

Understanding why sports and energy drinks remain increasingly popular among adolescents despite declines in other sugar sweetened beverages is critical. This study points to memory for advertising exposure and adolescent athletic identity as two aspects that together help to explain consumption. An online survey of U.S. adolescents aged 14-18 (n = 503) was combined with Nielsen data for television and social media advertising expenditures by sports and energy drink brands in participants' designated market areas (DMAs). Advertisement recall mediates the relationship between social media DMA expenditures and sports and energy drink consumption. Recall for television advertisements is related to consumption but is unrelated to television DMA expenditures. Athletic identity moderated the relationship between recall and consumption such that consumption increased as both recall and athletic identity increased, suggesting a role for motivated memory and motivated processing of ad messages based on athletic identity consistent with the limited capacity model of motivated media message processing. Based on these results, we conclude that effectiveness of expenditures in influencing behavior is dependent upon both ad recall and ad relevance, and that athletic identity is an important factor in ad effectiveness in the context of sports and energy drinks advertising.

International society of sports nutrition position stand: energy drinks and energy shots

Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a critical analysis of the literature regarding the effects of energy drink (ED) or energy shot (ES) consumption on acute exercise performance, metabolism, and cognition, along with synergistic exercise-related performance outcomes and training adaptations. The following 13 points constitute the consensus of the Society and have been approved by the Research Committee of the Society: Energy drinks (ED) commonly contain caffeine, taurine, ginseng, guarana, carnitine, choline, B vitamins (vitamins B1, B2, B3, B5, B6, B9, and B12), vitamin C, vitamin A (beta carotene), vitamin D, electrolytes (sodium, potassium, magnesium, and calcium), sugars (nutritive and non-nutritive sweeteners), tyrosine, and L-theanine, with prevalence for each ingredient ranging from 1.3 to 100%. Energy drinks can enhance acute aerobic exercise performance, largely influenced by the amount of caffeine (> 200 mg or >3 mg∙kg bodyweight [BW-1]) in the beverage. Although ED and ES contain several nutrients that are purported to affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES based on scientific evidence appear to be caffeine and/or the carbohydrate provision. The ergogenic value of caffeine on mental and physical performance has been well-established, but the potential additive benefits of other nutrients contained in ED and ES remains to be determined. Consuming ED and ES 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and/or endurance performance with doses >3 mg∙kg BW-1. Consuming ED and ES containing at least 3 mg∙kg BW-1 caffeine is most likely to benefit maximal lower-body power production. Consuming ED and ES can improve endurance, repeat sprint performance, and sport-specific tasks in the context of team sports. Many ED and ES contain numerous ingredients that either have not been studied or evaluated in combination with other nutrients contained in the ED or ES. For this reason, these products need to be studied to demonstrate efficacy of single- and multi-nutrient formulations for physical and cognitive performance as well as for safety. Limited evidence is available to suggest that consumption of low-calorie ED and ES during training and/or weight loss trials may provide ergogenic benefit and/or promote additional weight control, potentially through enhanced training capacity. However, ingestion of higher calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as part of the total daily energy intake. Individuals should consider the impact of regular coingestion of high glycemic index carbohydrates from ED and ES on metabolic health, blood glucose, and insulin levels. Adolescents (aged 12 through 18) should exercise caution and seek parental guidance when considering the consumption of ED and ES, particularly in excessive amounts (e.g. > 400 mg), as limited evidence is available regarding the safety of these products among this population. Additionally, ED and ES are not recommended for children (aged 2-12), those who are pregnant, trying to become pregnant, or breastfeeding and those who are sensitive to caffeine. Diabetics and individuals with preexisting cardiovascular, metabolic, hepatorenal, and/or neurologic disease who are taking medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should exercise caution and consult with their physician prior to consuming ED. The decision to consume ED or ES should be based upon the beverage's content of carbohydrate, caffeine, and other nutrients and a thorough understanding of the potential side effects. Indiscriminate use of ED or ES, especially if multiple servings per day are consumed or when consumed with other caffeinated beverages and/or foods, may lead to adverse effects. The purpose of this review is to provide an update to the position stand of the International Society of Sports Nutrition (ISSN) integrating current literature on ED and ES in exercise, sport, and medicine. The effects of consuming these beverages on acute exercise performance, metabolism, markers of clinical health, and cognition are addressed, as well as more chronic effects when evaluating ED/ES use with exercise-related training adaptions.

Knowledge, attitude, and perception of energy drinks consumption among university students in Jordan

Energy drinks gained popularity after the launch of Red Bull in 1997. Different brands are now available and young adults mainly consume these drinks. This study assesses the knowledge, attitude, and perception of energy drink consumption among university students in Jordan. A validated online survey was used to collect the required data, extracted from Google Forms into an Excel spreadsheet and statistically analysed using Statistical Package for Social Sciences version 24.0. A nationally representative sample of university students with a mean age of 22⋅2 ± 3⋅9 years (n 749) was obtained. The participating students demonstrated a neutral level of knowledge about energy drinks, as the mean score of knowledge = 7⋅1 ± 2⋅2 (out of 12), with 66 % (n 498) of them having consumed energy drinks and experienced their effects. Generally, the study's participants demonstrated a neutral attitude towards energy drinks and 70⋅5 % (n 528) acknowledged that energy drinks increase activity, but more than 70 % of them believed that energy drinks have harmful side effects. It was found that there is a significant (P-value <0⋅5) positive correlation between knowledge score and female gender, studying a medical major, and monthly income. The main reasons for consuming energy drinks were reported to be: to stay awake for longer, help study, and become more energetic. There is a need for more structured awareness campaigns to warn students about the possible side effects of these products in order to reduce the consumption and popularity of these drinks among students.

The Era of Energy Drinks: Consumption Pattern, Awareness, Perception, and Their Adverse Impact on Adolescent Health in Egypt

BACKGROUND

Despite the risks associated with energy drinks (EDs), the consumption of EDs remains high, especially among adolescents, so the study aimed to assess the consumption pattern, awareness, perception of EDs, and their adverse impact on adolescent health.

METHODS

A cross-sectional design was used. The study setting is Damanhur City, Beheira governorate, Egypt, with a sample size of 350 participants. A structured interview questionnaire was used to collect the data and consisted of five parts: socio-demographic data, pattern of use, negative adverse effects of EDs, knowledge, and perception.

RESULTS

The data reveal that 38.5% of the studied sample consumed EDs, and 14.2% of them consumed more than one time per day. The main reason for consumption was feeling fatigue among 46.4%, followed by 28.7% to increase concentration. Only 36% had satisfactory awareness, and 45.7% perceived that excessive consumption has dangerous effects. Age, educational stage, gender, awareness, and perception are significant influencers on the consumption of EDs. The reported adverse impacts were polyuria among 51.4%, followed by tachycardia (40.0%) and insomnia (35%).

CONCLUSION

About one-third of studied adolescents consume EDs regularly and reported several adverse health effects, such as polyuria and tachycardia. The main reason for consumption was feeling fatigued among about half of the studied adolescents. Low awareness levels and negative perceptions were significantly associated with consumption.

RECOMMENDATION

Implement educational programs about EDs and their possible risks to improve the awareness level among adolescents. Further studies should be carried out across different countries.

Caffeinated energy drink consumption among Emirati adolescents is associated with a cluster of poor physical and mental health, and unhealthy dietary and lifestyle behaviors: a cross-sectional study

Background

Consumption of caffeinated energy drinks (CED) has escalated during the last few years, especially among schoolchildren, with evident adverse health sequelae in this critical age group.

Objective

This study examined the prevalence of CED consumption and its associations with sleep, physical and mental health, and dietary and lifestyle habits among schoolchildren in the United Arab Emirates (UAE).

Method

A structured self-administered online questionnaire was developed and disseminated among schoolchildren aged 14-18 years, selected from schools of the seven emirates of the UAE.

Results

More than 4,500 (N= 4,648) responses received. A relatively low prevalence of CED consumption (20%) was found among schoolchildren in the UAE. However, those who reported CED consumption were more likely to report unhealthy dietary (skipping breakfast, frequent snacking, and eating fast foods, low fruit, and vegetable intake) and lifestyle behaviors (long screen time, poor sleep health), in addition to poor self-reported mental and physical health than non-users. CED consumption was significantly and variably associated with multiple sociodemographic factors such as students' nationality, parental companionship, sex, school type, education level (children's and parents'), daily allowance, academic performance, screen time, sleep quality parameters, self-reported physical and mental health, and parents' employment. Sources of knowledge about CED were social media (55%), friends/schoolmates (52%), and family members (52%). Students believed that CED constitute sugar (87%), caffeine (69%), artificial flavors (67%) sweeteners (54%), and stimulating components (43%). The majority (70%) of students reported that CED consumption increases the risks for heart disease, diabetes, high blood sugar (65%), addiction (64%), high blood pressure (59%), and obesity (57%).

Conclusion

These results offer important insights for health professionals, child health specialists, policymakers, and parents in the UAE regarding adolescents' attitudes, knowledge and behaviors toward CED consumption.

Life Satisfaction and Emerging Health Behaviors in Underserved Adolescents: A Narrative Review

Objectives: Obesity rates continue to rise in underserved adolescents. Obesity is linked to poor mental health outcomes. The purpose of this narrative review is to examine existing literature on life satisfaction and obesity-related emerging health behaviors (sugar-sweetened beverage consumption, sleeping patterns, and screen time) in underserved adolescents. Methods: We conducted a review of articles published in English between January 1995 and November 2021 to develop a narrative summary. Results: In general, few studies have been conducted investigating life satisfaction and the emerging behaviors of sugar-sweetened beverage consumption, sleeping patterns, and screen time use with adolescents, especially underserved adolescents. In the studies reviewed, we noted links between lower life satisfaction and more than once-a-day sugar consumption, including sugar-sweetened beverages, lower life satisfaction and lower sleep duration, and life satisfaction and screen-time, with both positive and negative relationships shown. Conclusions: Given the limitations in the number of studies, recommendations are provided for future research.

The extent of energy drink marketing on Canadian social media

BACKGROUND

Caffeinated energy drink (CED) consumption among children and adolescents is a growing global public health concern due to its potential to produce adverse effects. CED marketing viewed by children and adolescents contributes to this problem as it increases consumption and favourable attitudes towards these high-caffeine and high-sugar products. This study aimed to describe the social media marketing of CEDs by estimating the frequency of user-generated and company-generated CED marketing and analyzing the marketing techniques used by Canadian CED brands on social media.

METHODS

CED products and brands were identified using the list of CEDs that received a Temporary Marketing Authorization from Health Canada in June 2021. The data on the frequency, reach and engagement of CED-related posts created by users and Canadian CED brands on Facebook, Instagram, Twitter, Reddit, Tumblr, and YouTube were licensed from Brandwatch for 2020-2021. A content analysis was conducted to assess the marketing techniques used in Canadian CED company-generated posts using a coding manual.

RESULTS

A total of 72 Canadian CED products were identified. Overall, there were 222,119 user-level mentions of CED products in total and the mentions reached an estimated total of 351,707,901 users across platforms. The most popular product accounted for 64.8% of the total user-level mentions. Canadian social media company-owned accounts were found for 27 CED brands. Two CED brands posted the most frequently on Twitter and accounted for the greatest reach, together making up 73.9% of the total company-level posts and reaching 62.5% of the total users in 2020. On Instagram/Facebook, the most popular brand accounted for 23.5% of the company-level posts and 81.3% of the reach between July and September 2021. The most popular marketing techniques used by Canadian CED brands were the use of viral marketing strategies (82.3% of Twitter posts and 92.5% of Instagram/Facebook posts) and the presence of teen themes (73.2% of Twitter posts and 39.4% of Instagram/Facebook posts).

CONCLUSION

CED companies are extensively promoting their products across social media platforms using viral marketing strategies and themes that may appeal to adolescents. These findings may inform CED regulatory decision-making. Continued monitoring is warranted.

Sugar-sweetened beverage consumption retarded weight gain but not induced depression and anxiety-like behaviors in mice

AIMS

To assess the effects of sugar-sweetened beverage (SSB) consumption and exercise on behaviors.

METHODS

Twenty-four male mice were divided into four groups: the water + sedentary (WS), the SSB + sedentary (CS), the water + exercise (WE), and the SSB + exercise (CE). After three-month of interventions, forced swim test (FST), open field test (OFT), and morris water maze (MWM) were conducted. Then, mRNA levels of MAO-A, COMT, and 5-HT1A and protein levels of synapsin, STAT3, A2AR, CRTC1, CREB, and BDNF were measured.

RESULTS

Under a similar baseline body weight condition, SSB consumption reduced the weight gain from the 3rd week (p < 0.05, or p < 0.01). Exercise decreased the escape latency in the CE group when compared to the CS group on day5 (p < 0.01) and increased the time in the target quadrant in the WE group than the WS group on day4 (p < 0.05) and 5 (p < 0.01) during MWM. No significant differences were found during the FST and OFT. COMT mRNA level was increased after SSB consumption (p < 0.05), but no differences were found in the MAO-A and 5-HT1A mRNA levels and the concerned biomarkers, all of which were previously reported to be associated with depression and anxiety-like behaviors.

CONCLUSION

SSB consumption reduced weight gain but not result in depression and anxiety-like behaviors in mice. Therefore, the behavioral effects of exercise were not significant. This is not consistent with the results of previous epidemiological surveys of humans.

Use of Caffeine-Containing Energy Drinks by Japanese Middle School Students: A Cross-Sectional Study of Related Factors

Excessive consumption of caffeine negatively affects individuals' health. Therefore, we studied the use of energy drinks and the conditions associated with it among Japanese secondary school students. Participants were 236 students in grades 7-9 who completed anonymous questionnaires at home in July 2018. We measured the basic attributes and dietary, sleeping, and exercise habits. We used Chi-squared tests to compare differences between users and non-users of energy drinks. Logistic regression analyses were used to elucidate the complex association between the variables. The results showed that boys were more willing to consume energy drinks than girls. The reasons were 'feeling fatigued', 'needing to stay awake', 'for curiosity', and 'to quench one's thirst'. Among boys, the following were associated with the use of EDs. Buying their own snacks , not understanding nutritional labels on foods, high caffeinated beverage intake, late bed-times on weekdays, always waking up at about the same time, and weight. Health guidance is needed to prevent overconsumption and dependence on energy drinks. The cooperation of parents and teachers is needed to achieve these goals.

Secondary School Students and Caffeine: Consumption Habits, Motivations, and Experiences

Adolescents may be particularly vulnerable to the effects of caffeine due to a lack of tolerance, their small size, changing brain physiology, and increasing independence. Concerns about adolescent caffeine consumption relate to potentially serious physiological and psychological effects following consumption. Motivations driving caffeine intake are not well understood among adolescents but are important to understand to reduce harmful behavioural patterns. This study explored caffeine consumption habits (sources, amount, frequency) of New Zealand adolescents; and factors motivating caffeine consumption and avoidance. The previously validated caffeine consumption habits questionnaire (CaffCo) was completed by 216 participants (15-18 years), with most (94.9%) consuming at least one caffeinated product daily. Chocolate, coffee, tea, and kola drinks were the most consumed sources. The median caffeine intake was 68 mg·day^-1. Gender (boy) and being employed influenced the source, but not the quantity of caffeine consumed. One-fifth (21.2%) of adolescents consumed more than the recommended European Food Safety Authority (EFSA) safe level (3 mg·kg^-1·day^-1). Taste, energy, and temperature were the main motivators for consumption, and increased energy, excitement, restlessness, and sleep disturbances were reported effects following caffeine consumption. This study provides information on caffeinated product consumption among New Zealand adolescents, some of whom consumed caffeine above the EFSA safe level. Public health initiatives directed at adolescents may be important to reduce potential caffeine-related harm.

Associations between adolescents' energy drink consumption frequency and several negative health indicators

BACKGROUND

The purpose of this study was to identify how various negative health indicators are associated with energy drink consumption frequency among 13- and 15-year-old Finnish adolescents.

METHODS

Data (N = 2429) from the nationally representative international Health Behaviour in School-aged Children study (2018) were analyzed via descriptive analysis and logistic regression analyses, with control for salient covariates. Relative risks (RR) were derived from the adjusted odds ratios.

RESULTS

Even infrequent energy drink consumption was associated with various negative health indicators. Moreover, as compared to non-users, frequent energy drink consumers were more likely to report several health-compromising behaviors: current smoking (RR = 9.85, 95% CI: 5.68-16.02), current snus use (RR = 3.62, 95% CI: 1.80-6.85), cannabis use (RR = 3.42, 95% CI: 1.69-6.52), alcohol consumption (RR = 3.08, 95% CI: 2.49-3.71), problematic social media use (RR = 2.53, 95% CI:1.68-3.72), short sleep (RR = 2.12, 95% CI: 1.69-2.60), skipping breakfast (RR = 1.87, 95% CI: 1.51-2.29), drunkenness (RR = 1.59, 95% CI: 1.11-2.23), inadequate tooth brushing (RR = 1.28, 95% CI: 1.05-1.54). In addition, frequent energy drink consumption was associated with perceived negative health indicators: feelings of insufficient sleep (RR = 1.56, 95% CI: 1.11-2.15), low self-rated health (RR = 1.48, 95% CI: 1.15-1.87), and multiple health complaints (RR = 1.31, 95% CI: 1.07-1.56).

CONCLUSIONS

Energy drink consumption, even infrequent, was associated with several negative health indicators, and the reporting of these increased with the frequency of energy drink consumption. The findings support the concerns of health authorities regarding the negative associations between energy drink consumption and health, even among persons as young as 13 years. There is evidence to support specific policy level actions, including restrictions on the sale of energy drinks to adolescents. This measure has been proposed in a Finnish government program, but implementation has yet to occur. Moreover, marketing of these beverages in platforms that are popular among adolescents (e.g., the social media) should be rigorously evaluated, and comprehensive interventions and actions implemented to ensure that adolescents, parents/guardians, and professionals working with adolescents (e.g., in schools) have a good understanding of the links between energy drink consumption and health.

Associations between muscle-building exercise and concurrent e-cigarette, cigarette, and cannabis use among U.S. adolescents

Physical activity and team sports may be protective of substance use among adolescents, although there is mixed evidence on whether muscle-building exercise is associated with patterns of e-cigarette use (i.e., vaping), cigarette use, and cannabis use. Therefore, this study aimed to determine the association between muscle-building exercise and patterns of concurrent substance use among U.S. adolescents. Cross-sectional data from the 2019 Youth Risk Behavior Survey (N = 8,474) were analyzed in 2022. Muscle-building exercise was assessed by number of days of the behavior in the past week and categorized based on level of engagement (none, low, medium, and high). Concurrent vaping, cigarette use, and cannabis use within the past 30 days were assessed using a combined, four-category variable (no use, any single use, any dual use, and triple use). Multinomial logistic regressions, with coefficients transformed to relative risk ratios (RRR), were conducted to estimate the associations between muscle-building exercise and concurrent substance use among the overall sample, and by sex, while adjusting for relevant sociodemographic variables. Among the overall sample, high engagement (6-7 days) in muscle-building exercise was associated with greater relative risk of any single use (RRR 1.36, 95% confidence interval [CI] 1.06-1.72), any dual use (RRR 1.46, 95% CI 1.10-2.94), and triple use (RRR 1.81, 95% CI 1.05-3.12). While muscle-building exercise was associated with greater relative risk of concurrent patterns of vaping, cigarette use, and cannabis use among adolescent males, there were no significant relationships found among adolescent females. Healthcare professionals should consider this association when treating adolescent males, particularly given the high prevalence of muscle-building exercise and substance use among this group. More research is needed to understand the experiences of adolescent males who report high engagement in muscle-building exercise and substance use to uncover mechanisms of association.

Excessive Gaming and Online Energy-Drink Marketing Exposure Associated with Energy-Drink Consumption among Adolescents

In this study, we examined excessive online gaming by adolescents and the resultant effects of their exposure to the online marketing of energy drinks and alcohol, and whether marketing literacy could serve as a mitigating factor. This cross-sectional study was conducted in 2020. Data were obtained from a sample of 2613 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted. The results showed that nearly 18% of the adolescent respondents had used energy drinks, while 75% reported seeing energy-drink advertisements on the internet in the past year. Multiple regression results indicated that factors such as being male, reporting excessive gaming, being exposed to higher levels of online energy-drink marketing, and reporting alcohol use were positively associated with energy-drink consumption. A higher level of online energy-drink marketing-affective literacy, however, was negatively associated with energy-drink consumption. In conclusion, factors that predicted energy-drink consumption among adolescents included excessive gaming and exposure to online energy-drink marketing, but marketing-affective literacy tended to lessen the impact of such advertising.

Risky behaviors, substance use, and other lifestyle correlates of energy drink consumption in children and adolescents: a systematic review

Increasing concerns have been raised on the health-related risks connected with energy drink (ED) consumption in children and adolescents, with high acute or chronic consumers exceeding 10% in either age group in Europe in 2011. Preliminary evidence has suggested a common pattern of ED and substance use, especially alcohol. Additional evidence has been accumulating very fast; in addition, other lifestyle and risky behaviors may contribute to shed light on the complex interplay of factors involved in ED consumption. We have undertaken a comprehensive systematic review of the evidence on psychosocial correlates of ED consumption in 0-18 years subjects, as published up to April 1, 2021, in MEDLINE/PubMed, PsycINFO, and Cochrane Reviews and Central Register of Controlled Trials, which allowed to select 104 original articles. Only ~ 10% of the papers provided results based on longitudinal analyses. A common pattern of ED consumption and polysubstance use, including alcohol, tobacco, and soft and hard drugs, was still confirmed in adolescents; violent and risky behaviors were also related to a higher ED consumption. In addition, frequent ED consumers are more likely to have bad dietary habits, including consumption of sugar-sweetened beverages and junk foods. A generally inconclusive evidence was found for sport/physical activities, although sedentary behaviors were generally related to ED consumption.

CONCLUSIONS

Frequent ED consumption might be a screening indicator to identify students at risk of substance use or other risky/problem behaviors; enquiring about an adolescent's recent ED consumption could create opportunities for early intervention/prevention by informed pediatricians.

WHAT IS KNOWN

• Substances, especially alcohol, are associated with energy drinks in most cross-sectional studies.

WHAT IS NEW

• Violent behaviors are associated with energy drink consumption, in the absence of longitudinal studies; problematic use of internet/videogames deserves further investigation; unhealthy dietary patterns are related to energy drinks; evidence on physical activity is inconclusive, but sedentary behaviors are related to energy drinks.

Individual, Social, and Environmental Correlates of Energy Drink Use Among Adolescents

OBJECTIVE

To investigate the correlates of adolescent energy drink (ED) use using a socioecological approach to inform future interventions.

METHODS

In 2017-2018, 3,688 students attending 25 randomly selected Western Australian secondary schools completed a self-report survey. A backward stepwise logistic regression analysis was used to construct a model of the most significant individual (n = 12), social (n = 3), and environmental (n = 4) factors associated with being an ED user (ie, past month ED use).

RESULTS

Overall, 18% of participants were ED users. The factors significantly associated with being an ED user included being male (P < 0.001), having a higher disposable income (P < 0.001), perceiving EDs as good for health (P = 0.009), perceiving EDs as safe for someone their age to drink (P < 0.001), having a sensation-seeking personality (P = 0.011), having friends who drink EDs (P < 0.001), having parents who would give them an ED if asked (P < 0.001), and having EDs available at home (P < 0.001).

CONCLUSIONS AND IMPLICATIONS

Initiatives to reduce ED intake among adolescents need to be multifaceted, addressing individual, social, and environmental factors. It is also important that educational interventions target both parents and adolescents.

Psychological and socio-educational correlates of energy drink consumption in children and adolescents: a systematic review

Energy drinks (EDs) are non-alcoholic beverages providing an extra boost in physical/cognitive performance and mood. Besides the physiological effects related to the high-caffeine content of EDs, long-term emotional, social, and behavioral effects have been recently receiving attention. However, a few systematic reviews have focused on the critical yet understudied periods of childhood and adolescence. We have undertaken a comprehensive systematic review of the evidence on any psychosocial correlates of ED consumption in 0-18-year-old subjects, as published up to April 1, 2021, in MEDLINE/PubMed, PsycINFO, and Cochrane Reviews and Central Register of Controlled Trials. Of the initial 789 records, 104 original articles were included in the systematic review. Seventy percent of them were published from 2016 onwards; among investigated topics, substance use ranked first, followed by psychological and socio-educational factors; the less investigated topic was risky behaviors. Taste and energy-seeking were the main drivers of consumption, which generally happened at home or during sport/recreational activities, without perception of health-related risks. Positive associations with ED consumption were found for sensation seeking, irritability/anger, and suicide ideation, plan, or attempts. Finally, participants with lower grades, a low parental monitoring, or bad influences from peers were more likely to consume EDs. Conclusion: With ~ 70% of papers published since the 2 comprehensive reviews on children/adolescents were carried out, an update of the literature with a broad focus is of great importance. Consumption of EDs by children/adolescents lies in the potential interplay between personality traits, school performance, and influences by family members and peers. What is Known: • Taste and energy-seeking are the main drivers of energy drink consumption, which mostly happened at home or in sport/recreational activities. What is New: • Perception of risks related to energy drinks is associated with a lower consumption, as based on cross-sectional studies. • As mostly based on cross-sectional studies: 1. energy drink consumption is related to sensation seeking, irritability/anger, and suicide ideation or attempts; 2. students with a lower school performance, low parental monitoring, or bad peer influence, are more likely to consume energy drinks.

Effects of Caffeine and Caffeinated Beverages in Children, Adolescents and Young Adults: Short Review

The prevalence of ED consumption has increased over the past 10–15 years. Studies describing the effects of caffeine and caffeinated beverages show confusing results, so it seems important to regularly summarize the available facts, and in more detail. By a thorough analysis of more than 156 scientific papers, the authors describe the molecular background of absorption, as well as the positive and negative effects of different dosages of caffeine, just like its effects in physical activity and performance. ED and EDwA consumption is a regular habit of not only adults, but nowadays even of children and adolescents. There are no safe dosages described of caffeine or ED consumption for children. There are no positive short- or long-term effects of these compounds/products concerning developing brain functions, psycho-motor functions, or social development. Instead, there are many unpleasant side effects, and symptoms of regular or higher-dose ED consumption, especially at younger ages. This mini review describes many details of these unpleasant side effects, their severity, and motivations for consuming these compounds/products. In a quantitative research in Hungary (10–26 years, mean age: 15.6 ± 3.8 y, 1459 subjects, randomly chosen population), a survey based on a questionnaire asking people about their ED consumption habits was conducted. According to the data, 81.8% of the participants consumed EDs at least once, and 63.3% tried several products of the kind. A positive correlation was found between age and consumption (p < 0.001). The results show that a high proportion of this group often consumed EDwA, in many cases leading to harmful side-effects of caffeine overdose. In a sample of Hungarian high school and college students (17–26 years), ED consumption matched the international data, and only 19.7% of respondents did not use EDs at all (had never tasted an ED in their life).

Prevalence and correlates of highly caffeinated beverage consumption among Korean adolescents

OBJECTIVE

The purposes of this study were to (1) examine the multi-year prevalence of highly caffeinated beverage (HCB) consumption, (2) identify sex differences in the prevalence, and (3) investigate relationships between HCB consumption and behavioral characteristics in a nationally representative sample of Korean adolescents.

METHODS

Data from the Korea Youth Risk Behavior Web-based Survey (2014-2017) were analyzed.

RESULTS

HCB consumption was higher in 2017 than 2014 (23.9% vs. 12.0%), and higher among boys than girls (17.2% vs. 13.1%). HCB drinkers were more likely to (1) be boys, (2) be overweight or obese, (3) use alcohol and tobacco, (4) consume soda at least once per week, (5) consume sweetened beverages at least once per week, (6) have seriously considered suicide during the past 12 months, and (7) have attempted suicide during the past 12 months (p<0.05 for all).

CONCLUSION

Effective programs to curb HCB consumption among Korean adolescents need to be established.

Trends in energy drink and combined alcohol and energy drinks consumption among Italian high school students, 2008-2019

BACKGROUND

Energy Drinks (ED) are caffeinated beverages marketed as attention and endurance enhancers. The main purpose of this study is to provide national estimates of the prevalence of alcohol mixed with energy drink (AmED) and ED use among school-aged adolescents. A secondary objective is to examine the differences in the prevalence of AmED and ED consumption by gender.

METHODS

For this study, we used data from twelve consecutive years, from ESPAD-Italia®2008 to ESPAD-Italia®2019.

RESULTS

From 2008-2019, the prevalence of lifetime consumption of energy drinks increased significantly for male (64.5-75.7%, p < 0.001) and female (46.8-61.8%, p < 0.001). We also observed an increase in both genders for last year prevalence (male: 51.6-63.4%, p < 0.001; female: 32.5-38.3%, p < 0.001), instead prevalence in last month showed an increase only in males (males: 37.5-45.4%, p = <0.001; females: 19.9-20.3%, p = 0.426). Finally, frequent use showed a fluctuating trend, particularly in females (males: 3.2-4.3%, p = 0.422; females: 0.8-0.8%, p = 0.643). From 2013-2019, the prevalence of AmED consumption did not show relevant changes among adolescents. A clear gender gap is evident for both ED and AmED usage prevalence, in all the years considered for lifetime, last year, last month and frequent use.

CONCLUSIONS

The findings suggest that the prevalence of ED consumption among Italian high school students is very high and has grown substantially over the past 12 years. Differently the prevalence of AmED use, although widespread, did not increase overall since 2013.

Adolescent Energy Drink Consumption and Academic Risk: Results From the Monitoring the Future Study, 2010-2016

AIMS

The current study aims to examine the role of energy drink and energy shot consumption in school disengagement, low academic performance, and academic expectations, and investigates the robustness of these associations across sex, grade, race, and substance use history.

METHOD

This study employs a pooled cross-sectional design and uses a nationally representative sample of 8th (ages 13-14 years) and 10th (ages 15-16 years) grade adolescents from seven recent cohorts (2010-2016) of the Monitoring the Future study. Logistic regression and negative binomial regression were employed to examine the association between energy drink and energy shot consumption and academic risk factors, controlling for sociodemographic factors and other health and social behaviors. Ancillary robustness checks across key subgroups in the data were also performed.

RESULTS

The results indicate that energy drink and energy shot consumers are significantly more likely to report all academic risk outcomes. Specifically, youth who heavily use energy drinks and shots have significantly higher odds of each of the academic risk outcomes relative to both less habitual users and nonusers. These patterns hold across subgroups, despite associations being somewhat stronger among females, younger participants, Whites, and youth with no substance use history.

CONCLUSIONS

The current study suggests that energy drink consumption (particularly heavy consumption) may be an early warning sign of academic risk. It may be beneficial to limit adolescent energy drink consumption, provide early intervention for heavy adolescent consumers, and raise awareness of the dangers associated with their use.

Social determinants and changes in energy drink consumption among adolescents in Norway, 2017-2019: a cross-sectional study

OBJECTIVES

To describe the social determinants and development in energy drink consumption among Norwegian adolescents in 2017, 2018 and 2019.

DESIGN

Cross-sectional, online, annual, nationwide surveys (Ungdata).

SETTING

Responses collected online from January 2017 to December 2019.

PARTICIPANTS

Lower and upper secondary school students (n=297 102) aged 12-19 years who responded in 2017, 2018 and 2019.

MAIN OUTCOME MEASURES

Frequency of energy drink consumption.

RESULTS

Over the 3-year period, 66.4% of the men and 41.8% of the women had consumed energy drink once a week or more. The proportion of female high consumers (consuming energy drink more than four times a week) increased from 3.3% to 4.9% between 2017 and 2019; for male, the increase was from 9.8% to 11.5%. In females, the proportion of high consumers increased with 24% (relative risk; CI) (1.24; 1.09 to 1.41) from 2017 to 2018 and 46% (1.46; 1.31 to 1.62) from 2017 to 2019. The corresponding increases in males were 10% (1.10; 1.01 to 1.20) from 2017 to 2018 and 12% (1.12; 1.05 to 1.19) from 2017 to 2019. Any energy drink consumption as well as high energy drink consumption were independently associated with school level, less central residency, low socioeconomic status, physical inactivity and high leisure screen time.

CONCLUSION

We found an increase in high consumers among both boys and girls between 2017 and 2019. The observed increase in energy drink consumption among adolescents can explain some of the increased sales of energy drink in Norway.

Effects of Energy Drink Consumption on Physical Performance and Potential Danger of Inordinate Usage

The rise in energy drink (ED) intake in the general population and athletes has been achieved with smart and effective marketing strategies. There is a robust base of evidence showing that adolescents are the main consumers of EDs. The prevalence of ED usage in this group ranges from 52% to 68%, whilst in adults is estimated at 32%. The compositions of EDs vary widely. Caffeine content can range from 75 to 240 mg, whereas the average taurine quantity is 342.28 mg/100 mL. Unfortunately, exact amounts of the other ED elements are often not disclosed by manufacturers. Caffeine and taurine in doses 3–6 mg/kg and 1–6 g, respectively, appear to be the main ergogenic elements. However, additive or synergic properties between them seem to be implausible. Because of non-unified protocol design, presented studies show inconsistency between ED ingestion and improved physical performance. Potential side effects caused by abusive consumption or missed contraindications are the aspects that are the most often overlooked by consumers and not fully elucidated by ED producers. In this review, the authors aimed to present the latest scientific information on ED components and their possible impact on improving physical performance as well as to bring emphasis to the danger of inordinate consumption.

Energy Drink Consumption among Adolescents Attending Schools in Lubumbashi, Democratic Republic of Congo

BACKGROUND

The consumption of energy drinks (EDs) is increasing in the general population, but little is known about the consumption of EDs among pupils in Africa. This study was designed to assess the consumption of EDs among pupils between 10 and 17 years of age and to assess average caffeine concentrations contained in EDs sold in Lubumbashi.

METHODS

We conducted a cross-sectional survey in five schools using a standardised questionnaire taken face-to-face. Samples of locally purchased EDs were analysed by High Performance Liquid Chromatography with Ultra-Violet spectrometry (HPLC-UV).

RESULTS

Of 338 pupils (54% girls), 63% reported having consumed at least one ED in the last week and 34% drank at least one ED a day. The cheapest ED was the most widely consumed. Among pupils having consumed at least one ED in the last week, 79% reported consuming it for refreshment and 15% to get energy. For those who reported not consuming EDs, 40% reported that their parents or teachers forbade them to drink EDs. Some (14%) teenagers, mainly boys, mixed ED with alcohol. The concentrations of caffeine measured in twelve brands of EDs ranged from 7.6 to 29.4 mg/100 mL (median 23.3), giving caffeine contents of 37.5 to 160 mg (median 90 mg) per can or bottle. The estimated daily intake of caffeine through EDs was between 51.3 mg and 441.3 mg among those consuming EDs regularly.

CONCLUSION

Our study convincingly demonstrates that caffeine-containing EDs are not only consumed by youngsters living in affluent societies. We documented widespread regular consumption of EDs among (pre-)adolescent schoolchildren living in Lubumbashi, a large city of the Democratic Republic of Congo (DRC). In view of the global market expansion of caffeinated EDs, it is reasonable to suspect that similar surveys in other urban areas of sub-Saharan Africa would yield similar findings. Pricing and advertising regulations and education on EDs are necessary to limit the regular consumption of EDs among adolescents.

Energy drink consumption among Australian adolescents associated with a cluster of unhealthy dietary behaviours and short sleep duration

BACKGROUND

Non-alcoholic energy drinks ('energy drinks') are high in sugar, as well as caffeine, leading to concerns regarding their suitability for children and adolescents. Despite this, marketing of energy drinks is often directed at adolescents, and there are no age restrictions on the sale of these products in Australia. The current study aimed to examine patterns in consumption of energy drinks among Australian secondary school students and identify sociodemographic and behavioural correlates associated with regular consumption.

METHODS

Participants were 8942 students in Years 8 to 11 (aged 12 to 17 years) who participated in the 2018 National Secondary Students' Diet and Activity (NaSSDA) cross-sectional survey. A multistage stratified random sampling procedure was used. Within the school setting, students self-completed an online questionnaire assessing their dietary, physical activity and sedentary behaviours. A multilevel logistic regression model was used to examine associations between energy drink consumption and sociodemographic and behavioural factors.

RESULTS

Overall, 8% of students reported consuming energy drinks on a weekly basis ('regular consumers'). A further 16% indicated they consume less than one cup per week of these types of drinks, while around three-quarters (76%) reported they do not consume energy drinks. Regular consumption of energy drinks was independently associated with being male, having greater weekly spending money, high intakes of snack foods, fast food, other sugar-sweetened beverages and fruit juice, as well as short sleep duration. There was no independent association with other sociodemographic characteristics (i.e., year level, level of disadvantage, geographic location), consumption of vegetables and fruit, physical activity level, or sedentary recreational screen time.

CONCLUSIONS

While most Australian adolescents do not consume energy drinks, regular consumption is more prevalent among males, and consumption appears to cluster with other unhealthy dietary behaviours and short sleep duration. Findings support the need for policies that will reach identified at-risk groups (e.g., increased regulation of the marketing and sale of energy drinks), as well as suggest opportunities for interventions targeting energy drink consumption alongside other unhealthy dietary behaviours.

Longitudinal Associations Between Energy Drink Consumption, Health, and Norm-Breaking Behavior Among Swedish Adolescents

Objectives: To describe the intake of energy drinks (EDs) among a sample of Swedish adolescents while considering health-related variables, and to investigate the longitudinal associations between ED consumption, health, and norm-breaking behavior. Longitudinal studies on this topic are scarce. Methods: Questionnaire data were collected in the northern part of Sweden in 2010-2011 from 1,622 adolescents in grades 6-9. Analyses were performed using a chi-squared test and logistic regression. Results: Seventy-four percent of the boys and 54% of the girls had consumed EDs (P < 0.001). ED consumption was associated with variables related to low health, low support levels, and norm-breaking behavior. The associations were generally stronger among the girls and the boys who consumed EDs at least once a week. ED consumption was a predictor of worse health and norm-breaking behavior 1 year later. Adjusted odds ratios ranged from 1.53 (95% CI: 1.07, 2.20; school-related stress) to 4.88 (95% CI: 2.28, 10.43; gaming-related truancy). Conclusions: Health promotion activities benefit from a broad approach but could focus on girls who consume EDs and those boys with the highest consumption levels.

Knowledge and prevalence of energy drinks consumption in Shanghai, China: a cross-sectional survey of adolescents

Background

In recent years, energy drinks (EDs) have been widely used among young people around the world. The extensive use of EDs also affects the sleep and exercise of adolescents.

Aims

This study aimed to investigate the consumption of EDs, the knowledge, attitude towards EDs and associated factors of EDs consumption among adolescents in Shanghai, China.

Methods

A total of 4608 adolescents completed a self-administered questionnaire assessing EDs use history, knowledge and attitude towards EDs. Adolescent Self-rating Life Events Checklist (ASLEC) was used to assess their life events. All participants were divided into two groups based on whether they used them or not. t-test and χ² test were used to compare the differences between the two groups, and binary logistic regression analysis was used to investigate the related factors for EDs consumption.

Results

70.5% of the participants reported having ever used EDs. The main avenues to getting information on EDs were from advertisements. 67.56% of them believed that EDs had adverse effects on health. 22.09% of the participants and 31.55% of their parents took a negative attitude towards EDs. Compared with the non-consumption group, participants in the consumption group were likely to be male, with older age, identified EDs more correctly and did not believe EDs had adverse effects, with more positive attitude and higher ASLEC score. Logistic regression results showed that gender, age, attitude of parents and themselves, knowledge of EDs and ASLEC score significantly predicted EDs consumption.

Conclusion

EDs consumption was popular among adolescents in Shanghai, and the tailored intervention programmes need to be developed based on the characteristics of adolescents.

The Energy to Smoke: Examining the Longitudinal Association between Beverage Consumption and Smoking and Vaping Behaviours among Youth in the COMPASS Study

This study examined the longitudinal association between changes in sugar-sweetened and/or caffeinated beverage consumption and smoking/vaping behaviour among Canadian adolescents. Using longitudinal data from the COMPASS study (2015/16 to 2017/18), four models were developed to investigate whether beverage consumption explained variability in smoking and vaping behaviour in adolescence: (1) smoking initiation, (2) vaping initiation, (3) current smoking status, and (4) current vaping status. Models were adjusted for demographic factors. Multinomial logit models were used for model 1, 2, and 3. A binary logistic regression model was used for model 4. An association between change in frequency of beverage consumption and smoking/vaping behaviour was identified in all models. A one-day increase in beverage consumption was associated with smoking initiation (OR = 1.38, 95% CI: 1.25, 1.51), vaping initiation (OR = 1.23, 95% CI: 1.14, 1.32), identifying as a current smoker (OR = 1.17, 95% CI: 1.01, 1.35), and currently vaping (OR = 1.08, 95% CI: 1.04, 1.11). Change in high-energy drink consumption was the best predictor of smoking behaviours and vaping initiation but not current vaping status. Given the health consequences of smoking and vaping and their association with high-energy drink and coffee consumption, policy initiatives to prevent smoking/vaping initiation, and to limit youth access to these beverages, warrant consideration.

Price discounting as a hidden risk factor of energy drink consumption

OBJECTIVES

Global consumption of caffeinated energy drinks (CED) has been increasing dramatically despite increasing evidence of their adverse health effects. Temporary price discounting is a rarely investigated but potentially powerful food marketing tactic influencing purchasing of CED. Using grocery transaction records generated by food stores in Montreal, we investigated the association between price discounting and purchasing of CED across socio-economic status operationalized by education and income levels in store neighbourhood.

METHODS

The outcome, log-transformed weekly store-level sales of CED, was modelled as a function of store-level percent price discounting, store- and neighbourhood-level confounders, and an interaction term between discounting and each of tertile education and income in store neighbourhood. The model was separately fit to transactions from supermarkets, pharmacies, supercentres, and convenience stores.

RESULTS

There were 18,743, 12,437, 3965, and 49,533 weeks of CED sales from supermarkets, pharmacies, supercentres, and convenience stores, respectively. Percent price discounting was positively associated with log sales of CED for all store types, and the interaction between education and discounting was prominent in supercentres: -0.039 [95% confidence interval (CI): -0.051, -0.028] and -0.039 [95% CI: -0.057, -0.021], for middle- and high-education neighbourhoods relative to low-education neighbourhoods, respectively. Relative to low-income areas, the associations of discounting and log CED sales in supercentres for neighbourhoods with middle- and high-income tertile were 0.022 [95% CI: 0.010, 0.033] and 0.015 (95% CI: -0.001, 0.031), respectively.

CONCLUSION

Price discounting is an important driver of CED consumption and has a varying impact across community education and income.

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.

Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies

Background and objectives: The presence of mental health problems in the population of medical students in Italy has been evaluated in several cross-sectional studies, which have used different methodologies and study designs. However, a global overview of the prevalence of mental health problems in Italian medical students is not available, although this would be essential for promoting preventive strategies and supportive treatments. Materials and Methods: An integrative review aiming to describe the prevalence of mental health problems in Italian medical students has been performed. Results: The most relevant findings are the high prevalence of substance use, in particular alcohol and nicotine, and of depressive and anxiety disorders in Italian medical students. In particular, substance use ranges from 13 to 86%, which is higher compared to Italian students coming from other faculties. Italian medical students show a high rate of smoking and of depressive symptoms of about 20%. Conclusions: Our findings highlight the need to develop appropriate supportive interventions for the medical student population, which are rarely provided and implemented among the routine activities of Italian medical universities. A relevant aspect to be considered is the stigma and anticipated discrimination attached to mental disorders, which reduce the help-seeking process in medical students.

Interaction effects of co-consumption of fast food and sugar-sweetened beverages on psychological symptoms: Evidence from a nationwide survey among Chinese adolescents

BACKGROUND

Although fast food and sugar-sweetened beverages (SSBs) consumption have been closely linked to childhood and adolescent obesity, the data regarding their co-consumption and relationship to mental health remains controversial.

METHODS

A multi-centered population-based survey was conducted among Chinese adolescents from grades 7 to 12. Data about participants' consumption of fast foods and SSBs were obtained from self-reported questionnaires. Psychological symptoms were assessed using the Multi-dimensional Sub-health Questionnaire of Adolescents (MSQA). The association between co-consumption of fast food and SSBs and psychological symptoms was assessed using quantile regression analysis, adjusting for covariates.

RESULTS

Approximately one-fifth of the 14,500 participants reported psychological symptoms. The regression coefficient (β) value increased as the quantile of fast food, SSBs, and co-consumption increased in the quantile regression model, and the model had an excellent goodness-of-fit (F = 192.51, p < 0.001). In the interaction model, fast food and SSBs in combination were associated with greater odds of psychological symptoms (aOR = 1.90, 95% CI: 1.69, 2.12). The synergy index, relative excess risk of interaction, and attributable proportions were 1.86 (95% CI: 1.17, 2.96), 0.4 (95% CI: 0.20, 0.63), and 0.22 (95% CI: 0.11, 0.33), respectively.

LIMITATIONS

Information bias is inevitable in self-reported data among participants. The ability to assess causal relationships is reduced by a cross-sectional study design.

CONCLUSIONS

Our findings suggest that co-consumption of fast food and SSBs was cross-sectionally associated with mental health problems among adolescents.

Consumption of energy drinks is associated with depression, anxiety, and stress in young adult males: Evidence from a longitudinal cohort study

BACKGROUND

Energy drinks (EDs) claim to boost mental performance, however, few studies have examined the prospective effects of EDs on mental health. This study examined longitudinal associations between ED use and mental health symptoms in young adults aged 20 years over a 2-year period.

METHODS

Data were drawn from Gen2 (Generation 2) of the Raine Study, a prospective population-based study in Western Australia. Self-report questionnaires assessed ED consumption and mental health symptoms (Depression Anxiety Stress Scale [DASS]-21) when Gen2 participants were 20 and 22 years old. Changes in ED use and DASS-21 scores over time were analyzed and results presented for the whole sample and by sex.

RESULTS

For the whole sample (n = 429), participants who changed from being a non-ED user to an ED user had an average increase in stress scores of 2.30 (95% confidence interval [CI] = 0.04, 4.55) across the 2-year follow-up. Males, but not females who changed from being a non-ED user to an ED user had an average increase in depression, anxiety, and stress scores of 6.09 (95% CI = 3.36, 8.81), 3.76 (95% CI = 1.82, 5.70), and 3.22 (95% CI = 0.47, 5.97), respectively.

CONCLUSION

ED consumption may be a possible marker for mental health symptoms in young male adults. Practicing clinicians could consider screening for ED use in routine assessments of mental health, particularly for young males presenting with depression, anxiety, and stress symptoms.

Can Functional Beverages Serve as a Substantial Source of Macroelements and Microelements in Human Nutrition?-Analysis of Selected Minerals in Energy and Isotonic Drinks

Studies on the ingredients of energy drinks and isotonic drinks focus mainly on the evaluation of their content in terms of substances modulating the body's metabolism or those regarded as food additives. Having regard to the widespread availability of these beverages, their diversity and the limited number of studies in this area, the aim of this study was to analyse the contents of F, Al, Cd, Cr, Mn, V, Co, Ni, Zn, Bi and Na in the energy drinks and isotonic drinks available in the Polish market. Fluorine concentration was analysed using an ion-selective electrode. The other elements were analysed using ICP-OES. Obtained results showed that functional beverages need to be taken into account as a source of macroelements and microelements in human nutrition, particularly when ingested often and in large quantities (which applies particularly to the young population). Moreover, due caution needs to be maintained in consumer choices.

Prevalence and pattern of energy drink intake among Australian adolescents

BACKGROUND

Energy drinks (ED) are popular among young people despite evidence of associated health risks. Research into the prevalence and pattern of ED intake among young people is sparse. The present study investigates the prevalence and pattern of ED intake among a large sample of adolescents, including how many consume them, how often, for what reasons and in what contexts.

METHODS

In 2018, all students in grades 7-12 attending 25 randomly selected Western Australian schools were invited to complete an online self-report survey about EDs.

RESULTS

Of the 3688 respondents, 51.2% reported consuming an ED. Of these 'ever consumers', 23.4% drank them monthly, 19.2% weekly and 2% every day. The average age of first intake was 10.7 years. One-fifth (19.7%) of 'ever consumers' reported consuming more than two EDs in 1 day. Reasons for ED use included taste, to boost energy levels, sport performance and studying.

CONCLUSIONS

The findings add to limited international evidence about adolescent ED use and provide valuable information to help ensure interventions to reduce intake address the underlying reasons and contexts of ED consumption.

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.

Coffee and cigarettes: Examining the association between caffeinated beverage consumption and smoking behaviour among youth in the COMPASS study

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Caffeinated beverage consumption is associated with smoking behaviours in youth.

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High energy drink consumption is most strongly associated with smoking behaviours.

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Caffeinated beverages and smoking behaviour demonstrate a dose–response association.

In adults, coffee, sugar-sweetened beverage (SSB) and high energy drink consumption have been related to increases in risky behaviour, including smoking. However, these associations are not well understood during adolescence. The purpose of this study was to examine the association between beverage consumption and smoking behaviour among Canadian adolescents. Using data from the COMPASS study (2016–2017; n = 46,957), four models were developed to investigate whether beverage consumption explained variability in smoking behaviour in adolescence (age = 15.7 ± 1.2 yrs); 1) smoking status; 2) e-cigarette use status; 3) days smoking cigarettes per month; and 4) days using an e-cigarette per month. Models were adjusted for demographic factors. Logistic (models 1 and 2) and ordinal logistic (models 3 and 4) were used for analysis. An association between the frequency of SSBs, coffee/tea or high energy drinks consumption and smoking behaviour was identified in all models. Greater beverage consumption was associated with being a current smoker (OR = 2.46 (2.02, 2.99)), former smoker, (OR = 2.50 (1.53, 4.08)), and currently using an e-cigarette (OR = 4.66 (3.40, 6.40)). Higher beverage consumption was also associated with more days smoking/using an e-cigarette per month (OR = 2.67 (1.92, 3.70) and 3.45 (2.32, 5.12), respectively). High energy drink consumption on 4 or 5 days of the school week was the best predictor of smoking behaviour in all models. Given the health consequences of smoking and e-cigarette use and their association with SSB, high energy drinks and coffee consumption, policy initiatives to prevent smoking initiation and limit access to these beverages needs ongoing attention and implementation.

Prevalence of hypertension in relation to anthropometric indices among secondary adolescents in Mbarara, Southwestern Uganda

Background

Studies investigating the prevalence of hypertension and its correlation with anthropometric indices among adolescents are still scarce compared to those conducted in adults of greater than 40 years. So far, no other study estimating the prevalence and correlates of hypertension among adolescents in Uganda has been found.

Objective

The purpose of this study, therefore, was to asses the prevalence of hypertension and its correlation with anthropometric indices among adolescents in Mbarara Municipality, southwestern Uganda.

Methods

A cross-sectional study was carried out among 616 secondary school adolescents aged 12–19 years in Mbarara Municipality, Uganda. Blood pressure and anthropometric indices were determined by standard methods. In the statistical analysis, linear regression analysis was done to assess the relationship between blood pressure and anthropometric indices.

Results

Overall prevalence of hypertension among adolescents was at 3.1% (n = 19) while prehypertension was 7.1% (n = 44). There was a statistically significant correlation between blood pressure, neck circumference, waist to hip ratio and body mass index at bivariate analysis. In multivariate analysis for anthropometric indices and sex, only neck circumference remained significantly correlated with blood pressure (p < 0.05).

Conclusion

The prevalence of hypertension among adolescents in the study setting was low. An increase in neck circumference results in an increase in blood pressure among 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.

Energy drink consumption, psychological distress, and suicidality among middle and high school students

BACKGROUND

Previous research has found links between energy drink consumption and mental health outcomes in youth. However, little is known about the factors that could moderate these relationships. The present study examined the associations between energy drink consumption and psychological distress, suicidal thoughts, and suicide attempts among adolescents, and tested whether sex and school type (i.e. middle vs. high school) would moderate these associations.

METHODS

Data on students in grades 7 through 12 was obtained from the 2017 Ontario Student Drug Use and Health Survey (N  =  5,538). Multivariable Poisson regression analyses were used to examine associations between energy drink consumption and mental health outcomes. Analyses were weighted and adjusted for the complex survey design.

RESULTS

Energy drink consumption was associated with greater risk of moderate to serious (adjusted incidence rate ratio (IRR) 1.19, 95% confidence interval (CI) 1.03-1.37) and serious (IRR: 1.45, 95% CI: 1.13-1.86) levels of psychological distress, suicidal thoughts (IRR: 1.98, 95% CI: 1.62-2.42), and suicide attempts (IRR: 3.67, 95% CI: 2.26-5.95). The association between energy drink consumption and mental health outcomes was much stronger among boys and middle school students.

LIMITATIONS

The cross-sectional nature of the data precludes causal inferences and there is possibility of bias related to self-reports.

CONCLUSIONS

Energy drink consumption among adolescents is strongly and differentially associated with mental health problems among male and female middle and high school students. Future research is necessary to replicate and disentangle the observed differences in more detail to inform the development of tailored interventions.

Energy drinks consumption and perceptions among University Students in Beirut, Lebanon: A mixed methods approach

Background

Energy drinks (ED) are caffeine- and sugar-rich beverages with other ingredients that are marketed for their energy-boosting and performance-enhancing effects. The consumption of these drinks, with and without alcohol, is dramatically increasing worldwide, despite the reported side effects and potential harms to consumers. Few studies, to date, have explored the perceptions and experiences of young adults towards these beverages.

Objective

The present study aimed to explore the consumption patterns and correlates of ED consumption, as well as the perceptions and experiences of university students in Lebanon towards these beverages.

Methods

A sequential explanatory mixed-methods approach was adopted. Data collection was conducted in two private universities in Beirut, Lebanon. A self-administered 36-item quantitative survey was first used to explore the prevalence and correlates of ED consumption among a convenience sample of university students (n = 226). The survey included questions related to socio-demographic characteristics, anthropometric measurements, and other lifestyle behaviors, including physical activity of university students. The subsequent qualitative phase consisted of focus group discussions (FGD) conducted to further examine the perceptions and experiences of university students towards ED. Descriptive statistics and logistic regression analyses were conducted using survey data, whereas the transcribed FGD were analyzed thematically.

Results

A total of 226 university students completed the survey. Results showed that 45% of survey respondents consumed ED at least once in their life (ever consumers), among which 30% reported consumption of ED mixed with alcohol (AmED). Adjusting for socio-demographic and anthropometric characteristics, coffee and sports drinks consumption were significantly associated with ED (OR = 2.45, 95% CI = 1.20, 5.00, and OR = 4.88, 95%CI = 2.41, 9.88, respectively). In addition, physically active participants were 1.89 times (95%CI = 1.01, 3.51) more likely to consume ED compared to their inactive counterparts. During the qualitative phase, a total of six FGD were conducted with 29 university students, who reported consuming ED at least once per month. Three main themes were derived reflecting individual-, interpersonal/social- and environmental-level factors affecting ED consumption among university students. These themes were further supported by eight subthemes, including: perceived benefits of ED, experienced side effects, misinformation about content of ED, peer pressure and social image, as well as affordability and accessibility of ED.

Conclusion

Findings highlight the need for public health policies and programs to curb the growing public health phenomenon of ED consumption amongst university students. Such programs should consider the multi-level factors affecting ED consumption at the individual, interpersonal/social, and environmental levels, including educational campaigns on ED potential harms, regulating ED content and labeling, as well as restricting sales and marketing of these beverages, especially among young consumers.

Energy Drink Consumption and Substance Use Among Middle and High School Students

This study examined the association between energy drink consumption and substance use among adolescents and tested whether sex and/or grade level (i.e., middle vs. high school) moderate the association. Data were derived from the 2017 Ontario Student Drug Use and Health Survey, a representative survey of students in 7th to 12th grade. Analyses included 10,662 students who self-reported information on energy drink consumption and substance use. Poisson regression models were used with adjustments for important covariates. Energy drink consumption was associated with tobacco cigarette smoking (incidence rate ratio (IRR): 3.74; 95% confidence interval (CI): 3.22-4.35), cannabis use (IRR: 2.90; 95% CI: 2.53-3.32), binge drinking (IRR: 2.46; 95% CI: 2.05-2.96), opioid use (IRR: 2.23; 95% CI: 1.85-2.68), and alcohol use (IRR: 1.31; 95% CI: 1.26-1.36). The associations of energy drink consumption with tobacco cigarette smoking, cannabis use, and alcohol consumption were modified by grade level (two-way interaction terms p < 0.05). The association between energy drink consumption and substance use was generally much stronger among middle school students compared with high school students. The findings suggest that middle school students may be more vulnerable to the negative effects of energy drinks in relation with substance use.

Energy Drink Consumption, Depression, and Salutogenic Sense of Coherence Among Adolescents and Young Adults

The prevalence of energy drink consumption has increased in Hungary over the past 10–15 years. This study assesses the frequency, motivations, and adverse effects of energy drink consumption, and examines how the process of becoming a regular consumer is connected with sense of coherence and depression symptoms. A total of 631 high school and college students were assessed using the Depression Scale (BDS-13) and Sense of Coherence Scale (SOC-13). Logistic regression models were fit to test the effect of and links between factors influencing addiction to energy drink use. A total of 31.1% (95% CI: 27.4–34.7) of those surveyed consumed energy drinks, 24.0% of those affected consumed the energy drink with alcohol, 71.4% (95% CI: 64.7–77.3) experienced adverse effects following energy drink consumption, and 10.2% (95% CI: 6.7–15.2) experienced at least four symptoms simultaneously. The most common motivations of consumption were fatigue, taste, and fun. Obtained by multivariate logistic regression models, after adjustment for sex and age, SOC and tendency to depression had a significant influence on the respondents’ odds of addiction. The tendency to depression increases the chances of addiction, while a strong sense of coherence diminishes the effects of depression. Young people in Hungary have been shown to consume energy drinks in quantities that are detrimental to their health. Complex preventive measures and programs are needed to address the problem. Families and educators should strive to instill a strong sense of coherence in children from an early age.

Association of energy drink consumption with substance-use initiation among adolescents: A 12-month longitudinal study

BACKGROUND

Aggressive marketing has resulted in exponential growth of energy drink sales in recent years. Despite growing concerns about the negative health effects of energy drinks, they are increasingly popular among young people. Little is known about temporal associations between energy drink consumption and other drug use, though some researchers have suggested that energy drink consumption reflects an entry into a drug-using lifestyle.

AIMS

The purpose of this study was to evaluate whether energy drink use among adolescents who have never tried substances is associated with a risk of initiating tobacco (i.e. cigarettes, e-cigarettes, and hookah) and alcohol use.

METHODS

A school-based longitudinal study of 3071 adolescents ages 9-17 years was conducted in six federal states of Germany. Data analyses involved two assessment waves that took place approximately 12 months apart: baseline (fall-winter of school year 2016-2017), and 12-month follow-up (fall-winter of school year 2017-2018).

RESULTS

Multilevel models revealed that energy drink use at baseline was associated with cigarette (odds ratio for energy drink ever use, 3.15 (95% confidence interval, 2.07-4.78 )), e-cigarette (odds ratio, 4.32 (95% confidence interval, 2.87-6.51)), hookah smoking (odds ratio, 3.15 (95% confidence interval, 2.06-4.82)), and alcohol use (odds ratio, 2.26 (95% confidence interval, 1.75-2.93)) initiation within 12 months.

CONCLUSIONS

These results raise the possibility that energy drinks may potentially act as a gateway drug to other substances. However, inferences regarding whether this association is or is not causal cannot yet be made.

Association of frequent intake of fast foods, energy drinks, or convenience food with atopic dermatitis in adolescents

PURPOSE

Specific food consumption, besides food allergy, may aggravate atopic dermatitis (AD). However, previous reports on the association between AD and food intake in adolescents are scarce. The aim of this study was to determine the relationship between AD and specific food consumption frequency in adolescents.

METHODS

A cross-sectional analysis using data from the Korea Youth Risk Behavior Web-based Survey 2017 was performed. The frequency of food consumption in the recent-diagnosed AD group (AD diagnosed within 12 months) compared to those in the previous-diagnosed AD (AD diagnosed more than 12 months ago) or control group were investigated.

RESULTS

A total of 53,373 participants were eligible for this study. The weighted prevalence of the recent-diagnosed AD and the previous-diagnosed AD was 7.39% and 18.00%, respectively. When compared with subjects with the previous-diagnosed AD, those with the recent-diagnosed AD were significantly more likely to frequently consume fast foods (odds ratio OR 1.405; 95% CI 1.150-1.717), energy drinks (OR 1.457; 95% CI 1.175-1.807), or convenience food (OR 1.304; 95% CI 1.138-1.495). Patients of the recent-diagnosed AD were significantly more likely to frequently consume fast foods (OR 1.374; 95% CI 1.155-1.634) than the control group. The differences in the frequency of specific food consumption among groups were more pronounced in high school students than in middle school students.

CONCLUSIONS

Frequent intake of fast foods, energy drinks, and convenience food was related to the recent-diagnosed AD in adolescents. Prospective cohort and interventional studies are needed to identify causal relationships.