Energy drinks: an emerging public health hazard for youth

Regulation of Added Substances in the Food Supply by the Food and Drug Administration Human Foods Program

The US food supply is increasingly associated with diet-related diseases, toxicity, cancer, and other health harms. These public health concerns are partly attributable to a loophole in federal law. The Food and Drug Administration (FDA) evaluates the premarket safety of ingredients regulated as food additives but allows the food industry to self-regulate and determine which substances to classify as generally recognized as safe (GRAS) based on undisclosed data and conclusions that the FDA never sees. Furthermore, the FDA lacks a formal approach for reviewing food additives and GRAS substances already found in the food supply. Substances in the food supply thus include innocuous ingredients (e.g., black pepper), those that are harmful at high levels (e.g., salt), those that are of questionable safety (e.g., potassium bromate), and those that are unknown to the FDA and the public. A recent court decision codified these gaps in the FDA's current approach, leaving states to try to fill the regulatory void. The FDA and Congress should consider several policy options to ensure that the FDA is meeting its mission to ensure a safe food supply. (Am J Public Health. 2024;114(10):1061-1070. https://doi.org/10.2105/AJPH.2024.307755).

A scoping review of policies related to reducing energy drink consumption in children

BACKGROUND

Frequent consumption of Energy Drinks (EDs) is associated with numerous health problems, including overweight and obesity, particularly among children and adolescents. The extensive promotion, wide accessibility, and relatively low cost of EDs have significantly increased their popularity among this age group. This paper examines policies/programs that, directly and indirectly, contribute to reducing ED consumption in children and adolescents and shares global experiences to help policymakers adopt evidence-based policies.

METHODS

A systematic search was performed using PubMed, Scopus, and Web of Science databases from January 2000 to June 2024, along with reputable international organization websites, to find literature on policies aimed at reducing ED consumption among children and adolescents. All sources meeting the inclusion criteria were included without restrictions. Titles and abstracts were initially screened, followed by a full-text review. After evaluating the quality of the selected studies, data were extracted and, along with information from the selected documents, compiled into a table, detailing the country, policy type, and the effectiveness and weaknesses of each policy.

RESULTS

Out of 12166 reviewed studies and documents, 84 studies and 70 documents met the inclusion criteria. 73 countries and territories have implemented policies like taxation, sales bans, school bans, labeling, and marketing restrictions on EDs. Most employ fiscal measures, reducing consumption despite enforcement challenges. Labeling, access restrictions, and marketing bans are common but face issues like black markets.

CONCLUSION

This scoping review outlines diverse strategies adopted by countries to reduce ED consumption among children and teenagers, such as taxation, school bans, sales restrictions, and labeling requirements. While heightened awareness of ED harms has reinforced policy efforts, many Asian and African nations lack such measures, some policies remain outdated for over a decade, and existing policies face several challenges. These challenges encompass industry resistance, governmental disagreements, public opposition, economic considerations, and the intricacies of policy design. Considering this, countries should tailor policies to their cultural and social contexts, taking into account each policy's strengths and weaknesses to avoid loopholes. Inter-sectoral cooperation, ongoing policy monitoring, updates, and public education campaigns are essential to raise awareness and ensure effective implementation.

A Cross-Sectional Study of Oral Health Status and Behavioral Risk Indicators among Non-Smoking and Currently Smoking Lithuanian Adolescents

The purpose of this study was to evaluate oral health status, behavioral risk indicators, and the impact of smoking on oral health among Lithuanian adolescents. This representative cross-sectional study was conducted among 15-year-old Lithuanian adolescents. The method of multistage cluster sampling was used. A total of 1127 adolescents met the inclusion criteria. Two originally created self-reported questionnaires were used in this study. Dental caries, periodontal status, and oral hygiene status were evaluated by four trained researchers. A p-value ≤ 0.05 was set to indicate statistically significant differences. Statistical analysis included Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests. Out of all the participants, 9.6% self-reported being a current tobacco smoker. The mean PI value was 1.14 ± 0.69 among all the participants. Currently smoking adolescents had more active caries lesions (D-S) than those who did not smoke (13.2 ± 16.4 vs. 9.8 ± 10.7, p = 0.023). Considering periodontal status, non-smoking adolescents had significantly lower mean PSR index scores than current smokers (0.52 ± 0.51 vs. 0.61 ± 0.50, p = 0.0298). Tobacco smoking and the consumption of energy drinks were significantly associated (OR = 3.74, 95% CI 2.66-5.26, p < 0.001) among participants. Currently smoking adolescents tended to have improper dietary habits, especially a higher consumption of energy drinks; thus, they were more likely to have active dental caries lesions, as well as poorer periodontal status, than their non-smoking peers.

Functional Beverages in the 21st Century

Underlying the dawn of humanity was primarily the search for food and access to drinking water. Over the course of civilization, there has been a significant increase in drinking water quality. By the average of the nutritional standards, the daily water demand is 2.5 L (also including liquid products such as tea, coffee, or soup). However, it is worth noticing that the need is strictly individual for each person and depends on two major factors, namely, epidemiological (sex, age state of health, lifestyle, and diet) and environmental (humidity and air temperature). Currently, our diet is more and more often enriched with isotonic drinks, functional drinks, or drinks bearing the hallmarks of health-promoting products. As a result, manufacturing companies compete to present more interesting beverages with complex compositions. This article will discuss both the composition of functional beverages and their impact on health.

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.

Comparing taxes as a percentage of sugar-sweetened beverage prices in Latin America and the Caribbean

Background

Excise taxes can be used to reduce the consumption of sugar-sweetened beverages (SSBs), an important preventable risk factor for noncommunicable diseases. This study aimed to compare novel standardized indicators of the level of taxes applied on SSBs as a percentage of the price across beverage categories in Latin America and the Caribbean.

Methods

We used a method developed by the Pan American Health Organization and adapted from the World Health Organization's tobacco tax share. The analysis focused on the most sold brand of five categories of non-alcoholic beverages. Data were collected by surveying ministries of finance and reviewing tax legislation in effect as of March 2019.

Findings

Of the 27 countries analyzed, 17 applied excise taxes on SSBs. Of these, median excise taxes represented the highest share of the price for large sugar-sweetened carbonated drinks (6·5%) and the lowest for energy drinks (2·3%). In countries where excise taxes were applied on bottled waters, tax incidence exceeded the one applied on most SSBs. Overall, excise tax shares were higher in Latin America than in the Caribbean. Including all other indirect taxes (e.g., value added tax), median total tax shares were between 12·8% and 17·5%. At least two countries earmarked part of SSB excise tax revenues for health purposes.

Interpretation

Excise tax levels are generally low in the region. From a public health perspective, tax rates could be increased, and tax designs improved (e.g., excluding bottled waters). The method describe here provides a feasible and informative way to monitor SSB taxation and could be replicated in other regions and over time.

Funding

Bloomberg Philanthropies through the Global Health Advocacy Incubator.

Cardiovascular Effects of Energy Drinks in the Pediatric Population

ABSTRACT

Consumption of energy drinks in the pediatric population is correlated with more emergency department visits and causes adverse reactions, such as neurological, psychiatric, gastrointestinal, renal, and cardiovascular effects. These cardiovascular complications include increased cardiometabolic risk with high intake of sugar, short-term blood pressure increases and a decrease in cerebral blood flow due to the caffeine content, increased or decreased blood pressure from taurine, unmasked cardiac conditions, such as channelopathies, and atrial and ventral fibrillations. Cardiovascular complications can also arise when energy drinks are mixed with pharmaceutical drugs, such as amiodarone, potent CYP1A2 inhibitors, warfarin, digoxin, or corticosteroids. Combining energy drinks with alcohol also precipitates adverse cardiovascular events, posing a risk to the health of children and adolescents. This review further explores the ingredients in energy drinks and their mechanism of action in causing these cardiovascular complications.

Prevalence and comparisons of alcohol, candy, energy drink, snack, soda, and restaurant brand and product marketing on Twitch, Facebook Gaming and YouTube Gaming

Objective:

To compare and evaluate the prevalence of food and beverage marketing on the livestreaming platforms Twitch, Facebook Gaming and YouTube Gaming, as well as examine growth of food and beverage marketing on these platforms over a 17-month period of data collection.

Design:

Cross-sectional data were analysed across three livestreaming platforms and six food and beverage categories: alcohol, candy, energy drinks, snacks, sodas and restaurants.

Setting:

Stream titles of livestreamed events as well as corresponding hours watched on Twitch, Facebook Gaming and YouTube Gaming.

Participants:

None.

Results:

There were significant differences between the use of food and beverage brand mentions in stream titles across all three studied platforms (P < 0·05), as well as hours watched across platforms (P < 0·05). Energy drinks dominated food and beverage brand mentions across platforms, followed by restaurants, soda and snacks. All platforms demonstrated growth over the 17-month data collection period. Post-hoc analyses revealed that the COVID-19 pandemic impacted both immediate and sustained growth across all platforms, with the greatest impact observed on the Twitch platform.

Conclusions:

Food and beverage marketing as measured through stream titles is widely prevalent across the three most popular livestreaming platforms, particularly for energy drinks. Food marketing on these platforms experienced growth over the past 17 months which was accelerated substantially by the COVID-19 pandemic. Future work should assess the sustained impact this growth may have on marketing practices and eating behaviour.

Sugar sweetened beverages attributable disease burden and the potential impact of policy interventions: a systematic review of epidemiological and decision models

BACKGROUND

Around 184,000 deaths per year could be attributable to sugar-sweetened beverages (SSBs) consumption worldwide. Epidemiological and decision models are important tools to estimate disease burden. The purpose of this study was to identify models to assess the burden of diseases attributable to SSBs consumption or the potential impact of health interventions.

METHODS

We carried out a systematic review and literature search up to August 2018. Pairs of reviewers independently selected, extracted, and assessed the quality of the included studies through an exhaustive description of each model's features. Discrepancies were solved by consensus. The inclusion criteria were epidemiological or decision models evaluating SSBs health interventions or policies, and descriptive SSBs studies of decision models. Studies published before 2003, cost of illness studies and economic evaluations based on individual patient data were excluded.

RESULTS

We identified a total of 2766 references. Out of the 40 included studies, 45% were models specifically developed to address SSBs, 82.5% were conducted in high-income countries and 57.5% considered a health system perspective. The most common model's outcomes were obesity/overweight (82.5%), diabetes (72.5%), cardiovascular disease (60%), mortality (52.5%), direct medical costs (57.35%), and healthy years -DALYs/QALYs- (40%) attributable to SSBs. 67.5% of the studies modelled the effect of SSBs on the outcomes either entirely through BMI or through BMI plus diabetes independently. Models were usually populated with inputs from national surveys -such us obesity prevalence, SSBs consumption-; and vital statistics (67.5%). Only 55% reported results by gender and 40% included children; 30% presented results by income level, and 25% by selected vulnerable groups. Most of the models evaluated at least one policy intervention to reduce SSBs consumption (92.5%), taxes being the most frequent strategy (75%).

CONCLUSIONS

There is a wide range of modelling approaches of different complexity and information requirements to evaluate the burden of disease attributable to SSBs. Most of them take into account the impact on obesity, diabetes and cardiovascular disease, mortality, and economic impact. Incorporating these tools to different countries could result in useful information for decision makers and the general population to promote a deeper implementation of policies to reduce SSBs consumption.

PROSPERO PROTOCOL NUMBER

CRD42020121025 .

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.

Relationships between constituents of energy drinks and beating parameters in human induced pluripotent stem cell (iPSC)-Derived cardiomyocytes

Consumption of energy drinks has been associated with adverse cardiovascular effects; however, little is known about the ingredients that may contribute to these effects. We therefore characterized the chemical profiles and in vitro effects of energy drinks and their ingredients on human induced pluripotent stem cell (iPSC)-derived cardiomyocytes, and identified the putative active ingredients using a multivariate prediction model. Energy drinks from 17 widely-available over-the-counter brands were evaluated in this study. The concentrations of six common ingredients (caffeine, taurine, riboflavin, pantothenic acid, adenine, and L-methionine) were quantified by coupling liquid chromatography with a triple quadrupole mass spectrometer for the acquisition of LC-MS/MS spectra. In addition, untargeted analyses for each beverage were performed with a platform combining LC, ion mobility spectrometry and mass spectrometry (LC-IMS-MS) measurements. Approximately 300 features were observed across samples in the untargeted studies, and of these ~100 were identified. In vitro effects of energy drinks and some of their ingredients were then tested in iPSC-derived cardiomyocytes. Data on the beat rate (positive and negative chronotropy), ion channel function (QT prolongation), and cytotoxicity were collected in a dilution series. We found that some of the energy drinks elicited adverse effects on the cardiomyocytes with the most common being an increase in the beat rate, while QT prolongation was also observed at the lowest concentrations. Finally, concentration addition modeling using quantitative data from the 6 common ingredients and multivariate prediction modeling was used to determine potential ingredients responsible for the adverse effects on the cardiomyocytes. These analyses suggested theophylline, adenine, and azelate as possibly contributing to the in vitro effects of energy drinks on QT prolongation in cardiomyocytes.

Chemical 24/7

This chapter shines a light on what happens in the dark: specifically, we present ethnographic insights from the nightlife economy and how chemicals enable youth to work “24/7.” Producers, promoters, DJs, hosts, artists, performers, drag queens, musicians, stage managers, bartenders, hospitality girls, and dancers from Amsterdam, Brooklyn, Bira (Indonesia), and Puerto Princesa (the Philippines) share with the ChemicalYouth team the various stimulants they use to stay awake and perform their jobs during non-typical working hours, and the other chemicals that they take in order to be able to sleep and recover afterwards. In Chemical 24/7 we compare and contrast the chemical practices of youth working at leisure industry sites in the global North to those of the low-income service sector and manual workers in the global South, and discuss how these different working conditions perpetuate chemical use. Our interlocutors rely on a range of chemicals for their work and social lives, and they develop practices to moderate their use in order to avoid adverse effects. Yet their practices differ depending on the availability, marketing, and policing of the substances.

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 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.

Identifying food marketing to teenagers: a scoping review

Background

Teenagers are aggressively targeted by food marketing messages (primarily for unhealthy foods) and susceptible to this messaging due to developmental vulnerabilities and peer-group influence. Yet limited research exists on the exposure and power of food marketing specifically to teenage populations. Research studies often collapse “teenagers” under the umbrella of children or do not recognize the uniqueness of teen-targeted appeals. Child- and teen-targeted marketing strategies are not the same, and this study aims to advance understanding of teen-targeted food marketing by identifying the teen-specific promotion platforms, techniques and indicators detailed in existing literature.

Methods

A systematic scoping review collected all available literature on food marketing/advertising with the term “teenager” or “adolescent” from nine databases, as well as Google Scholar for grey literature, and a hand search of relevant institutional websites. Included were all peer-reviewed journal articles, book chapters, and grey literature in which food marketing to youth was the central topic of the article, of any study type (i.e., original research, reviews, commentaries and reports), and including any part of the 12–17 age range.

Results

The 122 articles reviewed define the scope of existing literature on food marketing to young people age 17 and under, identifying leading trends in countries studied (United States, 52%), populations identified (children and teens studied concurrently, 36%), outcomes measured (advertising exposure, 54%), study type (cross-sectional, 58%) and methods used (content analysis, 46%). The promotion platforms and techniques used by food marketers to appeal to young people (as reported in the literature) are also identified and classified. Few studies (7%) use indicators to identify teen-targeted food marketing.

Conclusions

Unique treatments of teen populations are limited in food marketing literature, as is the application of clear indicators to identify and differentiate teen-targeted food marketing from child- or adult-targeted content. Given the need to better measure the presence and power of teen food marketing, this is a significant oversight in existing literature. The indicators identified will help researchers to develop more accurate strategies for researching and monitoring teen-targeted food promotion.

Caffeinated energy drink consumption and predictors of use among secondary school students over time in the COMPASS cohort study

Consumption of caffeinated energy drinks (CED) by youth is a public health priority, given the lack of regulation and evidence for both short and long-term health effects of CED use. Considering the potential risks associated with excessive caffeine consumption, this paper examined CED consumption and predictors of CED use over time in a large sample of Canadian secondary school students participating in the COMPASS study.

Using linked longitudinal data (n = 4949) from the first three years of the COMPASS study (2012/13 to 2014/15), three logistic Generalized Estimated Equation models were performed to examine predictors of weekday CED use, weekend CED use, and weekly CED use.

The prevalence of weekly CED use remained fairly consistent across the three years of follow-up; 12.5% in year-1, 11.3% in year-2, and 11.4% in year-3. Smokers and marijuana users at follow-up were all at greater odds of weekday or weekly CED use, regardless of baseline use. Binge drinkers at baseline were at greater odds for weekday or weekly CED use, but not if they started binge drinking after their baseline year. Marijuana users at follow-up were all at greater odds of weekend CED use, regardless of baseline marijuana use.

>1 in 10 youth reported consuming CEDs one or more times per week, where specific subpopulations of youth, such as marijuana users, appear to be more frequent CED users. Although CED use remained relatively constant over the three-year period examined, prevalence of CED use remains problematic among secondary school students.

Cardiovascular prevention and at-risk behaviours in a large population of amateur rugby players

BACKGROUND AND AIM

We aimed to investigate cardiovascular risk factors and health behaviours prospectively in a large population of French amateur rugby players.

METHODS

An anonymous questionnaire was displayed to rugby players aged over 12 years enrolled in the 2014-2015 French amateur rugby championship from the Burgundy region (n = 5140). Questions addressed awareness on: (a) cardiovascular prevention; (b) tobacco, alcohol and highly caffeinated beverages consumption; and (c) adherence to prevention guidelines (ECG checks, training in basic life support, avoidance of sports practice during fever/infectious episodes).

RESULTS

Among the 640 participants who completed the questionnaires, most were male (90%) and were aged under 35 years (80%). Almost half had basic life support training (42%), but only a minority attended an ECG check-up before licensing (37%), and only a few were aware of the cardiovascular prevention information campaign (17%), similarly across the age groups. Surprisingly, playing rugby with fever was commonly reported (44%) and was even more frequent in young women (55%). A high number of respondents were current smokers (35%), of whom most reported consumption less than 2 hours before/after a rugby session. Alcohol drinkers were frequent (69%), of whom most (79%) drank alcohol less than 2 hours before/after a match. Highly caffeinated beverages consumption (34%) was high, particularly in younger players (39%). Half highly caffeinated beverages consumption was in the setting of a rugby session, even greater in women and mainly motivated by performance enhancement (34%).

CONCLUSION

Our findings from a representative regional cohort may help to identify targets for cardiovascular prevention through the development of educational programmes aiming to improve the knowledge and behaviour of amateur rugby players.

Are energy Drinks Scapegoats? Decomposing Teenagers' Caffeine intake from Energy Drinks and Soda Beverages

BACKGROUND

Energy drinks have been repeatedly blamed for contributing to caffeine intake among teenagers.

OBJECTIVES

This study aimed to estimate and compare the caffeine intake of US teenagers from soda drinks versus energy drinks and shots.

METHODS

Data were taken from a 2015 nationally representative survey (Monitoring the Future) of 8th and 10th graders in the US (47.2% 8th grade; 51.1% female). Participants reported their numbers of consumed sodas, diet sodas, energy drinks, and energy shots per day. These were converted into mg caffeine/day and were contrasted with common guidelines for healthy caffeine intake, stratified by age group and sex. Error-bar charts, ANOVA and ROC curves were used for contrasting caffeine intake from soda drinks and energy drinks, as well as their contribution to exceeding recommended caffeine intake cutoffs.

RESULTS

First, in both sexes and grades the intake from soda drinks was significantly higher than the intake from energy drinks. The soda and energy drink intake for males was higher than the intake for females; intake for 8th graders was higher than this of 10th graders. Second, caffeine intake from soda drinks was significantly higher even in those who exceeded the recommended maximum caffeine intake. Third, caffeine intakes from soda and energy drinks were efficacious in explaining the exceeding of the recommended threshold for daily caffeine intake, but the explanatory power of soda drinks was larger.

CONCLUSIONS

From a caffeine consumption standpoint, health professionals should emphasize reduction in both soda and energy drinks.

Associations Between Korean Adolescents' Energy Drink Consumption and Suicidal Ideation and Attempts

PURPOSE

This study examined associations between caffeinated energy drink consumption patterns and (1) participant characteristics and health-risk behaviors and (2) suicidal ideation and attempts in Korean adolescents.

METHODS

Participants included 8961 adolescents who consumed the drinks more than once weekly. Data were analyzed via logistic regression.

RESULTS

Rates of suicidal ideation and attempts in participants who consumed the drinks more than once daily were higher relative to those for participants who consumed the drinks 3-6 and 1-2 times weekly.

CONCLUSIONS

Further research is required to establish causality in these relationships.

Energy drink consumption among New Zealand adolescents: Associations with mental health, health risk behaviours and body size

AIM

With the increase in popularity of energy drinks come multiple concerns about the associated health indicators of young people. The current study aims to describe the frequency of consumption of energy drinks in a nationally representative sample of adolescents and to explore the relationship between energy drink consumption and health risk behaviours, body size and mental health.

METHODS

Data were collected as part of Youth'12, a nationally representative survey of high school students in New Zealand (2012). In total, 8500 students answered a comprehensive questionnaire about their health and well-being, including multiple measures of mental well-being, and were weighed and measured for height.

RESULTS

More than one-third (35%) of young people consumed energy drinks in the past week, and 12% consumed energy drinks four or more times in the past week. Energy drink consumption was significantly associated with greater depressive symptoms, greater emotional difficulties and lower general subjective well-being. Frequent energy drink consumption was also associated with binge drinking, smoking, engagement in unsafe sex, violent behaviours, risky motor vehicle use and disordered eating behaviours. There was no association between consumption of energy drinks and student body size.

CONCLUSIONS

Consumption of energy drinks is associated with a range of health risk behaviours for young people. Strategies to limit consumption of energy drinks by young people are warranted.

Association between adolescents' consumption of total and different types of sugar-sweetened beverages with oral health impacts and weight status

OBJECTIVE

To examine the associations between adolescents' intake of sugar-sweetened beverages (SSBs) with oral health impacts (OHI) and weight status.

METHODS

Cross-sectional health survey with anthropometry and self-report OHI (toothache and avoiding some foods because of oral problems) and SSB intake (fruit juice, flavoured water, soft, diet, sports and energy drinks) collected in 2015.

RESULTS

A total of 3,671 adolescents participated (50% girls; mean age 13.2 years ±1.7). Drinking ≥1cup/day of SSBs was consistently associated with higher odds of OHI compared with drinking <1cup/day: diet soft drinks (AOR, 5.21 95%CI 2.67, 10.18); sports drinks (AOR 3.60 95%CI 1.93, 6.73); flavoured water (AOR 3.07 95%CI 1.55, 6.06); and energy drinks (AOR 2.14 95%CI 1.44, 3.19). Daily SSB intake was not consistently associated with weight status. The odds of overweight/obesity (AOR 1.27 95%CI 1.01, 1.59) and obesity (AOR 1.61 95%CI 1.01, 2.57) were higher for energy drink consumption, compared with not drinking energy drinks; and the odds of abdominal obesity were twice as high among adolescents who drank ≥1cup/day of sports drinks, compared with <1cup/day intake.

CONCLUSIONS

Daily consumption of SSBs is prevalent among adolescents and is consistently associated with higher odds of OHI. The most popular SSBs among adolescents were energy drinks. Different types of SSB were differentially associated with OHI and weight status. Implications for public health: Different types of SSBs were differentially associated with OHI and weight status in adolescents. Diet soft drinks and new generation SSBs such as energy and sport drinks and flavoured water had a greater impact on adolescents' OHI compared with soft drinks and fruit juice.

How can we restrict the sale of sports and energy drinks to children? A proposal for a World Health Organization-sponsored framework convention to restrict the sale of sports and energy drinks

High-sugar drinks, including fruit drinks, soft drinks, sports drinks and energy drinks, are of no nutritional value and contribute to the burden of dental disease in all age groups. The manufacturers of sports and energy drinks have elected to target children in their marketing campaigns and promote a misleading association between their products, healthy lifestyles and sporting prowess. The World Health Organization (WHO) has acknowledged that strategies aimed at prevention of dental disease are the only economically viable options for managing the oral health of children in low- and middle-income countries. Developed nations will also be advantaged by preventive programmes given that the cost of providing dental care to those who cannot pay draws valuable resources away from more pressing health issues. The Convention on the Rights of the Child (CRC) obligates governments to develop legislation to protect the health of children. A framework convention modelled on the existing Framework Convention for Tobacco Control, supported by the WHO, would assist governments to proactively legislate to restrict the sale of sports and energy drinks to children. This article will consider how a framework convention would be an advantage with reference to the strategies used by sports and energy drink manufacturers in Australia.

Consumption of Caffeinated Energy Drinks Among Youth and Young Adults in Canada

The growing market for caffeinated energy drinks (CEDs) has caused concern about excessive caffeine intake and potential adverse effects, particularly among young people. The current study examined patterns of CED consumption among youth and young adults in Canada, using data from a national online survey conducted in October 2014. Data from a non-probability sample of 2040 respondents aged 12-24 from a consumer panel was weighted to national proportions; measures of CED consumption were estimated, including prevalence, excessive daily consumption, and context for use (locations and reasons). Separate logistic regression models for two outcomes, past-week consumption and "ever" exceeding two energy drinks in a day (as per common guidance), were conducted to examine associations with demographic variables (sex, age, geographic region, race/ethnicity, and language). Overall, 73.6% of respondents reported "ever" consuming energy drinks; 15.6% had done so in the past week. Any consumption of energy drinks in the past week was more prevalent among males, Aboriginal respondents (vs. white only or mixed/other), and residents of British Columbia. Among "ever-consumers," 16.0% reported ever consuming more than two energy drinks in a day. Exceeding two in a day was more prevalent among older respondents (young adults aged 18-24), aboriginal respondents (vs. white only), and British Columbia residents. While the majority of youth and young adults had consumed energy drinks, about half were "experimental" consumers (i.e., consumed ≤ 5 drinks in their lifetime). Approximately one in six consumers had exceeded the usual guidance for maximum daily consumption, potentially increasing their risk of experiencing adverse effects.

Caffeinated Beverage Consumption Rates and Reported Sleep in a United States Navy Ship

Ship crews live and work in an environment characterized by extreme sleep deprivation. In an attempt to maintain alertness, crewmembers frequently consume caffeinated beverages and energy drinks. As part of a broader study, this work assesses the consumption of caffeinated beverages and investigates the association between caffeinated beverage consumption and reported sleep amount. Crewmembers of a U.S. Navy aircraft carrier (N=767; age 18-49 years) completed a survey with questions pertaining to demographics, exercise frequency, average sleep duration, caffeine beverage consumption, the Epworth Sleepiness Scale (ESS), and the Fatigue Severity Scale (FSS). Results show that the sample of active duty personnel slept approximately six hours per night. Most respondents (~90%) reported using at least one type of caffeinated beverage (~55% coffee, ~50% soft drinks, ~35% energy drinks, and ~35% tea). The participants who reported drinking caffeinated drinks had an average weekly caffeine intake of 812±917 mg (MD=540), ranging from 30 to 9210 mg. Crewmembers who consumed more than 1,270 mg of caffeine weekly (equivalent to 180 mg daily) reported sleeping 5.79±1.17 hours, whereas crewmembers that drank less than 1,270 mg of caffeine reported sleeping 6.17±1.07 hours (p<0.001). Overall, our study shows widespread use of caffeine among active duty crewmembers in our sample. Our results suggest that caffeine intake – in the form of coffee, tea, caffeinated soft drinks, or energy drinks – is associated with sleep and may interfere with sleep patterns while working at sea. Future efforts should be directed at exploring causal relationships involved in this phenomenon. Better understanding of causal links will enable appropriate guidance for better sleep hygiene in the maritime operational environment.

A Retrospective Study of Clinical Effects of Powdered Caffeine Exposures Reported to Three US Poison Control Centers

INTRODUCTION

Anhydrous caffeine, often sold on the Internet as a powdered caffeine product, is sold as "pure caffeine" to be used as an additive to beverages and has also been used as an ingredient in energy supplement products.

METHODS

This is a retrospective multiple-poison center chart review of calls regarding powdered caffeine to poison centers covering Oregon, Alaska, Guam, Washington, and Utah between January 1, 2013 and June 30, 2015.

RESULTS

There were 40 calls to three poison centers over 30 months for powdered caffeine exposure. The majority of patients were over age 19 (52.5 %; 21/40) and male (70 %; 28/40). Sixty percent (24/40) of the patients were symptomatic but only 10 % (4/40) required admission; 52.5 % (21/40) of the patient calls were for inadvertent overdose of powdered caffeine; one patient overdosed in a self-harm attempt.

DISCUSSION

Powdered caffeine calls to three poison centers during a 30-month study period were rare, and severe caffeine toxicity due to exposure was found in few patients. The majority of symptoms were reported after an inadvertent powdered caffeine overdose.

CONCLUSIONS

An analysis of calls to three poison centers for powdered caffeine found that exposures were uncommon, but did result in toxicity, and highlighted that the lack of clear dosing instructions on product packaging may place patients at risk of inadvertent overdose.

Analysis of Consumption of Energy Drinks by a Group of Adolescent Athletes

BACKGROUND

Energy drinks (EDs) have become widely popular among young adults and, even more so, among adolescents. Increasingly, they are consumed by athletes, particularly those who have just begun their sporting career. Uncontrolled and high consumption of EDs, in addition to other sources of caffeine, may pose a threat to the health of young people. Hence, our objective was to analyze the consumption of EDs among teenagers engaged in sports, including quantity consumed, identification of factors influencing consumption, and risks associated with EDs and EDs mixed with alcohol (AmEDs).

METHODS

The study involved a specially designed questionnaire, which was completed by 707 students, 14.3 years of age on average, attending secondary sports schools.

RESULTS

EDs were consumed by 69% of the young athletes, 17% of whom drank EDs quite often: every day or 1-3 times a week. Most respondents felt no effects after drinking EDs, but some reported symptoms, including insomnia, anxiety, tachycardia, nervousness and irritability. The major determinant of the choice of EDs was taste (47%), followed by price (21%). One in ten respondents admitted to consumption of AmEDs. Among the consequences reported were: abdominal pains, nausea, vomiting, amnesia, headache, and hangover.

CONCLUSIONS

EDs consumption among adolescent athletes was relatively high. Considering the habit of AmEDs and literature data, it is worth emphasizing that it may lead to health problems in the near future, alcohol- or drug-dependence, as well as other types of risk behaviour.

Adolescent energy drink consumption: An Australian perspective

Caffeinated Energy Drinks (EDs) are not recommended for consumption by children, yet there is a lack of age-specific recommendations and restrictions on the marketing and sale of EDs. EDs are increasingly popular among adolescents despite growing evidence of their negative health effects. In the current study we examined ED consumption patterns among 399 Australian adolescents aged 12-18 years. Participants completed a self-report survey of consumption patterns, physiological symptoms, and awareness of current ED consumption guidelines. Results indicated that ED consumption was common among the sample; 56% reported lifetime ED consumption, with initial consumption at mean age 10 (SD = 2.97). Twenty-eight percent of the sample consumed EDs at least monthly, 36% had exceeded the recommended two standard EDs/day, and 56% of consumers had experienced negative physiological health effects following ED consumption. The maximum number of EDs/day considered appropriate for children, adolescents, and adults varied, indicating a lack of awareness of current consumption recommendations. These findings add to the growing body of international evidence of adolescent ED consumption, and the detrimental impact of EDs to adolescent health. Enforced regulation and restriction of EDs for children's and adolescents' consumption is urgently needed in addition to greater visibility of ED consumption recommendations.

Caffeine consumption, insomnia, and sleep duration: Results from a nationally representative sample

OBJECTIVE

Insomnia symptoms have been individually associated with both caffeine consumption and sleep duration abnormalities in prior studies. The goal of this study was to determine whether caffeine consumption was associated with insomnia symptoms from a population perspective and whether this relationship depended on habitual sleep duration.

METHODS

Data were extracted from the 2007-2008 National Health and Nutritional Examination Survey (N = 4730). Caffeine consumption was quantified as mg/d from 2 typical days of use, 7 to 10 d apart. Insomnia symptoms were evaluated using frequencies of difficulty falling asleep (DFA), difficulty staying asleep (DSA), non-restorative sleep (NRS), and daytime sleepiness (DS). Habitual sleep duration was assessed as the hours of sleep obtained on a typical night. Binomial logistic regression analysis evaluated the relationships of individual insomnia and sleepiness symptoms (DFA, DSA, NRS, and DS) with caffeine consumption and sleep duration variables, after adjusting for covariates.

RESULTS

The mean ± SD caffeine consumption was 176.6 ± 201 mg/d. Mean habitual sleep duration was 6.8 ± 1.4 h. Insomnia symptoms were prevalent in 19.1% to 28.4% of the respondents. Although caffeine consumption was associated with all insomnia symptoms in the unadjusted models, the adjusted models demonstrated a trend toward significance with DSA. Sleep duration was inversely associated with the insomnia symptoms in unadjusted and adjusted analysis. Finally, NRS was associated with an interaction between increased caffeine consumption and sleep duration.

CONCLUSION

The association between caffeine use and insomnia symptoms depends on habitual sleep duration at a population level.

A survey of energy drink and alcohol mixed with energy drink consumption

Background

Energy drink consumption among youth is increasing despite recommendations by the American Academy of Pediatrics to eliminate consumption by youth. This study provides information on consumption of energy drinks and alcohol mixed with energy drinks (AmED) in a sample of Israeli youth and how consumer knowledge about the risks affects consumption rates.

Methods

The study was conducted in three Tel Aviv public schools, with a total enrollment of 1,253 students in grades 8 through 12. Among them, 802 students completed a 49-item questionnaire about energy drink and AmED consumption, for a 64 % response rate Non-responders included 451 students who were absent or refused to participate. All students in the same school were administered the questionnaire on the same day.

Results

Energy drinks are popular among youth (84.2 % have ever drunk). More tenth through twelfth grade students consumed energy drinks than eighth and ninth grade students. Students who began drinking in elementary school (36.8 %) are at elevated risk for current energy drink (P < .001) and AmED (P = .002) use. Knowledge about amounts consumed and recommended allowances is associated with less consumption (OR 1.925; 95 %CI 1.18–3.14).

Discussion

The association between current AmED consumption and drinking ED at a young age is important. Boys and those who start drinking early have a greater risk of both ED and AmED consumption. The characteristics of early drinkers can help increase awareness of potential at-risk youth, such as junior and senior high school students with less educated or single parents.

Conclusions

Risks posed by early use on later energy drink and AmED consumption are concerning. We suggest that parents should limit accessibility. Increased knowledge about acceptable and actual amounts of caffeine in a single product might decrease consumption.

Public Concern about the Sale of High-Caffeine Drinks to Children 12 Years or Younger: An Australian Regulatory Perspective

Background. Dietary exposure to high caffeine is a health risk for children. Governments are considering measures to restrict the sale of formulated caffeinated beverages (FCB) to children. Objectives. To investigate community concern about sales of high-caffeine drinks to children among Western Australian adults and describe Australian and New Zealand regulatory processes regarding FCB. Methods. Data from the 2009 and 2012 Department of Health's Nutrition Monitoring Survey Series of 2,832 Western Australians aged 18–64 years was pooled with descriptive and ordinal logistic regression analysis performed. Current regulatory processes for FCB are reported. Results. Most (85%) participants were concerned about the sale of high-caffeine drinks to children; 77.4% were very concerned in 2012 compared to 66.5% in 2009, p < .008. Females and those living with children had higher concern (odds ratio (OR) 2.11; 95% confidence interval (CI) 1.44–3.10; OR 2.16; 95% CI 1.51–3.09, resp., p < .001). Concern increased with each year of age (OR 1.04; 95% CI 1.02, 1.05, p < .001). Conclusions. Community concern regarding sale of high-caffeine energy drinks to children is high and increasing. Being female and living with children were associated with greater concern. These findings support the Australian and New Zealand regulatory controls of FCB, including labelling, promotion, and advertising to children.

The association between state bans on soda only and adolescent substitution with other sugar-sweetened beverages: a cross-sectional study

BACKGROUND

Across the United States, many states have actively banned the sale of soda in high schools, and evidence suggests that students' in-school access to soda has declined as a result. However, schools may be substituting soda with other sugar-sweetened beverages (SSBs), and national trends indicate that adolescents are consuming more sports drinks and energy drinks. This study examined whether students consumed more non-soda SSBs in states that banned the sale of soda in school.

METHODS

Student data on consumption of various SSBs and in-school access to vending machines that sold SSBs were obtained from the National Youth Physical Activity and Nutrition Study (NYPANS), conducted in 2010. Student data were linked to state laws regarding the sale of soda in school in 2010. Students were cross-classified based on their access to vending machines and whether their state banned soda in school, creating 4 comparison groups. Zero-inflated negative binomial models were used to compare these 4 groups with respect to students’ self-reported consumption of diet soda, sports drinks, energy drinks, coffee/tea, or other SSBs. Students who had access to vending machines in a state that did not ban soda were the reference group. Models were adjusted for race/ethnicity, sex, grade, home food access, state median income, and U.S. Census region.

RESULTS

Students consumed more servings of sports drinks, energy drinks, coffee/tea, and other SSBs if they resided in a state that banned soda in school but attended a school with vending machines that sold other SSBs. Similar results were observed where schools did not have vending machines but the state allowed soda to be sold in school. Intake was generally not elevated where both states and schools limited SSB availability – i.e., states banned soda and schools did not have SSB vending machines.

CONCLUSION

State laws that ban soda but allow other SSBs may lead students to substitute other non-soda SSBs. Additional longitudinal research is needed to confirm this. Elevated SSB intake was not observed when both states and schools took steps to remove SSBs from school.

Energy drinks and youth self-reported hyperactivity/inattention symptoms

OBJECTIVE

To describe patterns in sweetened beverage consumption by race/ethnicity and sex, documenting both the amount and types of sweetened beverages consumed; and to examine the association of sweetened beverage consumption with hyperactivity/inattention symptoms among middle school students in a single urban school district.

METHODS

Middle school students (n = 1649; 47% Hispanic and 38% black, non-Hispanic) from 12 schools, randomly selected out of 27 district schools, completed health behavior surveys in fall 2011. Students reported quantity and types of sweetened beverages consumed in the past 24 hours and completed the 5-item Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire to measure symptoms.

RESULTS

Amount and variety of reported sweetened beverage consumption (including energy drinks) were greater among boys versus girls and among black and Hispanic versus white students. Risk of hyperactivity/inattention increased by 14% for each additional sweetened beverage consumed, adjusting for age, race/ethnicity, sex, school lunch eligibility, family structure, and sugary food consumption. Students reporting consumption of energy drinks were 66% more likely to be at risk for hyperactivity/inattention after adjusting for number of drinks, other types of drinks consumed, and other potential confounders.

CONCLUSIONS

Results support recommendations to limit consumption of sweetened beverages and to avoid consumption of energy drinks among children. Interventions to reduce sweetened beverage consumption should explicitly focus on energy drinks and other emerging sweetened beverages such as sports and sweetened coffee drinks. More research is needed to understand the direction of effects and the mechanisms behind the association between sweetened beverages and hyperactivity/inattention symptoms.

Implications of sleep and energy drink use for health disparities

The popularity of energy drinks has increased rapidly in the past decade. One of the main reasons people use energy drinks is to counteract effects of insufficient sleep or sleepiness. Risks associated with energy drink use, including those related to sleep loss, may be disproportionately borne by racial minorities and those of lower socioeconomic status. In this review, a brief introduction to the issue of health disparities is provided, population-level disparities and inequalities in sleep are described, and the social-ecological model of sleep and health is presented. Social and demographic patterns of energy drink use are then presented, followed by discussion of the potential ways in which energy drink use may contribute to health disparities, including the following: 1) effects of excessive caffeine in energy drinks, 2) effects of energy drinks as sugar-sweetened beverages, 3) association between energy drinks and risk-taking behaviors when mixed with alcohol, 4) association between energy drink use and short sleep duration, and 5) role of energy drinks in cardiometabolic disease. The review concludes with a research agenda of critical unanswered questions.

Effect of energy drink and caffeinated beverage consumption on sleep, mood, and performance in children and adolescents

The increasing availability of highly caffeinated beverages, including energy drinks, in the United States has resulted in a rise in consumption by children and adolescents. In addition, there is mounting evidence that these products are often consumed by youth for their perceived fatigue-mitigating and mood- or performance-enhancing effects. Although such perceptions by children and adolescents about the potential consequences of caffeine consumption are highly likely to influence decision making regarding the use of such products, there is still a relative paucity of studies that focus on the effect of caffeinated beverages on sleep, mood, and performance in the pediatric population. This review summarizes the following aspects of this topic, as derived from the information currently available: 1) the perception, among youth, of caffeine's risks and benefits and the sources of information about caffeine, particularly with regard to sleep, mood, and performance; 2) the bidirectional effect of caffeine on sleep in children and adolescents and the association of caffeine with other sleep-related practices, and 3) the evidence that supports caffeine as a performance and mood enhancer as well as a countermeasure to sleepiness in the pediatric population. Finally, gaps in knowledge are identified, and a direction for future research is outlined.

Alcohol and energy drink use among adolescents seeking emergency department care

Emergency department (ED) visits due to energy drinks rose drastically from 2007 to 2011. Consuming alcohol mixed with energy drinks by young people is particularly concerning. Among youth (aged 14-20 years) in the ED reporting past-year alcohol use, we assessed frequency, reasons, and medical consequences of consuming alcohol and energy drinks in the same beverage or on the same occasion, and relationships with other risk behaviors. The sample included 439 youth (M(age)=18.6 years, SD=1.4; 41% male; 73% Caucasian): those who drank alcohol, but not energy drinks (Non-Users; 41%, n=178), those who drank alcohol and energy drinks on separate occasions (Separate; 23%, n=103), and those who combined alcohol and energy drinks in the same beverage or on the same occasion (Combined; 36%, n=158). Common reasons for combining energy drinks and alcohol were hiding the flavor of alcohol (39%) and liking the taste (36%). Common consequences were feeling jittery (71%) and trouble sleeping (46%). Combined users had the highest rates of risk behaviors (e.g., drug use, sexual risk behaviors, driving after drinking) and alcohol use severity. Multinomial logistic regression indicated that men, those who had sex after substance use, those who had used drugs, and those with higher alcohol severity were more likely to be Combined users than Non-Users. Those with higher alcohol severity were also more likely to be Combined users than Separate users. Combining energy drinks and alcohol is associated with higher rates of other risk behaviors among young drinkers. Future studies are needed to determine longitudinal relationships of energy drink use on substance use problem trajectories.

Patterns of energy drink advertising over US television networks

OBJECTIVE

To describe programming themes and the inclusion of adolescents in the base audience for television channels with high levels of energy drink advertising airtime.

DESIGN

Secondary analysis of energy drink advertising airtime over US network and cable television channels (n = 139) from March, 2012 to February, 2013. Programming themes and the inclusion of adolescents in each channel's base audience were extracted from cable television trade reports.

MAIN OUTCOME MEASURE

Energy drink advertising airtime.

ANALYSIS

Channels were ranked by airtime; programming themes and the inclusion of adolescents in the base audience were summarized for the 10 channels with the most airtime.

RESULTS

Over the study year, 36,501 minutes (608 hours) were devoted to energy drink advertisements; the top 10 channels accounted for 46.5% of such airtime. Programming themes for the top 10 channels were music (n = 3), sports (n = 3), action-adventure lifestyle (n = 2), African American lifestyle (n = 1), and comedy (n = 1). MTV2 ranked first in airtime devoted to energy drink advertisements. Six of the 10 channels with the most airtime included adolescents aged 12-17 years in their base audience.

CONCLUSIONS AND IMPLICATIONS

Energy drink manufacturers primarily advertise on channels that likely appeal to adolescents. Nutritionists may wish to consider energy drink media literacy when advising adolescents about energy drink consumption.

Energy drink consumption and the risk of alcohol use disorder among a national sample of adolescents and young adults

OBJECTIVE

To assess the association between energy drink use and hazardous alcohol use among a national sample of adolescents and young adults.

STUDY DESIGN

Cross-sectional analysis of 3342 youth aged 15-23 years recruited for a national survey about media and alcohol use. Energy drink use was defined as recent use or ever mixed-use with alcohol. Outcomes were ever alcohol use and 3 hazardous alcohol use outcomes measured with the Alcohol Use Disorders Identification Test (AUDIT): ever consuming 6 or more drinks at once (6+ binge drinking) and clinical criteria for hazardous alcohol use as defined for adults (8+AUDIT) and for adolescents (4+AUDIT).

RESULTS

Among 15-17 year olds (n = 1508), 13.3% recently consumed an energy drink, 9.7% ever consumed an energy drink mixed with alcohol, and 47.1% ever drank alcohol. Recent energy drink use predicted ever alcohol use among 15-17-year-olds only (OR 2.58; 95% CI 1.77-3.77). Of these 15-17-year-olds, 17% met the 6+ binge drinking criteria, 7.2% met the 8+AUDIT criteria, and 16.0% met the 4+AUDIT criteria. Rates of energy drink use and all alcohol use outcomes increased with age. Ever mixed-use with alcohol predicted 6+ binge drinking (OR 4.69; 95% CI 3.70-5.94), 8+AUDIT (OR 3.25; 95% CI 2.51-4.21), and 4+AUDIT (OR 4.15; 95% CI 3.27-5.25) criteria in adjusted models among all participants, with no evidence of modification by age.

CONCLUSIONS

Positive associations between energy drink use and hazardous alcohol use behaviors are not limited to youth in college settings.

Caffeine addiction? Caffeine for youth? Time to act!

While data accumulate and discussion evolves on the clinical importance of caffeine addiction and its classification, the growing practices of (i) adding increasing amounts of caffeine to drinks and other consumables, (ii) promoting these as performance enhancers and (iii) targeting youth as the consumer raise concerns that require immediate action.

Ostracising caffeine from the pharmacological arsenal for attention-deficit hyperactivity disorder--was this a correct decision? A literature review

Caffeine is one of the most widespread psychotropic substances in the world. It exerts multiple effects on the brain including adenosine receptor antagonism, and thereby has been found to modulate aspects of cognition, including attention, in animal models and in healthy human volunteers. This review considers what is known of the effects of caffeine on symptoms and cognitive functions in attention-deficit hyperactivity disorder (ADHD), a prototypical disorder of cognitive dysfunction. We consider the merits of investigating further caffeine's therapeutic potential as a monotherapy or as an adjunctive agent in ADHD. The potential benefits of re-opening a dialogue regarding the use of caffeine in ADHD clinical practice are highlighted, along with potential implications for the use of adenosine receptor antagonists in ADHD and other disorders characterised by cognitive impairment.