Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

Differential consumption of alcohol, caffeine, and caffeinated alcohol by adolescent rats, and effects on post-adolescent gene expression signatures in the nucleus accumbens and orbitofrontal cortex

Caffeinated alcoholic beverages (CABs) are widely consumed despite little known about their behavioral and biological effects. Furthermore, CABs are also popular among adolescents, a particularly vulnerable and maturing demographic. In this preliminary study, we compared levels of daily adolescent voluntary consumption of caffeine (0.03%), alcohol (10%), caffeinated alcohol (0.03% + 10%), or vehicle and evaluated the effects of this on mRNA expression in brain regions associated with addiction and known to be affected by each drug. Beginning on postnatal day 30, rats were allowed unrestricted access to gelatin combined with one, both, or neither drug for twenty days. Compared to vehicle-consuming animals, consumption of gelatin was significantly attenuated when alcohol was included. The addition of caffeine to alcohol increased alcohol consumption in the early days of access compared to alcohol alone; however, after two weeks, alcohol consumption between these groups reached comparable levels. Compared to animals consuming caffeine alone, combining caffeine with alcohol significantly reduced caffeine intake. Targeted mRNA analysis of tissue collected from the nucleus accumbens and orbitofrontal cortex after the consumption period identified unique patterns of differentially expressed genes between treatment groups, across a broad array of neurotransmitter systems. Of particular note were genes related to a number of solute transporters and serotonergic functions. This preliminary work suggests unique pharmacological and behavioral effects from consuming caffeinated alcohol during adolescence. Since CABs are widely consumed by adolescents, these results suggest that more research into the pharmacological and behavioral effects elicited by CABs is warranted.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

The implications of alcohol mixed with energy drinks from medical and socio-legal standpoints

Co-ingestion of energy drinks and alcohol has long been in practice and has been poorly regulated despite a growing body of literature of their potential negative health impacts. Co-ingestion of energy drinks with alcohol has multiple counter-active effects such as reduction of body sway, fatigue and sedative effects induced by alcohol, along with increased subjective feeling of alertness, which may lead to increased binge-drinking, intoxication, decreased perception of intoxication, dehydration, and alcohol poisoning. Adding energy drinks to alcohol may also have synergistic effects in causing alcohol dependency and addiction. The association between caffeine, a common active ingredient in energy drinks, and alcohol is relatively well defined, however association with other active ingredients such as taurine, niacin, and pyridoxine, is less understood, pointing to a gap in our knowledge regarding this practice. Nonetheless, the current associations between AMED (Alcohol Mixed with Energy Drinks) and risky behavior secondary to intoxication and cases of alcohol poisoning have led various national governing bodies to regulate this practice. This review highlights the potential effects of AMED on human physiology based on what is known from human and animal models, and sheds light on specific biochemical interactions between alcohol and active ingredients found in energy drinks; Caffeine, Taurine, and Glucuronolactone. The review also touches on the regulation of this practice around the world, and the impact it has on its users, and points researchers to gaps in our knowledge on the interactions between alcohol and EDs and the full extent of their effects.

Interaction of Energy Drinks with Prescription Medication and Drugs of Abuse

In recent years, the consumption of energy drinks (EDs) has become increasingly popular, especially among adolescents. Caffeine, a psychostimulant, is the main compound of EDs which also contain other substances with pharmacological effects. This review aims to compile current evidence concerning the potential interactions between EDs, medicines, and drugs of abuse as they are frequently consumed in combination. The substances involved are mainly substrates, inductors or inhibitors of CYP1A2, psychostimulants, alcohol and other depressant drugs. Furthermore, intoxications reported with EDs and other substances have also been screened to describe acute toxicity. The results of our review show that the consumption of both EDs alone and in combination is not as safe as previously thought. Health professionals and consumers need to be aware of the potential interactions of these drinks as well as the absence of long-term safety data.

Effects of Mixing Energy Drinks With Alcohol on Driving-Related Skills

BACKGROUND

Energy drinks (EDs) reduce sleepiness and fatigue and improve driving performance whereas alcohol does just the opposite. Although it is a trendy combination among young people, the effects of alcohol mixed with EDs on driving performance have been poorly studied. The aim was to assess if there is an interaction between the effects of both drinks on driving-related skills as well as perceptions about driving ability.

METHODS

We conducted a randomized, double-blind, and placebo-controlled 4-way crossover clinical trial. Participants were 16 healthy volunteers. Interventions of 60 g of ethanol and 750 mL of Red Bull (RB) were administered in 2 separated doses. Conditions were alcohol + RB placebo, alcohol + RB, alcohol placebo + RB, and both placebos. Objective performance was assessed using a tracking test and simple reaction time, N-Back, and movement estimation tasks. Additionally, willingness to drive, other subjective effects, and ethanol and caffeine blood concentrations were also measured.

RESULTS

Alcohol increased the time outside the road in the tracking test and increased simple reaction time, but the addition of RB had no main or interaction effects on performance. Nonetheless, driving-related skills after alcohol + RB were better than after alcohol alone. Willingness to drive increased with the combination of drinks. RB also reduced alcohol-induced sedation whereas drunkenness did not change. These effects were seen even though alcohol + RB increased alcohol (14.8%) and caffeine plasma concentrations (17.6%).

CONCLUSIONS

Mixing EDs with alcohol predisposes consumers to drive under alcohol influence, perhaps in part because EDs counteract its detrimental effects on driving-related skills. Clinicaltrials.gov: NCT02771587.

Alcohol Mixed With Energy Drinks and Sexually Related Causes of Conflict in the Barroom

The popularity of alcohol mixed with energy drinks (AmED) among young adults has spurred studies that focus on its links to aggression and risk-taking behaviors, including risky sex and sexual victimization. However, no studies to date have looked at the relationship between AmED and causes of interpersonal conflict in bars at the event level. The present study evaluated whether AmED use at the time of the bar conflict was associated with greater odds that a bar conflict would be precipitated by sexually related causes. Online survey data, including a description of a recent bar conflict, were collected from a community sample of 175 young adult (97 female) AmED users age 18 to 30 in western New York state. Qualitative findings included the natural categorization of sexually related causes of conflict, consisting of unwanted sexual advances and jealousy, and the prominence of sexual competition in these conflicts. Proportion of AmED use (out of the total quantity of alcoholic drinks) predicted the odds that the bar conflict would have a sexually related cause, above and beyond control variables. How AmED use might be associated with sexual competition and conflict in the bar is discussed.

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.

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.

Correlates of nonmedical use of prescription opioids among a cohort of adolescents in Ontario, Canada

INTRODUCTION

Mortality and morbidity rates related to prescription opioid analgesics have been rising in North America and may be a gateway to the nonmedical use of prescription opioids (NUPO). The purpose of this study was to explore correlates of NUPO in the adolescent population given the scarce literature in this area.

METHODS

Cross-sectional data from 10,163 middle- and high-school students (15.1 ± 1.8 years old; 57.0% female; 55.6% White ethnic background) in Ontario were derived from the 2017 Ontario Student Drug Use and Health Survey. Potential correlates of NUPO in the past year included sociodemographic, behavioral, parental, and school characteristics.

RESULTS

Overall prevalence of NUPO was 10.7%. In the final multivariable model, NUPO was significantly associated with 8 of the 21 correlates examined. Students who used prescription opioids nonmedically were of black, South Asian, and "other" ethnic backgrounds (OR 2.83, OR 1.77, and OR 1.67, respectively); reported a lower subjective socioeconomic status (OR 0.92), lower parental support (OR 0.90), and lower academic performance (OR 0.86); met physical activity recommendations (OR 1.48); consumed energy drinks (OR 1.42); smoked tobacco cigarettes (OR 2.33); and used cannabis (OR 1.84).

CONCLUSIONS

Findings from this study show a wide variety of correlates of NUPO among Canadian adolescents, and highlight the need for further research and the value in targeted prevention and multi-level intervention programs for NUPO in this population.

Sub-chronic taurine administration induces behavioral sensitization but does not influence ethanol-induced dopamine release in the nucleus accumbens

Preclinical studies have shown that the amino acid taurine is of importance for the dopamine elevating properties of ethanol. Taurine intake has escalated over the last decade due to increased consumption of taurine-containing energy drinks and dietary supplements. Whether long-term intake of large amounts of taurine induces adaptations affecting ethanol-induced dopamine elevation is not clear. Thus the aim of the present studies was to explore the impact of repeated administration of large amounts of taurine on ethanol-induced behavior and dopamine neurotransmission. Repeated daily systemic administration of taurine increased taurine-induced locomotor activity and rearing. Acute administration of taurine and ethanol in naïve animals produced an additive effect on extracellular taurine but no alteration of the ethanol-induced dopamine elevation, as measured by in vivo microdialysis. Sub-chronic administration of taurine did not modify the taurine- or dopamine-elevating properties of ethanol. Daily taurine treatment also failed to change the mRNA expression of the taurine transporter and GABA_A- and glycine-receptor subunits, as measured by qPCR in nucleus accumbens tissue. We conclude that systemic administration of taurine may have long lasting central effects, here displayed as behavioral sensitization. However, repeated daily exposure to taurine does not appear to influence the dopamine elevating properties of ethanol.

Energy drink constituents (caffeine and taurine) selectively potentiate ethanol-induced locomotion in mice

Mixing alcohol with energy drinks has emerged as a popular trend over the last decade. However, epidemiological studies have found this consumption to be associated with increased hazards, such as binge drinking, increased alcohol-related harm and risk of developing alcohol use disorder. The mechanisms underlying these effects are not clear, but much attention has been attributed to caffeine. However, taurine, another common ingredient in energy drinks, has also been associated with the dopamine elevating properties of ethanol, and may in this respect contribute to the increased liability associated with the mixture of alcohol and energy drinks. In the present study we measured locomotor activity, a phenomenon previously linked to the dopamine activating and reinforcing properties of the drug, following acute systemic administration with caffeine (1, 5, 15, 30 mg/kg), taurine (30, 60, 300, 600 mg/kg) and ethanol (1.75, 2.5, 3.25 g/kg), alone or in combination. We found that ethanol and caffeine, but not taurine, increased locomotion compared to vehicle. In addition, when combined with ethanol, caffeine, but not taurine, increased the locomotor stimulatory effect of ethanol. Furthermore, the combination of caffeine and taurine were able to further enhance the ethanol-induced locomotor response. Eleven days of intermittent caffeine exposure produced a sensitized response to the caffeine-induced locomotion, but did not alter the additive effect produced by the combination of caffeine and taurine on ethanol-induced locomotion. Based on the present study we suggest that the combination of caffeine and taurine, at a specific dose range, enhances the locomotor stimulatory properties of ethanol, a phenomenon previously linked to the reinforcing properties of the drug.

European Cardiac Arrhythmia Society Statement on the cardiovascular events associated with the use or abuse of energy drinks

Energy drinks are increasingly used by young people and young athletes in order to improve their performance alone or in association of other substances, particularly alcohol. In recent years, a number of reports of reports have raised attention on the side-effects associated with the use or abuse of energy drinks particularly serious cardiovascular events. The European Cardiac Arrhythmia Society (ECAS) has undertaken a systematic and critical review of reported data on cardiovascular events including life-threatening arrhythmias with or without cardiac arrest and other cardiovascular events, and discussed in this review the possible causal effect of caffeine and other ingredients contained in energy drinks and the reported events. Twenty-two cardiovascular events were reported in association with the use or abuse of energy drinks. The European Cardiac Arrhythmia Society would like to draw attention on the possible cardiovascular complications that may occur with the consumption of these beverages and to emphasize the prevention measures to be taken particularly in the young population. Well-designed prospective studies are needed to clarify the possible role of energy drinks in inducing the cardiovascular events reported.

The influence of caffeine on ethyl glucuronide levels in rat serum and in rat hair

BACKGROUND

Ethanol and caffeine are the most widely used psychoactive substances in the world, with an observed steady increase in the combined consumption of alcohol and caffeine. Specific signs of ethanol-caffeine interactions have been reported both in humans and in animals. The metabolic effects of these interactions have not been fully elucidated. There are no published reports on the influence of caffeine on ethyl glucuronide (EtG) formation. EtG is a direct metabolite of ethanol and is very often used as a biomarker of alcohol consumption. Here, we investigated the influence of caffeine on the formation of EtG in rat plasma and EtG incorporation into the hair.

METHODS

Studies were conducted on three male Wistar rat groups, each receiving either ethanol at 3 g/kg/day, ethanol (at the same dose) with caffeine at 3 mg/kg/day, or caffeine at 3 mg/kg/day for four weeks. EtG and caffeine levels were evaluated in hair and in blood after the last administration.

RESULTS

Blood EtG levels after the administration of ethanol together with caffeine were significantly higher than after the administration of ethanol alone. EtG levels in rat hair in the ethanol-and-caffeine group were also higher than in the ethanol-only group, but the difference was not statistically significant.

CONCLUSION

This study shows the possible effect of ethanol and caffeine co-administration on EtG formation. Caffeine stimulates EtG synthesis resulting in increased blood and, possibly, hair levels of this metabolite. However, the role of these changes in estimating alcohol consumption requires further studies.

Alcohol Use and Problems in Daily and Non-Daily Coffee Drinking College Females

BACKGROUND

For more than a decade, a large proportion of research on caffeine use in college students has focused on energy drinks (ED), demonstrating an association between ED consumption and heavy/problem alcohol use. The present study examined the relationship between daily coffee consumption and varied measures of alcohol use and problems in a sample of college women.

METHODS

Participants were undergraduate females (N=360) attending an urban university in 2001-02 and prior to the rise in ED popularity on college campuses. Analyses compared women who reported drinking coffee daily (DC; 16.9%), to women who did not (NDC; 83.1%) on standardized measures of alcohol use and problems.

RESULTS

For both past month and year of drinking, DC women generally reported consuming more alcohol and were 2.1-2.6 times more likely to screen at risk for alcohol problems than their NDC counterparts. DC women were also more likely than NDC women to report problems related to drinking (e.g., experiencing blackouts, inability to stop drinking after they had started).

CONCLUSIONS

Findings support potential benefits of health education and screening that goes beyond EDs, focusing on varied forms of caffeine consumption.

Energy drink consumption: a survey in high school students and associated psychological effects

Introduction

Energy drinks represent an emerging health problem among young people. Energy drinks generally refer to a class of beverages containing sugars and various combinations of bioactive ingredients such as caffeine, taurine etc. Also the mix of energy drinks with alcohol is fairly frequent among young people and could be associated with dangerous effects.

Methods

In 2016-2017, a cross-sectional study was conducted in 1581 students attending eight high school in the Marche Region. Data were collected via an anonymous self-administered questionnaire.

Results

The 27.7% of students use energy drinks and the majority, corresponding with the 93.0%, are aware of the main ingredients contained in energy drinks. The main activities for which young people use these drinks are: sport, leisure, pleasure, study. Young people who admit to using alcohol mixed with energy drinks more than 4 times a month are an alarming fact.

Conclusions

This research confirms that energy drinks are used more by young males and especially by those who practice sports. Furthermore, the use these beverages to increase the concentration in the study and to be more brilliant in free time, is confirmed.

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

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

Energy drink and ginseng consumption by Italian university students: a cross-sectional study

INTRODUCTION

The consumption of energy drinks (ED) and ginseng by young people to enhance their mental and physical performance has become widespread. Reported side-effects of ED have raised doubts regarding their safety. This cross-sectional study investigates the phenomenon.

METHODS

An anonymous questionnaire was administered to a representative sample of Verona university students. The resulting data were analyzed with Excel 2013, STATA 13 software.

RESULTS

ED and ginseng consumption was reported by 38.6% and 37.4% of the students, respectively. More than 70% of ED and ginseng users were 18 to 22 years old. Excluding non-responders, ED consumers were mostly males (51.8% vs 33.0%), contrary to ginseng consumers (females 40.4% vs 30.9%). Being a working student was significantly positively associated both to EDs (OR 1.5) and ginseng use (OR 1.4). The most frequently reported academic and other reasons for ED use were: "to study longer" (47.5%), and "to socialize" (29.1%). The most often used combinations were ED containing alcohol (65.6%) and ginseng-coffee beverages (71.8%).

CONCLUSIONS

The diffusion of ED and ginseng consumption warrants prevention and monitoring measures, and deserves further analysis.

Adenosine A2A receptor mediates hypnotic effects of ethanol in mice

Ethanol has extensive effects on sleep and daytime alertness, causing premature disability and death. Adenosine, as a potent sleep-promoting substance, is involved in many cellular and behavioral responses to ethanol. However, the mechanisms of hypnotic effects of ethanol remain unclear. In this study, we investigated the role of adenosine in ethanol-induced sleep using C57BL/6Slac mice, adenosine A_2A receptor (A_2AR) knockout mice, and their wild-type littermates. The results showed that intraperitoneal injection of ethanol (3.0 g/kg) at 21:00 decreased the latency to non-rapid eye movement (NREM) sleep and increased the duration of NREM sleep for 5 h. Ethanol dose-dependently increased NREM sleep, which was consistent with decreases in wakefulness in C57BL/6Slac mice compared with their own control. Caffeine (5, 10, or 15 mg/kg), a nonspecific adenosine receptor antagonist, dose-dependently and at high doses completely blocked ethanol-induced NREM sleep when administered 30 min prior to (but not after) ethanol injection. Moreover, ethanol-induced NREM sleep was completely abolished in A_2AR knockout mice compared with wild-type mice. These findings strongly indicate that A_2AR is a key receptor for the hypnotic effects of ethanol, and pretreatment of caffeine might be a strategy to counter the hypnotic effects of ethanol.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Consumption of Energy Drinks among Undergraduate Students in Taiwan: Related Factors and Associations with Substance Use

Background: This study aimed to investigate the consumption of energy drinks and associated factors among undergraduate students in Taiwan. Methods: Data came from a cross-sectional survey conducted in 2015. Eligible participants completed a self-administered questionnaire assessing use and perceptions of energy drinks, tobacco, alcohol, and betel nut. Results: Among 606 surveyed undergraduate students, 24.8% reported consuming energy drinks in the past 30 days. The major reasons for use included keeping alert at work (48.7%), being curious about the products (32.0%), enjoying the flavor (31.3%), or preparing for school exams (26.7%). Among energy drink users, half have never read the nutrition label, and 15.3% reported that they had ever mixed energy drinks with alcohol. Most participants showed negative attitudes toward using tobacco, alcohol, or betel nut, while 54.1% reported positive attitudes toward consuming energy drinks. Being male, living away from parents’ home, tobacco use, alcohol use, and positive perceptions of energy drink’s effects significantly predicted energy drink consumption. Conclusions: In addition to exploring motivations of energy drink consumption in undergraduate students in Taiwan, the study findings indicated that energy drink consumption might relate to the use of tobacco and alcohol, which should be taken into account in substance use prevention programs.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

DISCUSSION

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

CONCLUSION

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

A Survey of Energy Drink Consumption Patterns Among College Students at a Mostly Hispanic University

Background: The purpose of this study was to determine energy drink (ED) consumption patterns among Hispanic college students. We measured the prevalence and frequency of ED consumption according to gender, degree programs, and specific university-related and social situations. In addition, we assessed the frequency of consumption of EDs mixed with alcoholic beverages. Methods: A total of 508 college students from the University of Puerto Rico, the largest Hispanic institution of higher education statewide, completed an online questionnaire. Results: Twenty-one percent of participants reported consuming EDs with the majority consuming EDs either occasionally (every 2-3 months) or at least once or twice a month. Men were found to be more likely to consume EDs than women. Undergraduate students were found less likely to consume EDs than graduate students. Most students consumed EDs while studying and during social activities. More than one-third of participants that consume EDs admitted mixing them with an alcoholic beverage. Graduate students were found to consume EDs mixed with alcohol more often. Conclusions: The majority of students consumed EDs occasionally and while studying. Most side effects reported after consuming EDs were similar to previous findings. The higher consumption of EDs and of EDs mixed with alcohol by students in graduate programs could be explained by a higher and more complex study load requiring longer periods of wakefulness and concentration. Future studies looking at the consumption patterns of EDs in more competitive graduate programs such as medical and/or dentistry school should be considered.

Adolescent intake of caffeinated energy drinks does not affect adult alcohol consumption in C57BL/6 and BALB/c mice

The rise in marketing and mass consumption of energy drink products by adolescents poses a largely unknown risk on adolescent development and drug reward. Yet, with increasing reports of acute health issues present in young adults who ingest large quantities of energy drinks alone or in combination with alcohol, the need to elucidate these potential risks is pressing. Energy drinks contain high levels of caffeine and sucrose; therefore, exposure to energy drinks may lead to changes in drug-related behaviors since caffeine and sucrose consumption activates similar brain pathways engaged by substances of abuse. With a recent study observing that adolescent caffeine consumption increased cocaine sensitivity, we sought to investigate how prolonged energy drink exposure in adolescence alters alcohol use and preference in adulthood. To do so, we utilized three different energy drink exposure paradigms and two strains of male mice (C57BL/6 and BALB/c) to monitor the effect of caffeine exposure via energy drinks in adolescence on adult alcohol intake. These paradigms included two models of volitional consumption of energy drinks or energy drink-like substances and one model of forced consumption of sucrose solutions with different caffeine concentrations. Following adolescent exposure to these solutions, alcohol intake was monitored in a limited-access, two-bottle choice between water and increasing concentrations of alcohol during adulthood. In none of the three models or two strains of mice did we observe that adolescent 'energy drink' consumption or exposure was correlated with changes in adult alcohol intake or preference. While our current preclinical results suggest that exposure to large amounts of caffeine does not alter future alcohol intake, differences in caffeine metabolism between mice and humans need to be considered before translating these results to humans.

Unique Behavioral and Neurochemical Effects Induced by Repeated Adolescent Consumption of Caffeine-Mixed Alcohol in C57BL/6 Mice

The number of highly caffeinated products has increased dramatically in the past few years. Among these products, highly caffeinated energy drinks are the most heavily advertised and purchased, which has resulted in increased incidences of co-consumption of energy drinks with alcohol. Despite the growing number of adolescents and young adults reporting caffeine-mixed alcohol use, knowledge of the potential consequences associated with co-consumption has been limited to survey-based results and in-laboratory human behavioral testing. Here, we investigate the effect of repeated adolescent (post-natal days P35-61) exposure to caffeine-mixed alcohol in C57BL/6 mice on common drug-related behaviors such as locomotor sensitivity, drug reward and cross-sensitivity, and natural reward. To determine changes in neurological activity resulting from adolescent exposure, we monitored changes in expression of the transcription factor ΔFosB in the dopaminergic reward pathway as a sign of long-term increases in neuronal activity. Repeated adolescent exposure to caffeine-mixed alcohol exposure induced significant locomotor sensitization, desensitized cocaine conditioned place preference, decreased cocaine locomotor cross-sensitivity, and increased natural reward consumption. We also observed increased accumulation of ΔFosB in the nucleus accumbens following repeated adolescent caffeine-mixed alcohol exposure compared to alcohol or caffeine alone. Using our exposure model, we found that repeated exposure to caffeine-mixed alcohol during adolescence causes unique behavioral and neurochemical effects not observed in mice exposed to caffeine or alcohol alone. Based on similar findings for different substances of abuse, it is possible that repeated exposure to caffeine-mixed alcohol during adolescence could potentially alter or escalate future substance abuse as means to compensate for these behavioral and neurochemical alterations.

Impact of an Energy Drink on the Structure of Stomach and Pancreas of Albino Rat: Can Omega-3 Provide a Protection?

BACKGROUND AND OBJECTIVES

A controversy developed between the benefits of energy drinks (EDs) versus the possible health threats since its revolution. Lack of information was a call to assess the effect of chronic consumption of Power Horse (PH) as one of the EDs, on the structure of pancreas and fundic mucosa of stomach in rats, and possible protective role of Omega-3.

MATERIALS AND METHODS

Thirty two adult male albino rats were divided equally into 4 groups; control received group which only received a standard diet, Omega-3 group, PH group which given PH and PH plus Omega-3 group received both PH plus Omega-3 for 4 weeks. Biochemical assessment of blood glucose, serum insulin, gastrin, tumor necrosis factor alpha (TNF-α) and inducible nitric oxide synthetase (iNOS) was performed. The antioxidant activity and histopathological examination of both pancreatic tissue and fundic mucosa of stomach were assessed.

RESULTS

Administration of PH significantly increased serum insulin and glucose levels while it significantly reduced serum gastrin level compared to control. PH also caused oxidants/antioxidants imbalance in both pancreas and fundic mucosa. The latter revealed degenerative changes and increased apoptosis which was evident by increased caspase-3 immunoexpression. Pancreas exhibited signs of β-cells overstimulation. Fundic mucosa showed reduced number of parietal cells, gastrin hormone expression compared to control group. Omega-3 administration could alleviate, to some extent, these changes. It significantly decreased TNF-α, iNOS and reduced glutathione (GSH) as well as significantly increasing superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities compared to the group which received PH alone.

CONCLUSION

Power Horse intake significantly injures islet cells, pancreatic acini as well as the glandular cells of the fundic mucosa. Omega-3 decreases these detrimental effects mostly through its antioxidant and anti-inflammatory action.

Knowledge, Attitudes, and Practices on Energy Drink Consumption and Side Effects in a Cohort of Medical Students

The purpose of this study was to evaluate knowledge, attitudes, and practices concerning energy drink consumption and the prevalence of side effects among medical students. Twenty-two percent of respondents were regular users, particularly men (p < .0005). Users were younger (p = .027) and drank alcohol more frequently (p = .008) than "non-users." Forty-nine percent consumed alcohol associated with energy drinks. Forty-five percent of medical students declared side effects after energy drink consumption, such as palpitations (35%), insomnia (21%), and irritability (20%). The study confirms a large use of energy drinks among students and the occurrence of side effects. The use of energy drinks may influence the ingestion of large amounts of alcohol.

High Alcohol Concentration Products Associated With Poverty and State Alcohol Policies

OBJECTIVES

We examined the associations among zip code demographics, the state alcohol policy environment, and the retail outlet availability of multiple fruit-flavored alcoholic drinks in a can (MFAC).

METHODS

In a nationally representative sample of zip codes (n = 872), we merged data from 4 sources: publicly available marketing information from 2 major MFAC producers, the US Census Bureau, state alcohol regulatory agencies, and recent research on state alcohol policies. We used zero-inflated negative binomial regression models to examine MFAC outlet availability in the United States.

RESULTS

More than 98% of MFAC outlets were off-premises alcohol establishments. After we controlled for population size and the number of licensed on- and off-premises alcohol outlets within zip codes, more families below the poverty line and weaker state alcohol control policies were associated with greater MFAC outlet availability.

CONCLUSIONS

Economic conditions and alcohol policy environment appeared to be related to MFAC outlet availability, after adjusting for the general availability of alcohol. Research is needed to determine whether MFACs are disproportionately contributing to alcohol-related harm in socially and economically disadvantaged communities. Policies to better regulate the off-premises sale of alcohol are needed.

Energy-drink consumption and its relationship with substance use and sensation seeking among 10th grade students in Istanbul

Aim of this study was to determine the prevalence and correlates of energy-drink (ED) consumption among 10th grade students in Istanbul/Turkey. Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul. The questionnaire included sections about demographic data, self-destructive behavior and use of substances including tobacco, alcohol and drugs. Also Psychological Screening Test for Adolescents (PSTA) was used. The analyses were conducted based on the 4957 subjects. Rate of those reported a ED consumption once within last year was 62.0% (n=3072), whereas rate of those reported ED consumption at least once in a month was 31.1%. There were consistent, statistically significant associations between genders, lifetime substance use (tobacco, alcohol and drug use), measures of sensation seeking, psychological problems (depression, anxiety, anger, impulsivity) and self-destructive behavior (self-harming behavior and suicidal thoughts) with ED consumption. In logistic regression models male gender, sensation seeking, life-time tobacco, alcohol and drug use predicted all frequencies of ED consumption. In addition to these predictors, anger and self-harming behavior also predicted ED consumption at least once in a month. There were no interactions between the associations of lifetime tobacco, alcohol and drug use with ED consumption. The findings suggest that the ED consumption of male students is related with three clusters of substances (tobacco, alcohol and drug) through sensation seeking and these relationships do not interact with each other.

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.

Frequency of energy drink use predicts illicit prescription stimulant use

BACKGROUND

The purpose of this study was to examine energy drink (ED) usage patterns and to investigate the illicit use of prescription stimulants among college students.

METHODS

A sample of 267 undergraduate and graduate students (mean age of 22.48 among stimulant users) from a large midwestern university and its branch campus locations voluntarily participated in the study.

RESULTS

Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of ED use was a significant predictor of the illicit use of prescription stimulants. Moreover, frequency of ED consumption was a significant predictor of the illicit use of prescription stimulant medications, with the odds for using increasing by .06 with each additional day of ED use past 0 day (odds for use = 1.06, P =.008).

CONCLUSIONS

Results indicate that the frequency of ED use is a significant predictor of the illicit use of prescription stimulants. All prescription stimulant users with or without a valid script also used EDs. This finding is important to practitioners because of the harmful interactions (eg, serotonin syndrome) that can occur when ED ingredients (eg, ginseng, yohimbine, evodamine, etc) are mixed with prescription stimulants.

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.

Use of caffeinated energy drinks among secondary school students in Ontario: Prevalence and correlates of using energy drinks and mixing with alcohol

OBJECTIVES

Caffeinated energy drinks have become increasingly popular among young people, raising concern about possible adverse effects, including increased alcohol consumption and related risk behaviours. The current study examined consumption of caffeinated energy drinks and use of energy drinks with alcohol, as well as associations with socio-demographic and behavioural characteristics, among a sample of secondary school students in Ontario.

METHODS

Survey data from 23,610 grade 9-12 students at 43 purposefully sampled Ontario secondary schools participating in the baseline wave (2012/13) of the COMPASS study were analyzed using generalized linear mixed-effects models. Outcomes were any energy drink use, frequency of use, and use of alcohol mixed with energy drinks; covariates were age, sex, race, spending money, bodymass index (BMI), weight-related efforts and alcohol use. Two-way interactions between sex and other covariates were tested.

RESULTS

Nearly one in five students (18.2%) reported consuming energy drinks in a usual week. Use of energy drinks was associated (p &lt; 0.01) with all socio-demographic variables examined and was more common among students who were male, off-reserve Aboriginal, had some spending money, had a BMI outside of "healthy" range, were trying to lose weight, and/or reported a higher intensity of alcohol use. Interactions with sex were observed for age, spending money and weight-related efforts. Use of energy drinks mixed with alcohol in the previous 12 months was reported by 17.3% of the sample, and was associated with race, spending money, and more frequent binge drinking.

CONCLUSION

Regular use of energy drinks was common among this sample of students and strongly linked to alcohol consumption.

Sports and energy drink consumption are linked to health-risk behaviours among young adults

OBJECTIVE

National data for the USA show increases in sports and energy drink consumption over the past decade with the largest increases among young adults aged 20-34 years. The present study aimed to identify sociodemographic factors and health-risk behaviours associated with sports and energy drink consumption among young adults.

DESIGN

Cross-sectional analysis of survey data from the third wave of a cohort study (Project EAT-III: Eating and Activity in Teens and Young Adults). Regression models stratified on gender and adjusted for sociodemographic characteristics were used to examine associations of sports and energy drink consumption with eating behaviours, physical activity, media use, weight-control behaviours, sleep patterns and substance use.

SETTING

Participants completed baseline surveys in 1998-1999 as students at public secondary schools in Minneapolis/St. Paul, Minnesota, USA and the EAT-III surveys online or by mail in 2008-2009.

SUBJECTS

The sample consisted of 2287 participants (55% female, mean age 25·3 years).

RESULTS

Results showed 31·0% of young adults consumed sports drinks and 18·8% consumed energy drinks at least weekly. Among men and women, sports drink consumption was associated with higher sugar-sweetened soda and fruit juice intake, video game use and use of muscle-enhancing substances like creatine (P≤0·01). Energy drink consumption was associated with lower breakfast frequency and higher sugar-sweetened soda intake, video game use, use of unhealthy weight-control behaviours, trouble sleeping and substance use among men and women (P<0·05).

CONCLUSIONS

Health professionals should consider the clustering of sports and energy drink consumption with other unhealthy behaviours in the design of programmes and services for young adults.

Consumption of energy drinks among lebanese youth: a pilot study on the prevalence and side effects

BACKGROUND

The new millennium has been together with a variety of synthetic and caffeinated high-energy drinks targeting the youth market. Energy drinks raise the level of energy and their consumption has been increased significantly worldwide.

OBJECTIVES

This research aimed to determine patterns of energy drink consumption and to assess the prevalence of adverse side effects among energy drink users.

PATIENTS AND METHODS

A pilot cross-sectional study survey was undertaken on students aged between 13 and 30 years in private and public schools and universities in Lebanon over 5 months. A self-administered questionnaire was used inquiring about sociodemographic characteristics, consumption patterns, attitudes and beliefs about energy drinks. Bivariate and multivariate analyses were conducted. Data was analyzed using SPSS 17.

RESULTS

We studied 1500 students (mean age: 18.92 ± 1.85; 51.3% were males). The overall prevalence of energy drinks consumption was 63.6% (60.5% were males), among which 50.5% used alcoholic energy drinks. Respondents indicated that most consumed energy drinks were "Red Bull" and "Boom Boom" (70.9% and 51.5% respectively). In total, 64.5% of participants believed the effect of these drinks in energizing the body, and 72.7% believed that they can stimulate intellectual capacities. In addition, 29.6% of consumers experienced at least one adverse effect, where tachycardia was reported in 21.1% of cases. On the other hand, desired effects felt after consumption were mostly pleasure (33.8%). Males had a 3-time more risk of consuming such drinks compared to females (OR: 0.381, P < 0.001; 95% CI: 0.300-0.484). Additionally, this analysis demonstrated a significant association between energy drinks consumption and regions outside Beirut (OR: 1.401, P: 0.006; 95% CI: 1.103-1.781), medical field of work (OR: 0.376, P: 0.010; 95% CI: 0.179-0.790) and higher personal income (OR: 1.317, P < 0.001; 95% CI: 1.117-1.553).

CONCLUSIONS

This study showed a high prevalence of energy drinks consumption among youth. The current results highlight the importance of education to prevent the consumption of energy drinks in excessive quantities and modifying some wrong perceptions regarding the benefits of energy drinks in youth.

[Abuse of energy drinks: does it pose a risk?]

BACKGROUND

Energy drinks designate "any product in the form of a drink or concentrated liquid containing a mixture of ingredients having the property to raise the level of energy and liveliness". Their introduction has raised many reluctance and reserves after numerous cardiovascular and neurological injuries among regular consumers.

OBJECTIVE

This article attempts to synthesize the existing literature on energy drinks. The review focuses to show that excessive energy drinks consumption cause many complications.

METHODS

The literature review was conducted from 2001 to 2014, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following keywords alone or combined: energy drinks, caffeine, taurine, toxicity, dependence, complications.

RESULTS

Occasional or moderate consumption of these cans seem to present little risk to healthy adults. However, their repeated consumption in proportions that far exceed the recommendations for recommended use by the manufacturers, combined with the use of alcohol or illicit drugs consumption increases the risk of occurrence of somatic and psychiatric complications, especially among underage, and subjects with cardiovascular and neurological history.

CONCLUSION

Repeated consumption of energy drinks increases the risk of somatic and psychiatric complications. Further studies must be controlled to improve our understanding of other possible negative consequences on health.

Increased Energy Drink Use as a Predictor of Illicit Prescription Stimulant Use

BACKGROUND

The purpose of this study was to examine energy drink usage patterns and to investigate the relationship between energy drink use and illicit use of prescription stimulants among college students.

METHODS

A sample of 605 undergraduate and graduate students (mean age±SD: 21.96±4.216) from a large midwestern university voluntarily participated in the study.

RESULTS

Of the participants, 48.9% (n=296) reported using energy drinks in the past 30 days, whereas 25.3% (n=153) reported using prescription stimulant drugs in the past 30 days. Among prescription stimulant users without a valid medical prescription, Mann-Whitney U tests and logistic regression analysis revealed that the frequency of energy drink consumption was a significant predictor of illicit prescription stimulant use, with the odds for use increasing by 14% with each additional day of energy drink use (odds ratio for using=1.143, P≤.001). Analyses revealed statistically significant differences (P<.05) between prescription stimulant users and nonusers for all energy drink use variables, with the strongest predictors of prescription stimulant use being the number of days using energy drinks in the past 30 days and number of energy drink binges in the past 30 days.

CONCLUSIONS

Results indicate that the frequency of energy drink use was a significant predictor of the illicit use of prescription stimulants.

Energy drink consumption in europe: a review of the risks, adverse health effects, and policy options to respond

With the worldwide consumption of energy drinks increasing in recent years, concerns have been raised both in the scientific community and among the general public about the health effects of these products. Recent studies provide data on consumption patterns in Europe; however, more research is needed to determine the potential for adverse health effects related to the increasing consumption of energy drinks, particularly among young people. A review of the literature was conducted to identify published articles that examined the health risks, consequences, and policies related to energy drink consumption. The health risks associated with energy drink consumption are primarily related to their caffeine content, but more research is needed that evaluates the long-term effects of consuming common energy drink ingredients. The evidence indicating adverse health effects due to the consumption of energy drinks with alcohol is growing. The risks of heavy consumption of energy drinks among young people have largely gone unaddressed and are poised to become a significant public health problem in the future.

'High' risk? A systematic review of the acute outcomes of mixing alcohol with energy drinks

AIMS

Alcohol mixed with energy drinks (AmED) is a relatively new consumption trend generating increasing concern regarding potential adverse effects. Despite the political and health imperative, there has been no systematic and independent synthesis of the literature to determine whether or not AmED offers additional harms relative to alcohol. The aim of this study was to review the evidence about whether co-consumption of energy drinks and alcohol, relative to alcohol alone, alters: (i) physiological, psychological, cognitive and psychomotor outcomes; (ii) hazardous drinking practices; and (iii) risk-taking behaviour.

METHODS

Pubmed, PsycInfo and Embase databases were searched until May 2013 for papers outlining descriptive, observational analytical and human experimental studies which compared target outcomes for AmED versus alcohol consumers (between-subjects), or AmED versus alcohol consumption (within-subjects). Odds ratios were calculated for target outcomes following screening, data extraction and quality assessment.

RESULTS

Data were extracted from 19 papers. Analyses typically revealed increased odds of self-reported stimulation-based outcomes and decreased odds of sedation-based physiological and psychological outcomes relative to when alcohol was consumed alone, as indicated by rigorous cross-sectional descriptive research. These findings typically have not been reflected in experimental research, due possibly to the low doses administered relative to typical self-reported 'real-life' intake. AmED consumers generally report more hazardous alcohol consumption patterns and greater engagement in risk-taking behaviour than alcohol consumers. While most studies had equivocal findings, two studies showed lower odds of risk-taking behaviour for AmED relative to alcohol drinking sessions but limitations with respect to the outcome measures used restrict conclusions with regard to the behavioural outcomes of AmED use.

CONCLUSIONS

Mixing alcohol with energy drinks may exert a dual effect, increasing stimulation-based effects and reducing sedation-based outcomes; the clinical severity and dose threshold has not been established. At this stage it is unclear whether these changes in the nature of intoxication translate into greater alcohol intake and risk-taking behaviour.

Risk for suicidal behaviors associated with alcohol and energy drink use in the US Army

PURPOSE

Suicidal behaviors have increased in the US Army since 2005. To identify potential interventions for suicide risk, we examined the relationship between alcohol and energy drink use, independently and in combination, and rates of seriously considering and/or attempting suicide in US Army soldiers.

METHODS

This study used the DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD HRB), which sampled 10,400 Army soldiers, with 5,927 responses representing 508,088 soldiers. Use of energy drinks in combination with alcohol (A/ED) and average daily amount of alcohol consumption over the past 30 days and history of seriously considering and/or attempting suicide in the past year were assessed via self-report questions.

RESULTS

Six percent of Army service members reported either seriously considering and/or attempting suicide in the past year. Twenty-six percent of soldiers reported A/ED. Those who reported the highest level of alcohol use were more likely to have seriously considered and/or attempted suicide. Soldiers who reported daily A/ED were over three times more likely to have reported suicidal ideation or attempts, and even after adjusting for overall alcohol consumption and energy drink use alone remained approximately two times (OR = 1.99) more likely to report suicidality.

CONCLUSIONS

Combination alcohol and energy drink use and heavy alcohol use contribute to suicidality and may be targets for potential intervention to address suicide risk.

Cardiovascular complications from consumption of high energy drinks: recent evidence

The energy drinks (ED) are caffeinated beverages that are popular among teenagers and young adults. They are aggressively marketed as providing alertness, energy and sex prowess. The EDs in addition to caffeine contain several plant stimulants and simple sugars, which increase their caloric content. The caffeine concentration in these drinks is high and their overconsumption could lead to insomnia, agitation, tremors and cardiovascular complications including sudden death. Alcohol is often mixed with EDs (AMEDs) in the wrong perception that the caffeine in the EDs will prevent the drowsiness and sleepiness from alcohol and allow the person to consume more alcohol. This false perception, could lead to alcohol intoxication and the taking of risky decisions, like driving under the influence of alcohol and the risk of serious physical harm to themselves and others. To prevent the problem of consumption of EDs and AMEDs, the caring physician could help by advising the parents and his young patients about the serious health risks from the consumption of these drinks. In order to grasp the extend of the problem of ED and AMED consumption, we did a Medline search of the English language literature from January 2010 to December 2013, using the terms EDs and alcohol-mixed EDs. All the findings from the recent studies regarding the cardiovascular complications from the consumption of EDs and AMEDs together with collateral literature will be discussed in this review.

Energy drink usage among university students in a Caribbean country: Patterns of use and adverse effects

Objective: There has been little inquiry addressing whether or not concerns about adverse effects of energy drink usage are relevant in the Caribbean. This survey investigated energy drink usage and adverse consequences among tertiary level students in Trinidad and Tobago.

Methods: A cross-sectional survey of 1994 students from eight institutions was conducted using a de novo questionnaire based on findings from a focus group of students. Chi-squared analyses and logistic regression were used to assess relationships between energy drink usage, adverse effects and other factors affecting energy drink use, and to verify predictors of energy drink use.

Results: Prevalence of use was 86%; 38% were current users. Males were more likely to use, used more frequently and at an earlier age. Energy drinks were used most commonly to increase energy (50%), combat sleepiness (45%) and enhance academic performance (40%), and occurred during sports (23%) and mixed with alcohol (22.2%). The majority (79.6%) consumed one energy drink per sitting; 62.2% experienced adverse effects, most commonly restlessness (22%), jolt and crash (17.1%) and tachycardia (16.6%). Awareness of adverse effects was associated with no use (p = 0.004), but adverse effects were not a deterrent to continued use.

Conclusion: Energy drink usage is prevalent among students. The use is not excessive, but associated with high rates of adverse effects and occurs in potentially dangerous situations like during exercise and with alcohol. There is a need to educate students about the potential adverse effects of energy drinks.

Motives for mixing alcohol with energy drinks and other nonalcoholic beverages, and consequences for overall alcohol consumption

Introduction

The aim of this survey was to assess the motives for energy drink consumption, both alone and mixed with alcohol, and to determine whether negative or neutral motives for consuming alcohol mixed with energy drinks (AMED) have a differential effect on overall alcohol consumption.

Methods

Demographics, alcohol and energy drink consumption-related questions, and motives for the consumption of energy drinks (alone or mixed with alcohol) were assessed. The motives to mix alcohol with energy drinks were compared with those for mixing alcohol with other nonalcoholic beverages.

Results

A total of 2,329 students who completed the study consumed energy drinks. The motives for consuming energy drinks (without alcohol) included “I like the taste” (58.6%), “To keep me awake” (54.3%), “It gives me energy” (44.3%), “It helps concentrating when studying” (33.9%), “It increases alertness” (28.8%), “It helps me concentrate better” (20.6%), and “It makes me less sleepy when driving” (14.2%). A total of 1,239 students reported occasionally consuming AMED (AMED group). The most frequent motives included “I like the taste” (81.1%), “I wanted to drink something else” (35.3%), and “To celebrate a special occasion” (14.6%). No relevant differences in motives were observed for using an energy drink or another nonalcoholic beverage as a mixer. A minority of students (21.6%) reported at least one negative motive to consume AMED. Despite these negative motives, students reported consuming significantly less alcohol on occasions when they consumed AMED compared to alcohol-only occasions.

Conclusion

The majority of students who consume energy drinks (without alcohol) do so because they like the taste, or they consume these drinks to keep them awake and give them energy. AMED consumption is more frequently motivated by neutral as opposed to negative motives. No relevant differences in drinking motives and overall alcohol consumption were observed between the occasions when energy drinks or other nonalcoholic beverages were mixed with alcohol.

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

OBJECTIVE

To examine the prevalence, patterns, and correlates of energy drink use among adolescents, and determine whether more frequent use of energy drinks is associated with poorer health and behavioral outcomes.

METHODS

Data were from a 2012 cross-sectional survey of 8210 students in grades 7, 9, 10 and 12 attending public schools in Atlantic Canada. Multinomial logistic regression analysis was used to examine correlates of energy drink use patterns, including substance use, sensation seeking, risk of depression, and socioeconomic status.

RESULTS

Nearly two-thirds of survey respondents (62%) reported consuming energy drinks at least once in the previous year, with about 20% reporting use once or more per month. Sensation seeking, depression, and substance use were all higher among energy drink users relative to non-users, and in higher frequency users relative to lower frequency users.

CONCLUSIONS

The prevalence of energy drink consumption among high school students was high. The association of energy drinks with other potential negative health and behavioral outcomes suggests that use of these products may represent a marker for other activities that may negatively affect adolescent development, health and well-being.

Energy drink consumption is associated with anxiety in Australian young adult males

BACKGROUND

Energy drinks are predominantly targeted to young adult consumers; however, there has been limited research into their effects on psychological functioning in this demographic group. This study examined cross-sectional associations between energy drink consumption and mental health in a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study.

METHODS

We used self-report questionnaires to assess energy drink consumption and mental health (Depression Anxiety Stress Scale-21; DASS-21) at the 20-year cohort follow-up. In the regression analyses, we considered associations between energy drink consumption (mL/day) and continuous DASS-21 scores, adjusting for sociodemographic variables, alcohol and drug use, physical activity, body mass index (BMI), and dietary intake. Our sample included 502 males and 567 females (mean age 20 ± 3 years).

RESULTS

After adjusting for potential confounding factors and controlling for coexisting mental health problems, energy drink consumption (per 100 mL/day) was significantly associated with anxiety (but not depression or stress), and this relationship was found only in males (β = 0.32; 95% CI = 0.05, 0.58).

CONCLUSIONS

Our study found that energy drink consumption was associated with increased anxiety in young adult males. Further research into the possible contribution of energy drink use to the development of mental health problems in young adults is needed.

Combining alcohol and energy drinks: An examination of psychosocial constructs and alcohol outcomes among college students using a longitudinal design

Combining alcohol and energy drinks (e.g., Red Bull and vodka) is a significant problem on college campuses. To date, few studies have examined psychosocial constructs specific to alcohol-energy drink cocktail (AmED) consumption that could be amenable to change via prevention efforts targeting this population. The aim of the current study was to examine differences in AmED-specific attitudes, beliefs, normative perceptions among students who report AmED use compared to college student drinkers who consume alcohol only. In addition, these two groups were compared on their intentions to consume AmEDs, actual AmED use, and other drinking outcomes using a longitudinal design. Participants (N = 386, 59% female) completed a web-based survey in the spring of their first year of college and fall of their second year assessing alcohol-energy drink cocktail use, psychosocial decision-making constructs, heavy drinking, and alcohol-related consequences. Findings revealed that combiners of alcohol and energy drinks had more positive attitudes and beliefs about AmED use, higher perceived peer norms, and stronger intentions toward future use. Accordingly, at Time 2, this group reported significantly higher AmED use, along with high-risk drinking and related consequences. The findings reinforce that AmED use is associated with risky drinking practices, and suggest potential targets for change for future prevention efforts.