Psych Intro

The Effects of Temporal Perspective on College Students’ Energy Drink Consumption

Jarim Kim Kookmin University

Deepa Anagondahalli University of Maryland

Objective: Consideration of future consequences (CFC) describes the extent to which individuals consider potential future outcomes of their present behaviors. This personality trait has been found to predict repetitive health behaviors. Research is yet to explore the role of health beliefs, which may mediate the relationship between CFC and self-directed health behaviors. Thus, this study examined how CFC affects energy drink-related health beliefs and consumption behavior. Design: A cross-sectional correlational online survey with 1,050 college students was conducted. Key measures include the CFC Scale, health belief measures, and current energy drink consumption pattern. Results: CFC was associ- ated with energy drink consumption as well as several health beliefs. CFC had indirect effects on energy drink consumption through health beliefs, including perceived severity of consuming energy drinks (indirect effect estimate � �.191, 95% confidence interval [CI] [–.271, �.122]), perceived benefits of avoiding energy drinks (indirect effect estimate � �.108, 95% CI [–.174, �.050]), and perceived barriers in abstaining from energy drinks (energy level-related barriers, indirect effect estimate � �.274, 95% CI [–.387, �.181]; and socialization-related barriers, indirect effect estimate � .152, 95% CI [.078, .249]). Conclusion: As the first study to examine CFC’s indirect effects on a self-directed health behavior through health beliefs, this study extended CFC’s applicability by examining its role in the context of college students’ energy drink consumption.

Keywords: consideration of future consequences, CFC, energy drink, health communication, health beliefs

Health behaviors often require individuals to endure immediate costs, such as time, money, and pains, to achieve benefits delivered in the future. According to exchange theory (Andreasen & Kotler, 2003; Bagozzi, 1978), individuals engage in a health behavior if they view future health benefits as exceeding or at least equal to the immediate costs associated with performing the behavior. However, research indicates how one weighs future consequences depends on several individual factors (e.g., Daugherty & Brase, 2010; Zimbardo, Keough, & Boyd, 1997).

One such factor is the individual’s consideration of future con- sequences (CFC; Strathman, Gleicher, Boninger, & Edwards, 1994), a measure of individual difference that reflects the extent to which one considers potential future outcomes of a present behav- ior. A related concern is the nature of the health behavior in question, specifically whether the behavior is self-directed (e.g., smoking, drinking) or non-self-directed (e.g., vaccination). Exist- ing research on CFC has mostly focused on non-self-directed behaviors. Few studies, if any, have examined individuals’ health beliefs as a mechanism through which CFC may influence self-

directed health behaviors. The current study attempted to fill this gap by examining CFC’s direct and indirect impacts on energy drink consumption, a self-directed health behavior of increasing popularity and concern and its related health beliefs.

Energy drinks occupy a unique place in today’s health context; they are perceived to be less risky compared to other risky behav- iors such as cigarette smoking but are however evolving into a health concern (Rienzi, 2016). Typically marketed to young adults between the ages of 18 and 34, these beverages contain large doses of caffeine and sugar as well as other stimulants such as ginseng. Energy drinks are increasingly being associated with an expanding list of health concerns such as stress, nervousness, rapid heartbeat, insomnia, increased blood pressure and even death (Avcı, Sari- kaya, & Büyükcam, 2013; Johnson, 2012; Mayo Clinic, 2015; Pettit & DeBarr, 2011). Despite the growing concern over the health effects, the energy drinks industry has experienced a 5,000% growth rate since 1999 and is worth over $27 billion (Ferdman, 2014). In particular, energy drinks are incredibly pop- ular on college campuses and are reportedly used for a variety of reasons, from staying awake to mixing with alcoholic drinks (Attila & Cakir, 2011). Therefore, this consumption trend on campuses, despite the health risks associated with it, warranted an exploration of the rationale to engage in this behavior. One such motive is the consumer’s CFC.

Consideration of Future Consequences

CFC refers to “the extent to which individuals consider the potential distant outcomes of their current behaviors and the extent

This article was published Online First July 20, 2017. Jarim Kim, School of Communication, Kookmin University; Deepa

Anagondahalli, Department of Communication, University of Maryland. Correspondence concerning this article should be addressed to Jarim

Kim, School of Communication, Kookmin University, Bugak Hall #603, 77 Jeongneung-ro, Seongbuk-gu, Seoul 136-702, South Korea. E-mail: [email protected]

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Health Psychology © 2017 American Psychological Association 2017, Vol. 36, No. 9, 898 –906 0278-6133/17/$12.00 http://dx.doi.org/10.1037/hea0000536

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to which they are influenced by these potential outcomes” (Strath- man et al., 1994, p. 743). This concept encapsulates both psycho- logical and economic meanings that posit that people who place greater value on future outcomes tend to engage in current behav- iors that maximize future benefits (vs. immediate benefits). Indi- viduals high in CFC are more likely to place value on future, long-term outcomes and therefore take actions that maximize future benefits, whereas individuals low in CFC are more likely to place value on immediate, short-term outcomes and take actions that maximize immediate benefits. Interestingly, there appears to be a neurobiological influence on intertemporal choice. This means that specific areas of the human brain influence how people make these decisions. Therefore, any damage to these areas can cause them to choose instant gratification over delayed rewards (Berns, Laibson, & Loewenstein, 2007; Sellitto, Ciaramelli, & di Pellegrino, 2011). CFC is also theoretically distinct from but has been found to be correlated with self-regulation capacity. For example, Joireman, Balliet, Sprott, Spangenberg, and Schultz (2008) found that CFC’s underlying factors predicted ego deple- tion and self-control, two key concepts in self-regulation theory (Baumeister, 2002; Muraven & Baumeister, 2000). Similarly, other research has also found the link between CFC and other behaviors connected to self-regulation (Sirois, 2004). Another study (Fieulaine & Martinez, 2011) further indicated that temporal perspective interacts with desire for control to impact substance abuse. However, CFC has been found to predict various health behaviors (e.g., cigarette use) more effectively than other similar measures (Strathman et al., 1994).

Health behaviors often involve a tradeoff between immediate costs and distant health benefits (Piko, Luszczynska, Gibbons, & Teközel, 2005). For example, the barriers to giving up energy drinks could cause short-term negative consequences such as fall- ing energy levels, whereas the health benefits of potential disease prevention are obtained in the long-term. Because the health ben- efits are delayed in time, those who value future benefits, despite immediate costs (e.g., discomfort, inconvenience), are more likely to engage in current healthy behaviors, whereas those who devalue delayed benefits are more unlikely to comply with promoted health behaviors or could engage in risky behaviors. CFC has been found to have negative association with risky behaviors and positive association with healthy behaviors (Adams, 2012; Burns & Dillon, 2005; Dorr, Krueckeberg, Strathman, & Wood, 1999; Kees, 2011; Kim & Nan, 2015; Orbell & Kyriakaki, 2008; Strathman et al., 1994). Further, although CFC has been found to predict self- directed health behaviors such as smoking, it has not been as successful in predicting other types of health behaviors such as medical service use (e.g., vaccination). Non-self-directed behavior, such as using medical service, is distinct from self-directed behav- ior because it involves only one action or a limited period of health behavior (Conner & Norman, 2005). This may mean that self- directed behaviors involve greater variability in health decision- making that is enough to yield different outcomes depending on levels of CFC, whereas non-self-directed behaviors do not. For example, abstaining from smoking, which is a self-directed behav- ior, requires people to regulate themselves every time they are tempted to smoke; therefore, individuals with high CFC abstain from smoking, but individuals with low CFC fail to abstain. Vaccination, a non-self-directed behavior, however only requires a one-time or limited number of visits to a doctor; this may not be

difficult to comply with even for individuals with low CFC. Health beliefs, in this regard, have the potential to explain the difference between self- and non-self-directed behaviors. Till date, only two studies (Kim & Nan, 2015; Nan & Kim, 2014) have shown that such behavioral differences in individuals with various CFC levels stem from the perceptual difference toward the benefits earned when complying with the promoted behavior; however, both stud- ies examined non-self-directed behavior. Due to the limited re- search of underlying mechanisms through which CFC exerts its effects on health behaviors (Joireman, Shaffer, Balliet, & Strath- man, 2012), specifically, on self-directed behaviors, it is difficult to understand where the nuance lies.

Research studies have also found that CFC predicts health- related beliefs, attitudes, and behavioral intentions. For example, high CFC individuals reported greater healthy behavioral inten- tions such as lower alcohol and cigarette consumption (Strathman et al., 1994). They also reported higher intention to use sunscreen (Orbell & Kyriakaki, 2008), higher concern about and practice of safe sex (Burns & Dillon, 2005; Rothspan & Read, 1996), more positive intentions to vaccinate for human papillomavirus (HPV; Morison, Cozzolino, & Orbell, 2010), and more engagement in exercise and healthy eating (Kees, 2011; van Beek, Antonides, & Handgraaf, 2013). Additionally, those with high CFC were more willing to engage in screening tests for HIV (Dorr et al., 1999), colorectal cancer (Orbell, Perugini, & Rakow, 2004), and Type 2 diabetes (Orbell & Hagger, 2006), as well as perceived greater health risks associated with H1N1 (Nan & Kim, 2014) and HPV (Kim & Nan, 2015).

Some studies have also examined the relationship between CFC and actual health behaviors, but the findings have not been con- sistent. CFC predicted self-directed behaviors such as sunscreen use (Orbell & Kyriakaki, 2008) or reduced alcohol and cigarettes intake (Adams, 2012), but not non-self-directed behaviors such as vaccinations (Chapman et al., 2001; Chapman & Coups, 1999; Kim & Nan, 2015; Nan & Kim, 2014). Energy drink consumption too is a self-directed behavior that involves repetitive health decision-making. Although research in general has shown associ- ations between CFC and self-directed health behaviors, it has yet to examine the relationship between CFC and energy drink con- sumption. Thus, the current study proposed the following hypoth- esis:

Hypothesis 1: Individuals low in CFC, compared to those high in CFC, will be more likely to consume energy drinks.

CFC’s Effect on Health-Related Beliefs

In addition to its effect on health behaviors, CFC may influ- ence different types of health-related beliefs. The importance of CFC lies in its ability to capture the intrapersonal struggle between positive and negative consequences occurring in the short- and long-term. This dilemma can be examined by dis- secting various beliefs associated with a given health behavior. The health belief model (HBM; Rosenstock, 1974), with its constructs reflecting various pros and cons that affect one’s health decision-making, is a useful framework for investigating how such different beliefs interact to influence the health decision-making process. According to HBM, four psychoso- cial constructs influence individuals’ decisions to engage in

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899TEMPORAL PERSPECTIVE AND ENERGY DRINK CONSUMPTION

health-related behaviors: (a) perceived susceptibility (the extent to which individuals perceive they are vulnerable toward health problems), (b) perceived severity (the extent to which individ- uals assess such problems to be threatening), (c) perceived benefits (the extent to which individuals believe they can reduce the threat of health problems by engaging in a particular be- havior), and (d) perceived barriers (the extent to which indi- viduals have concerns in executing a particular behavior). The model posits that individuals who perceive that they are more susceptible to a given health problem, perceive the problem as more severe, attach greater benefits to complying with the promoted behavior, see fewer barriers to engaging in the pro- moted health behavior and are more likely to adopt the pro- moted behavior.

CFC has been found to positively predict various health beliefs including perceived benefits of complying with a pro- moted behavior, such as HPV vaccination (Kim & Nan, 2015; Morison et al., 2010) and H1N1 vaccination (Nan & Kim, 2014); perceived barriers in complying with a promoted behav- ior, such as getting the HPV vaccine (Kim & Nan, 2015); self-efficacy in performing the promoted behavior, such as getting the H1N1 vaccine (Nan & Kim, 2014); perceived se- verity of a given disease, such as H1N1 flu (Nan & Kim, 2014) or HPV (Kim & Nan, 2015); and perceived susceptibility to a health problem, such as fast food-related health risks (Kees, 2011) or HPV (Kim & Nan, 2015). Interestingly, the valence between CFC and perceived susceptibility differed depending on context. Although CFC positively predicted perceived sus- ceptibility to fast food-related health risks (Kees, 2011), it negatively predicted perceived susceptibility to HPV (Kim & Nan, 2015). Unlike the positive relationships generally found between CFC and perceived susceptibility to diseases or risks, Kim and Nan (2015) explained that high CFC individuals may have perceived less susceptibility to HPV due to their general safe sex practices, as found in other research (Burns & Dillon, 2005; Rothspan & Read, 1996).

Similarly, energy drink-related beliefs and the valence of its correlates with CFC may not be consistent with those relationships found in research in other health contexts. For example, generally, high CFC individuals tend to perceive fewer barriers in complying with a promoted behavior. However, this is unclear in the energy drink consumption context because high CFC individuals were found to show better academic performance in terms of higher grade point average (Peters, Joireman, & Ridgway, 2005). This may mean that some high CFC individuals may perceive more barriers in avoiding energy drinks (i.e., complying with a promoted health behavior) because they are highly motivated to stay awake to study.

On the contrary, high CFC individuals may not need the aid of an energy drink to stay awake before an exam because they are less likely to procrastinate (Sirois, 2004) and therefore more likely to be prepared for an exam. In addition, as one study (Bunting, Baggett, & Grigor, 2013) revealed, the harmful ef- fects of energy drink consumption are not well-known as many young people believed that it would not be on sale if it was unsafe. High CFC individuals may show greater concern about such uncertain future consequences, while low CFC individuals may perceive the consequences as less serious or important. Therefore, CFC’s relationship with this health behavior needed

to be examined to answer these inquiries. Based on prior research where CFC predicted a number of health beliefs, the following hypothesis was proposed:

Hypothesis 2: Individuals high in CFC will perceive (a) greater levels of susceptibility to energy drink-associated risks, (b) greater levels of severity of energy drink-associated risks, (c) greater levels of benefits of abstaining from energy drink, and (d) less levels of barriers in abstaining from energy drink.

CFC’s Indirect Effect on Health Behaviors

Even though scholars (Joireman et al., 2012; Kim & Nan, 2015) have stressed the importance of understanding the under- lying mechanisms through which CFC influences health behav- iors, especially when CFC predicts some health behaviors but not others, very few studies (e.g., Morison et al., 2010) have investigated such mechanisms. In such studies, health beliefs mediated CFC’s impacts on an actual health behavior. For example, CFC had an indirect effect on HPV vaccine uptake (Kim & Nan, 2015) and H1N1 vaccine uptake (Nan & Kim, 2014) through the perceived benefits of receiving the vaccine. Vaccination behaviors, however, were not directly predicted by CFC. Few prior studies, if any, have examined if and how CFC indirectly affects a self-directed health behavior, even though this test is expected to demonstrate potentially different mech- anisms through which a self- and non-self-directed health be- havior exerts its effects. Thus, the following research question was posed:

Research Question 1: Does CFC have an indirect effect on energy drink consumption via health beliefs?

Method

Participants and Procedure

The sample consisted of 1,050 college students recruited from undergraduate classes at the University of Maryland in exchange for extra credit. As college-age young adults are a major target demographic and consumers of energy drinks (Heckman, Sherry, Mejia, & Gonzalez, 2010; McIlvain, No- land, & Bickel, 2011), college students were deemed an appro- priate sample for the current study. The research received approval from the university’s institutional review board. Par- ticipants accessed a web page with study-related information such as a brief description of the study, an estimate of the time required to complete it, and the extra credit they would earn in exchange for completing the study. They were also informed that they could stop participating at any time and were provided the name of the principal investigator if they had any questions or concerns about the study. Upon clicking their consent to participate on that page, an online survey questionnaire was presented to participants. There were no screening questions, and any student over the age of 18 was able to participate in the study. The survey took approximately 20 min to complete. Descriptive statistics for key measures are provided in Table 1.

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900 KIM AND ANAGONDAHALLI

Key Measures

Energy drink consumption status. Participants were asked if they currently consume energy drinks1 to which they could re- spond either “yes” or “no.” Among the respondents, 24.7% re- ported currently consuming energy drinks.

Consideration of future consequences. CFC was measured using the 12-item CFC Scale (Strathman et al., 1994). Participants rated each item on a 7-point Likert scale, with extremely unchar- acteristic and extremely characteristic as endpoints, to what extent each statement was characteristic of themselves. Sample items include “I only act to satisfy immediate concerns, figuring the future will take care of itself” and “I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a later time.” The scale has been reported to be unidimensional (Hevey et al., 2010). The 12 items were averaged to construct a CFC index, where higher scores indicated greater consideration of future consequences (M � 4.79, SD � .73, � � .79).

Health belief model constructs. Items assessing perceived susceptibility, perceived severity, and perceived benefits were adapted from prior studies (Kim & Nan, 2015; Witte, Meyer, & Martell, 2001). Items assessing perceived barriers were developed from existing literature that qualitatively and quantitatively as- sessed beliefs of young people and, more specifically, college students in the context of energy drink consumption (Malinauskas, Aeby, Overton, Carpenter-Aeby, & Barber-Heidal, 2007; Pennay & Lubman, 2012). Participants were asked to rate each item on a 7-point Likert scale where 1 � strongly disagree and 7 � strongly agree.

Perceived susceptibility. This construct was assessed using three items: “It is likely that I would have health problems because of consuming energy drinks,” “I am at risk for health problems because of consuming energy drinks,” and “It is possible that I will suffer health problems because of consuming energy drinks.” Participants’ responses were averaged to form an index for per- ceived susceptibility (M � 3.46, SD � 1.64, � � .81).

Perceived severity. This construct was assessed using three items: “I believe that energy drink consumption will result in severe health problems,” “I believe that energy drink consumption has serious negative consequences,” and “I believe that energy drink consumption is extremely harmful.” Participants’ responses were averaged to form an index for perceived severity (M � 4.97, SD � 1.34, � � .94).

Perceived benefits. This construct was assessed using three items: “I believe avoiding energy drinks will reduce the chance of health problems,” “I believe if I do not consume energy drinks, I will be less likely to have health problems,” and “I believe not consuming energy drink will result in reduced health-related inci- dence.” Participants’ responses were averaged to form an index for perceived benefits (M � 5.15, SD � 1.29, � � .84).

Perceived barriers. This construct was assessed using four items: “Not consuming energy drinks will decrease my energy level in general,” “Without energy drinks, it is hard for me to be awake when I need to,” “It would be hard for me to socialize with others, if I do not consume energy drinks,” and “I won’t be seen as cool if I don’t consume energy drinks.” Participants’ responses to the first two items were averaged to form an index for energy

1 This single-item dependent variable (“Are you currently a consumer of energy drinks?”) was used because it holistically represented whether participants considered themselves to be consumers of the product. A second item (“How many drinks did you consume in the last 30 days?”) was also measured in the study. In response to this question, 194 partici- pants out of 1,050 described themselves as current consumers of energy drinks (in response to the current consumer question) but said that they had not consumed any in the last 30 days (in response to the consumption in the last 30 days question). This pattern is entirely possible with energy drinks as consumption correlates with academic and social events for this age group. The hypothesis tests were rerun using this second measure as the dependent variable after deleting the 194 cases. The result pattern held consistent across all tests. Given this, the current consumer item was retained as the more appropriate dependent variable as it allowed the inclusion of all participants’ responses in the study.

Table 1 Spearman’s Rho and Descriptive Statistics for Predictor Variables

Variable Susceptibility Severity Benefits

Barriers– energy level

Barriers– socialization Age Gender Black Hispanic Asian

Heard harmful effects CFC

Susceptibility — Severity .19�� — Benefits .15�� .52�� — Barriers–energy level .22�� �.27�� �.22�� — Barriers–socialization .22�� �.18�� �.20�� .61�� — Age .04 �.03 �.08�� .15�� .10�� — Gender .51 .18�� .06� �.07� �.06 .13�� — Black .02 �.00 �.02 .01 �.02 .13�� .02 — Hispanic �.06 .07� .04 .00 �.05 .06 .02 �.09�� — Asian .06 �.01 �.00 .06 .10�� �.08� �.08� �.16�� �.14�� — Heard of harmful

effects .03 .17�� .10�� �.06 �.14�� �.01 .06 �.15�� �.03 �.02 — CFC �.03 .24�� .23�� �.28�� �.28�� �.05 .02 .02 �.01 �.13�� .10�� — M 3.46 4.97 5.15 2.31 1.54 19.49 1.66 .10 .07 .19 1.69 4.79 SD 1.64 1.34 1.29 1.34 1.11 2.77 .47 .29 .26 .40 .46 .73

Note. CFC � consideration of future consequences. Gender: male � 0, female � 1; Race (Black): Black � 1, other � 0; Race (Asian): Asian � 1, other � 0; Race (Hispanic): Hispanic � 1, other � 0; Heard of harmful effects of energy drink: yes � 1, no � 0; CFC: higher scores indicate more future-orientation and lower scores indicate more present-orientation. � p � .05. �� p � .01.

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901TEMPORAL PERSPECTIVE AND ENERGY DRINK CONSUMPTION

level-related perceived barriers (M � 2.31, SD � 1.34, � � .77) and the last two items were averaged to form an index for socialization-related perceived barriers (M � 1.54, SD � 1.11, � � .91).

Covariates. In addition to demographic information on age, gender, and race/ethnicity, whether the participant had heard of the harmful effects of energy drinks was included as a covariate. Approximately 70% indicated that they had heard of energy drink’s harmful effects. Additionally, three dummy variables (i.e., Black, Asian, and Hispanic) were created to test racial/ethnic differences with White as a baseline.

Analysis Strategy

Throughout the analysis, six covariates (i.e., age, gender, Black, Asian, Hispanic, and awareness of energy drink’s harmful effects) were controlled. A binary logistic regression with CFC as the independent variable and current use of energy drink as the de- pendent variable was conducted to test Hypothesis 1. To test Hypothesis 2, a series of multiple regression analyses were con- ducted with a two-block structure. The six control variables men- tioned above were entered as covariates in the first block, with CFC entered as a predictor in the second block. To address Research Question 1, Preacher and Hayes’s (2008) bootstrap pro- cedure was employed; their macro program allows for examining indirect and direct path coefficients and bias-corrected bootstrap confidence intervals between multiple variables. Preacher and Hayes’s Macromodel 4, which tests a predictor’s indirect effects on a response variable through multiple mediators simultaneously, was employed with CFC as the predicting variable, energy drink consumption as the response variable, and five health beliefs as mediators. Type I error rate was set at � � .05 for the entire study.

Results

Descriptive Data

Participants (66.2% women)’ ages ranged from 17 to 69 (M � 19.49; SD � 2.77), and 60.1% were White, 19.4% Asian, 9.6% Black, 7.0% Hispanic, and 3.8% other race/ethnicity. Participants over 28 years old were marked as outliers. However, as such nontraditional students also comprise the student body, this study did not drop the outliers. Instead, two sets of analyses were conducted with and without age-related outliers. Both hypotheses were examined to see whether these outliers affected the outcome. Results with and without outliers were consistent without any significance-level differences, which further strengthened the ra- tionale not to exclude the outliers. Participants indicated that they consumed energy drinks to get more energy in general (35%), study for an exam or complete school projects (26%), mix with alcohol while partying (20%), and fight insufficient sleep (13%).

Confirmatory Factor Analysis

To validate its dimensionality, the 13 health beliefs items were submitted to a confirmatory factor analysis with a five-factor structure. Results showed a very good fit of the model based on the relative fit indices (�2 � 346.75, p � .001, root mean square error of approximation � .071 (90% confidence interval [CI] [.064,

.078]), comparative fit index � .97, incremental fit index � .97, normed fit index � .96).

Test of Hypotheses and Research Question

Hypothesis 1 predicted that individuals low in CFC would be more likely to consume energy drinks. Results revealed that CFC predicted energy drink consumption (B � �.322, p � .002, odds ratio � .725, 95% CI [.594, .884]), therefore supporting Hypoth- esis 1.

Hypothesis 2 predicted that individuals high in CFC would perceive greater levels of severity of energy drink-associated risks, greater benefits of abstaining from energy drinks, and fewer bar- riers in abstaining from energy drinks. As shown in Table 2, results revealed that CFC was a predictor of health beliefs, including perceived severity (� � .227, p � .001), perceived benefits (� � .215, p � .000), perceived energy-level-related barriers (� � �.286, p � .000), and perceived socializing-related barriers (� � �.277, p � .000). CFC did not predict perceived suscepti- bility. Thus, Hypothesis 2 was mostly supported.

Some of the control variables predicted energy drink consump- tion and its related beliefs, as shown in Table 2 and Table 3. Older participants and males were more likely to consume energy drinks; they also perceived energy drink-related risks as less severe and as having fewer benefits to abstaining. Additionally, older partici- pants showed greater concern about the low energy levels that result from avoiding energy drinks. However, when 15 age-based outliers were removed and the analysis was rerun, the effect of age on severity and benefits disappeared. Asians and Hispanics per- ceived energy drink-related risks as more severe compared to Whites. Awareness of the harmful effects of energy drinks was a positive predictor of the perceived level of severity of energy drink-associated risks and the perceived benefits of abstaining from energy drink consumption, whereas it negatively predicted perceived socializing-related barriers caused by abstaining from energy drinks.

Research Question 1 explored whether CFC has an indirect effect on energy drink consumption via one’s health beliefs. Re- sults indicated that CFC had a statistically significant indirect effect on energy drink consumption through a number of health beliefs, including perceived severity (indirect effect esti- mate � �.191, 95% CI [–.271, �.122]), perceived benefits (indirect effect estimate � �.108, 95% CI [–.174, �.050]), perceived energy level-related barriers (indirect effect estimate � �.274, 95% CI [–.387, �.181]), and perceived socialization-related bar- riers (indirect effect estimate � .152, 95% CI [.078, .249]). Spe- cifically, individuals with higher CFC perceived energy drink- related risk as more severe (B � .439, p � .001), which led to abstaining from consuming energy drinks (B � �.435, p � .001); perceived greater benefits in avoiding energy drinks (B � .392, p � .001), which led to less likelihood of energy drink consump- tion (B � �.275, p � .001); and perceived less concerns about lowered energy level due to the avoidance of energy drinks (B � �.534, p � .001), which influenced them to avoid energy drinks (B � .512, p � .001). High CFC individuals perceived less socialization-related barriers (B � �.447, p � .001); however, this led to increased energy drink consumption (B � �.340, p � .001). After health beliefs were included as mediators, CFC had no direct effect on energy drink consumption.

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Discussion

The goal of this study was to examine whether CFC has con- sequences for health behavior, in terms of energy drink consump- tion, and what mechanisms are involved in the association between CFC and energy drink consumption. Individuals high in CFC tended to abstain from consuming energy drinks, held greater energy drink-related risk perceptions, perceived the benefits of avoiding energy drinks, and had fewer barriers to abstaining from energy drink consumption. In addition, CFC was found to have an indirect effect on energy drink consumption through perceived severity, benefits, and barriers. These findings add support to extant research that suggests CFC’s positive association with healthy behavior.

This study extends our understanding of CFC by demonstrating its role in an individual’s decision-making process in the context of energy drink consumption. Specifically, this study expected that CFC would predict energy drink consumption, given prior research that showed associations between CFC and self-directed health behaviors (e.g., Adams, 2012; Orbell & Kyriakaki, 2008), while small or null associations have been found between CFC and non-self-directed behaviors (Chapman & Coups, 1999; Chapman et al., 2001; Kim & Nan, 2015; Nan & Kim, 2014), and the results supported the hypothesis. Congruent with previous findings, in this study too, CFC negatively predicted energy drink consumption, a self-directed and repetitive behavior that develops over time and requires engaging in repetitive actions to prevent the associated

Table 2 Predictors of Energy Drink Consumption-Related Health Beliefs

Variable

Perceived susceptibility to energy drink-related

risks

Perceived severity of energy drink-

related risks

Perceived benefits of abstaining from

energy drink

Perceived energy level-related barriers of

abstaining from energy drink

Perceived barriers in socializing of abstaining from

energy drink

Block 1 Age .020 �.064� �.086�� .062� .006 Gender .054 .163��� .068� �.056 �.013 Race (Black) .027 .045 �.015 .028 .003 Race (Asian) .062 .060� .031 .012 .045 Race (Hispanic) �.041 .086�� .042 .006 �.005 Heard of harmful effects energy drink .038 .158��� .084�� �.016 �.120���

Total R2 .011 .071 .027 .013 .029 Adjusted R2 .005 .066 .021 .008 .023

Block 2 CFC �.007 .227��� .215��� �.286��� �.277���

Total R2 .011 .121��� .072��� .093��� .104���

Adjusted R2 .004 .116��� .066��� .087��� .098���

�R2 .000 .050��� .045��� .080��� .075���

Note. CFC � consideration of future consequences. Numbers are standardized regression coefficients. Gender: male � 0, female � 1; Race (Black): Black � 1, other � 0; Race (Asian): Asian � 1, other � 0; Race (Hispanic): Hispanic � 1, other � 0; Heard of harmful effects of energy drink: yes � 1, no � 0; CFC: higher scores indicate more future-orientation and lower scores indicate more present-orientation. � p � .05. �� p � .01. ��� p � .001.

Table 3 Predictors of Current Use of Energy Drink

Variable � Odds ratio [95% CI]

Block 1 Age .157��� 1.170 [1.097, 1.247] Gender �.506��� .603 [.447, .814] Race (Black) �.526 .591 [.342, 1.023] Race (Asian) �.293 .746 [.507, 1.097] Race (Hispanic) �.050 .952 [.544, 1.664] Heard of harmful effects energy drink �.090 .914 [.667, 1.252]

Block 2 CFC �.322�� .725 [.594, .884] �2 51.670���

Nagelkerke R2 .071

Note. CI � confidence interval; CFC � consideration of future consequences. Gender: male � 0, female � 1; Race (Black): Black � 1, other � 0; Race (Asian): Asian � 1, other � 0; Race (Hispanic): Hispanic � 1, other � 0; Heard of the harmful effects of energy drink: yes � 1, no � 0; CFC: higher scores indicate more future-orientation and lower scores indicate more present-orientation. �� p � .01. ��� p � .001.

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903TEMPORAL PERSPECTIVE AND ENERGY DRINK CONSUMPTION

risks. CFC may have a greater influence on self-directed, repetitive behaviors than non-self-directed behaviors (e.g., H1N1 or HPV vaccination) because the established practice of self-directed health behaviors (e.g., regular use of sunscreen) may mean the enduring regulation of one’s behavior driven by motivations (Ban- dura, 2005). Simply put, self-directed repetitive health behavior may be viewed as the accumulation of one’s repetitive decision- making (e.g., applying sunscreen whenever going out) which is affected by CFC. Self-directed behaviors may involve more bar- riers that need to be overcome because of which low CFC indi- viduals may stop complying. For example, both low and high CFC individuals may take a flu shot but low CFC individuals may not apply sunscreen every time they go out.

It is also possible that the perceived efficiency of self-directed health behaviors is relatively greater than that of non-self-directed health behaviors based on cost-benefit analysis. Individuals get involved in health behaviors when they perceive the benefits as exceeding costs (Lee & Kotler, 2011). Health behaviors using health services (e.g., vaccination) involve only one - three times of costs and its benefits are clear (e.g., preventing specific disease), whereas self-directed health behaviors require an individual to bear enduring costs (e.g., avoiding energy drink consumption) but its health benefit may not be definite or confirmed. With regard to taking vaccines that can prevent H1N1 (Nan & Kim, 2014), HPV, or cancer (Kim & Nan, 2015), most people may find no reason for not taking those vaccines, even if their CFC levels are low. CFC may have a minor effect on health behaviors when the behavior involves low cost and high benefit because low CFC individuals, perceiving high levels of benefits, endure all the related barriers. On the other hand, CFC’s influence may have been considerable in the current study, because the benefits of abstaining from energy drinks may not be perceived to be high compared to its barriers, thus causing low CFC individuals to consume the drinks while high CFC individuals tended to avoid the risk associated with consumption. This rationale is further supported by the results to Research Question 1.

CFC also predicted energy drink-related health beliefs, support- ing Hypothesis 2. High CFC individuals perceived consuming energy drinks as having more severe consequences and avoiding the drink was perceived as more beneficial and less difficult, supporting prior research (e.g., Dorr et al., 1999; Kees, 2011; Kim & Nan, 2015; Nan & Kim, 2014; Orbell & Kyriakaki, 2008; Rothspan & Read, 1996; Strathman et al., 1994). However, CFC was not associated with perceived susceptibility in this context, disconfirming the findings of both Kees (2011), who indicated a positive relationship in the context of healthy eating, and Kim and Nan (2015), who found the opposite relationship in the HPV vaccination context. Perhaps similar to the healthy eating context (Kees, 2011), high CFC individuals may have perceived greater susceptibility to energy drink-related risks. However, it could be that their generally healthy practices or their perceptions that they only moderately consume energy drinks, may have attenuated the associations between CFC and perceived susceptibility. The va- lence of the association was also not negative as found in Kim and Nan (2015). HPV can be avoided by healthy practice (e.g., condom use), but energy drink-related risks may not be perceived to be completely avoidable. This finding suggests that perceived suscep- tibility to a risk could be determined by the magnitude of other health-related variables that prevent the risk. In addition, it would

be helpful to measure the extent to which individuals have ab- stained from risky behaviors or have engaged in healthy behaviors to reach discrete levels of perceived susceptibility. These aspects warrant further research.

In response to Research Question 1, the results revealed that CFC had an indirect effect on energy drink consumption through perceived severity, perceived benefits, perceived energy level- related barriers, and perceived socialization-related barriers. CFC influenced various energy drink-related beliefs, which further af- fected participants’ actual drinking behavior. Although CFC has been found to be associated with all four constructs of HBM, prior research (Kim & Nan, 2015; Nan & Kim, 2014) demonstrated that CFC has indirect effects on behavior only through perceived benefits in the context of vaccination. However, in the context of energy drink consumption, a self-directed health behavior, CFC may have stronger effects through severity and barriers, as dis- cussed previously. This shows that different health behaviors in- volve different mechanisms of cost-benefit analysis. More impor- tantly, however, the current study implies such differences could be systematically approached and understood depending on the nature of health behavior (e.g., one-time or repetitive), although future research is necessary.

Individuals high in CFC perceived less socialization-related barriers, but surprisingly, the low perceived barriers in socializing with others was associated with greater consumption of energy drinks. It is possible that a floor effect occurred in measuring perceived barriers in socialization, as the mean of the construct was very low (i.e., M � 1.54 out of 7, SD � 1.11). This effect could be indicative of a social desirability bias in participants that makes them unwilling to admit that energy drinks helps them socialize or that consumption of energy drinks makes them appear more social. However, it remains unclear as to why CFC had a significant positive indirect effect on energy drink consumption via socialization-related barriers, thus requiring further investiga- tion.

There are some limitations to this study that should be noted. First, as a cross-sectional study conducted online, this research requires caution in drawing inferences about causal relationships. Although bootstrapping analysis for testing indirect effects sug- gested that CFC influences energy drink consumption through a number of health beliefs, future research would benefit from employing a longitudinal or an experimental research design. Second, this study has limitations in warranting the data’s validity because the survey was conducted online, and participants may have just lightly skimmed through it. Although studies (Ramo, Hall, & Prochaska, 2011; Ramo, Liu, & Prochaska, 2012) indicate that online surveys are reliable, valid, and a convenient and cost- effective way of conducting research, future studies should incor- porate methods to help reduce validity problems. For example, in using online survey tools, questionnaires completed in an unrea- sonably short time-period could be excluded from data. Third, the sample was limited to college students. Energy drink consumption is a highly relevant health topic for college students making them more than a sample of convenience, but it would be helpful to examine predictors of a self-directed health behavior such as energy drink consumption in different populations. The college students in this study indicated that their energy drink consumption was related with college life such as studying for an exam and completing school projects, mixing with alcohol while partying, or

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904 KIM AND ANAGONDAHALLI

fighting insufficient sleep. Noncollege populations may consume energy drinks for other reasons. Fourth, the current study measured energy drink consumption with one dichotomous variable. The perception of “current use” may differ depending on individuals. This study employed the word purposefully to capture partici- pants’ perceptions of continuous consumption and to accommo- date the consumption pattern’s correlation with academic and social events. However, future research may benefit from using a continuous variable to measure CFC consumption and to better understand its association with different health behaviors (e.g., repetitive or one-time). Lastly, as mentioned earlier, this study showed an unexpected positive association between perceived socialization-related barriers and energy drink consumption. Fu- ture research should examine this contrary result.

Despite these limitations, this study extended the applicability of CFC by examining its role in the context of college students’ energy drink consumption. More importantly, this was the first study to examine CFC’s indirect effects on a self-directed health behavior through health beliefs. The findings provide the follow- ing practical implications for health communicators.

Health campaigns need to consider individual differences, in- cluding CFC, to communicate better with more vulnerable groups when segmenting and targeting groups. CFC was found to be negatively associated with energy drink consumption, supporting prior studies’ argument that individuals with high CFC are more likely to engage in healthy behaviors, while those with low CFC are more likely to engage in risky behaviors (e.g., Burns & Dillon, 2005; Kees, 2011; Kim & Nan, 2015; Nan & Kim, 2014; Rothspan & Read, 1996). Health campaigns tend to employ demographic variables when selecting target audiences, often for convenience. However, such an approach has limitations in segmenting individ- uals in many health contexts, including cigarette smoking or alco- hol consumption (Slater, 1996). Psychological factors such as CFC could be a useful tool for selecting the most vulnerable groups of people in various contexts.

In addition to employing CFC as a segmentation tool, CFC may be further incorporated by health campaign designers when they develop campaign messages. For example, some studies (Kees, 2011; Orbell & Hagger, 2006; Orbell & Kyriakaki, 2008; Orbell et al., 2004) have revealed that individuals with low CFC are better persuaded by messages emphasizing immediate consequences. Specifically in the context of energy drink consumption, individ- uals with low CFC were found to be a more important group to communicate with regarding the risks of energy drink consump- tion. Thus, designing messages highlighting the immediate nega- tive consequences of energy drink consumption should be a strat- egy to be considered. Additionally, health campaign designers need to stress the severity of energy drink-related health risks, barriers to consuming energy drinks, and the benefits of abstaining from energy drinks, as these beliefs affected energy drink con- sumption. Increasing the awareness of energy drink’s harmful effects should also be a communication priority as it predicts health beliefs that further affect actual consumption.

To conclude, this study demonstrated CFC’s role in influencing health beliefs and behavior associated with a self-directed energy drink consumption. It also underlined that CFC’s influence on health decision-making differs with context. Researchers should continue to examine the role of temporal considerations in various

health decision-making contexts to better understand its influence and design more effective health messages.

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Received August 31, 2016 Revision received May 11, 2017

Accepted May 21, 2017 �

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