Psych Intro

O R I G I N A L P A P E R

Energy Drink Consumption and Associated Health Behaviors Among University Students in an Urban Setting

David K. Spierer • Nineequa Blanding •

Anthony Santella

Published online: 20 August 2013

� Springer Science+Business Media New York 2013

Abstract The objective of this study is to describe energy

drink consumption and health behaviors among college

students attending a predominantly minority university.

Undergraduate and graduate students attending a private,

minority-serving university were invited to participate in

an online survey between September 2009 and August

2010. Out of 2,500 students, 407 participated yielding a

response of 16 %. Analysis assessed energy drink con-

sumption as well as participation in sport activities and

high-risk behaviors. Energy drink consumption is signifi-

cantly related with drinking alcohol to inebriation and

driving (r = .14, p \ .05) and to riding with a drunk driver (r = .15, p \ .05). Athletes were more likely to engage in drinking alcohol to inebriation and driving F (1,

186) = 6.12, p \ .02. Energy drink consumption is a common practice among racial minority university stu-

dents. Tailored health promotion strategies and interven-

tions are needed to address misconceptions of energy drink

and alcohol mixing.

Keywords College students � Energy drinks � Health behaviors

Introduction

Energy drinks, also known as functional foods comprise

63 % of the beverage market and is the fastest growing

multi-billion dollar segment of consumed beverages in

North America [1, 2]. These beverages usually contain

large amounts of caffeine [3] sugar and other ingredients

such as taurine (a derivative of an amino acid), guarana

[(made from the seeds of a South American climbing plant

whose main ingredient is guaranine (chemically identical

to caffeine)], yerba mate (derived from Ilex paraguariensis;

a South African plant said to have a variety of bioactive

components, including polyphenols), ginseng (an herb used

to stimulate the adrenal gland and thereby increase energy)

and B vitamins. Varying ingredient combinations are

common and thus energy drinks will differ in taste as well

as claimed energy boost and health benefits [4].

Energy drinks are marketed specifically to young adults

with the majority of consumers being teenagers and indi-

viduals between the ages of 18–34 [5, 6]. Another large

market, in which energy drink consumption is abundant,

consists of athletes, who happened to be the first test

market of energy drinks in 1997 when Red Bull was

imported from Austria [7]. In support of many of the claims

made by the manufacturers of energy drinks, data dem-

onstrate that consumption of energy drinks result in mod-

erate effects on physical and cognitive performance [8–16].

For example, psychomotor performance (e.g., concen-

tration, reaction time and short-term memory) was

improved after consumption of Red Bull [8, 13]. In addi-

tion, consumption of energy drinks changed the subjective

perception of alertness in subjects (making them feel like

they were less fatigued) and improved physical endurance

in non-athletic subjects. Further, caffeine and taurine have

been shown to improve reaction time and accuracy in how

D. K. Spierer (&) Division of Athletic Training, Health and Exercise Science,

Long Island University Brooklyn, 1 University Plaza,

Room HS 303, Brooklyn, NY 11201, USA

e-mail: [email protected]

N. Blanding

Department of Public Health, Long Island University Brooklyn,

Brooklyn, NY, USA

A. Santella

Faculty of Medicine, The University of Sydney/Western Sydney

Sexual Health Centre, Sydney, Australia

123

J Community Health (2014) 39:132–138

DOI 10.1007/s10900-013-9749-y

one perceives and processes visual information as well as

verbal reasoning and attention [4, 14].

However, there are data to the contrary. Some data

demonstrate that energy drinks do not confer physical and

psychological benefits. In a placebo-controlled trial, con-

sumption of energy drinks did not improve performance in

cross country runners and it resulted in a perceived exertion

more commensurate with fatigue [17]. Others have shown

similar results [18].

Although energy drinks are often consumed by athletes

in hopes of improving performance, the popularity of

energy drink consumption in the general population is on

the rise [1, 19]. Due to its abundance, there is general

concern that energy drinks are being misused and abused

[20–22]. Many consumers mix energy drinks with alcohol

and some manufactures produce such drinks. Health offi-

cials warn against the mixing of energy drinks in or with

alcoholic beverages, as it has been shown to reduce per-

ceptions of impaired coordination [23], headache, weak-

ness and dry mouth [24–26]. Data demonstrate that both

homemade and manufactured energy drink alcoholic bev-

erages dampen perceived intoxication levels and may

increase the number of alcohol related deaths [27, 28].

Other consequences associated with energy drinks include

dehydration, insomnia, headaches, nervousness, and vom-

iting and more serious reactions such as seizures, heart

arrhythmia [29] and death [15, 30, 31].

Research demonstrates a close relationship between

those who drink an excessive amount of energy drinks and

behaviors that put them at risk [21, 32, 33]. Miller et al.

found that problem behaviors among college students were

closely associated with energy drink consumption, partic-

ularly among whites [34]. Further, Malinauskas et al. [35]

found that college students consume energy drinks for a

variety of reasons and outlined the need to explore further

the students’ recognition of what ingredients and how

much of each ingredient is being consumed. Research on

the use of energy drinks by college students and young

adults is relatively new [34–38]. However, in college aged

populations, the use of energy drinks with alcohol is a

popular concoction. Oteri et al. [36, 38] showed that 85 %

of college students mixed energy drinks with alcohol, and

across all colleges, approximately 25 % of students par-

ticipate in consuming alcohol related energy drinks.

Although there is data to support the notion that energy

drink consumption is related to high-risk behavior in pre-

dominantly White students [37] there is little to suggest

that this trend also exists in a minority based inner city

four-year institution where 70 % of the student body are

Black and Hispanic females.

Thus, the purpose of this investigation was to explore

the frequency with which energy drinks are consumed by

students and student/athletes at a private, predominantly

minority-serving four-year university and to then deter-

mine if there are consequent adverse health behaviors as a

result of this intake. We hypothesized there would be a

positive correlation between the frequency of energy drink

consumption and high-risk behaviors.

Methods

Data

During the academic year of 2009–2010 data were col-

lected from undergraduate and graduate students in a small

private urban university in the Northeast United States. No

compensation was given to participants and survey data

were anonymous. Informed consent was given via elec-

tronic waiver (part of survey) by the Institutional Review

Board of Long Island University Brooklyn for the protec-

tion of human subjects.

All students (undergraduate and graduate) numbering

approximately 2,500 were invited to participate. Four

hundred and seven students submitted viable surveys when

the study was completed, yielding an approximate response

rate of 16.3 %. The sample was associated with the diverse

demographics of the university. The survey did not include

information on race or ethnicity however, the racial com-

position of students on campus is approximately 70 %

black and 30 % white (www.liu.edu).

Analysis

Prior to analysis, select variables were recoded. Frequency

of energy drink consumption was recoded into a dichoto-

mous variable with high and low outcomes (high = 3 or

more times per week; low = 2 times or less per week,

including non-consumers). Athlete status was recoded into

a dichotomous variable where athlete was defined as a

student participating in university level sports or commu-

nity sports groups. Participation in extreme sports was also

recoded into a dichotomous variable (yes/no). Students

were defined as participating in extreme sport if they

reported in engaging in any of the variables listed including

buildings, antennas, spans (bridges), and earth (BASE)

jumping, body boarding, whitewater canoeing and/or

kayaking, cliff jumping, extreme motorsport, free running,

hang gliding, ice climbing, jet skis, kite surfing, bicycle

motocross (BMX), mountain biking, paragliding, rock

climbing, sand boarding, skateboarding, scoot ring, snow-

boarding, snow kiting, surfing, windsurfing, whitewater

rafting or sky diving. Due to Institutional Review Board

restrictions, the only demographic variables that could be

captured were, university level (freshman, sophomore,

junior, senior or graduate student), age and sex.

J Community Health (2014) 39:132–138 133

123

Statistical analyses were conducted using SPSS 14.0

software. (SPSS Inc., Chicago, IL, USA) The characteris-

tics of the study participants were calculated using

descriptive statistics such as frequency and percentage

rates. Bivariate correlations were calculated between

energy drink consumption and problem behavior variables

of interest. ANOVAs were performed on unadjusted mean

scores for frequency of energy drink consumption

(dichotomous variable) and athlete status (athlete and non-

athletes) on each problem behavior variable. ANOVAs

were also performed on unadjusted means scores for fre-

quency of energy drink consumption and athlete status on

variables that captured attitudes towards energy drinks.

Additionally, regressions were performed with three spe-

cific self-reported problem behaviors of interest: (1)

drinking alcohol to inebriation and driving; (2) riding with

a drunk driver; (3) engaging in extreme sports. Variables

such as age, university level (freshman, sophomore, junior,

senior, graduate student) and gender were controlled for

each regression.

Results

Four hundred and seven (223 males) students were inclu-

ded in the final analysis. The sample size for each variable

varied due to non-responders. Of 314 students, 34 % were

aged 19–23, 78 % were undergraduates and 64 % were

athletes. Of 318 students, 14 % engaged in extreme sports.

Out of 212 students, 16 % consumed energy drinks at least

three times per week. The characteristics of the study

participants are presented in Table 1 and the sample sizes

for each variable are noted under each category.

Pearson correlations between energy drink consumption

and the eight problem behavior variables of interest

revealed that within this population group, energy drink

consumption was significantly related with drinking alco-

hol to inebriation and driving (r = .14, p \ .05). Energy drink consumption is also significantly related to riding

with a drunk driver (r = .15, p \ .05). Energy drink con- sumption was not significantly related to problem behav-

iors such as sports-related risks, tobacco use, illegal drug

use, engaging in unprotected, or use of prescription drugs

Table 2.

One—way ANOVAs were performed on unadjusted

means for frequency on energy drink consumption and

athlete status on: (1) attitudes towards energy drinks (as

expressed in Table 3: ‘‘I like how they make me feel’’; ‘‘I

compete better in sports’’; ‘‘I can study longer’’; ‘‘When I

mix with alcohol, I don’t pass out’’; ‘‘They generally give

me more energy’’; ‘‘They help me to concentrate on my

school work’’; ‘‘I get a buzz’’) and (2) problem behaviors

Tables 3 and 4.

Within this sample, non-athletes who reported high

levels of energy drink consumption were more likely to

report to having ‘‘a buzz’’ from energy drinks than athletes.

Compared to non-athletes, athletes were more likely to

engage in drinking alcohol to inebriation and driving F

(1, 186) = 6.12, p \ .02. Athletes were more likely to ride with a drunk driver F (1, 186) = 7.76, p \ .01, participate in extreme sports F (1, 186) = 26.51, p \ .01 and take sport-related risks F (1, 186) = 20.41, p \ .01, compared to non-athletes. Frequent consumers of energy drinks (high

level as defined as 3 or more times per week) were more

likely than less frequent consumers to drink alcohol to

inebriation and drive F (1, 181) = 7.61, p \ .01, ride with a drunk driver F (1, 181) = 4.19, p \ .05, engage in extreme sports F (1, 181) = 5.19, p \ .05, and take ana- bolic steroids F (1, 181) = 4.11, p \ .05.

Logistic regressions of energy drink consumption on

three problem behaviors of interest were performed while

controlling for age, university level and sex. The three

problem behavior variables include: (a) drinking alcohol to

Table 1 Sample characteristics

n Percent

Age (n = 314)

18 or younger 63 15.48

19–23 139 34.15

24 or older 112 27.52

Gender (n = 313)

Male 223 54.79

Female 90 22.11

University level (n = 314)

Freshman 78 19.16

Sophomore 112 27.52

Junior 44 10.81

Senior 34 8.35

Graduate student 46 11.30

Athlete status (n = 314)

Athlete 263 64.62

Non-Athlete 51 12.53

Energy drink consumption (n = 314)

Low 146 35.87

High 66 16.22

Participate in extreme sports (n = 318) 57 14.10

Total percentages may not add to 100 % due to missing data

Due to IRB restrictions, demographic data was limited to age, gender

and university level. Other variables such as race could not be

captured

Athlete status is defined as student athlete or participation in com-

munity sports groups

High-energy drink consumption is defined as three or more times per

week

134 J Community Health (2014) 39:132–138

123

inebriation and driving; (b) riding with a drunk driver;

(c) engaging in extreme sports (see Table 5). The overall

model was not significant.

Comment

Our study revealed that energy drink consumption is sig-

nificantly correlated with both drunk driving and being a

passenger with a drunk driver. In addition, athletes sur-

veyed, were more likely to participate in extreme sports

and those who consumed energy drinks. Those who con-

sumed energy drinks more than 3 times per week were

more likely to engage in extreme sports and take anabolic

steroids than those who consumed energy drinks infre-

quently (less than 3 times per week). There are several

important public health implications of these findings.

First, energy drink consumption should be given additional

emphasis when designing evidence-based health education

and promotion strategies and initiatives for college stu-

dents. Second, if energy drinks are contributing to poor

decision making practices, culturally appropriate and tar-

geted interventions are needed to combat myths and pre-

conceptions about the impact of energy drinks, especially

when mixing them with alcohol. These decision making

practices may have more or less impact when adding

stressors related to minority or low socio-economic status

students. Cognitive-behavioral skills based interventions

and brief motivational feedback sessions have proven

efficacious in the college student population and should be

considered a tool to address energy drink consumption and

mixing with alcohol and/or high-risk sports [39].

It is also important to note that web-based and/or social

media alcohol prevention interventions may reduce the

negative consequences of alcohol consumption, especially

for universities with limited resources [40].

The data also suggest that student athletes who consume

energy drinks are more likely to take sports-related risks as

compared to non-student athletes. Although we cannot

assess whether these additional sport-related risks may

result in injury, disability or even death, we do know that

the sample of student athletes in this study were more

likely to participate in extreme sports. The combinations of

these activities are to be taken seriously. University athletic

departments should be mindful of these practices as they

educate mentor and train student athletes. As noted in

Table 2 Bivariate correlations of energy drink consumption on problem behaviors

Energy drink

consumption

1. Energy drink consumption (frequency) –

2. Drink alcohol and drive .1

3. Drink alcohol to inebriation and drive .14*

4. Ride with a drunk driver .15*

5. Non use of a safety belt in car -.04

6. Engage in dangerous and/or fast driving .07

7. Binge drink alcohol -.03

8. Engage in unprotected sex .03

9. Engage in extreme sports (frequency) .09

10. Take anabolic steroids -.02

11. Use illegal drugs .06

12. Use prescription drugs not prescribed for you -.02

13. Smoke/snuff tobacco -.01

14. Sport-related risks -.03

15. Major or minor criminal behavior -.03

Table presents Pearson correlation data on frequency of energy drink

consumption and the problem behaviors listed above (2–15)

* p \ .05

Table 3 Unadjusted mean comparison of attitudes towards energy drinks by athlete status and energy drink consumption

Athlete status

Non-athlete Athlete

Energy drink consumption [mean (sd)] Low High Low High

I like how they make me feel 3.57 (1.59) 3.42 (1.74) 3.92 (1.94) 3.22 (1.92)

I compete better in sports 5.20 (1.66) 5.04 (1.75) 4.15 (1.95) 4.78 (1.56)

I can study longer 2.75 (1.65) 2.82 (1.58) 3.19 (1.74) 3.44 (1.81)

When I mix with alcohol, I don’t pass out 5.66 (1.65) 5.45 (1.90) 5.96 (1.51) 5.22 (1.99)

They generally give me more energy 2.33 (1.40) 2.31 (1.25) 2.5 (1.39) 2.22 (1.39)

They help me to concentrate on my school work 3.35 (1.69) 3.47 (1.61) 3.42 (1.47) 3.33 (1.73)

I get a buzz 5.14 (1.48) 5.49 (1.30)* 4.85 (1.99) 5.78 (1.48)

Table presents mean comparisons of attitudes towards energy drinks by athlete status and level of energy drink consumption. Co-varied for age

and gender

* p \ .05

J Community Health (2014) 39:132–138 135

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previously published research, prevention efforts with

athletes should focus on the unique social and environ-

mental influences that impact their decisions [41].

Limitations

Although this study is one of the first to measure energy

drink consumption and associated sport and health behav-

iors among students at a minority university, it has some

limitations. First, the Institutional Review Board did not

allow race and ethnicity variables to be included on the

survey instrument for fear of losing anonymity. University-

wide race and ethnicity data may be used to generalize

results to the larger college student population. Second, the

response rate of the online survey was not high enough to

rule out non-response biases. Finally, many students

attending this university are first-generation college stu-

dents and come from low socio-economic backgrounds and

thus may not be represent all minority undergraduate

students.

Conclusions

Energy drinks, once considered a fad, are here to stay. It is

unconsionable for university and athletic department

administrators to ignore this growing health behavior. With

the aid of culturally appropriate, evidence-based public

health prevention interventions, messages and health pro-

motion strategies, we must strive to not only gain recog-

nition of this issue amongst university leadership and staff

but also increase student knowledge on the negative con-

sequences associated with regularly consuming energy

drinks; especially with alcohol.

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Table 4 Unadjusted mean comparisons of problem behaviors by athlete status and energy drink consumption

Athlete status Energy drink consumption

Mean (std. error) Non-athlete Athlete Low High

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136 J Community Health (2014) 39:132–138

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