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Health Education Journal 2016, Vol. 75(3) 318 –330

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Socio-demographic differences in energy drink consumption and reasons for consumption among US college students

Natalie S Poulos and Keryn E Pasch Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA

Abstract Background: Energy drink consumption has become increasingly prevalent among US college students, yet little is known about current rates of consumption and reasons for consumption among current energy drink users, particularly differences related to gender and race/ethnicity. Objectives: To better understand energy drink consumption alone and mixed with alcohol among US undergraduate college students who currently use energy drinks. Methods: Participants included 330 energy drink users (m age = 18.7; White = 48.5%; Women = 46.1%) and 229 energy drink mixed with alcohol users (m age = 18.8; White = 51.5%; Women = 51.8%). Students completed an online survey, which measured energy drink consumption alone and energy drinks mixed with alcohol. Descriptive statistics and differences by race/ethnicity and gender are reported for patterns and reasons of use. Results: Among past year energy drink users, 64.9% consumed energy drinks in the past month and 38.5% consumed in the past week. The most common reasons for energy drink consumption alone included studying for an exam and taste. Among past year energy drink mixed with alcohol users, 31.9% consumed within the past month. The most common reasons to mix alcohol and energy drinks included taste and to hide the flavour of alcohol. Key findings include that young men consume energy drinks alone and mixed with alcohol more often than young women. Young men are more likely to report energy drink consumption in the past week and report reasons related to partying than young women, while non-White youth report reasons related to academic performance as compared to White youth. Conclusion: Consideration of patterns and reasons for energy drink consumption may help interventions to ensure appropriate behaviours are targeted and are relevant to the population.

Keywords Alcohol, caffeine, college youth, emerging adults, energy drinks, USA

Corresponding author: Keryn E Pasch, Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto D3700, Austin, TX 78712, USA. Email: [email protected]

578299HEJ0010.1177/0017896915578299Health Education JournalPoulos and Pasch research-article2015

Original Article

Poulos and Pasch 319

Introduction Energy drinks claim to enhance energy levels, concentration, athletic performance, metabolism and focus of the mind (Red Bull, 2012; Rockstar Energy Drink, 2012) through the combination of caffeine, sugar, plant/herbal extracts (e.g. ginseng) and amino acids (e.g. taurine) (Reissig et al., 2009). Popularity of these drinks is evident by the fact that energy drink consumption has more than doubled between 2004 and 2008 in the USA (Mintel, 2009), and profits in the energy drink industry are expected to continue to rise (Heckman et al., 2010). Currently, the target markets for the energy drink industry include adolescents and young adults aged 18–34 years (Heckman et al., 2010), likely due to their fast-paced lifestyle (Lal, 2007). Given that the energy drink industry heavily markets towards young adults (Heckman et al., 2010), it is not surprising that college youth are particularly likely to consume energy drinks. For instance, previous research has estimated between 34% and 71% of college students use energy drinks (Malinauskas et al., 2007; Miller, 2008a; O’Brien et al., 2008; Pettit and DeBarr, 2011; Velazquez et al., 2011) even though many college youth are unaware of their ingredients or potential side effects (Attila and Cakir, 2010). College students may also rely on energy drinks due to the stimulant effects of caffeine provided by these drinks. Recent work among first-year college students suggests that 65% of students drink caffeinated beverages on a daily basis, and 94.7% of students used some form of caffeine in the last 2 weeks (McIlvain et al., 2011).

While each variety of energy drink is unique, the primary active ingredient is most often caf- feine (Higgins et al., 2010). Even though caffeine has been shown to have modest cognitive and performance benefits (Ivy et al., 2009), a recent review suggests that energy drinks have no therapeutic health benefit, contain ingredients that are understudied and unregulated and are inappropriate for children and youth (Seifert et al., 2011). For instance, large doses of caffeine, such as those found in energy drinks, have been associated with a wide array of side effects, including caffeine intoxication, caffeine dependence, anxiety, tachycardia (Reissig et al., 2009), seizure (Clauson et al., 2008), cardiac arrest (Berger and Alford, 2009) and death (Ballard et al., 2010). While the caffeine content of a single energy drink is likely not enough to result in com- plications this severe, college students may consume energy drinks in combination with other caffeinated beverages such as coffee or soda and may increase consumption during times of academic demand or stress. In addition, energy drink use has been associated with a variety of high-risk behaviours, including drugs use, sexual risk-taking, fighting and alcohol consumption and related consequences (Arria et al., 2010; Brache and Stockwell, 2011; Miller, 2008a; Thombs et al., 2010; Velazquez et al., 2011).

Of the many behaviours associated with energy drink consumption, one of the most concerning is the mixing of energy drink and alcohol. Previous research suggests 24%–40% of energy drink users mix these drinks with alcohol (Attila and Cakir, 2010; O’Brien et al., 2008; Velazquez et al., 2011). This is concerning as individuals’ perceptions of alcohol-related drunkenness decrease after consumption of energy drinks mixed with alcohol. This is likely due to the stimulant effects of caf- feine that reduces the perceived depressant effect of alcohol (Ferreira et al., 2006). Similarly, sev- eral alcohol-related consequences such as being taken advantage of or taking advantage of someone sexually, being physically hurt or injured, riding with an intoxicated driver (O’Brien et al., 2008), driving intoxicated or leaving a bar highly intoxicated (Thombs et al., 2010) have been found to occur at higher rates among individuals who mix energy drinks with alcohol.

Although research has shown a variety of consequences associated with energy drinks (Attila and Cakir, 2010; Ballestreri and Corradi-Webster, 2008; Brache and Stockwell, 2011; Malinauskas et al., 2007), little research has focused on understanding basic descriptive information concerning

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reasons students choose to consume these drinks, typical consumption patterns, types and brands preferred and side effects experienced. Furthermore, while the majority of studies focused on the use of energy drink mixed with alcohol have examined associations of energy drink mixed with alcohol consumption with behavioural outcomes (Attila and Cakir, 2010; Ballestreri and Corradi- Webster, 2008; Brache and Stockwell, 2011; Malinauskas et al., 2007; O’Brien et al., 2008), few studies that have examined reasons for consumption of energy drinks mixed with alcohol (Marczinski, 2011; Peacock et al., 2013). College youth are a particularly important population to consider, as they may be at greater risk for other substance use behaviours. When considering users, key descriptive indicators should be considered (e.g. consumption patterns and reasons for use) for the identification of behavioural patterns that may cluster. Additionally, research examin- ing gender differences in energy drink consumption patterns has been mixed. For example, several studies suggest men are more likely to consume energy drinks (Berger et al., 2011; Miller, 2008a, 2008b; O’Brien et al., 2008), while another study found women were more likely to consume energy drinks (Malinauskas et al., 2007). Finally, few studies have examined patterns and reasons for consumption by race/ethnicity among diverse samples (Marczinski, 2011). Therefore, the pur- pose of this study was to examine descriptive characteristics of current energy drinks users and users of energy drinks mixed with alcohol to better understand energy drink use behaviours overall as well as by race/ethnicity and gender.

Methods All incoming first-year college students (N = 6,198) enrolled in a large, public US university in the autumn of 2009 were used as the sampling frame for this study. Of eligible students, those who participated in an alcohol prevention curriculum, a total of 2,971 students were randomly selected to participate and were recruited through a series of emails sent during April–June of 2010. This resulted in a sample of 603 students (response rate = 20.3%). The Institutional Review Board of the University of Texas at Austin approved all the study protocols.

Participants Participants were, on average, 18.7 years of age. In all, 47% were non-Hispanic White, and slightly over half were women (56%). This student sample was similar to the first-year student class as a whole (51% non-Hispanic White; 53% women). Participants who were under the age of 18 years (n = 4); second-, third- or fourth-year students (n = 13) or identified themselves as transgender (n = 1) were excluded from analysis, which resulted in a final sample of 585 participants.

For the present study, the sample was restricted in two ways. First, to better understand energy drink consumption alone, analyses were limited to those who had reported using energy drinks at least once in the past year (n = 330). Second, to better understand the consumption of energy drinks mixed with alcohol, a second set of analyses were limited to those who had reported consuming alcohol at least once in the past year and energy drinks mixed with alcohol least once in the past year (n = 229). Within the first sample of energy drink users (n = 330), 53.2% of participants con- sumed alcohol and energy drink in the past year, suggesting that among energy drink users, more than half mix energy drinks and alcohol. Within the second sample of energy drink mixed with alcohol users (n = 229), 74% of students reported energy drink consumption in the past year, sug- gesting that more than a quarter of students who have consumed energy drinks mixed with alcohol do not consume energy drinks alone. Demographic differences between samples are presented in Table 1.

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Measures Energy drink consumption measures. Past month energy drink consumption was measured by a sin- gle question indicating the number of days energy drinks were consumed in the past month (range = 0–30 days) and included response options of ‘never’, ‘0 days’, ‘1–2 days’, ‘3–5 days’, ‘6–9 days’, ‘10–13 days’, ‘15–19 days’, ‘20–29 days’ and ‘all 30 days’. All responses were coded using median values to reflect actual consumption (i.e. 1–2 days was recoded to 1.5 days) (Velazquez et al., 2011).

Usual consumption of energy drinks was measured by a single question: ‘When you usually consume energy drinks, how many do you consume in one sitting?’ Response included, ‘I don’t drink energy drinks’, ‘1 drink’, ‘2 drinks’, ‘3 drinks’, ‘4 drinks’ and ‘5 or more drinks’. Responses ranged from I don’t drink energy drinks (recoded to 0) to 5 (adapted from Murray et al., 2002).

Last episode of energy drink consumption was measured by a single question: ‘Think about the last time you consumed energy drinks. How many energy drinks did you consume?’ Response options for both measures included six options and ranged from of ‘I don’t drink energy drinks’ (recoded to 0) to ‘5 or more drinks’ (adapted from Doyle and Donovan, 2009).

Type of energy drink consumed was measured by the question ‘What type of energy drink do you drink?’ Response options included ‘I don’t drink energy drinks’, ‘Regular energy drinks’ and ‘sugar-free energy drinks’ (Malinauskas et al., 2007).

Size of energy drinks consumed was measured by the question ‘What size of energy drink do you usually drink?’ Response options included six response options ranging from, ‘I don’t drink energy drinks’ to ‘32 ounces’.

Brand of energy drink was measured with one question: ‘Which brands of energy drinks do you usually have? (Check all that apply)’. Response options included 22 brands and varieties of energy drinks (i.e. Rockstar, Monster, Red Bull).

Side effects of energy drinks were determined through a single question where students could select as many or as few side effects as they wanted. The question read, ‘What are the side effects you have experienced associated with energy drinks? (Check all that apply)’. Response options included side effects such as ‘episodes of extra energy’ and ‘headaches’. See Table 2 for additional side effects. Response options were based on previous research (Malinauskas et al., 2007) or devel- oped specifically for this study.

Table 1. Demographics of overall sample, energy drinks users and energy drink mixed with alcohol users.

Overall sample (N = 585)

Energy drink users (SD) (n = 330)a

Energy drink mixed with alcohol users (SD) (n = 229)a

Age (mean) 18.7 18.7 (0.49)* 18.8 (0.46) Non-Hispanic White 47% 48.5% (0.50)** 51.1% (0.50) Non-White 51.5% (0.50)** 48.9% (0.50) Hispanic 20.9% 23.6% 25.8% Asian 25.5% 21.8% 17.9% Non-Hispanic Black 2.7% 2.7% 2.6% Other 4.4% 3.3% 2.6% Women 56% 46.1% (0.50)** 51.8% (0.50)

SD: standard deviation. aIndependent samples t-tests were run to determine whether energy drink users and energy drink mixed with alcohol users differed on demographic variables. *p < .05; **p < .001.

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Reasons for energy drink consumption were determined through a single question of, ‘What are your reasons for consuming energy drinks? (Check all that apply)’. This question was then fol- lowed by 20 reason options (see Table 3). Response options were based on previous literature (Ballestreri and Corradi-Webster, 2008; Malinauskas et al., 2007; Oteri et al., 2007). Participants selected all reasons that applied.

Energy drink mixed with alcohol measures. Past month consumption of energy drinks mixed with alcohol was measured by a single question, ‘In the past 30 days, on how many days did you drink a mixed drink of alcohol and energy drink?’ Response options included ‘0 days’, ‘1–2 days’, ‘3– 5 days’, ‘6–9 days’, ‘10–19 days’, ‘20–29 days’ and ‘all 30 days’ (Velazquez et al., 2011). Each

Table 2. Energy drink (ED) use among energy drink users (n = 330).

Energy drink variable Overall % Race Gender

White % Non-White % Women % Men %

Past month ED usea,b 64.9 51.9 48.1 39.6** 60.4 Past week ED usea,b 38.5 57.8* 42.2 26.5** 73.5 Usual ED per sitting 1 91.2 96.1 93.2 95.3 94.0 2 4.9 3.2 6.8 4.7 5.4 3 or more 0.3 0.6 0.0 0.0 0.6 ED last sitting 1 88.8 91.0 90.4 90.7 90.6 2 7.9 6.4 9.6 8.0 8.2 3 or more 1.2 2.6 0.0 1.4 1.2 Type of ED Regular 73.4 67.4 79.2 66.2 79.7 Sugar-free 26.6 32.6 20.8 33.8 20.3 Size ED 8 ounces 32.8 32.0 36.7 42.8 27.2 12 ounces 23.2 26.0 22.8 27.6 21.6 16 ounces 34.7 37.3 35.4 28.3 43.2 24 or more 4.6 4.7 5.1 1.4 8.0 ED side effects Extra energy 48.8 30.3 27.1 25.5 31.9 Energy followed by crash 26.4 15.9 15.1 16.2 14.5 Sleep difficulties 23.6 13.3 14.4 14.4 13.1 Loss of appetite 15.2 9.1 8.7 9.7 8.2 Headaches 12.7 6.8 8.0 8.6 6.4 Heart palpitations 10.3 4.5 7.4 7.2 4.6 Junk food cravings 10.0 4.9 6.7 6.1 5.7 No side effects 23.6 15.2 12.7 12.2 15.6 Past month ED mixeda,b,c 31.9 57.5 42.5 41.1* 58.9

aIndependent samples t-tests to determine whether energy drink consumption patterns differed by race. bIndependent samples t-tests to determine whether energy drink consumption patterns differed by gender. cPast month energy drink use mixed with alcohol was examined the limited sample of students who reported consump- tion of both alcohol and energy drinks in the past year (n = 229). *p < .05; **p < .001.

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response was coded to reflect the number of days the student consumed energy drinks mixed with alcohol in the past month (i.e. 1–2 days was recoded to 1.5 days).

Reasons for consumption of energy drinks mixed with alcohol were measured using the ques- tion, ‘Why do you mix energy drinks with alcohol? (Check all that apply)’. This question was then followed by 20 response options (see Table 4). Response options were based on previous research on the consumption of alcohol mixed with energy drinks (O’Brien et al., 2008) and energy drink consumption (Ballestreri and Corradi-Webster, 2008; Malinauskas et al., 2007; Oteri et al., 2007). Participants selected all response options that applied.

Data analysis Data were stratified according to past year energy drink consumption and past year energy drink mixed with alcohol consumption. Once stratified, descriptive statistics using SPSS 19 (SPSS, 2011) were calculated for each measure and sorted according to prevalence rates to improve read- ability. Independent samples t-tests were run to determine whether consumption of energy drinks alone, energy drinks mixed with alcohol and reasons for consumption differed by race (White and non-White) and gender.

Table 3. Reasons for energy drink use among past year energy drink users (n = 330).

Reason for energy drink use n Overall, % Racea Genderb

White % Non-White % Women % Men %

I do not drink energy drinks 8 2.4 25.0 75.0 50.0 50.0 Studying for an exam or to complete a project

202 61.2 43.1* 56.9 50.5 49.0

It tastes good 130 39.4 45.0 54.6 44.2 55.0 Mental alertness 128 38.8 48.4 51.6 42.2 57.8 Needing more energy in general 108 32.7 50.0 50.0 52.8 47.2 Insufficient sleep 83 25.2 55.4 44.6 54.2 45.8 Refreshment 72 21.8 41.7 58.3 38.0 62.0 Driving a car for a long time 64 19.4 59.4* 40.6 35.9 64.1 Replacement for coffee 58 17.6 50.0 50.0 58.6* 41.4 To get ready to go out for the night 51 15.5 64.7* 35.3 56.9 43.1 Drinking alcohol while partying 50 15.2 66.0* 34.0 44.0 56.0 To have more energy to party 44 13.3 68.1** 31.8 43.2 56.8 Hydration and thirst quenching 34 10.3 29.4* 70.6 35.3 64.7 Athletic performance 17 5.2 47.1 52.9 17.6* 82.4 Relaxation 15 4.5 40.0 60.0 26.7 73.3 To skip or replace a meal 10 3.0 50.0 50.0 60.0 40.0 When it is hot outside 5 1.5 60.0 40.0 25.0 75.0 Weight management 5 1.5 60.0 40.0 100* 0.0 To be more in control while partying 4 1.2 75.0 25.0 25.0 75.0 To treat a hangover or feel better in the morning

4 1.2 75.0 25.0 25.0 75.0

Health and nutrition 3 0.9 0.0 100.0 33.3 66.7 Other 10 3.0 50.0 50.0 30.0 70.0

aIndependent samples t-tests were run to determine differences between White and non-White students, df = 328. bIndependent samples t-tests were run to determine differences between male and female students, df = 326. *p ⩽ .05; **p ⩽ .005.

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Table 4. Reasons for energy drink mixed with alcohol use among past year energy drink mixed with alcohol users (N = 229).

Reasons for alcoholic energy drink use

n Overall % Racea Genderb

White % Non-White % Women % Men %

I don’t drink alcohol mixed with energy drinks

49 21.4 49.0 51.0 63.3 36.7

Tastes good 80 34.9 56.2 43.8 45.0 55.0 It hides the flavour of alcohol 72 31.4 59.7 40.3 47.2 52.8 Energy boost 34 14.8 64.7 35.3 38.2 61.8 To stay awake when I am drinking 23 10.0 65.2 34.8 34.8 65.2 I can party longer 22 9.6 59.1 40.9 31.8* 68.2 I can get buzzed quicker 22 9.6 50.0 50.0 36.4 63.6 Refreshment 12 5.2 50.0 50.0 41.7 58.3 Mental alertness 11 4.8 45.5 54.5 36.4 63.6 Relaxation 10 4.4 40.0 60.0 10.0** 90.0 I can drink more alcohol and not feel as drunk

9 3.9 44.4 55.6 11.1* 88.9

Hydration and thirst quenching 7 3.1 28.6 71.4 28.6 71.4 To drink more without looking drunk

5 2.2 80.0 20.0 20.0 80.0

It reduces hangovers 4 1.7 75.0 25.0 50.0 50.0 To avoid getting a hangover 3 1.3 0.0 100.0 33.3 66.7 I drink it and thought that I was drinking a non-alcoholic version

3 1.3 0.0 100.0 33.3 66.7

My parents thought that I was drinking a non-alcohol version

1 0.4 0.0 100.0 0.0 100

Health and nutrition 0 0.0 – – – – Weight management 0 0.0 – – – – Athletic performance 0 0.0 – – – – Other 10 4.4 40.0 60.0 30.0 70.0

aIndependent sample t-tests were run to determine race differences in reasons for energy drink mixed with alcohol use, df = 227. bIndependent sample t-tests were run to determine gender differences in reasons for energy drink mixed with alcohol use, df = 226. *p < .05; **p < .01.

Results

Energy drink consumption Among past year energy drink users (n = 330), 64.9% consumed energy drinks in the past month and 38.5% consumed energy drinks in the past week. Men were more likely to be both past month and past week energy drink users. There were no differences by race on either past month or past week energy drink consumption variables (Table 2). The majority of students reported that they usually consumed one drink per sitting and that the last time they consumed an energy drink, they only consumed one drink. Few students appear to consume more than two energy drinks per sit- ting. Students reported choosing regular drinks more often than sugar-free, and they chose drinks that were between the sizes of 8 ounces and 16 ounces. Side effects experienced following energy drink consumption by at least 15% of the sample included episodes of extra energy, episodes of

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energy followed by an energy crash, sleep difficulties and loss of appetite. Only 23.6% report that they experienced no side effects that they associated with energy drinks. See Table 2 for details on differences of consumption rates and patterns by race and gender. The most common brands usu- ally consumed included Red Bull (47.3%), Monster (39.7%), 5-Hour ENERGY (15.8%), AMP (14.8%) and Rockstar (11.5%).

Overall, the most common reasons for energy drink use included studying for an exam or to complete a project, taste, mental alertness, needing more energy in general and insufficient sleep. The least common reasons included to be more in control while partying, to treat a hangover and health and nutrition. See Table 3 for full list of reasons. White participants were more likely to report energy drink consumption for reasons such as driving a car for a long time, getting ready to go out for the night, drinking alcohol while partying and having more energy to party. Non-White participants were more likely to report energy drink alone consumption for reasons such as study- ing for an exam or to complete a project and hydration and thirst quenching (Table 3). Female participants were more likely to report energy drink alone consumption for reasons such as a replacement for coffee and weight management. Male participants were more likely to report con- sumption for athletic performance (Table 3).

Energy drinks mixed with alcohol Among past year energy drinks mixed with alcohol users (n = 229), 31.9% reported having con- sumed energy drinks mixed with alcohol in the past month (Table 2). Men were more likely than women to report energy drink mixed with alcohol consumption in the past month. The reasons most often reported for consuming energy drinks mixed with alcohol included taste, to mask the taste of the alcohol and to provide an energy boost. See Table 4 for full list of reasons. Men were more likely to report reasons for consumption of energy drinks mixed with alcohol such as to party longer, so that they can drink more without appearing drunk, and relaxation. There were no differ- ences by race of participant on consumption or reasons for energy drink mixed with alcohol con- sumption (Table 4).

Discussion Similar to previous work (Arria et al., 2011), this study found that among past year energy drink users, almost 65% of students consumed energy drinks in the past month, and that energy drink users were more likely to be men (Berger et al., 2011; Miller, 2008a; Miller, 2008b; O’Brien et al., 2008). Interestingly, this study found that 38.5% of past year energy drink users consumed energy drinks in the past week, compared to only 19.8% in previous research (Arria et al., 2011). This may have been due to a variety of reasons including timing of the survey. This survey was conducted at the end of the spring semester, which spanned the final exam period. Due to this increased stress of studying for exams, students may have consumed more recent energy drinks than is typical at other times of the year.

This study also supports previous research which suggests energy drink users typically fre- quently choose Red Bull (Attila and Cakir, 2010). In addition to Red Bull, it is likely that Monster brand energy drinks are highly popular among this population based on present study findings; these are also highly advertised brands of energy drinks (Harris et al., 2014). This is important for future interventions to consider as focusing on these brands may provide indication of upcoming trends in energy drinks use. Furthermore, as the energy drink market is continually expanding, practitioners would likely benefit from keeping up to date with these brands, as this will likely shape the attitudes and beliefs of energy drink users.

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As found in previous research, students appear to be choosing sugar-containing drinks more often than sugar-free drinks (Malinauskas et al., 2007). This may be particularly problematic when consid- ering the literature on negative health effects of sugar-sweetened beverages. For example, previous research has found increased sugar-sweetened beverage consumption is associated with increased weight gain, body mass index (BMI) and risk of chronic conditions such as diabetes (Hu and Malik, 2010). Additionally, it is important to consider that the use of sugared mixers when consuming alco- hol is a potential protective factor for spikes in blood alcohol concentration. For example, those who consume alcohol mixed with sugared drinks are more likely to have a lower blood alcohol concentra- tion than those who consume alcohol mixed with diet or sugar-free mixers (Wu et al., 2006). However, if mixing energy drinks with alcohol increases the risk for binge drinking and other problematic alcohol use behaviours (Arria et al., 2011; Kponee et al., 2014; O’Brien et al., 2008; Velazquez et al., 2011), the protective effects of using a sugared drink mixer may be diminished.

While this study confirms that a common reason for energy drink consumption is taste (Attila and Cakir, 2010; Malinauskas et al., 2007), results also support previous research findings that among current energy drink users, reasons for energy drink consumption alone include studying for an exam or completing a project, generally needing more energy and insufficient sleep (Attila and Cakir, 2010; Malinauskas et al., 2007), which may all be related to academic pressures felt while in college.

Given that the most common reasons for consumption include studying for an exam, to com- plete a project and mental alertness and that previous research suggests that perceived stress is positively associated with energy drink consumption (Pettit and DeBarr, 2011), college students may consume energy drinks to cope with the increasing pressures of academics. This is important to consider given the increasing demands of college students as they take on additional responsi- bilities, activities and course work over the course of their college career. Furthermore, it is possi- ble that as students are exposed to energy drink advertising, they may develop positive attitudes towards these drinks. For example, previous research on the relationship between academic perfor- mance, perceived stress and energy drinks suggests that there may be a shift in the new generation of college students to a reliance on energy drinks as previous generations have relied on coffee (Pettit and DeBarr, 2011). This is problematic as large doses of caffeine, such as those found in energy drinks, may lead to adverse health outcomes, including weight gain (Keast et al., 2011), increased blood pressure and sleep disturbances (Heatherley et al., 2006; Temple, 2009). Given this, future research should consider examining patterns of consumption among youth of younger ages as well as youth who are not attending college to determine whether these patterns are similar across age groups. Furthermore, as interventions are developed to address the increasing preva- lence of energy drink consumption, it is important to understand how consumption patterns and reasons may vary by age or environment.

When considering differences in reasons to consume energy drinks, this study suggests both race and gender differences exist. Specifically, study results reveal that White college youth were more likely to consume energy drinks when driving a car for extended periods of time, to get ready to go out for the night, in unison with drinking alcohol at parties and to have more energy to party. Conversely, non-White college youth were more likely to report consuming energy drinks to help study for an exam or complete a project and for hydration or thirst quenching. Given the differ- ences, future work should consider further exploring why these differences exist. For example, White college youth may view energy drinks as a beverage intended for use in social settings, while non-White youth may more often view energy drinks as concentration enhancing beverage used to excel in academics.

Results also suggest men were more likely to consume energy drinks for athletic performance, while women were more likely to consume energy drinks as a replacement for coffee or for weight

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maintenance. Men may choose energy drinks for athletic performance; it may be that energy drinks are often advertised using extreme sports and athletes (Heckman et al., 2010). It is possible that women report consuming energy drinks for weight maintenance due to perceived appetite suppres- sion effects of caffeine. While popular belief is that caffeine is an appetite suppressant, recent research suggests that caffeine has little effect on gastric emptying, appetite, glucose control or energy intake (Schubert et al., 2014).

Similar to previous research (Kponee et al., 2014; O’Brien et al., 2008), almost 32% of energy drink users had consumed an energy drink mixed with alcohol in the past month, and a primary reason for mixing energy drinks with alcohol was to hide the taste of alcohol. Additional com- mon reasons among energy drink mixed with alcohol users included general taste and to provide an energy boost (Marczinski, 2011; Peacock et al., 2013). Given that college students enjoy the taste of energy drinks alone, it is reasonable for students to use energy drinks as an alcohol mixer to mask the taste of alcohol, especially as college youth approach the legal drinking age of 21 and transition to more frequent alcohol consumption. Similar to previous research (Marczinski, 2011; Peacock et al., 2013), results also suggest that energy drink consumption may be associ- ated with social behaviour related to partying as almost 16% of students consumed energy drinks alone to get ready to go out for the night, and 13.3% consumed energy drinks to have more energy to party. This may be problematic because as college students mix alcohol with energy drinks, they are less able to determine their level of intoxication and drunkenness (Ferreira et al., 2006; Oteri et al., 2007), are at increased risk of alcohol consumption (Arria et al., 2011; O’Brien et al., 2008; Velazquez et al., 2011) and more likely to experience negative alcohol outcomes (O’Brien et al., 2008). Furthermore, there is possibility of energy drinks acting as an entry point or marker for future drug use, given that previous research has found that increased caffeine and energy drink consumption is associated with increased alcohol use, non-medicinal and illicit drug dependence, and high sensation seeking traits (Arria et al., 2010, 2011; Hamilton et al., 2013; Reissig et al., 2009).

Finally, results of this study suggest patterns and reasons for consumption of energy drinks mixed with alcohol differ by gender. Specifically, men were more likely to consume energy drinks mixed with alcohol when compared to women and were more likely to report they consumed energy drinks mixed with alcohol so that they can party longer, drink more without feeling as drunk, and for relaxation. While little work has examined gender differences among users of energy drinks mixed with alcohol, our findings are similar to previous work that suggests men are more likely to consume energy drinks (Berger et al., 2011; Miller, 2008a, 2008b; O’Brien et al., 2008) for reasons often associated with social activities (Peacock et al., 2013).

While this study provides insights into the patterns of consumption and reasons for energy drink use among a diverse sample of first-year college students, it also has limitations. Primarily, causal relationships cannot be drawn as cross-sectional data were used; yet, important associations have been found and should likely be explored in future longitudinal research. Data were also drawn from a single, large US university during the spring of 2010, possibly limiting generalisability and underreporting of current energy drink trends. Because of this, future research should consider examining energy drink consumption across a variety of campuses, age groups and countries through a variety of methods, including qualitative data collection techniques, as this may allow for a more nuanced understanding of the reasons for consumption of these beverages. Furthermore, this study did not directly assess the number of energy drinks consumed in an entire day. Because of this, future research should consider including additional questions regarding daily consumption of energy drinks. The response rate for this study was relatively low (20.3%) when compared to other survey methods; yet, it is not uncommon for Internet surveys (Shih and Fan, 2008) and is similar to previous web-based research with college students (Latimer et al., 2014).

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Conclusion and implications First-year college students appear to consume regular energy drinks most often for reasons related to academics. Of the many brands available, Red Bull and Monster branded energy drinks appear to be drink of choice among current energy drink users. Students mix energy drinks and alcohol for the taste as well as to hide the taste of alcohol, suggesting that energy drinks may help these under- age college youth transition to consuming alcohol as they allow for exploration with alcohol bever- ages without the unwanted taste of alcohol.

When considering the rates at which college students appear to be using energy drinks, the reported side effects and the adverse health outcomes associated with these drinks, universities should consider interventions to address the underlying reasons for consumption, such as aca- demic demands and social influences. Interventions and university programmes aimed at reduc- ing availability of these drinks on campus, educating students on the ingredients as well as potential side effects of energy drinks or providing alternative sources of healthy energy, such as nutrient dense snacks, during peak academic stress periods (e.g. finals week) should be consid- ered as they all have the potential to address the growing problem of energy drink use among college undergraduates.

Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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