Introduction An increasingly problematic
Background
An increasingly problematic issue among college students is the excessive
consumption of energy drinks and highly caffeinated beverages. Since the 1997 debut of
Red Bull, the consumption of energy drinks, and recently energy drinks containing
alcohol, has risen among college students (Miller, 2008). This has occurred for reasons
relating to pressures to perform well academically as well as socially (Malinauskas, Aeby,
Overton, Carpenter-Aeby, & Barber-Heidal, 2007). Companies like Red Bull have been
taking advantage of this market, as over 500 new energy drinks debuted in 2006,
contributing to a 5.7 billion dollar industry (Malinauskas et al., 2007). The Red Bull
company, which originated in Austria, controls nearly half of the energy drink market in
the United States, and the number of energy drink companies continues to grow (Kapner,
2008). Other popular brands of energy drinks include Tab Energy, Monster, Rockstar, No
Fear, Fixx and Wired X505 (Doehny, 2008). These products are produced by major
corporations, such as Pepsico, Coca-Cola, Anheuser Busch, Miller Brewing Company,
and Cadbury Schweppes (Kapner, 2008). In addition, these companies have been
producing energy drinks pre-mixed with alcohol, and marketing them to underage
consumers as well as youth (Kapner, 2008). Popular brands of this mixed beverage
include Four Loko and Joose (Brown University, 2008).
Prevalence
Among college students, 51% of participants reported consuming greater than one
energy drink each month in an average month for the current semester (Malinauskas et
al., 2007). The same study found that 73% of those energy drink consumers had mixed
the beverage with alcohol during the past month (Malinauskas et al., 2007). To support
this finding, O’Brien, Rhodes, Wagoner, Wolfson, and McCoy (2008) reported that
onefourth of past 30-day alcohol drinkers consumed at least one energy drink mixed with
alcohol in the past month. In addition, Miller (2008) had a similar finding, that 26% of
university students reported consuming energy drinks with alcohol in the past 30 days.
Physiological Effects
The main ingredient of concern in energy drinks is caffeine – which causes
detrimental effects in the body including dehydration (from the diuretic effect it carries),
a reduction in insulin sensitivity, increases in mean arterial blood pressure, chronic
headaches, and the possibility for central nervous system, cardiovascular, gastrointestinal
and renal dysfunction (Malinauskas et al., 2007). Steinke, Lanfear, Dhanapal, and Kalus
(2009) found that ingesting two cans of energy drinks elevated pulse pressure, which
“generally serves as a measure of decreased arterial compliance of the larger arteries” (p.
600). Because elevated pulse pressure has been linked to both a greater risk of developing
coronary heart disease and impaired coronary vascular reactivity, regular energy drink
consumption could play a major role in one’s risk for morbidity and mortality (Steinke et
al., 2009).
An even greater problem includes the mixing of energy drinks with alcohol, as
54% of students reported that they have tried this combination (Malinauskas et al., 2007).
There are many dangers and risks associated with combining highly caffeinated
beverages with alcohol. Clinical studies have shown that ingesting caffeine (a central
nervous system stimulant) with alcohol (a depressant) “reduces subjective perceptions of
alcohol-induced impairment in comparison to alcohol alone” (Thombs et al., 2008, p.
325). The major concern with this is that the user may “become desensitized to the
symptoms of alcohol intoxication, which may increase the potential for alcohol related
harm such as alcohol poisoning, physical injury, impaired driving, and sexual
victimization” (Thombs et al., 2008, p. 325-326).” Consequently, because the energy
drinks act as stimulants in the body and alcohol has the reverse effect, one may perceive
they are less intoxicated than they truly are (Miller, 2008).
Reasons for Use
Malinauskas et al. (2007) examined the reasons that students were consuming
energy drinks. Reported reasons were to compensate for insufficient sleep (67%), to
increase energy (65%), or to mix with alcohol while partying (54%) (Malinauskas et al.,
2007). A larger percentage of these users consumed one energy drink to treat the fatigue
from lack of sleep or low energy. There are also reports which suggest that the “ingestion
of energy drinks alone improves psychomotor performance (motor reaction time,
concentration, immediate memory, subjective sensation of alertness, and physical vigor),
physical performance, and mood” (Ferreira, Túlio de Mello, Pompéia, & Oliveira de
Souza-Formigoni, 2006, p.598).
For partying, mixing three or more energy drinks with alcohol was a common
practice, reported by 49% of college students (Malinauskas et al., 2007). One study found
that college students report consuming energy drinks with alcohol for reasons such as a
reduction in sleepiness and an increase in the pleasure sensation, which suggests that
these beverages might reduce the depressant effects and/or increase the excitatory effects
of alcohol (Ferreira et al., 2006). Those who consume energy drinks with alcohol may be
also doing so for the taste – mixing the sweet energy drink with hard liquor might make
the beverage easier to consume, therefore possibly increasing consumption (Arria,
Caldeira, Kasperski, Vincent, Griffiths, & O’Grady, 2011). Combined with alcohol, it is
possible that the caffeine in an energy drink could “reduce the subjective feelings of
being drunk and therefore lead to dose escalation, with the drinker consuming more
alcohol than they otherwise might” (Arria et al., 2011, p. 366).
Risk-taking in College Students
In general, there is reasonable evidence to suggest that college students tend to
engage in various risky behaviors, including substance abuse, violence, and eating
disorders (Ahearn, 2009). Many times, this is a result of stressful lifestyles and newfound
independence. The University of Indiana (2006) reports that more than 30% of all college
freshman report feeling overwhelmed a majority of the time. Engaging in these behaviors
can have major implications for the students’ mental and physical health, as well as their
academic performance (Ahearn, 2009). When looking at energy drink consumption and
its relationship to a college students’ propensity for risk taking, one study found that
energy drink consumption rates were positively associated with marijuana use, sexual
risk-taking, fighting, seatbelt omission, and taking risks on a dare (Miller, 2008).
Implications of the aforementioned study suggested using frequent consumption of
energy drink consumption as a screening indicator to identify students at risk for
substance use and/or other risky behaviors (Miller, 2008).
When looking at energy drink consumption with alcohol, potential negative
effects that may result include individuals consuming higher amounts of alcohol (more
susceptible to alcohol poisoning), physical injury, impaired driving, and sexual
victimization (Thombs et al., 2009). One study reported that in comparison to students
who consumed only alcohol, students who consumed energy drinks mixed with alcohol
had experienced a higher prevalence of alcohol-related consequences, including being
taken advantage of sexually, taking advantage of another sexually, riding with a driver
who was under the influence of alcohol, being hurt or injured, and requiring medical
treatment (O'Brien et al., 2008).
Conceptual Approach
Utilizing a conceptual and/or theoretical approach is important in examining
health promotion and behavior change because it brings an understanding to why people
engage in health-risk or health-compromising behavior (DiClemente, Crosby, & Kegler,
2002). The Theory of Planned Behavior may be a way to help explain one’s decision to
act in regards to certain health behaviors. The Theory of Planned Behavior states that
“individuals’ intention to perform a given behavior is a function of their attitude toward
performing the behavior, their beliefs about what relevant others think they should do,
and their perception about the ease or difficulty of performing the behavior” (Cottrell,
Girvan, & McKenzie, 2009, p. 124; Ajzen, 1991). Thus, the Theory of Planned Behavior
has been used as an underlying foundation in beginning to understand college students’
consumption of energy drinks, both with and without alcohol, in relation to their intention
and related influencing factors.
Statement of the Problem
The often-times stressful lifestyles and newfound independence of American
college students can lead to participation in various risky behaviors, including substance
abuse, violence, and eating disorders (Ahearn, 2009). Engaging in these behaviors can
have major implications for the students’ mental and physical health, as well as their
academic performance (Ahearn, 2009). One issue that is threatening the well-being of
college students is that of energy drink consumption, both with and without alcohol. The
college-student population has proven to be one of the most targeted groups by
energydrink beverage companies, as well as largest group of consumers of energy drinks
with alcohol (Malinauskas et al., 2007). It has been found that energy drink consumption
is closely related to problem behavior syndrome (Miller, 2008). However, because the
rates of production, marketing, and use of energy drinks have risen so greatly in the past
decade, many people are simply not aware of the various risks that consumption of these
beverages is associated with (Miller, 2008).
Because current literature shows that energy drink consumption (with and without
alcohol) is a threat to the health of college students, more evidence is needed not only in
regards to their consumption habits, but how this behavior relates to participation in other
risky behaviors. There is an existing gap in the literature relating energy drink
consumption to risky behaviors, and to the author’s knowledge, no published studies exist
which analyze the behavior of mixing and consuming energy drinks with alcohol (a fairly
new trend) among college students. In addition, the majority of the literature on the topic
of college students and energy drinks only looks at consumption habits, which does not
delve into the student’s attitudes, perception, and intention toward the behavior. This is a
gap which this study aimed to fill to gain a better understanding as to how energy drink
consumption (with and without alcohol) relates to other risky behavior participation, as
well as give some insight into factors which affect the consumption habits of college
students.
Purpose of the Study
The purpose of this study was to assess the relationships between energy drink
consumption (with and without alcohol) and other risky behaviors among college
students at the University of Kentucky, to find out whether a students’ risk awareness for
consuming energy drinks had an effect on whether or not they consumed these beverages,
and to determine if risk awareness affected behavioral intention to consume energy drinks
(with and without alcohol).
Research Questions
In order to achieve these aims, several research questions were investigated.
1. What is the past year energy drink usage (with and without alcohol) among
University of Kentucky college students?
2. Do students who are energy drink users at the University of Kentucky participate
in risky behaviors (i.e. illicit drug use, not wearing a seatbelt, etc.) more often
than non-energy drink users?
3. Is there a significant difference between energy drink users and non-energy drink
users in risk awareness of energy drink consumption (with and without alcohol)
among University of Kentucky college students?
4. Is there a significant difference in behavioral intention to consume energy drinks
(with and without alcohol) in those University of Kentucky students who are
aware of the risks and those who are not aware?
Hypotheses
The predicted outcomes for this study were tested through responses received
from a survey distributed to a convenience sample of University of Kentucky students.
The following hypotheses were addressed:
1. Energy drinks users will exhibit higher participation in other risky behaviors, as
compared to non-energy drink users.
a. Null hypothesis: There is no significant difference in participation in risky
behaviors between energy drink users and non-energy drink users.
2. Energy drink users have a lower awareness level of the risks associated with
energy drink consumption than non-energy drink users.
a. Null hypothesis: There is no significant difference in awareness level of
the risks associated with energy drink consumption between energy drink
users and non-energy drink users.
3. Energy drink users will have a lower awareness level of the risks associated with
energy drink (with alcohol) consumption than non-energy drink users.
a. Null hypothesis: There is no significant difference in awareness level of
the risks associated with energy drink (with alcohol) consumption between
energy drink users and non-energy drink users.
4. Students who are aware of the health risks involved with consuming energy
drinks will have less behavioral intention to use the products within the next 30
days compared with students who are unaware of the health risks associated with
consuming energy drinks.
a. Null hypothesis: There is no significant difference in behavioral intention
to use energy drinks in the next 30 days between students who are aware
of the risks associated with energy drink consumption and those who are
unaware of the risks.
5. Students who are aware of the health risks associated with consuming energy
drinks with alcohol will have less behavioral intention to use the products within
the next 30 days compared with students who are unaware of the health risks
associated with consuming energy drinks with alcohol.
a. Null hypothesis: There is no significant difference in behavioral intention
to use energy drinks with alcohol in the next 30 days between students
who are aware of the risks associated with energy drink with alcohol
consumption and those who are unaware of the risks.
Implications
As previously mentioned, research shows that college students have a propensity
toward risk-taking (Ahearn, 2009). In addition, the consumption of energy drinks with
and without alcohol among college students tends to be related to risk-taking as well
(Miller, 2008). By further investigating students’ energy drink consumption (with and
without alcohol) and their recent and past history regarding risky behaviors, any
relationships between the two variables may uncover a potential need for an increase in
awareness about the dangers of energy drinks. The results of this analysis may provide
health educators with the information necessary to formulate effective awareness
programming for college students.
College students tend to overlook the short-term implications of their actions
rather than the long-term (Ahearn, 2009). As a result, they may not be aware of the
negative physical and mental effects related to energy drink consumption. This study will
assess participants’ overall awareness level regarding the risks energy drink consumption
(with and without alcohol) carries, which will give a clearer understanding on whether
educational programming is needed on this topic. In addition, it will be important to find
out what effect the students’ risk awareness level has on their behavioral intention to
consume energy drinks. Results may show a need for future studies into factors which
may reduce overall intention to consume the beverages.
Delimitations
The scope of this study included Kinesiology and Health Promotion activity-class
(Life Fitness) students as well as students enrolled in General Education courses at the
University of Kentucky. These students were surveyed within a five-week time period
from January-February 2012. Information collected was based on demographics, energy
drink consumption (with and without alcohol), recent history involving risk-taking
behaviors, awareness levels of common side effects, and behavioral intention to consume
energy drinks (both with and without alcohol in the next 30 days.
Limitations
This study was limited by convenience sampling, utilizing students of activity
classes within the Kinesiology and Health Promotion department, as well as students
within General Education courses. Because the survey invitation was sent to course
instructors first, there is a possibility that the instructors did not then forward the survey
on to all of their students, thus limiting the size of the potential sample population. This
may be cause for another limitation, which was a limited number of responses (N=277).
Other limitations included data being self-report (participants may have given false or
socially desirable responses), using an online survey software which may have limited
participation to those who were interested in the topic. Due to the convenience sample
and small sample size, results may not be generalized to other college student
populations.
Definitions
Terms related to this study are defined in this section.
1. Energy drinks are soft drinks containing various ingredients marketed to increase one’s
real or perceived physiological performance. These ingredients include, but are not
limited to carbohydrates, taurine (an amino acid that assists with neurological
development and regulation of water and mineral salt concentrations in the blood),
glucuronolactone (a natural product resulting from metabolism of glucose), and
caffeine (Pettit & DeBarr, 2011).
2. Energy drinks with alcohol are alcoholic beverages that contain caffeine as an additive
and are packaged in combined form (U.S. Food and Drug Administration, 2010). This
term may also represent cocktails containing alcohol and energy drinks as mixers, such
as “Red Bull and vodka” and “Jager Bombs” (Jagermeister and Red Bull), often served
at bars and nightclubs (O'Brien et al., 2008).
Summary
This chapter introduced the reasons behind why energy drink consumption is both
popular among college students as well as potentially harmful for their health. In
addition, the college student population’s tendency to engage in risk-taking behaviors
was explained. The chapter examined that there may be a possible relationship between
energy drink consumption (with and without alcohol) and other risky behaviors, and that
there may be a relationship between energy drink risk awareness and usage rates. Another
potential relationship was mentioned between students’ overall energy drink risk
awareness and behavioral intention to consume the beverages. Thus, the purpose of the
study and related research questions were established. Concluding the chapter were the
limitations, delimitations, and related definitions.
Chapter 2: Literature Review
Introduction
The development, marketing, and consumption of energy drinks within recent
years have risen greatly, especially among college students (Miller, 2008). Since the 1984
founding of Red Bull, Dietrich Mateschitz, its creator, has realized the launch of a whole
new product category in energy drinks (Red Bull, 2011). An astounding 500 new energy
drinks debuted in 2006, which played a major role in creating a 5.7 billion dollar industry
(Malinauskas et al., 2007). Mateschitz’s company is based in Austria, yet controls nearly
half of the energy drink market in the United States (Kapner, 2008). Other popular brands
of energy drinks include Monster, Rockstar, Adrenaline Rush, Atomic Energy, Hansen’s
Hard E, Jones’ Whoop Ass, KMX, Niagra, Power House, SoBe, and Virgin Hi Energy.
Major corporations, such as Pepsico, Coca-Cola, Anheuser Busch, Miller Brewing
Company, and Cadbury Schweppes tend to be in control of many of these products
(Kapner, 2008).
Following this growing trend is the production of energy drinks pre-mixed with
alcohol. Companies are developing these products, which are a mix of energy drinks
(containing anywhere between 80 and 400mg of caffeine), and alcohol (between 6-9%
alcohol by volume) (Weldy, 2010). These major companies have also been marketing the
products to underage consumers and youth, a group which often includes college students
(Kapner, 2008). Energy drinks (neither with nor without alcohol) are not regulated by the
Food and Drug Administration (FDA), meaning beverage producers are not required to
label their products’ caffeine content (Doehny, 2008). Often, energy drinks are marketed
as ‘dietary supplements,’ and are not required to be approved or evaluated before they go
on sale to consumers (Doehny, 2008).
Prevalence
Few studies have been performed regarding the energy drink consumption habits
among college students. However, in a study done by Attila and Cakir (2011), 48.3% of
college students reported ever trying an energy drink (without alcohol). A study done by
Malinauskas et al. (2007) found that 51% of college students reported consuming greater
than one energy drink each month in an average month for the current semester. For
energy drinks with alcohol, the Malinauskas et al. (2007) study found that 54% of
participants reported ever trying the beverage, and that 73% of energy drink consumers
had mixed the beverage with alcohol during the past month. O’Brien et al. (2008)
reported that one-fourth of past 30-day alcohol drinkers consumed at least one energy
drink mixed with alcohol in the past month. In addition, Miller (2008) had a similar
finding, that 26% of university students reported consuming energy drinks with alcohol in
the past 30 days.
Reasons for Use
Some of the reasons that college students report consuming energy drinks
(without alcohol) include to compensate for insufficient sleep (67%), to increase energy
(65%), or to mix with alcohol while partying (54%) (Malinauskas et al., 2007). Ferreira et
al. (2006) reported that ingestion of energy drinks may improve motor reaction time,
concentration, immediate memory, and subjective sensation of alertness, physical vigor,
physical performance, and mood, all reasons that a typical college student may be
inclined to consuming energy drinks. Ferreira et al. (2006) found that college students
report consuming energy drinks with alcohol for reasons such as a reduction in sleepiness
and an increase in the pleasure sensation. It was also found that students may be
consuming the sweet energy drinks with alcohol for the taste, as to make the hard liquor
easier to consume (and possibly increase overall consumption) (Arria, et al., 2011).
Another reason students may consume energy drinks is to cope with stress. Many
times, college students spend a lot of time studying (cramming) for exams, or stay up late
to finish academic projects (Fitzpatrick, 2007). This can lead to increased caffeine
consumption from energy drinks, in order to keep up with pressures to perform well
academically (Fitzpatrick, 2007). In a study by Pettit and DeBarr (2011), it was actually
found that students who consumed energy drinks had lowered academic performance.
The same study also found that students who were characterized by higher levels of
perceived stress consumed more energy drinks on any occasion during the past 30 days,
compared to those with lower levels of perceived stress (Pettit & DeBarr (2011). This
indicates that energy drink consumption, similar to tobacco use or alcohol use, is used as
a coping mechanism for stress, but may not lead to increased academic performance
(Pettit & DeBarr, 2011).
Physiological and Psychological Effects of Energy Drinks
Energy drinks can have many physiological effects on the body, mainly due to the
stimulant ingredients they contain. One of the primary ingredients energy drinks contain
is caffeine. In energy drinks, caffeine content can vary greatly (due to no regulations by
the FDA, and by varying container size). According to the Center for Science in the
Public Interest (CSPI) (2012), the FDA limits caffeine content in sodas to 71mg/12oz
serving size. For the same serving size however (12oz), common energy drinks would
have much greater caffeine levels. Red Bull would contain approximately 120mg,
Rockstar would contain 180mg, and Cocaine would contain 428.6mg (CSPI, 2012). A
typical brewed coffee would contain approximately 80-135mg (CSPI, 2012), but would
typically be consumed much more slowly than an energy drink. Because caffeine causes a
diuretic effect in the body, dehydration, insulin sensitivity reductions, increases in mean
arterial blood pressure, chronic headaches, and the possibility for central nervous system,
cardiovascular, gastrointestinal and renal dysfunction can occur (Malinauskas et al.,
2007). Steinke et al. (2009) also found that elevated pulse pressure can occur after
consuming just two cans of energy drinks (elevated pulse has been linked to increased
risk of coronary heart disease). Franks, Schmidt, McCain and Fraer (2012) showed that
energy drinks alone increased 24-hour daytime blood pressure levels as well.
In one study, Worthley, Prabhu, De Sciscio, Schultz, Sanders, and Willoughby
(2010) examined the effects of energy drinks on blood platelet and endothelial function.
Results from the study showed that those who consumed energy drinks had an acute
increase in platelet aggregation, and decreased endothelial function. The problem with
this is that both of these results have been strongly associated with myocardial infarction
(heart attack) and sudden cardiac death (Worthley et al., 2010). Examinations of two case
studies involving surgical operations on patients who had consumed energy drinks
showed there was an increased risk of intraoperative bleeding (Foran, 2011). This
parallels the findings of Worthley et al. (2010), because intraoperative bleeding and
hemorrhaging is a result of decreased endothelial functioning, which has been shown to
be a result of energy drink consumption (Foran, 2011). Because of this, precautions
before surgeries should be followed regarding what the patient can and cannot consume
ahead of time (Foran, 2011).
Acute caffeine intoxication is also a concern associated with energy drink
consumption. Because energy drink companies are neither required to list caffeine
content nor provide warning labels for their products, consumers may be ingesting higher
levels of caffeine than anticipated (Reissig, Strain, & Griffiths, 2008). This is a
recognized clinical syndrome which is included in the Diagnostic and Statistical Manual
of Mental Disorders and the World Health Organization’s International Classification of
Diseases (Reissig et al., 2008). Specific symptoms of caffeine toxicity include
“nervousness, anxiety, restlessness, insomnia, gastrointestinal upset, tremors, tachycardia,
psychomotor agitation, and in rare cases, death” (Reissig, et al., 2008, p. 4).
Recent research has suggested that energy drink use might pose an additional risk
for alcohol dependence and nonmedical prescription drug use (Arria & O’Brien, 2011).
There is the possibility that “caffeine’s neuropharmacologic effects might play a role in
the propensity for addiction” (Arria & O’Brien, 2011, p. 601). Although more research
needs to be done pertaining to this specific relationship, results of previous studies done
on caffeine consumption have shown that there are many health and safety concerns
present.
Many other ingredients are present in energy drinks. These include various herbs,
pyruvate, protein and amino acids, creatine and cartinine, medium-chain triglycerides,
vitamins and minerals, and hornet’s saliva (Bonci, 2002). Although some of these
ingredients have been shown to have ergogenic effects (consumed alone and in larger
amounts), most have scant or no evidence that any positive effects exist when consumed
in energy drinks (Bonci, 2002).
Physiological and Psychological Effects of Energy Drinks Mixed with Alcohol
There are many dangers and risks associated with mixing alcohol and energy
drinks together. Because the ingredients in energy drinks act as stimulants in the body,
ingesting the beverages with alcohol (a depressant) can “reduce subjective perceptions of
alcohol-induced impairment in comparison to alcohol alone” (Thombs et al., 2008, p.
325). One study even showed that energy drinks mixed with alcohol led to
“neuropsychological deficits in visuospatial judgments and semantic [verbal] fluency”
(Curry and Stasio, 2009, p.480).
In addition, both alcohol and caffeine (main ingredient in energy drinks) are
diuretics. Traue and Stahlman (n.d.) report that this can quickly dehydrate the body,
which could make an individual more prone to alcohol toxicity. Other factors may also
contribute to increased absorption of alcohol into the bloodstream by these mixtures, such
as the carbonation and dilution of alcohol into the mixture (Weldy, 2010). Because of the
diluted alcohol content, the mixture is emptied from the stomach and enters the
fasterabsorbing small intestine quicker than beverages with higher concentrations of
alcohol (Weldy, 2010). In addition, this stimulant-depressant mixture can cause the
consumer to experience other negative effects such as vomiting and respiratory
depression after the stimulant effect wears off (Attila & Cakir, 2011).
Another problem with mixing alcohol and energy drinks is that the user may
“become desensitized to the symptoms of alcohol intoxication, which may increase the
potential for alcohol related harm such as alcohol poisoning, physical injury, impaired
driving, and sexual victimization” (Thombs et al., 2008, p. 325-326).” This can all be due
to the caffeine causing the individual to feel less drunk than they really are (Miller, 2008).
Ferreira et al. (2006) validate this notion, where participants in that study (after
consuming energy drinks mixed with alcohol) had a lower perception of intoxication, but
still exhibited diminished motor skills and visual reaction, both of which could lead to
disastrous consequences. Marczinski, Fillmore, Bardgett, and Howard. (2011) confirmed
this through a study on the effects of energy drinks mixed with alcohol on behavioral
control, stating that “the mix of impaired behavioral inhibition and enhanced stimulation
is a combination that may make energy drink with alcohol consumption riskier than
alcohol consumption alone.”
Marketing
Although the FDA (Food and Drug Administration) regulates the amount of
caffeine allowed in one 12 oz. can of soda (71mg), energy drink companies can navigate
around this by claiming that their product is a “natural dietary supplement,” thus not
needing to be regulated by the FDA (Seifert, Schaechter, Hershorin, & Lipshultz, 2011).
The problem with this lies in the fact that energy drink manufactures are left to determine
the safety of their products, and there is no regulation on what is to be printed on their
labels (such as warnings, adverse effects, testing, or restrictions against sales or
consumption by minors) (Seifert et al., 2011).
Reissig et al. (2008) report that energy drinks tend to be promoted for their
stimulant effects. In addition, energy drink companies often claim that their products
increase attention, endurance, and performance as well as having a positive effect on
weight loss (Reissig et al., 2008). These marketing claims could be reasons why
(according to the Marin Institute) 34% of those age 18-24 report being regular consumers
of energy drinks (Simon & Mosher, 2007). Energy drink companies are effective in
marketing to this age group, utilizing “grassroots” level strategies as opposed to
traditional strategies (television, radio, magazine, and outdoor advertising) (Simon &
Mosher, 2007). These include marketing at “events, extreme sports competitions, Internet
interactions, and communication among users on Internet sites such as MySpace and
Facebook” (Simon & Mosher, 2007, p.1).
Marketing strategies that are utilized to promote alcoholic energy drinks include
strategies such as attractive packaging, brand confusion and providing low-cost
alternatives (Simon & Mosher, 2007). Energy drinks and alcoholic energy drinks often
come in cans that exhibit colorful graphics, exciting fonts, and list sweet, fruity flavors
(Simon & Mosher, 2007). In addition, some companies that produce non-alcoholic energy
drinks also produce the same beverage mixed with alcohol (which plays upon a
consumer’s brand loyalty) (Simon & Mosher, 2007). Pre-mixed alcoholic energy drinks
(costing around three dollars per can) can also be a low-cost alternative to purchasing a
non-alcoholic energy drink and further mixing it with hard alcohol, which is another
reason this is an attractive option for young consumers (Traue & Stahlman, n.d.).
In the News
The growing trend of energy drinks has initiated bans and debates on college
campuses. In October 2011, the University of New Hampshire announced that it would
be banning the sale of energy drinks on its campus, although it later retracted that
decision (Diblasio, 2011). The ban was initially brought about due to the students’
tendency to abuse energy drinks and mix them with alcohol, which included a student
being sent to the hospital (Diblasio, 2011). Although this particular ban was later
retracted, the issue has brought about a great debate across the country. After dozens of
students were sick and nine hospitalized at Central Washington University after drinking
Four Loko (pre-mixed alcoholic beverage), Senator Charles Schumer (D-NY) and others
decided to step in and call for the Food and Drug Administration (FDA) to investigate the
safety of these beverages (Fulton, 2010). In November 2010, the FDA threatened a ban
on Four Loko, warning that “the combination of stimulants, caffeine, and alcohol [is]
unsafe and a public health threat” (Somerville, 2011).
Concerning the risk of energy drinks to one’s health, the Substance Abuse and
Mental Health Administration (SAMHSA) released data relating to energy-drink related
emergency room visits from 2005-2009. In 2005, the number of visits totaled 1,128,
while the number in 2009 was 13,114 – an 11-fold increase (SAMHSA, 2011). The
number even reached a whopping 16,055 in 2008, the highest number to date (SAMHSA,
2011). This report also mentioned that about 44% of these cases were related to
consuming energy drinks with alcohol or illicit drugs, and that 77% of the cases involved
individuals ages 18-39 (SAMHSA, 2011). The highest rate (52%) of the combination
(energy drink and another substance) related incidents were among users ages 18-25
(SAMHSA, 2011).
Link between Energy Drink Consumption and Risky Behaviors
College students tend to possess stressful lifestyles, as their newfound
independence requires them to often times live on their own, support themselves, and
balance their academic and social lives (Ahearn, 2009). In addition, there is evidence
suggesting that college students tend to engage in various risky behaviors, including
unsafe sex, substance abuse, violence, and eating disorders, which can affect their mental
and physical health (Ahearn, 2009). In regards to substance abuse, the National Center on
Addiction and Substance Abuse at Columbia University (CASA) (2007) reported that
49% (3.8 million) of full-time college students were found to binge drink and/or abuse
prescription and illegal drugs. The CASA (2007) study also found that 22.9% (1.8
million) of full-time college students meet the medical criteria for substance abuse and
dependence.
Combined with energy drink consumption (with and without alcohol), risk-taking
propensity can be related to marijuana use, sexual risk-taking, fighting, seatbelt omission,
and taking risks on a dare, as supported by the Miller (2008) study. In addition, energy
drink consumption has also been found to be related to alcoholic tendencies. The study
which determined this involved 1,000 university students (Arria, 2011). It was found that
those students who “consumed caffeinated energy drinks on a weekly or daily basis drank
alcohol more often and in greater quantities, and were more likely to become alcohol
dependent than students who used energy drinks occasionally or not at all” (Arria, 2011).
This study is another example of the link that energy drink consumption has on risktaking
behavior.
Aside from consuming energy drinks alone, ingesting them with alcohol may
bring about even more risk-taking behavior in college students. As was mentioned before,
individuals may end up consuming higher amounts of alcohol when also consuming
energy drinks, which could ultimately lead to alcohol poisoning (Thombs et al., 2009). In
addition, this act could lead to physical injury, impaired driving or riding with someone
who was under the influence, taking advantage of another sexually, and sexual
victimization (Thombs et al., 2009; O’Brien et al., 2008). One study by Cleary, Levine,
and Hoffman (2011) identified various emergency cases in which young adults were
admitted under the influence of the alcoholic energy drink, Four Loko. This product itself
contains a 23.5 oz mixture consisting of 12% alcohol, 156mg of caffeine, and unknown
amounts of guarana and taurine (Cleary et al., 2011). The case report identified patients
who were younger than 25 years old, who had been admitted to the emergency room
under altered mental statuses, having been found in potentially dangerous situations
(Cleary et al., 2011). These situations included laying on subway tracks, being lost and
confused alone in public parks or on public transportation, and being unconscious at
school (Cleary et al., 2011). More than one-third of the patients included in this study also
possessed blood-alcohol content greater than twice the legal limit (Cleary et al.,
2011).
Confirming an inherent risk to consuming energy drinks and alcohol is shown in a
study among intercollegiate athletes. In the study, those who were shown to be
“combined users” (using energy drinks with alcohol) “consumed significantly more
alcohol and had riskier drinking habits (e.g., heavy binge drinking) than athletes who
used alcohol only” (Woolsey, Waigandt, & Beck, 2010, p.65). Results from this study can
conclude that the combined use of alcohol and energy drinks could potentially contribute
to increased risk-taking and negative consequences (Woolsey et al., 2010).
Conceptual Approach
Health behaviors are complex and multifaceted. In order to fully understand the
reasoning behind college students’ energy drink (with and without alcohol) consumption,
it is important to use a conceptual approach. For the purposes of this study, the Theory of
Planned Behavior has been used as an underlying foundation in beginning to understand
college students’ consumption of energy drinks, both with and without alcohol, in relation
to their intention and related influencing factors. The Theory of Planned Behavior
involves an individual’s intention to engage in a certain behavior (Ajzen, 1991), and has
been used in health promotion to target many health behaviors (Frost, 2008). In general, it
can be said that the greater the intention one has to perform a behavior, the more likely
they are to perform it (Ajzen, 1991). Ajzen (1991) states: “Intentions to perform
behaviors of different kinds can be predicted with high accuracy from attitudes toward
the behavior, subjective norms, and perceived behavioral control; and these intentions,
together with perceptions of behavioral control, account for considerable variance in
actual behavior (p. 179).” A diagram of this theory is displayed below, in
Figure 2.1:
Figure 2.1
Ajzen’s Theory of Planned Behavior
Highlighting some of the underlying concepts of the Theory of Planned Behavior
aided in the development of a conceptual framework to guide the aims of the study. As is
shown in the diagram, the Theory of Planned Behavior involves an individual’s attitude
toward the behavior, subjective norm, and the individual’s perceived behavioral control.
According to Ajzen (2006), “Attitude toward a behavior is the degree to which
performance of the behavior is positively or negatively valued (n.p).”. In regards to
subjective norm, Ajzen (2006) writes, “Subjective norm is the perceived social pressure
to engage or not to engage in a behavior (n.p.).” Lastly, regarding perceived behavioral
control, Ajzen (2006) states, “Perceived behavioral control refers to people's perceptions
of their ability to perform a given behavior (n.p.).” Participants were asked questions
which were similar to these constructs in order to gain a better understanding of college
students’ intention and related factors toward energy drink consumption.
Cottrell et al. (2009) explains that an “individuals’ intention to perform a given
behavior is a function of their attitude toward performing the behavior, their beliefs about
what relevant others think they should do, and their perception about the ease or difficulty
of performing the behavior” (p. 124). Ajzen (1991) explains that behavioral intention can
“find expression in behavior only if the behavior in question is under volitional control,
i.e., if the person can decide at will to perform or not perform the behavior” (p. 181-182).
Because of the importance of utilizing a conceptual and/or theoretical approach in health
promotion and behavior change (DiClemente et al., 2002), it was intended this theory be
used to highlight some of the potential influencing factors related to college students’
energy drink consumption. Results from this study may assist future researchers
investigating energy drink consumption in college students to more clearly articulate
theoretical constructs which may be used in a predictive model for energy drink
consumption.
Summary
This literature review provided information relating to the background, marketing,
prevalence, reasons for usage, and physiological and psychological effects of energy
drink consumption, both with and without alcohol. This information was related to the
consumption of these products among college students. In addition, the Theory of
Planned Behavior was explained, as it may serve as a foundation in beginning to
understand the link between energy drink consumption and risky behavior, in addition to
the attitudes, beliefs and perceptions about energy drink consumption among college
students.
Chapter 3: Methodology
The purpose of this study was to assess the relationship between energy drink
consumption (both with and without alcohol) and other risky behaviors among college
students at the University of Kentucky in addition to finding out whether students’ risk
awareness (for consuming energy drinks with and without alcohol) had an effect on
whether or not they consumed or intended to consume these beverages. Differences in
risk awareness between energy drink users and non-users were also assessed. This
chapter will further explain the research design, target population, sampling procedures,
measures used and data analysis for this study.
Research Design
A cross-sectional design was used for this study to collect data on the
aforementioned variables at one time, thereby providing a snapshot of how selected
variables were represented in a convenience sample of college students. A cross-sectional
design can be described by Baumgartner and Hensley (2006) as a “method for testing
many groups and assuming each group is representative of all other groups when they are
at the point in time (p. 181).” Utilizing a cross-sectional design allow researchers to
compare many different variables at the same time (Institute for Work and Health, 2009).
Population and Sampling
Target population. The population included a convenience sample of college
students enrolled in the Life Fitness Program (activity classes) as well as General
Education courses at the University of Kentucky during the spring of 2012. Participants
were not excluded based on academic major, grade point average, gender, race/ethnicity,
or age. An e-mail was sent to course instructors of 57 Life Fitness activity classes within
the Kinesiology and Health Promotion (KHP) Department, as well as 50 general
education course instructors at the University of Kentucky during January and February
of 2012. Course instructors were asked to forward the survey invitation on to their
enrolled students. It was estimated the survey could have potentially reached 2,000
students (assuming all course instructors forwarded the survey).
According to the University of Kentucky’s Office for Institutional Diversity
(2011), during the 2008-2009 academic year, the total population of University of
Kentucky students was 26,054 undergraduate and graduate students (47% male, 53%
female). Seventy-five percent of the student body was age 24 or younger, while the
remaining 25% was age 25 and older. The population included students who were
classified as white/non-Hispanic (84%), African-American (6%), non-resident alien
(5%), Asian (3%), Hispanic (1%), American Indian (<1%), and unclassified (<1%) races.
These students represented 93 undergraduate programs, 99 graduate programs, 66
doctoral programs, and 4 professional programs (University of Kentucky, 2011). It was
determined by including KHP activity courses and General Education courses, a diverse
student body would be reached, as all majors have General Education requirements, and
KHP activity courses are open to any student.
Sampling. Calculating a required sample size based on the overall student
population size at the University of Kentucky was necessary. In doing so, level of
statistical significance, statistical power, and effect size were considered. The significance
criterion was set at α=0.05, power was set at 0.80, and a population correlation coefficient
of 0.15 was assumed. Using a standard sample size calculator, a minimum sample size of
379 was desired (Raosoft Inc., 2004) in relation to the total population of University of
Kentucky students. After several reminders to instructors of the selected courses, the total
number of responses received was 291. After discussing sampling with the thesis
committee members, this sample size was approved, because it elicits at least a 90%
confidence interval (Raosoft Inc., 2004), which is also commonly accepted in social and
behavioral sciences.
Description of Measures
The instrument used for this study was developed using existing measures and
literature findings (Appendix A). Many survey items were based off the long version of
the Core Survey, a 39-item survey developed in the late 1980’s by the Core Institute at
Southern Illinois University-Carbondale (Core Institute, 2010). The CORE Survey was
used as a template to guide instrument development. According to the Core Institute
website, this tool is used by universities to “assess the nature, scope, and consequences of
alcohol and other drug use on college campuses,” as well as to “also assess the students'
attitudes, perceptions, and opinions about alcohol and drugs.” In a doctoral dissertation
entitled Alcohol and Drugs: Attitudes and Use among Graduate/Professional Students at
a Health Science Center, the Core Survey was utilized. Regarding the survey’s validity
and reliability, Moorman (2002) writes:
During the construction of the instrument, a panel of experts reviewed each item
to ensure content related validity (Presley, Meilman, & Leichliter, 1998). Items
were selected for inclusion upon receiving an inter-rater agreement of .90. The
Pearson product-moment correlation coefficient (r) was utilized to measure the
relationship between variables. The results support the claims of stability and
reliability of the CORE Alcohol and Drug Survey. Additionally, item reliability
was tested using Cronbach alpha scores and item-to-total-test correlations for a
selection of individual items. In almost all cases, the results from the measures
met the criteria for inclusion (Presley et al., 1998). Therefore, a valid, reliable,
and standardized instrument with an aggregated national database is available for
comparison purposes (Presley, Meilman, and Lyerla, 1994) (p. 29).
In order to meet the needs of this research study, additional questions were added
regarding energy drinks, including rate of consumption, where students purchase the
beverage, and a measure of risk awareness pertaining to this behavior. From the original
long-form of the CORE Alcohol and Drug Survey, questions 1-9, 11, 14-18, 20, and 3034
remained unchanged. Questions 10, 12-13, 19, 22-25, 27-28, 30-32, and 37-29 were
omitted. In addition, some questions incurred minor alterations in order to be more
specific to consumption rates of, risk awareness of, and attitudes toward energy drinks as
well as energy drinks with alcohol. These questions from the original CORE Alcohol and
Drug Survey were 16, 17, 21, 26, 29, and 35-36.
The final instrument (Appendix A) used in this study included 52 items. In total,
13 questions were included on participant demographics, 5 questions on energy drink
consumption habits (with and without alcohol), 4 questions related to participant attitudes
toward energy drink consumption, 3 questions related to influence of peers and family,
and 2 questions related to availability of energy drinks. In addition, 2 questions were
added regarding participants’ behavioral intention to consume the beverages. The
aforementioned alterations and additions were necessary in order to examine the
relationships between consumption of these beverages and risky behaviors, risk
awareness, and behavioral intention. The final survey was developed after a review of
related literature, insight from university experts in college health and instrument
development, and the use of an underlying conceptual framework highlighting lessons
learned from constructs within the Theory of Planned Behavior.
Prior to completing the survey, participants had access to an initial page
documenting a waiver of informed consent (Appendix F), the purpose of the research,
and an invitation to participate. In addition, participants were made aware that their
answers would be kept confidential, as to maintain privacy. Once this was completed, it
was intended that the survey would take students approximately 15 minutes to complete.
This approximation was based on a pilot test, completed by two students. These students
were asked to take the surveys (before the initial distribution date), to determine if the
instrument needed to be modified (in which case it did not).
Procedures
Protection of human subjects. Prior to issuing the survey, the investigator and
faculty advisor completed the CITI Training and gained the University of Kentucky’s
Institutional Review Board (IRB) approval (Appendix B) to ensure compliance with all
ethical considerations in the handling of informed consent, participant interaction, data
collection, and analysis.
Data collection. All instructors for the activity classes of the Kinesiology and
Health Promotion department as well as General Education course instructors received a
link for the survey from the researcher (via e-mail) (Appendix C), and were instructed to
then distribute it to all students enrolled in their course(s) via e-mail (Appendix D). This
e-mail link was produced by the online-software, SurveyMonkey. Results from the online
survey could only be accessed by the Principal Investigator (PI) and faculty mentor
through the SurveyMonkey account, which was password-protected. The survey was
available online starting late January through February, 2012 (approximately five weeks).
After the first and third weeks of having the survey available, a reminder e-mail was sent
out to instructors (Appendix E), to remind students to complete the survey. An incentive
offered by the researcher for completing the survey was the chance to win one of two $25
retail gift cards. Participants had the opportunity to enter themselves in the drawing at the
end of the survey by providing their e-mail address. The incentive drawing entry was not
linked to an individual’s survey responses, as to keep survey results confidential. Winners
were e-mailed after all data were collected and analyzed (Appendix G).
Once data were collected, only the researchers had access to the completed
instruments (saved as electronic files). The instruments and results were stored on a
computer in the PI’s locked office, accessible only by the PI. The data were entered into
the PI’s password-protected computer, which was also located in the locked office. Only
the PI and faculty mentor had access to these data. Once all of the data were entered, the
PI kept it on file, to be held for a period of five years after submission of the final report
on this project.
Missing data. If the students failed to mark a response throughout the survey, it
was considered missing. If any student had more than 20% of the total responses
considered missing, their data were eliminated from the study. A total of 14 students were
eliminated from this study due to missing data.
Data Analysis
Using the software SPSS 20.0 (IBM, 2011), data were coded and later analyzed.
First, frequencies and percentages for descriptive questions were run, as well as
appropriate means and standard deviations calculated. Participants were grouped
according to their energy drink consumption status. Because many of the survey
participants had consumed both an energy drink with and without alcohol within the past
year, one variable was created to not only obtain the largest sample size (leading to
enhanced statistical significance), but to represent users of energy drinks as a whole.
Separating participants based on energy drink usage with or without alcohol would not
have yielded a large enough sample size for analysis. So, the sample population consisted
of the following: non-energy drink users (those who have consumed less than 6 energy
drinks with or without alcohol the past year) and energy drink users (those who have
consumed an energy drink with or without alcohol at least 6 times within the past year).
Hypotheses and associated independent and dependent variables are listed below:
1. Energy drinks users will exhibit higher participation in other risky behaviors, as
compared to non-energy drink users.
a. Independent variable: Energy drink consumption (with and without
alcohol)
b. Dependent variable: Participation in other risky behaviors
2. Energy drink users have a lower awareness level of the risks associated with
energy drink consumption than non-energy drink users.
a. Independent variable: Risk awareness (low or high) of energy drink
consumption
b. Dependent variable: Energy drink consumption (with and without alcohol)
3. Energy drink users will have a lower awareness level of the risks associated with
energy drink (with alcohol) consumption than non-energy drink users.
a. Independent variable: Risk awareness (low or high) of energy drink
consumption with alcohol
b. Dependent variable: Energy drink consumption (with and without alcohol)
4. Students who are aware of the health risks involved with consuming energy
drinks will have less behavioral intention to use the products within the next 30
days
a. Independent variable: Risk awareness (low or high) of energy drink
consumption
b. Dependent variable: Behavioral intention (low or high) to consume energy
drinks within the next 30 days
5. Students who are aware of the health risks associated with consuming energy
drinks with alcohol will have less behavioral intention to use the products within
the next 30 days.
a. Independent variable: Risk awareness (low or high) of energy drink
consumption with alcohol
b. Dependent variable: Behavioral intention (low or high) to consume energy
drinks with alcohol within the next 30 days
It was necessary to find if there was any difference between energy drink usage
(non-energy drink users and energy drink users) in relation to participation in the various
risky behaviors named in the survey. Participants were given a score based on the number
of risky behaviors in which they participated. Possible score range for awareness of
energy drinks alone was 0.00-22.00, and for energy drinks with alcohol was 0.00-
30.00.Those participants scoring above the mean were considered to have a high risky
behavior score, and those below the mean had a low risky behavior score. The subscale
for participation in risky behaviors was dichotomized so that analysis of results could be
simplified. This led to easily understandable interpretation and presentation of results,
with an estimate of the differences between groups. Once variable was dichotomized, a
2x2 chi-square test was performed to calculate any significant difference between each of
these groups. According to Choudhuri (2009), the assumptions of a chi-square test are
that the population is normal, and that the frequency in any cell is not less than 5.
To satisfy the research question of whether energy drink consumption status is
related to risk awareness of the behavior, a chi-square test was also run. The variables for
this test were risk awareness (low or high, based on participants’ score on how many risks
they were aware of) and consumption status of energy drinks (has or has not consumed an
energy drink at least 6 times within the past year).
In addition, the final research question involved risk awareness and intention to
consume an energy drink with or without alcohol in the next 30 days. To measure
intention, participants were asked how much they intended to consume the beverages
within the next 30 days. Those who answered ‘definitely will consume’ and ‘probably
will consume’ were classified as having high intention, while those who answered
‘probably will not consume’ or definitely will not consume’ were classified as having low
intention. A chi-square test was run, and the variables included risk awareness (low or
high), and behavioral intention to consume an energy drink (low or high).
Summary
This chapter outlined the methodology involved with the current study. First, the
research design was described (cross-sectional design), as well as the population and
what the sampling procedure entailed. In addition, the development of the measure used
for this study was described. Next, the study’s procedures were highlighted, including
IRB approval, data collection, and exclusion criteria for participants with missing data.
Finally, the chapter concluded by describing the processes used for data analysis.
Chapter 4: Results and Discussion
The purpose of this study was to assess the relationship between energy drink
consumption (with and without alcohol) and other risky behaviors among college
students at the University of Kentucky, to find out whether a students’ risk awareness for
consuming energy drinks had an effect on whether or not they consumed these beverages,
and to see if risk awareness affected behavioral intention to consume energy drinks. This
chapter presents the results of this study, summarizing participants’ demographics, energy
drink usage, engagement in risky behaviors, and risk awareness of energy drink
consumption. In addition, responses related to participants’ attitudes toward energy drink
consumption, influence of peers and family, availability and access to energy drinks, and
intent to consume energy drinks are summarized. Finally, the chapter concludes with a
discussion and analysis of the study’s results, as well as its limitations and a summary of
findings.
Demographics
The Energy Drink and Risky Behavior Survey (Appendix A) was sent to students
during the Spring 2012 semester at the University of Kentucky. In total there were 291
respondents; however, 14 participants were excluded due to more than 20% of survey
responses missing or unanswered. Thus, the adjusted total number of participants was
277. Respondents represented 68 different academic majors, with the most frequent
majors including: Kinesiology/Exercise Science (n=54), Nursing (n=16), Biology (n=15),
Psychology (n=13), Education (n=12), and Business (n=10). Table 4.1 displays the
breakdown of the participants’ demographics, including age, gender, race/ethnicity, and
marital status. A total of 58.4% (n=162) of the respondents were female, while 40.4%
(n=112) were male. Although the population ranged in age from 17 to 49 years, 94.6%
(n=262) of participants were between the ages of 18 and 25 years, with ages 19-21
representing 60.3% (n=167) of the population. The mean age of the population was 21.06
years (SD=3.09). The majority of respondents identified themselves as non-Hispanic
whites, with a total of 86.6% (n=240). In regards to marital status, 94.5% (n=262) of
students responded as single/never married, while a total of 5.1% (n=14) of participants
were married/partnered.
Table 4.1
Demographic Breakdown of Gender, Age, Race/Ethnicity, and Marital Status (N=277)
Demographic Frequency %N
Gender Male 112 40.4
Female 162 58.4
No Response 3 1.1
Age 17-19
20-22
23-25
26-28
29+
85
137
41
7
7
30.7
49.5
14.8
2.5
2.5
Race/Ethnicity American Indian/Alaskan
Native, Native Hawaiian
Hispanic or Latino
Asian or Pacific Islander
White (non-Hispanic)
Black (non-Hispanic)
Biracial or multiracial
Other
No Response
2
8
7
240
7
10
2
1
0.7
2.9
2.5
86.6
2.5
3.6
0.7
0.4
Marital Status Single/Never Married
Married/Partnered
Divorced
262
14
1
94.5
5.1
0.4
In addition to basic demographics, participants were also asked to report their
current student classification, enrollment status, grade point average (GPA), job status,
and housing situation (Table 4.2). A total of 23.8% (n=66) of participants were
sophomores, which was the largest class represented. In total, 84.7% (n=233) of
participants were undergraduates, while the remaining 15.3% (n=42) were
grad/professional students or other. GPA ranged from A (4.00) to D+ (1.30), however
91.3% (n=253) of students had a GPA between 2.70 (B-) and 4.00 (A). In addition to
academic and student status, participants reported their working (job) status. Of the 277
participants, 56.0% (n=155) worked part-time, while 6.1% (n=17) worked full-time. A
total of 37.5% (n=103) of students reported they were not currently working. For current
housing status, 65.3% (n=181) of participants reported they were currently living
offcampus.
Table 4.2
Demographic Breakdown of Student Classification, Student Status, Grade Point Average,
Job Status and Housing Situation (N=277)
Demographic Frequency %N
Student
Classification
Freshman
Sophomore
Junior
Senior
Grad/Professional
Other
48
66
58
63
40
2
17.3
23.8
20.9
22.7
14.4
0.7
Student Status Full-time undergraduate (12+
credits)
Part-time undergraduate (1-12
credits)
Full-time graduate (9+ credits)
Part-time graduate (1-9 credits)
227
6
36
6
82.5
2.2
13.1
2.2
Grade Point
Average
(GPA)
A
B
C
D
107
146
21
3
38.6
52.7
7.8
1.0
Job Status Employed full-time
Employed part-time
Not working
17
155
103
6.1
56.0
37.5
Housing Status On-campus
Off-campus
94
181
33.9
65.3
Past Energy Drink (with and without Alcohol) Use, Substance Use, and
Participation in other Risky Behaviors
In addition to participants’ basic demographics, additional descriptive data were
collected based on past energy drink (with and without alcohol) consumption, alcohol
consumption, drug use, and engagement in certain risky behaviors. Table 4.3 shows that
40.4% (n=111) of participants did not use energy drinks (without alcohol) within the past
year. A total of 16.4% (n=45) used energy drinks 6 times within the past year, and 14.2%
(n=39) used energy drinks once in the past year. Table 4.4 shows that for energy drink
usage (with alcohol), a total of 73% of participants (n=200) did not use the beverage at all
within the past year, while 9.9% of participants (n=27) used the beverage once during the
past year, and 10.2% of participants (n=28) used the beverage 6 times within the past
year.
Table 4.3
Past Year Energy Drink Usage (without Alcohol) (N=275)
Consumption Rates Frequency %N
Did not use
Once/year
6 times/year
Once/month
Twice/month
Once/week
3 times/week
5 times/week
Every Day
111
39
45
16
23
25
10
4
2
40.4
14.2
16.4
5.8
8.4
9.1
3.6
1.5
0.7
Table 4.4
Past Year Energy Drink Usage (with Alcohol) (N=274)
Consumption Rates Frequency %N
Did not use
Once/year
6 times/year
Once/month
Twice/month
Once/week
3 time/week
200
27
28
7
6
4
2
73.0
9.9
10.2
2.6
2.2
1.5
0.7
Energy drink users were classified as having used an energy drink (with and/or
without alcohol) at least 6 times within the past year. Thus, a total of 129 individuals were
classified as energy drink users (46.5% of the sample population). All other respondents
were classified as non-users (n=148, 53.4%), having consumed an energy drink less than
6 times within the past year. This variable was calculated to include respondents who
reported consuming an energy drink with or without alcohol (or both) at least 6 times
within the past year. For a participant to be considered as having ‘used’ or ‘engaged in’
other substances or risky behaviors, he or she must have done so at least once within the
past year.
Past-year participation in risky behaviors has been summarized in Table 4.5, for
both energy drink users (N=129) and non-users (N=148). For a participant to be
considered as having ‘used’ or ‘engaged in’ other substances or risky behaviors, he or she
must have done so at least once within the past year. For energy drink users, the most
frequent responses for past-year engagement in risky behaviors were alcohol use (87.5%,
n=113), missing a class (86.0%, n=111), performing poorly on a test or important project
(79.8%, n=103), doing something they later regretted (70.5%, n=91), not wearing a
seatbelt in the car (49.6%, n=64), and getting into an argument or fight (48.8%, n=63).
For non-users, the most frequent responses for past-year engagement in risky behaviors
were missing a class (78.3%, n=116), alcohol use (75.6%, n=112), performing poorly on
an important test or project (68.2%, n=101), and doing something they later regretted
(61.5%, n=91). A greater percentage of energy drink users were found to have engaged in
the following risky behaviors, as compared to non-users: tobacco use, alcohol use,
marijuana use, cocaine use, amphetamine use, sedative use, opiate use, inhalant use,
designer drug use, steroid use, other illegal drug use, missing a class, doing something
they later regretted, getting into an argument or fight, participating in an extreme sport,
being hurt or injured, riding in a car with someone who was driving under the influence,
being in trouble with authorities, seriously thinking about suicide, been taken advantage
of sexually, tried to commit suicide, and been arrested for DUI/DWI.
Table 4.5
Past-Year Participation in Risky Behaviors among Energy Drink Users (N=129) and
Non-Energy Drink Users (N=148)
Risky Behavior Energy Drink Users %N Non-Users %N
Tobacco
Alcohol
Marijuana
Cocaine
Amphetamines
Sedatives
Hallucinogens
Opiates
Inhalants
Designer drugs
Steroids
Other illegal drugs
Missed a class
Performed poorly on a test or
important project
Done something I later regretted
Got into an argument or fight
Not worn a seatbelt while in a car
Participated in an extreme sport
Been hurt or injured
Rode in a car with someone who
was driving under the influence
Driven a car while under the
influence
Been in trouble with police,
residence hall, or other college
authorities
Experienced signs/symptoms of an
eating disorder
Tried unsuccessfully to stop using
drugs or alcohol
Seriously thought about suicide
Have been taken advantage of
sexually
Damaged property, pulled fire
alarm, etc.
Have taken advantage of another
sexually
Tried to commit suicide
47
113
48
5
14
4
5
3
1
5
1
2
111
103
91
63
64
44
46
47
28
14
14
6
12
10
3
2
2
36.4
87.5
37.2
3.8
10.8
3.1
3.9
2.3
0.8
3.9
0.8
1.6
86.0
79.8
70.5
48.8
49.6
34.1
35.6
36.4
21.7
10.8
10.8
4.7
9.3
7.8
2.3
1.5
1.5
0.8
20
112
32
1
2
1
7
0
0
4
0
1
116
101
91
59
71
33
38
43
24
11
17
7
8
10
7
3
0
13.5
75.6
21.6
0.7
1.4
0.7
4.7
0.0
0.0
2.7
0.0
0.7
78.3
68.2
61.5
39.8
47.9
22.3
25.6
29.0
16.2
7.4
11.5
4.7
6.8
6.8
4.7
2.0
0.0
0.7
Been arrested for DUI/DWI 1 1
Reasons for Consuming Energy Drinks
Reasons for consuming energy drinks (without alcohol) were determined for those
who answered that they had ever consumed at least one energy drink (without alcohol)
(n=184). Results are summarized in Table 4.6. The most common reasons for consuming
energy drinks within the past year were feeling tired from insufficient sleep (54.9%,
n=101), increasing overall energy (50.0%, n=92), staying awake to study/finish a project
(49.4%, n=91), staying awake for class (32.6%, n=60), and staying awake to drive a car
for a long period of time (30.9%, n=57). Other reasons listed in the ‘other’ category
included being offered a free sample, wanting to try it/just for fun, and for the taste.
Reasons listed for choosing an energy drink over another beverage included wanting to
stay awake (60.3%, n=111), feeling tired (54.3%, n=100), the taste (34.2%, n=63), and
ease of availability (26.6%, n=49). Reasons listed in this ‘other’ category included calorie
count, experimentation, and to help with mental focus.
Table 4.6
Reasons for Consuming Energy Drinks (without Alcohol) (N=184)
Reason Frequency %N
Feeling tired from insufficient sleep
Increase overall energy
To stay awake to study/finish a project
To stay awake for class
Stay awake to drive a car for a long period of time
To stay awake for work
Drink with alcohol while partying
To deal with stress
To supplement an exercise routine
To treat a hangover
101
92
91
60
57
43
31
17
10
7
54.9
50.0
49.4
32.6
30.9
23.3
16.8
9.2
5.4
3.8
Table 4.7 summarizes the reasons participants consumed energy drinks with
alcohol (if they had consumed at least one of these beverages within the past year). A
total of 171 participants reported they had not consumed an energy drink with alcohol in
the past year, while 106 did consume an energy drink with alcohol. The most frequent
reasons reported for consuming an energy drink with alcohol were to get drunk (50.9%,
n=54), to stay awake longer for partying (33.9%, n=36), followed by a friend’s
influence/offering (32.1%, n=34). Other reasons for consuming an energy drink with
alcohol included the beverage being a good mixer with other liquors and taste of the
beverage. Reasons reported for consuming this type of beverage over another alcoholic
beverage included taste (42.4%, n=45), a friend’s influence (31.1%, n=33), stronger effect
of the alcohol (23.5%, n=25), alcohol content (22.6%, n=24), and price (8.4%, n=9).
Other reasons listed by respondents included wanting to try it/experimentation and to use
it as a ‘chaser’ for stronger liquors.
Table 4.7
Reasons for Consuming Energy Drinks (with Alcohol) (N=106)
Reason Frequency %N
To get drunk
To stay awake longer for partying
A friend offered it to you
Drink prior to going to bars
To see what would happen/effects
To increase ability to focus mentally
To impress a girl/guy
54
36
34
19
11
3
1
50.9
33.9
32.1
17.9
10.4
2.8
0.94
Side Effects Experienced after Consuming an Energy Drink (with and without
Alcohol)
Multiple questions on the survey dealt with whether or not respondents had
experienced any side effects from consuming energy drinks, both with and without
alcohol. For those who had ever consumed an energy drink without alcohol (Table 4.8),
frequencies were calculated to show how many participants had experienced certain side
effects as a result. The most common negative side effects experienced by respondents
were restlessness (28.1%, n=54) and difficulty sleeping (23.4%, n=45). Other common
side effects included experiencing a jolt/crash episode (21.3%, n=41), a headache (20.8%,
n=40), and an anxious/irritated feeling (20.8%, n=40). Some participants also mentioned
that they had experienced a racing heartbeat as a side effect.
Table 4.8
Side Effects Experienced as a Result of Consuming an Energy Drink (without Alcohol)
(N=192)
Side Effect Experienced Frequency %N
Negative side effects
Restlessness
Difficulty sleeping
Jolt/crash episode
Headache
Anxious/irritated
Stomach ache
Heart palpitation
Lack of concentration
Nausea
Muscle twitching
Panic attack
Positive side effects
More energy to go about activities of daily living (ADLs)
Increased ability to focus mentally
Better performance during exercise
54
45
41
40
40
33
23
22
17
16
3
68
52
18
28.1
23.4
21.3
20.8
20.8
17.2
11.9
11.5
8.9
8.3
1.6
35.4
27.1
9.4
For energy drinks with alcohol, side effects experienced are presented in Table
4.9. The most common negative side effects experienced by this group (after consuming
an energy drink with alcohol) included getting drunk quickly (41.3%, n=44),
experiencing a headache (24.3%, n=26), impaired motor control (18.7%, n=20), and
difficulty sleeping (18.7%, n=20).
Table 4.9
Side Effects Experienced as a Result of Consuming an Energy Drink (with Alcohol)
(N=107)
Side Effect Experienced Frequency %N
Negative side effects
Got drunk quickly
Headache
Impaired motor control (loss of balance and coordination)
Difficulty sleeping
Stomach ache
Nausea
Dry mouth
Restlessness
Jolt/crash episode
Heart palpitation
Muscle twitching
Lack of concentration
Anxious/irritated
Panic attack
Positive side effects
Did not feel drowsy effects of the alcohol
Felt less drunk than I really was
44
26
20
20
18
18
17
14
13
10
8
6
4
1
26
14
41.1
24.3
18.7
18.7
16.8
16.8
15.9
13.1
12.1
9.3
7.5
5.6
3.7
9.3
24.3
13.1
Awareness of Energy Drink (with and without Alcohol) Risks
Because there are many proven health risks associated with consuming energy
drinks, it was necessary to determine whether or not survey participants believed that
certain side effects could occur. Participants responded based on whether or not energy
drinks (with and without alcohol) caused selected side effects. Frequencies were
calculated for both energy drink users and non-users.
For energy drinks (without alcohol), results are summarized in Table 4.10. Energy
drink users most often believed that the following negative side effects could occur:
restlessness (61.2%, n=79), difficulty sleeping (60.5%, n=78), jolt/crash episode (51.1%,
n=66), and feeling anxious/irritated (43.4%, n=56). Non-users most often believed that
the following negative side effects could occur: difficulty sleeping (65.5%, n=97),
restlessness (65.5%, n=97), jolt/crash episode (65.5%, n=97), and feeling
anxious/irritated (59.5%, n=88).
Table 4.10
Respondents’ Perception of Risk for Energy Drink (without Alcohol) Consumption among
Energy Drink Users (N=129) and Non-Users (N=148)
Do energy drinks cause this symptom? Yes %N Yes %N (Users) (Non-
Users)
Jolt/crash episode
Headache
Heart palpitation
Stomach ache
Nausea
Difficulty sleeping
Restlessness
Muscle twitching
Anxious/irritated
Lack of concentration
Panic attack
66
53
45
48
30
78
79
44
56
44
24
51.1
41.1
34.9
37.2
23.2
60.5
61.2
34.1
43.4
34.1
18.6
97
87
82
68
60
97
97
85
88
74
52
65.5
58.8
55.4
45.9
40.5
65.5
65.5
57.4
59.5
31.8
35.1
For energy drinks (with alcohol), results are summarized in Table 4.11. Energy
drink users most often believed that energy drinks with alcohol could cause the following
negative side effects: get drunk quickly (52.7%, n=68), impaired motor control (51.1%,
n=66), headache (44.9%, n=58), and difficulty sleeping (43.4%, n=56). Non-users
believed that the following negative side effects could occur for energy drink with
alcohol consumption: impaired motor control (60.1%, n=89), headache (59.5%, n=88),
nausea (58.1%, n=86), restlessness (58.1%, n=86), and lack of concentration (58.1%,
n=86).
Table 4.11
Respondents’ Perception of Risk for Energy Drink (with Alcohol) Consumption among
Energy Drink with Alcohol Users (N=129) and Non-Users (N=148)
Do energy drinks cause this symptom? Yes
(Users)
%N Yes
(NonUsers)
%N
Jolt/crash episode
Dry mouth
Headache
Heart palpitation
Stomach ache
Impaired motor control (loss of balance
and coordination)
Nausea
Difficulty sleeping
Restlessness
Muscle twitching
Anxious/irritated
Lack of concentration
Panic attack
Don’t feel drowsy effects of alcohol
Get drunk quickly
Person feels less drunk than they really are
52
44
58
42
52
66
55
56
53
42
41
48
30
47
68
45
40.3
34.1
44.9
32.6
40.3
51.1
42.6
43.4
41.1
32.6
31.8
37.2
23.2
36.4
52.7
34.9
85
82
88
82
80
89
86
85
86
80
82
86
71
69
82
71
57.4
55.4
59.5
55.4
54.1
60.1
58.1
57.4
58.1
54.1
55.4
58.1
47.9
46.6
55.4
47.9
Perceived Susceptibility for Health Risks of and Addiction to Energy Drinks (with
and without Alcohol)
Survey participants were asked to rate their agreement on whether energy drinks
(both with and without alcohol) could be harmful to their health, and also if they could
become addicted to energy drinks. These ratings were based off of a five-point Likerttype
scale, ranging from strongly disagree to strongly agree. Figure 4.1 and Figure 4.2
summarize how strongly participants agreed that energy drinks (with and without
alcohol) can be harmful to their health.
The majority (73.6%, n=204) of respondents either agreed or strongly agreed that
energy drinks could be dangerous to their health, while 5.8% (n=16) disagreed. This trend
continued with the participants’ beliefs on whether they could become addicted to energy
drinks. A total of 10.1% (n=28) of participants strongly disagreed, 20.2% (n=56)
disagreed, 20.9% (n=58) were neutral, 37.2% (n=103) agreed, and 10.5% (n=29) strongly
agreed.
Figure 4.1: Results based on how strongly respondents agreed that energy drinks (without
alcohol) can be harmful to their health.
Results also showed the majority of respondents agreed that energy drinks with
alcohol could be harmful to their health. A total of 51.9% (n=144) of participants strongly
agreed, 37.9% (n=105) agreed, 7.2% (n=20) were neutral, 1.1% (n=3) disagreed, and
1.1% (n=3) strongly disagreed. In total, 89.8% of respondents agreed that energy drinks
with alcohol could be harmful to their health. In regards to the beverage’s addictive
qualities, the majority of participants also agreed that they could become addicted to
energy drinks with alcohol. A total of 25.9% (n=72) of participants strongly agreed,
28.9% (n=80) agreed, 20.6% (n=57) were neutral, 12.3% (n=34) disagreed, and 11.6%
(n=32) strongly disagreed. So in total, 54.8% of all respondents agreed that they could
become addicted to energy drinks with alcohol.
Figure 4.2: Results based on how strongly respondents agreed that energy drinks (with
alcohol) can be harmful to their health.
Conceptual Framework
This study was guided by a conceptual framework to determine the influencing
factors of energy drink consumption among college students. Building off of the
underpinnings of the Theory of Planned Behavior, students responded to questions which
involved their intent to consume energy drinks in the future, the possible influence of
peers and family, awareness of risk, attitudes, and perception of control regarding energy
drink consumption. Table 4.12 shows the level of intent for consuming both energy drinks
with and without alcohol in the next 30 days. In both categories of beverages, the most
frequent response among participants was ‘definitely will not consume.’ For energy
drinks alone, 48.4% (n=134) said they definitely would not consume the beverages within
the next 30 days. For energy drinks with alcohol, 61.7% (n=171) said they definitely
would not consume the beverages within the next 30 days. Although a small number of
participants were undecided, the majority of responses in both categories indicated
‘probably will not consume’ and the ‘definitely will not consume’ responses.
Table 4.12
Respondents’ Intent to Consume Energy Drinks with and without Alcohol in the Next 30
Days (N=255)
Energy Drinks
without alcohol
%N Energy drinks
with alcohol
%N
Definitely will consume
Probably will consume
Probably will not consume
Definitely will not consume
Undecided
19
24
61
134
17
7.5
9.4
23.9
52.5
6.7
10
13
50
171
12
3.9
5.1
19.5
67.1
4.6
Similar to the construct of perceived behavioral control, students were asked how
much control they had in consuming energy drinks with and without alcohol in the next
30 days. Participants were asked to rate their response anywhere from ‘I feel that I am in
complete control’ to ‘I feel that I am completely not in control’ (Table 4.13). For both
energy drinks with and without alcohol, the majority of respondents felt they were in
complete control. For energy drinks alone, this value was 84.1% (n=233), and for energy
drinks with alcohol, the value was 79.4% (n=220). The total of respondents who felt like
they had some level of control for consuming energy drinks alone was 87.7% (n=243),
compared to the 3.6% (n=10) who felt they were in some way not in control. For energy
drinks with alcohol, 84.5% (n=234) of respondents felt that they had some level of
control, while 5.4% (n=15) felt that they were in some way not in control.
Table 4.13
Perceived Level of Control in Consuming Energy Drinks with and without Alcohol in the
Next 30 Days (N=250)
Energy Drinks
without alcohol
%N Energy drinks
with alcohol
%N
I feel that I am in complete control
I feel that I am somewhat in
control
I feel that I am somewhat not in
control
I feel that I am completely not in
control
233
10
8
0
93.2
4.0
3.2
0.0
220
14
9
6
88.0
5.6
3.6
2.4
Questions were asked related to how friends and family would feel about regular
energy drink consumption (Table 4.14), as well as how many of the survey participants’
friends consumed energy drinks (Table 4.15). The majority (53.7%, n=146) of
participants listed that those who were important to them would be neutral to regular
energy drink consumption (without alcohol), while a total of 34.2% (n=93) of participants
said that those who were important to them would not approve of this behavior. For
regular energy drink with alcohol consumption, 70.5% (n=191) of participants reported
those who were important to them would disapprove or strongly disapprove of this
behavior.
Table 4.14
Attitudes toward Energy Drink Consumption (with and without Alcohol) by those who
were Important to Respondents (N=277)
Energy drinks
without alcohol
%N Energy drinks
with alcohol
%N
Strongly approve
Approve
Neutral
Disapprove
Strongly disapprove
6
27
146
66
27
2.2
9.9
53.7
24.3
9.9
6
10
64
81
110
2.2
3.7
23.6
29.9
40.6
A total of 42.7% (n=117) of participants reported that 1-3 of their friends
consumed energy drinks (without alcohol), while a total of 43.3% (n=119) reported that
1-3 of their friends consumed energy drinks with alcohol. For energy drinks (without
alcohol), another 47.4% (n=130) reported that four or more of their friends consumed the
beverages. For energy drinks mixed with alcohol, 25.8% (n=71) reported that four or
more of their friends consumed the beverages.
Table 4.15
Number of Survey Respondents’ Friends who Consume Energy Drinks (with and without
Alcohol) (N=275)
Energy drinks
without alcohol
%N Energy drinks
with alcohol
%N
0 friends
1-3 friends
4-5 friends
6-7 friends
8 or more friends
27
117
56
20
54
9.9
42.7
20.4
7.3
19.7
85
119
35
10
26
30.9
43.3
12.7
3.6
9.5
Using a semantic scale, participants’ attitudes toward energy drinks (with and
without alcohol) were assessed. Participants were asked whether consuming energy
drinks (with and without alcohol) within the next 30 days would be (somewhere along a
scale) bad to good, harmful to beneficial, foolish to wise, unenjoyable to enjoyable, and
unpleasant to pleasant. Table 4.16 summarizes these attitudes toward energy drink (with
and without alcohol) consumption. For all attitudes, the majority of participants felt that
the behavior was on the lower (more negative) end of each scale. Neutral responses were
excluded. For consuming energy drinks without alcohol, 45.1% (n=125) of participants
felt the behavior was bad, and 43.7% (n=121) felt the behavior was foolish. This is
compared to 7.6% (n=21) feeling the behavior was good, and 5.1% (n=14) feeling the
behavior was wise. For energy drinks mixed with alcohol, 64.3% (n=178) felt the
behavior was foolish, and 63.9% (n=177) felt the behavior was harmful. This is compared
to 3.6% (n=10) feeling the behavior was wise, and 4.0% (n=11) feeling the behavior was
beneficial.
Table 4.16
Attitudes Toward Energy Drink Consumption (with and without Alcohol) within the Next
Month (N=277)
Energy drinks
without alcohol
%N Energy drinks
with alcohol
%N
Bad
Good
Harmful
Beneficial
Foolish
Wise
Unenjoyable
Enjoyable
Unpleasant
Pleasant
125
21
118
29
121
14
105
57
108
14
45.1
7.6
42.6
10.5
43.7
5.1
3.8
20.1
3.9
5.1
174
14
177
11
178
10
139
35
145
27
62.8
5.1
63.9
4.0
64.3
3.6
50.2
12.6
52.3
9.7
Hypothesis Tests
The hypotheses of the research questions guided the statistical analyses. A
chisquare test was utilized in each analysis. For the first research question, it was
necessary to compare energy drink users and non-users according to whether or not they
had a high or low risky behavior score. Participants received a risky behavior score based
on whether or not they had used certain substances or participated in certain risky
behaviors at least once within the past year. The range of risky behavior scores was
calculated to be 0.00-23.00. The mean score for this variable was calculated to be 6.22
(SD=3.41). Any user who fell under this mean value was classified as having ‘low
participation’ in risky behaviors, while those who fell above the mean were classified as
having ‘high participation in risky behaviors. The subscale for participation in risky
behaviors was dichotomized so that analysis of results could be simplified. Since there
were two groups of participants (energy drink users and non-users), creating two groups
representing low and high participation in risky behaviors made performing a 2x2 chi-
square test possible. This led to easily understandable interpretation and presentation of
results, with an estimate of the differences between groups. Frequencies summarized in
Table 4.17 were cross-tabulated, and showed that there was a significant difference
between energy drink users and non-users and their level of participation in risky
behaviors The null-hypothesis stated that there would be no significant difference in
participation in risky behaviors between energy drink users and non-energy drink users. It
was found that energy drink users had significantly higher participation in risky
behaviors, as compared to non-energy drink users, 2 (1, N=250) = 10.639, p=0.001, so
the null-hypothesis was rejected. Of energy drink users, 49.1% (n=57) had a low risky
behavior score, while 50.9% (n=59) had a high risky behavior score. This is compared to
the 68.8% (n=93) of non-energy drink users who had a low risky behavior score, and the
30.6% (n=41) of non-energy drink users who had a high risky behavior score.
Table 4.17
Participation in Risky Behaviors Among Energy Drink Users (N=116) and Non-Users
(N=134)
Energy Drink
Users (n)
%N Non-Energy
Drink Users (n)
%N
Low Risky Behavior Score 57 49.1 93 68.8
High Risky Behavior Score
Total (N)
59
116
50.9 41
134
30.6
For the second research question, it was necessary to compare energy drink users
and non-users according to their risk awareness levels of energy drink consumption (with
and without alcohol). Participants received a risk awareness score based on whether or
not they believed that energy drinks (with and without alcohol) caused certain symptoms.
For energy drinks alone, the range was 11.00-22.00, and the mean score was calculated to
be 16.1 (SD=4.05), so any user who fell below the mean was classified as having a ‘low
awareness level’ of the risks of energy drink consumption, and those who fell above the
mean were classified as having a ‘high awareness level.’ For energy drinks without
alcohol, the range was 15.00-30.00, and the mean score was calculated to be 20.0
(SD=5.66), so any users who fell below the mean was classified as having a ‘low
awareness level’ of the risks of energy drink consumption, and those who fell above the
mean were classified as having a ‘high awareness level.’ The subscale for risk awareness
was dichotomized so that analysis of results could be simplified and easily
understandable, as was done with the risky behavior subscale. Separating each of these
variables in this way made performing a 2x2 chi-square test possible, yielding an estimate
of the differences between the groups.
The frequencies for energy drinks alone are summarized in Table 4.18, and were
cross-tabulated. The null hypothesis stated that there would be no significant difference in
risk awareness of energy drinks (without alcohol) between the energy drink users and
non-energy drink users. It was found that energy drink users had significantly higher
awareness level of the risks of energy drink consumption, as compared to non-energy
drink users, 2 (1, N=233) = 31.531, p=0.000, so the null-hypothesis was rejected. A total
of 63.9% (n=76) of energy drink users were found to have high risk awareness, compared
to 26.1% (n=31) of non-energy drink users.
Table 4.18
Risk Awareness of Energy Drink Consumption Among Energy Drink Users (N=119) and
Non-Users (N=114)
Energy Drink
Users (n)
%N Non-Energy
Drink Users (n)
%N
Low Risk Awareness
High Risk Awareness
Total (N)
43
76
119
36.1
63.9
83
31
114
73.9
26.1
The frequencies for energy drinks with alcohol are summarized in Table 4.19, and
were cross-tabulated. The null-hypothesis stated that there would be no significant
difference in risk awareness for energy drinks with alcohol between the energy drink
users and non-users. Results showed that there was a significant difference between
energy drink users and non-users and their awareness level of the risks of energy drinks
with alcohol, so the null-hypothesis was rejected. It was found that energy drink users had
significantly higher awareness level of the risks of energy drink with alcohol
consumption, as compared to non-energy drink users, 2 (1, N=186) = 31.837, p=0.000. A
total of 62.8% (n=54) of energy drink users had a high risk awareness of energy drink
with alcohol consumption, compared to 22.0% (n=22) of non-energy drink users.
Table 4.19
Risk Awareness of Energy Drink with Alcohol Consumption Among Energy Drink Users
(N=86) and Non-Users (N=100)
Energy Drink
Users (n)
%N Non-Energy Drink
Users (n)
%N
Low Risk Awareness
High Risk Awareness
Total (N)
32
54
86
37.2
62.8
78
22
100
78.0
22.0
For the third research question, it was necessary to compare those who intend or
don’t intend to consume energy drinks (with and without alcohol) and risk awareness
level of energy drink (with and without alcohol) consumption. Participants were asked
how strong their intention was to consume energy drinks (both with and without alcohol)
within the next 30 days. Those who answered that they ‘definitely will consume’ or
‘probably will consume’ energy drinks (with and without alcohol) within the next 30 days
were considered to have intent to consume the beverages, and those who answered that
they ‘probably will not consume’ or ‘definitely will not consume’ were classified as not
having intent to consume the beverages in the next 30 days. Those who answered
‘undecided’ were not included in this analysis. The frequencies for intention to consume
energy drinks alone and risk awareness of energy drinks alone are summarized in Table
4.20, and were cross-tabulated. The null hypothesis stated there would be no significant
difference in behavioral intention to consume the energy drinks among those who were
more or less aware of the health risks involved. Results showed that there was a
significant difference between those who had a high awareness level of the risks of
energy drinks and those who had a low risk awareness level and their level of intent to
consume energy drinks within the next 30 days. It was found that those who had a higher
awareness level of the risks of energy drinks (without alcohol) consumption had greater
intention to consume energy drinks (without alcohol) in the next 30 days, as compared to
those who had a low awareness level, 2 (1, N=202) = 11.781, p=0.001. Therefore, the
null-hypothesis was rejected. A total of 65.0% (n=26) of those who intended to consume
energy drinks (without alcohol) in the next 30 days had a high risk awareness, compared
to 35.2% (n=57) of those who did not intend to consume the beverages.
Table 4.20
Intention to Consume Energy Drinks (without Alcohol) in the Next 30 Days according to
Risk Awareness Level of Energy Drink (without Alcohol) Consumption
Intend to
consume (n)
%N Do not intend to
consume (n)
%N
Low Risk Awareness
High Risk Awareness
Total (N)
14
26
40
35.0
65.0
105
57
162
64.8
35.2
The frequencies for intention to consume energy drinks with alcohol and risk
awareness of energy drinks with alcohol are summarized in Table 4.21, and were
crosstabulated. The null-hypothesis stated there would be no significant difference in
behavioral intention to consume the beverages among those who were more or less aware
of the health risks involved. Results showed that there was a significant difference
between those who had a high awareness level of the risks of energy drinks (with alcohol)
and those who had a low risk awareness level and their level of intent to consume energy
drinks (with alcohol) within the next 30 days, so the null-hypothesis was rejected. It was
found that those who had a lower awareness level of the risks of energy drink (with
alcohol) consumption had significantly lower intention to consume energy drinks (with
alcohol) in the next 30 days, as compared to those who had a high awareness level, 2 (1,
N=179) = 11.670, p=0.001. A total of 73.6% (n=14) of those who intended to consume
energy drinks (with alcohol) in the next 30 days had a high risk awareness, compared to
33.3% of those who did not intend to consume the beverages.
Table 4.21
Intention to Consume Energy Drinks (with Alcohol) in the Next 30 Days according to
Risk Awareness Level of Energy Drink (with Alcohol) Consumption
Intend to
consume (n)
%N Do not intend to
consume (n)
%N
Low Risk Awareness 5 26.3 100 66.6
High Risk Awareness
Total (N)
14
19
73.6 50
150
33.3
Discussion of Results
The purpose of this study was to assess the relationship between energy drink
consumption (with and without alcohol) and other risky behaviors among college
students at the University of Kentucky, to find out whether a students’ risk awareness for
consuming energy drinks had an effect on whether or not they consumed these beverages,
and to see if risk awareness affected behavioral intention to consume energy drinks. The
study included a total of 277 students who were enrolled at the University of Kentucky.
The majority of participants were between the ages of 17 and 22 (80.1%) and the largest
class represented was sophomores (23.8%). The sample also represented a total of 68
academic majors, the largest group majoring in Kinesiology/Exercise Science (19.5%).
With regards to energy drink usage (without alcohol), 59.2% of participants
reported using energy drinks at least once within the past year, and 66.4% reported ever
trying an energy drink. The latter percentage is higher than the 48.3% of college students
who reported ever trying an energy drink (without alcohol) in a similar study (Attila,
2011). Participants most often reported using the energy drinks (without alcohol) for
reasons such as feeling tired from insufficient sleep (54.9%) and to increase overall
energy (50.0%). In a 2007 study, Malinauskas et al. surveyed college students about their
energy drink consumption habits and reasons for doing so. Results from the current study
are consistent with two similar studies, which showed that the most common reasons for
consuming energy drinks among college students were to overcome insufficient sleep and
to increase energy (Malinauskas et al., 2007; Banda, Marietta, Syler, & Hoover, 2010). It
would be interesting for future studies on this topic to also examine the role of gender in
consumption of energy drinks (with and without alcohol), in addition to each gender’s
reasons for consuming the beverages. Findings may be able to further guide how
prevention strategies are implemented on college campuses to target males and females
separately.
It is possible that for the participants in the current study, insufficient sleep may
have been a result of poor time management. A study by Macan, Shahani, Dipboye and
Philips (1990) concluded that learning time management skills is an effective coping
strategy for stresses relating to the busy academic and social lifestyles of college students.
The study found that college students who perceived greater control of their time also
reported significantly greater performance and greater work and life satisfaction (Macan
et al., 1990). Future studies regarding energy drink consumption may want to explore
whether time management has an effect on usage rates. This may give further insight into
whether there is a need for related time management programming on college campuses
(with the goal being to reduce energy drink consumption).
For energy drinks with alcohol, 26.7% of participants used the beverages at least
once within the past year and a total of 38.2% reported having ever tried the mixture. This
finding is lower than the 54% of participants in the Malinuaskas et al. (2007) study who
reported ever trying the beverage. The most common reasons reported for using energy
drinks with alcohol were to get drunk (50.9%), to stay awake longer for partying (33.9%),
and because a friend offered it (32.1%). There were no comparable studies found which
evaluated the most common reasons why college students consume energy drinks with
alcohol, so there is much potential for future research on this topic.
This study examined the relationship between energy drink users and non-users
and their participation in other risky behaviors (i.e. tobacco use, illicit drug use, driving
without a seatbelt, etc.). Energy drink users were considered to be those participants who
reported consuming an energy drink with or without alcohol at least 6 times within the
past year (a total of 46.5% of the population fit this category). After completing a
chisquare analysis, it was found that there was a statistically significant difference
between the groups, with energy drink users receiving a higher overall risky behavior
score compared to non-users (p=0.001). More specifically, differences for each risky
behavior were examined to determine if there was a notable difference among energy
drink users and non-users. The greatest differences between the two groups were seen
with tobacco use (energy drink users had a 23% higher usage rate compared to non-
energy drink users), marijuana use (16% higher usage rate), and alcohol use (13% higher
usage rate). It is shown that for the majority of risky behaviors listed, energy drink users
participated more often than non-users. These findings are consistent a similar study,
which found energy drink consumption co-occurred with substance use and other forms
of risk taking, especially those of tobacco use, alcohol use, and marijuana use (Miller,
2008). The results of the current study and the Miller (2008) study may show that energy
drink consumption (with and without alcohol) may be a predictor of other risky
behaviors. It would be important for future studies to examine whether or not the use of
energy drinks with or without alcohol directly leads to participation in other risky
behaviors and/or further investigate this correlation. If it were true that energy drinks
cause participation in other risky behaviors, aiming to reduce energy drink consumption
should be a major goal of health promotion programming efforts on campus. Engaging in
risky behaviors has been shown to negatively impact students’ mental and physical health
and academic performance (Ahearn, 2008). Thus, reducing energy drink consumption
(and possibly participation in other risky behavior) could lead to increases in students’
health status and
GPA.
Consumption of energy drinks with and without alcohol carries many potential
health risks. Therefore, a major component of this study aimed to examine participants’
overall awareness level of these associated risks. Because consuming energy drinks alone
pose some different risks than consuming energy drinks with alcohol, risk awareness was
assessed separately for each behavior. Many of the health concerns commonly associated
with energy drinks include a rapid heartbeat, headaches, nausea, restlessness/insomnia,
and anxiety (Reissig et al., 2008). For energy drinks mixed with alcohol, health risks
reportedly increase. Some of the risks associated with energy drinks with alcohol include
feeling less drunk than the person really is (increasing potential for alcohol poisoning or
driving under the influence) (Miller, 2008), severe dehydration (Traue & Stahlman, n.d.),
and physical injury (Thombs et al., 2008). This study assessed the level of awareness of
students related to the risks associated with energy drink consumption (with and without
alcohol). Results showed that there was a significant difference between energy drinks
users and non-users and overall risk awareness for both energy drinks alone (p=0.000)
and energy drinks with alcohol (p=0.000). Energy drink users exhibited a higher risk
awareness level for both energy drinks alone and energy drinks with alcohol, compared
with non-users.
According to this study’s underlying foundation (the Theory of Planned
Behavior), an individual’s attitudes and beliefs about a respective behavior contribute to
behavioral intention (Ajzen, 2006). With that in mind, it was hypothesized that one would
be less likely to consume energy drinks (have less behavioral intention) if he or she
believed (or were aware) health risks existed about the respective behavior. However, in
this study, energy drink users were found to be significantly more aware of the risks, yet
they were still consuming the beverages. These results give insight into future
programming efforts, which may need to look at a different approach in prevention
strategies. This study showed that knowledge of the risks does not necessarily prevent
consumption of energy drinks, so it may be necessary to look at the effectiveness of
educating on the alternatives to this behavior (which may elicit the same desired effects
without causing negative side effects). Some of these alternatives could be ensuring
proper water consumption, sufficient amounts of sleep, adequate exercise, and providing
recipes for nutritious, energy-boosting beverages/smoothies. To support this, Bandura
(1990) states: "It is not enough to convince people that they should alter risky habits.
Most of them also need guidance on how to translate their concerns into efficacious
actions (p.1).”
The current study utilizes a conceptual framework, which is guided by the Theory
of Planned Behavior. This theory incorporates one’s behavioral beliefs (attitude toward
the behavior), normative beliefs (subjective norms), and control beliefs (perceived
behavioral control) to explain intention to perform a behavior (Ajzen, 2006). In this
study, the theory was used as a framework, and the behavior focused on was energy drink
consumption, both with and without alcohol. Participants were asked questions which
were similar to the constructs of this theory. Similar to the construct of behavioral beliefs,
participants were asked about their attitudes toward the consumption of energy drinks,
with and without alcohol. Participants were asked how strongly they felt energy drinks
could be harmful to their health. The majority (73.6%) of participants either agreed or
strongly agreed that energy drinks could be harmful to their health. Because the
percentage of respondents who agreed that energy drinks are harmful (73.6%) was so
much greater than the percentage of those who actually were considered to be energy
drink users (46.5%), the finding is encouraging. It may be beneficial for future studies to
use this data in order to analyze whether there was a significant difference between
nonusers and users and agreement on whether energy drinks are harmful.
For energy drinks with alcohol, the results were similar (as shown in Figure 4.2).
A total of 89.8% of participants either agreed or strongly agreed that energy drinks with
alcohol could be harmful to their health. A greater percentage of participants agreed that
energy drinks with alcohol could be harmful to their health (compared to the results for
energy drinks alone). To continue with this trend, a total of 79.1% of participants felt that
consuming energy drinks with alcohol would pose a moderate to great health risk
(compared to 42.6% for energy drinks alone). These results show that the majority of
students are aware that energy drinks with alcohol pose a significant health risk and
possibly a greater risk than energy drinks alone, based on the higher percentage of
respondents answering that energy drinks with alcohol could be harmful to their health or
pose a significant health risk. Although students realize the risk involved with consuming
energy drinks, results show that they are also still consuming (and intend to consume) the
beverages. Overall, this shows that awareness of the health risks does not necessary
reduce consumption. Again, future studies would need to explore factors creating this
positive influence. Once these influential factors are determined, researchers may then
need to implement and test the effectiveness of intervention strategies for reducing energy
drink consumption.
According to Ajzen (2006), subjective norms are the perceived social pressures to
engage or not engage in a behavior. Similar to the construct of subjective norm
participants were asked how much they thought their close friends or family would feel if
they regularly consumed energy drinks with or without alcohol. A much higher
percentage of participants believed their close friends or family would disapprove of their
energy drink with alcohol consumption, compared to energy drinks alone. A total of
33.6% (for energy drinks alone) and 68.9% (for energy drinks with alcohol) of
participants believed that their close friends and family would either disapprove or
strongly disapprove of the respective behaviors. Future studies may need to examine this
question separately, in order to note how strongly close friends would approve or
disapprove of energy drink consumption, and how strongly close family would approve
or disapprove of the behavior. Then, the difference in peer and familial approval could be
more closely examined. In addition, it would be important to look at how much of an
influence students’ friends or family’s opinions actually have on their energy drink
consumption (to see if approval rating affects the decision to consume energy drinks with
or without alcohol). Overall, communication must be encouraged so that youth and young
adults understand associated health risks. In addition, family members must be aware of
these risks as well, especially since energy drink companies target this age group heavily
(Kapner, 2008).
Another question similar to subjective norm which was evaluated in this study
was peer influence, and how many of the participants’ friends consume energy drinks
(with and without alcohol). A total of 89.8% of participants reported that at least 1 or
more of their friends regularly consume energy drinks, and a total of 69.1% of
participants reported that at least 1 or more of their friends regularly consume energy
drinks with alcohol. Future studies could look more deeply at peer influence as a cause
for energy drink consumption. In all, a wide majority of participants had at least one
friend who regularly consumed energy drinks (with and without alcohol). Future studies
may find that peer influence is a predictor for energy drink consumption among college
students. If this finding is true, strategies can be implemented which help students resist
peer pressure. These efforts could utilize various resources on college campuses,
including student health centers, counseling centers, and student involvement. Strategies
these entities may need to employ would include educating students on refusal skills,
ways to build self-esteem, and the many involvement opportunities and resources
available to them. These efforts may work to reduce energy drink consumption (with and
without alcohol) among college students if peer pressure is found to be a major factor
influencing this behavior.
Participants were asked about perception of control, including questions related to
access and availability of energy drinks with and without alcohol. In this study, a total of
93.2% of participants felt that they were in complete control over their decision to
consume energy drinks in the next 30 days, and 88.0% of participants felt this way in
regards to their decision to consume energy drinks with alcohol in the next 30 days.
Although participants were not asked why they may not have felt in complete control,
one factor which may have contributed to this is the number of participants’ friends who
consume the beverages (relating to the subjective norms discussed earlier). Another factor
which may have contributed to perceived behavioral control was the beverages’ addictive
qualities. For energy drinks alone, 47.7% of participants believed they could become
addicted, and over half (54.8%) of participants believed they could become addicted to
energy drinks with alcohol. Also playing a role in affecting survey participants’
behavioral control was availability of the beverages, and how easy it would be for
students to obtain them. The majority (98.5%) of participants felt that obtaining an energy
drink (without alcohol) would be easy, and the same was true for energy drinks with
alcohol, as 80.1% of participants felt that these beverages would be easy to obtain.
Because energy drinks (with and without alcohol) are perceived to be easily available,
there is greater likelihood that students would seek them out if desired and be successful
in doing so.
An additional factor which should be further investigated relates to accessibility
of energy drinks (both with and without alcohol). Most participants in this study felt that
energy drinks with and without alcohol would be easy to obtain, indicating the beverages
were readily available. Although there are no published studies regarding the influence
that availability of energy drinks has on intention, Grover (n.d.) explains that this notion
is true for alcohol consumption. Grover (n.d.) states, “The more available alcohol is in the
environment, the more likely it is that the community will have a higher alcohol
consumption rate (p.11).” It would be helpful for future studies to determine if this is also
true for energy drink consumption as well. In addition, it would be beneficial for these
studies to more closely examine which factors most affect intention, such as peer
influence or availability of the beverages around campus. The findings from future
studies could help to further guide health promotion efforts aiming to prevent energy
drink consumption on college campuses.
Another aim of this study was to determine if there was a significant difference in
behavioral intention to consume energy drinks (with and without alcohol) among those
students who had high risk awareness and those who had low risk awareness. Students
were asked whether or not they intended to consume energy drinks (with or without
alcohol) in the next 30 days. For energy drinks alone, there was a significant difference
between those who were aware and those who were unaware of the health risks
associated, and behavioral intention to consume the beverages in the next 30 days
(p=0.001). The same finding was also true for energy drinks with alcohol (p=0.001). It
was hypothesized that those students who had a high awareness level of the health risks
involved would have a low behavioral intention to use the products within the next 30
days. Results showed however, that the opposite was true. For both beverages, students
who had a high awareness level of associated risks had a high intention to consume the
beverages.
Results showed that awareness of the health risks involved may not affect future
consumption of the beverages. This is important, because it may lead campus health
educators to focus energy drink prevention efforts away from using methods like scare
tactics or statistics. As with other issues prevalent among college students (i.e. smoking,
drunk driving, etc.), Asper (2006) explains that these methods are not successful. In
various studies, strategies used such as scare tactics included films and photos of what
would happen if students didn’t follow certain health recommendations (Rogers &
Mewborn, 1976), and dramatic reenactments of bad decisions (Matwychuk, 2003). In
cases like these, the scare tactics were not effective for the adolescent group being
studied. The main reason why scare tactics don’t work is biological. Studies show that in
adolescents, the regions of the brain responsible for controlling impulses and using proper
judgment are not fully developed until the early to mid-20’s (Asper, 2006). In the current
study, the majority of participants were between the ages of 18 and 22, and although
shown to be aware of the health risks involved, they still intended to consume energy
drinks with and without alcohol.
For future programming efforts involving the prevention of energy drink
consumption in this population, it would not be beneficial to utilize scare tactics, based
on results from similar studies, the population (age group) being targeted, and the little to
no influence risk awareness had toward intention to consume energy drinks. Perhaps
more effective methods for reducing energy drink consumption (with and without
alcohol) would be to employ sound intervention strategies based on theoretical guidance.
Using these strategies may determine what factors most influence outcomes. From there,
the intervention strategies would need to also be tested to determine if results were
significant for both the targeted population and health behavior (energy drink
consumption).
Limitations
There were several limitations to this study. First, a convenience sample of college
students was administered the survey, so the sample may not be representative of the
university and/or may not be generalized to other college campuses. In addition, all data
was self-report, which in itself lends to threats to validity. One limitation of self report
data is social desirability, in which respondents answer in a (possibly untruthful) way
which would be socially acceptable (Miller, 2011). According to the University of
Southern California’s Library Guide (2012), other sources of bias for self-report data
includes selective memory (whether or not a respondent remembers a past experience or
event), telescoping (when respondent recalls an event at a time different than when it
actually took place), attribution (respondent attributes positive outcomes to their own
agency, but negative outcomes to external forces), and exaggeration (embellishing events
or outcomes as more significant than they actually suggested from other data).
Regarding this study, another limitation was the online format of the survey.
Participants were aware of what the general subject matter was before agreeing to
participate, so it is possible that students who were knowledgeable about energy drinks
had a greater response rate. In addition, energy drinks (with and without alcohol) were
not explicitly defined on the survey. Therefore, some students may have been confused as
to what constituted an energy drink.
Finally, there are limitations on what conclusions can be drawn to explain whether
energy drink usage causes participation in other risky behaviors. Although results of the
study showed that energy drink users participated in risky behaviors more often than non-
users, the study did not indicate that consumption of energy drinks was a direct cause for
any of the risky behaviors in which students participated. In addition, the underpinnings
and constructs of the Theory of Planned Behavior were incorporated as a conceptual
model and thus not fully operationalized: therefore, findings cannot be used to generalize
theoretical implications.
Summary
This study had several aims, the first being to determine the current status of
energy drink consumption among students at the University of Kentucky. Overall, usage
rates were slightly higher than those reported in other similar studies. Next, the study
aimed to determine if energy drink users participated in risky behaviors more often than
non-users. Overall, energy drink users participated in risky behaviors more often than
non-users (p=0.001), specifically with tobacco, alcohol, and marijuana use. Third, the
study examined whether there was a difference between energy drink users and non-users
and overall risk awareness of energy drink consumption with and without alcohol. It was
expected that energy drink users would have a lesser risk awareness, based on the
premise that if they were aware of the health risks, they would not consume the beverage.
The findings were opposite however, as energy drink users actually had a higher risk
awareness (compared to non-users) of energy drink consumption with alcohol (p=0.000)
and without alcohol (p=0.000). Lastly, the study looked at risk awareness as it compares
to behavioral intention to consume energy drinks in the future. It was found that those
who had higher risk awareness of energy drinks with alcohol (p=0.001) and without
alcohol (p=0.001) also had a higher intention to consume the respective beverages in the
next 30 days, compared to those who had a lower risk awareness.
Chapter 5: Summary, Conclusions, and Implications
Summary
The present study examined college students’ current usage rates of energy drinks
(with and without alcohol), how high their risk awareness was regarding energy drink
consumption, and whether energy drink users participated in risky behaviors more often
than non-users. This study also utilized a conceptual approach, guided by the Theory of
Planned Behavior. Data collection was guided by the theory’s constructs in relation to
energy drink consumption. Results from these findings indicate possible factors affecting
the students’ overall intent to consume energy drinks in the near future, but further studies
more accurately representing this theory would need to take place. With this, the study
investigated how awareness of risks involved with energy drink consumption (with and
without alcohol) was related to intent to consume the beverages. This chapter presents the
conclusions and implications.
Conclusions
1. A total of 59.2% of participants reported using energy drinks (without alcohol) at
least once within the past year, and 66.4% reported ever trying an energy drink. A
total of 26.7% of participants consumed an energy drink with alcohol at least once
within the past year, while 38.2% reported having ever tried the mixture.
2. This study found that energy drink users exhibited a significantly higher
participation in other risky behaviors as compared to non-energy drink users
(p=0.001). Among energy drink users, 50.9% had a high risky behavior score,
while just 30.8% of non-users had a high risky behavior score. The greatest
differences seen between energy drink users and non-users were with tobacco,
alcohol, and marijuana use.
3. Regarding risk awareness of energy drinks alone, 63.9% of energy drink users
exhibited a high awareness level of assumed risks, as compared to 26.1% of
nonenergy drink users (p=0.000). For energy drinks with alcohol, this trend
continued, with a total of 62.8% of energy drink users being highly aware of these
specific risks, as compared to 22.0% of non-users (p=0.000).
4. Almost two-thirds (65.0%) of those who reported intent to consume energy drinks
within the next 30 days also exhibited a high awareness of associated health risks.
Only 35.2% of those who did not intend to consume energy drinks had high risk
awareness. This difference was found to be statistically significant (p=0.001). For
energy drinks with alcohol, 73.6% of those with intent to consume the beverages
had high risk awareness, compared to 33.3% of those who did not intend to
consume the beverages (p=0.001).
Implications
To the researcher’s knowledge, there are few studies examining energy drink
consumption among college students. Furthermore, there is only one study available
which looks specifically at energy drinks related to participation in other risky behaviors
(Miller, 2008). The current study shows that energy drink use is associated with
participation in other risky behaviors, but does not indicate whether energy drink use
(with or without alcohol) causes other risky behaviors to occur (or vice versa). It would
be important for future studies to look more into this, in addition to whether certain risky
behaviors co-occur more often with energy drink consumption, or what the risk factors
are for energy drink consumption/addiction. Gaining more insight into these topics would
further guide health promotion prevention and programming strategies, which may need
to target multiple risk factors. In addition, utilizing effective programming strategies for
other substance abuse programs for adolescents could prove beneficial. These strategies
would include focusing on decision making and refusal skills, especially if peer influence
is found to be a predictor for energy drink usage (Centers for Disease Control, 2011).
Many students mentioned they consumed energy drinks for reasons such as lack
of sleep, or to stay awake to study or work on a project. There is a possibility that these
reasons directly result from poor time management. Studies have shown that time
management skills help students cope with the various stressors of college life (Macan,
1990). Therefore, this may be an effective strategy to implement for future energy drink
prevention initiatives at the University of Kentucky. When the intent is to decrease or
prevent energy drink consumption among college students, health educators may look to
host time management workshops or webinars, or give out planners to students to aid in
these efforts.
Since there are different health risks involved when comparing energy drink
versus energy drink with alcohol consumption, it was important to examine the behaviors
separately (Thombs et al., 2008; Traue & Stahlman, n.d.). Consumption of energy drinks
with alcohol includes risks such as severe dehydration (Traue & Stahlman, n.d.) and a
perception that one is less drunk than he or she really is (Thombs et al., 2008). Although
in the current study only about a quarter of participants used energy drinks with alcohol
within the past year, 87.5% of energy drink users also reported using alcohol within the
past year. This shows that because most of the energy drink users are also using alcohol,
there is the possibility that at some point they may mix the two substances together
(which poses the greatest health risk). It is important that college administrators realize
this potential threat to students, and work to create environmental change on and around
campus. Some strategies already used in some communities have worked to regulate the
product or point of sale. According to one source, “one community has enacted an
ordinance requiring retailers to post signs warning of the risks of caffeinated alcoholic
beverages. Because cans of non-alcoholic energy drinks and [alcoholic energy drinks]
are so similar, the Virginia Department of Alcoholic Beverage Control has developed a
poster to educate the public on how to tell the difference (U.S. Department of Education,
2010, p.2).” College administrators should work to ban the marketing and sale of all
energy drinks on campus, as well as work to reduce or restrict the sale of alcoholic energy
drinks at local establishments. Changing the environment and availability of energy
drinks for students may enhance their behavioral control, and thus reduce their intention
to consume the beverages.
Previous studies have more specifically targeted the attitudes, perceptions, and
knowledge about energy drinks alone. However, by examining energy drinks mixed with
alcohol separately, this study allowed for more insight to be gained into this fairly new
trend. Interestingly, this study shows that college students are very aware of the health
risks involved. Therefore, it may be necessary for future prevention initiatives to focus on
why students are consuming the beverages (this study pointed toward reasons such as
taste, peer influence, stronger effect of the alcohol, alcohol content, and price). Once a
clearer understanding is reached about the reasons for consuming alcoholic energy
drinks, more emphasis can be placed on educating students of alternatives to the
beverages (ways to safely obtain similar effects without the same health threat).
As was previously mentioned, the present study incorporated an evaluation of
how aware college students were of the health risks associated with consuming the
energy drinks with and without alcohol. Overall, students were more aware of the health
risks involved than expected, but were still consuming (and intended to consume in the
future) the beverages. Therefore, it is important that college health educators understand
that knowledge of risk may not lead to prevention of this behavior specifically. In
addition, this study uncovered that energy drink users also partake in tobacco use, alcohol
use, and marijuana use at a much higher rate than non-users. It may be helpful for
educators to also incorporate energy drink prevention strategies with those already
established for alcohol and drug prevention.
Using the Theory of Planned Behavior to build the conceptual framework for the
current study gives some insight into factors influencing energy drink consumption
among college students. Future studies should operationally define each of the constructs
to further investigate predictors of intention to consume and actual consumption rates of
energy drinks (both with and without alcohol) among college students. This information
would be helpful in developing health promotion programming strategies to be used on
college campuses. In addition, future studies should develop validated measures using
these operationally defined constructs of the Theory of Planned Behavior. Researchers
could then collect and examine longitudinal data to determine the appropriateness of
using this theory as a predictor of energy drink consumption among college students,
Building on relevant findings, it would be beneficial to develop and implement energy
drink prevention programs using the Theory of Planned Behavior as a guideline.
In all, this study provided beneficial insight into the consumption of energy drinks
(with and without alcohol) among college students. Through analysis of the data
collected, many conclusions were made which pointed toward possible factors
influencing consumption of these beverages, as well as what relationships existed
between energy drink consumption and participation in other risky behaviors, awareness
of the health risks involved, and behavioral intention to consume the beverages. Results
from this study uncovered a need for future research on these topics. In addition, there is
a need for various intervention strategies to be implemented and tested, so that health
educators may work to effectively reduce energy drink consumption (with and without
alcohol) among college students.
