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Use of Energy Drinks Among Children and Adolescents: A Cross-Sectional Study



Gulsen Yalcin, Bahattin Sayinbatur, Musa Caynak

Euras J Fam Med 2021;10(1):14-20. doi:10.33880/ejfm.2021100103

 

Original Research


ABSTRACT

Aim: Energy drinks are widely consumed among young people, although they have serious side effects. This study is intended to describe the relations between variables such as socio-demographic characteristics, daily habits, consumption of energy drinks, and its frequency among participants.

Methods: This cross-sectional descriptive research is a survey of consecutive patients aged between 10 and 18 years who admitted to the Pediatric Emergency Outpatient Clinic of Diyarbakır Pediatric Diseases Hospital between November 1, 2019 and April 30, 2020. Note that the frequency distribution and averages were found and categorical data were compared using the chi-square test while numerical data were compared using the independent sample t test.

Results: Note that 503 participants were included in the study; the mean age of the participants was 16.0±1.9 years, 59.4% (n=299), of which were male. Moreover, 64.2% (n=323), of the participants consumed energy drinks with 65.3% (n=211) consuming one can per week; 45.5% (n=147)  of participants consumed energy drinks out of curiosity. Moreover, as the level of education and income of the participants and the parents decreased, the consumption of energy drinks increased, and this was statistically significant. Alcohol, smoking, and substance use increased the rate of energy drinks consumption, which was found to be statistically significant.

ConclusionEducational programs should be planned to inform the whole society, and especially children and adolescents with low socioeconomic status and educational background about the damages to health caused by energy drinks consumption. Moreover, it is necessary to review the legal regulations for the sale and marketing of energy drinks.

Keywords: energy drinks, consumption, adolescents


Introduction

Energy drinks (ED), which are accessible everywhere including shops, gas stations, and vending machines, are marketed to reduce the feeling of fatigue and to boost mental alertness and concentration. Currently, the consumers of ED are mostly adolescents aged between 10 and 18 years (1). In USA, the number of ED-related admissions to emergency services doubled between 2007 and 2011 (2). With an estimated global market share of 39 billion USD in 2013, it is estimated to reach 61 billion USD by 2021 (3). While the main active ingredient in the ED content is caffeine, ED also contain taurine, inositol, riboflavin, pyridoxine, nicotinamide, other types of vitamin B, and other herbal derivatives (4). Despite the side effects and potentially harmful effects, alcoholic and non-alcoholic consumption of these drinks is increasing worldwide. Studies report that ED can have serious short-term and long-term health effects, especially among children and adolescents (5). The most commonly reported side effects of ED include insomnia, headache, dizziness, nausea, vomiting, irritability, abdominal pain, tachycardia, and hypotension (6). Avcı et al. (7) reported death because of excessive consumption of ED before physical activity. Despite these results, the perception of ED among adolescents is usually positive, and this positive perception is associated with higher consumption of ED (8). Studies have mostly focused on the effects of ED consumption on behavior and physical activity. This study investigates the relation between variables such as socio-demographic characteristics, daily habits, and amount and frequency of ED consumption of the population that is at risk because of ED consumption. This study will be of use in developing strategies to reduce ED consumption.

Methods

This cross-sectional descriptive research is a survey of consecutive patients aged between 10 and 18 years who admitted to the Pediatric Emergency Outpatient Clinic of Diyarbakir Pediatric Diseases Hospital between November 1, 2019 and April 30, 2020. Informed written consent was obtained from parents and children before participating in the study and the questionnaire was administered directly to the children. The study protocol was approved by the ethical committee of Diyarbakir Training and Research Hospital (367.11/08/2019). The protocol met all legal requirements and the criteria of the Helsinki Declaration. The data were collected using a survey of 29 questions. Questions 1–10 and 27–29 were related to socio-demographic characteristics (age, gender, educational background of participants and their parents, employment status, economic status, problems in personal life, and health problems), while questions 11–15 were related to habits (daily fluid intake, smoking, alcohol, substance abuse, and habit of physical exercising). Questions 16–26 were related to ED consumption and awareness, and question 17 was determinative and designed to identify those who consumed ED. Participants were not asked to specify an energy drink brand in our study. The children and adolescents who tried ED once were not included among ED consumers. Those who reported that they used ED at least once a week were considered to be the regular consumers of ED. 

Analysis of the data obtained through surveying was carried out using SPSS 15.0, and frequency distribution and averages were identified. Categorical data were compared using the chi-square test, while numerical data were compared using the independent sample t test. Note that p

Results

The study included 503 participants. The mean age of the participants was 16.0±1.9 years (10–18) and 59.4% (n=299) of them were male. Note that 64.2% (n=323) of the participants reported that they consumed ED, and 35.8% (n=180) reported that they had never consumed ED. In this study, there was no statistical significance between the mean ages of the ED-consumers and the non-ED-consumers (p=0.145). In fact, 68.2% (n=204) of men and 58.3% (n=119) of women consumed ED and that was significant (p=0.023). Moreover, 13.3% (n=67) of the participants were students of primary school, 16.1% (n=81) were students of secondary school, 63.4% (n=319) were students of high school, and 7.2% (n=36) were university students. Furthermore, 25.2% (n=127) of the respondents were working, 13.3% (n=67) had separated parents, and 4.8% (n=24) had parental loss. In terms of the income level of the families who participated in our study, 26.2% (n=132) had an income of 4000 TL (Table 1). 

Table 1. Comparison of energy drinks consumption status by socio-demographic characteristics.

 

Energy Drinks Consumption

 

Yes

No

p

Age

 

16.1±2.0

15.9±1.6

0.145

Gender

Male

Female

68.2

58.3

31.8

41.7

0.023

Educational background

Primary school

Middle school

High school

University

97.0

65.4

59.2

44.4

3.0

34.6

40.8

55.6

<0.001

Maternal educational background

Illiterate

Primary school

Middle school

High school

University

97.9

85.2

62.5

31.3

11.8

2.1

14.8

37.5

68.7

88.2

<0.001

Educational background of father

              Illiterate

Primary school

Middle school

High school

University

98.7

97.9

88.8

43.7

15.7

1.3

2.1

11.2

56.3

84.3

<0.001

Parental loss

Yes

No

83.3

63.3

16.7

36.7

0.045

Are parents separated?

Yes

No

70.1

63.3

29.9

36.7

0.276

Are you employed?

Yes 

No

90.6

55.3

9.4

44.7

<0.001

Family income

Under 2000 TL

2000–4000 TL

>4000 TL

97.0

76.7

17.8

3.0

23.3

82.8

<0.001

 

Moreover, 7.2% (n=36) of the respondents had chronic diseases, and 4% (n=20) had chronic medication use. Interestingly, 36.6% (n=184) of those who filled out the questionnaire said they were smoking, while 17.5% (n=88) reported alcohol consumption and 7.8% (n=39) substance use. With decrease in the education level of the participants and their parents, the rate of ED consumption increased, and this was statistically significant (p<0.001). While ED consumption was significantly higher (p=0.045) in those with parental loss, there was no difference in those with separated parents (p=0.276). Moreover, 90.6% of those participants that were employed and 55.3% of the non-employed consumed ED, which was statistically significant (p<0.001). With decrease in the income level of families, the drinking rate increased, and this difference was found to be statistically significant (p<0.001). In fact, 75.5% of smokers and 57.7% of non-smokers had ED consumption, which was statistically significant (p<0.001). Also, 87.5% of alcohol drinkers and 59.3% of those without alcohol consumption had ED consumption, and this was statistically significant (p<0.001). The rate of ED consumption was found to be [a1] 97.4% in those who had substance use and 61.1% in those without substance use, and this was statistically significant (p<0.001). In our study, the ED consumption rate of those who had chronic diseases and who had chronic medication use was higher than those who had no chronic disease and did not have chronic medication use, and this difference was statistically significant (p=0.013, p<0.001). In this study, those who were engaged in regular physical exercising had less consumption of ED (p<0.001) than those who were not (Table 2).

Table 2. Comparison of energy drinks consumption state by some characteristics

 

 

Energy Drinks Consumption

Yes

No

p

Smoking status 

Yes 

No

75.5

57.7

24.5

42.3

<0.001

Alcohol drinking status

Yes

No

87.5

59.3

12.5

40.7

<0.001

Substance use

Yes

No

97.4

61.4

2.6

38.6

<0.001

Are there any chronic diseases?

Yes

No

83.3

62.7

16.7

37.3

0.013

Do you have any medications that you use all the time?

Yes

No

90.0

63.1

10.0

36.9

<0.001

Are you engaged in regular physical exercise?

Yes

No

45.1

71.7

54.9

28.3

<0.001

All values in n (%).

 

Besides, 54.9% (n=276) of our respondents stated that they started ED consumption upon a friend’s recommendation, while 38.8% (n=195) reported that they started through the media, 45.5% (n=147) did it out of curiosity, and 30% (n=97) did it for enjoyment. They stated that they could get more information from doctors 42.9% (n=216) and media 28.8% (n=145) concerning the harms caused by ED. Furthermore, 65.3% (n=211) of the ED consumers said they consumed 250 ml per week, and the respondents also stated that they mostly drank water and tea during the day (Table 3).

Table 3. Information status of respondents on energy drink

 

Issue (n)

%

Who suggested the energy drink?

Friend

Media

Promotion 

Family

 

 

276

195

18

14

 

 

54.9

38.8

3.6

2.8

What is the reason for drinking an energy drink? 

Curiosity

Enjoying

To be awake

Other

 

 

147

97

55

24

 

 

45.5

30.0

17.0

7.5

Who can we get information about their damages?

Doctor

Media

Friend

Family

School

 

 

216

145

69

60

13

 

 

42.9

28.8

13.7

11.9

2.6

How much energy drinks do you take a week?

250–500 ml

>500 ml

 

 

211

75

37

 

 

65.3

23.2

11.5

What is the liquid you consume most?

Water

Tea

Coffee

Coke

Energy drink

 

 

236

149

24

77

17

 

 

46.9

29.6

4.8

15.3

3.4

 

There was no difference between those with ED consumption and those without ED consumption in terms of consuming ED or sports drinks and in terms of reading the information on ED cans (p=0.757). All those who had ED consumption had previously used this drink with alcohol and cola (p<0.001). Compared to those without ED consumption, a higher number of ED consumers gave the response no to the questions concerning habituation and harms of energy drinks, and this difference was statistically significant (p<0.001). Those who had previously received psychiatric support had a higher rate of energy drinks consumption than those who did not receive psychiatric support (86.5% and 60.4%), which was statistically significant (p<0.001; Table 4).

Table 4. Comparison of some of the features of the participants in our study with the state of drinking energy drink

 

Energy Drinks Consumption

 

 

Yes 

No 

Did you read the stimulus inscription on it?

Yes

No

 

 

 

63.0

64.6

 

 

 

37.0

35.4

 

 

 

0.757

Did you take it with alcohol?

Yes

No

 

 

100.0

58.1

 

 

0.0

41.9

 

 

<0.001

Did you get it with a Coke?

Yes

No

 

 

100.0

54.3

 

 

0.0

45.7

 

 

<0.001

Is it harmful to drink an energy drink?

Yes

No

I have no idea

 

 

53.4

76.5

65.6

 

 

46.6

23.5

34.4

 

 

<0.001

Does an energy drink make a habit?

Yes

No

I have no idea

 

 

54.9

79.7

59.4

 

 

45.1

20.3

40.6

 

 

<0.001

Have you ever had psychiatric support?

Yes

No

 

 

86.5

60.4

 

 

13.5

39.6

 

 

<0.001

Do you have psychiatric support in your family?

Yes

No

 

 

 

80.9

61.6

 

 

 

19.1

38.4

 

 

 

0.002

All values in n (%).

Discussion

The lack of legal regulations in many countries has resulted in the aggressive marketing of ED primarily for adolescents and young adults around the globe (9). The frequency of ED consumption is higher in the 15–18 age group compared to the 10–14 age groups (1). In the study conducted by Mansour et al. (10) in Northern Israel with 375 adolescents, the mean age was found to be 16.26 years and that of our participants was 16.0±1.9 years, which was coherent with the literature. In their study, Costa et al. (11) reported that 56% of the participants had ED consumption, while Chang et al. (12) reported ED consumption in 54.1% of their participants. This study reported that 64.2% of the respondents had ED consumption, which was very close to what other researchers reported. In this study, boys were more likely to consume ED than girls, and this trend has been reported in the study by Utter et al. (13) in which it is very common to consume ED together with alcohol. Furthermore, men's emergency service admissions are more often attributed to consumption with alcohol or drugs, while in women it is more common to consume ED in conjunction with other drugs. Studies have reported that young people are more likely to consume ED if they use substances such as tobacco, marijuana, or alcohol (14). 

In this study it was found that men, alcohol consumers, smokers, and substance addicts had higher ED consumption. 

Although Wiggers et al. (15) reported that young people consumed ED to stay awake; this study reported that the reason for ED consumption was found to be curiosity in 45.5% of the participants. This can be explained by the fact that the level of education of young people is low and that they are being influenced by their siblings in their multi-sibling family structure. Moreover, 54.9% of the participants in this study started consuming ED upon the recommendation of their friends. The rate of 51.8% reported by Borlu et al. (16) is similar to this rate herein, and this study reported that 65.3% of the young people consume a can of ED per week. Studies have also reported that ~56% of consumers consume one can per week, whereas 24% can consume two cans per week (1). Borlu et al. (16) reported that the ED consumption rate was high in the young people engaged in regular physical exercise, while this study reported that those engaged in regular physical exercise had lower ED consumption, which can be explained by the high level of education of the children engaged in regular physical exercise. As in the study by Borlu et al. (16) the participants in our study did not know the difference between ED and sports drinks. This result can be explained by the low levels of education. The study conducted by Utter et al. (13) with 8500 adolescents in New Zealand reported that ED consumption and socioeconomic status are linked and that people at high poverty levels consume more ED. The income level of the families included in the present study was reported to be low income in 26.2% and middle income in 43.5%, which was coherent with Utter et al.’s study.

The study by Angles et al. (17) that included 8078 students in Barcelona (Spain) reported that low education levels and poor school performance are high risk factors for ED consumption, which was consistent with our study. However, the study by Park et al. (18) that included Korean adolescents reported different results. The Korean youth consume ED to enhance their cognitive performance, but the young population consumes ED out of curiosity. As in the study by Borlu et al. (16), the present study reported that there were a high number of ED consumers among those with chronic diseases and medication use, and these results show that children and adolescents consume ED even in risky situations. In this study, the rates of ED consumption were high in those who received psychiatric support or had a family member receiving psychiatric support, which is consistent with the study conducted by Park et al. (18) on 68.043 Korean adolescents that reported a high correlation between various mental health problems and ED consumption. Compared to those without ED consumption, a higher number of ED consumers gave the response no to the questions concerning habituation and harms of energy drinks, which is similar to the results from the study of Borlu et al. (16) Thus, ED consumption among children and adolescents will be reduced if their awareness and knowledge levels about the harmful health effects of ED are increased.

Conclusion

Energy drink consumption among adolescents was associated with low economic status, poor family structure, low level of education, and higher risk for tobacco, alcohol, and drug use. Good action plans are required because of the relation between ED consumption and the health-related harms caused by ED. In particular, children are vulnerable to marketing messages (19). Approaches such as launching educational campaigns on potential harms of ED, regulating ED content and labeling, as well as multilevel factors such as restricting the sale and marketing of these beverages and even prohibiting it, as it has been done by the governments, should be considered. Teachers, parents, and healthcare providers should inform all the patients and especially adolescents about the harms caused by ED.

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How to cite: Yalcin G, Sayinbatur B, Caynak M. Use of energy drinks among children and adolescents: a cross-sectional study. Euras J Fam Med 2021;10(1):14-20. doi:10.33880/ejfm.2021100103.


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