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Caffeinated Cocktails: Energy Drink Consumption, High-risk Drinking, and Alcohol-related Consequences among College Students

Abstract
Objectives: The consumption of alcohol mixed with energy drinks (AmED) is popular on college campuses in the United States. Limited research suggests that energy drink consumption lessens subjective intoxication in persons who also have consumed alcohol. This study examines the relationship between energy drink use, high-risk drinking behavior, and alcohol-related consequences. Methods: In Fall 2006, a Web-based survey was conducted in a stratified random sample of 4,271 college students from 10 universities in North Carolina. Results: A total of 697 students (24% of past 30-day drinkers) reported consuming AmED in the past 30 days. Students who were male, white, intramural athletes, fraternity or sorority members or pledges, and younger were significantly more likely to consume AmED. In multivariable analyses, consumption of AmED was associated with increased heavy episodic drinking (6.4 days vs. 3.4 days on average; p < 0.001) and twice as many episodes of weekly drunkenness (1.4 days/week vs. 0.73 days/week; p < 0.001). Students who reported consuming AmED had significantly higher prevalence of alcohol-related consequences, including being taken advantage of sexually, taking advantage of another sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring medical treatment (p < 0.05). The effect of consuming AmED on driving while intoxicated depended on a student’s reported typical alcohol consumption (interaction p = 0.027). Conclusions: Almost one-quarter of college student current drinkers reported mixing alcohol with energy drinks. These students are at increased risk for alcohol-related consequences, even after adjusting for the amount of alcohol consumed. Further research is necessary to understand this association and to develop targeted interventions to reduce risk. Energy drinks are beverages that claim to provide a burst of energy by using a combination of caffeine (the principal active ingredient), other plant-based stimulants (e.g., guarana, yerba mate), simple sugars (e.g., glucose, fructose), glucuronolactone (a naturally occurring glucose metabolite), amino acids (e.g., taurine, carnitine, creatine), herbs (e.g., ginkgo biloba, ginseng), and vitamins. The effects of these ingredients are incompletely understood. A 6-ounce serving of brewed coffee contains 100 mg of caffeine; the caffeine content of energy drinks varies considerably, with some energy drinks containing more than 300 mg or more per serving.1 In 2006, Americans spent more than $3.2 billion dollars on energy drinks.2 Declining soda sales have encouraged beverage companies to focus on this lucrative market2 and increasingly to market energy drinks to specific segments of the population,2 including women, herb and vitamin enthusiasts, the affluent, and youth.

” whose duties include distributing free samples and gathering information for Red Bull about individual college cultures to aid in targeted marketing.g. the consumption of a caffeinated beverage has been shown to lessen subjective intoxication in persons who also have consumed alcohol. waterfall kayaking. and alcohol-related consequences within a sample of college students. Red Bull. We hypothesized that college students who consumed AmED would have an increased risk of alcohol-related consequences. The survey was part of the Study to Prevent Alcohol-Related Consequences among college students (SPARC). Jager Bombs. Consuming alcohol mixed with energy drinks (AmED) is common on college campuses.841 students (graduate and undergraduate students combined). we invited a stratified random sample of undergraduate college students attending 10 universities (8 public and 2 private) in North Carolina to complete an online Internet-based survey of alcohol use and other risk behaviors.7 In two laboratory-based investigations.6 The alcohol industry has been criticized for actively promoting the consumption of AmED. Energy drinks are selectively and aggressively marketed to college students.. marketing alcoholic drinks that use energy drinks as an ingredient (e. pricing alcoholic energy drinks below nonalcoholic versions. “Get it up and keep it up”4).”“WhoopAss.. This study examines the relationships between energy drink use. Emergency physicians have an opportunity and a responsibility to address unhealthy alcohol use with their patients. “You can sleep when you’re 30”3.Thirty-four percent of 18.to 24-year-olds are regular energy drink users. Campus administrators were approached by the study team during the project protocol development and asked whether they wanted their students to participate. Red Bull and vodka).5 The company also employs “mobile energy teams” to provide free energy drinks to the public and to “educate” consumers about the benefits of energy drinks. These administrators . a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded randomized community trial to reduce highrisk drinking among college students. enlists “student brand managers. and using the student-based marketing strategies already exploited by energy drink companies..11 Alcohol is the major risk factor for injury.” and catchy slogans that emphasize endurance and sexual prowess (e. Young people are explicitly targeted at extreme sports events (e. parasailing). with all universities having a graduate program.g.8. Campus sizes ranged from approximately 5. Methods Study Design and Population In Fall 2006. race car driving.g. high-risk drinking behavior. for example.2 Many energy drinks are marketed to young consumers through the careful selection of “taboo” drink names such as “Daredevil. by creating brand confusion with nonalcoholic versions.9 A small double-blinded study detected no significant differences in the physiologic and biochemical parameters of volunteers who drank alcohol compared to alcohol plus energy drink.” and “Cocaine. where energy drink sponsorships fuel a belief in the invincibility and stamina of the average energy drink consumer.10 Caffeine has been shown to promote voluntary ethanol consumption in male rats.375 to 44.

We sent nonrespondents up to four reminder e-mails.001 from mixed-effects logistic regression comparing AmED vs. Overall mean ± SD n = 1. and ***p < 0.189 (52%) n = 697 (16%) 1. Human subjects review and study oversight were provided by the Wake Forest University School of Medicine (WFUSM) institutional review board (IRB).g.. one student from each school was randomly selected to receive $100. and cafeterias) encouraging students to check their e-mail accounts for an invitation to participate in the study. The sample size varied between campuses based on the enrollment.00 in PayPal® money.572 (61) 27 (<1) 1. Non-AmED.. We then randomly selected students from each campus by academic classification (“freshman.00 in PayPal® money. residence halls and dorms.01.05.351 (32%) n = 2. AmED. Characteristics of Students by Reporting of Mixing Alcohol and Energy Drinks (AmED) (N = 4. A description of the sample is provided in Table 1. From the list of completions.237) Characteristics. a target response quota of 33% was assumed so that the selected samples would produce sufficient completed surveys to provide the statistical power necessary for the SPARC study. n (%) or Nondrinkers.317 (60) 15 (<1) 468 (21) 546 (25) 331 (47) 360 (52) 6 (<1) 161 (23) 176 (25) Table 1. student unions.”“sophomore.271 students completed the survey. *p < 0.078 (25) 450 (33) 895 (66) 6 (<1) 481 (36) 356 (26) 857 (39) 1.” and “senior”) and sent postcards asking them to check their e-mail accounts for an invitation to complete the online Internet-based assessment.12–14 We first placed posters in common areas on each campus (e. . The e-mail messages contained a link to a secure uniform resource locator (URL) where the student completed the assessment. **p < 0.worked with the study team to ensure that the project adhered to university requirements as well as expectations for student recruitment and participation. All students who completed the survey were sent emails awarding them $10. Gender*** Male Female No response Academic classification Freshman Sophomore 1.”“junior. non-AmED only.110 (26) 1. The review boards of other universities participating in this study either approved this study or officially deferred to the WFUSM IRB.e. 365 per school). Survey procedures have been described in detail elsewhere. A total of 4.14 The Web-site was shut down shortly after the target number from each school was achieved (i. The registrar at each campus provided the e-mail addresses for each enrolled student. However.638 (39) 2. These same randomly selected students were sent messages by e-mail describing the study and encouraging them to complete the online Internet-based assessment.

291 Non-Hispanic white 939 (70) 1.285 (95) 1.7 ± 2.023 (47) 355 (51) (43) No response 23 (<1) 5 (<1) 12 (<1) 6 (<1) Survey Content and Administration The Web-based survey was developed after reviewing the Harvard College Alcohol Survey.766 (81) 586 (84) (78) African American 353 (8) 184 (14) 140 (6) 29 (4) Hispanic 161 (4) 58 (4) 77 (4) 26 (4) Asian/Pacific Islander 228 (5) 94 (7) 109 (5) 25 (4) Other 191 (5) 72 (5) 90 (4) 29 (4) No response 13 (<1) 4 (<1) 7 (<1) 2 (<1) Fraternity/sorority status** Pledge 143 (3) 20 (1) 85 (4) 38 (5) Member 368 (9) 46 (3) 221 (10) 101 (14) 3.16 the Youth Survey questionnaire used in the National Evaluation of the Enforcing Underage Drinking Laws program.4 ± 2.2 Race* 3. .9 20.15 the CORE questionnaire.883 (86) 558 (80) (88) Athletic status*** Intramural 936 (22) 242 (18) 471 (22) 223 (32) Varsity 220 (5) 80 (6) 107 (5) 33 (5) 3.081 Nonathlete 1.8 20.3 ± 2.154 (53) 336 (48) (57) 1. Non-AmED.813 Off-campus 435 (32) 1.0 ± 2.029 (76) 1.237) Characteristics.611 (74) 441 (63) (73) Campus residence 2. AmED.17 DeJong’s College Drinking Survey.8 20.18 and the Youth Risk Behavior Survey.351 (32%) n = 2. Overall mean ± SD n = 1.Characteristics of Students by Reporting of Mixing Alcohol and Energy Drinks (AmED) (N = 4. n (%) or Nondrinkers.045 Junior 334 (25) 546 (25) 165 (24) (25) Senior 840 (20) 158 (12) 515 (24) 167 (24) Other 129 (3) 16 (1) 91 (4) 22 (3) No response 35 (<1) 6 (<1) 23 (1) 6 (<1) Age** 20.19 The questionnaire had 307 items (with multiple skip patterns Table 1.726 Neither 1.401 On-campus 911 (67) 1.189 (52%) n = 697 (16%) 1.

Analysis of the outcome “driving while under the influence” resulted in a . they were permitted to select multiple reasons. Students were asked whether in the past 30 days they had experienced any of the following consequences as a result of their drinking or the drinking of others: being taken advantage of sexually. gender. race. typical number of drinks in a single episode (all as covariates). Items to assess high-risk drinking included: 1) typical number of drinks in a drinking episode. a random intercept model was fit to account for the withinuniversity correlation of student responses so that students were considered nested within campus.20 Students were also asked “In a typical week. Binge drinking was defined in the widely accepted manner as drinking four or more drinks in a row for females and five or more drinks in a row for males. We sought to examine the additional risk of adding energy drinks to alcohol. In the models for alcohol-related consequences. how many days do you get drunk?” where drunk was defined in the standard way as “dizzy. Mixed-effects logistic regression models were fit for the six alcohol-related consequences. These models adjusted for student gender. 68% of all students). pledge. 1 = yes. and within-campus clustering. or neither). or requiring medical treatment. other substance use behaviors.14 The survey measured demographic variables. 2) examine the association of mixing alcohol with energy drinks and high-risk drinking. race. Data Analysis The goals of the statistical analysis were to: 1) estimate the prevalence of mixing alcohol with energy drinks among past 30-day drinkers. and withincampus clustering (school as random effect). attitudes about alcohol consumption. intramural. and 4) greatest number of drinks in a single episode in the past 30 days. riding with a driver who was under the influence of alcohol. 3) number of days drunk in a typical week (range 0–7 days). The logistic models were used to assess if there was a significant increase in the probability of reporting the given consequence in the past 30 days. survey skip patterns restricted the questions about energy drink use to those students who reported that they had drunk alcohol at least once in the past 30. fraternity or sorority status (member. taking advantage of another sexually.886.days (N = 2. and 3) examine the association of mixing alcohol with energy drinks and alcohol-related consequences. of drinks) was first tested and retained in the model if significant at the 5% level. Predicted probabilities were calculated using observed marginals of the covariates. where the observed marginals of the covariates were used in estimating. 2) number of days of binge (or heavy episodic) drinking in the past 30 days (range = 0–30 days). drinking behaviors. and consequences experienced as a result of other students’ drinking. Specifically. age. 0 = no). unsteady.based on the absence of reported behaviors) and took between 17 and 24 minutes to complete. being hurt or injured. a mixed-model approach was used in the statistical analysis. fraternity or sorority status. or neither). The primary independent variable was the indicator variable for consuming energy drinks with alcohol on any day in the past 30 days (AmED. adjusting for student age. consequences experienced from one’s own drinking. the two-way interaction of AmED and typical alcohol consumption (No.”21 High-risk drinking was defined as either heavy episodic drinking or drinking to drunkenness. Because students were nested within 10 universities. or sick to your stomach. Students were asked why they mix alcohol with energy drinks. athlete status (varsity athlete. driving under the influence of alcohol. Drinking outcomes were analyzed using multivariable linear mixed-effects modeling. after adjusting for drinking behaviors. athlete status. Adjusted means and standard errors were calculated for consumption of AmED.

”) In multivariable analyses.23 Figure 1. To illustrate the nature of this interaction effect. p < 0. “That’s how you make Jager Bombs.gllamm. and younger (p < 0. fraternity or sorority members or pledges (p < 0.886 (68%) reported drinking alcohol at least once in the past 30 days. The average age of first drink was younger among students who reported consuming AmED (15. “It was being served at a party”.4 years (range = 17–30 years). Regression assumptions were assessed with residual analyses and influence diagnostics. 2.0 years. Forty-one percent of students provided other reasons (e. 1.040).7 days vs. 5% reported they mix to drink more alcohol and not look as drunk. Results A total of 4.g. 16. Seven percent of students reported mixing energy drinks and alcohol so as not to get a hangover.24 The criterion for statistical significance was a two-sided p-value of <0. white (p = 0.2 (Stata Corp.) Fifteen percent of students reported mixing alcohol with energy drinks to drink more and not feel as drunk. All subsequent analyses are restricted to past 30-day drinkers. Eighty-seven percent of past 30-day student drinkers were between the ages of 18 and 22 years.1 years vs. Multicollinearity diagnostics. Among drinkers. p < 0. Q-Q plots. and Shapiro-Wilk tests. Association of consuming alcohol mixed with energy drinks (AmED) and driving a car under the influence of alcohol.001).org/).22. The average student age was 20. 24% (697 students) reported consuming AmED on at least 1 day in the past 30 days.271 students completed the survey.001). A total of 4.2 days. College Station. Of the 4.01). such as variance inflation factors (VIFs).3. the consumption of AmED was strongly associated with all six highrisk drinking behaviors (see Table 2). Students who reported consuming AmED had more drinking days on average during their last year of high school than those who did not report consuming AmED (1. Compared to current drinkers who did not report consuming AmED. predicted probabilities were calculated for all combinations of these two variables (Figure 1).2%).001). below the diagnostic cutoff of 10).001). intramural athletes (p < 0. TX) and the Generalized Linear Latent and Mixed Models (GLLAMM) package (http://www. were checked and modeling adequacy supported (all VIFs < 1. Univariate analysis for checking normality was assessed using box plots. “It was the only mixer available”.05. 61% of these students were female.significant interaction effect between energy drink consumption with alcohol and typical number of drinks.01) were more likely to consume AmED (see Table 1). Fifty-five percent of students who consumed AmED said they did so to hide the flavor of the alcohol (48% of male mixers and 61% of female mixers. students who were male (p < 0. All analyses were performed using Stata v9..237 students. students who reported consuming AmED drank significantly more during a . In the bivariate analyses.237 students answered questions about past 30-day drinking and consuming AmED (99.

‡p-value is from comparing AmED vs.027). 3. athlete status. AmED. 2.17. p < 0.20. There were significant main effects of consuming AmED (p < 0. 0. 3. b† 95% pDrinking Behavior z Statistic n = 2.96.70 (0.001 Typical No.4 days.28 <0.001).61. or require medical treatment (AOR = 2.001. SE = standard error.15 single episode No.6) 2. Among students who reported mixing alcohol and energy drinks. p = 0.1 drinks. They reported almost twice as many heavy episodic drinking days in the past 30 days. the effect of mixing alcohol and energy drinks depended upon the typical number of drinks the student drank (AmED AOR = 2. p < 0.001). interaction AOR = 0.9 (2. p < 0.001 Most No. but the risk for driving a car under the influence of alcohol was greater at lower number of typical drinks for those students who consumed AmED. race.17 6.69 14. †b is the regression coefficient of the indicator variable comparing AmED to non-AmED drinkers.001).4 days vs. Association of Energy Drink/Alcohol Mixers and Drinking Behaviors (n = 2.4 days/week vs.886)* Non-AmED. p < 0. compared to those students who drank alcohol alone (see Figure 1).4 ± 0.5) 11. as defined by the genderspecific measure of four or more alcoholic beverages in a row for females and five or more alcoholic drinks in a row for males (6.21 <0. 4.8 ± 0.5 drinks/typical session. of drinks in 4.4 ± 0. be hurt or injured (AOR 2. Numbers given in first two columns are adjusted means ± SE from multivariable linear mixed-effects regression model adjusting for student gender.25. p < 0.001 <0.typical drinking session (5.44 14. 2.1. age. p < 0. fraternity or sorority status.5 ± 0. compared to drinking students who did not report mixing alcohol with energy drinks (8.001). *Students who reported drinking in past 30 days only.3 drinks vs. 5. non-AmED for each drinking behavior outcome.77.001).04 1. 5.79) 2. .001) and typical number of drinks (p < 0.93. Table 2. p < 0.002).19 15. of days drunk in a typical week 0.001).001. For driving in a car under the influence of alcohol. 0. 6. AmED = alcohol mixed with energy drinks. 1.189 (76%) n = 697 (24%) CI Value‡ 1.17 30 days No. p < 0.002).18.3 ± 0.2 (1.73 ± 0. 4.8 drinks vs. p = 0.5.001). p < 0. They were more likely to be taken advantage of sexually (adjusted odds ratio [AOR] = 1.3) 0.1 ± 0. the greatest number of drinks in a single episode of drinking was 36% higher.001 <0. take advantage of someone else sexually (AOR = 2. They reported twice as many episodes of weekly drunkenness (1. of drinks in single 6.73 days/week.4 (1. ride with a driver who was under the influence of alcohol (AOR = 2. 3. p < 0. and within-campus clustering.05 8.23 1.4 ± 0. of days with 5/4 heavy episodic drinking in past 3. typical number of drinks AOR = 1.23.007).9.15 episode in past 30 days Students who reported consuming AmED had increased prevalence of all six alcohol-related consequences due to their own drinking (see Table 3).

9) (1. *Students who reported drinking in past 30 days only. 1. age. This association may be a result of changes in the drinker’s perception of intoxication. subjects received a weight-based serving of alcohol alone. This is the first study to suggest that consuming AmED constitutes “high-risk drinking” for college students.2) (1.5. CI = confidence interval.9.20 38.3) 2. 2. Ferreira and colleagues8 evaluated the effects of energy drink ingestion on alcohol intoxication in 26 healthy male volunteers. The doses of alcohol and . typical number of drinks in an episode. students who consumed AmED had dramatically higher rates of serious alcohol-related consequences. independent of the quantity of alcohol consumed. 4.002 3. 1. race.13 0. drunk driving.9. energy drink alone.55) 2.7. 5. 4.17 Required medical treatment 1.55) Rode with a driver who was 2. †p-value is from comparing AmED users to Non-AmED for each drinking behavior outcome in a multivariable mixed-effects logistic regression model adjusting for student gender. ‡Drove a car while under the influence of alcohol not reported in this table due to significant interaction effect of AmED use and typical number of drinks. sexual assault. AOR z pConsequences n = 2.4) (1.25 Serious injury. 15. 2.96) 2. and within-campus clustering.002 7.9% (4. or alcohol plus energy drink.8 On three separate occasions. 2.34. 7.001 2.8) 6. athlete status.8) 2.25 12.7% (2.7% (2.4% (4.05 0.68) 2.77 3.886)* Non-AmED.1) (1. AmED. 3.8.9% (32. 1.6% (1.7) (1. 8.74 <0.2. 45.24.5% (18. sexually 3. under the influence of 22. fraternity or sorority status.7% (1. 3.4) 3.18 Took advantage of another 1. even after adjusting for alcohol consumption. Association of Consuming Alcohol Mixed with Energy Drinks (AmED) and Alcoholrelated Consequences (n = 2.6) alcohol‡ 2.007 Discussion Studies of college students have demonstrated that the risk of alcohol-related consequences is greatly increased at five or more drinks in a row for men and four or more drinks in a row for women.23.83 <0. and death are all associated with heavy episodic drinking.2% (0.8. 26.6.7.7.189 (76%) n = 697 (24%) (95% Statistic Value† (95% CI) (95% CI) CI) AOR = adjusted odds ratio. 4.81. Was hurt or injured 5.70 0.001 5.80) Was taken advantage of sexually 3.3% (9.70.Table 3.26 However.

Students whose motor skills and visual reaction times are impaired by alcohol ingestion may not perceive that they are intoxicated as readily as a result of concomitant energy drink ingestion. sensation-seeking individuals may be drawn to energy drinks. In addition. Ireland. A growing number of countries require manufacturers to have a label warning consumers not to drink AmED. Moreover. and risky behaviors. specifically. performance on tests of motor coordination and visual reaction times was not different among those who drank alcohol. Although this limits the generalizability of our results. post . The subjective symptoms of drunkenness were reduced.30 Australia.5 and 4 alcoholic drinks and 1 can of energy drink. Students who reported drinking AmED had a greatly increased risk of being taken advantage of sexually.28 Students who reported consuming AmED had more than twice the likelihood of taking sexual advantage of someone else. alcohol contributes to misperceptions about a woman’s sexual interest. The United States Food and Drug Administration (FDA) has not issued such a statement. However. but not the drunkenness.27 It may affect the willingness to act aggressively. but also their ability to judge intoxication in someone else. among men. Our results suggest that the association of energy drink ingestion with alcohol on driving a car under the influence was heightened at lower levels of alcohol consumption. breath alcohol concentration was not changed by the ingestion of an energy drink. the relationships between consumption of AmED.32 Finland. Limitations This study used cross-sectional data.29 Worldwide. heavy alcohol consumption. Most significantly. Students who drank AmED were twice as likely to report being hurt or injured compared to students who did not consume AmED and twice as likely to report that they required medical treatment. whether or not they had also ingested an energy drink. Seventy-eight percent of students in this study identified themselves as non-Hispanic whites. different strategies have been employed in efforts to discourage the mixing of alcohol with energy drinks. which limits our ability to assess causal relationships. headache. Students who reported consuming AmED were more than twice as likely to report riding with an intoxicated driver. independent of the amount of alcohol consumed. The ability to gauge one’s level of intoxication may be an important component of risk assessment. and 61% of the respondents were female. high-risk drinking. and alcoholrelated consequences may be result of selection effects. fatigue. trouble walking) were ameliorated when an energy drink was ingested along with the alcohol.33 and France34 have all issued statements about the health risks of consuming AmED. even after adjusting for the amount of alcohol consumed. intoxication may be seen as a justification for inappropriate sexual behavior. In this small double-blinded study. which is only seen at lower blood alcohol concentrations. participants reported that the subjective signs of intoxication (dizziness. The Scientific Committee on Food of the European Commission notes that extensive animal and human studies indicate a “modest” antagonistic effect of caffeine on the depressant effects of alcohol.energy drink chosen for the study approximated that usually ingested on a single occasion: between 2. We suggest that consuming AmED may impair not only students’ ability to judge their own intoxication.31 Sweden. This phenomenon may be responsible for an increased risk of alcohol-related consequences. independent of the amount of alcohol consumed.

References  1 Energy Fiend.or overestimated their alcohol use. including gender. These students are at increased risk for alcohol-related consequences. and ethnicity were related to the amount of alcohol necessary for subjective drunkenness. and gender compositions of the 10 study campuses. the demographic profile of this sample reflects that of undergraduate students in the United States.40 but several demographic and technologic criteria introduce variability in the response rate in Web-based surveys. school year.  3 .36 The study was limited to college students from a particular geographic area. Internet surveys are an efficient method for collecting survey data on college students’ alcohol use. Kerr and colleagues.41 in a summary of three national cross-sectional surveys. In addition. and the prevalence of computer use in everyday campus life. There is regional variation in alcohol use among college students. Health care providers in emergency departments and campus health centers should ask college students whether they consume AmED.38. found that gender. 2007. it is not known whether demographic variables affect subjective drunkenness when energy drinks are consumed concomitantly. such as requiring that energy drinks sold in the United States carry a warning label regarding the danger of consuming these beverages with alcohol. the free distribution of energy drinks at campus-sponsored events.hoc analyses confirmed that the sample reflected the ethnic.39 different patterns or levels of drinking might be associated with different response biases. racial. College administrators and staff should inform students about the risks of mixing alcohol with energy drinks as part of an overall program to reduce high-risk drinking and its consequences. age. Finally. Available at: http://www.35 Furthermore. Although self-report data have been validated in previous studies of alcohol use in college students. Although we statistically accounted for gender. Finally. Additional research is necessary to examine the health risks of drinking AmED. The Caffeine Database. age. should be reconsidered. Accessed Aug 5. and ethnicity in measuring the association of consuming AmED and alcohol-related consequences. Chicago. even after adjusting for the amount of alcohol consumed.com/the-caffeine-database. as part of routine conversations about unhealthy alcohol use.energyfiend. Conclusions Almost one-quarter of college student current drinkers reported mixing alcohol with energy drinks. which is common in the United States. 2007.37 Students may have under. Further research is necessary to understand this association and to develop targeted interventions to reduce risk.. IL: Mintel International Group Ltd. 2007. policy measures may be warranted.  2 Energy Drinks.

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and to treat a hangover. 2006. The purpose of this study was to determine energy drink consumption patterns among college students. Carpenter-Aeby T. the current leader in the energy drink market. Although energy drinks are targeted to young adult consumers. Couper MP. o o o CrossRef. to increase energy (in general). RESULTS: . USA. PubMed. and prevalence of adverse side effects and energy drink use dose effects among college energy drink users. 2006. METHODS: Based on the responses from a 32 member college student focus group and a field test. Aeby VG. prevalence and frequency of energy drink use for six situations. Boyd CJ. Barber-Heidal K. Greenville. Greenfield TK. 101:1428–37. malinauskasb@ecu. Web of Science® Times Cited: 12  41 Kerr WC. North Carolina. Overton RF. 31:162–8. How many drinks does it take you to feel drunk? Trends and predictors for subjective drunkenness. driving long periods of time. Addiction. Comparison of Web and mail surveys for studying secondary consequences associated with substance use: evidence for minimal mode effects. Source Department of Nutrition and Dietetics. Midanik LT. East Carolina University. drinking with alcohol while partying. a 19 item survey was used to assess energy drink consumption patterns of 496 randomly surveyed college students attending a state university in the Central Atlantic region of the United States.edu Abstract BACKGROUND: Energy drink consumption has continued to gain in popularity since the 1997 debut of Red Bull. Malinauskas BM. A survey of energy drink consumption patterns among college students. there has been little research regarding energy drink consumption patterns among college students in the United States. namely for insufficient sleep. Cranford JA. while studying. 40 McCabe SE. Addict Behav.

and to drink with alcohol while partying (54%). users consumed one energy drink with a reported frequency of 1 . and the physical side effects associated with caffeine consumption. Weekly jolt and crash episodes were experienced by 29% of users. the amounts of caffeine that they are consuming in various situations. The majority of users consumed energy drinks for insufficient sleep (67%). side effects from consuming energy drinks are fairly common.Fifty one percent of participants (n = 253) reported consuming greater than one energy drink each month in an average month for the current semester (defined as energy drink user). to increase energy (65%). . 22% reported ever having headaches. The majority of users consumed one energy drink to treat most situations although using three or more was a common practice to drink with alcohol while partying (49%). CONCLUSION: Using energy drinks is a popular practice among college students for a variety of situations. Further. many users consumed three or more when combining with alcohol while partying.4 days per month. There was a significant dose effect only for jolt and crash episodes. and a significant dose effect was found with jolt and crash episodes. Future research should identify if college students recognize the amounts of caffeine that are present in the wide variety of caffeine-containing products that they are consuming. and 19% heart palpitations from consuming energy drinks. Although for the majority of situations assessed.