High-Risk Alcohol Use Associated with Past 30-DAY Energy Drink Use.
Studies have indicated that 30%-50% of college students report regular consumption of energy drinks (Arria et al., 2011; Gallucci, Martin, & Morgan, 2016) with rates of up to 80% among specific college populations (Buxon & Hagan, 2012; Hoyte, Albert, & Heard, 2013). While the reasons for this high consumption rate are varied, research has suggested that increased use may be linked to strategic marketing through which energy drinks have been portrayed as having positive effects on health, endurance, and alertness (Reissig, Strain, & Griffiths, 2009). Students have reported multiple motivations for energy drink consumption including increasing energy, insufficient sleep, and drinking with alcohol to enhance effects (Malinauskas, Aeby, Overton, et al. 2007). Recent studies also indicated that consumption increases if students perceive energy drinks to be safe (Kumar, Park, & Onufrak, 2015; Treloar et al., 2017). Health concerns related to energy drinks have led medical and regulatory organizations to propose marketing and access restrictions in an effort to reduce overall consumption among children and adolescents (Thorlton, Colby, & Devine, 2014). Public health professionals urged the U.S. Food and Drug Administration to provide increased regulations on energy drinks due to the potential health consequences; however, energy drinks remain relatively unrestricted (Thorlton et al., 2014).
Energy drink consumption has been linked to various health risks including poor dietary behaviors, increased body mass index, increased use of licit and illicit drugs, high-risk driving, and increased risk for alcohol dependence (Arria et al., 2011; Gallucci et al., 2016; Housman, Williams, & Woolsey, 2016; Housman, Williams, & Woolsey, 2017; Scalese et al., 2017; Velazquez, Poulos, Latimer, & Pasch, 2012; Williams, Housman, Odum, & Rivera, 2017; Williams, Odum, & Housman, 2017; Williams, Housman, Woolsey, & Sather, 2018; Woolsey et al., 2015a; Woolsey et al., 2015b; Woolsey, Williams, Housman, & Sather, 2017). Of particular concern is the relationship of energy drinks and alcohol. While much research has explored the use of alcohol mixed with energy drinks among adolescents and young adults, relatively few studies have examined whether being a regular energy drink consumer (without alcohol) increases high-risk alcohol use or abuse. In a study of students at a private, minority-serving institution, researchers did find a relationship between energy drink consumption and drinking alcohol to inebriation (Spierer, Blanding, & Santella, 2014). College freshmen who consumed energy drinks have shown an increase in weekly and monthly alcohol use compared to those who did not consume energy drinks (Velazquez et al., 2012). In Australia, adult energy drink users were more likely to be heavier alcohol consumers (Trapp et al., 2014). A study of high school students in the U.S. showed that energy drink consumption was strongly correlated to 30-day alcohol use (Terry-McElrath, O'Malley, and Johnston, 2014). More recently, Gallucci and colleagues (2016) indicated that energy drink consumption was associated with heavy episodic alcohol drinking in a study examining college athletes and non-athletes. The extensive literature on alcohol mixed with energy drinks suggests a complex relationship between these two beverages which has been shown to increase overall health risks among consumers.
However, there is some literature suggesting that behavioral patterns of energy drink users may not align with behavioral intentions. A study of Taiwanese college students revealed that while alcohol and energy drink use were positively correlated, participants held more negative attitudes towards alcohol consumption (Change, Peng, and Lan, 2017). Other researchers have suggested that the relationship between energy drink and alcohol use may be overstated or misunderstood. In a critical review and meta-analysis funded by a major energy drink manufacturer, Verster and colleagues (2018) suggested that energy drink users (specifically those who consumed alcohol mixed with energy drinks compared to those who consumed alcohol only) showed lower odds of various risk-taking behaviors including negative alcohol-related consequences. The limited and conflicting research exploring how energy drink use (without alcohol) may be linked to overall alcohol consumption suggests a need to further study this relationship. The purpose of this study was to assess the relationship of energy drink use with specific 30-day measures of high-risk alcohol consumption among U.S. college students.
IRB approval was granted by the participating university prior to sample recruitment. An estimated 3,000 college students were recruited to participate through an email sent via the campuswide announcement system at a midwestern U.S. university. All students who received the recruitment email were provided the opportunity to complete the survey; therefore, those who did chose to participate were self-selected. In total, 605 students completed the survey which included measures of energy drink and alcohol consumption, health behaviors, and demographics. Due to incomplete surveys and missing data, the sample used in this study included 557 participants.
Alcohol and energy drink consumption were measured using a modified version of the National Institute on Drug Abuse's Quick Drinking Screen tool. The Quick Drinking Screen was developed as a guided interview tool that provides a retrospective estimate of a person's average alcohol consumption using is a quantity-frequency and daily estimation measures. It has been adapted to be used as a self-administered survey tool and has been modified to also include measures energy drink consumption in addition to alcohol. The modified tool has been used in several published alcohol and energy drink studies (de Haan, de Haan, van der Palen, Olivier, & Verster, 2012; Johnson, Alford, Verster, & Stewart, 2016; Woolsey, 2010; Woolsey et al., 2015 a; Woolsey et al., 2015b). Wilcoxon test yielded a test-retest coefficient of r = .92 for reliability (p < .001).
Participant energy drink use was dichotomized into two groups: a) past 30-day use and b) no past 30-day use. Similar to other energy drink research (Woolsey et al., 2015b), participants were asked to report frequency of various alcohol-use behaviors including high-risk consumption. For measurement of heavy episodic drinking, the standard frequencies of 5+ drinks in a row on one occasion for males and 4+ in a row on one occasion for females was used (Gallucci et al., 2016). Binary logistic regression analysis was used to examine demographic differences related to energy consumption while Mann Whitney U, Cohen's D and effect sizes were calculated to determine if past 30-day energy drink use was related to high-risk consumption of alcohol.
This study yielded a sample of 557 participants with 51.1% (n = 295) reporting energy drink use during the past 30 days. Mean age was 21.97 [+ or -] 4.268 (Mean [+ or -] SD) while the sample was primarily female (67.6%) and white (88.1%). A binary logistic analysis (Nagelkerke R2 = .071) indicated gender (Wald = 22.581; P < 0.01; OR = 0.409) and age (Wald = 5.596; P < 0.01; OR = 1.056) had statistically significant relationships with past 30-day energy drink use. Males were more likely than females to have consumed energy drinks during the past 30-days (65.4% vs. 58.6% of females). Past 30-day energy drink users reported slightly lower mean ages in comparison to non-users (21.51 [+ or -] 3.771 vs. 22.45 [+ or -] 4.692). No significant difference in past 30-day use was associated with participants' ethnicity (Wald = 0.811; P = 0.368; OR = 1.277).
A statistically significant relationship was found between energy drink use and each of the alcohol use measures (Table 1). Compared to nonusers (3.35 [+ or -] 2.803), participants who used energy drinks during the past 30 days (5.14 [+ or -] 3.424) reported a higher average number of alcoholic drinks consumed per occasion (P < .001; Cohen's D = 0.57; r = 0.28). Past 30-day energy drink users reported significantly higher scores on the number of days drinking alcohol (P < .001; Cohen's D = 0.55; r = 0.26), number of days 'getting drunk' (P < .001; Cohen's D = 0.61; r = 0.29), and number of days participating in 'binge' or heavy episodic drinking (P < .001; Cohen's D = 0.64; r = 0.30). Energy drink users also reported significantly higher averages when asked to report the greatest number of alcoholic drinks consumed on one occasion during the past 30 days (P < .001; Cohen's D = 0.74; r = 0.35) and when asked to report the number of hours of alcohol consumption during that single occasion (P < .001; Cohen's D = 0.53; r = 0.26). In addition to the 30-day alcohol measures, participants were also asked about the greatest number of alcoholic drinks consumed during one occasion over the past year. Similar to the 30-day measures, energy drink users reported significantly higher averages scores on the greatest number of drinks consumed on one occasion over the past 12 months (P < .001; Cohen's D = 0.73; r = 0.34).
Males were more likely than females to consume energy drinks in the past 30 days, while younger students were more likely to consume energy drinks than older students in this sample. Thirty-day energy drink use did not differ when examined by race/ethnicity. While effect sizes were small, past 30-day energy drink use was related to increased alcohol consumption among college students. Past 30-day energy drink users reported consuming alcohol nearly twice as many days as non-energy drink users. Of specific concern is that past 30-day energy drink users reported patterns of unsafe alcohol consumption (i.e., significant increases in heavy episodic drinking, number of days drunk, and greatest number of drinks on one occasion). For example, energy drink users reported a regular average consumption amount of 5.14 standard alcohol drinks per occasion which is higher than the intake criteria for heavy episodic drinking (Gallucci et al., 2016). Additionally, energy drink users reported both getting drunk and heavy episodic drinking on over twice as many days during the past month when compared to non-energy drink users. Furthermore, past 30-day energy drink users reported drinking for longer periods of time (1.5 hours longer) per alcohol drinking sessions compared to non-energy drink users.
In addition to these 30-day measures, energy drink users also reported consuming greater amounts of alcohol during heavy episodic drinking sessions over the past year. This is an important measure because it suggests that high-risk consumption among college student energy drink users may be occurring over a longer period of time thus increasing alcohol-related risks.
This study provides support for recent research which suggests energy drink use increases consumption of other substances including alcohol (Gallucci et al., 2016; Housman et al., 2016; Housman et al., 2017; Terry-McElrath et al., 2014; Woolsey et al., 2015a) While much of the research on energy drinks and alcohol focuses on the combined use of these two substances, this study provides additional evidence suggesting that young adults who regularly consume energy drinks may also be more likely to regularly use, misuse, or abuse alcohol. In addition to recognizing this behavioral correlation while designing interventions, substance use prevention and public health professionals may need to take on a more active role in the continued advocacy to reduce or restrict adolescent access to energy drinks.
Limitations of this study include the cross-sectional design, as well as the convenience sample and self-reported nature of the survey. Generalizability may be limited; however, the results are similar to other published studies (Gallucci et al., 2016; Spierer et al., 2014; Velazquez et al., 2012) suggesting some outcome reliability. A strength of this study is that it explores the energy drink-alcohol relationship beyond the more often-examined combined use of the two beverages together. Most research on this topic explores the combined use of alcohol mixed with energy drinks, so a strength of this study is that it explores the relationship between the independent consumption of these two substances. It provides evidence of the increased alcohol-related risks that are frequently experienced among energy drink users. Prevention and intervention initiatives should address the misuse and abuse of alcohol, but also seek to reduce the growing consumption of energy drinks.
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Ronald D. Williams, Jr., PhD, CHES
Conrad L. Woolsey, PhD, CMPC, CHES
Jeff M. Housman, PhD, MCHES
Corresponding author: Ronald D. Williams, Jr., PhD, CHES, Associate Professor, Department of Health and Human Performance, Texas State University, 601 University Drive, Jowers Center A145, San Marcos, TX 78666, Phone: 512-245-2947, Fax: 512-245-8678, firstname.lastname@example.org
Table 1 Demographic Characteristics of Respondents Alcohol Use Measure Energy N Mean SD P Drink Past 30-Day Use When you use alcohol, how Non-User 273 3.35 2.803 <.001 many standard drinks do you User 293 5.14 3.424 usually have? * In the past 30 days, how Non-User 281 4.42 4.849 <.001 many days did you drink User 294 7.27 5.556 alcohol? In the past 30 days, how Non-User 281 1.89 3.220 <.001 many days did you get User 295 4.15 4.170 drunk? In the past 30 days, how Non-User 231 2.13 3.639 <.001 many times have you had 5 User 261 4.85 4.841 or more drinks on one occasion (if you are a male) or 4 or more drinks on one occasion (if you are a female)? In the past 30 days, what Non-User 231 2.13 3.639 <.001 was the greatest number of User 261 4.85 4.841 alcoholic drinks you had on one occasion? On that occasion, over how Non-User 280 3.27 2.612 <.001 many hours did you consume User 294 4.65 2.568 alcohol? In the past 12 months, what Non-User 281 7.17 5.672 <.001 was the greatest number of User 294 12.05 7.509 alcoholic drinks you consumed on one occasion? Alcohol Use Measure Energy Mean Cohen's Effect Drink Past Rank D Size r 30-Day Use When you use alcohol, how Non-User 233.22 0.57 0.28 many standard drinks do you User 330.35 usually have? * In the past 30 days, how Non-User 237.19 0.55 0.26 many days did you drink User 336.56 alcohol? In the past 30 days, how Non-User 232.32 0.61 0.29 many days did you get User 342.01 drunk? In the past 30 days, how Non-User 193.95 0.64 0.30 many times have you had 5 User 293.01 or more drinks on one occasion (if you are a male) or 4 or more drinks on one occasion (if you are a female)? In the past 30 days, what Non-User 193.95 0.64 0.30 was the greatest number of User 293.01 alcoholic drinks you had on one occasion? On that occasion, over how Non-User 241.12 0.53 0.26 many hours did you consume User 331.67 alcohol? In the past 12 months, what Non-User 228.13 0.73 0.34 was the greatest number of User 346.00 alcoholic drinks you consumed on one occasion? * Standard amounts for one drink of beer, wine, and liquor were provided to participants on the survey instrument
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|Author:||Williams, Ronald D., Jr.; Woolsey, Conrad L.; Housman, Jeff M.|
|Publication:||American Journal of Health Studies|
|Date:||Jun 22, 2018|
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