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Use of caffeinated energy drinks and alcohol among secondary school students in Ontario, Canada. Jessica L. Reid , David Hammond, Scott T. Leatherdale , Cassondra McCrory , Joel Dubin CPHA: Public Health 2014 May 28, 2014 | Toronto, ON. Propel founded by: . BACKGROUND.

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Use of caffeinated energy drinks and alcohol among secondary school students in Ontario, Canada

Jessica L. Reid,

David Hammond, Scott T. Leatherdale,

Cassondra McCrory, Joel Dubin

CPHA: Public Health 2014

May 28, 2014 | Toronto, ON

Propel founded by:


BACKGROUND


BACKGROUND: Energy Drinks

246mg caffeine

160mg caffeine

80mg caffeine

220mg caffeine


BACKGROUND: Regulation & Recommendations

  • Caffeinated energy drinks recently moved under Food & Drugs Act; Temporary Marketing Authorization from Health Canada while undergoing review

  • Maximum caffeine amount: 400mg/L, not to exceed 180mg per single-serve container

  • Health Canada “has not developed definitive advice for adolescents 13 and older because of insufficient data.”

  • Recommendation for adolescents and children to limit caffeine consumption to 2.5mg/kg/day

    • For a 55kg (~120lb) adolescent, would be 137.5mg/day

    • For a 80kg (~175lb) adolescent, would be 200mg/day


BACKGROUND: Energy Drink Use

  • Increased consumption among young people

  • 40% past-year use in grade 7-12 students in Ontario; 12% past-week use (OSDUHS, 2013)

  • Concern about potential adverse effects of excessive caffeine consumption:

    • Effects on mood (irritability, nervousness, anxiety), dizziness, headache, gastrointestinal disturbances, dehydration, sleep problems

    • Effects on bone mineralization, arrhythmia, tachycardia, seizures, hemorrhage, hallucinations, death


BACKGROUND: Energy Drinks and Alcohol

  • Use of alcohol mixed with energy drinks (AmED) increasingly common among youth and young adults

  • Concern about an increase in alcohol consumption and alcohol-related risk behaviour

  • Studies of college/university-age students have found high use; little data for younger age groups


BACKGROUND: Energy Drinks and Alcohol

  • Use of alcohol mixed with energy drinks (AmED) increasingly common among youth and young adults

  • Concern about an increase in alcohol consumption and alcohol-related risk behaviour

  • Studies of college/university-age students have found high use; little data for younger age groups


OBJECTIVES

  • Objective: To examine the prevalence of consumption of caffeinated energy drinks among a large sample of high school students in Ontario, including socio-demographic and behavioural correlates, and relationship to alcohol use.


METHODS: COMPASS

  • COMPASS

    • Prospective cohort study, gr. 9-12 students in Ontario

    • School-based, self-completed questionnaire

    • Assesses multiple youth health behaviours and outcomes (e.g., obesity, healthy eating, physical activity, sedentary behaviour, tobacco use, alcohol and marijuana use, etc.)

    • Baseline data collection: 2012/13

    • More info: www.compass.uwaterloo.ca


METHODS: Sample

  • 43 purposefully sampled Ontario secondary schools

  • Total of 30,147 students enrolled in grades 9-12:

    • 80.2% completed questionnaire

    • 18.8% absent; 1% refusal (by parent or student)

  • Students missing grade, sex, energy drink use questions excluded (n=542)

  • This analysis: 23,631 grade 9-12 students


METHODS: Outcome measures

Usual energy drink use:

Responses to week and weekend questions added to get weekly frequency of energy drink use (range: 0-7 days); also recoded into any weekly energy drink use (0=no days; 1=1-7 days)

Past-year alcohol mixed with energy drink (AmED) use:

0=No

1=Yes

0=No


METHODS: Alcohol use measures

Current alcohol use:

Non-user

Alcohol user


METHODS: Alcohol use measures

Binge drinking:

Intensity of alcohol use: current alcohol use and binge drinking combined

  • Coded as 0=no drinking; 1=alcohol use, no binge drinking; 2=alcohol use, occasional binge drinking; 3=alcohol use, monthly binge drinking; or 4=alcohol use, weekly binge drinking

None

Occasional

Monthly

Weekly


ANALYSIS

  • Generalized linear mixed effects models (SAS 9.3)

    • Accounts for student clustering within schools

  • Separate models examining correlates of 3 outcomes:

    • any weekly energy drink use

    • frequency of energy drink use (# days/week)

    • any use of alcohol mixed with energy drinks (last 12 mo.)

  • Covariates: grade, sex, race, spending money, BMI, weight-related efforts, intensity of alcohol use


SAMPLE CHARACTERISTICS (n=23, 631)


SAMPLE CHARACTERISTICS (n=23, 631)


RESULTS: Usual Use of Energy Drinks

  • 18.2% reported energy drink use in a “usual” week.

  • Figure 1: Energy drink use (usual number of days per week)(n=23,631)


RESULTS: Correlates of Energy Drink Use

  • Use of energy drinks associated (at p<0.01) with all socio-demographic and behavioural covariates.*

  • Use more common among students who were:

    • Male (vs. female)

    • Grade 9 (vs. 10, 11, 12)

    • Off-reserve Aboriginal (vs. White or Other, non-Aboriginal)

    • Some spending money (vs. $0); >$100 (vs. all others)

    • BMI other than “healthy” or “overweight”

    • Trying to lose weight (vs. not trying to do anything)

    • Reported higher intensity of alcohol use

*In a generalized linear mixed effects model, with covariates grade, sex, race/ethnicity, spending money, BMI, weight-related efforts, and intensity of alcohol use; school included as a random intercept.


RESULTS: Correlates of Energy Drink Use

Use of energy drinks (any usual), by socio-demographic and behavioural variables (n=23,631)


RESULTS: Correlates of Energy Drink Use

Use of energy drinks (any usual), by intensity of alcohol use (n=23,631)


RESULTS: Correlates of Energy Drink Use

  • Results for frequency (number of days per week) of energy drink use similar to those for “any” use


RESULTS: Use of Alcohol Mixed with Energy Drinks

  • Use of energy drinks mixed with alcohol (AmED) in the last 12 months was reported by 17.3% of the total sample (n=4,020)

  • Among the 55.8% of students (n=12,853) who reported using alcohol in the last 12 months, 29.0% reported having used AmED

  • Using AmED associated with race, spending money, and binge drinking*

*In a generalized linear mixed effects model, with covariates grade, sex, race/ethnicity, spending money, BMI, weight-related efforts, and intensity of alcohol use; school included as a random intercept.


RESULTS: Correlates of AmED Use

Use of alcohol mixed with energy drinks (any in last 12 month) among current alcohol users, by socio-demographic and behavioural variables (n=12,804)


RESULTS: Alcohol mixed with Energy Drinks

  • More likely to use AmEDif less than monthly (OR=2.63; 2.11-3.28), monthly (OR=5.94; 4.81-7.33), or weekly (OR=14.75; 11.41-19.06) binge drinker (vs. none)

  • Monthly (OR=2.26; 1.92-2.65) and weekly (OR=5.60; 4.51-6.96) more likely to use AmED than < monthly binge drinkers

  • Weekly binge drinkers more likely to use AmED than monthly (OR=2.48; 2.03-3.04)

Use of alcohol mixed with energy drinks (any in last 12 month) among current alcohol users, by binge drinking (n=12,804)


DISCUSSION: Summary

  • Use of energy drinks common, linked to student characteristics and strongly linked to alcohol consumption

  • Use of alcohol mixed with energy drinks also fairly common

  • Binge drinking had the strongest association with using alcohol mixed with energy drinks


DISCUSSION: Strengths and Limitations

  • Self-report questionnaires

    • May underestimate consumption (esp. alcohol)

  • Sample of schools not probability based, but large number of schools/students and high participation within schools

  • Correlational; cohort follow-up will examine relationships over time


CONCLUSIONS: Implications

  • Caffeinated energy drinks currently under review by Health Canada; possible new regulations

  • Monitoring patterns of energy drink consumption among youth, including adverse events and risk behaviour

  • Future studies should examine quantity of consumption, and context/reasons for use


ACKNOWLEDGEMENTS

  • This project analysed data from the COMPASS study (PI: Scott Leatherdale), which was supported by a bridge grant from the Canadian Institutes of Health Research (CIHR) Institute of Nutrition, Metabolism and Diabetes (INMD) through the “Obesity – Interventions to Prevent or Treat” priority funding awards (OOP-110788; Leatherdale) and an operating grant from the CIHR Institute of Population and Public Health (IPPH) (MOP-114875; Leatherdale).

  • Additional support was provided by the Propel Centre for Population Health Impact, a Canadian Institutes for Health Research New Investigator Award (Hammond), and a Canadian Cancer Society Research Institute Junior Investigator Research Award (Hammond).


QUESTIONS?

Contact:

Jessica Reidjl3reid@uwaterloo.ca

(519)888-4567, x35620

Propel founded by:


Table 2: Estimates for all pair-wise comparisons from the modelsa for any energy drink use and frequency of energy drink use (n=22,861)

aSeparate generalized linear mixed effects models for each outcome, with covariates grade, sex, race, spending money, BMI, weight-related efforts, and intensity of alcohol use; school included as a random intercept.

bAdjusted for multiple comparisons (Bonferroni), α=0.01


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