Faculty of Medicine Consumption Patterns and Side Effects of Energy Drinks among University Students in Palestine Dr. Haleama Al-Sabbah, PhD Dr. Naeem Zaid Qamhiya, MD 2012
INTRODUCTION Energy drinks are carbonated drinks that contain large amounts of caffeine and sugar with additional ingredients, such as B vitamins, amino acids (e.g. Taurine), and herbal stimulants such as Guarana [1]. The Red Bull energy drink was introduced to Europe in 1987 and to the United States in 1997 500 new varieties of energy drink were introduced to the worldwide market in 2006 [2]. Energy drinks are nowadays available everywhere 2
The energy-drink industry is now considered to be one of the largest industries in beverage market The worldwide sales of the drinks rose from $3.5 billion in 2006 to $4.7 billion in 2007 [3] Energy drinks are marketed with exotic names and catchy slogans, with expensive marketing campaigns Effects used in advertisements: improve performance strength alertness concentration reaction speed increased metabolism 3
JUSTIFICATION Although energy drinks have been sold worldwide for more than a decade, only few studies have been published to test the effectiveness of these beverages on the physical or cognitive performance The language and images of such advertising are not directed at mature adults these products are meant to appeal to: teens and young adults University students represent part of the society with high vulnerability to stress mainly from studying, exams and lifestyle No reported or published studies about the exact situation of energy drink usage, patterns of consumption or side effects among young adults in Palestine 4
OBJECTIVES 1) Determine the patterns of energy drinks consumption and their associations with socio-demographic characteristics, and body mass index among An-Najah University students 2) Find out the occurrence of adverse side effects among users 3) Verify the relationship between energy-drink consumption and certain daily habits of users 4) Identify the main causes for using or not using energy drinks 5
METHODOLOGY A cross-sectional study was conducted at AN-Najah National University, Nablus, Palestine in the period between 8 th of Feb. to 7 th of Mar. 2011. IRB written approval for this study was obtained and the questionnaires were anonymous An Najah National University is considered to be one of the largest and highest ranked in Palestine. The number of students attending this university was 20,537 students in 2010 distributed on 18 different faculties 6
POPULATION AND SAMPLE A total of 300 students were randomly selected from the 3 targeted faculties at An-Najah National University 1) Faculty of Medicine 2) Faculty of Engineering 3) Faculty of Physical Education Students of these faculties are assumed to be more likely to use energy drinks in order to stay awake for studying due to high levels of academic stress 7
DATA COLLECTION Focus group discussion with students regarding situations they use energy drinks in, patterns, and side effects from using energy drink Based on the focus group responses, and with the help of previous studies on energy drinks, a selfadministered questionnaire consisted of 25 questions was developed 8
QUESTIONNAIRE The first section assessed the socio-demographic information The second section was concerned with daily behavior of participants including: sports, smoking, sleeping habits etc The third section evaluated energy drink consumption patterns among participants, causes of drinking, and any adverse side effect that might have possibly been encountered. 9
MAIN MEASURES The Body Mass Index (BMI): calculated by using selfreported weight and height, categorized based on the WHO international BMI classification of adults Monthly expenditure: was categorized by dividing them into quartiles as there was no reliable source determining household income categories in Palestine, according to the Palestinian Central Bureau of Statistics Smoking: categorized according to the recommendations of the World Health Organization (WHO) in which a heavy smoker is defined as that with a daily cigarettes consumption of more than 20 Cig. per day Sleeping hours: were divided into 3 categories, with the normal average sleeping hours considered to be between 7 and 8 hours per day, according to previous studies 10
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DATA ANALYSIS Out of 300 students: 279 were included in the analysis 8 students refused to participate (they had no time) 13 did not turn the questionnaire back All data were entered and analyzed using SPSS software version 17 A significance level of p<0.05 was assessed by chisquare test 13
SOCIO-DEMOGRAPHIC CHARACTERISTICS BY GENDER Characteristics Males % Females % P Total% Gender (of total) 59.1 40.9 100 Age groups (years) 20 21-24 25 28.8 70.5 0.6 45.5 53.6 0.9 0.018 35.8 63.4 0.7 Body Mass Index (BMI) < 18.5 18.5-24.9 25-29.9 30 Faculty Faculty of Medicine Faculty of Physical Education Faculty of Engineering Monthly expenditure <400 400-600 600-1000 >1000 3.6 65.5 30.9 0 28.5 37.6 33.9 15.5 27.1 29.0 28.4 7.1 78.6 14.3 0 38.6 32.5 28.9 25.0 29.3 26.1 19.6 0.004 5.1 70.8 24.2 0 0.208 32.6 35.5 31.9 0.185 19.0 27.9 27.9 25.1 14
DAILY HABITS BY GENDER Characteristics Cigarette smoking No 20 cigarettes per day >20 cigarettes per day Doing sports Regularly Irregularly Never Having breakfast Regularly Irregularly Never Sleeping pattern Regular Irregular Average sleeping hours 6 7-8 9 Male (N=165) % * 77.6 17.6 4.8 34.5 47.9 17.6 38.2 52.1 9.7 39.4 60.6 24.8 63.6 11.5 Female (N=114) % * 98.2 1.8 0 21.1 57.0 21.9 36.8 50 13.2 53.5 46.5 32.5 55.3 12.3 P 0.000 Total (N=279) % 86 11.1 2.9 0.050 29 51.6 19.4 0.664 37.6 51.3 11.1 0.020 45.2 54.8 0.331 28 60.2 11.8 15
REASON FOR NOT TRYING ENERGY DRINKS Don t need extra energy 61.5% Think they are unhealthy High caloric content Think they might be addictive Don t know their ingredients 46.6% 57.1% 57.8% 78.9% No curiosity to try them 70.2% Expensive 18.0% 0 10 20 30 40 50 60 70 80 90 16
REASON FOR USING ENERGY DRINKS OUT OF 279 PARTICIPANTS 118 REPORTED EVER USING ENERGY DRINKS Curiosity to know its taste 45.8% Relieve headache 10.2% Relieve stress Concentrate during studying Imitate friends Enjoy the taste 17.8% 7.6% 58.5% 59.3% Eliminate depression 16.9% Energy boost for sports Stay awake at night 44.1% 68.6% 0 10 20 30 40 50 60 70 80 17
SIDE EFFECTS REPORTED BY THE CURRENT USERS (N=44) 45 40 40.9% 35 30 25 20 15 10 22.7% 18.2 25.%0 13.6 9.1 18.2 29.5% 5 0 18
FREQUENCY OF ENERGY-DRINK USAGE AMONG CURRENT USERS 4.5% > 2 bottles per day 56.8% 11.4% 27.3% 2 bottles per day 1 bottle per day < 1 bottle per day 19
SOCIO-DEMOGRAPHIC CHARACTERISTICS AND ENERGY-DRINK USAGE Never Users Characteristics %* % P Gender Male Female Body Mass Index (BMI) < 18.5 18.5-24.9 25-29.9 30 Faculty Faculty of Medicine Faculty of Physical Education Faculty of Engineering Residency With family Student s house Alone Monthly income (NIS) <2600 2600-4000 4000-5000 >5000 Monthly expenditure (NIS) <400 400-600 600-1000 >1000 43.5 56.5 4.4 70.4 25.2 0 29.2 40.4 30.4 82.0 16.1 1.9 27.6 23.6 16.3 32.5 24.8 29.9 26.3 19.0 80.5 19.5 5.9 71.2 22.9 0 37.3 28.8 33.9 79.7 15.3 5.1 20.4 16.3 18.4 44.9 11.8 25.5 30.0 32.7 0.000 0.793 0.123 0.321 0.178 0.013 20
RELATIONSHIP BETWEEN SOME DAILY HABITS AND ENERGY-DRINK USAGE Characteristics Never % Users % P Total % Cigarette smoking No 20 cigarettes per day >20 cigarettes per day Doing sports Regularly Irregularly Never 90.7 8.1 1.2 29.2 52.2 18.6 79.7 15.3 5.1 28.8 50.8 20.3 0.022 86 11.1 2.9 0.938 29 51.6 19.4 Sleeping pattern Regular Irregular 48.4 51.6 40.7 59.3 0.224 45.2 54.8 21
CONCLUSIONS AND RECOMMENDATIONS Energy-drink usage is common among Palestinian university students and higher among males and those with higher monthly expenditure Campaigns should be encouraged in order to spread awareness about the contents and possible side effects of energy drinks.. Further research with a representative sample should be conducted to identify the side effects of energy drinks, and to study the prevalence of energy-drink consumption among all adolescents and young adults 22
REFERENCES [1] Energy Drinks. Alternative medicine website, 2006 (http:// altmedicine.about.com/od/completeazindex/a/ energy_drinks.htm, accessed 4 November 2010). [2] Fornicola F. Energy drinks: What s all the buzz about?. Coach and Athletic Director Magazine, 2007, 76(10), 38-43. [3] Paddock R. Energy Drinks Effects on Student-Athletes and Implications for Athletic Departments. The Sport Journal, 2008, 11(4), available from: (http://www.thesportjournal.org/article/ energy-drinks-effects-student-athletes-and-implications-athleticdepartments, accessed 15 November 2010) 23
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