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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. - PowerPoint PPT Presentation
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Propel founded by:
Use of caffeinated energy drinks and alcohol among secondary school students in Ontario, CanadaJessica L. Reid, David Hammond, Scott T. Leatherdale, Cassondra McCrory, Joel Dubin
CPHA: Public Health 2014May 28, 2014 | Toronto, ON
BACKGROUND
BACKGROUND: Energy Drinks
3
80mg caffeine
160mg caffeine
246mg 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 4
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
5
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
6
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
7
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.
8
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
9
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
10
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:
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0=No1=Yes
0=No
METHODS: Alcohol use measures
Current alcohol use:
12
Alcohol user
Non-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
13
NoneOccasional
Monthly
Weekly
ANALYSIS
14
• Generalized linear mixed effects models (SAS 9.3)• Accounts for student clustering within schools
• Separate models examining correlates of 3 outcomes: 1) any weekly energy drink use 2) frequency of energy drink use (# days/week)3) 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)
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Characteristic %
Sex Female Male
49.8%50.2%
Race/Ethnicity White, Non-Aboriginal Off-reserve AboriginalOther/Mixed/Not stated
71.4% 5.3%23.3%
Spending money $0$1-20$21-100$100 or moreNot stated
15.7% 30.5%27.0%14.1%12.9%
BMI category UnderweightHealthy WeightOverweightObeseNot stated
1.4% 57.1%13.9% 6.3%21.3%
Weight-related efforts Lose weightGain weightStay the same weightNot trying to do anything
42.1%18.6%18.4%20.9%
SAMPLE CHARACTERISTICS (n=23, 631)
16
Characteristic %
Alcohol use (past 12-month frequency) None Occasional (<once/month) Monthly (1-3 times/month) Weekly or more (≥once/week)
44.3%19.7%24.6%11.4%
Binge drinking (past 12-month frequency) None/Not applicable Occasional (<once/month) Monthly (1-3 times/month) Weekly or more (≥once/week)
60.6%16.0%17.3%6.2%
Intensity of alcohol use No alcohol use Alcohol use, no binge drinking Alcohol use with occasional binge drinking Alcohol use with monthly binge drinking Alcohol use with weekly binge drinking
44.6%15.2%16.3%17.7%6.3%
RESULTS: Usual Use of Energy Drinks
• 18.2% reported energy drink use in a “usual” week.
17
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
18
*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.
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Grade 9
Grade 1
1Male
Whit
eOthe
r
Underw
eight
Overw
eight
Not sta
ted
Try to
lose
weig
ht
Try t
o main
tain
$1-20
> $10
0
Use, n
o bing
e
Binge m
onthl
y0
5
10
15
20
25
30
35
40
45
50
19.0
17.4
17.9
18.3
12.9
23.4
17.4
30.5
17.6
24.3
15.9 19
.024
.421
.4
17.4
23.5
16.9
15.9
13.2 17
.1 19.5
25.3
16.0
11.4 15
.2 17.0
28.3
42.5
% o
f res
pond
ents
repo
rting
ene
rgy
drin
k us
e
Use of energy drinks (any usual), by socio-demographic and behavioural variables (n=23,631)
RESULTS: Correlates of Energy Drink Use
RESULTS: Correlates of Energy Drink Use
20
Use of energy drinks (any usual), by intensity of alcohol use (n=23,631)
No alcohol use
Alcohol use, no binge
Binge <monthly
Binge monthly Binge weekly0
5
10
15
20
25
30
35
40
45
50
11.4%15.2%
17.0%
28.3%
42.5%
% o
f res
pond
ents
repo
rting
ene
rgy
drin
k us
e
RESULTS: Correlates of Energy Drink Use
• Results for frequency (number of days per week) of energy drink use similar to those for “any” use
21
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*
22
*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
23
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)
Grade 9
Grade 1
1Male
Whit
eOthe
r
Underw
eight
Overw
eight
Not sta
ted
Try t
o los
e weig
ht
Try t
o main
tain
$1-20
> $10
0
Binge >
mon
thly
Binge w
eekly
0
10
20
30
40
50
60
24.3
24.6
30.4 33
.1
26.7 31
.3
27.7
34.4
32.6
27.7
28.7
29.7
28.4
29.5
28.7 33
.325
.7 27.7
23.6
24.3
30.1
35.9
29.3
10.0
22.5
39.3
62.7
% o
f alc
ohol
use
rs re
porti
ng u
sing
alc
ohol
+ C
ED
RESULTS: Alcohol mixed with Energy Drinks
24
Use of alcohol mixed with energy drinks (any in last 12 month) among current alcohol users, by binge drinking (n=12,804)
No binge drinking
Binge > monthly
Binge monthly
Binge weekly
0
10
20
30
40
50
60
70
10.0%
22.5%
39.3%
62.7%
% o
f alc
ohol
use
rs re
porti
ng u
sing
al
coho
l + C
ED
• More likely to use AmED if 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)
DISCUSSION: Summary
25
• 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
26
• 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
27
• 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).
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Propel founded by:
QUESTIONS?
Contact:Jessica Reid jl3reid@uwaterloo.ca(519)888-4567, x35620
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
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)
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