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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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  1. 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:

  2. BACKGROUND

  3. BACKGROUND: Energy Drinks 246mg caffeine 160mg caffeine 80mg caffeine 220mg caffeine

  4. 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

  5. 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

  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. 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

  8. 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.

  9. 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

  10. 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

  11. 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

  12. METHODS: Alcohol use measures Current alcohol use: Non-user Alcohol user

  13. 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

  14. 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

  15. SAMPLE CHARACTERISTICS (n=23, 631)

  16. SAMPLE CHARACTERISTICS (n=23, 631)

  17. 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)

  18. 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.

  19. RESULTS: Correlates of Energy Drink Use Use of energy drinks (any usual), by socio-demographic and behavioural variables (n=23,631)

  20. RESULTS: Correlates of Energy Drink Use Use of energy drinks (any usual), by intensity of alcohol use (n=23,631)

  21. RESULTS: Correlates of Energy Drink Use • Results for frequency (number of days per week) of energy drink use similar to those for “any” use

  22. 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.

  23. 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)

  24. 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)

  25. 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

  26. 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

  27. 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

  28. 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).

  29. QUESTIONS? Contact: Jessica Reidjl3reid@uwaterloo.ca (519)888-4567, x35620 Propel founded by:

  30. 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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