Young adolescents' perceptions, patterns, and contexts of energy drink use. A focus group study

Article (PDF Available)inAppetite 80 · May 2014with418 Reads
DOI: 10.1016/j.appet.2014.05.013 · Source: PubMed
Caffeinated Energy Drinks (EDs) are purported to increase energy and improve performance, but have been associated with adverse health effects and death. EDs are popular among adolescents and young adults, yet little is known about their use among young adolescents. This study explored perceptions, patterns, and contexts of ED use in six focus groups with 40 adolescents aged 12-15 years from two regional Australian schools. A thematic analysis of the data was used to investigate knowledge about ED brands and content, ED use, reasons for ED use, physiological effects, and influences on ED use. Participants were familiar with EDs and most had used them at least once but had limited knowledge of ED ingredients, and some had difficulty differentiating them from soft and sports drinks. EDs were used as an alternative to other drinks, to provide energy, and in social contexts and their use was associated with short-term physiological symptoms. Parents and advertising influenced participants' perceptions and use of EDs. These findings suggest young adolescents use EDs without knowing what they are drinking and how they are contributing to their personal risk of harm. The advertising, appeal, and use of EDs by adolescents appears to share similarities with alcohol and tobacco. Further research is needed to replicate and extend the current findings, informed by the lessons learned in alcohol research.
Research report
Young adolescents’ perceptions, patterns, and contexts of energy
drink use. A focus group study
Beth M. Costa*, Alexa Hayley, Peter Miller
School of Psychology, Faculty of Health, Deakin University, Geelong Waterfront Campus, Victoria 3220, Australia
Article history:
Received 19 January 2014
Received in revised form 13 May 2014
Accepted 15 May 2014
Available online 20 May 2014
Energy drinks
Qualitative research
Caffeinated energy drinks (EDs) are purported to increase energy and improve performance, but have
been associated with adverse health effects and death. EDs are popular among adolescents and young
adults, yet little is known about their use among young adolescents. This study explored perceptions,
patterns, and contexts of ED use in six focus groups with 40 adolescents aged 12–15 years from two re-
gional Australian schools. A thematic analysis of the data was used to investigate knowledge about ED
brands and content, ED use, reasons for ED use, physiological effects, and in
uences on ED use. Partici-
pants were familiar with EDs and most had used them at least once but had limited knowledge of ED
ingredients, and some had di
culty differentiating them from soft and sports drinks. EDs were used as
an alternative to other drinks, to provide energy, and in social contexts, and their use was associated with
short-term physiological symptoms. Parents and advertising in
uenced participants’ perceptions and use
of EDs. These
ndings suggest young adolescents use EDs without knowing what they are drinking and
how they are contributing to their personal risk of harm. The advertising, appeal, and use of EDs by ado-
lescents appear to share similarities with alcohol and tobacco. Further research is needed to replicate
and extend the current
ndings, informed by the lessons learned in alcohol research.
© 2014 Elsevier Ltd. All rights reserved.
Energy drinks (EDs), such as RedBull
, Monster
and V
, are pur-
ported to increase energy and improve performance (
Australia New
Zealand Food Authority, 2009). Aggressive marketing associates EDs
with high risk extreme behaviours that appeal to youth (
Miller, 2008)
through non-traditional mediums (such as social media) adoles-
cents frequently use (
Montgomery & Chester, 2009; Pomeranz,
Munsell, & Harris, 2013). Not surprisingly the popularity of EDs con-
tinues to rise, particularly among young consumers (
O’Dea, 2003).
Accumulating evidence associates ED use in adulthood with a range
of adverse health outcomes including headaches, heart palpita-
tions and gastrointestinal disturbance (
Gunja & Brown, 2012; Nordt
et al., 2012; Trapp et al., 2014a), and death (Reissig, Strain, & Gri
2009). While medical professionals have expressed concern over the
health implications for adolescents, very few studies have investi-
gated ED use among young adolescents. It is important to under-
stand how EDs are perceived and used by young consumers to
identify potentially harmful consumption patterns, at-risk groups
of consumers, and short- and long-term health consequences.
The most common ED ingredients are caffeine and glucose. Chil-
dren and adolescents consume caffeine in soft drinks and choco-
late, and less frequently in tea and coffee drinks.
Ludden and Wolfson
le of an adolescent (15–18 year old) caf-
feine user who began caffeine use early in the day and used a range
of caffeinated products (including EDs). These adolescents ex-
pected to experience both withdrawal symptoms and increased per-
formance, and used caffeine for social and experimental reasons.
Habitual caffeine use in young consumers has been associated with
headaches, anxiety, impaired sleep, daytime sleepiness and juve-
nile depression (
Benko et al., 2011; James, Kristjansson, & Sigfusdottir,
; Ludden & Wolfson, 2010).
The sugar content of EDs (25–32.5 g) is equivalent to that of cola
soft drinks (
Food Standards Australia and New Zealand, 2010). Sugar
sweetened beverages (SSBs) are energy-dense, nutrient poor, and
a signi
cant source of sugar in young people’s diets (Delpier,
Giordana, & Wedin, 2013). Children’s and adolescents’ intake of SSB
is a key nutritional concern that contributes to weight gain, obesity,
type 2 diabetes, dental caries and tooth erosion, poor nutrition, and
the establishment of unhealthy lifetime dietary habits (
Mitrou, Lawrence, & Zubrick, 2011
; Pomeranz et al., 2013).
In addition to caffeine and glucose, EDs typically contain other
ingredients which are implied to have active effects, such as guarana,
taurine, glucuronolactone, and B group vitamins, making this bev-
erage type unique (
Pennay & Lubman, 2011). In Australia (Australia
New Zealand Food Authority, 2009), as in many other countries
Acknowledgement: The authors wish to thank the students and school staff who
participated in this study.
* Corresponding author.
E-mail address: (B. Costa).
0195-6663/© 2014 Elsevier Ltd. All rights reserved.
Appetite 80 (2014) 183–189
Contents lists available at ScienceDirect
journal homepage:
(Oddy & O’Sullivan, 2009), EDs are not recommended for consump-
tion by children. To date, research speci
cally examining ED use
among adolescents is limited to two identi
ed studies. Almost half
of 11–18 year olds sampled from one Australian school had con-
sumed EDs in the previous fortnight as a soft drink substitute, source
of energy, or to improve sports performance (
O’Dea, 2003). More
Gallimberti et al. (2013) found that at least half of an Italian
sample of 11–13 year olds had consumed EDs at least once and the
proportion of regular weekly users within the sample increased with
age from 6% in 11-year-olds to 16% in 13-year-olds.
Prior research has documented that the prevalence of ED use
among adults ranges from 41% to 80% of university student samples
Arria & O’Brien, 2011; Berger, Fendrich, Chen, Arria, & Cisler, 2011;
Velazquez, Poulos, Latimer, & Pasch, 2012) and 31% to 60% of adult
sub-groups (Berger et al., 2011; Miller & Quigley, 2011; Nordt et al.,
2012; Trapp et al., 2014a). For example, 48% of a population-based
Australian young adult sample reported regular ED use, and these
individuals were more likely to smoke cigarettes, use alcohol and
other drugs (
Trapp et al., 2014b) and, in comparison with non-
users, these individuals experienced greater anxiety (Trapp et al.,
). Adults’ ED use has been associated with a range of nega-
tive effects, including headaches, heart palpitations, jitteriness
Malinauskas, Aeby, Overton, Carpenter-Aeby, & Barber-Heidal, 2007),
sleep di
culties (Nordt et al., 2012), anxiety, gastric disturbance,
nausea, and elevated blood pressure (
Gunja & Brown, 2012). Mixing
EDs with alcohol to enable greater intoxication is common among
young adults (
Peacock, Bruno, Martin, & Carr, 2013) and is associ-
ated with signi
cant harm (Ferreira, de Mello, Pompeia, &
Souza-Formigoni, 2006; Peacock et al., 2013).
The adolescent developmental stage may in
uence patterns and
consequences of ED use. During the psychological process of iden-
tity formation, risk-taking and novel behaviours increase as young
individuals experiment with perceived adult behaviours (
Laghi, Liga,
Baumgartner, & Baiocco, 2012
). Characteristic adolescent egocen-
trism associated with feelings of invulnerability may impair ado-
lescents’ ability to recognise the negative effects of high ED use or
mixing EDs with alcohol. Strong peer group in
uence in adoles-
cence has also been found to motivate adolescents to engage in risky,
extreme, or deviant behaviours valued by the peer group to be ac-
cepted and feel a sense of belonging (
Stead, McDermott, MacKintosh,
& Adamson, 2011
). ED use in the context of these developmental
processes has yet to be examined.
Bunting et al. (
Bunting, Baggett, & Grigor, 2013) found that a
sample of 16–21 year olds randomly recruited from the grounds of
a university campus and shopping centre in New Zealand re-
ported frequent consumption of EDs, consuming EDs for an energy
‘hit’ and the image associated with EDs despite being aware of their
potential harmful effects. In comparison, adults aged 22–35 years
recruited in the same way reported less frequent consumption,
greater scepticism of the purported bene
ts of EDs, and concern for
the potential negative health effects. These
ndings suggest ado-
lescents may be especially vulnerable to ED marketing that plays
on adolescent developmental processes and this may in
uence ED
consumption patterns.
The current study
Preliminary evidence indicates ED use among adolescents is
common, and ED use appears to increase with age. Chronic caf-
feine use among children and adolescents has been associated with
headaches, anxiety, impaired sleep, and daytime sleepiness, and ED
use has been linked to these and additional health effects in adults.
The perceptions young adolescents hold in relation to EDs have not
been examined, despite evidence that these individuals use EDs at
least occasionally. Therefore, the current study qualitatively ex-
plored perceptions and patterns of ED use in a small group of young
A qualitative approach using focus groups was used to explore
perceptions, patterns, and contexts of ED use among young ado-
lescents aged 12–15 years. Focus groups are ideally suited to study-
ing the perspectives of youth (
Peterson-Sweeney, 2005). In individual
interviews young participants are vulnerable, experience anxiety
about being interviewed, and may perceive pressure to provide the
right responses, limiting honest disclosures. The focus group setting
provides a relaxed natural atmosphere where group discussion is
encouraged, providing researchers with a richly layered under-
standing of individual perspectives on a given topic
Peterson-Sweeney, 2005).
The sample comprised 40 adolescents aged 12–15 years and in-
cluded 32 males and eight females. Participants were recruited
through convenience sampling of one public co-educational school
22) and one independent Catholic all-boys secondary school
18) in regional Victoria, Australia.
Approval for conduct of the study was granted by Deakin Uni-
versity, the Victorian Department of Education and Early Child-
hood Development (DEECD) and the Catholic Education O
Melbourne. Following ethics approval and school support, all stu-
dents in Years 7, 8, and 9 from the participating schools were invited
to participate. Those who returned signed parental consent forms
within a two week period were recruited into the study.
Focus groups with adult participants often comprise 8–12 par-
ticipants. However, in research with children and adolescents, four
to six participants per focus group is recommended to ensure control
over the group and allow all participants to contribute (
Heary &
Hennessy, 2002
). Therefore, focus groups were conducted with
to eight participants in school year levels 7, 8, and 9 from each school.
One focus group was conducted per year level (i.e., year levels 7, 8,
and 9) for each of the two schools, resulting in a total of six focus
groups. Interviews were conducted during school hours on school
premises during August and September 2013. One researcher con-
ducted all of the focus groups in the presence of a school represen-
tative. Focus groups lasted 20–40 minutes, were audio recorded, and
subsequently transcribed verbatim.
Seven semi-structured interview questions were developed for
the study, based on the previous literature and author PM’s re-
search with adults, and explored participants’ knowledge of EDs, prior
consumption behaviour, and perceptions of EDs and of ED consum-
ers. Interview questions included Have you ever had an energy drink?,
Can you tell me about the last time you had an energy drink? and What
do your friends think of people that use energy drinks?
Following transcription, the interview data were entered into the
qualitative data management computer program NVivo and sub-
jected to a thematic analysis. Initially broad themes related to ado-
lescents’ ED use were identi
ed from the data. Subsequently the data
were read and reread during which time themes and subthemes
were re
ned. Reliability of the analysis was veri
ed by having a
second researcher independently code a random 20% of the inter-
view data to achieve a reliability estimate greater than 80%. In the
case of disagreement the researchers conferred until consensus was
184 B.M. Costa et al./Appetite 80 (2014) 183–189
Five themes related to adolescent ED use emerged from the anal-
ysis: knowledge about ED brands and content, ED use, reasons for
ED use, physiological effects, and in
uences on ED use. Each of the
emergent themes will be presented in the following section. Example
quotes from the data are used for illustrative purposes and are
Knowledge about energy drink brands and content
All six focus groups discussed what EDs were and the different
ED brands participants had either used or seen. When asked what
the main ingredients in EDs were, many participants readily iden-
ed caffeine and sugar. Some of the youngest participants did not
identify caffeine as a key ingredient and attributed the stimulant
effect of EDs to their sugar content. A few participants identi
ed other
ED ingredients such as guarana and taurine.
Most participants easily identi
ed EDs by brand name and could
list both popular (e.g., Red Bull
, Mother
) and less well known (e.g.,
, Dragon
) brands. There was some confusion particularly
among the younger participants about the differences between EDs
and other drinks. In particular, some participants had trouble dif-
ferentiating EDs from non-caffeinated sports drinks, with a male Year
7 student stating EDs and sports drinks were sort of the same but
one of them has less sugar. Another male Year 7 participant incor-
rectly explained:
So some energy drinks, people that drink them they get the
back in them, the electrolytes and stuff, and then they can go back
out there and run more during games and sports . . .
Some students also confused EDs with drinks packaged in a way
similar to EDs (such as carbonated fruit juice), and other caffeinated
soft drinks. When asked to list ED brands they knew, a male Year
7 participant gave the response Red Bull, Mother. . .V. . .Coke.
There was some awareness within the sample that the caffeine
content of EDs varied across brands and sizes of ED cans/bottles.
For example, a female Year 7 participant explained with some of them
they’re more powerful than the other ones.
Energy drink use
Thirty-one participants had used EDs at least once and discus-
sion in all six focus groups centred on participants’ own or their
peers’ use of EDs.
Frequency of use
Regardless of gender, most of the Year 7 participants indicated
they had consumed an ED only once and for some this was just a
sip from a can. Those who had consumed EDs once recalled dislik-
ing the experience. Infrequent consumption was common and ranged
from not often to sometimes and on a special occasion. A male Year
8 participant who stated he drank EDs infrequently estimated he
had consumed a total of 10 EDs in his lifetime.
More frequent consumption of EDs was reported by some par-
ticipants in Years 8 and 9, with responses ranging from once a month,
to once a week and on weekends. When asked to recount the last time
they had had an ED, participants recalled various intervals such as:
three years ago, last year, about two or three months ago, two weeks
ago, and last Thursday.
Accessing EDs
Participants obtained EDs in various ways. It was generally agreed
that EDs were easily accessible and pretty easy to just grab one off
the shelf [male Year 9 student]. Purchasing EDs for themselves from
a milk bar, convenience store or supermarket was common, as a male
Year 7 participant explained:
I got a Red Bull once because I walked into the milk bar and it was
just cheap.
Friends, cousins, or older siblings often purchased and shared EDs,
as a male Year 8 participant explained:
My mate . . . bought, like, a four pack of V and he just shared it with
Some participants reported consuming EDs bought for their
parents’ use, and a few reported their parents speci
cally pur-
chased EDs for participants. For example:
My step-mum . . . gets the little packs of Thai Red Bull and I’ll just
drink some of those. [male Year 9 participant]
When I went camping, we went for 10 days and it was right next
to the beach. So I was in the water all day. I got really tired. So my
mum kept buying me energy drinks . . . and it just perked me up a
bit. [male Year 7 participant]
It was also common for participants to be given free EDs by pro-
motional vans and groups when with friends or family at spon-
sored events. A male Year 8 student explained:
I was snowboarding at the snow and then they had a Monster stand
so me and my cousins just went and grabbed a couple of
them . . . They were the free ones and they were just handing them
out because there was a new
When spectating at sponsored sports events, participants unani-
mously reported that free EDs were offered to them by promotion-
al vans/groups representing sponsor brands such as Red Bull and
Mother. Recounting their experiences, participants did not cite thirst
or fatigue as motivating their consumption, suggesting rather that
they drank it merely because it was a novel experience in a social
setting where the drinks were freely available. A male Year 8 par-
ticipant explained:
They were handing out free ones [EDs] to everyone. . .so I just had
one there.
Reasons for energy drink use
In discussing the reasons and contexts of using EDs, three broad
reasons emerged from the analysis across the focus groups: enjoy-
ment, function, and social.
Using EDs for their enjoyment related to the taste of EDs or the
avour of particular brand types, with some participants noting the
unique ‘bitter’ taste as enjoyable and an alternative to other sweeter
drinks available. For example, a male Year 9 participant explained
[b]ecause it’s kind of bitter and a lot of the other things that are on
the market really sweet all the soft drinks. So it’s something
In contrast other participants disliked the bitter taste of EDs and
cited this as the main reason they did not consume EDs more fre-
quently. For example, a female Year 7 participant explained after a
while ... the taste of it gets a bit weird.
It was common for participants to consume EDs when they felt
tired, or were playing sport and needed an energy boost. One male
Year 8 participant explained that he used an ED:
185B.M. Costa et al./Appetite 80 (2014) 183–189
[b]ecause I was going up to Queensland. I asked my dad if I could
have an energy drink to wake me up for the plane. I didn’t want it
long term, I just wanted it for the two hours, that kind of thing.
Another male Year 8 participant explained that an ED im-
proved his sports performance:
On athletics day when I was about Year 6 or something [I] just had
an energy drink [and then] came
Some participants indicated their parents or other adult family
members used EDs either occasionally or more frequently and related
this as necessary to get through the day. Participants mostly thought
the stimulant effects of EDs were positive when used to alleviate
fatigue and improve alertness, with a male Year 8 participant stating:
The good part is, it [ED] keeps you up if you need it.
A male Year 7 participant explained that EDs are:
[S]omething for quick relief, just to get up.
Scenarios where participants thought their own use of EDs was
‘normal’ and ‘acceptable’ primarily focused on relieving fatigue to
play everyday sports for school or with friends. As a male Year 9
participant described:
I was, like, half asleep on the way to footy once, so I had one [an
To explain acceptable forms of ED use, participants frequently
referred to scenarios where adults used them to relieve fatigue as-
sociated with work, travel, and raising a family. For example:
It’s de
nitely helpful if someone is a night worker and they have
trouble staying up. [male Year 8 participant]
He [father] doesn’t have them all the time say just if we’re driving
up to Melbourne he might have one. [female Year 7 participant]
They’ve just had a child, so my aunty needs that energy [from EDs]
to get up in the morning. [male Year 8 participant]
In these and other scenarios, participants justi
ed adults’ use of
EDs as a means to alleviate fatigue in order to meet their respon-
sibilities. Many participants generalised this attitude to their own
experiences of feeling tired, and hence normalised their own, and
their peers’, use of EDs as functional. A male Year 8 student
If you have a late night the night before, and you’re really asleep,
just hav e an energy drink. So people can’t really judge you for having
an energy drink if you’re tired or something.
Social situations were a common context for ED consumption
and related to spending time with friends such as when going to the
movies or at a sleepover. One female Year 9 participant indicated:
Whenever I go out with friends, just to hang around or whatever
...[I will have] a few, one or two.
Among the younger participants, using EDs in this social context
seemed to be experimental where an ED was often shared with a
group of friends. A male Year 7 participant recalled the
rst time
he consumed an ED:
We were young and we all just had a little bit each . . . my friends
bought it . . . they thought it was cool back then, I guess.
Additionally some participants also described being given, or
invited to share, an ED by older peers (mainly siblings), suggesting
both an opportunity for experimentation as well as social approv-
al. A male Year 7 student recalled:
I think I was at one of my brother’s footy games and my brother,
he’s around 17. . .He was having a Rockstar, so he offered me just
a sip.
Some social explanations of ED use suggested participants felt
pressured or persuaded by peers to use EDs and would not consume
EDs when they were not with friends:
I was like, ah, I don’t really want it. But then he said, have another
one. It doesn’t taste as bitter the next time. So I had it and then it
tasted a lot sweeter. [male Year 7 participant]
If I get offered some at a mate’s house I’ll have one, but I wouldn’t
go to the shops to buy one. [male Year 9 participant]
Physiological effects
There was an expectation that consuming EDs would provide a
stimulant effect, implying the adolescent participants used these
drinks speci
cally to experience the marketed physiological effects
of EDs. Some participants felt normal after consuming an ED and
reported that they don’t really get the effect more the taste. Some
of these participants were disappointed they did not experience the
expected energy ‘hit’ after drinking an ED.
Other participants recalled physiological effects after consum-
ing EDs, from feeling a little bit more awake and a bit hyper,tobounc-
ing off the walls, and feeling all jittery. Some participants reported
more severe symptoms that included increased heart rate, nausea,
headache, fatigue, and low mood. One female Year 9 student de-
scribed her emotional experience as:
dent than what I usually am. I got really hyper
and when it wore off, I got really sad and tired.
A few participants were shocked and scared by the negative
symptoms they experienced after using an ED and this caused them
to limit their subsequent use of EDs. For example:
I got . . . heart pains sometimes . . . that’s why I stopped them. I
noticed them and it’s like, what the hell? It freaked me out. [male
Year 8 participant]
In addition to personally experiencing negative physiological
symptoms, most participants were aware of the negative health
effects EDs could cause. Participants believed that EDs were bad for
you, that they can be hurtful to your system . . . you can get heart attacks
from them, and that they can keep you awake. Most participants con-
sidered EDs to be addictive and many recalled similarly aged peers
who they considered to be addicted to EDs. However, participants’
understanding of ED addiction appeared vague. For example, when
asked what made EDs addictive, a male Year 8 participant replied,
taste, I guess. I don’t know. Something.
uences on energy drink use
Key in
uences on adolescent ED use discussed in the focus groups
were parents and advertising.
Parents appeared to play a key role in in
uencing participants’
use or disuse of EDs. Parents were often sources of information about
the negative health effects of EDs and communicated concern or dis-
approval of participants’ use of EDs. For the younger Year 7 partici-
pants, parental disapproval appeared to prevent them from using
EDs, while some of the older participants reported using EDs despite
parental disapproval. For example, a female Year 9 ED user ex-
My mum doesn’t really approve much and neither does my Nan, but...
they don’t try and do anything to stop [me]. It’s just they give me
186 B.M. Costa et al./Appetite 80 (2014) 183–189
a heads up and say it’s really bad for you and stuff but they don’t
really stop me from doing it.
In some cases, there appeared to be a difference between parents’
own use of EDs and their disapproval of participants’ use of EDs. A
female Year 7 student reported:
My dad drinks them, and mum always says, ‘don’t drink them’ and
stuff because they’re really sugary . . . She [mother] does drink them
sometimes, but she just says [to me] ‘don’t’.
In other cases, participants indicated that their parents con-
doned or encouraged their use of EDs at times, particularly when
consumption had the functional aim of alleviating fatigue for sport
and recreation. For example, two Year 7 participants reported their
parents had purchased EDs for them and told them to drink it to
improve their stamina. One male Year 7 student who was too ill to
attend school and had a sports game to attend, reported that:
My dad bought home a Red Bull and told me to just have a bit and
it woke me up. I felt a bit better with that energy . . . then played
Participants readily recalled ED advertising slogans and cam-
paigns. ED advertising was presented in a way that appealed to ado-
lescents and participants considered them humorous, entertaining
and sometimes crazy. Noting this, a male Year 9 participant
They . . . make it [EDs] relatable, like in their ads. So say you have
a Coke ad, you’ve got a baby dancing, whereas when you’ve got a
Monster ad, you see people riding motor bikes and doing back
ips . . .
Participants reported often seeing ED advertising in various ways
including on television and the Internet, in convenience, depart-
ment and gaming stores, through video game cross-promotion, and
via sports sponsorship. Some participants found the amount of ED
advertising to be annoying and intrusive. However, it was effective
at increasing participants’ liking for different EDs, as a male Year 8
participant recounted:
When I was a kid, just watching energy drink ads, I can remember
the two main ones RedBull and V. I always liked [the ED] V because
of the
ies, so I always sort of liked V . . . Red Bull always con-
vinced me they’d give you wings, and just their cartoon ads, I liked
A number of Year 9 participants re
ected on the cool, rebellious
and independent image advertising projected and felt that people
who used EDs were not cool but were just the people that want to
be that type of [cool] person. This suggests EDs are being used to ful
a need for peer acceptance and to project a particular image of
oneself, although participants did not attribute this motivation to
their own use of EDs. A male Year 9 participant commented:
If someone’s feeling like, yeah, ‘I’ve got no one to talk to, no one to
relate with’, they think, yeah, ‘there’s people drinking those [EDs]
so I’ll try that. Then maybe they’ll see me . . .
The 12–15 year olds in this study were familiar with a range of
EDs and most had used them at least once; nonetheless, they had
limited knowledge of ED ingredients and could not easily differen-
tiate them from other drink types. EDs were used as an alternative
to soft drinks, to provide energy, and in social contexts, and their
use was associated with short-term physiological symptoms. Ado-
lescents’ perceptions and use of EDs were in
uenced by parents and
advertising. These
ndings are consistent with the limited previ-
ous research on adolescent ED use and indicate young adolescents
use EDs despite being unaware of their distinguishing features.
ED use was common in the current sample, as in other adoles-
cent samples (
Gallimberti et al., 2013; O’Dea, 2003). In a similar study,
almost half of the 12–17 year-olds sampled reported past fort-
night use of EDs (O’Dea, 2003). While Gallimberti et al. (2013) iden-
ed fewer ED consumers in a survey of 11–13 year-olds, their
sample was somewhat younger than that of both the current and
O’Dea’s study.
The reasons participants gave for using EDs are consistent with
those reported in other samples of younger (
Gallimberti et al., 2013)
and older (Bunting et al., 2013) adolescents. EDs were often used
as an alternative to sweeter soft drinks. The wide availability of EDs
and placement alongside soft drinks on supermarket and conve-
nience store shelves may contribute to this choice. Consuming EDs
for their bitter taste may be associated with a misperception that
the sugar content of EDs is lower than soft drinks (
Food Standards
Australia and New Zealand, 2010
) and lack of awareness of their con-
tribution to weight gain and obesity, dental caries and associated
long-term health risks (Pomeranz et al., 2013). EDs were often con-
sumed in a social context associated with experimentation and peer
pressure. Likewise, young adolescents have been found to smoke
cigarettes to appear popular and project a cool rebellious image of
engaging in forbidden adult behaviours (
Dijk, de Nooijer, Heinrich,
& de Vries, 2007
EDs are marketed as providing energy and enhancing perfor-
mance (
Australia New Zealand Food Authority, 2009). As in previ-
ous studies of adolescents (
O’Dea, 2003) and adults (Attila & Cakir,
2011; Malinauskas et al., 2007), using EDs for their stimulant effect
was common in the current sample. Adolescents’ and adults’ func-
tional use of EDs was normalised and perceived as necessary to meet
the demands of a busy lifestyle. This perception is consistent with
marketing messages that promote the use of EDs when undertak-
ing everyday activities such as working, studying, travelling, and
playing sports (
GmbH, 2014). When EDs did not have the desired
effect participants experienced disappointment and dissatisfac-
tion. Consumers may subsequently increase the number of EDs they
consume per session and/or the frequency with which they consume
EDs in order to achieve their marketed physiological effects. As young
consumers may have yet to develop a tolerance to caffeine, this may
have signi
cant adverse health effects.
Parents have been found to in
uence children’s and adoles-
cents’ healthy (Lytle, Varnell, & Murray, 2003) and unhealthy (Grimm,
Harnack, & Story, 2004
; Longbottom, Wrieden, & Pine, 2002)dietary
choices, alcohol use (Clark, Nguyen, Belgrave, & Tademy, 2011;
Schwinn & Schinke, 2014), and smoking (Kalesan, Stine, & Alberg,
2006; Scragg, Laugesen, & Robinson, 2003). Through role model-
ling, they provide access to, and communicate, health messages about
particular behaviours. In the current study, parents commonly dis-
cussed the health risks of ED use with adolescents and this pre-
vented younger adolescents but not older adolescents from using
EDs. Some parents were also reported to condone adolescents’ use
of EDs through purchasing, and recommending EDs for partici-
pants when they felt tired and unwell. This practice is similar to the
parental supply of alcohol to adolescents, which is common (
& Kypri, 2012
). In relation to underage drinking, the rules parents
set about alcohol use are an important determinant of the age at
which adolescents begin using alcohol (
Chan et al., 2013). Setting
clear rules against the use of alcohol has been associated with a lower
rate of lifetime, current, and risky alcohol use among adolescents
in comparison with parent supplied and supervised use of alcohol
McMorris, Catalano, Kim, Toumbourou, & Hemphill, 2011). In ad-
dition to the current laws prohibiting the sale of alcohol to young
people, setting age limits for adolescent behaviours has clear bene
in terms of delaying alcohol use among adolescents and reducing
subsequent problematic alcohol use in adulthood. Therefore,
187B.M. Costa et al./Appetite 80 (2014) 183–189
parental rules for and supply of EDs may be important determi-
nants of adolescent ED use.
Maintaining parental in
uence over young adolescent ED use may
be di
cult in the context of the prevalent advertising that appeals
to youth. Advertising strategies used by ED companies share simi-
larities with those employed by tobacco companies, and include tele-
vised advertising, free promotional samples, and sporting
sponsorship. Exposure to tobacco advertising has been found to
predict the uptake of smoking among adolescents and the transi-
tion to an established smoker identity in young adulthood (
Levine, Coeytaux, Slade, & Jaffe, 1996
; Gilpin, White, Messer, & Pierce,
2007). Research has yet to investigate the impact which ED adver-
tising has on consumer perceptions and use of EDs. Mass media anti-
smoking campaigns have been effective in delaying uptake of
smoking among youth (
Gilbert, 2008).
Older adolescents in the current sample appeared to use EDs
despite parental disapproval, indicating marketing may be more pow-
erful than parental in
uence particularly among older youth. This
nding suggests the need for legislation changes in ED availability
to better support parental choices in adolescent ED use. Alcohol pro-
vides an example where legislation is effective at curbing adoles-
cent drinking within a cultural context that normalises alcohol use.
Adolescents are only able to drink alcohol supplied by parents and
the current law sends a clear message to young people that for them
alcohol is not acceptable.
Parents’ knowledge about, and attitudes towards, EDs may be in-
uenced by youth-oriented marketing messages and the unre-
stricted availability of EDs. Within Australia (
Australia New Zealand
Food Authority, 2009), as in many other countries (Oddy & O’Sullivan,
2009), current regulations require product labelling to state EDs are
not recommended for children without a need for a speci
c age limit.
Individuals do not consciously look for warnings on food and drink
labels and so warning statements need to be highly visible in order
to be noticed (
Laughery, Young, Vaubel, & Brelsford, 1993). ED
warning statements are located below or beside nutrition informa-
tion tables in indistinct text colour and size and are often
characterised by low visibility. With no age limit imposed on ED use
and poorly visible warning labels, parents may not notice ED con-
sumption warnings and, if they do, they may be uncertain about
whether this warning relates to their adolescent child. In either case
parents are likely to remain unaware of the risks EDs pose to child
and adolescent health. Inconsistency between disapproval of ado-
lescents’ EDs use and parents’ own ED use suggests a lack of aware-
ness of the health risks associated with EDs, and/or the importance
of modelling desired behaviours. Further research is needed to in-
vestigate parents’ perceptions of EDs and their role in adolescent
ED use. Nonetheless, the current preliminary
ndings suggest that
educational intervention strategies to reduce adolescents’ ED use
could be effective if targeted to parents. Speci
cally, interventions
that increase parental knowledge around EDs, reduce inconsisten-
cy between modelling and disapproving ED use, in addition to pro-
viding alternative choices to redressing adolescent and parent fatigue,
could be effective at reducing adolescent ED use. Parent-focused in-
terventions have previously been shown to be effective, for example,
in reducing adolescent high-risk alcohol use (
Doumas, Turrisi, Ray,
Esp, & Curtis-Schaeffer, 2013
; Ichiyama et al., 2009).
The experience of physiological symptoms in relation to con-
suming a single ED was common and were consistent with those
documented among adult ED users (
Malinauskas et al., 2007; Nordt et al., 2012). No previous studies have
cally examined the short- or long-term health effects of chil-
dren’s and adolescents’ ED use. The current
ndings suggest EDs may
have similar physiological effects on young adolescents as adults.
However, given youth generally have a lower tolerance to caffeine
than adults, and are undergoing a period of rapid adolescent growth,
the adverse effects of EDs may be even greater. There was some
awareness within the sample of the harmful effects of EDs. However,
this was limited to a general health warning and not related to per-
sonal risk of harm.
Previous research has associated adult ED use with risk-taking
behaviours, including problematic alcohol use, cigarette smoking,
drug use and violence (
Arria et al., 2010; Arria & O’Brien, 2011; Miller,
). Weekly ED use among 11–13 year-olds has been associated
with cigarette smoking and alcohol use (
Gallimberti et al., 2013).
ED use and risk-taking behaviours were not directly explored in the
current study. However, there was a perception that rebellious youth
who engaged in risk-taking behaviours and adolescents with low
self-esteem striving to
t a particular identity were typical regular
ED users. Whether engagement in any one risk-taking behaviour
leads to uptake of other high risk behaviours, such as high and/or
frequent use of EDs, is unclear. Engagement in any high risk
behaviours is likely in
uenced by individual characteristics. None-
theless, prevention efforts targeted to adolescent alcohol use and
smoking behaviour would bene
t from incorporating health mes-
sages related to ED use.
ndings of this study need to be considered in light of a
number of limitations. Firstly,
ndings are based on the percep-
tions and experiences of a small group of adolescents, who were
mostly male and recruited from a public co-educational and an in-
dependent Catholic all-boys school in regional Victoria, Australia.
ndings are not likely to be representative. While Temple
et al. (Temple, Dewey, & Briatico, 2010) reported ED use was more
prevalent among males than females in their adolescent sample,
further research should explore gender differences in perceptions
and patterns of ED use, particularly with the introduction of sugar-
free EDs onto the market. Additionally, participants’ responses may
have been limited by the presence of a school representative during
focus groups (in accordance with ethical requirements). Although
there was a high level of participant engagement across all focus
groups, an anonymous survey design may ensure honest report-
ing of ED use. Despite these identi
ed limitations, this study has pro-
vided one of the
rst detailed accounts of young adolescents’
perceptions and patterns of ED use.
The young people interviewed in this study were very familiar
with the use of EDs and reported using EDs for enjoyment, func-
tion, and social reasons, despite their limited awareness of ED in-
gredients. ED use was in
uenced by parents and advertising and
associated with desired and undesired physiological symptoms.
ndings indicate that young adolescents may use EDs in a
manner similar to older individuals without knowing what they are
drinking and how they contribute to their personal risk of harm.
Further research is needed to replicate and extend these
in a larger, more representative sample, examine the short- and long-
term correlates and consequences of young adolescents’ ED use, and
investigate parents’ role in adolescent ED use. The long-term harms
of alcohol use by youth have only recently been adequately iden-
ed after more than 100 years of research. There is a strong case
for adopting the precautionary principle when it comes to young
people’s health. ED researchers and policy makers could bene
the lessons learned from alcohol and tobacco research about the in-
uence of advertising, appropriate labelling, and regulated sale of
risk-associated products. Possible recommendations include re-
stricting the sale of EDs to people under the age of 18, introducing
clearer labelling of risk of harm to children and adolescents,
as well as regulating ED advertisements targeting children and
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189B.M. Costa et al./Appetite 80 (2014) 183–189
    • "This finding is consistent with previous research (e.g., Costa et al., 2014; Gallimberti et al., 2013), but inconsistent with ED manufacturers' assertion that EDs are not marketed to nor consumed by those aged <12 years. While many adolescents are aware of ED brands, advertisements , and promotional activities, some adolescents (particularly those <15 years) are unaware that EDs are functionally distinct from other drink types such as sports drinks like Gatorade (Costa et al., 2014). There was wide variability in beliefs about the appropriate number of EDs that could be consumed per day. "
    [Show abstract] [Hide abstract] ABSTRACT: Caffeinated Energy Drinks (EDs) are not recommended for consumption by children, yet there is a lack of age-specific recommendations and restrictions on the marketing and sale of EDs. EDs are increasingly popular among adolescents despite growing evidence of their negative health effects. In the current study we examined ED consumption patterns among 399 Australian adolescents aged 12–18 years. Participants completed a self-report survey of consumption patterns, physiological symptoms, and awareness of current ED consumption guidelines. Results indicated that ED consumption was common among the sample; 56% reported lifetime ED consumption, with initial consumption at mean age 10 (SD = 2.97). Twenty-eight percent of the sample consumed EDs at least monthly, 36% had exceeded the recommended two standard EDs/day, and 56% of consumers had experienced negative physiological health effects following ED consumption. The maximum number of EDs/day considered appropriate for children, adolescents, and adults varied, indicating a lack of awareness of current consumption recommendations. These findings add to the growing body of international evidence of adolescent ED consumption, and the detrimental impact of EDs to adolescent health. Enforced regulation and restriction of EDs for children's and adolescents' consumption is urgently needed in addition to greater visibility of ED consumption recommendations.
    Full-text · Article · Jul 2016
    • "These findings are similar to those of Costa, Hayley, and Miller (2014) whose research suggests that these drinks are 'normalised and perceived as necessary to meet the demands of a busy lifestyle' (p. 187) and that they are readily accessible from local shops, supermarkets and vending machines in public places (Costa et al., 2014). Older pupils in the focus groups considered energy drinks as not 'cool'. "
    [Show abstract] [Hide abstract] ABSTRACT: The objective was to observe and document food behaviours of secondary school pupils from schools in a London borough. The research design combined a number of methods which included geographic information system (GIS) mapping of food outlets around three schools, systemised observations of food purchasing in those outlets before, during and after school, and focus groups conducted with pupils of those schools to gather their views in respect to those food choices. Results are summarised under the five 'A's of Access, Availability, Affordability and Acceptability & Attitudes: Access in that there were concentrations of food outlets around the schools. The majority of pupil food purchases were from newsagents, small local shops and supermarkets of chocolate, crisps (potato chips), fizzy drinks and energy drinks. Availability of fast food and unhealthy options were a feature of the streets surrounding the schools, with 200 m the optimal distance pupils were prepared to walk from and back to school at lunchtime. Affordability was ensured by the use of a consumer mentality and pupils sought out value for money offers; group purchasing of 'two for one' type offers encouraged this trend. Pupils reported healthy items on sale in school as expensive, and also that food was often sold in smaller portion sizes than that available from external food outlets. Acceptability and Attitudes, in that school food was not seen as 'cool', queuing for school food was not acceptable but queuing for food from takeaways was not viewed negatively; for younger pupils energy drinks were 'cool'. In conclusion, pupils recognised that school food was healthier but provided several reasons for not eating in school related to the five 'A's above.
    Article · Apr 2016
    • "As of August 2008, Food Standard Australia Zealand required that this guideline be conveyed to consumers via the advisory statement printed on the beverage container. However, there are no legal requirements as to the wording, location, size, and visibility of this statement, and this advisory statement has been described as confusing, of low visibility, and often worded to encourage, rather than discourage, excess consumption [19, 20]. Health advisory statements are targeted at " information-sensitive " consumers who are able and willing to attend to, comprehend, recall, and act on the message. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Despite concern regarding harms of energy drink (ED) consumption, no research has been conducted to determine awareness and compliance with ED intake guidelines displayed on product packaging in Australia (a novel approach internationally). Methods A convenience sample of 1922 people completed an online survey. Participants reported their knowledge of maximum recommended daily ED intake according to Australian guidelines. Results Guideline awareness was reported by 38, 23 and 19 % of past year consumers, lifetime, and non-consumers, respectively. Amongst past year consumers, ‘accurate estimators’ reported greater ED intake and were more likely to exceed intake guidelines and consume alcohol mixed with ED (AmED). After controlling for demographics and frequency of use, guideline awareness predicted increased likelihood of exceeding guidelines in ED sessions, but was not associated with exceeding ED guidelines in AmED sessions. Conclusions Australia is considered to have the most stringent regulatory approach to EDs internationally. However, advisory statements are not associated with greater awareness and compliance with intake guidelines. Failure to comply with standards for efficacious product labelling, and absence of broader education regarding guidelines, needs to be addressed.
    Full-text · Article · Dec 2015
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