Energy Drink Consumption Patterns and Associated Factors Among Nursing Students

Abstract

This study was conducted to examine energy drink consumption patterns among nursing students and to identify related factors that may influence those students' intake levels.
The subjects were nursing students from seven universities located in the Chungcheong Province of Korea. A total of 1,620 questionnaires were used for analysis.
Of the 1,620 nursing students, 1,265 students (78.1%) reported having consumed energy drinks. The average amount of energy drink consumption among the nursing students when studying for their most recent midterm examination was 1.63 ± 2.64 cans per week, and the number of energy drink cans drunk during that time spanned 1-30 per week. The major reason given for energy drink intake was combating fatigue. Eleven percent of the participants always checked ingredient levels. Mixing energy drinks with alcohol was not a popular choice. The side effect most reported by nursing students was that of palpitations (27.8%). Factors affecting energy drink intake included gender and monthly allowance amounts.
Many nursing students in this study had tried energy drinks, with some of them reporting the use of excessive amounts. Gender and monthly allowance amounts were affecting factors of energy drink intake. Precise labeling that includes all ingredients and their amounts is necessary to prevent future health problems. Nursing students' education should include an overview of energy drinks and their drawbacks as part of their nutrition or health education coursework.

Full text

Energy Drink Consumption Patterns
and Associated Factors Among
Nursing Students
A Descriptive Survey Study
In Kyung Kim, RN, PhD, APN mKyung Mi Kim, RN, PhD, APICN
Abstract
Background: This study was conducted to examine energy
drink consumption patterns among nursing students
and to identify related factors that may influence those
students’ intake levels.
Methods: The subjects were nursing students from
seven universities located in the Chungcheong Province
of Korea. A total of 1,620 questionnaires were used
for analysis.
Results: Of the 1,620 nursing students, 1,265 students
(78.1%) reported having consumed energy drinks. The
average amount of energy drink consumption among the
nursing students when studying for their most recent
midterm examination was 1.63 T2.64 cans per week,
and the number of energy drink cans drunk during that
time spanned 1Y30 per week. The major reason given
for energy drink intake was combating fatigue. Eleven
percent of the participants always checked ingredient
levels. Mixing energy drinks with alcohol was not a
popular choice. The side effect most reported by nursing
students was that of palpitations (27.8%). Factors
affecting energy drink intake included gender and monthly
allowance amounts.
Conclusions: Many nursing students in this study had
tried energy drinks, with some of them reporting the
use of excessive amounts. Gender and monthly allowance
amounts were affecting factors of energy drink intake.
Precise labeling that includes all ingredients and their
amounts is necessary to prevent future health problems.
Nursing students’ education should include an overview
of energy drinks and their drawbacks as part of their
nutrition or health education coursework.
Keywords: energy drink, nursing, student
INTRODUCTION
Over the past 20 years, the consumption of all caffeinated
drinks has steadily increased, with the consumption specifically
of energy drinks containing an excessive amount of caffeine dra-
matically increasing among young people (Malinauskas, Aeby,
Overton, Carpenter-Aeby, & Bargber-Heidal, 2007; Seifert,
Schaechter, Hershorin, & Lipshultz, 2011). These energy
drinks tend to include caffeine, vitamins, dietary supplements,
glucose, taurine, sweeteners, and herbal supplements, among
other ingredients (Iyadurai & Chung, 2007; Seifert et al.,
2011). Since stores began stocking Red Bull in Austria in 1987
and in the United States in 1997, many new energy drinks have
launched worldwide (Malinauskas et al., 2007; Reissig, Strain, &
Griffiths,2009).InKorea,Bacchus,adrinkcontainingtaurine
(2-amino-ethanesulfonic acid), caffeine, and other vitamin B,
has been on sale since the early 1990s, and other drinks, like
Hotsix, Red Bull, Monster Energy, and Burn, have been sold
in Korea since 2010. In addition, the preponderance of campus
convenience stores and university vending machines stocking
these drinks has led to easy access for Korean college students.
Students report using energy drinks as a way to help them
stay awake, sharpen their examination-taking skills, or get
through homework as well as drinking them during high-
energy activities or using them as a mixer with alcohol (Pennay,
Lubman, & Miller, 2011). Although they are known to help
ward off sleepiness, reduce tiredness, and temporarily en-
hance concentration for work or academics when drunk
within reason (Malinauskas et al., 2007; McLellan & Lieberman,
2012), overconsumption of energy drinks can also cause var-
ious health problems. Researchers have reported side effects
of tachycardia, hypertension, dehydration, and insomnia
from the overconsumption of energy drinks (Lohsoonthorn
et al., 2013; Reissig et al., 2009), and serious withdrawal symp-
toms have arisen from an increased caffeine tolerance because
of the overuse of energy drinks (Reissig et al., 2009).
In Kyung Kim, RN, PhD, APN, Hanseo University Department of Nursing,
Seosan-si, Chungcheongnam-do, South Korea.
Kyung Mi Kim, RN, PhD, APICN, Semyung University Department of
Nursing, Jecheon, Chungbuk, South Korea.
The authors contributed equally to this work.
The authors report no conflicts of interest. The authors alone are re-
sponsible for content and writing of the article.
This paper was supported by the Semyung University Research Grant of 2013.
Correspondence related to content to: Kyung Mi Kim, RN, PhD, APICN,
Semyung University Department of Nursing, 65 Semyung-ro, Jecheon,
Chungbuk, 390-711 South Korea.
E-mail: icpkim@semyung.ac.kr
DOI: 10.1097/JAN.0000000000000061
24 www.journalofaddictionsnursing.com January/March 2015
Original Article
Journal of Addictions Nursing &Volume 26 &Number 1, 24Y31 &Copyright B2015 International Nurses Society on Addictions
Copyright © 2015 International Nurses Society on Addictions. Unauthorized reproduction of this article is prohibited.

Because of the characteristics of their curricula and the
additional expectation of clinical rotations, nursing students
often find themselves under great academic pressure while
trying to functionwith minimal amounts of sleep. This study
seeks to investigate the conditions of energy drink intake among
nursing students and to analyze related factors that may in-
fluence their intake.
METHODS
Participants and Procedures
This is a descriptive study to identify the patterns of energy
drink intake and influencing factors among nursing stu-
dents in Korea. This study was conducted from March 25
to April 30, 2013. The subjects of this study included nursing
students from seven universities located in Chungcheong
Province. The students met with the researcher in classrooms
on each campus. The study was explained before the ques-
tionnaire was distributed. Completed questionnaires were
collected in a box in front of the classroom after 30 minutes.
The number of subjects was determined by using the
G*power 3.1.2 program; the power was .95 for logistic re-
gression analysis with a two-tailed significance level of .05,
odds ratio of 1.9, and probability of 0.3, and the distribu-
tion was binominal. The least sample size was 1,512 when
the sample size rate of two groups was 0.1. To account for
dropped scores and meet the least samplesize, questionnaires
were distributed to 1,700 students. Questionnaires were col-
lected from 1,664 students. Informed consent was obtained
from all respondents. Forty-four of the returned question-
naires were excluded because of incompleteness. A total of
1,620 questionnaires were used for analysis.
The study was approved by the institutional review
board of Semyung University Oriental Medicine Hospital
(Approval No. 2013-06).
Measures
The authors developed the questionnaire based on a review
of literature (Attila & /akir, 2011; Ballistreri & Corradi-Webste,
2008; Miller, 2008; Velazquez, Poulos, Latimer, & Pasch, 2012).
The questionnaire consisted of 25 questions, including 11 focus-
ing on the general characteristics of the subjects and 14
addressing the patterns of their energy drink intake. Two nursing
professors reviewed for content validity. Pilot testing was
conductedwith30nursingstudents.
Data Analysis
The collected data were analyzed with the SPSS program
(version 19.0; Chicago, CA). Descriptive statistics were used
to identify the general characteristics of the subjects, their en-
ergy drink intake behaviors, and the effects of energy drink
intake. A ttest and analysis of variance between groups were
used for analyzing the differences inenergydrink intake levels
according to the general characteristics of subjects. The
Scheffe test was conducted as a postcomparison test. Logistic
regression was used to compare energy drink use and nonuse
according to the subjects’ general characteristics and to
analyze influencing factors.
RESULTS
General Characteristics and Levels of Energy
Drink Consumption
Of the 1,620 nursing students, 1,265 students (78.1%)
reported having consumed energy drinks, 88.5% of whom
were women, and 30.8% of whom were college juniors.
Most students (97.2%) who used energy drinks were be-
tween the ages of 20 and 29 years. More nursing students
drank alcohol (37.9%) than abstained. The students who
reported eating breakfast (36.2%) consumed that meal
1Y3 times per week. Forty-eight percent of the students
never engaged in exercise. Half of the nursing students
had a spending allowance of more than $56/month. Only
15% of the students held part-time jobs. More than half of
the nursing students (56.9%) were coffee drinkers.
Significant differences in intake because of gender (t= 2.831,
p= .021), amount of sleep (F= 4.485, p=.004),breakfastcon-
sumption (F= 3.128, p= .025), monthly allowance (F= 2.770,
p= .006), and coffee intake (F=3.000,p= .003) were reported
(see Table 1).
Patterns of Energy Drink Intake
The average amount of energy drink consumption among
the nursing students when studying for their most recent
midterm examination was 1.63 T2.64 cans per week, and
the number of energy drink cans drunk during that time
spanned 1Y30 per week (see Table 2). The energy drink most
frequently imbibed by study subjects was Hotsix (38.4%), and
their most preferred one was Bacchus (50.2%). Two hundred
ninety-four students (25.9%) reported they were well
acquainted with the ingredients of the drinks they consumed.
Those who always checked the levels of the ingredients con-
stituted 10.9% of the total participants, and those who did
not equaled 47.1%. Over half of the participants (63.8%) said
they first tried an energy drink after enrolling for college. The
most frequently reported reason for using energy drinks was
‘‘to wake up’’ (78.8%). Only 0.9% of the nursing students
reported that they always have mixing energy drinks with
alcohol (see Table 3).
Physical Effects of Energy Drinks
When asked how they felt after having an energy drink,
most students (53.6%) responded that they ‘‘felt there were
few expected effects,’’ whereas 37.8% reported that they
‘‘could shake off sleepiness when working and studying.’’
The side effect reported most by subjects (27.8%) was that
of palpitations (see Table 4).
Knowledge of Ingredients in Energy Drinks
The greatest percentage of nursing students knew caffeine
was in energy drinks (29.8%). Knowledge of other drink
ingredients was reported by students as follows: taurine
Journal of Addictions Nursing www.journalofaddictionsnursing.com 25
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TABLE 1 General Characteristics and Amount of Drinking Energy Drinks (
N
= 1,265)
Characteristics
Amount of Energy Drink Consumption
tor Fpn(%) Mean TSD
Age (years) 1.141 .320
G20 24 (1.9) 1.79 T2.21
20 to G30 1,230 (97.2) 1.64 T2.65
Q30 11 (0.9) 0.45 T1.21
Gender 2.831 .021*
Male 146 (11.5) 2.21 T3.28
Female 1,119 (88.5) 1.55 T2.54
Grade 1.369 .251
Freshman 287 (22.7) 1.37 T2.75
Sophomore 301 (23.8) 1.72 T2.59
Junior 390 (30.8) 1.76 T2.77
Senior 287 (22.7) 1.61 T2.37
Sleeping times (hours) 4.485 .004*
G6
a
288 (22.8) 2.09 T3.46 a 9c, a 9d
6toG7
b
498 (39.4) 1.60 T2.48
7toG8
c
355 (28.0) 1.45 T2.25
Q8
d
124 (9.8) 1.22 T1.88
Alcohol consumption 1.768 .077
Yes 479 (37.9) 1.73 T2.72
No 786 (62.1) 1.46 T2.50
Eating breakfast (week) 3.128 .025*
Everyday
a
314 (24.8) 1.48 T2.42 b Gc
4Y6 times
b
359 (20.5) 1.31 T1.94
1Y3 times
c
458 (36.2) 1.89 T2.05
None
d
234 (18.5) 1.68 T2.68
Exercise (week) 1.097 .349
Daily 38 (3.0) 1.58 T4.54
4Y6 times 87 (6.9) 1.37 T1.98
1Y3 times 530 (41.9) 1.78 T2.74
None 610 (48.2) 1.54 T2.47
Allowance per month (U.S. dollars) 2.770 .006*
Q56 622 (49.6) 1.41 T2.06
G56 631 (50.4) 1.81 T2.97
Employment outside school 0.761 .447
Works outside school 187 (14.7) 1.76 T2.61
Does not work 1,078 (85.3) 1.61 T2.64
Work hours (per week; N= 188) 1.840 .067
G9 88 (46.8) 1.41 T2.01
Q9 100 (53.2) 2.10 T3.02
Coffee consumption 3.000 .003*
Yes 720 (56.9) 1.82 T2.78
No 545 (43.1) 1.37 T2.12
*pG.05.
26 www.journalofaddictionsnursing.com January/March 2015
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(19.3%), glucose (14.9%), citric acid (9.1%), vitamin C (7.4%),
minerals (5.9%), carbonic acid (5.0%), vitamin B (2.8%), herbal
medicines (2.5%), nicotine (1.8%), alcohol (0.8%), protein
(0.6%), and other contents (0.1%).
Factors Affecting Energy Drink Intake
There were statistically significant differences between the
energy drink intake group and the nonintake group in the
characteristics of gender, exercise, and monthly allowance.
The rate of energy drink intake was lower in female students
than in male students (OR =0.29,p= .016) and in those stu-
dents with allowances less than 56 dollars per month than in
those whose allowance was more (OR =0.40,p=.034).The
rate of energy drink intake in the group engaging in exercise
every day was lower than that of the group that did not work
out daily (OR = 2.46, p= .047; see Table 5).
A multiple logistic regression analysis revealed that gender
(OR =0.41,p= .001) and monthly allowance (OR = 0.71, p=
.005) had a significant influence on energy drink intake (see
Tabl e 6).
DISCUSSION
This descriptive study investigated the energy drink con-
sumption patterns among Korean nursing students and
associated factors.
Previous studies in Turkey and the United States reported
that less than 50% of the college students in those countries
drank energy drinks (Attila & /akir, 2011; Velazquez et al.,
2012); however, 78.1% of the nursing students in this study
reported having consumed energy drinks. Ninety-nine per-
cent of students in this study were between the ages of 20
and 29 years. This result was consistent with previous studies
(Heckman, Sherry, & Gonzalez, 2010; Seifert et al., 2011)
suggesting that energy drinks are consumed by young adults.
Of all the participants, most (64%) answered that they tried
energy drinks for the first time during their college years.
This result is similar to Attila and /akir (2011). However, many
participants answered that they first had an energy drink be-
tween the ages of 14 and 19 years, during middle or high
school. This result supports the creation of age-appropriate
health education on energy drinks throughout the educational
system.
The nursing students’ intake amounts averaged 1.63 T2.64
cans per week during the period of their examinations, but
some individuals averaged more than four cans a day, which
equals about 250 mg of caffeine. Because many students also
enjoy other caffeinated beverages, such as coffee, tea, cola
products, and hot chocolate, health problems because of ex-
cessive consumption of caffeine may become a concern. More
than half of the nursing students were coffee drinkers, and
there were statistical differences in the energy drink intake
levels between those study participants who drank coffee
and those who did not. The results suggest that there is a risk
of caffeine addiction for those who supplement energy drinks
with coffee and other caffeinated beverages.
Whereas college students listed Red Bull as the drink of
choice in Attila’s study, the nursing students of this study fa-
vored Hotsix. The price of Hotsix in Korea being half the
price of Red Bull (MK Business News, 2013) may have
influenced the selection. In this study, monthly allowance
was an influencing factor of energy drink intake, and there
were statistically significant differences in the levels of energy
drink intake according to monthly allowance. These findings
suggest that the purchase of energy drinks is related to prod-
uct cost.
The main reason for energy drink consumption among
the nursing students was ‘‘combating sleepiness,’’ which is
similar to results from other studies (Attila & /akir, 2011;
Malinauskas et al., 2007; Trend Monitor, 2012; Velazquez et al.,
2012). It can be extrapolated from the data that much of the
demand for the drinks is related to academic pressure. How-
ever, the number of those students who responded that they
experienced few of the expected effects was more than those
who reported that the ability to counteract sleepiness during
work or study after energy drink intake was as they expected.
The amount of caffeine contained in energy drinks ranges from
50 to 505 mg (Reissig et al., 2009). The Korean Ministry of
Food and Drug Safety has announced that the average amount
of caffeine found in energy drinks distributed in Korea is 101 mg,
an amount comparable with that in drinks found in Australia
and New Zealand (109 mg) and lower than that of their
counterparts in America (137 mg; Korean Ministry of Food
and Drug Safety, 2013). In addition, the caffeine content of
Hotsix (61.85 mg per serving) and Red Bull (62.50 mg per
serving) is still lower than that of a typical Korean coffeehouse
TABLE 2 Amount of Energy Drink
Consumption During the Period
of Examination (
N
=1,265)
Amount (Can) n(%)
1 846 (66.7)
2 151 (11.9)
3 88 (7.0)
4 48 (3.8)
5 59 (4.7)
6 16 (1.3)
7 24 (1.9)
8 5 (0.4)
9 2 (0.2)
10 14 (1.1)
11 3 (0.2)
12 2 (0.2)
15 1 (0.1)
16 3 (0.2)
25 1 (0.1)
28 1 (0.1)
30 1 (0.1)
Journal of Addictions Nursing www.journalofaddictionsnursing.com 27
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serving of coffee (123 mg, on average; see Table 7). Because of
this fact, it could be that the nursing students did not get the
expected fatigue alleviation because of a caffeine tolerance built
up from their coffee intake.
The nursing students who enjoyed less than 6 hours of
sleep per night reported drinking one more can than those
who slept more than 7 hours a night. It seems that those
nursing students with shorter sleep durations drank more
TABLE 3 Energy Drink Behavior Among
Users of Energy Drinks
Characteristics n(%)
Types of energy drinks tried
a
(N=1,265)
Hotsix 1,143 (38.4)
Bacchus 1,092 (36.7)
Red Bull 383 (12.9)
Burnintense 266 (8.9)
Monster Energy 66 (2.2)
Other brands 28 (0.9)
Popular high-caffeine drinks (N= 1,260)
Bacchus 632 (50.2)
Hotsix 492 (39.0)
Red Bull 45 (3.6)
Burn 27 (2.1)
Monster Energy 7 (0.6)
Other brands 57 (4.5)
Self-perceived knowledge level of elements (N=1,259)
Well 148 (10.4)
Moderately 817 (63.6)
Rarely 294 (25.9)
Check ingredients of energy drink
Always 127 (10.9)
Sometimes 545 (42.9)
None 593 (47.1)
Age when energy drink first tried
Middle school or younger 13 (1.0)
High school or younger 444 (35.1)
University or older 808 (63.9)
Reasons for energy drink consumption (N=1,241)
To wake up 1,000 (78.8)
Curiosity 110 (8.7)
Alleviate fatigue 60 (4.7)
Taste 34 (2.4)
Recommendation of friend 26 (2.0)
Habit 11 (0.7)
Stress relief 11 (0.7)
Other 26 (2.0)
Use of energy drink as a mixer
a
None 1,015 (77.5)
Whiskey 117 (8.9)
Soju 98 (7.5)
Beer 20 (1.5)
Juice 14 (1.1)
Milk 3 (0.2)
Other drinks 42 (3.2)
Continues
Characteristics n(%)
Frequency of mixing alcohol with energy drink (N=1,261)
Always 11 (0.9)
Sometimes 227 (17.8)
None 1,023 (81.2)
Subjective effects of energy drink
(N= 1,255)
Positive effect 367 (29.1)
No effect 505 (40.5)
Negative effect 383 (30.4)
a
Duplicate response.
TABLE 3 Energy Drink Behavior Among
Users of Energy Drinks,
Continued
TABLE 4 Effects After Energy Drink
Consumption (
N
= 1,265)
Effects n(%)
Positive effects
No effect 678 (53.6)
Awake from sleep 478 (37.8)
Recovery of fatigue 43 (3.4)
Elevation of concentration 33 (2.6)
Stress relief 8 (0.6)
Other 25 (2.0)
Negative effects
a
Palpitation 585 (27.8)
Sleep disorder 444 (21.1)
No symptom 338 (16.1)
Gastrointestinal trouble 221 (10.5)
Headache 186 (8.8)
Elevation of blood pressure 95 (4.5)
Fatigue 64 (3.0)
Dizziness 58 (2.8)
Depression 51 (2.4)
Elevation of bodyweight 28 (1.3)
Feel thirsty 29 (1.4)
Other 5 (0.2)
a
Duplicate response.
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TABLE 5 Comparison of General Characteristics of Drinking and Nondrinking Groups
by Using Simple Logistic Regression (
N
= 1,620)
Characteristics
Drinking (N= 1,265) Nondrinking (N= 355)
OR [95%CI] pValuen(%) n(%)
Age (years)
G20 24 (1.9) 12 (3.4) 1.00
20 to G30 1,230 (97.2) 337 (94.9) 0.28 [0.11, 0.78] .328
Q30 11 (0.9) 6 (1.7) 0.20 [0.03, 1.57] .598
Gender
Male 146 (11.5) 17 (4.8) 1.00
Female 1,119 (88.5) 338 (95.2) 0.29 [0.11, 0.78] .016*
Grade
Freshman 287 (22.7) 99 (27.9) 1.00
Sophomore 301 (23.8) 82 (23.1) 1.19 [0.24, 5.91] .818
Junior 390 (30.8) 96 (27.0) 0.52 [0.14, 1.90] .522
Senior 287 (22.7) 78 (22.0) 0.87 [0.24, 0.38] .872
Sleeping times (hours)
G6 288 (22.8) 81 (22.8) 1.00 .
6toG7 498 (39.4) 137 (38.6) 2.70 [0.58, 12.46] .203
7toG8 355 (28.0) 107 (30.1) 1.97 [0.48, 8.13] .348
Q8 124 (9.8) 30 (8.5) 0.39 [0.10, 1.60] .192
Drinking alcohol
Yes 479 (37.9) 199 (56.1) 1.00
No 786 (62.1) 156 (43.9) 0.40 [0.17, 0.93] .905
Eating breakfast (week)
None 234 (18.5) 58 (16.3) 1.00
Everyday 314 (24.8) 109 (30.7) 0.39 [0.11, 1.05] .610
4Y6 times 359 (20.5) 77 (21.7) 0.54 [0.13, 2.26] .537
1Y3 times 458 (36.2) 111 (31.3) 0.69 [0.17, 2.79] .399
Exercise
Everyday 38 (3.0) 11 (3.1) 1.00
4Y6 times 87 (6.9) 15 (4.2) 0.51 [0.14, 1.90] .646
1Y3 times 530 (41.9) 141 (39.7) 0.65 [0.10, 4.23] .439
None 610 (48.2) 188 (53.0) 2.46 [1.01, 5.97] .047*
Allowance per month (U.S. dollars)
Q56 631 (50.4) 146 (41.2) 1.00
G56 622 (49.6) 208 (58.8) 0.40 [0.03, 6.50] .034*
Employment outside school
Works outside school 187 (14.7) 37 (10.4) 1.00
Does not work 1,078 (85.3) 318 (89.6) 0.41 [0.03, 6.50] .521
Work hours (per week; n=226)
G9 88 (46.8) 23 (60.5) 1.00
Q9 100 (53.2) 15 (39.5) 1.38 [0.59, 3.22] .456
Coffee consumption
No 545 (43.1) 190 (53.5) 1.00
Yes 720 (56.9) 165 (46.5) 1.01 [0.42, 2.40] .984
Note. OR = odds ratio; CI = confidence interval.
*pG.05.
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energy drinks as they tired. As their tiredness increased, so did their
sleep needs, thus repeating the cycle until the students came to
negatively recognize the effects of their drink consumption.
In Attila and /akir’s (2011) study, most students did not
check the ingredients of energy drinks. In addition, the name
‘‘energy drink’’ rather than ‘‘high caffeine drink’’ may lead to
different expectations for consumers. For example, an emphasis
on guarana extraction as an ingredient gives an impression of nat-
ural fruit juice, which may make consumers feel that the drinks are
a healthier choice than coffee. Moreover, it is believed that college
students do not distinguish between energy drinks and functional
drinks like sport drinks. This may be because most energy drinks
do not indicate the percentages of their ingredients, instead em-
phasizing the ideas that they improve performance, endurance,
and concentration as well as promote metabolism, which then
can lead to an assumption that the energy drink is a healthy choice
(Reissig et al., 2009). Of the energy drinks sold in Korea, only
Bacchus, which counts taurine (2000 mg) as a main ingredient,
specifies the names and amounts of its ingredients on its label;
both Hotsix and Red Bull only indicate ingredients, not their
quantities. Although this study did not investigate whether the
nursing students could distinguish between energy and sports
drinks, almost half of the participants did not check ingredient
labels at all, and it has been reported that Koreans aged between
20 and 29 years think of energy drinks as similar to sport drinks
(Trend Monitor, 2012). Therefore, it could be that some of the nurs-
ing students confused energy drinks with more functional drinks.
It is known to be dangerous to mix energy drinks with
alcohol because of the stimulant effect of caffeine in energy
drinks negatively combining with the depressant effect of
alcohol (Attila & /akir, 2011; Miller, 2008). Unfortunately,
the consumption of these energy drink cocktails has spread
widely among college students (Arria et al., 2010) because
of the general taste of the drink and the reduction of the alcohol’s
depressive effect (Attila & /akir, 2011). People who consume
energy drinks also tend to be more inclined to use alcohol
and drugs (Attila & /akir, 2011; Brache & Stockwell, 2011;
Malinauskas et al., 2007; Velazquez et al., 2012). However, this
study found that the nursing students rarely mixed their en-
ergy drinks with alcohol. This result could be because the
nursing students used energy drinks primarily as a way to
keep themselves awake when studying for long periods rather
than as a recreational drink.
From previous studies (Attila & /akir, 2011; Ballistreri &
Corradi-Webste, 2008; Velazquez et al., 2012), it was found
that men drank more energy beverages, which was also the
case in this study. In a study with physical education students
(Ballistreri & Corradi-Webste, 2008), sports, in particular,
gym classes and athletic swimming practices, also were found
to be factors related to energy drink intake, although general
exercise was not. Whereas Ballistreri and Corradi-Webste
(2008) reported that physical education students drank energy
beverages in an effort to enhance the quality of their strength,
it can be considered that nursing students presented different
results because most did not regard exercise as part of their
academic progress but instead as a leisure activity.
Today’s nursing students are the nurses of tomorrow. Be-
cause of that, they need to be aware of the ingredients and physical
effects of energy drinks for their own health and for the health
of those they will serve. For this reason, nursing education should
include guidelines on the contents and side effects of energy drinks
during nutrition or health education coursework. Campaigns
focused on restraining the use of energy drinks during examina-
tion periods should be widespread on campuses, and warnings
of the caffeine contents and physical effects of the drinks should
be displayed prominently in university convenience stores and
on vending machines.
This study is limited by the fact that it had a specific target
population (Korean nursing students) and specific expectations
of their energy drink usage. In addition, the amounts of energy
drink intake were self-reported and referenced common can
sizes as sold in Korea rather than being measured precisely by
objective technicians.
TABLE 6 Influencing Factors on Drinking
Energy Drink From Logistic
Regression (
N
=1,620)
Variables OR 95% CI pValue
Gender 0.41 [0.24, 0.69] .001*
Allowance per
month (U.S.
dollars)
0.71 [0.56, 0.90] .005*
Exercise 1.10 [0.55, 2.24] .782
Note. OR = odds ratio; CI = confidence interval.
*pG.05.
TABLE 7 Amounts of Caffeine per Energy Drink Brands
Product ml/can mg/can mg/ml
Daily Requirements
(in Korea)
a
Hotsix 250 61.85 0.25 Adult (age Q19 years):
400 mg/day, pregnant
woman: 300 mg/day,
child (age G19 years):
2.5 mg/kg
Bacchus 100 30.00 3.33
Red Bull 250 62.50 0.25
Burn 250 78.05 0.31
Monster Energy 473 164.00 0.35
a
Korean Ministry of Food and Drug Safety (2012).
30 www.journalofaddictionsnursing.com January/March 2015
Copyright © 2015 International Nurses Society on Addictions. Unauthorized reproduction of this article is prohibited.

CONCLUSION
Many nursing students (78.1%) in this study had tried energy
drinks, with three study participants reporting the use of
excessive amounts (more than four cans a day). Although
the drinks were usually consumed to counteract fatigue when
doing schoolwork, many reported that they did not get the
expected effects after intake. Mixing energy drinks with alco-
hol is a popular cocktail with many college students, but this
was not a popular choice for the study participants, with only
18.7% reporting having indulged in the practice. Factors af-
fecting energy drink intake included gender and monthly
allowance amounts.
On the basis of the study results, precise ingredient label-
ing is necessary. All ingredients and their amounts should be
specified in the labeling of energy drinks. Then, by checking
the labeling, one could reduce the risk of excessive daily caf-
feine intake that can occur from excessive energy drink intake
combined with the additive effects of consuming coffee, en-
ergy drinks, and other caffeine-containing foods (e.g., green
tea, cola, chocolate, coffee-flavored ice creams). By making
sure that consumers are acquainted with the ingredients
and physical effects as well as the caffeine content of energy
drinks, we can prevent future health problems.
Nursing education should include guidelines on energy
drinks within the nutrition and/or health education aspects
of the curriculum. In addition, on-campus campaigns focused
on decreasing energy drink consumption is necessary.
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