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Energy Drink Consumption
Practices of Young People in
Bahrain
Maryam M. Nassaif, Ghufran J. J.
Alobed, Noor A. A. Alaam, Abdulla
N. Alderrazi, Muyssar S. Awdhalla,
Asokan G. Vaithinathan
College of Health Sciences, University of Bahrain,
Bahrain
Vol. 4, No. 2 (2015) | ISSN 2166-7403 (online)
DOI 10.5195/cajgh.2015.216 | http://cajgh.pitt.edu
NASSAIF
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
Abstract
Background: Energy drink (ED) consumption is becoming increasingly popular among young Bahrainis, who may be unaware of
the health risks associated with ED consumption. To date, there have been few publications on the consumption of ED in Bahrain,
particularly among adolescents. This study seeks to fill a gap in the literature on energy drink consumption practices of Bahraini
adolescents.
Methods: Data were collected using a previously established European Food Safety Authority questionnaire. Cross-sectional
analyses were conducted on a convenience sample of 262 Bahraini students aged 10 to 18 years.
Results: Most participants consumed energy drinks 2 to 3 times per week and consumed two or more cans at a time. Eighty percent
of partcipants preferred energy drinks with sugar. Participants in the older age group and higher educational level consumed more
ED. The majority (57%) consumed ED at home with friends as part of socialization. Notably, 60% of the parents of the respondents
have not consumed energy drinks. Prominent reasons for consumption of energy drinks included: taste (40%), energy (30%), stay
awake (13%), augment concentration (4%), and enhance sports performance (6%).
Conclusion: Energy drink consumption is a popular socialization activity among adolescents of Bahrain. The potential health risks
necessitates the need for novel health promotion strategies and advocacy efforts for healthy hydration practices.
Keywords: energy drinks, health effects, young people, health promotion
Energy Drink Consumption Practices
of Young People in Bahrain
Maryam M. Nassaif, Ghufran J. J.
Alobed, Noor A. A. Alaam, Abdulla N.
Alderrazi, Muyssar S. Awdhalla,
Asokan G. Vaithinathan
College of Health Sciences, University of Bahrain, Bahrain
Research
Energy drink(s) (ED) refers to beverages that
contain caffeine in combination with other ingredients
such as taurine, guarana, and B vitamins, with claims to
provide its consumers with extra energy.1 Over 140
countries report ED consumption, with children,
adolescents, and young adults representing half of the
consumers of ED.2 The prevalence of ED consumption
varies by age group and size. Regionally, ED are largely
consumed in the Middle East and in the Western World.
For instance, 55% of male and 26% of female students in
the University of Dammam consumed ED,3 and Saudi
Arabia was ranked among the top ten ED consuming
countries.4 In 2013, the Central Information Organization
of Bahrain reported that the consumption of ED in
Bahrain was 174 per 1,000 persons.5 In the USA, about 1
in 9 youths received counseling discouraging ED
consumption from a health care professional.6 The
prevalence of ED consumption in Europe was 68%,
varying from 48% in Greece to 82% in the Czech
Republic, and mostly observed in the age group of 15-18
years (73%).7 On average, adolescents consume 2.1 L of
ED per month in Europe.7 An Australian report revealed
that 48% of young adults consumed ED at least once a
month with an average intake of 1-2 cans per day.8
EDs act as non-nutritive stimulants with
purported ergogenic or performance-enhancing effects.
Caffeine, taurine, D-glucorono-y-lactone, and sugar are
the main ingredients. Other products found in ED are
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
vitamins, L-carnitine, and extracts such as guarana (1 gm
of guarana equates 40 to 80 mg of caffeine), ginkgo
biloba, bitter orange, and ginseng.2 The intended effects
of ED are to provide sustenance, endurance,
concentration, and enhanced performance.
Manufacturers of ED target their sales to students,
athletes, and people in professions that warrant sustained
alertness.9 Popularity of ED among teenagers is
associated with risk taking.10
Studies have shown that moderate caffeine
consumption (<400mg/ day) is not associated with the
adverse effects of caffeine such as general toxicity,
cardiovascular effects, effects on bone status, and
calcium balance;11 however, the amounts of caffeine in
ED far exceed that of safety limits.11 According to the
World Health Organization (WHO) 2015 sugar intake for
adults and children guidelines,12 the suggested limit of
sugar consumption for adults of normal BMI is 25g/day
(6 teaspoons). In general, sugar content in ED ranges
from 21 g to 34 g per 8 oz. Daily consumers of two or
three cans of ED could be ingesting 4 to 6 times the
maximum recommended daily intake of sugar, which
poses a risk for obesity and dental problems. 13
Common adverse effects of ED that have been
documented are dizziness, inability to focus,
nervousness, gastrointestinal upset, and insomnia.14 In
rare situations, anxiety, seizure, increased heart rate,
dehydration, acute mania, stroke, and behavioral
problems like fighting and addiction have been
observed.14 Potential problems associated with ED
consumption in children and adolescents include
cardiovascular effects and eating disorders. A systematic
review suggests using caution in consuming ED, even
though long term studies with health effects follow up
were lacking.14 The prevalence of non-communicable
diseases is similar to other developed economies
according to the National Non-Communicable Diseases
(NNCD) risk factor survey carried out in Bahrain,15 thus
nutritional factors are important to investigate.
As of 2016, no reports have been published on
the consumption practices of ED in Bahrain. Therefore,
this study was undertaken to explore energy drink
consumption practices of Bahraini adolescents.
Methods
Data collection for this cross-sectional study
was carried out by study investigators using a
convenience sampling approach from public places that
students frequently visit (i.e. parks and malls of Bahrain
during the weekends). Our study sample included
Bahraini adolescent students aged 10 to 18 years of both
genders.
To be 95% confident that the true value of the
estimate will be within 5 percentage points of the
prevalence of 17%,5 the required sample size was
calculated to be 217 in order to achieve the desired level
of accuracy. The final number of participants recruited
was 262. In the initial phase of data collection,
participants were asked whether they had ever consumed
ED. Those that answered yes were given a structured,
self-report questionnaire. The questionnaire was
modified from a previously established questionnaire for
gathering consumption data on specific consumer groups
of energy drinks by the European Food Safety Authority
(EFSA).16 The modifications introduced were designed
to make the questionnaire more suitable and compatible
with the Bahraini society regarding demographic,
economic, and socio-cultural aspects. Broadly, the
questionnaire had two sections: 1) demographic data (i.e.,
age, gender, and current education level); 2) energy drink
consumption data (i.e., consumption frequency,
consumption amount, place of consumption, reasons for
consumption, choice of sugar or sugar free, preferred
brand, and parental consumption). For affirming face and
content validity, the questionnaire was scrutinized by a
panel of experts from the College of Health Sciences and
Nutrition in Bahrain. The questionnaire was translated
into Arabic and back translated to English to ensure there
NASSAIF
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
were no translation errors. Before beginning the study,
the questionnaire was piloted with 30 participants to
determine feasibility.
The study was approved by the institutional
research committee of the College of Health Sciences,
Bahrain. After explaining the study purpose, a written
informed consent was obtained from all of the
participants. Confidentiality of the participants and
protection of data gathered was ensured by using study
codes on data documents and removing all identifiable
information.
Data Analysis
The data from the questionnaires were cleaned,
coded, and entered in Excel (Microsoft, Redmond, WA,
USA) and then exported to SPSS version 21 (SPSS Inc,
Chicago, Illinois, USA) for analysis. Descriptive
statistics were used to analyze baseline participant
characteristics. Chi-square tests were used to compare the
ED consumption patterns and baseline characteristics of
the participants.
Results
The median age of the participants was 16 years
(range: 10-18), which was not normally distributed. The
majority of participants were enrolled in secondary
education institutions (grades 10 to 12) and 51% were
male (Table 1).
Table 1: Qualitative demographic characteristics of
participants
Analyzing the consumption practices, habitual
consumption of ED was significantly higher in those
aged 16 to 18 compared to those aged 10 to 12 or 13 to
15 (p<0.01), and a similar significant difference was
observed in the group with higher levels of education
compared to groups with two other levels of education
(p<0.03). Sixty one percent of participants had initiated
ED consumption in the past year. Fifty seven percent
declared that they consumed ED at home and with friends
as a part of socialization adjoining sedentary high screen
media use such as watching TV or playing video games;
less than 10% consumed ED during physical activities
and sports or in public places. Frequency of ED
consumption varied in the sample (Table 2). Among the
respondents, one third consumed ED two to three days a
week, and one fifth consumed ED less than once per
month. Over 80% of respondants preferred a portion size
of 250 ml more than any other available choice of
portions. In an average month of the past year, 34% of
the respondents had 2-4 cans and 23% of the respondents
had 5-10 cans. In a single session of ED consumption
over the last year 51% consumed either two or more cans.
Table 2: Frequency and volume of energy drink
consumption
Table 3 describes respondents’ key reasons for
consumption of ED. Among them, 40% liked the taste of
the drink, and 30% thought that ED provides the needed
energy. Other reasons included: stay awake (13%),
augment concentration (4%), and enhance sports
performance (6%). The top three popular brands
consumed by the participants of this study were Red Bull,
Boom Boom, and Bison. Over 80% preferred ED with
sugar over sugar free ED, and no difference in the
preference between the age groups, gender or educational
levels was found. Among the parents of the respondents,
40% have consumed ED.
Table 3: Reasons for energy drink consumption
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
Discussion
Most participants consumed ED 2 to 3 times per
week, two or more cans at a time, and primarily preferred
ED with sugar. Older participants tended to consume
more ED. Many consumed ED as a part of socialization.
This study supports the idea that ED marketing
strategies have reached young people in Bahrain, since
the majority of the participants consumed two or more
cans in a single session 2 to 3 times a week, which is
similar to the frequency of ED consumption reported
from Italy.17 This study showed that in our sample, higher
intake of ED was found in the older age group with a
higher educational level, which may be due to
independent money spending capacity and the ability to
buy ED without parental supervision. The majority
admitted to consuming ED at home and with friends as
part of socialization. The primary reasons for
consumption of ED were for the taste of the drink and the
energy need. These findings corroborate the reasons
adolescents consume ED given in a report18 from
neighboring Saudi Arabia Findings of our study
contradict the belief that the intended effect of ED use is
endurance and physical activity. Less than 10% of the
respondents reported that they consumed ED during
physical activities or sports.
The majority of the respondents were habitual
consumers of ED and preferred ED with sugar, indicating
that this practice may also be associated with higher
consumption of other sugar-sweetened beverages. High
consumption of sweetened ED without physical activity,
along with sedentary high screen media use among young
people, are risk factors for non-communicable diseases,
such as cardiovascular disease and obesity. This finding
can be cautiously corroborated by the NNCD survey in
Bahrain. Almost two thirds of adults in Bahrain were
reported to be consumers of high calorie sugar-sweetened
beverages and less than 3% used artificial sweeteners
instead of sugar.5 NNCD has also revealed that the
overall prevalence of overweight was 33%, obesity was
36%, diabetes mellitus was 14%, and
hypercholesterolemia was 41%.15 Considering that over
60% of parents did not consume ED, and generalizing the
prevalence of non-communicable diseases by the NNCD
survey to our study, there is a trend of unhealthy
consumption practices of ED by the current generation of
young people in Bahrain, and with the anticipated
demographic shift of these young people to adults, the
burden of non-communicable diseases in Bahrain is
expected to escalate over the reported NNCD survey
prevalence rates. At the same time, it is possible that ED
consumption in various situations may serve as a marker
for other unhealthy behaviors among young people.19
Adolescents may not be fully capable of
understanding complex concepts of behavior and health
consequences, and their behavior patterns are different
from children and adults. The successful transition period
from childhood to adulthood of young people depends on
the support of families, communities, schools, and health
services. These support systems have the responsibility
to promote their development and intervene effectively
when problems arise.20
Increasing popularity of ED, particularly with
adolescents, has been observed since their introduction at
the end of the last century. It has been suggested that
some young adults consume ED for their perceived
physiologic benefits, unaware of the ingredients in ED
and the associated health risks.21 The American Academy
of Pediatrics22 suggests that ED pose potential health
risks to children and young adults primarily due to the
stimulant content. Often, young people do not distinguish
ED from sports drinks. Therefore, this exploratory study
was conducted to investigate the consumption practices
of ED among adolescents in Bahrain.
This preliminary study has a limitation. The
convenience sampling method used in this study of over
200 individuals may not be representative of the general
Bahraini population. Regardless of this limitation, our
study employed an EFSA validated survey tool with
reliable measures to examine practices of ED
consumption among young people of Bahrain. We
NASSAIF
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
recommend larger cross-sectional and logitudinal studies
in the future to address this limitation.
Conclusion
This study has shown that the ED consumption
is a popular, high frequency socialization tool used
among young people of Bahrain. The potential health
risks that high ED consumption may cause necessitates
the need for novel health promotion strategies. To
prevent consumption at home, where the majority
reported consuming ED, parents should be educated
about the potential consequences associated with ED
consumption and promote healthy habits of hydration.
Fundamental to the health promotion campaign is
instituting nutrition educational programs in educational
institutions. The encouragement of the consumption of
beverages with nutritive value, or water, and restricting
the sale and use of ED on the institutional premises could
curtail ED consumption. Taking the experience from the
health promotions of the Saudi government23 and the
active health promotion campaign in Bahrain, health
regulatory authorities may consider warning labels on the
containers of ED, and regulation of advertisements of ED
similar to alcohol and tobacco.
Conflicts of Interests
The author declares that they have no competing
interests.
Acknowledgements
We gratefully acknowledge all the participants
in the study and the European Food Safety Authority. We
thank the following from College of Health Sciences,
University of Bahrain: Dr. Aneesa Al Sindi, Dean, for the
encouragement and support, and Mr.Hassan Al Basri for
statistical analysis.
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This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
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NASSAIF
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
Table 1: Qualitative demographic characteristics of participants
Variables
N (%)
Age (in years)
10-12
38 (14.5)
13-15
90 (34.4)
16-18
134 (51.1)
Gender
Male
133 (50.8)
Female
129 (49.2)
Education
Primary (Grades 1-6)
31 (11.8)
Intermediate (Grades 7-9)
81 (30.9)
Secondary (Grades 10-12)
150 (57.3)
CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH
This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
Table 2: Frequency and volume of energy drink consumption
N(%)
Frequency of energy drinks consumed per month
Rarely
42 (22.8)
Once-twice a month
28 (15.2)
Once per week
19 (10.3)
2-3 days per week
53 (28.8)
4-5 days per week
19 (10.3)
Everyday
23 (12.5)
Consumption of energy drinks by volume
250 ml can
149 (81.0)
355 ml can
28 (15.2)
Others
7 (3.8)
Frequency of energy drinks consumed per month
1 or less
40 (21.7)
2 to 4 cans
63 (34.2)
5 to 10 cans
42 (22.8)
11 to 20 cans
24 (13.0)
>20 cans
15 (8.2)
Number of cans of energy drinks consumed in a
single session
1 Can
88 (47.8)
2 Cans
59 (32.1)
3 Cans
20 (10.9)
4 Cans
7 (3.8)
>4 Cans
10 (5.4)
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This work is licensed under a Creative Commons Attribution 4.0 United States License.
This journal is published by theUniversity Library System of the University of Pittsburgh as part
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press.
Central Asian Journal of Global Health
Volume 4, No. 2 (2015) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2015.216|http://cajgh.pitt.edu
Table 3: Reasons for energy drink consumption
N(%)
Need energy (in general)
54 (30.0)
Stay awake
24 (13.3)
I like their taste
72 (40.0)
Concentration augmenting (Studying/Working)
8 (4.4)
Enhance sport performance
11 (6.1)
Effect of promotions and advertisements
3 (1.7)
Stimulate my metabolism
1 (0.6)
Others
7 (3.9)
