Table 3

Cross-sectional studies

CitationTypeQuality assessmentCountryParticipantsStudy designOutcome measuresMain findings
Al-Hazzaa et al (2014)62Full paperModerateSaudi ArabiaBoys and girls (n=2908)
15–19 years
Multicentre cross-sectional studyWeight, height, BMI, total daily screen time (ST), physical activity (PA) and dietary habits (DH) using self-report questionnairesSignificant associations of higher consumption of EDs with higher PA levels and higher ST
PA did not correlate with consumption of sugar-sweetened drinks overall but did associate significantly with intake of EDs
Insignificant associations between PA and intake of EDs in females
Arria et al (2014)51Full paperModerateUSABoys and girls (n=12 267 at T1, n=12 381 at T2)
13–14, 15–16 and 17–18 years
Analysis of data from the 2010 and 2011 Monitoring the Future (school-based) SurveyUse of EDs and energy shots, sociodemographic variablesYounger students, males and Hispanic individuals were more likely to drink EDs. Consumption of energy shots was less prevalent than for EDs and ethnic variations were less apparent, although the gender differences were similar. Between 8% and 12% of students consumed EDs and energy shots. Results were largely consistent between 2010 and 2011
Azagba et al (2013)48Full paperStrongCanadaBoys and girls (n=36 155)
12–18 years
Cross-sectional, classroom-based, biennial Youth Smoking SurveyConsumption, mixed or premixed with alcohol during the past 12 monthsAbout 20% reported using alcohol mixed with EDs in the last year; prevalence
of use was highest among Aboriginal (33.8%) and black (25%) students
Students who were older; currently smoked; were involved in heavy drinking in the past year; used marijuana in the past year; were absent from school; participated in school team sports; and had $40 or more weekly spending money were more likely to consume alcohol mixed with EDs in the previous year
Students who felt more connected to school and who had an academic average of 70% or higher were less likely to consume EDs
Azagba and Sharaf (2014)55Full paperStrongCanadaBoys and girls (n=15 875)
14–18 years
Cross-sectional, classroom-based, biennial Youth Smoking SurveySusceptibility to smoking, consumption of alcohol mixed with ED (AmED)About 13% of students used AmED
A statistically significant positive association was identified between consuming AmED and susceptibility to smoking among adolescent students
Never-smoking students who reported consuming AmED had higher odds of susceptibility to smoking
Azagba et al (2014)29Full paperStrongCanadaBoys and girls (n=9226)
12–13 years, 14–16 years, 17–18 years
Cross-sectional, high school-based Student Drug Use SurveyED usage, substance use, sensation-seeking62% reported consuming EDs at least once in the previous year, with about 20% reporting use once or more per month
Sensation-seeking, depression, and substance use were all higher among ED users relative to non-users, and in higher frequency users relative to lower frequency users
Males were much more likely to report ED consumption than female students
Rates of ED use were higher among younger students and the prevalence of consumption decreased with age
Cotter et al (2013)56Full paperModerateUSABoys and girls (n=43)
13–17 years
Cross-sectional computerised questionnaire with subcritically ill or injured adolescents in paediatric emergency departmentPrevalence, quantity and coingestation of alcohol, caffeinated beverages, pills, illicit drugs and tobacco use over previous 30 days and lifetime usage
Reasons for ED use
ED drink use among adolescents far exceeded that of alcohol, ‘street’ or illicit drug and tobacco usage. Those who reported ED use had higher prevalence of street drug use than non-ED users
On a typical day, adolescents drank 1.5 EDs (range, 0–7 drinks)
The most highly cited reasons for ED use were: 29.4% ‘to play sport better’, 23.5% ‘to keep awake for school’, 23.5% ‘because your friends or others were using them’, 23.5% ‘to party’, 11.8% ‘to lose weight’ (less cited reasons: 5.9% ‘to not feel hungry’, ‘to keep awake for work’, ‘to do better at work’, ‘to keep awake while driving’)
Emond et al (2014)38Full paperModerateUSABoys and girls (n=3342)
15–23 years
Cross-sectional national survey conducted by phoneED and alcohol use (AUDIT scale), demographics, sensation-seeking16.2% had consumed EDs at least once in the past 7 days. Older participants, males and those with a higher propensity for sensation-seeking were more likely to have recently consumed EDs
Alcohol use was more common among those who reported ED use in the past 7 days (80.1%) compared with those who did not (59.9%). After adjusting for sex, ethnicity, number of friends who drink, parental drinking frequency and sensation-seeking, this association remained for 15–17 years only
Evren and Evren (2015)39Full paperStrongTurkeyBoys and girls (n=4957)
15–16 years (mean 15.6 years)
Cross-sectional, classroom-based online surveyDemographics, school life and performance, psychological trauma, psychological and behavioural problems, substance useED consumption was associated with being male, lifetime substance use, sensation-seeking, psychological problems and self-destructive behaviour. In most cases, there was evidence of a dose–response effect
There was no significant association between ED use and age
Faris et al (2015)49Full paperModerateSaudi ArabiaBoys only (n=1006)
12–18 years
Cross-sectional, school-based, multiple choice, validated questionnaireED use, nutritional and lifestyle factors60.2% consumed EDs. Frequency and quantity of consumption were both significantly higher in secondary school students than middle school students. Higher disposable income and poor lifestyle behaviours (irregular sleep, smoking, drinking alcohol, low physical activity and unsafe behaviours such as not wearing a seatbelt while driving) were also associated with ED consumption
Poor knowledge concerning ED composition was reported. Physiological effects reported by consumers were reduced sleeping hours (23.6%), changes in cardiac activity (18.9%) and becoming energised/activated (16.6%)
Gallimberti et al (2013)47Full paperModerateItalyBoys and girls (n=913)
11–13 years
Cross-sectional school-based surveyConsumption of EDs, other substance abuseUse of EDs increased significantly
with age, from 17.8% among sixth graders to 56.2% among eighth graders
Among the male student population, 16.5% of those in the eighth grade and 6.21% of those in the sixth grade drank them at least once a week
Independent variables conferring a higher likelihood of being at least once-a-week ED consumers were smoking and alcohol consumption. Awareness of the damage caused by EDs emerged as a protective factor that reduced the likelihood of young students consuming such drinks
Gallimberti et al (2015)40Full paperModerateItalyBoys and girls (n=1496)
10–16 years
Cross-sectional, school-based survey, from 76 classesAlcohol and substance use and abuseSmoking, alcohol and ED use increased with age. ED use was more common in males, with the exception of those in the fifth grade. Lifetime ED consumption in the eighth grade was 64.0% and 36.4% for males and females, respectively
Gambon et al (2011)30Full paperModerateThe NetherlandsBoys and girls (n=502)
12–19 years
Cross-sectional school-based survey, single centreData on consumption of EDs, soft drinks, sports drinks and alcopops39.4% used EDs (in comparison with 85.2% soft drinks, 44.7% sports drinks, 12.8% alcopops)
Boys consumed soft drinks, EDs and sports drinks more frequently than girls, and on average also consumed higher amounts of these drinks
Significant positive associations were observed between the consumption of soft drinks, EDs and/or sports drinks. Alcopop consumption was only associated with EDs
The mean consumption of soft drinks, EDs and sports drinks was highest at 14–15 years, after which it declined
Hamilton et al (2013)57Full paperStrongCanadaBoys and girls (n=4472)
12–19 years
Retrospective review of Ontario Student Drug Use and Health SurveyED intake49.6% of adolescents had consumed EDs in the previous year
Energy drink consumption in the previous year was highly associated with tobacco, cannabis and non-medicinal use of prescription drugs use in the previous year, and binge drinking in the previous month.
Consumption was also highly associated with sensation-seeking and self-reports of medical treatment for an injury (reported by 16% and 42% of adolescents)
Huhtinen et al (2013)31Conference abstractModerateFinlandBoys and girls (n=10 406)
12–18 years
Adolescent Health and Lifestyle Survey, postal and online surveyAssociation between EDs and four caffeine-induced health symptoms (headache, sleeping problems, irritation, tiredness/fatigue)44% of adolescents used EDs at least sometimes (2% of girls and 4% of boys used them daily, 0.5% several times a day)
Daily use of EDs was strongly associated with the four health symptoms. In adjusted models, health symptoms among those who used EDs several times a day were multifold compared with the non-users: headache (OR=4.5), sleeping problems (3.5), irritation (2.4) and tiredness/fatigue (3.4).
Ilie et al (2015)41Full paperModerateCanadaBoys and girls (n=10 272)
11–20 years
Population-based, cross-sectional school survey (Ontario Student Drug Use and Health Survey)Traumatic brain injuries (TBIs), ED and alcohol useGender, alcohol use, ED consumption, AmED and academic performance were identified as significant predictors of TMI. The odds of sustaining a lifetime or recent TBI increased with consumption of alcohol and EDs
Koivusilta et al (2016)63Full paperModerateFinlandBoys and girls (n=9446)
13 years
Cross-sectional, classroom based surveyFrequency of ED consumption, health symptoms, time of going to bed on school daysThe percentage of adolescents suffering from health symptoms (headache, irritation or outburst of anger, trouble falling asleep or waking at night, tiredness/fatigue) or going to bed late increased with increasing frequency of ED consumption. The relationship between EDs and health symptoms was partly mediated through going to bed late. Results were similar for both genders
Kristjansson et al (2014)42Full paperStrongIcelandBoys and girls (n=11 267)
10–12 years
Population-based primary school surveyPrevalence of caffeinated sugar-sweetened beverages (CSSBs) and the relationship with common physical symptomsJust over 7% of boys and almost 3% of girls
reported consuming EDs on a daily basis
Use of CSSBs was more common among boys and physical symptoms were more common among girls. About one in five girls reported having headaches, stomach aches and/or sleeping problems sometimes or often during previous 7 days. The prevalence of physical symptoms generally increased for both genders with greater ED use
Kumar et al (2014)32Full paperStrongUSABoys and girls (n=840)
12–17 years
Online surveyED consumption9% reported consuming ED ≥1 time/week
Significant differences were found by age and gender (increasing prevalence among older teens and in males) but not for the other characteristics examined
Only 11.5% were ever asked by their doctor/nurse about how often they drank EDs, and 11.1% were ever recommended by their doctor/nurse to not drink EDs
The proportion of youth who consumed energy drinks ≥1 time/week was higher among youth who were asked by their doctor/nurse about how often they drank energy drinks than by youth who were not
Larson et al (2014)33Full paperStrongUSABoys and girls (n=2793)
Mean 14.4 years (SD 2.0 years)
Cross-sectional school-based survey (questionnaire plus anthropometric measures)Sport and ED intake, PA and sport participation, media use, sleep, cigarette smoking, breakfast frequency and other beverage intake, weight status, demographicsOverall, EDs were consumed at least 1/wk by 14.7% of the sample (significantly higher among boys than girls). Differences in ED consumption by ethnicity were statistically significant only among girls
Regular ED consumption was associated with measures of media use, other beverage intake and cigarette use, but was unrelated to measures of PA. For both genders, regular consumption was positively associated with ever having smoked cigarettes and weekly video game use
There was a significant association between regular ED consumption and higher daily intake of sugar-sweetened soft drinks and fruit drinks. For girls only, there was also a significant association with lower frequency of breakfast
Locatelli et al (2012)34Full paperStrongBrazilBoys and girls (n=2705)
15–17 years
Self-administered questionnaire in private high schoolsAlcohol use by socioeconomic level and gender31.6% reported having used alcohol and ED together at least once in life. Boys reported a higher prevalence of frequent alcohol use, binge drinking and the combination of alcohol with ED
Mixing alcohol and ED was most common in students from class A1 (45.5%) and decreased gradually with socioeconomic class to 17.7% in classes D/E (high to low)
Lubman et al (2014)59Full paperModerateAustraliaBoys and girls (n=558)
17–18 years
Breathalyser tests and brief ‘on street’ surveysAlcohol, ED and illicit drug use, experience of aggressive incidents, alcohol-related injury and unprotected sexThose who coconsumed alcohol and energy drinks (one in six participants) recorded a significantly higher blood alcohol content (11.34 vs 8.30), reported feeling more intoxicated and were rated as more intoxicated by interviewers than alcohol-only users
Bryant Ludden and Wolfson (2010)36Full paperModerateUSABoys and girls (n=197)
14–18 years
Self-report measures completed during school hoursPatterns of caffeine use, linking to reasons for use, expectancies and sleep patternsAmong those who used caffeine the previous day, 6.1% reported ED use (compared with 60.5% soda, 19.3% coffee, 4.4% tea and 8.8% other)
Males drank soda and ED more frequently, although females were more likely to report withdrawal/dependence caffeine expectancies and appetite suppression expectancies
Magnezi et al (2015)50Full paperModerateIsraelBoys and girls (n=802)
14–18 years
School-based surveyED and alcohol mixed with ED (AmED) consumption84.2% had ever drunk EDs. Consumption was more common among older students, immigrants, those from single parent families, and boys, who were more likely than girls to drink them daily. Those who began drinking at an earlier age were more likely to consume AmED
50.2% drank EDs because of the taste, 12.7% to feel energised, 19.3% in order to mix with alcohol, 11% to stay awake and 5.3% reported drinking out of curiosity. More than half knew that EDs mask the effect of alcohol and most knew that those who drink AmED drink more alcohol than those who do not mix it with ED
Musaiger and Zagzoog (2014)35Full paperModerateSaudi ArabiaBoys and girls (n=1061)
12–19 years
School-based short questionnaire extracted from a validated questionnaire, after modifications to include EDKnowledge, attitudes and intake of energy drinks among adolescents31.9% of males and 24.7% of females drank EDs 1–2 days/week, with a significant difference between the genders
Advertisements were the main single source of information on ED. The main reasons for consumption were for their taste and flavour (58.4%), in order to ‘try them’ (51.8%) and to ‘get energy’ (43%)
About half did not know the ingredients of ED and a similar proportion knew they contained caffeine. Two-thirds viewed EDs as soft drinks
Nowak and Jasionowski (2015)43Full paperModeratePolandBoys and girls (n=2629)
12–20 years (mean 15.8 years)
Classroom-based surveyDemographics, self-reported weight, height, participation in sports, use of EDs, knowledge of contents and their effects67% participants drank EDs. Use was significantly more common among boys, those who played sport and younger students, although older participants were more likely to mix EDs with alcohol
Consumers reported using EDs for no particular reason (21%), when feeling tired (18%), before physical effort (13% and 10%) when thirsty (12%) and while at parties (10%). Around one-third believed EDs were bad for their health and 7% admitted feeling some discomfort after drinking an ED. The most common health problems were: stomach ache (46%), anxiety and heart palpitations (15%), and nausea and vomiting (15%). Nearly, 27% felt overexcited after drinking an ED
Park et al (2012)52Full paperStrongUSABoys and girls (n=11 209)
14–18 years
School-based surveyDemographic characteristics, weight status, availability of school vending machines, and behavioural factors with sugar-sweetened beverage (SSB) intakeMean total ED intake was 0.2 times per day and only ∼5% of students reported drinking a can, bottle or glass ≥1 time per day.
Being male, non-Hispanic black, or Hispanic (vs non-Hispanic white), eating at fast-food restaurants ≥3 time per week and watching television >2 hours/day were significantly associated with greater odds of drinking EDs ≥1 time/d, whereas having beverage vending machines in the school was significantly associated with reduced odds of drinking EDs ≥1 time/day
Reid et al (2015)44Full paperStrongCanadaBoys and girls (n=23 610)
14–18 years
Findings from year 1 of a retrospective cohort study (COMPASS) involving a school-based surveyED and alcohol use, sociodemographic variablesThe odds of using EDs were significantly greater in the following groups: males, off-reserve Aboriginal students, and students reporting some spending money. Among males, ED use increased with age, while the opposite was true for females. Students with a healthy BMI were less likely to report consuming EDs than those who were underweight or obese
Intensity of alcohol use was strongly associated with ED use. Binge drinking was the strongest predictor of using alcohol mixed with EDs
Schwartz et al (2015)45Full paperStrongUSABoys and girls (n=1649)
10–11, 12–13 and 13–14 years (mean 12.4 years)
30 min online, classroom based health surveyHyperactivity/Inattention subscale of the Strengths and Difficulties questionnaire, number and types of sweetened beveragesBoys reported drinking significantly more EDs. Black and Hispanic students were more likely to report consumption of EDs.
Students who reported consuming EDs were 66% more likely to score in the at-risk category on the hyperactivity/inattention subscale compared with students who did not, regardless of overall sweetened beverage intake.
For each additional sweetened beverage, the odds of being at risk for hyperactivity/inattention increased by 14%. After adding beverage types to the model, only EDs had an independent association with risk of hyperactivity/inattention, even after adjusting for number of drinks consumed and other potential confounders.
Terry-McElrath et al (2014)14Full paperStrongUSABoys and girls (n=21 995)
13–18 years
Classroom based self-completion questionnaireED consumption and substance useED/shot use was higher among boys, younger students and those residing outside of metropolitan areas. There were negative relationships with two parents in the home and higher average parental education. Neither race/ethnicity nor region was associated with ED/shot use and consumption did not significantly change between 2010 and 2011
ED/shot use frequency was significantly and positively correlated with past 30-day use frequency of all substance use measures (alcohol, cigarettes, marijuana and amphetamines) for all grades
Van Batenburg-Eddes et al (2014)61Full paperStrongThe NetherlandsBoys and girls (n=509)
11–16 years (mean 13.1 years, SD 0.85)
Cross-sectional school-based survey, part of a larger longitudinal projectExecutive functions, plus caffeine and ED intake6% reported consuming on average at least one ED a day. Problems with falling asleep and waking up were reported most often (23%). Consuming on average one ED or more a day was associated with problems with self-reported behaviour regulation. Participants who drank at least two consumptions of caffeine or ED also had more problems with metacognitive skills
Vilija and Romualdas (2014)54Full paperStrongLithuaniaBoys and girls (n=1747)
12–13 years
Cross-sectional school-based study using self- administered questionnairePost-traumatic stress (PTS) symptoms, lifetime traumatic experiences, food frequency scale, sense of coherence scale21.0% consumed EDs on a daily basis. All lifetime traumatic events were associated with unhealthy foods (including EDs) and sense of coherence weakened the strength of the associations