|Year : 2021 | Volume
| Issue : 3 | Page : 204-210
Prevalence and factors associated with energy drink consumption amongst undergraduate students in Kano, Nigeria
Usman Muhammad Ibrahim1, Hafsat Umar Sani2, Aminatu Kwaku Ayaba1, Hadiza Musa Abdullahi3, Rabiu Ibrahim Jalo3, Fatimah Ismail Tsiga Ahmed3, Aishatu L Adamu3, Abubakar Mohammed Jibo3
1 Department of Community Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
2 College of Health Sciences, Bayero University, Kano State, Nigeria
3 Department of Community Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano State, Nigeria
|Date of Submission||11-May-2021|
|Date of Decision||17-Jul-2021|
|Date of Acceptance||17-Jul-2021|
|Date of Web Publication||22-Oct-2021|
Dr. Usman Muhammad Ibrahim
Department of Community Medicine, Aminu Kano Teaching Hospital, PMB 3452, Kano State
Source of Support: None, Conflict of Interest: None
Background: Overconsumption of energy drinks (EDs) is a global public health concern because of its potential health consequence. Objectives: This study aimed to determine the prevalence and factors associated with ED consumption amongst undergraduate students in Kano, Northwest Nigeria. Methodology: A descriptive cross-sectional study design was used to study 381 undergraduate students, selected using a two-stage sampling technique. Data were collected using interviewer-administered questionnaires and analysed using SPSS version 22.0 with P ≤ 0.05 considered to be statistically significant. Results: A total of 381 students were studied. The mean ± standard deviation age of the students was 23.1 ± 3.6 years with male-to-female distribution of about 1:1. Period prevalence of 67.0% within the last 30 days and point prevalence of 23.9% were found. The commonly used ED was Power Horse 44.6%. Up to 59.6% consumed EDs to boost their physical and mental capacity. Odds of ever-consuming EDs were lower in female undergraduates (adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.3–0.7) and higher in Hausa/Fulani ethnic group (aOR: 1.7, 95% CI: 1.04–2.7). Amongst those who were currently consuming EDs, being 24 years or less (aOR: 1.9, 95% CI: 1.04–3.4) and coming from the Hausa/Fulani tribe (aOR: 2.5, 95% CI: 1.4–4.4) were associated with increased consumption. Male undergraduates (aOR: 0.2, 95% CI: 0.1–0.4) and students who were residing on campus were less likely to be current consumers of EDs (aOR: 0.5, 95% CI: 0.3–0.9). Conclusion: Consumption of EDs is increasing amongst students and therefore relevant government agencies should ensure regulated advertisement and consumption to avert the health consequences.
Keywords: Distribution, energy drinks, factors, Kano, prevalence
|How to cite this article:|
Ibrahim UM, Sani HU, Ayaba AK, Abdullahi HM, Jalo RI, Tsiga Ahmed FI, Adamu AL, Jibo AM. Prevalence and factors associated with energy drink consumption amongst undergraduate students in Kano, Nigeria. Niger Postgrad Med J 2021;28:204-10
|How to cite this URL:|
Ibrahim UM, Sani HU, Ayaba AK, Abdullahi HM, Jalo RI, Tsiga Ahmed FI, Adamu AL, Jibo AM. Prevalence and factors associated with energy drink consumption amongst undergraduate students in Kano, Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2021 Dec 1];28:204-10. Available from: https://www.npmj.org/text.asp?2021/28/3/204/328773
| Introduction|| |
Over the last 20 years, energy drinks (EDs) have shown a progressive global increase in popularity, and since then, each year, new EDs are becoming increasingly available, signifying the general increase in consumption of EDs, particularly amongst college students and youths.,,,, Between 2004 and 2009, the introduction of various energy products increased significantly, and the 2009 retail market of the available products was valued at $4.6 billion. Since the release of EDs in the US in 1997 with the presence of Austrian-import Red Bull®, ED companies have acquired 34.5 million consumers as of 2008. There are evidences that EDs consumption is marketed to result in healthy and active lifestyle, despite the recommendation that they should not be advertised and/or sold as sports drinks, which may serve as a promotional campaign for the products that can result in significant increase in consumption, and over an 8-year period, consumption of EDs in the UK significantly increased by several millions of litres.
EDs are beverages (e.g., Red Bull, Venom, Burn and Adrenaline Rush) containing stimulants, mainly caffeine, which is marketed as mental and physical stimulants.,,,,,, The other substances such as taurine, carbohydrates, glucuronolactone, inositol, niacin, panthenol and B complex vitamins, carbonated water, guarana, yerba mate, açaí and taurine are probably responsible for medical side effects., The key consumers are mainly involved in activities such as studying, partying, driving, for energy boost and wakefulness. Hundreds of different brands on the market have high caffeine content, ranging from 50 mg to as high as 505 mg per can or bottle.
Although there is an increasing ED market and media information of the potential adverse effects, research on use and the health consequences are scarce globally.,,,,,,,, In 2011, the European Food Safety Authority conducted a study to obtain data on the consumption of EDs in some countries in Europe and identified that adolescents had the highest consumption level of 68%, compared with other age groups. The consumption of caffeinated beverages has been reported to be as high as 83.2% while occasional consumption of 96%. Amongst caffeinated beverages, ED intake amongst those aged 18–34 years has been increasing worldwide. Reports confirm the high use globally including Europe, the USA and the Middle East. This is in keeping with the need for conducting this study in Kano, the largest state in northern Nigeria, having many public and private tertiary institutions with places within the campuses where the targets of energy drinks are patronizing for that purpose. This can help in providing information on the local consumption of the product in Kano, thereby providing basis for comparison with other parts of Nigeria and other countries globally for appropriate strategic interventions.
In adults, consumption of energy drinks was reported to promote cognitive activities, increase mood activities and provide more energy, and therefore ensures wakefulness, however evidences are evolving on the potential harmful effects of these drinks.,, Evidence shows that individuals who regularly consume EDs can become dependent and even moderate consumption may be dangerous. Based on the known health consequences of caffeine, consumption of EDs may lead to intoxication, withdrawal, interrupted sleep and insomnia, including risky behaviour. There is an additional risk with excessive sugar consumption, such as dental mottling and other diseases, obesity and insulin-resistant diabetes mellitus amongst other non-communicable diseases., It can also lead to chronic headaches, elevated blood pressure, insomnia, anxiety, irritation and nervousness, gastrointestinal disturbances, tremors and increased heart rate.
Mortality was found to increase due to the overuse of EDs in the United States, causing some governments to institute restrictions on their trade. Sweden, for example, permits the sale of EDs in pharmacies with other drugs following appropriate prescription. The required information on the health effects of overuse is not mostly presented on the labels in many countries. Canada, recommends that all forms of energy drinks with potential side effects should carry a warning label. Prohibitions like overconsumption, combined consumption with alcohol, use by children and pregnant women should be shown on labels.
This study therefore aimed to assess the prevalence and factors associated with ED consumption amongst undergraduate students of Bayero University, Kano, Nigeria.
| Methodology|| |
The study was a descriptive cross-sectional conducted amongst undergraduate students of Bayero University Kano. Data were collected by 12 trained research assistants from 15 January to 23 March 2021. The study population consisted of male and female undergraduate students of Bayero University Kano. All male and female undergraduate students of Bayero University Kano who have been in the university for more than one semester were included while those not available for any reason during data collection and students in other institutions affiliated to Bayero University Kano within or outside Kano were excluded.
Ethical approval was obtained from the Research Ethics Committee of the Ministry of Health, Kano State, and has the approval number of MOH/OFF/797/1989. Informed consent was obtained from all the respondents selected for participation in this study using consent forms. All the principles of Helsinki Declaration in dealing with human subjects in research were adhered to during the data collection process.
Kano is a state in northwestern Nigeria (11°30 N, 8°30 E) and is one of the most populous states of the Nigerian Federation with a projected population of 11,760,156 at 2015 from the census carried out in 2006 by the National Population Commission. Bayero University Kano was established in October 1960 as Abdullahi Bayero College under the Northern Nigerian University. The university has four campuses: old and new campuses, an affiliated teaching hospital for teaching clinical medical and dental students and other medical-related courses and school of continuing education. The university offers courses ranging from undergraduate to postgraduate courses. These courses run in the university's 13 faculties.
Sample size estimation
The sample size was estimated using the formula for sample size determination for descriptive studies. Using z = standard normal deviate corresponding to 95% confidence level, i.e., 1.96, p = prevalence of ED consumption amongst undergraduates = 66.1%, ~0.661, and q = complementary probability of p, it is equal to 1 − p = 1 − 0.661 = 0.339, and 10% possible non-response, the minimum sample size was 381.
A two-staged sampling technique was used to select respondents for the study. Mapping and numbering of shops in the campuses were conducted. There were 47 shops in new campus, 15 in old campus, 11 in Aminu Kano Teaching Hospital (AKTH) Campus and 5 in School of Continuing Education (SCE) Campus. The shops to be studied were proportionately allocated based on the number of shops.
Stage 1: Selection of shops
To choose the number of shops to be studied in each campus, balloting was done based on the total number of shops selling EDs generated during the numbering. The average number of students patronising the selected shops of the campuses was generated over 2 weeks to find out the average sampling frame. Each of the selected shops selling EDs had an average number of students patronising the shop daily, the sampling frame to be 200 for new campus, 195 for old campus, 250 for AKTH and 800 for SCE, respectively. Respondents were equally allocated in the randomly selected shops of all campuses.
Stage 2: Selection of respondents
Systematic sampling was used to study the eligible respondents. Sampling interval was obtained as the ratio of sampling frame to the calculated sample size. The equally allocated sample sizes based on the average number of students patronising the shops were used to calculate the sampling intervals. The list of undergraduate students patronising the selected shops was generated daily during data collection process. The first respondent was selected by balloting using the numbers within the range of the calculated sampling intervals in each of the study campuses. Thereafter, the sampling interval was added until the allocated numbers of eligible respondents were studied in each campus
Procedure of data collection and instrument of data collection
The interviewer-administered and semi-structured questionnaire, written in English language, was adapted from previous studies.,,,,,,,,,, The instrument has two sections: Section 1 of the questionnaire sought information on the sociodemographic characteristics of the students while 2 obtained information on the previous and current use of EDs, respectively, distribution, sources of information and reasons of ED consumption. Up to 40 questionnaires were pre-tested amongst undergraduate students in another university outside Kano.
Data analysis and measurement of variables
The plagiarism detection tool was used to reduce the similarity index to below 10%. Data collected were entered into Microsoft Excel spreadsheet, appropriately cleaned and analysed using IBM SPSS Statistics for Windows, version 22.0. Armonk, NY, USA: IBM Corp. Quantitative data were presented using mean and standard deviation (SD), while qualitative variables were presented using frequency and percentage. The outcome variables were ever consumed (consisting of those that never consumed or ever consumed the ED), the period prevalence within the last 30 days and currently consuming (consisting of not currently consuming and currently consuming), the point prevalence while the independent variables are the age, faculty, sponsorship, sex and ethnicity amongst others. Pearson's Chi-square test was used for comparison of proportions at ≤5% α-level of significance. Factors significantly associated with ED consumption at bivariate level were included in the logistic regression analysis model to adjust for confounding.
| Results|| |
A total of 381 questionnaires were distributed and returned giving a response rate of 100%. The age of the students lies within the range of 17–49 years with a mean and SD of 23.1 ± 3.6 years. Most of the students, i.e. 267 (70.1%), were below 24 years of age with a male-to-female ratio of about 1:1. About two-third of the students, i.e. 241 (63.3%), were from Hausa/Fulani ethnic groups, with majority of them, i.e. 328 (86.1%), being unmarried. Most of the students interviewed, i.e. 318 (83.5%), were in the 2nd year of the study or above. Parents of the students were the majority sponsors, i.e. 333 (87.4%), of their children, as shown in [Table 1].
Prevalence, reasons and types of energy drinks
About two-thirds, i.e. 252 (67.0%), of the respondents reported to have ever-consumed EDs providing the period prevalence while 91 (23.9%) were the current users of EDs providing the point prevalence of ED consumption. Regarding influence on choice, price (33.9%) and taste (21.8%) were the key reasons reported by the students. Similarly, more than half reported their desire to use it for improving physical and mental energy 59.6% and getting more energetic (59.1%), as shown in [Table 2]. The commonly used EDs include Power Horse by 44.6%, Fearless® by 42.5% and Red Bull 31.0%, while Power Fist was the least reported 8.1% to be in use, as shown in [Table 3].
|Table 2: Reasons and sources of information on energy drinks amongst students (n=381)|
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|Table 3: Distribution of commonly used energy drinks amongst the students (n=381)|
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Factors associated with energy drink consumption
Sex and ethnicity were found to be independently associated with ever-consuming EDs, as shown in [Table 4]. Female undergraduates were 50% less likely to ever consume EDs compared to their male counterparts (adjusted odds ratio [aOR]: 0.5, 95% confidence interval [CI]: 0.3–0.7). Furthermore, odds of ever-consuming EDs were higher in Hausa/Fulani respondents compared to those who were non-Hausa (aOR: 1.7, 95% CI: 1.04-2.7). On bivariate analysis, age, sex, religion, ethnicity, sponsorship and faculty were found to be associated with current consumption of EDs. After adjusting for all the variables in the final model, age, sex, ethnicity and residence remained independent predictors of current consumption of EDs [Table 5]. Being 24 years or less (aOR: 1.9, 95% CI: 1.04–3.4) and from the Hausa/Fulani tribe (aOR: 2.5, 95% CI: 1.4–4.4) were associated with increased consumption of EDs. Additionally, male undergraduates (aOR: 0.2, 95% CI: 0.1–0.4) and students who were residing on campus had less probability of currently consuming EDs (aOR: 0.5, 95% CI: 0.3–0.9).
| Discussion|| |
Consumption of EDs has become a global concern, especially amongst undergraduate students, perhaps due to increasing and sustained marketing strategies by various manufacturers on the benefits of consumption, with little emphasis on the negative consequences of over use, and the availability of these drinks in stores, shops and supermarkets has made it acceptable, readily available and regularly patronized especially by younger age groups including university students.,,,,
The study found up to 67.0% of the respondents to have ever-consumed EDs, but only 23.9% are currently using EDs. This is comparable with the study conducted in Sokoto, Nigeria, amongst undergraduate students that reported the lifetime prevalence rate of ED consumption was 55.4% while 25.7% were the current users. This may not be unconnected with the fact that the two studies were conducted in two states within the northwestern region of Nigeria and are known to share the same sociocultural and demographic characteristics. A study conducted in Port Harcourt, Nigeria, reported that 87.8% of respondents had consumed EDs at least once and 80.1% of respondents were current consumers of EDs. This study focused on medical and dental students who are considered to be more busy when compared with other undergraduate students, which may increase their chances of using the drinks for alertness or nutritional supplement with minimal consideration of the potential side effects. The study also reported higher prevalence when compared with another study conducted in Taiwan, with up to 24.8% consumption of EDs drinks within the past 30 days of the survey.
The commonly used EDs we identified in our study include Power Horse 44.6% and Fearless 42.5%, in contrast with another study, that identified participants of the study were more conversant with Power Horse 35.6% and Red Bull 28.9% likely due to difference in time with time lag resulting in increased popularity of EDs and resulting increase in its utilisation. Promoters are extensively advertising the product with minimal regard to the potential negative consequences as reported that advertisements were the main source of information of EDs (43%) by a study conducted in Saudi Arabia, slightly more than our finding of 37.3%. Some of the reported reasons for the use of EDs among students by a study conducted in Taiwan includes; to keep them alert during work by (48.7%), aware of the drinks by (32.0%), enjoying the ingredients by (31.3%) and for examination preparation by (26.7%. This study found that (59.6%) of the students consumed energy drinks to boost their physical and mental energy, (59.1%) makes reported the use to obtain energy while (65.6%) responded to be fully aware of the ingredients in energy drinks they are consuming. One of the most worrying aspects of the consumption by the students as reported by the study conducted in Taiwan is not sparing time to read the labels and possibly figure out the possible health benefit or consequences particularly taking into consideration that the study population are amongst the educated part of the society and the demographics are known to exhibit significant curiosity in their daily activities.
The manufacturers of energy drinks have changed their focus on consumers from athletes to young people. They aggressively marketed the products in places where many youth and young adults are present including universities. The students are the soft targets, perhaps their busy schedule in school can make them use it as a substitute to their meal., These underscore the importance of ensuring that all producers do their promotional campaign with all the needed information in clear terms through all the channels commonly used, especially looking at the fact that consumers get most of the information through their advertisement.
Female students whether living on or off campus are more likely to engage in cooking what to eat when compared with their male counterparts because they are culturally known to prepare food even at home and therefore less likely to use the drinks as a substitute to conventional food. Similarly, although Hausa/Fulani forms the predominant students in the university, higher consumption may be related to the tendency for significant of them to be living off campus and therefore that may influence their choice of using EDs as a source of energy before going back home which was in keeping with the finding of less likelihood of ED consumption amongst students residing on campus.
There is increasing public health concern related to the caffeine intoxication due to uncontrolled consumption of energy drinks, in addition the sugar present in the drinks can be high which can trigger the processes of non-communicable diseases development especially among predisposed individuals, for example, nutritional transition and sedentary life style, ED consumption is suspected to be associated with an increased likelihood of alcohol related problems amongst consumers. Although this study found a relatively lower proportion of alcohol ingestion amongst the students, there is an urgent need for health promotion in the areas of appropriate dietary practice principles to prevent disease and promote the health of the future leaders of the country. Linkage was also reported with possibility of negative effect on performance and future career achievement.
| Conclusion and Recommendation|| |
ED consumption is increasingly becoming a public health challenge amongst undergraduate students with an urgent need of the government to ensure proper advertisement and regulated consumption.
The authors are thankful to the undergraduate students for sparing time to be fully involved in the research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]