Alcohol Mixed With Energy Drinks Use Research Articles

Alcohol versus combined alcohol and energy drinks consumption: Risk behaviors and consumption patterns among European students.

Recent research found that drinking alcohol mixed with energy drinks (AmED) could be riskier than drinking alcohol alone. Our aim was to compare rates of risk behaviors in consumers of AmED versus exclusive alcohol drinkers, matching them based on their drinking frequency. Data about 16-year-old students who reported the number of occasions on which they had drunk AmED or alcohol only in the preceding 12 months (n=32,848) were drawn from the 2019 ESPAD study. After matching for consumption frequency, the sample consisted of 22,370 students (11,185 AmED consumers and 11,185 exclusive alcohol drinkers). Key predictors comprised substance use, other individual risk behaviors, and family characteristics (parental regulation, monitoring, and caring). The multivariate analysis showed significantly higher odds of being AmED consumers compared to being exclusive alcohol drinkers in the majority of the investigated risk behaviors, including: daily tobacco smoking, illicit drug use, heavy episodic drinking, truancy at school, engaging in physical fights and serious arguments, having troubles with the police, and having unprotected sexual intercourse. Instead, lower odds were found for reporting high parents' educational level, medium and low family economic status, perceived possibility to freely talk about problems to family members, spending free time reading books or other hobbies. Our study shows that, given the same consumption frequency in the past year, AmED consumers typically reported higher associations with risk-taking behaviors compared to exclusive alcohol drinkers. These findings advance past research that failed to control for the frequency of AmED use versus exclusive alcohol consumption.

Alcohol Mixed with Energy Drinks (AmED) Use among University Students: A Systematic Review and Meta-Analysis.

In the last decades, there has been a huge increase in the consumption of both Energy Drinks (EDs) and alcohol and, concurrently, these two trends generated the additional practice of mixing ED with alcohol, known as Alcohol mixed with Energy Drink (AmED). One of the most important group of AmED consumers is represented by young. Indeed, the study population of the researches in this field are mainly represented by college students and the results evidence a great range of negative consequences for health. The purpose of the systematic review was to explore the prevalence of AmED consumption among undergraduate students, together with motivations to their use, adverse effects and health-related behaviors associated to AmEDs use. The review was conducted according to the PRISMA Statement and PubMed, Scopus and Web of Science were interrogated. 42 articles, published from 2008 to 2021, were included in the review. An overall prevalence rate of 37% was estimated for AmEDs use in undergraduates, with geographical differences. Although a decrease in consumption was observed throughout the studied period, a continuous monitoring on this phenomenon is needed for identifying those risk groups that could develop risky behaviors related to AmEDs consumption and provide them targeted educational interventions.

Trends in energy drink and combined alcohol and energy drinks consumption among Italian high school students, 2008–2019

BackgroundEnergy Drinks (ED) are caffeinated beverages marketed as attention and endurance enhancers. The main purpose of this study is to provide national estimates of the prevalence of alcohol mixed with energy drink (AmED) and ED use among school-aged adolescents. A secondary objective is to examine the differences in the prevalence of AmED and ED consumption by gender. MethodsFor this study, we used data from twelve consecutive years, from ESPAD-Italia®2008 to ESPAD-Italia®2019. ResultsFrom 2008–2019, the prevalence of lifetime consumption of energy drinks increased significantly for male (64.5–75.7%, p < 0.001) and female (46.8–61.8%, p < 0.001). We also observed an increase in both genders for last year prevalence (male: 51.6–63.4%, p < 0.001; female: 32.5–38.3%, p < 0.001), instead prevalence in last month showed an increase only in males (males: 37.5–45.4%, p = <0.001; females: 19.9–20.3%, p = 0.426). Finally, frequent use showed a fluctuating trend, particularly in females (males: 3.2–4.3%, p = 0.422; females: 0.8–0.8%, p = 0.643). From 2013–2019, the prevalence of AmED consumption did not show relevant changes among adolescents. A clear gender gap is evident for both ED and AmED usage prevalence, in all the years considered for lifetime, last year, last month and frequent use. ConclusionsThe findings suggest that the prevalence of ED consumption among Italian high school students is very high and has grown substantially over the past 12 years. Differently the prevalence of AmED use, although widespread, did not increase overall since 2013.

Alcohol mixed with energy drinks: Expectancies of use and alcohol-related negative consequences among a young adult sample

ObjectiveEnergy drinks are a popular mixer with alcohol among college-aged young adults. Few studies to date have examined the relationships between expectancies of alcohol mixed with energy drink (AmED) use, AmED use and AmED-related negative consequences. MethodsEighty college-aged young adults were surveyed regarding their alcohol and AmED use, related negative consequences and AmED expectancies. Associations were assessed using chi-square tests and Cramér's V. A simple mediational model also was used to explore the potential relationships between AmED expectancies, AmED use and AmED-related negative consequences. ResultsAmED use was associated with more types of related negative consequences than heavy alcohol use alone, and where AmED use and heavy alcohol use were mutually associated with a related negative consequence, the strength of association was stronger for AmED use. While several AmED-related negative consequences were associated with AmED expectancies, unwanted sexual contact and getting into a verbal argument were associated with the greatest number of expectancies. The mediational model identified a statistically significant indirect effect of AmED expectancies on AmED-related negative consequences mediated by AmED use. ConclusionsThe study results contribute to the evidence that AmED use may confer additional risk for related negative consequences beyond heavy alcohol use and suggest that AmED expectancies may have a role in AmED use, which, in turn, is associated with AmED-related negative consequences. AmED expectancies may be targets for intervention to reduce AmED use considering the possible subsequent related negative consequences, especially those involving negative interpersonal experiences.

Case report on energy drink consumption among Health Sciences University students in Gauteng Province, South Africa

BackgroundThere are claims that energy drink (ED) consumption can bring about an improvement in mental functioning in the form of increased alertness and enhanced mental and physical energy. These claims address the lifestyle of a student of sleep deprivation and academic pressure with ED consumption becoming a popular practice amongst students. The study’s objectives were to determine the prevalence, reasons for, and patterns of ED and alcohol mixed with ED (AmED) consumption amongst university students.Case presentationRegistered students of the Health Sciences University, Gauteng Province, South Africa, formed the study population where this quantitative cross-sectional survey conveniently collected data by means of previous validated self-administered questionnaires from 490 students representing the diverse demographics of the university. Questions on the socio-demographic profile of the participants; pattern of alcohol use; reasons, pattern, and preferred types of EDs use; and the pattern, reason, and experience of AmED use during the past 12 months were asked. Frequency and percentages of distributions were determined, and the possible factors contributing to ED consumption were computed using the chi-square test. Results indicated that a total of 58% of students were consuming EDs mainly to stay awake (31%), to be more alert (14%), and to help with concentration (15%), 69% were consuming alcohol, and 16% were consuming AmEDs.ConclusionThere is an urgent need for an appropriate public health prevention intervention so that ED consumers can make informed choices when indulging in these health behaviors before the seemingly harmless consumption of ED amongst students becomes a public health issue.

Use of Alcohol Mixed with Energy Drinks Increases the Prevalence of Driving Violations among Brazilian Truck Drivers

Background: The use of alcohol mixed with energy drinks (AmED) has been reported to be associated with a variety of unsafe driving practices. Truck drivers are vulnerable to driving violations, particularly because of their engagement in drug use. The use of AmED among these professionals remains unknown. Aim: To estimate the prevalence of AmED use and its association with driving violations among truck drivers. Methods: 684 drivers were recruited in Sao Paulo, Brazil. The use of drugs was reported. Drivers were split into three groups: (a) alcohol abstainers (AA); (b) alcohol-only users (AO); and (c) users of AmED. Intergroup comparisons were performed by polynomial logistic regression (the reference category was AO). We also performed Poisson regression analysis to obtain the prevalence ratio; the significance level was stipulated at 5%. Results: The prevalence of drivers reporting the use of AmED was 16.8%. Users of AmED (a) were younger, (b) were less experienced drivers, (c) had a heavier pattern of alcohol use, (d) used illicit drugs more frequently, and (e) had poorer sleep quality than AO subjects. A higher prevalence of drivers who had arguments or fights while driving (PR = 1.71) and of drivers who drove unbelted (PR = 1.66) ingested AmED than of AO subjects. Conclusions/importance: The use of AmED increased the prevalence of driving violations beyond the risks commonly attributed to alcohol use. We suggest additional investments in preventative measures based on the beverage category and a revision of the work organization of truck drivers to reduce their health and social risks.

Alcohol mixed energy drink use as a risk factor for experiencing and perpetrating bar aggression.

Despite the recent, widespread trend of consuming alcohol mixed with energy drinks (AmEDs) in commercial bar settings, few studies have examined whether this practice exacerbates the risk of experiencing aggression in bars and licensed establishments. Past studies have been limited to between-subjects comparison analyses that are at risk for bias due to selection effects. The present analysis examines whether a sample of individuals who regularly use AmEDs are at elevated risk for experiencing or perpetrating physical aggression in bars when drinking AmEDs versus when they are drinking noncaffeinated alcohol (NCA) use alone. This within-subject analysis controls for any individual differences that may be related to both AmED use and the tendency to engage in aggressive behavior. An online survey was completed by 175 young adults (78 male) who were frequent bar patrons, used AmEDs regularly, and had experienced at least one recent bar conflict incident. Although NCA use was more common than was AmED use, AmED-involved bar aggression was more frequently reported than was aggression that coincided with NCA use only. Additionally, victimization and perpetration of aggression in bar environments were both more common when AmEDs were used than when only NCA was used. Frequency of going to bars was predictive of rates of experiencing bar aggression only when drinking NCA but not when drinking AmEDs. Results suggest that AmED use introduces a unique risk factor into the bar environment that must be considered in future research and in subsequent interventions meant to reduce the incidence of bar aggression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Alcohol Mixed with Energy Drinks (AmED) and Negative Alcohol-Related Consequences among South Korean College Students

Consumption of alcohol mixed with energy drinks (AmED) has been associated with various alcohol-related consequences among college students. However, more information is required to assess how this relationship is affected by sociodemographic and environmental factors. This paper investigates the association between AmED consumption and negative alcohol-related consequences while (1) stratifying AmED users by sex, (2) examining a range of outcomes specific to the college context (e.g., missing class), and (3) controlling for drinking frequency and amount. We surveyed and analyzed the data of 4592 students in a nationally representative sample of 82 colleges in South Korea. Multiple linear regression analysis was used to identify the association between AmED use and a number of alcohol-related consequences (ranging from a score of 0–12) while adjusting for covariates, including drinking frequency and intake per drinking session. Of our study population, 22.0% of alcohol-consuming men and 13.4% of alcohol-consuming women reported AmED consumption in the past 12 months. AmED users experienced a greater number of alcohol-related consequences (e.g., missing class, engaging in unplanned sexual activity) than non-AmED users (men β: 0.804, p ≤ 0.0001; women β: 0.522, p ≤ 0.0001). Male AmED users consuming alcohol once a month (β: 1.155, p ≤ 0.0001) and female users consuming less than once a month (β: 1.019, p ≤ 0.0001) experienced the greatest number of consequences compared to non-users, as did AmED users consuming 3–4 drinks per drinking session (men β: 1.012, p ≤ 0.0001; women β: 0.993, p ≤ 0.0001). Our findings reveal that both male and female college students who consume AmED experience a greater number of negative alcohol-related consequences than those who do not. Rather than high-risk drinkers, moderate drinkers who consume alcohol infrequently and/or in low amounts may experience more consequences when consumers of AmED.

Correlates of Alcohol Mixed with Energy Drink Use Among First Year College Students: Clinical and Research Implications.

Background: Alcohol mixed with energy drink (AmED) use among college students is associated with specific adverse effects (e.g., sexual assault, driving while intoxicated). This study offered the opportunity to evaluate correlates of past year AmED use in a large sample of college students. Methods: In autumn 2010, emails were sent to all first year students (n = 29,536) at 11 colleges and universities in North Carolina and Virginia, inviting them to participate in a brief web-based survey to be used to establish a cohort for the parent tobacco use study; 10,340 (35%) students responded to the web-based survey, which elicited items on demographics, past year use of AmED, and other health behaviors. Results: Past year of AmED was reported by 29.4% of students. Logistic regression analysis revealed that female gender (adjusted odds ratios [AOR] = 1.28, 95% confidence interval [CI] = 1.16-1.42); ever use of smokeless tobacco (AOR = 3.51, 95% CI = 3.00-4.10); current smoking (AOR = 4.97, 95% CI = 4.34-5.69); 2 or fewer days of physical activity per week (AOR = 1.16, 95% CI = 1.04-1.28); and 7 or 8 hours of sleep per day (AOR = 1.12, 95% CI = 1.02-1.24) predicted risk of past year use of AmED. Conclusions: Nearly a third of first year college students reported past year use of AmED. Our finding of increased past year use of AmED use among women is new and might reflect the changing epidemiology of female college alcohol use. Of additional concern, such use might also reflect targeted marketing to women by the energy drink industry. Findings can guide future research as well as substance counseling to college students.

Alcohol Mixed With Energy Drinks and Sexually Related Causes of Conflict in the Barroom.

The popularity of alcohol mixed with energy drinks (AmED) among young adults has spurred studies that focus on its links to aggression and risk-taking behaviors, including risky sex and sexual victimization. However, no studies to date have looked at the relationship between AmED and causes of interpersonal conflict in bars at the event level. The present study evaluated whether AmED use at the time of the bar conflict was associated with greater odds that a bar conflict would be precipitated by sexually related causes. Online survey data, including a description of a recent bar conflict, were collected from a community sample of 175 young adult (97 female) AmED users age 18 to 30 in western New York state. Qualitative findings included the natural categorization of sexually related causes of conflict, consisting of unwanted sexual advances and jealousy, and the prominence of sexual competition in these conflicts. Proportion of AmED use (out of the total quantity of alcoholic drinks) predicted the odds that the bar conflict would have a sexually related cause, above and beyond control variables. How AmED use might be associated with sexual competition and conflict in the bar is discussed.

The multiplicative effect of combining alcohol with energy drinks on adolescent gambling

PurposeThere has been increased concern about the negative effects of adolescents consuming a combination of alcohol mixed with energy drinks (AmED). To date, few studies have focused on AmED use and gambling. The present study analyzed the multiplicative effect of AmED consumption, compared to alcohol alone, on the likelihood of at-risk or problem gambling during adolescence. MethodsData from the ESPAD®Italia 2015 study, a cross-sectional survey conducted in a nationally representative sample of students (ages 15 to 19years) were used to examine the association between self-reported AmED use (≥6 times,≥10 times, and ≥20 times during the last month) and self-reported gambling severity. Multivariate models were used to calculate adjusted prevalence ratios to evaluate the association between alcohol use, AmED use, and gambling among a representative sample of adolescents who reported gambling in the last year and completed a gambling severity scale (n=4495). ResultsAmong the 19% students classed as at-risk and problem gamblers, 43.9% were classed as AmED consumers, while 23.6% were classed as alcohol consumers (i.e. did not mix alcohol with energy drinks). In multivariate analyses that controlled for covariates, AmED consumers were three times more likely to be at-risk and problem gamblers (OR=3.05) compared to non-consuming adolescents, while the effect became less pronounced with considering those who consumed alcohol without the addition of energy drinks (OR=1.37). ConclusionsThe present study clearly established that consuming AmED might pose a significantly greater risk of experiencing gambling-related problems among adolescents.

Daily conformity drinking motivations are associated with increased odds of consuming alcohol mixed with energy drinks

Recent research indicates that individuals drank more heavily and experienced more harms on days they consumed alcohol mixed with energy drinks (AmEDs). Limited research, thus far, has examined predictors of AmED use on a daily level. Drinking motives, or reasons for drinking, are shown to discern AmED users from non-users, but the extent to which daily drinking motives covary with AmED use has not been tested. The current study used a daily diary design to determine how motives differ between AmED and other drinking occasions. Participants included 122 college students (73.8% women) with a mean age of 20.39years. Participants completed up to 14 daily surveys, resulting in 389 drinking days (40days involved AmED use). Participants reported on their drinking motives at baseline as well as on each drinking day. Multilevel models revealed that, after controlling for other motives, AmED use was more likely on days where conformity motives were higher than usual and was less likely when enhancement motives were higher. Daily social and coping motives as well as all motives measured at baseline were unassociated with AmED use. Our findings suggest that conformity motives, or drinking to fit in with others, are the most salient drinking motive predicting AmED use on a drinking day. Given that conformity motives are often less associated with alcohol use outcomes in general, these findings highlight AmEDs as a unique alcoholic beverage. Clinicians and interventionists working with frequent AmED users should consider the unique conditions under which AmEDs are consumed.

Psychometric validation of the Anticipated Effects of Alcohol Mixed with Energy Drinks Scale.

Young people are increasingly consuming alcohol mixed with energy drinks (AmEDs). As coingestion of these beverages results in greater adverse consequences than from drinking alcohol alone, we need to understand what factors contribute to and deter coingestion. Existing studies in this area have not utilized a theoretically based or empirically validated measure of outcome expectancies for drinking AmEDs. Our study modified Morean, Corbin, and Treat's (2012) Anticipated Effects of Alcohol Scale to assess the expected effects of drinking AmEDs. We evaluated the factor structure and concurrent validity of the Anticipated Effects of Alcohol Mixed with Energy Drinks (AEAMEDS) among 549 university students, aged 18-25, who had a lifetime history of consuming alcohol (231 had consumed AmEDs in the past 90 days). Exploratory and confirmatory factor analysis supported a 4-factor structure. Consistent with hypotheses, stronger high arousal/positive expectancies and weaker low arousal/negative expectancies were associated with greater AmED use. At the bivariate level, stronger low arousal/positive expectancies were associated with greater quantities of AmED use, but this relationship disappeared when taking into account other outcome expectancies. Moreover, students expected low arousal/positive expectancies to be less intense when consuming AmEDs than alcohol alone, but ratings for all other AmED expectancies were equivalent to consuming alcohol alone. These findings contribute to our knowledge of risk and protective factors for AmED use. (PsycINFO Database Record

Intoxication-Related Alcohol Mixed with Energy Drink Expectancies Scale: Initial Development and Validation.

Young adult use of alcohol mixed with energy drinks (AmEDs) has been linked with elevated risks of a constellation of problem behaviors. These risks may be conditioned by expectancies regarding the effects of caffeine in conjunction with alcohol consumption. The aim of this study was to describe the construction and psychometric evaluation of the Intoxication-Related AmED Expectancies Scale (AmED_EXPI), 15 self-report items measuring beliefs about how the experience of AmED intoxication differs from the experience of noncaffeinated alcohol (NCA) intoxication. Scale development and testing were conducted using data from a U.S. national sample of 3,105 adolescents and emerging adults aged 13 to 25. Exploratory and confirmatory factor analyses were conducted to evaluate the factor structure and establish factor invariance across gender, age, and prior experience with AmED use. Cross-sectional and longitudinal analyses examining correlates of AmED use were used to assess construct and predictive validity. In confirmatory factor analyses, fit indices for the hypothesized 4-factor structure (i.e., Intoxication Management [IM], Alertness [AL], Sociability [SO], and Jitters [JT]) revealed a moderately good fit to the data. Together, these factors accounted for 75.3% of total variance. The factor structure was stable across male/female, teen/young adult, and AmED experience/no experience subgroups. The resultant unit-weighted subscales showed strong internal consistency and satisfactory convergent validity. Baseline scores on the IM, SO, and JT subscales predicted changes in AmED use over a subsequent 3-month period. The AmED_EXPI appears to be a reliable and valid tool for measuring expectancies about the effects of caffeine during alcohol intoxication.

Alcohol Mixed with Energy Drinks: Daily Context of Use

The link between use of alcohol mixed with energy drinks (AmEDs) and alcohol-related harms is well established, but limited research has examined the context in which AmEDs are consumed. Identifying the social and environmental characteristics of use may illuminate whether AmEDs are used in settings that could increase the likelihood of engaging in risky behaviors or experiencing harms. This study used a 2-week daily diary assessment to compare days in which AmEDs were consumed ("AmED days") and days where other types of alcohol were used ("non-AmED days") on where, when, and with whom drinking occurred. Participants were 122 (90 women) heavy drinking college students who reported mixing caffeine with alcohol at least once in the past week. Data were collected across 389 drinking days; 40 of these days involved AmED use. Multilevel modeling findings revealed that odds of drinking AmEDs were higher on days where individuals drank at a bar or club and drank at home relative to other locations. In addition, odds of pregaming were higher on AmED days as compared to non-AmED days. AmED use was linked with lower odds of drinking game behavior. Overall, AmEDs appear to be consumed in potentially risky contexts. In combination with prior findings that AmED days are linked with heavier alcohol use and more harms experienced, these findings support the unique nature of AmED consumption in terms of the factors that may predict or maintain potentially hazardous drinking patterns.

Alcohol Mixed With Energy Drinks and Risk of Injury: A Systematic Review.

The present study is a systematic review of the literature examining the relationship between alcohol mixed with energy drinks (AmED) and injury. The study provides a summary and critical analysis of the current literature. The review was conducted using PRISMA guidelines for systematic reviews. Studies included in the review were those that quantified the relationship between AmED use and injury risk relative to alcohol only. Records were considered along the following theme areas: controlled for drinking behaviors, controlled for impulsivity or risk-taking propensity, examined sex differences, and self-reported injury outcomes for (a) AmED versus alcohol consumers and (b) AmED versus alcohol sessions. The results support the association between AmED and increased risk of injury; however, substantial variability in harm outcomes and methodology makes it difficult to determine the extent of this risk. There is significant need for further examination of the role of AmED use in the risk of injury. A better understanding of the relationship between AmED use and injury and of the potential underlying mechanisms is crucial for informing effective preventive intervention strategies. This review can be used to inform the public and health practitioners of the risks associated with AmED use. Further, translating this knowledge to policy makers could inform regulations on the availability of AmED, with the goal of reducing injury-related outcomes.

Environmental contexts of combined alcohol and energy drink use: Associations with intoxication in licensed venues

BackgroundEnvironmental factors inside licensed venues have been found to influence the intoxication levels and consumption practices of patrons. The consumption of alcohol mixed with energy drinks (AmED) occurs primarily at or prior to attending licensed venues, however there is a lack of in situ research investigating AmED use in these contexts. Given that AmED use has been linked with increased alcohol consumption, intoxication, illicit substance use, and risk taking behaviours, this paper explores the environmental correlates and levels of intoxication associated with AmED use in licensed venues. MethodsStructured observations were undertaken in five Australian cities on Friday and Saturday nights. Covert teams spent 4–5h in venues and recorded hourly observations on patron, venue, and staff characteristics, alcohol, illicit drug and AmED consumption patterns and intoxication levels. Results898 hourly observations were recorded across 68 venues. All but one venue served energy drinks, and patron AmED use was observed during 34.9% of hourly records. AmED use was more prevalent after 12am and in nightclub venues compared to bars and pubs, and was positively associated with high intoxication levels, illicit drug use, and younger crowds. After controlling for environmental factors (i.e. venue crowding, service practices, venue characteristics, patron demographics and behaviour) AmED use did not predict high intoxication at a venue level in multivariable models. ConclusionAmED consumption is ubiquitous in the licensed venues of Australian night-time entertainment districts, particularly busy nightclub venues where intoxication and risky consumption are heightened. However, AmED use was not associated with high patron intoxication when environmental factors were considered.

The right place at the right time: The social contexts of combined alcohol and energy drink use

Aims: Little is known about the social and functional aspects of alcohol mixed with energy drink (AmED) consumption. Using a functional substance use perspective and via the lens of social identity theory, this paper aims to explore the role of AmED consumption amongst the milieu of nightlife and party culture. Methods: Twenty-five regular AmED consumers aged 18–33 participated in semi-structured interviews. Qualitative thematic analysis of transcripts was undertaken, with a focus on the social contexts and perceived functions of AmED consumption, group dynamics and social identity. Findings: Three main themes were identified: (i) AmED use was restricted to specific social contexts, (ii) AmED use performed a social function and (iii) AmED users identified with a coherent and consistent social identity. AmED use was almost exclusively reported to occur within group drinking scenarios at parties and licensed venues, particularly nightclubs. AmED users identified with a clear and consistent social identity that was distinct from other alcohol consumers, typified by gregarious and extroverted behaviour. AmED use was seen to facilitate these ideals and strengthen group cohesion in appropriate contexts. Conclusions: Future efforts aiming to elicit changes in AmED consumption practices must account for the fundamental importance of social contexts to AmED use.

Alcohol mixed with energy drink: Use may be a consequence of heavy drinking

AimsIn recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use. MethodData collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption. ResultsIncreased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED. ConclusionsResults support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.

Factors influencing young people's use of alcohol mixed with energy drinks

A growing evidence base demonstrates the negative health outcomes associated with the consumption of energy drinks (ED) and alcohol mixed with energy drinks (AMED), especially among young people. Work to date has focused on the physiological effects of ED and AMED use and the motivations associated with consumption, typically among college students. The present study adopted an exploratory, qualitative approach with a community sample of 18–21 year olds to identify relevant barriers, motivators, and facilitators to AMED use and to explicate the decision-making processes involved. The sensitisation method was used to collect data from a cohort of 60 young adult drinkers over a period of six months via individual interviews, focus groups, and introspections. The findings indicate that there may be a general understanding of the negative consequences of AMED use, and that these consequences can constitute barriers that serve to discourage frequent consumption among young people. This outcome suggests the potential application of positive deviance and social norms approaches in interventions designed to reduce AMED use among this population segment. The results are promising in the identification of a large number of concerns among young adults relating to AMED use. These concerns can constitute the focus of future communications with this target group. The results are likely to have relevance to other countries, such as the US and the UK, that share similar alcohol cultures and where energy drinks have achieved comparable market penetration rates.