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					Caffeinated Cocktails: Energy Drink Consumption,
     High-Risk Drinking and Alcohol-Related
     Consequences Among College Students.

                 Mary Claire O’Brien, MD
              NIDA/ODS Caffeine Symposium
                      July 8, 2009
              Acknowledgements
Supported by Grants Number RO1 AA14007-2 and 2R01AA014007-06A1
 from the National Institute on Alcohol Abuse and Alcoholism, and North
    Carolina DHHS/ OJJDP EUDL Award Number 2004-AH-FX-0014.
                    Co-authors


 Thomas P. McCoy
 Scott D. Rhodes
 Ashley Wagoner
 Mark Wolfson
                          Presenter Disclosure

             Mary Claire O’Brien, M.D.

The following personal financial relationships with
commercial interests relevant to this presentation
        existed during the past 12 months:
              “No relationships to disclose”
                          Yes!
It really is like the TV show.
                            Youth and alcohol
 Risk taking             Underage drinkers
 Independence seeking     consume almost 20%
 Experimentation          of all alcohol in the
                           U.S.
                          6th, 7th, and 8th
                           graders: 31.5%
                           reported drinking all
                           types of alcohol
                          4 out of 5 college
                           students drink; ½
                           binge
                          18-25 yr olds: highest
                           rate of binge drinking
                           among all U.S. adults
                    Study to Prevent Alcohol-Related Consequences
                                Among College Students (“SPARC”)



 Randomized group trial
 Community organizing approach
 Environmental strategies
    Availability (e.g. keg restrictions, compliance
     checks, responsible beverage service policies…)
    Price/ marketing (e.g. regulation of “happy hours,”
     limits on alcohol industry presence on campus…)
    Social norms (e.g. substance free housing,
     parental notification…)
    Harm minimization (e.g. Safe Ride programs)
 PrincipaI investigator: Mark Wolfson, Ph.D.
                                  SPARC: The Evaluation



College Drinking Survey (CDS)
 Resident Advisor Survey
 Alcohol Incident and Injury Reports
   Campus Police, Student Affairs, Campus Health,
    Campus EMS
 Coalition Member Survey
 Environmental Strategies and
  Implementation Survey (ESIS)
 Coalition Activity Tracking
                 Annual Consequences of College Drinking




 1,700 deaths
 599,000 injuries
 696,000 assaults
 97,000 sexual
  assaults
 2.8 MILLION DWI


     Hingson, 2005
Effects of Energy Drink Ingestion
    on Alcohol Intoxication.

Ferreira SE, Tulio de Mello M, Pompeia S, Oliviera de Souza-
                       Formigoni ML.
      Alcoholism: Clinical and Experimental Research.
              Vol 30, No 4, 2006: pp 598-605.
                                              26
  26
                                            Alcohol
Alcohol                                  + Energy drink
                       26

                  Energy drink


          Breath alcohol concentration
              Motor coordination
              Visual reaction time
            Feelings of intoxication
                                              Results


 Alcohol alone:
   Dizzy, weak, tired, headache, trouble walking
 Alcohol + Energy drink:
   Same BAC
   Felt much less “intoxicated”
 NOTE!
   Performance on motor coordination and visual
    reaction time were the same for both groups!
    “Buzz Beer”




≠
Caffeinated liquor
                             “Mix-your-own”

   Jager Bomb           Panty Dropper Punch
   Liquid Viagra        Cherry Bomb Shot
   Crunk Juice          Bazooka #2
   Bullvodka            Jacobo’s Melon Bomb
   Irish Trash Can      Touchdown
   Bull Blaster         Canadian Bull
   Up All Night         Flaming Liquid Cocaine
   Liquid Cocaine #6     Blaster
   Tucker Death Mix     Flip Passion
   Butt Plug            Raging Bull #2
   Dirty Gecko          Heart Attack
                              2006 SPARC CDS


 Ten NC Universities
 Stratified random sample
 Email invitation to participate
 Web-based (secure URL)
 Anonymous
 Reminder emails to non-respondents
 307 items, with skip patterns (~20 min)
 Paypal® incentive
                   SPARC College Drinking Survey: Content

 Demographic variables
 Alcohol consumption behaviors
 Alcohol availability
    How obtained (e.g. where, from whom)
    Where consumed
 Attitudes about drinking (one’s own, perception of other
  students’)
 Perceived campus drinking norms
 Knowledge of university policies
 Perception of enforcement (on campus, in the community)
 Consequences of one’s own drinking
 Consequences of other students’ drinking
 Sexual behaviors
 Other substance use behaviors
                                 2006 Additional Goals




 Estimate the prevalence of mixing alcohol with
  energy drinks (AmED) among past 30-day
  drinkers
 Examine the association of AmED and high-risk
  drinking
 Examine the association of AmED with alcohol-
  related consequences, after adjusting for drinking
  behaviors
                    2006 Sample characteristics

 N = 4,271
 Average age 20.4 ± 2.8 yrs
 61% Female
 78% Non-Hispanic White
 26% Fr; 25% So; 25% Jr; 20% Sr
 12% Greek society member or pledge
 22% intramural athlete; 5% varsity
 57% on-campus resident
                                              2006 SPARC CDS


                         4,271 students

                        4,237 answered
                       drinking questions
                             (99.2%)



2,886 past 30-day                           1,385 non past 30-day
 drinkers (68%)                                 drinkers (32%)



  697 past 30-day
   AmED (24%)


AmED = Alcohol mixed
 with energy drinks
                      Reasons given for consuming AmED




 To hide the flavor of the alcohol
   To drink more and not feel as drunk
   To drink more and not look as drunk
   To not get a hangover
   “Because it was being served at a party”
   “Because it was the only mixer available”
   “Because that’s how you make Jagerbombs”
                                        AmED more likely…



 Male (p < 0.001)
 White (p < 0.001)
 Intramural athletes (p < 0.001)
 Greek society members or pledges (p < 0.01)
 Younger (p<0.01)
 Average age of first drink: 15.1 yrs
    (vs. 16.0 yrs for non-AmED; p <0.001)
 More drinking during last year of high school (p < 0.001)
 More non-medical use of prescription stimulants
  (p < 0.001)
                                                        High-Risk Drinking

                    Non-AmED       AmED
   Drinking          N=2,189       N=697         b
                                                        z statistic   p-value
   Behavior           (76%)        (24%)       95% CI

                                                 1.4
Typical # drinks
                    4.5  0.15    5.8  0.17    (1.1,     11.69       <0.001
in single episode
                                                1.6)

 # days with 5/4
                                                 2.9
 heavy episodic
                    3.4  0.17    6.4  0.23    (2.5,     14.21       <0.001
drinking past 30
                                                3.3)
      days

                                                0.70
# days drunk in
                    0.73  0.04   1.4  0.05   (0.61,     15.44       <0.001
 a typical week
                                               0.79)
 Most # drinks                                   2.2
 single episode     6.1  0.15    8.3  0.19    (1.9,     14.28       <0.001
  past 30 days                                  2.5)
                                         Alcohol-Related Consequences

                          Non-AmED        AmED
                                                        AOR
     Consequence           N=2,189        N=697                 z statistic   p-value
                                                       95% CI
                            (76%)         (24%)
                                                        1.77
Was taken advantage of       3.7%          6.4%
                                                       (1.23,      3.05        0.002
       sexually            (2.9, 4.8)    (4.7, 8.7)
                                                       2.55)
                                                        2.18
  Took advantage of          1.7%          3.7%
                                                       (1.34,      3.13        0.002
   another sexually        (1.2, 2.4)    (2.5, 5.4)
                                                       3.55)
Rode with a driver who                    38.9%         2.20
                            22.5%
was under the influence                   (32.7,       (1.81,      7.83       <0.001
                          (18.6, 26.9)
      of alcohol                           45.6)       2.68)
                                                        2.25
                             5.9%          12.3%
 Was hurt or injured                                   (1.70,      5.74       <0.001
                           (4.8, 7.2)    (9.9, 15.3)
                                                       2.96)
                                                        2.17
  Required medical           1.2%          2.6%
                                                       (1.24,      2.70        0.007
     treatment             (0.8, 1.8)    (1.7, 4.1)
                                                       3.80)
    “Buzz Beer”




≠
                                                                     2007 SPARC CDS

                                   3, 783 answered
3,813 students                    drinking questions
                                        (99.2%)



       2,669 past 30-day                                      1,114 non-drinkers
        drinkers (70%)                                               (30%)



         704 past 30-day
          AmED (26%)



59 Pre-mix only                   249 Pre-mix + MYO                       393 MYO only
    (8.4%)                             (35.4%)                               (55.8%)

                        AmED = Alcohol mixed with energy drinks
             Pre-mix = Pre-mixed alcoholic energy drinks (e.g. Sparks®, Tilt®)
    MYO = Mix-your-own alcoholic energy drinks (e.g. Jagerbomb, Red Bull® and vodka)
                                 AME: Availability

 BOUGHT IT THEMSELVES: 65.5%
    Of these, 48.3% were under age 21
     (223 of 462)


 GIVEN THE ED FOR FREE: 13.4%
   Of these, 79.8% were under age 21
    (75 of 94)


 SOMEONE ELSE BOUGHT FOR THEM: 13.9%
   Of these, 71.4% were under age 21
    (80 of 112)
Questions?

				
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