1. Energy Drinks Martin Bushman Chemical Engineering Senior
University of Wisconsin-Madison
CBE 555
April 25, 2011

2. Outline Background Manufacturing What’s in Energy Drinks?
Health Effects
Marketing
Risks and Legal Issues
Alternatives

3. Claims “Redbull gives you wings.”
“Everlast Improves performance, increases concentration, improves reaction speed, increases metabolism.”
“ROCKSTAR is scientifically formulated to provide an incredible energy boost for those who lead active and exhausting lifestyles–from athletes to rock stars.”
You probably have the tools to critically evaluate these claims. Energy drinks effect people differently, though, whether you’re an athlete or a rock star.

4. History of Energy Drinks
Moxie, a Crème Soda invented in 1876, is now a synonym for energy.
Coca-Cola put 9mg of cocaine in its product in 1886
Lucozade originated in Newcastle, UK, in 1927, as a source of energy, electrolytes, and refreshment for hospital patients.
Lipovitan, released in 1962, began the energy drink craze in Japan.
Jolt Cola, released in the US in 1985, pioneered a marketing strategy which is still in use by energy drink marketers.
Red Bull appeared in the US in 1997, forerunner to Amp (2001), Rockstar (2001), Monster (2002), Full Throttle (2004), et al.
Wave of popularity with energy shots after the introduction of 5 Hour Energy in 2004.
The alcoholic energy drink craze lasted from 2002 with Sparks to 2010 with an FDA ban on adding caffeine to alcoholic beverages.
"Moxie Nerve Food,“ claimed panacea especially effective against "paralysis, softening of the brain, nervousness, and insomnia.“ Apparently Calvin Coolidge and Ted Williams swore by it.

5. Consumption In North America, 90% of adults consume caffeine daily.
Worldwide annual caffeine consumption is estimated at 120,000 tons.
Energy drinks are a $4.8 billion/year industry (400% growth since 2003)
2008 survey of teenagers indicated 35% use energy drinks, compared with 19% in 2003.
The “healthy” alternative to soft drinks.
Worldwide caffeine consumption is estimated at 120,000 tons, that’s 1.36 trillion red-bulls or cups of coffee or 1.8 trillion cups of tea, enough for every person on earth to have a 42mg serving of caffeine every day.
From 2003 to 2008, Mintel estimates that the regular carbonated soft drink market lost 15.6 million adult drinkers. Just 68% of respondents to Mintel’s November 2008 survey said they drank regular soda in 2008, down from 76% in During the same period, the number of diet soda drinkers grew: 7.8 million more adults reported drinking diet soda in 2008 than in 2003.
“Regular soda has taken the brunt of criticism from America’s obesity and health issues, because people associate it with ‘empty’ calories and artificial ingredients,” states Krista Faron, senior analyst at Mintel. “As health and wellness awareness grows, more people are turning away from old-fashioned pop and looking for healthier, lower calorie drinks, as well as drinks that offer the functionality to meet their specific lifestyle needs.”
The greatest changes in Americans’ drinking habits have occurred outside the soft drink market. As consumers adopt healthier lifestyles and look for new beverages to go with them, Mintel has seen rapid growth in the number of people who regularly drink non-soda options:
Bottled Water – 24 million more Americans drank bottled water in 2008 than in 2003
Energy Drinks – Driven by young adults, the number of energy drink users nearly doubled from 2003 to 2008 (to 34.5 million from 17.4 million)
Sports Drinks – In the past five years, 11 million adults started drinking sports drinks
In Mintel’s exclusive consumer survey, one in three beverage-purchasing adults (34%) said they’re drinking more water and less carbonated beverages to manage weight or other health conditions, compared to In addition to weight control, many people are concerned about high-fructose corn syrup and artificial sweeteners, causing them to turn away from all kinds of soda. Mintel found 16% of respondents worry about the health risks of high-fructose corn syrup, while 15% say they’re drinking less artificially sweetened beverages because of risks.
“During the past few years, health and wellness issues have come to the forefront of people’s minds, and we see that strongly reflected their changing beverage choices,” comments Krista Faron. “Manufacturers have done well at keeping pace with people’s new preferences, and we expect continued momentum in tea, coffee drinks and diet soda in particular.”

6. Energy Drink Market
“Twelve to nineteen-year-old boys consume thirty-four teaspoons of sugar a day in their diet, and about half of that comes from soft drinks.”
People see soft drinks as a root cause of obesity.

8. Carbonation Some energy drinks are carbonated
Myth: Calcium absorption and skeletal effects
Diuretic effects leach calcium from the body
Myth: Not the carbonate ion, but the phospates that cause bone/tooth degradation
Again, the experiments don’t agree with this hypothesis.
Conclusion: carbonated water has same effects as sparkling water.
Red bull, Monster, Rockstar, Amp, Full Throttle, Vault
One hypothesis to explain this relationship is that the phosphoric acid contained in some soft drinks (colas) displaces calcium from the bones, lowering bone density of the skeleton and leading to weakened bones, or osteoporosis.[37] However, calcium metabolism studies by Dr. Robert Heaney suggested that the net effect of carbonated soft drinks, (including colas, which use phosphoric acid as the acidulent) on calcium excretion in urine was negligible.
In the 1950s and 1960s there were attempts in France and Japan to ban the sale of Coca-Cola as dangerous since phosphates can block calcium absorption. However, these were unsuccessful as the amounts of phosphate were shown to be too small to have a significant effect.
The one effect soft drinks may have on bone health is to displace food and drink that contains calcium and other nutrients, which is a problem.

9. Manufacturing
Simplified diagram showing the production of an energy drink Zone.

10. A bit more complicated, here, we see the full process for manufacturing, in this case, soft-drinks.

11. What’s in Energy Drinks—Caffeine
Stimulant
Found naturally – natural plant pesticide
Metabolized in the liver
Antagonist of Adenosine
Moderate use:
mg daily
Heavy use:
mg+
Mayo Clinic:
For most healthy adults, moderate doses of caffeine — 200 to 300 milligrams (mg), or about two to four cups of brewed coffee a day — aren't harmful. But some circumstances may warrant limiting or even ending your caffeine routine.
Heavy use, mg, leads to insomnia, nervousness, restlessness, irritability, upset stomach, racing heartbeat, muscle tremors
In plants it acts as a natural pesticide, killing small insects that eat the leaves.

12. • Paraxanthine (84%): Has the effect of increasing lipolysis, leading to elevated glycerol and free fatty acid levels in the blood plasma. preferential path for human metabolism. (dimethylxanthine compound structurally related to caffeine). Like caffeine, it’s a CNS stimulant
Runners have used this to increase fatty acid metabolism.
• Theobromine (12%): Dilates blood vessels and increases urine volume. Theobromine is also the principal alkaloid in cocoa and chocolate, (one of the causes of chocolate’s mood elevation effects). Actually contains no bromine—name derived from Theobroma, Greek for “food of the gods.”
• Theophylline (4%): Relaxes smooth muscles of the bronchi, and is used to treat asthma. The therapeutic dose of theophylline, however, is many times greater than the levels attained from caffeine metabolism. Each of these metabolites is further metabolized and then excreted in the urine. Naturally found in black and green teas, CNS and cardiac stimulant, bronchodialator
1-Methyluric acid: minor urinary metabolite
1,7-Dimethyluric acid: major urinary caffeine metabolite
7-Methyluric acid: minor urinary metabolite, metabolized in liver
5-Acetylamino-4-amino-3-methyluracil:
Absorbed into the stomach and small intestine within 45 minutes of ingestion, then it is distributed throughout body tissues.
1st order kinetics for elimination
It is not stored in the body in any way—it can stay in the body for ~6 hours though.

13. Caffeine Pros – Temporarily: Improved concentration
Increased wakefulness
Fewer worker mistakes
Increased athletic performance
Lower risk of diabetes & cardiovascular disease
Increased Epinephrine, plasma lactate, and cortisol levels.
Cons –
Addictive
Methylxanthine – similar to adenosine
Mayo Clinic:
For most healthy adults, moderate doses of caffeine — 200 to 300 milligrams (mg), or about two to four cups of brewed coffee a day — aren't harmful. But some circumstances may warrant limiting or even ending your caffeine routine.
Heavy use, mg, leads to insomnia, nervousness, restlessness, irritability, upset stomach, racing heartbeat, muscle tremors
a study showed that caffeine could impair short-term memory and increase the likelihood of the tip of the tongue phenomenon. Can aid short-term memory when the information to be recalled is related to the current train of thought, but hinders short-term memory when the train of thought is unrelated.[125] So it increases mental performance related to focused thought while it may decrease broad-range thinking abilities.
Like many drugs, the cure to the withdrawl problems is more of the drug. Headache and depressed mood are common. Vasoconstriction in the brain, so results in brain swelling

14. Caffeine and Sugar Contents
Caffeine (mg/fl. oz)
Per Serving
(serving size)
Sugar (g/fl. oz)
Coffee, brewed
7-16 (varies)
(8fl oz)
(varies)
- (8 fl oz)
Tea, brewed
2-7.5 (varies)
16-60 (8 fl oz) -
Espresso
20-50 (varies)
(2fl oz)
- (2 fl oz)
Mountain Dew
4.5
54 (12 fl oz)
3.92
47 (12 fl oz)
Rockstar
10.00
160 (16 fl oz)
3.75
60 (16 fl oz)
Red Bull
10.88
80 (8.46 fl oz)
3.19
27 (8.46 fl oz)
5 Hour Energy 40
80 (2 fl oz)
(2 fl oz)
Coffee varies because I know I put sugar and cream in my coffee (one packet holds 2-4g sugar)
Tea -- White 1.9, SoBe green 1.8, Snapple 2.6, green 3.1, instant 3.2, iced 5.9, brewed 5.9, brewed (imported) 7.5
One of the differences noted here is that coffee, tea, and espresso are all sipped hot, whereas energy drinks are chugged cold
Sources:

15. Guarana Similar effects as Caffeine
Extract of the berry of the Guarana plant
Effects:
quickens perceptions
delays sleep
Increase effectiveness in endurance based activities
hangover recovery aid
impaired appetite/upset stomach
diuretic
increases blood pressure, heart rate
Jitters, tremors
Studies show cognitive and memory benefits in low doses.
Guaranine has very similar chemical characteristics to Caffeine, so guarana content should be treated as caffeine content.
Low dose 75 mg

16. Taurine Amino acid that naturally occurs in food
Necessary for skeletal muscle function
Benefits for regulating blood pressure, and cardiovascular disease
One study suggested physical activity benefits.
No studies capable of demonstrating cognitive performance claim.
Energy drinks contain significant amounts
Up to 3000mg is deemed safe
Little is known about long term use.
Amino acid. One of only a few naturally occurring sulfonic acids. Cysteine Derivative
Newborns cannot make it—they get it from breast milk or formula
Especially found in meat and fish, 58mg for average omnivore. Estimates of mg daily. To put that in perspective, a can of Rockstar has 2000mg.
First isolated from Ox Bile in 1827, 2-aminoethanesulfonic acid
Shown in rats to be necessary for the normal function of skeletal muscle.
Deemed not a safety concern – there’s a significant margin of safety ( mL,.5can-1.5can)
Have been fatalities (one case of a person drinking 1.4 liters of energy drink)
Ventricular effects increased when drinking taurine/caffeine enhanced Red Bull drink: Only 12 people were in this study.

17. Ginseng “Panacea” “Adaptogen” Effects:
Stress reduction
Quality of life, physical stamina improvement
No effect on memory
A number of side effects
Present in too low dosage in energy drinks to have any medicinal benefit
May enhance the effect of caffeine
Panacea: all-healing
Adaptogen: it increases resistance to physical, chemical, and biological stress and builds energy and general vitality.
“a non-toxic substance which reinforces the bodys ability to react to stress"
Saponins cause prohibiting effect in the aging process.
Stress: electroshock testing on mice builds up antinociception, increase in the threshold of pain. Anxiety and fear can play a role in stress-induced antinociception. Ginseng nullifies this physiological stress.
Side Effects: UMass Amherst publication, inability to sleep, other sources state ginseng causes no sleep difficulties. Other side effects can include nausea, diarrhea, headaches, nose bleeds,[24] high blood pressure, low blood pressure, and breast pain.[25] Ginseng may also lead to induction of mania in depressed patients who mix it with antidepressants.[26]

18. Glucuronolactone Natural metabolite found in the body Claims:
Detoxicant
Fight fatigue
Provide a “sense of well-being”
Benefits uncertain, but not a health concern
NOAEL = 1000 mg/kg/day
No observable adverse effect level
Red bull contains 600mg.

19. B-Vitamins Support and increase metabolism rate
Enhance immune system function
B6, B12
"[i]n general, B vitamins aren’t toxic in large amounts. They’re water-soluble, which means they pass out of the body in urine. But high doses of B6 can cause nerve damage, tingling, and numbness in the arms and legs."
Quote by Chris Rosenbloom, RD, PhD, a professor of nutrition at Georgia State University in Atlanta B3
Naicin lowers LDL (low density lipoprotein) levels – arteriosclerosis
Upper limit ~35mg/day, causing flushing B6
Help your body produce long-lasting energy more efficiently. - Helps your brain produce chemicals that keep you feeling positive - Naturally increase metabolism - Supports the brain and nervous system.
B12
Necessary for normal brain functioning
Helps in creation of healthy red blood cells
Only need a couple micrograms/day to gain all benefits
B3 - Naicin
B6 - Pyridoxine
B12 - Cobalamin

20. Health Impact of these chemicals
“Crash-and-burn” Effect
"The amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver either therapeutic benefits or adverse events”
“A psychosomatic placebo effect of having consumed an “energy drink” may compound the chemicals’ actual effects”
Indication of some synergistic effects
Quote in the Journal of American Pharmacists Association acknowledging the safety of the chemicals found in energy drinks by saying there’s not enough present to help or harm.
Quote in the Cal Nutrion Bytes journal
Because adenosine, in part, serves to regulate blood pressure by causing vasodilation, the increased effects of adenosine due to caffeine withdrawal cause the blood vessels of the head to dilate, leading to an excess of blood in the head and causing a headache and nausea. This means caffeine has vasoconstriction properties.[103] Reduced catecholamine activity may cause feelings of fatigue and drowsiness. A reduction in serotonin levels when caffeine use is stopped can cause anxiety, irritability, inability to concentrate, and diminished motivation to initiate or to complete daily tasks; in extreme cases it may cause mild depression. Together, these effects have come to be known as a "crash".[104]
Withdrawal symptoms—possibly including headache, irritability, an inability to concentrate, drowsiness, insomnia and pain in the stomach, upper body, and joints[105]—may appear within 12 to 24 hours after discontinuation of caffeine intake, peak at roughly 48 hours, and usually last from one to five days, representing the time required for the number of adenosine receptors in the brain to revert to "normal" levels, uninfluenced by caffeine consumption. Analgesics, such as aspirin, may relieve the pain symptoms, as may a small dose of caffeine.
Like caffeine and glucose or caffeine and ginseng, may have synergistic physiological effects.

21. Short-term Health Risks
Dehydration
It is not advisable to use energy drinks during or after athletic activity or a strenuous workout
Caffeine Intoxication
250mg+ / day (2.5 cups of coffee or 2-3 energy drinks)
Adverse effects are (to varying degrees) severe
Muscle twitching, impaired mental processes, heart palpitations
Caffeine Overdose
Cases involving seizures, deaths
“Man’s heart stops after consuming 8 Red Bulls”
Caffeine LD50 = mg / kg body mass
Caffeine Half-life ~= 5 hours
As little as ~2g may require hospitalization.
Caffeine acts as a diuretic to cells, stripping them of water and resulting in dehydration.
1% dehydration -> 10% reduction in performance
Fluvoxamine (reduced clearance 91.3%), half-life increases -> 56hours
Source quoted half-life at 4.9, another quoted depending on the individual.
The report, “New-onset seizures in adults: Possible association with consumption of popular energy drinks” describes four cases in four different individuals where researchers associated the onset of seizures with high-volume ingestion of popular energy drinks. "On abstinence from the energy drinks, none of the four patients reported any seizures,” the report stated. 
Seizures can result as people come down from their energy drink-induced energy high

22. Long-term Health Effects
Caffeinism, dependence, addiction
Stress hormone levels increased.
Affected sleep cycle
For moderate intake:
MYTH: Atrial Fibrillation
MYTH: Cardiovascular disease
MYTH: Arteriosclerosis
MYTH: Calcium loss in bones, osteoporosis
Caffeine is a popular stimulant commonly consumed in tea, coffee and cola beverages. Scientific studies have looked into potential health risks that may accompany the stimulant effects of caffeine, including heart disease. Many studies have found that caffeine, in moderation, does not cause or worsen heart disease, and the American Heart Association says that moderate consumption of one or two cups per day does not seem to be harmful.
Arteriosclerosis
In a study published in the October 2010 issue of "Arteriosclerosis Thrombosis and Vascular Biology," researchers examined the affect of coffee, tea and caffeine consumption on the development of hardening of the arteries in later life. More than 5,000 participants aged 18 to 30 were followed over a 20-year period. The researchers reported that no association was observed between average coffee, decaffeinated coffee or caffeine consumption and presence of coronary artery calcification or progression of coronary artery calcification. There was also no association between caffeine consumption and thickening of the lining of the carotid artery, a condition that leads to occlusion and cardiovascular risk.
Atrial Fibrillation
Risk of atrial fibrillation in women as a result of caffeine consumption was the subject of a study published in the September 2010 issue of "American Journal of Clinical Nutrition." More than 33,600 women without cardiovascular disease or atrial fibrillation participated in the study, which followed the participants over a 14-year period and used food-frequency questionnaires to determine rates of caffeine consumption. The researchers reported an incidence of 945 atrial fibrillation events occurring during the study period. Of the individual components of caffeine intake measured, including coffee, tea, cola and chocolate, none were significantly associated with increased risk of atrial fibrillation.
Cardiovascular Disease in Asian Populations
The relationship between green, black and oolong teas and caffeine consumption on cardiovascular disease in Asian populations was reported in a study published in the July 2010 issue of "Journal of Epidemiology and Community Health." The study followed nearly 77,000 individuals 40 to 79 years of age and determined caffeine consumption via diet questionnaire. The researchers found a decreased risk of death from cardiovascular disease associated with drinking each of the caffeinated beverages compared with not drinking them.
Heart Rate Variability
The influence of coffee on heart rate variability was tested in a study published in the August 2009 issue of "QJM." Study participants with irregular heart rhythm associated with recent heart attacks were given caffeinated coffee. Their heart rate variability was evaluated. Although certain nervous system functions were increased by the caffeine, heart rhythm was not adversely affected, in the short term time frame of the study.

23. Vehicle Most come as canned beverages Powdered Energy Drinks
Some are just an energy shot
Many people like the new packaging design because it cuts down on the volume. They feel: no sugar, no crash
Mix your own energy drink from a powder in a pouch. This means people can take their energy wherever they go, be it to rock concerts or races or some other awesome thing.

24. 5-Hour Energy Claim: No crash Half bottle = moderate energy
Whole bottle = MAXIMUM ENERGY
Warnings:
No more than 2 bottles/day
Caffiene Content
Naicin Flush
“It’s a sip” 1-2 fluid ounces
Caffiene in the amount of a premium coffee (nervousness, sleeplessness, rapid heartrate)
Naicin Flush, which is a hotness and redness to the skin, caused by increased bloodflow to the skin

25. Marketing Marketing targets: Speed, Energy, Flash, Instant Thrill
Overworked professionals
Young adults
Teens
Gamers
Speed, Energy, Flash, Instant Thrill
More specifically they are male teenagers and people in their 20s because they are most likely to believe in the fact that energy drinks will give them the boost they need.
Now everyone is susceptible to the fatigue of the super-charged, over-worked lifestyle, but young people are especially vulnerable to persistent exhaustion and insufficient energy.
Mana Energy Potion—directly marketed toward videogame aficionados (their shape is reminiscent of bottles from several fantasy role playing videogames)
Many energy drink companies are more exclusive in their marketing efforts because they gear their products and advertising to appeal to a very specialized group. These groups include gamers, extreme sports enthusiasts, and the hip hop crowd. You can see the effects of this emphasis on such a target market because it is seen in the advertising campaigns of energy drinks. A lot of the names of the beverages, like Crunk or Go Fast!, appeal to specific consumers. Also marketing strategies such as sponsoring public events or celebrity endorsements are very appealing to the consumers. The way the energy drink is packaged affects the target audience as well. For example, Energy Fizz is an energy drink but in the form of a powder that you mix with water. This energy drink appeals to people who are constantly on the go because they can just take a packet with them and grab some water and they are set.

26. Brands Red Bull Energy Drink Monster Energy Drink
Full Throttle Energy Drink
Amp Energy Drink
XS Energy Drink
Redline Energy Drink
Rockstar Energy Drink
Spark Energy Drink
All shiny brightly colored cans. Powerful, energy packed names

28. Legal Issues "As long as we sell drinks, I really don't care.”
Caffeine labeling voluntary?
Caffeinated alcoholic beverages
The FDA didn’t seem to think it was funny to use the name of an illegal street drug for the basis of marketing.
The maker of the drink boasted that he produced 200,000 cases of the stuff in the previous month and responded: "As long as we sell drinks, I really don't care."
The FDA deemed caffeine an “unsafe food additive” to the malt alcoholic beverages, and thus legal action including seizures could take place under federal law.
Phusion Projects’ Energy drink Four, or Four Loko, is named for the four active ingredients: caffeine, guarana, taurine, and alcohol.
Since its inception in 2005, cases of college students overdosing on alcohol when using the product
Concerns that the caffeine might mask the sensory cues that would gauge their current level of intoxication.
As a result of all the attention, a black market started up, people sold their cans for 5x what the purchase price.
Sparks (containing caffeine, guarana, taurine, ginseng) was purchased by MillerCoors in 2006 for $200 million, the company agreed to remove the caffeine from the drink after being sued by a consumer advocacy group in 2008
Sobe energy drink does not cure illness, enhance memory, or reduce stress as it claimed in 2002 and was fined $219 million for such claims.
Companies not required to disclose the amount of caffeine in their drinks, unlike other drugs. A group of scientists has recently petitioned the FDA to try to change that.

29. Dangers
Caffeine’s alertness and jitteriness effects are canceled by the alcohol’s effects.
Sensory cues telling a person that they’re drunk are masked by caffeine’s effects.
Blood alcohol content and its regulation independent of perception

30. Alternative Energy Adequate sleep Maintaining a healthy diet Exercise
Fruit Juices, Milk
Exercise
Water
Less than 250mg caffeine every day
People, especially young people, think of caffeine as a magic potion for staying awake longer, and it isn’t. It’s very important to get a good night’s sleep for proper mental alertness, metabolic process regulation.
Natural juices and milk are cheaper and provide

31. Yerba Mate Tea Active Ingredients: Health Benefits Health Risks
Caffeine, Theobromine, Theophylline
Health Benefits
Polyphenol Antioxidant
Lower dosage of caffeine
Claims: strengthen immune system, relieve allergy symptoms, aid in weight loss
Health Risks
May increase cancer risk
theobromine—also found in cocoa—an alkaloid known to help elevate the mood. Boosters of the drink say it also helps strengthen the immune system, relieve allergies and aid in weight loss. – immune system booster due to antioxidant
Yerba Mate (flex paraguariensis) is an evergreen member of the holly family. It grows wild in Argentina, Chile, Peru, and Brazil, but is most abundant in Paraguay  - Provides long-lasting energy  - Used for thousands of years in South America to increase endurance  - Supports a positive attitude and mental alertness A study by the International Agency for Research on Cancer showed a limited correlation between oral, throat, esophageal cancer and the drinking of large quantities of hot mate. The increased risk, is due to the high temperatures in which the mate is consumed in its most traditional way, the 'chimarrão'. The cellular damage caused by thermal stress could lead the esophagus and gastric epithelium to be metaplasic, adapting to the chronic injury. Then, mutations would lead to cellular dysplasia and to cancer.[34] Given the influence of the temperature of water, as well as the lack of complete adjustment for age, alcohol consumption and smoking, the study concludes that mate is "not classifiable as to its carcinogenicity to humans".[35]
Green tea is rich in epigallocatechin gallate compounds, while yerba mate's main antioxidant is chlorogenic acid
Antioxidant – cholorgenic acid a polyphenol antioxidant (red wine, chocolate, green tea)

32. Questions/Thoughts?

33. Major References
Taurine Clauson, KA; Shields, KM; McQueen, CE; Persad, N. "Safety issues associated with commercially available energy drinks". Journal of the American Pharmacists Association : JAPhA 48 (3): e55–63;

34. Pictures and References
Consumption
US Market
Carbonation
Manufacturing
Caffeine
Guarana
Ginseng
Glucuronolactone
5 Hour Energy
Taurine
Long term
Rockstar
Marketing
Brands
Kids
Legal Issues
Conclusion