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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
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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.
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Co-authors Thomas P. McCoy Scott D. Rhodes Ashley Wagoner Mark Wolfson
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Presenter Disclosure The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Mary Claire O’Brien, M.D. “No relationships to disclose”
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Yes! It really is like the TV show.
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Youth and alcohol Risk taking Independence seeking Experimentation Underage drinkers consume almost 20% of all alcohol in the U.S. 6 th, 7 th, and 8 th 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
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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.
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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
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Annual Consequences of College Drinking 1,700 deaths 599,000 injuries 696,000 assaults 97,000 sexual assaults 2.8 MILLION DWI Hingson, 2005
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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.
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Breath alcohol concentration Motor coordination Visual reaction time Feelings of intoxication 26 Energy drink 26 Alcohol + Energy drink 26 Alcohol
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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!
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“Buzz Beer” ≠
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Caffeinated liquor
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“Mix-your-own” Jager Bomb Liquid Viagra Crunk Juice Bullvodka Irish Trash Can Bull Blaster Up All Night Liquid Cocaine #6 Tucker Death Mix Butt Plug Dirty Gecko Panty Dropper Punch Cherry Bomb Shot Bazooka #2 Jacobo’s Melon Bomb Touchdown Canadian Bull Flaming Liquid Cocaine Blaster Flip Passion Raging Bull #2 Heart Attack
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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
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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
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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
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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
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2006 SPARC CDS 4,271 students 2,886 past 30-day drinkers (68%) 1,385 non past 30-day drinkers (32%) 697 past 30-day AmED (24%) 4,237 answered drinking questions (99.2%) AmED = Alcohol mixed with energy drinks
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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”
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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)
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Drinking Behavior Non-AmED N=2,189 (76%) AmED N=697 (24%) b 95% CI z statisticp-value Typical # drinks in single episode 4.5 0.155.8 0.17 1.4 (1.1, 1.6) 11.69<0.001 # days with 5/4 heavy episodic drinking past 30 days 3.4 0.176.4 0.23 2.9 (2.5, 3.3) 14.21<0.001 # days drunk in a typical week 0.73 0.041.4 0.05 0.70 (0.61, 0.79) 15.44<0.001 Most # drinks single episode past 30 days 6.1 0.158.3 0.19 2.2 (1.9, 2.5) 14.28<0.001 High-Risk Drinking
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Consequence Non-AmED N=2,189 (76%) AmED N=697 (24%) AOR 95% CI z statistic p-value Was taken advantage of sexually 3.7% (2.9, 4.8) 6.4% (4.7, 8.7) 1.77 (1.23, 2.55) 3.050.002 Took advantage of another sexually 1.7% (1.2, 2.4) 3.7% (2.5, 5.4) 2.18 (1.34, 3.55) 3.130.002 Rode with a driver who was under the influence of alcohol 22.5% (18.6, 26.9) 38.9% (32.7, 45.6) 2.20 (1.81, 2.68) 7.83<0.001 Was hurt or injured 5.9% (4.8, 7.2) 12.3% (9.9, 15.3) 2.25 (1.70, 2.96) 5.74<0.001 Required medical treatment 1.2% (0.8, 1.8) 2.6% (1.7, 4.1) 2.17 (1.24, 3.80) 2.700.007 Alcohol-Related Consequences
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“Buzz Beer” ≠
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2007 SPARC CDS 3,813 students 2,669 past 30-day drinkers (70%) 1,114 non-drinkers (30%) 704 past 30-day AmED (26%) 3, 783 answered drinking questions (99.2%) 249 Pre-mix + MYO (35.4%) 59 Pre-mix only (8.4%) 393 MYO only (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)
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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)
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