English summaries Suom Lääkäril 2025;80:e44699, www.laakarilehti.fi/e44699

Increased consumption of energy drinks among children and adolescents between 2014 and 2022 is associated with non-adherence to sleep duration recommendations

Maija PuupponenMarkus KulmalaRaili VälimaaJorma TynjäläLeena Paakkari

Background There is a lack of monitoring data on energy drink consumption by Finnish children and adolescents, despite the associated adverse health effects. Energy drinks are not recommended for children and adolescents, due especially to their high caffeine content.

Methods The nationally representative data are based on the HBSC study conducted in 2014, 2018, and 2022 (n = 15 171). Descriptive analyses and logistic mixed models were used to examine energy drink consumption among 11-, 13-, and 15-year-olds, its changes over time, and the associations with sociodemographic factors and adherence to sleep recommendations.

Results From 2014 to 2022, the consumption of energy drinks increased across all age groups, with a notable rise in frequent use (more than once a week). The differences between age groups widened, while the gender gap narrowed. Consumption was more prevalent among adolescents who did not meet the recommended sleep duration for their age group. In 2022, consumption was also more prevalent among those with higher family affluence.

Conclusions There has been a rise in the consumption rates of energy drinks among children and adolescents. More information on energy drink consumption is needed to promote healthy lifestyles, evaluate the effectiveness of current actions, and inform health policy.

The consumption of energy drinks among children and adolescents has been noted as a potential public health threat (1) and is associated with a number of adverse health effects. These include cardiovascular symptoms, such as increased blood pressure, changes in heart rate, and palpitations) (2). There is also evidence of sleep disturbances, including short sleep duration (3,4,5,6,7) and late bedtime or night-time awakenings (8), in addition to various psychological and somatic symptoms (2,5,8), and poor self-rated health (7). These effects are particularly related to the high caffeine content of energy drinks (9), for which no safe intake limit has been reliably established for this population group (10).

In Finland, efforts have been made to curb the consumption of energy drinks through recommendations from The National Nutrition Council of Finland and the Finnish Institute for Health and Welfare. The recommendations apply to persons under 15 years of age (11,12). Despite the recommendations, the consumption of energy drinks is common: in 2022, only around 50% of adolescents aged 13 and 15 reported non-consumption of energy drinks (13).

Already in 2013, the European Food Safety Authority recommended monitoring the increase in energy drink consumption (14). However, there have been only limited monitoring data in Finland on the prevalence of energy drink consumption among children and adolescents and the factors associated with their consumption, with a particular lack of data for children in primary education. The present study examined the consumption of energy drinks among persons aged 11, 13, and 15 in the years 2014, 2018, and 2022. It also examined the associations between energy drink consumption and age, gender, family affluence, and adherence to age-specific night sleep duration recommendations (15), and considered whether these associations had changed over the years. The association between sleep duration and energy drink consumption was examined because of a previously observed mutual connection – one that had been noticed, but had received little attention at national level (7,8,16).

Methods

The cross-sectional data of the study consisted of the nationally representative WHO School Health Survey (HBSC study) questionnaire data from the years 2014, 2018, and 2022 (N = 15 171; boys 50.2%; annual variation in respondents’ N = 3408–7925). The study data cover 11-, 13-, and 15-year-olds, representing the 5th, 7th, and 9th grade levels.

The sampling was conducted separately for each data collection year using the school register maintained by Statistics Finland. Participating schools were selected via stratified cluster sampling to ensure geographical and residential area representativeness. The sampling unit was the school, with the selection probability proportional to its size, and the participating classes within the sampled schools were randomly selected. The 2014 data were collected using paper questionnaires, while the 2018 and 2022 data were collected electronically using the Webropol survey program. Participation in the study was voluntary, and the questionnaire was answered anonymously. In addition to age and self-reported gender, the study used the variables described in Table 1. Statistical analyses were performed using Stata (version 18) statistical software; thus, the weighted percentages, corrected for sampling method, were calculated, along with their 95% confidence intervals for energy drink consumption across different background variables (Table 2). Two different models were fitted in the regression models, considering each year separately (Table 3). The first models accounted for age, gender, and family wealth. The second models included also the recommended night sleep duration. For 2018, the second model did not include 11-year-olds, as sleep duration was not asked of them at that time. The models accounted for clustering at the school level using a random effect. The regression estimates of the models could be compared across the years by examining the intersections of the 95% confidence intervals. The continuous variables in the models were standardized by mean and standard deviation. In addition, both marginal and conditional R2 values were calculated for the models (17). In the mixed models, marginal R2 refers to the explanatory power when only the predictor variables are considered, while conditional R2 also accounts for the random effect at the school level. The regression models were created using R software with the packages 'lmerTest' (model p-values), 'performance' (model explanatory power R2), and 'lme4' (random model estimation).

Results

In 2022, 26.5% of 11-year-olds, 53.5% of 13-year-olds, and 65% of 15-year-olds consumed energy drinks (Table 2). The differences between age groups were evident in weekly consumption, reported by 10.7% of 11-year-olds, 29.3% of 13-year-olds, and 46.5% of 15-year-olds. Furthermore, there were particularly pronounced differences between age groups regarding those consuming energy drinks more-than-once-a-week: 6.7% of 11-year-olds, 19.7% of 13-year-olds, and 33.7% of 15-year-olds. A gender difference was observed only among 11-year-olds, with boys consuming more than girls.

The consumption of energy drinks increased between 2014 (35.7%), 2018 (40.2%), and 2022 (48.6%). An examination of the temporal change in relation to age showed that from 2014 to 2022, the proportions of 11- and 13-year-olds consuming energy drinks more than once a week doubled, and for 15-year-olds, it tripled (Figure 1). Furthermore, the trend in the proportions of those not consuming energy drinks showed a decrease in all the age groups.

Throughout the study years, the proportion of boys consuming energy drinks remained the same. However, there were changes in the consumer groups; hence, while the proportion of those in the less-than-weekly category decreased, the proportion of those consuming more than once a week increased. In contrast, among girls, there was an increase in both the number of consumers overall and the consumer groups (weekly consumers). The most significant change for both genders occurred in the consumption of energy drinks more than once a week: among girls, the proportion more than quadrupled, and among boys, it almost doubled. The growth was greatest among 15-year-old girls, with the proportion of those consuming energy drinks more than once a week increasing sixfold.

Through simultaneous examination of the associations between age, gender, and family affluence and the consumption of energy drinks more than once a week (Table 3, Model 1B), it was found that consumption was more common among older respondents and boys. By 2022, the difference between the age groups had increased, but the gender difference had narrowed. Family affluence was associated with consumption only in 2022, with children and adolescents from higher affluence families consuming energy drinks more frequently than others. When recommended sleep duration was added to the analysis, it was found that in all the study years, more-than-once-a-week consumption of energy drinks was more common among children and adolescents who did not meet the age-specific night sleep duration recommendations (Table 3, Model 2B). Furthermore, the roles of age, gender, and family affluence as explanatory factors remained.

Over the years of 2014, 2018 and 2022, children and adolescents who did not consume energy drinks tended to be girls, younger in age, and to sleep the night before a school day in line with the recommendation (Table 3, Models 1A and 2A). The gender difference in non-consumption narrowed over the study years. Interestingly, in 2022, non-consumption was associated with lower rather than higher family affluence.

Discussion

The study examined the consumption of energy drinks among 11-, 13-, and 15-year-olds and the factors associated with it in the years 2014, 2018, and 2022. The results showed a significant increase in the consumption of energy drinks, most notably between 2018 and 2022, and particularly in the proportion of those consuming the drinks more than once a week. It was also noteworthy that consumption was not evenly distributed among children and adolescents, and that differences have occurred over time in relation to sociodemographic factors.

Over the study years 2014, 2018 and 2022, the consumption of energy drinks increased with age. Although the growth was strongest in the oldest age group, the consumption of energy drinks also became more common among 11-year-olds in primary education. Furthermore, while in 2022 the majority of 11-year-olds did not consume energy drinks, one in ten used them regularly, i.e. weekly. It was also notable that by 2022 the gender differences had narrowed and the role of family affluence strengthened. Thus, both in Finland and internationally, the consumption of energy drinks had been more common among boys than among girls, both in 2018 (6,18) and prior to that (8,18,19,20,21). The narrowing of the gender gap can be explained by the greater increase in the consumption of energy drinks among girls relative to boys. It seems likely that this result and also the overall increase in the consumption of energy drinks are influenced by changes in marketing, both in quantity and content, given that young people report this aspect as affecting their consumption of energy drinks (22,23,24). Marketing now reaches children and adolescents more effectively through social media and via public figures (25) such as athletes. Previously, marketing was particularly targeted at themes viewed as interesting to boys (6), but it now includes content related to wellbeing, exercise, and studying, in addition to extreme sports and video games (25). This diversification is reflected in the reasons young people report for using energy drinks (23,26,27). The WHO defines marketing as a commercial determinant of health (28) and has urged the restriction of energy drink marketing to children and adolescents (29).

The marketing changes mentioned above do not fully explain why in 2022 the consumption of energy drinks was more common among children and adolescents reporting higher family affluence. This result is surprising, bearing in mind previous research indicating that higher socioeconomic status is associated with more favourable health behaviours, such as healthier nutrition (30). This association was supported by international studies with data collected prior to 2020 (19,20,21,31), indicating lower consumption of energy drinks in families with higher affluence. Nor does the pricing of energy drinks explain the change, since the products available cover a very wide price range.

It is notable that, in line with previous research (32), the present study found that children and adolescents who consumed energy drinks had less than the recommended duration of sleep. In fact, short sleep duration could be one factor underlying consumption, insofar as children and adolescents may consume energy drinks to improve alertness and concentration, and stay awake (26,27). Note further that short night sleep can also be a consequence of energy drink consumption due to the effects of caffeine. One can thus identify a possible bidirectional relationship between energy drink consumption and insufficient sleep, along with similarities in the factors associated with them. Insufficient sleep negatively affects cognitive functions (33) and is also associated with various cardiometabolic risk factors (34) and anxiety (35). The use of caffeine in energy drinks can lead to anxiety (36), leading to a harmful cycle affecting learning and health. Overall, in healthcare situations, it would be reasonable to use adherence to sleep recommendations as an indicator in monitoring the consumption of energy drinks among children and adolescents. Furthermore, the consumption of energy drinks should be addressed when medical contact is made regarding sleep disorders or psychosomatic symptoms in children and adolescents.

This study suggests that current national measures have been insufficient to curb the increase in energy drink consumption among Finnish children and adolescents. In the light of the present study, the current national recommendation on energy drink consumption – which excludes persons aged 15 and older – should be updated in line with the opinion of the European Food Safety Authority regarding the safe daily intake limit of caffeine. This, it should be noted, defines the same intake per kilogram of body weight for all individuals, from 1 to 18 years of age. However, the opinion further states that since this limit is derived from adult studies, research on children and adolescents is needed to determine a safe intake limit. It is also worth noting that several European countries have legally banned the sale of energy drinks to persons under 18 (37,38,39).

The strengths of the study include the size and representativeness of the data collected – here adhering to the international HBSC study protocol (40) – and the eight-year observation period. This is the first study to provide nationally representative data on the consumption of energy drinks among children in primary education in Finland. However, over- or under-reporting is possible with self-reported data (41,42,43). Moreover, the study did not investigate the time of day or the actual quantity of energy drinks consumed. Nor were the cross-sectional data able to indicate causal relationships.

The study provides comparable information on the development of energy drink consumption among Finnish children and adolescents and the differences according to sociodemographic factors. These should continue to be monitored. To understand the factors influencing the increase in energy drink consumption, it is necessary to examine the situations and reasons for consumption, since these underlie the commercial success of the products in question. Further research should also examine in detail the effects of regular energy drink consumption and caffeine use on nervous system development. It is highly likely that early intervention could prevent the accumulation of factors threatening health and wellbeing and reduce the future burden of morbidity.

This was known

• The consumption of energy drinks is associated with adverse health effects and other harmful health behaviours.

• Energy drinks are not recommended for children and adolescents, due to their high caffeine content.

• The consumption of energy drinks is more common among boys than among girls.

The study taught

• Current recommendations have been insufficient to curb the increase in energy drink consumption among children and adolescents.

• Regular consumption is already present among 11-year-olds in primary education.

• The consumption of energy drinks is more common among children and adolescents who do not meet the age-specific night sleep duration recommendation.

Maija Puupponen, Markus Kulmala, Raili Välimaa, Jorma Tynjälä, Leena Paakkari

University of Jyväskylä, Finland

Kirjoittajat

Maija Puupponen TtM, apurahatutkija Jyväskylän yliopisto, Terveyden edistämisen tutkimuskeskus, liikuntatieteellinen tiedekunta

Markus Kulmala FM, projektitutkija Jyväskylän yliopisto, Terveyden edistämisen tutkimuskeskus, liikuntatieteellinen tiedekunta

Raili Välimaa TtT, dosentti, lehtori emerita Jyväskylän yliopisto, Terveyden edistämisen tutkimuskeskus, liikuntatieteellinen tiedekunta

Jorma Tynjälä LitT, terveystiedon lehtori Jyväskylän yliopisto, Terveyden edistämisen tutkimuskeskus, liikuntatieteellinen tiedekunta

Leena Paakkari, TtT, apulaisprofessori Jyväskylän yliopisto, Terveyden edistämisen tutkimuskeskus, liikuntatieteellinen tiedekunta

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