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Caffeinated Energy Drink Use in Adolescents and Young Adults: Associations with Mental Health, Academic Performance, and Problem Behaviour

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Caffeinated Energy Drink Use in Adolescents and Young Adults: Associations with Mental Health, Academic Performance, and Problem Behaviour Caffeinated Energy Drink Use in Adolescents and Young Adults: Associations With Mental Health, Academic Performance, and Problem Behaviour GARETH RICHARDS A thesis submitted for the award of PhD, 2016 Word count: 63702 Acknowledgements I am indebted to my supervisor, Prof Andy Smith, for giving me the chance to pursue this PhD, and also for supporting me throughout. I must also thank The Waterloo Foundation and the School of Psychology, Cardiff University for funding the project. Thanks are due to my parents, Mark and Dr Valerie Richards, my brother, Howard, and grandmother, Nancy, for their tireless support. Thank you for always encouraging me, and for giving me the confidence necessary to pursue this career path. I must thank Rosie Luffingham for putting up with my hectic schedule and frequent rants about statistics, research ethics, the peer-review system, or whatever else happens to be irritating me at any given time. Although you may have now developed a method of filtering a lot of this out, your support has been invaluable. I thank Mat Hunt for inspiring my interest in psychology, and Viv Webb for accepting me into Sixth Form College a month after the course had begun. Thanks go to Prof Ian Thornton, whose admiration of my (albeit unimpressive) juggling skills might be why I got to study for a PhD in the first place. I am indebted to Prof Alan Beaton for supervising my BSc project and recognising my potential, and to Dr Steve Stewart- Williams, for supervising my MSc project and inspiring my interests in evolution. Thanks go to everyone I’ve worked with at the COHP. In particular, Alice Malthouse: inputting 2307 questionnaires might not have been thrilling, but there was never a dull moment. Ethan Henry: collecting data at all times of day and night was tough, but somehow we still managed to make it fun. Special acknowledgments are owed to three people: Dr Roberto Capasso, Kenisha Nelson, and Dr John Galvin. Roberto: thank you for never tiring of me asking stupid questions, and for entertaining me with ridiculous conversations about seagulls. Kenisha: thank you for your constant support, your patience with me when I’m in a bad mood, and for teaching me rude words in Jamaican patois. John: over the past four years we have become research collaborators, lager connoisseurs, and general partners in crime. The fact we have both been referred to as ‘the work wife’, pretty much says it all. I am not sure how my PhD life would have worked out without the three of you: who knows, I might have been more productive, but I certainly wouldn’t have had so much fun! i DECLARATION This work has not been submitted in substance for any other degree or award at this or any other university or place of learning, nor is being submitted concurrently in candidature for any degree or other award. Signed: (candidate) Date: 01/12/2016 STATEMENT 1 This thesis is being submitted in partial fulfillment of the requirements for the degree of PhD. Signed: (candidate) Date: 01/12/2016 STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. The views expressed are my own. Signed: (candidate) Date: 01/12/2016 STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available online in the University’s Open Access repository and for inter-library loan, and for the title and summary to be made available to outside organisations. Signed: (candidate) Date: 01/12/2016 STATEMENT 4: PREVIOUSLY APPROVED BAR ON ACCESS I hereby give consent for my thesis, if accepted, to be available online in the University’s Open Access repository and for inter-library loans after expiry of a bar on access previously approved by the Academic Standards & Quality Committee. Signed: (candidate) Date: 01/12/2016 ii Peer-Reviewed Publications Resulting From This Thesis At the time of final submission (December 1st, 2016), sections of this PhD thesis had been published in the following peer-reviewed journal articles (though please note that Richards & Smith, 2016e, relates to an abstract for the Public Health Science Conference, held at the Radisson Blu Hotel, Cardiff, on November 25th, 2016, which appeared in a Special Issue of The Lancet): Richards, G., & Smith, A. P. (2015a). Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. Journal of Psychopharmacology, 29(12), 1236-1247. doi:10.1177/0269881115612404 Richards, G., & Smith, A. P. (2015b). Risk factors for, and effects of, stress, anxiety, and depression in adolescents. British Journal of Education, Society & Behavioural Science, 10(4), 1-10. doi:10.9734/BJESBS/2015/19501 Richards, G., & Smith, A. P. (2016a). A review of energy drinks and mental health, with a focus on stress, anxiety, and depression. Journal of Caffeine Research, 6(2), 49-63. doi:10.1089/jcr.2015.0033 Richards, G., & Smith, A. P. (2016b). Breakfast and energy drink consumption in secondary school children: Breakfast omission, in isolation or in combination with frequent energy drink use, is associated with stress, anxiety, and depression cross-sectionally, but not at 6-month follow-up. Frontiers in Psychology, 7, 106. doi:10.3389/fpsyg.2016.00106 Richards, G., & Smith, A. P. (2016c). Demographic and lifestyle correlates of school attendance, English and maths attainment, and behavioural sanctions in British secondary school children. British Journal of Education, Society & Behavioural Science, 17(1), 1-15. doi:10.9734/BJESBS/2016/26393 Richards, G., & Smith, A. P. (2016d). Caffeine consumption and general health in secondary school children: A cross-sectional and longitudinal analysis. Frontiers in Nutrition, 3, 52. doi:10.3389/fnut.2016.00052 Richards, G., & Smith, A. P. (2016e). Associations between energy drink consumption and school attendance, academic attainment, and problem behaviour: A cross-sectional and longitudinal analysis. The Lancet, 388(Special Issue), S101. doi:10.1016/S0140- 6736(16)32337-6 iii Richards, G., Malthouse, A., & Smith, A. P. (2015). The diet and behaviour scale (DABS): Testing a new measure of food and drink consumption in a cohort of secondary school children from the South West of England. Journal of Food Research, 4(3), 148-161. doi:10.5539/jfr.v4n3p148 Richards, G., Millward, N., Evans, P., Rogers, J., & Smith, A. P. (2015). Acute effects of energy drinks on behavioural sanctions in secondary school children: A preliminary study. Journal of Food Research, 4(4), 1-9. doi:10.5539/jfr.v4n4p1 iv Table of Contents Acknowledgements…………………………………………………………………….. i Declaration…………………………………………………………………………....... ii Peer-Reviewed Publications Resulting From This Thesis…………………………... iii Table of Contents………………………………………………………………………. v List of Tables………………………………………………………………………….... xv List of Figures………………………………………………………………………...... xix Summary……………………………………………………………………………….. xxi Chapter 1: Introduction……………………………………………………………….. 1 1.1 General Introduction………………………………………………………... 1 1.2 Energy Drinks……………………………………………………………..... 2 1.3 Pool Academy Pilot Study…………………………………………………... 4 1.4 Objectives of the Thesis…………………………………………………….. 5 1.4.1 Objective 1: To Review the Literature Relating to Associations Between Energy Drink Use and Mental Health and Academic Attainment……………………………………………………………… 5 1.4.2 Objective 2: To Develop a Questionnaire for Recording the Frequency and Amount of Consumption of Common Foods and Drinks That May Have Effects on Psychological Outcomes…………………... 5 1.4.3 Objective 3: To Assess Consumption Patterns of Energy Drinks, As Well As Their Correlates…………………………………………… 6 1.4.4 Objective 4: To Investigate Whether Energy Drink Consumption Is Associated With Mental Health, Academic Attainment, and Problem Behaviour………………………………………………………………. 6 1.4.5 Objective 5: To Determine Whether Associations Between Energy Drink Use and Mental Health, Academic Attainment, and Problem Behaviour Rely Primarily on the Action of Caffeine………… 7 1.4.6 Objective 6: To Investigate Whether Energy Drink Consumption Is a Cause or Outcome of Poor Mental Health, Low Academic Attainment, and Problem Behaviour, or Whether the Variables Are Merely Correlated……………………………………………………… 7 1.5 Overview of the Thesis Contents…………………………………………..... 8 1.6 A Note on Ethical Approval………………………………………………… 9 Chapter 2: A Review of Energy Drinks, Mood, Mental Health, and Academic Attainment ……………………………………………………………………………... 10 2.1 Introduction…………………………………………………………………. 10 2.1.1 Caffeine and Mental Health…………………………………….... 10 2.1.2 Acute Effects of Energy Drink Consumption on Mood………….. 11 2.2 Method………………………………………………………………………. 12 2.3 Results & Discussion………………………………………………………... 14 2.3.1 Case Reports of Energy Drink Consumption and Mental Health Problems………………………………………………………………... 14 2.3.2 Empirical Studies of Chronic Energy Drink Consumption and Mental Health Outcomes……………………………………………….. 18 2.3.2.1 Stress…………………………………………………... 22 2.3.2.2 Anxiety………………………………………………… 25 2.3.2.3 Depression……………………………………………... 27 2.3.2.4 Discussion of Energy Drinks and Mental Health……… 28 2.3.3 Energy Drinks and Academic Attainment……………………….. 30 2.3.3.1 Energy Drink Use and GPA………………………….... 31 2.3.3.2 Discussion of Energy Drinks and Academic v Attainment……………………………………………………... 33 2.4 General Discussion…………………………………………………………. 33 2.4.1 Potential Mechanisms of Action…………………………………. 33 2.4.2 Limitations and Directions for Future Research………………..... 34 2.5 Conclusions…………………………………………………………………. 35 Chapter 3: An Overview of the Diet and
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