Understanding the Role of Knowledge About Health Risks in the Consumption of Energy Drinks Among the Students of Maldives National University

UNDERSTANDING THE ROLE OF KNOWLEDGE ABOUT HEALTH RISKS IN THE CONSUMPTION OF ENERGY DRINKS AMONG THE STUDENTS OF MALDIVES NATIONAL UNIVERSITY

MARIYAM FIRASHA

The Maldives National University

November, 2015

UNDERSTANDING THE ROLE OF KNOWLEDGE ABOUT HEALTH RISKS IN THE CONSUMPTION OF ENERGY DRINKS AMONG THE STUDENTS OF MALDIVES NATIONAL UNIVERSITY

MARIYAM FIRASHA

A Project submitted in partial fulfillment of the requirements for the degree of Bachelors in Primary Health Care

Faculty of Health Sciences

The Maldives National University

November, 2015

DECLARATION

Name: Mariyam Firasha

Student Number: 000017535

I hereby declare that this Project is the result of my own work, except for quotations and summaries which have been duly acknowledged.

Signature: Date: 5th November 2015

UNDERSTANDING THE ROLE OF KNOWLEDGE ABOUT HEALTH RISKS IN THE CONSUMPTION OF ENERGY DRINKS AMONG THE STUDENTS OF MALDIVES NATIONAL UNIVERSITY

MARIYAM FIRASHA November 2015

ABSTRACT

Background: The term ‘energy drinks’ are refers to beverages, believed to reduce or prevent fatigue, enhance physical performances, enhance deposition and improve cognitive performances. Caffeine is one of the harmful ingredients in energy drinks which lead to reduce insulin sensitivity, increase arterial blood pressure associated with acute consumption. Students are more prone to this unacceptable habit due to their stress full life style and lack of awareness on stress management that they face during the study period for different issues. Objectives: Understanding the degree of awareness about the risks of consuming energy drinks among the tertiary students, to understand the student’s perspective about the consumption of energy drinks and to compare the consumption between the students of health sector and non-health sector. Research question: Does the knowledge of health risk affect the number of consumptions of Energy Drinks? Methods: A cross-sectional study with a descriptive research design was used for this study using quantitative data. 100 students were selected from 6 faculties as a sample size for the study. Results: As per statistical data it shows, that the students who have knowledge of health risks consume less number of energy drinks compare to those who do not have knowledge. Majority of the study participants are not aware of the health risks associated with energy drink consumption. Implications: this study can be used to conduct health education sessions and awareness programs about energy drink and its health risks to the university students based on the facts in this study.

Key words: Energy Drinks, Caffeine, health background and non-health background students.

iii

ACKNOWLEDGEMENTS

All praise is to Allah for bestowing the blessings for me to complete this project.

I would like to express my sincere appreciation to all those who provided me the possibility to complete this research project.

First, I would like to thank Faculty of Health Sciences, Maldives National University, in giving this opportunity to complete Bachelors of Primary Health care. With that I would like to mention department of public health in FHS for giving their support.

I want to give a very special gratitude to my project supervisor Ms.Aishath Shaheen

Ismail for providing guidance and suggestions throughout this project.

In this opportunity, I would like to express my sincere thanks to our lecturer Mr.

Mohamed Zaid for helping me to understand and use the statistical software, SPSS.

I would never forget to thank all the 100 participants who participated and giving their full support in the survey conducted throughout the research project.

I also am thankful to all my friends and classmates who provide support in understanding every part of the project and help me to overcome the difficulties I have faced.

And my sincere appreciation goes to my family and my in-laws for giving unconditional support all through the project completion.

Very special thanks to my husband for encouraging me to complete this project.

Last, but not least, a heart full of appreciation for my 2 year old daughter, yunaal, for tolerating such a long time, while I was working with this project.

Mariyam Firasha

TABLE OF CONTENTS DECLARATION ...... ii ABSTRACT ...... iii ACKNOWLEDGEMENTS ...... iv LIST OF ABBREVIATIONS ...... ix CHAPTER 1 ...... 1 INTRODUCTION ...... 1 1.1 Background to the Study ...... 1 1.2 Problem Statement/justification ...... 3 1.3 Objectives of the Study ...... 5 1.4 Research Question and Hypothesis ...... 5 1.5 Significance of the study ...... 6 1.6 Scope of the Study ...... 6 1.7 Definitions of Terms ...... 7 CHAPTER 2 ...... 10 REVIEW OF LITERATURE ...... 10 2.1 Introduction ...... 10 2.2 Theoretical Framework ...... 11 2.3 Conceptual framework ...... 13 2.4 Previous studies ...... 13 2.5 Methodological issues ...... 21 2.6 Summary ...... 22 CHAPTER 3 ...... 23 METHODOLOGY ...... 23 3.1 Introduction ...... 23 3.2 Research Design ...... 23 3.3 Population and sample ...... 23 3.4 Instrumentation ...... 24 3.5 Data collection Procedure and ethical considerations ...... 25 3.6 Data Analysis ...... 26

3.7 Framework for data analysis ...... 26 CHAPTER 4 ...... 29 DATA ANALYSIS AND RESULTS ...... 29 4.1 Introduction ...... 29 4.2 Participation Rate ...... 29 4.3 Survey Results for the research objectives, research question and research Hypothesis . 30 CHAPTER 5 ...... 51 DISCUSSION AND CONCLUSION ...... 51 5.1 Introduction ...... 51 5.2 Summary of Main Finding ...... 51 5.3 Discussion ...... 52 5.4 Implication ...... 60 5.5 Limitations of the Study ...... 60 5.6 Directions for Future Research ...... 61 CONCLUSION ...... 61 RECOMMENDATION ...... 62 REFERENCES ...... 63 APPENDICES ...... 67 APPENDIX A ...... 67 Final Questionnaire ...... 67 APPENDIX B ...... 75 Consent Form ...... 75

LIST OF TABLES Table 3.1: Summary of Data Analytical Framework ……………………………..…….27 Table 4.1: Frequency and Percentage of the Demographic characteristics of the participants ………………………………………………………...…31 Table 4.2: Frequency and Percentage of participants Perception about the consumption of energy drinks …………………………………………………….…...33 Table 4.3: Frequency and Percentage of participant’s awareness about energy drinks and health risks of its consumption …………………………………...…35

Table 4.4: Frequency and percentage of participant condition towards the consumption of energy drinks ………………………………………………...…….…36

Table 4.5: Frequency and Percentage of the extent of consumption among the consumers……………..……………………………………..……….37

Table 4.6: Frequency of percentage of how they consume energy drink ……………38

Table 4.7: Frequency and percentage of consumption of the energy drink between two genders ……………………………………………………………….39 Table 4 8: Frequency and percentage comparison of the energy drink consumption among the field of studies ………………………………………………… 39 Table 4. 9: Association between the consumption of energy drink and lack of the knowledge about health risks ……………………………………... 40 Table 4.10: frequency and percentage of most frequently preferred Brand of Energy Drinks ……………………………………………………………… 41

Table 4.11: frequency and percentage of most frequently preferred place to consume of Energy Drinks ………………………………………………………42 Table 4.12: frequency and percentage of most frequently preferred situations to consume of Energy Drinks ……………………………………………………43

vii

Table 4.13: frequency and percentage of the Reasons behind the consumption of energy drinks among the students …………………………………………..45 Table 4.14: frequency and percentage of the Reasons behind not consuming energy drinks among the students …………………………………………..46 Table 4.15: frequency and percentage of the encouraging factors to consume energy drink among the consumers ……………………………………………… 48 Table 4.16: Association between the knowledge of health risks and the number of ED consumption …………………………………………………………49 Table 4.17: Association between the consumption of energy drink and field of studies……………………………………………………………….. 50

LIST OF FIGURES

Figure 2.1: Bandura’s 1989 theory of The Reciprocal Triadic Determinism……….. 12

Figure 2.2: Conceptual framework of the study…………………………………...…13

viii

LIST OF ABBREVIATIONS BP – Blood Pressure

CCHS – Canadian Community Health Survey

FA – Faculty of Arts

FE – Faculty of Education

FHS – Faculty of Health Science

FIS – Faculty of Islamic Studies

FSL – Faculty of Sharia and Law

GSHS – Global School Health Survey

MBS – MNU business School

MNU- Maldives National University

OR – Odds Ratio

RDA – Recommended Dietary Allowances

RTD – Reciprocal Triadic Determinism

SGT – Social Cognitive Theory

SPSS – Statistical Package of Social Sciences

CHAPTER 1

INTRODUCTION

1.1 Background to the Study

Energy drinks (ED) are commonly available drinks in the market which is very popular among the teenagers, youth and matured people in the entire world including

Maldives. Energy Drinks are referred to the drinks that have caffeine, taurine, B vitamins as well as proprietary substances with other ingredients too (Buxton & Hagan, 2012).

“The term “energy drinks” refers to soft drinks believed to reduce or prevent fatigue, enhance physical performance, enhance deposition and improve cognitive performance”

(Buxton & Hagan, 2012, p.1).

Red bull was the first energy drink introduce in the energy drink market in 1987 in

Austria (Reissig, C.J et al., 2008) and in the year 1997, the brand name red bull was first introduced to the energy drink market in United States. Since then, the popularity and the consumption of energy drink were still in the top. In today’s date there are more than 500 brands of energy drinks available in the market (Malinauskas et al., 2007).

Though all the brands are not available in the Maldivian market, there are many different brands of energy drinks available in Maldives as well. According to the shops were energy drink sells the number one brand of energy drink till today is the debut energy drink brand red bull in Maldives. There are different versions of red bull energy drinks available in current market. Moreover, the other commonly consumed brands in

Maldives according to the shops which provides energy drinks includes XL energy drink

(different flavors), power gold, black, OK, shark, 9mm energy drink, Royce black, effect energy drink, burn, superman, tiger, monster, ester, battery, boost energy and thunder.

Energy drinks are beverages that consists of caffeine as its main active ingredient, with that it has high level of sugar, glucose and some other variety of substances like taurine, riboflavin, pyridoxine, vitamin B complex, ginseng and guarana, ( Alsunni &

Badar, 2011). The amount of ingredients that uses in different brands of energy drinks is also varying. Most of the energy drinks that consumes normally contain at least 80 to

300mg of caffeine and 35g of sugar per 8 ounce serving ( Alsunni & Badar, 2011).

Likewise, 250ml of a single can of the most popular energy drink red bull, contains 80mg of caffeine, 1000mg of taurine, 600mg of glucuronolactone and several vitamins B (

Rotstein J et al., 2013). The effects that causes after the consumption of ingredients that were used in energy drinks is still debated, either it is physical or cognitive performances

( Alsunni & Badar, 2011).

As mentioned before, energy drinks are popular because of its enhancing performance and giving strength to the body, these drinks are very common among the

athletes or sports personalities. Most of the sports people do think that there physical activity and performance will be improved if they consumes energy drinks as the name itself let people think it provides energy ( Badaam & Masroor, 2013). Not only athletes or sports man consumes energy drink but now a day’s all most all the age groups are exposed to these caffeinated beverages.

The harmful risks that can cause due to the single or continuous consumption of energy drinks are known to very few people. The consequences of the consumptions of energy drinks is also published very few. Caffeine is one of the harmful substance or ingredients in the energy drinks which leads to reduce insulin sensitivity, increase arterial blood pressure associated with acute consumption (Bawazeer & AlSobahi, 2013).

However, neural, cardiovascular, gastrointestinal and renal dysfunction has been associated with the chronic consumption of caffeine. On the on the other hand it can cause several neuropsychiatric effects that includes anxiety disorder, insomnia, loss of appetite, schizophrenia and many more ( Winston, Hardwick, & Jaberi, 2005). Basically the caffeine can describe as a destroyer of the body systems and functions.

1.2 Problem Statement/justification People are consuming energy drinks as a fashion or because of the misconceptions that they provide energy or strength and reduce fatigue and all. This could not vary the age group of people that consumes it. According to the shops that sells energy drinks, it is identified that the energy drinks are one of the high demanded beverage product among the Maldivians. Besides being so common of energy drink consumption there are no actions taken towards understanding the main reason behind

3 consuming it among the youths of Maldives. It is very important to understand the knowledge of health risks among the consumers and other people in the community.

Therefore it could help to conduct awareness programs between the energy drink consumers that will lead to save our youths from getting the adverse effects of caffeine to both psychological and physiological health. The main problem in our society is not only drinking or consuming energy drinks but as a trend or whatever it is identified that the growing youth is consuming energy drinks with other mixtures like alcohol and other stimulants. Unknowingly growing this habit could lead a life threatening incidences among the consumers.

Students are more prone to this unacceptable habit due to their stress full life style and lack awareness on stress management that they face during the study period for different issues. They are the one who face stressful life due to many reasons like study loads, day to day competition pressure, have to live away from family and home, peer pressure, environmental issues, and exposure to violence and so on (Faris, 2014). Most of the students are misunderstood that the way they can release those stress is to have some kind of energy boost drink that will help them to relax.

Through personal observations I have done it is seen that Maldives national university (MNU) is one single institute where number of youths or matured people consumes energy drink for those kind of many reasons mentioned before. So this study aims to understand the knowledge of health risks that they have while they are consuming energy drinks. Hopefully it will lead to minimize the health issues that causes due to the consumption through awareness based on this study.

1.3 Objectives of the Study 1. To Analyze the Demographic characteristics of the participants in the study.

2. To understand the students perspective about the consumption of energy drinks.

3. To understand the degree of awareness about the risks of consuming energy drinks

among the tertiary students.

4. To identify the extent of consumption of energy drinks among the students.

5. To identify whether the knowledge of health risk affects the number of consumptions

of Energy Drinks.

6. To identify the commonly used energy drinks among the students of MNU.

7. To compare the consumption of energy drinks between two gender of MNU students.

8. To figure out the main reason behind consuming Energy Drinks among the students.

9. To figure out the main reasons behind not consuming energy drinks among the

students.

10. To identify the factors related to energy drink consumptions.

1.4 Research Question and Hypothesis Question

Does the knowledge of health risk affect the number of consumptions of Energy Drinks?

Hypothesis

Ho: Students from health background shows no difference in the consumption of energy drinks compared to non-health background students.

Ha: Students from health background consume fewer amounts of energy drinks compared to non-health background students.

1.5 Significance of the study Result of this study will be an evidence to show that the university student’s behavior towards the consumption of energy drinks. The findings that originate from this study could help university to held awareness programs among the faculties about the health risks of consuming energy drinks. This will help to control the number of people consuming energy drinks from our society in order to bring up a healthy youths and matured people to the next generations. Also this will help government to think and take some actions throughout the country to avoid consumption of energy drinks.

1.6 Scope of the Study The scope of the study is targeted to the students who are currently studying in the different faculties of Maldives national university. Though there are some campuses of

MNU in island, due to the limited time frame to conduct the research and difficulty of transportation the target population will be selected only from six faculties located in male’. However the results of the study can be applied to the youths age 16-35 of whole country. According to last year statistics of MNU it shows the total number of students as

8927 from all over the country (Maldives National University, 2014).

Energy drink is not only common among the young youths but the matured people around age 30 to 35. So the target population of this study will be based on the students age between 16- 35.Since there is no gender difference to be seen in the consumption of energy drinks, both male and female students will be participated in the study.

1.7 Definitions of Terms Antagonist Receptor - is a type of receptor ligand or drug that blocks or reduces agonist-

mediated responses rather than provoking a biological response

itself upon binding to a receptor (Mosby’s medical Dictionary,

n.d).

Caffeine - an alkaloid compound (a drug) which is found especially in tea and coffee

plants and is a stimulant of the central nervous system (Mosby’s medical

Dictionary, n.d).

Cobalamin – Vitamin B12

Cognitive Performances - is an ability to utilize the knowledge acquired by mental

processes in brains. A well-functioning brain controls a range

of voluntary and involuntary actions (Mosby’s medical

Dictionary, n.d).

Consumers – A person that eats or uses something. Eg: energy drink users (oxford

dictionary, 2015)

Demographic Characteristics - characteristics of a population expressed statistically,

such as age, sex, education level (oxford dictionary,

2015).

Energy Drinks – A beverage that contains high amount of caffeine, sugar or another

stimulants oxforddictionary,2015).

Health Background Students – Students who study the modules related to health and

have general health knowledge.

Health Risks - a disease sign associated with a higher than average morbidity or

mortality rate. Disease signs include demographic variables, certain

individual behaviors, familial and individual histories, and certain

physiologic changes (Mosby’s medical Dictionary, n.d).

Ingredients - any of the foods or substances that are combined to make a particular dish

or a component part or element of something (oxford dictionary, 2015).

Insomnia - Insomnia is the inability to obtain an adequate amount or quality of sleep.

The difficulty can be in falling asleep, remaining asleep, or both (Mosby’s

medical Dictionary, n.d).

Knowledge - Facts, information, and skills acquired through experience or education; the

theoretical or practical understanding of a subject (oxford dictionary,

2015).

Neuropsychiatric Effects – A combination of neurological and Psychiatric effects

(Mosby’s medical Dictionary, n.d).

Niacin – Vitamin B3

Non-Health Background Students - Students who does not study the modules related to

health and/or students who do not have general

health knowledge.

Pantothenic Acid – Vitamin B5

Peer Pressure – influence of people who lived together or the group that a person

belongs (oxford dictionary, 2015).

Premature Infants - is a baby born before 37 completed weeks of gestation (more than 3

weeks before the due date).

Pyridoxine – Vitamin B6

Renal Dysfunction - is a medical condition in which the kidneys fail to adequately filter

waste products from the blood (Mosby’s medical Dictionary, n.d).

Riboflavin – Vitamin B2

Schizophrenia - group of severe mental disorders characterized by reality distortions

resulting in unusual thought patterns and behaviors (Mosby’s medical

Dictionary, n.d).

Seizure Disorder - A chronic disorder of cerebral function characterized by periodic

convulsive seizures. Also called epilepsy (Mosby’s medical

Dictionary, n.d).

Taurine - an amino acid containing sulphur and important in the metabolism of fats

(Mosby’s medical Dictionary, n.d).

Thiamine – Vitamin

CHAPTER 2

REVIEW OF LITERATURE

2.1 Introduction

This chapter includes two main parts. That is theoretical framework and previous studies. Theoretical frame work is an important part to make the readers more understand about the fact that why I have choose to conduct a research study about this matter, therefor I have choose social cognitive theory (SGT) for my study as I felt this was the most reliable theory to follow in this study. Second part of this literature review is previous studies. In this part I have written the related facts that found from the previous studies that have done by others. Areas that will focus in this part includes the prevalence of energy drink in worldwide and in Maldives, reasons for energy drink consumption,

Main Reasons for energy drink consumptions, students risk taking behavior, main ingredients of energy drinks, psychological effects of caffeine, physiological effects of caffeine, risks of mixing energy drinks with other substances, peer pressure towards the consumption of energy drinks and the gaps in the evidence bases.

2.2 Theoretical Framework

It is essential to understand the main reasons and the factors behind those reasons to understand why students are so attached to energy drinks. So to understand the clear picture, it is necessary to follow a working theoretical framework. In case, in this study it is using the social cognitive theory (SCT). Specifically The Reciprocal Triadic

Determinism (RTD) as a base to understand the human behavior. RTD is the central concept of this theory.

The Social Cognitive theory was first established by Miller and Dollar in 1941 as the Theory of Social Learning. Later in 1963 Albert Bandura reestablished as social cognitive theory (Pajares, 2002). This theory clearly explains the people’s behavior towards an activity in a certain way. The reasons of their ongoing behavior can clearly identify through this theory (Faris, 2014). For this study the most relevant aspect of this theory RTD which has three main areas they are personal factors, like knowledge and attitudes, environmental influences like social power and roll modeling and behavior as the effects for individual person ( Ward, 2009). Behavior includes buying products with their own willing as they are self-dependent and showing off their gut to others. The personal factor in this theory includes knowledge and attitudes which is two main aspects in the current study. These three aspects shows that each of this aspect influence to the other and the person in some way. Diagram is shown in figure1.

Peer pressure or peer influence is seem to be a major part of environmental factor to change behavior. However, it is not been identified as a main factor for energy drink or

11 caffeine consumption through a research but in general peer influence is concern to lead unhealthy behaviors (Ward, 2009).

Figure 2.1: Bandura’s 1989 theory of The Reciprocal Triadic Determinism

2.3 Conceptual framework

INDEPENDENT VARIABLE DEPENDENT

VARIABLE

Demographic Factors  Gender  Field of studies

Knowledge about

 the risk factors Energy Drink Consumers  the ingredients

Attitude towards

 Knowledge of risks factors  Information about warning labels  Other factors lead to consumption

Figure 2.2: Conceptual framework of the study

2.4 Previous studies

Prevalence

Some studies have been undertaken regarding energy drinks in the past days to understand energy drink consumption habits among the college students. A previous study shown that 48.3% of college students described that they have tries an energy drink without alcohol at some point of their life (Attila & Cakir 2011). Another study found that 51% of college students stated that they consume more than one energy drink each month in an average basis for the ongoing semester ( Buchanan, 2012). According to

Buchanan, another study reports that 26% of university students described that they

consume energy drinks with alcohol for the past 30 days. Although the energy drink

consumers are very high tin Maldives, there is no published data that we can refer and

say that the actual prevalence of energy drinks consumers even among the university

students of Maldives. But in Global School Health Survey (GSHS) country report

published in 2009 found that school students drink carbonated soft drinks such as coke

and Fanta which is not under the category of energy drink. 33% of school children drink

soft drinks. This does not have a much difference between both genders (Shifa, 2009).

Reasons for energy drink consumptions

Due to the marketing strategies that energy drink companies promote, make successfully wash the brain of young consumers to consume energy drinks. They advertise energy drinks saying that it provides energy to fight tiredness and fatigue and will improve physical performances which attracts young adults and matured people to energy drinks in order to be successful what they are doing either study or sports. The study done in the

University of East Carolina shows that 67% of students out of 500 students says that they consume energy drink to boost energy. Some of the students have the misconception that they can fill up the stomach only with energy drink and they do not need any other food to intake in order to get energy and to fill up their stomach (Faris, 2014).

Other reasons include that they consume it after sports activity to restore their energy. Recently a research done in to the football players in India shows that 30% of the participants consume energy drinks for several reasons for the last seven days. 37.77 % participants say that they are able to gain more energy after competition or exercise.

33.33% consume energy drink to maintain hydration of their body. 22.22% participants

14 say that energy drinks increases their abilities while 6.66% participants says they consume energy drinks because it reduce tiredness during and after game ( Badaam & Masroor,

2013).

Mixing energy drink with alcohol and other substances like coffee or other soft drinks is also one reason that more adults attract to use energy drinks. Consumers feel that they get more fun when they drink a mixture of energy drink with some other thing (Faris,

2014). A past study revealed that 54% of the participants consume energy drink with alcohol when they are partying (Ishak et al., 2012). Some mix energy drink with alcohol to make alcohol taste better and some of the consumers feel less intoxication symptoms of alcohol when they consume it with mixing energy drinks (Faris, 2014).

Students risk taking behavior

Students risk taking behavior has become a public health concern where many

health agencies, schools and parents with researchers started to study the ways to

intervene these behaviors (Faris, 2014). Previous studies have shown that 30% of college

students have no idea or knowledge about what they are consuming and what is healthy

and what is unhealthy to be ingested to their body as a diet or drink (CDCP., 1997). Most

people consume energy drinks occasionally though a study have shown that 6% of

college students do consumes energy drinks daily in order to avoid sleepiness during

study hours, to enhance energy and to put concentration on studies ( Verster, Aufricht, &

Alford, 2012).

Main ingredients

All most all the energy drinks contain caffeine as its main ingredient to boost energy. Apart from that, other main ingredients include sugar, taurine, vitamin B, and other herbal supplements such as ginseng and guarana among others (Ishak et al., 2012).

Caffeine is an antagonist receptor which stimulates central nervous system. It also

use as therapeutic agent to treat some sort of respiratory diseases in premature infants (

Seifert et al., 2011). Caffeine is the most frequently and widely used drug in the world

among adolescents, adults and matured people due to its stimulating effects. Most of the

energy drinks contain around 70mg to 200mg of caffeine per can. Caffeine is a naturally

available substance from coffee tree and tea and it also manufactures in the scientific

laboratories (Anonymous, 2015).

There are sugar free energy drinks but like other beverages it has sugar in some

other forms like glucose, sucrose or fructose corn syrup. The amount of sugar is different

for different type of energy drinks but most of the drinks contain around a range of 21to

34g/237ml can (Rotstein j et al., 2013).

Taurine is an important amino acid in the central nervous system which acts in neural growth and protection. Also helps cell metabolism and osmoregulation in the body.

Taurine is generally considered as safe substance by United States Food and drug

Authority. It helps to treat alcohol withdrawal and some other cardiac diseases like hypertension and congestive heart diseases. Moreover it helps to treat seizure disorder, cystic fibrosis and diabetes mellitus ( Seifert et al., 2011). As taurine is safe and has so many positive effects to the body such as enhancing physical activities, increasing

16 hormones in the body and showing some biological effects, it is being combined with energy drinks (Faris, 2014).

There is some sort of herbal substances in the energy drinks and ginseng is one of

them. It is an East Asian herbal substance which considers developing memory, raising

stamina and stimulating immune system in the body functions. Though it is a worldwide

well distinguished herb, the Asian people are more attached to this substance and dealing

with it for more than two thousand years. It is mostly found in the countries like china

and Korea (Faris, 2014). Ginseng is known for its positive effect to the physical

performance. On the other hand it so many side effects or negative effects to the body

such as diarrhea, vaginal bleeding, hypertension, insomnia and Stevens Johnson

syndrome. It is reported that some of these side effects may be associated with the

contaminations that use during its processing ( Seifert et al., 2011).

Guarana is the second most frequently used herbal substance in the energy drinks.

Unlike ginseng, the guarana is a South American herbal product which contains high

level of caffeine in it naturally. Though it contains some amount of caffeine in it, there is

no study that has proven that there is side effects from guarana yet even used up in large

amounts within a short period of time or small amount in long periods (Faris, 2014). It is

also considered as a safe substance by the United States Food and drug authority ( Seifert

et al., 2011). Guarana is more commonly found in Brazil especially in amazon (Faris,

2014). On the other hand it has been using for a long period of time not only in energy

drinks but in other products for its positive effects like helping to develop cognitive

capabilities such as concentration, changing the mood, fighting with mental fatigue and

improving the physical performances (Faris, 2014).

All most all the types of energy drinks contain the combination of vitamin B or

vitamin B complex which includes thiamine (vitamin B1), riboflavin (vitamin B2), niacin

(vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6) and Cobalamin

(vitamin B12) (Rotstein j et al., 2013).

According to a study done by Rotstein and his colleagues, some of the typical energy drink may not have thiamine in it but most of the energy drinks contains 5mg of thiamine per serving.

Usually thiamine is found in foods like meat, legumes and whole or enriched grain products. Typical energy drink product contains 1.65mg of riboflavin per 250ml of energy drinks and some other energy drinks contains 5mg of riboflavin. According to Canadian

Community Health Survey (CCHS), typical energy drinks contains 18mg of niacin per

250ml and other energy drinks contain 40mg of niacin per serving.

This study also had shown that adult intake 76.7mg of niacin per day. Vitamin B5 or Pantothenic is commonly found in meats especially liver, egg yolks and whole grains.

Recommended Dietary Allowance (RDA) for Adult male and female is 5mg/day. 250ml of energy drinks contain 6mg of vitamin B5. Typical 250ml energy drink contains 2mg of vitamin B6 and other energy drinks contain 10mg of vitamin B6 per serving. Typical

250ml of energy drink contains 1mcg of vitamin B12 and other energy drinks contain

20mcg per serving.

According to CCHS, 95% of dietary products indicate that adult intake 6mcg of vitamin B12 per day.

Psychological effects of caffeine

The psychological effects of caffeine are biphasic. It means that it has both positive and negative side effects to the body psychologically. Less amount of caffeine consumption causes positive impact to the body like it reduce fatigue and increase alertness which helps to improve performances ( Winston, Hardwick, & Jaberi, 2005).

Though it has some benefits for psychological health, caffeine cause number of specific psychiatric disorders such as anxiety disorder, sleep disorder, eating disorders and there is a possible link with schizophrenia too ( Winston, Hardwick, & Jaberi, 2005).

Physiological effects of caffeine

Caffeine not only causes the psychological effects to the body but physiological effects too. That includes coronary and cerebral vasoconstriction, relaxes smooth muscle, reduces insulin sensitivity and modulates gene expression in premature neonates. High amount of caffeine also can increase urine flow and sweat excretion and change blood electrolyte levels. Caffeine’s cardiovascular effects include decreasing heart rate from stimulation of medullary vagal nuclei and increase blood pressure. One study found that

70 minutes after consumption, heart rate returned to normal and blood pressure increased.

Still, these studies typically involve habitual caffeine consumers, and results reflect withdrawal-symptom reversal. Caffeine and taurine combined may significantly decrease heart rate initially. Another study of 15 healthy young adults in a 7-day trial in which they consumed 500 ml of an energy drink each day with 160 mg of caffeine and 2000 mg of taurine, reported an average increase in systolic blood pressure of 9 to 10 mm Hg and an average increased heart rate of 5 to 7 beats per minute 4 hours after consumption. On the other hand, Caffeine- and taurine-containing beverages increased left atrial

contractility in 13 athletes, thereby increasing left ventricular end-diastolic volume and

stroke volume. ( Seifert et al., 2011).

Risks of mixing energy drinks with other substances

Most of the studies related to energy drinks show the risk of energy drink mixing with alcohol. One study even showed that energy drinks mixed with alcohol led to a neuropsychological deficit called visuospatial judgements and semantic fluency (

Buchanan, 2012). Moreover, both alcohol and caffeine are diuretics which results quick dehydration of body that will make a person more prone to alcohol toxicity (Ferreira et al.,

2006). Participants also noted that they had lower insights of intoxication after consuming energy drink with alcohol. But they still show reduced motor skills and visual reaction that could lead to ruinous consequences (Ferreira et al., 2006).

When we look into Maldivian context there is no research studies that have shown

that how much is the prevalence that use energy drink with alcohol may be because

alcohol is a prohibited substance to use in the country. Still some people do mix with

other substance like coffee and soft drinks.

Peer pressure

Peer pressure or peer influence is always been a leading cause to most of the

negative behaviors not only consuming energy drinks. However, most of the studies that

have done about energy drink and energy drink related topics shown there are no much

relation between peer pressure or peer influence and the consumptions of energy drinks.

A previous study conducted to understand the factors influence to consume energy drinks

among college students shown that only 2.2% participants strongly agree that they

20 consume energy drink when their peer asks them to drink and 6.5% participant agrees that they consume energy drink when their friends ask them to drink (Faris, 2014).

Another study shows that 39.8% of participant consume energy drink due to peer influence (Ward, , 2009).

One more study conducted to the female students of Saudi Arabia to understand the consumption of energy drinks results that 48.6% of the participants said that they drink energy drink frequently because of peer pressure (Aluqmany et al., 2013).

Gaps in the evidence based

There are so many research studies done in the past related to energy drinks and but in the aspect of understanding the role of knowledge about health risks is a big gap identified in the literature review. There were no researches specifically focused to understand the role of knowledge about the health risks that occur due to the consumptions of energy drinks. A major gap is that there is lack of research studies done in relation to this topic and this aspect to Maldivian context. .

2.5 Methodological issues

The main issues identified as methodological issues from the previous studies were sample size, respondent rate and confidentiality of the participants. Sample size should be more in order to produce good results. This is very important to have in a good research study. On the other hand, respondent rate should be high to make an effective research especially in knowledge based descriptive research.

2.6 Summary

Above chapter was based on the literature review related to the topic of the current study and the aspects related to this study. Theoretical framework was given relevant to the topic. Social cognitive theory was explained as a theoretical framework for this study and

Reciprocal Triadic Determinism which was the base of the concept was used for this study. Moreover, in the literature review there was a glance to previous studies related to the prevalence of energy drink in worldwide and in Maldives, reasons for energy drink consumption, Main Reasons for energy drink consumptions, students risk taking behavior, main ingredients of energy drinks, psychological effects of caffeine, physiological effects of caffeine, risks of mixing energy drinks with other substances, peer pressure towards the consumption of energy drinks and the gaps in the evidence bases which is about the important area where facts could not found through literature review

CHAPTER 3

METHODOLOGY

3.1 Introduction This chapter will disclose the research design, population and sampling, instrumentation used for the data collection, data collection procedures, ethical considerations during the data collection, validity and reliability of the study, and data analysis framework that will describe how the data will be analyzed in this study.

3.2 Research Design A cross-sectional study with a descriptive research design was used for this study using quantitative data. Cross sectional studies allow researchers to compare several variables at a same time ( Buchanan, 2012). This is the main reason of choosing a cross sectional study for the current study as this study involves different variables and objectives to achieve.

3.3 Population and sample Target population for this study is the students from Maldives National University

(MNU). The study was conducts in 6 faculties of MNU including Faculty of Health

Sciences(FHS), Faculty of Education (FE), Faculty of Arts (FA), Faculty of Islamic

Studies(FIS), Faculty of Shari ’a And Law (FSL) and MNU Business School (MBS).

These six faculties were divided into two groups as health background group and non-

23 health background group. FHS was the health background group and all others considered as non-health background. Reason for dividing two groups is because the hypothesis for the study needs to prove the nature of the consumption between health background students and non-health background students.

Total population for the study was 4704 from the faculties mentioned before.

Sample size was calculates using Raosoft (an online sample size calculator), by taking

55% of response distribution with 5% of margin error and a 95% confidence level. The total sample size recommended from Rao soft was 254 students. But due to time constraint I was able to take around 40% of the recommended sample which is 100 students as a sample size for the study. Students were selected randomly from each faculty. As mentioned before the population was divided into two groups, so 50 students were from health background and other 50 were from non-health background as 10 students from a non-health background faculty.

3.4 Instrumentation Self-administered questionnaire was generated for as the instrument for this study.

This questionnaire was based on the available literature, research question, research objectives and the hypothesis. The questionnaire is attached in the Appendix A. The questionnaire was targeted to the students of Maldives national university aged 16-35. So, before approaching the questionnaire to the participant, it was pilot tested by the 10 other participants from outside the university of same age group. And the relevant changes are being identified and changed in the final questionnaire based on the pilot questionnaire.

The final questionnaire contains mainly three parts which is Section A with the demographic questions, Section B with the questions related about their view on the

24 general matter and Section C with questions related to the personal attitude toward the general matter. All the questions are very much directed so that participants will not have to face difficulty answering any of the questions. Estimated time to complete the questionnaire is fifteen minutes.

3.5 Data collection Procedure and ethical considerations

For data collection I have visited to the selected faculties by myself with the letter provided from the faculty and the consent form. From each faculty, the students were selected randomly from the most convenient class. At first student were given the consent form which include the information about the study purposes and the objectives of the study and they were asked to read carefully and sign the consent form if they are willing to participate in the study in order to get their consent to minimize any kind of ethical issue. Furthermore, consent form assures that there were no physical threat to the participants by taking part in the study and the information they have given remain confident and will only be used for academic purposes. A copy of a consent form is attached in Appendix B. After collecting all the consent forms, questionnaires were distributed to the student to fill their own as the questionnaire was generated as self- administered.

3.6 Data Analysis After finishing the data collection, all the data were entered in to the statistical data analysis software, SPSS (Statistical package for the Social Sciences) version 20.

And it was analyzed using this software. Approximate 14 days spent for data entry and data analysis. Analyzed data will be represented using tables and figures.

3.7 Framework for data analysis The analytical framework of this study is shown in a table below. It includes the techniques of data analysis, types of data, sources of data and the questions made to get the results for the research question and research objectives of the current study. And it also describes how each question is going to analyze.

Table 3.1: Summary of Data Analytical Framework

Instrument Technique of Research Question Research Hypothesis Sources of Data Types of Data Question No. Analysis To Analyze the Demographic MS Excel & characteristics of the participants in SPSS Section A Self-administered Primary the study. questionnaire

To compare the consumption of Section A1 & MS Excel & energy drinks between two gender Self-administered Primary SPSS of MNU students. Q10 questionnaire

To understand the students MS Excel & perspective about the consumption SPSS Q2,Q3 &Q5 Self-administered Primary of energy drinks. questionnaire

To understand the degree of MS Excel & awareness about the risks of SPSS consuming energy drinks among the Q1,Q4 &Q18 Self-administered Primary tertiary students. questionnaire

To identify the extent of MS Excel & consumption of energy drinks SPSS Q14 Self-administered Primary among the students. questionnaire

To identify whether the knowledge Does the knowledge MS Excel & of health risk affects the number of of health risk affect SPSS Q4,Q10 consumptions of Energy Drinks. the number of Self-administered Primary consumptions of Q18&Q20 questionnaire Energy Drinks?

MS Excel & SPSS Q13 Self-administered Primary questionnaire

To figure out the main reason MS Excel & behind consuming Energy Drinks Q12 Self-administered Primary SPSS among the students questionnaire

To figure out the main reasons MS Excel & behind not consuming energy SPSS Q11 Self-administered Primary drinks among the students. questionnaire

To identify the factors related to MS Excel & energy drink consumptions. SPSS Q6,Q7,Q8 &Q9 Self-administered Primary questionnaire

Students from health MS Excel & background consume fewer SPSS SectionA3 & amounts of energy drinks Self-administered Primary compared to non-health Q10 questionnaire background students.

CHAPTER 4

DATA ANALYSIS AND RESULTS

4.1 Introduction The purpose of this study was to understand the role of knowledge about health risks in the consumption of energy drinks among the university students. And to identify the knowledge about the ingredients in energy drink and the health risks involved in the energy drinks. Moreover the other aims of this study include studying the reasons of energy drink consumption, how frequent is the consumption and the factors that encourage consuming energy drink. Finally the difference between health background and non-health background students in the consumption of energy drinks. This Chapter includes the results of the study regarding the demographic characteristics, general view about the participants about the consumption of energy drink and the personal attitudes towards the energy drink consumption.

4.2 Participation Rate This study covers 100% Participation rate as all of the participants filled out the survey questionnaire proposed to them and were answered with their maximum knowledge. The study was focused to 100 students from 6 different faculty of MNU.

4.3 Survey Results for the research objectives, research question and research Hypothesis 4.3.1 Demographic characteristics of the participants in the study

Table 4.1 shows the frequency and the percentage of the demographic characteristics of the study.

Mean age of the participant was 22.70, minimum age was 16 and maximum age was 34. 19% of the participants were male and 81 of them were female

Education level of the participants was categorized in three levels as advanced certificate, diploma and bachelor’s degree. There were total 10 students from advanced certified level, 8 students from diploma level and 82 students from bachelor’s degree level.

As the background or the field of study is important for current study there participants were equally selected from both the groups which is 50% from health background and 50% from non-health background.

Table 4.1: Frequency and Percentage of the Demographic characteristics of the participants

Characteristics Frequency Percent n = 100 Age

Young Adults (16-35 years) 100 100%

Mean = 22.70 Min = 16 Max = 34

Gender

Male 19 19%

Female 81 81%

Current Level of Studies

Advanced Certificate 10 10%

Diploma 8 8%

Bachelor’s Degree 82 82%

Field of studies

Health Background 50 50%

Non-health Background 50 50%

4.3.2 The participants perspective about the consumption of energy drinks

Table 4.2 shows the frequency and percentage of participant’s perception about consumption of energy drinks.

7% of the participant said that was OK to consume energy drink for the children under18 and 37% of participants said that it was OK to consume energy drink when it is above 18 years of age and 56% of participants believed that it never OK to drink energy drinks.

33% of the participants said students consume energy drink due to peer pressure, 48% of the participants said it was just to fill up their stomach, 56% said student consume ED to gain energy/strength, 19% said that students consume ED to concentrate on their studies, 45% said that students consume energy drink to minimize stress, 15% said that students consume ED to show off and 10% of the participants believed that students consume energy drink because of its addictive taste.

When it was asked that if energy drink consumer were well aware about the health risks associated with energy drink consumption, 15% of the participants were pretty sure that they will stop where 22% said they will not stop and other 63% was not sure about it by choosing may be and I don’t know as their choice.

Table 4.2: Frequency and Percentage of participants Perception about the consumption of energy drinks

Frequency Percentage

n= 100

Age Groups which OK to consume energy Drink Under 18 7 7% Over 18 37 37% Never 56 56% Reason behind Consumption* Due to peer pressure 33 33%

Just to fill up the stomach 48 48% To gain energy/strength 56 56% To avoid fatigue/sleepiness 50 50% To concentrate on studies 19 19% To minimize stress 45 45% To show off 15 15% Because of its addictive taste 10 10% If ED consumers know the health risk, will they stop or minimize consumption Yes 15 15% No 22 22% Maybe 56 56% I don’t Know 7 7% *Multiple Responses

4.3.3 The degree of awareness about the risks of consuming energy drinks

among the tertiary students

Table 4.3 shows the frequency and percentage of the participant’s awareness about the energy drink and its health risks of its consumption.

35% of the participant knows the ingredients of energy drinks where 65% of the participants said that they don’t know from which ingredients the energy drinks is made up off. 4% of the participants said that main ingredients in energy drinks were caffeine, sugar and herbal substances, where 25 of participants said that its main ingredients were herbal substances, carbonated water and sugar. 20%of the participants said that energy drink contains only sugar, 4% of the participants said there was caffeine in energy drinks and 3% of the participants said that there were taurine in energy drinks.

45% of the participants in this study know what is the health risks associated in the energy drinks and 55% of the participants were not aware about the health risks associated with the consumption of energy drinks.

The most commonly said health risks by the participant were increasing sugar level in the body which is said by 20% of the participants. And least number of participants said the health risks associated with energy drink consumption were renal diseases and eye problem which is said by 2% of the participants. Where 3% of participants said it was sleep disorders/insomnia and 4% of the participants said it was gastritis. And 8% of the participants said it was high BP and increasing heart rate.

16% of the participant have seen a warning label of health risks in the energy drink can where 19% have not seen and other 19% don’t even bothered to look if there is a warning label or not.

Table 4.3: Frequency and Percentage of participant’s awareness about energy drinks and health risks of its consumption

Frequency Percentage n= 100 No. of Participants Know about the ingredients in ED Yes 35 35%

No 65 65%

Ingredients mentioned by the participants who said yes Caffeine, sugar and herbal substances 4 45 herbal substances 2 2% carbonated water and sugar 2 2% sugar 20 20% caffeine 4 4% taurine 3 3% No.of participants who know the Health Risks Yes 45 45%

No 55 55%

Risks that occur from ED consumption as mentioned by the participants cardiovascular diseases 6 6% renal diseases 2 2% sleep disorders/ insomnia 3 3% eye problems 2 2% gastritis 4 4% increasing sugar level 20 20% high BP and increasing heart rate 8 8% Number of Consumers who have seen a warning label on Ed can Yes 16 29.6%

No 19 35.2%

I don’t bother to look 19 35.2%

4.3.4 Energy Drink consumption among the participants

Table 4.4 shows the frequency of participant’s condition towards the

consumption of energy drinks.

54% of the participants were currently consuming energy drinks and 38

did not consume any time in their life where 8% of them stopped consuming energy

drinks.

In the next part, consumers were asked that whether they will stop

consuming or not once they know the health risks. 12.9%said no, 12.9% said yes and

rest of 74.1% said may be.

Table 4.4: Frequency and percentage of participant condition towards the consumption of energy drinks

Frequency Percentage n= 100 Conditions Yes 54 54% No 38 38%

Stopped 8 8% Will you stop consuming once you know the health risks? Yes 7 12.9% No 7 12.9% May be 40 74.1%

4.3.5 The Extent of consumption among the students who consume energy

drinks

Table 4.5 shows frequency and percentage of the extent of consumption

among the consumers. 19% of them consumes one at least one cane in a day, 175 of

them consume one can per week, 19% of them consume at least one can per month

and 8% consume rarely in a year.

Table 4.5: Frequency and Percentage of the extent of consumption among the consumers

Frequency Percentage

n = 54

Extent of consumption

one can in a day 19 35.2%

one can in a week 17 31.5%

one can in a month 10 18.5%

rarely in a year 8 14.8%

4.3.6 Mixing energy drink with other substances

Table 4.6 shows the frequency and percentage of how the energy drink

consumers consume energy drink. Do they mix it with other substances or not.

47% of them drink as it is available in market without mixing anything.

And 6% of them mix it with coffee where only 1% mixes with other substances.

Table 4.6: Frequency of percentage of how they consume energy drink

Choices of mixing Frequency percentage n = 54

Mix with Coffee 6 11.11% mix with others 1 1.85% i dont mix with anything else 47 87.03%

4.3.7 Comparison of Energy Drink consumption Between Male and

Female among the participants

Table 4.7 shows the frequency and percentage of consumption of energy

drink between two genders.

This shows 40% of female participants consume energy drink where male

consumers are 14%.

Table 4.7: Frequency and percentage of consumption of the energy drink between two genders

Characteristics Frequency percentage n = 54

Gender

Male 14 25.93% Female 40 74.07%

4.3.8 Comparison of Energy Drink Consumption Among the Field of

studies

Table 4.88 shows the frequency and percentage of energy drink consumption among the health field non-health field students.

There were 24%of students who consume energy drink from health field and 30% of students who consume energy drinks from non-health background.

Table 4 8: Frequency and percentage comparison of the energy drink consumption among the field of studies

Frequency percentage n= 54

Field of Studies Health 24 44.44%

Non-Health 30 55.65%

4.3.9 Effects of knowledge about health risks in the consumption of energy

drinks

Table 4.9 shows the association between the consumption of energy drink and lacking of knowledge about the health risks associated with the consumption.

It shows that the two variables has an association with an odd ratio of

0.418 and a P value of 0.033 as the P value less than 0.05 show the association between two variable.

Table 4. 9: Association between the consumption of energy drink and lack of the knowledge about health risks

Variable Knowledge about Crude 95% CI X2 p-value health risks OR

n Low Upper

(%)

(%) Yes

Consume energy drinks Yes 54 35.2 64.8 0.418 0.186 0.936 4.569 0.033

No 46 56.5 43.5

4.3.10 Most Commonly Preferred Brand of Energy Drinks

Table 4.10 shows the frequency and percentage of most frequently used brand of energy drinks among the consumers.

XL Energy Drink was most commonly consumed brand with 31%, Power

Gold was second with 10%, Redbull was 9% and least number of student consume shark with 4% of the participant who consume energy drink.

Table 4.10: frequency and percentage of most frequently preferred Brand of Energy Drinks

Frequency percentage n= 54

Brands

Red Bull 9 16.67% Power Gold 10 18.51% XL energy Drink 31 57.41% Shark 4 7.40%

4.3.11 Most preferred Place to consume Energy Drink

Table 4.11 shows the frequency and percentage of most frequently preferred place to consume energy drink.

25% of the participant drink at home, 21% drink at University/college, another 21% of the students prefer to drink at friend’s house and 6% drink at restaurant/café’ where 16% do not prefer any special place to drink energy drink.

Table 4.11: frequency and percentage of most frequently preferred place to consume of Energy Drinks

Frequency percentage n= 54

Places*

At home 25 46.29% University/College 21 38.89% I don’t prefer place (any place I like) 16 29.63% At Restaurant/café' 9 16.67% At a Friend's house 21 38.89% *Multi Responses

4.3.12 Most Preferred situations to consume Energy Drinks

Table 4.12 Shows the frequency and percentage of the participant preferred situations to consume energy drink.

24%of the participants said that they don’t prefer any special situation but they drink whenever they like, 145 of them consume when they feel thirsty, 4% drink when they are hungry, other 4% drink before sports activity to gain energy, another 30% consume energy drink for study purpose to keep awake and concentrate.

Table 4.12: frequency and percentage of most frequently preferred situations to consume of Energy Drinks

Frequency percentage n= 54

Places*

Whenever I am thirsty 14 25.9% When I am hungry 4 7.4% When I study for exam 11 20.3% When I’m working with assignments 13 24.1% Before sports activity 4 7.4% I don’t prefer any situation (anytime that I feel like ) 24 44.4% I feel easy to concentrate on studies 6 11.1% *Multi Responses

4.3.13 The Main Reasons behind the Consumption of Energy Drinks among

the students

Table 4.13 shows the frequency and percentage of the reasons why student consume energy drinks and reasons which makes unable to stop the consumption.

Part one shows the reasons for consumption which demonstrates 29% of the student consume because of the taste. 21% consume because they think it gives strength/energy, 17% consume just to fill up their stomach, 12% of them consume to keep themselves awake and 8% of the participants consume because they feel easy to concentrate on studies.

Part two shows the reason that consumers feel unable to stop consuming.

This shows 25% of them said they cannot stop because they like the taste of energy drink.

8% said they are addicted to energy drink, where other 8% said they cannot stop because it gives strength and keep themselves awake, 9% said may be they do not have complete knowledge of risks that’s why they did not stop and 3% of them said they are unable to stop due to peer pressure where only 1% said benefit is high than the risk as a reason that they do not want to stop.

Table 4.13: frequency and percentage of the Reasons behind the consumption of energy drinks among the students

Frequency Percentage n= 54 Reasons for consumption* You like the taste of energy drinks 29 53.7% To fill up the stomach 17 31.5% You think it gives energy/strength 21 38.9% You believe that it avoids sleepiness and fatigue 12 22.2% You feel easy to concentrate on your studies after 8 14.8% consuming energy drink Reasons which unable to stop I like it a lot 25 46.3% I am addicted to it 8 14.8% may be i don't have complete knowledge about the risks 9 16.7% there is more benefit than risk 1 1.8% unable to stop due to peer pressure 3 5.6% it gives strength and keep me awake 8 14.8%

*Multi Responses

4.3.14 Reasons behind Not consuming Energy Drinks

Table 4.14 shows frequency and percentage of the reasons behind not consuming energy drinks for the non-consumers.

36% of the students said because they have the knowledge of health risks that acquired by consuming energy drinks. 65 feels that it is waste of money and 4% of the participants just do not like to drink it.

Table 4.14: frequency and percentage of the Reasons behind not consuming energy drinks among the students

Frequency Percentage n= 46 Reasons

you felt it is waste of money 6 13.04%

you have the knowledge about its health risks 36 78.3%

you don’t like it 4 8.7%

4.3.15 Encouraging Factors to Consume Energy Drink among the

consumers

Table 4.15 shows the frequency and percentage of the factors that encourage consuming energy drinks.

40% of the consumers said that there are less than 5 people with them most of the time and 14% of the consumers said they live with more than 6 people most of the time.

34% of the consumers said the people around them consume energy drink

, 11% said people around them did not consume energy drink and 9%of them said they have no idea about that the people live around them consume energy drink or not.

Out of 54 consumers 26% said most of their friend consumes energy drink, 18% said few of them consume energy drink and 5% said all of them consume where 4% said some of their friends consume energy drinks.

42% of the participants said their sibling consume energy drinks, 25 said either mother or father drinks energy drink, 3% said husband/wife consume energy drink where 5% said no one from their family consume energy drink. And 2% don’t know about whether anyone consumes or not from their family.

Table 4.15: frequency and percentage of the encouraging factors to consume energy drink among the consumers

Factors Frequency Percentage n= 54 No. of people live together most of the time ≥5 40 74.1% ≤6 14 25.9% Do they consume Energy Drink? Yes 34 62.9% No 11 20.4% May be 6 11.11% I don’t Know 3 5.56% No.of friends consume energy Drinks Some 4 7.4% Few 18 33.3% Most 26 48.% All 5 9.3% None 0 0% ED consumption in family* Mother/Father 2 3.7% Siblings 42 77.8% Husband/Wife 3 5.56% None 5 9.3% I Don’t Know 2 3.7%

*Multi Responses

4.3.16 Research question

Does the knowledge of health risk affect the number of consumptions of Energy Drinks?

Table 4.16 shows that there is an association between the consumption of energy drink and lacking of health knowledge about the consumption of health knowledge with a p-value of 0.033. it also shows that the people with No knowledge is

29.6% more than the people with knowledge in the consumption.

Table 4.16: Association between the knowledge of health risks and the number of ED consumption

Variable Knowledge about Crude 95% CI X2 p-value health risks OR

n Low Upper

(%)

(%) Yes

Consume energy 0.418 0.186 0.936 4.569 0.033 drinks Yes 54 35.2 64.8

No 46 56.5 43.5

4.3.17 Hypothesis

Ho: Students from health background shows no difference in the consumption of energy drinks compared to non-health background students.

Ha: Students from health background consume fewer amounts of energy drinks compared to non-health background students.

Table 4.17 shows the Association between the consumption of energy drink and the student’s field of studies. With an OR of 0.615 and a P-value of 0.229, it shows that there is no association between the consumption of energy drink and the field of studies. This means that there is no difference in the consumption of energy drink by being health background student or non-health background student.

Table 4.17: Association between the consumption of energy drink and field of studies

Variable Health Crude 95% CI X2 p-value Background OR

n Lower Upper

(%)

(%) Yes

Consume energy 55.6 0.615 0.279 1.359 1.449 0.229 drinks Yes 54 44.4

No 46 56.5 43.5

CHAPTER 5

DISCUSSION AND CONCLUSION

5.1 Introduction This chapter will discuss the main findings of the study in relation with the theory based on this study. Moreover the discussion will compare the findings of this study with the similar studies done previously. Additionally the chapter will provide an implication and limitations of the study. Furthermore there will be a direction for further research and a conclusion.

5.2 Summary of Main Finding Majority of the participants were female with 81% and the rest of 19% were Male students. 82% of them were from Bachelor’s Degree, 8% from Diploma level and the rest of 10% from advanced certificate. 58% of the participants in this study think that students consume energy drinks to gain energy/strength. 56% of the participants think that if the energy drink consumers are well aware of the health risks, may be they will stop or minimize consuming energy drink.

54% of the participants from the study said that they are energy drink consumers where

46% of the participants did not consume energy drinks. 74.07% of the participants are female students who consume energy drinks where 25.93% of the consumers were male.

53.7% of them said they like the taste of energy drink, and 53.7% of them believed that they gain strength/energy which leads to consume it. As per statistical analysis generated

51 from SPSS it shows that the students who have knowledge of health risks consume less number of energy drinks compare to those who do not have knowledge. The nu hypothesis for the study was accepted by showing the statistical data that there is no relationship of energy drink consumption and being health background.

5.3 Discussion

Current study was based on the students of Maldives National University age 16-35.

Total of 100 students were randomly selected from 6 different faculties including health sector and non-health sector. Mean age of the sample group was 22.70 where minimum mean was 16 and maximum mean was defined as 34 in the study. Majority of the participants were female with 81% and the rest of 19% were Male students. Female percentage is increased because half of the sample size from faculty of health sciences

(health sector) where number of girls are more than the number of boys (Maldives

National University, 2014).

Participants were not selected by considering at their study level or course. When it was selected randomly, 82% of them were from Bachelor’s Degree, 8% from Diploma level and the rest of 10% from advanced certificate level.

Most of the participants of this study think that students consume energy drinks to gain energy/strength (58%), 50%of them said students consume energy drink to avoid sleep/fatigue, where 48% of them said that students consume energy drinks just to fill up their stomach. However 48% said students consume energy drinks to minimize stress.

Moreover, 56% of the participants think that if the energy drink consumers are well aware of the health risks, may be they will stop or minimize consuming energy drink.

Energy Drink consumption is very high among the university students due to different reasons. According to the results of this study, 54% of the participants from the studysaid that they are energy drink consumers where 46% of the participants did not consume energy drinks. Consumption rate of this study is similar with that of a previous study (Malinauskas et al, 2007). And the 46% of non-consumers include the participants who have stopped consuming energy drinks. Due to the small sample size this may not show the real picture of how much bigger is the problem in the target population.

However, this demonstrations more than half of the students were consuming energy drinks from MNU.

Moreover the study shows that female students consume more energy drink than male students. 74.07% of the participants are female students who consume energy drinks where 25.93% of the consumers were male. This result is similar to a study which shows female students consume more ED than male students among medical students

(Bawazeer & AlSobahi, 2013). Additionally another study shows that female consumption is high than male. This means that females consume more energy drinks than male (Malinauskas et al, 2007). However, this might be because of the sample size with more female, as mentioned before. Hence another study with more number of males than females shows that 81.91% of male consume energy drinks when 18.09% of female consume energy drinks ( Alsunni & Badar, 2011).

The extent of the energy drink consumption is needed to know in order to describe whether the energy drink consumer is addicted to it or they are just drinking it once in a while. This study demonstrate that majority of the consumers are addicted to it as 35.2%

53 of the consumer intakes at least one can of energy drink per day. 31.5% of them consume at least one can per week, 18.5% of them consume at least one can per month were only 14.8% consumes energy drink rarely in a year. These results are very much different from a previous similar study done in India which shows 80% of the consumer’s intake at least one can of energy drink per week rather than a can per day.

Other study shows that majority of the student’s intake ED 1-4 cans per a month which is similar to the results of this study (Malinauskas et al, 2007). Students need to minimize their consumption as they are in taking high amount of caffeine. “Energy drinks contain around 160-300mg caffeine per 500ml serve” (The Australalian

Nutritional Foundation, 2012).

According to literature review done for this study, Red bull was the most commonly consumed energy drink worldwide. A previous study even shows that red bull was the leading energy drink among the consumers ( Gunja & Brown, 2012). However, this study shows most frequently consumed energy drink among university students was XL energy drink with 57.41%. Second most frequent brand was power gold with 18.51% and only 16.67% of them consume red bull where 7.40% consume shark energy drink.

Most of the students consume energy drink both at university and at home may be because they consume when they are doing assignments and while studying for exam.

That is 46.29% of the students. And 38.89% of them consume at university. 29.63% of them do not prefer any place to consume. Some of the energy drink consumers prefer special situation to consume energy drink while most of them don’t prefer any special situations which consider 44.4% of the respondents. These results confirm similar with

54 that of a previous study which shows students consume energy drinks with similar place and situations (Verster et al, 2012).

Students mostly consume energy drink when they are hungry and when they feel sleepy.

25.9% of them consume when they feel thirsty. They do not bother about the health risks that occur to their body. Students risk taking behavior of this may lead to unexpected health issues. Most of them do not know about the warning labels which gives the instructions about the ingredients and health alerts in the energy drink cans. This is one of the major risk taking acts of the students. 35.2% of the consumers have not seen a warning label in the Ed cans; other 35.2% does not bother to look where only 29.6% have seen the warning label. Other studies show that 4.3% of the consumers have seen the warning label (Ward, , 2009). Despite knowing the warning label, these 29.6% consume energy drink taking the risk to their own body.

According to Reciprocal Triadic Determinism of social cognitive theory, environmental and behavioral factors lead to unhealthy behaviors like consumption of energy drinks.

Keeping mind in that, this study identified some factors that lead to consume energy drink. One is peer pressure. Some students have said that they are unable to stop energy drinks due to peer pressure. It show that 40% of them live with more than one person around them and 34% of them are energy drink consumers which says that peer influence and environmental factors are associated with energy drink consumptions.

Moreover 77.8% of the siblings of energy drink consumer also consume energy drinks.

This means if the family members or living environment has the consumers it is a factor to consume energy drinks as per environmental factor of RTD.

According to the prior literature review, mixing strategy of energy drink with alcohol and other substances is a raising concern as mentioned in the lit review of this study. As alcohol is a prohibited substance in Maldives people do not consume it openly. Though there might be some people who abuse it with energy drink. As being a sensitive area to be questioned, this part was asked indirectly from the respondents by asking whether they mix it with other drinks or not. The results may not be the real picture of the issue as it is a sensitive matter; participants might not be comfortable to answer honestly.

Although, 11.11% of them said that they mix energy drink with coffee. Coffee itself is a substance with caffeine and if it is added in the ED it increases the amount of caffeine in the whole portion. Moreover 1.85% of the participants said they mix with others and that others were not specified for their own reason. It might be alcohol or something else.

Beside, 87.03% of the respondents said they did not mix energy drink with any other substance. This results are straight opposite to a similar previous study saying 4.3%

(n=2) are consuming energy drink with alcohol (Faris, 2014). This might be differing due to the different culture of the two target groups.

There are various reasons for energy drink consumption. Most commonly the college students consume energy drinks because of their good taste. 53.7% of them said they like the taste of energy drink, and 53.7% of them believed that they gain strength/energy which leads to consume it, 31.5% of the university students consume energy drink fill up their stomach during class hours and doing assignments, 22.2% of them consume energy drink to avoid fatigue/sleepiness. And 14.8% of the participants said that they consume energy drink because they feel easy to concentrate in studies after consuming energy drink. As a researcher, I felt that the main reason for energy

56 drink consumption is that they do not have the clear information or knowledge about the health risks. Because 74.1% of the consumers said that they might stop consuming if they know the health risks of energy drink consumption. Additionally, 78.3% of the non- consumers said their reason for not consuming as they have the clear knowledge about the health risks associated with the energy drink consumption. An abstract of a previous study says that most of the students who consume energy drink are unable to define the potential hazard caused by energy drink which means they too are having lack of knowledge (Atilla & Cakir in 2011). Other study concluded by saying that the medical college students response regarding the knowledge of health risks associated with energy drink consumptions were unsatisfactory. This could be because they do not have enough knowledge (Hidiroglu et al, 2013). Due to the gaps in evidence it has been difficult to figure out similar studies exactly about the knowledge effects of consumption from the past studies.

It is disheartening to say that most of the students are unaware of the health risks that associate with energy drinks when they consume it. 55% of the study participants agreed that they have no idea about the health risks of energy drink consumption. While 45% says they know the health risks. Though, they said that they know the health risks, it shows that they actually don’t know the risks because 44% of them said that it is Ok to consume energy drink for the children fewer than 18 and even above 18 years. This means they do not know the risks of energy drink consumption.

However, 56% of the participants agreed that it is never OK to consume ED at any age due to its harmful effects to the body.

Additionally, respondents were also assessed whether they know the ingredients of the energy drink and the health consequences that may occur from those ingredients. Only 35% of the participant said that they know the ingredients of energy drinks when 65% of them said they don’t know. Most commonly said ingredients were sugar. 20% of them said only sugar when 4% said caffeine, sugar and herbal substances.

Thus, 2% said sugar and carbonated water. 4% said only caffeine, 3% said only taurine and other 2% said herbal substances when rest of the 3% said only taurine. Other studies also show that most of the students could not figure out the ingredients properly (Atilla

& Cakir in 2011). Mostly the participants think energy drinks have high amount of sugar as a harmful substances but the caffeine is the most harmful ingredient in energy drinks.

Those students who said that they know the consequences were also asked to specify the risks they know, in order to make sure whether they actually know or they are just saying that they know it. According to their answers, it is identified that very few of them know that energy drink has caffeine which occur so many health problems including psychological and physiological effects. Only 2% of the participants said sleep disorders or insomnia is associated with energy drink consumption. As many of the respondents said that sugar is the upmost ingredient in energy drinks, most commonly said health problem include increasing sugar level by 20% of the respondents. . Unlike a similar study done before, this study shows that minimum number of participants said that there is cardiovascular problems including high BP and increasing heart rate as a health risk of energy drinks. Previous study shows that 36.6% of them said about it

(Aslam et al, 2013), where in this study only 14% of them mentioned it. As per the participants view, other consequences include renal diseases, eye problems and gastritis.

Research question

Does the knowledge of health risk affect the number of consumptions of Energy Drinks?

As per statistical analysis generated from SPSS it shows that the students who have knowledge of health risks consume less number of energy drinks compare to those who do not have knowledge. Statistical values show that energy drink consumers are consuming it because they do not have the knowledge of health risks about energy drinks with a p-value of 0.033 and a chi-square 4.569. If p-value is below 0.5 it means there is a relation between two variables. It also shows that 29.6% is increased in the consumers who do not have knowledge compare to the consumers who have knowledge.

This clearly shows that students without knowledge of health risks consume more number of energy drinks. A very few studies have found regarding the association of knowledge and consumption. Those studies also describes that consumers have lack of knowledge about health risks.

Hypothesis

Ho: Students from health background shows no difference in the consumption of energy drinks compared to non-health background students.

Ha: Students from health background consume fewer amounts of energy drinks

compared to non-health background students.

The null hypothesis for the study was accepted by showing the statistical data that there is no relationship of energy drink consumption and being health background.

But the relation is only with the knowledge of health risks associated with the energy drinks no matter the student is from any sector. Statistical analysis shows there was a p- value with 0.229 and an OR of 0.615 with a chi-square of 1.449. In case there is no difference in the consumption of energy drink between health background student and non-health background students. On the other hand alternative hypothesis for the study was rejected by being opposite of that.

5.4 Implication As this study shows that the knowledge of health risk among university student is poor.

So this study can be used to conduct health education sessions and awareness programs about energy drink and its health risks to the university students based on the facts in this study.

5.5 Limitations of the Study There were so many limitations for this study to conduct; the major limitation for the study is limited time frame to complete the study. Though there are 12 faculties in male and other campuses in atolls, the sample size for the study was selected from six faculty of MNU located in male due to time constraints and limited resources. As there is no published research on this area in Maldives, it became a bit difficulty in finding literature for this study from Maldivian context so the lack of literature in Maldivian context is a factor that might effect to the result and the discussion where results were compared to the literature review.

5.6 Directions for Future Research

This might be the first research study that have been undertaken in this aspect for MNU about energy drinks, so if another researcher is interested to conduct a research same or similar to this aspect it will be more reliable and it will get effective results if the sample size is increased. And the number of male and female participants should be equal if the difference between genders in the consumption of ED is being measured. Moreover if the research is based on understanding the knowledge it will be more relevant if the research study is based on a qualitative study rather than a quantitative study. So that more factors associated with the cause will be revealed and discussed. For that it will take more time but the result will be more accurate and effective.

CONCLUSION Though, energy drink provides some quick and temporary benefits, it overall gives only harmful effects to human body. So it is important to be aware of the health risks associated with energy drink consumptions and be away from consuming it especially for a regular purpose. As it associates with both physical and psychological effects it is not wise to consume it especially for young adults as they have their future a head.

RECOMMENDATION • Energy drinks contain high amount of caffeine. Its usage must be done in limit because too much caffeine may cause both psychological and physiological effects.

• It is recommended to educate young adults about the risks of consuming energy drinks.

• do not use energy drinks to avoid sleep

• Parents and friends should play a major role in monitoring risk for caffeine related consequences among energy drink users.

• It is a responsibility of health care providers to provide information about the health risks and consequences associated with energy drink consumption to the public. So they must continue doing so.

REFERENCES Aslam HM, Mughal A, Edhi MM, Saleem S, Rao MH, Aftab A, Hanif M, Ahmed A, Khan AM. (2013). Assessment of pattern for consumption and awareness regarding energy drinks among medical students. Archives of Public Health, 71;31. doi:doi:10.1186/2049-3258- 71-31

Alsunni, A. A., & Badar, A. (2011). ENERGY DRINKS CONSUMPTION PATTERN, PERCEIVED BENEFITS. J Ayub Med Coll Abbottabad, 23(3), 7. Retrieved from http://www.ayubmed.edu.pk/JAMC/23-3/Alsunni.pdf

Aluqmany, R., Mansoor, R., Saad, U., Abdulla, R., & Ahamd, A. (2013, 01 07). Consumption of energy drinks among female secondary schoolstudents, Almadinah Almunawwarah, Kingdom of Saudi Arabia, 2011. Journal of Taibah University Medical Sciences, 08(01), 62. doi:http://dx.doi.org/10.1016/j.jtumed.2013.01.009

Anonymous. (2015, may 13). Energy Drink Ingredients and What They Do. Retrieved SEPTEMBER 30, 2015, from caffeineinformer: http://www.caffeineinformer.com/energy-drink- ingredients

Antagonist Receptors (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/Antagonist

Attila, S. & Cakir, B. (2011). Energy-drink consumption in college students and associated factors. Nutrition, 27(3):316-22. Abstract retreieved from http://www.ncbi.nlm.nih.gov/pubmed/20579846

Badaam, K. M., & Masroor, S. S. (2013, jan - feb). A Study Of Energy Drinks Consumption Practices Among Football Players In Aurangabad District Of Maharashtra in India. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 4(5), 25 -27. Retrieved august 19, 2015

Buchanan, J. K. (2012). ENERGY DRINK CONSUMPTION (WITH. UKnowledge, 18. Retreived from http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1004&context=khp_etds

Bawazeer, N. A., & AlSobahi, N. (2013, september). Prevalence and Side Effects of Energy Drink Consumption among Medical Students at Umm Al-Qura University,Saudi Arabia. International Journal of Medical Students, 1(3), 104 - 108. Retrieved 2015 from http://www.ijms.info/archives/v01/i03/a02/v01i03a02.pdf

Caffeine (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/Caffeine

Centers for Disease Control and Prevention. (1997). CDC Surveillance Summaries,. Atlanta, gerogia: Epidemiology Program Office,Centers for Disease Control and Prevention (CDC),

U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov/mmwr/PDF/ss/ss4606.pdf

Cognitive performances (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/Cognitive consumer (2015 oxford dictionary retrieved from http://www.oxforddictionaries.com/definition/english/consumer?q=Consumers

Energy drinks(2015 oxford dictionary retrieved from http://www.oxforddictionaries.com/definition/english/energy-drink?q=Energy+Drinks+

Faris, N. N. (2014). ENERGY DRINKS: FACTORS THAT INFLUNCE COLLEGE STUDENTS' CONSUMPTION". baghdad: Southern Illinois University Carbondale. Retreievd From http://opensiuc.lib.siu.edu/cgi/viewcontent.cgi?article=2413&context=theses

Ferreira, S.E., Túlio de Mello, M., Pompéia, S., & Oliveira de Souza-Formigoni, M.L.(2006). Effects of Energy Drink Ingestion on Alcohol Intoxication. Alcoholism-Clinical and Experimental Research, 30(4):598-605. Retrieved from http://www.researchgate.net/publication/7205131_Effects_of_Energy_Drink_Ingestion _on_Alcohol_Intoxication

Gunja, N., & Brown, J. A. (2012). Energy drinks: health risks and toxicity. Research, 46-49. doi:doi: 10.5694/mja11.10838 Retrieved from https://www.mja.com.au/journal/2012/196/1/energy-drinks-health-risks-and-toxicity

Health risk. (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/health+risk

Hidirogulu S., Tanriover O., Unaldi S., Sulun S. & Karavus M., (2011). A survey of energy-drink consumption among medical students. The Journal of the Pakistan Medical Association, 2013 Jul;63(7):842-5 Abstract retreieved from http://www.ncbi.nlm.nih.gov/pubmed/23901705

Ishak, W. W., Ugochukwu, C., Kara, B., Khailili, D., & Zaky, C. (2012). ENERGY DRINKS: Psycological Effects and Impact on Well-being and Quality of life. Innovations in Clinical Neuroscince, 12. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280075/

Insomnia (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/Insomnia

Knowledge (2015 oxford dictionary retrieved from http://www.oxforddictionaries.com/definition/english/knowledge?q=Knowledge+

Maldives National University. (2014). Annual Report. male': Maldives National University. Retrieved from http://www.mnu.edu.mv/index.php/the-university?catid=281&id=701

Malinauskas, B. M., Aeby, V. G., Overton, R. F., Aeby, T. C., & Heidal, K. B. (2007). A survey of energy drink consumption patterns among college students. Nutritional journal, 6-35. doi:10.1186/1475-2891-6-35

Neuropsychiatric effects (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical- dictionary.thefreedictionary.com/Neuropsychiatric

Peer pressure(2015 oxford dictionary retrieved from http://www.oxforddictionaries.com/definition/english/peerpressure?q=peer+pressure

Raosoft, Inc. (2004). Sample size calculator. Retrieved from http://www.raosoft.com/samplesize.html

Renal Dysfunction (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://encyclopedia2.thefreedictionary.com/renal+dysfunction

Rotstein, J., Barber, J., Strowbridge, C., Hayward, S., Huang, R., & Benrejeb , S. (2013). Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context. International Food Risk Analysis Journal, 3, 29. doi: 10.5772/56723

Schizophrenia (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://encyclopedia2.thefreedictionary.com/Schizophrenia

Seifert, S. M., Schaechter, J. L., Hershorin, E. R., & Lipshultz, S. E. (2011, march). Health Effects of Energy Drinks on Children,Adolescents, and Young Adults. PEDEATRICS, 127(3), 20. doi:10.1542/peds.2009-3592

Seizure disorder (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://encyclopedia2.thefreedictionary.com/Seizure+Disorder

Shifa, A. (2009). Global School- based student health survey. Male': Ministry of Education. Retrieved 10 09, 2015, from http://www.who.int/chp/gshs/2009_Maldives_GSHS_report.pdf

Taurine (n.d.) Mosby's Medical Dictionary, 8th edition. (2009). Retrieved November 4 2015 from http://medical-dictionary.thefreedictionary.com/Taurine

The Australalian Nutritional Foundation. (2012, octorber 14- 20). Natioonal Nutritional Week 2912. Retrieved november 2015, from Nutrition Australia: http://www.nutritionaustralia.org/sites/default/files/Caffeine%20and%20Energy%20Dri nks.pdf

Verster, J. C., Aufricht, C., & Alford, C. (2012, march 1). Energy drinks mixed with alcohol:misconceptions, myths, and facts. International Journal of General Medicine, 5, 187 - 198. Retrieved august 19, 2015, from http://www.dovepress.com/energy-drinks- mixed-with-alcohol-misconceptions-myths-and-facts-peer-reviewed-article-IJGM

Ward, , A. C. (2009). The Impact of Knowledge, Attitude, and Peer. Utah State University,, Health, Physical Education and Recreation. Logan,utah: All Graduate Theses and Dissertations. Retrieved september 30, 2015, from http://digitalcommons.usu.edu/etd/465

Winston, A. p., Hardwick, E., & Jaberi, N. (2005). Neuropsychiatric effects of caffeine. Advances in Psychiatric Treatment, 11, 432 - 439. Retrieved from http://apt.rcpsych.org/

APPENDICES

APPENDIX A

Final Questionnaire ` Form Number:

QUESTIONNAIRE FOR STUDENTS TO UNDERSTAND THEIR PERSPECTIVES AND BEHAVIOR TOWARDS ENERGY DRINKS

Section A

Please put a star (*) in the appropriate box. Choose more than one choice if required. And write your answer when necessary. Please do not write your name.

Personal information’s

Gender: male female

Age:

Faculty:

Course:

Semester:

Section B

General view about the matter

1. Do you know what energy drinks is made up of ?

Yes No

If yes, please specify ……………………………………………………………..

…………………………………………………………………………

2. At what age do you think it is OK to consume energy drink?

a. Under 12 b. 12 -13 c. 14-15

d. 16-17 e. Over 18 f. Never

3. In your view, why do students consume energy drinks?

a. Due to peer pressure

b. Just to fill up the stomach

c. To gain energy/ strengths

d. To avoid fatigue/sleepiness

e. To concentrate on studies

f. To minimize stress

g. Others

If others, please

specify………………………………………………………………………

………………………………………………………………………………

………………

4. Do you have any idea of the health risks that occur from the consumption of energy drinks?

Yes No

 If Yes, answer question 4a

4a. In your opinion, what are the risks involved in consuming energy drinks?

………………………………………………………………………..

5. Do you think if the energy drink consumers are well aware of the health risks, they will stop or minimize consumption of energy drink?

Yes No maybe I don’t know

Section C

Personal behavior towards energy drinks

6. How many people live together around you most of the time? a. 0

b. 1-5

c. ≥ 6

7. Do they consume energy drinks? a. Yes

b. No

c. May be

d. I don’t know

8. How many of your friends consume energy drinks? a. Most

b. Some

c. Few

d. None

9. Who consume energy drinks in your family? a. Mother

b. Father

c. Siblings

d. Others

e. None

f. I don’t know

If others, please

specify…………………………………………………………

…………………………………………………………………

………………

10. Do you consume any brand of energy drink?

Yes No stopped

 If YES, please continue with question 11.

 If NO or STOPPED please answer the question 10only.

11. Specify the reason why you don’t consume or stopped consuming energy

drink?

a. You felt it is waste of money

b. You got the knowledge that it has so many dangerous health

hazards in it

c. Energy drink gives adverse effects like headache or vomiting

d. You don’t like it anymore

e. Other reasons

If other reasons, please specify ……………………………………………………………………… ……………………………………………………………………… ……………… 12. Why do you consume energy drinks?

a. You like the taste of energy drinks

b. To fill up the stomach

c. You think it gives energy/strength

d. You believe that it avoids sleepiness and fatigue

e. You feel easy to concentrate on your studies after consuming

energy drink

f. Other reasons

If other reasons, please specify ………………………………………………………………………

……………………………………………………………………… ………… 13. Which brand of energy drink do you prefer most?

…………………………………………………………………………

14. How often do you consume energy drinks? a. More than one cans per day

b. One can in a day

c. One can in a week

d. One can in a month

e. Rarely in a year

If more than one, specify the

amount……………………………………….

15. Which occasion do you prefer consuming energy drinks? a. Whenever I am thirsty

b. When I am hungry

c. When I study for exam

d. When I’m working with assignments

e. Before sports activity

f. I don’t prefer occasions (anytime that I feel like )

g. Others

If others, please specify ………………………………………………………………………

……………………………………………………………………… ……………… 16. Which place do you prefer consuming energy drinks? a. At home

b. At Restaurant/cafe’

c. At Friends house

d. University/College

e. I don’t prefer place (any place I like)

f. Others

If others, please specify………………………………………………………… ………………………………………………………………… ……………….

17. How do you drink energy drinks? a. Mix with coffee

b. Mix with soft drinks

c. Mix with others

d. I don’t mix with anything else

If others, please specify………………………………………………………… ………………………………………………………………… …………….. 18. Have you seen a warning label on energy drinks can?

a. Yes

b. No

c. I don’t Know

19. what makes you to consume energy drinks even if you are aware of the health risks?

1. You like it a lot

2. You are addicted

3. You don’t have complete knowledge about the risks

4. You believe there is more benefit compare to the risks

5. You are unable to stop because of peer pressure

6. Other reasons

If others reasons please specify ………………………………………………………………… ………………………………………………………………… ………………

20. Will you stop consuming energy drinks, once you know the health risks associated with energy drinks?

Yes No May be

Thank you for your precious time…!

APPENDIX B

Consent Form I, Mariyam Firasha (ST.NO: 17535), student of bachelors in primary health care , Faculty of Health Sciences, is going to undertake a research study to understand the role of knowledge about health risks in the consumption of energy drinks among the students of MNU. To complete this study, I am going to use a questionnaire to collect the relevant information’s for the study.

So I kindly request you to complete this questionnaire as much as possible for you. Your name and contact details will not be exposed and not required to write in the questionnaire. The information you provide will be

confidential and it will only be used for academic purposes. Your participation is voluntarily and you will never force to answer any of the questions in the form. You have your own right to answer or ignore any question of the questionnaire. Still your contribution is highly preferable to complete this survey.

There is no physical or emotional risk for you after participating this survey. Even though, if you feel or decide to discontinue filling the questionnaire even after signing this consent form, you are welcome to stop from there. There is no penalty against you if you decide to end your participation. Your participation up to that end will be highly appreciated.

If you have any queries regarding any part of the questionnaire, you are most welcome to contact me.

Mariyam Firasha

9993644

E mail: [email protected]

Student of bachelors in primary health care

I have read and understood this consent form clearly. And I am agreeing to participate in this survey with my own willing and full conscious.

Signature:

Name:

Contact Number:

Date: