Caffeine Addiction on BPO Employees

DEPARTMENT OF COMMUNITY MEDICINE MGM MEDICAL COLLEGE, INDORE CME WORKSHOP 2010-11

Study of Effects of Caffeine Addiction on BPO Employees

Submitted to- Submitted by-

Dr. Sanjay Dixit Brijmohan Sahu Professor and Head Harshit Gehlot Department of Community Medicine, Harshul Patidar MGM Medical College, Indore. Humaeel Abbas Ali DEPARTMENT OF COMMUNITY MEDICINE MGM MEDICAL COLLEGE INDORE

CERTIFICATE

This is to certify that the research project entitled “Study of Effects of Caffeine Addiction on BPO Employees” has been successfully carried out under the Department of Community Medicine as a project under Orientation Workshop on Research Designing in Community Medicine. The project was carried out by

Brijmohan Sahu Harshit Gehlot Harshul Patidar Humaeel Abbas Ali

The work has been executed with due care and precision and my entire satisfaction.

Dr. Sanjay Dixit Date: Professor and Head Department of Community Medicine, MGM Medical College, Indore. DEPARTMENT OF COMMUNITY MEDICINE MGM MEDICAL COLLEGE INDORE

CERTIFICATE

Brijmohan Sahu Harshit Gehlot Harshul Patidar Humaeel Abbas Ali

The work has been executed with due care and precision and my entire satisfaction.

Dr. Bhagwan Waskel Date: Facilitator [CME Workshop] Assistant Professor Department of Community Medicine, MGM Medical College, Indore. DEPARTMENT OF COMMUNITY MEDICINE MGM MEDICAL COLLEGE INDORE

CERTIFICATE

Brijmohan Sahu Harshit Gehlot Harshul Patidar Humaeel Abbas Ali

The work has been executed with due care and precision and my entire satisfaction.

Dr. Harish Shukla Date: Facilitator [CME Workshop] Department of Community Medicine, MGM Medical College, Indore. DEPARTMENT OF COMMUNITY MEDICINE MGM MEDICAL COLLEGE INDORE

CERTIFICATE

Brijmohan Sahu Harshit Gehlot Harshul Patidar Humaeel Abbas Ali

The work has been executed with due care and precision and my entire satisfaction.

Dr. Satish Saroshe Date: Facilitator [CME Workshop] Department of Community Medicine, MGM Medical College, Indore. ACKNOWLEDGEMENT

Expressing gratitude is a difficult task, and words often fall short of reflecting one’s feeling. It is our proud privilege, however to do so and we undertake this task with utmost sincerity. We are grateful to Dr. Sanjay Dixit sir, Professor and Head of the Department of Community Medicine, MGM Medical College, Indore for assigning this project under the Continued Medical Education Workshop [CME Workshop] for his invaluable guidance, significant suggestion and help accomplishing the project work.

We express our heartfelt thanks to Dr. Bhagwan Waskel Sir, for providing us with an opportunity to do this project and giving invaluable encouragement in our endeavors. We also thank Dr. Deepa Raghunath Ma’am for her expert guidance.

We acknowledge with sincerity and deep sense of gratitude, the invaluable guidance given to us by Dr. Harish Shukla and Dr. Satish Saroshe Sir. Their suggestions and discussions were enlightening and constant source of inspiration during our project work. We are indebted to him for sparing valuable time for helping us in acquiring knowledge of current approaches.

Finally we thank the BPO employees of Teleperformance and First Source for cooperating with us. Without the help of all of them, this project could not have materialized.

THANK YOU

Brijmohan Sahu Date:

Harshit Gehlot

Harshul Patidar

Humaeel Abbas Ali

CONTENTS

• Introduction 7- 13 • Review of Literature 14 • Research Question 15 • Objectives 16 • Method and Materials 17 • Implementation 18 • Scoring Criteria 19-20 • Observations and Interpretation 21- 33 • Evaluation and Analysis 34-38 • Conclusion 39 • Discussion 40 • Recommendations 41 • Bibliography 42 • Appendix 43-49

I. Time Line Chart II. Questionnaire III.Master Table INTRODUCTION

Caffeine is a natural component of chocolate, coffee and tea, and is used as an added energy boost in most colas and energy drinks. It’s also found in diet pills and some over-the- counter pain relievers and medicines. Caffeine is the most commonly consumed psychoactive drug in the entire world.

Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic - it increases urine production. Recreationally, it is used to provide a "boost of energy" or a feeling of heightened alertness. College students often use it to stay awake while cramming for finals and drivers use it to push through to their destination. Many people feel as though they "cannot function" in the morning without a cup of coffee to provide caffeine and the boost it gives them.

In doses of 100-200 mg. caffeine can increase alertness, relieve drowsiness and improve thinking. At doses of 250-700 mg/day, caffeine can cause anxiety, nervousness, hypertension, and insomnia. It can curiously enough make it more difficult to lose weight because it stimulates insulin secretion, which reduces serum glucose, which increases hunger.

It's important to know that caffeine is an addictive drug. Among its many actions, it operates using the same mechanisms that amphetamines, cocaine, and heroin use to stimulate the brain. Relatively speaking, caffeine's effects are milder than amphetamines, cocaine and heroin, but it is manipulating the same channels in the brain, and that is one of the things that give caffeine its addictive qualities. If you feel like you cannot function without it and must consume it every day, then you may be addicted to caffeine.

Caffeine and Adenosine

Adenosine is found in every part of the body, but it has special functions in the brain. As adenosine is created in the brain, it binds to adenosine receptors. The binding of adenosine causes drowsiness by slowing down nerve cell activity. In the brain, adenosine binding also causes blood vessels to dilate, most likely to let more oxygen in during sleep.

Caffeine readily crosses the blood–brain barrier that separates the bloodstream from the interior of the brain. Once in the brain, the principal mode of action is as a nonselective antagonist of adenosine receptors. The caffeine molecule is structurally similar to adenosine, and binds to adenosine receptors on the surface of cells without activating them (an "antagonist" mechanism of action). Therefore, caffeine acts as a competitive inhibitor.

Instead of slowing down because of the adenosine's effect, the nerve cells speed up. Caffeine also causes the brain's blood vessels to constrict, because it blocks adenosine's ability to open them up. This effect is why some headache medicines like Anacin contain caffeine -- if you have a vascular headache, the caffeine will close down the blood vessels and relieve it. So, now you have increased neuron firing in the brain. The pituitary gland sees all of this activity and thinks some sort of emergency must be occurring, so it releases hormones that tell the adrenal glands to produce adrenaline (epinephrine). Adrenaline is the "fight or flight" hormone, and it has a number of effects on your body:

• Your pupils dilate. • Your breathing tubes open up (this is why people suffering from severe asthma attacks are sometimes injected with epinephrine). • Your heart beats faster. • Blood vessels on the surface constrict to slow blood flow from cuts and also to increase blood flow to muscles. • Blood pressure rises. • Blood flow to the stomach slows. • The liver releases sugar into the bloodstream for extra energy. • Muscles tighten up, ready for action.

This explains why, after consuming a big cup of coffee, your hands get cold, your muscles tense up, you feel excited and you can feel your heart beat increasing.

Caffeine and Dopamine

Caffeine also increases dopamine levels in the same way that amphetamines do. Dopamine is a neurotransmitter that activates pleasure centres in certain parts of the brain. Heroin and cocaine also manipulate dopamine levels by slowing down the rate of dopamine reabsorption. Obviously, caffeine's effect is much lower than heroin's, but it is the same mechanism. It is suspected that the dopamine connection contributes to caffeine addiction.

You can see why your body might like caffeine in the short term, especially if you are low on sleep and need to remain active. Caffeine blocks adenosine reception so you feel alert. It injects adrenaline into the system to give you a boost. And it manipulates dopamine production to make you feel good.

The problem with caffeine is the longer-term effects, which tend to spiral. For example, once the adrenaline wears off, you face fatigue and depression. So what are you going to do? You consume more caffeine to get the adrenaline going again. As you might imagine, having your body in a state of emergency all day long isn't very healthy, and it also makes you jumpy and irritable.

The most important long-term problem is the effect that caffeine has on sleep. Adenosine reception is important to sleep, and especially to deep sleep. The half-life of caffeine in your body is about six hours. That means that if you consume a big cup of coffee with 200 mg of caffeine in it at 3:00 p.m., by 9:00 p.m. about 100 mg of that caffeine is still in your system. You may be able to fall asleep, but your body will probably miss out on the benefits of deep sleep. That deficit adds up fast. The next day you feel worse, so you need caffeine as soon as you get out of bed. The cycle continues day after day.

Once you get in the cycle, you have to keep consuming the drug. Even worse, if you try to stop consuming caffeine, you get very tired and depressed, and you get a terrible, splitting headache as blood vessels in the brain dilate. These negative effects force you to run back to caffeine even if you want to stop.

Tolerance and withdrawal

Because caffeine is primarily an antagonist of the central nervous system's receptors for the neurotransmitter adenosine, the bodies of individuals that regularly consume caffeine adapt to the continuous presence of the drug by substantially increasing the number of adenosine receptors in the central nervous system. First, the stimulatory effects of caffeine are substantially reduced, a phenomenon known as a tolerance adaptation. Second, because these adaptive responses to caffeine make individuals much more sensitive to adenosine, a reduction in caffeine intake will effectively increase the normal physiological effects of adenosine, resulting in unwelcome withdrawal symptoms in tolerant users. Caffeine tolerance develops very quickly, especially among heavy coffee and energy drink consumers. A reduction in serotonin levels when caffeine use is stopped can cause anxiety, irritability, inability to concentrate, and diminished motivation to initiate or to complete daily tasks; in extreme cases it may cause mild depression. Together, these effects have come to be known as a "crash".

Careful research conducted by the department of psychiatry and behavioural sciences at Johns Hopkins University School of Medicine shows that low to moderate caffeine intake (as little as one 14-ounce mug per day) can quickly produce withdrawal symptoms.

Withdrawal symptoms — possibly including headache, irritability, an inability to concentrate, drowsiness, insomnia and pain in the stomach, upper body, and joints may appear within 12 hours after discontinuation of caffeine intake, peak at roughly 48 hours, and usually last from one to five days, representing the time required for the number of adenosine receptors in the brain to revert to "normal" levels, uninfluenced by caffeine consumption.

Caffeine Intoxication and Overdose

An acute overdose of caffeine usually in excess of about 250 mg, dependent on body weight and level of caffeine tolerance, can result in a state of central nervous system over- stimulation called caffeine intoxication (DSM- IV 305.90), or colloquially the "caffeine jitters". It may include restlessness, fidgetiness, nervousness, excitement, euphoria, insomnia, flushing of the face, increased urination, gastrointestinal disturbance, muscle twitching, a rambling flow of thought and speech, irritability, irregular or rapid heart beat, and psychomotor agitation. In cases of much larger overdoses, mania, depression, lapses in judgment, disorientation, disinhibition, delusions, hallucinations, and psychosis may occur, and rhabdomyolysis (breakdown of skeletal muscle tissue) can be provoked.

These symptoms can cause significant social and occupational disturbances. Caffeine intoxication is rarely fatal, although 5,000-10,000 mg of caffeine can actually kill you. Fortunately, most people won’t ever ingest this much caffeine accidentally - it would take between 30 and 60 cups of coffee in one morning.

Overuse

In large amounts, and especially over extended periods of time, caffeine can lead to a condition known as Caffeinism. Caffeinism usually combines caffeine dependency with a wide range of unpleasant physical and mental conditions including nervousness, irritability, anxiety, tremulousness, muscle twitching (hyper-reflexia), insomnia, headaches, respiratory alkalosis, and heart palpitations. Furthermore, because caffeine increases the production of stomach acid, high usage over time can lead to peptic ulcers, erosive esophagitis, and gastroesophageal reflux disease. Caffeine may also increase the toxicity of certain other drugs, such as paracetamol.

There are four caffeine-induced psychiatric disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: caffeine intoxication, caffeine-induced anxiety disorder, caffeine-induced sleep disorder, and caffeine-related disorder not otherwise specified (NOS).

Caffeine-induced sleep disorder

Caffeine-induced sleep disorder is a psychiatric disorder that results from overconsumption of the stimulant caffeine. The specific criteria for this disorder in the fourth axis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) include that there must be a significant inability to sleep which is caused entirely by the physiological effects of caffeine as proven by an examination; if sleeping issues can be accounted for due to a breathing-related sleep disorder, narcolepsy, or another mental disorder, then caffeine-induced sleep disorder is not the cause. This condition causes a notable impairment in functioning in sufferers

Although the number of symptoms due to caffeine consumption are many, however on the basis of importance, severity and relation to working habits of the BPO employees we have selected- Sleep Disturbances, Headache & Irritability. REVIEW OF LITERATURE

Although a number of studies on caffeine addiction have been conducted in the past, the following two appeared to be significant with respect to our study.

The first study done by the University of the Philippines (UP) Population Institute is about prevalence of caffeine consumption among BPO workers. The study, entitled Lifestyle and Reproductive Health Issues of Young Professionals in Metro Manila and Metro Cebu (), focused on the profile and lifestyle of young workers in the call center and non-call center industries in Metro Manila and Metro Cebu. The results obtained were: ○ Highly-caffeinated drinks like coffee and tea are a staple of BPO workers diets, which are provided by management through establishment of Vendor machines, free of cost. ○ In all, 2/3 of young workers drink coffee daily, but call center workers drink more coffee that their non-call center counterparts (2.3 cups a day for call center workers vs 1.7 cups for the latter). ○ More call center workers also consume tea (1/4 of respondents), compared to non-call center workers (only 1/5). ○ The study also revealed that half of young workers drink soda daily, at an average of 1.5 bottles/cans a day, regardless of group. ○ However, energy drinks are not as popular: only 15% of young workers drink energy drinks daily, the study found out.

The second was a study conducted by American Academy of Pediatrics (Charles P. Pollak, 2003) to study the Caffeine consumption and its effect on sleep patterns in teenagers. A total of 191 students participated. Caffeine intake ranged between 0 and 800 mg/d. Mean use over 2 weeks ranged up to 379.4 mg/d and averaged 62.7 mg/d. According to the study, higher caffeine intake in general was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep. Regardless of whether caffeine use disturbed sleep or was consumed to counteract the daytime effect of interrupted sleep, caffeinated beverages had detectable pharmacologic effects. RESEARCH QUESTION

“Will a cross-sectional study on 100 BPO workers of age group 20-50 yrs to detect the effects of caffeine addiction show any relationship between altered working habits and excess caffeine consumption as assessed by questionnaire method? ” OBJECTIVES

• To find the prevalence of caffeine consumption among BPO employees.

• To assess the proportion of BPO employees experiencing headache, irritability and sleep related symptoms.

• To explore the relationship between the above mentioned symptoms and excess caffeine consumption.

• To give recommendations to BPO employees based on the observations of the study. MATERIALS & METHODS

Design of study Cross-sectional study Subjects Randomly selected Sample of 100 BPO Employees 20 to 50 years old and working at BPO firms-Telecommunication and First Source Inclusion Criteria All BPO workers in the age group 20-50 yrs

Exclusion Criteria BPO employees older than 50 yrs

BPO employees working at BPO firms other than Telecommunication and First Source Sampling Simple Random Sampling Technique Study Tool Pre-determined Semi-structured Questionnaire Study Area Indore

Require Availabl Cost d e

Manpower Volunteers 4 4 Nil

Questionnai Material 100 100 Rs. 150 re Incidental Rs. 50 Charges

IMPLEMENTATION

The entire research study was done on 2 BPO firms in Indore- Telecommunications and First Source. A Qualitative protocol was used which involved data collection through a detailed objective-questionnaire. The questionnaire was distributed in random manner through the HR manager of the firms to BPO workers. Due to the concerns of the HR about compromise of their office time, they were given 2 days to fill the questionnaires. The Instrument for data collection, in the form of a ‘Structured Questionnaire’, consisted of the following sections:

1. Demographic aspects included name, age, gender, working hours and Alcoholic & Smoking nature. 2. Caffeine Consumption was assessed by objective questions about choice of beverage, size of cup and interval between drinks. (Q1-5) 3. Sleep disturbance suspected to be caused due to caffeine was assessed mainly by subject’s perception of his quality of sleep along with the duration of sleep. (Q6-10) 4. Headache problems were asked directly. (Q11) 5. Irritability as a part of the mood disorders suspected to be caused by Caffeine was assessed by 8 part questionnaire modified and adopted from The Irritability Questionnaire by K.J. Craig et al. 2008 (Kevin J. Craig, 2008). (Q12)

A copy of Questionnaire is given in the Appendix.

The responses thus obtained were then compiled, processed and analysed to arrive at the opinions on various issues. SCORING CRITERIA

As already mentioned the questions were divided in four sections. Most questions had three responses. Maximum points were allotted to exaggerated responses and associations, whereas minimum points were allotted to responses depicting least degree of association. The score of each section was then added to attain the total score.

RESPONSE SCORE 1. Which beverage you take often?

a Tea 1

b Coffee 2

c Energy Drinks 3

d De-Caffeinated Beverages 0 2. How often do you drink?

a Never 1

b Often 2

c Daily 3 3. How many cups you drink/day?

a 1-2 1

b 3-5 2

c >5 3 4. Which cup do you prefer?

a Disposable Tea Cup 1

b Regular Coffee Mug 3 c Other 2 5. Usual interval between 2 beverages?

a ½-2 hr 3

b 4-6 hrs 2

c >12 hrs 1

6. How much do you usually sleep in a day? a 4-6 hrs 3

b 6-8 hrs 2 c 8-10 hrs 1 7. Do you have trouble sleeping at night?

a Yes 3 b No 0 8. Do you feel sleepy all the day?

a Yes 3 b No 0 9. The amount of time that you usually take to fall asleep is:

a < 15 mins 1 b 15 mins – 1 hr 2

C > 1 hr 3 10 After taking a nap you usually feel- .

a Refreshed 0 b Sleepy 3 11 How often do you have a headache? . a Daily 2

b Once every 3-4 days 1 c Rarely 0

Total score for Caffeine Consumption (Q1-5) 1-6 Mild intake 7-10 Moderate intake 11-15 Heavy intake OBSERVATIONS & INTERPRETATION INITIAL RESEARCH FINDINGS

○ Out of the total 100 respondents 71% were male and 29% were female. ○ All of the subjects worked in Day Shifts. ○ Most of the subjects fall in the range of age 20-25 yrs. 1. Which beverage you take often…

Table 1 – Choice of Beverage Choice of Beverage Percentage (%)

Tea 61

Coffee 34

Energy Drinks 5

De-Caffeinated Beverages 0

Grand Total 100

Most of the respondents selected Tea as their drink of choice, followed by Coffee, whereas none opted for De-Caffeinated Beverages. This indicates a need to create awareness amongst the BPO employees about the benefits of switching to De- Caffeinated Beverages (like Decaf Coffee).

Tea- 61%, Coffee- 34%, Energy Drink- 5%, De-Caffeinated- 0% 2. How often do you drink…

Table 2 – Frequency of Beverage Consumption Frequency of Beverage Percentage (%) Consumption

Never 10

Often 29

Daily 61

Grand Total 100

As the above table shows, 61% of the subjects consume a caffeine containing beverages on a daily basis.

Never- 10%, Often- 29%, Daily- 61% 3. How much cups you drink/day…

Table 3 – Number of cups consumed per day Cups consumed per day Percentage (%)

1 - 2 49

3 – 5 27

> 5 24

Grand Total 100

The responses show that only about a fourth of the subjects drink more than 5 cups a day, or in other word are dependent on caffeine. While half of the subjects have only an ordinary intake of upto 2 cups per day.

1-2 cups- 49%, 3-5 cups- 27%, >5 cups- 24% 4. Which cup do you prefer…

Table 4 – Type of Cup preferred Preference of Cup Percentage (%)

Disposable Tea Cup 58

Regular Coffee Mug 34

Other 8

Grand Total 100

Since majority of the respondents have selected Tea as their choice of beverage, so it’s understandable that 58% chose Disposable Tea Cup as their option.

Disposable Tea Cup- 58%, Regular Coffee Mug- 34%, Other- 8% 5. Usual interval between 2 beverages…

Table 5 – Interval between consumption of Beverages Interval between 2 beverages Percentage (%)

½ - 2 hrs 27

4 - 6 hrs 54

> 12 hrs 19

Grand Total 100

More than 50% of the subjects consume the beverage at an avg. interval of 4-6 hrs. However, 27% drink a Caffeine containing beverage more frequently at an interval of ½ to 2 hrs.

½-2hrs- 27%, 4-6 hrs- 54%, >12 hrs- 19% 6. How much do you usually sleep in a day…

Table 6 – Duration of Sleep Duration of Sleep Percentage (%)

4 - 6 hrs 14

6 - 8 hrs 63

8 - 10 hrs 23

Grand Total 100

63% of the respondents sleep for a normal duration of 6-8 hrs. Only 14% were found to have reduced amount of sleep.

4-6 hrs- 14%, 6-8 hrs- 63%, 8-10 hrs- 23% 7. Do you have trouble sleeping at night…

Table 7 – Percentage of people having trouble sleeping at night Trouble sleeping at night Percentage (%)

Yes 52

No 48

Grand Total 100

More than half of the BPO employees have reported they have trouble sleeping at night, which may be due their caffeine consumption in addition to other factors.

Yes- 52%, No- 48% 8. Do you feel sleepy all the day…

Table 8 – Percentage of people feeling sleepy all day Sleepy all Day Percentage (%)

Yes 55

No 45

Grand Total 100

Despite the fact all of the BPO employees were day-shift workers and majority having an adequate sleep, more than half of them feel sleepy all day.

Yes- 55%, No- 45% 9. The amount of time that you usually take to fall asleep is…

Table 9 – Time taken to fall asleep Time taken to fall asleep Percentage (%)

0 – 15 mins 13

15 mins – 1 hr 83

> 1 hr 4

Grand Total 100

Maximum of the respondents require a considerable time of upto 1 hr to fall asleep. Only 4 respondents out of 100 take even longer than 1 hr to fall asleep.

0-15 mins- 13%, 15 mins-1hr- 83%, > 1hr- 4% 10. After taking a nap you usually feel…

Table 10 – Proportion of people who Percentage (%)

Refreshed 63

Sleepy 37

Grand Total 100

Around 1/3rd of the subjects feel sleepy upon waking up.

Refreshed- 63%, Sleepy-37% 11. How often do you have a headache…

Table 11 – Frequency of Headache Frequency of Headache Percentage (%)

Daily 23

Once every 3-4 days 37

Rarely 40

Grand Total 100

1 out of 4 respondents experience headache on a daily basis, which indicates the need to change the working conditions of the BPO employees.

Daily- 23%, Once every 3-4 days- 37%, Rarely- 40%

Prevalence of Caffeine Consumption

Caffeine Consumption Percentage (%)

I - Mild intake 8

II - Moderate intake 57

III - Heavy intake 35 Grand Total 100 EVALUATION & ANALYSIS

According to this study about 1/3rd of BPO employees were heavy consumers of Caffeine, and more than 50% fall in the category of moderate intake. However, this may not represent the overall trends due to limitation of sample size.

Mild intake- 8%, Moderate intake- 57%, Heavy intake- 35% Sleep Disturbance

Kruskal-Wallis Test Caffeine Consumption N Mean Rank

I - Mild intake 8 35.56

II - Moderate intake 57 44.20

III - Heavy intake 35 64.17 Total 10 0

Calculated χ2 = 12.724, Df= 2 Table χ2 = 10.60 (For 95% confidence interval)

Since the calculated χ2 is more than Table value so the Null Hypothesis is rejected and Alternate Hypothesis is accepted.

According to Spearman’s rho, correlation coefficient, r= 0.403 This means that around 16% of prevalence of Sleep Disturbance amongst BPO employees may be due to Caffeine consumption. Headache

Caffeine Consumption Total

Headache I - Mild II - III - Heavy intake Moderate intake intake

Rarely 4 29 7 40

Occasionally 3 15 19 37

Daily 1 13 9 23 Total 8 57 35 GT = 100

Pearson’s χ2 = 10.468, P value = 0.033

According to the above table, frequency of daily headache increases with increasing intake of Caffeine. From 12.5% in Group I to 22.8% in Group II to 25.7% in Group III experience headache on a daily basis.

Also total subjects complaining of headache rose significantly from 50% among workers with Moderate intake to 80% among those with Heavy intake. Irritability

Kruskal-Wallis Test Caffeine N Mean Rank Consumption

I - Mild intake 8 20.25

II - Moderate intake 57 40.05

III - Heavy intake 35 74.43 Total 100

Calculated χ2 = 39.958, Df= 2 Table χ2 = 10.60 (For 95% confidence interval)

Since the calculated χ2 is more than Table value so the Null Hypothesis is rejected and Alternate Hypothesis is accepted.

According to Spearman’s rho, correlation coefficient, r= 0.720 This means that about 50% of prevalence of Irritability amongst BPO employees may be due to Caffeine consumption. CONCLUSION

• More than 50% of the BPO employees were found to have moderate intake of Caffeine. And as many as 35% were heavy consumers of Caffeine.

• 61% of subjects are habituated to drink a Caffeine containing beverage daily.

• According to this study 16% of prevalence of Sleep disturbance, 50% of Irritability may be attributed to high Caffeine consumption.

• Also Heavy consumers of Caffeine were found to have significantly more complaints (80%) of headache as compared to Mild consumers (50%). DISCUSSION

Caffeine is the most commonly consumed psychoactive drug in the world. It produces tolerance very quickly which is responsible for its various withdrawal symptoms. Out of various side-effects of Caffeine we have selected to study- Sleep disturbances, headache and Irritability.

The aim of our study was to find out the overall prevalence of caffeine consumption, and to explore the relationship between excess caffeine consumption and the above mentioned symptoms.

It was a cross sectional study done in a randomly selected sample of 100 BPO employees 20 to 50 years old working at Telecommunications & First Source, Indore. Data was collected via a semi-structured questionnaire which was then compiled and analyzed.

According to the study 57% of the BPO employees were found to have moderate intake of Caffeine and as many as 35% were heavy consumers. This might be ascribed to free vending machines provided by the management. Also in the study we were able to correlate Sleep Disturbance (16%), Irritability (50%) with Caffeine consumption. 80% of Heavy consumers were found to have complaints of Headache as compared to 50% of Mild consumers.

In comparison to a previous study- “Lifestyle and Reproductive Health Issues of Young Professionals in Metro Manila and Metro Cebu” conducted by the University of the Philippines (UP) Population Institute which stated that 2/3rd of BPO employees consumed Caffeine containing beverage on a daily basis, our results of 61% correlate well, considering the demographic and geographic limitations. RECO MMENDATIONS

• The BPO workers and all who have moderate to heavy intake should be made aware of the ill-effects of long term caffeine consumption.

• DRINK LOTS OF WATER, LOTS AND LOTS OF WATER. Get yourself a replacement drink, it could be water, juice, decaf - just something to get when the urge for a cup sneaks in.

• Herbal Tea can also be used a good alternative to Caffeine containing beverages.

• Workers should avoid drinking Caffeine beverage at least 4hrs prior to sleeping, and get adequate sleep of 6-8 hrs.

• They should indulge in relaxation activities such as Meditation, Exercise.

• The BPO management should have provisions for De-Caffeinated beverages, which will improve the working capacity of their employees along with a healthy life style. BIBLIOGRAPHY

1. http://www.abs-cbnnews.com/lifestyle/08/05/10/call-center- workers-diet-fast-food-caffeine-and-alcohol. [Online]

2. Charles P. Pollak, David Bright. Caffeine Consumption and Weekly Sleep Patterns in US Seventh-, Eighth-, and Ninth- Graders. Pediatrics. 2003, 111.1.42.

3. Kevin J. Craig, Heidi Hietanen, Ivana S. Markova, German E. Berrios. The Irritability Questionnaire: A new scale for the. Psychiatry Research. 2008, 367–375.

4. Park, K. Park's textbook of Preventive and Social Medicine.

5. http://health.howstuffworks.com/wellness/drugs- alcohol/caffeine.htm. [Online]

6. www.medterms.com. [Online]

7. http://en.wikipedia.org/wiki/Caffeine. [Online]

8. http://coffeeaddic.blogspot.com/. [Online] APPENDIX Appendix I

Time Line Chart Appendix II

Department of Community Medicine MGM Medical College & MY Hospital Indore PSBH Questionnaire

Name- Age: ___ yrs Sex: M/F

Working hours- Day Shift/Night Shift

Alcoholic/Non-Alcoholic Smoking/Non-Smoking

1. Which beverage you take often?

Tea Coffee Energy drinks De-Caffeinated Beverages

2. How often do you drink?

Never Often Daily

3. How much cups you drink/day?

1-2 3-5 >5

4. Which cup do you prefer?

Disposable Tea Cup Regular Coffee Mug Other- ______

5. Usual interval between 2 beverages?

½-2 hr 4-6 hrs >12 hrs

6. How much do you usually sleep in a day?

4-6 hrs 6-8 hrs 8-10 hrs

7. Do you have trouble sleeping at night? Yes/No 8. Do you feel sleepy all the day? Yes/No 9. The amount of time that you usually take to fall asleep is: ______10.After taking a nap you usually feel- Refreshed Sleepy

11.How often do you have a headache?

Daily Once every 3-4 days Rarely

12. The following statements are about feelings that everyone experiences from time to time. Please circle the number that best shows how you have been feeling over the last 2 weeks. Don't take too long with your answers. Your immediate response is probably the most accurate. • I become impatient easily when I feel under pressure. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • At times I find everyday noises irksome. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • At times I can’t bear to be around people. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • When I get angry, I use bad language or swear. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • Things are not going according to the plan at the moment. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • I am quiet sensitive to others remarks. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • I feel as if people make my life difficult on purpose. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so • Other people always seem to be getting the breaks. How often? How much? 0 – Never 0 – Not at all 1 – Occasionally 1 – A little 2 – Quite often 2 – Moderately 3 – Most of the time 3 – Very much so Appendix III

Master Table Age(y Q Q Q Q Q Q Q Q Q Q1 Q1 Names rs) Sex 1 2 3 4 5 6 7 8 9 0 1 Q12 Aashiq Ali 28 M a c b a b a a a b b a 40 Abijeet Singh 30 M a b c a b b a a b b b 33 Abishek Nageshwar 21 M b c c b a b a a b b c 41 Ajay 25 M c c c a a b a a b b b 43 Akansha Dawar 20 F c c a a c c b b c a a 18 Akida Wahi 20 F b b a a c b b b a a c 11 Alka 22 F b c a b b a b b b a b 28 Altaf Khan 22 M b b c a b c b a a a a 11 Anil Bbhosle 25 M b a c b b b a a b a b 23 Anil Maurya 22 M a b a a c c b a b b b 9 Anish Tripathi 25 M a a a a b a b a c a b 21 Ankit Khourke 21 M a c a c b a b a b a a 23 Anshul Kumar 25 M a c c a b c b a b a a 34 Anuj Gupta 20 M a c a a c c b b b a c 6 Anurag Mohan 22 M c b b b b c a a b b b 34 Arjun Verma 25 M a c a c a b a a b b a 33 Arpit Navlikha 21 M b b a a b b b b b a c 16 Ashok Khare 22 M b b b b b b a b b b c 37 Bharat Kumar 45 M a c b a b b b a b a c 10 Bijendra Jaiswal 28 M b c c a b b a a b b b 42 Birbal Singh 30 M a c b b b b b b b a b 34 Brijesh Chaurasia 21 M a c b b b b b a b a a 23 Chagan Lal 50 M a c a a b a a a b a b 26 Chanchal Singh 23 F a b b a a b a b b a a 21 Chandni Likhar 20 F b b a b a b b b b a c 21 Debashish 25 M a b a a c c b b b a c 13 Deepak Bhavsar 22 M a b b b b c b a b a c 18 Devendra Bhayal 20 M b b b b b a a b b b b 39 Dinesh 22 M a c a b b b a b b a a 21 Fatema Collegewala 20 F a c a a b c b a b a c 12 Gaurav Gupta 23 M a b b a c b b a b a b 13 Gokul kumar 23 M b a c a a a a a b a b 24 Gopal Rathore 22 M a c a a c c b a c b c 7 Jayshree 20 F b b a c a b b b a a c 17 Jitendra 20 M a b a b b b b a b b b 20 Kamlesh Wadhwani 21 M a c b b b b b a b b a 33 Karan Kumar 30 M a c c a a b a a b b b 42 Karan Trivedi 24 M b c a c c c b b b a c 8 Keerthi 21 F a b a a c c a b b b c 12 Kratika Joshi 22 F b c b b b b a b b b a 33 Laxmi bai 50 F a c b a b b a b b b b 24 Mahesh Rathore 24 M a c c a a b a a b b b 43 Manish 20 M a c a a c b a a b a c 19 Manisha Goyal 20 F a c a a c c a a b a c 12 Mazhar Ali 22 M a c c a a b a a b b b 36 Monica Verma 24 F a c a c b b b a b a b 22 Muffadal Bhojawala 24 M b c b b b a a b a a c 32 Mulayam Singh 36 M a c b a a a a a b b a 27 Munish Nandwani 27 M b a a b b b b b a a c 11 Murtaza Johar 20 M a b b a b b b a b a b 30 Muskan Jain 22 F b c b a b a a b a a c 44 Naman Srrivastava 25 M b c c c a b a a b b b 44 Natasha Shah 25 F c c b b a b b b b a a 33 Naveen Jaiswal 31 M a c c a b c a b b a a 29 Neelam Bajaj 21 F a c a b c b a b b a c 20 Neeraj K 35 M b b a a b b b b b a c 26 Nilesh 22 M a a c a c c a a b b b 20 Nitesh 23 M a c a a a b a a b a b 20 Nishant Rai 23 M b c b a b a a b b b b 31 Palak Dave 22 M a c b a b c a a b a c 12 Parul Shah 31 F a b b a b c b b b a b 28 Pawan Rathore 24 M a c b a b b a a b a a 17 Pawan Sahu 22 M a c c a a b a a b b b 40 Pinky Verma 21 F a c a b b a a b b a c 31 Prashant Choudhary 25 M b b b a b b b b a a c 33 Preeti 21 F a c c b a c b a a a a 32 Preeti Singh 27 F b b b b b b b a b b b 28 Radhe Shyam 47 M a c a a b b b b b a c 28 Rahul Medla 21 M a b b c a b a a b a c 21 Rahul Tare 31 M a a a a a b b b a b c 16 Rajendra Verma 33 M a c a b b b a b b a b 26 Rajesh Verma 25 M b c c b b b a a b b b 38 Rakesh Verma 24 M a a a a c c b a a b b 8 Ram Singh 25 M a b a a c b b b b a c 11 Ram Kumar 32 M a c b b b b b a b a a 26 Ram Kumar Gehlot 30 M b c c a b b a a b b a 37 Ranjana Beeghal 23 F b c a b a b b b b a c 21 Rashmi 20 F b a a a b b b b c a c 16 Richya Vyas 20 F b c a a c c b a b a c 14 Rishika 23 F a c a a a b b b b a b 20 Sanju 22 M a c a a a c b b b a c 23 Shagun Sharma 24 M b c c a a b a b b b c 48 Shankar Rathore 30 M a c c a b b a a b b a 34 Shivam Rathore 25 M b c c b b b a a b b b 42 Shraddha Prapanna 21 F a a a b a b b b a a a 17 Sneha 23 F b b a a b b b b a a c 13 Sonal Patil 20 F a c a c c b b b b a c 21 Shubham 20 F b b a b b b a a b b b 22 Surbhi Khatwa 20 F a c a a b c b a b a c 12 Sumit Yadav 21 M c c a b c b a a b b c 19 Swati Sharma 21 F a b a a c b a a b a a 30 Upendra Ranjan 28 M a b a a b a b b b a c 12 Vijay Prakash 28 M a a a a b b b b b a c 9 Vijay Gujral 25 M a c c a a b a a b b b 38 Vikas Soni 25 M b b a b a b a b a a a 31 Vinay Patodia 21 M a c a b b b a b b a c 31 Vinod Gupta 28 M a c c a a b a a b b b 36 Vinod Jaiswal 25 M b b a b b b a a b a a 17 Yash Bhrammabha tt 22 M b c c b a a a a b b b 44 Yogesh Sharma 29 M a c b b b c a b b a b 35