1. Emerging Patterns in Beverage Consumption among New Brunswick Students: Alcohol and Energy Drinks Hao Wang, Neeru Gupta, Maurice Collette, Suzanne Clair, Laura Brennan New Brunswick Department of Health

2. Content Background Questions to Answer NB Student Drug Use Survey Data Analysis Energy Drinks Policy Consideration 2

3. Background Growing concern about the consumption of energy drinks among children and youth –Substance in energy drinks Caffeine, taurine, herbal supplements, sugar –Deleterious health effects Anxiety, irritability, headache, insomnia –Mixing of alcohol and energy drinks 3

4. Questions to Answer What is the picture of energy drinks consumption among New Brunswick students? Are there associations between energy drinks consumption and other substances, especially alcohol? What policy approaches can be considered to reduce the health risk of consuming energy drinks among New Brunswick students? 4

5. Energy Drinks and Alcohol Consumption New Brunswick Student Drug Use Survey 2012 (NBSDUS) –Cross-sectional survey in NB public schools –Survey sample: 3,507 –Grades: 7, 9, 10, and 12 –Age: 11 - 19 –Survey questions: Energy drinks, alcohol, smoking, cannabis 5

6. Energy Drinks and Alcohol Consumption 6

7. Results of Multinomial Regression Model Table 1. Odds ratios from the adjusted multinomial logistic regression of energy drink use in past 12 months One to two times vs. Non-use Three to twelve times vs. non-use More than once a month vs. non-use Sex Male 1.05 (0.99,1.10) 1.78(1.65, 1.92) 2.99 (2.74, 3.27) Female Ref Grade 7 1.30 (1.19, 1.42) 1.39 (1.23, 1.58) 3.21 (2.76, 3.73) 9 1.82 (1.68, 1.98) 2.02 (1.82, 2.24) 3.61 (3.20, 4.07) 10 1.34 (1.24, 1.45) 1.20 (1.09, 1.33) 1.47 (1.31, 1.65) 12 Ref Cannabis use Use at least once 2.42 (2.22, 2.63) 3.40 (3.08, 3.74) 6.31 (5.65, 7.05) Not use Ref Alcohol Use More than once a week 2.87 (2.53, 3.25) 5.58 (4.81, 6.47) 8.28 (7.02, 9.77) Once a week or less 2.97 (2.77, 3.19) 5.38 (4.88, 5.93) 6.15 (5.45, 6.95) Not use Ref Cigarette Use More than once 3.40 (2.95, 3.93) 6.37 (5.49, 7.40) 10.03 (8.60, 11.70) Not use Ref Note: 95% confidence interval in the parenthesis 7

8. Key Findings from NBSDUS 57% of students have consumed energy drinks in the past 12 months 12% of students have consumed energy drinks regularly (more than once a month) in past 12 months Male students are more likely to use energy drinks, with an increased odds ratio at higher levels of consumption Strong association between energy drinks and alcohol use among students Strong association between energy drinks consumption and other risk behaviors (smoking, Cannabis use) 8

9. Energy Drinks Policy - Federal Regulation (2013) Compositional –Maximum limit for total caffeine of 400 mg/L –Maximum amount of caffeine not to exceed 180 mg per single serve container –Energy drinks cannot be used as an ingredient in pre-mixed alcoholic beverages –Limits on other ingredients such as vitamins and minerals –Listing of accepted and unaccepted ingredients 9

10. Energy Drinks Policy- Federal Regulation (2013) Labeling –Required statement: “Not recommended for children, pregnant/breastfeeding women, individuals sensitive to caffeine” “Do not mix with alcohol” “High source of caffeine” –Requires the labeling of the amount of caffeine from all sources to be shown in milligrams per container or per serving size –Requires that all general food labeling provisions apply (nutrition facts table, ingredient labeling, allergen labeling) 10

11. Energy Drinks Policy Consideration – New Brunswick Department of Education and Early Childhood Development has a policy (policy 711) that says sweetened beverages are not permitted to be served or sold in the school setting Some schools have implemented their own policies that restrict students from bringing energy drinks into the school 11

12. Energy Drinks Policy Consideration – New Brunswick New Brunswick Department of Heath is in the process of considering energy drink policy options –Regulatory –Non-regulatory Education and awareness Research Partnership and collaboration 12

13. Reference 1.Azagba S, Langille D, and Asbridge M. An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school students. Preventative Medicine, 2014; 62:54-59 2.Azagba S, Langille D, Asbridge M. The consumption of alcohol mixed with energy drinks: prevalence and key correlates among Canadian high school students. CMAJ Open, 2013; 1(1):E19-E26 3.Gupta N, Wang H, Collette M, and Pilgrim W. New Brunswick Student Drug Use Survey Report 2012. Fredericton: New Brunswick Department of Health, 2013 4.New Brunswick Health Indicators, Issue 9, September 2013 5.New Brunswick Stakeholder Dialogue on Energy Drinks Summary Report, New Brunswick Department of Health, 2014 (Publishing soon) 13

14. Thank You 14