Knowledge and Attitude of Medical Students Regarding Coffee Consumption
Asuncion, Marjorie __ R.N., Astudillo, Janah B. R.N., Barcena, Melden Darrell.T. R.N.,
Barcena, Lowrey Gail U. R.N., Bringas, Anne Lorraine H. R.N., Cacanindin, Kristin Deanne Q.
R.N., Maddumba, Dominic A. R.N., Servano, Raymund Jeffrey __ R.N., Willis, Steven John __
R.N.
_______________________________________________
Affiliation: Department of Research, School of Medicine
Saint Louis University Baguio City
A Research Paper Submitted to the
Faculty of Department of Research
School of Medicine
Saint Louis University
Disclaimer: The opinions expressed by the authors in this research do not necessarily reflect
those of the Department of Research, School of Medicine, Saint Louis University or other
organizations the authors are affiliated with.
Correspondence:
Dominic
mengmaddumba@gmail .com
A.
Maddumba,
Reprints not available from the authors.
__________________________________
Word Count
Pages: 14
Words: 3,373
Characters (no spaces): 18, 381
Characters: (with spaces): 21, 399
Paragraphs: 393
Lines: 632
_________________________________
Number of tables: 5
Number of Figures: 1
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ABSTRACT
The study utilized a cross-sectional study to investigate the attitudes and perceptions of
1st to 3rd year medical students associated with coffee consumption which was conducted in Saint
Louis University, School of Medicine Baguio City, Philippines. The research data was collected
using a 7-itemed questionnaire. All questions were calibrated prior to commencement of the
study, by discussing as a group questionnaire administration and recording of data accurately.
Questionnaires outlined information needed in an informed consent and was answered and
collected during the participants’ free time.
Of the 449 participants, the vast majority of the participants (78.61%) reported
consuming coffee beverages, with no significant difference among the three academic years. As
far as the frequency of caffeine usage is concerned, majority of the participants (46.74%)
consumed at least one cup per day. The study found out that Students usually consume coffee for
academic purposes with preferences to taste and quality of the product. Medical students also
rely on coffee to give them an energy boost and attention for their studies. Coffee consumption
in cups also increases as one progress through the ladder of medical education (from first year to
third year).Though caffeine is widely used and consumed, medical students in general are using
caffeine without having sufficient knowledge (ranging from little to moderate knowledge) of its
benefits, side-effects and withdrawal symptoms.
INTRODUCTION
Caffeine is the most widely consumed behaviorally active substance in the world. Almost
all caffeine comes from dietary sources (beverages and food), most of it from coffee and tea.
Acute and, especially, chronic caffeine intake appear to have only minor negative consequences
on health. For this reason and because few caffeine users report loss of control over their caffeine
intake, governmental regulatory agencies impose no restrictions on the use of caffeine. Ordinary
caffeine use has generally not been considered to be a case of drug abuse, and is indeed not so
classified in DSM-IV (Diagnostic and Statistical Manual of Mental Disorder). However, some
years ago it was pointed in a study that ‘caffeine may be a potential drug of abuse’1, and more
recently caffeine has been described as ‘a model drug of abuse’2 and the possibility that caffeine
abuse, dependence, and withdrawal should be added to diagnostic manuals has been seriously
considered. Furthermore, given the ‘potential for physical dependence and the side effects
associated with use and withdrawal’3, it is important to increase our understanding of the factors
that characterized the caffeine use.
Medical students, with heavy academic loads, had succumbed to the effects of caffeine.
With the stressful schedule and the inherent pressure of the course, many medical students have
tried using caffeinated products to enhance their academic standing. Caffeine is often used for its
benefits, which include increased vigilance. It does have side-effects, however, such as
palpitations and withdrawal symptoms that include headaches and drowsiness. Tertiary
education often requires students to study for extended hours, especially during periods of
increased workload prior to tests and examinations. Medical students, who have to master a very
large volume of academic work in a limited period of time, are no exception. Caffeine is often
used for some positive effects that can result when it is consumed in moderation. There is
increased evidence of adverse physical effects related to caffeine such as sleep deprivation,
increased heart rate and blood pressure, central nervous systems disorders, vasodilation,
trembling, seizures, urticaria, headaches, and increased body temperature. Caffeine has been
shown to have effects on behavior as well. In a study, it has been shown to be related to ‘poorer
grades and decreased performance in the classroom, disruption of coordination in complex tasks,
sleep disorders such as sleep apnea, nervousness, hyperactivity, agitation, anxiety, withdrawal
from play and interaction, attention disorders, and disruptive behaviors’.4
This study aims to determine the knowledge and attitude of Medical Students towards
coffee consumption, to determine the knowledge that contribute to the prevalence of coffee
consumption, and to determine the attitude of medical students on the benefits, side-effects and
withdrawal symptoms related to coffee consumption.
METHODS
Study Design:
The study utilized a cross-sectional study to investigate the knowledge and attitudes
associated with coffee consumption.
Setting, Subject Participant and Procedure:
The research was conducted in SLU in Rizal Building in middle of the second semester
through the use of a 7-itemed questionnaire. All questions were calibrated prior to
commencement of the study, by discussing as a group questionnaire administration and
recording of data accurately. Questionnaires outlined information needed in an informed consent
and was answered and collected during the participants’ free time. The research procedures
conform to the ethical standards for the treatment of human participants.
Participants were chosen based on a pre-formed criterion which includes: 1st year to 3rd
year students who are currently enrolled in SLU-School of Medicine S.Y. 2013 – 2014, should
be more than 18 years of age and in a regular year-level schedule with at least 8 hours of school
time. A total participation rate of 96.35% (449 out of a possible total 466) was obtained, with the
participation from the first-years (87%; 145/165), second-years (99%; 164/165), and third-year
students (84%: 140/165). One hundred seventy seven were male (39.42%) and 253 were female
(56.34%), while twenty participants (4.23%) did not indicate their gender.
Measures:
Coffee Consumption: Participants were questioned whether they consumed coffee or not.
For those consuming coffee, additional questions were asked regarding a) the frequency of
coffee consumed in a day b) certain attitudes that influenced them to consume coffee products.
All participants were asked on knowledge regarding the benefits, side-effects and withdrawal
symptoms of coffee consumption.
Data Analyses:
First, demographic data were assessed. For each variable of interest, frequency and
percentages were utilized to define the study’s findings. Participant’s knowledge and attitudes
were ascertained in relation to year level and coffee consumption. Analyses of variance were
conducted to examine differences in coffee consumption between year levels. All data
management and statistical analyses were performed using comparison of frequencies and
percentages.
RESULTS
Of the 449 participants, the vast majority of the participants (353/449; 78.61%) reported
consuming coffee beverages, with no significant difference among the three academic years
(p=0.04) As far as the frequency of caffeine usage is concerned, one cup per day users comprised
of 46.74% (165/353) of the participants, while 43.06% of participants (152/553) drank 2-3 cups
of coffee per day, 7.37% (26/353) drank 3-5 cups per day, 2.27% (8/353) drank 7 cups or more
per day and 0.57% (2/353) drank 5-7 cups per day. The frequency of caffeine consumption by
participants in each academic year group is shown in Figure 1.
Figure 1: Frequency of coffee consumption
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
1
2
3
FIRST
SECOND
4
5
THIRD
Participants consuming 4 or more cups of coffee could be regarded as heavy coffee
drinkers, those drinking 2-3 cups as moderate coffee drinkers and those drinking 1 cup as light
coffee drinkers.
The participants’ scores on the section of the questionnaire testing their knowledge
regarding the benefits, side effects and withdrawal symptoms of coffee consumption were
calculated and categorized (0= without knowledge; 1-3= little knowledge; 4-6= moderate
knowledge; 8-10= good knowledge). Average scores obtained by the different year groups are
presented in Table 1
TABLE 1
Knowledge Regarding the Benefits, Side Effects and Withdrawal Symptoms of Coffee Consumption
Category
Level of Knowledge*
Year Level
“YES” Questions
“NO” Questions
Average
st
1 Year (N=145)
5.13
6.14
5.64
2nd Year (N=164)
4.94
6.14
5.54
3rd Year (N=140)
5.14
4.75
4.95
*Legend:
0= without knowledge, 1-3= little knowledge
4-6= moderate knowledge, 8-10= good knowledge
The average score obtained on their knowledge of the benefits of caffeine for the total
group of participants was 5.14 out of 10. About 88.20% were categorized as having moderate
knowledge, while 7.80% had little knowledge, 3.34% had good knowledge and 0.67% had no
knowledge at all. Table 2 shows the frequency and percentage of the correct responses of the
medical students, with most having correct responses to the misconception that coffee “Prevents
impotence” (363/449; 81.39%), “Slows metabolism” (341/449; 76.80%) and “Increases alcohol
intolerance” (333/449; 74.66%)
TABLE 2
Knowledge of Medical Students Regarding the Benefits of Coffee Consumption
Statements
Prevents impotence
Increases alcohol tolerance
Slows metabolism
Increases vigilance
Substitute for sleep
Increases short-term memory
Increases long-term memory
Prevents Parkinson’s disease
Prevents Alzheimer’s disease
Prevents type 2 diabetes mellitus
Correct Response
NO
NO
NO
YES
NO
NO
YES
YES
YES
YES
Frequency
363
333
341
320
283
267
111
99
99
82
Percentage
81.39%
74.66%
76.80%
71.91%
63.45%
59.87%
24.89%
22.20%
22.20%
18.39%
The average score on the knowledge of side effects of caffeine was 7.16 out of 10
for all three groups. Only 0.67% had no knowledge while 50.33% had good knowledge, 47.88%
had moderate knowledge and 1.11% had little knowledge. Table 3 shows the frequency and
percentage of the correct responses of the medical students, with most having correct responses
to the fact that coffee “Causes rapid beating of the heart” (421/449; 94.18%), and “Increases
Cardiac Output” (359/449; 80.31%) and to the misconception that coffee “Causes impotence”
(368/449; 82.33%)
TABLE 3
Knowledge of Medical Students Regarding the Side-Effects of Coffee Consumption
Statements
Causes rapid beating of the heart
Causes impotence
Increases cardiac output
Causes slow beating of the heart
Causes acne
Increases cardiac contraction force
Increases gastric secretion
Causes dry eyes
Increases respiration rate
Causes hot flushes
Correct Response
YES
NO
YES
NO
NO
YES
YES
NO
YES
NO
Frequency
421
368
359
353
343
328
328
297
263
157
Percentage
94.18%
82.33%
80.31%
78.97%
76.73%
73.54%
73.54%
66.44%
58.84%
35.12%
The average score on the knowledge of withdrawal symptoms was 6.14 out of 10 for all
three year groups. About 76.39% had moderate knowledge, while 21.16% had good knowledge
of the withdrawal symptoms. Little and moderate knowledge was demonstrated by 1.78% and
0.67% of participants, respectively. Table 4 shows the frequency and percentage of the correct
responses of the medical students, with most having correct responses to the misconception that
withdrawal symptoms include “Skin Itching” (358/449; 80.09%), “Hallucinations” (344/449;
76.96%) and “Congestion” (323/449; 72.42%)
TABLE 4
Knowledge of Medical Students Regarding the Withdrawal Symptoms of Coffee Consumption
Statements
Skin itching
Hallucinations
Congestion
Forgetfulness
Aggression
Fatigue
Decreased alertness
Headache
Drowsiness
Constipation
Correct Response
NO
NO
NO
NO
NO
YES
YES
YES
YES
YES
Frequency
358
344
323
293
261
Percentage
80.09%
76.96%
72.42%
65.70%
58.39%
57.94%
56.15%
55.48%
55.48%
38.93%
259
251
248
248
174
The options “Drinking coffee gives me an energy boost” (159/353; 45.71%), “I drink
coffee to keep me awake” (143/353; 40.63%) and “I drink coffee for the taste” (136/353;
38.64%) were the three most common reasons agreed by the participants in choosing their
caffeine product. While the three most disagreed options are: “I drink coffee because it is
fashionable” (177/353; 50.28%), “Drinking coffee makes me feel important” (148/353; 42.05%)
and “I drink coffee because my friends do” (142/353; 40.34%) The comparison of these
differences is shown in Table 5.
Questions
1.
2.
3.
4.
5.
6.
Drinking coffee
increases my risk of
getting cancer.
Drinking coffee
increases my risk of
heart disease.
I cannot fall asleep
when I drink coffee
during the day.
I prefer drinking tea
to drinking
decaffeinated coffee.
Drinking coffee gives
me an energy boost.
I drink coffee
because my friends
do.
Table 5
Attitudes Regarding Coffee Consumption
Level of Attitude*
SD
D
N
A
f
%
f
%
f
%
f
%
SA
f
%
Ave
%
81
23.01
132
37.50
106
30.11
25
7.10
8
2.27
2.28
53
15.06
90
25.57
106
30.11
77
21.88
26
7.39
2.81
66
18.75
99
28.13
95
26.99
73
20.74
19
5.40
2.66
68
19.32
72
20.45
118
33.52
53
15.06
41
11.65
2.79
10
2.84
30
8.52
101
28.69
159
45.17
51
14.49
3.60
142
40.34
88
25.00
81
23.01
29
8.24
12
3.41
2.09
7.
8.
9.
10.
11.
12.
13.
14.
I drink coffee for the
taste.
I drink coffee
because it is
fashionable.
Drinking coffee
relaxes me.
I prefer drinking tea
to drinking any type
of coffee.
I cannot fall asleep
when drinking coffee
in the evening.
I drink coffee to help
me stay awake.
I prefer local brands
of coffee to imported
ones.
Drinking coffee
makes me feel
important.
29
8.24
30
8.52
88
25.00
136
38.64
68
19.32
3.52
177
50.28
93
26.42
59
16.76
11
3.13
12
3.41
1.83
35
9.94
37
37
90
25.57
124
35.23
66
18.75
3.42
90
25.57
77
21.88
119
33.81
41
11.65
25
7.10
2.53
71
20.17
105
29.83
93
26.42
60
17.05
21
5.97
2.59
26
7.39
29
8.24
78
22.16
143
40.63
74
21.02
3.60
29
8.24
31
8.81
207
58.81
59
16.76
24
6.82
3.05
148
42.05
85
24.15
90
25.57
16
4.55
13
3.69
2.04
*Legend:
SD=Strongly Disagree (1), D=Disagree (2) , N=Neutral (3) , A=Agree (4), SA=Strongly Agree (5)
DISCUSSION
Participation was 96.35% for the entire population of first- to third- year medical
students. Based on the high response rate from each academic year group, it can be stated that
the results obtained in this investigation are representative of the target population. The results
indicated that 78.61% of the 446 participants used caffeine. This is in line with the idea that
caffeine is one of the most widely consumed substances.
According to reports, coffee consumption (which ranks second only to oil among the
world's legally traded commodities), continues to increase. A similar study on caffeine
consumption on high school students is also consistent with the results, where only ‘around 10%
of participants did not consume coffee’.5
Experts predict that the level of consumption will follow population growth. Moreover,
domestic consumption also increases by 2.25% per year. This could be attributed to the
proliferation of coffee specialty shops, catering to a wider and younger clientele. With the
growing awareness of coffee drinking in the Philippines, it is no wonder that the option “I drink
coffee for the taste” ranked 3rd in the most agreed option. It can be noted that the consumer of
today's specialty or ordinary coffee ‘declares a certain intellectual awareness, and perhaps
superiority, with his purchase’.6
The options “Drinking coffee gives me an energy boost” and “I drink coffee to keep me
awake” were the two most common reasons agreed by the participants in drinking caffeine
product. Most of the students drink coffee to help them in their academic performance. In
another study supports this result stating that ‘improvements in mental functioning are of interest
among college students, many who suffer from sleep deprivation’.7
Studies show that caffeine, the most widely used ergogenic aid, was proven to be a highly
effective energy booster. Caffeine is a ‘central nervous system stimulant that can help you
perform better because it acts to increase alertness as well as lower your perception of effort’.6
But another study show the contrary, it was found out that: ‘caffeine use among undergraduate
students was least likely when studying for an exam or doing project related to their
coursework’.3 The difference may be attributed to the different academic load between under
graduate courses and the more strenuous medical post-graduate course.
The option “I drink coffee because it relaxes me” was also agreed upon by the
respondents. This could be attributed to the effect of low dose caffeine which improves hedonic
tone and reduces anxiety, while at high doses, increases in tense arousal, including anxiety,
nervousness, and jitteriness.
Energy drink consumption is a popular practice among college students, particularly if
the student has had insufficient sleep, if they need more energy in general, while studying for
exams or working on major course projects. Caffeine was found to be the ‘primary constituent
responsible for these effects’.7
Third year students had the highest percentage of light drinkers among the three year
levels followed by the first years and the second years. Second year students had the highest
percentage of moderate drinkers followed by the first year and the third year students. Highest
percentage of heavy drinkers was noted with the third year students followed by the second year
and the first year students. The increasing amount of coffee consumption in the third year
students (highest light and heavy drinkers) may be attributed to the increasing academic load of
the year level in relation to the proportion of stress in the course. This is supported in another
study wherein the ‘Average caffeine use increases with each year in school, with seniors
consuming more caffeine’.3 This is explained in part by students having busier schedules as they
continue through medical school. Caffeine intake seems to be more closely correlated with
performing school-related tasks than with socializing and partying. This is also congruent in
another research study wherein ‘coffee consumption was closely related to school work’. 9
The average score for the caffeine knowledge test was 6.15 out of 10 for the total group
of participants. From the results obtained on the individual questions, it appeared that the
participants had the most knowledge on the side effects of caffeine intake, less knowledge on the
withdrawal symptoms and the least knowledge on its benefits.
In relation to the common facts and misconceptions concerning caffeine, it was evident
that many students did not believe that coffee consumption can increase long term memory and
can be a substitute for sleep. These perceptions are supported by studies. Caffeine may help in
short term-memory but there is yet a study to support the claim that it enhances long termmemory. Also, caffeine is not a substitute for sleep. There is no substitute for a loss of sleep.
Though a dose of caffeine may transiently improve concentration or attention, its effects are
limited. Since coffee contains caffeine, a stimulant, coffee drinking is not generally considered to
be part of a healthy lifestyle. However, coffee is a ‘rich source of antioxidants and other
bioactive compounds’.10
Though students were aware that caffeine increases vigilance (which could be attributed
to the prevalence of caffeine consumption among medical students) it was also found out that
students had little knowledge on the benefits of caffeine in age-related degenerative diseases.
Caffeine has been found to delay the progression of Alzheimer’s, Parkinson’s and Diabetes
mellitus type 2. The lack of awareness may be due to the focus on the conventional ways to treat
these degenerative diseases which not includes the intake of some supplements.
Participants were more knowledgeable about the side-effects of caffeine, especially with
regards to its effects on the cardiovascular system: Tachycardia, Increased cardiac output,
Increases cardiac contraction, and Increased gastric secretion. Most, however, appears to be
unaware that the option “Hot flushes” is not considered as a side effect of coffee consumption.
Most of the participants have correctly identified that Skin itching, Hallucination, and
Congestion are not experienced during caffeine withdrawal, but it is also noted that less than
60% of the participants have correctly identified withdrawal symptoms such as Fatigue,
Decreased alertness, Drowsiness, and Headache. Merely around 1/3 of the participants have
identified Constipation as a symptom of withdrawal.
The trend of these results was likewise noted in a similar research study conducted. 11 The
knowledge regarding coffee consumption may be attributed to the participants’ personal
experiences as most are consumers of coffee and may have at one time experienced the benefits
and side effects. It is also not surprising that the participants have a high percentage in their
knowledge regarding caffeine side-effects; unpleasant effects of caffeine are noted earlier while
benefits are less likely to be experienced immediately. Due to the ongoing consumption of coffee
by the participants, and the probable heavy consumption of caffeine, it is also less likely for them
to experience withdrawal symptoms (as most will manifest upon cessation of caffeine
consumption).
While the study focused only on coffee consumption, it would also be noteworthy to
compare the study results on the attitudes and knowledge of medical students to other caffeine
containing products like tea, soda and energy drinks.
The results obtained in this study show that students usually consume coffee for
academic purposes with preferences to taste and quality of the product. Medical students also
rely on coffee to give them an energy boost and attention for their studies. Coffee consumption
in cups also increases as one progress through the ladder of medical education (from first year to
third year). Though caffeine is widely used and consumed, medical students in general have
insufficient knowledge (ranging from little to moderate knowledge) of the benefits, side effects
and withdrawal symptoms.
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drinks/2011/09/26/gIQAft8y1K_blog.html
2) Majithia , N. (2007, November). Retrieved from http://www.jyi.org/issue/caffeineunderstandingthe-worlds-most-popular-psychoactive-drug/
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