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Research Article
Adolescent Attitudes and Beliefs Regarding Caffeine
and the Consumption of Caffeinated Beverages
Paige Turton, MScFN, RDy; Len Piche, PhD, RD; Danielle S. Battram, PhD, RD
ABSTRACT
Objectives: To explore adolescents’ attitudes and beliefs toward the consumption of caffeinated beverages and factors influencing their caffeinated beverage choice and consumption patterns.
Design: Twenty focus groups were conducted with grades 9 to 12 secondary school students.
Setting: Two secondary schools in London, Ontario, Canada.
Participants: This study included 166 adolescents, 42% of whom were male and 72% of whom were in
grades 9 and 10.
Phenomenon of Interest: Adolescent views regarding caffeine and caffeinated beverages.
Analysis: Three researchers independently conducted inductive content analysis on the data using the
principles of the immersion-crystallization method.
Results: Awareness levels regarding types of caffeinated beverages and their negative health effects were
high in adolescents whereas awareness of other aspects of caffeine itself and recommended consumption
levels were low. Adolescents also identified reasons for caffeine use, including providing energy, taste,
accessibility, and image enhancement. Influences for caffeine use most noted by participants included
parental role modeling, media and advertising, and social norms.
Conclusions and Implications: Further education is needed to correct the misconceptions adolescents
have regarding certain aspects of caffeine. By gaining a deeper understanding of adolescents’ caffeine
use, effective educational strategies may be developed to reduce its use and mitigate potential harms.
Key Words: adolescents, caffeine, caffeinated beverages, attitudes, focus groups (J Nutr Educ Behav.
2016;48:181-189.)
Accepted December 5, 2015.
INTRODUCTION
Caffeine is the most available and
widely used psychoactive substance in
the world. It is also the only drug that
is legally accessible and socially acceptable for consumption by children and
adolescents.1 Currently, adolescents
are the fastest-growing population of
caffeine users, with caffeinated beverage
consumption rates increasing considerably over the past decade.2 Recent
studies have determined that 83.2%
of adolescents consume caffeinated
beverages regularly and at least 96%
consume them occasionally.3,4 For
adolescents who consume caffeine,
their estimated intake ranges from 60
to 800 mg/d, which suggests that a
percentage of this population may
be overconsuming the substance.1,5
Mitchell et al3 indicated that adolescents in the 90th percentile consume
an average of 2.9 mg/kg body weight
per day of caffeine, which exceeds
Health Canada's6 current recommendation of 2.5 mg/kg body weight per
day for this age group.
Division of Food and Nutritional Sciences, Brescia University College, Ontario, Canada
Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online
with this article on www.jneb.org.
†
P. Turton was a graduate student and dietetic intern at the time this work was conducted.
Address for correspondence: Danielle S. Battram, PhD, RD, Division of Food and Nutritional Sciences, Brescia University College, 1285 Western Rd, London, Ontario N6G
1H2, Canada; Phone: Telephone: (519) 432-8353, extension 28228; Fax: (519) 858-5137;
E-mail: dbattra@uwo.ca
Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights
reserved.
http://dx.doi.org/10.1016/j.jneb.2015.12.004
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
Because adolescents are consuming
more caffeine, and more caffeinated
products are available in the marketplace, there is reason to be concerned
about the potential negative health effects of its use. Indeed, caffeine overconsumption and caffeine intoxication
have resulted in serious health effects.7
Symptoms of caffeine intoxication include nervousness, anxiety, restlessness,
insomnia, gastrointestinal upset, tremors,
tachycardia, and in rare instances,
death.8,9 The extent to which caffeine
intoxication occurs in adolescents is
currently unknown; however, even
moderate doses of caffeine (100–400
mg) can result in nervousness and jitteriness in children and adolescents.10-12
To date, the majority of published
research regarding caffeine has been
conducted with adults, not adolescents.1 Furthermore, in-depth research
has not been done to discover adolescents' perceptions and understanding.
Although Ludden and Wolfson13
investigated caffeine use, reasons for
use, and expectancies in adolescents,
they used a survey with predetermined
181
182 Turton et al
responses, and therefore did not allow
adolescents to freely express themselves.
Bunting et al14 explored adolescents'
perceptions of caffeinated drinks through focus group discussions; however, they focused only on caffeinated
energy drinks, not caffeine itself.
This limits their findings to only 1
source of caffeine. Because only 10%
of adolescents consume caffeinated
energy drinks on a regular basis,3 a
broader understanding of caffeine in
general, from all sources, is warranted.
Therefore, the aims of this study were
to investigate (1) adolescents' attitudes and beliefs toward caffeinated
beverages, and (2) factors influencing
their caffeinated beverage choice and
consumption patterns.
METHODS
Research Design
A qualitative study design using focus
groups as a means of data collection
provided the framework for this study.
The researchers also chose the PRECEDEPROCEED model for Health Promotion Planning and Evaluation to guide
this study because it includes a
comprehensive diagnosis of the problem (PRECEDE; ie, social and environmental factors), while being mindful
of collecting information for the
future implementation and evaluation of programming (PROCEED).15
The authors obtained ethics approval
from the research ethics boards at
both Brescia University College and
Western University.
Sampling Methods and
Recruitment
Upon the researchers receiving permission from the local school board, 2
local high schools from different areas
of the city were contacted by school
board personnel. Because income level
was not an area of interest in this
study, these schools were selected
randomly from the representative
pool of schools contained within
middle-income neighborhoods. The
investigators then contacted health
and physical education teachers
(n ¼ 5) at these schools, at which
time the purpose of the study was explained. All teachers agreed to help recruit students from their respective
classes and to aid in the logistics of
conducting the focus groups. Investi-
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
gators then attended these classes to
explain the study to all eligible participants. Recruitment packages were
handed out to all students (n ¼ 230)
with instructions to obtain informed,
written parental consent and, when
appropriate, students' assent for those
interested in participating in the
study. Students were eligible to participate if they were in grades 9–12,
currently enrolled in a health class,
and aged 13–18 years. In total, 177 students agreed to participate in the
study, which gave a response rate of
77%. Because focus groups were conducted during a designated date and
time, all students absent from their
designated session (n ¼ 11) were
removed from the study, which left a
total of 166 participants.
Focus Group Protocol and Data
Collection
Focus group sessions took place during
a regularly scheduled class on a day predetermined by the classroom teacher.
Each focus group was conducted by a
trained moderator and an assistant
moderator or note taker. Graduate students with an interest in adolescent
health were chosen to assist with this
study, because moderators who enjoy
interacting with adolescents increase
the success of focus groups.16 The
moderator guided the focus group discussions using a guide developed by
the researchers. Taking into consideration the population group, questions
were short, unambiguous, and openended.17 The semi-structured nature
of the interview guide ensured consistency and flexibility as the discussion
unfolded within each focus group.18
After the first day of focus groups
(n ¼ 4), the moderators and researchers
met to discuss the guide and modifications were made to improve clarity.
The final guide consisted of 8 questions. Four questions focused on adolescents' thoughts on caffeine: ‘‘What
comes to mind when you hear the
word caffeine?’’ ‘‘What effects does
caffeine have on the body?’’ ‘‘Why do
you think students your age use
caffeine?’’ and ‘‘What do you think influences students your age to use
caffeine?’’ Two questions explored
their knowledge regarding which beverages contained caffeine and how
much caffeine is recommended each
day. The final 2 questions were:
‘‘What advice would you give your
peers and younger siblings about
caffeine?’’ and ‘‘Where would you go
to get reliable information about
caffeine?’’ Focus groups were stratified
by sex and grade level to capture potential differences. For logistical reasons, 2
focus groups included both males and
females. Focus groups ranged from 15
to 60 minutes in duration. Although
the intent was to conduct focus groups
until saturation was reached (12 focus
groups), at the request of the schools,
all students enrolled in a health and
physical education class who wished
to participate in the study (and had provided consent or assent) could do so (20
focus groups in total).
All transcripts were audio recorded
and transcribed verbatim by a professional transcriber to ensure that all
data were captured. To improve the
trustworthiness of the data, a detailed
journal was completed by the moderator after each set of focus groups, to
serve as an audit trail. Member checking
was conducted throughout the focus
group discussions to ensure that participant responses were understood and
clarification was obtained as needed.
Debriefing sessions also were conducted
at the end of each focus group to discuss
overall impressions and any concerns
with the session. These data provided
the researchers with the context for
each focus group. A brief demographic
questionnaire with questions about
age, sex, grade level, caffeinated beverage
consumption patterns, and smoking
habits was administered to participants upon completion of the focus
group session. Because a detailed
assessment of caffeine intake was not
the purpose of this study, a comprehensive validated questionnaire was
not used; rather, questions were asked
only to obtain a general understanding of the frequency and types of
caffeinated beverages consumed. Participants received a $10 iTunes gift
card for participation and participating classes received a 90-minute
interactive, educational lesson on
caffeine, delivered by the researchers
after the focus groups were completed.
Data Analysis
Using the principles of the immersioncrystallization method,19 the researchers used inductive content
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
analysis to analyze and explore the
dominant and recurrent themes arising
from the focus group data.20 All investigators coded the transcripts independently and then met to discuss their
findings. Where coding discrepancies
occurred, the group discussed and
resolved these discrepancies by
consensus until a common theme template was developed. Transcripts from
male and female focus groups as well
as from different grade levels were
coded separately to explore possible differences. Data were managed using Microsoft Word (version 14.0.0, Microsoft
Corporation, Santa Rosa, CA, 2010).
The demographic data were analyzed
by simple descriptive statistics using
Microsoft Excel (version 14.0.0, Microsoft Corporation).
RESULTS
Twenty focus groups (n ¼ 166) were
conducted in 2 secondary schools in
London, Ontario between December,
2013 and May, 2014. Each group was
composed of 3–12 participants
(average, 8.3 participants). Table 1 lists
participant characteristics. With regard
to caffeinated beverage consumption,
4.8% of participants reported never
drinking caffeinated beverages, 11.4%
reported drinking caffeinated beverages
every day, 44.6% reported consuming
caffeinated beverages 1–6 d/wk, and
39.2% reported drinking caffeinated
beverages once in a while. The most
popular beverages consumed were
soft drinks (69.9%), coffee beverages
(such as lattes) (48.2%), tea (41.6%),
coffee (22.3%), and energy drinks
(11.4%).
Supported by participant quotations, 3 important primary themes
emerged during data analysis: (1) a
generally high level of awareness and
knowledge regarding caffeinated beverages and their negative health effects
(Table 2), (2) reasons for caffeinated
beverage
consumption
patterns
(Table 3), and (3) key factors influencing caffeinated beverage choice
and consumption patterns (Table 4).
Secondary themes also are included in
the respective tables. Sex and grade
level differences were evident and are
described subsequently where applicable.
Turton et al 183
Table 1. Characteristics of the Study Participants (n ¼ 166)
Male
42
Female
58
Total
Age (mean [SD])
15.0 (1.29)
15.0 (1.31)
15.1 (1.30)
Grade level (%)
9/10
11/12
31
10
41
18
72
28
Smoker (%)
Yes
No
2
98
0
100
Sex (%)
Note: A sample size of 165 was used to calculate average age.
Awareness Level and
Knowledge
Caffeine and caffeinated beverages.
Overall, participants had a high level
of awareness with regard to identifying
beverages containing caffeine (eg, coffee, soft drinks, or energy drinks)
(Table 2). Participants also were able
to identify other sources of caffeine
(eg, chocolate, chocolate milk, and
hot chocolate), noncaffeinated soft
drinks, and herbal teas. Despite this
awareness, however, there appeared
to be some confusion regarding which
caffeinated beverages contained the
most caffeine. Although coffee and energy drinks were most often reported,
some participants were unclear about
tea and soft drinks.
No participant was able to state
Health Canada's current recommendation correctly as to the maximum
amount of caffeine to consume per
day; the majority of participants referred to the maximum amount in
cups of coffee rather than milligrams
of caffeine per day. Despite this,
when asked what they would tell their
peers or younger siblings about
caffeine, almost all participants stated
that moderation should be exercised
by their peers, whereas strict limits
and avoidance should be imposed on
their younger siblings.
When participants were asked,
‘‘What comes to mind when you hear
the word caffeine?’’ the majority responded with an outcome expectancy
of caffeine, such as ‘‘energy’’ or ‘‘hyper,’’ or with a caffeinated beverage
such as coffee. Most adolescents did
not understand what caffeine is, and
often equated it with sugar. Their
perception was that most caffeinecontaining drinks (with the exception
of coffee) contained sugar. Only a few
participants (mostly older students in
grades 11 and 12) mentioned caffeine
as a drug.
Health effects of caffeine use. When
participants were asked to state the potential effects of caffeine on the body,
the majority of responses were related
to perceived negative health effects.
When further prompted by moderators, only a few positive effects were
mentioned. Participants had a high
level of awareness regarding the risks
of consuming too much caffeine; the
most cited effects were short-lived energy, elevated heart rate, insomnia,
and shakiness or jitteriness. Stunting
of growth also was noted as a dominant theme, but only by female participants. With regard to positive health
effects, the most commonly stated
ones included increased energy, wakefulness, and improved focus or concentration. When asked where they
would go for reliable information, participants most often responded by
saying the Internet (including company Web sites) and their parents, followed by their doctor or teachers.
Reasons for Caffeine Use
Energy provision. The most common
reason mentioned by participants for
consuming caffeinated beverages was
the perceived outcome expectancy of
alertness (Table 3). Caffeine was
consumed in the morning, evening,
and during exams to stay awake for
class and to study. This energy provision, however, was strongly interconnected with the type of beverage, such
as coffee and energy drinks. When
asked how they would feel if caffeine
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
184 Turton et al
Table 2. Representative Quotations Regarding Adolescents’ Awareness Level and Knowledge of Caffeine
Theme
Quotation
Caffeine and caffeinated ‘‘Energy, like hyper.’’ (grade 12 girl)
beverages
‘‘Coffee is the first thing you think of.’’ (grade 10 girl)
‘‘I would say, like a cup, like 1 serving.’’ (grade 9 girl)
‘‘Like, kids have enough energy as it is. They don’t need to be drinking any coffee or whatever.’’
(grade 9 boy)
Health effects of
caffeine use
‘‘Sugar rush.’’ (grade 12 boy)
‘‘I would get really shaky.’’ (grade 12 girl)
‘‘Like, even more tired when you crash, so it’s like you are kind of going backward by even drinking it
in the first place.’’ (grade 12 girl)
‘‘Completely messes with your blood sugar. Like, it spikes it and then you crash half an hour or an
hour later.’’ (grade 12 boy)
‘‘Like, coffee, everyone always says that if you drink too much it will stunt your growth.’’ (grade 9 girl)
were removed from these beverages,
the majority of participants stated it
would be problematic, particularly if
the beverage were purposefully being
used for energy. Furthermore, a few
participants indicated that they consumed some caffeinated beverages
(eg, coffee) for the perceived energy,
despite not liking its taste. There was
a significant sex difference in that only
older male participants mentioned
consuming caffeine for energy during
sporting events, training, and social
gatherings (eg, house parties). Finally,
combining caffeinated beverages and
alcohol was mentioned by a few male
participants (grades 9–12) despite
their understanding of potential negative health effects.
Taste. Taste was the second most
common reason why adolescents
chose to consume specific caffeinated
beverages. This was especially true for
soft drinks. Participants also stated
that if caffeine were removed from
beverages that are consumed for taste,
it would not alter their choice, unless
the removal of caffeine affected the
taste of the beverage.
Accessibility. Accessibility was mentioned throughout all of the focus
groups as a primary reason for
consuming caffeinated beverages. Participants mentioned the close proximity of stores and restaurants and
the simplicity of obtaining caffeinated
beverages within a short walking distance of their schools. Having the
ability to bring caffeinated beverages
back into the school and classroom
also was mentioned as a reason for
consumption. Participants discussed
the lack of barriers, such as an age
limit, to purchase such beverages. In
addition, some participants noted
that caffeine is accessible because it
is present in the beverages they like
to drink, such as soft drinks and coffee
beverages (eg, iced cappuccino).
Image enhancement. Although it was
a relatively minor secondary theme,
image enhancement and feeling
mature were mentioned, particularly
Table 3. Representative Quotations Regarding Adolescents’ Reasons for Caffeine Use
Theme
Energy provision
Quotation
‘‘Getting through the day.’’ (grade 10 girl)
‘‘. For coffee and energy drinks, it’s more like the energy boost in the morning or through the day kind
of deal.’’ (grade 12 boy)
Taste
‘‘I think that it defeats the purpose of energy drinks if you were to take the caffeine out, but other
beverages, I think its fine.’’ (grade 12 boy)
‘‘I don’t really drink for the caffeine. I drink for the taste.’’ (grade 9 girl)
‘‘. I only drink coffee for the caffeine. That’s all I drink with it. I don’t like the taste.’’ (grade 11 girl)
Accessibility
‘‘Because it’s in what we drink.’’ (grade 10 boy)
‘‘It’s in so much stuff that it gets to a point where you don’t exactly care what it’s in.’’ (grade 10 boy)
‘‘Very convenient. Very easy to find.’’ (grade 12 boy)
‘‘We can probably name 4 to 5 places on the corner within 100 feet or less that we could go get any type
of caffeine .’’ (grade 12 girl)
‘‘You can purchase it, like basically anywhere. So it’s not really anything bad like alcohol. You don’t have
restrictions to buying it or using it.’’ (grade 9 girl)
Image enhancement ‘‘Like, we as teenagers, we want to grow up and we feel that coffee kind of seems like a more mature
adult beverage, so we want to drink it.’’ (grade 9 girl)
‘‘My mom and dad are coffee drinkers, so I would always want to try it to be like them, even though
I didn’t really like the taste, but now I find I am actually starting to accept the taste a little bit more.’’
(grade 9 student)
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
Turton et al 185
Table 4. Representative Quotations Regarding Factors That Influence Adolescents’ Caffeinated Beverage Choice and
Consumption Patterns
Theme
Parental role
modeling
Quotation
‘‘If you see your parents drinking it, you are like, oh, it’s not that bad because they are supposed to be a
role model so it can’t be that harmful, right?’’ (grade 12 girl)
‘‘Like, if you see your parents drinking it, and it gets them through the day, then maybe if you are having a tired
day, then you can do it, too, to help you get through the day.’’ (grade 9 girl)
‘‘Say if we are going somewhere, my mom usually gets a (brand coffee), so then I have a choice to have one or
not.’’ (grade 10 boy)
‘‘I go to [coffee house] with her [mom] almost every day and so I feel like if I go with her I might as well grab a
drink just since I’m there, right, I might as well.’’ (grade 9 girl)
‘‘Also, most of us don’t do our own grocery shopping. Our parents will buy the groceries for us, so it’s kind of
whatever is in the house that’s available to eat or drink.’’ (grade 12 girl)
Media and
‘‘I know that you get more drawn toward products that you do see advertised, like if I am going to get an energy
advertising
drink, I am more drawn toward [common brands] because they are advertised so much. So I know that they
are the better choice of energy drink . because they have been advertised more.’’ (grade 12 boy)
‘‘I think you also eat with your eyes, so if something looks appealing to you on the outside then you’ll
be more inclined to try it.’’ (grade 9 girl)
‘‘If it is colorful and pretty looking, I get drawn toward that more because it will taste better because of the looks
of it.’’ (grade 12 girl)
Social norm
‘‘Because like it’s not really a taboo. It’s like a social thing. You don’t see people being ashamed of drinking
caffeine, so it encourages you and tells you that it’s not wrong.’’ (grade 9 girl)
‘‘Just because your peers or your friends do it, so they might drink energy drinks, so you might just drink it
purely because you think other people are drinking it, so why not, kind of thing.’’ (grade 12 boy)
‘‘. People nowadays, if you ask them, do you drink coffee, and they say no, it’s surprising now because
it’s just kind of expected, I guess.’’ (grade 12 girl)
by younger participants (grades 9 and
10). Drinking caffeinated beverages,
and in particular coffee, was seen as
something older adolescents and adults
do, and the ability to drink coffee
without restriction by parents was
seen as a sign of being grown-up.
Factors That Influence
Caffeinated Beverage Choice
and Consumption Patterns
Parent role modeling. Regardless of
age or sex, when adolescents were
asked what influences them to drink
caffeinated beverages, parental role
modeling was the most commonly
mentioned response (Table 4). Adolescents most often mentioned observing
their parents drinking caffeinated beverages (eg, coffee in the morning),
which implied that caffeine (coffee)
was safe and acceptable for use. Adolescents also stated that parents' purchase of caffeinated beverages outside
the home (eg, fast-food outlet) was a
common routine before work and
school. Whether prepared at home or
bought on the way to work or school,
participants mentioned that their parents either offered a caffeinated
beverage to them directly or simply allowed free access to these beverages.
Fewer participants stated that their
parents had some control over what
types of products were purchased and
available at home, although control
over the use of these beverages once
in the home was not mentioned.
Media and advertising. Media and
advertising of caffeinated beverages
also emerged as major influencing factors for caffeinated beverage use.
Although participants frequently mentioned the use of catchy phrases, attractive packaging, and role models
(celebrities) as key ways by which companies promoted the appeal of their
products, adolescents appeared to
focus primarily on the frequency and
placement of advertisements on television and in sport venues and how this
affected their brand choice. Furthermore, participants seemed to have
some awareness of the different marketing techniques used by companies
to sell their products. This led to some
discussion about the image often portrayed by energy drink advertisements,
and how a specific product could boost
sport performance. Finally, some participants also mentioned the use of incentives to influence their beverage
choice and purchase, although this
was a minor theme.
Social norm. Some participants mentioned social norms as a factor that
influenced their choice and consumption of caffeinated beverages. Participants discussed how commonly these
beverages are consumed by their peers
and how it is perceived to be against
the social norm when one of their
peers declines drinking them. Some
participants also mentioned that
seeing their peers drinking a particular
beverage could encourage them to try
it themselves.
DISCUSSION
Adolescents provided a rich understanding of their overall attitudes
186 Turton et al
and beliefs regarding the consumption of caffeine and caffeinated
beverages. Guided by the PRECEEDPROCEED model,15 participants not
only identified a variety of intrinsic,
social, and environmental factors
contributing to their intake but also
provided some key insights into potential program planning regarding
caffeine use in this population. Overall, participants exhibited high awareness regarding beverages that contain
caffeine and the potential negative
health effects of caffeine overconsumption. However, these findings
are in contrast to those previously
observed by both O'Dea21 and Bunting et al,14 who found that youth as
well as adolescents and young adults
(aged 11–18 and 16–21 years, respectively) had a low level of awareness
regarding the potential health risks
associated with energy drink consumption. It is possible that owing to
their enrolment in a health class, participants in the current study had
higher levels of awareness. Although
caffeine and its health effects are addressed in the current provincial
Health and Physical Education curriculum for grade 10 and therefore were
taught to the majority of participants,22 when asked where they
would go for credible information
regarding caffeine, the dominant
source mentioned was the Internet
rather than their teachers. Regardless,
there continues to be a lack of awareness about caffeine, the amount found
in beverages, and the current recommendations for safe consumption.
Although participants' awareness
regarding the potential negative health
effects of too much caffeine use may
have been high, their caffeine consumption patterns were similar to
those previously reported in the literature. Based on findings from the
demographic questionnaire, 95% of
participants reported consuming
caffeinated beverages at least once in
a while, which is similar to that reported by Temple et al.4 Furthermore,
the types of caffeinated beverages
consumed by participants (eg, soft
drinks, coffee-type beverages, and energy drinks) were consistent with
recent findings by Mitchell et al3 and
Branum et al,23 which suggests that
despite the increased awareness, participants appear to consume caffeinated beverages at a level similar to
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
that of the general adolescent population. The concept of increased awareness not translating into better health
behaviors was previously observed in
adolescents with regard to healthy
eating24 and is consistent with the
notion that although awareness of
health behaviors can be present, it is
only at a later age that health consciousness develops and translates to
choosing healthier products.25
Participants identified many reasons
for consuming caffeinated beverages.
The finding that these adolescents
consume caffeinated beverages for the
outcome expectancy of providing energy is consistent with that previously
reported for both adolescents and
young adults.13,14,26 Bunting et al14
found that energy seeking was a dominant motivating factor for consuming
energy drinks among 16- to 21-yearolds; however, whereas participants in
that study sought the pleasurable kick
of using energy drinks, the majority of
adolescents in the current study did
so to stay awake to study or to handle
busy schedules. Furthermore, whereas
Ludden and Wolfson13 found that
experimentation and fun were reasons
for caffeine use among high school students, this was rarely mentioned by
participants in the current study.
When caffeine use was mentioned for
use at social gatherings by participants,
it, too, was for the purpose of staying
awake.
Taste continues to be a dominant
reason for caffeinated beverage choice
and is consistent with previous findings in children, adolescents, and
young adults.14,26-28 Similarly, taste
tends to override awareness of the
negative health effects of consuming
such beverages.14,27 This is in contrast
to the idea that taste, too, could be
ignored if a beverage were being used
specifically for energy provision. The
removal of caffeine from beverages
consumed for taste was not deemed
problematic by participants, unless
the taste was altered by its removal.
Although caffeine has been suggested
to be a flavor enhancer in soft drinks,
this remains controversial.29,30
Participants noted that accessibility
was a dominant reason for consuming
caffeinated beverages, particularly
within and in close proximity to the
school environment. A negative correlation has been observed between
accessibility and soft drink consump-
tion in children.31 Furthermore,
school-based policy interventions
have been shown to be effective in
reducing sweetened beverage consumption in the US.32 Although a
School Food and Beverage Policy that
limits the type of beverages sold
within the school environment exists
in Ontario,33 it does not address beverages purchased off-site and brought
into the school environment.
Some younger adolescents (grades
9 and 10) found that drinking caffeinated beverages, and in particular coffee, made them feel mature. This is
consistent with findings from Bunting et al,14 who found that adolescents and young adults value the
image aspects of energy drinks even
above their functionality of providing
energy. This concept of maturity was
further demonstrated by participants'
beliefs that these beverages (eg, coffee
and energy drinks) should be limited
or banned for consumption by
younger siblings, and speaks to the influence of role modeling by older siblings and, more importantly, parents.
In addition to the reasons why adolescents consume caffeinated beverages, participants also mentioned
some factors that influence their
beverage choice and consumption.
Parental role modeling was consistently mentioned by participants,
particularly with respect to the availability and accessibility of caffeinated
beverages both within and outside
the home. This is consistent with previous findings indicating that the
home food environment has a strong
influence over children's beverage
consumption patterns.34 Furthermore,
parental role modeling practices are
also known to influence children's
eating behaviors and soft drink consumption.31,35,36 In contrast to that
observed in children,28 parental control practices were not directly
mentioned by participants. In a qualitative study involving both parents
and adolescents, Bassett et al37 found
that although adolescents have autonomy over their food choices, parents
still exerted influence by control practices (eg, controlling household food
supplies) and by coaching, coaxing,
and coercing. One could argue that
although adolescents in the current
study did not acknowledge these control practices, they were present,
because parents controlled the access
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
of beverages in the home but also
when frequenting food outlets on the
way to school.
Media and advertising also were
common influences noted by participants, which is consistent with previous literature involving energy drink
use in adolescents.14,21,38 Whereas
participants mentioned the attractiveness and appeal of certain products
(commonly reported in the literature),14,21 the primary focus was on
the frequency and placement of advertisements and messaging implied by
beverage companies (eg, enhanced
sport performance). This, too, is consistent with previous research that
has demonstrated the ability of media
to have an impact on the dietary
habits of children.39 In contrast to children, however,28 participants appeared
to have some media literacy regarding
the potential marketing strategies and
underlying intentions of advertisers.
The effect of media exposure and literacy on caffeinated beverage consumption patterns in adolescents is
currently unknown. However, Chang
et al40 employed multivariate analysis
to demonstrate higher alcohol and tobacco use among 10th graders with
higher media exposure and lower media literacy for alcohol and tobacco,
respectively. The modest media literacy observed in the current study's participants is in contrast to that observed
by Bunting et al,14 who found that
with respect to energy drinks, adolescents had little media literacy. This
may be because participants in the current study learned about media literacy in grade 9 as part of the health
curriculum.22
Adolescents also noted that social
norms were a common influence on
their caffeinated beverage choice
and consumption patterns. This is
similar to findings by Bunting
et al,14 who found that older adolescents and young adults (aged 16–
21 years) were more conscious of
social image and peer group norms
than were older individuals (aged
22–35 years) with respect to energy
drinks. The concept of social conformity has been reported among adolescents with respect to healthy
eating,41 which suggests that whereas
direct peer pressure (eg, taunting or
ridicule) may not have a significant
role in choosing foods, the potential
risk of not fitting in is enough to
change behavior.
Only students enrolled in a health
and physical education class were
eligible to participate in this study.
Therefore, it is possible that these students may have been more interested
in health (and may avoid caffeine)
and may have had a higher level of
awareness regarding caffeine and its
negative health effects. Although a
comprehensive assessment of caffeine
intake was not done, intake appears to
be similar to that found by Mitchell
et al3 in the same age group, which
suggests that the current sample did
not avoid caffeine despite their
exposure to the health curriculum.
Furthermore, although the sex distribution of the current study's sample
is representative of the school population (M. Reagan, oral communication,
2015), it contained a higher proportion of grade 9 and 10 students, which
limits the current study's findings to
younger adolescents. The greater proportion of grade 9 and 10 students is
likely the result of more students being enrolled in lower-level health classes, because students are required
to take only 1 of these classes to graduate. To ensure that the current
findings were transferable to all adolescents, the researchers compared focus
groups by grade level and identified
themes where appropriate. The number of participants per focus group
ranged from 3 to 12 and may have influenced responses; however, debriefing
notes suggest that this was not a
concern. Finally, although not the
focus of this work, both high schools
were located in middle-income areas
neighborhoods, and therefore the
findings may not be transferable to adolescents living in other income areas.
IMPLICATIONS FOR
RESEARCH AND
PRACTICE
Data emerging from this qualitative
study add to the existing body of primarily quantitative knowledge concerning adolescents' perceptions of
caffeine and caffeinated beverages.
Although awareness of certain aspects
of caffeinated beverages was high
among the current study's participants, some misconceptions remain.
Turton et al 187
In particular, the current Health Canada recommendation of caffeine in
milligrams per body weight did not
appear to resonate with participants;
therefore, presenting these recommendations in more relatable and understandable ways (eg, common serving
sizes) may be warranted to improve
awareness within this population.
Because caffeine consumption was
strongly seen as an energy provider,
to reduce caffeine use effectively in
adolescents, a broader educational
approach beyond caffeine may be
needed and should include alternate
strategies to improve perceived energy
level, such as eating a healthy diet and
getting adequate sleep. Furthermore,
parents as role models and arbiters of
adolescent intake were identified as a
key influence on participants' caffeine
use. Therefore, it would appear that
there is a continued need to include
parents in educational strategies not
only to understand their continued
influence on adolescents' beverage
choices and consumption patterns
but also to increase their awareness
and knowledge with respect to the
amount of caffeine deemed safe for
use by their children.
In addition to education, participants suggested some potential policy
and environmental influences that
may inform strategies to reduce caffeine
intake among adolescents. Because soft
drinks contribute to the amount of
caffeine in the adolescent diet,23 the
reduction or removal of caffeine from
these beverages could be a means of
decreasing caffeine intake. Furthermore, because accessibility beyond the
school environment was seen as a major influence on intake, advocating for
policies regarding the built (and food)
environment (eg, limit vendors selling
caffeinated beverages around school
environments) may enhance and
complement existing policies in the
schools. Finally, renewed interest in
advocating for policies regarding restricting advertising to children, in
addition to continued education
surrounding media literacy, appears
warranted. By developing more
comprehensive educational strategies
and enhancing policies, it may be
possible to decrease caffeine use in adolescents and mitigate the potential
health risks of caffeine overuse within
this population.
188 Turton et al
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
ACKNOWLEDGMENTS
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This study was supported and funded
by Brescia University College. The authors thank the participants, the high
school staff for their support (especially M. Reagan and T. Swift), the London District Catholic School Board for
allowing access to their students and
families, and the graduate and undergraduate students who helped conduct
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189.e1 Turton et al
CONFLICT OF INTEREST
D. Battram gave an invited lecture at
the Dietitians of Canada conference
Journal of Nutrition Education and Behavior Volume 48, Number 3, 2016
in 2012 for PepsiCo. She received a
monetary stipend for the presentation,
for accommodation, and for the prep-
aration of a handout for health professionals. The other authors have not
stated any conflicts of interest.