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. 2024 Nov 27;11(12):1448. doi: 10.3390/children11121448

Relationships Among Soda and Energy Drink Consumption, Substance Use, Mental Health and Risk-Taking Behavior in Adolescents

Surya Suresh 1, Jennifer L Temple 1,2,*
Editor: Matteo Fabris
PMCID: PMC11674941  PMID: 39767877

Abstract

Background/Objectives: Energy drink (ED) use is increasing among children and adolescents, but little is known about the impacts on health, including substance use and mental health. The purpose of this study was to examine the relationship between soda and ED consumption and substance use, mental health, and risk taking in a nationally representative sample of high school students. Methods: We used data from the 2019 Youth Risk Behavior Surveillance System (YRBS) from New Jersey, Montana, and Florida to assess these relationships using binary and multinomial regression analyses to determine odds ratios, comparing non-consumers with daily consumers. The sample was 10,548 adolescents (51.6% female) between the ages of 13–19 years. Results: Daily soda and ED consumption were associated with greater odds of substance use (OR(95% CI): 5.8 (3.7, 6.9)/10.2 (6.4, 16.3)), poorer mental health (OR(95% CI): 2.6 (1.3, 4.8)/1.8 (1.2, 2.8), and higher odds of eating fast food (OR(95% CI): 17.2 (8.9, 33)/10.6 (5.6, 19.9). These effects were moderated by sex. Conclusions: These findings suggest that soda and ED use are associated with greater risk taking among adolescents and that these relationships are moderated by sex. Future studies should determine the directionality of these relationships and examine the impact of reduced soda and ED consumption on health behaviors in children and adolescents.

Keywords: caffeine, energy drinks, substance use, risk taking, adolescent, mental health

1. Introduction

Caffeine use is prevalent in the US diet, with 87% of adults consuming it daily, averaging 193 mg (1.2 mg/kg body weight) [1]. In children, caffeine intake is far lower, with the average being around 50 mg/day in adolescents [2], and the primary source is carbonated soda [2]. Although energy drinks (ED) contributed to a relatively smaller proportion of the total caffeine intake, ED consumption is growing, in particular among adolescents [3]. While there are some benefits of caffeine in terms of attention and mental alertness [4], overconsumption can lead to insomnia, anxiety, and physical discomfort [5]. Caffeine intake can be especially concerning in children and adolescents, and concerns are growing due to the popularity of highly caffeinated beverages, such as EDs [6,7]. EDs are considered dietary supplements and, therefore, have no limit on the amount of caffeine that can be added. The average ED contains about 200 mg of caffeine, but the amount varies widely from as little as 85 mg to over 400 mg. The US Food and Drug Administration recognizes caffeine as safe for adults in amounts < 400 mg/day, but recommendations differ for children, with 100 mg limits for children 12 and older and no caffeine consumption for children under the age of 12 years [6].

Children and adolescents may be particularly vulnerable to the harmful effects of caffeine, especially in the form of EDs. The review by Soós et al. concluded that there are no safe dosages described regarding caffeine or ED consumption for children [8]. Similarly, Pollak et al. found that caffeine intake among 7th to 9th graders ranged between 0 and 800 mg/d, with an average of 62.7 mg/d, and that higher caffeine intake was associated with shorter nocturnal sleep duration, increased wake time after sleep onset, and increased daytime sleep [9]. Another study by Richards and Smith (2016) found that high caffeine consumption (i.e., 1000 mg/week) was associated with low general health in secondary school children [10]. Although adolescent caffeine intake does not appear to be increasing over time [11], the proportion of caffeine intake represented by coffee and EDs has increased and that represented by soda intake has declined [12]. Similarly, Vercammen et al. (2019) found that from 2003 to 2016, the prevalence of ED consumption increased significantly for adolescents, young adults, and middle-aged adults [13]. Lastly, the study by Tran et al. found that, based on NHANES data from 2003 to 2012, almost 85% of US teenagers (ages 13–17), young adults (ages 18–24), and adults (ages 25–29) reported consuming caffeine [14].

Daily caffeine intake is significantly higher for males, older people, smokers, and those showing higher scores on impulsivity, sensation seeking, and a facet of reward sensitivity [15,16]. This suggests that caffeine intake may be related to decision-making processes that lead to higher risk-taking behaviors among adolescents. Previous studies in college students showed a strong relationship between ED consumption and risk-taking behavior, in particular in males [17,18], but these relationships have not been examined in younger adolescents. A recent meta-analysis found that ED consumption was associated with greater violent and risky behaviors, “junk food” intake, and polysubstance use, including tobacco and alcohol [19]. In addition, a previous study from our laboratory showed that daily soda consumption was associated with greater risk taking among adolescents when compared with non-soda consumers in the 2011 YRBS [20]. Our prior analysis was limited to soda, as the survey did not include EDs at that time. Finally, previous studies have not examined relationships between soda and ED consumption and newly emerging risk behaviors, such as vaping, and few have examined mental health outcomes in the same study populations.

The objective of this research was to extend the findings of our previous study [19] by investigating the associations between soda and ED consumption and risk-taking behavior, including behaviors not previously studied, such as vaping and mental health outcomes. We hypothesized that the daily consumption of sodas and EDs would be associated with greater risk-taking behavior in high school students compared to no consumption. To examine this hypothesis, we analyzed data from the 2019 YRBS, comparing the likelihood of engaging in various risk-taking behaviors among students who reported daily or no soda and ED intake.

2. Materials and Methods

2.1. Study Sample

For these analyses, we used data from the 2019 Youth Risk Behavior Surveillance System (YRBS), which is an annual survey of risk-taking and other behaviors in US high school students sponsored biennially by the Centers for Disease Control and Prevention (CDC; [21]). While there is a standard set of questions asked on all surveys, each state is allowed to individualize the survey. Questions about ED use were only asked in three states, Montana, New Jersey, and Florida. We, therefore, limited our analyses to participants from these states for a total of 10,548 teens. The CDC Institutional Review Board approved the protocol for national data collection [21]. The methods of the YRBS data collection have been published previously and have been shown to be reliable and valid [22,23].

The primary goal of our analysis was to determine differences in the odds of engaging in certain risk-taking and health behaviors as a function of beverage consumption. Our two predictor variables in this analysis were soda and ED consumption. Adolescents were asked the following questions: “During the past 7 days, how many times did you drink a can, bottle, or glass of soda or pop, such as Coke, Pepsi, or Sprite?” and “During the past 7 days, how many times did you drink a can, bottle or glass of ED, such as Red Bull or Jolt?”. The choices for both of these questions were “I did not drink ___ in the past 7 days, 1–3 times, 4–6 times, 1 time per day, 2 times per day, 3 times per day, 4 or more times per day”. We used these answers to create three categories for soda and ED consumption: No consumption, occasional consumption (1–6 times in a week), and daily consumption (1 or more times per day). For the sake of consistency, all comparisons shown are between “No” intake and “Daily” intake. Our dependent measures in these analyses included illicit substance use behavior, such as cigarette smoking, vaping, alcohol use, marijuana use, and prescription drug use; violent behaviors, including bringing a weapon to school and engaging in physical fights; mental health outcomes, including feeling sad or hopeless, reporting mental health as “not good”, and suicide attempts; and general lifestyle behaviors, including sleep, physical activity, fast food, and fruit and vegetable intake. Some of the questions related to mental health were not asked in every state, so the number of teens responding was lower.

2.2. Analytic Plan

Study sample demographics were analyzed using Chi-squared and ANOVA with soda consumption as the between subjects variable. We included sex, age, race/ethnicity, grade, BMI percentile, estimated daily caffeine consumption (from soda and EDs), and hours of sleep on weeknights. Sex was assessed with the question “what is your sex?” and the options were female, male, or missing. We chose to use the term “sex” throughout the paper, as that was the term used in the question. We used binary and multinomial regression analyses to determine if daily soda and ED consumption predicted our various risk-taking behavior. We used sex and age as a covariate in all analyses, since consumption of soda and ED increases as a function of age and differs as a function of sex. Response options differed across the dependent measures, so they were recoded to fit into 5 levels of analysis (1 being never and 5 being the maximum number of times in the time frame offered). Each model was run twice, once without sex as a predictor and once with sex as a predictor to determine the impact of sex. All data were analyzed using SPSS 27.0 and data were considered significant if p < 0.05. All data shown are the fully adjusted models. Missing data were not included in the analyses.

3. Results

3.1. Sample Characteristics

The total sample size for this analysis was 10,548, with 51.6% female and 48.4% male. Respondents were fairly evenly divided among grade level, with the majority being aged 15–17 years. About 50% of the sample was non-Hispanic white with a BMI percentile of 61.6 kg/m2, an average daily caffeine intake of 64.5 mg, and average hours of sleep on school nights of 6.5 h. Table 1 shows the characteristics for the entire study population as well as the data divided by soda consumption condition. There were significant differences as a function of soda consumption frequency for all variables except BMI percentile (Table 1).

Table 1.

Study participant characteristics.

All No Soda Occasional Soda Daily Soda p No ED Occasional ED Daily ED p
N % N % N % N % N % N % N %
Sex <0.001 <0.001
Female 5442 51.6 2053 37.7 2818 51.8 571 10.5 3698 69.8 1320 24.9 277 5.2
Male 5106 48.4 1381 27.0 2811 55.1 914 17.9 2779 55.8 1691 33.9 507 10.2
Age <0.001 <0.001
<14 1248 11.8 394 11.4 678 12.0 176 11.8 739 61.1 384 31.8 86 7.1
15 2826 26.7 883 25.6 1555 27.5 388 25.9 1739 62.9 809 29.3 215 7.8
16 2827 26.7 847 24.5 1515 26.8 365 24.4 1747 63.8 782 28.6 209 7.6
17 2378 22.4 806 23.4 1234 21.8 338 22.6 1487 64.2 658 28.4 171 7.4
>18 1324 12.4 421 12.2 675 11.9 228 15.3 797 61.2 391 30.1 113 8.7
Grade <0.001 <0.001
9th 2937 27.9 909 26.6 1612 28.7 416 28.1 1721 60.3 914 32.0 219 7.7
10th 2862 27.2 900 26.3 1557 27.7 405 27.4 1797 64.1 775 27.7 230 8.2
11th 2633 25.1 900 26.3 1380 24.5 353 23.9 1621 63.9 736 29.0 178 7.0
12th 2087 19.8 708 20.7 1073 19.1 306 20.7 1318 64.1 584 28.4 155 7.5
Race/Ethnicity <0.001 <0.001
American Indian/Alaskan Native 253 2.4 52 1.5 159 2.8 42 2.9 144 57.4 79 31.5 28 11.2
Asian 314 3.0 138 4.1 149 2.7 27 1.8 243 78.9 54 17.5 11 3.6
Black/African American 1098 10.5 377 11.1 548 9.8 173 11.8 517 52.3 339 34.3 133 13.4
Hawaiian/Pacific Islander 55 0.5 13 0.4 32 0.6 10 0.7 24 46.2 22 42.3 6 11.5
White/Caucasian 5241 50.2 1682 49.5 2825 50.6 734 49.9 3537 67.6 1407 26.9 285 5.5
Hispanic/Latino 428 4.1 134 3.9 239 4.3 55 3.7 221 55.8 141 35.6 34 8.6
Multiple Race–Hispanic 2543 24.3 821 24.2 1357 24.3 365 24.8 1398 57.1 802 32.8 248 10.1
Multiple Race–Non-Hispanic 515 5.0 178 5.2 271 4.9 66 4.5 331 65.4 138 27.3 37 7.3
Mean SEM Mean SEM Mean SEM Mean SEM p Mean SEM Mean SEM Mean SEM
BMI Percentile 61.6 0.29 61.6 0.49 61.9 0.39 60.1 0.29 0.12 60.8 0.37 62.9 0.54 62.1 1.1 0.005
Estimated Caffeine Use (mg/Day) 64.5 1.15 21.7 a 1.20 51.9 b 0.96 209.2 c 5.2 <0.001 16.8 0.34 84.5 0.78 381.7 7.5 <0.001
Hours of Sleep/Night 6.45 0.01 6.43 a 0.03 6.51 b 0.02 6.29 c 0.04 <0.001 6.5 0.02 6.4 0.03 6.3 0.06 <0.001
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Participant characteristics as a function of soda and energy drink consumption. p values represent differences in each category as assessed by Chi-squared or ANOVA. Different letters (a,b,c) indicate significant difference from one another (p < 0.001).

3.2. Relationship Among Soda Consumption and Substance Use Behaviors

We found significantly higher odds of engaging in substance use behaviors in daily vs. no soda consumers (Table 2). Thirty percent of the sample reported vaping at least once in the past 30 days. Individuals who consumed soda daily were 7.3 times more likely (CI 4.8, 11.1; p < 0.0001) to have reported vaping every day and 1.9 times more likely (CI 1.3, 2.8; p < 0.0001) to have reported vaping at least one time as compared to soda non-consumers. Similarly, individuals who consumed soda daily were 6.4 times more likely (CI 3.7, 11.0; p < 0.0001) to have reported drinking alcohol every day and 1.3 times more likely (CI 1.1, 1.5; p < 0.0001) to have reported drinking alcohol at least one time in the past month as compared to soda non-consumers.

Table 2.

Substance use behavior as a function of soda and ED consumption.

Soda Energy Drinks
Daily Soda No Soda Daily vs. No Soda Daily EDs No EDs Daily vs. No EDs
N N Odds Ratio (95% CI) p N N Odds Ratio (95% CI) p
Cigarette Smoking in past 30 days
Everyday 52 21 5.95 (3.6, 9.9) <0.001 40 42 8.36 (5.3, 13.1) <0.001
20–29 Days 9 3 10.02 (2.2, 47.3) 0.004 6 6 7.65 (2.3, 25.2) <0.001
10–19 Days 14 11 2.95 (1.3, 6.6) 0.009 10 23 4.23 (2.0, 8.9) <0.001
1–9 Days 73 100 1.82 (1.3, 2.5) <0.001 38 180 1.89 (1.3, 2.7) <0.001
0 Days 1300 3263 ref ref ref 667 6173 Ref ref ref
Vape Use in past 30 days
Everyday 80 39 7.27 (4.8, 11.1) <0.001 38 134 10.92 (6.8, 17.5) <0.001
20–29 Days 25 32 2.99 (1.7, 5.2) <0.001 4 77 1.98 (0.7, 5.6) 0.20
10–19 Days 24 32 2.54 (1.4, 4.4) 0.001 12 90 4.65 (2.3, 9.3) <0.001
1–9 Days 51 92 1.94 (1.3, 2.8) <0.001 18 240 2.83 (1.6, 4.9) <0.001
0 Days 203 704 ref ref ref 50 1757 Ref ref ref
Alcohol Use in past 30 days
Everyday 47 20 6.41 (3.7, 11.0) <0.001 45 20 19.54 (11.4, 33.6) <0.001
20–29 Days 16 12 3.59 (1.7, 7.6) <0.001 7 18 3.62 (1.5, 8.7) 0.004
10–19 Days 44 33 3.52 (2.2, 5.6) <0.001 26 67 3.67 (2.3, 5.8) <0.001
1–9 Days 489 1013 1.29 (1.1, 1.5) <0.001 209 1975 0.99 (0.8, 1.2) 0.90
0 Days 823 2231 ref ref ref 452 4196 Ref ref ref
Marijuana Use in past 30 days
40+ Times 123 57 5.54 (3.9, 7.7) <0.001 83 148 5.11 (3.8, 6.8) <0.001
20–39 Times 28 31 2.32 (1.4, 3.9) 0.002 10 73 1.26 (0.6, 2.5) 0.495
10–19 Times 46 56 2.09 (1.4, 3.1) <0.001 31 106 2.56 (1.7, 3.9) <0.001
1–9 Times 270 762 0.87 (0.7, 1.0) 0.079 129 1455 0.80 (0.6, 0.9) 0.034
0 Times 996 2500 ref ref ref 520 4673 Ref ref ref
Prescription Drugs in lifetime
40+ Times 59 35 3.71 (2.4, 5.7) <0.001 48 54 6.87 (4.6, 10.3) <0.001
20–29 Times 21 15 3.44 (1.7, 6.8) <0.001 18 24 6.05 (3.3, 11.2) <0.001
10–19 Times 30 42 1.71 (1.1, 2.8) 0.031 18 66 2.11 (1.2, 3.6) 0.007
1–9 Times 152 239 1.47 (1.2, 1.8) <0.001 83 480 1.35 (1.1, 1.7) 0.021
0 Times 1101 2541 ref ref ref 586 4749 Ref ref ref
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3.3. Relationship Among ED Consumption and Substance Use Behaviors

We conducted a similar analysis for ED consumption and found a similar pattern (Table 2), with daily ED consumption associated with higher odds of substance use when compared with no EDs. Individuals who consumed EDs daily were 10.9 times more likely (Cl 6.8, 17.5; p < 0.001) to have reported vaping every day and 2.8 times more likely (Cl 1.6, 4.9; p < 0.001) to have reported vaping at least once in the last 30 days when compared to ED non-consumers. In addition, individuals who consumed EDs daily were 19.5 times more likely (Cl 11.4, 33.6; p < 0.001) to have reported alcohol consumption every day for the past 30 months as compared to ED non-consumers.

3.4. Relationship Among Soda and ED Consumption and Violent Behaviors

For this analysis, we examined daily vs. none for both soda and ED consumption and assessed the relationship with self-reported “Brought a weapon to school” and “Been in a physical fight” in the past 30 days. We found that both daily soda and daily ED consumption increased the odds of bringing a weapon to school as well as being in a physical fight. Individuals who consumed soda daily were 3.1 times more likely (Cl 2.5, 3.9; p < 0.001) to have reported bringing a weapon to school, whereas individuals who consumed EDs daily were 2.1 times more likely (Cl 1.8, 2.5; p < 0.001) to have reported bringing a weapon to school in the past month. On the other hand, individuals who consumed soda every day were 5.1 times more likely (Cl 3.5, 7.6; p < 0.001) to have reported being in a physical fight at least 12 times and 2.6 times more likely (Cl 2.2, 3.1; p < 0.001) to have reported being in a physical fight at least once in the past 30 days. Individuals who consumed EDs daily were 2.6 times more likely (Cl 1.9, 3.6; p < 0.001) to have reported being in a physical fight at least 12 times and 2.2 times more likely (CI 1.9, 2.5; p < 0.001) to have reported being in a physical fight at least once in the past month as compared to ED non-consumers.

3.5. Relationship Among Soda and ED Consumption and Mental Health Outcomes

For this analysis, we examined daily vs. none for both soda and ED consumption and assessed the relationships with self-reported “Felt sad or hopeless almost every day for two weeks in the past 12 months”, number of suicide attempts in past 12 months, and “Mental Health Not Good” in past 30 days (Table 3). We found that both daily soda and daily ED consumption increased the odds of feeling sad or hopeless for 2 weeks in the past year and the number of suicide attempts reported. Individuals who consumed soda every day were 1.3 times more likely (Cl 1.1, 1.5; p < 0.001) to have been sad or hopeless every day for two weeks in the past 12 months, whereas there was no significant relationship between daily ED consumption and reports of feeling sad or hopeless every day for the past 12 months (p > 0.05). However, individuals who consumed soda everyday were 5.5 times more likely (Cl 2.8, 10.7; p < 0.001) to have attempted suicide at least six times in the past 12 months and individuals who consumed EDs were 3.1 times more likely (Cl 1.8, 5.3; p < 0.001) to have attempted suicide at least six times in the past 12 months. There were no relationships between reporting “Mental health not good in past 30 days” and soda or ED consumption (all p > 0.05).

Table 3.

Relationship among soda and ED consumption and mental health outcomes.

Soda EDs
Daily None Odds Ratio (95% CI) p Daily None Odds Ratio (95% CI) p
Sad or hopeless almost every day for 2 weeks (past 12 months) <0.001 <0.001
Yes 606 876 1.3 (1.1, 1.5) 297 2234 1.4 (1.2, 1.6)
No 1174 2230 ref 487 4203 ref
Suicide attempt (past 12 months)
6+ Times 30 15 5.5 (2.8, 10.7) <0.001 33 24 13.0 (7.3, 23.3) <0.001
4–5 Times 6 14 1.3 (0.5, 3.5) 0.58 3 21 5.7 (2.9, 11.2) <0.001
2–3 Times 46 64 1.8 (1.2, 2.7) 0.003 32 126 4.4 (2.2, 8.9) <0.001
1 Time 95 128 1.9 (1.5, 2.6) <0.001 43 225 8.1 (2.0, 31.6) <0.001
0 Times 1098 2852 ref ref 521 5555 ref ref
Mental health not good (past 30 days)
All 30 Days 11 35 1.1 (0.51, 2.3) 0.81 7 81 0.54 (0.19, 1.5) 0.23
14–29 Days 15 79 0.65 (0.34, 1.2) 0.19 2 134 2.8 (0.64, 12.6) 0.17
7–13 Days 10 88 0.35 (0.16, 0.75) 0.007 2 151 2.7 (0.77, 9.3) 0.12
1–6 Days 47 203 0.75 (0.47, 1.2) 0.22 9 411 1.9 (0.72, 4.8) 0.20
0 Days 47 151 ref ref 19 343 ref ref
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3.6. Relationship Among Soda and ED Consumption and Lifestyle Behaviors

For this analysis, we examined daily vs. none for both soda and ED consumption and assessed the relationship with self-reported average hours of sleep on school nights, servings of fruit eaten per week, servings of vegetables eaten per week, fast food consumed during the week, and number of days each week they carried out at least an hour of physical activity (Table 4). We found that daily soda and daily ED consumption increased the odds of fast-food consumption at least 7 times during the week. There was no significant relationship between daily soda consumption and average hours of sleep on school nights, fruit consumption per week, vegetable consumption per week, and physical activity (p > 0.05 for all). However, people who consumed soda were 17.5 times more likely (Cl 11.2, 27.4; p < 0.001) and individuals who consumed EDs daily were 4.9 times more likely (Cl 3.45, 6.94; p < 0.001) to have consumed fast food at least 7 times in the past week. There was no significant relationship between ED consumption and nightly sleep duration or ED consumption and vegetable consumption per week. However, there was a relationship between ED consumption and fruit consumption per week and physical activity, with daily ED consumption associated with higher fruit consumption, but an increase of 2.7 times more likely (CI 2.3, 3.1; p < 0.001) to not engage in any physical activity compared to ED non-consumers.

Table 4.

Relationship among soda and ED consumption and lifestyle behaviors.

Soda EDs
Daily None Odds Ratio (95% CI) p Daily None Odds Ratio (95% CI) p
Sleep
<5 h 447 917 0.88 (0.68, 1.14) 0.34 145 348 0.8 (0.6, 1.1) 0.25
6 h 370 754 0.87 (0.67, 1.13) 0.30 273 1193 1.7 (1.2, 2.2) <0.001
7 h 345 926 0.66 (0.51, 0.86) 0.002 174 1863 2.1 (1.6, 2.9) <0.001
8 h 201 593 0.61 (0.46, 0.81) <0.001 111 2423 2.1 (1.5, 2.9) <0.001
>9 h 113 203 ref ref 76 348 ref ref
Fruit (per week)
0 times 247 534 1.07 (0.88, 1.3) 0.48 94 898 1.9 (1.4, 2.5) <0.001
1–3 times 459 1003 1.06 (0.89, 1.3) 0.49 173 2275 2.3 (1.8, 2.9) <0.001
4–6 times 238 699 0.78 (0.65, 0.95) 0.014 127 1411 1.9 (1.5, 2.6) <0.001
7 times 188 368 1.18 (0.95, 1.46) 0.13 104 687 1.2 (0.92, 1.6) 0.18
8 or more times 366 843 ref ref 122 1230 ref ref
Vegetables (per week)
0 times 402 718 1.12 (0.97, 1.45) 0.09 179 1345 2.0 (1.6, 2.5) <0.001
1–3 times 431 1073 0.85 (0.69, 1.03) 0.09 203 2264 2.9 (2.3, 3.6) <0.001
4–6 times 254 741 0.73 (0.59, 0.90) 0.004 125 1440 2.9 (2.3, 3.7) <0.001
7 times 173 428 0.84 (0.66, 1.06) 0.14 105 727 1.8 (1.4, 2.4) <0.001
8 or more times 231 485 ref ref 184 733 ref ref
Fast Food (per week)
7 times 89 33 17.5 (11.2, 27.4) <0.001 66 50 10.7 (6.9, 16.6) <0.001
5–6 times 54 34 10.7 (6.6, 17.3) <0.001 41 70 6.1 (4.1, 9.3) <0.001
2–4 times 259 224 7.6 (5.8, 9.9) <0.001 160 472 3.4 (2.2, 5.2) <0.001
1–2 times 344 678 3.3 (2.6, 4.3) <0.001 228 1184 1.84 (1.1, 3.2) <0.001
0 times 114 731 ref ref 101 884 ref ref
Physical Activity (2 h per day)
0 days 429 909 1.03 (0.84, 1.28) 0.76 349 1293 1.8 (1.2, 2.8) 0.009
1–2 days 634 1318 1.07 (0.87, 1.31) 0.54 304 2414 1.3 (0.85, 1.98) 0.23
3–4 days 118 377 0.69 (0.52, 0.90) 0.007 39 884 0.42 (0.31, 0.94) <0.001
5–6 days 133 422 0.69 (0.53, 0.91) 0.008 33 993 0.22 (0.16, 0.29) <0.001
7 days 175 393 ref ref 61 892 ref ref
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3.7. Sex Differences in Soda and ED Consumption and the Relationships with Other Behaviors

For both soda consumption and ED consumption, girls were more likely to be non-consumers than boys and less likely to be daily consumers when compared to boys (Figure 1). For EDs, girls were also less likely to be occasional consumers than boys.

Figure 1.

Figure 1

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Soda (A) and energy drink (B) consumption in boys (left set of bars) and girls (right set of bars). A higher percentage of girls were soda and energy drink non-consumers compared to boys, and a lower percentage of girls were daily consumers compared to boys. For energy drinks, girls were also less likely to be occasional consumers compared to boys. All p < 0.05. * = significantly different from Boys.

When we examined the relationships among sex, soda consumption, and engaging in different behaviors, we found sex differences in all of them. However, for several of the behaviors (alcohol use, being in a physical fight, and consuming fast food), if girls were daily soda consumers, they had greater odds of engaging in these behaviors compared to boys with the same level of soda use (Table 5). Girls who consumed soda everyday were 17.8 times more likely (Cl 5.0, 62.9; p < 0.001) to have consumed alcohol every day in the past month compared to boys, who were only 3.3 times more likely (Cl 1.8, 6.2; p < 0.001) to have consumed alcohol every day for the past month. Girls who consumed soda daily were 4.9 times more likely (Cl 2.8, 8.3; p < 0.001) to have reported being in a physical fight at least 12 times in the past month, whereas boys were 3.6 times more likely (CL 2.3, 5.8; p < 0.001) to have reported being in a physical fight at least 12 times in the past month. Girls who consumed soda every day were 20.9 times more likely (Cl 10.5, 41.7; p < 0.001) to consume fast food 7 times a week compared to males, who were 13.4 times more likely (Cl 7.3, 24.3; p < 0.001) to consume fast food 7 times a week. These same-sex differences in odds ratios were observed for daily ED consumption as well (Table 5).

Table 5.

Sex effects on relationships among soda and ED consumption and various health behaviors.

Boys Girls
Daily Soda No Soda Daily Adjusted Odds Ratio Daily Soda No Soda Daily Adjusted Odds Ratio
N N (95% CI) p N N (95% CI) p
Vape Use (past 30 days)
Everyday 60 17 6.9 (3.9, 12.4) <0.001 18 22 6.6 (3.3, 13.1) <0.001
20–29 Days 18 14 2.4 (1.2, 5.1) 0.017 6 17 3.1 (1.1, 8.2) 0.027
10–19 Days 17 13 2.6 (1.2, 5.5) 0.014 6 19 2.4 (0.9, 6.1) 0.081
1–9 Days 31 29 2.0 (1.2, 3.5) 0.011 20 63 2.2 (1.2, 4.0) 0.008
0 Days 142 268 ref ref 60 428 ref ref
Alcohol Use (past 30 days)
Everyday 29 16 3.3 (1.8, 6.2) <0.001 14 4 17.8 (5.0, 62.9) <0.001
20–29 Days 10 6 3.1 (1.1, 8.7) 0.28 6 6 4.0 (1.3, 12.6) 0.017
10–19 Days 32 15 3.8 (2.0, 7.2) <0.001 10 18 2.2 (1.0, 4.9) 0.044
1–9 Days 280 345 1.5 (1.2, 1.8) <0.001 206 661 1.3 (1.0, 1.5) 0.024
0 Days 500 921 ref ref 317 1295 ref ref
Marijuana Use (past 30 days)
40+ Times 88 31 5.1 (3.3, 7.9) <0.001 32 24 4.8 (2.8, 8.3) <0.001
20–39 Times 17 14 2.3 (1.1, 4.7) 0.029 11 17 2.3 (1.1, 5.2) 0.037
10–19 Times 30 21 2.3 (1.3, 4.1) 0.004 16 34 1.9 (1.0, 3.5) 0.042
1–9 Times 151 264 0.96 (0.78, 1.2) 0.715 117 497 0.87 (0.69, 1.1) 0.246
0 Times 599 1022 ref ref 387 1457 ref ref
Been in a Physical Fight (past 30 days)
12+ Times 56 30 3.6 (2.3, 5.8) <0.001 14 12 4.9 (2.3, 11.0) <0.001
8–11 Times 11 9 2.3 (0.93, 5.5) 0.072 8 8 3.9 (1.4, 10.7) 0.010
4–7 Times 39 37 2.0 (1.2, 3.3) 0.004 18 24 3.6 (1.9, 6.7) <0.001
1–3 Times 216 212 1.9 (1.5, 2.3) <0.001 107 163 3.1 (2.4, 4.1) <0.001
0 Times 573 1060 ref ref 416 1826 ref ref
Sleep (per school night)
<5 h 241 349 0.92 (0.64, 1.3) 0.624 201 557 1.1 (0.73, 1.7) 0.62
6 h 222 272 1.1 (0.73, 1.5) 0.792 145 479 0.93 (0.61, 1.4) 0.76
7 h 222 372 0.78 (0.6, 1.1) 0.172 118 549 0.66 (0.42, 1.0) 0.058
8 h 137 260 0.69 (0.48, 1.0) 0.052 64 328 0.60 (0.38, 0.97) 0.036
>9 h 75 98 ref ref 34 105 ref ref
Fast Food (per week)
7 times 48 19 13.4 (7.3, 24.3) <0.001 36 14 20.9 (10.5, 41.7) <0.001
5– 6 times 23 14 8.8 (4.3, 18.1) <0.001 31 20 13.3 (6.9, 25.3) <0.001
3–4 times 141 85 8.5 (5.8, 12.5) <0.001 116 135 7.0 (4.7, 10.4) <0.001
1–2 times 211 257 4.3 (3.1, 5.9) <0.001 129 419 2.6 (1.8, 3.7) <0.001
0 times 65 326 ref ref 48 398 ref ref
Boys Girls
Daily ED No ED Daily Adjusted Odds Ratio Daily ED No ED Daily Adjusted Odds Ratio
N N (95% CI) p N N (95% CI) p
Vape Use (past 30 days)
Everyday 28 69 10.3 (5.9, 18.1) <0.001 8 65 7.2 (2.9, 18.0) <0.001
20–29 Days 2 34 2.9 (1.5, 6.1) 0.003 2 41 3.8 (1.1, 13.4) 0.036
10–19 Days 10 37 1.5 (0.66, 3.5) 0.33 1 52 5.9 (0.7, 48.7) 0.10
1–9 Days 14 99 6.6 (1.5, 29.6) 0.013 4 140 2.5 (0.5, 12.6) 0.26
0 Days 35 837 ref ref 15 903 ref ref
Alcohol Use (past 30 days)
Everyday 26 17 9.6 (5.1, 17.9) <0.001 15 3 69.1 (19.8, 241.0) <0.001
20–29 Days 4 7 8.3 (4.3, 15.7) <0.001 3 11 81.5 (23.1, 287.9) <0.001
10–19 Days 22 34 2.2 (0.98, 5.0) 0.057 2 33 82.2 (12.4, 544.1) <0.001
1–9 Days 134 762 2.6 (0.7, 10.2) 0.18 73 1204 18.3 (3.1, 108.5) 0.001
0 Days 283 1834 ref ref 167 2325 ref ref
Marijuana Use (past 30 days)
40+ Times 61 81 4.6 (3.2, 6.5) <0.001 19 65 4.2 (2.5, 7.1) <0.001
20–39 Times 8 28 5.8 (3.8, 8.7) <0.001 2 45 4.9 (2.7, 8.8) <0.001
10–19 Times 21 49 1.8 (0.99, 3.4) 0.053 10 57 1.7 (0.73, 3.9) 0.22
1–9 Times 74 581 2.6 (1.1, 6.2) 0.027 53 872 6.7 (1.5, 30.1) 0.014
0 Times 328 1997 ref ref 186 2632 ref ref
Been in a Physical Fight (past 30 days)
12+ Times 40 56 5.7 (3.8, 8.8) <0.001 16 16 17.3 (8.5, 35.2) <0.001
8–11 Times 8 18 2.3 (1.5, 3.7) <0.001 4 13 6.1 (2.9, 13.0) 0.010
4–7 Times 28 56 1.5 (0.8, 2.7) 0.21 9 49 5.4 (2.0, 14.6) <0.001
1–3 Times 131 423 1.9 (0.7, 4.9) 0.20 53 327 3.2 (0.87, 12.1) 0.081
0 Times 277 2190 ref ref 187 3269 ref ref
Sleep (per school night)
<5 h 137 588 0.89 (0.60, 1.3) 0.59 106 925 1.1 (0.67, 1.8) 0.72
6 h 114 583 1.6 (1.1, 2.3) 0.01 55 906 2.0 (1.2, 3.5) 0.008
7 h 116 842 2.1 (1.4, 3.0) <0.001 54 1008 2.3 (1.4, 3.9) 0.002
8 h 77 547 1.99 (1.3, 3.0) <0.001 34 640 2.3 (1.3, 4.1) 0.004
>9 h 50 175 ref ref 22 171 ref ref
Fast Food (per week)
7 times 42 20 11.7 (6.5, 21.3) <0.001 19 29 9.4 (4.8, 18.4) <0.001
5–6 times 19 25 6.3 (3.6, 11.0) <0.001 22 44 6.1 (3.3, 11.4) <0.001
3–4 times 96 161 3.5 (2.0, 6.5) <0.001 62 309 3.2 (1.7, 6.0) <0.001
1–2 times 148 446 2.8 (1.2, 6.2) 0.012 78 732 1.3 (0.6, 2.8) 0.51
0 times 66 364 ref ref 35 510 ref ref
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4. Discussion

Our investigation explored the potential link between frequent soda and ED consumption and the propensity for engaging in risk behaviors in high-school students. In this analysis, we designated soda and ED consumption as our two predictor variables to examine their influence on these behaviors. The results were consistent with our hypothesis, revealing a positive relationship between daily consumption of both soda/EDs and behaviors such as vaping, alcohol use, weapon carrying, physical altercations, and reported suicide attempts. Both daily soda and ED consumption were linked to greater feelings of sadness or hopelessness and greater odds of suicide attempts, but neither beverage was directly related to self-reported mental health in the past month. Interestingly, there were mixed results between daily soda and ED consumption and relationships with sleep duration, with daily soda consumption associated with lower odds of insufficient sleep, but daily ED consumption associated with greater odds of insufficient sleep. Daily consumption of both drinks were linked to increased fast food consumption, suggesting a potential link to unhealthier dietary patterns. Sex differences emerged when examining specific behaviors, with girls who were daily soda and ED drinkers exhibiting a stronger association with negative outcomes like daily alcohol use and frequent physical fights. Although these findings are cross-sectional and cannot determine a causal relationship, they suggest that further investigation into the potential causal links between soda and ED consumption and these risky behaviors, particularly among adolescents, is warranted.

Daily consumption of soda and EDs was found to be strongly associated with substance use behaviors. These findings are similar to our earlier research, which focused solely on soda [20]. Previous studies have also shown links between ED use and substance use behaviors in adults [24,25] and adolescents [26,27]. Our study extends these findings by using a national sample and adding additional mental health and vaping outcomes that were not available in earlier studies. When taken together, these findings replicate and extend previous research, showing that soda and ED consumption is strongly positively associated with substance use, including alcohol, vaping, and other illicit drug use. The question remains whether there are causal links between soda and ED consumption and these behaviors, or whether they are coincidental. For example, it is possible that the caffeine contained within these drinks acts directly on the neural substrate that responds to substance use, thereby increasing a desire to use illicit drugs. It is also possible that these behaviors are linked indirectly, with teens who are generally higher in sensation seeking being more likely to engage in risk behaviors and to consume soda and EDs regularly.

We also found relationships between the consumption of caffeine and violent acts, such as physical fights and carrying a weapon to school. This replicates the findings from our previous study that examined only soda consumption [20]. In the current study, we found that daily soda and ED use was associated with a greater likelihood of both carrying a weapon to school and getting into a physical fight. Research conducted by Scalese et al., also concluded that the consumption of EDs and alcohol-mixed EDs were both associated with physical violence in teenagers [26]. Finally, a longitudinal study by Kristjansson et al., (2021) showed that caffeine consumption at baseline was positively associated with aggressive behavior one year later in adolescents [28]. This shows that there may be a causal relationship between caffeine consumption and aggressive behavior, but more work needs to be carried out to replicate and extend these analyses to other types of risk behaviors and consider variations in beverage types and potential moderating factors like sex. By employing longitudinal study designs, similar to Kristjansson et al.’s approach, researchers can understand the temporal and causal pathways that underlie the relationship between caffeinated beverage consumption and risky behaviors.

We also examined relationships between soda and ED consumption with mental health outcomes. Unlike the other analyses, our findings here were mixed. The daily intake of soda and EDs raised the likelihood of experiencing depression or hopelessness as well as the number of suicide attempts that were reported; however, there was no relationship between reporting “Mental health not good in past 30 days” and soda or ED consumption. Previous studies have shown that greater caffeine intake is associated with internalizing behavior symptoms such as anxiety, depression, and psychosomatization [28,29]. A study similar to ours conducted in New Zealand adolescents found that greater energy drink consumption was associated with greater depressive symptoms, mental health difficulties, and poorer overall well-being [30]. A review by Richards and Smith (2016) of studies in both adults and adolescents suggests that the literature is mixed, but in general, chronic caffeine consumption is associated with poorer mental health outcomes [10]. While the current study identified relationships between daily soda and ED consumption and sadness/ hopelessness and suicide attempts, it did not find a clear association with overall self-reported mental health. This may represent a trend in adolescents to acknowledge poorer general mental health than in the past. Indeed, in this sample, the majority of respondents, regardless of consumption frequency, reported at least some degree of poor mental health. These findings, while somewhat contradictory to existing research, highlight the need for more current research that represents changing trends in both beverage consumption and other health behaviors. Our ability to examine these relationships is also limited by the relatively weak assessment of mental health outcomes in the YRBS. A more robust analysis of mental health needs to be included in the updated YRBS and should be considered in all states and not just a subset.

Daily consumption of soda and EDs was linked to some, but not all, of the lifestyle behaviors that we examined. Daily ED consumption was associated with shorter sleep duration, although there was no clear relationship between the consumption of soda and reduced sleep duration. Shorter sleep duration and quality have been linked to greater caffeinated beverage consumption in a number of previous studies in adolescents and young adults [31,32,33]. In fact, insomnia is one of the most consistent side-effects of caffeinated beverage consumption. In the current study, less than 8% of adolescents, in any consumption category, reported getting the recommended amount of sleep per night. In addition, when we examined sleep duration as a continuous variable in the ANOVA analysis, we did find a significant difference among the soda consumption groups, with shorter average weeknight sleep in the daily group compared with the occasional and soda non-consumers. It should be noted that the averages were far below the recommended 9 h of sleep, with all three groups being at 6.5 h or below. Further research is needed to explore this inconsistency and to elucidate the specific factors influencing these relationships. In addition, studies that employ objective measures of sleep instead of relying on self-report can provide more accurate data related to these relationships. In addition to sleep, we also found that daily soda and ED consumption were significantly associated with greater intake of fast food and that the odds were two to three times higher for soda and EDs. This is similar to findings from a study by Almulla and Faris (2020), who found that ED consumption was associated with both reduced sleep and increased energy-dense food consumption in adolescents from the UAE [34]. One possible explanation for this is that fast food establishments are a common source of soda for consumers. It may also be part of a pattern of less healthy food and beverage consumption.

Finally, we examined how the relationships described above were influenced by sex. In general, we discovered that boys were more likely than girls to be daily consumers of both soda and EDs. This is consistent with previous studies showing sex differences in caffeine consumption patterns [9,35,36]. However, when girls did regularly consume soda and EDs, the likelihood of them participating in risky behaviors, such as drinking alcohol, getting into physical altercations, and consuming fast food, was higher than that of boys at the same level of consumption. When considered collectively, these results imply that there might be sex-dependent variations in the motivations and consequences of beverage intake. Specifically, although girls rarely consume soda and ED daily, when they do, it appears to be strongly associated with other risky behaviors. Again, a causal link cannot be established here, but this relationship may be relevant for future interventions aimed at educating youth about caffeine consumption and mitigating the risks associated with caffeine consumption in adolescents.

Strengths and Limitations

This study benefits from several strengths that enhance the generalizability and informativeness of its findings. First, it leverages a large sample that encompasses participants from various states, increasing the study’s representativeness of the national population. Second, it incorporates recent data on ED consumption and risk-taking behaviors, such as vaping, which represents a novel contribution to the existing research in this field. Furthermore, the study design ensured a balanced participation rate between boys and girls, along with representation from diverse racial/ethnic groups and socioeconomic backgrounds (SES). This study was not without limitations. First, these data are cross-sectional and correlational; thus, causal links between ED and soda consumption and risk behaviors cannot be established from these findings. More longitudinal, prospective studies need to be conducted to interpret casual relationships. Second, since the data rely on self-reporting, it is susceptible to potential biases and inaccuracies. Third, the surveys did not distinguish between caffeinated soda and non-caffeinated soda consumption. Thus, while all EDs are highly caffeinated and the consumption of these can be a proxy for caffeine consumption, the soda intake is not a direct index of caffeine intake in this sample. Fourth, the lack of access to physiological or medical records further restricts the ability to verify self-reported information on drug use, caffeine and alcohol intake, sleep behaviors, and mental health diagnoses. Fifth, the YRBS did not assess other potential confounders, such as socioeconomic status, parental influence, or school environment. Finally, the YRBS did not collect details on the timing of caffeine consumption, which could have provided a more nuanced understanding of its correlation with sleep patterns, among other behaviors.

5. Conclusions

This study showed that daily soda and ED consumption in adolescents was associated with greater risk-taking behaviors such as vaping, alcohol and substance use, weapon carrying, and physical altercations. Daily consumption was associated with increased odds of reported suicide attempts, particularly for ED consumption. These findings replicate and extend our previous work [19] and that of others, and highlight a worrying association between soda and ED consumption frequency and adolescent risk-taking behaviors, mental health, and other health behaviors. Future research should investigate the potential causality of these associations and how these beverages impact other aspects of adolescent health and well-being, given their growing popularity. From there, harm reduction approaches can be used to educate adolescents and parents and, hopefully, limit adolescent caffeinated beverage consumption. To our knowledge, there are no public policies in the US aimed at reducing soda or ED consumption in youth. If causal links are established between soda and ED consumption and risk behaviors, this evidence could put pressure on law makers to institute common-sense policies, such as age limits on energy drink purchasing and public health messaging about the potential harms of the consumption of highly caffeinated beverages.

Author Contributions

S.S. was involved in the methodology, data curation, data analysis, original draft preparation, and the review and editing of the final manuscript draft. J.L.T. was involved in the conceptualization, data analysis, original draft preparation, the editing of the final manuscript, and manuscript submission. J.L.T. is the corresponding author and will handle future communication about the manuscript. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The CDC Institutional Review Board approved the protocol for national data collection [20]. The methods of the YRBS data collection have been published previously and have been shown to be reliable and valid [21,22].

Informed Consent Statement

Patient consent was waived due to this is a secondary data analysis from a large, nationally available dataset.

Data Availability Statement

The YRBS data are publicly available (https://www.cdc.gov/yrbs/data/index.html).

Conflicts of Interest

The authors have no conflicts of interest to declare.

Funding Statement

This research received no external funding.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The YRBS data are publicly available (https://www.cdc.gov/yrbs/data/index.html).

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