Abstract
Purpose:
To understand what factors are associated with adolescents’ perceived healthfulness of sports drinks (SD) and of energy drinks (ED), with a focus on health risk, athletics, and media-related variables.
Design:
Cross-sectional survey
Setting:
Online
Subjects:
U.S. adolescents ages 14–18 years (n = 501) recruited from a combination of non-probability and probability-based panels.
Measures:
Outcome variables were perceived healthfulness of SDs and of EDs. Independent variables included adolescents’ health background (oral health, diabetes risk, self-reported weight); behaviors (SD and ED consumption, athletic identity, sports participation, physical activity), and media items (media literacy, exposure to advertisements on TV, YouTube, social media).
Results:
Regression results indicated that adolescents’ increased perception that SDs are healthy was significantly associated (p<.05 level) with casual sports participation (b=.56, se=.27), athletic identification (b=.28, se= .11), exposure to SD advertisements on social media (b=.55, s =.25), and higher consumption (b=.28, se= .13). For adolescents’ perceptions of EDs, significantly related correlates included athletic identification (b=.26, se=10), having an increased risk of diabetes (b= −.79, s =.26), poorer oral health (b=.33, se=.16), and consumption (b=.76, s =.16); increased media literacy was associated with more accurate perceptions (b=−.35, se=.14).
Conclusions:
Adolescents’ hold different perceptions about the healthfulness of sports and energy drink, and their beliefs about each drink are related to different types of factors that may have implications for public health interventions. Cross-sectional survey design and adolescent self-reports are limitations.
Keywords: adolescents, sports drinks, energy drinks, perceived healthfulness, media literacy
Purpose
Sports drinks are advertised as drinks that replenish electrolytes after strenuous exercise. They are sweetened with glucose, high-fructose corn syrup and sucrose, or contain low-calorie sweeteners (1). Energy drinks are beverages with large amounts of caffeine, added sugars, other additives, and legal stimulants such as guarana (1). Sports and energy drink consumption is high among youth (2), who are targeted by beverage companies with extensive marketing campaigns (3). However, adolescents consume sports and energy drinks for different reasons. For example, adolescents typically consume energy drinks at home, during athletic activities and parties, and while playing video games (4). They also perceive energy drinks as more helpful for athletic performance (5). Comparatively, adolescents talk about sports drinks as substitutes for soft drinks and parents view them as healthy alternatives to other sugar-sweetened beverages (SSB; 6).
Previous research suggests that interventions and campaigns for limiting sports and energy drink consumption require different message strategies (7), yet these drinks are often grouped together in research and programming efforts. This study examines adolescents’ perceived healthfulness of sports and of energy drinks separately, and how relationships between healthfulness beliefs and various factors - adolescents’ health background, consumption, athletic identity and participation, exposure to advertising, and SSB media literacy - may be different between the two types of drinks.
Method
Design
Data were collected in October 2020 by SSRS using a combination of an opt-in panel and a nationally representative probability-based web panel (the SSRS Opinion Panel). Adolescents ages 14–18 years old living in the United States were recruited through their parents. A hybrid sample increases the generalizability of the sample by including youth selected through probability methods. The sample (n=501; 403 from volunteer panels) included quotas across age and sex to ensure comparable numbers of adolescents in each of these groups. Data were weighted to provide nationally representative estimates of teens ages 14 to 18. Unless noted otherwise, all results here use the weighted data.
Sample
The unweighted sample (n=501) was evenly split by sex (49.7% male), and most participants were white, non-Hispanic (71.37%). Respondents were grouped into 14–16 years old (50%) and 17–18 years old (49.5%).
Measures
Perceived healthfulness.
Two items asked participants to assess the extent to which they perceive sports (M=5.29, SD=2.47) and energy drinks (M=3.2, SD=2.57) each as healthy on a scale from 1 (very unhealthy) to 10 (very healthy) (5).
Health conditions.
Three questions assessed participant’s risk for physical health issues that are commonly associated with excess SSB consumption. First, participants were asked if they have a grandparent, parent, or sibling with type II diabetes (30.2%). Second, participants were asked if a medical professional had ever talked to them about being overweight (10.9%). Lastly, five questions from the COHIP-SF 19 scale (8) asked participants to best describe their teeth, mouth, or face in the past three months (e.g., had pain in your teeth/toothache) where 1= never and 5= almost all of the time. A reliable scale was created using the five items (α=.87, M=0.69, SD=.84).
Sports and Energy Drink Consumption.
Participants were asked how often they drink sports drinks like Gatorade, Powerade, and Vitamin Water (M=1.10, SD=.98) and energy drinks like Monster Energy, 5 Hour Energy, and Redbull (M=0.59, SD=.88). Consumption was assessed using a 5-point scale where 1 = never during the past 7 days, 2 = 1 to 3 times during the past 7 days, 3 = 4 to 6 times during the past 7 days, and 4 = 1 time per day or more.
Athletic identity.
Athletic identity was assessed using 10 items from the athletic identity scale (9) (e.g., I consider myself an athlete) on a scale from 1 to 7, strongly disagree/strongly agree; α=.87; M=4.04, SD=1.86.
Physical activity type.
Participants were also asked about their involvement (yes/no) in different types of athletic activities including organized sport (e.g., through a school or league; 47%) casual sport (e.g., with friends, like a pick-up game of basketball; 42%), physical activity (e.g., running, biking, or swimming; 42%), gym (e.g., working out or taking classes at a gym; 33%), and other activities (18%).
Media exposure.
Participants rated on a scale from 1 (never) to 4 (a lot) how frequently they see advertisements for sports drinks on television (M=1.41, SD=.86), social media other than YouTube (M=1.21, SD=.91), and YouTube (M=1.21, SD=.96), and energy drinks on television (M=1.24, SD=.93, social media other than YouTube (M=1.22, SD=.9), and YouTube (M=1.24, SD=.98).
SSB Media literacy.
Participants were asked on a scale from 1 to 5 (strongly disagree/strongly agree) to indicate their agreement with 5 statements pertaining to messages about sports (α=.81; M=3.54, SD=.77) and energy drinks (α=.87; M=3.7, SD=.81) in the media (e.g., most movies and TV shows that show people drinking sports drinks make it look more attractive than it really is)(10).
Statistical Analysis
Descriptive and bivariate correlations were calculated on the dependent and independent variables. Seemingly unrelated regression was used to account for shared covariance between the two correlated outcomes (healthfulness of sports and energy drinks; r=.54, p=.00).
Results
Participants rated sports drinks as healthier (M=5.29, SD=2.47) than energy drinks (M=3.20, SD=2.57). Results from the regression analyses for perceived healthfulness of both types of drinks are in Table 1. Casual sport activity, athletic identity, exposure to sports drinks advertisements on social media, and consumption were significantly associated with perceived healthfulness of sports drinks. Those who played more casual sports, reported stronger athletic identity, were more frequently exposed to sports drinks advertisements on social media, and who consumed more sports drinks were significantly more likely to perceive sports drinks are healthier.
Table 1.
Relationships between media exposure, health conditions, health behaviors, demographics and perceived healthfulness of sports and energy drinks
| Sports drinks healthfulness n=501 | Energy drinks healthfulness n=501 | |
|---|---|---|
| Predictors | b (SE) | b (SE) |
| Media Exposure | ||
| Media literacy scale | −.29(.19) | −.35(.14) |
| YouTube advertisements | .03(.19) | .25(.18) |
| Social media advertisements | .55(.25) | −.10(.21) |
| TV advertisements | −.11(.21) | .15(.18) |
| Health conditions | ||
| Diabetes | −.27(.29) | −.79(.26) |
| Overweight | −.07(.40) | .37(.37) |
| Oral health | .12(.16) | .33(.16) |
| Behaviors | ||
| Consumption | .28(.13) | .76(.16) |
| Athletic variables | ||
| Athletic identity scale | .28(.11) | .26(.10) |
| Organized sport | −.31(.33) | −.36(.28) |
| Casual sport | .56(.27) | −.15(.25) |
| Physical activity | −.05(.28) | .04(.25) |
| Gym | .22(.27) | .13(.25) |
| Other activity | .43(.35) | .22(.42) |
| Demographics | ||
| Race (referent: White) | -- | -- |
| Black | -.52(.44) | .50(.44) |
| Hispanic | −.46(.41) | .49(.46) |
| Other | 1.55(1.76) | −1.41(1.77) |
| Age | −.06(.25) | −.39(.26) |
| Sex (Female) | −.03(.24) | .27(.24) |
Notes: N = 501, Bold p ≤ .05. Table entries are unstandardized regression coefficients, with standard errors in parentheses.
There were some common factors associated with perceptions of healthiness for energy drinks. Those with stronger athletic identity, oral health problems, and consume more energy drinks believed energy drinks are healthy. Having an increased risk for diabetes and more SSB media literacy skills was related to perceiving energy drinks as less healthy.
Discussion
Sports drinks were perceived as healthier than energy drinks among adolescent respondents, and having a strong athletic identity was related to perceptions of increased healthiness of both types of drinks, which is consistent with marketing for sports and energy drinks that link the beverages to sports and athletic performance (6). Factors associated with more accurate perceptions included high SSB media literacy and being at risk for diabetes. It is likely that youth who are at risk for diabetes may be more aware of problematic nutritional choices. Improving media literacy regarding sugary drinks may be a promising avenue of intervention.
Limitations
Using a cross-sectional survey design does not allow for causal claims; it is possible that perceptions of healthiness drives consumption, for example, or that those sports and energy drink consumers attend more to sports and energy drink-related advertisements.
Significance.
This study suggests that regardless of campaigns and interventions such as warning labels, adolescents continue to have inaccurate perceptions of sports and energy drinks.
So What?
What is already known on this topic?
The consumption of sports and energy drinks among adolescents has increased as the consumption of other SSBs has declined (3). There is confusion among consumers about whether sports and energy drinks are healthy in part due to advertisements that frame sports and energy drinks as beneficial to their health (3). Beliefs about whether these drinks are healthy informs both purchasing and consumption decisions (7). Sports and energy drinks are often grouped together in efforts to reduce consumption, but adolescents consume sports and energy drinks for different reasons.
What does this article add?
The current study highlights individual level characteristics that are differentially associated with adolescents’ perceptions of sports drinks and of energy drinks as healthy. Poor oral health and diabetes risk were associated with perceptions of healthiness for energy drinks, but not sports drinks. Exposure to social media advertisements was associated with greater perceptions of healthiness for sports drinks, but not energy drinks. Stronger identification as an athlete was associated with increased perceptions of healthfulness for both types of drinks.
What are the implications for health promotion practice or research?
Identifying common and shared factors associated with misleading perceptions of healthfulness has implications for efforts to prevent or reduce consumption. Initiatives such as media campaigns or media literacy programs should consider different approaches to sports drink reduction and energy drink reduction, but athletes may be an appropriate target audience for prevention efforts for either type of drink.
Funding acknowledgements:
This paper was made possible by Grant No. 1R21DE028414-01 from the National Institute of Dental and Craniofacial Research (NIDCR). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIDCR.
Footnotes
Contributors certify that all potential conflicts of interest have been acknowledged in the Contribution and covering letter accompanying the Contribution, including but not limited to, all forms of financial and commercial support, including pharmaceutical company support and any commercial or financial involvements that might present an appearance of a conflict of interest related to the Contribution and any other potential conflicts identified in the Journal’s manuscript submission guidelines.
Contributor Information
Emily Pfender, University of Delaware, Newark, DE, USA.
Amy Bleakley, University of Delaware, Newark, DE, USA.
Morgan Ellithorpe, University of Delaware, Newark, DE, USA.
Michael Hennessey, University of Delaware, Newark, DE, USA.
Erin Maloney, University of Delaware, Newark, DE, USA.
Amy Jordan, Rutgers University, New Brunswick, NJ, USA.
Robin Stevens, University of Southern California, CA, USA.
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