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INTRODUCTION: Caffeine is a psychostimulant possessing arousal, motor activation, and reinforcing properties, which is consumed daily by most adolescents aged 12-19 years. Although current understanding of the implications of adolescent caffeine consumption for school behaviors remains incomplete, studies have shown that in addition to acute effects of the drug, in common with other habit-forming psychoactive substances, regular use leads to physical dependence, evidenced by recurring negative withdrawal symptoms. METHODS: Employing two waves of longitudinal data, we tested the prospective association between daily caffeine use and homeroom teacher-observed self-control and problem behavior in a sample of middle-school students in 20 schools in West Virginia in the United States. Caffeine was operationalized with two dichotomized variables, daily consumption of <100 mg, and daily consumption of >100 mg, versus no daily use. Gender, mother's education, family financial status, social support by primary caregiver and adults in school, and school climate, were applied as covariates in linear mixed models. RESULTS: Daily caffeine use of >100 mg was robustly and inversely associated with self-control and positively associated with problem behavior. CONCLUSIONS: Caffeine consumption and associated withdrawal symptoms may be an important factor in problematic school behavior among adolescents. Recent advent of highly concentrated caffeine products (e.g., caffeine "shots") commonly marketed directly at youth, should give rise to concerns including consideration about limiting caffeine consumption among children and youth.
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Preventing or delaying the onset of alcohol use among children and youth is an important public health goal. One possible factor in alcohol use onset among early adolescents is caffeine. The aim of this study was to assess the possible contribution of caffeine to the onset of alcohol use during early adolescence. We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020, and again approximately 6 months later in spring of 2021. We limited our analyses to students reporting never having used any form of alcohol at baseline. Logistic regression was employed in multivariable analyses and both Odds Ratios and Relative Risks reported. At follow-up, almost 14% of participants reported having consumed alcohol at least once and 57% used caffeine of 100 mg + daily. In multivariable analyses we controlled for social and behavioral variables known to impact tobacco use. Caffeine use was operationalized as a three-level factor: no use, <100 mg per day, and 100 + mg per day, with the latter being the approximate equivalent of the minimum of a typical cup of coffee or can of energy drink. Caffeine use of 100 mg + per day was significantly related to alcohol use at 6-months follow-up (OR: 1.79, RR: 1.56, p = .037). We conclude that caffeine consumption among 11-12-year-old adolescents may be a factor in early onset of alcohol use.
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Cafeína , Bebidas Energéticas , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Criança , Humanos , Estudantes , Inquéritos e Questionários , Uso de TabacoRESUMO
Background: Adolescent caffeine consumption has been linked to aggressive behaviors, although no longitudinal tests have been reported to date. The purpose of this study was to test the longitudinal relations between daily adolescent caffeine consumption and aggressive behaviors. Methods: Two waves of survey data collected 12 months apart in the spring of 2018 and 2019, from the 2004 birth cohort in the Icelandic LIFECOURSE study, were analyzed using structural equation modeling (N = 2,278). Both direct and mediated models were employed. Results: Caffeine use at time 1 (T1) was associated with aggressive behavior at time 2 (T2) (ß = .12, p < .001) independent of aggressive behavior at T1. A considerable added relation was observed between caffeine at T1 and aggressive behavior at T2 via indirect (i.e., mediated) effects of aggressive behavior at T1 (standardized ß = .20, p < .001). Over 64% of the standardized total effect (ß = .31) observed between caffeine at T1 and aggressive behavior at T2 was due to mediation. Conclusion: Adolescent caffeine consumption forecasts aggressive behaviors. Caffeine use at T1 increased the likelihood of self-reported aggressive behaviors 12 months later irrespective of level of reported aggressive behavior at T1 while controlling for common confounders.
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Comportamento do Adolescente , Cafeína , Adolescente , Agressão , Humanos , Estudos Longitudinais , Inquéritos e QuestionáriosRESUMO
Disclosing conflict of interest is widely believed to mitigate bias and harm from industry entanglement in healthcare research, education and practice. However, evidence is lacking of disclosure-related mitigation. Radical and extensive severing of industry ties to health care is necessary to curtail industry-related bias and harm.
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Viés , Conflito de Interesses , Revelação , Indústria Farmacêutica , Políticas Editoriais , Setor de Assistência à Saúde , HumanosRESUMO
Public financing to incentivise private sector innovation in antimicrobial pharmaceuticals is believed by many to be necessary to defeat growing threats from antimicrobial resistance. Large cash incentives from the public sector are said to be essential to stimulate 'normal' market forces capable of unleashing much-needed innovation. However, there is little evidence to suggest that lack of innovation in drug development is peculiar to antimicrobials or that current deficits in the supply of antimicrobials is due to unique inefficiencies in the antimicrobial market. Neither the history of drug development in general nor of antimicrobial innovation in particular supports economic interventions intended to stimulate private sector supply of new antimicrobials. On the contrary, public underwriting of the private sector, which by definition is compelled to prioritise profit, risks dire consequences for future global health.
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Anti-Infecciosos/uso terapêutico , Descoberta de Drogas/economia , Indústria Farmacêutica/economia , Resistência Microbiana a Medicamentos , Financiamento Governamental , Setor Privado/economia , Anti-Infecciosos/economia , Descoberta de Drogas/métodos , Financiamento Governamental/métodos , Saúde Global , HumanosRESUMO
Throughout the quarter century since the advent of evidence-based medicine (EBM), medical research has prioritized 'efficacy' (i.e. internal validity) using randomized controlled trials. EBM has consistently neglected 'effectiveness' and 'cost-effectiveness', identified in the pioneering work of Archie Cochrane as essential for establishing the external (i.e. clinical) validity of health care interventions. Neither Cochrane nor other early pioneers appear to have foreseen the extent to which EBM would be appropriated by the pharmaceutical and medical devices industries, which are responsible for extensive biases in clinical research due to selective reporting, exaggeration of benefits, minimization of risks, and misrepresentation of data. The promise of EBM to effect transformational change in health care will remain unfulfilled until (i) studies of effectiveness and cost-effectiveness are pursued with some of the same fervour that previously succeeded in elevating the status of the randomized controlled trial, and (ii) ways are found to defeat threats to scientific integrity posed by commercial conflicts of interest.
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Análise Custo-Benefício , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Pesquisa Biomédica , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos TestesRESUMO
Self-reported dietary caffeine and alcohol consumption were examined in relation to anger and violent behavior in Icelandic tenth-graders. Structural equation modeling (SEM) was used to investigate direct and indirect effects of measured and latent variables in the population sample of 3,670, controlling for parental financial standing, family structure, ADHD, and peer delinquency. Gender differences were observed that have not been reported previously, especially in relation to anger as a possible mediator of violent behavior against a background of caffeine and alcohol consumption. Study findings suggest the need to take account of caffeine consumption in relation to adolescent anger and violence.
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Comportamento do Adolescente/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Ira , Cafeína , Caracteres Sexuais , Violência/psicologia , Adolescente , Bebidas , Família/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Fatores SexuaisRESUMO
OBJECTIVE: Consumption of caffeinated sugar-sweetened beverages (CSSBs) among children and adolescents has increased markedly in recent years but the consequence of their consumption is not well understood. The objective of this study was to assess the prevalence of CSSBs in children aged 1012 years and examine the relationship between CSSBs and common physical complaints. METHODS: Data from the 2013 cross-sectional population school survey Youth in Iceland (N=11,267, response rate: 90.1%, girls 49.7%)was used to assess the prevalence of cola and energy drink consumption and associations to headaches, stomachaches, sleeping problems and low appetite. RESULTS: Around 19% of boys and 8% of girls reported consuming cola drinks on a daily basis and 7% of boys and 3% of girls reported consuming energy drinks. A general trend of a doseresponse relationship was observed between CSSBs and physical complaints for both types of beverages. These relationships were generally stronger for energy drinks than cola drinks. CONCLUSION: Our findings call into question the acceptability, availability, and marketing of CSSBs to 1012 year-old children and adolescents. For validation purposes replications of these analyses are needed in other parts of the world, including studies using prospective longitudinal designs.
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Bebidas/estatística & dados numéricos , Sacarose Alimentar/efeitos adversos , Bebidas Energéticas/estatística & dados numéricos , Transtornos Somatoformes/epidemiologia , Bebidas/efeitos adversos , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Humanos , Islândia/epidemiologia , Masculino , Transtornos Somatoformes/etiologia , Transtornos Somatoformes/psicologiaRESUMO
Caffeine is the most widely used psychoactive substance in the world and currently the only one legally available to children and adolescents. The sale and use of caffeinated beverages has increased markedly among adolescents during the last decade. However, research on caffeine use and behaviors among adolescents is scarce. We investigate the relationship between adolescent caffeine use and self-reported violent behaviors and conduct disorders in a population-based cross-sectional sample of 3,747 10th grade students (15-16 years of age, 50.2 % girls) who were enrolled in the Icelandic national education system during February 2012. Through a series of multiple regression models, while controlling for background factors, Attention Deficit Hyperactivity Disorder symptoms and current medication and peer delinquency, and including measures on substance use, our findings show robust additive explanatory power of caffeine for both violent behaviors and conduct disorders. In addition, the association of caffeine to the outcomes is significantly stronger for girls than boys for both violent behaviors and conduct disorders. Future studies are needed to examine to what extent, if at all, these relationships are causal. Indication of causal connections between caffeine consumption and negative outcomes such as those reported here would call into question the acceptability of current policies concerning the availability of caffeine to adolescents and the targeting of adolescence in the marketing of caffeine products.
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Bebidas , Cafeína/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Transtorno da Conduta/induzido quimicamente , Violência , Adolescente , Transtorno da Conduta/etiologia , Estudos Transversais , Inquéritos sobre Dietas , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Fatores de Risco , Autorrelato , Fatores SexuaisRESUMO
BACKGROUND: Preventing nicotine use onset among children and youth is an important public health goal. One possible contributor that has received little empirical investigation is caffeine use. The goal of this study was to examine the possible contribution of caffeine to nicotine onset during early adolescence. METHODS: We used data from the Young Mountaineer Health Study Cohort. Survey data were collected from 1,349 (response rate: 80.7%) 6th grade students (mean age at baseline 11.5 years) in 20 middle schools in West Virginia during the fall of 2020 and spring of 2021. We limited our analyses to students reporting never having used any form of nicotine at baseline. Logistic regression was employed in analyses. RESULTS: Approximately 8% of participants reported having used nicotine at least once between baseline and the follow-up, and 4.7% reported solely using electronic nicotine delivery systems (ENDS) and no other forms of nicotine. In multivariable analyses, we controlled for many environmental, social, and behavioral variables known to influence nicotine use such as alcohol use, peer substance use, and perceived access to nicotine. We formulated our main independent variable, caffeine consumption, as continuous deciles. Any nicotine use, as well as ENDS use only at follow-up, were modeled as dependent variables. Caffeine was significantly associated with nicotine use in both models with ORs of 1.15 (1.04-1.27) and 1.13 (1.00-1.28). CONCLUSIONS: Caffeine consumption among 6th grade non-nicotine users was associated with nicotine use at approximately 6-months follow-up.
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Sistemas Eletrônicos de Liberação de Nicotina , Transtornos Relacionados ao Uso de Substâncias , Criança , Humanos , Adolescente , Nicotina/efeitos adversos , Cafeína , Consumo de Bebidas Alcoólicas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. OBJECTIVE: The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school-aged youth in resource-poor Appalachian rural communities. METHODS: This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. RESULTS: In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. CONCLUSIONS: The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40451.
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Using academic achievement as the key outcome variable, 7377 Icelandic adolescents were surveyed for cigarette smoking, alcohol use, daytime sleepiness, caffeine use, and potential confounders. Structural equation modeling (SEM) was used to examine direct and indirect effects of measured and latent variables in two models: the first with caffeine excluded and the second with caffeine included. A substantial proportion of variance in academic achievement, which might otherwise have been attributed to the harmful effects of cigarette smoking and alcohol use, was found to be attributable to caffeine. Evidence was obtained that daytime sleepiness, which was found to be independently associated with usage of licit substances (nicotine and alcohol) and caffeine, may be an important mediator of the negative impact of those substances on academic achievement. Findings suggest the importance of including measurements of caffeine consumption in future studies of adolescent substance use.
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Cafeína/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Sono , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Comportamento do Adolescente , Estudos Transversais , Escolaridade , Feminino , Humanos , Islândia , Masculino , Privação do SonoRESUMO
OBJECTIVES: Caffeine is a habit-forming substance consumed daily by the majority of pregnant women. Accordingly, it is important that women receive sound evidence-based advice about potential caffeine-related harm. This narrative review examines evidence of association between maternal caffeine consumption and negative pregnancy outcomes, and assesses whether current health advice concerning maternal caffeine consumption is soundly based. METHODS: Database searches using terms linking caffeine and caffeinated beverages to pregnancy outcomes identified 1261 English language peer-reviewed articles. Screening yielded a total of 48 original observational studies and meta-analyses of maternal caffeine consumption published in the past two decades. The articles reported results for one or more of six major categories of negative pregnancy outcomes: miscarriage, stillbirth, low birth weight and/or small for gestational age, preterm birth, childhood acute leukaemia, and childhood overweight and obesity. RESULTS: Of 42 separate sets of findings reported in 37 observational studies, 32 indicated significantly increased caffeine-related risk and 10 suggested no or inconclusive associations. Caffeine-related increased risk was reported with moderate to high levels of consistency for all pregnancy outcomes except preterm birth. Of 11 studies reporting 17 meta-analyses, there was unanimity among 14 analyses in finding maternal caffeine consumption to be associated with increased risk for the four outcome categories of miscarriage, stillbirth, low birth weight and/or small for gestational age, and childhood acute leukaemia. The three remaining meta-analyses were also unanimous in reporting absence of a reliable association between maternal caffeine consumption and preterm birth. No meta-analyses were identified for childhood overweight and obesity, although four of five original observational studies reported significant associations linking maternal caffeine consumption to that outcome category. CONCLUSIONS: The substantial majority finding from observational studies and meta-analyses is that maternal caffeine consumption is reliably associated with major negative pregnancy outcomes. Reported findings were robust to threats from potential confounding and misclassification. Among both observational studies and meta-analyses, there were frequent reports of significant dose-response associations suggestive of causation, and frequent reports of no threshold of consumption below which associations were absent. Consequently, current evidence does not support health advice that assumes 'moderate' caffeine consumption during pregnancy is safe. On the contrary, the cumulative scientific evidence supports pregnant women and women contemplating pregnancy being advised to avoid caffeine.
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Cafeína , Nascimento Prematuro , Cafeína/efeitos adversos , Criança , Feminino , Humanos , Recém-Nascido , Mães , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/induzido quimicamente , Nascimento Prematuro/epidemiologiaRESUMO
OBJECTIVE: To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities among Icelandic adolescents. METHODS: This study used a quasi-experimental, non-randomized control group design to compare outcomes in 4 Icelandic communities (n=3117) that participated in community-based substance use prevention activities designed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities (n=1,907). Annual, nationwide, population-based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icelandic adolescents, aged 14-15 years (N=5,024), in all communities from 1997 to 2009. RESULTS: Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not, whereas unmonitored idle hours and attendance at unsupervised parties decreased. Over time, alcohol use (OR=0.89, 95% CI 0.82, 0.98, p=0.012) and being intoxicated during the last 30 days (OR=0.86, 95% CI 0.78, 0.96, p=0.004) decreased more in the intervention than control communities. CONCLUSION: Community-based prevention designed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use.
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Comportamento do Adolescente , Atividades de Lazer , Relações Pais-Filho , Prevenção Primária/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Intoxicação Alcoólica/epidemiologia , Intoxicação Alcoólica/prevenção & controle , Redes Comunitárias/organização & administração , Estudos Transversais , Feminino , Humanos , Islândia/epidemiologia , Modelos Logísticos , Masculino , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Esportes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
RATIONALE: Until recently, little account had been taken of the confounding effects of caffeine withdrawal and withdrawal reversal when examining the net effects of dietary caffeine. OBJECTIVES: By including a manipulation involving sleep restriction, the present study aimed to extend recent findings from research in which caffeine withdrawal and withdrawal reversal were controlled. The main aims of the study were to examine the net effects of caffeine, as well as its potential restorative effects following sleep restriction, on EEG, performance and mood. METHOD: A randomised cross-over design was used in which 15 participants alternated weekly between ingesting placebo and caffeine (1.75 mg/kg) three times daily for four consecutive weeks following either usual sleep or sleep restriction. EEG activity was measured at 32 sites during eyes closed, eyes open and performance of a vigilance task. RESULTS: Modest effects of caffeine were found in the delta and beta bandwidths, but no main effects of caffeine were observed in the theta or alpha bandwidths. Overall, the effects of caffeine on EEG activity were relatively few, weak and inconsistent, and no evidence was found of net restorative effects of caffeine for any outcome variables. CONCLUSIONS: The findings do not support the use of caffeine as a means for enhancing human function or as an antidote to the negative effects of sleep loss.
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Afeto/efeitos dos fármacos , Cafeína/farmacologia , Eletroencefalografia/efeitos dos fármacos , Desempenho Psicomotor/efeitos dos fármacos , Descanso/fisiologia , Privação do Sono/psicologia , Adolescente , Cafeína/administração & dosagem , Cafeína/farmacocinética , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/farmacocinética , Estimulantes do Sistema Nervoso Central/farmacologia , Estudos Cross-Over , Dieta , Feminino , Humanos , Masculino , Privação do Sono/tratamento farmacológico , Síndrome de Abstinência a Substâncias/psicologia , Adulto JovemRESUMO
BACKGROUND: There is a large corpus of observational evidence claiming that coffee is health protective and a similarly large corpus of experimental psychopharmacological evidence to suggest that habitual caffeine consumption may be harmful to health. AIM: The purpose of this study was to examine the disjunction between observational and experimental findings with specific reference to the implications of coffee/caffeine consumption for elevated blood pressure, cardiovascular disease, type 2 diabetes and neurodegenerative disease. METHOD: Illustrative recent major reviews alleging health protective effects from coffee consumption were examined in light of findings from relevant experimental studies of caffeine. FINDINGS: Decades-long coffee consumption is but one of countless lifestyle variables that may benefit or harm health. Contradictions concerning the implications of coffee/caffeine consumption for health between observational and experimental research are attributable mostly to poor control over potential confounders in observational studies. CONCLUSION: When considered in the context of experimental evidence concerning caffeine's known pharmacological actions, there is reason to be sceptical about observational findings alleging health-protective effects from coffee consumption. Long-term randomised trials are needed to end the enduring interpretative disjunction between observational and experimental evidence concerning coffee/caffeine consumption and health.