Online ISSN:1234-5678
Document Type : Original Article
Authors
College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012, Iraq
Keywords
Energy drinks (EDs) are non-alcoholic beverages containing high concentrations of caffeine, sugar, taurine, guarana, B vitamins, and other stimulants that are marketed to enhance alertness, improve physical performance, and reduce fatigue. Over the past two decades, their popularity has increased dramatically, particularly among adolescents and young adults, making them one of the fastest-growing beverage categories worldwide. Although these beverages are promoted as products that enhance physical and cognitive performance, increasing evidence indicates that excessive consumption is associated with adverse cardiovascular, neurological, metabolic, and psychological effects, making energy drink consumption an emerging public health concern [1,2].
Adolescents and young adults represent the largest consumer group of energy drinks because of academic demands, sports participation, social influences, and aggressive marketing strategies. A recent systematic review and meta-analysis estimated that more than half of young adults worldwide consume energy drinks regularly, with many reporting weekly or daily intake [3]. Frequent consumption has also been associated with unhealthy lifestyle behaviors, including inadequate sleep, smoking, alcohol consumption, poor dietary habits, and reduced academic performance [2,4]. Furthermore, excessive caffeine intake may increase the risk of hypertension, tachycardia, anxiety, sleep disturbances, gastrointestinal disorders, and, in rare cases, severe cardiovascular complications, particularly among susceptible individuals [1,5].
Despite growing public awareness regarding the adverse health effects of energy drinks, knowledge alone does not necessarily lead to healthier consumption behaviors. Previous studies have demonstrated that many young people continue consuming energy drinks despite recognizing their potential risks [6,7]. Factors such as peer influence, social media marketing, attractive packaging, easy accessibility, and the perceived benefits of improved concentration and physical performance continue to encourage frequent consumption [8]. Consequently, the discrepancy between awareness and actual consumption behavior has become an important public health challenge.
The prevalence of energy drink consumption has increased considerably throughout the Middle East, including Iraq. Studies conducted among university students in Iraq, Jordan, Saudi Arabia, and other neighboring countries have consistently reported high rates of energy drink consumption despite moderate-to-high levels of health awareness [6,9–11]. In Iraq, commonly available brands such as Red Bull, Tiger, Monster, and locally marketed products are widely accessible in supermarkets, cafés, and educational institutions, facilitating frequent consumption among adolescents and young adults. Nevertheless, epidemiological evidence regarding consumption patterns and awareness among Kurdish youth remains limited, particularly in the Kurdistan Region of Iraq.
Understanding the relationship between sociodemographic characteristics, lifestyle behaviors, awareness, and energy drink consumption is essential for developing effective health promotion strategies and evidence-based regulatory policies. Identifying the factors associated with excessive consumption may assist healthcare professionals, educators, and policymakers in designing targeted educational interventions and preventive programs aimed at reducing the health risks associated with energy drink use among young people.
Therefore, this study aimed to assess the patterns of energy drink consumption, evaluate awareness regarding their potential health effects, and identify demographic and lifestyle factors associated with energy drink consumption among young people in Rania City, Kurdistan Region, Iraq. The findings are expected to provide evidence to support future public health policies and educational initiatives promoting healthier beverage choices among Iraqi youth.
A quantitative cross-sectional study was conducted to assess energy drink consumption patterns and health awareness among young people in Rania City, Kurdistan Region, Iraq. The study employed a questionnaire-based survey to collect data from participants during the study period.
The study was carried out in Rania City, located in the Raparin Administration of the Kurdistan Region, Iraq. Data collection was conducted between 22 October 2024 and 10 February 2025 in educational institutions, workplaces, and public locations within the study area.
The target population consisted of adolescents and young adults aged 15–24 years residing in Rania City and its surrounding urban and rural areas. Participants of both sexes who met the eligibility criteria were invited to participate in the study.
Participants were eligible if they:
Individuals were excluded if they:
The required sample size was estimated using Cochran's formula for cross-sectional studies with a 95% confidence level, 5% margin of error, and an assumed population proportion of 50%. The minimum calculated sample size was 385 participants, which was increased by approximately 10% to compensate for possible non-response, resulting in a target sample of approximately 425 participants. A convenience sampling technique was employed to recruit eligible participants from schools, universities, workplaces, and public settings throughout Rania City. A total of 410 participants completed the survey and were included in the final analysis.
Data were collected using a structured questionnaire developed after an extensive review of previously published literature on energy drink consumption and awareness. The questionnaire was translated into Kurdish to ensure clarity and comprehension among participants. It consisted of three sections:
Data were collected through face-to-face interviews conducted by the principal researcher using the structured questionnaire. Participants were informed about the objectives of the study before completing the survey, and confidentiality was maintained throughout the data collection process.
Ethical approval was obtained from the Institutional Review Board of the College of Nursing, University of Raparin, Kurdistan Region, Iraq (Reference No. 2866/28-5-2023). Written informed consent was obtained from all participants before enrollment. Participation was voluntary, anonymity was preserved, and collected data were stored securely and used solely for research purposes in accordance with the principles of the Declaration of Helsinki.
Data were analyzed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, medians, and interquartile ranges, were used to summarize participant characteristics, awareness levels, and consumption patterns. Associations between categorical variables were examined using the Chi-square test or Fisher's exact test, as appropriate. Factors associated with energy drink consumption were further evaluated using ordinal logistic regression analysis, and results were expressed as parameter estimates with 95% confidence intervals (95% CI). Statistical significance was established at p < 0.05.
A total of 410 young people participated in the study. The median age of the participants was 21 years (interquartile range = 3 years). Males constituted 51.5% of the sample, while females represented 48.5%. Nearly half of the participants (49.3%) had attained institute or college education, followed by preparatory education (34.9%). Regarding body mass index (BMI), 58.2% had normal weight, 26.6% were overweight, and 7.6% were obese. Most participants resided in urban areas (95.4%) and were single (82.0%). Students represented the largest occupational group (56.3%), while 43.7% reported engaging in occasional physical activity. Approximately one-quarter (27.6%) reported having at least one chronic disease, with palpitations and renal diseases being the most frequently reported conditions (Table 1).
The distribution of energy drink consumption according to beverage type is presented in Table 2. Red Bull was the most frequently consumed brand, with 37.6% of participants reporting daily consumption, followed by Tiger (34.4% daily). Asan ranked third, with 26.3% of participants consuming it daily. Conversely, Jaguar, Red Strong, and Monster were among the least frequently consumed beverages, with 43.9%, 46.1%, and 45.9% of participants, respectively, reporting that they never consumed these brands. Overall, Red Bull and Tiger remained the dominant energy drink brands among the study population (Table 2).
Overall energy drink consumption frequency is illustrated in Figure 1. More than half of the participants (57.1%) reported consuming energy drinks daily, while 22.7% consumed them two to three times per week. Weekly consumption was reported by 18.0%, whereas only 2.2% indicated that they rarely consumed energy drinks, demonstrating a remarkably high prevalence of regular energy drink use among young people in Rania City.
Participants generally demonstrated satisfactory awareness regarding the health effects of energy drinks (Table 3). More than 90% recognized that regular energy drink consumption could be harmful to health, while 89.0% were aware of its negative effects on sleep quality. Furthermore, 87.8% understood that energy drinks may contain artificial additives and that marketing strategies frequently target young people. Approximately 84.9% recognized the risk of caffeine dependence, and 80.5% were aware of safer alternatives for increasing energy levels. Nevertheless, only 58.5% stated that they would reconsider their consumption if they became more informed about the health risks, suggesting a discrepancy between knowledge and behavioral intention (Table 3).
The relationship between awareness level and participants' characteristics is summarized in Table 4. No statistically significant associations were observed between awareness level and gender (p = 0.112), educational level (p = 0.389), BMI (p = 0.809), residential area (p = 0.818), marital status (p = 0.455), occupation (p = 0.464), physical activity (p = 0.362), history of chronic diseases (p = 0.140), or frequency of energy drink consumption (p = 0.216). Overall, the majority of participants across all demographic categories demonstrated good awareness regarding energy drinks (Table 4).
As illustrated in Figure 2, 76.5% of participants demonstrated good awareness, 18.9% had moderate awareness, and only 4.5% exhibited poor awareness regarding energy drinks and their potential health effects. Despite this relatively high level of knowledge, regular consumption remained widespread among the study population.
Significant associations were identified between energy drink consumption and several demographic characteristics (Table 5). Consumption frequency differed significantly according to gender (p < 0.001), educational level (p = 0.042), BMI (p = 0.005), occupation (p < 0.001), physical activity (p = 0.017), and history of chronic disease (p < 0.001). Females reported higher daily consumption than males, overweight participants consumed energy drinks more frequently than individuals with normal BMI, and students represented the occupational group with the highest overall consumption. Additionally, participants with chronic diseases reported significantly higher daily consumption than those without chronic illnesses (Table 5).
Ordinal logistic regression analysis identified several independent predictors of energy drink consumption (Table 6). Underweight participants were significantly less likely to consume energy drinks than obese participants (Estimate = −1.076, p = 0.026). Being single was associated with lower consumption compared with married participants (Estimate = −0.794, p = 0.003). Students (Estimate = −0.957, p = 0.003) and unemployed participants (Estimate = −0.833, p = 0.041) demonstrated lower odds of frequent consumption compared with non-governmental employees. Moreover, participants who never exercised (Estimate = −1.287, p < 0.001) and those without chronic diseases (Estimate = −0.568, p = 0.007) were less likely to consume energy drinks frequently. Gender and educational level were not significant independent predictors after adjustment for other variables (Table 6)
| Variable | Category | n | % |
|---|---|---|---|
| Age (years) | Median (IQR) | 21 (3) | — |
| Gender | Male | 211 | 51.5 |
| Female | 199 | 48.5 | |
| Educational level | Illiterate/Read & write | 31 | 7.6 |
| Primary | 34 | 8.3 | |
| Preparatory | 143 | 34.9 | |
| Institute/College | 202 | 49.3 | |
| Body mass index (BMI) | Underweight | 31 | 7.6 |
| Normal weight | 239 | 58.2 | |
| Overweight | 109 | 26.6 | |
| Obese | 31 | 7.6 | |
| Residence | Rural | 19 | 4.6 |
| Urban | 391 | 95.4 | |
| Marital status | Single | 336 | 82.0 |
| Married | 74 | 18.0 | |
| Occupation | Unemployed | 42 | 10.2 |
| Self-employed | 50 | 12.2 | |
| Student | 231 | 56.3 | |
| Housewife/Housemaid | 23 | 5.6 | |
| Government employee | 17 | 4.1 | |
| Non-government employee | 47 | 11.5 | |
| Physical activity | Never | 86 | 21.0 |
| Once/week | 32 | 7.8 | |
| 2–3 times/week | 63 | 15.4 | |
| Occasionally | 179 | 43.7 | |
| Daily | 50 | 12.2 | |
| History of chronic disease | No | 297 | 72.4 |
| Yes | 113 | 27.6 | |
| Reported diseases | Renal disease | 42 | 10.2 |
| Palpitation | 50 | 12.2 | |
| Migraine | 11 | 2.7 | |
| Gastric disease | 10 | 2.4 |
| Energy drink brand | Never n (%) | Rarely n (%) | Once/week n (%) | 2–3 times/week n (%) | Daily n (%) |
|---|---|---|---|---|---|
| Red Bull | 42 (10.2) | 74 (18.0) | 62 (15.1) | 78 (19.0) | 154 (37.6) |
| Tiger | 55 (13.4) | 75 (18.3) | 41 (10.0) | 98 (23.9) | 141 (34.4) |
| Jaguar | 180 (43.9) | 22 (5.4) | 4 (1.0) | 111 (27.1) | 93 (22.7) |
| Heavy 1+ | 135 (32.9) | 61 (14.9) | 26 (6.3) | 127 (31.0) | 61 (14.9) |
| Smart | 142 (34.6) | 134 (32.7) | 12 (2.9) | 50 (12.2) | 72 (17.6) |
| Mexiky | 92 (22.4) | 104 (25.4) | 69 (16.8) | 80 (19.6) | 65 (15.9) |
| Pling | 127 (31.0) | 115 (28.0) | 52 (12.7) | 46 (11.2) | 70 (17.1) |
| Asan | 74 (18.0) | 50 (12.2) | 33 (8.0) | 145 (35.4) | 108 (26.3) |
| Red Strong | 189 (46.1) | 37 (9.0) | 16 (3.9) | 70 (17.1) | 98 (23.9) |
| White Tiger | 138 (33.7) | 43 (10.5) | 12 (2.9) | 128 (31.2) | 89 (21.7) |
| Monster | 188 (45.9) | 67 (16.3) | 24 (5.9) | 31 (7.6) | 100 (24.4) |
| Awareness statement | Yes n (%) | No n (%) |
|---|---|---|
| Aware of common ingredients | 332 (81.0) | 78 (19.0) |
| Provide quick energy | 273 (66.6) | 137 (33.4) |
| Regular consumption is harmful | 381 (92.9) | 29 (7.1) |
| Cause side effects | 349 (85.1) | 61 (14.9) |
| High caffeine may cause dependence | 348 (84.9) | 62 (15.1) |
| Suitable for immediate energy | 311 (75.9) | 99 (24.1) |
| Affect sleep quality | 365 (89.0) | 45 (11.0) |
| Improve concentration temporarily | 230 (56.1) | 180 (43.9) |
| Risk when mixed with alcohol | 282 (68.8) | 128 (31.2) |
| Aware of safer alternatives | 330 (80.5) | 80 (19.5) |
| Contain artificial additives | 360 (87.8) | 50 (12.2) |
| Marketing targets youth | 360 (87.8) | 50 (12.2) |
| Excessive intake causes complications | 314 (76.6) | 96 (23.4) |
| Health effects differ among individuals | 316 (77.1) | 94 (22.9) |
| Would reconsider consumption | 240 (58.5) | 170 (41.5) |
| Aware of environmental impact | 243 (59.3) | 167 (40.7) |
| Variable | P value |
|---|---|
| Gender | 0.112 |
| Educational level | 0.389 |
| Body mass index | 0.809 |
| Residence | 0.818 |
| Marital status | 0.455 |
| Occupation | 0.464 |
| Physical activity | 0.362 |
| History of chronic disease | 0.140 |
| Energy drink consumption frequency | 0.216 |
Chi-square test. No statistically significant associations were observed (p > 0.05).
| Variable | P value |
|---|---|
| Gender | <0.001 |
| Educational level | 0.042 |
| Body mass index | 0.005 |
| Residence | 0.703 |
| Marital status | <0.001 |
| Occupation | <0.001 |
| Physical activity | 0.017 |
| History of chronic disease | <0.001 |
Bold values indicate statistically significant associations (p < 0.05).
| Predictor | Estimate | 95% CI | P value |
|---|---|---|---|
| Underweight BMI | -1.076 | -2.023 to -0.130 | 0.026 |
| Single marital status | -0.794 | -1.322 to -0.266 | 0.003 |
| Unemployed | -0.833 | -1.631 to -0.036 | 0.041 |
| Student | -0.957 | -1.591 to -0.323 | 0.003 |
| Never exercise | -1.287 | -1.966 to -0.609 | <0.001 |
| Occasionally exercise | -0.919 | -1.523 to -0.315 | 0.003 |
| No chronic disease | -0.568 | -0.981 to -0.155 | 0.007 |
Ordinal logistic regression model. Statistically significant predictors are shown in bold.
The present study investigated energy drink consumption patterns and health awareness among young people in Rania City, Kurdistan Region, Iraq. The findings revealed a remarkably high prevalence of regular energy drink consumption, with more than half of the participants reporting daily intake despite most demonstrating good awareness of the potential adverse health effects. This discrepancy between knowledge and behavior suggests that awareness alone is insufficient to discourage energy drink consumption among young people, emphasizing the influence of behavioral, social, and environmental factors.
One of the most important findings was the high prevalence of daily energy drink consumption (57.1%). This proportion is considerably higher than that reported in many international studies, where regular consumption among adolescents and young adults generally ranges from 20% to 40% [1,2]. The widespread availability of energy drinks, intensive marketing campaigns, affordable prices, and their perceived ability to improve concentration and physical performance may explain the high consumption observed in the present study. Similar findings have been reported among university students in Jordan and Saudi Arabia, where frequent energy drink consumption was largely attributed to academic pressure, social influence, and easy product accessibility [3,4].
Among the various products evaluated, Red Bull and Tiger were the most frequently consumed brands. This finding is consistent with reports from Middle Eastern countries indicating that internationally recognized brands dominate the regional market because of extensive advertising and greater consumer confidence [5]. Brand popularity may also be influenced by aggressive social media marketing targeting adolescents and young adults, which has been shown to increase both product recognition and purchase intention [6].
Although 76.5% of participants demonstrated good awareness regarding the health risks associated with energy drinks, this knowledge did not translate into healthier consumption behavior. Most participants recognized that excessive intake could negatively affect sleep, increase caffeine dependence, and cause other health complications; however, regular consumption remained common. Similar discrepancies have been observed in previous studies conducted in Iraq, Malaysia, and Jordan, where adequate knowledge coexisted with frequent energy drink use [3,7,8]. This phenomenon suggests that consumption decisions are influenced not only by knowledge but also by taste preferences, peer pressure, marketing exposure, lifestyle habits, and perceived short-term benefits.
Interestingly, awareness level was not significantly associated with any sociodemographic characteristic. Participants demonstrated relatively similar levels of knowledge regardless of gender, educational attainment, residence, marital status, occupation, or physical activity. These findings indicate that information regarding energy drinks may be widely disseminated across different population groups through schools, universities, healthcare campaigns, and social media. Similar observations have been reported in previous cross-sectional studies where demographic characteristics had limited influence on awareness levels despite differences in consumption behavior [8,9].
Conversely, several demographic and lifestyle factors were significantly associated with energy drink consumption. Gender, educational level, body mass index, occupation, physical activity, marital status, and the presence of chronic diseases significantly influenced consumption frequency. These findings support previous research demonstrating that lifestyle characteristics play a greater role than awareness in determining consumption patterns [2,5]. Individuals with higher BMI and those reporting chronic diseases appeared more likely to consume energy drinks frequently, possibly because of sedentary lifestyles, poor dietary habits, or misconceptions regarding the stimulating effects of these beverages.
Ordinal logistic regression further identified BMI, marital status, occupation, physical activity, and chronic disease status as independent predictors of energy drink consumption. Participants who were underweight, single, unemployed, students, or physically inactive demonstrated significantly different consumption behaviors after adjustment for potential confounders. These findings emphasize that energy drink use is a multifactorial behavior influenced by demographic, behavioral, and health-related characteristics rather than knowledge alone. Comparable predictors have been identified in systematic reviews examining determinants of energy drink consumption among adolescents and young adults worldwide [1,2].
From a public health perspective, the high prevalence of daily energy drink consumption observed in this study is concerning because excessive caffeine intake has been associated with cardiovascular disorders, hypertension, arrhythmias, anxiety, sleep disturbances, and metabolic complications [1,10]. Young people may underestimate these risks because many adverse effects develop gradually or are perceived as temporary. Therefore, educational interventions should move beyond merely increasing knowledge and instead focus on behavioral change strategies, restricting youth-oriented marketing, strengthening warning labels, and promoting healthier beverage alternatives.
Overall, the present study contributes valuable evidence regarding energy drink consumption among young people in the Kurdistan Region of Iraq. The findings highlight that while awareness of health risks is relatively high, unhealthy consumption patterns remain widespread. Future health promotion initiatives should combine educational programs with behavioral interventions and policy measures to reduce excessive energy drink consumption among adolescents and young adults.
This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design precludes the establishment of causal relationships between participants' characteristics and energy drink consumption. Second, the use of a convenience sampling technique from a single city may limit the generalizability of the findings to other regions of Iraq. Third, data were collected through self-reported questionnaires, making the results susceptible to recall and social desirability biases. Finally, although health awareness was assessed, the study did not evaluate participants' actual caffeine intake, quantity of energy drinks consumed, or long-term health outcomes associated with regular consumption. Future multicenter longitudinal studies are recommended to provide a more comprehensive understanding of consumption behaviors and their health consequences.
The present study demonstrated a high prevalence of energy drink consumption among young people in Rania City despite generally good awareness of the potential health risks associated with these beverages. Red Bull and Tiger were the most frequently consumed energy drink brands, and more than half of the participants reported daily consumption. While awareness levels were relatively high, they were not significantly associated with consumption behavior, indicating that knowledge alone is insufficient to reduce energy drink use. Instead, demographic and lifestyle factors, including gender, educational level, body mass index, occupation, physical activity, marital status, and chronic disease status, were significant determinants of consumption patterns. These findings underscore the need for comprehensive public health interventions that combine health education with behavioral change strategies, stricter regulation of energy drink marketing directed at young people, and promotion of healthier beverage alternatives to reduce excessive consumption and its potential adverse health effects.
