Energy Drink Consumption Among Kabul University Students: A Cross-Sectional Study of Prevalence, Patterns, Awareness, and Adverse Health Effects

Energy Drink Consumption Among Kabul University Students: A Cross-Sectional Study of Prevalence, Patterns, Awareness, and Adverse Health Effects | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Energy Drink Consumption Among Kabul University Students: A Cross-Sectional Study of Prevalence, Patterns, Awareness, and Adverse Health Effects Ershad Ahmad Mushkani, Fahima Hamidy, Tawfiq Ahmad Mushkani, Ahmad Farid Daanish, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7275718/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Harm Reduction Journal → Version 1 posted 11 You are reading this latest preprint version Abstract Background : Energy drinks are stimulant-containing beverages, primarily formulated with caffeine and marketed to enhance mental and physical performance. Unlike coffee, tea, or caffeinated soft drinks, these products are specifically designed as functional stimulants. Purpose : This study aimed to assess university students’ awareness of energy drinks and evaluate their consumption patterns, associated side effects, and reasons for use. Methods : This cross-sectional observational study was conducted from April to August 2023 at three major universities in Kabul, Afghanistan: Kabul University of Medical Sciences, Kabul Education University, and Kabul University. We distributed 401 questionnaires to students across these institutions, achieving a response rate of 96.76% (n=379 completed questionnaires). Thirteen students (3.24%) did not return their questionnaires. All collected data were entered and analyzed using SPSS software (version 21). Results: All participants were male, with ages ranging from 17 to 29 years (mean = 21.1 years; SD = 3.9). Energy drink consumption was reported by 89.97% of participants, of whom 41.34% were occasional users (less than one drink per week) and 56.59% were habitual consumers (3–4 drinks per week). Higher consumption (more than one can) was significantly associated with living alone ( P = 0.000) and daily coffee intake ( P = 0.005). The primary reasons for consumption included needing energy (33.66%, n = 169), enjoying the taste (24.90%, n = 125), and increased use during exams to improve alertness (12.35%, n = 62). There were no significant differences in energy drink consumption across academic years (P > 0.05). Most students recognized caffeine (86.8%) and sugar (89.97%) as key ingredients. Habitual consumers reported reducing sleep hours more frequently than occasional consumers (34.89% vs. 18.18%; P < 0.05) and were more likely to use it to aid studying/major projects (83.28% vs. 14.66%; P < 0.05). Adverse effects were reported by 67.44% ( n = 230), primarily palpitations (44.54%) and insomnia (21.56%). Conclusion: This study highlights the widespread consumption of energy drinks among university students. The primary motivations for consumption included boosting energy, enjoying the taste, and enhancing alertness during exams. More than half of the participants reported adverse effects, with the most common being palpitations and insomnia. Our findings emphasize the need for educational campaigns to raise awareness of potential health risks. Additionally, policymakers should reconsider legal regulations on the production, marketing, and advertising of energy drinks to mitigate excessive consumption and protect public health. Palpitation Energy drinks Consumption University Students Figures Figure 1 Figure 2 Figure 3 Background Caffeinated beverages known as energy drinks (EDs) first appeared in Europe and Asia in the 1960s but didn't gain widespread popularity until 1987, when Red Bull - now the most prominent brand - launched in Austria. These drinks entered the US market in 1997. By 2006, annual US energy drink sales surpassed $ 500 million, with over 500 brands available worldwide.¹ The market grew dramatically between 2008 and 2012, with sales increasing by 60% to exceed $ 12.5 billion.² Today, energy drinks account for over 20% of the total beverage market. Energy drinks are a class of beverage that contains stimulants, primarily caffeine, and are marketed as both physical and mental stimulants. In general, coffee, tea, and other naturally caffeine-containing liquids are not categorized as energy drinks. Although soft drinks like cola can contain caffeine, they are not classified as energy drinks. One thing unifies all of the many EDs brands: they all include caffeine. The amount of caffeine in each can varies between 50 to 505 mg, while a cup of coffee contains 80 mg. 3 Extracts of guarana, taurine, ginseng, inositol, carnitine, glucuronolactone, B group vitamins, methylxanthines, and carbohydrates (ribose, sucrose, and fructose) are also present in EDs in addition to caffeine. Its side effects may be likely due to these substances. 4 Between 30 and 50 percent of adolescents and young adults utilize energy drinks. 5 Research has also shown that young athletes consume a lot of energy drink. 6 In 2011, a study of 439 students at a Turkish university revealed that 48.3% had used EDs at least once in their lives, and 33% were continuous users. 7 In North America, the prevalence rates of EDs use among college students range from 36.4–70.1%, 8,9 whereas in Central South America, they are approximately 38%. 10, 11 In Riyadh, Saudi Arabia, 29.3% of students reported consuming energy drinks. 12 while another study in Taif University found 74.88%. 13 According to a study conducted in New Delhi, India, 62% of medical college students consumed energy drinks. 14 42.89% of students at Dow Medical College in Karachi, Pakistan, reported consuming energy drinks. 15 Energy drinks are used by young people for several purposes, including studying, partying, driving, energy increase, and wakefulness. 16 There is a lack of evidence to support claims that any of the other chemicals in EDs improve physical performance or cognitive functioning, with the exception of the extracts of guarana, caffeine, and glucose. 17 Young individuals often use EDs in clubs, often in combination with illegal substances like marijuana and amphetamines. 18 A study found that energy drinks significantly affect the cardiovascular system by changing heart rate and blood pressure. 19 Caffeine consumption has been linked to neuropsychosis, even in persons without a pre-existing psychotic condition. 20 Energy drink usage has been linked to 'problem behaviors' such as sexual risk-taking, marijuana use, fighting, and failure to use seat belts. 21 Caffeine-related issues, such as intoxication, dependency, and withdrawal, may be associated with genetics and pharmacological intolerance. 3 There is a major concern that advertisements claim these substances improve performance, reduce physical and mental stress, and enhance concentration, reaction time, wakefulness, attention, emotional regulation, and metabolism. Unfortunately, there is no regulation regarding the sale of energy drinks to children or by children in some counties in Afghanistan, where energy drinks are being sold extensively by teenagers in some stores and at many street corners. Several countries have implemented regulatory measures to curb aggressive energy drink promotions, including bans on media advertisements. 16 A notable example is Saudi Arabia, where authorities banned the sale of these beverages in schools, universities, and government premises. Objectives This study aims to investigate the prevalence and consumption patterns of energy drinks among Kabul University students, assess their awareness of the ingredients and potential side effects, and identify the underlying reasons for their use. By addressing these aspects, the research seeks to fill the existing knowledge gap regarding energy drink consumption in Afghanistan and its implications for student health. Methods Data A cross-sectional and observational study was conducted from April to August 2023 at three biggest public universities in Kabul, Afghanistan. The study involved students from nine faculties, including Science, Engineering, Agriculture, Nursing, public health, stomatology, Psychology, computer science, and foreign language. A multi-stage cluster sampling technique was used, with students randomly selected from each university's respective faculties. A total of 401 questionnaires were distributed among students. Of these, 379 students (96.76%) agreed to participate and completed the questionnaire, while 13 students (3.24%) did not return the questionnaire. Measures For this study, four trained researchers were involved: one from the Clinical Nursing Department, two from the Pharmacology Department, and one from the Ophthalmology Department at Kabul University of Medical Sciences in Kabul, Afghanistan. A previously used questionnaire is translated into the local language for data collection. A few items are self-generated in the questionnaire. Before the data collection through the questionnaire, it was pre-tested on 10 students to ensure the readability and precise administration of the data collection forms. The questionnaire took around two minutes to complete, and no changes were required based on the field test results. Before distributing the questionnaires, the researchers verified that the participants met the study’s sample criteria and were university students. Questionnaire The questionnaire, structured around 14 variables, was divided into six sections: (1) demographic information, (2) consumption frequency and patterns, (3) why people consume energy drinks, (4) reported side effects, (5) ingredient knowledge, and (6) sources of introduction to energy drinks Analysis All data were recorded and analyzed using SPSS version 21. Categorical data were analyzed using frequency and percentage, whereas continuous data were analyzed using mean and standard deviation. To establish the significance of the association between users and non-users, P values were determined using the Chi-square test. The acceptable level of significance was fixed at < 0.05. Ethical considerations The study was non-interventional, participation was voluntary, the questionnaires were anonymous and short, the purpose of the study was explained to the participants, hence filling and returning the questionnaires was taken as implied consent to participate. A written approval on the study was obtained from the Education Development Centre of KUMS (Reference: 83 − 7/08/2023). Results Demographic characteristics The study included 379 students, who agreed to participate and fill the questionnaire, and 13 (3.24%) did not participate in study. All participants were male, with ages ranging from 17 to 29 years (mean = 21.1 years; SD = 3.9). The sample included students from three government universities: Kabul University of Medical Sciences (n = 140, 36.9%), Kabul University (n = 118, 31.1%), and Education University (n = 121, 32%). Participants represented different academic years: second year (n = 139, 36.67%), third year (n = 135, 35.62%), and fourth year (n = 105, 27.7%) (Table 1 ). Table 1 Demographic characteristics of participants. characteristics N (%) Age groups (years) 25 24 (6.33) Gender Male 379 (100) Female 0 (0) Marital status Single 281 (74.14) Married 98 (25.85) Divorced/widowed 0 (.00) Living status Dormitory living 64 (16.88) Living with family 304 (80.21) Living alone 11 (2.90) Frequency of physical activity Daily 103 (27.17) Once a week 19 (5.01) Once a month 7 (1.84) Never 250 (65.96) Name of University KUMS 145 (38.25) Kabul university 115 (30.34) Education university 119 (31.39) Year of study 2nd year 130 (34.30) 3rd year 132 (34.82) 4th year 117 (30.87) Among all participants, 341 (89.97%) reported having consumed energy drinks at least once, while 38 (10.03%) reported never consuming them (Fig. 1 ). Statistical analysis showed significant difference in consumption patterns between energy drink users and non-users (p < 0.05). Energy drink consumers were categorized into two groups: habitual consumers (those consuming EDs 3–4 times per week) and occasional consumers (those consuming EDs less than once per week). Habitual consumers accounted for 56.59% of ED users, while occasional consumers represented 41.34% and only seven students reported daily ED consumption (Fig. 2 ). A higher proportion of habitual consumers (24.7%) engaged in physical activity compared to occasional consumers (18.1%). When asked about their perception of EDs, 76.7% of consumers considered them "healthy," 7.5% deemed them "useless," 0.5% viewed them as "dietetic," and 93.3% described them as "energizing." In terms of purchasing habits, one-quarter of consumers bought EDs at supermarkets, 66% purchased them from roadside vendors, and the remaining small percentage obtained them at gyms. According to the Mode of introduction to energy drink the most common cause were social settings 179 (52.49%) followed by Advertisements especially by TV and social media 36 (10.55%) (Table 2 ). Table 2 Mode of introduction to energy drink. How student was introduced N (%) Social settings 179 (52.49) Advertisements at the supermarket/store 36 (10.55) Recommendations from friends and family 21 (6.15) Others 105 (30.79) Energy drink consumption did not vary significantly across academic years or universities (p > 0.05; Table 3 ). Table 3 Energy Drink Consumption by University and Academic Year Category Consumers (n = 341) Non-Consumers (n = 38) Total (N = 379) p-value University > 0.05 KUMS 125 (86.2%) 20 (13.8%) 145 (100%) Kabul University 107 (93.0%) 8 (7.0%) 115 (100%) Education University 109 (91.6%) 10 (8.4%) 119 (100%) Academic Year > 0.05 2nd Year 125 (96.2%) 5 (3.8%) 130 (100%) 3rd Year 123 (93.2%) 9 (6.8%) 132 (100%) 4th Year 93 (79.5%) 24 (20.5%) 117 (100%) Overall 341 (90.0%) 38 (10.0%) 379 00%) Notes: • Percentages are row-based (e.g., 86.2% = 125/145 KUMS students). • p -values from Chi-square tests (no significant differences). Reasons for Consuming Energy Drink The most common reason for consuming energy drinks was energy need 169 (33.66%), followed by enjoy the taste 125 (24.90%) (Fig. 3 ). Awareness of contents and possible side-effects of energy drinks Nine percent of energy drinkers always check ingredient levels and cations in the cans. Most students recognize caffeine (86.8%) and sugar (89.97%) in energy drinks, but awareness drops for other ingredients like taurine (31.66%) and guarana (20.58%). Many are unsure about carbonated water (53.03% "I don’t know") and herbal supplements (18.2% unsure) (Table 4 ). Table 4 Students’ knowledge about energy drink ingredients. Which of these substances do you think are contained in energy drinks? No Yes I do not know N (%) N (%) N (%) Caffeine 39 (10.29) 329 (86.80) 11 (2.90) Sugar 28 (7.38) 341 (89.97) 10 (2.63) B Vitamins 155 (40.89) 170 (44.85) 54 (14.24) Herbal supplements 209 (55.14) 101 (26.64) 69 (18.20) Taurine 225 (59.36) 120 (31.66) 34 (8.97) Ginseng 158 (41.68) 187 (49.34) 34 (8.97) Carbonated water and citric acid 65 (17.15) 113 (29.81) 201 (53.03) Flavoring and coloring 139 (36.67) 209 (55.14) 31 (8.17) Guarana 76 (20.05) 78 (20.58) 225 (59.36) Of the participants, 230 (67.44%) reported adverse effects. The most common side effects of energy drinks are palpitations (44.54%) and insomnia (21.56%), likely due to high caffeine. Less frequent but notable issues include headaches (8.53%), nervousness (6.63%), and tremors (4.73%). Rare but serious effects like hypertension (0.94%) and allergies (0.94%) also occur (Table 5 ). Table 5 Prevalence of adverse effects associated with energy drink consumption. Effect No (%) Palpitations 88 (44.54) Insomnia 41 (21.56) Headache 36 (8.53) Nervousness 28 (6.63) Increased urination 24 (6.55) Tremors 20 (4.73) Tingling 16 (3.79) Abdominal pain 8 (1.89) Hypertension 4 (0.94) Allergy 4 (0.94) Discussion This study represents the first nationwide survey examining energy drink consumption patterns among Kabul University students. The prevalence of energy drinks consumption was 89.97% among the universities. This is higher than the established ranges (22.6–62.2%) reported in multinational studies of university populations. 6 , 16 , 21 , 28 , 29 A study conducted in Pakistan reported that 42.89% of medical students consumed energy drinks. 15 However, studies from different regions of Saudi Arabia present conflicting results. For instance, research from Riyadh province documented a substantially higher usage rate (82.4%), 22 while another study in Makkah reported a significantly lower consumption rate (27.7%). 23 The use of energy drinks (EDs) is frequently provoked by advertising. This is expected, as marketing campaigns are strategically designed to appeal to individuals with demanding lifestyles who seek enhanced energy. Key target groups include university students requiring sustained focus for extended study sessions, social attendees, and participants in high-intensity sports. Furthermore, the easy accessibility of energy drinks even being sold roadside contributes to their widespread consumption. In our study most students recognize caffeine (86.8%) and sugar (89.97%) in energy drinks, but awareness drops for other ingredients like taurine (31.66%) and guarana (20.58%). Many are unsure about carbonated water (53.03% "I don’t know") and herbal supplements (18.2% unsure) (Table 4 ). This suggests strong familiarity with key stimulants but gaps in knowledge about less-promoted ingredients. A study in Saudi Arabian revealed high awareness of caffeine content in energy drinks (88.1%), while demonstrating limited knowledge about other ingredients with 82.5% unaware of taurine and 95.5% unfamiliar with guarana content. 12 In our study participants most frequently mentioned, energy needs as reasons for using energy drinks. This result is in line with a previous study that found that the main motivation for consuming energy drinks was to increase energy levels during study sessions and out of curiosity. 24 Meanwhile, our findings identified taste as an important consumption factor this is in a contrasting with prior research that did not highlight this determinant. 25 Similarly, other research found that taste (39.9%), energy demands (27.7%), and studying (13.1%) were the motivations of energy drinks consumption. 26 In the current study, a majority of students (67.44%) reported adverse effects from energy drinks a significantly higher percentage than the 30.62% reported in a comparable study, both studies identified increased urination, insomnia, abnormal heart rhythm, and irritability as the most common adverse effects. 25 Our study demonstrates that students who consumed energy drinks rapid heart rate and insomnia were the most common side effects while a study conducted in Saudi reported that participants who daily consumed EDs frequently complained of nervousness and other problems such as chest pain, insomnia, headache, constipation, diuresis, fatigue, and tremors. 27 Consuming more than 400 mg of caffeine per day is considered a high intake. Excessive caffeine consumption can lead to intoxication, often caused by factors like aggressive marketing of energy drinks, a preference for their taste (which drives higher consumption), the combined effects of caffeine with other additives in these beverages, and additional caffeine intake from other sources. The findings of this study provide preliminary evidence to support international calls for regulatory interventions on energy drinks. These measures should include revised labeling standards, stricter advertising controls, reformulation of problematic ingredients, and retail restrictions particularly for student populations. Studies show that such measures increase consumer awareness, reduce consumption, and help curb excessive intake particularly among young people. 30 Limitations The primary limitation of the present study is related to the sample composition, which consists exclusively of males, resulting in a gender imbalance. This was not an intentional decision made during the planning phases of the study; rather, it reflects current policies in Afghanistan that restrict female attendance at universities. Consequently, we were unable to include female participants in this study. The second limitation pertains to the reliance on self-reported data, which is subject to recall bias and social desirability bias. Strengths This study was conducted at one of the largest universities in Kabul, Afghanistan, utilizing multistage cluster sampling for data collection. Another strength of our study lies in its assessment of awareness regarding the ingredients of energy drinks and their patterns of consumption among university students. All efforts were made to ensure that the collected data was reliable and that the methods were reproducible. Furthermore, our questionnaire was culturally adapted and piloted for clarity. Along with mentioned ethical and STROBE criteria, our questionnaire has been culturally adjusted and piloted for clarity. This ensures the validity of the data gathered and the accuracy of the findings based on the techniques employed. Conclusion This study highlights the widespread consumption of energy drinks among students. The primary motivations for consumption included boosting energy, enjoying the taste, and enhancing alertness during exams. While students were generally aware of key ingredients like caffeine and sugar, many reported adverse effects such as palpitations and insomnia. These findings emphasize the need for educational campaigns and increase awareness of potential health risks. Additionally, policymakers should reconsider legal regulations on the production, marketing, and advertising of energy drinks to mitigate excessive consumption and protect public health. Declarations Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Author Contribution A.B. and C. conceived the study and designed the methodology. D and E coordinated data collection at Kabul University. I.J. performed statistical analysis. A.B. drafted the manuscript, with critical revisions from S.T. and Q.R. All authors approved the final version. References Pennay A, Lubman DI. Alcohol and energy drinks: a pilot study exploring patterns of consumption, social contexts, benefits and harms. BMC Res Notes. 2012;5:369. Zucconi S, Volpato C, Adinolfi F, Gandini E, Gentile E, Loi A, Fioriti L. Gathering consumption data on specific consumer groups of energy drinks. Parma: EFSA 2013. (External Sci entific Report for European Food Safety Authority). Available at: https://www.efsa.europa.eu/en/supporting/pub/en-394 . Ac cessed in May 2017. Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks-growing problem. Drug Alcohol Depend. 2009; 1;99(1 3):1–10. 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Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2026 Read the published version in Harm Reduction Journal → Version 1 posted Editorial decision: Revision requested 28 Sep, 2025 Reviews received at journal 21 Sep, 2025 Reviewers agreed at journal 31 Aug, 2025 Reviewers agreed at journal 31 Aug, 2025 Reviewers agreed at journal 30 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers invited by journal 04 Aug, 2025 Editor assigned by journal 04 Aug, 2025 Submission checks completed at journal 04 Aug, 2025 First submitted to journal 02 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7275718","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496833173,"identity":"deee1488-dfa6-41d8-b13b-c11e3a2a2d98","order_by":0,"name":"Ershad Ahmad Mushkani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYHACNhBKADIMH3ww+CcHEjrwgEgtxoYzKg4Yg7UkEKnFTJrjzIHEBpAYPi380sefPfhRZpen2354gzRj2530+WGHHwJtsZPTbcCuRbIvx9yw51xysdmZtALjwrZnuRtvpxkAtSQbmx3ArsXgDA+bBG8bc+K2AzkGyTPbmHM3zk4AaTkAFMGuxf4M+zPJv231idvOvzE4DNSbbjg7/QNeLQY8QF/zth1O3HYjx7CZ58zhBHnpHPy2SJzhMZOWOXccqOVZMeOMijTDDdI5BQcSDHD7hb8H6LA3ZdVAhyVv//HBwEZefnb65g8fKuzkcGnB4lSwSgNilYOAfAMpqkfBKBgFo2AkAAChc2m8jjiZlgAAAABJRU5ErkJggg==","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Ershad","middleName":"Ahmad","lastName":"Mushkani","suffix":""},{"id":496833178,"identity":"2a102239-a56b-4e97-806c-67ecb899d3e1","order_by":1,"name":"Fahima Hamidy","email":"","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fahima","middleName":"","lastName":"Hamidy","suffix":""},{"id":496833179,"identity":"0a97b57b-6d57-4afa-95fe-8d41a56e0d5a","order_by":2,"name":"Tawfiq Ahmad Mushkani","email":"","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Tawfiq","middleName":"Ahmad","lastName":"Mushkani","suffix":""},{"id":496833180,"identity":"1304fa96-c8b7-4d77-916e-44ee377d82ee","order_by":3,"name":"Ahmad Farid Daanish","email":"","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ahmad","middleName":"Farid","lastName":"Daanish","suffix":""},{"id":496833181,"identity":"944147e2-3cf6-438e-84cf-729a8b835855","order_by":4,"name":"Mohammad Rafi Rahmani","email":"","orcid":"","institution":"Kabul University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"Rafi","lastName":"Rahmani","suffix":""}],"badges":[],"createdAt":"2025-08-02 05:38:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7275718/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7275718/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12954-025-01389-4","type":"published","date":"2026-01-06T15:58:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88643898,"identity":"5e78cac4-92c8-488e-9206-fdf537c3de96","added_by":"auto","created_at":"2025-08-08 16:18:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19594,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Energy Drink Consumption Among University Students.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7275718/v1/b64ca9766a66ddcf2ae0c6e3.png"},{"id":88643895,"identity":"16bc65ca-c485-4e4d-aa7c-58e7544d96f7","added_by":"auto","created_at":"2025-08-08 16:18:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29995,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of study participants by energy drink consumption frequency.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7275718/v1/15fe525d431884bd23ea5020.png"},{"id":88643899,"identity":"415c2a51-5f8e-40c5-ae23-cfc690457c04","added_by":"auto","created_at":"2025-08-08 16:18:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49674,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for using energy drinks.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7275718/v1/46e3b267c0909316737c940f.png"},{"id":100070480,"identity":"76c805f3-30d2-4e5b-bc1b-21483c1b2ebc","added_by":"auto","created_at":"2026-01-12 16:17:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":961124,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7275718/v1/d1953a2f-aeb0-42f3-b89e-7d3d57cb0e39.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Energy Drink Consumption Among Kabul University Students: A Cross-Sectional Study of Prevalence, Patterns, Awareness, and Adverse Health Effects","fulltext":[{"header":"Background","content":"\u003cp\u003eCaffeinated beverages known as energy drinks (EDs) first appeared in Europe and Asia in the 1960s but didn't gain widespread popularity until 1987, when Red Bull - now the most prominent brand - launched in Austria. These drinks entered the US market in 1997. By 2006, annual US energy drink sales surpassed \u003cspan\u003e$\u003c/span\u003e500\u0026nbsp;million, with over 500 brands available worldwide.¹ The market grew dramatically between 2008 and 2012, with sales increasing by 60% to exceed \u003cspan\u003e$\u003c/span\u003e12.5\u0026nbsp;billion.² Today, energy drinks account for over 20% of the total beverage market.\u003c/p\u003e\u003cp\u003eEnergy drinks are a class of beverage that contains stimulants, primarily caffeine, and are marketed as both physical and mental stimulants. In general, coffee, tea, and other naturally caffeine-containing liquids are not categorized as energy drinks. Although soft drinks like cola can contain caffeine, they are not classified as energy drinks.\u003c/p\u003e\u003cp\u003eOne thing unifies all of the many EDs brands: they all include caffeine. The amount of caffeine in each can varies between 50 to 505 mg, while a cup of coffee contains 80 mg.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Extracts of guarana, taurine, ginseng, inositol, carnitine, glucuronolactone, B group vitamins, methylxanthines, and carbohydrates (ribose, sucrose, and fructose) are also present in EDs in addition to caffeine. Its side effects may be likely due to these substances.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBetween 30 and 50 percent of adolescents and young adults utilize energy drinks.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Research has also shown that young athletes consume a lot of energy drink.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In 2011, a study of 439 students at a Turkish university revealed that 48.3% had used EDs at least once in their lives, and 33% were continuous users.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn North America, the prevalence rates of EDs use among college students range from 36.4–70.1%,\u003csup\u003e8,9\u003c/sup\u003e whereas in Central South America, they are approximately 38%.\u003csup\u003e10, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In Riyadh, Saudi Arabia, 29.3% of students reported consuming energy drinks.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e while another study in Taif University found 74.88%.\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAccording to a study conducted in New Delhi, India, 62% of medical college students consumed energy drinks.\u003csup\u003e14\u003c/sup\u003e 42.89% of students at Dow Medical College in Karachi, Pakistan, reported consuming energy drinks.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eEnergy drinks are used by young people for several purposes, including studying, partying, driving, energy increase, and wakefulness.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e There is a lack of evidence to support claims that any of the other chemicals in EDs improve physical performance or cognitive functioning, with the exception of the extracts of guarana, caffeine, and glucose.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Young individuals often use EDs in clubs, often in combination with illegal substances like marijuana and amphetamines.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA study found that energy drinks significantly affect the cardiovascular system by changing heart rate and blood pressure.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Caffeine consumption has been linked to neuropsychosis, even in persons without a pre-existing psychotic condition.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Energy drink usage has been linked to 'problem behaviors' such as sexual risk-taking, marijuana use, fighting, and failure to use seat belts.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Caffeine-related issues, such as intoxication, dependency, and withdrawal, may be associated with genetics and pharmacological intolerance.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThere is a major concern that advertisements claim these substances improve performance, reduce physical and mental stress, and enhance concentration, reaction time, wakefulness, attention, emotional regulation, and metabolism. Unfortunately, there is no regulation regarding the sale of energy drinks to children or by children in some counties in Afghanistan, where energy drinks are being sold extensively by teenagers in some stores and at many street corners. Several countries have implemented regulatory measures to curb aggressive energy drink promotions, including bans on media advertisements.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e A notable example is Saudi Arabia, where authorities banned the sale of these beverages in schools, universities, and government premises.\u003c/p\u003e"},{"header":"Objectives","content":"\u003cp\u003eThis study aims to investigate the prevalence and consumption patterns of energy drinks among Kabul University students, assess their awareness of the ingredients and potential side effects, and identify the underlying reasons for their use. By addressing these aspects, the research seeks to fill the existing knowledge gap regarding energy drink consumption in Afghanistan and its implications for student health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eData\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional and observational study was conducted from April to August 2023 at three biggest public universities in Kabul, Afghanistan. The study involved students from nine faculties, including Science, Engineering, Agriculture, Nursing, public health, stomatology, Psychology, computer science, and foreign language. A multi-stage cluster sampling technique was used, with students randomly selected from each university's respective faculties. A total of 401 questionnaires were distributed among students. Of these, 379 students (96.76%) agreed to participate and completed the questionnaire, while 13 students (3.24%) did not return the questionnaire.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFor this study, four trained researchers were involved: one from the Clinical Nursing Department, two from the Pharmacology Department, and one from the Ophthalmology Department at Kabul University of Medical Sciences in Kabul, Afghanistan.\u003c/p\u003e\u003cp\u003eA previously used questionnaire is translated into the local language for data collection. A few items are self-generated in the questionnaire. Before the data collection through the questionnaire, it was pre-tested on 10 students to ensure the readability and precise administration of the data collection forms. The questionnaire took around two minutes to complete, and no changes were required based on the field test results. Before distributing the questionnaires, the researchers verified that the participants met the study’s sample criteria and were university students.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuestionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe questionnaire, structured around 14 variables, was divided into six sections: (1) demographic information, (2) consumption frequency and patterns, (3) why people consume energy drinks, (4) reported side effects, (5) ingredient knowledge, and (6) sources of introduction to energy drinks\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll data were recorded and analyzed using SPSS version 21. Categorical data were analyzed using frequency and percentage, whereas continuous data were analyzed using mean and standard deviation. To establish the significance of the association between users and non-users, P values were determined using the Chi-square test. The acceptable level of significance was fixed at \u0026lt; 0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was non-interventional, participation was voluntary, the questionnaires were anonymous and short, the purpose of the study was explained to the participants, hence filling and returning the questionnaires was taken as implied consent to participate. A written approval on the study was obtained from the Education Development Centre of KUMS (Reference: 83 − 7/08/2023).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eDemographic characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study included 379 students, who agreed to participate and fill the questionnaire, and 13 (3.24%) did not participate in study.\u003c/p\u003e\u003cp\u003eAll participants were male, with ages ranging from 17 to 29 years (mean\u0026thinsp;=\u0026thinsp;21.1 years; SD\u0026thinsp;=\u0026thinsp;3.9). The sample included students from three government universities: Kabul University of Medical Sciences (n\u0026thinsp;=\u0026thinsp;140, 36.9%), Kabul University (n\u0026thinsp;=\u0026thinsp;118, 31.1%), and Education University (n\u0026thinsp;=\u0026thinsp;121, 32%). Participants represented different academic years: second year (n\u0026thinsp;=\u0026thinsp;139, 36.67%), third year (n\u0026thinsp;=\u0026thinsp;135, 35.62%), and fourth year (n\u0026thinsp;=\u0026thinsp;105, 27.7%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of participants.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003echaracteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge groups (years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (24.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e261 (68.86)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (6.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e379 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e281 (74.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (25.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced/widowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDormitory living\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (16.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving with family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e304 (80.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (2.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFrequency of physical activity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103 (27.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (5.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (1.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e250 (65.96)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eName of University\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKUMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e145 (38.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKabul university\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115 (30.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation university\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (31.39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eYear of study\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130 (34.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132 (34.82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4th year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117 (30.87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong all participants, 341 (89.97%) reported having consumed energy drinks at least once, while 38 (10.03%) reported never consuming them (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Statistical analysis showed significant difference in consumption patterns between energy drink users and non-users (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEnergy drink consumers were categorized into two groups: habitual consumers (those consuming EDs 3\u0026ndash;4 times per week) and occasional consumers (those consuming EDs less than once per week). Habitual consumers accounted for 56.59% of ED users, while occasional consumers represented 41.34% and only seven students reported daily ED consumption (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A higher proportion of habitual consumers (24.7%) engaged in physical activity compared to occasional consumers (18.1%). When asked about their perception of EDs, 76.7% of consumers considered them \"healthy,\" 7.5% deemed them \"useless,\" 0.5% viewed them as \"dietetic,\" and 93.3% described them as \"energizing.\" In terms of purchasing habits, one-quarter of consumers bought EDs at supermarkets, 66% purchased them from roadside vendors, and the remaining small percentage obtained them at gyms.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAccording to the Mode of introduction to energy drink the most common cause were social settings 179 (52.49%) followed by Advertisements especially by TV and social media 36 (10.55%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMode of introduction to energy drink.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow student was introduced\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial settings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e179 (52.49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdvertisements at the supermarket/store\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (10.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRecommendations from friends and family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (6.15)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e105 (30.79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eEnergy drink consumption did not vary significantly across academic years or universities (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEnergy Drink Consumption by University and Academic Year\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConsumers (n\u0026thinsp;=\u0026thinsp;341)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Consumers (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;379)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKUMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125 (86.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (13.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e145 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKabul University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e107 (93.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (7.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e115 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e109 (91.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAcademic Year\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2nd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e125 (96.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (3.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e130 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3rd Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e123 (93.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (6.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e132 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4th Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e93 (79.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24 (20.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e117 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e341 (90.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38 (10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e379 00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cp\u003eNotes:\u003c/p\u003e\u003cp\u003e\u0026bull; Percentages are row-based (e.g., 86.2% = 125/145 KUMS students).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026bull; p\u003c/em\u003e-values from Chi-square tests (no significant differences).\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eReasons for Consuming Energy Drink\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most common reason for consuming energy drinks was energy need 169 (33.66%), followed by enjoy the taste 125 (24.90%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAwareness of contents and possible side-effects of energy drinks\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNine percent of energy drinkers always check ingredient levels and cations in the cans. Most students recognize caffeine (86.8%) and sugar (89.97%) in energy drinks, but awareness drops for other ingredients like taurine (31.66%) and guarana (20.58%). Many are unsure about carbonated water (53.03% \"I don\u0026rsquo;t know\") and herbal supplements (18.2% unsure) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStudents\u0026rsquo; knowledge about energy drink ingredients.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eWhich of these substances do you think are contained in energy drinks?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eI do not know\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaffeine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39 (10.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e329 (86.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11 (2.90)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSugar\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (7.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e341 (89.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10 (2.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB Vitamins\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e155 (40.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e170 (44.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54 (14.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal supplements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e209 (55.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (26.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69 (18.20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaurine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225 (59.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e120 (31.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (8.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGinseng\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158 (41.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e187 (49.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34 (8.97)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarbonated water and citric acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65 (17.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e113 (29.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e201 (53.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFlavoring and coloring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e139 (36.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e209 (55.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31 (8.17)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGuarana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e76 (20.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (20.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e225 (59.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the participants, 230 (67.44%) reported adverse effects. The most common side effects of energy drinks are palpitations (44.54%) and insomnia (21.56%), likely due to high caffeine. Less frequent but notable issues include headaches (8.53%), nervousness (6.63%), and tremors (4.73%). Rare but serious effects like hypertension (0.94%) and allergies (0.94%) also occur (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of adverse effects associated with energy drink consumption.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEffect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalpitations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e88 (44.54)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsomnia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41 (21.56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeadache\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (8.53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNervousness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (6.63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased urination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (6.55)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTremors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (4.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTingling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (3.79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (1.89)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAllergy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first nationwide survey examining energy drink consumption patterns among Kabul University students.\u003c/p\u003e\u003cp\u003eThe prevalence of energy drinks consumption was 89.97% among the universities. This is higher than the established ranges (22.6–62.2%) reported in multinational studies of university populations.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eA study conducted in Pakistan reported that 42.89% of medical students consumed energy drinks.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e However, studies from different regions of Saudi Arabia present conflicting results. For instance, research from Riyadh province documented a substantially higher usage rate (82.4%),\u003csup\u003e22\u003c/sup\u003e while another study in Makkah reported a significantly lower consumption rate (27.7%).\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe use of energy drinks (EDs) is frequently provoked by advertising. This is expected, as marketing campaigns are strategically designed to appeal to individuals with demanding lifestyles who seek enhanced energy. Key target groups include university students requiring sustained focus for extended study sessions, social attendees, and participants in high-intensity sports. Furthermore, the easy accessibility of energy drinks even being sold roadside contributes to their widespread consumption.\u003c/p\u003e\u003cp\u003eIn our study most students recognize caffeine (86.8%) and sugar (89.97%) in energy drinks, but awareness drops for other ingredients like taurine (31.66%) and guarana (20.58%). Many are unsure about carbonated water (53.03% \"I don’t know\") and herbal supplements (18.2% unsure) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This suggests strong familiarity with key stimulants but gaps in knowledge about less-promoted ingredients. A study in Saudi Arabian revealed high awareness of caffeine content in energy drinks (88.1%), while demonstrating limited knowledge about other ingredients with 82.5% unaware of taurine and 95.5% unfamiliar with guarana content.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn our study participants most frequently mentioned, energy needs as reasons for using energy drinks. This result is in line with a previous study that found that the main motivation for consuming energy drinks was to increase energy levels during study sessions and out of curiosity.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Meanwhile, our findings identified taste as an important consumption factor this is in a contrasting with prior research that did not highlight this determinant.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Similarly, other research found that taste (39.9%), energy demands (27.7%), and studying (13.1%) were the motivations of energy drinks consumption.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the current study, a majority of students (67.44%) reported adverse effects from energy drinks a significantly higher percentage than the 30.62% reported in a comparable study, both studies identified increased urination, insomnia, abnormal heart rhythm, and irritability as the most common adverse effects.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Our study demonstrates that students who consumed energy drinks rapid heart rate and insomnia were the most common side effects while a study conducted in Saudi reported that participants who daily consumed EDs frequently complained of nervousness and other problems such as chest pain, insomnia, headache, constipation, diuresis, fatigue, and tremors.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eConsuming more than 400 mg of caffeine per day is considered a high intake. Excessive caffeine consumption can lead to intoxication, often caused by factors like aggressive marketing of energy drinks, a preference for their taste (which drives higher consumption), the combined effects of caffeine with other additives in these beverages, and additional caffeine intake from other sources.\u003c/p\u003e\u003cp\u003eThe findings of this study provide preliminary evidence to support international calls for regulatory interventions on energy drinks. These measures should include revised labeling standards, stricter advertising controls, reformulation of problematic ingredients, and retail restrictions particularly for student populations. Studies show that such measures increase consumer awareness, reduce consumption, and help curb excessive intake particularly among young people.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary limitation of the present study is related to the sample composition, which consists exclusively of males, resulting in a gender imbalance. This was not an intentional decision made during the planning phases of the study; rather, it reflects current policies in Afghanistan that restrict female attendance at universities. Consequently, we were unable to include female participants in this study. The second limitation pertains to the reliance on self-reported data, which is subject to recall bias and social desirability bias.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study was conducted at one of the largest universities in Kabul, Afghanistan, utilizing multistage cluster sampling for data collection. Another strength of our study lies in its assessment of awareness regarding the ingredients of energy drinks and their patterns of consumption among university students. All efforts were made to ensure that the collected data was reliable and that the methods were reproducible. Furthermore, our questionnaire was culturally adapted and piloted for clarity.\u003c/p\u003e\u003cp\u003eAlong with mentioned ethical and STROBE criteria, our questionnaire has been culturally adjusted and piloted for clarity. This ensures the validity of the data gathered and the accuracy of the findings based on the techniques employed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the widespread consumption of energy drinks among students. The primary motivations for consumption included boosting energy, enjoying the taste, and enhancing alertness during exams. While students were generally aware of key ingredients like caffeine and sugar, many reported adverse effects such as palpitations and insomnia. These findings emphasize the need for educational campaigns and increase awareness of potential health risks. Additionally, policymakers should reconsider legal regulations on the production, marketing, and advertising of energy drinks to mitigate excessive consumption and protect public health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFinancial support and sponsorship\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNil.\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConflicts of interest\u003c/h2\u003e\u003cp\u003eThere are no conflicts of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B. and C. conceived the study and designed the methodology. D and E coordinated data collection at Kabul University. I.J. performed statistical analysis. A.B. drafted the manuscript, with critical revisions from S.T. and Q.R. All authors approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePennay A, Lubman DI. Alcohol and energy drinks: a pilot study exploring patterns of consumption, social contexts, benefits and harms. BMC Res Notes. 2012;5:369.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZucconi S, Volpato C, Adinolfi F, Gandini E, Gentile E, Loi A, Fioriti L. Gathering consumption data on specific consumer groups of energy drinks. Parma: EFSA 2013. (External Sci entific Report for European Food Safety Authority). Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.efsa.europa.eu/en/supporting/pub/en-394\u003c/span\u003e\u003cspan address=\"https://www.efsa.europa.eu/en/supporting/pub/en-394\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Ac cessed in May 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eReissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks-growing problem. Drug Alcohol Depend. 2009; 1;99(1 3):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeidl R, Peyrl A, Nicham R, Hauser E. A taurine and caffeine-containing drink stimulates cognitive performance and well-being. Amino Acids. 2000;19(3\u0026ndash;4):635\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeifert SM, Schaechter JL, Hershorin ER, Lipshultz SE. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics. 2011;127(3):511\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuxton C, Hagan JE. A survey of energy drinks consumption practices among student-athletes in Ghana: lessons for developing health education intervention programmes. Sports Nutr Rev J. 2012;9(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAttila S, Cakir B. Energy-drink consumption in college students and associated factors. 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Cureus. 2025;17(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAslam HM, Mughal A, Edhi MM, Saleem S, Rao MH, Aftab A, Hanif M, Ahmed A, Khan AM. Assessment of pattern for consumption and awareness regarding energy drinks among medical students. Archives Public Health. 2013;71(1):31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalinauskas BM, Aeby VG, Overton RF, Carpenter-Aeby T, Barber-Heidal K. A survey of energy drink consumption patterns among college students. Nutr J. 2007;6(35):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcLellan TM, Lieberman HR. Do energy drinks contain active components other than caffeine? Nutr Rev. 2012;70(12):730\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1753-4887.2012.00525.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1753-4887.2012.00525.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBitancourt T, Tissot MC, Fidalgo TM, et al. Factors associated with illicit drugs\u0026rsquo; lifetime and frequent/heavy use among students results from a population survey. Psychiatry Res. 2016;30:237:290\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBichler A, Swenson A, Harris M. A combination of caffeine and taurine has no effect on short term memory but induces changes in heart rate and mean arterial blood pressure. Amino Acids 2006, 31(4):471\u0026ndash;476. 10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLara DR. Caffeine, mental health, and psychiatric disorders. J Alzheimers Dis. 2010;20:239\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiller KE. Energy drinks, race, and problem behaviors among college students. J Adolesc Health. 2008;43(5):490\u0026ndash;7. 12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahamathulla MP. Prevalence, side effects and awareness about energy drinks among the female university students in Saudi Arabia. Pak J Med Sci. 2017;33:347\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBawazeer NA, AlSobahi NA. Prevalence and side effects of energy drink consumption among medical students at Umm Al-Qura University, Saudi Arabia. Int J Med Students. 2013;1:104\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUsman A, Bhombal ST, Jawaid A, Zaki S. Energy drinks consumption practices among medical students of a Private sector University of Karachi, Pakistan. J Pak Med Assoc. 2015;65:1005\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlsunni AA, Badar A. Energy drinks consumption pattern, perceived benefits and associated adverse effects amongst students of University of Dammam, Saudi Arabia. J Ayub Med Coll Abbottabad. 2011;23:3\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobby MA, Sanad S. Survey of energy drink consumption and adverse health effects: a sample of university students in the United Arab Emirates. J Sci Res Rep. 2017;15:1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.9734/JSRR/2017/34978\u003c/span\u003e\u003cspan address=\"10.9734/JSRR/2017/34978\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSubaiea GM, Altebainawi AF, Alshammari TM. Energy drinks and population health: Consumption pattern and adverse effects among Saudi population. BMC Public Health. 2019;19:1539\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOteri A, Salvo F, Caputi AP, Calapai G. Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina. Alcohol Clin Exp Res. 2007;31(10):1677\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarczinksi CA. Alcohol mixed with energy drinks: consump tion patterns and motivations for use in U.S. college students. Int J Environ Res Public Health. 2011;8:3232\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHammond D. Health warning messages on tobacco products: a review. Tob Control. 2011;20:327\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/tc.2010.037630\u003c/span\u003e\u003cspan address=\"10.1136/tc.2010.037630\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Palpitation, Energy drinks, Consumption, University Students","lastPublishedDoi":"10.21203/rs.3.rs-7275718/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7275718/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Energy drinks are stimulant-containing beverages, primarily formulated with caffeine and marketed to enhance mental and physical performance. Unlike coffee, tea, or caffeinated soft drinks, these products are specifically designed as functional stimulants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: This study aimed to assess university students’ awareness of energy drinks and evaluate their consumption patterns, associated side effects, and reasons for use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This cross-sectional observational study was conducted from April to August 2023 at three major universities in Kabul, Afghanistan: Kabul University of Medical Sciences, Kabul Education University, and Kabul University. We distributed 401 questionnaires to students across these institutions, achieving a response rate of 96.76% (n=379 completed questionnaires). Thirteen students (3.24%) did not return their questionnaires. All collected data were entered and analyzed using SPSS software (version 21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAll participants were male, with ages ranging from 17 to 29 years (mean = 21.1 years; SD = 3.9). Energy drink consumption was reported by 89.97% of participants, of whom 41.34% were occasional users (less than one drink per week) and 56.59% were habitual consumers (3–4 drinks per week). Higher consumption (more than one can) was significantly associated with living alone (\u003cem\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/em\u003e= 0.000) and daily coffee intake (\u003cem\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/em\u003e = 0.005). The primary reasons for consumption included needing energy (33.66%, \u003cem\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/em\u003e = 169), enjoying the taste (24.90%, \u003cem\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/em\u003e = 125), and increased use during exams to improve alertness (12.35%, \u003cem\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/em\u003e = 62). There were no significant differences in energy drink consumption across academic years (P \u0026gt; 0.05). Most students recognized caffeine (86.8%) and sugar (89.97%) as key ingredients. Habitual consumers reported reducing sleep hours more frequently than occasional consumers (34.89% vs. 18.18%; P \u0026lt; 0.05) and were more likely to use it to aid studying/major projects (83.28% vs. 14.66%; P \u0026lt; 0.05). Adverse effects were reported by 67.44% (\u003cem\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/em\u003e = 230), primarily palpitations (44.54%) and insomnia (21.56%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study highlights the widespread consumption of energy drinks among university students. The primary motivations for consumption included boosting energy, enjoying the taste, and enhancing alertness during exams. More than half of the participants reported adverse effects, with the most common being palpitations and insomnia. Our findings emphasize the need for educational campaigns to raise awareness of potential health risks. Additionally, policymakers should reconsider legal regulations on the production, marketing, and advertising of energy drinks to mitigate excessive consumption and protect public health.\u003c/p\u003e","manuscriptTitle":"Energy Drink Consumption Among Kabul University Students: A Cross-Sectional Study of Prevalence, Patterns, Awareness, and Adverse Health Effects","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 16:18:10","doi":"10.21203/rs.3.rs-7275718/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-28T11:53:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-21T13:04:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235822224773045341412731898503834161067","date":"2025-08-31T17:01:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157392331862445653178691414859991158937","date":"2025-08-31T10:42:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175596074033728334368591898178171171926","date":"2025-08-30T10:59:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T09:50:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39781260989540897927223957225242770848","date":"2025-08-17T19:02:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-05T03:30:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-04T10:26:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-04T10:25:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Harm Reduction Journal","date":"2025-08-02T05:31:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"harm-reduction-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"harj","sideBox":"Learn more about [Harm Reduction Journal](http://harmreductionjournal.biomedcentral.com/)","snPcode":"12954","submissionUrl":"https://submission.nature.com/new-submission/12954/3","title":"Harm Reduction Journal","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb749c71-76f5-48e5-a095-3471e534b9a3","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T16:13:01+00:00","versionOfRecord":{"articleIdentity":"rs-7275718","link":"https://doi.org/10.1186/s12954-025-01389-4","journal":{"identity":"harm-reduction-journal","isVorOnly":false,"title":"Harm Reduction Journal"},"publishedOn":"2026-01-06 15:58:24","publishedOnDateReadable":"January 6th, 2026"},"versionCreatedAt":"2025-08-08 16:18:10","video":"","vorDoi":"10.1186/s12954-025-01389-4","vorDoiUrl":"https://doi.org/10.1186/s12954-025-01389-4","workflowStages":[]},"version":"v1","identity":"rs-7275718","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7275718","identity":"rs-7275718","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}