Frequent energy drink consumption and associated factors among Japanese adolescents

Background: Frequent energy drink consumption among adolescents is a public health concern; however, the as sociated factors and detailed consumption patterns among Japanese adolescents remain poorly characterized.Purpose: We estimated the prevalence of frequent energy drink consumption and examined its associated factors and consumption patterns among Japanese high school students. Methods:We conducted this schoolbased crosssec tional survey from April to June 2024 in 19 high schools in western Japan (n=6,764).Frequent consumption was defined as intake on ≥6 days during the past 30 days.In this study, the term "energy drink consumption" referred to the consumption of tonic drinks, energy drinks, or both.Multivariable logistic regression models were used to ex amine the associations with beveragerelated perceptions, caffeine interest, advertising exposure, lifestyle habits, gaming disorder, and depressive symptoms.Among current consumers, defined as students reporting energy drink consumption on ≥1 day during the past 30 days, we analyzed age at first consumption, amount consumed per occasion, and usual consumption timing.Sexstratified and sexbyfactor interaction analyses were exploratory.Results: Overall, 79.3% of the students reported consum ing energy drinks at least once, and 11.5% reported frequent consumption.In the primary model, frequent consumption was associated with male sex; energy drinks being perceived as making one feel energetic or relaxed; less frequent breakfast consumption; exercising ≥5 days/ wk; supplement use; and presence of a gaming disorder.Perceiving energy drinks as unhealthy was inversely as sociated with frequent consumption.Exploratory in teraction analyses suggested possible sexrelated hete rogeneity in the associations with caffeine interest and breakfast consumption and, among current consumers, consumption timing.Among current consumers, higher peroccasion intake and consumption upon waking or in the morning were associated with frequent consumption.Conclusion: Among Japanese high school students, 79.3% had consumed energy drinks at least once, and 11.5% reported frequent consumption (≥6 days during the past 30 days).Frequent consumption was associated with beveragerelated perceptions, lifestyle habits, and gaming disorder.Among current consumers, a higher per occasion intake and consumption upon waking or in the morning were also associated with frequent consumption.These findings identified factors and consumption pat terns that warrant attention in pediatric public health and schoolbased health education; however, their causal and clinical implications require confirmation.