Behaviour of Students of Senior Secondary School towards Caffeine in Western Uttar Pradesh, India

1. Tutor, Department of Anatomy, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India. 2. Associate Professor, Department of Anatomy, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India. 3. Assistant Professor, Department of Biochemistry, Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India.

Abstract

Introduction: On entering 11^th and 12^th standard students feels a load of studies and lack of energy to combat that, an increase in caffeine consumption is observed in students which have both short and long term side-effects.

Aim: This study has been undertaken to throw light on the unspoken side of the coin called caffeine consumption by students of senior secondary school to relieve stress.

Materials and Methods: This was an observational study done over a period of six weeks from 1^st September to 15^th October 2021. Data was collected from senior secondary schools of western Uttar Pradesh, India, via semistructured questionnaire which was followed by the audio-visual presentation about caffeine. After one week of presentation same questionnaire was distributed and change was evaluated and compiled in form of adequate tables to study the responses. Data were entered in an MS Excel and tabulated in form of tables.

Results: Out of 1000 students, 920 (92%) students knew caffeine, among whom 500 (50%) students knew the side-effects of caffeine. A total of 780 (78%) students had a perception that caffeine is addictive. Among the reasons for caffeine consumption, to ward away sleep (51%) was the most prominent. Coffee was the most consumed caffeinated product (61%).

Conclusion: From the present study, it be concluded that there is a lack of knowledge in students about caffeine intake and its side-effects which can affect their health.

11^th and 12^th standard, Coffee, Harmful effect, Health

When students enter the 11^th standard there is a lot of pressure on them regarding their careers. Regardless of the stream they chose, they are just concerned about the upcoming competitive exams and their board exams. They need to attend long coaching hours after school and late-night studies leading to a very hectic lifestyle to overcome their energy deficiency they start consuming a lot of caffeine unaware of the harmful effects and dangerous signs. Caffeine is a pharmacologically active substance which is both used and abused worldwide. It is present in many different products such as tea, coffee, soft drink, and energy drinks. Caffeine consumption is popular among people because of its unique ability to enhance mood and alertness, increase exercise capacity, to increase wakefulness and mental alertness (1). Students are not even aware that some of the products they are consuming contain caffeine. One major question is what actually is caffeine? Sixty plant species produce caffeine as xanthine alkaloid. Cocoa beans, kola nuts, tea leaves, and coffee beans are most famous ones. Some other example of these species is Yerba mate and gharana berries (2).

Apart from coffee and tea, dark chocolates, soft drinks, soda, milk chocolate, energy drinks, energy bars, green tea, weight loss pills, etc., also contain a considerable amount of caffeine (2). Consumption of these products without knowing about the amount of caffeine in these products can lead to side-effects. The side-effects mentioned in Diagnostic and Statical Manual of Mental Disorder (DSM-5) includes nervousness, insomnia, restlessness, excitement, diuresis, gastrointestinal disturbance, jitters, psychomotor agitation and tachycardia (3). During childhood and adolescence, the brain undergoes intensive development, especially those centres which are responsible for the performance, planning and emotional control, where frequent caffeine consumption by these groups may have adverse health impacts. When consumed in adequate amount (20-200 mg/day) caffeine produces favourable effects like alertness, increase in energy, low fatiguability, improvement in behavioural and cognitive function but if consumed at a higher dose (>200 mg/day) it can cause undesired effects like anxiety, gastrointestinal disturbances, jitters, tremors, tachycardia and psychomotor agitation (4). The over and influential advertising of these caffeinated products and their easy accessibility in market has made them acceptable and readily available for all age groups in a population. Caffeine can also show synergistic effects with other substances and reinforce as unhealthy behaviour for example caffeine in sugar drinks can lead to obesity and other lifestyle-related disorders, caffeine show neurobiological effects which stimulates the relaxing effect of nicotine leading to increase consumption of both caffeine and tobacco. Food and Drug Administration (FDA) classify caffeine as generally safe and according to them, the toxic dose is >10 g/day
for an adult (5). Pure powder form of caffeine is also available in market as a dietary supplement which is life threatening even in a table spoon amount (5). Caffeine has ability to produce physiological effects which are produced by any drug of dependence, it also shows potential of tolerance, withdrawal and dependence so all these points makes caffeine to fit into the criteria of addictive substances. Therefore, everyone should be careful and aware of what they are consuming.

The study was conducted to evaluate the knowledge and behaviour of students of 11^th and 12^th standards of Indian schools regarding the consumption of caffeinated products. This knowledge is important for both short and long-term health-related effects. Students should be aware that what they are consuming contains what and how can it affect their health.

Material and Methods

The present study was an observational study, conducted over a period of six weeks from 1^st September to 15^th October 2021. Before starting the study approval from the Institutional Ethical Committee (IEC) (ECA{EWINST/202111540}) of Subharti Medical College (SMC), Meerut, India, in accordance with the Helsinki Declaration of 1975, revised in 2000 was taken.

The study was conducted in senior secondary schools of western Uttar Pradesh, India, which were selected purposively because of the presence of an easily accessible school canteen that provides caffeinated products. Also, as per general observation, most of the students belong to upper socio-economic classes which increase the probability of their caffeine consumption. For conducting the study on 1000 students of the 11^th and 12^th standard, a semi-structured questionnaire [Questionnaire] was used. The sample size was calculated using a 4PQ/L².

Inclusion criteria: Students of 11^th and 12^th class of western Uttar Pradesh, India and willing to participate were included in this study.

Exclusion criteria: Students below 11^th class and unwilling to participate were excluded in this study.

Study Procedure

After taking informed consent from the participating students information was gathered on a semi-structured questionnaire by distributing them amongst the students assembled in the school library. Through the questionnaire, knowledge was gained on their current knowledge and behaviour regarding the consumption of caffeinated products. It was followed by an audio-visual presentation about the side-effects, safe limit, addiction, health hazards of caffeine along with a list of non caffeinated products. Then after one week, the schools was visited again and the same questionnaire was distributed to the same students. The motive of the second round of questionnaires was to see the percentage change in their knowledge about caffeine.

Statistical Analysis

Data were entered in an MS Excel Sheet and tabulated in form of tables.

Results

In (Table/Fig 1) socio-demographic characteristics of the study population is shown. A 21% of students were of 15 years of age, 57% were 16 years, and 22% were 17 years age. Amongst the students, 72% students were boys and 28% students were girls. Father of 47% students was professional, 33% were semi-professional, 16% were cleric/shop-owner/farmer and 4% were skilled worker by occupation. Socio-economic class according to modified Kuppuswamy socio-economic classification 2017 (6), 46% of students belonged to the upper class and 54% belonged to the upper-middle class. A total of 17% students were of commerce and 83% students were of science stream. A 22% of students were in 11^th standard and 78% students were in 12^th standard.

The (Table/Fig 2) shows the association between students who knew about caffeine before and after the audio-visual presentation. There was an increase of 8% in the knowledge of students regarding caffeine after the presentation.

The (Table/Fig 3) shows the association between students’ knowledge about individual side-effects of caffeine before and after the audio-visual presentation. About 780 (78%) students had a perception that caffeine is addictive. There was an increase of 13% in the knowledge of addiction, a decrease of 4% in the knowledge of caffeine being carcinogenic, and an increase of 8% in the knowledge of caffeine affecting Central Nervous System (CNS), after the presentation.

The (Table/Fig 4) shows the association between the knowledge of students about products containing caffeine before and after the audio-visual presentation. There was an increase of 26% in the knowledge of students regarding products containing caffeine after the presentation.

The (Table/Fig 5) shows the distribution of students of the study group according to caffeine consumption. Amongst the students, 51% said that they consume caffeine to ward away sleep, 24% for enhancing taste, 23% for increasing concentration, 13% for driving long distances, 12% to cure headaches, and 4% to decrease the effect of alcohol and before the workout.

The (Table/Fig 6) shows the distribution of students according to most common problems faced by students after consuming caffeine. After consuming caffeine 20% experience racing thoughts, 15% gastrointestinal disturbance 10% insomnia, 8% nervousness, and 6% jitters.

Discussion

In present study group, it was observed that 21% of the participating students were of 15 years of age, 57% were of 16 years of age, 22% were 17 years of age, similarly Gera M et al., showed that majority of age group was 21% in 15 years of age (7). In the present study, there was a male preponderance with 72% and 28% of female students while in the study by Ahmad M et al., male to female number was a bit higher with 75% males and 45% were females (8). In present study, conducted on school students of 11^th and 12^th standard where 17% were from commerce stream and 83% were from science stream while Ahmad M et al., in their study found that the ratio was equal in both the streams i.e., 50% from science and 50% from commerce which was inconsistent with the results of present study (8).

In the present study, it was observed that among all the students 51% students consumed caffeine to ward away sleep, 23% to increase concentration, 4% to decrease the effect of alcohol and boost workout, 24% to enhance taste, 13% for aiding to drive long distances, 12% to cure headache, 23% did not have any reason. While Ahmad M et al., in their study found that 38.7% of students consumed caffeine to ward off sleep which was lower than present study, 33% used caffeine to increase concentration which was higher as compared to present study and 7.9% said that caffeine helped in memorising their subjects (8). In present study, common problems faced by students were- GI disturbances, insomnia, nervousness, jitters, racing thoughts whereas Evans MS et al., in their study found that the common problems after consuming caffeine were feeling of anxiety, nausea, jitteriness, nervousness, restlessness, insomnia, GI disturbances, tremors, tachycardia (9).

Limitation(s)

This study only includes students of senior secondary school. Only change in knowledge about caffeine was evaluated after an audio-visual presentation.

Conclusion

From this study, it can be concluded that students are lacking in knowledge about caffeine and caffeinated products. Due to which there is irrational consumption of caffeinated products. Caffeine is the new alcohol of youngsters as there is no as such ‘restriction on consuming it and it is slowly becoming a part of student’s lifestyle with its harmful effects. So, students need to realise that they should be aware of what they are consuming. Students should learn how to limit their caffeine intake otherwise they have to face health issues. Proper consoling is necessary for parents, students and teachers.

DOI and Others

DOI: 10.7860/JCDR/2022/53370.16098

Date of Submission: Nov 20, 2021
Date of Peer Review: Dec 18, 2021
Date of Acceptance: Jan 13, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 23, 2021
• Manual Googling: Jan 12, 2022
• iThenticate Software: Jan 14, 2022 (4%)

ETYMOLOGY: Author Origin