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J. DRUG EDUCATION, Vol. 18(3), 1988

A SURVEY OF CAFFEINE USE AND ASSOCIATED

SIDE EFFECTS IN A COLLEGE POPULATION* **

DOUGLAS JOHNSON-GREENE M.A.

Region Two Mental Health Center
Oxford, Mississippi

MICHAEL FATIS, PH.D.

DONNASONNEK
CAPITA SHAWCHUCK

Mankato State University

Mankato, MN

ABSTRACT
While caffeine ingestion is commonplace, there is a relative lack of research on
normative standards of caffeine consumption. The present investigation surveyed
two hundred and seventy students at a midwestern state university concerning their
consumption of various caffeine products. The results of the investigation suggest
that there is an identifiable group of individuals who use excessive amounts of
caffeine. The survey has also identified several deleterious effects that may be
related to caffeine use. The most important finding of the study was that roughly
75 percent of the individuals who use caffeinated products rarely sought
information concerning the caffeine content of the products they were using nor did
they attempt to avoid substances containing caffeine. Suggestions for education
and prevention are offered.

*This research was supported in part by a research grant awarded to Michael Fatis
Ph.D, and Douglas Johnson-Greene by Mankato State University, Mankato, Minnesota.
**A copy of the questionnaire used in this study can be obtained by writing to Dr.
Michael Fatis, Department of Psychology, Mankato State University, Mankato, MN 56001.

211

© 1988, Bay wood Publishing Co., Inc.

212 / JOHNSON-GREENE ET AL.

REVIEW OF THE LITERATURE

Although caffeine is seemingly harmless in ordinary daily intake, there has been
increasing concern about the possible side effects of habitual caffeine ingestion.
Aside from the immediate effects of caffeine ingestion several disease states
have implicated caffeine as a possible etiological factor. Thus, literature
concerning caffeine’s psychological and biological effects dictates a need to
reexamine this common stimulant.
The excessive daily ingestion of caffeine in the form of coffee, soda pop,
tea, and various medications may lead to a chronic disorder known as
caffeinism [1-4]. Characteristics of caffeinism range from mild physiological
responses such as: insomnia, irritability, tremulousness, and diuresis [1,5], to
more pronounced psychological symptoms such as depression and anxiety
[6-9].
In addition, there is growing evidence that caffeine may be a contributing
factor in the development of a number of disease states [4]. Conditions such
as: cardiovascular disease [10-14], and birth defects [15-17] have been
linked to excessive use of caffeine. Other disease states that have been
implicated include cancer of the bladder [18, 19], cancer of the pancreas [20],
cancer of the gastrointestinal tract [21], and fibrocystic breast disease [22-
24]. It has been suggested that an intake of 500 to 600 mg of caffeine per day
(approximately 4 to 7 cups of coffee) represents a significant health risk [4],
although at least one study dealing with the treatment of caffeinism cited 300
mg per day as the level at which the literature has failed to demonstrate
deleterious effects [2]..
Caffeine occurs naturally in coffee, tea, and cocoa from plants widely
distributed throughout the world. Coffee contains approximately 100-150 mg
of caffeine per 5 ounce cup and accounts for roughly 75 percent of all caffeine
consumed in the United States [25-27]. Caffeine is also used as a food
additive in soft drinks, which contains approximately 50 mg of caffeine, and in
many over the counter medications as a headache remedy or as an additive to
counteract the side effects of drowsiness [28]. Moreover, caffeine is the
principle ingredient of artificial stimulants and weight control pills, each
containing approximately 200 mg of caffeine.
Despite the deleterious effects of habitual caffeine use it is estimated that
16-20 percent of the U.S. population consumed dangerous levels of caffeine
on a daily basis [6, 28], making coffee the most widely used central nervous
system stimulant. Indeed, caffeine is found in a number of substances we
consume everyday but are probably unaware of. At least one study has found
that the primary source of caffeine may be from over the counter medications
such as analgesics, stimulants and appetite suppressants [29]. Other
investigators have indicated a greater use of other psychoactive substances
among high caffeine consumers [30].
 CAFFEINE USE / 213

Several factors may account for the high prevalence of caffeine use. First,
sources of caffeine may be largely unknown to the general public. Secondly,
caffeine is seen by many as a desirable substance that should be actively
pursued [28, 31]. Additional factors contributing to high caffeine use may
include the addictive qualities associated with caffeine products [26, 32-34],
and for relief of withdrawal symptoms associated with cessation or reduction of
caffeine consumption [9, 35].
The purpose of the present study is threefold: 1) to determine the quantity
of caffeine typically ingested by college students; 2) to investigate the caffeine
substances commonly ingested; and 3) to explore the adverse reactions that
individuals may encounter in relation to caffeine use.

METHODOLOGY

Subjects

Two hundred and seventy students enrolled in undergraduate courses at a

Midwestern University were surveyed regarding their caffeine use. At least 90
percent of the respondents were between the ages of eighteen and twenty-five
and 49 percent were female. Subjects were offered extra credit points for
completion of the questionnaire. Table 1 illustrates the demographic and
biographic characteristics of subjects in percentages.

Measurement

The instrument employed in this study was a thirty-two item, self­

administered questionnaire. The questionnaire elicited information regarding:
1) demographic and biographic variables such as age, 2) amount and type of
caffeinated products regularly used, 3) most common time caffeine products
were consumed (i.e., morning, afternoon and evening), 4) adverse effects
associated with caffeine use; and 5) preference for avoiding caffeinated
products, and the degree to which subjects sought information regarding the
caffeine content of the products they regularly used. Each respondent was
asked to circle one of five descriptors which best estimated the questions asked.
Sources of caffeine that were investigated include: coffee, tea, cola drinks,
over-the-counter stimulants, diet pills, analgesics and cold medications.

RESULTS

Figure 1 illustrates the frequency of male and female respondents who

reported regular consumption of caffeinated beverages and products. The
results are consistent with previous studies which have indicated a higher rate
of use of caffeinated products by females. Females in this study consumed
 214 / JOHNSON-GREENE ET AL.

Table 1. Demographic Characteristics of Respondents, in Percentages

Male Female
Characteristics (N = 138) (N = 142)

College Status
Freshman 56.5 54.9
Sophomore 21.0 27.5
Junior 13.8 8.5
Senior 6.5 4.9
Graduate 2.2 2.8
Age
Under 20 64.5 6 9.0
21-25 27.5 21.1
26-30 4.3 7.0
36-45 2.2 1.4
46 and over 1.4 1.4
Weight
Under 120 2.9 29.6
121-150 33.3 56.3
151-180 48.6 11.3
181-210 12.3 1.4
Over 210 2.9 1.4

more coffee, tea, soda pop and caffeinated analgesics while males consumed
more over-the-counter cold medications. Approximately 10 percent of the
respondents who reported using coffee used in excess of four cups of coffee or
500 mg of caffeine daily.

Caffeine Use Among Subgroups of the Total Sample

Table 2 illustrates several important differences between low and high

caffeine users. Age was found to be significant with older respondents
consuming significantly more caffeinated products (F — 4.6, dfl,13S,p < .05).
In addition, fatigue following cessation of caffeine was found to be significant
with high caffeine users experiencing significantly more fatigue (F = 7.9,
df== l,138,p<.01).
Table 3 illustrates differences between male and female respondents in the
study. Females who used caffeinated products more often reported fatigue
following caffeine cessation (F= 4.3, df— 1,138, p < .05). Finally, females
sought information more frequently concerning the caffeine content of the
products they were consuming and therefore were theoretically more
 FEMALE

215
Figure 1. Comparison of Male and Female Use of Selected Caffeinated Products.
216 / JOHNSON-GREENE ET AL.

Table 2. Comparison of Low and High Caffeine Groups

Low High
(below 300 mg) (above 300 mg)
Differences X SD X SD F (1,138)

College Status 1.9 1.2 2.0 .9 .07

Age 1.5 .9 1.9 1.0 4.6*
Muscle Tremors 1.6 .9 1.8 1.2 2.3
Insomnia 3.6 1.1 3.5 1.2 .02
Stomach Problems 2.0 1.1 1.8 1.2 .07
Fatigue 4.1 1.0 3.5 1.2 7.9**
Avoid Caffeine 2.4 1.1 2.2 1.1 .9
Seek Information 3.5 1.2 3.2 1.2 2.9

*p < .05
**p < .01

“caffeine conscious” (F = 5.6, df = l,138,p < .05). Despite this finding males
and females both reported rarely avoiding products containing caffeine.

Avoidance of Caffeinated Products

In addition to the aforementioned results the present study also sought

confirmation of the desirability of caffeine that has been suggested in the
literature. Respondents were asked if they try to avoid caffeine and if they
actively try to find out if the product they are using contains caffeine. A
correlation of— .5292 {p <Z .001) was found for these two items suggesting that
individuals who are aware of the sources of caffeine tend to more actively use
caffeinated products. As previously mentioned, females sought information
regarding caffeine products more often than males. Thus, it appears that

Table 3. Comparison of Male and Female Caffeine Use

Male Female

Differences X SD X SD F (1,138)

Muscle Tremors 1.4 .8 1.5 .9 .2

Insomnia 3.8 1.1 3.6 1.0 .4
Stomach Problems 1.7 1.0 2.0 1.1 .01
Fatigue 4.3 .9 4.0 1.2 4.3*
Avoid Caffeine 2.4 1.1 2.7 1.2 3.0
Seek Information 3.7 1.2 2.2 1.2 5.6*

*p < .05
 CAFFEINE USE / 217

females may be more aware of the caffeine content associated with certain
products but this knowledge does not appear to act as a deterrent towards
caffeine consumption.

DISCUSSION

These data partially confirm many of the findings of previous studies.

Namely that a proportion of the population is using excessive and/or
dangerous levels of caffeine; adverse biological and psychological effects are
being experienced by users of excessive amounts of caffeine; and caffeine may
in fact be a desirable substance for many individuals because the findings of the
present study indicate that respondents who used and actively sought
caffeinated products were aware of the presence of caffeine in the products they
used. A possible reason for the continued use of caffeine by individuals who are
experiencing adverse effects and are aware that the products they use contain
caffeine may include: 1) a lack of awareness of the potential biological and
psychological effects of caffeine, 2) an inability to recognize the current
adverse effects and manifestations of one’s own caffeine use; and 3) the
possibility that caffeine can become a conditioned reinforcer in that cessation
of caffeine for even brief periods of time can produce dysphoric states followed
by relief of the dysphoric state upon ingestion of caffeine [4,32]. This has
been more commonly referred to as “relief from withdrawal” in alcohol abuse
literature. In addition, it has also been suggested that the use of caffeine may
be used more frequently in times of stress [29]. The use of caffeine at these
times may in fact be a method by which individuals who are aware of the
properties of caffeine are able to augment their performance through increased
mental alertness and vigilance.
The fact that caffeine use is widespread, socially acceptable [31], and has
probable underlying factors such as addictive qualities maintaining its use in
some individuals has significant ramifications for the continued misuse and
subsequent consequence of physical pathology for individuals who use
excessive amounts of caffeine for extended periods of time. The present study
should be viewed as part of a continuing effort to define and assess the use of
caffeine and its effects. Future studies should strive to obtain accurate
information regarding the reasons underlying excessive use of caffeine and the
development of a more comprehensive understanding of how caffeine use is
related to specific antecedents and use of other substances.

ACKNOWLEDGMENTS

The authors wish to express their appreciation to the members of the

Behavioral Health Psychology Program at Mankato State University for their
helpful comments and suggestions in the development of this paper. The
218 / JOHNSON-GREENE ET AL.

authors also wish to thank Dr. Thomas Petros, Associate Professor of

Psychology, University of North Dakota, for providing a prototype of the
caffeine questionnaire used in this study, Paul Skjoldager of the University of
Mississippi Department of Psychology for his statistical assistance, and one
anonymous reviewer for his/her helpful comments and suggestions on an earlier
version of this manuscript.

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 CAFFEINE USE / 219

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220 / JOHNSON-GREENE ET AL.

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Direct reprint requests to:

Douglas Johnson-Greene, M.A.
Region Two Mental Health Center
Route H, Box 32
Oxford, MS 38655