title: Alcohol mixed with energy drink: Use may be a consequence of heavy drinking.
abstract: OBJECTIVE
  In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.
  
  
  METHODS
  Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.
  
  
  RESULTS
  Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.
  
  
  CONCLUSIONS
  Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.
authors.affiliation: Department of Global and Community Health, George Mason University, VA, United States. Electronic address: mrosshei@gmu.edu.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Rossheim
authors.affiliation: Department of Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Thombs
authors.affiliation: Department of Global and Community Health, George Mason University, VA, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Weiler
authors.affiliation: Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Barry
authors.affiliation: Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Sumihiro
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Walters
authors.affiliation: Department of Epidemiology, University of Florida, Gainesville, FL, United States.
authors.forename: Tracey E
authors.initials: TE
authors.lastname: Barnett
authors.affiliation: Department of Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Raheem J
authors.initials: RJ
authors.lastname: Paxton
authors.affiliation: Department of Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Pealer
authors.affiliation: Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, United States.
authors.forename: Brad
authors.initials: B
authors.lastname: Cannell
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D000067292:Alcohol Drinking in College / Q000523:psychology; D000434:Alcoholic Beverages / Q000706:statistics & numerical data*; D061215:Energy Drinks / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012309:Risk-Taking; D013781:Texas; D055815:Young Adult
keywords: Alcohol mixed with energy drink; AmED; Drink mixers