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Caffeine Consumption and Academic Performance among Medical Students

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 Original Article

Caffeine Consumption and Academic Performance

among Medical Students of Dow University of
Health Science (DUHS), Karachi, Pakistan

Muhammad Sami Khan1, Nighat Nisar2, Syed Arsalan Ahmed Naqvi3, Faryal Nawab4

Abstract

Objective: To determine the frequency of caffeine consumption and its effect on academic perfor-
mance among medical students of DUHS, Karachi, Pakistan.
Methods: A cross-sectional study was conducted at Dow Medical College, DUHS. About 400 medical
undergraduate students from first to final year MBBS were included through systematic sampling.
Those students who were on leave on the day of interview and addicted to substance abuse other
than caffeine and those who were on drug use rehabilitation were excluded from the study. The dura-
tion of study was from January 2016 to May 2016. The data was collected by self-administered struc-
tured questionnaire which included the information regarding socio-demographic characteristics,
perceptions regarding caffeine consumption on academic performance. The data were entered and
analysed by using SPSS version 16. Frequency and percentages were calculated and multivariate
analysis was performed to determine the association of caffeine consumption and academic perfor-
mance of medical students.
Results: The mean age of the medical students were 20.83 ± 1.57 years. About 58.5% were females,
46.3% of the students scored less than 3 Grade Point Average (GPA). Majority (94%) of the students
consume caffeine in any form such as tea, coffee. About 68% students reported that caffeine use in-
creases their academic performance. On multivariate analyses, caffeine consumption did not show
any significant association with academic performance.
Conclusion: High proportions of medical students were found to be consuming caffeine due to the
misconception that caffeine increases academic performance. This study found no significant asso-
ciation with academic performance and caffeine consumption.
Keywords: Social perception, universities, medical students, addictive behaviour, caffeine.
IRB: Approved by Institutional Review Board, Dow University of Health Sciences.
Dated: 1st January 2015.
Citation: Khan MS, Nisar N, Naqvi SAA, Nawab F. Caffine Consumption and Academic Performance
among Medical Students of Dow University of Health Sciences (DUHS), Karachi, Pakistan [Online]. An-
nals ASH KM&DC 2017;22:81-7. Available from: www.annals-ashkmdc.org.
(ASH & KMDC 22(3):179;2017)

Introduction consumption. The effect starts from an hour and re-

mains for 3-4 hours2. The peak plasma concentra-
Caffeine is a central nervous system stimulant tion is reached after 40 to 60 minutes3. The half-life
and belongs to the category of xanthine group1. A of caffeine is about six hours in healthy adults4.
cup of coffee contains about 90% of caffeine and it The human history showed that it is a widely con-
needs
_ 20
___________________minutes
________________to
_____clear
___________from
__________the stomach
_________________________after
_______ sumed drug worldwide. About 80% of the world's
1,3
Dow University of Health Sciences
2,4
Department of Community Medicine,
population consumes caffeine in one form or the
Dow University of Health Sciences other. The caffeine quantity reported was( ± 137 mg/
cup of caffeinated coffee and ± 2 mg/cup of
Correspondence: Dr. Faryal Nawab
Department of Community Medicine decaffeinated coffee; the volume of one cup is ap-
Dow University of Health Sciences proximately 240 ml), tea ( ± 47 mg/cup), caffeinated
Email: [email protected] soft drinks ( ± 46 mg/340 ml can or bottle of cola
Date of Submission: 24th May 2017
Date of Acceptance: 12th September 2017 beverage), energy drinks (up to 80 mg/can)3,4, and
Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College 179
 Muhammad Sami Khan, Nighat Nisar, Syed Arsalan Ahmed Naqvi, Faryal Nawab

caffeinated chocolates, non-beverage foodstuff, Material and Methods

medications ( ± 7 mg/200 g). The scientific litera-
ture reported that it is hard to find complete non-us- A cross-sectional study was conducted at Dow
ers of caffeine2,4,5. The reason behind caffeine University of Health Sciences for the period of five
consumption reported was increased self-reported months from January 2016 to May 2016. The
alertness, improved performance, vigilance in per- sample size of 384 was calculated by WHO
forming tasks, concentration, improved long-term sample size calculator by using the proportion of
memory and faster locomotors speed6,7. The ha- 52%10 caffeine consumption among medical stu-
bitual consumption of caffeine has not been re- dents of private medical college with 95% confi-
ported to improve short-term memory, information dence interval and 5% margin of error and it was
processing, planning and attention7. The caffeinated rounded off to 400. About 80 MBBS students from
beverages consumption among students and ath- first year to final year were enrolled in the study
letes has become very popular due to media pro- through systematic sampling. The study excluded
motion and social marketing of caffeinated drinks. A students who were on leave; addicted to substance
study conducted in the United States among col- abuse other than caffeine and those who were on
lege students reported that 51% reported at least drug use rehabilitation. A structured questionnaire
one energy drink consumed in the preceding which was pretested through pilot study on 30 stu-
month. The reason reported was to reduce sleep dents in similar setting was self-administered to the
67%, to increase energy 65%, and to drink with al- students after taking the written consent. The ethi-
cohol while partying 54%8. A study conducted cal approval was obtained from Institutional Review
among medical students of Turkey showed 32.6% Board of Dow University of Health Sciences. The
consumed energy drink at least once9. Another re- variables included in questionnaire were age, gen-
search from The Aga Khan University, Pakistan re- der, year of MBBS, caffeine use, perceptions re-
ported 52% of medical students consumed caffeine garding caffeine consumption, cost spent on
to cope up with academic and athletic stress and caffeinated drinks and its association with academic
workloads10. Another survey conducted inthe United performance. Academic performance was assessed
States examined the relationship between energy through latest GPA of the study participants. GPA
drinks consumption and academic performance by less than 3.0 was considered as below average
using self-reported cumulative Grade Point Average academic performance and GPA more than 3.0 was
(GPA) to measure academic performance. Results labelled as above average academic performance.
from this survey showed that energy drink con- The data were entered and analysed by using
sumption and academic performance were nega- SPSS version 16. Frequency and percentages were
tively correlated11. calculated and multivariate analysis was performed
for determining the association of caffeine consump-
Literature suggests that use of caffeinated bev- tion and academic performance.
erages is quite common among medical under-
graduates12,13. Several studies have been
Results
conducted internationally to examine the physical
and social impact of energy drink consumption The mean age of the sample was 20.83 ± 1.57
among undergraduate students14,15. years. About 58.5% were females and 41.5% were
males. About 46.3% of students scored less than 3
In general, medical students face extended
GPA and 53.8% scored more than 3 GPA. Majority
study load and for this purpose they prefer
(94%) of the students consumed caffeine in any
caffeinated beverages so there was need to deter-
form and only 6% of the students did not consume
mine the use of caffeine containing products among
caffeine in any form. The cost spend on caffeine
medical students and the effect of caffeine on their
was 3 USD per day with mean cost 0.54 ± 0.37
academic performance as there was no recent data
USD (Table 1).
available from our setup. Caffeinated products con-
sumption has become a public issue in the last de- About 46.8% of students consumed caffeine in
cade due to extensive publicity and easy availability form of coffee, 67.5% tea, 59.5% soft drinks, 6% en-
of these beverages especially in youth. This study ergy drinks and 53.8% in chocolate form (Table 2).
was aimed to determine the association between all
types of caffeine containing substances used and Regarding perception about caffeine consump-
academic performance among medical students of tion 71.5% reported that it increases overall aca-
a large public sector medical college of Pakistan. demic performance and 22% reported that it
180 Volume No. 22 (3), September 2017
Caffeine Consumption and Academic Performance among Medical Students of Dow University of Health Science

increases IQ. About half of the students reported Table 3. Distribution of variables regarding perceptions of students
that caffeine helps in overnight study, 71% reported about caffeine consumption
that it increases self-confidence, 36.7% reported Variables Frequency Percentage
that it increases reading power, 45% reported it in- Caffeine consumption increases academic performance
Yes 286 71.5
creases study hours, 70% reported it invigorate fa-
No 114 28.5
tigue and 75% reported it improves group activity Caffeine consumption increases IQ
(Table 3). Yes 88 22
No 312 78
Uni-variate analyses were conducted for caf-
Caffeine helps in overnight study
feine consumption and academic performance Yes 187 46.7
(GPA). Female gender showed significant associa- No 213 53.3
tion with GPA more than 3.0 as compared to male Caffeine increases self-confidence
(OR=1.59, 95% CI, 1.06-2.37). Caffeine consump- Yes 286 71.5
tion did not show any significant association with No 114 28.5
academic performance (GPA). (Table 4) Caffeine increases reading power
Table 1. Socio-demographic characteristics of the study participants Yes 147 36.7
n= 400 No 253 63.3
Characteristics Frequency (N= 400) Percentage (%) Caffeine increases recalling power
Yes 310 77.5
Age in years No 90 22.5
<20 years 165 41.3 Caffeine increases study hours
>20 years 235 58.8 Yes 180 45
Gender No 220 55
Male 166 41.5 Caffeine invigorate fatigue
Female 234 58.5 Yes 279 70.0
Academic Year No 121 30.0
1st Year 81 20.3 Caffeine improves group work activity
2nd year 80 20.0 Yes 300 75.0
3rd year 82 20.5 No 100 25.0
4th year 77 19.3
5th year 80 20.0 Table 4. Characteristics of socio-demographics, caffeine containing
GPA substances consumption and Grade Pont Average (GPA)
<3.0 185 46.3
>3.0 215 53.8 Characteristics GPA<3 GPA>3 Odds Ratio p-value
Consume caffeine in any form Gender
Yes 376 94.0 Male 88 78 1.593
No 24 6.0 Female 97 137 Ref 0.023
Age in years
<20 77 88 1.029
Table 2. Frequency distribution of consumption of Caffeine containing >20 106 129 Ref 0.889
items by the study participants Consume caffeine containing items
Yes 171 205 0.596
Caffeine containing items Frequency (N=400) Percentage No 14 10 Ref 0.225
Consume coffee Consume Coffee
Yes 187 46.8 Yes 77 110 0.681
No 213 53.2 No 108 105 Ref 0.057
Consume tea Consume tea
Yes 270 67.5 Yes 118 152 0.730
No 130 32.8 No 67 63 Re f0.141
Consume soft drink Consume energy drink
Yes 238 59.5 Yes 12 12 1.173
No 16 40.5 No 173 203 Ref 0.704
Consume energy drink Consume soft drink
Yes 24 6.0 Yes 104 134 0.776
No 376 94.0 No 81 81 Ref 0.215
Eat chocolate Eat chocolate
Yes 215 53.8 Yes 106 109 1.305
No 135 46.2 No 79 106 Ref 0.187

Annals Abbasi Shaheed Hospital & Karachi Medical & Dental College 181
 Muhammad Sami Khan, Nighat Nisar, Syed Arsalan Ahmed Naqvi, Faryal Nawab

Discussion study from Serbia revealed that the common rea-

sons for caffeine intake among adolescents were
Caffeine is the most widely used drug all over
leisure, peer influence and habit21. In contrast to
the world. In this study majority of the medical stu-
general perceptions scientific evidence from different
dents reported use of caffeine in different forms, cof-
research studies showed no such relationship. A
fee, tea, energy drinks and chocolate. Caffeine
study conducted in Turkey on medical students
consumption was found popular among students.
showed similar results that students reported caf-
This study demonstrates that majority of the partici-
feine consumption improves cognitive performance9.
pating students self-perceive that caffeinated bever-
A systematic review from University of California
ages improve the academic performance. However,
conducted on relationship between tea, coffee, caf-
no association was found between caffeine con-
feine consumption and cognitive decline. This review
sumption and academic performance.
did not prove any significant association of reducing
The most popular caffeinated beverage among cognitive decline among tea and coffee consumer;
students was tea followed by soft drinks and coffee hence research studies did not prove protective ef-
respectively. Similar results have been reported by fect of coffee consumption and reduction in cogni-
the study of Iran in which tea was the most popular tive decline22.
beverage among high school students16. However,
A study conducted on first year and second
studies from Saudi Arabia and South Africa reported
year students of University Puerto Rico Medical
coffee and soft drinks were commonly consumed
Sciences Campus showed that more than two third
beverages among medical students17,18. This can
of students consumed caffeinated beverages and re-
be attributed to the fact that due to easy availability
ported that it helps them awake during exam, de-
and inexpensiveness of tea, it is widely consumed
creases stress and work load but none of the factor
in Indo-Pak.
was found significantly associated with academic
It is a common perception that caffeinated stress or load on statistical analysis23. The findings
drinks, for example coffee, tea, soft drinks, energy of this study were consistent with the findings of our
drinks, and chocolate, are being considered to en- study. Our study did not report significant associa-
hance information processing speed, attention, and tion of caffeine consumption with increased aca-
reaction time in humans19. In our study majority of demic performance. Majority of students perceived
students perceived that caffeine consumption in- that it decreases workload and stress and in-
creases academic performance, increases IQ, helps creases academic performance but in reality, it has
in overnight study, increases self-confidence, in- not been proven by research and studies recom-
creases reading power, increases recalling power, mended that students should remain careful while
increases study hours and provide energy and im- consuming caffeinated beverages due to the harmful
proves group activity. More than half of the students effects of caffeine. This false perception was pro-
reported that caffeine improves academic perfor- moted by media and social marketing of caffeinated
mance, build confidence, promote group activity, en- drinks companies which attract youngsters.
ergize them and relieve fatigue. Research studies
In our study only 6% of students reported en-
from other parts of the world reported similar find-
ergy drinks consumption, which is a good sign and
ings. A survey conducted in America showed that
if medical students are aware of the side effects of
almost all students participated in the survey was
energy drinks, they can counsel young and adoles-
consuming caffeine in one or other forms. The
cent individuals in general population about the
same survey reported that caffeine is the most
harmful effects of energy drinks. In contrast to our
popular substance in the campus with an average
findings several other studies reported high con-
of 1106.23-1698.02 mg per week, increasing with
sumption of energy drinks in medical school due to
year in school20. However, in contrast our findings, a

182 Volume No. 22 (3), September 2017

Caffeine Consumption and Academic Performance among Medical Students of Dow University of Health Science

the perception that it improves mental alertness be- Acknowledgement

cause of caffeine content in energy drinks24-26. A
We are thankful to the medical students who
qualitative study conducted in India on student's
participated in the study
preparation in examination showed that addiction
level during exam increases among students and
Conflict of Interest
consumption of tea, coffee, tobacco and smoking
increased especially among those who studied late Authors have no conflict of interests and no
night27. The reason could be peer pressure, media grant/funding from any organisation for this study.
and social marketing of energy drinks. This stimu-
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