The results of this study show that at least four of every ten Spanish students aged 14 to 18 years consumed energy drinks between 2014 and 2023. In general, consumption has risen over time in both sexes but is especially noteworthy in girls aged 14 and 15 years. The likelihood of consuming energy drinks is higher in students who are male, older, non-Spanish nationals, repeat students of at least 1 academic year; have fathers/mothers without higher education; and are smokers, cannabis users, or alcohol consumers.

A significant research gap exists in understanding the dynamic trends in energy drink consumption in Spain, particularly in the systematic tracking of consumption patterns and the vigilant monitoring of changes in user behavior. Our study is consistent with findings from other European countries that show an increase in energy drink consumption among adolescents. For example, a study of Finnish adolescents aged 13 and 15 found a notable increase in weekly consumption from 18.2% in 2014 to 24.4% in 2018 [23].

The case of Canada serves as a notable example that there are steps that can be taken. In 2012, regulatory changes to energy drinks required manufacturers to comply with caffeine limits, marketing restrictions, and health risk warnings [24]. This regulatory change resulted in a significant decline in energy drink consumption. In 2011, consumption estimates for the previous year were reported at 49.6% in the population aged 12–19 years and 19.1% in the previous week [25]. A subsequent study in 2017 showed a significant decline, with consumption in the previous year dropping to 32.9%, and in the previous week, to 11.8% [26]. These findings underscore the effectiveness of legislative changes as a valuable tool in promoting reductions in the consumption of such beverages among youth. In addition to these regulatory measures, role models to children and adolescents, such as athletes and influencers, given their significant public reach and potential impact on vulnerable populations, particularly children, should also bear responsibility for preventing the initiation of consumption by not participating in the promotion of energy drinks.

It is important to note that several European countries, including Lithuania, Latvia, Norway, and Poland, have also implemented similar restrictions on sales and advertising to minors. Considering the success of ongoing initiatives, which have demonstrably reduced energy drink consumption among youth, Spain should strongly consider implementing similar legislative measures to protect its own youth population.

An examination of the addiction plans of the ARs, which aim to tackle addiction at the regional level with a focus on vulnerable groups, reveals a significant gap in coverage of energy drink consumption. Specific addiction plans targeting energy drinks are currently only active in La Rioja [27] and the Region of Murcia [28], both of which were implemented after the surveys in this study. Between 2014 and 2023, both Murcia and La Rioja experienced a significant relative increase in energy drink consumption. In addition, Galicia, which has experienced the largest increase in energy drink consumption across Spanish ARs (2014, 29.3% vs. 2023, 45.6%), plans to restrict their sale to minors and regulate advertising [29].

In 2023, Ceuta and Melilla, Catalonia, Extremadura, Andalusia, the Canary Islands, and the Balearic Islands had the highest prevalence rates of energy drink consumption. Notably, these ARs have not yet included energy drink consumption in their addiction plans. It is also noteworthy that these regions face significant challenges, such as high levels of immigration, with the exception of Extremadura [30, 31]; elevated unemployment rates, with the exception of Catalonia and the Balearic Islands [32]; and lower levels of education, with the exception of Catalonia [33], compared to other areas of Spain. Recognizing these regional differences and understanding the characteristics of users is critical to grasping the complex factors influencing energy drink consumption patterns.

This study has identified a series of factors associated with an increased OR of consumption. Although some of these factors have been identified in previous studies [18, 20, 21, 23, 34], they have never been evaluated together to assess their individual contributions to the overall risk.

The results of our study reflect that boys consume more energy drinks than girls, which is consistent with the findings of other studies. Branco et al. propose a distinction in consumption motives based on gender: boys seek energy and physical performance enhancement, while girls consume out of curiosity [35]. This gender difference, coupled with male-targeted advertising influenced by gender socialization [20], likely contributes to the observed variation in energy drink consumption and may explain sex differences across countries. In particular, there has been a significant increase in energy drink consumption among girls over time. Analyzing prevalence trends from 2008 to 2019, an Italian study found an increase from 37.5% to 45.4% among boys and a more modest change from 19.9% to 20.3% among girls [36]. Although the change in consumption by girls is less pronounced than in our study, it represents a visible narrowing of the gender gap, driven mainly by a significant increase in consumption by girls. A possible explanation, according to Kaldenbach et al., who found the same trend, is a recent increase in the exposure, and perhaps susceptibility, of girls to energy drink marketing [37]. On the other hand, parallel trends among Finnish adolescents [36] suggest a plausible link to the escalating adoption of this behavior among girls, similar to patterns observed for behaviors such as smoking [20, 23].

Our study shows a significant association between higher energy drink consumption and academic underachievement, as reflected in students who repeated at least 1 academic year. This is consistent with similar associations reported in other Spanish studies [20, 21]. Parental employment status also plays a role, with children of non-working parents showing higher energy drink consumption. Socio-economic variables, especially those related to education level, emerge as critical factors influencing unhealthy lifestyles and reduced awareness of associated risks [20, 21].

Looking at nationality as a factor, not being born in Spain is associated with a higher OR of energy drink consumption. This association is consistent with a study conducted among young men in Switzerland, in which excessive energy drink consumption was associated with immigrant origin [34]. The proposed explanation suggests that the lifestyles of immigrants are shaped by their specific health context, possibly in combination with lower levels of education. These associations highlight the complex interplay between socioeconomic factors, educational background, and energy drink consumption patterns.

Furthermore, energy drink consumption was found to be correlated with tobacco use, alcohol consumption, and cannabis use in the previous 30 days. This concurrent use has been consistently reported in previous studies [18, 20]. A study conducted among students in Spain concluded that energy drink consumption was associated with increased tobacco use, alcohol consumption, and accident frequency [20]. Future studies could further explore these associations, considering the frequency of energy drink consumption and its links to other risky behaviors, as well as the potential health effects of concurrent use.

This study has some limitations. First, a limitation of the present study is the restriction of the time frame of energy drink consumption to the previous 30 days, as this is the only question regarding these beverages in the ESTUDES questionnaire. This is a limitation shared by many previous studies [38]. The paucity of uniform criteria on the methodology for the assessment of energy drink consumption is evidenced by numerous systematic reviews [38, 39]. This is an aspect that should be taken into account in future studies, as it is not possible to differentiate different consumption patterns within this time frame. Another related limitation is that we did not consider the frequency of consumption when estimating its prevalence or analyzing the factors that could influence consumption. Two recent systematic reviews emphasize that daily consumption is associated with adverse health effects, while those from occasional consumption remain less clear [40, 41]. In this regard, future research examining the health effects of energy drink consumption should account for both the frequency of consumption and the potential confounding influence of dietary patterns. The examination of variables associated with energy drink consumption is limited, precluding an assessment of the impact of factors such as personal relationships with parents or peers, as well as other lifestyle-related variables like sports performance or problematic internet use. This limitation is linked to the absence of data specifically addressing sports and internet use throughout all the periods covered by the study surveys. Additionally, the prevalence obtained at an AR level could not be analyzed by sex and age, due to the limited sample size in each AR. Finally, the data analyzed were drawn from self-reported behavior in the educational setting; this may be associated with social-desirability bias, in that students may conceal consumption, yet this aspect may well seem somewhat irrelevant in the case of energy drinks, given that they are not illegal beverages or considered harmful by adolescents [42]. The use of an anonymous, printed questionnaire might also help mitigate this potential bias.

In terms of strengths, our study utilizes a nationally representative sample that spans eight years, providing comprehensive insights into energy drink consumption trends. In particular, despite the existence of other studies with similar characteristics, this study is the first to evaluate the temporal evolution of consumption, taking into account the characterization of users. Furthermore, stratification by sex and age is emphasized, which may offer pertinent information, particularly in light of the observed differences in energy drink consumption by sex. Finally, this study provides prevalence data specific to each AR in Spain, contributing to a more nuanced understanding of regional differences in energy drink consumption patterns.