1 INTRODUCTION

Energy drinks (EDs) are formulated beverages containing the caffeine equivalent of approximately 2–3 cups of coffee per 500 mL (16 oz).¹ Children in many countries report ever drinking an ED,^2-5 which is a key concern among health professionals,⁵ as there is no agreed safe caffeine intake level for children. Children's smaller body weight/size and caffeine naivety makes them more susceptible than adults to the adverse cognitive, cardiovascular and behavioural effects of caffeine.⁶ Child ED intake has been linked to palpitations, dyspnea, tachycardia, chest and/or abdominal pain, diuresis, gastrointestinal upset, headache, dizziness, nausea/vomiting, insomnia/sleep-disturbance, stress/anxiety/irritability, suicidal ideation/plan/attempt,^{4, 7} and other health-damaging behaviours like smoking, alcohol and other drug use, sexual risk-taking, violence, seat-belt omission, prolonged screen time and poor diet.^{5, 8} To reflect these risks, ED labels must state that EDs are ‘Not recommended for children’.⁹ Nevertheless, EDs remain popular among children,^{1-5, 8} possibly due to children's ED marketing exposure.

Although the non-alcoholic beverage industry pledges to not direct any ED ‘marketing and advertising activities at children’,¹⁰ the commitment is voluntary and self-regulated with no monitoring, enforcement or penalty mechanisms. Similar self-administered food and alcohol advertising codes have been criticised for failing to reduce children's overall exposure to unhealthy product advertising.^{11, 12} Globally, few mandatory ED marketing regulations exist, meaning many children may be regularly exposed to high volumes of ED marketing, which often features child-appealing themes like action-adventure, fantasy and fun.¹³ While previous studies have examined the frequency and contexts of youth ED use,^{2, 14} few studies have explored where children are exposed to ED marketing. There is also little evidence around how children perceive ED marketing. This study aimed to identify where children have seen ED marketing and determine whether they believe ED marketing targets them.

2 METHODS

3 RESULTS

Participant exposure to ED marketing mediums stratified by demographic characteristics is presented in Table 1.

Overall, participants reported seeing ED advertisements on an average of 6.5 (SD = 2.5) of 11 possible marketing mediums. The most prevalent ED marketing mediums were television (seen by 91% of participants), posters or signs in shops (88%), online/internet (82%) and movies (71%).

The average number of ED marketing strategies seen by participants was significantly higher for ever versus never users of EDs (7.0 vs. 6.1; p < .001); males versus females (6.7 vs. 6.4; p < .001); children in upper versus lower secondary school (6.9 vs. 6.4; p < .001); and children attending schools located in low versus high SES areas (6.7 vs. 6.4; p < .001). No significant differences were found in the average number of marketing strategies seen by children attending schools located in metropolitan versus regional schools (6.6 vs. 6.5).

Table 2 presents the proportion of participants who perceived each of the three ED advertisements to target different age groups. Participants perceived all three ED advertisements targeted children (<18 years). The ED advertisement featuring the ‘V’ ED brand and slogan (Image 3) was perceived by most participants (81.4%) to target 13–17 year-olds, as well as children aged ‘12 years or less’ (19.8%). Approximately three-fifths of participants perceived the ED advertisement featuring Marvel Avengers™ (Image 1) to target children aged ‘12 years or less’ (61.3%) and ‘13–17 years’ (60.7%). The ED advertisement featuring Halo 4™ characters (Image 2) was perceived by participants to target 13–17 year-olds (48.3%) and 18–23 year-olds (69.0%).

TABLE 2. Proportion of participants who perceived sample energy drink (ED) advertisements to target different age groups.

	Proportion (%) of participants (n = 3688) who perceived the ED ad targeted each age group
	Image 1	Image 2	Image 3
Perceived target age group
12 years or less	61.3	8.2	19.8
13–17 years	60.7	48.3	81.4
18–23 years	21.1	69.0	39.1
24 years or older	10.1	34.9	14.0

4 DISCUSSION

Overall, ED marketing had a high reach among participants, who were exposed to an average of 6.5 of 11 possible marketing channels. ED marketing was most seen on television, on posters/signs in shops, online/internet and in movies. These results reinforce previous research showing similarly high levels of ED marketing exposure among children and young people in other developed countries, including the United Kingdom and Canada.^{8, 16} However, respondents in the current study viewed ED marketing in almost twice as many mediums and in greater proportions than participants in Canadian research, which showed that adolescents and young adults saw ED marketing on an average of 3.4 of 10 marketing channels, most commonly television, posters/signs in shops and online.¹⁶ These differences may be attributable to Health Canada's statutory prohibition on marketing EDs to children being more effective than Australia's voluntary ED advertising commitments. For example, Health Canada prohibits the promotion of EDs to children in any advertising medium, including promotional samples/giveaways.¹⁷ Australian research suggests similar statutory prohibitions on the placement and content of ED marketing may reduce its appeal to children and their overall exposure to it.¹⁸

The finding that most participants reported seeing ED advertisements on television is unsurprising, given watching television remains a dominant pastime for children, who view an average of 92 minutes of television daily.¹⁹ ED advertising spending is also higher on television than on other mediums.²⁰

This study found males were exposed to a significantly higher average number of ED marketing strategies than females (6.7 vs. 6.4; p < .001), which is consistent with previous research showing a gendered pattern of ED marketing, which features heavily in channels and settings that are popular with young males.⁸

Participants in upper secondary school (age 15–17 years) reported seeing significantly more ED marketing mediums than participants in lower secondary school (age 12–14 years) (6.9 vs. 6.4; p < .001). This is consistent with Canadian research,¹⁶ and may relate to older adolescents having more opportunities to come across ED marketing, due to simply being alive longer and/or their greater autonomy to access wider social and online settings.

More ED marketing strategies were seen by children attending schools in low SES areas compared to children attending schools in high SES areas (6.7 vs. 6.4; p < .001), which aligns with evidence showing that unhealthy outdoor food advertising clusters in proximity to schools and low socioeconomic areas.²¹ Our results suggest that perhaps, like other unhealthy food and beverage marketing, ED marketing is disproportionately present and seen by children in low SES areas.

When shown three ED advertisements, participants perceived all three examples to target children. The advertisement featuring Marvel Avengers™ characters had the highest proportion of participants perceiving the advertisement to target children aged 12 years or less. Previous research shows marketers often use licensed characters to cue children's consumption, purchase or purchase requests for the advertised product or brand.²² Interestingly, 81% of participants perceived the ED advertisement without licensed characters targeted 13–17 year-olds, possibly due to the presence of a slogan/description and a logo/company name—2 of the 10 most salient food marketing features that attract adolescents to advertised products.²³ The use of bright colours, such as the bright green featured in the tested ads, is also known to cue children's food preferences, even when children associate bright colours with unhealthy foods.²²

Despite an industry pledge to not market EDs to children, our research shows that ED marketing reaches large numbers of children via multiple channels. Moreover, children themselves believe ED advertising targets them, indicating the current voluntary commitments operating in Australia do not effectively reduce children's overall ED marketing exposure. Given the adverse health risks of child ED use, several countries have banned ED sales to minors.¹ Short of such bans, mandatory marketing regulations with sufficient scope and independent enforcement could help protect children from the influential reach of ED marketing, For example, the regulation that defines children as those up to 18 years would recognise and protect teens who, like younger children, lack skills like scepticism, required to distinguish the persuasive commercial intent of marketing from entertainment.^{22, 23} In an Australian study exploring interventions to reduce child ED use, children and young people themselves suggested age-restricted ED sales and/or consumption bans, making ED product packaging/labels plain and unappealing to children and restricting retail display/promotion of EDs.¹⁸ Given digital marketing and children's online activity are both ubiquitous, it is also crucial for policymakers to consider regulating the infrastructure of online environments. Currently, digital platforms can indiscriminately collect user data to target advertising, including children,²⁴ who often unwittingly extend marketing reach by freely liking, commenting on and/or sharing content.²⁵ Children's health would be better protected with regulatory oversight and control of this kind of marketing.

While our study did not measure children's actual exposure to ED marketing and was limited by recall bias and selection bias (due to active consent), its strengths include the large sample size, wide participant age range and inclusion of schools varying in socio-economic status and location (metropolitan and regional). The results also fill significant evidentiary gaps around children's perceptions of ED marketing, particularly the perceived target age group/s of real-life ED advertisements. We note that the list of potential ED advertising mediums was not exhaustive and future studies should investigate young people's exposure to ED marketing at events where ED marketing is common (e.g., extreme sports, motorsport racing and rock concerts).

In conclusion, this study found Western Australian children perceived ED marketing to target children (<18 years), with participants exposed to ED marketing in many different settings. These findings confirm that the voluntary ED marketing pledge operating in Australia does not adequately prevent children from being exposed to or targeted by ED advertisements.

FUNDING INFORMATION

This study was funded by the Telethon-Perth Children's Hospital Research Fund. Dr. Trapp is supported by an Australian Research Council DECRA Fellowship (DE210101791).

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no conflicts of interest.

ETHICS STATEMENT

Ethical approval to conduct this study was obtained from the University of Western Australia's Human Research Ethics Committee, The WA Department of Education, The WA Catholic Education Office and the Association for Independent Schools of WA.