Assessment of Knowledge, Attitude and Practice Towards Caffeinated Products Consumption among General Population

Caffeinated product consumption is the world most widely consumed psychoactive drug. The consumption of caffeinated product is highly prevalent among Asian countries. This study aimed to assess knowledge attitude and practice towards caffeinated product consumption. A cross sectional descriptive study was conducted through online Questionnaire through the social media platform. We assessed demographic characteristics and intake of caffeine from different products like tea, coffee, energy drinks and soft drinks. Both genders were included in the study and above 18 years old, repeated and incomplete data submission were excluded from the study. A total of 273 participants replied to the survey. Out of 273 participants; 148(54.22%) were female, 125(45.78%) were male, among them 241(88.30%) participants were under the age group of 18-28 years. Multiple choice procedure was carried out to assess the different products, most preferred products are 156(59.77%) consuming coffee, 146(55.93%) consuming tea, 106(40.99%) consuming chocolate, 47(18.00%) consuming carbonated drink, 26(9.96%) consuming energy drinks and 7(2.68%) consuming caffeine from other products. The major reason for intake of Original Research Article Rajendran et al.; JPRI, 34(24A): 1-7, 2022; Article no.JPRI.83592 2 caffeinated products for refreshment was 163(62.45%) and most of the participants intake while studying 115(44.06%). The Most common symptom occurred due to excessive consumption of caffeine is vomiting 30(11.49%), the study participants faced difficulties faced missing a regular intake of caffeine is headache 71(27.20%). Out of 273 participants,the majority of the participants has lack knowledge and a positive attitude towards caffeine consumption. The Majority of the study participants believe the merits of caffeinated product consumption outweigh its demerits. It was found that side effect due to the usage of caffeinated products raising exceedingly it is essential to educate the consumption product in a recommended limit in their daily life style. This study result will give an idea for upcoming research on the consumption of caffeinated products.


INTRODUCTION
Caffeine is a central nervous system stimulant (CNS), a psychoactive substance it is attained from natural plants, one of the world's major ingredients consumed every day in daily life for several reasons [1]. Caffeine can be consumed by caffeinated products like coffee, tea, chocolates, soft drinks and energy drinks. Extracted or synthesized caffeine from natural plants is frequently added to food and beverages to boost their stimulant properties [1,2]. The most widely used products are coffee, tea, energy drinks and soft drinks [2,3]. Among these tea and coffee have become the most popular beverages in the world, and are used on a regular basis by the majority of people followed by other products [4]. Caffeine is mostly absorbed in the small and found in the intestine about 99% of caffeine is absorbed in the intestine within 45 minutes all body fluids, it crosses the cellular membrane and also crosses through the Placenta [5]. Caffeine promotes alertness and wakefulness by blocking adenosine receptors [6]. People consume caffeine for a number of reasons which include increased alertness and attention, improved job performance, greater focus, postpone sleep [7]. Surgeons use caffeinated products for attentiveness and reduce tiredness [8], sportspersons use a caffeinated product for physical performance [9], young people to boost their energy levels, for the flavour, or as part of social events [10]. According to the Food and Drug Administration (FDA), daily intake of caffeine has recomended within the limit of 400mg/day [11], European Food Safety Authority (EFSA), and the American Institute of Medicine have controlled the caffeine intake in pregnant women is 200mg/day [12,13]and higher intake of caffeine during pregnancy may lead to miscarriage evidence remains inconclusive [14]. caffeine it has both positive and negative effect, many studies show that decreases the risk of type 2 diabetes mellitus(DM), liver cancer, uterine or prostate cancer, and basal cell carcinoma [15]. Caffeinated product consumption may also leads to sleep disorder and also increased risk for obesity, most common side effects are sleeplessness, repeated urination, anxiety, and headaches [16]. When caffeine intake increases more than 3 mg/kg/day side effects may occurs, acute clinical toxicity occurs when daily doses reach 1 g, Doses of 5 g and 10 g can be fatal [17]. Consumption patterns, as well as information about caffeine, are not efficiently handled among people that knowledge needs. Most of the populations were oblivious about the amount of caffeine intake and its chemical constituents in the market. Hence, it is important to create awareness about it.

AIM AND OBJECTIVES
Our study aimed to assess and investigate knowledge, attitude and practice towards caffeinated product consumption. We assessed Socio demographic details of participants, consumption patterns of caffeinated products, health risk and side effects of caffeinated products.

MATERIALS AND METHODS
The study designed as a cross-sectional webbased survey was conducted at kumarapalayam, Tamil Nadu during August and September 2020. The sample size was estimated about 200 and we got the responses of about 273. For this study, we had developed a questionnaire based on previously published questionnaires Bhojaraja VS et al. [18], Jahrami H et al. [19], Alaa Hammami et al. [20]. Data were collected through google forms. The questionnaire contains 4 sections which includes sociodemographic details, Knowledge, Attitude and practice about caffeinated product consumption, which is validated by using the sample population of 30 participants. The questionnaire was sent via different social media platforms, with the subject being able to read and answer the questions by clicking on the link, each participant's permission was obtained before the start of the survey and the final page included a confidentiality statement, the questions were based on multiple choice (English language). Ethical approval for this study was obtained from the Institutional Ethics Committee (Ref number: JKKNCP/ETHICS_PRACTICE/020PDS07).
Participants with an age 18 years and above, both genders and both caffeinated product consumers and non-consumers were included in the study. Participants below 18 years, repeated data from the same participants and incomplete data were excluded from the study. Data were managed and analysed using Microsoft Excel by using simple descriptive statistics.

RESULTS AND DISCUSSION
A questionnaire link was circulated through social media like WhatsApp, Facebook, and e-mail, A total of 273 participants completed the questionnaire, Among these 261(95.60%) participants consumes caffeinated products and 12(4.40%) did not consume caffeinated products as represented in (Table 1).
In our study demographic report shows that 148(54.22%) were female, 125(45.78%) were male, among them, 241(88.30%) participants were under the age group between 18-28 years followed by 20(7.32%), 9(3.29%) and 3(1.09%) participants were under the age group of 29-39 years, 40-50 years and 51-61 years respectively. The Education and occupation of the study participants were illustrated in (Table 1). In the study conducted by Al Ghali et al.,(2017) caffeinated products consumed by students and adults were increased it is contrasted with our study [21,22].
In our study participants, intake of caffeinated products are associated with various reasons, frequency, and activities as showed in (Table 2). Most of the study participants 163(62.45%) intake caffeinated products for refreshment followed by Taste and flavor 106(40.61%), respectively. Our result contrast with the study conducted by M. Khalil & J. Antoun(2020), Mahoney R C et al. [11,26] In Frequency, majority of the participants 190(72.79%) intake caffeinated products 1 to 3 times per day showed in ( Table 2). The study conducted by (Jahrami et al., 2020) coincides with our study [19]. Major activities associated with regular consumption of caffeinated products are 115(44.06%) while reading or studying and 92(35.24%) while outing with friends and reasons for caffeinated product consumptions are illustrated in (  (Table 3). The study conducted by Nowak D et al.,(2015) contrasts with our study [28]. The study conducted by Juliano M et al.,(2012) reported weakness/sleepiness, low attentiveness/difficulty concentrating, mood disturbances, loss of focus in work, flu-like feelings, and headache it is similar to our study [29].
From our current study, the knowledge regarding caffeine consumption was not in a satisfactory manner. 127(46.52%) participants don't know the energy drinks contain caffeine, 158(57.87%) don't believe that taking more than 400 mg of caffeine per day is harmful to your health. A majority of the study participants 194(71.06%) do not know whether caffeine increases frequent urination. 164(60.07%) study participants were not knowing that caffeine consumption causes an increase in heart rate. 201(73.62%) participants were not knowing that caffeine causes bone weakness. 214(78.38%) participants do not know that regular caffeine consumption reduces the risk of Alzheimer's disease and Parkinson's disease. 220(80.58%) participants do not know whether caffeine is safe for pregnant women as clarified in (Table 4), contrasts the study by Alla Hammani M et al. [20].

Agree
Neither agree Nor disagree Disagree Limiation of our study was the sample was relatively small. A large population could have been included in this study. Because of the small sample size study may not be imitated on the whole population since it is mainly based on selfreported data, it relies on the honesty of the dependent respondents. We are unable to demonstrate a correlation between caffeine intake and associated symptoms reported by participants in this study.

CONCLUSION
The majority of the study participants consume caffeinated products are female 148(54.22%) and the age group is between 18-28 years old 241(88.30%) ie, student population. The maximum recorded patterns of caffeinated products on daily basis was 1 to 3 times per day. Coffee and tea are the major sources of caffeine.
To increase concertation or focus while studying and other activities. Intake of caffeine at higher doses and withdrawal leads to various health risks. The majority of the student participants believe the merits of the caffeinated product outweigh its demerits. It was found out that there is a lack of knowledge in the consumption of caffeinated products. So there is indeed to improve the knowledge of population about the consumption of caffeinated products. Hence we need to create awareness and educate them through seminars, and conducting camps, etc., This study result will give an idea for the upcoming researchers about caffeinated product consumption.

CONSENT
As per international standard or university standard, Participants' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
Ethical approval for this study was obtained from the institutional ethics committee (ref number: jkkncp/ethics_practice/020pds07).