This study was aimed at assessing the occurrence of energy drink consumption among commercial long-distance bus drivers operating from the Ho municipality and also investigating their awareness of potential health problems associated with the consumption of these energy drinks. Information on the consumption status of the drivers, the reasons for consumption, the pattern of consumption and general knowledge on energy drinks was obtained from 132 participants using a structured questionnaire.
Socio-Demographic Characteristics of the Commercial Bus Drivers
Aside all the participants being males, 36 – 45 (34.1%) years was the leading age range. According to Achulo et al.  and , most commercial drivers in Ghana have been reported to be within the age range of 30 – 50 years which could also explain the majority of the drivers being between 36 – 45 years of age. The least age range (9.1%) being within 18 – 25 years suggest that many vehicle owners consider long years of experience before they hand over their vehicles to a driver for commercial purposes. The absence of ages less than 18 years implies that the Drivers and Vehicle Licensing Authority (DVLA), a regulatory body in Ghana, sticks to the law governing the issuance of driver’s license to people above 18 years only . SHS, vocational training or technical training being the dominant educational level of majority (58.3%) of the drivers suggests that, most people opt for commercial driving as an occupation as a result of their inability to further their studies to the university to get them jobs of their interest. It may also be due to limited vacancy for blue- and white-collar jobs in Ghana especially for people without very high levels of education . Additionally, it was observed that 80.3% were Ewes which may be because the study was carried out in the Volta region which is inhabited mainly by Ewes. It also suggests that the routes commercial drivers use in Ghana might be influenced by ethnicity. Almost half of the drivers had a monthly income range of Ghȼ 100 – 500 ($17.83-89.93). This suggests that many commercial drivers may be earning around the daily minimum wage of Ghȼ 10.65 ($1.90), translated into Ghȼ 319.5 ($56.95) . The low income the drivers collect may be the reason why some of them consume energy drinks, so as to boost their energy levels at the least cost. Concerning years of commercial driving experience and the number of working hours per day, most (62.1%) of them had greater than 10 years of experience and almost half of the drivers (47.0%) worked for between 4 – 6 hours per day.
Prevalence of Energy Drink Consumption among the Commercial Bus Drivers
This present study reveals a 75% prevalence of energy drink consumption among commercial bus drivers in Ho. Sharwood et al. , stipulates that commercial bus long-distance drivers have developed many strategies to improve their performance while driving, among which is the use of energy drinks. This supposed positive effect of energy drinks could explain their widespread use amongst the study participants . Klu et al.  however observed a slightly higher prevalence of energy drink consumption of 78% among commercial bus drivers and hawkers in the Tema Municipality of the Greater-Accra region, Ghana. In line with this, Buxton and Hagan  reported that commercial bus drivers are among the high consumers of energy drinks in Ghana.
On the other hand, findings by Sharwood et al.  in a case-control study to investigate the existence of an association between caffeinated beverage use and the risk of crash in long-distance commercial bus drivers, reported a lower prevalence of energy drink consumption, thus, 14% and 6% among the controls and cases respectively.
The difference in prevalence among the various studies could be attributed to the variations in population and sample sizes as well as the types of study.
Reasons for Consuming Energy Drinks among the Commercial Bus Drivers
Respondents of this present study gave varied reasons for consuming energy drinks which included enhancing driving performance (keeping awake while driving, for an energy boost, reduce fatigue and mental enhancement), to quench thirst, for the taste, as well as sexual enhancement. The most predominant reason given by almost 8 out of 10 drivers (78.8%) was to enhance driving performance. This is in line with findings by Acevedo and colleagues , in which the majority (61%) of the study participants took energy drinks for enhanced performance. This suggests that most drivers overwork and need to be educated to take rests to reduce fatigue-related accidents on the roads. According to Sharwood et al. , long-distance drivers of commercial vehicles routinely experience monotonous and extended driving periods in a sedentary position. This, often combined with the disruption to circadian rhythms linked to the common requirement of night driving, has been associated with wake time drowsiness and increased fatigue. This could also account for most of the drivers energy drinks consumption to increase energy and counter sleepiness and fatigue thereby enhancing driving performance.
The percentage of drivers who consumed energy drinks due to the taste in this present study was 7.1%. Similarly, the pleasant taste was a reason given by participants of a study conducted by Klu et al. . According to Giles and colleagues , most energy drinks contain sweeteners like glucose and other flavorings which contribute to improving their taste.
Energy drinks are consumed to quench thirst or as sexual enhancer and implied that little or no attention is given to the quantity or even frequency of consumption. This can be attributed to the unchecked and inadequate regulatory control of caffeinated energy drinks in Ghana .
The pattern of Energy Drink Consumption among the Commercial Bus Drivers
Results of this study showed that participants were first introduced to energy drinks either through advertisement, recommendations from family or friends, exposure by hawkers or at convenience stores. The predominant mode of introduction was advertisement (44.2%). This was followed by recommendations from family/friends which constituted 31.0%. Initiating energy drink use through the influence of advertisements is not surprising since the adverts on energy drinks are very appealing, having individuals with fast-paced lifestyles and looking for an energy boost as their target. These could include drivers wanting to sustain long hours of driving . Manufacturers of these drinks also advertise their products by sponsoring extreme sports like race car driving  and this manner of advertisement can easily appeal to commercial bus drivers who seek heightened driving performance when behind the steering wheel.
Reid et al.  revealed from their study that 31.2% of the study participants were introduced to energy drinks through recommendations from friends and family, similar to 31.0% this study found, followed by 30.6% introduced through advertisement. This suggests that close relatives and associates play a critical role in the eating pattern of these drivers.
Taking into consideration the quantity and frequency of energy drink intake, this present study identified that almost a third of the participants consumed 7 to 10 bottles of energy drinks per week with less than 3 bottles being the least number of bottles consumed per week. This was much lower than the 7 to 21 bottles, 28 to 42 bottles and 49 bottles of energy drinks per week consumed by 94%, 2% and 4% of participants respectively reported by Klu et al. . The reasons for this sharp disparity could be attributed to brisk economic activities in Tema compared to Ho. Tema has the major export and import harbour in Ghana. Additionally, it is in a close proximity to Accra, Ghana’s capital city. The economic activities in Ho is predominantly petty trading and subsistence farming. This suggests that the busier the place the drivers operated, the longer the hours the drivers sat behind the wheels and this influenced the quantities of energy drink intake. The intake of a high number of bottles of energy drinks per week could be due to the addictive nature of caffeine and other stimulants such as taurine, guarine ..etc in these drinks . Moreover, the results of this study showed that the number of bottles of energy drinks the drivers consume is related to the income they earn. Drivers who earned less than Ghȼ 100 ($17.83) were more likely to consume 5 - 6 bottles in a week whereas Ghȼ 100-500 ($17.83-89.93), Ghȼ 600-1000 ($106.95-178.25) and > Ghȼ 1000 ($178.25) earners were more likely to consume 7 – 10 bottles in a week.
This study also revealed that 29.2% of the drivers took energy drinks every day and most commonly in the afternoon. This pattern of energy drink consumption could be attributed to the quest for a cool sensation to alleviate perceived stress which is due to increased levels of heat especially from the sun, experienced during the afternoon. The perception of stress can cause reduced alertness and productivity among drivers . Drivers who work for less than 3 hours had a higher likelihood of consuming energy drinks as their first food of the day. This could be because they presumed the drinks would supply them with energy to proceed with the day's activities. Those who worked more than 10 hours a day were more likely to consume the drink any time of the day, probably because they might have felt fatigued at any point in time as they worked and hence resorted to energy drinks to replenish their energy. Most of those who work for 4 – 6 and 7 – 10 hours consumed energy drinks in the afternoon. This suggests their work hours spanned through the afternoon or even beyond and as a result, end up consuming energy drinks with the intention of cooling the body as a result of heat from the sun.
Majority (88.9%) of the respondents also affirmed getting the desired results when they take energy drinks. This is much higher than the 57.1% reported by Klu et al. . This suggests that when the drivers keep consuming higher quantities of energy drinks, they develop an addiction for the caffeine and hence require much higher quantities to obtain their desired results.
The commonly consumed brands of energy drinks among the drivers were “Rush”, “Storm”, “5 -Star”, “Lucozade” and “Red Bull”. “Rush” energy drink being the most consumed (54.5%) is consistent with findings by Klu et al. , in which most (52.6%) of the participants who consume energy drinks took “Rush”. However, the least consumed energy drink from this present study was “Red bull” (2.0%) whereas “5-Star” was the least consumed from findings by Klu and colleagues . This variation in choice of brand could be attributed to difference in price, taste, ingredient concentrations as well as popularity of the various brands. The different energy drink brands have different volumes per container as well as varied levels of caffeine. The assay results by Klu et al.  showed that “Rush” energy drink had the highest caffeine concentration (0.245 mg/ml) while Red bull had the least concentration of caffeine (0.089 mg/ml). According to Reid et al. , caffeine effects are dose dependent and this could explain why most participants attained their desired results. The “rush” was the most patronized and has the highest concentration of caffeine amongst the other commonly consumed energy drinks probably because it’s locally manufactured and the cheapest.
General Knowledge on Energy Drinks among the Commercial Bus Drivers
Over 6 out of 10 drivers (63.6%) had relatively poor knowledge on energy drinks including knowledge on the ingredients and associated side / adverse health effects. Subaiea et al  also recorded poor knowledge in energy drinks adverse effects among Saudi Arabian populace. According to Gunja and Brown , generally, there is a poor knowledge level on energy drink ingredients, effects and toxicity. This can be attributed to the fact that some manufactures do not have many of the ingredients and their quantities likewise warning labels on their products . Also, messages about the risks and potential undesirable effects associated with energy drink use are seldomly mentioned or talked about compared with the high level of exposure of these drinks .
The study results also showed that there was no statistically significant relationship between consumption of energy drinks by drivers and their knowledge on the potential side / adverse health effects linked with energy drink intake. This suggests that having knowledge on the potential health problems associated with energy drink intake does not influence a drivers’ decision to consume energy drinks or not.
Our inference using the Health Belief Model suggests that the commercial bus drivers are most likely to take preventative actions if they perceive the threat of a health risk to be serious, if they feel they are personally susceptible and if there are fewer costs than benefits to engaging in it. Also behavior change mediations will be more effective if they address these commercial bus driver’s specific opinions about vulnerability, benefits, barriers, and self-efficacy.