CHAPTER TWO

LITERATURE REVIEW
2.1 Conceptual Review

Caffeine Intake

Caffeine is a naturally occurring stimulant belonging to the methylxanthine class of compounds.

It is predominantly found in coffee beans, tea leaves, kola nuts, cacao pods, and is also added to

a variety of manufactured beverages and pharmaceutical products. Its primary mechanism of

action involves antagonism of adenosine receptors in the brain, leading to increased neuronal

firing and the release of neurotransmitters such as dopamine and norepinephrine. These

biochemical changes contribute to the heightened alertness, increased concentration, and

temporary reduction in fatigue reported by users (Zhu et al., 2021). It is one of the most widely

consumed psychoactive substances globally and is legally and socially accepted in almost all

cultures.

Globally, caffeine consumption is pervasive. According to the International Coffee Organization

(ICO), over 1.6 billion cups of coffee are consumed worldwide every day, making coffee one of

the most traded commodities globally. In the United States and Europe, approximately 80-90%

of adults consume caffeine daily, mostly from coffee and energy drinks. In Japan and China, tea

is the dominant source of caffeine, while in Latin America, yerba mate and coffee are widely

consumed. The World Health Organization (WHO) classifies caffeine as a substance with no

proven adverse effects when taken in moderation, recommending a safe intake level of up to

400mg per day for healthy adults (Kharaba et al., 2022).

Among university students worldwide, caffeine use has been reported to range from 70% to over

90%, with the primary reasons being academic stress, sleep deprivation, and conventration
enhancement. A cross national survey conducted in 12 countries showed that students in

competitive academic environments often exceed recommended caffeine limits, particularly

during exam periods (Higbee et al., 2021). While caffeine is legal and socially accepted across

cultures, its high prevalence and potential for misuse especially among youth and students

continue to attract research interest in public health and education.

In Africa, caffeine consumption is mostly linked to tea and kola nut chewing, but urbanization

and the rise of Western dietary patterns have led to increased intake of processed caffeinated

products such as instant coffee and energy drinks. In sub Saharan Africa, young adults and

university students now represent a growing market for caffeinated beverages (Sholeye et al.,

2022). In Sub Saharan Africa, caffeine consumption is on the rise, particularly in urban areas

where western dietary patterns are becoming more prevalent. Countries like South Africa and

Ghana have reported significant increases in the consumption of energy drinks among

adolescents and young adults, often marketed as lifestyle enhancers.

In Nigeria, caffeine consumption is widespread across all age groups but is particularly common

among university students. Common sources include brewed coffee, soft drinks like cola, and a

wide array of imported and locally produced energy drinks. Traditional caffeine sources such as

kola nuts also remain popular, especially in rural and semi urban areas. Studies conducted in

Nigerian tertiary institutions show that students consume caffeinated products to stay awake for

academic activities, with many unaware of their exact caffeine intake or its potential health

implications (Eduviere et al., 2021; Onoh et al., 2024). A cross national survey conducted in 12

countries showed that students in competitive academic environments often exceed

recommended caffeine limits, particularly during exam periods (Higbee et al., 2021). While
caffeine is legal and socially accepted across cultures, its high prevalence and potential for

misuse especially among youth and students continue to attract research interest in public health

and education

Overall, while moderate caffeine use may offer temporary cognitive advantages, excessive intake

negatively impacts both health and learning outcomes, particularly in stress prone populations

like nursing students.

Caffeinated Substances

Caffeinated substances refer to all consumables that contain caffeine as an active ingredient.

These include natural sources such as coffee, tea, and cocoa, as well as commercial products like

energy drinks, carbonated soft drinks, caffeine tablets, and dietary supplements. Each of these

products contains varying levels of caffeine, depending on brand formulation, brewing methods,

or manufacturing processes (Kharaba et al., 2022).

The popularity of these substances among nursing students can be attributed to easy accessibility,

affordability, social influence, and aggressive marketing. Energy drinks are particularly attractive

due to their association with improved stamina, enhanced cognitive performance, and their

appeal in youthful branding. Coffee remains a classic choice, favored for its quick stimulation

and routine integration into academic culture. Additionally, the emergence of caffeine-based

health supplements has expanded the ways students incorporate caffeine into their daily routines.

Caffeinated Substance Consumption

Caffeinated substance consumption refers to the intake of products that contain caffeine as a

primary or addictive ingredient. These products include both natural and synthetic sources such
as brewed coffee, tea, kola nuts, cocoa, energy drinks, soft drinks, and over the counter

stimulants. Caffeine is often added to medication for headache relief, weight loss supplements,

and alertness enhancing tablets. Consumption habits can be influenced by cultural practices,

availability, socioeconomic status, advertising , academic stress, and personal preferences

(Higbee et al., 2021)

Globally, caffeine-containing substances are consumed by billions of people daily. Coffee,

energy drinks, and sodas are particularly prominent in Western nations, where busy lifestyles and

demanding work environments have normalized high caffeine consumption. According to the

International Coffee Organization (ICO), over 10 million tons of coffee are consumed annually,

and over 30% of that is by people aged 18–35, including students and young professionals. In the

United States, around 90% of adults consume caffeine daily, with approximately 75% sourced

from coffee alone. In countries like Germany, the UK, and Canada, caffeine is also present in

chocolate, prescription medications, and even chewing gum (EFSA, 2021).

In many Asian countries, tea remains a culturally rooted source of caffeine. Countries such as

Japan, China, and India show strong cultural preferences for green and black tea, with emerging

trends showing an increase in Western-style coffee shops and energy drinks, especially in urban

university campuses. These beverages are often marketed as performance boosters, targeting

students, athletes, and young professionals (Zhu et al., 2021).

Regionally, in Sub-Saharan Africa, the patterns of caffeinated substance consumption are

evolving rapidly. Traditional sources such as kola nuts and locally brewed teas are still in use,

especially in rural communities. However, urban youth and university students are shifting

towards more accessible and commercially branded caffeine sources. In Ghana, for example,
over 70% of university students reported consuming energy drinks during exams to prolong

study hours (Mogotsi et al., 2024). The advertising of caffeine products often downplays

potential health risks, and the lack of strict regulation in many African countries exacerbates the

situation.

In Nigeria, the consumption of caffeinated substances is increasingly common, particularly

among students in tertiary institutions. Factors such as long lecture hours, clinical rotations,

limited sleep, and academic anxiety contribute to the reliance on caffeine to enhance

concentration and reduce fatigue. Energy drinks such as Fearless, Predator, and Monster are

readily available in school canteens and supermarkets. According to Eduviere et al. (2021), more

than 60% of students in a private Nigerian university reported consuming caffeine regularly, with

many unaware of the safe consumption limits.

Additionally, Ighorodje et al. (2024) found that about 68% of Nigerian students consumed

caffeinated substances during examination periods, with up to 40% experiencing side effects

such as irregular heartbeat, restlessness, and disturbed sleep. Alarmingly, some students admitted

to consuming multiple caffeine products (e.g., combining coffee, soft drinks, and energy drinks)

within a single day. The increasing trend of mixing caffeine with alcohol during social events

raises concerns about substance abuse and long-term health implications. Sholeye et al. (2022)

emphasized that the rising popularity of these beverages among adolescents and young adults

necessitates targeted public health interventions.

Given the prominent role of nursing students in future healthcare delivery, their pattern of

caffeine consumption presents a dual concern: their own health and the health advice they may

one day provide to patients. Without adequate awareness and self-regulation, the misuse of
caffeinated products may undermine academic performance, mental health, and long-term well-

being.

Caffeine and Health

The World Health Organization (WHO) defines health as “a state of complete physical, mental,

and social well-being and not merely the absence of disease or infirmity.” This definition

emphasizes that health is not limited to physical functioning but includes emotional balance,

cognitive capacity, and overall quality of life (WHO, 2023). Against this backdrop, the

consumption of caffeine a widely used psychoactive substance can have varying implications for

health, depending on the quantity consumed, individual sensitivity, and behavioral context.

Caffeine is a naturally occurring methylxanthine compound found in coffee beans, tea leaves,

kola nuts, cocoa, and guarana. It is also a common additive in energy drinks, carbonated soft

drinks, analgesics, weight-loss supplements, and stimulatory pills. According to the European

Food Safety Authority (EFSA, 2021), caffeine is consumed daily by more than 80% of adults

worldwide. While low to moderate intake (up to 400 mg/day for healthy adults) is considered

generally safe, overconsumption and frequent use especially among young adults can result in

negative physical and psychological health outcomes.

From a physiological perspective, caffeine exerts its effects primarily by antagonizing adenosine

receptors in the brain. Adenosine is a neuromodulator that promotes sleep and relaxation by

slowing down neural activity. When caffeine blocks adenosine receptors (A1 and A2A), it results

in heightened neural stimulation and increased release of neurotransmitters such as dopamine,

norepinephrine, and serotonin, which enhance alertness, elevate mood, and reduce the perception
of fatigue (Zhu et al., 2021; Kharaba et al., 2022). However, chronic interference with adenosine

pathways can lead to overstimulation of the central nervous system, causing restlessness,

anxiety, tremors, and disrupted sleep patterns.

Excessive caffeine intake especially beyond the 400 mg/day threshold has been associated with a

wide array of adverse health effects. These include tachycardia, palpitations, hypertension,

gastric irritation, acid reflux, dehydration, and psychological symptoms such as irritability and

panic attacks (Guest et al., 2021). Dependence and withdrawal are also well documented

concerns; symptoms such as headaches, fatigue, and difficulty concentrating often emerge within

12–24 hours of missed doses (Higbee et al., 2021). For individuals with underlying

cardiovascular issues or high stress levels, these effects may be compounded.

Globally, the WHO (2022) and health bodies like the CDC have raised concerns about increasing

caffeine misuse among adolescents and young adults. In countries like the United States and

Canada, caffeine is routinely consumed in combination with sugar and synthetic additives in

energy drinks, increasing both caloric intake and stimulant load. The Global Burden of Disease

Study (GBD, 2022) attributes a rising percentage of sleep disorders, digestive dysfunction, and

anxiety cases in university-aged populations to lifestyle factors, including unregulated caffeine

use.

In Sub-Saharan Africa, the rising use of caffeine among university students is becoming a public

health concern. Boakye and Ofori (2023) observed that over 60% of Ghanaian university

students reported physical symptoms such as dizziness, muscle twitching, and nausea following

the intake of caffeine-laden energy drinks often consumed during academic stress periods.

Similarly, Mogotsi et al. (2024) in South Africa documented frequent cases of dehydration,
irritability, and low energy crashes after high doses of caffeine among part-time nursing students

balancing employment and education.

In Nigeria, the trend is similarly troubling. Eduviere et al. (2021) reported that 71.4% of students

at a private university in southern Nigeria regularly consumed caffeine-containing products,

especially during exam weeks. Among these, more than half experienced adverse symptoms such

as restlessness, sleep loss, stomach discomfort, and concentration difficulties. Yet, only 28% of

the students surveyed were aware of the recommended safe intake limit. In another Nigerian

study, Sholeye et al. (2022) found that caffeine use was socially normalized, with many students

combining coffee, cola drinks, and energy beverages in a single day, unaware of the cumulative

dosage.

For nursing students, who face a demanding mix of theoretical study and clinical responsibility,

the health risks posed by excessive caffeine consumption are compounded. Their schedules often

require early mornings, late nights, and high emotional engagement—all of which create fertile

ground for caffeine dependence. However, long-term reliance on stimulants to offset fatigue may

compromise immune health, increase cortisol levels (the stress hormone), and result in poor

emotional regulation (Ighorodje et al., 2024). These effects not only interfere with academic

performance but can also reduce clinical competence and interpersonal communication with

patients.

Moreover, as future healthcare providers, nursing students are expected to model responsible

health behaviors. Their personal choices, such as unregulated caffeine consumption, not only

affect their well-being but may influence how they educate and counsel patients in the future.
Promoting a balanced understanding of caffeine's physiological impact is essential to fostering

healthier coping strategies and reinforcing professional standards in nursing practice.

Caffeine and Academic Performance

Academic performance refers to the measurable achievements and outcomes of a student's

learning efforts, typically assessed through tests, assignments, clinical evaluations, Grade Point

Average (GPA), and participation in academic activities. In the nursing profession, academic

performance is particularly important as it is closely tied to future clinical competence, patient

safety, and evidence based decision making. Among nursing students, academic responsibilities

are compounded by clinical rotations, night shifts, and emotional stress, prompting many to seek

performance enhancing strategies, including caffeine consumption.

Caffeine is widely believed to improve mental alertness, concentration, and stamina factors that

are critical to academic success. Its effects on the brain include enhanced attention span, reaction

time, and short term memory. This has made it a popular substance among students during

periods of high academic pressure, such as examination seasons or final year projects. However,

while caffeine may offer short-term cognitive benefits, excessive and unregulated use can

undermine the very academic success it is intended to support (Zhu et al., 2021).

Globally, caffeine use among university students is prevalent and often linked to the pursuit of

academic excellence. According to the American College Health Association (2023),

approximately 75% of students consume caffeine regularly, with usage increasing significantly

during midterms and finals. Many students report using energy drinks and coffee as tools to
extend study sessions and combat mental exhaustion. However, Higbee et al. (2021) found that

while students who consumed caffeine experienced improved wakefulness initially, chronic

overuse was associated with disrupted sleep, poor memory retention, and increased anxiety

factors that negatively impact academic productivity.

The cognitive toll of poor sleep quality is well documented. Students who sacrifice sleep in favor

of prolonged caffeine fueled study sessions often report next-day fatigue, low concentration, and

diminished learning capacity. This is especially relevant in nursing education, where students

must synthesize theoretical knowledge and apply it in clinical settings. A fatigued mind is less

capable of absorbing information, retaining knowledge, or making accurate clinical judgments

placing both academic and professional performance at risk (Ighorodje et al., 2024).

In Sub-Saharan Africa, similar patterns are emerging. In Ghana, Boakye and Ofori (2023) found

that 68% of university students used caffeine containing products to cope with academic

demands. Although some reported increased focus and motivation, a larger portion

acknowledged experiencing burnout, headaches, and lack of motivation after the stimulant

effects wore off. In South Africa, Mogotsi et al. (2024) found that part-time nursing students who

relied on caffeine to manage school and work responsibilities were more likely to perform poorly

in both theoretical and practical assessments compared to peers who followed healthier routines.

In Nigeria, caffeine is often marketed to students as a reliable solution for "burning the midnight

oil." Eduviere et al. (2021) observed that over two-thirds of students in a southern Nigerian

tertiary institution consumed caffeine regularly during exams. However, the majority did not

associate their insomnia, nervousness, and frequent headaches with caffeine overuse. Onoh et al.

(2024) further reported that many students mistakenly believed that more caffeine equaled better
academic performance, leading to the simultaneous consumption of multiple products like

coffee, energy drinks, and cola without calculating total caffeine intake.

Among nursing students, this behavior is particularly problematic. Their education demands both

mental acuity and emotional resilience. The overuse of caffeine may enhance temporary focus

but eventually disrupts circadian rhythms, reduces sleep quality, and increases vulnerability to

academic fatigue. Chronic sleep deprivation impairs cognitive performance, reduces attention

span, and increases the likelihood of academic errors all of which are dangerous in clinical

environments where patient safety is paramount.

Furthermore, the belief that caffeine boosts academic performance may lead students to ignore

healthier strategies such as time management, regular exercise, balanced nutrition, and scheduled

rest all of which are scientifically proven to support learning and memory. The normalization of

caffeine as an academic crutch may delay the development of effective study habits and coping

skills, making students dependent on external stimulation to meet academic goals.

In conclusion, although caffeine may serve as a short-term enhancer of alertness and endurance,

unregulated consumption poses substantial risks to academic success, especially in the high-

pressure environment of nursing education. Nursing students must be educated not only about

caffeine’s temporary benefits but also about its long-term impact on memory, sleep, and

emotional regulation. Promoting balanced health practices is essential to building a competent

and reliable future healthcare workforce.

Diagram: Common Caffeinated Substances and Their Average Caffeine Content

 Caffeinated Substance Average Caffeine Content (mg per
serving)

Brewed Coffee (1 cup) 95

Energy Drink (250 ml) 80

Black Tea (1 cup) 47

Cola (1 can) 35

Dark Chocolate (100g) 43

Caffeine Tablet 100

Knowledge of Caffeine and Perception of Health Risks

In public health and behavioral science, knowledge refers to the accurate awareness and

understanding an individual has about a health-related subject such as risk factors, side effects,

safe limits, and prevention strategies. Perception, on the other hand, is an individual’s belief,

attitude, or interpretation of that subject. Both knowledge and perception directly influence
behavior, especially when it comes to substance use like caffeine. While knowledge is grounded

in facts, perception may be shaped by culture, personal experience, media, and peer influence.

Caffeine is often socially and culturally accepted as a harmless stimulant that boosts energy and

alertness. However, poor knowledge and distorted perceptions about caffeine can lead to health

risk behaviors, particularly among adolescents and young adults in academic environments. The

World Health Organization (WHO, 2023) highlights that low health literacy is one of the biggest

challenges to achieving effective preventive health behavior. When knowledge is poor or

incomplete, individuals may not recognize health risks until negative outcomes occur.

Globally, the misuse of caffeine among university students is often linked to misinformation and

inadequate health education. In a systematic review of caffeine use in Europe and North

America, Guest et al. (2021) reported that over 60% of students could not accurately estimate the

caffeine content in drinks such as energy beverages, black tea, or stimulant supplements.

Moreover, less than 40% knew that the recommended safe limit is 400 mg/day for healthy adults.

Many students believed caffeine increased intelligence and long-term memory, despite no

scientific basis for these claims.

According to Kharaba et al. (2022), 92.8% of UAE university students used caffeine products

regularly, but fewer than 30% read nutritional labels or monitored their intake. Peer behavior,

stress, and social media were major influences. The normalization of caffeine in media

advertisements often downplays its negative effects, reinforcing the misperception that caffeine

is both harmless and necessary for academic success.

In Sub-Saharan Africa, similar trends are evident. Many university students consume caffeine

without understanding its pharmacological properties or risks. Boakye and Ofori (2023) found

that only 15% of Ghanaian students were aware of the symptoms of caffeine overdose, despite

more than 68% consuming caffeine during exams. The perception that caffeine provides “mental

strength” was widespread but unfounded.

In South Africa, Mogotsi et al. (2024) surveyed part-time nursing students and found that while

most believed caffeine helped manage fatigue, over 70% experienced side effects such as

palpitations, sleeplessness, and anxiety yet did not associate these outcomes with caffeine use.

The gap between knowledge and perception was striking, showing that personal beliefs often

override clinical awareness, even among health-related students.

In Nigeria, there is growing concern about students’ limited understanding of caffeine’s health

risks. Eduviere et al. (2021) discovered that while 71.4% of Nigerian tertiary students consumed

caffeine during exams, only 32.5% were aware of the daily intake limit. Many reported side

effects like stomach cramps, insomnia, and nervousness but continued consumption due to the

belief that caffeine was necessary for academic endurance.

Sholeye et al. (2022) found that adolescents in Sagamu viewed energy drinks and caffeine

products as fashionable and helpful for staying active, with only a minority recognizing long-

term risks. Some even substituted meals or water with caffeinated beverages, exacerbating issues

like dehydration and malnutrition. This behavior was more influenced by peer pressure and

branding than any scientific understanding.

Onoh et al. (2024), in a study involving medical and nursing students, reported that excessive

caffeine intake often combining coffee, soft drinks, and energy beverages—was common during

high-stakes academic periods. Ironically, those who consumed the most caffeine also reported

high levels of anxiety and poor academic focus, demonstrating the counterproductive impact of

misuse.

Implications for Nursing Students

Nursing students are a critical focus group in caffeine-related behavioral research. As future

healthcare professionals, they are expected to possess and apply accurate health knowledge in

both personal and clinical settings. Yet, many nursing students are unaware of the potential for

caffeine dependency, withdrawal symptoms, and chronic side effects such as elevated blood

pressure and mood disturbances (Higbee et al., 2021). When this knowledge gap exists, it not

only affects their well-being but may also influence the quality of care and health education they

provide to patients.

According to Ighorodje et al. (2024), health literacy among nursing students must move beyond

textbook theory and address everyday health behaviors, including caffeine use. Students who

cannot identify the signs of caffeine overuse such as irritability, insomnia, or gastrointestinal

distress—are unlikely to adopt safe consumption habits or guide others effectively. Worse, when

these behaviors are normalized in academic or clinical environments, it creates a culture of silent

harm.
Conclusion

Improving knowledge and reshaping perception are essential for reducing the negative impact of

caffeine use among nursing students. Universities should integrate caffeine education into

student wellness initiatives and curricula. This includes promoting accurate label reading,

awareness of daily intake limits, and recognizing early symptoms of misuse. When students

understand the difference between beneficial and harmful use, they are empowered to make

better choices. Furthermore, informed students are more capable of modeling healthy behavior

and delivering accurate patient education in their future clinical practice.

Concept of Influence and Behavioral Motivation

Behavioral motivation refers to the internal drives and external pressures that shape individuals’

decisions to engage in specific behaviors. These can be influenced by psychological needs, social

pressures, perceived rewards, environmental factors, or institutional norms. In the context of

caffeine consumption, behavioral motivation explains why students choose to use caffeinated

substances despite known or potential health risks. Influence refers to the impact that peers,

media, culture, academic demands, or environmental cues have on individual behavior.

Among nursing students, the consumption of caffeine is not only shaped by personal choice but

also by academic stressors, emotional needs, peer behavior, and institutional culture. The Health

Belief Model (HBM) helps frame these behaviors by identifying components such as perceived

susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-

efficacy (Zhu et al., 2021). When students perceive caffeine as beneficial and safe, and do not
fully understand its risks or barriers to consumption, they are more likely to use it excessively,

especially in high-stress academic settings.

Academic Pressure and Task Demands

Academic pressure is one of the most significant motivators for caffeine use among nursing

students. The intense demands of nursing programs such as long lectures, clinical shifts, night

study sessions, and frequent assessments often exceed what students can comfortably manage.

As a result, many students turn to caffeine as a quick fix to extend study time, delay fatigue, and

stay alert.

Higbee et al. (2021) found that undergraduate nursing students in the United States frequently

used caffeine during periods of academic overload, often substituting proper rest and nutrition

with stimulants. Similarly, Ighorodje et al. (2024) reported that Nigerian nursing students facing

clinical posting deadlines and project submissions relied heavily on energy drinks and coffee,

seeing them as essential to “push through” academic challenges. Over time, this creates a cycle

where caffeine use is no longer occasional but routine and necessary for academic survival.

Peer Pressure and Social Modeling

Peer influence is another critical factor in the behavioral motivation for caffeine consumption.

Students are more likely to mimic the behaviors of close friends or roommates, especially when

those behaviors are perceived as acceptable or beneficial. Group study sessions, night shifts, or

hostel routines often include collective caffeine consumption, which reinforces the habit socially.
According to Onoh et al. (2024), peer modeling was a major contributor to caffeine use among

medical students in Nigeria. Students reported first using energy drinks because their friends

were doing so during exam periods. These social reinforcements create a behavioral norm,

making it difficult for individuals to critically assess their consumption patterns.

Media, Branding, and Cultural Promotion

The role of marketing, branding, and social media cannot be overstated. Caffeine-containing

products especially energy drinks are often advertised as tools for enhanced focus, strength, and

academic endurance. These messages glamorize caffeine use while downplaying health risks,

particularly for young audiences. Slogans such as “ignite your energy” or “power through your

day” directly appeal to exhausted students.

Kharaba et al. (2022) found that students exposed to high volumes of digital marketing were

more likely to believe that energy drinks were harmless. In Nigeria, Sholeye et al. (2022)

reported that many students chose energy drinks based on online promotions and branding, rather

than nutritional information or awareness of caffeine content. Cultural norms also play a role: in

many academic circles, caffeine use is so normalized that it’s rarely questioned or discouraged.

Emotional Coping and Stress Response

Many students use caffeine not just for alertness, but to cope with psychological and emotional

stress. Academic anxiety, performance pressure, personal struggles, and burnout often push

students toward stimulants as a form of relief. This behavior reflects a form of self-medication—
where caffeine acts as a quick-acting solution to manage fatigue, low mood, or insecurity about

academic readiness.

Boakye and Ofori (2023) noted that university students in Ghana frequently increased caffeine

consumption when feeling mentally unprepared or anxious before exams. Mogotsi et al. (2024)

found similar patterns among South African part-time nursing students, who used caffeine to

handle emotional and cognitive exhaustion from balancing work, school, and home

responsibilities. However, prolonged reliance on caffeine for emotional regulation can worsen

underlying issues such as anxiety, poor sleep, and emotional instability.

Environmental Accessibility and Institutional Norms

The environment in which students live and study also plays a role. In many institutions, caffeine

products are readily available in vending machines, kiosks, or cafes. Cafeterias often promote

coffee and soft drinks, while energy drinks are widely sold on and off campus. In some cases,

even clinical settings provide caffeine-based refreshments during long shifts or academic

meetings.

In Nigeria, Eduviere et al. (2021) observed that most tertiary institutions lack structured

guidelines on stimulant use, leaving students to self-regulate their consumption. Moreover, there

is little integration of caffeine education into student orientation or wellness programs. This

absence of institutional checks reinforces the perception that caffeine use is both acceptable and

necessary in the academic environment.

Conclusion
Caffeine consumption among nursing students is influenced by a combination of internal

motivators like fatigue, stress, and academic ambition—and external influences—such as peer

behavior, media messaging, and institutional culture. These motivators are often stronger than

risk awareness, especially when health education is lacking. Understanding these behavioral

drivers is crucial for designing targeted interventions.

Educational institutions must respond by integrating mental health support, time-management

training, and accurate health communication into their academic support systems. Only by

addressing both the "why" and the "how" of caffeine use can universities create a culture where

informed, balanced behaviors are encouraged allowing nursing students to thrive academically

without compromising their well being.

Concept of Physiological Effects of Caffeine

Caffeine (1,3,7-trimethylxanthine) is one of the most widely consumed central nervous system

stimulants worldwide. Found naturally in coffee, tea, kola nuts, and cocoa, and synthetically

added to energy drinks, sodas, and medications, it acts as a powerful psychoactive compound.

Caffeine is rapidly absorbed through the gastrointestinal tract, reaching peak blood levels in

under two hours, and is primarily metabolized in the liver by the cytochrome P450 enzyme

CYP1A2. Its systemic effects are mediated through active metabolites paraxanthine,

theobromine, and theophylline each of which exerts distinct physiological influences on various

organ systems (Zhu et al., 2021). Its pharmacological actions primarily result from antagonism of

adenosine receptors, leading to increased neuronal firing and subsequent release of

neurotransmitters such as dopamine, norepinephrine, and serotonin. While moderate caffeine

intake (up to 400 mg/day for healthy adults) is generally considered safe (FDA, 2020), excessive

or chronic consumption may have far-reaching physiological effects across multiple body

systems. Nursing students, who often depend on caffeine to maintain academic and clinical

performance, are particularly vulnerable to both its beneficial and adverse consequences. A

detailed understanding of caffeine's physiological impact is crucial to inform safer consumption

habits.

Central Nervous System (CNS)

Caffeine rapidly crosses the blood-brain barrier and acts as a non-selective antagonist of

adenosine A1 and A2A receptors. Adenosine typically exerts a sedative effect by promoting

sleep and suppressing arousal. Inhibition of this neuromodulator results in increased release of

excitatory neurotransmitters especially dopamine and norepinephrine thereby enhancing

alertness, mood, learning capacity, and reaction time (Zhu et al., 2021).

However, high doses (>400 mg/day) can lead to overstimulation of the CNS, causing symptoms

such as insomnia, agitation, irritability, and in some cases, caffeine-induced anxiety disorder

(Guest et al., 2021). Prolonged use fosters tolerance, necessitating increased doses to achieve the

same stimulatory effects and increasing the likelihood of dependence. Withdrawal symptoms—

commonly including headaches, fatigue, irritability, and cognitive impairment—can emerge

within 12–24 hours and may persist for up to a week (Higbee et al., 2021).
Furthermore, genetic polymorphisms in CYP1A2 and ADORA2A genes modulate caffeine

metabolism and CNS sensitivity. Slow metabolizers are at greater risk for adverse CNS effects

even at moderate intake levels (Cornelis, 2020).

Cardiovascular System

Caffeine stimulates the adrenal medulla to release epinephrine and norepinephrine, enhancing

cardiac contractility and increasing heart rate (tachycardia) and blood pressure. These effects are

typically transient in healthy individuals but may provoke arrhythmias and palpitations in those

with underlying cardiovascular conditions (Ighorodje et al., 2024).

Energy drinks often compound this effect by including additional stimulants like taurine and

guarana. Kharaba et al. (2022) noted elevated incidence of chest pain and irregular heart rhythms

in students consuming multiple energy drinks in short intervals, particularly under academic

stress.

Estrogen, particularly from oral contraceptives, can slow caffeine metabolism in females,

prolonging cardiovascular stimulation (Boakye & Ofori, 2023).

Endocrine and Hormonal System

Caffeine activates the hypothalamic-pituitary-adrenal (HPA) axis, promoting the release of

cortisol a glucocorticoid involved in stress regulation. Chronic elevation of cortisol disrupts

glucose metabolism, impairs immune function, increases visceral fat deposition, and contributes

to mood instability (Boakye & Ofori, 2023).

Late-day caffeine consumption suppresses melatonin secretion, disrupting circadian rhythms and

delaying sleep onset. Guest et al. (2021) observed poorer sleep quality among students

consuming caffeine after 4 PM, which in turn exacerbates stress and cognitive fatigue.

Reproductive System

Caffeine affects reproductive health, particularly in females. It has been associated with

increased risk of menstrual irregularities and reduced fertility in high doses (>300 mg/day).

Caffeine crosses the placenta, and during pregnancy, its metabolism is significantly slowed,

increasing fetal exposure (Boakye & Ofori, 2023). Excessive prenatal caffeine intake has been

linked to low birth weight, preterm birth, and miscarriage.

In males, some studies suggest that high caffeine intake may reduce sperm count and motility,

although findings remain inconclusive.

Psychological and Behavioral Effects

While caffeine is known to improve vigilance, excessive intake can exacerbate anxiety,

irritability, and emotional instability. Ighorodje et al. (2024) reported higher prevalence of

anxiety, nervousness, and reduced sleep quality among students consuming more than two

caffeinated beverages daily.

A behavioral dependence may develop, wherein students believe that cognitive efficiency is

impossible without caffeine, promoting habitual overuse. This creates a cycle of fatigue, poor

coping strategies, and emotional burnout.

Respiratory System
Caffeine exerts mild bronchodilatory effects by increasing intracellular cyclic AMP (cAMP)

through phosphodiesterase inhibition. This may offer temporary relief for individuals with mild

asthma or bronchospastic conditions (Nehlig, 2020). However, excessive use may cause

tachypnea (increased respiratory rate), particularly during anxiety episodes induced by

overstimulation.

Digestive System

Caffeine stimulates gastric acid secretion and intestinal peristalsis. While beneficial in promoting

digestion, high doses—especially on an empty stomach—may result in gastritis, acid reflux, or

peptic ulcers (Eduviere et al., 2021).

It also accelerates gastrointestinal transit time, potentially leading to diarrhea in sensitive

individuals or when combined with stress or poor diet. Caffeine-induced nausea is common

when consumed in large volumes or in combination with carbonated beverages.

Renal and Diuretic Effects

As a mild diuretic, caffeine increases glomerular filtration and inhibits sodium reabsorption in

the renal tubules, enhancing urine output. This promotes fluid and electrolyte loss, potentially

leading to dehydration and muscle cramps (Sholeye et al., 2022).

Among nursing students who often replace water with energy drinks, the risk of dehydration and

fatigue becomes pronounced, especially during long clinical shifts.

Neuromuscular and Skeletal System

Caffeine enhances neuromuscular transmission by facilitating acetylcholine release at the

neuromuscular junction. While this may improve motor performance, excessive doses may lead

to muscle twitching, tremors, and reduced fine motor control—an issue during tasks like

intravenous insertions (Higbee et al., 2021).

Caffeine also promotes calcium excretion in urine, reducing bone mineral density over time.

Female nursing students are at elevated risk due to hormonal fluctuations and inadequate dietary

calcium, predisposing them to osteopenia or osteoporosis.

Hepatic (Liver) Effects

Caffeine is metabolized in the liver via the cytochrome P450 1A2 (CYP1A2) enzyme pathway.

Liver function and genetic variants in this enzyme influence caffeine clearance. Hepatic

impairment may delay metabolism, increasing susceptibility to toxicity even at standard doses

(Cornelis, 2020).

Immune System

Chronic caffeine intake may suppress immune function indirectly through cortisol elevation.

Prolonged cortisol release inhibits lymphocyte proliferation, reduces cytokine production, and

impairs wound healing. Students with high caffeine consumption during stress may experience

more frequent infections and slower recovery (Boakye & Ofori, 2023).
Genetic and Pharmacological Considerations

Genetic polymorphisms in CYP1A2 (affecting metabolism) and ADORA2A (affecting receptor

sensitivity) significantly influence individual caffeine tolerance and response. Students on

medications such as ciprofloxacin, antipsychotics, or oral contraceptives may have impaired

caffeine metabolism, increasing risks of overstimulation and drug interactions (Cornelis, 2020).

Circadian Rhythm Disruption

Late-night caffeine use desynchronizes the circadian clock, leading to delayed sleep phase

disorder or Shift Work Disorder—particularly problematic for nursing students with night shifts.

Chennaoui et al. (2021) observed that inappropriate caffeine timing reduces melatonin

production and impairs overall sleep architecture.

Academic and Clinical Performance Implications

While caffeine improves short-term alertness, over-reliance may impair higher-order cognitive

functions such as decision-making, memory consolidation, and flexibility under fatigue. Nehlig

(2020) warned that habitual overuse may result in cognitive rigidity and poor adaptability—

critical skills in high-stakes clinical scenarios.

Conclusion

Caffeine affects nearly every major physiological system. While moderate consumption can offer

cognitive and physical benefits, excessive or habitual use leads to disruptions in neurochemical

balance, cardiovascular strain, metabolic instability, and psychological dependence. For nursing

students, the stakes are higher due to their intense academic and clinical demands. Hence,
caffeine use must be guided by awareness of individual tolerance, proper hydration, diet, and

sleep hygiene. Tailored education on safe caffeine practices should be integrated into nursing

curricula to promote long-term health and academic sustainability.

Summary of Conceptual Review

This chapter explored the fundamental concepts related to the study on the influence of

caffeinated substance consumption among nursing students. The conceptual review began by

examining caffeine as a widely used psychoactive stimulant, detailing its natural and synthetic

sources, pharmacodynamics, and common consumption patterns. It was observed that nursing

students, due to academic pressure and irregular routines, often rely heavily on caffeine to boost

mental alertness, manage fatigue, and extend study hours.

The concept of caffeinated substance intake was further clarified to include a variety of

beverages and products, such as coffee, tea, energy drinks, soft drinks, and caffeine tablets, all of

which vary in potency and accessibility. The review highlighted how excessive consumption—

especially during high-stress academic periods—could lead to physical and psychological health

concerns.

Additionally, the link between caffeine and academic performance was explored. While some

studies show that moderate caffeine intake can temporarily enhance concentration and memory,

chronic use may impair cognitive function, disrupt sleep, and lead to academic fatigue. The

concepts of health and well-being were emphasized using the World Health Organization's
definition, underlining the role of physical, mental, and social health in supporting effective

academic performance.

Key concepts such as knowledge, perception, behavioral influence, and physiological outcomes

were also examined. These concepts are directly tied to the research objectives, which aim to

assess the level of knowledge about caffeine use, identify the motivating factors behind its

consumption, and determine its overall influence on the well-being and academic behavior of

nursing students.

Finally, the review of the physiological effects of caffeine revealed that it impacts multiple body

systems, including the central nervous, cardiovascular, gastrointestinal, renal, endocrine,

musculoskeletal, and immune systems. These effects are mediated through various biochemical

pathways, such as adenosine receptor antagonism, increased catecholamine release, and

hormonal disruption. For nursing students, these physiological responses can interfere with sleep,

cognitive performance, clinical precision, and overall health resilience.

In summary, this chapter laid a solid theoretical foundation for understanding the multifaceted

nature of caffeine consumption among nursing students. It underscores the need for empirical

investigation into how knowledge, perception, and behavior around caffeinated substance intake

affect students' health and academic performance. These insights justify the relevance of the

present study and inform the methodological approaches that will be discussed in the next

chapter.

2.2Theoretical Review

Health Belief Model (HBM)

This study is anchored on the Health Belief Model (HBM), a theory developed in the 1950s by

social psychologists Irwin M. Rosenstock, Godfrey Hochbaum, and Stephen Kegels, working

under the U.S. Public Health Service. The model emerged from an effort to understand why

people failed to adopt preventive health measures, such as disease screenings and vaccinations,

even when services were free and available. Since then, the HBM has evolved into one of the

most robust and widely used frameworks for studying health behaviors, particularly those

influenced by risk perception, motivation, and belief systems.

At its core, the HBM suggests that a person’s decision to engage in health-related behavior is

influenced more by individual perceptions than by objective reality. These perceptions include

how vulnerable a person feels to a health issue, how severe they think the consequences are,

what benefits they see in a preventive action, and what barriers they perceive in taking such

action. The model also accounts for the triggers (cues to action) that prompt a person to act and

the confidence (self-efficacy) that they can succeed in making the change.

DIAGRAMATIC ILLUSTRATION OF HEALTH BELIEF MODEL

Core Constructs of the HBM and Their Definitions

The Health Belief Model consists of six key components that determine whether a person

engages in or avoids a health-related behavior:

Perceived Susceptibility
The belief about how likely one is to experience a health problem.

Perceived Severity

The belief about how serious the health issue and its consequences are.

Perceived Benefits

The belief in the effectiveness of the advised action to reduce risk or severity.

Perceived Barriers

The perceived costs, difficulties, or obstacles to adopting the health behavior.

Cues to Action

Factors that trigger the decision-making process to accept a recommended health action.

Self-Efficacy

Confidence in one’s ability to take action and successfully execute the behavior change.

These constructs interact to influence decision-making. If a person perceives high susceptibility

and severity, sees strong benefits, and feels capable of action with minimal barriers, they are

more likely to adopt the health behavior.

Relevance of the HBM to This Study

The Health Belief Model provides an excellent framework for understanding the consumption

behavior of caffeinated substances among nursing students. Despite their background in health

sciences, many students persist in consuming large quantities of caffeine—especially during

examinations, clinical rotations, or periods of poor sleep. This suggests that knowledge alone is

not enough; beliefs, perceptions, and motivations also play a key role.

Perceived Susceptibility

Nursing students may not believe they are personally at risk of the negative effects of excessive

caffeine intake, such as insomnia, anxiety, gastrointestinal issues, or cardiovascular strain. The

low perceived vulnerability leads to complacency and continued consumption.

Perceived Severity

Even when they are aware of potential side effects, students may underestimate their seriousness.

For example, they may regard sleep loss as a temporary issue rather than a health threat that

affects academic performance, immune function, or mental health.

Perceived Benefits

Caffeine is widely perceived as helpful for enhancing alertness, extending study time, and

improving academic performance. These perceived benefits often outweigh the awareness of

risks, reinforcing habitual use, especially during stressful academic periods.

Perceived Barriers
Barriers to reducing caffeine use may include peer pressure, easy availability of caffeinated

products, lack of knowledge about safe alternatives, or deeply ingrained habits. Students may

feel that without caffeine, they cannot meet academic expectations.

Cues to Action

Triggers that might prompt behavior change include experiencing negative symptoms (e.g.,

tremors, headaches, palpitations), health education interventions, or feedback from peers and

lecturers. Academic fatigue or a medical consultation may also act as a cue to reconsider caffeine

use.

Self-Efficacy

Students with high self-efficacy who believe they can manage academic stress without relying on

caffeine are more likely to adopt healthier study habits, improve their sleep hygiene, and seek

sustainable energy sources like hydration, nutrition, or exercise.

Application in the Context of Caffeinated Substance Use

In the context of this study, the Health Belief Model allows for an in-depth exploration of why

nursing students consume caffeinated substances, what beliefs drive that behavior, and what

internal or external factors may encourage them to change. The model provides a basis for

constructing research questions, survey items, and intervention strategies, helping to identify

areas where behavior change is most likely to be effective.

For example, if a significant number of students score low on perceived susceptibility but high

on perceived benefits, targeted educational campaigns could focus on increasing awareness of

long-term risks and offering safer alternatives. If perceived barriers are prominent, institutional

policies might be recommended to limit caffeine sales on campus or provide healthier

refreshments during study periods.

Justification for the Use of HBM in This Study

This model is particularly relevant for several reasons:

It is behavior-centered, not just knowledge-centered, aligning with the study’s interest in actions

and habits.
It emphasizes individual belief systems, which influence caffeine consumption even among

health science students.

It accounts for modifiable variables, making it useful for designing future interventions.

It is appropriate for preventive behavior studies, such as reducing substance use before it leads to

serious health consequences.

Nursing students are in a unique position—they are both the subjects of health behavior and the

future educators of health behavior. Thus, understanding their beliefs about caffeine use provides

insight not only into their personal health practices but also into the quality of future healthcare

delivery they will participate in.

Conclusion

The Health Belief Model offers a powerful lens through which to analyze the factors influencing

caffeine consumption among nursing students. It provides a structure to evaluate their

perceptions, beliefs, motivators, and barriers—thus explaining not only what behaviors occur,

but why they occur. Using this model, this study seeks to understand how caffeine use is shaped

by perceived risks and benefits, and how knowledge, self-efficacy, and external triggers

influence consumption patterns. Ultimately, this theoretical foundation supports evidence-based

recommendations for education, policy, and lifestyle change among student populations.

Theory of Planned Behavior (TPB)

To broaden the explanatory strength of this research, the Theory of Planned Behavior (TPB),

developed by Icek Ajzen in 1985, is adopted as a complementary framework. This theory

extends the Theory of Reasoned Action (TRA), which was originally introduced by Martin

Fishbein and Ajzen in 1975 to explain how attitudes influence behavior. While TRA posited that

human behavior is guided by intentions shaped by attitudes and subjective norms, it assumed that

all behaviors were under voluntary control.

Recognizing that many real-life actions are constrained by perceived or actual barriers, Ajzen

developed the TPB by introducing a third construct Perceived Behavioral Control (PBC) to

account for situations where individuals intend to act but fail to do so due to internal or external

constraints.

Since its development, TPB has become one of the most widely used models in behavioral

sciences, particularly in fields such as public health, education, environmental psychology, and

substance use research. It has been employed to explain behaviors ranging from smoking

cessation and dietary change to alcohol use and academic decision-making.

Core Components of the TPB

The TPB asserts that behavior is directly influenced by behavioral intention, which in turn is

influenced by three major components:

Attitude Toward the Behavior

This refers to the individual’s positive or negative evaluation of performing the behavior. For

example, if a student believes caffeine helps them stay alert and study effectively, they are more

likely to consume it.

Subjective Norms
This refers to perceived social pressure from peers, lecturers, or society to perform or avoid the

behavior. If caffeine consumption is common and accepted among classmates, students may feel

compelled to do the same.

Perceived Behavioral Control (PBC)

This refers to the individual’s belief in their capacity to perform the behavior. It reflects how

easy or difficult they perceive the behavior to be. For instance, students who feel they cannot

function academically without caffeine may perceive low control over reducing their intake.

Behavioral intention is the immediate precursor to action, while PBC may also influence

behavior directly, especially in cases where actual control is limited.

Application of TPB to This Study

The Theory of Planned Behavior is particularly applicable to this study on caffeinated substance

consumption among nursing students. It allows for an analysis not only of what students believe

about caffeine, but also of the social and control-related factors that influence their consumption

habits.

Attitude: Students may hold favorable beliefs about caffeine’s role in boosting academic

performance, which supports continued use.

Subjective Norms: If peer culture or academic expectations normalize caffeine use, students are

more likely to adopt similar behaviors, even when aware of the risks.
Perceived Behavioral Control: Nursing students often face intense academic schedules, night

shifts, and stress, which can reduce their perceived ability to control or stop caffeine use. Even if

they intend to reduce consumption, they may not feel capable.

The TPB provides a framework to explore these dynamics and design interventions that not only

increase awareness but also address motivation, social influence, and behavioral confidence.

Conclusion

The Theory of Planned Behavior complements the Health Belief Model by offering insight into

the social-cognitive drivers of caffeine consumption. While the HBM explains students’ health-

related perceptions, the TPB explores the psychological and social processes that influence

behavioral intention and action. Using both models provides a comprehensive framework for

understanding the knowledge, motivation, and behavioral patterns associated with excessive

caffeine use among nursing students.

Together, they help shape research tools, interpret findings, and design targeted interventions

that address both perceptions of health risk and intentional behavior change.
Author Yea Country Sample Key Findings

Eduviere et al. 2021 Nigeria 350 Students 68.5% consumed caffeine; 70% reported daytime

sleepiness

Higbee et al. 2021 USA 212 Students High intake linked to poor sleep and stress

Ighorodje et 2024 Nigeria 420 students High use during exams; insomnia and nervousness noted

al.

Kharaba et al. 2022 UAE 500 students 92.8% consumed caffeine; withdrawal symptoms

observed

Mogotsi et al. 2024 South 300 students 52% used caffeine for fatigue; poor sleep reported

Africa

Onoh et al. 2024 Nigeria 310 students Caffeine linked to emotional exhaustion

2.3 Empirical Review

Empirical Review

This section presents current empirical evidence relating to caffeine consumption among

students, particularly nursing students, with emphasis on knowledge levels, behavioral effects,

and the factors influencing usage. Findings are grouped based on major themes aligned with the

study’s objectives, drawing from global, regional (Sub-Saharan Africa), and Nigerian studies

conducted between 2020 and 2025.

Knowledge of Excessive Caffeine Consumption Among Nursing Students

Globally, multiple studies reveal a widespread lack of knowledge about caffeine’s health risks,

despite its high prevalence among university students. Guest et al. (2021) conducted a study

involving 1,200 undergraduate students in Canada, where 84% consumed caffeine daily.

However, only 37% correctly identified the safe daily intake of 400 mg, and fewer than 30%

could recognize symptoms of excessive use such as restlessness, rapid heartbeat, or insomnia.

The same study noted that a substantial number of students assumed caffeine enhanced

intelligence, despite no medical evidence to support that claim.

Similarly, a European cross-sectional survey by VanDusseldorp et al. (2021) found that even

among medical and nursing students, only 42% were aware of the potential health complications

associated with habitual caffeine use, including hypertension and gastrointestinal irritation.
Among first-year students, only 18% demonstrated adequate label-reading habits when

purchasing caffeinated products.

Regionally, in Sub-Saharan Africa, Boakye and Ofori (2023) studied 750 university students in

Ghana and found that while 68% were regular caffeine users, only 24% could identify common

side effects such as sleep disturbance, anxiety, and elevated heart rate. Furthermore, only 19%

were aware of cumulative caffeine intake from different sources coffee, tea, soda, and energy

drinks often combining multiple products daily.

In Nigeria, Eduviere et al. (2021) found that out of 350 students at a private tertiary institution,

68.5% consumed caffeine at least three times per week, yet only 26.4% had correct knowledge

about the associated health risks. Most students relied on brand advertising, word-of-mouth, or

peer recommendations instead of scientific sources. Likewise, Sholeye et al. (2022) noted that

among adolescents in Sagamu, 71.2% believed that caffeine-based beverages had no long-term

effect on health, a belief influenced heavily by marketing and peer culture.

Beyond mere awareness, several studies emphasize the quality and source of knowledge students

possess. Many rely on informal sources like social media, product advertising, and peer advice.

Guest et al. (2021) noted that fewer than 15% of students in their Canadian sample reported

learning about caffeine from medical or academic sources. This misinformed awareness

contributes to normalization of overuse. In Ghana, Boakye and Ofori (2023) found that over 50%

of students confused caffeine with other stimulants or narcotics, indicating a conceptual

misunderstanding of caffeine's pharmacology. Students also underestimated the caffeine content

in "non-obvious" products like iced tea, chocolate, or headache medications.

These findings reveal a pervasive lack of caffeine health literacy among students, suggesting the

need for curriculum-based intervention and better labeling standards to reduce risk exposure.

Effects of Excessive Caffeine Use on Academic Behavior and Student Health

Empirical research consistently shows that while caffeine is often consumed with the intention of

boosting academic focus and physical endurance, excessive or prolonged use is associated with

significant health and academic drawbacks.

Higbee et al. (2021) surveyed 212 undergraduate nursing students in the U.S. and reported that

those who consumed two or more caffeinated beverages per day scored significantly higher on

stress and fatigue indices. Sleep quality, as assessed using the Pittsburgh Sleep Quality Index

(PSQI), declined by 29% among high users. More than 40% experienced frequent insomnia,

which reduced their memory retention and academic motivation.

Mogotsi et al. (2024) in South Africa found that 52% of part-time nursing students used caffeine

as a tool to manage fatigue during exam seasons and clinical postings. While 68% believed

caffeine enhanced their attention span, 48% suffered from adverse effects including mood

swings, acid reflux, and headaches. These symptoms affected their ability to complete

coursework and participate effectively in clinical activities.

In Nigeria, Onoh et al. (2024) surveyed 310 students from medical faculties and found that

although 75% reported increased caffeine use during examination periods, 63% later experienced
physical or emotional side effects. Reported symptoms included poor sleep, trembling hands

during clinical tasks, difficulty concentrating, and general exhaustion. Notably, 42% admitted

that their performance in exams or practical sessions worsened after consecutive days of caffeine

use.

Similarly, Ighorodje et al. (2024) observed that students who consumed more than three

caffeinated products per day including coffee, kola-based soft drinks, and energy drinks showed

a 12% lower average GPA compared to moderate users. These students also had higher rates of

clinical absenteeism and missed assessments due to health-related complications.

Multiple studies now link chronic caffeine intake not only to academic fatigue, but also to long-

term physiological changes. Higbee et al. (2021) noted that over 30% of students with consistent

high caffeine intake had altered sleep wake cycles and increased baseline anxiety levels, even

outside exam periods. This adaptation to chronic stress and stimulation is associated with

dependency patterns. Further, excessive caffeine intake has been found to impair clinical

performance. Nursing students in Mogotsi et al. (2024) reported hand tremors and poor short-

term memory retention during patient assessments or skills demonstrations suggesting that

overconsumption may affect precision-based learning.

These findings confirm that caffeine’s short-term benefits may lead to long-term performance

declines, particularly when unregulated.

Factors Influencing Excessive Caffeine Intake Among Nursing Students

Excessive caffeine use among students is influenced by a complex interplay of behavioral,

psychological, environmental, and cultural factors.

Kharaba et al. (2022) conducted a survey of 500 university students in the United Arab Emirates

and found that 78% consumed caffeine to enhance alertness, 56% to cope with stress, and 39%

because of peer influence. More than 60% admitted to taking caffeine late at night before tests or

clinical simulations. However, only 22% actively monitored their intake or read ingredient

labels. Many consumed caffeine from multiple sources coffee in the morning, energy drinks in

the evening, and soda with meals without realizing they were exceeding safe limits.

Regionally, Boakye and Ofori (2023) found that easy availability of energy drinks and the lack

of institutional regulations contributed significantly to overconsumption among Ghanaian

university students. Psychological dependency was noted in 41% of students, with many

expressing concern about reduced energy or “brain fog” if they skipped caffeine.

In Nigeria, Ighorodje et al. (2024) reported that academic pressure, particularly during mid-

semester and final examinations, was the top driver of excessive caffeine use among 420 nursing

and health sciences students. Other major factors included inadequate sleep due to clinical

rotations (76%), peer culture (62%), and misinformation about the safety of energy drinks (53%).

Sholeye et al. (2022) further emphasized that among adolescents in Sagamu, caffeine was

commonly used as a meal substitute, especially in the mornings. Branding and pricing also

played key roles; many students opted for the most affordable yet highly caffeinated drinks

available at roadside shops and campus kiosks.

Environmental design and institutional culture also play roles in shaping caffeine behaviors. On

many campuses, cafeterias, vending machines, and nearby shops promote energy drinks, coffee,

and soda more than water or healthy alternatives, as observed by Kharaba et al. (2022). Their

accessibility reinforces habitual use. Psychologically, caffeine use is linked to performance

anxiety and perfectionism. Boakye and Ofori (2023) observed that students with higher anxiety

scores were significantly more likely to consume caffeine excessively. Among Nigerian students,

Ighorodje et al. (2024) reported that "fear of failure" and the belief that caffeine is essential to

survive in nursing school were prominent motivators for use.

These nuances highlight that caffeine use is not only an academic coping tool but a socially and

culturally embedded behavior requiring multidimensional intervention.

Summary of Empirical Findings

The reviewed empirical studies provide strong evidence that caffeine use among students is both

high in prevalence and often based on misconceptions or environmental pressures. Globally,

students display low levels of knowledge about caffeine’s long-term health effects, despite

consuming it regularly. Regionally and locally, the problem is compounded by limited public

health education, normalization of use in academic culture, and social reinforcement.

While caffeine is perceived as an academic aid, overuse often leads to negative outcomes

including sleep disruption, fatigue, anxiety, and impaired academic performance. These findings

underscore the importance of this study in providing data-driven recommendations and

informing health education policies at institutional and national levels.