Abstract
BACKGROUND: Alcohol mixed with energy drinks (AmED) has emerged as a public health concern, particularly among young adults. Evidence shows that combining energy drinks (EDs) with alcohol can mask ethanol's sedative effects, promoting higher intake and risky behaviors. METHODS: A cross-sectional online survey was conducted among university students in the Mazovia region of Poland (July 2025). An anonymous questionnaire assessed sociodemographic characteristics, EDs consumption, AmED use, co-use of psychoactive substances, consumption contexts, and adverse effects. Associations were analyzed using chi-square tests and logistic regression. RESULTS: A total of 871 students (mean age = 22.1 ± 3.05 years; 73.2% women) participated. One in four (25.5%) reported at least occasional AmED use. Logistic regression showed that a later age of first energy drink consumption was associated with a higher likelihood of AmED (OR = 1.34; 95% CI: 1.14-1.56; p<0.001). Gender was the only significant sociodemographic predictor. Men were more likely to report co-consumption (OR = 1.37; 95% CI: 1.00-1.86; p < 0.05). Over half did not mix energy drinks with other substances; when they did, nicotine (e-cigarettes) and caffeine (coffee) were the most common. The main AmED social contexts were parties and studying, differing by gender. About one-third (36.7%) of AmED users experienced reported unspecified self-reported adverse effects. CONCLUSIONS: AmED consumption is common among university students from the Mazovia region of Poland and appears to be associated with contextual factors, while age of ED initiation showed an ordinal association with the likelihood of AmED use. These findings may inform prevention strategies addressing social drinking contexts and promoting responsible attitudes toward stimulant-alcohol co-use among young adults.