OBJECTIVES: Adolescents are increasingly consuming energy drinks (EDs), prompting worries about their potential mental health impacts. The association between ED use and psychological effects among Palestinian teenagers, particularly the impact of smoking habits such as waterpipes, electronic cigarettes, and cigarettes, is little studied. This study explores the correlation between ED consumption and mental health outcomes such as depression, insomnia, and stress among adolescents in Palestine. METHODS: A cross-sectional study was conducted from February to June 2024, involving adolescents aged 12-18 recruited from schools in the West Bank. Data collection utilized a structured questionnaire assessing ED consumption, smoking habits, depression (PHQ-9), insomnia (ISI), and stress (Adolescent Stress Scale). Data were analyzed using SPSS version 29. RESULTS: The research involved 1,668 adolescents, with a mean age of 15.67 years (±1.57 years). ED consumption was prevalent at 74.7 % (95 % CI: 76.5-72.7). Males and smokers, especially those using traditional cigarettes and waterpipes, exhibited a higher likelihood of consuming energy drinks (aPR: 2.18
95 %CI: 1.64-2.91), (aPR: 2.99
95 %CI: 1.49-5.59), and (aPR: 2.54
95 %CI: 1.23-5.19). Depression exhibited a significant relationship with ED consumption (aPR: 2.25
95%CI: 1.51-3.37). A dose-response relationship was identified between insomnia and ED consumption, with an adjusted prevalence ratio (aPR) of 2.42 (95 % CI: 1.56-3.47) for moderate severity and 2.95 (95 % CI: 1.28-6.75) for severe insomnia. CONCLUSIONS: ED consumption is associated with poorer mental health outcomes, particularly among smokers. Interventions targeting both ED use and smoking behaviors are crucial to improving mental health in Palestinian adolescents. The study was conducted during the Gaza war, a period marked by heightened stress levels among participants due to increased security checks and economic hardships. These challenges may have influenced participants' stress levels and impacted their purchasing behaviors for EDs and tobacco shisha products. Further research is needed to explore the long-term effects of these behaviors.