ers went through earlier studies and reports on both energy drinks and sports drinks, which don't contain any stimulants. They note that energy drinks contain a jumble of ingredients -- including vitamins and herbal extracts -- with possible side effects that aren't always well understood. While there aren't many documented cases of harm directly linked to the beverages, stimulants can disturb the heart's rhythm and may lead to seizures in very rare cases, Benjamin said. Recently, she saw a 15-year-old boy with attention deficit hyperactivity disorder who came into the hospital with a seizure after having drunk two 24-ounce bottles of Mountain Dew, a soft drink that contains caffeine. The boy was already taking stimulant ADHD medication, and the extra caffeine in principle might have pushed him over the edge, according to Benjamin. "You just never know," she said. "It's definitely a concern." Earlier this year, Pediatrics published another review of the literature on energy drinks. In it, Florida pediatricians described cases of seizures, delusions, heart problems and kidney or liver damage in people who had drunk one or more non-alcoholic energy drinks -- including brands like Red Bull, Spike Shooter and Redline. While they acknowledged that such cases are very rare, and can't be conclusively linked to the drinks, they urged caution, especially in kids with medical conditions (see Reuters story of February 14, 2011). U.S. sales of non-alcoholic energy drinks are expected to hit $9 billion this year, with children and young adults accounting for half the market. Manufacturers claim their products will enhance bothoyees, making it easier to predict, project and estimate savings, which tend to accumulate in later years. As of last July, at least 16 states had created wellness incentive programs for their public employees, according to the NCSL. The list includes Alabama, Arkansas, Delaware, Kansas, Minnesota, Mississippi, Missouri, Montana, New Hampshire, North Dakota, Ohio, Oklahoma, South Dakota, Virginia, Washington and West Virginia. Most offer positive reinforcement as a way to encourage healthy lifestyles. In Arkansas, public employees who complete a health risk assessment, which gauges smoking, alcohol consumption, seatbelt usage, body mass index and weekly physical activity, receive a $10 monthly discount on their health insurance premium. Those found to be low-risk receive an additional $10 discount. Alabama, however, in 2008 gave its 37,527 employees a year to start getting fit. If they don't, they have to pay $25 a month for insurance that is otherwise free. Robert Krzys, an attorney and health care expert for a coalition of Connecticut state employee unions, said the proposed Health Enhancement Program was a concept first suggested by the unions. Krzys, who sits on a health care cost-containment committee, said it's a way to make the state employee population healthier while holding the line on health care spending. Connecticut now spends about $1.3 billion a year on health care for 250,000 active and retired workers and their dependents. Recent figures show that 12 percent of state employees use an existing program that provides workers with disease counseling, such as education about controlling their diabetes. "It doesn't really do us any good if they're not using it," Krzys said. When he pitches the Health Enhancement Program to union members, he mentions that a 57-year-old worker didn't feel well last year, was told to get a colonoscopy and discovered he had stage four-cancer. The man's treatment cost the state $1.3 million and he died shortly afterward. Under this plan, he would have gotten his first colonoscopy at age 50. The plan is voluntary. Those state workers and retirees who decide to participate, including their dependents, must agree to have physicals — annually for those 50 years and older — age-related screenings such as mammograms and cholesterol tests, and cervical and colorectal cancer screenings. The two insurance companies that administer the state's insurance program will inform the state Comptroller if employees are getting their proper screenings and filling their prescriptions. If they're deemed to be noncompliant, they are dropped from the program and allowed to participate in the regular insurance program for state employees, but will pay $100 more a month and a $350 annual deductible, Krzys said. Some state employees already see the initiative as big brother watching to see if people quit smoking or a way to eventually ration their health care. Others have posted concerns on union message boards suggesting there's a political motive behind the plan, which is being promoted by union leaders who support universal health care. Godfrey Fergus