(Written in consultation with Amy E. Anderson, Dominic Cavenagh, Peta Forder, Deborah Loxton and Julie Byles)
‘First you get a swimming pool of liquor, then you dive into it.’ – Swimming Pools (Drank) by Kendrick Lamar (2012)
What do Drake, Pink and Luke Bryan have in common? These artists have the most songs with at least one reference to alcohol in the Billboard Hot 100 music charts. In fact, from 2007 to 2016, an average of 22.4 per cent of songs from Billboard’s Hot 100 year-end charts included one or more mentions of alcohol.
Pop culture plays a significant role in our lives and there’s a growing level of research to show how references to alcohol in pop music is increasingly influencing its use.
Researchers found ‘the average adolescent is exposed to approximately 84 references to explicit substance use daily in popular songs’, and replacing love songs, alcohol, including excessive drinking, is now an increasingly common theme for songwriters searching for that elusive hit.
Australian country singer, Morgan Evans, went to number one in 2019 with his so-called party anthem, ‘Day Drunk’ (‘I’m thinking happy hour on the hour, Get a good buzz on an hour, Dancing tipsy, sing it with me baby, And get a little day drunk’).
Young women, are increasingly under the influence of artists such as Rhianna, Beyonce and Pink. Each of these modern-day superstars have five global hits with strong references to alcohol and drinking.
The consequences of excessive drinking, of course, can be catastrophic.
Amy Winehouse’s 2006 smash hit ‘Rehab’ tragically preceded her death from alcohol poisoning by five years. Amy was just 27 when her body was found in her bedroom with empty vodka bottles (‘they tried to make me go to rehab, but I said ‘no, no’).
COVID-19 certainly hasn’t dampened efforts to market alcohol during the pandemic. A report in May showed that in one hour on a Friday night, 107 sponsored alcohol advertisements were displayed on a personal Facebook and Instagram account, which equates to approximately one alcohol advertisement every 35 seconds. The ads promoted buying and drinking more alcohol to cope and ‘survive’ isolation, with messages like ‘wine from home’ and ‘Stay in. Drink up’.
Increasingly, young women have become a higher risk group due to a combination of factors. A new study just released in the Australian and New Zealand Journal of Public Health aims to fill the gap from previous research, and in particular the alcohol related harm that may increase from ‘pre-loading’ and heavy episodic drinking (HED) amongst young Australian women.
International alcohol guidelines provide recommendations on levels of consumption that would minimise related harm. In some countries, such as Australia and the UK, alcohol guidelines include the risk of harm from heavy drinking. For example, the Australian National Health and Medical Research Council (NHMRC) alcohol guidelines recommend that to reduce the risk of harm on a single occasion that men and women should drink no more than four standard drinks of alcohol.
There is a higher reported prevalence of heavy episodic drinking among men, but this rate has reduced over recent years, whereas it has remained stable for Australian women according to the 2017-18 National Health Survey.
In addition to the public health concern over harm associated with heavy episodic drinking, a growing body of research has also been examining the prevalence of pre-loading associated with alcohol-related harm.
Pre-loading, also referred to as ‘front-loading’ or ‘pre-partying’, describes a pattern of drinking where the individual typically consumes alcohol off-premise before going out to a licensed venue or event. Pre-loading is a common drinking behaviour among Australians, often due to the lower costs of drinking at home compared to buying alcohol at venues.
Pre-loading with alcohol has been found to increase the risk of intoxication, violence and sexual assault, as well as non-violent alcohol-related injuries and blackouts. Some evidence suggests that being female increases the risk of particular adverse outcomes from pre-loading such as emergency department visits and memory loss.
The additional burden of pre-loading
Although previous research has found that pre-loading is associated with drinking in excess, little has been done to assess the additional burden that pre-loading may place on those already at risk of harm from their heavy episodic drinking behaviour, particularly for young women.
This study therefore went one step further, aiming to identify how common the behaviours of heavy episodic drinking and pre-loading are among young Australian women, and the connections of these behaviours with alcohol related harms such as memory loss, vomiting and injury. In particular it set out to determine whether pre-loading leads to a higher risk of such harms amongst young women already at risk from heavy episodic drinking.
The results were collected as part of the Australian Longitudinal Study on Women’s Health. Surveys of 7,800 young Australian women aged 20-25 gathered information about their alcohol intake and adverse alcohol-induced events, and they painted a startling picture.
Around two-thirds of participants reported alcohol pre-loading, while 83.4% reported heavy episodic drinking at least once or more frequently in the past 12 months. A total of 10% reported heavy episodic drinking weekly or more, and 6% reported pre-loading at the same frequency. The level of harms associated with these behaviours was also cause for serious concern, with 44.6% reporting having vomited due to alcohol in the past 12 months, 31.5% reporting memory loss, and 15.5% reporting having received an injury due to alcohol in the past year. More than half the participants indicated experiencing at least one of these events in the past year, with 709 women (9.1%) reporting all three adverse events of vomiting, memory loss and alcohol-related injury.
Public health implications
Heavy drinking within Australia, particularly among young people, has been a major target of public health interventions. A number of powerful interventions have been venue-focused, such as a tax on the supply of alcoholic drinks, introducing early lockouts, and targeting venues that were linked to alcohol-related incidents.
In the case of pre-loading, such approaches have little impact as the alcohol is being consumed prior to entering licensed venues or events. If anything, such strategies could potentially lead to more people engaging in pre-drinking behaviour, as a Queensland study showed.
Addressing harmful alcohol consumption through public health guidelines and interventions is a key strategy in mitigating the overall burdens alcohol places on society at large. This was recently demonstrated through the mandate to improve pregnancy warnings on alcoholic products sold in Australia. Without investigating and addressing pre-loading behaviours, alcohol consumption guidelines and public health interventions may be incomplete.
In the meantime, those alcohol-infused hits keep influencing our most vulnerable demographic.
Pour up, drank, head shot, drank
Sit down, drank, stand up, drank
Pass out, drank, wake up, drank
Faded, drank, faded, drank
- Swimming Pools (Drank) by Kendrick Lamar (2012)
Dr Amy Anderson is a Senior Research Officer in the Faculty of Health and Medicine at the University of Newcastle. Her areas of research expertise include antenatal health behaviours, alcohol use, public health guideline adherence, predictors of negative health behaviours and women’s health.