{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:20:23Z","timestamp":1773757223538,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2017,6,9]],"date-time":"2017-06-09T00:00:00Z","timestamp":1496966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Alcohol-related facial flushing is a sign of compromised alcohol metabolism and increased risk of certain cancers. This project examined how facial flushing might be used to reduce alcohol use to lower cancer risks. Interviews with Chinese university students identified gender, friendship, and drinking purpose as important variables related to whether someone would encourage a person who flushes when drinking alcohol to stop or reduce their drinking. A questionnaire was developed that incorporated these variables into 24 drinking scenarios in which someone flushed while drinking. Students responded whether they would (a) encourage the flusher to stop or drink less; (b) do nothing while wishing they could; or (c) do nothing because there was no need. Analysis of survey responses from 2912 university students showed a three-way interaction of the variables and implied that the probability students will intervene when a drinker flushes was highest when the flusher was a female, a close friend, and the drinking purpose was for fun and lowest if the flusher was a male, the friendship was general, and the drinking purpose was risky. The results provide important details about the social factors affecting how other people respond to a person who flushes when drinking alcohol. This information is useful for those considering ways to reduce and prevent aerodigestive cancers through education and information programs.<\/jats:p>","DOI":"10.3390\/ijerph14060622","type":"journal-article","created":{"date-parts":[[2017,6,9]],"date-time":"2017-06-09T10:29:59Z","timestamp":1497004199000},"page":"622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["How Social Reactions to Alcohol-Related Facial Flushing Are Affected by Gender, Relationship, and Drinking Purposes: Implications for Education to Reduce Aerodigestive Cancer Risks"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4669-7064","authenticated-orcid":false,"given":"Ian","family":"Newman","sequence":"first","affiliation":[{"name":"Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanyan","family":"Ding","sequence":"additional","affiliation":[{"name":"Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duane","family":"Shell","sequence":"additional","affiliation":[{"name":"Nebraska Prevention Center for Alcohol and Drug Abuse, Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lida","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Psychology in Education, School of Education, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2017,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhang, J., Zhang, S., Song, Y., Ma, G., Meng, Y., Ye, Z., Ma, X., and Liu, M. (2017). Facial flushing after alcohol consumption and the risk of cancer: A meta-analysis. Medicine, 96.","DOI":"10.1097\/MD.0000000000006506"},{"key":"ref_2","first-page":"2623","article-title":"Meta-analysis of ALDH2 variants and esophageal cancer in Asians","volume":"12","author":"Fang","year":"2011","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_3","first-page":"38","article-title":"Alcohol metabolism and cancer risk","volume":"30","author":"Seitz","year":"2007","journal-title":"Alcohol Res. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/1479-7364-2-2-138","article-title":"Analysis and update of the human aldehyde dehydrogenase (ALDH) gene family","volume":"2","author":"Vasiliou","year":"2005","journal-title":"Hum. Genom."},{"key":"ref_5","unstructured":"Zbeda, R. (2017, May 19). Esophageal cancer and the \u201cAsian Glow\u201d. Available online: http:\/\/dujs.dartmouth.edu\/2009\/11\/esophageal-cancer-and-the-\u2018asian-glow\u2019\/#.WMBmXRiZPjA."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.yrtph.2017.02.024","article-title":"ALDH2-deficiency as genetic epidemiologic and biochemical model for the carcinogenicity of acetaldehyde","volume":"86","author":"Lachenmeier","year":"2017","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"31172","DOI":"10.1074\/jbc.271.49.31172","article-title":"Heterotetramers of human liver mitochondrial (Class 2) aldehyde dehydrogenase expressed in Escherichia coli a model to study the heterotetrotetramers expected to be found in oriental people","volume":"271","author":"Wang","year":"1996","journal-title":"J. Biol. Chem."},{"key":"ref_8","first-page":"48","article-title":"Aldehyde dehydrogenase deficiency as cause of facial flushing reaction to alcohol in Japanese","volume":"19","author":"Goldman","year":"1995","journal-title":"Alcohol Health Res. World"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"349","DOI":"10.15288\/jsa.2006.67.349","article-title":"ALDH2*2 is associated with a decreased likelihood of alcohol-induced blackouts in Asian American college students","volume":"67","author":"Luczak","year":"2006","journal-title":"J. Stud. Alcohol"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0899-3289(12)80004-6","article-title":"Genetic or cultural determinants of drinking: A study of embarrassment at facial flushing among Japanese and Japanese-Americans","volume":"2","author":"Parrish","year":"1990","journal-title":"J. Subst. Abuse"},{"key":"ref_11","first-page":"18","article-title":"Cultural aspects of drinking patterns and alcohol controls in China","volume":"2002","author":"Newman","year":"2002","journal-title":"Globe"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/02791072.1987.10472419","article-title":"Chinese, alcohol and flushing: Sociohistorical and biobehavioral considerations","volume":"19","author":"Lee","year":"1987","journal-title":"J. Psychoact. Drugs"},{"key":"ref_13","first-page":"1497","article-title":"Beyond liver and culture: A review of theories and research in drinking among Chinese in North America","volume":"28","author":"Cheung","year":"1993","journal-title":"Subst. Use Misuse"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/S0140-6736(94)91629-2","article-title":"Aldehyde dehydrogenase genotypes in Japanese alcoholics","volume":"343","author":"Higuchi","year":"1994","journal-title":"Lancet"},{"key":"ref_15","first-page":"1227","article-title":"Alcohol flushing, alcohol and aldehyde dehydrogenase genotypes, and risk for esophageal squamous cell carcinoma in Japanese men","volume":"12","author":"Yokoyama","year":"2003","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e190","DOI":"10.1016\/S2214-109X(15)70017-3","article-title":"Alcohol and related health issues in China: Action needed","volume":"3","author":"Jiang","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_17","unstructured":"World Health Organization (2014). Country Profiles: China, World Health Organization. Global Status Report on Alcohol and Health 2014."},{"key":"ref_18","unstructured":"Ma, S.B., and Kong, L.Z. (2006). Nutrition and Health Situation Survey among Chinese Residents: Research Report No. 9 Behavior and Lifestyle, Renmin Weisheng Chubanshe (People\u2019s Medical Publishing House)."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"233","DOI":"10.2188\/jea.JE20120162","article-title":"Epidemiology of esophageal cancer in Japan and China","volume":"23","author":"Lin","year":"2013","journal-title":"J. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Brooks, P.J., Enoch, M.A., Goldman, D., Li, T.K., and Yokoyama, A. (2009). The alcohol flushing response: An unrecognized risk factor for esophageal cancer from alcohol consumption. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000050"},{"key":"ref_21","first-page":"271","article-title":"The social meaning of alcohol-related flushing","volume":"23","author":"Zhang","year":"2007","journal-title":"Zhongguo Jiankang Jiaoyu (Chin. J. Health Educ.)"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Newman, I.M., Jinnai, I., Zhao, J., Huang, Z., Pu, J., and Qian, L. (2013). Social meaning of alcohol-related flushing among university students in China. Asia Pac. J. Public Health, 25.","DOI":"10.1177\/1010539511420702"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Newman, I.M., Shell, D.F., Huang, Z., and Qian, L. (2015). The educational potential of alcohol-related flushing among Chinese young people. Drugs (Abingdon Engl.), 22.","DOI":"10.3109\/09687637.2014.979764"},{"key":"ref_24","first-page":"105","article-title":"Survey of drinking patterns of university students","volume":"31","author":"Newman","year":"2014","journal-title":"Chin. J. Soc. Med."},{"key":"ref_25","unstructured":"Muth\u00e9n, L.K., and Muth\u00e9n, B.O. (2012). Mplus, Muth\u00e9n & Muth\u00e9n."},{"key":"ref_26","unstructured":"Newman, I.M., Ding, L., Shell, D.F., and Lin, L. (2017, June 09). Alcohol Flushing Social Reactions Survey Data 2011 (MS #1237). Available online: http:\/\/digitalcommons.unl.edu\/edpsychpapers\/227\/."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12929-017-0327-y","article-title":"ALDH2 polymorphism and alcohol-related cancers in Asians: A public health perspective","volume":"24","author":"Chang","year":"2017","journal-title":"J. Biomed. Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/622\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:38:32Z","timestamp":1760207912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,9]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,6]]}},"alternative-id":["ijerph14060622"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14060622","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,9]]}}}