{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T08:15:35Z","timestamp":1761293735623,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T00:00:00Z","timestamp":1524614400000},"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>This study explored bystanders\u2019 willingness to help a friend who flushes when drinking to reduce his\/her drinking. Alcohol-related facial flushing is an indicator of an inherited variant enzyme, aldehyde dehydrogenase (ALDH), that impairs alcohol metabolism and increases drinkers\u2019 lifetime risk of certain aerodigestive cancers. Individuals who flush should reduce their alcohol exposure, but they may continue to drink if social pressures and rules of etiquette make not drinking socially risky. The analysis used data from 2912 undergraduate students from 13 universities in southwestern, central and northeastern China from a survey asking how they respond to someone\u2019s flushing in various scenarios. Latent class analysis grouped students by similar responses to flushing. A multinomial logistic regression explored how class membership was associated with knowledge, drinking status, and reactions to one\u2019s own flushing. Five classes were derived from the latent class analysis, ranging from always intervene to mostly hesitate to help; in between were classes of students who were willing to help in some scenarios and hesitant in other scenarios. Only 11.6% students knew the connection between facial flushing and impaired alcohol metabolism, and knowledgeable students were somewhat more likely to assist when they saw someone flushing. In the absence of knowledge, other factors\u2014such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed\u2014determined how willing a person was to help someone reduce or stop drinking. Class membership was predicted by knowledge, gender, drinking status, and reactions to one\u2019s own flushing. Of these 4 factors, knowledge and reactions to one\u2019s own flushing could be influenced through alcohol education programs. It will take some time for alcohol education to catch up to and change social and cultural patterns of drinking. Meanwhile, motivational strategies should be developed to increase the willingness of bystanders to assist friends and to create a social expectation that flushers should stop or reduce their drinking.<\/jats:p>","DOI":"10.3390\/ijerph15050850","type":"journal-article","created":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T11:15:39Z","timestamp":1524654939000},"page":"850","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["University Students\u2019 Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking"],"prefix":"10.3390","volume":"15","author":[{"given":"Lanyan","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lok-Wa","family":"Yuen","sequence":"additional","affiliation":[{"name":"Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4669-7064","authenticated-orcid":false,"given":"Ian M.","family":"Newman","sequence":"additional","affiliation":[{"name":"Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duane F.","family":"Shell","sequence":"additional","affiliation":[{"name":"Department of Educational Psychology, University of Nebraska, Lincoln, NE 68588-0345, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,4,25]]},"reference":[{"key":"ref_1","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. 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