{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:31:13Z","timestamp":1788280273487,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,1,13]],"date-time":"2019-01-13T00:00:00Z","timestamp":1547337600000},"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 consumption among individuals who experience a flushing response (reddening of the face, nausea, dizziness, headache, anxiety, and increased heartbeat) can result in serious health problems. However, studies on reasons for drinking among flushers, especially in the college context, are limited. Thus, this study investigated the association between primary reason for drinking and alcohol use among a nationally representative sample of current, former, and never flushing college students. The aim was to measure whether college students with current or former experience of facial flushing have different primary reasons for drinking compared to students with no experience of facial flushing. We surveyed and analyzed the data of 4590 students in a nationally representative sample of 82 colleges in South Korea. Multiple regression analysis was used to identify the association between primary reason for drinking and alcohol intake. Alcohol intake was measured using the Alcohol Use Disorders Identification Test (AUDIT). Among 1537 current (33.5%), 152 former (3.3%), and 2901 (63.2%) never flushers, mean AUDIT scores were 7.715 \u00b1 5.434, 11.039 \u00b1 6.405, and 10.465 \u00b1 5.779, respectively. Current flushers had significantly higher AUDIT scores when drinking for pleasure (\u03b2 = 2.696, p &lt; 0.0001) or stress\/depression (\u03b2 = 2.578, p &lt; 0.0001). Primary reasons for drinking were not associated with alcohol intake for former flushers. Never flushers had significantly higher AUDIT scores when drinking for pleasure (\u03b2 = 2.696, p &lt; 0.0001), stress\/depression (\u03b2 = 2.578, p &lt; 0.0001), or boredom (\u03b2 = 0.740, p = 0.029) than peer pressure. Our results suggest that former and never flushers consume higher amounts of alcohol on average than never flushers. For current flushers, drinking for pleasure or stress\/depression may increase alcohol intake, while for never flushers, drinking for pleasure, stress\/depression, as well as boredom may have the same effect.<\/jats:p>","DOI":"10.3390\/ijerph16020211","type":"journal-article","created":{"date-parts":[[2019,1,14]],"date-time":"2019-01-14T12:20:07Z","timestamp":1547468407000},"page":"211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Primary Reason for Drinking Among Current, Former, and Never Flushing College Students"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2311","authenticated-orcid":false,"given":"Sarah Soyeon","family":"Oh","sequence":"first","affiliation":[{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"},{"name":"Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4891-0524","authenticated-orcid":false,"given":"Yeong Jun","family":"Ju","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"},{"name":"Department of Public Health, Graduate School, Yonsei University, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4834-8463","authenticated-orcid":false,"given":"San","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"},{"name":"Department of Psychiatry, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2306-5398","authenticated-orcid":false,"given":"Eun-Cheol","family":"Park","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research, Yonsei University, Seoul 03722, Korea"},{"name":"Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"299","DOI":"10.15288\/jsad.2014.75.299","article-title":"State variation in underreporting of alcohol involvement on death certificates: Motor vehicle traffic crash fatalities as an example","volume":"75","author":"Castle","year":"2014","journal-title":"J. Stud. Alcohol Drugs"},{"key":"ref_2","first-page":"65","article-title":"Effects of Environmental Correlates on Alcohol-related Problems among Colleges","volume":"23","author":"Kim","year":"2006","journal-title":"Korean J. Health Educ. Promot."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1037\/0022-3514.69.5.990","article-title":"Drinking to regulate positive and negative emotions: A motivational model of alcohol use","volume":"69","author":"Cooper","year":"1995","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1037\/0893-164X.17.1.13","article-title":"Examining the role of drinking motives in college student alcohol use and problems","volume":"17","author":"Read","year":"2003","journal-title":"Psychol. Addict. Behav."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"332","DOI":"10.15288\/jsa.2000.61.332","article-title":"Generalized expectancies for negative mood regulation and problem drinking among college students","volume":"61","author":"Kassel","year":"2000","journal-title":"J. Stud. Alcohol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0899-3289(01)00098-0","article-title":"Peer influences on college drinking: A review of the research","volume":"13","author":"Borsari","year":"2001","journal-title":"J. Subst. Abus."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/07448480209595714","article-title":"Underage college students\u2019 drinking behavior, access to alcohol, and the influence of deterrence policies: Findings from the Harvard School of Public Health College Alcohol Study","volume":"50","author":"Wechsler","year":"2002","journal-title":"J. Am. Coll. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.15288\/jsa.2001.62.32","article-title":"Social influence processes and college student drinking: The mediational role of alcohol outcome expectancies","volume":"62","author":"Wood","year":"2001","journal-title":"J. Stud. Alcohol"},{"key":"ref_9","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_10","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/BF02267057","article-title":"The contribution of polymorphism in the alcohol dehydrogenase \u03b2 subunit to alcohol sensitivity in a Japanese population","volume":"97","author":"Takeshita","year":"1996","journal-title":"Hum. Genet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"74","DOI":"10.15288\/jsa.2002.63.74","article-title":"Genetic risk for alcoholism relates to level of response to alcohol in Asian-American men and women","volume":"63","author":"Luczak","year":"2002","journal-title":"J. Stud. Alcohol"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1751-2980.2011.00480.x","article-title":"Acetaldehyde and gastric cancer","volume":"12","author":"Salaspuro","year":"2011","journal-title":"J. Dig. Dis."},{"key":"ref_13","first-page":"6020","article-title":"Meta-analysis of ADH1B and ALDH2 polymorphisms and esophageal cancer risk in China","volume":"16","author":"Zhang","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ishioka, K., Masaoka, H., Ito, H., Oze, I., Ito, S., Tajika, M., Shimizu, Y., Niwa, Y., Nakamura, S., and Matsuo, K. (2018). Association between ALDH2 and ADH1B polymorphisms, alcohol drinking and gastric cancer: A replication and mediation analysis. Gastric Cancer.","DOI":"10.1007\/s10120-018-0823-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102401","DOI":"10.18632\/oncotarget.22060","article-title":"Association between ALDH2 rs671 G>A polymorphism and gastric cancer susceptibility in Eastern Asia","volume":"8","author":"Jiang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wang, H.L., Zhou, P.Y., Liu, P., and Zhang, Y. (2014). ALDH2 and ADH1 genetic polymorphisms may contribute to the risk of gastric cancer: A meta-analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088779"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6630","DOI":"10.18632\/oncotarget.14250","article-title":"Effects of alcohol consumption, ALDH2 rs671 polymorphism, and Helicobacter pylori infection on the gastric cancer risk in a Korean population","volume":"8","author":"Yang","year":"2017","journal-title":"Oncotarget"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4314\/ahs.v17i1.14","article-title":"Association between ALDH2 Glu504Lys polymorphism and colorectal cancer risk: A meta-analysis","volume":"17","author":"Xinhua","year":"2017","journal-title":"Afr. Health Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1158\/1055-9965.EPI-09-0398","article-title":"A novel polymorphism rs1329149 of CYP2E1 and a known polymorphism rs671 of ALDH2 of alcohol metabolizing enzymes are associated with colorectal cancer in a southwestern Chinese population","volume":"18","author":"Yang","year":"2009","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhao, S., Du, X.M., Ma, S.S., and Wang, L.M. (2016). Association between aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphism and susceptibility to colorectal cancer: A meta-analysis. Genet. Mol. Res., 15.","DOI":"10.4238\/gmr.15037872"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1093\/carcin\/bgt080","article-title":"The aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphism interacts with alcohol drinking in the risk of stomach cancer","volume":"34","author":"Matsuo","year":"2013","journal-title":"Carcinogenesis"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.15288\/jsa.1985.46.196","article-title":"Alcohol-induced facial flushing and drinking behavior in Japanese men","volume":"46","author":"Suwaki","year":"1985","journal-title":"J. Stud. Alcohol"},{"key":"ref_23","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_24","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1177\/1010539511420702","article-title":"Social meaning of alcohol-related flushing among university students in China","volume":"25","author":"Newman","year":"2013","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1097\/00004872-199715110-00004","article-title":"Effects of daily alcohol intake on the blood pressure differ depending on an individual\u2019s sensitivity to alcohol: Oriental flushing as a sign to stop drinking for health reasons","volume":"15","author":"Itoh","year":"1997","journal-title":"J. Hypertens."},{"key":"ref_26","unstructured":"Babor, T., Higgins-Biddle, J., Saunders, J., and Monteiro, M. (2001). The Alcohol Use Disorders Identification Test, World Health Organization."},{"key":"ref_27","first-page":"1152","article-title":"Screening criteria of alcoholism by alcohol use disorders identification test(AUDIT) in Korea","volume":"20","author":"Kim","year":"1999","journal-title":"J. Korean Acad. Fam. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1111\/j.1349-7006.2010.01709.x","article-title":"Past and current tendency for facial flushing after a small dose of alcohol is a marker for increased risk of upper aerodigestive tract cancer in Japanese drinkers","volume":"101","author":"Yokoyama","year":"2010","journal-title":"Cancer Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/acer.13569","article-title":"Validation of Alcohol Flushing Questionnaires in Determining Inactive Aldehyde Dehydrogenase-2 and Its Clinical Implication in Alcohol-Related Diseases","volume":"42","author":"Shin","year":"2018","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Newman, I.M., Ding, L., Shell, D.F., and Lin, L. (2017). How Social Reactions to Alcohol-Related Facial Flushing Are Affected by Gender, Relationship, and Drinking Purposes: Implications for Education to Reduce Aerodigestive Cancer Risks. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14060622"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"553","DOI":"10.15288\/jsa.1992.53.553","article-title":"The relationship between three subtypes of the flushing response and DSM-III alcohol abuse in Japanese","volume":"53","author":"Higuchi","year":"1992","journal-title":"J. Stud. Alcohol"},{"key":"ref_32","first-page":"270","article-title":"Drinking patterns and drinking problems among Asian-Americans and Pacific Islanders","volume":"22","author":"Makimoto","year":"1998","journal-title":"Alcohol Health Res. World"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"291","DOI":"10.12934\/jkpmhn.2017.26.3.291","article-title":"Factors Affecting Problem Drinking in Korean College Women","volume":"26","author":"Park","year":"2017","journal-title":"J. Korean Acad. Psychiatr. Ment. Health Nurs."},{"key":"ref_34","first-page":"213","article-title":"Supervised Disulfiram\u2019s Superior Effectiveness in Alcoholism Treatment: Ethical, Methodological, and Psychological Aspects","volume":"52","author":"Brewer","year":"2017","journal-title":"Alcohol Alcohol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3109\/08039481003686180","article-title":"Disulfiram in severe alcoholism-an open controlled study","volume":"64","author":"Ulrichsen","year":"2010","journal-title":"Nord. J. Psychiat."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"125","DOI":"10.15288\/jsad.2011.72.125","article-title":"Daily stress and alcohol consumption: Modeling between-person and within-person ethnic variation in coping behavior","volume":"72","author":"Roesch","year":"2011","journal-title":"J. Stud. Alcohol Drugs"},{"key":"ref_37","first-page":"464","article-title":"Evaluation of the use of self-reported facial flushing and ethanol patch test for ALDH2 genotypes","volume":"45","author":"Ishibashi","year":"2010","journal-title":"Nihon Arukoru Yakubutsu Igakkai Zasshi Jpn. J. Alcohol Stud. Drug Depend."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/2\/211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:25:40Z","timestamp":1760185540000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/2\/211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,13]]},"references-count":37,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,1]]}},"alternative-id":["ijerph16020211"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16020211","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,13]]}}}