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. 2018 Apr 25;15(5):850.
doi: 10.3390/ijerph15050850.

University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking

Lanyan Ding  1 , Lok-Wa Yuen  2 , Ian M Newman  3 , Duane F Shell  4
Affiliations

University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking

Lanyan Ding et al. Int J Environ Res Public Health. .

Abstract

This study explored bystanders’ 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’ 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’s 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’s 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—such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed—determined 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’s own flushing. Of these 4 factors, knowledge and reactions to one’s 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.

Keywords: ALDH; China; aerodigestive cancer; alcohol; bystander; education; esophageal cancer; ethanol.

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Conflict of interest statement

Lok-wa Yuen and Lanyan Ding declare no conflicts of interest. Duane F. Shell has consulted for the National Institute for Health Education, Chinese CDC, and received an honorarium and travel support. In the past five years, Duane F. Shell has received university employment-related funding through grants from the U.S. Department of Education, the National Science Foundation, U.S. Department of Energy, University of Nebraska-Lincoln Office of Research, the Association of American Colleges and Universities, the Nebraska Department of Health and Human Services, the Nebraska Department of Transportation/Office of Highway Safety, and the Association of Performing Arts Presenters. He has received private consulting funds from the Buffalo Beach Company, Lincoln, NE, and the St. Elizabeth Foundation, Lincoln, NE. Prior to 2014 Ian Newman was a member of the Research Advisory Committee of the International Center for Alcohol Policies, Washington, D.C. (which is now known as the International Alliance for Responsible Drinking). Prior to 2014 he received fees and travel support to attend meetings sponsored or co-sponsored by the International Center for Alcohol Policies. Prior to 2013 Ian Newman consulted for the National Health Education Institute, China CDC, Chinese Center for Health Education (CCHE)/Health News & Communication Center, Ministry of Health (HNCC, MOH). In the past 5 years, he has received University of Nebraska employment-related funding from the U.S. Department of Education, the Nebraska Department of Health and Human Services, the Nebraska Department of Transportation/Office of Highway Safety. As American deputy director of the American Exchange Center at Xi’an Jiaotong University from 2012–2015, Newman received funds from the US State Department and the University of Nebraska. Ian Newman owns an equity interest in The Buffalo Beach Company (Lincoln, Nebraska) and has received consulting fees from The Buffalo Beach Company for independent research related to indigenous alcohol use, traffic safety, and evaluation of alcohol risk reduction programs.

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