Chinese Young Adults Research Articles

Associations between personality and problematic internet use among Chinese adolescents and young adults: A network analysis

BackgroundWith the number of internet users booming, problematic internet use (PIU) has become a public health threat. This study aims to figure out the inter-relationships between PIU symptoms and personality traits with network-based analysis among young people and to discuss the gender difference in the above networks. MethodsBased on a national cross-sectional study in 2022, 4655 Chinese adolescents and young adults aged 14 to 25 were included. We adopted the 6-item Short-Form Problematic Internet Use Questionnaire (PIUQ-SF-6) and the 10-item version of the Big Five Inventory (BFI-10) to measure PIU and personality traits, respectively. Network analysis was used to identify influential nodes and edges and compare the network models between male and female participants. ResultsThe mean age of 4655 participants was 19.84, and 52.1 % (2424) of them were females. There are differences in age and gender between participants with and without PIU (P < 0.05). The network of personality and PIU showed that 22 out of the 28 edges were estimated to be nonzero, and “obsession-neuroticism” was the strongest positive edge between the two communities. Central symptoms (i.e., “obsession” and “control disorder”) and bridge symptoms (i.e., “obsession” and “neuroticism”) have been identified. Gender differences existed in network global strength: female = 3.71, male = 3.18 (p < 0.001). LimitationsThe cross-sectional study needs more evidence to build causal inference. ConclusionsThe results of PIU-personality networks may contribute to the personalized prevention and treatment of PIU. The gender difference in PIU-personality networks also requires more attention and discussion.

Does parental compensation matter when we grow up? The relationship between childhood emotional neglect, attachment and depressive symptoms among Chinese young adults

Does parental compensation matter when we grow up? The relationship between childhood emotional neglect, attachment and depressive symptoms among Chinese young adults

The relationship between social environmental stressors and depressive symptoms among Chinese young adults: Above and beyond the effects of childhood trauma

Childhood trauma has been identified as an important etiological risk factor for depressive symptoms, but there are other modifiable social environmental factors that may be equally, if not more, important. This study aimed to improve our understanding of the social determinants of depressive symptoms among young people while taking childhood trauma into account. We analyzed survey data from a convenience sample of Chinese young adults aged between 18 to 24 (N = 205). Participants completed standardized assessments of childhood trauma (the Brief Betrayal Trauma Survey), depressive symptoms (the PHQ-9), and social environmental stressors (the Social Environmental Stress Questionnaire). Social environmental stressors had the strongest relationship with depressive symptoms (β = .416, p < .001), above and beyond the effects of childhood trauma. We also identified some specific modifiable and targetable social environmental stressors (e.g., school work and occupation issues, high expectations from others, sleep environment) that were positively correlated with depressive symptoms, even when the Bonferroni correction was applied. Although childhood trauma is a well-documented risk factor for mental health problems, there are modifiable factors associated with depressive symptoms, above and beyond the effects of childhood trauma. Educators, healthcare practitioners, social service providers, and policymakers can play a vital role in changing the trajectory of depression in the community.

Trajectories of body mass index and incident kidney stone disease: a prospective cohort study in Chinese young adults.

The present study aims to explore the potential changing trajectory patterns of body mass index(BMI) for Chinese young adults and identify the relationship of BMI trajectory patterns with kidney stone disease(KSD) incidence. Latent class growth analysis was used to identify distinct trajectories of BMI during young adulthood. Cox proportion hazard models were conducted to explore the association between the BMI trajectory group memberships and incident KSD. Subgroup and sensitivity analyses were undertaken to test the robustness of the findings. In total, 2,966 young adults who attended at least three annual check-ups from 2014 to 2021 without KSD at baseline were enrolled in the cohort analysis. Three district BMI trajectories were identified for young adults, labeled as low-stable in normal BMI (28.5%), medium-rising to high BMI (67.4%), and rapid-rising to high BMI (4.1%). Compared with the low-stable in normal BMI group, Hazard ratios(HRs) of the rapid-rising and medium-rising to high BMI groups were 3.19 (95% CI: 1.54-6.63) and 1.78 (95% CI: 1.08-2.92) after adjusting the covariates. The cumulative incidence curves likewise illustrated that young adults in the rapid-rising to high BMI group had the highest risk of developing KSD compared to the other two groups. The rapid BMI growth trajectories during young adulthood were identified to be independently associated with a higher risk of KSD. The findings supplied novel insights that monitoring the BMI changing pattern may be favorable to early intervention of KSD during young adulthood.

Distribution and Determinants of Anterior Chamber Angle and Anterior Chamber Volume in Young Chinese Adults

ABSTRACT Purpose Current study aimed to understand the distribution and determinants of anterior chamber angle (ACA) and anterior chamber volume (ACV) in Chinese young adults, which can help fill current data gaps and aid in early detection and intervention for high-risk population of primary angle closure glaucoma. Methods This cross-sectional study utilized data from 2014 participants who completed questionnaire and eye examination in September 2021. ACV and ACA were measured using a Pentacam tomographer. Spherical equivalent (SE) was evaluated by autorefractor without cycloplegia. Central corneal thickness (CCT) and biomechanically corrected intraocular pressure (bIOP) were evaluated using Corvis-ST. Axial length (AL), corneal radius (CR), anterior chamber depth (ACD), and white to white were assessed using the IOL Master. Results A total of 1635 students were included in the analysis. The mean ACV and AVA were 194.74 ± 32.30 μL and 38.81 ± 4.84°, respectively. Males have a larger ACV and wider ACA than females. ACV was positively correlated with ACA (r = 0.24, p < 0.001), and the correlation was stronger for non-myopic students than for myopic students. Multivariable linear regression model showed that AL (β = 2.41), CR (β = –4.12), CCT (β = –0.11), ACD (β = 97.93), and bIOP (β = 0.40) were associated with ACV, and CCT (β = –0.01), CR (β = 0.38), and ACD (β = 7.41) were associated with ACA (all p < 0.05). Random forest model indicated that ACD was the most critical predictor of both ACV and ACA. Conclusions This study reported the distribution and determinants of ACA and ACV. Deeper ACD was associated with larger ACV and wider ACA.

Knowledge, attitude regarding osteoporosis, dietary calcium intake and food sources of calcium among Chinese young adults in Klang Valley, Malaysia

BackgroundOsteoporosis is a major public health issue with huge socioeconomic implications. Adequate knowledge and a positive attitude regarding osteoporosis with sufficient dietary calcium intake are important to prevent osteoporosis, especially in young adults. Nonetheless, data on the knowledge and attitude regarding osteoporosis, dietary calcium intake and its food sources among the high-risk population, including Malaysian Chinese are limited.ObjectiveThe study aimed to determine the knowledge and attitude regarding osteoporosis, dietary calcium intake, and food sources of calcium among young Malaysian Chinese.MethodsA total of 130 Malaysian Chinese aged 18 to 26 years living in Klang Valley were recruited. Knowledge and attitude regarding osteoporosis were assessed using the Osteoporosis Prevention and Awareness Tool (OPAAT) and Osteoporosis Health Belief Scale (OHBS). Dietary calcium intake and food sources were obtained from a 7-day diet history.ResultsParticipants had low knowledge regarding osteoporosis (48.8% ± 16.6), but moderate knowledge (53.2% ± 17.9) regarding preventive measures of osteoporosis. The median dietary calcium intake was 546 mg/day and only 6.2% of the participants achieved the Recommended Nutrients Intake (RNI). There was a discernible weak positive correlation between knowledge and dietary calcium intake (r = 0.192, p = 0.029).ConclusionYoung Malaysian Chinese adults exhibited low knowledge about osteoporosis and reported inadequate dietary calcium intake. Thus, there is a need for community-based health education programs focusing on osteoporosis awareness among Malaysian young adults.

Reduced Arsenic Methylation Capacity in Young Chinese Adults After Short-Term Arsenic Exposure From Rice

Reduced Arsenic Methylation Capacity in Young Chinese Adults After Short-Term Arsenic Exposure From Rice

Alterations of Arsenic Methylation Among Young Chinese Adults on a Wheat Diet Followed by a Rice Diet

Alterations of Arsenic Methylation Among Young Chinese Adults on a Wheat Diet Followed by a Rice Diet

The burden of allergic rhinitis is undermanaged in a large proportion of Chinese young adults from Singapore

BackgroundAllergic rhinitis (AR) is a nasal disorder characterized by the simultaneous manifestation of at least 2 out of 4 possible symptoms: rhinorrhea, nasal itching, nasal pruritus, and sneezing. Presently, among Chinese young adults from Singapore, we characterised AR phenotypes, established Total Nasal Symptom Score (TNSS) baselines, and examined the management of AR. MethodsParticipants completed an investigator-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and underwent a skin prick test (SPT). Individuals exhibiting sensitization during the SPT while having at least 2 rhinitis symptoms were identified as AR cases, then categorized into Allergic Rhinitis in Asthma (ARIA) classifications. ResultsThere were 9323 subjects analyzed. AR prevalence was estimated at 35.4%. Rhinorrhea was perceived as the most severe (mean Nasal Symptom Score (mNSS) ± SD: 1.42 ± 0.74), while nasal pruritus was the least severe (mNSS ± SD: 1.24 ± 0.68). Among moderate-severe AR (68.1%), most were affected by either troublesome symptoms (27.7%) or sleep disturbances (18.4%). By ARIA classes, 26.6% were mild intermittent, 5.4% were mild persistent, 50.3% were moderate-severe intermittent, and 17.6% were moderate-severe persistent. The mean TNSS (mTNSS) of AR cases was 4.43 (SD = 2.49) and between AR classifications, the mTNSS was significantly different. Notably, a large proportion of AR cases remained undiagnosed (85.2%), untreated (72.5%), or both (65.4%); 19.8% self-medicated for AR. ConclusionsThere was a significant difference in TNSS of the AR phenotypes, and among phenotypes with a higher mTNSS, a large proportion remained untreated, undiagnosed, or both. The evidence indicates an existing burden of AR among Chinese young adults in Singapore which is notably undermanaged.

Characteristics of dietary patterns, and serum metabolites during the low-gluten diet among Chinese young adults

The number of gluten-restricted dieters is growing, yet its impact on healthy diets and serum profiles is unclear. This study investigated the effects of a 2-week low-gluten diet (LGD) on the dietary patterns, serum metabolic profiles, and health status of 61 young individuals from a university in southeastern China. Data on food intake, serum metabolomics, blood biochemistry, and fecal SCFA were collected. This population was divided into four dietary patterns by k-means method:1 Processed food group (PB, n = 17), 2 Rice group (RB, n = 10), 3 Fish/shrimp-based group (SB, n = 4), and 4 Vegetable group (VB, n = 30). Serum metabolites and fecal SCFA were measured using HPLC-MS and GC-MS, respectively. After 2-week of LGD, the SB group had the highest diet diversity. There were remarked differences in nutrient intake among the four dietary patterns, but no differences in health indices or fecal SCFA. WGCNA method revealed the differences in metabolite metabolite modules 4 and 5, and 3-hydroxybutyric acid, hydrolyzed fumonisin（HFB1）, and palmitoleic acid were the different metabolites among clusters. Following a 2-week LGD, different dietary patterns lead to different nutrient intakes and serum metabolite profiles.

Effects of replacing sedentary time with alterations in physical activity or sleep on mood states in Chinese young adults during the pandemic

BackgroundPoor mood states pose the most frequent mental health, creating a considerable burden to global public health. Sedentary behavior is an essential factor affecting mood states, however, previous measures to reduce sedentary time in Chinese young adults have focused only on increasing physical activity (PA). Sedentary, PA, and sleep make up a person’s day from the standpoint of time use. It is not known whether reallocating sedentary time to different types of PA (e.g. daily PA and structured PA) or sleep during an epidemic has an effect on mood states. Therefore, this study aimed to examine the association between replacing sedentary time with different types of PA or sleep during the pandemic and the mood states of Chinese young adults and to further examine whether this association varies across sleep populations and units of replacement time.Method3,579 young adults aged 18 to 25 years living in China and self-isolating at home during the COVID-19 outbreak were invited to complete an online questionnaire between February from 23 to 29, 2020. Subjects’ PA, sedentary time, and mood states were assessed using the International Physical Activity Questionnaire and the Chinese version of the Profile of Mood States, respectively. Participants also reported sleep duration and some sociodemographic characteristics. Participants were divided into short sleepers (< 7 h/d), normal sleepers (7–9 h/d), and long sleepers (> 9 h/d) based upon their reported sleep duration. Relevant data were analyzed using Pearson correlation analysis and isotemporal substitution model (ISM).ResultsSedentary time was negatively associated with mood states in Chinese young adults during the pandemic (r = 0.140) and correlated strongest among short sleepers (r = 0.203). Substitution of sedentary time with structured PA was associated with good mood states (β=-0.28, 95% CI: -0.49, -0.08). Additionally, substituting sedentary time with daily PA (e.g. occupational PA, household PA) was also associated with good mood states among normal sleepers (β=-0.24, 95% CI: -0.46, -0.02). The substitution of sedentary time with sleep could bring mood benefits (β=-0.35, 95% CI: -0.47, -0.23). This benefit was particularly prominent among short sleepers. Furthermore, for long sleepers, replacing sedentary time with sleep time also resulted in significant mood benefits (β=-0.41, 95% CI: -0.69, -0.12). The longer the duration of replacing sedentary behavior with different types of PA or sleep, the greater the mood benefits.ConclusionsA reallocation of as little as 10 min/day of sedentary time to different types of PA or sleep is beneficial for the mood states of young adults. The longer the reallocation, the greater the benefit. Our results demonstrate a feasible and practical behavior alternative for improving mood states of Chinese young adults.

Association of frequent intake of trans fatty acids and saturated fatty acids in diets with increased susceptibility of atopic dermatitis exacerbation in young Chinese adults: A cross-sectional study in Singapore/Malaysia.

Numerous evidence has attributed diets with a high fatty acids (FAs) intake to be associated with atopic dermatitis (AD) development. Therefore, this study investigated the association between intake frequencies of five dietary FAs and AD exacerbations among young Chinese adults from Singapore and Malaysia. A validated International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was investigator-administered to 13,561 subjects to collect information on socioeconomic, anthropometric, dietary and lifestyles habits, and personal/family medical histories. Six novel dietary indices were derived to analyse the associations between total FAs, trans fatty acids (TFAs), saturated fatty acids (SFAs), monounsaturated fatty acids, linoleic acids, and alpha-linolenic acids in diets and AD exacerbation. Synergy factor (SF) analysis was used to identify interactions between the dietary FAs to influence disease susceptibility. In our multivariable model adjusted for age, gender, BMI, parental eczema, and lifestyle factors, a diet high in total estimated FAs was strongly associated with AD (Adjusted Odds Ratio (AOR): 1.227; 95% Confidence Interval (CI): 1.054-1.429; adjusted p-value <0.01). Particularly, high estimated total TFAs and SFAs were significantly associated with AD exacerbations including chronic and current moderate-to-severe AD. The association between TFAs and AD remained strong even controlled for the total FAs in diets and false discovery rate corrected (AOR: 1.516; 95% CI: 1.094-2.097; adjusted p-value <0.05). Similarly, having a high SFAs in diets was associated with AD (AOR: 1.581; 95% CI: 1.106-2.256; adjusted p-value <0.05) independently on the total FAs in diets. FAs in diets do not interact to influence AD. Overall, these results highlighted an association between high dietary TFAs and SFAs and AD exacerbations in an Asian population.

Internal Strengths for Adverse Life Events.

In this study, a brief measure of four internal attributes found to protect against the impact of adverse life events on mental health was developed and validated. In addition, profiles of internal strengths that significantly predict mental health outcomes in young Chinese adults were identified. The results of exploratory and confirmatory factor analyses on data from 831 Chinese university students supported the proposed four-factor model of the ISALES. Participants in the current study fell into two clusters, with one cluster being higher than the other in all four internal strengths, with the former cluster demonstrating better overall mental health than those in the latter cluster. The ISALES is a promising instrument for use in clinical settings and may be used to identify individuals who are more 'at risk' of developing poor mental health in the aftermath of a negative life event. The use of the ISALES may permit tailored interventions and timely support to be provided to individuals within clinical settings.

Living with parents or attaining residential independence? A comparative study of young adults’ living arrangements in China and South Korea

This study examines the living arrangements of never-married urban young adults in China and South Korea from 2003 to 2018. Using data from the Chinese General Social Survey and the Korean General Social Survey, we investigate the relationship between socioeconomic status and young adults’ living arrangements. Our findings show that a majority of Korean young adults lived with their parents during the observed time period, while Chinese young adults experienced large shifts in their living arrangements. Findings from weighted logistic models demonstrate that employed or high-income young adults were more likely to leave the parental home than those who were not working, suggesting the important role of economic security in independent living. Highly educated young adults in China tended to have residential independence, while education was not significantly associated with Korean young adults’ living arrangements. Korean young adults with highly educated fathers were more likely to stay with parents. The interconnection between family socioeconomic characteristics at the micro level and variations in opportunity structures at the macro level results in country-specific patterns of living arrangements.

Neuropsychological and psychiatric outcomes among community-dwelling young Chinese older adults affected by falls in the past year with and without vision impairment.

This study was to investigate the differences between young older adults with and without vision impairment on neuropsychological and psychiatric outcomes following falls during the past year and to identify predictors of cognitive decline or mental distress. A secondary analysis of 668 young older Chinese adults aged 65 ∼ 79 years old with a history of falls was conducted from the cross-sectional survey data in the 2018 wave of the Chinese Longitudinal Health Longevity Survey (CLHLS). Participants with vision impairment scored significantly higher on anxiety and depression and lower on cognitive function and SWB than those without vision impairment. And vision impairment was a significant predictor of adverse outcomes for all four neuropsychological and psychiatric measures. Neurocognitive deficits, psychological problems, and decreased self-sufficiency are quite common among community-dwelling older adults with visual impairment who have a history of falls within a year.

The Influence of Digital Affluence Display on Emerging Adults Self-Esteem

This study investigates the relationship between the frequency of engaging with digital affluence display wealth-related content on social media and self-esteem among Chinese young adults aged 18-26. A quantitative analysis of self-reported survey data showed a significant negative correlation between the frequency of viewing wealth-flaunting content and levels of self-esteem, challenging the traditional views of Social Comparison Theory. The results indicate a complex interaction between online displays of wealth and psychological well-being, including influences of stimuli and thresholds, underscoring the need for a more detailed understanding of how young people interpret and respond to social media in todays digital environment.

Correlation between hyperuricemia and thickened left ventricular wall in hypertensive young adults

BackgroundIn this study, we examine the association between the hyperuricemia(HU) and hypertension(HTN) in Chinese young adults. Besides, the correlation between the occurrence of thickened left ventricular wall and HU was identified in patients with HTN.MethodsIn all, 360 patients with HTN and 1991 young adults with normal blood pressure(NBP) were enrolled in the study. Participant characteristics were collected. Univariable and multivariable logistic regression tests were utilized to identify the correlation between the presence of HU and HTN, and the correlation between the occurrence of thickened ventricular septum and HU in patients with HTN.ResultsThe prevalence of HU in Chinese young adults with HTN was significantly higher than young adults with NBP(36.39% vs. 16.93%). Univariable analyses revealed that 8 factors were related with the presence of HTN with p value < 0.001, including HU, male, body mass index(BMI) ≥ 24 kg/m2, total cholesterol(TC) > 5.17mmol/L, triglyceride(TG) > 1.70mmol/L, high density lipoprotein cholesterol(HDL-C) < 1.0mmol/L, fasting blood glucose(FBG) > 6.10mmol/L and fatty liver. After adjusting these covariates, multivariable analysis revealed that HU[odds ratio(OR):1.47, 95% confidence interval(CI): 1.10–1.95, p = 0.008] remained independent association with HTN in young adults. Additionally, univariable and multivariable logistic analyses revealed that HU kept the independent effect on the presence of thickened interventricular septum(adjusted OR = 1.81, 95% CI: 1.05–3.11, P = 0.03) and thickened left ventricular posterior wall(adjusted OR = 2.28, 95% CI: 1.28–4.08, P = 0.005) in young adults with HTN.ConclusionHU was independently associated with HTN in young adults. HU was independently correlated with thickened left ventricular wall, including interventricular septum and left ventricular posterior wall, in young adults with HTN.

The Negative Effect of Siblings on Perspective-Taking in Adulthood under Chinese Culture.

Evidence from Western developed countries has consistently found that children with sibling(s) showed better perspective-taking (PT) than only children. However, this was not the case in developing countries like China. Our study investigates whether the potentially hindering effect of having sibling(s) on PT persists into adulthood within the context of contemporary Chinese culture. We employed self-report questionnaires to measure PT, perceived parental care, and sibling relationships among Chinese young adults (21.93 ± 2.35 years old). Our findings indicate that in China, (1) having sibling(s) hinders individuals' PT in adulthood, (2) a potential mechanism for this effect is that having sibling(s) leads individuals to perceive less parental care during early life, and (3) for those with sibling(s), higher sibling intimacy can enhance PT, particularly among older sister-younger brother pairs. These results suggest that in developing countries such as China, while sibling(s) may diminish PT to some extent, factors like parental care and sibling intimacy can serve as protective factors that mitigate the negative impacts of sibling(s) on PT.

Infectious mononucleosis complicated by transitory Epstein-Barr virus infection of T and natural killer cells

Epstein-Barr virus (EBV) typically infects B cells in infectious mononucleosis (IM), but a rare case shows EBV infection in T cells. Seven cases of lymphoproliferative disorder caused by EBV-positive cytotoxic T/natural killer (NK) cell proliferation in the lymph nodes, termed IM with transient EBV infection of T and NK cells (EBV + T/NK cells in IM), are reported here. The purpose of the study is to describe clinicopathological features of EBV + T/natural killer (NK) cells in IM of the lymph node. We retrospectively analysed seven cases of Chinese children and young people adults with EBV + T/NK cells in IM. We used morphological observation, immunohistochemical staining, EB virus in situ hybridisation detection, and analysis of T-cell receptor gene rearrangement. The patients were healthy prior to illness, experiencing sudden onset occurring in all the patients, with high fever as the first symptom, followed by lymphadenopathy and hepatosplenomegaly. Diagnosis occurred < 1.5 months of symptom onset. Most lymphocytes in lesions expressed CD3 and Granzyme B or TIA-1 and lacked CD5. CD56 was expressed in numerous cells in 5 of the 7 cases. EBV-encoded RNA (EBER) was detected in medium-to-large-sized cells (50–100 cells per cell/high-power field). T-cell receptor (TCR) gene rearrangement was seen in six cases, with monoclonal rearrangement in four cases. Treatment was conservative treatment but not chemotherapy. Four received anti-HLH therapy and others anti-inflammatory treatment. All patients survived with relapse after long-term clinical observation and follow-up. EBV + T/NK cells in IM can elicit malignant features that mimic T/NK-cell lymphoma pathologically and benign features mimicking IM clinically. These findings indicate that EBV + T/NK cells in IM could serve as valuable diagnosis. Additional clinical information, including age of onset (children and young people), nature of onset (sudden), disease course (short), symptoms (systemic), EBV infection status (acute), and lymph node involvement, is crucial for accurate diagnosis and prognostic evaluation.

Who is being targeted by alcohol social media marketing? A study of Chinese young adults in Hong Kong.

Due to the widespread use of social media by young adults, the alcohol industry has been increasingly using social media marketing (SMM) to target potential customers. This study examines the prevalence and factors associated with past-month exposure to alcohol SMM among young Chinese adults, a group with rapidly increasing uptake of alcohol consumption. An anonymous, random telephone survey was conducted between June and August 2021 on Hong Kong Chinese residents between 18 and 34 years old (n = 675). Of respondents, 52.3% reported past-month exposure to alcohol SMM (68.6% of past-month drinkers and 48.0% of non-past-month drinkers, p < 0.05) while 71.6% reported exposure to non-SMM alcohol marketing. Direct alcohol SMM exposure was reported by 40.9% (e.g., business-to-consumer postings, alcohol banner ads) while 27.4% of respondents reported exposure to indirect alcohol SMM marketing (e.g., shared/'liked' alcohol brand posts). Of those exposed to alcohol SMM, 13.7-15.5% reported that the various forms indirect alcohol SMM influenced them to drink more (vs. 6.2-8.9% for direct alcohol SMM). Being male, lower-income, university educated and spirits/cocktail drinker were independently associated with exposure to direct alcohol SMM (ORmv 1.71-3.14). Past-month exposure to indirect alcohol SMM was independently associated with lower income, not working full-time and drinking any type of alcohol (ORmv 1.59-4.44). The comparative effectiveness of indirect SMM on influencing young adults drinking intentions may be a form of peer endorsement of drinking. The pervasiveness of alcohol SMM and lack of alcohol SMM policies may indicate the need for greater alcohol marketing regulation in this region.