Task: Question Generation
Input (English): The phrase "51st state" can be used in a positive sense, meaning that a region or territory is so aligned, supportive, and conducive with the United States, that it is like a U.S. state. It can also be used in a pejorative sense, meaning an area or region is perceived to be under excessive American cultural or military influence or control. In various countries around the world, people who believe their local or national culture has become too Americanized sometimes use the term "51st state" in reference to their own countries.
Output (English): If a country refers to themselves as the "51st state" after cultural changes, what can we assume has changed?