3450 of the sampled 3,854 participants agreed to take part in the study and were included in the analyses (89.5%). Of these participants, approximately 40% were male, while 50% were from urban areas (Additional file1: Table S1).
The median overall age of participants was 33 years. No significant difference was found between the median age of rural and urban participants (32 and 34 years respectively, p = 0.08), Female median age was 3 years older than male counterparts (p <0.05).
Approximately two-thirds of participants were educated to a secondary school level with 30% having been to university, 6% having received only a primary school education, and 21% being students, of which half were women. Significantly more urban participants had received secondary or tertiary education, with 2% having received only primary education in urban areas and 11% in rural areas.
By employment status, two-fifths of participants reported to be employed and 15% unemployed. One-fifth of participants were retired or home-makers, of which 75% were women. Finally, there were no significant differences in relation to employment status between rural and urban populations.
Domain one: prevalence of alcohol consumption
This survey reveals that approximately 50% of males and 30% of females were current drinkers of alcohol (MOR 3.6), confirming the findings of the 2009 STEPS (Additional file 2: Table S2) .
Disaggregated by age, the highest alcohol consumption rates were observed among those 25-34 years at 52% (MOR 2.1). The occurrence of youth drinking (15-24 years) was lower than in older age groups, with approximately one in five younger Mongolians drinking alcohol. Interestingly, drinking rates in the youngest urban populations were almost twice as high as compared to rural counterparts. Indeed, 34.8% (28.8-40.8) of males and 24.9% (20.0-30.0) of females were current drinkers, as compared to 19.5% (14.7-24.3) of males and 11.0% (7.5-14.5) of females in this age group in rural areas (data not shown).
Domain two: prevalence of risky drinking practices among Mongolians
Following, current drinkers were questioned on risky drinking practices. Questions based on the CAGE clinical assessment tool probed alcohol consumption in the morning, and explored the participants’ own perceptions around their need to reduce their alcohol intake [20, 21] (Additional file 3: Table S3). Other questions aimed to identify the prevalence of current drinkers having driven a car while under the influence of alcohol.
With an increase in road traffic accidents in Mongolia , participants who drive a vehicle were asked whether they had ever driven under the influence of alcohol (Additional file 3: Table S3 and Additional file 4: Table S4). As a result, 15% of current drinkers who drive a vehicle reported having driven while influenced by alcohol, with one in five males and around one in thirteen females (MOR 4.1) acknowledging this behavior. No differences were found by location, education, employment or age (Additional file 4: Table S4).
To further gauge the level of risky practices, and reflecting the CAGE clinical tool for assessing problematic alcohol consumption, current drinkers were asked two additional questions: whether they had consumed alcohol between waking in the morning and lunchtime in the past month, and whether they had considered the need to reduce their own alcohol intake (Additional file 5: Table S5) .
Among males, almost one-third of current drinkers reported morning drinking in the past month, compared with one in eleven women (p < 0.01). When questioned about their need to reduce their alcohol intake, 24% of all males and 6% of females current drinkers reported both morning drinking and the perception that they needed to cut down their alcohol intake (MOR 5.0, p < 0.01).
Comparing urban and rural men, morning drinking was more prevalent among the former at 25.0% (21.3 - 28.7) and 16.2% (13.6 - 18.6) respectively (p < 0.05), and whilst highest in the oldest age group (25%, 18.7 – 31.3), the 25-34 year age group was most at-risk when other variables were controlled (MOR 2.0, P = 0.04).
Domain three: risk perceptions of the general public towards daily drinking
The harms of daily alcohol consumption were generally perceived to be high among participants of this survey. More than 90% of respondents stated that they regard daily alcohol consumption as either ‘harmful’ or ‘very-harmful’ to health (data not shown).
There was no significant difference in mean perceived risk by age, education level or sex; nevertheless, urban dwellers on average regarded daily drinking to be more harmful than their rural counterparts. This urban-rural difference in perceived risk of daily drinking was small, but significant (harmful with a mean of 2.0 and moderately-harmful of 1.8 respectively, p < 0.01).
Finally, exploring the relationship between risk perception and risky drinking practices (represented by morning drinking), current drinkers who felt daily alcohol drinking was slightly harmful, as compared with very harmful, were more likely to engage in risky drinking practices (MOR 3.7, 1.1 – 12.3) (Additional file 6: Table S6).
Domain four: awareness of heavy episodic drinking as a public health concern
Nine out of ten respondents either agreed or strongly agreed that heavy episodic drinking of alcohol is common among Mongolians.
There was no significant difference in awareness for men and women or across age groups (Additional file 7: Table S7). However, higher levels of education, being retired and urban dwelling were significantly associated with heightened levels of awareness (p < 0.05).
Domain five: the major social, cultural and psychosocial drivers of heavy episodic drinking
‘Celebrations’ (91%, 89.5 - 92.2) as well as ‘Drinking with friends or family’ (87.1%, 85.4 – 88.3) were the most common reason for engaging in heavy episodic drinking among respondents. There were no significant differences between men and women (Additional file 8: Table S8).
Rural Mongolians were more likely than their urban counterparts to drink following receiving income at 51.6% (49.2 – 54.0) and 47.5% (45.1 – 49.1) respectively, while urban Mongolians tended to more commonly do so ‘with friends or family’ and during ‘celebrations’.
In terms of age, youth (15-24 years) were most likely to cite ‘customs or traditions’ as the reason for engaging in heavy episodic drinking, as volunteered by 67.1% (64.3 – 69.9) of these participants.
Participants were also asked, in an unprompted fashion, to list commonly used methods for psychological stress management in their everyday life (Additional file 9: Table S9). Common answers included exercise and talking with friends. Remarkably, almost one in ten men listed ‘alcohol’, while less than one in one hundred women did so (MOR 20). Furthermore, urban participants were almost three-times more likely to list alcohol as a stress reduction technique than their rural counterparts (MOR 2.6). Finally, participants aged 35 – 44 years (MOR 3.3) and those unemployed (OR 2.8) were also more likely to list alcohol use as a coping mechanism for psychological stress.