The Differences in Alcohol Use between Urban and Rural Students of Inner Mongolia Medical University , China

Objective: The purpose of this study was to evaluate the difference in alcohol use between urban and rural students of Inner Mongolia Medical University. Methods: A cross-sectional census was conducted on medical students on campus in 2013. We use multivariate logistic regression models to assess the factors associated with alcohol use. We further use chi-square test assess on differences in alcohol use between urban and rural people among significance factors in logistic regression models. Results: The prevalence of alcohol use among students in rural area was higher than that in urban area (p = 0.016). Alcohol use was associated with Gender, monthly expenses, residence, ethnic and faculty. The odds of alcohol use for Mongolia students were 1.139 times higher than that for Han students. The prevalence of alcohol consumption among students from pharmacy or Traditional Chinese Medicine and Mongolian Medicine faculties in rural area was higher than that among student in urban area (p = 0.03; p = 0.001). The prevalence of alcohol use among female students in rural area was higher than that among female students in urban area (p < 0.043). The proportion of alcohol use among students with <600 in rural area was higher than that among students in urban area (p < 0.001). Conclusion: Considering the differences in the prevalence of alcohol use between rural area and urban area, university administrators aiming at students from various regions develop various approaches.


Introduction
Alcohol use between adolescent has been widely proclaimed as a significant public health problem [1].Young adulthood is the stage of life in which the highest levels of alcohol use occur [2] [3].After entering university, a student's life situation changes, and he or she experiences increased independence, decreased parental guidance, supervision and support, and more social contacts with peers on the university campus [4].Alcohol use is the result of the interaction between personal, environmental and sociodemographic factors [5].Although there are a number of other risks and protective factors associated with alcohol consumption in young adults, the scope of our analysis covers a subset of sociodemographic variables such as gender, year of study, socioeconomic status [4], and ethnic [6], which are linked to, and seem to be specifically important for, the university environment.In different regions, alcohol use varies [7].It was reported that there were differences of alcohol use between urban and rural area and rural adolescents were more likely to use alcohol than their peers in urban area [8] [9].Studies suggest that youth in rural area are more likely than youth in urban area to begin drinking at an early age and to engage in binge and heavy drinking and driving while intoxicated [10] [11].The different between rural and urban area was also performed in some other aspects in Inner Mongolian medical university, such as breakfast consumption [12], overweight [13] and distress [14].Therefore, furthermore to study the difference in alcohol use for urban and rural.These results will help university administrators aiming at students from different regions (urban and rural) to develop different approaches.

Methods
A cross-sectional survey was conducted among medical students in the Inner Mongolia Medical University of China in 2013.We recruited students who were living on campus at the time of the survey.In this university, the duration of undergraduate study is 4 or 5 years.Some of these students have internships in the final or last 2 years of their courses, which are conducted off campus.Students who were completing internships and living off campus were not included in the investigation [15].
This study involved a self-administered questionnaire.Field workers from IMMU were trained to administer the survey.Students completed the questionnaires in the classroom.Informed consent was obtained from all participants, who were informed about the aim and design of our study, and assured that participation was voluntary.When students filled out the questionnaire, they returned the questionnaire in a sealed envelope to field workers [12].
Alcohol use was defined as one consumed any kinds of alcoholic beverage at least 12 times last year [16].Urban area was defined as the cities or suburbs; and rural area was defined as the villages or pastoral areas [14].
Data was recorded with EpiData (Epi-Data Association, Denmark; v3.1).The age of the students was expressed as the mean age and standard deviation (SD).We used multivariate logistic regression models to assess the factors associated with alcohol use.In the binary logistic regression models, alcohol use was introduced as the dependent variables and independent variables included in the model were year of study (years 1 -5), monthly expenses (<300 CNY, 300 -600 CNY, 600 -1000 CNY, >1000 CNY), residence (urban, rural), ethnic (Han, Mongolia and other minority), faculty (Clinical Medicine, Public Administration and Information Management, pharmacy, Traditional Chinese Medicine and Mongolian Medicine, other).Results are provided as odds ratios (OR) with 95% confidence intervals (CI).We further use chi-square test to assess alcohol use differences between urban and rural area among significance factors in logistic regression models.Statistical analysis was carried out by using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA, v13.0).A P-value < 0.05 was considered statistically significant.
Ethical approval to conduct the study was obtained from the Ethical Committee of Inner Mongolia.

Results
6104 students responded to the question about alcohol use in 6109 participants (response rate = 99.9%).There were 1668 male respondents (27.3%) and 4436 female (72.7%) respondents.The average age was 21 ± 1.5 years old.The overall prevalence of alcohol use was 55.3%.The prevalence of alcohol use in rural area (56.6%) was higher than that in urban area (53.5%).(p = 0.016).Table 1 showed the results of the multivariate logistic regression models.Based on these analyses, we found out that alcohol use was associated with gender, ethnic, monthly expenses, residence and faculty.The odds of alcohol use were 1.264 times higher for students in rural area than those in urban area and the odds of alcohol use were 1.139 times higher for Mongolia students than those for Han students.Figure 1 showed the differences of alcohol use between urban and rural area among different faculties.The prevalence of alcohol use among students from pharmacy or Traditional Chinese Medicine and Mongolian Medicine faculties in rural area was about 8% higher than that in urban area (p = 0.03; p = 0.001).However, there was no significantly difference in alcohol use prevalence between urban and rural area in other three faculties (p > 0.05).
Figure 2 showed the differences in proportion of alcohol use for students with various monthly expenses between urban and rural area.The proportion of alcohol use among students whose monthly expenses were less than 600 CNY in rural area was higher than that in urban area (p < 0.001).The proportion of alcohol use among students whose monthly expenses were more than 1000 CNY in rural area was lower than that in urban area (p < 0.001).
Figure 3 showed the prevalence of alcohol use for students with different genders between urban and rural area.The prevalence of alcohol use among female students in rural area was higher than that in urban area (p < 0.043).There was no significantly difference in breakfast use prevalence between urban males and rural males (p > 0.05).

Discussion
Our study shows that the prevalence of alcohol use in rural area was higher than that in urban area.Similarly, in Australia, alcohol use is more prevalent in rural area than urban area [17].A study revealed the reason why adolescents from rural area were at higher risk of alcohol use was likely that rural adolescent and peer attitudes regarding alcohol use are influenced by lower levels of parental less disapproval of adolescent alcohol use and the higher tolerance for alcohol use in rural communities [9].Although there are significant difference in the prevalence of alcohol use between rural and urban area (56.6% vs 53.5%), the difference is small.The prevalence of alcohol use among students who major in pharmacy or come from Traditional Chinese Medicine and Mongolian Medicine faculties in rural area was higher than that in urban area.The reason of the urban-rural difference is that the proportion of Mongolia students come from pharmacy or Traditional Chinese Medicine and Mongolian Medicine faculties in rural area is far higher than that in urban area and Mongolia is also associated with increasing odds of alcohol use in our study.It is well known that Mongolians have drinking culture that more likely to drink [18].
Both in rural and urban area, the prevalence of alcohol use for males is higher than that for females in our study.A research indicates that no matter which countries they are from and what cultures they have, males are more likely to drink alcohol [19].In our study, we also find out that there is no significant urban-rural difference in the prevalence of alcohol use among males.This is similar with the study in South Africans [20].Whereas, the prevalence of alcohol use among female students in rural area is higher than that in urban area.
The proportion of alcohol use among students with lower expenses in rural area was higher than that in urban area.It is reported that economic strain and life stress predicted symptoms for lower-income families in rural area [21] and stress induced drinking [22].On the contrary, the proportion of alcohol use among students with higher expenses in rural area was lower than that in urban area.Some literatures revealed that drinking is perceived as the most effective way of providing social support, and high-income urban people more like to social and increased social drinking occasions [23].

Conclusion
There was urban-rural difference in the prevalence of alcohol use.It is well-known that Mongolians like to drink.Mongolia students who major in pharmacy or come from Traditional Chinese Medicine and Mongolian Medicine faculties in rural area are more than in urban area which leads to their higher prevalence of alcohol use than those in urban area.Life level of students also impacts on urban-rural difference in alcohol use.

Figure 1 .
Figure 1.Prevalence of alcohol consumption for various faculties students between urban and rural.

Figure 2 .
Figure 2. Proportion of alcohol consumption for various monthly expenses students between urban and rural.

Figure 3 .
Figure 3. Prevalence of alcohol consumption for various genders students between urban and rural.

Table 1 .
Evaluation of factors for alcohol consumption by multivariate logistic regression analysis.