Sexual Behavior, Substance Use, and Psychosocial Factors Among Mongolian University Students

Abstract

While Mongolian university students have been exposed to rapid sociocultural changes, also shifting their sexual norms and substance use behaviors, there is limited empirical evidence on them. Therefore, we examined associations between substance use (smoking, drinking, illicit drug use), sexual behaviors (sexual intercourse, casual and unprotected sex), sexual beliefs, social support, and psychological factors (self-efficacy, optimism, and general well-being). Using a cross-sectional design, we employed self-administered online questionnaires in a sample of Mongolian undergraduate students (N = 396; aged 18–24 years; 49.2% males). More than 62% reported ever drinking, 40.4% ever smoking, 23.0% illicit drug use; 64.9% was the lifetime prevalence of sexual intercourse, 41.2% reported engagement in casual sex, and 29.5% had engaged in unprotected sex. Differences by sex were significant with a higher prevalence among males, except for current illicit drug use and unprotected sex. Substance use was significantly associated with an increased likelihood of having sexual intercourse and participating in casual sex. While higher levels of well-being, self-efficacy, optimism, and social support from family and friends were significantly linked to ever being engaged in sexual intercourse, these positive constructs did not prevent them from risky sexual behaviors. Sex differences in substance use, sexual behaviors, and beliefs support the influence of the prevailing social expectations and traditional gender role perceptions in Mongolia. These findings emphasize the importance of comprehensive health education and supportive psychosocial environments.

1. Introduction

The university experience is widely recognized as a critical, transformative, and foundational developmental stage that acts as a bridge between adolescence and adulthood. University years are a critical period where health behaviors frequently shift, often worsening due to lifestyle changes. As young people move into adulthood, they experience increased independence and reduced parental supervision, which is often accompanied by a heightened likelihood of engaging in risky behaviors such as substance use and sexual activity (Arsandaux et al., 2020; Ayalew et al., 2018; Guan, 2021). In addition, substance use and sexual activity among young people are closely interrelated, and these behaviors increase the risk of facing multiple negative outcomes related to physical health (e.g., sexually transmitted infections, unintended pregnancy) and mental health (e.g., depression, anxiety) (Cho & Yang, 2023; Lo et al., 2019).

Sexual behavior and attitudes among youths are shaped by a wide range of factors. In addition to individual characteristics such as personal beliefs, cultural norms, religious values, influences from school, parents, and peers play significant roles. Furthermore, psychological well-being, socioeconomic conditions, social influences, and physical health status have been shown to significantly affect sexual decision-making and behavior among young people (Guan, 2021; Jahanfar & Pashaei, 2022; K. Y. Kim & Shin, 2022). Recent studies have also reported that, compared to other population groups, young people account for a higher proportion of exposure to sexually transmitted infections and sexual risk behaviors (Reeves et al., 2024). Consequently, emphasizing that sexual and reproductive health among the youth remains a priority area within public health research and policy.

1.1. Sexual Behavior Among Mongolian Young People

Recent studies show that Mongolian youth face similar challenges related to sexual risk behaviors and substance use. As a recent study found, Mongolian adolescents and college students reported a high level of alcohol consumption but an insufficient awareness regarding alcohol-related harms (Dashpuntsag et al., 2021). The prevalence of tobacco use and heavy drinking also increased during the past decades among Mongolian youth (Pengpid & Peltzer, 2022). Substance use among Mongolian youth shows clear sex differences, with substantially higher prevalence among males than females. Age-related differences are also evident, as substance use increases sharply during young adulthood as compared to adolescence (UNFPA, 2025). Mongolia has a high prevalence of sexually transmitted infections, particularly among young people, whose rates are considerably higher than those observed in other age groups (Badrakh et al., 2017; Choi & Huh, 2021). Sexually transmitted infections are widespread in Mongolia as a result of risky sexual behaviors (J. Kim & Hyun, 2021). Additionally, 4.7% of abortions in 2024 happened among those under the age of 20 and 60.0% for those aged 20–34 years (Health Development Center, 2025; National Statistics Office of Mongolia, 2025a).

For approximately the past 20 years, cohabitation and non-marital relationships during university years have been regarded as more accepted in parallel with a decline in traditional cultural attitudes that required women to be virgins at marriage (Roberts et al., 2005; Terbish, 2013; UKEssays, 2018). As a result, these circumstances have contributed to a situation in which young people experience changes in their sexual behaviors (Badrakh et al., 2017; Choi & Huh, 2021; J. Kim & Hyun, 2021). Studies have also highlighted that Mongolian university students possess relatively low levels of knowledge regarding sexual and reproductive health, particularly in areas related to sexual risk behaviors and their negative consequences (Badrakh et al., 2017; Choi & Huh, 2021; J. Kim & Hyun, 2021; Mundur et al., 2017). On the other hand, although Mongolian university students tend to have relatively open sexual attitudes, some limitations related to cultural and personal values remain, and a positive association has been found between sexual knowledge and sexual attitudes (J. Kim & Hyun, 2021). While the Ministry of Health and the Ministry of Education in Mongolia introduced a school-based health education curriculum in 2018 (UNFPA, 2025), at present, there is an absence of health education programs specifically designed for university students, particularly in the realm of sexual health education.

Thus, comprehensive research on university students’ health risk behaviors (e.g., substance use and risky sexual behaviors) and mental health is critically needed to support the design and implementation of evidence-based prevention and health education interventions. Despite the growing amount of research on university students’ health risk behaviors in Mongolia, significant gaps still remain in the exploration of individual, social, and psychological factors as correlates of these behaviors. Our study aims to fill these existing gaps by exploring the prevalence of health risk behaviors among university students in Mongolia as well as examining the relationships of these behaviors to social support and other psychosocial factors.

1.2. Sexual Behavior and Substance Use

Research among university students has shown that substance use is closely linked to risky sexual behaviors, such as early initiation of sexual activity, inconsistent condom use, and having multiple sexual partners (Adal et al., 2024; Bryan et al., 2012; Cho & Yang, 2023; Hlahla et al., 2024, Jahanfar & Pashaei, 2022). Problem behavior theory suggests that behaviors like alcohol consumption, smoking, and risky sexual activity share a common psychological background, contributing to the tendency for these behaviors to occur together (Jessor & Jessor, 2016). Using this framework helps us understand why university students who engage in substance use are more likely to engage in early sexual activity, practice unsafe sex, or have multiple partners (Jahanfar & Pashaei, 2022; Rizk et al., 2025). Additionally, substance use can impair cognitive functioning by narrowing focus to immediate situations instead of considering long-term consequences (Gasparyan et al., 2023). This reduced consideration of potential risks increases the likelihood of engaging in risky sexual behaviors among the youth (Rizk et al., 2025).

1.3. Sexual Behavior and Sexual Beliefs

University students’ sexual behavior is determined by individual cognitive processes as well as by social and cultural contexts, sexual attitudes and beliefs being key determinants among them (Guan, 2021; Lin et al., 2021). Beliefs about the acceptability of sexual intercourse and its consequences are capable of predicting both behavioral intentions and actual behavior. In particular, permissive or approving attitudes are associated with earlier sexual initiation, a higher number of sexual partners, and the inconsistent use of protective resources, whereas protective attitudes are associated with delayed sexual debut and safer sexual behavior (Fahey et al., 2024; Jahanfar & Pashaei, 2022). The interaction between personal beliefs and behavioral attitudes is supported by religiosity, which may play a significant role in shaping sexual behavior (Durham & McKinney, 2025; Koletić et al., 2023). Students with stronger religious commitment are more likely to support conservative sexual beliefs, initiate sexual activity at a later age, and report fewer sexual partners (Durham & McKinney, 2025; Fahey et al., 2024). Additionally, sex and gender also influence sexual beliefs and behaviors. Some studies show that gender expectations and social norms impact how male and female students express their sexual beliefs and behavior (Durham & McKinney, 2025). For example, in certain cultures boys are expected to demonstrate active sexual behavior and may feel pressure to have multiple partners, whereas girls are typically expected to embody modesty and may face social stigma and a loss of dignity if they engage in sexual activities (Hegde et al., 2022; Tseng et al., 2021; Vasilenko, 2022). Cultural and social norms further condition sexual beliefs, while ethnic identity and cultural values affect both normative beliefs and behavioral outcomes (Lahoz-García et al., 2025; Tseng et al., 2021; Vasilenko, 2022).

1.4. Psychological Variables and Sexual Behavior

Several psychological variables are also associated with risky sexual behavior either as a protective or predisposing factor; in particular those with inadequate psychological protection are vulnerable to engaging in risky sexual behavior (Ferrer-Urbina et al., 2022; Mollaei et al., 2023). Young people with lower levels of psychological well-being are more likely to engage in casual sexual intercourse, have multiple sexual partners, and unprotected sexual intercourse (Dubé et al., 2017; Owen et al., 2010). Conversely, positive psychological constructs (e.g., self-efficacy, well-being, and optimism) serve as strong protective factors against health risk behaviors and unprotected sex (Dębska-Janus et al., 2025; Torregosa & Patricio, 2022). Self-efficacy, resilience, or optimism, as important elements of positive psychological capital, can play a decisive role in young people’s psychosexual health (Luo et al., 2025). Self-efficacy promotes the adoption of healthy behaviors and the refusal of risky sexual behaviors, including negotiating condom use, declining unwanted sexual advances, and maintaining personal sexual boundaries (Brasileiro et al., 2021; de Vries et al., 2024). In addition, optimism can contribute to responsible sexual behaviors and healthy relationships, and thus, more positive sexual experiences (Rincón Uribe et al., 2022). However, we should also note here that unrealistic optimism may lead to biased estimation of health risks. For example, college students showing unrealistic optimism reported lower risk of unintended pregnancy, HIV and other STIs, and lower likelihood of sexual engagement with multiple partners in the near future as compared with an average college student (Lopez & Leffingwell, 2020).

Besides individual psychological factors, the quality of family functioning and social support from both family members and friends may not only act as informal educators but also help the students with emotional guidance (Garcia Saiz et al., 2021; Muraleetharan & Brault, 2023).

1.5. The Present Study

The present study aims to explore the prevalence of health risk behaviors among university students in Mongolia as well as to examine the relationships of these behaviors with social support and other psychosocial factors. Specifically, we examine associations between substance use (smoking, drinking and illicit drug use), sexual risk behaviors (sexual intercourse, casual and unprotected sex), sexual beliefs, social support, and psychological factors (general self-efficacy, optimism, and well-being). Furthermore, our study analyzes how these variables vary by sex, substance use status, and sexual activity. While Mongolian university students are exposed to rapid sociocultural changes, including increased urbanization, shifting sexual norms, and expanding access to health information, there is limited empirical evidence on these psychosocial factors in relation to their substance use and sexual behavior. Therefore, logistic regression analyses were applied to detect the role of each independent variable (i.e., measures of substance use, sexual beliefs and psychological variables) in increasing or decreasing the odds of student sexual behaviors (i.e., lifetime prevalence of sexual intercourse, casual and unprotected sex) as dependent variables. Age and sex were also tested in these analyses. By examining these associations, this study aims to enhance our understanding of health-related risk and protective factors among them and to provide an empirical basis for developing health education and prevention programs in higher education.

2. Materials and Methods

2.1. Design

We used a cross-sectional design and employed a self-administered online questionnaire to examine substance use, sexual behavior, and psychosocial factors among university students in Mongolia. As part of a multilevel and multipurpose research project detecting Mongolian youth’s health risk behaviors, we plan to provide a wide range of data to be collected from adolescents to young adults (Uuganbayar & Piko, 2025).

2.2. Participants

The study participants were selected from 14 public universities in Mongolia. Universities were selected to ensure coverage of a wide spectrum of academic disciplines, including law, economics, science and technology, medicine, defense, agriculture, engineering, and the arts (i.e., the Mongolian National University of Education, the National University of Mongolia, the Mongolian University of Science and Technology, the National Defense University, and the Mongolian National University of Medical Sciences). The study employed a multi-stage sampling strategy (i.e., purposive selection of universities followed by cluster sampling within institutions), with the primary sampling units being the universities. Inclusion criteria were the following: (1) age as 18 years or older; (2) active enrollment in a bachelor’s degree program (years 1–6); and (3) provision of informed consent. Students were excluded from participation if they were enrolled in non-bachelor programs (such as master’s, doctoral, preparatory, or exchange programs), were under 18 years of age, refused to participate, failed to provide informed consent, or submitted incomplete questionnaires or ones with logically inconsistent responses. During the data cleaning process, 8 cases were excluded due to missing data and logically inconsistent responses (e.g., male students reporting pregnancy or participants reporting no lifetime sexual activity while indicating engagement in casual sexual encounters). The final analytical sample comprised 396 undergraduate students aged 18–24 years (M = 20.78, SD = 1.75, 49.2% males and 50.8% female). Among those aged 24 years, the majority were students in their fifth and sixth years at the Mongolian National University of Medical Sciences. Age difference by sex was not significant (males: M = 20.91, SD = 1.54 years; females: M = 20.67, SD = 1.94 years; p > 0.05).

2.3. Procedure

Data were collected using a self-administered online questionnaire from 15 September to 11 November during the 2025–2026 autumn academic year. The study instruments were translated into Mongolian using a standardized forward–backward translation procedure conducted by bilingual specialists. As this was the first study in Mongolia to use several applied measures, additional steps were taken to ensure linguistic clarity and cultural appropriateness. A professional English–Mongolian translator and a Mongolian language teacher reviewed the translated questionnaire. The survey link was shared via university email lists and student online platforms (e.g., LMS, social media groups), allowing participants to complete the questionnaire independently and anonymously. The questionnaire took approximately 15–20 min to complete. Clear instructions highlighted voluntary participation, ensured anonymity, and encouraged honest responses based on personal experiences. Informed consent was obtained electronically prior to participation. Ethical approval for this study was obtained from the Institutional Review Board of the Doctoral School of Education, University of Szeged. Participation in this study was voluntary and anonymous. We emphasize that data collection would be anonymous and that no personal information would be used in publications.

2.4. Instruments

This study’s measurements included demographic factors (age and sex), sexual risk behaviors (sexual intercourse ever, casual sex ever, unprotected sex ever), substance use (both lifetime and last-month prevalence of drinking, smoking, and illicit drug use). In addition, we also applied scales for measuring sexual beliefs, social support, and psychological factors (general self-efficacy, optimism, and general well-being).

As part of the measurement of sexual behavior, participants were asked three questions. The first question was, “Have you ever had sexual intercourse (sometimes this is called “making love,” “having sex,” or “going all the way” or [other appropriate colloquial terms])?”. The participants provided replies in a dichotomous format (yes or no). The second question focused on casual sex ever. Participants were asked, “Have you ever engaged in casual sexual intercourse?”. Responses were evaluated on a dichotomous form, with “yes” or “no”. The third question was, “Have you ever engaged in unprotected casual sexual intercourse (without using a condom)?”. Participants were provided with the following response options: “yes, two or more times”, “yes, once”, and “no”.

Substance use was measured in two ways: lifetime and the past 30 days, using the Health Behaviour in School-aged Children (HBSC) study (Inchley et al., 2018) and the European School Survey Project on Alcohol and Other Drugs (ESPAD) study (ESPAD Group, 2020). These items were previously translated and adapted into the Mongolian language, similar to the psychological scales (Uuganbayar & Piko, 2025). Participants selected the response that best described their use for each time frame. Participants were presented with response options: never, 1–2 days, 3–5 days, 6–9 days, 10–19 days, 20–29 days, 30 days or more. In our study, due to the relatively low percentages, the dichotomized prevalence rates (yes/no) were used.

Sexual behavioral beliefs were assessed using the Integrative Model (IM) Belief Measures (Bleakley et al., 2009; Uuganbayar & Piko, 2025). These beliefs can be evaluated on 7-point scales ranging from 1 (extremely unlikely) to 7 (extremely likely). Each assessment is preceded by the stem: “If I were to engage in sexual intercourse within the next 12 months, it would…”. In total, there are 12 items that have been grouped into 4 categories (with 3 items each) for the purpose of analysis. These categories encompass beliefs related to different aspects: beliefs about oneself (e.g., “Make me feel as though someone had taken advantage of me”); beliefs about relationships with partners (e.g., “Increase the quality of relationship with my partner”); beliefs about relationships with others, e.g., friends (e.g., “Gain the respect of my friends”); and beliefs about physical outcomes (e.g., “Give me a STD, HIV/pregnancy”, reverse item). Cronbach’s alphas for the subscales were the following: self (α = 0.77); partners (α = 0.89); others (α = 0.89); and physical (α = 0.91).

Students’ general well-being was measured using the 5-item version of the WHO Well-Being Questionnaire (WBI-5) (Topp et al., 2015). The questionnaire includes five statements (e.g., “I have felt calm and relaxed”) about the students’ feelings during the past two weeks. Responses were measured on a 4-point Likert-type scale from 0 to 3, evaluating the summarized scores, where a greater level of well-being was based on higher scores. The reliability coefficient (Cronbach’s alpha) was α = 0.93 with this sample.

The General self-efficacy was measured using the General Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1995). This scale is a self-report measure of self-efficacy, consisting of 10 items. Responses were evaluated on a 4-point Likert-type scale from “not at all true” to “exactly true”. The reliability coefficient (Cronbach’s alpha) was α = 0.87 with this sample.

The Life Orientation Test-Revised (LOT-R) (Scheier et al., 1994) was applied to evaluate levels of optimism. The students were asked to indicate how strongly they agreed with each of the 10 statements in the questionnaire. Responses were evaluated on a 5-point Likert-type scale from “strongly disagree” to “strongly agree”. The Cronbach’s alpha coefficient of reliability for this sample was 0.70.

The Multidimensional Scale of Perceived Social Support (MSPSS) measured the students’ social support (Zimet et al., 1988). The scale assesses social support in three dimensions, in this study two of them have been applied: friend support (4 items, e.g., “My friends really try to help me”), and family support (4 items, e.g., “I get emotional help and support I need from my family”). The students were asked to indicate how strongly they agree with each statement of the questionnaire. Responses were evaluated on a 5-point Likert-type scale from “strongly disagree” to “strongly agree”. Higher scores reflect higher levels of social support. In our study, the subscales were reliable with the following Cronbach’s alphas: family support (α = 0.82); friend support (α = 0.79).

2.5. Data Analysis

IBM SPSS Statistics for Windows, Version 25.0 (Armonk, NY, USA: IBM Corp., 2017) was used for the calculations, with the level of statistical significance set at p < 0.05. Group differences were assessed using independent samples t-tests (Welch correction when variances were unequal), while categorical variables were compared using chi-square tests. Bivariate logistic regression analyses (calculating Odds Ratio and 95% Confidence Intervals) and Pearson correlation coefficients were used to examine associations among substance use, psychological variables, sexual beliefs, and sexual behaviors.

3. Results

3.1. Descriptive Statistics for Substance Use Prevalence and Sexual Behavior

Table 1. Percentage of substance use prevalence and sexual behavior by sex.

	Total N = 396 n (%)	Males N = 195 n (%)	Females N = 201 n (%)	Chi-Square p-Value
Lifetime prevalence of drinking	249 (62.9)	149 (76.4)	100 (49.8)	30.137 p < 0.001
Three-month prevalence of drinking	138 (34.8)	89 (45.6)	49 (24.4)	19.709 p < 0.001
Lifetime prevalence of smoking	160 (40.4)	103 (52.8)	57 (28.4)	24.597 p < 0.001
Three-month prevalence of smoking	96 (24.2)	63 (32.3)	33 (16.4)	13.607 p < 0.001
Lifetime prevalence of illicit drug use	91 (23.0)	58 (29.7)	33 (16.4)	9.930 p = 0.002
Three-month prevalence of illicit drug use	24 (6.1)	10 (5.1)	14 (7.0)	0.587 p = 0.444
Sexual intercourse ever	257 (64.9)	152 (77.9)	105 (52.2)	28.720 p < 0.001
Casual sex ever	163 (41.2)	108 (55.4)	55 (27.3)	11.540 p = 0.001
Unprotected sex ever	117 (29.5)	77 (39.5)	40 (19.9)	0.037 p = 0.848

presents lifetime and three-month prevalence rates of drinking, smoking, and illicit drug use. A total of 62.9% of the students reported having used alcohol at some point in their lives, with a significantly higher prevalence among males compared to females (χ²(1, N = 396) = 30.137, p < 0.001). In the past three months, 34.8% of the students indicated that they had consumed alcohol, again showing a higher rate among males than females (χ²(1, N = 396] = 19.709, p < 0.001).

In terms of smoking, the lifetime prevalence was 40.4% and the three-month prevalence was 24.2%. Statistical analysis indicated that both lifetime and recent smoking were significantly more common among males than females. Specifically, the lifetime prevalence of smoking showed a significant association with sex (χ²(1, N = 396) = 24.597, p < 0.001), as did the three-month prevalence of smoking (χ²(1, N = 396) = 13.607, p < 0.001).

Regarding illicit drug use, 23.0% of the students reported lifetime drug use, with higher rates observed among males compared to females (χ²(1, N = 396) = 9.930, p = 0.002). However, three-month illicit drug use was relatively low (6.1%), and there was no significant difference by sex (p = 0.444).

Overall, 64.9% of students reported having had sexual intercourse, with a significant difference between sexes: 77.9% of males compared to 52.2% of females (χ²(1, N = 396) = 28.720, p < 0.001). Among those who were sexually active, 41.2% reported having casual sex, which was also more prevalent among males than females (χ²(1, N = 396) = 11.540, p = 0.001). Of these individuals, 29.5% reported having unprotected sex, with no significant difference observed between males and females (p = 0.848).

3.2. Descriptive Statistics for the Psychological Scales and Sexual Beliefs

Table 2. Descriptive Statistics for Study Scales and Sex Differences (N = 396).

	Minimum– Maximum	Total M (SD)	Male M (SD)	Female M (SD)	t-Test p-Value
General well-being	5–30	19.26 (6.00)	20.36 (4.86)	18.19 (6.77)	3.644 p < 0.001
Self-efficacy	10–40	29.14 (6.41)	30.54 (6.12)	27.78 (6.41)	4.375 p < 0.001
Optimism	12–29	20.90 (3.47)	21.26 (3.42)	20.55 (3.49)	2.026 p = 0.043
Social support from family	4–20	14.15 (4.04)	14.68 (3.71)	13.64 (4.28)	2.580 p = 0.010
Social support from friends	4–20	14.97 (3.71)	15.96 (3.35)	14.00 (3.79)	5.443 p < 0.001
Self-respect	3–21	14.79 (4.90)	14.82 (4.32)	14.76 (5.41)	0.130 p = 0.896
Partner’s positive feelings	3–21	15.09 (3.38)	16.00 (3.39)	14.21 (3.13)	5.449 p < 0.001
Others’ positive opinion	3–21	11.82 (2.58)	12.31 (2.02)	11.36 (2.96)	3.680 p < 0.001
Negative physical consequences	3–21	12.14 (5.43)	11.59 (4.25)	12.66 (6.34)	−1.961 p < 0.049

Notes: Student’s t-test.

shows the results for psychological scales, social support and sexual behavioral belief variables by sex. Analyses showed that, compared to females, males reported significantly higher levels of well-being (t(394) = 3.644, p < 0.001), self-efficacy (t(394) = 4.375, p < 0.001), and optimism (t(394) = 2.026, p = 0.043). Moreover, social support from both family (t(394) = 2.580, p = 0.01) and friends (t(394) = 5.443, p < 0.001) was higher among male students.

In terms of sexual beliefs, no significant differences in self-respect were found between sexes (p = 0.896). Male students scored higher on partners’ positive feelings (t(394) = 5.449, p < 0.001) and on others’ positive opinions (t(394) = 3.680, p < 0.001). Conversely, female students reported greater worries about the negative physical consequences (t(394) = −1.961, p = 0.049).

3.3. Associations Between Substance Use and Sexual Behavior

Table 3. Bivariate logistic regression estimates (OR) of the students’ sexual behavior I. Substance use and sociodemographics as correlates (N = 396).

	Sexual Intercourse Ever		Casual Sex Ever		Unprotected Sex Ever
Substance Use and Sociodemographics	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value
Lifetime prevalence of drinking (No = 1.00)	1.51 (0.22)	4.47 (2.87; 6.95) p < 0.001	0.93 (0.29)	2.52 (1.43; 4.44) p = 0.001	−0.09 (0.45)	0.91 (0.37; 2.22) p = 0.834
Three-month prevalence of drinking (No = 1.00)	0.97 (0.24)	2.63 (1.64; 4.23) p < 0.001	0.91 (0.27)	2.49 (1.47; 4.21) p = 0.001	−0.07 (0.35)	0.93 (0.47; 1.84) p = 0.841
Lifetime prevalence of smoking (No = 1.00)	1.14 (0.23)	3.14 (1.98; 4.98) p < 0.001	1.07 (0.26)	2.92 (1.74; 4.91) p < 0.001	0.59 (0.35)	1.81 (0.91; 3.60) p = 0.091
Three-month prevalence of smoking (No = 1.00)	0.99 (0.28)	2.70 (1.55; 4.69) p < 0.001	0.70 (0.29)	2.02 (1.13; 3.60) p = 0.017	0.53 (0.39)	1.71 (0.80; 3.64) p = 0.166
Lifetime prevalence of illicit drug use (No = 1.00)	0.90 (0.28)	2.46 (1.41; 4.28) p = 0.002	1.16 (0.32)	3.20 (1.70; 6.04) p < 0.001	0.46 (0.38)	1.59 (0.75; 3.33) p = 0.223
Three-month prevalence of illicit drug use (No = 1.00)	1.05 (0.56)	2.85 (0.95; 8.51) p = 0.061	−0.41 (0.46)	0.67 (0.27; 1.63) p = 0.343	0.61 (0.80)	1.83 (0.38; 8.83) p = 0.450
Age (Cont.)	0.57 (0.07)	1.76 (1.53; 2.03) p < 0.001	0.16 (0.08)	1.17 (0.99; 1.37) p = 0.057	0.15 (0.13)	1.16 (0.91; 1.50) p = 0.232
Sex (Male = 1.00)	−1.17 (0.22)	0.31 (0.20; 0.48) p < 0.001	−0.87 (0.26)	0.42 (0.25; 0.69) p = 0.001	0.07 (0.37)	1.07 (0.52; 2.22) p = 0.848

Notes. B = Unstandardized regression coefficient, SE = Standard Error, OR = Odds Ratio, 95% CI = 95% Confidence Intervals. Significant results are bold.

shows findings from a bivariate logistic regression analysis examining the associations between substance use, sex, age, and students’ sexual behavior. Students who reported lifetime alcohol use had higher probabilities of ever having sexual intercourse (OR = 4.47, 95% CI: 2.87; 6.95, p < 0.001) and casual sex (OR = 2.52, 95% CI: 1.43, 4.44, p = 0.001). Three-month alcohol use revealed similar connections. Lifetime smoking was also related to sexual intercourse (OR = 3.14, 95% CI: 1.98; 4.98, p < 0.001) and casual sex (OR = 2.92, 95% CI: 1.74–4.91; p < 0.001), while three-month smoking predicted sexual intercourse and casual sex. Lifetime illicit drug use also increased the likelihood of sexual intercourse and casual sex. Age was positively associated with having ever had sexual intercourse (OR = 1.76, 95% CI: 1.53; 2.03, p < 0.001), while female students were less likely than males to report ever having sexual intercourse (OR = 0.31, 95% CI: 0.20; 0.48, p < 0.001) and casual sex (OR = 0.42, 95% CI: 0.25; 0.69, p = 0.001).

3.4. Associations Between Sexual Beliefs and the Students’ Sexual Behavior

Table 4. Bivariate logistic regression estimates (OR) of the students’ sexual behavior II. Sexual beliefs as correlates (N = 396).

	Sexual Intercourse Ever		Casual Sex Ever		Unprotected Sex Ever
Sexual Beliefs	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value
Self-respect	0.06 (0.02)	1.06 (1.02; 1.10) p = 0.007	0.01 (0.03)	1.01 (0.96; 1.07) p = 0.688	−0.04 (0.04)	0.96 (0.88; 1.05) p = 0.385
Partner’s positive feelings	0.06 (0.02)	1.06 (1.02; 1.11) p = 0.009	−0.02 (0.03)	0.98 (0.93; 1.04) p = 0.596	−0.03 (0.05)	0.97 (0.88; 1.06) p = 0.468
Others’ positive opinion	−0.06 (0.02)	0.94 (0.91; 0.98) p = 0.001	−0.06 (0.02)	0.94 (0.91; 0.99) p = 0.009	0.05 (0.04)	1.05 (0.98; 1.13) p = 0.180
Negative physical consequences	0.01 (0.02)	1.00 (0.97; 1.04) p = 0.832	−0.01 (0.02)	0.99 (0.94; 1.04) p = 0.679	0.01 (0.04)	1.00 (0.93; 1.08) p = 0.970

Notes. B = Unstandardized regression coefficient, SE = Standard Error, OR = Odds Ratio, 95% CI = 95% Confidence Intervals. Significant results are bold.

shows that among sexual beliefs, self-respect (OR = 1.06, 95% CI: 1.02; 1.10, p = 0.007) was significantly associated with ever having sexual intercourse. In addition, partner positive feelings were also positively associated with sexual intercourse (OR = 1.06, 95% CI: 1.02; 1.11, p = 0.009), while the relationship was the reverse in the case of others’ opinion (OR = 0.94, 95% CI: 0.91; 0.98, p = 0.001). A similar association was found in the case of casual sex. Other sexual belief variables were not significantly related to casual sex and unprotected sex.

3.5. Associations Between Psychological Variables and Sexual Behavior

Table 5. Bivariate logistic regression estimates (OR) of the students’ sexual behavior III. Psychological variables as correlates (N = 396).

	Sexual Intercourse Ever		Casual Sex Ever		Unprotected Sex Ever
Psychological Variables	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value	B (SE)	OR (95% CI) p Value
General well-being	0.04 (0.02)	1.04 (1.02; 1.08) p = 0.023	0.02 (0.02)	1.02 (0.98; 1.07) p = 0.269	−0.03 (0.03)	0.97 (0.91; 1.03) p = 0.283
Self-efficacy	0.07 (0.02)	1.07 (1.04; 1.11) p < 0.001	0.04 (0.02)	1.04 (1.02; 1.08) p = 0.036	−0.03 (0.03)	0.97 (0.91; 1.03) p = 0.290
Optimism	1.09 (0.03)	1.10 (1.03; 1.17) p = 0.002	0.05 (0.04)	1.05 (0.98; 1.14) p = 0.164	−0.03 (0.05)	0.96 (0.87; 1.07) p = 0.496
Social support from family	0.08 (0.03)	1.08 (1.03; 1.14) p = 0.004	0.03 (0.03)	1.04 (0.97; 1.10) p = 0.275	−0.06 (0.05)	0.95 (0.86; 1.04) p = 0.236
Social support from friends	0.14 (0.03)	1.15 (1.08; 1.22) p < 0.001	0.06 (0.04)	1.06 (0.99; 1.14) p = 0.093	−0.09 (0.05)	0.91 (0.82; 1.02) p = 0.096

Notes. B = Unstandardized regression coefficient, SE = Standard Error, OR = Odds Ratio, 95% CI = 95% Confidence Intervals. Significant results are bold.

shows that several psychological variables were significantly associated with ever having sexual intercourse. Students who reported higher levels of well-being (OR = 1.04, 95% CI: 1.02–1.08, p = 0.023), self-efficacy (OR = 1.07, 95% CI: 1.04–1.11, p < 0.001), optimism (OR = 1.10, 95% CI: 1.03–1.17, p = 0.002), and social support from family (OR = 1.08, 95% CI: 1.03–1.14, p = 0.004) and friends (OR = 1.15, 95% CI: 1.08–1.22, p < 0.001) were all significantly related to ever having sexual intercourse, while higher self-efficacy was also associated with casual sex (OR = 1.04, 95% CI: 1.02–1.08, p = 0.036). However, none of the psychological variables were significantly related to unprotected sex.

3.6. Correlations Between the Students’ Sexual Beliefs and Psychogical Characteristics

As

Table 6. Correlation matrix for the associations between the students’ sexual beliefs and psychological characteristics (N = 396).

Psychological Variables	2	3	4	5	6	7	8	9
1. General well-being	0.43 ***	0.26 ***	0.44 ***	0.35 ***	−0.26 ***	0.09	0.26 ***	−0.35 ***
2. Self-efficacy	--	0.50 ***	0.66 ***	0.64 ***	0.04	0.37 ***	0.21 ***	−0.26 ***
3. Optimism		--	0.47 ***	0.46 ***	0.14 **	0.41 ***	0.10 *	−0.08
4. Social support from family			--	0.63 ***	0.01	0.37 ***	0.21 ***	−0.29 ***
5. Social support from friends				--	0.11 *	0.44 ***	0.21 ***	−0.21 ***
6. Self-respect					--	0.50 ***	−0.44 ***	0.65 ***
7. Partner’s positive feelings						--	−0.06	0.14 **
8. Others’ positive opinion							--	−0.55 ***
9. Negative physical consequences								--

Notes. r = correlation coefficients: * p < 0.05, ** p < 0.01, *** p < 0.001.

demonstrates, students’ sexual beliefs were significantly correlated with their psychological characteristics. Self-respect was positively associated with optimism (r = 0.14, p < 0.01) and social support from friends (r = 0.11, p < 0.05) and negatively with well-being (r = −0.26, p < 0.001). Regarding partner’s positive feelings, self-efficacy (r = 0.37, p < 0.001), optimism (r = 0.41, p < 0.001), and social support from family (r = 0.37, p < 0.001) and friends (r = 0.44, p < 0.001) were related. Additionally, others’ positive opinions were positively associated with psychological well-being (r = 0.26, p < 0.001), self-efficacy (r = 0.21, p < 0.001), optimism (r = 0.10, p < 0.05), and social support from family (r = 0.21, p < 0.001) and friends (r = 0.21, p < 0.001), while negative physical consequences were negatively correlated with well-being (r = −0.35, p < 0.001), self-efficacy (r = −0.26, p < 0.001), and social support from family (r = −0.29, p < 0.001) and friends (r = −0.21, p < 0.001).

4. Discussion

Sexual and reproductive health issues among university students, as well as their health risk behaviors and psychosocial factors linked to them, represent an important public health issue (Arsandaux et al., 2020; Ayalew et al., 2018; Guan, 2021). In Mongolia, university students represent a considerable part of the population (National Statistics Office of Mongolia, 2025b). While there has been a significant increase in research focused on sexual risk behaviors among young people (Badrakh et al., 2017; Choi & Huh, 2021; J. Kim & Hyun, 2021; Mundur et al., 2017), substantial gaps remain in exploring potential correlates of these behaviors. Thus, our study aimed to fill these gaps by considering a sample of Mongolian university students, a group that has been underrepresented in national health behavior research.

In our study we found that the lifetime prevalence of alcohol consumption among university students was 62.9%, with a prevalence of 34.8% in the past three months. In addition, the lifetime prevalence of smoking was recorded at 40.4%, while the rate for the past three months was 24.2%. Findings of this study are largely consistent with earlier research conducted in Mongolia (Dashpuntsag et al., 2021; Pengpid & Peltzer, 2022). Dashpuntsag et al. (2021) reported that 58.8% of Mongolian university students had consumed alcohol in the past month. Similarly, other studies (Pengpid & Peltzer, 2022; UNFPA, 2025) highlighted a relatively high rate of alcohol consumption among the Mongolian youth. Compared to other Asian countries, alcohol consumption among Mongolian students is similar to Japan (52.9% binge drinking), China (41.7% lifetime), and Laos (55% binge drinking), but higher than Taiwan (28%), Myanmar (20.3%), and Indonesia (29%) (Htet et al., 2020; Supit et al., 2017; Yi et al., 2017; Yang et al., 2025; Yoshimoto et al., 2017). These differences likely reflect various cultural norms, policy environments, alcohol accessibility, and social attitudes. In the Mongolian population, among those aged between 15 and 24 years, 15.2% of them were smokers in 2010 (Demaio et al., 2014), significantly lower than the percentage of current smokers in our study (24.2%), reflecting the rising tendency found in a recent paper, especially in urban settings (Pengpid & Peltzer, 2022). Additionally, previous studies also highlighted that health risk behaviors significantly increased during the transition from adolescence to university life (Arsandaux et al., 2020; Guan, 2021; Uuganbayar & Piko, 2025).

In terms of substance use by sex, our findings showed that male students had a significantly higher prevalence of substance use than female students. This result is consistent with the conclusions of previous research conducted in Mongolia and internationally (Dashpuntsag et al., 2021; Pengpid & Peltzer, 2022; Supit et al., 2017; UNFPA, 2025; Yang et al., 2025). In European adult populations, where men and women occupy similar social roles and work habits, they have equal likelihood of smoking or drinking alcohol (except for heavy drinking) (Emslie et al., 2002), in contrast with more traditional Asian cultures (Cui et al., 2018). Historically, smoking and drinking for women has been discouraged because these behaviors were not in line with traditional feminine traits, such as modesty. However, depending on their socioeconomic levels and changing cultural norms due to globalization, a rising tendency among women is also present.

Our findings on students’ sexual behavior also reflect their increased independence, reduced parental supervision, and stronger peer influence in the university environment (Ayalew et al., 2018; Arsandaux et al., 2020). In our study, 64.9% of participants reported having engaged in sexual intercourse, highlighting a relatively high level of sexual activity among Mongolian university students. This result is in line with previous research conducted on both Mongolian and international university students (Guan, 2021; Jahanfar & Pashaei, 2022; J. Kim & Hyun, 2021; Mundur et al., 2017; Uuganbayar & Piko, 2025). For example, the study by J. Kim and Hyun (2021) found that 61.1% of university students reported having had sexual intercourse, which significantly corresponds with our findings. Also, sexual activity is common among university students in European countries, with a significant number of young people engaging in sexual activities during their university years, as reported in previous studies (Dębska-Janus et al., 2025; Dubé et al., 2017; ESPAD Group, 2020; Koletić et al., 2023; Owen et al., 2010). Therefore, the level of sexual activity observed in our study is consistent with the typical patterns of “emerging adulthood” recognized internationally (Dubé et al., 2017; Durham & McKinney, 2025; Owen et al., 2010). In the context of Mongolia, this situation can be explained by social and cultural transitions and the gradual weakening of traditional sexual norms. Namely, attitudes toward sexual behavior among Mongolian youth are evolving toward a more open perspective (Roberts et al., 2005; Terbish, 2013; UKEssays, 2018), which aligns with our findings. In comparison with Mongolian adolescents at the age of 18 years, only 11.5% reported having engaged in sexual intercourse (Uuganbayar & Piko, 2025), suggesting that sexual activity increases with age, especially within the university environment, where parental control decreases.

Our results suggest that substance use may often be accompanied by an increased likelihood of having sexual intercourse and participating in casual sexual encounters. This finding is consistent with previous findings (Adal et al., 2024; Bryan et al., 2012; Cho & Yang, 2023; Hlahla et al., 2024; Jahanfar & Pashaei, 2022). The main principles of Problem Behavior Theory (Jessor & Jessor, 2016) posit that health risk behaviors often co-occur in youth (Bozzini et al., 2021). Additionally, a meta-analysis by Cho and Yang (2023) found that alcohol use was associated with early sexual initiation, inconsistent condom use, and multiple sexual partners among young adults. In a similar study conducted among university students in Lebanon, around 54.9% of participants reported being sexually active under the influence of alcohol, while among those who reported illicit drug use, the prevalence of risky sexual behavior was 72.5% higher than that of non-users (Rizk et al., 2025). Generally, these international findings are consistent with the tendencies observed in our study, demonstrating that substance use is an important predictor of sexual risk behaviors among Mongolian university students.

Furthermore, we also examined the sexual beliefs of Mongolian university students, as sexual attitudes and beliefs are important factors determining sexual behavior (Guan, 2021; Lin et al., 2021). The results of our study show that students’ sexual beliefs are to some extent related to gender roles, sexual behavior, and several psychosocial factors.

First, our analysis revealed significant differences between males and females in certain aspects of sexual beliefs. Male students scored higher than female students on the dimensions of positive feelings toward their partners and the positive opinions of others, suggesting that male students may place greater emphasis on their partner’s satisfaction and on social evaluation in the context of sexual relationships. This finding regarding male students’ sexual beliefs may reflect social expectations and pressures related to the traditional social norms still prevalent in Mongolian society (Boënnec & Saunier, 2025; Enkhbold et al., 2024). Conversely, female students expressed greater concern about the negative physical consequences of sexual activity, as women may exhibit greater sensitivity to sexual health risks. In particular, risks such as unwanted pregnancy and sexually transmitted infections may affect women more directly, and female students perceive these risks more sensitively. At the same time, concerns about the potential negative consequences of female students’ sexual behavior may be related to traditional expectations still prevalent in Mongolian society that emphasize women’s modesty and responsibility (Durham & McKinney, 2025; UNICEF, 2019; Uuganbayar & Piko, 2025). These findings from our study align with international studies showing the influence of social expectations and traditional gender role perceptions on young people’s sexual attitudes and behaviors (Durham & McKinney, 2025; Hegde et al., 2022; Tseng et al., 2021; Vasilenko, 2022).

Second, we found that students’ sexual beliefs were somewhat associated with sexual behavior (sexual intercourse, casual intercourse, unprotected sexual intercourse). For example, our results showed that university students who had positive self-respect and valued their partner’s positive feelings were more likely to engage in sexual intercourse, while students who placed greater importance on others’ opinions and social evaluation appeared to approach sexual activity more cautiously. However, other aspects of sexual beliefs and psychosocial variables were not significantly associated with casual or unprotected sexual intercourse. These findings align with previous studies suggesting that young people’s sexual behavior is not solely an individual decision but is closely shaped by sexual beliefs and the broader sociocultural context (Guan, 2021; Ferrer-Urbina et al., 2022; Hegde et al., 2022; Lahoz-García et al., 2025; Lin et al., 2021; Mollaei et al., 2023).

Third, our research indicates that students’ sexual beliefs were positively related to the psychological variables and social support. Specifically, self-respect was positively related to optimism and social support from friends. This result is consistent with Social Cognitive Theory, which suggests that behavior and beliefs are affected by interactions among personal factors (such as beliefs and expectations), environmental conditions, and behavioral processes, as explained by Bandura (1986). Additionally, partners’ positive feelings were positively associated with self-efficacy, optimism, and social support from family and friends, while positive opinions by others were positively correlated with well-being, self-efficacy, optimism, and social support. Our findings are in line with previous studies suggesting that social support and individual psychological variables shape young people’s attitudes and beliefs about relationships (Brasileiro et al., 2021; de Vries et al., 2024; Dębska-Janus et al., 2025; Garcia Saiz et al., 2021; Luo et al., 2025; Muraleetharan & Brault, 2023; Rincón Uribe et al., 2022; Torregosa & Patricio, 2022). Further, we found that beliefs about negative physical consequences were negatively correlated with well-being, self-efficacy, and social support, in line with previous studies (Dubé et al., 2017; Ferrer-Urbina et al., 2022; Mollaei et al., 2023; Owen et al., 2010). These results suggest that young people with lower levels of psychological well-being and social support may perceive greater risks associated with sexual behavior and tend to focus more strongly on potential negative consequences.

Finally, regarding students’ psychosocial factors, male students reported higher levels of well-being, self-efficacy, and optimism, as well as greater social support from family and friends, compared with female students. These findings provide additional validation for earlier research indicating that factors such as social environment and gender role expectations may influence how students perceive their psychological and social well-being (Durham & McKinney, 2025; Koletić et al., 2023; UNICEF, 2019; Uuganbayar & Piko, 2025). Previous studies have demonstrated that psychological constructs can either be protective or risk-enhancing in relation to young people’s sexual behavior (Dubé et al., 2017; Ferrer-Urbina et al., 2022; Mollaei et al., 2023; Owen et al., 2010). Particularly, positive psychological constructs such as psychological well-being, self-efficacy, and optimism are often considered protective factors that help prevent engagement in health risk behaviors (Brasileiro et al., 2021; Dębska-Janus et al., 2025; Jin et al., 2021; Luo et al., 2025; Torregosa & Patricio, 2022). Our findings support this concept; higher levels of well-being, self-efficacy, optimism, and greater levels of social support from family and friends were significantly associated with ever being engaged in sexual intercourse. However, these psychological variables were not significantly associated with unprotected sexual intercourse, suggesting that these positive constructs do not prevent them from risky sexual behaviors.

Overall, these findings highlight some important information about Mongolian university students’ sexual behavior and attitudes, substance use, and psychological characteristics. This is a unique contribution to the literature as we know much less about Mongolian students’ health risk behaviors as compared to their western peers. However, we should also mention several limitations to the results. First, due to the cross-sectional study design, causal effects cannot be justified. In addition, while the aim of this study has been to detect the risky or protective nature of each independent variable using simple logistic regression analysis, multivariate methods would be more convincing to test potential confounding variables. However, due to differences in the measurement levels of independent variables, we do not rely on these statistics in the current study. Although anonymity provided the students the opportunity to reply to these sensitive questions in confidence, answers may be biased by social desirability. Future research should also include additional psychological scales, not only characteristics acting as protective factors, but also those that may elevate health risks (e.g., sensation-seeking or unrealistic optimism). In particular, future research should also include abusive patterns of substance use in relation to risky sexual behavior, as measures of frequency or severity would strengthen the analysis. Finally, beyond mapping the current study’s variables of sexual behavior, several other variables may also be useful to get a more detailed picture of university students’ sexual activities, e.g., use of contraceptives, sexual orientation and identity, etc. While in this research we have concentrated on calculating odds of associations, detecting their protective or risky nature, a more elaborate model also would allow us to conduct more sophisticated analysis using multivariate methods.

5. Conclusions

Our study highlights the relatively high prevalence of substance use and sexual activity among Mongolian university students and shows that substance use, sexual beliefs, and other psychosocial factors are interconnected in shaping students’ sexual behaviors. These findings emphasize the importance of comprehensive health education and supportive psychosocial environments in promoting healthier behaviors among university students in Mongolia.