ArticleBMC public health2026
HPV vaccination willingness and its determinants among male university students post-approval of male-specific HPV vaccines in China: a large-scale cross-sectional study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGiven limited prior studies on Chinese male university students’ human papillomavirus (HPV) vaccination willingness and SARS-CoV-2 vaccination shaping their relevant understanding/awareness, we conducted a large-scale cross-sectional study to explore their HPV-related willingness post male-approved HPV vaccines and key determinants of vaccination decisions.
methodsThe cross-sectional study used convenience sampling to conduct a questionnaire online survey for male university students aged 18–30 years old across 30 provinces/autonomous regions/municipalities of China in 2025. A standardized questionnaire was designed to evaluate the knowledge, attitude and willingness of the students to HPV and HPV vaccine. Two-level mixed-effects logistic regression model and a random forest model were performed to identify factors that were associated with HPV vaccine hesitancy and willingness-to-pay. The adjusted odds ratio (aOR) with the corresponding 95% confidence interval (95% CI) was calculated.
resultsOf 25,188 male university students, 62.21% were willing to receive HPV vaccination, 32.45% were unsure and 5.34% were refused (total 37.79% with vaccine hesitancy). Higher parental education (especially bachelor’s or above), increased household and personal income, better HPV/HPV vaccine knowledge and attitudes, and attending medical/pharmaceutical universities or those with over 30,000 students were linked to higher willingness; homosexual (66.53%, aOR = 0.867, 95% CI 0.784–0.959) and bisexual (70.61%, aOR = 0.686, 95% CI 0.553–0.851) students showed greater acceptance than heterosexual peers, and those with 4–6 sexual partners had the highest willingness (78.48%), followed by > 6 (73.50%) and 1–3 (73.24%) partners, higher than those without (58.51%, P < 0.05). Among willing students, 65.78% accepted paying less than 1,000 RMB for full vaccination, and random forest analysis showed HPV infection knowledge, HPV vaccine knowledge and personal income were top three factors influencing 9-valent and 4-valent vaccine willingness.
conclusionsThis survey represents a large-scale evaluation of HPV vaccination willingness among male university students in China post male-applicable HPV vaccine approval, and the findings highlight the potential importance of health education regarding men’s HPV infection risk and vaccine protective value.
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