[A statistical survey of infectious disease awareness among university freshmen in Hunan Province: Knowledge gaps regarding HPV infection and their moderating factors].

objectivesUniversity freshmen are an important target population for infectious disease health education. Improving their knowledge of infectious disease prevention and control is essential for safeguarding public health on university campuses. This study aims to assess the awareness of four major infectious diseases, acquired immunodeficiency syndrome (AIDS), human papilloma virus (HPV) infection, hepatitis B, and pulmonary tuberculosis (PTB), among newly enrolled university students in Hunan Province and to identify influencing factors. Particular attention was given to the differential effects of institutional-level characteristics, including academic structure, availability of academic programs, and geographical location, on students' infectious disease awareness, thereby providing empirical evidence for the development of targeted and effective health education during university entry.

methodsDuring the autumn semester of 2025, an anonymous cross-sectional questionnaire survey was administered to all first-year students at 36 higher education institutions in Hunan Province, covering different geographic areas, institutional levels, and institution types. A total of 156 185 valid questionnaires were collected. The questionnaire assessed basic knowledge, routes of transmission, and preventive measures relating to the four infectious diseases and collected institutional-level information. The proportion of correct responses to each question was used as the dependent variable. After arcsine square-root transformation, linear mixed-effects models were constructed. The fixed effects included the geographic location and level of the institution, whether the institution offered a clinical medicine program, the proportion of male and female students, the proportion of undergraduate students, the proportion of postgraduate students, and disease type. Random intercepts for institutions and questionnaire items nested within disease type were included to account for the hierarchical structure of the data. Models containing interaction terms, particularly the interactions of the proportion of undergraduate students and the availability of a clinical medicine program with disease type, were compared with a main-effects model to identify key moderating factors.

resultsOverall knowledge accuracy differed significantly across the four diseases. Freshmen demonstrated relatively high proportions of correct responses for AIDS (84.5%) and TB (90.6%), but lower proportions for HPV infection (55.1%) and hepatitis B (76.5%). Knowledge accuracy regarding HPV infection was significantly lower than that regarding the other diseases (

conclusionsSignificant differences were observed in infectious disease awareness among students newly enrolled in higher education institutions in Hunan Province in 2025, with knowledge accuracy regarding HPV infection being the lowest. Institutional characteristics primarily influenced awareness through moderating effects. Institutions with a higher proportion of undergraduate students were at a relative disadvantage in terms of students' knowledge of HPV infection and hepatitis B, whereas the availability of a clinical medicine program was associated with greater knowledge accuracy regarding HPV infection. The period of university entry represents an important window for delivering targeted infectious disease health education. The differential moderating effects of the institutional environment on awareness of different infectious diseases provide a new analytical perspective for the precise allocation of health education resources for infectious disease prevention and control.