HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study

Figures & data

Table 1. Demographic characteristics of study participants (n = 4,062)

Variable	Number	Percentage (%)
Gender
Male	2,126	52.3
Female	1,936	47.7
Ethnic group
Han	3,953	97.3
Others	109	2.7
School type
Urban school	2,074	51.1
Rural school	1,988	48.9
Survey year
2015	2,185	53.8
2016	1,877	46.2
Regions
Liaoning	376	9.3
Shanxi	736	18.1
Shandong	365	9.0
Guangdong	417	10.3
Hubei	814	20.0
Xinjiang	377	9.3
Sichuan	977	24.1

Table 2. Knowledge and perceived of adolescent sexual health and vaccination among Chinese adolescents by gender and school types

		Gender			School types
Items	All n (%)	Female n (%)	Male n (%)	P	Urban school n (%)	Rural school n (%)	P
Received adolescent sexual health education*
No	1,592 (39.3)	684 (35.4)	908 (42.8)	<.001	754 (36.5)	838 (42.2)	<.001
Yes	2,460 (60.7)	1,247 (64.6)	1,213 (57.2)		1,313 (63.5)	1,147 (57.8)
How well do you know about adolescent sexual health? *
None	389 (9.7)	138 (7.2)	251 (11.9)	<.001	194 (9.4)	195 (9.9)	<.001
A little	2,037 (50.6)	933 (48.6)	1,104 (52.4)		947 (46.0)	1,090 (55.4)
Well	1,338 (33.2)	737 (38.4)	601 (28.6)		759 (36.9)	579 (29.4)
Very well	262 (6.5)	113 (5.9)	149 (7.1)		158 (7.7)	104 (5.3)
Prevention is better than treatment
No	1,064 (26.2)	521 (26.9)	543 (25.5)	.321	518 (25.0)	546 (27.5)	.071
Yes	2,998 (73.8)	1,415 (73.1)	1,583 (74.5)		1,556 (75.0)	1,442 (72.5)
Vaccination can effectively prevent diseases
No	1,989 (49.0)	928 (47.9)	1,061 (49.9)	.209	970 (46.8)	1,019 (51.3)	.004
Yes	2,073 (51.0)	1,008 (52.1)	1,065 (50.1)		1,104 (53.2)	969 (48.7)
Vaccine is useless
No	3,995 (98.4)	1,914 (98.9)	2,081 (97.9)	.014	2,045 (98.6)	1,950 (98.1)	.199
Yes	67 (1.6)	22 (1.1)	45 (2.1)		29 (1.4)	38 (1.9)
Vaccination is only required after getting sick
No	3,952 (97.3)	1,902 (98.2)	2,050 (96.4)	<.001	2,043 (98.5)	1,909 (96.0)	<.001
Yes	110 (2.7)	34 (1.8)	76 (3.6)		31 (1.5)	79 (4.0)
Whose opinion do you value most about vaccination? *
Myself	479 (12.9)	171 (9.6)	308 (15.9)	<.001	262 (13.8)	217 (11.9)	<.001
Parents	2,951 (79.2)	1,504 (84.2)	1,447 (74.6)		1,525 (80.3)	1,426 (78.1)
Teachers	295 (7.9)	111 (6.2)	184 (9.5)		112 (5.9)	183 (10.0)

HPV, human papillomavirus.

* The total number do not add up to 4,062 due to missing data.

Table 3. Knowledge and attitude toward HPV, HPV-related diseases, and HPV vaccines among Chinese adolescents by gender and school types

		Gender			School types
Items	All n (%)	Female n (%)	Male n (%)	P	Urban school n (%)	Rural school n (%)	P
Have you ever heard of cervical cancer? *
No	2,717 (67.2)	1,113 (57.6)	1,604 (75.9)	<.001	1,358 (65.8)	1,359 (68.6)	.061
Yes	1,329 (32.8)	820 (42.4)	509 (24.1)		706 (34.2)	623 (31.4)
Do you perceive a risk of developing cervical cancer or other HPV-related cancers? *
No	2,556 (68.2)	839 (47.1)	1,717 (87.2)	<.001	1,362 (70.6)	1,194 (65.5)	.001
Yes	1,194 (31.8)	942 (52.9)	252 (12.8)		566 (29.4)	628 (34.5)
Have you ever heard of HPV? *
No	3,507 (87.1)	1,638 (85.3)	1,869 (88.7)	.002	1,769 (85.9)	1,738 (88.3)	.026
Yes	521 (12.9)	282 (14.7)	239 (11.3)		290 (14.1)	231 (11.7)
Have you ever heard of the HPV vaccines? *
No	3,313 (82.9)	1,555 (81.5)	1,758 (84.1)	.031	1,676 (82.0)	1,637 (83.8)	.126
Yes	684 (17.1)	352 (18.5)	332 (15.9)		368 (18.0)	316 (16.2)
Are you willing to vaccinate yourself?
No	1,329 (32.7)	530 (27.4)	799 (37.6)	<.001	718 (34.6)	611 (30.7)	.008
Yes	2,733 (67.3)	1,406 (72.6)	1,327 (62.4)		1,356 (65.4)	1,377 (69.3)

HPV, human papillomavirus.

* The total number do not add up to 4,062 due to missing data.

Table 4. Factors associated with willingness to be vaccinated with HPV vaccines among Chinese adolescents

Variables	Number of subjects in analysis	Willing to vaccinate N (%)	OR (95%CI)	P	AOR (95%CI)	P
Gender
Male	2,126	1,327 (62.4)	Ref
Female	1,936	1,406 (72.6)	1.60 (1.40–1.82)	<.001
School type
Urban school	2,074	1,356 (65.4)	Ref		Ref
Rural school	1,988	1,377 (69.3)	1.19 (1.05–1.36)	.008	1.19 (1.02–1.39)	.027
Survey year
2015	2,185	1,473 (67.4)	Ref
2016	1,877	1,260 (67.1)	0.99 (0.87–1.13)	.847
Regions
Liaoning	376	193 (51.3)	Ref		Ref
Shanxi	736	426 (57.9)	1.30 (1.02–1.67)	<.001	1.31 (1.00–1.71)	.049
Shandong	365	237 (64.9)	1.76 (1.31–2.36)	<.001	1.68 (1.21–2.33)	.002
Guangdong	417	281 (67.4)	1.96 (1.47–2.61)	<.001	1.84 (1.35–2.51)	<.001
Hubei	814	555 (68.2)	2.03 (1.58–2.61)	<.001	2.83 (2.08–3.83)	<.001
Xinjiang	377	283 (75.1)	2.86 (2.10–3.89)	<.001	2.69 (1.93–3.75)	<.001
Sichuan	977	758 (77.6)	3.28 (2.55–4.22)	<.001	3.06 (2.33–4.03)	<.001
Received sexual education/knowledge
No	1,592	980 (61.6)	Ref		Ref
Yes	2,460	1,747 (71.0)	1.53 (1.34–1.75)	<.001	1.35 (1.15–1.58)	<.001
Missing	10
How well do you know about adolescent sexual health?
None	389	224 (57.6)	Ref
A little	2,037	1,339 (65.7)	1.41 (1.13–1.76)	.002
Well	1,338	960 (71.7)	1.87 (1.48–2.36)	<.001
Very well	262	193 (73.7)	2.06 (1.47–2.90)	<.001
Missing	36
Prevention is better than treatment
No	1,064	650 (61.1)	Ref		Ref
Yes	2,998	2,083 (69.5)	1.45 (1.25–1.68)	<.001	1.45 (1.22–1.72)	<.001
Vaccination can effectively prevent diseases
No	1,989	1,246 (62.6)	Ref		Ref
Yes	2,073	1,487 (71.7)	1.51 (1.33–1.73)	<.001	1.37 (1.17–1.60)	<.001
Vaccine is useless
No	3,995	2,701 (67.6)	Ref
Yes	67	32 (47.8)	0.44 (0.27–0.71)	.001
Vaccination is only required after getting sick
No	3,952	2,670 (67.6)	Ref
Yes	110	63 (57.3)	0.64 (0.44–0.95)	.024
Whose opinion do you value most about vaccination?
Myself	479	282 (58.9)	Ref		Ref
Parents	2,951	2,018 (68.4)	1.51 (1.24–1.84)	<.001	1.41 (1.12–1.76)	.003
Teachers	295	212 (71.9)	1.78 (1.31–2.44)	<.001	1.54 (1.08–2.17)	.016
Missing	337
Have you ever heard of the cervical cancer?
No	2,717	1,716 (63.2)	Ref		Ref
Yes	1,329	1,006 (75.7)	1.82 (1.57–2.11)	<.001	1.33 (1.12–1.58)	.001
Missing	16
Do you perceive a risk of developing cervical cancer or other HPV-related cancers?
No	2,556	1,600 (62.6)	Ref		Ref
Yes	1,194	955 (80.0)	2.39 (2.03–2.81)	<.001	2.04 (1.70–2.44)	<.001
Missing	312
Have you ever heard of the HPV?
No	3,507	2,314 (66.0)	Ref
Yes	521	399 (76.6)	1.69 (1.36–2.09)	<.001
Missing	34
Have you ever heard of the HPV vaccines?
No	3,313	2,169 (65.5)	Ref		Ref
Yes	684	525 (76.8)	1.74 (1.44–2.11)	<.001	1.35 (1.08–1.68)	.008
Missing	65

All factors in the table were variables with P < 0.10 in univariate logistic regression models. A total of 3,365 participants were enrolled into multivariable analysis.

OR, odds ratio; AOR, adjusted odds ratio; 95%CI, 95% confidence interval; HPV, human papillomavirus.

Adjusted OR, adjusted odds ratio using multivariable logistic regression model, and six factors (gender, race, heard of HPV, adolescent sexual health knowledge level, vaccination is only required after getting sick, vaccine is useless) were excluded from this multivariable logistic regression model.