­­Human papillomavirus and Chinese international students in the United States: attitudes, knowledge, vaccination trends, healthcare behaviors, and sexual activity

Figures & data

Table 1. Demographics

	n (%)
Q#1: What is your age in years?
18	14 (3.54)
19	34 (8.59)
20	20 (5.05)
21	30 (7.58)
22	55 (13.89)
23	84 (21.21)
24	90 (22.73)
25	33 (8.33)
26	16 (4.04)
27–32	18 (4.55)
Over 32	2 (0.51)
Q#2: What sex were you assigned at birth?
Female	212 (53.54)
Male	184 (46.46)
Other	0 (0.00)
Q#3: What is your preferred gender identity?
Woman	214 (54.04)
Man	181 (45.71)
Trans Man	1 (0.25)
Trans Woman	0 (0.00)
Nonbinary or Genderqueer	0 (0.00)
Questioning	0 (0.00)
Other	0 (0.00)
Q#4: What is your country or place of origin?
China	374 (94.44)
Hong Kong	10 (2.53)
Taiwan	12 (3.03)
Other, Please Specify:	0 (0.00)
Q#5: How many years have you spent living in the United States?
Less than 1 year	151 (38.13)
1 year	67 (16.92)
2 years	73 (18.43)
3 years	35 (8.84)
4 or more years	70 (17.68)

Table 2. HPV disease and vaccine knowledge, attitudes, and behavior

	Male n (%)	Female n (%)	n (%)
Q#9: Have you received the HPV vaccine series, or are you in the process of completing the series?
Yes	59 (32.07)	181 (85.38)	240 (60.61)
No	118 (64.13)	26 (12.26)	144 (36.36)
I don’t know	7 (3.80)	5 (2.36)	12 (3.03)
Q#10: Which option best describes your knowledge of Human Papillomavirus (HPV) and the HPV vaccine?
No knowledge	56 (30.43)	7 (3.30)	63 (15.91)
Some knowledge	123 (66.85)	194 (91.51)	317 (80.05)
A great deal of knowledge	5 (2.72)	11 (5.19)	16 (4.04)
Q#11: Select all that apply:
HPV can’t cause cancer	44 (23.91)	50 (23.58)	94 (23.74)
HPV can cause cervical cancer	93 (50.54)	108 (50.94)	201 (50.76)
HPV can cause oropharyngeal cancer	59 (32.07)	56 (26.42)	115 (29.04)
HPV can cause anal cancer	61 (33.15)	48 (22.64)	109 (27.53)
HPV can cause vulvar and penile cancers	54 (29.35)	43 (20.28)	97 (24.49)
Decline to Answer	18 (9.78)	17 (8.02)	35 (8.84)
Q#12: Do you know anyone who has been diagnosed with HPV, cervical cancer, or any of the following cancers: throat, vagina, vulva, penis, anus, or rectum?
Yes	15 (8.15)	11 (5.19)	26 (6.57)
No	141 (76.63)	160 (75.47)	301 (76.01)
I don’t know	28 (15.22)	40 (18.87)	68 (17.17)
Decline to Answer	0 (0.00)	1 (0.47)	1 (0.25)
Q#13: How common is HPV?
So common that nearly everyone will be infected with HPV at some point in their lives	21 (11.41)	38 (17.92)	59 (14.90)
About half of all people will be infected with HPV at some point in their lives	17 (9.24)	39 (18.40)	56 (14.14)
About one-quarter of all people will be infected with HPV at some point in their lives	31 (16.85)	47 (22.17)	78 (19.70)
Less than 1%	18 (9.78)	15 (7.08)	33 (8.33)
I have no idea	95 (51.63)	73 (34.43)	168 (42.42)
Decline to Answer	2 (1.09)	0 (0.00)	2 (0.51)
Q#14: How likely do you believe you are to acquire HPV?
Extremely Likely	13 (7.07)	32 (15.09)	45 (11.36)
Very Likely	12 (6.52)	21 (9.91)	33 (8.33)
Likely	42 (22.83)	51 (24.06)	93 (23.48)
Unlikely	84 (45.65)	89 (41.98)	173 (43.69)
Impossible	33 (17.93)	19 (8.96)	52 (13.13)
Q#15: Which of the following best describes your feelings if you were to acquire HPV (which can lead to increased risk of cancer and genital warts)?
Worst thing that could happen	44 (23.91)	50 (23.58)	94 (23.74)
Extremely upset	69 (37.50)	98 (46.23)	167 (42.17)
Somewhat upset	52 (28.26)	41(19.34)	93 (23.48)
Not at all upset	19 (10.33)	22 (10.38)	41 (10.35)
Decline to Answer	0 (0.00)	1 (0.47)	1 (0.25)
Q#16: Has your doctor or other healthcare provider ever spoken to you about the HPV vaccine?
Yes	48 (26.09)	104 (49.06)	152 (38.38)
No	125 (67.93)	98 (46.23)	223 (56.31)
I don’t know	10 (5.43)	10 (4.72)	20 (5.05)
Decline to Answer	1 (0.54)	0 (0.00)	1 (0.25)
Q#17: What groups of people is the HPV vaccine recommended for?
Females only	9 (4.89)	23 (10.85)	32 (8.08)
Males only	0 (0.00)	0 (0.00)	0 (0.00)
Both females and males	156 (84.78)	185 (87.26)	341 (86.11)
I have no idea	19 (10.33)	4 (1.89)	23 (5.81)
Q#20: How much money would you hypothetically be willing to pay for the HPV vaccine series (recommended as 3 doses for those older than 15 years of age, the cost is approximately $150/dose)?
$0	32 (17.39)	17 (8.02)	49 (12.37)
$1 - $150	94 (51.09)	81 (38.21)	175 (44.19)
$150 to $450	49 (26.63)	89 (41.98)	138 (34.85)
>$450	9 (4.89)	25 (11.79)	34 (8.59)
Q#24: If the HPV vaccine was presented to you now, would you be interested in acquiring it free of charge?
Yes	167 (90.76)	203 (95.75)	370 (93.43)
No	17 (9.24)	9 (4.25)	26 (6.57)
Q#25: Did you know that you can get the HPV vaccine at the Engemann Student Health Center or Eric Cohen Student Health Center free of charge with Aetna Student Health Insurance?
Yes	148 (80.43)	195 (91.98)	343 (86.62)
No	36 (19.57)	17 (8.02)	53 (13.38)

Table 3. Healthcare and vaccination attitudes and history

	n (%)
Q#18: What is the most common information source on health and vaccines for you?
Family and Friends	209 (52.78)
Personal Healthcare Provider	66 (16.67)
Social Media	134 (33.84)
Other	11 (2.78)
Decline to Answer	0 (0.00)
Q#19: Which of the following factors would most determine whether or not you were going to get a certain vaccine?
Time and Accessibility	134 (33.84)
Family Values	18 (4.55)
Cost	48 (12.12)
Safety Concerns	176 (44.44)
Vaccine Effectiveness	82 (20.71)
Q#21: Have you visited a medical provider in the United States outside of the Engemann Student Health Center or Eric Cohen Student Health Center?
Yes	147 (37.12)
No	248 (62.63)
Decline to Answer	1 (0.25)
Q#22: Do you have Aetna Student Health Insurance through USC?
Yes	306 (77.27)
No	90 (22.73)
Q#23: Have you visited the Engemann Student Health Center or Eric Cohen Student Health Center?
Yes	334 (84.34)
No	62 (15.66)

Table 4. Sexual activity and sexual history

	n (%)
Q#6: Select all that apply:
I have had intercourse in the last 12 months	100 (25.25)
I have had oral sex in the last 12 months	52 (13.13)
I have had anal sex in the last 12 months	8 (2.02)
I have had sexual contact in the last 12 months	100 (25.25)
I have had no sexual contact in the last 12 months	219 (55.30)
Q#7: How many sexual partners have you had in the last 12 months?
0 Partners	215 (54.29)
1 Partner	158 (39.90)
2–5 Partners	21 (5.30)
More than 5 Partners	0 (0.00)
Decline to Answer/Inconsistent Responses	2 (0.51)
Q#8: Have you been diagnosed with a sexually transmitted disease (STD) like chlamydia, gonorrhea, syphilis, or HPV, in the past?
Yes	9 (2.27)
No	383 (96.72)
Prefer not to say	4 (1.01)

Table 5. Significant chi-square analysis results following conservative correction

Variable 1	Variable 2	p-value
Q#2: Sex	Q#9: HPV Vaccination Status	<0.0001
Q#2: Sex	Q#10: Self-Perceived HPV Knowledge	<0.0001
Q#2: Sex	Q#13: Knowledge of HPV Infection Rate	0.0004
Q#2: Sex	Q#16: Spoken to Doctor Regarding HPV Vaccine	<0.0001
Q#2: Sex	Q#20: Willingness to Pay for HPV Vaccine	<0.0001
Q#5: Resident Years in USA	Q#6: Sexual Activity	0.0003
Q#5: Resident Years in USA	Q#7: Number of Sex Partners in Past 12 Months	<0.0001
Q#9: HPV Vaccination Status	Q#10: Self-Perceived HPV Knowledge	<0.0001
Q#9: HPV Vaccination Status	Q#13: Knowledge of HPV Infection Rate	0.0005
Q#9: HPV Vaccination Status	Q#20: Willingness to Pay for HPV Vaccine	0.0007
Q#9: HPV Vaccination Status	Q#23: Past Student Health Center Visit	<0.0001
Q#14: Perceived Likelihood of Personal HPV Infection	Q#15: Feelings Toward Personal HPV Infection	<0.0001

Table 6. Multivariate regression of HPV vaccination status (Q#9) by sex (Q#2), university-sponsored student health insurance status (Q#22), and past student health center visit (Q#23)

	Coefficient	Standard Error	z-value	Pr(>|z|)	[95% Conf. Int.]
Constant	−3.4291	0.4536	−7.5599	0.0000	−4.3181	−2.5400
Q#2: Sex	2.9742	0.2735	10.8730	0.0000	2.4381	3.5104
Q#22: University-Sponsored Student Health Insurance Status	0.7508	0.2950	2.5457	0.0109	0.1728	1.3289
Q#23: Past Student Health Center Visit	1.8946	0.3779	5.0131	0.0000	1.1539	2.6354
Model Summary	No. Observations	Df Model	Df Residual	Pseudo R^2	Log-Likelihood	LL Null	LLR p-value
	434	3	430	0.335	−200.17	−300.83	2.21*10^−43

Table 7. Multivariate regression of HPV knowledge (Q#10) by HPV vaccination status (Q#9) and perceived likelihood of personal HPV infection (Q#14)

	Coefficient	Standard Error	z-value	Pr(>|z|)	[95% Conf. Int.]
Constant	1.5032	0.1585	9.4815	0.0000	1.1925	1.8140
Q#9: HPV Vaccination Status	−2.6993	0.2172	−12.4304	0.0000	−3.1249	−2.2737
Q#14: Perceived Likelihood of Personal HPV Infection	−1.2027	0.2201	−5.4650	0.0000	−1.6340	−0.7714
Model Summary	No. Observations	Df Model	Df Residual	Pseudo R^2	Log-Likelihood	LL Null	LLR p-value
	592	2	589	0.283	−294.23	−410.34	3.73*10^−51