Human papillomavirus vaccination coverage and knowledge, perceptions and influencing factors among university students in Guangzhou, China

Figures & data

Table 1. Demographic characteristics of the study participants (N = 5307)

Demographic & Basic Information	Coverage	Total (%, N = 5307)	Vaccination group (%, n = 164)	Non-vaccination groups	χ^2	p	OR
	(rate, 95%CI)			(%, n = 5143)
Sex
Male	2.0(1.3, 2.8)	1475 (27.8)	30 (18.3)	1445 (28.1)	7.6	<.05	1.0
Female	3.5(2.9, 4.1)	3832 (72.2)	134 (81.7)	3698 (71.9)			1.8 (1.2–2.6)
Hometown
Rural area	1.6(1.1, 2.1)	2690 (50.7)	43 (26.2)	2647 (51.5)	40.5	<.001	1.0
Urban area	4.6(3.8, 5.4)	2617 (49.3)	121 (73.8)	2496 (48.5)			3.0 (2.1–4.2)
Education
College:1–3 years of technical school training	2.3(0.0, 5.5)	86 (1.6)	2 (1.2)	84 (1.6)	5.6	.1	1.0
Undergraduate	3.0(2.6, 3.5)	5041 (95.0)	152 (92.7)	4889 (95.1)			1.3 (0.3–5.4)
Graduate or above	5.6(2.21, 8.9)	180 (3.4)	10 (6.1)	170 (3.3)			2.5 (0.5–11.5)
Marital status and sexually active
Single without sexually active	2.2(1.7, 2.7)	2824 (53.2)	62 (37.8)	2762 (53.7)	16.6	<.05	1.0
Married	6.7(0.0, 19.3)	15 (0.3)	1 (0.6)	14 (0.3)			3.2 (0.4–24.6)
In a relationship with sexually active	3.9(2.5, 5.3)	742 (14.0)	29 (17.7)	713 (13.9)			1.8 (1.2–2.8)
In a relationship without sexually active	4.2(3.2, 5.1)	1698 (32.0)	71 (43.3)	1627 (31.6)			1.9 (1.4–2.8)
Single with sexually active	3.6(0.0, 10.4)	28(0.5)	1 (0.6)	27 (0.5)			1.7 (0.2–12.3)
Sexual active
Not sexually active	2.9(2.5, 3.4)	4522 (85.2)	133 (81.1)	4389 (85.3)	9.4	<.05	1.0
Homosexual	3.8(0.0, 7.9)	80 (1.5)	3 (1.8)	77 (1.5)			1.3 (0.4–4.1)
Heterosexual	3.7(2.3, 5.1)	683 (12.9)	25 (15.2)	658 (12.8)			1.3 (0.8–1.9)
Bisexual	13.6(0.0, 28.0)	22 (0.4)	3 (1.8)	19 (0.4)			5.2 (1.5–17.8)
Monthly expenses
<1000 RMB	1.3(0.6, 2.0)	1021 (19.2)	13 (7.9)	1008 (19.6)	78.6	<.001	1.0
1000–1999 RMB	2.5(1.9, 3.0)	3422 (64.5)	84 (51.2)	3338 (64.9)			2.0 (1.1–3.5)
≥2000 RMB	7.8(6.0, 9.5)	864 (16.3)	67 (40.9)	797 (15.5)			6.5 (3.6–11.9)
Cervical cancer screen
No	3.1 (2.6, 3.7)	3771 (98.4)	118 (88.1)	3653 (98.8)	99.9	<.001	1.0
Yes	26.2 (14.9, 37.6)	61 (1.6)	16 (11.9)	45 (1.2)			11.0 (6.1–20.0)
Knowledge acquisition
No	1.9 (1.1, 2.8)	978 (35.7)	19 (14.3)	959 (36.8)	27.9	<.001	1.0
Yes	6.5 (5.3, 7.6)	1762 (64.3)	114 (85.7)	1648 (63.2)			3.5 (2.1–5.7)

Table 2. Knowledge of the HPV among college students, 2018 (N = 5307)

		Vaccination status
Knowledge of the HPV	% (n/N*100%)	Vaccination group (164)	Non-vaccination group −5143	χ^2	p	OR
Q1: Have you ever be heard of cervical cancer, anus cancer penile cancer and genital wart?
Yes	4234 (79.8)	141 (86.0)	4093 (79.6)	4.1	.1	1.0
NO	655 (12.5)	15 (9.2)	650 (12.6)			0.7 (0.4–1.1)
Not sure	408 (7.7)	8 (4.9)	400 (7.8)			0.6 (0.3–1.2)
Q2: Dose HPV infection lead to cervical cancer?
Yes	300 (5.7)	21 (12.8)	279 (5.4)	35.6	<.001	1.0
No	1858 (35.0)	79 (48.2)	1779 (34.6)			0.6 (0.4–0.9)
Not sure	3149 (59.3)	64 (39.0)	3085 (60.0)			0.3 (0.2–0.5)
Q3: How do you think about transmission way of HPV infection? (multiple choice)
Sexually	5164 (97.3)	160 (97.6)	5004 (97.3)	-	-	-
Blood	4356 (82.1)	118 (72.0)	4238 (82.4)
Airborne	365 (6.9)	13 (7.9)	352 (6.8)
Contact	302 (5.7)	12 (7.3)	290 (5.6)
Insect borne	646 (12.2)	19 (11.6)	627 (12.2)
Humoral	824 (15.5)	18 (11.0)	806 (15.7)
Q4: How do you think of the high-risk about the HPV infection? (multiple choice)
Unprotective sexual behavior	4940 (93.1)	155 (94.5)	4785 (93.0)	-	-	-
Obesity	125 (2.4)	8 (4.9)	117 (2.3)
Premature sexual behavior	1888 (35.6)	52 (31.7)	1836 (35.7)
Contact with infected case	1573 (29.6)	56 (34.2)	1517 (29.5)
On the sexually active age	1240 (23.4)	41 (25.0)	1199 (23.3)
50 years old or above	213 (4.0)	5 (3.1)	208 (4.0)
Multiple sexual partners	3461 (65.2)	98 (40.2)	3363 (34.6)
HPV carriers’ sexual partners	4368 (82.3)	136 (17.1)	4232 (17.7)
Sexual precocity	156 (2.9)	6 (96.3)	150 (97.1)
Low immunity	2308 (43.5)	62 (62.2)	2246 (56.3)
Sexually transmitted diseases	3479 (65.6)	100 (39.0)	3379 (34.3)
Q5:Understood the rout of transmission (based on Q3)
Yes	754 (14.2)	36 (22.0)	718 (14.0)	8.3	<.05	1.0
No	4410 (83.1)	124 (75.6)	4286 (83.3)			0.6 (0.4–0.8)
Not sure	143 (2.7)	4 (2.4)	139 (2.7)			0.6 (0.2–1.6)
Q6: Understood the risk factors of infection (based on Q4)
Yes	348 (6.6)	9 (5.5)	339 (6.6)	6.2	<.05	1.0
No	14 (0.3)	2 (1.2)	12 (0.2)			6.3 (1.2–32.3)
Not sure	4945 (93.2)	153 (93.3)	4792 (93.2)			1.2 (0.6–2.4)

Q3 ”How do you think about transmission way of HPV infection? “ and Q4 ”How do you think of the high-risk about the HPV infection? “ are multiple choice questions. Answers were classified into “Yes”, “No”, “Not sure”. For Q3, answers only choose “Sexually” classified to “Yes”, never choose “Sexually” classified to “NO”, except for these, classified to “Not sure”. For Q4, only if ”Unprotective sexual”, “Premature sexual behavior”, “On the sexually active age”, “Multiple sexual partners”, “HPV carriers’ sexual”, “Low immunity”, “Sexually transmitted” items are completely selected, were classified to “Yes”. Never choose ”Unprotective sexual”, “Premature sexual behavior”, “On the sexually active age”, “Multiple sexual partners”, “HPV carriers’ sexual”, “Low immunity”, “Sexually transmitted” items are completely selected, were classified to “No”. Except for these, classified to “Not sure”.

Table 3. Knowledge of the HPV vaccine among college students, 2018 (N = 5307)

		Vaccination Status
Knowledge of the HPV	% (n/N*100%)	Vaccination group (164)	Non-vaccination group −5143	χ^2	p	OR
Have you ever been heard of HPV vaccine?
	5307	164	5143
Yes	2740 (51.6)	133 (81.1)	2607 (50.7)	60.1	<.001	1.0
No	1859 (35.0)	18 (11.0)	1841 (35.8)			0.2 (0.1–0.3)
Not sure	708 (13.3)	13 (7.9)	695 (13.5)			0.4 (0.2–0.7)
HPV vaccine can100% protect from getting cervical cancer?
	2740	133	2607	29.9	<.001
Yes	67 (2.5)	10 (7.5)	57 (2.2)			1.0
No	2153 (78.6)	116 (87.2)	2037 (78.2)			0.3 (0.2–0.7)
Not sure	520 (19.0)	7 (5.3)	513 (19.7)			0.1 (0.0–0.2)
How do you think of the adaptive population for HPV vaccine?
	2740	133	2607
Both	1762 (64.3)	112 (84.2)	1650 (63.3)	27.6	<.001	1.0
Only female	973 (35.5)	20 (15.0)	953 (36.6)			0.3 (0.2–0.5)
Only male	5 (0.2)	1 (0.8)	4 (0.2)			3.7 (0.4–33.2)
How do you think of the difference between the bivalent vaccine, tetravalent vaccine and nine valent vaccine? (multiple choice)
	2740	133	2607
Protective effect	1300 (47.5)	70 (52.6)	1230 (47.2)	-	-	-
Protected pathogens	1288 (47.0)	91 (68.4)	1197 (45.9)
Price	1051 (38.4)	53 (39.8)	998 (383)
Adaptive population	679 (24.8)	30 (22.6)	649 (24.9)
Adaptive age	673 (24.6)	26 (19.6)	647 (24.8)
Inoculation process	367 (13.4)	18 (13.5)	349 (13.4)
Duration of protection	341 (12.5)	11 (8.3)	330 (12.7)
Side effect	326 (11.9)	11 (8.3)	315 (12.1)
Manufacturer	140 (5.1)	11 (8.3)	129 (5.0)

“How do you think of the difference between the bivalent vaccine, tetravalent vaccine and nine valent vaccine?” is a multiple choice question, was not included in univariable logistic regression.

Table 4. Attitude of the HPV vaccine vaccination among college students, 2018 (N = 5307)

		vaccination status
Knowledge of the HPV	% (n/N*100%)	Vaccination group (164)	Non-vaccination group −5143	χ^2	p	OR
	(n/N*100%)	group (164)	−5143	χ^2	p
Are you considering of taking the HPV vaccine?
	5307	164	5143
Yes	1320 (24.9)	164(100.0)	1156 (22.5)	309.7	<.001	1.0
Not sure	2949 (55.6)	-	2949 (57.3)			0.0 (0.0–0.0)
No	1038 (19.7)	-	1038 (20.2)			0.0 (0.0–0.0)
What kind of HPV vaccine will you select?
	1313	164	1149	3.3	.2
Bivalent	190 (14.5)	27(16.3)	163 (14.2)			1.0
Quadrivalent	463 (35.3)	40 (24.4)	423 (36.8)			0.6 (0.2–1.6)
Nine valent	660 (50.3)	97 (59.3)	563 (49.0)			1.2 (0.5–2.7)
Will you recommend your relatives to vaccinate?
	5307	164	5143	105.0	<.001
Yes	2213 (41.7)	132 (80.5)	2081 (40.5)			1
No	430 (8.1)	6 (3.7)	424 (8.2)			0.2 (0.1–0.5)
Not sure	2664 (50.2)	26 (15.9)	2638 (51.3)			0.2 (0.1–0.3)
The considering factors while selecting HPV vaccine. (multiple choice)
	1320	164	1156
Protect effect	1215 (92.1)	149 (91.1)	1066 (92.2)	-	-	-
Side effect	858 (65.0)	97 (59.3)	761 (65.8)
Price	850 (64.4)	78(47.4)	772 (66.8)
Doctor recommendation	353 (26.7)	41 (25.2)	312 (27.0)
Vaccine manufacturer	591 (44.8)	74 (45.2)	517 (44.7)

Figure 1. The reason decide to vaccinate or not

Table 5. Multivariable logistic regression analysis of the predictors for college students’ vaccination behavior

Factors	B	S.E	Wald	df	P		95% CI
						OR	lowwer	upper
Gender: female	0.7	0.3	4.6	1.0	<.05	2.0	1.1	3.7
Hometown: urban area	0.6	0.2	10.9	1.0	<.05	2.1	1.4	3.3
Monthly expenses	1.0	0.2	30.8	1.0	<.05	2.6	1.9	3.6
Sexual behavior			8.1	3.0	<.05
Asexual behavior (reference)	-	-	-	-	-	1.0	-	-
Heterosexual behavior	−0.3	0.6	0.3	1.0	.6	0.7	0.2	2.5
Homosexual behavior	−0.4	0.3	2.2	1.0	.1	0.7	0.4	1.1
Bisexual behavior	1.7	0.8	5.1	1.00	<.05	5.4	1.3	23.3
HPV vaccine do protected from cancer: NO or not sure	1.6	0.4	16.6	1.0	<.05	3.2	2.0	5.2
Will recommendate relatives to vaccinate: yes	1.6	0.3	29.9	1.0	<.05	4.7	2.7	8.3
Quite know of HPV vaccine adaptive population	1.1	0.3	20.1	1.0	<.05	3.1	1.9	5.0
Know of HPV infection high risk factors	0.9	0.4	4.6	1.0	<.05	2.5	1.1	5.7

*The option of “Will you recommendate your relatives to vaccinate?” has been classed to “yes” (original “yes” option) and “not sure” (original “no” and “not sure” options). The response option of “adaptive population for HPV vaccine” classed to “yes” (original “both male and female” option) and “not sure” (original “only male” and “only female” options). Assign values (0 or 1) to each option of question “How do you think of the high-risk about the HPV infection?” and assembled into ordered categorical variable as followed: 1 = completely know, 2 = know some, 3 = don’t know. “Monthly expenses” was input into multivariable logistic regression model as continuous variable.

Table

University Name	Registered student’s number	Constituent ratio(%)	Sample size
Guangzhou Academy of Fine Arts	5465	3.24%	168
Guangdong Pharmaceutical University	9000	5.34%	276
Guangdong University of Technology	29619	17.56%	910
South China University of Technology	16860	10.00%	518
Guangzhou Medical University	5290	3.14%	162
South China Normal University	16400	9.72%	504
Sun Yat-sen University	18450	10.94%	567
Guangdong University of Foreign Studies	13380	7.93%	411
Guangzhou University	29622	17.56%	910
Xinghai Conservatory of music	3953	2.34%	121
Guangzhou University of Chinese Medicine	13000	7.71%	399
Jinan University	7618	4.52%	233
Total	168657		5179

Sample size is calculated as 3884 by formula N＝t²PQ/d², d = 0.1 × P and assumed coverage of 9%, which is concluded from Hong Kong surveys. Taking a no response rate of 25%, the final sample size is 5179.