Gender differences in HPV vaccine hesitancy among college students: Implications for targeted health education...

Male HPV vaccine hesitancy in China has been understudied, especially since the vaccine's 2025 introduction. This study aimed to explore gender-specific factors associated with HPV vaccine hesitancy among college students to inform targeted public health interventions.

A cross-sectional online survey of 3591 college students from eastern, central, and western China (January-February 2025) collected data on sociodemographic characteristics, HPV knowledge and attitudes, social influence, and vaccine hesitancy. Gender-stratified multivariable logistic regression analyses identified determinants, with results presented as forest plots.

HPV vaccine hesitancy was higher among males (64.8%) than among females (30.6%). Among males, hesitancy was associated with lower HPV indication awareness (OR = 1.76, 95% CI: 1.34-2.31, P < 0.001), distrust in medical recommendations (OR = 1.46, 95% CI: 1.16-1.84, P = 0.001), lower perceived necessity (OR = 1.80, 95% CI: 1.48-2.21, P < 0.001), lack of medical recommendation (OR = 1.79, 95% CI: 1.33-2.42, P < 0.001), lower perceived severity (OR = 0.93, 95% CI: 0.88-0.98, P = 0.012), and lower fear of HPV (OR = 0.84, 95% CI: 0.80-0.88, P < 0.001). Among females, hesitancy was associated with lower HPV awareness (OR = 1.29, 95% CI: 1.08-1.56, P = 0.006), lower perceived preventive effectiveness (OR = 1.24, 95% CI: 1.00-1.54, P = 0.049), distrust in medical recommendations (OR = 1.74, 95% CI: 1.38-2.19, P < 0.001), lower perceived necessity (OR = 2.69, 95% CI: 2.20-3.31, P < 0.001), lower perceived severity (OR = 0.85, 95% CI: 0.78-0.91, P < 0.001), and lower peer recommendation (OR = 1.61, 95% CI: 1.18-2.18, P = 0.002).

Male and female college students may require differentiated HPV vaccination strategies. Strategies for males may need to focus on enhancing awareness of male HPV vaccination and reinforcing medical guidance.