A nationwide survey on knowledge, attitude and practice regarding human papillomavirus (HPV), HPV-related disease and HPV vaccine among young adults in China

BACKGROUND: Human papillomavirus (HPV) is a common sexually transmitted infection with a substantial disease burden in China. Despite the importance of vaccinating young adults, coverage remains suboptimal. This study aims to assess the knowledge, attitude, and practice (KAP) towards HPV, HPV-related disease, and HPV vaccine among young adults in China. METHODS: A nationwide cross-sectional survey was conducted between July and August 2024, enrolling 1000 young adults aged 18-30 years through stratified sampling across seven administrative regions. Participants completed a structured electronic questionnaire assessing socio-demographics and KAP regarding HPV, HPV-related disease, and HPV vaccination. Descriptive analyses summarized KAP, and regression models identified associated factors. RESULTS: Overall, 70.4% of participants had heard of HPV and 75.2% had heard of HPV vaccine. The mean knowledge score was 5.3/10 for HPV and related diseases and 8.2/12 for HPV vaccine. Multivariable analysis demonstrated that higher knowledge levels were significantly associated with more favorable attitudes and stronger willingness to vaccinate in both sexes. There was a substantial gap between self-reported vaccination willingness (36.0% of males, 71.4% of females) and actual uptake (5.0% of males, 22.2% of females). Key barriers included insufficient knowledge about HPV vaccine, the absence of vaccinated individuals within participants' social networks, and safety concerns. CONCLUSION: KAP regarding HPV and vaccination have improved among young adults in China but still lag behind developed countries. Despite increased knowledge and vaccination willingness, a substantial gap persisted between intention and actual uptake. This requires not only strengthening HPV knowledge, reducing safety concerns, advocating universal vaccination strategies, and enhancing on-campus education, but also implementing systemic policy reforms to translate willingness into action, with the ultimate goal to reduce HPV-related disease burden.