Willingness to receive cross-border human papillomavirus vaccination among Chinese male university students: a cross-sectional study with statistical indirect-association analysis

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Background Human papillomavirus (HPV) vaccination is an important strategy for preventing HPV-related disease among males. Access to male HPV vaccination may involve cross-border health seeking for some university students in mainland China. This study estimated willingness to receive cross-border HPV vaccination among Chinese male university students and examined associations of HPV-related disease recognition, awareness of cross-border vaccination availability, and demographic and informational characteristics with willingness. Methods A cross-sectional anonymous online survey was conducted between September 2025 and March 2026 among 4,260 male university students in mainland China, Hong Kong, Macao, and overseas. The primary outcome was willingness to travel at personal expense to Hong Kong or Macao for HPV vaccination. HPV-related disease recognition was assessed using four conditions with established HPV associations: anogenital warts, penile cancer, anal cancer, and oropharyngeal cancer. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Of 4,260 participants, 3,182 (74.69%) reported willingness to receive cross-border HPV vaccination. Participants with a disease-recognition gap had substantially lower adjusted odds of willingness than those identifying at least one condition (aOR = 0.041, 95% CI: 0.017–0.095; p < 0.001). Awareness of cross-border HPV vaccination availability was positively associated with willingness (aOR = 1.233, 95% CI: 1.056–1.441; p = 0.008). Students studying in Guangdong province had higher adjusted odds of willingness than students in other mainland provinces (aOR = 1.213, 95% CI: 1.045–1.409; p = 0.011). Higher academic grade (aOR per level = 1.111, 95% CI: 1.023–1.206; p = 0.012) and exposure to school-based HPV information (aOR = 1.203, 95% CI: 1.005–1.440; p = 0.044) were also independently associated with willingness. The estimated indirect association through cross-border service awareness was statistically significant but small ( B = −0.022, bootstrap 95% CI: −0.040 to −0.006). Conclusion Willingness to receive cross-border HPV vaccination was reported by approximately three-quarters of participants. Recognition of established HPV-related male diseases and awareness of cross-border vaccination availability were associated with willingness. The cross-sectional design precludes causal inference. Longitudinal and intervention studies are needed to determine whether male-focused HPV education and service-navigation strategies increase actual vaccine uptake.

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