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Human papillomavirus vaccination willingness under resource inequities: momentary intervention effects of an educational video
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Yuxi Liu1, Rujing Shi2, Mengmeng Jia3, Luodan Suo4, 5, 6, Wenxuan Li7, Luzhao Feng1, Juan Li4, 5, 6
Cancer Biology & Medicine | 2025, 22(9) : 1010 - 1016
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Cancer Biology & Medicine | 2025, 22(9): 1010-1016
• Letter •
Human papillomavirus vaccination willingness under resource inequities: momentary intervention effects of an educational video
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Yuxi Liu1, Rujing Shi2, Mengmeng Jia3, Luodan Suo4, 5, 6, Wenxuan Li7, Luzhao Feng1, Juan Li4, 5, 6
Affiliations
  • 1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, State Key Laboratory of Respiratory Health and Multimorbidity; Public Health Emergency Management Innovation Center, Beijing 100730, China
  • 2Department of Programmed Immunization, Haidian District Center for Diseases Control and Prevention, Beijing, China
  • 3National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102629, China
  • 4Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China
  • 5Beijing Research Center for Respiratory Infectious Diseases, Beijing 100013, China
  • 6School of Public Health, Capital Medical University, Beijing 100069, China
  • 7Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Human Major Diseases, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
About Author:

Author contributions

Conceived and designed the analysis: Yuxi Liu, Luzhao Feng, Juan Li.

Collected the data: Rujing Shi, Mengmeng Jia.

Performed the analysis: Wenxuan Li, Luodan Suo.

Wrote the paper: Yuxi Liu.

Published: 2025-09-15 doi: 10.20892/j.issn.2095-3941.2025.0400
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Yuxi Liu, Rujing Shi, Mengmeng Jia, Luodan Suo, Wenxuan Li, Luzhao Feng, Juan Li. Human papillomavirus vaccination willingness under resource inequities: momentary intervention effects of an educational video[J]. Cancer Biology & Medicine, 2025 , 22 (9) : 1010 -1016 . DOI: 10.20892/j.issn.2095-3941.2025.0400
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In 2022, cervical cancer accounted for approximately 662,301 new cases worldwide, representing 6.9% of all cancers diagnosed in women. Furthermore, it was the fourth leading cause of cancer-related deaths among women1. In China, human papillomavirus (HPV) vaccination is not included in the National Immunization Program, thus creating marked urban–rural disparities: only 5.7% of rural children are vaccinated2. Local publicly funded initiatives have increased vaccination uptake in some cities (e.g., Shenzhen pilot; Jinan first-dose coverage > 90% among eligible girls)3,4. Between 2017 and 2022, first-dose HPV vaccination among females 9–45 years of age rose from 0.01% to 10.15%, but remained far below the World Health Organization (WHO)’s 2030 target of 90% among 15-year-old girls5,6. Beijing’s 2023–2030 action plan prioritizes 9–14-year cohort and provides free voluntary vaccination for first-year female students, alongside targets to strengthen screening and treatment7. To decrease hesitancy, the WHO’s behavioural and social drivers (BeSD) framework guides identification of behavioral and social drivers, and supports brief, timely interventions8. Video- and Short Message Service (SMS)-based prompts have been demonstrated to improve vaccine knowledge, attitudes, and uptake, thus supporting momentary educational approaches in resource-limited settings9,10. For a single-event vaccination behavior such as HPV vaccination, incorporating acceptance determinants at the design stage might increase efficiency and cost-effectiveness.
This study used a quasi-experimental pre-post within-subjects design embedded in a multi-university survey, integrating an intention assessment with a brief educational video to analyze its effects on university students’ willingness to receive the HPV vaccine (Figure S1). The study was implemented across 23 universities in Beijing (from January 10 to February 10 of 2025) and yielded 6,244 valid questionnaires. Identical items on HPV knowledge, attitudes, and willingness were administered immediately before and after a 5-min educational video. We described respondent characteristics, vaccination status, and willingness, and examined heterogeneity and determinants aligned with BeSD domains. Pre-post changes in binary outcomes were assessed with the McNemar test, and changes in multicategory outcomes were assessed with the Stuart–Maxwell test. Associations between explanatory factors and vaccination willingness were analyzed with logistic regression. A two-sided P-value < 0.05 was considered statistically significant. No external control group was included; the outcomes captured immediate within-person change after the single-exposure video. The study was approved by the Medical Ethics Committee of the Beijing Center for Disease Prevention and Control, Beijing, China (Approval No. BJCDC2025011). All participants provided written informed consent.
Respondent characteristics
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A total of 6,244 valid questionnaires were collected (Table 1), the average participant age was 18.95 ± 1.82 years. Rural residents accounted for 29.74% of participants, among whom 198 (10.66%) had received the HPV vaccine; this percentage was lower than that among students from Beijing (28.73%) and other urban areas (18.70%). Among female respondents, 974 (27.16%) had been vaccinated (average age 19.52 years). Students whose parents had higher educational qualifications had relatively higher vaccination rates. Respondents with higher monthly living expenses exhibited higher vaccination rates; among those with monthly living expenses ≥ 3,000 CNY, 154 (32.91%) had received the HPV vaccine. Among vaccinated participants, 79.72% had received the nonavalent vaccine (Table S1); 84.35% reported reminders for subsequent doses. The mean service satisfaction score was 4.44 (SD = 0.62) on a 0–5 scale.
Heterogeneity in vaccination willingness
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Among participants not yet vaccinated, vaccination willingness was significantly associated with sex, age, place of origin, monthly living expenses, and sexual history (Figure S2). Compared with respondents willing to vaccinate immediately, those who were hesitant or unwilling had distinct characteristics: female sex was associated with markedly lower odds of hesitancy (OR = 0.10, 95% CI: 0.08–0.12, P < 0.01), older age was positively associated with hesitancy or refusal (OR = 1.14, 95% CI: 1.08–1.12, P < 0.01). Rural-origin respondents were associated with lower likelihood of hesitancy or refusal than urban origin (OR = 0.51, 95% CI: 0.35–0.74, P < 0.01). Regarding sexual history, participants without a sexual history (OR = 2.75, 95% CI: 1.91–3.99, P < 0.01) or those who were unwilling to disclose their sexual histories (OR = 2.55, 95% CI: 1.60–4.07, P < 0.01) had elevated likelihood of hesitation or refusal. Among respondents indicating that they were “willing to vaccinate but prefer to wait,” similar associations with female sex (OR = 0.44, 95% CI: 0.39–0.50, P < 0.01) and not being sexually active (OR = 1.78, 95% CI: 1.33–2.39, P < 0.01) were observed and remained significant. Rural (OR = 0.58, 95% CI: 0.44–0.78, P < 0.01) or other-city origin respondents (OR = 0.56, 95% CI: 0.43–0.72, P < 0.01), compared with Beijing origin, were associated with greater inclination to vaccinate immediately.
Determinants of vaccination willingness
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We compared unvaccinated individuals—grouped by their willingness to vaccinate—with vaccinated individuals to analyze differences in BeSD-aligned domains. (Table S2). A decline in trust was associated with a significantly decreased likelihood of willingness to vaccinate (OR = 1.26, 95% CI: 1.05–1.15, P = 0.01). Among individuals who were hesitant or unwilling to be vaccinated, individuals with vaccine safety concerns were more likely to exhibit a negative attitude than those who did not (OR = 2.30, 95% CI: 1.62–3.29, P < 0.01). Social processes were also associated with attitudes: respondents who did not receive vaccination recommendations from healthcare professionals were more likely to adopt negative attitudes than the counterparts who had received such advice (OR = 1.94, 95% CI: 1.65–2.30, P < 0.01). Peer influence reinforced these trends: lower peer vaccination rates was associated with lower likelihood of vaccination (OR = 2.18, 95% CI: 1.86–2.58, P < 0.01). Family support played a crucial role: weaker family support was associated with significantly lower likelihood of vaccination, particularly among those who were hesitant or unwilling to be vaccinated (OR = 6.38, 95% CI: 5.20–7.89, P < 0.01). Practical issues also played key roles: low accessibility was associated with significantly more pronounced hesitancy and refusal (OR = 5.22, 95% CI: 3.91–7.00, P < 0.01), and high out-of-pocket vaccination costs were negatively associated with willingness to vaccinate (OR = 1.99, 95% CI: 1.62–2.45, P < 0.01).
Post-intervention changes
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The willingness to be vaccinated increased among unvaccinated respondents after they had watched an educational video on HPV-related knowledge (Figure 1A). The proportion of respondents willing to vaccinate immediately increased from 33.50% to 53.44%, whereas that of participants who were entirely unwilling to vaccinate decreased from 0.96% to 0.51%. The intervention promoted the dissemination of HPV-related knowledge (Figure 1B): comprehensive HPV knowledge increased from 32.69% to 40.44% (P < 0.01); knowledge of HPV vaccination timing increased from 74.88% to 78.28% (P < 0.01); recognition of sex-inclusive vaccination increased from 53.41% to 77.03% (P < 0.01); and awareness that screening remains necessary after vaccination increased from 67.60% to 86.64% (P < 0.01). The intervention also improved attitudes toward HPV and HPV vaccination (Figure 1C): among non-vaccinated individuals, HPV risk perception increased from 15.76% to 50.40% (P < 0.01), and vaccine acceptance increased from 81.28% to 93.69% (P < 0.01).
Objective constraints and enablers of change
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Objective factors significantly influenced changes in vaccination willingness after the intervention (Table S3). Participants who remained unwilling to vaccinate exhibited significantly lower knowledge acquisition than those whose willingness improved (OR = 0.86, 95% CI: 0.80–0.92, P < 0.01). Participants whose parents supported HPV vaccination showed a marked increase in vaccination willingness (OR = 0.32, 95% CI: 0.14–0.65, P < 0.01). Vaccine affordability emerged as a key factor: compared with individuals who transitioned from unwillingness to willingness, those who perceived HPV vaccination costs as scarcely affordable (OR = 1.68, 95% CI: 1.13–2.54, P = 0.01) or unaffordable (OR = 1.79, 95% CI: 1.19–2.73, P < 0.01) were more likely to remain hesitant or unwilling.
Integrating intention assessment with a brief educational-video momentary intervention produced immediate and measurable improvements in HPV-related knowledge, attitudes, and willingness in a large university sample. However, the study was based on convenience sampling among universities in Beijing, thus potentially limiting the generalizability of the findings. In addition, clustering by university was not adjusted, and the subgroup analyses were exploratory in nature. These issues should be further addressed in future studies with larger and more representative populations. The profile of willingness was shaped by social processes, including healthcare-professional recommendations, peer vaccination uptake, family support, as well as by practical constraints, including accessibility and affordability. Our results indicated that an educational video alone is insufficient for subgroups facing limited access or high out-of-pocket burden. Implementation should therefore pair momentary education with one-click appointment links, campus or near-campus sessions, evening/weekend clinics, automated reminders for series completion, and providing targeted subsidies when affordability is a barrier. Brief provider-recommendation scripts and family-engagement messages can strengthen social cues. Such integration is feasible in university settings and resource-limited contexts, and may accelerate equitable HPV vaccination and cervical cancer prevention.
Funding
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  • This work was supported by grants from the China Association for Science and Technology (KXYJS2024012), the Gates Foundation (INV-006373 and INV-023808), Capital’s Funds for Health Improvement and Research (2024-2-30117), and Beijing Municipal Health Commission’s Funds for the High-qualified Public Health Professionals Development Project (Discipline Core-03-36).
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Appendix
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Year 2025 volume 22 Issue 9
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Article Info
doi: 10.20892/j.issn.2095-3941.2025.0400
  • Receive Date：2025-08-20
  • Online Date：2026-11-07
  • Published：2025-09-15
Article Data
Affiliations
History
  • Received：2025-08-20
  • Accepted：2025-09-05
Funding
This work was supported by grants from the China Association for Science and Technology (KXYJS2024012), the Gates Foundation (INV-006373 and INV-023808), Capital’s Funds for Health Improvement and Research (2024-2-30117), and Beijing Municipal Health Commission’s Funds for the High-qualified Public Health Professionals Development Project (Discipline Core-03-36).
Affiliations
    1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, State Key Laboratory of Respiratory Health and Multimorbidity; Public Health Emergency Management Innovation Center, Beijing 100730, China
    2Department of Programmed Immunization, Haidian District Center for Diseases Control and Prevention, Beijing, China
    3National Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102629, China
    4Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, Beijing Center for Disease Prevention and Control, Beijing 100013, China
    5Beijing Research Center for Respiratory Infectious Diseases, Beijing 100013, China
    6School of Public Health, Capital Medical University, Beijing 100069, China
    7Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Human Major Diseases, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China

Corresponding:

Correspondence to: Luzhao Feng and Juan Li, E-mail: and
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表12种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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