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Article(id=1311350070658822697, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511203, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763049600000, receivedDateStr=2025-11-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579820550, onlineDateStr=2026-09-28, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579820550, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579820550, creator=13701087609, updateTime=1790579820550, updator=13701087609, issue=Issue{id=1311349984730116963, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579800064, creator='13701087609', updateTime=1790588348354, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385838924169506, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385838924169507, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349984730116963, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2633, endPage=2638, ext={EN=ArticleExt(id=1311350070851760682, articleId=1311350070658822697, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Changes in influenza vaccine hesitancy and comparison of influencing factors among university students in central and western China: a repeated cross-sectional survey, 2022-2025, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the changing trends and the stability of influencing factors of influenza vaccine hesitancy among university students in central and western China between 2022 and 2025, and to provide evidence for targeted interventions in universities.

Methods

Two rounds of repeat cross-sectional surveys were conducted among university students in central and western China in June 2022 and between January and February 2025. Propensity Score Matching (PSM) was used to balance baseline characteristics. Binary Logistic Regression analyses were employed to identify factors associated with vaccine hesitancy.

Results

A total of 1 786 matched pairs were included in the analysis. From 2022 to 2025, the vaccine hesitancy rate significantly decreased from 47.65% (851/1 786) to 33.31% (595/1 786) (P<0.001). Logistic regression revealed that perceived severity of influenza (2022 OR=0.799 (0.763-0.837), 2025 OR=0.845 (0.793-0.900)), perceived necessity of vaccination (2022 OR=0.275 (0.131-0.579), 2025 OR=0.157 (0.068-0.361)), and previous influenza vaccination history (2022 OR=0.284 (0.222-0.363), 2025 OR=0.469 (0.363-0.606)) were stable protective factors against hesitancy in both years (allP<0.05). Influenza vaccine knowledge changed from a risk factor in 2022 (OR=1.118 (1.009-1.240), P=0.033) to a protective factor in 2025 (OR=0.827 (0.730-0.938), P=0.003). The protective effect of recommendations from family, classmates, or friends was significantly strengthened in 2025 (OR=0.362 (0.278-0.473), P<0.001).

Conclusion

The influenza vaccine hesitancy rate among university students in central and western China decreased significantly between 2022 and 2025, primarily driven by improved vaccine knowledge, enhanced positive social norms, and heightened risk perception. Further efforts to reduce hesitancy should focus on optimizing knowledge dissemination, leveraging social networks, and strengthening guidance from authoritative sources.

, authors=Hua-mei WU1, Xi-chen TONG2, Lu-ying ZHANG2, authorsList=Hua-mei WU, Xi-chen TONG, Lu-ying ZHANG, authorCompany=null, correspAuthors=Lu-ying ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350072902775353, articleId=1311350070658822697, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中西部大学生流感疫苗犹豫的变化及影响因素比较：基于2022与2025年的重复横断面调查, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

分析2022～2025年间中西部地区大学生流感疫苗犹豫的变化趋势及影响因素的稳定性，为高校精准干预提供依据。

方法

于2022年6月和2025年1～2月，对中西部地区高校学生开展两轮重复横断面调查，采用倾向得分匹配（Propensity Score Matching, PSM）平衡基线特征，使用二元logistic回归分析流感疫苗犹豫的影响因素。

结果

共纳入1 786对匹配样本。2022至2025年间，流感疫苗犹豫率由47.65%（851/1 786）显著下降至33.31%（595/1 786）（P<0.001）。Logistic回归显示，感知流感严重性（2022年OR=0.799（0.763~0.837），2025年OR=0.845（0.793~0.900））、认为接种有必要（2022年OR=0.275（0.131~0.579），2025年OR=0.157（0.068~0.361））及既往接种史（2022年OR=0.284（0.222~0.363），2025年OR=0.469（0.363~0.606））在两个年份均为稳定的保护因素（所有P<0.05）；流感疫苗知识水平从2022年的风险因素（OR=1.118（1.009~1.240），P=0.033）转变为2025年的保护因素（OR=0.827（0.730~0.938），P=0.003），家人、同学或朋友推荐的作用在2025年显著增强（OR=0.362（0.278~0.473），P<0.001）。

结论

2022～2025年间中西部地区大学生流感疫苗犹豫率显著下降，专业知识提升、社会规范增强与风险感知提高是主要驱动因素。建议通过优化知识传播、激活社会网络与强化权威引导，进一步降低流感疫苗犹豫。

, authors=吴华梅1, 童禧辰2, 张璐莹2, authorsList=吴华梅, 童禧辰, 张璐莹, authorCompany=null, correspAuthors=张璐莹, authorNote=

吴华梅和童禧辰为共同第一作者。

吴华梅（1981—），女，硕士，副教授，研究方向：公共管理/公共政策

童禧辰（2000—），女，博士在读，研究方向：卫生政策与卫生经济学研究

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张璐莹，E-mail：
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Chinese journal of vaccines and immunization, 2025, 31(4): 456-461.(In Chinese), articleTitle=Vaccine literacy and factors influencing literacy among residents ≥50 years of age in Henan province, 2023, refAbstract=null), Reference(id=1311350087402484353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, doi=null, pmid=null, pmcid=null, year=2023, volume=24, issue=9, pageStart=986, pageEnd=990, url=null, language=null, rfNumber=[22], rfOrder=32, authorNames=高语嫣, 孙昊, 闫威, journalName=中国预防医学杂志, refType=null, unstructuredReference=高语嫣，孙昊，闫威，等．北京市东城区重组带状疱疹疫苗受种者疫苗认知及推荐意愿调查［J］．中国预防医学杂志，2023，24(9)：986-990．, articleTitle=北京市东城区重组带状疱疹疫苗受种者疫苗认知及推荐意愿调查, refAbstract=null), Reference(id=1311350087473787522, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, doi=null, pmid=null, pmcid=null, year=2023, volume=24, issue=9, pageStart=986, pageEnd=990, url=null, language=null, rfNumber=[22], rfOrder=33, authorNames=Gao YY, Sun H, Yan W, journalName=China Preventive Medicine, refType=null, unstructuredReference=Gao YY, Sun H, Yan W, et al. 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Journal of American College Health, 2024, 72(4): 995-1000., articleTitle=The multi-dimensional impact of different sources of information on influenza vaccination of college students in China, refAbstract=null)], funds=[Fund(id=1311350077369709152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, awardId=72374049, language=CN, fundingSource=国家自然科学基金面上项目(72374049), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350073208959546, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, xref=1., ext=[AuthorCompanyExt(id=1311350073217348155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, companyId=1311350073208959546, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shanghai Urban Construction Vocational College, Shanghai 200438, China), AuthorCompanyExt(id=1311350073221542460, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, companyId=1311350073208959546, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.上海城建职业学院，上海 200438)]), AuthorCompany(id=1311350073271874109, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, xref=2., ext=[AuthorCompanyExt(id=1311350073276068414, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, companyId=1311350073271874109, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.复旦大学公共卫生学院)])], figs=[ArticleFig(id=1311350076103029336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=EN, label=Fig.1, caption=Influenza vaccine information sources among university students in central and western China in 2022 and 2025, figureFileSmall=31gp3cA3aIqmFyTjRuyXZg==, figureFileBig=HCDLmU89mDsy14rsdYipqQ==, tableContent=null), ArticleFig(id=1311350076203692633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=CN, label=图1, caption=2022和2025年中西部地区大学生的流感疫苗信息来源

注：***P<0.001，**P<0.05。

, figureFileSmall=31gp3cA3aIqmFyTjRuyXZg==, figureFileBig=HCDLmU89mDsy14rsdYipqQ==, tableContent=null), ArticleFig(id=1311350076551819866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=EN, label=Table 1, caption=

Sociodemographic characteristics of the sample after propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
特征2022（n=1 786）2025（n=1 786）标准偏差
（%）		P值
女性［n（%）］897（50.22）876（49.05）-2.40.482
年龄（岁），21.06±2.2521.21±2.536.60.048
医学专业［n（%）］945（52.91）972（54.42）3.10.365
研究生［n（%）］232（12.99）294（16.46）9.80.003
农村户口［n（%）］917（51.34）938（52.52）2.40.482
参加医保［n（%）］1 611（91.88）1 621（90.76）-4.00.235
流感史［n（%）］670（37.51）668（37.40）-0.30.945
), ArticleFig(id=1311350076635705947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=CN, label=表1, caption=

倾向得分匹配后样本的社会人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征2022（n=1 786）2025（n=1 786）标准偏差
（%）		P值
女性［n（%）］897（50.22）876（49.05）-2.40.482
年龄（岁），21.06±2.2521.21±2.536.60.048
医学专业［n（%）］945（52.91）972（54.42）3.10.365
研究生［n（%）］232（12.99）294（16.46）9.80.003
农村户口［n（%）］917（51.34）938（52.52）2.40.482
参加医保［n（%）］1 611（91.88）1 621（90.76）-4.00.235
流感史［n（%）］670（37.51）668（37.40）-0.30.945
), ArticleFig(id=1311350076732174940, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=EN, label=Table 2, caption=

Comparison of influenza vaccine hesitancy and related factors between 2022 and 2025

, figureFileSmall=null, figureFileBig=null, tableContent=
因素2022
（n=1 786）		2025
（n=1 786）		χ2/t自由度P值
流感疫苗犹豫
是否犹豫［n（%）］851（47.65）595（33.31）76.191<0.001
环境因素
在媒体上看到过关于流感疫苗不良事件报告［n（%）］594（33.26）959（53.70）151.771<0.001
个体与群体因素
流感知识水平（0~3）,2.54±0.912.25±0.8410.133 544<0.001
流感疫苗知识水平（0~3）,1.23±1.121.63±0.95-11.483 483<0.001
感染流感的感知可能性（0~10）,4.85±2.585.12±2.17-3.323 471<0.001
流感的感知严重性（0~10）,5.44±2.456.08±2.02-8.613 444<0.001
认为有必要接种流感疫苗［n（%）］1 703（95.35）1 610（90.15）36.001<0.001
流感疫苗接种史［n（%）］601（33.65）853（47.76）73.661<0.001
曾自费接种其他疫苗［n（%）］460（25.76）563（31.52）14.531<0.001
周围有人接种过流感疫苗［n（%）］997（55.82）1 141（66.69）24.161<0.001
家人、同学和朋友推荐接种［n（%）］615（34.43）949（53.14）126.881<0.001
疫苗相关因素
认为流感疫苗有效［n（%）］1 726（96.64）1 598（89.47）70.991<0.001
医务人员推荐流感疫苗［n（%）］540（30.24）1 022（57.22）264.321<0.001
信任医务人员推荐［n（%）］1 773（99.27）1 606（89.92）152.761<0.001
信任国产流感疫苗［n（%）］1 776（99.44）1 611（90.20）155.201<0.001
信任进口流感疫苗［n（%）］1 742（97.54）1 588（88.91）105.121<0.001
), ArticleFig(id=1311350076912530013, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=CN, label=表2, caption=

2022年和2025年流感疫苗犹豫和相关因素的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
因素2022
（n=1 786）		2025
（n=1 786）		χ2/t自由度P值
流感疫苗犹豫
是否犹豫［n（%）］851（47.65）595（33.31）76.191<0.001
环境因素
在媒体上看到过关于流感疫苗不良事件报告［n（%）］594（33.26）959（53.70）151.771<0.001
个体与群体因素
流感知识水平（0~3）,2.54±0.912.25±0.8410.133 544<0.001
流感疫苗知识水平（0~3）,1.23±1.121.63±0.95-11.483 483<0.001
感染流感的感知可能性（0~10）,4.85±2.585.12±2.17-3.323 471<0.001
流感的感知严重性（0~10）,5.44±2.456.08±2.02-8.613 444<0.001
认为有必要接种流感疫苗［n（%）］1 703（95.35）1 610（90.15）36.001<0.001
流感疫苗接种史［n（%）］601（33.65）853（47.76）73.661<0.001
曾自费接种其他疫苗［n（%）］460（25.76）563（31.52）14.531<0.001
周围有人接种过流感疫苗［n（%）］997（55.82）1 141（66.69）24.161<0.001
家人、同学和朋友推荐接种［n（%）］615（34.43）949（53.14）126.881<0.001
疫苗相关因素
认为流感疫苗有效［n（%）］1 726（96.64）1 598（89.47）70.991<0.001
医务人员推荐流感疫苗［n（%）］540（30.24）1 022（57.22）264.321<0.001
信任医务人员推荐［n（%）］1 773（99.27）1 606（89.92）152.761<0.001
信任国产流感疫苗［n（%）］1 776（99.44）1 611（90.20）155.201<0.001
信任进口流感疫苗［n（%）］1 742（97.54）1 588（88.91）105.121<0.001
), ArticleFig(id=1311350076992221790, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=EN, label=Table 3, caption=

Binary logistic regression analysis of factors associated with influenza vaccine hesitancy in 2022 and 2025

, figureFileSmall=null, figureFileBig=null, tableContent=
因素2022年2025年
OR值（95%CI）P值OR值（95%CI）P值
学历2.044（1.472~2.837）<0.0010.881（0.633~1.228）0.455
参保基本医疗保险1.861（1.252~2.766）0.0020.996（0.666~1.488）0.984
流感严重性0.799（0.763~0.837）<0.0010.845（0.793~0.900）<0.001
流感疫苗知识1.118（1.009~1.240）0.0330.827（0.730~0.938）0.003
流感他人接种0.520（0.407~0.665）<0.0010.772（0.586~1.016）0.065
认为流感疫苗有效0.467（0.224~0.975）0.0430.274（0.136~0.549）<0.001
流感疫苗必要性0.275（0.131~0.579）0.0010.157（0.068~0.361）<0.001
流感亲朋推荐0.782（0.604~1.011）0.0600.362（0.278~0.473）<0.001
流感医务推荐信任度0.052（0.005~0.586）0.0170.345（0.171~0.696）0.003
曾经接种流感疫苗0.284（0.222~0.363）<0.0010.469（0.363~0.606）<0.001
), ArticleFig(id=1311350077055136351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350070658822697, language=CN, label=表3, caption=

2022年和2025年流感疫苗犹豫相关因素的二元logistic回归

, figureFileSmall=null, figureFileBig=null, tableContent=
因素2022年2025年
OR值（95%CI）P值OR值（95%CI）P值
学历2.044（1.472~2.837）<0.0010.881（0.633~1.228）0.455
参保基本医疗保险1.861（1.252~2.766）0.0020.996（0.666~1.488）0.984
流感严重性0.799（0.763~0.837）<0.0010.845（0.793~0.900）<0.001
流感疫苗知识1.118（1.009~1.240）0.0330.827（0.730~0.938）0.003
流感他人接种0.520（0.407~0.665）<0.0010.772（0.586~1.016）0.065
认为流感疫苗有效0.467（0.224~0.975）0.0430.274（0.136~0.549）<0.001
流感疫苗必要性0.275（0.131~0.579）0.0010.157（0.068~0.361）<0.001
流感亲朋推荐0.782（0.604~1.011）0.0600.362（0.278~0.473）<0.001
流感医务推荐信任度0.052（0.005~0.586）0.0170.345（0.171~0.696）0.003
曾经接种流感疫苗0.284（0.222~0.363）<0.0010.469（0.363~0.606）<0.001
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中西部大学生流感疫苗犹豫的变化及影响因素比较：基于2022与2025年的重复横断面调查
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吴华梅 1 , 童禧辰 2 , 张璐莹 2
现代预防医学 | 健康与社会行为 2026,53(14): 2633-2638
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现代预防医学 |健康与社会行为 2026 , 53 (14) : 2633 -2638
中西部大学生流感疫苗犹豫的变化及影响因素比较：基于2022与2025年的重复横断面调查
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吴华梅1, 童禧辰2, 张璐莹2
作者信息
  • 1.上海城建职业学院，上海 200438
  • 2.复旦大学公共卫生学院
通讯作者:
张璐莹，E-mail：
作者简介:

吴华梅和童禧辰为共同第一作者。

吴华梅（1981—），女，硕士，副教授，研究方向：公共管理/公共政策

童禧辰（2000—），女，博士在读，研究方向：卫生政策与卫生经济学研究

Changes in influenza vaccine hesitancy and comparison of influencing factors among university students in central and western China: a repeated cross-sectional survey, 2022-2025
Hua-mei WU1, Xi-chen TONG2, Lu-ying ZHANG2
Affiliations
  • Shanghai Urban Construction Vocational College, Shanghai 200438, China
出版时间: 2026-07-25 doi: 10.20043/j.cnki.MPM.202511203
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摘要
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目的

分析2022～2025年间中西部地区大学生流感疫苗犹豫的变化趋势及影响因素的稳定性，为高校精准干预提供依据。

方法

于2022年6月和2025年1～2月，对中西部地区高校学生开展两轮重复横断面调查，采用倾向得分匹配（Propensity Score Matching, PSM）平衡基线特征，使用二元logistic回归分析流感疫苗犹豫的影响因素。

结果

共纳入1 786对匹配样本。2022至2025年间，流感疫苗犹豫率由47.65%（851/1 786）显著下降至33.31%（595/1 786）（P<0.001）。Logistic回归显示，感知流感严重性（2022年OR=0.799（0.763~0.837），2025年OR=0.845（0.793~0.900））、认为接种有必要（2022年OR=0.275（0.131~0.579），2025年OR=0.157（0.068~0.361））及既往接种史（2022年OR=0.284（0.222~0.363），2025年OR=0.469（0.363~0.606））在两个年份均为稳定的保护因素（所有P<0.05）；流感疫苗知识水平从2022年的风险因素（OR=1.118（1.009~1.240），P=0.033）转变为2025年的保护因素（OR=0.827（0.730~0.938），P=0.003），家人、同学或朋友推荐的作用在2025年显著增强（OR=0.362（0.278~0.473），P<0.001）。

结论

2022～2025年间中西部地区大学生流感疫苗犹豫率显著下降，专业知识提升、社会规范增强与风险感知提高是主要驱动因素。建议通过优化知识传播、激活社会网络与强化权威引导，进一步降低流感疫苗犹豫。

流感疫苗  /  疫苗犹豫  /  大学生  /  中西部地区  /  影响因素
Objective

To analyze the changing trends and the stability of influencing factors of influenza vaccine hesitancy among university students in central and western China between 2022 and 2025, and to provide evidence for targeted interventions in universities.

Methods

Two rounds of repeat cross-sectional surveys were conducted among university students in central and western China in June 2022 and between January and February 2025. Propensity Score Matching (PSM) was used to balance baseline characteristics. Binary Logistic Regression analyses were employed to identify factors associated with vaccine hesitancy.

Results

A total of 1 786 matched pairs were included in the analysis. From 2022 to 2025, the vaccine hesitancy rate significantly decreased from 47.65% (851/1 786) to 33.31% (595/1 786) (P<0.001). Logistic regression revealed that perceived severity of influenza (2022 OR=0.799 (0.763-0.837), 2025 OR=0.845 (0.793-0.900)), perceived necessity of vaccination (2022 OR=0.275 (0.131-0.579), 2025 OR=0.157 (0.068-0.361)), and previous influenza vaccination history (2022 OR=0.284 (0.222-0.363), 2025 OR=0.469 (0.363-0.606)) were stable protective factors against hesitancy in both years (allP<0.05). Influenza vaccine knowledge changed from a risk factor in 2022 (OR=1.118 (1.009-1.240), P=0.033) to a protective factor in 2025 (OR=0.827 (0.730-0.938), P=0.003). The protective effect of recommendations from family, classmates, or friends was significantly strengthened in 2025 (OR=0.362 (0.278-0.473), P<0.001).

Conclusion

The influenza vaccine hesitancy rate among university students in central and western China decreased significantly between 2022 and 2025, primarily driven by improved vaccine knowledge, enhanced positive social norms, and heightened risk perception. Further efforts to reduce hesitancy should focus on optimizing knowledge dissemination, leveraging social networks, and strengthening guidance from authoritative sources.

Influenza vaccine  /  Vaccine hesitancy  /  University students  /  Central and western China  /  Influencing factors
吴华梅, 童禧辰, 张璐莹. 中西部大学生流感疫苗犹豫的变化及影响因素比较：基于2022与2025年的重复横断面调查. 现代预防医学, 2026 , 53 (14) : 2633 -2638 . DOI: 10.20043/j.cnki.MPM.202511203
Hua-mei WU, Xi-chen TONG, Lu-ying ZHANG. Changes in influenza vaccine hesitancy and comparison of influencing factors among university students in central and western China: a repeated cross-sectional survey, 2022-2025[J]. Modern Preventive Medicine, 2026 , 53 (14) : 2633 -2638 . DOI: 10.20043/j.cnki.MPM.202511203
正文
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流行性感冒（流感）是急性呼吸道传染病，传播迅速、变异频繁，对公共卫生构成持续威胁[1-3]。接种流感疫苗是预防流感及其并发症最经济有效的措施[4,5]，然而我国接种率长期处于较低水平，2021—2022年流行季全国流感疫苗接种率仅为2.47%[6]，远低于同期欧美国家，提示我国在疫苗推广方面仍面临严峻挑战。
“疫苗犹豫”作为影响接种决策的关键心理与行为障碍，已于2019年被世界卫生组织列为全球十大健康威胁之一[7]。大学生居住密集、社交活跃，是呼吸道传染病传播的高风险群体，其疫苗犹豫状况可能影响群体免疫屏障的形成[8]。
COVID-19大流行重塑了公众疫苗认知。尽管部分研究显示疫情后流感疫苗接受度提高[9]，但也出现了“疫苗疲劳”和信息回避现象[10-12]，提示后疫情时代疫苗犹豫机制更趋复杂。中西部地区社会经济和卫生系统发展相对滞后于东部地区，且已有研究显示不同地区疫苗素养差异较大[13]，西部地区民众疫苗犹豫比例（62.98%）显著高于东部地区（54.00%）[14]。然而，现有关于中国大学生流感疫苗犹豫的研究多基于单一时点横断面调查[15]，难以揭示其随时间的变化规律，尤其针对中西部地区高校学生的系统性分析仍然匮乏。鉴于此，有必要开展重复调查，通过跨时间比较，全面评估该群体流感疫苗犹豫水平的变化趋势，并探讨影响因素的稳定性，为制定针对性干预策略提供实证依据。
基于上述背景，本研究于2022年6月与2025年1～2月对中西部地区高校学生开展两轮重复横断面调查，旨在分析：（1）2022～2025年间该群体流感疫苗犹豫水平与结构的变化；（2）影响流感疫苗犹豫的关键因素在时间维度上的稳定性。研究结果可为中西部地区高校流感疫苗的精准推广提供科学依据。
1　对象与方法
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1.1　对象
本研究选取我国中西部高校在校大学生作为研究对象，涵盖专科、本科及研究生等多个培养层次，并同时包括医学与非医学相关专业。研究对象需满足以下纳入标准：（1）持有高校正式注册学籍；（2）自愿参与并签署知情同意书。本研究的实施方案已通过复旦大学公共卫生学院伦理审查委员会的审批（批号：IRB-2022-080992）。
1.2　方法
1.2.1　抽样方法
采用多阶段分层随机抽样设计，于2022年与2025年开展两轮横断面调查。研究范围涵盖《中国卫生健康统计年鉴》定义的中部8省（山西、吉林、黑龙江、安徽、江西、河南、湖北、湖南）与西部12省区市（内蒙古、广西、重庆、四川、贵州、云南、西藏、陕西、甘肃、青海、宁夏、新疆）。高校抽样依据办学层次（高职院校/综合大学）及是否设有医学专业分层，从中部、西部分别随机抽取16所和12所高校（共28所）。每校随机选取一个学院，通过在线平台向全院学生发放问卷，学生在知情同意后参与调查。样本量的计算基于横断面调查中总体比例估计的公式：
其中Z1-α/2=1.96（α=0.05时双侧检验的临界值，对应95%置信区间），δ为0.05（容许误差），P=44.7%（参照既往中国大学生流感疫苗犹豫人数占比设定）[8]。经计算，所需最小样本量为380例。为充分覆盖中、西部两个地区，将总样本量扩大至760例。
1.2.2　调查工具
采用结构化电子问卷收集数据。问卷基于课题组2022年全国大学生流感疫苗犹豫调查中经过验证的版本修订[8]，并根据后疫情时代特点及中西部情况进行优化，经专家评审保证内容效度。问卷以WHO疫苗犹豫矩阵为理论框架，核心模块包括：（1）社会人口学特征；（2）流感疫苗犹豫状况；（3）疫苗相关知识与信念；（4）信息来源渠道；（5）疫苗接种史与社会规范。2025年调查前对修订问卷进行信效度检验：Cronbach α为0.793，KMO值为0.822，巴特利特球形检验P<0.001，表明问卷信效度良好。2022年所用问卷的相应指标（Cronbach α=0.892, KMO=0.957）已见于文献[8]。
1.2.3　变量定义
核心变量包括：因变量为流感疫苗犹豫，通过意愿（综合为“愿意”与“犹豫/不愿意”的二分变量）和0~10分的犹豫程度评分进行测量；自变量依据WHO疫苗犹豫矩阵框架，涵盖环境因素（社会人口学特征、疫苗不良信息接触史）、个体与群体因素（流感及疫苗知识水平、感染风险与严重性感知、接种必要性认知、接种史、社会规范）以及疫苗与接种相关因素（对疫苗有效性、医务人员推荐、国产与进口疫苗的信任度）；信息来源则为多选题，渠道包括医务人员、亲友、互联网及传统媒体等。
1.3　质量控制
实施全过程质量控制：问卷设计阶段设置必答题项并限制同一IP或设备重复提交；正式调查前开展预调查（n=80）以优化问卷；数据收集后依据以下标准剔除无效问卷：（1）2022版问卷填写时间少于120秒，2025版少于180秒；（2）答案存在逻辑矛盾；（3）填报高校所在地非中西部地区，以确保数据真实有效。
1.4　统计分析
采用描述性与推断性统计方法分析数据。连续变量以均值±标准差表述，组间比较采用独立样本t检验。分类变量以频数（构成比）描述，组间差异比较采用χ2检验，若理论频数小于5或总样本量低于40，则选用Fisher精确概率法。为探讨流感疫苗犹豫的影响因素，分别基于2022年与2025年数据构建二元logistic回归模型。因变量为是否存在流感疫苗犹豫（1=是，0=否），自变量依据WHO疫苗犹豫矩阵框架选取。采用方差膨胀因子诊断多重共线性（VIF<10为判断标准）。为便于跨年度比较，最终选取两年模型中共同纳入的影响因素进行分析，结果以比值比及其95%置信区间表示。所有分析采用StataMP 17完成，图表绘制使用GraphPad Prism 10，检验水准设定为α=0.05（双侧）。
2　结果
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2.1　参与者社会人口学特征
本研究采用倾向得分匹配（Propensity Score Matching, PSM）平衡2022年与2025年中西部样本的基线特征，以控制潜在混杂因素。经1:1匹配后，共获得1 786对样本纳入分析。由表1可见，匹配后多数变量的标准化偏差小于10%，满足平衡性假设。两组参与者在性别、医学专业、户籍类型及医疗保险覆盖情况上的差异均无统计学意义（P>0.05）。然而，2025年样本的平均年龄略高于2022年（21.21±2.53 vs.21.06±2.25，P=0.048），研究生比例也显著更高（16.46% vs.12.99%，P=0.003）。
2.2　流感疫苗犹豫及相关因素的变化
2022年至2025年间，中西部地区大学生流感疫苗犹豫状况显著改善（表2）。流感疫苗犹豫率从47.65%（851/1 786）显著下降至33.31%（595/1 786）（χ2=76.19，P<0.001），降幅达14.34个百分点。
相关因素亦呈现显著变化。环境因素方面，接触过疫苗不良事件报告的学生比例从33.26%上升至53.70%（χ2=151.77，P<0.001）。个体与群体因素方面，学生的流感基础知识水平均值从2.54下降至2.25（t=10.13，P<0.001），而流感疫苗专业知识水平均值则从1.23显著提升至1.63（t=-11.48，P<0.001）；与此同时，感染流感的风险感知（均值从4.85升至5.12；t=-3.32，P<0.001）与严重性感知（均值从5.44升至6.08；t=-8.61，P<0.001）均显著增强。行为层面，拥有流感疫苗接种史（33.65% vs.47.76%；P<0.001）、曾自费接种其他疫苗（25.76% vs.31.52%；P<0.001）、周围有人接种过流感疫苗（55.82% vs.66.69%；P<0.001）以及获得家人、同学或朋友推荐（34.43% vs.53.14%；P<0.001）的比例均显著提高。然而，认为接种流感疫苗有必要性的比例出现小幅但显著的下降（95.35% vs.90.15%，P<0.001）。在疫苗相关因素中，学生对疫苗有效性、医务人员推荐、国产及进口流感疫苗的信任度均出现显著下降，但仍维持在较高水平（>88%）。
2.3　疫苗信息来源的变化
信息来源分析结果显示（图1），互联网始终是中西部大学生获取流感疫苗信息的最主要渠道。与2022年相比，2025年学生通过“互联网”、“家人、同学和朋友”以及“医务人员”获取信息的比例均出现显著上升（所有比较P<0.05），而“电视”、“报纸杂志”等传统媒体的使用率虽亦有增长，但幅度相对较小。这反映了数字与社交平台在信息传播中的主导作用日益增强。
2.4　流感疫苗犹豫影响因素的二元logistic回归分析
为识别中西部地区大学生流感疫苗犹豫的独立影响因素，分别对2022年与2025年数据进行二元logistic回归分析（表3）。结果显示，部分保护性因素在两年间表现稳定。感知的流感严重性（2022年OR=0.799（0.763~0.837）；2025年OR=0.845（0.793~0.900））、认为接种流感疫苗有必要（2022年OR=0.275（0.131~0.579）；2025年OR=0.157（0.068~0.361））以及既往流感疫苗接种史（2022年OR=0.284（0.222~0.363）；2025年OR=0.469（0.363~0.606））在两个年份均为显著的负向预测因素。
部分影响因素的作用呈现年际变化。流感疫苗知识水平在2022年与犹豫风险呈正相关（OR=1.118，为危险因素），但在2025年转变为保护因素（OR=0.827）。类似地，家人、同学或朋友的推荐在2022年效应不显著（OR=0.782，但P>0.05），在2025年则成为显著的保护因素（OR=0.362）。对医务人员推荐的信任在两个年份均显示为显著的保护因素（OR均<1），但其效应值有所变化。此外，高学历（研究生）（2022年OR=2.044，为危险因素）和参保基本医疗保险（2022年OR=1.861，为危险因素）在2022年为显著的危险因素，但在2025年其效应不再显著。
3　讨论
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本研究通过2022年与2025年的两轮重复横断面调查，系统分析了中西部地区大学生流感疫苗犹豫的演变趋势，发现该群体的流感疫苗犹豫率从47.65%显著降至33.31%，犹豫程度评分同步下降，表明该群体对流感疫苗的接受度在三年间获得实质性提升。
流感疫苗犹豫的下降主要归因于疫苗专业知识提升、积极社会规范增强及流感严重性感知提高，这与健康信念模型和社会认知理论相契合[16-17]。2022年调查处于COVID-19疫情影响期，该疫情重塑了公众对呼吸道传染病风险的认知。一方面，COVID-19的高关注度可能弱化了对流感的相对严重性感知；另一方面，疫情期的广泛疫苗讨论也提升了公众的疫苗信息暴露和素养。
多数疫苗信息来源的接触比例在2025年上升，提示信息环境在“量”和“结构”上均得到扩展。多渠道信息有助于形成更全面稳定的认知，降低单一负面信息的影响。这在不良信息暴露增加但犹豫率下降的结果中尤为明显。尽管学生接触疫苗不良事件报告的比例显著上升（33.26% vs. 53.70%），流感疫苗犹豫率却未随之上升，反而持续下降。这表明，在专业知识、正向社会规范和风险感知共同构成的积极信息环境中，负面信息的潜在影响被显著稀释甚至抵消[18-19]，从而支持“多渠道、均衡化疫苗信息供给”作为降低流感疫苗犹豫的有效策略。
需注意，发挥积极作用的是“流感疫苗专业知识”（均值从1.23升至1.63），而非下降的“流感基础知识”。这表明，精准的疫苗专业信息比疾病常识对降低犹豫更关键。
影响因素的年际变化揭示了干预策略调整的关键方向。流感疫苗知识水平在2022年与犹豫风险呈正相关（OR=1.118），但在2025年转变为显著的保护因素（OR=0.827），这一现象可能与新冠肺炎疫情背景下信息环境的阶段性特征有关。2022年疫苗相关信息高度密集且质量不一，随着信息环境的逐步完善与净化，早期因信息过载或误解而产生的困惑得以消解，系统、准确的疫苗知识最终发挥了积极的引导作用[20-21]。同时，家人、同学或朋友的推荐在2025年保护作用显著增强（OR=0.362），结合其报告率从34.43%大幅上升至53.14%的结果，提示亲密社交圈的“口碑”传播与正面社会规范的建立，正成为越来越重要的干预杠杆[22-23]。
2022年我国大学生流感疫苗犹豫比例约为44.7%[8]，而本研究发现中西部地区大学生的流感疫苗犹豫比例为47.7%，高于全国平均水平，提示中西部地区高校学生中流感疫苗犹豫问题相对更为突出，与已有研究结论一致[14]，进一步凸显了在中西部地区高校中开展针对性干预的现实必要性。
降低流感疫苗犹豫需多维干预。首先，利用互联网主渠道，以生动形式精准传播疫苗相关知识。其次，激活社会网络，鼓励已接种者在社交圈内正面分享，将高涨的亲朋推荐（53.14%）转化为接种推动力。最后，强化权威引导，通过提升校医院等医务人员沟通能力与专业形象，进一步促进接种行为。
本研究存在一定局限性。第一，两次调查时点不同（2022年在流感季前，2025年在流感季中），可能引入季节性混杂，一定程度上放大了犹豫改善的幅度。第二，网络问卷可能导致选择偏倚。主动参与网络调查的大学生通常具有较高的信息获取能力和疫苗相关素养，可能低估总体人群中的流感疫苗犹豫水平，影响结果的外推性。第三，尽管研究覆盖中西部多地区高校，但调查问卷未纳入民族相关变量，无法进一步分析不同民族背景大学生在流感疫苗犹豫方面的潜在差异。这在一定程度上限制了对社会文化因素作用的深入探讨，未来研究有必要将民族因素纳入调查与分析框架。
基金
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  • 国家自然科学基金面上项目(72374049)
文献
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2026年第53卷第14期
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doi: 10.20043/j.cnki.MPM.202511203
  • 接收时间：2025-11-14
  • 首发时间：2026-09-28
  • 出版时间：2026-07-25
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  • 收稿日期：2025-11-14
基金
国家自然科学基金面上项目(72374049)
作者信息
    1.上海城建职业学院，上海 200438
    2.复旦大学公共卫生学院

通讯作者:

张璐莹，E-mail：
参考文献
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202511203
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2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
species		 占总种数比例
Percentage of total
species (%)
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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