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Article(id=1241067201558532517, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411411, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1732377600000, receivedDateStr=2024-11-24, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773823078765, onlineDateStr=2026-03-18, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773823078765, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773823078765, creator=13701087609, updateTime=1773823078765, updator=13701087609, issue=Issue{id=1241067197318091153, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773823077754, creator=13701087609, updateTime=1773823268053, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241067995544482681, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241067995544482682, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241067197318091153, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=854, endPage=858, ext={EN=ArticleExt(id=1241067206201627206, articleId=1241067201558532517, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Preliminary evaluation of the effects of three intervention strategies on HPV vaccination rates among Chinese female adolescents aged 15 to 18, columnId=1241067204725232186, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health,Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To preliminarily evaluate the effects of three online intervention models— “Health Education,”“Subsidy,” and “Relay Vaccination”—on HPV vaccination rates among female adolescents aged 15 to 18 in China, as well as the willingness of guardians to delay vaccination and their confidence in vaccines.

Methods

Eight secondary schools in Chengdu and Nanjing were recruited using convenience sampling and divided into three groups: “Health Education” (health education video + postcards), “Subsidy” (financial assistance), and “Relay Vaccination” (health education video + postcards +financial assistance). The study subjects were high school girls aged 15 to 18 who had not yet received the HPV vaccine and one guardian per participant. The primary outcome was the rate of first HPV vaccination among high school girls within one-month post-intervention; secondary outcomes included changes in guardians’ willingness to delay vaccination and their confidence in vaccines before and after the intervention.

Results

A total of 238 pairs of participants were included. Within one-month post-intervention, the vaccination rates were 43.9% for the “Relay Vaccination” group, 43.1% for the “Subsidy” group, and 16.7%for the“Health Education” group. The willingness to delay vaccination significantly decreased in the “Relay Vaccination”group (57.89% vs. 46.49%, P=0.004) and the “Health Education” group (50.00% vs. 33.33%, P=0.001), while there was no significant change in the “Subsidy” group (51.72% vs. 48.28%, P=0.688). Prior to the intervention, guardians in all three groups had high confidence in vaccines, and no statistically significant changes were observed post-intervention (P>0.05).

Conclusion

The “Relay Vaccination” and “Subsidy” groups exhibited superior effects on increasing vaccination rates compared to the“Health Education” group. The health education information included in the intervention strategies helped reduce the willingness to delay vaccination. The study conclusions require further validation with a larger sample size.

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目的

初步评价“健康教育、津贴和接力种”三种线上干预模式对我国15～18岁女性HPV疫苗接种率、监护人的疫苗接种延迟意愿和疫苗信心的干预效果。

方法

采用便利抽样在中国成都和南京招募8所中学，以学校为单位分为健康教育组（健康教育视频+明信片）、津贴组（经济补助）和接力种组（健康教育视频+明信片+经济补助）。研究对象为15～18岁未接种HPV疫苗的高中女生及其一名监护人。主要结局：干预后高中女生一月内首针HPV疫苗接种情况；次要结局：干预前后监护人疫苗接种延迟意愿和疫苗信心变化。

结果

共纳入238对参与者。干预后一月内接力种组女生接种率43.9%、津贴组43.1%、健康教育组16.7%；干预后接力种组（57.89% vs. 46.49%, P=0.004）和健康教育组（50.00% vs. 33.33%, P=0.001）监护人疫苗接种延迟意愿均显著降低，津贴组监护人疫苗接种延迟意愿变化不明显（51.72% vs. 48.28%, P=0.688）。干预前三组监护人的疫苗信心均很高，干预后均未出现具有统计学意义的变化（P>0.05）。

结论

接力种组和津贴组对接种率的提升效果优于健康教育组。干预策略中包含的健康教育信息有助于降低疫苗接种延迟意愿。研究结论尚需扩大样本量后进一步验证。

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李静，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=82Ga1HS11iDLfJO9hRrd2A==, magXml=9UJjdd4Vtsgk8JYNOdCyAg==, pdfUrl=null, pdf=/x5UzzLr/I4kDNK4mgwISA==, pdfFileSize=677957, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=+qrUZVpWDiL9clliomxt/g==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=j0shINlE4zK7m4eh6cC4Ag==, mapNumber=null, authorCompany=null, fund=null, authors=

陆娅胶（1998—），女，硕士在读，研究方向：肿瘤流行病学

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陆娅胶（1998—），女，硕士在读，研究方向：肿瘤流行病学

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陆娅胶（1998—），女，硕士在读，研究方向：肿瘤流行病学

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Patient Education and Counseling, 2011, 84(1): 118-122., articleTitle=The effect of school-based cervical cancer education on perceptions towards human papillomavirus vaccination among Hong Kong Chinese adolescent girls, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241067207363449498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, xref=1., ext=[AuthorCompanyExt(id=1241067207392809630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, companyId=1241067207363449498, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University / West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241067207405392542, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, companyId=1241067207363449498, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)]), AuthorCompany(id=1241067207518638758, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, xref=2., ext=[AuthorCompanyExt(id=1241067207547998890, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, companyId=1241067207518638758, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京医科大学公共卫生学院)]), AuthorCompany(id=1241067207694799542, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, xref=3., ext=[AuthorCompanyExt(id=1241067207707382459, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, companyId=1241067207694799542, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.玉林社区卫生服务中心)])], figs=[ArticleFig(id=1241067221494059223, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=EN, label=Figure 1, caption=HPV vaccination status of the first dose within one month after the intervention, figureFileSmall=cvZmO/bSMBpPnYxLUXpn4Q==, figureFileBig=+qrUZVpWDiL9clliomxt/g==, tableContent=null), ArticleFig(id=1241067221594722526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=CN, label=图1, caption=干预后一月内首针HPV疫苗接种情况, figureFileSmall=cvZmO/bSMBpPnYxLUXpn4Q==, figureFileBig=+qrUZVpWDiL9clliomxt/g==, tableContent=null), ArticleFig(id=1241067221863157998, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=EN, label=Table 1, caption=

Baseline characteristics of participants ［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
接力种组 (n=114)健康教育组 (n=66)津贴组 (n=58)H/χ2值P值合计 (n=238)
监护人年龄（岁）42（40，45）41（39，44）41（39，44）0.852a0.65342（39～44）
监护人性别0.1460.901
男性12(10.5)8(12.1)7(12.1)27(11.3)
女性102(89.5)58(87.9)51(87.9)211(88.7)
家庭年收入（元/年）2.9670.227
≤80 00072(63.2)46(69.7)44(75.9)162(68.1)
>80 00042(36.8)20(30.3)14(24.1)76(31.9)
教育程度2.8080.246
高中及以下81(71.1)49(74.2)48(82.8)178(74.8)
本科/大专及以上33(28.9)17(25.8)10(17.2)60(25.2)
婚姻状况—0.753
未婚7(6.1)5(7.6)4(6.9)16(6.7)
已婚93(81.6)57(86.4)48(82.8)198(83.2)
其他14(12.3)4(6.0)6(10.3)24(10.1)
是否听说过HPV疫苗2.163 a0.339
没听说过5(4.4)1(1.5)1(1.7)7(2.9)
了解一点98(86.0)55(83.3)50(86.2)203(85.3)
非常了解11(9.6)10(15.2)7(12.1)28(11.8)
是否听说过HPV疫苗负面信息2.0110.366
是41(36.0)18(27.3)16(29.1)75(31.5)
否73(64.0)48(72.7)42(72.4)163(68.5)
), ArticleFig(id=1241067221972209910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=CN, label=表1, caption=

研究对象的基线特征［M（P25，P75），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
接力种组 (n=114)健康教育组 (n=66)津贴组 (n=58)H/χ2值P值合计 (n=238)
监护人年龄（岁）42（40，45）41（39，44）41（39，44）0.852a0.65342（39～44）
监护人性别0.1460.901
男性12(10.5)8(12.1)7(12.1)27(11.3)
女性102(89.5)58(87.9)51(87.9)211(88.7)
家庭年收入（元/年）2.9670.227
≤80 00072(63.2)46(69.7)44(75.9)162(68.1)
>80 00042(36.8)20(30.3)14(24.1)76(31.9)
教育程度2.8080.246
高中及以下81(71.1)49(74.2)48(82.8)178(74.8)
本科/大专及以上33(28.9)17(25.8)10(17.2)60(25.2)
婚姻状况—0.753
未婚7(6.1)5(7.6)4(6.9)16(6.7)
已婚93(81.6)57(86.4)48(82.8)198(83.2)
其他14(12.3)4(6.0)6(10.3)24(10.1)
是否听说过HPV疫苗2.163 a0.339
没听说过5(4.4)1(1.5)1(1.7)7(2.9)
了解一点98(86.0)55(83.3)50(86.2)203(85.3)
非常了解11(9.6)10(15.2)7(12.1)28(11.8)
是否听说过HPV疫苗负面信息2.0110.366
是41(36.0)18(27.3)16(29.1)75(31.5)
否73(64.0)48(72.7)42(72.4)163(68.5)
), ArticleFig(id=1241067222144176383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=EN, label=Table 2, caption=

Comparison of guardians’ willingness to delay vaccination before and after the intervention

, figureFileSmall=null, figureFileBig=null, tableContent=
组别疫苗延迟意愿［n（%）］P*值
干预前干预后
接力种组 (n=114)66（57.89）53（46.49）0.004
健康教育组 (n=66)33（50.00）22（33.33）0.001
津贴组 (n=58)30（51.72）28（48.28）0.688
), ArticleFig(id=1241067222253228294, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=CN, label=表2, caption=

干预前后监护人疫苗延迟意愿比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别疫苗延迟意愿［n（%）］P*值
干预前干预后
接力种组 (n=114)66（57.89）53（46.49）0.004
健康教育组 (n=66)33（50.00）22（33.33）0.001
津贴组 (n=58)30（51.72）28（48.28）0.688
), ArticleFig(id=1241067222362280202, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=EN, label=Table 3, caption=

Comparison of guardians’ vaccine confidence before and after the intervention ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
疫苗信心接力种组 (n=114)健康教育组(n=66)津贴组(n=58)
干预前干预后P*值干预前干预后P*值干预前干预后P*值
2v-HPV
重要性106(95.61)109(95.61)0.45358(87.88)61(92.42)0.50856(96.55)58(100.00)0.500
有效性109(95.61)109(95.61)0.68862(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性106(95.61)110(96.49)0.28963(95.45)62(93.94)>0.99958(100.00)58(100.00)—
4v-HPV
重要性106(95.61)109(95.61)0.45359(89.39)63(95.45)0.28956(96.55)58(100.00)0.500
有效性107(93.86)109(95.61)0.72762(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性107(93.86)110(96.49)0.45363(95.45)62(93.94)>0.99958(100.00)58(100.00)—
9v-HPV
重要性110(96.49)109(95.61)0.56461(92.42)64(96.97)0.37556(96.55)58(100.00)0.500
有效性109(95.61)109(95.61)>0.99962(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性109(95.61)109(95.61)>0.99963(95.45)62(93.94)>0.99958(100.00)58(100.00)—
), ArticleFig(id=1241067222458749202, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241067201558532517, language=CN, label=表3, caption=

干预前后监护人疫苗信心比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
疫苗信心接力种组 (n=114)健康教育组(n=66)津贴组(n=58)
干预前干预后P*值干预前干预后P*值干预前干预后P*值
2v-HPV
重要性106(95.61)109(95.61)0.45358(87.88)61(92.42)0.50856(96.55)58(100.00)0.500
有效性109(95.61)109(95.61)0.68862(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性106(95.61)110(96.49)0.28963(95.45)62(93.94)>0.99958(100.00)58(100.00)—
4v-HPV
重要性106(95.61)109(95.61)0.45359(89.39)63(95.45)0.28956(96.55)58(100.00)0.500
有效性107(93.86)109(95.61)0.72762(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性107(93.86)110(96.49)0.45363(95.45)62(93.94)>0.99958(100.00)58(100.00)—
9v-HPV
重要性110(96.49)109(95.61)0.56461(92.42)64(96.97)0.37556(96.55)58(100.00)0.500
有效性109(95.61)109(95.61)>0.99962(93.94)64(96.97)0.62558(100.00)58(100.00)—
安全性109(95.61)109(95.61)>0.99963(95.45)62(93.94)>0.99958(100.00)58(100.00)—
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三种干预策略提高中国15～18岁青少年女性HPV疫苗接种率的初步效果评价
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陆娅胶 1 , 杨英 1 , 李一凡 1 , 秦川玉 1 , 何宇 3 , 赵丹丹 1 , 黄崇弼 1 , 赵帆 1 , 陶雨桐 2 , 黎美玲 2 , 吴丹 2 , 李静 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(5): 854-858
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(5): 854-858
三种干预策略提高中国15～18岁青少年女性HPV疫苗接种率的初步效果评价
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陆娅胶1, 杨英1, 李一凡1, 秦川玉1, 何宇3, 赵丹丹1, 黄崇弼1, 赵帆1, 陶雨桐2, 黎美玲2, 吴丹2, 李静1
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
  • 2.南京医科大学公共卫生学院
  • 3.玉林社区卫生服务中心

    • 陆娅胶（1998—），女，硕士在读，研究方向：肿瘤流行病学

通讯作者:

李静，E-mail:
Preliminary evaluation of the effects of three intervention strategies on HPV vaccination rates among Chinese female adolescents aged 15 to 18
Ya-jiao LU1, Ying YANG1, Yi-fan LI1, Chuan-yu QIN1, Yu HE3, Dan-dan ZHAO1, Chong-bi HUANG1, Fan ZHAO1, Yu-tong TAO2, Mei-ling LI2, Dan WU2, Jing LI1
Affiliations
  • West China School of Public Health, Sichuan University / West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2025-03-10 doi: 10.20043/j.cnki.MPM.202411411
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摘要
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目的

初步评价“健康教育、津贴和接力种”三种线上干预模式对我国15～18岁女性HPV疫苗接种率、监护人的疫苗接种延迟意愿和疫苗信心的干预效果。

方法

采用便利抽样在中国成都和南京招募8所中学，以学校为单位分为健康教育组（健康教育视频+明信片）、津贴组（经济补助）和接力种组（健康教育视频+明信片+经济补助）。研究对象为15～18岁未接种HPV疫苗的高中女生及其一名监护人。主要结局：干预后高中女生一月内首针HPV疫苗接种情况；次要结局：干预前后监护人疫苗接种延迟意愿和疫苗信心变化。

结果

共纳入238对参与者。干预后一月内接力种组女生接种率43.9%、津贴组43.1%、健康教育组16.7%；干预后接力种组（57.89% vs. 46.49%, P=0.004）和健康教育组（50.00% vs. 33.33%, P=0.001）监护人疫苗接种延迟意愿均显著降低，津贴组监护人疫苗接种延迟意愿变化不明显（51.72% vs. 48.28%, P=0.688）。干预前三组监护人的疫苗信心均很高，干预后均未出现具有统计学意义的变化（P>0.05）。

结论

接力种组和津贴组对接种率的提升效果优于健康教育组。干预策略中包含的健康教育信息有助于降低疫苗接种延迟意愿。研究结论尚需扩大样本量后进一步验证。

HPV疫苗  /  接力种  /  疫苗延迟意愿  /  疫苗接种
Objective

To preliminarily evaluate the effects of three online intervention models— “Health Education,”“Subsidy,” and “Relay Vaccination”—on HPV vaccination rates among female adolescents aged 15 to 18 in China, as well as the willingness of guardians to delay vaccination and their confidence in vaccines.

Methods

Eight secondary schools in Chengdu and Nanjing were recruited using convenience sampling and divided into three groups: “Health Education” (health education video + postcards), “Subsidy” (financial assistance), and “Relay Vaccination” (health education video + postcards +financial assistance). The study subjects were high school girls aged 15 to 18 who had not yet received the HPV vaccine and one guardian per participant. The primary outcome was the rate of first HPV vaccination among high school girls within one-month post-intervention; secondary outcomes included changes in guardians’ willingness to delay vaccination and their confidence in vaccines before and after the intervention.

Results

A total of 238 pairs of participants were included. Within one-month post-intervention, the vaccination rates were 43.9% for the “Relay Vaccination” group, 43.1% for the “Subsidy” group, and 16.7%for the“Health Education” group. The willingness to delay vaccination significantly decreased in the “Relay Vaccination”group (57.89% vs. 46.49%, P=0.004) and the “Health Education” group (50.00% vs. 33.33%, P=0.001), while there was no significant change in the “Subsidy” group (51.72% vs. 48.28%, P=0.688). Prior to the intervention, guardians in all three groups had high confidence in vaccines, and no statistically significant changes were observed post-intervention (P>0.05).

Conclusion

The “Relay Vaccination” and “Subsidy” groups exhibited superior effects on increasing vaccination rates compared to the“Health Education” group. The health education information included in the intervention strategies helped reduce the willingness to delay vaccination. The study conclusions require further validation with a larger sample size.

HPV vaccine  /  Relay vaccination  /  Willingness to delay vaccination  /  Vaccination uptake
陆娅胶, 杨英, 李一凡, 秦川玉, 何宇, 赵丹丹, 黄崇弼, 赵帆, 陶雨桐, 黎美玲, 吴丹, 李静. 三种干预策略提高中国15～18岁青少年女性HPV疫苗接种率的初步效果评价. 现代预防医学, 2025 , 52 (5) : 854 -858 . DOI: 10.20043/j.cnki.MPM.202411411
Ya-jiao LU, Ying YANG, Yi-fan LI, Chuan-yu QIN, Yu HE, Dan-dan ZHAO, Chong-bi HUANG, Fan ZHAO, Yu-tong TAO, Mei-ling LI, Dan WU, Jing LI. Preliminary evaluation of the effects of three intervention strategies on HPV vaccination rates among Chinese female adolescents aged 15 to 18[J]. Modern Preventive Medicine, 2025 , 52 (5) : 854 -858 . DOI: 10.20043/j.cnki.MPM.202411411
正文
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2020年，中国约有11万宫颈癌新发病例，约6万人死于宫颈癌[1]，接种HPV疫苗是最经济有效的预防手段[2]。2022年，我国9～14岁女孩的HPV疫苗接种率仅为4.0%[3]，远低于WHO提出的90%HPV疫苗覆盖率的目标[4]。2021年，十五个资源充足的城市率先启动了由地方政府财政支持的青少年女孩HPV疫苗接种试点项目，其中，除鄂尔多斯外其他试点城市仅覆盖13～14岁重点人群。错过该项目的15～18岁次重点接种人群处于青春懵懂时期且即将步入社会，我国HPV感染第一个高峰为17～24岁[5]，这部分青少年女性及时接种HPV疫苗对保护她们免受宫颈癌和宫颈癌前病变侵袭至关重要。迫切需要创新性策略有效提升15～18周岁次重点女性人群HPV疫苗接种率。
接力种是一项亲社会行为干预和筹资模式，为目标人群提供一项有补助的医疗服务，同时邀请他接受医疗服务后通过捐款传递爱心和温暖，以帮助和鼓励更多人接受该医疗服务。前期在社区开展的双臂随机对照试验显示[6]：接力种显著提高了15～18周岁青少年女性HPV疫苗接种率。但接力种干预模式包含：经济补助、健康教育、爱心传递、社区关怀等综合性因素，各个要素发挥的作用尚不明确，是否有更具成本效益的优化模式有待探索。本研究在前期试验的基础上，将接力种干预策略进一步优化为线上干预并拆分为三种干预措施：接力种（健康教育视频+明信片+经济补助）、健康教育（健康教育视频+明信片）和津贴（经济补助）。本研究旨在初步评价这三种线上干预模式对中国15～18周岁青少年女性HPV疫苗接种率、监护人疫苗延迟意愿和疫苗信心的有效性，为后续开展以人群为基础大样本研究提供依据。
1　对象与方法
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1.1　研究对象
2024年1—4月，采用便利抽样在成都市和南京市共招募8所中学，其中6所以学校为单位按照1∶1∶1随机分为健康教育组、津贴组和接力种组，后又增加2所中学分入接力种组。从每所学校招募符合纳入标准的青少年及其一名监护人作为研究对象。纳入标准：（1）15～18岁青少年女性；（2）无HPV疫苗接种史。其中排除HPV疫苗过敏、拒绝参与研究或不能给予知情同意者。本研究通过四川大学华西公共卫生学院/华西第四医院伦理委员会批准（批号：Gwll2023229），所有研究对象均已签署知情同意书。
1.2　研究方法
1.2.1　样本量和检验效能
成都市和南京市分别从2021和2022年起为符合条件的在校适龄女生按照自愿原则由政府补贴接种HPV疫苗，至2024年摸底调查一所中学内约100名15～18岁女生未接种HPV疫苗，参与率约30%，故计划在每所学校招募30名符合标准的女生及一名监护人。根据本研究中三个组的接种率16.7%，43.1%和43.9%，根据相关文献参与者行为和改变这些行为的意图的群内相关系数（ICC）通常小于0.1[7]，ICC设定为0.02，按照现有样本量采用PASS 2021和广义估计方程（接力种组为参照）比较组间接种率差异的检验效能为0.85。
1.2.2　干预措施
接力种组：（1）健康教育视频，内容包括HPV及宫颈癌的预防、HPV疫苗的重要性、有效性和安全性等；（2）获得一份包含宫颈癌预防信息及来自他人的社会关怀（爱心留言）明信片；（3）获得他人慈善支持的330元接力种（PIF）专项健康促进资金；（4）有在线留言激励他人接种和/或力所能及捐款传递爱心的机会。
健康教育组：（1）健康教育视频；（2）获得一份包含健康教育信息和爱心留言的明信片；（3）有在线留言激励他人接种的机会。
津贴组：（1）获得他人慈善支持的330元专项健康促进资金；（2）有力所能及的捐款传递爱心的机会。
其中健康教育视频嵌在问卷星中，参与本研究的监护人将根据步骤提示，扫描二维码后填写基线调查问卷，然后观看健康教育视频，观看视频后继续填写干预后问卷。
1.2.3　结局变量定义
一月内首针HPV疫苗接种：接受干预后1个月内监护人自愿前往接种门诊为女儿接种目前中国大陆地区已上市的五种疫苗之一（Cecolin，Walrinvax，Cervarix，Gardasil，Gardasil 9）。
疫苗延迟意愿：当社区卫生服务中心在4/9价疫苗供应不足的情况下，监护人选择为女儿接种可获得的2价疫苗还是选择等待更高价次的疫苗。如果选择等待4/9价疫苗而不是接种现有疫苗则定义为存在疫苗接种延迟意愿；反之定义为无疫苗接种延迟意愿。
疫苗信心：采用疫苗信心指数（VCI）[8]进行测量，根据参与者对“总体而言，我相信2v-HPV疫苗很重要”“总的来说，我相信2v-HPV疫苗是安全的”“总的来说，我相信2v-HPV疫苗是有效”的回答，“非常同意”和“同意”定义为同意，“非常不同意”和“不同意”定义为不同意。
1.2.4　数据收集与质量控制
问卷调查包括：（1）干预前的基线调查：社会人口学信息，HPV及疫苗认知、疫苗信心、疫苗延迟意愿等；（2）干预后问卷调查：接种意愿、疫苗延迟意愿、疫苗信心等。问卷填写完毕后，由经过统一培训的调查员进行核查，剔除不合格问卷，如填写孩子已接种HPV疫苗、孩子性别男性等问卷。
疫苗接种情况：填写问卷后第15 d和第30 d对有接种意愿的家长通过微信随访收集首针接种情况和接种HPV疫苗类型；并根据参与者提供的接种发票或通过社区接种登记记录进行核实。
1.2.5　统计学分析
使用SAS 9.4软件进行分析。不符合正态分布的连续变量采用M（P25，P75），分类资料采用率和构成比进行统计描述。对不符合正态分布的连续变量和等级变量的组间差异比较采用Kruskal-Wallis 检验，分类资料使用χ2检验、fisher精确概率法比较组间差异，两两比较采用Bonferroni法，精确McNemar检验用于干预前后组内差异性检验，广义估计方程用于干预后接种率的比较。双侧检验，检验水准α=0.05。
2　结果
收起
2.1　参与者的基线特征
本研究共纳入238名高中女生及238名监护人。监护人年龄中位数为42岁，女性监护人占88.7%。三个组参与者基线特征均衡（P>0.05），具有可比性。见表1。
2.2　一个月内接种情况
36.1%（86/238）的高中女生在干预后一个月内接种HPV疫苗，83.7%的接种者选择接种9价HPV疫苗，见图1。
根据既往研究，监护人的性别、教育程度、家庭年收入和干预前是否听说过HPV疫苗可能是潜在混杂因素，对其进行调整，使用广义估计方程分析结果显示接力种组接种HPV疫苗的可能性是健康教育组的3.97倍，（OR=3.97，95%CI：1.23～12.85，wald χ2=5.31，P=0.021），接力种组与津贴组之间接种率无统计学差异（OR=1.04，95%CI：0.167～6.490，wald χ2=0.002，P=0.966）。
2.3　干预前后疫苗延迟意愿和疫苗信心的比较
干预前，超50%的监护人存在疫苗延迟意愿；干预后，接力种组和健康教育组监护人疫苗延迟意愿均降低，干预前后变化具有统计学意义（P<0.05），但是津贴组干预前后疫苗延迟意愿变化无统计学意义（P>0.05）。见表2。
干预前后监护人对2价、4价和9价疫苗的重要性、有效性和安全性的认同度均较高，干预前后疫苗信心的三个维度未出现具有统计学意义的变化（P>0.05），见表3。
3　讨论
收起
本研究在前期社区干预试验的基础上将接力种策略进行拆分、精简和优化并初步评估优化后的干预效果，为后续开展大规模人群验证提供初步依据。初步研究结果显示，接力种干预促进HPV疫苗首针接种的效果优于健康教育，与津贴无统计学差异。健康教育组和接力种组干预策略能显著降低家长的疫苗延迟意愿，津贴组则未呈现出这一作用。疫苗信心干预前后未呈现出统计学差异。
在干预后一月内接力种组与津贴组高中女生首针接种率未呈现出统计学差异，健康教育组接种率（16.7%）最低，但仍然高于2022年中国15～19岁青少年女性的HPV疫苗首针接种率（4.66%）[3]。三个组接种的疫苗价次占比略有不同，这可能与试点现场所在地疫苗供应情况有关，但均以9价疫苗为主。这提示提供具有针对性的健康教育视频或能提高接种率，而接力种与津贴干预策略中提供的经济补贴则能在此基础上进一步提高接种率。但受限于较小的样本量不足以分析不同社会特征人群中这三种干预模式的成本效益。
初步研究结果显示，接力种和健康教育干预策略有效降低了监护人的疫苗接种延迟意愿。这与疫苗认知干预研究的结果类似[9-11]，接力种和健康教育干预措施中包含的健康教育信息可以提高监护人疫苗认知，降低疫苗接种延迟意愿。一项荟萃分析结果显示中国适龄女性HPV疫苗的接种意愿较高（58.6%～81%）[12]，但实际接种率远低于这一水平。不少家长认为HPV疫苗价次越高，预防宫颈癌的效果越好[13]，而市场上9价疫苗短缺，适龄女性对高价次疫苗的等待而出现的疫苗延迟可能是接种率低的原因[14-17]。鉴于目前4/9价疫苗短缺可能会持续一段较长的时间[18]，以及将来更高价次疫苗上市后仍会出现类似的等待现象。需要通过健康教育和社会动员提高公众对HPV疫苗的正确认识，早接种比等待高价次更重要。
此外，在本研究中仅约14%的监护人表示对HPV疫苗非常了解，这提示提高公众对HPV疫苗认知仍是促进接种的关键环节。因此在后续研究中，需要以青少年和其父母为中心有针对性的优化健康教育材料，突出家长和青少年关注的信息。此外还需结合目标人群获取信息的主要途径、已有的知识水平、信息接受度等拓展信息传播渠道，开展简洁有效的健康教育。
既往研究中对疫苗安全性和有效性的担忧是拒绝接种HPV疫苗的常见原因[13,19]。姜雯雯等人[20]的研究中参与者感知到流感疫苗的重要性介导了接力种干预策略对重点人群流感疫苗接种率的影响。但是在本研究中，干预前后监护人对三种价次的HPV疫苗重要性、安全性和有效性的认同度均未呈现出统计学差异，这可能是存在选择偏移，招募的参与者疫苗信心较高。也可能研究现场所在城市均有政府补助HPV疫苗接种惠民项目，由于民众对政府和卫生系统普遍信任，并且该研究以学校为基础开展，从而对该疫苗信任度高。
相比西方发达国家，我国开展HPV疫苗接种的时间较晚，目前大部分干预性研究关注HPV疫苗接种意愿及其相关的认知情况[21-22]，对促进HPV疫苗接种行为的干预措施研究有限。本研究以首针接种率为主要结局，探索三种干预措施的干预效果，为后续开展以人群为基础大规模的研究提供初步依据。此外，相比于前期开展的社区为基础的线下一对一干预模式，本研究将干预材料数字化、干预过程简洁化，为将来进行大规模人群验证提供可行性和科学性支撑。本研究也存在一定的局限性，如仅在成都和南京便利抽样选取8所中学，代表性欠佳；此外本研究为小规模探索性研究，样本量较小不足分析探讨不同社会特征，如不同教育程度、收入水平、HPV认知情况等人群中三种措施的干预效果和成本效益。将来还需要扩大研究现场和样本量，进一步探索不同干预策略对疫苗接种行为的作用效果；试点学校中未接种HPV疫苗的高中女生有效应答率约为30%，其中拒绝参与本研究的女生和家长对HPV疫苗接种障碍或对干预措施的顾虑尚不清楚，后续需针对这部分人群开展访谈，对如何扩大信息传播，吸引更多目标人群关注需进一步探索，为将来大规模推广应用提供参考依据。
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doi: 10.20043/j.cnki.MPM.202411411
  • 接收时间：2024-11-24
  • 首发时间：2026-03-18
  • 出版时间：2025-03-10
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  • 收稿日期：2024-11-24
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    1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
    2.南京医科大学公共卫生学院
    3.玉林社区卫生服务中心

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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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