Analysis of the influencing factors of female college students' cognition of cervical cancer and willingness to pay for HPV vaccination under the Bayesian framework

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Methods A group of female students in a medical university were studied by questionnaire, and then applied Test to examine the association of different factors, and to further analyze the influencing factors of female college students willingness to pay for HPV vaccination through multivariate Logistic regression and Bayesian regression model. Results In the participating sample of 428 female college students, most (96.26%) said they had heard of cervical cancer; 39.49% of participants recognized that the leading cause of cervical cancer was viral infection. Of the 394 students who were aware of the HPV vaccine, up to 89.09% expressed a willingness to get the HPV vaccine at their own expense. The analysis revealed that the influencing factors were: students major, age, and consent to HPV vaccination more freely [the posterior mean was 0.69 (0.25 ~ 1.15), -0.60 (-1.01~ -0.18), and-0.34 (-0.70~ -0.01)]. Conclusion The female college students in medical schools are insufficient in the knowledge of cervical cancer and related HPV vaccines. It is suggested to strengthen relevant health education, deepen students correct understanding and value understanding of HPV vaccines, and guide them to make choices conducive to their own health. female college students cervical cancer HPV vaccine willingness to pay for vaccination Bayesian regression model Background As a common malignant tumor in the field of gynecology in China and even the world, the incidence of cervical cancer is significantly related to the infection of human papillomavirus (HPV). Studies have shown that HPV infection increases the risk of oral squamous, esophageal, esophageal squamous, lung and breast cancer, but does not increase the risk of cervical cancer [1–3]. In addition, HPV multiple infections were positively associated with age; and the proportion of HPV multiple infections in the total infected population with increasing age. A large body of scientific evidence shows that HPV vaccination is one of the most economical and effective measures to prevent cervical cancer [4–5]。 In this context, it is particularly important to optimize HPV vaccination strategies, especially for women aged 9 to 26 years, especially before the age of 17 years, vaccination should be recommended first [6]. Modeling studies in China suggest that HPV vaccination is cost-effective but vaccination rates and population coverage are relatively low [7]. Studies conducted in Gansu Province, China, showed differences in HPV vaccination rates among women of different ages. The first dose of HPV vaccination rate for women aged 9 to 45 years was 2.02%, and the women aged 9 to 14 years were the lowest, less than 1%. In domestic practice, Jinan in Shandong province, Ordos in Inner Mongolia, Guangdong Province (including Guangzhou, Zhaoqing, Shenzhen, Xiamen and other places have taken the lead in carrying out the pilot work of HPV immunization. For example, Wuxi and Lianyungang will receive free vaccination to school-age students in junior middle schools from 2022 and 2023, respectively. However, female college students who also belong to the appropriate age group have not been fully included in the vaccination program. Although female college students in China are at the ideal age of vaccination, the actual vaccination rate is relatively low, with only 2.96%. Relevant studies suggest that vaccination is a highly cost-effective behavior, and that one dose of routine vaccination can avoid most cervical cancer avoided by two doses of vaccination and be more efficient [8–9]. Therefore, it is of great significance to deeply analyze the relevant factors affecting the HPV vaccination of domestic female college students to promote the progress of domestic preventive medical treatment. The current HPV vaccination rate among Chinese female healthcare workers is very high [10]. How is the vaccination rate of female medical college students as future medical staff? Health benefits can be further expanded when vaccination rates are expanded to age 26 years [11]. Is in the age of college students, through careful study of medical college students for HPV vaccine voluntary paid vaccination cognitive attitude and influencing factors, can be more deeply insight into the present situation of the field, the development trend and the existing problems, and put forward improvement strategies, so as to effectively improve the domestic female college students vaccination rate, further strengthen the cervical cancer prevention. Methods Study population Between September 2024 and October 2024, we selected enrolled students from a medical school as the subjects of this study. To ensure the representativeness and universality of the sample, we implemented a stratified random sampling strategy within the medical school, ensuring that at least 30 students from each college were included in the sample range. In this process, we distributed a total of 450 questionnaires. The inclusion criteria are clearly limited to female college students in medical schools. Detailed exclusion criteria were also developed to exclude two types of students from any health condition which may interfere with their participation or compromise the effectiveness of their responses (such as serious mental health disorders or any acute illness), and students who refuse to participate. The questionnaire used in this study was specifically designed to investigate the factors influencing female college students' willingness to pay for cervical cancer knowledge and the human papillomavirus vaccine. A detailed version of the questionnaire can be found in Additional file 1. Collection of questionnaire data was conducted through an online questionnaire on the questionnaire star platform (website: www.wjx.cn). To prevent repeated submissions, we set the limit that each mobile phone IP address can only be submitted once. Finally, we collected a total of 431 questionnaires. During the data cleaning phase, we removed the invalid questionnaires, including those for less than three minutes and all answers to the same option. After this rigorous data cleaning process, we obtained a total of 428 valid questionnaires, with a recovery rate of 95.11%. Questionnaire design The questionnaire included basic personal information (gender, age, nationality, origin, etc.), as well as perception of cervical cancer, cognition of human papillomavirus (HPV), perception of HPV vaccine and assessment of attitudes towards paying for vaccination. The level of cervical cancer cognition refers to the knowledge of female college students about cervical cancer risk factors and screening knowledge; HPV cognition involves the knowledge of female college students about HPV infection and related symptoms; and the payment attitude reflects the acceptance and willingness to pay for vaccination costs. The HPV Vaccine Knowledge Scale consists of seven items with a range of 0 to 7, including 1 for each correct answer and 0 for a wrong or "I dont know". Higher scores on this scale indicate deeper knowledge of the HPV vaccine. In this study, the consistency of this scale was verified by testing with a Cronbachs alpha coefficient of 0.802. Statistical model and construction The Logistic regression model is a generalized linear regression analysis model that estimates the occurrence probability of events according to a given data set of independent variables, and because the result is a probability, the dependent variable ranges between 0 and 1. The input features are integrated by a linear combination, and the formula is expressed as: $$\:\text{P}(\text{y}=1\mid\:\text{x})={\sigma\:}(\:{{\omega\:}}^{\text{T}}\:\text{x}+\text{b})$$ Where: ω is the weight vector, x is the eigenvector, and b is the deviation term, also called the intercept. In order to make the output map of the linear regression between 0 and 1, the logistics regression uses the sigmoid function, where the sigmoid function formula is expressed as: $$\:{\sigma\:}\left(\text{Z}\right)=\frac{1}{1+{\text{e}}^{-\text{Z}}}$$ Bayesian Logistic regression model, in Bayesian logistic regression, the parameter ω is treated as a random variable rather than a fixed value. The Bayesian method computes the posterior distribution of the parameters by combining the prior distribution and the likelihood function. That is, the Bayesian estimation and Bayesian incremental learning process are added to the original regression model, where the prior distribution represents our belief in the parameters before seeing the data; the likelihood function represents the possibility of the model parameters given the data; the posterior distribution is determined by the Bayes theorem, jointly by the prior distribution and the likelihood function: $$\:\text{P}({\omega\:}\mid\:\text{X},\text{Y})\propto\:\text{P}(\text{Y}\mid\:\text{X},{\omega\:})\text{P}\left({\omega\:}\right)$$ Compared with traditional regression models, Bayesian Logistic regression provides the quantification of the uncertainty of model parameters, giving the distribution of parameter estimates rather than just point estimates, and the Bayesian method is particularly suitable for model training with a small amount of data. Questionnaire data were checked for data reasonableness and logic errors through the SPSS 26.0 software. Data analysis was performed using SPSS 26.0 and Jupyter notebook software, first with univariate outcome analysis to screen variables, and then with Logistics regression and Bayesian Logistics model to explore various factors affecting the intention to pay for HPV vaccination. Results General situation of the survey respondents A total of 431 questionnaires were collected in this survey, among which 3 questionnaires were removed due to the research purpose (not filled in by women), and 428 valid questionnaires were finally recovered, with an effective recovery rate of 99.31%. The mean age of the 428 respondents was 19.51 years, with a minimum age of 17 years and a maximum age of 26 years. Medical profession has the largest number of respondents, totaling 329, accounting for 76.87% of the respondents; there was little difference between urban and rural hukou. The specific basic information of the respondents is shown in Table 1 . Table 1 General situation of the survey respondents variable divide into groups number of people constituent ratio (%) age ≤ 18 131 30.61 18 ~ 26 297 69.39 Study major Medical class 329 76.87 other 99 23.13 place of domicile city 215 50.23 rural area 213 49.77 Knowledge of cervical cancer and HPV Of the 428 valid questionnaires received, 96.26% (412 people) of the respondents said they had heard of the HPV virus. However, only 39.49% (169 people) of the respondents accurately realized that the most important causative factor for cervical cancer was viral infection. In addition, 92.99% (398) were information about the mode of HPV transmission,as shown in Table 2 . Table 2 Knowledge of cervical cancer and HPV clauses and subclauses number of people scale (%) The most important risk factor for cervical cancer 169 39.49 A condom use reduces HPV infection 360 76.87 Both sexes were infected with HPV 306 71.50 HPV infection can lead to genital warts 345 80.61 HPV infection can cause vulvar cancer 306 71.50 HPV infection cannot be cured by antibiotics 368 85.99 Most HPV-infected individuals do not have any symptoms 7 1.64 The route of infection of HPV 398 92.99 Knowledge of the HPV vaccine Among the 428 questionnaires participating in the survey, only 53.34% (224 / 428) of the respondents knew what HPV vaccine was. Among them, "women do not need HPV screening before HPV vaccination" had the lowest awareness rate, only 3.50%, followed by "young girls had better get HPV vaccine before the first sex life", 18.00%, and the awareness rate of the remaining items exceeded 80%,as shown in Table 3 Table 3 Awareness of female college students about HPV vaccine-related knowledge clauses and subclauses number of people scale (%) The HPV vaccine prevents cervical cancer 420 98.13 The HPV vaccine is given to women who have had sex 417 97.43 Women do not need to undergo HPV screening before HPV vaccination 15 3.50 Regular cervical cancer screening is still required after HPV vaccination 422 98.60 HPV vaccines do not prevent all types of HPV infection 350 81.78 People vaccinated against HPV still have a risk of cervical cancer 421 98.36 Young girls should better get the HPV vaccine before their sex debut 77 18.00 Survey results and cause analysis of HPV vaccination intention Of the 394 female college students who have known about the cervical cancer vaccine, 351 (89.09%) said they would be willing to pay for the vaccination. Among the 43 female college students who chose not to receive HPV vaccine, the main reason was that the cost of the vaccine was too high for 24 (55.81%), and no time to get it, 17 (39.53%) agreed,as shown in Table 4 . Table 4 Reasons why some female college students are unwilling to receive HPV vaccination Reasons for not getting the HPV vaccination number of people scale (%) Not aware of the HPV vaccine 6 13.95 Worried about the vaccines side-effects 9 20.93 Vaccine costs are too high 24 55.81 No physician advice or recommendations were available 8 18.60 There is no time to get vaccinated 11 25.58 I dont know where to book for a vaccination 10 23.26 Make an appointment difficult 17 39.53 Afraid of pain 3 6.98 No one around was vaccinated 3 6.98 No sex, no necessity 8 18.60 Physical health is not necessary 8 18.60 Factors influencing the willingness to pay for HPV vaccine vaccination Among 394 female college students who had heard of HPV vaccine, after univariate factors to pay for HPV vaccination, the variable with P < 0.1 included the willingness to pay for vaccination as the dependent variable multivariate Logistic regression analysis and Bayesian Logistic regression analysis. For the Bayesian regression iteration, the Monte Carlo standard error is less than 0.01, and the Markov chain converges. The results showed that non-medical majors were more willing to pay for HPV vaccination than medical students, minors compared to adult students who disagreed with HPV vaccination ,as shown in Table 5 . Factors such as students residence had no effect on their willingness to pay for vaccination. Discussion Students’ willingness to pay for vaccination is influenced by multiple factors, including parental willingness and preferences, as well as communication with parents. Although the overall level remains relatively low, there has been an increasing trend in recent years. Previous studies have indicated that income and education levels do not significantly affect willingness to pay, which is consistent with the findings of this study [12–16]. In our research, we found that monthly disposable income and place of residence had no significant impact on vaccination willingness. This result differs from studies conducted in the United States [17], but aligns with findings from studies in China [18], possibly reflecting differences in national contexts. Some studies have suggested that vaccination history plays a mediating role between willingness and actual behavior [19]; however, this effect was not statistically significant in our study. Other potential influencing factors should therefore be considered, such as differences in sample characteristics, cultural backgrounds, or policy environments. From a methodological perspective, this study employed weakly informative priors and t-distributions to approximate flat normal prior distributions. As a result, the outcomes were not substantially different from those obtained using traditional logistic regression. However, Bayesian estimation still produced partially different results compared to conventional regression, mainly reflected in the \(\:{\beta\:}\) values. The theoretical basis for estimating \(\:{\beta\:}\) values differs between logistic regression and Bayesian logistic regression: traditional logistic regression uses maximum likelihood estimation (MLE) to identify the set of \(\:{\beta\:}\) values that maximize the probability of observing the given data—these are point estimates representing the most likely parameter values. In contrast, Bayesian logistic regression applies Bayes’ theorem to derive posterior distributions by combining prior distributions with the likelihood function, resulting in full distributions rather than single estimates. These distributions reflect uncertainty around each \(\:{\beta\:}\) value and generate a range of plausible values through sampling. In addition, traditional logistic regression typically provides standard errors and confidence intervals to assess estimation uncertainty, but these measures often rely on asymptotic theory or specific assumptions. By comparison, Bayesian logistic regression naturally offers more comprehensive measures of uncertainty, such as the standard deviation of the posterior distribution and the highest density interval (HDI),which are directly derived from the posterior without additional assumptions. Furthermore, while traditional logistic regression does not incorporate prior knowledge about parameters and assumes all parameters are unknown and learned entirely from the data, Bayesian methods allow for the integration of expert knowledge or findings from previous studies into the analysis as prior distributions, thereby influencing the final posterior estimates. This approach can improve estimation efficiency in small-sample settings and help prevent overfitting [20]. This survey represents the first cross-sectional investigation and analysis of female college students’ willingness to pay for vaccination. The results showed that awareness and willingness to pay for cervical cancer-related information among female college students reached 96.26% and 89.09%, respectively, which aligns with previous studies [21]. However, when examining their understanding of cervical cancer and HPV vaccine-related knowledge, it was found that although awareness rates for most knowledge points exceeded 70%, the awareness rate for the “most important risk factor for cervical cancer” was only 39.49%, indicating a lack of understanding of this key concept. Related research suggests that induced abortion, number of sexual partners, cervicitis, vaginitis, staying up late, and psychological stress are risk factors for HPV infection [22]. When exploring reasons for refusing HPV vaccination among female college students, we found that the top two reasons were "complex appointment procedures" and "lack of time for vaccination." These findings differ from other studies where concerns about vaccine side effects were the main reason for refusal [23], suggesting insufficient knowledge about the vaccine. Limitations This study is a cross-sectional survey and thus has several limitations:Causal inference not possible: Due to the one-time data collection design, this study captures only a snapshot of current conditions and cannot establish causal relationships between variables. While associations were observed, it remains unclear whether these factors cause changes in willingness or are consequences of it.Risk of recall bias: The self-reported nature of the questionnaire may lead to inaccurate memory or subjective bias, potentially affecting the accuracy and reliability of some responses.Selection bias: Participants who volunteered for the survey may systematically differ from non-participants—for example, those with greater health awareness may be more likely to participate, which could overestimate the general level of vaccine awareness and willingness to pay among female college students.Unmeasured confounding factors: Due to the nature of the cross-sectional design, some potential confounders, such as psychological status or family support, were not fully accounted for in the analysis.Lack of behavioral validation: This study assessed willingness to vaccinate rather than actual vaccination behavior. Future longitudinal studies are needed to verify whether willingness translates into action. Conclusion In conclusion, female college students demonstrate a high level of awareness and willingness to pay for the HPV vaccine. However, understanding of key health knowledge—such as the primary risk factors for cervical cancer—still requires improvement. Additionally, practical barriers during the vaccination process, such as complex appointment procedures and limited availability of time slots, emerged as major obstacles. These findings suggest that future efforts to promote HPV vaccination should focus on optimizing service delivery processes and improving accessibility. This study applied Bayesian logistic regression, which not only confirmed the basic conclusions of traditional logistic regression but also provided richer insights into uncertainty through the incorporation of prior information and posterior distributions. This approach is particularly valuable in studies with limited sample sizes or those requiring integration of domain-specific knowledge. It is recommended that future health promotion initiatives further refine educational materials, prioritize vaccination for older female students, and explore school-based screening or vaccination programs to enhance coverage and uptake rates [24–26]. Table 5 Multivariate and Bayesian logistic regression of willingness to pay for HPV vaccination variable β price P price OR price The 95%CI of the OR value The posterior mean HDI95% specialty -1.03 0.02 0.31 0.12 ~ 0.80 0.69 0.25 ~ 1.15 age -1.10 0.01 0.34 0.15 ~ 0.79 -0.60 -1.01~--0.18 domicile 0.35 0.32 1.42 0.72 ~ 2.81 -0.13 -0.49 ~ 0.23 Understand the basics of HPV vaccines -0.44 0.21 0.64 0.32 ~ 1.29 -0.23 -0.60 ~ 0.13 Improving autoimmunity can eliminate HPV 0.01 0.98 1.01 0.49 ~ 2.10 -0.22 -0.59 ~ 0.15 Have been vaccinated against HPV -0.42 0.33 0.66 0.29 ~ 1.52 -0.32 -0.75 ~ 0.12 Consent to the HPV vaccination allows for a more liberal sexual behavior − .71 0.04 0.49 0.25 ~ 0.96 -0.34 -0.70~-0.00 Abbreviations HPV Human papillomavirus Declarations Consent for publication Written informed consent for publication was obtained from all participants. A copy of the signed consent forms is available for review by the Editor-in-Chief upon request. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Medical Ethics Committee of Xuzhou Medical University. Written informed consent was obtained from all participants prior to their participation in the study. Competing interests The authors declare that they have no competing interests. Funding The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Social Development Project of Xuzhou City (Number: KC21267). Author Contribution Author ContributionsY.S. conceptualized the study, collected and analyzed the data, and drafted the manuscript. Q.W. supervised the research, provided critical feedback, and revised the manuscript. H.Z. assisted in questionnaire design, participated in data collection, and contributed to the literature review. All authors read and approved the final manuscript. Data Availability Due to privacy concerns, supporting data cannot be made publicly available. Data may be requested from the corresponding author upon reasonable request and with appropriate ethical approval. References Cao F, Li YZ, Zhang DY, Wang XY, Chen WX, Liu FH, Men YX, Gao S, Lin CQ, Zou HC et al : Human papillomavirus infection and the risk of cancer at specific sites other than anogenital tract and oropharyngeal region: an umbrella review . EBioMedicine 2024, 104 :105155. Li R, Meng W, Zuo Y, Xu Y, Wu S: The cervical cancer related distribution, coinfection and risk of 15 HPV types in Baoan, Shenzhen, in 2017-2023 . Virology journal 2024, 21 (1):164. Zhou YX, Ma XH, Wang TT, Qu XL, Zhang XQ: Analysis of age-specified and genotype distribution of HPV multiple infections in the Chinese population . Scientific reports 2024, 14 (1):2678. 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Gao M, Hu S, Zhao X, You T, Jit M, Liu Y, Qiao Y, Zhao F, Wang C: Health and economic impact of delaying large-scale HPV vaccination and screening implementation on cervical cancer in China: a modelling study . The Lancet regional health Western Pacific 2023, 36 :100768. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6800508","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486011772,"identity":"2f9de509-bbaf-4faa-8b56-a77436e40cab","order_by":0,"name":"Yi Sun","email":"","orcid":"","institution":"Xuzhou Medical Unversity","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Sun","suffix":""},{"id":486011773,"identity":"fa156156-914a-4540-a2ec-c003ac9483de","order_by":1,"name":"Qiushuang Wang","email":"","orcid":"","institution":"Xuzhou Medical Unversity","correspondingAuthor":false,"prefix":"","firstName":"Qiushuang","middleName":"","lastName":"Wang","suffix":""},{"id":486011774,"identity":"5290793d-3d11-4e44-bad6-1c3b09c39577","order_by":2,"name":"Huashuo Zhao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACAwYGNiBlw8AgAeYzE60ljXQth0nQYs5//NmDHxXnE+fP7k6TYKiwTmxgP3sArxbLGQnphj1nbhszzjm7TYLhTHpiA09eAn6H3WA4JsHbdluOWSJ3mwRj2+HEBgkeA/xazh9sk/zbdo6HDazlHzFaDiSzSfO2HZDjAWtpIEbLjTQ2aZkzycYSErmbLRKOpRu38eQQctjxZ5JvKuwS58/I3XjjQ421bD/7GfxaUEECAySaRsEoGAWjYBRQCADjzEDQH3fZWQAAAABJRU5ErkJggg==","orcid":"","institution":"Xuzhou Medical Unversity","correspondingAuthor":true,"prefix":"","firstName":"Huashuo","middleName":"","lastName":"Zhao","suffix":""}],"badges":[],"createdAt":"2025-06-02 09:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6800508/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6800508/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88868121,"identity":"4ce8f5a1-d621-433b-88a2-433bf22fce6c","added_by":"auto","created_at":"2025-08-12 08:53:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2190339,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6800508/v1/65e62be6-14ef-4a72-b5d8-9427a012e00b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the influencing factors of female college students' cognition of cervical cancer and willingness to pay for HPV vaccination under the Bayesian framework","fulltext":[{"header":"Background","content":"\u003cp\u003eAs a common malignant tumor in the field of gynecology in China and even the world, the incidence of cervical cancer is significantly related to the infection of human papillomavirus (HPV). Studies have shown that HPV infection increases the risk of oral squamous, esophageal, esophageal squamous, lung and breast cancer, but does not increase the risk of cervical cancer [1\u0026ndash;3]. In addition, HPV multiple infections were positively associated with age; and the proportion of HPV multiple infections in the total infected population with increasing age. A large body of scientific evidence shows that HPV vaccination is one of the most economical and effective measures to prevent cervical cancer [4\u0026ndash;5]。\u003c/p\u003e\u003cp\u003eIn this context, it is particularly important to optimize HPV vaccination strategies, especially for women aged 9 to 26 years, especially before the age of 17 years, vaccination should be recommended first [6]. Modeling studies in China suggest that HPV vaccination is cost-effective but vaccination rates and population coverage are relatively low [7]. Studies conducted in Gansu Province, China, showed differences in HPV vaccination rates among women of different ages. The first dose of HPV vaccination rate for women aged 9 to 45 years was 2.02%, and the women aged 9 to 14 years were the lowest, less than 1%. In domestic practice, Jinan in Shandong province, Ordos in Inner Mongolia, Guangdong Province (including Guangzhou, Zhaoqing, Shenzhen, Xiamen and other places have taken the lead in carrying out the pilot work of HPV immunization. For example, Wuxi and Lianyungang will receive free vaccination to school-age students in junior middle schools from 2022 and 2023, respectively. However, female college students who also belong to the appropriate age group have not been fully included in the vaccination program. Although female college students in China are at the ideal age of vaccination, the actual vaccination rate is relatively low, with only 2.96%. Relevant studies suggest that vaccination is a highly cost-effective behavior, and that one dose of routine vaccination can avoid most cervical cancer avoided by two doses of vaccination and be more efficient [8\u0026ndash;9]. Therefore, it is of great significance to deeply analyze the relevant factors affecting the HPV vaccination of domestic female college students to promote the progress of domestic preventive medical treatment.\u003c/p\u003e\u003cp\u003eThe current HPV vaccination rate among Chinese female healthcare workers is very high [10]. How is the vaccination rate of female medical college students as future medical staff? Health benefits can be further expanded when vaccination rates are expanded to age 26 years [11]. Is in the age of college students, through careful study of medical college students for HPV vaccine voluntary paid vaccination cognitive attitude and influencing factors, can be more deeply insight into the present situation of the field, the development trend and the existing problems, and put forward improvement strategies, so as to effectively improve the domestic female college students vaccination rate, further strengthen the cervical cancer prevention.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy population\u003c/h2\u003e\u003cp\u003eBetween September 2024 and October 2024, we selected enrolled students from a medical school as the subjects of this study. To ensure the representativeness and universality of the sample, we implemented a stratified random sampling strategy within the medical school, ensuring that at least 30 students from each college were included in the sample range. In this process, we distributed a total of 450 questionnaires.\u003c/p\u003e\u003cp\u003eThe inclusion criteria are clearly limited to female college students in medical schools. Detailed exclusion criteria were also developed to exclude two types of students from any health condition which may interfere with their participation or compromise the effectiveness of their responses (such as serious mental health disorders or any acute illness), and students who refuse to participate.\u003c/p\u003e\u003cp\u003eThe questionnaire used in this study was specifically designed to investigate the factors influencing female college students' willingness to pay for cervical cancer knowledge and the human papillomavirus vaccine. A detailed version of the questionnaire can be found in Additional file 1.\u003c/p\u003e\u003cp\u003eCollection of questionnaire data was conducted through an online questionnaire on the questionnaire star platform (website: www.wjx.cn). To prevent repeated submissions, we set the limit that each mobile phone IP address can only be submitted once. Finally, we collected a total of 431 questionnaires. During the data cleaning phase, we removed the invalid questionnaires, including those for less than three minutes and all answers to the same option. After this rigorous data cleaning process, we obtained a total of 428 valid questionnaires, with a recovery rate of 95.11%.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eQuestionnaire design\u003c/h3\u003e\n\u003cp\u003eThe questionnaire included basic personal information (gender, age, nationality, origin, etc.), as well as perception of cervical cancer, cognition of human papillomavirus (HPV), perception of HPV vaccine and assessment of attitudes towards paying for vaccination. The level of cervical cancer cognition refers to the knowledge of female college students about cervical cancer risk factors and screening knowledge; HPV cognition involves the knowledge of female college students about HPV infection and related symptoms; and the payment attitude reflects the acceptance and willingness to pay for vaccination costs. The HPV Vaccine Knowledge Scale consists of seven items with a range of 0 to 7, including 1 for each correct answer and 0 for a wrong or \"I dont know\". Higher scores on this scale indicate deeper knowledge of the HPV vaccine. In this study, the consistency of this scale was verified by testing with a Cronbachs alpha coefficient of 0.802.\u003c/p\u003e\n\u003ch3\u003eStatistical model and construction\u003c/h3\u003e\n\u003cp\u003eThe Logistic regression model is a generalized linear regression analysis model that estimates the occurrence probability of events according to a given data set of independent variables, and because the result is a probability, the dependent variable ranges between 0 and 1. The input features are integrated by a linear combination, and the formula is expressed as:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\text{P}(\\text{y}=1\\mid\\:\\text{x})={\\sigma\\:}(\\:{{\\omega\\:}}^{\\text{T}}\\:\\text{x}+\\text{b})$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhere: ω is the weight vector, x is the eigenvector, and b is the deviation term, also called the intercept. In order to make the output map of the linear regression between 0 and 1, the logistics regression uses the sigmoid function, where the sigmoid function formula is expressed as:\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:{\\sigma\\:}\\left(\\text{Z}\\right)=\\frac{1}{1+{\\text{e}}^{-\\text{Z}}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBayesian Logistic regression model, in Bayesian logistic regression, the parameter ω is treated as a random variable rather than a fixed value. The Bayesian method computes the posterior distribution of the parameters by combining the prior distribution and the likelihood function. That is, the Bayesian estimation and Bayesian incremental learning process are added to the original regression model, where the prior distribution represents our belief in the parameters before seeing the data; the likelihood function represents the possibility of the model parameters given the data; the posterior distribution is determined by the Bayes theorem, jointly by the prior distribution and the likelihood function:\u003cdiv id=\"Equc\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equc\" name=\"EquationSource\"\u003e\n$$\\:\\text{P}({\\omega\\:}\\mid\\:\\text{X},\\text{Y})\\propto\\:\\text{P}(\\text{Y}\\mid\\:\\text{X},{\\omega\\:})\\text{P}\\left({\\omega\\:}\\right)$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCompared with traditional regression models, Bayesian Logistic regression provides the quantification of the uncertainty of model parameters, giving the distribution of parameter estimates rather than just point estimates, and the Bayesian method is particularly suitable for model training with a small amount of data.\u003c/p\u003e\u003cp\u003eQuestionnaire data were checked for data reasonableness and logic errors through the SPSS 26.0 software. Data analysis was performed using SPSS 26.0 and Jupyter notebook software, first with univariate outcome analysis to screen variables, and then with Logistics regression and Bayesian Logistics model to explore various factors affecting the intention to pay for HPV vaccination.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eGeneral situation of the survey respondents\u003c/h2\u003e\u003cp\u003eA total of 431 questionnaires were collected in this survey, among which 3 questionnaires were removed due to the research purpose (not filled in by women), and 428 valid questionnaires were finally recovered, with an effective recovery rate of 99.31%. The mean age of the 428 respondents was 19.51 years, with a minimum age of 17 years and a maximum age of 26 years. Medical profession has the largest number of respondents, totaling 329, accounting for 76.87% of the respondents; there was little difference between urban and rural hukou. The specific basic information of the respondents is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral situation of the survey respondents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003edivide into groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003enumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003econstituent ratio (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026thinsp;~\u0026thinsp;26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy major\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eother\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eplace of domicile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003erural area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eKnowledge of cervical cancer and HPV\u003c/h2\u003e\u003cp\u003eOf the 428 valid questionnaires received, 96.26% (412 people) of the respondents said they had heard of the HPV virus. However, only 39.49% (169 people) of the respondents accurately realized that the most important causative factor for cervical cancer was viral infection. In addition, 92.99% (398) were information about the mode of HPV transmission,as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKnowledge of cervical cancer and HPV\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eclauses and subclauses\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003enumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003escale (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe most important risk factor for cervical cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA condom use reduces HPV infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoth sexes were infected with HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV infection can lead to genital warts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e345\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e80.61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV infection can cause vulvar cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV infection cannot be cured by antibiotics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMost HPV-infected individuals do not have any symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe route of infection of HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eKnowledge of the HPV vaccine\u003c/h3\u003e\n\u003cp\u003eAmong the 428 questionnaires participating in the survey, only 53.34% (224 / 428) of the respondents knew what HPV vaccine was. Among them, \"women do not need HPV screening before HPV vaccination\" had the lowest awareness rate, only 3.50%, followed by \"young girls had better get HPV vaccine before the first sex life\", 18.00%, and the awareness rate of the remaining items exceeded 80%,as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAwareness of female college students about HPV vaccine-related knowledge\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eclauses and subclauses\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003enumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003escale (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe HPV vaccine prevents cervical cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe HPV vaccine is given to women who have had sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen do not need to undergo HPV screening before HPV vaccination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegular cervical cancer screening is still required after HPV vaccination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e422\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHPV vaccines do not prevent all types of HPV infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeople vaccinated against HPV still have a risk of cervical cancer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e421\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung girls should better get the HPV vaccine before their sex debut\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSurvey results and cause analysis of HPV vaccination intention\u003c/h3\u003e\n\u003cp\u003eOf the 394 female college students who have known about the cervical cancer vaccine, 351 (89.09%) said they would be willing to pay for the vaccination. Among the 43 female college students who chose not to receive HPV vaccine, the main reason was that the cost of the vaccine was too high for 24 (55.81%), and no time to get it, 17 (39.53%) agreed,as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReasons why some female college students are unwilling to receive HPV vaccination\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReasons for not getting the HPV vaccination\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003enumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003escale (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot aware of the HPV vaccine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWorried about the vaccines side-effects\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaccine costs are too high\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo physician advice or recommendations were available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThere is no time to get vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI dont know where to book for a vaccination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMake an appointment difficult\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfraid of pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo one around was vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo sex, no necessity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical health is not necessary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFactors influencing the willingness to pay for HPV vaccine vaccination\u003c/h2\u003e\u003cp\u003eAmong 394 female college students who had heard of HPV vaccine, after univariate factors to pay for HPV vaccination, the variable with P\u0026thinsp;\u0026lt;\u0026thinsp;0.1 included the willingness to pay for vaccination as the dependent variable multivariate Logistic regression analysis and Bayesian Logistic regression analysis. For the Bayesian regression iteration, the Monte Carlo standard error is less than 0.01, and the Markov chain converges. The results showed that non-medical majors were more willing to pay for HPV vaccination than medical students, minors compared to adult students who disagreed with HPV vaccination ,as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Factors such as students residence had no effect on their willingness to pay for vaccination.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eStudents\u0026rsquo; willingness to pay for vaccination is influenced by multiple factors, including parental willingness and preferences, as well as communication with parents. Although the overall level remains relatively low, there has been an increasing trend in recent years. Previous studies have indicated that income and education levels do not significantly affect willingness to pay, which is consistent with the findings of this study [12\u0026ndash;16]. In our research, we found that monthly disposable income and place of residence had no significant impact on vaccination willingness. This result differs from studies conducted in the United States [17], but aligns with findings from studies in China [18], possibly reflecting differences in national contexts.\u003c/p\u003e\u003cp\u003eSome studies have suggested that vaccination history plays a mediating role between willingness and actual behavior [19]; however, this effect was not statistically significant in our study. Other potential influencing factors should therefore be considered, such as differences in sample characteristics, cultural backgrounds, or policy environments.\u003c/p\u003e\u003cp\u003eFrom a methodological perspective, this study employed weakly informative priors and t-distributions to approximate flat normal prior distributions. As a result, the outcomes were not substantially different from those obtained using traditional logistic regression. However, Bayesian estimation still produced partially different results compared to conventional regression, mainly reflected in the \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e values. The theoretical basis for estimating \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e values differs between logistic regression and Bayesian logistic regression: traditional logistic regression uses maximum likelihood estimation (MLE) to identify the set of \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e values that maximize the probability of observing the given data\u0026mdash;these are point estimates representing the most likely parameter values. In contrast, Bayesian logistic regression applies Bayes\u0026rsquo; theorem to derive posterior distributions by combining prior distributions with the likelihood function, resulting in full distributions rather than single estimates. These distributions reflect uncertainty around each \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\beta\\:}\\)\u003c/span\u003e\u003c/span\u003e value and generate a range of plausible values through sampling.\u003c/p\u003e\u003cp\u003eIn addition, traditional logistic regression typically provides standard errors and confidence intervals to assess estimation uncertainty, but these measures often rely on asymptotic theory or specific assumptions. By comparison, Bayesian logistic regression naturally offers more comprehensive measures of uncertainty, such as the standard deviation of the posterior distribution and the highest density interval (HDI),which are directly derived from the posterior without additional assumptions. Furthermore, while traditional logistic regression does not incorporate prior knowledge about parameters and assumes all parameters are unknown and learned entirely from the data, Bayesian methods allow for the integration of expert knowledge or findings from previous studies into the analysis as prior distributions, thereby influencing the final posterior estimates. This approach can improve estimation efficiency in small-sample settings and help prevent overfitting [20].\u003c/p\u003e\u003cp\u003eThis survey represents the first cross-sectional investigation and analysis of female college students\u0026rsquo; willingness to pay for vaccination. The results showed that awareness and willingness to pay for cervical cancer-related information among female college students reached 96.26% and 89.09%, respectively, which aligns with previous studies [21]. However, when examining their understanding of cervical cancer and HPV vaccine-related knowledge, it was found that although awareness rates for most knowledge points exceeded 70%, the awareness rate for the \u0026ldquo;most important risk factor for cervical cancer\u0026rdquo; was only 39.49%, indicating a lack of understanding of this key concept.\u003c/p\u003e\u003cp\u003eRelated research suggests that induced abortion, number of sexual partners, cervicitis, vaginitis, staying up late, and psychological stress are risk factors for HPV infection [22]. When exploring reasons for refusing HPV vaccination among female college students, we found that the top two reasons were \"complex appointment procedures\" and \"lack of time for vaccination.\" These findings differ from other studies where concerns about vaccine side effects were the main reason for refusal [23], suggesting insufficient knowledge about the vaccine.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study is a cross-sectional survey and thus has several limitations:Causal inference not possible: Due to the one-time data collection design, this study captures only a snapshot of current conditions and cannot establish causal relationships between variables. While associations were observed, it remains unclear whether these factors cause changes in willingness or are consequences of it.Risk of recall bias: The self-reported nature of the questionnaire may lead to inaccurate memory or subjective bias, potentially affecting the accuracy and reliability of some responses.Selection bias: Participants who volunteered for the survey may systematically differ from non-participants\u0026mdash;for example, those with greater health awareness may be more likely to participate, which could overestimate the general level of vaccine awareness and willingness to pay among female college students.Unmeasured confounding factors: Due to the nature of the cross-sectional design, some potential confounders, such as psychological status or family support, were not fully accounted for in the analysis.Lack of behavioral validation: This study assessed willingness to vaccinate rather than actual vaccination behavior. Future longitudinal studies are needed to verify whether willingness translates into action.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, female college students demonstrate a high level of awareness and willingness to pay for the HPV vaccine. However, understanding of key health knowledge\u0026mdash;such as the primary risk factors for cervical cancer\u0026mdash;still requires improvement. Additionally, practical barriers during the vaccination process, such as complex appointment procedures and limited availability of time slots, emerged as major obstacles. These findings suggest that future efforts to promote HPV vaccination should focus on optimizing service delivery processes and improving accessibility.\u003c/p\u003e\u003cp\u003eThis study applied Bayesian logistic regression, which not only confirmed the basic conclusions of traditional logistic regression but also provided richer insights into uncertainty through the incorporation of prior information and posterior distributions. This approach is particularly valuable in studies with limited sample sizes or those requiring integration of domain-specific knowledge.\u003c/p\u003e\u003cp\u003eIt is recommended that future health promotion initiatives further refine educational materials, prioritize vaccination for older female students, and explore school-based screening or vaccination programs to enhance coverage and uptake rates [24\u0026ndash;26].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate and Bayesian logistic regression of willingness to pay for HPV vaccination\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eβ price\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP price\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR price\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe 95%CI of the OR value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eThe posterior mean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHDI95%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003especialty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.12\u0026thinsp;~\u0026thinsp;0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.25\u0026thinsp;~\u0026thinsp;1.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15\u0026thinsp;~\u0026thinsp;0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.01~--0.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edomicile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.72\u0026thinsp;~\u0026thinsp;2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.49\u0026thinsp;~\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstand the basics of HPV vaccines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.32\u0026thinsp;~\u0026thinsp;1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.60\u0026thinsp;~\u0026thinsp;0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImproving autoimmunity can eliminate HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.49\u0026thinsp;~\u0026thinsp;2.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.59\u0026thinsp;~\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave been vaccinated against HPV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29\u0026thinsp;~\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.75\u0026thinsp;~\u0026thinsp;0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsent to the HPV vaccination allows for a more liberal sexual behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.25\u0026thinsp;~\u0026thinsp;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.70~-0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHuman papillomavirus\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003e Written informed consent for publication was obtained from all participants. A copy of the signed consent forms is available for review by the Editor-in-Chief upon request.\u003c/p\u003e\u003c/p\u003e\u003cdiv class=\"Heading\"\u003eDeclarations\u003c/div\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Medical Ethics Committee of Xuzhou Medical University. Written informed consent was obtained from all participants prior to their participation in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Social Development Project of Xuzhou City (Number: KC21267).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor ContributionsY.S. conceptualized the study, collected and analyzed the data, and drafted the manuscript. Q.W. supervised the research, provided critical feedback, and revised the manuscript. H.Z. assisted in questionnaire design, participated in data collection, and contributed to the literature review. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDue to privacy concerns, supporting data cannot be made publicly available. Data may be requested from the corresponding author upon reasonable request and with appropriate ethical approval.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCao F, Li YZ, Zhang DY, Wang XY, Chen WX, Liu FH, Men YX, Gao S, Lin CQ, Zou HC\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eHuman papillomavirus infection and the risk of cancer at specific sites other than anogenital tract and oropharyngeal region: an umbrella review\u003c/strong\u003e. \u003cem\u003eEBioMedicine \u003c/em\u003e2024, \u003cstrong\u003e104\u003c/strong\u003e:105155.\u003c/li\u003e\n\u003cli\u003eLi R, Meng W, Zuo Y, Xu Y, Wu S: \u003cstrong\u003eThe cervical cancer related distribution, coinfection and risk of 15 HPV types in Baoan, Shenzhen, in 2017-2023\u003c/strong\u003e. \u003cem\u003eVirology journal \u003c/em\u003e2024, \u003cstrong\u003e21\u003c/strong\u003e(1):164.\u003c/li\u003e\n\u003cli\u003eZhou YX, Ma XH, Wang TT, Qu XL, Zhang XQ: \u003cstrong\u003eAnalysis of age-specified and genotype distribution of HPV multiple infections in the Chinese population\u003c/strong\u003e. \u003cem\u003eScientific reports \u003c/em\u003e2024, \u003cstrong\u003e14\u003c/strong\u003e(1):2678.\u003c/li\u003e\n\u003cli\u003eTsu VD, LaMontagne DS, Atuhebwe P, Bloem PN, Ndiaye C: \u003cstrong\u003eNational implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects\u003c/strong\u003e. \u003cem\u003ePreventive medicine \u003c/em\u003e2021, \u003cstrong\u003e144\u003c/strong\u003e:106335.\u003c/li\u003e\n\u003cli\u003eMahumud RA, Alam K, Keramat SA, Ormsby GM, Dunn J, Gow J: \u003cstrong\u003eCost-effectiveness evaluations of the 9-Valent human papillomavirus (HPV) vaccine: Evidence from a systematic review\u003c/strong\u003e. \u003cem\u003ePloS one \u003c/em\u003e2020, \u003cstrong\u003e15\u003c/strong\u003e(6):e0233499.\u003c/li\u003e\n\u003cli\u003eZhao C, Zhao Y, Li J, Li M, Shi Y, Wei L: \u003cstrong\u003eOpportunities and challenges for human papillomavirus vaccination in China\u003c/strong\u003e. \u003cem\u003eHuman vaccines \u0026amp; 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39.49% of participants recognized that the leading cause of cervical cancer was viral infection. Of the 394 students who were aware of the HPV vaccine, up to 89.09% expressed a willingness to get the HPV vaccine at their own expense. The analysis revealed that the influencing factors were: students major, age, and consent to HPV vaccination more freely [the posterior mean was 0.69 (0.25 ~ 1.15), -0.60 (-1.01~ -0.18), and-0.34 (-0.70~ -0.01)].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The female college students in medical schools are insufficient in the knowledge of cervical cancer and related HPV vaccines. It is suggested to strengthen relevant health education, deepen students correct understanding and value understanding of HPV vaccines, and guide them to make choices conducive to their own health.\u003c/p\u003e","manuscriptTitle":"Analysis of the influencing factors of female college students' cognition of cervical cancer and willingness to pay for HPV vaccination under the Bayesian framework","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 14:38:46","doi":"10.21203/rs.3.rs-6800508/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f2c674f2-bfa9-458d-9d1c-f31a14780249","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-12T08:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 14:38:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6800508","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6800508","identity":"rs-6800508","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}