Willingness and Compliance with Helicobacter pylori Screening among Chinese University Students Aged 18–25 Years: A Cross-Sectional Study

Willingness and Compliance with Helicobacter pylori Screening among Chinese University Students Aged 18–25 Years: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Willingness and Compliance with Helicobacter pylori Screening among Chinese University Students Aged 18–25 Years: A Cross-Sectional Study Yu Zhang, Xin Peng, Minghan Zhang, Guoming Luo, Haowei Li, Weigang Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7650385/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2025 Read the published version in BMC Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background Helicobacter pylori infection is a major risk factor for various gastrointestinal diseases, including gastric cancer. While early screening and eradication are critical in young adults, screening rates in this age group remain low. Despite expert recommendations targeting those aged 18–25 years, few studies have examined the factors influencing their willingness to undergo screening or comply with testing procedures. This study aimed to explore these determinants in this population. Materials and Methods A cross-sectional study was conducted from November 2024 to January 2025 among individuals aged 18–25 years at a university in China. Participants completed electronic questionnaires after undergoing serological testing, and the 13 C-urea breath test ( 13 C-UBT) and the H. pylori stool antigen test (HpSAT) were also offered. The primary and secondary outcomes were screening willingness and compliance, respectively. Chi-squared tests and logistic regression identified associated factors. Results The university’s target population was approximately 30,000. Eighty-two were randomly selected, yielding a theoretical sample size of 2460. Of these, 595 students participated, and 576 valid questionnaires were collected. The screening rate was 24.2% (595/2460); among respondents, 86.5% (498/576) expressed willingness to undergo H. pylori screening. Multivariate analysis showed that female sex, complete acceptance of serological testing, and willingness to pay were significantly associated with greater screening willingness. Compliance rates were highest for the 13 C-UBT (100%, 576/576), followed by serological testing (83.3%, 480/576) and the HpSAT (66.7%, 384/576). Conclusion Although willingness to undergo H. pylori screening was high among college students aged 18–25 years, the actual screening rate remained relatively low. Enhancing acceptance of serological testing and implementing diverse health education strategies to boost motivation may help increase screening uptake. For confirming H. pylori infection in this population, a combination of 13 C-UBT and serological testing is recommended, while HpSAT is not advised for population-level screening in this target group. Young Adults Helicobacter pylori Screening willingness Screening Compliance Noninvasive screening methods 1.Introduction Helicobacter pylori is the most significant controllable risk factor for various benign and malignant diseases of the stomach and duodenum[ 1 ]. Globally, more than 50% of the population is infected with H. pylori [ 2 ], and the infection rate in China ranges from 40% to 60%[ 3 ], which is comparable to the global prevalence. In recent years, there has been a trend toward earlier onset of H. pylori infection, with a reported infection rate of approximately 45% among adults aged 18 years[ 4 , 5 ]. Screening for H. pylori is of profound importance for eradication efforts, treatment of H. pylori -related diseases, and the prevention of gastric cancer. H. pylori detection methods are categorized as either invasive or non-invasive[ 6 ]. Noninvasive tests include serological assays, the H. pylori stool antigen test (HpSAT), and the urea breath test (UBT)[ 7 ]. UBT is further divided into 13 C-UBT and 14 C-UBT; the former is non-radioactive but more expensive, while the latter contains trace radioactivity. Chinese experts advise against the use of 14 C-UBT in pregnant or lactating women and in children[ 7 ]. Compared to invasive and costly procedures, such as gastroscopy, noninvasive methods offer lower cost, greater acceptance, and enable large-scale H. pylori screening[ 8 ]. However, serological tests are not recommended for diagnosing current H. pylori infection. Studies have shown that young adults benefit significantly from H. pylori screening and eradication. These interventions can cure H. pylori -related gastritis, reduce the risk of gastric cancer, and lower the likelihood of transmission to offspring[ 9 ]. The Kyoto Global Consensus recommends that individuals aged 12 years and above undergo H. pylori screening and eradication[ 9 ]. Similarly, Chinese experts propose that H. pylori screening should begin in the youth, ideally during university years or early adulthood[ 10 ]. The “ Screening and eradication of Helicobacter pylori for gastric cancer prevention: The Consensus” further indicates that eradicating H. pylori before the onset of gastric atrophy or intestinal metaplasia—particularly in individuals aged 18–25 years—is the most cost-effective approach[ 11 ]. Despite these recommendations, the current screening rate among Chinese university students aged 18–25 years remains generally low[ 12 , 13 ]. Therefore, understanding the factors that influence both willingness to undergo H. pylori screening and compliance with screening protocols in this age group is essential for guiding public health strategies. Currently, few studies have examined H. pylori screening willingness among individuals aged 18–25 years, and comprehensive analyses of the factors affecting compliance with serological tests and HpSAT are lacking. Therefore, this study aimed to investigate the determinants of H. pylori screening and compliance in this age group. By identifying key behavioral and perceptual factors, the findings are expected to support the development of targeted health education strategies and improve engagement in early disease screening. 2. Materials and Methods 2.1 Study Population and Sample Size Calculation The study population comprised individuals aged 18–25 years who underwent serological tests, HpSAT, and 13 C-UBT and completed electronic questionnaires at a university between November 2024 and January 2025. Inclusion criteria were: (1) aged 18–25 years, and (2) voluntary participation with signed informed consent. Exclusion criteria were: (1) presence of severe cardiovascular, hepatic, or renal diseases; (2) failure to meet requirements for serological testing, HpSAT, or 13 C-UBT; and (3) withdrawal request during the study process. This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Shihezi University (Ethical Review Number: KJ2024-471-01). The sample size was determined using a random cluster sampling method with the following parameters: estimated screening willingness (p) = 79.9%[ 1 ], 95% confidence interval (CI) (Z = 1.96), margin of error (E) = ± 5%, design effect (Deff) = 2, response rate (r) = 20.1%[ 12 ]. Using the formula[ 14 ] N = [Z²×p×(1 - p)] / E², the initial sample size was calculated as N = 247. After adjusting for the design effect, the sample size became N adjust = N×Deff = 494. To account for the response rate, the final target was N total = N adjust / r = 2458. With an average class size of 30 students, 82 classes were randomly selected to achieve the theoretical sample size of 2460 participants. This sampling framework accounted for both the expected response rate and design effect. Ultimately, 595 individuals participated in the study, and 576 valid questionnaires were returned, yielding a response rate of 23.4%, which was within the allowable margin of error. 2.2 Questionnaire Design The questionnaire was adapted from an epidemiological survey published in The Lancet [ 3 ]. Additional items were included to assess willingness to undergo H. pylori screening and to identify factors influencing compliance. As the questionnaire did not involve complex psychological scales, content validity was established through logical consistency and expert review. The primary outcome of the study was the willingness to undergo H. pylori screening, defined according to the minimum acceptance threshold principle from behavioral decision theory[ 15 ], whereby individuals set a minimum acceptable standard when making decisions. Screening willingness was classified as follows: participants who agreed to at least one noninvasive test were considered willing, while those who simultaneously refused both serological tests and the HpSAT were considered unwilling. The secondary outcome was screening compliance, measured by participants’ acceptance of the serological tests and the HpSAT (yes/no). Compliance with the 13 C-UBT was indirectly assessed by calculating the proportion of individuals who both underwent the test and submitted valid questionnaires out of the total number of valid responses. Questionnaire Administration: Participants completed the questionnaire immediately after undergoing serological testing and the 13 C-UBT. For the HpSAT, sample containers were provided, and responses were collected within 48 h. 2.3 Statistical Analysis Statistical analyses were conducted using SPSS 27.0. Categorical variables, including binary and unordered data, were analyzed using the chi-squared test to assess differences between groups. Variables with a p-value < 0.15 in the univariate analysis (a relaxed threshold used to avoid overlooking potentially important factors) were entered into a binary logistic regression model to examine their independent associations with the outcome variable. 3. Result 3.1 Screening Willingness Among individuals aged 18–25 years, the willingness to undergo H. pylori screening was 24.2% (595/2460). Univariate analysis (Table 1 ) indicated that sex, history of H. pylori testing, acceptance of serological tests, acceptance of HpSAT, willingness to pay, and willingness to receive treatment were significantly associated with screening willingness ( P < 0.05). Gastrointestinal symptoms ( P = 0.091) and other statistically significant variables were included in the binary logistic regression analysis. The results showed that female sex (odds ratio [OR] = 2.221, P = 0.007), complete acceptance of serological testing (OR = 28.030, P < 0.001), and willingness to pay (OR = 2.752, P = 0.001) were independently associated with greater willingness to undergo H. pylori screening. Table 1 Analysis of Influencing Factors for HP Infection Screening Willingness in 18-25-Year-Old Population of a University Screening Willingness Univariate Analysis Multivariate Analysis Item [n(%)] Sample Size Refusal Group Consent Group χ 2 P OR(95% CI ) P Gender 13.589 <0.001 Male 244 48(19.7) 196(80.3) 1 0.007 Female 332 30(9.0) 302(91.0) 2.221(1.248–3.952) Gastrointestinal Symptoms No 252 41(16.3) 21(83.7) 2.848 0.091 1 0.927 Yes 324 37(11.4) 287(88.6) 1.027(0.580–1.821) Serological Acceptability Unacceptable 17 10(58.8) 7(41.2) 108.798 <0.001 1 Partially 197 59(29.9) 138(70.1) 2.942(0.855–10.121) 0.870 Fully 362 9(2.5) 353(97.5) 28.030(7.247-108.411) <0.001 HpSAT Acceptability Unacceptable 54 17(31.5) 37(68.5) 53.249 <0.001 1 Partially 259 54(20.8) 205(79.2) 1.251(0.538–2.910) 0.603 Fully 263 7(2.7) 256(97.3) 3.265(1.042–10.236) 0.042 Willingness to Pay No 255 58(22.7) 197(77.3) 33.104 <0.001 1 Yes 321 20(6.2) 301(93.8) 2.752(1.505–5.034) 0.001 Willingness to Treat No 42 11(26.2) 31(73.8) 6.191 0.013 1 Yes 534 67(12.5) 467(87.5) 1.573(0.622–3.977) 0.338 Abbreviations: HP = Helicobacter pylori; OR = Odds Ratio; CI = Confidence Interval 3.2 Noninvasive Testing Compliance 3.2.1 Serological test The compliance rate for serological tests was 83.33% (480/576). The associated influencing factors are presented in Table 2 . Sex, history of H. pylori testing, acceptance of serological tests, willingness to pay, and willingness to receive treatment were significantly associated with compliance ( P < 0.05). These variables, along with gastrointestinal symptoms ( P = 0.071), were included in the binary logistic regression analysis. Female sex (OR = 1.895, P = 0.021), higher acceptance of serological tests (partial acceptance: OR = 7.031, P = 0.005; complete acceptance: OR = 107.924, P < 0.001), and willingness to pay (OR = 2.544, P = 0.001) were positively correlated with higher compliance. Conversely, individuals with a history of H. pylori testing (OR = 0.379, P = 0.012) were less likely to comply with serological testing. Table 2 Analysis of Influencing Factors on Serological Compliance for HP Infection among 18-25-Year-Old University Populations Serological Test Univariate Analysis Multivariate Analysis Item[n(%)] Refusal Group(n = 96) Consent Group(n = 480) χ 2 P OR(95% CI ) P Gender Male 54(22.1) 190(77.9) 9.101 0.003 1 Female 42(12.7) 290(87.3) 1.895(1.100-3.267) 0.021 Gastrointestinal Symptoms No 50(19.8) 202(80.2) 3.251 0.071 1 Yes 46(14.2) 278(85.8) 1.095(0.638–1.881) 0.741 History of gastroscopy No 86(16.1) 449(83.9) 1.896 0.169 Yes 10(24.4) 31(75.6) History of HP testing No 74(15.1) 416(84.9) 5.785 0.016 1 Yes 22(25.6) 64(74.4) 0.379(0.186–0.773) 0.008 Serological Acceptability Unacceptable 14(82.4) 3(17.6) 149.762 <0.001 1 Partially 70(35.5) 127(64.5) 7.031(1.806–27.376) 0.005 Fully 12(3.3) 350(96.7) 107.924(25.283-460.685) <0.001 Willingness to Pay No 67(26.3) 188(73.7) 30.041 <0.001 1 Yes 29(9.0) 292(91.0) 2.544(1.458–4.442) 0.001 Willingness to Treat No 13(31.0) 29(69.0) 6.657 0.010 1 Yes 83(15.5) 451(84.5) 1.599(0.647–3.952) 0.310 Abbreviations : HP = Helicobacter pylori; OR = Odds Ratio; CI = Confidence Interval 3.2.2 HpSAT The compliance rate for the HpSAT was 66.67% (384/576). These influencing factors are presented in Table 3 . Acceptance of HpSAT and willingness to pay were significantly associated with compliance ( P < 0.05). These variables, along with sex ( P = 0.084), gastrointestinal symptoms ( P = 0.080), and history of gastroscopy ( P = 0.067), were included in the binary logistic regression analysis. Higher acceptance of HpSAT (partial acceptance: OR = 55.177; complete acceptance: OR = 944.490, both P < 0.001) and willingness to pay for H. pylori screening (OR = 1.598, P = 0.044) were positively associated with increased compliance. Conversely, individuals with a history of gastroscopy (OR = 0.296, P = 0.008) were less likely to comply with the HpSAT. Table 3 Analysis of Influencing Factors on HpSAT Compliance for Hp Infection among 18-25-Year-Olds in a University HpSAT Univariate Analysis Multivariate Analysis Item [n(%)] Refusal Group (n = 192) Consent Group(n = 384) χ 2 P OR(95% CI ) P Gender Male 91(37.3) 153(62.7) 2.990 0.084 1 Female 101(30.4) 231(69.6) 1.501(0.943–2.390) 0.087 Gastrointestinal Symptoms No 99(39.3) 153(60.7) 7.143 0.080 1 Yes 93(28.7) 231(71.3) 1.420(0.894–2.253) 0.137 History of gastroscopy No 173(32.3) 362(67.7) 3.361 0.067 1 Yes 19(46.3) 22(53.7) 0.296(0.121–0.723) 0.008 History of HP testing No 164(33.5) 326(66.5) 0.027 0.869 Yes 28(32.6) 58(67.4) HpSAT Acceptability Unacceptable 53(98.1) 1(1.9) 220.914 <0.001 1 Partially 125(48.3) 134(51.7) 55.177(7.473-407.378) <0.001 Fully 14(5.3) 249(94.7) 944.490(120.167-7423.488) <0.001 Willingness to Pay No 111(43.5) 144(56.5) 21.406 <0.001 1 Yes 81(25.2) 240(74.8) 1.598(1.013–2.519) 0.044 Willingness to Treat No 18(42.9) 24(57.1) 1.849 0.173 Yes 174(32.6) 360(67.4) Abbreviations: HP = Helicobacter pylori; OR = Odds Ratio; CI = Confidence Interval 4. Discussion H. pylori infections remain a global public health concern. Screening and eradicating H. pylori can cure H. pylori -related gastritis, reduce the risk of gastric cancer, and prevent parent-to-child transmission[ 9 ]. According to the Kyoto Global Consensus [ 9 ], individuals aged ≥ 12 years should undergo H. pylori screening and eradication. Chinese experts further emphasized that individuals aged 18–25 years benefit most from screening and eradication[ 11 ]. However, studies on H. pylori screening willingness among this age group are limited, and screening rates remain low[ 12 , 13 ]. Thus, investigating screening willingness and compliance in this population has important public health implications for developing targeted intervention strategies. In this study, while the willingness to undergo H. pylori screening among 18–25-year-olds was relatively high (86.5%), the actual screening rate was low (24.2%). This finding is consistent with previous reports showing that although Chinese adults express positive attitudes toward H. pylori screening, their behavioral compliance is low[ 12 , 13 ]. For example, Wu et al.' s[ 13 ] found that 87.0% of participants supported H. pylori screening, but only 21.7% actually underwent screening. This gap between intention and behavior supports the well-documented “intention–behavior gap” in health behavior theory, highlighting the limitations of relying solely on voluntary participation. In line with the World Health Organization's call for gastric cancer prevention, systematic interventions are urgently needed to address this gap. Integrating H. pylori screening into routine university admission health examinations may reduce barriers and promote participation through institutionalized channels. This discrepancy may arise from two key mechanisms in the Health Belief Model—where asymptomatic individuals underestimate the risk of infection[ 16 ]—and high perceived barriers, such as the need to fast for the 13 C-UBT and psychological resistance to the HpSAT[ 1 ]. Additionally, to improve diagnostic certainty, this study applied strict inclusion criteria, including the requirement to complete multiple tests simultaneously. While this approach enhanced diagnostic efficiency, it also increased the time burden[ 17 ], which—along with the need for venous blood sampling and limited acceptability of HpSAT—may have contributed to the low screening rate in this population. This study found that compliance was highest with the 13 C-UBT, followed by serological testing, while HpSAT compliance was significantly lower than both. Based on these findings, we recommend using a combination of 13 C-UBT and serological testing for H. pylori infection diagnosis in this age group and do not recommend HpSAT for widespread screening. Screening method acceptability and individual preferences significantly influence compliance[ 18 ]. Serological test acceptability, in particular, was a key determinant of both screening willingness and test compliance. This may be explained by prior negative experiences with blood sampling. One report noted that although more than 80% of individuals accept venous blood collection for H. pylori testing, around 21% experience psychological resistance to venipuncture[ 19 ]. Such resistance is closely related to examinees’ psychological preparedness, the skills of phlebotomists, and the quality of nursing care. Post-procedural care, therefore, can play a role in reducing adverse reactions[ 20 ]. A Canadian study found that fear of venipuncture was the primary cause of dizziness and nausea following blood sampling[ 21 ]. Similarly, a Chinese study reported that using effective communication techniques during venipuncture significantly reduced patients' psychological burden and increased compliance with serological testing by 40%[ 22 ]. During H. pylori screening promotion, medical staff should enhance their use of communication skills during venipuncture, engage promptly with examinees, and provide timely reassurance and encouragement[ 22 ]. After blood collection, examinees should receive clear instructions on compression techniques, potential post-sampling adverse reactions, and appropriate coping strategies. These measures can improve the acceptability of serological testing, help overcome key barriers to H. pylori screening, and ultimately increase the participation rate. Similarly, the acceptability of the HpSAT is a key factor in determining compliance. Individuals aged 18–25 years may experience psychological resistance to stool collection, which lowers the acceptability of the HpSAT[ 7 , 23 ]. Additionally, the inability to collect stool samples promptly on the day of screening and the lack of convenient collection sites at universities contribute to reduced compliance. Limited awareness of screening methods[ 1 ], tight academic schedules, and scarce free time further decreased attention to the HpSAT, leading to low participation. These findings suggest that the HpSAT may be more suitable for specific groups, such as children or individuals with mobility impairments[ 7 ], rather than for widespread implementation in university settings. This study found that willingness to pay is a major factor influencing H. pylori screening behavior. Participants who were willing to pay had significantly higher screening willingness (OR = 2.752, 95% CI: 1.505–5.034), serological compliance (OR = 2.544, 95% CI: 1.458–4.442), and HpSAT compliance (OR = 1.598, 95% CI: 1.013–2.519). However, most individuals aged 18–25 years were university students with limited financial independence, and only 55.7% (321/576) expressed willingness to pay. Economic constraints not only reduced willingness to undergo screening but also influenced the compliance of those who had previously undergone H. pylori screening or gastroscopy, as they were reluctant to incur repeated or additional costs[ 24 ]. Therefore, in university or hospital settings, using cost-effective methods, such as w 13 C-UBT combined with serological testing, for those who have never been screened may improve willingness and raise the overall screening rate. The results of this study showed that females demonstrated a higher willingness to undergo H. pylori screening (OR = 2.221, 95% CI: 1.248–3.952) and greater serological compliance (OR = 1.895, 95% CI: 1.100–3.267) than males. These differences may be attributed to male lifestyle factors, occupational exposures, physiological differences, and lower awareness of disease prevention[ 25 , 26 ]. Social media offer unique advantages in improving compliance with target populations. A study conducted in China indicated that social media can enhance the H. pylori eradication rate[ 27 ], which is significant for increasing screening participation. Diversified publicity and educational strategies can strengthen men's understanding of H. pylori infection-related knowledge and improve screening participation rates among male populations. The population targeted in this study was characterized by low infection and screening rates but strong social networks, representing a crucial opportunity to interrupt H. pylori transmission. Achieving widespread screening in this group could not only directly lower infection rates but also promote healthy behaviors within families and society at large. Therefore, it is recommended that university-based screening initiatives be integrated with community health record systems to establish a school-family-community hierarchical network for H. pylori prevention and control. This layered model is expected to facilitate more efficient identification and management of infected individuals, ultimately reducing the sources of H. pylori transmission and the overall disease burden in the population. This study has some limitations. First, as a cross-sectional study, it could not establish a causal relationship between risk factors and willingness to undergo screening. Second, the study did not investigate or analyze individuals who refused to participate in H. pylori screening, which may have introduced selection bias and led to an overestimation of overall screening willingness in the target population. Finally, since the study population consisted solely of university students, caution is warranted when generalizing the findings to non-student groups. Future research should include qualitative studies to explore the reasons for screening refusal, as well as cohort studies in non-student populations for validation. In conclusion, although the target population demonstrated a high willingness to undergo H. pylori screening, the actual screening rate remained low. Compliance was the highest with the 13 C-UBT, followed by serological testing, while compliance with the HpSAT was significantly lower than both. Based on these results, the combined use of 13 C-UBT and serological testing is recommended for diagnosing H. pylori infection, whereas HpSAT is not advised for widespread screening in this group. To improve screening rates, efforts should focus on enhancing humanistic care to increase acceptance of serological testing and implementing diverse publicity strategies to strengthen screening motivation and participation. Declarations Ethical Disclosure: This study adhered to the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants, and the study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Shihezi University Institution (approval no. KJ2024-471-01, dated 10/12/2024). All data were anonymized to protect participant privacy. Conflicts of Interest: The authors declare no conflicts of interest. Funding information: The study was supported by the project “2024 Talent Development Fund (CZ001228) ” Acknowledgments: The authors gratefully acknowledge Beijing Richen-force Science & Technology Co., Ltd. for its generous support, including the free provision of urea breath test and fecal antigen test reagents. Author Contributions Statement: Yu Zhang: Experimental design, statistical analysis, manuscript writing, and final approval of the manuscript. Xin Peng: Data collection and public science communication. Minghan Zhang：Data Processing and Analysis. Guoming Luo, Haowei Li: Data collection. Weigang Chen: Overall research design, funding acquisition, manuscript guidance and review, and final approval of the manuscript. References Jiyan L, Yingying H, Jialun G, et al. Survey of willingness to detect Helicobacter pylori infection among physical examination population. 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Shihezi University School, Xinjiang, China","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Peng","suffix":""},{"id":529394405,"identity":"85b180a0-0872-4c05-8a20-9497d4e75850","order_by":2,"name":"Minghan Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital, Shihezi University School, Xinjiang, China","correspondingAuthor":false,"prefix":"","firstName":"Minghan","middleName":"","lastName":"Zhang","suffix":""},{"id":529394406,"identity":"0f882dfb-3f1f-4d53-a670-54910825d71f","order_by":3,"name":"Guoming Luo","email":"","orcid":"","institution":"The First Affiliated Hospital, Shihezi University School, Xinjiang, China","correspondingAuthor":false,"prefix":"","firstName":"Guoming","middleName":"","lastName":"Luo","suffix":""},{"id":529394407,"identity":"92300438-5973-4edb-a2eb-532aaa7d6ab6","order_by":4,"name":"Haowei Li","email":"","orcid":"","institution":"The First Affiliated Hospital, Shihezi University School, Xinjiang, China","correspondingAuthor":false,"prefix":"","firstName":"Haowei","middleName":"","lastName":"Li","suffix":""},{"id":529394408,"identity":"e64f092e-686f-4c47-90ce-55f0be6bed51","order_by":5,"name":"Weigang Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACNv7+5z8+8PyT45c/fPBBQoUNYS18EmcYJGfIHDCWnMGWbPDgTBphLXIMOQzSPDYHEg1u8JhJPmw7RITDGM4eMObJuZNgcLvHrCKB7QADf3t3An4tzH0JiXPOPMuTvHOs7EYCzx0GiTNnNxCw5YDBgbc9zMV8B5K33UiQeMZgIJFLSEuCYQPvP+bEhgMJZgUJBoeJ0ZJjzMjDczhxwo0UM4aEBGK0SBxLY5zBk2Ys2XMsWSLhQBoPQb/I9zcfY/jAYyPHz9588OPPf0BGey9+LRiAhzTlo2AUjIJRMAqwAgB/1lC2+T8d+AAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital, Shihezi University School, Xinjiang, China","correspondingAuthor":true,"prefix":"","firstName":"Weigang","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-09-18 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13:24:37","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":128183,"visible":true,"origin":"","legend":"","description":"","filename":"575d3d26ea9c4625b834d7048eaa9e2c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7650385/v1/8cdfba77ca58884a6fbe0238.xml"},{"id":93594728,"identity":"70f9a413-957f-48db-8895-ec451dfc62f3","added_by":"auto","created_at":"2025-10-15 13:24:37","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127976,"visible":true,"origin":"","legend":"","description":"","filename":"575d3d26ea9c4625b834d7048eaa9e2c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7650385/v1/28ba58b9f81e481a10de63df.xml"},{"id":93594729,"identity":"63b2bf56-62f6-442b-bfb0-550d0bd101c0","added_by":"auto","created_at":"2025-10-15 13:24:37","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136826,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7650385/v1/4513a9dbb6a214e68cbc783f.html"},{"id":97178283,"identity":"9cfdc141-4226-41ec-9615-897667bcbece","added_by":"auto","created_at":"2025-12-01 16:07:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1072118,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7650385/v1/361610d9-c847-4685-888c-fd60cfa93285.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Willingness and Compliance with Helicobacter pylori Screening among Chinese University Students Aged 18–25 Years: A Cross-Sectional Study","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e is the most significant controllable risk factor for various benign and malignant diseases of the stomach and duodenum[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, more than 50% of the population is infected with \u003cem\u003eH. pylori\u003c/em\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and the infection rate in China ranges from 40% to 60%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which is comparable to the global prevalence. In recent years, there has been a trend toward earlier onset of \u003cem\u003eH. pylori\u003c/em\u003e infection, with a reported infection rate of approximately 45% among adults aged 18 years[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Screening for \u003cem\u003eH. pylori\u003c/em\u003e is of profound importance for eradication efforts, treatment of \u003cem\u003eH. pylori\u003c/em\u003e-related diseases, and the prevention of gastric cancer.\u003c/p\u003e\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e detection methods are categorized as either invasive or non-invasive[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Noninvasive tests include serological assays, the \u003cem\u003eH. pylori\u003c/em\u003e stool antigen test (HpSAT), and the urea breath test (UBT)[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. UBT is further divided into \u003csup\u003e13\u003c/sup\u003eC-UBT and \u003csup\u003e14\u003c/sup\u003eC-UBT; the former is non-radioactive but more expensive, while the latter contains trace radioactivity. Chinese experts advise against the use of \u003csup\u003e14\u003c/sup\u003eC-UBT in pregnant or lactating women and in children[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Compared to invasive and costly procedures, such as gastroscopy, noninvasive methods offer lower cost, greater acceptance, and enable large-scale \u003cem\u003eH. pylori\u003c/em\u003e screening[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, serological tests are not recommended for diagnosing current \u003cem\u003eH. pylori\u003c/em\u003e infection.\u003c/p\u003e\u003cp\u003eStudies have shown that young adults benefit significantly from \u003cem\u003eH. pylori\u003c/em\u003e screening and eradication. These interventions can cure \u003cem\u003eH. pylori\u003c/em\u003e-related gastritis, reduce the risk of gastric cancer, and lower the likelihood of transmission to offspring[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The \u003cem\u003eKyoto Global Consensus\u003c/em\u003e recommends that individuals aged 12 years and above undergo \u003cem\u003eH. pylori\u003c/em\u003e screening and eradication[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Similarly, Chinese experts propose that \u003cem\u003eH. pylori\u003c/em\u003e screening should begin in the youth, ideally during university years or early adulthood[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The \u0026ldquo;\u003cem\u003eScreening and eradication of Helicobacter pylori for gastric cancer prevention: The Consensus\u0026rdquo;\u003c/em\u003e further indicates that eradicating \u003cem\u003eH. pylori\u003c/em\u003e before the onset of gastric atrophy or intestinal metaplasia\u0026mdash;particularly in individuals aged 18\u0026ndash;25 years\u0026mdash;is the most cost-effective approach[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these recommendations, the current screening rate among Chinese university students aged 18\u0026ndash;25 years remains generally low[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, understanding the factors that influence both willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening and compliance with screening protocols in this age group is essential for guiding public health strategies.\u003c/p\u003e\u003cp\u003eCurrently, few studies have examined \u003cem\u003eH. pylori\u003c/em\u003e screening willingness among individuals aged 18\u0026ndash;25 years, and comprehensive analyses of the factors affecting compliance with serological tests and HpSAT are lacking. Therefore, this study aimed to investigate the determinants of \u003cem\u003eH. pylori\u003c/em\u003e screening and compliance in this age group. By identifying key behavioral and perceptual factors, the findings are expected to support the development of targeted health education strategies and improve engagement in early disease screening.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003e2.1 Study Population and Sample Size Calculation\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eThe study population comprised individuals aged 18\u0026ndash;25 years who underwent serological tests, HpSAT, and \u003csup\u003e13\u003c/sup\u003eC-UBT and completed electronic questionnaires at a university between November 2024 and January 2025. Inclusion criteria were: (1) aged 18\u0026ndash;25 years, and (2) voluntary participation with signed informed consent. Exclusion criteria were: (1) presence of severe cardiovascular, hepatic, or renal diseases; (2) failure to meet requirements for serological testing, HpSAT, or \u003csup\u003e13\u003c/sup\u003eC-UBT; and (3) withdrawal request during the study process. This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Shihezi University (Ethical Review Number: KJ2024-471-01).\u003c/p\u003e\u003cp\u003eThe sample size was determined using a random cluster sampling method with the following parameters: estimated screening willingness (p)\u0026thinsp;=\u0026thinsp;79.9%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], 95% confidence interval (CI) (Z\u0026thinsp;=\u0026thinsp;1.96), margin of error (E)\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;5%, design effect (Deff)\u0026thinsp;=\u0026thinsp;2, response rate (r)\u0026thinsp;=\u0026thinsp;20.1%[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Using the formula[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] N = [Z\u0026sup2;\u0026times;p\u0026times;(1 - p)] / E\u0026sup2;, the initial sample size was calculated as N\u0026thinsp;=\u0026thinsp;247. After adjusting for the design effect, the sample size became N\u003csub\u003eadjust\u003c/sub\u003e = N\u0026times;Deff\u0026thinsp;=\u0026thinsp;494. To account for the response rate, the final target was N\u003csub\u003etotal\u003c/sub\u003e = N\u003csub\u003eadjust\u003c/sub\u003e / r\u0026thinsp;=\u0026thinsp;2458. With an average class size of 30 students, 82 classes were randomly selected to achieve the theoretical sample size of 2460 participants. This sampling framework accounted for both the expected response rate and design effect. Ultimately, 595 individuals participated in the study, and 576 valid questionnaires were returned, yielding a response rate of 23.4%, which was within the allowable margin of error.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Questionnaire Design\u003c/h2\u003e\u003cp\u003eThe questionnaire was adapted from an epidemiological survey published in \u003cem\u003eThe Lancet\u003c/em\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Additional items were included to assess willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening and to identify factors influencing compliance. As the questionnaire did not involve complex psychological scales, content validity was established through logical consistency and expert review.\u003c/p\u003e\u003cp\u003eThe primary outcome of the study was the willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening, defined according to the minimum acceptance threshold principle from behavioral decision theory[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], whereby individuals set a minimum acceptable standard when making decisions. Screening willingness was classified as follows: participants who agreed to at least one noninvasive test were considered willing, while those who simultaneously refused both serological tests and the HpSAT were considered unwilling.\u003c/p\u003e\u003cp\u003eThe secondary outcome was screening compliance, measured by participants\u0026rsquo; acceptance of the serological tests and the HpSAT (yes/no). Compliance with the \u003csup\u003e13\u003c/sup\u003eC-UBT was indirectly assessed by calculating the proportion of individuals who both underwent the test and submitted valid questionnaires out of the total number of valid responses.\u003c/p\u003e\u003cp\u003eQuestionnaire Administration: Participants completed the questionnaire immediately after undergoing serological testing and the \u003csup\u003e13\u003c/sup\u003eC-UBT. For the HpSAT, sample containers were provided, and responses were collected within 48 h.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Statistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using SPSS 27.0. Categorical variables, including binary and unordered data, were analyzed using the chi-squared test to assess differences between groups. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.15 in the univariate analysis (a relaxed threshold used to avoid overlooking potentially important factors) were entered into a binary logistic regression model to examine their independent associations with the outcome variable.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Screening Willingness\u003c/h2\u003e\u003cp\u003eAmong individuals aged 18\u0026ndash;25 years, the willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening was 24.2% (595/2460). Univariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) indicated that sex, history of \u003cem\u003eH. pylori\u003c/em\u003e testing, acceptance of serological tests, acceptance of HpSAT, willingness to pay, and willingness to receive treatment were significantly associated with screening willingness (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Gastrointestinal symptoms (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.091) and other statistically significant variables were included in the binary logistic regression analysis. The results showed that female sex (odds ratio [OR]\u0026thinsp;=\u0026thinsp;2.221, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), complete acceptance of serological testing (OR\u0026thinsp;=\u0026thinsp;28.030, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and willingness to pay (OR\u0026thinsp;=\u0026thinsp;2.752, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) were independently associated with greater willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening.\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\u003eAnalysis of Influencing Factors for HP Infection Screening Willingness in 18-25-Year-Old Population of a University\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\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eScreening Willingness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eUnivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eMultivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem [n(%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample Size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRefusal Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConsent Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOR(95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e13.589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(19.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e196(80.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e302(91.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.221(1.248\u0026ndash;3.952)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eGastrointestinal Symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(83.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2.848\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(11.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e287(88.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.027(0.580\u0026ndash;1.821)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eSerological Acceptability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnacceptable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(58.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(41.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e108.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59(29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e138(70.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.942(0.855\u0026ndash;10.121)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.870\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e353(97.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.030(7.247-108.411)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eHpSAT Acceptability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnacceptable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(31.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(68.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e53.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54(20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e205(79.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.251(0.538\u0026ndash;2.910)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.603\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e256(97.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.265(1.042\u0026ndash;10.236)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Pay\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(22.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e197(77.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e33.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e301(93.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.752(1.505\u0026ndash;5.034)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Treat\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(73.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e534\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67(12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e467(87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.573(0.622\u0026ndash;3.977)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.338\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: HP\u0026thinsp;=\u0026thinsp;Helicobacter pylori; OR\u0026thinsp;=\u0026thinsp;Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval\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\u003e3.2 Noninvasive Testing Compliance\u003c/h2\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e\u003cb\u003e3.2.1 Serological test\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eThe compliance rate for serological tests was 83.33% (480/576). The associated influencing factors are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Sex, history of \u003cem\u003eH. pylori\u003c/em\u003e testing, acceptance of serological tests, willingness to pay, and willingness to receive treatment were significantly associated with compliance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These variables, along with gastrointestinal symptoms (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.071), were included in the binary logistic regression analysis. Female sex (OR\u0026thinsp;=\u0026thinsp;1.895, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.021), higher acceptance of serological tests (partial acceptance: OR\u0026thinsp;=\u0026thinsp;7.031, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005; complete acceptance: OR\u0026thinsp;=\u0026thinsp;107.924, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and willingness to pay (OR\u0026thinsp;=\u0026thinsp;2.544, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) were positively correlated with higher compliance. Conversely, individuals with a history of \u003cem\u003eH. pylori\u003c/em\u003e testing (OR\u0026thinsp;=\u0026thinsp;0.379, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012) were less likely to comply with serological testing.\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\u003eAnalysis of Influencing Factors on Serological Compliance for HP Infection among 18-25-Year-Old University Populations\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSerological Test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eUnivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eMultivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem[n(%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRefusal Group(n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConsent Group(n\u0026thinsp;=\u0026thinsp;480)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR(95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54(22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e190(77.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e9.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42(12.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e290(87.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.895(1.100-3.267)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eGastrointestinal Symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50(19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202(80.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3.251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e278(85.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.095(0.638\u0026ndash;1.881)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eHistory of gastroscopy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86(16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e449(83.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(75.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eHistory of HP testing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74(15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e416(84.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e5.785\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22(25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(74.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.379(0.186\u0026ndash;0.773)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eSerological Acceptability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnacceptable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(82.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(17.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e149.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70(35.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127(64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.031(1.806\u0026ndash;27.376)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e350(96.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e107.924(25.283-460.685)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Pay\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67(26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188(73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e30.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e292(91.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.544(1.458\u0026ndash;4.442)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Treat\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(31.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(69.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83(15.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e451(84.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.599(0.647\u0026ndash;3.952)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: HP\u0026thinsp;=\u0026thinsp;Helicobacter pylori; OR\u0026thinsp;=\u0026thinsp;Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval\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=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 HpSAT\u003c/h2\u003e\u003cp\u003eThe compliance rate for the HpSAT was 66.67% (384/576). These influencing factors are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Acceptance of HpSAT and willingness to pay were significantly associated with compliance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These variables, along with sex (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.084), gastrointestinal symptoms (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.080), and history of gastroscopy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.067), were included in the binary logistic regression analysis. Higher acceptance of HpSAT (partial acceptance: OR\u0026thinsp;=\u0026thinsp;55.177; complete acceptance: OR\u0026thinsp;=\u0026thinsp;944.490, both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and willingness to pay for \u003cem\u003eH. pylori\u003c/em\u003e screening (OR\u0026thinsp;=\u0026thinsp;1.598, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) were positively associated with increased compliance. Conversely, individuals with a history of gastroscopy (OR\u0026thinsp;=\u0026thinsp;0.296, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) were less likely to comply with the HpSAT.\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\u003eAnalysis of Influencing Factors on HpSAT Compliance for Hp Infection among 18-25-Year-Olds in a University\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHpSAT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eUnivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eMultivariate Analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem [n(%)]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRefusal Group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;192)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConsent Group(n\u0026thinsp;=\u0026thinsp;384)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR(95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91(37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153(62.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101(30.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e231(69.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.501(0.943\u0026ndash;2.390)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eGastrointestinal Symptoms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99(39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153(60.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e7.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.080\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93(28.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e231(71.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.420(0.894\u0026ndash;2.253)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eHistory of gastroscopy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e173(32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e362(67.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3.361\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(46.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.296(0.121\u0026ndash;0.723)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eHistory of HP testing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164(33.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e326(66.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(67.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eHpSAT Acceptability\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnacceptable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(98.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e220.914\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartially\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125(48.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134(51.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55.177(7.473-407.378)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFully\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e249(94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e944.490(120.167-7423.488)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Pay\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e111(43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144(56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e21.406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81(25.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240(74.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.598(1.013\u0026ndash;2.519)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.044\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eWillingness to Treat\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(42.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(57.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e174(32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e360(67.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: HP\u0026thinsp;=\u0026thinsp;Helicobacter pylori; OR\u0026thinsp;=\u0026thinsp;Odds Ratio; CI\u0026thinsp;=\u0026thinsp;Confidence Interval\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\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e infections remain a global public health concern. Screening and eradicating \u003cem\u003eH. pylori\u003c/em\u003e can cure \u003cem\u003eH. pylori\u003c/em\u003e-related gastritis, reduce the risk of gastric cancer, and prevent parent-to-child transmission[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to the \u003cem\u003eKyoto Global Consensus\u003c/em\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;12 years should undergo \u003cem\u003eH. pylori\u003c/em\u003e screening and eradication. Chinese experts further emphasized that individuals aged 18\u0026ndash;25 years benefit most from screening and eradication[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, studies on \u003cem\u003eH. pylori\u003c/em\u003e screening willingness among this age group are limited, and screening rates remain low[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Thus, investigating screening willingness and compliance in this population has important public health implications for developing targeted intervention strategies.\u003c/p\u003e\u003cp\u003eIn this study, while the willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening among 18\u0026ndash;25-year-olds was relatively high (86.5%), the actual screening rate was low (24.2%). This finding is consistent with previous reports showing that although Chinese adults express positive attitudes toward \u003cem\u003eH. pylori\u003c/em\u003e screening, their behavioral compliance is low[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For example, \u003cem\u003eWu et al.'\u003c/em\u003es[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] found that 87.0% of participants supported \u003cem\u003eH. pylori\u003c/em\u003e screening, but only 21.7% actually underwent screening. This gap between intention and behavior supports the well-documented \u0026ldquo;intention\u0026ndash;behavior gap\u0026rdquo; in health behavior theory, highlighting the limitations of relying solely on voluntary participation. In line with the World Health Organization's call for gastric cancer prevention, systematic interventions are urgently needed to address this gap. Integrating \u003cem\u003eH. pylori\u003c/em\u003e screening into routine university admission health examinations may reduce barriers and promote participation through institutionalized channels.\u003c/p\u003e\u003cp\u003eThis discrepancy may arise from two key mechanisms in the Health Belief Model\u0026mdash;where asymptomatic individuals underestimate the risk of infection[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026mdash;and high perceived barriers, such as the need to fast for the \u003csup\u003e13\u003c/sup\u003eC-UBT and psychological resistance to the HpSAT[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Additionally, to improve diagnostic certainty, this study applied strict inclusion criteria, including the requirement to complete multiple tests simultaneously. While this approach enhanced diagnostic efficiency, it also increased the time burden[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], which\u0026mdash;along with the need for venous blood sampling and limited acceptability of HpSAT\u0026mdash;may have contributed to the low screening rate in this population.\u003c/p\u003e\u003cp\u003eThis study found that compliance was highest with the \u003csup\u003e13\u003c/sup\u003eC-UBT, followed by serological testing, while HpSAT compliance was significantly lower than both. Based on these findings, we recommend using a combination of \u003csup\u003e13\u003c/sup\u003eC-UBT and serological testing for \u003cem\u003eH. pylori\u003c/em\u003e infection diagnosis in this age group and do not recommend HpSAT for widespread screening. Screening method acceptability and individual preferences significantly influence compliance[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Serological test acceptability, in particular, was a key determinant of both screening willingness and test compliance. This may be explained by prior negative experiences with blood sampling. One report noted that although more than 80% of individuals accept venous blood collection for \u003cem\u003eH. pylori\u003c/em\u003e testing, around 21% experience psychological resistance to venipuncture[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Such resistance is closely related to examinees\u0026rsquo; psychological preparedness, the skills of phlebotomists, and the quality of nursing care. Post-procedural care, therefore, can play a role in reducing adverse reactions[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA Canadian study found that fear of venipuncture was the primary cause of dizziness and nausea following blood sampling[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Similarly, a Chinese study reported that using effective communication techniques during venipuncture significantly reduced patients' psychological burden and increased compliance with serological testing by 40%[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. During \u003cem\u003eH. pylori\u003c/em\u003e screening promotion, medical staff should enhance their use of communication skills during venipuncture, engage promptly with examinees, and provide timely reassurance and encouragement[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. After blood collection, examinees should receive clear instructions on compression techniques, potential post-sampling adverse reactions, and appropriate coping strategies. These measures can improve the acceptability of serological testing, help overcome key barriers to \u003cem\u003eH. pylori\u003c/em\u003e screening, and ultimately increase the participation rate.\u003c/p\u003e\u003cp\u003eSimilarly, the acceptability of the HpSAT is a key factor in determining compliance. Individuals aged 18\u0026ndash;25 years may experience psychological resistance to stool collection, which lowers the acceptability of the HpSAT[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Additionally, the inability to collect stool samples promptly on the day of screening and the lack of convenient collection sites at universities contribute to reduced compliance. Limited awareness of screening methods[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], tight academic schedules, and scarce free time further decreased attention to the HpSAT, leading to low participation. These findings suggest that the HpSAT may be more suitable for specific groups, such as children or individuals with mobility impairments[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], rather than for widespread implementation in university settings.\u003c/p\u003e\u003cp\u003eThis study found that willingness to pay is a major factor influencing \u003cem\u003eH. pylori\u003c/em\u003e screening behavior. Participants who were willing to pay had significantly higher screening willingness (OR\u0026thinsp;=\u0026thinsp;2.752, 95% CI: 1.505\u0026ndash;5.034), serological compliance (OR\u0026thinsp;=\u0026thinsp;2.544, 95% CI: 1.458\u0026ndash;4.442), and HpSAT compliance (OR\u0026thinsp;=\u0026thinsp;1.598, 95% CI: 1.013\u0026ndash;2.519). However, most individuals aged 18\u0026ndash;25 years were university students with limited financial independence, and only 55.7% (321/576) expressed willingness to pay. Economic constraints not only reduced willingness to undergo screening but also influenced the compliance of those who had previously undergone \u003cem\u003eH. pylori\u003c/em\u003e screening or gastroscopy, as they were reluctant to incur repeated or additional costs[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, in university or hospital settings, using cost-effective methods, such as w \u003csup\u003e13\u003c/sup\u003eC-UBT combined with serological testing, for those who have never been screened may improve willingness and raise the overall screening rate.\u003c/p\u003e\u003cp\u003eThe results of this study showed that females demonstrated a higher willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening (OR\u0026thinsp;=\u0026thinsp;2.221, 95% CI: 1.248\u0026ndash;3.952) and greater serological compliance (OR\u0026thinsp;=\u0026thinsp;1.895, 95% CI: 1.100\u0026ndash;3.267) than males. These differences may be attributed to male lifestyle factors, occupational exposures, physiological differences, and lower awareness of disease prevention[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Social media offer unique advantages in improving compliance with target populations. A study conducted in China indicated that social media can enhance the \u003cem\u003eH. pylori\u003c/em\u003e eradication rate[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which is significant for increasing screening participation. Diversified publicity and educational strategies can strengthen men's understanding of \u003cem\u003eH. pylori\u003c/em\u003e infection-related knowledge and improve screening participation rates among male populations.\u003c/p\u003e\u003cp\u003eThe population targeted in this study was characterized by low infection and screening rates but strong social networks, representing a crucial opportunity to interrupt \u003cem\u003eH. pylori\u003c/em\u003e transmission. Achieving widespread screening in this group could not only directly lower infection rates but also promote healthy behaviors within families and society at large. Therefore, it is recommended that university-based screening initiatives be integrated with community health record systems to establish a school-family-community hierarchical network for \u003cem\u003eH. pylori\u003c/em\u003e prevention and control. This layered model is expected to facilitate more efficient identification and management of infected individuals, ultimately reducing the sources of \u003cem\u003eH. pylori\u003c/em\u003e transmission and the overall disease burden in the population.\u003c/p\u003e\u003cp\u003eThis study has some limitations. First, as a cross-sectional study, it could not establish a causal relationship between risk factors and willingness to undergo screening. Second, the study did not investigate or analyze individuals who refused to participate in \u003cem\u003eH. pylori\u003c/em\u003e screening, which may have introduced selection bias and led to an overestimation of overall screening willingness in the target population. Finally, since the study population consisted solely of university students, caution is warranted when generalizing the findings to non-student groups. Future research should include qualitative studies to explore the reasons for screening refusal, as well as cohort studies in non-student populations for validation.\u003c/p\u003e\u003cp\u003eIn conclusion, although the target population demonstrated a high willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening, the actual screening rate remained low. Compliance was the highest with the \u003csup\u003e13\u003c/sup\u003eC-UBT, followed by serological testing, while compliance with the HpSAT was significantly lower than both. Based on these results, the combined use of \u003csup\u003e13\u003c/sup\u003eC-UBT and serological testing is recommended for diagnosing \u003cem\u003eH. pylori\u003c/em\u003e infection, whereas HpSAT is not advised for widespread screening in this group. To improve screening rates, efforts should focus on enhancing humanistic care to increase acceptance of serological testing and implementing diverse publicity strategies to strengthen screening motivation and participation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Disclosure: \u003c/strong\u003eThis study adhered to the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants, and the study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Shihezi University Institution (approval no. KJ2024-471-01, dated 10/12/2024). All data were anonymized to protect participant privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe study was supported by the project \u0026ldquo;2024 Talent Development Fund (CZ001228) \u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments: \u003c/strong\u003eThe authors gratefully acknowledge Beijing Richen-force Science \u0026amp; Technology Co., Ltd. for its generous support, including the free provision of urea breath test and fecal antigen test reagents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYu Zhang: Experimental design, statistical analysis, manuscript writing, and final approval of the manuscript.\u003c/p\u003e\n\u003cp\u003eXin Peng: Data collection and public science communication.\u003c/p\u003e\n\u003cp\u003eMinghan Zhang：Data Processing and Analysis.\u003c/p\u003e\n\u003cp\u003eGuoming Luo, Haowei Li: Data collection.\u003c/p\u003e\n\u003cp\u003eWeigang Chen: Overall research design, funding acquisition, manuscript guidance and review, and final approval of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJiyan L, Yingying H, Jialun G, et al. 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Influence of Humanistic Care on Blood Donation Nursing Quality. \u003cem\u003eJournal of Clinical Transfusion and Laboratory Medicine. \u003c/em\u003e2017;19(5): 521-524. （in Chinese）\u003c/li\u003e\n\u003cli\u003eTao Wang T, Boklage S, Mangel A, Ramamohan V, Mladsi D. Impact of patient adherence on the cost-effectiveness of noninvasive tests for the initial diagnosis of Helicobacter pylori infection in the United States. \u003cem\u003ePatient Preference and Adherence. \u003c/em\u003e2016. \u003c/li\u003e\n\u003cli\u003eFeng T, Zheng Z, Xu J, Cao P, Gao S, Yu X. Cost-Effectiveness Analysis of the Helicobacter Pylori Screening Programme in an Asymptomatic Population in China. \u003cem\u003eInternational Journal of Environmental Research and Public Health. \u003c/em\u003e2022;19(16). \u003c/li\u003e\n\u003cli\u003eCai Q, Zhu C, Yuan Y, et al. Development and validation of a prediction rule for estimating gastric cancer risk in the Chinese high-risk population: a nationwide multicentre study. \u003cem\u003eGut. \u003c/em\u003e2019;68(9):1576-1587. \u003c/li\u003e\n\u003cli\u003eLiu CC, Shi CL, Shi JF, et al. [Study on the health literacy and related factors of the cancer prevention consciousness among urban residents in China from 2015 to 2017]. \u003cem\u003eZhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. \u003c/em\u003e2020;54(1):47-53. 31914569\u003c/li\u003e\n\u003cli\u003eLuo M, Hao Y, Tang M, et al. Application of a social media platform as a patient reminder in the treatment of Helicobacter pylori. Helicobacter. 2020;25(2). \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Young Adults, Helicobacter pylori, Screening willingness, Screening Compliance, Noninvasive screening methods","lastPublishedDoi":"10.21203/rs.3.rs-7650385/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7650385/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e\u003cem\u003eHelicobacter pylori\u003c/em\u003e infection is a major risk factor for various gastrointestinal diseases, including gastric cancer. While early screening and eradication are critical in young adults, screening rates in this age group remain low. Despite expert recommendations targeting those aged 18\u0026ndash;25 years, few studies have examined the factors influencing their willingness to undergo screening or comply with testing procedures. This study aimed to explore these determinants in this population.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted from November 2024 to January 2025 among individuals aged 18\u0026ndash;25 years at a university in China. Participants completed electronic questionnaires after undergoing serological testing, and the \u003csup\u003e13\u003c/sup\u003eC-urea breath test (\u003csup\u003e13\u003c/sup\u003eC-UBT) and the \u003cem\u003eH. pylori\u003c/em\u003e stool antigen test (HpSAT) were also offered. The primary and secondary outcomes were screening willingness and compliance, respectively. Chi-squared tests and logistic regression identified associated factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe university\u0026rsquo;s target population was approximately 30,000. Eighty-two were randomly selected, yielding a theoretical sample size of 2460. Of these, 595 students participated, and 576 valid questionnaires were collected. The screening rate was 24.2% (595/2460); among respondents, 86.5% (498/576) expressed willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening. Multivariate analysis showed that female sex, complete acceptance of serological testing, and willingness to pay were significantly associated with greater screening willingness. Compliance rates were highest for the \u003csup\u003e13\u003c/sup\u003eC-UBT (100%, 576/576), followed by serological testing (83.3%, 480/576) and the HpSAT (66.7%, 384/576).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAlthough willingness to undergo \u003cem\u003eH. pylori\u003c/em\u003e screening was high among college students aged 18\u0026ndash;25 years, the actual screening rate remained relatively low. Enhancing acceptance of serological testing and implementing diverse health education strategies to boost motivation may help increase screening uptake. For confirming \u003cem\u003eH. pylori\u003c/em\u003e infection in this population, a combination of \u003csup\u003e13\u003c/sup\u003eC-UBT and serological testing is recommended, while HpSAT is not advised for population-level screening in this target group.\u003c/p\u003e","manuscriptTitle":"Willingness and Compliance with Helicobacter pylori Screening among Chinese University Students Aged 18–25 Years: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 13:24:32","doi":"10.21203/rs.3.rs-7650385/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-02T17:43:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-01T22:43:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T09:06:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300777995027687001147958753156044550974","date":"2025-10-17T10:21:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208353072285864082199595301399981265626","date":"2025-10-14T10:30:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191536557495475888683220683287913702539","date":"2025-10-10T07:23:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-02T01:35:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-22T06:42:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-19T09:14:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-19T09:13:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-09-18T13:47:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51791b43-9dfb-45aa-8b52-0de2d0ee9653","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:00:26+00:00","versionOfRecord":{"articleIdentity":"rs-7650385","link":"https://doi.org/10.1186/s12889-025-25779-2","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-11-25 15:57:15","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-10-15 13:24:32","video":"","vorDoi":"10.1186/s12889-025-25779-2","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25779-2","workflowStages":[]},"version":"v1","identity":"rs-7650385","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7650385","identity":"rs-7650385","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}