Trust in HPV vaccine effectiveness and safety and willingness to initiate HPV vaccination among unvaccinated female college students recruited through university-based online networks in China: a cross-sectional study

Background Human papillomavirus (HPV) vaccination is an important strategy for preventing cervical cancer and other HPV-related diseases. Vaccine trust may encompass distinct perceptions of effectiveness and safety. This study examined cross-sectional associations of trust in HPV vaccine effectiveness and safety with HPV vaccination willingness among unvaccinated female college students recruited through university-based online networks in China. Methods This cross-sectional online survey recruited female college students from 24 universities located in 12 provincial-level administrative regions of China between January 2025 and March 2026. The primary analysis included participants who reported no prior HPV vaccination. High willingness was defined as reporting being somewhat willing or very willing to receive HPV vaccination. Trust in HPV vaccine effectiveness, the safety of domestically produced bivalent HPV vaccines, and the safety of imported HPV vaccines were modeled as categorical variables. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Among 2,215 unvaccinated participants, 818 (36.9%) reported high HPV vaccination willingness. Higher categories of effectiveness trust and safety trust were associated with greater odds of reporting high willingness. Compared with participants who were very distrustful of HPV vaccine effectiveness, those who were very trustful had an aOR of 5.397 (95% CI 3.246–8.973). The corresponding aORs for being very trustful of the safety of domestically produced bivalent HPV vaccines and imported HPV vaccines were 3.307 (95% CI 1.930–5.665) and 5.022 (95% CI 2.741–9.201), respectively. Associations were directionally consistent after excluding participants reporting uncertain willingness. Conclusions Among unvaccinated female college students recruited through university-based online networks in 12 provinces in China, higher self-reported trust in HPV vaccine effectiveness and safety was associated with greater reported willingness to initiate HPV vaccination. Longitudinal and intervention studies are needed to examine whether approaches addressing effectiveness and safety concerns improve HPV vaccine uptake.