HPV vaccination willingness and its determinants among male university students post-approval of male-specific HPV vaccines in China: a large-scale cross-sectional study

Given limited prior studies on Chinese male university students’ human papillomavirus (HPV) vaccination willingness and SARS-CoV-2 vaccination shaping their relevant understanding/awareness, we conducted a large-scale cross-sectional study to explore their HPV-related willingness post male-approved HPV vaccines and key determinants of vaccination decisions. The cross-sectional study used convenience sampling to conduct a questionnaire online survey for male university students aged 18–30 years old across 30 provinces/autonomous regions/municipalities of China in 2025. A standardized questionnaire was designed to evaluate the knowledge, attitude and willingness of the students to HPV and HPV vaccine. Two-level mixed-effects logistic regression model and a random forest model were performed to identify factors that were associated with HPV vaccine hesitancy and willingness-to-pay. The adjusted odds ratio (aOR) with the corresponding 95% confidence interval (95% CI) was calculated. Of 25,188 male university students, 62.21% were willing to receive HPV vaccination, 32.45% were unsure and 5.34% were refused (total 37.79% with vaccine hesitancy). Higher parental education (especially bachelor’s or above), increased household and personal income, better HPV/HPV vaccine knowledge and attitudes, and attending medical/pharmaceutical universities or those with over 30,000 students were linked to higher willingness; homosexual (66.53%, aOR = 0.867, 95% CI 0.784–0.959) and bisexual (70.61%, aOR = 0.686, 95% CI 0.553–0.851) students showed greater acceptance than heterosexual peers, and those with 4–6 sexual partners had the highest willingness (78.48%), followed by > 6 (73.50%) and 1–3 (73.24%) partners, higher than those without (58.51%, P < 0.05). Among willing students, 65.78% accepted paying less than 1,000 RMB for full vaccination, and random forest analysis showed HPV infection knowledge, HPV vaccine knowledge and personal income were top three factors influencing 9-valent and 4-valent vaccine willingness. This survey represents a large-scale evaluation of HPV vaccination willingness among male university students in China post male-applicable HPV vaccine approval, and the findings highlight the potential importance of health education regarding men’s HPV infection risk and vaccine protective value.