{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T06:28:56Z","timestamp":1762151336351,"version":"build-2065373602"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Hepatitis E virus (HEV) is a major global public-health threat. University students are at high risk of HEV infection. This study aimed to assess the knowledge, attitude, and practice (KAP) levels regarding hepatitis E among university freshmen and their willingness to receive HEV vaccination.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A cross-sectional study was conducted from September to December 2023 among 3,276 freshmen from six universities in Anhui Province, China. Data were collected using structured questionnaires. A stratified cluster random sampling method was used to select participants. Multivariate logistic regression was performed to identify factors associated with KAP levels. Data were analyzed with SPSS version 23.0.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of the 3,276 questionnaires distributed, 3,120 were valid, with a response rate of 95.2%. Only 9.0% of participants had received the HEV vaccine. The overall correct knowledge rate of HEV was 50.8%. A positive attitude was reported by 59.9% of students, and 60.9% demonstrated good practices related to HEV. Multivariate analysis showed that vaccinated students had significantly higher knowledge levels than non-vaccinated students (\n OR<\/jats:italic>\n = 1.999, 95%\n CI<\/jats:italic>\n : 1.536\u20132.602). Female students (\n OR<\/jats:italic>\n = 1.193, 95%\n CI<\/jats:italic>\n : 1.029\u20131.382) and those from Wuhu (\n OR<\/jats:italic>\n = 1.571, 95%\n CI<\/jats:italic>\n : 1.299\u20131.900) also had higher knowledge levels. Medical students were more likely to have a positive attitude than non-medical students (\n OR<\/jats:italic>\n = 1.367, 95%\n CI<\/jats:italic>\n : 1.161\u20131.610). Students from rural areas (\n OR<\/jats:italic>\n = 1.336, 95%\n CI<\/jats:italic>\n : 1.148\u20131.553) and Wuhu (\n OR<\/jats:italic>\n = 1.317, 95%\n CI<\/jats:italic>\n : 1.088\u20131.594) showed higher levels of positive attitude. Rural students also reported better health practices than urban students (\n OR<\/jats:italic>\n = 1.288, 95%\n CI<\/jats:italic>\n : 1.088\u20131.524). The result also showed both knowledge (\n r<\/jats:italic>\n = 0.042,\n P<\/jats:italic>\n = 0.020) and attitude (\n r<\/jats:italic>\n = 0.049,\n P<\/jats:italic>\n = 0.006) exhibited statistically significant but weak positive correlation with practice.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Over half of the university freshmen demonstrated good KAP levels regarding HEV. However, the vaccination rate remained low. Therefore, determinants identified will guide health promotion and vaccine advocacy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1604049","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T06:23:29Z","timestamp":1762151009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hepatitis E vaccination status, knowledge, attitude, and practice among university freshmen: a cross-sectional study in China"],"prefix":"10.3389","volume":"13","author":[{"given":"Niannian","family":"Bi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Gong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuang","family":"Nie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanfang","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyuan","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanwan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiabing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongkang","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"B1","unstructured":"Global 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