{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T03:09:00Z","timestamp":1774494540118,"version":"3.50.1"},"reference-count":98,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"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":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Research on human papillomavirus (HPV) vaccination willingness and behavior among patients with cervical intraepithelial neoplasia (CIN) remains limited, although such evidence is essential for improving disease prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A knowledge, attitude, practice (KAP) questionnaire was administered to CIN patients aged 20\u201360\u202fyears in Gansu Province, China to explore HPV vaccine willingness and its influencing factors. Logistic regression identified demographic factors associated with vaccination willingness, including patients &amp;gt;45\u202fyears. Mediation analysis tested whether knowledge indirectly influenced willingness through attitude and practice. This study also compared the differences between willingness and actual behavior, and restricted cubic splines (RCS) assessed the age-behavior relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,012 patients, 87.45% reported willingness to receive HPV vaccination, while only 27.96% had been vaccinated. Logistic regression showed that patients who were younger, lived in urban areas, had higher education and income, reported frequent sexual activity (&amp;gt;4 times\/month), had more sexual partners, and achieved higher KAP scores demonstrated greater willingness (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). Mediation analysis showed that knowledge influenced vaccination willingness mainly through attitude and practice, especially attitude (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), while a direct effect was observed only in the chain model. Among participants &amp;gt;45\u202fyears old (73.96% willing), those with high-grade squamous intraepithelial lesion (HSIL) were less likely to accept vaccination. RCS revealed a significant non-linear association between age and actual vaccination behavior (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients showed strong willingness to vaccinate, but the actual vaccination proportion was modest. Misconceptions that infection blocks vaccination may obscure the path to protection. It is recommended to highlight the role of HPV vaccination in preventing recurrence among older HSIL patients and extend the appropriate age of vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1708917","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:55:15Z","timestamp":1769064915000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["HPV vaccination willingness and behavior among patients with cervical intraepithelial neoplasia in low-resource areas of Western China: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Kefan","family":"Jiang","sequence":"first","affiliation":[{"name":"School of Public Health, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yawen","family":"Shao","sequence":"additional","affiliation":[{"name":"Cervical Cancer Prevention and Treatment Center, Gansu Provincial Maternity and Child-care Hospital (Gansu Provincial Central Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiling","family":"Wang","sequence":"additional","affiliation":[{"name":"Cervical Cancer Prevention and Treatment Center, Gansu Provincial Maternity and Child-care Hospital (Gansu Provincial Central Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanghui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cancer Epidemiology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Su","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengyun","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haitao","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shumei","family":"Tuo","sequence":"additional","affiliation":[{"name":"Cervical Cancer Prevention and Treatment Center, Gansu Provincial Maternity and Child-care Hospital (Gansu Provincial Central Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru","family":"Lin","sequence":"additional","affiliation":[{"name":"Cervical Cancer Prevention and Treatment Center, Gansu Provincial Maternity and Child-care Hospital (Gansu Provincial Central Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junling","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Lanzhou University","place":["Lanzhou, Gansu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2315653","DOI":"10.1080\/21645515.2024.2315653","article-title":"Real-world data of China: analysis of HPV vaccine coverage and post-vaccination adverse reaction monitoring in Western Chinese 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