{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:49:46Z","timestamp":1791355786503,"version":"4.3.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"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>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the perceived knowledge, attitudes, and practices regarding genital warts and HPV vaccination among college students in Shandong Province, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted on Chinese college students from March 13 to April 2, 2026, in four universities in Shandong Province, China. Data were collected using a self-administered questionnaire in Chinese that was newly developed for this study and covered demographic characteristics and the three dimensions of the knowledge\u2013attitude\u2013practice (KAP) framework: perceived knowledge (14 items, score range 0\u201328), attitude (9 items, score range 9\u201345), and practice (10 items, score range 10\u201350). Bloom's cut-off criteria were applied to the attainable range of each scale, calculated as (observed score \u2013 minimum possible score) \/ (maximum possible score \u2013 minimum possible score) \u00d7 100%, and scores were classified as poor (&amp;lt; 60%), moderate (60%\u221279%), or good (\u226580%). Structural equation modeling (SEM) was used to examine the associations among perceived knowledge, attitude, and practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 959 participants were included, with 58.39% of participants being male. The mean perceived knowledge, attitude, and practice scores were 15.34 \u00b1 7.64, 35.92 \u00b1 7.42, and 36.84 \u00b1 11.71, corresponding to 54.79%, 74.78%, and 67.10% of the attainable range of each scale, and therefore to poor perceived knowledge and moderate attitude and practice. In the SEM, perceived knowledge was directly associated with attitude (\u03b2 = 0.119,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.012) and with practice (\u03b2 = 0.461,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.014), and attitude was directly associated with practice (\u03b2 = 0.118,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007). An indirect association between perceived knowledge and practice through attitude was also observed (\u03b2 = 0.014,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003). Perceived knowledge, attitude, and practice scores were positively correlated with each other (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>College students in Shandong Province, China had poor perceived knowledge and moderate attitudes and practices regarding genital warts and HPV vaccination. Perceived knowledge showed the strongest association with the practice construct in the specified SEM, with attitude acting as a modest indirect association through attitude. Because the design was cross-sectional; these findings represent associations rather than causal effects. Campus-based sexual health education should prioritize accurate HPV-related knowledge, male vaccination awareness, and accessible referral pathways for STI examination and HPV vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1931591","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:52:09Z","timestamp":1791352329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceived knowledge, attitudes, and practices toward genital warts and HPV vaccination among college students in Shandong Province, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Min","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Weifang People's Hospital","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Prevention and Control, Huantai Center for Disease Control and Prevention","place":["Zibo, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningfeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Weifang People's Hospital","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Weifang People's Hospital","place":["Weifang, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"680","DOI":"10.3390\/v16050680","article-title":"Human papillomavirus and associated cancers: a review","volume":"16","author":"Jensen","year":"2024","journal-title":"Viruses"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1345","DOI":"10.1016\/S2214-109X(23)00305-4","article-title":"Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis","volume":"11","author":"Bruni","year":"2023","journal-title":"Lancet Glob Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually transmitted infections treatment guidelines, 2021","volume":"70","author":"Workowski","year":"2021","journal-title":"MMWR Recomm Rep"},{"key":"B4","unstructured":"Human papillomavirus and cancer Geneva: World Health Organization\n          \n          \n          2024"},{"key":"B5","doi-asserted-by":"publisher","first-page":"137","DOI":"10.4103\/joc.joc_42_22","article-title":"The Prevalence of Cervical HPV Infection and Genotype Distribution in 856,535 Chinese Women with Normal and Abnormal Cervical Lesions: A Systemic Review","volume":"39","author":"Yu","year":"2022","journal-title":"J Cytol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"108029","DOI":"10.1016\/j.ijid.2025.108029","article-title":"Epidemiologic, clinical, and economic burden of anogenital warts among adults: a global systematic review","volume":"161","author":"You","year":"2025","journal-title":"Int J Infect Dis"},{"key":"B7","first-page":"156","article-title":"Genital warts: rapid evidence review","volume":"111","author":"Temple","year":"2025","journal-title":"Am Fam Physician"},{"key":"B8","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(19)30298-3","article-title":"Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis","volume":"394","author":"Drolet","year":"2019","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1080\/21645515.2020.1797368","article-title":"Human papillomavirus vaccination: coverage rate, knowledge, acceptance, and associated factors in college students in mainland China","volume":"17","author":"Deng","year":"2021","journal-title":"Hum Vaccin Immunother"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.1080\/21645515.2021.1899731","article-title":"Have you ever heard of Human Papillomavirus (HPV) vaccine? The awareness of HPV vaccine for college students in China based on meta-analysis","volume":"17","author":"Yin","year":"2021","journal-title":"Hum Vaccin Immunother"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1211","DOI":"10.1007\/s13187-020-01750-0","article-title":"Exploring Chinese college students' HPV awareness, knowledge, attitudes, and intent of HPV vaccination: a qualitative study","volume":"36","author":"Chen","year":"2021","journal-title":"J Cancer Educ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"26553","DOI":"10.1038\/s41598-024-77474-8","article-title":"Knowledge, attitude, and practice of adolescents and parents toward malocclusion and orthodontic treatment","volume":"14","author":"Liu","year":"2024","journal-title":"Sci Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1186\/s12877-025-05776-1","article-title":"Knowledge, attitude, and practice of frailty management among clinical nurses: a cross-sectional study","volume":"25","author":"Huang","year":"2025","journal-title":"BMC Geriatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1177\/0253717620946111","article-title":"Designing and conducting knowledge, attitude, and practice surveys in psychiatry: practical guidance","volume":"42","author":"Andrade","year":"2020","journal-title":"Indian J Psychol Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2316","DOI":"10.1186\/s12889-024-19792-0","article-title":"HPV infection and vaccination: a cross-sectional study of knowledge, perception, and attitude to vaccine uptake among university students in Qatar","volume":"24","author":"Cheema","year":"2024","journal-title":"BMC Public Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1451320","DOI":"10.3389\/fpubh.2024.1451320","article-title":"Awareness of HPV and HPV vaccine among college students in China","volume":"12","author":"Li","year":"2024","journal-title":"Front Public Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"774767","DOI":"10.3389\/fpubh.2022.774767","article-title":"Vaccine hesitancy among medical students in China: a multicenter survey","volume":"10","author":"Zhou","year":"2022","journal-title":"Front Public Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1186\/s12889-024-18166-w","article-title":"Risk perception and trust in the relationship between knowledge and HPV vaccine hesitancy among female university students in China: a cross-sectional study","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Public Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2228163","DOI":"10.1080\/21645515.2023.2228163","article-title":"HPV vaccine information, knowledge, attitude, and recommendation intention among male college students in China","volume":"19","author":"Wu","year":"2023","journal-title":"Hum Vaccin Immunother"},{"key":"B20","doi-asserted-by":"publisher","first-page":"189","DOI":"10.12290\/xhyxzz.2021-0082","article-title":"Chinese expert consensus on clinical application of human papilloma virus vaccine","volume":"12","year":"2021","journal-title":"Med J PUMCH"},{"key":"B21","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1111\/jebm.12494","article-title":"Clinical guideline for the diagnosis and treatment of cutaneous warts","volume":"15","author":"Zhu","year":"2022","journal-title":"J Evid Based Med"},{"key":"B22","first-page":"1","article-title":"Learning for Mastery","volume":"1","author":"Bloom","year":"1968"},{"key":"B23","first-page":"7","article-title":"Guidelines for conducting a knowledge, attitude and practice study","volume":"4","author":"Kaliyaperumal","year":"2004","journal-title":"AECS Illumination"},{"key":"B24","doi-asserted-by":"publisher","first-page":"100688","DOI":"10.1016\/j.apjon.2025.100688","article-title":"Knowledge, attitudes, and practices toward nutritional management among patients with gastrointestinal cancer: A cross-sectional study","volume":"12","author":"Zhi","year":"2025","journal-title":"Asia Pac J Oncol Nurs"},{"key":"B25","article-title":"Assumptions in structural equation modeling","author":"Kline","year":"2012","journal-title":"Handbook of structural equation modeling"},{"key":"B26","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1177\/0013164413495237","article-title":"Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety","volume":"73","author":"Wolf","year":"2013","journal-title":"Educ Psychol Meas"},{"key":"B27","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1037\/a0029315","article-title":"When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions","volume":"17","author":"Rhemtulla","year":"2012","journal-title":"Psychol Methods"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives","author":"Hu","year":"1999","journal-title":"Struct Equ Model"},{"key":"B29","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1037\/1082-989X.12.4.381","article-title":"The insidious effects of failing to include design-driven correlated residuals in latent-variable covariance structure analysis","volume":"12","author":"Cole","year":"2007","journal-title":"Psychol Methods"},{"key":"B30","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1080\/21645515.2019.1638727","article-title":"Knowledge, practice and attitude towards HPV vaccination among college students in Beijing, China","volume":"16","author":"Liu","year":"2020","journal-title":"Hum Vaccin Immunother"},{"key":"B31","first-page":"241","article-title":"Human papillomavirus vaccines: WHO position paper","volume":"92","year":"2017","journal-title":"Wkly Epidemiol Rec"},{"key":"B32","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1136\/sti.75.5.317","article-title":"Detection of human papillomavirus DNA on the fingers of patients with genital warts","volume":"75","author":"Sonnex","year":"1999","journal-title":"Sex Transm Infect"},{"key":"B33","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1136\/sti.78.2.135","article-title":"Contamination of environmental surfaces by genital human papillomaviruses","volume":"78","author":"Strauss","year":"2002","journal-title":"Sex Transm Infect"},{"key":"B34","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1186\/s12905-023-02455-4","article-title":"Knowledge and perceptions regarding Human Papillomavirus (HPV) and willingness to receive HPV vaccination among university students in a north-eastern city in Turkey","volume":"23","author":"Varer Akpinar","year":"2023","journal-title":"BMC women's health"},{"key":"B35","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1080\/07448481.2021.1967362","article-title":"Knowledge, beliefs, and practice regarding human papillomavirus (HPV) vaccination among American college students: Application of the health belief model","volume":"71","author":"Oh","year":"2023","journal-title":"J Am Coll Health"},{"key":"B36","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1186\/s12909-025-07286-5","article-title":"Knowledge, attitudes and practices regarding sexual health among Chinese medical students: a multicenter cross-sectional study","volume":"25","author":"Yao","year":"2025","journal-title":"BMC Med Educ"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2776","DOI":"10.1002\/jmv.27478","article-title":"Willingness to human papillomavirus (HPV) vaccination and influencing factors among male and female university students in China","volume":"94","author":"Dai","year":"2022","journal-title":"J Med Virol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"971707","DOI":"10.3389\/fpubh.2022.971707","article-title":"Low awareness of HPV infection and willingness of HPV vaccination among Chinese male college students in the east of China","volume":"10","author":"Ran","year":"2022","journal-title":"Front Public Health"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2552061","DOI":"10.1080\/21645515.2025.2552061","article-title":"Addressing male HPV vaccination in China: A narrative review of challenges and opportunities","volume":"21","author":"Wong","year":"2025","journal-title":"Hum Vaccin Immunother"},{"key":"B40","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.jadohealth.2016.03.014","article-title":"Sexually transmitted infection services for adolescents and youth in low-and middle-income countries: perceived and experienced barriers to accessing care","volume":"59","author":"Newton-Levinson","year":"2016","journal-title":"J Adolesc Health"},{"key":"B41","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1186\/1471-2458-13-916","article-title":"Effect of an educational intervention on HPV knowledge and vaccine attitudes among urban employed women and female undergraduate students in China: a cross-sectional study","volume":"13","author":"Chang","year":"2013","journal-title":"BMC Public Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1001\/jamapediatrics.2013.2752","article-title":"Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature","author":"Holman","year":"2014","journal-title":"JAMA pediatrics"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1931591\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:52:12Z","timestamp":1791352332000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1931591\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":42,"alternative-id":["10.3389\/fpubh.2026.1931591"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1931591","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1931591"}}