Xueying Liu1
1Duke Kunshan Univerisity
To The Editor,
I carefully read the cross-sectional study by Dai, Z et
al1. I appreciated the work, especially the purposive
selection of these universities in different geographical regions of
China and the analysis of males and females separately, which is
critical considering the policies of HPV vaccination in mainland China.
Still, there are some issues that I would like to discuss.
First, it is the discordance of a set of data. In the abstract part,
“Female students were more willing to be vaccinated against HPV if they
had ever had sexual experiences (AOR=2.628, 95% CI:
1.788–3.863).”1 In the results part, “Students who
ever had sexual experience were almost three times more likely to take
the vaccine than those who had not (AOR = 2.628,
95%
CI:1.788–3.863) (Table 4).”1 In table 4, according
to the cells of row: “Ever had sexual behavior”, column: “Female”,
OR = 2.628, AOR = 1.646, 95% CI: 1.088–2.490.1Though the conclusion remains the same whichever set of data, I still
think it needs to be clarified.
Second, the university choice is not representative enough. All
universities selected are Project 985 schools, which are the top schools
in China. In other words, the sample has been pre-screened by the
Chinese education system, while these students only make up less than
3% of university students2. As a result, the sample
of the article is unlikely to be representative of university students
in China.
Last but most important, the article argues that university students’
perceptions of threat and severity of HPV are related to the result that
“female students were less willing to be vaccinated against HPV and to
encourage their friends to be vaccinated while they were more likely to
receive sex education and knowledge of HPV”.1 But it
contradicts a set of data in the study that there was no significant
difference in fairness between males and females.1Besides, this assumption totally ignored the inclusion criterion- “had
never been vaccinated against HPV before”1 and the
policies related to HPV vaccination in China. Since vaccination against
males has not been proved in China, it was highly possible that part of
the women who were willing to be vaccinated had been excluded. In other
words, the proportion of women who knew the severity but would not get
vaccinated would be bigger than it really was. Yet, they could get the
conclusion based on other results, like “female students were more
willing to be vaccinated, if relatives or friends had certain
cancer”1. However, the correlation was not the same
with males. So the conclusion should be accessed cautiously. Maybe, they
should not exclude females who had been vaccinated against HPV at the
beginning of the study. In that way, they would not get into this
quandary and could analyze the rate of HPV vaccination among university
students in China as well, which might be a good reason for the urgency
for the promotion of HPV vaccination.
In conclusion, though the article filled the gap of a national study on
HPV awareness among university students based on sex, it still has some
small confusing parts to be clarified. Further research could be
conducted by involving a broader range of university students, like
students in midstream universities, or investigating whether the level
of a university is associated with HPV infection and willingness to HPV
vaccination, which is significant since some
universities3 have started the trial to provide HPV
vaccination on campus.
References
1. Dai Z, Si M, Su X, et al. Willingness to human papillomavirus (HPV)
vaccination and influencing factors among male and female university
students in China. Journal of Medical Virology .
2022;94(6):2776-2786.
2. Shen J, Ye M, Wang Y, Zhao Y. Massive open online course (MOOC) in
China: Status quo, opportunities, and challenges. presented at: 2016
IEEE Global Engineering Education Conference (EDUCON); 2016;
3. CCYL. These colleges are booking HPV vaccines for girls on campus!
https://baijiahao.baidu.com/s?id=1726800827208939256&wfr=spider&for=pc