HPV vaccination intention among unvaccinated international and domestic college students in the U.S.: A cross-sectional survey

Nearly 85% of people will contract human papillomavirus (HPV) at some point in their lives. When given at the recommended ages, the HPV vaccine can prevent over 90% of HPV-related cancers. However, vaccination rates among young adults, including college students, remain low. Moreover, millions of international students enrolled in U.S. tertiary institutions may not have had access to preventive vaccines, including the HPV vaccine, in their countries of origin. This cross-sectional study conducted in October 2021, guided by the Theory of Planned Behavior (TPB), examined how attitudes, perceived behavioral control (PBC), and subjective norms relate to college students' intentions to receive the HPV vaccine. Conducted at a U.S. university, the study recruited 199 unvaccinated students through the university registrar's office and Amazon Mechanical Turk. Data were collected during the study period using an anonymous Qualtrics survey and analyzed using descriptive statistics, t-tests, and generalized linear models. We aimed to examine the influence of independent variables including attitude, subjective norms, and PBC, on the dependent variable, intention to receive the HPV vaccine. Of the 419 students who completed the survey, 199 (61 domestic and 138 international) who had not received the HPV vaccine were included in the study. The mean age of these participants was 21.27 y (SD = 3.29), with 135 males and 64 females. For both international and domestic students, attitudes toward HPV vaccination and subjective norms were significantly associated with higher vaccination intentions (international: attitude B = 0.11, <i>p</i> = .004; norms B = 0.38, <i>p</i> < .001; domestic: attitude B = 0.09, <i>p</i> = .027; norms B = 0.40, <i>p</i> < .001) in regression analyses. No significant differences were observed between the two groups in attitudes, perceived behavioral control, subjective norms, or vaccination intentions. These findings provide partial support for the TPB in explaining HPV vaccination intentions among college students. Public health initiatives and university-based programs may benefit from applying this framework by fostering positive attitudes and reinforcing supportive social norms. For routine practice, healthcare providers and campus health centers should integrate targeted education and outreach to improve vaccine uptake, particularly among international students. Future research should evaluate the effectiveness of TPB-based interventions in increasing actual vaccination rates and explore additional factors influencing vaccine intentions across diverse student populations.