Factors associated with HPV vaccination among female college students in China: a cross-sectional study

Human papillomavirus (HPV) vaccination is central to cervical cancer elimination. Before China introduced free bivalent HPV vaccination for eligible 13-year-old girls through the national immunisation programme in November 2025, uptake among young women was shaped by out-of-pocket payment, regional service access, and socioeconomic position. This study estimated pre-implementation uptake and examined individual and structural factors associated with vaccination among female college students in China. Data came from the 2025 National College Students’ Sexual and Reproductive Health Survey (NCSS-SRH). The analytic sample comprised 44,052 female respondents with valid HPV vaccination responses. Vaccinated respondents reported at least one dose of bivalent, quadrivalent, or 9-valent vaccine. Weighted multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for reproductive health knowledge, sexuality education, gender temperament, penetrative sexual intercourse, age, grade, residence, region, monthly expenditure, and school type. Weighted HPV vaccination uptake was 18.4%. Among vaccinated students, 74.9% reported receiving 9-valent vaccine. Uptake increased from 11.6% in the lowest reproductive health knowledge quartile to 24.5% in the highest. In the adjusted model, knowledge was positively associated with vaccination (aOR 2.19, 95% CI 1.97–2.45). Positive associations were also observed for school-based sexuality education (aOR 1.17, 95% CI 1.09–1.26), penetrative sexual intercourse (aOR 1.20, 95% CI 1.11–1.30), urban residence (aOR 1.65, 95% CI 1.56–1.73), monthly expenditure of at least CNY 2000 versus less than CNY 1000 (aOR 2.13, 95% CI 1.95–2.32), undergraduate study (aOR 1.42, 95% CI 1.34–1.50), and postgraduate study (aOR 4.07, 95% CI 3.54–4.67). Compared with Eastern China, adjusted odds were lower in Central (aOR 0.39, 95% CI 0.37–0.42) and Western China (aOR 0.86, 95% CI 0.81–0.91). HPV vaccination uptake among female college students was low before national programme implementation and was socially and geographically patterned. Catch-up strategies for college-age women should combine reproductive health education with financing and delivery measures that reduce access barriers, with particular attention to lower-expenditure students, junior college students, non-urban residents, and institutions in regions with low uptake.