An increasing need for Human Papillomavirus (HPV) vaccines in China remains unmet in the mainland and the knowledge and intentions of Chinese youth regarding vaccination is unknown. In the fall of 2013, 44 Chinese international students (CIS) attending a university in the United States Midwest participated in 10 focus group discussions (five female and five male). Result showed that participants have limited awareness and knowledge about HPV infection and vaccination, participants erroneously believed that the causes of cervical cancer are abortion and miscarriage. Participants rely heavily on informal sources such as Chinese-based social media platforms and personal social networks for information on sexually transmitted infections. Sexual cultures and behaviors are perceived differently between CIS born in the 1990s and 1980s. Interestingly, participants’ perceived stigma about HPV infection decreased with improving knowledge level during group discussions. In conclusion, HPV vaccine should be further promoted alongside sex education among CIS.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Hu SY, Hong Y, Zhao FH, Lewkowitz AK, Chen F, Zhang WH, Pan QJ, Zhang X, Fei C, Li H, Qiao YL. Prevalence of HPV infection and cervical intraepithelial neoplasia and attitudes towards HPV vaccination among Chinese women aged 18–25 in Jiangsu Province. Chin J Cancer Res. 2011;23(1):25–32.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
Zhao FH, Tiggelaar SM, Hu SY, Xu LN, Hong Y, Niyazi M, Gao XH, Ju LR, Zhang LQ, Feng XX, Duan XZ, Song XL, Wang J, Yang Y, Li CQ, Liu JH, Liu JH, Lu YB, Li L, Zhou Q, Liu JF, Zhao N, Schmidt JE, Qiao YL. A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China. Cancer Epidemiol. 2012;36(4):384–90.
Agosti JM, Goldie SJ. Introducing HPV vaccine in the developing countries: key challenges and issues. N Engl J Med. 2007;356(19):1908–10.
Gu C, Chan CWH, Twinn S. How sexual history and knowledge of cervical cancer and screening influence Chinese women’s screening behavior in mainland China. Cancer Nurs. 2010;33(6):445–53.
Zhao FH, Hu SY, Zhang SW, Chen WQ, Qiao YL. Cervical cancer mortality in 2004–2005 and changes during last 30 years in China. Zhonghua Yu Fang Yi Xue Za Zhi. 2010;44(5):408–12.
CDC. Teen Vaccination Coverage. National Immunization Survey (NIS)-Teen. 2011. https://doi.org/www.cdc.gov/vaccines/who/teens/vaccination-coverage.html. Accessed 23 Aug 2015.
Keam SJ, Harper DM. Human papillomavirus types 16 and 18 vaccine (recombinant, AS04 adjuvanted, adsorbed) [Cervarix]: profile report. BioDrugs. 2008;22(3):205–8.
Cancer Foundation of China. 13th Annual Meeting of National Cervical Cancer Consortium and Symposium of Cervical Cancer Prevention. https://doi.org/www.cfchina.org.cn/show.php?contentid=933. Accessed on 07 Nov 2015.
Li J, Li LK, Ma JF, Wei LH, Niyazi M, Li CQ, Xu AD, Wang JB, Liang H, Belinson J, Qiao YL. Knowledge and attitudes about human papillomavirus (HPV) and HPV vaccines among women living in metropolitan and rural regions of China. Vaccine. 2009;27(8):1210–5.
Hsu YY, Fetzer SJ, Hsu KF, Chang YY, Huang CP, Chou CY. Intention to obtain human papillomavirus vaccination among Taiwanese undergraduate women. Sex Transm Dis. 2009;36(11):686–92.
Kwan TT, Chan KK, Yip AM, Tam KF, Cheung AN, Lo SS, Lee PW, Ngan HY. Acceptability of human papillomavirus vaccination among Chinese women: concerns and implications. BJOG. 2009;2–9116(4):501–10.
Lee PW, Kwan TT, Tam KF, Chan KK, Young PM, Lo SS, Cheung AN, Ngan HY. Beliefs about cervical cancer and human papillomavirus (HPV) and acceptability of HPV vaccination among Chinese women in Hong Kong. Prev Med. 2007;45(2–3):130–4.
Nguyen GT, Chen B, Chan M. Pap testing, awareness, and acceptability of a human papillomavirus (HPV) vaccine among Chinese American women. J Immigr Minor Health. 2012;14(5):803–8.
Jeng CJ, Lin H, Wang LR. The effect of HPV infection on a couple’s relationship: a qualitative study in Taiwan. Taiwan J Obstet Gynecol. 2010;49(4):407–12.
Lin H, Jeng CJ, Wang LR. Psychological responses of women infected with cervical human papillomavirus: a qualitative study in Taiwan. Taiwan J Obstet Gynecol. 2011;50(2):154–8.
Institute of International Education. Fast Facts Open Doors 2014. https://doi.org/www.iie.org/Research-and-Publications/Open-Doors. Access on Sep 5th, 2015.
Wang DC, Mallinckrodt B. Acculturation, attachment, and psychosocial adjustment of Chinese/Taiwanese international students. J Couns Psychol. 2006;53(4):422–33.
Wei M, Heppner PP, Mallen MJ, Ku TY, Liao KYH, Wu TF. Acculturative stress, perfectionism, years in the United States, and depression among Chinese international students. J Couns Psychol. 2007;54(4):385–94.
Ye J. Traditional and online support networks in the cross-cultural adaptation of Chinese international students in the United States. J Comput-Mediat Commun. 2006;11(3):863–76.
Yeh CJ, Inose M. International students’ reported English fluency, social support satisfaction, and social connectedness as predictors of acculturative stress. Couns Psychol Q. 2003;16(1):15–28.
Tung WC, Lu M, Cook DM. HIV/AIDS knowledge and attitudes among Chinese college students in the US. J Immigr Minor Health. 2012;15(4):788–95.
Huang K, Uba L. Premarital sexual behavior among Chinese college students in the United States. Arch Sex Behav. 1992;21(3):227–40.
Chan CY, Lam CH, Lam DY, Lee LY, Ng KK, Wong ML. A qualitative study on HPV vaccination from a nursing perspective in HongKong. Asian Pac J Cancer Prev. 2011;12(10):2539–45.
Kwan TT, Chan KK, Yip AM, Tam KF, Cheung AN, Young PM, Lee PW, Ngan HY. Barriers and facilitators to human papillomavirus vaccination among Chinese adolescent girls in Hong Kong: a qualitative-quantitative study. Sex Transm Infect. 2008;84(3):227–32.
Hsu YY, Hsu KF, Cheng YM, Fetzer SJ, Chou CY. Health beliefs of Taiwanese women seeking HPV vaccination. Vaccine. 2010;28(25):4224–8.
Marlow LA, Waller J, Evans RE, Wardle J. Predictors of interest in HPV vaccination: a study of British adolescents. Vaccine. 2009;27(18):2483–8.
Marlow LAV, Waller J, Wardle J. Parental attitudes to pre-pubertal HPV vaccination. Vaccine. 2007;25(11):1945–52.
Olshen E, Woods ER, Austin SB, Luskin M, Bauchner H. Parental acceptance of the human papillomavirus vaccine. J Adolesc Health. 2005;37(3):248–51.
Zimet GD. Improving adolescent health: focus on HPV vaccine acceptance. J Adolesc Health. 2005;37(6):S17–23.
Higgins LT, Sun C. Gender, social background and sexual attitudes among Chinese students. Cult Health Sex. 2007;9(1):31–42.
The Judy K. Black Scholarship from the Department of Health and Kinesiology, Purdue University, funded the data collection of this study.
Conflict of interest
The first author declares that he/she has no conflict of interest. The second author declares that he/she has no conflict of interest. The third author declares that he/she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All individual participants included in the study provided informed consent.
About this article
Cite this article
Gao, H., Okoror, T.A. & Hyner, G.C. Focus Group Study of Chinese International Students’ Knowledge and Beliefs About HPV Vaccination, Before and After Reading an Informational Pamphlet About Gardasil® . J Immigrant Minority Health 18, 1085–1092 (2016). https://doi.org/10.1007/s10903-016-0349-7
- HPV vaccination
- Chinese international students
- Cervical cancer
- HPV infection