Self-reported HPV vaccination status and HPV vaccine hesitancy in a university student population
Abstract
Background: Human papillomavirus (HPV) infection is a common sexually transmitted infection that causes 4.5% of all cancers in women and men globally. HPV vaccines are among the most effective vaccines available worldwide. Despite this, HPV vaccine hesitancy and low HPV vaccination coverage remain significant public health challenges in some countries, including Croatia. This study aimed to investigate self-reported HPV vaccination status and general vaccine hesitancy among university students in Eastern Croatia.
Methods: This cross-sectional questionnaire study was conducted on a convenience sample of university students from the University of Osijek in Eastern Croatia between February 2021 and May 2021. A specially designed anonymous questionnaire was used to collect sociodemographic data and self-reported HPV vaccination status, while the Vaccination Attitudes Examination (VAX) scale was used to assess general vaccine hesitancy. Higher scores on the VAX scale indicate increased vaccine hesitancy.
Results: The study sample included 840 subjects, with a median age of 20 years (interquartile range 20–21), 45.8% male and 54.2% female. The median VAX scale score was 39.0 (interquartile range 32.0–46.0). The prevalence of HPV vaccination in the study population was 20.8%. Increased vaccine hesitancy was found among students studying social sciences (p < 0.001), students with a lower average grade (p < 0.001), and students who were not vaccinated against HPV (p < 0.001).
Conclusions: The study revealed increased general vaccine hesitancy and low HPV vaccination coverage among Croatian university students. Identifying factors that influence vaccine hesitancy among university students would enable the design of more effective public health interventions to promote HPV vaccine uptake.
Key messages: • Positive attitudes towards vaccination among university students are a crucial precondition for improving HPV vaccination coverage in this vulnerable subgroup.
• Public health interventions aimed at promoting HPV vaccine uptake among university students must include activities targeting the reduction of general vaccine hesitancy within this subgroup.
Related
- Vaccine hesitancy across educational stages and health disciplines among healthcare students at a public university in the Western Black Sea region of Türkiye: a cross-sectional study
- Beyond vaccine hesitancy: Vaccine fatigue and sustained engagement with vaccination
- Trust in HPV vaccine effectiveness and safety and willingness to initiate HPV vaccination among unvaccinated female college students recruited through university-based online networks in China: a cross-sectional study
- Heterogeneity in pre-vaccination population immunity can contribute to variability in vaccine effectiveness estimates
- A safety-first machine learning framework for precision public health: segmenting vaccine hesitancy among Iranian adults
BibTeX
@article{miskulin2026selfreported,
title = {{Self-reported HPV vaccination status and HPV vaccine hesitancy in a university student population}},
author = {M Miskulin and R Nedic and N Lovrincevic Pavlovic and I Kotromanovic Simic and K Bevanda and J Kovacevic and L Radaus and M Mikulic and J Milic and I Miskulin},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1597},
url = {https://doi.org/10.1093/eurpub/ckag169.1597},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Self-reported HPV vaccination status and HPV vaccine hesitancy in a university student population
AU - M Miskulin
AU - R Nedic
AU - N Lovrincevic Pavlovic
AU - I Kotromanovic Simic
AU - K Bevanda
AU - J Kovacevic
AU - L Radaus
AU - M Mikulic
AU - J Milic
AU - I Miskulin
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1597
UR - https://doi.org/10.1093/eurpub/ckag169.1597
AB - Background: Human papillomavirus (HPV) infection is a common sexually transmitted infection that causes 4.5% of all cancers in women and men globally. HPV vaccines are among the most effective vaccines available worldwide. Despite this, HPV vaccine hesitancy and low HPV vaccination coverage remain significant public health challenges in some countries, including Croatia. This study aimed to investigate self-reported HPV vaccination status and general vaccine hesitancy among university students in Eastern Croatia. Methods: This cross-sectional questionnaire study was conducted on a convenience sample of university students from the University of Osijek in Eastern Croatia between February 2021 and May 2021. A specially designed anonymous questionnaire was used to collect sociodemographic data and self-reported HPV vaccination status, while the Vaccination Attitudes Examination (VAX) scale was used to assess general vaccine hesitancy. Higher scores on the VAX scale indicate increased vaccine hesitancy. Results: The study sample included 840 subjects, with a median age of 20 years (interquartile range 20–21), 45.8% male and 54.2% female. The median VAX scale score was 39.0 (interquartile range 32.0–46.0). The prevalence of HPV vaccination in the study population was 20.8%. Increased vaccine hesitancy was found among students studying social sciences (p < 0.001), students with a lower average grade (p < 0.001), and students who were not vaccinated against HPV (p < 0.001). Conclusions: The study revealed increased general vaccine hesitancy and low HPV vaccination coverage among Croatian university students. Identifying factors that influence vaccine hesitancy among university students would enable the design of more effective public health interventions to promote HPV vaccine uptake. Key messages: • Positive attitudes towards vaccination among university students are a crucial precondition for improving HPV vaccination coverage in this vulnerable subgroup. • Public health interventions aimed at promoting HPV vaccine uptake among university students must include activities targeting the reduction of general vaccine hesitancy within this subgroup.
SN - 1101-1262
SN - 1464-360X
ER -