Disparity in Mpox Awareness and Vaccine Hesitancy: A Cross-Sectional Study of 3483 University Students in Northwest China

Ying Zhang¹Jun Gan²Dong Miao³Ning-Hui Zhu⁴Li Xiao⁵Qing-Ming Shi²Yue Liu²Yuan- Yuan Li¹Xiao-Bing Hu²Jun-Feng Zheng²Wei Wang²Ji-Jun Chen⁶Zi-Peng Li²Jing-Jing Yu²Wen-Juan Ba²Yi-Jun Yang²Jing Zuo^2*Xiaoning Wang^1*Xiao-Lei Ye^2*

• ¹The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
• ²Center for Disease Control and Prevention in Western Theater Command，Lanzhou 730030, China, Lanzhou, China
• ³The 980th Hospital of the Joint Logistics Support Force of the PLA, Shijiazhuang, Hebei Province 050082, P. R. China, Shijiazhuang, China
• ⁴The Second Affiliated Hospital of Xi 'an Jiaotong University,, Xi 'an, Shaanxi Province 710000, China
• ⁵Chengdu Medical College, Chengdu, China
• ⁶Lanzhou Center for Disease Control and Prevention, Lanzhou, China

Background: Mpox has shown a westward spreading trend in China and university students are a high-risk group. This study aimed to assess the current status of Mpox-related knowledge, attitudes, vaccination willingness, and associated factors among college students in northwestern China, so as to provide a basis for formulating targeted prevention and control strategies. Methods: A cross-sectional survey utilizing a structured questionnaire was administered to students from nine higher education institutions in northwestern China between October 1 and 14, 2024. Results： The study sample comprised 3,483 university students, of whom 56.90% were female, 84.81% identified as Han ethnicity, 60.03% resided in rural areas, 52.89% were younger than 20 years, and 57.45% were enrolled in medical-related majors. The median Mpox knowledge score (Kscore) was 10, with only 33.68% classified into the high-score group (>11). Kscore was significantly higher among female, medical major, and urban residents, whereas smokers and alcohol consumers exhibited lower scores (all P < 0.001). Logistic regression identified medical major (adjusted odds ratio [aOR] = 1.336) and Han ethnicity (aOR = 1.242) as protective factors associated with higher Kscore, while male gender (aOR = 0.808), rural residence (aOR = 0.847), and alcohol consumption (aOR = 0.739) were risk factors. Vaccine acceptance was reported by 81.94% of participants, and side effects were primary concern for hesitancy. Female gender (aOR = 0.665), younger age (<20 years; aOR = 2.169), and heterosexual orientation (aOR = 2.835) were associated with greater willingness to receive vaccination. Spearman correlation analysis revealed significant positive correlations between Kscore and proactive information-seeking (r = 0.235, P < 0.001), vaccination willingness (r = 0.148, P < 0.001), and healthcare-seeking behavior (r = 0.146, P < 0.001). Conclusions：College students in northwestern China have insufficient Mpox knowledge but high vaccination acceptance. Targeted health education interventions should be implemented via new media platforms, focusing on male students, rural residents, and alcohol consumers, to enhance understanding of transmission routes and vaccine safety, reduce stigma, and strengthen Mpox prevention and control among young people in northwestern China.