Original article Knowledge of human papillomavirus vaccination and related factors among parents of young adolescents: a nationwide survey in China Shao-Kai Zhang PhD a, b , Xiong-Fei Pan BSc c , Shao-Ming Wang PhD a , Chun-Xia Yang PhD c , Xiao-Hong Gao PhD d , Zeng-Zhen Wang PhD e , Man Li PhD f , Ze-Fang Ren PhD g , Quan-Qing Zheng PhD h , Wei Ma PhD i , Fang-Hui Zhao PhD a , You-Lin Qiao PhD a, * a Department of Cancer Epidemiology, Cancer Institute of Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China b Department of Cancer Epidemiology, Hennan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Henan Office for Cancer Control and Research, Zhengzhou, China c Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, China d Department of Epidemiology, School of Public Health, Dalian Medical University, Dalian, China e Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China f Department of Epidemiology, School of Public Health, Capital Medical University, Beijing, China g Department of Epidemiology and Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China h Department of Public Health, Medical School of Xi’an Jiaotong University, Xi’an, China i Institute of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, China article info Article history: Received 29 January 2014 Accepted 27 December 2014 Available online 7 January 2015 Keywords: Cervical cancer HPV Vaccination Knowledge Parents abstract Purpose: To investigate the human papillomavirus (HPV) vaccineerelated knowledge and factors asso- ciated with the knowledge among parents of young adolescents in China. Methods: The study was based on data of a survey carried out in seven geographic regions of China. Parents of students in junior middle school were surveyed during parents’ meetings. Results: A total of 2895 parents were included in the analyses. Of parents, 38.3% responded with “yes” to more than three of the six knowledge questions, among whom only 4.5% of them correctly answered all six questions. Social benefit programs (41.3%), doctors and/or nurses (39.7%), and newspapers and/or magazines (36.5%) were selected as the top three sources of HPV-related knowledge. Mothers, parents who work in the health care sector, and parents with a higher annual income or with vaccination experience outside the expanded program on immunization showed a better knowledge base. Parents who consented to sex education for children or showed fear of cervical cancer were likely to have more HPV-related knowledge. In particular, the knowledge level of parents with prior consultation regarding HPV vaccines was higher. Conclusions: Parents of young adolescents in China possessed a low level of HPV vaccineerelated knowledge. Findings highlight the need for tailored health education through different channels to improve HPV-related knowledge among parents. Ó 2015 Elsevier Inc. All rights reserved. Introduction Cervical cancer is the third most commonly diagnosed gyne- cologic cancer and the second leading cause of gynecologic cancererelated deaths in China. Annual absolute estimates of cases and deaths of cervical cancer were 75,400 and 33,900 [1]. It is becoming one of the priorities in the long-term strategy for cancer prevention and control in China [2]. However, there is no nationwide population-based cervical cancer screening program in China. Government-sponsored mass screening has only been made available to a limited population in rural China. An earlier large-scale free screening initiative based on visual inspection and cytology covered only about 10 million rural women aged between 35 years and 59 years between 2009 and 2012 [3]. Women in urban areas are referred to cervical cancer screening at an opportunistic basis or through employment-based physical examination [2]. In addition to limited coverage, the effectiveness of cervical cancer screening is compromised because The authors have no conflicts of interest to disclose. * Corresponding author. Department of Cancer Epidemiology, Cancer Institute of Chinese Academy of Medical Sciences and Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing, China 100021. Tel.: þ86-10-8778-8900; fax: þ86-10-6771-3648. E-mail address: qiaoy@cicams.ac.cn (Y.-L. Qiao). Contents lists available at ScienceDirect Annals of Epidemiology journal homepage: www.annalsofepidemiology.org http://dx.doi.org/10.1016/j.annepidem.2014.12.009 1047-2797/Ó 2015 Elsevier Inc. All rights reserved. Annals of Epidemiology 25 (2015) 231e235