Abstract
Following the approval of human papillomavirus (HPV) vaccination for males in China in January 2025, this study aimed to investigate parental knowledge of HPV, willingness to recommend HPV vaccination for their children, and associated determinants. The study also assessed parental awareness of HPV-associated oropharyngeal cancer (OPC) among parents of minor boys and girls in China. A cross-sectional online survey of parents in Shandong Province conducted from February to March 2025 yielded 1251 submissions, with 1041 valid questionnaires retained after applying prespecified exclusion criteria (refer to flowchart). Data were collected using anonymous self-administered questionnaires that covered demographic characteristics, knowledge of HPV, attitudes toward vaccination, vaccination intentions, and perceived barriers. Among the 1041 parents who completed the survey, 71.3% were aware of HPV and the vaccination program for girls, while only 35.73% were aware of the newly approved program for boys. After receiving information about the vaccine, 62% expressed an intention to vaccinate their child, 10% declined, and 28% remained undecided. Parents of daughters demonstrated significantly higher vaccination intent compared to parents of sons (OR = 0.110, 95% CI: 0.077-0.157, p = 5.3 × 10(-34)), indicating that the odds of intending to vaccinate were significantly lower for parents of boys. Key determinants influencing parental decisions included perceived health risks, beliefs about vaccine efficacy, trust in healthcare provider recommendations, and the child's gender, which were identified as significant determinants influencing parental HPV vaccination decisions. Significant knowledge gaps remain among Chinese parents regarding HPV and HPV-associated OPC. Public health initiatives are urgently needed to enhance parental understanding of HPV vaccination benefits, including its extension to boys, and to elucidate the risks of HPV-associated OPC. The implementation of a gender-neutral HPV vaccination policy faces substantial challenges rooted in awareness and gender norms. It is imperative to address these barriers through targeted health education, systematic training of healthcare professionals, and robust policy support. By dismantling gendered perceptions of health, we can achieve the overarching goal of comprehensive HPV prevention for all. Addressing these knowledge deficits and mitigating barriers to vaccine uptake are critical public health priorities.