Abstract
To estimate the prevalence of hepatitis vaccine hesitancy among Chinese university students and identify modifiable correlates to guide campus programs. We ran a multicampus cross-sectional survey (December 2023-February 2024) using a two-stage stratified cluster design across eastern, central, and western China. Hesitancy was measured with an 11 item hepatitis-adapted Vaccine Hesitancy Scale (α = 0.83). Multivariable logistic regression examined Health Belief Model constructs and convenience (travel/visit time). Among 2526 respondents, 51.8% met the prespecified hesitancy threshold. Seniors were more hesitant than juniors (aOR = 1.55, 95% CI: 1.25-1.91); students in the central region exceeded those in the east (1.30, 1.07-1.59). Off-campus residence (0.58, 0.41-0.83) and non-medical majors (0.68, 0.54-0.85) had lower odds. Higher perceived risk was also associated with lower hesitancy (0.66, 0.55-0.78). Ordering takeout showed a dose - response (e.g. 3-4/week vs never: 2.52, 1.67-3.82), whereas sharing tableware/drinkware was inversely associated (e.g., 3-4/week vs never: 0.38, 0.23-0.63). Time costs mattered: travel time >30 minutes was linked to higher hesitancy (1.43, 1.06-1.94), and unclear visit duration was also associated (1.40, 1.02-1.93). Hepatitis vaccine hesitancy is common among university students. Two modifiable levers - risk perception and service convenience - support highyield campus strategies.