Abstract
Human papillomavirus (HPV) infection represents a critical public health issue that affects both sexes. We aimed to investigate HPV vaccination intention and its associated factors in young men by conducting a web-based cross-sectional survey among men aged 18–26 years in Japan. The survey assessed sociodemographic characteristics, HPV knowledge and awareness, history of coronavirus disease 2019 (COVID-19) vaccination, vaccination readiness, digital health literacy, and HPV vaccination intention. Ordinal logistic regression analysis was conducted with HPV vaccination intention as the dependent variable to identify associated factors. Out of 824 respondents, 814 were included in the analysis after excluding those who had already received the HPV vaccine. Overall, 122 (15.0%) participants expressed their intention to receive the HPV vaccine. Ordinal logistic regression analysis revealed that HPV awareness (adjusted odds ratio [AOR]: 1.54, 95% confidence interval [CI]: 1.11–2.15), HPV knowledge (AOR: 1.15, 95% CI: 1.03–1.27), vaccination readiness (AOR: 2.30, 95% CI: 1.78–2.96), history of COVID-19 vaccination (AOR: 1.90, 95% CI: 1.31–2.74), personal income (AOR: 2.02, 95% CI: 1.30–3.14), and employment status (AOR: 0.61, 95% CI: 0.43–0.88) were significantly associated with HPV vaccination intention. In conclusion, HPV vaccination intention among young men was positively associated with HPV knowledge and awareness, attitudes toward vaccination, and personal income; conversely, regular employment was associated with reduced HPV vaccination intention. These findings suggest that increasing HPV vaccination uptake may require broadening HPV knowledge, improving attitudes toward vaccination, and reducing access barriers.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10900-026-01564-z.
Keywords: HPV vaccination, Vaccination intention, Vaccination readiness, Young men
Introduction
Human papillomavirus (HPV) causes one of the most common sexually transmitted infections worldwide and affects individuals across both sexes. Although HPV infection is traditionally linked to cervical cancer in women, it is also associated with a wide range of HPV-related diseases in men, including genital warts and oropharyngeal, anal, and penile cancers [1]. The incidence of HPV-related oropharyngeal cancer is particularly increasing among men [2], underscoring the importance of HPV vaccination in men.
Recently, several countries have expanded HPV vaccination to men based on evidence supporting its direct protective effects against HPV-related diseases, including genital lesions and anal intraepithelial neoplasia [3–5]. Moreover, international studies have reported moderate HPV vaccination intention rates among men. For instance, Reiter et al. showed intention levels of 55–60% among young U.S. men [6], and a recent meta-analysis reported an estimated general male acceptance rate of approximately 47% [7].
In Japan, routine HPV vaccination targeting only girls aged 12–16 years (from the sixth grade to the third year of high school) began in 2013. However, owing to reports of adverse reactions, the Ministry of Health, Labour and Welfare suspended its active promotion for 8.5 years until 2022. This prolonged suspension led to a decline in vaccination rates in the target female cohort, which decreased to below 1% during the suspension period [8]. Even after resuming active promotion, the vaccination rates in Japanese women remain lower than those in other countries [9, 10].
The World Health Organization (WHO) HPV dashboard revealed that the global first-dose HPV (HPV1) coverage among girls aged 9–14 years ranged from 40% to 50% in the early 2020s. Currently, HPV vaccination policies have been implemented in approximately 150 WHO member states, and the vaccine has been administered irrespective of sex in approximately 80 countries. This reflects the recognition of the vaccine’s direct disease-preventive benefits in men and its contribution to herd immunity at the population level. Contrarily, in Japan, HPV vaccination among men is voluntary and generally not covered by public subsidies, requiring a personal cost of > 50,000 yen. Vaccination in women has been shown to only be effective in preventing HPV-related diseases in men, suggesting a potential contribution to herd immunity [11, 12]. Modelling research has indicated that achieving large herd effects or approaching elimination with female-only programs requires a high coverage of approximately 60–80% [13]; however, in countries, such as Japan, where female vaccination rates are low, expanding vaccination to men is essential to reduce the overall population risk of HPV-related diseases.
Young men represent a particularly important target group for HPV vaccination. In Japan, young men typically initiate sexual activities at 20 years of age [14]; thus, they become a vaccination cohort as they enter the period of highest risk for new HPV infections. Nevertheless, they notably lack HPV awareness and knowledge [15], which has been recognized as a substantial barrier to vaccination among men [16]. The insufficient awareness and knowledge of HPV in Japan is concerning. Young men in their late teens to twenties belong to the same age cohort as the “catch-up vaccination” generation of women who missed routine vaccination during the suspension period. However, only women have recently been targeted by catch-up vaccination and health education campaigns, receiving information about HPV infection, while young men remain unaware, receiving little information or education about HPV infection and prevention. Thus, the knowledge level of this male age cohort may have been equivalent to or even lower than that of the female catch-up generation [17].
Despite the growing international concern regarding male HPV vaccination, empirical evidence on HPV vaccination intention among young Japanese men remains extremely limited, with only a few studies having directly evaluated this population. Understanding the factors associated with HPV vaccination intention is crucial for developing effective strategies to increase vaccination uptake. Given the high risk of infection among young Japanese men, as well as their low HPV knowledge level and limited access to systematic health education, identifying the determinants of their vaccination intention is essential for developing targeted public health interventions.
Therefore, in the present study, we aimed to investigate the HPV vaccination intention among young Japanese men and identify associated factors, offering foundational evidence to develop effective strategies for promoting HPV vaccination in this population.
Methods
Study Design and Participants
This cross-sectional study was conducted in May 2025 through a web-based survey of Japanese men aged 18–26 years. Participants were recruited from an online survey panel (Macromill Inc., Tokyo, Japan), and all data were collected online. Japanese men aged 18–26 years were eligible for inclusion in the study. Men who had been advised by a physician to refrain from vaccination, regardless of vaccine type, and those who had already received the HPV vaccine were excluded.
Several procedures were performed to mitigate the potential sources of bias. Selection bias was mitigated via age-balanced recruitment across the 18–26-year range. Information bias was reduced by applying the quality control procedures of the survey company, in which internally inconsistent or evidently inattentive responses and those completed within an abnormally short time were excluded.
The participants who completed all items received incentives in accordance with the internal policy of the survey company; specific amounts and calculation methods were not disclosed. This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by The University of Osaka Hospital Ethical Review Board (approval number: 24497(T2)). The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) under the identifier UMIN [UMIN000056989]. Electronic informed consent was obtained from all participants after they were informed of the purpose and procedures of the study.
Sample Size
The sample size for this study was determined using G*Power 3.1.9.7, assuming an effect size of 0.10, α = 0.05, and power = 0.80, with a two-tailed test aligned with the primary analysis based on Suzuki et al.’s study [18]. Calculations indicated that the minimum sample size required was 620 participants. However, we planned to enroll more participants to account for the pre-specified exclusion criteria.
Measurements
HPV vaccination intention was assessed as the primary outcome using the item “Do you want to receive the HPV vaccine?” Responses were recorded in seven categories, ranging from “strongly disagree” to “strongly agree.”
Awareness of HPV vaccination was evaluated dichotomously (“yes” = “I know it,” “I know a little,” and “I have heard of it” and “no” = “I don’t know”). HPV knowledge was assessed using six items that inquired whether the participants knew about the key aspects of HPV and the HPV vaccine, including (1) “The HPV vaccine is expected to prevent cervical cancer,” (2) “The HPV vaccine is expected to prevent oropharyngeal cancer,” (3) “The HPV vaccine prevents all sexually transmitted infections,” (4) “A single dose of the HPV vaccine provides complete protection,” (5) “The HPV vaccine is most effective when administered before the onset of sexual activity,” and (6) “HPV can cause HIV/AIDS.” These items, which were based on previous studies [19–22], were reviewed for content validity by five university-based researchers with expertise in obstetrics, midwifery, and public health. Each item was scored 1 for correct and 0 for incorrect or “I don’t know,” summing to a score of 0–6; higher scores indicated greater knowledge.
Vaccination readiness was measured using the Japanese version of the 7 C Vaccination Readiness Scale [23, 24]. The participants also reported their history of coronavirus disease 2019 (COVID-19) vaccination (yes/no). The perceived importance of the 20 determinants of HPV vaccination decisions was rated on a 5-point scale (1 = not important, 5 = very important). These items were based on previous studies [21, 25, 26] and included adverse reactions, effectiveness, safety/reliability, protection against personal infection and severe disease, prevention of transmission to close contacts, prevention of community spread, health conditions, physician’s opinion, family’s opinion, friends/acquaintances’ opinion, patients’ experiences, public health authority recommendation, school/workplace recommendation, convenience, cost, trust in pharmaceutical companies, accurate information, social media posts, vaccination uptake among peers, and social pressure.
Digital health literacy was assessed using the validated Japanese version of the eHealth Literacy Scale (eHEALS) [27]. The eHEALS, originally developed by Norman and Skinner [28], comprises eight items that measure an individual’s ability to search for, evaluate, and utilize health information obtained from the Internet. Each item is rated on a 5-point Likert scale, with higher scores indicating higher health literacy.
Health locus of control was assessed as a psychological factor based on Rotter’s social learning theory [29], which conceptualizes how individuals attribute responsibility for their health outcomes. The study used the Japanese version of the Health Locus of Control (HLC) scale developed by Watanabe et al. [30], which is based on the HLC scale by Wallston et al. [31], multidimensional HLC scale [32], children’s HLC scale by Parcel et al. [33], and Locus of Control scale by Kambara et al. [34]. This scale consists of 14 items that assess two dimensions: internal control (reflects the belief that one’s health is determined by one’s own efforts) and external control (reflects the belief that health is influenced by external factors, such as healthcare professionals or chance). In this scale, items are scored such that higher total scores indicate a stronger internal control orientation.
In addition, data on sociodemographic characteristics, such as age, educational level, employment status, annual personal income, and marital status, were collected. Annual personal income was defined as the participant’s own annual income (i.e., not their household income).
Statistical Analysis
An exploratory factor analysis of 20 decision determinants was conducted using principal component extraction with Promax rotation. The number of factors was determined by parallel analysis and scree plot inspection. Items with primary loadings ≥ 0.40 were retained, and the internal consistency for each factor was assessed using Cronbach’s alpha following a factor analysis. Factor scores were entered into an ordinal logistic regression model.
For bivariate associations, ordinal logistic regression models were used, with the outcome being the intention to receive the HPV vaccine. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression coefficients and standard errors.
For the multivariate analyses, ordinal logistic regression models were fitted using the forced-entry method. Correlations and multicollinearity were examined among the independent variables, confirming the absence of problematic multicollinearity (all VIFs < 2, all correlations < 0.7). Three models were constructed: Model 1 included sociodemographic variables (age, marital status, employment status, educational level, and personal income); Model 2 additionally included the history of COVID-19 vaccination, awareness of HPV vaccination, HPV knowledge score, and vaccination readiness; and Model 3 additionally included the eHEALS and HLC, as well as decision-making factors and factor scores derived from the factor analysis. Listwise deletion was employed for missing data in the multivariate analyses, and imputation was not performed. The model fit was assessed using Nagelkerke’s R² and the Pearson’s and deviance goodness-of-fit tests. All analyses were performed using IBM SPSS Statistics version 30 (IBM Corp., Armonk, NY, USA), with statistical significance set at a p-value of < 0.05.
Results
Sociodemographic Characteristics
A total of 824 participants responded to the survey, and 10 respondents who had already received the HPV vaccine were excluded from the primary analyses, leaving 814 unvaccinated participants. In total, 122 (15.0%) participants expressed a positive intention to receive the HPV vaccine (Table 1). The characteristics of the participants are summarized in Table 2. Of the 814 respondents, 40.0% were permanent employees, whereas 49.2% were temporary or part-time workers, students, or others. In some instances, educational level and annual personal income were not reported (n = 44 and n = 190, respectively). The median HPV knowledge score was 1.0 (IQR: 0.0–2.0). The number of correct responses for the six items was generally low. Of all participants, 26.8% correctly recognized that the HPV vaccine was expected to prevent cervical cancer, and only 13.4% knew about its protective effects against oropharyngeal cancer. For all six items, the correct response rate did not exceed 34% (Table S1 in Online Resource 1). The median vaccination readiness score was 4.0 (IQR: 3.6–4.3).
Table 1.
Vaccination status and intention among the participants
| Strongly agree | n | % |
|---|---|---|
| 13 | 1.6 | |
| Agree | 25 | 3.1 |
| Somewhat agree | 84 | 10.3 |
| Neither agree nor disagree | 371 | 45.6 |
| Somewhat disagree | 118 | 14.5 |
| Disagree | 71 | 8.7 |
| Strongly disagree | 132 | 16.2 |
| Total | 814 | 100.0 |
Table 2.
Participants’ sociodemographic characteristics and health-related measures
| Variable | All (n = 814) | |
|---|---|---|
| n | % | |
| Age | 23.0 | (20.0, 25.0) |
| Marital status | ||
| Married | 43 | 5.3 |
| Unmarried | 771 | 94.7 |
| Educational level | ||
| Bachelor’s degree or higher | 431 | 52.9 |
| Less than a bachelor’s degree | 340 | 41.8 |
| Declined to answer | 43 | |
| Employment status | ||
| Permanent employee | 327 | 40.2 |
|
Temporary or part-time Worker/student/others |
487 | 59.8 |
| Personal income | ||
| ≥4 million yen | 109 | 17.4 |
| <4 million yen | 519 | 82.6 |
| Declined to answer | 186 | |
| HPV knowledge score | 1.0 | (0.0, 2.0) |
| HPV awareness | ||
| Yes | 408 | 50.1 |
| No | 406 | 49.9 |
| Vaccination readiness score | 4.0 | (3.6, 4.3) |
| History of COVID-19 vaccination | ||
| Yes | 625 | 76.8 |
| No | 189 | 23.2 |
| eHEALS score | 24.0 | (19.0, 27.0) |
| HLC score | 36.0 | (34.0, 38.0) |
HPV, human papillomavirus; COVID-19, coronavirus disease 2019; eHEALS, eHealth literacy scale; HLC score, health locus of control score.
Values are presented as n (%) unless indicated otherwise. Continuous variables are expressed as medians (interquartile ranges). Percentages for non-missing responses were calculated. “Declined to answer” refers to respondents who selected the option not to provide an answer; therefore, counts may not sum to n = 814.
Factor Analysis of Decision Determinants
We summarized the 20 decision determinants into four decision-making factors: health impact, interpersonal influence, accessibility, and social conformity. The sampling adequacy was excellent (KMO = 0.943), and Bartlett’s test indicated factorability (p < 0.001). Although the initial eigenvalue criterion (eigenvalues > 1) suggested a three-factor solution, both the scree plot and theoretical and interpretability considerations supported a four-component solution. The four-factor model accounted for 66.9% of total variance. The loadings are listed in Table 3. The internal consistency was acceptable (Cronbach’s α = 0.76–0.84).
Table 3.
Factor loadings of the decision-making determinants of HPV vaccination
| Item | Health impact | Interpersonal influence | Accessibility | Social conformity |
|---|---|---|---|---|
| Adverse reactions | 0.880 | −0.270 | −0.014 | 0.209 |
| Effectiveness | 0.776 | −0.110 | 0.175 | −0.025 |
| Safety/reliability | 0.831 | −0.093 | 0.131 | −0.028 |
| Prevention of infection and severe disease in the individual | 0.793 | 0.222 | −0.096 | −0.034 |
| Prevention of transmission to close contacts | 0.713 | 0.276 | −0.082 | −0.011 |
| Prevention of community spread | 0.633 | 0.309 | −0.080 | 0.089 |
| Health conditions | 0.550 | 0.128 | 0.215 | −0.024 |
| Physician’s opinion | 0.407 | 0.363 | 0.158 | −0.033 |
| Family’s opinion | 0.132 | 0.879 | −0.141 | −0.072 |
| Friends’/acquaintances’ opinions | 0.004 | 0.917 | −0.187 | −0.016 |
| Patients’ experiences | 0.109 | 0.511 | 0.272 | −0.001 |
| Public health authority recommendation | −0.102 | 0.499 | 0.353 | 0.100 |
| School/workplace recommendation | −0.219 | 0.502 | 0.243 | 0.318 |
| Convenience | −0.067 | −0.004 | 0.758 | 0.174 |
| Cost | 0.049 | −0.109 | 0.901 | −0.063 |
| Trust in pharmaceutical companies | 0.223 | −0.065 | 0.705 | −0.030 |
| Accurate information | 0.261 | −0.039 | 0.712 | −0.133 |
| Social media posts | −0.073 | 0.234 | −0.048 | 0.687 |
| Vaccination uptake among peers | −0.028 | 0.186 | 0.031 | 0.718 |
| Social pressure | 0.228 | −0.262 | −0.067 | 0.930 |
n = 814.
Factor loadings of ≥ 0.40 are presented in bold to indicate primary loadings.
The extraction method was principal component analysis.
Promax with Kaiser normalization was used as the rotation method, and the rotation converged in eight iterations.
Factors Associated with HPV Vaccination Intention
Among the participants, higher HPV vaccination intention was associated with having a bachelor’s degree or higher (OR: 1.44, 95% CI: 1.11–1.87), higher annual personal income (≥ 4 million yen; OR: 1.60, 95% CI: 1.10–2.34), a history of COVID-19 vaccination (OR: 2.22, 95% CI: 1.65–2.99), and HPV awareness (OR: 2.04, 95% CI: 1.58–2.63) (Table 4). Greater vaccination readiness (OR: 2.98, 95% CI: 2.42–3.66), increased HPV knowledge (OR: 1.24, 95% CI: 1.15–1.35), and a higher eHEALS score (OR: 1.05, 95% CI: 1.03–1.07) were also positively associated with HPV vaccination intention.
Table 4.
Bivariate ordinal logistic regression analysis of factors associated with HPV vaccination intention
| Variable | n | OR | 95% CI | p-value |
|---|---|---|---|---|
| Age | 814 | 0.97 | (0.92–1.01) | 0.153 |
| Marital status | 814 | |||
| Married | 0.77 | (0.44–1.35) | 0.363 | |
| Educational level | 771 | |||
| ≥Bachelor’s degree | 1.44 | (1.11–1.87) | 0.007 | |
| Employment status | 814 | |||
| Permanent employee | 0.85 | (0.66–1.10) | 0.222 | |
| Personal income | 628 | |||
| ≥4 million yen | 1.60 | (1.10–2.34) | 0.015 | |
| History of COVID-19 vaccination | 814 | |||
| Yes | 2.22 | (1.65–2.99) | < 0.001 | |
| HPV awareness | 814 | |||
| Yes | 2.04 | (1.58–2.63) | < 0.001 | |
| Vaccination readiness | 814 | 2.98 | (2.42–3.66) | < 0.001 |
| HPV knowledge score | 814 | 1.24 | (1.15–1.35) | < 0.001 |
| Decision-making factors | 814 | |||
| Health impact | 1.11 | (0.98–1.26) | 0.101 | |
| Interpersonal influence | 1.41 | (1.25–1.61) | < 0.001 | |
| Accessibility | 1.17 | (1.04–1.33) | 0.012 | |
| Social conformity | 1.35 | (1.19–1.54) | < 0.001 | |
| eHEALS score | 814 | 1.05 | (1.03–1.07) | < 0.001 |
| HLC score | 814 | 1.02 | (0.99–1.05) | 0.233 |
HPV, human papillomavirus; COVID-19, coronavirus disease 2019; eHEALS, eHealth literacy scale; HLC score, health locus of control score; OR, odds ratio; CI, confidence interval.
ORs were derived from the regression coefficients and standard errors (not shown) of the ordinal logistic regression model.
Reference categories: marital status (unmarried), educational level (< bachelor’s degree), employment status (non-regular employment), personal income (< 4 million yen), history of COVID-19 vaccination (no), and HPV awareness (no).
Among the decision-making domains, interpersonal influence (OR: 1.41, 95% CI: 1.25–1.61), accessibility (OR: 1.17, 95% CI: 1.04–1.33), and social conformity (OR: 1.35, 95% CI: 1.19–1.54) were positively associated with HPV vaccination intention. Health impact, age, marital status, and regular employment were not significantly associated.
A multivariate ordinal logistic regression analysis using the three models was conducted. In Model 3 (Table 5), personal income (adjusted odds ratio [AOR]: 2.02, 95% CI: 1.30–3.14), prior COVID-19 vaccination (AOR: 1.90, 95% CI: 1.31–2.74), HPV awareness (AOR: 1.54, 95% CI: 1.11–2.15), vaccination readiness (AOR: 2.30, 95% CI: 1.78–2.96), and HPV knowledge (AOR: 1.15, 95% CI: 1.03–1.27) were positively associated with HPV vaccination intention, whereas being permanent employment was associated with a lower intention (AOR: 0.61, 95% CI: 0.43–0.88). The eHEALS and HLC were included in Model 3; however, they showed no statistically significant association with HPV vaccination intention. Model 3 demonstrated an adequate fit (Pearson’s p = 0.433; deviance p = 1.000), with a Nagelkerke R² of 0.217. We also estimated Models 1 and 2 sequentially; however, the pattern of statistical significance did not change (Table S2 in Online Resource 1).
Table 5.
Multivariate ordinal logistic regression analysis of factors associated with HPV vaccination intention (Model 3)
| Variable | AOR | 95% CI | p-value |
|---|---|---|---|
| Age | 0.99 | (0.93–1.06) | 0.793 |
| Marital status: married | 0.89 | (0.46–1.70) | 0.717 |
| Educational level: bachelor’s degree or higher | 0.97 | (0.72–1.32) | 0.862 |
| Employment status: permanent employee | 0.61 | (0.43–0.88) | 0.009 |
| Personal income: ≥4 million yen | 2.02 | (1.30–3.14) | 0.002 |
| History of COVID-19 vaccination: yes | 1.90 | (1.31–2.74) | < 0.001 |
| HPV awareness: yes | 1.54 | (1.11–2.15) | 0.010 |
| Vaccination readiness score | 2.30 | (1.78–2.96) | < 0.001 |
| HPV knowledge score | 1.15 | (1.03–1.27) | 0.009 |
| Decision-making factors | |||
| Health impact | 1.02 | (0.84–1.24) | 0.841 |
| Interpersonal influence | 1.08 | (0.88–1.32) | 0.482 |
| Accessibility | 0.97 | (0.79–1.20) | 0.801 |
| Social conformity | 1.15 | (0.96–1.38) | 0.143 |
| eHEALS score | 1.02 | (0.99–1.04) | 0.231 |
| HLC score | 0.98 | (0.95–1.02) | 0.315 |
n = 616; HPV, human papillomavirus; COVID-19, coronavirus disease 2019; eHEALS, eHealth literacy scale; HLC score, health locus of control score; AOR, adjusted odds ratio; CI, confidence interval.
Nagelkerke R2 = 0.217.
AORs were derived from regression coefficients and standard errors (not shown) using a forced-entry ordinal logistic regression model.
Reference categories: marital status (unmarried), educational level (< bachelor’s degree), employment status (non-regular employment), personal income (< 4 million yen), history of COVID-19 vaccination (no), and HPV awareness (no).
Discussion
This study demonstrated that HPV vaccination intention was higher among young men with greater HPV awareness and knowledge, higher vaccination readiness, a history of COVID-19 vaccination, and higher personal income. In contrast, regular employment was associated with lower HPV vaccination intention. Bivariate analysis showed that three decision-making factors—namely, interpersonal influence, accessibility, and social conformity—were positively associated with HPV vaccination intention. However, these associations were not statistically significant in the multivariate analysis. This attenuation suggests that these domains may not exert independent effects once stronger determinants such as HPV knowledge and vaccination readiness are considered.
Our study demonstrated that higher HPV awareness and knowledge were associated with higher intention to receive the HPV vaccine, consistent with the results of previous studies [15, 35, 36]. However, men tend to have lower HPV awareness and knowledge than women [37]. In our study, HPV awareness in young Japanese men was 50%, and only 13% knew that HPV vaccination could prevent oropharyngeal cancer, while only 15% expressed a positive intention to receive the HPV vaccine. Therefore, improving awareness and knowledge among men is essential to increase both vaccination intention and uptake. Given that sex-biased approaches constrain discussions about vaccination for men [38], systematically expanding opportunities for knowledge sharing in schools and other group-education settings is essential to strengthen the delivery of trustworthy communication regarding how HPV affects all sexes.
The positive associations between vaccination readiness, a history of COVID-19 vaccination, and the intention to receive the HPV vaccine suggest that favorable attitudes toward vaccination in general may extend to HPV vaccination. This finding aligns with a previous study indicating that COVID-19 vaccination status predicts the intention to receive other vaccines [39] and implies that individuals with a history of vaccination experience develop a generally positive attitude toward vaccines and perceive fewer barriers to vaccination. Vaccination readiness reflects the “7 C” components—confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy [23, 24].
From this perspective, governments and public bodies should enhance vaccine literacy through evidence-based information dissemination [40] and educational interventions, while countering the infodemic through strategies such as teach-back to ensure understanding [41]. Thus, sustained policy support, transparent risk communication, and empathetic community engagement are essential to rebuilding trust [42].
Educational and communicative approaches also play important roles in supporting HPV vaccination. School-based programs and strengthened communication and education between patients and healthcare providers have been reported to promote vaccination behaviors [43]. Enhancing vaccine literacy requires educational approaches that are accessible, easy to understand, and capable of promoting dialogue, supporting evidence-based decision making, and strengthening trust in vaccination [16]. In our study, digital health literacy measured by the eHEALS showed a significant association with HPV vaccination intention in the bivariate analysis; thus, individuals who can effectively find and use online health information may be more inclined toward vaccination. However, this association was not significant in the multivariate model, indicating that digital health literacy does not independently predict HPV vaccination intention. Therefore, literacy-focused education alone may not be sufficient, and efforts to promote HPV vaccination need to address other key elements—including improving HPV knowledge, strengthening trust in vaccination, and reducing access barriers—to promote vaccination more effectively.
In this study, sociodemographic characteristics were also associated with HPV vaccination intention. Personal income and employment status were associated with vaccination intention. Particularly, higher personal income was associated with higher intention, aligning with the evidence that lower-income groups tend to show lower vaccine acceptance [44]. Access constraints, such as cost, scheduling, and opportunity costs, are known contributors to vaccination hesitancy [45]. Thus, the observed negative association with regular employment likely reflects time and access barriers, including difficulty in receiving vaccination during working hours. As of 2025, HPV vaccination for men in Japan is not positioned as a routine vaccination program with uniform public funding. Therefore, differences in the presence and number of subsidies from local governments may influence their intention to receive vaccination. Policies that reduce barriers to vaccination, such as expanding vaccination opportunities and flexible delivery models, are required to improve vaccination intention and coverage.
The strength of this study lies in its comprehensiveness of multiple factors associated with HPV vaccination intention, providing critical insights for public health efforts to promote HPV vaccination. However, this study had some limitations. First, it measured vaccination intention rather than actual uptake. Second, the cross-sectional design limited causal inference. Third, this survey was Internet-based, and selection bias due to higher health consciousness among the respondents could not be fully ruled out.
Conclusion
This study revealed that HPV vaccination intention among young men was positively associated with HPV awareness and knowledge, vaccination readiness, a history of COVID-19 vaccination, and personal income, whereas regular employment served as a barrier that reduced vaccination intention. These findings suggest that improving HPV vaccination rates will require not only educational efforts to enhance literacy but also broader approaches that address multiple elements such as knowledge, trust, and access. Future research should incorporate longitudinal and intervention-based designs to examine HPV vaccine uptake and to clarify causal relationships between identified factors and vaccination behavior.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors thank the participants and those who contributed to the study for their valuable advice and guidance.
Author contributions
HA: Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Validation, Writing – original draft, Writing – review & editing, Funding acquisition, Project administration. JS: Conceptualization, Methodology, Formal analysis, Validation, Writing – review & editing. KM: Conceptualization, Methodology, Writing – review & editing, Validation. HW: Conceptualization, Methodology, Supervision, Writing – review & editing. All authors have read and approved the final manuscript.
Funding
Open Access funding provided by The University of Osaka. This work was supported by JSPS KAKENHI (grant number JP24K14174).
Declarations
Conflict of interest
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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