Date of Award

Spring 2015

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Health and Kinesiology

First Advisor

Gerald C. Hyner

Committee Chair

Titilatyo A. Okoror

Committee Co-Chair

Mohan Dutta

Committee Member 1

Thomas J. Templin


The Human Papillomavirus (HPV) vaccine provides an effective prevention strategy against HPV infection, cervical cancer, and genital warts. As increasing numbers of Chinese international students (CIS) are living and studying in United States, this specific ethnic group has become the candidate for HPV vaccination promotion. Despite an increased awareness and knowledge of HPV infection and HPV vaccine among U.S. college students, studies focused on CIS as a unique ethnic group regarding HPV vaccine promotion were limited. This project is the first time aimed to examine CIS's awareness, knowledge and beliefs about HPV infection, HPV vaccine, cervical cancer and genital warts. During the summer and fall of 2013, CIS attending a Midwestern university in the United States were recruited to take part in two studies: one quantitative study (employing online anonymous survey) and one qualitative study (employing focus group discussions). A total of 751 students participated in the survey. Surveys from 350 participants aged 18-26 years (mean=21.42) who had not been vaccinated for HPV were included in the data analysis. Ten focus groups were conducted with 44 CIS aged 18-34 (mean=24.6). The discussions were audio taped, transcribed and analyzed. The results demonstrated six major findings: (1) There was limited awareness, knowledge and intention about HPV vaccine among CIS. Only 27.2% of the 350 participants had ever heard of the HPV vaccine. Most participants were unaware of the cause of cervical cancer, and considered genital warts as "secret" "dirty" diseases. (2) There were sex differences with regard to CIS's intentions and beliefs of HPV infection and HPV vaccine. Female CIS 69.2% were more likely than male CIS (34.9%) to receive an HPV vaccine in the future. Significantly, more female than male participants thought that HPV infection would influence their romantic relationship and that their family and partners would support their decision to receive an HPV vaccination. The only significant predictors of CIS' vaccination intention was the vaccination behavior of best friends, particularly among female subjects. (3) There was evidence of a significant lack of formal sex education and formal information sources for all CIS. Parents and friends were not considered appropriate sources to seek support and information. Sources for information were informal: street advertisements and social websites such as "Renren." (4) There were more open attitudes toward sexual behavior compared to Chinese women who were subjects of earlier surveys. Premarital sexual behaviors and multiple sexual relationships were acceptable in this cohort of CIS. (5) Sexual cultures and behaviors were perceived different between CIS born in the 1990s versus the 1980s. (6) CIS' perceived stigma about HPV infection varied by knowledge level during the discussion. This study describes current perceptions of STI and HPV vaccination among CIS and identifies current perceptions of young Chinese adults who live abroad, especially with respect to their values concerning vaccination behavior, STIs prevention, relationships and cultural identity.