Objectives This study aimed to investigate the knowledge–attitude–practice (KAP) of Chinese college students regarding COVID-19 and evaluate their psychological status against the background of the COVID-19 outbreak. Design This was a cross-sectional study. Setting This study covered 31 provinces, municipalities and autonomous regions of mainland China. Participants The participants, who were college students with ordinary full-time status, were surveyed anonymously on their KAP regarding COVID-19 by using self-made questionnaires. In addition, the Self-Rating Anxiety Scale was used to assess the psychological status of the students. Methods The online cross-sectional study among Chinese college students was conducted in February 2020. Logistic regression analysis was used to analyse the predictors of anxiety symptoms. Primary outcome measures The level of KAP and anxiety symptoms. Results A total of 740 college students from 31 provinces, municipalities and autonomous regions in China were recruited in the survey. Among them, 139 (18.78%) revealed having anxiety. Multivariable logistic regression analysis revealed that female gender was the risk factor for anxiety symptoms with an increased 2.164-fold risk than male gender (OR=2.164, 95% CI=1.279 to 3.662). The knowledge (OR=0.825, 95% CI=0.779 to 0.873) and attitude (OR=0.822, 95% CI=0.762 to 0.887) regarding COVID-19 were protective factors against anxiety symptoms. Conclusions The level of KAP regarding COVID-19 was significantly negatively correlated with anxiety symptoms. Thus, understanding the level of KAP among college students during the early stages of major public health emergencies, such as a pandemic, is important. Such understanding plays an important role in adopting targeted health education strategies and reducing the psychological damage caused by these emergencies.

Purpose: This study aimed to assess the knowledge, attitude and practice (KAP) towards COVID-19 of Chinese college students during the COVID-19 outbreak and identify the determinants considerably associated with KAP. Methods: An online cross-sectional questionnaire survey was conducted in February 2020 in China to recruit participants on the Wen-Juan-Xing online platform. A self-made questionnaire was used to assess the KAP towards COVID-19. Results: The average scores of COVID-19-related KAP among college students were 32.16 ± 4.09, 16.84 ± 3.18 and 15.36 ± 1.83, respectively. The average correct response rate of COVID-19-related knowledge was 84.62%. 94.59% of the respondents believed China could control and conquer the pandemic; 98.92% of the respondents wore a mask when they went out. The multiple linear regression showed that the female students had higher scores of COVID-19-related knowledge than male students (β = 0.79, P = 0.01), and the students from 985 or 211 universities (β = − 2.22, P < 0.01) were significantly associated with higher knowledge scores. Furthermore, a significantly positive correlation was found between the scores of COVID-19-related KAP among students. Conclusion: The college students had a good KAP towards the COVID-19 pandemic. The present study was able to access the COVID-19-related KAP among college students during the pandemic and identify their weaknesses in pandemic prevention. Consequently, the results of this study provide theoretical basis for implementing precision health education among college students and reference for campuses to conduct scientific prevention and control during a pandemic. Results also provide beneficial experience to curb similar major public health emergencies in the future.

Background: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease. Objective: This study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control. Methods: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors. Results: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t0.05/2,1=2.4041 P=.02), per capita gross domestic product (t0.05/2,1=2.6955; P=.01), per capita disposable income (t0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t0.05/2,1=2.7452; P=.01), and PCCE for health care (t0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R2 values in north and northeast China. Conclusions: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control.

Background: Mpox (monkeypox) remains a global public health threat. However, data on mpox-related knowledge, attitudes, and practices (KAP) and vaccination willingness among Chinese medical students, who are key future health care practitioners, remain lacking. Objective: This study aimed to investigate systematically the KAP and mpox vaccination willingness of Chinese medical students and identify the factors influencing their vaccination decisions. Methods: A nationwide cross-sectional survey was conducted from November 2023 to March 2024. An anonymous self-designed questionnaire was used to assess basic information, KAP toward mpox, vaccination-related behaviors, and willingness. Categorical data were presented as frequency (constituent ratio). The normality of continuous variables was assessed using the Kolmogorov-Smirnov test. Continuous variables that did not conform to a normal distribution were presented as median (IQR). Data were analyzed using the chi-square test, 2-tailed t test, ANOVA, Kruskal-Wallis H test, and multinomial logistic regression. Results: Among the 4098 participants, 84.63% (n=3468) accepted mpox vaccination. The median scores of KAP toward mpox were 43 (IQR 33-50), 33 (IQR 32-36), and 20 (IQR 19-24), respectively, with a median score of 73 (IQR 68-79) for vaccination-related practices. Multinomial logistic regression showed that factors associated with vaccination hesitancy (vs acceptance) included male individuals (odds ratio [OR] 1.416, 95% CI 1.158‐1.732), being an only child (OR 1.340, 95% CI 1.098‐1.635), no history of COVID-19 in family or friends (OR 1.520, 95% CI 1.161‐1.991), no influenza vaccination (OR 1.429, 95% CI 1.146‐1.783), and low mpox knowledge (OR 0.948, 95% CI 0.941‐0.955). Factors associated with vaccination rejection (vs acceptance) included male sex (OR 1.641, 95% CI 1.003‐2.686), high academic grade (OR 1.442, 95% CI 1.154‐1.802), family or friends working on COVID-19 frontlines (OR 2.243, 95% CI 1.337‐3.764), no internship experience (OR 2.049, 95% CI 1.076‐3.901), presence of organic diseases (OR 3.733, 95% CI 1.778‐7.838), and low mpox knowledge (OR 0.954, 95% CI 0.938‐0.971). Good self-reported health status was a protective factor against refusal (OR 0.748, 95% CI 0.580‐0.965). Conclusions: The high willingness to receive mpox vaccination among Chinese medical students and its determinants, as identified in this study, carry clear implications for both education and policy. These findings inform the design of targeted health education programs for students and guide the development of evidence-based prevention strategies on campuses during public health emergencies.

The coronavirus disease 2019 (COVID-19) was an international public health emergency announced by the World Health Organization (WHO) on 31 January 2020 [1–4]. As of 4 August 2024, a total of 775 867 547 confirmed cases of COVID-19, including 7 057 145 deaths, have been reported to the WHO. As one of the many seriously affected countries, China has […]