The Attitude-Uptake Gap in HPV Vaccination Among Adults Aged 18-45 Years in Poland: Sociodemographic and Psychosocial Correlates.

BACKGROUND: Favorable attitudes toward human papillomavirus (HPV) vaccination do not necessarily translate into vaccine uptake, particularly among young adults who were too old to benefit from recently expanded adolescent programs. We assessed the gap between attitudes and self-reported HPV vaccination and examined sociodemographic and psychosocial correlates of uptake in a non-probability sample of young adults residing in Poland. METHODS: An anonymous cross-sectional online survey was conducted from 12 January 2025 to 14 August 2026. The analysis included 334 complete responses from adults aged 18-45 years recruited through social media. The 42-item questionnaire assessed sociodemographic characteristics, HPV knowledge, vaccine trust, perceived personal threat, social exposure to vaccinated persons, access, and barriers. Group differences were examined using Pearson chi-square tests. Multivariable logistic regression estimated adjusted odds ratios (aORs) for self-reported vaccination; two respondents reporting sex as other/prefer not to say were excluded from the sex-adjusted model (N=332). RESULTS: Overall, 113/334 participants (33.8%) reported HPV vaccination, whereas 300/334 (89.8%) considered vaccination important. Among unvaccinated respondents, the most frequent barriers were lack of a clinician recommendation (83/221; 37.6%) and cost (75/221; 33.9%). In the adjusted model, vaccination was associated with female sex (aOR 2.49, 95% CI 1.10-5.65), greater vaccine trust (aOR 1.70 per scale point, 95% CI 1.17-2.45), and knowing a vaccinated person (aOR 7.73, 95% CI 4.02-14.86). Compared with participants aged <20 years, those aged 23-25 years (aOR 0.33, 95% CI 0.12-0.86) and >25 years (aOR 0.27, 95% CI 0.09-0.86) had lower odds of vaccination. Objective HPV knowledge, education, urban residence, region, and medical/health-related study or work were not independently associated with uptake in this exploratory model. Model AUC was 0.846. CONCLUSIONS: In this non-probability sample, the gap between endorsing HPV vaccination as important and self-reported uptake was substantial; this construct should not be interpreted as an intention-behavior gap. Vaccine confidence and reported social exposure showed stronger cross-sectional associations with HPV vaccination than the exploratory objective-knowledge score, while lack of clinician recommendation and cost remained prominent barriers. These findings support evaluation of catch-up strategies that combine clear clinician recommendation, affordable and convenient access, gender-neutral cancer-prevention communication, and social normalization of vaccination.