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Abstract：
BACKGROUND: The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022.
OBJECTIVE: This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM.
METHODS: An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants\' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention.
RESULTS: A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001).
CONCLUSIONS: Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM\'s mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.
OBJECTIVE: This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory-related factors among Chinese YMSM.
METHODS: An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants\' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention.
RESULTS: A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2% to 88.4% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=-0.056, 95% CI -0.090 to -0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=-0.069, 95% CI -0.137 to -0.001).
CONCLUSIONS: Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM\'s mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress.
摘要：
背景：2022年全球人类猴痘（mpox）爆发主要影响与男性发生性关系的男性（MSM）。在中国,与男性发生性关系的年轻男性（YMSM）由于其性活动和在2022年底放宽的COVID-19限制而处于潜在的高痘病毒感染风险。
目的：本研究旨在调查4种不同情景下接受水痘疫苗接种和进行水痘检测的行为意向，并探讨其与背景和行为理论相关因素的关系。
方法：于2022年9月对中国6个代表性省份18-29岁的YMSM进行了在线横断面调查。招募的参与者（招募率=2918/4342，67.2％）被要求自我管理一份匿名问卷，该问卷是根据有关水痘和经典健康行为理论的先验知识设计的。关于参与者背景的数据，水痘知识和认知，水痘疫苗接种和测试认知，收集接受水痘疫苗接种和进行水痘检测的行为意向。进行描述性分析以及单变量和多变量线性回归。使用地理检测器测量行为意图的分层异质性。
结果：共纳入2493个YMSM，平均年龄为24.6（SD2.9）岁。根据情景，有接受水痘疫苗接种的行为意向的患病率从66.2%到88.4%不等。流行状况和成本各不相同。在所有情况下，无论是否存在症状和费用，均具有水痘测试意图的患病率均超过90％。与疫苗接种意向相关的积极因素包括水痘知识(ba=0.060,95%CI0.016-0.103),天花感知易感性(BA=0.091，95%CI0.035-0.146)，天花的严重程度(BA=0.230，95%CI0.164-0.296)，由天花引起的情绪困扰（BA=0.270，95%CI0.160-0.380），水痘疫苗接种的感知益处(BA=0.455，95%CI0.411-0.498)，水痘疫苗接种的自我效能(ba=0.586，95%CI0.504-0.668)，并有1名男性性伴侣（ba=0.452，95%CI0.098-0.806），而负面因素是疫苗接种障碍（ba=-0.056，95%CI-0.090至-0.022）。与测试意图相关的积极因素是感知到的天花严重程度(ba=0.283，95%CI0.241-0.325)，羊痘检测的感知益处(BA=0.679，95%CI0.636-0.721)，水痘测试自我效能感(BA=0.195，95%CI0.146-0.245)，有1个男性性伴侣（BA=0.290，95%CI0.070-0.510），并与MSM面对面聚会(ba=0.219，95%CI0.072-0.366)，而负面因素是天花引起的情绪困扰（ba=-0.069，95％CI-0.137至-0.001）。
结论：在中国YMSM中，进行水痘测试的意图是最佳的，而水痘疫苗接种意向还有改进的空间。未来的国家应对措施应该提高YMSM的水痘知识，传播有关水痘和预防措施的最新信息，改善预防性服务的可访问性和隐私性，并就积极应对相关的情绪困扰提供建议。
目的：本研究旨在调查4种不同情景下接受水痘疫苗接种和进行水痘检测的行为意向，并探讨其与背景和行为理论相关因素的关系。
方法：于2022年9月对中国6个代表性省份18-29岁的YMSM进行了在线横断面调查。招募的参与者（招募率=2918/4342，67.2％）被要求自我管理一份匿名问卷，该问卷是根据有关水痘和经典健康行为理论的先验知识设计的。关于参与者背景的数据，水痘知识和认知，水痘疫苗接种和测试认知，收集接受水痘疫苗接种和进行水痘检测的行为意向。进行描述性分析以及单变量和多变量线性回归。使用地理检测器测量行为意图的分层异质性。
结果：共纳入2493个YMSM，平均年龄为24.6（SD2.9）岁。根据情景，有接受水痘疫苗接种的行为意向的患病率从66.2%到88.4%不等。流行状况和成本各不相同。在所有情况下，无论是否存在症状和费用，均具有水痘测试意图的患病率均超过90％。与疫苗接种意向相关的积极因素包括水痘知识(ba=0.060,95%CI0.016-0.103),天花感知易感性(BA=0.091，95%CI0.035-0.146)，天花的严重程度(BA=0.230，95%CI0.164-0.296)，由天花引起的情绪困扰（BA=0.270，95%CI0.160-0.380），水痘疫苗接种的感知益处(BA=0.455，95%CI0.411-0.498)，水痘疫苗接种的自我效能(ba=0.586，95%CI0.504-0.668)，并有1名男性性伴侣（ba=0.452，95%CI0.098-0.806），而负面因素是疫苗接种障碍（ba=-0.056，95%CI-0.090至-0.022）。与测试意图相关的积极因素是感知到的天花严重程度(ba=0.283，95%CI0.241-0.325)，羊痘检测的感知益处(BA=0.679，95%CI0.636-0.721)，水痘测试自我效能感(BA=0.195，95%CI0.146-0.245)，有1个男性性伴侣（BA=0.290，95%CI0.070-0.510），并与MSM面对面聚会(ba=0.219，95%CI0.072-0.366)，而负面因素是天花引起的情绪困扰（ba=-0.069，95％CI-0.137至-0.001）。
结论：在中国YMSM中，进行水痘测试的意图是最佳的，而水痘疫苗接种意向还有改进的空间。未来的国家应对措施应该提高YMSM的水痘知识，传播有关水痘和预防措施的最新信息，改善预防性服务的可访问性和隐私性，并就积极应对相关的情绪困扰提供建议。
