The number and gender of children synergistically impact on a mother's practice of human papillomavirus testing and attitudes towards vaccination in Shenzhen, China.

It has been reported that the number of children a mother has may impact on her concept of health and behavior, and there is a need to understand the role of children in the acceptability of human papillomavirus (HPV) testing and vaccination among Chinese mothers. A cross-sectional survey was conducted between January and June 2015 in Shenzhen, China, in which representative females were recruited from healthcare institutions through the Cervical Cancer Prevention Network. A total of 9058 females were included. Women with one child had a greater awareness of HPV (49.9 % versus 34.0 %, p < 0.001) and its vaccine (26.0 % versus 15.0 %, p <0.001), and were more likely to receive HPV testing (38.1 % versus 25.8 %, p <0.001) and vaccination (65.7 % versus 60.6 %, p <0.001) than those with two or more children. Mothers having one child who was a daughter were more likely to receive HPV testing (OR 1.53, 95 %CI 1.25-1.89) and HPV vaccination (OR 1.63, 95 %CI 1.38-1.93) than those having two or more children but without a daughter (p for interaction 0.014 and <0.001, respectively). Our findings provide a novel insight into cervical cancer prevention: a smaller number of children helps to improve a mother's awareness of HPV and its vaccine, to promote their practice for HPV testing, and to promote the acceptability of HPV vaccination. Having one or more daughters synergistically interacts with having fewer children in facilitating a mother's positive involvement in action against HPV infection.