Objective To understand the current status and differences in related Knowledge, Attitudes, and Practices (KAP) regarding influenza prevention and control among parents of students and school health management personnel, and examine the associations between knowledge, attitude, and prevention and control practice behaviors, thereby providing evidence for improving school-based influenza prevention and control strategies. Methods A cross-sectional survey was conducted in 16 cities in China in 2025. The participants included students’ parents and school health management personnel. The questionnaire collected information on demographic characteristics and KAP related to influenza prevention and control. Knowledge and attitude scores were classified as qualified or unqualified based on the predefined thresholds. Based on vaccination or implementation of prevention and control work and the corresponding intentions, practice behaviors were uniformly categorized into three ordered stages: no intention or hesitation, intention without action, and action. Chi-square tests were used to compare the qualification rates of knowledge and attitude across groups with different characteristics. Multivariate logistic regression models were constructed to identify the influencing factors associated with knowledge and attitude qualification. Ordinal logistic regression models were further used to examine the associations of knowledge and attitude with the stages of prevention and control practice behavior in both populations. Results A total of 4 763 parents of students and 6 865 school health management personnel were included. School health management personnel had higher knowledge and attitude scores than students’ parents (P<0.001). The distribution of practice behavior stages differed significantly between the two groups (P<0.001). Most school health management personnel were predominantly in the “action” stage, whereas a relatively high proportion of students’ parents remained in the “no intention or hesitation” or “intention without action” stages. Multivariate analysis showed that among parents, those with higher educational attainment were more likely to achieve qualified knowledge and attitudes. Among school health management personnel, higher educational attainment and specific job positions were associated with higher knowledge and attitude qualification levels. Ordinal logistic regression showed that among parents of students, higher attitude scores were associated with being in a more advanced stage of prevention and control practice, whereas the influence of knowledge scores on the behavioral stage was relatively weaker. Among school health management personnel, higher knowledge scores were associated with being in a more advanced practice stage, whereas no significant association was found between attitude scores and the stage of prevention and control practice behavior. Conclusions There are marked differences between parents of students and school health management personnel in terms of influenza prevention and control knowledge, attitude, and practice behavior stages. Moreover, the patterns through which knowledge and attitude influence prevention and control behaviors differ between the two populations. Campus influenza prevention and control interventions should simultaneously address both the family and school dimensions, optimizing health education content, training mechanisms, and organizational support measures according to the characteristics of different groups, so as to facilitate the effective implementation of prevention and control behaviors.

Objective To understand the awareness of influenza and influenza vaccine among parents of children in Gulou District, Nanjing, and to examine the influencing factors associated with childhood vaccination. Methods A cross-sectional study design with a stratified random sampling method was adopted. A questionnaire survey was conducted in April 2025 among 20 724 parents of children in Gulou District. Multivariate logistic regression was used to analyze factors associated with childhood vaccination. For the 12 218 parents who did not have their children vaccinated but believed that the vaccine could reduce the risk of infection. The stratified analyses were performed using the chi-square test, with the child’s vaccination history in the previous influenza season, the child’s age, and the guardian’s education level, and identity as stratifying variables, to compare differences in the mention rates of various barriers across subgroups. Results The annual influenza vaccination rate among children in the 2024-2025 surveillance season was 37.24%. Multivariate logistic regression analysis showed that children’s age (7-<10 years: OR=0.66, ≥10 years: OR=0.63) and the guardian’s education level (specialized college: OR=0.81) were negatively associated with childhood influenza vaccination. Guardian identity (father: OR=1.32, other: OR=1.76), guardian’s knowledge about influenza vaccine (“believing influenza poses a considerable threat to children’s health”, OR=1.49; “believing influenza poses a very serious threat”, OR=2.16; “agreeing that the influenza vaccine can reduce infection risk”, OR=1.61; “knowing the optimal timing for influenza vaccination”, OR=1.60; “understanding the reason for annual influenza vaccination”, OR=1.33), and a history of vaccination in the previous influenza season (OR=10.57) were positively associated with childhood influenza vaccination. Among parents who “considered the vaccine effective but did not have their child vaccinated,” the main barriers were concerns about side effects, doubts about vaccine efficacy, convenience barriers, and lack of clear guidance. Stratified analysis revealed that parents of children without a vaccination history in the previous influenza season reported a higher proportion of “concern about side effects” compared to those with a vaccination history (χ2=407.07, P<0.001); conversely, the group with a vaccination history reported higher proportions of “inconvenient time or location” (χ2=110.25, P<0.001) and “lack of clear guidance” (χ2=17.86, P<0.001). Significant differences in barriers such as “concern about side effects” and “belief that symptoms are mild and vaccination is unnecessary” were also observed across different child age groups and guardian identities (all P<0.001). Conclusions Parents of children in Gulou District, Nanjing, generally have a relatively high level of knowledge about influenza and the influenza vaccine. However, the childhood influenza vaccination rate remains low, indicating a gap between knowledge, attitude, and practice. Different vaccination barriers vary significantly across population subgroups with distinct characteristics. Multi-dimensional, tiered intervention strategies are recommended to guide parents toward correct perceptions, improve childhood influenza vaccination coverage, and reduce the risk of influenza transmission in schools.

Objective To evaluate the changes and influencing factors of influenza vaccination coverage after the launch of the special influenza vaccination campaign in 2023 among primary and middle school students from 2022 to 2024 in Minhang District, Shanghai, and to analyze the protective effect of the influenza vaccine in this population in 2024, providing a scientific basis for improving school-based influenza prevention and control strategies. Methods Based on student enrollment data from the Minhang District Education Bureau, vaccination data from the immunization program system, and influenza case data from the disease surveillance system, the χ2 test was used to compare the differences in vaccination coverage among groups with different sexes, educational stages, and school management categories, and the protective rate of vaccine in 2024 was calculated. Results The influenza vaccination coverage rates among primary and middle school students in Minhang District from 2022 to 2024 were 4.23% (8 138/192 influenza 603), 21.02% (42 528/202 276), and 10.87% (22 595/207 913), respectively. After the launch of the school-based influenza vaccination campaign in 2023, the coverage rate significantly increased compared to that of 2022 (P<0.001). Girls had significantly higher vaccination coverage than boys (P<0.01). The vaccination coverage among students with Shanghai household registration was higher than that among students without Shanghai household registration (P<0.001) in 2022 and 2024. The vaccination coverage showed a significant downward trend with increasing educational stages (P<0.01). The vaccination coverage of schools under the jurisdiction of the bureau and towns was higher than that in public schools (P<0.001). The school-based vaccination campaign was mainly concentrated in the afternoon of Friday, on Monday and Saturday. The overall protective rate of vaccine in 2024 was 8.55% (23.99% after standardization). The protective effect was significant in primary and middle school students with Shanghai household registration, and those without vaccination history in 2023. The protective rate was 65.70% among middle school students without any vaccination history. Conclusions The school-based influenza vaccination campaign among primary and middle school students in Minhang District is associated with a significant increase in vaccination coverage. Sex, household registration, educational stage, school management category, and vaccination convenience (time and distance) are the crucial factors influencing vaccination coverage. The influenza vaccine shows an estimated protective effect among primary and middle school students in 2024, with population heterogeneity. Targeted optimization of vaccination services and publicity strategies is needed to improve vaccination coverage among key populations.

Objective To analyze the epidemiological characteristics and spatial distribution patterns of pertussis among school-aged children and adolescents in China, explore its influencing factors, and to provide a basis for optimizing prevention and control strategies. Methods Individual pertussis case-based data for school-aged children and adolescents aged 6-22 years were obtained from the China Information System for Disease Control and Prevention during 2018 and 2024. Descriptive epidemiological methods were applied to analyze the temporal, spatial, and population distribution characteristics of reported pertussis cases among school-aged children and adolescents. The chi-square test was applied to compare differences between groups. Spatial autocorrelation analyses of global and local Moran’s I, and spatial regression analyses were performed using R 4.4.3 software to investigate the spatial clustering of incidence rates and their influencing factors. Results From 2018 to 2019, the number of pertussis cases in China showed an increasing trend, experienced a temporary decline in 2020, and increased rapidly from 2021 to 2024, with an explosive surge in 2024. A total of 191 994 pertussis cases among school-aged children and adolescents were reported in 2024, representing a 20.4-fold increase compared with 2023. Temporally, pertussis exhibited a consistent summer peak, while the 2024 outbreak showed a peak in spring and summer (April-July), with May as the peak month, occurring slightly earlier than in previous years. Regarding population distribution, children aged 6-9 years consistently constituted the group with the highest proportion, accounting for 83.5% of total cases in 2024, with 7-9 years as the peak age range. Cases among adolescents aged 10 and above increased significantly, indicating an upward shift in age. Spatially, the incidence rates decreased from the southeastern coastal regions toward the northwestern inland areas, with the Yangtze River Delta identified as a “high-high” clustering area. Global spatial autocorrelation analysis demonstrated significant spatial clustering of pertussis incidence (Moran’s I = 0.319, P<0.01). Spatial regression model revealed a positive correlation between the comprehensive economic development index and the number of reported cases (coefficient=1 923.12, P=0.007 7), whereas the number of hospital beds per 1 000 people showed no significant effect. Conclusions In 2024, the incidence of pertussis among school-aged children and adolescents in China exhibits a high-incidence pattern, characterized by pronounced seasonality, an upward shift in age, and spatial clustering characteristics. However, potential imperfections in the surveillance system require further attention. Economic development level is correlated with the number of reported cases, and the transmission linkages between neighboring regions might be possible. To actively respond to the current pertussis prevention and control efforts in China, it is recommended to accelerate vaccine development and improve the testing and immunization systems.

Objective To analyze the current status and influencing factors of Knowledge, Attitudes, and Practices (KAP) regarding Human Papillomavirus (HPV) prevention and control from the dual perspectives of educational practitioners (including school principals, healthcare staff, and teachers) and student guardians, thereby providing a reference for enhancing nationwide school-based HPV prevention and control capacity. Methods A cross-sectional survey design was adopted from July to December 2025. A total of 6 872 educational practitioners and 5 250 student guardians from eastern, central, western, and northeastern regions of China were surveyed for their knowledges of HPV prevention, attitude toward HPV vaccination and related actions. Descriptive statistics, χ2 tests, and logistic regression analysis were applied to examine the knowledge and attitude levels, their influencing factors and the association with practical behaviors in both groups. Results The qualified rate of HPV knowledge among educational practitioners (84.9%) was significantly higher than that of student guardians (56.7%). Multivariate analysis showed that being female, working as school healthcare staff, and understanding relevant policies were positive factors for achieving qualified knowledge among educators. For guardians, a higher education level and policy awareness were significant positive factors for knowledge enhancement. Although 93.0% of student guardians held a positive attitude toward HPV vaccination for their children, the actual vaccination rate was only 7.0%. Insufficient health risk awareness, concerns regarding vaccine safety, and vaccination costs were the primary barriers hindering guardians’ practical actions. Conclusions (1) The KAP patterns for HPV prevention differ significantly between educators and guardians. Guardians present a “high intention, low knowledge” profile and a clear knowledge-action gap. (2) Policy awareness critically influences the cognition and attitudes of both groups. Moving forward, school doctors and homeroom teachers should serve as central hubs for health education to address guardians’ safety concerns. Concurrently, leveraging the HPV vaccine’s integration into the National Immunization Program, multi-channel policy advocacy should be enhanced to translate intentions into actual vaccination.

Objective To explore the sleep quality status and its influencing factors among adolescents, and to provide a basis for improving adolescents’ sleep quality in Nantong. Methods From January to March 2024, adolescents in Nantong City were surveyed using the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9). Descriptive analysis was performed to analyze the current status of adolescents’ sleep quality. Multivariate logistic regression was used to identify influencing factors for sleep disorders. Results A total of 3 248 individuals were surveyed. The detection rate of sleep disorders was 12.25% (398/3 248). Insufficient sleep duration was found in 92.4% of adolescents. Mild depression was identified in 610 individuals (18.78%), and moderate-to-severe depression in 188 individuals (5.79%). Statistically significant differences in sleep disorder detection rates were observed across groups with different daily exercise durations and depression severity levels (all P<0.05). Multivariate logistic regression analysis showed that mild depression (OR=3.68, 95%CI: 2.87-4.71) and moderate-to-severe depression (OR=13.61, 95%CI: 9.83-18.81) were risk factors for poor sleep quality. Daily exercise duration of 1-2 hours (OR=0.51, 95%CI: 0.41-0.64) and 2-3 hours (OR=0.41, 95%CI: 0.25-0.69) was protective factors. Conclusion Adolescents can regulate their subjective sleep quality, sleep duration, and daytime dysfunction through appropriate exercise, thereby improving their sleep quality.

Objective To investigate and analyze the epidemiological characteristics and main risk factors of an influenza outbreak at a primary school in Yingjiang County, Dehong Prefecture, and to provide a scientific basis for improving emergency response capacity to school outbreaks and strengthening campus influenza prevention and control. Methods In accordance with the Guidelines for the Management of Influenza-like Illness Outbreaks (2018 edition), a field epidemiological investigation was conducted on influenza cases occurring at the school between June 8 and July 1, 2024. Descriptive epidemiological analysis was used to assess the spatial distribution of the cases by time, place, and person. A case-control study was performed to identify risk factors associated with the outbreak. Throat swabs were collected from cases and tested by nucleic acid assay for confirmation. Results A total of 44 influenza cases were reported (43 students and 1 teacher), of whom 15 were laboratory-confirmed cases, resulting in an overall prevalence rate of 4.26%. Students in Grade 1 and 2 accounted for 65.91% (29/44) of cases, with a prevalence rate (9.48%) significantly higher than that in other grades (2.07%, χ2=28.97, P<0.05). Among them, students aged 7-8 years constituted the majority (26 students). The prevalence rate among day students (5.87%) was significantly higher than among boarding students (1.91%, χ2=9.58, P<0.05). The influenza vaccination coverage rate among all teachers and students was 26.55% (27.66% for students, 9.52% for faculty), but there was no significant association between vaccination history and illness occurrence (χ2=1.65, P>0.05). Case-control study analysis indicated that getting caught in the rain within 3 days prior to onset was the primary risk factor for increasing the likelihood of the outbreak (OR=18.87, 95%CI: 2.28-156.39), while mask-wearing (OR=0.06, 95%CI: 0.01-0.24) and self-perceived good health status (OR=0.08, 95%CI: 0.02-0.27) were protective factors. Conclusions This outbreak is caused by the H1N1 influenza virus. Getting caught in the rain is the primary risk factor for the outbreak, while inadequate source control and implementation of prevention and control measures are the main reasons for the spread of the outbreak. It is recommended that schools should strengthen health education during the rainy season (e.g., avoiding rain exposure, wearing masks), increase vaccination coverage, and adopt comprehensive prevention and control measures to address influenza outbreaks.

Against the backdrop of declining physical activity levels and rising health risks among college students, college physical education urgently needs to shift from a skill-oriented to a literacy-oriented approach, aiming to foster students’ proactive exercise and health literacy. Based on a review of domestic and international research, this paper proposes a systematic teaching reform framework grounded in Outcome-Based Education (OBE) and the Technological Pedagogical and Content Knowledge (TPACK) model. The reform aims to promote the development of students’ self-directed health management and lifelong physical activity abilities. In terms of teaching content, it integrates knowledge from exercise science, health management, and psychology to construct an interdisciplinary curriculum system. Pedagogical methods incorporate exercise diary, behavioral goal setting, and digital health monitoring, forming a “goal setting-behavior execution-feedback optimization” learning cycle. At the teacher level, TPACK-oriented teaching competencies are emphasized. At the policy and environmental level, the construction of a campus health culture and an informatized support system is proposed. Research indicated that this reform pathway can significantly enhance university students’ exercise motivation, self-monitoring capabilities, and health literacy, facilitating a shift from “passive exercise” to “proactive health,” and provide theoretical foundations and practical pathways for innovating the paradigm of physical education in Chinese universities.

Objective To conduct an online intervention targeting health knowledge and skills related to children’s physical activity and screen exposure among parents of preschool children, analyze its intervention effects, and to promote increased physical activity and reduced screen exposure duration in preschoolers. Methods With a staged cluster sampling method, 396 parents of children aged 3-5 years from 3 kindergartens in Daxing District, Beijing, were recruited, with classes as the sampling units. Participants were divided into an intervention group (194 individuals) and a control group (202 individuals) based on kindergarten allocation. The intervention group received an online intervention, including daily push notifications related to health knowledge and weekly reading reminders. A self-designed questionnaire was used to collect baseline and post-intervention data on general characteristics of children and parents, as well as children’s physical activity and screen exposure. Mann-Whitney U tests, paired-sample Wilcoxon signed-rank tests, and linear mixed models were conducted using SPSS 26.0 software to analyze the effects of the intervention on preschool children’s physical activity and screen time. Results Wilcoxon test showed that both total physical activity and moderate-to-vigorous activity duration increased significantly in both groups after the intervention (P<0.001). Linear mixed models revealed that, after controlling for demographic variables, the intervention group showed an increase of 60.438 minutes in total physical activity duration and 38.539 minutes in moderate-to-vigorous physical activity duration compared to pre-intervention levels (P<0.001). After intervention, the intervention group had 27.596 minutes more total physical activity (P<0.001) and 19.651 minutes more moderate-to-vigorous physical activity duration (P<0.001) than the control group. No statistically significant differences were observed in screen exposure duration, either within or between groups (P>0.05). Conclusions An online health knowledge and skills intervention targeting parents of preschool children can effectively promote increased physical activity time in this population. However, its effect on reducing screen exposure duration was not significant. Future efforts may consider designing more targeted knowledge and skill education programs for parents and exploring effective methods and skills for controlling screen exposure duration, thereby facilitating the early establishment of physical activity behaviors in children.

Objective To investigate the Knowledge, Attitudes, and Practices (KAP) regarding Endocrine Disrupting Chemicals (EDCs) among college students in Dali City, and to provide a scientific basis for the prevention of EDC-related diseases in this population. Methods A total of 627 college students in Dali were enrolled using a stratified random cluster sampling method for a questionnaire survey from May to June 2025. A self-developed scale was used to assess students’ KAP regarding EDCs, and an EDCs Exposure Self-Assessment Scale was applied to evaluate EDCs exposure. The t-test/F-test, Pearson correlation analysis, and multiple linear regression model were performed to examine the associations between college students’ various characteristics and their KAP status. Results The scores of EDC-related KAP were 8.95±3.31, 29.98±6.42 and 23.84±4.07, respectively, with corresponding score rates of 63.93%, 93.69%, and 54.18%. These rates indicated suboptimal levels of knowledge and practices, whereas the attitude was excellent. Multivariate analysis showed that female students had higher knowledge scores (β=0.095, P=0.030), whereas students majoring in non-medicine (β=-0.190, P<0.001) and those who had not learned environment-related knowledge (β=-0.142, P<0.001) had lower knowledge scores. Minority students had higher attitude scores (β=0.094, P=0.018), while higher self-assessment exposure scores were associated with lower attitude scores (β=-0.140, P=0.001). Students with monthly living expenses>1 500 yuan had higher practice scores, indicating more risky practices (β=0.117, P=0.005); students without environment-related diseases had lower practice scores, indicating better practices (β=-0.132, P=0.002); and higher self-assessment exposure scores were associated with higher practice scores, indicating more risky practices (β=0.188, P<0.001). Conclusions College students in Dali exhibit favorable attitudes toward EDCs. However, there is still considerable room for improvement in both knowledgc masey and actual behaviors. Targeted health education on EDCs should be strengthened, especially among male students, students who are non-medical majors, and those without prior exposure to environmental-related knowledge. And behavioral interventions should be prioritized for students with higher monthly living expenses, those with environment-related diseases, and those with higher self-assessed exposure scores.

Objective To analyze the current status of acne cognition and awareness of risk factors among college students in Zigong City, and to provide a theoretical basis and practical guidance for acne prevention, treatment, and popular science education in this targeted population. Methods From March to April 2025, the stratified cluster random sampling method was adopted to select research subjects, and a questionnaire survey was conducted among college students at a university in Zigong City. Data regarding acne cognition and awareness of risk factors were collected. Categorical data were presented as frequencies and constituent ratios, and intergroup comparisons were performed using the chi-square test. Results A total of 1 248 valid questionnaires were retrieved. Respondents who reported being unaware, partially aware, fairly aware, and very aware of acne accounted for 5.6%, 51.0%, 36.4%, and 7.0%, respectively. The primary source of information (74.8%) was the Internet, while only 46.9% had consulted a physician. Merely 10.3% of students recognized acne as a disease requiring medical attention. There were significant differences in gender, grade level, and history of acne (P<0.001). In addition, 86.5% of the students knew that acne occurs not only in adolescence, and 93.9% knew that acne is preventable and treatable. The awareness rates of external medications, oral medications, traditional Chinese medicine, and medical skin care products were all over 50%, whereas the awareness rates of laser therapy, acne extraction, chemical peeling, intense pulsed light, red and blue light therapy, and photodynamic therapy were relatively low. The vast majority of students believed that acne exerts multifaceted impacts. Female students were significantly, more likely than males to report that acne adversely affected mood, caused skin discomfort, and impaired physical appearance and self-confidence (P<0.001). The overall awareness rate of acne risk factors was 95.8%. Awareness rates for most specific risk factors exceeded 90%, whereas awareness rates for constipation, genetics, electronic device use, sun exposure, and dairy consumption were comparatively lower. Significant differences in awareness were observed across genders, grade levels, student origins, and whether participants had received medical education (P<0.05). Conclusions College students exhibit inadequate cognition regarding acne. It is imperative to develop differentiated health education programs, with particular emphasis on reinforcing the understanding of acne as a medical condition and promoting knowledge of modern therapeutic modalities, thereby enhancing overall awareness and improving the prevention and management of acne among this population.

Objective To understand the epidemiological characteristics of varicella in Xiangshui County from 2017 to 2024, and to evaluate the protective effectiveness of the varicella vaccine. Methods Data on the reported varicella cases in Xiangshui County from 2017 to 2024 from the China Information System for Disease Control and Prevention were analyzed using descriptive epidemiological methods. The screening method was applied to varicella vaccination data in the Jiangsu Provincial Integrated Immunization Service Management Information System corresponding to individual varicella cases to assess the vaccine effectiveness. Results The average annual reported incidence rate of varicella in Xiangshui County from 2017 to 2024 was 41.45 per 100 000, showing an overall declining trend (χ2trend=156.95, P<0.001). The incidence exhibited a distinct bimodal seasonal distribution, with annual peaks occurring from May to July and from October to January of the following year. The average annual reported incidence rates were 50.11 per 100 000 for males and 38.29 per 100 000 for females, with the incidence rate in males being significantly higher than in females (χ2= 29.46, P<0.001). Cases were primarily concentrated in individuals aged 0-19 years, with the highest number of cases (622, accounting for 38.85% of the total) in the 5-9 years age group. The majority of cases were students, accounting for 69.71% of the total cases. The overall vaccine effectiveness was 95.71%. Breakthrough cases were more common 5-9 years after vaccination, with the highest number (43 cases) occurring in the 5th year post-vaccination. Conclusions From 2017 to 2024, the incidence of varicella in Xiangshui County has gradually declined, with the age of onset shifting toward older groups, and students being the most affected population. Surveillance and immunization efforts should continue to be strengthened in key settings such as schools and childcare institutions. Furthermore, in response to the new trend of increasing age of onset, varicella vaccination among adolescents should be enhanced to control the occurrence of outbreaks.