Willingness and compliance with Helicobacter pylori screening among Chinese university students aged 18-25 years: a cross-sectional study.

[BACKGROUND] Helicobacter pylori infection is a major risk factor for various gastrointestinal diseases, including gastric cancer. While early screening and eradication are critical in young adults, screening rates in this age group remain low. Despite expert recommendations targeting those aged 18-25 years, few studies have examined the factors influencing their willingness to undergo screening or comply with testing procedures. This study aimed to explore these determinants in this population.

[MATERIALS AND METHODS] A cross-sectional study was conducted from November 2024 to January 2025 among individuals aged 18-25 years at a university in China. Participants completed electronic questionnaires after undergoing serological testing, and the C-urea breath test (C-UBT) and the H. pylori stool antigen test (HpSAT) were also offered. The primary and secondary outcomes were screening willingness and compliance, respectively. Chi-squared tests and logistic regression identified associated factors.

[RESULTS] The university's target population was approximately 30,000. Eighty-two were randomly selected, yielding a theoretical sample size of 2460. Of these, 595 students participated, and 576 valid questionnaires were collected. The screening rate was 24.2% (595/2460); among respondents, 86.5% (498/576) expressed willingness to undergo H. pylori screening. Multivariate analysis showed that female sex, complete acceptance of serological testing, and willingness to pay were significantly associated with greater screening willingness. Compliance rates were highest for the C-UBT (100%, 576/576), followed by serological testing (83.3%, 480/576) and the HpSAT (66.7%, 384/576).

[CONCLUSION] Although willingness to undergo H. pylori screening was high among college students aged 18-25 years, the actual screening rate remained relatively low. Enhancing acceptance of serological testing and implementing diverse health education strategies to boost motivation may help increase screening uptake. For confirming H. pylori infection in this population, a combination of C-UBT and serological testing is recommended, while HpSAT is not advised for population-level screening in this target group.