{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T18:43:54Z","timestamp":1784227434665,"version":"3.55.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01IP001121"],"award-info":[{"award-number":["U01IP001121"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005801","name":"Facebook","doi-asserted-by":"publisher","award":["Unrestricted Gift"],"award-info":[{"award-number":["Unrestricted Gift"]}],"id":[{"id":"10.13039\/100005801","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>\n                    The development and deployment of COVID-19 vaccines were crucial to combating the global pandemic, but vaccine hesitancy posed a challenge and remains a crucial problem today. Understanding who delays or refuses vaccination and why can help with current and future vaccine campaigns by suggesting both target audiences and messaging. Because hesitant individuals report different reasons for their hesitancy, distinguishing between different types of hesitancy can help identify who will benefit from which strategies. Using 311,494 responses from the U.S. COVID-19 Trends &amp; Impact Survey (CTIS), we used Latent Class Analysis to examine distributions of concurrently reported reasons for hesitancy, comparing distributions of responses across racial and ethnic groups. Using responses from both the early phase of vaccine availability and after all U.S. adults became eligible in the spring of 2021, we investigated differences between prospective vs. lived hesitancy. LCA revealed three different types of COVID-19 vaccine hesitancy. Some respondents primarily reported health-related concerns as reasons for hesitancy, while others indicates distrust of the government and vaccines, but the majority report fewer distinct reasons. In February 2021, White, Black, and Hispanic respondents had similar distributions of these types, but by May the results diverged. In May, White respondents were more likely to report trust concerns than Black or Hispanic respondents, who were more likely to report health concerns as their reasons for continued hesitancy. Our results contribute to the development of a more nuanced picture of COVID-19 vaccine hesitancy and the motivations behind it. The distinction between\n                    <jats:italic>health-concerned<\/jats:italic>\n                    and\n                    <jats:italic>distrustful<\/jats:italic>\n                    types of vaccine hesitancy highlights the importance of confidence in vaccine uptake, and in targeted strategies to address address hesitancy.\n                  <\/jats:p>","DOI":"10.1371\/journal.pgph.0004942","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:24:10Z","timestamp":1780507450000},"page":"e0004942","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Health concerns and government distrust: Variation in types of COVID-19 vaccine hesitancy by racial and ethnic group before and at universal vaccine eligibility in the US"],"prefix":"10.1371","volume":"6","author":[{"given":"Meg","family":"Ellingwood","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6658-514X","authenticated-orcid":true,"given":"Alex","family":"Reinhart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Phuong","family":"Do","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-5286","authenticated-orcid":true,"given":"Robin","family":"Mejia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"pgph.0004942.ref001","article-title":"The COVID-19 \u201cVaccination Line\u201d: An Update on State Prioritization Plans","author":"J Kates","year":"2021","journal-title":"KFF Health News"},{"key":"pgph.0004942.ref002","article-title":"Who is eligible for a COVID-19 vaccine in your state?","author":"K Hubbard","year":"2021","journal-title":"US News & World Report"},{"key":"pgph.0004942.ref003","article-title":"Racial Disparities in Flu Vaccination: Implications for COVID-19 Vaccination Efforts","author":"S Artiga","year":"2020","journal-title":"KFF Health 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Szilagyi","year":"2021","journal-title":"JAMA"},{"key":"pgph.0004942.ref010","doi-asserted-by":"crossref","first-page":"107724","DOI":"10.1016\/j.intimp.2021.107724","article-title":"COVID-19 vaccine hesitancy and related fears and anxiety","volume":"97","author":"A Bendau","year":"2021","journal-title":"Int Immunopharmacol"},{"key":"pgph.0004942.ref011","doi-asserted-by":"crossref","first-page":"106727","DOI":"10.1016\/j.ypmed.2021.106727","article-title":"The role of trust in the likelihood of receiving a COVID-19 vaccine: Results from a national survey","volume":"153","author":"PG Szilagyi","year":"2021","journal-title":"Prev Med"},{"key":"pgph.0004942.ref012","doi-asserted-by":"crossref","first-page":"113638","DOI":"10.1016\/j.socscimed.2020.113638","article-title":"Correlates and disparities of intention to vaccinate against COVID-19","volume":"272","author":"T Callaghan","year":"2021","journal-title":"Soc Sci Med"},{"issue":"4","key":"pgph.0004942.ref013","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1037\/pspa0000320","article-title":"Two large-scale global studies on COVID-19 vaccine hesitancy over time: Culture, uncertainty avoidance, and vaccine side-effect concerns","volume":"124","author":"JG Lu","year":"2023","journal-title":"J Pers Soc Psychol"},{"issue":"1","key":"pgph.0004942.ref014","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3390\/vaccines10010106","article-title":"Vaccination against COVID-19: Factors That Influence Vaccine Hesitancy among an Ethnically Diverse Community in the UK","volume":"10","author":"EJ Cook","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"pgph.0004942.ref015","doi-asserted-by":"crossref","first-page":"101569","DOI":"10.1016\/j.pmedr.2021.101569","article-title":"COVID-19 vaccine hesitancy January-May 2021 among 18\u201364 year old US adults by employment and occupation","volume":"24","author":"WC 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real-time measurement of COVID-19 symptoms, risks, protective behaviors, testing, and vaccination","volume":"118","author":"JA Salomon","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pgph.0004942.ref023","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jclinepi.2022.05.008","article-title":"Part I: A friendly introduction to latent class analysis","volume":"147","author":"K Aflaki","year":"2022","journal-title":"J Clin Epidemiol"},{"key":"pgph.0004942.ref024","unstructured":"Kim Y, Chung H. 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COVID-19 vaccine uptake: A mediation framework","volume":"41","author":"L Na","year":"2023","journal-title":"Vaccine"},{"key":"pgph.0004942.ref033","doi-asserted-by":"crossref","first-page":"928","DOI":"10.15585\/mmwr.mm7025e2","article-title":"COVID-19 Vaccination Coverage and Intent Among Adults Aged 18\u201339 Years \u2014 United States, March\u2013May 2021","volume":"70","author":"BN Baack","year":"2021","journal-title":"Morbidity and Mortality Weekly Report"},{"issue":"10","key":"pgph.0004942.ref034","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.28575","article-title":"COVID-19 Vaccine Acceptance and Access Among Black and Latinx Communities","volume":"4","author":"L Balasuriya","year":"2021","journal-title":"JAMA Network Open"},{"key":"pgph.0004942.ref035","doi-asserted-by":"crossref","first-page":"106833","DOI":"10.1016\/j.ypmed.2021.106833","article-title":"U.S. frontline workers and COVID-19 inequities","volume":"153","author":"DP 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