{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T20:33:20Z","timestamp":1744230800393,"version":"3.37.0"},"reference-count":25,"publisher":"American Public Health Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p> Objectives. To identify factors associated with persistent COVID-19 vaccine refusal among Nebraska residents 6 months after an initial COVID-19 diagnosis. <\/jats:p><jats:p> Methods. Using case investigation surveillance data and vaccination records from the Nebraska Department of Health and Human Services, a cohort of 16\u2009344 unvaccinated, COVID-19\u2012confirmed individuals (May 2021\u2012February 2023) were asked for their reason for nonvaccination (RNV), then followed for 6 months to assess subsequent vaccination status. We used a modified Poisson regression to estimate risk of unvaccinated status at follow-up against predictors, including RNV, demographic characteristics, adherence to mitigation measures, hospitalization, and rurality. <\/jats:p><jats:p> Results. Compared with those whose RNV was missed opportunity\/lack of convenience, individuals who cited religious exemption (adjusted incidence risk ratio [AIRR\u2009=\u20091.36; 95% confidence interval [CI]\u2009=\u20091.31, 1.41), philosophical objection (AIRR\u2009=\u20091.28; 95% CI\u2009=\u20091.24, 1.34), or institutional confidence\/complacency concerns (AIRR\u2009=\u20091.26; 95% CI\u2009=\u20091.19, 1.33) showed greatest risk of nonvaccination. Older age, nonadherence to mitigation measures, and higher rurality are positively associated with nonvaccination. Minority status and hospitalization were correlated with vaccination. <\/jats:p><jats:p> Conclusions. Ideology-centered objections held significant weight among previously infected individuals who displayed sustained reluctance toward COVID-19 vaccination. Distinguishing sources of misinformation among ideologically similar communities could instigate reconsideration for vaccination. ( Am J Public Health. 2025;115(3):414\u2013424. https:\/\/doi.org\/10.2105\/AJPH.2024.307921 ) <\/jats:p>","DOI":"10.2105\/ajph.2024.307921","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T21:03:07Z","timestamp":1739394187000},"page":"414-424","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Persistent COVID-19 Vaccine Refusal Among Previously Infected Patients in Nebraska"],"prefix":"10.2105","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5022-4289","authenticated-orcid":false,"given":"He (Julia)","family":"Bai","sequence":"first","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7583-8495","authenticated-orcid":false,"given":"David","family":"Brett-Major","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4044-1989","authenticated-orcid":false,"given":"Yi","family":"Du","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai","family":"Paritala","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4928-6532","authenticated-orcid":false,"given":"Edward S.","family":"Peters","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0265-2400","authenticated-orcid":false,"given":"Kendra L.","family":"Ratnapradipa","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. Ratnapradipa, and Patrick Maloney are with the College of Public Health, University of Nebraska Medical Center, Omaha."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2376-9819","authenticated-orcid":false,"given":"Patrick","family":"Maloney","sequence":"additional","affiliation":[{"name":"He (Julia) Bai, David Brett-Major, Yi Du, Sai Paritala, Edward S. Peters, Kendra L. 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