Public Health Education and Promotion Commons^™

Determinants Of Multimorbidity Among Stroke Patients For Epidemiological Management In Indonesia's Agro-Coastal Communities, Krish Naufal Anugrah Robby, Isa Ma'rufi, Farida Wahyu Ningtyias, Latifatul Izzah, Nurjazuli Nurjazuli, Suhartono Suhartono, Muchlis Achsan Udji Sofro, Ida Srisurani Wiji Astuti, Olivia Listiowati Prawoto, Dedek Sutinbuk, Taufik Kurrohman, Elhoussin Ouassou

Kesmas

Multimorbidity remains a major public health challenge among stroke patients, particularly in agro-coastal communities characterized by socioeconomic vulnerability, limited healthcare access, and lifestyle changes. This study aimed to analyze the determinants of multimorbidity among stroke patients in agro-coastal communities. A quantitative observational analytical design was employed, involving 45 stroke patients selected through total sampling in Jember District, Indonesia. Data were collected through structured interviews, anthropometric measurements, and secondary health records. The model included biological, socioeconomic, healthcare access, and lifestyle as exogenous variables, with multimorbidity as the endogenous variable. Data were analyzed using PLS-SEM, including evaluation of measurement and structural models …

School-Centered Tobacco Retailer Exposure And Neighborhood Opportunity Across Urban And Rural Tennessee, Sima Namin Dr, Jacob Black, Jennifer Ferris, Robert E. Heidel Dr

Journal of Appalachian Health

Introduction: Tobacco retailer availability contributes to youth tobacco use, and retailers are concentrated in socioeconomically disadvantaged communities. However, few studies have examined how school-centered retailer exposure intersects with neighborhood opportunity in a predominantly rural Appalachian state.

Purpose: The purpose of this study is to assess the association between neighborhood opportunity and school-centered tobacco retailer exposure across Tennessee (TN), including differences by rurality and Appalachian status.

Methods: We constructed a tract-level, school-centered youth tobacco exposure index for TN using tobacco retailer locations and public and private K-12 school data. The index incorporated retailer proximity, density, and distance-decay accessibility measures. Child Opportunity …

Deaths Of Despair Among Cancer Survivors In Rural/Urban Appalachia (2000-2022), Jason Semprini, Anders Erickson, Nosa Osazuwa-Peters

Journal of Appalachian Health

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were …

Assessing Hpv And Hpv Vaccine Awareness And Perception Amongst Undergraduate Students, Maura Hawkins

Honors Theses

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States. Vaccination rates remain low among college-aged students despite an effective vaccine being available. This study investigates HPV and HPV vaccination-related knowledge, beliefs, and perceptions among undergraduate students to inform targeted intervention strategies. Participants included undergraduate students (n = 19) who attended one of three focus groups conducted in April 2025 at the University of South Alabama. Structured interview guides explored HPV knowledge, perceived risk and severity, attitudes towards vaccination, autonomy in health decision-making, trust in health information sources, and preferred educational strategies. Discussions were …

Urban-Rural Differences In The Association Between Physical Activity And Overweight/Obesity Among Indonesian Adolescents: A Cross-Sectional Study, Wahyu Wulandari, Mufti As Siddiq M. Irzal, Lady Farah Fatmawati

Jurnal Epidemiologi Kesehatan Indonesia

Adolescent overweight/obesity is an increasing public health concern and contributes to the risk of non-communicable diseases later in life. Physical activity plays an important role in weight regulation. However, its association with overweight/obesity may vary according to residential setting. This study aimed to examine the association between physical activity and overweight/obesity among adolescents living in rural and urban areas of Indonesia. A cross-sectional study was conducted using data from the 2023 Indonesian Health Survey. The study included 115,372 adolescents aged 10–18 years. Physical activity was classified based on total Metabolic Equivalent of Task (MET)-minutes per week (≥600 MET-minutes/week), while nutritional …

Analysis Of Priority Vaccine-Preventable Diseases Using The Paho-Adapted Hanlon Method In Bogor City In 2024, Sonia Annisa Br Ketaren, Tri Yunis Miko Wahyono, Bai Kusnadi

Jurnal Epidemiologi Kesehatan Indonesia

Vaccine-preventable diseases (VPDs) remain a major public health challenge despite substantial progress in immunization programs. In Indonesia, routine immunization coverage has shown a post-pandemic recovery trend; however, disparities in access to health services and surveillance quality persist across regions. This study aimed to determine priority VPD problems in Bogor City and identify factors contributing to the highest-ranked disease. A mixed-methods study was conducted in Bogor City from October 2024 to January 2025. Quantitative prioritization was performed using the Pan American Health Organization (PAHO)-adapted Hanlon method across eight VPDs. Qualitative data were collected through in-depth interviews with key informants and analyzed …

Activities Of Daily Living Limitations In Middle-Aged And Older Adults With Joint Disorders And Osteoporosis: Indonesia Longitudinal Aging Survey 2023, Desfalina Aryani, Mufti As Siddiq As Siddiq M. Irzal, Agustina Sianipar

Jurnal Epidemiologi Kesehatan Indonesia

Population ageing is associated with an increasing prevalence of limitations in activities of daily living. Joint disorders and osteoporosis are common health problems among older adults and may begin to emerge during middle age, potentially accelerating functional decline. However, studies examining the association between these conditions and limitations in activities of daily living in Indonesia remain limited. This study aimed to analyse the association between joint disorders and osteoporosis and limitations in activities of daily living among middle-aged and older adults in Indonesia. This study employed a cross-sectional design using data from the Indonesia Longitudinal Aging Survey (ILAS) 2023. The …

Determinants Of Hypertension Status Among Patients With Type 2 Diabetes Mellitus At Menteng Primary Health Center, 2024–2025, Ira Susanti Haryoso, Yudha Radityadana, Muthik Hanim Mufallahah, Lhuri Dwianti Rahmartani

Jurnal Epidemiologi Kesehatan Indonesia

Hypertension is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and substantially increases the risk of both macrovascular and microvascular complications. Data on the determinants of hypertension status among T2DM patients in primary healthcare settings remain limited. This study aimed to analyze the determinants of hypertension status in T2DM patients at Puskesmas Menteng during 2024–2025. This was an analytic observational study employing a cross-sectional design. Study subjects comprised T2DM patients registered and undergoing examinations at Puskesmas Menteng over the 2024– 2025 period. Data were extracted from electronic medical records, included age, sex, occupation, socioeconomic status, blood pressure, …

Knowledge, Attitudes, And Practices Among Hepatitis B Patients In Jakarta, Indonesia: A Cross-Sectional Study, Hashem S. Arkok, Tri Yunis Miko Wahyono, Nurhayati Adnan Prihartono, Dipo Aldila

Kesmas

Hepatitis B remains a major public health problem in Indonesia. This study assessed the knowledge, attitudes, and practices (KAP) of hepatitis B patients in Jakarta to identify gaps in prevention and control and to explore relationships among KAP components. A cross-sectional study was conducted among 128 patients at a government hospital in South Jakarta, using a structured questionnaire that collected demographic information and assessed knowledge, attitudes, and practices regarding hepatitis B transmission and prevention. Despite moderate knowledge levels, major gaps remained. Only a small proportion (10.9%) correctly identified common symptoms, transmission routes (10.2%), and possible complications (18.8%). Misconceptions about transmission …

Determinants Of Behavioral Intention To Change Sexual And Reproductive Health Practices Among Adolescents: A Hierarchical Multiple Linear Regression Analysis, Md Mizanur Rahman, Gerraint Gillan Ahi, Rafazila Ramli, Rasitasam Safii, Jacey Lynn Minoi, Stephanie Chua Hui Li, Ahmad Sofian Bin Shminan, Lee Jun Choi

Kesmas

Conventional and web-based sexual and reproductive health (SRH) interventions are increasingly used with adolescents, yet their comparative effectiveness and underlying mechanisms remain unclear. This study compared the two formats and examined the Theory of Planned Behavior (TPB) constructs as predictors of changes in intention to adopt health-protective SRH practices (including contraceptive use, service utilization, and parent–child communication) among Malaysian adolescents. A randomized controlled trial allocated adolescents to conventional or web-based SRH education. Intention-to-change behavior towards sexual and reproductive health scores was assessed at baseline, 1 month, and 3 months; change scores were modeled using hierarchical linear regression, including intervention type, …

The Quantification Of Fluoride Water Quality And Its Significance On Oral Health, Harleen Kaur Maroak

Electronic Theses, Projects, and Dissertations

Fluoride is a naturally occurring mineral and studies have shown that when added to community water supplies, it effectively reduces dental caries. According to the U.S. Public Health Services (PHS), 0.7mg/L is the optimal fluoride level in drinking water to prevent tooth decay. This study focuses on examining the fluoride levels in water in San Bernardino County (SBC) and Riverside County (RC). Data is collected from recently published articles, databases along with assessing the laboratory water sample (n=45) analysis to determine if the fluoride levels are meeting the optimal standards. In SBC, there are total of 154 water systems with …

Associations Between Water Intake, Dietary Quality, And Beverage Consumption Among University Students, Mohammad A. Qazi

Electronic Theses, Projects, and Dissertations

Title: Associations Between Water Intake, Dietary Quality, and Beverage Consumption Among University Students

Background and Aims: Sugar-sweetened beverage (SSB) and ultra-processed food (UPF) consumption significantly contribute to chronic disease risk and is often more common in underserved and racially/ethnically diverse communities. Drinking water is a low-cost, calorie-free behavior that may support healthier beverage and dietary patterns. Previous studies show that increased daily water consumption positively correlates with better diet quality and is inversely correlated with SSB and UPF consumption. This study aims to examine whether (1) increased daily water intake is associated with self-reported diet quality and (2) self-reported hydration …

Health Data And Policy Related To Methamphetamine-Use Suicide In Mississippi, Mary C. Drane

Honors Theses

The purpose of this research is to investigate how methamphetamine use in Mississippi, especially in its rural areas, intersects with public health, policy, and suicide outcomes in the state. Mississippi's methamphetamine crisis has evolved significantly, shifting from locally produced drugs to cartel-supplied crystal methamphetamine, while state and federal policies have struggled to keep pace with the scale and complexity of the problem. Using a convergent parallel mixed-methods design, this research analyzed CDC Wonder multiple causes of death data and SAMHSA Treatment Episode Data Set Admissions (TEDS-A) data from 2018 to 2024 alongside four qualitative key informant interviews with stakeholders across …

Connectivity, Classroom, And Contagion: An Ecological Analysis Of Testing Availability, Sex Education, And Sti Rates In The Upper Midwest, Macey M. Boerhave

Honors Thesis

Rural and frontier communities in the Upper Midwest face unique challenges that shape how young people access sexual health information and testing. While sexually transmitted infection (STI) rates continue to rise nationally, less is known about how sexual health education, digital access, and geographic distance influence these trends at a county level. This study examines the relationship between broadband internet access rates, poverty rates, proximity to free or low-cost STI testing sites, and county-level STI rates among individuals aged 15-24 in selected counties across South Dakota, North Dakota, Minnesota, Iowa, and Nebraska. Using an ecological, cross-sectional design, county-level STI surveillance …

Factors Associated With Lapses In Care Among People Living With Hiv In South Carolina, Xueying Yang Ph.D., Fanghui Shi, Shujie Chen, Gavi Samuel, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Utilizing statewide electronic health records (EHR) data, this study aims to assess the factors determining the occurrence of lapses in HIV care among people with HIV (PWH) in South Carolina (SC). All adult (≥ 18 years old) PWH who were diagnosed with HIV between 2006 and 2018 with at least two HIV care encounters and at least 1-year follow-up record were included in the analysis. The outcome, a lapse in care, was defined as a repeated measure of HIV care encounter that occurs over a year following the previous visit. Generalized Estimation Equation models were employed. The study cohort had …

Implementation And Costs Of A Food Insecurity Resource Navigation Program For Primary Care Patients With Diabetes And Hypertension In South Carolina, Deeksha Gupta, Darin Thomas, Stella Coker Watson Self Ph.D., Ms, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, Joseph A. Ewing, Lynnette Ramos-Gonzalez, Lynnette Ramos-Gonzalez

Faculty Publications

Objective

To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients.

Methods

This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n= 219) had diabetes (9.13%), hypertension …

Risk Factors Of Leptospirosis Among Agricultural Workers In Southeast Asia: Literature Review, Ronggo Adi Wibowo, Wawa Najwa Nurzakia, Meirany Sasitha Kirana, Yulia Arthemisia Wijaya, Jasmine Ayumaharani Sekaryudha, Dwi Sarwani Sri Rejeki, Rosita Dwi Jayanti

Jurnal Epidemiologi Kesehatan Indonesia

The agricultural sector is the primary source of livelihood for communities in Southeast Asia; however, these activities increase the risk of exposure to zoonotic diseases, particularly leptospirosis. Southeast Asia is one of the regions with the highest incidence of leptospirosis in the world. This literature review aims to identify risk factors for leptospirosis among agricultural workers in Southeast Asia. The search for research articles utilized three databases (Google Scholar, PubMed, and ScienceDirect) using a descriptive approach based on literature review and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 9,800 articles were screened for …

Factors Associated With Stunting Among Children Aged 6 – 59 Months Attending Integrated Health Post (Posyandu) In Selapajang And Kedaung Wetan Villages, Neglasari Sub-District, Tangerang City: A Matched Case-Control Study, Michael Alexander Solang, Joue Abraham Trixie, Gloria Semula, Tiona Simamora, Conny Tanjung

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is a problem in Indonesia. In 2022, Kedaung Wetan and Selapajang Villages in Neglasari sub-district, Tangerang City, were identified as a priority. This study aimed to identify factors associated with stunting among children (6 – 59 months) in these villages. A matched case-control study consisting of 214 children (107 cases and 107 controls) was conducted, with individual matching based on age, sex, and prematurity at birth. Cases were children with height-for-age (H/A) measurement less than -2SD (according to WHO standard), while controls were children with H/A equal to or greater than -2SD. Conditional logistic regression was used for the …

Characteristics Of Leprosy Chemoprophylaxis Recipeints In The Tirtayasa Public Health Center Area, 2023–2024, Rifa Imaroh, Maria Angela Lumaksono, Izzah Imani, Dhelya Widasmara

Jurnal Epidemiologi Kesehatan Indonesia

Leprosy remains a public health problem in Indonesia. In 2023, Indonesia ranked third globally in the number of leprosy cases, with 14,376 reported cases, after India (107,851 cases) and Brazil (22,773 cases). One of the key strategies for leprosy control in Indonesia is the implementation of preventive measures, including home visits and the administration of chemoprophylaxis using single-dose rifampicin (SDR). Post-exposure prophylaxis plays an important role in preventing leprosy transmission among contacts of confirmed patients. This study aimed to describe the characteristics of leprosy chemoprophylaxis recipients in the Tirtayasa Public Health Center area during 2023–2024. This study was an descriptive …

The Relationship Between Smartphone Screen Time Duration And Individual Chronotype: A Systematic Literature Review, Diego Sergio Giasia Lumbantobing, Thalia Altamilano Pramudya

Jurnal Epidemiologi Kesehatan Indonesia

The rapid increase in smartphone use over the past decade led to prolonged screen time across age groups, particularly during nighttime hours. Exposure to artificial light and pre-sleep digital activities was associated with circadian rhythm disruption and alterations in individual chronotype. This systematic literature review aimed to synthesize empirical evidence on the relationship between smartphone screen time duration and individual chronotype across all age groups and to identify key moderating factors influencing this association. The review was conducted in accordance with PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, and ScienceDirect for studies published between 2015 and 2025. …

Prevalence And Determinant Factors Of Depression Among Pregnant Women In Poned Health Center In Tangerang City Area, Dian Geumala Hayati, Sudijanto Kamso, Popy Yuniar, Yuli Puspita Devi

Jurnal Epidemiologi Kesehatan Indonesia

According to World Health Organization (WHO), approximately 10% of pregnant women experience mental disorders, with depression being particularly prevalent. In developing countries, this rate is was even higher, reaching 19.8% after childbirth and 15.6% during pregnancy. Various studies conducted in Indonesia show that the prevalence of depression among pregnant women ranges widely, from 21.4% to 26.2%.This study aimed to determine the prevalence and risk factors associated with depression during pregnancy in pregnant women at the PONED Community Health Center in Tangerang City Area. A facility-based cross-sectional study was conducted with 105 pregnant women attending antenatal check-ups at the 17 PONED …

Factors Associated With Antiretroviral Therapy Adherence In Patients With Hiv At A Public Hospital In Central Jakarta, Indonesia, Kareena Sari Fatimah, Laily Hanifah, Chandrayani Simanjorang, Nayla Kamilia Fithri

Kesmas

Patients with human immunodeficiency virus (HIV) are required to take antiretroviral therapy (ART) to suppress the virus. However, suboptimal adherence remains a critical barrier that can lead to treatment failure and persistent transmission risks. This study aimed to identify factors associated with ART adherence in patients with HIV. This quantitative study with a cross-sectional design consisted of patients with HIV aged >18 years who received care at the voluntary counseling and testing clinic of a public hospital in Jakarta, Indonesia. Purposive sampling was used. This study used HIV care and ART overview forms as instruments. Data were analyzed using multiple …

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Trends In Self-Reported Responses To Nutrition Facts Labels Before And After Nutrition Labeling Policy Implementation: A Comparison Of Adults In The United States And Mexico, Jim Thrasher Ph.D., Ma, Ms, Victor Vilalobos, Dai Fang, Alejandra Jáuregui, Alejandra Contreras-Manzano, Rachel Davis Ph.D., Lana Vanderlee, Christine M. White, Rachel B. Acton, James W. Hardin, Edward A. Frongillo Jr. Ph.D., Simón Barquera, David Hammond

Faculty Publications

Background

Objectives

Methods

An Impact Assessment Of The Effectiveness Of Utilizing Informal Health Communication Interventions To Spread Health Recommendations And Change Public Perception, Lina Mohamed Ezzat Ahmed Abdel Mawgoud

Theses and Dissertations

Brain health is an increasingly urgent but critically under-addressed public health priority in Egypt and the wider MENA region. Despite its centrality to aging, productivity, and overall quality of life, public understanding of brain health remains limited, and stigma continues to shape responses to dementia and cognitive decline. This study evaluates the effectiveness of informal, culturally adapted health communication as a tool to shift perception, increase awareness, and promote behavior change among non-medically trained adults in Egypt.

Grounded in global evidence on cognitive reserve, neuroplasticity, and the life-course approach to brain health, the intervention translated expert-informed brain health recommendations into …

Sociodemographic And Hiv-Related Characteristics Associated With Mental Health Diagnoses Among People Living With Hiv, Monique J. Brown Ph.D., Mph, Jiayang Xiao, Xueying Yang Ph.D., Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Mental health diagnoses have been linked to poor HIV treatment outcomes and poorer quality of life among people living with HIV (PLWH). Therefore, this study aimed to investigate the association between sociodemographic and HIV-related characteristics, and common and serious mental health disorders among PLWH in South Carolina (SC). Data were obtained from the integrated system of statewide electronic health record (EHR) data in SC (2006–2019; N = 8,124). Multivariable logistic regression models were used to determine the associations between sociodemographic and HIV-related characteristics, and common mental health disorders and serious mental health disorders. Among the study population, 4% were 60 …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Kejadian Luar Biasa Gondongan Di Sd Islam X Samarinda, 2024, Rudy Agus Riyanto, Irfansyah Baharuddin Pakki, Mela Sabena, Meli Pasiakan, Erlina Erlina, Rima Andriani

Jurnal Epidemiologi Kesehatan Indonesia

Mumps outbreaks are a public health issue that still frequently occur in elementary school settings, particularly among children with low immunization coverage. Therefore, a comprehensive epidemiological understanding is needed as a basis for control. This research aims to describe the epidemiological picture and causative factors of the mumps outbreak that occurred at Islamic Elementary School X in Samarinda City in 2024, using a case series design. The outbreak occurred from April to October 2024, while epidemiological data collection and case verification were conducted from December 2nd to 8th, 2024. The analysis uses surveillance data, field observations, and questionnaires administered to …

Hubungan Kehamilan Usia Remaja Dengan Kelahiran Prematur Di Rsud Cengkareng Jakarta Barat Tahun 2022: Sebuah Studi Kohort Retrospektif, Anna Triana, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Premature birth is leading causes of neonatal mortality. According to the World Health Organization (WHO), global premature birth rates reached 9.9% in 2020, it’s rising compared to preterm birth rates in 2010. One of the risk factors for preterm birth is the mother's age, which pregnant adolescents are more at risk of giving birth to preterm babies due to physiological, psychological, and socioeconomic immaturity. This study is an analytical study with a retrospective cohort design to determine the relationship between adolescents pregnancy and preterm birth. This study was conducted in Cengkareng General Hospital West Jakarta using patient’s medical record data. …

Public Perception About Covid-19 Vaccine Hesitancy In South Central Nebraska, Rita Nnenne Oparaocha

Biology Theses, Dissertations, and Student Creative Activity

The COVID-19 pandemic created a shift in the trajectory of vaccination hesitancy, altering risk perceptions and vaccination attitudes among individuals in rural communities. The 5C framework highlights confidence, complacency, constraints, calculation, and collective responsibility as influencing factors of vaccine hesitancy. This study assessed the proportion of adults who refused COVID-19 vaccination and identified the individual reasons for hesitancy among those who refused the COVID -19 vaccines in South Central Nebraska. Data was analyzed from a local cross-sectional public health survey administered to 2,034 adult participants over a six-month period (March-August 2024), including 91 respondents who were from outside the seven-county …