COVID-19-Related Beliefs and Dietary Behaviors of American Undergraduate Students Vary by Race via the Lens of the Health Belief Model

Abstract

The COVID-19 pandemic caused immense physical disruptions, affecting young adults in the U.S. The Health Belief Model is a social psychological framework that predicts the likelihood of adopting health behavior. The purpose of this research is to investigate COVID-19-related health beliefs and dietary behaviors among undergraduate students during the pandemic. Using convenience sampling, a cross-sectional survey was completed by 304 individuals at a New Jersey state university. Survey data included the frequency of COVID-19 prevention behaviors (e.g., wearing an indoor mask, handwashing), and consumption of fruit and vegetables. The Health Belief Model constructs measured perceived susceptibility to COVID-19, severity, benefits, barriers, and self-efficacy. Frequency distributions, t-tests, and Kruskal–Wallis tests were investigated for racial subgroups (Whites, Blacks, Latinos, and Asians). The mean age of the sample was 21.7, with 27% males, and 46% self-identified as White. Whites adopted fewer COVID-19 prevention behaviors (p < 0.001) than non-Whites. Black students perceived less COVID-19 severity (p < 0.01) and stronger perceived benefits (p < 0.05) than the other subgroups. Latino students perceived greater susceptibility (p < 0.01) and greater barriers than non-Latinos. Asians practiced higher mask wearing frequency (p < 0.05) but less daily fruit intake than their counterparts (p < 0.01). This research highlights the importance of handwashing, wearing indoor masks, and consuming produce among university students. Addressing barriers to health action while promoting the benefits of enacting behaviors to mitigate the risk of COVID-19 is warranted.

1. Introduction

COVID-19 triggered a global pandemic in 2020, with a very high risk of human-to-human transmission [1]. COVID-19 is characterized as atypical, with an incubation period of days to weeks, and is a human-to-human droplet and contact infection. Infected individuals may develop symptoms such as fever, cough, runny nose, weakness, headache, and chest tightness [2]. Associated with these physical symptoms are psychological, emotional, and social challenges such as stress, anxiety, and depression [3].

Within the U.S., colleges and universities closed and transitioned to virtual learning [4] as students adjusted to stay-at-home restrictions and changes in eating behaviors and hygiene. Lifestyles were disrupted with shifted eating behaviors marked by increased snacking, a preference for sweets, and ultra-processed food rather than fresh fruits and vegetables [5]. The COVID-19 pandemic affected dietary shifts among racial groups in the U.S., impacting fruit and vegetable consumption before and during the pandemic. Researchers assert that a diet rich in fruits and vegetables may be beneficial in reducing the duration and severity of COVID-19 symptoms [6].

Since the pandemic, Monroe-Lord et al. [7] noted that African American individuals reduced their fruit intake when compared to White individuals. Hispanic individuals tended to reduce their consumption of vegetables and fruit more than White individuals. Researchers asserted that a decrease in fruit and vegetable consumption was particularly seen in less educated individuals, underscoring the need to develop strategies to consume more of these plant-based foods during times of crisis. In addition, public policies and recommendations emphasized wearing masks, frequent handwashing, and practicing social distancing to mitigate the spread of the virus.

Increased physical and mental stress emerged among many university students due to limited in-person contact. Even though college students were typically at a low risk for severe COVID-19 infection and mortality, the spread of the virus on campuses could spill over to vulnerable social communities in the area [8]. Multiple stressors among college students were identified, which included fear and worry about personal and family health, decreased social interactions due to social distancing, difficulty concentrating, and concerns over academic performance [9]. To our knowledge, there are limited data contrasting differences in COVID-19-related beliefs and prevention behaviors among dormitory residents and commuter students.

The Health Belief Model (HBM) is a social psychological framework that predicts the likelihood of individuals adopting health behavior based on perceptions of threat (perceived susceptibility + severity) to a disease or condition [10]. Perceptions of the benefits of taking a health action to mitigate the risk of getting the condition, along with perceptions of barriers to performing the health action, serve as a basis for cost–benefit analysis within an individual. If perceptions of benefits outweigh the barriers, then individuals are more likely to enact health behavior. Cues to action are internal (e.g., personal symptoms) and external (e.g., media messages) prompts that can spark individuals into enacting the health behavior. Self-efficacy was later added to the model, which is defined as an individual’s confidence to perform the action, despite barriers encountered when attempting to perform it.

A systematic review was conducted of the HBM’s ability to predict COVID-19 prevention behavior and findings indicate that the model had a good predictive ability (R² > 25%) in 28 of 32 studies examined [11]. In half of these studies, HBM demonstrated the ability to explain 50% or more of the variance of COVID-19-related behavior and intention. In a separate systematic review on the effectiveness of the HBM interventions in improving adherence to health behavior, 83% of the studies attained statistical significance, with the variance explained for HBM ranging from 6.5% to 90.1% [12]. The significant ratio of each of the six constructs of HBM with COVID-19 prevention behavior and intention was computed. The most significant predictor or highest significance ratio was perceived benefit, followed by self-efficacy, cues to action, and perceived barriers. These systematic reviews emphasize the robustness of HBM and its application in COVID-19 preventive behavior.

In this study, the Health Belief Model is utilized as a theoretical guide to understand American university students’ beliefs and health behaviors related to COVID-19. The goal of this research investigation is to determine COVID-19-related beliefs and health behaviors (e.g., indoor mask wearing, handwashing, intake of fruit and vegetables) among undergraduate students in a large state university in the northeastern U.S. The researchers hypothesize that differences will exist in perceptions of COVID-19 susceptibility, severity, benefits, and barriers according to racial groups involving Whites, Blacks, Asians, and Latino/Hispanic students. In addition, these beliefs will differ between dormitory residents and commuters.

2. Materials and Methods

Undergraduate students were recruited at a state university in the northeastern region of the United States. Based on convenience sampling strategy, eligibility criteria included (a) individuals enrolled in undergraduate coursework for bachelors’ degrees at a New Jersey state university and (b) male and female commuters and non-commuters from diverse race and ethnicities (Montclair State University, Institutional Review Board Number: IRB-FY21-22-2619, Project Title: Survey on COVID-19 Risk and Prevention among Undergraduate Students, Date of Approval, 24 July 2022). The recruitment period of participants was between 1 August 2022 and 1 March 2023, as campus-wide student listservs and academic clubs were approached across different disciplines and ethnicities. The primary researcher solicited student participants at various campus events and club meetings from five colleges of the university, encompassing business, humanities, arts, science, and mathematics. Eligible participants were given research information and completed informed consent forms. A total of 434 surveys were distributed, of which 70% of the questionnaires were returned, resulting in a sample size of 304. Participants were excluded from the study if they were enrolled in master’s and doctoral programs. The surveys were completed between September 2022 and March 2023, and on average, participants took approximately 5–10 min to complete the 41-item questionnaire. Respondents were eligible for a raffle drawing for Amazon gift cards of $25 and $50.

A survey instrument was systematically developed via qualitative interviews with undergraduate students at a New Jersey state institution and a comprehensive review of the literature [13]. Demographic questions were queried, such as age, sex at birth (male or female), and academic major (health science, non-health, undeclared). The question on race included the categories of White, non-Hispanic, Black, Hispanic/Latino, Asian Pacific Islander, and two or more races. Questions pertaining to marital status, birthplace, and residence status (dormitory resident, commuter) were also included in the questionnaire. Participants were queried on the frequency of engaging in physical activity over the previous week, on a scale of 1 to 5, with ‘1’ denoting never and ‘5’ representing always.

COVID-19 prevention behaviors were measured by two questions involving the frequency of wearing a mask indoors when in public and the frequency of handwashing over the previous week. Respondents indicated on a scale of 1–5, with ‘1’ denoting never and ‘5’ representing always. The frequency of physical activity engaged in over the previous week was also assessed. In addition, participants indicated their consumption of fruits and dark green and orange vegetables (number of cups) over the previous seven days.

The measurement of the HBM constructs reflected four items measuring the participants’ perceived susceptibility to COVID-19 due to compromised immune systems, active social interaction in public, and taking in-person classes. Four items measured perceived severity to COVID-19, such as harsh physical symptoms, negative mental effects, social isolation, and being contagious to others. Six items assessed perceived benefits to reduce COVID-19 contraction such as getting vaccinated, handwashing, wearing a mask in public, consuming lots of fruits/vegetables, and having sufficient vitamins C and D. Five items measured perceived barriers, which included limited accessibility, time constraints, increased cost, academic stress, and negative impacts of social media on food choices. Cues to action were reflected in five items and self-efficacy items were assessed by four questions involving the ability to update COVID-19 vaccination, to select foods beneficial to the immune system, and to prepare nutritionally balanced meals. For the six HBM constructs measured, respondents indicated on a scale of 1–5 the degree to which they agreed or disagreed with each statement (‘1’ denoted ‘strongly disagree’ and ‘5’ as ‘strongly agree’). Sample survey items measuring health behaviors and HBM constructs are displayed in

Table 1. Examples of questionnaire items.

Constructs	Sample Questionnaire Statements
Health Behaviors
COVID-19 Prevention	Over the past week, how often did you wear a mask indoors when in public? Over the past week, how often did you practice handwashing?
Physical Activity	Over the past week, how often did you engage in physical activity (e.g., =walking, sports, running)?
Fruit Consumption	Over the past week, approximately how many cups of fruit did you consume each day?
Vegetable Consumption	Over the past week, approximately how many cups of dark green vegetables did you consume on each day? Over the past week, approximately how many cups of orange vegetables (e.g., =carrots, squash, sweet potato) did you consume on each day?
Health Belief Model
Perceived Susceptibility	I am very likely to contract COVID-19 or other coronaviruses in the upcoming month.
Perceived Severity	If I test positive for COVID-19, I will experience harsh physical symptoms, such as fever, cough, and fatigue.
Perceived Benefits	If I consume lots of fruit and vegetables, my chances of contracting COVID-19 will be reduced.
Perceived Barriers	It is difficult to consume plant-based foods because of their limited accessibility near me.
Cues to Action	When I hear or read about CDC recommendations to protect against COVID-19, I keep wearing a mask in an indoor public setting.
Self-Efficacy	I am confident in my ability to select foods that are beneficial to my immune system.

.

2.1. Instrument Validity and Reliability

A separate pilot study of 20 students provided feedback about the clarity and meaning of the questionnaire items and provided face validity of the instrument. Nutrition experts and behavioral science researchers examined the instrument for content validity and accurate reflection of the Health Belief Model. The reliability of the instrument was confirmed by Cronbach’s alpha coefficients above 0.70 on behavioral and psychosocial subscales.

Construct validity was supported by applying exploratory factor analyses of the HBM variables. This statistical method resulted in seven distinct factors, accounting for 59% of the variance in responses. After additional factor analysis for each subscale, two items with factor loadings of less than 0.40 were deleted from the scale. The rest of the factor loadings were >0.4, revealing strong relations between factors and items. A reasonable model-data fit was supported by the Kaiser–Meyer–Olkin measure of sampling adequacy (0.81), indicating that the distribution of values is strong for conducting factor analysis.

Behavioral questions on daily fruit and vegetables (green and orange) over the previous week were validated against 3-day food records of 20 undergraduate students enrolled in an introductory nutrition course at the university. A Pearson correlation of 0.61 was statistically significant for fruit intake (p < 0.01). For both green and orange vegetables, a Pearson correlation of approximately 0.20 was recorded (p = 0.53). It is speculated that the low correlation observed for vegetable intake may be attributed to the lack of accessibility and affordability of plant-based foods during the pandemic.

2.2. Data Analysis

All data was input into the Statistical Package for the Social Sciences 23.0. The statistical analyses included frequency distributions, calculations for central tendency, dispersion, Cronbach’s alpha coefficients, and confirmatory factor analyses. Independent t-tests for race subgroups were based on individuals from White, Black, Asian, and Latino/Hispanic ethnicities. Kruskal–Wallis tests (one-way analysis of variance) were conducted to determine if differences in mean values existed for the subgroups of race according to the behavioral and psychosocial outcomes.

3. Results

3.1. Demographic Characteristics

The demographics of the undergraduate sample included a mean age of 21.7 ± 4.7, with 80% of the students between the ages of 18 and 22. As for biological sex, 73% of the sample were females and 27% were males. As for race, 46% identified as non-Hispanic Whites, 15% Blacks, 26% Hispanic/Latinos, and 9% Asians. Four percent of the participants were from two or more races. Approximately 93% of the participants were single or never married, with 34% declaring their major within the health sciences (e.g., nutrition, biology, exercise science, public health). Forty percent of the participants (n = 121) were categorized as having low physical activity over the previous week (below 3 on a scale of 1–5). Seventy-three percent of the respondents were commuters and 27% of the students lived in the dormitories on campus (

Table 2. Demographic data of university students.

Demographic Factor	N	%
Sex:
Male	82	27.0
Female	222	73.0
Age Group:
Younger Group (18–22 years)	244	80.3
Older Group (23 years and above)	60	19.7
Mean Age (SD) = 21.7 (4.7)
Race:
White, non-Hispanic	139	45.7
Black	46	15.1
Hispanic/Latino	80	26.3
Asian Pacific Islander	26	8.6
Two or More Races	13	4.3
Academic Major:
Health Science	103	34.2
Non-Health	198	65.1
Undeclared	3	0.7
Marital Status:
Single or Never Married	284	93.4
Married	19	6.3
Divorced	1	0.3
Residence Status:
Dormitory Resident	81	26.6
Commuter	223	73.4

).

t-tests were conducted to determine if there were mean differences between the psychosocial factors and behaviors among dormitory residents and commuters. Commuters practiced higher frequencies of COVID-19 prevention behaviors (handwashing and indoor masking) (mean = 3.19 ± 0.64) than dormitory residents (mean = 2.97 ± 0.51) (p < 0.01). Commuters also perceived greater susceptibility to COVID-19 (mean = 2.40 ± 0.79) than the dormitory residents (mean = 2.11 ± 0.76) (p < 0.01). On the other hand, dormitory residents perceived stronger barriers (mean = 3.21 ± 0.80) than commuters (mean = 2.94 ± 0.81) (p < 0.01).

3.2. COVID-19 Prevention Behaviors and Fruit/Vegetable Consumption

For the entire sample, participants’ mean score for practicing COVID-19 prevention behaviors (e.g., wearing indoor masks + handwashing) was 3.13 ± 0.61 (range of 1–5), reflecting ‘sometimes’ in wearing indoor face coverings and frequency of handwashing. The survey participants consumed approximately 0.95 ± 1.00 cups of fruit per day, 0.81 ± 0.83 cups of green vegetables, and 0.46 ± 0.60 cups of orange vegetables per day.

Table 3. Mean fruit and vegetable consumption according to race.

Race	N	Mean Fruit Intake per Day (Cups)	SD	Mean Vegetable Intake per Day (Cups)	SD
White	138	1.01	0.78	0.65	0.55
Black	46	0.98	1.36	0.76	1.07
Latino	80	0.85	1.19	0.54	0.50
Asian	26	0.65	0.40	0.55	0.43

provides descriptive data on mean daily fruit and vegetable consumption for each racial group.

3.3. White Racial Group

t-tests were conducted to assess if there were mean differences between behaviors and psychosocial factors among Whites and non-White groups. Non-Whites encompassed Latinos/Hispanics, Asians, Blacks, and Middle Easterners. Whites adopted lower frequencies of COVID-19 prevention behaviors (e.g., handwashing, indoor masking) (mean = 2.98 ± 0.54) than their non-White counterparts (mean = 3.26 ± 0.64) (p < 0.001). In comparison with non-Whites, Whites perceived fewer benefits of health actions to mitigate COVID-19 infection (mean = 3.66 ± 0.70 versus mean = 3.96 ± 0.59) (p < 0.001). Cues to action were weaker in Whites (mean = 2.77 ± 0.86) as opposed to non-Whites (mean = 3.33 ± 0.77) (p < 0.001) (

Table 4. t-test comparison between White and non-White subgroups according to COVID-19 prevention behaviors and beliefs.

Category	White Group Mean (SD) (n = 139)	Non-White Group Mean (SD) (n = 165)	Significance (2-Tailed)
COVID-19 Prevention Behavior (Mask Wearing, Handwashing)	2.98 (0.54)	3.26 (0.64)	p = 0.000
Perceived Susceptibility	2.25 (0.81)	2.39 (0.77)	p = 0.39
Perceived Severity	2.96 (0.70)	2.85 (0.93)	p = 0.55
Perceived Benefits	3.66 (0.84)	3.96 (0.59)	p = 0.000
Perceived Barriers	2.92 (0.82)	3.09 (0.78)	p = 0.08
Cues to Action	2.77 (0.86)	3.33 (0.77)	p = 0.000
Self-Efficacy	3.82 (0.69)	3.80 (0.61)	p = 0.09

).

Further analyses using Kruskal–Wallis tests provided pairwise comparisons of race. White students (3.66 ± 0.70) perceived fewer health benefits compared with Latino/Hispanic (3.92 ± 0.58), Black (3.99 ± 0.59), and Asian students (4.04 ± 0.69) (p < 0.01). In addition, White students (2.9 ± 0.82) perceived fewer barriers when compared with Latino/Hispanic students (3.24 ± 0.60) (p < 0.01). In general, White students (2.99 ± 0.54) practiced less frequency of COVID-19 prevention behaviors compared with Latino/Hispanic (3.19 ± 0.65) and Black groups (3.26 ± 0.67) (p < 0.05), and Asian individuals (3.5 ± 0.65) (p < 0.001).

t-tests were conducted between White dormitory residents and commuters. White commuter students (3.05 ± 0.52) practiced more COVID-19 prevention behaviors than White dormitory residents (2.83 ± 0.56) (p < 0.05). These commuter students also perceived fewer barriers (2.78 ± 0.80) than their residential counterparts (3.19 ± 0.80) (p < 0.01).

3.4. Black Racial Group

Self-identified Blacks (n = 46) perceived less COVID-19 severity (mean = 2.5 ± 0.9) compared to non-Black subgroups (mean = 3.0 + 0.9) (p < 0.01) (

Table 5. t-test comparison between Black and non-Black subgroups according to COVID-19 prevention behaviors and beliefs.

Category	Black Group Mean (SD) (n = 46)	Non-Black Group Mean (SD) (n = 258)	Significance (2-Tailed)
COVID-19 Prevention Behavior (Mask Wearing, Handwashing)	3.26 (0.67)	3.11 (0.60)	p = 0.19
Perceived Susceptibility	2.20 (0.78)	2.35 (0.79)	p = 0.66
Perceived Severity	2.53 (0.93)	2.97 (0.87)	p = 0.002
Perceived Benefits	3.99 (0.59)	3.80 (0.67)	p = 0.047
Perceived Barriers	2.99 (0.84)	3.02 (0.81)	p = 0.93
Cues to Action	3.61 (0.64)	2.98 (0.86)	p = 0.000
Self-Efficacy	3.82 (0.54)	3.81 (0.67)	p = 0.11

). However, Blacks perceived higher benefits of taking health actions to reduce the risk of viral contraction mean = 4.0 ± 0.6) when contrasted with other ethnic groups (mean = 3.8 ± 0.7) (p < 0.05). Blacks also scored higher in cues to action (mean = 3.6 ± 0.6) than the rest of the sample (mean = 3.0 ± 0.9) (p < 0.001).

Independent samples Kruskal–Wallis tests indicated that Black students (3.26 ± 0.67) engaged in more COVID-19 prevention behaviors when contrasted with White students (2.99 ± 0.54) (p < 0.05) and Black individuals (3.99 ± 0.59) perceived greater health benefits than their White counterparts (3.66 ± 0.70) (p < 0.01). However, Black students (0.98 ± 1.36) consumed less fruit per day than their White peers (1.01 ± 0.78) (p < 0.05).

t-tests revealed no statistically significant differences in HBM-related beliefs and COVID-19 prevention behaviors between Black dormitory residents and Black commuter students.

3.5. Latino/Hispanic Racial Group

Latino/Hispanic participants (n = 80) perceived greater personal susceptibility of contracting COVID-19 (mean = 2.6 ± 0.8) than their counterparts (mean = 2.2 ± 0.8) (p < 0.01) (

Table 6. t-test comparison between Latino and non-Latino subgroups according to COVID-19 prevention behaviors and beliefs.

Category	Latino Group Mean (SD) (n = 80)	Non-Latino Group Mean (SD) (n = 224)	Significance (2-Tailed)
COVID-19 Prevention Behavior (Mask Wearing, Handwashing)	3.19 (0.65)	3.11 (0.60)	p = 0.21
Perceived Susceptibility	2.56 (0.78)	2.24 (0.78)	p = 0.002
Perceived Severity	2.91 (0.85)	2.90 (0.91)	p = 0.88
Perceived Benefits	3.92 (0.58)	3.79 (0.68)	p = 0.14
Perceived Barriers	3.24 (0.70)	2.93 (0.86)	p = 0.001
Cues to Action	3.15 (0.73)	3.04 (0.90)	p = 0.35
Self-Efficacy	3.78 (0.63)	3.82 (0.66)	p = 0.60

). Latino/Hispanic students perceived greater barriers to enact health behaviors (mean = 3.2 ± 0.6) than the other racial groups (mean = 2.9 ± 0.9) (p < 0.01). Although the variable, cues to action, was higher in the Latino/Hispanic group (mean = 3.2 ± 0.7) when contrasted with the other subgroups (mean = 3.0 ± 0.9), this was not statistically significant (p = 0.35).

Significant pairwise comparisons indicated that Latino/Hispanic students (3.92 ± 0.58), when compared to White students (3.66 ± 0.70), perceived stronger health benefits (p < 0.01). Latino/Hispanic individuals also perceived greater barriers (3.24 ± 0.60) in performing health actions than White individuals (2.90 ± 0.82) (p < 0.01). Latino/Hispanic participants (3.19 + 0.65) engaged in more COVID-19 prevention behaviors than White students (2.99 + 0.54) (p < 0.05), but less than their Asian counterparts (3.5 ± 0.65) (p < 0.05). It is also noted that Latino/Hispanic participants (0.85 cups ± 1.19) consumed less daily fruit intake than their White peers (1.01 cups ± 0.78) (p < 0.01).

According to t-tests, Latino/Hispanic commuters (3.23 ± 0.71) scored higher on cues to action than Latino/Hispanic dormitory residents (2.68 ± 0.74) (p < 0.01).

3.6. Asian Racial Group

Lastly, t-tests were conducted between self-identified Asians (n = 26) versus non-Asian participants (

Table 7. t-test comparison between Asian and non-Asian subgroups according to COVID-19 prevention behaviors and beliefs.

Category	Asian Group Mean (SD) (n = 26)	Non-Asian Group Mean (SD) (n = 278)	Significance (2-Tailed)
COVID-19 Prevention Behavior (Mask Wearing, Handwashing)	3.59 (0.65)	3.02 (0.60)	p = 0.001
Perceived Susceptibility	2.41 (0.81)	2.32 (0.79)	p = 0.56
Perceived Severity	3.11 (0.97)	2.88 (0.88)	p = 0.22
Perceived Benefits	4.04 (0.69)	3.80 (0.65)	p = 0.08
Perceived Barriers	3.09 (0.96)	3.01 (0.80)	p = 0.60
Cues to Action	3.59 (0.75)	3.02 (0.85)	p = 0.001
Self-Efficacy	3.82 (0.65)	3.81 (0.65)	p = 0.94

). Frequency of mask wearing was significantly higher for Asians (mean = 2.2 ± 1.2) when compared to the rest of the sample (mean = 1.5 ± 0.9) (p < 0.05). Asians practiced more behaviors related to COVID-19 prevention (mean = 3.5 ± 0.6) when compared to non-Asian individuals (mean = 3.1 ± 0.6) (p < 0.01). On average, Asians consumed less fruit per day (mean = 0.7 ± 0.4 cups) than their non-Asian counterparts (mean = 1.0 ± 1.0 cups) (p < 0.01). Asians also scored higher in cues to action (mean = 3.6 ± 0.8) than the other racial groups (mean = 3.0 ± 0.9) (p < 0.01).

Pairwise comparisons confirmed that Asian students (3.50 ± 0.65) engaged in health actions to prevent COVID-19 more frequently than their White peers (2.99 ± 0.54) (p < 0.001) and Latino/Hispanic counterparts (3.19 ± 0.65) (p < 0.05). Furthermore, Asian individuals (4.04 ± 0.69) possessed greater perceived benefits than White individuals (3.66 ± 0.70) in the study (p < 0.01). Asians (3.59 ± 0.75) also perceived stronger cues to action than their White counterparts (2.78 ± 0.86) (p < 0.001) and Latino/Hispanic peers (3.15 ± 0.73) (p < 0.05).

Based on t-test comparisons, Asian commuter students perceived greater susceptibility to COVID-19 (2.62 ± 0.73) than Asian dormitory residents (1.86 ± 0.79) (p < 0.05).

4. Discussion

The aim of this research is to uncover similarities and differences in COVID-19 beliefs and health behaviors among American undergraduate students from four racial groups (Whites, Blacks, Latino/Hispanics, Asians). Through the lens of the Health Belief Model, perceptions of COVID-19 susceptibility, severity, benefits, barriers, cues to action, and self-efficacy were ascertained. In addition to these beliefs, the frequency of fruit and vegetable consumption among racial groups was also assessed. This research also highlighted differences in HBM-related beliefs among dormitory residents and commuters. The stronger perceived susceptibility to COVID-19 among commuter students and increased adoption of indoor mask wearing and handwashing are noteworthy.

In the study, White students practiced less frequency of COVID-19 prevention behaviors (e.g., handwashing, indoor masking wearing) than non-White students at the state university in New Jersey. Furthermore, Whites perceived fewer benefits of health actions to reduce the COVID-19 threat. Similarly, Tessler et al. [14] collected data in November 2020 from a nationally representative survey in the U.S. Whites had the lowest levels of concern in their attitudes about COVID-19 compared with Asian Americans, Blacks, and Hispanics. All racial minority groups worried more about the consequences of being infected by the virus, as compared to Whites. Tessler et al. reported that women were more likely to view COVID-19 as a major threat to the health of the U.S. population. Women perceived greater severity (getting sick and spreading the virus to other people) in contracting the virus compared to men.

Earle-Richardson et al. [15] noted that White respondents were influenced by seeing others wearing masks (descriptive norm). In addition, attitude toward the behavior (e.g., believing that wearing masks was important) was particularly distinctive in this racial group. The researchers alluded to a more individualistic perspective among White respondents in which personal determination of the behavior was relevant and salient. However, participants in varying social environments during the pandemic have different motivations for wearing masks. Future research is needed in local communities to identify unique drivers and barriers inherent in each racial subgroup. Behavioral theory-based messaging tailored to specific audiences is critical to achieve health promotion during COVID-19 outbreaks, or for other future health emergencies.

In this New Jersey sample, Black students perceived less severity of contracting COVID-19 than their non-Black counterparts. However, Black students scored higher on cues to action than the other racial groups. Reiter and Katz [16] examined differences in knowledge, attitudes, and beliefs about COVID-19 across racial groups of adults in the U.S. via an online survey. During the early stages of the pandemic, fewer Blacks stated correctly that COVID-19 is not caused by the same virus as influenza, as compared to non-Latinx whites. Black participants also reported a lower perceived likelihood of contracting COVID-19 than White participants. Earle-Richardson et al. [15] examined mask-wearing behaviors among four racial and ethnic groups early in the COVID-19 pandemic. Psychosocial factors most strongly associated with mask wearing among Black respondents were outcome expectations (e.g., wearing a mask to protect others), personal agency (e.g., sense of capability), and cues to action (e.g., hearing messages about the importance of masks).

Neves et al. [17] evaluated dietary patterns among Brazilian university students during the COVID-19 pandemic. Black students with lower income had less consumption of foods from the vegetable group. The monetary cost of healthy foods increased significantly and is more expensive than ultra-processed foods [18]. In this New Jersey study, Black students daily consumed 0.98 cups of fruit and 0.76 cups of vegetables, as opposed to 1.01 cups of fruit and 0.65 cups of vegetables among White students.

In addressing the Latino/Hispanic group in this New Jersey sample, these students perceived stronger health benefits and perceived greater barriers in the performance of these health actions than their counterparts. In comparison, Earle-Richardson et al. [15] highlighted the drivers of mask wearing among Hispanic participants as seeing others wearing masks and the belief in the importance of social distancing and wearing a mask. The role of social environment is highlighted in mask-wearing behavior as contributing to an atmosphere of protection. In a study on undergraduate students, Trammel et al. [19] reported that Latinx students experienced higher COVID-19-related threat and negative beliefs than White students. The Latinx students expressed greater economic impacts due to the pandemic.

As for the Asian group in this study, they practiced a higher frequency of mask wearing and behaviors related to COVID-19 prevention than their counterparts. Asian students also scored higher in cues to action than the rest of the racial groups. However, Asian respondents consumed less fruit per day as compared with their counterparts. Earle-Richardson et al. [15] noted that Asian respondents believed that people important to them should wear a mask when being in public (subjective norm). In another study in the U.S., Asian individuals had higher levels of concern regarding COVID-19 than white individuals [14]. Regarding COVID-19 as a major threat to the health of the U.S. population, Asian respondents scored higher than white respondents. Racial minority groups, including Asians, Blacks, and Hispanics, worried more about getting sick with the virus and about its spread, when compared to White individuals.

The findings in this quantitative study need to be carefully interpreted due to study limitations from a relatively small sample size recruited through convenience sampling, in particular, Black and Asian students. Eligible volunteers may be more health-conscious than non-volunteer participants, thus potentially skewing the results due to social desirability bias. Nevertheless, the researcher recruited respondents from varying majors, ethnicities, and ages to aim for a representative sample based on the university’s demographic profile. Due to the period of data collection when COVID-19 vaccinations were available to the public, and mask mandates were lifted at universities, beliefs about COVID-19 may be different if the survey was administered early in the pandemic before vaccinations were approved.

5. Conclusions

This study provides a salient investigation of COVID-19 beliefs and prevention behaviors among American undergraduates from four different racial groups. In general, Whites practiced less frequency of handwashing and indoor mask wearing during the late stages of the pandemic as compared to all other races. Perceptions of the benefits of taking health action, along with cues to action, were weaker in White college students than their counterparts. In contrast, Black students perceived stronger benefits of performing health behaviors and cues to action as compared with non-Blacks. Interestingly, Black individuals perceived less COVID-19 severity, encompassing harsh physical symptoms, negative mental effects, including depression and anxiety.

In this study, Latino/Hispanic students perceived a higher level of susceptibility to COVID-19, coinciding with greater barriers such as cost to eat healthfully, limited time to prepare home-cooked meals, and academic stress affecting dietary intake in a negative manner. Asian students practiced more indoor mask wearing during the late stages of the pandemic, being more aware of prompts to action, entailing media reports of upticks in COVID-19 or Centers for Disease Control and Prevention (CDC) recommendations on masking indoors. In this sample, Asians consumed less fruit per day as compared with all non-Asians.

Future research should consider university students from other metropolitan and rural regions of the U.S. to uncover their beliefs and health behaviors related to COVID-19. Post-pandemic surveys of young adults from varying racial identities and residential status would ascertain if their health beliefs and practices remain stable from those reported during the pandemic. Public health administrators would benefit from these insights to prepare for future outbreaks and viral infections.