Perceived COVID-19 threat, perceived healthcare system inequities, personal experiences of healthcare discrimination and their associations with COVID-19 preventive behavioral intentions among college students in the U.S.

College students are often reluctant to follow U.S. preventive guidelines to lower their risk of COVID-19 infection, despite an increased risk of transmission in college settings. Prior research suggested that college students who perceived greater COVID-19 severity and susceptibility (i.e., COVID-19 threat) were more likely to engage in COVID-19 preventive behaviors, yet there is limited research examining whether perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination collectively influence college students’ COVID-19 preventive behaviors. This study identified latent classes of perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination, examined whether latent classes were associated with COVID-19 preventive behavioral intentions, and assessed whether latent class membership varied across racial/ethnic groups. Students from the University of Maryland, College Park (N = 432) completed the Weighing Factors in COVID-19 Health Decisions survey (December 2020-December 2021). Latent class analysis identified latent classes based on perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination. Regression analyses examined associations between the latent classes and COVID-19 preventive behavioral intentions (i.e., social distancing, mask-wearing, COVID-19 vaccination) and whether latent class membership varied across racial/ethnic groups. Students in Latent Class 1 (27.3% of the sample) had high perceived COVID-19 threat and U.S. healthcare system inequities and medium probability of experiencing personal healthcare discrimination. Students in Latent Class 1 had higher social distancing, mask-wearing, and vaccination intentions compared to other latent classes. Compared to Latent Class 4 (reference group), students in Latent Class 1 had higher odds of identifying as Hispanic or Latino, Non-Hispanic Asian, Non-Hispanic Black or African American, and Non-Hispanic Multiracial versus Non-Hispanic White. Latent classes of higher perceived COVID-19 threat, perceived U.S. healthcare system inequities, and personal experiences of healthcare discrimination were associated with higher COVID-19 preventive behavioral intentions and latent class membership varied across racial/ethnic groups. Interventions should emphasize the importance of COVID-19 preventive behaviors among students who perceive lower COVID-19 threat. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-14438-5.