Introduction

A fundamental factor for pandemic control is the population’s engagement in their self-care to prevent further transmission. Effective risk communication that is understandable to the population, regardless of their social, economic or educational status, is crucial for ensuring appropriate action. However, to structure an effective risk communication program, it is essential to understand people’s perception of the risks they face ^1,2.

Risk perception (RP) refers to the subjective assessment individuals make regarding the understanding-perception of vulnerability-susceptibility, potential for harm and effect-consequences of environmental risks ^1,2. However, RP is a dynamic concept and vary across different groups of individuals and contexts ^2,3.

University students exhibit risky behaviors that may heighten their susceptibility to transmission ^2,4,5. Studies have extensively examined RP in relation to communicable diseases, especially sexually transmitted diseases ⁶, and more recently COVID-19 transmission dynamics ^3-5. Research in this area predominantly focuses on students of health programs ^7,8 and other studies focused on analyzing RP’s impact on academic performance ⁹.

Moreover, vaccination programs may have altered people’s perception by providing new information that modifies the initial understanding of the pandemic, potentially influencing preventive behaviors to mitigate transmission risks. This is particularly relevant for younger population who may perceive the elderly as highly vulnerable to COVID-19 ^10-14.

Furthermore, in the face of the return to in-person classes during the COVID-19 pandemic, assessing students’ psychological responses to potential transmission is crucial ¹¹. This facilitates an analysis of how preventive behaviors function in perceived threatening situations and how the perception of an event as threatening influences subsequent behaviors ¹². These elements are necessary to prevent infecting oneself and spreading a disease to others. Therefore, this information is relevant for public health in the face of possible future pandemics.

Therefore, this study aims to evaluate the level of COVID-19 risk perception (PCR-CV19) by returning to in-person classes and to analyze this perception with sociodemographic and health variables.

Materials and methods

Results

Discussion

In the study population, a moderate RP was found regarding the return to in-person classes. The cognitive vulnerability and emotional vulnerability dimensions showed the greatest statistical differences among the surveyed students. This may be due to their experiences during the pandemic, such as diagnoses of COVID-19 among close contacts and COVID-19-related deaths among close contacts. These experiences have likely influenced their perception and increased the uncertainty about returning to in-person classes ¹⁷.

These findings align with reports on RP, where previous experiences play an important role in shaping this perception. As is well known, emotional responses and cognitive representations about disease transmission may have changed since the beginning of the pandemic, mainly due to how the risk of the disease was communicated. These aspects influence RP and the preventive measures that people implement to avoid transmission ^18-20.

An important point of this study is that students consider infection to be serious, particularly because of the possibility of infecting others. However, they do not feel personally vulnerable, which may be due to their perception of risk control. This is a substantial element in people’s perception of the risks they face. This finding is consistent with other studies and the theoretical basis of RP, which suggests that the more people feel they can control a risk, the lower their RP. Not feeling vulnerable or failing to recognize the seriousness of transmission may affect RP and lead to an increase in transmission, which could negatively impact the social, political and economic conditions of populations ²¹.

Significant differences were also observed in both the RP index and each dimension of the PCR-CV19 in relation to the variables, particularly gender, alcohol consumption, physical activity, obesity and symptoms of depression and stress. Females and non-binary individuals tend to perceive a higher PCR-CV19 by returning to in-person classes during the pandemic. Similarly, studies related to vaccination have shown that both females and non-binary individuals have greater RP. This heightened RP may stem from their increased sense of vulnerability and greater fear and distrust in the face of new health challenges ²².

It is worth mentioning that understanding risky behaviors requires considering the symbolic dimension of risk and its meanings. These behaviors are influenced by the social context in which risk is produced and managed. Social expectations, cultural patterns and pressure from groups, peers or family shape how threats or dangers are constructed and perceived. Social expectations and cultural patterns are mediated by a socialization system that emphasizes differences and inequalities between males and females. Over the years, evidence has shown a strong relationship between gender identity and the risky behaviors young individuals may adopt. For instance, males often engage in unhealthy behaviors as a way to assert their virility. Courtenay ²³ indicates that males who adhere to traditional beliefs about manhood are more likely to have poor health habits compared to their nontraditional counterparts. These gender considerations are crucial for understanding RP and behaviors, which are essential for developing effective health programs and risk communication strategies. As suggested, gender is an important predictor of fear ^16,23-27.

Another important contribution of this study is the examination of the health conditions of young people and their relationship with RP, particularly concerning the risk of COVID-19 infection. This includes symptoms related to depression and stress, which showed significant differences (p < 0.001) in the RP index, especially in terms of emotional vulnerability. These findings demonstrate that the COVID-19 pandemic has had not only physical but also mental repercussions ²⁸. Some authors have even suggested that we are facing an epidemic of mental health issues, with significant consequences for both individuals and societal health. Therefore, the data from this study can be beneficial for developing health promotion and risk communication programs aimed at providing formal support to improve psychological and social well-being ^29-32.

Another key element contributed by this study is related to the consumption of legal substances. A significant difference was found between young people who consume alcohol and those who do not (p < 0.05). Notably, Chilean youths exhibit moderate to high levels of alcohol consumption (19). Adolescence is a stage where the RP differs from that of adults, i.e., adolescents often see the dangers of behaviors like drug or alcohol use as less significant compared to adults, who would perceive these behaviors as highly risky to their health ^2,33-36.

In addition, studies on the psychological effects of COVID-19 and mass isolation have found an increased rate of anxiety and depression, as well as hazardous and harmful alcohol consumption ^{36 _-38)} . These findings align with our results, which suggest that pandemic control measures, lacking in health promotion and adequate risk communication, may have created a vicious cycle. Consequently, such measures may have contributed to the emergence of mental health issues like anxiety, depression and stress, leading some individuals to consume alcohol or other substances or to increase their consumption. This likely exacerbated mental health issues by prolonging social isolation and reducing social interaction, ultimately affecting their RP and behavior.

This research has key implications for public health and education. Effective risk communication is a fundamental strategy for controlling a pandemic and must be based on people’s RP. We continue to face constant risk conditions, making it necessary to maintain a surveillance scheme of the PCR-CV19 experienced by the population, particularly regarding transmission risk, a significant contribution of this study. Additionally, the COVID-19 pandemic has tested global health systems, highlighting the urgent need for public health to redefine and adapt its practices to new social, political, economic and health demands ^8,36.

Despite the participation of students from a state university, it would be beneficial to extend this study to a larger population, including private universities, educators and the broader educational community. The information obtained would enable higher education institution managers to establish guidelines, measures and policies supported by public health. This would allow for better anticipation and management of scenarios posed by COVID-19 and other possible communicable diseases, as well as exploring differences in RP.

In conclusion, university students who do not feel vulnerable or do not perceive the seriousness of transmission may neglect self-care behaviors; these findings have key implications for public health and therefore require an intersectoral approach.