University Students' understanding of masking policies and their mask use in relation to COVID-19 vaccination history, both in and out of the classroom, during the pandemic, 2022–2023

This study aimed to identify masking behaviors in and out of the classroom and knowledge of masking policies in relationship to COVID-19-vaccination among university students during the COVID-19 pandemic in 2022–2023. A total of 2223 students at four universities in Pennsylvania completed a survey in the spring of 2023 on masking requirements at their schools, when they wore a mask (in and outside of the classroom), their COVID-19 vaccination history, and their likelihood of continuing to mask during their in-person classes in the future. Masking in class was not required at the universities during the 2022–2023 academic year; two schools allowed instructors to determine masking policies for their classes. At schools with no masking requirement, 46.2 % of students in fall 2022 and 62.1 % of students in spring 2023 correctly reported there was no requirement. In fall 2022, 50 % of students reported they did not wear a mask during class; the rate rose to 76 % during spring 2023. Outside of class, 52 % indicated they wore a mask in healthcare facilities, 44 % wore a mask when they thought they might be sick, 30 % reported masking when required outside of class or when in large crowds, and 18 % indicated they never wore a mask outside of class. Students who masked reported receiving more doses of COVID-19 vaccine compared with students who never masked. Students who planned to continue to mask, regardless of university requirements, tended to be non-White, non-male, and up-to-date on COVID-19 vaccinations. Masking behavior among university students varied by semester, location (in or out of the classroom), perceptions of their university's masking policy and COVID-19 vaccination status. These findings provide perspective on student behaviors around masking as an important public health measure and may inform students' likelihood of adhering to masking recommendations in future outbreaks or pandemics. • Students who masked received more doses of COVID-19 vaccine. • Students who did not mask were not up-to-date on their COVID-19 vaccinations. • Fewer students masked in large crowds and when they thought they might be sick. • Interest in masking was lower at universities where faculty could require masking. • Hesitancy in masking and vaccination persists among a fraction of university students.