Vulnerability and resilience to extreme weather hazards are a function of diverse physical, social, and psychological factors. Previous research has focused on individual factors that influence public perceptions of hazards, such as politics, ideology, and cultural worldviews, as well as on socioeconomic and demographic factors that affect geographically based vulnerability, environmental justice, and community resilience. Few studies have investigated individual socioeconomic and racial/ethnic differences in public risk perceptions of the health hazards associated with extreme heat events, which are now increasing due to climate change. This study uses multilevel statistical modeling to investigate individual- and geographic-level (e.g., census tract level and regional) social, economic, and biophysical influences on public perceptions of the adverse health impacts associated with heat waves. Political orientation and climate change beliefs are the strongest predictors of heat wave health risk perceptions; household income also has a relatively strong and consistent effect. Contextual socioeconomic vulnerability, measured with a social vulnerability index at the census tract level, also significantly affects heat wave risk perceptions. The strong influence of political orientation and climate beliefs on perceptions of adverse health impacts from heat waves suggests that ideological predispositions can increase vulnerability to climate change.