A Mixed Methods Approach to Understanding Body Image and Sexual Risk Behaviors among Female College Students: The Influence of Race and Sexual Orientation

Annually, there are approximately 19 million new sexually transmitted infections (STIs), half among individuals ages 15-24. College females are particularly vulnerable to STIs, and research has shown that body image influences sexual decision making. However, the impact of body image on sexual risk behaviors has not been extensively investigated. A greater understanding of these dynamics could inform strategies for reducing STI transmission on college campuses.To examine whether body image is associated with sexual risk behaviors among college females and explore the potential moderating influence of race and sexual orientation on this association. A sequential explanatory mixed-methods design was employed. Data were collected in 2011 from college females (ages 18-25) at a public university. Survey data were collected from 585 students, who completed an anonymous, self-administered questionnaire. Semi-structured, face-to-face interviews were conducted with 30 students.Quantitative results suggest that the association between body image and sexual risk behaviors differs by both race and sexual orientation (p=0.04). Specifically, among white females, body image did not influence whether heterosexual females use protective barriers during sex. However, positive body image among lesbian and bisexual women was associated with sexual risk. Furthermore, qualitative analyses indicate that negative body image does affect sexual behavior, particularly, frequency of sex. Findings suggest that University health care programs developed to address female sexual behaviors include a focus on body image. When designing interventions for diverse groups, researchers and program developers should consider how race and sexual orientation moderate the relationship between body image and sexual risk taking.