Toward a Multi-Item Measure to Identify Involvement in and Circumstances of the Sex Trades: Findings from Cognitive Interviews

Background and Purpose:

Studies of university students in the United States (U.S.) suggest that up to 4.5% of students report sex trading. However, similar to most quantitative sex trading studies in the U.S., these studies predominantly use a single item to identify a complex, stigmatized phenomenon (e.g., “have you ever traded sex for money or drugs?”). Single-item measures are potentially problematic; they do not differentiate between in-person or virtual forms (e.g., OnlyFans) and fail to assess the associated circumstances, risk or reduction of harms, and consequences of sex trading. Further, multiple, behavior-specific items have been shown to better detect sensitive phenomena. Therefore, we sought to develop, adapt and refine a multi-item sex trading measure from the perspectives of university students who were familiar with sex trading.

Methods:

Using a community-engaged approach, we conducted cognitive interviews with students who were familiar with sex trading to determine whether participants comprehend and answer questions accurately. The method involves asking participants to “think aloud” about how they would answer questions (Wills, 2005). Undergraduate and graduate students (ages 18+) at a large, Midwest public university who were familiar with sex trading were invited to participate.

Participants (N=34) were mostly undergraduate (n= 25), white (n=24), cis women (n=24), and queer (n=19). Race demographics were consistent our predominantly white institution. Most disclosed considering or having personal experience with sex trading (n=18).

Data analysis occurred in a multi-stage process. We (1) identified problems with item wording and response options, which led to iterative measure revisions for subsequent interviews; (2) developed pre-determined codes that reflected the meaning of terminology (e.g., sugaring), circumstances, benefits, and harms; (3) developed new codes that emerged from students’ narratives; (4) compared interpretations of our items from those who disclosed compared to those who did not; (5) sought feedback on the revised measure from knowledgeable students.

Results:

Participants reports demonstrated that the language used in single-item measurement of sex trading is too narrow to capture important dimensions of this construct. For example, participants described specific virtual and in-person acts, compensation types, and circumstances that should be reflected in the measurement of sex trading. To increase disclosures, participants emphasized the need to (1) introduce items with destigmatizing statements that normalize the diverse range of circumstances (including economic needs, wants, exploitation, pleasure) and (2) balance positive and negative response options in items that assess perceived consequences stemming from sex trades (e.g., mental, reproductive, and physical health consequences vs. paying off debt; trying out fantasies). Items developed to understand exploitation or coercion resulted in two different interpretations including exploitation from a third party (e.g., sex trafficking) or being scammed or assaulted by a buyer or client.

Conclusions and Implications: Surveying young people, particularly university students, about their involvement in the sex trades is a complex, multi-faceted process. Destigmatizing statements introducing nuanced survey items with diverse response options may be critical. Survey recommendations and implications for using these measures to broaden our understanding of people in the sex trades as well as other hard-to-reach populations will be discussed.