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

Abstract

Quantitative studies in the United States that identify involvement in the sex trades predominantly use a single item to address a complex, stigmatized phenomenon. This item typically does not differentiate between in-person or virtual forms, nor does it assess the associated compensation types, circumstances, and perceived consequences. University students’ involvement in the sex trades is also critically understudied. Therefore, we sought to adapt, develop, and refine a multiitem measure from the perspectives of undergraduate and graduate students who were familiar with sex trading. We conducted 34 cognitive interviews with students to understand how they perceived items on our measure. Results indicated that language used in single item studies may not reflect participants’ views of the sex trades. Participants suggested the necessity of introducing survey items with inclusive introductory statements that recognize the range of circumstances, benefits, and potential harms. Items that address the circumstances of sex trading (including economic needs, wants, exploitation, empowerment/pleasure) were important in capturing diverse experiences. We make recommendations for multi-item measures to identify involvement in and circumstances of the sex trades. Implications for future research using this measure to broaden the field’s understanding of the sex trades are discussed.

Introduction

The sex trades, or trading sex for compensation (e.g., money, drugs, alcohol), is a complex, global public health issue (Krisch et al., 2019) that is associated with vulnerability to sexual and physical victimization and increased risk for sexual risk behaviors/STIs, substance use and mental health disorders problems (Gerassi et al., 2021; Head et al., 2021; Kaestle, 2012; Martin et al., 2020; Miller et al., 2011; Ulloa et al., 2016). These studies largely focus implicitly or explicitly on in-person forms of sex trading. Increases in internet access have drastically changed the landscape of sex trading by: (1) altering how in-person sex trading is facilitated (e.g., meeting potential clients online before meeting them in-person), and (2) increasing virtual forms of sex trading (e.g., webcamming, photos; Jones, 2015, 2020; Nayar, 2017; Upadhyay, 2021; van Doorn & Velthuis, 2018). Though some elements of virtual forms of sex trading may be safer than in-person sex trading, people who trade sex virtually experience in-person and virtual (also known as cyber) violence, harassment, stalking, and doxing (Jones, 2015). Therefore, the sex trades include the exchange of virtual or in-person sexual acts or materials for something of value.

Many studies across high school, college, and community samples in the United States (US), including longitudinal research using the National Longitudinal Study of Adolescent Health (Add Health) survey, use a single item to identify people who have ever traded sex and largely focus on in-person acts only (e.g., Kaestle, 2012; McNeal & Walker, 2016). These studies cannot differentiate behavior type (e.g., virtual or in-person), compensation types (e.g., housing, money, clothing), or circumstances (e.g., economic need, exploitation, empowerment). Further, the use of multiple, behaviorally specific questions has been shown to better detect highly sensitive and stigmatized behaviors (Cook et al., 2011), which may be instrumental to fully capturing sex trades involvement. A new study using MTurk suggests that acceptability of trading sex was higher when words like “sex work” and “transactional sex” were used as compared to “prostitution,” and that “sex work” was more clearly understood by participants (Hansen & Johansson, 2023). However, not all people who have traded sex for compensation identify their experiences as “sex work” (Gerassi et al., 2018; Martin, 2013). Therefore, the development of a multi-item, behaviorally-specific measure that avoids labeling experiences as sex work or sex trading has crucial implications for future research to comprehensively understand the scope of sex trading within the university context. The purpose of this study was to ascertain how undergraduate and graduate students think about sex trading for financial compensation and adapt, develop, and refine a multi-item, behaviorally-specific measure to identify sex trading acts, compensation types, and circumstances.

The Sex Trades: A Multifaceted Phenomenon

The sex trades consist of various virtual and in-person sex acts that hold different levels of stigma, potential for criminalization, and definitional issues due to age and other factors. In the US, minors who trade sex for financial compensation under any circumstance and adults who trade sex because they experience force, fraud, or coercion are federally viewed as victims of sex trafficking (United States Department of State, 2019). Adults who are engaged in the sex trades may do so by coercion (e.g., trafficking or exploitation typically involving a third party), circumstances (e.g., because of homelessness or economic vulnerabilities), or choice (e.g., as a form of work that is criminalized in much of the U.S.; Weber, 2020). Adults engaged in the sex trades often refer to themselves as sex workers, connoting that these acts are a form of employment (Sanders et al., 2016; Wahab & Panichelli, 2013). However, other adults who engage in the sex trades do not identify as sex workers, thereby creating complex methodological issues in labeling people’s experiences (Gerassi et al., 2016; Martin, 2013). Further, the sex trades are stigmatized for many reasons, including, but not limited to, the criminalization of sex trades as well as the conflation between sex trafficking and sex work or the beliefs that all forms of sex work are exploitative (Benoit et al., 2019; Stoklosa & Ash, 2021). Therefore, research in this area requires methodologically rigorous and diverse approaches to reflect the multifaceted complexity of the sex trades, which are not extensively reflected in the literature.

Extant survey research predominantly uses a single item that does not adequately differentiate between sex trading acts, circumstances, compensation types, or circumstances. The survey item used is typically phrased as whether participants have ever “traded sex for financial compensation” or “traded sex for money or drugs” (Gerassi et al., 2021; Krisch et al., 2019; Martin et al., 2020; Ulloa et al., 2016). Using a single item, a nationally representative sample of adolescent and young adults (< age 27) found that approximately 5% of the general population had ever exchanged sex, and those young people were more likely to report past child abuse, STIs and HIV (Ulloa et al., 2016). Estimates of sex trading in representative samples of high school youth range from 1.4% to 7.5%, and youth who trade sex are significantly more likely to report homelessness or economic instability (i.e., going hungry, working to support family), substance use, and child abuse (Gerassi et al., 2021; Head et al., 2021; Kaestle, 2012; Martin et al., 2020). Similarly, a study using a convenience sample of undergraduate and graduate university students found that 4.5% of students reported trading sex; students who experienced emotional neglect and greater alcohol use problems had a higher likelihood of exchanging sex (Gerassi et al., 2023). Some trafficking-specific studies among homeless and runaway youth have used up to three items to assess whether a participant had been compelled, forced, coerced, or pressured to perform sexual acts for compensation or protection (Middleton et al., 2018), but did not allow for other circumstances of the sex trades. These findings begin to inform possible intervention strategies to reduce harm.

Consequently, the use of a single item in U.S. studies does not allow for identification of the diverse circumstances under which the sex trades occur, e.g., as a form of victimization, coercion, choice, or because of economic need/precarity within a capitalistic system (Benoit et al., 2019). For example, whether and how survey participants would endorse this question if they engaged in sexual touching, fondling (but not intercourse), or virtual forms of the sex trades remains unclear, underscoring a significant gap in our understanding. Increases in virtual transactions due to the COVID-19 pandemic has only further underscored the need for a multi-item measure that assesses both virtual and in-person behaviors (Risman, 2020; Todres & Diaz, 2021).

Extant Use of a Multi-Item Measure

Some work, typically outside of the US, has aimed to develop rigorous multi-item measures. For instance, one study in the UK, the Student Sex Work Project, used a mixed methods approach and action research methods to develop a comprehensive, multi-item measure to identify sex trading acts and circumstances in a sample of university students (Sagar et al., 2016). To generate new knowledge on the characteristics and extent of sex trading, the Student Sex Work Project trained seven students who worked in the sex trades to assist with all aspects of data collection and analysis, including survey development (Sagar, Jones, Symons, Bowring et al., 2015). Findings suggest that more than half of students who report involvement in the sex trades are motivated to do so to fund their education and cover basic living expenses (Sagar et al., 2016). Further, almost 75% reported some type of difficulty in paying bills and 63% reported experiencing current debt (Roberts et al., 2013). This is alarming because UK college tuition is generally capped at $12,000 USD, nearly half of the level of average tuition in the US (Barr et al., 2019). Further, this study took place well before the COVID-19 pandemic, which changed the landscape of sex trading and may have heightened disparities more broadly.

The aims of this paper were to use cognitive interviews with undergraduate and graduate students who are familiar with sex trading and enrolled at a large public US university to (1) adapt, develop and refine a multi-item, behaviorally specific measure to identify sex trading acts and associated compensations, circumstances (e.g., exploitation, empowerment, economic need), and (2) understand the comprehensiveness and acceptability of the measure. Findings from a third aim to understand the experiences of students’ involvement in virtual and in-person sex trades are additionally important and will be discussed in a second paper.

Method

In this community-engaged study, we developed a preliminary quantitative measure and conducted cognitive interviews with students who were knowledgeable with sex trading to understand their comprehension, judgment decisions, and response processes of our measure (Wills, 2004). The purpose of cognitive interviews is to determine whether respondents can comprehend and answer questions accurately by asking participants to think aloud about how they would answer questions (Wills, 2004). Participants are asked to describe how they came up with the types of answers they gave and clarify their thoughts regarding terms, language, and concepts. Cognitive interviews are used to identify problems with participants reporting specific behaviors, and understand vocabulary used by participants to describe phenomena (Dykema et al., 2019; Schaeffer & Dykema, 2015). Using this method is an important step in developing measures prior to psychometric property testing and is not intended to produce generalizable results (Maitland & Presser, 2016; Wills, 2004). Data collection occurred from February 2022 to January 2023. Human subjects’ approval was granted by the the University of Wisconsin-Madison’s Institutional Review Board.

The faculty researchers worked closely with students involved in this project’s undergraduate and graduate team members and a predominantly undergraduate student advisory board (SAB) to inform and contribute to data collection and analysis. The SAB consisted of four undergraduate students who met with some members of the research team to provide feedback and suggestions on language use in flyers to recruit students to participate in qualitative interviews and on the qualitative interview guide itself. SAB members were provided $15 gift cards for attending project planning meetings. Student project team members, who had some familiarity or personal experiences with the sex trades, were paid hourly or received academic credit, to assist with project tasks. Specifically, three undergraduate students who were familiar with sex trading among university students were instrumental in disseminating materials by word-of-mouth and student groups that targeted underrepresented groups. A graduate student leader similarly disseminated the study to her networks. We were unable to conduct multiple rounds of cognitive interviews. However, two students (undergraduate and graduate) who participated in the qualitative interviews were involved in reviewing and giving feedback on the final revision of the measure in addition to the student members of the research team.

Participants

Sample characteristics are summarized in Table 1. Over two-thirds of the sample were undergraduate students. In the undergraduate sample, we had representation from students across all years of study. The location for this study was a predominantly White institution (PWI) with approximately 65% of students identifying as White and 52% as women (university collects gender data as man/woman only). The majority of our sample identified as White (70.6%) and cisgender women (70.6%). However, we had substantial variation in sexuality, with less than half of the sample (41.2%) identifying as heterosexual. We did not ask about country of origin or region or state of the U.S. The team was aware of the stigmatized and underexplored nature of student sex trading as well as the power dynamic between faculty researchers and student participants. Although we repeatedly made clear that personal disclosure was not required to participate, more than half of our sample (n = 18) disclosed personal experiences of considering or engaging in the sex trades. The rest reported drawing from their friends’ experiences and/or social media accounts of people they knew.

Table 1.

Participant demographics and characteristics (N = 34).

Characteristic	Participants (n)	%
Year in School
Freshman	6	17.6%
Sophomore	7	20.6%
Junior	6	17.6%
Senior/5th Year	6	17.6%
Graduate Student	9	26.6%
Race
White	24	70.6%
Latino/Latina/LatinX	3	8.8%
Multi-Racial	3	8.8%
Asian	2	6.0%
Black or African Descent	1	2.9%
Prefer Not to Say	1	2.9%
Gender
Cisgender Woman	24	70.6%
Cisgender Man	3	8.8%
Trans and Gender Expansive	6	17.7%
Prefer Not to Say	1	2.9%
Sexuality
Heterosexual	14	41.2%
Bisexual	11	32.4%
Queer	3	8.8%
Pansexual	3	8.8%
Lesbian	2	5.9%
Prefer Not to Say	1	2.9%
Disclosure Status
Yes	12	35.3%
Considered	6	17.6%
No	16	47.1%

Development of the Preliminary Quantitative Measure

Our preliminary measure sought to identify the following aspects of students’ involvement in the sex trades: forms (e.g., virtual vs. in-person), circumstances (e.g., economic need; being pressured/tricked; experimentation), compensation types (e.g., money, substances, gifts), risk and strategies to reduce harm (e.g., unprotected sex, substance use, identity protections), time spent, and consequences (e.g., physical/emotional harm, paid bills). First, we began by drawing from items from the multi-item measure of in-person sex trades, compensations, and circumstances that was developed for use with university students in the U.K. (Roberts et al., 2007, 2013; Sagar, Jones, Symons, Bowring, et al., 2015, 2015; Sagar et al., 2016). Second, we adapted this measure by including virtual forms of sex trading identified in the literature (Jonsson et al., 2015; Sanders et al., 2016). Third, we expanded on compensation types and circumstances by reviewing U.S. studies with non-university specific populations. This study also suggested that compensation types should be expanded to include Amazon Wishlist. We also included items that assessed for exploitation, such as being encouraged/pressured/forced to exchange sex (Middleton et al., 2018). Fourth, we examined news articles from reputable national and local news sources (e.g., New York Times, the Atlantic) including articles on sugaring among university students in the U.S. (Bauer-Wolf, 2017; Fairbanks, 2017; Kitchener, 2014; Rosman, n.d., 2018) and created items about types, circumstances, and facilitation methods, based on descriptions included in the articles. Fifth, we scanned language used by young people who participated in online forms of sex trading (Camming Advice From a Webcam Model, n.d.; Drolet, 2020). Sixth, we discussed the measure within our research team, which led to an additional item of selling sexual items like underwear for someone else’s pleasure. Seventh, we presented the measure to students during our cognitive interviews and incorporated their feedback to iteratively revise the measure.

Interview Guide

The first and last authors developed a three-part interview guide that was initially edited by our SAB. The cognitive portion of our interview guide involved sharing survey items and asking for students to think aloud and share how they would interpret them. Some prompts specifically assessed how participants would interpret a particular item (e.g., what are some scenarios that come to mind when you read this question?). Other questions asked for recommendations regarding how items or response options were worded (e.g., Is there anything that we’re missing? Is there anything you would change? Add? Delete?). We provided positive affirmation when students provided suggestions or edits to encourage continued participation and constructive feedback. Another section of our interview guide included questions that explored students’ perspectives and examples of the sex trades. While these questions predominantly helped us understand students’ perspectives of sex trades, and therefore will be written elsewhere, they also provided some suggestions of language to integrate in the measure. Finally, we asked students about their concerns regarding future studies that would use the (revised) measure to identify involvement in and circumstances of the sex trades. These questions elucidated concerns of stigma and judgment, which resulted in introductory statements to some items that were subsequently integrated into our measure.

Procedure

Data collection occurred February to May 2022 (phase 1) and then again in September 2022 to January 2023 (phase 2) to recruit students during the academic year. In Phase 1 we planned to conduct focus groups with students because we were not asking for personal disclosures of the sex trades. We initially chose this approach to allow students to weigh in with each other about how they would interpret questions. Guided by our SAB, we designed and disseminated recruitment flyers that advertised focus groups for university students who were “familiar with trading sex for financial compensation.” The SAB suggested that we indicate that sex trading was “often referred to as being an ‘accountant’ or ‘sugar baby.’” This phase of the project resulted in only 8 participants because we encountered two challenges: (1) scheduling issues such that all but one focus group included one student, and (2) participants indicating that others may not have known that we were also interested in virtual forms (e.g., OnlyFans). In phase 2, we changed our strategy to schedule individual interviews and revised the flyer to indicate that sex trading could include “webcamming or posting on sites like OnlyFans,” “sex work,” “using apps like Seeking Arrangements,” “Sugaring or being an ‘accountant,’” “selling clothing articles for someone with a fetish,” “providing emotional or sexual companionship,” “something else?.” This phase yielded a total of 26 participants. Both sets of recruitment materials were posted in all undergraduate and graduate academic buildings and campus-wide, residential buildings. We also emailed departmental list serves and affinity groups to reach students who represented minoritized groups, e.g., Gender and Sexuality Campus Center, Black Student Union.

Students could participate in this study if they were (1) an undergraduate or graduate student at [university], and (2) familiar with sex trading. We allowed students to determine what “familiar” meant. Potential participants scanned a QR code or clicked a link routing them to a brief eligibility screener, which included questions about student level and open-ended demographic questions. In phase 1, a project member sent a scheduling poll, and a subsequent e-mail inviting them to the scheduled focus group. In phase 2, a project team member sent a follow-up e-mail with the scheduling link to the first and last author’s calendars. Students were sent the informed consent document with an e-mail reminder the day before their scheduled interview. The first or third author verbally reviewed the informed consent before asking for permission to record and turning on recording and Zoom transcript features. After the interviews, the first or third author debriefed with the student and offered resources. Participants were provided $25 gift card to their choice of Amazon, Walmart, or Target. All interviews were transcribed and entered into Dedoose for analysis.

In all, 34 participants completed the study. In phase 1, 17 participants completed the screener but only 8 participated. In phase 2, 39 completed the screener, of whom 26 participated. Two potential participants who scheduled an interview later canceled and never rescheduled. We were unable to reach others who completed the screener but did not complete the interview.

Data Analysis

Data analysis occurred in a multi-stage process. First, the team met frequently to discuss new language and insights from interviews, which led to iterative revisions of the measure for subsequent interviews. Second, we developed pre-determined codes that reflected the terminology used in the interview guide (e.g., sugaring, emotional companionship) as well as ways that students became involved in the sex trades (e.g., circumstances). Consistent with a directed content analytic approach (Hsieh & Shannon, 2005), all three authors contributed to the development of new codes that reflected emerging themes or new insights that were experienced by participants of the study, e.g., “social capital” as a perceived benefit. We also developed codes for personal disclosures, compared to students who did not disclose, and found no major differences between the two groups for the analysis presented here, e.g., how they would comprehend and interpret survey items. The first and second authors led the initial coding of the data and provided sample de-identified codes to students on the research team. We clarified language used to code throughout and found no substantive discrepancies.

Results

Participant recommendations are summarized in Table 2. Overall, items that used language like “have you ever traded sex for compensation” were found to be confusing (see below for more details). Participants reported specific virtual and in-person acts, compensation types, and circumstances that they thought should be reflected in the measure. To increase student disclosure, participants emphasized the need to (1) introduce items with destigmatizing statements that normalize the diverse range of circumstances (e.g., choice, circumstance, and coercion) and consequences (e.g., positive and negative), and (2) balance response options in items that assess for perceived consequences stemming from sex trades. Finally, items developed to understand exploitation or coercion resulted in two different interpretations, including exploitation from a third party or being scammed or assaulted by a buyer or client. In presenting the narratives from our data, we have opted to introduce students by their undergraduate or graduate status only, unless another aspect of the student’s identity (e.g., race, gender) were relevant in the meaning of the quote. We have chosen to be as authentic as possible to our participants and present quotes verbatim as recommended in prior work (Corden et al., 2006; Lingard, 2019).

Table 2.

Summary of participant recommendations.

Construct	Item & Response Option Recommendations
Types/Acts	Introduce items with normalizing statements, e.g., “Sometimes people do things for money or financial compensation because they want to, need to, or for other reasons.” Specify virtual and in-person items. Follow initial items with language like “for the rest of the survey, we refer to the items above as providing sexual contact, content, or services for compensation.” Avoid language like “trading sex” for financial compensation. Separate sexual contact and intercourse. Include personal items like bath water, socks, and underwear.
Compensations	Separate money, drugs/alcohol, food, and other response options. Specify payments directly to a bill (e.g., rent, tuition). Include tokens for online gaming subpopulations. Include Amazon Wishlist items, gift cards, Cashapp or Venmo.
Method	To encourage responding about platforms for meeting people, include a statement indicating that “the goal is to better understand participants’ experiences. We will not publish specific names of sites.”
Time Spent	Include two items for all sex trades to identify the time spent “preparing” and “providing.” Another item to identify “editing” for virtual forms. Provide examples for each item. For example, preparing can include: “personal grooming like makeup as well as setting up the space.”
Consequences	Introduce items with normalizing statements, e.g., “People have many different experiences because of providing sexual content, contact, or services compensation. Some can be positive, negative, both or neither.” Include many diverse options that could be perceived as positive or negative. Group thematically rather than by perceived level of positivity, e.g., physical, emotional, financial, relational. Add violence. This is the only sub-theme that may have exclusively negative items.
Circumstances	Introduce items with a normalizing statement, e.g., “sometimes people do so because they need to, want to, or for other reasons.” Include items that examine economic needs (e.g., spending money, avoid or pay off debts) and wants (e.g., spending money), empowerment (e.g., seek pleasure), and exploitation (e.g., pressured or asked in a way that I couldn’t say no, forced to).
Harm reduction	Use Likert scale items. Include a mix of positive and negative strategies.
Identity or labeling of experiences	Ask the participant whether they consider any of sex trading acts to use a check all that apply format to allow for multiple experiences. Response options may include sugaring, sex trading, sex work, sex trafficking, hobby, employment, sexual favors, something I do.

General Framing of Sex Trading Measure Items

Overall, items aimed to identify the sex trades were found to be potentially difficult to answer truthfully, but students provided strategies to mitigate this concern. One strategy is exemplified by an undergraduate senior who participated in our study after the research team had revised the recruitment flyer to state, “this study will be used to support, empower, and advocate for students.” She expressed,

Saying in [the] introduction of, like, our goal is or, like on those like fliers [for the current study] or like however you introduce it to future participants. Like, we want to reduce the stigma and we want to figure out … blah blah blah [purpose of study] ….

[9]

Participants, like her, suggested that adding these introductory statements and diverse responses options across items would be crucial to help increase participation and counteract stigma. As a first-year undergraduate student stated when assessing students’ willingness to complete surveys,

I feel like [there’s] a lot of negative stigma, so people might not necessarily answer honestly … I guess just, like, making sure that there are, like, plenty of options so people feel like there isn’t necessarily a right or wrong option.

[17]

Efforts to reduce stigmatization in the survey were viewed as critical and somewhat differed based on the type of sex act. For instance, another undergraduate senior reflected:

I think it’s super valid to acknowledge that these different forms of sex trade are assigned different, like, stigmas and … values. So like right now … there’s still stigma with like Only Fans and Sugar Daddies and things like that, but it’s … a lot more empowering … very normalized, very, and popular, and people are really open about sharing their experiences. But like we’re talking about people having sex with tutors or professors or people in organizations. There’s like this, ‘Oh, why would you do that like, that’s, like, demoralizing’. But it’s like we’re talking about pretty much the same thing, and there’s this power dynamic that’s present in both instances.

[11]

As this participant suggested, comfort in disclosing virtual sex trades as compared to in-person forms varied and, consequently, should be addressed by integrating multiple survey items.

Items to Assess Sex Trades: Acts, Compensations, Frequencies, and Time Spent

Terminology and Acts

Students viewed language such as “sex trading” or “trading sex for financial compensation” in diverse and conflicting ways. Some students rejected the terminology entirely and preferred “sex work” because it reflected the labor involved in both virtual and in-person forms. As a graduate student who engaged in virtual sex trades suggested,

I feel like sex trading is kind of a loaded term and it’s kind of problematic because doing sex work doesn’t mean [that] you’re having sex with people, especially like in the realm of what I do, it’s more like a service in kink.

However, others did not associate the acts of the sex trades with “sex work,” typically because of illegality concerns. As reflected by a graduate student,

The word that comes to mind [when thinking about sex work] is like ‘heavy’. Like someone may have done things that are like by definition considered sex work, but because of the heaviness that the term sex work holds … It’s also illegal, and like things like that, [so] including the term sexual favors, might be more like inclusive to some folks, and how they identify their experiences.

[11]

As she suggested, some participants thought that they would be less likely to endorse items that were specifically assessing for “sex work.” Similarly, some participants did not believe that “sex trading” was an all-encompassing term that “fit” with their experiences but would endorse a specific item focused on virtual forms, such as photos or videos. As an undergraduate sophomore indicated,

I wouldn’t say I’m like fully on board with like sex trading … if someone were to ask me like, oh do you do sex trading? I’d be like uh, no. (short laugh) But like if people were to ask like, “oh hey have you ever like sent nudes?” or like “have you ever been paid to be sexual?” I feel like a lot of, like more like women and people would be like, “oh yeah, like I’ve done that before” and like that’s pretty normal.

[30]

Consequently, multiple specific items that assess both virtual and in-person sex trades were viewed as necessary to fully capture the issue. Furthermore, virtual acts were perceived to be commonly occurring among university students and easier to endorse. These findings did not differ based on whether the participant disclosed personal experiences of the sex trades. In the latest revision, we moved to categorizing nine items of virtual and in-person sex trades as “providing sexual contact, content, or services for compensation,” which was well received by later participants.

Average Time Spent

Participants, particularly those who disclosed personal experiences, expressed the need to separate survey items that aimed to assess how much time was spent on sex trades involvement to understand: (1) preparation, (2) providing the act, and (3) editing for distribution (for virtual sex trades only). Students described the considerable time that was important to calculate in getting physically and emotionally ready, setting up virtual spaces, and researching potential clients. As an undergraduate senior with personal experiences (of in-person sex work) described,

I feel like you could say anything from, like, twenty plus hours a week, if you’re counting like getting ready, going through these profiles, going out on the date ….It’s a lot, like, honestly, like 30, 40, it’s very time-consuming that’s like, ultimately, why I stopped, it’s just too much.

[8]

These experiences were reported to differ based on racialization and transphobia, which may contribute to hours spent changing one’s appearance. As a Black cisgender woman and undergraduate senior described when discussing time spent preparing for in-person sex work,

Honestly getting ready, that was a long part of it. They want you to look like perfect little Barbies, and like, at the time, like now my hair is curly, like, when I were on dates, I was specifically asked to like straighten my hair, have my full make up done, wear heels. That takes a long time, and I remember I would like miss class because I would have dates in like the early evening, and I was like I gotta straighten my hair, I got to wash this, I got find an outfit.

[9]

She suggested that she would not have accounted for additional time spent before or after the event when answering an item about how much time spent. However, time preparing and editing virtual content was perceived to be significant. Further, they recommended that response options include ranges because it would be difficult for students to respond honestly and accurately to open-ended questions to assess the frequency of and time spent.

Compensation Types

Students identified diverse compensation types for the sex trades. New suggestions included online currency like tokens, particularly for students who participated in gaming, as well as tutoring or other academic advantages, gift cards, Amazon Wishlist items, and payments that went directly to support rent, tuition or cellphone (rather than the buyer giving a cell phone or place to stay directly to the person). These response items were suggested in part because the method often protected students’ addresses, e.g., Amazon Wishlist items and direct payments. Further, undergraduate participants identified some response items that they felt were unique to college students, such as higher grades and tutoring on college campuses as well as career advice and social capital. For instance, an undergraduate senior who provided in-person sex trades indicated,

They [her clients] love like college girls … I think it makes them, like, feel good about themselves. That they feel like they can, like, give advice for that, and they feel like, ‘Oh, you’re not a sex worker’. That’s just like, you know, yeah, like not going to college or like. So- they think of you as like a step up, I guess? I feel like they’re always like they’ll, give advice, and they’re like, ‘Oh, yeah keep studying’ [or] give advice on like career things and internships. Or, like, people in [that] circle … have, like, internship opportunities and how to kind of just navigate having conversations with your professors or um grad school sort of situations … Like, I’m first generation, so, I would have just navigating the whole college process. I would just ask them all these questions.

[9]

As this narrative suggests, some students, particularly from low-income and/or first-generation backgrounds, gained cultural capital that they found helpful as they advanced through their studies. Further, some of these compensation types were linked to the positive consequences that were perceived to be important to integrate in the measure.

Items to Assess the Consequences: Balancing Positive and Negative Response Options

Participants emphasized the importance of items and response options that included positive and negative consequences of the sex trades. Our first preliminary draft included an item with 11 response options, only two of which were perceived as positive. Yet, participants, such as this graduate student, suggested that this balance was insufficient and noticeable,

I think it’s like something that just stands out about this is like the balance of like … like the first two [response options], seem like the only sort of like gains that someone could get … When [people in the sex trades] talked about the things they get … like ‘I’m an artist and I get to like work on my art’ or, like the thing about if you have like a disability or chronic pain, and you’re able to like make money that you wouldn’t have access to otherwise. And … the connection, ‘I have like connection, I have community.’ … just other examples of like that, especially for people who have experienced this. Like what can it be like for them psychologically to then be in like contact with like, [whereas] these are all the shitty things that you might experience.

[4]

Importantly, students thought that including positive and negative response options would also signal to participants that the researchers understand the complexity of sex trades involvement, thereby encouraging them to answer honestly. In another example, an undergraduate junior provided many positive response options stemming from her own experiences,

Another benefit [is that] you get to choose your own hours, you get to choose any work, I love being self-employed … I don’t think I can ever fully work for someone else, or having a lot of flexibility ever quite frankly … I feel like I have a better quality of life just by the like, you know, like well negative things that gets to me, but like I wouldn’t be able to get like a puppy and I just love her to death. (Laughter) My apartment, like I just express gratitude every day because I’m so thankful that I was able to … do this for myself and … have such a nice, you know, home. When I got a car, just things like that, there is like there is a sense of stability that can come with it and that is priceless.

[19]

This may have been especially important to students like her who reported foster care involvement and, therefore, providing response options that reflect these benefits were viewed as essential. On the other hand, she suggested multiple negative items, such as pelvic floor damage, mental health concerns, and relational trust issues in intimate relationships. She added, “so I would say kind of like almost making more options for like … because there is so many there’s so many positive things that can come out of it, and there is also so many negative things.”

Students in later interviews, such as this graduate student, greatly appreciated the revised version that included over 30 response options that were positive (e.g., been able to pay off debts, had flexible work schedules, built community, discovered something about your own sexuality, etc.) and negative (e.g., been scammed, experienced stigma, being stalked, physical injuries, mental health concerns, etc.),

I think it was very thorough. At the beginning I was like, oh like what about potentially losing family or friend; and then we got to that, so this one was kind of on my mind. But it sounds like you’ve done a lot of thinking about the list.

[32]

Further, two students from early interviews also reviewed the revised response items and expressed similar agreements.

Items to Address the Circumstances: Factors Contributing Involvement in the Sex Trades

Students reported diverse circumstances that contributed to their involvement in the sex trades and that should be included as survey items. Broadly, they suggested: (1) economic needs (e.g., pay tuition, living expenses), (2) economic wants (e.g., spending money, luxurious experiences), (3) curiosity and empowerment (e.g., for pleasure), (4) flexible work conditions (e.g., setting your own hours), (5) reclaiming body after interpersonal or systemic violence and abuse (e.g., child sexual abuse, transphobia), (6) access to social capital or advancement (e.g., career advice from wealthy men), and (7) exploitation from a third party.

Economic Need

Students who indicated that they were first generation and/or experiencing some type of economic precarity described economic need as an important factor that contributed to their involvement in the sex trades. Therefore, identifying the multi-faceted aspects that could contribute to economic need in demographic and sex trading items was viewed as essential. For instance, an undergraduate junior, with a full scholarship dedicated for first generation students who are predominantly from low-income families, shared about how she became involved in in-person sex work:

I was first generation. I was going into a [pre-college summer] program where.I was like taking classes at [university] … So I was like, what am I going to do? … We just weren’t allowed to work. You’re taking all these low-income students, and then putting them in college, no stipend for food or anything. And then … what? So, then I, that’s why, literally, I remember in the dorms, that’s when I started doing Seeking Arrangements.

[7]

As this narrative demonstrates, students indicated that a condition of their involvement was that they were encouraged or not allowed to work but needed money to support themselves and/or their families. Economic precarity was also viewed as important to assess among graduate students, like one graduate student who indicated that “grad students tend to do [sex work] because … you will have less access to financial aid and hope to fund your higher education. [4]” Other students suggested that involvement was less about economic need but rather economic wants, such as spending money to buy “luxurious” items or experiences, such as “fancy dinners” or trips.

Others suggested that items to identify empowerment and pleasure as a circumstance were critical. This was particularly found among minoritized students engaged in the sex trades because they experienced varied forms of identity-based violence in their everyday life. As a sophomore trans woman shares about her own experiences with webcamming,

It’s like capitalizing off of how people objectify [me], but this time using it for like my own personal gain. I get called, like, stuff or slurs every day in some way and I experience a lot of really shitty things that result from factors about our society. But when it’s like in that context and somebody’s like trying to tell me something it’s attached to a donation and that’s a big difference ….Like transphobia exists in the world and … I’ve suffered from so much, like it’s me benefiting from it this time, and like that’s why it’s like empowering.

[27]

She, like other students, suggested that items assessing the flexibility and convenience of the sex trades, particularly virtual forms, was also important. As she noted, “it’s incredibly convenient, like I just do it from like my, you know, my computer and my house, and I can like easily do like a 100 - per hour on a good day.” These response options were seen as important for university students who have blocks of time for courses in which they cannot work a more typical multi-hour shift. Further, students from religious backgrounds that they viewed as conservative reported similar aspects of empowerment. We had not included any items to identify current or former religious backgrounds, but the narratives suggested these identity-based aspects may contribute to students’ involvement in the sex trades and should be assessed.

Participants had two main interpretations regarding items that aimed to understand whether the student had been coerced into the sex trades. After several iterations in early interviews, the items presented to most of our sample asked whether students had been “pressured, tricked, or asked in a way that they felt they couldn’t say no to engage” in the specific act. Most often, this phrasing was interpreted as a participant feeling scammed by a buyer who broke an agreement regarding condom use, type of sex (e.g., buyer engaging in anal sex instead of vaginal), or money. For example, an undergraduate senior said,

I’ve been in situations where people have … taken the condom off … in the middle of it or came in places that they weren’t supposed to or, yeah, just been like very tricky and deceitful. Like, I was with an older man, and I remember him being like, yeah, [using a condom is] okay. And then, like five minutes. later, [he] just took the condom off in the middle of it, making a joke about … pregnancy. I felt very tricked. Felt very scammed.

[8]

This differed from other participants who interpreted this language as potential exploitation by a third party, who had set up the exchanges. As an undergraduate junior shared: “I think of … if a boyfriend or girlfriend encourages their significant other like, ‘hey, uh, do you want to try doing this so we can make money because we’re a little short?’ It’s usually like because the person pressuring wants something out of it. [5]” Similarly, an undergraduate senior suggested that the question was asking whether the third party “manipulated” the student because the question “feels like there’s a bit less autonomy in making choices [9].” Collectively, however, the predominant interpretation of items aimed to assess for exploitation yielded examples of buyers who scammed students from their agreed upon terms (e.g., compensation, condoms). Additionally, most students in our sample who shared their own or their friends’ situations did not describe instances of a third party coercing them into involvement in the sex trades while enrolled in a university program.

Items that Assess Risk or Reduction of Harm in the Sex Trades

Students identified diverse potential response options to a survey item that could influence their risk of harm when engaging in virtual and in-person sex trades. Response options for in-person and virtual forms that could increase risk of harm included substance use and dissociation. Virtually, response options predominantly focused on reducing harm by protecting their identities, e.g., avoiding showing faces in videos, using a watermark to protect against someone leaking photos, changing physical appearance by wearing wigs, masks, covering tattoos, and using a VPN. In-person harm reduction options often involved working with someone to research customers or to enact a safety plan, e.g., meeting in a bar or restaurant with a friend at a nearby table. Students emphasized the importance of assessing these strategies because the findings could be helpful to future students. For instance, the undergraduate senior who described gaining social capital and paying bills but who was also scammed, reflected,

I just wish I wouldn’t have been as I’m afraid to speak on for myself and advocate for myself. I think eighteen-year-old [name] versus, like right now, I’m 24, I think that experience would have gone different. Like I still necessarily don’t look as it at it as a bad experience. But … I think I wish I would have just advocated for myself or not been afraid to, like, something when I talk about with my friends, or like when I talked about partners, or talk to partners about this specific time in my life.

[8]

This story demonstrates the importance of understanding students’ perceptions of the sex trades, and whether and how students mitigate potential harms.

Discussion

Our study confirms that surveying young people, particularly university students, about their involvement in the sex trades is a complex, multi-faceted process. Extant studies that establish the prevalence of the sex trades across contexts are thought to be underestimated, partially because they most often use a single item to identify a complex, stigmatized, and often illegal act (Martin et al., 2020). Further, the criminalization of prostitution in much of the U.S. may serve as an additional barrier to disclosure in research and practice (Benoit et al., 2019). Our findings suggest practical ways to move the knowledge base forward: use a refined multi-item measure that includes methodological strategies to counteract stigma. Destigmatizing statements introducing nuanced survey items with diverse response options may be critical to understanding the extent and impact of the sex trades. Therefore, working toward a validated measure ultimately holds essential implications for anti-oppressive policies and practices to heighten benefits and reduce possible harms.

It is important to note that this study assessed the perceptions and experiences of the sex trades among students who are currently enrolled in an undergraduate or graduate program. We do not yet know the extent to which our measure is generalizable to the general population or to students in a non-PWI context. While some revised response options are specific to a university context, such as receiving tutoring as compensation or obtaining a better grade, others may be much more general, such as assessing virtual and in-person sex trades and including positive and negative outcomes (see Table 2). Further, participants of color and/or those who are queer, trans, low-income, and/or hold another minoritized identity or experience suggested that including items that reflect one’s personal experiences of racism, transphobia, and so on are crucial to creating an inclusive survey. While the dynamics of oppression may manifest differently in a university context, the underlying root causes, including capitalism and white supremacy, transcend all U.S. contexts (and beyond). Therefore, research using the revised or future adaptations of our multi-item measure is crucial. Future work is needed to cognitively test our revised measure with young people outside of the university context and assess its psychometric properties in rigorously obtained and diverse samples of young people.

Inclusivity and Neutrality in Sex Trading Survey Research

Our findings present a methodological conundrum. On one side, students indicated that they would feel more comfortable endorsing items if they knew that the researchers understood the complexity of the sex trades and its associated circumstances, benefits, and consequences. They also suggested that knowing the intent of the researchers would be beneficial, that is to empower and support students, rather than dissuade them from participating in activities or shutting down websites. Further, “trading sex,” which is a term that has been used in many longitudinal and cross-sectional studies (e.g., ADD Health), may not be specific enough. Students who engaged in both in-person and virtual forms of the sex trades indicated that they may not have endorsed a single item about trading sex. Revising survey items to reflect these suggestions was seen as crucial to understanding the nature of sex trading among university students and, consequently, implications for practice and policy.

On the other side, survey items should be worded in simple, neutral language (Blair et al., 2014; Dillman et al., 2014) and our revised measure no longer fully does this. Several of our introductory statements could be construed as lengthy and possibly unwieldy (see Table 2 for sample language). Further, the revised introductory statements suggest that not all involvement in the sex trades (among adults) is negative or exploitative, which could suggest researchers’ point of view. Any research in this field occurs within the context of stigma, conflation between sex work and sex trafficking, and contentious theoretical and legal debates regarding agency and victimization in the sex trades (Benoit et al., 2019). Including destigmatizing statements and diverse response options may demonstrate the researchers’ position in these debates, and yet, was seen as critical to our participants. Although it is possible that university students are more familiar with these theoretical debates compared to other subpopulations of young people who trade sex, only a few participants in our sample discussed the debates in their thinking. Further, our study confirms that items to identify exploitation through force, fraud, or coercion should be interpreted with extreme caution. The scenarios that students discussed predominantly focused on the buyer revoking previously agreed upon terms, rather than force, fraud, or coercion to initially perform the act. Although the revised items reflect the best, co-constructed language to identify exploitation, it would likely be inaccurate to interpret any endorsement of these items as absolute confirmation of trafficking.

Taken together, there may be no way to be completely neutral in constructing a measure to identify this multifaceted, stigmatized, and contentiously debated phenomenon. This may be especially true for people who are minoritized, such as people of color, low-income, and queer and/or trans participants. To avoid naming the positive and negative consequences of the sex trades could contribute to further stigma and compromise efforts to gain a clearer understanding of the phenomenon. Further, using a single item about “trading sex” is ostensibly limiting. The revised measure will likely still underestimate involvement in the sex trades, particularly vaginal, oral, or anal sex, due to the differential stigma and legal concerns. However, our study found that a more well-rounded assessment of the sex trades, as described here, may provide the most comprehensive understanding of involvement in the sex trades and, certainly, much more than the commonly used single item.

Strengths and Limitations

This study should be taken within the context of its strengths and limitations. A strength of this study was its community-engaged approach to understanding a stigmatized phenomenon, particularly in an understudied subpopulation of college students. A limitation is that we do not yet understand the relevance to young people who trade sex who are not in a university setting or whose university context is different than a large, public, Midwestern, PWI. Further we did not ask about country or US state of origin, which could be important areas for future research. Additionally, although students sometimes disclosed relevant information, we did not intentionally sample participants who varied in economic status. However, students who gave rich examples of their involvement in the sex trades also reported experiences that are known to heighten risk in non-university populations of young people who trade sex, e.g., foster care involvement, experiencing discrimination or violence related to racialization, gender, and/or sexual violence. Future work should cognitively interview people who trade sex outside of the university context with the goal of tailoring this measure to understand sex trading in representative samples of minors and young adults. This study would have been strengthened by conducting multiple rounds of cognitive interviews. However, we presented the revised measure to multiple students, including two from our sample and other students who were a part of our research team. We also chose to recruit students who were “familiar with” the sex trades to encourage participation and captured nuanced experiences and personal disclosures from a diverse group of students. A limitation of this approach is that 47% of our sample did not personally disclose their own experiences but rather discussed others’ accounts. We strongly suspect, but cannot confirm, that at least some of them had personal experiences themselves based on their narratives (e.g., a high degree of familiarity with online platforms).

Conclusion

Our study suggests that prior quantitative studies of young people in the sex trades may not be fully capturing the extent and scope of involvement in the sex trades. Using a multi-item measure to identify involvement in the sex trades as well as associated compensations, circumstances, and consequences may be crucial to providing tailored practice and policy implications for the prevention of harm and exploitation. Findings serve as an important first step to expand our understanding of this phenomenon and move the evidence base on the sex trades forward. This measure could potentially be adapted for use with non-college young people, and used to assess sex trading experiences over time. Therefore, future research using this measure may help to disentangle causal relationships between economic need and sex trades involvement (particularly in circumstances that cause harm) as well as the relationship between virtual and in-person forms of the sex trades. Finally, these items may also inform qualitative research of young people in the sex trades who must endorse sex trading to participate in a study. Above all, it is our hope that this study will be used to support, empower, and advocate for students as well as young people more broadly. Indeed, it is most certainly our ethical responsibility.