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Providing sexual acts and materials for pay (SAMP) or financial compensation is a complex phenomenon involving virtual and in-person acts as well as nuanced circumstances of agency and victimization. Studies of university students using the rigorously developed, multi-item, SAMP index suggest that 14% report SAMP. They report experiencing violence, mental and physical health harms, and are more likely to be first-generation students, trans or nonbinary, queer, disabled, and have difficulty meeting basic needs- suggesting substantial health disparities. The SAMP index has yet to be used with nationally representative samples, which could reveal important insights needed to reduce harm.
This community-engaged study aimed to adapt the existent SAMP index for use with the general population of young adults (ages 18-34) in the United States. Using the adapted SAMP index with the general population holds the potential to provide a more rigorous understanding of young people who provide SAMP and inform tailored harm reducing practices and policies.
Methods: We (1) used the cognitive interview method to interview young people (ages 18 to 34) who have provided SAMP to understand how they comprehend and respond to the SAMP index, (2) revised the index after themes emerged to assess new wording and interpretations, and (3) conducted focus groups with this population in which we presented the revised measure for discussion and made final changes based on community insights.
Data analysis occurred through an iterative process in which interview transcripts and focus group notes were coded deductively using predetermined substantive codes (e.g., acts, circumstances) as well as emerging themes that reflected methodological issues and solutions (e.g., changes to response items).
Cognitive interview participants (n= 25) consisted primarily of people of color (n= 16), cisgender women (n= 12), and trans and gender expansive people (n= 8). Focus group participants (n= 14) were predominantly white (n= 8) and queer (n= 11).
Findings: Findings suggest that the SAMP index is relevant to and appropriate for use with the general population of young people with some adaptations that broadly address the pervasive stigma and understandable fear of criminalization- even in research using certificates of confidentiality. Participants suggested adding reminder statements that responses would be kept confidential and would not be reported to authorities. Item-specific recommendations further (1) differentiated acts (e.g., sex type), (2) reduced cognitive burden (e.g., age follow-ups), and (3) disentangled circumstances and who received the financial compensation (e.g., trafficker, sex worker). Participants suggested that questions about circumstances be adapted to better reflect differing levels of agency when providing SAMP, including both consensual sex work and exploitation or trafficking.
Conclusion and Implications: Using the revised, multi-item, behaviorally specific SAMP index is crucial to a more nuanced and accurate understanding of the phenomenon, but the criminalization of SAMP, associated stigma, and the complexity of circumstances under which participants have differing levels of agency, may still lead to underestimates of SAMP prevalence. Strategies for effectively surveying people who provide SAMP at a national level will be discussed, with the goal of ultimately informing tailored, harm reducing interventions and policies.