A Predictive Theory of Intentions to Exit Street-Level Prostitution PDF

Preview

Summary

Violence Against Women http://vaw.sagepub.com/ A Predictive Theory of Intentions to Exit Street-Level Prostitution Andrea N. Cimino Violence Against Women 2012 18: 1235 DOI: 10.1177/1077801212465153 The online version of this article can be found at: http://vaw.sagepub.com/content/18/10/1235 Publish...

Description

Violence Against Women http://vaw.sagepub.com/

A Predictive Theory of Intentions to Exit Street-Level Prostitution Andrea N. Cimino Violence Against Women 2012 18: 1235 DOI: 10.1177/1077801212465153 The online version of this article can be found at: http://vaw.sagepub.com/content/18/10/1235

Published by: http://www.sagepublications.com

Additional services and information for Violence Against Women can be found at: Email Alerts: http://vaw.sagepub.com/cgi/alerts Subscriptions: http://vaw.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav

>> Version of Record - Nov 7, 2012 What is This?

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

465153 2465153Violence Against WomenCimino © The Author(s) 2011

VAWXXX10.1177/107780121

Reprints and permission: http://www. sagepub.com/journalsPermissions.nav

Theoretical Article

A Predictive Theory of Intentions to Exit Street-Level Prostitution

Violence Against Women 18(10) 1235­–1252 © The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801212465153 http://vaw.sagepub.com

Andrea N. Cimino1

Abstract Street-level prostitution is notoriously difficult to escape and rarely do women exit prostitution on their first attempt or without experiencing serious negative consequences to their physical or mental health. Unfortunately, few theories exist that explain the exiting process and those that do exist are difficult to test quantitatively. This article applies the integrative model of behavioral prediction to examine intentions to exit prostitution through attitudes, norms, and self-efficacy beliefs that underlie a woman’s intention to exit prostitution. Constructs unique prostitution—agency and societal context—enhance the model. This theory may explain and predict an exit from street-level prostitution. Keywords exiting, health behavior, street-level prostitution, theory

Exiting street-level prostitution is a long and involved process, and little is known about predictors of exiting. Once involved in the prostitution “lifestyle” many women do not simply leave; rather, prostitution is characterized by a cycle of entry, exit, and reentry (Dalla, 2006a; Mayhew & Mossman, 2007; Williamson & Folaron, 2003). There are few theories that explain the exiting process, and to date, none have been empirically testable. This article synthesizes existing street prostitution theories and literature with the integrative model of behavioral prediction to provide the foundation for an empirically testable theory that may explain and predict an exit from street-level prostitution as well as quantitatively validate what is already known about exiting street-level prostitution. The proposed theory examines attitudes, norms, and self-efficacy beliefs as they relate to one’s

1

Arizona State University, Phoenix, AZ, USA

Corresponding Author: Andrea N. Cimino, Arizona State University, College of Public Programs, School of Social Work, Phoenix, AZ 85004, USA Email: [email protected]

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1236

Violence Against Women 18(10)

intentions to perform a behavior, such as exiting, and is enhanced with the addition of two variables, agency and societal context.

Literature Review Entering Street-Level Prostitution The literature describes a combination of “push” and “pull” factors that prompt women to engage in prostitution (Mayhew & Mossman, 2007). Poverty, a push factor, is a common reason some women enter street-level prostitution (Farley & Kelly, 2000; Sanders, 2007; Williamson & Folaron, 2003). Other push factors include an unstable home life, childhood physical and sexual abuse, and neglect (Farley et al., 2003; McClanahan, McClelland, Abram, & Teplin, 1999; Nadon, Koverola, & Schludermann, 1998; Norton-Hawk, 2001; Silbert & Pines, 1982; Ward & Roe-Sepowitz, 2009; Weitzer, 2009; Williamson & Folaron, 2003) or drug addiction (Brawn & Roe-Sepowitz, 2008; Edlund & Korn, 2002; Young, Boyd, & Hubbell, 2000). Pull factors include one’s glamorization of the lifestyle (Williamson & Folaron, 2003), a sense of excitement from dangerous and risky behavior (Dalla, 2006a), feeling in control or empowered (Mayhew & Mossman, 2007), encouragement from others (Kennedy, Klein, Bristowe, Cooper, & Yuille, 2007), and the desire for economic independence (Edlund & Korn, 2002; Weitzer, 2009). Regardless of one’s motivations for entering prostitution, undeniable are the damaging effects street-level prostitution has on women’s emotional and physical health including disease, violence, rape, and murder (Farley et al., 2003; Farley & Kelly, 2000; Pauw & Brener, 1997; Williamson & Folaron, 2003). It is important to differentiate between street-level prostitution and indoor prostitution (e.g., escorts, brothels) because street prostitution has more risks than other kinds of prostitution (Sanders, O’Neill, & Pitcher, 2009; Weitzer, 1991, 2005, 2009; West, 2000). Street prostitution is a dangerous way of life characterized by coercion, exploitation, and violence. Several studies indicated that 41 to 68% of street-level prostituted women experienced threats with weapons, and physical and sexual assaults by clients while prostituting (Farley & Kelly, 2000; Pearl, 1987; Raphael & Shapiro, 2004; Surratt, Inciardi, Kurtz, & Kiley, 2004). When compared to nonprostitutes of similar demographics, prostituted women are nearly 18 times more likely to be murdered (Potterat et al., 2004). Due to the nature of the work, these women are at an increased risk of contracting human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) than women who do not prostitute (Farley & Kelly, 2000). Many prostituted women are addicted to substances and use them to cope with their lifestyle (Allen, Flaherty, & Ely, 2010; Farley & Kelly, 2000; Hedin & Månsson, 2004; Logan, & Leukefeld, 2000). In addition, most street-level prostituted women experience some form of mental health problems such as depression or bipolar disorder (Davis, 2000; Farley & Kelly, 2000; Weitzer, 2009; Williamson & Folaron, 2003; Young et al., 2000), and in a study of 854 prostituted persons in nine countries, 68% met the criteria for posttraumatic stress disorder (Farley et al., 2003).

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1237

Cimino

Barriers to Exiting While entrance histories are unique, some of the factors that pushed women into streetlevel prostitution (e.g., economic necessity, drug addiction, coercion from others) are factors that continue to make it difficult for them to exit. These barriers to exiting prostitution are well described in the literature as a constellation of individual, relational, and structural factors (Baker, Dalla, & Williamson, 2010; Månsson & Hedin, 1999; Sanders, 2007). Poverty and a lack of resources are persistent needs of street-level prostituted women and act as barriers to exiting (Farley & Kelly, 2000; Mayhew & Mossman, 2007). Some women perform “survival sex” where they trade sexual services for basic necessities such as food or a place to stay (Dalla, 2006a). Addiction (Allen et al., 2010; Benson & Matthews, 1995; Farley & Kelly, 2000; Mayhew & Mossman, 2007), severe mental illness (Farley & Barkan, 1998), and interpersonal stigma from selling oneself (Mayhew & Mossman, 2007) prevents some prostituted women from seeking formal services or help from family. Coercion, deception, and violence from pimps and fellow prostitutes serve to normalize and reinforce prostitution (Kennedy et al., 2007; Nixon, Tutty, Downe, Gorkoff, & Ursel, 2002); these associates provide an underground network of social support and encourage continued involvement in street-level prostitution (Mayhew & Mossman, 2007). Women attempting to exit who lack education and job skills or have criminal histories are often unable to gain legitimate employment, thus compelling them to resort to prostitution (Edlund & Korn, 2002; Sanders, 2007).

The Effectiveness of Formal Prostitution Exiting Services Prostitution exiting programs offer formal services for women who are trying to escape prostitution, but only a few states in the United States offer such programs (Farley, 2010). Typically, these programs provide substance abuse treatment and counseling for psychological traumas common among prostituted women. Best practice exiting interventions are holistic and include a combination of counseling, housing, employment training, and education (Arnold, Stewart, & McNeece, 2000; Mayhew & Mossman, 2007). As an added benefit, exiting programs reduce environmental barriers to exiting (e.g., separation from violent pimps and johns, no need to engage in survival sex). With these services, commonsense would suggest the “push and pull” factors should no longer be an issue. It is curious, however, that despite ameliorating many barriers to exiting, reentry is routine among women in exiting programs. For instance, in Davis’s (2000) study, only 73 women completed treatment and left prostitution, while 291 dropped out of the program. Only a quarter of Saphira and Herbet’s (2004) study of 47 prostituted women were able to exit, though two-thirds made several attempts. In Dalla’s (2006a) study, 13 of 18 women returned to prostitution. In a study of brothel sex workers in Thailand, 60% (n = 42) quit and reentered sex work at least once (Manopaiboon et al., 2003). While 16 of these women successfully left prostitution, 23% said they would return to prostitution if their situation made it necessary. Finally, in a Canadian study of 201 sex workers, 7 in 10 had exited sex

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1238

Violence Against Women 18(10)

work at least once, over half exited three or more times, and women who did exit made an average of 5.6 exiting attempts (Benoit & Millar 2001). The pervasiveness of the “enter, exit, reenter” cycle among street-level prostituted women suggests there may be a fundamental difference between women who can permanently exit prostitution and those who cannot. Researchers have begun studying exiting more closely, proposing several models that describe the exiting process. Much of this research is based on in-depth interviews between prostituted women and scholars in the field. These qualitative examinations are necessary and appropriate given the complex nature of the population and the need for sensitive, nonexploitative research practices (Shaver, 2005). These methods provide rich data and much insight into the lived experiences of prostituted women but have only been able to describe the stages street-level prostituted women naturally experience as they transition out of prostitution and into a conventional lifestyle. Research now calls for more sophisticated, testable theories that can better explain and predict an exit from prostitution, while incorporating existing models (Baker et al., 2010; Dalla, 2006b). This article proposes a theory examining attitudes, norms, and self-efficacy beliefs toward prostitution; notions of agency; and the impact of societal context that may contribute to the exiting process. This theory may help predict an exit from street-level prostitution.

Current Models of Exiting Williamson and Folaron’s “Phases of the Lifestyle” Several researchers have conceptualized the exiting process among street-level prostituted women. Williamson and Folaron (2003) described a five-stage entry-to-exit process where one becomes enticed by the prostitution lifestyle, then learns the prostitution culture, and begins to survive and thrive in prostitution or “trust the game” (p. 279). Prostituted women exit once they become disillusioned with the lifestyle after violence, drug addiction, arrests, and trauma have taken their toll. This last stage is described as “taking stock and getting out” (p. 283). While their description was not solely about exiting, it highlights the accumulation of negative events and attitude changes that are necessary precursors to exiting: “It is the sum total of daily hassles, acute traumas, and chronic conditions that precipitate a woman’s decision to exit prostitution” (p. 283).

Månsson and Hedin’s “Breakaway Model” Månsson and Hedin’s (1999) prostitution “breakaway” model, based on role exit theory (see Fuchs Ebaugh, 1988; Oselin, 2010; Vanwesenbeeck, 1994), describes how most women experience a turning point such as a traumatic, eye-opening event that prompts their break away from prostitution. After this event, they contemplate leaving, try to locate exiting resources, and then either quickly or gradually leave prostitution. A complex interplay of structural, relational, and individual factors also impact a woman’s ability to exit prostitution. Structural factors included access to welfare or resources for securing conventional employment; relational factors included seeking or repairing relationships with

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1239

Cimino

family, children, and men as well as accessing formal support from social workers; individual factors were beliefs in one’s ability to change. After exiting, a woman faced continual challenges as old lifestyle habits conflict with her newly assumed role. As women incorporated these more conventional lifestyles, they began to heal from the traumas suffered while prostituting. Hedin and Månsson (2004) found the ability of an ex-prostituted woman to change social networks was integral to her continued success away from prostitution. In sum, they concluded exiting prostitution required “the restructuring of everyday life and the occurrence of critical incidents” (p. 72), believing in one’s abilities to make positive change, and building a network of supports.

Sanders’s “Typology of Transitions” In another discussion of exiting, Sanders (2007) identified four pathways or transitions out of prostitution, many of which are rooted in interpersonal or environmental factors. Some street-level prostitutes, Sanders described, experience reactionary transitions out of prostitution after experiencing a significant life-changing event, such as a death, rape, pregnancy or incarceration. Others experience a gradual transition out as they begin to access formal support services and put elements of a conventional lifestyle into place. A natural progression out of prostitution, Sanders observed, begins with an intrinsic desire for a new and safer lifestyle. The fourth transition, yo-yoing was the common drifting in and out of prostitution, treatment centers, and the criminal justice system. Sanders added that the positive impact of cognitive transformations (e.g., willingness to change, cutting off old ties and developing new ones) and structural disadvantages such as a lack of affordable housing, treatment for substance abuse and employment alternatives, affected the exiting process.

Baker and Colleagues’ “Integrative Model of Exiting” More recently, a theory combining earlier exiting models with nonprostitution specific theories such as Prochaska, DiClemente, and Norcross’s (1992) Stages of Change was proposed by Baker et al. (2010). Their integrative model describes the exiting process in six stages from immersion into the lifestyle, to coming to a visceral and conscious awareness about leaving prostitution, then engaging in deliberate acts to exit prostitution (e.g., seeking formal and informal services), which would ultimately lead to an initial exit. This initial exit, they caution, often results in reentry. A “final exit” is the last stage and occurs after numerous exiting attempts are made, resulting in a complete change in identity, habits, and social networks. Baker and colleagues’ research highlighted cognitive and behavioral changes necessary in a successful exit, as well as the alleviation of structural, relational, and individual barriers women face when exiting prostitution.

Limitations of the Current Exiting Models Part of a theory’s usefulness is determined by empirical testing (Renzetti, 2006), and while there is much inherent value in these four models of exiting, a more defined and

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1240

Violence Against Women 18(10)

operationalized theory1 is needed (Baker et al., 2010; Dalla, 2006b). To be testable, a theory should lend itself to refutable hypotheses and contain well-operationalized variables used to measure differences across groups and for replication. Ambiguity in definitions across research studies may result in vague theory building and other methodological difficulties (Herzberger, 1990; Lee & Renzetti, 1990). As with most research on vulnerable populations, the four models described here possess similar challenges. A more rigorous theoretical model that draws from earlier models, and one that builds on the cognitive change processes described in the literature, is needed to deepen our understanding of the prostitution exiting process. The theory that follows is an attempt to synthesize existing literature into more focused and measurable variables to empirically test.

Applying the Integrative Model of Behavioral Prediction to Street-Level Prostitution One theory well known in health-related behavioral research that may reveal factors underlying a successful exit is the integrative model of behavioral prediction. This model combines four major behaviorally based theories: the health belief model, social cognitive theory, the theory of reasoned action, and the theory of planned behavior (Fishbein, 2000; Fishbein & Ajzen, 1975; Fishbein et al., 2001; Fishbein & Yzer, 2003). It has undergone numerous empirical examinations (see Ajzen, 2010) and has been applied to a range of topics such as condom use, weight loss, and consumer behaviors (Ajzen & Fishbein, 1980; Fishbein & Yzer, 2003; Morrison, Baker, & Gillmore, 1998). The theory assumes all behaviors under a person’s volitional control involve a choice: to perform or not to perform a given behavior (Ajzen & Fishbein, 1980). Behaviors consist of four elements: the action (e.g., exiting), the target (e.g., the woman), the context (e.g., street-level prostitution), and the time period under which the behavior is to be observed (e.g., permanently; Fishbein & Ajzen, 1975). According to the model (see Figure 1), the performance of a behavior, such as exiting prostitution, is likely to occur if a person has (a) strong intentions to perform the behavior, (b) the necessary skills and abilities to perform the behavior, and (c) does not experience environmental constraints that prevent the performance of the behavior (Fishbein, 2000; Fishbein et al., 2001; Fishbein & Yzer, 2003). Intention, Ajzen and Fishbein (1980) contend, is an intermediate determinant of behavior. By presenting a person with several options and observing which choice was picked, it is possible to measure2 his or her intention to perform a given behavior (Fishbein & Ajzen, 1975; Fishbein & Yzer, 2003). Intention to perform a behavior is a function of attitudes, norms, self-efficacy and one’s underlying belief system (Fishbein, 2000; Fishbein et al., 2001). The relative importance of these three determinants depends on the population and the target behavior. Some behaviors may be attitudinally driven, while others may be influenced by subjective norms or feelings of self-efficacy. Therefore, it is important to identify behavioral outcomes, normative and efficacy beliefs within the context of the population and the behavior (e.g., street-level prostitution).

Downloaded from vaw.sagepub.com at ARIZONA STATE UNIV on November 13, 2012

1241

Cimino

Figure 1. Constructs in the predictive theory of ...