Article

Youth Arrested for Trading Sex Have the Highest Rates of Childhood Adversity: A Statewide Study of Juvenile Offenders

Authors:
  • Florida Department of Juvenile Justice
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Abstract

A history of childhood adversity is associated with high-risk behaviors and criminal activity in both adolescents and adults. Furthermore, individuals with histories of child maltreatment are at higher risk for engaging in risky sexual behavior, experiencing re-victimization, and in some cases, becoming sexual offenders. The purpose of the current study was to examine the prevalence of individual and cumulative adverse childhood experiences (ACEs) reported by 102 offending youth who were arrested for trading sex and 64,227 offending youth who were arrested for various other crimes, using Florida's Positive Achievement Change Tool. Youth with violations related to sex trafficking had higher rates for each ACE as well as number of ACEs, particularly sexual abuse and physical neglect. These findings have implications for identifying adverse experiences in both maltreated and offending youth as well as tailoring services to prevent re-victimization. © The Author(s) 2015.

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... To our knowledge, there are five studies in the last 5 years that specifically focus on the association between various forms of trauma and sexual risk behavior among juvenile detainees (K. Clements-Nolle et al., 2017;Fasula et al., 2018;Leve et al., 2015;Naramore, Bright, Epps, & Hardt, 2017;Seth et al., 2017) (although Fasula and Seth use the same study population). Four of the five studies bring issues of female youth incarceration to the forefront by focusing only on female detainees (K. ...
... Comparing our results with the literature on the association of domestic violence to sex under the influence of alcohol or marijuana was not straightforward. The term domestic violence has several synonyms in the literature including family violence (Fix, Alexander, & Burkhart, 2018) family dysfunction (Dube et al., 2003), household dysfunction (Campbell, Walker, & Egede, 2016) and household violence (Naramore et al., 2017). The definition varies considerably in the literature and across states in the US (Child Welfare Information Gateway, 2018). ...
... A sexual partner with unknown HIV status does include persons engaged in transactional sex. In a study of over 64,000 justice-involved youth, those arrested for trading sex were significantly more likely to have a higher ACE score, and to have a higher prevalence of one or more of the 10 ACES than youth arrested for other reasons (Naramore et al., 2017). These youth are particularly vulnerable to re-victimization, implying that interventions designed to break the cycle of delinquency and victimization could have a substantial impact on the life trajectory of these youth (Naramore et al., 2017;Negriff, 2018;Thompson et al., 2017). ...
Article
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Background: Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population. The objective of this analysis is to determine the association of trauma, specifically, domestic violence and forced sex, to six sexual risk behaviors and a history of chlamydia among detained youth. Methods: The analysis uses data from a convenience sample of detainees assenting to HIV testing conducted December 2016 - August 2017 using the state-certified Voluntary Counseling Testing and Referral (VCTR) process. Results: Of the 379 youth that received VCTR at the facility, 308 (81.3%) were used in this analysis. Report of domestic violence was significantly associated with sex under the influence of alcohol and was also significantly associated with sex under the influence of marijuana. Forced sex was associated with a sexual partner of unknown HIV status. Conclusions: Traumatic experiences were related to sexual risk behaviors in this analysis, and substance use was strongly implicated in the association. Trauma is known to be a catalyst to sexual risk behaviors, substance use, and delinquency in adolescence. Results support the findings of other investigators and re-iterate the need for trauma-informed interventions that can improve the life trajectories of detained youth.
... Survivors of human trafficking-who have been exploited for labor or services through the use of force, fraud, or coercion-experience trauma at particularly high rates (Gozdziak & Collett, 2005). Victimization involves substantial recurring trauma, and many survivors have extensive histories of trauma prior to becoming trafficked (Naramore, Bright, Epps, & Hardt, 2017;Reid, 2012;Zimmerman, Hossain, & Watts, 2011). Leading theory and practice have begun to recognize the utility of trauma-informed and trauma-responsive practice for this population (e.g., Hopper, 2017), augmenting the dominant "three P's" framework (i.e., protection, prosecution, prevention;Lagon, 2015;Zimmerman et al., 2011). ...
... Trauma experienced by trafficked persons is associated with a range of deleterious outcomes (e.g., Jonson- Reid, Kohl, & Drake, 2012;Mersky, Topitzes, & Reynolds, 2012;Sousa et al., 2011), including heightened vulnerability for future victimization, which is consistent with the perpetual cycle of traumatic experiences among human trafficking victims (Hopper, 2017;Naramore et al., 2017;Reid, 2012;Zimmerman et al., 2011). Many victims experience ongoing trauma and interpersonal abuse, including psychological abuse, physical and sexual violence, and deprivation of basic needs (Hopper, 2017;U.S. ...
... Such long-term trauma contributes to an exceedingly high rate of post-traumatic stress disorder among victims (Greenbaum, 2014;Hopper, 2017). Moreover, many victims have extensive histories of adverse experiences and service system utilization (e.g., foster care) prior to victimization (Hopper, 2017;Naramore et al., 2017;Reid, 2012;Zimmerman et al., 2011). While there is some concern that a focus on trauma may lead to negative, deficit-based assumptions of victims (Tseris, 2019), existing literature suggests that a trauma perspective is highly appropriate for both preventing and responding to human trafficking victimization (Hemmings et al., 2016). ...
... Adverse childhood experiences and ongoing adversity such as child abuse and neglect, homelessness (running away or being "thrown-away"), LGBTQ+ identity, and being involved with child welfare or criminal justice systems, all contribute to exposing youth to risky circumstances leading to their sexual exploitation [7]. Recent research confirms that youth who have been sexually exploited have the highest numbers of ACES, with sexual abuse being the most common [8,9]. Poor family functioning or conflict is a significant contributing or exacerbating factor for running away or being asked to leave home [8][9][10]. ...
... Recent research confirms that youth who have been sexually exploited have the highest numbers of ACES, with sexual abuse being the most common [8,9]. Poor family functioning or conflict is a significant contributing or exacerbating factor for running away or being asked to leave home [8][9][10]. ...
... Minorities, inclusive of sexual/gender minority youth are disproportionately overrepresented in current estimates of people who have been sexually exploited [8,11,12]. ...
Article
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Background: Sexually exploited youth are disconnected from societal tethers and need support systems, which makes them some of the most vulnerable of youth. This heightened level of vulnerability increases their risk for violence, abuse, ongoing sexual exploitation and all its sequelae. The purpose of this study was to examine an evidence-based intervention called STRIVE (support to reunite, involve and value each other) that has been a successful family re-engagement strategy with newly homeless youth. We sought to explore its contextual relevance for youth with risk factors for sexual exploitation and identify necessary adaptations to reduce risk factors for sexual exploitation. We deliberately took an intersectional approach in conducting this study. Methods: Six community-based focus groups were conducted with youth at risk for sexual exploitation and their service providers. Each group was recorded, transcribed, coded, and thematically analyzed. Results: Results from 29 youth and 11 providers indicate that there are unique considerations that must be taken into account while working with youth at risk for sexual exploitation to ensure effective service delivery and/or ethical research. Emergent themes included: setting the stage by building rapport and acknowledging experiences of structural violence, protect and hold which balances youth's need for advocacy/support with their caregivers' need for validation/understanding, and walking the safety tightrope by assessing risks and safety planning. Discussion: Focus groups are an effective methodology when working with traditionally disempowered populations particularly in gaining a range of perspectives to meet unique needs/preferences. Youth at risk for commercial sexual exploitation needs require strengths-based, individualized, multi-systemic approaches.
... The few studies that have examined gender or racial/ethnic differences with regard to the relationship between ACEs and delinquency among justice-involved youth suggest racial/ethnic or gender differences exist (DeLisi et al., 2017;Fagan & Novak, 2018;Muir, 2020;Naramore et al., 2015). For example, Fagan and Novak (2018) found that compared to White youth, ACEs have a more significant impact on Black youths' self-reported delinquency, including the likelihood of violence, marijuana use, alcohol use, and being arrested by age sixteen. ...
... Some studies have also identified gender differences regarding the relationship between ACEs and delinquency (Craig et al., 2019;Leban & Gibson, 2020;Naramore et al., 2015). ...
Thesis
Justice-involved youth are exposed to adverse childhood experiences (ACEs) at higher rates than youth in the general public, highlighting the importance of addressing childhood trauma and adversity in juvenile justice settings. A majority of ACEs research has focused on the general population and has demonstrated the long lasting negative impact of ACEs, on mental health, physical health, and engagement in health risk behaviors. Both gender and racial/ethnic differences have been identified in ACEs literature, suggesting that not all groups in society have the same likelihood of experiencing ACEs. Additionally, ACEs may also impact individuals from racial/ethnic or gender groups differently, resulting in variable outcomes. In comparison to the ACEs literature among the general public, little research has examined ACEs among justice involved youth, and even fewer studies have examined gender and racial/ethnic differences in these settings. A historical account of gender and racial/ethnic discrimination within the juvenile justice system, coupled with the feminist pathways perspective within an intersectional context, illustrates gendered racial/ethnic differences regarding pathways into the system and ongoing discrimination. To advance the ACEs literature, this dissertation explores the prevalence of ACEs as well as the relationship between ACEs, behavioral factors associated with delinquency, and recidivism within gendered racial/ethnic groups of justice-involved youth. The findings of the current study demonstrate the importance of accounting for both gender and race/ethnicity, as few studies have done so. Overall, the findings were mixed in relation to the prior literature and highlight the need for more research in this area, as few conclusions can be drawn from the current study’s findings. While more research is needed, broad policy implications are drawn from this study to help guide equitable assessment and treatment/services of trauma among justice-involved youth.
... 20 Several of these studies find the greatest risk for juvenile justice contact emerges among those with exposure to 4 or more ACEs. 11,14,16,17 A substantially smaller body of research has also shown that ACEs are associated with increased likelihood of having been arrested 19 or incarcerated as an adult. 21 In their recent review on ACEs and criminal justice contact, Graf and colleagues point to the dearth of research on ACEs and adult criminal justice system contact, noting that research assessing the long-term consequences of ACEs for criminal justice contact in adulthood is lacking. ...
... These findings are largely consistent with the broader ACEs literature that has found that accumulating ACEs exposure, particularly when they cross a threshold of 4 or more ACEs, is associated with a wide range of negative social outcomes 2−5 including juvenile justice system contact. 11,14,16,17 Overall, these findings answer the call of recent research for work to examine the impact of ACEs on various forms of criminal justice contact in adulthood. 6 Before discussing the implications of this work, it is important to detail a few limitations that can be expanded upon by future research. ...
Article
Objective To assess the relationship between adverse childhood experiences (ACEs) and formal criminal justice system processing during young adulthood and middle adulthood. Methods Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 8,531). Logistic regression, multinomial logistic regression, and Poisson regression models were used to assess the relationship between accumulating ACEs (0, 1, 2, 3, or 4 or more) and criminal justice system processing during young adulthood (24-32) and middle adulthood (33-43). Results Accumulating ACEs —especially four or more ACEs— was significantly associated with various forms of criminal justice contact during young and middle adulthood, including having been arrested, experiencing a greater number of arrests, having been incarcerated in adulthood, having been incarcerated multiple times, and having spent longer periods of time incarcerated. Conclusions This study documents that the association between ACEs and formal criminal justice extends into young and middle adulthood. Considering the consequences of both ACEs and criminal justice system contact for a variety of life domains, the findings suggest the need for developing and employing early interventions to disrupt pathways to criminal justice system involvement.
... Youth who experienced human trafficking were at particularly high risk for experiencing more ACEs (Naramore et al., 2017;Reid et al., 2019). In addition to higher overall levels of ACEs, youth arrested for sex-trafficking violations, who were disproportionately female and Black youth, tended to experience higher levels of every type of ACE (Naramore et al., 2017). ...
... Youth who experienced human trafficking were at particularly high risk for experiencing more ACEs (Naramore et al., 2017;Reid et al., 2019). In addition to higher overall levels of ACEs, youth arrested for sex-trafficking violations, who were disproportionately female and Black youth, tended to experience higher levels of every type of ACE (Naramore et al., 2017). ...
Article
Justice-involved youth experience high rates of adverse childhood experiences (ACEs), placing them in great need of behavioral health treatment and risk for continued justice involvement. Policymakers, government agencies, and professionals working with justice-involved youth have called for trauma-informed juvenile justice reform. Yet, there is currently no available review of the literature on ACEs and their impact on justice-involved youths' psychological, legal, and related (e.g., academic) outcomes to rigorously guide such reform efforts. The current systematic scoping review synthesizes existing literature related to the impact of ACEs on justice-involved youth and offers recommendations for data-driven intervention along the Sequential Intercept Model, which describes five different points of justice system contact (i.e., first arrest, court diversion, detention, and community supervision) in which there is opportunity to intervene and improve youth behavioral health, legal, and associated outcomes. Eight unique studies were included in 40 articles examining ACEs among justice-involved youth; 38% were longitudinal or prospective analyses and none were intervention studies. Studies included delinquency (e.g., recidivism; n = 5), psychiatric (n = 4), substance use (n = 3), and other (n = 2; e.g., academic, pregnancy) outcomes, documenting high prevalence of ACEs and significant associations between ACEs and a variety of outcomes. Implications for clinical services (e.g., targeting youth dysregulation and aggression), agency context (e.g., training police officers in trauma-responsive practices), and system-level changes (e.g., intervening at the time of first ACE documentation such as parent's arrest) are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... 12 Furthermore, children who are trafficked have higher adverse childhood experience scores, particularly in the sexual abuse and physical neglect domains. [13][14][15] Health and Trafficking Trafficked persons report that they seek health care for urgent issues often relating to psychiatric emergencies or physical trauma, as well as for reproductive health concerns and for acute exacerbations of chronic disease. 16 Trafficked persons are at increased risk for physical injury, sexually and non-sexually transmitted infections, malnutrition, unwanted pregnancy and associated complications, physical exhaustion, untreated chronic medical conditions and sexual assault. ...
... Unfortunately, most trafficked persons are not recognised during medical encounters, and spontaneous disclosure of trafficking status is unlikely. 13,19 Reluctance to disclose may stem from language or cultural barriers, mistrust of health-care professionals, a sense of loyalty to the exploiter, shame and/or fear. In addition, many of these patients may not see themselves as 'victims' at all or may not feel ready to disclose. ...
Human trafficking is a public health issue and humanitarian crisis. Most alarming is that children are especially at risk. Although many studies demonstrate that the majority of trafficked persons surveyed engage with the health-care system during the time in which they are trafficked, health-care practitioners lack the knowledge, tools and resources to assist these patients. The present efforts in training health-care professionals have been fragmented and largely ineffective. While prior training has produced short-term changes in knowledge or attitudes of health professionals, it has not produced sustained changes in knowledge and attitudes nor meaningful changes in screening or intervention. No training has demonstrated changes in patient outcomes. Trafficked persons, particularly children and survivors of labour trafficking, are inadequately served by our present training options for health-care practitioners, and evidence-based protocols are needed to care for this underserved, disenfranchised and traumatised population. To provide optimal care for trafficked youth, health-care practitioners may benefit from: (i) evaluating training for health care providers (HCP) rigorously and meaningfully; (ii) advocating for high-quality training for all HCPs; (iii) fostering partnerships with key stakeholders to inform training and practice; and (iv) designing HCP training that is comprehensive, spanning all forms of human trafficking and including all populations involved.
... There is also an overlap between being a sexual service provider and both childhood maltreatment (e.g. Naramore et al., 2015) and poverty (Mac & Smith, 2018). Less is known about purchasersparticularly in terms of their childhood experiences. ...
... Desai, Arisa, Thompson, & Basile, 2002;Lalor & McElvaney, 2010;Trickett, Noll, & Putnam, 2011). Naramore et al. (2015) found that among youth that are arrested, those who had been sex trafficked had higher rates of overall ACEs, especially in terms of sexual abuse and physical neglect. Reid, Baglivio, Piquero, Greenwald, and Epps (2017) found that boys and girls who are sex trafficked had much higher rates of child sexual abuse than a matched sample. ...
Article
Background Previous research has tied adverse childhood experiences (ACEs) to a variety of deleterious mental health, physical, and behavioral outcomes. There has been some examination of the relationship between ACEs and selling sexual services, but not on the relation of ACEs to purchasing. Objective We hypothesize a cumulative impact of ACEs on the propensity to purchase and buy and sell sex. We further hypothesize that childhood sexual abuse will have unique impacts on buying and selling. Participants & setting We recruited participants who had ever/never exchanged money or things of values for sex through Amazon MTurk (n = 930). Methods Using logistic regression, we examined how cumulative ACEs and each separate ACE increased propensity to buy or sell sex. We controlled for sex, age, race, employment status, and sexuality. Results Utilizing the analysis from cumulative ACEs found that the propensity to buy (odds ratio 1.11***) and sell sex (odds ratio 1.094**) increased as cumulative ACE score increased. Bisexuals had high propensity of both buying (odds ratio 2.12) and selling sex (odds ratio 2.74). Women (odds ratio 0.53) and people of color (odds ratio 0.65) where more likely to sell than others. For odds of buying sex, childhood sexual abuse (odds ratio 1.57) had the most impact. For selling sex, childhood sexual abuse (odds ratio 1.96) and household physical violence (odds ratio 2.73) increased propensity while household mental abuse (odds ratio 0.57) decreased propensity. Conclusions Understanding the impact of ACEs is important to understand participation as a buyer and seller in the commercialized sex market.
... As has been highlighted throughout this book, criminal justice-involved individuals have higher rates of childhood adversity than the general population, and people who have committed sexual crimes have especially high rates (Baglivio et al., 2014;Jespersen, Lalumière, & Seto, 2009;Levenson, Baglivio, et al., 2017;Levenson, Willis, & Prescott, 2016;Maschi, Gibson, Zgoba, & Morgen, 2011;Reavis, Looman, Franco, & Rojas, 2013;Simons, Wurtele, & Durham, 2008). Moreover, a history of childhood trauma is associated with early onset of sexual activity, sexually transmitted diseases, sexual delinquency, higher numbers of sexual partners, being raped as an adult, and being a victim of sex trafficking (Dietz et al., 1999;Hillis, Anda, Felitti, Nordenberg, & Marchbanks, 2000;Levenson, Baglivio, et al., 2017;Naramore, Bright, Epps, & Hardt, 2015). ...
Chapter
Adverse childhood experiences (ACEs) are common in the life histories of people who have sexually abused. Early relational traumas can affect both dynamic risk and responsivity in treatment. It is important to consider the role of trauma in self-regulation and risk management, and in responding to the wellbeing needs of our clients. In this chapter, we describe the principles of trauma-informed care (TIC). We then synthesise theoretical and empirical literature, offering a rationale for TIC in evidence-based treatment of sex offending behaviours. Next, we discuss the clinical implications for transforming current treatment methods within a risk–needs–responsivity model to become more trauma-informed, strengths-based, and process-oriented. Finally, we argue that empirical inquiry into the application and effectiveness of trauma-informed services should become part of our collective research agenda.
... In total, 67 453 participants were included, with a mean (SD) age of 16 Taiwan, India, Norway, and the Philippines. All 37 articles 5,6,14-19, [22][23][24][25][26][28][29][30][31][32]34,35,38,[50][51][52][53][54][55][56][57][59][60][61][62][63][64][65][66] were categorized in the high-quality range, with a mean (SD) study quality score of 8.4 (0.7) (see Table 1 and eTables 2 and 3 in the Supplement). ...
Article
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Importance: Although research has examined factors associated with child sexual exploitation (CSE), consensus is lacking in regard to which factors should be prioritized, thereby hindering policy reform, prevention efforts, and development of early detection and intervention. Objective: To provide a meta-analytic synthesis of studies examining factors associated with CSE and to quantify their relative importance. Data sources: Electronic databases searched to June 2019 included Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Informit, yielding 396 nonduplicative records. Literature search was performed in July 2019. Study selection: Inclusion criteria were quantitative investigations of sexual exploitation and mean sample age of 18 years or younger. Data extraction and synthesis: Literature review and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Thirty-seven studies met final inclusion criteria. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive odds ratios (ORs) for each factor. Data were analyzed from September 1 to October 28, 2019, and prediction intervals calculated in June 2020. Main outcomes and measures: Child sexual exploitation, defined as coerced sexual acts between a child or a young person (aged ≤18 years) and an individual or a group in exchange for money, gifts, substances, or other commodities and associated factors. Results: Thirty-seven unique studies were included with a total of 67 453 unique participants (mean [SD] age of 16.2 [2.5] years; 49.9% female). Fifty-two factors associated with CSE were included in the meta-analysis. The strongest factors significantly associated with exposure to sexual exploitation were engagement in sexual risk behaviors (OR, 6.31 [95% CI, 3.12-12.76]; P < .001), having more than 5 sexual partners (OR, 5.96 [95% CI, 1.63-21.87]; P = .007), a diagnosis of posttraumatic stress disorder (OR, 5.29 [95% CI, 3.40-8.22]; P < .001), historical exposure to child pornography (OR, 5.50 [95% CI, 0.99-30.53]; P = .049), and a history of childhood sexual abuse (OR, 3.80 [95% CI, 3.19-4.52]; P < .001). A number of other potentially modifiable factors had moderate to strong associations. Conclusions and relevance: In this systematic review and meta-analysis, children and adolescents affected by sexual exploitation showed high levels of sexual risk taking, multiple sexual partners, posttraumatic stress disorder, exposure to child pornography, and childhood trauma. Accurate detection of CSE may prevent this type of sexual violence occurring to adolescents and/or provide opportunities for intervention and recovery. Therefore, prevention and intervention efforts will likely benefit from integrating these factors into screening, assessment, and treatment.
... Every juvenile probation counselor (JPC) must become certified in implementing the PACT by the state's quality assurance coordinator before commencing solo practice. While the primary goal of the PACT is to assess a youth's risk to reoffend, important social history information is also collected which researchers have used to assess the prevalence of trauma (specifically ACEs), substance use, and mental health in juvenile justiceeinvolved youth [16,28,29]. JPCs implement the risk-assessment tool during a one-on-one semi-structured interview, using motivational interviewing strategies to elicit responses and triangulating information with court records (e.g., juvenile dependency case filing records) and/or interviews with collateral contacts (e.g., parents and teachers). ...
Article
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Purpose This study used Washington statewide administrative data to document the prevalence and trend of trauma history, suicidality, and mental health problems among all youth ordered to probation for the first time between 2011 and 2015. We also examined the extent to which trauma and mental health problems were associated with youth suicide risk during this time. Methods More than 16,500 youth started probation (2011–2015) and received a standardized risk assessment. We used descriptive statistics to assess the prevalence of trauma history, suicidality, mental health problems, and overall risk to reoffend. We then used multilevel logistic regression models (youth within counties) to assess each measure's association with suicidality. Results About 80% of the youth had a history of at least one traumatic experience. As fewer youth started probation for the first time each year, the prevalence of trauma, suicidality, mental health problems, and overall risk to reoffend increased. Trauma, mental health, and overall risk were significantly associated with suicide risk among probation youth. Conclusions This epidemiological study is expected to motivate discussion around the best ways to integrate trauma-informed care and suicide prevention in the juvenile justice system.
... Similar to the adult literature, research on the health and well-being of children also finds this association between adversity and poor health. Children exposed to adversity as compared to children without these exposures are at an increased risk for social disruptions, such as perpetrating violence and being involved in the criminal justice system; [52][53][54][55][56] mental health and behavioral problems, such as depression, anxiety and attention-deficit hyperactivity disorder; [57][58][59][60][61][62][63][64][65][66] obesity; [67][68][69][70] asthma; [71][72][73] risk for cardiovascular disease; 70,74) multiple somatic complaints such as headaches, fatigue, gastrointestinal Data expressed as frequency (%). *not reported, † participants were only males, ‡ not reported, § ACE scores included peer/community violence. ...
... Adverse childhood experiences are common among sex trafficked youth (Naramore, Bright, Epps, & Hardt, 2017). One study of trafficked youth participating in a specialty court reported that 92% of the sample had a child abuse report investigated and substantiated by child protective services (Cook, Barnert, Ijadi-Maghsoodi, Ports, & Bath, 2018). ...
Article
Full-text available
Background Sex trafficking is a public health and social justice issue that has traditionally been addressed with criminal justice solutions. Because many sex trafficking survivors are incarcerated for crimes related to their exploitation, specialty, human trafficking courts were developed to offer resources and assistance to labor and sex trafficking survivors. This study assessed justice-involved youth participating in a specialty, anti-trafficking court program. The purpose of this study was to investigate justice-related outcomes of participants in a specialty court program. We examined: (1) the relationship between age at first citation and justice characteristics (number of bench warrants, number of citations, number placements, and number of times ran away); and (2) the number of months between first citation and enrollment into the program with the aforementioned justice characteristics. We used negative binomial models to estimate the relationships between age at first citation, number of months between first citation and program enrollment, with the four justice characteristics ( n = 181). Results Adjusted models showed that younger age at first citation was associated with significantly more bench warrants and citations while in the program. Likewise, fewer months between first citation and program entry was related to more bench warrants and citations. Conclusions There is a need to evaluate the appropriateness of specialty, trafficking court programs in reducing continued justice involvement and these programs ability to meet the evolving needs of sex trafficking survivors over time. We recommend universal screening for trafficking indicators for all systems-involved youth and relocating trafficking specialty courts out of juvenile courts to dependency courts.
... The significant concerns among providers stem from observed severe health impacts of CSEC that are often different from other forms of child abuse. Victims of CSEC are more likely to have experienced multiple and prolonged forms of adversity during childhood (Naramore, Bright, Epps, & Hardt, 2017). These experiences of cumulative and cooccurring victimizations can reduce resiliency and are related to health outcomes such as post-traumatic stress disorder, suicidal ideation, cognitive impairment, anxiety and depression, and a range of other emotional and behavioral problems (Cole, Sprang, Lee, & Cohen, 2016;Varma, Gillespie, McCracken, & Greenbaum, 2015). ...
Article
Despite an increasing awareness about the existence and harms of commercial sexual exploitation of children (CSEC), the identification of victims remains a challenge for practitioners, hindering their ability to provide appropriate services. Tools that gauge risk of CSEC support the identification of victims but are underdeveloped because most tools assess risk of CSEC within a general youth population. An understanding of what predicts actual CSEC victimizations among youths at higher risk of CSEC due to experiences of childhood adversities has been left unassessed. Research in this area is limited in part because traditional methods do not allow for an assessment of the unique impact of childhood adversities that tend to co-occur. To address these difficulties, the current study applied predictive regularization methods to identify the most decisive risk items for CSEC. Proximal risk of CSEC was assessed among 317 youths who were referred to a specialized program in the Northeast of the United States due to suspicion of CSEC. With an innovative methodological approach, this study seeks to prompt other scholars to examine risk utilizing novel techniques and provides a foundation for the development of concise tools that assess risk of CSEC among populations of youths at higher levels of risk.
... A more explicit exploration of the impact of juvenile justice-involvement specifically among YAEH is warranted since the juvenile justice system can play a preventive role prior to adult transitions and provide transition planning services as youth are discharged from their system. Youth with juvenile justice exposure are also known to have elevated rates of mental health diagnoses, substance use, trade sex, adult criminal justice-involvement, and lower social connectedness than peers who are not justice-involved (Coker et al., 2014;Lee & Villagrana, 2015;Naramore, Bright, Epps, & Hardt, 2017;Seiter, 2017). However, no known studies to date have examined risk factors in young people experiencing homelessness who have a history of juvenile-justice involvement. ...
Article
Young adults experiencing homelessness (YAEH) have been found to have high rates of prior involvement with foster care and juvenile justice, but little is known about whether YAEH differ in their risk behaviors based on exposure to different systems. This study used a dataset of 1426 YAEH from 7 different US cities to examine the historical risk and resilience characteristics of those involved in foster care alone, juvenile justice alone, both systems (dual status), and no system involvement. Logistic regression was used to examine whether different types of childhood system involvement predicted risk behaviors in young adulthood including substance use, trade sex, suicide attempts, unplanned pregnancy, and involvement in the adult criminal justice system. Notably, 57% of youth had been exposed to one of the systems – 20% foster care only (n = 291), 18% juvenile justice only (n = 254), and 18% dual status (n = 261). YAEH without a history of system involvement had significantly lower childhood trauma scores and lower rates of lifetime mental health diagnoses compared to all three system involved groups, with dual status youth having the highest rates of both. In relation to risk outcomes, youth with dual status histories had higher odds of trading sex and those with juvenile justice involvement, either alone or as dual status, had higher odds of being arrested after age 18 and of problematic substance use. Results suggest YAEH with prior involvement in child-serving systems have unique risk characteristics that vary by type of system involvement, with dual-system involved youth at particularly high risk. Findings highlight the need for foster care and juvenile justice systems to work collaboratively in providing preventive interventions prior to system exit.
... Studies with service providers as participants have often stressed CCSE survivors' mental health service needs (Clawson, Salomon, & Grace, 2008;Countryman-Roswurm, & Shaffer, 2015;Greenbaum & Crawford-Jakubiak, 2015;Hardy, Compton, & McPhatter, 2013;Hossain, Zimmerman, Abas, Light, & Watts, 2010;Levine & Schumacher, 2017;Oram et al., 2015;Rafferty, 2018). However, many CCSE victims are trapped in the sex trade due to poverty and other vulnerability factors (e.g., childhood experiences of sexual abuse, limited education, and homelessness) linked to basic human needs (Clawson, Salomon, & Grace, 2008;Dank et al., 2015;Greenbaum & Crawford-Jakubiak, 2015;Laser-Maira, Huey, Castro, Ehrlich, & Nicotera, 2018;Laser-Maira, Huey, Castro, & Ehrlich,, 2016;Naramore, Bright, Epps, & Hardt, 2017;Roe-Sepowitz, 2012;Steiner et al., 2018). In studies of survivors as participants, food, housing and job opportunities were stated as their primary needs (Estes & Weiner, 2001;Curtis, Terry, Dank, Dombrowski, & Khan, 2008;Hounmenou & Her, 2018;Laser-Maira, Huey, Castro, Ehrlich, & Nicotera, 2018;Maney et al., 2011;Swaner et al., 2016). ...
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There is increasing evidence that children who are subject to commercial child sexual exploitation (CCSE) are likely to experience complex mental health needs. Failure to address the trauma experienced by victims of CCSE can lead to suicide attempts, self-harm, and long-term mental health needs (Powell, Asbill, Louis, & Stoklosa, 2018). A ‘trauma-informed’ approach (TIA) creates a responsive environment that improves the motivation of victims of CCSE to seek treatment and service providers to address unmet needs. Merging Maslow’s (1943) hierarchy of needs with a TIA approach provides a comprehensive framework to assess the service requirements necessary to meet CCSE survivors’ needs. Particularly, when Maslow’s hierarchy of needs model is coupled with contemporary extensions, which address our greater understanding of the neurological impact of abuse on physiological well-being greater resilience can be created. Additionally, a TIA instigates a shift from victims of CCSE being viewed as damaged, to an understanding of the impact abusive experiences have had on their development. That approach permits them and others to perceive their “survivorhood” and develop their capacity to achieve self-actualization. This paper critically examines what is constituted as best practice in trauma-informed mental health service delivery to not only meet needs but to support CCSE survivors’ attainment of self-actualization.
... Basson et al., 2012;Choi, 2015;Cole et al., 2016;Gragg, Petta, Bernstein, Eisen, & Quinn, 2007;Reid, 2011;Sewell, 2012;Walker, 2013), only one study has applied the ACEs framework to this population. Naramore, Bright, Epps, and Hardt (2017) compared ACEs among youth arrested for trading sex with those of youth arrested for other, non-sexual offenses among a juvenile justice population and found that youth who traded sex had higher rates for each individual ACE and higher overall ACE scores. In another study, Landers et al. (2017) found much higher rates of emotional and behavioral health needs among commercially sexually exploited (CSE) youth compared to what has been found among the general population of children entering the child welfare system (e.g. ...
Article
Background: Research indicates that youth exposed to commercial sexual exploitation tend to have extensive histories of trauma, including physical abuse, sexual abuse, and neglect, which increases their vulnerability to exploitation. Trauma literature finds youth who present to treatment with greater behavioral health needs tend to have higher trauma scores than youth with fewer behavioral health needs (Copeland et al., 2007; Finkelhor et al., 2007). Objective: There is, however, limited research on the role of youth strengths as a buffer against the outcomes associated with trauma. With this in mind, the purpose of this study was to examine the relationship between Adverse Childhood Experiences (ACE scores) and youth outcomes such as risk behaviors, behavioral needs, and impairment in functioning across major life domains. Secondly, we explored how this relationship might be better explained by examining youth strengths as mediators-specifically, peer relationships and the stability of significant relationships in the youth's life. Participants and setting: Data on clients served in a treatment program specialized for commercially sexually exploited youth were used for this research. Results: Results indicated that youth with higher ACE scores had a greater number of risk behaviors, behavioral needs, and impairment in functioning across major life domains. Findings of the mediation analysis provide some support that peer relationships and relationship stability, at least in part, mediates the relationship between ACEs and youth outcomes. Post hoc analyses indicated youth strengths mediated 9-18% of the total effect of ACE scores on youth outcomes. Conclusions: Developing peer relationships and sustaining significant relationships can mitigate some of the adverse effects of trauma experienced by exploited youth.
... As research on sexual exploitation and trafficking evolved, recent studies have employed quantitative methods to determine if risk factors linked to sexual exploitation and trafficking, documented in studies using qualitative research methods, can be replicated and validated by advanced statistical modeling or analyses. Several studies using matched samples, with samples using one-to-one matching on demographic characteristics or propensity score matching, have provided comparisons of risk factors and trauma symptom profiles of youth exposed or not exposed to sexual exploitation and trafficking (Cole, Sprang, Lee, & Cohen, 2016;Reid, 2011Reid, , 2014bNaramore, Bright, Epps, & Hardt, 2015). Other quantitative studies used multivariate analyses to investigate the importance of certain factors in predicting sexual exploitation and trafficking while controlling for other risk factors in the models (Reid & Piquero, 2013. ...
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The emergence of human trafficking as an international, national, and local crime prompted interest among criminology researchers in human trafficking and its intersections with the criminal justice system. This chapter aims to underscore research strategies employed by criminology researchers to gain greater understanding of sexual exploitation and human trafficking. Over the past decade, researchers have conducted community and criminal justice assessments, interviewed hundreds of street youth entangled in criminal environments, and reviewed case records in order to expose the nature of the problem. Advancing beyond descriptive typologies, criminology researchers have employed multivariate analyses to investigate correlates and causes of human trafficking and sexual exploitation. Unique contributions of criminology research include challenging societal illusions of the “ideal victim” and exposing complicated victim-offender dynamics that often impede police intervention and hinder prosecutions. Although considered a new subfield, criminology research on sexual exploitation and trafficked has produced research that has informed prevention, legislation, and policy.
... Notably, childhood trauma is associated with risky sexual behavior, such as early onset of sexual activity, higher rates of sexually transmitted diseases, unwanted pregnancies, and higher numbers of sexual partners (Dietz et al., 1999;Hillis, Anda, Felitti, Nordenberg, & Marchbanks, 2000). Youths who were lured into sex trafficking and later arrested were found to have extraordinarily high rates of every single ACE (the highest being parental neglect and sexual abuse), and higher cumulative ACE scores than non-trafficked youths (Naramore, Bright, Epps, & Hardt, 2015). Thus, maltreated children are especially vulnerable to re-victimization by sexual predators and human traffickers, but they may also be at increased risk for engaging in behaviors that violate the sexual boundaries of others. ...
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p>ocial workers often find themselves working with children or adolescents who have been victims of adverse childhood experiences (ACEs), including youths who have ended up in the juvenile justice system. Childhood trauma has been linked to negative health, mental health, and behavioral outcomes across the lifespan. The aim of this study was to examine the prevalence rates of child maltreatment and household dysfunction in the lives of juveniles who have been arrested for sexual offenses (JSO; n = 6,549). ACE prevalence rates for JSOs were compared by gender to juveniles arrested for other crimes, to adults arrested for sexual offenses, and to the general population. Youths in the delinquency system in Florida had much higher rates of high-ACE scores than the general population, indicating that they came from households where the accumulation and variety of early adversity is a salient feature in their lives. For those who have engaged in sexually abusive behavior, the existence of early maltreatment and family problems was prominent. Through a better understanding of the traumatic experiences of these youths, we can inform and enhance interventions designed to improve the functioning of sexually abusive juvenile clients and their families, and reduce risk of future recidivism.</p
... Applying the concept of gender minority stress to our review of Jade's experiences and outcomes guided our findings on specialized service treatment, which warrants future inquiry. Like many cisgender girls who experience commercial sexual exploitation, Jade's psychosocial development and attachment formation were negatively impacted by adverse experiences in her childhood (Cimino et al., 2017;Naramore et al., 2017). However, the intrafamilial conflict appeared to have been compounded by her mother's rejection of her gender identity along with any judgment and stigma she likely experienced as a result of her exploitive experiences (Pflum et al., 2015;Rood et al., 2016). ...
Article
Purpose The available research on specialized interventions for youth experiencing commercial sexual exploitation almost exclusively focuses on the impact and efficacy related to cisgender girls, despite the inclusion of youth who identify as transgender in these programs. This paper aims to present a case study on the experience of a transgender adolescent girl who experienced commercial sexual exploitation and provides a narrative of the multifarious challenges she faced while involved in institutional systems of care. Design/methodology/approach This paper conducted an in-depth case review of all records on “Jade,” a white adolescent transgender girl who experienced commercial sexual exploitation, from a specialty court program in the juvenile justice system between 2012 and 2016. Her experiences throughout childhood exemplify many of the unique challenges that transgender girls and young women with histories of exploitation or trafficking may encounter within service delivery and socioecological systems. This paper applied concepts adapted from the gender minority stress theoretical model to understand how minority gender identity can shape the experiences and outcomes of the youth impacted by commercial sexual exploitation. Findings Jade’s narrative underscores the interplay of gender-based sexual violence, heteronormative structural barriers, transphobia and their intersectional impact on her experience while receiving specialized care. The intersectional hardships she experienced likely contributed to adverse biopsychosocial outcomes, including high rates of medical and behavioral health diagnoses and expectations of further rejection. Originality/value This paper highlights the extraordinary challenges and barriers faced by an often under-recognized and overlooked subset of the youth impacted by commercial sexual exploitation, who may receive services that do not account for their unique needs related to gender expression and identity. This paper exemplifies how internalized stigma along with expectations of further rejection and victimization have implications for clinical and multidisciplinary intervention settings. Jade’s case underscores the need for improved access to supportive services for youth with minority gender identities, including peer community-building opportunities. Finally, this paper identifies a critical gap in US legislation and social policy. This gap contributes to the structural harms faced by transgender and gender-nonconforming youth receiving services during or following experiences of commercial sexual exploitation.
... Beyond prevalence, a recent prospective analysis of "high-risk" families noted higher ACE scores increased likelihood of alcohol use, marijuana use, violence, and arrest, with noted race differences (Fagan & Novak, 2018), while a separate study of Chicago youth suggests higher ACEs related to delinquency for boys but more so substance use for girls (Leban & Gibson, 2020). Importantly, justice-involved youth with higher ACE exposures have been demonstrated to have be at increased odds of internalizing and externalizing behaviors (Hunt et al., 2017;Muniz et al., 2019), higher recidivism rates and shortened time to reoffense , violent felony arrests (Johnson, 2018), being more likely to attempt suicide (Perez et al., 2016), being victims of human trafficking (Reid et al., 2016) and arrested for trading sex (Naramore et al., 2017), being placed in a long-term juvenile justice residential program prior to age 18 (Zettler et al., 2018), being gang-involved and to evidence early-onset, serious, violent, and chronic juvenile offending trajectories Fox et al., 2015;Perez et al., 2018). Further, recent work has demonstrated adverse exposures increase offending up to age 56 , and distinguish life-course persistent offending from adolescent-limited and adult-onset offending types and from non-offenders (Kerridge et al., 2020). ...
Article
The maltreatment-offending relationship has been well elucidated. Less examined are protective factors that effectively serve to mitigate offending among ACE-exposed youth. The current study examines whether cumulative positive childhood experiences (PCEs) are themselves associated with a reduction in recidivism among juvenile justice-involved adolescents, and the ability of cumulative PCE to moderate the ACE-recidivism relationship. Results demonstrate, among over 28,000 juvenile offenders, high ACE scores were associated with increased reoffending, and high PCE scores were associated with decreased recidivism, as measured by both rearrest and reconviction. Further, among juveniles with four or more ACEs who have six or more PCEs, reconviction was 23% lower and rearrest 22% lower when compared to those youth with four or more ACEs and less than six PCEs, controlling for a host of demographic and criminal history measures. Findings indicate that among youth with high PCE scores the positive association between ACEs and recidivism is no longer significant. Implications for juvenile justice practice and policy are discussed.
... In the United States (U.S.), minors (below age 18) who exchange sexual activity for anything of value are federally defined as child sex trafficked (Trafficking Victims Protection Act, 2000). Vulnerabilities to exploitation include having a marginalized identity due to a minority race, ethnic, gender, or sexuality as well as having histories of substance use, running away, homelessness, and adverse childhood experiences (Atteberry-Ash et al., 2019;Choi et al., 2015;Fedina et at., 2016;Franchino-Olsen, 2021;Hernandez, 2021;Naramore et al., 2017;Varma et al., 2015). While there is no decisive estimate of the scope or prevalence of CSE in the United States (Franchino-Olsen et al., 2022;Miller-Perrin & Wurtele, 2017), the overrepresentation of CSE-impacted adolescents in the juvenile justice and child welfare systems Franchino-Olsen, 2021;Gezinski, 2021) highlight a continuum of needs related to abuse and maltreatment (Gies et al., 2020;Hounmenou & O'Grady, 2019;Saar et al., 2015). ...
Article
Nationwide efforts to enhance services for adolescents experiencing commercial sexual exploitation (CSE) in the judicial system have led to the emergence of specialty courts, including human trafficking and girls’ courts. Given that prior research has documented competing stances on the effectiveness of specialty courts for CSE-impacted populations, we conducted a systematic review of the literature to identify key characteristics of programming, profiles of adolescents served, and effectiveness of these courts. To identify relevant research and information, we systematically searched scholarly databases and information sources, conducted reference harvesting, and forwarded citation chaining. Articles presenting primary data with quantitative, qualitative, or mixed methodologies or programmatic descriptions of specialty courts serving adolescents at risk or with confirmed histories of CSE that were published after 2004 were included. We identified 39 articles on 21 specialty courts serving adolescents at risk or with confirmed histories of CSE, including seven specialty courts with evaluation or outcome data. Across specialty courts, adolescents benefited from an increase in linkage to specialized services, improved residential placement stability, and reduction in recidivism—measured by new criminal charges. Specialty court participation was also associated with improved educational outcomes and decreased instances of running away. A lack of empirical data, specifically of evaluation studies, emerged as a weakness in the literature. Still, findings support that specialty courts can be an integral judicial system response to CSE. Multidisciplinary collaboration can help target and respond to the multifaceted needs of adolescents, encourage healthy behaviors, and promote their overall wellness.
... Almost half of the Highest Risk class engaged in sex trading versus about 9% of the Delayed Risk and none in the other classes. Prominent sex trading may be associated with higher rates of childhood abuse and trauma (Naramore et al. 2017). ...
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Background Juvenile justice-involved African American girls are considered uniformly high-risk for adverse sexual health outcomes such as sexually transmitted infections (STIs) and pregnancy; however, their sexual health statuses may be more complex.Objective The present study assessed whether diverse subgroups of sexual risk exist and explored variations by socio-contextual indicators and sexual health outcomes.Method The sample consisted of 188 detained African American adolescent girls. Six key sexual risk model indicators were selected for latent class analysis: early sex initiation, unprotected sex, high number of sex partners, sex while intoxicated, having sex with a recently incarcerated partner, and trading sex.ResultsResults revealed a four-class solution: “Lowest Risk” (40.3%), with relatively low endorsement of sexual risk items; “Precocious Debut” (19.5%), with early sexual initiation and highest number of sex partners; “Delayed Risk” (30.3%), with later sexual debut but elevated unprotected sex and number of sex partners; and “Highest Risk” (9.9%), with the highest proportions on most indicators, but lower numbers of sex partners compared to Precocious Debut. Classes differed significantly on sexual health outcomes and demographic, neighborhood, peer, family, and individual factors. High Risk, Precocious Debut, and Delayed Risk were associated with greater prevalence of STIs. Lowest Risk and Precocious Debut classes had fewer prior pregnancies. Lowest Risk girls were significantly lower on a range of risk outcomes.Conclusions Heterogeneous profiles of sexual risk may inform future prevention and interventions for at-risk or detained African American girls.
... Our analysis also demonstrated that adverse childhood experiences are extremely prevalent in our trafficked population, consistent with other studies showing overall higher ACE scores among sex trafficking victims. 33,34 This study's findings highlight the importance of screening and early intervention for at-risk youth, and also the need to develop an infrastructure for multidisciplinary collaboration with child welfare, law enforcement, and victim services. 1,3,35 The tools and findings discussed here may help address the need for clinically oriented screening measures to identify sex trafficking victims. ...
Article
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With knowledge about red flags, health professionals can better identify sex trafficking victims. This research seeks to confirm a match between items on one screening tool and trafficked youth’s actual experiences. Also considered are high levels of adverse childhood experiences, another red flag among trafficked youth. Both provide evidence that health care professionals should regularly screen for trafficking risk factors, including personal and family adversity, among youth in all health care settings. Existing clinically oriented tools can serve as a starting point for nurse leaders to integrate system-wide interventions to identify youth at risk for and currently being trafficked.
... 9 The racial wealth gap has likely contributed to the disproportionate representation of Black individuals among sex trafficking victims. 10,11 Adverse childhood experiences increase the risk of being trafficked, 12,13 and these personal histories of trauma and violence are frequently compounded by violence within the industry itself. 14 The longstanding stigma surrounding sex trafficking and commercial sex work creates barriers to health care for women in the sex trade. ...
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Introduction: Service learning can teach medical students about the social determinants of health and prepare them to better serve marginalized populations, while people in the sex trade can serve as effective educators for their peers and health professions trainees. However, service-learning projects involving medical students and people in the sex trade are currently rare. Methods: We modified a curriculum from an author's prior institution to provide a unique service-learning experience for medical students and peer health education for women in the sex trade in a new city and new context. Medical students partnered with a local community organization to implement a 10-week course on physical and mental health for women in the sex trade. Coled by a medical student and a woman who had utilized the community partner's services, the course's instructional methods included in-class demonstrations, group discussion, games, and worksheets. Results: Ten women participated in the course, and six medical students facilitated its implementation. The participants demonstrated increased knowledge in physical and mental health topics and reported being more comfortable speaking with health care providers. The coleaders developed skills and confidence to pursue additional leadership opportunities. The medical student coleader gained a better understanding of addiction and was more prepared to work with patients with substance use disorders. Discussion: This mutual learning experience was a valuable health education opportunity for a local underserved community and helped medical students understand the barriers women in the sex trade face when seeking health care and how physicians can better meet their needs.
... Research with this population thus far has predominately examined the prevalence of ACEs and their impact on recidivism Craig et al., 2017Craig et al., , 2019Fox et al., 2015;Wolff et al., 2017). Initial findings indicate ACEs are highly prevalent among justice-involved youth and related to risk of re-offense (Baglivio et al., 2014;Kowalski, 2018;Logan-Greene et al., 2016), with each additional ACE increasing the risk for serious, violent, chronic offending Fox et al., 2015;Naramore et al., 2017;Wolff et al., 2017Wolff et al., , 2018. ...
Article
Objective: Justice-involved youth report high rates of adverse childhood experiences (ACEs; abuse, neglect, household dysfunction) and are at high risk for elevated behavioral health needs (i.e., substance use, psychiatric symptoms). Research with broad samples of adolescents shows ACEs predict behavioral health outcomes, yet most research on the impact of ACEs among justice-involved youth focuses on recidivism. The present study addresses this gap by examining the prospective association between ACEs and psychiatric symptoms, substance use, and substance-related problems (i.e., consequences of use) among first-time justice-involved youth. Method: First-time justice-involved youth (n = 271; 54.3% male; M age = 14.5 years; 43.5% Latinx; non-Latinx: 34.2% White, 8.6% Black, 7.1% Other, 6.7% Multiracial) and their caregivers were assessed at youth's first court contact and 4- and 12-month follow-ups. Youth and caregivers reported youth's exposure to ACEs through a series of instruments at baseline and 4-months (e.g., Childhood Trauma Questionnaire Short-Form; Traumatic Life Events Inventory). Primary outcomes included youth alcohol and cannabis use (Adolescent Risk Behavior Assessment), consequences of use (Brief Young Adult Alcohol Consequences Questionnaire; Brief Marijuana Consequences Scale), and psychiatric symptoms (Behavior Assessment System for Children; National Stressful Events Survey PTSD Short Scale). Results: Youth were exposed to three ACEs, on average, prior to first justice contact (M = 3). Exposure to more ACEs, particularly abuse, predicted substance use and psychiatric outcomes. Gender differences emerged for cannabis use and internalizing symptoms. Conclusions: Implications for trauma-responsive juvenile justice reform are discussed, including screening for ACEs and their sequelae at first court contact and considering the role of masculine norms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Article
This study examines associations between childhood maltreatment and developmental trajectories of sexual risk behaviors (SRBs) in a sample of 882 sexually active adolescent girls, predominantly Hispanic or Black, assessed every 6 months between 13 and 23 years. Latent profile analyses revealed four distinct maltreatment profiles: Low Maltreatment (76%), Moderate Emotional Neglect Only (15%), Severe Physical/Emotional Abuse (3%), and Severe Sexual Abuse (6%). Multilevel growth analyses showed the Moderate Emotional Neglect Only and Severe Sexual Abuse profiles exhibited more SRBs starting in late adolescence, and the Severe Sexual Abuse profile also exhibited a faster increase than the Low Maltreatment profile. Understanding heterogeneity within maltreated populations may have important implications for healthy sexual development.
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This chapter aims to describe the role of the pediatric healthcare system in the prevention and identification of children and youth who are trafficked, and what the pediatric healthcare response should entail. To help providers understand the relevance of this work, the authors provide a detailed context for trafficking in children, specifically with regards to risk factors, special populations, vulnerabilities, and healthcare interactions, and then delve into an exploration of the evidence base describing pediatric health care provider knowledge, studied interventions, screening tools and strategies, and the pediatric provider response. Summary tables and case vignettes are included to provide the reader with helpful quick references.
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Youth who engage in animal cruelty are known to be at increased risk of perpetrating violence on other people in their lives including peers, loved ones, and elder family members. These youths have often been exposed to family violence, including animal cruelty perpetrated on their beloved pets by violent adults. The current study utilizes a data set of 81,000 juvenile offenders whose adverse childhood experiences are known and includes 466 youth who self-report engaging in animal cruelty. Compared to the larger group of juvenile offenders, the children admitting to engaging in animal cruelty are younger at time of first arrest, more likely to be male, and more likely to be White. When looking at their reports of adverse childhood experiences (ACEs), they are more likely than other juvenile offenders to have an array of adverse experiences beyond family violence and to have four or more ACEs. Although the youth who are cruel to animals are already troubled, the fact that they present to law enforcement at early ages provides early opportunities for intervention. Service providers outside the law enforcement field, such as teachers, physicians, veterinarians and animal control officers may be able to identify these vulnerable youth, and refer them to needed services before violence is visited on other humans.
Article
Objectives African American girls in juvenile detention are disproportionately affected by sexually transmitted diseases (STDs) and other psychosocial health problems, yet few studies have examined associations between experiencing multiple psychosocial health problems and sexual risk behaviors and STD diagnosis. Method The study included 188 detained African American girls aged 13–17 years. We conducted three sets of logistic regressions. First, bivariate analyses assessed associations among seven psychosocial factors (substance use disorder; depression; post-traumatic stress disorder [PTSD]; emotional abuse; pregnancy coercion; physical abuse; and sexual abuse) and four outcomes (early sexual initiation; condomless sex; multiple sexual partners; self-reported STD) to examine their interrelationships. Second, we examined associations between experiencing multiple psychosocial factors and outcomes. Third, psychosocial factors were categorized into four domains: substance use disorder; mental health (depression, PTSD); psychological abuse (emotional abuse, pregnancy coercion); and violence (physical abuse, sexual abuse) and included as independent associations with each outcome to assess their relative importance. Results Multiple interrelationships among psychosocial factors and outcomes were identified. An increase of one psychosocial health problem was associated with an 18% to 27% increased odds of sexual risk behaviors or a previous STD diagnosis. Reporting violence was associated with increased odds of having multiple partners (odds ratio = 3.31; confidence interval = 1.57–6.97), and experiencing psychological abuse was associated with increased odds of reporting an STD diagnosis (odds ratio = 3.95; confidence interval = 1.62–9.63). Conclusion Multiple psychosocial health problems, particularly psychological abuse and violence, are associated with sexual risk and STDs in this vulnerable population.
Article
This study examines the differential childhood adversities experienced by two samples of Australian adolescents involved in the juvenile justice system: male youth who had been adjudicated for sexual offences and their counterparts who had been adjudicated for nonsexual violence. The sample is comprised of clients referred to a service that explicitly prioritises cases identified to be high risk, high need, and living in rural or remote areas. Male youth who had committed a sexual offence were more likely than their counterparts to have experienced emotional and sexual abuse and neglect in their childhoods. Alternatively, the childhoods of the comparison group were marked by characteristics of more general household dysfunction. Potential explanations for these findings are provided. The onset of sexual offending is presented as a possible consequence of poor attachment and emotional dysregulation and the impact of vicarious violence, and a chaotic family life are considered in the development of subsequent nonsexual violence. The implications of these findings for both clinical practice and future research are discussed.
Article
Scholars and practitioners have drawn attention to the issue of commercial sexual exploitation (CSE) of minors, yet we continue to lack a clear understanding of which factors increase a minor's risk to this type of victimization. The current article reviews the literature about the impact of sexual, physical, or emotional abuse on the risk of CSE. The study utilizes quantitative meta-analytical techniques to estimate an overall impact of prior abuse. Nineteen studies were selected after a comprehensive search of electronic databases covering the fields of social science, criminology, psychology, or related fields. To be included in the analyses, all articles had to measure the direct impact of sexual, physical, and/or emotional abuse on minor's risk to CSE, utilizing multivariate techniques and presenting statistical metrics to assess the impact of prior abuse. Key findings demonstrate that sexual abuse considerably increases the risk of exploitation, especially among female youth in the United States. Physical and emotional abuse show negligible or no significant independent impacts, even though a few studies have begun to suggest that experiencing multiple types of childhood abuse may aggravate a risk of sexual exploitation. Our findings can guide further research on the impact of prior victimizations and inform screening instruments that are being developed to identify youth at risk of CSE.
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People convicted of sex crimes have high rates of child maltreatment and family dysfunction as youngsters. Early adversity can create distorted thinking and maladaptive coping patterns. Adverse childhood experiences (ACEs) can interfere with attachment and bonding, healthy relationship skills, and empathy development. Using guidelines developed by SAMHSA, trauma-informed practitioners can integrate knowledge about the neurobiological, psychological, and social consequences of childhood trauma into policies, procedures, and practices that guide a safe, compassionate, respectful treatment environment. Sex offending treatment programs can use trauma-informed care to transform their interventions from primarily content-driven psycho-education to a more collaborative, dynamic, process-oriented, and experiential approach that utilizes the therapeutic encounter as a corrective emotional experience to help clients build skills that reduce risk for recidivism.
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This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Cherish House, an Illinois residential treatment program for trafficked girls. Cherish House utilizes a trauma-focused, integrated model to provide for medical, mental health, educational and life-skill needs of sex trafficked girls.
Article
Child sexual exploitation (CSE) is a serious and persistent global issue affecting up to 5% of the child and youth population worldwide; yet there is no universally accepted definition. To develop a theoretically robust definition of CSE, this review systematically synthesized literature examining CSE definitions aiming to develop a conceptual model and typology. Electronic databases were searched to February 2021, yielding 384 nonduplicative records. Inclusion criteria were peer-reviewed and grey literature investigations of sexual exploitation, with a mean sample age of 18 years or younger, available in the English language. Literature review and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Sixty-six studies met final inclusion criteria. Two independent reviewers extracted relevant data and used an epistemological approach to thematically analyse meaning and patterns across CSE definitions. Key findings demonstrate that CSE nomenclature is widely inconsistent, and despite growing awareness of this severe form of abuse, language continues to perpetuate stigma and criminalisation, utilising terms such as ‘adolescent or child prostitute’. Our findings propose a scientifically and trauma-informed definition and conceptualisation of CSE, based on the following four-dimensional components: (1) A child/young person; (2) sexual acts; (3) abuse; and (4) exploitation (abuse + exchange). In this systematic review, a unified definition and conceptual model aims to advance knowledge and understanding of CSE, contributing to the progression of social norms which embrace nuances of trauma-informed practice and support for the identification and recovery of children, young people and families affected by sexual exploitation.
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Background A growing body of research documents the high rates of trauma among individuals who have sexually offended. Yet the relationship between prior victimization and subsequent sexual offending remained unclear. Objective: By including the voices and perspectives of individuals convicted of sexual offenses, we sought to strengthen professionals’ understanding of the connection between victimization and offending. Method This qualitative study used an online survey to collect data from individuals convicted of sexual offenses (n = 195) with the aims of understanding their perceptions of the link between trauma and offending and what they would like sex-offense treatment providers to know about this connection. Results Using grounded theory, five major themes emerged from the data analysis: Relationship between Trauma Offending (n = 91), Acknowledging the Connection (n = 57), Specific Effects of Trauma (n = 48), Individualized Treatment (n = 34), and Recognition of Humanity (n = 26). Conclusions The participants perceived a strong connection between one’s own victimization and subsequent sexual offending. In addition, they offered specific recommendations for treatment providers, including individualizing treatment with an emphasis on humanity and compassion. Implications for trauma-informed practice and policy are discussed.
Pediatricians are uniquely and well positioned to recognize risk factors for and experiences of labor and sex trafficking in children. While clinical and social interventions are well discussed in the literature, the underlying mechanisms that cause and contribute to trafficking are poorly addressed among healthcare professionals. A “colorblind” or otherwise “apolitical” approach to trafficking prevention is ineffective and may be detrimental to the patient-practitioner relationship. Pediatricians must be historico-socially aware of the contexts in which they practice to improve the health of pediatric populations. This article addresses the relevant trafficking legal terminology that may be unfamiliar to most pediatricians and focuses on a few “ism”-schisms (capitalism, racism, sexism, cis-heteronormativity, nativism, and classism) that create vulnerability to trafficking in pediatric populations. The article closes with some intervention recommendations and many more prevention-measure recommendations.
Article
Regardless of their practice setting or subspecialty, pediatricians are likely to encounter children who have experienced sex or labor trafficking or who are at risk for exploitation. Only 24.1% of health professionals in one study reported receiving previous training on human trafficking; after a brief presentation on the topic, 39.6% indicated that they knew or suspected they had cared for a trafficked person in the past 3 months. Trafficked and exploited children can present with myriad physical or mental health conditions; most have experienced repeated, significant trauma; and few are likely to spontaneously disclose their exploitative situation. As a result, clinicians face challenges in recognizing and appropriately responding to potential human trafficking. Knowledge of common risk factors and potential indicators of exploitation can assist the pediatrician in recognizing affected and at-risk youth. However, health professionals report that existing training tends to focus on general information about trafficking, with relatively little time spent discussing the specifics of the trauma-informed approach to patient interactions. Given the critical importance of building patient trust, empowering patients to share their concerns, and engaging them in their own care and safety planning, this article focuses on the practical aspects of working with trafficked and exploited children. A brief overview of human trafficking is followed by an extensive discussion of rights-based, culturally sensitive, trauma-informed strategies for interacting with vulnerable patients.
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Human trafficking is the use of force, fraud, or coercion for the purpose of forced labor or sexual exploitation. It is a serious human rights violation and public health issue. The experience of a trafficked individual sits at the nexus of multiple structural factors including socioeconomic status, family structure, race, gender, the criminal justice system, and experience of adverse childhood experiences. These factors contribute to an individual’s risk of trafficking, their ability to leave trafficking, and their recovery from the various physical and psychological sequelae of trafficking. Healthcare professionals have a unique opportunity to provide services to people being trafficked, yet many feel undertrained to recognize, evaluate, and manage patients who are trafficked. To appropriately treat individuals experiencing trafficking, clinicians must identify and address their own implicit biases, understand the cultural and structural factors impacting patients, and practice cultural humility as well as trauma-informed care. Systemic changes must also occur to improve the cultural responsiveness of care for distinct populations experiencing trafficking. This chapter explores exploitation from cultural and clinical perspectives, across care delivery settings, and the criminal justice system. It examines policies and practices with a focus on distinct populations including BIPOC (black, indigenous, and people of color), women and children, adolescents, LGBTQ, and immigrants. Work must be done to eliminate structural racism embedded in existing mental health services and to reduce the upstream factors that put people at risk of trafficking. To achieve health equity for people at risk of trafficking, there must be increased emphasis on understanding cultural factors such as structural racism, gender discrimination, and the policies and practices in place to support and perpetuate exploitation of BIPOC.
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Context: Given the wide-ranging health impacts of justice system involvement, we examined evidence for the association between adverse childhood experiences (ACEs) and justice system contact in the United States. Objective: To synthesize epidemiological evidence for the association between ACEs and justice system contact. Data sources: We searched 5 databases for studies conducted through January 2020. The search term used for each database was as follows: ("aces" OR "childhood adversities") AND ("delinquency" OR "crime" OR "juvenile" OR criminal* OR offend*). Study selection: We included all observational studies assessing the association between ACEs and justice system contact conducted in the United States. Data extraction: Data extracted from each eligible study included information about the study design, study population, sample size, exposure and outcome measures, and key findings. Study quality was assessed by using the Newcastle-Ottawa Scale for nonrandomized trials. Results: In total, 10 of 11 studies reviewed were conducted in juvenile population groups. Elevated ACE scores were associated with increased risk of juvenile justice system contact. Estimates of the adjusted odds ratio of justice system contact per 1-point increase in ACE score ranged from 0.91 to 1.68. Results were consistent across multiple types of justice system contact and across geographic regions. Limitations: Most studies reviewed were conducted in juvenile justice-involved populations with follow-up limited to adolescence or early adulthood. Conclusions: ACEs are positively associated with juvenile justice system contact in a dose-response fashion. ACE prevention programs may help reduce juvenile justice system contacts and improve child and adolescent health.
Article
Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p = 0.033 marijuana; AOR = 4.01, p = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.
Chapter
Children from every demographic have experienced sex trafficking; however, research has repeatedly shown that girls, children who identify as BIPOC (Black, Indigenous, and people of color), and children who identify as LGBTQ2S+ (lesbian, gay, bisexual, transgender, queer/questioning, Two-Spirit, and other) are overrepresented among this population. Historically, the anti-trafficking field has referred to this overrepresentation by identifying gender, race, ethnicity, and sexual orientation as individual risk factors. However, less attention has been paid to the identity trauma and historical trauma often experienced by these populations, or the role that systemic and internalized oppression (sexism, racism, ethnocentrism, homophobia, and transphobia) plays in these children’s vulnerabilities. This chapter addresses gaps in current literature by discussing the role of trauma and oppression as risk factors for child sex trafficking and the disproportionate impact trauma and oppression have on girls, children who identify as BIPOC, and children who identify as LGBTQ2S+. It then examines the role that child-serving systems have played in responding to childhood trauma and the manner in which current responses may further contribute to the oppression of these populations and their overrepresentation among trafficked children. Finally, recommendations are made for how the anti-trafficking field and child-serving systems can move forward to address trauma and oppression, especially among overrepresented populations and provide better foundational prevention so that children are not trafficked in the first place.
Chapter
In this case, we meet Maya, an adolescent girl in foster care who is trafficked for sex. We follow her medical visits for contraceptive care and sexually transmitted infection screening over approximately one year. During this time, she is caught in a cycle of intermittent trafficking and transitioning to new foster homes. Her story highlights many unique risk factors that make children in foster care more vulnerable to traffickers. We also discuss reproductive coercion, its risk factors, socioeconomic implications, and provide guidance for medical professionals responding to the needs of trafficking victims in foster care.
Article
Background Since the passage of the Victims of Trafficking and Violence Prevention Act of 2000 in the United States, awareness has increased about the problem of commercial sexual exploitation of children (CSEC). Moreover, United States Federal law calls upon child welfare agencies to establish policies and practices that help identify and provide services to minors at risk of CSEC. Although awareness has increased about the problem of CSEC, little attention has been paid to understanding why some youths are re-referred to CSEC programs after initial referral and intervention. Objective The present study examines which factors drive re-referrals of youths for CSEC concerns. Participants and setting Data about a population of high-risk youths (n = 416) referred to a CSEC-specific program in the Northeast of the United States between 2011 and 2018. Methods Using logistic regression analyses, we investigate what factors are associated with youth having multiple referrals. Results Youths with multiple referrals were more likely to have histories of missing from care (OR = 2.996, p < 0.001), substance misuse (OR = 2.802, p < 0.01), and greater agency involvement (OR = 1.260, p < 0.05). However, youths with multiple referrals were not at heightened risk of CSEC as compared to youths that were not re-referred. Conclusion The results demonstrate that re-referred youths meet the profile of a victim as depicted on screening and assessment instruments, which has important implications for victim services and referral systems dedicated to identifying CSEC and protecting youths who may experience re-victimization for CSEC.
Article
This systematic review synthesized current knowledge about the prevalence of adverse childhood experiences (ACEs) among young people known to have offended and examined evidence of associations between ACEs, trauma symptoms, and offending behavior. A systematic search of English-language, peer-reviewed studies published from the year 2000 onwards was conducted. A final pool of 124 studies that reported quantitative data were included in the review. The Cambridge Quality Checklist for the assessment of studies on offending was used to assess methodological quality of included studies. Pooled data indicated that almost 87% of justice-involved young people across 13 countries experienced at least one traumatic event. The odds of experiencing at least one ACE were over 12 times greater for justice-involved young people compared with nonjustice-involved young people. Prevalence of individual ACEs ranged from 12.2% for childhood sexual abuse to 80.4% for parental separation among justice-involved young people. Those who reported both a higher number and multiple types of ACEs were more likely to be diagnosed with post-traumatic stress symptoms. However, when considering only high-quality studies, there was minimal evidence to suggest that a higher incidence of ACEs predicted trauma symptoms or that trauma symptoms mediated the association between ACEs and offending behavior. Further research is needed to elucidate factors that differentiate young people exposed to ACEs who go on to offend from those who do not. This research is essential to understanding whether ACEs and trauma are drivers of offending behavior and for informing prevention and intervention strategies.
Article
Purpose: Youth who trade sex for something of value experience enduring harm and risk of being trafficked. This study provides empirically-based prevalence estimates to guide policy and practice. Methods: This secondary analysis of 2019 population-level surveillance data from high school students in Minnesota (N = 71,007) uses descriptive statistics and chi-square tests to analyze self-reports of trading sex by demographics, relevant experiences, and health indicators. Results: The prevalence of trading sex among high school students in Minnesota was 1.4%. Cisgender boys and girls had similar rates; transgender students were much higher (5.9%). Rates varied significantly across race/ethnicity (e.g., Native youth, 3.1%), school location, and economic indicators. Students indicating other relevant experiences, such as having been treated for alcohol or drug use (15.1%), reported elevated rates of trading sex. Conclusions: Trading sex is a public health issue that affects high school students. The results show disparate rates of trading sex based on race/ethnicity and gender, with elevated rates among youth who engage in other risky behaviors and experienced other adverse experiences.
Article
As trusted health care providers in the school setting, school nurses are positioned uniquely to identify children at risk for or victims of commercial sexual exploitation of children (CSEC). Nevertheless, many victims go unrecognized and unaided due to inadequate provider education on victim identification. This review provides a comprehensive overview of the major risk factors for CSEC of girls aged 12–18, the largest group of CSEC victims in the United States. A search of four databases (Web of Science, CINAHL, PsychINFO, and PubMed) yielded 21 articles with domestic focus, published in English between January 2014 and May 2020. While childhood maltreatment trauma was found most relevant, a variety of other risk factors were identified. Future nursing research is called to address the numerous research gaps identified in this review that are crucial for the development of policies and procedures supporting school nurses in recognizing victims quickly and intervening appropriately.
Article
Human trafficking involves the use of force, fraud, or coercion to facilitate commercial sex, labor, involuntary servitude, peonage debt bondage, or slavery. Youth within the child welfare system are considered to be at risk for sex trafficking victimization. Additionally, the experiences of youth in the child welfare system, particularly abuse and neglect, have been identified as risk factors for youth sex trafficking. One way to further address human trafficking is by understanding what vulnerabilities may put individuals at risk of being a victim of human trafficking. This study analyzed indicators that are believed to increase the risks for sex trafficking among youth in the child welfare system. A qualitative directed content analysis was conducted to analyze child welfare case narratives (N = 167) to examine the extent to which common vulnerability factors for human trafficking (e.g., trading sex for things of value, unwanted physical contact, previous sexual abuse) were present in substantiated child welfare cases flagged for human trafficking. A total of 75 unique items across 10 assessments were used to create the deductive codebook based on existing human trafficking screening tools (e.g., Trafficking Victim Identification Tool, Adult Trafficking Screening Tool). Findings demonstrated that although there was wide variance across narratives, sexual abuse and sex exchange were the most common vulnerability factors expressed in the case intake narratives. Further, the vast majority of screening variables were not represented in the narratives. These findings call for the use of standardized screening tools, as well as a universal definition of human trafficking, in the child welfare system.
Article
As juvenile justice systems across the country explore ways to best serve youth who have been commercially sexually exploited, challenges may arise between youths' clinically indicated needs and the probation‐driven requirements of CSEC specialty court involvement. This article explores some of the clinical‐probation dualities CSEC specialty courts may encounter, conceptualized as tensions related to issues of confidentiality, responses to behaviors that jeopardize youths' safety, and the timing of healing. Future directions for consideration to better meet the needs of youth involved in the justice system who have experienced sexual exploitation are also discussed.
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The study of adverse childhood experiences (ACEs) and their negative repercussion on adult health outcomes is well documented. In a population of insured Californians, a dose-response relationship has been demonstrated among 10 ACEs and a host of chronic physical health, mental health, and behavioral outcomes. Less widely studied is the prevalence of these ACEs in the lives of juvenile offenders, and the effect of ACEs on children. This study examines the prevalence of ACEs in a population of 64,329 juvenile offenders in Florida. This article reports the prevalence of each ACE and assigns an ACE composite score across genders and a risk to reoffend level classification, and compares these with ACE studies conducted on adults. Analyses indicate offenders report disturbingly high rates of ACEs and have higher composite scores than previously examined populations. Policy implications underline the need to screen for and address ACEs as early as possible to prevent reoffending and other well-documented sequelae.
Technical Report
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The Florida Department of Juvenile Justice (Department) began efforts in 2005 to develop a comprehensive, evidence-based system of assessing the risks and needs of youth referred to the juvenile justice system. A system change of this magnitude was not easily accomplished and required strong collaboration within the Department, as well as with juvenile justice stakeholders and community partners. The Department followed a long-range plan for developing and implementing its new risk and needs assessment instrument referred to as the Positive Achievement Change Tool (PACT). This process included pilot testing of the assessment and a Pre-Validation Study to norm the instrument to Florida’s delinquency population and examine its initial validity in predicting offender risk to re-offend. The current evaluation examined the validity and reliability of the PACT in three phases: Phase I assessed the validity of the PACT risk and needs assessment in accurately predicting recidivism; Phase II involved confirmatory and exploratory factor analyses of all PACT assessment data to assess the utility and parsimony of PACT scoring; and Phase III examined consistency in PACT scoring through assessment of inter-rater reliability. The Justice Research Center (JRC) performed the analyses reported under contract (Contract P2085) with the Department following a competitive procurement process
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Background—Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. Methods—After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological “case example” of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a “dose-response” relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Results—Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. Conclusions—The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
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The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology . Anda R.F., Felitti V.J., Bremner J.D., Walker J.D., Whitfield C., Perry B.D., Dube S.R. & Giles W.H. ( 2005 ) European Archives of Psychiatry and Clinical Neuroscience , ePub, posted online 29 November 2005 . Background Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. Methods After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological ‘case example’ of the convergence between epidemiological and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17 337 adult HMO (Health Maintenance Organization) members and assessed eight adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a ‘dose–response’ relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Results Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual, and aggression-related domains increased in a graded fashion as the ACE score increased (P < 0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. Conclusions The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
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Notable discursive changes are afoot with respect to individuals, particularly sex trade–involved youth in the United States. Where once they may have been profiled as juvenile offenders, they are now, thanks to widespread attention to human trafficking, provisionally viewed by law enforcement and their non-state allies as potential victims of domestic minor sex trafficking, replete with traumatic pasts and turbulent family histories that authorize state intervention. This article examines how anti-trafficking policies have been discursively re-imagined to expand policing and rehabilitative interventions for youth. Drawing on in-depth interviews and ethnographic observations, it tracks the discursive sites and spaces in which criminal justice and social justice agendas have coalesced to assist youth and further assesses how attention to domestic minor sex trafficking has simultaneously authorized a multiprofessional detention-to-protection pipeline.
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The contemporary international slave trade has received little attention in the social work literature. In keeping with the profession's commitment to social justice and human rights, this article reviews perhaps the most prominent and fastest-growing component of the trade—the trafficking of young women and children for prostitution and other forms of sexual exploitation. The role of criminal networks in the globalization of sexual trafficking is discussed, along with the recruitment strategies used by the networks. Suggestions are offered for advocating on behalf of women and children, and information is provided to assist social workers in the provision of services to victims of trafficking.
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Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior. Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample. Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types. On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.
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Importance Child maltreatment and other adverse childhood experiences, especially when recent and ongoing, affect adolescent health. Efforts to intervene and prevent adverse childhood exposures should begin early in life but continue throughout childhood and adolescence. Objectives To examine the relationship between previous adverse childhood experiences and somatic concerns and health problems in early adolescence, as well as the role of the timing of adverse exposures.Design Prospective analysis of the Longitudinal Studies of Child Abuse and Neglect interview and questionnaire data when target children were 4, 6, 8, 12, and 14 years old.Setting Children with reported or at risk for maltreatment in the South, East, Midwest, Northwest, and Southwest United States Longitudinal Studies of Child Abuse and Neglect sites.Participants A total of 933 children who completed an interview at age 14 years, including health outcomes.Exposures Eight categories of adversity (psychological maltreatment, physical abuse, sexual abuse, neglect, caregiver’s substance use/alcohol abuse, caregiver’s depressive symptoms, caregiver treated violently, and criminal behavior in the household) experienced during the first 6 years of life, the second 6 years of life, the most recent 2 years, and overall adversity.Main Outcomes and Measures Child health problems including poor health, illness requiring a doctor, somatic concerns, and any health problem at age 14 years.Results More than 90% of the youth had experienced an adverse childhood event by age 14 years. There was a graded relationship between adverse childhood exposures and any health problem, while 2 and 3 or more adverse exposures were associated with somatic concerns. Recent adversity appeared to uniquely predict poor health, somatic concerns, and any health problem.Conclusions and Relevance Childhood adversities, particularly recent adversities, already show an impact on health outcomes by early adolescence. Increased efforts to prevent and mitigate these experiences may improve the health outcome for adolescents and adults.
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Engaging in trading sex is associated with many co-occurring problems, including elevated risk for sexually transmitted infections. Various dimensions of social support from parents, schools, and mentors may be protective against sex trading and may ameliorate the impact of risk factors. This study analyzes data from respondents to Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health) who had not participated in sex trading for money or drugs in Wave I so that risk and protective factors for first initiations of selling or buying sex could be examined longitudinally. About 2% of the study sample began selling sex and about 2% began buying sex between Wave I and Wave III. The respondent's sex, race/ethnicity, history of sexual abuse, shoplifting, marijuana use, and experiences of homelessness or running away were significant predictors of trading sex (p < 0.05). Being happy at school was associated with lower selling of sex, and feeling part of school was associated with lower buying of sex even after controlling for demographics and risk factors (p < 0.05). Results indicate a need for early intervention for youth who experience sexual abuse or running away. Elements of school connectedness have a protective effect on selling and buying sex. Promoting school connectedness may advance public health goals.
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Two studies were conducted to identify the incidence (Study 1) and characteristics (Study 2) of juvenile prostitution cases known to law enforcement agencies in the United States. Study 1 revealed a national estimate of 1,450 arrests or detentions (95% confidence interval [CI]: 1,287-1,614) in cases involving juvenile prostitution during a 1-year period. In Study 2, exploratory data were collected from a subsample of 138 cases from police records in 2005. The cases are broadly categorized into three main types: (a) third-party exploiters, (b) solo prostitution, and (c) conventional child sexual abuse (CSA) with payment. Cases were classified into three initial categories based on police orientation toward the juvenile: (a) juveniles as victims (53%), (b) juveniles as delinquents (31%), and (c) juvenile as both victims and delinquents (16%). When examining the status of the juveniles by case type, the authors found that all the juveniles in CSA with payment cases were treated as victims, 66% in third-party exploiters cases, and 11% in solo cases. Findings indicate law enforcement responses to juvenile prostitution are influential in determining whether such youth are viewed as victims of commercial sexual exploitation or as delinquents.
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Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood. This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood. Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009. Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years. ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.
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The relationship between adverse childhood exposures and poor health, illness, and somatic complaints at age 12 was examined. LONGSCAN (Consortium for Longitudinal Studies of Child Abuse and Neglect) tracks a group of children with variable risk for maltreatment. Of the participating child-caregiver dyads, 805 completed an interview when the child was age 4 or age 6, as well as interviews at age 8 and 12. The relationships between 8 categories of childhood adversity (psychological maltreatment, physical abuse, sexual abuse, child neglect, caregiver's substance/alcohol use, caregiver's depressive symptoms, caregiver's being treated violently, and criminal behavior in the household) and child health at age 12 were analyzed. The impact of adversity in the first 6 years of life and adversity in the second 6 years of life on child health were compared. Only 10% of the children had experienced no adversity, while more than 20% had experienced 5 or more types of childhood adversity. At age 12, 37% of the children sampled had some health complaint. Exposure to 5 or more adversities, particularly exposure in the second 6 years of life, was significantly associated with increased risks of any health complaint (odds ratio [OR] 2.24, 95% confidence interval [95% CI] 1.02-4.96), an illness requiring a doctor (OR 3.69, 95% CI 1.02-15.1), and caregivers' reports of child's somatic complaints (OR 3.37, 95% CI 1.14-1.0). There was no association between adverse exposures and self-rated poor health or self-rated somatic complaints. A comprehensive assessment of children's health should include a careful history of their past exposure to adverse conditions and maltreatment. Interventions aimed at reducing these exposures may result in better child health.
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This study examined the prevalence and correlates of survival sex among runaway and homeless youths. A nationally representative sample of shelter youths and a multicity sample of street youths were interviewed. Approximately 28% of street youths and 10% of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. Intensive and ongoing services are needed to provide resources and residential assistance to enable runaway and homeless youths to avoid survival sex, which is associated with many problem behaviors.
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This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.
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Background: We examined the relationship of the number of adverse childhood experiences (ACE score) to six health problems among four successive birth cohorts dating back to 1900 to assess the strength and consistency of these relationships in face of secular influences the 20th century brought in changing health behaviors and conditions. We hypothesized that the ACE score/health problem relationship would be relatively "immune" to secular influences, in support of recent studies documenting the negative neurobiologic effects of childhood stressors on the developing brain. Methods: A retrospective cohort study of 17,337 adult health maintenance organization (HMO) members who completed a survey about childhood abuse and household dysfunction, as well as their health. We used logistic regression to examine the relationships between ACE score and six health problems (depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, smoking, and alcoholism) across four successive birth cohorts: 1900-1931, 1932-1946, 1947-1961, and 1962-1978. Results: The ACE score increased the risk for each health problem in a consistent, strong, and graded manner across four birth cohorts (P < 0.05). For each unit increase in the ACE score (range: 0-8), the adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a narrow range (ORs: 1.2-1.3 per unit increase) for each of the birth cohorts; the increase in risk for suicide attempts was stronger but also in a narrow range (ORs: 1.5-1.7). Conclusions: Growing up with ACEs increased the risk of numerous health behaviors and outcomes for 20th century birth cohorts, suggesting that the effects of ACEs on the risk of various health problems are unaffected by social or secular changes. Research showing detrimental and lasting neurobiologic effects of child abuse on the developing brain provides a plausible explanation for the consistency and dose-response relationships found for each health problem across birth cohorts, despite changing secular influences.
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Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: <or=14 years, 15 to 18 years, or as an adult (>or=19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with >or=5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.
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Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress-responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well-being. After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological "case example" of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggression-related domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
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Alcohol is the most common and frequently used drug and has the potential to cause multiple deleterious effects throughout the lifespan. Because early age at initiation of alcohol use increases this potential and programs and laws are in place to attempt to delay the onset of alcohol use, we studied the relationship between multiple adverse childhood experiences (ACEs) and both the likelihood of ever drinking and the age at initiating alcohol use. This was a retrospective cohort study of 8417 adult health maintenance organization (HMO) members in California who completed a survey about ACEs, which included childhood abuse and neglect, growing up with various forms of household dysfunction and alcohol use in adolescence and adulthood. The main outcomes measured were ever drinking and age at initiating alcohol use among ever-drinkers for four age categories: < or = 14 years (early adolescence), 15 to 17 years (mid adolescence), and 18 to 20 years (late adolescence); age > or = 21 years was the referent. The relationship between the total number of adverse childhood experiences (ACE score) and early initiation of alcohol use (< or =14 years) among four birth cohorts dating back to 1900 was also examined. Eighty-nine percent of the cohort reported ever drinking; all individual ACEs except physical neglect increased the risk of ever using alcohol (p < .05). Among ever drinkers, initiating alcohol use by age 14 years was increased two- to threefold by individual ACEs (p < .05). ACEs also accounted for a 20% to 70% increased likelihood of alcohol use initiated during mid adolescence (15-17 years). The total number of ACEs (ACE score) had a very strong graded relationship to initiating alcohol use during early adolescence and a robust but somewhat less strong relationship to initiation during mid adolescence. For each of the four birth cohorts, the ACE score had a strong, graded relationship to initiating alcohol use by age 14 years (p < .05). Adverse childhood experiences are strongly related to ever drinking alcohol and to alcohol initiation in early and mid adolescence, and the ACE score had a graded or "dose-response" relationship to these alcohol use behaviors. The persistent graded relationship between the ACE score and initiation of alcohol use by age 14 for four successive birth cohorts dating back to 1900 suggests that the stressful effects of ACEs transcend secular changes, including the increased availability of alcohol, alcohol advertising, and the recent campaigns and health education programs to prevent alcohol use. These findings strongly suggest that efforts to delay the age of onset of drinking must recognize the contribution of multiple traumatic and stressful events to alcohol-seeking behavior among children and adolescents.
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Much investigation remains to be done regarding the commercial sexual exploitation of children (CSEC). As with other “low visibility” crimes, there is a lurking “dark figure” of unreported cases. Moreover, little reliable information exists about the types of people who exploit children in this way.
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Objectives: Little is known about why people continue to smoke after learning that they have diseases and conditions that contraindicate smoking. Using data from the Adverse Childhood Experiences (ACE) Study, we examined the relation between ACEs and smoking behavior when smoking-related illnesses or conditions are present, both with and without depression as a mediator. Methods: Participants were more than 17,000 adult HMO members who retrospectively reported on eight categories of ACEs (emotional, physical, and sexual abuse; witnessing interparental violence; parental divorce; and growing up with a substance-abusing, mentally ill, or incarcerated household member). The number of maltreatment categories was summed to form an ordinal variable called the ACE Score. We measured current smoking, conditions that contraindicate smoking (heart disease, chronic lung disease, and diabetes), and symptoms of these illnesses (chronic bronchitis, chronic cough, and shortness of breath). Logistic regression models compared the ACE Score of smokers with smoking-related illnesses to participants who reported these illnesses but were not current smokers (n = 7483). Results: Significant dose—response relations between the ACE Score and smoking persistence were found (odds ratio = 1.69; confidence interval = 1.34–2.13 for participants with ≥4 ACEs). Depression was a significant independent predictor of smoking persistence as well as a mediator. Depression only slightly attenuated the relation between the ACE Score and persistent smoking, however. Conclusion: Medical practitioners should consider the maltreatment history and depression status of their patients when a smoking-related diagnosis fails to elicit smoking cessation. Programs should be developed that better address the underlying motivations for continuing to smoke in the face of health problems that contraindicate smoking.
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Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and early sexual debut. Analyses were stratified by sex and sexual orientation. Larger effect estimates depicting the association between ACEs and sexual debut were seen for women compared to men, and among sexual minorities, particularly among men who have sex with men (MSM) and women who have sex with women (WSW), compared to heterosexuals. Sexual health education programs with a focus on delaying sexual debut among children and adolescents should also consider addressing ACEs, such as neglect, physical, psychological and sexual abuse, witnessing parental violence, and parental incarceration and psychopathology. Public health practitioners, researchers and sexual health education curriculum coordinators should consider these differences by sex and sexual orientation when designing these programs. Copyright © 2015 Elsevier Ltd. All rights reserved.
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The interrelatedness of adverse childhood experiences (ACEs) in 64,329 juvenile offenders was examined. ACEs include childhood abuse (physical, emotional, and sexual), neglect (physical and emotional), and household dysfunction (family violence, family substance use, family mental illness, separation/divorce, and family incarceration). Prevalence ranged from 12% to 82% for each ACE. Of youth experiencing one ACE 67.5% reported four or more additional exposures and 24.5% exposure to six or more additional ACEs. Females have higher prevalence and multiple exposures. ACEs are interrelated, necessitating assessment of multiple ACEs rather than one or a few. ACE exposure differs by gender and race/ethnicity.
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Health care professionals who routinely interact with young people have an important role to play in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. These crimes—which include any sexual activity with someone younger than 18 years in exchange for something of value—occur every day in the United States and have serious, long-term consequences for individuals who have experienced this violence and exploitation. Unfortunately, pediatricians may not recognize children and adolescents who are at risk or who may be abused. A recent report from the Institute of Medicine and the National Research Council sheds light on these crimes and provides recommendations designed to increase awareness, advance understanding, and support efforts to prevent and respond to this abuse.
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Previous research into age-related variables relevant to girls and young women being involved in commercial sexual exploitation (including prostitution) has not distinguished between its onset and limitation to adolescence and its early onset and persistence into adult life. The aims of this study were to examine variables associated with adolescent versus adult onset of commercial sexual exploitation and identify potential risk and resiliency factors differentiating adolescence-limited sexual exploitation and early-onset-adult persistent exploitation. Interviews with 174 vulnerable mostly African-American women, 23% of whom reported commercial sexual exploitation in adolescence and/or adulthood, yielded data, which were analysed using multinomial logistic regressions. Adolescent sexual victimisation, younger age at first alcohol/drug use, being a victim of intimate partner violence and sense of stigmatisation of sexual self/others were all variables associated with adolescent onset of commercial sexual exploitation. Educational attainment differentiated adolescence limited from adolescent-adult persistent exploitation; exploitation had ceased by adulthood among over two-thirds of those who completed at least high school education, but only 13% of those exploited into adult life had finished high school. As level of education was linked to cessation of exploitation by adulthood, support for vulnerable girls to complete education at least to high school level may be protective. The link between early onset of substance misuse and persistent exploitation suggests that education and support specifically targeted within this field could reduce likelihood of persistent abuse. Work directed at improvement of self-image may also reduce risk of persistent exploitation. Copyright © 2014 John Wiley & Sons, Ltd.
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Analysis of predictive validity of the risk/needs assessment used by a criminal justice agency is paramount. The validity of the Positive Achievement Change Tool (PACT) across gender/race/ethnicity in a juvenile sample was examined. Results demonstrate recidivism increases as PACT score increases, with minor exceptions. Findings suggest similar prediction of referral/arrest and adjudication/conviction across subgroups. 95% confidence intervals overlapped for all subgroups on 13 of 19 measures examined. However, which factors predict recidivism across subgroups differ. Criminal history was the most prevalent predictor, while no factor predicted White female offending. “Gender-responsive” item inclusion measuring abusive/traumatic circumstances did not improve prediction.
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Although there is evidence for specific risk factors leading to child sexual exploitation and prostitution, these influences overlap and have rarely been examined concurrently. The present study examined case files for 175 young persons who attended a voluntary organization in Leicester, United Kingdom, which supports people who are sexually exploited or at risk of sexual exploitation. Based on the case files, the presence or absence of known risk factors for becoming a sex worker was coded. Data were analyzed using t-test, logistic regression, and smallest space analysis. Users of the voluntary organization's services who had been sexually exploited exhibited a significantly greater number of risk factors than service users who had not been victims of sexual exploitation. The logistic regression produced a significant model fit. However, of the 14 potential predictors - many of which were associated with each other - only four variables significantly predicted actual sexual exploitation: running away, poverty, drug and/or alcohol use, and having friends or family members in prostitution. Surprisingly, running away was found to significantly decrease the odds of becoming involved in sexual exploitation. Smallest space analysis of the data revealed 5 clusters of risk factors. Two of the clusters, which reflected a desperation and need construct and immature or out-of-control lifestyles, were significantly associated with sexual exploitation. Our research suggests that some risk factors (e.g. physical and emotional abuse, early delinquency, and homelessness) for becoming involved in sexual exploitation are common but are part of the problematic milieu of the individuals affected and not directly associated with sex trading itself. Our results also indicate that it is important to engage with the families and associates of young persons at risk of becoming (or remaining) a sex worker if one wants to reduce the numbers of persons who engage in this activity.
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Although childhood maltreatment has been found to contribute to a variety of youth problem behaviors, the implications of being maltreated on gang involvement remain unclear. This research examines whether physical and sexual maltreatment raises the risk of gang involvement among secondary school students. Findings show that being maltreated increases the probability of gang involvement, independent of demographic factors. When youth are subjected to extreme levels of maltreatment, their odds of participating in gang activities differ only slightly from youth who report occasional maltreatment, suggesting that prevalence measures may be better predictors of gang involvement than incidence measures. When youth are beaten physically and molested sexually, their odds of gang involvement are four times higher than youth who do not experience maltreatment. Finally, being maltreated is a much more robust correlate of gang involvement than the level of support, communication, educational interest, and supervision youth receive from their parents.
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Objective: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs).Method: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score).Results: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4–19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001).Conclusion: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.
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The present study examines the association of adverse childhood experiences (ACEs) to suicidal behavior and mortality in 508 Finnish adolescents (aged 12-17 years) who required acute psychiatric hospitalization between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) were used to obtain information about ACEs, adolescents' suicidal behavior and psychiatric diagnoses. The cases of death were obtained from Statistics Finland. The results of our study indicated that, among girls, exposure to sexual abuse statistically significantly increased the risk of non-suicidal self-injury (NSSI) (OR, 1.8; 95 % CI, 1.0-3.2) and suicide attempts (OR, 2.3; 95 % CI, 1.0-4.5). The cumulative number of ACEs was also associated with an increased risk of NSSI (OR, 1.2; 95 % CI, 1.0- 1.4) and suicide attempts (OR, 1.2; 95 % CI, 1.0-1.4) in girls. Among all deceased adolescents, ACEs were most notable among those who had died due to accidents and injuries. Gender differences in the types of ACEs were noted and discussed.
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This study seeks to assess the nature and extent of childhood emotional abuse among adult women in a residential prostitution-exiting program. Regression analyses were conducted to assess the unique role of childhood emotional abuse in the prediction of age of entry into prostitution. Childhood emotional abuse, a history of running away during childhood, and participating in survival-based exchanges of sex were significantly associated with the commercial sexual exploitation of girls younger than age 18, while childhood emotional abuse contributed to predicting a younger age of entry. Results are discussed regarding policy, prevention, and future research.
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The Florida Department of Juvenile Justice has implemented a new fourth-generation risk/need assessment to assess the risk to re-offend for juveniles referred to the department. The new assessment, the Positive Achievement Change Tool, or PACT, is adapted from the validated Washington State Juvenile Court Assessment, on which the Youth Assessment Screening Inventory (YASI) was also modeled. This study validated the PACT assessment, and examined whether the instrument is as predictive of female delinquency as it is of male delinquency, utilizing subsequent official delinquency referral as the dependent measure. Gender differences were explored and illustrated the instrument to be effective in predicting female and male delinquency, yet the factors predicting female delinquency did not mimic those predictive of male delinquency. Furthermore, for both male and female juveniles, a score of environmental and personal characteristics and situations had a stronger relationship with recidivism than did a score of official criminal history.