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Abstract

Despite increased effort to respond to human trafficking at national and state levels, very little empirical research has been conducted on domestic child sex trafficking. This study retrospectively examines associations between multiple risk factors and domestic child sex trafficking (i.e., entry into the commercial sex industry under the age of 18) in a sample of individuals aged 16 and older currently involved in the commercial sex industry (N = 273). Two primary research questions are addressed: (1) What set of risk factors, prior to entering the commercial sex industry, are associated with domestic child sex trafficking and (2) what group differences, if any, exist in risk factors between current or former domestic child sex–trafficking victims and non-trafficked adults engaged in the commercial sex industry? A cross-sectional survey was administered using Respondent-Driven Sampling (RDS) in five cities in one Midwestern state. Overall, 115 participants (48.3%) were identified as current or former domestic child sex–trafficking victims. Bivariate results suggest that childhood emotional and sexual abuse, rape, ever running away from home, having family members in sex work, and having friends who purchased sex were significantly associated with domestic child sex trafficking. Multivariate results indicate that domestic child sex trafficking victims were significantly more likely to have ever run away and to be a racial/ethnic minority than non-trafficked adults engaged in the commercial sex industry. Findings can inform state-level policies on human trafficking and assist child protection and juvenile justice agencies in developing prevention and intervention responses to commercial sexual exploitation.

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... Demographic data related to sex trafficking are typically derived from federal or state prosecuted cases (Snyder & Mulako-Wangota, 2014;Farrell et al., 2016), the National Human Trafficking Hotline (Polaris, 2019a(Polaris, , 2019b, and research literature drawing from organization or city-based samples (Bigelsen & Vuotto, 2013;Fedina et al., 2019;Murphy, 2017;Wright et al., 2021). There is a dearth of statewide analyses, and those that are available may not emphasize demographic characteristics of survivors or the forms of sex trafficking experienced, as the study aims vary (Busch-Armendariz et al., 2016;Martin et al., 2021;Schwarz, 2017). ...
... The extant literature implicates structural racism in the victimization of Black, Latinx, and Indigenous populations (Farrell et al., 2019;Martin et al., 2021;Stark & Hudon, 2020). City-based studies and studies using samples of homeless or transient youth find disproportionate victimization of LGBTQ+ people, as well as POC of all genders (Chisolm-Straker et al., 2019;Dank et al., 2015aDank et al., , 2015bFedina et al., 2019;Murphy, 2017). Poverty or low socioeconomic status is also known to be connected to trafficking risk, as shown in multiple research studies (Lutnick, 2016;Martin et al., 2014Martin et al., , 2021Murphy, 2017). ...
... Sexuality and gender identity are typically not included in state-level analyses, and a small number of studies focusing on these variables are city-based studies that also tend to focus on homeless or transient youth populations (Dank et al., 2015a;Fedina et al., 2019;Murphy, 2017). Such studies generally find disproportionate victimization of POC, cisgender and transgender women and girls, and LGBTQ+ individuals, but may be limited in their generalizability to other region types or service populations (Dank et al., 2015a;Fedina et al., 2019;Hogan & Roe-Sepowitz, 2020;Martin et al., 2014;Murphy, 2017). ...
Article
Demographic trends of sex trafficking are understudied in Midwestern regions of the United States and in state-level analyses. The aim of the current statewide study is threefold: to examine the provider-reported 1) demographic characteristics of identified survivors (i.e., race/ethnicity, gender identity, social class, sexuality, region of origin, and age), 2) forms of sex trafficking experienced (i.e., survival sex, intimate partner, familial, manager-facilitated), and 3) relationship between demographic characteristics and the different forms of sex trafficking experienced. Drawing from a larger study examining survey responses of 107 social, healthcare, and legal service providers, respondents reported working with 422 survivors of human trafficking accessing services in a Midwestern state in the previous 12 months, including survivors of sex trafficking (n = 349, 82.7%), sex/labor trafficking combined (n = 53, 12.6%), and labor trafficking (n = 20, 4.7%). The current study focuses on provider-reported data specifically related to sex trafficking and sex/labor trafficking combined. Results indicate disproportionate victimization by race/ethnicity, age, sexuality, gender identity, region, and social class. Providers indicated sex trafficking was most commonly experienced within the contexts of an intimate partner relationship (n = 134, 28%) or survival sex (n = 102, 22%). Sex/labor trafficking combined most commonly involved sexual labor trafficking in massage parlors (n = 40, 70%). Implications for micro, mezzo, and macro-level practice to address identity-based oppression and precursors to trafficking as indicated by the results are provided.
... Methodological weaknesses, such as nonrandomized sampling strategies and small sample sizes, likely contribute to these conflicting findings. Even so, research consistently finds a relationship between childhood neglect and abuse (including physical, emotional and sexual abuse) and DMST (Fedina, Williamson, & Perdue, 2019;McMahon-Howard & Mufti c, 2017;O'Brien, Li, Givens, & Leibowitz, 2017;Perkins & Ruiz, 2017;WestCoast Children's Clinic, 2012). In one study, rape was reported by 50 percent of participants trafficked as youths, followed by childhood sexual abuse (45 percent) and childhood emotional abuse (41 percent) (Fedina et al., 2019). ...
... Even so, research consistently finds a relationship between childhood neglect and abuse (including physical, emotional and sexual abuse) and DMST (Fedina, Williamson, & Perdue, 2019;McMahon-Howard & Mufti c, 2017;O'Brien, Li, Givens, & Leibowitz, 2017;Perkins & Ruiz, 2017;WestCoast Children's Clinic, 2012). In one study, rape was reported by 50 percent of participants trafficked as youths, followed by childhood sexual abuse (45 percent) and childhood emotional abuse (41 percent) (Fedina et al., 2019). In addition, substance misuse was correlated with DMST in multiple studies (McMahon-Howard & Mufti c, 2017;O'Brien, White, & Rizo, 2017). ...
... In addition, substance misuse was correlated with DMST in multiple studies (McMahon-Howard & Mufti c, 2017;O'Brien, White, & Rizo, 2017). Other risk factors include the death of a parent, divorcing parents, and family and peers' involvement in sex work (Fedina et al., 2019;McMahon-Howard & Mufti c, 2017). Research suggests that youths of color are disproportionately vulnerable to DMST (Fedina et al., 2019;Mitchell, Finkelhor, & Wolak, 2010). ...
Article
Survivors of domestic minor sex trafficking (DMST) are failing to be identified and are frequently criminalized. Examining the linkages between DMST and the juvenile legal system is important, as many trafficked youths are only identified after entry into the child welfare or juvenile court system as a result of being arrested or detained on related delinquency charges. Due to legacies of structural violence, marginalized youths are reluctant to approach police officers for help. Therefore, social workers have an opportunity to identify, intervene, and advocate for trafficked youths. In this article, the author provides an overview of existing research related to the demographic profile of DMST, homelessness and survival sex, recruitment and entry, barriers to effective community response, and prevention and intervention strategies. This article represents a call to broaden our view of young people in the sex trade and supports the decriminalization of trafficked youths. Interventions and policies must be designed to fit their complex needs and experiences, resulting in empowerment, opportunity, and new beginnings.
... Minors who experience sex trafficking are found to be disproportionately involved in the juvenile justice and child welfare systems (Cimino et al., 2017;Cole et al., 2016;Fedina et al., 2016;Gibbs et al., 2015;Reid, 2018;Sprang et al., 2020). Gibbs et al. (2015) found that almost a quarter of their sample of those experiencing DMST (n = 201) were involved in the juvenile justice system and 38% were involved in the child welfare system. ...
... Gibbs et al. (2015) found that almost a quarter of their sample of those experiencing DMST (n = 201) were involved in the juvenile justice system and 38% were involved in the child welfare system. Similarly, Fedina et al. (2016) found nearly a quarter of minors involved in sex trafficking had prior involvement in child welfare systems, approximately 20% had been in juvenile detention, and nearly 16% were in foster care prior to being sex trafficked. Farrell et al. (2019) found that among programs providing residential services for trafficked youth, 77% of youth had prior involvement with juvenile justice and 89% with child welfare systems. ...
... First, experiences with violence and abuse at home lead to child welfare involvement and potential foster care placement when parents are charged with abuse or neglect. Research indicates DMST survivors experience child abuse and/or neglect at elevated rates (Cole et al., 2016;Fedina et al., 2016;Gibbs et al., 2019). One study indicated 34% of DMST survivors experienced child sexual abuse (Gibbs et al., 2015). ...
Article
Background Domestic minor sex trafficking (DMST) survivors are disproportionately involved in the juvenile justice system, but frequently run away and experience retrafficking. However, little research explores how practitioners who work with juvenile justice-involved DMST survivors address such dynamics. Objective This study examines challenges related to chronic runaway behaviors and related retrafficking of juvenile justice-involved DMST survivors from the perspective of practitioners. Participants and Setting. 35 in-depth interviews were conducted with social service and justice system practitioners working with DMST survivors in a Midwestern metropolitan area. Methods Inductive analysis of the transcribed interviews involved a multi-phase, independent co-coding process conducted by three members of the research team, including selective coding, open coding, and taxonomic analysis to identify recurring themes and subthemes. Core themes that focused on challenges experienced by practitioners working with minors who chronically ran away and returned to a trafficking situation were further developed. Results Practitioners reported that their ability to provide care to minors returning to trafficking situations was limited because of their informal authority in the juvenile justice system, inaccessibility of residential therapeutic care and drug treatment, and punitive measures directed toward parents seeking assistance from Children's Division. Provider narratives indicated that without effective interventions, minors typically exit a retrafficking situation only after experiencing emotional distress, extreme violence, pregnancy or birth, or contracting an STI. Conclusions Non-punitive responses to address chronic runaway behaviors and retrafficking of minors in the justice system include: placement with foster families trained in dynamics of sex trafficking, trauma, and runaway behaviors; safety planning including risk assessments and providing resource information about drop in centers and healthcare; revising hotlining procedures for concerned parents; and increasing minors' access to trauma-informed residential care, therapeutic care, and substance use treatment by legislatively expanding healthcare coverage under Safe Harbor laws.
... Department of Justice, 2004), with the most commonly cited study estimating upward of 325, 000 children at risk for sexual exploitation in the United States each year (Estes & Weiner, 2001). However, available statistics are problematic as they often fail to distinguish between domestic and international victims, are based on varying definitions of sex trafficking, are geographically limited, and utilize nonreplicable, unreliable methodologies (Fedina et al., 2019;Franchino-Olsen et al., 2020;Stransky & Finkelhor, 2012). Researcher error aside, the very nature of the sex trafficking industry presents barriers to the acquisition of accurate statistics. ...
... While research on risk and vulnerability have highlighted the enhanced risk for LGBTQIAþ youth for recruitment into sex trafficking (e.g., Choi, 2015;Fedina et al., 2019), the reviewed articles largely failed to include diverse samples of youth identifying as LGBTQIAþ. Thus, it remains unclear whether traffickers utilize similar or different tactics in the recruitment, entrapment, and enmeshment of LGBTQIAþ youth. ...
Article
Full-text available
The domestic sex trafficking of minors is occurring across Canada and the United States. Understanding the routes into sex trafficking, including the way traffickers target, recruit and enmesh youth in the sex trade is invaluable information for service providers and law makers developing prevention and intervention initiatives. This review synthesized research on the exploitation processes and tactics employed by traffickers in the sex trafficking of domestic minors in Canada and the US. The authors comprehensively and systematically searched five electronic databases and obtained additional publications and grey literature through a backward search of the references cited in articles reviewed for inclusion. Inclusionary criteria included: Studies published in the English language between January 1990 and June 2020 containing original research with quantitative or qualitative data on the recruitment or pathways into sex trafficking for minors trafficked within the US and Canada. The search yielded 23 eligible studies. The synthesis of the studies in the review converged on the notion of sexual exploitation occurring on a continuum comprising of three components; the recruitment context, entrapment strategies utilized by traffickers, and enmeshment tactics used to prolong exploitation. Findings highlight the significant physical, psychological and emotional hurdles faced by youth victims of sex trafficking and point to the importance of comprehensive and holistic approaches to prevention and intervention practices.
... Due to significant challenges in data collection in relation to sex trafficking [18,22,46], information about networks within sex trafficking operations is limited. Thus the potential impacts of network interdictions and disruptions are even less well-known. ...
... Connections between legal and criminalized commercial sex, as well as between formal and informal networks, add complexity to how networks function [10,14]. Social problems such as poverty, running away from home, homelessness and addictions make some people more vulnerable to being trafficking for sexual exploitation [18,45,21]. These nuanced market and social factors shape how sex trafficking networks function, including how they recruit and retain victims [10,14]. ...
Preprint
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We consider a new class of max flow network interdiction problems, where the defender is able to introduce new arcs to the network after the attacker has made their interdiction decisions. We provide an example of when interdiction can result in an increase to the maximum flow, and prove properties of when this restructuring will not increase the value of the minimum cut, which has important practical interpretations for problems of disrupting drug or human trafficking networks. In particular, it demonstrates that disrupting lower levels of these networks will not impact their operations when replacing the disrupted participants is easy. For the bilevel mixed integer linear programming formulation of this problem, we devise a column-and-constraint generation (C&CG) algorithm to solve it. Our approach uses partial information on the feasibility of restructuring plans and is shown to be orders of magnitude faster than previous C&CG methods. We apply this algorithm to the application of disrupting drug trafficking networks. We demonstrate that applying decisions from standard max flow network interdiction problems can result in significantly higher flows than interdictions that account for the restructuring. We also show that interdicting lower level participants is less impactful when recruitment of new participants is allowed.
... Pre-existing vulnerabilities appeared to have an impact on the means and depths of trafficking. Previous studies investigating risk factors for mental disorders in survivors of trafficking found that a significant percentage of trafficking victims reported childhood sexual abuse (Abas et al., 2013;Fedina et al., 2019;Hardy et al., 2013;Hossain et al., 2010;Ijadi-Maghsoodi et al., 2016;Kiss et al., 2015). The current study supported these findings, with family-related childhood sexual and physical abuse being the most common form of vulnerability described. ...
... On one hand, victims described poor family relationships and dysfunctional homes as putting them in a vulnerable position in their lives. These findings support previous research suggesting that a number of risk factors, including domestic violence and childhood physical abuse, may increase susceptibility to victimization later on in life (Fedina et al., 2019;Greenfield & Marks, 2010;Hardy et al., 2013;Jiménez et al., 2019;Jirapramukpitak et al., 2011). On the other hand, victims also described experiencing a number of traumatic life events prior to trafficking, increasing their vulnerability to later mental illness. ...
Article
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In recent years, human trafficking has received increasing public awareness and media attention, and sex trafficking in particular has become a prevailing human rights issue on a global scale. Despite growing scientific literature in the field, there remains a limited number of international qualitative studies investigating victims’ needs. This study aims to explore the experiences of people who have been sex trafficked in a Western country and how this impacted their mental health, as described in online first-person accounts. First-person online narratives of sex trafficking victims (n = 30) were retrieved from a systematic online search. A thematic analysis identified overarching themes, with the most prominent being 1) preexisting vulnerabilities, 2) psychological mechanisms involved in trafficking (i.e. deception, manipulation), and 3) barriers to recovery. The results showed how preexisting vulnerabilities can impact victims’ susceptibility to trafficking and how psychological control tactics utilized in the trafficking process maintain victims’ vulnerability. The results of this thematic analysis provide insight into the diverse set of mental, social, and legal needs that trafficking victims face and may inform potential post-trafficking interventions to meet these needs and prevention efforts to reduce vulnerability to trafficking. Further implications and methodological considerations are discussed in full.
... In the United States, the majority of youths identified as victims of CSE are cisgender girls and young women; however, boys and gender-nonconforming girls are often underidentified. Youths who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are also at increased risk of exploitation (Fedina, Williamson, & Perdue, 2016;Franchino-Olsen, 2019;Swaner, Labriola, Rempel, Walker, & Spadafore, 2016). Most youths identified as commercially sexually exploited have multiple marginalized identities and histories of trauma, including belonging to racial and ethnic minority groups, havdoi: 10.1093/sw/swaa040 V C 2020 National Association of Social Workers ing histories of childhood maltreatment or neglect, and becoming homeless because of their sexual orientation or gender identity (Fedina et al., 2016;Lederer & Wetzel, 2014;Varma, Gillespie, McCracken, & Greenbaum, 2015). ...
... Youths who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are also at increased risk of exploitation (Fedina, Williamson, & Perdue, 2016;Franchino-Olsen, 2019;Swaner, Labriola, Rempel, Walker, & Spadafore, 2016). Most youths identified as commercially sexually exploited have multiple marginalized identities and histories of trauma, including belonging to racial and ethnic minority groups, havdoi: 10.1093/sw/swaa040 V C 2020 National Association of Social Workers ing histories of childhood maltreatment or neglect, and becoming homeless because of their sexual orientation or gender identity (Fedina et al., 2016;Lederer & Wetzel, 2014;Varma, Gillespie, McCracken, & Greenbaum, 2015). Thus, youths affected by CSE are a highly vulnerable group of young people of major concern to social workers. ...
Article
Historically, youths who are affected by commercial sexual exploitation (CSE) in the United States have been implicated as perpetrators of crime and overrepresented in the juvenile justice system. As an intriguing example of the “smart decarceration” social work grand challenge, policy and practice initiatives have converged to decriminalize cisgender girls and young women experiencing CSE by reframing them as victims of exploitation rather than as criminals. To date, these efforts have largely focused on gender-specific programming for cisgender girls and young women. In this article, the authors describe how federal, state, and local policy and practice innovations have supported reframing CSE as a form of child maltreatment and rerouted girls and young women from the juvenile justice system to specialized services. Using Los Angeles County as a case example, the authors detail how innovative prevention, intervention, and aftercare programs can serve as models of smart decarceration for CSE-affected cisgender girls and young women with the potential to address the needs of youths with diverse gender and sexual identities.
... Individuals of any sociocultural background, socioeconomic status, or education level can become sex trafficked. The extant body of literature has identified homelessness, drug use, and child sexual abuse as significant vulnerability factors that may predict entry into the sex trafficking trade (Cobbina & Oselin, 2011;Fedina et al., 2016;Middleton et al., 2018). Individuals living in poverty as well as those with mental health disorders, limited education, and few employment prospects may also be at greater risk for becoming trafficked (Franchino-Olsen, 2019). ...
... For instance, adolescents with parents, friends, and peers who are involved in sex work may be more vulnerable to sexual exploitation themselves because of the familiarity of abuse. Finally, gender and sexual minorities may be especially susceptible to sex trafficking due to the increased risk of physical, emotional, and sexual abuse, as well as high rates of homelessness, substance use, and neglect (Choi, 2015;Clayton et al., 2013;Fedina et al., 2016). ...
Article
Full-text available
Human trafficking represents the fastest growing form of transnational crime and remains the third largest criminal enterprise following the sale of drugs and arms. Though the call to incorporate sex trafficking content into counsellor education programs has been established, a lack of training remains. Professional counsellors must therefore cultivate the necessary awareness, knowledge, and skills to effectively support sex trafficking survivors across diverse settings, especially given the presence of severe and chronic mental health sequelae among survivors. The authors used a multipronged approach to help professional counsellors (a) recognize the prevalence of sex trafficking in clinical settings, (b) understand the clinical implications of counselling adult sex trafficking survivors, and (c) employ trauma-informed and evidence-based interventions for counselling adult sex trafficking survivors.
... In the United States, the majority of youths identified as victims of CSE are cisgender girls and young women; however, boys and gender-nonconforming girls are often underidentified. Youths who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are also at increased risk of exploitation (Fedina, Williamson, & Perdue, 2016;Franchino-Olsen, 2019;Swaner, Labriola, Rempel, Walker, & Spadafore, 2016). Most youths identified as commercially sexually exploited have multiple marginalized identities and histories of trauma, including belonging to racial and ethnic minority groups, havdoi: 10.1093/sw/swaa040 V C 2020 National Association of Social Workers ing histories of childhood maltreatment or neglect, and becoming homeless because of their sexual orientation or gender identity (Fedina et al., 2016;Lederer & Wetzel, 2014;Varma, Gillespie, McCracken, & Greenbaum, 2015). ...
... Youths who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are also at increased risk of exploitation (Fedina, Williamson, & Perdue, 2016;Franchino-Olsen, 2019;Swaner, Labriola, Rempel, Walker, & Spadafore, 2016). Most youths identified as commercially sexually exploited have multiple marginalized identities and histories of trauma, including belonging to racial and ethnic minority groups, havdoi: 10.1093/sw/swaa040 V C 2020 National Association of Social Workers ing histories of childhood maltreatment or neglect, and becoming homeless because of their sexual orientation or gender identity (Fedina et al., 2016;Lederer & Wetzel, 2014;Varma, Gillespie, McCracken, & Greenbaum, 2015). Thus, youths affected by CSE are a highly vulnerable group of young people of major concern to social workers. ...
Article
For the first time in US history, first-year female medical school matriculants (50.7%) outnumbered men (49.3%) in 2017 [1]. Moreover, in 2019, women accounted for 50.5% of all medical students for the first time [1]. Yet, female faculty continue to be underrepresented at the highest rankings in academic medicine as a whole and in psychiatry [2, 3]. Women represent only 26% and 32% of full professors among all medical faculty and psychiatry faculty, respectively, with a majority identified as White [3]. Structural racism, gender bias, and discrimination, along with the lack of systematic strategies that aim to achieve gender and racial equity, result in persistent achievement and promotion disparities among students, residents, and faculty, especially among those who are underrepresented in medicine [4, 5]. We will review the barriers women face advancing their careers in academic medicine in general, and academic psychiatry in particular, with specific attention paid to inequities for Black, Indigenous, and People of Color (BIPOC) women and especially underrepresented in medicine (URM) women compared to White women based on race/ethnicity. We will also consider the intersecting impact of sexual orientation and gender identities on women. Although there is a substantial body of research on academic medical career progression for women and URM, research identifying strategies and challenges for URM women is limited. Challenges noted include institutional barriers related to mentoring, time management, influence of bias, exclusion from formal and informal networks, and involvement in committees and non-promotion activities. Notably, the literature often considers women homogenously and does not account for nuanced differences between groups. Still, we propose solutions to narrow persistent gender and racial/ethnic disparity gaps for womenidentifying faculty. The Association of American Medical Colleges defines underrepresented in medicine (URM) as “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population” [6].We use the term “URM women” to describe these women, who include all who do not identify as exclusively White or Asian [6]. We use the term “Black, Indigenous, and People of Color (BIPOC) women” to describe women whose racial/ ethnic identities are non-White to recognize the significant past and present history of violence, structural racism, and injustice toward Black and Indigenous people in the USA. We use the term “LGBTQIA+ women” to refer to lesbian, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minoritized women in recognition of the discrimination and oppression they experience
... The exact number of youth who experience CST within the United States remains hidden for several reasons. First, the majority of media coverage on sex trafficking focuses on international cases, effectively eclipsing the prevalence of the issue domestically (Fedina, Williamson, & Perdue, 2019). Second, compared to global estimates of CST, records of domestic prevalence are inconsistent and inaccurate due to differing definitions and beliefs among service providers and law enforcement about who is a victim of human trafficking (Farrell & Reichert, 2017). ...
... Researchers also indicated that many sex trafficked youth engage in criminal acts such as underage drinking, prostitution, or drug use (Corrigan & Shdaimah, 2015), making it less likely for them to disclose their current situation for fear of legal repercussions. Largely due to an emphasis on gendered pathways into crime and greater awareness of female involvement in CST, information regarding prevalence and circumstances affecting age of onset for boys, young men, or LGBTQ youth is distinctly missing from scholarly research despite worldwide growing evidence of their susceptibility to CST (Fedina et al., 2019;U.S. Department of State, 2019). ...
Article
Child sex trafficking (CST) has continued to exist in plain sight and often goes unidentified or misidentified in mental health settings. Often generalized as human trafficking, official statistics of children who fall victim of sex trafficking remains unknown and understudied. With social platforms becoming more available to youth, children are increasingly vulnerable to CST and are unaware of their exposure to victimization. Counselors working with children and adolescents are in a unique position to prevent and disrupt CST if detected in the counseling relationship, but the lack of CST assessment tools hinders an accurate assessment of CST. Therefore, the authors reviewed existing published screening or identification tools for CST available and applicable for mental health and school settings. At the completion of an expansive search of tools, the authors excluded results that did not meet the strict criteria. This paper reviews the four remaining instruments and presents information on their scope, reliability, validity, strengths, limitations, and source. The authors also discuss considerations for each instrument in clinical practice, providing a resource for counselors seeking a CST assessment tool that best fits their population and setting.
... Multiple studies of CSE/T youth indicate the rates of reported physical abuse, neglect, emotional abuse, and sexual abuse by caregivers are extraordinarily high. 12,13 Violence and trauma exposure is not limited to the family context, as research confirms that youth who have experienced CSE/T are commonly victims of dating violence, sexual assault perpetrated by someone outside of their family, and witnessing violence outside the home. 14,15 Further, CSE/T youth have numerous other contextual experiences that can increase an individual's vulnerability to mental health challenges, including but not limited to growing up in poverty, significant placement instability influenced by conflictual and stressful family environments, runaway behavior, child protective services involvement, and foster care. ...
... CSE/T is a significant public health problem, and youth impacted by this type of victimization are at a high risk for adverse mental health outcomes as compared to youth who report other forms of traumatic experiences. [5][6][7][8] Youth who have experienced CSE/T often have high rates of trauma exposure beyond their exploitation or trafficking victimization experiences, 12,13 and emerging research conducted with CSE/T youth in a specialty court program indicated that those who reported an abuse history prior to trafficking presented with greater mental health and substance abuse challenges than CSE/T youth with no such history. 21 Because trafficked youth report such high rates of trauma, it is important to further examine the influence of specific types of potentially traumatic experiences and polytrauma on youth mental health outcomes to better inform the customization of mental health treatment, which was the purpose of the current study. ...
Article
This study explores the types and extent of potentially traumatic events that youth who have experienced commercial sexual exploitation and trafficking (CSE/T) report, and how these experiences influence mental health. CSE/T youth (N = 110, 11–19 years old) referred to Trauma-Focused Cognitive Behavioral therapists affiliated with Project Intersect provided self-report data between August 2013 and March 2020 at the start (baseline), mid-point, and completion of therapeutic services. This study focuses on the baseline data collected. Bivariate relationships were analyzed, and where bivariate associations were statistically significant, associations were assessed in adjusted regression models. Two logistic regressions were performed: one for the adjusted associations between types of potentially traumatic events reported by CSE/T youth and the outcome PTSD, and a second for the outcome emotional distress. Results indicated that polytrauma was significantly associated with PTSD diagnosis among CSE/T youth. Direct violence victimization and polytrauma were significantly associated with CSE/T youth emotional distress. Results inform behavioral medicine practitioner considerations for how to appropriately assess the potentially traumatic experiences of CSE/T youth, and how these experiences may differentially impact the mental health presentations of youth in clinical treatment. Effective treatment may include precision-based customization of evidence-based practices to ensure that the diverse traumatic experiences and related symptomatology of CSE/T youth are effectively addressed.
... Despite the age of the data, minors may continue to be sufficiently unprotected from abuse and exploitation as in the mid-1990s, especially because many of the factors that are linked to or create trafficking vulnerability (e.g., racism, poverty, child abuse and maltreatment) remain social concerns. Findings from studies using Add Health data to investigate risk and protective factors for and the outcomes stemming from MSE are similar to results from DMST samples collected more recently, which seems encouraging and may indicate the continued relevance of the Add Health measures to the DMST field (Edwards et al., 2006;Fedina et al., 2019;Franchino-Olsen, 2019;Gerassi et al., 2021;Havlicek et al., 2016;Kaestle, 2012;Le et al., 2018;Ulloa et al., 2016). However, the age of the data should not be overlooked as a limitation. ...
... As the only available measure is male or female biological sex, we were not able to assess how these relationships vary for respondents who are transgender, gender non-conforming, or gender non-binary. This is particularly relevant when considering minor sex trafficking, as previous work has noted that minors who identify as a gender minority may experience a disproportionate burden of DMST (Choi, 2015;Fedina et al., 2019;IOM & NRC, 2013). The MSE events captured via the Add Health measure are lacking in detail about these events as it does not allow the distinction of the context of the MSE events (e.g., coerced versus needs-based exchanges). ...
Article
Full-text available
Little is known about how minor sex exchange (MSE) may impact violence victimization during adulthood. This study investigates potential associations between MSE and forms of interpersonal violence victimization in young adulthood, while controlling for additional forms of violence experienced in childhood and adolescence. Data from The National Longitudinal Study of Adolescent to Adult Health ( n = 11,500 ) were used in this analysis. Multivariable logistic regression estimated associations between adolescent victimizations and interpersonal violence in young adulthood, while controlling for demographic variables, adolescent risk behaviors, and child maltreatment. Although multivariable models found that MSE was not significantly associated with either form of interpersonal violence in young adulthood, adolescent IPV and community violence significantly increased the likelihood of IPV in young adulthood, and adolescent community violence significantly increased the likelihood of community violence in young adulthood. Adolescent risk behaviors, child maltreatment, and certain demographic characteristics were also associated with violence in young adulthood. Prevention, intervention, and screening efforts should consider how violence victimization across the life course—from childhood to young adulthood—impacts the experiences and needs of violence survivors.
... Although the clandestine nature of sex trafficking (i.e., involuntary prostitution) makes it difficult to estimate the total number of trafficking victims, the number of cases known to officials suggests that sex trafficking is not rare in the United States (Bishop-Royse et al., 2021;Fedina et al., 2019;Weitzer, 2011). For example, the National Human Trafficking Hotline, which provides trafficking data to most U.S. states (Farrell & Reichert, 2017), identified more than 34,000 likely cases of sex trafficking between 2015 and 2019, with data from 2019 indicating that a majority (79%) of trafficked individuals had entered into prostitution as minors (National Human Trafficking Hotline, 2020a, 2020b) More generally, people who engage in sex work often suffer from physical, mental, and behavioral health problems; social consequences (e.g., stigma, troubled romantic relationships); and criminal victimization (Bellhouse et al., 2015;Benoit et al., 2018;Bishop-Royse et al., 2021;Fedina et al., 2019;Miller & Schwartz, 1995). ...
... Although the clandestine nature of sex trafficking (i.e., involuntary prostitution) makes it difficult to estimate the total number of trafficking victims, the number of cases known to officials suggests that sex trafficking is not rare in the United States (Bishop-Royse et al., 2021;Fedina et al., 2019;Weitzer, 2011). For example, the National Human Trafficking Hotline, which provides trafficking data to most U.S. states (Farrell & Reichert, 2017), identified more than 34,000 likely cases of sex trafficking between 2015 and 2019, with data from 2019 indicating that a majority (79%) of trafficked individuals had entered into prostitution as minors (National Human Trafficking Hotline, 2020a, 2020b) More generally, people who engage in sex work often suffer from physical, mental, and behavioral health problems; social consequences (e.g., stigma, troubled romantic relationships); and criminal victimization (Bellhouse et al., 2015;Benoit et al., 2018;Bishop-Royse et al., 2021;Fedina et al., 2019;Miller & Schwartz, 1995). Thus, although prostitution can be freely entered into and involve an exchange between mutually consenting adults, an unknown proportion of sex workers are exploited or abused. ...
Article
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This study explores the moralization of purity and perceptions of harm as constraints on sex buying among men. Purchasing sex has long been considered an offense against public morality. While personal morality provides a powerful constraint on offending, and people may vary in the extent to which they experience moral intuitions about bodily and spiritual purity, research has so far neglected the role of purity moralization in understanding sex buying behavior. We hypothesize specifically that moral intuitions about purity constrain sex buying by leading people to perceive it as inherently wrong and by eliciting perceptions that sex buying is harmful to prostitutes. We test these hypotheses in a nationally representative survey of U.S. men (N = 2,525). Results indicate that purity moralization is associated with reduced sex buying, and that this relationship is mediated fully by perceptions of sex buying as harming prostitutes.
... Community violence was measured at Waves I and II, while IPV was assessed only at Wave II, making it difficult to determine if community violence was truly more prevalent than IPV for respondents across adolescence, as shown in our descriptive findings. Finally, Add Health at Wave I and Wave II does not offer any nuance around gender beyond binary biological sex, meaning gender identities that may experience a disproportionate risk of DMST-such as transgender, gender nonconforming, and gender nonbinary-could not be detected in this sample (Choi, 2015;Fedina et al., 2019;IOM & NRC, 2013). ...
Article
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This work investigates the associations between experiences of domestic minor sex trafficking and adolescent interpersonal violence victimizations, including intimate partner violence (IPV) and community violence. Abuse and violence in childhood are commonly proposed as risk factors for domestic minor sex trafficking. However, less is known about how interpersonal violence victimizations in adolescence connect to domestic minor sex trafficking experiences. The poly-victimization framework provides a means to understand domestic minor sex trafficking as a type of violence amid a web of additional interconnected violence victimizations. Efforts to better understand the interpersonal violence experienced by survivors of domestic minor sex trafficking are valuable in contextualizing trafficking experiences for adolescents. Data from The National Longitudinal Study of Adolescent to Adult Health, a population-based sample of adolescents in the United States ( n = 12,605) were used to examine experiences of domestic minor sex trafficking for minor respondents, as measured through questions about exchanging sex for money or drugs. A multivariable logistic regression model was used to estimate the associations between domestic minor sex trafficking and IPV or community violence, while controlling for demographic variables and adolescent risk behaviors. Minors who experience community violence had significantly greater odds of having exchanged sex (aOR: 1.86; 95% CI: 1.32 -2.64). However, IPV was not significantly associated with minors’ experiences of sex exchange (aOR: 1.14; 95% CI: 0.85 -1.54). Alcohol or drug use (aOR: 1.87; 95% CI: 1.32 -2.65) and having run away (aOR: 2.04; 95% CI: 1.53 -2.72) were also significantly associated with minor sex exchange. As experiences of domestic minor sex trafficking were significantly associated with community violence victimizations, prevention and intervention efforts targeting youth at high risk for or survivors of domestic minor sex trafficking should consider how community violence victimizations impact these adolescent populations, and programming/messaging should be adjusted to account for these additional violence victimizations.
... Children with prior trauma are more at risk for sex trafficking, as well [57]. More attention is now being directed to addressing human trafficking of children and adolescents and recognizing this as a critical health threat [58]. ...
Chapter
Gender-based violence and other forms of trauma affect individuals throughout the lifespan, with effects accumulating to impact biopsychosocial functioning across all domains of the socioecological model. We need effective proximal and distal trauma-informed/trauma-responsive interventions for all age groups to prevent and interrupt negative sequelae. There are many opportunities to intervene; it is better to intervene as proximally to the trauma/GBV as possible, and the younger the better in the life cycle. Distal intervention is possible but hampered by the development of mental health sequelae, maladaptive coping, concurrent/subsequent adversities/traumas and other challenging life circumstances.
... Because low education (i.e., high school dropout rates) negatively affects opportunities for growth and capital (e.g., physical, social) gains [12], it is also likely associated with higher rates of victimization through trafficking [17,39]. Fedina and colleagues [15] found that nearly half their sample of trafficked individuals had dropped out of school. It follows that countries with higher levels of educational achievement would be generally less prone to trafficking, as their citizens would be less vulnerable to exploitation, have more prosocial opportunities, and be more likely to understand the consequences of illegal behavior. ...
Article
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Given the worldwide magnitude, pervasiveness and deleterious consequences of human trafficking (Roth, 45), a more comprehensive understanding of its underlying causes is imperative. This study attempted to examine the influence of three social factors (i.e., economics, social capital, and criminal justice) on human trafficking in 60 countries. Although regression and Bayesian analyses showed that macro level economic, social, and criminal justice factors were not predictive of human trafficking, our findings highlighted the variability and potential inaccuracy in reporting of information in many countries. Many factors contribute to unreliable human trafficking data including: (1) inconsistencies in the application of trafficking legislation, (2) problems with victim identification and reporting, (3) varying definitions and counts of trafficking, (4) the creation of cultural binaries in the media, and (5) problematic human-trafficking policies. To accurately identify factors contributing or maintaining human trafficking, it is critical for governmental and non-governmental agencies to collect a range of standardized information.
... Advocacy is an essential component of the CAC model, and survivors seen at CACs are provided with medical exams, mental health referrals, substance abuse counseling, and housing assistance. Forensic interviewers have experience interviewing minors with histories of trauma/ neglect and running away from home, common characteristics among sex trafficking survivors (Choi, 2015;Countryman-Roswurm & Bolin, 2014;Fedina et al., 2019;Jordan et al., 2013). However, based on prior research and findings from the current study, CACs may have difficulty identifying certain types of trafficking victims (Brandt et al., 2018). ...
Article
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Although human trafficking of minors is an increasing concern within the United States, very little information is known about how trafficking cases are processed within child advocacy centers (CACs). The current study addresses this gap in the literature by providing descriptive information about victims, service referrals, and prosecutorial outcomes for human trafficking cases presenting at CACs across a Midwestern state. The data originates from a state-wide study focused on understanding the scope of human trafficking cases. Specifically, the dataset includes 210 youth presenting at CACs over a three-year period of time. In this sample, the typical human trafficking case involved sex trafficking of a self-identified white female victim, with an offender known to the victim. Most child survivors passing through CACs were referred to medical and mental health services, although these service referrals did not greatly differ across at-risk versus substantiated trafficking cases. Overall, the findings suggest that CACs are uniquely positioned to encounter human trafficking cases and provide needed services to trafficking survivors. Finally, recommendations are provided for CACs regarding the intake and identification of trafficking cases more broadly.
... In the preliminary sample, 42% of programs endorsed either currently serving transgender youth (usually female identifying youth) or a willingness to accept transgender referrals. Likewise, both cisgender males and male-identifying youth have been systematically excluded from programs and housing opportunities despite research that indicates the prevalence of male victims (7). 31% Once youth have entered a formal system such as child welfare or juvenile justice, they are much more likely to have continued and increased rates of institutional interventions (8). ...
Technical Report
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This study outlines the policies, practices, and programming that have been implemented across the US to provide specialized responses to exploited and trafficked youth within residential placement settings. Although there is not currently sufficient data in the field to support a comprehensive assessment of the effectiveness of different placement models, this study describes the features of a specialized response and offers suggestions to improve programming and practice. Our specific aims included: Data for this study included a review of existing state law and policy related to the provision of specialized services for child trafficking victims, a survey of 128 providers offering specialized responses to child trafficking within a residential setting and in-depth interviews with 23 program directors or clinical staff to better understand the nature, strengths and challenges of various specialized responses to child trafficking within residential settings. Five key components of a specialized child trafficking response are outlined. These include: Contextualizing the legal landscape of each state through a review of mandatory provisions to protect child victims of human trafficking. Describing the national landscape of existing residential programs across the United States that offer specialized services for child victims of human trafficking. Data for this study included a review of existing state law and policy related to the provision of specialized services for child trafficking victims, a survey of 128 providers offering specialized responses to child trafficking within a residential setting and in-depth interviews with 23 program directors or clinical staff to better understand the nature, strengths and challenges of various specialized responses to child trafficking within residential settings. Five key components of a specialized child trafficking response are outlined. These include: 1) Staffing; 2) Participation in a Multi-Disciplinary Team response; 3) Physical Space; 4) Practices and Programming; 5) Safety
... Vulnerable women and youth, such as racial-ethnic or sexual minority youth and those with histories of trauma, maltreatment, or running away, have an increased risk of experiencing CSE. [1][2][3][4][5] These predisposing factors may also lead to involvement in systems of care (i.e., juvenile justice and child welfare systems), resulting in a compounded risk for CSE. Additionally, these youth are often diverted into the justice and/ or child welfare systems as a result of their exploitation, such as receiving criminal and status offenses that lead to judicial involvement and/or child welfare referrals because of the CSE. ...
Article
Objective: We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement. Methods: We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories. Results: Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources. Conclusions: Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.
... Much of what puts youth at risk for being trafficked is abuse and neglect, often at the hands of family members who they rely on for their basic needs (Cole et al., 2016;Fedina et al., 2019;. As a result, youth run away from home, skip or have difficulties in school. ...
Article
Trafficked youth have numerous needs that must be addressed to give them opportunities to rebuild their lives. Few organizations offer comprehensive services to meet all these needs, which forces survivors to seek out services from multiple organizations and puts them at risk for not receiving important services. This study highlights the needs of organizations in an interagency task force that serve trafficked youth to identify barriers and generate potential solutions to service provision challenges. We conducted a mixed-methods needs assessment by conducting interviews with 15 service providers belonging to a regional human trafficking task force, which revealed a need for more services for trafficked youth, particularly in criminal justice and gender-based violence organizations. Implications of these findings include a need for centralized referral processes and more prevention services, such as a youth drop-in center and educational interventions.
... Risk domains could be used entirely differently, one that turns the risk gaze away from individuals towards the carceral state and to its reactions to unwanted behavior. Namely, risk factors would inform state-or local-level policies on delinquency and crime, as well as racialized justice system reactions to them (for an analogous point but in the context of protecting children from human trafficking, see Fedina et al.) [75]. In this way, risk domains would only inform decisions on how to reform the justice system itself while assisting agencies in developing prevention and intervention responses to social and economic correlations to delinquency and crime and the material deprivations necessary for rehabilitative programming to stick [76]. ...
Article
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Risk assessments in carceral settings have proliferated in recent decades and are now prominent in numerous states and regions. A ubiquitous variety is actuarial risk assessment instruments that are used on children and adults to predict their future chance for misconduct (e.g., recidivism) in several vital decision points in carceral processing (e.g., pretrial confinement). These instruments rely on information about past behavior (e.g., criminal history) and an understanding of offending (e.g., antisocial personality) that is thought to be neutral, reliable, and enjoys predictive validity. However, it will be argued that when justice system personnel assess the chance of unwanted behavior in the future, several risk domains are differentially prevalent and more frequently experienced by some groups. Much of this disparity is caused by, or due to, forces external to those being assessed, for instance, inequitable social and economic conditions and inequitable decisions by justice personnel to arrest, charge, or sentence people of color. As such, risk assessment instruments inevitably and disproportionately mark some groups of people as a higher risk to violate rules, conditions, orders, or laws. Consequently, risk assessment instruments systematically disfavor disadvantage, and by inference, favor advantage, leading to the need for a radical shift in the taxonomy of classifying risk for future misconduct.
... Traffickers are cunning and seek out vulnerable individuals such as children in foster care, runaways, or children in dysfunctional living situations (National Human Trafficking Hotline, 2019). Additional risk factors targeted by traffickers include a history of abuse (sexual or physical), past trauma (violence, sexual assault, and discrimination), substance abuse, mental health issues, disabilities, or poverty (Fedina et al., 2019;Polaris, 2019). Individuals looking for affection and validation with inappropriate sexual boundaries or low self-esteem are also at high risk (Macias-Konstantopoulos, 2016). ...
Article
Violence and human trafficking are frequently paired and violate human rights. Human trafficking is a complex, global health issue. Trafficking survivors report seeking medical care for women's services, physical abuse, mental health, and gastrointestinal issues while being held in captivity. However, the majority of healthcare providers are unaware or unprepared to intervene, thus missing the chance to identify victims during these encounters. Rehabilitation nurses are no exception. Trafficking victims may come in contact with rehabilitation nurses because of injuries or chronic diseases caused by trafficking abuse. This article shares human trafficking red flags, victims' access to services, barriers to identification, and nursing interventions and implications.
... 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.
... Increased likelihood of sex trafficking among minors with disabilities can be situated within the broader body of research literature examining the relationship between disability, child abuse, and neglect. The extant research shows child abuse and neglect are risk factors for minor sex trafficking (Cole, 2016;Fedina et al., 2016;Gibbs et al., 2019). Notably, children with disabilities experience child abuse and neglect at higher rates than the general population (Hershkowitz et al., 2007;U.S. ...
Article
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The current academic discourse examining human trafficking is lacking in focus on survivors with a disability. The increased likelihood of abuse experienced by people with a disability is well documented in the research literature, and a small body of research indicates heightened sex trafficking victimization of minor girls with a disability. Yet, very little research specifically examines sex and/or labor trafficking of people with a disability, and no systematic research analyzes prosecuted cases of trafficking with disability as the focal point of analysis. Drawing from a content analysis of 18 federal and 17 state cases of human trafficking, the current study specifically aimed to increase our understandings of sex and labor trafficking involving survivors with a disability. The findings revealed the following patterns and themes: 1) the type of trafficking experienced (sex, labor, or both), 2) whether state level or federal cases 3) the types of disabilities identified among trafficking survivors, 4) the nature of the relationship between traffickers and survivors, 5) methods of recruitment, 6) case outcomes; and 7) demographic characteristics of traffickers and survivors (e.g., gender/citizenship). Implications include prevention efforts in the form of developmentally grounded sex education and healthy relationships curriculum for survivors with an intellectual disability, as well as specialized anti-trafficking training for those in legal, healthcare, and social services that is inclusive of people with a disability.
... Franchino-Olsen (2021), Hampton and Lieggi (2020), and Reid (2012) also mention growing up in neighborhoods where sex work and crime are normalized (including involvement of friends or family in trafficking or sex work) as a risk factor. Other frequently cited vulnerabilities are: substance (ab)use (Busch-Armendariz et al., 2009;Franchino-Olsen, 2021;Hampton and Lieggi, 2020;Moore et al., 2020), mental health problems (Franchino-Olsen, 2021), intellectual disabilities (Reid, 2018) or being lesbian, gay, transgender or bisexual (Fedina et al., 2019). Reid (2012) concludes in her systematic review that there are more commonalities than dissimilarities between the vulnerabilities of victims of (near-)domestic and cross-border sex trafficking. ...
Article
Hardly any research exists that empirically compares (near-)domestic and cross-border sex trafficking. The few studies that do, are based on relatively small samples, and only represent US data. This study substantially extends the scarce scientific knowledge about the differences between the two types of sex trafficking, based on European data. Our sample consists of all 658 (near-)domestic sex traffickers, and all 424 cross-border sex traffickers, registered by the prosecution service in 2008–2017, who are brought to court in the Netherlands. We collected data on these traffickers from registers of the prosecution service, from a file analyses on the indictments/verdicts, and from registers of Statistics Netherlands. These data provide insight into the characteristics of the traffickers, their victims and modus operandi. Our findings show that significant differences between the two types of sex trafficking exist, which is of great importance for better tailored prevention and identification strategies. The most prominent finding is that the threshold to get involved into (near-)domestic sex trafficking is lower than for cross-border sex trafficking. (Near-)domestic sex traffickers are, compared to cross-border sex traffickers, younger (as are their victims), they seldom need to migrate, they operate on a smaller scale (more one-to-one and for a shorter period of time) and practically never in a criminal organization. Furthermore, they use violent means of coercion to control their victims more frequently than cross-border sex traffickers, which can be interpreted as additional evidence for a less organized practice. These findings contribute to a more complete understanding of sex trafficking, in particular of the traffickers who were seldom the direct subject of research.
Article
Introduction Our understanding of youths’ sex trading predominantly stems from non-representative studies with high-risk populations (e.g. homeless/runaway youth). The purpose of this study is to identify the prevalence and associated characteristics of youth who report sex trading (compared to those who do not) in a representative sample of high school students. Methods Data comes from the 2018 Youth Assessment, a cross-sectional survey administered to 9th through 12th graders across 24 high schools in Dane County, a predominantly urban area in Wisconsin, U.S.A. All youth who answered the question, “have you ever had sexual contact in order to stay safe or to get something like a place to stay, money, gifts, alcohol or drugs?” were included for secondary data analysis (n = 13,714). Participants were 70% White, 50% female/47% male, and 90% minors. Chi-square tests and logistic regression analyses were conducted. Results 2.47% of youth reported sex trading, of whom 91% were minors. Bivariate analysis revealed significant differences across demographics, economic instability, behavioral health and substance use, delinquency, and romantic/sexual behaviors. Multivariate results suggested that students who reported substance use, cutting class, 3 or more out-of-school suspensions, knowing a friend involved in a gang, dating violence, foster care involvement, or identifying as LGBTQ+ were more likely to report sex trading. Conclusions Although the causal order of characteristics analyzed in relation to the sex trading is not known, these findings have important implications for sex trading prevention, assessments, and intervention, particularly among youth with marginalized identities and adverse experiences.
Article
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Sex trafficking involving children is a human rights issue of growing concern, with immediate and lasting impacts on victims. Although victimization is consistently associated with prior maltreatment and foster care placements, reliable estimates of minor sex trafficking prevalence do not exist. In a statewide child welfare database of all children with maltreatment allegations between 2011 and 2016, 3,420 children were investigated for sex trafficking allegations (1.15% of 296,167 children with investigated maltreatment). We used two independent methods to estimate prevalence. A capture-recapture model estimated 3.3% of this population experienced sex trafficking victimization, and due to positive contagion this model is expected to underestimate prevalence. Mixture models predicted sex trafficking victimization for 17.16% of the children, and due to limitations of the data this model is expected to over-estimate prevalence. Findings suggest the prevalence rate of sex trafficking is between 2.9 and 14.9 times the observed rate, even within the state child welfare system that investigates more trafficking allegations than any other. Increasingly sophisticated modeling methods require concurrent efforts to improve identification of sex trafficking within the systems where victims are most likely to be encountered.
Article
The sexual exploitation of LGBTQ+ young adults and how to best serve this population is an emerging field of knowledge. In July 2015, a cross-sectional purposeful sampling design was used to recruit 215 homeless young adults (ages 18–25) from greater Phoenix and Tucson, Arizona, to complete the paper and pencil Youth Experiences Survey. Over a third of the sample reported having been sex trafficked, and of those, over half were LGBTQ+. Further, amongst the sample, the odds of being LGBTQ+ and sex trafficked were two times higher compared to being heterosexual. Sex trafficked LGBTQ+ homeless young adults were found to be significantly more likely to report exchanging sex for money and were also found to have reported higher rates of challenging life experiences, including suicide attempts, drug use, risk-taking, and being raped between ages 13–17 compared to sex trafficked heterosexual homeless young adults. The implications of these findings are discussed, and future research on sex trafficked LGBTQ+ home- less individuals is recommended.
Article
Juvenile and family court judges are a professional group that have a significant amount of decision‐making power in cases of sex trafficking of minors. The purpose of this project is to examine the association of juvenile and family court judges’ gender, race, and U.S. region with their attitudes and knowledge about sex trafficking of minors. Drawing from a survey of 55 juvenile and family court judges in the U.S., this study used standardized scales to measure attitudes and knowledge about child sex trafficking. Results indicate some differences by gender and geography in a sample of experienced judges across the U.S. The consistency of these findings are discussed in the context of other research and implications for targeted training.
Chapter
This chapter presents Prevention Now's design and use of predictive analytics as a method to identify risk factors for human trafficking and to intervene the upstream of exploitation. The method relies on a social-ecological framework for organizing risk factors and to guide analytical prevention efforts. Prevention Now is a non-profit anti-trafficking organization that is prioritizing a data-driven and multidisciplinary approach to trafficking prevention. This approach has three central aims: to develop trans-disciplinary partnerships, to build geographically-specific analytical models, and to translate model findings into targeted prevention. This chapter presents efforts undertaken by Prevention Now towards building collaborative partnerships across systems in a given geography, county, state, to inform data collection and prevention efforts. The chapter centers around Prevention Now's predictive analytics project involving four US states and its ability to leverage data collection and analysis in efforts to better understand the drivers of trafficking.
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
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.
Article
The purpose of the current article is to educate psychiatric providers on domestic minor sex trafficking (DMST). Psychiatric providers (e.g., psychiatric-mental health nurse practitioners, psychiatrists, physician assistants, therapists, case managers) interact with victims of sex trafficking but may fail to recognize the signs of victimization and the risk factors associated with becoming a victim of DMST. This educational article offers an overview of the definitions of sex trafficking, and the risk factors, prevalence, and health consequences of DMST. It also summarizes what is known about how those at-risk for DMST and DMST victims interact with the mental health care system. Mental health professionals provide a crucial point of contact with these populations and must strive to prevent, identify, and respond to DMST and at-risk youths. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 21-28.].
Article
Background Given the formidable health burdens associated with children’s exposure to community-based violence (CBV) and trafficking and exploitation (TE), continued investments in determining their epidemiology constitute an important focus for Canada. Objective The objective of the present study is to provide a narrative summary and policy perspective concerning the quantitative studies reporting on the risk and protective factors and prevalence of children’s (<18 years) exposure to CBV and TE in Canada. Methods To identify literature, we searched eight electronic databases. English and French citations from database inception to December 2018 were included; this was supplemented with citation chaining for peer-reviewed publications and grey literature up to December 2019. Evidence is synthesized via a narrative summary. Results There are few studies that have investigated children’s exposure to TE and CBV in Canada. Self-reported exposure to these forms of violence varies according to the type investigated, with estimates ranging from 2 % - to - 23 % and 5 % - to - 53 % for TE and CBV, respectively. Literature focused on risk and protective factors for these forms of victimization are also limited. Conclusions Canada has the infrastructure in place to make significant gains in their data collection and monitoring of children’s exposure to TE and CBV via five national-level studies. To help realize the goal of ending all forms of violence against children by 2030, incorporation of reliable measures of these forms of exposure in new and ongoing national-level data collection systems is urgently needed.
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
We integrated core community based participatory research (CBPR) principles in an intervention research study that aimed to address the sexual health needs of system-involved youth with histories of commercial sexual exploitation (CSE). Researchers, multidisciplinary stakeholders, and individuals with lived experience built upon each other’s strengths and resources to adapt an evidenced-based reproductive health curriculum and develop an innovative sexual health intervention. This article presents key findings and recommendations that researchers can implement prior to, during, and after engaging individuals with lived experience and multidisciplinary stakeholders to support a prosperous bi-directional relationship. It is imperative that all collaborators recognize the value of lived experience and create a culture that encourages contributions beyond one’s history of exploitation. Conducting an assessment to ensure individuals with lived experience feel mentally and emotionally prepared to participate may help reduce the potential for re-traumatization. Given the dearth of available health-related interventions for this population and strategies to guide collaboration, our findings may inform future efforts aimed at reducing health disparities, promoting equity, and improving sexual health outcomes amongst this population.
Article
Aim: The aim was to improve the knowledge and skill about human trafficking in nursing, and to identify the key components to support nurses to learn the skills of screening, identifying, and referral. Background: Worldwide human trafficking is a hidden epidemic crossing all countries exploiting over 4.3 million people. Nurses have received inconsistent or nonexistent human trafficking education. Nurses need training to have the self-efficacy, knowledge, and skill to refer persons entrapped in human trafficking. Evaluation: This novel online educational program titled See, Pull, Cut the Threads of Human Trafficking Violence© was piloted with a small group of emergency nurses to study the variables of self-efficacy, knowledge, and skills as they related to performance of screening, identifying, and referral of human trafficked persons. Conclusion: Emergency nurses gained human trafficking knowledge after education that examined the nurses', self-efficacy, knowledge, and skills to perform screening, identification, and referral. Implications for nursing management: Transformational leadership style is an important model to introduce new nursing practices that educate and train staff about human trafficking. Nursing administrators and directors are in an ideal position to promote and secure human trafficking training for nurses.
Article
Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.
Article
Introduction Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool. Method A retrospective chart review was conducted on random patients, aged 11–17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations. Results Two or more indicators from the CSEC/CST screening tool were identified in 43% (n = 121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators. Discussion Targeted screening and interventions are needed to identify and help these vulnerable youth.
Article
Largely characterized as an urban issue, empirical studies of minor sex trafficking in rural communities—including India, a global hotspot for child sex trafficking—are exceptionally uncommon. Yet, the commercial sexual exploitation of children thrives in many rural Indian villages, fueled by caste discrimination, family tradition, and poverty. In response, this study aimed to investigate minor sex trafficking among a particular culturally unique and geographically isolated population, in relation to the dominant human trafficking literature. In-depth interviews were conducted with 31 female members of the Bedia caste—a unique population whose primary form of income is derived from participation in the rural sex trade. Framed by the social theory of intersectionality, we sought to (1) identify vulnerabilities for commercial sex industry entry among Bedia youth and (2) examine the cultural context of the commercial sex industry among the Bedia, with particular attention to the dominant victim/perpetrator paradigms. Implications for continued research, practice, and policy are included.
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The current study administered a self-report survey with behaviorally specific questions to a stratified sample of non-college educated women, aged 18 to 29, in the general population (N = 996). Notably, the women were classified as being trafficked as adults only (3.8%), minors only (9.6%), or as both adults and minors (9.3%) using the federal legal definition. More than 1 in 5 (22.7%) women in the sample met the criteria for sex trafficking victimization at some point in their lives. However, only 39.6% of the respondents who experienced trafficking as an adult reported these events to police—further contributing to the “hidden figure” of crime. Guided by victimological theories, vulnerabilities, individual characteristics, and lifestyle factors increased the odds of being trafficked but varied depending on the type of exploitation. The implications of these findings are reviewed, including the utility of studying trafficking using behaviorally worded self-report surveys.
Article
Child sex trafficking (CST) has become a global public health crisis and is a $150 billion criminal enterprise. Nurse practitioners are key in the recognition and prevention of CST in health care settings. Evidence demonstrates that up to 80% of CST victims have had a recent health care encounter. It is the role of the NP in practice to understand risk factors, screen for CST, and educate parents and caregivers on signs of victimization and prevention.
Article
Background: Girls who are victims of commercial sexual exploitation (CSEC) have high rates of substance use and childhood sexual abuse. We compared girls who are victims of CSEC and matched controls on childhood sexual abuse and substance use, and examined if substance use is associated with increased CSEC odds. Methods: Data were retrospectively collected from assessments completed by 80 girls who were referred by the Department of Child Services (Mage=15.38, SD=1.3, 51.9%White). Results: CSEC girls reported higher substance use (t=-2.76, p=.007), and were more likely report childhood sexual abuse (χ2=6.85, p=.009). The relationship between childhood sexual abuse and substance use outcomes did not differ across the groups (b’s 0.12-1.38, p’s .22-.85). Substance use disorder diagnosis was associated with greater odds of being in the CSEC group (ORs 2.95-6.72, p’s<.05). Conclusions: Substance use and childhood sexual abuse are important risk indicators for exploitation, but should not be used to reduce criminality of CSEC perpetrators.
Article
Sex trafficking in the United States has emerged as a critical social issue that negatively impacts the health and mental health of victims. The existence of sex trafficking in Hawaiʻi has been questioned due to a lack of empirical evidence and lack of successful prosecutions of sex traffickers. The purpose of this study is to determine the rate of sex trafficking and the sex trafficking experiences among clients of a large social service agency serving five islands in Hawaiʻi. The 363 participants completed a paper and pencil survey over a three month period in 2019. The survey included questions about the participants’ experiences including sex trafficking and the Adverse Childhood Experiences Survey (ACES). Sex trafficking victimization experiences were reported by 97 (26.7%) of the participants. Of the sex trafficking victims, 23 (23.7%) reported that they were under age 18 when they were first sex trafficked. The sex trafficking victims identified as 83% female, 23% male, 1% transgender, and 1% non-conforming. Sixty-four percent of the sex trafficking victims identified as being all or some Native Hawaiian. Implications and policy recommendations from these findings were identified and discussed.
Article
Of the 30+ forms of human trafficking that exist worldwide, family-facilitated trafficking of minors receives little attention in the United States. This original research study sought to identify the prevalence, characteristics, and challenges associated with familial trafficking cases as experienced by justice professionals in the areas of case identification, investigation, prosecution, and victim services. The study included a survey and in-depth interviews leading to recommendations for increased training, improved data collection and reporting, heeding minors’ testimony, and expanding our victim service options.
Chapter
The strategies utilized by traffickers to exploit vulnerable humans continues to be one of history's cruelest treatment of others. At the heart of the manipulation is the misuse of the relational need for connection. The inherent need to attach to others is well researched throughout the field of psychology and serves as the basis for prevention of exploitation. This chapter focuses on a community-based intervention accessing the present strengths of minority communities with church partnerships through a psychological framework. The primary ways churches can detect and prevent human trafficking are through mental health education, integration, and intentional-movement-toward. These strategies engage at a community and relational level of engagement to create a resilient environment.
Chapter
The aim of this chapter is to provide a brief overview of human trafficking from a mental health standpoint. The goal is to inform education about and clinical services for individuals experiencing human trafficking or those recovering from human trafficking exploitation. The chapter (1) defines human trafficking, (2) reviews risk factors for human trafficking, (3) discusses the epidemiology of human trafficking, (4) examines the psychological and physical health conditions commonly reported by trafficked persons, (5) explores considerations for screening and assessment, (6) reviews mental health treatment considerations, and (7) delineates future directions to improve the health and well-being of individuals who have experienced trafficking.
Chapter
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.
Article
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A population is “hidden” when no sampling frame exists and public acknowledgment of membership in the population is potentially threatening. Accessing such populations is difficult because standard probability sampling methods produce low response rates and responses that lack candor. Existing procedures for sampling these populations, including snowball and other chain-referral samples, the key-informant approach, and targeted sampling, introduce well-documented biases into their samples. This paper introduces a new variant of chain-referral sampling, respondent-driven sampling, that employs a dual system of structured incentives to overcome some of the deficiencies of such samples. A theoretic analysis, drawing on both Markov-chain theory and the theory of biased networks, shows that this procedure can reduce the biases generally associated with chain-referral methods. The analysis includes a proof showing that even though sampling begins with an arbitrarily chosen set of initial subjects, as do most chain-referral samples, the composition of the ultimate sample is wholly independent of those initial subjects. The analysis also includes a theoretic specification of the conditions under which the procedure yields unbiased samples. Empirical results, based on surveys of 277 active drug injectors in Connecticut, support these conclusions. Finally, the conclusion discusses how respondent- driven sampling can improve both network sampling and ethnographic 44 investigation.
Article
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Street-level prostitution is comprised of both pimp-controlled prostitution and independent entrepreneurial prostitution. Although much of the more recent research has focused on the latter group, this work reports on a qualitative study designed to understand pimp-related violence to women involved in pimp-controlled prostitution. In addition, this work contributes to the understandingof the relationships between pimps and pros titutes, the roles that each play, and the social rules of the business. Because these women constitute a significant number of those involved in street-level prostitution, more research is called for that focuses on pimp-controlled prostitution.
Article
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The experiences of prostitutes have been missing from studies of violence and rape, as has the problem of violence from studies of prostitution. Interviews here with 16 street prostitutes, most of whom are crack users, reveal an enormous amount of rape and violence against these women. Further, it is found that rape myths generally discussed in the literature uniquely come together around prostitutes to fuel both the violence and the devaluation that allows us to ignore such violence. Themes emerging from the interviews include: that people often see prostitutes as unrapeable; that no harm is done; that prostitutes deserve to be raped; and that all prostitutes are the same. This paper sees violence against prostitutes as an extreme case that sheds light on violence against women generally.
Article
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The present study examines the violence and change in violence experienced by domestically sex trafficked women from their pimps since their recruitment. A total of 100 women who currently had a pimp were interviewed, and 71 indicated that they had been recruited into prostitution, many under conditions meeting the federal definition of trafficking. Violence and coercive control were measured at 2 different points for each woman and compared separately and together. On average, violence had increased since recruitment, and those women who experienced more forms of coercive control generally experienced higher levels of violence from their pimps. The majority of women experienced violence and coercion, thereby meeting federal sex trafficking definitions.
Article
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To assess the sequence, timing, and prevalence of sexual and illegal drug use milestones in prostitute women, we interviewed 237 prostitutes in the community and 407 comparison women at an STD clinic. Drug use was more commonly reported by prostitutes than comparisons (86% vs. 23%), as was non‐consensual prepubertal sex (32% vs. 13%). Sexual‐ and drug‐related milestones occurred in the same order in both groups, with drug use preceding sexual activity and injecting drug use preceding prostitution. Ninety‐four percent of prostitutes who injected drugs reported noninjectable drug use before prostitution, and 75% of prostitutes who injected drugs reported doing so before beginning prostitution. The age distributions at critical events were similar for prostitutes and comparison women who reported regular drug use. Comparison women who did not report regular drug use were in general older than both these groups at the time of early sexual experience and drug experimentation. However, the ordering of these events was the same. Within the prostitute cohort, ethnic groups differed in their age distributions at several critical events, but not in the order in which these events occurred. Information reported by prostitutes on sex‐ and drug‐related milestones was reproducible on reinterview a year later. Further research is needed to develop a coherent understanding of the relationship of underlying psychological and environmental factors to the observed progression from substance abuse to prostitution.
Article
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This study examines the trauma symptoms and life experiences of 49 women in a residential prostitution-exiting program and identifies differences among women who complete 90 days of the program and women who drop out of the program prior to completing 90 days. The majority of the women reported childhood abuse, adult abusive relationships, and victimization. Women who completed 90 days of treatment were found to be older than the non-completers. Non-completers were more likely to report clinically significant trauma symptoms including dissociation, poor coping behaviors, sex-related issues, and dysfunctional sexual behavior than completers. These findings suggest the importance of incorporating trauma-focused intervention early in the services provided in the exiting programs as well as the need to address the traumatic symptoms related to childhood and adult trauma histories. Findings also indicate the importance of clinically addressing trauma-related sexual issues, concerns, and behavior.
Article
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Researchers studying hidden populations–including injection drug users, men who have sex with men, and the homeless–find that standard probability sampling methods are either inapplicable or prohibitively costly because their subjects lack a sampling frame, have privacy concerns, and constitute a small part of the general population. Therefore, researchers generally employ non-probability methods, including location sampling methods such as targeted sampling, and chain-referral methods such as snowball and respondent-driven sampling. Though nonprobability methods succeed in accessing the hidden populations, they have been insufficient for statistical inference. This paper extends the respondent-driven sampling method to show that when biases associated with chain-referral methods are analyzed in sufficient detail, a statistical theory of the sampling process can be constructed, based on which the sampling process can be redesigned to permit the derivation of indicators that are not biased and have known levels of precision. The results are based on a study of 190 injection drug users in a small Connecticut city.
Article
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Trafficking of domestically born children in the United States into the sex trade has been recognized by the U.S. government under the Trafficking Victims Protection Act of 2005. The Midwest has been exposed as a recruitment site for traffickers. Children who have been trafficked into prostitution often experience mental health problems, suffer physical and sexual assaults, have low self-esteem, and are put at risk for HIV/AIDS and other health problems. This article is based on qualitative interviews with 13 trafficked children from the Midwest. Findings reveal the experiences of victims and the network of players involved in trafficking in the Midwest.
Article
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This study is a secondary data analysis aimed to examine the influence of recent homelessness on recent sex trade among pregnant women in drug treatment after controlling for psychiatric comorbidity, age, education, and race. Eighty-one pregnant women from a drug treatment program in Baltimore, Maryland attended an in-person interview and completed the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-IV for Axis I disorders, the HIV Risk Behavior Interview, and demographic questionnaires, which assessed psychiatric symptoms, recent homelessness, and sexual risk behavior respectively. Women who experienced recent homelessness had a 4.74 greater odds of having recently traded sex than women who had not been recently homeless, suggesting that homelessness uniquely influences sex trade beyond psychiatric status, which was also a significant correlate of recent sex trade. Addressing both homelessness and psychiatric problems may effectively reduce sex trade and risk for infectious diseases, which could adversely impact maternal and child health outcomes.
Article
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To evaluate the association between history of childhood sexual abuse (CSA) and having transactional sex among adolescents who have been in foster care. We used an existing dataset of youth transitioning out of foster care. Independent CSA variables included self report of history of sexual molestation and rape when participants were, on average, 17 years of age. Our outcome variables were self-report of having transactional sex ever and in the past year, when participants were an average age of 19 years. Separate multiple logistic regression analyses were conducted to assess the associations between CSA variables and transactional sex variables. Initial analyses were performed on both genders; exploratory analyses were then performed evaluating each gender separately. Total N=732; 574 were included in the main analyses. History of sexual molestation was significantly associated with increased odds of having transactional sex, both ever and in the past year (OR [95% CI]: 3.21 [1.26-8.18] and 4.07 [1.33, 12.52], respectively). History of rape was also significantly associated with increased odds of having had transactional sex ever and in the past year (ORs [95% CI]: 3.62 [1.38-9.52] and 3.78 [1.19, 12.01], respectively). Odds ratios in female-only analyses remained significant and were larger in magnitude compared with the main, non-stratified analyses; odds ratios in male-only analyses were non-significant and smaller in magnitude when compared with the main analyses. Both CSA variables were associated with increased likelihood of transactional sex. This association appears to vary by gender. Our results suggest that policymakers for youth in foster care should consider the unique needs of young women with histories of CSA when developing programs to support healthy relationships. Health care providers should also consider adapting screening and counseling practices to reflect the increased risk of transactional sex for female youth in foster care with a history of CSA.
Article
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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.
Article
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To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among nonprostitutes, drug abuse did not explain entry into prostitution. Running away and childhood sexual victimization provide distinct pathways into prostitution. The findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced.
Article
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Risk factors associated with the likelihood of being sexually victimized by a stranger or friend/acquaintance since being on the street was examined among 372 homeless and runaway youth. Young people were interviewed on the streets and in shelters by outreach workers using a systematic sampling strategy. Youth who engaged in more high-risk behaviors were expected to be at greater risk for sexual victimization by both known and unknown assailants. Results indicated that for females, running from home for the first time at an earlier age was associated with sexual victimization by both a stranger and friend/acquaintance. However, engaging in deviant subsistence strategies, survival sex, and grooming predicted being sexually victimized by a friend/acquaintance. For males, survival sex and grooming predicted stranger sexual victimization, whereas sexual orientation was associated with sexual victimization by a friend/acquaintance. Overall, 35% of the sample had been sexually victimized.
Article
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To compare HIV risk factors of male street youth involved in survival sex with those of their never involved peers and to describe the sexual activities of the involved youths. From 2001 to 2003, street youth aged 14-23 years were recruited from street youth agencies in Montreal, Canada. Information was collected on sociodemographic characteristics, substance use, and sexual behaviours. Involvement in survival sex was defined as having ever exchanged sex for money, gifts, drugs, shelter, or other needs. Logistic regression was used to identify HIV risk factors associated with involvement in survival sex. Among the 542 male participants recruited, 27.7% reported involvement in survival sex. HIV risk factors independently associated with such involvement were injection drug using partners (modulated by length of homelessness), unprotected oral sex with male partners, steroid injection, history of sexual abuse, and drug injection. Among involved youths, 32.0% had only female clients, 41.3% only male clients, and 26.7% had clients of both sexes. Unprotected sexual activities were common with clients. However, even more risks were taken with non-commercial sexual partners. Male street youth involved in survival sex are at higher risk for HIV than their non-involved peers not only because of their unprotected commercial sexual activities. They have multiple other HIV risks related to non-commercial sexual activities, drug injection, and sexual abuse. All these risks need to be addressed when providing sexual health interventions for this population.
Article
The trafficking of individuals within U.S borders is commonly referred to as domestic human trafficking, and it occurs in every state of the nation. One form of domestic human trafficking is sex trafficking. Research indicates that most victims of sex trafficking into and within the United States are women and children, and the victims include U.S. citizens and noncitizens alike. Recently, Congress has focused attention on domestic sex trafficking, including the prostitution of children, which is the focus of this report.
Article
The objective of the study is to describe distinguishing characteristics of commercial sexual exploitation of children/child sex trafficking victims (CSEC) who present for health care in the pediatric setting. This is a retrospective study of patients aged 12-18 years who presented to any of three pediatric emergency departments or one child protection clinic, and who were identified as suspected victims of CSEC. The sample was compared with gender and age-matched patients with allegations of child sexual abuse/sexual assault (CSA) without evidence of CSEC on variables related to demographics, medical and reproductive history, high-risk behavior, injury history and exam findings. There were 84 study participants, 27 in the CSEC group and 57 in the CSA group. Average age was 15.7 years for CSEC patients and 15.2 years for CSA patients; 100% of the CSEC and 94.6% of the CSA patients were female. The two groups significantly differed in 11 evaluated areas with the CSEC patients more likely to have had experiences with violence, substance use, running away from home, and involvement with child protective services and/or law enforcement. CSEC patients also had a longer history of sexual activity. Adolescent CSEC victims differ from sexual abuse victims without evidence of CSEC in their reproductive history, high risk behavior, involvement with authorities, and history of violence. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Recent articles have raised important questions about the validity of prevalence data on human trafficking, exposing flawed methodologies behind frequently cited statistics. While considerable evidence points to the fact that human trafficking does exist in the United States and abroad, many sources of literature continue to cite flawed data and some misuse research in ways that seemingly inflate the problem, which can have serious implications for anti-trafficking efforts, including victim services and anti-trafficking legislation and policy. This systematic review reports on the prevalence data used in 42 recently published books on sex trafficking to determine the extent to which published books rely on data estimates and just how they use or misuse existing data. The findings from this review reveal that the vast majority of published books do rely on existing data that were not rigorously produced and therefore may be misleading or at minimum, inaccurate. Implications for practice, research, and policy are discussed, as well as recommendations for future prevalence studies on human trafficking.
Article
Using survey data obtained from 309 women working in street-level prostitution in Phoenix, Arizona, this investigation examines the influence of minority status, educational level, and the experience of risk factors in an individual's childhood or adolescence on the hazard rate for age of entry into prostitution. Findings of this study show that women engaging in prostitution have limited educational backgrounds and often do not complete high school. Results indicate that both white and minority women engaging in prostitution experienced high rates of physical and sexual abuse in childhood, as well as parental substance abuse. When compared to minority women, white women are more likely to have experienced any one of these three risk factors thought to influence entry into pro- stitution, yet event-history analysis indicates that minority women consistently experience significantly higher hazard rates for entry into prostitution. Findings suggest the need for future research to better assess the impact of race—in the form of socioeconomic and social disadvantages associated with minority status—as it relates to entry into the sex trade.
This study seeks to explore factors related to age at entry into prostitution. Participants were 389 women arrested for prostitution who had attended a diversion program. Women who entered prostitution as minors were found to be more likely to be African-American; report having a family member with a substance use problem; have a history of attempted suicide; and not have completed middle or high school. The age at first drug use was found to significantly impact the reported age at entry. Key areas for intervention should include improving school connectedness and preventing adolescent substance abuse, specifically for African-Americans.
Article
In this paper I will be describing the results of a study conducted to link culturally constructed gender-identity development to violence against women in intimate relationships and to women's participation in crime. The social process that constitutes this link offers a new perspective on violence in the lives of African American women, a new theoretical explanation of battered women's criminality, and a new social paradigm that I am calling gender entrapment. I undertook the research for this project in the midst of a number of academic and social trends that captured both my intellectual and political attention. I was exhilarated by the new scholarship on the intersection of race/ethnicity, gender, and class that was beginning to influence the social sciences. In particular, I was interested in feminist epistemological approaches to research on African American women and the Black family. These approaches suggest that to produce accurate knowledge about an understudied, marginalized group, an "interested" standpoint must be assumed (Collins, 1990; Harding, 1987). Second, I was interested in evaluating the movement to end violence against women in which I had been a participant observer for the past ten years. In my view, this grassroots-feminist movement has had limited success in creating the necessary social changes to end violence against women, partly because it has failed to address the needs of those whose lives are most marginalized (Dobash, l992). While the literature suggests that there is little difference between the rates of violence per se in different
Article
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.
Article
Standard statistical methods often provide no way to make accurate estimates about the characteristics of hidden populations such as injection drug users, the homeless, and artists. In this paper, we further develop a sampling and estimation technique called respondent-driven sampling, which allows researchers to make asymptotically unbiased estimates about these hidden populations. The sample is selected with a snowball-type design that can be done more cheaply, quickly, and easily than other methods currently in use. Further, we can show that under certain specified (and quite general) conditions, our estimates for the percentage of the population with a specific trait are asymptotically unbiased. We further show that these estimates are asymptotically unbiased no matter how the seeds are selected. We conclude with a comparison of respondent-driven samples of jazz musicians in New York and San Francisco, with corresponding institutional samples of jazz musicians from these cities. The results show that some standard methods for studying hidden populations can produce misleading results.
Article
In this article I point to some common pitfalls and particular challenges in research on human trafficking. I start out by presenting some of the challenges in identifying observable populations and behaviours, arguing that primary data collection in the trafficking field should focus on former victims, and not current victims or persons at risk. Thereafter I discuss some of the factors that have inhibited the development and use of explicit operational definitions of trafficking. Third, I present some of the challenges in identification of trafficking victims, when the victims themselves do not want to identify with the trafficking label. Finally, the usefulness of different research strategies in the trafficking fields for the current knowledge-needs is discussed.The article concludes that there will always be some limitations and biases in empirical research in the trafficking field. However, as long as we acknowledge these limitations and make them explicit in our research, sound empirical research that enhances our knowledge in this field is possible. The best potential for good quality research lies in small-scale, thematically focused empirical studies, while attempts to describe worldwide trafficking across regions and arenas is less likely to be successful.
Article
The experience of runaway and homeless youth in the United States is not entirely unique and should be viewed in an international context. The youth in this country do have some unique characteristics and needs. Homeless youth in affluent societies such as ours are often on the streets for different reasons than those of their counterparts in developing countries. Nonetheless, life on the streets brings with it hazards for all homeless young people. Homeless youth are at risk for a number of serious physical and mental health problems, some resulting in pain and discomfort, others in disability and death.Less dramatic, but just as critical, is the role that homelessness plays in disrupting an adolescent's healthy development. Many of the youth who become homeless come from dysfunctional families where physical and sexual abuse, neglect, and substance abuse are common.Homelessness and the experiences associated with homelessness further negatively impact youths' physical, emotional, psychologic, and social development. As a result, most do not develop a healthy sense of self, nor do they establish healthy, supportive peer relationships. The majority of homeless youth drop out of school during their early teens. Thus, they miss the opportunity to develop the kinds of problem-solving and intellectual skills required for securing and maintaining employment as adults.Homeless youth involved in alcohol and other drug abuse are even more likely to have significant deficits and may be more irresponsible and emotionally immature. Thus, a vicious cycle is established. Rather than acquiring the types of enriching experiences and skills that would enable them to develop into healthy adults, homeless youth become over time more alienated from society. As a result, many will become chemically dependent and chronically homeless adults.
Article
Runaway and homeless youth are at high risk for substance abuse and unsafe sexual behavior. Our study describes the personal social networks of these youth and examines network characteristics associated with risky behaviors. In 1995 and 1996, we interviewed a purposive sample of youth aged 14 through 21 who were living in Washington, DC and were identified on the streets or through shelters or other service agencies (N = 327). Although we found that most youth reported current social relationships, a significant minority (26%) did not. Youth without a social network were significantly more likely to report current illicit drug use, multiple sex partners, and survival sex than youth with a network. For youth with a network, the networks were small, strong in affective and supportive qualities, comprised primarily of friends, typically included an alcohol or illicit drug user, and usually were not a source of pressure for risky behaviors. Our results indicate that networks had risk-enhancing and risk-decreasing properties in that network characteristics were associated in both positive and negative directions with risky behaviors.
Article
This exploratory study contributes to the sparse literature on sexually assaulted sex workers. We examined 462 sexual assault cases seen at an emergency department-based sexual assault service and reported to the police between 1993 and 1997. More than one fifth of victims were sex workers. We compared them to other victims on victim characteristics, assault characteristics, and medical-legal findings. Relative to other victims, sex workers were younger, had lower incomes, and were more likely to be heroin and/or cocaine users. They suffered a greater number of injuries and forensic samples collected from their bodies were more likely to test positive for sperm and/or semen. These victims were also less likely to have been using alcohol and/or marijuana prior to the assault and to be emotionally expressed during the medical- legal examination. The substantial proportion of sex workers in the study population suggests that attention to their particular needs should be an important part of hospital-based sexual assault services. Clinical implications and directions for future research are discussed.
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