Ethical and Practical Considerations for Collecting Research-Related Data from Commercially Sexually Exploited Children

Trauma-Informed Research With Emerging Adult Survivors of Sexual Violence

Health researchers have had increasing calls to include vulnerable populations in research to tailor inclusive evidence-based practice interventions. The inclusion of vulnerable populations in research is sensitive and complex. Sensitive topics such as dating and sexual violence are especially complex, with emerging adults the highest risk group for all forms of sexual violence and an especially hard-to-reach population for inclusion in research. Impacts of trauma, including physiological and psychological, complex needs of survivors, and potential for revictimization during interactions when participating in research must be considered. Researchers must be equipped with specialized, trauma-informed skills to safely and ethically conduct all aspects of research. Using the trauma-informed framework, the purpose of this paper is to discuss the complexities of conducting research with emerging adult survivors of sexual violence and to explore evidence-based approaches that can safely include this vulnerable population through the application of trauma-informed approaches. The use of evidence-based, trauma-informed research approaches tailored to engage this population in research can further help to develop effective interventions that are context-sensitive to emerging adults.

Safeguarding research staff “in the field”: a blind spot in ethics guidelines

Across disciplines there is a large and increasing number of research projects that rely on data collection activities in low- and middle-income countries (LMICs). However, these are accompanied by an extensive range of ethical challenges. While the safeguarding of study participants is the primary aim of existing ethics guidelines, this paper argues that this “do no harm” principle should be extended to include research staff. This study is a comprehensive review of more than 80 existing ethics guidelines and protocols that reveals a lack of safeguarding research staff regarding the ethical challenges faced during data collection activities in LMICs. This is particularly the case when it comes to issues such as power imbalances, political risk, staff’s emotional wellbeing or dealing with feelings of guilt. Lead organizations are called upon to develop guiding principles that encompass the safeguarding of research staff, which are then to be adapted and translated into specific protocols and tools by institutions.

Rigor and Respect: Recruitment Strategies for Engaging Vulnerable Populations in Research

Engaging vulnerable populations in research is a critical focus for researchers seeking to find ways to improve safety and well-being for broader populations. Vulnerabilities often co-occur, meaning that individuals may experience vulnerabilities in multiple facets of their life (e.g., victim of abuse and mental health diagnoses). Unfortunately, many vulnerable populations remain underinvestigated due to difficulty reaching, engaging, and safely including such populations in research. While most researchers assert the importance of including vulnerable populations in research, few actively and successfully recruit them. Many vulnerable populations are understandably weary of research participation. Victims and survivors of domestic minor sex trafficking (DMST) are one such vulnerable population, in that identification may incur substantial risk for DMST victim's physical safety and well-being. In addition, DMST victims and survivors often experience co-occurring vulnerabilities including substance use, histories of abuse, delinquency, and poor mental health. Accordingly, they are notoriously difficult to recruit for research participation. The current paper uses a detailed case example to describe the recruitment and retention strategies used by one researcher to promote DMST survivor research participation. A candid account of challenges, successes, and lessons learned is offered in service of building methodological techniques for recruitment that both honor participant experiences while championing methodological rigor. Findings detail the importance of trust and a trauma-informed approach to qualitative data collection and analysis. Authors include specific strategies to promote comfort and candor amid traumatic response in ways that may empower research participants. A detailed discussion of how such strategies may be adapted for vulnerable populations beyond DMST victims and survivors is provided.

Confusing Terms: A Concept Analysis of Naming Youth Trafficking

Human trafficking is a growing population health problem. More than half of all persons experiencing trafficking are youth, with many in the United States unrecognized despite experiencing exploitation. Available peer-reviewed articles report a myriad of descriptions of trafficking, yet the concept and operational definition of youth trafficking, specifically, is lacking and unclear. Youth trafficking is described differently across multidisciplinary researchers and clinicians working with trafficked youth. Furthermore, labor trafficking of youth is largely excluded from the conversation surrounding trafficking. This article presents a concept analysis of naming trafficking of persons under the age of 18 years to clarify the concept specific to youth experiencing all forms of trafficking and approaches professionals can take with this specific subpopulation of trafficked persons and survivors.

Commercial Sexual Exploitation During Adolescence: A US-Based National Study of Adolescent to Adult Health

OBJECTIVES

National data on the health of children and adolescents exposed to commercial sexual exploitation (CSE) are lacking, during both adolescence and adulthood. Using nationally representative data, we examined the health of male and female adolescents in grades 7-12 who experienced CSE exposure and subsequent adult health outcomes and access to health care.

METHODS

Our retrospective cohort study used data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (1994-2008) to characterize relationships between CSE exposure before or during adolescence and health during adolescence and adulthood. The analytic sample included 10 918 adult participants aged 24-34 in Wave IV. We performed bivariate analyses, stratified by sex, to quantify the relationship between CSE exposure before or during adolescence and adolescent and adult health outcomes.

RESULTS

Four percent of participants reported having a CSE exposure before or during adolescence (5% of males, 3% of females). Factors associated with CSE exposure among adolescents included race/ethnicity, parental education level, previous abuse, same-sex romantic attractions, history of ever having run away from home, and substance use. During adolescence, exposure to CSE was associated with worse overall health, depressive symptoms, and suicidal thoughts for both males and females. In adulthood, adolescent CSE exposure was associated with depression among males and functional limitations among females. A higher percentage of males with CSE exposure before or during adolescence, compared with their non-CSE-exposed peers, used the emergency department as their usual source of care during adulthood.

CONCLUSIONS

CSE exposure before or during adolescence was associated with poor adolescent and adult health outcomes and health care access. Observed differences between males and females warrant further exploration.

The Prevalence of Sex Trafficking of Children and Adolescents in the United States: A Scoping Review

TOPIC

This scoping review investigated research regarding the magnitude of minor sex trafficking (domestic minor sex trafficking and/or commercial sexual exploitation of children) in the United States, summarizing estimates, methodologies, and strengths and weaknesses of the studies.

METHOD

Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, peer-reviewed articles and the gray literature were accessed via databases searches, reference harvesting, and expert advice. Articles were included if they provided a count or prevalence proportion estimate of trafficked or at-risk minors across or within a region of the United States. Six empirical studies, published from 1999 to 2017, were included in the review.

RESULTS

Included studies produced count estimates (n = 3) or prevalence proportion estimates (n = 3) for youth at risk of minor sex trafficking (n = 2) or reporting victimization (n = 5). Studies examined sex trafficking risk and victimization in different geographical areas, including across the United States (n = 2), in New York City (n = 1), and in Ohio (n = 1). Further, several studies focused on particular populations, such as street and shelter youths (n = 1) and adjudicated males (n = 1). Sampling methodologies of reviewed estimates included traditional random sampling (n = 1), nationally representative sampling (n = 2), convenience sampling (n = 1), respondent-driven sampling (n = 1), purposive sampling (n = 1), and use of census data (n = 2).

CONCLUSION

Little research has estimated the prevalence of minor sex trafficking in the United States. The existing studies examine different areas and populations and use different categories to estimate the problem. The estimates reviewed here should be cited cautiously. Future research is needed on this important topic, including methodologies to produce more representative estimates of this hard-to-reach population.

A systematic review on ethical challenges of 'field' research in low-income and middle-income countries: respect, justice and beneficence for research staff?

Introduction

Primary data collection in low-income and middle-income countries (LMICs) is associated with a range of ethical complexities. Considerations on how to adequately ensure the well-being of research staff are largely neglected in contemporary ethics discourse. This systematic review aims to identify the ethical challenges that research staff across different hierarchical levels and scientific disciplines face when conducting research in LMICs.

Methods

We searched 13 electronic databases and handsearched publications in six selected journals as well as the reference lists of all included studies. No restrictions were applied with respect to the publication date, research design, and target population.

Results

23 151 studies were retrieved, 183 of which met our inclusion criteria. We identified nine different types of ethical challenges that research staff may be exposed to during field research, including (1) role conflicts that can emerge from participants’ help requests and the high level of deprivation found in certain study settings, (2) feelings of guilt and (3) detrimental mental health impacts. Further challenges were (4) sexual harassment (5) safety risks and (6) political repression, particularly in postconflict, disaster-ridden or autocratic study contexts. Additionally, studies reported (7) inadequate working conditions and (8) power imbalances within research teams, while (9) ethics boards were found to be ill equipped to anticipate and address emerging risks, thus increasing the ethical liability of researchers.

Conclusion

This review revealed several complex ethical challenges that research staff may face during data collection. In order to achieve the Sustainable Development Goal 8.8 on ‘safe and secure working environments’ and to protect research staff from harm, amendments must urgently be made to current ethical standards.

PROSPERO registration number

CRD42019131013

Gender, rights and responsibilities: The need for a global analysis of the sexual exploitation of boys

The United Nations Convention on the Rights of the Child confirmed child and youth rights globally. Their right to participation is a critical driver for the 2030 Sustainable Development Goals (SDGs). Youth prioritize the need to end violence against them, charging adults with safeguarding, and identify gender inequality as an underlying cause of child sexual exploitation (CSE). SDG 5 includes targets for ending sexual exploitation of girls; however, it is critical to review whether we are supporting both boys and girls adequately. Based on recent research, it is clear that male victims of CSE are prevalent, yet they have been relatively excluded in policy, research, and interventions. The aim is not to minimize the importance of understanding and eliminating CSE of girls, but to acknowledge that vulnerable sub-groups of boys exist in community (street-connected boys, refugees, sexual minorities) and service systems (justice, child welfare, humanitarian aid). Gender-based challenges persist in protection, disclosure, help-seeking, professional recognition, programming and prevention. In this discussion article, we outline responsibilities in human rights law to understand and address boys' CSE and overview key literature on its impact on boys. It is argued that gender-, trauma-, and violence-informed approaches are expanded to address the contribution of harmful gender norms, and to target prevention in the adolescent years for sexually transmitted infections, mental health, and substance abuse and violence problems. This discussion advances a pressing need for a global analysis of CSE among boys.

A longitudinal evaluation of a survivor-mentor program for child survivors of sex trafficking in the United States

BACKGROUND

Commercial sexual exploitation (CSE) of children is a significant public health and criminal justice problem, but there are few evaluated models of CSE mentorship service.

OBJECTIVES

To assess whether youth who participated in a CSE survivor-mentor program evidenced changes in CSE victimization, dating abuse victimization, health, delinquency, social support, and coping during the year following their enrollment in the program.

PARTICIPANTS

41 youth who were CSE-experienced at baseline (72%) or determined very high risk, 11-18 years old, 95% female, 58% heterosexual, 29% White, 29% Hispanic, and 42% other races/ethnicities.

SETTING

An urban city in the Northeast United States.

METHODS

We used a one-group repeated measures design and a GEE analysis. Data were collected at baseline, six months after baseline (71% follow-up) and 12 months after baseline (68% follow-up).

RESULTS

At baseline 72% could be characterized as CSE-experienced, while at 6 months the percentage decreased to 24% (p < 0.001) and at 12 months to 14% (p < 0.001). After 6 months of receiving survivor-mentor services, youth were less likely to have experienced CSE, engaged in sexually explicit behavior (SEB), used illicit drugs, engaged in delinquent behavior, been arrested or detained by police, and they had better social support and coping skills. After 12 months, youth were less likely to have experienced CSE, to have engaged in delinquent behavior, be arrested or detained by police, and had improved coping skills.

CONCLUSION

Findings demonstrate that youth who received survivor-mentor services from MLMC experienced improved well-being and less drug use, delinquent behavior, and exploitation.

Understanding Commercially Sexually Exploited Young Women's Access to, Utilization of, and Engagement in Health Care: "Work Around What I Need"

PURPOSE

We sought to understand the perspectives of commercially sexually exploited (CSE) young women regarding their health care needs, access, and use patterns.

METHODS

Twenty-one CSE young women participated in this mixed methods study. Data collection included brief surveys measuring health care use, followed by in-depth, semistructured interviews to gain insight into CSE young women's health care needs, barriers and facilitators to health care, use patterns, and recommendations for improving care. Data analysis techniques included descriptive statistics for the quantitative survey data and thematic analysis for the qualitative interviews.

RESULTS

Survey data demonstrated relatively high health care use across health care types, especially for reproductive and mental health treatment services. Barriers to care included being "on the run," fear of bad diagnoses, and trafficker control. The fierce autonomy conceptual model emerged from the analyses to describe participants' strong desire for self-determination in their health care decision making, including when to access care. Recommendations for improving care for CSE young women include preserving autonomy in health care decisions while meeting their basic needs, such as safety and shelter.

CONCLUSIONS

Overall, the CSE young women expressed high health care needs. Despite experiencing significant barriers to accessing care, study participants frequently sought care in a variety of settings. Furthermore, they shared insights about how to improve engagement in health care among CSE young women. Improving CSE young women's engagement in care requires health professionals and health systems that foster a sense of safety, trust, and autonomy over health care decisions-a need intertwined with CSE young women's experiences of abuse, survival, and sexual exploitation.