Sex trafficking of adolescents and young adults in the United States: healthcare provider's role

Risk and Protective Factors for Sexual Exploitation in Male and Female Youth From a Cross-Cultural Perspective: A Systematic Review

Youth are at elevated risk of becoming victims of sexual exploitation, which has a detrimental impact on their physical and psychological well-being. Understanding factors associated with sexual exploitation is key for prevention efforts and adequate and timely treatment. This systematic review sheds more light on this by providing an overview of both risk and protective factors for sexual exploitation in male and female youth from a cross-cultural perspective. In all, 65 studies were selected meeting the inclusion criteria: qualitative or quantitative peer-reviewed studies in English, Dutch, or German with findings on risk and protective factors associated with sexual exploitation in youth aged up to 24 years. Results show that there are common risk factors in male and female youth worldwide (e.g., adverse childhood experiences, lack of a social network, substance use, and running away). Positive and supportive relationships are an important protective factor in mitigating the risk of sexual exploitation. Geographic differences were found. In non-Western continents, more environmental factors (e.g., economic vulnerabilities, residential instability) were cited. Research in countries outside the United States is limited and protective factors and males are underexamined. To fully understand vulnerabilities in youth, their interactions, and possible gender differences and to address the needs of diverse populations, more insight should be gained into the broader range of risk and protective factors worldwide. This systematic review has made a valuable contribution to this by providing practice, policy, and research guidance in the establishment of more targeted prevention efforts, adequate treatment, and areas to address in future research.

Healthcare providers' experience of identifying and caring for women subjected to sex trafficking: a qualitative study

BACKGROUND

Men's violence against women, including human trafficking for sexual exploitation, is a severe threat to global health. Healthcare providers are uniquely positioned to identify and care for women subjected to human trafficking for sexual exploitation. They are among the few professionals the women interact with while being exposed to human trafficking for sexual exploitation. This study aims to describe healthcare workers' experience of identifying and caring for women subjected to human trafficking for sexual exploitation seeking women's healthcare.

METHOD

A qualitative design was chosen and nine qualitative interviews with healthcare providers were conducted and analyzed using the content analysis method.

RESULTS

Three main categories were revealed: (1) the importance of being attentive, (2) the importance of providing safety, and (3) the importance of collaborating, followed by a number of subcategories: behavioral and physical signs, limited time to interact, security measures, value of confidence building, organizational collaboration, essential external network, and information transmission.

CONCLUSIONS

As the women subjected to sex trafficking have limited time in healthcare, it is important for healthcare providers to be attentive and act immediately if suspecting human trafficking for sexual exploitation. It may be the only possibility for the healthcare providers to care for these women and reach them. They must endeavor to provide the women with safety due to their vulnerable position at the hospital. However, these women may leave the healthcare setting unidentified and unaided, which highlights the importance of collaboration on multiple levels.

Methods Used to Control the Reproductive Choices of Women Who Are Sex Trafficked: Considerations for Health Care Providers

Reproductive control or reproductive coercion has negative health consequences but has not been systematically studied within the context of sex trafficking. Our goal is to identify the range of methods used by sex traffickers and buyers to control the reproductive choices of trafficked women and to provide specific examples of these methods. We searched PubMed, Embase, and PsycInfo using the terms "reproductive control" or "reproductive coercion" and "human trafficking" or "sex trafficking," including papers that contained original, specific examples of reproductive control occurring within the context of sex trafficking. These reports were described and categorized into established domains of reproductive control. Eight articles were located that met our inclusion criteria, of which 6 described outcomes of birth control sabotage, 2 described pressuring into pregnancy, 5 described controlling the outcome of a pregnancy, and 2 described forced birth control or sterilization. Our findings have implications for how to take sexual histories and for identifying and assisting trafficked persons.

Comparative healthcare use by adolescents screening positive for sexual exploitation

BACKGROUND

Although screens for commercial sexual exploitation of children (CSEC) have been developed, little is known about how adolescents at high risk for, or victims of, CSEC compared to non-CSEC adolescents in healthcare utilization as previous studies have not included a control group.

OBJECTIVE

Identify where and how often CSEC adolescents presented to medical care in 12 months prior to being identified as compared to non-CSEC adolescents.

PARTICIPANTS AND SETTING

Adolescents between 12 and 18 years seen in a tertiary pediatric health care system in a Midwestern city with a metropolitan population of >2 million.

METHODS

This was a 46-month retrospective case-control study. Cases included adolescents who screened high risk or positive for CSEC. Control group 1 included adolescents who screened negative for CSEC. Control group 2 were adolescents who were not screened for CSEC, matched to cases and to control group 1. The three study groups were compared for frequency of, location of, and diagnosis given for medical visits.

RESULTS

There were 119 CSEC adolescents, 310 CSEC negative, and 429 unscreened adolescents. Compared to the controls, CSEC positive adolescents sought care less frequently (p < 0.001) and were more likely to present to an acute care setting (p < 0.0001). CSEC cases sought medical care in the acute setting more commonly for inflicted injuries (p < 0.001), mental health (p < 0.001), and reproductive health (p = 0.003). In primary care, CSEC adolescents were more commonly seen for reproductive health (p = 0.002) and mental health (p = 0.006).

CONCLUSIONS

CSEC adolescents differ from non-CSEC adolescents in frequency, location, and reasons for seeking healthcare.

Syndemic Profiles and Sexual Health Risks Among Sexually Exploited Adolescent Girls in Taiwan: A Latent Class Analysis

Sexually exploited adolescent girls are disproportionately affected by adverse psychosocial conditions, such as intra-familial child physical and sexual abuse, extra-familial violence and sexual assault, alcohol and drug use, and suicide. Syndemic theory suggests that these adverse psychosocial or syndemic conditions are concentrated and co-occurring in socially marginalized populations, including sexually exploited adolescents, and increase their sexual health risks, including pregnancy, abortion, and the acquisition of sexually transmitted diseases (STDs). To examine clusters of syndemic conditions, latent class analysis (LCA) was conducted to classify 335 sexually exploited girls in Taiwan into subgroups based on their probability of experiencing each syndemic condition. We used syndemic class membership to predict their sexual health outcomes, specifically pregnancy, abortion, and the acquisition of STDs. The results of LCA revealed three classes, which were "low-risk syndemic," "moderate-risk syndemic," and "high-risk syndemic." The risk of acquisition of STDs among sexually exploited girls in the "high-risk syndemic class" and "moderate-risk syndemic class" was 239% and 135% higher, respectively, than the risk of acquisition of STDs among sexually exploited girls in the "low-risk syndemic class." Differences between these three classes in pregnancy and abortion were not significant. Our findings support the syndemic theory that a pattern of syndemic conditions is associated with an increased risk of acquiring STDs. Interventions aimed at reducing the acquisition of STDs among sexually exploited girls in Taiwan should adopt a comprehensive approach to address co-occurring conditions.

Exploitation, Labor and Sex Trafficking of Children and Adolescents: Health Care Needs of Patients

Exploitation and labor and sex trafficking of children and adolescents is a major public health problem in the United States and throughout the world. Significant numbers of US and non-US-born children and adolescents (including unaccompanied immigrant minors) are affected by this growing concern and may experience a range of serious physical and mental health problems associated with human trafficking and exploitation (T/E). Despite these considerations, there is limited information available for health care providers regarding the nature and scope of T/E and how providers may help recognize and protect children and adolescents. Knowledge of risk factors, recruitment practices, possible indicators of T/E, and common medical, mental, and emotional health problems experienced by affected individuals will assist health care providers in recognizing vulnerable children and adolescents and responding appropriately. A trauma-informed, rights-based, culturally sensitive approach helps providers identify and treat patients who have experienced or are at risk for T/E. As health care providers, educators, and leaders in child advocacy and development, pediatricians play an important role in addressing the public health issues faced by children and adolescents who experience exploitation and trafficking. Working across disciplines with professionals in the community, health care providers can offer evidence-based medical screening, treatment, and holistic services to individuals who have experienced T/E and assist vulnerable patients and families in recognizing signs of T/E.

Coping strategies and stressors of nursing students in the care of sex trafficking victims

During their clinical practice, nursing students face a number of complex clinical situations, which may include treating victims of sex trafficking. These clinical experiences can lead to stress for the nursing students, which may hinder their learning process. Nonetheless, there is very little educational training provided in nursing programmes on this topic. The objective of this study was to identify the coping strategies and stressors perceived by nursing students in the care of sex trafficking victims. A pre-post study of a single group was carried out. The TREND guidelines were followed. The Perceived Stress Scale (PSS) and Coping Behavior Inventory (CBI) were used for data collection. On the PSS, the average scores were lower after the intervention in all dimensions, except related to teachers and nursing staff and peers and daily life. Statistically significant differences were found when comparing the results of the total average score of the PSS and the time of measurement (pre/post-intervention) (t(106) = 38.811; P < 0.001). Regarding the Coping Behavior Inventory, the average scores in each dimension increased after the intervention, except transference behaviours. Statistically significant differences were found when comparing the total average score of the questionnaire and the time of measurement (Z = -13.357; P < 0.001). The total stress levels and coping strategies of nursing students in caring for victims of sex trafficking improved significantly after the intervention. Nursing educators should promote the training of future nursing professionals as a potential effective strategy for the rapid identification and adequate care of sex trafficking victims.

Oral Health Implications of Risky Behaviors in Adolescence

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.

Recognizing and responding to sex-trafficked minors in the healthcare setting

Nearly 6,100 reports of sex trafficking were made to the United States Human Trafficking Hotline in 2017; 29% of those reports involved minors. Physician assistants (PAs), especially those working in emergency medicine and primary care, are among the few frequently accessed healthcare providers who have the opportunity for a private conversation with a sex trafficking victim or survivor. PAs must be able to recognize the risk factors and signs of trafficking and respond in a trauma-informed, survivor-centered manner. Connecting trafficking victims, survivors, and at-risk youth with wraparound services is critical to their well-being.

Share our stories: An exploration of the healthcare experiences of child sex trafficking survivors

BACKGROUND

The trafficking of children and adolescents is widespread, and pediatric providers are on the front line. Current research demonstrates that trafficked children do access health care. However, few studies describe these interactions from their perspectives. In order to elucidate the healthcare experiences of sex trafficked children, we designed a qualitative study utilizing semi-structured interviews to explore their health care interactions.

PARTICIPANTS AND SETTING

Homeless youth currently aged 18-21 who were sex trafficked before age 18.

METHODS

Semi-structured interviews were conducted with seventeen youth who met the study criteria. Interview transcripts were coded and analyzed using constant comparative methods. Themes were inductively extracted by consensus with the study team, and thematic saturation was determined when no new themes emerged.

RESULTS

Themes included: victims endured serious injuries and illnesses without being brought to medical attention, traffickers limited victims' access to care, logistical barriers limited access, traffickers directed victims to lie to providers, and medical providers rarely separated victims to interview them separately resulting in missed opportunities.

CONCLUSIONS

These themes illustrate the experiences of sex trafficked youth experiencing homelessness and provide pediatric practitioners the opportunity to become more informed and equipped to recognize them. They also highlight serious health consequences of not being identified and egregious examples of providers exhibiting denial or inappropriate responses to their disclosure.

The Impact of Human Trafficking Training on Healthcare Professionals' Knowledge and Attitudes

OBJECTIVES

The objective of this study was to evaluate a CME-accredited human trafficking didactic and discussion-based training for healthcare professionals by comparing participant knowledge and attitudes on human trafficking before and after attending the training.

METHODS

A novel 18-item survey was developed to test the knowledge of and attitudes towards human trafficking. Participants of 17 standardized trainings delivered by 4 physician-trainers over a two-year period were invited to take a pre-test and 2 post-tests at 1-week and 6-months post training. Surveys were anonymously collected and linked to each participant with a de-identified number. Data were analyzed using SPSS software with scores given to the overall and knowledge and attitude subscales. Data are presented as mean ± standard deviation. Comparisons were made using paired t-tests or ANOVA, as appropriate.

RESULTS

Total of 424 participants submitted the pre-test and were predominantly female (81%) and students in healthcare fields (55%). Of these participants, 237 (56%) submitted the 1-week post-test. Scores increased from pre-test to 1-week post-test in both knowledge (54.7 ± 18.7%-84.5 ± 12.8%, P = .001) and attitude (49.4 ± 14.7%-71.0 ± 12.8%, P < .001) subscales. Forty-seven participants (11%) submitted the 6-month post-test, which demonstrated a decrease in knowledge score from the 1-week post-test (84.5 ± 12.8%-50.0 ± 13.6%, P < .001). However, improvements in attitude scores were sustained across time (71.0 ± 12.8%-68.8 ± 12.4%, P < .001).

CONCLUSIONS

Among health professionals, the CME-accredited LIFT training leads to a short-term improvement in knowledge of human trafficking and a sustained improvement in awareness and attitudes about human trafficking.

Teen Knowledge of Commercial Sexual Exploitation of Children

INTRODUCTION

The commercial sexual exploitation of children (CSEC) is a pediatric health care problem with significant physical and mental health consequences for victims, even death. Although there exists community-wide collaborations in the United States to address professional response to CSEC, these efforts often have a limited capacity to reach adolescents and involve them in CSEC prevention. As part of a prevention strategy, the National Institute of Justice recommends educating youth about CSEC and exploiters' recruitment tactics. Despite this recommendation, little is known regarding American youth knowledge of CSEC.

METHODS

A descriptive research design was used for this study. All adolescents, male and female, presenting to a high-volume urban pediatric hospital-based Midwestern Child Advocacy Center (CAC) due to concerns for alleged sexual abuse were invited to participate in the study by answering a self- administered electronic questionnaire. This questionnaire explores the participants' knowledge, awareness, and attitudes about CSEC, in addition to collecting demographic data, such as participant age, gender identity, grade, school district, and school.

RESULTS

During the six-month study period, 286 CAC patients were eligible to participate in the study. Nearly all participants (n = 217; 97%) agreed that pimping is wrong. While the majority of participants indicated an awareness of human trafficking (n = 198; 94%) and sex trafficking (n = 193; 87%); just (n = 91; 41%) had heard of labor trafficking. Fewer participants (n = 55; 25%) identified that a doctor, nurse, or other health care provider had ever spoken with them about sex trafficking.

DISCUSSION

Study participants overwhelmingly conveyed negative attitudes toward CSEC. Participating adolescents indicated a significantly higher awareness of sex trafficking (87%) versus labor trafficking (10%). Sex trafficking receives more attention in the media than labor trafficking. Given that study participants indicated hearing about trafficking primarily from the media (74%) and family/friends, this may explain the deficit in labor trafficking awareness. Although study participants demonstrated mostly accurate baseline knowledge of CSEC, that knowledge was not universal.

Systematic review of facilitators of, barriers to, and recommendations for healthcare services for child survivors of human trafficking globally

BACKGROUND

Child trafficking is associated with multiple physical and mental health problems, yet relatively little is known about the factors that facilitate or hamper delivery of high-quality health care services to trafficked children.

OBJECTIVE

To summarize information about identified facilitators of, barriers to, and recommendations for medical and mental health service provision to trafficked children.

PARTICIPANTS AND SETTING

A systematic review was conducted of the English-language, peer-reviewed literature on medical and mental healthcare of trafficked children published since 2010.

METHODS

Inclusion criteria were: (1) the study population or focus included, wholly or in part, individuals under the age of 18 years; (2) the study focus was clearly defined as human trafficking or commercial sexual exploitation; (3) a main focus included health services or barriers to care, and (4) the article contained original data.

RESULTS

Of the 29 articles meeting inclusion criteria, 19 included facilitators of health service provision to trafficked populations, 22 included barriers to that provision, and 25 included explicit recommendations for service improvement. 45 distinct facilitators were identified a total of 140 times, 118 distinct barriers were identified a total of 174 times, and 52 distinct recommendations were identified a total of 100 times. The majority of facilitators, barriers, and recommendations fell under the locus of the healthcare provider and healthcare organization.

CONCLUSIONS

Existing research reveals abundant areas of opportunity for healthcare professionals and healthcare administrators to improve access to, and quality of, medical and mental health care for trafficked children.

Modern slavery and public health: a rapid evidence assessment and an emergent public health approach

OBJECTIVES

Modern slavery is a human rights violation and a global public health concern. To date, criminal justice approaches have dominated attempts to address it. Modern slavery has severe consequences for people's mental and physical health, and there is a pressing need to identify and implement effective preventative measures. As such, a public health approach to modern slavery requires elucidation. The objectives of this study were to explore the case for public health involvement in addressing modern slavery and the components of a public health approach and to develop a globally relevant framework for public health action.

STUDY DESIGN

A Rapid Evidence Assessment.

METHODS

This study is a rapid systematic review of published literature and stakeholder consultation.

RESULTS

The accounts of 32 consultees and evidence from 17 papers including reviews, commentaries and primary studies were included in the evidence assessment. A strong ethical rationale for public health engagement in addressing modern slavery was evident. Multilevel and multicomponent interventional strategies were identified across global, national, regional, local and service levels. Although public health could add value to existing approaches, multiple barriers and tensions exist.

CONCLUSION

Published literature and stakeholder opinion indicate an emergent public health approach to modern slavery. It involves intervention at multiple levels and is guided by a rights-based, survivor-centred and trauma-informed approach. This synthesis offers an important early step in the construction of a globally relevant public health approach to modern slavery.

Social determinants of health in teenage girls involved with sexual exploitation on downtown streets late at night

The purpose of this study was to chronicle the experiences of teenage girls who stay downtown late at night and are involved in sexual exploitation, and to clarify characteristics of their social circumstances and social determinants of health: socioeconomic status and educational opportunities. Between November 2009 and June 2013, we spoke with 89 adolescents who were loitering late at night in downtown Nagoya, Japan. We focused our research efforts on a case series of 22 girls who were 14-19 years of age and were involved in sexual exploitation. Semi-structured interviews were performed with the use of a questionnaire on the girls' sexual and mental health, families, school life, living conditions, and future aspirations. Along with the questionnaires, we analyzed case series interviews with a qualitative approach (narratives-under-analysis by in-depth understanding in context). Nine girls worked in the sex industry, while thirteen were independent sex workers. Our observations included child maltreatment, unstable families, distressing school life, insufficient education, and inappropriate relationships with gangs and similar organizations. Moreover, an illegal sex market was linked with these gang associations. Despite their severe living conditions, most of them hoped to have happy families someday. To provide support to this vulnerable population and support their life aspirations, improvement of public health, social welfare, education, and school health systems should be considered carefully.

LGBT Youth, Sex Trafficking, and the Nurse Practitioner's Role

Sex trafficking is one of the most profitable forms of transnational crimes (U.S. Department of Homeland Security, 2018). Sex traffickers prey on vulnerable populations to commission these crimes. Lesbian, gay, bisexual, and transgender (LGBT) youth are subject to adversity from an early age, which leaves them especially vulnerable to sex traffickers. Health care providers lack the resources, education, protocols, and policies required to protect these youth members of society. This literature review explores LGBT youth's risk factors for becoming a trafficked child, a provider's role in protecting and treating these youth, the legalities of a provider reporting sex trafficking, and research opportunities pertinent to these issues.

Commercial Sexual Exploitation of Children: An Update for the Forensic Nurse

Commercial sexual exploitation of children (CSEC) is the sexual abuse of children through buying, selling, or trading their sexual services. This may involve engaging a child under the age of 18 years in prostitution, pornography, stripping, exotic dancing, escort services, or other sexual services. CSEC is a problem of epidemic proportions throughout the world including the United States; however, the actual number of CSEC victims in the United States is unknown. Studies indicate that most child victims are seen by a healthcare provider while being trafficked and that many victims receive care at a pediatric hospital within 1 year of their identification as a victim. CSEC is a significant pediatric healthcare problem. It is vital that forensic nurses possess a thorough understanding of the problem and be poised to better identify, intervene, and prevent CSEC. In this article, we focus on risk factors commonly experienced by victims, recruitment strategies used by traffickers, indicators to identify child victims, and intervention and educational strategies of relevance to forensic nurses.

Human Trafficking Victim's Service Needs and Outcomes: An Analysis of Clinical Law Data

Background

Human trafficking is a human rights violation occurring around the world. Despite the profound social, health, and economic consequences of this crime, there is a lack of research about the prevalence and needs of human trafficking victims. The purpose of this study is to describe the healthcare, social service, and legal needs of human trafficking victims seeking services at the University of Michigan Human Trafficking Clinic.

Methods

A secondary analysis of the University of Michigan Human Trafficking Clinic closed case files from 2009-2016 was performed. Data were extracted from the legal files to create a database and data analyses were completed using descriptive frequencies, logistic, and linear regression.

Results

Data were extracted from 65 closed cases made up of 49 female victims(75.4%) and 16 male victims (24.6%) between the ages of 13 and 68 years old (M=30.15). Victims had experienced labor (56.9%) and sex (47.7%) trafficking. Logistic regression modeling indicated that trafficking experiences significantly influenced posttrafficking mental healthcare, social service, and legal needs.

Conclusions

Victims of human trafficking have extensive needs; however, there are many barriers to seeking and receiving comprehensive services. In order to serve this vulnerable population, collaboration between disciplines must occur.

Sexual Violence in Adolescents

Sexual violence and intimate partner violence are common among adolescents, especially for those who are developmentally disabled. Pediatricians have a critical role in treating and preventing sexual violence in adolescents. As medical providers, they possess trusted access to identify sexual violence in adolescents and to intervene to help prevent further violence and mitigate associated health effects. Therefore, it is imperative that pediatricians are aware of the scope of sexual violence in adolescents. Specific sexual violence screening recommendations for sexual assault, intimate partner violence, reproductive coercion, and sex trafficking are reviewed in this article. In addition, recommendations for the comprehensive treatment of adolescents exposed to sexual violence are examined. National and local resources for victims and promising strategies to prevent sexual violence, including sex trafficking, are identified. Through collaboration with community partners in multidisciplinary efforts, pediatricians can most effectively promote the health of adolescents and prevent further victimization. [Pediatr Ann. 2019;48(2):e58-e63.].

Identifying Sexual and Labor Exploitation among Sheltered Youth Experiencing Homelessness: A Comparison of Screening Methods

Human trafficking is a significant and growing public health concern. Subgroups of adolescents and young adults are particularly vulnerable to human trafficking, especially youth who are unstably housed or homeless. While youth experiencing trafficking come into contact with the healthcare system, they are often not identified during routine assessment due to lack of specific inquiry and low disclosure. Therefore, we utilized a mixed-methods study design to assess the differences in the identification of human trafficking among youth experiencing homelessness (n = 129) between a standard psychosocial assessment tool and a human trafficking specific assessment tool. Findings indicate that the tool developed to specifically assess for human trafficking was more likely to identify youth experiencing sexual and labor exploitation, as well as the risk factors for human trafficking. Secondly, youth reported that mistrust of the system, fear of involving the police if reported, not wanting to interact with the mental healthcare system, and stigma are barriers to disclosing human trafficking. In conclusion, healthcare providers caring for youth experiencing homelessness should adopt improved screening tools for human trafficking to reduce the risk of missed opportunities for prevention and treatment among this high-risk population of youth.

Health inequalities and health equity challenges for victims of modern slavery

Background

Modern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors.

Methods

We conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care.

Results

Survivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications.

Conclusions

The importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed.

Commercial Sexual Exploitation of Children: Health Care Use and Case Characteristics

OBJECTIVE

The purpose of this study was to describe pediatric health care utilization, familial psychosocial factors, child sexual abuse case characteristics, and patient demographic characteristics of adolescents prior to or at the time of their most recent identification as a victim of commercialized sexual exploitation of children (CSEC).

METHODS

A retrospective chart review was conducted for the above detailed information of all adolescents presenting to the Emergency Department (ED) or Child Advocacy Center (CAC) of a pediatric hospital with concerns of suspected CSEC.

RESULTS

Sixty-three adolescents were referred to the ED or CAC for CSEC concerns in the eighteen-month period. Nearly all (52, 82.5%) adolescents identified as potential CSEC victims received care at the pediatric hospital within one year of the CSEC concern being identified.

CONCLUSIONS

Pediatric health care providers, including pediatric nurse practitioners, need to be more skilled in the prevention and identification of CSEC.

An Ecological Approach Toward Prevention and Care of Victims of Domestic Minor Sex Trafficking

Sex trafficking is a widespread form of human trafficking that exists globally. The forced sexual exploitation of young women for profit at the hands of traffickers is a human rights violation. Sex trafficking is a form of modern-day slavery where youths are sold as a commodity. It is difficult to determine the wide range of negative health outcomes associated with domestic minor sex trafficking due to the hidden nature of the crime and its lack of statistical data to determine prevalence. Viewing domestic minor sex trafficking through an ecological lens assists in the understanding of the multiple complex interactions between victims, their relationships, and environments that influence their health. Forensic nurses are poised as experts in the healthcare of vulnerable populations and possess the knowledge to understand that social determinants of vulnerability depend on the distinct setting or environment where victims of sex trafficking reside and how different factors affect their victimology, resilience, and well-being.

Trafficking and Trauma: Insight and Advice for the Healthcare System From Sex-trafficked Women Incarcerated on Rikers Island

BACKGROUND

Sex-trafficked persons experience significant trauma while exploited, resulting in complex health issues and barriers to health care. Incorporating survivor perspectives is critical in optimizing health care delivery for this population.

OBJECTIVES

We interviewed sex-trafficking survivors regarding their experiences with trauma while being trafficked and elicited advice about health care delivery.

RESEARCH DESIGN

Qualitative interviews were conducted in New York City's Rikers Island jail from July to September 2015.

SUBJECTS

In total, 21 English-speaking women who had experienced sex trafficking were the subjects of the study.

MEASURES

Interview domains included: interpersonal violence, behavioral health, and health care delivery advice.

RESULTS

Interviewees described experiencing severe and chronic trauma perpetrated by traffickers and sex buyers. Substance use was the primary method of coping with trauma. With regard to mental health, interviewees noted diagnoses of depression, anxiety and posttraumatic stress disorder, low self-esteem, and challenges in intimate relationships. Health care delivery themes included approaches to discussing trafficking in health care settings, concerns regarding sexual assault examinations, and suggestions for improving direct-services and prevention programming.

CONCLUSIONS

With this perspective into the complex intersection of trauma and behavioral health that sex-trafficked women can experience, health care providers can better understand the context and recommendations regarding trauma-informed care practices for this population. Our results also offer several avenues for future studies with regard to discussing trafficking in clinical settings and an opportunity for stakeholders to incorporate survivor-based input to improve health care for this population.

The impact on mental and physical health of human rights as they relate to gender and sexual minority adolescents and emerging adults

Purpose

The purpose of this paper is to discuss the human rights issues pertinent to adolescents of diverse sexual orientation and gender identities and the health consequences resulting for the transgression of these rights. In 1948, the United Nations General Assembly passed a resolution endorsing the Universal Declaration of Human Rights. Yet, 73 member states criminalize the activities of these individuals. The other member states do not impose legal penalties on these activities, yet sexual and gender minority youth within these states continue to experience acts of physical and psychological aggression.

Design/methodology/approach

A commissioned position paper grounded in a convenient scholarly literature review on this topic.

Findings

Human rights transgressions by states or individuals lead to minority stress affecting the mental health and physical health of these youth.

Originality/value

The author makes a number of recommendations to address some of the impact resulting from the transgression of human rights in the world.

All the darkness we don't see

Trafficking of women and children for sexual exploitation is the fastest growing criminal enterprise in the world. This is a public health crisis; as physicians who have direct contact with victims, we have a unique opportunity to intervene. The authors developed a specialty clinic for survivors of sex trafficking in 2013 at an academic medical center in New York City. Twenty of the 24 women seen in the Survivor Clinic saw a physician while being trafficked. Sex trafficking violates basic human rights, which include the rights to bodily integrity, dignity, health, and freedom from violence and torture. The stories of the patients seen in the Survivor Clinic bear witness to the health consequences of commercial sexual exploitation and reinforce the previous literature on the rates of physical and psychologic harms of trafficking. Health consequences of trafficking include traumatic brain injuries, drug addiction, depression, and neglect of chronic health conditions. All physicians, but gynecologists especially, need more education about the prevalence and dynamics of trafficking and how to assess and intervene on behalf of survivors.