An exploratory model of girls' vulnerability to commercial sexual exploitation in prostitution

Cognitive impairment and exploitation: connecting fragments of a bigger picture through data

BACKGROUND

Exploitation poses a significant public health concern. This paper highlights 'jigsaw pieces' of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation.

METHODS

We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and 'analysis of variance'.

RESULTS

Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be 'slipping through the net'. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation.

CONCLUSIONS

This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for 'at-risk' adults.

Stressful Life Events Among Women Suffering Homelessness and Prostitution in Spain

The aim of the study was to analyze the differences in suffering stressful life events (SLE) among women experiencing homelessness who had or had not been in prostitution. Data were collected from a sample of 135 women experiencing homelessness in Madrid. A total of 81% of the women interviewed had never been in prostitution, while 19% had been in prostitution at some point in their lives. Participants were recruited from shelters, drop-in centers, and public spaces. The information was collected using a structured interview. The results showed that women experiencing homelessness who had been in prostitution suffered a greater number of SLE, both in childhood and adolescence and throughout life. The interviewed who had been in prostitution were between two and nine times more likely to have experienced during their childhood and adolescence violence in their family, as well as to have run away from home, experienced abuse, attempted suicide, and used drugs excessively. Furthermore, during their lifetime, the interviewed who had been in prostitution were between two and four times more likely to suffer from serious physical and mental health issues, excessive alcohol consumption, intimate partner violence, physical violence from others, suicide attempts, police reporting, and unwanted pregnancies. Additionally, they were four to six times more likely to have been sexually assaulted or convicted/imprisoned for a crime, seven times more likely to have been arrested, and a striking 32 times more likely to have used drugs excessively.

On the Overlap of Commercial Sexual Exploitation and Intimate Partner Violence: An Exploratory Examination of Trauma-Related Shame

Every year, millions of people experience intimate partner violence (IPV) and commercial sexual exploitation (CSE), with researchers increasingly discussing the overlap between these two forms of interpersonal violence. However, researchers have not yet used quantitative methods to examine the link between IPV and CSE or to explore potential mechanisms underlying the overlap, including child maltreatment risk factors and psychological mechanisms. One potential mechanism is trauma-related shame, a symptom of post-traumatic stress disorder commonly experienced by both victims of CSE and IPV. The current study explores trauma-related shame, childhood maltreatment, and IPV and their associations with CSE using a sample of 174 primarily Black women. Binomial logistic regression is used to analyze the impact of IPV, child abuse and neglect, and trauma-related shame on CSE. Results indicate that IPV and trauma-related shame are both significant predictors of CSE. Implications for future research and the incorporation of shame in trauma-related treatment are discussed.

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.

The Role of Childhood Violence in Adult Victimization Among Women Experiencing Homelessness in Spain

Persons experiencing homelessness represent one of the principal manifestations of the phenomenon of social exclusion, with homeless women constituting a group in a particularly vulnerable situation. The article analyzed the experience of violence in childhood and adolescence, and its implications in terms of violence experienced as an adult, in a sample of women experiencing homelessness in Madrid (Spain) (n = 138). All participants were of legal age and had spent the night before the interview in a shelter or other facility for the homeless, on the street, in public spaces or in places not suitable for sleeping. Information was gathered through a structured interview. The results show that the interviewees had experienced a high percentage of physical, psychological, and/or sexual violence, both in their childhood and adolescence and throughout their lives, with a strong correlation between the experience of violence in childhood and the experience of violence in adulthood, particularly sexual assaults, intimate partner violence, and sex work. The experience of childhood sexual abuse among women experiencing homelessness appears to have had particularly negative consequences in adulthood. Public policies, prevention programs, and care mechanisms with a gendered perspective must be implemented, aimed at reducing the number and intensity of situations of violence experienced by women and girls at risk of social exclusion or in a homeless situation.

Toward a Global Definition and Understanding of Child Sexual Exploitation: The Development of a Conceptual Model

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.

Exploring the Role of Prior Sexual Abuse in the Commercial Sexual Exploitation of Boys and Young Men

Although there has been a large body of research conducted on girl and young women victims of commercial sexual exploitation, boy and young men victims do not receive the same attention. The scant research that exists demonstrates mixed findings on the prevalence of boys and young men as victims of commercial sexual exploitation. For example, some studies find they are not as likely to be victims and others find they are victimized equally, or in some cases, potentially even more so than girls and young women, depending on location. ECPAT published a study in 2013 that revealed a lack of awareness and misclassification of boys as victims and the lack of services available to help them. The purpose of this study is to replicate the ECPAT study and determine what changes might have occurred over the past decade. We consulted with key individuals involved in serving boys and young men and conducted a survey of anti-trafficking service agencies to gather current information on the boys/young men being referred to them for care, the dynamics of their victimization, their most pressing needs, the services/programs being offered, and gaps in service in their respective locations. Among other relevant findings, one commonality among the boys and young men served by the responding agencies was a history of sexual abuse. Findings inform service providers and contribute to advocacy efforts and policy recommendations at the local, state, and federal levels.

Family Sex Trafficking Among the Bedia Caste of India: Defying the Dominant Human Trafficking Discourse

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.

Physical Disabilities and Low Cognitive Ability Increase Odds of Minor Sex Exchange among Adolescent Males in the United States

Disability is a well-established risk factor for sexual violence victimization among both male and female children. Some research indicates that adolescent females with disabilities are at higher risk of experiencing minor sex exchange (a form of minor sex trafficking victimization) compared to females without disabilities, but there is a dearth of similar research among adolescent males. This study investigates whether physical disability and low cognitive ability are related to sex exchange among minor adolescent males. This cross-sectional analysis using data from a nationally representative cohort study, The National Longitudinal Study of Adolescent to Adult Health (Add Health), included 4,401 male participants who were age 18 or younger at Wave II. Unadjusted and adjusted logistic regression models estimated the odds of adolescent experiences of sex exchange by physical disability and cognitive ability. Both severe physical disability and low cognitive ability in adolescent males were significantly associated with increased odds of exchanging sex, results similar to those found in studies of adolescent females. Because of these associations for both males and females, disability should be taken into account when designing and implementing prevention and intervention programs related to sex trafficking. These results underscore the importance of addressing system-wide gaps contributing to the relationship between disability and the involvement of minors in commercial sex exchange.

Double-Edged Sisterhoods: Transgender Identity, Peer Groups and the Commercial Sexual Exploitation of Transgender Girls

One of the existing gaps in the literature on the commercial sexual exploitation (CSE) of children is on transgender (trans) girls. Most of the available literature is heavily skewed toward experiences of cisgender girls. However, there is an undeniable need to understand the experiences of trans children given their unique experiences and vulnerabilities to CSE related to their identity. This article is a case study on the complex interaction between trans identity, peer influence, and other micro, meso, and macro factors that have predisposed trans girls to CSE. The paper is based on interviews with six trans girls, complemented by interviews with four social workers, research notes, and a review of related literature. Data was analyzed thematically. Based on the findings, peer groups provide critical support to trans girls, particularly, in terms of trans identity formation, gender transition information, security and protection, and other forms of support. Ironically, they play the contradictory role of priming and initiating them to CSE. Various structural and personal factors have compounded these and predisposed them to victimization. An interplay of macro (societal), meso (interpersonal), and micro (individual) factors have come into play in the commercial sexual exploitation of these trans girls.

A Single-Case Series Trial of Emotion-Regulation and Relationship Safety Intervention for Youth Affected by Sexual Exploitation

Child sexual exploitation (CSE) is a significant global problem. Interventions implemented with youth affected by CSE frequently target singular adjacent issues (e.g., substance misuse or running away); however, research indicates these interventions are most efficacious when they simultaneously treat CSE sequelae (e.g., emotion dysregulation) paired with relationship skill-building; yet few such interventions exist. Furthermore, the evidence-based reports on CSE research currently lacks rigorous research methods, such as the use of validated measures and the provision of robust outcome data. The current study aimed to implement a combined emotion regulation and safe-relationships intervention (ERIC + YR: emotion regulation, impulse control and ‘your relationships’) in a community service providing outreach for young women affected by CSE. A randomised single-case series design was used to test the effects of ERIC + YR on emotion regulation strategies, psychological wellbeing, relationship safety knowledge and behaviours, across repeated measurements for young women affected by CSE (N = 2; Mage = 18.00). Phase A consisted of baseline measures for two to three weeks. Phase B consisted of 8-sessions of ERIC + YR delivered across three to six weeks by practitioners who had undertaken ERIC + YR training. Data collection included pre/post intervention measures as well as a daily questionnaire delivered via a smartphone application. While results showed clinically significant and reliable improvements in psychological wellbeing, no other outcome measures showed change between pre and post-intervention. The current study contributes to the evidence-base as an initial step in illuminating how an empirically driven intervention can be delivered as an adjunctive treatment for youth affected by CSE. Implications inform the current evidence-base, with future directions for intervention research discussed.

Correlates of Exchanging Sex for Drugs or Money for Adolescent Males: A Hidden Population

Research from prostitution, sex trafficking, and commercial sexual exploitation (CSE) literature have found risk factors that can lead to both male and female youth becoming involved in this sex trade. These behaviors have been clearly defined and institutions have begun to address known risk factors. Youth who have reported involvement in trading/exchanging sex still remain hidden with limited information known about this group. The exchanging/trading sex literature has failed to explore correlates of involvement for adolescent males. This study explores factors found in prior research related to prostitution, sex tracking, and CSE to begin to understand adolescent males who exchanged sex for drugs or money. A secondary data analysis was used to examine the exchange of sex for male youth aged 12 to 18 in the United States. Results reveal that sexual activities were significant in predicting exchanging sex indicating a need for a more in-depth analysis of current and potential correlates for males.

Understanding factors associated with re-referral of youth for commercial sexual exploitation

BACKGROUND

Since the passage of the Victims of Trafficking and Violence Prevention Act of 2000 in the United States, awareness has increased about the problem of commercial sexual exploitation of children (CSEC). Moreover, United States Federal law calls upon child welfare agencies to establish policies and practices that help identify and provide services to minors at risk of CSEC. Although awareness has increased about the problem of CSEC, little attention has been paid to understanding why some youths are re-referred to CSEC programs after initial referral and intervention.

OBJECTIVE

The present study examines which factors drive re-referrals of youths for CSEC concerns.

PARTICIPANTS AND SETTING

Data about a population of high-risk youths (n = 416) referred to a CSEC-specific program in the Northeast of the United States between 2011 and 2018.

METHODS

Using logistic regression analyses, we investigate what factors are associated with youth having multiple referrals.

RESULTS

Youths with multiple referrals were more likely to have histories of missing from care (OR = 2.996, p < 0.001), substance misuse (OR = 2.802, p < 0.01), and greater agency involvement (OR = 1.260, p < 0.05). However, youths with multiple referrals were not at heightened risk of CSEC as compared to youths that were not re-referred.

CONCLUSION

The results demonstrate that re-referred youths meet the profile of a victim as depicted on screening and assessment instruments, which has important implications for victim services and referral systems dedicated to identifying CSEC and protecting youths who may experience re-victimization for CSEC.

Examining Commonly Reported Sex Trafficking Indicators From Practitioners' Perspectives: Findings From a Pilot Study

Commonly reported sex trafficking indicators have been disseminated widely by government and non-governmental organizations in trainings aimed to increase identification and referral to resources. However, very little research evaluates such indicators. Drawing from survey responses of 86 social service providers, health care practitioners, and justice system officials in a Midwestern City, this pilot study aimed to examine: (a) the pervasiveness of the commonly reported indicators, (b) the salience of domains of indicators, and (c) the extent to which indicators differ across service populations (U.S.-born minors, U.S.-born adults, foreign born minors, and foreign born adults). The most commonly identified indicators included mental health symptoms of depression (M = 3.82); low self-esteem (M = 3.59); anxiety (M = 3.55); low levels of interpersonal trust (M = 3.52); sense of fear (M = 3.36); feelings of shame or guilt (M =3.34); isolation from family, friends, and communities (M = 3.3); and fear/distrust of law enforcement (M = 3.80). The least commonly identified indicators included exhibiting low English proficiency (M = 1.62), previous history of loitering charges (M = 1.74), presenting false documents (M = 1.85), presence of tattoos or branding (M = 1.89), presenting delayed cognitive development (M = 1.91), being unaware of one's location (M = 1.94), owing large debt (M = 1.95), previous history of prostitution or drug charges (M = 1.98, M = 2.01), and physical evidence of torture (M = 2.07). The mental health domain was identified as especially common among U.S.-born adults (M = 3.07). Criminal justice involvement was identified as less common among foreign-born minors (M = 1.82) and foreign-born adults (M = 1.96). The most commonly identified indicators, according to the service providers, health care workers, and justice system officials who work with them, are inconsistent with many of the indicators that are used frequently across governmental and community trainings. Trainings focusing on diverse case examples of trafficking may be important in strengthening identification of sex trafficked individuals, as well as accounting for regional contexts.

Frameworks and Theories Relevant for Organizing Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking Risk Factors: A Systematic Review of Proposed Frameworks to Conceptualize Vulnerabilities

The commercial sexual exploitation of children (CSEC) and domestic minor sex trafficking (DMST) are abusive and exploitative practices occurring to children and youth across the United States. Prevention efforts should understand the factors that increase vulnerability and how these factors interact to eventually lead to exploitation. Understanding the mechanisms of action of these factors is best done within relevant frameworks and models. This review summarizes proposed frameworks for these vulnerabilities as collected via a systematic literature review. Fifteen studies capturing 12 frameworks or theories were selected for inclusion having met the following criteria: original research studies published in English from January 2010 to September 2017 with titles or abstracts that indicated a focus on the risk factors, vulnerabilities, or statistics of CSEC/DMST; a domestic focus on CSEC/DMST (for U.S.-based journals) with findings that did not combine associations between minors and adults in the study; and inclusion or mention of frameworks or theories which considered potential vulnerabilities prior to exploitation. Highly applicable frameworks include the life-course perspective, ecological model, multilevel model, ecodevelopment model, traumagenic factors, and general strain theory. Others found by this review include the age-graded theory of informal social control, career criminal paradigm, revictimization theory, an economic model, feminist theory, and a rights-based model. By mapping known risk factors to their appropriate place in the reviewed and relevant frameworks, this article seeks to enhance our understanding of the connections between and mechanisms of these risk factors, while also clarifying areas where prevention efforts can be targeted.

Individual and Parental Risk Factors for Sexual Exploitation Among High-Risk Youth in Uganda

This study examined risk factors to determine associations with commercial sexual exploitation of children and youth (CSEC) in a convenience sample of adolescents living in the slums in Kampala, Uganda. Individual-level factors included demographic, adverse experiences (ever living on the streets; victim of dating violence, parental abuse, or rape), and behavioral risk (social media, alcohol use, age at first intercourse). Parental-risk factors included parent alcohol use and approval attitudes toward youth sex. Analyses included those who self-reported sexually active adolescents (n = 593) of whom 39% reported CSEC history. CSEC was significantly associated with being female (odds ratio [OR] = 6.85, 95% confidence interval (CI) = [4.22, 11.12]), living on the streets (OR = 2.68; 95% CI = [1.65, 4.36]), using social media (OR = 1.48; 95% CI = [0.94, 2.35]), being a victim of physical dating violence (OR = 1.74; 95% CI = [1.08, 2.80]), and ever being raped (OR = 4.03; 95% CI = [2.51, 6.47]). Further analyses suggested differential risk associates among females and males. This study contributes to our knowledge of risk factors for CSEC among adolescents living in high-risk circumstances in low-resource countries and suggests that preventive efforts should prioritize adolescents with a history of living on the streets who engage in social media, use alcohol, and have a history of trauma.

Identifying Youth at Risk for Commercial Sexual Exploitation Within Child Advocacy Centers: A Statewide Pilot Study

Commercial sexual exploitation of children (CSEC) is a social problem in the United States that has recently received growing attention from policy makers, advocates, and researchers. Despite increasing awareness of this issue, information on the prevalence, demographic profile, and psychosocial needs of victims of CSEC is scarce. To better understand the scope of CSEC and to examine the feasibility of screening for CSEC in Child Advocacy Centers (CACs), a pilot study was initiated through Arkansas Building Effective Services for Trauma (ARBEST) to identify youth who may be at risk for commercial sexual exploitation. Data for this pilot study were collected from all of the state's CACs (n = 14) over a 6-month period. Family advocates completed a screening questionnaire adapted from Greenbaum, Dodd, and McCracken with 918 youth aged 12 to 18 years old treated at CACs. Almost 20% of youth were identified as being at high risk for experiencing CSEC. Furthermore, youth classified as high-risk for commercial sexual exploitation reported significantly more avoidance symptoms on the UCLA (University of California at Los Angeles) PTSD (Posttraumatic Stress Disorder) Reaction Index than youth classified as low-risk. The results suggest that a significant portion of youth treated at CACs in Arkansas are at high risk for experiencing commercial sexual exploitation, which may be associated with a particular pattern of trauma symptoms. These findings also lend support for the feasibility and utilization of a screening questionnaire as part of routine care in CACs to potentially identify youth at risk for CSEC.

Vulnerabilities Relevant for Commercial Sexual Exploitation of Children/Domestic Minor Sex Trafficking: A Systematic Review of Risk Factors

The commercial sexual exploitation of children (CSEC) and domestic minor sex trafficking (DMST) occur across the United States, violating the rights and health of far too many children and youth. Adequate prevention efforts should seek to understand the factors that make minors vulnerable to sexual exploitation in order to properly design programs to prevent victimization. This review presents the identified risk factors collected via a systematic literature review. Following full-text review, 15 studies were selected for inclusion by meeting the following criteria: original quantitative or qualitative research studies published in English from January 2010 to September 2017 with titles or abstracts that indicated a focus on the risk factors, vulnerabilities, or statistics of CSEC/DMST and a domestic focus on CSEC/DMST (for U.S.-based journals) with findings that did not combine associations between minors and adults in the study. Relevant risk factors and vulnerabilities found in this review include child abuse and maltreatment, caregiver strain, running away or being thrown away, substance use, peer influence, witnessing family violence or criminality, poverty or material need, difficulty in school, conflict with parents, poor mental health or view of self, involvement in child protective services, involvement in juvenile detention or delinquency, early substance use, and prior rape or adolescent sexual victimization.

The Impact of Childhood Abuse on the Commercial Sexual Exploitation of Youth: A Systematic Review and Meta-Analysis

Scholars and practitioners have drawn attention to the issue of commercial sexual exploitation (CSE) of minors, yet we continue to lack a clear understanding of which factors increase a minor's risk to this type of victimization. The current article reviews the literature about the impact of sexual, physical, or emotional abuse on the risk of CSE. The study utilizes quantitative meta-analytical techniques to estimate an overall impact of prior abuse. Nineteen studies were selected after a comprehensive search of electronic databases covering the fields of social science, criminology, psychology, or related fields. To be included in the analyses, all articles had to measure the direct impact of sexual, physical, and/or emotional abuse on minor's risk to CSE, utilizing multivariate techniques and presenting statistical metrics to assess the impact of prior abuse. Key findings demonstrate that sexual abuse considerably increases the risk of exploitation, especially among female youth in the United States. Physical and emotional abuse show negligible or no significant independent impacts, even though a few studies have begun to suggest that experiencing multiple types of childhood abuse may aggravate a risk of sexual exploitation. Our findings can guide further research on the impact of prior victimizations and inform screening instruments that are being developed to identify youth at risk of CSE.

Demographic and Psychosocial Factors Associated With Child Sexual Exploitation: A Systematic Review and Meta-analysis

IMPORTANCE

Although research has examined factors associated with child sexual exploitation (CSE), consensus is lacking in regard to which factors should be prioritized, thereby hindering policy reform, prevention efforts, and development of early detection and intervention.

OBJECTIVE

To provide a meta-analytic synthesis of studies examining factors associated with CSE and to quantify their relative importance.

DATA SOURCES

Electronic databases searched to June 2019 included Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Informit, yielding 396 nonduplicative records. Literature search was performed in July 2019.

STUDY SELECTION

Inclusion criteria were quantitative investigations of sexual exploitation and mean sample age of 18 years or younger.

DATA EXTRACTION AND SYNTHESIS

Literature review and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Thirty-seven studies met final inclusion criteria. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive odds ratios (ORs) for each factor. Data were analyzed from September 1 to October 28, 2019, and prediction intervals calculated in June 2020.

MAIN OUTCOMES AND MEASURES

Child sexual exploitation, defined as coerced sexual acts between a child or a young person (aged ≤18 years) and an individual or a group in exchange for money, gifts, substances, or other commodities and associated factors.

RESULTS

Thirty-seven unique studies were included with a total of 67 453 unique participants (mean [SD] age of 16.2 [2.5] years; 49.9% female). Fifty-two factors associated with CSE were included in the meta-analysis. The strongest factors significantly associated with exposure to sexual exploitation were engagement in sexual risk behaviors (OR, 6.31 [95% CI, 3.12-12.76]; P < .001), having more than 5 sexual partners (OR, 5.96 [95% CI, 1.63-21.87]; P = .007), a diagnosis of posttraumatic stress disorder (OR, 5.29 [95% CI, 3.40-8.22]; P < .001), historical exposure to child pornography (OR, 5.50 [95% CI, 0.99-30.53]; P = .049), and a history of childhood sexual abuse (OR, 3.80 [95% CI, 3.19-4.52]; P < .001). A number of other potentially modifiable factors had moderate to strong associations.

CONCLUSIONS AND RELEVANCE

In this systematic review and meta-analysis, children and adolescents affected by sexual exploitation showed high levels of sexual risk taking, multiple sexual partners, posttraumatic stress disorder, exposure to child pornography, and childhood trauma. Accurate detection of CSE may prevent this type of sexual violence occurring to adolescents and/or provide opportunities for intervention and recovery. Therefore, prevention and intervention efforts will likely benefit from integrating these factors into screening, assessment, and treatment.

Enhancing the Identification of Commercial Sexual Exploitation Among a Population of High-Risk Youths Using Predictive Regularization Models

Despite an increasing awareness about the existence and harms of commercial sexual exploitation of children (CSEC), the identification of victims remains a challenge for practitioners, hindering their ability to provide appropriate services. Tools that gauge risk of CSEC support the identification of victims but are underdeveloped because most tools assess risk of CSEC within a general youth population. An understanding of what predicts actual CSEC victimizations among youths at higher risk of CSEC due to experiences of childhood adversities has been left unassessed. Research in this area is limited in part because traditional methods do not allow for an assessment of the unique impact of childhood adversities that tend to co-occur. To address these difficulties, the current study applied predictive regularization methods to identify the most decisive risk items for CSEC. Proximal risk of CSEC was assessed among 317 youths who were referred to a specialized program in the Northeast of the United States due to suspicion of CSEC. With an innovative methodological approach, this study seeks to prompt other scholars to examine risk utilizing novel techniques and provides a foundation for the development of concise tools that assess risk of CSEC among populations of youths at higher levels of risk.

An Intersectional Content Analysis of Inclusive Language and Imagery Among Sex Trafficking-Related Services

The extent to which services are available for and inclusive of diverse survivors of sex trafficking remains understudied. This content analysis in a U.S. Midwestern region designated as a hub explores the availability of sex trafficking-specific organizations and perceived inclusivity of organizations regarding diverse identities (including Lesbian, Gay, Bisexual, Trans, or Queer [LGBTQ]+ and racial/ethnic groups). 186 regional organizations were analyzed, of which only 7 were trafficking specific. Of nontrafficking organizations (n = 179), less than 12% (n = 21) stated that they provided services to individuals who identify as LGBTQ+, 6% (n = 10) included LGBTQ+ symbols/language, 36% (n = 65) featured perceived People of Color (POC). Lack of inclusive language, photos, and symbols may contribute to trafficking survivors who identify as POC, English language learners, or as LGBTQ+ feeling as though services do not apply to them. Implications are discussed.

Assessment of commercially sexually exploited girls upon entry to treatment: Confirmed vs. at risk victims

BACKGROUND

Research has documented many risk factors for commercial sexual exploitation of children as well as serious emotional and behavioral consequences for such victims.

OBJECTIVE

This study aims to provide an understanding of risk factors and symptom presentation of girls who are victims or at risk for commercial sexual exploitation.

PARTICIPANTS AND SETTING

Ninety-six girls (12-18 years) who were referred to a child advocacy center's specialized treatment program for commercially sexually abused girls served as participants (56 confirmed victims, 40 at risk of commercial sexual exploitation).

METHODS

At intake participants were administered the Youth Self-Report, the Trauma Symptom Checklist for Children, and the UCLA Post-Traumatic Stress (PTSD) Reaction Index for DSM -5. Parents or guardians were asked to complete the Child Behavior Checklist and the UCLA PTSD Reaction Index for DSM - 5(Parent/Caregiver).

RESULTS

Intake information revealed significant differences between groups with confirmed victims reporting higher levels of sex work, kidnapping, physical abuse, physical assault and sexual abuse by a non-family member (p < .05) than at risk victims. All participants were exposed to traumas, were racially and ethnically diverse and lived primarily with their families. At risk girls were significantly more likely to be in school than the confirmed victims. The UCLA PTSD Index revealed that the confirmed victims had experienced significantly more physical abuse than the at-risk group and 26.7% of confirmed victims and 7.7% of the at risk victims met the DSM criteria for PTSD. Twenty percent of the confirmed victims met criteria for Dissociative subtype, while only 7.7% of at risk victims did. On the CBCL, victims from both groups scored in the clinical range on Externalizing Problems and Total Problems and the at risk group scored significantly higher on the School subscale than the confirmed victims group.

CONCLUSION

Commercially sexually exploited girls have experienced multiple traumas in their lives and display emotional and behavioral difficulties. Early detection of girls who may be at risk for sexual exploitation may allow for prevention and intervention as these girls also have traumatic backgrounds and display similar symptoms.

Exploring relationships as mediators of treatment outcomes among commercially sexually exploited youth

BACKGROUND

Research indicates that youth exposed to commercial sexual exploitation tend to have extensive histories of trauma, including physical abuse, sexual abuse, and neglect, which increases their vulnerability to exploitation. Trauma literature finds youth who present to treatment with greater behavioral health needs tend to have higher trauma scores than youth with fewer behavioral health needs (Copeland et al., 2007; Finkelhor et al., 2007).

OBJECTIVE

There is, however, limited research on the role of youth strengths as a buffer against the outcomes associated with trauma. With this in mind, the purpose of this study was to examine the relationship between Adverse Childhood Experiences (ACE scores) and youth outcomes such as risk behaviors, behavioral needs, and impairment in functioning across major life domains. Secondly, we explored how this relationship might be better explained by examining youth strengths as mediators-specifically, peer relationships and the stability of significant relationships in the youth's life.

PARTICIPANTS AND SETTING

Data on clients served in a treatment program specialized for commercially sexually exploited youth were used for this research.

RESULTS

Results indicated that youth with higher ACE scores had a greater number of risk behaviors, behavioral needs, and impairment in functioning across major life domains. Findings of the mediation analysis provide some support that peer relationships and relationship stability, at least in part, mediates the relationship between ACEs and youth outcomes. Post hoc analyses indicated youth strengths mediated 9-18% of the total effect of ACE scores on youth outcomes.

CONCLUSIONS

Developing peer relationships and sustaining significant relationships can mitigate some of the adverse effects of trauma experienced by exploited youth.

Control creep and the multiple exclusions faced by women in low-autonomy sex industry sectors

Abstract This article unites the co-authors’ years of empirical research with women in policed, stigmatized, and low-autonomy sex industry sectors in Brazil, China, Italy, and the United States to identify six prevalent forms of exclusion: economic, intersectional, health, safety, public vilification, and policing. We analyze the distinct manifestations of these exclusionary forces in all four sites to introduce criminal creep as theoretical shorthand for the global seepage of ideological, structural, and interpersonal exclusionary forces into social life, professional practice, and socio-legal procedures that marginalize women in the sex industry as victim-criminals in need of rehabilitation. Uniting and building upon literature on feminist engagement with and critiques of citizenship, conceptual uses of “creep”, carcerality and crimmigration, and critical anti-trafficking studies, we argue that criminal creep facilitates a perfect storm of exclusion that promotes sex workers’ de facto and de jure exclusion from citizenship through a set of wide-ranging set of harms. Furthermore, we identify “control creep” as a factor limiting - even radically - the political organization of and social scientific production regarding the vulnerable populations anti-sex work and anti-trafficking laws are supposedly designed to aid.

Examining the Impact of Victimization on Girls' Delinquency: A Study of Direct and Indirect Effects

Previous research has acknowledged that there is a relationship between victimization and later delinquency, but the specific attributes of this relationship are unclear because measures of both direct and indirect victimization are rarely explored in a single study. We included both indirect and direct victimization to examine which form of victimization was a stronger predictor of substance use, fighting, running away, and sex work among girls committed to a juvenile justice facility. Findings indicated that direct victimization was typically a more salient predictor of delinquency than indirect forms of victimization. Further, running away and sex work appear to be unique outcomes that are particularly likely when girls experience direct rather than indirect victimization. Findings are summarized with implications for health and public policy.

Comparing cumulative index and factor analytic approaches to measuring maltreatment in the National Longitudinal Study of Adolescent to Adult Health

Child maltreatment is a complex and multifaceted construct in need of advanced statistical techniques to improve its measurement. The current study compared the predictive utility of a cumulative index to a factor analytic approach for constructing a measure of maltreatment. Data were from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health (Wave III: n = 14,800; Wave IV: n = 12,288). As adults, participants retrospectively reported on their childhood experiences of physical abuse, sexual abuse, emotional abuse, physical neglect, supervisory neglect, and social services investigations. Both the cumulative index and a two-factor solution showed evidence of convergent validity, predicting lifetime incidence of homelessness, being paid for sex, and various measures of running away or living apart from biological parents, and prospectively predicting depression, substance use, and criminal behavior. The latent variables, derived from a factor analytic approach, had greater explanatory power for many outcomes compared to the cumulative index, even when controlling for sociodemographic variables. Results suggest that factor analysis is a better methodology than a cumulative index for measuring maltreatment in large datasets when explanatory power for external outcomes is of greatest concern.

Evaluation of a Tool to Identify Child Sex Trafficking Victims in Multiple Healthcare Settings

PURPOSE

Estimate the prevalence of child sex trafficking (CST) among patients seeking care in multiple healthcare settings; evaluate a short screening tool to identify victims in a healthcare setting.

METHODS

This cross-sectional observational study involved patients from 16 sites throughout the U.S.: five pediatric emergency departments, six child advocacy centers, and five teen clinics. Participants included English-speaking youth ages 11-17 years. For emergency department sites, inclusion criteria included a chief complaint of sexual violence. Data on several domains were gathered through self-report questionnaires and examiner interview. Main outcomes included prevalence of CST among eligible youth; sensitivity, specificity, positive/negative predictive values, and positive/negative likelihood ratios for a CST screening tool.

RESULTS

Eight hundred and ten participants included 91 (11.52%) youth from emergency departments, 395 (48.8%) from child advocacy centers, and 324 (40.0%) from teen clinics. Overall prevalence of CST was 11.1%: 13.2% among emergency department patients, 6.3% among child advocacy center patients, and 16.4% among teen clinic patients, respectively. The screen had a sensitivity, specificity, and positive likelihood ratio of 84.44% (75.28, 91.23), 57.50% (53.80, 61.11), and 1.99% (1.76, 2.25), respectively.

CONCLUSIONS

This study demonstrates a significant rate of CST among patients presenting to emergency departments (for sexual violence complaints), child advocacy centers, and teen clinics. A six-item screen showed relatively good sensitivity and moderate specificity. Negative predictive value was high. Intervention for a "positive" screen may identify victims and help prevent high-risk youth from becoming victimized. This is one of the first CST screening tools specifically developed and evaluated in the healthcare setting.

Survivors’ Perspectives on Recovery From Commercial Sexual Exploitation Beginning in Childhood

This study explored the process of exiting and recovery from commercial sexual exploitation beginning in childhood, utilizing semistructured interviews with 11 adult female survivors who had been out of the commercial sex industry for at least six months. The narratives were analyzed using consensual qualitative research. Participants described a complex interface of internal motivation and external resources in the exiting process. They identified a need for comprehensive, nonjudgmental services across all stages of change, in order to support a profound reconstruction of identity and community. Subgroup comparisons revealed that women who were exploited at younger ages were more vulnerable to coercive and dehumanizing exploitation and required especially intensive services. These results support the methods of many survivor-led programs for sexually exploited youth. Implications of survivors’ perspectives for counseling, research, and advocacy are discussed.

Trafficking and Health: A Systematic Review of Research Methods

Trafficking in persons (TIP) is a human rights violation with serious public health consequences. Unfortunately, assessing TIP and its health sequelae rigorously and reliably is challenging due to TIP's clandestine nature, variation in definitions of TIP, and the need to use research methods that ensure studies are ethical and feasible. To help guide practice, policy, and research to assess TIP and health, we undertook a systematic literature review of 70 peer-reviewed, published articles to (a) identify TIP and health research methods being used, (b) determine what we can learn about TIP and health from these varied methodologies, and (c) determine the gaps that exist in health-focused TIP research. Results revealed that there are various quantitative and qualitative data collection and analysis methods being used to investigate TIP and health. Furthermore, findings show that the limitations of current methodologies affect what is known about TIP and health. In particular, varying definitions, participant recruitment strategies, ethical standards, and outcome measures all affect what is known about TIP and health. Moreover, findings demonstrate an urgent need for representative and nonpurposive recruitment strategies in future investigations of TIP and health as well as research on risk and protective factors related to TIP and health, intervention effectiveness, long-term health outcomes, and research on trafficked people beyond women trafficked for sex. We offer recommendations for research, policy, and practice based on review results.

Sex Trafficking of Girls With Intellectual Disabilities: An Exploratory Mixed Methods Study

Few researchers have examined sex trafficking of girls with intellectual disabilities (IDs). Drawing from 54 juvenile sex trafficking (JST) cases, this exploratory, mixed methods study compared 15 JST cases involving girls with ID with 39 JST cases involving girls without ID. Findings revealed a disproportionate risk for exploitation in JST for girls with ID, endangering circumstances creating vulnerability among this population, as well as the perpetrator-victim dynamics that complicate prevention and intervention. Complicating dynamics included victim lack of awareness of exploitation and its endangerments, inability of victims to self-identify, and the relative ease with which traffickers manipulated these girls. The disproportionate risk faced by girls with ID substantiates the need for enhanced safeguards to prevent sexual exploitation of girls with ID including stiffer penalties for those who exploit and buy sex with youth with disabilities.

Domestic Minor Sex Trafficking

Commercial sexual exploitation of children and child sex trafficking is a major public health issue globally. Domestic minor sex trafficking has become increasingly recognized within the United States. Sexually exploited minors are commonly identified as having psychosocial risk factors, including histories of abuse or neglect, running away, substance use or abuse, and involvement with child protective services. Youth also suffer a variety of physical and mental health consequences, including posttraumatic stress disorder, depression, anxiety, and suicidality. Child psychiatrists and other medical providers have the opportunity to identify, interact, and intervene on behalf of involved and at-risk youth.

Federal and State Responses to Domestic Minor Sex Trafficking: The Evolution of Policy

Domestic minor sex trafficking (DMST) is a rapidly growing problem in the United States, yet legislative efforts to address victim needs have begun only recently. DMST is an issue that spans several areas of social work practice, as emerging research shows that most children and youths exploited in commercial sex have typically experienced prior abuse, neglect, or other forms of trauma. Many have been involved with the child welfare and juvenile justice systems and are often lured by promises of love, security, protection, and belonging. Policy development to address DMST is still relatively new and evolving at both federal and state levels, but the general trend is to recognize such minors as victims rather than perpetrators of sex crimes. In this article the authors trace the development of legislation addressing DMST at the federal and state levels, with a particular focus on states' "safe harbor laws" that provide limited or total criminal immunity and a varying range of services to victims. Although space limitation precludes a detailed discussion of specific state laws, comparative analysis of representative provisions are discussed, highlighting social work application and further policy and research implications.

Youth Involved in Prostitution (YIP)

Since the Victims of Trafficking and Violence Protection Act (TVPA) legally defined anyone under the age of 18 who is induced to engage in a commercial sex act as a sex trafficking victim, there has been a shift in the conceptualization of youth involved in prostitution (YIP). While YIP were historically viewed and treated as juvenile delinquents, this shift has called for the processing and treatment of YIP as victims in need of services. Despite these changes, the results of the present study suggest that there have been little changes in the interactions that YIP have with police and social service agencies. Also, similar to the participants who were involved in prostitution as minors before the adoption of the TVPA, those who were involved in prostitution as minors after the TVPA strongly reject the victim label.

Sexually Transmitted Infections In A Sample Of At-Risk Youth: Roles Of Mental Health And Trauma Histories

Little is known about whether there are specific subpopulations of youth with known problem behaviors that are more likely to engage in sexual risk behaviors. This study's sample (n=4,117) was drawn from a larger longitudinal administrative data, consisting of young adults with child abuse and/or poverty histories and records of some form of high-risk behavior or mental health diagnosis during adolescence. A cluster-controlled, logistic regression resulted in eleven statistically significant relationships. Youth treated for a mental health disorder and experienced multiple forms of abuse were more likely to be treated for Sexually Transmitted Infections (STIs). Youth who were delinquent,, treated for substance abuse and had substance use related offenses were less likely to be treated for STIs. Youth treated for STIs were more likely to be identified through mental health systems or child protective services system than through known delinquent behaviors. Health care providers treating youth for STIs should explore the possible role of mental health and trauma histories.

From Exploitation to Industry: Definitions, Risks, and Consequences of Domestic Sexual Exploitation and Sex Work Among Women and Girls

In the last 15 years, terms such as prostitution, sex trafficking, sexual exploitation, modern-day slavery, and sex work have elicited much confusion and debate as to their definitions. Consequently several challenges have emerged for both law enforcement in the prosecution of criminals and practitioners in service provision. This article reviews the state of the literature with regard to domestic, sexual exploitation among women and girls in the United States and seeks to (1) provide definitions and describe the complexity of all terms relating to domestic sexual exploitation of women and girls in the United States, (2) explore available national prevalence data according to the definitions provided, and (3) review the evidence of mental health, social, and structural risk factors at the micro-, mezzo-, and macrolevels.

Risk and resiliency factors influencing onset and adolescence-limited commercial sexual exploitation of disadvantaged girls

BACKGROUND

Previous research into age-related variables relevant to girls and young women being involved in commercial sexual exploitation (including prostitution) has not distinguished between its onset and limitation to adolescence and its early onset and persistence into adult life.

AIMS

The aims of this study were to examine variables associated with adolescent versus adult onset of commercial sexual exploitation and identify potential risk and resiliency factors differentiating adolescence-limited sexual exploitation and early-onset-adult persistent exploitation.

METHOD

Interviews with 174 vulnerable mostly African-American women, 23% of whom reported commercial sexual exploitation in adolescence and/or adulthood, yielded data, which were analysed using multinomial logistic regressions.

RESULTS

Adolescent sexual victimisation, younger age at first alcohol/drug use, being a victim of intimate partner violence and sense of stigmatisation of sexual self/others were all variables associated with adolescent onset of commercial sexual exploitation. Educational attainment differentiated adolescence limited from adolescent-adult persistent exploitation; exploitation had ceased by adulthood among over two-thirds of those who completed at least high school education, but only 13% of those exploited into adult life had finished high school.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

As level of education was linked to cessation of exploitation by adulthood, support for vulnerable girls to complete education at least to high school level may be protective.The link between early onset of substance misuse and persistent exploitation suggests that education and support specifically targeted within this field could reduce likelihood of persistent abuse.Work directed at improvement of self-image may also reduce risk of persistent exploitation.

Commercial sexual exploitation and sex trafficking of children in the United States

Child commercial sexual exploitation and sex trafficking are global health problems requiring a multidisciplinary approach by individuals, organizations, communities, and national governments. The adverse emotional, physical, and social consequences for victims are legion and in many areas of the United States and the rest of the world, victim resources are scarce. Since violence, deprivation, abuse, and infection are so integral to the exploitation experience, victims may present for care to community and academic pediatric and adolescent health care providers. It is essential that medical professionals have the knowledge, skills, and resources to recognize victims, assess their needs, and treat them appropriately, including making key referrals for community services. However, to date medical information and resources regarding commercial sexual exploitation and sex trafficking has been sparse. There are no clinically validated screening tools specifically designed to identify victims in the health care setting and since victims seldom self-identify, it is likely that the majority of victims are unrecognized. The opportunity for comprehensive assessment and intervention is lost. Further, professionals receive little training on appropriate interview techniques for this special population, and many are ill equipped to ensure safety and optimal medical evaluation during the visit. This article provides a general overview of child sex trafficking and commercial sexual exploitation (CSEC), describing the epidemiology of international and domestic exploitation, and reviewing the challenges of conducting research on this population. The five stages of trafficking are explained, as are typical physical and emotional consequences of exploitation. The medical evaluation is described, including potential indicators of CSEC and sex trafficking, common medical presentations by victims, approaches to the comprehensive medical interview, and the appropriate medical exam with diagnostic testing and treatment. Finally, a discussion of common victim needs is provided, with a description of resources and referrals.

Age-graded risks for commercial sexual exploitation of male and female youth

Emerging evidence indicates male youth are affected by commercial sexual exploitation (CSE). However, most studies investigating risk markers influencing age of onset of CSE have focused on vulnerabilities of girls and women. Using a sample of 1,354 serious youthful offenders (of whom approximately 8% of males and females reported being paid for sex), the current study assessed whether risks associated with age of onset of CSE for girls and young women operated similarly in boys and young men. Findings showed that African American male youth were at heightened risk for CSE, while female youth of all races/ethnicities were at similar risk. For all youth, maternal substance use and earlier age of first sex were associated with early age of onset of CSE. For male youth, experiencing rape and substance use dependency were associated with early age of onset. Psychotic symptoms, likely experienced as social alienation, were associated with both early and late age of onset. For all youth, lower educational attainment was associated with CSE beginning in later adolescence or young adulthood. In addition, substance use dependency was linked to late age of onset for female youth. Implications of the study findings for theory development and application to CSE are noted.

Rationalising predictors of child sexual exploitation and sex-trading

Although there is evidence for specific risk factors leading to child sexual exploitation and prostitution, these influences overlap and have rarely been examined concurrently. The present study examined case files for 175 young persons who attended a voluntary organization in Leicester, United Kingdom, which supports people who are sexually exploited or at risk of sexual exploitation. Based on the case files, the presence or absence of known risk factors for becoming a sex worker was coded. Data were analyzed using t-test, logistic regression, and smallest space analysis. Users of the voluntary organization's services who had been sexually exploited exhibited a significantly greater number of risk factors than service users who had not been victims of sexual exploitation. The logistic regression produced a significant model fit. However, of the 14 potential predictors--many of which were associated with each other--only four variables significantly predicted actual sexual exploitation: running away, poverty, drug and/or alcohol use, and having friends or family members in prostitution. Surprisingly, running away was found to significantly decrease the odds of becoming involved in sexual exploitation. Smallest space analysis of the data revealed 5 clusters of risk factors. Two of the clusters, which reflected a desperation and need construct and immature or out-of-control lifestyles, were significantly associated with sexual exploitation. Our research suggests that some risk factors (e.g. physical and emotional abuse, early delinquency, and homelessness) for becoming involved in sexual exploitation are common but are part of the problematic milieu of the individuals affected and not directly associated with sex trading itself. Our results also indicate that it is important to engage with the families and associates of young persons at risk of becoming (or remaining) a sex worker if one wants to reduce the numbers of persons who engage in this activity.

Qualitative perspectives toward prostitution's perceived lifestyle addictiveness

BACKGROUND AND AIMS

The aim of the present study was to provide a phenomenological perspective of individuals who actively engage in street-level prostitution and identified a lifestyle addiction associated with their activities.

METHODS

We interviewed 25 women who were incarcerated in American county jails (at the time of interviews) for prostitution crimes. The transcripts were analyzed for themes that represented the shared consensus of the research participants.

RESULTS

Four negative psychological dynamics related to prostitution. First, participants described accounts of physical and emotional violence which they experienced at the hand of clients and others involved in the lifestyle. Second, interviewees explained an extreme dislike for their actions relating to and involving prostitution. These individuals did not describe themselves as being sexually addicted; sex was means to a desired end. Third, participants described how prostitution's lifestyle had evolved into something which they conceptualized as an addiction. As such, they did not describe themselves as feeling addicted to sex acts - but to lifestyle elements that accompanied prostitution behaviors. Finally, participants believed that freedom from prostitution's lifestyle would require social service assistance in order to overcome their lifestyle addiction.

CONCLUSIONS

The results show that, although the prostitutes repeatedly and consistently used the term "addiction" when describing their lifestyles, they did not meet the DSM-IV-TR criteria for addiction. Rather, they shared many of the same psychological constructs as do addicts (e.g., feeling trapped, desiring escape, needing help to change), but they did not meet medical criteria for addictive dependence (e.g., tolerance or withdrawal).

An evaluation of a child welfare training program on the commercial sexual exploitation of children (CSEC)

With the growing awareness of the nature and scope of the commercial sexual exploitation of children (CSEC) in the United States, a few state child welfare agencies have started to develop and implement training on CSEC for their social service staff. Since other state child welfare agencies may adopt a similar training model, it is important to evaluate the effectiveness of these CSEC trainings. Therefore, in the present study, we used a randomized, control group design to evaluate the effectiveness of a CSEC webinar training program for child protective service (CPS) employees. We discuss our findings and make recommendations for child welfare agencies interested in providing CSEC training to their staff. Given the lack of sophisticated research evaluating the effectiveness of child welfare training programs, in general, and CSEC training programs, more specifically, this study fills a gap in the literature and offers a training model that could be replicated with child protection systems in other states.

Commercially sexually exploited girls and participant perceptions of blameworthiness: examining the effects of victimization history and race disclosure

Prostitution among female youth has been largely misunderstood, trivialized, or ignored. Increased attention has been directed toward juvenile female delinquency, particularly related to the overlap in their status as victims and offenders. Areas in this research continue to be underinvestigated, however, especially with regard to public perceptions of commercially sexually exploited girls. The current study used survey questionnaires to examine participant perceptions of the blameworthiness of a prostituted minor while considering her victimization history disclosure and race. Results indicate that victimization history disclosure significantly reduced perceptions of blameworthiness and reduced blameworthiness operated similarly for Caucasian and African American females forced into prostitution. Further research directions are discussed.

Disrupted reinforcement learning and maladaptive behavior in women with a history of childhood sexual abuse: a high-density event-related potential study

IMPORTANCE

Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major depressive disorder (MDD), and high-risk behaviors. Despite the epidemiological data available, the mechanisms underlying these maladaptive outcomes remain poorly understood.

OBJECTIVE

We examined whether a history of CSA, particularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in reinforcement learning, and whether such dysfunction is linked to maladaptive behavior.

DESIGN

Participants completed a clinical evaluation and a probabilistic reinforcement task while 128-channel event-related potentials were recorded.

SETTING

Academic setting; participants recruited from the community.

PARTICIPANTS

Fifteen women with a history of CSA and remitted MDD (CSA + rMDD), 16 women with remitted MDD with no history of CSA (rMDD), and 18 healthy women (controls).

EXPOSURE

Three or more episodes of coerced sexual contact (mean [SD] duration, 3.00 [2.20] years) between the ages of 7 and 12 years by at least 1 male perpetrator.

MAIN OUTCOMES AND MEASURES

Participants' preference for choosing the most rewarded stimulus and avoiding the most punished stimulus was evaluated. The feedback-related negativity and error-related negativity-hypothesized to reflect activation in the anterior cingulate cortex-were used as electrophysiological indices of reinforcement learning.

RESULTS

No group differences emerged in the acquisition of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological differentiation between correct and incorrect responses (relative to controls), and (3) increased activation in the subgenual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with impairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer performance of previously rewarded, but not previously punished, trials.

CONCLUSIONS AND RELEVANCE

Irrespective of past MDD episodes, women with a history of CSA showed neural and behavioral deficits in utilizing previous reinforcement to optimize decision making in the absence of feedback (blunted "Go learning"). Although our study provides initial evidence for reward-specific deficits associated with CSA, future research is warranted to determine if disrupted positive reinforcement learning predicts high-risk behavior following CSA.