On the relationships between commercial sexual exploitation/prostitution, substance dependency, and delinquency in youthful offenders

Examining Individual and Contextual Correlates of Victimization for Juvenile Human Trafficking in Florida

Despite extant literature on individual-level risk factors for sex trafficking among children and adolescents, little is known about the impact of social and ecological contexts on risk of human trafficking victimization. The purpose of this study was to examine the correlates signaling risk of human trafficking victimization at the individual, family, social, and community levels utilizing a sample of 40,531 justice-involved male and female youth, a small fraction of whom were suspected or verified victims of human trafficking between 2011 and 2015 (N = 801, including 699 female and 102 male youth). Using this sample, we examined differences across individual, family, social, and community characteristics of youth involved in the juvenile justice system who have a history of trafficking victimization and youth without such histories. Series of logistic regression analyses were conducted using varying control groups, created through exact matching and randomized matching groups to address sample imbalances. These analyses indicate that, at the individual level, youth who had experienced childhood adversities were more likely to report human trafficking victimization. Sex differences were found regarding risk factors pertaining to the family and broader socio-ecological contexts. Female youth who had witnessed family violence had an antisocial partner or antisocial friends, or resided in a community with a greater proportion of the population being foreign-born or speaking English less than very well were at heightened risk for human trafficking victimization. Little evidence was found for community-level risk factors of victimization in this specific sample of justice-involved youth. These findings encourage more research to unpack the multilevel correlates of victimizations at the individual, family, social, and community levels, recognizing potential differences between female and male youth regarding the factors that put them at heightened risk for juvenile sex trafficking victimizations. Practice and policy should direct awareness and prevention measures to social and ecological contexts.

A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking

BACKGROUND

The child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking-or are at risk of victimization-are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement.

OBJECTIVE

Building on previous research with child welfare-and juvenile justice-involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida.

PARTICIPANTS AND SETTING

The overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses.

METHODS

Analyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system-involved children and examine predictors of child welfare, juvenile justice, and dual system involvement.

RESULTS

(1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system.

CONCLUSIONS

This study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state.

The effect of individual characteristics on susceptibility to aggressive and/or intimidating approaches: quantifying probability pathways by creating a victimization model

Background: A significant body of literature has identified multiple factors that contribute to established victimization by aggressive and/or intimidating behaviours. These studies primarily originate from the fields of intimate partner violence (IPV), bullying, sexual abuse, and/or commercial sexual exploitation (CSE), and generally focus on female victims. It appears, however, complicated to quantify the cumulative contribution of these factors on susceptibility to intimidating and/or hostile engagements on an individual level.Objective: To develop a comprehensive risk model to quantify, on an individual level, the cumulative effects of previously reported characteristics on susceptibility to aggressive/intimidating approaches, leading to victimization (e.g. in the context of IPV/sexual abuse).Methods: A Bayesian belief network was developed using data from previous studies, capturing the multivariate contribution of previously reported characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches (e.g. in the IPV/CSE context) in female victims aged 12-24 years.Results: The model showed that specific combinations of characteristics may contribute to an increased likelihood of victimization (e.g. in the context of IPV/bullying/sexual abuse or CSE). This likelihood could be quantified and categorized into specific clusters of factors differentiating between victimization by physically violent, non-physical, and/or sexual aggressive/intimidating approaches.Conclusion: The present model appears to be the first to successfully quantify the cumulative contribution of individual characteristics on the likelihood of becoming victimized by aggressive and/or intimidating approaches, typically leading to victimization. Moreover, the present scientific effort and resulting model suggest that there may be a latent variable mediating between the implemented factors and overall outcome, i.e. the susceptibility to aggressive and/or intimidating approaches. From that perspective, the model may also be considered as an initial outline to effectively indicate susceptibility to such approaches.

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.

Predictors for runaway behavior in adolescents in South Korea: national data from a comprehensive survey of adolescents

Background

Runaway behavior is reported to impede the growth, mental health development, and social adjustment of adolescents. Exposure to harmful media causes problematic behaviors in adolescents, sometimes inducing them to run away from home.

Methods

This study examined the factors influencing adolescents' runaway behavior. Utilizing the data of 11,354 adolescents from the Survey of Media Usage and Harmful Environment among Adolescents, a hierarchical logistic regression analysis was conducted using the SPSS 24.0 program.

Results

The significant predictors of runaway behavior were the grade of the adolescent, deviant behaviors (drinking, smoking), autonomous control ability, relationship with family, and harmful media (p < 0.001). This regression model explained 13.1% of the variance in runaway behavior. A significant outcome of this study is that harmful media was identified as one of the factors affecting adolescents' runaway behavior. Adjusted OR and 95% CI of harmful media was 1.23 (1.10-1.38).

Conclusion

This study showed that individual, family, social factors, and harmful media influence adolescents' runaway behavior. The results emphasize the importance of health teachers and the need for early intervention programs, for the identification and prevention of risk factors for adolescents' runaway behavior.

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.

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.

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.

Development of a Multi-Session Curriculum Addressing Domestic Minor Sex Trafficking for High-Risk Male Youth

Males, in particular adolescents and young adults, have been increasingly recognized as involved in domestic minor sex trafficking (DMST). However, there are very sparse resources and organizations that provide prevention, identification, and interventions for boys and young men who are involved in or at-risk for DMST involvement. The objective was to develop and assess an educational curriculum to prevent adolescent male involvement in DMST through a three-pronged educational approach: as victims of sexual exploitation; receiving financial benefit as exploiters; as buyers of sex. Through quality improvement cycles, changes were made to enhance the curriculum by utilizing the outcome measures of participant questionnaires and feedback from a steering committee of clinical experts. Male youth at the state's juvenile detention center were asked to participate in pilot groups, as they were identified as a high-risk population of adolescents to become involved. The curriculum was modified by adding sessions, including additional community guest speakers, and providing a more holistic educational experience that involves trafficking prevention from both a victimization and perpetration standpoint. Our goal is to expand this educational opportunity to be utilized in multiple settings (e.g., schools, hospitals) across the country.

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.

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

Objective

We gathered the perspectives of girls and young women affected by commercial sexual exploitation (CSE) to understand the acceptability and feasibility of mobile health (mHealth) for enhancing access and engagement in health and social services during judicial involvement.

Methods

We conducted four focus groups with 14 girls and young women (ages 14 to 21) with self-identified CSE histories.

Results

Participants perceived mHealth as viable for accessing and engaging providers, and health and social services, and navigating judicial systems. Participants expressed that mHealth tools increased self-efficacy and self-navigation of required services. Recommendations to improve mHealth functionality included push-notification appointment reminders, wellness and safety promotion, enhancement of provider communication, peer-to-peer support, and access to health education and community resources.

Conclusions

Findings provide insight for how mHealth may be leveraged to increase self-management skills, fulfill judicial obligations, and improve access and engagement in health and social services for CSE-affected girls and young women.

Personality traits and male vulnerability to commercial sexual exploitation victimisation

BACKGROUND

There has been little research into whether personality traits increase vulnerability to serious forms of recurring victimisation, such as commercial sexual exploitation of young people.

AIMS

To investigate whether impulsivity, emotional dysregulation or high psychopathy scale scores indicative of personality traits increase vulnerability to commercial sexual exploitation.

METHODS

Data were used from the longitudinal Pathways to Desistance Study 1170 justice-involved men who were aged 14-19 at baseline data collection. Ninety-eight (8%) reported having been commercially sexually exploited during adolescence or young adulthood. We investigated whether personality traits measured at baseline were related to such victimisation.

RESULTS

Results of binomial logistic regression among the young men in this sample indicated that Factor 1 scores on the Psychopathy Checklist-Youth Version (PCL-YV), reflecting affective and interpersonal features, are associated with having been commercially sexually exploited, while impulsivity, emotional dysregulation and Factor 2 PCL-YV, reflecting antisocial activities, were not. Having been a victim of other violence and being a member of a cultural or ethnic minority group were also independently related to being exploited.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our findings show that individual differences in personality, such as fearless temperament and boredom susceptibility, could differentially disadvantage young people, and put them at greater risk of commercial sexual exploitation. This knowledge could be beneficial to prevention efforts supporting male adolescents at risk for victimisation by commercial sexual exploitation, and to shed new light on the theoretical understanding of vulnerability to it.

Substance Use and Childhood Sexual Abuse among Girls Who Are Victims of Commercial Sexual Exploitation

Background: Girls who are victims of commercial sexual exploitation (CSEC) have high rates of substance use and childhood sexual abuse. We compared girls who are victims of CSEC and matched controls on childhood sexual abuse and substance use, and examined if substance use is associated with increased CSEC odds. Methods: Data were retrospectively collected from assessments completed by 80 girls who were referred by the Department of Child Services (Mage=15.38, SD=1.3, 51.9%White). Results: CSEC girls reported higher substance use (t=-2.76, p=.007), and were more likely report childhood sexual abuse (χ2=6.85, p=.009). The relationship between childhood sexual abuse and substance use outcomes did not differ across the groups (b's 0.12-1.38, p's .22-.85). Substance use disorder diagnosis was associated with greater odds of being in the CSEC group (ORs 2.95-6.72, p's<.05). Conclusions: Substance use and childhood sexual abuse are important risk indicators for exploitation, but should not be used to reduce criminality of CSEC perpetrators.

Sex Trafficking in the United States: A Scoping Review

PURPOSE

Human trafficking is a public health social work issue. This review aimed to present the current state (nature and extent) of sex trafficking research, categorize best practices, and identify recommendations for professionals.

METHODS

Comprehensive literature searches of online databases were conducted to identify eligible articles from January 2000 to March 2019.

RESULTS

The search yielded 467 studies, 87 met the predetermined criteria for inclusion. Seven themes identified: awareness, identification, at-risk populations, health issues, implementation of trafficking legislation, service and program implementation, and exploiters.

DISCUSSION AND IMPLICATIONS FOR PRACTICE

Findings indicate the need for additional research to determine the most effective practices to increase awareness and identification, widespread TVPA implementation, reduce risk factors and resulting health disparities, offer services to survivors and prevention of potential victims.

CONCLUSION

There should be significant efforts to enhance all sex trafficking research in the United States to implement effective, sustainable and evidence-based interdisciplinary interventions.

Recognizing the Risk Factors, Signs, and Symptoms of Domestic Minor Sex Trafficking in Mental Health Clinical Practice

The purpose of the current article is to educate psychiatric providers on domestic minor sex trafficking (DMST). Psychiatric providers (e.g., psychiatric-mental health nurse practitioners, psychiatrists, physician assistants, therapists, case managers) interact with victims of sex trafficking but may fail to recognize the signs of victimization and the risk factors associated with becoming a victim of DMST. This educational article offers an overview of the definitions of sex trafficking, and the risk factors, prevalence, and health consequences of DMST. It also summarizes what is known about how those at-risk for DMST and DMST victims interact with the mental health care system. Mental health professionals provide a crucial point of contact with these populations and must strive to prevent, identify, and respond to DMST and at-risk youths. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 21-28.].

Consequences associated with the use of psychoactive substances among female adolescents placed in residential care: the role of sexual exploitation

Sexual exploitation is a major burden among female adolescents placed in residential care centers. Moreover, problematic psychoactive substance use is a concern because of its prevalence and various associated consequences. However, little is known about the consequences resulting specifically from the use of psychoactive substances among sexually exploited female adolescents. This study explored the association between sexual exploitation and the various consequences associated with substance use among adolescent female (15.3-17.1 years old) living in Quebec's residential care centers during 2008-2009. To better understand this association, 83 sexually exploited female adolescents and 66 non-sexually exploited female adolescents responded to self-reported questionnaires. As expected, even controlling for age of onset and frequency of substance use, an ANCOVA showed that sexually exploited female adolescents experience more consequences associated with their use of psychoactive substances (F (4, 148) = 24.79, p <.001, d = 0.83). The associations between sexual exploitation and the consequences of psychoactive substance use were particularly strong for risk-taking (OR = 7.99; p <.001) and delinquency (OR = 4.27; p <.001). Such results highlight the importance of not dissociating the use of psychoactive substances from sexual exploitation when working with female adolescents in rehabilitation centers.

A specialty court for U.S. youth impacted by commercial sexual exploitation

BACKGROUND

Specialty courts have emerged as a model of care for U.S. youth impacted by commercial sexual exploitation (CSE) to ensure comprehensive service provision. However, there is a lack of published research that documents the extent to which these programs achieve this goal.

OBJECTIVE

We sought to understand a specialty juvenile justice court's role in identifying mental health and substance use treatment needs, providing linkages to services, and facilitating stability for youth with histories of CSE.

PARTICIPANTS AND SETTING

We conducted an exhaustive court file review of the 364 participants in a U.S. based juvenile delinquency specialty court for youth affected by CSE. The observation period spanned 2012-2017.

METHODS

The research team systematically transferred data from court files into a secure, electronic database. Descriptive statistics and Chisquared tests were calculated to explore potential associations.

RESULTS

Participation in the specialty court for youth impacted by CSE suggests an increase in identification of mental health and substance use needs and linkages and referrals to mental health and substance use treatment services. In addition, there was increased stabilization as indicated by decreased substantiated child welfare allegations, fewer running away episodes, and placements and criminal involvement.

CONCLUSIONS

Specialty courts that incorporate a multidisciplinary, trauma-informed approach offer a promising intervention model for meeting the high treatment needs of youth impacted by CSE.

An Ecological Analysis of Risk Factors for Runaway Behavior among Individuals Exposed to Commercial Sexual Exploitation

Running away from home is a known risk factor for commercial sexual exploitation among youth; however, research has not fully investigated the process by which multiple factors at individual, familial, and extra-familial levels increase youths' risk for runaway behavior. This study applies an ecological risk factor framework to assess risk for runaway behavior among individuals exposed to commercial sexual exploitation and examines mediating relationships between salient risk factors (i.e. substance abuse, insufficient basic needs, having a much older boyfriend/girlfriend) and runaway behavior. A cross-sectional, retrospective survey was administered to individuals involved in the commercial sex industry using Respondent Driven Sampling methods (N = 273). Bivariate results suggested associations between runaway behavior and childhood emotional and physical abuse, having friends who sold sex, having a much older boyfriend/girlfriend, dropping out of school, being worried about where to eat/sleep, homelessness, and frequent alcohol and drug use prior to entering the commercial sex industry. Hierarchical logistic regression revealed that individuals with runaway behavior histories were more likely to have frequently used alcohol and/or drugs and to have insufficient basic needs compared to those did not run away; however, these factors were no longer significant after accounting for having a much older boyfriend/girlfriend. Having an older boyfriend/girlfriend fully mediated the relationship between frequent alcohol and/or drug use and runaway behavior. Findings support the need for community and school-based prevention programs that target these risk factors with a specific focus on healthy dating relationships, which may reduce risk for runaway behavior and subsequent commercial sexual exploitation.

Early life adversities and polyvictimization in young persons with sexual behavior problems: A longitudinal study of child protective service referrals

There is scarce research on children and youth with sexual behavior problems (SBP) and their developmental antecedents and the research that does exist is mostly retrospective and correlational. While prior research focused on the central role of sexual victimization, recent research suggests that young persons with SBP are exposed to a series of adversities not limited to child sexual victimization and require multifaceted assessment and intervention using a developmental life course perspective. The current study includes an examination of the complete longitudinal sequence of child protective service (CPS) investigations involving young persons with SBP. The study is based on a sample of 957 youth referred to the CPS in Quebec, Canada. The data include their longitudinal sequence of referrals from birth to age 18. Semi-parametric analyses identified four trajectories of referrals with significant differences in terms of onset, frequency, types of life adversity, and polyvictimization. The trajectories suggest that a range of developmental profiles characterize young persons with SBP, with SBP often occurring after CPS contacts for compromising issues other than sexual victimization, especially parental neglect and serious behavior problems. Of importance, polyvictimization was relatively common for this group throughout childhood and adolescence, which highlights the multiintervention needs of this population.

Substance Use among Female Sex Workers in Two US-Mexico Border Cities: Associations with Age of Entry

BACKGROUND

Research has documented consistent associations between entry into sex work as a minor and sexual HIV risk. However, previous studies have not examined whether substance use and related HIV risk are elevated among those who enter sex work under age 18.

METHODS

Quantitative data were collected via time-location sampling of 603 female sex workers (FSWs) ages 18 years and older residing in two Mexico-US border cities. Age of entry into sex work (categorized as 15 years or younger, 16-17 years, or 18 years and older) was assessed as a predictor of substance use (forced and voluntary) within the first month post-entry and recent (past 30 days) substance use with clients.

RESULTS

Compared to those who entered as adults, participants who entered sex work at age 15 or younger were significantly more likely to report drug use (AOR = 5.2, CI = 2.9-8.9) and forced drug use within the first 30 days of entry (AOR= 6.0, CI = 1.9-18.9), as well as past month drug use with clients (AOR= 3.4, CI = 1.9-5.8). Similar results were found among participants who entered sex work at age 16-17.

CONCLUSIONS

Increased risk of recent substance use with clients indicates continuing elevated risk for those entering sex work at these early ages. Early and forced substance use at entry may underlie the elevated risk of HIV infection consistently observed among this population.

Lack of health insurance among juvenile offenders: a predictor of inappropriate healthcare use and reincarceration?

OBJECTIVES

Relationships between the health insurance status and healthcare use among justice-involved youths transitioning into adulthood is an underexplored topic, even if transition to adulthood is a crucial time period for healthcare outcomes. To fill in these knowledge gaps, this study had two aims: (1) to examine trajectories of health insurance coverage and healthcare use among serious juvenile offenders transitioning into adulthood; and (2) to explore associations between the lack of health insurance, healthcare use and reincarceration.

STUDY DESIGN

We conducted a secondary analysis on the data of the US longitudinal Pathways to Desistance study between ages 20 and 23 years (2000-2010).

METHODS

Participant data on health insurance coverage, healthcare use, reincarceration and sociodemographic variables (n = 1215) were extracted and analysed using descriptive statistics, generalized linear regressions and cross-lagged panel models.

RESULTS

About half of the young offenders had no health insurance coverage or intermittent coverage between the age of 20 and 23 years. Emergency services were used (≥17.4%), notably more by insured participants and were increasingly used over time. Being uninsured at the age of 20 years was associated with reincarceration at the age of 23 years (b = -0.052, p = 0.014, odd-ratio = 0.95), but incarceration at the age of 20 years did not predict the insurance status at the age of 23 years (b = 0.009, p = 0.792).

CONCLUSIONS

Serious juvenile offenders, especially if uninsured, faced major barriers to accessing health care and often reported an inappropriate healthcare use. This likely led to reincarceration. The lack of continuity of care and of access to health care may, therefore, increase health disparities, and efforts are needed to mitigate detrimental outcomes, by effective in and out of detention coordination of health insurance coverage and among health services.

Treatment of a Commercially Sexually Abused Girl Using Trauma-Focused Cognitive Behavioral Therapy and Legal Interventions

This case study describes the use of trauma-focused cognitive behavioral therapy (TF-CBT) and legal interventions for a 16-year-old girl who was the victim of commercial sexual exploitation (CSE) and suffered from substance abuse, anxiety, and body image issues. Over the course of 1 year, the client was able to discontinue involvement in sexual exploitation, cease substance use, decrease her anxiety level, improve her self-concept, and reduce posttrauma symptoms. The case calls attention to the need for extended rapport building, flexibility in treatment, and tailoring manualized treatments. It highlights the path to CSE for one teenager as well as the resultant emotional and behavioral consequences. Given the extensive nature of her past traumas, case management was continued following the clients’ discharge from treatment to support her adjustment. These follow-up sessions were conducted about once a month and assisted with maintenance of treatment goals.

Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review

This article reviews studies examining health issues associated with commercial sexual exploitation and sex trafficking (CSE/ST) of children in the United States. We searched five health and social sciences databases for peer-reviewed articles published in English between January 1990 and April 2017. After independent screening of the records, we identified 27 studies that met the inclusion criteria. Descriptions of the included studies and their definitions of CSE/ST are provided. Most of the studies sampled children and youth in urban, metropolitan areas and employed cross-sectional surveys or reviewed case files and medical records of convenience samples. Studies differed widely in their operationalization of CSE/ST, which limit systematic comparison across studies and the generalizability of findings. Qualitative analysis of the included studies shows that among commercially sexually exploited/trafficked children, there are elevated burdens of substance use and abuse, mental health disorders such as depression, PTSD, suicidal behaviors, and sexual and reproductive health issues including STIs, HIV, and pregnancy. This review underscores the need for more empirical studies, to guide an evidence-based understanding of and response to the range and complexity of the health issues in this population. Of particular utility are studies that address some of the methodological limitations of prior research in this field (e.g., cross-sectional, convenience samples) and those that assess overlooked health issues (e.g., malnutrition, eating disorders, post-trauma growth, and long-term health consequences).

Barriers to Accessing Detox Facilities, Substance Use Treatment, and Residential Services among Women Impacted by Commercial Sexual Exploitation and Trafficking

More than 50% of women entering substance use treatment in the United States reported having traded sex for money or drugs. Women's participation in addiction treatment and related services is essential to their recovery and increased safety, stabilization, and quality of life. This article's aim is to explore the barriers related to accessing detox facilities and essential services including substance use treatment and residential services for women impacted by commercial sexual exploitation (CSE). Data are drawn from a larger, community-based, grounded theory study. In-depth interview data were collected from 30 adult women who traded sex as adults (through maximum variation and snowball sampling), as well as 20 service providers who come into contact with adult women who trade sex (through nominations and purposive sampling). Finding suggest that women often encountered sobriety requirements, which created barriers to accessing addiction treatment or residential services. Some organizations' policies required evicting women if they were caught using, which created additional challenges for women who relapsed. Women wanted to avoid becoming "dopesick" on the streets or at home, which partially contributed to them needing to maintain their addiction. Consequently, some returned to sex trading, thus increasing their risk of trafficking. Some women engaged in creative strategies, such as claiming they were suicidal, in order to access the detox facilities in hospitals. Some women indicated they were only able to detox when they were forced to do so in jail or prison, often without medical assistance. Implications to improve health care delivery for this population are discussed.

Predicting running away in girls who are victims of commercial sexual exploitation

Youth that are victims of commercial sexual exploitation of children (CSEC) have a host of clinical problems and often run away from home, residential care, and treatment, which complicates and limits treatment effectiveness. No research to date has attempted to predict running away in CSEC victims. The present study aimed to 1) characterize a clinically referred sample of girls who were victims of CSEC and compare them to other high-risk girls (i.e., girls who also have a history of trauma and running away, but deny CSEC); and 2) examine the utility of using the Youth Level of Service/Case Management Inventory (YLS/CMI) to predict future running away. Data were collected from de-identified charts of 80 girls (mean age = 15.38, SD = 1.3, 37.9% White, 52.5% CSEC victims) who were referred for psychological assessment by the Department of Child Services. Girls in the CSEC group were more likely to have experienced sexual abuse (χ² = 6.85, p = .009), an STI (χ² = 6.45, p = .01), a post-traumatic stress disorder diagnosis (χ² = 11.84, p = .001), and a substance use disorder diagnosis (χ² = 11.32, p = .001) than high-risk girls. Moderated regression results indicated that YLS/CMI scores significantly predicted future running away among the CSEC group (β = 0.23, SE = .06, p = .02), but not the high-risk group (β = -.008, SE = .11, p =.90). The YLS/CMI shows initial promise for predicting future running away in girls who are CSEC victims. Predicting running away can help identify those at risk for and prevent running away and improve treatment outcomes. We hope current findings stimulate future work in this area.

Design strategies from sexual exploitation and sex work studies among women and girls: Methodological considerations in a hidden and vulnerable population

The study of sex trafficking, prostitution, sex work, and sexual exploitation is associated with many methodological issues and challenges. Researchers' study designs must consider the many safety issues related to this vulnerable and hidden population. Community advisory boards and key stakeholder involvement are essential to study design to increase safety of participants, usefulness of study aims, and meaningfulness of conclusions. Nonrandomized sampling strategies are most often utilized when studying exploited women and girls, which have the capacity to provide rich data and require complex sampling and recruitment methods. This article reviews the current methodological issues when studying this marginalized population as well as strategies to address challenges while working with the community in order to bring about social change. The authors also discuss their own experiences in collaborating with community organizations to conduct research in this field.

Human Trafficking of Minors and Childhood Adversity in Florida

OBJECTIVES

To examine the link between human trafficking of minors and childhood adversity.

METHODS

We compared the prevalence of adverse childhood experiences (ACEs) and cumulative childhood adversity (ACE score) among a sample of 913 juvenile justice-involved boys and girls in Florida for whom the Florida child abuse hotline accepted human trafficking abuse reports between 2009 and 2015 with those of a matched sample.

RESULTS

ACE composite scores were higher and 6 ACEs indicative of child maltreatment were more prevalent among youths who had human trafficking abuse reports. Sexual abuse was the strongest predictor of human trafficking: the odds of human trafficking was 2.52 times greater for girls who experienced sexual abuse, and there was a 8.21 times greater risk for boys who had histories of sexual abuse.

CONCLUSIONS

Maltreated youths are more susceptible to exploitation in human trafficking. Sexual abuse in connection with high ACE scores may serve as a key predictor of exploitation in human trafficking for both boys and girls.

Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center

The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N=62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth's sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs.