Onto the Next Generation: Exploring the Impact of Mother's Experiences of Child Abuse and Commercial Sex Industry Involvement on Child Custody Outcomes

Women and girls remain substantially overrepresented in the commercial sex industry. While a number of outcomes have been linked to childhood abuse and involvement with the commercial sex industry, there exists a gap in understanding the unique impact of child abuse on child custody outcomes among adult women involved in the commercial sex industry. Drawing from data collected from 107 case files of adult women with a history of commercial sex industry involvement, the aim of the current study was to understand the link between child abuse history, commercial sex industry involvement, and child custody outcomes. Results indicated that among women who reported a history of child sex trafficking, 91.7% reported having endured child abuse. Further, 82.4% of women reported that their children were not under their custody. Dysfunctional family dynamics, substance abuse, and economic and structural barriers endured by these women are explored further, and intergenerational continuity of such traumagenic precarities is considered as a prolonged implication of such issues. Through a trauma-informed perspective, implications for prevention and intervention are discussed.

Risk and Protective Factors of Commercial Sexual Exploitation of Children and Adolescents in sub-Saharan Africa: A Systematic Review

Commercial sexual exploitation of children (CSEC) has emerged as a critical child protection and public health concern in recent years. While the phenomenon is prevalent globally, its impact is compounded in sub-Saharan Africa owing to the cultural and socioeconomic challenges that leave many households in the region vulnerable. The present study synthesized existing evidence using the socioecological model as a guiding framework to assess the risk and protective factors associated with CSEC in sub-Saharan Africa. A protocol for the study was published in PROSPERO (CRD42022331832) with pre-specified inclusion and exclusion criteria. Studies were screened and extracted from eight databases: PsycINFO, Scopus, Web of Science, PROQUEST (Social Science Premium), PubMed, CINAHL, EMBASE, and MEDLINE via Ovid. After an initial screening of 4,377 papers, seven studies were found eligible for the final review. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide for reporting systematic reviews. Included studies were appraised and rated using the Cambridge Quality Checklist and GRADE. Findings revealed risk factors, including adverse childhood experience and victimization, females aged 16 years and older, school dropouts, technology influence, child and parental alcohol use, and separation from caregivers. On the other hand, protective factors such as the number of female adolescents in a household, frequent health screening in schools, children being in school, and high parental monitoring were found to be associated with a lower risk of CSEC. Based on these findings, we recommend that interventions in sub-Saharan Africa adopt a holistic approach that addresses identified risk factors while harnessing protective factors to combat CSEC effectively.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

An Exploratory Investigation of Childhood Sexual Abuse and Other Theory-Driven Predictors of Sex Work Among Women with and without Childhood ADHD

Limited research has identified prospective risk factors for young-adult sex work or examined overlapping predictors concurrently. We investigated childhood sexual abuse (CSA), along with other theory-driven predictors of sex work, among a well-characterized sample of girls with and without childhood diagnoses of attention/deficit-hyperactivity disorder (ADHD).

METHODS

Participants were a racially and socioeconomically diverse sample of 140 girls with rigorously diagnosed ADHD (47 Inattentive [ADHD-I], 93 Combined [ADHD-C]), and 88 age- and ethnicity-matched comparison girls, all followed longitudinally into adulthood. Self-report data on young-adult occupations revealed a subsample of 7 participants reporting engagement in "sex work" or "prostitution." Logistic regressions tested whether CSA, measured both dichotomously and by discrete age ranges, predicted later sex work, accounting for other risk factors.

RESULTS

A lifetime history of CSA was positively associated with sex work in initial analyses (β = 1.51, p = .045), but not after adjusting for additional risk factors. When examined by age ranges, only CSA occurring between ages 9-15 significantly predicted sex work (β = 2.84, p = .043), even after adjusting for additional risk factors. Childhood ADHD-C also emerged as a significant predictor (β = 4.94, p = .015). ADHD-related medication and years of education were protective factors only when CSA was considered dichotomously.

CONCLUSIONS

Findings from this exploratory study underscore the need for longitudinal research that (a) considers the developmental timing of CSA and (b) accounts for impulsivity and inattention as risk factors for sex work among young-adult women. Implications for clinical practice are briefly discussed.

Understanding the longitudinal relationship between substance use and violent victimization among street-based women who exchange sex in Baltimore, Maryland

BACKGROUND

Women who exchange sex (WES) experience extensive interpersonal violence from multiple perpetrators. Violence towards WES contributes to poor mental and behavioral health outcomes, including high rates of drug use. However, it is difficult to disentangle the temporal relationship between drug use and violence among WES.

METHODS

We used data from 251 WES, who completed baseline and 6-month follow up surveys. WES reported baseline sociodemographic characteristics, including homelessness and hunger. Participants reported their drug use by type and violent experiences by perpetrator at each time point. We conducted a path analysis examining the associations between drug use and violent victimization over time.

RESULTS

Participants were on average 37.8 years old, non-Hispanic White (57.4%) and experiencing high levels of structural vulnerability (59.4% homelessness; 58.6% weekly hunger). Drug use and violence were significantly correlated within each time point. Prospectively, baseline violent victimization was significantly associated with drug use (ß (SE) = 0.13 (0.06)) and violence (ß (SE) = 0.47 (0.05)) at follow up. Baseline drug use was associated with drug use at follow up (ß (SE) = 0.45 (0.05)) but was not significantly associated with violence at follow up (ß (SE) = 0.10 (0.06)).

CONCLUSIONS

Violence and drug use are closely linked in this population; and violence appears to facilitate sustained drug use. Interventions to address the dual epidemics of violence and substance use in this population should address underlying trauma as well as socio-structural drivers of violence as well as tailored harm reduction services for this population.

Profile of Runaway Youths from Residential Care Centers: Variation in Risk-Taking Propensity

During runaway episodes, adolescents engage in various high-risk behaviors and are exposed to various dangers. This situation is even more pronounced among runaway youths from residential care centers, given their personal and familial backgrounds that place them at risk. The current study attempted to disentangle the heterogeneous characteristics of runaway youths while considering the adolescent risk-taking literature. A latent profile analysis was performed among 112 runaway youths from residential care centers based on runaway characteristics (number, duration, context of return). The Parent involvement, Independent and Police involvement runaway youth profiles were compared on various characteristics involved in risk-taking, their high-risk behaviors and mental health problems. The clinical implications for these three runaway profiles are 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.

Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique

Childhood sexual abuse (CSA) is a global problem with serious repercussions for survivors in various domains of adult interpersonal functioning, including sexual risk behavior. This review aimed to summarize findings from the recent literature on the connections between CSA and later adult sexual risk behaviors (e.g., unprotected intercourse, sexually transmitted infection [STSI] diagnosis). The sexual risk behaviors consistently associated with CSA were having sex under the influence of alcohol/substances and reports of concurrent sexual partners/infidelity. Notably, studies investigating the links between CSA and history of STI diagnosis and CSA and reports of unprotected sex (with the exception of samples comprised men who have sex with men) produced inconsistent findings. The methodological limitations of existing studies are considered and suggestions for future research are offered.

Latent Classes and Cumulative Impacts of Adverse Childhood Experiences

Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n = 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n = 3,303), (3) sexual abuse only (4.3%, n = 2,260), (4) emotionally abusive and alcoholic (30.3%, n = 17,460), and (5) normative, low risk (56.3%, n = 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.

Comparing Sex Buyers With Men Who Do Not Buy Sex: New Data on Prostitution and Trafficking

We investigated attitudes and behaviors associated with prostitution and sexual aggression among 101 men who buy sex and 101 age-, education-, and ethnicity-matched men who did not buy sex. Both groups tended to accept rape myths, be aware of harms of prostitution and trafficking, express ambivalence about the nature of prostitution, and believe that jail time and public exposure are the most effective deterrents to buying sex. Sex buyers were more likely than men who did not buy sex to report sexual aggression and likelihood to rape. Men who bought sex scored higher on measures of impersonal sex and hostile masculinity and had less empathy for prostituted women, viewing them as intrinsically different from other women. When compared with non-sex-buyers, these findings indicate that men who buy sex share certain key characteristics with men at risk of committing sexual aggression as documented by research based on the leading scientific model of the characteristics of non-criminal sexually aggressive men, the Confluence Model of sexual aggression.

Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour

OBJECTIVES

To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use.

METHODS

Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices.

RESULTS

The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours.

CONCLUSIONS

Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.

A Systematic Review of HIV and STI Behavior Change Interventions for Female Sex Workers in the United States

The lives of female sex workers (FSW) in the US are typically marked by substance abuse, violence, trauma, and poverty. These factors place FSW at risk for acquiring and transmitting HIV and other sexually transmitted infections (STIs). The purpose of this systematic review is to examine HIV/STI interventions conducted in the US that aim to reduce sexual- or drug-related risk behavior among FSW. Eighteen studies describing 19 unique interventions met our selection criteria: five exclusively targeted FSW, two reported stratified data for FSW, and 12 included at least 50 % FSW. Results indicate that 15 interventions provided HIV/STI information, 13 provided substance abuse prevention information, and few included content tailored to specific needs of FSW. Our findings suggest that current HIV/STI prevention efforts in the US do not adequately address the needs of FSW. Interventions are needed to address issues facing FSW in order to reduce HIV/STI transmission in this high-risk group.

Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers

Women involved in sex work experience myriad challenges, such as poverty, illiteracy, low social status and gender inequity, as they struggle to access healthcare. These challenges place them at high risk for poor health outcomes. The purpose of this article is to describe the formation of a strong cross-system Coalition representing both the criminal justice and healthcare systems to address the health needs of sex workers in Delaware. The Delaware Coalition for Health and Justice implemented a Coalition-building strategy to design interventions and streamline systems to promote health and reduce criminal justice contact for sex workers. The sequential intercept model was utilized to organize Coalition membership and build consensus among varied stakeholders. The model assisted the Coalition in understanding differing primary objectives for key system programs, recognizing the limitations and barriers of each stakeholder group, sharing findings and discovering opportunities for partnership, and engaging stakeholders in designing and providing a comprehensive "systems" approach. This work suggests that aligning the criminal justice, healthcare, and community social services in a systemic process to build consensus can result in the implementation of effective systems change initiatives that address gender disparities and promote the health of justice-involved women.

Expanding the scope of inquiry: exploring accounts of childhood and family life among sex workers in London, Ontario

This article presents findings from a qualitative research project that sought to explore the organization of sex work and women's experiences in the trade in a medium-size Canadian city. Drawing upon 14 semi-structured life-history interviews with women between 24 and 60 years of age who have taken part in sex work, primarily street-based, this discussion examines the women's accounts of childhood and early family experiences. Findings related to childhood highlight the role of the women's mothers, fathers, and a range of non-normative conditions in shaping their social experience of childhood. Our participants' accounts of family dynamics feature discussions of loving familial relations, inter-generational involvement in the sex trade, and feelings of exclusion. These findings support existing studies on childhood and family experiences among street-based sex workers and contribute new data to this relatively under-developed area of study within the sex work literature. One of the most unique insights is that although the women's accounts reveal difficult experiences across the spheres of socialization related to childhood and family, they did not identify them as the root cause of their sex trade participation. We discuss the practical significance of this finding for health care and social service professionals (i.e., case worker, support staff, community clinic workers), who work with women in the sex trade but may be uncertain how to broach and/or navigate the sensitive issues of childhood and family in their work with these marginalized groups of women.

Prostitution push and pull: male and female perspectives

Smith, Grov, Seal, and McCall's (2012) analysis, focusing on how young men become, and stay, involved in male escorting, is a welcome contribution to the still relatively thin male sex worker literature. For this study group, notably supportive working surroundings, effective coping strategies, and a growing sense of "self-efficacy" eventually turn sex work into an increasingly comfortable experience and viable moneymaking option. In this commentary, I add some reflections from a broader perspective to these insights. I also consider some evidence on the numbers of men and women in sex work and make some observations on male versus female positions related to push and pull factors, stigma, and the experience of sex work.

Identity management, negotiation and resistance among women in the sex trade in London, Ontario

Sex work, and ideas about women in the trade, have long been represented as tragic and/or threatening. However, such portrayals tell us very little about how women think about themselves and the kinds of work they do. The data for this paper come from an ethnographic, community-based study in London, Ontario, that involves women in street-based, indoor and transactional sex work. This discussion focuses on how women develop different individual identities, including the management of multiple selves, their sexual identities and what we have termed the 'good junkie' identity. We also examine how these women employ aspects of dominant representation of sex workers, namely the low status accorded to those in street-based work and the defamatory term 'whore' or 'ho', when negotiating the moral hierarchies that exist within various kinds of sex work (i.e., stripping, massage parlours) and making sense of their professional and personal lives. The work that goes into the creation and maintenance of the women's divergent identities sheds important light on this complicated and tremendously demanding, yet inadequately understood, aspect of life as women in the sex trade.

Pornography actresses: an assessment of the damaged goods hypothesis

The damaged goods hypothesis posits that female performers in the adult entertainment industry have higher rates of childhood sexual abuse (CSA), psychological problems, and drug use compared to the typical woman. The present study compared the self-reports of 177 porn actresses to a sample of women matched on age, ethnicity, and marital status. Comparisons were conducted on sexual behaviors and attitudes, self-esteem, quality of life, and drug use. Porn actresses were more likely to identify as bisexual, first had sex at an earlier age, had more sexual partners, were more concerned about contracting a sexually transmitted disease (STD), and enjoyed sex more than the matched sample, although there were no differences in incidence of CSA. In terms of psychological characteristics, porn actresses had higher levels of self-esteem, positive feelings, social support, sexual satisfaction, and spirituality compared to the matched group. Last, female performers were more likely to have ever used 10 different types of drugs compared to the comparison group. A discriminant function analysis was able to correctly classify 83% of the participants concerning whether they were a porn actress or member of the matched sample. These findings did not provide support for the damaged goods hypothesis.

Association between childhood sexual abuse and transactional sex in youth aging out of foster care

PURPOSE

To evaluate the association between history of childhood sexual abuse (CSA) and having transactional sex among adolescents who have been in foster care.

METHODS

We used an existing dataset of youth transitioning out of foster care. Independent CSA variables included self report of history of sexual molestation and rape when participants were, on average, 17 years of age. Our outcome variables were self-report of having transactional sex ever and in the past year, when participants were an average age of 19 years. Separate multiple logistic regression analyses were conducted to assess the associations between CSA variables and transactional sex variables. Initial analyses were performed on both genders; exploratory analyses were then performed evaluating each gender separately. Total N=732; 574 were included in the main analyses.

RESULTS

History of sexual molestation was significantly associated with increased odds of having transactional sex, both ever and in the past year (OR [95% CI]: 3.21 [1.26-8.18] and 4.07 [1.33, 12.52], respectively). History of rape was also significantly associated with increased odds of having had transactional sex ever and in the past year (ORs [95% CI]: 3.62 [1.38-9.52] and 3.78 [1.19, 12.01], respectively). Odds ratios in female-only analyses remained significant and were larger in magnitude compared with the main, non-stratified analyses; odds ratios in male-only analyses were non-significant and smaller in magnitude when compared with the main analyses.

CONCLUSIONS

Both CSA variables were associated with increased likelihood of transactional sex. This association appears to vary by gender. Our results suggest that policymakers for youth in foster care should consider the unique needs of young women with histories of CSA when developing programs to support healthy relationships. Health care providers should also consider adapting screening and counseling practices to reflect the increased risk of transactional sex for female youth in foster care with a history of CSA.

Understanding the social and economic contexts surrounding women engaged in street-level prostitution

Prostitution involves the exchange of sexual services for economic compensation. Due to the sexual promiscuity surrounding prostitution, women involved in prostitution constitute a high-risk group for contracting and transmitting STDs, including HIV. Prostitution is not only a public health concern, but also an economic one. Cities throughout the United States spent an average of $7.5 to $16 million per year enforcing prostitution laws and addressing negative outcomes associated with prostitution. Thus, women involved in prostitution are a cause for concern from both public health and economic perspectives. However, little is known about why women remain in this type of behavior given the risks prostitution presents, and even less is known about how to intervene and interrupt the complex cycle of prostitution. Thus, the purpose of this study was to understand what factors contribute to a woman's decision to remain in prostitution. A series of interviews were conducted with 12 women engaged in street-level prostitution. Results of the study revealed that drug use not only spurs entry into prostitution, but also contributes to the tenure of prostitution. Further, social support and economic stability are plausible reasons for women remaining in prostitution. These findings lead us to recommendations for policy and program development. Women involved in prostitution are a highly marginalized population, rarely recognized as individuals with life histories. Understanding why women remain in prostitution is important, because until these determinants are known, intervention programs designed to interrupt the cycle, and ultimately prevent prostitution, cannot be formulated.