Research Briefs

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

Franchino-Olsen, Trauma, Violence, and Abuse, 2019

The author states that the commercial sexual exploitation of children (CSEC) and domestic minor sex trafficking (DMST) which occurs across the United States, violates the rights and health of far too many children and youth. She contends that 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. Her study seeks to identify risk factors associated with CSEC and DMST based on a systemic literature review that then examined, in depth, 15 studies which based on their original research status, contained 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.

Franchino-Olsen notes the devastating effect CSEC/DMST can have on victims but states that are limitations on both the knowledge of the practices and  effective means of identifying or screening victims. This need becomes more tangible as there has been a shift in a law enforcement perspective toward minors as victims rather than just underage sex workers following the Victims of Trafficking and Violence Protection Act (VTVPA) of 2000, which sought to decriminalize selling sex for both underage and adult victims of trafficking (prior to the VTVPA, minors found selling sex or related acts were charged and prosecuted with juvenile prostitution). While this shift is promising in tackling sex trafficking, the author contends much more action is currently needed to address the issue.

Research determining the prevalence of CSEC/DMST needs to overcome barriers. The underground nature of the activities and the lack of a common national database makes data unreliable in assessing the scope of the problem, its victims, frequency, and prevalence. However, while the U.S. is seen as a profitable destination country for international sex traffickers, most data suggest that the majority of minor victims of sex exploitation in the U.S. are citizens. Unfortunately no consensus has been reached in the field regarding how to screen or identify victims in an efficient and trauma informed manner with ongoing debate around how to prevent CSEC among high-risk populations, since the presence of some risk factors, like childhood sexual abuse (CSA) only leads a small proportion of those children to experience exploitation. Policies to address these risk factors would have to be on a macrolevel with interventions addressing abuse, neglect, and poverty, and on a microlevel involving increased engagement with law enforcement, social services, and other government agencies. The author states that the stereotype of an exploitation victim is a young female tricked or coerced into the sex trade but boys and transgender youth are often exploited as well. Because females are more likely to be arrested, as well as be controlled by a third party exploiter, they tend to have a higher visibility and draw more public attention along with prevention and intervention efforts. Some victims through the exploitation and grooming experiences may settle in for the “prostitution life” and not recognized they’re being exploited. Victims of CSEC/DMST are at risk for a wide variety of physical, psychological, social problems because of their victimization.

However, a complete understanding of the issue and its victimizations are lacking because of gaps in the literature surrounding risk factors for CSEC/DMST and the evaluation of preventative strategies. Consequently, risk factors must be clearly identified in order to assure preventative efforts are effective and target the right populations.

The author gathered domestic research studies from 2010-2017 pertaining to CSEC/DMST risk factors, winnowing the search down to appropriate methodologies, and research subjects and outcomes, to arrive at an analysis of 15 studies that specifically addressed minor sexual exploitation risk factors. Studies included both qualitative and quantitative and her analysis and results show there are numerous risk factors noted in peer-reviewed studies that increase a minor’s vulnerability to exploitation.

Childhood abuse-the most commonly cited risk factor in the literature includes physical, emotional, and sexual abuse. This abuse may be motivation for youth to run away from home and lead to CSEC/DMST. Maltreatment like neglect is also common among CSEC/DMST victims and is also connected with other associated risks like running away and early onset of drug and alcohol use, while emotional abuse increases vulnerability to victimization by reducing youths’ coping skills and keeping them dependent on their exploiters. Sexual abuse may also lead youth to believe that selling sex, even if controlled by a pimp or third party exploiter, gives them control over their sexuality. Other risk factors related to sexual activity include, early sexual initiation (which pushes youths toward exploitive sexual activities) or sexual denigration; prior rape experience or adolescent sexual victimization (from outside the home or family); and survival sex (which leads youths into high risk situations and cause them to interact with individuals in a position to exploit them).

Compromised parenting and/or unstable home life, while related to maltreatment, also encompasses alcohol and drug use, emotional and mental health problems (e.g., depression, anxiety, poor anger management), arrests, relationship problems between caregivers, and family violence. Witnessing family violence or criminal activity is itself a risk factor for victimization. While research found a pre-exploitation history of witnessing family violence or criminality to be common with victims most studies did not investigate further regarding the nature, duration, or severity of what these illegal activities entailed. Other family and home factors that are linked to CSEC/DMST victimization are conflicts with parents and  peer and family influences of those already linked to the sex trade or exploitation (which gives these youths the impression of normality and inhibits recognizing these transactions as exploitive), and child protection services involvement including a history of out of home placement. Running away or being thrown away by caregivers is another commonly cited risk factor for exploitation and victimization as they can fall into the hands of third party exploiters or engage in survival sex, which is also a risk factor for CSEC/DMST.

Social factors also play a role as well. Poverty or material need have been shown to be a risk factors for victimization (especially so in rural, micropolitan, and metropolitan areas) as well as subsequently prevent them from leaving the exploitation. Other factors like difficulty in school (which may be related to experiencing the other risk factors here), negative mental health/view of self/psychoticism, juvenile detention involvement or delinquency, and an early age of drug/alcohol use onset (though there is discussion of whether this is a risk for exploitation in itself or if it is employed later either as a coping mechanism for the victim or a means of control for the exploiter).

The author concludes that some of these risk factors cluster together and many are interrelated as the presence of one risk factor may lead to, or generate others, and that internalized norms around violence and sex work seem key to later victimizations, however the author, because of conflicting research, could not draw a conclusion as to whether gender, specifically female, was a risk factor. She states that implications of these findings for practice include improved and targeted provision of services and CSEC/DMST prevention programs to youth who are marginalized and potentially “high risk” in their vulnerability. The review also points to the need for advocacy and policy to improve the protections for at-risk groups of children and youth. The author states policy and prevention efforts should focus on awareness and training programs for populations that interact with CSEC/ DMST individuals or youth who may be particularly vulnerable. This includes teachers, counselors, law enforcement, and health-care workers, all of whom should know the factors that increase a minor’s vulnerability, as well as knowing how to handle CSEC/DMST disclosures and provide trauma-informed care to victims.

Examining the risk factors as Franchino-Olsen did in the sexual exploitation of children finds links to sexual violence through abuse and assault through family, strangers, and third party exploiters. As these experience mold the cognitive perceptions of these victims and how they view exploitation, Bowes, Walker, Hughes, Lewis, and Hyde  explore how cognitive perceptions affect the behaviors of violence perpetrators.

The Role of Violent Thinking in Violent Behavior: It’s More About Thinking Than Drinking

Bowes, Walker, Hughes, Lewis & Hyde, Journal of Interpersonal Violence, 2020

The authors discuss the development of theories on violence and aggression, from that of frustration stemming from thwarted goals leading to aggression to that of the current perspective, which incorporates a deeper cognitive base to aggressive behaviors. The cognitive process is important both in the path toward aggression and in the interpretation and appraisal of the outcome.

 The authors relate how cognition plays a part in violence and aggression through a combination of hostile thoughts and scripts. Hostile thoughts refers to aggressive thinking drawn from the memory of the individual. These thoughts, and the process of rumination, means that these thoughts more frequently and more quickly come to mind; the hostile thoughts taking preeminence,. become more readily, or chronically, accessible. Scripts are less of a conscious activity and are developed through exposure and experience, The greater level and frequency of  exposure to violence, the stronger the associated scripts will become. So people with a strong focus on hostile thinking are more likely to attribute a hostile intention from an ambiguous encounter and those who have been  more exposed to violence, may automatically anticipate, or “short cut” to, violence being an appropriate response. These approaches to thinking are also referred to as  “hostile attribution bias”. Identifying and treating problematic cognitive processes is important for achieving effective psychological interventions and sex offending research has identified and validated many methods for identifying and assessing these within the offender population. Measuring these cognitions feeds directly into the design and evaluation of sex offender treatment programs. However while measures may examine things like anger, hostility, impulsivity, and paranoia, they tend to be oriented to antisocial or criminal thinking rather than specifically to violence. The authors note the Maudsley Violence Questionnaire (MVQ) has demonstrated a robust reliability, validity, and predictive value and they utilized it in the current study which examines two factors, Machismo and Acceptance. Machismo was defined as  the embarrassment of backing down from a violent confrontation, justifying violence as a means of response, and violence as being part of a man and Acceptance related to the acceptance of violence as entertainment in sports or media and the perception that violence is acceptable behavior. The authors also recognized the link between alcohol and violence and their study also uses the valid and reliable AUDIT alcohol misuse  measure to explore the roles of alcohol misuse along with violent thinking on self-reported violence in an adult (non-offender) population. They hypothesized that both  violent thinking and alcohol misuse would demonstrate a positive associate with self-reported violence.

808 UK college students complete the MVQ, AUDIT, and a self-reported violence scale. Levels across the violence measure were low and were re-coded into categories of nonviolent behavior to any violent behavior. The authors logistic regression analysis showed that Acceptance was not predictive of self-reported violence and while alcohol misuse was strongly correlated with self-reported violence, it was not a significant factor. Only the Machismo factor had a significant effect on both male and female self-reported violent behavior. Machismo actually explained one third of the variation in self-reported violent behavior but in the female model it accounted for only 11 percent of the variation, and surprisingly to the authors, Acceptance was not a factor with female violence as previous research had demonstrated. This along with what the gendered nature of the term macho, signals to the authors the needs for further research to identify factors in female violence, and specifically in violent cognition measures specific for females.

While Bowes et al. found that violent cognitive processes contribute to the expression of  violent behavior, helping to explain sexual violence, less is known about the sexual violence perpetrated by females. Weare and Bates examine the role aggression and violence plays in female Intimate Partner Violence perpetrators in the form of sexual violence involving forced penetration.

Sexual Violence as a Form of Abuse in Men’s Experiences of Female Perpetrated Intimate Partner Violence

Weare and Bates, Journal of Contemporary Criminal Justice, 2020

The authors examined a little researched areas of intimate partner violence (IPV), where the female is the perpetrator and the male is sexually victimized. They state the vast amount of literature on male perpetrated IPV in a heterosexual relationship is important and existing research has demonstrated that men can experience significant verbal and physical aggression, and  emotional or psychological abuse, as well as demonstrating how such violence affects men’s physical and mental health and their relationships with their children . What is less understood, however, is men’s experiences of sexual violence within abusive relationships where the perpetrator is a woman.

The majority of academic research studies have focused on men’s sexual victimization in a same sex relationship. In 2018, the most recent National Intimate Partner and Sexual Violence Survey indicated that in the U.S., 8.2% of men experienced ‘contact sexual violence’ (a term which includes rape, forced-to-penetrate cases, sexual coercion, and/or unwanted sexual contact) from an intimate partner during their lifetime while a 2018 crime survey in the UK found that 39% of men reported experiencing rape or assault by penetration (including attempts) from a partner or ex-partner. While in terms of academic research, the majority of studies have explored men’s sexual victimization in the context of same-sex relationships. One of the only studies to have specifically explored the experiences of men who have been subjected to sexual aggression from a female partner within an abusive relationship was a 2016 report that found over half of the 611 U.S. men in their sample had experienced some form of sexual aggression within their relationship, with 28% having experienced severe sexual aggression that involved threats or force to engage in vaginal, oral, or anal sex.

Weare and Bates conducted two UK studies, the first, a qualitative survey of 161 men centered around their experiences in female perpetrated IPV, for example, the aggression and violence experienced, the control of personal freedom and the effects on relationships with friends and family. The second, a mixed methods survey of 154 men  involved their most recent experiences about being forced-to-penetrate (FTP) women including the context of the occurrence, physical and mental impacts, and the police and legal processes. The authors note the term FTP is used as the UK does not consider this type of sexual violence as rape. From these surveys, responses that indicate both FTP and IPV were pulled for further analysis and these 41 responses who experienced both types of abuse (13% of the total respondents to both surveys) were thematically analyzed for similarities and overarching themes.

Results show these men suffered a wide range of abuse beside sexual violence to include, physical violence and abuse, emotional and financial abuse, and coercive and controlling behaviors. Some occurred in isolation to one another, where physical violence wouldn’t necessarily lead to sexual violence, or coercive and controlling (e.g. belittling or monitoring) behavior occurred independently of other forms of abuse. However, they did see two areas where sexual violence was linked to other forms of abuse: in physical violence/force and coercive and controlling behaviors. Physical violence and force typically occurred preceding or during the sexual violence involving, beating, choking, and restraint, typically for refusing to comply with sexual demands. Some reported this occurred during vulnerable states like while intoxicated or while asleep.

Women’s coercive and controlling behavior was linked to this sexual violence as men saw the sexual assaults as a form of control and manipulation, similar to other controlling behavior in the relationship. Women decided the parameters of the sexual relationship, including forcing men to have unprotected sex in attempts to get pregnant, and the men were subjected to violence or emotional abuse in order to get them to comply. Some men even reported that if they were noncompliant, their partner would purposely stir up tension in the family in order to coerce her partner into compliance.

The authors hoped to challenge the stereotypes around men’s victimization (such as “women can’t force a man to have sex”) by demonstrating the range of abusive behavior experienced by men and that besides other forms of IPV that men can suffer sexual violence and victimization as well. In doing so they hoped for improving practitioners’ responses to male victims of female perpetrated domestic and sexual violence and increasing knowledge in the field of IPV. Much of the existing literature around men’s victimization has focused on women’s use of physical violence within the relationship, as well as highlighting women’s use of coercive and controlling behaviors. However, only a small amount of research has explored the range of abuse experienced by men  and very little has considered the possibility of sexual violence occurring in this context. Their analysis points to relationships existing between the different forms of abuse experienced by men. It also provides evidence of other forms of abuse forming part of men’s sexual victimization, as well as being independent of this but forming part of a wider pattern of abuse within the relationship. Establishing this pattern can also provide useful in the prosecution of female perpetrated sexual assault case as evidence of physical violence and coercive and controlling behavior may help juries overcome stereotypes around male sexual victimization.

As Weare and Bates bring attention to forced penetration as part of a larger component of sexual violence, and its link to other features in intimate partner violence, Anderson, Goodman and Thimm take a deeper look in to the experiences of men victimized by forced penetration and ways to better identify and assess the occurrences.

The Assessment of Forced Penetration: A Necessary and Further Step Toward Understanding Men’s Sexual Victimization and Women’s Perpetration

Anderson, Goodman, and Thimm, Journal of Contemporary Criminal Justice, 2020

The authors discuss that most sexual violence research has focused on men as perpetrators and women as victims. However, recent CDC data revealed that one in five men in the U.S. experience sexual victimization as well. Recent data on college age men suggest higher rates-28 to 50%. A unique form of sexual victimization that often goes undiscussed and, therefore, under-assessed is that of being forced to penetrate another person (i.e., forced penetration). Because  forced penetration is a relatively new addition to the definition of rape, little research has been done on the subject. Sparse data does indicate that the majority of perpetrators in forced penetration cases are female. There is a lack of assessment tools available that can identify forced penetration cases and measurement strategies have varied widely. Until 2012, the FBI held a gender biased position in the definition of rape and the bias in research has also tended to frame questionnaires in a gendered manner that typically frames the male as perpetrator. Questionnaires less specific about gendered behavior like “forced you to have sex” may encompass instances of forced penetration but yet are not specific enough to examine the prevalence of those incidence. The authors state that despite some gender neutral questionnaires such as the Revised Conflict Tactics Scales and Post-Refusal Persistence Scale-Victimization, which do reveal higher rates of sexual victimization for men, they are unaware of any questionnaires that specifically address forced penetration.

The author’s goal of the study was to improve the understanding of men’s experience in this type of victimization by designing and testing new methods to assess this type of behavior. They developed new items for the Sexual Experiences Survey–Short Form Victimization (SES-SFV and Sexual Experiences Survey–Short Form Perpetrator (SES-SFP) questionnaires that more specifically addressed being forced or coerced into penetrating another person. The authors included all genders (even though some data indicated women being forced to penetrate another woman is very rare, gender was included so as to better understand any gender differences in this behavior) and a variety of racial, ethnic, and sexual orientations in the 1,456 college student and 293 American MTurk samples, The authors assessed the utility of the items by examining how many cases of  sexual victimization were identified and validity of the new items by examining correlation with other SES-SFV items, hypothesizing the would find good evidence of such in the SES-SFV and SES-SFP. The authors wanted to document the rate of forced penetration victimization in two high-risk samples (college students) with the SES-SFV, administer the SES-SFP to a third sample of MTurk workers and investigate whether assessing forced penetration results in higher prevalence rates by expanding the scope of cases identified and evaluate which type of forced penetration (completed vaginal, completed anal, attempted anal) is most common.  

Their results showed that in the first two samples, 22 % of men and approximately 50% of women reported some type of sexual victimization and in the third sample 12% of men and 10% of women reported some type of sexual perpetration. When they examined the prevalence of forced penetration they found the rate varied between 5 and 11 % between the two victimization samples. In the first victimization sample 7.4 percent of the total male sample and 33.8% of victimized men having experienced forced penetration, while in the second victimization sample, 13.1% of the total male sample and 58.7% of victimized males experienced forced penetration. While men were more likely than women to have experienced forced penetration in the first sample there was no significant difference between the sexes in the second sample. The new survey items did show evidence of validity and were somewhat effective in discovering unique cases of sexual victimization compared to the old questionnaires, discovering what would have been 13 undiscovered cases of victimization among the two samples; all, with the exception of one heterosexual woman, were heterosexual men. The types of forced penetration varied in prevalence between the two SES-SFV samples. In Sample 1, considering all participants, completed vaginal was the most frequent type of forced penetration reported, followed by attempted anal and completed anal forced penetration. In Sample 2, attempted anal was the most prevalent, followed by completed vaginal and completed anal (n = 24), which were both being reported at similar rates. Overall, completed vaginal was the most common type of forced penetration reported by college men whereas attempted anal was the most common type reported by college women.

The characteristics of those victimized by being forced to penetrate bore both some similarities and differences. In Sample One, of the 30 participants having experienced forced penetration 73% (n=22) were male, of which 91% were heterosexual. Men who experienced forced penetrations reported significantly higher female perpetration than those who experienced other forms of sexual victimization. In Sample Two there was no significant difference in the gender of the perpetrators for men, but for female victims they were more likely to report female perpetrators. In both samples men who were forced to engage in penetration were more likely to report romantic partner perpetrators than those men who suffered other forms of sexual victimization.

In assessing perpetration, the authors second study found that the rate of endorsing forced perpetration at 3.8% (n=11), with 10 of them being female (8 heterosexuals) and one gender queer. Most (72.72%) reported completed vaginal, with 81.8% reporting attempted vaginal along with 45.5% reporting both completed and attempted anal forced penetration. In total, one third of those who endorsed any kind of sexual victimization perpetration also reported forcing someone to penetrate them. The new items questionnaire, in comparison to the traditional SES-SFP, however only uncovered one other unique case of perpetration by a heterosexual female. While the new iteration of the SES-SFP demonstrated validity there was a greater amount of missing data regarding answers to forced penetration questions in the SES-SFP perpetrator questionnaire compared to the SES-SFV victimization questionnaire.

The authors note their studies indicate higher prevalence rates for male victims of forced penetration than evidenced by previous research and that by not identifying and assessing forced penetration, the number of men experiencing sexual victimization and violence would be underestimated. This also applies to the underestimation of female perpetrators of forced penetrations. In total, their data suggests forced penetration is a dramatically under-recognized form of sexual victimization affecting heterosexual men that is mostly perpetrated by heterosexual women, most often in the context of a romantic relationship. One third of men sexually victimized experienced being forced to penetrate someone. They state this underscores how problematic it is that currently, there are no standardized measures of sexual victimization that assess forced penetration.

In conclusion, they strongly recommend that clinical service providers inquire about forced penetration and that health and legal professionals advocate for policy change to better recognize this form of sexual victimization as both men’s sexual victimization and women’s sexual perpetration is woefully under-researched and in need of further scrutiny to reduce the public health burden of sexual violence.

While the previous research has examined the connections of sexual violence to youth risk factors, cognitive perceptions of violence, physical and mental health difficulties, intimate partner violence, and a view of women as a source of violence, Gang, Loffl, Naylor and Kirkman consider whether a restorative justice approach is appropriate in addressing sexual and family violence and the needs of the victims and perpetrators, but find more questions than answers.

A Call for Evaluation of Restorative Justice Programs

Gang, Loffl, Naylor, and Kirkman, Trauma, Violence, and Abuse, 2019

The authors consider that restorative justice as a response to sexual violence continues to be subject to significant criticism. They define “restorative justice” as a system that repairs the harm and ruptured social bonds caused by crime, specifically the relationships between crime victims, offenders, and society. This is achieved by the perpetrator explicitly, or implicitly, admitting responsibility for the crime and the process allows parties to resolve collectively how to deal with the aftermath of the offence and its implications for the future. The use of restorative justice in the context of sexual or family violence has been questioned for a number of reasons as it would potentially represent a weaker societal response to sexual assault. There are fears that adult perpetrators will vacate the traditional criminal justice settings for private ones with little accountability, and provided with opportunities to escape punishment, doubts that restorative justice will prevent re-traumatization if the process fails to address the power imbalance underpinning sexual and family violence, and concerns that if a goal of the process is to change an entrenched pattern of behavior, substantial change is unlikely after the usual single restorative justice conference. And while scholars argue for or against the use of restorative justice for sexual and family violence without nominating specifics of the program, the arguments tend to be made from a strictly academic position without the benefit of empirical evidence.

The authors sought to examine the evidence that existed regarding the evaluation of restorative justice in sexual or family violence cases by conducting a systematic review of peer-reviewed literature. On six academic journal databases, using search terms like, “restorative justice”, “victim offender mediation” and “sexual assault”, their initial title search reduced the bulk of articles down to 97 however, after an abstract review, that number dropped to six. Of those six, five were eliminated because they didn’t include the requisite focus on sexual or family violence by a sample made up of at least 75% of those cases, or they did not include a program evaluation.

The one study, which reported on a 2014 evaluation of the Arizona program Project RESTORE, was based on 22 cases. The program was found to decrease the rates of diagnosed post-traumatic stress disorder in survivor victims, most participants agreed or strongly agreed that their preparation for the conference achieved its intended goals, and all survivor victims who attended their conference were satisfied with the conference. The authors do note that these results are not generalizable, having a small sample only referred to the program by prosecutors, and an unusually high number of male survivor victims. The authors report being shocked and disappointed at the paucity of research regarding the effectiveness of restorative justice in sexual and family violence cases considering that it has been used in those situations for decades and has been argued that restorative justice for sexual and family violence may be a justice option with potential to be more responsive to the needs of survivors (and perhaps perpetrators) than the criminal justice system. The authors conclude that without critically reviewed evidence, theoretical and practical problems cannot be resolved and important questions are left unanswered, which include: Are restorative justice programs being appropriately implemented? Are their aims specified and being met? Which elements of restorative justice will create the best outcomes for victims? How and when will victims be best placed to engage in restorative justice? Which kinds of participants would derive significant benefit from restorative justice and for which offenses? Can sexual harms that are not criminalized in that jurisdiction be included? Which (if any) elements of programs are effective in or detrimental to addressing sexual and family violence?

They state that without evaluations that are available for systematic review, there is a lack of  a robust body of evidence to complement other empirical research and to demonstrate whether restorative justice is an effective intervention for sexual and family violence. Thus, the use of restorative justice for sexual, family, and other gendered violence remains controversial as there is a lack of evidence to support any point of view. It is important that policy makers and program designers should be able to draw on a suite of evidence to justify funding these programs and to design them to ensure that program aims are both feasible and likely to be achieved.