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Mannarino JA, Carrico AW, Ean N, Bruce S, Vandermause R, Kryah R, Stein E, Bertram J, Shom V, Paul RH. Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN). Contemp Clin Trials 2023; 131:107257. [PMID: 37271413 PMCID: PMC10526682 DOI: 10.1016/j.cct.2023.107257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Low- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults. METHODS A stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization. PLANNED ANALYSES The percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes. DISCUSSION Findings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings.
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Affiliation(s)
- Julie A Mannarino
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America.
| | - Adam W Carrico
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States of America
| | - Nil Ean
- The Center for Trauma Care and Research Organization, Phnom Penh, Cambodia; Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Steven Bruce
- Center for Trauma Recovery, University of Missouri - St. Louis, St. Louis, MO, United States of America; Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Roxanne Vandermause
- College of Nursing, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Rachel Kryah
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Ellen Stein
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Julie Bertram
- College of Nursing, University of Missouri - St. Louis, St. Louis, MO, United States of America
| | - Vireak Shom
- The Center for Trauma Care and Research Organization, Phnom Penh, Cambodia
| | - Robert H Paul
- Missouri Institute of Mental Health, University of Missouri - St. Louis, St. Louis, MO, United States of America; Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, United States of America
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Halkett A, O’Grady SM, Hinshaw SP. An Exploratory Investigation of Childhood Sexual Abuse and Other Theory-Driven Predictors of Sex Work Among Women with and without Childhood ADHD. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:949-962. [PMID: 36439670 PMCID: PMC9684379 DOI: 10.1007/s40653-022-00467-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Ashley Halkett
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
| | - Sinclaire M. O’Grady
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
| | - Stephen P. Hinshaw
- Department of Psychology, University of California, Berkeley, 2121 Berkeley Way West, Berkeley, CA 94704 USA
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA 94143 USA
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Wanjiru R, Nyariki E, Babu H, Lwingi I, Liku J, Jama Z, Kung'u M, Ngurukiri P, Nyamweya C, Shah P, Okumu M, Weiss H, Kaul R, Beattie TS, Kimani J, Seeley J. Beaten but not down! Exploring resilience among female sex workers (FSWs) in Nairobi, Kenya. BMC Public Health 2022; 22:965. [PMID: 35562733 PMCID: PMC9107275 DOI: 10.1186/s12889-022-13387-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Kenya sex work is illegal and those engaged in the trade are stigmatized and marginalized. We explored how female sex workers in Nairobi, Kenya, utilize different resources to navigate the negative consequences of the work they do. METHODS Qualitative data were collected in October 2019 from 40 FSWs who were randomly sampled from 1003 women enrolled in the Maisha Fiti study, a 3-year longitudinal mixed-methods study exploring the relationship between HIV risk and violence and mental health. All interviews were audio-recorded, transcribed and translated. Data were thematically coded and analyzed using Nvivo 12. RESULTS Participants' age range was 18-45 years. Before entry into sex work, all but one had at least one child. Providing for the children was expressed as the main reason the women joined sex work. All the women grew up in adverse circumstances such as poor financial backgrounds and some reported sexual and physical abuse as children. They also continued to experience adversity in their adulthood including intimate partner violence as well as violence at the workplace. All the participants were noted to have utilised the resources they have to build resilience and cope with these adversities while remaining hopeful for the future. Motherhood was mentioned by most as the reason they have remained resilient. Coming together in groups and engaging with HIV prevention and treatment services were noted as important factors too in building resilience. CONCLUSION Despite the adverse experiences throughout the lives of FSWs, resilience was a key theme that emerged from this study. A holistic approach is needed in addressing the health needs of female sex workers. Encouraging FSWs to come together and advocating together for their needs is a key resource from which resilience and forbearance can grow. Upstream prevention through strengthening of education systems and supporting girls to stay in school and complete their secondary and/or tertiary education would help them gain training and skills, providing them with options for income generation during their adult lives.
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Affiliation(s)
- Rhoda Wanjiru
- Partners for Health and Development in Africa, Nairobi, Kenya.
| | - Emily Nyariki
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Ibrahim Lwingi
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Jennifer Liku
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Zaina Jama
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Mary Kung'u
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Polly Ngurukiri
- Partners for Health and Development in Africa, Nairobi, Kenya
| | | | | | - Pooja Shah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Monica Okumu
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Helen Weiss
- London School of Hygiene and Tropical Medicine, London, UK.,MRC International Statistics and Epidemiology Group, London, UK
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Tara S Beattie
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
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Parcesepe AM, Toivgoo A, Chang M, Riedel M, Carlson C, DiBennardo R, Witte SS. Physical and sexual violence, childhood sexual abuse and HIV/STI risk behaviour among alcohol-using women engaged in sex work in Mongolia. Glob Public Health 2014; 10:88-102. [PMID: 25383593 DOI: 10.1080/17441692.2014.976240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although the prevalence of human immunodeficiency virus (HIV) in Mongolia is low, it could increase without strategic prevention strategies. Female sex workers (FSWs) often experience barriers to prevention, including interpersonal violence. This study investigated if childhood sexual abuse (CSA) or recent physical or sexual violence was associated with HIV sexual risk behaviours and if CSA modified associations between recent violence and HIV sexual risk behaviours. Two-hundred twenty-two women who (1) were at least 18 years old and clients at the National AIDS Foundation; (2) reported vaginal or anal sex in the past 90 days in exchange for money or goods and (3) met criteria for harmful alcohol use in the past year were enrolled. In-person interviews assessed sexual risk behaviours and violence in childhood and adulthood. Negative binomial regression, ordinary least squares regression and modified Poisson regression were performed. Sexual risk with paying partners was associated with penetrative CSA and sexual violence by paying partners. CSA and recent violence were not associated with sexual risk behaviours with intimate partners. CSA modified the association between recent sexual violence and unprotected sex with intimate partners. Findings highlight the need for integrated violence and sexual risk reduction services to ensure safe and effective prevention for FSWs.
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Affiliation(s)
- Angela M Parcesepe
- a Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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McCarthy B, Benoit C, Jansson M. Sex work: a comparative study. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1379-90. [PMID: 24671729 DOI: 10.1007/s10508-014-0281-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 12/06/2013] [Accepted: 12/13/2013] [Indexed: 05/10/2023]
Abstract
Explanations of adult involvement in sex work typically adopt one of two approaches. One perspective highlights a variety of negative experiences in childhood and adolescence, including physical and sexual abuse, family instability, poverty, associations with "pimps" and other exploiters, homelessness, and drug use. An alternative account recognizes that some of these factors may be involved, but underscores the contribution of more immediate circumstances, such as current economic needs, human capital, and employment opportunities. Prior research offers a limited assessment of these contrasting claims: most studies have focused exclusively on people working in the sex industry and they have not assessed the independent effects of life course variables central to these two perspectives. We add to this literature with an analysis that drew on insights from life course and life-span development theories and considered the contributions of factors from childhood, adolescence, and adulthood. Our comparative approach examined predictors of employment in sex work relative to two other low-income service or care work occupations: food and beverage serving and barbering and hairstyling. Using data from a study of almost 600 workers from two cities, one in Canada and the other in the United States, we found that both immediate circumstances and negative experiences from early life are related to current sex work involvement: childhood poverty, abuse, and family instability were independently associated with adult sex work, as were limited education and employment experience, adult drug use, and marital status.
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Affiliation(s)
- Bill McCarthy
- Department of Sociology, University of California Davis, One Shields Ave., Davis, CA, 95616, USA,
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Vidal CEL, Amara B, Ferreira DP, Dias IMF, Vilela LA, Franco LR. Preditores de prováveis transtornos mentais comuns (TMC) em prostitutas utilizando o Self-Reporting Questionnaire. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Avaliar a prevalência de prováveis transtornos mentais comuns (TMC) e os fatores associados em um grupo de prostitutas de Minas Gerais. Métodos Estudo transversal utilizando o Self-Reporting Questionnaire (SRQ-20) em mulheres cadastradas na Associação de Prostitutas de Minas Gerais (Aprosmig). Avaliaram-se características sociodemográficas e aspectos do trabalho na prostituição. Teste do qui-quadrado foi empregado na análise de associação entre variáveis categóricas sociodemográficas e a presença de prováveis TMC. A análise dos fatores associados à presença de prováveis TMC foi realizada por meio de modelo de regressão logística. Resultados Foram entrevistadas 216 prostitutas. A prevalência global de prováveis TMC foi de 57,9%, mais observada em mulheres com baixa escolaridade, história de violência física e ingresso precoce na prostituição. Conclusão Os resultados deste estudo mostraram que a prevalência de prováveis TMC entre prostitutas foi superior à observada na população geral, indicando a necessidade de melhorar os cuidados com a saúde dessas mulheres.
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Orchard T, Farr S, Macphail S, Wender C, Wilson C. Expanding the scope of inquiry: exploring accounts of childhood and family life among sex workers in London, Ontario. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2014. [DOI: 10.3138/cjhs.2323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Treena Orchard
- School of Health Studies, University of Western Ontario, London, ON
| | - Sara Farr
- Community Support and Mental Health Worker- WOTCH, London, ON
| | - Susan Macphail
- WOTCH Community Mental Health Services and My Sister's Place, London, ON
| | - Cass Wender
- WOTCH Community Mental Health Services and My Sister's Place, London, ON
| | - Christine Wilson
- WOTCH Community Mental Health Services and My Sister's Place, London, ON
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Griffith JD, Mitchell S, Hart CL, Adams LT, Gu LL. Pornography actresses: an assessment of the damaged goods hypothesis. JOURNAL OF SEX RESEARCH 2012; 50:621-632. [PMID: 23167939 DOI: 10.1080/00224499.2012.719168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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.
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Affiliation(s)
- James D Griffith
- Department of Psychology, Shippensburg University, Shippensburg, PA 17257, USA.
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Lalor K, McElvaney R. Child sexual abuse, links to later sexual exploitation/high-risk sexual behavior, and prevention/treatment programs. TRAUMA, VIOLENCE & ABUSE 2010; 11:159-77. [PMID: 20679329 DOI: 10.1177/1524838010378299] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This paper reviews the literature on the nature and incidence of child sexual abuse, explores the link between child sexual abuse and later sexual exploitation, and reviews the literature on prevention strategies and effective interventions in child sexual abuse services. Our understanding of the international epidemiology of child sexual abuse is considerably greater than it was just 10 years ago, and studies from around the world are examined. Childhood sexual abuse can involve a wide number of psychological sequelae, including low self-esteem, anxiety, and depression. Numerous studies have noted that child sexual abuse victims are vulnerable to later sexual revictimization, as well as the link between child sexual abuse and later engagement in high-risk sexual behaviour. Survivors of child sexual abuse are more likely to have multiple sex partners, become pregnant as teenagers, and experience sexual assault as adults. Various models which attempt to account for this inter-relationship are presented; most invoke mediating variables such as low self-esteem, drug/alcohol use, PTSD and distorted sexual development. Prevention strategies for child sexual abuse are examined including media campaigns, school-based prevention programmes, and therapy with abusers. The results of a number of meta-analyses are examined. However, researchers have identified significant methodological limitations in the extant research literature that impede the making of recommendations for implementing existing therapeutic programmes unreservedly.
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Affiliation(s)
- Kevin Lalor
- Department of Social Sciences, Dublin Institute of Technology, Dublin, Ireland.
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10
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Baker LM, Dalla RL, Williamson C. Exiting Prostitution: An Integrated Model. Violence Against Women 2010; 16:579-600. [DOI: 10.1177/1077801210367643] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exiting street-level prostitution is a complex, convoluted process. Few studies have described this process within any formal conceptual framework. This article reviews two general models and two prostitution-specific models and their applicability to the exiting process. Barriers encountered as women attempt to leave the streets are identified. Based on the four models, the barriers, the prostitution literature, and the authors’ experience with prostituted women, a new integrated six-stage model that is comprehensive in scope and sensitive to women’s attempts to exit prostitution is offered as a foundation for continued research on the process of women leaving the streets.
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Wilson HW, Widom CS. The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2010. [PMID: 20186260 DOI: 10.1111/j.1532-7795.2009.00624.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines five potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0-11) with cases processed during 1967-1971 were matched with non-abused, non-neglected children and followed into young adulthood. Data are from in-person interviews at approximate age 29 and arrest records through 1994. Structural Equation Modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors, except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.
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Affiliation(s)
- Helen W Wilson
- Department of Psychology at John Jay College of Criminal Justice, The City University of New York
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Wilson HW, Widom CS. The Role of Youth Problem Behaviors in the Path From Child Abuse and Neglect to Prostitution: A Prospective Examination. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2010; 20:210-236. [PMID: 20186260 PMCID: PMC2825751 DOI: 10.1111/j.1532-7795.2009.00624.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Behaviors beginning in childhood or adolescence may mediate the relationship between childhood maltreatment and involvement in prostitution. This paper examines five potential mediators: early sexual initiation, running away, juvenile crime, school problems, and early drug use. Using a prospective cohort design, abused and neglected children (ages 0-11) with cases processed during 1967-1971 were matched with non-abused, non-neglected children and followed into young adulthood. Data are from in-person interviews at approximate age 29 and arrest records through 1994. Structural Equation Modeling tested path models. Results indicated that victims of child abuse and neglect were at increased risk for all problem behaviors, except drug use. In the full model, only early sexual initiation remained significant as a mediator in the pathway from child abuse and neglect to prostitution. Findings were generally consistent for physical and sexual abuse and neglect. These findings suggest that interventions to reduce problem behaviors among maltreated children may also reduce their risk for prostitution later in life.
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Affiliation(s)
- Helen W Wilson
- Department of Psychology at John Jay College of Criminal Justice, The City University of New York
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Seib C, Fischer J, Najman JM. The health of female sex workers from three industry sectors in Queensland, Australia. Soc Sci Med 2009; 68:473-8. [DOI: 10.1016/j.socscimed.2008.10.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Indexed: 10/21/2022]
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Wilson HW, Widom CS. A prospective examination of the path from child abuse and neglect to illicit drug use in middle adulthood: the potential mediating role of four risk factors. J Youth Adolesc 2008; 38:340-54. [PMID: 19636749 DOI: 10.1007/s10964-008-9331-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 08/08/2008] [Indexed: 11/29/2022]
Abstract
This study examines prostitution, homelessness, delinquency and crime, and school problems as potential mediators of the relationship between childhood abuse and neglect (CAN) and illicit drug use in middle adulthood. Children with documented cases of physical and sexual abuse and neglect (ages 0-11) during 1967-1971 were matched with non-maltreated children and followed into middle adulthood (approximate age 39). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1,196). Drug use was assessed via self-reports of past year use of marijuana, psychedelics, cocaine, and/or heroin during 2000-2002 (N = 896). Latent variable structural equation modeling (SEM) was used to test: (1) a four-factor model with separate pathways from CAN to illicit drug use through each of the mediating risk factors and (2) a second-order model with a single mediating risk factor comprised of prostitution, homelessness, delinquency and crime, and poor school performance. Analyses were performed separately for women and men, controlling for race/ethnicity and early drug use. In the four-factor model for both men and women, CAN was significantly related to each of the mediators, but no paths from the mediators to drug use were significant. For women, the second-order risk factor mediated the relationship between CAN and illicit drug use in middle adulthood. For men, neither child abuse and neglect nor the second-order risk factor predicted drug use in middle adulthood. These results suggest that for women, the path from CAN to middle adulthood drug use is part of a general "problem behavior syndrome" evident earlier in life.
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Affiliation(s)
- Helen W Wilson
- Department of Psychology, John Jay College of Criminal Justice, The City University of New York, New York, NY 11231, USA.
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Stoltz JAM, Shannon K, Kerr T, Zhang R, Montaner JJS, Wood E. Associations between childhood maltreatment and sex work in a cohort of drug-using youth. Soc Sci Med 2007; 65:1214-21. [PMID: 17576029 PMCID: PMC2254224 DOI: 10.1016/j.socscimed.2007.05.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Indexed: 10/23/2022]
Abstract
Although research has examined the impacts of childhood maltreatment among various marginalized populations, few studies have explored the relationship between child abuse and subsequent involvement in sex work among drug-using street-involved youth. In the present study, the relationships between the level of childhood maltreatment and involvement in sex work were examined using the Childhood Trauma Questionnaire (CTQ) as part of an extensive interview protocol in an ongoing prospective cohort study of street-involved youth in Vancouver, Canada. Between September 2005 and June 2006, 361 youth were recruited using extensive outreach methods and snowball sampling. The prevalence rates for abuse in the sample were 73% for physical abuse; 32.4% for sexual abuse; 86.8% for emotional abuse; 84.5% for physical neglect; and 93% for emotional neglect. Univariate and logistic regression analyses demonstrated that not only was sexual abuse independently associated with sex work, but emotional abuse was as well. These findings have implications for early intervention efforts aimed at vulnerable, high-risk youth populations as well as intervention strategies for active sex trade workers.
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Affiliation(s)
| | - Kate Shannon
- Faculty of Medicine, University of British Columbia,
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS; Faculty of Medicine, University of British Columbia,
| | | | - Julio J. S. Montaner
- BC Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia,
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia,
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Roxburgh A, Degenhardt L, Copeland J. Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia. BMC Psychiatry 2006; 6:24. [PMID: 16719928 PMCID: PMC1481550 DOI: 10.1186/1471-244x-6-24] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 05/24/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history. METHODS Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history. RESULTS All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours. CONCLUSION These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority.
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Affiliation(s)
- Amanda Roxburgh
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Ompad DC, Ikeda RM, Shah N, Fuller CM, Bailey S, Morse E, Kerndt P, Maslow C, Wu Y, Vlahov D, Garfein R, Strathdee SA. Childhood sexual abuse and age at initiation of injection drug use. Am J Public Health 2005; 95:703-9. [PMID: 15798133 PMCID: PMC1449244 DOI: 10.2105/ajph.2003.019372] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. METHODS We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. RESULTS The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. CONCLUSIONS Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.
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Affiliation(s)
- Danielle C Ompad
- New York Academy of Medicine, Center for Urban Epidemiologic Studies, 1216 Fifth Avenue, New York, NY 10029, USA.
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Brody S, Potterat JJ, Muth SQ, Woodhouse DE. Psychiatric and characterological factors relevant to excess mortality in a long-term cohort of prostitute women. JOURNAL OF SEX & MARITAL THERAPY 2005; 31:97-112. [PMID: 15859370 DOI: 10.1080/00926230590477943] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We previously reported on the causes of death in a 30-year open cohort of 1,969 prostitute women. Excess mortality was mostly accounted for by homicide, suicide, drug and alcohol toxicity, and AIDS, with AIDS deaths occurring in prostitutes identified as injecting drug users. Presently, we examine observed mortality trends in light of the literature on personality and psychopathological characteristics reported for prostitute women, and with reports linking such personality characteristics to excess mortality. We observed consistency between the observed pattern of mortality in prostitute women and mortality that would be expected in a sample of persons at high risk for antisocial and borderline personality disorder.
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Affiliation(s)
- Stuart Brody
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany.
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Parsons JT, Bimbi DS, Koken JA, Halkitis PN. Factors related to childhood sexual abuse among gay/bisexual male Internet escorts. JOURNAL OF CHILD SEXUAL ABUSE 2005; 14:1-23. [PMID: 15914408 DOI: 10.1300/j070v14n02_01] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This exploratory investigation examined the relationship between childhood sexual abuse (CSA) and related psychosocial characteristics and sexual behaviors among 46 gay/bisexual male escorts who advertise via the Internet. More than a quarter of men (28.3%) reported some history of CSA. Men reporting CSA were more likely to be from an ethnic minority group, identify as bisexual, have a primary male partner, and were less likely to identify an anal receptive ("bottom") sexual role preference. Men with a history of CSA were more likely to report unprotected sex with work-related partners, increased internalized homophobia, and decreased adolescent isolation. Interventions designed for male escorts with a history of CSA should emphasize safer sex strategies with work partners and reducing internalized homophobia.
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Affiliation(s)
- Jeffrey T Parsons
- Department of Psychology, Hunter College and Graduate Center of the City University of New York, New York, NY 10021, USA.
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Du Mont J, McGregor MJ. Sexual assault in the lives of urban sex workers: a descriptive and comparative analysis. Women Health 2004; 39:79-96. [PMID: 15256357 DOI: 10.1300/j013v39n03_06] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This exploratory study contributes to the sparse literature on sexually assaulted sex workers. We examined 462 sexual assault cases seen at an emergency department-based sexual assault service and reported to the police between 1993 and 1997. More than one fifth of victims were sex workers. We compared them to other victims on victim characteristics, assault characteristics, and medical-legal findings. Relative to other victims, sex workers were younger, had lower incomes, and were more likely to be heroin and/or cocaine users. They suffered a greater number of injuries and forensic samples collected from their bodies were more likely to test positive for sperm and/or semen. These victims were also less likely to have been using alcohol and/or marijuana prior to the assault and to be emotionally expressed during the medical- legal examination. The substantial proportion of sex workers in the study population suggests that attention to their particular needs should be an important part of hospital-based sexual assault services. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Janice Du Mont
- Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre and the University of Toronto, Ontario, Canada.
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Weber AE, Boivin JF, Blais L, Haley N, Roy E. Predictors of initiation into prostitution among female street youths. J Urban Health 2004; 81:584-95. [PMID: 15466840 PMCID: PMC3455930 DOI: 10.1093/jurban/jth142] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prostitution among female street youths represents an important risk factor for several health problems. Little is known about the incidence and determinants of prostitution in this vulnerable population, and no data have been previously reported based on a longitudinal follow-up study. The objective of this study was to determine predictors of initiation into prostitution among female street youths. Female youths aged 14 to 25 years were enrolled in the Montreal Street Youth Cohort. They completed a baseline and at least one follow-up questionnaire between January 1995 and March 2000. Girls who reported never having engaged in prostitution at baseline were followed prospectively to estimate the incidence and predictors of prostitution. Of the 330 female street youths enrolled as of September 2000 in the cohort, 148 reported no history of involvement in prostitution at baseline and completed at least one follow-up questionnaire. Of these 148 girls, 33 became involved in prostitution over the course of the study (mean follow-up 2.4 years), resulting in an incidence rate of 11.1/100 person-years. Multivariate Cox regression analysis revealed having a female sex partner (adjusted hazard ratio [AHR] 3.8; 95% confidence interval [CI] 1.6-9.1) was an independent predictor of initiation into prostitution after controlling for having been on the street at age 15 years or younger (AHR 1.8, 95% CI 0.9-3.8), using acid or phencyclidine (PCP; AHR 2.0, 95% CI 0.9-4.6), using heroin (AHR 1.9, 95% CI 0.7-5.5), the use of drugs greater than twice per week (AHR 1.9, 95% CI 0.9-4.2), and injection drug use (AHR 0.8, 95% CI 0.3-2.4). The incidence of prostitution in female street youths was elevated. Having a female sex partner was a strong predictor of initiating involvement in prostitution.
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Affiliation(s)
- Amy E Weber
- Joint Departments of Epidemiology and Biostatistics and Occupational Health, McGill University, Canada.
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Dalla RL. When the Bough Breaks ... : Examining Intergenerational Parent-Child Relational Patterns Among Street-Level Sex Workers and Their Parents and Children. APPLIED DEVELOPMENTAL SCIENCE 2003. [DOI: 10.1207/s1532480xads0704_1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hwang SL, Bedford O. Precursors and pathways to adolescent prostitution in Taiwan. JOURNAL OF SEX RESEARCH 2003; 40:201-210. [PMID: 12908127 DOI: 10.1080/00224490309552181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper identifies the major precursors and pathways to prostitution for contemporary Taiwanese girls and the socioeconomic and cultural changes that have facilitated the shift in pathways over the past 10 years. Special attention is paid to the case of Taiwanese aborigines, who have particularly suffered systemic disruption due to prostitution. Analysis of case files and interviews provide quantitative and qualitative data that highlight the role of filial piety and the shift from indenture to runaway as the major pathway in Taiwan. Discussion includes relation of these findings to juvenile entry into prostitution in other countries, directions for future research, and policy recommendations for Taiwan's government.
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Abstract
Adolescents who reported to have given sexual favors for payment were investigated. The sample consisted of all adolescents in the public and private school systems in Oslo, the capital in Norway (age group 14-17, response rate 94.3%, N=10,828). Adolescents who had sold sex form 1.4%, three times as many boys as girls. Half the group had done it more than 10 times. Most were under the legal age of sex in Norway (16 years) when this first happened. We found no associations with sociodemographic variables or residential area in Oslo. However, sex sale was associated with low intercourse debut age, conduct problems, alcohol problems, use of drugs (including heroin) and violent victimization. The conclusion is that a small group in the general adolescent population sells sex, and many of the clients are assumed to be homosexual or bisexual men. Adolescents who take part in these activities are often heavily involved in delinquent behaviors and use of drugs, and many probably are in a risk zone for sexually transmitted diseases (including HIV), drug abuse and a delinquent and criminal development.
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Affiliation(s)
- Willy Pedersen
- Department of Sociology and Human Geography, University of Oslo, Blindern, Norwegian Social Research, Oslo, Norway.
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Johnson BL, von Haeften I, Fishbein M, Kasprzyk D, Montano D. Factors influencing IDU and non-IDU female commercial sex workers' intentions to always use condoms for vaginal sex with their regular partner. PSYCHOL HEALTH MED 2001. [DOI: 10.1080/13548500123901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Romans SE, Potter K, Martin J, Herbison P. The mental and physical health of female sex workers: a comparative study. Aust N Z J Psychiatry 2001; 35:75-80. [PMID: 11270461 DOI: 10.1046/j.1440-1614.2001.00857.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this study was to compare the mental and physical health, adult abuse experiences and social networks of female sex workers with data previously collected from two large community samples of age-matched women. METHOD A convenience sample of sex workers were interviewed and completed two well-established questionnaires, the General Health Questionnaire (GHQ-28) and the Intimate Bond Measure (IBM). Sex workers were invited to reflect on their experiences of their work. RESULTS There were no differences in mental health on the GHQ-28 or in self-esteem (measured by an item on the Present State Examination) between the two groups. Neither were there any differences in their assessment of their physical health or the quality of their social networks. Sex workers were less likely to be married and had been exposed to more adult physical and sexual abuse than the comparison group. They were more likely to smoke and to drink heavily when they drank. One-third said that their general practitioner was not aware of their work. A subgroup not working with regular clients or in a massage parlour had higher GHQ-28 scores and may be an at-risk group. Narrative information about the work, particularly its intermittent nature, is presented. CONCLUSIONS No evidence was found that sex work and increased adult psychiatric morbidity are inevitably associated, although there may be subgroups of workers with particular problems. The illegal and stigmatized nature of sex work are likely to make usual public health strategies more difficult to apply, considerations which should give concern from a preventive health standpoint.
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Affiliation(s)
- S E Romans
- Dunedin School of Medicine, New Zealand.
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