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.

Gendered Dimensions of Demand for Commercial Sexual Exploitation of Children (CSEC) in Kathmandu, Nepal.

Breaking the demand chain for sex from minors would render supply worthless, contributing to the elimination of commercial sexual exploitation of children (CSEC). Using a novel sampling technique, this study reports on actual and potential adult customers of CSEC in two areas in Kathmandu (n = 466). Controlling for refusal conversion, age, education, and income, higher scores on a new Love-Fantasy Scale (LFS) were associated with increased odds of purchasing sex from young girls, as were patriarchal norms emphasizing the power of men. Further research is needed to design interventions that include aspects related to sexual fantasy for young girls to combat demand for CSEC.

Evaluating and Validating the Classification Accuracy of a Screening Instrument to Assess Risk for Commercial Sexual Exploitation of Child Welfare-Involved Children and Adolescents.

OBJECTIVES: Identifying children and adolescents within child welfare at risk for commercial sexual exploitation (CSE) can ensure referrals to appropriate services. However, screening measures to understand the prevalence of CSE are missing in child welfare. We evaluated the classification accuracy of a screener developed for the purpose of this study, guided by the Sexual Exploitation among Youth (SEY) risk assessment framework used in practice with child welfare-involved young people, (1) to identify young people at high versus low risk for experiencing CSE and (2) to estimate the prevalence of CSE risk for child welfare-involved children and adolescents. METHODS: We used extant data from the National Survey of Child and Adolescent Well-being study with a nationally representative sample of children and adolescents aged 11-17 years (n = 1054) investigated by child welfare from February 2008 to April 2009. The 26-item screener showed acceptable reliability (α = .73) and test-criterion validity evidence using a CSE proxy outcome (ie, narrowly defined as being paid for sexual relations). We used the receiver-operating curve to classify risk and calculate the optimal cutoff score. RESULTS: Higher scores on the SEY screener (range, 0-20 points) increased the odds of experiencing CSE by 34%. The screener was good at discriminating CSE risk at the 6-point cutoff, with 26.7% of child welfare-involved young people identified as being at high risk for CSE. CONCLUSIONS: Given the absence of accurate prevalence rates of CSE risk in the population, a theoretical cutoff index using an established method can provide an objective decision on how to distinguish risk levels. Prevalence estimates for CSE risk highlight the need for systematic screening in child welfare to identify and provide services for young people at risk.

Youth survivor perspectives on healthcare and sex trafficking.

PURPOSE: This study aimed to assess the perspectives of youth survivors of sex trafficking on healthcare to improve care for this vulnerable and often unrecognized population. DESIGN AND METHODS: Semi-structured focus groups were conducted with eight survivors in Southern California who interacted with the healthcare system while being sex trafficked. Interviews were audio- and/or video-recorded and transcribed verbatim. The analysis utilized a grounded theory approach, where researchers reviewed the data collected, then inductively generated codes and themes based on the findings from the interviews. RESULTS: The focus group interviews revealed the following themes: unequal treatment, barriers to patient care, risk identifiers, support, and survivor recommendations. CONCLUSIONS: Youth survivors seeking healthcare reported multiple barriers based on their interaction with healthcare providers, such as the lack of provider awareness, education, training, feelings of shame, judgment, fear, racial biases, and lack of empathy. Improving patient outcomes relies on understanding the complexities of human trafficking and implementing an approach to decrease barriers to care. PRACTICE IMPLICATIONS: This study resulted in invaluable survivor recommendations with practical solutions on addressing human trafficking and exploitation in the healthcare system. The solutions proposed by participants included strengthening relationships and experiences with healthcare providers by increasing awareness, establishing rapport, creating a safe space, asking questions about their safety and situation, using a non-judgmental approach, and providing resources.

The relationship between commercial sexual exploitation of children (CSEC) and childhood sexual abuse (CSA) among boys and girls in Haiti.

To test the hypothesis that childhood sexual abuse (CSA) is a risk factor for commercial sexual exploitation of children (CSEC), we analysed data from the Haiti Violence Against Children Survey (VACS), a population-based sample of adolescents and young adults ages 13-24 (1459 males and 1457 females). Twenty-one percent of males and 25% of females reported CSA; 6% of males and 4% of females reported CSEC. The adjusted odds ratios (AORs) for CSEC based on exposure to CSA were 5.6 (95% confidence interval/CI: 3.1-10.2) for males and 5.9 (CI: 2.6-13.0) for females. For each year earlier that males first experienced CSA, the odds of CSEC increased 60% (AOR 1.6, CI 1.2-2.0). In this first nationally-representative study of lifetime CSEC, both boys and girls victimised by CSA in Haiti were more likely to have also experienced CSEC than other youth, with children who experienced CSA at younger ages at the greatest risk.

Police Interviewing Behaviors and Commercially Sexually Exploited Adolescents' Reluctance.

Little is known about the relation between law enforcement interviewing behaviors and commercially sexually exploited children's (CSEC) reluctance. This study examined the relation between officers' use of maximization, (references to) expertise, minimization, and support and adolescent CSEC victims' reluctance in a small sample of police interviews (n = 2,416 question-answer pairs across ten interviews). Twenty-six percent of officers' utterances contained at least one interviewing tactic. When statements were paired with maximization, they were correlated with more reluctance than when they were not paired with an interviewing tactic. Contrary to predictions, support was also related to greater reluctance. Open-ended (recall) questions and statements were associated with greater reluctance than closed-ended (recognition) questions. The results highlight the importance of understanding the context in which interviewing strategies are employed when assessing the relation between interviewer behavior and interviewee reluctance.

Risk Factors and Indicators for Commercial Sexual Exploitation/Domestic Minor Sex Trafficking of Adolescent Girls in the United States in the Context of School Nursing: An Integrative Review of the Literature.

As trusted health care providers in the school setting, school nurses are positioned uniquely to identify children at risk for or victims of commercial sexual exploitation of children (CSEC). Nevertheless, many victims go unrecognized and unaided due to inadequate provider education on victim identification. This review provides a comprehensive overview of the major risk factors for CSEC of girls aged 12-18, the largest group of CSEC victims in the United States. A search of four databases (Web of Science, CINAHL, PsychINFO, and PubMed) yielded 21 articles with domestic focus, published in English between January 2014 and May 2020. While childhood maltreatment trauma was found most relevant, a variety of other risk factors were identified. Future nursing research is called to address the numerous research gaps identified in this review that are crucial for the development of policies and procedures supporting school nurses in recognizing victims quickly and intervening appropriately.

The Intersection of Child Trafficking and Health Care: Our Unique Role as Pediatric Clinicians.

Human trafficking is a pervasive public health problem that affects children of all ages. Health care clinicians can play a unique role in identifying and intervening for trafficking victims through acknowledging biases, understanding the risk factors and red flags, and implementing a trauma-informed care approach in their clinics and institutions. It is through collaboration, education, and research that health care clinicians can work to recognize and respond to this crime perpetrated against the youngest and most vulnerable patients.

A longitudinal evaluation of a survivor-mentor program for child survivors of sex trafficking in the United States.

BACKGROUND: Commercial sexual exploitation (CSE) of children is a significant public health and criminal justice problem, but there are few evaluated models of CSE mentorship service. OBJECTIVES: To assess whether youth who participated in a CSE survivor-mentor program evidenced changes in CSE victimization, dating abuse victimization, health, delinquency, social support, and coping during the year following their enrollment in the program. PARTICIPANTS: 41 youth who were CSE-experienced at baseline (72%) or determined very high risk, 11-18 years old, 95% female, 58% heterosexual, 29% White, 29% Hispanic, and 42% other races/ethnicities. SETTING: An urban city in the Northeast United States. METHODS: We used a one-group repeated measures design and a GEE analysis. Data were collected at baseline, six months after baseline (71% follow-up) and 12 months after baseline (68% follow-up). RESULTS: At baseline 72% could be characterized as CSE-experienced, while at 6 months the percentage decreased to 24% (p < 0.001) and at 12 months to 14% (p < 0.001). After 6 months of receiving survivor-mentor services, youth were less likely to have experienced CSE, engaged in sexually explicit behavior (SEB), used illicit drugs, engaged in delinquent behavior, been arrested or detained by police, and they had better social support and coping skills. After 12 months, youth were less likely to have experienced CSE, to have engaged in delinquent behavior, be arrested or detained by police, and had improved coping skills. CONCLUSION: Findings demonstrate that youth who received survivor-mentor services from MLMC experienced improved well-being and less drug use, delinquent behavior, and exploitation.

A new role for a COPII cargo adaptor in autophagy.

Endoplasmic reticulum (ER) homeostasis is maintained by the removal of misfolded ER proteins via different quality control pathways. Aggregation-prone proteins, including certain disease-linked proteins, are resistant to conventional ER degradation pathways and require other disposal mechanisms. Reticulophagy is a disposal pathway that uses resident autophagy receptors. How these receptors, which are dispersed throughout the ER network, target a specific ER domain for degradation is unknown. We recently showed in budding yeast, that ER stress upregulates the reticulophagy receptor, triggering its association with the COPII cargo adaptor complex, Sfb3/Lst1-Sec23 (SEC24C-SEC23 in mammals), to discrete sites on the ER. These domains are packaged into phagophores for degradation to prevent the accumulation of protein aggregates in the ER. This unconventional role for Sfb3/Lst1 is conserved in mammals and is independent of its role as a cargo adaptor on the secretory pathway. Our findings may have important therapeutic implications in protein-aggregation linked neurodegenerative disorders.

Ethical and Practical Considerations for Collecting Research-Related Data from Commercially Sexually Exploited Children.

This article presents seven challenges of collecting primary (i.e., firsthand) data from commercially sexually exploited children (CSEC). We drew on our research team's experience collecting longitudinal data from 28 CSEC survivors with a 12-month follow-up period. We used both face-to-face and electronic group brainstorming methods to nominate a list of research-related challenges. The two main themes that were identified were challenges that can limit data quality and concerns about the impact of research on participants, researchers, and others. The three challenges related to data quality are (1) the age of the research participants; (2) questions about obtaining informed consent from parents or guardians; and (3) the over-interrogation of CSEC youth. The four challenges related to concerns about the impact of research were (4) concerns that research participation may further exploit youth; (5) staying in the role of researcher and refraining from providing advocacy; (6) secondary trauma and burnout experienced by research staff; and (7) the additional burden that research and data collection may place on the advocates and direct service providers. Because the process of collecting data from CSEC youth can be complicated, and rife with ethical and practical challenges, we have relayed our experiences with seven specific research-related challenges in order to stimulate discourse and further progress in the field.

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

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

Domestic Minor Sex Trafficking.

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

Genetic and Morphological Differentiation of the Semiterrestrial Crab Armases angustipes (Brachyura: Sesarmidae) along the Brazilian Coast.

The genetic and morphometric population structures of the semiterrestrial crab Armases angustipes from along the Brazilian coast were examined. The influence of the Central South Equatorial Current on larval dispersal of A. angustipes also was evaluated. Six populations were sampled from estuarine areas in São Luis do Maranhão, Maranhão; Natal, Rio Grande do Norte; Maceió, Alagoas; Ilhéus, Bahia; Aracruz, Espírito Santo; and Guaratuba, Paraná. Patterns of genetic differentiation were assessed using DNA sequence data corresponding to parts of the mitochondrial cytochrome c oxidase subunit 1. Geometric morphometric techniques were used to evaluate morphological variation in shape and size of the carapace and right cheliped propodus. Our results revealed low genetic variability and lack of phylogeographic structure; geometric morphometrics showed statistically significant morphological differentiation and geographic structuring. Our data indicate the absence of possible barriers to gene flow for this mobile species, and no clear correlation of morphological or genetic variation with ocean currents and/or geographic distance. Our results also suggest that historical geological and climatological events and/or possible bottleneck effects influenced the current low genetic variability among the populations of A. angustipes.

Sex Trafficking of Minors.

Sex trafficking is an increasingly recognized global health crisis affecting every country and region in the world. Domestic minor sex trafficking is a subset of commercial sexual exploitation of children, defined as engagement of minors (<18 years of age) in sexual acts for items of value (eg, food, shelter, drugs, money) involving children victimized within US borders. These involved youth are at risk for serious immediate and long-term physical and mental health consequences. Continued efforts are needed to improve preventive efforts, identification, screening, appropriate interventions, and subsequent resource provision for victimized and high-risk youth.

Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital.

BACKGROUND: The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital. METHODS: We conducted a retrospective, matched case-control-control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection. RESULTS: Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26-12.42), tracheostomy (OR:2.24; 95%CI: 1.14-4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31-28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52-95.4), urinary system disease (OR: 16.69; 95%CI: 3.01-89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46-5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89-26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01). CONCLUSION: Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.

Supporting youth involved in domestic minor sex trafficking: Divergent perspectives on youth agency.

Domestic-minor sex trafficking (DMST) continues to affect youth in the United States; however, lack of empirical evidence for interventions and the complex sociopolitical discourses surrounding sex trafficking and the commercial sexual exploitation of children (CSEC) hamper delivery of effective services to this population. To explore perspectives on best practices with these young people, 20 in-depth interviews were conducted with key stakeholders whose work provides them with a unique vantage point on the needs and experiences of survivors of DMST in New Jersey. Notes from interviews were coded and analyzed for emergent themes. While key stakeholders generally agreed on best practices, there were several important areas of dispute that emerged regarding how best to serve youth involved in DMST, specifically with regard to youth running away from services, models of service provision, and the use of technology by these youth. Findings suggest that professionals from diverse backgrounds may disagree about the extent to which youth involved in DMST possess agency in their decision-making capacities as adolescents. This study explores these areas of dispute, and discusses the implications for the many different professionals and systems that must work together in providing services to this population.

Sex trafficking of minors in metropolitan, micropolitan, and rural communities.

The purpose of the study was to examine professionals' awareness, knowledge, and experiences working with youth victims of sex trafficking in metropolitan and non-metropolitan communities. Professionals who worked with at-risk youth and/or crime victims were recruited from all counties in a southern, rural state in the U.S. to complete a telephone survey. Surveys included closed and open-ended questions, which were theme coded. Professionals' (n=289) were classified into one of four categories based on the counties in which they worked: metropolitan, micropolitan, rural, and all three community types. Although there were many similarities found in trafficking situations across the different types of communities, some expected differences were found. First, as expected, more professionals in metropolitan communities perceived CSEC as being a fairly or very serious problem in the state overall. Consistent with other studies, more professionals in metropolitan communities had received training on human trafficking and reported they were familiar with the state and federal laws on human trafficking (Newton et al., 2008). Significantly more professionals in metropolitan (54.7%) communities reported they had worked with a suspected or definite victim of STM compared to professionals in micropolitan communities (29.8%). There were few differences in victim characteristics, vulnerability factors, and trafficking situations (e.g., relationship to trafficker, traffickers' techniques for controlling victims, transportation, and Internet-facilitation of trafficking) across the community types. There is a continued need for awareness building of STM and training, particularly in non-metropolitan communities, as well as adoption of screening tools, integration of trauma-informed care, and identification of best practices.

Principales problemas identificados en la investigación y atención de víctimas de la explotación sexual comercial infantil en México / Principal problems identified in research on and treatment of victims of the commercial sexual exploitation of children (CSEC) in Mexico

The purpose of this study is to identify and describe the actions designed to combat the commercial sexual exploitation of children (CSEC) which jeopardizes or affects the victims of exploitation. To this end, the paper analyzes the paradoxical results obtained in the research and actions to combat CSEC, implemented under the auspices of the institutions to promote research on CSEC and the prevention, protection and care of child victims of the phenomenon. These results were obtained by the research team when it systematized 16 CSEC diagnoses undertaken in various parts of the country and from the information derived from the fieldwork carried out between 2000 and 2005 by the Inter-Institutional Committees to combat CSEC and at the institutions for the protection and care of child victims of sexual exploitation. The fieldwork involved participant observation during the working meetings of the Inter-Institutional Committees and at the <

El objetivo del presente trabajo es identificar y describir las acciones en contra de la explotación sexual comercial infantil (ESCI) que ponen en riesgo o afectan a las víctimas de dicha explotación. Para ello, se documentan los resultados paradójicos obtenidos en la investigación y en las acciones contra la ESCI, implementadas bajo el auspicio de instituciones promotoras de la investigación de la ESCI y de la prevención, protección y atención a victimas infantiles del fenómeno. Estos resultados fueron obtenidos por el equipo de investigación al desarrollar una sistematización de 16 diagnósticos de la ESCI promovidos en diferentes partes del país, y al sistematizar la información del trabajo de campo desarrollado entre los años 2000 y 2005, en los comités interinstitucionales en contra de la ESCI, y en instituciones de atención de las víctimas infantiles de la explotación sexual. El trabajo de campo consistió en la realización de observación participante durante las reuniones de trabajo de los comités interinstitucionales y en los albergues de <