Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis.

BACKGROUND: Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces sustaining it need to be better understood among specific subpopulations. We aimed to explore risk and protective factors for human trafficking, the health impact of exploitation, and barriers and facilitators of seeking help throughout the human trafficking trajectory among forced labor and sex trafficking victims in Kampala, Uganda. METHODS: Between March and November 2020, in-depth, semi-structured qualitative interviews were conducted with 108 victims of forced labor and sex trafficking who had completed a human trafficking survey conducted by the Uganda Youth Development Link (UYDEL). Participants who experienced various forms of exploitation were purposively invited for qualitative interviews and a convenience sample was interviewed. Interviews explored personal history, trafficking recruitment, experiences of exploitation and abuse, and experiences seeking help. Interviews were analyzed using a combination of deductive and inductive thematic analysis. Themes and subthemes were organized using an adapted conceptual framework of human trafficking. RESULTS: Poverty and an abusive home life, frequently triggered by the death of a caretaker, underpinned vulnerability to human trafficking recruitment. Limited education, lack of social support, and survival needs pushed victims into exploitative situations. Victims of human trafficking were systematically exploited and exposed to dangerous working conditions. Victims suffered from sexually transmitted diseases, incontinence, traumatic fistulae, musculoskeletal injuries, and mental health symptoms. Lack of awareness of resources, fear of negative consequences, restrictions on movement, and dependence on the trafficker and exploitation income prevented victims from seeking help. The police and healthcare workers were the few professionals that they interacted with, but these interactions were oftentimes negative experiences. CONCLUSIONS: To address and prevent human trafficking, localized interventions are needed at all stages of the human trafficking trajectory. Health impacts of human trafficking are severe. As some of the few professionals trafficking victims interact with, police and healthcare workers are important targets for anti-trafficking training. Improved understanding of human trafficking drivers and barriers and facilitators to seeking help can inform the design of necessary interventions.

Learning to endure: A qualitative examination of the protective factors of homeless transgender and gender expansive youth engaged in survival sex.

Background: Transgender and gender expansive (TGE) youth face a number of adversities that are associated with deleterious consequences, including mental health problems, substance misuse, suicide, and homelessness. However, there is evidence that TGE youth still demonstrate resilience under extraordinary conditions. Aims: Therefore, this study examined how TGE youth who are homeless and engaging in survival sex describe and understand the protective factors present in their lives. Methods: In-depth qualitative interviews were conducted with 57 TGE youth living in a large U.S. city. Participants were 17-26 years old (M = 19.88, SD = 1.55), and identified as transgender woman (53%), transgender man (16%), and other (32%; gender-queer, gender-fluid, androgynous, or non-binary). Youth identified as Black (40%), multiracial (35%), Latinx (16%), White (5%), and as another race (3%). Researchers conducted a secondary analysis of qualitative data using thematic analysis. Results: We identified three themes to capture youth's understanding of their protective factors: relying on oneself and others to avoid violence, accessing gender-affirming health and mental health care, and proactively maintaining sexual health. Participants described strategies for mitigating risk of harm while attempting to meet their basic needs. Additionally, they discussed the importance of having gender-affirming health and mental health services. Participants also expressed keen awareness of their sexual health risks and making calculated, often proactive decisions about their sexual health. Conclusion: The protective factors described by TGE youth reflect the unique ways in which hyper-marginalized youth must navigate their own survival and well-being, and align with literature suggesting resilience is not mutually exclusive from risk. By focusing on TGE youth, this research privileges the experiences of individuals historically underrepresented in research and encourages future research to incorporate these perspectives into policies and programs.

Victimization and Resilience Among Sexual and Gender Minority Homeless Youth Engaging in Survival Sex.

This study examined how a diverse group of sexual and gender minority (SGM) homeless youth described and understood their victimization experiences occurring before they were homeless and those occurring after they were homeless and engaging in survival sex. In addition, the study explored how these youths manifested resilience when living on the street. The sample consisted of 283 racially/ethnically diverse youth between the ages of 15 and 26 years (M = 19.6, SD = 1.28) living in a large U.S. city. Participants identified their gender as male (47%), female (36%), transgender (15%), or queer and other (3%) and their sexual orientation as bisexual (37%), gay (23%), lesbian (15%), heterosexual (13%), or queer and other (13%). Thirty-seven percent identified as Black, 30% as multiracial, 22% as Latino/a, 5% as White, and 5% as another race. Content and thematic analyses were used to conduct a secondary analysis of qualitative data. Four themes were identified: unsafe and unsupported at home; barriers to housing and employment stability; ongoing victimization and lack of protection; and unexpected opportunities for resilience. Findings demonstrated that participants experienced victimization related not only to their SGM identities but also to chaotic home environments. Once homeless and engaging in survival sex, youth experienced barriers to securing employment and housing as well as victimization by police and clients. These experiences frequently involved prejudice related to their intersecting identities. Despite encountering numerous challenges, participants described surviving on the streets by living openly and forming relationships with other youth. Implications for practice and policy are discussed.

Understanding Forced Marriage in the United States: Developing Measures, Examining its Nature, and Assessing Gender Disparities.

In Western European countries and Canada, an emerging scholarly literature has helped inform awareness and prevention efforts and justice system responses to address forced marriages. But, little is known about this issue in the United States. The present study, the first large scale examination of forced marriage prevalence in the United States, surveys a national sample of Internet users over 18 years of age. Using a Google Consumer Survey platform, this exploratory study seeks to estimate prevalence of and gender disparities in forced marriages for this sample; examine conditions and circumstances associated with forced marriage; develop adequate measurement tools to identify individuals who have faced forced marriage; and better understand how and to what extent those experiencing forced marriage face psychological abuse from intimate partners and access victim services. Contrary to the experiences of legal and social service providers, findings indicate that more men than women reported forced marriage experiences. The discrepancy between this finding and prior research underscores the need to further develop survey measures and reconsider closed-ended, web-based survey screener questions such as the one used to identify respondents experiencing forced marriage in this study. These considerations may help identify victims with better precision and locate the underlying causes of gender disparities in forced marriage. In addition, many respondents reported entering forced marriages while facing concerns over their own or their family's reputation and threats of harm (to themselves or self-harm of a family member).A majority of respondents also reported experiencing psychological intimate partner violence and seeking help, particularly from law enforcement and for medical assistance. This large overlap between forced marriage and psychological intimate partner violence, as well as between forced marriage and seeking help from law enforcement and medical assistance providers, indicates that service provision needs are notably acute for this population..

Patterns of Help-Seeking Behavior Among Victims of Teen Dating Violence and Abuse: Variations Among Boys and Girls.

BACKGROUND: Despite the extensive research on rates of teen dating violence and abuse and its' consequences, less is known about help-seeking behaviors among victims. The goals of this study were to document patterns of help-seeking behaviors among teen victims of dating violence and abuse and examine sex differences related to such patterns. METHODS: The study involved cross-sectional surveys of 3745 dating youth from 10 middle and high schools in the northeastern United States, 59% of whom reported some kind of dating abuse victimization. We examined the characteristics of youth who reported any type of dating abuse victimization comparing youth who reported seeking help to youth who did not report seeking help following their victimization. RESULTS: Only 9% of victims reported seeking help after their victimization experience. Help-seeking differed significantly by sex; female victims were more likely to seek help than male victims, and the types of dating abuse that help-seekers experienced also varied by sex. Overall, 17% of youth sought help from school counselors and 13% sought help from teachers. CONCLUSIONS: Results suggest that help-seeking behavior is very uncommon among victim populations, particularly if they are not part of specific dating violence prevention programs. In addition, we found female victims were nearly 2 times more likely to seek help than male victims. Given that few youth seek help on their own, schools might create more formalized reporting mechanisms to ensure such violence is addressed effectively and efficiently, and create peer and parental support networks to build awareness and create comfort for victims.

Navigating an Unclear Terrain: Challenges in Recognizing, Naming, and Accessing Services for "Forced Marriage".

Despite the attention forced marriage has received abroad, it remains poorly understood in the United States. This study is one of the first to examine the practice domestically, with a focus on service provision. Using interviews with those who have experienced forced marriage and relevant stakeholders, we describe challenges in recognizing, naming, and disclosing forced marriage. Findings indicate that people are unaware forced marriage services exist, face barriers to disclosing, may not identify with the term, and are reluctant to seek services. They suggest the need for training, consistent organizational definitions, inclusive terminology, programming aimed at root causes, standardized identification methods, and cultural competency.

Do Substance Use, Psychosocial Adjustment, and Sexual Experiences Vary for Dating Violence Victims Based on Type of Violent Relationships?

BACKGROUND: We examined whether substance use, psychosocial adjustment, and sexual experiences vary for teen dating violence victims by the type of violence in their relationships. We compared dating youth who reported no victimization in their relationships to those who reported being victims of intimate terrorism (dating violence involving one physically violent and controlling perpetrator) and those who reported experiencing situational couple violence (physical dating violence absent the dynamics of power and control). METHODS: This was a cross-sectional survey of 3745 dating youth from 10 middle and high schools in the northeastern United States, one third of whom reported physical dating violence. RESULTS: In general, teens experiencing no dating violence reported less frequent substance use, higher psychosocial adjustment, and less sexual activity than victims of either intimate terrorism or situational couple violence. In addition, victims of intimate terrorism reported higher levels of depression, anxiety, and anger/hostility compared to situational couple violence victims; they also were more likely to report having sex, and earlier sexual initiation. CONCLUSIONS: Youth who experienced physical violence in their dating relationships, coupled with controlling behaviors from their partner/perpetrator, reported the most psychosocial adjustment issues and the earliest sexual activity.

The co-occurrence of physical and cyber dating violence and bullying among teens.

This study examined the overlap in teen dating violence and bullying perpetration and victimization, with regard to acts of physical violence, psychological abuse, and-for the first time ever-digitally perpetrated cyber abuse. A total of 5,647 youth (51% female, 74% White) from 10 schools participated in a cross-sectional anonymous survey. Results indicated substantial co-occurrence of all types of teen dating violence and bullying. Youth who perpetrated and/or experienced physical, psychological, and cyber bullying were likely to have also perpetrated/experienced physical and sexual dating violence, and psychological and cyber dating abuse.

Dating violence experiences of lesbian, gay, bisexual, and transgender youth.

Media attention and the literature on lesbian, gay, and bisexual youth overwhelmingly focus on violence involving hate crimes and bullying, while ignoring the fact that vulnerable youth also may be at increased risk of violence in their dating relationships. In this study, we examine physical, psychological, sexual, and cyber dating violence experiences among lesbian, gay, and bisexual youth--as compared to those of heterosexual youth, and we explore variations in the likelihood of help-seeking behavior and the presence of particular risk factors among both types of dating violence victims. A total of 5,647 youth (51 % female, 74 % White) from 10 schools participated in a cross-sectional anonymous survey, of which 3,745 reported currently being in a dating relationship or having been in one during the prior year. Results indicated that lesbian, gay, and bisexual youth are at higher risk for all types of dating violence victimization (and nearly all types of dating violence perpetration), compared to heterosexual youth. Further, when looking at gender identity, transgender and female youth are at highest risk of most types of victimization, and are the most likely perpetrators of all forms of dating violence but sexual coercion, which begs further exploration. The findings support the development of dating violence prevention programs that specifically target the needs and vulnerabilities of lesbian, gay, and bisexual youth, in addition to those of female and transgender youth.

Correlates of cyber dating abuse among teens.

Recent advancements in technology (e.g., social networking, texting) have created new ways for dating youth to relate to one another, including in abusive ways via "cyber dating abuse." Cyber dating abuse is a form of teen dating violence that overlaps with other types of abuse (e.g., psychological) but also has several unique characteristics. Given the phenomenon's limited presence in dating violence literature, we focus on identifying how experiencing cyber dating abuse relates to youths' individual behaviors and experiences (e.g., substance use, sexual activity), psychosocial adjustment, school connection, family relationships, and partner relationships. A total of 3,745 youth (52% female, 74% White) in three northeastern states participated in the survey and reported currently being in a dating relationship or having been in one during the prior year. We found that experiences of cyber dating abuse were most significantly correlated with being female, committing a greater variety of delinquent behaviors, having had sexual activity in one's lifetime, having higher levels of depressive symptoms, and having higher levels of anger/hostility. Further, cyber dating abuse appeared somewhat more strongly related to depressive symptoms and delinquency than did other forms of teen dating violence and abuse.

The rate of cyber dating abuse among teens and how it relates to other forms of teen dating violence.

To date, little research has documented how teens might misuse technology to harass, control, and abuse their dating partners. This study examined the extent of cyber dating abuse-abuse via technology and new media-in youth relationships and how it relates to other forms of teen dating violence. A total of 5,647 youth from ten schools in three northeastern states participated in the survey, of which 3,745 reported currently being in a dating relationship or having been in one during the prior year (52 % were female; 74 % White). Just over a quarter of youth in a current or recent relationship said that they experienced some form of cyber dating abuse victimization in the prior year, with females reporting more cyber dating abuse victimization than males (particularly sexual cyber dating abuse). One out of ten youth said that they had perpetrated cyber dating abuse, with females reporting greater levels of non-sexual cyber dating abuse perpetration than males; by contrast, male youth were significantly more likely to report perpetrating sexual cyber dating abuse. Victims of sexual cyber dating abuse were seven times more likely to have also experienced sexual coercion (55 vs. 8 %) than were non-victims, and perpetrators of sexual cyber dating abuse were 17 times more likely to have also perpetrated sexual coercion (34 vs. 2 %) than were non-perpetrators. Implications for practice and future research are discussed.

Systems and strategies for identifying and enumerating children outside of family care.

Methodologies to identify and enumerate children outside of family care vary as do the vulnerability categories of the children themselves. Children outside of family care is a broad term encompassing children absent of permanent family care, e.g., institutionalized children, children on/of the street, child-headed households, separated or unaccompanied children, trafficked children, children working in exploitive labor situations, etc. This paper reviews the various methodologies applied to identify and enumerate these often hidden and/or mobile populations. Methodologies that identify and enumerate children outside of family strive to meet two objectives: (1) to estimate the number and characteristics of a specific vulnerability category and (2) to determine eligibility to receive services. The paper reviews eight methodologies; six are categorized as survey sample methods (time-location sampling, capture recapture sampling, respondent driven sampling, the neighborhood method, household surveys, and establishment surveys) while two were labeled as data management systems (child labor management system, and databases of institutions). Each review includes a concise description of the methodology, its strengths and limitations, the most appropriate population it is suited to identify and/or enumerate, and any necessary conditions. Conclusions from these reviews advocate for tailoring a methodology (or a combination of methodologies) to the specific circumstances under which it is meant to identify or enumerate children outside of family care. In addition, further research and validation studies are needed to identify the conditions under which the strategies described here can be used and to develop appropriate protocols for utilization.