Awareness of commercial sexual exploitation and sex trafficking of children has increased in recent years. The prevalence of commercial sexual exploitation and sex trafficking in the United States is unknown as a result of a combination of factors, including the hidden nature of this crime, inconsistent definitions and screening, incomplete data systems, and low rates of disclosure. It has been estimated that between 100,000 and 300,000 children are at risk of commercial sexual exploitation and sex trafficking each year (Estes & Weiner, 2001). However, recent articles have questioned the validity of the existing prevalence data on human trafficking, making data estimates even more difficult to ascertain (Fedina, 2015; Weitzer, 2010).

Several terms are often used interchangeably when referring to this phenomenon, including commercial sexual exploitation of children (CSEC), sex trafficking of minors, domestic minor sex trafficking, and survival sex. Efforts have been made to clarify the use of these terms and promote consistent usage of the terms in research, policy, and programming, however, confusion and inconsistent application still exists [IOM (Institute of Medicine) and NRC (National Research Council), 2013]. This paper will use the term child sex trafficking to refer to the range of sexual crimes against children including any commercial sex act, regardless of force, fraud, or coercion as defined by the Office of Juvenile Justice and Delinquency Prevention and the Trafficking Victims Protection Act (P.L. 106-386) of 2000.

The complex trauma experienced by victims of child sex trafficking has devastating consequences including psychological disorders like anxiety, depression, and post-traumatic stress disorder (Hossain, Zimmerman, Abas, Light, & Watts, 2010; Tsutsumi, Izutsu, Poudyal, Kato, & Marui, 2008), emotional and developmental dysregulation, and substance abuse (Cole, Sprang, Lee & Cohen, 2016). Unique to the phenomenon of sex trafficking is the stigma assigned to those who are perceived to violate social norms about sexuality and sexual behaviors. This stigma can present barriers to fair treatment within justice systems (Gray, 2006; Page, 2010) and to health care access (Lazarus et al., 2012). Researchers have noted that social norms related to trafficking are influenced by myths and moral ideologies that often attribute blame to victims (Cunningham & Cromer, 2014). This knowledge of social norms is especially important with regard to the complicated issue of child sex trafficking. Here, we propose a framework for conceptualizing child sex trafficking that incorporates an understanding of social norms as influencing risk, prevention, and intervention.

Ecological theory provides a framework to explain how the inherent qualities of a child interacts with the environment to influence growth and development (Bronfenbrenner, 1981). This theory is ideal for understanding the individual, relational, social and environmental relationships which occur with a phenomenon like child sex trafficking (Barner, Okech & Camp, 2018; Bronfenbrenner, 1981). Children are understood to be enmeshed simultaneously in multiple environments, from the most immediate home to school to the larger society and culture. In addition, there is the concept of the chronosystem, i.e., the dimension of time, which speaks to the influence of both change and constancy in a child’s environment throughout their development (Bronfenbrenner, 1994).

Our proposed framework adapts Bronfenbrenner and Ceci’s (1994) conceptualization of the individual embedded and influenced by multiple settings and examines how factors at four levels contribute to child sex trafficking: (a) societal level, (b) community level, (c) relationship/interpersonal level, and (d) individual/intrapersonal level. Social norms can be seen as existing at or being influenced by all four of these levels. For this conceptualization, they are described at the community level with examples of how social norms interact with societal and relationship/interpersonal levels to influence the individual/interpersonal level. The framework considers Belsky’s (1980) delineation of how the influence of one’s personal history relates to the social–psychological phenomenon of child maltreatment, which contributes to individual vulnerability. It also considers Finkelhor and Browne’s (1985) traumagenic model, which attempts to explain how sexual abuse damages children’s emotional, cognitive, and relational development through four dynamics: traumatic sexualization, stigmatization, betrayal, and powerlessness.

Furthermore, the etiology of behaviors that deviate from broader social norms, such as commercial sex work, are viewed within the framework of Agnew’s general strain theory (2006), which argues that offending behavior is a response to stress or strain (Snyder et al., 2016). Although it was originally developed to explain juvenile delinquency, other authors have applied strain theory to victimization and child sex trafficking (Reid, 2011; Reid & Piquero, 2016; Schreck, Stewart, & Osgood, 2008). Strain theory emphasizes how individual choices and behaviors are influenced by the broader social and physical environment, as illustrated by the social ecological framework described in this article.

The authors of this manuscript are experts in child maltreatment and child sex trafficking from five different states who have all received funding from the Children’s Bureau.Footnote 1 The goal of this funding is to develop multidisciplinary approaches to identification and protection of children and youth in child welfare who have been sex trafficked or are at risk of being trafficked. In addition, all authors aim to ensure that these youth have access to an array of comprehensive, high-quality services. They are aware of the limited extant literature about child sex trafficking, specifically the lack of a theoretical framework for both research and intervention. In this article, we aim to provide this theoretical underpinning based on our research and expertise (Fig. 1).

Fig. 1
figure 1

Traumagenic social ecological framework for child sex trafficking

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Societal Level

This level concerns the broad societal factors that create a climate in which child sex trafficking is either encouraged or inhibited. These include large, macro-level processes such as health, economic, educational, and social policies that contribute to and perpetuate economic or social inequalities, or conversely, that seek to reduce inequality and create greater social justice. Factors at this level that shape vulnerability to child sex trafficking include the culture of capitalism, federal and state legislation and policy regarding trafficking, and societal and community awareness of child sex trafficking. These processes serve to establish a dominant set of social norms regarding how child sex trafficking is conceptualized and treated in our society, as particular beliefs and values are promoted through policy.

Capitalism

The phenomenon of human trafficking is inherently linked to the dominant logic of capitalism and neoliberal policies, which have become a hegemonic force in the global economy. Exploitation is the foundation of capitalism; human trafficking could be considered an expression of unregulated, unfettered capitalism (Bales & Soodalter, 2010; Musto, 2009). Though not legal or specifically acceptable to broad social norm expectations in any capitalist economy, child sex trafficking is consistent with the themes of capitalism: commoditization and individualization of responsibility. As Sandel (2012) noted, market logic and values have come to permeate nearly every aspect of our lives, increasingly reaching into new spheres of life that were previously governed by nonmarket values. One of the implications of this expanding reach, Sandel argued, is commoditization. The commercial sex industry is one example. Over the last few decades, the commercial sex industry has undergone rapid expansion and diversification (Bernstein, 2001). The industry relies on the idea that women’s bodies are commodities subjected to the rules of the market (Anderson & O’Connel Davidson, 2004). This normative belief does not preclude the possibility that some individuals enter into the commercial sex industry voluntarily. As Anderson and O’Connel Davidson noted, however, “[t]here are some fairly obvious reasons to expect that the rapid expansion of a market that is poorly regulated, widely stigmatized, and partially criminalized will be associated with an increase in the incidence of abusive labour practices (p. 11).” When the logic of capitalism and free markets is allowed to flow unrestricted into all areas of life, exploitation of the most vulnerable populations will follow.

The rapid spread and increasing global domination of neoliberal policies, furthermore, have disproportionately affected women and children in negative ways, including increased poverty and decreased access to social welfare services and basic resources (Chuang, 2006; Scheper-Hughes & Sargent, 1998). Forced prostitution and child sex trafficking are directly connected to global inequities of capital and labor that leave women—and, increasingly, children—with few viable options in the global economy. From this perspective, poverty, hunger, and low wages must be understood as equally pressing forms of violence (Soderlund, 2005). In a study exploring gendered experiences of homelessness through an examination of survival sex, Watson (2011) found that young women experiencing homelessness are subject to the pressures of individualization produced by the neoliberal policies of Western capitalist societies. As such, these women are required to find individual solutions to structural problems, and sex and intimate relationships are among the few resources at their disposal. As this study indicates, the exchange of sex is sometimes the only means that young women and youth have available to meet basic needs under the current political–economic system that promotes an ideology of self-sufficiency while ignoring structural inequalities.

Legislation and Policy

The Trafficking Victims Protection Act (TVPA; P.L. 106-386) passed into U.S. law in 2000, and promotes a three-pronged approach to address human trafficking (which includes child sex trafficking): prevention of trafficking, protection of victims, and prosecution of traffickers. In practice, however, prosecution tends to be emphasized over prevention or protection, with protection provided coercively only to those who cooperate with investigative and prosecutorial efforts (Smith, 2010; Soderlund, 2005; Srikantiah, 2007). Prevention is narrowly conceptualized through a neoliberal lens, promoting individual-oriented market-based strategies, such as micro-credit lending programs, business development training, and secondary education. Notably, this legislation promotes a predominantly law enforcement–driven response to human trafficking, with an assumption that tougher laws and harsher punishments will serve as a deterrent for traffickers. In assuming that the primary problem is the activity of criminals and criminal enterprises, rather than recognizing the perpetuation of structural inequalities like poverty and discrimination as the root cause of human trafficking, this approach provides only shortsighted “Band-Aid” solutions. If the goal is to eliminate human trafficking in its entirety, an approach is needed that addresses the global socioeconomic conditions and structural inequalities that create vulnerability and allow human trafficking to persist (Chuang, 2006; Fukushima, 2014; Todres, 2010). Current U.S. legislation and policy are insufficient in this regard; as a result, children and youth remain vulnerable to sexual exploitation.

In addition, many states have begun to develop and implement state-level legislation to address human trafficking. With regard to child sex trafficking specifically, a number of states have passed Safe Harbor laws that direct law enforcement to refer youth engaged in the sex trade to social services (e.g., Safe Houses and/or child welfare) rather than placing them in juvenile detention. Thirty-four states have passed Safe Harbor laws, although the provisions of these laws vary considerably in terms of defining who qualifies and how services are provided (Polaris, 2015b). In general, these laws enable the diversion of sexually exploited youth from the criminal justice system and encourage their recognition and treatment as victims instead.

Although legislation and policy at the federal and state levels have sought to recognize minors involved in the sex industry as victims rather than perpetrators, the larger social and legal reality is that prostitution continues to be criminalized. The criminalization of prostitution exacerbates the vulnerability of women and youth in the sex trade, as enforcement of the law has primarily focused on the arrest of sex workers (including trafficking victims and minors) for prostitution-related offenses while their exploiters (pimps, johns) are arrested and charged at much lower rates (Farrell, Owens, & McDevitt, 2014; Farrell, Pfeffer, & Bright, 2015). Historically, minors involved in the sex trade (particularly racial minorities) have been criminalized (Butler, 2015; Musto, 2013; Saar, Epstein, Rosenthal, & Vafa, 2015; Swaner, Labriola, Rempel, Walker, & Spadafore, 2016). Criminalization creates an environment in which those involved in the sex trade are routinely harassed by and are often fearful and distrustful of law enforcement, which serves to deter victims from seeking help.

Even with the passage of the TVPA, research has suggested that efforts to address trafficking, primarily in the form of greater policing of prostitution, have largely resulted in increased arrests of women, including trafficking victims, for prostitution-related offenses, but few arrests of traffickers (Bernstein, 2010; Dewey, 2014; Farrell et al., 2015). Furthermore, although all minors involved in the sex trade are specifically classified as victims of sex trafficking under the TVPA regardless of whether force, fraud, or coercion are evident, many jurisdictions, including those that have passed Safe Harbor laws, continue to arrest and charge youth for prostitution (Musto, 2013). Thus, the existence of Safe Harbor laws does not necessarily ensure that youth will be protected. For example, although Florida passed a Safe Harbor law in 2012 (Florida HB 99), it was not until 2016 that the state passed legislation that explicitly protects minors from being charged with prostitution-related offenses (Florida HB 545). Similar circumstances exist in other states.

Societal and Community Awareness

There have been increasing efforts to build community awareness about the presence of child sex trafficking and factors that place children at risk.Footnote 2 In particular, professionals who regularly interact with youth (teachers, health care providers, law enforcement officers, child welfare workers) can play a critical role in identifying at-risk and exploited children if trained to recognize the indicators of possible trafficking and vulnerability to trafficking (Institute of Medicine, 2013). In addition, broader public awareness campaigns that target the general community, families, and youth themselves are important in creating community vigilance (e.g., Project NO REST in North Carolina; https://www.projectnorest.org/). Research has suggested that many people lack sufficient knowledge to recognize indicators of trafficking and often perceive it to be a problem in “other places,” not something that happens in their own communities (Bales & Soodalter, 2010; Cole & Sprang, 2015; Jones, Engstrom, Hilliard, & Diaz, 2007). Awareness is a necessary component to create community commitment to address trafficking and the factors that enable its occurrence.

Many organizations have taken up the call to raise awareness; however, the dominant public discourse used by these campaigns often frames the problem of child sex trafficking in individualistic moral terms (e.g., a threat to the sexual integrity of girls) and as an issue of criminality (e.g., criminal perpetrators who prey on vulnerable youth) while downplaying or ignoring altogether the socioeconomic conditions and structural inequalities that create vulnerability to exploitation (Bernstein, 2010; Farrag, Flory, & Loskota, 2014; Musto, 2009). One implication of this focus is that prevention efforts are likely to view sexual behavior (of youth and of adults who purchase sex) as the primary target for intervention. The failure to recognize poverty and inequality as the root causes of human trafficking has resulted in largely ineffective responses to human trafficking that do not address the underlying systemic issues (Fukushima, 2014; Todres, 2010). Thus, there is a need for greater community and societal awareness of the broader social, economic, and political factors that facilitate child sex trafficking (as discussed in this article) in order to garner the necessary public support for anti-trafficking approaches that address these underlying factors.

In addition, there is a need for a greater public sense of responsibility toward children and the social norms that dictate the individualization of parenting. U.S. policy has increasingly promoted the delegation of responsibility for ensuring the well-being of children to parents, as opposed to promoting state and societal responsibility for the care of children. This is evidenced in welfare reform that has increasingly limited financial support for struggling families; child welfare policies that have historically viewed impoverished parents as neglectful; and the failure to provide affordable, state-supported childcare options for working parents (Lindsey, 2004). As a result, low-income families are stigmatized rather than supported by society. Currently, the United States remains the only United Nations member country that has failed to ratify the UN Convention on the Rights of the Child. The massive failure of U.S. policy to meet the needs of children and ensure their well-being, and the social norms that allow this failure to continue under the form of individual responsibility, have placed children and youth at risk of sexual exploitation. At the societal level, there needs to be a sense of responsibility to ensure that all children are adequately cared for in order to effectively prevent child sex trafficking.

Community Level

Community contexts in which social relationships occur, such as schools, neighborhoods, and workplaces, affect vulnerability to child sex trafficking. Notably, these contexts are strongly influenced by processes at the societal level, as the effects of those policies trickle down to shape knowledge, resources, and priorities at local levels. Communities also operate as smaller units that can express social norms that are in addition to, separate from, or even in opposition to broader societal expectations. At the community level, risk factors for child sex trafficking may include socioeconomic status, social values and norms, and involvement in the child welfare and juvenile justice systems.

Poverty

Poverty is the single largest determinant of health and, as such, is one of the drivers at the community level, especially as it pertains to sex trafficking. Although trafficking victims may come from a variety of backgrounds, limited socioeconomic resources, especially job opportunities and educational inequities, are inextricably linked to risk of trafficking. Many of the youth who are victims of sex trafficking are vulnerable as a result of their socioeconomic status (Logan, Walker, & Hunt, 2009). They tend to reside in neighborhoods characterized by high rates of violence and/or criminal activity and low socioeconomic status. The social milieu in such environments encourages rather than inhibits criminal activity such as drug dealing and sex trafficking (Finigan-Carr, 2017). The higher prevalence of the sex trade and trafficking in communities with few employment opportunities is associated with a greater likelihood of involvement for both victims and traffickers as it is viewed as a viable, even lucrative, financial path that is normalized by the participation of family, peers, and neighbors (Dank et al., 2014). When familial or peer sex trafficking occurs, it is more likely due to financial needs (McMahon-Howard, 2017). Sex-trafficked youth often cite lacking viable alternatives to making money and the inability to find a conventional job as reasons why they cannot exit the sex industry once they are a part of it (Dank, 2011; Gibbs, Walters, Lutnick, Miller, & Kluckman, 2015).

Discrimination

In addition to poverty, inequalities with regard to race, gender, and sexuality further marginalize particular populations of youth, increasing their risk of sexual exploitation. Sexual violence and abuse is a common occurrence among groups socially ostracized because of racism, sexism, or stigma based on sexual orientation (Chong, 2014). Discrimination results in poorer access to critical resources (e.g., financial, housing, nutrition, health care), opportunities (e.g., educational, employment), and supports, which significantly increases vulnerability.

Race intersects with other forms of subordination, including age, class, and gender, which has resulted in women and girls of color disproportionately being victimized by sex trafficking (Butler, 2015). This oppression is fueled by myths related to minority teen sexuality (e.g., that they are more promiscuous and sexually more mature), which prevents their recognition as victims while also promoting risky sexual behaviors (Butler, 2015; Chong, 2014). Although sexual exploitation affects children of all races, racial stereotypes about prostitution and sex work have made it difficult to shift the paradigm and identify children of color as victims. The majority of research in the extant literature, however, describes victims who are between 25 and 65% U.S.-born children of color (predominantly African American and/or Latino; e.g., Gibbs et al., 2015; Twill, Green, & Traylor, 2010; Varma, Gillespie, McCracken, & Greenbaum, 2015). This is disproportionate when compared to the percentage of African Americans in the U.S. population at ~ 13% or Latinos at 16% of the population (U.S. Census, 2010).

Youth marginalized because of their sexual identity and/or gender orientation may also experience increased vulnerability to sexual victimization (Tyler, 2008; Walls & Bell, 2011). This circumstance is exacerbated for youth whose families reject their identity, leaving them with few if any social supports and, in some cases, forcing them to leave home while lacking the means to be self-sufficient. The intersection of multiple marginal identities greatly increases risk; youth who are multiply minoritized (i.e., marginalized because of their gender, sexuality, race, class, and national identities) should be considered vulnerable to trafficking on multiple levels.

Involvement in Child Welfare and Juvenile Justice Systems

Much of the current literature and the authors’ experiences as researchers identify a positive relationship between out-of-home care placements in systems such as child welfare and juvenile justice and the occurrence of child sex trafficking. This relationship has been noted since the early part of this century as both systems became more aware of the prevalence of victims. Estes and Weiner (2001) noted that 33% of the sexually exploited children in their survey had a prior history of child welfare involvement. Similarly, a multi-state evaluation of outreach programs to victims of sex trafficking found that more than one-third of the clients had previous involvement with child welfare agencies and juvenile justice systems (Gibbs et al., 2015). Most recently, O’Brien, White, and Rizo (2017) found a bivariate relationship between domestic minor sex trafficking and out-of-home care placements. Much of the work in developing services for victims originated in the juvenile justice system because, historically, minor victims were charged with prostitution. As a result, many of the service models (Bounds, Julion, & Delaney, 2015; Twill et al., 2010) and screening protocols (e.g., InterCSECt; Salisbury, Dabney, & Russell, 2015) originated and were tested among juvenile justice system-involved youth.

System involvement can be the source of youth’s victimization as well. Youth have been recruited directly from group homes and other out-of-home placements as traffickers are aware of these placements being locations where vulnerable youth may be found. System-involved youth often have limited connectedness to the overall community. The trauma of being removed from one’s home and other adverse childhood experiences lead to a disruption of social networks; limited connections to caring adults; and difficulty in developing healthy relationships, both romantic and platonic (Storer, Barkan, Sherman, Haggerty, & Mattos, 2012). This all has an effect on the individual youth at the center of this framework and their vulnerability to sex trafficking.

Social Values and Norms

Sociocultural beliefs and values regarding female and male sexuality also play an important role in shaping child sex trafficking risk. The dominant moral ideology in the United States continues to dictate the importance of protecting the sexual integrity of girls and young women, expressing an aversion to female engagement in nonreproductive, nonmarital sexual relations (Miller, 2004; Soderlund, 2005). One of the implications is that girls who engage in “promiscuous” sex, or any sex outside of marriage, are commonly viewed as “damaged goods” and thus cannot be sexually violated (Grauerholz, 2000; Russell, 1986). This logic often extends into popular perceptions regarding sex trafficking. As Menaker and Franklin (2013, p. 2) noted, “Girls under the control of the juvenile justice system as a result of involvement in commercial sex activity (i.e., exchanging sex for money or other reimbursement) are often labeled ‘bad’ for their deviation from normative sex role behaviors, particularly if they are girls of color.” The pervasiveness of this ideology affects the way women and girls view themselves and can result in their embrace of such beliefs (Grauerholz, 2000). Thus, teenage girls who have had multiple sexual partners, including girls who have been sexually abused or raped, may perceive themselves through this derogatory lens and come to view sex work as their proper place in society. Social norms regarding male sexuality, however, tend to view male sexual dominance and male demand for sex, including the purchase of sexual services, as acceptable and normative (Hanna, 2002). Anderson and O’Connel Davidson (2004) found that consumption of sexual services might be constructed socially as a demonstration of masculinity or, for young men, as a rite of passage into manhood. Whereas women are expected to maintain their sexual integrity, it is socially acceptable for men to indulge their sexual desires.

Furthermore, the acceptance of violence toward and subordination and sexualization of women and girls is evident throughout American popular culture, in movies and television shows, in video games, in music. Some have pointed specifically to the glorification of pimps in hip-hop culture as a key element promoting the prostitution of women and girls (e.g., Kortla, 2010; Lagon, 2008). The inclination to explicitly target a genre of music and subculture associated primarily with African American communities, however, belies the racial bias inherent in the dominant discourse on child sex trafficking. This discourse largely fails to recognize how women’s subordination is maintained by the white mainstream culture or the vast structural inequalities that have made pimping and prostitution one of few viable economic options available to marginalized populations. The larger social acceptance of gender violence and inequity evident in the United States (and globally) facilitates sex trafficking by viewing such treatment of women and girls (particularly racially and ethnically “other” women and girls) as normative, thereby obscuring their recognition as victims.

Relationship/Interpersonal Level

At the interpersonal level, the main focus is on how individual or intrapersonal factors affect relationships with persons in various microsystems (e.g., home and peer) to increase the likelihood of a victim’s involvement in sex trafficking. Consistent with Grauerholz’s (2000) approach to understanding sexual revictimization, two primary mechanisms operate in tandem at this level to increase risk: a greater exposure to potential traffickers as well as the activity of trafficking and a heightened vulnerability to the psychologically manipulative behaviors used by traffickers. Social norms are particularly important at this level of analysis, as the individual is exposed to and influenced by the views, beliefs, and behaviors of family, friends, and community members with regard to both sexual exploitation and conceptions of normative interpersonal relationships.

Several studies have found that many victims of sex trafficking grew up in homes characterized by high levels of parental and family dysfunction (child maltreatment, domestic violence, substance abuse, and mental illness), financial strain (food deprivation, poverty), and instability (running away, being kicked out of home, unsafe housing, and homelessness) (Clawson, Dutch, Salomon, & Grace, 2009; Estes & Weiner, 2001; Gibbs et al., 2015). These factors interact to increase exposure to traffickers and trafficking activity at home, among peers, and in the community and may make youth more susceptible to the tactics of traffickers. For instance, Reid (2011) documented a pathway from caregiver strain (substance abuse, mental illness, domestic violence) to higher levels of child maltreatment, which led to running away, early alcohol or drug use, and sexual self-denigration, all of which were related to greater engagement in sex trafficking as minors in a sample of African-American girls. Similarly, in a sample of adolescent females charged with prostitution, Brawn and Roe-Sepowitz (2008) found those who reported using alcohol and other substances experienced higher rates of childhood abuse and neglect, less supervision at home, more suspensions or expulsions from school, and greater association with negative peers. Further, evidence suggests that traffickers specifically target potential victims from unstable homes, such as youth living in group homes, detention centers, and runaway and homeless youth shelters (National Alliance to End Homelessness, 2011; Saar, Epstein, Rosenthal, & Vafa, 2015; Walker & Quraishi, 2014).

In addition to risks from caregiver strain, parents’ or guardians’ involvement in the sex trade may increase the trafficking risk for youth (Gibbs et al., 2015). For some youth, the initiator of sex trafficking is the parent, guardian, other caretaker or relative, especially for victims who were first exploited as very young children (Gibbs et al., 2015; Marcus, Horning, Curtis, Sanson, & Thompson, 2014; Newton, Mulcahy, & Martin, 2008). This exploitation often continues into young adulthood (Polaris, 2015a). Peers are also influential, as many youth report being recruited into sex trafficking by friends (Curtis, Terry, Dank, Dombrowski, & Khan, 2008). Once involved, youth may find it more difficult to leave if their peers are also engaged in trafficking, especially as time passes and they are more disconnected from social supports outside the sex industry (Chase & Statham, 2004; Palmer, 2001; Taylor-Browne, Broadfoot, Broadhead, Downie, & McKetty-Campbell, 2002). If sex work is normalized among family, peers, and community, youth are less likely to view it as exploitative.

Traffickers use a number of techniques to recruit and control victims, including physical force and violence, threats of harm to the victim or their loved ones, false promises of legitimate work or lucrative employment, and psychological coercion or manipulation (Dank et al., 2014; Godoy, Sadwick, & Baca, 2016; Harris, 2012; Kennedy, Klein, Bristowe, Cooper, & Yuille, 2007; Marcus et al., 2014). Manipulative tactics are the hallmark of the Romeo or boyfriend style trafficker, who uses attention and affection to form a romantic relationship with the potential victim and then exploits this relationship by coercing the victim into sex trafficking (Dank et al., 2014; Harris, 2012). In addition to economic vulnerability, youth from homes with high levels of dysfunction and instability may be more susceptible to the manipulative tactics of traffickers, especially if they experienced child maltreatment.

The vulnerability may lie in the damaging effects that child maltreatment has on a youth’s ability to form healthy romantic and sexual relationships. Along with physical health, child abuse and neglect can have long-term negative consequences for psychological development and behavior problems that affect relational capacity (Child Welfare Information Gateway, 2015). For example, infants who have been maltreated may be 2–3 times more likely to have disorganized attachment than non-maltreated children, which has implications for poor management of stress and emotions, externalizing or aggressive problem behavior, and dissociative symptoms (van Ijzendoorn, Schuengel, & Bakermans-Kranenburg, 1999). These early problems affect children’s ability to form positive relationships with peers and romantic partners in adolescence and adulthood (Wolfe, Jaffe, & Crooks, 2006). For youth who have grown up in unstable and abusive environments, dysfunctional and violent relationships are often normalized.

The coercive relationship with a trafficker may be a familiar one to youth who have been maltreated, especially those who have been sexually abused. Much research has documented the increased likelihood of victims of sexual abuse to be involved in abusive relationships as adults (Messman & Long, 1996). The traumagenic model (Finkelhor & Browne, 1985) attempts to explain how sexual abuse damages children’s emotional, cognitive, and relational development through four dynamics: traumatic sexualization, stigmatization, betrayal, and powerlessness.

Traumatic sexualization comes about through the perpetrator rewarding the child’s sexual behavior with affection, attention, or gifts such that the child begins to view sex as an exchange, a process with obvious parallels to trafficking. Studies have found that maltreated children, especially those who were sexually abused, begin sexual activity at earlier ages, which is also associated with greater engagement in prostitution (Fergusson, Horwood, & Lynskey, 1997; Institute of Medicine, 2013; Lodico & Diclemente, 1994; Noll, Trickettt, & Putnam, 2003; Springs & Friedrich, 1992; Wilson & Widom, 2010). Stigmatization involves the shame and guilt from the abusive experience that affect the child’s self-worth and have implications for future risky behavior. The importance of this dynamic is underscored by Reid (2011), who found that sexual self-denigration plays a mediating role between child maltreatment, running away, early alcohol or drug use, and sex trafficking. Betrayal involves the realization that a loved one caused the child harm, which negatively affects their trust and judgement in relationships. Finally, powerlessness involves the continued violation of the child’s sense of efficacy at the hands of the perpetrator. These dynamics may help explain how victims of sexual abuse enter into and stay involved in abusive relationships through impaired judgement about the riskiness of people and situations, as well as lack of coping skills to end these relationships (Miller et al., 1978; Walker et al., 1992). Under traumagenic dynamics, the violent and manipulative behaviors of the trafficker would be a powerful force for victims to overcome, especially if they lack other financial resources and social support, as is often the case.

Individual/Intrapersonal Level

At the individual level, personal history, psychological, and biological factors influence how individuals behave and can increase their likelihood of becoming a victim of child sex trafficking. Among these ontogenic factors are being a victim of child abuse or maltreatment; homelessness or running away; alcohol and/or substance abuse; and personal characteristics such as race, class, gender, and sexual orientation. At this level, values, beliefs, and social norms from the interpersonal, community, and societal levels may be internalized by the individual, thereby shaping their personal beliefs and behaviors.

There has been some research on factors that moderate the impact of trauma, abuse, and homelessness on subsequent sexual exploitation. One study found that low self-esteem, manifested as higher levels of sexual denigration of self and others, increased the likelihood that homeless youth would be commercially sexually exploited (Reid, 2011). Another study that compared trafficked youth with a group with similar trauma history found that trafficked youth were more likely to have had problems with skipping school, developmentally inappropriate sexualized behavior, alcohol and other substance use, criminal activity, and running away from home (Cole et al., 2016). Multiple studies have identified substance use and addiction as moderators of sexual exploitation (Brawn & Roe-Sepowitz, 2008; Chettiar, Shannon, Wood, Zhang, & Kerr, 2010; Reid, 2011; Walls & Bell, 2011), as these behaviors may impair judgement, increase desperation, and expose the youth to exploitative peers while further isolating them from supportive, healthy relationships. The relationship is complex since substance use, in addition to being a potential vulnerability for trafficking, may also be a means of control used by traffickers as well as a coping mechanism for youth (Gibbs et al., 2015). Overall, the body of research described here indicates that the interaction of multiple risk factors contributes to youth vulnerability to sex trafficking.

Applying Agnew’s (2006) general strain theory, child sex trafficking is more likely to occur when youth have experienced one or more of three types of strains: negatively valued stimuli (e.g., physical abuse, chronic police harassment, racism), failure to achieve socially normative goals (e.g., dropout from school, lack of housing), and loss of positively valued stimuli (e.g., being “thrown away” by parents, broken relationships). After or while these stressors occur, certain conditions increase the probability of youth finding themselves in environments where they are exploited. These conditions are that: (1) legitimate options are unavailable or difficult to obtain; (2) the illegitimate option (commercial sex) is available; (3) the person is exposed to a subgroup of peers with social norms that are accepting of the behavior, or the person receives guidance on how to engage in the behavior from peers or traffickers; and (4) the person has some experience with the activities (such as when survival sex, used for a place to stay at night, leads to sex for money). Therefore, some of sex trafficking from the individual level could be understood as a limited expression of agency and control by people who—as a result of their age, gender status, race/ethnicity, lack of support networks, and lack of education—have extremely limited housing and employment options (Marcus et al., 2014; Warf et al., 2013). Indeed, there is significant ethnographic and qualitative research challenging the dominant “child as victim, adult as criminal” paradigm (Marcus et al., 2011, 2014). Evidence for this is that many of those who have left the sex industry report that they felt desperate, coerced, or manipulated, while they simultaneously reject the “victim” label and emphasize their agency and choice to engage in commercial sex (McMahon-Howard, 2017; Tyler & Johnson, 2006). Survivors report having felt a contradictory sense of being trapped while making free choices (McMahon-Howard, 2017; Williams, 2010).This represents a unique dialectic, whereby sex trafficking is an expression of both victimization and agency, or an adaptive choice when limited choices exist or are perceived to exist.

The quantitative research on risk factors for child sex trafficking is consistent with strain theory, with reviews finding that the most commonly identified individual level risk factors include childhood maltreatment, family dysfunction, homelessness (running away and being thrown away) and other residential instability, youth, poverty, presence of a trafficker, poor education, and drug abuse and addiction (Choi, 2015; Nail, 2015; Wilson, Butler, & Gold, 2014). Homelessness is a particularly salient risk factor, with one study finding that 23% of male and 14% of female homeless adolescents reported having sex for money (Kral, Molnar, Booth, & Watters, 1997). Several studies have further identified trafficked youth as more likely to be female, members of racial/ethnic minorities, and gender nonconforming (Marshall, Shannon, Kerr, Zhang, & Wood, 2010; Quintana, Rosenthal, & Krehely, 2010; Smith, 2010; Varma, Gillespie, McCracken, & Greenbaum, 2015). As discussed previously, this increased risk is likely due to society’s marginalization of these identities, which results in fewer resources and legitimate options available to such individuals.

Findings from qualitative interviews with youth who are homeless and involved in sex trafficking are also consistent with general strain theory. Because of their age, youth have few options for livable wage employment (due to lack of experience and education), short- and long-term housing (aside from the child welfare system), food security, and health care. Some youth have reported that the only options for someone under the age of 16 trying to leave an abusive home environment were homelessness or child welfare. These youth further described shelters as unavailable to juveniles and considered child welfare to be an unacceptable option (Conner, 2015; Dank et al., 2015). Homeless youth who had been in child welfare previously often report very negative experiences with the child welfare system, such as overcrowded home placements that lacked privacy, autonomy, and a sense of belonging, or that were dangerous because of the behaviors of other foster youth placed in the home (Conner, 2015). This, they reported, led to bouts of running away from foster placements and vulnerability to traffickers and peers engaged in sex work. There are significant barriers to shelter use among homeless youth, including attitudinal barriers such as stigma, shame, and a desire for self-reliance, and access barriers such as a lack of shelters available to juveniles, age limits, services that are not designed to meet youth-specific needs, adverse shelter conditions, and restrictive shelter rules (Ha, Narendorf, Santa Maria, & Bezette-Flores, 2015). Even when shelters are available, they only provide a temporary living situation, whereas many homeless youth require long-term solutions to develop self-sufficiency.

In addition to lack of resources and homelessness, many trafficked youth suffer from specific vulnerabilities that make it more difficult for them to achieve positively valued goals and more likely that they will find themselves in exploitative environments. Mental health needs and trauma experiences, including a history of neglect and abuse, are very common among this population (Rand, 2009; Roe-Sepowitz, 2012) but do not always distinguish youth who are sexually exploited from comparable youth who are not exploited. As compared to the general population, some research suggests that trafficked youth are more likely to suffer from mental health problems and co-occurring disorders, both prior to and after their exploitation (Edwards, Iritani, & Hallifors, 2006; Twill et al., 2010). However, Smith (2010) found that foster youth who were sexually exploited had similar rates of mental health problems as foster youth who were not sexually exploited. Similarly, Cole et al. (2016) found no differences in lifetime trauma exposure history between trafficked youth and non-trafficked youth who had suffered sexual abuse or assault. Many youth who are homeless, furthermore, report no experiences of sexual exploitation (Kral et al., 1997). In comparing homeless women who were and who were not engaged in survival sex, Warf et al. (2013) found that these women did not differ significantly on rates of sexual abuse, child welfare involvement, delinquency systems involvement, or psychiatric hospitalization. Thus, the presence of these risk factors alone does not appear to predict trafficking victimization, alluding to the need for more research exploring factors that contribute to resilience against trafficking.

Conclusion

The presence of any one or combination of factors at the social ecological levels described should not be construed as meaning that a young person is destined to become involved in sex trafficking. Just as there are factors at each level that create or increase risk, there are also protective factors that mediate or reduce risk. For instance, most youth who grow up in dysfunctional, unstable homes are not involved in sex trafficking, and some youth who engage in trafficking do not come from these types of homes (Gibbs et al., 2015). Further, we should not lose sight of the youth’s own agency in engaging in sex work even if he or she has many factors that increase vulnerability and is introduced into trafficking by manipulative means (Marcus et al., 2014). To do so would be to diminish respect for the dignity and worth of individuals involved in sex work and their right to self-determination, which is inconsistent with the values and ethical principles of social work and related disciplines (Workers, 2017).

In this article, we propose a traumagenic social ecological framework for understanding child sex trafficking and demonstrate the vulnerability of youth to adverse outcomes. In applying this framework, we expand beyond the usual individual risk factors typically emphasized in the literature on child sex trafficking (e.g., history of physical and/or sexual abuse, neglect, drug use, running away, homelessness) to describe how broader interpersonal and macrosocial processes shape risk. Thus, the experiences of trafficked youth, and their interpretations of those experiences, are understood within the context of the larger social, political, and cultural environment. In particular, this framework points to the structural nature of the underlying causes of child sex trafficking. The perpetuation of social inequalities, both within the United States and globally, creates and exacerbates vulnerability among those who are marginalized as a result of poverty, race/ethnicity, gender, sexuality, and age. Despite being one of the wealthiest nations in the world, the United States continues to show disregard for those suffering from poverty and discrimination within its borders. In order to effectively prevent and eradicate trafficking, our society must demonstrate the political will to address these structural inequalities. The framework described here can be used both for understanding the issues relevant to trafficked youth, and for developing prevention strategies and service approaches for this population.

Recommendations for Research, Policy, and Practice

The traumagenic social ecological framework posited here may be beneficial for future research and practice. First and foremost, if the proclaimed objective is to eradicate trafficking entirely, then it is essential to shift the focus from prosecution to prevention, and particularly measures that address the socio-economic conditions underlying the proliferation of trafficking. Perhaps most pressing is the need to expand social welfare programs to alleviate the harmful effects of poverty and eliminate the need for vulnerable individuals to engage in exploitative activities in order to meet basic needs. Protecting children from sexual exploitation must begin with protecting them from poverty. At the national level, this requires a reversal of current economic policies with the goal of adequately funding social safety net programs.

Closely related is the need to improve labor laws in order to provide better worker protections and hold employers accountable for the fair treatment of workers. Of the utmost importance is the need to increase the minimum wage to an actual living wage. Additionally, we must strengthen and expand anti-discrimination laws to ensure equality in employment opportunities and wages. Discriminatory employment practices along the lines of race, gender, and sexuality should be addressed. If people have access to gainful employment that provides a living wage and ensures their fair treatment, they will be less dependent on the government for support and less likely to enter into exploitative enterprises like sex work. This is especially true for youth trying to achieve independence who, due to lack of education and experience, typically only have access to low paying jobs and may be easily manipulated if they are struggling to meet basic needs.

There are also important legislative and policy changes that can be made with regard to the response to victims. The first recommendation is to decriminalize prostitution preferably at the federal level. While some states have taken significant steps in this direction as far as minors are concerned, the inconsistencies in laws across states are problematic, given the fact that it is not uncommon for victims to cross state lines. We further recommend that decriminalization be expanded to adults engaged in prostitution. This is the best way to ensure all victims of trafficking can seek legal protection without fear of prosecution. To be clear, decriminalization is not the same as legalization, and it is still possible to criminalize buyers and traffickers while decriminalizing sex workers. Finally, we advise removing any stipulations that require victims of trafficking to cooperate with prosecutors in order to receive services. This may be the greatest barrier to victims coming forward, as they may not be interested in seeking criminal prosecution against their traffickers. It is critical that assistance be provided in non-coercive ways so as to avoid further victimizing survivors.

Another strategy that has gained traction concerns addressing the demand for trafficking. End demand efforts are widespread throughout the United States, with one report finding that over 800 cities and counties have employed some sort of anti-demand tactic (Shively, Kliorys, Wheeler, & Hunt, 2012). Approaches include efforts to interfere with supply, demand, and distribution, with fewer efforts focused on primary prevention through attempts to transform social norms or reduce the inequalities that contribute to commodification of bodies. While evidence of the effectiveness of supply and distribution disruption efforts is limited, there is an accumulation of evidence that demand reduction efforts can be successful (Shively et al., 2012). Examples of effective programs include “John Schools” for arrested buyers, which usually feature some discussion of social norms (Poland, Boswell, & Killett, 2008; Shively et al., 2008), and efforts to focus criminalization on buyers rather than sellers (Minor, 1997; Weisel, 2004).

Other approaches capitalizing on technology have recently emerged, but studies have not yet been conducted of their effectiveness. For example, Seattle Against Slavery is an organization that engages in demand disruption efforts via a variety of approaches, including computer-based, automated chats that engage potential buyers of youth in online text-based conversation and then, prior to purchase, provide the potential buyer with resources and information about the damaging effects of sex trafficking and the potential legal repercussions. These efforts apply shaming and social norm adjustment to potential buyers by reminding them that society does not approve of sex trafficking.

A more ambitious goal of transforming social norms and cultures to reduce or eliminate the demand for sex trafficking is no easy task. Effective, broad, social-system based interventions do not exist, and would require development and testing. Unfortunately, these approaches are likely to fail in large-scale terms if, as we assert in this manuscript, social inequity is the root cause of exploitative sex trafficking. If efforts focus too narrowly on ending the demand for sex, without addressing structural inequalities, then we will simply leave those same individuals vulnerable to other forms of exploitation. Instead, early preventive efforts must focus on reducing inequalities that lead to the trading of sex for resources.

The development of more individually-based interventions that address social norms and positive coping skills among youth are equally important. As we move forward with both research and interventions, youth should be engaged in identifying their needs and interests and developing programs that respond to these expressed needs (e.g., autonomy and self-sufficiency). It is important that adults recognize and validate youth’s expressions of agency/autonomy while working with youth to develop less exploitative means for them to exercise agency. Furthermore, changing the perceptions of agencies and communities toward these youth is critical to reducing the stigmatization and criminalization of youth involved in sex trafficking. Such initiatives might include human trafficking education and trauma-informed care training for law enforcement, child welfare, juvenile justice, health providers, and other agencies that interact with this population. Sensitivity training that addresses racial, gender, and sexual discrimination and stereotypes is also necessary. This can help to change disparaging beliefs and attitudes about the sexuality of minority and LGBT youth. In particular, social norms about youth sexuality that assign value to the virginity of girls while touting sexual curiosity and exploration as normal for boys are extremely problematic. Changing beliefs about the importance of female virginity and reducing the sense of self-blame that girls or young women who are not virgins may experience can greatly decrease the likelihood of self-denigration and future sexual exploitation. Comprehensive sexual education that teaches sexual decision-making skills and promotes self-worth for all youth, regardless of their sexual history, needs to be provided. Another important strategy is early therapeutic intervention for youth who have been sexually abused or assaulted to mediate the damaging effects of such trauma.

There are substantial opportunities and need for future research to expand our current understanding of child sex trafficking and effective interventions. One suggestion is for research that develops a deeper understanding of the social norms of sex trafficked children and buyers. Using ethnographic methods and social network analysis, it would be useful to identify the most salient reference groups for trafficked youth, traffickers, and buyers, and identify the most salient social norms that act as the context to support the continuation of sex trafficking. This information could be used to identify useful leverage points for developing interventions that decrease both supply and demand. It would also be useful to understand where and how these norms converge with and diverge from broader social norms, and which norms are held as most salient. In other words, what social factors impact the decisions of traffickers, buyers, and sex trafficked youth? In addition, are these decisions experienced as resistant or subversive actions within the broader culture, as acceptable decisions within a subculture’s norms, or as actions that are dissonant and conflicting? In dissonant situations, how do people reconcile these conflicts?

In addition to this ethnographic and deep approach, big data may offer opportunities for studying social norms around sex trafficking in ways that were previously unavailable. Data from search engines and commonly used purchasing websites could be harvested to identify social trends in the awareness of sex trafficking, and linked to local and statewide data from the justice system and child welfare.

Finally, researchers and practitioners should investigate the efficacy of trauma-informed mental health interventions adapted for this population, such as trauma-focused cognitive behavioral therapy. Although literature supports the use of such interventions, there has been limited empirical research to verify the efficacy of such treatments with this particular population. In fact, at present there are no established evidence-based practices or programs for the treatment of commercially sexually exploited children (for emerging work in this area, see Johnson, Armstrong, Landers, Dollard, & Burr, 2018; Johnson, Armstrong, Landers, & James, 2018). Thus, it is important that research continue to expand the evidence base regarding child sex trafficking prevention and intervention.