Perspective Chapter: Online Sex Trafficking of Minors – Exploring Effective Interventions and Prevention

Abstract

Sex trafficking of minors has been increasing in many countries worldwide and for those victims that survive, they are left with significant trauma and mental health concerns due to the abuse they have lived through. Trafficking inordinately impacts vulnerable populations worldwide, with an estimated 80% of trafficking victims being women. The commercial sexual exploitation of minors creates almost irreparable negative outcomes for victims. One of the best prevention tools is the ability to identity child risk factors before any degree of sex trafficking even occurs. Education on sexual abuse awareness and the potential approaches abusers take, while addressing low self-esteem, unmet needs and psychosocial support, are significant considerations in a prevention intervention. This chapter reveals that identifying children who are at risk for online commercial sexual exploitation is critical for preventing its occurrence. Interventions such as screenings through the school system, self-esteem and self-compassion promotion, animal-assisted interventions, physical exercise programs to improve self-esteem, and psychoeducation programs for minors and parents are some suggestions that may have a strong prevention impact. Taking a multi-pronged, holistic approach while addressing the most significant elements is likely most impactful for prevention.

1. Introduction

The exploitation of children through the use of the internet is a form of sexual violence and is directly connected to the issue of online sex trafficking of minors. The work of Yakushko [1, 2] provides a review of relevant research on human trafficking as the international community has become much more aware and concerned about increases in trafficking and the enslavement of children, women and men worldwide since the early 1990s. The United Nations, the International Organization of Migration, the International Labor Organization and UNICEF have extensively increased their level of concern and interest in this issue. In 2000, the United States sanctioned the Trafficking Victims Protection Act, marking a new area of awareness and significance regarding the sex trafficking of minors as a significant societal issue and concern. The prevention of sex trafficking of minors is increasingly at the forefront of important topics in the international community [1, 2].

2. Background

Sex trafficking of minors has been increasing in many countries worldwide and for those victims that survive, they are left with significant trauma and mental health concerns due to the abuse they have lived through [1, 2]. The United Nations defines human trafficking as, “The recruitment, transportation, transfer, harboring or receipt of persons by means of threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving payments or benefits to achieve the consent of a person having control over another person for the purposes of exploitation” (Article 3, paragraph (a), [1, 2]). Trafficking for forced labor is more prevalent worldwide, however sex trafficking is a horrendous violation of human rights with extreme long-lasting negative impacts on victims and it produces a majority of global trafficking profits. As of 2007, the United Nations stated that human trafficking now impacts every country on the globe and the number of victims is now at epidemic levels, and continues to increase and take on new forms that had not previously existed [1, 2].

Globalization is believed to be behind the rise in the rate of sex trafficking of minors and the increased demand for cheap labor. Trafficking inordinately impacts vulnerable populations worldwide, with an estimated 80% of trafficking victims being women. Trafficking victims can be lured through things such as ‘modeling’ schools, tourist agencies, false promises of paying jobs, coercion through believing they are loved or in a romantic relationship with the trafficker. A high level of mental health services is needed for survivors due to the severe psychological and physical abuse and life-threatening situations they regularly experience. Survivors are at high risk of suicide, self-harm and substance abuse. The extreme abuse survivors experience is so great that it is important to address prevention efforts so that individuals never have to face the seemingly impossible challenge of recovery [1, 2].

There are numerous factors creating increased levels of online sex trafficking of minors. Some of these include increasing demand for commercial sex with minors, the rise of individuals who are addicted to pornography, patriarchal cultural beliefs that protect buyers and traffickers and create demand, as well as mainstream organizations such as Facebook, Uber, Lyft, Instagram, texting and communication from cell phone providers that facilitate these transactions in plain sight. Mainstream social media apps, rather than the dark web, are a significant part of this growing issue and demand. Most online sex trafficking of minors is ‘hidden in plain sight’ through mainstream applications such as Instagram and Snapchat [3].

Aside from child trafficking being hidden in plain view, it is also an issue because society does not understand the extent of the problem or the reality of what prostitution and pornography really looks like. There are many stereotypes and incorrect societal beliefs that contribute greatly to the continuation and growth of this issue [3, 4, 5]. Traffickers benefit from the naivety, needs, vulnerabilities and ignorance of victims.

3. Sex trafficking of minors

The general acceptance of violence against women globally as well as the vulnerable status of children and disabled groups puts these individuals at heightened risk of sex trafficking [6]. In the United States and most of the world, any individual who sells sexual acts and is under the age of 18 years old is considered a sex trafficking victim. The elements of force, fraud and coercion do not need to be present for minors for it to be considered trafficking. Child sex trafficking is associated with numerous symptoms and specifically with the symptoms of complex trauma. Many victims of child sex trafficking experienced sexual abuse or other forms of abuse before being trafficked. Therefore, identifying at-risk children and implementing interventions is important for addressing and preventing this issue [3, 7].

4. Pornography and sex trafficking

An underlying problem that is vastly under-recognized is the rise in internet pornography addiction and the impact this is having on the rise of child trafficking demand. The statistics are not clear but there are estimates that at least 25–40% of individuals in pornography are trafficking victims. However, because pornography is legal, general assumptions that trafficking does not exist within a legal, accessible entity prevail. Yet this is a misconception as a trafficker will sell their ‘product’ however they can. They can sell children through both pornography and in-person as demand and opportunity allow [3, 8]. The rise in internet pornography addiction has also created an increase in market demand for more violent sex and sex with minors. However, violent sex and sex with minors is not easily accessible or legal and this has created an increased market demand for hidden, underground, illegal commercial sexual exploitation of children [3].

5. Negative outcomes for minors experiencing sex trafficking

The commercial sexual exploitation of minors creates exceptionally negative outcomes for victims. According to Ottisova [9], at least 53% of trafficked children experience significant physical violence and 49% experience sexual violence. This trafficking can include both general labor trafficking as well as sex trafficking of children [9]. Iglesias-Rios [10], conducted a qualitative analysis that survivors of trafficking experience much higher levels of anxiety, depression and PTSD than average rates and long-term mental health services are an essential component to addressing survivor needs. Hemmings conducted a systematic review and qualitative analysis revealing that human trafficking survivors require significant amounts of trauma-informed healthcare [11]. Many of the victims that are rescued are diagnosed with Borderline Personality Disorder, Psychosis, Post-Traumatic Stress Disorder, Complex Trauma, Bipolar disorder, different forms of severe depression, suicidal ideation, self-harming tendencies, substance abuse, severe anxiety and panic attacks, paranoia and attachment traumas [2, 3, 12, 13]. The abuse and repercussions are so severe to victims that preventing sex trafficking is a critical concern and the most logical way to effect a change so these issues do not even occur [11].

6. Risk factors

One of the best prevention tools is the ability to identity child risk factors before any degree of sex trafficking even occurs. Healthcare practitioners have a unique position to identify and help support children that are at-risk for commercial sexual exploitation. Commercial sexual exploitation of children is defined by the U.S. Department of Justice as sexual abuse of a minor for economic gain. The Preventing Sex Trafficking and Strengthening Families Act of 2014 was a landmark bill that established commercial sexual exploitation and sex trafficking of children as organized sexual abuse of children and adolescents. The work of Jaeckl and Laughon [14], provides a comprehensive overview of the most significant risk factors for girls ages 12–18 for commercial sexual exploitation of children (CSEC). Girls aged 12–18 years old are the largest CSES population in the United States. Their work found that childhood maltreatment trauma was the most important risk factor for children. This means that female children that have experienced or are currently experiencing childhood maltreatment trauma are at greatest risk for CSEC [14].

The work of Choi [15] also highlights some of the most important risk factors for youth to be groomed and recruited into sex trafficking as well as the prevalence and importance of recognition [15]. A literature review conducted by Choi [15] addresses this significant gap and area of concern. Choi [15] integrates risk factors of domestic sex trafficking of minors using PRISMA criteria and three databases for investigation, CINAHL, PsychInfo and PubMed. This study demonstrated that the most important risk factors were childhood maltreatment trauma and running away from home. Other research has also supported this finding that childhood maltreatment trauma is the most significant risk factor. Within this category, there are significant types of maltreatment trauma such as dysfunctional family environments, neglect and childhood sexual abuse [15]. Within child maltreatment trauma, childhood sexual abuse was the most significant risk factor overall and within the category of trauma for CSEC. This has also been supported by many other reviews and experts. Even within CSA, the degree of severity is a significant factor. Factors that created worse CSA impacts were the experience of things such as rape or very young age of victimization. Childhood rape and sexual abuse at age 5 or younger were particularly concerning risk factors for later risk of online sex trafficking as a minor. CSA also largely occurred with other forms of abuse such as neglect, emotional and physical abuse [14].

Reid and colleagues [16] also found that emotional neglect greatly increased the vulnerability of girls to experience CSEC. Emotionally neglected girls are at a higher risk of looking for love, affection and support from others outside the family and home environment when these are not provided at home. The unmet needs for love, care and belonging put these girls at high risk of risky influences. Landers et al. [17] found that the child’s history of sexual abuse helps to normalize abuse for these children so that they often do not view a trafficker as exploitative, but as someone who loves and cares for them in exchange for selling sex. This traumatized worldview further compounds the issue.

Landers et al. [17] found that close to 90% of Commercially Sexually Exploitated Children (CSEC) victims had experienced childhood sexual abuse and close to 60% had experienced moderate to severe levels of childhood neglect. In addition, approximately 70% of victims displayed signs of Stockholm Syndrome or trauma bonding with their traffickers. CSA is the strongest risk factor for CSEC, coupled with additional abuse, particularly neglect. Other significant factors included running away, homelessness, poverty, hunger, survival sex, being part of a minority group, being female, substance abuse, mental illness, frequent encounters with CPS, and foster care were also important factors of consideration for putting children at risk of CSEC. Given the knowledge of these risk factors, it is important to create prevention programs around CSEC using these factors. It is possible to prevent much of CSEC by addressing the most significant factors, particularly the impact of child sexual abuse [14].

7. Debunking myths

Contrary to popular sentiment, much sex trafficking is targeted to domestic minor females in the United States through the internet, social networking sites, and through individuals connected to traffickers that target schools, malls and other areas children frequent. A common approach is to target minors by pretending to engage in a romantic relationship with them online and/or by pretending to address unmet needs they may have for validation, attention, material items, acceptance and love. Minors that participate in risky online conduct like meeting ‘online’ people in person, providing personal information and sending or receiving photos are at higher risk of becoming victims of human sex trafficking. Children that need love, acceptance, validation and attention are at greater risk for seeking out this high risk, external attention and affirmation [18].

In general, children that live in dysfunctional, toxic home environments are at greater risk for online sex trafficking due to unmet needs for love, validation, acceptance and security. Individuals from higher-functioning home environments with a greater number of met needs, tend to engage in less risky behaviors and attitudes and are more safety conscious. Individuals with lower self-esteem are at greater threat of engaging in risky attitudes and becoming an online victim of human sex trafficking. The understanding of risk factors is significant in prevention here. Black et al. [18] also found that prevention efforts through increasing individuals’ awareness and watchfulness online directly reduces the risk of becoming a victim of online crime. Therefore, prevention interventions with youth that educate minors about human sex trafficking, online risks, and psychoeducational approaches and address issues of self-esteem and unmet emotional and physical needs have merit [18].

8. Theoretical framework

The humanistic theory approach is particularly useful and important when addressing the needs and concerns of children at risk for sexual abuse. A humanistic perspective is particularly important and powerful as it incorporates compassion and sensitivity to the circumstances an individual is experiencing. This is significant when addressing the vulnerability factors for children that are more at risk for sexual abuse [19]. Under the humanistic theory perspective, it is useful to apply Maslow’s hierarchy of needs to clients. At-risk children must have their basic needs such as food, water, shelter, safety, stability, and human connection met in order to positively respond to therapeutic treatment. If their needs are not met regarding the first three levels in Maslow’s hierarchy of needs, there is a significant possibility the at-risk child will be exposed to potentially harmful individuals [3, 4, 5, 20, 21]. In addition to this, it is important to apply the humanistic approach and Socioecological Model to address the perspective of the at-risk child. Service providers also need to demonstrate a person-centered approach with unconditional positive regard so children feel safe to seek help and speak up about their vulnerabilities and concerns [3, 4, 5, 20, 21]. The work of Warria [22] looks at not only the importance of prevention in regards to sex trafficking, but also prevention in fragile environments through the adaptation of the Socioecological Model approach. This framework posits that both protective factors and risks should be addressed in situations such as parents and schools as well as areas with greater societal fragility and conflict [22]. Education, addressing needs and vulnerabilities and positive mental health are all helpful for prevention to avoid the horrendous experience of sex trafficking to begin with [1, 2]. Models that reflect this need are relevant in prevention.

9. Effective interventions with minors at risk for sex trafficking

9.1 Education

Education on sexual abuse awareness and the potential approaches abusers take, while addressing low self-esteem, unmet needs and psychosocial support, are significant considerations in a prevention intervention. Children need to be educated about the dangers of the internet and places outside the home such as the school or mall where they could be targeted. They also need to be educated on sexual abuse that can occur through grooming and cell phone use. Children and adolescents can be manipulated and coerced to provide sexually explicit photos and videos and groomed on what content to send through applications such as Snap Chat and Instagram. It is important for minors to have preventative education on the risks of social media before they are targeted [3, 4, 5, 20, 21].

Essential components for sex trafficking prevention of minors include education on mental health, self-esteem, well-being and education on risk factors for online grooming, recruitment and trafficking. It cannot be assumed this education and mental health wellness and support can be provided at home by family or friends. If it is not someone from online, many child abusers are known to the child. Also, oftentimes family and friends have misinformation and misunderstanding of the risk factors and true realities of sex trafficking today. Resources and efforts to help children feel loved, secure, accepted and educated are needed to prevent issues before they even occur. Also, educating children on the spectrum of abuse and what is entailed in the grooming process is critical. Children may not realize and understand how they are being groomed and the inappropriateness of adults talking to them online in sexual ways. Oftentimes when minors have low self-esteem, are in need or love, validation, attention and affirmation and are online, they are at risk for slowly engaging in risky behaviors they would not otherwise participate in [3, 4, 5, 20, 21].

Additional support for education can include policies that provide general education in the school system on how to help children manage their emotions, feel loved, validated and have positive self-esteem while also being aware of dynamics and risks with adults. On average, children are generally recruited for trafficking at age 11 or 12 years old. Both boys and girls are targeted but the majority are female. Therefore, interventions with education on mental health, wellness and sexual abuse prevention need to be enacted before minors reach the age of recruitment and grooming. Nine to ten years of age is likely an optimal time where minors are old enough to understand certain concepts and warning signs of risky people online, but young enough that they have probably not yet experienced grooming or recruitment [3, 4, 5, 20, 21].

9.2 Network alliance and framework approach

To implement successful prevention efforts, it may also be important to incorporate task force alliance work for a more holistic, impactful strategy. The Human Trafficking Task Force of the Global Alliance for Behavioral Health and Social Justice developed a primary prevention framework to assist in the creation of a comprehensive way to apply community strengths and resources for the prevention of child trafficking in every form. This framework has elements of human rights, public health and the Socioecological Model (SEM). It views children as having human rights that need to be honored and protected, and looks at issues of inequality and discrimination. It addresses society’s responsibility to children and the Convention on the Rights of the Child. The public health aspect is concerned about preventing harm before it occurs. The public health perspective looks to address an issue by understanding its determinants [23].

In the case of prevention, it would mean understanding the factors that put children at risk and addressing those factors in a prevention approach. It means addressing the problem of trafficking before it even occurs. The Socioecological Model (SEM) approach looks at individual, relationship, community and societal influences at various socioecological levels. This framework emphasizes a culture of prevention. Primary prevention is not often discussed but it is the central way to improve the human condition. Key components with this framework for prevention are the elements of 1) belonging and identity, 2) social relations, 3) love and care, 4) respect for bodily integrity, 5) physical health, 6) participation, 7) self-expression and well-being, 8) sense of safety, 9) feeling respected, 10) feeling provided for, 11) adequate standard of living, 12) enjoying learning, 13) age appropriate development and 14) access to information. According to the Socioecological Model, these elements collectively comprise categories for overall well-being of children and important needs for CSEC prevention interventions. When these needs of a child are met, their risk of CSEC significantly decreases. Knowledge of these components is power over the incidence of CSEC [23].

9.3 Mandated large scale school-based interventions

In 2017, in ground breaking legislature, California became the first state in the United States to mandate anti-trafficking education for 7th–12th grade education in public school curriculum. This legislature was founded in relation to Congress’ Trafficking Victims Protection Act of 2000. Before the establishment of this law, numerous California schools in ‘high intensity child prostitution’ areas created and implemented anti-trafficking curriculum. These early experiences helped establish the necessity of this prevention education. There has also been movement and breakthroughs for school officials to address problematic behaviors as potentially reflective of symptoms of abuse and victimization. Children are trafficked in every state of the union and other jurisdictions need to consider creating and implementing curriculum for this purpose as well [24].

9.4 Higher risk areas

For education intervention and prevention, certain cities in the United States have been labeled as more at risk than others. These are considered “high intensity child prostitution (HICP)” zones. In California alone, Los Angeles, San Diego and San Francisco/Oakland are high intensity child prostitution regions. The HTPETA reaffirms that educating 7th–12th graders on anti-trafficking is a positively impactful anti-trafficking strategy. All school personnel can potentially have a positive role in prevention and therefore this education needs to be applied to school personnel as well as students. The ten other cities in the United States that are high intensity child prostitution areas includes Minneapolis, Minnesota; Dallas, Texas; Detroit, Michigan; Tampa, Florida; Chicago, Illinois; Miami, Florida; New York City, New York; Washington, DC; Las Vegas, Nevada; and St. Louis, Missouri. The success and strong initiative of the California curriculum is a groundbreaking initiative. It is worthwhile for other states to follow this initiative and normalize the efficacy and importance of trafficking prevention work [24].

9.5 Risk factor reduction and interventions

Sex trafficking prevention and education curriculum for minors is especially important because child trafficking is empowered and growing in part due to lack of awareness, stigma and denial. It is necessary to confront this issue to overpower and defeat it. Child trafficking is not largely a foreign or ‘third world’ issue. In the United States alone, according to the Federal Bureau of Investigation, a great majority of the victims are domestic U.S. citizens. Prevention training for educators needs to occur in collaboration with law enforcement personnel and social service providers that have greater understanding and experience with prevention training. Anti-trafficking prevention work is most effective with a multi-disciplinary approach. The groups most at risk for trafficking and most in need for prevention efforts are African American females, transgender youth, girls and homeless boys. The FBI data shows that the average age a girl is trafficked in the United States in 12 years but children as young as nine years old are now at risk according to the most recent data. The business of trafficking children is increasing and schools are vulnerable areas to recruit new victims. Girls in foster care situations are also particularly at risk [24].

Aside from this, general education components need to be included in prevention curriculum. This includes more awareness of social media such as Instagram, SnapChat, Facebook, chat rooms and apps such as Lyft and Uber. It also includes posting and providing general information and resources in elevators, hotel rooms, stores like 7–11 and gas stations, sporting events, busses and bathrooms. Like the issue of smoking, there needs to be a general public awareness campaign of the issue. This awareness will shift the general consciousness of society and change the way online sex trafficking of minors is viewed and understood. It also increases awareness and education to at-risk children who are otherwise unreachable [3, 4, 5, 20].

9.6 Physical exercise

Liu et al. [25] conducted a systematic review and meta-analysis on the impact of physical activity interventions on self-esteem and self-concept in children and adolescents. This study assessed the role of a supervised physical activity on participants ages 3–20 years and looked at 25 randomized controlled trials and 13 non-randomized controlled trials for a total of 2991 cases. The authors identified that physical activity is associated with increased self-concept and self-worth in children and adolescents. Stronger effects were found with school-based and gymnasium-based intervention physical activities. Prevention interventions that consider the significance of physical activity for self-esteem improvement may be relevant for curriculum development and therefore the prevention of sex trafficking [25].

10. Self-compassion as prevention

Self-esteem is an important protective factor against online sex trafficking risk. With the high prevalence of trauma, dysfunctional families and relationships, influx of toxic social media and bullying, it is arguably harder now than ever before for children and adolescents to have healthy self-esteem. Cultivating self-compassion may be a positive reinforcement and intervention to self-esteem and one that has a strong positive effect on reducing negative symptoms associated with trauma, dysfunctional families, unmet needs, social media and bullying. A study with 2809 adolescents and a close to 50% equal male–female ratio examined self-esteem and self-compassion over the course of 4 years. It was found that self-esteem consistently predicted positive changes in self-compassion over the four years. Therefore, self-esteem seems to be a significant component of developing self-compassion. Self-compassion has important implications for recovery from trauma, abuse and mental health issues that can also put one at risk for online sex trafficking. Therefore, prevention interventions that incorporate self-compassion training and education are worthwhile in psychosocial education programs and sex trafficking risk reduction [26].

11. Animal assisted interventions, psychoeducation and parental training as prevention

Animal assisted interventions are another approach that could be potentially effective in prevention efforts to reduce the risk of online sex trafficking of minors. A study conducted by Schuck, et al. [27] with a group of children with vulnerable mental health conditions assessed whether Animal Assisted Interventions (AAI) were an effective approach to improving self-esteem in children. A group of 80 children ages 7–9 years old was assessed. It was found that interventions that included the participation of certified therapy dogs for a period of 12 weeks, 1 weekday evening for 2 hours and on Saturdays for 2.5 hours for a total of 4.5 hours a week had a positive impact. This was also accompanied by 2 hours of parental group-based behavioral parent training (BPT) once a week and Positive Assertive Cooperative Kids (P.A.C.K) social skills training for the children [26, 27].

This study found that the psychosocial intervention of the social skills curriculum P.A.C.K. along with parent behavioral training and the assistance of therapy dogs improved levels of self-reported self-competence, behavioral conduct and academic competence among the vulnerable children participating in the study. Animal assisted interventions are an increasingly recognized form of complementary therapy for self-competence, self-worth and self-esteem with children. The combination of psychosocial intervention, parental behavior training and animal assistance intervention created a powerful, holistic approach with improved self-esteem outcomes for children [26, 27].

12. Conclusion

This perspective chapter explored the importance of effective prevention interventions for the growing global concern of online sex trafficking of minors. Major topics of concern that were addressed include background information on the issue; specifics concerning sex trafficking of minors, myths and misunderstandings; the humanistic theory as a theoretical framework to address this issue; and effective interventions such as education, network alliance and large-scale mandated school-based interventions as well as specific prevention measures. This chapter reveals that identifying children who are at risk for online commercial sexual exploitation is critical for preventing its occurrence. Interventions such as screenings through the school system, self-esteem and self-compassion promotion, animal-assisted interventions, physical exercise programs to improve self-esteem, and psychoeducation programs for minors and parents are some suggestions that may have a strong prevention impact. Prevention is significant because many children are at risk and naïve to the prevalence of online sex trafficking. Naivety and ignorance coupled with unmet needs and prior trauma history lead to risky behaviors online. Addressing the risk factors, family system elements, and creating awareness are all important. Taking a multi-pronged, holistic approach while addressing the most significant elements is likely most impactful [3, 18, 28].