Examining Adverse Childhood Experiences (ACEs) Among Sex Trafficked Women: Implications for Social Workers and Other Service Providers

Background and Purpose. According to the Trafficking Victims Protection Act, sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purposes of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained eighteen years of age. Sex trafficking is a criminal activity that is associated with violence against women, forced criminality, trauma, and Adverse Childhood Experiences (ACEs). ACEs in turn are linked to poor health and behavioral outcomes including mental health problems, overweight/obesity, cardiovascular diseases, poor coping and socialization skills and substance misuse. The purpose of this study was to first describe the rate of trauma exposure as well as prevalence of specific types of ACEs among women who formerly met the legal definition of human trafficking. Second, we benchmarked observed rates against reported rates in similar populations across the United States. The authors will discuss findings in the context of women’s help seeking behaviors as they crossed over into social services and health care systems.

Methods. A total of 50 women who formerly met the legal definition of human trafficking were surveyed and interviewed using purposive and snowball sampling methods. Participants who were at least 18 years of age were asked to describe their substance use histories, exposure to traumatic events in childhood and in adulthood, and past and ongoing medical histories. The researchers also explored participants’ and traffickers’ demographics. We benchmarked observed rates using two-tailed one-sample tests of means and proportions. All analyses were performed in Stata 15.

Results. Women were 42.58 years of age on average. These women self-identified as White (68%; n=34), Black (n=13; 26%), Native American/Indigenous (4%; n=2), and other (2%; n=1). Half of the sample reported annual incomes of <$10,000 per year and 54% (n=27) reported 10 or more years of trafficking victimization. Results show that adults were exposed to 7.2 ACEs on average. Ninety four percent (n=47) reported 4+ ACEs and 24% (n=12) scored 10/10 on the ACEs scale. Emotional and sexual abuse tied at 88% as the most frequently cited adverse childhood experiences among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared to known estimates in similar populations, ranging from 20% to 54% (P<=0.000).

Conclusions and Implications. The authors found that sex trafficked women in this study report higher levels of ACEs than the general population as well as other marginalized populations. Considering the well-established link between adverse childhood experiences and poor health outcomes, these findings point to the need for innovative and targeted service provision to formerly trafficked women that take into consideration the high level of adverse childhood experiences of the women. Given the gender, racial, class, and educational diversity of our sample, there is a need for trauma-informed services that are innovative, culturally sensitive and that are made available in a variety of settings including jails and prisons.