Supplemental Material for Taking a Bite Out of the Sex Trafficking Epidemic: Disordered Eating Symptomology Among Sex Trafficking Survivors

There is a growing understanding of the intersection of natural disasters and human trafficking, but there are few empirical research studies on this phenomenon. This exploratory study seeks to advance knowledge on the nexus of human trafficking after natural disasters in the Gulf South region of the United States. We conducted semistructured interviews with 46 disaster responders and human trafficking responders working in Louisiana during a major hurricane between 2017 and 2022. These interviews explored the landscape of human trafficking in the wake of disasters, the impact of natural disasters on respondents' abilities to identify and respond to trafficking, and the lessons that respondents learned from their experiences. Thematic analysis of the interviews revealed that respondents identified both sex and labor trafficking that occurred after hurricanes. Responders were severely limited in their ability to respond to trafficking in postdisaster settings. However, responders found creative and innovative partnerships to overcome challenges in postdisaster settings. We discuss implications for human trafficking responders, disaster responders, and researchers to advance antitrafficking response in postdisaster settings.

This comparative study examines human trafficking in the Republic of Moldova and Romania, highlighting differences and similarities in the types of exploitation and the profile of victims. In Moldova, labor exploitation is more common, targeting both minors and economically vulnerable adults, with a significant presence of transnational labor trafficking. Socio-economic vulnerabilities, migration, and rural or marginalized environments increase the risk of victims. In Romania, sexual trafficking predominates, affecting mainly young women and girls, including minors, and labor exploitation has a lower share. Although both countries apply countermeasures, under-identification and limited capacity of the authorities remain major challenges, requiring strengthened policies adapted to the local contex

Human trafficking remains a serious and persistent challenge in Uganda, affecting over 1,200 individuals annually, with women and girls disproportionately impacted. Female survivors are often vulnerable to re-trafficking due to the interaction of individual and communal factors. The current study examines the socio-demographic characteristics, perceived social support (PSS), and communal and individual factors influencing re-trafficking vulnerability among female survivors in Uganda. This cross-sectional study, conducted in January 2025, examined factors among 350 female survivors of sex and labor trafficking aged 18 to 35 years, receiving rehabilitation services at seven sites in Kampala. Participants were selected through convenience sampling, and data were collected via face-to-face interviews with the same sex individuals using a structured questionnaire. PSS was measured using the 12-item Multidimensional Scale of Perceived Social Support, with scores ≥8.6 indicating positive support. Re-trafficking risk was assessed using the 8-item Adult Human Trafficking Screening Tool (AHTST), with scores ≥5.0 indicating elevated risk. Data analysis involved bivariate and multivariate Poisson regression models with robust variance using Stata version 17. Results showed 70.3% of participants were aged 18 to 24 (mean = 25.4, SD = 8.5), 80% were single, and 48% had only primary education. The mean PSS score was 24.8 (SD = 8.6), and 63.4% reported recent exchange of sex for money. Re-trafficking vulnerability was significantly associated with transactional sex (99.1%, χ2 = 11.1, p < .01). Adjusted models indicated that transactional sex and widowhood increased re-trafficking risk by 6% (Adjusted Relative Risk [aRR] = 1.06, p = .014) and 4% (aRR = 1.04, p = .012), respectively, while primary education and family support reduced risk by 5% (aRR = 0.95, p = .021 and p = .003). This study highlights the need to adopt an approach tailored toward reducing trafficking vulnerability, strengthening social support, promoting education, eliminating transactional sex, and creating economic opportunities, which are relevant for long-term reintegration.

ABSTRACT This study examined how culturally competent mental health care shapes the therapeutic experiences of Black survivors of sex trafficking during incarceration. Twelve formerly incarcerated Black survivors participated in semistructured, in-depth interviews exploring their experiences with mental health services in carceral settings. Using interpretative phenomenological analysis, this study investigated how survivors make meaning of therapeutic encounters in racially stratified correctional systems. The findings revealed that incarceration often functions as an extension of trauma, characterized by racialized punishment and the absence of trauma-informed care. Access to culturally competent therapy, however, emerged as a transformative factor, fostering trust, safety, and openness.

Sex trafficking is one of the most heinous crimes in the world. Generally, these acts are covert in nature. The main aim of this research is to study the life of the prostitutes using ethnographic research methodology. By employing Michel Foucault’s notions of Parrhesia &amp; Governmentality, it is intended to be seen if the streetwalkers are willing to express the truth about themselves. It has been found out from the research that corruption and coercion are the two main contributors to trafficking and the eliciting of parrhesia from the victims and the police leads to positive transformation, thereby ushering in governmentality. Studying the lives of this underrepresented community following an interactionist approach motivates them to take better care of themselves.

ABSTRACT Prevention of trafficking is legislated and funded through federal law, with victim services for child sex trafficking assigned to local departments of social services. Among child welfare workers, research has documented mislabeling, misidentification, misunderstanding of policy, and improper care for youth involved in sex trafficking, and pointed to a need for training of professionals. A survey of five years of classes of child welfare workers (n = 1,061) in departments of social services was conducted, measuring changes in the pre-training knowledge and self-efficacy workers arrived with regarding engaging with survivors of child sex trafficking. Correlations and regression analysis (controlling for gender, race, and years working in the field) showed that the passage of time was associated with markedly higher levels of pre-training knowledge by successive cohorts of workers arriving for training but not with higher self-efficacy in these areas. Professional development training for child welfare workers about child trafficking should deliver more advanced content, while expanding experiential training components that build self-efficacy.

This study examined the effectiveness of a brief educational intervention designed to reduce sex trafficking (ST) myth acceptance. Using a 2×2 mixed design, participants (N=189) viewed either an educational video addressing common ST myths or a control video on human memory. Measures of ST myth acceptance and victim empathy were collected before, immediately after, and 1month following the intervention. Participants also evaluated a vignette describing an alleged ST case and responded to items assessing empathy, victim blaming, and perceptions of the defendant's guilt. The intervention did not significantly reduce ST myth acceptance or influence vignette-based judgements, which may reflect a ceiling effect given participants' already supportive baseline attitudes. However, a protective effect emerged over time: participants in the intervention condition maintained supportive victim attitudes at follow-up, whereas control participants demonstrated increased victim blaming and decreased empathy.

Background/Objectives: Sex trafficking is a form of modern-day slavery still present in our societies. Health professionals are in a key position to identify and support victims, but adequate training is required. The aim of this study was to analyze the impact of a structured educational intervention on knowledge, perceived professional role, and attitudes toward sex trafficking of women among undergraduate nursing students at the University of Seville, Spain. Methods: A cluster randomized pilot educational trial with a pre-test–post-test control group design and one-year follow-up was conducted. A two-hour educational session addressed key concepts related to sex trafficking, health professionals’ responsibilities, and survivor support. Knowledge and attitudes were assessed at baseline, immediately after the intervention, and at one-year follow-up. Results: 199 students participated. Significant post-intervention improvements were observed in knowledge and attitudes, with sustained impact after one year despite some knowledge decay. Conclusions: This pilot educational intervention appears to improve knowledge and attitudes toward sex trafficking among undergraduate nursing students and may represent a useful strategy for sensitizing and training future health professionals in this area.

ABSTRACT The current study examines the minoritized identities of sex trafficking survivors compared to the professionals who served them to understand representation in a Midwestern state. Survey data from 107 anti-trafficking professionals working with survivors of sex/sex and labor trafficking combined in a Midwestern state were analyzed to uncover demographic details among 388 survivors, and 58 professionals. Relative rate ratios were calculated to understand the race/ethnicity and gender of providers and survivors relative to the population, as well as identity matching between survivors and providers. Results indicate service providers’ race/ethnicity and gender did not reflect the diversity of the survivors they served. While most survivors were White (47.2%), survivors of color were 1.5x-8x more likely than White peers to experience trafficking. The anti-trafficking providers were also overwhelmingly White (79.3%) and there were no providers identifying as Asian American or Indigenous. Matching provider to survivor gender proved to be more diverse; however, there were no transgender providers to serve the transgender survivors who represented nearly 3% of the study participants. Enhancing staff diversity improves cultural competency among workers. Implications include anti-oppressive practice in organizations to reflect upon, uncover, and ameliorate bias in systems level responses.

Perceptions of Trauma-Informed Care: The Experiences of Minor Sex Trafficking Survivors in Medical Settings

ObjectiveTo examine the impact of the extent of education and/or training on sex trafficking among healthcare, social and community service providers and the impact of education and/or training on their capacity to respond to sex trafficked persons.DesignCross-sectional survey.SettingAn anonymous, online survey assessing perceptions of, and capacity to respond to, sex trafficking was distributed between February and August 2023 via social media platforms and with professional healthcare, social service and community associations and organisations across Canada to share with their members.Participants553 healthcare, social and community service providers.Outcome measuresSeven 6-point Likert scale items were used, as part of a larger survey, to measure capacity to respond to sex trafficking. Specifically, respondents were asked to rate their awareness of red flags and capacity to identify, talk to, interview, enhance the safety of, provide appropriate resources or referrals for and collaborate with other professionals to support sex trafficked persons.ResultsAlthough most respondents (86.8%) reported having received some education and/or training on sex trafficking, the vast majority (94.8%) believed that they would benefit from additional education and/or training. Compared with those with no previous sex trafficking education and/or training, those who received less than 5 hours of education and/or training (b=3.56, p<0.0001), 5–15 hours (b=8.03, p<0.0001), and 16 or more hours (b=11.13, p<0.0001) reported higher overall capacity to respond appropriately to sex trafficked persons.ConclusionsAs the number of hours of education and/or training on sex trafficking increased, so did respondents’ capacity to respond to sex trafficked persons. These results highlight a need for more education and training to help build capacity among healthcare, social and community service providers in identifying sex trafficked persons and providing appropriate care. Appropriately trained service providers can better support sex trafficked persons’ complex needs and potentially mitigate adverse outcomes.

“Like shooting fish in a barrel:” recruitment into sex trafficking in emergency shelters for youth experiencing homelessness

Despite the elevated risk of youth with disabilities experiencing sex trafficking, little is known regarding coordination among organizations that provide services critical to prevention. This study utilized social network analysis to explore the association between six organizational sectors and three coordination types (i.e., referrals, information and resource sharing, and trainings). Organizational representatives (n = 47) were surveyed about their coordination, communication frequency, and trust and reliability toward 190 organizations in a southeastern state. Communication frequency was significantly associated with all coordination types. Among disability and violence prevention organizations, 71.9% of information and resource sharing ties and 12.5% of training ties were present. Violence prevention organizations sent more referrals to disability organizations than the inverse. Future research should explore how coalition building among organizations occurs via interpersonal ties (e.g., boundary spanners). Findings can influence cohesive responses to sex trafficking that incorporate service needs of youth with disabilities.

Problem definition: The internet facilitates sex trafficking through adult service websites (ASWs) that host online advertisements for sexual services (sex ads). Since the closure of the popular site Backpage.com, the ecosystem of ASWs has expanded to include multiple competing sites that are hosted outside U.S. jurisdiction. Gaining intelligence for counter-trafficking efforts requires collecting, linking, and cleaning the data from multiple sites. However, high ad volumes, disparate data types, and the existence of generic and misappropriated data make this process challenging. We present an end-to-end process for linking sex ad data and filtering potentially erroneous links. Outputs of the developed process have been used to inform counter-trafficking operations that have helped identify more than 60 potential victims of sex trafficking, some of whom are getting help to transition out of the life. Methodology/results: Our process leverages concepts and techniques from network science, information systems, and artificial intelligence to link ads across sites at the level of an individual or unique posting entity. Our approach is computationally efficient, allowing millions of ads to be processed in under an hour. A key component of our process is an edge-filtering procedure that identifies and removes potentially erroneous links in a graph representation of sex ad data. A comparison of the proposed process to an existing approach shows that our process is typically more computationally efficient and yields substantial increases in the number of individuals for which we can derive actionable intelligence. Managerial implications: The proposed process is an efficient and effective approach for transforming the high volumes of disparate data from sex ads into intelligence that can save lives. It has been refined over years of collaboration with practitioners and represents a strong foundation upon which further counter-trafficking tools can be built. Funding: This research is partially supported by the National Science Foundation [Grant D-ISN-2240299].

There is a lack of research on the impact of trauma-informed care for survivors of sex trafficking. This article examines service providers’ perspectives on trauma-informed best practices for engaging survivors in service provision. Twenty-one service providers in the southwestern US participated in a virtual semi-structured interview that was approximately 1-h in length. Interviews were audio-recorded, transcribed, and data analysis consisted of Braun & Clark’s six-stage process for thematic analysis. Five themes were generated from the data, including (1) judgment and stigma, (2) building trust through consistency, (3) compassionate communication, (4) providing opportunities for survivor autonomy and choice, and (5) creating a warm and welcoming environment. Survivors experience stigma and distrust healthcare providers, which can impede their access to and engagement with care. This study highlights the vital role of trauma-informed care in fostering survivor-centered support systems that promote dignity and healing for survivors of sex trafficking.

Human Trafficking Survivor Advocate: Observational Evaluation of a Community-Based Pilot Program to Support Trafficked Persons in the Hospital Setting.

ABSTRACT Stigma and heightened safety risks impede recruitment of research participants from some populations, which can contribute to gaps in knowledge in areas especially needing attention from social scientists. This paper describes challenges and solutions researchers have navigated in recruiting from stigmatized and heightened-risk groups. It presents a case study of successfully recruiting sex trafficking survivors (N = 40) despite encountering barriers. The case study highlights adjustments to methods and procedures, and dynamics related to recruitment collaboration with partners in a community-engaged research project. The paper provides recommendations for facilitating research recruitment from populations facing stigma and increased risks.

ABSTRACT This study examines how often domestic sex traffickers have criminal family members. It employs judicial register data on the mothers, fathers, (half-)siblings, and (ex-)partners of a sample of 630 domestic sex traffickers who were brought to court in the Netherlands, and who are compared to control groups of general and non-offenders. The results show that nearly nine out of ten domestic sex traffickers have a criminal family member (89%), which is much more often than non-offenders (24%) and—even more noticeably—than general offenders (64%). Furthermore, (half-)siblings and (ex-)partners of domestic sex traffickers are relatively often also involved in human trafficking specifically. Additionally, among four subgroups of domestic sex traffickers with different offending trajectories (low-rate, early-peak, late-peak, and high-rate-persistent offenders), familial offending is least prevalent for low-rate offenders (81% compared to 93–100%). Still, their prevalence is very high when compared to general and non-offenders. The findings suggest that the intergenerational, intragenerational, and partner similarity of criminal behavior, as well as the underlying explanatory mechanisms, play an even greater role in domestic sex trafficking than in general offending. Clearly, prevention and resocialization measures should also target the family system, rather than only individual domestic sex traffickers.

This study explores the deeply rooted issue of sex trafficking and clandestine sex work among Rohingya refugee women in Bangladesh. Taking a 100-sample size and drawing on mixed methods, including structured interviews, in-depth interviews, key informant interviews, and case studies, the study examines the socio-economic and structural vulnerabilities that contribute to the exploitation of Rohingya women. Findings reveal that gender-based violence, dowry practices, poverty, statelessness, and lack of employment are major drivers of trafficking. The research also uncovers the roles of brokers, local complicity, and transnational networks in perpetuating this crisis. With trafficking occurring both within and beyond the refugee camps, and victims often lured through deception, coercion, or fake marriages, the need for urgent intervention is evident. Four interrelated theories (1. Intersectionality Theory, 2. Social Disorganization, 3. Rational Choice Theory, and 4. Demand Theory) have upheld the situations of Rohingya women’s trafficking and clandestine sex work at the Bangladeshi refugee camps. The study recommends a multi-tiered response, including legal reforms, economic empowerment, community surveillance, and international resettlement initiatives to ensure safety, dignity and justice for Rohingya women.