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“Commercial sexual exploitation and sex trafficking of minors should be understood as acts of abuse and violence against children and adolescents.”
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This chapter first defines terms relevant to the problem of commercial sexual exploitation and sex trafficking of minors in the United States. It then presents a set of guiding principles that should inform any efforts to address the problem. Next is a brief discussion of what is known about the extent of the problem. The final section summarizes the current understanding of risk factors and consequences. One of the messages that emerges from this discussion is that, while the gravity of the problem is clear, critical gaps in the knowledge base for understanding and addressing it need to be filled.
The language used to describe aspects of commercial sexual exploitation and sex trafficking crimes and their victims and survivors—a collection of terms derived from the range of agencies, sectors, and individuals working to prevent and address these crimes—varies considerably. Some terms are diagnostic and scientific (e.g., screening and medical forensic exam). Others are legal terms (e.g., trafficking, offender, perpetrator). Some terms are used frequently in popular culture (e.g., pimp, john, child prostitute). Still others are focused on the experiences of exploited children (e.g., victim, survivor,
modern-day slavery). The result is the absence of a shared language regarding commercial sexual exploitation and sex trafficking of minors.
The implications of this absence of a common language can be significant. For example, a child or adolescent victim identified as a prostitute may be treated as a criminal and detained, whereas the same youth identified as a victim of commercial sexual exploitation will be referred for a range of health and protective services. Box 1 provides the definition used in the IOM/NRC report for the commercial sexual exploitation and sex trafficking of minors. Box 2 presents the report’s definitions for some of the more common terms related to these crimes.
Commercial sexual exploitation and sex trafficking of minors are distinct but overlapping terms. Indeed, disentangling commercial sexual exploitation from sex trafficking is impossible in many instances. Two points are particularly important for readers of this guide. First, programs designed for victims and survivors will need to account for a range of experiences and needs among those being served. Second, as reflected in the guiding principles presented in the next section, it is crucial to recognize and understand commercial sexual exploitation and sex trafficking of minors as part of a broader pattern of child abuse (as illustrated by Figure 1).
BOX 1
Definition of Commercial Sexual Exploitation and Sex Trafficking of Minors
Commercial sexual exploitation and sex trafficking of minors encompass a range of crimes of a sexual nature committed against children and adolescents, including
BOX 2
Definitions of Other Key Terms
Minors—Refers to individuals under age 18.
Prostituted child—Used instead of child prostitute, juvenile prostitute, and adolescent prostitute, which suggest that prostituted children are willing participants in an illegal activity. As stated in the guiding principles in the text below, these young people should be recognized as victims, not criminals.
Traffickers, exploiters, and pimps—Used to describe individuals who exploit children sexually for financial or other gain. In today’s slang, pimp is often used to describe something as positive or glamorous. Therefore, the IOM/NRC report instead uses the terms trafficker and exploiter to describe individuals who sell children and adolescents for sex. It is also important to note that traffickers and exploiters come in many forms; they may be family members, intimate partners, or friends, as well as strangers.
Victims and survivors—Refers to minors who are commercially sexually exploited or trafficked for sexual purposes. The terms are not mutually exclusive, but can be applied to the same individual at different points along a continuum. The term victim indicates that a crime has occurred and that assistance is needed. Being able to identify an individual as a victim, even temporarily, can help activate responses—including direct services and legal protections—for an individual. The term survivor is also used because it can have therapeutic value, and the label victim may be counterproductive at times.
“Minors who are commercially sexually exploited or trafficked for sexual purposes should not be considered criminals.”
The IOM/NRC report offers the following guiding principles as an essential foundation for understanding and responding to commercial sexual exploitation and sex trafficking of minors:

FIGURE 1 Commercial sexual exploitation and sex trafficking of minors are forms of child abuse.
NOTE: This diagram is for illustrative purposes only; it does not indicate or imply percentages.
“Despite the current imperfect estimates, commercial sexual exploitation and sex trafficking of minors in the United States clearly are problems of grave concern.”
Despite the gravity of commercial sexual exploitation and sex trafficking of minors in the United States, these crimes currently are not well understood or adequately addressed. Many factors contribute to this lack of understanding. For example:
As a result of these factors, the true scope of commercial sexual exploitation and sex trafficking of minors within the United States is difficult to quantify, and estimates of the incidence and prevalence of commercial sexual exploitation and sex trafficking of minors in the United States are scarce. Further, there is little to no consensus on the value of existing estimates. This lack of consensus is not unusual and indeed is the case for estimates of other crimes as well (e.g., rape and intimate partner violence).
The IOM/NRC report maintains that, despite the current imperfect estimates, commercial sexual exploitation and sex trafficking of minors in the United States clearly are problems of grave concern. Therefore, the report’s recommendations go beyond refining national estimates of commercial sexual exploitation and sex trafficking of minors in the United States to emphasize that unless additional resources become available existing resources should be focused on what can be done to assist the victims of these crimes.
Risk factors for victims of commercial sexual exploitation and sex trafficking of minors have been identified at the individual, family, peer, neighborhood, and societal levels (see Figure 2).1 Adding to this complexity, these risk factors, as well as corresponding protective factors, interact within and across levels.
Figure 2 highlights the complex and interconnected forces that contribute to commercial sexual exploitation and sex trafficking of minors. It should
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1It should be noted that the evidence base for risk factors, as well as for consequences, is very limited. Therefore, the IOM/NRC report draws heavily on related literature (such as child maltreatment, sexual assault/rape, and trauma), as well as evidence gathered through workshops and site visits.
be noted, however, that the factors shown are likely only a subset of the risk factors for these crimes. Moreover, these factors do not operate alone. For example, the presence of one or more risk factors would not result in the commercial sexual exploitation and sex trafficking of minors without the presence of an exploiter or trafficker. The factors depicted in Figure 2 may function independently of one another or in combination. In addition, risk factors in one sphere may trigger a cascade of effects or initiate pathways into or out of commercial sexual exploitation and sex trafficking.
Finally, the factors in Figure 2 also may be risks for other types of adverse youth outcomes. Therefore, their presence does not necessarily signal commercial sexual exploitation and sex trafficking of minors, but should be considered as part of a more comprehensive assessment to determine youth at risk of or involved in these crimes.
Box 3 summarizes findings from the IOM/NRC report that highlight the risk factors depicted in Figure 2.
“Overall, research suggests that victims and survivors of commercial sexual exploitation and sex trafficking face developmental, social, societal, and legal consequences that have both short- and long-term impacts on their health and well-being.”
The available literature shows that child maltreatment, particularly child sexual abuse, has significant negative impacts on the physical health, mental health, and social functioning of victims in adulthood, and leads to increased health risk behaviors and mental health problems among adolescents. While studies focused on consequences for commercially sexually exploited children and adolescents are rare, the data based on child sexual abuse are useful given evidence that these problems are linked in some cases. Overall, research suggests that victims and survivors of commercial sexual exploitation and sex trafficking face developmental, social, societal, and legal consequences that have both short- and long-term impacts on their health and well-being.
BOX 3
Findings on Risk Factors