2


The Nature and Extent of Commercial
Sexual Exploitation and Sex Trafficking
of Minors in the United States

Despite a growing literature on commercial sexual exploitation and sex trafficking of minors in the United States, reliable estimates elude the field. When estimates are presented, they are generally accompanied by qualifiers and caveats. For example, Stransky and Finkelhor (2008) reviewed extant estimates of the number of juvenile prostitutes in the United States and found that the estimates ranged from 1,400 to 2.4 million. Indeed, following the recitation of these estimates, Stransky and Finkelhor implore readers, “PLEASE DO NOT CITE THESE NUMBERS [emphasis in original]” (Stransky and Finkelhor, 2008, p. 1). This chapter explains why such a caveat may be appropriate for all extant estimates of commercial sexual exploitation and sex trafficking of minors in the United States and why obtaining such estimates is so challenging. The chapter describes the current state of research focused on estimating commercial sexual exploitation and sex trafficking of minors in the United States. It includes examples of data collection efforts at the local, state, and federal levels and their relative strengths and limitations. It describes the difficulties inherent in counting crime in general and in counting commercial sexual exploitation and sex trafficking of minors in particular. The information presented illuminates why the estimates available today do not offer a full accounting of the incidence or prevalence of commercial sexual exploitation and sex trafficking of minors in the United States and why a full accounting of these problems may never be accomplished. The committee’s review offers insights into the complexities of different research strategies, and also underscores the challenges posed by current estimates for policy makers, practitioners, advocates, and researchers. At the same time, the committee explains that, while



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2 The Nature and Extent of Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States Despite a growing literature on commercial sexual exploitation and sex trafficking of minors in the United States, reliable estimates elude the field. When estimates are presented, they are generally accompanied by quali- fiers and caveats. For example, Stransky and Finkelhor (2008) reviewed extant estimates of the number of juvenile prostitutes in the United States and found that the estimates ranged from 1,400 to 2.4 million. Indeed, following the recitation of these estimates, Stransky and Finkelhor implore readers, “PLEASE DO NOT CITE THESE NUMBERS [emphasis in origi- nal]” (Stransky and Finkelhor, 2008, p. 1). This chapter explains why such a caveat may be appropriate for all extant estimates of commercial sexual exploitation and sex trafficking of minors in the United States and why obtaining such estimates is so challenging. The chapter describes the cur- rent state of research focused on estimating commercial sexual exploitation and sex trafficking of minors in the United States. It includes examples of data collection efforts at the local, state, and federal levels and their relative strengths and limitations. It describes the difficulties inherent in counting crime in general and in counting commercial sexual exploitation and sex trafficking of minors in particular. The information presented illuminates why the estimates available today do not offer a full accounting of the in- cidence or prevalence of commercial sexual exploitation and sex trafficking of minors in the United States and why a full accounting of these problems may never be accomplished. The committee’s review offers insights into the complexities of different research strategies, and also underscores the chal- lenges posed by current estimates for policy makers, practitioners, advo- cates, and researchers. At the same time, the committee explains that, while 41

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42 Commercial Sexual Exploitation and Sex Trafficking of Minors perfect estimates of commercial sexual exploitation and sex trafficking of minors in the United States may not be attainable, improving the estimates is a worthy and attainable goal. Existing Estimates of Commercial Sexual Exploitation and Sex Trafficking of Minors in the United States Scholarly interest in commercial sexual exploitation and sex trafficking of minors has been increasing, especially since the Trafficking Victims Pro- tection Act was passed in 2000.1 Still, this area of research is underdevel- oped and uneven. Estimates of the incidence and prevalence of commercial sexual exploitation and sex trafficking of minors in the United States are particularly 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). As Best (2012) notes, no estimate is perfect, but some are more perfect than others. How perfect are extant estimates of commercial sexual exploitation and sex trafficking of minors in the United States? Incidence and Prevalence One of the most widely cited estimates of the commercial sexual ex- ploitation of children comes from the research of Estes and Weiner (2002). That research, using data gathered from January 1, 1999, to March 31, 2001, indicates that between 244,000 and 325,000 children are at risk of commercial sexual exploitation in the United States, in addition to the esti- mated “105,000 children who are substantiated or indicated to be victims of other types of child sexual abuse annually in the United States” (Estes and Weiner, 2002, p. 46). Estes and Weiner’s 27-month study gathered data from a variety of sources in 17 U.S. cities, as well as cities in Canada and Mexico. These sources included, but were not limited to, interviews with key stakeholders, commercial sexual exploitation customers, law enforce- ment representatives, and human service representatives. In addition, the authors gathered information from 124 sexually exploited runaway and thrown-away street children and 86 sexually exploited children under the care of human service and law enforcement agencies. The limitations of Estes and Weiner’s (2002) estimates are well docu- mented (see, e.g., Stransky and Finkelhor, 2008) and are clearly acknowl- edged by the authors. First, these estimates focus on youth “at risk” for 1  ictims V of Trafficking and Violence Protection Act of 2000, Public Law 106-386, Division A, 114 Stat. 1464.

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The Nature and Extent of Commercial Sexual Exploitation 43 commercial sexual exploitation as opposed to actual victims; a distinction between actual victims and those at risk for exploitation is not made. A second issue is that the at-risk numbers do not take into account individuals who may belong in multiple risk categories (Stransky and Finkelhor, 2008). For instance, if a child were homeless, lesbian, gay, bisexual, transgender, or questioning, and the victim of child sexual abuse, he/she would belong in three of the risk categories and might have been counted three (or more) times in the estimates. While Estes and Weiner (2002) describe how their research corrects for possible duplicate counts in some categories, the ex- tent of duplicate counting, if any, is unknown. The authors acknowledge that with greater resources, a different methodological approach might be taken that could yield improved estimates. Specifically, they note that “a different type of study from ours—one that used a different methodology and a higher investment of resources—is needed to carry out a national prevalence and incidence survey that could produce an actual headcount of the number of identifiable commercially sexually exploited children in the United States” (Estes and Weiner, 2002, p. 143). Even with these limi- tations, however, Estes and Weiner’s estimates are the most widely cited national-level estimates of commercial sexual exploitation of minors. Subsets and Subpopulations of Victims In an effort to understand the nature and extent of commercial sex- ual exploitation and sex trafficking of minors in the United States, some have examined specific subpopulations or subsets of victims. For example, Greene and colleagues (1999) focus on the prevalence of survival sex among a shelter sample and a sample of street youth. The shelter youth participants were selected using a multistage sample methodology to derive nationally representative data on youth in shelters. The street youth participants were selected as a convenience sample from 10 U.S. cities. Aggregated, these data, gathered in November and December 1992 and focusing on youth aged 12 to 21, revealed that 9.5 percent of the shelter youth and 27.5 per- cent of the street youth had engaged in survival sex during that year (Greene et al., 1999). While this work did not yield an estimate of the prevalence of minors who are victims or survivors of commercial sexual exploitation and sex trafficking, it demonstrates that shelter and street youth may be at high risk for being subject to these crimes given their involvement in survival sex. Nonetheless, a limitation of this research for purposes of understanding the extent of commercial sexual exploitation and sex trafficking of minors is that the samples included only youth aged 12 to 21. Unfortunately, the study does not disaggregate minors (under age 18) from others in the samples, and it does not offer information on minors under age 12. This

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44 Commercial Sexual Exploitation and Sex Trafficking of Minors limitation is not uncommon as much research in this area combines a range of ages encompassing children, adolescents, and young adults. Arrest Records Yet another approach used to understand the extent of commercial sexual exploitation and sex trafficking of minors in the United States is to examine arrest records. Using 2009 data from the Federal Bureau of Inves- tigation’s (FBI’s) Uniform Crime Reporting (UCR) program, Puzzanchera and Adams (2011) estimate that 1,400 youth were arrested for prostitution and commercialized vice in the United States during that year. In this work, the authors define juveniles as persons younger than age 182 and detail the characteristics of those juveniles arrested. Fully 78 percent of the 1,400 ar- rests involved a female, 12 percent involved a juvenile under age 15, and 40 percent involved a white juvenile (Puzzanchera and Adams, 2011). Ar- rest statistics, however, while informative, are no substitute for prevalence rates. One cannot know, for example, whether the 1,400 arrests were of unique individuals or included individuals who were arrested on multiple occasions for the same offense. Furthermore, the number of arrests is not equivalent to the number of incidents of commercial sexual exploitation and sex trafficking of minors; one incident may have involved multiple ju- veniles who were arrested for prostitution and commercialized vice. Further, this estimate includes only arrests for prostitution of minors and does not offer insight into the number of juveniles engaging in other related activi- ties. And finally, arrest numbers cannot convey the number of minors being prostituted who escaped detection from police; were arrested for a different offense (e.g., drug related); or were handled in ways not involving arrest at the discretion of the officer or other criminal justice official, including those who were recognized as victims and treated accordingly. Therefore, the use of prostitution arrest numbers offers a highly conservative and incomplete estimate of commercial sexual exploitation and sex trafficking of minors in the United States. Victim Identification Another approach used to estimate commercial sexual exploitation and sex trafficking of minors in the United States is to quantify known victims by groups such as service providers, health care providers, school personnel, and law enforcement, among others. An example is estimates derived from 2  he authors note that their definition of juvenile (i.e., under age 18) conflicts with the legal T definition of the term in 13 states. In 10 states, juveniles are defined as persons aged 16 and younger and in 3 states as those under age 16.

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The Nature and Extent of Commercial Sexual Exploitation 45 the FBI’s Innocence Lost National Initiative, indicating that the program has led to the “recovery”3 of more than 2,100 children being prostituted since its inception in 2003 (FBI, 2012). This number, while indicative of the FBI’s success in helping victims of commercial sexual exploitation and sex trafficking of minors, must be viewed as a highly conservative estimate as well. First, the number of children recovered from prostitution includes only those victims of commercial sexual exploitation and sex trafficking who come to the attention of law enforcement. Further, as with arrest re- cords, one cannot know whether this estimate includes some minors who have been recovered multiple times. And finally, the estimate is limited to those minors who have been prostituted; it does not include minors in- volved in survival sex or other forms of sexual exploitation. Human Trafficking Task Force Data The Bureau of Justice Assistance requires its human trafficking task force grantees to collect data and enter them into the Human Traffick- ing Reporting System. This system was developed and is maintained by researchers at Northeastern University and is designed to track the perfor- mance of federally funded human trafficking task forces. It is currently the only source of information from state and local law enforcement agencies involved in human trafficking investigations. Investigations are guided by the definition of human trafficking found in the Trafficking Victims Protec- tion Act of 2000. The data reported to the Human Trafficking Reporting System include incidents of labor and sex trafficking of minors and adults investigated by Bureau of Justice Assistance human trafficking task forces. Data in this system have been examined by analysts at the Bureau of Justice Statistics. That research indicates that from January 2008 through June 2010, feder- ally funded human trafficking task forces identified 1,016 alleged incidents of prostitution or sexual exploitation of children (Banks and Kyckelhahn, 2011). While this number encompasses both prostitution and sexual ex- ploitation of children, it is limited. First, it reflects only those cases that came to the attention of the 45 federally funded task forces, which are not geographically representative of the nation (Banks and Kyckelhahn, 2011). Second, data were entered into the system only if an investigator spent more than 1 hour on the alleged case. Third, the data represent alleged cases only and thus include cases that may subsequently have been determined to be unfounded. Fourth, an analysis of the data indicated that data entry was incomplete as a result of variation in reporting by individual task forces 3  he T FBI offers no definition of “recovered” children.

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46 Commercial Sexual Exploitation and Sex Trafficking of Minors (Banks and Kyckelhahn, 2011).4 While these data offer some insight into the commercial sexual exploitation and sex trafficking of minors in the United States, then, they are imperfect and incomplete. State-Level Data A number of states have conducted prevalence studies of commercial sexual exploitation and sex trafficking of minors within their borders (Gragg et al., 2007; Ohio Trafficking in Persons Study Commission Re- search and Analysis Sub-Committee, 2012; Quin et al., 2011). These stud- ies were conducted at the request of different offices and agencies (e.g., the state attorney general, state legislatures). The studies used different research methods and different definitions and produced—understandably—notably different findings. In New York, a study that included as one of its purposes estimating the prevalence of commercial sexual exploitation was conducted for the state’s Office of Children and Family Services at the request of the New York State Legislature. This study defined sexually exploited children as those younger than 18 who “have engaged or agreed or offered to engage in sexual conduct with another person in return for a fee, traded sex for food, clothing or a place to stay, stripped, been filmed or photographed performing or engaging in sexual acts, or loitered for the purpose of en- gaging in a prostitution offense” (Gragg et al., 2007, p. i). The authors gathered data for July 15 to September 15, 2006, from a broad range of stakeholders and agencies in a nonprobability sample of upstate counties and New York City boroughs. The study used a multimethods approach that included multiple mail surveys, qualitative interviews, and focus groups. The mail surveys were sent to 159 entities (e.g., law enforcement and probation agencies, detention facilities, child advocacy centers, shel- ters, rape crisis centers) in areas known to have high rates of prostitution arrests and reports of child sexual abuse. Qualitative interviews were conducted with numerous stakeholders. Focus groups involved survivors/ victims of commercial sexual exploitation in New York City. Survivors were asked about their “perception of their home environment when they entered ‘the life’ and (in a few cases) when they returned to it; how they became involved in sexual exploitation; their experience on the street, particularly regarding violence and involvement with exploiters and solici- tors; leaving the life; and supports needed to succeed” (Gragg et al., 2007, p. 43). The researchers also used arrest records and information from Of- fice of Children and Family Services intake records to provide an annual 4  or more information on the methodology used for the Human Trafficking Reporting F System, consult the user’s manual for the system at https://www.humantrafficking.neu.edu (accessed April 24, 2013).

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The Nature and Extent of Commercial Sexual Exploitation 47 prevalence estimate of commercial sexual exploitation. Prevalence data were gathered using mail surveys sent to children known to be survivors of commercial sexual exploitation. In total, this study identified 2,652 victims of commercial sexual ex- ploitation on an annual basis in New York State (Gragg et al., 2007). The authors, however, note limitations associated with this research, including that the estimates are based on identified victims only and cannot account for those who have been victimized but not identified. In addition, the re- search focuses on a relatively short time frame (2 months in 2006). Also, two large law enforcement agencies failed to participate, and the authors believe that “participation from these agencies would have increased the prevalence counts” (Gragg et al., 2007, p. 16). Germane to present pur- poses, this research has additional limitations. First, it utilizes a broader definition of commercial sexual exploitation than that used by the commit- tee, so its estimates will be higher than those derived from work using a narrower definition. Second, the findings pertain to parts of New York State only; they cannot be generalized statewide (given the methodology used), and they cannot provide nation-level information. National-Level Data While some research offers estimates based on state- and city-level data (Curtis et al., 2008), at least one example of research focused on com- mercial sexual exploitation uses a nationally representative sample. In an examination of the national incidence and utilization of social networking- facilitated commercial sexual exploitation, Mitchell and colleagues (2010) estimate that law enforcement made between 440 and 669 arrests for this crime in 2006 in the United States. That this estimate is so low is not sur- prising given the study’s narrow focus on Internet-facilitated commercial sexual exploitation and resulting arrests. One cannot know from this work how many Internet-facilitated commercial sexual exploitation incidents did not come to the attention of law enforcement or the extent to which those that did come to attention resulted in an arrest. Issues in developing estimates of commercial sexual exploitation and sex trafficking of minors in the United States Efforts to measure commercial sexual exploitation and sex trafficking of minors in the United States confront virtually every challenge associated with measuring crime. This section identifies elements of “good” esti- mates and points out challenges associated with generating “good” crime estimates. Best (2012) identifies five necessary elements of a valid estimate. First,

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48 Commercial Sexual Exploitation and Sex Trafficking of Minors the estimate must be based on more than guessing. As Best notes, sometimes a guesstimate or the inclusion of some guessing is the best option available for a social problem. Nonetheless, while a good guess may be a starting point, it rarely produces a good or valid estimate. Second, the estimate must be based on a clear and reasonable definition. As discussed in this report, definitions of commercial sexual exploitation and sex trafficking of minors in the United States are inconsistent (see Chapter 1 and Appendix A). With- out a clear and reasonable definition, what exactly is to be measured is un- clear. Without clarity, measurement is muddled, and this directly influences the quality of the resulting estimate. Third, the estimate must come from clear and reasonable measurement. That is, the measurement method (e.g., survey questions, interviews with service providers, observations) must gather information based on the clearly outlined definition. Fourth, a good estimate is one based on data from a quality sample. Finally, a good esti- mate is more than a number; in addition to the number, information must be provided about the definition, measurement, and sample used to gener- ate this estimate so the reader can understand the estimate’s limitations. A surprising number of estimates related to commercial sexual exploitation and sex trafficking of minors in the United States are accompanied by no information on the methods used to generate them (Stransky and Finkelhor, 2008). Even with these five elements present, there may be disagreement regarding the quality of an estimate; using these basic guidelines, however, interested parties can work toward producing improved estimates. The following sections outline the measurement and sampling issues and other methodological challenges associated with measuring crime. These issues directly affect efforts to measure commercial sexual exploita- tion and sex trafficking of minors in the United States. Understanding these challenges provides insight into the difficulties involved in estimation of such crimes and points to strategies for addressing them. Definition Definitions drive measurement. As discussed above, without a clear and reasonable definition, clear and reasonable measurement (and estima- tion) of a crime is impossible. A clear definition makes clear the elements of the crime. For example, stalking is defined in part as being something that is “repeated.” Thus during measurement, one ascertains whether the behavior in question occurred two or more times. A reasonable definition is one that makes sense. For example, defining sex trafficking of minors as “children transported without their parents’ presence” is not reasonable because it means that when a child rides a school bus, is picked up by a nanny for an after-school event, or is taken by a friend or nonparent relative to a birthday party, sex trafficking has occurred. A reasonable definition

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The Nature and Extent of Commercial Sexual Exploitation 49 is not overly broad or unnecessarily narrow. While it may not be possible to achieve total agreement on what a reasonable definition is, a definition should be understood by most interested parties as reasonable. Efforts to define commercial sexual exploitation and sex trafficking of minors in the United States are characterized by disagreement. For example, agreement is lacking on whether a third-party exploiter is necessary for a situation to be considered commercial sexual exploitation or sex trafficking. (See Chapter 1 for the committee’s discussion of key terms and additional definitions.) The lack of consensus on clear definitions of commercial sexual ex- ploitation and sex trafficking of minors in the United States contributes directly to the difficulty of measuring and estimating the extent and nature of the problems. In addition to technical difficulties, the lack of consensus creates measurement challenges because it fosters a lack of understand- ing among a variety of actors that has real consequences. For example, if commercial sexual exploitation and sex trafficking of minors were clearly defined and if those definitions were widely accepted and publicized in a way that could reach minors, a victim might be better able to self-identify. At present, victims may instead view themselves as criminal offenders and fail to cooperate with entities seeking to assist them. Similarly, without clear and widely accepted definitions of commercial sexual exploitation and sex trafficking of minors, individuals in a position to provide assistance to victims (e.g., law enforcement agents, health care providers, teachers, social workers, foster parents) may not do so because they may see these minors as offenders, promiscuous adolescents, or difficult juveniles rather than the victims of a crime. Until agreement is reached on clear and reasonable definitions of both commercial sexual exploitation and sex trafficking of minors, measurement will remain difficult, and, as a result, it will not be possible to derive valid estimates. Measurement Measuring crime is not easy, and in some cases, such as commercial sexual exploitation and sex trafficking of minors in the United States, it is very difficult. This section describes discusses several measurement issues associated with measuring crime. Unit of Analysis Before any measurement or the calculation of any estimate is con- ducted, one first must determine who or what is being studied, or the “unit of analysis.” Numerous units of analysis may be used in measuring crime. One may be interested in understanding the incident (which may have

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50 Commercial Sexual Exploitation and Sex Trafficking of Minors multiple victims and even more victimizations), the victim (the people of- fended against), or the victimization (the crime committed during an inci- dent). Different national data sources utilize different units of analysis. For example, the unit of analysis that forms the basis of official FBI estimates depends on the crime of interest: robbery and burglary counts focus on incidents, whereas rape counts focus on victimizations. In contrast, official estimates from the National Crime Victimization Survey (NCVS) focus on victimizations. Lack of clarity about the unit of analysis can contribute to misreporting and distortion of research findings and estimates. In 2010, for example, the Bureau of Justice Statistics estimated that there were 15 violent victimiza- tions per 1,000 people in the United States. It would not be surprising to find this statistic repeated as 15 victims of violent victimizations per 1,000 people in the United States. Though similar, these statements convey two very different findings: the first counts the number of victimizations, while the second counts the number of victims. It is theoretically possible, as conveyed by the latter finding, that each victim experienced one violent victimization during the year, making the two statements equivalent. This is unlikely, however, given the well-documented phenomenon whereby individuals who are victimized tend to be victimized repeatedly over time (Dodge and Balog, 1987; Pease, 1998). Attention to the unit of analysis is therefore critical. In terms of commercial sexual exploitation and sex trafficking of mi- nors in the United States, it is important to determine what one wishes to estimate (e.g., current victims, individuals at heightened risk of being com- mercially exploited and trafficked, victimizations, former victims, incidents, exploiters, abettors). And when reading published estimates, it is important to note what exactly has been estimated. The Hierarchy Rule Determining how to count crime is complex even when the unit of analysis is clearly identified. Imagine that an offender walks into a crowd of 20 people; takes everyone’s wallet; and hits one individual with a pipe on the head, leaving a gash that requires hospitalization. How many crimes were committed? There are multiple ways to count the number of crimes associated with this event, one of which involves the “hierarchy rule.” The hierarchy rule counts only the most serious type of victimization commit- ted during an incident. Focusing on violence only, the UCR program5 ranks 5  he newer-generation National Incident-Based Reporting System (NIBRS) uses the hierar- T chy rule in few cases, so it would count all of these crimes in this single incident. The NCVS could be used to count all of these crimes as well. Rarely, however, do researchers use the

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The Nature and Extent of Commercial Sexual Exploitation 51 homicide as the most serious type of crime, followed by rape, robbery, and aggravated assault. The NCVS ranks rape/sexual assault as the most serious type of violent crime, followed by robbery, aggravated assault, and simple assault.6 Returning to the above example, both the UCR and the NCVS would count the robberies as the most serious victimization in this incident; the aggravated assault (i.e., being hit on the head) would not be counted. Given the differences in the unit of analysis used by each data collection effort, the UCR would record a single robbery incident, while the NCVS would record 20 robbery victimizations. Series Victimizations Many crimes (e.g., burglary and robbery) are discrete events with a clear beginning and end. Others (e.g., intimate partner violence and bully- ing) are continuous in nature and have no clear beginning or end. The latter are referred to as series victimizations, and they pose additional challenges to counting crime. How one handles series victimizations has an enormous impact on resulting estimates. Commercial sexual exploitation and sex traf- ficking of minors appear to be a form of series victimization, which further complicates attempts to estimate these crimes in the United States.7 There is no agreement on how series victimizations should be counted. One possibility is to count such a victimization as a single (ongoing) crime, carrying the same weight in crime estimates as a single 1-minute discrete crime. Another option is to count a series victimization according to the number of days on which it has occurred. Thus, a boy bullied every day for a year would be included in official statistics as 365 victimizations. Some argue that this approach fails to capture the essence of the violence and artificially inflates resulting estimates. A third option is to ask the victim (if possible) how many times he/she thinks the violence occurred and include that number in the estimate. This approach leads to rounding and impreci- sion in estimates. Thus, series victimizations can be handled in a number of ways, none of which is perfect. Asking Questions to Gather the Data After determining the unit of analysis and making decisions about the hierarchy rule and series victimizations, investigators must ascertain how data without the hierarchy rule. For one exception, in which researchers examined rape and its co-occurring crimes, see Addington and Rennison (2008). 6  ecause the NCVS interviews victims, it does not collect data on homicide. B 7  or additional information on approaches to counting series victimization and how the F choice of approach influences estimates, see Lauritsen et al. (2012) and Rand and Rennison (2005).

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66 Commercial Sexual Exploitation and Sex Trafficking of Minors gather retrospective information on commercial sexual exploitation and sex trafficking that occurred when they were children and adolescents, it is important to reiterate that those participating in Add Health were listed on school rosters in the mid-1990s; children and adolescents who were not in school for any reason, including being housed in a detention facility or being home-schooled at that time, were ineligible for inclusion in the survey, and their experiences are not reflected in the data. Runaway and Homeless Youth Management Information System (RHYMIS) The Runaway and Homeless Youth Management Information System (RHYMIS) is an automated data collection tool that collects information from grantees in three federal programs that provide support to home- less and runaway youth in the United States: the Basic Center Program, the Transitional Living Program, and the Street Outreach Program (ACF, 2012). The Family and Youth Services Bureau in the Administration on Children, Youth and Families awards and administers federal grants in these programs. Collectively, these programs support homeless and run- away youth in need of emergency services (e.g., referrals to emergency shelters, hygiene products, crisis intervention services, counseling) and lon- ger-term services (e.g., stable living arrangements [up to 21 months], Gen- eral Educational Development preparation, vocational training, parenting skills, assistance with substance abuse, routine physical health care). The Reconnecting Homeless Youth Act of 200815 (the most recent amendment to the original authorizing legislation, the Runaway Youth Act of 1974) directs grantees to collect, maintain, and provide to the Department of Health and Human Services, to the maximum extent possible, statistical data on the youth served by each of the three programs. The informa- tion submitted to RHYMIS includes demographic characteristics of youth served, types of services provided, living arrangements prior to entering the program, and aftercare plans upon exit from the program. A child or ado- lescent may enter a program, receive services, exit the program, and then subsequently reenter the program. Each entry into a program is recorded in RHYMIS by grantees in all three programs. During fiscal year (FY) 2011, the Basic Center Program recorded 36,859 entrances, the Transitional Liv- ing Program recorded 3,880 entrances, and the Street Outreach Program recorded 772,732 outreach contacts to youth (ACF, 2012). In addition to youth served, RHYMIS records the number of youth turned away; in FY 2011, this number was 2,484 for the Basic Center Program and 4,619 for the Transitional Living Program (ACF, 2012). 15  ublic P Law 110-378.

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The Nature and Extent of Commercial Sexual Exploitation 67 An accurate, current national estimate of homeless and runaway youth does not exist. Available data sources, such as RHYMIS, likely underrep- resent the actual number of children and adolescents who are homeless or living in unstable housing. This population of youth is highly vulnerable to significant health risks, including survival sex, sexually transmitted infec- tions, substance abuse, depression, and suicide (Kaestle, 2012). RHYMIS has the advantage of offering access to a portion of a difficult- to-reach population: homeless and runaway youth. Access to this popula- tion is crucial for improved estimation of commercial sexual exploitation and sex trafficking of minors in the United States. However, RHYMIS also is characterized by limitations for estimation purposes. First, as noted above, RHYMIS does not offer a representative accounting of all home- less and runaway youth, which limits its utility for estimating commercial sexual exploitation and sex trafficking of minors in the United States. To the extent that minors who are victims of these crimes do not obtain services that report to RHYMIS, those minors will not be represented in these data. Second, RHYMIS data offer counts of services provided, not prevalence or incidence information. The same individual may obtain services multiple times for multiple incidents of commercial sexual exploitation or sex traf- ficking. Third, RHYMIS includes only children and adolescents who are runaways or are homeless. While extant research documents the vulner- ability and victimization of runaway, thrown-away, and homeless children and adolescents, findings also indicate that many who are at risk and many who are being victimized have not run away and are not homeless. Adverse Childhood Experiences (ACE) Study The ACE Study was a longitudinal study that examined the impact of early life experiences on future health risk behaviors. It was developed by CDC and conducted at Kaiser Permanente’s Health Appraisal Clinic in San Diego, California. Between 1995 and 1997, more than 17,000 indi- viduals who underwent a comprehensive physical examination voluntarily completed anonymous surveys regarding childhood experiences, if any, with abuse (emotional, sexual, and physical), household dysfunction (e.g., mental illness of a caregiver or incarceration of a household member), and neglect (physical and emotional) (CDC, 2012a). The total number of adverse childhood experiences reported by a study participant represents the individual’s ACE score. The major findings of the ACE Study suggest that the higher the ACE score, the greater is the risk for developing behav- iors that contribute to the leading causes of illness, death, and poor social outcomes in adulthood, including alcoholism, drug abuse, and depression (Anda et al., 2006). The study’s data sets are available to researchers and have resulted in numerous scientific publications regarding the association

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68 Commercial Sexual Exploitation and Sex Trafficking of Minors of adverse childhood experiences with various poor health and social out- comes in adulthood. For example, victims of childhood sexual abuse are more than twice as likely to attempt suicide and are at a significantly higher risk for interpersonal problems than adults who did not experience such abuse (Dube et al., 2005). CDC and Kaiser Permanente continue to track the health and social outcomes of the study participants in order to assess the associations with earlier adverse childhood experiences. Although the study sample was large (n = 17,337), it was not demo- graphically representative. For example, the sample comprised 74.8 percent Caucasians, and more than 90 percent of those surveyed had graduated from high school. In addition, all participants were over the age of 18, and nearly half were over age 60 (CDC, 2012a). The demographic character- istics of the sample raise questions about the generalizability of the study’s findings to broader populations, as well as the accuracy of recollections of childhood experiences. The limitations of the ACE Study mirror those of Add Health: The study is not accepting new participants, and there is no evidence of plans to contact original participants for future waves of questions. A second issue is that the study did not gather data specifically on the commercial sexual exploitation or sex trafficking of minors. Since these crimes are forms of child sexual abuse, however, the study findings regarding the association between child sexual abuse and increased risk for poor health and social outcomes in adulthood likely are applicable to these victims of exploitation. As discussed in Chapter 3 of this report, the adverse childhood experiences tracked by the ACE Study are believed to be risk factors for commercial sexual exploitation and sex trafficking of minors; therefore, child and ado- lescent victims of these crimes are likely at increased risk for the poor health and social outcomes identified by the ACE Study and related research. National Child Abuse and Neglect Data System (NCANDS) The NCANDS is an electronic data collection and analysis system that examines child abuse and neglect reports made to state child welfare agen- cies in all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico (Children’s Bureau, 2011). The Child Abuse Prevention and Treatment Act,16 which authorized this national data collection and analy- sis system, defines the minimum threshold of child abuse as “any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm” (Children’s Bureau, 2011, p. vii). The information collected and analyzed 16  2 4 U.S.C. § 5101.

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The Nature and Extent of Commercial Sexual Exploitation 69 through NCANDS includes the number of child abuse and neglect reports made to the state child welfare agency; the source of the report (e.g., service professional or neighbor); the type of maltreatment reported (e.g., neglect, physical or sexual abuse); the relationship between the perpetrator and the victim; demographic characteristics of the victim (e.g., age, race/ethnicity); demographic characteristics of the perpetrator; risk factors identified for the child and the family (e.g., substance abuse, physical disability, domestic violence); services, if any, that were rendered as a result of the report; and the size and responsibilities of the workforce responsible for managing re- ports of child abuse and neglect (Children’s Bureau, 2011). All jurisdictions voluntarily submit agency-level data to NCANDS, and nearly all states submit case-level data, referred to as the Child File, which tracks informa- tion for a specific child. Federal agencies use the NCANDS data to inform policies relating to child abuse and neglect, and the data also are available to independent researchers. In FY 2011, approximately 3.4 million reports of child abuse and neglect were made to state child welfare agencies, involv- ing an estimated 6.4 million children (Children’s Bureau, 2011). Of those referrals, 1.7 million were screened in, and an investigation was initiated. Victims of child abuse and neglect are at increased risk for commer- cial sexual exploitation and sex trafficking. NCANDS therefore provides an opportunity to identify risk, as well as potential for prevention and intervention. Like all the data sources discussed here, NCANDS has advantages and disadvantages for purposes of measuring commercial sexual exploitation and sex trafficking of minors in the United States. An important advantage is that the data are based on child abuse and neglect reports and capture experiences of all children and adolescents, regardless of whether they are in school, living in a housing unit, or homeless. A limitation of the data pertains to dependence on the perception of a reporter. The data are focused on child abuse and neglect, so to the extent that a person witnessing the maltreatment mistakes a child or adolescent for an adult, the incident may go unreported. This issue is problematic for commercial sexual exploitation and sex trafficking of minors as research shows that many of the young people being exploited and trafficked appear older than 18. A second limi- tation is that the system gathers data only on acts committed by a parent or caretaker. While there is evidence that parents and caretakers commit acts of commercial sexual exploitation and sex trafficking involving their own children, evidence also suggests that these crimes often are committed by persons other than parents and caretakers. The latter instances would not be reflected in the NCANDS data.

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70 Commercial Sexual Exploitation and Sex Trafficking of Minors Challenges AND Opportunities Estimates of a social problem are important. They inform interested parties about the extent of the problem, they lead to attention to the need to address the problem and the funding required to do so, and they offer a baseline for evaluating policies. In addition, estimates provide information for policy makers, identify the need for education, point to where assistance is needed, and help direct assistance toward victimized populations. As this chapter has explained, however, generating crime estimates is not an easy task and in some cases is extraordinarily difficult. Commercial sexual exploitation and sex trafficking of minors in the United States are social problems that are characterized by numerous challenges to estimation. The population of interest is difficult to identify and locate and at times uncoop- erative. The sampling strategies available for estimating these problems are limited. Consensus is lacking on the definitions of the problems. Measure- ment of the problems is costly, time-consuming, and extremely difficult. It is not surprising, then, that extant estimates are imperfect. Best (2012) notes that all statistics are imperfect, but some are less per- fect than others. This is an important point. First, it highlights the costs of basing decisions on poor estimates. If an estimate is wildly inaccurate and grossly inflates the extent of a problem, scarce resources (time and money) will be misallocated, and other, more prevalent problems will go unad- dressed. Best’s comment also indicates that a perfect estimate is unlikely. While identifying the limitations of an estimate is easy, identifying what is needed to improve it is more difficult. Certainly, the use of a probability sample of all minors in the United States would be useful, but it may not be feasible for many reasons. At some point, one must ask whether the avail- able national estimates are good enough. Do extant estimates suggest that the problems are large enough to warrant attention and resources? Would slightly higher estimates than those already obtained change the approach to the problems or alter their importance? Is there value in seeking more perfect estimates in an environment of scarce resources? The committee identified two potential opportunities to enhance mea- surement and understanding of commercial sexual exploitation and sex trafficking of minors in the United States: (1) leverage existing measurement efforts that collect data on related issues or populations, and (2) shift focus and resources from exclusively national-level counting to more targeted counting. As noted in this chapter, two existing crime measurement efforts (NIBRS and UCR/SRS) have begun to collect data related to all forms of human trafficking, including sex trafficking of minors (as of January 2103). Although existing non-criminal justice measurement efforts do not cur- rently collect data on commercial sexual exploitation and sex trafficking, a

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The Nature and Extent of Commercial Sexual Exploitation 71 number of these efforts that collect information on related issues and poten- tial risk factors and from relevant populations could be adapted to do so. For example, the YRBS and Add Health collect data on related issues and potential risk factors, such as dating violence, sexually transmitted infec- tions, substance use/abuse, and mental health status from national samples of adolescents. In addition, the RHYMIS collects data from a national sample of runaway, “thrown-away,” and homeless youth, populations that are at risk for commercial sexual exploitation and sex trafficking. Like the NIBRS and UCR/SRS, these measurement efforts could add specific ques- tions and data elements related to commercial sexual exploitation and sex trafficking to enhance measurement and understanding of these problems. Additional research would be needed to determine specific questions to add to the various data collection efforts. While changes to current data collection efforts could enhance mea- surement and understanding of commercial sexual exploitation and sex trafficking of minors in the United States, as discussed earlier, these ef- forts would still yield insufficient estimates of these problems. As noted in this chapter, efforts to estimate the overall occurrence of commercial sexual exploitation and sex trafficking of minors in the United States have been largely unsuccessful given the difficulties inherent in measuring these crimes. As a result, insufficient attention, research, and resources have been devoted to resolving these problems. It is the position of the committee that a continued focus on obtaining better national incidence and prevalence estimates of commercial sexual exploitation and sex trafficking of minors in the United States may detract from progress on other important aspects of these problems. Other fields of research and practice demonstrate that it is possible to make progress on issues even in the absence of strong evidence on their nature and extent. For example, the scope and severity of sexual violence, intimate partner violence, and child abuse and neglect were viewed with skepticism and were characterized by poor estimates during the early stages of work on these problems. (For a more detailed discussion of estimates of child abuse and neglect, see the recent Institute of Medicine [IOM]/National Research Council [NRC] publication Child Maltreatment Research, Pol- icy, and Practice for the Next Decade: Workshop Summary [IOM/NRC, 2012].) Although debates regarding estimates of sexual violence, intimate partner violence, and child abuse and neglect continue, these issues are now accepted as legitimate problems that have benefited from greater public attention, improved funding, and research. Ideally, work on commercial sexual exploitation and sex trafficking of minors in the United States will follow suit. Therefore, the committee does not suggest that efforts to ob- tain better estimates of commercial sexual exploitation and sex trafficking of minors in the United States be abandoned. Rather, the committee urges

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72 Commercial Sexual Exploitation and Sex Trafficking of Minors that efforts to measure the scope and severity of these problems not inhibit other important work. Focusing on better prevalence and incidence estimates is challeng- ing and expensive. Devoting additional resources exclusively to further national-level counting efforts may not be the best strategy to advance work on commercial sexual exploitation and sex trafficking of minors in the United States. An alternative strategy is to shift focus and resources from national-level counting to more targeted counting (e.g., regional or subpopulation estimation). In this scenario, there are a number of possible benchmark measures that can be used to better understand commercial sexual exploitation and sex trafficking of minors in the United States, in- cluding counting • survivors from a specified region or subpopulation receiving services, • charges brought forth by prosecutors, and • successful convictions of exploiters and traffickers. Finally, valuable lessons regarding difficult-to-measure problems can be drawn from the above-mentioned IOM/NRC report Child Maltreatment Research, Policy, and Practice for the Next Decade: Workshop Summary (IOM/NRC, 2012) and the forthcoming NRC report Estimating the Inci- dence of Rape and Sexual Assault. In sum, based on its review of the available evidence, the committee maintains that, despite the current imperfect estimates, commercial sexual exploitation and sex trafficking of minors in the United States clearly are problems of great concern and worthy of attention. Therefore, this report and the committee’s recommendations go beyond counting 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. FINDINGS AND CONCLUSIONS This chapter has emphasized that efforts to generate estimates of com- mercial sexual exploitation and sex trafficking of minors in the United States are characterized by many difficulties. Given the inherent challenges, no approach will result in perfect—or perhaps even nearly perfect—estimates. Still, attempts to provide better, more targeted estimates are warranted. The committee finds that

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The Nature and Extent of Commercial Sexual Exploitation 73 2-1 No reliable national estimate exists of the incidence or preva- lence of commercial sexual exploitation and sex trafficking of minors in the United States. 2-2 Definitional issues inhibit the measurement of these problems. 2-3 Clear and reasonable definitions of commercial sexual exploita- tion and sex trafficking of minors are needed to generate better estimates. 2-4 Reliable estimates of numbers of exploiters and traffickers and solicitors and purchasers do not exist for commercial sexual exploitation and sex trafficking of minors in the United States. 2-5 Estimates that rely solely on interactions with law enforce- ment, crime victim surveys, and arrest records are inherently underinclusive. 2-6 Specific data fields related to commercial sexual exploitation and sex trafficking of minors have been added to existing crime measurement efforts (e.g., UCR/SRS and NIBRS) to enhance estimates of these crimes; similar changes could be made to existing non-criminal justice measurement efforts (e.g., YRBS and Add Health) to enhance estimates of commercial sexual exploitation and sex trafficking of minors that may not involve law enforcement (e.g., instances in which police are not notified or the crime is not recognized). 2-7 Increased awareness and understanding of commercial sexual exploitation and sex trafficking of minors in the United States can improve data collection efforts and estimates. 2-8 While some research methods (e.g., capture/recapture and respondent-driven sampling) look beyond simple reporting of known incidents to generate estimates, the methods cur- rently used to gather national-level data (i.e., UCR/SRS, NIBRS, NCVS) cannot capture the full extent of commercial sexual exploitation and sex trafficking of minors in the United States. The limited information available from the UCR/SRS, NIBRS, and NCVS needs to be combined with data from other sources or circumstances in which victims are identified.

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74 Commercial Sexual Exploitation and Sex Trafficking of Minors 2-9 Devoting additional attention and limited resources to the ex- tremely difficult task of counting victims of commercial sexual exploitation and sex trafficking of minors is unnecessary. The next several chapters describe an array of settings and stakehold- ers that—knowingly or not—interact with underage victims of commercial sexual exploitation and sex trafficking and individuals who are at risk for these forms of victimization. Chapter 11 includes the committee’s recom- mendations for strategies for future measurement efforts. References ACF (Administration for Children and Families). 2012. The Runaway and Homeless Youth Management System (RHYMIS). https://extranet.acf.hhs.gov/rhymis/custom_reports.jsp (accessed December 21, 2012). Addington, L. A., and C. M. Rennison. 2008. Rape co-occurrence: Do additional crimes af- fect victim reporting and police clearance of rape? Journal of Quantitative Criminology 24(2):205-226. Anda, R. F., V. J. Felitti, J. D. Bremner, J. D. Walker, C. Whitfield, B. D. Perry, S. R. Dube, and W. H. Giles. 2006. The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256(3):174-186. Bales, K., and S. Lize. 2007. Investigating human trafficking: Challenges, lessons learned, and best practices. FBI Law Enforcement Bulletin 76(4):24-32. Banks, D., and T. Kyckelhahn. 2011. Characteristics of suspected human trafficking incidents, 2008-2010. Washington, DC: Bureau of Justice Statistics. Best, J. 2012. Damned lies and statistics: Untangling numbers from the media, politicians, and activists. Berkeley, CA: University of California Press. Biderman, A. D., and A. J. Reiss. 1967. On exploring the “dark figure” of crime. The ANNALS of the American Academy of Political and Social Science 374(1):1-15. Bureau of Justice Statistics. 2013. The nation’s two crime measures. http://bjs.gov/index. cfm?ty=tp&tid=3 (accessed April 24, 2013). CDC (Centers for Disease Control and Prevention). 2012a. Adverse Childhood Experiences (ACE) Study participant demographics. http://www.cdc.gov/ace/demographics.htm (ac- cessed December 21, 2012). CDC. 2012b. Youth risk behavior surveillance—United States, 2011. Morbidity and Mortality Weekly Report Surveillance Summaries 61(4):1-168. Child Trends. 2012. Violent crime victimization indicators on children and youth. http:// childtrendsdatabank.org/sites/default/files/71_Violent_Crime_Victimization.pdf (accessed April 24, 2013). Children’s Bureau. 2011. Child maltreatment 2011. http://www.acf.hhs.gov/sites/default/files/ cb/cm11.pdf (accessed December 20, 2012). Curtis, R., K. Terry, M. Dank, K. Dombrowski, and B. Khan. 2008. Commercial sexual ex- ploitation of children in New York City. Volume one: The CSEC population in New York City: Size, characteristics, and needs. New York: Center for Court Innovation. Dodge, R. W., and F. D. Balog. 1987. Series crimes: Report of a field test. Technical report, NCJ 104615. Washington, DC: Bureau of Justice Statistics.

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