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A Short Screening Tool to Identify Victims of Child Sex Trafficking in the Health Care Setting

Greenbaum, V., Jordan, MD*; Dodd, Martha, DNP, FNP-BC*; McCracken, Courtney, PhD

doi: 10.1097/PEC.0000000000000602
Original Articles

Objectives The aim of this study was to describe characteristics of commercial sexual exploitation of children/child sex trafficking (CSEC/CST) victims and to develop a screening tool to identify victims among a high-risk adolescent population.

Methods In this cross-sectional study, patients aged 12 to 18 years who presented to 1 of 3 metropolitan pediatric emergency departments or 1 child protection clinic and who were identified as victims of CSEC/CST were compared with similar-aged patients with allegations of acute sexual assault/sexual abuse (ASA) without evidence of CSEC/CST. The 2 groups were compared on variables related to medical and reproductive history, high-risk behavior, mental health symptoms, and injury history. After univariate analysis, a subset of candidate variables was subjected to multivariable logistic regression to identify an optimum set of 5 to 7 screening items.

Results Of 108 study participants, 25 comprised the CSEC/CST group, and 83 comprised the ASA group. Average (SD) age was 15.4 (1.8) years for CSEC/CST patients and 14.8 (1.6) years for ASA patients; 100% of the CSEC/CST and 95% of the ASA patients were female. The 2 groups differed significantly on 16 variables involving reproductive history, high-risk behavior, sexually transmitted infections, and previous experience with violence. A 6-item screen was constructed, and a cutoff score of 2 positive answers had a sensitivity of 92%, specificity of 73%, positive predictive value of 51%, and negative predictive value of 97%.

Conclusions Adolescent CSEC/CST victims differ from ASA victims without evidence of CSEC/CST across several domains. A 6-item screen effectively identifies CSEC/CST victims in a high-risk adolescent population.

From the *Children's Healthcare of Atlanta and †Emory University School of Medicine, Atlanta, GA.

Disclosure: The authors declare no conflict of interest.

Reprints: Virginia Jordan Greenbaum, MD, Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, 975 Johnson Ferry Rd, NE, Suite 350, Atlanta, GA 30342 (e-mail:

Supported by the Blank Family Foundation through funding portions of the study (portions of salary for Drs Greenbaum and Dodd), but it had no role in study design; collection, analysis, and interpretation of data; and the writing of the report or of the decision to submit the paper for publication.

Jordan Greenbaum, MD, wrote the first draft of this manuscript. Her general work in research on child maltreatment is supported by the Blank Family Foundation, and this includes the work of Marni Dodd, DNP, FNP-BC, on this project.

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