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This article was downloaded by: [ECU Libraries] On: 11 August 2015, At: 12:04 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: 5 Howick Place, London, SW1P 1WG Journal of Human Behavior in the Social Environment Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/whum20 Age at Entry into Prostitution: Relationship to Drug Use, Race, Suicide, Education Level, Childhood Abuse, and Family Experiences a a b Ross J. Clarke , Elizabeth A. Clarke , Dominique Roe-Sepowitz & Richard Fey c a Psychology Department , Arizona State University , Phoenix , Arizona , USA b School of Social Work, Arizona State University , Phoenix , Arizona , USA c School of Social and Family Dynamics, Arizona State University , Phoenix , Arizona , USA Published online: 29 Mar 2012. To cite this article: Ross J. Clarke , Elizabeth A. Clarke , Dominique Roe-Sepowitz & Richard Fey (2012) Age at Entry into Prostitution: Relationship to Drug Use, Race, Suicide, Education Level, Childhood Abuse, and Family Experiences, Journal of Human Behavior in the Social Environment, 22:3, 270-289, DOI: 10.1080/10911359.2012.655583 To link to this article: http://dx.doi.org/10.1080/10911359.2012.655583 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. 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Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions Journal of Human Behavior in the Social Environment, 22:270–289, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1091-1359 print/1540-3556 online DOI: 10.1080/10911359.2012.655583 Age at Entry into Prostitution: Relationship to Drug Use, Race, Suicide, Education Level, Childhood Abuse, and Family Experiences ROSS J. CLARKE and ELIZABETH A. CLARKE Psychology Department, Arizona State University, Phoenix, Arizona, USA DOMINIQUE ROE-SEPOWITZ Downloaded by [ECU Libraries] at 12:04 11 August 2015 School of Social Work, Arizona State University, Phoenix, Arizona, USA RICHARD FEY School of Social and Family Dynamics, Arizona State University, Phoenix, Arizona, USA This study seeks to explore factors related to age at entry into prostitution. Participants were 389 women arrested for prostitution who had attended a diversion program. Women who entered prostitution as minors were found to be more likely to be AfricanAmerican; report having a family member with a substance use problem; have a history of attempted suicide; and not have completed middle or high school. The age at first drug use was found to significantly impact the reported age at entry. Key areas for intervention should include improving school connectedness and preventing adolescent substance abuse, specifically for AfricanAmericans. KEYWORDS Juvenile prostitution, sex work, substance use, drugs, race, education, suicide Juvenile prostitution is a growing social problem worldwide, but the issue has yet to receive sufficient public health attention (Willis & Levy, 2002). There are presently no credible estimates of the number of juveniles involved in prostitution in the United States (Stransky & Finkelhor, 2008). In recent years, the issue has begun to receive increased awareness and interest, both from the public and in the research community. Previous research has examined Address correspondence to Dominique Roe-Sepowitz, School of Social Work, Arizona State University, 411 N. Central Avenue, Suite 800, Phoenix, AZ 85004, USA. E-mail: [email protected] 270 Correlates with Age at Entry into Prostitution 271 pathways of entry into prostitution, but more clarity is needed on this topic in order to understand and serve a population that has long been overlooked and misunderstood. Downloaded by [ECU Libraries] at 12:04 11 August 2015 REVIEW OF LITERATURE Research literature has identified physical and emotional risks for women associated with their involvement in prostitution. Many of these women encounter numerous forms of severe violence, trauma, degradation, and extreme poverty (Willis & Levy, 2002). Drug use has been found to be high among this population, further adding to the many negative outcomes associated with involvement in prostitution (Kuhns, Heide, & Silverman, 1992). A significant amount of research in previous decades has focused on the pathways leading toward entry into prostitution. This study attempts to add to the existing body of knowledge by exploring childhood abuse, education level, race, familial drug use, attempted suicide, and drug use as they relate to age at entry into prostitution. Due to the uncertainty currently surrounding the chronology of drug abuse and entry into prostitution in existing literature, particular focus is paid to the start of drug use in relation to entry into prostitution. Childhood Abuse and Family Dysfunction in Relation to Entry into Prostitution Experiences of childhood abuse—sexual, physical, and emotional—have been widely reported in the backgrounds of women involved in prostitution (Silbert & Pines, 1982; Tyler, Hoyt, Whitbeck, & Cauce, 2001). Childhood abuse has been found to be associated with an increased likelihood of entry into prostitution (Schissel & Fedec, 1999). In a study of 309 women involved in prostitution, Kramer and Berg (2003) found that Caucasian women had higher rates of parental drug and alcohol abuse and more often reported experiencing sexual or physical abuse by a family member when compared to minority women. Interestingly, minority women were found to enter prostitution 2.5 years earlier than Caucasians, and their reported childhood risk factors (sexual abuse, physical abuse, parental substance use) had twice the impact on the hazard rate for entry (Kramer & Berg). Running away, possibly from abusive home situations (Bagley & Young, 1987), has been identified as a common pathway to juvenile entry into prostitution (Estes & Weiner, 2001), increasing the odds of entry during early adolescence by more than 40 times (McClanahan, McClelland, Abram, & Teplin, 1999). In a study of 200 women (juveniles and adults) formerly or Downloaded by [ECU Libraries] at 12:04 11 August 2015 272 R. J. Clarke et al. currently involved in prostitution, Silbert and Pines (1982) found that 94% of the juveniles were runaways. Bagley and Young, in their study of 45 women formerly involved in prostitution, found nearly half of the women to have reported leaving home because of sexual abuse. In a sample of 71 adult women attending a residential prostitution exiting program, women who entered prostitution as juveniles were more likely to have run away from home and to have experienced childhood emotional abuse (Roe-Sepowitz, in press). After controlling for childhood physical and sexual abuse and race, a hierarchical regression revealed childhood emotional abuse to explain an earlier age at entry into prostitution (Roe-Sepowitz). Childhood abuse appears to be the beginning of a negative chain of events leading into eventual involvement in prostitution. Dysfunctional family systems and poor social and educational experiences also appear to be important links in this chain. Dalla (2001), in a qualitative study of 31 women involved in street prostitution, illustrated that most participants reported abandonment by valued individuals during key developmental stages. In other studies, family dysfunction was evidenced in commonly reported experiences of familial substance abuse and parental domestic violence (Bagley & Young, 1987; Silbert & Pines, 1982). Though it is clear that childhood abuse and dysfunctional family situations are common factors in the backgrounds of women involved in prostitution, discrepancies exist concerning the relationship between childhood abuse and age at entry into prostitution. Some have found that childhood sexual abuse presents an equal risk of entry for minors and adults (McClanahan et al., 1999), whereas others have found that certain types of abuse, such as emotional abuse, predict a younger age at entry (Roe-Sepowitz, in press). School Involvement and Social Influences of Entry Seventy-eight percent of the sample in Silbert and Pines (1982) reported being school age at the time of first involvement in prostitution, whereas only 19% actually reported attending school. As children’s schooling progressed, those who would later become involved in prostitution grew increasingly involved with deviant peers, with 40% feeling they had no friends after leaving school (Silbert & Pines, 1982). In fact, Silbert and Pines described the situation of juveniles in their study as almost completely devoid of positive social support. Kuhns et al. (1992) compared 53 women arrested for prostitution to 47 other arrestees and identified that school problems, specifically dropping out of school, increased the likelihood of involvement in prostitution. Similarly, Kramer and Berg (2003) found that each additional year of school attended decreased the likelihood of involvement in prostitution, possibly due to Downloaded by [ECU Libraries] at 12:04 11 August 2015 Correlates with Age at Entry into Prostitution 273 youths’ connectedness to school and the healthy social bonds that could be fostered there. Schissel and Fedec (1999) also discovered that, among 52 youths (male and female) involved in prostitution, returning to school significantly decreased the likelihood of involvement in prostitution. These findings highlight the importance of school connectedness and education in the lives of youths at risk for entry into prostitution. The combined effects of running from home to escape abusive situations, truancy from school, and involvement with deviant peers put juveniles at risk for entry into prostitution (Bagley & Young, 1987; Silbert & Pines, 1982). Entry may be facilitated by a need for survival and a lack of alternatives (Bagley & Young, 1987), coupled with absorption into the negative patterns of street culture. In one of the only studies to compare juvenile to adult entry into prostitution, Loza et al. (2010) interviewed 920 women involved in prostitution in Tijuana and Ciudad Juarez, Mexico. Loza et al. found those who entered prostitution as adults to be less educated, more likely to have children before entry, and more likely to have migrated to the area where they became involved in prostitution than those who entered as minors. However, the findings by Loza et al. pertain to populations engaging in prostitution near the U.S.–Mexico border and may not generalize to other areas. These results, which suggest adults have a lower level of education than minors upon entry into prostitution, may be more reflective of migration from a rural area out of economic necessity and less to do with education directly influencing the specific age at entry. Peer involvement in prostitution was explored by Gossop, Powis, Griffiths, and Strang (1994) in a study of 51 drug-using women involved in prostitution with an average age at entry of 19.3. Fifty-nine percent reported being introduced to prostitution by a close friend (Gossop et al.). This finding suggests poor social support networks among adult women prior to entry and indicates the powerful influence of association with deviant peers, even for adults. Suicide Behavior Severe mental health problems and a high frequency of suicide attempts have been found to be common among women involved in prostitution. Homeless youths involved in prostitution were twice as likely to have a serious mental health problem and twice as likely to be suicidal or to have attempted suicide as homeless youths not involved in prostitution (Yates, Mackenzie, Pennbridge, & Swafford, 1991). In Bagley and Young (1987), those previously involved in prostitution had much poorer mental health and severely damaged self-esteem and were three times more likely to have attempted suicide than a control group. Schissel and Fedec (1999) found 274 R. J. Clarke et al. nearly all participants involved in prostitution to have attempted suicide, with many also engaging in self-mutilation. Suicide behaviors appear to be higher among women involved in prostitution than other populations, but it is difficult to obtain credible estimates of suicide attempts among women involved in prostitution. What remains to be tested among women involved in prostitution is whether entry at a younger age produces different mental health issues and/or different suicidal behaviors than entry at an older age. Downloaded by [ECU Libraries] at 12:04 11 August 2015 Substance Use and Prostitution Though it is commonly known that drug use and prostitution are closely linked, the order in which they occur and the degree of influence they have on one another is not fully understood. Much is still to be learned about the relationship between substance use and age at entry into prostitution and the motivations behind initiating both. An area worthy of investigation in the matrix of prostitution and drug use is how the type of drug(s) being used influences involvement in prostitution. Alcohol and crack cocaine appear to be the most commonly abused substances among women involved in prostitution (Kuhns et al., 1992; Weiner, 1996), whereas the prevalence of heroin use appears to vary by region (Surratt, Kurtz, Weaver, & Inciardi, 2005; Gossop et al., 1994). One of four women engaging in prostitution in Gossop et al. (1994) reportedly drank alcohol on a daily basis, with some drinking at dangerously high levels. Kuhns et al. (1992) discovered that early drug/alcohol use posed a greater risk for involvement in prostitution. On average, women arrested for prostitution had an earlier age at first alcohol intoxication—14.6 versus 16.6 for the other arrestees (Kuhns et al.). However, the severity and frequency of drug use among this population were not accounted for. The type of substances women involved in prostitution use may be related to the type of prostitution in which they become involved. Involvement in street prostitution was found to present a greater risk of using hard drugs when compared with indoor prostitution (Cusick & Hickman, 2005), and most women involved in street prostitution reportedly entered to support an existing drug habit (Cusick, 1998). Women involved in both indoor and street prostitution indicated that the use of drugs helped to enhance their sexual performance; however, women involved in street prostitution also indicated that drugs were used to numb and cope with fears of violence (Cusick, 1998). Women involved in indoor prostitution tended to look negatively upon the sex-for-drug exchanges that were more commonly seen in street prostitution (Cusick & Hickman, 2005). These findings indicate different degrees of drug abuse and dependence based on the type of prostitution in which women become involved in addition to group differences regarding what constitutes acceptable drug use. In their study of 237 women involved in prostitution, Correlates with Age at Entry into Prostitution 275 Potterat, Rothenberg, Muth, Darrow, and Phillips-Plummer (1998) also found 94% of those involved in indoor prostitution to be Caucasian, suggesting the possible role of race in influencing the type of prostitution in which women become involved. Hard drug use and frequent drug use appear to have close time links with entry into prostitution among both juveniles and adults (Gossop et al., 1994; Loza et al., 2010; Weber, Boivin, Blais, Haley, & Roy, 2004). However, little is known about what, if any, differences exist between juvenile and adult entry into prostitution in relation to substance use. Downloaded by [ECU Libraries] at 12:04 11 August 2015 Substance Use and Juvenile Entry into Prostitution Adolescence is a time when important social relationships are formed and goals are set but is also a time of higher-level brain development (Steinberg, 2005). Because of the rapid changes occurring in the adolescent brain, substance use during this period makes the brain more vulnerable to longterm adverse effects (Monti et al., 2005). The literature on the relationship between juvenile entry into prostitution and drug use suggests multiple risks and pathways to entry. Brawn and Roe-Sepowitz (2008) conducted a study of 128 juveniles arrested for prostitution and discovered 57% to be using drugs or alcohol, with most beginning substance use 1 year prior to entry into prostitution. Similar to the results of Kramer and Berg (2003), significantly more Caucasian juveniles involved in prostitution were using drugs than non-Whites, reiterating the importance of considering race (Brawn & Roe-Sepowitz, 2008). Among juveniles arrested for prostitution, those who used drugs were found to have less parental supervision at home, higher rates of childhood abuse and neglect, more negative peer influences, and prior occurrences of delinquency and/or conduct problems at school than those who did not use drugs (Brawn & Roe-Sepowitz, 2008). Most drug-using juveniles had backgrounds with more severe dysfunction than non–drug-using juveniles; however, it was less clear how non–drug-using juveniles entered prostitution and whether continued involvement would lead to drug use in the future. The timing of first drug use and age at entry into prostitution is a topic of research that has yet to yield consistent results. In a sample of 51 drugusing women involved in prostitution in London, 37% stated they became involved in prostitution to support an established drug habit, whereas twothirds continued prostitution to support a drug habit (Gossop et al., 1994). In Gossop et al., the average age at first heroin use, 18.9, correlated highly with age at entry into prostitution (average, 19.15) r D 0.69, p < 0.001. Of those who entered prostitution prior to heroin use, the average entry was less than 1 year prior to first heroin use, and women who started using heroin prior to prostitution continued using for about 2 years before involvement in prostitution (Gossop et al.). Women who entered prostitution prior to using Downloaded by [ECU Libraries] at 12:04 11 August 2015 276 R. J. Clarke et al. heroin were more likely to say they would continue to prostitute if they were not using drugs, whereas those who used heroin prior to prostitution were more likely to say they would stop prostituting if they were not using drugs (Gossop et al.). The findings of Gossop et al. are implicative of different motivations for entry into prostitution based on the sequence of entry into prostitution and drug use (heroin in particular). Economic necessity, or survival sex, may be one pathway to entry into prostitution (Gossop et al., 1994; Brawn & Roe-Sepowitz, 2008). The findings of McClanahan et al. (1999) appear to support this view, as evidenced by the greatly increased risk of entry during adolescence after running away. Deviant lifestyles leading to substance use may form another pathway to entry (that is, persons who enter prostitution to support a drug habit; Gossop et al., 1994), although McClanahan et al. did not find drug use to be a significant predictor of entry. Because experiences of abuse, attempted suicide, family dysfunction, discontinued education, and drug use are commonly reported among individuals involved in prostitution, more clarity is needed to understand these variables as they relate to age at entry into prostitution. In extant literature, race was also found to be a significant factor relating to entry into prostitution (Brawn & Roe-Sepowitz, 2008; Kramer & Berg, 2003) and is therefore considered in this study. This study seeks to introduce new information regarding risk factors of a younger age at entry into prostitution and to add to the body of knowledge on the complex relationship between drug use and entry into prostitution. This study attempts to address the following research questions: 1. Are there differences between women who entered prostitution as minors compared to women who entered as adults in race, highest level of education completed, and experiences of: childhood physical, sexual, and emotional abuse, family drug use, and attempted suicide among a sample of women from a prostitution diversion program in Phoenix, Arizona? 2. Are there relationships between age at entry into prostitution and age at which drug use began, having a self-identified drug problem, having a prior drug arrest, and type of drug(s) used among a sample of women from a prostitution diversion program in Phoenix, Arizona? METHOD Participants Data for this study included case files of 389 female attendees of a citysponsored diversion program for adults arrested for prostitution in Phoenix, Arizona between the years 2004 and 2006. Those selected for inclusion in the study were taken from a total of 465 available electronic and paper Downloaded by [ECU Libraries] at 12:04 11 August 2015 Correlates with Age at Entry into Prostitution 277 records of a program intake survey. Of the total available records, 430 were female, and 35 were males identified as transgendered. Due to significant differences in reasons for involvement and experiences during prostitution among transgendered populations, these individuals were excluded from the study. A further 41 cases were not included in the study due to missing or incomplete records regarding the dependent variable for this study (age at entry into prostitution). Participants were not asked what type of prostitution they were involved in but had all been charged with and signed a plea agreement for prostitution; thus, individuals involved in street prostitution, brothels, massage parlors, online prostitution, call-out sex services, hotel, and home-based prostitutes are included. The participants were identified as Caucasian (169; 43.4%), AfricanAmerican (139; 35.7%), Hispanic/Latino (53; 13.6%), and other (Native American, Hawaiian, Alaskan; 20; 5.1%). Data of race from eight participants (2.1%) were missing. Reported age at entry into prostitution ranged from 8 to 63 years (M D 25.38, standard deviation [SD] D 9.97). Procedures Information regarding demographics, history of involvement in prostitution, and other important related background factors was compiled by the diversion provider agency through intake interviews and was entered into SPSS. Questions from the intake assessment pertaining to the variables of interest for this study (age at entry into prostitution, race, highest level of education completed, experiences of childhood physical abuse, childhood sexual abuse, childhood emotional abuse, family drug use, and attempted suicide) were selected. Juvenile entry into prostitution was coded if participants answered age 17 or less to the question ‘‘How old were you when you entered into prostitution?’’ Childhood sexual abuse was coded as yes for an affirmative answer to either or both of the following questions: (1) ‘‘Were you a victim of sexual abuse by family members?’’ (2) ‘‘Growing up, were you a victim of sexual abuse by people outside your family?’’ Childhood physical abuse was coded as yes for an affirmative answer to either or both of the following questions: (1) ‘‘Were you a victim of physical abuse by family members?’’ (2) ‘‘Growing up, were you a victim of physical abuse by people outside your family?’’ Childhood emotional abuse was coded as yes for an affirmative answer to the question ‘‘Were you a victim of emotional abuse?’’ Familial drug problems were coded as yes for an affirmative answer to the question ‘‘Did any of your family members have problems with drugs or alcohol when you were growing up?’’ Highest level of education completed was coded according to participants’ answers to the question ‘‘What is your highest degree of education Downloaded by [ECU Libraries] at 12:04 11 August 2015 278 R. J. Clarke et al. completed?’’ Survey responses were then separated into elementary school (completion of any grade between kindergarten and sixth grade); middle school (completion of grade 7 or grade 8); partial high school (completion of grade 9, 10, or 11); high school (completion of grade 12, GED, or vocational training); and higher education (some college, associates degree, bachelors degree, or graduate degree) for analysis. Attempted suicide was coded based on participants’ responses to the following instruction: ‘‘If you have ever attempted suicide, please explain.’’ Age at first drug use was measured by the question ‘‘How old where you when you first started using?’’ Type of drugs was measured by the question ‘‘What drugs have you used in the last 6 months?’’ Perception of drug problem was coded as yes for an affirmative answer to the question ‘‘Do you consider yourself to have a problem with drugs or alcohol?’’ Having a prior drug arrest was coded as yes for an affirmative answer to the question ‘‘Have you ever been convicted of a drug charge?’’ Description of Participants A total of 81 women reported entry into prostitution prior to age 18 (20.8%), and 308 (79.2%) reported entry into prostitution as adults. The age at first drug use ranged from 2 to 52. Participants with a very young reported age at first drug use, such as 2, were likely given substances by their parents. Population descriptors for age at first drug use, age at entry into prostitution, number of children, and prior number of prostitution charges are presented in Table 1. The most commonly used drugs were crack/cocaine (41.1%), alcohol (39.8%), and marijuana (26.2%; see Table 2). Around two of five (38.6%) self-reported having a problem with drugs or alcohol, and 74 (19%) had attempted suicide. Growing up with a family member with a drug or alcohol problem was common, with 62.2% reporting such experiences. More than one-fourth of participants (26.2%) had a drug-related arrest, and 62.5% had an arrest prior to the arrest that led them to participate in the diversion program. TABLE 1 Means and Standard Deviations for Population Descriptors Juvenile entry Adult entry Total Variable M SD M SD M SD Current age Age at first drug use Age at prostitution entry Prior number of charges Number of children 28.23 14.68 14.9 3.44 1.83 9.78 5.115 2.14 5.93 2.21 34.2 18.52 28.1 2.28 2.08 10.1 7.42 9.27 3.18 2.06 32.95 17.69 25.38 2.52 2.03 10.31 7.16 9.97 3.95 2.09 279 Correlates with Age at Entry into Prostitution TABLE 2 Types of Drugs Used Total Adult entry Juvenile entry Drug type N (%) N (%) N (%) Crack/cocaine Alcohol Marijuana Stimulants Other opioids Depressants 160 155 102 60 53 4 (41.1) (39.8) (26.2) (15.4) (13.6) (1.0) 39 36 23 8 15 1 (48.1) (44.4) (28.4) (9.9) (18.5) (1.2) 121 119 79 52 38 3 (39.3) (38.6) (25.6) (16.9) (13.3) (1.0) Downloaded by [ECU Libraries] at 12:04 11 August 2015 Stimulants D amphetamines/speed/methamphetamines; other opioids D heroin, codeine, Demerol, methadone; depressants D barbiturates/sedatives. RESULTS To analyze the differences between women who entered prostitution as juveniles compared to women who entered prostitution as adults, chi-square and t-tests were used. To explore the relationship between age at first drug use and age at entry into prostitution, a simple regression analysis was conducted. Chi-square analysis revealed that African-Americans were more likely to enter into prostitution before the age of 18, whereas Caucasians were more likely to enter as adults, 2 D (3, N D 381) D 10.410, p D .015. Table 3 shows the proportion of Caucasian, African-American, Hispanic/Latina, and women self-identified as Other who entered into prostitution as juveniles compared with adults in relation to their own race as well as other races. The highest degree of education completed ranged from second grade to graduate level (see Table 4 for a full description of age at entry and level of education). Level of education was found to have a highly significant relationship with age at entry into prostitution. Women who entered pros- TABLE 3 Age at Entry into Prostitution and Race Juvenile entry Adult entry Total Race N Race % Juv % N Race % Adult % N % African-American Caucasian Hispanic/Latina Other 41 25 11 3 29.5 14.8 20.8 15.0 51.3 31.3 13.8 3.8 98 144 42 17 70.5 85.2 79.2 85.0 32.6 47.8 14.0 5.8 139 169 53 20 36.5 44.4 13.9 5.2 Race % D percent of women of the specified race who entered prostitution during the specified age at entry category; juv % D percent of women who entered as juveniles of the specified race; adult % D percent of women who entered as adults of the specified race; % D percent of women of the entire sample of women who were the specified race. 280 R. J. Clarke et al. TABLE 4 Age at Entry into Prostitution and Level of Education Juvenile entry Adult entry Level of education N % N % Elementary school Middle school Partial high school Completed high school Higher education 1 9 41 20 10 1.2 11.1 50.6 24.7 12.3 4 13 80 114 96 1.3 4.2 26.1 37.1 31.3 Downloaded by [ECU Libraries] at 12:04 11 August 2015 Elementary school D completion of any grade between kindergarten and sixth grade; middle school D completion of grade 7 or grade 8; partial high school D completion of any grade between ninth and eleventh grade; complete high school D completion of twelfth grade, GED, or vocational training; higher education D some college, associate’s degree, bachelors degree, or graduate degree. titution as adults were more likely to have completed high school or have an advanced education, whereas those who entered as juveniles were more likely to have dropped out during middle school or high school, 2 D (4, N D 388) D 29.017, p D .000. Women who entered into prostitution as juveniles were more likely to report familial drug problems during their childhood, 2 D (1, N D 389) D 4.916, p D .027, and were more likely to have attempted suicide, 2 D (1, N D 353) D 5.378, p D .02. Most women (84.1%) maintained contact with their families, and 65.5% reported feeling somewhat or very satisfied with the current level of interaction and support from their family. One hundred thirty-seven women (35.2%) reported experiences of childhood emotional abuse, 123 (31.6%) reported childhood sexual abuse, and 95 (24.4%) reported childhood physical abuse. However, a chi-square analysis did not find experiences of childhood emotional, sexual, or physical abuse to be significantly different among those who entered as juveniles compared with those who entered as adults. Additionally, a prior history of a drugrelated arrest, having a self-identified drug or alcohol problem, and type of drugs used were not found to be significantly different between the two groups. Additional analysis revealed that experiences of violence from a trick or John were common, with 42.7% reporting rape and 54.8% reporting assault. Violence from pimps was not as common, with 8.5% reporting rape and 26.2% reporting assault. An independent samples t-test was conducted to examine the difference between women who entered prostitution as juveniles and women who entered prostitution as adults in regard to their age at first drug use. Women who entered as juveniles had a significantly lower age at first drug use (M D 14.68, SD D 5.11) than women who entered prostitution as adults (M D 18.52, SD D 7.42), t (155.595) D 4.953, p D .000. Correlates with Age at Entry into Prostitution 281 A simple regression analysis was performed to explore whether age at first drug use could predict age at entry into prostitution. The mean of age of drug use was centered so the intercept would be meaningful (age at first drug use-mean). The R2 statistic indicated that the model explained 10.4% of the variance in age at entry into prostitution. The model was significant at the .01 level, and the impact of age at first drug use on age at entry into prostitution was for every 1 year increase of age at first drug use, there was an increase of .4 years of age at entry into prostitution. Thus, for every year one delays starting drug use, he or she delays entry into prostitution for .4 of a year. Downloaded by [ECU Libraries] at 12:04 11 August 2015 DISCUSSION The goal of this study was to examine age at entry into prostitution in relation to race, highest level of education completed, experiences of childhood physical abuse, childhood sexual abuse, childhood emotional abuse, family drug use, attempted suicide, and drug use. Five statistically significant differences were found between those who entered prostitution as juveniles and those who entered as adults: having a family member with an alcohol or drug problem, age at first drug use, highest level of education completed, race, and attempting suicide. Abuse There were no statistically significant differences in rates of abuse between those who entered prostitution as minors compared to those who entered as adults. These results differed from the findings of Roe-Sepowitz (in press), where emotional abuse was significantly higher among women who entered prostitution as juveniles compared to those who entered as adults. The prevalence of abuse by type matched that in Silbert and Pines (1982), with emotional abuse most frequent, followed by sexual, then physical abuse. However, this differed from Bagley and Young (1987) and Roe-Sepowitz, who found sexual abuse to be most prevalent. Rates of all types of abuse were significantly lower than those reported in other studies (Bagley & Young, 1987; Roe-Sepowitz; Silbert & Pines). These differences in the prevalence of abuse types may be a result of sampling methods and methodological dissimilarities in how abuse was measured in addition to regional differences. Greater standardization in measurements of abuse in research studies would be beneficial to provide clarity about the prevalence of rates and types of abuse among women involved in prostitution. Unfortunately, this study did not have access to information regarding running away from home. Previous studies have found youths to run away from abusive home experiences, leaving them vulnerable to recruitment 282 R. J. Clarke et al. into prostitution for survival and protection (Bagley & Young, 1987; RoeSepowitz, in press). Though women who reported entering prostitution as juveniles may have experienced severe family dysfunction (as indicated by familial substance abuse), experiences of childhood abuse were not directly related to an earlier age at entry into prostitution in this study. Downloaded by [ECU Libraries] at 12:04 11 August 2015 Family Alcohol or Drug Problem Women who entered prostitution as juveniles were significantly more likely to report having a family member with a drug or alcohol problem while growing up than those who entered as adults (72.8% and 59.4%, respectively). Such differences between the family situations of those who entered prostitution as juveniles and those who entered as adults were not found in Roe-Sepowitz (in press); however, the high prevalence of familial substance problems in general has been observed in other studies (Bagley & Young, 1987; Silbert & Pines, 1982). The relationship between familial substance abuse, childhood abuse, and juvenile entry into prostitution warrants additional research attention. Roe-Sepowitz (in press) found women who entered prostitution as juveniles to have significantly higher levels of emotional abuse than adults but not familial substance abuse problems. However, the results of this study were exactly opposite. Dube et al. (2001) found that substance-using parents were more likely to neglect and abuse their children. Further research is needed in order to determine whether a lack of parental monitoring and support resulting from intoxication and substance dependence contributes to a younger age at entry into prostitution. Drawing on the results of this study and other relevant literature, possible pathways of entry into prostitution are beginning to be understood. Individuals with severe experiences of child abuse (regardless of income level) may run away from home in order to escape abuse (Roe-Sepowitz, in press; Silbert & Pines, 1982). They may find themselves at an increased risk for entry into prostitution upon entering the street economy, as they need to secure income, shelter, and protection (Roe-Sepowitz, in press). Others from families with high levels of substance abuse may experience parental neglect, leaving them vulnerable to becoming involved with deviant peers, truancy, and substance abuse. This normalization of criminal and deviant behaviors without positive social support networks or influences may draw individuals into the lifestyle of prostitution. Age at First Drug Use Significant differences in age at first drug use were found among those who entered prostitution as juveniles compared to those who entered as adults (ages 14.68 and 18.52, respectively). This finding may be associated with the Downloaded by [ECU Libraries] at 12:04 11 August 2015 Correlates with Age at Entry into Prostitution 283 higher rates of alcohol and drug problems found in the families of those who entered prostitutions as juveniles. Youths with substance-using family members may have had easier access to substances in their homes. Parents’ problem substance use may have resulted in a lack of monitoring or neglect, which may have allowed juveniles’ deviant behaviors to go unchecked. The results of the regression analysis provide support to previous studies that found a correlation between substance use and subsequent entry into prostitution (Brawn & Roe-Sepowitz, 2008; Weber et al., 2004). In many cases, entry into prostitution may serve as a means to fund a drug habit, or the use of drugs may lower inhibitions, resulting in increased sexual behavior. However, there are no doubt alternative pathways that this study was unable to detect. Further study of the relationship between drug use and entry into prostitution is needed in order to bring greater clarity to the complex relationship between these variables. In a national longitudinal study on adolescent drug use in 2009, about 20% of eighth graders (typically ages 13 and 14) had ever used an illicit substance, and 37% had ever tried alcohol (Johnston, O’Malley, Bachman, & Schulenberg, 2010). Comparing these national averages to the average age at first substance use among women who entered prostitution as minors in this study (14.68) shows this population to deviate from the patterns typical of youths in the United States. Though there was not a significant difference between women who entered prostitution as juveniles compared with adults on the types of drugs being used at the time of interview, future studies should explore whether differences exist between juvenile and adult drug use at the time of entry into prostitution. Such studies would be valuable in further understanding the role of drugs in relationship to entry into prostitution. This would potentially identify drugs that increase risk of entry into prostitution at different points across the lifespan. Education Though most women who entered prostitution as adults completed high school or higher education, most of those who entered as juveniles dropped out before completing high school. School attendance has been related to decreased involvement in prostitution (Schissel & Fedec, 1999), whereas dropping out of school has been associated with increased risk (Kuhns et al., 1992). Further studies should attempt to understand the mechanisms by which school attendance acts as a protective factor against involvement in prostitution. A possible area of investigation could include an examination of increased education as a protective factor and the benefits afforded by academic engagement. Alternatively, school connectedness could be examined to determine whether positive social relationships with peers and adults in school settings act as protective factors against involvement in prostitu- Downloaded by [ECU Libraries] at 12:04 11 August 2015 284 R. J. Clarke et al. tion. Extracurricular activities, mentorship, and other forms of institutional connectedness may also warrant further examination to see whether these provide protective effects against juvenile entry into prostitution. Those who held advanced degrees likely had different motives for entry in comparison to those with an elementary level education. Further study of the relationship between education level and entry into prostitution may reveal more about such a relationship. Those who had educational credentials beyond high school likely had more opportunities for employment than those with only elementary educational experience. Exploring the reasons such individuals enter prostitution could yield information regarding other pathways into the lifestyle besides a lack of alternatives or survival purposes. Education level could also be explored in relation to the type of prostitution in which women become involved, in order to determine whether any correlations exist. Those who drop out before completing elementary or middle school likely have extremely poor family situations and a lack of parental monitoring. Parents may be unaware of or unresponsive to the risks associated with dropping out of school at this age. Abusive or drug-using parents may lack the necessary involvement with their children to encourage them to stay in school (Brawn & Roe-Sepowitz, 2008). Such a lack of monitoring may extend to children’s peer relationship choices and substance use, possibly allowing the foundations of a pathway to prostitution to be laid. Further exploring the factors associated with dropping out of elementary or middle school may provide useful information that could be used to shape interventions for children at risk for dropping out and subsequently entering prostitution. Race Of all racial groups studied, African-Americans had the highest rates of juvenile entry into prostitution. Kramer and Berg (2003) found minorities to experience twice the impact of the hazard rate for entry. Further studies examining race, socioeconomic status, and juvenile entry into prostitution are needed to explore this relationship more fully and to identify the factors that place minorities, especially African-Americans, at heightened risk. Determining factors that could reduce the hazard rate for entry into prostitution among minority youths would be useful for community-based intervention. Suicide Attempt Women who entered prostitution as juveniles were significantly more likely to have attempted suicide than women who entered as adults (p D .02). Around one in three women (31%) who entered prostitution prior to age 18 had attempted suicide, compared to 18% of women who entered as adults. It is not certain whether this was a direct result of earlier involvement in Downloaded by [ECU Libraries] at 12:04 11 August 2015 Correlates with Age at Entry into Prostitution 285 prostitution or a combination of other factors that led to an earlier age at entry. Suicide attempts may have some relationship to pre-prostitution experiences such as childhood abuse or neglect or to other underlying mental health issues. Experiences during prostitution such as isolation, social stigmatization, and exposure to violence at such a young age may also impact suicidal behavior. The negative and permanent effects of using substances during critical developmental periods may play a role in the higher prevalence of suicide attempts among those who enter prostitution as juveniles. Alcohol may have less of a sedative effect on adolescents than adults (Silveri & Spear, 1998), and addictive substance use behavior patterns may be programmed during this period (Monti et al., 2005). Substance use during this critical developmental period may have permanent negative effects on cognitive functioning, behavioral inhibition, emotion regulation, decision making, impulse control, and risk/reward systems (Monti et al., 2005; Steinberg, 2005). The development of substance abuse or dependence during this time may have significant impacts on juveniles’ mental health, possibly captured in this study by suicidal behavior. Roe-Sepowitz (in press) discovered that women who entered prostitution as juveniles experienced significantly greater levels of dissociation than women who entered prostitution as adults. Roe-Sepowitz also found women who entered prostitution as juveniles to have a greater number of clinically significant symptoms of trauma (as measured by the Trauma Symptom Inventory) than women who entered prostitution as adults. These findings suggest that women who enter prostitution at a younger age may have more severe mental health problems that lead them to attempt taking their own lives. They also highlight the importance of considering the experiences of juveniles involved in prostitution from a developmental standpoint, as effects may differ significantly from those experienced by adults. Additionally, the frequency of suicide attempts among women who entered prostitution as adults should not be overlooked and warrants further attention. Limitations As with all research, this study had a number of limitations. A significant limitation was the use of self-report data. As a result, self-presentation biases or memory errors may have skewed results. Further, there was considerable variation among the women who entered prostitution as adults: An 18-yearold entering prostitution is very different from a 63-year-old. Several other factors may have resulted in under-reporting. During the intake interview, definitions of emotional, physical, and sexual abuse were not offered; this may have resulted in an under-reporting of experiences of abuse, as participants may not have recognized certain experiences as constituting abuse. 286 R. J. Clarke et al. This study used participants’ responses about past events in order to obtain information regarding variables relating to age at entry into prostitution. However, longitudinal studies on this topic would provide more confident conclusions about the temporal order of events. Data regarding running away and the type of prostitution in which women became involved were not obtained in the intake assessment. The absence of such meaningful variables limited the identification of key background factors prior to entry, and of age-related pathways to involvement in specific types of prostitution. Downloaded by [ECU Libraries] at 12:04 11 August 2015 Clinical Implications African-American women were found to enter prostitution earlier than other racial groups. The findings of this study suggest a need for improved resources for young African-American women in schools and communities in order to improve the social experiences of these individuals and prevent negative outcomes that could lead to entry into prostitution. In light of findings regarding the premature discontinuation of education among those who enter prostitution as juveniles, programs that aim to prevent truancy and dropping out of school should be supported and expanded. Opportunities for after-school activities and resources to improve school connectedness should be increased, especially in underserved communities where these social resources may currently be lacking. An earlier initiation of drug use was related to early entry into prostitution. Therefore, targeted interventions that focus on prevention of entry into prostitution for youths found to be using drugs are advisable. These could possibly be incorporated into existing school-based substance useprevention programs. Interventions and treatment facilities should provide educational opportunities for those involved in prostitution, as a general lack of education appears to be pervasive, especially among those who entered prior to age 18. Clinicians working with this population should be trained in suicide prevention and should especially monitor those who entered prostitution as juveniles. Treatment programs should also address substance use and childhood abuse due to the high rates of these found among this population. Summary of Implications for Future Research This study, along with several others (Brawn & Roe-Sepowitz, 2008; Kramer & Berg, 2003), found race to be related to an earlier age at entry into prostitution, with African-Americans facing the highest risk. Further studies should examine this relationship in greater detail in order to identify the specific factors that place certain racial groups at an increased risk for entry into prostitution. Downloaded by [ECU Libraries] at 12:04 11 August 2015 Correlates with Age at Entry into Prostitution 287 The relationship between discontinued education and entry into prostitution should be investigated further in order to identify the components of school attendance that have protective effects. Areas of focus could include school connectedness, educational achievement, and peer support and the perception of school attendance and influence. Further studies should be conducted to identify a clearer picture of the chronology of substance abuse and entry into prostitution. Longitudinal data would be optimal in providing temporal clarity, although this population is methodologically challenging to research, and sustained access to individuals involved is difficult (Melrose, 2002). Further research is needed to examine the impact of familial substance abuse on entry into prostitution. This would allow for more-specific identification of the risks for entry into prostitution children face when growing up around substance abuse. Factors may include neglect, lack of monitoring, ease of access to substances, normalization of deviant behaviors, and a lack of positive opportunities. More research is needed to examine the relationship between mental health problems and entry into prostitution and the effects of remaining involved in prostitution. This would inform treatment and prevention efforts and could hopefully lead to better services for the treatment of mental health disorders and prevention of suicide among women involved in prostitution. Research that examines the interrelation of age at first substance use, familial substance abuse, experiences of childhood abuse, and cessation of school as they relate to age at entry into prostitution would yield rich information regarding temporal sequences and timing of significant negative events. Such information would be useful to help prevention efforts focus their resources in areas posing the greatest risks of entry into prostitution. Future studies may yield useful information about age at entry into prostitution by examining minors, young adults, and middle-aged adults separately. Such research would be beneficial for future education and prevention efforts. CONCLUSION There appear to be significant differences between women who enter prostitution as juveniles and women who enter as adults. This study, although restricted to an analysis of limited self-reported variables, suggests different pre- and post-prostitution experiences based on age at entry. 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