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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
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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
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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.
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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
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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
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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.
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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.
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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
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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
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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
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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)
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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
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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.
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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
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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.
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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
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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-
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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
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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.
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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.
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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.
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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.
Women who entered prostitution as juveniles were typically less educated, were African-American, had histories of substance-using family members, began substance use at an earlier age, and had higher rates of attempted suicide. Though this study did not test the interrelation among
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these variables, there are likely to be underlying factors of influence on
these relationships.
This study is among the first to examine experiences before and during
involvement in prostitution in relation to age at entry. A greater understanding of age in relation to experiences before, during, and after prostitution is
needed in order to better understand and meet the needs of this population.
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