# Risk factors for sex trafficking of domestic minors: An umbrella review of recent international literature

Nadine Proia-Lelouey, Gillonne Desquesnes

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Nadine Proia-Lelouey, Gillonne Desquesnes. Risk factors for sex trafficking of domestic minors: An umbrella review of recent international literature. Neuropsychiatrie de l'Enfance et de l'Adolescence, 2025, 73 (1), pp.29-35. 10.1016/j.neurenf.2024.10.003. hal-05149977

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Submitted on 8 Jul 2025

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Review

# Risk factors for sex trafficking of domestic minors: An umbrella review of recent international literature

<figure><img src="image_2.png" /></figure>

## *Facteurs de risque de la traite sexuelle des mineurs nationaux : une méta-revue de la littérature internationale récente*

N. Proia-Lelouey<sup>a, *</sup>, G. Desquesnes<sup>b</sup>

## INFO ARTICLE

## ABSTRACT

**Purpose.** – The sex trafficking of domestic minors remains a major problem despite the many laws designed to protect them. This risk has expanded to an unprecedented scale through the Internet and social networks. However, there are no reliable data on prevalence.

**Methods.** – The authors carried out an umbrella review of the literature on the risk of sexual exploitation among young people by conducting a narrative analysis of the six most recent literature reviews.

**Results.** – A strong congruence among sociodemographic, economic, and family factors was identified. The review was useful in highlighting the complexity of the process of recruitment and retention in prostitution, and in reflecting on protection strategies for young people.

**Discussion.** – There is a debate about whether girls are at greater risk than boys, but all authors agree that the age group most at risk is young people aged 12 to 14. However, no author links this to their adolescence, or considers the impact of this phase of development on the potential risk behaviors of these young people. The main finding of contemporary studies is the negative involvement of intermediary institutions such as schools and welfare services. However, these authors did not use these data in their recommendations. This should be a priority in future prevention programs.

© 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC

BY license (http://creativecommons.org/licenses/by/4.0/).

## RÉSUMÉ

**Contexte.** – Le trafic sexuel des mineurs nationaux est une préoccupation majeure malgré les nombreuses lois destinées à les protéger. Ce risque a pris une ampleur sans précédent avec Internet et les réseaux sociaux. Il n'existe cependant pas de données fiables sur sa prévalence.

**Méthodes.** – Les auteurs ont réalisé une analyse narrative des six revues de littérature internationale les plus récentes portant sur le risque d'exploitation sexuelle chez les jeunes mineurs.

**Résultats.** – L'analyse met en évidence une forte congruence entre les facteurs sociodémographiques, économiques et familiaux. Elle met aussi en évidence la complexité du processus de recrutement et de maintien dans la prostitution, et ouvre des perspectives sur les stratégies à développer pour protéger ces jeunes.

**Discussion.** – La question de savoir si les filles sont plus exposées que les garçons fait l'objet d'un débat, mais tous les auteurs s'accordent à dire que le groupe d'âge le plus exposé est celui des jeunes âgés de 12 à 14 ans. Cependant, aucun auteur n'établit de lien avec l'adolescence, ni ne considère l'impact de cette phase de développement sur les éventuels comportements à risque de ces jeunes. L'autre

**Keywords :**
Narrative review
Domestic minor
Sexual trafficking
Risk factors
Adolescent

**Mots clés :**
Revue narrative
Mineur nationaux
Traite sexuelle
Facteurs de risque
Adolescent

<footnote><sup>a</sup> Department of psychology, University of Caen-Normandy, Caen, France</footnote>

<footnote><sup>b</sup> University School of Management of Caen, University of Caen-Normandy, Caen, France</footnote>

<footnote>* Corresponding author.</footnote>

<footnote>Adresse e-mail : Nadine.proia-lelouey@unicaen.fr (N. Proia-Lelouey).</footnote>
donnée fondamentale soulignée par les études contemporaines est l'implication négative des institutions intermédiaires telles que l'école et les services de la protection de l'enfance. Donnée qui n'est pas reprise dans les recommandations des auteurs alors qu'elle devrait être une priorité dans les futurs programmes de prévention.

© 2024 Les Auteurs. Publié par Elsevier Masson SAS. Cet article est publié en Open Access sous licence CC BY (http://creativecommons.org/licenses/by/4.0/).

# 1. Abbreviations

DMST Domestic Minors Sex Trafficking

CSEC Commercial Sexual Exploitation of Children

# 2. Introduction

The Domestic Minors Sex Trafficking (DMST), also known as Commercial Sexual Exploitation of Children (CSEC), has become known to the public through recurring scandals. However, there are currently no precise data on its prevalence, as pointed out by Franchino-Olsen et al. [1] for the United States, Laird et al. [2] for Australia, and Benavente et al. [3] for Europe. All authors stress that the age group from 12–14 is most at risk. Laird et al. [2], contradicted by others [3,4], consider girls the most likely victims. The issue of commercial sexual exploitation of members of the LGBTQ+ community has only recently become a subject of research [5]. In any case, all authors agree that the sexual commercial exploitation of young people has increased in recent years, particularly via the Internet and digital social networks.

A literature review was conducted as part of a research project on the life paths of young minors involved in prostitution [6]. Initial investigations of the literature have shown that this multidisciplinary issue includes medicine (pediatrics and psychiatry), psychology, criminology, nursing research, social intervention research, legal sciences, and sociology. It has also been the focus of in-depth surveys by investigative journalists [7] and led to the publication of numerous testimonials. Finally, this issue has been widely debated in international academic literature since the 1970s. It has continued to develop over the following decades and has become exponential over the last five years, proven by the number of literature reviews since the 2000s. Of the 13 literature reviews (LRs) identified between 1985 and 2023 (Fig. 1), the six most recent were selected for narrative analysis. The first five deal with two of three levels of Sullivan's classification of risk factors [8]: (1) economic and rational factors, (2) psychological and familial factors. The sixth [9] with the third level: (3) coercive factors (recruitment and entrapment). According to the ecological systems theory of Bronfenbrenner and Morris [10], the first two delimit a first (long) chrono-system and the third a second (short) one. Six (LRs) were also selected because they cover almost all the high-income countries: the United States [4,11,12], Australia [2], Canada [9], and Europe [3]. In addition, they offer a panel of literature from the 1990s to the present day. This choice is further justified by the low overlap of references: out of a total of 171, only 37 are referenced by two of the six LRs, and only six by three of them (including that of Franchino-Olsen [4]). A further three are referenced by four of the six LRs [13–15]. Only one reference [16] is cited by five of the six LRs. It should be noted that this is already an LR and that this reference is mainly cited for its analysis of the evolution of terminology concerning the sexual exploitation of children.

# 3. Methods

This literature review combined the umbrella review method [17] and narrative analysis [18]. This option was imposed by the very nature of the data processed, since these were RLs bringing together heterogeneous data: quantitative for Laird et al. [2], qualitative for Hampton and Lieggi [11], and mixed for the others. Moreover, the level of description of the data collected varies from one study to the next, making statistical comparison of the various factors impossible. From a statistical point of view, the study by Laird et al. [2] is the strongest, which is why it will be presented first. Based on quantitative data analyzed from multiple meta-analyses, it establishes risk probabilities by factor, but also by cumulating several factors.

The search was conducted until June 2023, with no specific date for the year of publication of the articles. Initially, the search was double-blind, with one author working on Google Scholar and the other on Scopus, Web of Science, PubMed, PBSC, and Psycarticle. A bibliographic alert was set up to inform the readers of any new publications.

The following three groups of words were selected:

* Child* OR Youth* OR Juvenile* OR Minor* OR Adolescent*;

* Prostitution* OR sexual* exploitation* OR sex* trafficking* OR transactional sex.

At least one term from each list had to appear in the title or abstract of the publication. Only articles published in English were included in this analysis. The review was limited to studies conducted on populations in high-income countries with a “Western” culture (USA, Canada, European Union, Australia, and New Zealand). This study focused exclusively on individuals who were born in these countries or lived in them during their early childhood. There are two reasons for these choices: on one hand, this criterion corresponds to that of the ongoing study; on the other hand, the prostitution of young people from low-income countries and that of young foreigners who are victims of international trafficking constitute specific problems (predominance of economic factors, political instability, overlap with migration issues, weak organization of social protection, etc.). The limitation to the Western cultural sphere is due to the need for a good knowledge of family and institutional systems.

# 4. Objective

To carry out an umbrella review of the literature on the risk of sexual exploitation among young people by conducting a narrative analysis of the six most recent literature reviews (Table 1).

# 5. Results

## 5.1. Long chrono-system

The LR by Laird et al. [2] only included studies with quantitative data (37 in total) without geographical limitations. The authors had a two-fold objective: to identify the risk factors reported in the
<figure><img src="image_3.png" /><figcaption>**Fig. 1.** Flow chart. Alt-text: the image shows the screening of the literature reviews on child sexual exploitation (CSE) (1985–2023). We have identified 55 references on literature review (LR) on CSEC, 16 on risk factors exclusively, 3 are excluded, 3 had been added.</figcaption></figure>

studies and statistically calculate their cumulative effect on CSEC risk to provide an effective screening tool. The authors identify 52 factors grouped into six sectors.

### 5.1.1. Economic and rational factors

#### 5.1.1.1. Sociodemographic factors.
Regarding gender, girls were twice as likely to be sexually exploited. In terms of age, each additional year reduced the risk of exploitation by 50%. Furthermore, the risk of exploitation is more than twice as high for children from linguistic and cultural minority groups. Thus, the typical portrait of a person at high-risk of sexual exploitation is a young girl (12–14 years) from a linguistic and cultural minority background.

#### 5.1.1.2. Psychosocial data.
Being from a single-parent household with a family income below the poverty line increased the risk five-fold. Furthermore, being in the care of a child protection agency doubled the risk. Being part of a family with antisocial behaviors is not highly representative of the risk of CSEC, increasing it by 1.5 times.

### 5.1.2. Psychological and family factors

#### 5.1.2.1. Trauma and exposure to abuse and/or violence.
In total, nine negative childhood experiences were associated with an increased risk of sexual exploitation (exposure to child pornography, sexual abuse, exposure to violent/rape pornography, intimate partner violence, neglect, physical abuse, emotional abuse, and repeated exposure to abuse and/or violence). A history of sexual abuse quadrupled the risk, while a combination of neglect, physical abuse, and emotional abuse doubled the risk. Conversely, domestic violence was not significantly associated with the risk of sexual exploitation.

#### 5.1.2.2. Sexual behaviors.
Sexual behaviors were most strongly associated with CSEC risk. The accumulation of risky sexual behaviors (sex without a condom, sex in public, or meeting strangers in an online chat for physical sex), and having (a) multiple lifetime sexual partners, (b) sending a sext (sexually explicit content via an electronic device), (c) being sexually active, and (e) a history of sexually transmitted infection increases the likelihood of being sexually exploited by a factor of 18.

#### 5.1.2.3. Other externalized behaviors.
Other behaviors, such as alcohol and drug use, interpersonal difficulties, conflict at school,

running away from home, and a history of homelessness, all combined to increase the risk of CSEC eightfold.

##### 5.1.2.4. Internalized disorders.
In terms of mental health, the accumulation of various items in the fields of anxiety and depression (particularly those related to post-traumatic stress disorder [PTSD]) revealed a 16-fold higher risk of CSEC.

The data from longitudinal studies broadly confirm the previous results, although there are some notable differences: the variables of gender, physical abuse and neglect, and depression are not considered significant.

In the discussion, Laird et al. [2] emphasize the importance of early and risky sexual behaviors (both online and offline), while acknowledging that such behaviors may be part of the sexual exploitation of young people and therefore less of a risk factor than a sign of an already established prostitution practice. In their conclusion, the authors insisted that screening tools are essential. They also highlighted the need to include the management of PTSD as well as a psychoeducational component of interpersonal relationships in interventions for young people.

## 5.2. Additional data from others RL

The Franchino-Olsen review [4] gathered 15 publications using the following criteria: any study (qualitative or quantitative) published in English between 2010 and 2017 without geographical limitations. The author identified sixteen CSEC/DMST risk factors. In the first level, the economic (poverty and deprivation of primary needs) and ethnic (minorities) factors are found. On the other hand, the author disputes the prevalence of women, attributing it to a bias linked to the lower visibility of young boys in prostitution. In the second level, all the family factors (maltreatment and sexual abuse, parental neglect, witnessing violence or criminal activity, peer or family influence) and externalized and internalized psychological factors (conflict with parents, educational difficulties, running away or exclusion from home, survival sex, early sexual initiation or sexual denigration, early age of first use of alcohol or drugs, previous experience of rape or sexual violence in adolescence, mental health problems or poor self-image) are identified. Franchino-Olsen identifies two other factors: being monitored by child welfare, being monitored by juvenile justice. She concludes that this review will help practitioners better identify victims and those at risk, provide appropriate support, and help relevant ser-
<table><caption>**Table 1**
Overview of the six current literature reviews.</caption><thead><tr><th></th><th></th><th></th><th></th><th></th><th></th><th></th><th></th></tr></thead><tbody><tr><td>Authors</td><td>Franchino-Olsen, 2019/2021</td><td>De Coux Hampton & Lieggi, 2020</td><td>Laird et al., 2020</td><td>Jaeckl & Laughon, 2021</td><td>Benavente et al., 2022</td><td>Baird & Connolly, 2023</td></tr><tr><td>Title</td><td>Vulnerabilities relevant for commercial sexual exploitation of children/domestic minor sex trafficking: a systematic review of risk factors</td><td>Commercial sexual exploitation of youth in the US: a qualitative systematic review</td><td>Demographic and psychosocial factors associated with child sexual exploitation: a systematic review and meta-analysis</td><td>Risk factors and indicators for commercial sexual exploitation/domestic minor sex trafficking of adolescent girls in the United States in the context of school nursing: an integrative review of the literature</td><td>Commercial sexual exploitation of children and adolescents in Europe: a systematic review empirical studies</td><td>Recruitment and entrapment pathways of minors into sex trafficking in Canada and the United States: a systematic review</td></tr><tr><td>Country</td><td>USA</td><td>USA</td><td>Australia</td><td>USA</td><td>Europe</td><td>Canada</td></tr><tr><td>Years reviewed</td><td>2010–2017</td><td>&lt; 2000</td><td>1990–2019</td><td>2014–2020</td><td>July 2020</td><td>1990/2020</td></tr><tr><td>Number articles</td><td>15</td><td>19</td><td>37</td><td>21</td><td>56</td><td>23</td></tr><tr><td>Search terms</td><td>Sex* trafficking*/minor*/child*<br>youth/domestic*/<br>commercially<br>sexually/exploited<br>children/domestic<br>minor</td><td>Human trafficking/prostitution/<br>commercial sexual<br>exploitation, adolescent/teen/youth</td><td>"Sexual exploitation"/"sexual exploitation of children"/"survival sex"/"transaction*<br>sex"/"sex<br>traffic"/"commercial sexual exploitation of children"/"domestic min/sex<br>traffic"/"commercial sexual exploitation"/"child sexual exploitation"/prostitution/"sex w/k"/"trading<br>sex"/"selling sex"/"child p/n"/"Sex industry"/"sex N4 swap"/"Sex<br>exchange"/"sex N4 exchange"<br>AND<br>"young people"/youth*/adolescen*/"young person"/min*/teen*/child*/juvenile*<br>AND<br>vulnerab*/risk*/"risk fact"/"protective fact"/"coping/protect"/sociocultural*/psychosocial*/resilien*/hardiness/c/relate*/indicat/*/determin*/predict*/fact/*/characteristic*/sequalae*/strength*</td><td>Human trafficking /ex<br>trafficking/sexual/ exploitation<br>prostitut*<br>/sex work*<br>AND<br>child*/adolescen*/juvenile*/youth*<br>AND<br>risk*/predictor*/ causality</td><td>Sexual*<br>exploit*/CSEC/<br>CSEY/CSE/CST/DMS/<br>human traffic*/sex*<br>traffic*/domestic service/prostitution/sex*<br>work/survival<br>sex/ransactional<br>sex/ex tourism<br>AND<br>child*/adolescen*/youth*/<br>young/teen*/<br>juvenile/minor*/girls/boys</td><td>Human Trafficking/Sex<br>Traffick*/<br>Trafficking in Persons/commercial sex* exploit*/anti-trafficking/Prostitut*<br>/Sex<br>Work/Domestic minor<br>sex/Trafficking<br>DMST/sex trade<br>sex* exploit* AND<br>coerc*/coercive control*/recruit*/groom*/entrap*/deception/<br>forc*/threat*/sexual grooming/abuse of power AND<br>Young person/<br>juvenile/young people/minor*<br>/child*/een*/adolescen* youth*<br>under 18/at risk populations/predelinquent youth</td></tr><tr><td>Methodology art. reviewed</td><td>Mixed</td><td>Qualitative</td><td>Quantitative and/or control group</td><td>Mixed</td><td>Mixed</td><td>Mixed</td></tr><tr><td>Methodology of RL</td><td>Narrative</td><td>Narrative</td><td>Statistical meta-analysis</td><td>Narrative</td><td>Narrative</td><td>Narrative</td></tr></tbody></table>

vices and professionals improve their support programs. It will also help policymakers improve the protection of at-risk children and professional training. Finally, it will help researchers to better study the possibilities of action for young people.

Jaeckl and Laughon's [12] review brought together 21 publications (quantitative and qualitative) on adolescent girls, conducted in the USA between 2014 and 2020. These data are consistent with previous reports. The authors clearly identify several risks factors as part of the second level: "childhood maltreatment trauma (sexual abuse, physical abuse, emotional abuse, and neglect)" and being a runaway and/or homeless in connection with "survival sex transactions." They are more circumspect about other factors. In particular, from the first level, racial minority status, and from the second level, dysfunctional home environments, mental health disorders

and substance use. The authors also pointed out that being followed by child protection services (and juvenile justice services) increased the risk of sexual exploitation (see below the discussion). The authors specifically targeted school nurses, highlighting the deficiencies in their training. Nurses were aware of the risk factors of CSEC/DMST and were able to identify these factors in students, making it crucial for school nurses to know whom they should contact and how to refer them for appropriate support. Additionally, the authors emphasize the need for school nurses to be sensitive to the fact that even in the absence of apparent risk factors, a student could still be a victim of CSEC/DMST.

The review by Benavente et al. [3] focused on European studies. Their data were also congruent with previous studies. The authors initially mentioned the impossibility of assessing the prevalence of
CCSE and subsequently listed several risk factors. Level 1 factors include poverty, migration and cultural problems; level 2 factors include abuse, neglect and physical and psychological health risks (posttraumatic stress, addiction, suicide and self-harm). They similarly noted that being monitored by protection and justice systems was a pejorative factor and indicated the lack of studies on boys. Finally, they highlighted a study that found a high-risk of not existing prostitution, even after social service intervention [19]. The authors also presented studies on professionals: some related to their own views and knowledge of the sexual exploitation of young people, while others related to the views of others involved, including exploited young people. In the section on the limitations of the research, the authors mentioned criticisms of the very notion of CSEC and the dominant victim paradigm. Some authors defend the idea that young people can be agents of their own activities and advocate moving away from the binary approach to victimization/offending (see below). In terms of recommendations, the authors highlighted the difficulties in proposing appropriate responses, and in connection with the multiplicity of factors involved in the risk of CSEC, the need to construct theoretical frameworks adapted to this complexity. They mentioned the lack of awareness in society in general, particularly highlighting the lack of training for professionals involved with young victims of CSEC to prevent them from returning to prostitution.

The review by Hampton and Lieggi [11] was limited to qualitative studies conducted in the USA between 2000 and 2015. The authors were interested in the experiences of young people who had been sexually exploited. Accordingly, they focused on qualitative studies focusing on what young people had to say. Their data are congruent with those of other reviews: a childhood marked by family violence and neglect, the slide into prostitution for reasons of survival and to obtain drugs, the influence of the environment in the drift into prostitution, and the existence of PTSD linked to prostitution activity. Two other observations were more salient: institutions were perceived negatively, schools were seen as "inhospitable" ("indifferent" to young people), and child welfare interventions were seen as aggravating their problems. The authors insist that exiting prostitution requires multiple and intense forms of support: social (money, housing, change of residence), educational, and mental health (addiction, PTSD management, etc.). They recommend organizing services concerned with the care of these people into a collaborative platform, providing specific training for professionals adapted to their roles, creating procedures to make agents accountable and offering safe facilities to victims. The authors also highlighted certain factors that can facilitate an exit from prostitution: emotional fatigue, the desire to change one's life, the absence of a trafficker, and commitment to a service organization.

## 5.3. Short chrono-system: recruitment and entrapment (coercive factors)

Baird and Connolly [9] specifically focused on the techniques used by recruiters with future young victims of DMST in the USA and Canada. Recruiters/traffickers are primarily men; however, they may also be women. The latter have often been exploited themselves, with recruitment activity constituting an elevation in the 'hierarchy' of the group. Recruiters may be part of a gang or criminal groups. Family members can also perform recruitment. Although less cited in these studies, this form of recruitment is the most coercive.

The relationships may be old or, on the contrary, very recent and may be part of the "approach" to recruiting the victim. The relationship between recruiters and victims is essentially either a "love relationship" or a "peer relationship" facilitating "the process

of normalizing the selling of sex and operating as a role model by teaching youth the 'ropes' of the sex trade" (p. 195).

In seven of the studies examined, the trafficker/victim relationship was described as protective (pseudo-parental) during the recruitment phase, meeting the victim's material and psychological needs. The first contact could be performed at different collective places but is most frequently conducted through the Internet.

Coercive methods are used less frequently than the conditioning and luring methods. "Some studies highlight a shift from grooming to violence, particularly in the context of a romancing recruitment strategy" (p. 196).

This may include coercion into prostitution to pay off debts or blackmail to release a sex tape. This also involves "more insidious aversive tactics, including slowly pushing sexual boundaries or desensitizing youths to non-consensual sex through repeated sexual abuse. In many cases, traffickers use sexual assault to condition youth to non-consensual sex during the process of entrapment" (ibid.).

Three factors explain young people's vulnerability to recruitment by organized sexual exploitation networks, and the obstacles they may encounter in exiting. Two are linked to the traffickers (control and dependence) and the third to the victim [20]. This third factor is referred to as "psychological benefits" during the recruitment phase.

Targeting is aimed at the most psychologically and socially vulnerable youth, particularly those in foster homes or those who are runaways. Moreover, traffickers target locations where youth spend unsupervised time, such as malls, around schools, parks, and above all, online (p. 197).

Finally, the authors highlight the increasing risk of online recruitment and stress the need for online prevention.

They also make various recommendations. They recommend communication and collaboration between structures to ensure that victims receive coordinated services. States should provide the means to assist victims materially, and regional bodies should set up specialized divisions well-trained in human trafficking. They stress the importance of post-traumatic care for young survivors of sex trafficking. Finally, they recommend developing studies on LGBTQ+ youth involved in sex trafficking.

The authors conclude that this review is useful in highlighting the complexity of the process of recruitment and retention in prostitution, and in reflecting on protection strategies for young people, particularly those identified as vulnerable. They emphasized the importance of providing organized, multidimensional (economic, social, and psychological) support for the successful exfiltration of young people from sex trafficking.

# 6. Discussion

The narrative analysis showed a high degree of congruence between data from the six studies. This congruence also extends to older studies [21]. The application of the ecological systems model [10] highlights the complexity of the process of vulnerability to the risk of sexual exploitation. It is less a question of distinguishing the different sub-systems (macro, meso-, exo- and micro-system) than of identifying the many reinforcing and feedback effects. The first concerns the two chrono-systems. Although differentiated, it is clear that they overlap and reinforce each other. For example, if externalized disorders contribute to the risk of entrapment, the abuse and violence suffered in childhood reinforce externalized disorders and therefore entrapment. Family conflicts, which are at the root of many runaways, also increase the risk of entrapment. However, the first chrono-system does not entirely cover the second, as the latter incorporates other micro-systems, in particular that of peers and, partly stackable, aggressors. In addition to these
meso-systems, there are the two exo-systems of sociodemographic and psychosocial factors.

While this systemic dynamic of the risk of sexual exploitation of young people has been broadly identified since the 1980s, its application to the contemporary world remains incomplete. To give an up-to-date picture of the phenomenon, we need to add two other micro-systems: the school system and social services, which together with the family form a meso-system with multiple interactions. These two micro-systems are directly concerned with the prevention of CSEC: primary and secondary in the case of school, and secondary and tertiary in the case of social services. Unfortunately, authors agree on the negative involvement of these institutions. Regarding school, Hampton and Lieggi [11] pointed out that young people describe their relationship with school as "inhospitable" or "indifferent" making them reluctant to seek help there, which is similarly highlighted by Laird et al. [2]. The situation seems so critical that Jaeckl and Laughon [12] specifically address school nurses but leave it at a few general recommendations (see above). We need to turn to older studies [22,23] to understand the importance of the school micro-system in the dynamics of young people's sexual exploitation. Over and above failure at school, dropping out indicates the failure of the socialization process within the peer group. Isolation within the family is then coupled with isolation within the educational community. This isolation, compounded by behavioral problems (insolence, fighting, insults, inappropriate dress and attitudes on school premises), pushes these young people towards deviant groups willing to take them in.

Regarding welfare services and/or juvenile justice services, Franchino-Olsen [4], Jaeckl and Laughon [12], and Benavente et al. [3] noted that being monitored by them is an indicator of risk. Young people make no mistakes about this, as they feel that intervention by social services only worsens their problems [11]. Benavente et al. [3], citing a study by Semerci et al. [19], reported a high-risk of never exiting prostitution even after intervention by welfare services. However, authors do not make any specific recommendations on this point. Nonetheless, this factor is well known [24]. It has even been included in some assessment tools in the UK since 2010 [25]. This specific vulnerability of children in the care of welfare services can be understood in two ways: as children in the care of these services concentrate all the factors mentioned above, it is normal for them to constitute a population at risk; the fact of being in the care of child protection services is in itself a risk (e.g., targeting of welfare home by pimps, influence of peers in the welfare home already involved in these practices). A third explanation involves the welfare services themselves. Hallet [26] refers to the inadequacy of their response, while McKebbin et al. [27] refer to insufficient secondary prevention, secondary prevention requested by young people themselves [28].

A global vision of all the systems involved in the vulnerability of young people to sexual exploitation also leads us to consider the macro-system that is society, and the revolution brought about by the advent of the Internet and digital social networks. Regarding Internet use, Laird et al. [2] and Baird and Connolly [9] pointed out that access to the Internet increases the risk of recruitment tenfold and that the implementation of online prevention is an absolute necessity. Laird et al. [2] pointed out that the Internet certainly offers a global hunting ground for predators, but above all, trivializes sexuality (along with other media) and permits unlimited and uncontrolled access to pornographic sexual content. This habituates young people to non-respectful sexuality, which is ultimately perceived as a norm by both boys and girls. This habituation is further reinforced by the possibility of having online sex (offering 'no contact' sex) for a fee (or not). Hence the recommendations of Laird et al. [2] and Baird and Connolly [9] are to set up psychoeducational programs concerning 'unhealthy and exploitive romantic relationships'.

There is still one more point to discuss: the existence of a psychological dimension that is specific to the victim. Briefly mentioned by Baird and Connolly [9], this refers to Reid's recruitment model [15] which distinguishes three types of factors leading to the recruitment of young prostitutes: two linked to the perpetrators and one linked to the victim. Reid [15] suggested (but failed to develop) the notion of 'dysfunctional attachment' to describe the emotional dependency of victims on their pimp.

In so doing, they open the door to questions about the psychology of victims, which was often discussed in the literature of the 1980s but which disappeared from studies from the 1990s onwards. Only post-traumatic stress disorders were mentioned in the six studies, but no author made a connection between the age of the majority of victims at the start of their exploitation (12-14 years) and pre-adolescence. However, this is known to be a high-risk developmental phase, particularly in terms of behavioral disorders [29]. A recent longitudinal study has also shown a link between attachment quality and sexual behavior disorders [30]. Fergusson and Woodward [31] had already shown that the association between girls' behavioral problems and risky sexual behavior (i.e., multiple sexual partners and teenage pregnancy) was mediated by a poor-quality parental attachment relationship. The current study tends to confirm these data for adolescent girls and boys. The link is particularly significant in the youngest age groups and diminishes with advancing age. This confirms that the age most susceptible to risky sexual behavior and, in the background, to sexual exploitation, is indeed early adolescence.

## 7. Conclusion

The knowledge accumulated over more than 40 years now shows that juvenile prostitution is a complex process with multiple causalities arising from three interdependent dimensions: the societal context in which it takes place (particularly the Internet), the experiences of the young people concerned (family and institutional), and the neurodevelopmental phase in which these young people find themselves (adolescence).

As most authors emphasize in their conclusions, this complexity requires training for those working in the field as well as genuine collaboration between the structures involved, particularly schools and child welfare services [32]. Close collaboration between researchers and those working in the field is required. This collaboration should be based on a horizontal and collaborative model [27], transforming field workers into co-researchers. This should facilitate the transmission of knowledge and the removal of resistance to changes in practices, in order to implement new working methods more in tune with the needs of young victims.

## Funding

This study received no additional funding.

## Disclosure of interest

The authors declare that they have no competing interest.

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