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Adolescent Pregnancy 

Prevention Program 

Human Trafficking: Implications for Adolescent 

Health Outcomes

June 2020

Human trafficking occurs in many forms and locations, domestically and internationally. It is a crime and a 

public health issue that requires local, state, and federal efforts to effectively prevent trafficking and respond 

to the needs of survivors. This tip sheet focuses on domestic minor sex and labor trafficking in the United 

States and the implications for adolescent sexual, physical, and mental health. It also includes multiple

resources and information about human trafficking for providers who work with or on behalf of youth. 

OVERVIEW

Human trafficking has been recognized as a federal crime since Congress passed the Victims of Trafficking and 

Violence Protection Act of 2000, also known as the Trafficking Victims Protection Act (TVPA), which defines

“severe forms of trafficking” as follows: 

The TVPA endorses a victim-centered approach to youth who are trafficked. Any person under the age of 18 

involved in a commercial sex act where anything of value is exchanged (e.g., money, drugs, clothing, shelter, 

rent, or food) is considered a victim of domestic minor sex trafficking, regardless of whether force, fraud, or 

coercion is involved (TVPA, 2000). It is important to note that this includes incidents in which minors trade sex 

to meet their basic needs (Gibbs et al., 2018). 

Labor trafficking of youth occurs across the U.S. economy. Some trafficked youth enter into fraudulent or 

abusive work situations as domestic, factory, or agriculture workers or as commission-based salespeople; 

others may be forced to beg or sell drugs (Gibbs et al., 2018; Murphy, 2016).
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The graphic below describes the three facets of human trafficking: action, means, and purpose, as defined by 

the TVPA (2000): NOCTIA Recruiting 

Harboring

Transporting

Providing

Obtaining

Soliciting*

Patronizing*

*Only for sex trafficking

*SNAEM Force 

Fraud

Coercion

*Does not need to be 

present for sex trafficking 

of minors

ESOPRUP Commercial Sex Act

Involuntary Servitude

Debt Bondage

Slavery

Source: Office on Trafficking in Persons, 2017.

Child welfare agencies have specific mandates regarding sex trafficking dictating that any child who is a victim 

of severe forms of trafficking is to be considered a victim of child neglect/maltreatment (2015 Justice for 

Victims of Trafficking Act; Pub. L. 114-22). Child welfare agencies must identify, document, and address sex 

trafficking of youth who are in their placement, care, or supervision (2014 Strengthening Safe Families Act; 

Pub. L. 113-183).

WHO IS AT RISK?

Although youth are at risk for trafficking regardless of their age, sexual orientation, gender identity, or racial, 

ethnic, cultural, or socioeconomic background, those with a history of multiple adverse childhood experiences

(ACEs) are at higher risk (National Human Trafficking Hotline, 2018; Reid, et al., 2018; U.S. Department of 

Health and Human Services [HHS], 2013; n.d.). Youth risk factors for trafficking include experiences that may 

lead to greater emotional or physical vulnerability.

Child/Youth Factors

•Abuse/neglect

•Untreated 

mental/behavioral 

health issues

•Disabilty status

•LGBTQ+ status* 

•Runaway/kicked 

out/homeless or 

unaccompanied**

•Involvement with 

juvenile justice or child 

protective services

•Race/ethnicity

Family Factors

•Poverty

•Family dysfunction

•Migration

Community Factors

•Natural disaster

•Tolerance of 

exploitation

•Lack of educational 

and job opportunities

•Violence

•Lack of awareness of 

trafficking

Societal Factors

•Gender 

bias/discrimination

•Sexualization and 

objectification of 

females

•Systemic inequalities

•Social media 

Sources: Adapted from Greenbaum, 2017; National Center for Homeless Education [NCHE], 2018; Reid, 2016.

*LGBTQ+ refers to individuals who identify as lesbian, gay, bisexual, transgender, or queer/questioning.

**Kicked out refers to youth who are kicked out or told to leave; unaccompanied refers to youth who are not in the physical custody of a 

parent/guardian and are experiencing homelessness.
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Traffickers capitalize on youth vulnerabilities and the lack of ability to work or generate income to meet their 

basic needs, along with some limitations in their ability to analyze risks, generate alternatives, or control 

impulses because of a not yet developed prefrontal cortex (HHS, 2013; n.d.; Greenbaum & Crawford-Jakubiak, 

2015). For some youth, such as those who are experiencing homelessness, system-involved, or have 

intellectual disabilities, these vulnerabilities may be exacerbated by a lack of social and familial connections 

that either meet basic needs or provide social support (Dank et al., 2015; Latzman et al., 2019; Reid, 2016). 

HOW DOES TRAFFICKING INFLUENCE ADOLESCENT HEALTH OUTCOMES?

Health risks are especially high for trafficked youth. Youth who are trafficked seek medical attention in a 

variety of settings; however, these youth are not identified as victims because they may not disclose or selfidentify, and providers may not ask probing questions to assess the youth’s involvement in trafficking

(Goldberg et al., 2017; Greenbaum, 2017).

These youth face an increased risk of multiple reproductive, mental, and physical health problems that may 

compound one another, including the following:

 

Sexual and Reproductive Health

 

• Multiple pregnancies and/or abortions

 

• HIV/sexually transmitted infection (STI) exposure

Physical Health 

• Serious communicable diseases (e.g., tuberculosis, hepatitis)

• Malnutrition

• Trauma to vagina or rectum

• Bruising, burns, scars, or broken bones

• Somatic manifestations of trauma, including headaches, stomach aches, difficulty sleeping

Mental Health

• Suicidal behavior (attempts and ideation)

• Substance and alcohol use

• Hypervigilance and/or anxiety

• Post-traumatic stress disorder (PTSD)

• Depression

 

Sources: Goldberg et al., 2017; HHS, n.d.; Le et al., 2018; National Human Trafficking Resource Center, 2016.

ACEs have been strongly associated with negative health outcomes for youth and adults and higher health 

care utilization in adulthood (Chartier et al., 2010; Kalmakis & Chandler, 2015). One study explored how ACEs 

related to human trafficking and found that childhood maltreatment, including emotional abuse, physical 

abuse, sexual abuse, emotional neglect, physical neglect, and family violence, was higher among youth who 

had experienced human trafficking than among youth who had not (Reid et al., 2018). 

Higher prevalence of these other forms of violence among trafficked youth may contribute to complex trauma 

and a series of mental health symptoms. Research on the mental health impacts of trafficked youth have 

found that these youth experience high rates of PTSD and depression (Hopper & Gonzalez, 2018). However, 

behaviors that are often attributed to mental health symptoms in the context of trauma may be adaptive 

traumatic responses. For instance, youth may be hypervigilant about their environment to prevent future 

harm, which may lead to an inattentiveness to classroom instruction at school. To avoid possible abuse, some 

youth may become angry or fight back, while others may withdraw (Perry et al., 1995). When youth are 
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removed from threatening situations like human trafficking or child maltreatment, these same protective 

responses may be viewed as maladaptive and impact their interactions with others as they seek to navigate 

life outside of an abusive context.

WHAT DOES TRAFFICKING LOOK LIKE?

There is not a specific trafficker profile. Traffickers can be intimate partners, strangers, family members, 

employers, drug dealers, or gang members (Lutnick, 2016; Reid, 2016; Sprang & Cole, 2018). Traffickers often 

act as third parties, facilitating and controlling transactions to gain something of value (Lutnick, 2016). 

Research on familial sex trafficking suggests that family members may traffic youth to obtain illicit substances 

(Sprang & Cole, 2018).

To create or maintain control and a dependent relationship with youth, traffickers use psychological 

manipulation, deception, coercion, or force. By doing so, traffickers isolate young victims from family and

friends. To recruit youth, traffickers use psychological tactics, such as promising youth a better life or giving 

them the attention that they may have rarely experienced (Reid, 2016). After youth are manipulated and 

recruited into trafficking, the traffickers maintain control by often reminding victims that they are powerless 

and helpless. 

These strategies used to gain power and control may impact whether a young victim can seek needed care or 

what information, if any, they share with service and health care providers (Hemmings et al., 2016). When 

victims do seek help, providers can observe possible indicators of trafficking, such as the following:

Accompanied by a 

controlling person

Defers to other 

person to speak for 

them

Inconsistent details 

and history Medical neglect

Signs of physical 

deprivation

Fearful or 

hypervigilant 

behavior

Not in control of 

own ID documents

Lack control over 

finances or unable 

to pay large debt

Sources: Dignity Health, 2018; National Human Trafficking Resource Center, 2016.

WHAT CAN YOU DO TO HELP?

Those working with or on behalf of youth can assist and support youth who have been trafficked and help to 

reduce rates of trafficking incidents among youth. 

Supporting Youth Survivors

One of the most effective ways to help those who have been trafficked is to connect them with local providers

trained in working with trafficked youth or other service providers who are trauma informed and “youth 

friendly.”
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Adopting a victim-centered approach to providing care and assistance is another way to support survivors. 

Implementing the following practices may help victims and others feel safe and supported: 

Meet the Basic Needs

• Help the victim find resources to address basic needs first: food, water, clothing.

• Ask the victim what their primary needs and concerns are.

Reassure the Potential Victim

• State your role to provide support, not to judge or arrest.

• Respect where the victim is at and how they want to proceed.

Build Trust and Rapport

• Be patient, recognizing that trust will be built with time and consistency. 

• Refrain from questioning details of the victim's story. 

• Affirm the victim's strength.

Be Conscious of Language

• Guide conversation with open-ended questions.

• Model the language the victim uses, recognizing they may not self-identify as a "victim."

Remain Sensitive to Power Dynamics

• Seek to speak to the victim one-on-one, if possible, because traffickers may want to stay in the room 

to control what the victim says.

• Avoid contacting anyone, including the victim's family, unless given permission by the victim.

• Ensure that the victim knows that they do not need to disclose to receive your support and services.

• Understand your role as a mandated reporter and communicate with youth if you need to make a 

report 

Avoid Re-Traumatization

• Educate yourself on the signs and symptoms of trauma and be mindful of them as you provide care.

Source: National Human Trafficking Resource Center, 2016.

To Prevent Future Trafficking 

Because human trafficking is a public health issue, it is important to build the skills and capacity of public 

health professionals to prevent and address human trafficking in their programs and communities. The 

following are some specific actions you can take: 

EDUCATE 

• Incorporate education about trafficking prevention into existing adolescent pregnancy prevention 

programming. This might include helping young people distinguish between healthy and unhealthy 

relationships, recognize recruitment tactics used by traffickers, and locate supportive resources. 

• Build your capacity to understand human trafficking, including how this issue impacts your community and 

youth. 
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COLLABORATE AND ADVOCATE

• Join a local task force to coordinate efforts between youth advocacy 

organizations, welfare and mental health services, health care centers, 

law enforcement, juvenile justice, and schools.

• Host presentations or community awareness events to discuss human 

trafficking and its impact on youth. 

• Get youth involved in awareness-raising projects and campaigns in 

their schools, organizations, and communities. 

• Integrate a human trafficking prevention project as part of a youth 

activity or community project. 

RECOGNIZE AND CONNECT

• Attend a training or coordinate a training for staff on how to identify 

signs of human trafficking. Discuss how screening processes may be implemented within your 

organization.

• Contact the National Human Trafficking Hotline (NHTH) if you notice something suspicious.

RESOURCES

This section provides many useful resources, including books, videos, and organizations working to prevent 

trafficking.

Hotlines 

National Human Trafficking Hotline (NHTH)

www.traffickingresourcecenter.org

1-888-373-7888

Text INFO or HELP to BeFREE (233733)

National Runaway Safeline 

https://www.1800runaway.org/

1-800-786-2929 or 1-800-RUNAWAY

Chat and email available via website

Compilations of Human Trafficking Resources

Futures without Violence: https://www.futureswithoutviolence.org/wp-content/uploads/Resources-on-AntiHuman-Trafficking-Eletronic-Links-by-Topic-2019.pdf

NHTH Referral Directory: https://humantraffickinghotline.org/training-resources/referral-directory

Human Trafficking Task Force e-Guide: https://www.ovcttac.gov/taskforceguide/eguide/

Resources for Victim Populations: Adolescents, Males, LGBTQ, Native Americans, and Victims with Disabilities: 

https://www.ovcttac.gov/taskforceguide/eguide/4-supporting-victims/resources-45-victim-populations/

Resources on Child Welfare/Justice-Involved Youth

Report to Congress: The Child Welfare System Response to Sex Trafficking of Children: 

https://www.acf.hhs.gov/cb/resource/report-congress-children-sex-trafficking

Resources on Runaway and Homeless Youth

Report on Labor and Sex Trafficking among Homeless Youth:

https://oag.ca.gov/sites/all/files/agweb/pdfs/ht/murphy-labor-sex-trafficking-homeless-youth.pdf

Human Trafficking Digital Resources and Factsheets: https://www.rhyttac.net/human-trafficking-resourcesand-factsheets

Resource Guide: Runaway and Human Trafficking for Runaway and Homeless Youth Serving Programs: 

https://www.rhyttac.net/assets/docs/Resources/HumanTraffickingResourceGuide-508.pdf
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Resources on Youth with Intellectual Disabilities

Webinar: Human Trafficking and Individuals with Disabilities:

https://www.acf.hhs.gov/otip/resource/nhttacwebinarindiv

Trainings, Toolkits, & Curriculum

CDC Technical Prevention Packages: https://www.cdc.gov/violenceprevention/pub/technical-packages.html

HHS & NHTH PowerPoint Trainings: https://humantraffickinghotline.org/nhth-hhs-online-trainings

Look Beneath the Surface: https://www.acf.hhs.gov/otip/partnerships/look-beneath-the-surface

Let’s Talk: Runaway Prevention Curriculum: https://www.1800runaway.org/runaway-prevention-curriculumsign-up/

SOAR to Health and Wellness: https://www.acf.hhs.gov/otip/training/soar-to-health-and-wellness-training

Human Trafficking Webinars: https://www.rhyttac.net/human-trafficking-webinars

Posters & Visual Resources

Department of Homeland Security, Blue Campaign: https://www.dhs.gov/blue-campaign/library

Hotline Poster: https://humantraffickinghotline.org/get-involved/downloadable-resources

OVC Webinar: Human Trafficking, Domestic Violence, and Sexual Assault: Strategies to Strengthen Community 

Collaboration to Respond to Survivors' Needs: 

https://www.ovcttac.gov/views/TrainingMaterials/dspWebinars.cfm

Look Beneath the Surface Posters, Brochures, Bookmarks: https://www.acf.hhs.gov/otip/resource/lbs-public

REFERENCES

Chartier, M., Walker, J., & Naimar, B. (2010). Separate and cumulate effects of adverse childhood experiences in 

predicting adult health and health care utilization. Child Abuse & Neglect, 34, 454–464. 

Dank, M., Yu, L., Yahner, J., Pelletier, E., Mora, M., & Conner, B. (2015). Locked in. Interactions with the criminal justice

and child welfare systems for LGBTQ youth, YMSM, and YWSW who engage in survival sex. Washington, DC: Urban 

Institute. Retrieved from http://www.urban.org/sites/default/files/publication/71446/2000424-Locked-InInteractions-with-the-Criminal-Justice-and-Child-Welfare-Systems-for-LGBTQ-Youth-YMSM-and-YWSW-WhoEngage-in-Survival-Sex.pdf

Dignity Health. (2018). PEARR Tool. Retrieved from https://www.dignityhealth.org/-

/media/Documents/PEARRToolm7.ashx?

Gibbs, D. A., Feinberg, R. K., Dolan, M., Latzman, N. E., Misra, S., & Domanico, R. (2018). Report to Congress: The child 

welfare system response to sex trafficking of children. Washington, DC: U.S. Department of Health and Human 

Services, Administration for Children and Families.

Goldberg, A. P., Moore, J. L., Houck, C., Kaplan, D. M., & Barron, C. E. (2017). Domestic minor sex trafficking patients: A 

retrospective analysis of medical presentation. Journal of Pediatric and Adolescent Gynecology, 30(1), 109–115.

Greenbaum, V. J., & Crawford-Jakubiak, J. E. (2015). Child sex trafficking and commercial sexual exploitation: Healthcare 

needs of victims. Pediatrics, 135(3), 566–574.

Greenbaum, V. J. (2017). Child sex trafficking in the United States: Challenges for the healthcare provider. PLoS 

Medicine, 14(11), 1–8.

Hemmings, S., Jakobowitz, S., Abas, M., Bick, D., Howard, L. M., Stanley, N., Zimmerman, C. & Oram, S. (2016). 

Responding to the health needs of survivors of human trafficking: a systematic review. BMC Health Services 

Research, 16(1), 320–329.

Hopper, E. K., & Gonzalez, L. D. (2018). A comparison of psychological symptoms in survivors of sex and labor trafficking. 

Behavioral Medicine, 44(3), 177–188.

Justice for Victims of Trafficking Act of 2015, Pub. L. 114-122.

Kalmakis, K. A., & Chandler, G. E. (2015). Health consequences of adverse childhood experiences: A systematic review. 

Journal of the American Association of Nurse Practitioners, 27(8), 457–465.
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Latzman, N. E., Gibbs, D. A., Feinberg, R., Kluckman, M. N., & Aboul-Hosn, S. (2019). Human trafficking victimization 

among youth who run away from foster care. Children and Youth Services Review, 98, 113–124.

Le, P. D., Ryan, N., Rosenstock, Y., & Goldmann, E. (2018). Health issues associated with commercial sexual exploitation 

and sex trafficking of children in the United States: a systematic review. Behavioral Medicine, 44(3), 219–233.

Lutnick, A. (2016). Domestic minor sex trafficking: Beyond victims and villains. New York: Columbia University Press.

Murphy, L. T. (2016). Labor and sex trafficking among homeless youth: A ten-city study. Modern Slavery Research 

Project: Loyola University New Orleans.

National Human Trafficking Hotline. (2018). 2018 Statistics from the National Human Trafficking Hotline. Retrieved from 

https://polarisproject.org/resources/u-s-national-human-trafficking-hotline-statistics/

National Human Trafficking Resource Center. (2016). Recognizing and responding to human trafficking in healthcare 

context. Retrieved from https://humantraffickinghotline.org/resources/recognizing-and-responding-humantrafficking-healthcare-context

National Center for Homeless Education (NCHE). (2018). Sex trafficking of minors: What schools need to know to 

recognize and respond to the trafficking of students. Washington, DC: Department of Education. Retrieved from 

https://nche.ed.gov/wp-content/uploads/2018/10/trafficking.pdf

Office on Trafficking in Persons. (2017). Fact sheet: Human trafficking. Retrieved from 

https://www.acf.hhs.gov/otip/resource/fshumantrafficking

Perry, B. D., Pollard, R. A., Blakely, T. L., Baker, W. L., & Vigilante, D. (1995). Childhood trauma, the neurobiology of 

adaptation, and “use-dependent” development of the brain: How “states” become “traits.” Infant Mental Health 

Journal, 16(4), 271-291.

Reid, J. A. (2016). Entrapment and enmeshment schemes used by sex traffickers. Sexual Abuse: A Journal of Research 

and Treatment, 28(6), 491–511.

Reid, J. A., Baglivio, M. T., Piquero, A. R., Greenwald, M. A., & Epps, N. (2017). Human trafficking of minors and childhood 

adversity in Florida. American Journal of Public Health, 107, 306–311. 

Sprang, G., & Cole, J. (2018). Familial sex trafficking of minors: Trafficking conditions, clinical presentation, and system 

involvement. Journal of Family Violence, 33(3), 185–195.

Strengthening Safe Families Act Pub. L. 113-183 (2014).

Trafficking Victim Protections Act, 22 USC §106–386. (2000).

U.S. Department of Health and Human Services (HHS), Administration for Children, Youth and Families. (2013). Guidance 

to states and services on addressing human trafficking of children and youth in the United States. Washington, DC. 

Retrieved from http://www.acf.hhs.gov/sites/default/files/cb/acyf_human_trafficking_guidance.pdf

U.S. Department of Health and Human Services (HHS), Administration for Children, Youth and Families. (n.d.). A resource 

guide: Human trafficking for runaway and homeless youth serving programs. Washington, DC: Runaway and 

Homeless Youth Training and Technical Assistance Center. Retrieved from 

https://www.rhyttac.net/assets/docs/Resources/HumanTraffickingResourceGuide-508.pdf

This tip sheet was developed by RTI International under contract #HHSP233201500039I/HHSP23337003T Task 4 with the 

U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Family and Youth 

Services Bureau.

Suggested Citation: Houston-Kolnik, J. (2020). Human trafficking: Implications for adolescent health outcomes. 

Washington, DC: Administration on Children Youth and Families, Family and Youth Services Bureau.