Research Methodology
Two main sources of data were collected to understand the physical and psychological health concerns, health accessing experiences, and challenges to meeting the healthcare needs of young people experiencing CSE. Quantitative data from surveys of young people between the ages of 13-24 who have experienced CSE, or are at high risk for experiencing CSE provided information about the health needs and conditions, health care utilization, and health care experiences of this population (research questions 1-4). Qualitative data gathered through in-depth, semi-structured interviews of 35 adult survivors who experienced CSE as a minor provided survivor narratives of their experiences seeking healthcare and meeting their healthcare needs across multiple stages of survivorship (research questions 1, 4, & 5).
This mixed-methods approach facilitated a nuanced understanding of the complex short-term and long-term health needs and challenges faced by people who experienced CSE as a minor at different stages of survivorship. This project was approved by the Northeastern University IRB (IRB#2021-04-06) as well as the Human Subjects Protection Office at the National Institute of Justice.
Quantitative
Youth Survey
Ages 13–24, n=534
Qualitative
Survivor Interviews
n=35
Youth Survey: Design & Participants
Study Design
A survey of young people who experienced, or were at risk of, CSE across the U.S. was conducted to better understand their health concerns, the types of health care services that this population utilizes, their experiences accessing health care, and the barriers to meeting their healthcare needs.
Participant Demographics
Survey participants (n=534) represented diverse backgrounds across race, gender identity, sexual orientation, and geographic regions. The chart below shows the demographic breakdown of participants recruited through agency referrals and social media.
Gender Identity
Two-thirds of the respondents (67%) identified as female, 11% as male, 6% as transman, and 2% as transwomen. An additional 13% identified as genderqueer.
Sexual Orientation
Approximately 1/3 of the respondents identified as straight, 5% as gay, 7% as lesbian, 32% as bisexual, 15% as queer, and 6% as questioning.
Racial & Ethnic Identity
38% identified as white (17% agency, 59% social media), 18% as Black, 22% as Latina/o/e, 3% as Asian, and 18% as multi-racial.
Age & Geographic Distribution
The average age was 19 (range: 13–24). Regional distribution: Northeast (43.8%), South (32.9%), Midwest (11.1%), West (12.2%).
How Participants Were Recruited
Agency Partnerships
We collaborated with service and advocacy organizations that directly assist young people who have experienced or are at high risk of experiencing CSE. These agencies were from across the U.S., including but not limited to Massachusetts, Connecticut, Florida, Rhode Island, Texas, and Washington.
youth participants recruited via partner agencies
Social Media Advertisements
Since not all youth are connected to agencies, we used Instagram and Facebook to reach young people who experienced or were at risk for CSE. Recruitment spanned 44 states.
participants recruited via social media
Survey Recruitment Timeline
Recruitment occurred between April 1, 2022, and January 15, 2024.
• Agency-based recruitment used flyers, business cards, texts, and in-person communication by staff at partner orgs.
• Social media ads on Instagram and Facebook used approved, youth-friendly language without sensitive terms.
Qualitative Interviews
Study Design
In-depth semi-structured interviews were conducted with a purposeful sample of adults who had experienced CSE victimization as a minor. The interviews focused on participants' experiences with health and healthcare utilization at three distinct points in their lives:
- Prior to exploitation
- During exploitation
- After exploitation
Participant Demographics
Gender Identity
- 28 cis-gender women (80%)
- 2 trans-women (5.7%)
- 2 non-binary individuals (5.7%)
- 1 trans-man (2.9%)
- 2 cis-gender men (5.7%)
Sexual Orientation
- 23 straight (65.7%)
- 6 gay (17.1%)
- 3 bisexual (8.6%)
- 2 questioning (5.7%)
- 1 no label preference (2.9%)
Geographic Distribution
- Northeast: 40%
- Southeast: 9%
- Midwest: 14%
- Southwest: 17%
- West: 20%
Racial Identity
Additional Demographics
- Ethnicity: 9% identified as Hispanic or Latinx.
- Age Range: 18 to 60 years old.
Participants were purposively recruited through programs serving survivors of commercial sexual exploitation. All were confirmed to be free from CSE victimization and able to provide deep insight into survivorship.
Recruitment Procedure
Qualitative interview participants were recruited through partnerships with service providers who provide services to adults (and sometimes youth and adults) who have experienced CSE victimization. Information about the study and opportunities to participate were distributed via:
- The National Survivor Network listserve
- The HEAL newsletter
Interested and eligible adults were directed to contact the research team for screening and interview scheduling. The research team did not receive information about any survivors or contact any potential participants who did not explicitly reach out to the research team with an interest in research participation. In this way, we ensured we did not have information about or from any individual who had not actively affirmed research interest.
Data Collection
After prospective participants contacted the study team and all inclusion criteria were affirmed, each participant completed a demographic questionnaire. After the demographic form was completed, an interview time and date were scheduled at the convenience of the participant, and a confidential, HIPPA-compliant videoconferencing link was provided via a participant-provided email address.
The interview instrument was piloted with partner agency members and guided all qualitative interviews. Two research team members conducted interviews:
- A lead member of the research team with experience in trauma-informed interviewing techniques
- A second member of the research team who took detailed case notes and captured non-verbal cues
All interviewers had been part of the team that developed the interview instrument, and all interviewers were briefed on distress protocols to ensure interviewee comfort and safety during the interview process. Prior to beginning each interview, a brief description of the interview content and process was provided, and informed consent was obtained from all participants.
The semi-structured interview guide included general information on health and wellness and then asked participants to think about three stages in their lives: prior to exploitation, during exploitation, and after exploitation. Interviewees were asked to provide the approximate age ranges for each stage, which guided for questions and prompts to elicit age-appropriate details and glean depth of response.
Interview Details
- Interviews ranged in length from 30 to 90 minutes, with most lasting approximately one hour
- All participants were compensated with a $100 gift card
- All recorded interviews were transcribed verbatim and checked for accuracy
- Participant details were redacted to protect confidentiality
Validity and Reliability
Multiple strategies were employed to enhance the study's feasibility and rigor:
Methodological Approach
- Semi-structured interviews with open-ended questions
- Virtual interviews for participant comfort and geographic inclusion
- Verbatim transcription of all recordings
- Use of QSR-NVivo14 for systematic analysis
- Team debriefing sessions and reflexive journals
Coding Process
- Grounded theory approach (Glaser & Strauss, 1967)
- Initial inductive coding based on participant narratives
- Collaborative code refinement
- Team coding training sessions
- Systematic organization of coded materials