Building Individual and Institutional Capacity of an Urban Academic Health System to Serve Local Sex Trafficking Victims

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John Murray-Garcia
Kupiri W. Ackerman-Barger
Ellen Goldstein
Jerry John Nutor


Every day, there are unrecognized sex trafficked victims visiting urban academic health systems in the United State, victims who are perhaps hoping against hope that a frontline provider, student, or staff member would ask that one question that would identify them as enslaved or otherwise trapped in an unthinkable situation. Health care providers’ lack of awareness of the relatively hidden population of sex trafficked victims causes missed opportunities to improve public health. Training healthcare providers to recognize and serve sex trafficked victims is critical, but such training will likely be less effective without addressing the institutional capacity of urban academic health systems. Indeed, local sex trafficking industries can thrive in the shadow of urban health systems, many associated with world class universities. This exploratory study aimed to assess and enhance the institutional capacity of an urban academic health system in the United States, and that of its employees, to appropriately serve victims of sex trafficking.

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Ahn, R., Alpert, E. J., Purcell, G., Konstantopoulos, W. M., McGahan, A., Cafferty, E., & Burke, T. F. (2013). Human trafficking: Review of educational resources for health professionals. American Journal of Preventive Medicine, 44(3), 283-289. DOI:

Baldwin, S. B., Eisenman, D. P., Sayles, J. N., Ryan, G., & Chuang, K. S. (2011). Identification of human trafficking victims in health care settings. Health and Human Rights, 13(1), E36-49.

Bandura, A. (1995). Self-efficacy in changing societies. New York, NY: Cambridge University. DOI:

Banks, D., & Kyckelhahn, T. (2011). Trafficking incidents, 2008-2010 (Vol. NCJ 233732), Washington, D.C.: United States Department of Justice.

Barrows, J., & Finger, R. (2008). Human trafficking and the health care professions. Southern Medical Journal, 101(5), 521-524. DOI:

Boyatzis, R. E. (1998). Transforming qualitative information. Thousand Oaks, CA: Sage.

Bridget's Dream. (2013). About us. Retrieved from

Clause, K. J., & Lawler, K. B. (2013). The hidden crime: Human trafficking. South Carolina Nurse, 20(4), 3-5.

Cwikel, J., & Hoban, E. (2005). Contentious issues in research on trafficked women working in the sex industry: Study design, ethics, and methodology. Journal of Sex Research, 42(4), 306-316. DOI:

Diaz, A., Clayton, E., & Simon, P. (2014). Confronting commercial sexual exploitation and sex trafficking of minors. JAMA Pediatrics, 168(9), 791-792.

Dovydaitis, T. (2010). Human trafficking: The role of the health care provider. Journal of Midwifery and Womens Health, 55(5), 462-467. DOI:

Gajic-Veljanoski, O., & Stewart, D. E. (2007). Women trafficked into prostitution: Determinants, human rights and health needs. Transcultural Psychiatry, 44, 338-358. DOI:

Grace, A., Ahn, R., & Konstantapoulos, W. M. (2014a). Integrating curricula on human trafficking into medical education and residency training. JAMA Pediatrics, 168(9), 793-794.

Grace, A., Lippert, S., Collins, K., Pineda, N., Tolani, A., Walker, R., …Horwitz, S. M. (2014b). Educating health care professionals on human trafficking. Pediatric Emergency Care, 30(12), 856-861. DOI:

Gushulak, B., & MacPherson, D. (2000). Health issues associated with the smuggling and trafficking of migrants. Journal of Immigrant Health, 2(2), 67-78. DOI:

Harris, K. (2012). The state of human trafficking in California, 2012. Sacramento: California Department of Justice. Retrieved from

Hom, K. A. (2013). Trauma and its aftermath for commercially sexually exploited women as told by front-line service providers. Issues In Mental Health Nursing, 34, 75-81. DOI:

Hossain, M. (2010). The relationship of trauma to mental disorders among traffıcked and sexually exploited girls and women. American Journal of Public Health, 100(12), 2442-2449. DOI:

Morse, J. A., & Field, P. A. (1995). Qualitative research methods for health professionals. Thousand Oaks, CA: Sage.

Murray-Garcia, J., & Garcia, J. A. (2008). The institutional context of multicultural education: What is your institutional curriculum. Academic Medicine, 83, 646-652. DOI:

Sexually Exploited Children & Teens Collaborative (SECT). (2015). Retrieved from

Siskun A., & Wyler L. S. (2013) Trafficking in persons: U.S. policy and issues for congress. Washington, D.C.: Congressional Research Service.

Squires G & Kubrin C. (2006). Priviledged places: Race, Opportunity, and uneven development in urban America. Montclair, NJ: National Housing Institute. Retrieved from

Taft I. (2014). FBI's Sacramento office finds nine child sex trafficking victims in region. Sacramento Bee, June 23. Retrieved from

Tervalon M & Murray-García J. (1998). Cultural Humility versus Cultural Competence: A critical distinction in physician training outcomes. Journal of Healthcare for the Poor and Underserved, 9(2), 117-125. DOI:

United Nations News Centre (December 11, 2015). Women in US lagging behind in human rights, UN experts report after 'myth-shattering' visit. Retrieved from

United States Census Bureau, Population Division. (2015). Annual estimates of the resident population for incorporated places of 50,000 or more, July 1, 2014. Retrieved from

United States Department of Education. (2013). Human trafficking of children in the United States: A fact sheet for schools, 2013. Retrieved from

United States Department of Justice. (2011). Characteristics of suspected human trafficking incidents, 2008-2010. Retrieved from

United States Department of State. (2014). Trafficking in persons report, 2014. Retrieved from

University of California, Davis Medical Center. (2015). About the health system. Facts and figures. Retrieved from

WEAVE, Inc. (Women Escaping A Violent Environment). (n.d.). Retrieved from

Zimmerman, C., Kiss, L., Hossain, M., Mazeda, H., & Watts, C. (2009). Trafficking in persons: A health concern. Ciência & Saúde Coletiva, 14(4), 1029-1035.

Zimmerman, C., Hossain, M., Yun, K., Gajdadziev, V., Guzun, N., Tchomarova, M., & Watts, C. (2008). The health of trafficked women: A survey of women entering post-trafficking services in Europe. American Journal of Public Health, 98(1), 55-59. DOI: