Introduction: Commercial Sexual Exploitation of Children (CSEC), which encompasses acts of domestic minor sex trafficking, is a hidden problem in the U.S. that affects an estimated 300,000 children. Significant health impacts to victims include violence, substance abuse, mental illness, sexually transmitted diseases, and unintended pregnancy. However, due to the covert nature of sexual exploitation, the lack of understanding among service providers and law enforcement, and complex psychological factors experienced by victims, identifying CSEC is a tremendous challenge. Primary care providers can play a critical role in identifying CSEC victims within clinical settings to help address this silent epidemic.

Objective: The goal of this project was to assess the prevalence of CSEC using a clinic-based screening tool within a community health center serving indigent populations, with a large proportion of the patients being of Asian and Pacific Islander descent.

Methods: Medical charts were reviewed of young female patients (n=621) between 13-23 years of age and seeking clinical services in Asian Health Services’ Teen Clinic from 2008 through 2011, during the implementation of a clinic-based CSEC screening tool used by primary care providers. The CSEC screening tool consists of two questions about sexual exploitation.

Results: Of the 621 patients in the study, 57.5% were Asian and Pacific Islander. Clinical providers applied the CSEC screening tool on 28.5% (n=177) of female patients in the study. Of the 177 patients who were screened, 7.3% (n=13) responded positive to questions about commercial sexual exploitation.

Discussion: Using a clinic-based screening tool with patients who have identified risk factors helps primary care providers identify CSEC victims and link them to available resources. Under-reporting among victims and under-screening among providers remain major considerations in estimating CSEC prevalence. To address under-screening, it is important to raise awareness among primary care providers around the CSEC epidemic and their potential role for intervention, including screening for a history of sexual exploitation among youth patients.

Key Take Away Points

  • The commercial sexual exploitation of children in Oakland, especially among Asian and Pacific Islander girls of Southeast Asian descent, is a problem that needs to be addressed.
  • Patterns of clinical testing and sexual health serve as important indicators for identifying CSEC victims.
  • Under-screening and under-reporting are significant challenges to identifying CSEC victims in service provision settings.
  • Primary care providers in clinical settings have the opportunity to curb the growing rate commercial sexual exploitation through the universal screening for commercial sexual exploitation in youth patients.

Author Biography

Kimberly S.G. Chang, MD is the former site director of the Frank Kiang Medical Center at Asian Health Services (AHS) from 2009-2014. She has cared for many commercially sexually exploited children (CSEC) at AHS and is a Co-founder and Steering Committee Member of HEAL Trafficking. She was faculty on CSEC issues for the National District Attorneys Association across the United States, and internationally to the Compact of Free Association nations in the Western Pacific. She served on a Technical Working Group for the SOAR to Health & Wellness Administration for the U.S. Department of Health and Human Services, and assisted the Administration of Children and Families to develop and pilot an educational training for health care providers Alameda County, California. In 2011, she was nationally recognized for her work with a Physician Advocacy Merit Award from the Institute on Medicine as a Profession. Dr. Chang received her medical degree from the University of Hawaii John A. Burns School of Medicine, Honolulu, HI, and completed her family medicine residency at San Francisco General Hospital, the University of California, San Francisco, CA. She is currently earning her MPH in Health Care Management and Policy at the Harvard T.H. Chan School of Public Health and is a Mongan Commonwealth Fund Fellow in Minority Health Policy at Harvard Medical School. Kevin Lee is a Research Assistant at Asian Health Services and has been at AHS since 2011. His work has focused on sexual health and HIV prevention through service provision and program implementation among vulnerable communities of color. Kevin is a Master in Public Health candidate at the University of California, Berkeley with an emphasis in Health and Social Behavior. Terrence Park received his B.A. in Mathematics at the University of California, Berkeley and worked with Asian Health Services as a Research Intern and Research Assistant. Terrence is currently a M.S. Biostatistics candidate at the Harvard School of Public Health. Elizabeth Sy started delivering direct services to women involved in the underground sex trade in 2003 when she worked for A&PI Wellness Center, doing outreach work and HIV/AIDS education to Vietnamese women working in massage parlors in the Tenderloin District of San Francisco. In 2004, Elizabeth co-founded Banteay Srei in order to respond to the growing number of underage Southeast Asian American-born women that were being commercially sexually exploited. Currently, Elizabeth is finishing her nursing program at California Sate University, East Bay. Thu Quach, Ph.D., M.P.H. As an epidemiologist, Dr. Quach’s primary research interest has focused on the influence of environmental and sociocultural factors on immigrant population health. As a research scientist at the Cancer Prevention Institute of California, a non-profit research organization, she leads research studies focusing on the booming nail salon workforce, comprised mainly of Vietnamese immigrants, as well as environmental health issues affecting disadvantaged populations. In addition, in 2011 she became the Research Director at Asian Health Services, a community health center in Oakland, California, where she oversees both the Research and Community Services departments.


The authors would like to acknowledge the support and work of Asian Health Services Teen Clinic providers, and Youth Program and Banteay Srei staff.