Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers

Ju Nyeong Park; Michele R. Decker; Judith K. Bass; Noya Galai; Catherine Tomko; Kriti M. Jain; Katherine H.A. Footer; Susan G. Sherman

doi:10.1177/0886260519884694

Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers

Ju Nyeong Park, Michele R. Decker, Judith K. Bass, Noya Galai, Catherine Tomko, Kriti M. Jain, Katherine H.A. Footer, Susan G. Sherman

Research output: Contribution to journal › Article › peer-review

Abstract

Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p <.05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p <.05). Binge drinking also appeared to be a contributing factor (p <.05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.

Original language	English
Pages (from-to)	10383-10404
Number of pages	22
Journal	Journal of Interpersonal Violence
Volume	36
Issue number	21-22
DOIs	https://doi.org/10.1177/0886260519884694
State	Published - Nov 2021
Externally published	Yes

Bibliographical note

Funding Information:
We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health.

Funding Information:
https://orcid.org/0000-0001-6490-9887 Park Ju Nyeong PhD, MHS 1 https://orcid.org/0000-0002-7085-7080 Decker Michele R. ScD, MPH 1 Bass Judith K. PhD, MPH, MIA 1 Galai Noya PhD 1 Tomko Catherine MHS 1 Jain Kriti M. MSPH, PhD 1 Footer Katherine H.A. LLB, MSc 1 Sherman Susan G. PhD, MPH 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Ju Nyeong Park, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 186, Baltimore, MD 21205, USA. Email: ju.park@jhu.edu 11 2019 0886260519884694 © The Author(s) 2019 2019 SAGE Publications Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity ( p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity ( p < .05). Binge drinking also appeared to be a contributing factor ( p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use. sex work trauma mental health National Institutes of Health https://doi.org/10.13039/100000002 1P30AI094189 National Institute on Drug Abuse https://doi.org/10.13039/100000026 R01DA038499–01 edited-state corrected-proof We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. ORCID iDs Ju Nyeong Park https://orcid.org/0000-0001-6490-9887 Michele R. Decker https://orcid.org/0000-0002-7085-7080

Publisher Copyright:
© The Author(s) 2019.

Keywords

mental health
sex work
trauma

ASJC Scopus subject areas

Clinical Psychology
Applied Psychology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1177/0886260519884694

Cite this

@article{04b87ef3dbdd46cb81bee295e659dae4,

title = "Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers",

abstract = "Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p <.05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p <.05). Binge drinking also appeared to be a contributing factor (p <.05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.",

keywords = "mental health, sex work, trauma",

author = "Park, {Ju Nyeong} and Decker, {Michele R.} and Bass, {Judith K.} and Noya Galai and Catherine Tomko and Jain, {Kriti M.} and Footer, {Katherine H.A.} and Sherman, {Susan G.}",

note = "Funding Information: We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. Funding Information: https://orcid.org/0000-0001-6490-9887 Park Ju Nyeong PhD, MHS 1 https://orcid.org/0000-0002-7085-7080 Decker Michele R. ScD, MPH 1 Bass Judith K. PhD, MPH, MIA 1 Galai Noya PhD 1 Tomko Catherine MHS 1 Jain Kriti M. MSPH, PhD 1 Footer Katherine H.A. LLB, MSc 1 Sherman Susan G. PhD, MPH 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Ju Nyeong Park, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 186, Baltimore, MD 21205, USA. Email: ju.park@jhu.edu 11 2019 0886260519884694 {\textcopyright} The Author(s) 2019 2019 SAGE Publications Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity ( p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity ( p < .05). Binge drinking also appeared to be a contributing factor ( p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use. sex work trauma mental health National Institutes of Health https://doi.org/10.13039/100000002 1P30AI094189 National Institute on Drug Abuse https://doi.org/10.13039/100000026 R01DA038499–01 edited-state corrected-proof We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. ORCID iDs Ju Nyeong Park https://orcid.org/0000-0001-6490-9887 Michele R. Decker https://orcid.org/0000-0002-7085-7080 Publisher Copyright: {\textcopyright} The Author(s) 2019.",

year = "2021",

month = nov,

doi = "10.1177/0886260519884694",

language = "English",

volume = "36",

pages = "10383--10404",

journal = "Journal of Interpersonal Violence",

issn = "0886-2605",

publisher = "SAGE Publications Inc.",

number = "21-22",

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TY - JOUR

T1 - Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers

AU - Park, Ju Nyeong

AU - Decker, Michele R.

AU - Bass, Judith K.

AU - Galai, Noya

AU - Tomko, Catherine

AU - Jain, Kriti M.

AU - Footer, Katherine H.A.

AU - Sherman, Susan G.

N1 - Funding Information: We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. Funding Information: https://orcid.org/0000-0001-6490-9887 Park Ju Nyeong PhD, MHS 1 https://orcid.org/0000-0002-7085-7080 Decker Michele R. ScD, MPH 1 Bass Judith K. PhD, MPH, MIA 1 Galai Noya PhD 1 Tomko Catherine MHS 1 Jain Kriti M. MSPH, PhD 1 Footer Katherine H.A. LLB, MSc 1 Sherman Susan G. PhD, MPH 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Ju Nyeong Park, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 186, Baltimore, MD 21205, USA. Email: ju.park@jhu.edu 11 2019 0886260519884694 © The Author(s) 2019 2019 SAGE Publications Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity ( p < .05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity ( p < .05). Binge drinking also appeared to be a contributing factor ( p < .05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use. sex work trauma mental health National Institutes of Health https://doi.org/10.13039/100000002 1P30AI094189 National Institute on Drug Abuse https://doi.org/10.13039/100000026 R01DA038499–01 edited-state corrected-proof We thank the sex workers who participated in the study. We are grateful to the SAPPHIRE field team, especially to Steve Huettner, Sean Allen, Brad Silberzahn, Eddie Poole, Orline Johnson, Jackie Toppins, Suzanne Lebovit, Miles Morris and Katelyn Riegger for their contributions to data collection. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the National Institute on Drug Abuse (R01DA038499). Additional support for this work was provided by the Johns Hopkins University Center for AIDS Research (1P30AI094189). JNP was partially supported by the Charlotte Silverman Award. The content is solely the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health. ORCID iDs Ju Nyeong Park https://orcid.org/0000-0001-6490-9887 Michele R. Decker https://orcid.org/0000-0002-7085-7080 Publisher Copyright: © The Author(s) 2019.

PY - 2021/11

Y1 - 2021/11

N2 - Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p <.05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p <.05). Binge drinking also appeared to be a contributing factor (p <.05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.

AB - Female sex workers (FSW) are a marginalized and vulnerable population at high risk of gender-based violence within and outside of their occupation. However, FSW remain underrepresented in the trauma and mental health literature. The aims of this study were to (a) characterize exposure to violence among street-based FSW, including violence type, patterns over the life course, and key perpetrator groups, and (b) examine the multivariate associations between posttraumatic stress disorder (PTSD) symptom severity and two constructs (revictimization across life stages and cumulative violence). Data were drawn from the Sex Workers and Police Promoting Health in Risky Environments (SAPPHIRE) study, an observational community-based cohort of street-based FSW recruited through targeted sampling across Baltimore, Maryland (USA) in 2016 to 2017. PTSD symptom severity was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL-5). At baseline, 61% of FSW screened positive for PTSD symptoms. The mean PCL-5 score was 38.6. We documented extensive histories of sexual and physical violence (lifetime: 81.8%; childhood and adult revictimization: 15.0% for sexual and 37.7% for physical). The vast majority of perpetrators were male and included paying clients, police officers, family members, and intimate partners. Exposure to childhood and adult sexual violence were independently associated with higher PTSD severity (p <.05), with marginal associations observed for physical violence. Data supported a cumulative violence model of PTSD severity (p <.05). Binge drinking also appeared to be a contributing factor (p <.05). The levels of PTSD observed among our sample were comparable with that reported among treatment-seeking war veterans. Our findings underscore the urgent need for tailored trauma-informed interventions and policies to address violence among urban street-based FSW, a population experiencing extremely high levels of violence, PTSD, and substance use.

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DO - 10.1177/0886260519884694

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JO - Journal of Interpersonal Violence

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ER -

Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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