One in Five Southern California College Students Report Human Trafficking

The Hidden Clinical Burden of Sexual Exploitation in Young Adults

Clinicians often face significant challenges when addressing sexual health, as inconsistencies in medical curricula can leave providers ill-equipped to manage complex trauma [1]. While routine gynecologic exams are essential for reproductive health, survivors of sexual violence frequently experience heightened psychological distress and physical pain during these encounters, necessitating a trauma-informed approach (a clinical framework that recognizes the impact of past trauma on a patient's current health and behavior) [2]. Effective sexual history-taking is a critical diagnostic tool that can reveal underlying intimate partner violence or previous trauma, yet it remains an underutilized skill in many clinical settings [3]. Furthermore, the long-term sequelae of such victimization are profound, with established links between post-traumatic stress and an increased risk for chronic conditions like dementia [4]. Identifying barriers to care is essential for improving service utilization among survivors who hold marginalized identities [5]. A new multi-campus study now provides data on the prevalence and clinical markers of human trafficking within the university student population.

High Prevalence in the University Setting

The study investigated the occurrence of human trafficking among a cohort of 971 college students recruited from 12 campuses across Southern California. Researchers utilized campus fliers to solicit participants, who then completed online self-administered surveys to report their experiences. The research focused specifically on San Diego County and the Imperial Valley, regions recognized for having some of the highest documented national rates of human trafficking. For the purposes of this clinical investigation, human trafficking was defined as the use of force, coercion, or fraud to induce individuals into sex exchanges for something of monetary or other value. This definition aligns with federal standards but highlights a specific vulnerability within the transition to adulthood, where financial and academic pressures can be weaponized by exploiters.

The results indicate a substantial burden of exploitation within the academic environment, as nearly one in five students (18%) surveyed reported experiencing human trafficking while enrolled in college. This high prevalence suggests that the university setting does not insulate young adults from the risks of sexual exploitation, particularly in geographic areas where trafficking networks are well established. Clinicians treating this demographic should be aware that the definition of trafficking used in the study encompasses a range of coercive behaviors, including situations where students are pressured into sex for grades, schoolwork, or basic necessities. These findings underscore the necessity for healthcare providers to maintain a high index of suspicion for exploitation when treating college-aged patients in high-risk regions, as the clinical presentation may be masked by the patient's status as a high-functioning student.

Identifying Vulnerable Student Populations

Bivariate analyses (a statistical method used to determine the relationship between two variables, such as the link between a specific demographic and the likelihood of being trafficked) identified several groups at elevated risk for exploitation. The researchers found that trafficked students were more likely to be BIPOC (Black, Indigenous, and People of Color) and to identify as LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer). Additionally, a history of involvement in the child welfare system was a significant marker, as trafficked students were more likely to be former foster youth. For clinicians, these findings suggest that social marginalization and a lack of traditional support structures may increase vulnerability to coercive sex exchanges, requiring providers to integrate social determinants of health (the non-medical factors, such as housing and social support, that influence health outcomes) into their risk assessments.

The study also highlighted specific behavioral and institutional associations that may serve as clinical red flags during patient intake. Trafficked students were more likely to be members of a fraternity or sorority and were more likely to use illicit substances. These individuals also reported higher rates of involvement in other forms of exploitation and criminalized activity, including performing labor and transporting or selling drugs. These findings indicate that trafficking often co-occurs with broader patterns of substance use and economic or criminal coercion, necessitating a comprehensive screening approach that looks beyond sexual health alone to address the patient's entire social and behavioral profile. This suggests that for some students, trafficking is not an isolated event but part of a larger constellation of high-risk behaviors and systemic exploitation.

Clinical history and academic-specific exploitation were also prominent in the data. The researchers noted that trafficked students were more likely to experience physical, emotional, or sexual abuse, or to have been told to recruit others into similar situations. Furthermore, the study identified a specific form of institutional exploitation where students were more likely to exchange sex for grades or schoolwork. This highlights the need for clinicians to recognize that trafficking in the university context can involve academic authority figures or peers, utilizing academic advancement as a tool for coercion (the use of force, fraud, or power to obtain sexual favors). Understanding these power dynamics is essential for physicians when evaluating a student's psychological distress or reluctance to engage with university-based health services.

Clinical Comorbidities and Barriers to Intervention

The researchers utilized multiple logistic regression analyses (a statistical method that estimates the strength of the association between variables while adjusting for potential confounders such as age, sexual orientation, and race to ensure the findings are independent of those factors). This analysis identified several critical clinical comorbidities that may serve as indicators for physicians treating this population. Specifically, the study found that trafficked students were more likely to acquire a sexually transmitted infection (OR: 1.63; CI: 1.04-2.57). Beyond infectious disease, the findings highlighted a significant link to social determinants of health, noting that trafficked students were more likely to experience food insecurity, defined as wondering how they would afford their next meal (OR: 1.20; CI: 1.03-1.40). For the practicing clinician, these data suggest that patients presenting with recurrent infections or signs of nutritional instability should be screened for potential exploitation, as these may be the only visible signs of an underlying coercive environment.

The study also detailed the institutional and interpersonal barriers that prevent students from accessing support. The findings indicated that trafficked students were more likely to be inhibited from seeking academic counseling (OR: 2.58; CI: 1.63-4.10), suggesting that the trauma of exploitation or the control exerted by traffickers may interfere with a student's ability to utilize university resources. This isolation is often compounded by direct coercion within the academic environment, as trafficked students were more likely to feel pressure from others, such as instructors or peers, to engage in sex (OR: 2.69; CI: 11.75-4.12). This pressure from figures of authority or social circles creates a complex barrier to disclosure, as the exploiter may be integrated into the student's daily professional or social life, making traditional reporting pathways feel unsafe.

Geographic factors also played a significant role in the risk profile of the surveyed population. Given the proximity of the 12 campuses to international boundaries, the researchers found that trafficked students were more likely to exchange sex across the U.S.-Mexico border (OR: 4.02; CI: 2.52-6.17). This high odds ratio (a measure of the association between an exposure and an outcome, representing the odds that an outcome will occur given a particular exposure compared to the odds of the outcome occurring in the absence of that exposure) underscores the heightened vulnerability of students in border regions. Clinicians practicing in these areas must be cognizant of the cross-border nature of trafficking networks, which may complicate both the legal and medical management of these cases, particularly when coordinating follow-up care or social services across different jurisdictions.

Implications for Institutional Policy and Prevention

The researchers argue that current institutional frameworks are insufficient to address the complexities of student exploitation and suggest specific systemic reforms to improve identification and support. One primary recommendation is expanding Title IX implementation to encompass human trafficking and sexual exploitation information at all universities. Title IX is the federal civil rights law that prohibits sex-based discrimination in any school or education program receiving federal financial assistance. By broadening the scope of Title IX to explicitly include trafficking, institutions could create more robust reporting mechanisms and support services for students coerced into sex exchanges. For the practicing physician, such a policy shift would likely result in better-integrated care pathways, as university health centers would be required to maintain higher standards of awareness and protocols for students experiencing these forms of trauma, facilitating a smoother referral process from clinical settings to campus support.

Beyond internal university policies, the study highlights the necessity of legislative action to standardize prevention efforts across the higher education sector. The authors recommend amending or introducing state laws to mandate human trafficking prevention awareness training at colleges and universities. While some jurisdictions currently require such training in primary and secondary education, the researchers emphasize that these mandates must be extended to the university level to address the unique vulnerabilities of the adult student population. Implementing state-mandated training would ensure that faculty, staff, and peer leaders are equipped to recognize the signs of force, fraud, and coercion. For clinicians, these legislative changes could lead to a more informed patient population and a stronger network of institutional allies, facilitating earlier intervention and more effective management of the long-term physical and psychological sequelae associated with trafficking. This systemic approach aims to move the burden of identification from the individual clinician to a broader, more vigilant institutional network.

References

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2. Coleman JN, Arthur SS, Shelby RA. Psychological distress and pain related to gynecologic exams among female survivors of sexual and physical violence: A systematic review. Journal of Traumatic Stress. 2023. doi:10.1002/jts.23006

3. Coverdale J, Roberts LW. Recognizing the Value of Teaching Sexual History-Taking. Academic Medicine. 2025. doi:10.1097/acm.0000000000005974

4. Günak MM, Billings J, Carratu E, Marchant NL, Favarato G, Orgeta V. Post-traumatic stress disorder as a risk factor for dementia: systematic review and meta-analysis. The British Journal of Psychiatry. 2020. doi:10.1192/bjp.2020.150

5. Hassanpour P, Panwalkar S, Klein LB, Luebke J, Stulting TTS, Walsh K. Measures Assessing Barriers and Facilitators to Post-Sexual Violence Services: A Critical Review.. Trauma, violence & abuse. 2025. doi:10.1177/15248380251330319