Funded Projects

Medical-Arts: Graphic Novels to Prevent Exploitation

Project Year

2024

City & State

San Diego, California

Program Name

CATCH Implementation

Topic

Child Abuse & Neglect

Program Description

A landmark 2016 study by Chisolm-Straker et al showed that 68% of adult survivors of human trafficking (HT) interacted with healthcare professionals (HCPs) while they were actively being trafficked. Data from our 2021-2022 AAP CATCH Planning Grant mixed methods study of youth in San Diego County with experience of HT showed that only 45.8% of youth were able to see a HCP while being exploited for labor and/or sex. Among 24 youth with experience of labor and sex traffacking, 87.5% were non-White, 75% of participants were female, 54.2% were recruited between ages 15-17 years, and 75% disclosed experience with law enforcement. Of those who were able to see a HCP during their exploitation, 1/3 described accessing reproductive health services. Qualitative data revealed that several youth needed health care services but were unaware of free services, such as California Family PACT (which provides free family planning care to all California residents with low income or no other form of coverage), or were dependent on others for transportation. In fact, lack of health insurance, lack of money, lack of transportation, and fear/history of negative experiences with medical professionals were leading reasons for not accessing the health care services that these youth needed. Youth described wanting non-judgmental, trauma-informed care – particularly reproductive health care such as STI treatment, HIV PrEP, and contraception. Several youth stated that they wish they had been educated about HT and tactics for recruitment by exploiters as early as middle school and feel that this awareness of manipulative and exploitative vs healthy relationships might have prevented their own exploitation.   BACKGROUND: In 2016, the FBI ranked San Diego in the top 13 areas nationally for commercial sexual exploitation of children (CSEC). Conservative 2016 estimates identified an underground San Diego sex-trade economy surpassing $800 million. Estimates for labor trafficking, which is grossly under-reported, are harder to find. San Diego’s border with Mexico, booming construction, gang activity (associated with forced drug trafficking), agricultural communities, domestic work, and massage parlors point to abundant labor trafficking. Several youth from our 2021-2022 mixed methods study endorsed labor trafficking in the form of forced/coerced illicit activities, such as drug sales, while also being sexually exploited.  SPECIFIC AIMS are twofold: (1) in alignment with California AB 1227, the Human Trafficking Prevention Education and Training Act, we aim to augment existing human trafficking and relationship violence education efforts in San Diego Unified School District middle schools through creation of a graphic novel (enduring educational materials) with narrative of human trafficking risk factors, protective factors, recruitment tactics, health sequelae (especially reproductive health,) and community resources; and (2) to better connect reproductive healthcare resources such as long-acting reversible contraception methods to San Diego middle school youth and to youth within the juvenile justice system, who are disproportionately at risk for human trafficking (HT). San Diego nonprofits, health care and academic leaders, artists, and community stakeholders will partner to provide educational and healthy relationship/reproductive services to San Diego middle school students, youth with experience of HT, and youth at risk for HT. The target population will include 6th - 8th graders in South Bay (approximately 1400 students) and National City (approximately 800 students) school districts and those involved in juvenile justice who are seen by Vista Hill Juvenile Hall Clinic physicians (approximately 80 per month).  We anticipate that middle school aged teens will report easy accessibility to graphic novel content, increased knowledge about human trafficking, and formation of healthy relationships and friend groups. We also anticipate that middle school students will demonstrate ability to connect to community resources for human trafficking and reproductive care issues.

Project Goal

To develop and deliver to San Diego youth enduring health education content in the form of a graphic novel detailing human trafficking risks, grooming tactics of traffickers, health sequelae of exploitation, and community resources available to San Diego youth for safe and healthy relationships and ongoing reproductive health support. 

Project Objective 1

The medical, educational, survivor, and artistic collaborative team will author a 10-page graphic novel in gray-scale (to facilitate low-cost replication) educating San Diego middle school youth and incarcerated youth about risks of human trafficking, recruitment tactics of traffickers, health sequelae, and community resources, including reproductive health clinics. The graphic novel will be available in English and Spanish and will be available for free to South Bay San Diego youth and incarcerated youth.

Project Objective 2

The graphic novel will be distributed to South Bay Unifed School District and National School District (both in South San Diego, where recruitment for human trafficking is more common) in concert with performances of "Zion's Story," a 90-minute interactive play informed by trafficking survivors and San Diego-specific research, as well as separately (as promoted by the school districts). The graphic novel will be distributed to juvenile justice involved youth at the Vista Hill Juvenile Hall Health Clinic. It will also live online for wider distribution and accessibility.

Project Objective 3

Through a web-based survey (linked from a QR code on the graphic novel,) youth will be invited to leave feedback about the graphic novel's (1) readability, (2) usefulness in promoting safe and healthy relationships, (3) knowledge of human trafficking, and (4) impact on their relationships, reproductive health knowledge, and health. These data will be presented at upcoming AAP conferences and will be used to improve and expand upon the current educational initiative.

AAP District

District IX

Institutional Name

UCSD/Rady Children's Hospital

Contact 1

Kanani Titchen, MD