Purpose: Adolescent substance use increases exposure to other risk behaviors, including involvement in the exchange of sex for drugs. Limited research has investigated exploitation among teens in regular schools. This study examined substance use patterns, demographics, and personality factors that discriminate between youth who reported exchanging sex for drugs (exploited) and youth who did not (non-exploited) among substance-using students in rural western Canada.
Methods: We used data from the 2009 East Kootenay Adolescent Drug Use Survey, a census of grade 7-12 students in a Canadian rural area. Our sample included the 2,360 teens (49% boys) who had ever used alcohol, marijuana, or any of nine other drugs such as inhalants, ecstasy, and cocaine. Bivariate analyses compared sexually exploited teens and non-exploited teens, stratified by gender, on the prevalence of substance use. To examine factors associated independently with ever exchanging sex for drugs, we selected variables from past-year substance use patterns (using alcohol or marijuana only; both alcohol and marijuana but not other drugs; or drugs with or without alcohol or marijuana), living arrangement, social connectedness/involvement (e.g., family, school, sports; standardized scores ranging from 0-1), and personality factors associated with substance use (introversion/hopelessness, impulsivity, or anxiety; scores 0-1). Multivariate logistic regressions were conducted with variables that had significant bivariate relationships to the outcome.
Results: Of the sample reporting any substance use, sexually exploited youth accounted for 2% of boys and 3% of girls, the majority of whom reported living with family (83% boys, 92% girls). Past-year alcohol use did not differ by group. Exploited youth were more likely to report using marijuana (ORs 2.6 for boys, 4.5 for girls) and each of the other drugs in the past year (ORs 6.1-33.1 for boys, 5.8-17.3 for girls). The most frequent patterns of past-year substance use were using only alcohol or marijuana for non-exploited youth (48% boys, 50% girls), and use of any other drugs, with or without alcohol or marijuana, for exploited youth (68% boys, 74% girls). In the multivariate model, exploited boys were more likely to use drugs other than marijuana in the past year (vs. only alcohol or marijuana use; OR 4.8), live with friends/on their own/homeless (vs. with family; OR 5.8), and report higher levels of impulsivity (OR 114.2). For girls, independent factors associated with exchanging sex for drugs were other drug use (OR 4.9) and higher levels of impulsivity (OR 25.2).
Conclusions: Youth in school who use substances may be at risk for sexual exploitation, such as exchanging sex for drugs, even in rural schools, although such exchanges may be between peers. Increased in-school education about healthy relationships, sexual exploitation, and substance use could help protect youth, particularly those who are using substances other than alcohol or marijuana. Skill based programs that help youth who are impulsive may also reduce the risk of sexual exploitation. Clinicians should assess for exploitation among teens who disclose substance use.