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Consequences:The Impact of Commercial Sexual Exploitation on GirlsCycles of ViolenceGirls who are victims of CSE are often caught in a cycle of violence. Many are running away from violenthomes. One of the dominant features of CSE of girls is that most are under the control of a pimp wherephysical and emotional violence are routine (Estes & Weiner, 2001). In addition, girls face numerous otherthreats when on the streets and while engaging in prostitution, including rape, assault, robbery and murder.Street prostitution tends to be more dangerous than other forms of commercial sex. Nevertheless, girlsengaging in escort services, stripping, and pornography are not exempt from violence and degradation.Part of the System: Juvenile JusticeOne of the consequences of CSE is that many girls end up in the juvenile justice system. Their entry intothe juvenile justice system is not necessarily for prostitution-related charges. As a result, they may slip thoughthe cracks unnoticed because they appear for status offenses and probation violations. In addition, many girlsprovide false names and lie about their age. Pimps often provide girls with false identification. As a result, theyare arrested as adults and released back to their exploiters without ever being identified as minors.These girls are often very angry, and because of their participation in delinquent or criminal behavior, theytend to be viewed as offenders rather than victims. These misperceptions may block or delay referral forappropriate services. This is particularly alarming in light of a recent study that found the mortality rates ofdelinquent female youth were nearly eight times that of the general population (Teplin, McClelland, Abram,& Mileusnic, 2005). CEASE has played a crucial role in educating the judicial community about the warningsigns of sexual exploitation. Girls entering Metro Regional Youth Detention Center are screened for signs ofsexual exploitation and referred to CEASE.Tolls on the Body: Health ConsequencesInvolvement in prostitution places girls at greater risk of health problems and health-compromising behaviorsincluding drug and alcohol abuse, depression, and suicide attempts. Several studies have documented thecorrelation between the sexual and physical violence and negative health outcomes and risk behaviors ofadolescent girls (Silverman, Raj, Mucci, Hathaway, 2001; also see Cunningham, Stiffman, Dore, Earls, 1994;Nagy, DiClemente, Adcock, 1995). A girl who is a victim of CSE has a high risk of unplanned pregnancy,STD infection, and HIV infection.Depression and Risk of SuicideExposure to violence by adolescents has been associated with depression, hopelessness, decreased sense ofpurpose, and other psychological and emotional trauma (DuRant, et al. 2000). Girls who suffer from depression,especially those experiencing high levels of conflict with a parent, are at a higher risk of depression recurrence(Lewinsohn et al., 2000). They miss more days of school, perform at lower grade levels than their peers, andengage in drug use and binge drinking (Glied & Pine, 2002). Girls who have experienced sexual abuse arealso more likely to engage in self-mutilating behavior and suicidal ideation (Lipschitz et al., 1999).28