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Mandi L. Burnette, PhD; Emma Lucas, MPH, MSW; Mark Ilgen, PhD; Susan M. Frayne, MD, MPH; Julia Mayo, BA; Julie C. Weitlauf, PhD

Arch Gen Psychiatry. 2008;65(3):337-344.

Context  Studies of prostitution have focused largely on individuals involved in the commercial sex trade, with an emphasis on understanding the public health effect of this behavior. However, a broader understanding of how prostitution affects mental and physical health is needed. In particular, the study of prostitution among individuals in substance use treatment would improve efforts to provide comprehensive treatment.

Objectives  To document the prevalence of prostitution among women and men entering substance use treatment, and to test the association between prostitution, physical and mental health, and health care utilization while adjusting for reported history of childhood sexual abuse, a known correlate of prostitution and poor health outcomes.

Design, Setting, and Participants  Cross-sectional, secondary data analysis of 1606 women and 3001 men entering substance use treatment in the United States who completed a semistructured intake interview as part of a larger study.

Main Outcome Measures  Self-reported physical health (respiratory, circulatory, neurological, and internal organ conditions, bloodborne infections) and mental health (depression, anxiety, psychotic symptoms, and suicidal behavior), and use of emergency department, clinic, hospital, or inpatient mental health services within the past year.

Results  Many participants reported prostitution in their lifetime (50.8% of women and 18.5% of men) and in the past year (41.4% of women and 11.2% of men). Prostitution was associated with increased risk for bloodborne viral infections, sexually transmitted diseases, and mental health symptoms. Prostitution was associated with use of emergency care in women and use of inpatient mental health services for men.

Conclusions  Prostitution was common among a sample of individuals entering substance use treatment in the United States and was associated with higher risk of physical and mental health problems. Increased efforts toward understanding prostitution among patients in substance use treatment are warranted. Screening for prostitution in substance use treatment could allow for more comprehensive care to this population.

Author Affiliations: Sierra Pacific Mental Illness Research and Education Clinical Center (Drs Burnette and Weitlauf) and Center for Health Care Evaluation (Mss Lucas and Mayo and Drs Frayne and Weitlauf), Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Departments of Psychiatry and Behavioral Sciences (Drs Burnette and Weitlauf) and Medicine (Dr Frayne), Stanford University School of Medicine, Stanford, California; and Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center, and Department of Psychiatry, University of Michigan, Ann Arbor (Dr Ilgen).