Patterns and Correlates of New Drug Initiation among Female Exotic Dancers: The Contribution of Occupational and Structural Risks

Abstract

Introduction: Exotic dance clubs (EDCs) can play pivotal roles in the production of drug-related risks for female exotic dancers (FED). We aimed to characterize the structural and occupational factors associated with new drug initiation post-EDC entry among new FED (N = 117) in Baltimore, Maryland. Materials and Methods: Logistic regression models tested the associations of new drug uptake, measured as initiating any illicit drug (including non-prescribed and diverted prescription narcotics) not used prior to EDC employment, with structural (e.g. debt sources, housing instability) and occupational (e.g. sex work, dancing as sole income source) vulnerabilities. Results: Most FED were younger than 24 years-old (60%), identified as Black/African American (61%), and did not complete high school (56%). Twenty-nine (25%) reported using any new drug post-EDC entry, with cocaine (34%) cited most frequently among newly initiated substances. In multivariable analysis, drug initiation was significantly associated with cumulative debt sources (Adjusted Odds Ratio [AOR] = 1.82, 95% Confidence Interval [CI]: 1.19–2.77), dancing as only income source (AOR = 4.21, CI: 1.29–13.71), and sex work (AOR = 9.26, CI: 2.74–31.32). Conclusions: Our findings implicate co-occurring structural and occupational factors in FED’s initiation of illicit drugs proceeding EDC employment. Results demonstrate the coping role of drug use for FED in stressful working environments and the multiple vulnerabilities associated with illicit drug uptake. The study reinforces a need for harm reduction interventions (i.e. debt relief, employment connections, increased hourly pay) that consider the contribution of overlapping financial insecurities to the production of occupational risks motivating drug uptake.

Keywords:

• Exotic dance
• drug use
• sex work
• structural vulnerability
• Baltimore

Acknowledgments

JGR performed data analysis, with guidance from JNP and NO. SL and SGS developed data collection instruments and oversaw study implementation. JGR developed the first draft of the manuscript. All authors contributed to, reviewed, and approved the final version of the manuscript. We are grateful for the support of the STILETTO study team for recruitment and data collection and for all women who participated in this research.

Declaration of interest

SGS is involved on the plaintiff’s side of opioid litigation.

Data availability

The data that support the findings of this study are available from the corresponding author, SGS, upon reasonable request.

Additional information

Funding

This work was supported by the National Institute of Drug Abuse [R21 DA033855]; the Johns Hopkins Center for AIDS Research [1P30AI094189]; and the National Institute of Allergy and Infectious Disease [T32 AI050056-12] (to S. Lim).