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dollar global criminal enterprise. According to the U.S. Department of Justice, it is one of the world’s fastest growing crimes (Bureau of Justice Assistance, U.S. Department of Justice, 2015). It is a complex problem tied to social, cultural, and economic issues. Factors fueling trafficking include men’s demand for paid sex, traffickers’ ability to generate recurring revenues and to reap high profits, and law enforcement’s failure to arrest and prosecute perpetrators. Perpetrators can be as close to their victims as family members or as distant as heads of international criminal organizations. They exploit persons already made vulnerable by an array of social, cultural, economic, and political issues, including gender and ethnic discrimination, a history of abuse or neglect, poverty, globalization, social instability, corruption, lawlessness, and military conflict. All of these factors can, in turn, hamper law enforcement (Kara, 2009). Trafficking is a particularly brutal and dehumanizing crime. Victims of trafficking are often deprived of their most basic human rights: life, liberty, and security of person; freedom from slavery or servitude; freedom from torture and/or cruel, inhuman, or degrading treatment; a standard of living adequate for health and well-being; medical care; freedom of movement; and freedom of expression.2 The range of abuses and traumas they endure result in multiple acute and long-term physical and psychological problems. Adverse physical outcomes include injuries from violence (bruises, concussions, fractures, lacerations, perforations of vagina and rectal walls), infections (sexually transmitted diseases (STDs), pelvic inflammatory disease (PID), and HIV/AIDS), gynecologic issues (repeat unintended pregnancies/abortions, lacerations, hemorrhaging), untreated chronic conditions (diabetes), malnourishment, and poor dental care (Kiss et al., 2015; Lederer & Wetzel, 2014; Oram, Stöckl, Busza, Howard, & Zimmerman, 2012). Adverse psychological outcomes include complex traumarelated posttraumatic stress disorder (PTSD), anxiety disorder, major depressive disorder, suicidal ideation, psychosomatic illness, trauma-bonding and Stockholm syndrome, drug/alcohol addictions, and eating disorders (Oram, Khondoker, Abas, Broadbent, & Howard, 2015; Tsutsumi, Izutsu, Poudyal, Kato, & Marui, 2008; Zimmerman et al., 2008). Beyond the individual human cost, human trafficking is also a serious public health issue, placing a greater demand on the health care system and thereby increasing the financial costs associated with its numerous sequelae (U.S. Department of Health and Human Services, Administration for Children and Families, 2015). Other societal costs include increased utilization of law enforcement and the legal system, as well as greater demands for resources provided by the federal and state governments and numerous nongovernmental organizations. Traffickers look upon their victims as “product” and thus want to prolong their product’s value. When a trafficked person is ill or injured, as so often happens given the day-to-day deprivations, the trafficker might take the individual to a hospital or clinic for treatment. Studies conducted with both domestic and foreign survivors of trafficking in the United States suggest that 28–88% of survivors were seen by a health care provider at least once during the time they were trafficked (Baldwin, Eisenman, Sayles, Ryan, & Chuang, 2011; Lederer & Wetzel, 2014). But trafficking victims are often unable or unwilling to self-identify—physical, emotional, and/or psychological abuse and deep fear and shame prevent it. Social, cultural, and language barriers, as well as mistrust of authority figures also hinder self-identification (Baldwin et al., 2011). Furthermore, trafficking victims often do not recognize their victim status due to a variety of reasons, including the development of trauma bonding between victim and exploiter (Smith et al., 2009). Health care providers and other professionals have important roles to play in identifying and caring for victims, as well as in referring them to additional support services for assistance with their various needs, including shelter, food, clothing, job training, and legal and educational services (American Professional Society on the Abuse of Children, 2013). However, even among health care providers, most have not been trained and thus are unprepared to make appropriate interventions and referrals on behalf of trafficking victims (Beck et al., 2015; Viergever, West, Borland, & Zimmerman, 2015). 112 H. G. ATKINSON ET AL. Brief legal history In 2000, the United Nations General Assembly adopted the Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children (“The Palermo Protocol”).3 The Palermo Protocol commits signatory countries, of which there are now 166, to undertake initiatives to prevent and combat human trafficking, to protect and assist victims, and to cooperate with other states. In the United States over the past 15 years, the federal government and all 50 states have enacted anti-trafficking laws. The federal Trafficking Victims Protection Act (TVPA) of 2000, reauthorized most recently in 2013, seeks to punish traffickers, to protect victims, and to coordinate anti-trafficking initiatives.4 The law defines “severe forms of trafficking” as (a) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act has not attained 18 years of age and (b) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.5 Specifically, the William Wilberforce Reauthorization Act classified trafficking as a Part I Crime in the Federal Bureau of Investigation’s (FBI) Uniform Crime Report, mandating the collection of data about two newly created categories: commercial sex acts and involuntary servitude.6 Since the State of Washington enacted the first state human-trafficking criminal statute in 2002, all 50 states and the District of Columbia have passed legislation making human trafficking a felony offense. In response to the evolving awareness of the problem of trafficking, states are now increasingly passing legislation that specifically addresses physicians’ and other health care providers’ roles in addressing human trafficking, especially the problem of trafficking of minors for commercial sexual exploitation. Focus: New state laws This article focuses on a still-evolving and underexamined legal development: state laws that address human trafficking by providing education and/or imposing reporting obligations on a wide range of health care providers (e.g., doctors, nurses, physician’s assistants, nurse practitioners, dentists, psychologists, counselors, etc.) and other professionals (e.g., teachers, coaches, social workers, public employees). Our purpose is to provide a systematic review of legislation creating educational initiatives and mandating the reporting of trafficking victims by physicians and other professionals with a particular focus on the health care field. (For ease of reading and to reflect what seems to be the predominant legislative intent, this article most often uses the term “health care provider.”) To date, we are not aware that any such analysis has been conducted. The comparison of the legislative strategies and the key elements of the laws reveals significant differences and raises important issues. The findings should be helpful not only to health care providers who are now mandated reporters of trafficking in some states but also to state legislatures considering similar laws and regulatory agencies charged with their enforcement. Methodology An initial search was conducted using standard web search engines for background information, news reports, and articles to identify commonly used terms and identifiers. Broad legal database searches were then formulated and undertaken. Twenty-one separate legal searches of federal and state law databases were conducted from October 2014 through November 2015. Searches were conducted using both Westlaw (“WestlawNext”) and Lexis (“Lexis Advance”). There were no date restrictions. WestlawNext filters were used to narrow the results. Searches were not limited by content, meaning searches spanned all of the databases’ categories, including but not limited to statutes, regulations, administrative decisions, proposed legislation, enacted legislation, case law, court orders, and secondary materials. Geographically, database searches were limited to the United States, all states and territories. Jurisdictionally, the searches were run at the federal and state levels.