Skip to main content

Pathways to Health Risk Exposure in Adult Film Performers


Despite being part of a large and legal industry in Los Angeles, little is known about adult film performers’ exposure to health risks and when and how these risks might occur. The objective was to identify exposure to physical, mental, and social health risks and the pathways to such risks among adult film performers and to determine how risks differ between different types of performers, such as men and women. Semi-structured in-depth interviews were conducted with 18 female and ten male performers as well as two key informants from the industry. Performers and key informants were recruited through Protecting Adult Welfare, adult film venues, and snowball sampling. Performers engaged in risky health behaviors that included high-risk sexual acts that are unprotected, substance abuse, and body enhancement. They are exposed to physical trauma on the film set. Many entered and left the industry with financial insecurity and suffered from mental health problems. Women were more likely than men to be exposed to health risks. Adult film performers, especially women, are exposed to health risks that accumulate over time and that are not limited to sexually transmitted diseases.

This is a preview of subscription content, access via your institution.


  1. 1.

    United States Census Bureau. Table 1: Annual estimates of the population for incorporated places over 100,000. Ranked by July 1, 2005 population. April 1, 2013 to July 1, 2005. 2005 population estimates. Accessed on: June 25, 2008.

  2. 2.

    Ackman D. Forbes website. How big is porn? Accessed on: June 26, 2008.

  3. 3.

    Schlosser E. Reefer madness: sex, drugs and cheap labor in the American black market. New York: Houghton Mifflin; 2003:168.

    Google Scholar 

  4. 4.

    People v Freeman, 250 Cal.Rptr. 589 (Cal. 1988).

  5. 5.

    Grudzen CR, Kerndt PR. The adult film industry: time to regulate? PLoS Med. 2007;4(6):e126. doi:10.1371/journal.pmed.0040126.

    PubMed  Article  Google Scholar 

  6. 6.

    Grudzen CR, Elliott MN, Kerndt PR, Schuster MA, Brook RH, Gelberg L. Condom use and sexual acts in the adult film industry: a comparison of heterosexual and homosexual films. Am J Public Health. In press.

  7. 7.

    HIV transmission in the adult film industry—Los Angeles, California, 2004. MMWR Morb Mortal Wkly Rep. 2005;54(37):923–926.

    Google Scholar 

  8. 8.

    Flaskerud JH, Winslow BJ. Conceptualizing vulnerable populations health-related research. Nurs Res. 1998;47(2):69–78. doi:10.1097/00006199-199803000-00005.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDS. 2001;15(1):41–51. doi:10.1089/108729101460092.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Villano CL, Cleland C, Rosenblum A, et al. Psychometric utility of the childhood trauma questionnaire with female street-based sex workers. J Trauma Dissociation. 2004;5(3):33–41.

    PubMed  Article  Google Scholar 

  11. 11.

    Nuttbrock LA, Rosenblum A, Magura S, Villano C, Wallace J. Linking female sex workers with substance abuse treatment. J Subst Abuse Treat. 2004;27(3):233–239. doi:10.1016/j.jsat.2004.08.001.

    PubMed  Article  Google Scholar 

  12. 12.

    Wallace JI, Porter J, Weiner A, Steinberg A. Oral sex, crack smoking, and HIV infection among female sex workers who do not inject drugs. Am J Public Health. 1997;87(3):470.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    WHO. Constitution of the World Health Organization. Accessed on: January 8, 2008.

  14. 14.

    Landis J, Koch GG. Measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. March 1977.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Brooks JT, Robbins KE, Youngpairoj AS, et al. Molecular analysis of HIV strains from a cluster of worker infections in the adult film industry, Los Angeles 2004. AIDS. 2006;20(6):923–928. doi:10.1097/01.aids.0000218558.82402.59.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Taylor MM, Rotblatt H, Brooks JT, et al. Epidemiologic investigation of a cluster of workplace HIV infections in the adult film industry: Los Angeles, California, 2004. Clin Infect Dis. 2007;44(2):301–305. doi:10.1086/510487.

    PubMed  Article  Google Scholar 

  17. 17.

    DiClemente RJ, Wingood GM, Crosby RA, et al. A prospective study of psychological distress and sexual risk behavior among black adolescent females. Pediatrics. 2001;108(5):E85. doi:10.1542/peds.108.5.e85.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Anderson JE, Wilson R, Doll L, Jones TS, Barker P. Condom use and HIV risk behaviors among U.S. adults: data from a national survey. Fam Plann Perspect. 1999;31(1):24–28. doi:10.2307/2991553.

    PubMed  Article  CAS  Google Scholar 

Download references


This project was supported by the Robert Wood Johnson Clinical Scholars Program. There are no financial disclosures reported. Funding organizations had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data or preparation, review, or approval of the manuscript.

Author information



Corresponding author

Correspondence to Corita R. Grudzen.

Additional information

At the time of the study, Grudzen was with the Robert Wood Johnson Clinical Scholars Program at the University of California, Los Angeles, Los Angeles, CA, USA; Grudzen is now with the Department of Emergency Medicine, Mt. Sinai School of Medicine, New York, NY, USA; Ryan is with the RAND Corporation, Santa Monica, CA, USA: Margold is with Protecting Adult Welfare, Sherman Oaks, CA, USA; Torres is with the School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA; Gelberg is with the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Grudzen, C.R., Ryan, G., Margold, W. et al. Pathways to Health Risk Exposure in Adult Film Performers. J Urban Health 86, 67 (2009).

Download citation


  • Health behaviors
  • Health policy
  • Occupational health
  • Sexually transmitted diseases
  • Mental health
  • Substance abuse