The development of anti-bullying, discrimination and harassment guidance: a survey among the Association of Surgeons in Training (ASiT) council members

INTRODUCTION

Surgical trainees have a reasonable expectation to feel safe and valued in their workplace. Previous reports proved that poor behaviour and misconduct existed in national health systems. This study aimed to conduct a survey among the Association of Surgeons in Training (ASiT) council members to identify the need for guidance to report bullying, discrimination and harassment for trainees who experienced any type of poor behaviour in the workplace.

METHODS

Data among executive and council members were collected. Questions were related to trainee demographics, level of training, specialties, and experience of, witnessed or reported poor behaviours including bullying, discrimination and harassment. We asked if participants lacked direction when experiencing poor behaviours, and if support strategies were needed such as a standardised guidance for reports.

RESULTS

A total of 58 survey responses were received: 55.17% of participants experienced bullying, 77.58% witnessed it and 67.25% did not report the incidents. Furthermore, 37.93% experienced discrimination, 62.07% witnessed it and 68.97% did not report. A total of 24.14% experienced sexual harassment, 29.69% witnessed it, while 72.41% did not report. Over 80% mentioned they need more guidance to support trainees. Almost all participants (98%) agreed that surgical trainees should be made aware of routes for reporting, and 88% agreed that ASiT should develop the guidance to support trainees against poor behaviours.

CONCLUSION

Most of the trainees who experienced or witnessed poor behaviours did not report the incidents. A new standardised anti-bullying, anti-discrimination and anti-harassment guidance was developed based on our study results. We envisage that its use may play a role in eliminating misconduct in surgical training.

Beyond reporting: proactive strategies for safer scientific fieldwork

Fieldwork is crucial for science but poses heightened risks of gender-based harassment and assault. Current practices prioritize post-incident reporting, despite the demonstrated potential of preventive approaches. We recommend proactive practices, training strategies, and systemic policy changes to build safe and inclusive fieldwork settings from the outset.

Prevalence and Impact of Workplace Sexual Harassment Experienced by Medical Sonographers

OBJECTIVE

To assess the prevalence and impact of sexual harassment among a nationwide sample of medical sonographers.

METHODS

A survey was distributed anonymously to a convenience sample of medical sonographers via email contacts and sonographer-specific social media pages. Data were analyzed to determine respondent demographics, the prevalence of sexual harassment in the last 2 years, the type and severity of harassment experienced, demographics of perpetrators, personal and institutional responses to such experiences, and the impact of sexual harassment on sonographer physical and mental health and job satisfaction.

RESULTS

Of the 220 sonographers (83% female) most (45%) were between 18 and 34 years and identified as white (81%). A total of 192 (87%) reported experiencing at least 1 incident of harassment within the last 2 years. Female respondents experienced higher harassment rates (76%) compared to males (50%, P = .02). The most common forms of harassment were verbal, including suggestive or sexist jokes (69%) and offensive sexist remarks (61%). Perpetrators were predominantly male (78%) and most commonly patients (89%) or their friends/family members (46%). The majority of respondents either ignored the harassing behavior (70%) or treated it like a joke (50%), with only a minority (12%) officially reporting incidents. Of those who reported, 44% were unsatisfied with their institution's response. Among respondents, 34% reported negative impacts of workplace sexual harassment, such as anxiety, depression, sleep loss, or adverse workplace consequences.

DISCUSSION

Workplace sexual harassment is a common occurrence for sonographers and often leads to negative health and career outcomes. Further institutional policies to prevent harassment and mitigate its effects are needed.

Testing the effectiveness of interactive training on sexual harassment and assault in field science

Fieldwork is a critical tool for scientific research, particularly in applied disciplines. Yet fieldwork is often unsafe, especially for members of historically marginalized groups and people whose presence in scientific spaces threatens traditional hierarchies of power, authority, and legitimacy. Research is needed to identify interventions that prevent sexual harassment and assault from occurring in the first place. We conducted a quasi-experiment assessing the impacts of a 90-min interactive training on field-based staff in a United States state government agency. We hypothesized that the knowledge-based interventions, social modeling, and mastery experiences included in the training would increase participants' sexual harassment and assault prevention knowledge, self-efficacy, behavioural intention, and behaviour after the training compared to a control group of their peers. Treatment-control and pre-post training survey data indicate that the training increased participants' sexual harassment and assault prevention knowledge and prevention self-efficacy, and, to a lesser extent, behavioural intention. These increases persisted several months after the training for knowledge and self-efficacy. While we did not detect differences in the effect of the training for different groups, interestingly, post-hoc tests indicated that women and members of underrepresented racial groups generally scored lower compared to male and white respondents, suggesting that these groups self-assess their own capabilities differently. Finally, participants' likelihood to report incidents increased after the training but institutional reports remained low, emphasizing the importance of efforts to transform reporting systems and develop better methods to measure bystander actions. These results support the utility of a peer-led interactive intervention for improving workplace culture and safety in scientific fieldwork settings. PROTOCOL REGISTRATION: "The stage 1 protocol for this Registered Report was accepted in principle on August 24, 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.21770165 .

Can Virtual Reality be Used for the Prevention of Peer Sexual Harassment in Adolescence? First Evaluation of the Virtual-PRO Program

Objective: The present study analyzed the Virtual-PRO program's efficacy in preventing peer sexual harassment by promoting the bystanders' active intervention and incorporating a virtual reality (VR) component. The impact of the program on sexist attitudes, moral disengagement, the intention to intervene as bystanders, and the involvement in sexual aggression and victimization was tested. Method: Virtual-PRO is a VR-enhanced sexual harassment curricular prevention program of six one-hour sessions. The evaluation comprised a pre-test, a post-test after the intervention, and a follow-up measure at three months. In the study, 579 Spanish adolescent students aged between 12 and 17 years (M = 14.76, SD = 0.88; 47.1% boys) were randomly grouped into experimental (n = 286) and control (n = 293) conditions. Results: The Virtual-PRO program effectively controlled participants' levels of sexism and reduced moral disengagement in the experimental group compared to the control group three months after the intervention. The program also showed positive results in changing bystander behavior, increasing the intention to intervene when the victim was not a friend. Finally, visual/verbal and online victimization decreased in the experimental group and increased in the control group. No differences were found for physical sexual victimization and sexual aggression. Conclusions: The first trial of the Virtual-PRO program is promising and highlights the use of VR as a sexual harassment prevention tool. Follow-up measures are essential to determine the impact of interventions accurately.

[Sexual harassment towards patients by a fellow physician]

Patients can become victims of sexual harassment by their healthcare provider. Sometimes patients disclose this unpleasant experience to a healthcare provider. In those cases it's important to deal with this adequately. It's also possible that the doctor himself witnesses sexual harassment by a colleague towards a patient. Although the need for speaking up is obvious, the Dutch Code of Conduct for Doctors gives few words to such situations. The noncommittal reaction of the bystander is thus given all the space it needs. In this article, we call on the reader to advocate for awareness, prevention and intervention in their own working environment.

Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations

BACKGROUND

Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace.

METHODS

We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis.

RESULTS

Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power.

CONCLUSIONS

The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.

Improving Sexual Assault and Sexual Harassment Prevention from the Bottom-up: a Pilot of Getting To Outcomes in the US Military

While the Department of Defense (DoD) has given increased attention and priority to preventing sexual assault and sexual harassment (SA/SH), it remains a problem. To build its prevention capacity, DoD piloted Getting To Outcomes® (GTO®) from 2019 to 2022 at 10 military installations. GTO is an evidence-based planning and implementation support that has been used in many civilian contexts but has only recently been adapted for military SA/SH. The purpose of this study was to describe GTO use, identify its benefits and challenges, and discuss lessons the GTO effort yielded for prevention more broadly using a framework of organizational and program-level capacities needed for successful prevention in the military context, called the Prevention Evaluation Framework (PEF). GTO was piloted with 10 military installations ("sites") representing all Military Services, plus the Coast Guard and National Guard. GTO is comprised of a written guide, training, and ongoing coaching. The pilot's goal was for each site to use GTO to implement a SA/SH prevention program twice. Participants from each site were interviewed and data was collected on GTO steps completed, whether GTO spurred new evaluation activities and collaborations, and the degree of leadership support for GTO. Most sites completed all GTO steps at least once. Interviews showed that DoD participants believe GTO improved prevention understanding, planning, and evaluation capacity; strengthened confidence in chosen programs; and helped sites tailor programs to the military context. Barriers were the complexity of GTO, DoD personnel turnover, and the disruption that the COVID pandemic caused in sexual assault prevention program delivery. Many respondents were unsure if they would continue all of GTO after the coaching ended, but many believed they would continue at least some parts. According to the PEF, the GTO pilot revealed several additional prevention system gaps (e.g., need for leadership support) and changes needed to GTO (e.g., stronger leader and champion engagement), to support quality prevention. The military and other large organizations will need to focus on these issues to ensure prevention implementation and evaluation are conducted with quality.

Primary Versus Secondary Prevention Effects of a Gender-Transformative Sexual Violence Prevention Program Among Male Youth: A Planned Secondary Analysis of a Randomized Clinical Trial

Engaging adolescent males is a promising violence prevention strategy. This study explored primary versus secondary prevention effects of a gender-transformative program (i.e., Manhood 2.0) versus job-readiness training on multiple forms of violence perpetration. Adolescent males, ages 13 to 19 years, were recruited through youth-serving organizations in Pittsburgh, PA, between July 27, 2015, and June 5, 2017, to participate in an unblinded community-based cluster-randomized trial in 20 neighborhoods. The intervention curriculum, Manhood 2.0, focused on challenging norms that foster gender-based violence and building bystander skills. The control program was job-readiness training. We completed a planned secondary analysis of surveys from baseline and 9 months post intervention (follow-up), wherein we stratified participants based on any sexual violence/adolescent relationship abuse (SV/ARA) at baseline and examined risk of perpetration of SV/ARA, incapacitated sex, sexual harassment, cyber sexual abuse, peer violence, bullying, and homophobic teasing at follow-up. Among 866 participants, mean age was 15.6 years, 70% identified as Black, 6% as Hispanic, and 6% as multiracial. In both the Manhood 2.0 intervention group and job-readiness control groups, youth who reported SV/ARA at baseline were significantly more likely to report any form of SV/ARA, incapacitated sex, sexual harassment, cyber sexual abuse, bullying, and homophobic teasing at follow-up. Among participants who reported no SV/ARA perpetration at baseline, participating in the Manhood 2.0 intervention program was associated with increased risk of SV/ARA at follow-up compared to participating in the job-readiness control program. Among participants who reported SV/ARA perpetration at baseline, participating in the Manhood 2.0 intervention group was associated with lower risk of peer violence at follow-up. Synergizing gender-transformative approaches with job-readiness training may offer opportunities for crosscutting prevention programming to address multiple forms of violence.

Work-related sexual and gender harassment: conceptual challenges and the need for evidence-based prevention

The topic of work-related sexual harassment has gained renewed attention in recent years following the public accounts of sexually harassing experiences – many of which were work-related – that emerged during the #MeToo movement beginning in October 2017 (1). The many testimonials from the movement illustrated the magnitude of the problem and put faces to the numbers of statistics on the topic. However, work-related sexual harassment is not a new phenomenon. In fact there are accounts of experiences that could be classified as sexual harassment in legal procedures dating back to at least the early 1900s (2). In labelling these experiences, feminist legal scholars MacKinnon (3) and Farley (4) introduced the term `sexual harassment` in the late 1970s in the United States. The behaviors were considered unlawful when occurring in a work-setting and conducted or condoned by the employer. Since they negatively affected employment conditions of women, they were considered a violation of laws regarding equal rights between women and men (5). From the outset, sexual harassment was considered a legal rather than a working-conditions problem. Over time, it has become acknowledged also in the literature on working conditions, and recent studies have illustrated the salience of this exposure, showing increased risk of severe outcomes such as long-term sickness absence (6), depression (7), psychotropic treatment (8), alcohol-related morbidity and mortality (9), suicide and suicide attempt (10).

Definitions and concepts But how should we define this exposure, which appears to be associated with such severe negative consequences? This question has been a topic of long-standing academic debate (11, 12). Legally, sexual harassment definitions differ between countries. In the European Union legal framework, sexual harassment is when “Any form of unwanted verbal, non-verbal or physical conduct of a sexual nature occurs, with the purpose or effect of violating the dignity of a person, in particular when creating an intimidating, hostile, degrading, humiliating or offensive environment.” (13) . From an academic perspective, leading scholars have argued that research should not be confined to those behaviors that are illegal but should have a broader focus and definition of the concept (14). An early definition from pioneering researcher Fitzgerald and colleagues (15) was that sexual harassment is “Unwanted sex-related behavior at work that is appraised by the recipient as offensive, exceeding her resources, or threatening her wellbeing”. Another more recent perspective focuses on sex-based rather than sexual harassment, suggesting that “sexual harassment should be viewed as harassment that is based on sex – as behavior that derogates, demeans, or humiliates an individual based on that individual’s sex” (16, p644). A key notion to this research is that sexual harassment is rooted in power and gender dynamics rather than sexual attraction.

A leading conceptual framework has been the tripartite model, introduced in the mid 1990s (17), stating that sexual harassment consists of three interrelated but distinct phenomena: gender harassment, unwanted sexual attention, and sexual coercion (5, 15). Gender harassment denotes behaviors that convey insulting, hostile or degrading attitudes about another person’s gender (often, but not always, towards women). The behaviors do not necessarily involve any explicit sexual content, and they are not aimed at sexual encounters. Unwanted sexual attention comprises sexual behaviors and advances – verbal or nonverbal – that are unwelcome, offensive, and unreciprocated. According to the tripartite model, this category also encompasses sexual assault, such as rape. Sexual coercion relates to quid pro quo scenarios, such as being promised a reward in exchange for sex or threatened with sanctions if one does not comply. The tripartite model has been foundational to much research in the area, and proponents of the model argue that gender harassment is the most common but often overlooked form of sexual harassment (5). As an illustration, an iceberg model has been developed, proposing that the behaviors most commonly associated with sexual harassment – unwanted sexual advances – are merely the visible tip of a much larger structure, with the hidden base of the iceberg consisting of a wide array of derogatory treatment of women (5). Most of the empirical work supporting the model, however, has been conducted in the US, and often analyzes data collected a couple of decades ago. Consequently, it is unclear how accurately the model describes the phenomenon of sexual harassment in a contemporary context outside of the US. More recently, a number of studies concerning the potential serious consequences of sexual harassment have emerged, mainly from a Scandinavian context (6–10). Notably, most of these studies are based on questionnaires measuring sexual harassment using a single item – a method referred to as the self-labelling approach (18). This measurement identifies only those cases of sexual harassment that are defined by the respondent as such. Research suggests that the estimates for prevalence are much higher when measuring situations that could be classified as sexual harassment – but may not be labelled as such by the respondent – using specific questions concerning experiences related to unwanted sexual attention, gender harassment, or sexual coercion (19).

Theoretical perspectives on the causes of sexual harassment Similar to debates concerning the definition and measurement of sexual harassment, there is no single unifying theory to explain why sexual harassment occurs. According to Pina et al (11), the most widely recognized theories include: (i) sociocultural theories; (ii) organizational theories; and (iii) natural-biological theories. In brief, the sociocultural theories, largely feminist [eg, (20)], view gender inequality and sexism as the root of sexual harassment. Similarly, organizational theories [eg, (21)] acknowledge that power differentials play a central role in sexual harassment. However, organizational theories do not focus on gender-specific differentials, but on status inequalities within the organization. These theories also consider other organizational factors, such as tolerance of sexual harassment, gender norms, and organizational policies. These theories are often supported by empirical studies showing that especially women, young individuals, and individuals in precarious work arrangement are more often exposed to sexual harassment (22). In contrast, the natural-biological theories [eg, (23)] view sexual harassment as an expression of a natural sexual attraction between people. According to this understanding, the reason that men are more inclined to sexually harass than women is because they have a higher sex drive than women. Considering that each of these perspectives may be too simplistic to understand the phenomenon of sexual harassment, the four-factor model (24) has been developed. This model can be characterized as multifactorial, seeking to incorporate many of the elements from the preceding theories. According to this model, sexual harassment depends on (i) a motivation to harass (eg, any combination of power, control, or sexual attraction), (ii) overcoming internal inhibitions (eg, moral restraints), (iii) overcoming external inhibitions (eg, specific organizational workplace barriers), and (iv) target resistance (eg, assertiveness or the targets’ relative status within the workplace).

Workplace prevention The prevention of work-related sexual harassment is a topic of high importance and – perhaps unsurprisingly – high complexity. To our knowledge, no interventions exist that have strongly documented effects on reducing the risk of sexually harassing behaviors at work. Researchers often highlight sexual harassment policies and training as essential prevention efforts, but the evidence of their effect remains limited (25–28). The aim of preventive workplace efforts is typically to change employee’s knowledge, skills, and attitudes, for instance to increase self-protection skills, alter gender beliefs and reduce tolerance of sexual harassment in order to change the organizational culture. However, despite more than a decade of research, rigorous evaluations remain scarce and most existing studies are from the US, possibly with limited generalizability (22, 25, 27, 28). Training interventions are diverse, ranging from brief online programs to intensive face-to-face programs that include group discussions and roleplay (27, 28). Training may include all employees or target specific groups with a special responsibility to manage sexual harassment, eg, managers and human resource personnel. Given the diversity of the interventions, it is difficult to assess how the duration, content, and mode of delivery affects the intervention`s effectiveness. Similarly, considerable controversy exists regarding zero-tolerance policies – a widely applied instrument (25, 29). Proponents argue that zero-tolerance policies send a strong signal that reduces employee’s proclivity to sexually harass others and encourages targets and witnesses to come forward. However, critics argue that strict zero-tolerance policies that are followed by severe punishment may make targets and witnesses more hesitant to come forward and result in pushback from employees if sanctions and procedures are deemed unfair (29).

Future directions in research and practice To advance our state of knowledge in this complex area of sexual harassment, we suggest two important tasks. First, there is a need for conceptual clarity. Given that even the definition of the concept of sexual harassment has been a topic of debate for decades (11, 12), this is no small task. Nonetheless, it is pivotal to advancing the state of knowledge that we strive towards conceptual clarity so that it is clear what phenomenon we are actually researching or trying to prevent. We argue that it may be helpful to use specific terminology whenever possible, and, to this end, the terminology of the tripartite model, distinguishing between gender harassment, unwanted sexual attention and coercion may be useful. The usefulness of insisting on using the umbrella term `sexual harassment` to encompass all of these very different experiences may be more questionable. Furthermore, whether the tripartite model provides an accurate understanding of sexual harassment in countries outside the US, and in a contemporary context, is an empirical question that remains unanswered. Second, the lack of solid evidence-based methods to prevent work-related sexual harassment is striking. In our experience, the recent attention on sexual harassment in public debate has spawned an extensive demand from workplaces asking what to do in terms of prevention. Currently, there is little to offer regarding evidence-based preventive interventions. Thus, an important task for future research is to develop and test interventions so we may provide answers to inform prevention. Such development and testing may also be guided by appropriate use of specific terminology so that it is clear what behaviors the interventions are designed to prevent. Given that sexual harassment is a substantial work environment problem associated with severe health consequences, its prevention constitutes an important societal task.

References

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The presence, action, and influence of bystanders who witness sexual harassment against medical students

PURPOSE

Sexual harassment (SH) is a widespread problem in academia, with a disproportionate impact on female medical students and those who experience marginalization via multiple systems of oppression (e.g. racism, heterosexism). Bystander intervention education is a potential approach which frames violence as a community issue where all members have a role to play in response and prevention. This study assessed the presence and influence of bystanders in SH situations for students at two medical schools.

MATERIALS AND METHODS

Data came from a larger U.S. campus climate study administered online in 2019 and 2020. The sample included 584 students who responded to validated survey questions about sexual harassment experiences, bystander behavior, disclosure, perceptions of the university response to SH, and demographics.

RESULTS

More than one-third of respondents experienced some form of SH by a faculty/staff member. Bystanders were present for more than half of these incidents, yet they rarely intervened. When bystanders intervened, people were more likely to disclose an incident than not.

CONCLUSIONS

The results indicate that there are many missed opportunities for intervention and given the profound impact that SH has on the well-being of medical students, continued work is needed to determine effective intervention and prevention methods.[Box: see text].

An application of the ecological model to sexual harassment in informal areas of Cairo, Egypt

Street-based sexual harassment is a prevalent but understudied form of gender-based violence that restricts women's access to public spaces. Drawing on adaptations of the ecological model that identify the root causes of gender-based violence in patriarchy, in this study, we explore the causes of street harassment in informal areas of Greater Cairo. Our analysis is based on qualitative interviews and focus groups with male and female youth aged 13-29 years, parents of youth and community leaders in two informal areas. We supplement the qualitative data with descriptive analysis of a representative, 2016 survey of youth in informal areas of Cairo that measured experiences with and attitudes toward harassment. Harassment was prevalent in the study areas, and respondents tended to place the blame for harassment at the individual level of the ecological model, particularly women's behavior. However, there were also community- and societal-level factors that contributed to the prevalence of harassment. Patriarchal norms and stigmatization of women who are harassed reinforced victim-blaming, such that most young women were afraid to report experiences of harassment due to social censure. In this context, educational or awareness raising interventions are unlikely to be effective in combating harassment, which is widely acknowledged to be a problem. Rather, interventions are needed along the different levels of the ecological model to target peer group and community norms that encourage harassment, address harassment in schools and strengthen reporting mechanisms.

Graduate students' knowledge and utilization of campus sexual violence and sexual harassment resources

Graduate students are uniquely vulnerable to sexual violence and harassment (SVSH) and largely marginalized in campus-based prevention and response efforts. Objective: This study is a preliminary investigation of graduate students' experiences with on-campus SVSH training and knowledge and utilization of SVSH resources. Methods: We conducted 21 in-depth interviews and 8 focus group discussions with 43 graduate students on three public university campuses in California. Results: Graduate students had limited knowledge of SVSH services, and mandatory SVSH training curricula was perceived to center around "responsible employee" duties rather than information about how to prevent or seek help for SVSH themselves. Graduate students had mixed experiences seeking SVSH-related assistance. Conclusions: Graduate students should be prioritized in SVSH prevention and education efforts beyond required responsible employee training. Graduate students are invaluable to the everyday success of universities; accounting for their vulnerabilities in SVSH prevention and response is vital for campus communities everywhere.

Sexual harassment allegations leveled at Swiss biologist

Evolutionary biologist Laurent Keller, who is no longer employed by the University of Lausanne, denies all claims.

Sports Participation, Social Networks, and Sexual Violence Perpetration

Adolescent sexual violence (SV), which includes non-contact verbal sexual harassment (SH) and forced sexual contact (FSC), is a significant public health problem with long-term impacts on health and well-being. Understanding how sports participation is linked to SV can inform prevention efforts; however, the current literature is unclear about the nature of this association. Using data from 20 high schools, we investigate whether athletes in certain sports are at higher risk of SH and FSC perpetration than either other athletes or sports non-participants, and whether the risk is moderated by gender, dismissiveness of SV, or substance use intentions. We also utilize social network data to explore the role of relationships with peers and trusted adults to attenuate SH and FSC perpetration. Second, we incorporate characteristics of friends to further examine the role and composition of peer groups in the association between sports participation and perpetration of SH and FSC. Findings revealed a bivariate association between sport contact level and SH perpetration, but not FSC, and the association disappeared after adjusting for other covariates. Most prominently, dismissiveness of SV, intentions to use substances, and prior perpetration had the strongest association with perpetration regardless of sport contact level. Results also provided some support for the influence of peers and trusted adults in the sports context. Notably, the percentage of friends who perpetrated FSC and the percentage of friends who play a low-contact sport were positively associated with FSC perpetration, and the percentage of friends who play a high-contact sport was positively associated with SH perpetration. The paper concludes with a discussion of the sports context as an important venue for comprehensive prevention efforts, including a focus on changing norms around adolescent SV and substance use.

Expert Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment in Healthcare Settings

BACKGROUND

Patient-perpetrated sexual harassment toward staff and patients is prevalent in Veterans Affairs and other healthcare settings. However, many healthcare facilities do not have adequate systems for reporting patient-perpetrated harassment, and there is limited evidence to guide administrators in developing them.

OBJECTIVE

To identify expert recommendations for designing effective systems for reporting patient-perpetrated sexual harassment of staff and patients in Veterans Affairs and other healthcare settings.

DESIGN

We conducted qualitative interviews with subject matter experts in sexual harassment prevention and intervention during 2019.

PARTICIPANTS

We used snowball sampling to recruit subject matter experts. Participants included researchers, clinicians, and administrators from Veterans Affairs/other healthcare, academic, military, and non-profit settings (n = 33).

APPROACH

We interviewed participants via telephone using a semi-structured guide and analyzed interview data using a constant comparative approach.

KEY RESULTS

Expert recommendations for designing reporting systems to address patient-perpetrated sexual harassment focused on fostering trust, encouraging reporting, and deterring harassment. Recommendations included the following: (1) promote a climate in which harassment is not tolerated; (2) take proportional, corrective actions in response to reports; (3) minimize adverse outcomes for reporting parties; (4) facilitate and simplify reporting processes; and (5) hold the reporting system accountable. Specific strategies related to each recommendation were also identified.

CONCLUSIONS

This qualitative study generated initial recommendations to guide healthcare administrators and policy makers in assessing, developing, and improving systems for reporting patient-perpetrated sexual harassment toward staff and other patients. Results indicate that proactive, careful design and ongoing evaluation are essential for ensuring that reporting systems have their intended effects and mitigating the risks of inadequate systems. Additional research is needed to evaluate strategies that effectively address patient-perpetrated harassment while balancing patients' clinical needs.

How Do You Define Sexual Harassment?: Why Context Matters

Sexual violence affects one in four college-aged women. Multiple studies support the use of bystander prevention programs to help reduce the amount of sexual violence occurring; however, bystander action is dependent upon recognizing occurrences of sexual harassment. The present study investigated perceptions of sexually harassing behaviors in two contexts: at work and outside of work. A total of 302 undergraduate student participants rated their perceptions of sexually harassing behaviors and various attitudes related to sexual violence. The exact same behaviors were perceived as more likely to constitute sexual harassment if they occurred at work. Implications are discussed.

Systematic Review of Policies and Interventions to Prevent Sexual Harassment in the Workplace in Order to Prevent Depression

BACKGROUND

Sexual harassment in the workplace (SHWP) is highly prevalent and has a negative impact, including depression, on its victims, as well as a negative economic impact resulting from absenteeism and low productivity at work. This paper aims to outline the available evidence regarding the prevention of depressive symptoms among workers through policies and interventions that are effective in preventing SHWP.

METHODS

We conducted two systematic reviews. The first focused on the association of depression and SHWP, and the second on policies and interventions to prevent SHWP. We conducted a meta-analysis and a narrative synthesis, respectively. We identified 1831 and 6107 articles for the first and second review. After screening, 24 and 16 articles were included, respectively.

RESULTS

Meta-analysis results show a prevalence of depression of 26%, as well as a 2.69 increased risk of depression among workers who experience SHWP. Variables such as number of harassment experiences and exposure to harassment from coworkers and other people increase this risk.

CONCLUSIONS

There is limited evidence regarding the effectiveness of policies and training to prevent SHWP, mostly focused on improvements in workers' knowledge and attitudes about SHWP. However, there is no available evidence regarding its potential impact on preventing depression.

Advancing Sexual Harassment Prevention and Elimination in the Sciences: "Every ... Health Organization Must Do Something Similar"

BACKGROUND

Sexual harassment is pervasive in science. A 2018 report found that the prevalence of sexual harassment in academia in the United States is 58%. An activity held at an international scientific congress was designed to advance sexual harassment prevention and elimination and empower binary and nonbinary persons at risk for harassment, discrimination, and violence. The objective is to describe the activity and outcomes to provide a promising model for other scientific communities.

METHODS

A description of the plenary and key components as well as the data collection and analysis of selected outcomes are provided.

RESULTS

Among 1338 congress participants from 61 countries, 526 (39%) attended the #MeToo plenary, and the majority engaged in some way during the plenary session. Engagement included standing for the pledge (~85%), participating in the question and answer session (n = 5), seeking counseling (n = 3), and/or providing written post-it comments (n = 96). Respondents to a postcongress survey (n = 388 [24% of all attendees]) ranked the plenary as number 1 among 14 congressional plenaries. In postanalysis, the written post-it comments were sorted into 14 themes within 6 domains, including: (1) emotional responses, (2) barriers to speaking out, (3) public health priorities, (4) reframing narratives about the issue, (5) allyship, and (6) moving the issue forward.

CONCLUSIONS

Scientific organizations, agencies, and institutions have an important role to play in setting norms and changing enabling policies toward a zero-tolerance culture of sexual harassment. The activity presented offers a promising model for scientific communities with similar goals. The outcomes suggest that the plenary successfully engaged participants and had a measurable impact on the participants.

Sexual Harassment in the Academy: Harnessing the Growing Labor Movement in Higher Education to Address Sexual Harassment Against Graduate Workers

Higher education is not immune to the epidemic of sexual harassment in the United States, particularly sexual harassment of graduate workers. This is due largely to power differentials of status and income, as academia relies on low-wage work. While the literature shows sexual harassment is prevalent across disciplines, current work to address the problem does not account for graduate worker precarity. The graduate labor movement, which addresses precarity, is beginning to tackle sexual harassment. We review how the labor and anti-gender-based violence movements in higher education should come together to prevent sexual harassment, presenting recommendations for structural changes to academia.

NIH rolls out stricter disclosure rules for sexual harrassment

Institutions now legally required to inform agency if grantees are "disciplined" for workplace misbehavior.

Ending Sexual Harassment in Science: Designing and Administering a Survey That Can Lead to an Improved Organizational Climate

Workplace harassment, particularly sexual harassment, has substantial negative implications for individuals and organizations and for scientific advancement. The National Institutes of Health (NIH) is uniquely positioned to lead the effort to prevent sexual harassment in the scientific community and mitigate its detrimental effects. Recognizing the need for benchmark data, NIH developed and validated the 2019 NIH Workplace Climate and Harassment Survey. The goal was to use best practices in survey design methods to create an instrument for rigorous assessment of harassment incidence and organizational climate predictors of sexual harassment in scientific research environments. This article summarizes the processes used to design and administer the NIH survey and provides brief descriptions of 3 products of the process developed to guide scientific institutions wishing to embark on a data-driven approach to assess and prevent harassment: a document detailing survey development and methods, a survey implementation guide, and the key findings obtained from the survey, including recommendations for interventions targeting the organizational climate at NIH and limitations of the survey. The survey identified that 1 in 5 respondents had experienced sexual harassment in the 12 months preceding their participation in the survey and that women, sexual and gender minorities, younger respondents, trainees/students, and individuals with a disability were more likely to have experienced sexual harassment. Those who had experienced sexual harassment during that period were also more likely to have experienced incivility, bullying, and intimidating behaviors in the workplace. NIH intends to use the survey findings as a quality assurance and quality improvement guide to inform future activities to prevent and address harassment across NIH.

Prevention Strategies for Sexual Harassment in Academic Medicine: A Qualitative Study

Sexual harassment and gendered discrimination in the workplace are global issues that can affect anyone regardless of their age, gender, job title, or field of employment. The medical field is also relevantly concerned, yet effective prevention measures are scarce. The purpose of this study was to explore preventive options for sexual harassment in an academic medical context from the employees' perspective and to develop transferable strategies. We conducted semi-structured interviews with 15 female physicians and 15 female nurses working at a tertiary referral center in Berlin, Germany, in the months of April to November 2015. The one-on-one interviews addressed the perception of sexual harassment and available and desirable preventive measures. Data were analyzed by qualitative content analysis. The participants outlined preventive measures at two levels: individual and institutional. Individual options included personal safety measures and individual protection strategies against patients, peers, and superiors. Institutional strategies included guidelines and workplace policies, structured complaint and reporting procedures, formal training options, and organizational development and leadership strategies. The current study highlights how the prevention of sexual harassment hinges on a combination of individualized and system-wide measures to capture the personal as well as the organizational dimension of sexual harassment. Only a concerted effort addressing both aspects will sensitize the workforce, support the victims, and prevent sexual harassment in medical institutions.

Sexual harassment in secondary school: Prevalence and ambiguities. A mixed methods study in Scottish schools

BACKGROUND

Adolescence is characterized by identity formation, exploration and initiation of intimate relationships. Much of this occurs at school, making schools key sites of sexual harassment. Schools often lack awareness and understanding of the issue, and UK research on the topic is scarce. We explored prevalence and perceptions of sexual harassment in a school-based mixed-methods study of 13-17 year-old Scottish adolescents.

METHODS

A student survey (N = 638) assessed past 3-months school-based victimization and perpetration prevalence via 17 behavioral items based on the most commonly used school-based sexual harassment measure ('Hostile Hallways'). Eighteen focus groups (N = 119 students) explored which of 10 behaviors were perceived as harassing/unacceptable and why.

RESULTS

Two-thirds reported any victimization: 64.7% 'visual/verbal' (e.g. sexual jokes) and 34.3% 'contact/personally-invasive' behaviors (e.g. sexual touching; most of whom also reported experiencing visual/verbal types) in the past 3-months. Data suggested a gateway effect, such that contact/personally-invasive behaviors are more likely to be reported by those also reporting more common visual/verbal behaviors. Some survey participants reported being unsure about whether they had experienced certain behaviors; and in focus groups, participants expressed uncertainty regarding the acceptability of most behaviors. Ambiguities centered on behavioral context and enactment including: degree of pressure, persistence and physicality; degree of familiarity between the instigator-recipient; and perception of the instigator's intent. In attempting to resolve ambiguities, students applied normative schemas underpinned by rights (to dignity, respect and equality) and 'knowingness', usually engendered by friendship.

CONCLUSIONS

Our study confirms school-based sexual harassment is common but also finds significant nuance in the ways in which students distinguish between acceptable and harassing. School-based strategies to tackle sexual harassment must engage with this complexity.

Men Tackling Isolating Gender Violence to Fight against Sexual Harassment

Scientific literature has shown that both suffering gender-based violence and taking a stand against it could provoke severe retaliation from bystanders, including negative consequences on health. Together with some women, several men-defined as New Alternative Masculinities-have also contributed to fighting against sexual violence in several contexts, also suffering dramatic consequences, known as Isolating Gender Violence (IGV). This article fills the gap on inquiring how men suffering IGV due to intervening in supporting survivors has affected the men's health. Six in-depth interviews were conducted with men from different contexts and countries and men of different social profiles. The findings reveal how men's health is better protected when they build networks of support while overcoming the fear of retaliation in achieving to empower direct survivors. In addition, the results recognize men as crucial actors in the struggle against GBV and overcoming IGV, as women potentially do. This may inspire other men to intervene and break the silence regarding GBV in societies and institutions, as it shows that men and women together are needed to fight against GBV.

The effects of sex and outcome expectancies on perceptions of sexual harassment

Using an outcome expectancy framework, this research sought to understand sex differences in the underlying beliefs that influence harassment perception. One hundred and ninety-six participants (52% women) read a series of vignettes depicting common examples of digital male-on-female sexual harassment. They were asked to what extent they thought each scenario constituted sexual harassment, and how likely the perpetrator would experience positive and negative outcomes. Consistent with predictions, women were more likely to consider the behaviours as harassment than men were. Both sexes harassment perceptions had significant relationships with their outcome expectancies, but we also found evidence of a sex specific moderation; the link between men's negative outcome expectancies was moderated by their positive ones. The results suggest that perceptions of harassment may have sexually asymmetrical underpinnings. Measuring the interplay between positive and negative outcome expectancies in relation to sexual harassment perception is a novel approach, that may have implications for the development of anti-sexual harassment interventions. Implications for theory and future research directions are discussed.

Effects of Dating Matters® on Sexual Violence and Sexual Harassment Outcomes among Middle School Youth: a Cluster-Randomized Controlled Trial

Sexual violence (SV), including sexual harassment (SH), is a significant public health problem affecting adolescent health and well-being. This study extends prior research by evaluating the effectiveness of a comprehensive teen dating violence prevention model, Dating Matters, on SV and SH perpetration and victimization, inclusive of any victim-perpetrator relationship, among middle school students. Dating Matters includes classroom-delivered programs for youth in 6th, 7th, and 8th grades; community-based programs for parents; a youth communications program; training for educators; and community-level activities. Middle schools in four urban areas in the USA were randomly assigned to receive Dating Matters (DM, N = 22) or a standard-of-care intervention (SC, N = 24) over four consecutive school years (2012-2016). The analytic sample included two cohorts who entered the study in 6th grade and completed 8th grade by the end of the study allowing for full exposure to Dating Matters (DM: N = 1662; SC: N = 1639; 53% female; 50% black, non-Hispanic; 6 waves of data collection for each cohort). Structural equation modeling was employed with multiple imputation to account for missing data. Dating Matters was associated with significant reductions in SV and SH perpetration and victimization scores in most-but not all-sex/cohort groups by the end of 8th grade relative to an evidence-based TDV prevention program. On average, students receiving Dating Matters scored 6% lower on SV perpetration, 3% lower on SV victimization, 4% lower on SH perpetration, and 8% lower on SH victimization by the end of middle school than students receiving an evidence-based violence prevention program. Overall, Dating Matters shows promise for reducing SV and SH, occurring both within and outside dating relationships, through middle school. Clinicaltrials.gov Identifier: NCT01672541.

Effects of gender harassment on science popularization behaviors

In this pilot study, we used a mixed methods online survey to ask science popularizers how gender harassment influences the way they communicate science to the public. Popularizers reported that gender harassment caused the science popularization field to increasingly strive for gender inclusivity in the creation of content. However, harassment made female popularizers feel they must emphasize their legitimacy, quite conscious of their clothing choices, and wary of engaging the public through mediums or topics that provoke more severe harassment. Implications for science communication and public engagement are discussed.

Isn't high school bad enough already? Rates of gender harassment and institutional betrayal in high school and their association with trauma-related symptoms

Germinal studies have described the prevalence of sex-based harassment in high schools and its associations with adverse outcomes in adolescents. Studies have focused on students, with little attention given to the actions of high schools themselves. Though journalists responded to the #MeToo movement by reporting on schools’ betrayal of students who report misconduct, this topic remains understudied by researchers. Gender harassment is characterized by sexist remarks, sexually crude or offensive behavior, gender policing, work-family policing, and infantilization. Institutional betrayal is characterized by the failure of an institution, such as a school, to protect individuals dependent on the institution. We investigated high school gender harassment and institutional betrayal reported retrospectively by 535 current undergraduates. Our primary aim was to investigate whether institutional betrayal moderates the relationship between high school gender harassment and current trauma symptoms. In our pre-registered hypotheses (https://osf.io/3ds8k), we predicted that (1) high school gender harassment would be associated with more current trauma symptoms and (2) institutional betrayal would moderate this relationship such that high levels of institutional betrayal would be associated with a stronger association between high school gender harassment and current trauma symptoms. Consistent with our first hypothesis, high school gender harassment significantly predicted college trauma-related symptoms. An equation that included participant gender, race, age, high school gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal also significantly predicted trauma-related symptoms. Contrary to our second hypothesis, the interaction term was non-significant. However, institutional betrayal predicted unique variance in current trauma symptoms above and beyond the other variables. These findings indicate that both high school gender harassment and high school institutional betrayal are independently associated with trauma symptoms, suggesting that intervention should target both phenomena.

School Personnel's Bystander Action in Situations of Dating Violence, Sexual Violence, and Sexual Harassment Among High School Teens: A Qualitative Analysis

We examined school personnel's engagement in bystander action in situations of teen dating violence (DV), sexual violence (SV), and sexual harassment (SH). We conducted focus groups with 22 school personnel from three high schools in New Hampshire. School personnel identified their own barriers to intervening in situations of teen DV, SV, and SH (e.g., not having the time or ability to intervene). School personnel also discussed the ways in which they intervened before (e.g., talking with teens about healthy relationships), during (e.g., breaking up fights between dating partners) and after (e.g., comforting victims) instances of teen DV, SV, and SH. These data can be used to support the development of bystander training for school personnel as one component of comprehensive DV, SV, and SH prevention for teens. In addition, these data provide information that can be used to develop measures that assess school personnel bystander action barriers and behaviors in instances of teen DV, SV, and SH.

Protecting Youth in the Mental Health Service Settings

The authors present the development of the field of psychiatry with the evolution of patient safeguards. They address the recent publicized events involving sexual harassment and abuse perpetrated by mental health service providers who have harmed youth who were under their direct psychiatric care. Recommendations are provided for primary care physicians and parents and legal guardians to further ensure patient safety.

Bias-Based Bullying and School Adjustment among Sexual and Gender Minority Adolescents: The Role of Gay-Straight Alliances

Adolescents identifying as sexual and/or gender minorities face many challenges at school due to stigma-based peer harassment. This study examined the extent to which sexual and gender minority adolescents experience bias-based bullying across a range of stigmatized identities and attributes, as well as the potential of gay-straight alliances (GSAs, also referred to as gender-sexuality alliances) to reduce simultaneously multiple forms of bias-based bullying, and in turn support school adjustment. Using a United States sample of diverse sexual and gender minority adolescents (N = 17,112; M_age = 15.57, SD_age = 1.27), multiple mediation analyses indicated lower levels of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexuality) at schools with versus without GSAs, and in turn higher perceived school safety, as well as higher grades and reduced school suspension (due to less weight- and sexuality-based bullying). The findings shed light on the broad-reaching stigma-reduction potential of GSAs.

Addressing Sexual Harassment in the #MeToo Era: An Institutional Approach

Sexual harassment is a particularly pernicious form of harassment that can result in long-lasting psychological damage to victims. In health care, it has deleterious effects on teamwork and communication and may affect patient care. Although concerns regarding sexual harassment in the workplace, including within health care, are not new, increased attention has been focused on this topic since late 2017 as a result of the #MeToo movement. As in other sectors, health care centers have experienced instances of sexual harassment. Evidence indicates that harassment in health care centers is not uncommon and has not decreased with time. Beyond reporting and addressing, health care institutions must establish policies that clearly outline the unacceptability of harassing behaviors. Moreover, institutions must have a systematic method to thoroughly investigate allegations of sexual harassment and to impose fair and consistent corrective actions when allegations are substantiated. This article describes Mayo Clinic's approach to this complex problem, including targeted efforts toward developing a culture intolerant of sexually harassing behavior.

Analyzing and learning the language for different types of harassment

THIS ARTICLE USES WORDS OR LANGUAGE THAT IS CONSIDERED PROFANE, VULGAR, OR OFFENSIVE BY SOME READERS. The presence of a significant amount of harassment in user-generated content and its negative impact calls for robust automatic detection approaches. This requires the identification of different types of harassment. Earlier work has classified harassing language in terms of hurtfulness, abusiveness, sentiment, and profanity. However, to identify and understand harassment more accurately, it is essential to determine the contextual type that captures the interrelated conditions in which harassing language occurs. In this paper we introduce the notion of contextual type in harassment by distinguishing between five contextual types: (i) sexual, (ii) racial, (iii) appearance-related, (iv) intellectual and (v) political. We utilize an annotated corpus from Twitter distinguishing these types of harassment. We study the context of each kind to shed light on the linguistic meaning, interpretation, and distribution, with results from two lines of investigation: an extensive linguistic analysis, and the statistical distribution of uni-grams. We then build type- aware classifiers to automate the identification of type-specific harassment. Our experiments demonstrate that these classifiers provide competitive accuracy for identifying and analyzing harassment on social media. We present extensive discussion and significant observations about the effectiveness of type-aware classifiers using a detailed comparison setup, providing insight into the role of type-dependent features.