Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine.

Importance: The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective: To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants: A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures: Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures: Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results: Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance: High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.

Women in Surgery Italia: National Survey Assessing Gender-Related Challenges.

BACKGROUND: In 2019, women accounted for 46% of surgical residents. Despite the international debate on gender disparities, no literature regarding the experience in Italy is available. The aim of this survey study was to assess satisfaction among female surgeons in Italy, and determine whether they encounter gender-based discrimination. STUDY DESIGN: An anonymous, 83-item web-based survey was distributed among female surgeons working in Italy, from November 18 to December 31, 2020. Gender equity, satisfaction, and factors associated with higher satisfaction and work-life balance were explored. RESULTS: There were 3,242 volunteer respondents, 1,833 of whom completed at least 50% of the specific questions and were included in the study. Approximately 54% of female Italian surgeons reported being satisfied with their job, but only 34% with their work-life balance. Among residents, 67% thought they were not adequately trained. The majority of respondents were responsible for most of the housekeeping (60%) and childcare duties (53%), regardless of their partner's workload, and 62% reported that gender affects the way they are treated at work, with most of them experiencing microaggressions. Sexual harassment was common (59%), but only 10% of women reported it. CONCLUSIONS: Most Italian female surgeons are satisfied with their professional choice. However, they face gender discrimination, including incidents of sexual harassment and microaggression. Due to the fact that half of surgeons working in Italian hospitals will be females in the next few years, actions are urgently required to build a culture that supports a gender-neutral environment.

Sexual harassment by peers in Chilean schools.

BACKGROUND: Although a significant amount of literature has explored peer sexual harassment in higher education, little is known about peer sexual harassment in primary and middle school. Among existing studies, most have examined individual student characteristics that predict peer sexual harassment without considering the importance of the classroom and school context, which may prevent or promote such harassment. OBJECTIVE: The purpose of this study was to identify individual and school-related factors predicting sexual harassment victimization. METHODS: A sample of 17,364 Chilean students from Grades 5 through 8 in 405 schools with low socioeconomic status answered instruments concerning peer sexual harassment, other types of peer victimization and discrimination, and perceptions of classroom and school climate and norms against sexual harassment. Data were analyzed through hierarchical multivariate regression. RESULTS: Experiences of being sexual harassed by other students were reported by 13.5 % of students, with higher frequencies in male students, students from Grades 5 and 6, and students with lower individual socioeconomic status. School-related experiences of being discriminated against due to sexual orientation, ethnic origin, and disability were the strongest predictors of sexual harassment victimization. CONCLUSION: We discuss how peer sexual harassment might be understood as a consequence of peer social discrimination based on sexism, racism, and ableism. We also discuss the need to provide inclusive school climate policies that allow all students to feel safe and included.

Prevalence and factors associated with violence against high school teachers in Teresina, Piauí, 2016: a cross-sectional study. / Prevalência e fatores associados à violência contra professores em escolas do ensino médio em Teresina, Piauí, 2016: estudo transversal.

OBJECTIVE: to analyze prevalence of violence against high school teachers and associated factors in Teresina, Piauí, Brazil. METHODS: this was a cross-sectional study using convenience sampling. Data was collected in 2016 in public and private high schools, using a self-administered questionnaire. Prevalence ratios (PR) using Poisson regression and 95% confidence intervals (95%CI) were calculated. RESULTS: 279 teachers participated, of whom 54.8% (95%CI 48.8;60.7) reported having suffered at least one type of violence. Verbal insults were most prevalent (39.4%; 95%CI 33.7;45.4), positively associated with public schools (PR=1.45; 95%CI 1.00;2.11) and with schools in the city's Eastern region (PR=1.85; 95%CI 1.17;2.93) and Southern region (PR=1.59; 95%CI 1.05;2.41). Sexual harassment was associated with males (PR=2.38; 95%CI 2.02;2.71). CONCLUSION: violence against teachers was higher in public schools in poorer outskirt regions and regions with high indicators of urban violence.

Understanding, Experience and Response to Sexual Harassment among the Female Students: A Mixed Method Study.

BACKGROUND: Sexual harassment has received global attention and has been recognized as a public health problem with increased physical and mental health risks among the victims. This study attempted to assess understanding, experience, response and effect of sexual harassment among the secondary school female students in Kathmandu, Nepal. METHODS: It was a mixed method study conducted among 441 secondary level female students. In quantitative component, a structured questionnaire was used to collect information relating to socio-demographic characteristics, and understanding, experience, response and effect of sexual harassment from 441 participants from three clusters (schools) of Tokha Municipality, Kathmandu. For qualitative method, two focused group discussions were conducted to assess the understanding of and response to sexual harassment. Quantitative and qualitative data were analyzed using Chi square test and thematic analysis method respectively. RESULTS: Around 76% of the participants had experienced some forms of sexual harassment in their life. Sexual harassment was significantly associated with religion and parental occupation. Majority of participants who faced sexual harassment reported that the perpetrators were strangers and they either ignored it or did nothing at the time of events. School, roads and public places were the most common settings where participants encountered sexual harassment. CONCLUSIONS: Sexual harassment is prevalent among female secondary students in Kathmandu. However, they lacked a clear understating of and ways to respond to sexual harassment. Raising awareness to recognize and respond to different forms of harassment and to change the victim-blaming attitudes can be a potential strategy for tackling the problem in Nepalese society.

See No Evil, Hear No Evil, Stop No Evil: Institutional-Level Tracking to Combat Mistreatment of Residents and Fellows.

BACKGROUND: Mistreatment of trainees, including discrimination and harassment, is a problem in graduate medical education. Current tools to assess the prevalence of mistreatment often are not administered institutionally and may not account for multiple sources of mistreatment, limiting an institution's ability to respond and intervene. OBJECTIVE: We describe the utility of a brief questionnaire, embedded within longer institutional program evaluations, measuring the prevalence of different types of trainee mistreatment from multiple sources, including supervisors, team members, colleagues, and patients. METHODS: In 2018, we administered a modified version of the mistreatment questions in the Association of American Medical Colleges Graduation Questionnaire to investigate the prevalence and sources of mistreatment in graduating residents and fellows. We conducted analyses to determine the prevalence, types, and sources of mistreatment of trainees at the institutional level across graduate medical education programs. RESULTS: A total of 234 graduating trainees (77%) from the University of Minnesota-Twin Cities completed the questions. Patients were cited as the primary source of mistreatment in 5 of 6 categories, including both direct and indirect offensive remarks, microaggressions, sexual harassment, and physical threats (paired t test comparisons from t = 3.92 to t = 9.71, all P < .001). The only category of mistreatment in which patients were not the most significant source was humiliation and shaming. CONCLUSIONS: Six questions concerning types and sources of trainee mistreatment, embedded within an institutional survey, generated new information for institutional-, departmental- and program-based future interventions. Patients were the greatest source for all types of mistreatment except humiliation and shaming.

Gender discrimination in the United States: Experiences of women.

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.

Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans.

OBJECTIVE: To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. METHODS: We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. PRINCIPAL FINDINGS: Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system CONCLUSIONS: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.

Workplace violence against doctors involved in clinical care at a tertiary care hospital in Pakistan.

A study was conducted to determine perceptions, attitudes and experience of workplace violence among residents and faculty at a tertiary care centre in Karachi, Pakistan. An anonymous, electronic, self-administered questionnaire was circulated among all residents and faculty members working at Aga Khan University Hospital, Karachi. A standard questionnaire was devised and used, and workplace violence and its types were defined as per World Health Organization (WHO) definitions. An overall response rate of 44.9% was achieved. A total of 53.4% of the respondents reported being victims of some form of workplace violence with verbal abuse being the most prevalent (41.6%) followed by bullying and threat. Most frequent perpetrators were found to be faculty members followed by patients or their attendants. Specialty of respondents was found to be significantly associated with verbal abuse and significantly more females were subjected to sexual harassment, while ethnicity was found to be significantly associated with racial harassment. The results correspond to previously available literature, while they also highlight some findings unique to our culture. We suggest that measures should be taken as per WHO and Joint Commission International Accreditation ( J CIA) recommendations to prevent workplace violence across the country.

An Empirical National Assessment of the Learning Environment and Factors Associated With Program Culture.

OBJECTIVES: To empirically describe surgical residency program culture and assess program characteristics associated with program culture. SUMMARY BACKGROUND DATA: Despite concerns about the impact of the learning environment on trainees, empirical data have not been available to examine and compare program-level differences in residency culture. METHODS: Following the 2018 American Board of Surgery In-Training Examination, a cross-sectional survey was administered to all US general surgery residents. Survey items were analyzed using principal component analysis to derive composite measures of program culture. Associations between program characteristics and composite measures of culture were assessed. RESULTS: Analysis included 7387 residents at 260 training programs (99.3% response rate). Principal component analysis suggested that program culture may be described by 2 components: Wellness and Negative Exposures. Twenty-six programs (10.0%) were in the worst quartile for both Wellness and Negative Exposure components. These programs had significantly higher rates of duty hour violations (23.3% vs 11.1%), verbal/physical abuse (41.6% vs 28.6%), gender discrimination (78.7% vs 64.5%), sexual harassment (30.8% vs 16.7%), burnout (54.9% vs 35.0%), and thoughts of attrition (21.6% vs 10.8%; all P < 0.001). Being in the worst quartile of both components was associated with percentage of female residents in the program (P = 0.011), but not program location, academic affiliation, size, or faculty demographics. CONCLUSIONS: Residency culture was characterized by poor resident wellness and frequent negative exposures and was generally not associated with structural program characteristics. Additional qualitative and quantitative studies are needed to explore unmeasured local social dynamics that may underlie measured differences in program culture.

Achieving Gender and Social Equality: More Than Gender Parity Is Needed.

In this Perspective, the authors review Association of American Medical Colleges data on gender parity and intersectionality, consider the literature on gender parity in academic medicine and the underlying gender norms that explain these statistics, and offer recommendations for moving past indicators of parity to achieve gender and social equality.Improvements in gender parity among medical school graduates have not translated to gender parity among practicing physicians or medical school faculty, particularly for racial/ethnic minorities. Further, gender parity does not correspond to gender equality, such that gender-based disparities in salaries and advancement persist. In addition, social norms related to traditional gender role expectations reinforce existing biases and lead to sexual harassment and discrimination against women in the workplace.Building on their analysis of existing data and the literature, the authors offer concrete recommendations to achieve gender equality in academic medicine that not only improve parity but also support policies and practices to address the norms that further bias and discrimination. These recommendations include the collection, monitoring, and open reporting of data on salaries as well as on sex and race/ethnicity; stronger policies related to family leave and sexual discrimination and harassment; and accountability structures to ensure that policies are enforced. While these efforts alone cannot eliminate gender inequalities, academic medicine should be at the forefront of creating a climate in medicine that is supportive of gender equality as part of their larger goal of promoting social equality.

Every doctor needs a wife: An old adage worth reexamining.

Half of medical school graduates are women, but female doctors experience significant professional tensions. Low numbers of women in leadership roles, high burnout and attrition, and continued harassment suggest a culture that undermines the contributions of women. This manuscript explores research from sociology, business and medicine through a personal lens. Understanding the way gender influences the complex state of women in medicine suggests changes are needed in the architecture of the modern medical workforce. Individuals, mentors and organizations can make changes that would improve the way that the working environment cultivates a diverse workforce to reach its full potential.

Faculty Equity, Diversity, Culture and Climate Change in Academic Medicine: A Longitudinal Study.

There is a national call for academic medicine to use evidence-based initiatives to improve its culture and climate. The authors report data-driven policy and programmatic interventions that were associated with increased faculty diversity, equity, respectful behavior and improved faculty climate, at UC San Diego Health Sciences. METHODS: Based on demographic and survey data, interventions were designed to improve the climate between 2005 and 2015. Interventions included routine measuring and dissemination of demographic data, changes and dissemination of policy and procedures, and new and improved faculty development programming. Impact was measured using demographic data over time, salary equity studies, and school-wide climate surveys in 2005, 2011, and 2015. Specific outcomes included measures of diversity, salary equity, behavior, and climate. RESULTS: Over the ten-year period, the proportion of women increased from 16% to 23% of tenure/tenure-track faculty and 31%-40% of all faculty. Underrepresented minority faculty increased from less than 1%-7% of tenure/tenure-track faculty and from 5% to 8% of all faculty. While women continued to be paid less than men, the adjusted difference dropped from 23% to 12%. Reports of inappropriate behavior by faculty decreased significantly, while satisfaction and knowledge about institutional mentoring and resources improved. CONCLUSION: Multiple interventions including new faculty development programs, changes in policy, and measuring demographics/climate supported diverse faculty recruitment, enhanced a culture of respect and improved faculty morale. Cultural changes in policy, periodic faculty data collection with dissemination, and increased faculty development, improve the climate in academic medicine.

Traditional and cyber bullying and sexual harassment: A longitudinal assessment of risk and protective factors.

Adolescents engage in bullying and sexual harassment perpetration both in-person and online. Yet, little is known about the overlap of traditional (in-person) and cyber bullying and sexual harassment perpetration. The present study assessed the co-occurrence of these forms of aggression in high school and identified middle school predictors based on participants' perceptions of factors across the social ecology. Racially diverse middle and high school students (n = 3549) were surveyed over four time points from Spring 2008 to Spring 2013. A latent class analysis was used to identify classes of individuals according to endorsement of traditional and cyber bullying and sexual harassment items in high school. Four classes were identified: (1) high all, consisting of traditional and cyber bullying and sexual harassment perpetration (n = 227); (2) traditional bullying perpetration (n = 604); (3) traditional and cyber bullying perpetration (n = 450); and (4) low all (n = 1,261). Students who reported high levels of anger, self-esteem, empathy, pornographic exposure, and traditional masculinity (individual level), lower levels of social support and parental monitoring (relational level), and higher levels of school belonging (community level) had increased odds of being in the high all class when compared to the other classes. Given the co-occurrence of traditional and cyber bullying and sexual harassment, prevention programming that addresses both forms of aggression across traditional and online contexts may be beneficial. This study also suggests the importance of comprehensive prevention efforts that incorporate approaches at the different ecological levels, such as teaching adolescents healthy emotional and interpersonal skills, and engaging parents in prevention.

Poly-Victimization and Peer Harassment Involvement in a Technological World.

This article explores the ways poly-victimized youth (those experiencing multiple different types of victimization over the course of 1 year) use technology to interact with peers. Particular attention is given to the peer harassment victimization and perpetration experiences of poly-victimized youth compared with less victimized and non-victimized youth-both overall and through technology. Data were collected as part of the Technology Harassment Victimization (THV) study; a national survey of 791 youth, ages 10 to 20 across the United States. Study results document the heightened risks that poly-victimized youth experience when interacting with peers. Low and high poly-victimized youth were both at significantly greater risk of being dual victims and perpetrators of peer harassment when compared with non-victimized youth even after taking into account other potentially explanatory factors. This was not found to be the case for less victimized youth. This was true for high poly-victims and technology-involved harassment risk as well. There were indications that poly-victimized youth were interacting with peers in more intense and risky ways in general using new technology. The increase in attention to poly-victimization in recent years has importantly identified the detrimental role that experiencing different forms of victimization have on youth. This study not only adds to that literature but suggests that there is an opportunity to interrupt additional victimization by understanding how poly-victimized youth interact with peers before and during adolescence. Although preliminary, the differences in technology use by poly-victimized youth versus others suggest that more information is needed to understand how they are relating to peers in both positive and risky ways in this environment.

Restorative Justice as the Rx for Mistreatment in Academic Medicine: Applications to Consider for Learners, Faculty, and Staff.

The mistreatment of learners is an ongoing issue at U.S. medical schools. According to responses to the 2017 Association of American Medical Colleges Graduation Questionnaire, 39.3% of medical students nationally reported being mistreated. Many articles have been published on the topic of mistreatment at medical schools over the last 20 years. These articles have focused primarily on the definition of mistreatment, the impact of mistreatment, and initiatives put into place to help mitigate the problem. To date, very little attention has been paid to repairing the harm caused by mistreatment and rebuilding community trust. Academic medicine is in need of new forums of interaction to achieve more positive learning and workplace environments.The authors discuss restorative justice practices and the potential applications that they may have in academic medicine learning and workplace environments to serve vulnerable students, faculty, and staff who are targets of mistreatment. Restorative justice practices are used to convene groups of people to engage in substantive dialogue about consequential issues that impede community functioning. This process can help a group identify and gain mutual understanding of the personal and collective harm that has occurred, create the conditions that incentivize offenders to admit responsibility rather than deny or minimize the harm, and explore and define a set of problem-solving steps to address the harm and rebuild community trust.

Determinants of Intimate Partner Violence in Europe: The Role of Socioeconomic Status, Inequality, and Partner Behavior.

This article presents an analysis of determinants of intimate partner violence (IPV) in the European Union (EU). Based on an EU-wide survey with 42,000 women that examined women's diverse experiences of violence-from violence by strangers to sexual harassment-this article looks specifically at the survey's research with respect to the occurrence of IPV in current partnerships. The analysis explores selected determinants of IPV by focusing on specific indicators in relation to a couple's socioeconomic status, and analyzes inequalities in the sense of unequal distribution of resources. In addition, a partner's behavior outside a relationship, as captured through specific survey questions, is looked at as providing additional evidence of factors that strongly indicate IPV. The results of the article show that, when averaging across the EU Member States, among couples with lower socioeconomic status, there is higher prevalence of violence. In particular, women reporting problems with their household income also report higher rates of IPV. Furthermore, women suffer more often from violence if they do not have an equal say about household income. While reported inequality in income between partners, in the sense of a partner earning more or less than a woman, does not show a consistent result, a woman who reports having less say about the family income is more likely to experience IPV. This result points to the importance of "norm" related inequality compared with actual inequality with respect to IPV, which holds true across all EU Member States. Finally, a partner's behavior-in terms of being violent outside a relationship and frequently getting drunk-shows a strong influence on women reporting incidents of IPV across all countries in the survey.

Prevalence of bullying, discrimination and sexual harassment among trainees and Fellows of the College of Intensive Care Medicine of Australia and New Zealand.

BACKGROUND: Anecdotal reports about bullying behaviour in intensive care emerged during College of Intensive Care Medicine (CICM) hospital accreditation visits. Bullying, discrimination and sexual harassment (BDSH) in the medical profession, particularly in surgery, were widely reported in the media recently. This prompted the College to formally survey its Fellows and trainees to identify the prevalence of these behaviours in the intensive care workplace. METHODS: An online survey of all trainees (n = 951) and Fellows (n = 970) of the CICM. RESULTS: The survey response rate was 51% (Fellows, 60%; trainees, 41%). The overall prevalences of bullying, discrimination and sexual harassment were 32%, 12% and 3%, respectively. The proportions of Fellows and trainees who reported being bullied and discriminated against were similar across all age groups. Women reported a greater prevalence of sexual harassment (odds ratio [OR], 2.97 [95% CI, 1.35-6.51]; P = 0.006) and discrimination (OR, 2.10 [95% CI, 1.39-3.17]; P = 0.0004) than men. Respondents who obtained their primary medical qualification in Asia or Africa appeared to have been at increased risk of discrimination (OR, 1.88 [95% CI, 1.15-3.05]; P = 0.03). Respondents who obtained their degree in Australia, New Zealand or Hong Kong may have been at increased risk of being bullied. In all three domains of unprofessional behaviour, the perpetrators were predominantly consultants (70% overall), and the highest proportion of these was ICU consultants. CONCLUSIONS: The occurrence of BDSH appears to be common in the intensive care environment in Australia and New Zealand.

Sexual harassment victimization in adolescence: Associations with family background.

Sexual harassment has been studies as a mechanism reproducing inequality between sexes, as gender based discrimination, and more recently, as a public health problem. The role of family-related factors for subjection to sexual harassment in adolescent has been little studied. Our aim was to study the role of socio-demographic family factors and parental involvement in adolescent's persona life for experiences of sexual harassment among 14-18-year-old population girls and boys. An anonymous cross-sectional classroom survey was carried out in comprehensive and secondary schools in Finland. 90953 boys and 91746 girls aged 14-18 participated. Sexual harassment was elicited with five questions. Family structure, parental education, parental unemployment and parental involvement as perceived by the adolescent were elicited. The data were analyzed using cross-tabulations with chi-square statistics and logistic regressions. All types of sexual harassment experiences elicited were more common among girls than among boys. Parental unemployment, not living with both parents and low parental education were associated with higher likelihood of reporting experiences of sexual harassment, and parental involvement in the adolescent's personal life was associated with less reported sexual harassment. Parental involvement in an adolescent's life may be protective of perceived sexual harassment. Adolescents from socio-economically disadvantaged families are more vulnerable to sexual harassment than their more advantaged peers.