A Report of Gender Bias and Sexual Harassment in Current Plastic Surgery Training: A National Survey.

BACKGROUND: Gender bias and sexual misconduct continue to pervade medicine. The authors hypothesize that gender bias and sexual misconduct disproportionately and negatively affect female plastic surgery trainees. METHODS: A national survey of plastic surgery trainees (2018 to 2019) was conducted using previously validated sexual harassment surveys adapted for relevance to plastic surgery. Respondents were queried about experiences with workplace gender bias and harassment; personal and professional impact; and reporting practices. Analyses included chi-square, logistic regression, and analysis of variance. Significance was accepted for values of p < 0.05. RESULTS: There were 236 responses (115 female respondents; 20.1 percent response rate). Most respondents were Caucasian (Asian/Pacific Islander, n = 34) residents (n = 123). The feeling of hindrance to career advancement was greater for women, by 10-fold (p < 0.001), and increased with age (p = 0.046). Women felt uncomfortable challenging attitudes regarding gender inequality (p < 0.001), regardless of training levels (p = 0.670) or race (p = 0.300). Gender bias diminished female trainees' career goals/ambition (p < 0.001). Women were more likely to experience sexual harassment, in the form of jokes (p = 0.003) and comments about their body or sexuality (p = 0.014). Respondents reported the majority of perpetrators of harassment to be attending physicians (30 percent) and other trainees (37 percent). Most common reasons to not report incidents included "futility" (29 percent) and "fear" (20 percent). Women experienced at least three symptoms of depression/anxiety, significantly higher than men (p = 0.001). CONCLUSIONS: Gender bias and sexual misconduct negatively affect female trainees' attitudes toward their career. Two-thirds of cases of sexual harassment originate from other physicians. Minority trainees are less prepared to address transgressions and more likely to experience sexual coercion. Trainees perceive a culture nonconducive to reporting. These findings can guide changes and discussions surrounding workplace culture in plastic surgery training.

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.

You have to be twice as good and work twice as hard: a mixed-methods study of perceptions of sexual harassment, assault and women's leadership among female faculty at a research university in the USA.

Introduction: The purpose of this study was to examine the perceptions of institutional policies and practices for the prevention of and response to gender inequities as experienced by female faculty working in the health sciences at a US research university. Methods: Data from the institution's Faculty Campus Climate Survey (n = 260 female faculty) were coupled with qualitative interviews (n = 14) of females in leadership positions, exploring campus climate, and institutional policies and practices aimed at advancing women. Results: Two-thirds (59%) of the female faculty respondents indicated witnessing sexual harassment and 28% reported experiencing sexual harassment. Several organizational themes emerged to address this problem: culture, including cultural change, transparency, and accountability. Conclusions: The findings reveal the ways in which university culture mimics the larger societal context. At the same time, the distinct culture of higher education processes for recruitment, career advancement - specifically tenure and promotion - are identified as important factors that require modifications in support of reductions in gender inequalities.

Gender role attitudes, awareness and experiences of non-consensual sex among university students in Shanghai, China.

BACKGROUND: Non-consensual sex (NCS) among young people, an important subject with public health and human rights implications, was less studied in China. This study is to investigate the NCS awareness and victimization of university students in Shanghai, China and whether they were associated with adolescent gender-role attitudes. METHODS: Gender-role attitudes, awareness and victimization of different forms of NCS were examined among 1099 undergraduates (430 males and 669 females) in four universities in Shanghai using computer-assisted self-interview approach. RESULTS: University students held relatively egalitarian attitude to gender roles. Gender difference existed that girls desired to be more equal in social status and resource sharing while more endorsed the submissiveness for women in sexual interaction than boys. They held low vigilance on the risk of various forms of NCS, with the mean score on perception of NCS among boys (5.67) lower than that among girls (6.37). Boys who adhered to traditional gender norms were less likely to aware the nature of NCS (ß = - 0.6107, p = 0.0389). Compared with boys, higher proportion of girls had been the victims of verbal harassment, unwanted touch, fondling, and penetrative sexual intercourse. Multivariable analysis revealed that girls who held more traditional gender-role attitudes were more vulnerable to physical NCS (OR = 1.41, p = 0.0558). CONCLUSIONS: The weakening but still existing traditional gender norms had contributions in explaining the gender difference on the low vigilance of NCS and higher prevalence of victimization among university students in Shanghai, China. Interventions should be taken to challenge the traditional gender norms in individual and structural level, and promote the society to understand the nature of NCS better as well as enhance negotiation skills of adolescents and young people that prevent them from potentially risky situations or relationships.

A cluster-randomized trial of a middle school gender violence prevention program: Design, rationale, and sample characteristics.

INTRODUCTION: High rates of adolescent relationship abuse (ARA) and sexual violence (SV) reported among adolescents point to the need for prevention among middle school-age youth. This is a cluster randomized controlled trial to test an athletic coach-delivered ARA/SV prevention program in 41 middle schools (38 clusters). Trained coaches talk to their male athletes about 1) what constitutes harmful vs. respectful relationship behaviors, 2) dispelling myths that glorify male sexual aggression and promoting more gender-equitable attitudes, and 3) positive bystander intervention when aggressive male behaviors toward females are witnessed. METHODS: A total of 973 male athletes (ages 11-14, grades 6-8) are participating. Athletes complete surveys at the beginning and end of sports season (Time 2), and one year later (Time 3). The primary outcome is an increase in positive bystander behaviors (i.e., intervening in peers' disrespectful or harmful behaviors); secondary outcomes are changes in recognition of what constitutes abusive behavior, intentions to intervene, and gender equitable attitudes (Time 2 and 3) as well as reduction in abuse perpetration (Time 3). RESULTS: Participating schools have a greater proportion of non-White students and students on free/reduced lunch compared to schools that declined participation. Participants' self-reported ethnicities are 54.5% White, 29.0% Black, 1.4% Hispanic and the remainder, multi-racial, other, or not reported. CONCLUSIONS: This study will evaluate the effectiveness of a coach-delivered ARA/SV prevention program for middle school male athletes. Findings will add to the evidence base regarding developmentally appropriate violence prevention programs as well as the role of coaches in adolescent health promotion. Clinical Trials #: NCT02331238.

'Even though a man takes the major role, he has no right to abuse': future male leaders' views on gender-based violence in Sri Lanka.

BACKGROUND: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. OBJECTIVES: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. METHODS: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. RESULTS: Four categories were developed through the analytic process: fixed gender roles - patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. CONCLUSIONS: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

Association between workplace psychosocial factors and mental health in Black, Hispanic, and White women: Cross-sectional findings from the National Health Interview Survey.

Research evaluating the relation of workplace psychosocial factors to mental health among U.S. women of different racial/ethnic backgrounds is limited. This study investigated the relationship between work-related psychosocial factors and mental health among non-Hispanic Black, Hispanic, and non-Hispanic White women using data from the 2010 National Health Interview Survey. Independent variables of interest included job insecurity, workplace harassment, and work-family conflict (WFC). Multiple Poisson regression models were used to examine the associations between the outcome and independent variables. The prevalence of unfavorable mental health was highest among non-Hispanic Black women (36%) compared to Hispanic (34%) and non-Hispanic White (30%) women. A higher proportion of non-Hispanic Black women reported WFC compared to Hispanics and non-Hispanic Whites (χ2 = 15.50, p < .01), while more Hispanics reported job insecurity (χ2 = 116.81, p < .01). Prevalence of workplace harassment did not differ significantly by race/ethnicity. Odds of unfavorable mental health were significantly higher for women reporting psychosocial work factors. Unexpectedly, a greater association between psychosocial work factors and unfavorable mental health was observed among non-Hispanic White women compared to non-White women; however, caution should be taken in interpreting these cross-sectional results. Future studies should investigate temporal associations and additional psychosocial variables that were not available for use in the current study.

Perception Differences in Ambiguous Forms of Workplace Sexual Harassment: A Comparison between the United States and Turkey.

Certain social-sexual behaviors that could be potentially encountered in workplaces are ambiguous in nature and perceiving them as sexual harassment can depend on the culture. With an aim to delineate the overlap and distinctions of sexual harassment perceptions of such behaviors across samples of women university students from Turkey (TR, N = 215) and the United States (US, N = 209), measurement invariance and latent mean differences in perceiving three ambiguous forms; sexist hostility, sexual hostility, and insinuation-of-interest, were examined. It was hypothesized that the US sample would perceive sexist hostility more sexually harassing as sexist workplace discriminatory practices are emphasized as a form of sexual harassment, and that the TR sample would perceive sexual hostility and insinuation-of-interest as more sexually harassing as women in TR operate in a conservative context. Despite similarities in rank ordering, US participants perceived sexist hostility more sexually harassing; insinuation-of-interest and sexual hostility less sexually harassing than Turkish participants, supporting all three hypotheses. There are implications of differing perceptions across cultures for organizations in terms of disseminating awareness via training programs about the forms of sexual harassment (SH) in a local context and for taking account of local findings in shaping the labor code of countries in relation to SH.

Social, Occupational, and Spatial Exposures and Mental Health Disparities of Working-Class Latinas in the US.

Grounded in ecosocial theory, this paper discusses the mental health disparities of working-class Latinas from multiple perspectives. An overview of working-class Latinas' prevalent mental health disorders, barriers to care and suggestions for interventions and future studies are provided.

High school students' experiences of bullying and victimization and the association with school health center use.

BACKGROUND: Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of school-based bullying and victimization and their use of SHCs. METHODS: Data was analyzed from 2063 high school students in 5 Northern California school districts using the 2009-2010 California Healthy Kids Survey. Chi-square tests and multivariate logistic regression were used to measure associations. RESULTS: Students who were bullied or victimized at school had significantly higher odds of using the SHCs compared with students who were not, and were also significantly more likely to report confidentiality concerns. The magnitude of associations was largest for Asian/Pacific Islander students, though this was likely due to greater statistical power. African American students reported victimization experiences at approximately the same rate as their peers, but were significantly less likely to indicate they experienced bullying. CONCLUSIONS: Findings suggest that SHCs may be an important place to address bullying and victimization at school, but confidentiality concerns are barriers that may be more common among bullied and victimized youth.

Contextualising sexual harassment of adolescent girls in Bangladesh.

Violence against women is a social mechanism confirming women's subordination in many societies. Sexual violence and harassment have various negative psychological impacts on girls, including a persistent feeling of insecurity and loss of self-esteem. This article aims to contextualize a particular form of sexual harassment, namely "eve teasing", experienced by Bangladeshi adolescent girls (12-18 years) which emerged from a study of adolescent sexual behaviour carried out by young people. The study used qualitative methods and a participatory approach, including focus group discussions, key informant interviews and observation. Despite taboos, unmarried adolescents actively seek information about sex, erotic pleasure and romance. Information was easily available from videos, mobile phone clips and pornographic magazines, but reinforced gender inequality. "Eve teasing" was one outlet for boys' sexual feelings; they gained pleasure from it and could show their masculinity. The girls disliked it and were afraid of being blamed for provoking it. Thus, "eve teasing" is a result of socio-cultural norms relating to sexuality, as well as a lack of access to sexual and reproductive health information and services in Bangladesh. These findings underscore the importance of comprehensive sexuality education that goes beyond a mere health focus and addresses gender norms and helps youth to gain social-sexual interaction skills.

La violencia ocupacional en centros de atención primaria de la salud / Workplace violence in primary care

La violencia laboral es un fenómeno creciente en el sectorsalud que se manifiesta en diversas formas: acoso, agresiónfísica, sexual y psicológica. En centros de atención primariaeste problema ha sido menos estudiado que en hospitales.El objetivo fue determinar la presencia de situaciones deviolencia laboral a la que están expuestos trabajadores deatención primaria de la ciudad de Córdoba. Se diseñó unestudio exploratorio de corte transversal. La muestra fue de183 trabajadores, escogidos aleatoriamente. Se aplicó uncuestionario autoadministrado. Los encuestados reconocieronsituaciones de violencia en un 64,1%. Los gritos (65,1%) ylos insultos (55,1%) fueron las principales manifestaciones.Los agresores externos identificados más frecuentementeson los familiares y/o acompañantes de pacientes (80,1%) ycomo agresores internos los trabajadores con mayor jerarquía(46,4%). Se concluye que los trabajadores de atenciónprimaria reconocen frecuentemente la presencia de violencialaboral, siendo las más percibidas las de tipo psicológico

Risk of sexually transmitted infections and violence among indoor-working female sex workers in London: the effect of migration from Eastern Europe.

OBJECTIVES: To examine risk factors associated with HIV and sexually transmitted infections (STIs) and experience of physical and sexual violence among sex workers in London, with a particular focus on differences in risk between migrants from Eastern Europe (EE) or the Former Soviet Union (FSU) and UK-born sex workers. METHODS: The authors conducted a cross-sectional survey of sex workers born in the UK, EE or FSU (n = 268), collecting behavioural data, testing for antibodies to HIV and Treponema pallidum, and testing for infection with Chlamydia trachomatis or Neisseria gonorrhoea. FINDINGS: Migrants were younger, saw more clients, and were less likely to use contraception; few reported being coerced into sex work. Overall, prevalence of HIV was 1.1% (95% CI -0.1% to 2.4%), prevalence of syphilis was 2.2% (95% CI 0.4 to 4.0%), and prevalence of infection with chlamydia or gonorrhoea was 6.4% (95% CI 3.2% to 9.6%). Risk factors associated with any infection included having no contact with an outreach worker, age, and having a non-paying sex partner. Increased risk of physical violence from clients was associated with a history of imprisonment or arrest and having a non-paying sex partner. CONCLUSION: Findings suggest an association between outreach services and reduced risk of STIs and between having non-paying partners and increased risk of STIs. Findings also suggest an association between enforcement policies, such as arrest or imprisonment, and drug use and increased risk of physical violence. Interventions are needed to expand outreach, improve uptake of contraceptives for migrants, and reduce levels of violence for all women.

Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the 'inverse hazard law'.

BACKGROUND: Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations. METHODS: A cross-sectional study (2003-2004) of 1202 workers employed at 14 worksites in the greater Boston area of Massachusetts investigated the independent and joint association of occupational, social and relationship hazards with psychological distress (K6 scale). RESULTS: Among this low-income cohort (45% were below the US poverty line), exposure to occupational, social and relationship hazards, per the 'inverse hazard law,' was high: 82% exposed to at least one occupational hazard, 79% to at least one social hazard, and 32% of men and 34% of women, respectively, stated they had been the perpetrator or target of intimate partner violence (IPV). Fully 15.4% had clinically significant psychological distress scores (K6 score ≥ 13). All three types of hazards, and also poverty, were independently associated with increased risk of psychological distress. In models including all three hazards, however, significant associations with psychological distress occurred among men and women for workplace abuse and high exposure to racial discrimination only; among men, for IPV; and among women, for high exposure to occupational hazards, poverty and smoking. CONCLUSIONS: Reckoning with the joint and embodied reality of diverse types of hazards involving how people live and work is necessary for understanding determinants of health status.

[Rape and transgression. Forensic medicine and sexual morality in Spain in the 19th century]. / Violación y transgresión. Medicina forense y moral sexual en la España del siglo XIX.

The purpose of this paper is to analyse the importance of the contribution of the Spanish forensic medical discourse in the 19th century, and its application in cases of sexual harassment, to legitimize the sexual moral value of the time. For that reason we will analyse the main forensic medicine treaties edited in Spain during this century.

Understanding adolescent peer sexual harassment and abuse: using the theory of planned behavior.

This study examines intentions to take protective action against peer sexual harassment and abuse (PSHA). The theory of planned behavior (TPB) proposes that attitudes about protective action, perceptions of what others would think about doing this (subjective norms), and behavioral control would be important predictors. A total of 1,531 Chinese secondary school students (769 boys and 762 girls) from Hong Kong were surveyed to test this model. Results showed that the TPB model was predictive for girls, but only subjective norms and behavioral control significantly predicted boys' intentions to protect themselves. Results supported the influence of subjective norms and perceived behavioral control on youths' intentions to reject PSHA. These factors may be useful in guiding the development of an educational program for prevention of PSHA.

Examining the sexual harassment experiences of Mexican immigrant farmworking women.

This study examined sexual harassment experiences of Mexican immigrant farmworking women (n = 150) employed on California farms. Of the estimated one million California farmworkers, 78% are Latino, mostly from Mexico, and 28% are women. Unlike gender-segregated worksites of Mexico, women farmworkers in the United States labor alongside men, facilitating harassment from coworkers and supervisors. Simultaneous sexist, racist, and economic discrimination are comparable to converging lanes of automobile traffic (Crenshaw, 2000) that women, standing at the intersections, manage to avoid harm. Findings highlight how discrimination shapes women's experiences and demonstrate the need for institutional policies to protect them.