The Impact of Verbal Abuse, Sexual Harassment and Sexual Assault at Work: An Investigation into the Health of Flight Attendants in the Harvard Flight Attendant Health Study

Abstract

BACKGROUND: Sexual harassment and other types of workplace abuse are frequently experienced by workers worldwide and are related to adverse mental health outcomes and injuries. Flight attendants are an understudied occupational group and are susceptible to experiencing harassment due to working in a feminized, client-facing occupation with few protections or sanctioned responses against aggressive behaviors. In our study, we investigated the relationship between workplace verbal abuse, sexual harassment or sexual assault and health outcomes in a cohort of cabin crew. We also aimed to characterize perpetrator profiles according to type of abuse. METHODS: Among 4,459 participants from the Harvard Flight Attendant Health Study, we examined associations between episodes of workplace harassment or abuse in the past year (overall and by frequency of episodes) and a range of health outcomes using multivariate logistic regression. FINDINGS: We report that exposures to verbal abuse, sexual harassment and sexual assault are common among cabin crew, with rates of 63%, 26% and 2%, respectively, in the past year alone. Workplace abuse was associated with depression, sleep disturbances, and musculoskeletal injuries among male and female cabin crew, with a trend towards increasing odds ratios (ORs) given a higher frequency of events. For example, sexual harassment was related to an overall increased odds for depression (OR=1.91, 95% confidence interval [CI]: 1.51-2.30), which increased in a dose response-like manner among women who reported harassment once (OR=1.44, 95% CI: 0.93-1.95), 2-3 times (OR=1.83, 95% CI: 1.29-2.38), and 4 or more times (OR=4.12, 95% CI: 3.18-5.06). We found that passengers were the primary perpetrators of all types of abuse. INTERPRETATION: Our study is the first to comprehensively characterize sexual harassment and its relation to health in a largely female customer-facing workforce. Future research should track findings longitudinally and should compare results across professions. Funding: Flight Attendant Medical Research Institute. Declaration of Interest: The authors have no conflicts on interest to declare. Ethical Approval: This research was approved the Harvard T.H. Chan School of Public Health’s Institutional Review Board. All participants provided their written informed consent prior to enrollment in the study.