The Journal of Public Health Management and Practice understands and respects the critical importance of inclusive language in reporting race and ethnicity in scientific writing and strives to adhere to the guidance of the AMA Manual of Style, which has recently updated its recommendations to reflect fairness, equity, consistency, and clarity in the literature. Clear, precise word choice and usage are essential for writers and editors of scientific publications.

As Stacy L. Christiansen reports here, the stylebook committee undertook an intensive reassessment process in the spring of 2020, publishing an initial revision of the manual’s section on Inclusive Language (Section 11.12.3) as an editorial in JAMA in February 2021. After inviting feedback from reviewers, scholars, and researchers, the committee performed another round of research, revision, and review, and produced the updated guidance, reported in JAMA on August 17, 2021. 

While the stylebook committee acknowledges that terminology will continue to change as usage and understanding evolve, definitions of commonly used terms to describe race and ethnicity have been clarified. The following is a summary of notable recommendations:

• 1.  Language must be clear and precise and reflect fairness, equity, and consistency in the reporting of race and ethnicity.
  2. The committee recommends capitalizing all racial and ethnic categories (eg, Black, White) except in situations that may be deemed as inappropriate (eg, “white supremacy”) in which case, discretion is advised to vary from guidance.
  3. The committee recommends no longer using the construction “race/ethnicity” since a slash indicates “and/or,” which can cause confusion. Instead, it recommends “race and ethnicity.”
  4. Do not use race and ethnicity as nouns to label people. Any discussion of race and ethnicity should be done using modifiers (eg, Asian patient, Black individual) or predicate adjectives, also referred to as “person-first language” (eg, patients who are Asian or Black). Do not hyphenate terms such as Asian American, African American, Mexican American, and similar combinations, and in compound modifiers (eg, African American patient).
  5. Race and ethnicity categories should be listed in alphabetical order, not according to order of proportion.
  6. Geographic origin associated with racial and ethnic designations is important. Careful attention should be given to specificity that avoids broad categories that lump together numerous regions, countries, or populations. When possible, a more specific term is preferred. Awareness of the relevance of terms and usage is also vital (eg, the term Caucasian is no longer considered appropriate to indicate the term White as it’s technically specific to people from the Caucasus region in Eurasia.) Depending on how information is collected, certain terms may or may not be used interchangeably.  
  7. Avoid abbreviations of categories for race and ethnicity. In instances such as unavoidable space constraints in tables or figures, terms should be defined in footnotes.
  8. Do not use the terms minority or minorities as nouns as they may be inaccurate or stigmatizing. When appropriate, use a modifier (eg, “racial and ethnic minority groups”). The term minoritized may be used as an adjective (eg, “racial and ethnic minoritized group”). Marginalized may be suitable at times as long as it is clearly explained (eg, “groups that have been historically marginalized”).
  9. Unless it was specifically used in data collection, avoid using the term mixed race as it may carry negative connotations. If used in data collection, provide a clear explanation. Multiracial and multiethnic may be acceptable if the terms comprising specific categories are defined. If study participants self-identified with more than 1 entry on a form, “more than 1 race and ethnicity” may be acceptable. It’s important that these terms include a clear understanding of how data on race and ethnicity were collected.
  10. Avoid statistical comparisons of White vs “non-White” in favor of more precise reporting. If a comparison is justified, explain the rationale and specify categories included in the “non-White” group.
  11. Avoid the catchall term “other” by being as specific as possible when reporting racial and ethnic categories. It’s not necessary to report specific data in such instances when they may potentially identify study participants; however, this information should be noted. If “other” is used but not defined, further explanation should be included.
  12. Terms such as people of color, BIPOC (Black, Indigenous, and people of color, and BAME (Black, Asian, and minority ethnic) may be “too inclusive” and thereby minimize differences among groups. The committee suggests that while these terms may be used in opinion articles, the preference is always to describe or define specific racial or ethnic categories in research reports unless the terms are included in a database on which a study is based or specified in a research data collection instrument such as a survey questionnaire.
  13. Underserved (eg, disparities among groups) or underrepresented (eg, a disproportionately low number of individuals in a particular program) may be used provided the categories of individuals included are defined at first mention.

While this list is not intended to provide a complete summary of the stylebook committee’s recommendations, we encourage authors, editors, and publishers to pay careful attention to language and usage to reduce unintentional bias and to consult the AMA for a more comprehensive explanation of the updated guidance.

For the most complete and updated guidance for reporting race and ethnicity in research writing, please consult the AMA Manual of Style, available here.