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Correct and Preferred Usage

Roxanne K. Young

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PRINTED FROM AMA MANUAL OF STYLE ONLINE ( © American Medical Association, 2009. All Rights Reserved. Under the terms of the license agreement, an individual user may print out a PDF of a single chapter of a title in AMA Manual of Style Online for personal use (for details see Privacy Policy and Legal Notice).

Subscriber: null; date: 21 June 2018


UPDATE: We will discontinue using quotation marks to identify parts of an article, but retain the capitalization; eg, This is discussed in the Methods section (not the “Methods” section). This change was made February 14, 2013.

Race is defined as “a category of humankind that shares certain distinctive physical traits.”19 Ethnicity relates to “groups of people classed according to common racial, national, tribal, religious, linguistic, or cultural origin or background.”19

Like gender, race and ethnicity are cultural constructs, but they can have biological implications. Caution must be used when the race concept is described in health-related research. Some have argued that the race concept should be abandoned, on the basis of the scientific evidence that human races per se do not exist. Others argue for retaining the term but limiting its application to the social, as opposed to the biological, realm.

A person’s genetic heritage can convey certain biological and therefore medically related predispositions (eg, cystic fibrosis in persons of Northern European descent, lactose intolerance in persons with Chinese or Japanese ancestry, Tay-Sachs disease in persons with Jewish Eastern European ancestry, sickle cell disease seen primarily in persons of West African descent).

Specifying persons' race or ethnicity can provide information about the generalizability of the results of a specific study. However, because many people in ethnically diverse countries such as the United States, Canada, and some European, South American, and Asian nations have mixed heritage, a racial or ethnic distinction should not be considered absolute, and it is often based on a person’s self-designation.

JAMA and several of the Archives Journals indicate the following in their instructions for authors:

If race and/or ethnicity is reported, indicate who classified individuals as to race/ethnicity, the classifications, and whether the options were defined by the investigator or the participant. Explain why race and/or ethnicity was assessed in the study. See also Winker MA. Measuring race and ethnicity: why and how? JAMA. 2004;292(13):1612-1614.

A manuscript’s Methods section is a good place in which to explain how persons were classified according to race/ethnicity. Authors should explain and justify the inclusion or exclusion of certain groups. Following are some examples from manuscripts' Methods sections.


Categorization of Race/Ethnicity

Individuals were categorized on the basis of self-reported race/ethnicity. Individuals were categorized as non-Hispanic, non-Jewish white (white); Ashkenazi Jewish (Jewish); African American; Hispanic; or Asian. Because of the unique spectrum and frequency of BRCA1 and BRCA2 mutations that occur in Ashkenazi Jewish individuals, these persons were analyzed separately from other whites.


Study Participants

Race or ethnicity was self-reported by the parents of the children from a list including non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American (including Alaskan), biracial or multiracial (specify), or other (specify).


Participants and Measures

Participants were asked to self-identify their race with the question, “Do you consider yourself to be primarily white or Caucasian, black or African American, American Indian, Asian, Hispanic or Latino, or something else?” We combined American Indian, Asian, and other categories into “other” because of the small numbers in those categories. We considered all participants to be Hispanic regardless of whether they also identified themselves as white, black, or other.


Study Population

Race was determined by self-identification and for analysis was categorized as African American or non–African American. Non–African American cases were predominantly white but also included 14 women who reported their race as Native American, Hispanic, Asian American, or multiracial. Information on race was obtained because a primary goal of the study was to better understand breast cancer in African American women.

When mention of race or ethnicity is relevant to an understanding of scientific information, be sensitive to the designations that individuals or groups prefer. Be aware also that preferences may change and that individuals within a group may disagree about the most appropriate designation. For terms such as white, black, and African American, manuscript editors should follow author usage.

Exception: Despite the example given above, Caucasian is sometimes used to indicate white but is technically specific to people from the Caucasus region in Eurasia and thus should be avoided.

In the United States, the term African American may be preferred to black (note, however, that this term should be allowed only for US citizens of African descent). A hyphen is not used in either the noun or adjectival form (see also When Not to Use Hyphens in 8.3.1, Punctuation, Hyphens and Dashes, Hyphen).

In reference to persons indigenous to North America (and their descendants), American Indian is generally preferred to the broader term Native American, which is also acceptable but includes (by US government designation) Hawaiian, Samoan, Guamanian, and Alaskan natives. Whenever possible, specify the nation or peoples (eg, Navajo, Nez Perce, Iroquois, Inuit).

Hispanic and Latino are broad terms that may be used to designate Spanish-speaking persons as well as those descended from the Spanish-speaking people of Mexico, South and Central America, and the Caribbean. However, the terms are not interchangeable, since Latino is understood by some to exclude those of Mexican or Caribbean ancestry. In either case, these terms should not be used in noun form, and when possible, a more specific term (eg, Mexican, Mexican American, Latin American, Cuban, Cuban American, Puerto Rican) should be used.

Similarly, Asian persons may wish to be described according to their country or geographic area of origin, eg, Chinese, Indian, Japanese, Sri Lankan. Note that Asian and Asian American (Chinese and Chinese American, and so on) are not equivalent or interchangeable. Do not use Oriental or Orientals.

Note: Avoid using “non-” (eg, “white and nonwhite participants”), which is a nonspecific “convenience” grouping and label. Such a “category” may be oversimplified and misleading, even incorrect. Occasionally, however, one sees these categorizations used for comparison in data analysis. In such cases, the author should be queried. Multiracial and people of color are sometimes used in part to address the heterogeneous ethnic background of many people.

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