Do Changes Actually Create Change?

Amanda Ehrhardt, MA, JAMA Network

Part of the purpose of the AMA Style Insider is to report on changes made in the AMA Manual of Style that aim to improve not only the editing process but also advance ethics and equity in medical publishing. Changes are not made arbitrarily but as a result of many experts building consensus on what represents best practices, and they’re made to create a widespread standard.

However, the manual can only release these standards to the world–what requires more follow up is whether the changes are actually implemented in publishing and how successful they are in creating new standards.

This year, in JAMA Network Open, several JAMA Network editors and staff published a cross-sectional study1 that examined race and ethnicity reporting across 3 JAMA Network journals before (January to March 2019 and May to July 2021) and after (January to March 2022) the implementation of the Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals2 in August 2021 (which was based on revisions made to 11.12.3 of the style guide).

Among the key takeaways were that the number of articles that reported race and ethnicity information for study participants increased by 10.4% from 2019 to 2022, more articles reported participants’ age or sex and gender, and the number of articles that defined categories included in the term “other” increased 58.1% from 2019 to 2022.

Additionally, the number of articles that listed racial and ethnic group categories by alphabetical order increased by 75.9% between 2021 and 2022, and there was a 24.1% increase in the number of articles that defined how race and ethnicity were determined.

Although this study had limitations (which are clearly stated in the article) and more improvement is needed, these results seem encouraging that AMA Style Manual updates are not made just to alter the day-to-day of editors across medical publishing, but to potentially create real and lasting change.

References

  1. Flanagin A, Cintron MY, Christiansen SL, et al. Comparison of reporting race and ethnicity in medical journals before and after implementation of reporting guidance, 2019-2022. JAMA Netw Open. 2023(6):e231706. doi:10.1001/jamanetworkopen.2023.1706
  2. Flanagin A, Frey T, Christiansen SL, et al. Updated guidance on the reporting of race and ethnicity in medical and science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304

September 5, 2023.

The AMA Garden of Hyphens

Timothy Gray, PhD, JAMA Network

If your professional life requires adherence to AMA style, you may have gotten lost in the weeds styling hyphenated compounds in titles. No capitalization after a hyphen if a prefix or a suffix, if both parts are considered a single word (requiring a field trip to Merriam-Webster), if the compound is temporary, or if the parts do not carry equal weight.

I have long wondered how parts of a compound carry weight, which isn’t to say that I don’t like the idea. As a practical suggestion, though, it lacks a little, uh, practicality.

If you think of a compound as an entity on its own, any word that may carry weight because of its particular part of speech loses that identity (and drops the weight!) when it gets pulled into that magical realm of a hyphenated compound (all adjectives all the time). So “Short-term Effects” and “Full-time Coverage” have always read as weird to me, especially if they have appeared near “Early-Onset Disease.”

How fitting, then, that the AMA Manual of Style has finally addressed the weed problem with hyphenation. No need to kill them. We can just get them out of our way. Let the weeds live happy lives in some other organization’s style manual.

The new guidance in 10.2.2 reads “In titles, subtitles, and text headings, capitalize both parts of a hyphenated compound.” Hence, “Short-Term Effects” and “Full-Time Coverage.” Take a look in the online manual for more information and other new style guidance.

Now when you review capitalization in titles with hyphenated compounds to align with AMA style, you needn’t make excursions to other sources. You can stay in the AMA garden without getting lost in the weeds.

Published August 1, 2023.

Style vs Substance—Is There Room for Both?

Peter J. Olson, ELS, JAMA Network

There’s a scene in the film Pirates of the Caribbean: The Curse of the Black Pearl in which the heroine, Elizabeth, is taken captive by the infamous Captain Barbosa aboard his ship. In an attempt to negotiate her release, she invokes the Pirates Code, a set of rules to which she knows Barbosa is beholden. Barbosa initially appears to comply, then abruptly reneges. When Elizabeth protests his disregard for the Code, Barbosa defends his decision with a snide retort:

“The Code is more what you’d call guidelines than actual rules.”

His deviousness aside, the Captain has a point. As humans, we have an innate tendency to create rules with the intent of establishing order and certainty, yet those rules are occasionally subject to exceptions, inapplicability, and multiple interpretations. Try as we might, it’s virtually impossible to anticipate every possible scenario and account for it, which means there will be times when the rules we make for ourselves simply do not apply—and editorial style rules are no exception.

The question is: does style always supersede substance?

The AMA Manual of Style is a renowned and authoritative reference manual, and for good reason. It’s a meticulously crafted, oft-updated repository of linguistic and stylistic information steeped in authentic medical language and policy, and the guidance within its pages is critical to physicians, authors, and editors alike.

In that sense, the argument could be made that when it comes to the AMA Manual, style is substance. However, as editors, we at times find ourselves in scenarios in which adhering to a particular style point is akin to the proverbial placement of a square peg in a round hole. The gadget doesn’t quite fit into the device, and the results can be ugly. It’s those circumstances in which the absence of a peg may be preferable to the sight of a horribly splintered one.

What’s more, rules are almost always subject to change, and depending on the impetus behind an amendment, it can take the purveyors of a style manual weeks, months, even years to discuss and formulate a responsible and sustainable update before disseminating it to the manual’s users.

Take the topic of race and ethnicity language (Chapter 11.12.3), which continues to evolve at an unprecedentedly rapid pace—enough so that the requisite section in the AMA Manual was updated less than a year after the release of the 11th edition.1 Language and terms that may have been deemed acceptable just months previously may shift suddenly, and the intuitive and attentive editor may need to set aside current style guidelines to align with cultural and/or societal trends.

That said, style deviations should be made only after careful consideration of the potential ramifications, especially those involving reader perception. In other words: if you’re going to deviate from style, you’d better have a really good explanation ready.

Authors are often quick to point out style infractions in previously published material, either to defend their own infringements or to object to style-adherent edits (“If this author got to do it, why can’t I?”), and trivial or inexplicable noncompliance can undermine the authority of your style manual as well as your publication. If you can’t justify a style detour that goes beyond “I just thought it sounded better that way,” you probably shouldn’t take it.

Fictional though he may be, I expect that Captain Barbosa fully honors the Pirates Code—he is a pirate, after all. Yet even he knows to adapt the rules when necessary to achieve his goals. This is not to suggest that editors should swashbuckle their way through a manuscript, playing fast and loose with the style rules they’ve sworn to uphold. Those rules are there for a reason, and they wouldn’t exist if they didn’t almost always apply.

However, absolutism is fraught with its own perils, and the astute editor must be mindful of those rare situations in which a rule may need to be bent—or perhaps broken—for the greater good. And although there’s no single, comprehensive answer to the question of whether and when to sacrifice style for substance, if preserving the integrity of a publication is given precedence, the answers will at least be easier to identify.

Reference

  1. Frey T, Young RK. Race and ethnicity. In: Christiansen SL, Iverson C, Flanagin A, et al, eds. AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:545-547.

Hawaiian Diacritics

Miriam Cintron, BA, JAMA Network

https://decolonialatlas.wordpress.com/2015/06/03/the-hawaiian-islands/

The islands of Hawaiʻi and its people have a culture rich in history, traditions, and the Native Hawaiian language.

Sadly, use of the Native Hawaiian language began to decline in 1896, when it was banned from schools just 3 years after the Hawaiian monarchy was overthrown.1 Without being taught in schools, the Native Hawaiian language became dangerously close to being completely forgotten. By the early 1980s, fewer than 50 children spoke the language.2

A resurgence in cultural pride and identity in the 1970s led to the resurgence of many Native Hawaiian cultural traditions, including the language.

With this in mind, the AMA Manual of Style strives to be accurate, fair, and respectful in reflecting the identities of individuals and groups. The Manual is adding 2 diacritical marks used in Native Hawaiian to the Accent Marks (Diacritics) section (chapter 12.2).

The okina (ʻ) is a glottal stop and the kahakō is a macron (ā) that lengthens and adds stress to the marked vowel.

The marks are used throughout the language, including in many of the names of the main Hawaiian islands (eg, Hawaiʻi, Kahoʻolawe, Kauaʻi, Lānaʻi, Molokaʻi, Niʻihau, and Oʻahu).

Note that Hawaiʻi has 2 official languages according to the state constitution: English and Hawaiian.3 “Hawaiian” is considered an English word, so it doesn’t take the okina.

  1. Hawaii State Department of Education. History of Hawaiian education. Accessed January 19, 2022. https://www.hawaiipublicschools.org/TeachingAndLearning/StudentLearning/HawaiianEducation/Pages/History-of-the-Hawaiian-Education-program.aspx
  2. The Hawaiian Islands. The Hawaiian language. Accessed January 19, 2022. https://www.gohawaii.com/hawaiian-culture/hawaiian-language-guide
  3. The Constitution of the State of Hawaii. Article XV. Accessed January 22, 2022. https://lrb.hawaii.gov/constitution#articlexv

Updated Guidance on Reporting Race and Ethnicity: Let’s Start With the Why

Kim Penelton Campbell, BS, JAMA Network

I have used many adjectives to describe myself, but I’ve never referred to myself as other. When teachers called my name during morning attendance, I responded by saying “Here.” I never said, “Invisible.”

In medical literature, the failure to fairly and respectfully recognize and include individuals of all races and ethnicities can severely adversely affect patients’ lives and the quality of care they receive. It can misinform clinicians. It can compromise the credibility of a journal.

This means that race and ethnicity data should be reported in a way that encourages fairness, equity, consistency, and clarity in medical and science journals.1

Changing the b in Black and the w in White to uppercase lettering when describing race is not about mere political correctness—these changes are part of a conscientious movement toward equitable delivery of health care services to all people.

The objective of this post is to emphasize that updated guidance about the reporting of race and ethnicity is important, not because the AMA Manual of Style says so, but because inattentiveness to these changes can contribute to unconscious bias and ultimately affect how patients are treated or unintentionally mistreated.

Bias, when unintentional, is not mitigated—it remains bias all the same. Unintentional bias can occur simply because the writer or editor is removed from the patient’s life experience. When the writer or editor is unaware, they may not recognize how insensitive wording can affect the reader.

Example: “Adherence to the prescribed medication was higher among White patients than among Blacks.”

Consequence: Does this mean that if you are White you are a patient but if you are Black you are nothing? What is a Black?

When a person is called a Black instead of a Black patient or a patient who is Black, the wording detracts from that person’s humanity.

Likewise, use of lowercase lettering for Black and White, as well as referring to people as minorities instead of as members of a racial or ethnic minority group, also diminishes their humanity. Stating race or ethnicity in noun form can be interpreted pejoratively and is akin to labeling patients by their disease (eg, the blind, schizophrenics, epileptics) instead of putting the individual first (eg, a person with schizophrenia).2 Other things that can be interpreted pejoratively and should be avoided are using the term mixed race, which can carry negative connotations, instead of multiracial or multiethnic, merging race and ethnicity with a virgule (ie, race/ethnicity) rather than recognizing the numerous subcategories within race and ethnicity with the term race and ethnicity, and using abbreviations for racial and ethnic terms. Although the writer or manuscript editor may not have intended to negatively portray a group of people, the potential effect on readers remains unchanged.

  • To potential authors, the absence of a single word can indicate that a journal is insensitive to the health care needs of a population of patients.
  • To clinicians with the same racial or ethnic background as the one negatively represented, this can promote the inference that the journal has no diversity on its editorial board or staff.
  • To a practicing physician, this language can translate to offensive or insensitive communication when speaking with a patient or a patient’s family member.
  • To a patient, this wording can indicate that the medical community views individuals from their racial or ethnic group as nonpersons—unseen, unconsidered, and uncared for.
  • For all of these individuals, this can deepen a sense of mistrust.

Language that excludes a racial or ethnic group can subtly influence a medical trainee to “unsee” the humanity in people who are from a different background. If their research and educational sources are written or edited without intercultural competence, the medical trainee may unintentionally miscommunicate or make incorrect assumptions about patients from other backgrounds. This breach can interfere with a clinician’s understanding of the patient and, in response, impede the patient’s trust in the clinician.

Among some patients from communities that have been medically underserved or ignored, information about medical mistreatment can transcend generations. Past miscommunication can lead to mistrust, which can then lead to fear.

A family may never forget that Grandma never came home from the hospital and that no clinician took the time to explain why. Although this family was made to feel invisible because of miscommunication, it is quite possible that the clinician intended no disrespect and had no knowledge of how the family was affected. A patient with a historic burden of oppression can potentially interpret disrespectful communication as an initial step down the road to medical abuse.

My godfather once expressed such fear. He was Black, the clinicians were White, and he had grown up in Mississippi during the 1940s. Although I asked, he refused to ever repeat details of what was said by these physicians many years ago. But decades later, when I was a teenager and a novice driver, my godmother phoned and urgently asked that I come to their home immediately to rush him to our local VA hospital.

On my arrival, she exclaimed, “I think he had a heart attack while gardening in the back yard!” I said, “I’ll call 911. The ambulance will get him there faster.” Then, she stopped me. She pleaded that I drive him there myself. As I rushed to his aid, she continued by telling me that he would die of fear if an ambulance came to their home. She told me that I must speak for him when we arrived, remain by his side, and do everything in my power to keep him calm.

He cried like a baby during the entire ride. He was afraid. He was humiliated about expressing fear in my presence. I did not know what to say. I just kept driving. My heart was broken.

This brief story is an example of deep-seated fear that some Black people experience in a health care setting, a fear that can only begin to be abated with a conscientious effort to ensure that language humanizes Black patients and patients from all racial and ethnic backgrounds.

How does one address suboptimal reporting on race and ethnicity?

  • First, follow the guidelines.
  • Second, write and edit with a raised antenna. Look for what is unsaid in addition to what is written on the page.
  • Try to interpret as if you are a person from a racial or ethnic group unlike your own. Think about how you would you feel as the subject or nonsubject of the article.
  • Consider how wording can be misinterpreted.
  • Consider how inattentiveness to detail can affect the health, safety, or life of someone who is misrepresented.
  • Edit responsibly, but without fear of respectfully questioning the author.

Remember: no one is invisible, and no one is other.

“Not everything that is faced can be changed, but nothing can be changed unless it is faced.”3

James Baldwin

References

  1. Flanagin A, Frey T, Christiansen SL; AMA Manual of Style Committee. Updated guidance on the reporting of race and ethnicity in medical science journals. JAMA. 2021;326(7):621-627. doi:10.1001/jama.2021.13304
  2. Christiansen SL, Iverson C, Flanagin A, et al, eds. Correct and preferred usage. In: AMA Manual of Style: a Guide for Authors and Editors. 11th ed. Oxford University Press; 2020:547-548.
  3. Baldwin J. As much truth as one can bear. New York Times. January 14, 1962: Book review 1, 38. https://www.nytimes.com/1962/01/14/archives/as-much-truth-as-one-can-bear-to-speak-out-about-the-world-as-it-is.html

Abbreviating the Pandemic

If you’ve followed AMA style for at least the last several years, you may remember this big (welcome) announcement:

The companion abbreviation “AIDS” was given expansion-exempt status even before this with the 2007 publication of the 10th edition. It took some time for HIV to catch up.

Why did we decide that these 2 abbreviations no longer needed expansion? For one, they are ubiquitous, instantly recognizable (at least to English-reading audiences), and are long and cumbersome to write out in full.

After more than a year of publishing coronavirus-related content (JAMA’s first article was published in January 2020 by Fauci and colleagues), the AMA Manual committee has determined that COVID-19 and SARS-CoV-2 meet those same criteria to forgo expansion: ubiquity, familiarity, and cumbersome expansions.

  • Before: Protection against coronavirus disease 2019 (COVID-19) is mediated in large part by an immune response directed against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein.
  • After: Protection against COVID-19 is mediated in large part by an immune response directed against the SARS-CoV-2 spike protein.

While we all hope to soon have this pandemic in our collective rearview mirror, it is not likely that we will forget coronavirus disease 2019 or severe acute respiratory syndrome coronavirus 2.–Stacy Christiansen, Chair, AMA Manual of Style

Citing Online Journal Articles and Data from Repositories

The new edition of the AMA Manual of Style is here, and it has nearly 200 more pages on everything from reference citations to the ethical and legal issues associated with medical publishing.

If the amount of new content seems overwhelming, may I suggest starting with the basics?

I dove in by reviewing the References chapter.

Online Journal References

According to section 3.11.4, “Online Journal Articles, Preprints, and Manuscripts,” the basic components of an online journal reference haven’t changed: authors’ surnames and initials, the title of the article, abbreviated name of the journal, publication year, pagination, the date the article was accessed, and the DOI or URL.

What has changed it that the date accessed should now be listed before the DOI or URL, and the URL is not followed by a period.

Data Repositories

I’ve also edited a few articles that included an analysis of data sets from a repository. Data repositories serve as archives for isolated data sets that allow data to be mined for secondary use in research. In a situation like this, the data set used and the original source for the data should be cited.

In the example shown below, the information for the original source for the data is listed first, followed by the name of depository, the date of data deposit, and the DOI for the data set.

DeLeon TT, Almquist D, Kipp BR, et al. Data from: Assessment of clinical outcomes with immune checkpoint inhibitor therapy in melanoma patients with CDKN2A and TP53 pathogenic mutations. Dryad Digital Repository. Deposited March 12, 2020. doi:10.5061/dryad.m0cfxpp0g

Accurate references are a critical element of any published article. The updated guidelines on references ensure that readers are directed to additional resources for more information.—Juliet Orellana

Preprints in the Time of COVID

Fans of the 1985 Gabriel García Márquez novel Love in the Time of Cholera are all too familiar with the concept of pining over something long desired, but luckily for medical editors, the 11th edition of the AMA Manual of Style has been quick to provide necessary and accessible updates for editors to use during the time of coronavirus disease 2019 (COVID-19).

The worldwide effort to provide research on COVID-19 has led to a substantial emerging literature, and many study results and manuscripts have been posted on preprint servers prior to peer-reviewed publication. Thus, medical editors who are working with COVID-19 articles may find that more authors are citing sources from preprint servers, leading to references that are, just like Florentino Ariza’s love life, a bit…complicated.

However, medical editors will not need to inhabit a world of magical realism to solve this dilemma. They only have to refer to the recent update to chapter 3.11.4.1, Preprint and Publication of Unedited Manuscripts. In it, they’ll find that many of the things that made citing these sources cumbersome, such as duplicative ID numbers, have been removed and that the order of elements is similar to other, perhaps more familiar, references.

This update hopefully makes life easier for medical editors during a high-volume time. It may even leave more time for reading for pleasure! I can make a great book suggestion 😉–Amanda Ehrhardt

An Interview With AMA Manual of Style Committee Member Connie Manno

With the recent release of the 11th edition of the AMA Manual of Style, I was curious to learn more about the members of the style committee, their background, and their experience working on the manual update. After all, these editorial masterminds spent countless hours debating every detail of AMA style to make our jobs as editors easier.

The first person with whom I chose to chat was Connie Manno, Director of the Freelance Editing Unit at JAMA Network and coauthor of chapter 4, Tables, Figures, and Multimedia. (Full disclosure—she’s my manager.)

Background

Connie started working as a coordinator in the freelance unit at the JAMA Network in 1998 after getting started with the organization as a freelance proofreader. In 2017, she was promoted to the director of the unit.

The freelance team currently consists of 5 in-house coordinators, 12 freelance editors, and 4 freelance copyreaders and is constantly growing. The team has doubled since Connie started in the unit to keep up with the increasing number of manuscripts and the greater amount of content published by the JAMA Network.

Expectations for Freelance Editors

When asked about the expectations of the freelance editors, Connie stated that the preference is for each to edit at least 3 major manuscript per week and to handle the initial set of author revisions. The editors are expected to take a substantive editing approach, with strict adherence to the AMA Manual of Style.

They are contacted at least monthly with updates to or reminders about journal style and policy. The coordinators review the work of the freelance editors and provide feedback as necessary. Furthermore, every spring, the freelance editors are invited to a day-long conference to experience a deeper dive into style and policy.

Over the years, Connie has discovered her aptitude and joy in training new freelancers and coordinators. She attributes her knowledge of AMA style to this aspect of her job. She finds that it’s more effective to provide the exact sections of the manual to new editors on their reviewed manuscripts so that they can see why changes were made and know where to look for those items in the future. Like many of your manuals, Connie’s is meticulously organized with tabs, highlights, and underlines.

On Editing Figures

One section of scientific manuscripts that can be particularly challenging to edit is figures. Because of her eye for visual representation of data, Connie was asked to take over development of chapter 4 from Stacy Christiansen, Chair of the AMA Manual of Style and Managing Editor of JAMA. Connie worked on the chapter for the last 3 years of development. Basic editing had been done, but Connie was responsible for finding good examples and, of course, making sure that those examples were edited according to AMA style.

In the process and by working with figure and statistical experts on JAMA for about a year, she gained more in-depth knowledge about which type of figures are best for representing different types of statistics and the data needed for completeness of presentation. You can see Connie’s recent AMA Style Insider post for a summary of updates to the chapter–she hopes that you find it informative and helpful!

Questions?

Please feel free to send your questions about figures and tables style to stylemanual@jamanetwork.org or @AMAManual on Twitter.–Sara Billings

Updates to Reporting Black and White as Racial Categories

Everyone in the business of communication has a responsibility to use and promote the use of clear and accurate language, with words that reflect the world around us. As evidenced by perpetual updates to style manuals, dictionaries, and other resources, nomenclature is never a static enterprise.

Specifying the race or ethnicity of an individual can provide information about the generalizability of the results of a specific study. Because many individuals may have mixed heritage, a racial or ethnic distinction should not be considered absolute, and ideally it should be based on a person’s self-designation.

In the JAMA Network journals, we ask authors to provide an explanation of who classified individuals’ race, ethnicity, or both, the classifications used, and whether the options were defined by the investigator or the participant. In addition, the reasons that race/ethnicity were assessed in the study also should be described (eg, in the Methods section and/or in table footnotes).1

We have received a number of queries about the presentation of racial and ethnic terms in the AMA Manual of Style, in particular the manual’s style current preference for using lowercase for the term black. The 11th edition specifies capitalizing racial and ethnic terms that derive from geographic nouns such as Asian, Alaska Native, and Latina (chapter 10.3.2, Capitalization, Proper Nouns, Sociocultural Designations), but the terms black and white have been lowercased as racial designators (because they are not derived from proper nouns).

However, ongoing and recent events spurred us to reconsider this style recommendation. The manual’s committee met several times, conducted research, and sought input on this issue from multiple sources. We deem this issue too important to wait for change.

In weighing the options (keep black and white lowercase, capitalize just Black, or capitalize both Black and White), we reviewed usage recommendations in a variety of sources, including other style manuals (Chicago Manual of Style,2APA style,3 and the AP Stylebook4), writing by an array of scholars, and guidance on diversity from academic and government sources, such as the US National Institutes of Health.5

The committee has concluded that we will now capitalize both Black and White, which aligns with the capitalization preference applied to other racial/ethnic categories. We acknowledge that there may be instances in which a particular context may merit exception to this guidance, for example, in cases for which capitalization could be perceived as inflammatory or otherwise inappropriate.

The online style manual will be updated to reflect this change, including the section on race/ethnicity in the Usage chapter  (chapter 11.12.3, Usage, Inclusive Language, Race/Ethnicity) and the aforementioned entry in the Capitalization chapter.

There are additional language issues to consider, including use of “other” as a category and abbreviating racial and ethnic terms. The nonspecific “other” is sometimes used for comparison in data analysis but may also be a “convenience” grouping/label that should be avoided, unless it was a prespecified formal category in a database or research instrument.

In such case, the categories included in “other” should be defined and reported. Authors and researchers are advised to be as specific as possible when reporting on racial/ethnic categories (even if these comprise a small percentage of participants).

Example (not recommended): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity.”

In this situation, an editor should ask the author for further explanation, considering that the racial/ethnic background of a quarter of the study is not provided.

Example (preferred): “The study included 200 White individuals, 100 Black individuals, and 100 of other race/ethnicity, which included Chinese, Japanese, Korean, and Native Hawaiian/Pacific Islander and those who reported multiple categories.”

Racial and ethnic terms also should not be abbreviated unless necessary for space constraints (eg, in tables and figures with clear expansion in explanatory footnotes or legends).

The manual’s committee will continue to explore changing trends in usage of other racial and ethnic terms as well, such as Latinx. As with all changes to the style manual, we welcome input from readers. The update to the manual online will be implemented as soon as possible, and the JAMA Network journals will begin to use Black and White as we edit new content.–Stacy Christiansen and Tracy Frey, for the AMA Manual of Style committee

References:

1. Instructions for Authors. JAMA. Updated April 13, 2020. Accessed June 19, 2020.  https://jamanetwork.com/journals/jama/pages/instructions-for-authors#SecReportingRace/Ethnicity

2. Black and White: a matter of capitalization. CMOS Shop Talk. Posted June 22, 2020. Accessed June 22, 2020. https://cmosshoptalk.com/2020/06/22/black-and-white-a-matter-of-capitalization/

3. APA Style. Racial and ethnic identity. Accessed June 20, 2020. https://apastyle.apa.org/style-grammar-guidelines/bias-free-language/racial-ethnic-minorities

4. AP Stylebook. Race-related coverage. Accessed June 22, 2020. https://www.apstylebook.com/race-related-coverage

5. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. National Institutes of Health. Released April 8, 2015. Accessed June 20, 2020. https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html