Update 1: On May 16, 2024, the U.S. Department of Justice sent a proposed rule to the Federal Register to downgrade marijuana from a Schedule I to a Schedule III drug. This is the first step in a lengthy approval process that starts with a 60-day comment period.

Update 2: Two recent research studies were added to the “Studies on marijuana and driving” section of this piece on July 18, 2024.

As marijuana use continues to rise and state-level marijuana legalization sweeps the U.S., researchers and policymakers are grappling with a growing public safety concern: marijuana-impaired driving.

As of April 2023, 38 U.S. states had legalized medical marijuana and 23 had legalized its recreational use, according to the National Conference of State Legislatures. Recreational or medical marijuana measures are on the ballot in seven states this year.

The issue of marijuana-impaired driving has not been an easy one to tackle because, unlike alcohol, which has well-established thresholds of impairment, the metrics for marijuana’s effects on driving remain rather elusive.

“We don’t have that kind of deep knowledge right now and it’s not because of lack of trying,” says Dr. Guohua Li, professor of epidemiology and the founding director of the Center for Injury Science and Prevention at Columbia University.

“Marijuana is very different from alcohol in important ways,” says Li, who has published several studies on marijuana and driving. “And one of them is that the effect of marijuana on cognitive functions and behaviors is much more unpredictable than alcohol. In general, alcohol is a depressant drug. But marijuana could act on the central nervous system as a depressant, a stimulant, and a hallucinogenic substance.”

Efforts to create a breathalyzer to measure the level of THC, the main psychoactive compound found in the marijuana plant, have largely failed, because “the THC molecule is much bigger than ethanol and its behavior after ingestion is very different from alcohol,” Li says.

Currently, the two most common methods used to measure THC concentration to identify impaired drivers are blood and saliva tests, although there’s ongoing debate about their reliability.

Marijuana, a term interchangeably used with cannabis, is the most commonly used federally illegal drug in the U.S.: 48.2 million people, or about 18% of Americans reported using it at least once in 2019, according to the latest available data from the Centers for Disease Control and Prevention. Worldwide, 2.5% of the population consumes marijuana, according to the World Health Organization.

Marijuana is legal in several countries, including Canada, where it was legalized in 2018. Despite state laws legalizing cannabis, it remains illegal at the federal level in the U.S.

As states grapple with the contentious issue of marijuana legalization, the debate is not just about public health, potential tax revenues and economic interests. At the heart of the discussion is also the U.S. criminal justice system.

Marijuana is shown to have medicinal qualities and, compared with substances like alcohol, tobacco, and opioids, it has relatively milder health risks. However, it’s not risk-free, a large body of research has shown.

Marijuana consumption can lead to immediate effects such as impaired muscle coordination and paranoia, as well as longer-term effects on mental health and cognitive functions — and addiction. As its use becomes more widespread, researchers are trying to better understand the potential hazards of marijuana, particularly for younger users whose brains are in critical stages of development.

Marijuana and driving

The use of marijuana among drivers, passengers and pedestrians has increased steadily over the past two decades, Li says.

Compared with the year 2000, the proportion of U.S. drivers on the road who are under the influence of marijuana has increased by several folds, between five to 10 times, based on toxicology testing of people who died in car crashes, Li says.

A 2022 report from the National Transportation Safety Board finds alcohol and cannabis are the two most commonly detected drugs among drivers arrested for impaired driving and fatally injured drivers. Most drivers who tested positive for cannabis also tested positive for another potentially impairing drug.

“Although cannabis and many other drugs have been shown to impair driving performance and are associated with increased crash risk, there is evidence that, relative to alcohol, awareness about the potential dangers of driving after using other drugs is lower,” according to the report.

Indeed, many U.S. adults perceive daily marijuana use or exposure to its smoke safer than tobacco, even though research finds otherwise.

Several studies have demonstrated marijuana’s impact on driving.

Marijuana use can reduce the drivers’ ability to pay attention, particularly when they are performing multiple tasks, research finds. It also slows reaction time and can impair coordination.

“The combination is that you potentially have people who are noticing hazards later, braking slower and potentially not even noticing hazards because of their inability to focus on competing things on the road,” says Dr. Daniel Myran, an assistant professor at the Department of Family Medicine and health services researcher at the University of Ottawa.

In a study published in September in JAMA Network Open, Myran and colleagues find that from 2010 to 2021 the rate of cannabis-involved traffic injuries that led to emergency department visits in Ontario, Canada, increased by 475%, from 0.18 per 1,000 traffic injury emergency department visits in 2010 to 1.01 visits in 2021.

To be sure, cannabis-involved traffic injuries made up a small fraction of all traffic injury-related visits to hospital emergency departments. Out of 947,604 traffic injury emergency department visits, 426 had documented cannabis involvement.

Myran cautions the increase shouldn’t be solely attributed to marijuana legalization. It captures changing societal attitudes toward marijuana and acceptance of cannabis use over time in the lead-up to legalization. In addition, it may reflect an increasing awareness among health care providers about cannabis-impaired driving, and they may be more likely to ask about cannabis use and document it in medical charts, he says.

“When you look at the 475% increase in cannabis involvement in traffic injuries, rather than saying legalizing cannabis has caused the roads to be unsafe and is a public health disaster, it’s that cannabis use appears to be growing as a risk for road traffic injuries and that there seem to be more cannabis impaired drivers on the road,” Myran says. “Legalization may have accelerated this trend. Faced with this increase, we need to think about what are public health measures and different policy interventions to reduce harms from cannabis-impaired driving.”

Setting a legal limit for marijuana-impaired driving

Setting a legal limit for marijuana-impaired driving has not been easy. Countries like Canada and some U.S. states have agreed upon a certain level of THC in blood, usually between 1 to 5 nanograms per milliliter. Still, some studies have found those limits to be weak indicators of cannabis-impaired driving.

When Canada legalized recreational marijuana in 2018, it also passed a law that made it illegal to drive with blood THC levels of more than 2 nanograms. The penalties are more severe for blood THC levels above 5 nanograms. The blood test is done at the police station for people who are pulled over and are deemed to be drug impaired.

In the U.S., five states — Ohio, Illinois, Montana, Washington and Nevada — have “per se laws,” which set a specific amount of THC in the driver’s blood as evidence of impaired driving, according to the National Conference of State Legislatures. That limit ranges between 2 and 5 nanograms of THC per milliliter of blood.

Colorado, meanwhile, has a “permissible inference law,” which states that it’s permissible to assume the driver was under the influence if their blood THC level is 5 nanograms per milliliter or higher, according to NCSL.

Twelve states, most which have legalized some form of marijuana of use, have zero tolerance laws for any amount of certain drugs, including THC, in the body.

The remaining states have “driving under the influence of drugs” laws. Among those states, Alabama and Michigan, have oral fluid roadside testing program to screen drivers for marijuana and other drugs, according to NCSL.

In May this year, the U.S. Department of Transportation published a final rule that allows employers to use saliva testing for commercially licensed drivers, including truck drivers. The rule, which went into effect in June, sets the THC limit in saliva at 4 nanograms.

Saliva tests can detect THC for 8 to 24 hours after use, but the tests are not perfect and can results in false positives, leading some scientists to argue against using them in randomly-selected drivers.

In a 2021 report, the U.S. National Institute of Justice, the research and development arm of the Department of Justice, concluded that THC levels in bodily fluids, including blood and saliva “were not reliable indicators of marijuana intoxication.”

Studies on marijuana and driving

Over the past two decades, many studies have shown marijuana use can impair driving. However, discussions about what’s the best way to measure the level of THC in blood or saliva are ongoing. Below, we highlight and summarize several recent studies that address the issue. The studies are listed in order of publication date. We also include a list of related studies and resources to inform your audiences.

State Driving Under the Influence of Drugs Laws
Alexandra N. Origenes, Sarah A. White, Emma E. McGinty and Jon S. Vernick. Journal of Law, Medicine & Ethics, July 2024.

Summary: As of January 2023, 33 states and D.C. had a driving under the influence of drugs law for at least one drug other than cannabis. Of those, 29 states and D.C. had a law specifically for driving under the influence of cannabis, in addition to a law for driving under the influence of other drugs. Four states had a driving under the influence of drug laws, excluding cannabis. Meanwhile, 17 states had no law for driving under the influence of drugs, including cannabis.  “The 17 states lacking a DUID law that names specific drugs should consider enacting such a law. These states already have expressed their concern — through legislation — with drug-impaired driving. However, failure to name specific drugs is likely to make the laws more difficult to enforce. These laws may force courts and/or law enforcement to rely on potentially subjective indicators of impairment,” the authors write.

Associations between Adolescent Marijuana Use, Driving After Marijuana Use and Recreational Retail Sale in Colorado, USA
Lucas M. Neuroth, et al. Substance Use & Misuse, October 2023.

Summary: Researchers use data from four waves (2013, 2015, 2017 and 2019) of the Healthy Kids Colorado Survey, including 47,518 students 15 and older who indicated that they drove. They find 20.3% of students said that they had used marijuana in the past month and 10.5% said they had driven under the influence of marijuana. They find that the availability of recreational marijuana in stores was associated with an increased prevalence of using marijuana one to two times in the past month and driving under the influence of marijuana at least once. “Over the study period, one in ten high school age drivers engaged in [driving after marijuana use], which is concerning given the high risk of motor vehicle-related injury and death arising from impaired driving among adolescents,” the authors write.

Are Blood and Oral Fluid Δ9-tetrahydrocannabinol (THC) and Metabolite Concentrations Related to Impairment? A Meta-Regression Analysis
Danielle McCartney, et al. Neuroscience & Biobehavioral Reviews, March 2022.

Summary: Commonly used THC measurements may not be strong indicators of driving impairment. While there is a relationship between certain biomarkers like blood THC concentrations and impaired driving, this correlation is often weak. The study underscores the need for more nuanced and comprehensive research on this topic, especially as cannabis usage becomes more widespread and legally accepted.

The Effects of Cannabis and Alcohol on Driving Performance and Driver Behaviour: A Systematic Review and Meta-Analysis
Sarah M. Simmons, Jeff K. Caird, Frances Sterzer and Mark Asbridge. Addiction, January 2022.

Summary: This meta-analysis of experimental driving studies, including driving simulations, confirms that cannabis impairs driving performance, contrary to some beliefs that it might enhance driving abilities. Cannabis affects lateral control and speed — typically increasing lane excursions while reducing speed. The combination of alcohol and marijuana appears worse than either alone, challenging the idea that they cancel each other out.

Cannabis Legalization and Detection of Tetrahydrocannabinol in Injured Drivers
Jeffrey R. Brubacher, et al. The New England Journal of Medicine, January 2022.

Summary: Following the legalization of recreational marijuana in Canada, there was a notable increase in injured drivers testing positive for THC, especially among those 50 years of age or older. This rise in cannabis-related driving incidents occurred even with new traffic laws aiming to deter cannabis-impaired driving. This uptick began before legalization became official, possibly due to perceptions that cannabis use was soon-to-be legal or illegal but not enforced. The data suggests that while legalization has broad societal impacts, more comprehensive strategies are needed to deter driving under the influence of cannabis and raise public awareness about its risks.

Cannabis and Driving
Godfrey D. Pearlson, Michael C. Stevens and Deepak Cyril D’Souza. Frontiers in Psychiatry, September 2021.

Summary: Cannabis-impaired driving is a growing public health concern, and studies show that such drivers are more likely to be involved in car crashes, according to this review paper. Drivers are less affected by cannabis than they are by alcohol or cocaine, but the problem is expected to escalate with increasing cannabis legalization and use. Unlike alcohol, THC’s properties make it challenging to determine direct impairment levels from testing results. Current roadside tests lack precision in detecting genuine cannabis-impaired drivers, leading to potential wrongful convictions. Moreover, there is a pressing need for research on the combined effects of alcohol and cannabis on driving, as well as the impact of emerging popular forms of cannabis, like concentrates and edibles. The authors recommend public awareness campaigns about the dangers of driving under the influence of cannabis, similar to those against drunk driving, to address misconceptions. Policymakers should prioritize science-based decisions and encourage further research in this domain.

Demographic And Policy-Based Differences in Behaviors And Attitudes Towards Driving After Marijuana Use: An Analysis of the 2013–2017 Traffic Safety Culture Index
Marco H. Benedetti, et al. BMC Research Notes, June 2021.

Summary: The study, based on a U.S. survey, finds younger, low-income, low-education and male participants were more tolerant of driving after marijuana consumption. Notably, those in states that legalized medical marijuana reported driving after use more frequently, aligning with studies indicating a higher prevalence of THC detection in drivers from these states. Overall, while the majority perceive driving after marijuana use as dangerous, not all research agrees on its impairment effects. Existing studies highlight that marijuana impacts motor skills and executive functions, yet its direct correlation with crash risk remains debated, given the variations in individual tolerance and how long THC remains in the system.

Driving Under the Influence of Cannabis: A Framework for Future Policy
Robert M. Chow, et al.Anesthesia & Analgesia, June 2019.

Summary: The study presents a conceptual framework focusing on four main domains: legalization, driving under the influence of cannabis, driver impairment, and motor vehicle accidents. With the growing legalization of cannabis, there’s an anticipated rise in cannabis-impaired driving cases. The authors group marijuana users into infrequent users who show significant impairment with increased THC blood levels, chronic users with minimal impairment despite high THC levels, and those with consistent psychomotor deficits. Current challenges lie in the lack of standardized regulation for drivers influenced by cannabis, primarily because of state-to-state variability and the absence of a federal statutory limit for blood THC levels. European nations, however, have established thresholds for blood THC levels, ranging from 0.5 to 50.0 micrograms per liter depending on whether blood or blood serum are tested. The authors suggest the combined use of alcohol and THC blood tests with a psychomotor evaluation by a trained professional to determine impairment levels. The paper stresses the importance of creating a structured policy framework, given the rising acceptance and use of marijuana in society.

Additional research

Cannabis-Involved Traffic Injury Emergency Department Visits After Cannabis Legalization and Commercialization
Daniel T. Myran, et al. JAMA Network Open, September 2023.

Driving Performance and Cannabis Users’ Perception of Safety: A Randomized Clinical Trial
Thomas D. Marcotte, et al. JAMA Psychiatry, January 2022.

Medicinal Cannabis and Driving: The Intersection of Health and Road Safety Policy
Daniel Perkins, et al. International Journal of Drug Policy, November 2021.

Prevalence of Marijuana Use Among Trauma Patients Before and After Legalization of Medical Marijuana: The Arizona Experience
Michael Levine, et al. Substance Abuse, July 2021.

Self-Reported Driving After Marijuana Use in Association With Medical And Recreational Marijuana Policies
Marco H. Benedetti, et al. International Journal of Drug Policy, June 2021.

Cannabis and Driving Ability
Eric L. Sevigny. Current Opinion in Psychology, April 2021.

The Failings of per se Limits to Detect Cannabis-Induced Driving Impairment: Results from a Simulated Driving Study
Thomas R. Arkell, et al. Traffic Injury Prevention, February 2021.

Risky Driving Behaviors of Drivers Who Use Alcohol and Cannabis
Tara Kelley-Baker, et al. Transportation Research Record, January 2021.

Direct and Indirect Effects of Marijuana Use on the Risk of Fatal 2-Vehicle Crash Initiation
Stanford Chihuri and Guohua Li. Injury Epidemiology, September 2020

Cannabis-Impaired Driving: Evidence and the Role of Toxicology Testing
Edward C. Wood and Robert L. Dupont. Cannabis in Medicine, July 2020.

Association of Recreational Cannabis Laws in Colorado and Washington State With Changes in Traffic Fatalities, 2005-2017
Julian Santaella-Tenorio, et al. JAMA Internal Medicine, June 2020.

Marijuana Decriminalization, Medical Marijuana Laws, and Fatal Traffic Crashes in US Cities, 2010–2017
Amanda Cook, Gregory Leung and Rhet A. Smith. American Journal of Public Health, February 2020.

Cannabis Use in Older Drivers in Colorado: The LongROAD Study
Carolyn G. DiGuiseppi, et al. Accident Analysis & Prevention, November 2019.

Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado
Jayson D. Aydelotte, et al. American Journal of Public Health, August 2017.

Marijuana-Impaired Driving: A Report to Congress
National Highway Traffic Safety Administration, July 2017

Interaction of Marijuana And Alcohol on Fatal Motor Vehicle Crash Risk: A Case–Control Study
Stanford Chihuri, Guohua Li and Qixuan Chen. Injury Epidemiology, March 2017.

US Traffic Fatalities, 1985–2014, and Their Relationship to Medical Marijuana Laws
Julian Santaella-Tenorio, et al. American Journal of Public Health, February 2017.

Delays in DUI Blood Testing: Impact on Cannabis DUI Assessments
Ed Wood, Ashley Brooks-Russell and Phillip Drum. Traffic Injury Prevention, June 2015.

Establishing Legal Limits for Driving Under the Influence of Marijuana
Kristin Wong, Joanne E. Brady and Guohua Li. Injury Epidemiology, October 2014.

Cannabis Effects on Driving Skills
Rebecca L. Hartman and Marilyn A. Huestis. Clinical Chemistry, March 2014.

Acute Cannabis Consumption And Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-Analysis
Mark Asbridge, Jill A. Hayden and Jennifer L. Cartwright. The BMJ, February 2012.

Resources for your audiences

The following resources include explainers from federal agencies and national organizations. You’re free to use images and graphics from federal agencies.

• CDC’s main marijuana page.
• CDC’s marijuana data and statistics.
• Marijuana Drug Facts from the National Institute on Drug Abuse.
• Health Effects of Marijuana from the CDC.
• Learn About Marijuana Risks from the Substance Abuse and Mental Health Services Administration.
• Marijuana and Lung Health from the American Lung Association.
• Substance Use Disorder 101 from the U.S. Department of Health & Human Services.
• What You Need To Know About Marijuana Use and Driving from the CDC.
• Does marijuana use affect driving? from the National Institute on Drug Abuse.
• Drug-Impaired Driving from the National Highway Traffic Safety Administration.

The post Driving under the influence of marijuana: An explainer and research roundup appeared first on The Journalist's Resource.

Many companies emit carbon dioxide in the course of their normal business. The amount emitted may differ — an airline or fossil fuel-based energy producer will emit much more carbon than a textile manufacturer.

To offset those emissions, some companies purchase carbon credits through brokers or exchanges. Those credits are meant to fund projects that reduce or capture pollutants.

Companies can also buy credits from project developers. Forestry projects are common, since trees capture carbon during photosynthesis. Projects might aim to preserve a swath of trees from destruction, or plant new ones. The forests saved or replenished can be anywhere in the world.

Companies buy carbon credits for various reasons. They are often the cornerstone of company public relations statements that they are carbon neutral, or they have “net zero” greenhouse gas emissions.

A big question for journalists investigating the growing voluntary carbon market is whether claims of carbon neutrality are true.

Companies don’t necessarily have to buy offsets to help the environment. They can reduce emissions produced by one part of their business to make up for other parts where they can’t reduce them.

But changing business processes to reduce emissions can be difficult.

That’s a big reason why offsets are so commonly used in carbon neutrality claims. According to a 2021 study of such pledges from 35 large global firms, 66% of them used carbon offsets.

Another wrinkle in carbon neutrality claims: Products companies make may produce pollutants when consumers or other businesses use them. In gas fuel production, for example, there is carbon emitted to refine gas, and carbon emitted to make the energy that powers the refinery.

Then there is the carbon emitted when someone burns the fuel to drive their car. For firms working in those industries, more than 90% of greenhouse gas emissions don’t come from the company itself, according to the 2021 study, from the Columbia Center on Sustainable Development.

The growing voluntary carbon market

Though many companies purchase carbon offsets voluntarily there are two U.S. states, California and Washington, which regulate their biggest polluters using market mechanisms. Most states in the northeastern U.S. have binding regulations that do the same, but they focus on energy producers.

The voluntary market, valued at about $2 billion in 2020, could be worth $250 billion by 2025, according to a 2023 research memo from investment bank Morgan Stanley.

Companies access vital information about offset markets through registries, which are usually nonprofits. Registries record credit ownership, for example. Registries also have protocols, or rules, on how projects measure their carbon reductions. Protocols are meant to ensure carbon offsetting projects produce the environmental benefits claimed.

While records in states that regulate carbon emissions are likely to be subject to public record laws, records for voluntary carbon offsets are not. But the major registries make some data public.

Another question for journalists to ask is whether a carbon-saving project would have happened anyway without carbon credits being purchased.

Did carbon credits save that forest? Or was that forest in no danger of being cut down?

A major challenge in reporting on carbon offsets is disparate sources offer data in various formats — registries may use different phrases to note that a carbon credit has been issued, for example.

Those differences make market-wide analyses difficult and time consuming.

OffsetsDB from CarbonPlan

Enter OffsetsDB, a navigable and standardized repository of carbon offset data from five of the biggest registries operating in the voluntary carbon offset market: American Carbon Registry, ART TREES, Climate Action Reserve, Gold Standard and Verra.

The free tool is updated daily and produced by CarbonPlan, a nonprofit open data organization focusing on climate change solutions. Anyone can download the data and access documentation for carbon offset projects around the world.

To help journalists understand the offset market and get to know OffsetsDB, we recently hosted an hourlong webinar featuring Grayson Badgley, a research scientist at CarbonPlan, and longtime science journalist Maggie Koerth, editorial lead at CarbonPlan.

“I really genuinely believe that at the core of just about every single project there’s this nugget of truth,” Badgley said during the webinar. “There is this good thing that is happening. The real question is, is it being credited appropriately?”

Watch the video to learn more — and read four takeaways from the presentation and conversation.

1. Know these key terms before digging into offset data.

There are lots of specialized words and phrases in the world of carbon offsets.

Here are a few you need to know.

Additionality: This refers to whether a carbon-saving or carbon-reducing project funded by carbon credits is adding environmental benefits that couldn’t have existed without the credits.

Credit: A credit is a financial instrument that represents carbon-removing activities. Credits are often created by projects that remove carbon from the atmosphere, such as reforestation, or prevent it from reaching the atmosphere, such as landfills that capture and burn methane.

“Many [companies] buy credits,” Koerth said. “And that is, somebody else does the carbon removing activity and then sells the company the right to claim that removed carbon.”

Offsets: Credits become offsets when a company or other entity makes a claim, such as carbon neutrality, based on the credits they’ve purchased. The company is claiming that their carbon emitting activities are offset by the credits.

“The terms credit and offset are kind of used interchangeably because the majority of credits are ultimately used to make offsetting claims,” Koerth said.

Registry: A registry is an organization, typically a nonprofit, that tracks carbon credit markets, including the buying and selling, issuance and retirement of carbon credits.

“[Registries] keep a record of all the credits produced by a project when they’re sold, when the sold credits have officially been used,” Koerth said. “Basically, this whole system of the registries exists so that the same credits can’t be sold multiple times to different people.”

Issuance: When a credit has been created, registered, and a registry confirms it exists, the registry issues the credit.

Purchase: When a credit is bought, typically by companies seeking to offset their carbon-producing activities. While credit issuances and retirements are publicly available, purchase information is usually not public.

Retirement: When the buyer of a credit declares they have used the credit and put it toward an offsetting goal, the credit is retired. Retired credits can’t be used again.

Vintage: This is the year a carbon credit was created.

Carbon neutral or net zero: These are claims companies make that their carbon emissions are balanced, for example, by buying credits. Say a small coal plant emits 900 million metric tons of carbon each year. It then buys credits equaling 900 million metric tons in carbon offsetting activities. On net, the coal plant claims to be neutral in their emissions.

There are many more phrases to know in the world of carbon offsets. The U.K.-based news organization Carbon Brief offers an extensive glossary.

2. Understand additionality.

Additionality is a big word with a big question behind it: Would a carbon sequestration or reduction project have happened anyway without funding from carbon credits?

Journalists need a basic understanding of additionality, a crucial concept that carbon offset projects use to justify their existence.

“In practice, determining whether a proposed project is additional requires comparing it to a hypothetical scenario without revenue from the sale of carbon credits,” according to this explainer on additionality from the nonprofit Stockholm Environment Institute.

In other words, is the sale of carbon credits adding environmental benefits by funding a carbon offsetting project that could not have happened without that funding?

“A lot of this is based around both trying to see what you have done and trying to estimate what would have happened if you hadn’t done that thing,” Koerth said during the webinar.

As Badgley and Freya Chay write in a 2023 analysis for CarbonPlan, “Rather than creating new climate benefits, non-additional credits simply reward a landowner for doing what they already planned on doing.”

While there are no hard and fast rules for determining whether a project is adding carbon benefits, journalists and others can use data in OffsetsDB to identify projects that potentially are not.

Think of a hypothetical landfill. Landfills produce methane, which scientists consider a worse air pollutant than carbon dioxide. But when methane is burned, it turns into carbon dioxide. So the landfill burns methane and receives carbon credits it can sell on the offset market because the carbon it is emitting is not as bad for the environment as methane.

Badgley and Chay recently analyzed 14 such carbon offset landfill projects. If a landfill stops receiving carbon credits to sell, the methane burns at those landfills should drop off or stop — if those projects are adding environmental benefits that wouldn’t be possible without the credits.

That’s not what Badgley and Chay found.

“By comparing crediting data from the Climate Action Reserve with landfill gas collection data from the U.S. Environmental Protection Agency, we found that nearly 50 percent of the credits issued under this protocol are likely non-additional,” they write. “These credits do not represent high-quality outcomes for the climate.”

For example, the Resource Recovery Landfill project in Cherryvale, Kansas, received credits from 2006 to 2011 for its gas collection operations, including burning methane, according to the analysis.

In 2012, those credits stopped — the landfill didn’t file paperwork to keep them going, Badgley and Chay found. But the gas collection continued. Crediting began again in 2022. During those 10 years, the landfill’s gas collection didn’t disappear or slow down. It expanded, according to the analysis.

“To be clear, the fact that Resource Recovery’s gas collection system ran continuously is a good thing for the planet,” write Badgley and Chay. “In addition to reducing methane emissions, collecting and treating landfill gas can help reduce smells and other environmental side effects associated with operating a landfill. But offsets must be used to spur new climate action — not just reward existing actions.”

(CarbonPlan)

3. Know that parts of the carbon offset market aren’t disclosed in public registry data — but this information may exist elsewhere.

Offset credit purchases, for example, are not usually public information. Other transaction details are also missing in public data.

For example, OffsetsDB shows that Jaiprakash Hydro Power in India has issued 16.7 million credits and retired nearly 9 million since 2010.

But which entities bought and retired those credits is potentially unavailable.

Sometimes, companies will voluntarily disclose to registries that they have purchased or are retiring credits.

But that doesn’t always happen.

Company sustainability reports are one place to look for information on how many credits a company has retired, and why, Badgley said. A company might, for example, purchase carbon credits to offset executive travel and publicly disclose that for public relations purposes.

“What we’re hoping to do with OffsetsDB is start to pull in a lot of that information,” Badgley said, adding that it’s a manual process of gathering supplementary knowledge from places like sustainability reports and news articles. This appears as a timeline for individual carbon offset projects within the database.

(CarbonPlan)

Recent legislation passed in California requires that any company marketing or selling carbon credits in the state, or any company buying or selling credits, disclose much more information online.

This includes the type of offset project, where the project is located, whether a third party has verified the project, and more. (But it’s unclear when the law will take effect and how it will be enforced, Politico reports.)

“This is something that we’re really excited about,” Badgley said. “And we’re hoping to be able to sort of pull that paperwork and pull that information into OffsetsDB.”

4. Ask about registry buffer pools.

What happens when a carbon-emitting company buys credits from, say, a forestry project in northern California that later is subsumed by wildfire? The registry that issued the credits will likely dip into its buffer pool to make up for the loss.

A buffer pool is a sort of rainy day fund, made up of carbon credits reserved for emergencies. Usually a carbon offsetting project can’t sell all its credits, but has to put a fraction of them into the registry’s buffer pool, Badgley said.

While the practice “makes total sense,” Badley said, it also raises questions. What types of credits are in the buffer pool? Do replacement credits represent similar offsetting projects to the original ones?

Here’s a relevant question for journalists to ask of registries: “Is this buffer pool that this program is administering, is it designed to make good on the liabilities of the program for the next X years?” Badgley said.

Further reading

Another Forest Offset Project is Burning — If You Know Where to Look
Grayson Badgley. CarbonPlan, July 2024.

The First Offset Credits Approved by a Major Integrity Program Don’t Make the Grade
Grayson Badgley and Freya Chay. CarbonPlan, July 2024.

Reporter’s Guide to Investigating Carbon Offsets
Global Investigative Journalism Network. Toby McIntosh, March 2024.

Instead of Carbon Offsets, We Need ‘Contributions’ to Forests
Libby Blanchard, William R.L. Anderegg and Barbara K. Haya. Stanford Social Innovation Review, January 2024.

What Every Leader Needs to Know About Carbon Credits
Varsha Ramesh Walsh and Michael W. Toffel. Harvard Business Review, December 2023.

Glossary: Carbon Brief’s Guide to the Terminology of Carbon Offsets
Daisy Dunne and Josh Gabbatiss. Carbon Brief, September 2023.

In-Depth Q&A: Can ‘Carbon Offsets’ Help to Tackle Climate Change?
Josh Gabbatiss, et. al. Carbon Brief, September 2023.

Action Needed to Make Carbon Offsets From Forest Conservation Work for Climate Change Mitigation
Thales West, et. al. Science, August 2023.

The Voluntary Carbon Market: Climate Finance at an Inflection PointBriefing Paper. World Economic Forum, January 2023.

Corporate Net-Zero Pledges: The Bad and the Ugly
Jack Arnold and Perrine Toledano. Columbia Center on Sustainable Development, November 2021.

The post Carbon offsets: 4 things journalists need to understand appeared first on The Journalist's Resource.

On July 11, The Journalist’s Resource and the Council for the Advancement of Science Writing’s CASW Connector hosted an online chat discussing how journalists can better cover hot-button topics, focusing on abortion as an example of a medical topic that has become increasingly political. The panelists shared lessons from their research and reporting, offered guidance for journalists covering abortion, and answered questions from the audience.

The event was moderated by Naseem Miller, senior health editor at The Journalist’s Resource, and the panelists were:

• Sarah McCammon, a national political correspondent at NPR who covers abortion policy among other divisive topics.
• Katie Woodruff, a public health social scientist in the Department of Obstetrics, Gynecology, and Reproductive Services at the University of California, San Francisco.

Below you’ll find a recording of the chat and links to resources curated by the panelists, as well as other links and tips provided during the session.

Sign up for CASW Connector’s and The Journalist’s Resource’s newsletters to receive updates about future online events.

Takeaways from Dr. Woodruff’s research:

• Research links:
  • Coverage of Abortion in Select U.S. Newspapers – PMC, Women’s Health Issues, 2019. 
  • Coverage of abortion in major U.S. newspapers, 2022-23, poster presentation for National Abortion Federation annual meeting, April 2024.
  • More details about Dr. Woodruff’s 2022-23 research from the University of California, San Francisco.
• Her 2019 paper found most news coverage treated abortion as a political buzzword without exploring the issue in-depth.
• Stories largely didn’t cover the experiences of people seeking abortion and omitted basic facts, such as that abortion is common and safe and that pregnancy carries a higher risk for women, especially people of color.
• Following the 2022 Supreme Court decision overturning Roe v. Wade, abortion coverage significantly increased. More stories covered the policy and health aspects of this issue in depth.
• Stories of people seeking abortion are more common in news stories in 2022-23 than pre-Dobbs, but news coverage tends to focus on atypical cases. Basic facts about abortion and pregnancy are still rarely included.
• News coverage also rarely focuses on medication abortion, even though this is now the most common method.
• We have an overwhelming body of evidence showing that abortion is safe, and that anti-abortion policies lead to harm. Journalists could do more to ensure these facts are clearly stated in stories.
• Be careful of language used to describe abortion policies; terms like “heartbeat ban” or referring to people seeking abortion as “mothers” can impact readers’ perceptions.

Finding sources, navigating interviews:

• Reproductive health clinics and providers can offer sources, including doctors and patients. Health care providers are good secondary sources if you aren’t able to talk to a patient.
• Abortion funds and advocacy groups can also connect journalists with sources. (Don’t call an abortion hotline; connect with organizers.) However, some of these organizations have been overwhelmed post-Dobbs and may not have the capacity to or be comfortable with sharing patient information. It is also worth taking note of whether any groups pay sources, as a few do this.
• Ethical consent is important during interviews. Make sure the source understands who you are and how their story will be used. Make it clear what it means to be on- or off-the-record, and let sources know they can choose not to answer a question if they’re uncomfortable with it.
• Vetting information from a source can include searching public databases and checking information between patients and providers.
• Expand your perception of who can be a source. Historians and other scholars may be able to offer historical context for news pieces.
• Providing sources with some level of anonymity, such as using a first name only, can help protect those at more risk from speaking out about their experience. Be clear about your outlet’s policy for anonymity during the interview.

McCammon’s other tips for covering hot-button topics:

• A framework to avoid bias: A journalist’s own experiences and perspectives are not nearly as important to a news story as the evidence. Consider your job to be informing the audience and shedding light on different aspects of an issue, not persuading anyone of a particular argument.
• Personal stories from sources can help your audience understand the impacts of policies on real people. These may be tough to find for some stories but are important to include when possible.
• Don’t assume you have all the answers, even if you’re experienced in covering an issue. Be curious and open-minded.
• Aim to be as accurate and specific as possible in language to reduce misinterpretation. For example, some outlets (like NPR) have moved to use “abortion rights supporter” and “abortion rights opponent” over “pro-choice” and “pro-life.”
• Ask rigorous questions of politicians and policy platforms and weigh their positions against scientific evidence and potential health impacts.

Articles & resources:

• Media briefing: Reproductive health and abortion, SciLine, July 11, 2024.
• Abortion pill mifepristone: An explainer and research roundup about its history, safety and future, The Journalist’s Resource, Naseem S. Miller, November 1, 2023.
• Covering abortion as a health care issue in all its complexity, politics aside, Association of Health Care Journalists, Tara Haelle, May 24, 2023.
• Covering abortion as a health care story, not just a political one, Association of Health Care Journalists, Jordan Gass-Pooré, June 12, 2024.
• NPR Public Editor: How abortion language evolves, NPR, Kelly McBride, April 4, 2024.
• Post-Roe: Journalistic “objectivity” meets the heated issue of abortion, Center for Journalism Ethics, Audrey Thibert, November 29, 2022.
• Editing Controversial Science, in Knight Science Journalism Science Editing Handbook, Laura Helmuth.
• Research highlights need for public health approach in news reporting of gun violence, The Journalist’s Resource, Naseem S. Miller, June 25, 2024.
• Trauma-informed journalism: What it is, why it’s important and tips for practicing it, The Journalist’s Resource, Naseem S. Miller, April 13, 2022.
• Covering scientific consensus: What to avoid and how to get it right, The Journalist’s Resource, Denise-Marie Ordway, November 23, 2021.

This tip sheet was published in collaboration with the CASW Connector, where it first appeared. It has been lightly edited for style.

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Migrants often face a variety of health challenges in their host countries, depending on the circumstances of their migration and a host of obstacles such as language barriers, lack of knowledge about the health care system, lack of health insurance and fear of deportation.

During this pivotal election year, when immigration is a hot political topic, it’s important for journalists to help news consumers better understand the specific health challenges that immigrants and refugees encounter in the U.S. and humanize their stories to counter stereotypes, misconceptions and misinformation.

For instance, some states claim that immigrants, especially those who lack legal documentation, are a financial burden on the health care system. However, research suggests the opposite, showing that immigrants, particularly those who lack legal documentation, may subsidize the U.S. health care financing system.

“Immigrants’ substantial contributions to health care funding (despite their relatively low incomes) may be associated with their high labor force participation rate, particularly among men who have recently arrived in the US. Hence, they and their employers (whose benefit payments are widely considered part of the employee’s earned compensation) contribute to health insurance premiums as well as payroll and other taxes,” write the authors of a 2022 study published in JAMA Network Open, noting that “immigrants contributed $58.3 billion more in premiums and taxes in 2017 than insurers and government paid for their health care, and US-born citizens incurred a net deficit of $67.2 billion.”

Immigration is not an issue unique to the United States.

Today, more people than ever live in a country other than the one in which they were born, according to the United Nations. As of July 2020, there were an estimated 281 million international migrants, making up 3.5% of the global population. That’s compared with 2.8% in 2000 and 2.3% in 1980, according to the UN.

In 2022, there were 21.2 million noncitizen immigrants in the U.S., accounting for roughly 7% of the country’s population, according to a June 2024 policy brief by the Kaiser Family Foundation, now called KFF. About 40% are people who lack the legal documents needed to stay in the country.

Immigrant health is strongly shaped by the social, economic and political conditions of their host country, write Michael D. Stein and Sandro Galea in the 2020 book “Pained: Uncomfortable Conversations about the Public’s Health.”

“Legal status in the host country, for example, is associated with access to a broad range of health services and resultant better health,” they write. “Perhaps unsurprisingly, aggressive anti-immigration policies create poor health for the population they target. For example, family separation and detention at our borders traumatize families, deepening the mental health needs of this vulnerable group.”

In addition, as we explain below, research shows many immigrants and refugees experience traumatic events before, during and after their migration, which can lead to mental health problems such as post-traumatic stress disorder, depression and anxiety.

Children and pregnant women often face challenges in accessing pediatric and prenatal care. There is also research on the health risks associated with the types of jobs that immigrants and refugees hold.

But first, a primer on terminology and level of access to health care based on immigration status:

Immigrants, migrants, refugees and asylum seekers

The terms “refugee,” “asylum seeker” and “immigrant” are often used in discussions about people moving from one country to another, but they have distinct meanings based on the reasons for their move and individuals’ legal status.

Immigrant

An immigrant is a person who makes the decision to leave their home country and moves to another country with the intention of settling there, according to the International Rescue Committee, a humanitarian aid nongovernmental organization.

Immigrants move for various reasons, including economic opportunities, family reunification or a desire for a change in lifestyle. Unlike refugees or asylum seekers, immigrants do not typically flee persecution or immediate life-threatening situations. Their move can be either permanent or temporary, and they may go through legal channels to obtain residency rights, work permits or citizenship in the host country.

The AP Stylebook says immigrant, “rather than migrants, is most commonly used for people established in the U.S., which usually is their final destination. It also is used when another specific country is the final destination.”

Migrant

There’s no internationally accepted legal definition for the term ‘migrant.’ But the term generally refers to people who are staying outside of their home country and are not asylum seekers or refugees, according to Amnesty International, a global non-governmental organization focused on human rights.

“While dictionary definitions sometimes distinguish ‘immigrants’ — people who are, or intend to be, settled in their new country — from ‘migrants’ who are temporarily resident, ‘immigrant’ and ‘migrant’ (as well as ‘foreigner’) are often used interchangeably in public debate and even among research specialists,” according to The Migration Observatory at the University of Oxford.

The UN defines an international migrant as any person who has changed their country of residence, regardless of legal status or the nature and motive of their move.

The AP Stylebook says the term also “may be used for those whose reason for leaving their home country is not clear, or to cover people who may also be refugees or asylum-seekers.”

Refugee

A refugee is forced to leave their country to escape war, persecution or natural disaster. Refugees have a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Many have been forced to flee with little more than the clothes on their back, according to the UN Refugee Agency UNHCR, formerly the United Nations High Commissioner for Refugees. Today, there are 43.4 million refugees around the world.

People go through a process known as refugee status determination in their host country to establish whether their circumstances make them refugees, according to the UN Refugee Agency.

Refugees have a right to international protection, according to Amnesty International. Those rights and protections include the right not to be expelled from their host country, the right to non-discrimination, the right to housing, education and work, according to the UN Refugee Agency.

To become a refugee in the United States, a person has to apply for protection while outside the U.S., while to become an asylum seeker, the application for protection must be submitted from inside the U.S. or at the border, according to the Migration Policy Institute, a nonpartisan policy and research organization. 

Asylum Seeker

An asylum seeker is someone who is seeking international protection from persecution and serious human rights violations in their home country, according to the UN Refugee Agency and Amnesty International. Their request for refugee status, or complementary protection status, has yet to be processed, or they may not yet have requested asylum but they intend to.

“Seeking asylum is a human right. This means everyone should be allowed to enter another country to seek asylum,” according to Amnesty International.

The length and outcome of this process can vary greatly depending on the laws of the host country and the specifics of the individual’s case. Not all asylum seekers will be found to be refugees, but all refugees were once asylum seekers, according to the UN Refugee Agency.

According to the AP Stylebook, “Asylum, under U.S. and international law, is permission granted to refugees to remain within the country to which they have fled. It is not intended for people leaving for economic reasons.” In addition, “In the United States, people fleeing their home countries who do not qualify for asylum may be eligible for ‘withholding of removal’ or the U.N. Convention Against Torture, which offer similar protections.”

“People who are likely to be asylum-seekers or refugees should not be referred to as migrants,” according to the UN Refugee Agency. “To do so can undermine the legal protections afforded to refugees under international law.”

Asylee

Journalists may come across the term “asylee,” referring to a person who has been granted asylum, but the AP Stylebook recommends against using the word. “We would say she was granted asylum,” according to the Stylebook.

Illegal immigration

The term refers to “entering or living in a country without authorization in violation of civil or criminal law,” according to AP Stylebook. Except in direct quotations, use “illegal” only to refer to an action, not a person, the Stylebook advises: “’illegal immigration’ but not ‘illegal immigrant’.”

Also, “do not use the terms alien, unauthorized immigrant, irregular migrant, an illegal, illegals or undocumented (except when quoting people or government documents that use these terms),” according to the AP Stylebook.

Access to U.S. health care based on immigration status

Health and health care access issues are not the same for all noncitizen immigrants. In the U.S., health care coverage of immigrants is based on their immigration status, as defined by the federal government. This HealthCare.gov page defines the terminology and coverage options.

Immigrants who are lawfully in the U.S. have a five-year waiting period to enroll in Medicaid, a government program primarily serving people with low incomes, or the Children’s Health Insurance Program (CHIP). CHIP is a state-federal insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women, according to HealthCare.gov.

Migrants who lack legal documentation to stay in the country can’t enroll in any federally-funded coverage, including Medicaid, CHIP, Medicare and the Affordable Care Act marketplace, according to KFF.

Refugees and those granted asylum seeker status don’t have to wait five years before enrolling in Medicaid and CHIP, according to HealthCare.gov. Others, including asylum seekers who haven’t been granted asylum status don’t qualify for Medicaid or CHIP, according to KFF.

But some states have tried to close the health coverage gap, especially for children and pregnant people.

So far, 22 states have extended insurance coverage to pregnant people regardless of immigration status through CHIP, according to KFF. Ten states — California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, and Washington — offer extended postpartum coverage for a year regardless of immigration status.

Meanwhile, 35 states, plus D.C., provide Medicaid coverage to children and pregnant people who are in the U.S. legally, without the five-year waiting period, according to HealthCare.gov

As of June 2024, 12 states — California, Connecticut, Illinois, Maine, Massachusetts, New Jersey, New York, Oregon, Rhode Island, Utah, Vermont, Washington — and D.C. cover children through CHIP regardless of immigration status, according to KFF.

The National Immigration Law Center also has maps of states that provide health coverage to immigrant children and pregnant people and a state-by-state list of medical assistance programs available to immigrants.

Six states — California, Colorado, Illinois, New York, Oregon, Washington — plus D.C. have expanded coverage to adults regardless of immigration status, as long as they fall within Medicaid’s income criteria.

In May 2024, the Biden Administration published a new regulation that will include individuals with Deferred Action for Childhood Arrivals (DACA) status as lawfully present in the U.S., so that they will be eligible to gain insurance coverage through the ACA Marketplace, starting this November.

“From a social justice standpoint, we really see legal status as a social determinant of health,” said Dr. Alan Shapiro, during a panel on covering immigrants at the Association of Health Care Journalists’ annual conference in New York City in June. Shapiro is the co-founder and chief strategy officer of Terra Firma National, which provides a range of services to immigrant families.

In a 2023 KFF report based on a joint survey with the LA Times, including 3,358 immigrants 18 years and older, nearly 80% said that they were in good to excellent health, while 20% reported being in fair or poor health. Nearly one in five of those with household incomes below $40,000 per year reported a health condition that required ongoing treatment, compared with about one in ten of those with higher incomes.

“Although most immigrants are healthy and employed, many face challenges to accessing and using health care in the U.S. due to higher uninsured rates, affordability challenges, linguistic and cultural barriers, and immigration-related fears, which has negative implications for their health and financial security,” according to the survey.

Advice for journalists

At the recent AHCJ panel on covering immigration, experts advised journalists to remind their audiences that many people leave their home countries out of necessity for survival.

“Cover migration differently than it’s been covered,” said Shapiro, who is also an assistant professor of pediatrics at Albert Einstein College of Medicine. “I don’t think there’s enough talk about the country conditions and what children and families are really struggling with in their home countries, and I think if the public knew more about how terrible life is for children and families there, and how little protection there is, there would be a lot more empathy and sympathy for [them].”

Dr. Laura Vargas, an assistant professor of psychiatry at the University of Colorado’s Institute of Behavioral Science, who has spent much time speaking to migrants at the U.S.-Mexico border advised journalists to explain the flow of firearms from the U.S. to Latin American countries, a trend that has fueled violence in the region. She has published several studies on the health and mental health of immigrants from Latin America.

“Firearms facilitate the criminal gangs, who are sometimes outgunning the police force and other local law enforcement,” said Vargas. “There’s rampant criminal activity in terms of extortion, robberies, territorial disputes among criminal gangs.”

Those conditions create instability for families and affect the health and mental health of adults and children.

“There’s a lack of future for children and families,” she said. “There’s no employment, and if you graduate with a degree, there’s no job available for you.”

It’s also critical that journalists build trust with the communities they’re covering. At Documented, a nonprofit news site devoted to covering New York City’s immigrants and policies that affect their lives, the staff created a WhatsApp channel to connect with migrants and asylum seekers after learning that the app was the main source of information and communication for them, said Rommel Ojeda, a bilingual journalist, filmmaker and a community correspondent for Documented.

The channel, which has more than 6,000 members, prioritizes privacy by masking phone numbers and offers anonymity to people who agree to be interviewed.

“All of that is to say that we were able to build trust and the trust gave us access so that we can report better,” said Ojeda. “And when I say we can report better, it’s because we can go into the community and really ask for the nuances of each individual who’s talking to us.”

Research roundup

Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible
Julia Rosenberg, Veronika Shabanova, Sarah McCollum and Mona Sharifi. Pediatrics, September 2022.

The study: The study investigates the impact of expanded Medicaid eligibility on children in immigrant families and children who are not in immigrant families. The researchers uses data from the 2019 National Survey of Children’s Health, a nationally representative cross-sectional survey, to compare health care outcomes in states that provide Medicaid eligibility to children regardless of their documentation status (“extended-eligibility states”) with the states that don’t (“nonextended-eligibility states”). There were six extended-eligibility states plus Washington, D.C., at the time of the study. The primary aim was to assess how residing in these different regions affects the rates of uninsured people and health care use among children.

The findings:

• Children in extended-eligibility states had a significantly lower rate of being uninsured (3.7%) compared with those in states that didn’t offer extended eligibility (7.5%).
• Children in immigrant families were more likely to be uninsured compared to those who were not from immigrant families, even if they lived in an extended-eligibility state.
• Children in extended-eligibility states were less likely to forgo medical care (2.2% compared with 3.1%) and dental care (17.1% compared with 20.5%) compared with those in states that didn’t offer extended eligibility.
• There were similar rates of emergency department visits between children in extended- and nonextended-eligibility states.

The takeaway: The study highlights that expanding public health insurance eligibility to all children, regardless of documentation status, is associated with lower rates of being uninsured. “This builds upon the evidence that policies which expand insurance access can improve enrollment within and beyond the target expansion demographic through a ‘welcome mat’ effect,” the authors write. The findings also suggest that states with restrictive health insurance policies for migrant children who lack legal documents to stay in the country may face higher rates of being uninsured and poorer health care use, impacting long-term health and social equity, they add.

Companion commentary: Children in Immigrant Families Deserve Health Care, by Fernando S. Mendoza et al., published in the journal Pediatrics in August 2022.

California’s Health4All Kids Expansion And Health Insurance Coverage Among Low-Income Noncitizen Children
Brandy J. Lipton, Jefferson Nguyen and Melody K. Schiaffino. Health Affairs, July 2021.

The study: Implemented in May 2016, California’s Health4AllKids expanded Medicaid eligibility to all low-income children regardless of their immigration status. The research uses data from the 2012 to 2018 American Community Survey to evaluate the impact of this expansion on health insurance coverage rates among noncitizen children in California compared with eleven states (Delaware, Hawaii, Illinois, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Ohio, Rhode Island, and Washington) plus Washington, D.C.

The findings:

• The rate of noncitizen children lacking health insurance coverage dropped by 34%, translating to a 9 percentage-point increase in any coverage and a 12 percentage-point increase in Medicaid coverage.
• Before the expansion, noncitizen children were significantly less likely to have health insurance compared with citizen children. The Health4All Kids program effectively reduced this disparity by more than half, showcasing the impact of inclusive health policies.
• The study found no significant evidence of a substantial shift from private to public insurance coverage, indicating that the expansion primarily reduced the uninsured rates rather than substituting one form of coverage for another.

The takeaway: “Our analysis provides some of the first evidence on the effects of expanding Medicaid and CHIP to undocumented children. Findings suggest that these policies have the potential to reduce coverage disparities by immigration status,” the authors write.

Publicly-Funded Services Providing Sexual, Reproductive, and Maternal Healthcare to Immigrant Women in the United States: A Systematic Review
Tanvi Jain, Jessica LaHote, Goleen Samari and Samantha Garbers. Journal of Immigrant and Minority Health, June 2022.

The study: The authors review published research about the availability and impact of publicly funded sexual, reproductive and maternal health services on immigrant women in the U.S. The review examines nine studies published from December 2007 to August 2020, focusing on the use of services such as Medicaid, CHIP, and other federally or state-funded programs, particularly among Latina immigrants.

The findings:

• Immigrant women, especially those who lack legal documentation to stay in the country or with low income and education, had higher rates of adequate prenatal care when they had access to Medicaid or CHIP. Six of the nine studies reviewed indicated improved prenatal care adequacy due to access to these programs.
• Immigrant women faced significant barriers to accessing sexual, reproductive, and maternal health services, including cost, language barriers, fear of deportation and lack of knowledge about available services. These barriers often led to delayed or inadequate prenatal care, which can result in severe health outcomes.
• Policies like the “public charge” rule negatively impacted immigrant women’s access to sexual, reproductive, and maternal health services, with many avoiding enrollment in Medicaid due to fear of jeopardizing their immigration status. This led to later initiation of prenatal care and fewer prenatal visits. Public charge is a federal law that determines if a non-citizen applying for a visa or permanent residence is likely to rely on the government for support in the future.

The takeaway: The study underscores the importance of inclusive and comprehensive publicly-funded sexual, reproductive, and maternal health services for immigrant women in the United States. Access to Medicaid and CHIP significantly improves prenatal care adequacy, but numerous barriers still prevent many immigrant women from using those services. Anti-immigrant policies exacerbate challenges, leading to poorer health outcomes. “Similar to women born in the US, immigrant women with low income and educational attainment would most benefit from publicly-funded programming,” the authors write.

More on research funding: Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020 by Mehak Kaur, Lana Bridi and Dahlia Kaki, published in JAMA Network Open in January 2024.

The Health of Undocumented Latinx Immigrants: What We Know and Future Directions
India J. Ornelas, Thespina J. Yamanis and Raymond A. Ruiz. Annual Review of Public Health, April 2020.

The study: The authors aim to explore the health outcomes and determinants for Latino migrants who lack legal documentation to stay in the country. The study highlights the social, political and economic factors that impact their health and identifies gaps in current research.

The findings:

• Social and political factors significantly influence the health of migrants who lack legal documentation to be in the country. Factors vary across different stages of migration and are influenced by the immigrants’ country of origin, how they entered the U.S., and changes in their legal and health status over time.
• The study notes that conducting research with migrants who lack legal documentation is challenging due to their precarious living conditions, unstable employment, frequent changes in contact information, and low literacy levels. However, strategies like conducting research at community-based organizations and using social media for communication can help overcome those challenges.

The takeaway: “Public health practitioners can continue to support and advocate for programs and policies that create healthful social and political environments for undocumented Latinx immigrants,” the authors write. They also call for additional research.

Delve deeper: Traumatic Experiences and Place of Occurrence: An Analysis of Sex Differences Among a Sample of Recently Arrived Immigrant Adults from Latin America, by Laura X. Vargas, et al., published in PLOS One in June 2024.

US Immigration Policy Stressors and Latinx Youth Mental Health
Kathleen M. Roche, Rebecca M. B. White and Roushanac Partovi. JAMA Pediatrics, May 2024.

The study: The authors investigate how immigration-related stressors affect parent-child relationships and the subsequent mental health of Latino adolescents. The study includes adolescent-mother duos surveyed at three different time points over four years — 2018, 2020, and 2022, conducted in a suburban Atlanta, Georgia, school district, involving Latino adolescents aged 11 to 16 years.

The findings:

• Immigration-related stressors, such as mothers’ anti-immigrant worries and adolescents’ experiences of family member detention or deportation, were linked to disruptions in parent-child relationships.
• Specifically, anti-immigrant worry was associated with increased parent-child conflict, leading to higher odds of symptoms such as aggression and impulsivity in adolescents.
• For girls, family member detention or deportation led to reduced parental support, which in turn was linked to increased depression and anxiety.

The takeaway: “Our research signals the need for school personnel to address stressors faced by Latinx students and families and for health care institutions to advocate for policies expanding access to affordable, culturally competent mental health services, including for children of immigrants. Congress and both state and local lawmakers have the power to enact policies that reduce risks faced by children in immigrant families. Inclusive immigration policies prioritizing the best interests of children and their families may help protect the mental health of this country’s Latinx youth, the vast majority of whom are US citizens,” the authors write.

Additional reading

• Assessment of Immigrants’ Premium and Tax Payments for Health Care and the Costs of Their Care
  Mark J. Ommerborn, et al. JAMA Network Open, November 2022.
• Health and Health Care Experiences of Immigrants: The 2023 KFF/LA Times Survey of Immigrants
  Drishti. Pillai, et al. KFF, September 2023.
• Medical Care for Newly Arrived Displaced Persons
  Radhika Jain, Geren S. Stone and Matthew G. Gartland. NEJM Evidence, October 2023.
• State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children
  Natalie Slopen, et al. Pediatrics, August 2023.
• Understanding the Role of Immigration Status in U.S. Health Coverage: From Barriers to Pathways
  Robert Wood Johnson Foundation, November 2023.
• Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well-Being, & Health
  Samantha Artiga and Petry Ubri. KFF, December 2017.
• The Mental Health of Migrants Living in Limbo: A Mixed-Methods Systematic Review with Meta-Analysis
• Marianne Côté-Olijnyk, J. Christopher Perry, Marie-Ève Paré and Rachel Kronick. Psychiatry Research, July 2024.
• Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs
  Lisa Gantz et al. Academic Pediatrics, July 2024.
• The Impact of Detention on the Health of Asylum Seekers: An Updated Systematic Review: A Systematic Review
  Trine Filges, Elizabeth Bengtsen, Edith Montgomery and Malene Wallach Kildemoes. Campbell Systematic Reviews, July 2024.
• Migrants Come to the U.S. with Trauma. A Broken Mental Health System Adds Stress.
  Anika Nayak and Divya K. Chhabra. Harvard Public Health, February 2024.
• The Health Coverage of Noncitizens in the United States, 2024
  Matthew Buettgens and Urmi Ramchandani. Urban Institute, May 2023.
• 7 Ways to Inform News Coverage of the Southern US Border The Journalist’s Resource, January 2023.

Additional resources

Migration Policy Institute

• This primer on U.S. public benefits (including health care) is a useful resource in sifting through immigrant eligibility by program as well as immigrant legal status.
• The State Immigration Data Profiles have a wealth of data on the immigrant population in the U.S. and state levels, including health insurance coverage for immigrants and U.S.-born overall and by U.S. citizenship status.
• This data tool that looks just at the unauthorized segment of the immigrant population at U.S., state, and top county levels.

Protecting Immigrant Families

Human Rights Watch: Refugees and Migrants

American Immigration Council

ACLU: Immigrants’ Rights

Conscious Style Guide: Ethnicity, Race + Nationality

The post How migrants, asylum seekers and refugees seek health care in the US: A primer and research roundup appeared first on The Journalist's Resource.

We updated this piece on the four-day school week, originally published in June 2018, on July 15, 2023 to include new research and other information.

More than 2,100 public schools in 25 states have switched to a four-day school week, often in hopes of recruiting teachers, saving money and boosting student attendance, researchers estimate.

Small, rural schools facing significant teacher shortages have led the trend, usually choosing to take off Mondays or Fridays to give employees and students a three-day weekend every week. To make up for the lost day of instruction, school officials typically tack time onto the remaining four days.

In some places where schools made the change, school district leaders have marveled at the resulting spikes in job applications from teachers and other job seekers. Teacher shortages, made worse by the COVID-19 pandemic, have plagued public schools nationwide for decades.

“The number of teacher applications that we’ve received have gone up more than 4-fold,” Dale Herl, superintendent of the Independence, Missouri school district, told CBS News late last year.

The impact on students, however, has not been as positive. Although peer-reviewed research on the topic is limited, focusing only on a single state or small group of states, there is evidence that some groups of students learn less on a four-day schedule than on a five-day schedule.

A new analysis of student performance in six states — Colorado, Iowa, Kansas, Montana, North Dakota and Wyoming — finds that students who went to class four days a week, as a whole, made less progress in reading during the academic year than students who went five days a week. Kids on a four-day schedule earned lower reading scores on a spring assessment known as the Measures of Academic Progress Growth, on average.

However, the authors of the paper, published last month, also found that the condensed schedule had little to no effect on the rural students they studied, on average. Schools located in towns and suburbs, on the other hand, saw student performance drop considerably after adopting a four-day week.

The authors also discovered differences among student groups. For example, Hispanic students going to class four days a week made less progress in math during the school year than white students on the same schedule. White students made less progress in math than Native American students during the 11-year study.

“For policymakers and practitioners, this study addresses previous ambiguity about the effects of four-day school weeks on academic outcomes and provides evidence supporting concerns about four-day school week effects on student achievement and growth, particularly for those implemented in non-rural areas,” write the authors, Emily Morton, Paul Thompson and Megan Kuhfeld.

In the spring before the COVID-19 pandemic, a total of 662 public school districts used the schedule — up more than 600% since 1999, Thompson and Morton write in a 2021 essay for the Brookings Institution. That number climbed to 876 during the 2022-23 academic year, they told The Journalist’s Resource in email messages.

In addition to studying the schedule’s effect on student achievement, researchers are also investigating its impact on other aspects of school operations, including education spending, student discipline and employee morale. To make the research easier to find, the University of Oregon’s HEDCO Institute for Evidence-Based Educational Practice has created the Four-Day School Week Research Database.

Anyone can use the interactive platform to sift through research completed as of May 2023. It’s worth noting that most research in the database is not peer-reviewed journal articles. Seventy of the more than 100 papers are student dissertations, theses and other papers.

If you keep reading, you’ll find that we have gathered and summarized several relevant journal articles below. To date, the scholarly literature indicates:

• Some schools cut instructional time when they adopt a four-day schedule.
• The impact of a four-day school week differs depending on a range of factors, including the number of hours per week a school operates, how the school structures its daily schedule and the race and ethnicity of students.
• The condensed schedule does not save much money, considering employee salaries and benefits make up the bulk of school expenses. In a 2021 analysis, Thompson estimates schools save 1% to 2% by shortening the school week by one day.
• Staff morale improves under a four-day school week.
• Fighting and bullying decline at high schools.

Both Thompson and Morton urged journalists to explain that the amount of time schools dedicate to student learning during four-day weeks makes a big difference.

“It’s pretty critical to the story that districts with longer days (who are possibly delivering equal or more instructional time to their students than they were on a five-day week) are not seeing the same negative impacts that districts with shorter days are seeing,” Morton, a researcher at the American Institutes of Research, wrote to JR in late 2023.

In a follow-up conversation with JR in July 2024, Morton pointed out that parents like the four-day schedule despite concerns raised by education scholars. In interviews with researchers, she wrote, “parents mention that they appreciate the additional family time and perceive other benefits of the schedule for their children, and they overwhelmingly indicate that they would choose to keep a four-day schedule over switching back to a five-day schedule.”

Morton would not recommend schools adopt a four-day schedule if their main aim is saving money, boosting student attendance or recruiting and retaining teachers. Research findings “do not provide much support for the argument that four-day school weeks are delivering the intended benefits,” she wrote to JR.

Keep reading to learn more. We’ll update this collection of research periodically.

——————–

A Multi-State, Student-Level Analysis of the Effects of the Four-Day School Week On Student Achievement and Growth
Emily Morton, Paul N. Thompson and Megan Kuhfeld. Economics of Education Review, June 2024.

Summary: This study looks at how switching to a four-day school week affects student achievement over the course of the school year in Colorado, Iowa, Kansas, Montana, North Dakota and Wyoming. A key takeaway: On average, across those six states, students on a four-day schedule learned less during the school year than students who went to class five days a week. However, students in rural areas fared better on that schedule than students in “non-rural” areas.

Researchers studied the scores that students in grades 3-8 earned on an assessment called the Measures of Academic Progress Growth, administered each fall and spring to gauge how much kids learned over the course of the school year. The analysis uses 11 years of test score data in reading and math, collected from the 2008-09 to the 2018-19 academic year.

Researchers found that students who went to school four days a week, as a whole, made smaller gains in reading during the academic year than students who went five days a week. They also earned lower scores in reading on the spring assessment, on average.

When researchers looked at the data more closely, however, they found differences between students attending rural schools and students attending schools located in towns and suburbs — communities the researchers dubbed “non-rural.”

Although adopting a four-day schedule had little to no impact on kids at rural schools, student performance fell considerably at schools in non-rural areas. Those children, as a whole, made less progress in reading and math during the academic year than children attending non-rural schools that operated five days a week. They also earned lower scores in both reading and math on the spring exam.

“The estimated effects on math and reading achievement in non-rural four-day week schools are ‘medium’ and meaningful,” the researchers write, adding that the difference is roughly equivalent to a quarter of a school year worth of learning in the fifth grade.

Researchers also discovered that student performance at schools with four-day schedules varied by gender and race. At schools using a four-day-a-week schedule, girls made smaller gains in reading and math than boys, on average. Hispanic students made less progress in math than white students, who made less progress in math than Native American students.

“The estimated effects on math and reading gains during the school year are not ‘large’ by the developing standards used to interpret effect sizes of education interventions, but they are also not trivial,” the researchers write. “For the many districts and communities who have become very fond of the schedule, the evidence presented in this study suggests that how the four-day school week is implemented may be an important factor in its effects on students.”

Impacts of the Four-Day School Week on Early Elementary Achievement
Paul N. Thompson; et al. Early Childhood Research Quarterly, 2nd Quarter 2023.

Summary: This study is the first to examine the four-day school week’s impact on elementary schools’ youngest students. Researchers looked at how children in Oregon who went to school four days a week in kindergarten later performed in math and English Language Arts when they reached the third grade. What they found: Overall, there were “minimal and non-significant differences” in the test scores of third-graders who attended kindergarten on a four-day schedule between 2014 and 2016 and third-graders who went to kindergarten on a five-day schedule during the same period.

When the researchers studied individual groups of students, though, they noticed small differences. For example, when they looked only at children who had scored highest on their pre-kindergarten assessments of letter sounds, letter names and early math skills, they learned that kids who went to kindergarten four days a week scored a little lower on third-grade tests than those who had gone to kindergarten five days a week.

The researchers write that they find no statistically significant evidence of detrimental four-day school week achievement impacts, and even some positive impacts” for minority students, lower-income students,  special education students, students enrolled in English as a Second Language programs and students who scored in the lower half on pre-kindergarten assessments.

There are multiple reasons why lower-achieving students might be less affected by school schedules than high achievers, the researchers point out. For example, higher-achieving students “may miss out on specialized instruction — such as gifted and enrichment activities — that they would have had time to receive under a five-day school schedule,” they write.

Effects of 4-Day School Weeks on Older Adolescents: Examining Impacts of the Schedule on Academic Achievement, Attendance, and Behavior in High School
Emily Morton. Educational Evaluation and Policy Analysis, June 2022.

Summary: Oklahoma high schools saw less fighting and bullying among students after switching from a five-day-a-week schedule to a four-day schedule, this study finds. Fighting declined by 0.79 incidents per 100 students and bullying dropped by 0.65 incidents per 100 students.

The other types of student discipline problems examined, including weapons possession, vandalism and truancy, did not change, according to the analysis, based on a variety of student and school data collected through 2019 from the Oklahoma State Department of Education and National Center for Education Statistics.

“Results indicate that 4-day school weeks decrease per-pupil bullying incidents by approximately 39% and per-pupil fighting incidents by approximately 31%,” writes the author, Emily Morton, a research scientist at NWEA, a nonprofit research organization formerly known as the Northwest Evaluation Association.

Morton did not investigate what caused the reduction in bullying and fighting. She did find that moving to a four-day schedule had “no detectable effect” on high school attendance or student scores on the ACT college-entrance exam.

Only a Matter of Time? The Role of Time in School on Four-Day School Week Achievement Impacts
Paul N. Thompson and Jason Ward. Economics of Education Review, February 2022.

Summary: Student test scores in math and language arts dipped at some schools that adopted a four-day schedule but did not change at others, according to this analysis of school schedule switches in 12 states.

Researchers discovered “small reductions” in test scores for students in grades 3 through 8 at schools offering what the researchers call “low time in school.” These schools operate an average of 29.95 hours during the four-day week. The decline in test scores is described in terms of standard deviation, not units of measurement such as points or percentages.

At schools offering “middle time in school” — an average of 31.03 hours over four days — test scores among kids in grades 3 through 8 did not change, write the researchers, Paul N. Thompson, an associate professor of economics at Oregon State University, and Jason Ward, an associate economist at the RAND Corp., a nonprofit research organization.

Scores also did not change at schools providing “high time in school,” or 32.14 hours over a four-day school week, on average.

When describing this paper’s findings, it’s inaccurate to say researchers found that test scores dropped as a result of schools adopting a four-day schedule. It is correct to say test scores dropped, on average, across the schools the researchers studied. But it’s worth noting the relationship between test scores and the four-day school week differs according to the average number of hours those schools operate each week.

For this analysis, researchers examined school districts in states that allowed four-day school weeks during the 2008-2009 academic year through the 2017-2018 academic years. They chose to focus on the 12 states where four-day school weeks were most common. The data they used came from the Stanford Educational Data Archive and “a proprietary, longitudinal, national database” that tracked the use of four-day school weeks from 2009 to 2018.

The researchers write that their findings “suggest that four-day school weeks that operate with adequate levels of time in school have no clear negative effect on achievement and, instead, that it is operating four-day school weeks in a low-time-in-school environment that should be cautioned against.”

Three Midwest Rural School Districts’ First Year Transition to the Four Day School Week
Jon Turner, Kim Finch and Ximena Uribe-Zarain. The Rural Educator, 2019.

Abstract: “The four-day school week is a concept that has been utilized in rural schools for decades to respond to budgetary shortfalls. There has been little peer-reviewed research on the four-day school week that has focused on the perception of parents who live in school districts that have recently switched to the four-day model. This study collects data from 584 parents in three rural Missouri school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis identifies significant differences in the perceptions of parents classified by the age of children, special education identification, and free and reduced lunch status. Strong parental support for the four-day school week was identified in all demographic areas investigated; however, families with only elementary aged children and families with students receiving special education services were less supportive than other groups.”

Juvenile Crime and the Four-Day School Week
Stefanie Fischer and Daniel Argyle. Economics of Education Review, 2018.

Abstract: “We leverage the adoption of a four-day school week across schools within the jurisdiction of rural law enforcement agencies in Colorado to examine the causal link between school attendance and youth crime. Those affected by the policy attend school for the same number of hours each week as students on a typical five-day week; however, treated students do not attend school on Friday. This policy allows us to learn about two aspects of the school-crime relationship that have previously been unstudied: one, the effects of a frequent and permanent schedule change on short-term crime, and two, the impact that school attendance has on youth crime in rural areas. Our difference-in-difference estimates show that following policy adoption, agencies containing students on a four-day week experience about a 20 percent increase in juvenile criminal offenses, where the strongest effect is observed for property crime.”

Staff Perspectives of the Four-Day School Week: A New Analysis of Compressed School Schedules
Jon Turner, Kim Finch and Ximena Uribe–Zarian. Journal of Education and Training Studies, 2018.

Abstract: “The four-day school week is a concept that has been utilized in rural schools for decades to respond to budgetary shortfalls. There has been little peer-reviewed research on the four-day school week that has focused on the perception of staff that work in school districts that have recently switched to the four-day model. This study collects data from 136 faculty and staff members in three rural Missouri school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis identifies strong support of the four-day school week model from both certified educational staff and classified support staff perspectives. All staff responded that the calendar change had improved staff morale, and certified staff responded that the four-day week had a positive impact on what is taught in classrooms and had increased academic quality. Qualitative analysis identifies staff suggestions for schools implementing the four-day school week including the importance of community outreach prior to implementation. No significant differences were identified between certified and classified staff perspectives. Strong staff support for the four-day school week was identified in all demographic areas investigated. Findings support conclusions made in research in business and government sectors that identify strong employee support of a compressed workweek across all work categories.”

The Economics of a Four-Day School Week: Community and Business Leaders’ Perspectives
Jon Turner, Kim Finch and Ximena Uribe–Zarian. Journal of Education and Training Studies, 2018.

Abstract: “The four-day school week is a concept that has been utilized in rural schools in the United States for decades and the number of schools moving to the four-day school week is growing. In many rural communities, the school district is the largest regional employer which provides a region with permanent, high paying jobs that support the local economy. This study collects data from 71 community and business leaders in three rural school districts that have transitioned to the four-day school week within the last year. Quantitative statistical analysis is used to investigate the perceptions of community and business leaders related to the economic impact upon their businesses and the community and the impact the four-day school week has had upon perception of quality of the school district. Significant differences were identified between community/business leaders that currently have no children in school as compared to community/business leaders with children currently enrolled in four-day school week schools. Overall, community/business leaders were evenly divided concerning the economic impact on their businesses and the community. Community/business leaders’ perceptions of the impact the four-day school week was also evenly divided concerning the impact on the quality of the school district. Slightly more negative opinions were identified related to the economic impact on the profitability of their personal businesses which may impact considerations by school leaders. Overall, community/business leaders were evenly divided when asked if they would prefer their school district return to the traditional five-day week school calendar.”

Impact of a 4-Day School Week on Student Academic Performance, Food Insecurity, and Youth Crime
Report from the Oklahoma State Department of Health’s Office of Partner Engagement, 2017.

Summary: “A Health Impact Assessment (HIA) utilizes a variety of data sources and analytic methods to evaluate the consequences of proposed or implemented policy on health. A rapid (HIA) was chosen to research the impact of the four-day school week on youth. The shift to a four-day school week was a strategy employed by many school districts in Oklahoma to address an $878 million budget shortfall, subsequent budget cuts, and teacher shortages. The HIA aimed to assess the impact of the four-day school week on student academic performance, food insecurity, and juvenile crime … An extensive review of literature and stakeholder engagement on these topic areas was mostly inconclusive or did not reveal any clear-cut evidence to identify effects of the four-day school week on student outcomes — academic performance, food insecurity or juvenile crime. Moreover, there are many published articles about the pros and cons of the four-day school week, but a lack of comprehensive research is available on the practice.”

Does Shortening the School Week Impact Student Performance? Evidence from the Four-Day School Week
D. Mark Anderson and Mary Beth Walker. Education Finance and Policy, 2015.

Abstract: “School districts use a variety of policies to close budget gaps and stave off teacher layoffs and furloughs. More schools are implementing four-day school weeks to reduce overhead and transportation costs. The four-day week requires substantial schedule changes as schools must increase the length of their school day to meet minimum instructional hour requirements. Although some schools have indicated this policy eases financial pressures, it is unknown whether there is an impact on student outcomes. We use school-level data from Colorado to investigate the relationship between the four-day week and academic performance among elementary school students. Our results generally indicate a positive relationship between the four-day week and performance in reading and mathematics. These findings suggest there is little evidence that moving to a four-day week compromises student academic achievement. This research has policy relevance to the current U.S. education system, where many school districts must cut costs.”

Other resources

• The Education Commission of the States offers a 50-state comparison of public school students’ instructional time requirements. For example, students in Colorado are required to be in school for a minimum of 160 days each academic year while in Vermont, the minimum is 175 days and in North Carolina, it’s 185.
• The State of the American Teacher project offers insights into how teachers feel about their jobs and the education field as a whole. In early 2022, RAND Corp. surveyed a nationally representative sample of teachers, asking questions on topics such as job-related stress, school safety, COVID-19 mitigation policies and career plans. Survey results show that 56% of teachers who answered a question about their attitude toward their job “strongly” or “somewhat” agreed with the statement, “The stress and disappointments involved in teaching aren’t really worth it.” Meanwhile, 78% “strongly” or “somewhat” agreed with the statement, “I don’t seem to have as much enthusiasm now as I did when I began teaching.”
• Opinions about the four-day school week vary among school board members, district-level administrators, school principals and teachers. These organizations can provide insights: the Schools Superintendents Association, National School Boards Association, National Association of Elementary School Principals and National Association of Secondary School Principals.

Looking for more research on public schools? Check out our other collections of research on student lunches, school uniforms, teacher salaries and teacher misconduct.

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Journalists can’t report accurately on research involving human subjects without knowing certain details about the sample of people researchers studied. It’s important to know, for example, whether researchers used a nationally representative sample.

That’s important whether a journalist is covering an opinion poll that asks American voters which presidential candidate they prefer, an academic article that examines absenteeism among U.S. public school students or a clinical trial of a new drug designed to treat Alzheimer’s disease.

When researchers design a study, they start by defining their target population, or the group of people they want to know more about. They then create a sample meant to represent this larger group. If researchers want to study a group of people across an entire country, they aim for a nationally representative sample — one that resembles the target population in key characteristics such as gender, age, political party affiliation and household income.

Earlier this year, when the Pew Research Center wanted to know how Americans feel about a new class of weight-loss drugs, it asked a sample of 10,133 U.S. adults questions about obesity and the effects of Ozempic, Wegovy and similar drugs. Pew designed the survey so that the answers those 10,133 people gave likely reflected the attitudes of all U.S. adults across various demographics.

If Pew researchers had simply interviewed 10,133 people they encountered at shopping malls in the southeastern U.S., their responses would not have been nationally representative. Not only would their answers reflect attitudes in just one region of the country, the individuals interviewed would not represent adults nationwide.

A nationally representative sample is one of several types of samples used in research. It’s commonly used in research that examines numerical data in public policy fields such as public health, criminal justice, education, immigration, politics and economics.

To accurately report on research, journalists must pay close attention to who is and isn’t included in research samples. Here’s why that information is critical:

1. If researchers did not use a sample designed to represent people from across the nation, it would be inaccurate to report or imply that their results apply nationwide.

A mistake journalists make when covering research is overgeneralizing the results, or reporting that the results apply to a larger group of people than they actually do. Depending on who is included in the sample, a study’s findings might only apply to the people in the sample. Many times, findings apply only to a narrow group of people at the national level who share the same characteristics as the people in the sample — for example, individuals who retired from the U.S. military after 2015 or Hispanic teenagers with food allergies.

To determine who a study is designed to represent, look at how the researchers have defined this target population, including location, demographics and other characteristics.

“Consider who that research is meant to be applicable to,” says Ameeta Retzer, a research fellow at the University of Birmingham’s Department of Applied Health Sciences.

2. When researchers use a nationally representative sample, their analyses often focus on what’s happening at a national level, on average. Because of this, it’s never safe to assume that national-level findings also apply to people at the local level.

“As a word of caution, if you’re using a nationally representative sample, you can’t say, ‘Well, that means in California …,” warns Michael Gottfried, an applied economist and professor at the University of Pennsylvania’s Graduate School of Education.

When researchers create a nationally representative sample of U.S. grade school students, their aim is to gain a better understanding of some aspect of the nation’s student population, Gottfried says. What they learn will represent an average across all students nationwide.

“On average, this is what kids are doing, this is how kids are doing, this is the average experience of kids in the United States,” he explains. “The conclusion has to stay at the national level. It means you cannot go back and say kids in Philadelphia are doing that. You can’t take this information and say, ‘In my city, this is happening.’ It’s probably happening in your city, but cities are all different.”

3. There’s no universally accepted standard for representativeness.

If you read a lot of research, you’ve likely noticed that what constitutes a nationally representative sample varies. Researchers investigating the spending habits of Americans aged 20 to 30 years might create a sample that represents this age group in terms of gender and race. Meanwhile, a similar study might use a sample that represents this age group across multiple dimensions — gender, race and ethnicity along with education level, household size, household income and the language spoken at home.

“In research, there’s no consensus on which characteristics we include when we think about representativeness,” Retzer notes.

Researchers determine whether their sample adequately represents the population they want to study, she says. Sometimes, researchers call a sample “nationally representative” even though it’s not all that representative.

Courtney Kennedy, vice president of methods and innovation at Pew Research Center, has questioned the accuracy of election research conducted with samples that only represent U.S. voters by age, race and sex. It’s increasingly important for opinion poll samples to also align with voters’ education levels, Kennedy writes in an August 2020 report.

“The need for battleground state polls to adjust for education was among the most important takeaways from the polling misses in 2016,” Kennedy writes, referring to the U.S. presidential election that year.

4. When studying a nationwide group of people, the representativeness of a sample is more important than its size.

Journalists often assume larger samples provide more accurate results than smaller ones. But that’s not necessarily true. Actually, what matters more when studying a population is having a sample that closely resembles it, Michaela Mora explains on the website of her research firm, Relevant Insights.

“The sheer size of a sample is not a guarantee of its ability to accurately represent a target population,” writes Mora, a market researcher and former columnist for the Dallas Business Journal. “Large unrepresentative samples can perform as badly as small unrepresentative samples.”

If a sample is representative, larger samples are more helpful than smaller ones. Larger samples allow researchers to investigate differences among sub-groups of the target population. Having a larger sample also improves the reliability of the results.

5. When creating samples for health and medical research, prioritizing certain demographic groups or failing to represent others can have long-term impacts on public health and safety.

Retzer says that too often, the people most likely to benefit from a new drug, vaccine or health intervention are not well represented in research. She notes, for example, that even though people of South Asian descent are more likely to have diabetes than people from other ethnic backgrounds, they are vastly underrepresented in research about diabetes.

“You can have the most beautiful, really lovely diabetes drug,” she says. “But if it doesn’t work for the majority of the population that needs it, how useful is it?”

Women remain underrepresented in some areas of health and medical research. It wasn’t until 1993 that the National Institutes of Health began requiring that women and racial and ethnic minorities be included in research funded by the federal agency. Before that, “it was both normal and acceptable for drugs and vaccines to be tested only on men — or to exclude women who could become pregnant,” Nature magazine points out in a May 2023 editorial.

In 2022, the U.S. Food and Drug Administration issued guidance on developing plans to enroll more racial and ethnic minorities in clinical trials for all medical products.

When journalists cover research, Retzer says it’s crucial they ask researchers to explain the choices they made while creating their samples. Journalists should also ask researchers how well their nationally representative samples represent historically marginalized groups, including racial minorities, sexual minorities, people from low-income households and people who don’t speak English.

“Journalists could say, ‘This seems like a really good finding, but who is it applicable to?’” she says.

The Journalist’s Resource thanks Chase Harrison, associate director of the Harvard University Program on Survey Research, for his help with this tip sheet.  

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Competition for audience attention is fierce in this era of infinite scroll, with a seemingly endless array of information sources for readers to filter.

But new research in Science Advances suggests editors and reporters can get more readers to click their stories using this strategy: Write simple headlines.

Based on more than 30,000 experiments conducted by the Washington Post and Upworthy, the finding is an important reminder for news organizations. Past research suggests mainstream news outlets tend to use more complex wording than hyper-partisan outlets, which use shorter sentences and less formal language.

“Extreme news has already gotten the memo,” says Todd Rogers, one of the authors of the paper and a professor of public policy at Harvard Kennedy School’s Shorenstein Center, where The Journalist’s Resource is housed.

But headline preference can be in the eye of the beholder. In fact, the authors find in follow-up surveys that professional journalists do not favor simple headlines, “suggesting that those writing the news may read it differently from those consuming it,” the authors write. This in contrast to past research indicating that other professionals, such as lawyers, prefer simple writing.

Here’s how Rogers and co-authors — Hillary Shulman, an associate professor of communication at The Ohio State University and David Markowitz, an associate professor of communication at Michigan State University — assess headline complexity:

• Whether the headline includes common words.
• Use (or not) of a formal, complex, analytic style.
• Readability, which accounts for words per sentence and syllables per word.
• Overall character count.

To measure common words and analytic writing the authors used statistical software called Linguistic Inquiry and Word Count. For readability and character count, they used text analysis packages in the statistical programming interface R.

The study doesn’t offer rules for headlines, such as writing at a particular reading grade level or staying below a certain character count.

But Rogers says the findings suggest a rule of thumb for journalists to consider: If you’re choosing between two headlines, where both make sense, are accurate and otherwise equal, choose the less complex one.

In the newsroom, gauging simplicity can be subjective. Rogers recommends journalists choose words that are shorter, more common and that they aim for simple grammatical construction when writing headlines.

Thousands of headline tests at the Washington Post and Upworthy

Readers may not be aware that the headlines they see on a news website could be different from what another reader sees. News outlets often test headlines to gauge which one audiences prefer. These are called A/B tests — a portion of site visitors get headline A, others get headline B.

The authors obtained all headline tests the Washington Post ran from March 3, 2021 to December 18, 2022. In total, they analyzed nearly 20,000 headlines, the popularity of which was determined by the click-through rate, or the percentage of people who clicked on that headline.

Some of the Washington Post headline tests included three or four headlines for a single story. Regardless of the content of the headline, the authors’ analysis links simpler headlines with higher click rates.

While Rogers notes that “the effect is not gigantic” he says crafting simpler headlines “will disproportionately help those who are not doing it, which is the non-extremist news.”

The authors note in the paper that because of the large size of the Washington Post’s readership, even a small percentage bump in click rates could mean tens of thousands more reads.

And simple headlines are not necessarily shorter, the research finds. While using common words, an informal style and better readability were associated with higher click rates, character count was not.

For example, this Washington Post headline, about Oprah Winfrey’s March 2021 interview with the Duke and Duchess of Sussex, has 14 words:

“Meghan and Harry are talking to Oprah. Here’s why they shouldn’t say too much.”

The authors’ analysis finds it is less complex than this 13-word version:

“Are Meghan and Harry spilling royal tea to Oprah? Don’t bet on it.”

The authors did the same analysis with headline tests from Upworthy conducted January 2013 to April 2015 across more than 105,000 headlines.

The conclusion was the same.

“Thousands of field experiments across traditional (i.e., The Washington Post) and nontraditional news sites (i.e., Upworthy) showed that news readers are more likely to click on and engage with simple headlines than complex ones,” the authors write.

Audiences and journalists see headlines differently

In two follow-up surveys the authors aimed to explore whether the results of the headline tests held up in a controlled setting and whether professional news makers also prefer simple headlines.

In early May 2023, the authors recruited 524 people from Amazon’s Mechanical Turk and assessed whether they more closely read simple or complex headlines. Participants were roughly equally split between men and women, with about 77% identifying as white, 11% Black, 7% Asian, 1% American Indian or Alaska Native and 3% multiracial.

They were shown 10 headlines and asked to pick one they’d click on a news site.

Within that set, participants saw four “target” and six “control” headlines. The target headlines were either simple or complex. All participants saw the same control headlines.

Participants were split into two treatment groups: either four simple or four complex headlines. Those who saw simple headlines picked one of them 34.8% of the time, compared with 15.3% for control headlines.

But when participants got the complex headlines, they picked one of them 22.2% of the time, compared with 27.7% for the controls.

Participants were also presented with a three-word phrase and asked to recall whether the phrase had appeared in the headlines. They were more likely to recognize the three-word phrase within simpler headlines.

“[T]he finding that readers engage less deeply with complex writing has important practical implications,” the authors write. “Specifically, writing simply can help news creators increase audience engagement even for stories that are themselves complicated.”

For the second survey, 249 participants were recruited from a September 2023 webinar about strategies for people writing for busy readers, which Rogers led and The Journalist’s Resource presented.

All participants identified as professional writers and most were current or former journalists with about 14 years of experience, on average. They were presented with the same headlines and asked the same questions as participants in the other survey.

The authors write that the findings of this survey represented a “notable departure” from the other findings. The writers and journalists surveyed did not prefer simpler headlines over complex ones, and they were much better at recalling whether the three-word phrase appeared in both simple and complex headlines.

“They’re not deterred by cognitive complexity,” Rogers says. “They don’t have the same intuitions or experiences reading as normal news readers.”

That, Rogers adds, is a main takeaway for journalists: Be aware that your experience and your audiences’ experience when interpreting headlines may be leagues apart — and lean into simplicity.

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For decades, researchers have urged journalists to avoid framing gun violence solely as a crime issue and provide a broader public health context. Yet, as evidenced by the findings of a recent study of local TV news in Philadelphia, the focus on the crime angle remains very much at the forefront of gun violence coverage.

The researchers’ call for change was further underscored on June 25, when the U.S. surgeon general declared firearm violence a public health crisis for the first time in a 40-page advisory, calling on the nation to take a public health approach to address gun violence, much like it has done before to address tobacco and car crashes.

In “Public health framing of firearm violence on local television news in Philadelphia, PA, USA: a quantitative content analysis,” published in BMC Public Health in May 2024, researchers analyzed 192 TV news clips aired on four local news stations between January and June 2021 and found that 84% contained at least one element that could be harmful to communities, audiences and gun violence survivors. Some of those elements are visuals of the crime scene, not following up on the story, naming the treating hospital and the relationship between the injured person and the shooter.

Meanwhile, public health elements such as root causes of gun violence, solutions and sources other than law enforcement officials were missing from most news clips.

“The main message is that the majority of reporting on firearm violence, at least in TV news, has many harmful content elements and we have to do better,” says the study’s lead author, Dr. Jessica Beard, director of research at The Philadelphia Center for Gun Violence Reporting, a trauma surgeon at Temple University Hospital and an associate professor at the Lewis Katz School of Medicine at Temple University. “The public does not have an accurate understanding of what gun violence is and the policy implications are huge.”

Beard was part of a panel on covering gun violence as a public health emergency at the Association of Health Care Journalists’ annual conference in New York City earlier this month. She also spoke with The Journalist’s Resource after the panel.

Previous studies have shown that when the news media covers community gun violence as a single incident in isolation, audiences are more likely to blame victims. This approach also reinforces racist stereotypes and suggests that policing is the most effective way to prevent violence, undermining public health measures that could curb gun violence, Beard and her co-authors of the BMC Public Health study write.

This type of coverage also has a negative effect on people who are injured in shootings, they point out.

Injured people say that graphic content, inaccuracies and mention of treating hospitals resulted in distress, harm to their reputation and threats to their personal safety, according to a 2023 study by the same research team, which included interviews with 26 adults who had recently sustained a gunshot wound. They said that news reports that neglected their personal perspectives left them feeling dehumanized and compounded their trauma.

“Some people were afraid to get discharged from the hospital,” Beard says.

More about the study and its findings

The researchers chose to study TV news because more people in the U.S. get their news from TV than other legacy sources such as radio and print, according to a 2023 survey by Pew Research Center. (That same survey found that more Americans get their news from digital devices than from TV, and there’s a need for research on firearm violence content in digital news, the authors note.)

They focus on Philadelphia for several reasons. The city is the birthplace of Eyewitness News, which launched in 1965, and Action News, which launched in 1970. The two newscasts pioneered reporting approaches that have been criticized for the way they are produced and for casting a negative light on Black communities, the authors write. A 2022 story by The Philadelphia Inquirer delves deep into this history.

Moreover, the epidemic of gun violence in Philadelphia reflects a trend across the country where shooting rates have increased since the onset of the COVID-19 pandemic, disproportionately affecting young people and Black people. A June report from the CDC’s Morbidity and Mortality Weekly Report finds that between January 2019 and September 2023, rates of emergency medical services encounters for gun-related injuries were highest among males, non-Hispanic Black people and people between 15 and 24 years old.

The study compares Philadelphia news clips based on two main characteristics: news clips that focused on a single incident in isolation, called episodic framing, and those with more of a public-health approach, exploring the broader social and structural context in which the violence occurs, called thematic framing.

Among the findings:

• Nearly 80% of the stories used episodic framing.
• In 21% of the clips, a law enforcement official was the main interview source.
• In 50.5% of the clips where the journalists were the only news narrators, police were the predominant source of information on firearm violence.
• More than 84% of the stories contained at least one harmful element, such as a visual of the crime scene, not following up on the story, the number of gunshot wounds, the name of the treating hospital and the relationship between the injured person and the shooter. About 7% of the clips included video or audio of the shooting.
• The 192 news clips mentioned a total of 433 injured people.
• More than 80% of the clips mentioned an injured person, although in 67%, the only information about injured people was age or gender.
• None of the 192 news segments included a health or public health professional or an injured person as the main interview source.
• Only 10% of the clips included discussions about public health solutions.
• And only five stories (2.6%) used the word “prevent.” Another four stories (2.1%) offered resources related to firearm prevention.

The authors point out that the study findings may not be generalizable to all U.S. cities, to national TV news, or to print, radio, or social media content.

Also, it’s still not clear whether harmful reporting on community firearm violence increases rates of gun violence. The connection between the two is complex, Beard says, adding that she’s hoping to explore and study the topic in the future.

In their 2023 study, Beard and colleagues asked injured participants if they would be willing to speak with a journalist about their shooting incident and what would they tell the journalist.

One participant said, “You report the gun violence, but why not do a follow-up report […] for the victims, the survivors, the families that had to bury these people, the whole process? Just don’t do a guy got shot over there, a guy got shot over here. You’re making people more fearful. You’re more fearful, you’re going to arm yourself more.”

The authors underscore the study participant’s point: Reporting on firearm violence with limited information and no follow-up stories may perpetuate fear, which may contribute to increasing firearm use and, in turn, the increasing incidence of firearm violence.

The BMC Public Health study was funded by the Stoneleigh Foundation, Lehigh University Research Investment Programs, the National Institute on Minority Health and Health Disparities of the National Institutes of Health, and the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention.

Gun violence as a public health issue

Two days after the Pulse nightclub mass shooting, where 49 people were killed by a lone gunman in Orlando, The American Medical Association adopted a policy calling gun violence “a public health crisis,” which requires a comprehensive public health response.

In addition to death, gun violence can result in long-term physical, mental and financial burdens among injured individuals, studies show, including a 2023 study published in JAMA Network Open. It impacts communities, causing fear and economic decline. And compared with infectious diseases, it poses a larger burden on society in terms of potential years of life lost, according to a 2020 report by the Educational Fund to Stop Gun Violence (now the Johns Hopkins Center for Gun Violence Solutions).

Gun violence affects the health of entire communities, said Dr. Ruth Abaya, an attending physician in the Children’s Hospital of Philadelphia emergency department, during the panel on covering gun violence as a public health emergency at the Association of Health Care Journalists.

“We’re seeing young people who have crippling anxiety that is limiting their abilities to participate in daily life, they’re being medicated and even being hospitalized, and that’s directly related to this other public health crisis of gun violence,” said Abaya, who’s also the senior director of health systems and CVI — community violence intervention — integration at The Health Alliance for Violence Intervention. “And I’m also seeing young people with other unrelated chronic diseases like asthma that’s out of control because their caregiver was killed in a violent incident.”

Recommendations for journalists

The study’s findings are not surprising to Rick Brunson, a senior instructor of journalism at the University of Central Florida’s Nicholson School of Communication and Media.

Brunson, who worked as a reporter and editor in Central Florida for 20 years, including at a local TV station, mentions several reasons why many TV stations’ coverage of gun violence lacks a broader public health context.

Commercial news stations’ economic lifeblood depends on ratings, and as much as audiences may say they are put off by coverage of crime and violence, stations’ internal research shows that people watch crime news, he says.

Also, with the plethora of streaming options and multiple screens, viewers are distracted and TV stations are often vying for their attention, which results in newscasts packed with videos and short stories without space for context and explanation.

And there’s the broader, growing trend of news avoidance among audiences.

“When they watch the news, it just makes them feel despair and exhaustion, especially the focus on crime coverage and because there’s no context,” Brunson says. “They’re just presented with problem after problem after problem. Violence after violence.”

“The question for news directors to ask in the face of this where people are just avoiding the news and you’re seeing your audience erode more and more, year after year, is can the news business also be in the hope business?” Brunson says. “It’s going to take some serious consideration and the reversal of the kind of coverage that you put on your air.”

Even though there are widely accepted journalistic guidelines to protect victims and audiences in cases of suicide, mass shootings, sexual assault, abuse, and crime involving minors, no such guidelines crafted by journalists and public health practitioners exist for reporting on community firearm violence, Beard and her colleagues note in their study.

They say their research aims to lay the foundation for understanding harmful content in TV news clips and share several recommendations, including the practice of trauma-informed reporting.

Trauma-informed journalism recognizes the need for journalists to better understand how trauma can affect survivors and how to avoid reporting that could cause additional harm to vulnerable people and those who have experienced trauma. The practice also helps journalists to protect their own mental health.

When covering firearm violence, trauma-informed reporting would involve engaging with survivors using trauma-informed principles, including giving them control over the narrative of their injuries. It also minimizes harmful elements such as graphic visuals.

“This type of reporting could humanize firearm-injured people and build empathy in audiences, deconstructing the existing racialized news narratives around firearm violence in cities,” the authors write.

They also recommend:

• Public health practitioners partner with firearm violence survivors to offer alternative perspectives to journalists reporting on firearm violence.
• Journalists seek training in trauma-informed practices and solutions journalism.
• Newsrooms adopt a public health approach to reporting on firearm violence, provide resources to audiences and use the public health framing.

To help journalists and newsrooms meet these recommendations, the Philadelphia Center for Gun Violence Reporting and Frameworks Institute created a free gun violence reporting toolkit, which provides more information on trauma-informed reporting, the drivers of gun violence, and tips for more complete news coverage of gun violence.

Brunson advises reporters to seek out public health professionals as a source to help add context to their reporting and to read BMC Public Health study.

“People are always trying to tell us what to do,” Brunson says. “But we should take that as a compliment because the folks like the people who did this study acknowledge that they’re doing it because the media has influence, and journalists help shape and frame public debate and discussions and the problems that get looked at. Policymakers look at what journalists are doing.”

Additional research

Systematic disparities in reporting on community firearm violence on local television news in Philadelphia, PA, USA
Jessica H. Beard, et al. Preventive Medicine Reports, April 2024.

“Like I’m a nobody:” firearm-injured peoples’ perspectives on news media reporting about firearm violence
Jessica H. Beard, et al. Qualitative Research in Health, June 2023.

Firearm Injury — A Preventable Public Health Issue
Jay Patel, et al. Lancet Public Health, November 2022.

Making the News: Victim Characteristics Associated with Media Reporting on Firearm Injury
Elinore J Kaufman, et al. Preventive Medicine Reports, December 2020.

Resources

• To help journalists with better reporting of gun violence, PCGVR has created a free gun violence reporting toolkit.
• “Firearm Violence: A Public Health Crisis in America” is the U.S. Surgeon General’s 2024 advisory, a first of its kind for gun violence.
• The American Public Health Association’s Gun Violence page links to several useful resources.
• The Dart Center for Journalism & Trauma, the Canadian Broadcasting Corporation (CBC/Radio-Canada), and the Canadian Journalism Forum on Violence and Trauma recently launched a news industry toolkit on trauma-aware journalism.
• This fact sheet by the American Public Health Association lists some of the recommended public health responses to gun violence.

The post Research highlights need for public health approach in news reporting of gun violence appeared first on The Journalist's Resource.

Threats against poll workers made national news following false claims from former President Donald Trump and supporters that Joe Biden had fraudulently won the 2020 presidential election.

For example, in Georgia “two local election workers, Ruby Freeman and Wandrea Moss were pressured to make false claims of voter fraud in the 2020 presidential election,” write the authors of a 2022 essay on local political violence, published in the State and Local Government Review. “After refusing to lie, a far-right media outlet spread conspiracies about the two women that resulted in a mob surrounding their house.”

In April 2024, a federal judge upheld a $148 million judgment for Freeman and Moss from a civil case against former Trump lawyer Rudy Giuliani, who admitted to making false claims about the poll workers.

Poll workers perform fundamental tasks in democratic societies, ensuring citizens can safely and freely cast their ballots for measures and candidates, often working long hours on Election Day for low pay.

More than 900,000 poll workers staffed early voting sites and Election Day polling places during the 2016 national elections in the U.S., according to the federal Election Assistance Commission. That number dipped to about 775,000 for 2020, when the COVID-19 pandemic curtailed in-person voting.    

Poll workers are often temporary government employees hired to help on Election Day, though they almost always undergo training beforehand. They greet voters, remind them of their voting district, verify their eligibility, help them use voting equipment, assist voters with disabilities and register voters in states that allow same-day registration, among other tasks.

While poll worker job titles vary by election district, districts may hire a clerk in charge of overall operations on Election Day along with assistant clerks, equipment operators, inspectors who verify that voters are registered, and deputies who greet voters.

Pay varies by election administration jurisdictions, which usually align with county boundaries. In Miami-Dade County, for example, poll workers are paid between $200 and $346 including training, pre-election setup and Election Day duties.

Most poll workers in New York City get $250 for Election Day and are expected to work from 5 a.m. to after 9 p.m., when polls close. In rural Coffee County, Alabama, Election Day pay maxes out at $185.

Election officials, by contrast, are government employees who work on Election Day but also during the rest of the year to prepare for and administer elections.

Journalists can reach out to election officials or visit election office websites to find poll worker duties and job titles. The nonpartisan U.S. Vote Foundation offers this election official directory by state.

Poll worker intimidation and threats

Poll workers are often motivated by civic duty, according to research and reporting featured in the tipsheet below. Despite their commitment to democracy, poll workers have recently been increasingly concerned about threats and violence while doing their jobs.

More than one-third of election officials — 38% — have experienced “threats, harassment, or abuse” specifically because of their job, finds a 2024 survey of 928 local election officials conducted by the Brennan Center for Justice at New York University.

That’s up from 30% who reported the same the year prior. More than half of the officials surveyed in 2024 by the Brennan Center said they are worried about the safety of their staff in future elections and 92% have enacted measures to protect voters and poll workers since 2020.

Some 28% indicated they were “very” or “somewhat” concerned about harassment or threats aimed at their family or loved ones while 27% were “very” or “somewhat” concerned about being assaulted at home or work.

Looking to November

The 2024 presidential race is poised to be a rematch between Trump and Biden.

The ongoing potential for threats to poll workers and election officials is real enough that the U.S. Department of Justice has launched a task force to address those threats.

But some election officials don’t think the task force is doing enough. National Association of State Election Directors Executive Director Amy Cohen in June told reporter Zachary Roth with the nonprofit Oregon Capital Chronicle that it is “very clear that we are not seeing a deterrent effect.”

At the same time, threats do not always come to the attention of police — 45% of local election officials surveyed by the Brennan Center who reported being threatened did not file a report to law enforcement.

We put together this tipsheet, mostly based on recent academic research, to bolster your coverage of threats and violence against election workers in advance of Election Day 2024.

1. Understand the social forces that tend to lead to political violence.

Rachel Kleinfeld, a senior fellow with the nonpartisan think tank Carnegie Endowment for International Peace, identifies four risk factors for political violence in an October 2021 paper in the Journal of Democracy. Kleinfeld defines political violence broadly as “physical harm or intimidation that affects who benefits from or can participate fully in political, economic, or sociocultural life.”

To identify social and political situations that increase the risk for political violence, she draws from examples of political violence abroad, such as anti-Muslim attacks during the political rise of Indian Prime Minister Narendra Modi in the early 2000s.

The risk factors, according to Kleinfeld, are:

• A contested election with high stakes for the balance of power. “For much of U.S. history, one party held legislative power for decades,” Kleinfeld writes. “Yet since 1980, a shift in control of at least one house of Congress was possible — and since 2010, elections have seen a level of competition not seen since Reconstruction.”
• Partisanship based on broad groups. “Up to the 1990s, many Americans belonged to multiple identity groups –for example, a union member might have been a conservative, religious, Southern man who nevertheless voted Democratic,” Kleinfeld writes. “Today, Americans have sorted themselves into two broad identity groups: Democrats tend to live in cities, are more likely to be minorities, women, and religiously unaffiliated, and are trending liberal. Republicans generally live in rural areas or exurbs and are more likely to be white, male, Christian, and conservative.”
• Election rules, such as winner-take-all, that let candidates exploit partisanship. “Winner-take-all elections are particularly prone to violence, possibly because small numbers of voters can shift outcomes,” Kleinfeld writes. “Two-party systems are also more correlated with violence than are multiparty systems, perhaps because they create us-them dynamics that deepen polarization.”
• A lack of institutional checks on political violence. “The United States suffers from three particularly concerning institutional weaknesses today — the challenge of adjudicating disputes between the executive and legislative branches inherent in presidential majoritarian systems, recent legal decisions enhancing the electoral power of state legislatures, and the politicization of law enforcement and the courts,” Kleinfeld writes.

Kleinfeld concludes: “Although political violence in the United States is on the rise, it is still lower than in many other countries. Once violence begins, however, it fuels itself. Far from making people turn away in horror, political violence in the present is the greatest factor normalizing it for the future.”

2. Know that a small but notable segment of the U.S. population thinks political violence is sometimes justified.

To capture a snapshot of Americans’ views of political violence, nine scholars affiliated with the Violence Prevention Research Program at the University of California, Davis, conducted a nationally representative survey with 8,620 participants during the summer of 2022. Results were published in September 2023 in the journal Injury Epidemiology.  

Nearly 20% of those surveyed strongly or very strongly agreed that having a “strong leader for America is more important than having a democracy.” About 14% strongly or very strongly agreed that “in the next few years, there will be civil war in the United States.” And nearly 8% reported that in the future they would be very or extremely likely to be “armed with a gun” in a situation where political violence is justified.

The researchers define political violence as “the use of physical force or violence to advance political objectives.” When they asked participants to imagine a scenario in which they believed political violence was justified “to advance an important political objective,” nearly 22% responded that political violence is never justified.

But, given the same scenario, 4.5% responded that they would be sometimes, very or completely willing to use violence against a poll worker and 6.1% reported the same for using force or violence against an elected local official.

The authors estimate 8 million adults in the U.S. think violence in general can be justified to make political gains, though they emphasize caution since their survey is small compared with the overall population. 

“Our extrapolations also suggest that millions of Americans would be very or completely willing to engage in violence themselves to advance a political objective that they support; between 5 and 6 million people would threaten or intimidate someone, injure them, or kill them,” the authors write.

3. Remind audiences of the long history of electoral violence in the U.S.

While recent violence and threats toward poll workers may seem startling to audiences, they should be made aware of the long history of electoral violence in the U.S.

For example, Black politicians faced violent attacks from white individuals and mobs following the Civil War. This violence formed the foundation for Jim Crow laws that segregated public facilities for white and Black Americans and sharply curtailed Black voting rights for generations.

“The pursuit of legalized voter suppression by Southern Democrats only became possible once violence had been successful enough to put Democrats back in power, Southern state governments (re)developed electoral institutions, and national Republicans abandoned black voters,” write the authors of a March 2019 paper in Perspectives on Politics.

Before and after the civil rights legislation of the 1960s outlawed Jim Crow era segregation, Black voters attempting to register in the south faced physical threats and violence, including from white individuals, mobs and law enforcement.

“Sporadic violence to discourage black political participation persisted as late as the 1960s and lynching continued to be a tool to limit black civil rights, repress black labor, reinforce white racial solidarity, and punish blacks for alleged crimes for many years,” write the authors of the Perspectives on Politics paper.

4. Interview poll workers about what motivates them.

Despite sometimes facing threats to their safety, many poll workers remain resilient in their commitment to facilitating free and fair elections in the U.S. In reviewing recent research, the authors of a chapter in a 2024 book on lessons learned from the 2020 presidential race, published by academic press Springer Link, relay that civic duty and social engagement are top motivators for poll workers.

The authors also conduct their own survey on what motivates poll workers — specifically, 1,729 poll workers in Miami-Dade County during early 2021. Those surveyed were most motivated by being part of the democratic process, performing their civic duty or wanting “to make a difference.”

They were least motivated by financial considerations, such as making some extra money, a finding that tracks with a quarter of participants being retired and despite large job losses at the time stemming from COVID-19 business closures.

But, the authors note, returning poll workers were more interested in pay than first-time poll workers, suggesting that “financial motivations may be less important for recruitment of new poll workers but may become increasingly important for retaining poll workers from election to election.”

The poll workers in Miami motivated by a sense of civic duty are not alone. For example, a poll worker near Seattle received an envelope of white powder while counting mail-in ballots during November 2023. But the elected official in charge told Stateline reporter Matt Vasilogambros that after the fire department arrived, “everybody marched right into that building, and said, ‘Oh, heck no, you are not disrupting the democratic process.’”

5. Understand how election officials try to manage the emotional burden of intimidation, for themselves and their staff.

Poll workers are often steadfast in their commitment to the democratic process, but intimidation and violence can take an emotional toll on them.

Experts and journalists who have researched and worked with trauma survivors say trauma-informed journalism is a good way to tell better, more accurate stories and help protect survivors from further harm.

“Most election workers come to the job with a strong sense of patriotism and pride in their work,” write the authors of a November 2022 article in the journal Administration and Society. “The enthusiasm election workers have for their job is crucial to maintaining trust in the system and creating a connection with the citizen-customer.”

For many citizens, the voting experience and interactions with poll workers “can shape voter perceptions of the government in a broader sense,” the authors write. For poll workers, greeting citizens in a friendly way and doing their best to ensure a smooth voting experience is part of what the authors call “emotional labor,” borrowing a phrase from past research.

For example, the burden of emotional labor might be high for a poll worker who is tired at the end of a long Election Day but is still expected to be helpful and courteous to voters.

The authors of the Administration and Society article identify three ways election administrators have recently tried to relieve or limit the emotional labor of poll workers in the face of violence or violent threats. Some are leaning into more public outreach, while others are making their election offices and workers less accessible to the public.

• Administrative strategies “focus on changes to the way the job is done to avoid burnout from emotional labor,” the authors write. This may include administrators investing in public education campaigns and offering tours of poll sites to build trust with voters they serve. Strategies may also include establishing election associations for officials to share best practices for combating misinformation and ensuring poll worker safety.
• Security strategies “may encompass tactics to protect and manage any direct and indirect attack or threat,” the authors write. Some election officials have put bulletproof glass in their offices and have decreased public outreach. Training for some poll workers now includes “deeper security instructions and quick ways to contact the main election office in the case of incidents.”
• Personal protective strategies, such as those used by the city clerk of Detroit, who “took firearms training and now carries a concealed weapon after receiving threats, including one outside of her home,” the authors write. Other officials, such as Georgia Secretary of State Brad Raffensperger, have requested more police presence at polling places and election offices following threats.

6. Note the difference between poll watchers and poll workers.

Poll workers and poll watchers sound similar but they’re very different. While poll workers are employed by election administration offices, poll watchers, sometimes called “election observers,” are members of the public or partisan groups interested in observing parts of the Election Day process.

States have different rules for people interested in observing voting. In certain jurisdictions they may be able to arrive early to polling sites and verify that voting machines are empty of ballots, watch election officials testing voting machines and other routine but important parts of setting up on Election Day.

Poll watchers are often members of partisan groups or political parties that may favor or oppose certain candidates or ballot measures. Election administration agencies may offer guides detailing poll watcher rights and rules.

They generally are allowed only to ensure that the voting process appears fair. No one watching an election may disrupt the process. States also restrict electioneering — trying to influence voters by handing out pamphlets or partisan apparel, for example — near polling sites.

But poll watchers too have a fraught history. During Reconstruction and again during the 1950s and 1960s, poll watchers intimated racial minorities attempting to exercise their right to register and vote. More recently, before the 2020 presidential election, Trump called on supporters to volunteer as poll watchers and “watch all the thieving and stealing and robbing they do,” none of which happened.

Other resources

Academic

Georgetown University Law Center | What to do if armed groups are near polling or registration places

MIT Election Data + Science Lab | Opting Out? Recent Challenges in Recruiting and Retaining Poll Workers

Election Law Journal | What Do We Actually Know About Poll Worker Recruitment in the United States?

Federal government

U.S. Department of Justice | Public Integrity Section annual reports

U.S. Election Assistance Commission | Election Administration and Voting Survey reports | Election Official Security

Nonprofit

Brookings Institution | The Americans on the front lines of elections

U.S. Vote Foundation | Election Official Directory

National Association of State Election Directors | State voter information

National Association of Election Officials | Board of Directors

News coverage

NBC News | Election worker turnover has reached historic highs ahead of the 2024 vote, new data shows

Oregon Capital Chronicle | Election workers worry that federal threats task force isn’t enough to keep them safe

Stateline | In face of threats, election workers vow: ‘You are not disrupting the democratic process’

The New York Times | Election Workers Face Flood of Threats, but Charges Are Few

The post Reporting on violence and threats against US election workers: 6 things to know appeared first on The Journalist's Resource.

This piece was updated on June 13, 2024 to reflect the recent Supreme Court decision about access to mifepristone, and to highlight new research on medication abortion. It was originally published in November 2023, shortly after the interviews with Ruvani Jayaweera and Carrie Baker took place.

On June 13, the Supreme Court justices in a unanimous decision preserved access to mifepristone, a medication that’s used for the safe termination of early pregnancy, writing that “federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions.”

The legal future of mifepristone had hung in the balance for several months.

In August 2023, the 5th U.S. Circuit Court of Appeals ruled that mifepristone should not be prescribed past the seventh week of pregnancy, prescribed via telemedicine, or shipped to patients through the mail. In September, the Justice Department asked the Supreme Court to consider a challenge to that ruling.

On Dec. 13, 2023, the Supreme Court justices announced that they would take up the case on the availability of mifepristone. The American College of Obstetricians and Gynecologists issued a statement on the same day urging the court to rule in favor of keeping the pill on the market and available to patients. The justices heard oral arguments on March 26, 2024 before issuing the June 13 ruling.

Meanwhile, abortion is on the ballot in four states this year so far. Measures have also been proposed in several other states, with initiatives that aim to ban, restrict, or expand abortion rights. (State laws that ban abortion apply to both abortion medications and surgical procedures.)

It’s important for journalists covering abortion to have a good understanding of medication abortion so that they can better inform their audiences. Below, we explain what medication abortion is, how individuals access it, and what research shows about its safety and effectiveness.

Medication abortion

Medication abortion is also known as abortion with pills or medical abortion. The Food and Drug Administration has approved medication abortion for up to 10 weeks of pregnancy and the World Health Organization authorizes its use for up to 12 weeks. It is endorsed by several organizations, including the American College of Obstetricians & Gynecologists and the American Medical Association. Medication abortion can also be used beyond 12 weeks of pregnancy, according to several organizations including the World Health Organization and the International Federation of Gynecology and Obstetrics.

Medication abortions accounted for 51% of all abortions in the U.S. in 2020, according to a 2022 CDC report. Use of medication abortion has been on the rise in recent years, increasing by 154% from 2011 to 2020, and by 22% from 2019 to 2020.

In many parts of the world, including the U.S., a two-medication protocol is used for medication abortion: mifepristone followed by misoprostol. Mifepristone blocks the hormone that is required for the continuation of pregnancy, and misoprostol causes the uterus to cramp and expel the pregnancy tissue.

The current approved regimen for medication abortion is 200 mg of mifepristone, followed by 800 mcg of misoprostol within 24 to 48 hours. Individuals are advised to follow up with a health care provider seven to 14 days after taking mifepristone, according to the FDA.

Studies have shown that both drugs are safe and effective. In consultation with medical experts, The New York Times has curated and reviewed a collection of 101 studies on medication abortion, all of which conclude that the pills are safe.

History of mifepristone

Mifepristone, or RU-486, is a drug that blocks progesterone, a hormone that’s needed for a pregnancy to continue.

Developed by the now-defunct French pharmaceutical firm Roussel-Uclaf, the pill was first approved in France and China in 1988. As of May this year, 96 countries have approved it for medication abortion, according to the Guttmacher Institute, a sexual and reproductive health research and policy organization that supports abortion rights.

The FDA approved mifepristone for medical termination of pregnancy in September 2000. Some 5.9 million women in the U.S. used mifepristone between September 2000 and December 2022, 32 of whom died, according to the FDA, which notes in its report that “the fatal cases are included regardless of causal attribution to mifepristone.” Causes of death included infection, homicide, ruptured ectopic pregnancy, drug overdose, and suicide.

Danco Laboratories manufactures Mifeprex, the brand name for mifepristone. In 2019, the FDA approved a generic version of the drug, which is manufactured by GenBioPro. The drug is also manufactured by other companies around the globe.

When the FDA first approved the pill in 2000, the recommended dosage of mifepristone was higher, 600 mg, compared with the current 200 mg. Studies over time showed the lower dose is effective.

Initially, the FDA also required three doctor office visits, on days one, three, and 14 after taking the pill. Prescribers had to be licensed physicians and the drug had to be dispensed in person at a medical facility. The pill was approved to be prescribed within 49 days of gestation, or seven weeks.

By 2016, after evaluating safety data, the FDA modified prescribing requirements, extending the prescription period to up to 70 days of pregnancy, or 10 weeks. It reduced the number of required office visits to one, between seven and 14 days of taking the pill, and the prescriber no longer had to be a physician. Still, mifepristone was not available at brick-and-mortar pharmacies for patients who had a prescription, nor was it available via telemedicine.

But the onset of the COVID-19 pandemic in 2020, which closed many practices and limited in-office doctor visits, changed that.

Mifepristone prescription after COVID-19 and overturn of Roe v. Wade

In December 2021, the FDA reviewed mifepristone’s long-standing safety data and decided to remove the in-person dispensing requirements, expanding access to telehealth visits in states where abortion isn’t banned. The pill can also be mailed to patients since providers no longer have to dispense the pills in person.

It also allowed brick-and-mortar pharmacies that obtain certification from manufacturers to dispense the drug to people in person or through mail with a prescription.

So far, 18 independent brick-and-mortar pharmacies are dispensing mifepristone, and larger drugstore chains may soon join their ranks.

It’s important to note that since approving mifepristone, the FDA has required prescribers to be certified — which means they have to register with the drugmaker. Pharmacies too need to be certified. Advocates say this requirement further limits who can distribute the drug.

In June 2022, the U.S. Supreme Court overturned Roe v. Wade, striking down the constitutional right to abortion and allowing individual states to decide on access to abortion. Since the decision, 14 states have banned abortion altogether. Those bans apply to both surgical and medication abortions.

Misoprostol and misoprostol-only abortions

The second pill used in the two-pill regimen for medication abortion is misoprostol. The pill is approved by the FDA to prevent stomach ulcers in people at high risk of developing them. It was first approved in 1988.

Even though the FDA hasn’t approved it for medication abortion, misoprostol is used off-label as part of the approved two-pill regimen for medication abortion.

Off-label use means health care providers prescribe a drug for diseases or conditions for which it’s not approved by regulatory bodies such as the FDA. They do so when they deem its use is medically appropriate for the patient.

It is also used worldwide for medication abortion, medical management of miscarriage, induction of labor, and treatment of postpartum bleeding. The drug causes the uterus to cramp and expel pregnancy tissue.

The pill can be used alone for medication abortion.

The World Health Organization has endorsed the use of misoprostol-only for ending a pregnancy in parts of the world where mifepristone is not available. Studies have shown the regimen is safe and effective, although it may have more side effects compared with the two-medication regimen.

A study published in JAMA Network Open in October 2023 finds that misoprostol alone is highly effective in self-managed medication abortions.

Abortion with misoprostol alone is rare in the U.S. but the a legal ban on mifepristone could have made it it the only option for some individuals, she says.

“What our study adds is that under the worst-case scenario in which mifepristone is removed, it doesn’t mean that there’s a ban on medication abortion,” says Ruvani Jayaweera, an epidemiologist and research scientist at Ibis Reproductive Health, a nonprofit organization that conducts social science research primarily on access to abortion and contraception around the world. “Our hope is that this study provides assurance to providers and people who are using misoprostol alone, whether it’s in a clinic-based setting or a telehealth setting or a self-managed setting, about the effectiveness of this method.”

Accessing abortion pills

Abortion pills are prescription medications in the U.S. Individuals in states where abortion is still legal can obtain them from licensed providers in person or via telehealth.

Abortion is currently banned in 14 states. Eleven states have laws limiting abortion between six and 22 weeks. Twelve of the 36 states where abortion is available have restrictions on prescribing medication abortion via telehealth, according to the Kaiser Family Foundation.

In response, activists have created networks of support to help individuals access abortion pills, explains Carrie N. Baker, a contributing editor to Ms. Magazine and professor at Smith College who studies and teaches courses on gender, law and public policy.

“The mainstream press is not adequately paying attention to what’s happening in the United States with regard to the underground network of abortion pill access,” says Baker, who has a forthcoming book on the history and politics of abortion pills in the United States.

These networks have also existed to help individuals around the world.

Europe-based Aid Access mails the medication abortion regimen — mifepristone and misoprostol — to all 50 states, regardless of abortion restrictions. There are other U.S.-based services, including Plan C, which provides people with available options to get abortion pills based on the state they live in.

In a November 2022 research letter published in JAMA, Aid Access reported that after the U.S. Supreme Court overturned Roe v. Wade, the average daily requests for telemedicine services for medication abortion increased from 82.6 to 231.7.

In the U.S., prescribing abortion medications via telehealth is nuanced based on state abortion laws.

For instance, U.S.-based virtual reproductive and sexual health clinic Hey Jane and online pharmacies like Honeybee can provide care and ship the pills to people in states where abortion is not banned. In all states, people may obtain medication abortion from alternative telemedicine services, online websites, or community networks, though the legal risk of each of these options may differ depending on the state. Services like ReproLegal Helpline help guide individuals on laws in their state, Jayaweera says.

Also, physicians in states that have passed shield laws can also prescribe medications via telemedicine to people in states where abortion is banned. So far, several states including Washington, Colorado, Massachusetts, Vermont, New York and California have passed telemedicine shield laws for health providers.

Abortion shield laws “seek to protect abortion providers, helpers, and seekers in states where abortion remains legal from legal attacks taken by antiabortion state actors,” according to a review article published in The New England Journal of Medicine in March 2023. Seven states so far have enacted a shield law since the overturn of Roe v. Wade.

But it’s important to know and note that those laws don’t protect individuals, Jayaweera says.

“One of the things to be especially sensitive to is with telemedicine or online models is that even if the risk is very much minimized for the provider, the legal risk falls on the individual in restricted states,” she says, underscoring the importance of educating individuals about those risks during counseling.

Self-managed abortion

Self-managed abortion is when individuals use medication abortion without medical supervision, ordering pills via telehealth, online pharmacies, mail or in-person.

Worldwide, most medication abortions are self-managed, Jayaweera says.

As a reminder, although the drugs are shown to be safe and effective, the individuals who use self-managed abortion may face legal risks, explain Drs. Daniel Grossman and Nisha Verma in a viewpoint published in JAMA in November 2022.

“Resources like the If/When/How legal helpline may be useful for patients and clinicians who are trying to understand their legal risks related to self-managed abortion. Patients requesting emotional support could be connected with resources that provide free confidential talk lines,” the authors write.

Worldwide, 22 countries ban abortion altogether, according to the Center for Reproductive Health, a global advocacy organization, and many others restrict it. This has given rise to safe abortion hotlines and “accompaniment groups” of people who have training in abortion counseling for individuals who are using medication abortion.

They also “provide a lot of empathetic counseling throughout the process and provide people with additional assurance and support and to help them understand if what they are experiencing is normal, or if they need to seek care,’” says Jayaweera.

She was part of a research team that found the outcomes of self-managed abortions were comparable to the ones performed under clinical supervision. The study, among others, contributed to the World Health Organization revising its guidelines last year to add self-managed abortion in early pregnancy to its abortion guidelines.

National organizations including the American Medical Association and the American College of Obstetricians and Gynecologists oppose the criminalization of self-managed abortion because it deters patients from seeking care when complications occur, write Dr. Lisa H. Harris and Daniel Grossman in a review article published in the New England Journal of Medicine in March 2020.

“Given the safety of the combination of mifepristone and misoprostol for self-managed abortion, the biggest danger to patients may be legal prosecution,” the study authors add. “Doctors and health care institutions must develop strategies that favor effective, compassionate clinical care over legal investigation of patients.”

A note on abortion ‘reversal’ pills

On Oct. 30, a judge in Kansas blocked a state law that requires health care providers to tell patients that medication abortion can be reversed, despite a lack of scientific evidence. A few days earlier, in Colorado, a federal judge ruled that a Catholic medical center can’t be stopped from offering medication abortion “reversal” treatment.

So-called abortion medication “reversal” treatment involves taking a dose of the hormone progesterone in an attempt to stop the effects of mifepristone, but it’s important for journalists to inform their audiences that “reversal” of medication abortion is not supported by science. (The Associated Press recommends using quotation marks in order to stress the lack of scientific evidence.) The American College of Obstetricians and Gynecologists has publicly stated that it does not support the treatment.

“Despite this, in states across the country, politicians are advancing legislation to require physicians to recite a script that a medication abortion can be ‘reversed’ with doses of progesterone, to cause confusion and perpetuate stigma, and to steer women to this unproven medical approach,” reads a statement on ACOG’s website. “Unfounded legislative mandates like this one represent dangerous political interference and compromise patient care and safety.”

Between 2012 and 2021, 14 states had enacted abortion “reversal” laws, according to a February article in the American Journal of Public Health.

“States largely use explicit language to describe reversal, require patients receive information during preabortion counseling, require physicians or physicians’ agents to inform patients, instruct patients to contact a health care provider or visit abortion pill reversal resources for more information, and require reversal information be posted on state-managed Web sites,” the authors write. “Reversal laws continue a dangerous precedent of using unsound science to justify laws regulating abortion access, intrude upon the patient‒provider relationship, and may negatively affect the emotional and physical health of patients seeking [a medication abortion].”

A 2020 randomized controlled study of medication abortion reversal, involving 40 patients, ended early because of safety concerns for 12 participants. Some of the women in the study received 400 mg of progesterone after taking mifepristone to “reverse” the abortion. Others were given a placebo after taking mifepristone. Three patients – one had taken progesterone and two had received placebo – had severe hemorrhage and required ambulance transport to the hospital, the authors write.

“We could not estimate the efficacy of progesterone for mifepristone antagonization due to safety concerns when mifepristone is administered without subsequent prostaglandin analogue treatment. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage,” they write in the study.

A March 2023 systematic review of four studies finds, “based mostly on poor-quality data, it appears the ongoing pregnancy rate in individuals treated with progesterone after mifepristone is not significantly higher compared to that of individuals receiving mifepristone alone.”

A 2015 systematic review of 11 studies on medication abortion reversal during the first trimester of pregnancy finds “evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies compared to expectant management.”

Research roundup

The following roundup of systematic reviews examines the safety and effectiveness of medication abortion. They are listed by publication date. The list is followed by additional research and reporting resources.

Effectiveness and Safety of Misoprostol-Only for First-Trimester Medication Abortion: An Updated Systematic Review and Meta-Analysis
Elizabeth G. Raymond, Mark A. Weaver, and Tara Shochet. Contraception, November 2023.

A review of 49 published studies, including a total of 16,354 patients, finds misoprostol-only is effective and safe for the termination of first-trimester pregnancy, especially when mifepristone is not available.

“Technically An Abortion”: Understanding Perceptions and Definitions of Abortion in the United States
Alicia J. VandeVusse, et al. Social Science & Medicine, October 2023.

The study is based on in-depth interviews of 64 cisgender women and 2009 participants in an online survey. Individuals were asked about their understanding of pregnancy outcomes including abortion and miscarriage. “The blurred boundaries between different types of pregnancies and their outcomes emphasize the differences in people’s notions of what constitutes an abortion,” the authors write. “It shapes how abortion stigma can arise across different pregnancy outcomes, as well as people’s own perceptions of the care they have sought, the legality of this care, and their experience in accessing it. Understanding how people construct boundaries around abortion allows for more effective healthcare messaging and advocacy, which is increasingly relevant as legal restrictions on abortion mount while telemedicine and medication abortion become more widely available to some.”

Requests for Self-managed Medication Abortion Provided Using Online Telemedicine in 30 US States Before and After the Dobbs v Jackson Women’s Health Organization Decision
Abigail R. A. Aiken, et al. JAMA, November 2022.

The authors analyze anonymized requests for abortion pills to Aid Access, a Europe-based abortion pill provider. They analyzed the requests before Roe v. Wade was overturned, after the decision was leaked, and after the decision was announced. They find that each of the 30 states from which requests came, regardless of abortion policy, showed a higher request rate after the leak and announcement compared to before. The largest increases were in states that enacted total bans on abortion.

Systematic Review of the Effectiveness, Safety, and Acceptability of Mifepristone and Misoprostol for Medical Abortion in Low- and Middle-Income Countries
Ian Ferguson and Heather Scott. Journal of Obstetrics and Gynaecology Canada. April 2020.

A review of 36 studies, including a total of 25,385 medical abortions, finds the combination of mifepristone and misoprostol is “highly effective, safe, and acceptable to women in low- and middle-income countries, making it a feasible option for reducing maternal morbidity and mortality worldwide.” Among a group of 17,381 women, 0.8% required hospitalization.

Telemedicine for Medical Abortion: A Systematic Review
M. Endler, et al. British Journal of Obstetrics and Gynaecology, March 2019.

A review of 13 studies, mostly based on self-reported data, finds the rates of complete abortion, hospitalization, and blood transfusion after abortion through 10 weeks of pregnancy were at similar levels to those reported after in-person abortion care in the published studies.

First-Trimester Medical Abortion with Mifepristone 200 mg and Misoprostol: A Systematic Review
Elizabeth G. Raymond, Caitlin Shannon, Mark Weaver, and Beverly Winikoff. Contraception, January 2013.

A review of 87 studies, including a total of 47,283 women, finds medical abortion in early pregnancy with 200 mg mifepristone followed by misoprostol is highly effective and safe.

Additional research

Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening
Daniel Grossman, et al. JAMA Internal Medicine, May 2024.

Pharmacists’ Experiences Dispensing Misoprostol and Readiness to Dispense Mifepristone
Meron Ferketa, et al. Journal of the American Pharmacists Association, October 2023.

Medication Abortion Safety and Effectiveness With Misoprostol Alone
Ruvani Jayaweera, et al. JAMA Network Open, October 2023.

Prior Cesarean Birth and Risk of Uterine Rupture in Second-Trimester Medication Abortions Using Mifepristone and Misoprostol: A Systematic Review and Meta-analysis
Andrea Henkel, et al. Obstetrics & Gynecology, October 2023.

Changes in Induced Medical and Procedural Abortion Rates in a Commercially Insured Population, 2018 to 2022
Catherine S. Hwang, et al. Annals of Internal Medicine, October 2023.

Explaining the Fifth Circuit Court of Appeals Ruling on Mifepristone Access
Molly A. Meegan, JAMA, October 2023.

Effectiveness of Self-Managed Medication Abortion Between 9 and 16 Weeks of Gestation
Heidi Moseson, et al. Obstetrics & Gynecology, August 2023.

Comparison of Mifepristone Plus Misoprostol with Misoprostol Alone for First Trimester Medical Abortion: A Systematic Review and Meta-Analysis
Tariku Shimels, Melsew Getnet, Mensur Shafie, and Lemi Belay. Frontiers in Global Women’s Health, March 2023.

Experiences Seeking, Sourcing, and Using Abortion Pills at Home in the United States Through an Online Telemedicine Service
Melissa Madera, et al. Social Science & Medicine: Qualitative Research in Health. December 2022.

Abortion Surveillance — United States, 2020
Katherine Kortsmith, et al. Morbidity and Mortality Weekly Report, November 2022.

Mifepristone: A Safe Method of Medical Abortion and Self-Medical Abortion in the Post-Roe Era
Elizabeth O. Schmidt, Adi Katz, and Richard A. Stein. American Journal of Therapeutics, October 2022.

Effectiveness of Self-Managed Abortion During the COVID-19 Pandemic: Results From a Pooled Analysis of Two Prospective, Observational Cohort Studies in Nigeria
Ijeoma Egwuatu, et al. PLOS Global Public Health, October 2022.

Increasing Access to Abortion
American College of Obstetricians & Gynecologists, December 2020.

Abortion Pill “Reversal”: Where’s the Evidence
Advancing New Standards In Reproductive Health, July 2020.

A Qualitative Exploration of How the COVID-19 Pandemic Shaped Experiences of Self-Managed Medication Abortion with Accompaniment Group Support in Argentina, Indonesia, Nigeria, and Venezuela
Chiara Bercu, et al. Sexual and Reproductive Health Matters, June 2022.

Medical Abortion in the Late First Trimester: A Systematic Review
Nathalie Kapp, Elisabeth Eckersberger, Antonella Lavelanet, Maria Isabel Rodriguez. Contraception, February 2019.

Continuing Pregnancy After Mifepristone and “Reversal” of First-Trimester Medical Abortion: A Systematic Review
Daniel Grossman, et al. Contraception, September 2015.

Medical Compared With Surgical Abortion for Effective Pregnancy Termination in the First Trimester
Luu Doan Ireland, Mary Gatter, Angela Y. Chen. Obstetrics & Gynecology, July 2015.

Resources

What to Know About Fetal Viability — And Why Some Advocates Want It Out of Abortion Law
Mary Chris Jaklevic. Association of Health Care Journalists’ Covering Health blog, October 2023.

#WeCount: A series of reports by the Society of Family Planning aiming to capture the shifts in abortion volume by state and month following the Supreme Court decision to overturn Roe.

History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion
Carrie N. Baker. Journal of Health Politics, Policy and Law, August 2023.

Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2022
Food and Drug Administration

Questions and Answers on Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation
Food and Drug Administration

Key Facts on Abortion in the United States
Usha Ranji, Karen Diep and Alina Salganicoff. Kaiser Family Foundation, August 2023.

The Availability and Use of Medication Abortion
Kaiser Family Foundation, June 2023.

A Review of Exceptions in State Abortions Bans: Implications for the Provision of Abortion Services
Kaiser Family Foundation, May 2023.

State Requirements for the Provision of Medication Abortion
Kaiser Family Foundation, April 2023.

Are Abortion Pills Safe? Here’s the Evidence.
Amy Schoenfeld Walker, Jonathan Corum, Malika Khurana, and Ashley Wu. The New York Times, April 2023.

Abortion Care Guideline
World Health Organization, March 2022.

Center for Reproductive Rights provides a global view of abortion.

Abortion Facility Database by Advancing New Standards in Reproductive Health, based at the University of California San Francisco, is a research program that informs the most pressing debates on abortion and reproductive health.

The post Abortion pill mifepristone: An explainer and research roundup about its history, safety and future appeared first on The Journalist's Resource.

Over the past two years dozens of newsrooms around the world have crafted policies and guidelines on how their editorial staff can or should — or cannot or should not — use artificial intelligence tools.

Those documents are tacit acknowledgement that AI, particularly generative AI like chatbots that can produce images and news stories at a keystroke, may fundamentally change how journalists do their work and how the public thinks about journalism.

Generative AI tools are based on large language models, which are trained on huge amounts of existing digital text often pulled from the web. Several news organizations are suing generative AI maker OpenAI for copyright infringement over the use of their news stories to train AI chatbots. Meanwhile, The Atlantic and Vox Media have signed licensing deals allowing OpenAI access to their archives.

Despite the litigation, some news organizations have used generative AI to create news stories, including the Associated Press for simple coverage of company earnings reports and college basketball game previews.

But others that have dabbled in AI-generated content have faced scrutiny for publishing confusing or misleading information, and the utility of generative AI in journalism is not obvious to everyone.

“The reality is that AI models can often prepare a decent first draft,” Julia Angwin, longtime tech reporter and newsroom leader, wrote recently in a New York Times op-ed. “But I find that when I use AI, I have to spend almost as much time correcting and revising its output as it would have taken me to do the work myself.”

To gain insight on what the future of AI and journalism might look like — and where the industry’s biggest challenges are — I reached out to Angwin, who has reported for The Wall Street Journal and ProPublica and in 2020 launched the award-winning nonprofit newsroom The Markup, which, among other things, covered recent AI developments.

In early 2023 Angwin left The Markup and founded Proof News, a nonprofit news outlet that uses the scientific method to guide its investigations. Angwin is also a 2023-2024 Walter Shorenstein Media and Democracy Fellow at Harvard Kennedy School’s Shorenstein Center on Media, Politics and Public Policy, where The Journalist’s Resource is housed.

Social media creators and trust in news

During her time at the Shorenstein Center, Angwin interviewed a panel of social media creators to find out what journalists can learn from how creators and influencers share information and build trust with audiences. This summer, Angwin will publish a discussion paper on the findings.

One important way social media creators build trust is by directly engaging with their audiences, she found.

At the same time, some news organizations have turned away from direct audience engagement online.

“Newsrooms have, for all sorts of legitimate reasons, turned off the comments section because it’s hard to moderate,” Angwin says. “It also does mean that there’s a feeling from the audience that traditional news is less accountable, that it’s less responsive.”

AI in journalism

Angwin is not optimistic that generative AI will be useful to journalists, though AI tools are “totally legit and accepted” for reporting that includes statistical analysis, she says. But Angwin points to several concerns for the future, including that the use of copyrighted content to train generative AI systems could disincentivize journalists from doing important work.

Here are a few other highlights from our conversation about journalistic trust and the future of AI in journalism:

• The news business isn’t ready. Competing in an information ecosystem with generative AI that creates plausible sounding (but sometimes untrue) text is a new frontier for news organizations, which will have to be even more attentive in showing audiences the evidence behind their reporting.
• To gain trust, journalists need to acknowledge what they don’t know. It’s OK for journalists not to know everything about a topic they’re covering or story they’re pursuing. In published work, be upfront with audiences about what you know and areas you’re still reporting.   
• When covering AI tools, be specific. Journalists covering AI topics need to know the types of AI tools out there — for example, generative versus statistical versus facial recognition. It’s important to clearly explain in your coverage which technology you are talking about.

The interview below has been edited for length and clarity.

Clark Merrefield: Some commentators have said AI is going to fundamentally change the internet. At this point it would be impossible to disentangle journalism and the internet. How would you characterize this moment, where AI is here and being used in some newsrooms? Is journalism ready?

Julia Angwin: Definitely I’d say we’re not ready. What we’re not ready for is the fact that there are basically these machines out there that can create plausible sounding text that has no relationship to the truth.

AI is inherently not about facts and accuracy. You’ll see that in the tiny disclaimer at the bottom of ChatGPT or any of those tools. They are about word associations. So for a profession that writes words that are meant to be factual, all of a sudden you’re competing in the marketplace — essentially, the marketplace of information — with all these words that sound plausible, look plausible and have no relationship to accuracy.

There’s two ways to look at it. One is we could all drown in the sea of plausible sounding text and lose trust in everything. Another scenario is maybe there will be a flight to quality and people will actually choose to go back to these mainstream legacy brand names and be like, “I only trust it if I saw it, you know, in the Washington Post.”

I suspect it’s not going to be really clear whether it’s either — it’s going to be a mix. In an industry that’s already under a lot of pressure financially — and, actually, just societally because of the lack of trust in news.

[AI] adds another layer of challenge to this already challenging business.

CM: In a recent investigation you found AI chatbots did a poor job responding to basic questions from voters, like where and when to vote. What sorts of concerns do you have about human journalists who are pressed for time — they’re on deadline, they’re doing a thousand things — passing along inaccurate, AI-generated content to audiences?

JA: Our first big investigation [at Proof News] was testing the accuracy of the leading AI models when it came to questions that voters might ask. Most of those questions were about logistics. Where should I vote? Am I eligible? What are the rules? When is the deadline for registration? Can I vote by text?

Or, in one ZIP code, it said there’s no place for you to vote, which is obviously not true.

Llama, the Meta [AI] model, had this whole thing, like, here’s how you vote by text: There’s a service in California called Vote by Text and here’s how you register for it. And it had all these details that sounded really like, “Oh, my gosh! Maybe there is a vote-by-text service!”

There is not! There is no way to vote by text!

Having experts involved made it easier to really be clear about what was accurate and what was not. The ones I’ve described were pretty clearly inaccurate, but there were a lot of edge cases where I would have probably been like, “Oh, it seems good,” and the election officials were like, “No.”

You kind of already have to know the facts in order to police them. I think that is the challenge about using [AI] in the newsroom. If you already knew the answer, then maybe you should have just written the sentence yourself. And if you didn’t, it might look really plausible, and you might be tempted to rely on it. So I worry about the use of these tools in newsrooms.

CM: And this is generative AI we’re talking about, right?

JA: Yes, and I would like to say that there is a real difference between generative AI and other types of AI. I use other types of AI all the time, like in data analysis — decision trees and regressions. And there’s a lot of statistical techniques that sort of technically qualify as AI and are totally legit and accepted.

Generative AI is just a special category and made of writing text, creating voice, creating images, where it’s about creation of something that humans used to only be able to create. And that is where I think we have a special category of risk.

CM: If you go to one of these AI chatbots and ask, “What time do I need to go vote and where do I vote?” it’s not actually searching for an answer to those questions, it’s just using the corpus of words that it’s based on to create an answer, right?

JA: Exactly. Most of these models are trained on data sets that might have data up until 2021 or 2022, and it’s 2024 right now. Things like polling places can change every election. It might be at the local school one year, and then it’s going to be at city hall the next year. There’s a lot of fluidity to things.

We were hoping that the models would say, “Actually, that’s not something I can answer because my data is old and you should go do a search, or you should go to this county elections office.” Some of the models did do that. ChatGPT did it more consistently than the rest. But, surprisingly, none of them really did it that consistently despite some of the companies having made promises that they were going to redirect those types of queries to trusted sources.

The problem is that these models, as you described them, they’re just these giant troves of data basically designed to do this are-these-words-next-to-each-other thing. When they rely on old data, either they were pulling up old polling places or they’re making up addresses. It was actually like they made up URLs. They just kind of cobbled together stuff that looked similar and made up things a lot of the time.

CM: You write in your founder’s letter for Proof News that the scientific method is your guide. Does AI fit in at all into the journalism that Proof News is doing and will do?

JA: The scientific method is my best answer to try to move on from the debate in journalism about objectivity. Objectivity has been the lodestar for journalism for a long time, and there’s a lot of legitimate reasons that people wanted to have a feeling of fairness and neutrality in the journalism that they’re reading.

Yet it has sort of devolved into what I think Wesley Lowry best describes as a performative exercise about whether you, as an individual reporter, have biases. The reality is we all have biases. So I find the scientific method is a really helpful answer to that conundrum because it’s all about the rigor of your processes.

Basically, are your processes rigorous enough to overcome the inherent bias that you have as a human? That’s why I like it. It’s about setting up rigorous processes.

Proof is an attempt to make that aspect the centerpiece. Using the scientific method and being data driven and trying to build large sample sizes when we can so that we have more robust results will mean we will do data analysis with statistical tools that will qualify as AI, for sure. There’s no question that will be in our future, and I’ve done that many times in the past.

I think that is fine — as I think it’s important to disclose those things. But those tools are well accepted in academia and research. Whenever I use tools like that, I always go to experts in the field, statisticians, to review my work before publishing. I feel comfortable with the use of that type of AI.

I do not expect to be using generative AI [at Proof News]. I just don’t see a reason why we would do it. Some of the coders that we work with, sometimes they use some sort of AI copilot to check their work to see if there’s a way to enhance it. And that, I think, is OK because you’re still writing the code yourself. But I don’t expect to ever be writing a headline or a story using generative AI.

CM: What is a realistic fear now that we’re adding AI to the mix of media that exists on the internet?

JA: Generative AI companies, which are all for-profit companies, are scraping the internet and grabbing everything, whether or not it is truly publicly available to them.

I am very concerned about the disincentive that gives for people to contribute to what we call the public square. There’s so many wonderful places on the internet, like Wikipedia, even Reddit, where people share information in good faith. The fact that there’s a whole bunch of for-profit companies hoovering up that information and then trying to monetize it themselves, I think that’s a real disincentive for people to participate in those public squares. And I think that makes a worse internet for everyone.

As a journalist, I want to contribute my work to the public. I don’t want it to be behind a paywall. Proof is licensed by Creative Commons, so anyone can use that information. That is the best model, in my opinion. And yet, it makes you pause. Like, “Oh, OK, I’m going to do all this work and then they’re going to make money off of it?” And then I’m essentially an unpaid worker for these AI companies.

CM: You’re a big advocate of showing your work as a journalist. When AI is added to that mix, does that imperative become even more critical? Does it change at all?

JA: It becomes even more urgent to show your work when you’re competing with a black box that creates plausible text but doesn’t show how it got that text.

Trust is declining — not just in journalistic institutions but in government, in corporations. We are in an era of distrust. This is where I take lessons from the [social media] creators because they don’t assume anyone trusts them. They just start with the evidence. They say, here’s my evidence and put it on camera. We have to get to a level of elevating all the evidence, and being really, really clear with our audiences.

CM: That’s interesting to go down to the story level, because that’s fundamentally what journalism is supposed to be about. The New York Times of the world built their reputation on the trust of their stories and also can lose it based on that, too.

JA: A lot of savvy readers have favorite reporters who they trust. They might not trust the whole institution, but they trust a certain reporter. That’s very similar to the creator economy where people have certain creators they trust, some they don’t.

We’re wired as humans to be careful and choose with our trust. I guess it’s not that natural to have trust in that whole institution. I don’t feel like it’s a winnable battle, at least not for me, to rebuild trust in giant journalistic institutions. But I do think there’s a way to build trust in the journalistic process. And so I want expose that process, make that process as rigorous as possible and be really honest with the audience.

And what that means, by the way, is be really honest about what you don’t know. There’s a lot of false certainty in journalism. Our headlines can be overly declarative. We tend to try to push our lead sentences to the max. What is the most declarative thing we can say? And that is driven a little bit by the demands of clickbait and engagement.

But that overdetermination also alienates the audience when they realize that there’s some nuance. One of the big pieces of our ingredients label is the limitations. What do we not know? What data would we need to make a better determination? And that’s where you go back to science, where everything is iterative — like, the idea is there’s no perfect truth. We’re all just trying to move towards it, right? And so we build on each other’s work. And then we admit that we need someone to build on ours, too.

CM: Any final thoughts or words of caution as we enter this brave new world of generative AI and journalism, and how newsrooms should be thinking about this?

JA: I would like it if journalists could work a little harder to distinguish different types of AI. The reality is there are so many kinds of AI. There’s the AI that is used in facial recognition, which is matching photos against known databases, and that’s a probability of a match.

There’s then the generative AI, which is the probability of how close words are to each other. There’s statistical AI, which is about predicting how a regression is trying to fit a line to a data set and see if there’s a pattern.

Right now everything is conflated into AI generally. It’s a little bit like talking about all vehicles as transportation. The reality is a train is really different than a truck, which is really different than a passenger car, which is really different than a bicycle. That’s kind of the range we have for AI, too. As we move forward journalists should start to distinguish a little bit more about those differences.

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As artificial intelligence infiltrates virtually every aspect of life, more states in the U.S. are seeking to regulate (or at least monitor) its use. Many are passing legislation, issuing policy rules or forming committees to inform those decisions. In some cases, that includes health insurance, where AI holds great promise to speed and improve administration but also brings potential for peril, including racial bias and omissions inherent in formulas used to determine coverage approvals.

Meanwhile, major health insurers Humana, Cigna, and UnitedHealth all face lawsuits alleging  that the companies improperly developed algorithms that guided AI programs to deny health care. The suit against Cigna followed a ProPublica story revealing “how Cigna doctors reject patients’ claims without opening their files.” The class action suits against United Health and Humana followed an investigative series by STAT, in which reporters revealed that multiple major health insurers had used secret internal rules and flawed algorithms to deny care.

Journalists should pay attention to guardrails governments are seeking to erect to prevent problematic use of AI — and whether they’ll ultimately succeed as intended. Both federal and state governments report they are working to prevent discrimination, a broad concern as AI systems become more sophisticated and help administrators make decisions, including what’s covered by a policy. Proposed state legislation and regulatory guidelines aim to require health insurance companies to be more transparent about how their systems were created, what specific data sets are fed into those systems and how the algorithms that instruct a program’s decision-making are created.

We’ve created this guide to help journalists understand the nascent regulatory landscape, including proposed state laws; which regulators are compiling and issuing guidelines; and what researchers have learned so far.                                       

Government efforts to regulate AI use among health insurers

Who regulates health insurers, and how, depends largely on the type of health insurance itself. Congress and the Biden administration are stepping up efforts to form a blueprint for AI use, including in health insurance.

State-level resolutions and legislation

For local journalists, this complex landscape provides an avenue rich with potential reporting opportunities.

According to the National Conference of State Legislatures, at least 40 states introduced or passed legislation aimed at regulating AI in the 2024 legislative session through March 17, with at least half a dozen of these actions tied to health care. Six states, Puerto Rico and the Virgin Islands adopted resolutions or enacted new laws.

That’s on top of 18 states and Puerto Rico’s adoption of resolutions or legislation tied to AI in 2023, according to data from the NCSL. Many states are modeling regulations to include guidance from the National Association of Insurance Commissioners (NAIC) issued in December 2023.

The Colorado Division of Insurance, for example, is mulling how to apply new rules adopted by the state legislature in 2021, which are designed to be a check for consumers on AI-generated decisions. It was the first state to target AI use in insurance, according to Bloomberg.

Colorado’s insurance commissioners have so far issued guidance for auto and life insurers under the statute. In recent months, commissioners held hearings and called for written comments to help form its approach to applying the new rules to health insurers, according to materials on the agency’s website.

Colorado’s legislation seeks to hold “insurers accountable for testing their big data systems – including external consumer data and information sources, algorithms, and predictive models — to ensure they are not unfairly discriminating against consumers on the basis of a protected class.”  In Colorado, protected class includes race, color, religion, national origin/ancestry, sex, pregnancy, disability, sexual orientation including transgender status, age, marital status and familial status, according to the state’s Civil Rights Division.

There isn’t yet a firm timeline for finalizing these rules for health insurance because the agency is still early in the process as it also works on life insurance, Vincent Plymell, the assistant commissioner for communications and outreach at the Colorado Division of Insurance, told The Journalist’s Resource.

In California, one bill sponsored by the California Medical Association would “require algorithms, artificial intelligence, and other software tools used for utilization review or utilization management decisions” be “fairly and equitably applied.” Earlier language that would have mandated a licensed physician supervise AI use for decisions to “approve, modify, or deny requests by providers” was struck from the bill.

In Georgia, a bill would require coverage decisions using AI be “meaningfully reviewed” by someone with authority to override them. Illinois,  New York,  Pennsylvania, and Oklahoma are also among states that introduced legislation tied to health care, AI and insurance.

Several states including Maryland, New York, Vermont and Washington state have issued guidance bulletins for insurers modeled after language crafted by the NAIC. The model bulletin, issued in December 2023, aims to set “clear expectations” for insurers when it comes to AI. The bulletin also has standard definitions for AI-related terms, like machine learning and large language models.

A group of NAIC members is also developing  a survey of health insurers on the issue.      

One concern insurers have is that rules may be different across states, Avi Gesser, a data security partner at the law firm Debevoise & Plimpton LLP, told Bloomberg Law.

“It would be a problem for some insurers if they had to do different testing for their algorithm state-by-state,” Gesser said in a November 2023 article. “Some insurers may say, ‘Well, maybe it’s not worth it—maybe we won’t use external data, or maybe we won’t use AI.’”

It’s useful for journalists to read published research to learn more about how artificial intelligence, insurers and health experts are approaching the issue technically, politically and legally. To help, we’ve curated and summarized several studies and scholarly articles on the topic.      

Research Roundup:    

Responsible Artificial Intelligence in Healthcare: Predicting and Preventing Insurance Claim Denials for Economic and Social Wellbeing
Marina Johnson, Abdullah Albizri and Antoine Harfouche. Information Systems Frontiers, April 2021.

The study: The authors examine AI models to help hospitals identify and prevent denials of patient insurance claims, aiming to cut the costs of appeals and reduce patient emotional distress. They examine six different kinds of algorithms to recommend the best model for predicting claim rejections and test it in a hospital. The authors use “white box” and “glass box” models, which reveal more data and mechanisms in an AI program than “black box” models, to develop what they label a Responsible Artificial Intelligence recommendation for an AI product to solve this problem.

In developing the proposed solution, the authors take into account five principles: transparency, justice, a no-harm approach, accountability and privacy.

To develop their proposal, the researchers used a dataset of 57,458 claims from a single hospital submitted to various insurance companies. They caution that their experiment involved using data from a single hospital.

The findings      
The solution the authors propose seeks to identify, in part, errors in coding and billing, medical needs, and mismatched codes for services and procedures to a patient’s diagnosis. Once flagged by the system the error can be fixed before submitting to an insurance company. That may spare the insured patient from going through the appeals process. The technical solution proposed by the authors “delivers a high accuracy rate” at about 83%, they write.

They recommend future research use data from insurance companies in which “many providers submit claims, providing more generalizable results.”

The authors write: “Insured patients suffering from a medical condition are overburdened if they have to deal with an appeal process for a denied claim. An AI solution similar to the one proposed in this study can prevent patients from dealing with the appeal process.”

Fair Regression for Health Care Spending
Anna Zink and Sherri Rose. Biometrics, September 2020.

The study: In this study, the authors examine and suggest alternative methods to predict spending in health insurance markets so insurers can provide fair benefits for enrollees in a plan, while more accurately gauging their financial risk. The authors examine “undercompensated” groups, people who are often underpaid by health insurance formulas, including people with mental illness or substance abuse disorders. They then suggest new tools and formulas for including these groups in regression analysis used to calculate fair benefits for enrollees. Regression analysis is a way of parsing variables in data to glean the most important factors in determining risk, what the impact is and how robust those factors are in calculations used to predict fair benefits and coverage.   

The findings: In their analysis, the authors use a random sample of 100,000 enrollees from the IBM MarketScan Research database in 2015 to predict total annual expenditures for 2016. Almost 14% of the sample were coded with a diagnosis of mental health and substance abuse disorder. When insurance companies “underpredict” spending for groups like these, “there is evidence that insurers adjust the prescription drugs, services, and providers they cover” and alter a plans’ benefit design “to make health plans less attractive for enrollees in undercompensated groups.”

The authors propose technical changes to formulas used to calculate these risks to produce what they find are more inclusive results for underrepresented groups, in this case those categorized as having mental health and substance use disorders. One of their suggested changes meant a 98% reduction in risk that insurers would be undercompensated, likely leading to an improvement in coverage for that group. It only increased insurer risk tied to predicting cost for enrollees without mental health and substance use disorders by about 4%, or 0.5 percentage points. The results could lead to “massive improvements in group fairness.”

The authors write: “For many estimators, particularly in our data analysis, improvements in fairness were larger than the subsequent decreases in overall fit. This suggests that if we allow for a slight drop in overall fit, we could greatly increase compensation for mental health and substance use disorders. Policymakers need to consider whether they are willing to sacrifice small reductions in global fit for large improvements in fairness.”

Additional reading: The authors outline this and two other studies tied to the topic in a November 2022 policy brief for the Stanford University Human Centered Artificial Intelligence group.

The Imperative for Regulatory Oversight of Large Language Models (or Generative AI) in Healthcare
Bertalan Meskó and Eric J. Topol. NPJ Digital Medicine, July 2023.

The article: In this article, the authors argue a new regulatory category should be created specifically for large language models in health care because they are different from previous artificial intelligence mechanisms in scale, capabilities and impact. LLMs can also adapt their responses in real-time, they note. The authors outline categories regulators could create to harness — and help control — LLMs.

By creating specific prescriptions for managing LLMs, regulators can help gain the trust of patients, physicians and administrators, they argue.

The findings: The authors write that safeguards should include ensuring:
• Patient data used for training LLMs are “fully anonymized and protected” from breaches, a “significant regulatory challenge” because violations could run afoul of privacy laws like the Health Insurance Portability and Accountability Act (HIPAA.)
• Interpretability and transparency for AI-made decisions, a “particularly challenging” task for “black box” models that use hidden and complex algorithms.
• Fairness and safeguards against biases. Biases can find their way into LLMs like Chat GPT-4 during model training that uses patient data, leading to “disparities in healthcare outcomes.”
• Establishing data ownership, something that’s hard to define and regulate.
• Users don’t become over-reliant on AI models, as some AI models can “hallucinate” and yield errors.

The authors write: “LLMs offer tremendous promise for the future of healthcare, but their use also entails risks and ethical challenges. By taking a proactive approach to regulation, it is possible to harness the potential of AI-driven technologies like LLMs while minimizing potential harm and preserving the trust of patients and healthcare providers alike.”

Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions
Michelle M. Mello and Sherri Rose, JAMA Health Forum, March 7, 2024

The article: In this Forum article, the authors, both professors of health policy,   call for national policy guardrails for AI and algorithmic use by health insurers. They note investigative journalism helped bring incidents to light in cases tied to Medicare Advantage as well as congressional hearings and class-action lawsuits against major health insurance companies.

The authors highlight and describe class-action suits against UnitedHealthcare and Humana that allege the companies pressured managers to discharge patients prematurely based on results from an AI algorithm. They also note Cigna, another insurance firm, is facing a class action suit alleging it used another kind of algorithm to deny claims at an average of 1.2 seconds each.
Algorithms can now be trained “at an unprecedented scale” using datasets such as Epic’s Cosmos, which represents some 238 million patients, the authors note.  But even developers may not know the mechanics behind — or why — an AI algorithm makes a recommendation.

The authors write: “The increased transparency that the CMS, journalists, and litigators have driven about how insurers use algorithms may help improve practices and attenuate biases. Transparency should also inspire recognition that although some uses of algorithms by insurers may be ethically unacceptable, others might be ethically obligatory. For example, eliminating the use of (imperfect) algorithms in health plan payment risk adjustment would undermine equity because adjusting payments for health status diminishes insurers’ incentive to avoid sicker enrollees. As the national conversation about algorithmic governance and health intensifies, insurance-related issues and concerns should remain in the foreground.”

Additional resources for journalists

• This research review and tip sheet from The Journalist’s Resource offers a primer, definitions and foundational research on racial bias in AI in health care. 

• The Association of Health Care Journalists  on its website features a guide to how health insurance works in each state. Created by Georgetown University’s Center on Health Insurance Reforms and supported by the Robert Wood Johnson Foundation, the guide provides useful statistics and resources that give journalists an overview of how health insurance works in each state. That includes a breakdown of different kinds of insurance that serve the population in each place, including how many people are covered by Medicare, Medicaid and employer-backed insurance. The guide can help inform journalist’s questions about the health insurance landscape locally, says      Joe Burns, the beat leader for health policy (including insurance) at AHCJ.

• The National Association of Insurance Commissioners has a map of which states adopt its model bulletin as well as a page documenting the work of its Big Data and Artificial Intelligence working group.

• Congress.gov features a clickable map of state legislature websites.

•The National Conference of State Legislatures tracks bills on AI for legislative sessions in each state. This list is current as of March 2024.

• The National Center for State Courts links to the websites of state-level courts.

• Here’s the Office of the National Coordinator for Health Information Technology’s final rule and fact sheets under the 21st Century Cures Act.

• Here’s a video and transcripts of testimony from a Feb. 8 U.S. Senate Finance hearing titled “Artificial Intelligence and Health Care: Promises and Pitfalls.”    

• KFF, formerly called the Kaiser Family Foundation, maintains a map showing what percentage of each state’s population is covered by health insurance.

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School board elections have grown increasingly politicized in recent years as conservative politicians and advocacy organizations push to restrict how public schools address issues related to race, gender and sexuality.

But the job of school board members, many of whom are unpaid volunteers, isn’t just setting education policy. In fact, they oversee and make decisions about a range of programs and projects, including the school district’s annual budget, which, in the largest cities, can total tens of billions of dollars.

Their primary responsibility: Being a watchdog for their communities to ensure public money is well spent, schools and buses are safe, and students receive a high-quality education.

Nationwide, more than 82,000 people served on school boards in more than 13,000 public school districts during the 2022-23 academic year, according to Ballotpedia, a nonpartisan online political encyclopedia. Texas alone has 1,022 school districts.

The vast majority of board members are elected to office. And this fall, counties, cities and towns in many states will hold school board elections.

These races tend to be decided by a small number of people, however. A “discouragingly low” number of voters participate in school board elections — often 5% to 10%, according to the National School Boards Association. Even when voters show up at the polls, many skip school board races because they tend to appear at the bottom or on the back of their ballots.

Nonprofit groups such as Campaign for Our Shared Future and the XQ Institute are trying to change that by calling attention to the importance of school board elections.

Meanwhile, Moms for Liberty, a conservative political organization, and Run for Something, a progressive political organization, are vying to get their candidates seated on local school boards.

Moms for Liberty, founded in 2021 by two former school board members in Florida, has grown to 130,000 members and 300 chapters in 48 states, according to its X account. Of the 166 school board candidates it publicly endorsed in 2023, 54 won their elections, according to a recent analysis from the nonprofit think tank the Brookings Institution.

Last year, Run for Something endorsed 416 candidates running for various local offices across the U.S. and 226 won, according to the group’s 2024 Strategic Plan. Late last year, Run for Something announced its 50 State School Board Strategy to “fight back and recruit and train young, diverse progressive candidates for school board.”

Guidance for journalists

To help journalists cover school board elections, we’ve gathered and summarized six academic studies that look at how school board members are chosen and the impact they can have on school funding and student achievement.

Journalists need to keep in mind that while school boards make decisions on such things as book bans and which bathrooms transgender children use, their overarching goal is ensuring nearly 50 million students in pre-kindergarten through 12^th grade develop the skills necessary to get jobs, go to college or otherwise become responsible adults.

The most recent research suggests:

• Most people who vote in school board elections in California, Illinois, Ohio and Oklahoma are white and likely don’t have children in local public schools. Estimates further suggest that in at least two-thirds of school districts where the majority of students are racial and ethnic minorities, the majority of voters are white.
• Teacher unions maintain a strong influence over school board elections in Florida and California, where most candidates endorsed by teacher unions prevail.
• In North Carolina, public schools become less racially segregated when Democrats join school boards than when someone affiliated with another political party or someone with no party affiliation joins.
• Student test scores rise and schools serving large percentages of Hispanic students receive more funding in California when a white school board member is replaced by someone who is not white.

Although much of the most recent research on U.S. school board elections focuses on a small group of states, these studies provide insights on issues affecting school boards nationwide.

We elaborate on these studies below. But first, we’d like to spotlight three important pieces of context journalists should consider including in news stories about school board elections.

• Voter turnout in school board races is notoriously low in some parts of the U.S. In Newark, New Jersey, for example, about 3% to 4% of voters typically participate in school board elections, according to Chalkbeat Newark. Only a few hundred people voted in the school board election held in April in Oklahoma City, home to more than 700,000 people, the Oklahoma State Election Board reports.
• In many communities, most school board members are white men. Ballotpedia examined the demographics of more than 82,000 people who served on school schools during the 2022-2023 academic year and found that 52% were male and 43% were female. In Arkansas, Missouri, Nebraska, Oklahoma, Tennessee and Texas, more than 60% were men. Meanwhile, 78% of school board members who participated in a survey the National School Boards Association conducted in 2017 and 2018 identified as white.
• School board elections are generally nonpartisan, but that may be changing. In nonpartisan races, candidates’ political party affiliation, if they have one, is not listed on the ballot. In November, Florida voters will decide whether to amend the state constitution to allow school board elections there to be partisan. In recent months, legislators in Arizona, Indiana, Kentucky and New Hampshire have introduced bills to make school board elections partisan in those states. In North Carolina, where counties can decide whether their school board races are partisan, a growing number of boards have made the change.

No organization tracks school board elections in all 50 states and the District of Columbia. However, Ballotpedia provides information on elections in 475 of the largest school districts, including the 100 most populous cities.

Research roundup

The Democratic Deficit in U.S. Education Governance
Vladimir Kogan, Stéphane Lavertu and Zachary Peskowitz. American Political Science Review, March 2021.

The study: Researchers looked at how the demographics of people who vote in school board elections in the U.S. differ from the demographics of students attending local public schools. They examined a variety of data on voters who participated in school board elections between 2008 and 2016 and students who attended public schools during that period. The researchers focused on four states — California, Illinois, Ohio and Oklahoma — because they are large states with numerous school districts and higher percentages of students who are racial and ethnic minorities.

Because votes are confidential, the researchers predicted the race or ethnicity of each voter by combining census surname distributions with demographic information from the Census block where each voter lived. This is a common procedure for this type of research and has a 90% accuracy rate, the researchers note.

The findings: The study documents a “demographic disconnect.” Most people who voted in school board elections in these four states during this period likely didn’t have children enrolled in local public schools. The authors also note that voters and students differed in terms of race and ethnicity. In at least two-thirds of school districts where the majority of students were racial and ethnic minorities, the majority of voters were white, according to the researchers’ analysis.

The researchers also discovered that the gaps in student achievement separating white students and non-white students tended to be “larger in districts where the electorate looks most dissimilar from the student population.”

In the authors’ words: “If elected officials are motivated to respond to voter preferences, our results suggest that school board members face the least political pressure to address persistent racial achievement gaps in precisely the districts where these gaps are largest because minority populations are most politically underrepresented in these jurisdictions.”

School Boards and Student Segregation
Hugh Macartney and John D. Singleton. Journal of Public Economics, August 2018.

The study: To better understand the role school boards play in student segregation, the researchers matched data on school board members in 105 North Carolina school districts with data on student enrollment patterns in those districts from 2008 to 2012. The researchers looked at whether student enrollment at local elementary schools became more racially diverse after a Democrat joined the school board.

Intentionally segregating students by race is illegal in the U.S. In many parts of the country, public schools are racially segregated as the result of residential sorting, school attendance boundaries and other factors.

The researchers measured changes in race-based segregation in North Carolina by calculating what they call the “black dissimilarity index.” During the study period, 26% of students in North Carolina school district were Black, on average. Meanwhile, 63% of students were deemed “economically disadvantaged.”

The findings: When a Democrat was elected to a school board in North Carolina, racial segregation in local public schools fell. The Black dissimilarity index dropped about 8 percentage points across schools within the district, the researchers write, adding that a main way school boards reduce segregation is by adjusting public schools’ attendance boundaries. 

The researchers note this change typically occurs two years after an election, but is likely temporary. “In the long run, much of it may be undone by household re-sorting,” they write. The researchers found that some white students left their public schools when attendance boundaries shifted and moved to private schools or charter schools.

In the authors’ words: “Taken together, our findings underscore the central role that school boards play in allocating students to schools, with likely implications for the production of learning and social inequality more generally. Understanding how school boards may influence human capital accumulation is of key policy interest and an important direction for future work.”

Are School Boards and Educational Quality Related? Results of an International Literature Review
Marlies Honingha, Merel Ruiterband and Sandra van Thiel. Educational Review, 2020.

The study: Researchers reviewed 16 academic studies published between 1996 and 2016 to better understand the relationship between school boards and educational quality in different countries. The 16 studies look at how various aspects of school boards, including their composition and the behavior of school board members, affect student test scores in the public schools they govern. Twelve studies focus on U.S. school boards, two focus on school boards in the United Kingdom and two examine them in the Netherlands.

The findings: Differences in how school boards and school districts operate in different countries and regions make it difficult to draw any conclusions that would apply to school boards globally, the researchers write. Because several studies examine a single school district or rely heavily on anecdotal evidence, their results cannot be broadly applied. The researchers write that, based on the literature they reviewed, it’s unclear whether school board members have an impact on student achievement in their school districts.Whatever affect they do have is indirect, the researchers add.

The researchers stress the need for larger and more rigorous studies on this issue as well as the need to investigate school board impacts beyond student test scores.

In the authors’ words: “This article draws on a systematic literature review to show that there is a lack of solid empirical evidence on the relation between boards and educational quality. This means that we know less than is reflected in policy assumptions about school boards. The ambitions for school boards and the expectations upon them are not evidence-based.”

How Does Minority Political Representation Affect School District Administration and Student Outcomes?
Vladimir Kogan, Stéphane Lavertu and Zachary Peskowitz. American Journal of Political Science, July 2021.

The study: The researchers investigate whether student achievement changes after racial and ethnic minorities are elected to local school boards. The researchers reconstructed the composition of local school boards between 2000 and 2014 using election data obtained from the California Election Data Archive. They collected data on public school districts and student test scores during that period from the California Department of Education.

The findings: After a racial or ethnic minority was elected to a school board in California, test scores rose among students who were racial or ethnic minorities. While the increase did not materialize until several years after the election and then gradually declined in magnitude, it was substantial.

“The largest estimated effect occurs five years after the election, when the estimated effect of a pivotal minority candidate victory is approximately 0.15 standard deviations,” the researchers write, adding that the change is roughly equivalent to an additional 46 days of learning.

The researchers could not determine the effect on white students’ scores. However, they found “no evidence that the improvements in non-white student performance come at the expense of white students.” They suggest gains in minority students’ test scores may have been driven in part by increased operational spending and changes in school administration that happened after the election of the minority school board member.

In the authors’ words: “We find little evidence that minority representation on school boards affects the total number of employees or the racial and ethnic composition of rank-and-file workers. Nor does school board composition appear to have a consistent effect on school-level segregation. We do, however, find evidence that the share of school district principals who are non-white increases when minorities win more school board seats, providing another potential policy lever through which changes in board composition may affect student learning.”

No Spending without Representation: School Boards and the Racial Gap in Education Finance
Brett Fischer. American Economic Journal: Economic Policy, May 2023.

The study: This paper, which also focuses on California school boards, looks at whether replacing a non-Hispanic school board member with a Hispanic board member results in greater spending on Hispanic students. The researcher examined capital spending specifically — how local school boards used grant money that they received from the state’s School Facility Program to fund projects such as campus renovations between 1999 and 2016.

The findings: After a non-Hispanic school board member was replaced with a Hispanic board member, California school boards invested more money in schools where the majority of students were Hispanic. The researcher’s analysis “indicates that a 20 percentage point increase in Hispanic board representation raises [School Facility Program] modernization spending by $93 per student (81 percent) among high-Hispanic schools within the district.” Schools with relatively low Hispanic enrollment received an increase, too, although a smaller one. However, that increase was determined not to be statistically significant.

The analysis also suggests that after a Hispanic person joined a school board, that school district directed more construction funding to schools with a high percentage of students who qualify for free or reduced-price meals at school. There’s also evidence that having a Hispanic school board member is linked to improvements in teacher retention at “high-Hispanic” schools.

In the author’s words: “My analysis confirms that school boards play an integral role in education finance. Using spending data from the [School Facility Program], I find that an additional minority (Hispanic) school board member increases spending on school renovations using state transfer grants. In particular, SFP spending on high-Hispanic and high-poverty schools within the district increases by up to 69 percent, which juxtaposes smaller, insignificant changes among low-Hispanic and relatively affluent schools.”

Teachers’ Unions and School Board Elections: A Reassessment
Michael T. Hartney. Chapter in Groups in U.S. Local Politics, September 2023.

The study: The researcher examines the impact that teacher-union endorsements have on school board elections in California and Florida. The researcher chose to study California because it’s a large, racially diverse state where unions representing government employees are especially powerful, he writes. He chose Florida, another large, racially diverse state, because labor law there has historically been less favorable to teacher unions.

He analyzed union endorsements given to 3,336 school board candidates across 468 school districts in California between 1995 and 2020. He also analyzed endorsements of 361 school board candidates running for office in 36 Florida school districts between 2010 and 2020.

The findings: In both states, school board candidates backed by local teacher unions did “exceptionally well” in most elections. In California, about 90% of union-backed incumbents were reelected and two-thirds of union-backed candidates running against an incumbent won their races. Meanwhile in Florida, about 80% of incumbents endorsed by teacher unions won reelection and more than half of candidates who challenged an incumbent and had union endorsements prevailed.

In the author’s words: “I have shown, quite simply, that union power in school board elections remains both robust and resilient. Irrespective of the very real setbacks that unions have faced in state and national politics, in the local trenches of school board electioneering, the data tell an unambiguous story: teacher-union interest groups remain an important player, they are still the ones to beat.”

Additional resources

• In “Outside money targets school board elections,” we examine research on how wealthy individuals and national advocacy groups have used their money to influence local school board elections.
• The National School Boards Association offers various national reports on school boards. Organizations such as the Illinois Association of School Boards and Texas Association of School Boards provide state-level data and reports.
• We created a tip sheet to help journalists understand and cover teacher unions, including their influence on local school boards.
• This article warns journalists about the dangers of horse race coverage of elections — focusing on who’s in the lead and who’s behind instead of policy issues. It can harm political candidates, the public and news outlets themselves.
• Tammy Patrick, a former federal compliance officer for the Maricopa County Elections Department in Arizona, offers eight tips to help journalists improve their overall coverage of U.S. elections.

The image above was obtained from the Flickr account of Joe Brusky and is being used under a Creative Commons license. No changes were made.

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Sports venue construction in the U.S. tends to happen in waves, roughly every three decades. Sports economists suggest another wave is happening now, with numerous proposed or approved venue construction projects around the country seeking or having secured public dollars, from Tennessee to Wisconsin to Nevada to Florida.  

Professional sports owners often justify asks of hundreds of millions in taxpayer dollars for new or revamped stadiums with estimates of huge economic returns for communities. It’s important that journalists covering these projects understand how public dollars are raised to pay for them and how to interrogate economic impact claims that teams produce.

Across the four biggest sports leagues in the U.S. — Major League Baseball, the National Football League, the National Basketball Association and the National Hockey League — there have been eight new venues built since 2020 at a total construction cost of roughly $3.3 billion, according to a September 2023 paper in the Journal of Policy Analysis and Management. About $750 million in public funds went toward those construction projects, not including bond interest, the paper finds.

Research conducted over decades indicates these investments almost never lead to massive economic gains for host cities. Legislators have since pushed the recent public contribution figure even higher. This includes $500 million to renovate the Milwaukee Brewers ballpark, more than $1 billion in bonds toward a new stadium for the NFL’s Tennessee Titans and $380 million for a new ballpark for the A’s, which are poised to move from Oakland to Las Vegas in 2028.

We recently published two pieces on public financing of sports venues: A research-based primer and research roundup and a short tipsheet for covering the topic.

To give journalists an even stronger foundation for their coverage of sports venue financing, The Journalist’s Resource co-hosted an hourlong webinar May 16 with Econofact, a nonpartisan, online publication out of The Fletcher School at Tufts University.

I co-moderated the panel discussion with Michael Klein, the William L. Clayton Professor of International Economic Affairs at Tufts and founder and executive editor of Econofact. The panelists were:

• Andrew Zimbalist, the Robert A. Woods Professor Emeritus of Economics at Smith College.
• Victor Matheson, a professor of economics and accounting at the College of the Holy Cross who specializes in sports economics.
• Alan Snel, the publisher of LVSportsBiz.com, a news outlet that covers the convergence of sports, business, stadiums and politics.

One takeaway: There are numerous examples of professional sports franchises that built their venues with little or no public investment.

“We have the Golden State Warriors playing in an entirely privately financed stadium in San Francisco,” Matheson said during the webinar. “We have SoFi stadium in [Los Angeles], almost entirely privately financed there, and that’s about a $5 billion stadium. I think one of the most important things to take from this hour is that public financing is not required.”

Here are 7 key tips from the webinar.

1. Ask these three questions about economic impact estimates. If team officials can’t explain their numbers, don’t report them.

Who commissioned the study?

“If it is a study that is paid for by the league or the team, that is not an economic impact study,” Matheson said. “That is a press release.”

Can I see a copy of the study?

While teams or municipalities may or may not release lengthy economic impact reports, public officials and journalists sometimes cite big number estimates from teams without scrutiny of the underlying analysis.

“You would be amazed by how many people say, ‘There is a study that says [the economic impact] is a billion dollars,” Matheson said. “But you can never get your hands on that study.”

What do economists think?

“Call an economist,” Matheson said. “You can find lots of us. Whatever your local jurisdiction is, there’s a sports economist there who teaches in your state or your local region who understands these issues who has a good local feel. Most of us have a good national feel as well.” 

If team representatives can’t justify estimates of economic growth, or show than an independent analysis exists, don’t report those estimates.

“The big problem with these gigantic economic impact numbers is that the methodology is not explained,” said Snel.

He noted that LVSportsBiz will not publish economic impact estimates unless team officials explain how they did their analysis. 

2. Note that when people spend money at a sports venue and nearby businesses, this often means they don’t spend that money elsewhere.

A new or revamped sports venue tends to shift economic activity, not create new spending, economic research shows.

Interview an economist or two to help explain to audiences how this works. The basic idea is that spending shifts within communities, or from one community to another. The underlying reason has to do with household budgeting.

“Most of the money spent at a sports facility is money that is part of people’s leisure budgets, and they have a certain amount of money that they can spend on various kinds of leisure,” Zimbalist said. “When they spend $200 or $500 taking their family to the ballpark, that’s $200 or $500 they don’t have to spend at the local bowling alley, at a local theater, at a local restaurant. That’s money being displaced, from spending in one part of the city to spending in another, and the net impact can be very close to zero.”

3. Ask hotel owners and rental car firms how they incorporate tax rate changes into their pricing. If public money is raised through hotel and rental car taxes, proponents may claim the tax burden will fall on tourists. But local businesses and franchises may bear some of the burden, too.

Tourists do not necessarily pay hotel and rental car taxes. Why? Because of something called tax incidence, which is how the burden of a tax is divided among consumer and producer — essentially, who pays the tax and at what proportion.

“It’s not always the person who buys the product who pays the tax,” Matheson said. “It can also be the person who sells the product.”

When legislators increase a hotel tax or pass a new one, hotel owners typically respond by adjusting their pricing in one of three ways:

• Raise prices and pass on the entire cost of the tax to consumers. That can hurt their ability to compete for convention and tourism business, Matheson said.
• Hold prices steady and pay the tax burden entirely, reducing profits.
• Some combination, where they pass some of the cost of the tax to consumers and eat the rest.

The same goes for rental car taxes, another sales tax commonly used to help finance stadiums. Local economic conditions will determine how the tax burden shakes out. In extremely competitive markets, businesses may be able to pass on the entire cost to consumers. Point is, it’s important to ask hotel owners and rental car firms how they incorporate tax rate changes into their pricing.

While officials may claim visitor taxes are a way to pass the cost to out-of-towners, the authors of the September 2023 paper note that local people also rent cars. And residents with lower incomes are more likely to use extended stay hotels and potentially have to pay the higher taxes.

4. Don’t forget that team owners stand to benefit most from these projects.

Teams seeking public financing naturally focus public statements on their estimates of community benefits, typically in the form of jobs created and consumer spending.

But team owners, by far, have the most to gain.

“The bottom line is, it’s the pro teams that are garnering the benefits of the revenues from the stadiums,” Snel said. He recommended journalists also report on how new or improved stadiums affect team valuations.

He pointed to the National Football League’s Raiders, which moved from Oakland to Las Vegas in 2020. The team was valued at $2.2 billion in 2019. That figure nearly tripled to $6.2 billion by the end of 2023.

There are a variety of reasons for the increase, Snel reports, including TV deals that generate tens of billions of dollars yearly across the NFL, and the sale of the Washington Commanders in 2023 for more than $6 billion, which set the market for premium franchises. But according to Forbes, $1.4 billion of the team’s current value is tied to the stadium itself, which was heavily subsidized with public dollars.

5. Learn about “leakage” and how it can affect economic impact estimates.

When people spend money at local businesses, there is less of what economists call “leakage” than when people spend with mega corporations like sports franchises.

This means every dollar spent at a local café has a better chance of staying within the local economy than money spent at a sporting event, which tends to “leak” out of the economy and into the savings accounts of team owners. The café owner, by contrast, uses revenue to, for example, pay staff, who also live and spend in the community, or for laundry services provided by another local businesses, or any number of other things.

“The proprietor of the local restaurant or bowling alley or theater tends to have a more moderate income and tends to live almost 100% of the year in that town,” Zimbalist said. “When you spend money at the restaurant, it tends to circulate and stay in the town more. When you spend money at a ballpark, it’s going to millionaires and billionaires. They generally don’t live in the town year-round.”

This ties back into those economic impact estimates. They’ll sometimes include a simple multiplier equation, suggesting money spent at sporting events “multiplies,” or circulates within the local economy, just like spending at the local café.

But sporting event spending tends to have less chance of staying in the local economy, compared with other types of entertainment spending.

Zimbalist explained that team owners “generally have much, much higher savings rates, so they take the money and they put it into the world’s money markets and the money doesn’t stay in the town for these and other reasons. So the leakages are much, much greater and, therefore, the multiplier, the sports multiplier, is much lower than a typical entertainment multiplier.”

6. Keep track of lease deals. When they expire, teams may come asking for more public money.

When covering a city that has a major professional sports franchise, or several of them, review lease agreements to figure out when team owners might ask taxpayers for help revamping their venue, or building a new one.

The National Sports Law Institute of Marquette University Law School has obtained dozens of lease agreements for professional baseball and football franchises, most of them from the 1990s and early 2000s.

The institute has summarized these agreements, available here. The summaries detail, among other things, the yearly rent the franchise owes the municipality, which may be set below market rates. They outline how much the public contributed toward sports venue construction and how much came from the team, along with whether the team or municipality is responsible for regular operating expenses and repairs.

“We had this huge wave of stadium construction in 1992,” Matheson said. “Most of those stadiums are associated with a 30-year lease deal. And because of that, these teams are tied to the stadiums for 30 years, which means that they really can’t start asking for a new stadium, start asking for new public subsidies, until those lease deals expire. But as soon as those lease deals expire, all of the bargaining power shifts to the teams and away from the taxpayer.”

7. If you don’t have time to do a deep dive, at least include these two “boilerplate necessities” in your reporting.

Journalists may not have time to do a deep investigation into how public money is being used to finance sports venue construction or renovation — especially broadcast journalists, who might only have a minute or two to cover a lot of ground.

Snel recommends reporters at least include these two “boilerplate necessities” in their coverage.

• Report the principal and interest on debt. If public money is raised through bonds, tell audiences about the interest on the principal that the city, county or state will have to repay. For example, Clark County, Nevada, took on debt of $750 million toward building the Raiders’ stadium. With interest, that number will grow over the next quarter century. The final tally will actually be north of $1.3 billion, Snel recently reported.
• Remind your audience that economic activity related to sporting events by and large goes back to team owners. “The beneficiaries are the teams,” Snel said. “They’re garnering the lion’s share of all the revenues.”

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This piece, originally published in July 2021, was updated in May 2024 with new data from the Centers for Disease Control and Prevention and the findings of two recent studies on drowning prevention interventions.

Worldwide, at least 235,000 people fatally drown each year, making it one of the leading causes of injury-related death. The U.N. General Assembly has said drowning is “largely unrecognized relative to its impact.”

In the United States, drowning deaths are on the rise after decades of decline. More than 4,500 people drowned each year from 2020 to 2022, according to the most recent data from the Centers for Disease Control and Prevention. That’s about 500 more drowning deaths each year compared with 2019, the agency reported.

While local news stories about drownings — fatal or non-fatal — often focus on single events, journalists have the power and responsibility to inform their audience with statistics, trends and research on prevention. As noted in a 2019 report in the Health Promotion Journal of Australia, “Transmission of messages about drowning risk factors and prevention strategies, during summer, may lead to behavior change at a time when drowning risk is highest.”

Drowning is medically defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. Drowning can be fatal, non-fatal with no injuries or non-fatal with injuries. In the U.S. there are about twice as many non-fatal drownings each year, which can lead to long-term health problems and costly hospital stays, according to the CDC. 

This explainer includes information on fatal drowning trends over the past two decades; the findings of three recent reports on racial disparities in fatal drowning rates; the factors contributing to disparities in drowning death rates among Black, Alaska Native and American Indian youth; the role of socioeconomic status; the role of climate change and the COVID-19 pandemic; and, finally, research on prevention.

An overview

Downing deaths differ by age and race and ethnicity.

For children aged 1 to 4, drowning rates increased by 28% in 2022 compared with 2019. For adults aged 65 to 74, drowning rates increased by 19% in that period, according to the CDC.

Among racial and ethnic groups, American Indian or Alaska Native people have historically had the highest rates of drowning deaths, followed by Black people. In 2021, drowning deaths among Black people increased by 28% compared with 2019, while the rates remained unchanged for AIAN people, the 2024 CDC data shows.

The greatest percentage of drowning deaths in babies under 1 year occur in bathtubs; in swimming pools in children between 1 and 13; and in natural bodies of water such as lakes, rivers, streams, and oceans in youth between ages 14 and 17, according “Unintentional Drowning Deaths Among Children Aged 0–17 Years: United States, 1999–2019,” released in July by CDC’s National Center for Health Statistics.

Some groups, including males, children and people with underlying medical conditions have a higher risk of fatal drowning. Also, factors like inability to swim, lack of close supervision, place of swimming and use of alcohol during water activities make drowning more likely.

In the U.S. roughly 40 million adults don’t know how to swim, including 37% of Black adults, compared to 15% of all adults. More than 60% of Black adults and 72% of Hispanic adults reported never taking a swimming lesson, the latest CDC data shows. Among all adults, nearly 55% have never taken a swimming lesson.

In the 2018 study “Predictors of Swimming Ability among Children and Adolescents in the United States,” published in Sports, researchers found that parents have a strong influence on kids’ ability to swim. Other factors that were positively associated with swimming ability included knowledge of water safety, having access to pools that were open all year and having a best friend who enjoys swimming.

There are still many unanswered questions about drowning, partly due to gaps in data and lack of research.

Many studies that look at fatal drowning data use death certificates, which don’t have information on the circumstances of drowning, details of known risks or other potential social or cultural influences, leaving a gap in better understanding of drowning data.

In addition, there are fewer studies on drowning compared with other unintentional injuries.

In “NIH Portfolio of Unintentional Injury Research Among Racial and Ethnic Minority Children: Current Landscape and Future Opportunities,” published in the Journal of Racial and Ethnic Health Disparities in July 2020, researchers found that between 2011 and 2018, 130 NIH-funded grants examined unintentional injuries — fatal and non-fatal — such as burns, drownings, falls, poisoning and car accidents. Of those, 34 were focused on children. And of the 34, eight focused on racial and ethnic minority children. Of the eight, half studied car injuries and none focused on drowning.

“In my mind, drowning prevention is the poor cousin in injury prevention,” says Dr. Linda Quan, a professor in the Department of Pediatrics at the University of Washington School of Medicine whose area of research includes drowning prevention and pediatric resuscitation. For motor vehicle injuries, which have received far more attention, there’s the National Highway Traffic Safety Board, or NHTSA, at the federal level. “But we don’t have really any kind of unity or single organization to push drowning prevention,” she says.

In “Interventions associated with drowning prevention in children and adolescents: systematic literature review,” published in Injury Prevention in 2015, researchers looked at academic literature about drowning prevention in children and teens, published between 1980 and 2010, and found that “few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning.” The studies, the authors wrote, lacked consistency in measuring outcomes and the use of drowning terminology.

For instance, the study authors use the terms “fatal” and “non-fatal” drowning instead of “immersion,” “submersion,” “drowning” and “near drowning.”

“Terms such as ‘near-drowning,’ ‘dry or wet drowning,’ ‘active and passive drowning,’ ‘secondary,’ and ‘delayed onset of respiratory distress’ should not be used,” according to BMJ Best Practice.

Another term used by researchers is “water competency.” Water Safety USA, a roundtable of several national nonprofit and governmental organizations with a focus on drowning prevention and water safety programs, defines water competency as the ability to anticipate, avoid and survive common drowning situations in addition to being able to recognize and provide assistance to those in need. It also includes water safety awareness, basic swimming skills and helping others.

To be sure, drowning death rates declined by 32% in the U.S. and 57% worldwide between 1990 and 2017, thanks to educational campaigns and increased awareness. The rate of unintentional drowning deaths among children aged 0 to 17 years declined 38% in the U.S., according to the CDC report. But disparities in certain racial and ethnic groups have persisted.

Three 2021 reports to help you report on disparities in drowning deaths

Three reports released in June and July show that some racial disparities in drowning deaths exist and have persisted for more than 20 years, even though overall drowning death rates have declined.

Each report focuses on a slightly different age group, but they all show similar trends by age, sex, place of drowning, race and ethnicity.

Specifically, the reports show that disparities in drowning death rates are largest among Black, American Indian and Native Alaskan youth compared to whites, while there are little or no disparities among Hispanics, Asians, Pacific Islanders and whites.

The first study, “Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years — United States, 1999–2019,” published in the June 18 issue of CDC’s Morbidity and Mortality Weekly Report, shows that the drowning death rate among American Indian and Alaska Native people under 30 was twice as high as the drowning death rates for white people, while the rate for Black people was 1.5 times that of whites.

“Disproportionately high drowning death rates among certain racial and ethnic groups represent an important health equity issue,” says Dr. Tessa Clemens, a health scientist in the division of injury prevention at the CDC and one of the authors of the CDC study. “So, I think progress towards eliminating drowning in the United States, which is our goal — for there to be zero drowning — will only occur if we address these inequities and reduce drowning death rates in all groups.”

Fear of drowning has been identified as one factor contributing to limited swimming ability in some Black youths, write the authors. They point to the 2019 study “Vanishing Racial Disparities in Drowning in Florida,” published in Injury Prevention, which shows a reduction in drowning disparities between Black and white children potentially due to community-level initiatives to teach Black children how to swim.

The authors also point out an important limitation in the death certificate data, which they used for their study: the race and ethnicity on death certificates are reported by next of kin or by observation and people who identify as American Indian/Alaska Native, Asian or Hispanic are sometimes reported as white or non-Hispanic on death certificates, “leading to possible underestimations of deaths among these groups,” the authors write. “Proxy reporting of race/ethnicity is especially inaccurate for AI/AN persons.”

A 2016 CDC Vital and Health Statistics report “The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update,” found that while reporting for whites and Blacks has been “excellent” and had improved between 1979 to 2011 for Hispanics and Asian or Pacific Islanders, it has been poor for American Indian or Alaska Natives, where as many as 40% were misclassified on death certificates. The decedent’s country of birth and the racial and ethnic composition of where they lived at death have important effects on the quality of death certificate race and ethnicity reporting, the authors write.

“So an important message that we have in this study is that further research is really needed on the determinants that contribute to these disparities so that we can understand what’s driving them and what are the barriers to implementing effective drowning prevention programs in the communities that are at highest risk of drowning,” says Clemens.

The second report of note is the American Academy of Pediatrics’ technical report “Prevention of Drowning,” released in mid-July and forthcoming in the August issue of Pediatrics. It shows that from 2014 to 2018, in babies and children under 19, fatal drowning rates were highest among Black and American Indian and Alaska Native individuals. And while most white children died in residential pools, Black youths were most likely to die in a public pool, often at a motel or hotel.

Many times those pools are not supervised or don’t have a lifeguard on duty, says Quan, who is one of the study’s co-authors.

The American Academy of Pediatrics’ report also notes that there is “no data to support a recommendation for infant swim lessons. Aquatic programs for young children (especially those younger than 1 year) pose some medical concerns, and initiation of a swim program should be discussed between an infant’s caregiver and pediatrician.”

And the third report, “Unintentional Drowning Deaths Among Children Aged 0–17 Years: United States, 1999–2019,” released in July by CDC’s National Center for Health Statistics, shows that in the study’s two-decade period, fatal drowning rates were higher for Black children than for white or Hispanic children. Rates were also higher for children living in rural counties compared with urban counties. After declining from 1999 through 2003, the unintentional drowning death rate for Black children remained stable from 2003 through 2019, the report shows. Meanwhile, drowning rates for white and Hispanic children showed a steady decline during those years.

Drowning disparities among Black youth

Some of the contributing factors to higher drowning rates, particularly among Black children, are poor swimming skills in both children and their parents, lack of swim training during childhood, and lack of lifeguards at motel and hotel pools, according to the American Academy of Pediatrics’ new report.

“With no physiologic differences to explain the difference in drowning risk, race and ethnicity are likely a proxy for social and cultural differences between the groups,” the report adds.

A look back at U.S. history also helps explain why Black children and their parents are less likely to swim. Black families had limited access to public swimming pools not only during segregation but also afterward.

“When public swimming pools were racially desegregated, the reaction to that was for individuals and communities to invest money in private swimming pools,” says Jeff Wiltse, a history professor at the University of Montana and author of the 2010 book “Contested Waters: A Social History of Swimming Pools in America.” “The shift from public provision to private provision was in large part, not entirely, but was in large part driven by racial desegregation.”

Many public swimming pools closed and for Black families who didn’t have the means to join private clubs or pay for expensive swimming lessons, lack of access to public swimming pool continued after desegregation in the 1960s.

“This past discrimination casts a long shadow,” writes Wiltse in his 2014 paper “The Black-White Swimming Disparity in America: A Deadly Legacy of Swimming Pool Discrimination,” published in the Journal of Sports and Social Issues. “As a result of limited access to swimming facilities and swim lessons and the unappealing design of most pools earmarked for Blacks, swimming did not become integral to the recreation and sports culture within African American communities.”

Wiltse says that lack of access to swimming pools is “largely responsible for this contemporary disparity,” and says that generally, lack of swimming ability contributed to drowning deaths.

“In my mind, the lower swimming rates among Black Americans partly contributed to the higher drowning rates,” he says.

Drowning disparities among American Indian and Native Alaskan youth

There’s a dearth of research on what’s driving drowning disparities between American Indian and Alaska Native youth compared with whites.

“Swimming skill and other factors contributing to increased drowning risk in AI/AN persons have not been thoroughly explored,” write the authors of the June CDC study.

But Dean Seneca, CEO and founder of the consulting firm Seneca Scientific Solutions+ and an adjunct professor at the University at Buffalo who is teaching a class on Indigenous health disparities, points to a few contributing factors.

Many reservation communities don’t have swimming pools, he says.

“Our exposure to swimming at a very early age is very limited if you compare that to other populations,” says Seneca, a Seneca Indian.

In Alaska, even though many of the villages are by the water, people rarely go for a swim because the water is cold, even in the summertime. The majority of the villages don’t have swimming pools, Seneca says.

Also, Alaska Natives are more likely to have water-related jobs, without proper safety equipment, thus increasing their risk of drowning. Many go fishing and practice subsistence to feed their family.   

“Did they go on ice with their snowmobile? Was it working properly? Were they putting themselves in a risky situation?” says Seneca, adding that many drownings happen under the influence of alcohol or other substances.

And in many tribes, a focus on swimming is not a top priority.

“We don’t have the prevention messaging in many communities to educate on the seriousness of swimming and drowning,” he says. Also, “look at the Navajo Nation and many of our tribes in the Southwest. They’re struggling just to have water. They don’t even have running water to drink. A pool is probably a last priority.”

Seneca advises journalists to dig deeper into data by looking at Indian Health Services’ reports and contacting tribal epidemiology centers for more information.

Interventions work but they take funding, which Seneca says is severely lacking.

In the widely-cited 2003 study “Reducing Injuries Among Native Americans: Five Cost-Outcome Analysis,” published in Accident Analysis & Prevention, researchers reported that drowning rates dropped by 53% after local residents who used Alaska’s Yukon and Kuskokwim rivers as the primary mode of transportation were offered light-weight coats that doubled as floatation devices.

“To sell the floating properties of the coats to the public, tribal elders suggested a culturally appropriate marketing message: ‘Wear a float coat so that if you drown, people will not have to drag the river for your body,'” the authors write. “This message resonated strongly with communities accustomed to hours and days of uncertainty surrounding most drownings.”

Role of income

Studies haven’t shown that income level is an independent predictor of swimming ability, but some studies have shown an association.

In “Childhood unintentional injury: The impact of family income, education level, occupation status, and other measures of socioeconomic status. A systematic review,” published in Feb. 2021 in Pediatrics and Child Health, researchers looked at 54 studies between 1997 and 2017 on children 19 years and younger. They found that while most studies report higher injury rates among lower-income populations, results vary based on the type of injury and factors such as parental income or education and household size. For instance, 18 of the studies found a significant relationship between income and unintentional childhood injuries. Six studies that focused on traumatic dental injuries found no significant association, while three others did. One study reported that high family income was associated with an increased risk of traumatic dental injury in children.

Of the 54 studies, only one study, from Bangladesh, looked at drownings and found that a mother’s education was a risk factor of increased childhood drowning deaths, the authors report.  

In its new report, the American Academy of Pediatrics writes that “inadequate funding for pools, swimming programs, and lifeguards, as well as the cost associated with swimming lessons, may affect water competency and community resources for low-income populations.”

Wiltse calls this a class-based disparity.

“We’re going to find, especially in children of poor and working-class Americans of all races, drowning at a much higher rate than the children of middle- and upper-class Americans,” he says. “I think that’s the piece that the media reporting hasn’t begun to recognize. And unless we reverse, and again reinvest in public swimming pools and swim lessons at public pools, I think we’re going to see worsening of growing drowning disparities along class lines.”

Role of climate change and the COVID-19 pandemic

Some studies are starting to show that warmer winters could result in more fatal drownings.

In the study “Increased winter drownings in ice-covered regions with warmer winters,” published in PLOS One in Nov. 2020, researchers found that winter drownings increased as winter air temperatures got warmer and closer to 32 F, partly because ice covers on bodies of water became more unpredictable.

“The complex nature of changing winters including warming temperatures, rain on snow, and freeze-thaw events could decrease the stability of ice, suggesting that the risk of winter drowning may increase until lakes become completely ice-free,” the authors write.

Researchers used detailed data from Minnesota and found that the most vulnerable age groups for winter drowning were children and young adults. Most children drowned while playing or skating on thin ice. “The risk of drowning was exacerbated by curiosity, inadequate supervision, and a lack of risk-awareness and water-safety education,” the authors write.

As for the COVID-19 pandemic and its impact on drowning death rates in 2020 and so far this year, some local news reports have documented increases. The Boston Globe reported 18 drownings in Massachusetts in May, more than the previous three Mays combined. MLive reported 56 drownings in Lake Michigan in 2020, breaking the previous record of 49 in 2012. And according to the StarTribune, more people have drowned in Minnesota so far this year than in the same period for each of the past nine years.  

Meanwhile, home pool sales increased by 21% last year compared with 2019, according to ConsumerAffairs.

But there’s a lag in government data analysis and it might be too soon to tell whether a year of isolation and canceled activities like swimming lessons have led to a significant increase in fatal drownings nationwide.

“We have not been able to look at the data yet,” says Clemens of CDC. “We’re waiting for the final 2020 data to be able to look at whether there’s actually a significant difference in drowning numbers over previous years.”

Solutions

Many studies on drowning call for promoting basic swimming and water safety skills, installing barriers around pools, proper use of life jackets, active supervision of kids in the water and knowing how to perform CPR.

In his aforementioned study, Wiltse writes, “affordable, accessible, and, most importantly, appealing swimming pools are needed to popularize swimming among Black Americans and expand access for poor and working-class Americans more generally.”

A 2023 review of 22 English-language studies on drowning prevention interventions, including research published between 2011 and 2021, finds small but important changes in a range of outcomes. These include changes in awareness, water safety knowledge, attitudes, water safety behaviors and skills, policy changes and drowning rates. The interventions included swimming lessons, mandatory personal floatation devices, awareness campaigns and barriers to prevent access to water. One experimental study, published in 2019 in the journal Injury Epidemiology, finds that posting a sign at a park, informing visitors that water entry was illegal and could result in a fine exceeding $200, reduced the odds of someone entering the water by 63%.

A 2024 review of 47 English-language studies on life jackets finds that overall, life jacket usage is low — but that life jackets are highly effective at preventing drowning when people wear them. The authors underscore the significance of targeted interventions, regulation and educational programs that promote the use of life jackets to reduce drowning incidents. They also highlight the role of health care professionals in educating patients about the benefits and proper use of life jackets.

In the Dec. 2020 study “Adolescent Water Safety Behaviors, Skills, Training and Their Association with Risk-Taking Behaviors and Risk and Protective Factors,” published in Children, Quan and colleagues recommend diversity in swimming education. “Water safety education programs must include input from culturally diverse and immigrant populations throughout program development and implementation and provide information for parents in languages other than English,” Quan and colleagues write. “Furthermore, it’s essential that water safety programs recruit and retain lifeguards, swimming instructors, program administrators, and educators that reflect the communities that they aim to reach.”

Some researchers also suggest including water safety training in school curriculums.

Shawn Slevin, executive director of Swim Strong Foundation, a nonprofit organization in New York City, is working on legislation to mandate water safety training in New York State schools.

The Pew Charitable Trusts’ Stateline reported on July 15 that drowning prevention could be getting a boost in the federal budget. The story also provides a roundup of drowning prevention legislation in several states.

“The ability to enter a safe body of water during a warm summer is one of the real pleasures of life,” says Wiltse. “It’s an escape from the heat. It’s refreshing. It’s rejuvenating. It’s physically pleasurable. It’s mentally healthy and physically healthy. And I think it’s a matter of social justice. All people should have access to safe swimming venues. And just because you’re poor, working class, you shouldn’t be deprived of that pleasure.”

Story ideas and sources of drowning data

Check your community for local organizations that are offering free or no-cost swimming lessons to children and adults.

Check your county or state health department website for local and state data. Also check Indian Health Services’ reports and contact tribal epidemiology centers for more local information.

CDC’s WISQARS [Web-Based Injury Statistics Query and Reporting System] provides an interactive database about fatal and nonfatal injuries, violent deaths and cost of injury data.

CDC WONDER [Wide-ranging ONline Data for Epidemiologic Research] is another source of data. Use this Quick Start guide to learn how to use the system.

CDC’s Drowning Prevention website provides state-by-state drowning death rates.

Water Safety USA is a roundtable of several national nonprofit and governmental organizations with a focus on drowning prevention and water safety programs. The group is planning to publish the first-ever U.S. National Water Safety Action Plan, Pew’s Stateline reports.

The American Red Cross is another good source of drowning prevention information and facts.

If you’re looking to put together an info box for drowning prevention measures, the American Academy of Pediatrics and the CDC have helpful bullet points.

If you’re looking to learn more about disparities in recreational activities, here are three books to get you started: “Race, Riots, and Roller Coasters: The Struggle Over Segregated Recreation in America” by Victoria Wolcott. “The land was ours: how black beaches became white wealth in the coastal south” by Andrew Kahrl. “Contested Waters: A Social History of Swimming Pools in America” by Jeff Wiltse.

Remember that The Journalist’s Resource publishes its content under a Creative Commons license, meaning you’re free to republish this piece in your own news publication, provided you include author credit and a link back to the original piece. You’re also welcome and encouraged to embed the map and the Swimming Safety Tips graphic into your own stories.

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