education policy peer reviewed journals

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Educational Policy

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As a peer-reviewed journal, Educational Policy provides an interdisciplinary forum for improving education in primary and secondary schools, as well as in higher education and non school settings. Educational Policy blends the best of educational research with the world of practice, making it a valuable resource for educators, policy makers, administrators, researcher, teachers, and graduate students. Educational Policy is concerned with the practical consequences of policy decisions and alternatives. It examines the relationship between educational policy and educational practice, and sheds new light on important debates and controversies within the field. You''ll find that Educational Policy is an insightful compilation of ideas, strategies, and analyses for improving our educational system.

Articles and Essays: Present thought-provoking, original -- and often controversial -- analyses for improving educational policy.

Review Essays: Critical discussions compare and contrast collections of recent works.

Special Issues: Single-theme issues provide in-depth coverage of topics of current concern.

Annual Index:   Alphabetical listings of authors and titles provide quick and easy reference to valuable information and ideas.

Educational Policy provides an interdisciplinary forum for improving education in primary and secondary schools, as well as in high education and non school settings.  Educational Po licy blends the best of educational research with the world of practice, making it valuable resource for educators, policy makers, administrators, researchers, teachers, and graduate students. Educational Policy is concerned with the practical consequences of policy decisions and alternatives.  It examines the relationship between educational policy and educational practice, and sheds new light on important debates and controversies within the field. You'll find that Educational Policy is an insightful compilation of ideas, strategies, and analyses for improving our educational systems.

Articles and Essays: present thought-provoking, original -- and often controversial -- analyses for improving educational policy.

PEA Yearbook: A collection of papers from the Politics in Education Association, published as a double issue in the beginning of each calendar year.

Annual Index: Alphabetical listings of authors and titles provide quick and easy reference to valuable information and ideas.

• Abstract Journal of the Educational Resources Information Center (ERIC)
• Clarivate Analytics: Current Contents - Physical, Chemical & Earth Sciences
• Clarivate Analytics: Social Sciences Citation Index (SSCI)
• EBSCO: Educational Administration Abstracts
• ERIC Current Index to Journals in Education (CIJE)
• Educational Research Abstracts Online (T&F)
• Higher Education Abstracts
• International Bibliography of Periodical Literature on the Humanities and Social Sciences (IBZ)
• MLA International Bibliography
• ProQuest Education Complete
• ProQuest: CSA Sociological Abstracts
• Research into Higher Education Abstracts
• Wilson Education Index/Abstracts

Manuscripts should be typed, double-spaced, and on one side only of white 8 1/2 x 11 paper. The article should be no longer than 35 pages. Leave generous margins on all four sides of the page. Article title, author's name, professional title, and institutional affiliation on a separate cover sheet. Only the article title should appear on subsequent pages to facilitate anonymize review. Authors should closely follow the Publication Manual of the American Psychological Association (current edition). Tabular material should be kept to a minimum - three to four at most - authors will be asked to provide camera-ready copy for charts and graphs of articles accepted for publication. Also, include a 100-word abstract with each article.

Manuscripts should be submitted electronically to http://mc.manuscriptcentral.com/epy . Authors will be required to set up an online account on the SageTrack system powered by ScholarOne. Obtaining permission for any quoted or reprinted material that requires permission is the responsibility of the author. Submission of a manuscript implies commitment to publish in the journal. Authors submitting manuscripts to the journal should not simultaneously submit them to another journal, nor should manuscripts have been published elsewhere in substantially similar form or with substantially similar content. Authors in doubt about what constitutes prior publication should consult the editor.

Authors who want to refine the use of English in their manuscripts might consider utilizing the services of SPi, a non-affiliated company that offers Professional Editing Services to authors of journal articles in the areas of science, technology, medicine or the social sciences. SPi specializes in editing and correcting English-language manuscripts written by authors with a primary language other than English. Visit http://www.prof-editing.com for more information about SPi’s Professional Editing Services, pricing, and turn-around times, or to obtain a free quote or submit a manuscript for language polishing.

Please be aware that Sage has no affiliation with SPi and makes no endorsement of the company. An author’s use of SPi’s services in no way guarantees that his or her submission will ultimately be accepted. Any arrangement an author enters into will be exclusively between the author and SPi, and any costs incurred are the sole responsibility of the author.

If you or your funder wish your article to be freely available online to nonsubscribers immediately upon publication (gold open access), you can opt for it to be included in Sage Choice, subject to the payment of a publication fee. The manuscript submission and peer review procedure is unchanged. On acceptance of your article, you will be asked to let Sage know directly if you are choosing Sage Choice. To check journal eligibility and the publication fee, please visit Sage Choice . For more information on open access options and compliance at Sage, including self author archiving deposits (green open access) visit Sage Publishing Policies on our Journal Author Gateway.

As part of our commitment to ensuring an ethical, transparent and fair peer review process Sage is a supporting member of ORCID, the Open Researcher and Contributor ID . ORCID provides a unique and persistent digital identifier that distinguishes researchers from every other researcher, even those who share the same name, and, through integration in key research workflows such as manuscript and grant submission, supports automated linkages between researchers and their professional activities, ensuring that their work is recognized.

The collection of ORCID iDs from corresponding authors is now part of the submission process of this journal. If you already have an ORCID iD you will be asked to associate that to your submission during the online submission process. We also strongly encourage all co-authors to link their ORCID ID to their accounts in our online peer review platforms. It takes seconds to do: click the link when prompted, sign into your ORCID account and our systems are automatically updated. Your ORCID iD will become part of your accepted publication’s metadata, making your work attributable to you and only you. Your ORCID iD is published with your article so that fellow researchers reading your work can link to your ORCID profile and from there link to your other publications.

If you do not already have an ORCID iD please follow this link to create one or visit our ORCID homepage to learn more.

For more information, please refer to the Sage Manuscript Submission Guidelines .

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2022 Impact Factor: 2.1 2023 Google Scholar h5-index: 29 ISSN: 1557-3060 E-ISSN: 1557-3079

Education Finance and Policy (EFP) publishes policy-relevant research papers concerning education finance, policy, and practice. The journal draws from a range of fields—including economics, political science, public administration and policy, law, and education—covering topics that span from early childhood to graduate education in the United States and around the world. The journal publishes two types of articles: research papers and policy briefs. We encourage authors to consult our Style Guides for Research Papers and Policy Briefs.

Li Feng , Editor Cassandra Hart , Editor Tolani Britton , Associate Editor Sean Corcoran , Associate Editor Oded Gurantz , Associate Editor Joshua Hyman , Associate Editor Tammy Kolbe , Associate Editor Carolyn Sattin-Bajaj , Associate Editor Roddy Theobald , Associate Editor

Article Takeaways

Summary of: Setren, E. (2023). Race to the Tablet? The Impact of a Personalized Tablet Educational Program. Education Finance and Policy , 18 (2): 213- 231.    Summary of: Chen, B., Dougherty, S., Goldhaber, D., Holden, K., & Theobald, R. (2023). CTE Teacher Licensure and Long-Term Student Outcomes. Education Finance and Policy , 18 (2): 253-276.  Summary of: Yang, L., Gopalan, M. (2023). The Effects of Campus Shootings on School Finance and Student Composition. Education Finance and Policy ;18 (2): 277-301.    Summary of: Komisarow, S. & Gonzalez, R. (2023). Can Community Crime Monitoring Reduce Student Absenteeism? Education Finance and Policy , 18 (2): 319-350. 

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Education policy : Journals

• Education and urban society "Education and Urban Society (EUS) is the preeminent journal for communicating new ideas on educational processes, controversies, research, and policy. It places special emphasis on the relationship between educators and society."
• Education finance and policy "Education Finance and Policy (EFP) publishes policy-relevant research papers concerning education finance, policy, and practice. The journal draws from a range of fields—including economics, political science, public administration and policy, law, and education—covering topics that span from early childhood to graduate education in the United States and around the world."
• Education policy analysis archives "Education Policy Analysis Archives/Archivos Analíticos de Políticas Educativas/Arquivos Analíticos de Políticas Educativas (EPAA/AAPE) is a peer-reviewed, open-access, international, multilingual, and multidisciplinary journal designed for researchers, practitioners, policy makers, and development analysts concerned with education policies."
• Educational evaluation and policy analysis "Educational Evaluation and Policy Analysis (EEPA) is the premier journal for rigorous, policy-relevant research on issues central to education. The articles that appear inform a wide range of readers—from scholars and policy analysts to journalists and education associations—working at local, state, and national levels. EEPA is a multidisciplinary journal, and editors consider original research from multiple disciplines, orientations, and methodologies."
• Educational policy "Educational Policy (EPX) focuses on the practical consequences of educational policy decisions and alternatives. It examines the relationship between educational policy and educational practice, and sheds new light on important debates and controversies within the field."
• International journal of education policy and leadership "IJEPL is a refereed electronic journal dedicated to enriching the education policy, leadership, and research use knowledge bases, and promoting exploration and analysis of policy alternatives."
• Journal for critical education policy studies Seeks to develop Marxist and other Left analysis of education; publishes articles that critique global, national, neo-liberal, neo-conservative, New Labour, Third Way, postmodernist and other analyses of policy developments.
• Journal of education policy "The Journal of Education Policy (JEP) publishes original, critically and theoretically informed research that discusses, analyses and debates policymaking, policy implementation and policy impact at all levels, and within and across all spheres of formal and informal education."
• Journal of emerging trends in educational research and policy studies "Journal of Emerging Trends in Educational Research and Policy Studies (JETERAPS) is scholarly, open access, peer reviewed, double blind, interdisciplinary, and fully refereed journal. JETERAPS seeks and publishes articles from academics and activists throughout the globe." (South African)
• Policy reviews in higher education "The journal aims to open up a space for publishing in-depth accounts of significant areas of policy development affecting higher education internationally. We encourage authors from a range of disciplinary backgrounds to analyse higher education from fresh perspectives, including drawing on concepts and theories from other academic fields and disciplines."
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• Welcome to the eJournal of Education Policy

Welcome to the eJournal of Education Policy 

ISSN 2158-9232

About the Journal

The eJournal of Education Policy was established in 2000. The eJournal of Education Policy is an international refereed journal providing perspectives on current policy issues facing both K-12 and higher education.  This is an Open Access journal.

Aim and scope

It is the aim of the editors to fulfill an ongoing commitment to support empirical research, make connections between theory and practice, and engage in thoughtful analysis of the policy issues in education.

We hope to serve as a valuable resource for educational leaders, teachers, policymakers, scholars, and graduate students by shedding light on the practical implications of policy decisions and their implementation.

• The eJournal of Education Policy is blind peer-reviewed, and is available to authors and researchers worldwide.
• The eJournal of Education Policy is an Open Access journal.
• The eJournal of Education Policy does not charge authors for manuscript publication.
• International papers must be submitted in English.

The following organizations are affiliates of the Northern Arizona University College of Education  eJournal of Education Policy:

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American Educational Research Journal Publishes original  articles that advance the empirical, theoretical, and methodological understanding of education and learning.  View journal website . | @ aerj_journal

Educational Evaluation and Policy Analysis Publishes scholarly manuscripts of theoretical, methodological, or policy interest to those engaged in educational policy.  View journal website . |  @ EEPAjournal

Educational Researcher Publishes articles of general significance to the education research community. A ims to make major programmatic research and important findings widely accessible.  View journal website . | @ ERjournal_AERA

Journal of Educational and Behavioral Statistics An outlet for papers that are useful to those applying statistical approaches to issues in educational or behavioral research.  View journal website .

Review of Educational Research Publishes critical, integrative reviews of research literature bearing on education.  View journal website . | @RERjournal_AERA

Review of Research in Education Each annual volume p rovides a forum for analytic research reviews on selected education topics of significance to the field.  View journal website .

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Search here for journal, magazine or newspaper titles. If you're looking for articles on a topic, use the  databases .

Examples: Newsweek , Journal of Educational Psychology .

Selected Education Journals

These links take you to a source with recent issues of the journal. Additional issues may be available via other sources. Use  Find Journals by Title  (above) to find alternate sources for a title.

• AERA Open "A peer-reviewed, open access journal published by the American Educational Research Association (AERA)."
• Afterschool Matters An open access peer-reviewed journal from the National Institute on Out-of-School Time.
• American Educational Research Journal AERJ "publishes original empirical and theoretical studies and analyses in education that constitute significant contributions to the understanding and/or improvement of educational processes and outcomes." A blind peer reviewed journal from the American Educational Research Association.
• American Journal of Education Sponsored by the Pennsylvania State College of Education, this peer reviewed journal publishes articles "that present research, theoretical statements, philosophical arguments, critical syntheses of a field of educational inquiry, and integrations of educational scholarship, policy, and practice."
• Australian Journal of Teacher Education This open access peer- reviewed journal publishes research related to teacher education.
• Child Development "As the flagship journal of the Society for Research in Child Development (SRCD), Child Development has published articles, essays, reviews, and tutorials on various topics in the field of child development since 1930." Uses blind peer review.
• Cognition and Instruction This peer reviewed journal publishes articles on the "rigorous study of foundational issues concerning the mental, socio-cultural, and mediational processes and conditions of learning and intellectual competence." Articles are sometimes blind reviewed.
• Comparative and International Education This open access peer-reviewed journal "is published twice a year and is devoted to publishing articles dealing with education in a comparative and international perspective."
• Computers and Education Publishes peer reviewed articles on the use of computing technology in education.
• Contemporary Educational Psychology "publishes articles that involve the application of psychological theory and science to the educational process."
• Current Issues in Emerging eLearning (CIEE) "an open access, peer-reviewed, online journal of research and critical thought on eLearning practice and emerging pedagogical methods."
• Democracy and Education Open access peer-reviewed journal "seeks to support and sustain conversations that take as their focus the conceptual foundations, social policies, institutional structures, and teaching/learning practices associated with democratic education."
• Developmental Review This peer reviewed journal "emphasizes human developmental processes and gives particular attention to issues relevant to child developmental psychology."
• Education 3-13: International Journal of Primary, Elementary and Early Years Education This official publication of the Association for the Study of Primary Education (ASPE) publishes peer reviewed articles related to the education of children between the ages of 3-13.
• Educational Administration Quarterly This peer reviewed journal from the University Council for Educational Administration (UCEA) offers conceptual and theoretical articles, research analyses, and reviews of books in educational administration."
• Educational and Psychological Measurement "scholarly work from all academic disciplines interested in the study of measurement theory, problems, and issues."
• Educational Evaluation and Policy Analysis EEPA "publishes scholarly articles of theoretical, methodological, or policy interest to those engaged in educational policy analysis, evaluation, and decision making." Blind peer reviewed journal from the American Educational Research Association.
• Educational Measurement: Issues and Practice Sponsored by the National Council on Measurement in Education, this journal promotes "a better understanding of and reasoned debate on assessment, evaluation, testing, and related issues."
• Educational Policy "focuses on the practical consequences of educational policy decisions and alternatives"
• Educational Researcher "Educational Researcher publishes scholarly articles that are of general significance to the education research community and that come from a wide range of areas of education research and related disciplines." A peer reviewed journal from the American Educational Research Association.
• Educational Research Quarterly ERQ "publishes evaluative, integrative, theoretical and methodological manuscripts reporting the results of research; current issues in education; synthetic review articles which result in new syntheses or research directions; book reviews; theoretical, empirical or applied research in psychometrics, edumetrics, evaluation, research methodology or statistics" and more. Uses blind peer review.
• Educational Research Review Publishes review articles "in education and instruction at any level," including research reviews, theoretical reviews, methodological reviews, thematic reviews, theory papers, and research critiques. From the European Association for Research on Learning and Instruction (EARLI).
• Educational Studies "publishes fully refereed papers which cover applied and theoretical approaches to the study of education"
• Education and Culture This peer reviewed journal from Purdue University Press "takes an integrated view of philosophical, historical, and sociological issues in education" with a special focus on Dewey.
• FIRE: Forum of International Research in Education This open access, peer reviewed journal promotes "interdisciplinary scholarship on the use of internationally comparative data for evidence-based and innovative change in educational systems, schools, and classrooms worldwide."
• Frontline Learning Research An official journal of EARLI, European Association for Research on Learning and Instruction. Open Access.
• Future of Children Articles on policy topics relevant to children and youth. An open access journal from the Woodrow Wilson School of Public and International Affairs at Princeton University and the Brookings Institution.
• Harvard Educational Review "a scholarly journal of opinion and research in education. It provides an interdisciplinary forum for discussion and debate about the field's most vital issues."
• High School Journal "The High School Journal publishes research, scholarship, essays, and reviews that critically examine the broad and complex field of secondary education."
• IDEA Papers A national forum for the publication of peer-reviewed articles pertaining to the general areas of teaching and learning, faculty evaluation, curriculum design, assessment, and administration in higher education.
• Impact: A Journal of Community and Cultural Inquiry in Education A peer-reviewed, open-access journal devoted to the examination and analysis of education in a variety of local, regional, national, and transnational contexts.
• Instructional Science "Instructional Science promotes a deeper understanding of the nature, theory, and practice of the instructional process and resultant learning. Published papers represent a variety of perspectives from the learning sciences and cover learning by people of all ages, in all areas of the curriculum, and in informal and formal learning contexts." Peer reviewed.
• Interdisciplinary Journal of Problem-based Learning - IJPBL This open access, peer reviewed journal "publishes relevant, interesting, and challenging articles of research, analysis, or promising practice related to all aspects of implementing problem-based learning (PBL) in K–12 and post-secondary classrooms."
• International Journal of Computer-Supported Collaborative Learning An Official Publication of the International Society of the Learning Sciences
• International Journal of Educational Leadership Preparation - IJELP An open access journal from the National Council of Professors of Educational Administration. Articles undergo a double-blind peer review process.
• Internet and Higher Education Publishes peer reviewed articles "devoted to addressing contemporary issues and future developments related to online learning, teaching, and administration on the Internet in post-secondary settings."
• Journal for Research in Mathematics Education An official journal of the National Council of Teachers of Mathematics (NCTM), JRME publishes peer reviewed research articles and literature reviews, as well as commentaries and book reviews. Concerned with mathematics education at both the K-12 and college level.
• Journal of Applied Research on Children - JARC Published by the CHILDREN AT RISK Institute, this open access. peer reviewed journal publishes "interdisciplinary research that is linked to practical, evidenced-based policy solutions for children’s issues."
• Journal of Computer Assisted Learning JCAL "is an international peer-reviewed journal which covers the whole range of uses of information and communication technology to support learning and knowledge exchange."
• Journal of Education A scholarly peer-reviewed journal focusing on K-12 education. This long-standing journal is sponsored by the Boston University School of Education.
• Journal of Educational Psychology This blind peer reviewed journal from the American Psychological Association publishes "original, primary psychological research pertaining to education across all ages and educational levels," as well as "exceptionally important theoretical and review articles that are pertinent to educational psychology."
• Journal of Educational Research "publishes manuscripts that describe or synthesize research of direct relevance to educational practice in elementary and secondary schools, pre-K–12."
• Journal of Interactive Media in Education - JIME This long-standing peer reviewed open access journal publishes research on the theories, practices and experiences in the field of educational technology.
• Journal of Research in Science Teaching - JRST This blind peer reviewed journal is the official journal of NARST: A Worldwide Organization for Improving Science Teaching and Learning Through Research, which "publishes reports for science education researchers and practitioners on issues of science teaching and learning and science education policy."
• Journal of Teacher Education The flagship journal of the American Association of Colleges for Teacher Education (AACTE) publishes peer reviewed articles on teacher education and continued support for teachers.
• Journal of the Learning Sciences "JLS provides a multidisciplinary forum for research on education and learning as theoretical and design sciences." This official journal of the International Society of the Learning Sciences uses a double blind review process.
• Journal of Vocational Behavior "The Journal of Vocational Behavior publishes empirical and theoretical articles that expand knowledge of vocational behavior and career development across the life span. " Peer reviewed.
• Learning and Instruction This peer reviewed journal from the European Association for Research on Learning and Instruction (EARLI) publishes "advanced scientific research in the areas of learning, development, instruction and teaching."
• Mentoring & Tutoring: Partnership in Learning - National Council of Professors of Educational Administration (NCPEA) Publishes "papers on all aspects of mentoring, tutoring and partnership in education, other academic disciplines and the professions."
• Merrill-Palmer Quarterly Publishes "empirical and theoretical papers on child development and family-child relationships."
• Michigan Journal of Community Service Learning MJCSL is an open-access journal focusing on research, theory, pedagogy, and other matters related to academic service-learning, campus-community partnerships, and engaged/public scholarship in higher education. Published by the University of Michigan. All articles are free online --don't worry about the "Buy a copy" messages.
• Michigan Reading Journal Open access journal from the Michigan Reading Association.
• NACADA Journal - National Academic Advising Association "The NACADA Journal is the biannual refereed journal of the National Academic Advising Association. It exists to advance scholarly discourse about the research, theory and practice of academic advising in higher education."
• Numeracy Published by the National Numeracy Network, this open access and peer reviewed journal "supports education at all levels that integrates quantitative skills across disciplines."
• Policy and Society A highly ranked open access journal that publishes peer-reviewed research on critical issues in policy theory and practice at the local, national and international levels. Includes articles on Education policy.
• Reading Research Quarterly RRQ publishes peer reviewed scholarship on literacy, including original research, theoretical and methodological essays, review articles, scholarly analysis of trends and issues, as well as reports and viewpoints. Published by the International Literacy Association.
• Review of Educational Research RER "publishes critical, integrative reviews of research literature bearing on education." A blind peer reviewed journal from the American Educational Research Association.
• Review of Higher Education Published by the Association for the Study of Higher Education this journal provides peer-reviewed research studies, scholarly essays, and theoretically-driven reviews on higher education issues.
• Review of Research in Education RRE "provides an annual overview and descriptive analysis of selected topics of relevant research literature through critical and synthesizing essays."
• Science Education "Science Education publishes original articles on the latest issues and trends occurring internationally in science curriculum, instruction, learning, policy and preparation of science teachers with the aim to advance our knowledge of science education theory and practice."
• Scientific Studies of Reading The official Journal of the Society for the Scientific Study of Reading "publishes original empirical investigations dealing with all aspects of reading and its related areas, and occasionally, scholarly reviews of the literature and papers focused on theory development. " Uses blind peer review.
• Sociology of Education "SOE publishes research that examines how social institutions and individuals' experiences within these institutions affect educational processes and social development." A blind peer reviewed journal from the American Sociological Association.
• Studies in Science Education This blind peer reviewed journal publishes review articles that offer "analytical syntheses of research into key topics and issues in science education."
• Teachers College Record "The Teachers College Record is a journal of research, analysis, and commentary in the field of education. It has been published continuously since 1900 by Teachers College, Columbia University."
• Theory into Practice "TIP publishes articles covering all levels and areas of education, including learning and teaching; assessment; educational psychology; teacher education and professional development; classroom management; counseling; administration and supervision; curriculum; policy; and technology." Peer reviewed.
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Philosophy of Education

A peer-reviewed journal of the philosophy of education society, issn 2771-9618.

About This Journal

Philosophy of Education publishes a wide range of work that addresses philosophical questions about education, with philosophical and education both construed broadly.  This international peer-reviewed journal welcomes work in ethics, epistemology, politics, and aesthetics, including work in the overlapping domains of race and gender theory, pedagogy, and methodology.  Philosophy of Education is committed to the rigorous and vigorous exploration of questions about curriculum, pedagogy, school policy, higher education, and the school’s relationship with the larger society. 

The journal is produced in 4 issues per year, with a distinctively dialogical aspect.  Articles are paired with responses, which may support, challenge, and/or extend the ideas in the original article.  Philosophy of Education invites readers to consider these pairs as a set, and as a particularly philosophical mode of publication that treats ideas always as the prompt to further conversation.

Philosophy of Education  has always been and will remain a fully Open Access journal. There are no fees or costs involved with publishing in the journal or accessing content. 

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Journal of Education & Social Policy

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Call for Papers

Journal of Education & Social Policy (JESP) is a quarterly peer reviewed journal

Recruitment of Reviewers

Reviewer's name and affiliation will be listed in the printed journal and on the journal's webpage.

Aims and Scope

Journal of Education & Social Policy (JESP) is an open access, peer-reviewed, and refereed journal published by The Brooklyn Research and Publishing Institute. The main objective of JESP is to provide a platform for the international scholars, academicians and researchers to share the contemporary thoughts in the fields of education and social policies. JBEP aims to promote policy development in education and thus become the leading international journal in education in the world.

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Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program

• Heidi E. Jones 1 , 2 ,
• Meredith Manze 1 ,
• Anita Brakman 3 ,
• Amy Kwan 1 ,
• MiQuel Davies 3 &
• Diana Romero 1  

BMC Medical Education volume  24 , Article number:  476 ( 2024 ) Cite this article

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Medical curricula include advocacy competencies, but how much physicians engage in advocacy and what enables this engagement is not well characterized. The authors assessed facilitators and barriers to advocacy identified by physician alumni of a reproductive health advocacy training program.

The authors present secondary results from a mixed methods program evaluation from 2018 to 2020, using alumni data from a cross-sectional survey ( n  = 231) and in-depth interviews (IDIs, n  = 36). The survey measured engagement in policy, media, professional organization, and medical education advocacy and the value placed on the community fostered by the program (eight questions, Cronbach’s alpha = 0.81). The authors estimated the association of community value score with advocacy engagement using multivariable Poisson regression to estimate prevalence ratios and analyzed IDI data inductively.

Over one third of alumni were highly engaged in legislative policy ( n  = 90, 39%), professional organizations ( n  = 98, 42%), or medical education ( n  = 89, 39%), with fewer highly active in media-based advocacy ( n  = 54, 23%) in the year prior to the survey. Survey and IDI data demonstrated that passion, sense of urgency, confidence in skills, and the program’s emphasis on different forms of advocacy facilitated engagement in advocacy, while insufficient time, safety concerns, and sense of effort redundancies were barriers. The program community was also an important facilitator, especially for “out loud” efforts and for those working in environments perceived as hostile to abortion care (e.g., alumni in hostile environments with high community value scores were 1.8 times [95% CI 1.3, 2.6] as likely to report medium/high levels of media advocacy compared to those with low scores after adjusting for age, gender, and clinical specialty).

Physician advocacy training curricula should include both skills- and community-building and identify a full range of forms of advocacy. Community-building is especially important for physician advocacy for reproductive health services such as abortion care.

Peer Review reports

Physicians play an important role in advocating for policies and systems that promote their patients’ health [ 1 ]. Advocacy is included as a core curriculum requirement by the Accreditation Council for Graduate Medical Education [ 2 ]. Yet, in a 2017 survey of Family Medicine Residency Program Directors in the United States (US), only one-third reported requiring advocacy in their curriculum [ 3 ].

Post-residency advocacy training programs can supplement residency programs to hone physicians’ advocacy skills and increase their level of advocacy engagement. One such program is Physicians for Reproductive Health’s Leadership Training Academy (LTA), a 9-month physician training to develop leadership in advocacy on sexual and reproductive health, including abortion and contraceptive care, in the US. The training program started in 2004 for post-residency family planning fellows, before broadening to physicians outside the fellowship in 2012. Additionally, the training program began with small cohorts of less than 5 students from 2004 to 2009 (no new students in 2005) to larger cohorts of 20 to 30 students from 2010 onward. The curriculum focuses on skills related to communication, media, interacting with policymakers, and leadership, in instructional workshops that last three to five days every three months, with on-line webinars and one-on-one feedback interspersed. Program applicants are selected based on professional aspirations and goals, leadership experience and potential, commitment to LTA values/goals, policy/media readiness, and regional and lived experience diversity.

While a 2004 survey found that over 90% of US physicians rated advocacy as important to their profession, at least one-third had not engaged in any advocacy work in three years prior to the survey [ 4 ]. Similarly, in 2018 a survey of 886 physicians at the University of Wisconsin, found 21% reported not being engaged in any type of health policy or advocacy activities. As restrictions to reproductive health, especially abortion [ 5 , 6 ], increase in the US, the role of physicians in advocating for patients’ access to these services is critical. Identifying barriers and facilitators to physician engagement in advocacy can inform training curricula. We present secondary results from a mixed methods evaluation of the LTA program from 2018 to 2020 to describe physicians’ post-training advocacy engagement and its barriers and facilitators.

The mixed methods evaluation included a survey and in-depth interviews (IDIs) of alumni (as of 2018). The survey asked questions on advocacy efforts across four domains targeted by the curriculum—legislative policy (e.g., interacting with policymakers), media (e.g., interviews with television/radio), professional organization (e.g., participation in committees), and medical education (e.g., lecturing on abortion service delivery); the value they place on the LTA program community; and sociodemographic characteristics.

We sent the on-line survey to all alumni from 2004 to 2018 ( n  = 326) by email with reminders from September to November 2018. In total, 231 (71%) completed 80% or more of the survey, with no significant differences by response for age, race, ethnicity, gender, clinical specialty, or participation in post-residency fellowship; we therefore present unweighted data. The first page of the survey included informed consent language with survey entry indicating consent. The survey included 97 questions altogether with 31 min as the median time of completion. Participants received $35 giftcards.

We categorized engagement as low, medium, or high in each domain based on types of activities reported in the last year (one or no activity coded as low, two or three as medium, and four or more as high). For legislative policy, we incorporated frequency of policymaker meetings; those who met with policymakers almost every week were coded as high, and once or twice a month as medium, regardless of number of types of activities. Similarly, for media, those who reported posting on social media almost every day in combination with at least one other form of media advocacy were coded as high; those who posted on social media almost every day or once a week as their only form of media advocacy were coded as medium.

The IDI guide development included questions on advocacy activities, program community engagement, and barriers and facilitators to advocacy. Survey results informed probes to operationalize categories of engagement and barriers and facilitators to advocacy engagement. Further, we used purposive sampling based on survey results to identify a subgroup of alumni ( n  = 44), with variation in low, medium, and high levels of advocacy across the domains; self-reported level of hostility toward abortion in their work environment; years of practicing medicine; or not having responded to survey ( n  = 6); 36 (82%) completed IDIs. Participants provided informed consent and received $50 giftcards. We used iterative inductive analysis informed by grounded theory methodology. Three authors [AK, MM, DR] double-coded a subset of transcripts, revised codes to increase analytic dependability, and created a detailed code structure. The current analysis focuses on themes related to engagement in advocacy. Perspectives on what constitutes effective advocacy are reported elsewhere [ 7 ]. Pseudonyms are used for illustrative quotes, with overall engagement level indicated in parentheses.

Using survey data, we present descriptive statistics on levels of engagement and types of advocacy activities. We estimated a Spearman’s correlation to test the extent to which level of engagement in advocacy domains were correlated. We combined eight 5-point Likert questions on the value of the LTA program community into a score (Cronbach’s alpha = 0.81). Results from the IDIs informed our analytic approach to the survey. Given that the importance of the program community emerged in the IDIs, for the survey we tested whether community value (dichotomized at the median, given generally high scores) was associated with engagement using Poisson regression with robust standard errors to estimate prevalence ratios, after adjusting for age, gender, and clinical specialty as a priori hypothesized confounders. Similarly, qualitative data suggested that clinicians working in regions with low levels of support for abortion care, relied on social support provided by the program community more heavily than those working in highly supportive environments. We therefore stratified this analysis by self-reported local level of hostility to abortion (very/somewhat versus little/no hostility) to test whether this association differed by level of hostility and present p-values for interaction when stratum specific estimates differed. We also explored whether level of engagement in each of the advocacy domains was associated with age, gender, clinical specialty, alumni cohort (2004–2009, 2010–2014, 2015–2018) and participation in post-residency family planning fellowships using Chi-Squared or Fisher’s exact tests, as appropriate. We compared survey results with thematic findings. We present integrated quantitative and qualitative findings by advocacy domain, facilitators and barriers to advocacy and the role of community.

Researchers from the City University of New York Graduate School of Public Health and Health Policy led data collection and analysis; two program authors [AB, MD] were blinded to individual-level data. The study was approved by the CUNY SPH’s Institutional Review Board (protocol 2018 − 1045).

The median age of respondents was 38 years (range 31 to 79); 58% had completed the program in 2015–2018, 36% in 2010–2014 and 6% in 2004–2009. The majority identified as women ( n  = 211, 91%), with 65% ( n  = 151) identifying as white, 15% ( n  = 34) Asian/Pacific Islander, 7% ( n  = 16) Black, 5% ( n  = 12) Hispanic, and 8% ( n  = 18) mixed race/other. The most represented clinical specialties were obstetrics and gynecology ( n  = 156, 68%) and family medicine ( n  = 59, 26%). Almost all ( n  = 226, 98%) were practicing medicine at the time of the survey and 87% ( n  = 200) had provided abortions in the previous year. Most alumni ( n  = 183, 79%) practiced medicine in urban settings, with all but six states represented. For the level of hostility toward abortion in the area where they do most of their clinical care, 16% ( n  = 37) reported very hostile, 21% ( n  = 48) somewhat hostile, 34% ( n  = 77) a little hostile and 28% ( n  = 63) not hostile environments ( n  = 6, 3% were not practicing or did not respond to this question).

Overall advocacy

Over one-third of alumni were highly engaged in professional organization advocacy work, medical education, or legislative policy advocacy, with fewer highly active in media-based advocacy (Table  1 ). Only three (1%) were highly active across all domains, and three (1%) not active across all domains. Those who reported being engaged in legislative policy were more likely to be engaged with media (Spearman’s ρ = 0.46), and those who reported being active in professional organizations were more likely to be engaged in medical education (Spearman’s ρ = 0.38). Findings from the IDIs suggested that the program’s emphasis on different forms of advocacy facilitated physicians’ ability to leverage their strengths.

…if you think that whoever has time to be on MSNBC has time to sit on three committee meetings a week at a hospital to get something done, that’s a fallacy, that can’t be the same person doing all of that. The wonderful part of the LTA is it gives you potential lanes and the skills of what you do in that lane.– Sandy [low].

Legislative policy advocacy

In the year prior to the survey, 77% ( n  = 178) reported emailing, writing, or calling policymakers, 49% ( n  = 113) met with policymakers in person, and 32% ( n  = 75) provided context expertise to policymakers. Legislative policy advocacy was associated with higher community value scores (Table  1 ) with no differences by age, gender, clinical specialty, time since graduation, or participation in post-residency fellowship. Those working in hostile environments to abortion were more likely to report interacting with policymakers frequently; 36% ( n  = 31/85) of those in very/somewhat hostile environments reported interacting with policymakers every week compared to 16% ( n  = 22/140) of those in little/not hostile environments ( p  < 0.01).

In the IDIs, many alumni attributed the program with preparation needed to engage in policy-related advocacy and highlighted the importance of the LTA network.

I feel it [policy-related advocacy activity] was non-existent before the LTA. That I didn’t really know how to approach reaching out to my local politicians, or my national politicians about these issues. I feel after LTA, I had much more of a support system and just a better understanding of how to do that, and so felt much more confident reaching out to those people to make them aware of certain reproductive health issues.– Rafaela [high].

Media advocacy

In terms of media activities, about one-quarter of alumni survey respondents (24%) were highly engaged, 40% reported medium levels of engagement and 37% low levels (Table  1 ). In the last year, 54% ( n  = 123) had interviewed with print media; 38% ( n  = 86) wrote an opinion piece/commentary; and 29% ( n  = 67) wrote a letter to the editor. One-quarter (25%, n  = 57) had participated in telephone interviews and 23% ( n  = 52) were interviewed on camera. Level of engagement in media was not associated with age, gender, clinical specialty, time since graduating or participation in post-residency fellowship.

Professional organization advocacy

The most common types of professional organization advocacy reported were participating in a committee, working group or task force ( n  = 149, 65%), developing organizational/institutional policies ( n  = 144, 63%), or attending professional organization advocacy events ( n  = 115, 50%). The level of engagement was not associated with age, clinical specialty, time since graduation or post-residency fellowship. However, men were more likely than women to engage in professional organization activities; 58% ( n  = 11/19) of men versus 41% ( n  = 86/210) of women reported high levels of this type of engagement ( p  < 0.01).

A common theme in the IDIs centered on increased awareness, from the program, of the importance of participating in professional medical societies and the incremental nature of this type of work (“it’s a marathon not a sprint”).

I sit on a committee for the [state’s group for family physicians], which is an opportunity that I wouldn’t necessarily have gotten involved in. We don’t do anything specific to reproductive health now, but again, a lot of it is the long game of getting my foot in the door at [this professional organization], so that I can make a long-term difference. Just even having that on my radar as something to do, would not have come out without PRH and the LTA.– Diana [medium].

Medical education advocacy

The most common forms of medical education reported were teaching/lecturing students ( n  = 194, 84%), developing educational material/curriculum ( n  = 127, 55%), and presenting at a panel/conference ( n  = 124, 54%). Medical education efforts were common among those who reported participating in post-residency fellowships in academic medicine—89% ( n  = 136/152) of those in a fellowship had medium/high levels of engagement versus 68% ( n  = 51/75) of those not in a fellowship ( p  < 0.01).

Barriers/Facilitators

Factors influencing engagement identified in the IDIs were categorized into personal, professional, and program-related (Fig.  1 ). Factors related to high levels of engagement included: passion regarding reproductive health ( personal ); urgency of issue ( professional ); skills fostered by the program ( program-related ). Factors related to low levels of engagement included: concerns regarding personal/family safety especially for ‘out loud’ activities ( personal ); advocacy handled by others ( professional ); and less successful aspects of the training ( program-related ).

Relative importance of factors that facilitate physician’s engagement in reproductive health-related advocacy, especially abortion; Mixed methods evaluation of physician advocacy program, 2018–2020

Many of these factors were confirmed in survey responses. When provided with a list of abortion advocacy facilitators, the top five selected were: motivation to promote social or reproductive justice ( n  = 177, 77%); motivation to increase abortion care access ( n  = 170, 74%); supportive network of LTA colleagues ( n  = 146, 63%); supportive family/friends ( n  = 140, 61%) and sense of important/valuable contribution ( n  = 131, 57%). The number one barrier to abortion advocacy reported was lack of time ( n  = 160, 69%), followed by concerns for safety of family ( n  = 74, 32%) and concerns about being harassed ( n  = 69, 30%).

Confidence and comfort in abortion advocacy were situated in the center of the engagement continuum. In both the survey and IDIs, alumni generally reported confidence in their role as abortion advocates—96% ( n  = 222) of survey respondents reported that the program increased their confidence as abortion advocates. However, alumni described their comfort with advocacy as situational, varying by topic, setting/audience, and communication modality.

Role of community

Generally, alumni felt positively about the LTA community (Table  2 ). After adjusting for clinical specialty, age, and gender, highly valuing the LTA community was modestly associated with reporting medium/high levels of engagement in advocacy. Valuing community was especially important for alumni reporting working in areas hostile to abortion for public-facing media efforts (test for interaction p  < 0.01, Table  3 ).

The value of the LTA community as a facilitator to advocacy engagement emerged from the IDIs as well. For many, the LTA community functioned as a source of informational, motivational, and emotional support. As Lauren [medium] said, “you feel there’s no one else out there that cares about these issues, so it was very nice to be able to find your people.” Patti [high] expanded on this:

… it was a safe space inside a community of reproductive health providers… And I think that some of the stigma associated with being a provider for abortion or contraception care means that leadership looks different, or has to look different, or it’s more important to have very highly evolved leadership skills in order to overcome that stigma and also be strategic around the advocacy in that area. And I think that having that protected space inside that community is extremely important.

Further, as Robert [medium] stated, “part of me continuing to be an abortion provider is feeling responsibility to the other members of the LTA class that I was in, as well as my own personal motivations…creating that shared responsibility…was really powerful.” Sally [high] described the importance of community for informational support:

I think that for those of us who have gone through the LTA, who continue to be pretty active in advocacy, particularly the abortion advocacy and in the not-so-comfortable spaces…I will say that we have a really great relationship between all of us, where we can… shoot ideas back and forth, practice questions with each other, do review talking points. I think that we rely a lot on each other in that space, both for the content, the knowledge, the practice, and also for just like, “Okay, it’s going to be fine.”

In this mixed methods evaluation of the LTA advocacy and leadership training program, survey and in-depth interview findings informed one another to gain a comprehensive understanding of barriers and facilitators to advocacy engagement. We found moderate to high levels of engagement of advocacy among most alumni, with alumni often focusing efforts on one or two domains. Physician engagement in legislative policy was correlated with engagement with the media, while engagement in professional organizations was correlated with engagement in medical education. Both legislative policy and media advocacy efforts are public facing, while work within professional organizations and medical education involve interactions with other physicians, which may explain this grouping of effort; alumni likely aligned advocacy efforts within their comfort zone. One of the strengths of the training program identified by alumni was that it taught them to consider which advocacy domain(s) to focus on based on their strengths, skills, and personal and professional considerations.

In general, fewer alumni were involved in media advocacy than in other domains. This may be due to ‘out loud’ abortion advocacy in the media being associated with safety risks in the US. In a study of 88 individuals who shared their abortion stories publicly as part of two abortion story-sharing campaigns, 60% reported experiencing harassment after this publicity, with 14% reporting receiving death threats [ 8 ].

We found that men were more likely than women to report engagement with medical professional organization efforts. Historically, in the US, women have had less access to leadership roles in medicine than men. A study of medical school graduates from 1979 to 2013 found that women physicians at academic medical centers were less likely than men to be promoted to higher faculty ranks or to be made department chairs, and this difference did not wane over time [ 9 ]. Training programs, such as the LTA may help rectify this situation, as most program participants identified as women, and many reported not having considered participation in professional organizations and/or seen the relevance for advocacy in this domain prior to the program.

We found that moderate and high levels of engagement in advocacy, especially public-facing advocacy, were associated with the strength of value placed on the community of colleagues established by the training program. This sense of community was especially important for media engagement (i.e. ‘out loud’ advocacy) for physicians working in areas they perceived as hostile to abortion care. Previous research has shown the importance of interpersonal communication among physicians in reducing burnout and compassion fatigue among abortion providers [ 10 ]. Advocacy efforts, especially public-facing efforts, may equally require support from physician colleagues for sustainability. Advocacy training curricula should include community-building in addition to skills-building.

These findings should be interpreted within the limitations of our study. We created the low, medium, and high advocacy engagement levels as we could not find previously validated measures; however, triangulation of findings with IDIs increased confidence in the validity of these categories. All data are self-reported; social desirability may have impacted physicians’ reports.

Advocacy is an important component in medical education training. Programs such as the LTA may increase physicians’ confidence to engage in advocacy and to identify the advocacy domains that speak to their strengths and professional and personal circumstances. Establishing a community of colleagues is an important element of physician advocacy training programs to ensure sustainability of advocacy. This need for physician community-building may be especially important in the US within the realm of abortion services, which continue to be subject to increased restrictions [ 6 ], especially in the context of the Supreme Court’s Dobbs decision [ 5 ]. Given such continued restrictions, increasing advocacy training in medical and post-medical curricula can help to broaden advocacy efforts to ensure equitable access to abortion.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to the sensitive nature of identifying providers of abortion and contraception in the US but are available from the corresponding author on reasonable request.

Abbreviations

adjusted prevalence ratio

confidence interval

in-depth interviews

Leadership Training Academy

Physicians for Reproductive Health

United States

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HJ, DR, MM designed the survey and IDI guide; HJ analyzed the survey data; DR, MM, AK analyzed the IDI data. All of the authors contributed to interpretation of the results. HJ wrote the main manuscript text with substantive feedback from all of the authors. All authors read and approved the final manuscript.

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Correspondence to Heidi E. Jones .

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This study was approved by the City University of New York Institutional Review Board (IRB) protocol 2018 − 1045, 08/11/2018. All IDI participants completed informed consent forms prior to being interviewed; the first page of the on-line cross-sectional survey included informed consent information with entry into the survey documenting consent.

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Jones, H.E., Manze, M., Brakman, A. et al. Physician engagement in reproductive health advocacy: findings from a mixed methods evaluation of a leadership and advocacy program. BMC Med Educ 24 , 476 (2024). https://doi.org/10.1186/s12909-024-05410-5

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The Impact of Mindfulness on Pro-Social Behavior in Adults

| Published: May 10, 2024

Mindfulness, characterized by heightened self-awareness and non-judgmental acceptance of thoughts and emotions, equips individuals with the capacity to respond to life’s challenges. In times of rising anxiety, increased cases of depression, and burnout, prioritizing mindfulness becomes essential for promoting holistic well-being. This research paper aims to explore the relationship between mindfulness practices and prosocial behavior. A sample of 135 adult volunteers was gathered. A series of research questionnaires and scales were employed to measure mindfulness and prosocial behavior. Based on the responses, participants were divided into groups of adults who practice mindfulness and others who do not. The statistical analysis of the data has been done to report the findings of the study. The author seeks to shed light on how inculcating mindfulness in the routine can support the growth and improve prosocial behavior in people by exploring the underlying mechanisms and psychological processes at play. This research investigates the potential association between mindfulness practice and prosocial behavior in adults. While the findings suggest a trend, further studies with larger samples are needed to confirm a causal relationship.

Mindfulness , Pro-social behavior

This is an Open Access Research distributed under the terms of the Creative Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any Medium, provided the original work is properly cited.

© 2024, Singh, A. & Dangwal, P.

Received: April 29, 2024; Revision Received: May 06, 2024; Accepted: May 10, 2024

Apurva Singh @ [email protected]

Article Overview

Published in   Volume 12, Issue 2, April-June, 2024

Geographic Disparities in Cancer Incidence in the US Population Aged 20 to 49 Years, 2016–2020

GIS SNAPSHOTS — Volume 21 — May 9, 2024

Tesla D. DuBois, MS 1 ,2 ; Kevin A. Henry, PhD 1 ,2 ; Scott D. Siegel, PhD, MHCDS 3 ; Shannon M. Lynch, PhD 1 ,4 ( View author affiliations )

Suggested citation for this article: DuBois TD, Henry KA, Siegel SD, Lynch SM. Geographic Disparities in Cancer Incidence in the US Population Aged 20 to 49 Years, 2016–2020. Prev Chronic Dis 2024;21:230335. DOI: http://dx.doi.org/10.5888/pcd21.230335 .

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Data and Methods

Acknowledgments, author information.

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Geographic disparities in cancer incidence in the US population aged 20 to 49 years, 2016–2020. The most prevalent cancer site groups diagnosed among adults aged <50 years are female breast, female genital, male genital, digestive, lymphohematopoietic, endocrine, skin, and urinary. The incidence of early-onset cancers is not distributed evenly across the US. Differing geographic patterns emerge by cancer site group as measured by overall incidence rates, advanced-stage incidence rates, and recent temporal trends. Some states have significantly higher rates of early-onset cancer than the nation overall. In A, dark circles indicate a group of cancer sites; light circles indicate cancer sites within the group. The category Skin excludes basal cell and squamous cell carcinomas. In B, for the male genital group, data on cancer stage were not available for cancer of the testis. In C, shaded bars indicate 95% CIs, and the vertical dashed line indicates the reference group, the US, excluding Puerto Rico. Abbreviations: IRR, incident rate ratio; NOS, not otherwise specified. Data source: Centers for Disease Control and Prevention (1). [A tabular version of this figure  is available.]

A growing awareness of the increase in the incidence of early-onset cancer, defined as cancer diagnosed in adults aged 50 years or younger (2), has prompted researchers to investigate the underlying drivers of this trend (3). These investigations have focused on racial and ethnic disparities (4) and colorectal (5–8) and breast cancers (9,10). The objective of our analysis was to describe the geospatial patterns of states with a high incidence of early-onset cancer. By identifying priority states and cancer types, our analysis can generate hypotheses about drivers of early-onset cancer and guide prevention and screening interventions.

Data for this analysis are from the US Cancer Statistics Public Use Research Database, provided by the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results programs (1). The analysis included adults aged 20 to 49 with invasive cancer (excluding in situ cases) diagnosed during the 6-year period from 2015 through 2020. We calculated age-adjusted incidence rates (IRs) per 100,000 population for each cancer site by using the 2000 US standard population and, separately, for each cancer site for each state for the 5-year period from 2016 through 2020. Breast cancer and female genital cancer rates were based on the female population, and male genital cancer rates were based on the male population. We calculated incidence rate ratios (IRRs) and associated 95% CIs for the same period for each state by using the national rate as the reference. We calculated a second set of IRs, IRRs, and 95% CIs for advanced-stage early-onset cancer cases diagnosed at regional and distant stages, demonstrating how each state compares to the US in overall incidence and advanced-stage incidence for all early-onset cancers; we considered states whose 95% CIs did not cross 1 to be significantly different from the US rate. We calculated trends as the average annual percentage change (APC) in the 5-year period before the COVID-19 pandemic (2015–2019) to avoid the effect of postponed diagnoses. Trends were significant when the 95% CI for the APC did not cross zero. Negative APCs indicate falling rates, and positive APCs indicate rising rates. The percentage of early-onset cancer cases contributed by each site group and all visualizations were produced in R Statistical Computing Language version 4.3.1. All other analyses were conducted in SEER*Stat version 8.4.2 (R Core Team).

In our study, early-onset cancer (IR = 158.2) accounted for 11.4% of all cancer cases (IR = 599.9), including 17.3% of female breast cancers (overall IR = 177.9) and 8.8% of digestive cancers (overall IR = 108.7). We found that 87.2% of early-onset cancer cases fell into 8 groups of early-onset cancer sites (Panels A and B). Breast cancer contributed 23.3% of all early-onset cancer. Digestive cancers, including colon and rectum sites, contributed 14.4%. Lymphohematopoietic cancers (or “blood cancers”), which include lymphomas and leukemias, contributed 11.0%. Endocrine cancers, predominately thyroid cancer, contributed 10.7%. Female genital cancers, including uterus and cervix sites, contributed 9.1%, and skin (excluding basal and squamous) cancers, predominately melanoma, contributed 7.8%. Male genital cancers, including testis and prostate, contributed 5.8%, and urinary cancers, including kidney and renal pelvis, contributed 5.1%. Three prevalent early-onset cancer sites were not represented in the 8 site groups: lung and bronchus (IR = 4.7), brain (IR = 3.5), and tongue (IR = 1.3).

Our maps of high overall incidence and high advanced-stage incidence indicate that the incidence of early-onset cancer is not evenly distributed (Panel B). States that have worse-than-national rates are frequently near each other geographically. States with changing rates only sometimes have the highest incidence.

The rate of early-onset female breast cancer (IR = 75.1) was worse than the national rate in 17 states, which, except for Hawaii, are located in the eastern half of the US, and rates were rising in 3 states (Georgia, Illinois, Wisconsin) (Panels A and B). Eighteen states had worse-than-national rates of digestive cancers (IR = 22.7). Aside from Hawaii and Puerto Rico, these states are located in the eastern half of the US, with a concentration in the South. Rates of digestive cancers were rising in 3 states (Illinois, Maryland, New York). The incidence of lymphohematopoietic cancers (IR = 16.9) was highest in 3 states in the Southeast, 7 states in the Northeast, and Puerto Rico. Rates were rising in 1 state (Alabama) and falling in 5 (Alaska, Connecticut, Florida, Georgia, Maine). Rates of endocrine cancers (IR = 16.5) were worse than national rates in 25 states, which form a horizontal core of the country running from east to west, plus Puerto Rico. Rates of endocrine cancers were falling in 9 states (Arizona, Arkansas, Georgia, Indiana, Massachusetts, Mississippi, North Carolina, Pennsylvania, Tennessee) and not rising in any. Rates of female genital cancers (IR = 14.5) were worse than national rates in 16 states, largely in the Midwest and South, plus California and Puerto Rico; rates were not rising or falling in any state. Rates of skin cancer (IR = 12.3) were worse than national rates in 32 states, concentrated in the northern portion of the country. Three states had falling rates of skin cancer (Connecticut, New Hampshire, Pennsylvania), and none had rising rates. Rates of male genital cancers (IR = 8.7) were worse than national rates in 18 states, mostly in the eastern half of the country, plus Montana, Nebraska, and Puerto Rico. These rates were rising in 2 states (Louisiana, Texas) and falling in one (Hawaii). Rates of urinary system cancers (IR = 8.2) were worse than national rates in 17 contiguous states, from New Mexico to Pennsylvania. Rates were rising in 2 states (New York, West Virginia) and falling in one (Pennsylvania).

The states with the highest overall and advanced-stage incidence rates of early-onset cancer for all cancer sites combined were Kentucky and West Virginia (Panel C), followed by 13 others that also had worse-than-national rates on both (Arkansas, Connecticut, Florida, Georgia, Iowa, Louisiana, Maine, Missouri, New Jersey, New York, North Carolina, Ohio, and Pennsylvania).

This study provides the first analysis of age-adjusted rates of early-onset cancer based on state-level population and case counts. Geographic patterns in early-onset cancer indicate possible similarities that could relate to demographic, socioeconomic, behavioral, or environmental risks. By uncovering geospatial patterns across various cancer sites, this analysis informs hypotheses about factors driving early-onset cancer. Because important local patterns may be masked in a state-level analysis, future analyses may consider a more granular geographic unit such as county or zip code. However, focusing prevention efforts on the highest-incidence states for the most prevalent sites may reduce the rate of early-onset cancer nationally.

The authors received no external financial support for the research, authorship, or publication of this article. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. No copyrighted materials were used in this article.

Corresponding Author: Shannon M. Lynch, PhD, Division of Cancer Prevention and Control, Fox Chase Cancer Center, 333 Cottman Ave, 4th Fl, Young Pavilion, Philadelphia, PA 19111 ( [email protected] ).

Author Affiliations: 1 Fox Chase Cancer Center, Division of Cancer Prevention and Control, Philadelphia, Pennsylvania. 2 Temple University, Geography and Urban Studies, Philadelphia, Pennsylvania. 3 Christiana Care Health System, Helen F. Graham Cancer Institute, Wilmington, Delaware. 4 Temple University School of Medicine, Center for Biostatistics and Epidemiology, Philadelphia, Pennsylvania.

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