Sanford Health Diversity, Equity and Inclusion Style Guide


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Please reference this guide often. Terms change and evolve and are continuously updated to be current and relevant.

To ensure inclusivity, we at Sanford Health are careful and thoughtful when choosing language and terms in our written and spoken communications to project a sense of sincerity, comfort and trust. The Sanford Health Diversity, Equity and Inclusion Style Guide is a tool to ensure we are choosing the most current term and phrase preferences.

American Indian, indigenous American, Native American – terminology specific to regions served by Sanford Health

Sanford Health adheres to the Associated Press Stylebook with some exceptions. However, since it is a national reference guide that doesn’t represent the specific regions that Sanford Health serves, locally-focused guidelines are not listed.

Be sure to inquire about your subjects’ regional and personal preferences to describe themselves and their tribal communities. The term Native American refers to hundreds of tribes and nations that were present before the arrival of Europeans, each with its own identity, history, culture and language. Always attempt to obtain more precise terminology.

For national information, see American Indians, Native Americans

Based on the Associated Press Stylebook

Reporting and writing about issues involving race calls for thoughtful consideration, precise language, and discussions with others of diverse backgrounds whenever possible about how to frame coverage or what language is most appropriate, accurate and fair.

Avoid broad generalizations and labels; race and ethnicity are one part of a person’s identity. Identifying people by race and reporting on actions that have to do with race often go beyond simple style questions, challenging journalists to think broadly about racial issues before having to make decisions on specific situations and stories.

In all coverage — not just race-related coverage — strive to accurately represent the world, or a particular community, and its diversity through the people you quote and depict in all formats. Omissions and lack of inclusion can render people invisible.

Be aware that some words and phrases that seem innocuous to one group can carry negative connotations, even be seen as slurs, to another. As with all news coverage, be sensitive to your varied audiences and their different perceptions of language and the larger world.

For instance, many people see thug as code for a racial slur; Black boy has a loaded history and should be avoided in referring to Black males of any age; unarmed Black man could be seen as assuming the default is for Black men to be armed.

Do not write in a way that assumes white is default. Not: The officer is accused of choking Owens, who is Black. Instead: The white officer is accused of choking Owens, who is Black.

Some guidelines:


Consider carefully when deciding whether to identify people by race. Often, it is an irrelevant factor and drawing unnecessary attention to someone’s race or ethnicity can be interpreted as bigotry. There are, however, occasions when race is pertinent:

In stories that involve significant, groundbreaking or historic events, such as being elected U.S. president, being named to the U.S. Supreme Court or other notable occurrences. Barack Obama was the first Black U.S. president. Sonia Sotomayor is the first Hispanic justice of the U.S. Supreme Court. Jeremy Lin is the first American-born NBA player of Chinese or Taiwanese descent.

In cases where suspects or missing persons are being sought, and the descriptions provided are detailed and not solely racial. Any racial reference should be removed when the individual is apprehended or found.

When reporting a demonstration, disturbance or other conflict involving race (including verbal conflicts), or issues like civil rights.

In other situations when race is an issue, use news judgment. Include racial or ethnic details only when they are clearly relevant and that relevance is explicit in the story.

Do not use a derogatory term except in rare circumstances — when it is crucial to the story or the understanding of a news event. Flag the contents in an editor’s note.

See obscenities, profanities, vulgarities.

racist, racism 

Racism is a doctrine asserting racial differences in character, intelligence, etc., and the superiority of one race over another, or racial discrimination or feelings of hatred or bigotry toward people of another race.

Deciding whether a specific statement, action, policy, etc., should be termed racist, or characterized in a different way, often is not clear-cut. Such decisions should include discussion with colleagues and/or others from diverse backgrounds and perspectives. At the AP, that conversation should also include senior managers.

Begin by assessing the facts: Does the statement or action meet the definition of racism? That assessment need not involve examining the motivation of the person who spoke or acted, which is a separate issue that may not be related to how the statement or action itself can be characterized.

In general, avoid using racist or any other label as a noun for a person; it’s far harder to match the complexity of a person to a definition or label than it is a statement or action. Instead, be specific in describing the person’s words or actions. Again, discuss with senior managers, colleagues and others from diverse backgrounds when the description may be appropriate for a person.

Cases in which the term racist might be used include identifying as racist support for avowed racist organizations, statements calling another race or ethnic group inferior, or employing negative stereotypes for different racial or ethnic groups. The video shows the candidate wearing blackface and making racist statements including, “You’re not white so you can’t be right.”

If racist is not the appropriate term, give careful thought to how best to describe the situation. Depending on the specifics of what was said or done, alternatives may include xenophobic, bigoted, biased, nativist, racially divisive, or in some cases, simply racial.

Avoid racially charged, racially motivated or racially tinged, euphemisms which convey little meaning.

Always provide specifics to describe the words or actions in question; using a broad and descriptive term such as racist requires supporting details and context. In doing so, avoid repeating derogatory terms except in the rare circumstances when it is crucial to the story or the understanding of a news event.

Provide context and historical perspective when appropriate to help convey the impact or implications of the words or actions. For example, a story about a candidate wearing blackface should include context about performers in the 1800s who darkened their faces to create bigoted caricatures of Black people. A story about comments that certain members of Congress should “go back” to their “broken and crime-infested” countries should include the context that “go back to where you came from” is a racist insult aimed for decades at immigrants and African Americans in the United States. See racially charged, racially motivated, racially tinged, and other entries in race-related coverage.

racially charged, racially motivated, racially tinged 

Avoid using these vague phrases to describe situations in which race is or is alleged or perceived to be a central issue, but that do not meet the definition of racist or racism. As alternatives, terms including xenophobic, bigoted, biased, nativist or racially divisive may be clearer, depending on the context. In some cases, the term racial is appropriate: racial arguments, racial tensions, racial injustice. Always give specifics about what was done, said or alleged.

Do not use euphemisms for racist or racism when the latter terms are truly applicable. Mississippi has a history of racist lynchings, not a history of racially motivated lynchings. He is charged in the racist massacre of nine people at a Black church, not the racially motivated massacre of nine people at a Black church. See racist, racism, and other entries in race-related coverage.


Asian Americans and Pacific Islanders. The acronym is widely used by people within these communities but is not as well known outside of them. Spell out the full term; use AAPI only in direct quotations and explain the term.


The term for the people and culture of Afghanistan. Afghani is the Afghan unit of currency.

anti-Asian sentiment 

Avoid this euphemism, which conveys little meaning. Alternatives may include anti-Asian bias, anti-Asian harassment, anti-Asian comments, anti-Asian racism or anti-Asian violence, depending on the situation. Be specific and give details about what happened or what someone says happened.

Asian American 

No hyphen (a change in 2019 for this and other dual heritage terms). Acceptable for an American of Asian descent. When possible, refer to a person’s country of origin or follow the person’s preference. For example: Filipino American or Indian American. Do not describe Pacific Islanders as Asian AmericansAsians or of Asian descent. Avoid using Asian as shorthand for Asian American when possible.

Orient, Oriental

Do not use when referring to East Asian nations and their peoples. Asian is the acceptable term for an inhabitant of those regions.

Pacific Islander 

Used to describe the Indigenous people of the Pacific Islands, including but not limited to Hawaii, Guam and Samoa. Should be used for people who are ethnically Pacific Islander, not for those who happen to live in Pacific Islands. Be specific about which communities you are referring to whenever possible. Do not use Asian Pacific Islander unless referring to Pacific Islanders of Asian descent. Do not describe Pacific Islanders as Asian AmericansAsians or of Asian descent.

Stop AAPI Hate 

A movement that was launched in March 2020 in response to a rise in anti-Asian bias and racism stemming from the coronavirus pandemic that originated in China. The Asian Pacific Planning and Policy Council, Chinese for Affirmative Action and the Asian American Studies Department of San Francisco State University created a reporting center under the name Stop AAPI Hate to track and respond to cases of hate, violence, harassment and discrimination against Asian Americans and Pacific Islanders in the United States. Some prefer to use the hashtag #StopAsianHate.

Black(s), white(s) (n.) 

Do not use either term as a singular noun. For plurals, phrasing such as Black people, white people, Black teachers, white students is often preferable when clearly relevant. White officers account for 64% of the police force, Black officers 21% and Latino officers 15%. The gunman targeted Black churchgoers. The plural nouns Blacks and whites are generally acceptable when clearly relevant and needed for reasons of space or sentence construction. He helped integrate dance halls among Blacks, whites, Latinos and Asian Americans. Black and white are acceptable as adjectives when relevant.

Black (adj.) 

Use the capitalized term as an adjective in a racial, ethnic or cultural sense: Black people, Black culture, Black literature, Black studies, Black colleges.

African American is also acceptable for those in the U.S. The terms are not necessarily interchangeable. Americans of Caribbean heritage, for example, generally refer to themselves as Caribbean American. Follow an individual’s preference if known, and be specific when possible and relevant. Minneapolis has a large Somali American population because of refugee resettlement. The author is Senegalese American.

Use of the capitalized Black recognizes that language has evolved, along with the common understanding that especially in the United States, the term reflects a shared identity and culture rather than a skin color alone.

Also use Black in racial, ethnic and cultural differences outside the U.S. to avoid equating a person with a skin color.

Use Negro or colored only in names of organizations or in rare quotations when essential.

See obscenities, profanities, vulgarities.

boy, girl 

Generally acceptable to describe males or females younger than 18. While it is always inaccurate to call people under 18 men or women and people 18 and older boys or girls, be aware of nuances and unintentional implications. Referring to Black males of any age and in any context as boys, for instance, can be perceived as demeaning and call to mind historical language used by some to address Black men. Be specific about ages if possible, or refer to Black youths, child, teen or similar.

dual heritage 

No hyphen (a change in 2019 from previous style) for terms such as African American, Asian American and Filipino American, used when relevant to refer to an American person’s heritage. The terms are less common when used to describe non-Americans, but may be used when relevant: Turkish German for a German of Turkish descent.

African American 

No hyphen (a change in 2019 for this and other dual heritage terms). Acceptable for an American Black person of African descent. The terms are not necessarily interchangeable. Americans of Caribbean heritage, for example, generally refer to themselves as Caribbean American. Follow a person’s preference.

brown (adj.) 

Avoid this broad and imprecise term in racial, ethnic or cultural references unless as part of a direct quotation. Interpretations of what the term includes vary widely.

COMPOUND PROPER NOUNS AND ADJECTIVES: No hyphen in designating dual heritage: Italian American, Mexican American (a change in 2019).


Avoid as a synonym for white, unless in a quotation.

people of color, racial minority 

The terms people of color and racial minority/minorities are generally acceptable terms to describe people of races other than white in the United States. Avoid using POC. When talking about just one group, be specific: Chinese Americans or members of the Seminole Indian Tribe of Florida, for example. Be mindful that some Native Americans say the terms people of color and racial minority fall short by not encompassing their sovereign status. Avoid referring to an individual as a minority unless in a quotation.

biracial, multiracial 

Acceptable, when clearly relevant, to describe people with more than one racial heritage. Usually more useful when describing large, diverse groups of people than individuals. Avoid mixed-race, which can carry negative connotations, unless a story subject prefers the term. Be specific if possible, and then use biracial for people of two heritages or multiracial for those of two or more on subsequent references if needed. Examples: She has an African American father and a white mother instead of She is biracial. But: The study of biracial people showed a split in support along gender lines. Multiracial can encompass people of any combination of races.


The term should not be used to describe people who have adopted a different racial identity.


A term that Mexican Americans in the U.S. Southwest sometimes use to describe their heritage. Use only if it is a person’s preference.

Latino, Latina 

Latino is often the preferred noun or adjective for a person from, or whose ancestors were from, a Spanish-speaking land or culture or from Latin America. Latina is the feminine form. Some prefer the recently coined gender-neutral term Latinx, which should be confined to quotations, names of organizations or descriptions of individuals who request it and should be accompanied by a short explanation. Hernandez prefers the gender-neutral term Latinx. For groups of females, use the plural Latinas; for groups of males or of mixed gender, use the plural LatinosHispanics is also generally acceptable for those in the U.S. Use a more specific identification when possible, such as Cuban, Puerto Rican, Brazilian or Mexican American.


A person from — or whose ancestors were from — a Spanish-speaking land or culture. Latino, Latina or Latinx are sometimes preferred. Follow the person’s preference. Use a more specific identification when possible, such as Cuban, Puerto Rican or Mexican American.

American Indians, Native Americans 

Also see American Indian, Indigenous American, Native American – Terminology Specific To Regions Served By Sanford Health

Both are acceptable terms in general references for those in the U.S. when referring to two or more people of different tribal affiliations. For individuals, use the name of the tribe; if that information is not immediately available, try to obtain it. He is a Navajo commissioner. She is a member of the Nisqually Indian Tribe. He is a citizen of the Cherokee Nation of Oklahoma. Some tribes and tribal nations use member; others use citizen. If in doubt, use citizen. Avoid words such as wampum, warpath, powwow, teepee, brave, squaw, etc., which can be disparaging and offensive. In Alaska, the Indigenous groups are collectively known as Alaska Natives.

First Nation is the preferred term for native tribes in Canada.

Indian is used to describe the peoples and cultures of the South Asian nation of India. Do not use the term as a shorthand for American Indians.


Refers to a sovereign political entity, communities sharing a common ancestry, culture or language, and a social group of linked families who may be part of an ethnic group. Capitalize the word tribe when part of a formal name of sovereign political entities, or communities sharing a common ancestry, culture or language. Identify tribes by the political identity specified by the tribe, nation or community: the Apache Tribe of Oklahoma, the Cherokee Nation. The term ethnic group is preferred when referring to ethnicity or ethnic violence.

Indigenous (adj.)

Capitalize this term used to refer to original inhabitants of a place. Aboriginal leaders welcomed a new era of Indigenous relations in Australia. Bolivia’s Indigenous peoples represent some 62% of the population.


An outdated term referring to aboriginal people in Australia. It is considered offensive by some and should be avoided.

ghetto, ghettos 

Do not use indiscriminately as a synonym for the sections of cities inhabited by minorities or poor people. Ghetto has a connotation that government decree has forced people to live in a certain area.

In most cases, district or neighborhood is the more accurate word.

reverse discrimination 

A term sometimes used to describe bias or perceived bias against majority groups. Limit its use to quotes; generally just discrimination will suffice to describe such allegations or practices.


Based on the Associated Press Stylebook

The terms disabilities and disabled include a broad range of physical, psychological, developmental and intellectual conditions both visible and invisible.

Perceptions of disabilities vary widely. Language about disabilities is both wide-ranging and evolving. Disabled people are not monolithic. They use diverse terms to describe themselves. Many, for example, use the term people with disabilities. Both people with disabilities and disabled people are acceptable terms, but try to determine the preference of a person or group.

Use care and precision, considering the impact of specific words and the terms used by the people you are writing about.

When possible, ask people how they want to be described. Be mindful that the question of identity-first vs. person-first language is vital for many.

The terms disabilities and disabled are generally embraced by disabled people and are acceptable when relevant. Do not use euphemisms such as handi-capabledifferently abled or physically challenged, other than in direct quotations or in explaining how an individual describes themself. Do not use handicap for a disability or handicapped for a person.

Limit use of the term disorder other than in the names of specific conditions, as well as words such as impairment, abnormality and special.

In general, refer to a disability only if relevant to the story, and if a medical diagnosis has been made or the person uses the term. If relatives or others use the term, ask how they know, then consider carefully whether to include the information.

Avoid writing that implies ableism: the belief that abilities of people who aren’t disabled are superior. Ableism is a concept similar to racism, sexism and ageism in that it includes stereotypes, generalizations, and demeaning views and language. It is a form of discrimination or prejudice against people with disabilities.

Don’t limit coverage of disabled people to coverage of disabilities. People with disabilities are experts in as many fields as nondisabled people are. Include their voices and their images in your regular coverage of any topic.

Avoid “inspiration porn” — stories or photos meaning to portray something positive or uplifting, with the unintended implication that a disability is negative and that disabled people are objects of pity or wonder.

If a disability is pertinent to the story, provide brief details explaining that relevance. For example: Merritt, who is blind and walks with the help of a guide dog, said she is pleased with the city’s walkway improvements. Feldman said the airline kicked her family off a plane after her 3-year-old refused to wear a mask. She said the mask refusal relates to her son’s autism. But not: Zhang, who has paraplegia, is a fan of the Philadelphia Phillies.

Some people use person-first language in describing themselves: a man with Down syndrome or a woman with schizophrenia.

Others view their disability as central to their identity and use identity-first language, such as an autistic woman or deaf students. Autistic people and deaf people often — but not always — use identity-first language.

When preferences of an individual or group can’t be determined, try to use a mix of person-first and identity-first language.

Avoid using disability-related words lightly or in unrelated situations, and avoid direct quotations using such wording unless essential to the story. Some examples: calling a person or an idea demented, psychotic, lame, blind, catatonic, moronic, retarded, on the spectrum, etc.; saying the warning falls on deaf ears or he turned a blind eye or the awards show is schizophrenic. As in all writing, consider word choice carefully. Words that seem innocuous to some people can have specific and deeply personal or offensive meanings to others. Alternative phrasing is almost always possible.

Do not write in a way that implies a person’s condition or disability is related to a crime or other wrongdoing unless that link has been firmly established by experts in the specific case and is explained in the story.

Other language or constructions not to use:

  • Words that suggest pity, such as afflicted with, battling or suffers from any disability or illness, or that a person overcame her disability. Instead: has cancer, being treated for ADHD. Bear in mind that disabilities can be a combination of both challenges and assets. Generally avoid living with constructions unless a person uses that for themself.
  • Cliches such as inspiring and brave.
  • Dehumanizing mass terms such as the disabled, the blind, the mentally ill, etc. As with all writing, avoid broad generalizations, labels and stereotypes.
  • Terms such as normal or typical for someone who does not have a disability. Instead: People without a disability, nondisabled. Use care in deciding whether to use the term able-bodied, although the term has specific meaning in contexts such as some government reports and is appropriate in such references.

Negative or condescending language such as wheelchair-bound or Alzheimer’s victim. Instead use accurate, neutral language such as uses a wheelchair or a person with Alzheimer’s disease.

gender, sex and sexual orientation

Pronouns format for Sanford Health email signatures, business cards, etc.

  • (They/Them)
  • (She/ Her/ Hers)
  • (He/Him/His)
    • Capitalize, use slashes instead of commas and enclose in parentheses. Whether to list pronouns, how many and which to list is optional, but the format should be consistent.

Based on the Associated Press Stylebook

Gender refers to internal and social identity and often corresponds with but is not synonymous with sex. Experts say gender is a spectrum, not a binary structure consisting of only males and females, that can vary by society and change over time.

Sex refers to biological characteristics, such as chromosomes, hormones and reproductive anatomy, which can also vary or change in understanding over time, or be medically and legally altered.

Since not all people fall under one of two categories for sex or gender — as in the cases of nonbinary and intersex people — avoid references to both, either or opposite sexes or genders.

Relatedly, not all people use gendered pronouns such as his or hers. Such pronouns are often an example of gender expression, but they do not always align with typical or stereotypical expectations of gender and are not certain indicators of someone’s gender identity.

Language around gender is ever-evolving. Newsrooms and organizations outside the AP may need to make decisions, based on timing, necessity and audience, on terms that differ from or are not covered by the AP’s specific recommendations.

More details and key terms:

gender A social construct encompassing a person’s behaviors, intrinsic identity and appearance. Gender often corresponds with but is not synonymous with sex. A person’s sex and gender are usually assigned at birth by parents or attendants and can turn out to be inaccurate. Experts say gender is a spectrum, not a binary structure consisting of only men and women, that can vary among societies and can change over time. See gender expressiongender identitysextransgender.

gender identity A person’s sense of feeling male, female, neither or some combination of both. Often just gender will suffice: She spent a lot of time explaining her gender may work just as well as She spent a lot of time explaining her gender identity. Examples of gender identities include man or boywoman or girlnonbinarybigenderagendergender-fluidgenderqueer; and combinations of identities, such as nonbinary woman. See gendergender expressionLGBTQ+nonbinarypronounstransgender.

gender expression How people outwardly convey their gender, intentionally or not, such as through fashion choices, mannerisms or pronouns. Gender stereotypes can lead others to incorrectly perceive someone’s gender or sexual orientation. See gender identitygender-nonconformingpronouns.

gender-fluid, gender-fluidity Refers to a gender identity or expression that changes over time. Include the hyphen.

gender-nonconforming (adj.) Gender-nonconforming is acceptable in broad references to describe people whose identities or expressions do not follow gender norms. The term gender-expansive is similar but carries a connotation of flexibility and exploration of one’s gender identity. Both terms may include but are not synonymous with transgender. Avoid dated terminology such as gender-bending or tomboy.

genderqueer (adj.) An identity describing people whose gender expression does not follow norms; use only if the person or group identifies as such. Not synonymous with nonbinary.

nonbinary (adj.) Describes people who don’t identify as strictly male or female; can include agender (having no gender), gender-fluid (an identity that fluctuates) or a combination of male and female. Not synonymous with transgender, though some nonbinary people are also transgender. See gender expressiongender identitypronouns.

pronouns See the separate pronouns entry.

transgender (adj.) Describes people whose gender does not match the one usually associated with the sex they were assigned at birth. Identify people as transgender only when relevant, and use the name by which they live publicly. Unless it is central to the story, avoid mention of a person’s gender transition or gender-affirmation surgery in news coverage, which can be intrusive and insensitive.

Avoid references to a transgender person being born a boy or girl, or phrasing like birth genderSex (or genderassigned at birth is the accurate terminology. The shorthand trans is acceptable on second reference and in headlines.

A person who is assigned female at birth and transitions to align with their identity as a boy or man is a transgender boy or transgender man, and a person who is assigned male at birth and transitions to align with their identity as a girl or woman is a transgender girl or woman. Avoid the one-word compounds transman and transwoman. Instead, when relevant, say transgender man or transgender woman. In subsequent references, trans man or trans woman are acceptable.

Do not use as a noun, such as referring to someone as a transgender, or use the term transgendered. Do not use the terms transgendered or transgenderism.

Not synonymous with terms like cross-dresser or drag queen. Do not use the outdated term transsexual unless a source specifically asks to be identified as such.

Avoid derogatory terms such as tranny. Follow guidelines for obscenities, profanities, vulgarities as appropriate.

Refer to a transgender person’s previous name, also called a deadname, only in the rare instance it is relevant to the story. See biologicaldeadnaminggender-affirming caretransition, gender transition.

cisgender Describes people whose gender identity matches the sex they were assigned at birth; that is, not transgender. Explain if necessary. Do not use terms like normal to describe people who are not transgender. Not synonymous with heterosexual, which refers to sexual orientation. See transgender.

deadnaming The practice, widely considered insensitive, offensive or damaging, of referring to transgender people who have changed their name by the name they used before their transition. Use a person’s previous name or pre-transition image only if required to understand the news or if requested by the person.

The issue of deadnaming often arises when public figures announce a gender transition. In these and other cases, generally use the deadname only once and not in the opening paragraph, with future coverage using only the new name.

Deadnaming a transgender person, even posthumously in obituaries or other coverage, is often considered disrespectful to the deceased, their survivors and any transgender people.

In the AP, use of a transgender person’s previous name must be approved by managers.

When naming suspects or victims in stories about crimes or accidents, be cognizant that authorities or family members may be ignorant of or be disregarding the person’s wishes; when possible, take into account information given by the person or by current friends or others who may have better information about how the person lived and identified. See transgender.

transition (n., v.), gender transition The legal, medical or social processes some transgender or nonbinary people undergo to match their gender identity. Examples can include a formal or informal change to names or pronouns, makeup and hairstyles, hormone therapy, or gender-affirmation surgery. Mention or describe it only when relevant. See gender-affirming caretransgender.

gender dysphoria Use this term, not gender identity disorder, for the distress felt when someone’s gender expression does not match their gender identity. It is also a medical diagnosis often required for people to undergo gender-affirmation procedures.

gender-affirming care Refers to a swath of mental and medical treatments (such as counseling, hormones or surgery) that help bring a person’s gender expression (such as voice, appearance or anatomy) in line with their gender identity. It can be but is not necessarily part of a gender transition. Such care is not limited to transgender people; it can also serve cisgender, nonbinary or intersex people.

If surgery is involved, gender-affirming or gender-affirmation surgery. Do not use abbreviations such as GAS, GCS or SRS unless in quotations, and introduce the full term before the quote. Do not use the outdated term sex change, and avoid describing someone as pre-op or post-op.

Gender-affirming care is the phrasing used by leading medical groups, including the American Medical Association and the American Academy of Pediatrics. Other common phrasing, such as gender-confirming care and gender-confirmation or sex-reassignment surgery, are acceptable in quotations and in proper names. Phrasing like transgender health care and gender-transition surgery is acceptable when the context is confined to transgender people or a gender transition, respectively, but gender-affirming care is best in broader references or when the scope or context is unclear.

Refer to a person’s gender-affirming surgery only when relevant. See transition, gender transition, gender expression, gender identity.

transsexual Some people who have undergone gender-affirmation procedures refer to themselves as transsexual; use the term only if a person requests it. See gender-affirming care.

biological A word often best confined to medical or scientific contexts, especially in stories or passages about gender. While sex is a biological feature, terms like biological male, man, female or woman are sometimes used by opponents of transgender rights to portray sex as more simplistic than scientists assert, and to downplay the significance of gender and how it differs from sex.

hormones Avoid references to male or female hormones. All humans have varying levels of sex hormones, including testosterone and estrogen. Hormone replacement therapy may be an element of a person’s gender transition. See transition, gender transition.

cross-dresser Use this term instead of the outdated transvestite for someone who wears clothing associated with a different gender, and only when the subject identifies as such. Not synonymous with drag performer or transgender.

drag performer, drag queen, drag king Entertainers who dress and act as a different gender. Drag queens act as women; drag kings act as men. Male impersonator and female impersonator are also acceptable. Not synonymous with cross-dresser or transgender.

sex Refers to biological and physiological characteristics, including but not limited to chromosomes, hormones and reproductive organs. A person’s sex is usually assigned at birth by parents or attendants, sometimes inaccurately. Sex often corresponds with but is not synonymous with gender, which is a social construct. See genderhormonesbiological.

female, male In general, female and male are adjectives that can describe people of any age and are used only rarely as nouns, such as for a range of ages or an unknown age. The study included males ages 10-21. She is the first female governor of North Carolina.

Woman, women, man and men are usually reserved for use as a noun to describe adults, while girl, girls, boy and boys are typically used as a noun for people under age 18.

Be aware of nuances and pitfalls in the use of female and woman/women.

Since female primarily describes sex, not gender, some people object to its use as a descriptor for women because it can be seen as emphasizing biology and reproductive capacity over gender identity. It can also sometimes carry misogynistic tones that may vary in severity by race, class and other factors.

For this reason, woman or women is increasingly common as an adjective. But its use as such can often be awkward, especially if the words man or men would not be used adjectivally in a parallel sense.

For instance: He is the only man construction worker on the otherwise all-woman crew is awkward, and He is the only male construction worker on the all otherwise all-woman crew is not parallel. Options for being both sensitive and eloquent include He is the only man on the otherwise all-woman construction crew. See boy, girlgender-neutral language.

intersex Describes people born with genitalia, chromosomes or reproductive organs that don’t fit typical definitions for males or females. Do not use the outdated term hermaphrodite. Do not conflate with transgender or nonbinary.

sexual orientation Not sexual preference. Examples include lesbian (women attracted to women), gay (men attracted to men), bisexual (attraction to men and women), pansexual (attraction regardless of gender), asexual (people who don’t experience sexual attraction), and straight or heterosexual (women attracted to men, and vice versa). Mention a person’s sexual orientation only when relevant to the subject matter, and do so only if the information is verified.

Avoid references to a gay or alternative lifestyle. Avoid homosexual to describe people, though homosexuality is acceptable as a noun for the concept of same-sex attraction. Gays is acceptable as a plural noun when necessary, but use the singular gay only as an adjective, not as a noun. Lesbian is acceptable as an adjective or as a noun in singular or plural form.

Avoid salacious terminology and unnecessary modifiers in phrasing like gay lovers or lesbian kiss; instead use neutral terms like couple or kiss.

Transgender is not a sexual orientation. Like anyone, transgender people can have any sexual orientation. See asexualbisexualLGBTQ+.

LGBTQ+ (adj.) Acceptable in all references for lesbian, gay, bisexual, transgender, and queer and/or questioning, plus other sexual and gender minorities. Fewer or additional letters can be used to be more inclusive or in quotations and names of organizations and events, such as LGBT or LGBTQIAI stands for intersex, and A typically stands for asexual (a person who doesn’t experience sexual attraction). Use of LGBTQ+ is best used as a collective adjective: Walters joined the LGBTQ+ business association. Avoid using LGBTQ+ to describe individuals, and don’t default to LGBTQ+ if discussing a more specific population: a bisexual advocacy group, a transgender health program. Follow guidelines for obscenities, profanities, vulgarities as appropriate. See sexual orientation; gender identity.

queer Many LGBTQ+ people now use the word queer as a point of empowerment to refer to a sexual orientation or gender identity.

The term sometimes is used as a synonym for LGBTQ+. However, because of its origins as a slur, queer is not universally accepted among LGBTQ+ people, and its use tends to be more prevalent among younger generations. Use caution when it isn’t being used to describe the way an individual identifies, in the names of organizations or in a direct quote. When it is meant as a slur, follow guidelines for obscenities, profanities, vulgarities. See LGBTQ+.

asexual Describes people who don’t experience sexual attraction, though they may feel other types of attraction, such as romantic or aesthetic. Not synonymous with and does not assume celibacy. A person’s asexuality can be constant or change over time. See sexual orientation.

bisexual (n. and adj.) Describes people attracted to men and women. The shortened form bi is acceptable in quotations. See sexual orientation.

conversion therapy The scientifically discredited practice of using therapy to “convert” LGBTQ+ people to heterosexuality or traditional gender expectations. Either refer to it as so-called conversion therapy or put quotation marks around it. Do not do both. Gay conversion therapy should take no hyphen. Always include the disclaimer that it is discredited. See so called, so-called.

homophobia, homophobic Acceptable in broad references or in quotations to the concept of fear or hatred of gays, lesbians and bisexuals. The governor denounced homophobia. In individual cases, be specific about observable actions; avoid descriptions or language that assume motives. The leaflets contained an anti-gay slur. The voters opposed same-sex marriage. Related terms include biphobia (fear or hatred of bisexuals) and transphobia (fear or hatred of transgender people).

openly, out The terms out and openly can imply that to identify as LGBTQ+ is inherently shameful, so use them only when relevant: Xiong is the group’s first openly gay president (which would allow for the possibility that previous presidents were gay but not out) or Xiong, who came out at age 29, wishes he had done so sooner.

Do not use terms like avowed or admitted.

Don’t assume that because news figures address their sexual orientation or gender transition publicly, it qualifies as coming out; public figures may consider themselves out even if they haven’t previously addressed their identity or orientation publicly.

Outing or outed is usually used when someone’s identity or orientation is revealed against their knowledge or will.

same-sex marriage The preferred term over gay marriage, because it is more inclusive and because the laws generally don’t address sexual orientation. Where legal, same-sex marriages do not differ from other marriages, so the term should be used only when relevant and needed to distinguish from marriages of other couples.

sexual identity People’s awareness of themselves in a sexual sense. It incorporates a person’s sex, gender identity, gender expression and sexual orientation. See SOGI.

SOGI Increasingly popular shorthand for the concept of sexual orientation and gender identity. Avoid using the acronym unless necessary, as in a quote or name of an organization, and explain the term if used. See sexual identity.

homeless, homelessness

Based on the Associated Press Stylebook

Homeless is generally acceptable as an adjective to describe people without a fixed residence. Avoid the dehumanizing collective noun the homeless, instead using constructions like homeless people, people without housing or people without homes. Mention that a person is homeless only when relevant. Do not stereotype homeless people as dirty, mentally ill, addicted to drugs or alcohol, reliant on charity, or criminals. Those conditions can often contribute to or be byproducts of homelessness, but many homeless people also hold jobs and are self-sufficient.

Homeless shelter is an acceptable term for a building that provides free or very inexpensive but temporary indoor refuge for people without homes, generally run by a government or charity. Do not use flophouse.

Government agencies do not always agree on what legally constitutes homelessness, but the term generally refers to people staying in shelters or on the street.

Avoid disparaging terminology such as derelict, bum, beggar, tramp and hobo. Terms like couch surfing (staying temporarily in various households) or transient (someone who moves from city to city but is not necessarily homeless) can be useful to describe specific situations. Avoid vagrant.

migrant is someone who moves from place to place for temporary work or economic advantage and is usually not considered homeless.

Indigent describes someone who is very poor and is not synonymous with homeless.

mental illness 

Behavioral and mental health terms specific to Sanford Health

Always ask Sanford Health providers and professionals for their preferred terms.

Based on the Associated Press Stylebook

Do not describe an individual as having a mental illness unless it is clearly pertinent to a story and the diagnosis is properly sourced.

When used, identify the source for the diagnosis. Seek firsthand knowledge derived from a medical examination; ask how the source knows. Don’t rely on hearsay or speculate on a diagnosis. Specify the time frame for the diagnosis and ask about treatment. A person’s condition can change over time, so a diagnosis of mental illness might not apply anymore. Avoid anonymous sources. On-the-record sources may be family members, mental health professionals, medical authorities, law enforcement officials or court records.

Mental illness is a general term. Specific conditions are disorders and should be used whenever possible: He was diagnosed with schizophrenia, according to court documents. She was diagnosed with anorexia, according to her parents. He said he was treated for depression. Avoid wording such as he is a schizophrenic, she was anorexic or he is mentally ill.

Avoid descriptions that connote pity, such as afflicted with, suffers fromvictim of, battling and demons. Rather, he has obsessive-compulsive disorder.

Avoid terms such as the mentally ill. Instead: people with mental illnesses.

Do not use derogatory terms, such as insane, crazy/crazed, nuts or deranged, unless they are part of a quotation that is essential to the story.

Avoid using mental health terms to describe unrelated issues. Don’t say that an awards show, for example, was schizophrenic.

Do not assume that mental illness is a factor in a violent crime, and avoid unsubstantiated statements by witnesses or first responders attributing violence to mental illness.

Studies have shown that the vast majority of people with mental illnesses are not violent, and experts say most people who are violent do not have mental illnesses.

Nevertheless, a first responder often is quoted as saying, without direct knowledge, that a crime was committed by a person with a “history of mental illness.” If used, such comments must be attributed to law enforcement authorities, medical professionals, family members or others who have knowledge of the history and can authoritatively speak to its relevance. In the absence of definitive information, there should be a disclaimer that a link had yet to be established.

Double-check specific symptoms and diagnoses. Avoid interpreting behavior common to many people as symptoms of mental illness. Sadness, anger, exuberance and the occasional desire to be alone are normal emotions experienced by people who have mental illness as well as those who don’t.

When practical, let people with mental disorders talk about their own diagnoses.

Use the term mental or psychiatric hospital, not asylum.

Here is a link that can be used as a reference: