Writing Resource Guide
Version 1.0, Fall 2002 By Lucy Honig

Contents
Introduction Writing for the MPH: A W/Rite of Passage A message to BUSPH students Useful writing references for SPH students The writing process: some practical tips Common problems The Paramedic Method of editing Referencing: Styles of citation Citation of electronic sources A note about plagiarism Using direct quotations and paraphrases Boston University writing resources 6 9 10 15 21 25 27 29 31 2 3

INTRODUCTION
Public health professionals write all the time. Writing is an important tool for bringing about changes in policy, practice, public understanding, and health behaviors. You may create exciting and effective methods for addressing these matters, but if you cannot effectively communicate those ideas it is as if they do not exist at all. Furthermore, the process of writing helps to sharpen one’s ideas; good writing requires good thinking. Writing assignments in SPH courses have a variety of goals: to test your knowledge, to foster critical thinking, to enhance your research skills, to assess your communication skills and to prepare you for the myriad writing tasks you will encounter in your professional work. We expect you to carry out writing assignments with the thought and skill consistent with graduate level work, and we believe the improvement of writing skills is essential for the health of our profession. An MPH degree implies that you are equipped with the many competencies that are required to be a successful public health practitioner; effective writing is one of the essential competencies. Lucy Honig, Associate Professor of International Health, has been the writing specialist for that department for seven years, working with students on IH's required concentration paper and developing a departmental writing program. Professor Honig is also a prize-winning author (read her recent book entitled “Open Season” if you wish to see an example of superb writing). Although her direct work with students is restricted to IH concentrators and those registered in IH810 (Public Health Writing), she has compiled this valuable resource guide for the benefit of all students enrolled in the Boston University School of Public Health. She considers it a work in progress and welcomes suggestions for future editions. I hope you will take the time to thoroughly review this guide, and I suggest you keep it handy so that you may refer to it as you tackle your writing assignments. Leonard Glantz Associate Dean for Academic Affairs

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Writing for the MPH: a W/Rite of Passage
A message to BUSPH students A recent BUSPH graduate compared her experience writing an International Health paper with an arduous ocean voyage. It was the year of the film "Titanic" and images of shipwreck and disaster plagued her all along the way, but she finally reached the other shore, safe, satisfied, and ready to begin anew. With that metaphor in mind, I urge you to think of the writing that you do for the MPH degree as an engine that drives your crossing from public health student to public health professional. Many SPH course writing assignments assist you in this transition. You will likely be expected to write scholarly research papers, critical analyses, and argumentative essays, as well as reports on your field practice experience. Courses may also require that you write funding proposals, briefing papers, study designs, recommendations for interventions, policy analyses, program evaluations, needs assessments, budget justifications, media campaign kits--the possibilities are as diverse as the writing tasks you will encounter in professional practice, for which these assignments aim to prepare you. You may find that the skills that got you through your learner-centered undergraduate writing may no longer be sufficient for the purposes of an audience-centered graduate level writing assignment, in which we expect you to move from the sheltered stance of exploration and discovery to a riskier one of analysis, authority and advocacy. The transition from student to professional has a stylistic counterpart in the way you write: a move from writer-based prose to reader-based prose. Linda Flower, a specialist in teaching writing, comments on this distinction:
Good writers know how to transform writer-based prose (which works well for them) into reader-based prose (which works for their readers as well). Writing is inevitably a somewhat egocentric enterprise. We naturally tend to talk to ourselves when composing. As a result, we often need self-conscious strategies for trying to talk to our reader[1].

Those "self-conscious strategies" are at the core of the resources and recommendations presented in this guide. The process of writing is both distinct from and inseparable from the product. Many faculty emphasize both components and require that you submit two drafts of an assigned paper; others might make an early draft optional. These assignments allow time for revision, further probing, and rethinking--not just so you can tinker with words and style, but to give you the chance to make substantial changes in content and structure as your thinking develops and deepens. You may not figure out what you're really talking about until you complete one draft, and this discovery is a good use of the first run-through. But as you work on later drafts, you apply what you know, manipulate it critically, and pitch it to a certain audience, with the ultimate intent of getting someone to take action. And that intent has implications for structuring the argument, for providing enough detail to make your case, for using language that will be acceptable and accessible to your 3

audience, and for writing in as clear and powerful a style as possible. We don't expect you to accomplish all this in a first draft, but we do expect it in a final one! A first draft isn't wrong, it's just raw. Redrafting is a process of ripening. Like all ripening, it takes time. Even if an assignment doesn't require multiple drafts, as mature writers you should allow the time for them. The multiple-drafting process goes hand-in-hand with other elements of writing I most often emphasize. For example, when IH students begin their concentration papers, I ask at the outset that they work hard to clarify the problem they're focusing on (and why it's a problem) and their purpose in writing the paper, in terms of a particular audience. These may be especially difficult tasks if you're just starting out in the field. But the more clearly you can focus the problem and the purpose at the very start, the more firmly you will grasp the logical structuring of the paper to follow. I also harp a lot on "appropriate use of source material". I admit that I use this phrase as a euphemism for "avoiding plagiarism", which can be a very big, intimidating and complex issue. (A recent article referred to a finding of plagiarism as "the academic death sentence" [2]). But using sources appropriately means not only staying out of academic trouble; it has a larger and more positive purpose. It's how you seize control of the narrative, how you use your sources to establish your context and make your point rather than let the sources overwhelm and use you. The way you introduce and weave other voices of authority into your narrative will be a key component of your "pitch". I am a stickler for clear, jargon-free language and a simple, direct style even in presenting the most complex and nuanced material. I may often contradict the rules that your English teachers, professors or employers have set down in the past. For example, I tell students that it's acceptable to use the first person. I say that pompous, academic-sounding gobbledygook prevents you from getting your message across. I encourage students to express their opinions fearlessly when they can base them on strong evidence and reasoning. I insist that bad public health writing has bad public health consequences and urge you to edit yourselves ruthlessly. We all know how frustrating it is to read brambly thickets of prose, constantly getting stuck on thorny wording, with no light coming in and no discernible path. There's more than enough of that kind of writing out there, and we hope that one of your contributions to public health will be to shed light and clear a path. Whether you're already an accomplished professional but now struggling with a return to school after many years and maybe using English as a second language, or whether you're well-habituated to academic routines but just starting out in the field of public health, the rite of passage embodied in writing for the MPH will undoubtedly involve significant challenges. I hope that the resources and tips included in these pages help to make the passage a fruitful and satisfying one. Lucy Honig Writing Specialist for the Department of International Health

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References 1. Flower L. Problem-Solving Strategies for Writing. 4th Edition. Fort Worth: Harcourt Brace Jovanovich, Inc., 1993:224. 2. Howard RM, Plagiarisms, authorships, and the academic death penalty. College English 1995;57(7):788-806.

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Useful Writing References for SPH Students
Annotated by Lucy Honig, Writing Specialist, Department of International Health For your bookshelf…. Becker, H.S. 1986. Writing for Social Scientists: How to Start and Finish Your Thesis, Book or Article. Chicago: University of Chicago Press. $10 paperback. A very readable, practical, humorous and helpful book about the writing process, aimed at graduate students. Becker understands your pain, and he consoles and cajoles you into getting a handle on a process that necessarily takes time and effort but doesn't have to cause you suffering. Because public health straddles so many fields, I find this book much more appropriate for SPH students than guides to writing scientific or clinical papers O'Conner. P.T. 1999. Words Fail Me: What Everyone who Writes Should Know About Writing. $12, in most bookstores. Aimed at a general audience of people who have to write anything, this book is very funny and very useful in its approach to process, product, style and fundamentals. Read it through once, then make forays back for specifics as you're writing. Hacker, D. 1995. A Writer's Reference, 3rd Edition. New York: Bedford Books of St. Martin's Press. One of the most complete, user-friendly basic academic guides to composing and revising, structuring, grammar, punctuation, documenting sources and avoiding plagiarism, and with a bonus section on ESL trouble spots, this handbook is organized for quick reference on particular topics. O'Conner. P.T. 1996. Woe is I: The Grammarphobe's Guide to Better English in Plain English. New York: Riverhead Books. $12 in bookstores everywhere. You can't go wrong with Patricia T. O'Conner. This is another very funny and very useful guide. If your progressive, whole-language-minded English teachers never taught you the essentials of grammar in your American primary or secondary school, read this book! Booth, W.C., Colomb G.G, Williams J.M. 1995. The Craft of Research. Chicago: University of Chicago Press. $14 paperback, usually available in BU Barnes & Noble. Amazon.com says: "… the book shows how to choose a topic, plan and organize research, and how to draft and revise a report of findings such that a convincing solution is offered to a significant problem…. Recog-nizing that good research is rarely a simple, sequential procedure, but is instead a complex and intricate process, it discusses the subtle ways in which asking questions about your topic can influence how you draft your report, how a quality introduction can send you back to the library, and how the process of drafting can highlight flaws in your argument that need to be addressed. Clear and explicit, sophisticated and practical, The Craft of Research encourages high standards of scholarly achievement, and spells out the steps by which to get there." Swales, J.M. and Feak, C.B. 1994. Academic Writing for Graduate Students: A Course for Nonnative Speakers of English. Ann Arbor: University of Michigan Press. This no-nonsense textbook can be used as a tutorial by the serious international 6

student; its analysis of the conventions of the research paper is also valuable for nativespeakers of English. A sequel by the same authors, English in Today's Research World (2001), focuses on writing dissertations, with special attention to abstracts, literature reviews, poster presentations, and job applications.

If you're glued to the computer screen…
There are so many online writing references, courses and tutorials to turn these days, we are in danger of being overwhelmed. But if you have access to the internet, there is NO EXCUSE for ignorance. Surf around these sites to get a sense of what's out there and what you might not even know you don't know.

http://www.icmje.org/ Uniform Requirements For Articles Submitted to Biomedical Journals, from the International Committee of Medical Journal Editors: the best guide to the Vancouver system of citation; http://www.bartleby.com/141/ Strunk and White's entire Manual of Style, courtesy of Columbia University; and http://depts.washington.edu/hsic/journals/journals.shtml Guidelines for authors for hundreds of health service and medical journals. http://webster.commnet.edu/writing/writing.htm Ø A staggering array of links to on-line writing courses, grammar guides, technical writing guides, ESL references, dictionaries, and university writing tutorials. You might scroll through to see if something rings a particular bell for you. Here are my favorite links from this site: http://writecenter.cgu.edu/students/index.html From Claremont Graduate University's Writing Center, a good online source for advice on graduate-level research and writing, including long papers and projects, grant proposals, book critiques, annotated bibliographies, CVs, and much more. http://www.powa.org The Paradigm Online Writing Assistant: full of useful exercises on the whole range of composition, revising, and editing tasks as well of strategies for various types of arguments and essays. http://owl.english.purdue.edu/ 7

The Purdue Online Writing Lab offers exercises (under handouts and materials) and tutorials (go to workshops & presentations) on specific writing skills. You won't have access to Purdue's writing classes and one-on-one help, but there's plenty here for self-help.

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The writing process: some practical tips (in no particular order)
1. Get accustomed to writing many drafts and throwing things out. Use the first draft to find out what you think, and the second to begin making your ideas clear to an audience. 2. When you first sit down to write, start with whatever you can, wherever you have something to say. (You can move it later to where it actually belongs.) 3. Don't stop and grope for the best possible word. Use a word that's not very good or put in a cue to yourself to hold the place. You'll come back to it and find a better phrasing next time around; in the meantime, you won't lose your train of thought. 4. Leave yourself time to stop and take your mind off the subject: nap, walk, incubate. A lot of writing happens when you're not actually at the keyboard. 5. It's okay to use "I". Really. 6. It's okay to say what you really mean, directly and in plain English. It is not good for the public's health to use pretentious language in order to sound "classier" or more "academic" or more "professional". 7. It's okay to take a position--more often than not, your instructor will want you to. Just make sure you show how you got there. 8. Start every paper with a clear statement of the problem you're addressing and your purpose in addressing it, but don't expect to be able to write a good introduction until you finish at least one draft. 9. Be explicit: as you revise, show the connections you're making from one idea to another, one paragraph to another, one section of the paper to another. 10. Read your draft out loud and listen for awkward wordings, convoluted or incomplete sentences, abrupt interruptions of "flow," and other problems. If you hear yourself gasping for breath, something's wrong. 11. Never hand in your first attempt at writing a paper, even if your instructor asks you to submit more than one draft. The truly first version is for your eyes only; your second (or third) attempt is the first draft for anyone else to see. 12. If your instructor requests more than one draft, consider yourself lucky, and even luckier if s/he gives you feedback on the early draft and the opportunity to revise accordingly. 13. Leave enough time to accommodate this recursive process of writing, rethinking, revising, rethinking, revising, rethinking and rewriting. This is the normal way that mature writers write. You are not doing something wrong if you don't get it right on the first try, but you are doing something wrong if you expect to. 14. Proofread carefully for spelling, grammar, citations, and format. If your carelessness undermines your own credibility or annoys your reader/instructor, you have failed to make your argument, no matter how good your research, logic or style.

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COMMON PROBLEMS
Every so often, students ask me for tips about the most frequent problems I see in papers. Based on my observations over seven years of International Health concentration papers, here they are, along with suggestions for tackling them. The list is not complete, and neither are the remedies, but I hope these notes are helpful in writing any paper. 1. WHAT IS THIS PAPER ABOUT, ANYWAY? Your reader isn't motivated to read the paper because she's lost. After two pages, she still can't figure out what it's really about and where it's going. **Start the paper with a clear statement of the problem you are addressing and your purpose in writing the paper, keeping in mind the audience you're (ideally) aiming for. (There's time for background information and detail later.) Why are you writing about this issue? What is the position you expect to establish? How do you plan to do that? The reader needs to have a good idea from the very beginning (or at least by the end of the first page!) of why you think this topic is important and why the reader should also care about it. Don't assume the reader will figure this out as he/she goes along: state it explicitly.

2. THE OVERALL ORGANIZATION IS A MESS! You've done a tremendous amount of research and the paper is filled with detail. Everything you want to say is in there -- somewhere. But in the first draft the points you're trying to make are utterly lost, and the reader can't figure out how parts of the paper are connected . **Outlining can be most useful after you've written the first draft. Try constructing a new outline directly from the draft, identifying main section headings, then subissues, going through the paper paragraph by paragraph, sentence by sentence. Does each detail in each paragraph fit logically into the main topic of that paragraph? Do the main topics of each paragraph in a section fit logically into the overall theme of that section? Keep an eye out for details that don't fit, that should be moved elsewhere or don't belong at anywhere. OR.... **Put away your drafts and notes. Without looking at any of your material, quickly write a one-page summary, explaining what the paper is really trying to say, as if you were explaining it to a smart friend who's not in the health field, or as if you were asked to summarize it and teach the basics of it in only 5 minutes to a group of colleagues. Draw up a rough new outline on the basis of that summary, identifying the major issues. Does that outline correspond to the present structure of the paper? Would it be better to change the structure of the paper to correspond to this outline? Can you expand the outline so that major section headings are in complete sentences?

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*Outlining in complete sentences forces you to think about the sections of the paper in terms of whole ideas, not fragments. Once you can express the overall point of a section in a sentence, it will be easier to (1) link one section to another and (2) cluster your details and plug your sub-issues into the most appropriate section. **Give your reader cues to the structure of the paper. Clearly divide the paper into sections and related sub-sections, focusing on the paper's main issues and sub-issues, by using section headings and sub-headings, which are helpful guideposts (and can, of course, come directly from your outline). As you move from issue to issue, it's also helpful to add transitional sentences that tell the reader why you're making those moves. Remember -- Americans are insistent on explicitness: the burden is always on the writer to lead the reader through the paper , summing up every now and then where you've been and where you intend to go. In many other cultures, the writer trusts the reader to be intelligent and to figure out these connections for her/himself. But not here!

3. PARAGRAPHS, PLEASE! Paragraphs wander off from their topic into alien territory; or isolated sentences aren't combined into paragraphs; or there are no paragraphs, but page after page of text without a break. **Readers of academic English are addicted to paragraphing as a way to organize and separate ideas. If paragraphs don't conform to their expectations, readers tend to get lost. (If they get lost, they're less likely to accept your position.) The expectations include (1) familiar forms of paragraph organization, (2) the coherence of the ideas within the paragraph, and (3) the physical appearance of a paragraph. **Use topic sentences to introduce the main point of a paragraph, then make sure all the sentences in the paragraph relate to that point somehow. Think of a paragraph as a family, in which all the ideas are related in some ways. A nuclear family of closely related points may be easy to follow, but once you get into the extended family -- the second cousin from Madagascar or your sister's father-in-law's great aunt -- you need to introduce the newcomer and state the relationship, so everyone will get along. Just as it can be very exciting to meet a long-lost distant relative, it's good to bring together complex ideas that other people don't automatically associate -- that's called thinking. But don't leave it to the reader to make connections that exist, so far, only in your head. You, the writer, need to "spell it out" so that those new relationships and new ideas (which might be new health policies or interventions) can be established in other people's heads, too. (Now test this paragraph: are all the sentences related to the main idea?) **Paragraphing is also established by the physical demarcation on the page. You need to either indent the line when starting a new paragraph, or double the spacing between paragraphs (one or the other -- not both). Otherwise the reader does not get the signal 11

that a paragraph break exists and that something new is about to begin. And remember -- one sentence standing by itself is not a paragraph. It either has to be developed more fully with other sentences, or woven into what comes before or after. **Sometimes writers substitute numbered lists of ideas in incomplete sentences, or sentences unrelated to one another, for paragraphing. This system doesn't work. The ideas need to be completed in complete sentences, and their connections established in narrative.

4. WAIT -- THIS JUST DOESN'T ADD UP. The argument doesn't make sense. You may have made sweeping generalizations, made claims beyond the evidence you use in support, or disregarded research that takes an opposing view. Here are some comments about argument I repeatedly make on concentration papers. ** Your argument, the real importance of what you are saying, is hidden, and in the reorganization of the paper in the second draft you need to reveal it. (My colleague Louise Dunlap often asked her graduate students at MIT: "What are you trying not to say?") **When you know you have a problem in your argument -- serious exceptions, insufficient or partial evidence, gaping holes in the research, strong disagreements that you're aware of -- talk about it. That's right, discuss the problem. It will add interest and depth and credibility to your discussion. Bring it right into the open. If your readers know you're dealing with it, and what limits it might place on your argument, they will be more likely, not less, to accept what you're trying to say. **You begin to raise very important issues that are related to your general argument -and then drop them, without any development or analysis. **Occasional transitional phrases and some "therefores" and "thuses" give the appearance of logical progression but don't quite add up, or need some more explicit statement of the links between the premise and the conclusion drawn. **Your line of reasoning would be stronger if you recognized counter-arguments and dealt with them directly.

5. YOUR GRAMMAR IS ATROCIOUS. YOUR READERS DON'T UNDERSTAND WHAT YOU'RE SAYING. GET HELP!! Actually, I never say this. Well, almost never.

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Grammar and punctuation problems exist, but not as much as you might think, even for students who don't feel 100% confident with English, especially once you've figured out what you really want to say. More serious are problems with awkward sentence structure, incorrect word choice and leaden or verbose prose style, which often reflect problems with thinking, with having a solid grasp on your own ideas and the confidence to state them.

6. YOU, NEED TO; CONSULT? A GUIDE: TO...PUNCTUATION, Alas, American students tend to have the most problems with punctuation, using commas in places that don't need punctuation at all, semi-colons where colons should go, commas where there should be semi-colons, and nothing where there should be something. I do not attribute these problems to defects in character, intelligence or aptitude; instead, I blame trends--some of which I supported wholeheartedly--in U.S. education over the past couple of decades. (Now: please study the punctuation in this paragraph. Although some of it could have been handled differently, it is basically correct.)

7. USE SPELCHICK!! In the 21st century, there's no excuse for spelling errors. Run drafts through Spellcheck (or an equivalent word processing function) before handing them in. But watch out: if you wrote "too" instead of "two," Spellcheck won't stop you. And think twice before accepting a word that Spellcheck suggests: if Spellcheck guesses that you meant "impotent" when you accidentally dropped the "r" from "important", the meaning of your sentence is likely to be altered dramatically when Spellcheck makes the change!

8. WITH PRUDENT EDITING AND NO CHANGE IN THE CONTENT, THIS 20-PAGE PAPER COULD BE 12 PAGES. Early drafts usually have a lot of "lard", excess words that need to be trimmed. Awkward sentences also frequently result from trying to pack too many ideas into one sentence, because you haven't taken the time to sort out the different steps in the line of thought, leading to "lists" of little phrases that lose their focus (and probably their reader, too), like this one that you're reading now. **Below are comments I've often written on student papers, which you might consider as you approach your own revisions. "I've done some editing to demonstrate how you can tighten up the prose, weed out some of the passive-tense verbs, eliminate wordiness, combine sentences, get rid of redundant sentences, and make smoother transitions." 13

"I've drawn attention to some awkward sentence constructions and vague/confusing language and word order, as well as a few spots where the meaning of a paragraph would be clearer with the addition of some guiding words (cues) or transitional phrases that establish the cause/effect or chronology or interconnectedness of the elements. Just a bit more explicitness and more precise language would make a big difference in conveying your meaning." See the following pages for tips on using the Paramedic Method of sentence editing.

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Paramedic Method of Editing
The writing expert Richard Lanham offers a strategy for revising at the sentence level (i.e. after revising for structure and content). I like the Paramedic Method because the name has the ring of public health and suggests that we can rescue sick sentences and breathe life back into dead (or deadly) prose. Using this method helps to detect and correct the passive, wordy, unemphatic language so common in bureaucratic and scholarly writing. There are four main steps: 1.Circle the prepositions. One prepositional phrase is fine, two in a row sometimes unavoidable, but three in a row should raise a red flag--that the sentence lacks focus and is full of nouns. Our goal is more (and meatier) verbs, fewer nouns. 2. Circle the "is" forms. Watch for "is", "was", "will be", "seems to be", "have been", and other forms of "to be", which often signal the passive voice. "Is" is not a meaty verb. 3. Ask: Where's the action? Who's "kicking" who? You will likely find the action nominalized, that is, turned into a noun in a prepositional phrase, with no actual actor in sight. 4. Put this action in a simple active verb. If this verb has a human subject, all the better. Example: Before: This sentence is in need of an active verb. (9 words) After: This sentence needs an active verb. (6 words; Lanham calls the 3 word difference a "lard factor" of 33%)
This passage is from a draft of a paper entitled, "Drug Donations: Benefit or Burden?" It's typical of an early draft, in which the writer has captured some important ideas but not yet attended to readability.

Drug donations, given by various donors (corporate, governments, and NGOs) are generally a humanitarian response to emergency or disaster situations; they can also represent an integral part of development aid in non-emergency situations. Drug donations can either be beneficial or a burden to recipient countries and organizations depending on the understandings and agreements, or lack of, between respective recipients and donors…. In terms of long-term development aid, drug donations often supplement meager health budgets in developing countries. In countries where annual health expenditure is as low, or lower, as $8 per capita, drug donations can go a long way. For example, in Ecuador there are 100 community medical centers run by the Catholic Relief Service relying soly on medical supplies and drug donations. The collection of unsorted and unused drugs, unfortunately, is something many donors do without considering implications and, sometimes, dangerous consequences. Donations of large quantities of drugs without any content specifications result in the recipient loss of valuable time and effort in sorting and classifying. Further, unused 15

drugs are sometimes partially empty or contain only a portion of the contents, which represents a loss of money and time for transporting them. 193 words
In the editing demonstrated below, the Paramedic Method is the guiding strategy, but not the only one.

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A first stab at editing yields the following paragraphs, which still have room for improvement, but at least we've (1) eliminated some wordiness and redundancy; (2) combined sentences; (3) sharpened the emphasis of sentences; (4) made a few word changes, for precision; (5) converted many nouns to verbs or adjectives and thereby reduced the passive tone and several prepositional phrases; (6) replaced "fancy" wording ("without content specifications") with simpler language ("unlabeled"); (7) let the actors be the grammatical subject of sentences and thereby (8) made the people involved in the issue a little more visible, which is always good in public health. The passage has shrunk from 193 to 125 words, or 35%.

Drug donations from corporate, government and NGO donors can be either a humanitarian response to emergency situations or an integral part of non-emergency development aid. They can either benefit or burden their recipients, depending on the understanding and agreements, if any, between recipients and donors. In the context of long-term aid, drug donations often supplement meager health budgets in developing countries, where annual health expenditure is $8 per capita or lower. In Ecuador, for example, 100 Catholic Relief Service community medical centers rely solely on donated supplies and drugs. However, many donors collect unsorted and unused drugs without considering the implications and sometimes dangerous consequences. Recipients waste valuable time and effort sorting and classifying unlabeled drugs and transporting containers that come to them partly empty. 125 words
A second round of editing might begin the passage much more actively:

Corporations, governments and NGOs donate drugs in response to humanitarian emergencies as well as through non-emergency development aid. These donations can either…..
And so the editing and re-editing should continue….

9. THE WRITING IS WEIGHED DOWN BY PASSIVE VERBS. (PASSIVE VERBS ARE KILLING YOUR WRITING.) The real meaning of the sentence is hidden -- and you are "off the hook" as far as precision -- when you use the passive voice. For example, look at sentences from a paper about the one-child policy in China: "The political structure in China...has been criticized as an instrument for exploitation." Has been criticized BY WHOM? "Chinese dissidents have criticized the political structure..." would be very different in meaning from "American women's groups have criticized the political structure...."When you really have to think about who is really doing what to whom, you have to be more demanding on yourself--and clearer to the reader. Another sentence in the same paragraph could also benefit from a conversion to active: "Mr. Lee's wife....was eventually found and forced to have an abortion...." could become: "The local cadres of two districts eventually found Mrs. Lee and forced her to have an abortion." 17

10. IT'S OKAY TO USE THE FIRST PERSON "I". REALLY. FORGET ALL THE TEACHERS WHO TOLD YOU NEVER TO USE 'I'. Compare these two sentences: "In this section I will analyze why HIV interventions must recognize the importance of gender roles." "In this section the reasons why HIV interventions must recognize the importance of gender roles will be analyzed." Which one is clearer? You can use "I", selectively and judiciously, to narrate parts of your paper. And if you are a player in your research, you can say so. In the postmodern world, we no longer have to pretend there we're reporting on an objective reality "out there" that has nothing to do with our own agency or world view. You establish credibility and validity by the strength of your argument, not by eliminating yourself from the scene or using impersonal language that pretends to be objective. (Serious skeptics: please see me for examples of the first person in research papers published in The Lancet, American Journal of Public Health, New England Journal of Medicine, and other professional journals.)

11. IF ANY WORDING IS BORROWED FROM YOUR SOURCE, BE SURE TO PUT THOSE WORDS IN QUOTATION MARKS AND CITE THE SOURCE. **Be very careful about borrowing words, phrases and sentences from sources. If you use another writer's phrasing, the borrowed words must be enclosed in quotation marks, and the source must be cited. But stringing together many sentences in quotation marks is not a very mature approach to bringing sources into your narrative. There is rarely a good reason to stick so closely to the original text; think of your own writing as commenting on a source, or telling a story about it. Step back and report on what you've read. Make sure that paraphrases and summaries are in your own words and sentence structures. (You'll still need to cite the source, but you won't need quotation marks.) **A good way to avoid inadvertent plagiarism while summarizing ideas from a source is to write the summary WITHOUT looking at the source. That means you really have to understand it well. This is a method recommended by Rebecca Moore Howard, a writing specialist at Colgate University. She suggests that you read the source at least twice, first quickly to get a general idea, then more carefully, taking some notes. Then let some time go by -- about half an hour -...and with the book closed, write your own summary of it.....Once you have drafted your summary, go back to the book and check to see if any of our phrasing resembles that of the source; if so, quote it exactly. Provide page citations for both your 18

paraphrases and quotations. Also, check your version to see what you forgot; what you forgot is usually what you didn't understand [1]. (Howard R.M. Plagiarisms, authorships, and the academic death penalty. College English 1995; 57:801.) (Notice, by the way, that when you include a direct quotation of four lines or more, like this one, it should be set off in an indented, single-spaced block. No quotation marks are used in this case; the block format itself signals that the source is quoted directly.) I also suggest that you think about how accurately you've used sources, and how appropriately you've cited them, in terms of your own role as an expert among colleagues. What if you were invited to read your paper at a conference, where all the experts on your topic will be congregating? (This happens.) You can expect that the authors of your source materials will be in your audience, listening carefully, and will, of course, recognize references to their own work. Have you credited them for their ideas? Have you made it clear when you've quoted their words? Are you sure no one will be angry at you?

12. DIRECT QUOTATIONS HAVE BEEN 'DROPPED' INTO THE TEXT WITHOUT ATTRIBUTION OR EXPLANATION. It's not polite to either your reader or your source to use someone else's words -- even if you've correctly cited and punctuated them -- without some form of introduction or attribution that gives the reader an idea of why you're bringing someone else into your narrative. Direct quotations need to be integrated into your own writing. Notice how I did it with the quotation from Rebecca Moore Howard, up there in #11. You might name your source, if it's an important authority worth noting: "According to X, the Director of the World Federation of YZ, "this intervention is foolproof." Or you might write a less personalized attribution : "A 1992 study in Zambia revealed that "direct quotation here". But once you've signaled with quotation marks that you're bringing another voice into your monologue, it's only fair to let the reader know why.

13. THE REFERENCE LIST IS A MESS! You need to attach a list of references to all drafts of the paper. The two most frequently used styles of referencing in the health literature are the Vancouver system (used by the AJPH, NEJM, BMJ, JAMA) and the Author-Date (Harvard) system (used by Social Science and Medicine). Stick with one or the other in any single paper. Don't waste valuable brain space trying to memorize the format, but do have models and guidelines in view as you proceed. Here, once again, are samples of my most frequent comments: "If you have more than one reference to the same source, then you use the page number in addition to the reference number. For example, two separate references to the document numbered 14 might look like this (14, p. 57) and this (14, p. 102). In this case, you don't repeat the reference in the list of references at the end, but re-use 19

number 14. In all other cases, when a reference is cited only once, use only the reference number in parenthesis (or superscript) in the text, and include in the list at the end the page/pages." "You need many more citations within the text. I've written "ref" for reference where it was most obvious to me that you needed to cite a source. ANY information or idea that originated in something you've read needs to be cited -- and in this first draft, it's much safer to over-reference than under-reference. If you are referring to the same source throughout a paragraph, you'll need, at minimum, a citation at the end of the first sentence that begins the reference and at the end of the last sentence that closes the reference." (Vancouver system) "The numbering of citations must be in the order in which they appear in the text, so your first citation MUST be number 1, the second 2, the third 3. Then the list at the end of the paper must be chronological 1-2-3-4- etc." (Author-date system) "The in-text citations in parenthesis should NOT include the first initials of the authors, only the last names. When a source has two authors, both names belong in the in-text citation; with more authors, the first author's name can be followed by "et al." In the list of references at the end, the first initials should be included, but not the first names. The year always immediately follows the author in the author-date list. " "Journal articles require the title of the journal, volume and page number, but not the month or the issue number. Anything that is not a journal -- a book or report -- must include the place of publication and the publisher, as well as page numbers when appropriate."

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Referencing: Styles of Citation
Professors may specify the referencing style expected for their courses, or they may leave it up to you. From undergraduate days, you may be familiar with styles commonly used in the Humanities (MLA or Chicago, for example) or in social sciences (such as APA), but in the medical and health literature, two styles prevail. The following summary of these styles of citation is taken from Health Policy & Planning's guidelines for authors at http://heapol.oupjournals.org/misc/ifora.shtml.

Referencing may be either by author/date (Harvard) or by numbers (Vancouver system), but the format chosen must be used consistently throughout the article. The style of the reference list varies between the two systems, but in both cases, the following details must be included in a reference to a journal article: the surnames and initials of all authors when six or less (when seven or more, list three and add et al), title of article, name of journal abbreviated according to Index Medicus style, year, volume, first and last page numbers. For books, names and initials of all authors, the full title, place of publication, publisher, year of publication and page number should be included. Examples of the style for the two systems are shown below.

Vancouver system
References should be numbered sequentially in the text, with a number being inserted above the line on each occasion a reference is cited. In the reference list, entries should appear like this: 2 Ganapati R, Naik SS, Acharekar MY, Pade SS. Leprosy endemicity in Bombay: an assessment through surveys of municipal schools. Lepr Rev. 1976; 43: 127-31. 4 Abrams C. Housing in the modern world: man's struggle for shelter. London: Faber Editions, 1969: 185. For more details of the Vancouver style, see the Uniform Requirements of Manuscripts Submitted to Biomedical Journals at http://www.icmje.org/.

Author/Date (Harvard) system
In the text the author's name and the date of publication are quoted, e.g. 'as confirmed by Abrams (1969)' or 'as confirmed in another study (Abrams 1969)'. Reference list entries are as follows: Ganapati R, Naik SS, Acharekar MY, Pade SS 1976 Leprosy endemicity in Bombay: an assessment through surveys of municipal schools. Lepr Rev 47: 127-31 Abrams C 1969 Housing in the modern world: man's struggle for shelter. London: Faber Editions, p. 165. ------------

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Different journals interpret these guidelines somewhat differently. Most put initial letters of words in titles of books in upper case, for example, and some italicize journal and book titles. If you choose one of the variations, use it consistently. Following are sample reference lists from The Lancet (Vancouver) and Social Science and Medicine (Author/Date).

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Citation of electronic sources
There is not yet complete consistency of style from journal to journal--as revealed by minor differences below between the NEJM and BMJ, even though they both subscribe to the Vancouver system of citation. But the principle is the same: provide enough information so that the reader can perform the search and retrieve the cited documents.

Examples from the New England Journal of Medicine
1. Millar JD. Paradox in prevention: managing the threat of smallpox bioterrorism. Health policy focus. Washington, D.C.: Public Health Policy Advisory Board, 2000. (Accessed March 12, 2002, at http://www.phpab.org/Editorials/ReprintOfParadoxIn.htm.) 2. Interim smallpox response plan & guidelines: draft 2.0. Atlanta: Centers for Disease Control and Prevention, November 21, 2001. (Accessed April 5, 2002, at http://www.bt.cdc.gov/DocumentsApp/Smallpox/RPG/index.asp.) 3. Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID. Smallpox and its eradication. Geneva: World Health Organization, 1988:1-68, 121-208. (Accessed April 5, 2002, at http://www.who.int/emc/diseases/smallpox/Smallpoxeradication.html.)

4. O'Toole T, Inglesby T. Shining light on Dark Winter. Baltimore: Johns Hopkins Center for Civilian Biodefense Strategies, 2001. (Accessed April 5, 2002, at http://www.hopkinsbiodefense.org/lessons.html.) 5. National Transportation Safety Board. Report on injuries in America, 2001. (Accessed March 12, 2002, at http://www.nsc.org/library/rept2000.htm.) 6. National Vaccine Program Office. Pandemic influenza: pandemics and pandemic scares in the 20th century. Atlanta: Centers for Disease Control and Prevention, 2001. (Accessed April 5, 2002, at http://www.cdc.gov/od/nvpo/pandemics/flu3.htm#8.)

Examples from British Medical Journal
1. e-Health Ethics Initiative. e-Health code of ethics. J Med Internet Res 2000;2:e9. www.jmir.org/2000/2/e9/ (accessed 1 Nov 2001). 2. American Sociological Association. American Sociological Association code of ethics. www.asanet.org/members/ecoderev.html (updated 1 Aug 1999, accessed 12 Jan 2001). 3. Social Sciences and Humanities Research Council of Canada. Tri-Council policy statement: ethical conduct for research involving humans. www.sshrc.ca/english/programinfo/policies/Index.htm

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(updated 14 Sep 2001). 4. Fox S, Rainie L, Horrigan J, Lenhart A, Spooner A, Burke M, et al. The online health care revolution: how the web helps Americans take better care of themselves. Pew Internet and American Life Project. 1. www.pewinternet.org (accessed 5 January 2001).

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A Note About Plagiarism
Plagiarism is in the news a lot these days. In January of 2002, the best-selling historian Stephen Ambrose was accused of copying passages from Thomas Childer's The Wings of Morning in his own new book, The Wild Blue. Journalists following up on the first allegations found that similar close or verbatim "borrowed" wording appeared in a number of other books by Ambrose. Similar instances of "borrowing" were identified soon thereafter in several works by Doris Kearns Goodwin, another high-profile historian who has admitted to sloppy note-taking but not to intentional use of other people's words. Debates have raged as to severity of the lapses by these two writers. But nearly all of the examples put forward in the media would certainly constitute plagiarism by the definition we use in Boston University and in academia generally. In a January 10, 2002 article in the New York Times, David Kirkpatrick wrote that both the Ambrose and Childers books "tell the stories of World War II bomber pilots. Professor Ambrose included footnotes in his book acknowledging that Professor Childers's book was a source of information in the relevant pages. But Professor Ambrose does not acknowledge quoting from the book or borrowing phrases or wording." Kirkpatrick went on to show two examples:
1. Childers wrote, "Up, up, up, groping through the clouds for what seemed like an eternity." He added later, "No amount of practice could have prepared them for what they encountered. B24's, glittering like mica, were popping up out of the clouds all over the sky." Ambrose wrote: "Up, up, up he went, until he got above the clouds. No amount of practice could have prepared the pilot and crew for what they encountered -- B-24's, glittering like mica, were popping up out of the clouds over here, over there, everywhere." 2. Childers wrote, "Howard struggled to master the internal electronics of the radio, building generators, studying vacuum tubes and amplifiers, transformers and transmitters. He disassembled the sets, examined the intricate ganglia of tubes and wires, and reassembled them blindfolded." Ambrose wrote, "He mastered the internal electronics of the radio, built generators, studied vacuum tubes and amplifiers, transformers and transmitters. He learned to disassemble a set, then reassemble it blindfolded."

Pretty sleazy, don't you think? If you don't see why Ambrose's passages are unacceptable by conventional academic standards, you need to brush up on your understanding of plagiarism. Consult the BUSPH Student Handbook as well as Hacker's A Writer's Reference, listed among the useful references earlier in these pages. And ask yourself: why would a writer of popular history--or any other subject--want to adhere so closely to someone else's wording? Doesn't he know his stuff? And if the image of B24s "glittering like mica" is so uniquely suited to the description, doesn't it merit quotation marks and a clear attribution to the guy who originated it? Graduate students, who we like to believe have the best intentions, still often have difficulty paraphrasing and using direct quotations accurately; manipulating these strategies well takes attention and practice. The results are worth the effort. The following page briefly demonstrates how authors of an article in The American Journal of Public Health handled many sources in a relatively short stretch of prose. 27

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Integrating direct quotations and paraphrases
The facing paragraphs are from the article, "To Boldly Go," by McKinley and Marceau, in the January 2000 AJPH. In a two-page section entitled "some limitations of conventional public health," they weave into their discussion more than two dozen references, bringing in the "voices" and opinions of many writers to build their argument. They do this by summarizing and paraphrasing their sources (paragraph 1, citation #9, 10) as well as with direct quotations. The direct quotations are sometimes partial sentences (paragraph 1, citation #8) which fit grammatically into the structure of the authors' complete sentence. Occasionally they use full sentence quotations, as in citation #13 in paragraph 2. Notice that this direct quotation is carefully attributed to Rose with the introductory phrase, "He observed". In fact, all of the direct quotations and paraphrases are attributed to their originators: they are not merely "dropped" into the text to substitute for the authors' own wording. Instead, the authors tell a story about what others have said, reporting on other people's research and thought, and using this "report" to come to their own conclusion. This use of source material is similar to what SPH students must do in their research papers. By carefully summarizing, paraphrasing, and using a limited number of especially salient direct quotations, they give an account of the "conversation" on their topic as they review the literature or build a step-by-step argument. Imagine your sources as stepping stones, and your own narrative thread as the leaps you take from one to the next that keep you getting down the stream of your thinking.
Note: The paragraphs to the right are cut and pasted from a full-text Medline article, and the citations are underlined because they are hyperlinked in Medline format. In a word-processed academic paper, your numbered citations should be in super-script or in brackets. Note also that in the case of direct quotations, the page number is indicated with the citation number, a style you should also use in papers.

Some Limitations of Conventional Public Health….
As an illustration, consider one discipline within public health, epidemiology, which has much to offer health policy (other equally good illustrations might be economics, biostatistics, sociology, or toxicology). In marked contrast to its origins, the established epidemiology that is shaping public health today appears hamstrung by its adherence to an individualist/medical natural science paradigm.1,2 Conventional epidemiology is limited by the following:…. 1. Lack of theory development. Established epidemiology can actually explain very little, because in epidemiology, unlike most disciplines, there is little interest in developing theories that can be tested.6,7 Lamenting the absence of theory development, Smith likened the product of today's epidemiology to "a vast stock-pile of almost surgically clean data untouched by human thought."8 Krieger, among others, has called for theory development in public health so as to understand and improve by planned actions the health of the public.9,1 2. Limitations of dichotomous thinking. Even though it is now widely accepted that the response curve is continuous and smooth for most risk factors and conditions, dichotomous thinking nonetheless prevails and still determines our actions.11 Using hypertension as one example, Rose 12,13 described the different activities that logically follow from dichotomous thinking and

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from continuous thinking. He observed, "Paradoxically, it is epidemiologic research which has now repeatedly demonstrated that in fact disease is nearly always a quantitative rather than a categorical or qualitative phenomenon, and hence it has no natural definitions."13(pxx) Wholepopulation approaches to public health that follow from acceptance of the continuous nature of risk are precluded "because it is a departure from the ordinary process of binary thought to which they are brought up."13 (p8)

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Boston University Writing Resources
Boston University offers help with writing on its Commonwealth Avenue campus. The College of Arts and Sciences Writing Program Geared for students at the undergraduate level, the Writing Program courses are open to graduate students who need to improve their skills. If your professors raise a red flag and say you are unlikely to succeed without major improvement in writing skills, this may be the place to go. The program offers Introduction to College Reading and Writing; more advanced Writing Seminars; Writing and Research Seminars; tutorials; and ESL-only sections of Introduction to College Reading and Writing. The credits from these courses cannot be applied to the MPH, but they are covered by university tuition. You may be asked to take the Boston University Writing Assessment before being admitted into the courses: Contact Daniel Ivey, Program Administrator, at (617)358-1501, 730 Commonwealth Ave., 3rd Floor. Metropolitan College www.bu.edu/met/programs/undergraduate/courses/english.html BU's continuing education college also offers courses to which regular tuition may apply but which are not counted toward the MPH. Of interest are courses in Basic Writing Skills, Composition (Basic and Intermediate), and Expository Composition for International Students. For more information on availability of courses, assessment and registration, check the website or go to Metropolitan College's Charles River Campus site, 775 Commonwealth Ave., Room 103, 617/353-3000; email met@bu.edu. The University Resource Center An academic support center located at One University Road in the Sargent Gym Building (Suite 150), the URC includes a Writing Center to help any BU student by providing consultation on organization, documentation, style, and specific grammar problems. Its services do not include editing, grammar checking, or proofreading. The website notes that appointments for meetings with a writing fellow should be made in person or by phone. You can reach the URC at 617/353-7077 or urc@bu.edu. Center for English Language and Orientation Programs (CELOP) www.bu.edu/celop If English is not your first language and you're having trouble with any language skills, CELOP offers intensive full- and part-time courses--for a separate price and a separate admissions process. This year CELOP expects to offer new afternoon and evening courses in Academic and Professional Writing. The admissions office is at 617/3534870; email is celop@bu.edu; offices are located at 890 Commonwealth Ave., 2nd floor. Adult education programs and other colleges and universities in the Boston area also offer writing courses that may be tailored to your schedule and budget.

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