comparing college student mortality rates in the …...the total numbers of u.s. students studying...

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COMPARING COLLEGE STUDENT MORTALITY RATES IN THE U.S. WITH MORTALITY RATES WHILE ABROAD

ABOUT THE FORUM ON EDUCATION ABROAD

The Forum on Education Abroad is a 501(c)(3) non-profit, membership association recognized by the U.S. Department of Justice and the Federal Trade Commission as the Standards Development Organization (SDO) for the field of education abroad. The Forum’s institutional members include U.S. colleges and universities, overseas institutions, consortia, agencies, provider organizations, and foundations.

MISSION STATEMENT

The Forum on Education Abroad serves as the collective voice of U.S. post-secondary education abroad. To benefit students, The Forum develops and disseminates comprehensive standards of good practice, resources and training, advocates for education abroad and its value, and engages the field in critical dialogue.

CONTENTS

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

The Insurance Claims Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Calculating Annualized Mortality Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Comparing Annualized Mortality Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Limitations and Future Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Key Finding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Using The Forum as a Resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Thank You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


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INTRODUCTION

Education abroad is one of the most eagerly anticipated activities of a student’s post-secondary educational experience. When a death occurs abroad, distance, logistics, and bureaucracy compound the tragedy. While data can provide insight to practitioners and the public to make informed decisions about education abroad, it cannot prevent all tragedies nor relieve the grief of the families and friends who have lost loved ones abroad. The goal of this research project is not to minimize the tragedies, but to provide context for student mortality abroad and ultimately to help all stakeholders assess and continually improve student safety abroad.

The field of education abroad must better understand critical incidents involving students abroad in order to improve the measures taken to keep students safe. While concerns have been raised that education abroad is unsafe and results in many student deaths, no large-scale data existed to support or refute those claims. U.S. government records do not make it possible to sort the deaths of American citizens abroad by age or student status. U.S. college and university records of student deaths are not widely available to the public and do not necessarily include incidents that occurred during educational programming abroad. In response to the need for more information, The Forum on Education Abroad (The Forum) began a collaborative project in 2015 with two major insurers of education abroad programs with the purpose of providing objective information regarding critical incidents involving U.S. post-secondary students participating in education abroad. Focusing specifically on student mortality, the data included in this report, which expand upon the data presented in a 2016 study,1 span the calendar years 2010 through 2016.

BACKGROUND

The initial report published in 2016 analyzed a variety of insurance claim types for the calendar year 2014, with the key finding being that students were no more likely to die while studying abroad than while studying domestically. Presentations, conversations, and correspondence with Forum members, concerned parents, and experts in education abroad and health, safety, security and risk management raised a series of questions about factors affecting the data in the original report. What if there were a natural disaster or act of terror in an education abroad destination in a given year? Are there any causes of death, e.g., suicide, or drug- or alcohol-related incidents, excluded from these claims? Colleges and universities often insure their faculty leaders and chaperones on the same policies as their students who travel abroad: are the insured in the data set only students?

To address these questions, The Forum’s insurance company partners provided data from calendar years 2010 through 2016 for the current report. These years include years that suffered a natural disaster (the earthquake in Haiti in 2010) and acts of terror in locations that host many U.S. education abroad students (e.g., 2015 Paris attacks, 2016 Brussels bombing). Further discussion with insurance company representatives clarified any policy exclusions, and provided more information regarding the ages of the insured. The Forum contracted with economist Dr. Stephen Erfle, Professor of International Business and Management and Chair of the Department of Economics at Dickinson College, to analyze the claims data and assist with the preparation of this report.

1 “Insurance Claims Data and Mortality Rate for College Students Studying Abroad,” available at: https://forumea.org/wp-content/uploads/2016/04/ ForumEA_InsuranceClaims_MortalityRateStudentsAbroad.pdf.

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THE FORUM ON EDUCATION ABROAD

THE INSURANCE CLAIMS DATA The 2010-2016 claims data used for this analysis were provided by two insurance providers: Cultural Insurance Services International (CISI) and GeoBlue (GEO, formerly HTH until 2014). From 2010-2016, CISI and GEO insured a total of 1,342,405 individuals,2 approximately 78.5% of whom were 24 or younger,3 who spent an average of 63.1 days in at least 210 countries. When compared with the total numbers of U.S. students studying abroad in 2009-2010 through 2015-2016 based on Open Doors data,4 the students insured by CISI and GEO during the 2010-2016 calendar years represent 51.2% of study abroad students represented in the Open Doors survey, and all major education abroad destination regions of the world were represented.

The data from both insurance providers were compiled from actual claims for repatriation of remains. The insurance providers deleted personal identifying information before sharing the claims information with The Forum to ensure anonymity of the individuals involved. The choice to focus on repatriation of remains claims, in which the insurance company assists in returning the remains of the deceased to the U.S. following a death abroad, was made in consultation with the insurance companies to ensure that the data represented here included as many cases of student mortality abroad as possible. While other fatality-related claims, e.g., accidental death and dismemberment, may have exclusions in the policy for deaths by suicide or from drug- or alcohol-related incidents, the two companies involved in this project report that in their policies such exclusions do not apply to repatriation of remains claims, making it the best option for capturing cases of student mortality abroad.5

This report focuses on the statistical analysis of the 32 individuals aged 24 years or younger covered by CISI and GEO who died while abroad. Table 1 provides information on these 32 individuals including year of death, gender, location by region, and cause.6 Half of the mortalities were female and half were male. The number of student deaths per year varied from one each in 2014 and 2016 to eight in 2015. Four died in the Haitian earthquake and nine died from falls of various kinds. Nine died from various medical conditions, including two mental health-related incidents.

2 Each of the insurance companies removed duplicates from their data sets before providing them to The Forum. Students covered by multiple policies from the same company during the same period of time are only represented once in the present data.

3 One company provided the numbers of insured individuals aged 24 or younger together with the total number of insured individuals. Individuals 24 or younger represented 78.5% total insured individuals for this company. The other company did not provide this information but suggested that 90% were students. We chose to use 78.5% for both insurance companies because it represents the most conservative approach in estimating the total number of education abroad students insured. We know the exact number of mortalities by age group (32 were 23 or younger, 13 were 27 or older and none were 24, 25 or 26 years old at time of death) because both insurance companies track this information and provided it to The Forum in the data set.

4 Open Doors® is “a comprehensive information resource on…U.S. students studying abroad for academic credit at their home colleges or universities” prepared by the Institute for International Education (IIE) and funded by the Bureau of Educational and Cultural Affairs at the U.S. Department of State. While the insured in this study may include students participating in not-for-credit education abroad travel, Open Doors is the best data available for overall participation in education abroad by U.S. college and university students, and thus serves as our best point of reference.

Open Doors Data – U.S. Study Abroad. Retrieved December 8, 2017, from http://www.iie.org/Research-and-Publications/ Open-Doors/Data/Us-Study-Abroad.

5 It is theoretically possible that this data set does not include all mortalities of students abroad covered by CISI and GEO if a repatriation claim was not filed for an insured student’s death, but these are likely very rare. A representative from one of the insurance companies reported that on only one occasion in memory, a claim was not filed for repatriation. In that instance, the U.S. government repatriated the remains of a student abroad following a natural disaster.

6 Information offered by insurance providers has been edited for inclusion in this table in order to maintain the anonymity of the deceased while still offering as much information as possible regarding cause of death. Details related to cause of death were classified based on Critical Incident Database (CID) “Nature of Incident” categories (see: https://forumea.org/ resources/data-collection/critical-incident-database/). “Unknown” indicates that the insurance company did not have details related to cause of death.


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TABLE 1. EDUCATION ABROAD DEATHS COVERED BY TWO INSURANCE PROVIDERS, 2010–2016*

YEAR GENDER LOCATION (BY REGION) DETAILS

2010

Female Caribbean Natural Disaster




Male Europe Accidental Death – Fall

Male Asia Medical – Illness

2011

Female Europe Accidental Death – Fall

Female Europe Medical – Pre-existing Medical Condition

Female Asia Accidental Death – Fall

Female Latin America Medical – Pre-existing Medical Condition

Male Europe Medical – Illness

Male Europe Medical – Illness

2012

Female Europe Medical – Illness


Male Europe Accidental Death – Injury

Male Europe Accidental Death – Hypothermia

Male Asia Accidental Death – Fall

Male Asia Accidental Death – Drowning

2013

Female Europe Medical – Unknown



Male Europe Unknown

2014 Female Europe Medical – Seizure

2015

Female Middle East Accidental Death – Heatstroke

Female Europe Medical – Illness



Male Latin America Accidental Death – Drowning

Male Asia Unknown

Male Oceania Accidental Death – Injury

Male Europe Accidental Death

2016 Male Asia Accidental Death – Injury

* Based on repatriation of remains of individuals 24 or younger covered by CISI and GEO.

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CALCULATING ANNUALIZED MORTALITY RATES

To compare how the number of deaths abroad compares with the number of domestic student deaths we must create a common time frame. Education abroad experiences tend to be shorter than domestic study. To create comparable rates, we annualized both rates for the sake of direct comparison.

The actual number of deaths forms the basis for the annualized mortality rate per 100,000.7 This annualized rate is not an actual number of deaths but provides comparability with other mortality rates.8 Dividing the number of days insured by the number of students provides an average days insured per student, d. This ratio declined modestly over the seven-year period as seen in Table 2. This result is consistent with the increase in short-term duration of study (8 weeks or less) over this period (from 49.7% in 2009-2010 to 52.8% in 2015-2016) recorded in the Open Doors data.9 Multiplying the number of deaths by 365 and dividing by average duration provides an annualized number of deaths. Multiplying the annualized number of deaths times 100,000 divided by the number of students insured provides the annualized mortality rate per 100,000.

TABLE 2. EDUCATION ABROAD MORTALITY RATES COVERED BY TWO INSURANCE PROVIDERS

YEARSTUDENTS INSURED, S

DAYS INSURED

AVERAGE DAYS PER

STUDENT, dDEATHS, n

ANNUALIZED RATE PER 100,000*

95% CI FOR RATE**

LOWER UPPER

2010 113,711 8,174,099 71.9 6 26.8 17.3 36.3

2011 126,775 8,297,417 65.4 6 26.4 17.5 35.3

2012 138,845 8,931,121 64.3 6 24.5 16.3 32.8

2013 151,089 9,400,720 62.2 4 15.5 9.2 21.8

2014 166,769 9,940,485 59.6 1 3.7 0.8 6.6

2015 174,868 10,557,239 60.4 8 27.7 19.9 35.5

2016 182,161 11,209,233 61.5 1 3.3 0.6 5.9

7 Year Total 1,054,219 66,510,314 63.1 32 17.6 15.0 20.1

*Annualized Mortality Rate/100000 = n∙(365/d)∙(100000/S).**95% UB/LB = (100000/S)∙(n∙365/d ± 1.96∙(n∙365/d)0.5).

The annualized mortality rate provides us with a point estimate of the mortality rate for this class of individuals. This rate varies due to year-to-year variations in the number of individuals insured, S, the average duration of stay, d, as well as the number of deaths, n. The year of the Haitian earthquake in which four insured died in a single event (2010), for example, did not provide a substantially larger annualized mortality rate than other years. That result is merely an artifact of the difficulty in analyzing events that occur only rarely. In such situations, it is especially important to increase sample size by pooling across years to model more accurately the actual underlying process.

A 95% confidence interval on the annualized mortality rate is readily calculated. This confidence interval gets smaller as the number of insured, S, gets larger. This provides a second reason we should place greater confidence in the seven-year annualized rate than in any individual year rate. Pooling across years provides us with greater confidence about the results we obtain.

7 It is worth remembering that an annualized mortality rate per 100,000 is simply the probability of mortality times 100,000 so that an incidence of 20 per 100,000 is the same as saying the probability of occurrence is p = .00020.

8 It is also worth noting why the number of deaths covered by CISI and GEO in 2014, 1, differs from the four mentioned in our 2016 report. Three of the four 2016 deaths were persons who were 25 or older (and were part of the 13 total deaths by individuals who were 25 or older during the seven years). As noted in footnote 3, we exclude these deaths from the present analysis.

9 Institute of International Education. (2017). "Detailed Duration of U.S. Study Abroad, 2005/6-2015/16" Open Doors Report on International Educational Exchange. Retrieved from http://www.iie.org/opendoors December 20, 2017.


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In order to understand how the number of deaths abroad compares with the number of student deaths on U.S. campuses, we identified the study, “Causes of Mortality Among American College Students: A Pilot Study,” published in the Journal of College Student Psychotherapy in 2013 (the Turner Study).10 A weakness of this study is that it includes data from only one academic year, but it is the only large-scale study of mortality of college students available for comparison. The Turner study collected survey response data from 157 four-year universities and colleges to investigate the leading causes and rate of mortality for students at a sample of U.S. institutions of higher education during the 2009-2010 academic year. During this 10-month period, 254 deaths occurred out of the 1,361,304 students that were included in this database. The result of this research was a determination of an annualized mortality rate of 22.4 per 100,000 college students on U.S. campuses.11 Table 3 provides summary information from that study annualized by multiplying actual rates by 12/10.

TABLE 3. DOMESTIC MORTALITY RATES FOR 18–24 YEAR OLD STUDENTS

CATEGORY OF DEATH NUMBER*ANNUALIZED RATE PER

100,000**95% CI FOR RATE***

LOWER UPPER

All Injury 122 10.8 9.1 12.5

Vehicular Injury 78 6.9 5.6 8.2

Nontraffic Injury 44 3.9 2.9 4.8

Suicide 70 6.2 5.0 7.4

Unknown 34 3.0 2.2 3.8

Cancer 22 1.9 1.3 2.6

Homicide 6 0.5 0.2 0.9

Total 254 22.4 19.9 24.9

*Drawn from Table 3 of the Turner Study (2013), based on 1,361,304 students from 157 four-year institutions over the course of the 10 month academic year (8/1/2009-5/31/2010).**Annualized Mortality Rate/100000 = n∙(12/10)∙(100000/1361304).***95% UB/LB = (100000/1361304)∙(n∙12/10 ± 1.96∙(n∙12/10)0.5).

10 Turner, J.C., Leno, E.V., & Keller, A. “Causes of Mortality Among American College Students: A Pilot Study.” Journal of College Student Psychotherapy 27.1 (2013): 31-42.

11 This rate is lower than the rate we reported in our 2016 report (referenced in footnote 1 above), where we adjusted the published mortality rate based on a definition of academic year as 7.5 months, rather than 10 months. Here, we return to a 10-month definition of academic year after corresponding with the authors of that study to confirm their methods.

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COMPARING ANNUALIZED MORTALITY RATES

Table 4 provides a direct comparison of the annualized mortality rates. The education abroad rate, 17.6, 95% CI (15.0, 20.1), is lower than the domestic rate, 22.4, 95% CI (19.9, 24.9). Education abroad has a lower mortality rate than domestic study. We use odds ratios and confidence intervals on odds ratios in Table 5 to determine the statistical significance of this difference.

TABLE 4. COMPARING ANNUALIZED MORTALITY RATES*

STUDENT COHORT MORTALITY RATE PER 100,000 STUDENTS

College students studying abroad (n = 1,054,219) 17.6, 95% CI (15.0, 20.1)

College students on U.S. campuses (n = 1,361,304) 22.4, 95% CI (19.9, 24.9)

*Education abroad data is drawn from bottom row of Table 2 and domestic data is drawn from the bottom row of Table 3. As noted in the previous section, annualized rates do not represent actual number of student deaths. The first row in Table 5 shows that this difference in mortality rates is statistically significant at the 99% level based on a two-tail test, p = .009.

It is common practice to use odds ratios to compare the relative rates of rarely occurring events such as mortality rates. By calculating a confidence interval for the odds ratio, one can make a statement with specified certainty that compares the relative risk of death for students studying in the U.S. with students participating in education abroad. The first row of Table 5 (see next page) provides this analysis. OR = 1.275 means that domestic students face a 27.5% higher risk of death than education abroad students.12 This result is statistically significant at the 99% level meaning that there is only a one in one hundred chance that this could occur because of random processes.

The rest of Table 5 provides a sensitivity analysis on those results by examining various alternative scenarios for number of deaths while abroad. Rather than discuss individual rows, it is worthwhile to provide some broad comments on those results. The first three rows and the last three rows examine how many deaths abroad would be required to be able to state statistically significant results at the 1%, 5% and 10% levels in both directions. Rows 4 through 7 describe results that tilt in either the domestic or abroad direction, but do not exhibit a significant tilt at even the 10% level (we see this by having the CI include 1.00 and by having p > .10).

Only if the number of student deaths abroad were to increase by more than 27.5% would domestic study become safer (in terms of risk of mortality) than education abroad. That conclusion would not be statistically significant at the 10% level or higher unless abroad deaths increased by more than 45% (see Row 8). Deaths of students studying abroad would have to be almost 60% higher than actual in order for that conclusion to become statistically significant at the same level of significance, as the data suggests that students are actually less likely to die while studying abroad than during domestic study (compare Rows 1 and 10).

12 An odds ratio (equation in Table 5, endnote **) is essentially indistinguishable from relative risk (ratio of probabilities or the ratio of annualized incidence per 100,000) when the probability of occurrence is small. In Table 5, Row 1, OR = 1.2747 and RR = (304.8/1361304)/((32∙365/63.1)/1054219) = .000224/.000176 = 1.2752 both of which round to 1.275, is a case in point. Relative risk has greater intuitive appeal but odds ratios have superior statistical properties.


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TABLE 5. SEVEN YEAR SENSITIVITY ANALYSIS ON NUMBER OF DEATHS WHILE ABROAD*

ROWNUMBER

OF ABROAD DEATHS, D

ANNUALIZED INCIDENCE

PER 100,000, M

ODDS RATIO, OR** TWO-TAIL p VALUE FOR THIS

SCENARIO

INCREASE OVER

ACTUAL 7 YEAR

DEATHS (32)OR

SIGNIFICANCE LEVEL, s

(1-s)% OR CI***

LB UB

1 32 17.6 1.275 .01 1.003 1.621 .009 -

2 34 18.7 1.200 .05 1.003 1.435 .047 6.3%

3 35 19.2 1.165 .10 1.004 1.353 .091 9.4%

4 40 22.0 1.020 .05 0.860 1.210 .831 25.0%

5 40.8 22.4 1.000 .05 0.844 1.185 - 27.5%

6 41 22.5 0.995 .05 0.840 1.179 .952 28.1%

7 46 25.3 0.887 .10 0.772 1.018 .152 43.8%

8 47 25.8 0.868 .10 0.757 0.996 .089 46.9%

9 48 26.3 0.850 .05 0.722 0.9998 .0496 50.0%

10 51 28.0 0.800 .01 0.648 0.987 .006 59.4%

*Row 1 denotes the actual comparison of seven-year abroad deaths described in Tables 1 and 2 with 10 month domestic student deaths from the Turner study described in Table 3. Rows 2-10 provide a sensitivity analysis on these results obtained by varying the number of abroad deaths over this seven year period, D. Key results are shown in bold in the table and described by row at the bottom of this table.**The Turner Study had T = 1,361,304 students and 254 domestic deaths in 10 months, the annualized domestic number of deaths is 304.8 = 254∙12/10. If there are a total of D abroad deaths out of a total of S = 1,054,219 abroad students spending an average of 63.1 days abroad per student, the annualized abroad number of deaths is A = D∙365/63.1 and the annualized abroad incidence per 100,000 is M = A∙100000/S. Based on these values, the odds ratio is calculated as OR = (304.8/(T - 304.8))/(A/(S - A)). In this context, an OR > 1 means that domestic incidence is higher than incidence abroad.***The (1-s)% odds ratio confidence interval bounds are given by: (1-s)% UB/LB = EXP(LN(OR) ± ts∙(1/304.8 + 1/(T - 304.8) + 1/A + 1/(S - A))0.5),where EXP() is the exponential function, LN() is the natural logarithm function, and ts depends on significance level s: ts = 1.645 if s = .10; ts = 1.96 if s = .05; and ts = 2.576 if s = .01.

1. Actual 7-year number of abroad deaths insured by two companies. Domestic is 27.5% riskier than abroad. Abroad is significantly safer than domestic at the 1% level (the entire 99% CI > 1, p = .009).

2. With two more abroad deaths than actual (34, 6.3% above actual), our best guess is that domestic is riskier at the 5% but not 1% level (the entire 95% CI > 1, p = .047).

3. With three more abroad deaths than actual (35, 9.4% above actual), our best guess is that domestic is riskier at the 10% but not 5% level (the entire 90% CI > 1, p = .091).

4. 40 abroad deaths (25% above actual), is the largest number of abroad deaths where abroad is nominally safer than domestic. The best guess is that staying domestic is 1.02 times riskier than going abroad.

5. 40.8 abroad deaths (27.5% above actual), produces an odds ratio of OR = 1.00 signifying equal risk.

6. 41 abroad deaths (28.1% above actual), is the smallest number of abroad deaths for which going abroad is nominally riskier than domestic study.

7. 46 abroad deaths (43.8% above actual), is the largest abroad death toll for which going abroad is NOT significantly more hazardous than staying in the U.S. at the 10% level (the 90% CI includes 1, p = .152).

8. 47 abroad deaths (46.9% above actual), is the smallest abroad death toll for which going abroad is significantly more hazardous at the 10% but not 5% level (the entire 90% CI < 1, p = .089).

9. It would take at least 50% more abroad deaths (48) before going abroad is significantly more hazardous than staying in the U.S. at the 5% but not 1% level (the entire 95% CI < 1, p = .0496).

10. It would take almost 60% more abroad deaths (51) before going abroad is significantly more hazardous than staying in the U.S. at the 1% level (the entire 99% CI < 1, p = .006). This is the level of significance by which abroad is actually safer than domestic in Row 1.

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In the interest of completeness, it is worth noting that had we used the 90% participation rate suggested by the second insurer instead of the 78.5% rate based on actual student participation rate from the other insurer (see footnote 3 above), the results would be even more starkly in favor of education abroad presenting less risk of mortality. In this instance, the annualized morality per 100,000 is 16.2, the odds ratio is 1.384 which is significant at the 99.9% level, p = .0005 (Row 1’). Other Table 5 hypothesized deaths abroad would be 35 at 99% (same significance level as Row 1 but now a hypothesized, rather than actual, number of deaths abroad), 37 at 95% (Row 2’), 38 at 90% (Row 3’), OR = 1 at 44.24 (Row 5’). Deaths would have to increase to 51 in order for domestic study to be significantly safer at the 90% level (Row 8’), 52 at 95% (Row 9’), and 55 at 99% (Row 10’). Finally, to match the significance level of the actual results in the reverse direction, deaths abroad would have to increase by more than 80% to 58 in order for mortality during domestic study to be significantly less likely at the 99.9% level, p = .0006.

CONCLUSION

The present data represent the largest known sample-size for a study of student mortality abroad. When compared with the only known study of U.S. college student mortality domestically, they indicate that U.S. college and university students are less likely to die while participating in education abroad than they are during study on their home campuses. This result is presented in order to offer information regarding the relative risk of student mortality during education abroad based on data rather than anecdote.

LIMITATIONS AND FUTURE RESEARCH

Counting events that happen rarely, and all over the world, is challenging. The present study was unable to identify unequivocally the student status of the insured in the data set, but instead chose to use the best available approximation, age, by matching the age bracket used here to that represented in the Turner Study. The Turner work points to a further limitation. The conclusions in this study are limited to some degree by the available comparison data, of which there is very little. Researchers in public health and student health services are encouraged to undertake comprehensive, multi-year studies of student mortality rates and other critical incidents on U.S. campuses. Future directions for research in the area of education abroad should include investigation into rates of other critical incidents, including injury, crime, and illness, which can pose risks to student safety, as well as expanded sample sizes in order to investigate the nature of critical incidents by factors such as cause and location.

KEY FINDINGU.S. college and university students are less likely to die during education abroad experiences than while studying on campuses in the U.S.


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USING THE FORUM AS A RESOURCE

The Forum’s Standards of Good Practice for Education Abroad offer a roadmap for evaluating and improving education abroad pro-grams and operations. The Forum offers online resources and professional training and events to support the Standards with the goal of continually improving the field and highlighting best practices in education abroad. Organizations, professionals, students and their families are all encouraged to use the Standards as a guide when selecting and participating in a program. Mitigating health and safety risks is a fundamental goal of all stakeholders in education abroad. Ultimately, when a tragedy occurs, it is the responsibility of everyone in the field to respond with professionalism and, above all, compassion.

THANK YOU

The Forum is grateful to Carol Foley and colleagues at GeoBlue (formerly HTH) and to Linda Langin of Cultural Insurance Services International (CISI) for their cooperation, and to the many colleagues who provided their generous feedback on earlier presentations and drafts of the present report.

Dickinson CollegeP.O. Box 1773, Carlisle, PA 17013

717-245-1031www.forumea.org

The Forum on Education Abroad is hosted by Dickinson College.

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