relaxation/stress reduction were the reasons consumers were most likely to discuss massage with their healthcare provider. The growing number of referrals from health care professionals as cited by both massage therapists and consumers indicated increased integration of massage therapy in health care environments. Twenty percent of massage therapists were reimbursed by insurance for massage. For practicing massage therapists, 8% were reimbursed by health insurance (either private payer or public system), 9% by auto insurance, 6% were reimbursed through worker’s compensation, and 4% accepted other insurance reimbursement. 4 Training and Education of Massage Therapists During 2020, 54% of schools had either closed or cancelled classes at some point because of COVID-19. By October 2020, 91% of schools were open and holding classes. Many schools have shifted to providing more online education, with 47% of schools offering some online learning for their entry-level program. Massage therapists reported an average of 677 hours of entry-level of education, with most therapists having more education than is required for licensure in their state. Ninety-five percent of massage schools offer a certificate in massage therapy, with 40% also offering continuing education courses in massage. Across all schools, the average number of graduates was 33 per year across all locations. Fifty-five percent of schools reported decreased enrollment because of COVID-19. The top challenges cited for schools were dealing with COVID-19 issues followed by difficulty in attracting students. 5 Section 1 — Consumers of Massage Therapy1 Consumer use of massage therapy is the engine that drives the massage profession. The number of consumers and the frequency consumers receive massage impacts the employment of massage therapists, the earning potential of therapists, and the demand for new therapists coming out of massage school. This section provides information on the latest data and trends in the U.S. population, overall economy and factors around consumer use of massage therapy. Key Concerns: What changes do massage consumers want to see because of COVID-19? How can we market our practices to the demographic groups who are most likely to seek massage? How can we gear our massage practice towards the markets most likely to grow? How can this information help us make our massage therapy program more attractive to prospective students? Key Findings: · Twenty-one percent of American adults received a massage in the past 12 months ending June 2020. · Almost half of regular massage consumers had to cancel plans to get a massage because of COVID-19. · Overall population growth is small in the United States. · Consumers continue to believe in the efficacy of massage. · COVID-19 greatly impacted consumer use of massage in 2020. The effects of the pandemic will not be fully realized for some time. These questions will be answered: 1A. What changes are taking place in the overall U.S. population? 1B. What is the current state of the U.S. economy? 1C. How has COVID-19 impacted consumer use of massage therapy? 1D. What drives consumer use of massage therapy? 1E. Who gets massage? 1F. Why do consumers get massage? 1G. Where are consumers getting massage? 6 1A. What changes are taking place in the overall U.S. population?2 Consumers drive growth in the profession. Overall population growth has been low the past several years. According to the U.S. Census Bureau, the U.S. population is growing, but at a slow rate The U.S. population grew to an estimated 329.4 million in 2020, up from 328.3 million in 2019. That’s a population growth of less than one percent. The population is projected to grow slowly over the next several decades as the number of births and international migrations are expected to be lower than in previous years. As the 2020 Census was just completed and results are being released slowly in batches by the Census Bureau, there is not much information from the 2020 Census available at present. More current data from the 2020 Census will be summarized in future research reports. For the latest information on U.S. population and economic trends, refer to the U.S. Census Bureau data at www.census.gov. 7 1B. What is the current state of the U.S. economy? The strength of the economy is one of the main factors that impacts massage consumption. When the economy is strong, consumers are more likely to get a massage than in uncertain economic times. As COVID-19 has impacted every aspect of daily life in the US, its effects on the economy as a whole are far-reaching, and will probably not be fully realized or understood for several years. With shelter-in-place orders enacted in many states across the country in the early months of 2020, massage consumption came to a sudden halt for several months. Additional peaks of the virus in the summer months and again in the fall caused varying degrees of shutdown measures to be reemployed. Economic relief for those out of work and struggling due to the pandemic was passed in March of 2020, and was the only economic relief passed as of December 2020. Many Americans are still struggling to pay for basic needs like food, housing, and utilities. The pandemic has forced many people to either work from home,