ama guidelines for research papers

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AMA Writing Guide: AMA Style Formatting

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Writing Resources

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The Liberty University Writing Center is available to provide writing coaching to students. Residential students should contact the  On-Campus Writing Center  for assistance. Online students should contact the  Online Writing Center  for assistance. 

The Jerry Falwell Library has a physical and eBook edition of the AMA Manual of Style: A Guide for Authors and Editors .  The AMA Manual contains exhaustive guidance for students needing more detailed information about ethical and legal considerations, correct and preferred usage, abbreviations, nomenclature, units of measure, numbers and percentages, study design and statistics, and mathematical composition,

If you need assistance in developing your qualitative or quantitative methodology, the SAGE Research Methods database provides resources for researchers conducting research in the social sciences. 

General Rules

Liberty University Students will either write AMA 11 style papers using the Non-structured Abstract format, or using the Practicum Class or Other Papers Requiring Structured Abstract format. To assist you in formatting, Liberty University's Writing Center provides a template and a sample paper for each formatting style. 

Papers with Non-Structured Abstract 

• Sample AMA 11 paper 
• Template AMA 11 paper  

Papers Using Structured Abstract 

• Template AMA 11 paper 

Additionally, the Writing Center also has a sample AMA 11 style annotated bibliography .

Here are a few things to keep in mind as you format your paper : 

• Title Page : The title page should include the report's title, student's name, and student ID number, date, and word count. A sample title page is found on the Liberty University's Writing Center's sample papers . 
• Margins/Alignment : Your papers should use 1-inch margins on standard-sized paper (8.5' X 11'). Make sure that you use Align left (CTRL + L) throughout the paper, except for the title page.  
• Spacing : The AMA does not have a standard for line spacing. Double-spaced lines are recommended throughout the body of your work, excluding block quotations. Block quotations are single-spaced, left-justified, with the entire left margin indented 1/2 inch. 
• Indentation : The first sentence in each new paragraph in the body of the paper should be indented 1/2 inch. AMA style references are listed in numerical order and do not receive any indentation. 
• Fonts : The AMA does not have a standard font or font size. Liberty University recommends that you write your papers in 12-point Times New Roman font for the body, and for all elements other than the title of the paper and headings. 
• Headings : The AMA Manual outlines four different heading levels. The title of your report and Level 1 headings must be in bold Arial 14-point font. Level 2 headings are in bold Arial 12-point font. Level 3 headings are in bold Arial 12-point font and underlined. Level 4 headings are in bold Arial 12-point font and italicized. 
• Tables and Figures:  In AMA-style papers, tables and figures are included in the body of the report. Section 4.0 of the AMA Manual of Style outlines how to format tables, figures, and multimedia. Tables and figures are numbered consecutively: Figure 1, Figure 2, etc. 
• Formatting Your References : Section 3.0 of the AMA Manual of Style outlines how to cite sources in text and how to format the references list found at the end of the work. The AMA style uses an endnote citation system, with references being provided in order of first use. 
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AMA Guide - 11th Edition: Paper Formatting

• Paper Formatting
• In-Text Citations
• Database Specific Formatting

Explicit instructions for paper format are not given in the AMA manual because publishers provide specific requirements for submitted manuscripts.  These research paper format guidelines have been chosen by faculty for South College students, and can be found in the official South College AMA Style Guide. 

Note:  Your instructor may have specific or additional requirements not listed in this guide.

AMA Paper Formatting Checklist

General format.

• Margins are 1 inch on all sides throughout. 
• Paper is double spaced throughout, including the title page, block quotes, and references.
• Use the serif typeface Times New Roman or Arial. 
• Use a 12pt font size throughout. 
• Pages are numbered consecutively, right aligned in the header, starting on the first page of text. Exclude the title page and, if required, the abstract page.
• All text is center aligned and double spaced.
• Full title of the paper begins a quarter down the page. 
• Authors' full name(s) including middle initials.
• Couse Number - Course Name
• Assignment: Assignment Name if required
• Affiliated institution

Abstract (If Required by Instructor)

• Separate page after the title page.
• Abstract is the section title, it is left aligned and not indented.
• Text is in a block under the section title, it is not indented. 
• Maximum 500 words.
• Does not include quotations or reference citations. 
• Keywords: 
• Introduction
• Body Paragraphs
• Section headings are bold and left aligned. 
• Subsection headings are italicized and left aligned. 
• The first line of each paragraph is indented 1/2 inch.
• There is no extra line space between paragraphs or headings. 
• Block quotes are double spaced, are not indented, and are 1/2 inch from the left margin. 
• Avoid starting a sentence with a number.  If unavoidable, write out the number instead of using Arabic numerals.

Reference List

• References  heading is bold and left aligned at the top of the page.
• References are left aligned. 
• References are numbered in the order they are first cited in the body of the paper. 
• A tab space separates the number and the first name or word of the reference. 

Tables & Figures

Each table is assigned a number based on the order it is used in the article. Following the table number (and just above the table itself) should be a clear but concise title in title case.  All elements in the table are in sentence case.

Footnotes are listed at the bottom of the table, each on its own line. However, to save space, tables with more than a few footnotes can use 2 columns for the footnotes.

For more information on formatting and when to use tables, see the Tables Components section of the AMA Manual online. 

• AMA Manual of Style - Ebook This link opens in a new window 11th edition ebook. May need to refresh page after logging in.

Similar to tables, each figure is assigned a number based on the order it is used in the article. Types of figures include, but are not limited to, graphs, charts, maps, drawings, and photographs. Some figures use symbols to represent data, and those figures use legends embedded in the graphic to explain those symbols. 

Following the figure number (and just above the figure itself) should be a clear but concise title.  All elements in the table are in sentence case.

For more examples and guidelines for how and when to use figures in a paper, see the Figures section of the AMA Manual online.

Do I use an appendix in AMA?

• What is an appendix?
• How do I use an appendix?
• How do I make an appendix?

Appendices are not regularly used in AMA. AMA formatting prefers that the information, if relevant to the article, be included in the body of the article as a table or figure.  If the appendix is important, AMA favors publishing them online as online only, supplemental materials.  

The AMA Manual of Style does note that an appendix may be used "on rare occasions...for data that cannot easily be represented as a table or figure and are too central to the article to be deposited elsewhere".  The appendix is included at the end of the paper but  before  the references. Sources for any materials in an appendix are then included in the reference list. 

When an appendix is included in an article, it is cited in the text like a table or figure.  

Example:  This kitchen is rated a 5 on the Hazard Scale (Appendix 1). 

Format an appendix the same way you would start a reference list, with "Appendix" at the top left of a new page. If there is more than one appendix, start each on a new page. Appendices are numbered and organized by the order they are referred to in the body of the article.

Example: 

Hazard Scale

• 1 - The room is completely safe and the likelihood of being injured is very low.
• 2 - The room is relatively safe, but injury is likely if one is inattentive to the environment.
• 3 - The room is completely unsafe and injury or illness is very likely.
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These resources provide guidance on how to cite sources in the text and on a reference list using American Medical Association (AMA) Manual of Style, 11th Ed., including examples for print and electronic sources. AMA was developed by the American Medical Association for the purpose of writing medical research.

References are found at the end of a manuscript and are titled “References,” and each item should be listed in numerical order (two references should not be combined under a single reference number) as opposed to alphabetically. Additionally, each item should be single-spaced.

Sample Reference

AuthorLastname FirstInitialMiddleInitial. Title in sentence case.  Abbreviated Journal Title in Title Case . Year;volume(Issue#):PP-PP. doi: ##

If you are citing an online article, you should include the day and month of publication as well in the format of Month Day, Year.

Use sentence case for all titles (capitalize only the first word of the title). Abbreviate and italicize names of journals according to the listing in the  National Library of Medicine database .

Author Names

When writing up your references list, be sure to always include the last name and the first and middle initial of the authors  without  punctuation. However, do use a comma to separate more than one author in a single bibliographic group (e.g., Wheeler T, Watkins PJ).

If the author's middle initial isn't available, omit it. The abbreviations "Jr" and "Sr" ("Junior" and "Senior") may follow authors' names when applicable (e.g., Jameson JJ Jr). Use Roman numerals to signify "2nd," "3rd," "4th," and so on (e.g., Doe JF III).

Use all authors’ names unless there are more than 6 authors. In that case, list the names of the initial 3 authors, followed by “et al” in place of the others.

Bibliographic Elements

Each reference is divided with periods into bibliographic groups; each bibliographic group contains bibliographic  elements , which may be separated using the following punctuation marks:

• A comma : if the items are sub-elements of a bibliographic element or a set of closely related elements (e.g., the authors’ names).
• A semicolon:  if the elements in the bibliographic group are different (e.g., between the publisher’s name and the copyright year) or if there are multiple occurrences of logically related elements within a group; also, before volume identification data.
• A colon:  before the publisher’s name, between the title and the subtitle, and after a connective phrase (e.g., “In,” “Presented at”).

See the following examples:

In-Text Citations

Each reference should be cited in the text using superscript arabic numerals. These superscript numbers should be outside periods and commas but inside colons and semicolons . Multiple references may be cited in the same instance. If you are citing sequential references, these should be indicated with a hyphen. Nonsequential references should be separated with commas. There should not be a space between numbers. For example: 

As Smith et al have reported, 1-3,5

Smith et al reported 1-3,5 :

AMA recommends that you do not place a superscript reference citation immediately following a number, and advises that you revise the sentence to prevent any possible confusion with an exponent.

Parenthetical citations should ONLY be used for items that do not occur in the references list, such as unpublished material, personal communications, and news articles. These citations may or may not include a title or author, but should include page numbers and, if possible, a DOI or URL.

AMA Style Quick Guide

• Citation Type
• In-Text Citations & Headings
• General Guidelines
• Journal Articles
• Books & eBooks
• Presentations
• Grey Literature
• Tertiary Sources & Additional Publication Types
• RefWorks & Zotero This link opens in a new window

Format Standards

Because AMA formatting is dependent on the publisher where you may be submitting research, it is helpful to pick a source for guidelines and be consistent with those guidelines. A few starting points are suggested below:

• National Library of Medicine | Formatting Requirements The International Committee of Medical Journal Editors (ICMJE) offers guidance to authors in its publication Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals (ICMJE Recommendations), which was formerly the Uniform Requirements for Manuscripts. The recommended style for references is based on the National Information Standards Organization NISO Z39.29-2005 (R2010) Bibliographic References as adapted by the National Library of Medicine for its databases.
• Citing Medicine: The NLM Style Guide for Authors, Editors, and Publishers (2nd Ed.) Citing Medicine provides assistance to authors in compiling lists of references for their publications, to editors in revising such lists, to publishers in setting reference standards for their authors and editors, and to librarians and others in formatting bibliographic citations.

Sample Papers

• AMA Non-Structured Abstract Paper Sample
• AMA Structured Abstract Paper Sample
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AMA Citation Guide: Format Your Paper

• Format Your Paper
• In-text Citations
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• For Authors

Setting Up Your Paper

Margins : Use one inch margins on all pages.

Line Spacing :

• All sections of the paper are single-spaced.
• Double-space between paragraphs and sections.
• A serif (e.g., Times New Roman ) 10pt - 12pt font is used for all sections of the paper.
• In diagrams and charts, a sans serif font is used (e.g., Arial ).

Indents : Use a 1/2 inch indent.

Page Numbering :

• Each page, beginning with the title page, should be numbered consecutively.
• Page numbers are usually placed in the upper, right corner.

Page Headers : Short title headers are placed at the top of the page, aligned with the page number.

Reference List :

• Number the references in the order that they were cited in the text .
• Single-space within the citation and double-space between citations .
• There are no hanging indents as seen in other citation styles.

Be sure to ask your instructor or the publisher to whom you're submitting the paper for more specific formatting rules.

Structured Abstracts

Some publishers require a structured abstract depending on the type of research paper submitted. Be sure to check what the publisher's requirements are.

Basic format for structured abstracts can be seen in PubMed: http://www.nlm.nih.gov/bsd/policy/structured_abstracts.html .

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AMA Citation Guide: Getting Started

• Getting Started
• How do I Cite?
• In-Text Citations
• Reference List and Sample Paper
• Additional Resources

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AMA Style Basics

AMA style is widely used in medicine and the health sciences :

• It uses superscript arabic numerals  for in-text references.
• All cited references  should also be listed at the end of the document.
• Only use the last name and first initial of authors' names, without punctuation , in the reference list (example: Smith A).
• References are divided by specific punctuation into bibliographic groups .
• You must use the standard National Library of Medicine  abbreviations for all journal titles .

Digital Object Identifiers (DOI)

Also known as a permalink, a DOI, or  digital object identifier , is an article's permanent online location. DOIs are used for a variety of academic and non-academic sources that are located online.

Include a DOI for all works that have a DOI. If an online work has both a DOI and a URL, include only the DOI; if the source only has a URL, include the URL.

What is AMA?

AMA stands for  American Medical Association . The  AMA Manual of Style  is the official style guide defining the  citation rules of AMA .  It is a set of rules for research papers and publications.

In AMA, you must cite sources that you have paraphrased, quoted, or consulted to write your research paper. Cite your sources in two places:

• In the body of your paper (in-text citation).
• In the Reference list at the end of your paper (full bibliographic reference).
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AMA Style Guide

Paper format.

• Reference Works
• Miscellaneous
• Mechanics of Style
• Citation Ethics

AMA does not have a specific style for formatting papers, so check with your instructor or assignment guidelines when it comes to margins, line spacing, fonts, indents, title papers, etc.

Recommended Formatting Guidelines

Always refer to the assignment guidelines when it comes formatting your writing. If your assignment does not specify any formatting, follow these general AMA guidelines:

• Margins:  One inch margins are required around the text. Leave the right margin unjustified (ragged). No columns!
• Line Spacing:  Double-space the main text (single space only within the abstract, notes, titles and headings, block quotes, tables and figures, and references—everything but the main text)
• Font:  Use Times New Roman, 12-point font
• Indents:  Half-inch indents are standard (use the “tab” button) for new paragraphs
• Page Numbers:  Place page numbers in the top right-hand corner throughout (starting with the title page)
• Page Headers:  Put the title of your document in the top left-hand corner of the page
• Title of document
• Your Instructor’s name
• Course title
• Your instructor’s name

References Page

• This is a separate page at the end of your paper. Each citation in the text must be listed on the References page; each listing on the References page must appear in the text. 
• Left-justify the word References.  Then double space and start your list with 1.
• References are listed numerically in the order they are cited in the text of the paper.  Put a period after each number.
• Single space each reference.  Double space between references.
• If the citation extends to a second line, do NOT indent.
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AMA Citation Style: Format Paper

• Format Paper
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General Formatting Rules

• Abstract: 2.5.3 Always consult the journal’s instructions for authors; do not begin the abstract by repeating the title; do not cite references; include hypothesis... (see Abstract: general guidelines for full description)
• Acknowledgement: 2.10 “Acknowledgments” is the term used to cover the information that follows the body of the article and precedes the references. NOTE: Placement may vary among journals.
• Appendixes: 2.11 Appendixes are material that might be considered ancillary to the content of the article (i.e. survey).
• Bylines and End-of-Text Signatures: 2.2 In general major articles, authors are listed in a byline, which appears immediately below the title or subtitle. The authors' names and academic degrees are used, as in the byline.
• Capitalization 10.1 First word of every complete sentence should be capitalized, as well as the first word of a title.
• Figures: 4.2 Graphs, line art, diagrams, charts, and other black-and-white figures should be submitted as a high quality resolution electronic file. NOTE: Preferred format for submitting figures varies among scientific journals.
• ePub Ahead of Print 2.10.15 For manuscripts and articles that have been previously posted to a preprint server, the following formats may be used... (see page for full details).
• Quotation Marks in Titles: 2.1.1 If quotation marks are part of the title or subtitle, then use double, not single quotation marks. more... less... Example: "Count Me In": Advocacy in Public Health
• Running Foot: 2.4 Pages customarily have the journal name or journal abbreviation, volume number, date of issue, and page number. You may also include a shortened version of the article title.
• Subtitles: 3.10 Follow the same rules for titles for spelling, abbreviations, numbers, capitalization, and use of italics. NOTE: Only exception is for journal articles the subtitle begins with a lowercase letter. more... less... Example: Hallier J, Baralou E. Other voices, other rooms: differentiating social identity development in organisational and pro-am virtual teams. New Technology, Work & Employment. 2010;25(2):154-166. doi: 10.1111/j.1468-005X.2010.00245.x.
• Tables: 4.1 Information in the table must be accurate and consistent with that in the text in content and style. It should be able to stand independently, without requiring explanation from the text.
• Titles & Subtitles: 2.1 At the top of the page, use a short title header that is concise and informative. The subtitle may expand on the title as supplementary information but should not contain key elements of the study.

AMA Style Citation Tips

Tips: References List 3.2

• Cited works are numbered in order of initial appearance in the text and appear in the Reference List in numerical order.
• Use Arabic superscript numerals outside periods and commas, and inside colons and semicolons.
• Authors’ names are inverted and use only initials for first and middle names. No periods between initials.  ( Example - Antosh, MA)
• In article titles, only capitalize the first word, proper nouns, and abbreviations that are ordinarily capitalized.
• Use accepted Index Medicus abbreviations of journal names (see the List of Journals Indexed in Index Medicus ).
• For journals, use issue numbers in parentheses after the volume number. If there is no issue number specify the month before the year.

Tips: Titles 3.9

• In titles of articles, books, parts of books, and other material, retain the spelling, abbreviations, and style for numbers used in the original. 
• Numbers that begin a title are spelled out (although exceptions are made for years; see 2.1.2 , Manuscript Preparation, Titles and Subtitles, Numbers).

Tips: Numbering 3.5

• References should be numbered consecutively with Arabic numerals in the order in which they are cited in the text. 
• Two references should not be combined under a single reference number.

Tips: Reference Given In text 3.3

• In the text, the author(s) may not be named,
• The title may not be given,
• The name of the journal is abbreviated only when enclosed in parentheses,
• Inclusive page numbers are given.
• Some resources, such as Web URLs, may be listed in the text when it is the Web site itself that is referred to rather than content on the site.

Subject Guide

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Citation Styles & Evaluation Guides: AMA 11 (AMA Manual of Style)

• APA 7 (American Psychological Association)
• MLA 9 (Modern Language Association)
• Chicago 17 (Chicago Manual of Style)
• ASA 7 (American Sociological Association)
• Citations During Public Speaking
• AMA 11 (AMA Manual of Style)
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AMA 11 Updates & Video

The Reference List

• AMA Citation uses a NUMBERED Reference List
• The Reference List is NOT Alphabetized
• For example, the first item in the Reference List should be 1.  This should also be the first item cited in the paper. 

AMA 11 How to...

• AMA Abstract Format
• AMA Paper Format
• AMA PDF Citation Examples

General Guidelines for an AMA Paper

• The AMA Manual of Style provides no specific preferences for font style or size; however, the following are good standards for a college-level paper  
• Font: 12-Point Times New Roman is mentioned for easy readability
• Double spaced
• 1" margins
• Title Page:
• In center: Title of Paper, Name, College, Course # and Name, Instructor, Due Date
• Page numbers in upper right corner
• Section headings
• References List (numbered, not alphabetical)
• NOTE:  A DOI (digital object identifier) is preferred over URL. If you use the DOI, you should NOT include the URL or date accessed. 
• NOTE:  If there is no date, put "date unknown" in place of the year
• NOTE: To ensure you are following assignment guidelines, check with your professor.

The abstract and 3-10 key words should be included on the title page following the title, author and institution information.

Most often, you will be writing a literature review or reporting original data, and therefore will use a structured abstract, limited to 250 words, that uses predetermined headings.

The AMA handbook recommends use of the following:

• Evidence acquisition
• Conclusions

However, this is a common variation asked for by professors:

• Methodology and/or Research Design
• Results (often reported quantitatively when appropriate)

Objective:  To investigate the effect of music therapy on overall recovery time in pediatric patients post-operation.  Methods:  We used data collected from previous literature to compare recovery times in the population of interest.  Results : Review of literature revealed a weak, negative correlation between exposure to music therapy and length of stay in recovery.  Conclusion:  While there appears to be a correlation between specialist administered music therapy and shorter recovery times in post-operation patients, more research is needed to objectively define any benefits such therapy can have in a pediatric population.

Key Words:  music therapy, auditory therapy, pediatrics, post-operation recovery, length of stay.

AMA does not outline specifics requirements for typeface (e.g. boldface, italicized) or alignment (e.g centered, left-justified) of headings; as long as they are consistent within the paper and distinguishable from each other they will be acceptable.

• May be centered or left-justified on the line above the text
• May be bolded or not
• Left-justified above the text or at the beginning of the text on the same line
• May be bolded, italicized, or not

The main sections in an AMA literature review are often the same as those found in an APA paper (Introduction, Methods, Results, Discussion, etc.).

Introduction

This is where your background information goes. After informing the reader about your topic, this section should also present your research question and reason for your research. Include information about why this research is important and/or why it’s a problem, as well as how it ties to previous research in the field.

This section details how you conducted your research. You should outline databases (e.g., Ebsco Host, PubMed, etc.) filters (e.g., academic/peer-reviewed sources, date limitations, etc.), and keywords used in your searches and describe trends in the outcomes of these searches. This is also the section in which you should describe and justify your inclusion and exclusion criteria – i.e., the details of a study’s publication, design, or population that either allow it to be included or excluded from your research (e.g., “only studies published after 2005 were included” or “studies including participants over the age of 16 years were not considered”).

In a report of original data, this section will most often summarize the collected data and include tables and figures used to analyze the results. If you are reporting on original research or quantitative data, this section will not provide any commentary or analysis of the results’ significance. In a literature review, this section will summarize and synthesize the major results and conclusions of the reviewed literature. It will often be structured with subheadings that organize your analysis by topic (e.g. “Music Therapy in Neurosurgery Recovery” or “Music Therapy in Addition to Pain Management via Pharmaceuticals”).

The interpretation of your results goes here. Possible biases and/or weaknesses of the study or studies may be discussed, such as how sample demographics, study design, or reporting methods may have biased the results to a particular conclusion. You should also identify any gaps in the literature that may lead to potential for future research. In addition to this, your discussion section should describe the significance of your research to the greater body of knowledge or its role in solving the presented problem.

The heading for this section should be “References,” bolded and left-justified at the top of the next page. The references should then be numbered down the page in the order they appear in the text. References should not be double-spaced.

AMA 11 Citation Examples

• In-Text Citations
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AMA Style (10th ed.): AMA Style

• Citing Online Materials
• Citing Print Materials
• References Within Your Paper
• Details to Remember

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What is AMA Style?

The American Medical Association (AMA) style was created by editors of the Journal of the American Medical Association (JAMA). AMA style specifies writing and citation styles for scholarly works in medicine. AMA style is internationally recognized and is used throughout disciplines in the health sciences. The AMA Manual of Style was first published in 1963, and is currently in its 11th edition (2020).

Helpful AMA Guides

• Purdue OWL: AMA Style A guide to AMA Style from the Purdue Online Writing Lab.

Citing and Writing Handouts

• Using Review Articles Review this handout to make sure you're using review articles appropriately.
• Quick Citing Reference - AMA Used with permission of Norris Library

All content used by permission of the Norris Medical Library

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AMA Journal Citation | Guide with Examples

Published on September 16, 2022 by Jack Caulfield . Revised on June 1, 2023.

To cite a journal article in AMA citation format , you need an AMA reference listing the author’s name, article title (in sentence case), journal name (title case, italicized, and abbreviated ), publication year, volume, issue, page range of the article, and DOI if available.

An AMA in-text citation for a journal article consists of the number of the relevant reference, written in superscript. You can also add page numbers in parentheses if you need to refer to a specific part of the article.

Table of contents

Citing an article with a doi, citing an online article with no doi, citing a print article with no doi, journal name abbreviations, other interesting articles, frequently asked questions.

AMA states that when an article lists a DOI (digital object identifier), you should always include it in your reference. This applies whether you read the article online or in print. The DOI may be shown in the text of the article itself or on the webpage hosting it.

The DOI appears at the end of the reference, preceded by “doi:” This text is not capitalized , and there’s no space between it and the DOI number itself. The DOI ends with a period. Don’t present the DOI in the form of a link, and don’t include an access date.

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If you accessed the article online and you don’t see a DOI, you should include the URL instead. The page will often list a “stable link” that shouldn’t change over time; it’s best to use this whenever available, instead of copy-pasting the URL from your browser.

Whenever you include a URL for any source type in AMA style, you should also add an access date. Write the access date right before the URL, as its own sentence starting with “Accessed.”

When a DOI is available, include it instead, and don’t add an access date.

When you cite an article that you accessed in print, you should still list a DOI if one is indicated. If not, though, you can simply omit this part, ending the reference with the article page range.

AMA citation format requires you to always use standard abbreviations for the names of journals in your references. The abbreviated journal name is presented in italics, with a period at the end (but no periods at the end of each abbreviated word).

The standard abbreviations are the ones used in the National Library of Medicine database . To check the correct abbreviation for a journal, you can search for it (or for the name of the particular article you’re trying to cite) in the database.

For example, in the screenshot below you can see the correct abbreviation for the journal searched for: “ Int J Qual Health Care .”

If you want to know more about ChatGPT , AI tools , citation , and plagiarism , make sure to check out some of our other articles with explanations and examples.

• ChatGPT vs human editor
• ChatGPT citations
• Is ChatGPT trustworthy?
• Using ChatGPT for your studies
• What is ChatGPT?

 Working with sources

• Paraphrasing
• Critical thinking
• Boolean operators
• Synthesizing sources

 Plagiarism

• Types of plagiarism
• Self-plagiarism
• Avoiding plagiarism
• Academic integrity
• Consequences of plagiarism
• Common knowledge

A DOI (digital object identifier) is preceded by the text “doi:” (no capitalization and no space) in an AMA reference . Don’t present it in the form of a link; only include the DOI number itself. For example: “doi:10.1177/2373379916644449.”

AMA style states that you should include the DOI of a source whenever one is available. They mainly appear in AMA journal citations and can also appear in AMA book citations . When you include a DOI, don’t add a URL or access date.

The names of up to six authors should be listed for each source on your AMA reference page , separated by commas . For a source with seven or more authors, you should list the first three followed by “ et al ” : “Isidore, Gilbert, Gunvor, et al.”

In the text, mentioning author names is optional (as they aren’t an official part of AMA in-text citations ). If you do mention them, though, you should use the first author’s name followed by “et al” when there are three or more : “Isidore et al argue that …”

Note that according to AMA’s rather minimalistic punctuation guidelines, there’s no period after “et al” unless it appears at the end of a sentence. This is different from most other styles, where there is normally a period.

Yes, you should normally include an access date in an AMA website citation (or when citing any source with a URL). This is because webpages can change their content over time, so it’s useful for the reader to know when you accessed the page.

When a publication or update date is provided on the page, you should include it in addition to the access date. The access date appears second in this case, e.g., “Published June 19, 2021. Accessed August 29, 2022.”

Don’t include an access date when citing a source with a DOI (such as in an AMA journal article citation ).

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If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

Caulfield, J. (2023, June 01). AMA Journal Citation | Guide with Examples. Scribbr. Retrieved April 15, 2024, from https://www.scribbr.com/ama/ama-journal-citation/

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AMA Style (11th ed): Citing Your Sources

• Reference List
• References Within Your Paper
• Manuscript styling
• Videos and tutorials

Basic rules for all AMA citations

Anonymous works:

If there is no named author, follow the citation style for the item, and omit the author name field.  If the item is really authored by a person going by the name Anonymous, use the word "Anonymous" as if it were a complete name of the author, and then use the appropriate style.

Author names in all references:

For materials with 1-6 authors or editors, list all author or editor names.

For materials with 7 or more authors or editors, list the first three, then abbreviate with et al. 

Capitalization of titles in reference list:

For journal article titles and book chapters: capitalize the first letter of the first word, proper names, names of trials or study groups, and abbreviations. For titles of books and government documents, capitalize the first letter of each major word, but not articles, prepositions of less than 3 letters, conjunctions, or infinitives.

(note: No guidance is provided regarding capitalization for titles of conference materials, titles of journals, or other titles used in AMA citations.)

Titles of journals :

Use PubMed journal abbreviations. You can find these by using the citing tool within PubMed, or search the NLM Catalog for journal titles to locate the preferred abbreviation. If no abbreviation is found in PubMed or the NLM Catalog, consult section 13.10 of the AMA Manual of Style for standard abbreviations for individual words used in a title.

Non-scholarly or non-peer-reviewed materials appearing in journals (editorials, letters to the editor, comments, interviews, etc.):

Unlike prior editions of AMA style, the 11th edition has removed the suggestion to indicate special types of materials within journals. Cite all materials published in journals using the article style.

Use of Artificial Intelligence (A.I.):

"Nonhuman artificial intelligence, language models, machine learning, or similar technologies cannot be listed as authors because these technologies do not qualify for authorship." (quotation from AMA Manual, section 5.1.12). According to a strict reading of the Manual, AI programs should never appear in a reference list as an author or creator of content. Instead, AMA suggest that writers place an acknowledgement into the acknowledgement section of the manuscript or describe how AI was used in the Methods section of the manuscript. The primary goal of the AMA Manual of Style is to share the official JAMA (Journal of the American Medical Association) guidance for formatting manuscripts for JAMA, so this is helpful in this context. However, it is difficult to put into place in coursework, where assignments typically do not include either an acknowledgements or Methods section. When writing for a class, review  the syllabus or  speak with the faculty member to determine if you are allowed to use AI tools, then use the guidance on this page to appropriately describe use of AI in your written assignments.

How to cite information when there is no guidance on this website:

This website attempts to summarize over 500 pages of content from the AMA Manual and cannot cover all. Read the AMA Manual of Style, section 3, to find guidance for citing many other types of publications. If there is no guidance in the Manual on your specific type of publication-- which there may be, the Manual does not include everything-- adapt an existing AMA citation style.

General format: Author AA, Author BB, Author CC. Title of article. Abbreviated Title of Journal. Year of publication;volume(issue):complete page numbers or e-locator. DOI (if not provided, omit and replace with an accessed date and a URL)

Note that there is no period at the end of the DOI or URL in online journal article citations.

Print journal article:

Towfighi A, Markovic D, Ovbiagele B. Utility of Framingham coronary disease risk score for predicting cardiac risk after stroke.  Stroke. 2012;43(11):2942-2947.

Journal article viewed online with DOI available:

Towfighi A, Markovic D, Ovbiagele B. Utility of Framingham coronary disease risk score for predicting cardiac risk after stroke. Stroke . 2012;43(11):2942-2947. doi: 10.1161/STROKEAHA.112.668319

Journal article viewed online, but the journal does not use DOI:

Ng L, Karunasinghe N, Benjamin CS, Ferguson LR. Beyond PSA: are new prostate cancer biomarkers of potential value to New Zealand doctors? N Z Med J. 2012;125(1353). Accessed April 15, 2020. https://www.nzma.org.nz/journal-articles/beyond-psa-are-new-prostate-cancer-biomarkers-of-potential-value-to-new-zealand-doctors/

Artificial Intelligence (A.I.)

"Nonhuman artificial intelligence, language models, machine learning, or similar technologies cannot be listed as authors because these technologies do not qualify for authorship." (quotation from AMA Manual, section 5.1.12). No AI programs should ever appear in the numbered reference list. AMA suggests that writers place an acknowledgement into the acknowledgement section of the manuscript or describe how AI was used in the Methods section of the manuscript. This advice is difficult to put into place in coursework, where assignments typically do not include either an acknowledgements or Methods section. When writing for a class, review  the syllabus or  speak with the faculty member to determine if you are allowed to use AI tools, then use this guide to get ideas for how to acknowledge the source.

"Section 5.2.1.1 Acknowledgment of Use of Artificial Intelligence and Language Models in Writing and Editing

Authors should report the use of artificial intelligence, language models, machine learning, or similar technologies to create content or assist with writing or editing of manuscripts in the Acknowledgment section or the Methods section if this is part of formal research design or methods. This should include a description of the content that was created or edited and the name of the language model or tool, version and extension numbers, and manufacturer. (Note: this does not include basic tools for checking grammar, spelling, references, etc.)."

Strict interpretation of this for publication in a journal:

In 1-5 sentences, describe what you used AI to do in the manuscript, with enough information to explain the actual model used. Place this in the Methods section if the AI content was important to the methods. Otherwise, place in the Acknowledgements section. The AMA Manual does not provide any examples. Here are two examples created by a USC librarian that attempt to fulfill the AMA rules:

"On August 3, 2023, I used AI to summarize five research papers, to help me determine which idea was least studied and focus my topics for this essay. I used ChatGPT, model 3.5, made by OpenAI, hosted at https://chat.openai.com/."

"I used Bard, release 2023.07.13, made by Google and hosted at https://bard.google.com/, to edit my manuscript. I uploaded my original writing and asked Bard to reduce the word count and make the language more formal. I also used Bard to determine which of the data points I had collected would be the most useful for including as figures, and used its advice to create figure 1 and table 2."

Potential ways to acknowledge use of AI tools in a written document for a course:

There is no guidance on this from the AMA Manual. As typical with this style, when no guidance exists, try to follow the basic rules of the style while respecting the underlying goal of any citation system: to acknowledge the use of other's ideas, thoughts, and opinions. While AI might not be a person, it’s still not you, so its ideas and work needs to be acknowledged. Based  on this, here are some options that might work:

- While your assignment may not require you to include a formal Methods section, you could decide to include one anyway. You could describe all the methods used to create this assignment: searching for literature, using modeling software, collaboratively editing with a colleague, etc., alongside how you used AI, and which model you used.

- Add a few sentences about your use of AI and the model (as recommended by AMA) into another section of the assignment. If you used AI to generate ideas, perhaps this acknowledge would fit into the introduction. If you used AI to edit the paper, this might be acknowledged in the conclusion. 

- AMA style requires a numbered reference list. You could add an unnumbered bullet point to the start or end of your reference list that acknowledges the use(s) of AI in your assignment and provides the model number as instructed by AMA.

Books and chapters

General format: Author AA, Author BB, Author CC. Title of book . Edition number (if beyond first). Publisher name; year of publication. To indicate online access, add the word Accessed and the date you accessed the item, then the URL.

While some books and book chapters may have assigned DOIs, book citations do not include DOIs, only URLs and accessed dates. If a book has editors instead of or in addition to authors, their names are indicated with "eds." after the author field names.

Print book:

Wasserman K, Hansen JE, Sue DY, et al . Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications . 5th ed. Wolters Kluwer Health/Lippincott William and Wilkins; 2012. 

Entire edited print book:

Alldredge BK, Corelli RL, Ernst ME, et al., eds. Koda-Kimble and Young’s Applied Therapeutics: The Clinical Use of Drugs. 10th ed. Lippincott Williams and Wilkins; 2013.

Chapter within an edited book in print:

Relling MV, Giacomini KM. Pharmacogenomics. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics . 12th ed.  McGraw-Hill; 2011: 145-168.

Book viewed online:

Suchmacher M, Geller M. Practical Biostatistics. Elsevier; 2012. Accessed November 5, 2012. https://www.sciencedirect.com/science/book/9780124157941

Edited book viewed online :

Brunton LL, Blumenthal DK, Murri N, Hilal-Danden R, Knollmann BC, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics . 12th ed. McGraw-Hill; 2011. Accessed November 4, 2012. https://www.accesspharmacy.com/resourceToc.aspx?resourceID=28

Chapter within an edited book viewed online:

Relling MV, Giacomini KM. Chapter 7. Pharmacogenomics. In : Brunton LL, Blumenthal DK, Murri N, Hilal-Danden R, Knollmann BC, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics . 12th ed. McGraw-Hill; 2011. Accessed October 4, 2012. https://www.accesspharmacy.com/content.aspx?aID=16659580

Conference presentations

If materials presented at a conference are published elsewhere as a book, issue of a journal, or other medium, AMA instructs you to cite them using that reference style. Only use this style for materials not formally published as part of another publication.

General format: Author AA, Author BB, Author CC. Title of poster.  Poster presented at: Name of conference; Month, Day Year; City, State abbreviation.

Pasternak B. Carvedilol vs metoprolol succinate and risk of mortality in patients with heart failure: national cohort study. Paper presented at: European Society of Cardiology Congress; August 31, 2014; Barcelona, Spain. Morales M, Zhou X. Health practices of immigrant women: indigenous knowledge in an urban environment. Paper presented at: 78th Association for Information Science and Technology Annual Meeting; November 6-10, 2015; St Louis, MO. Accessed March 15, 2016. https://dl.acm.org/doi/10.5555/2857070.2857108

• If the conference is held outside the US, replace "City, State" with City, Country.
• The manual instructs you to use this to cite any type of presentation occurring at a conference, using any special name the conference chose to use. To cite a poster, a presentation, a keynote address, a panel, a lecture, etc., replace the word 'paper' in the phrase  "Paper presented at."
• Add the Accessed date and the DOI (preferred) or the accessed date and URL (if DOI not available) for materials you viewed online.

Government or agency reports

3.13.2 Special Materials: Government or Agency Reports provides this format for citing reports issued by a department or agency of a government.

(1) name of author (if given); (2) title of bulletin in italics; (3) name of issuing bureau, agency, department, or other governmental division; (4) date of publication; (5) page numbers (if specified); (6) publication number (if any); (7) series number (if given); (8) online accessed date (if applicable); and (9) web address (if applicable).

3.15.5 Electronic References:Government/Organization Reports provides this guidance for citing Government/Organization reports: "These reports are treated much like electronic journal and book references: use journal style for articles and book style for monographs."

• There is no guidance provided in the Manual for how to differentiate between "reports issued by a department or agency of a government" or a "government/organization report," and so there is no way to determine which of these is "more correct." Be consistent in your choices for citation in your document and within content: if you cite two articles from MMWR, use the same style for each.
• While some online-issued government reports include DOIs, AMA style requires the accessed date and URL.
• The example in the Manual for Government or Agency Reports includes semicolons between each field; the worked examples in the Manual show semicolons, colons, periods, and commas between fields, and there is no explanation for how or why to use each diacritical mark.. In creating examples, the diacritical marks used in the Manual were used as guides.

MMRW is a journal that publishes reports from the US CDC. Based on the rules of AMA Style, you could choose to cite reports from MMWR as a Government Report or a Journal Article. Here is the same report in both styles:

Selik RM, Mokotoff ED, Branson B, Owen SM, Whitmore S, Hall HI. Revised Surveillance Case Definition for HIV Infection- United States, 2014 . Centers for Disease Control and Prevention. 2014;1-11: Morbidity and Mortality Weekly Report. Accessed January 5, 2019. https://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf

Selik RM, Mokotoff ED, Branson B, Owen SM, Whitmore S, Hall HI. Revised Surveillance Case Definition for HIV Infection- United States, 2014. MMWR. 2014;63(3):1-11. Accessed January 5, 2019. https://www.cdc.gov/mmwr/pdf/rr/rr6303.pdf

The Government Accountability Office is a federal office charged with assessing the function of federal government. They publish reports in the form of monographs. Based on the rules of AMA Style, you could choose to cite reports from this office as a Government Report or Monograph style:

Covid-19:Federal Efforts Could be Strengthened by Timely and Concerted Actions . United States Government Accountability Office. September 21, 2020. GAO-20-701. Accessed January 5, 2021. https://www.gao.gov/assets/710/709934.pdf

United States Government Accountability Office. Covid-19:Federal Efforts Could be Strengthened by Timely and Concerted Actions. Government Publication Office; 2020. Accessed January 5, 2021. https://www.gao.gov/assets/710/709934.pdf

In citing data from a website, include the following elements, if available, in the order shown:

■ Authors’ surnames and initials, if given, or name of the group who made the site

■ Title of the specific item cited. If none is given, use the name of the organization responsible for the site.

■ Name of the website

■ [Date published]

■ Updated [date]

■ Accessed [date]

■ URL (verify that the link still works as close as possible to publication)

There is no guidance in the Manual on how to separate elements (using periods, commas, semicolons, etc.); the example above is directly copied from the Manual. The examples below use the diacritical marks as shown in one example in the Manual, separating each field with a period.

Warfarin. Drug Information Online: Drugs.com. September 1, 2012. Updated January 23, 2020. Accessed April 15, 2020. https://www.drugs.com/cons/warfarin.html

DrugBank Online. Acetaminophen. DrugBank Online. June 13, 2005. Updated January 5, 2021. Accessed January 5, 2021. https://go.drugbank.com/drugs/DB00316

Additional citation types

Package insert s and prescribing information

Name of drug. Type of material. Company Name; year of publication. To indicate online access, add the accessed date and URL.

Lamasil. Package insert. Sandoz Pharmaceutics Corporation; 1993.

Lovenox. Prescribing information. s anofi - aventis U.S. LLC. Accessed April 15, 2020. https://products.sanofi.us/Lovenox/Lovenox.pdf

Drug Monographs . AMA style does not provide rules for citing drug monographs. These are suggested by the Norris Library and were created by adapting the book and website styles, as these contain similar pieces of information.

Print drug monographs

Author AA. Title of monograph being cited . Editor AA, ed. Title of book . Edition (if beyond first). Publisher name; year of publication.

Online drug monographs

Title of monograph. Title of book of monographs . Title of compendia where book is found (only include if different than book title). Pub lished date. Updated date. Accessed date. URL

Lisinopril. McEvoy GK, ed. AHFS Drug I nformation 2014 . American Society of Health - System Pharmacists, Inc.; 2014.

Lisinopril. AHFS DI (Adult and Pediatric) . Lexicomp. Updated March 11, 2016. Accessed May 11, 2016. https://online.lexi.com/lco/action/doc/retrieve/docid /complete_ashp /414040

Inventor names, inventor; assignee company, assignee. Title of patent. Patent issued agency and number. Date patent was grant ed.

Abram AZ, Fuchsuber L, inventors; Stiefel Research Australia, assignee. Foamable suspension gel. US Patent 8,158,109. April 17, 2012.

Note: this example is for a patent that was granted by the US Patent Office. To cite a patent issued by a different patent office, use this same style but replace the words "US Patent" with the issuing body: WIPO Patent.   You may instead need to cite a patent application. Use the same style, but replace the words "US Patent" with "US Patent Application."

Personal communications:

AMA Style states that personal communications such as phone calls, emails, conversations, etc. are not included in the reference list. However, you should cite these materials parenthetically within the text. Provide the name and highest academic degree of the author, type of communication, and date sent. If this would compromise patient anonymity, replace the name with a title and remove the day of communication.

Individuals on this new experimental drug should not take aspirin. (Sara P. Norris, M.D., email communication, November 3, 2012.)

For all five patients I have seen with this rare disorder, I have prescribed Interferon. (Physician at LAC + USC Healthcare Network, phone call, October 2012).

Common questions about AMA

What is a DOI?:

A DOI is a Digital Object Identifier. It is a series of letters and numbers that identifies a specific online item. Depending on the publisher, DOIs may be registered through international clearinghouses and function as web links or may not. AMA style allows you to choose to display DOIs in references in two ways, with or without the https://.  doi:10.1001/jama.2017.13737 and  https://doi.org/10.1001/jama.2017.13737 are both acceptable, and used interchangeably throughout the Manual when a DOI is included in a reference. When you discuss a DOI in writing, capital letters are used to denote that this is an abbreviation. When using a DOI in a citation, AMA Style requires all lowercase: doi.

Including words/phrases like "Paper presented at", "Date Accessed," "Date Updated," etc. in the citations: AMA Style sometimes requires the use of these "helper phrases" in the reference; in other cases, they are used in examples to show you where to place the information and will be deleted in your final completed citation. AMA Style is not particularly consistent nor logical in its choices to include or exclude "helper phrases" in citations. Examine both the example citation format and the worked examples citing a specific item to determine what to include.

Use Online or Print style?

AMA Style requires you to cite the version of an item you read. An article might be available online and in a print journal. If you read the online copy, cite it using the online citation format. If you read the print item, use the print format.

The URL is incredibly long-- do I need to include the whole thing? AMA Style's main preference is for you to include the entire and functional URL. However, if a URL is very long and breaks across lines, you may remove portions of the lengthy URL as long as the reader would reasonably be able to access the item from the short URL and information from the citation itself.

Here is an example of when and how to edit URLs:

is a citation to a drug monograph appearing in the book AHFS DI (Adult and Pediatric) available on the online database Lexicomp. The URL provided by Lexicomp for this monograph is actually much longer (it is https://online-lexi-com.libproxy1.usc.edu/lco/action/doc/retrieve/docid/complete_ashp/414040?cesid=aNQswQkZlPy&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dlisinopril%26t%3Dname%26va%3Dlisinopril). If you paste the short URL provided in this citation into your browser, you will arrive at the table of contents of the book AHFS DI (Adult and Pediatric) and can then look for the monograph described in this citation (Lisinopril).

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The AMA Manual of Style does not have specific font type or size requirements for publications.  They do recommend including authors’ complete names on the title page, following the title.  They also recommend putting author information in footnotes on the title page.  Individual journals or assignments may have their own requirements.

Titles should be concise, specific, and informative.  Publishers or assignments may have specific title requirements.  Avoid cute or overly generic titles.  A good rule of thumb is to include these key terms in order:

• Exposure/Intervention

Example: Effect of Behavioral Interventions (1) on Inappropriate Antibiotic Prescribing (2) Among Primary Care Practices (3): A Randomized Clinical Trial (4)

Subtitles should be useful in expanding on the title.  The title should be able to stand on its own and the subtitle is meant to complement it without including too much detail.  Subtitles may also contain the type of study performed or the name of the group responsible for the study.

Complete names of all authors should be included on the title page following the title or as the publisher or assignment specifies.  Authors' names should be consistent in all forms of the text.  The order of the authors should be determined by the following criteria:

• Substantial contributions to the conception or design
• Drafting the work or revising it critically for important intellectual content
• Final approval of the version to be published
• Agreement to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity are appropriately investigated and resolved

Author Footnotes

Author footnotes should be included on the title page or as specified by your publisher/assignment.  Include these in order:

• Author Affiliations
• Information about members of a group (if there is a group author)
• Corresponding author contact information

If there is a group author, you may separately identify and tag members of the group who were authors, non-author collaborators, and other members of the group.

An abstract summarizes the main points of an article and it is meant to stand alone to represent the article.  In many databases, the abstract is searched for keywords and the full text of the article isn't.  If someone doesn't have access to the full text of an article, they will judge whether to purchase access (or request through Inter-Library Loan) by the abstract.  Abstracts are usually 350 words or less, but publishers or assignments may have other requirements. There are two types of abstracts, structured and unstructured.  An unstructured abstract is a paragraph without section headings.  More information on structured abstracts can be found below.

General Guidelines

• Don't begin by restating the title
• Don't cite references or URLs in the abstract - save it for the body of the paper!
• Include major terms
• Include the hypothesis or study question if applicable
• All of the concepts and data mentioned in the abstract must be in the full text

Some publications or assignments may require keywords.

Structured Abstracts

An abstract with section headings.  Different kinds of papers require different headings, but they should always match the text of the article.  If your article doesn't have the section in the text, exclude it from the abstract.

• Participants
• Intervention(s) or Exposure(s)
• Main Outcome(s) and Measure(s)
• Conclusions and Relevance
• Trial Registration
• Data Sources
• Study Selection
• Data Extraction and Synthesis
• Evidence Review
• Observations

The body of your paper will be divided into sections called headings.  You can also have sub-headings within these sections.  While the AMA Style Guide does not give specific font style or size, it recommends being consistent throughout the paper. 

Recommendations

• Always put your headings or sub-headings on their own line.  The text of the section should follow after a return.
• Prepare three levels of headings and sub-headings.
• Use simple formatting to distinguish your headings from each other and the body text.  Consider the font style and size as well as the quality of the font if it is bold or italicized.  Changing just one element is enough - BE CONSISTENT
• Don't introduce abbreviations for the first time in a heading.
• Don't use citations in your headings for references, tables, or figures.  Put these in the body text.

Section Headings

Introduction:.

States the main focus of the paper, why it is important or significant, and gives relevant background information

Outlines the steps taken in performing the research described in the paper in such a way that it can be replicated

The data, qualitative or quantitative, that was produced during the research of this paper

Discussion:

An interpretation of the results and how they relate to the main focus of the paper and other similar studies

Conclusions and Relevance:

The article should end with a clear conclusion that does not go beyond the findings and a statement of relevance.

References should be included after the body of your paper.  They should start on their own page with number 1 and match the order of citations in the text. 

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• Creating In-Text Citations
• Avoiding Plagiarism

Table Components

Citing tables, figure components, figure citation.

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For more information about formatting Tables. Go to section 4.1.4 in the AMA Manual.

• Tables are usually are set off from the text by horizontal rules, or thicker bars (as shown below) boxes, or white space.
• Each table should have a brief, specific, descriptive title that conveys the topic of the table succinctly but should not provide detailed background information or summarize or interpret the results.
• Tables are  numbered consecutively as referred to in the text. The first table that you mention is titled Table 1.
• In your paper you can refer to the specific table you are describing by the title such as "As described in Table 1 ...."
• Position them as close to the referring text as possible.
• Horizontal lines, not vertical.
• ​Descriptive footnotes  contain information about the entire table, portions of the table (eg, a column), or a discrete table entry. The order of the footnotes is determined by the placement in the table of the item to which the footnote refers.  They are then indicated with superscript lowercase letters in alphabetical order (a-z) listed at the bottom each on its own line such as indicated below . In Table 4, Footnote a and b  refer to the  Information in the entire column. 
• To cite references for information used in the table . See Citing Tables below in this guide.

_________________________________________________________________________________________________________________

Table 4.  Ten-Year Prevalence of Fractures, Falls, or Musculoskeletal Injuries Among Beneficiaries  With Disorders of Binocular Vision

References for information in a table should be numbered and listed according to how it was listed in the text.  In other words, if the source from which the material referred to in the table is one of the references used in the text, that same reference number should also be used in the table. See example below for Arabic superscript numeral, 28.

Keep in mind, it is acceptable for a reference to be cited only in a table and not in the text.    If the reference pertains only to the table or figure (ie, the source is not cited elsewhere in the text), the reference should be listed and numbered according to the first mention of the table or figure in the text .  All references in an article should appear in the reference list regardless if it only appears in the table.

Use Footnotes for citing references. 

Use footnotes that contain lower case Arabic letters for citing your references along with  Arabic superscript numerals  outside  periods and commas,  inside  colons and semicolons. See example below with Footnote a  and superscript number 28.

When using footnotes as in the example above ( a ) to reference your sources, use terminology such as:

• if you changed or modified the table as opposed to an exact copy (not suggested or preferred) from the original source.
• If you copied exactly, which is discouraged.
• If you did a calculation. In this case you created a table and used only a minimal amount of data from a source.

When both a footnote letter and reference number follow data within a table , set the reference number first, followed by a comma and the footnote letter.  See example :

427 Patients 5 ,b

For more detailed information about figure components, see section 4.2.6 in the AMA Manual.

The figure title follows the designation “Figure” numbered consecutively (ie, Figure 1, Figure 2). Articles that contain a single figure (as in the one below) use the designator “Figure” (not “Figure 1”). 

The figure legend (caption) is written in sentence format and printed below or next to the figure. It will also contain citations if you did reproduce any data from another source.

Citing your sources.  It is preferable to use original figures rather than those already published.

However when use of a previously published illustration, photograph, or other figure is necessary, written permission to reproduce it must be obtained from the copyright holder (usually the publisher). The original source should be cited in the legend (see example below)  with the citation number for the reference corresponding to its first appearance in the text, tables, or figures. 

These examples of legends that serves as citations, should be placed below the descriptive legend.

Reprinted with permission from the American Academy of Pediatrics. 5

Terminology:  As in proper citation for tables, use terminology that applies to whether you modified or performed a calculation:

Adapted from. . .

Data were derived from. . .

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AMA Style - 10th edition

• Title Page & Formatting
• Text Citations
• Journal Title Abbreviations
• Book Chapters
• Dissertations/Theses
• Journal Articles
• Title (capitalize all major words)
• Author(s) full name(s); if more than one author use semi-colons between names
• Degrees - highest degree/certification is noted; academic degrees below master's degrees are not noted
• Author Affliliations with location
• 12-point font
• Double-spaced throughout (including title page and references)
• Page numbers continuing through the references
• Delineate new paragraphs with indents
• Title page includes
• title of manuscript
• five keywords or descriptive phrases concerning the manuscript's topic
• word counts for the paper including references
• author contact information - full names, academic degreens, and affiliations
• 1-inch margins all around
• Times New Roman font
• Double spaced text - including title page and bibliography
• Title starts approximately 2 inches down from bottom of the top margin
• Left-justify text
• Do not hypenate words and the end of the line

Example: Title Page

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Format your paper, customize our template, cite a book part / chapter / entry in a book, cite a website, cite a journal article, cite a book or an ebook, reference an image in text.

• AMA Citation Style Quick Guide - PDF - 635 KB A custom guide for NWACC classes.
• Sample Essay in AMA Style - PDF - 271 KB This sample essay briefly explains and shows how to format an essay or paper in AMA style.
• Sample Essay in AMA Style - MS Word Doc - 20 KB Download and edit in Microsoft Word or other compatible editor.
• Docx - Formatting the AMA Reference List in Microsoft Word - 46.5 KB Step by step illustrated guide to using Microsoft Word to format the numbered reference list.

FORMATTING YOUR PAPER

AMA citation style is intended to prepare a scholarly article for publication in a medical research journal, such as  JAMA  or  New England Journal of Medicine .  AMA does not address formatting a college research paper.  There are no standards on formatting like we'd expect to find. For example, line spacing, page numbers, etc. Many NWACC instructors provide assignments that spell out the formatting requirements. When the assignment does not provide specific formatting instructions, use these recommended guidelines.

Formatting Guidelines

• Font: Times New Roman 12 pt.
• Line Spacing: Single
• Margins: 1 inch
• Page Numbers: Arabic numerals in the upper right corner (1, 2, 3, etc.)
• Instructor Name
• Course Name
• Title of Paper: Centered on the page in bold type.
• LEVEL ONE : All caps, bold, flush on the left margin. Begin content on the line below.
• Level Two: Title case, bold, flush on left margin. Begin content on the line below. What is "title case?" Title Case is when the first letter of each main word is capitalized. Example of Title Case.
• Section heading: REFERENCES or REFERENCE LIST are both acceptable.
• Numbered list (1, 2, 3, etc.)
• Sources are listed in the order used in the paper.
• Single space entries.
• Double space between entries.

FORMATTING REFERENCE LIST ENTRIES

Because the current version of AMA Citation Style has some ambiguities, NWACC classes use the formatting shown below. Use of citation generators may not produce the same results and result in scoring or grade deductions. For NWACC assignments, use the following format. More information can be found in the Quick Guide pdf document above.

• Docx - Template for Microbiology Infectious Disease papers This template puts the microbiology infectious disease assignment into AMA format. Replace the instructions with your answers.
• Docx - Template for AP2 Disease Research Papers This template uses the Anatomy & Physiology II disease research paper assignment to create a document you can use to replace the questions with your answers.
• Docx: Template for API drug research papers

If it is an ebook or online source, just add the URL & an access date. If it's a print book, just leave those off.

• No period after the URL

Author (if any). Entry or chapter title. In: Editor’s name, ed. Title of Book . Vol. x (if any). n th ed. Publisher’s name; copyright year:page range (if any). Accessed [date]. URL

[If author & name of website are the same, use it as the author and skip listing website.]

Cholera - Vibrio cholerae infection. Centers for Disease Control and Prevention. Reviewed October 30, 2020. Accessed October 24, 2022. https://www.cdc.gov/cholera/index.html

• List the names of all authors unless there are more than 6, in which case the names of the first 3 authors are used, followed by “et al.”
• Journal titles should be listed using their National Library of Medicine (NLM) abbreviation. Find the journal abbreviation in the NLM Catalog .
• Only include the Accessed date if using a URL.

Book 1 or eBook 2 

(citing the entire book)

Image from a Book 1  or a Website 2

1. 10391: Zolpidem. In: O'Neil MJ, Hekcelman PE, Dobbelaar PH, Roman KJ, eds. The Merck  Index . 15th ed. The Royal Society of Chemistry; 2013.

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Citation Quick Guide (APA, MLA, Chicago, AMA)

• Getting Started
• Chicago-Style

Journal Articles

Print books, chapter of a book, government/organization reports, news releases, additional ama guidelines.

For additional AMA Style guidelines, please see the AMA Style page from the OWL at Purdue .

Tip: Use the most recent version of the citation style unless your instructor requests otherwise. 

General Formatting Guidelines

• For both the body of the paper and the references list, cite each source in numerical order (in the order which they were cited) using superscript numerals. Put these numerals outside of commas and periods and inside semicolons and colons. 
• Two references to the same source should not be combined in the reference list, and should be listed the same number of times, in the same order, it was cited in the text. 
• Single space within citations, and double space between citations. 
• Do not use commas or periods to separate author's last name and first and middle initial. Only separate multiple authors' names. 
• Sample AMA Papers In the AMA Format Quick Guide from Liberty University you will find a few examples of AMA formatted papers.
• How to Format the Paper using AMA Style Formatting Guidelines from the University of Washington's Health Sciences Library's AMA Style Guide.

Reference List Basic Format: Online Journal Article

AuthorLast FirstInitial. Title of article. Abbreviated Journal Title . Year;Volume(Issue):Pages. URL/DOI. 

Reference List Example: Online Journal Articles

Quiroz YT, Schultz AP, Chen K, et al. Brain imaging and blood biomarker abnormalities in children with autosomal dominant Alzheimer disease: a cross-sectional study. JAMA Neurol . 2015;72(8):912-919. doi:10.1001/jamaneurol.2015.1099. 

Reference List Basic Format: Print Journal Article 

AuthorLast FirstInitital. Title of article. Abbreviated Journal Title . Year:Volume(Issue):Pages. 

Reference List Example: Print Journal Article

Compston A, Coles A. Multiple sclerosis. The Lancet . 2008;372(9648):1502-1517. 

• Use journal abbreviations provided in the AMA Manual of Style (11th edition) on pages 575-579. Journal abbreviations can also be found in th NLM Catalog by doing an advanced search for the full journal title (be sure to change the filed to journal using the drop down arrow). 

Reference Page Basic Format:

Author Last FirstInitial. Title of Book . Edition (if applicable). Publisher; Year. 

Reference Page Example: Whole Authored Books

Patterson JW. Weedon's Skin Pathology . 4th ed. Churchill Livingstone; 2016. 

Reference Page Example: Edited Books

Etzel RA, Balk SJ, eds. Pediatric Environmental Health . American Academy of Pediatrics; 2011. 

Author Last FirstInitial.  Title of Book . Edition (if applicable). Publisher; Year. Accessed Date. DOI/URL

Reference Page Example:

Williamson J. The Complete Guide to Precision Reflexology . 2nd ed. Andrews UK; 2010. Accessed September 9, 2021. https://ebookcentral.proquest.com/lib/gfcmsu/detail.action?docID=1790770

Reference List Basic Format:

AuthorLast FirstIinitial. Title of book chapter. In: EditorLast FirstInitial, ed. Title of Whole Book . Edition (if applicable). Publisher; Year:chapter pages. 

Reference List Example:

Hemer SR. Global health, Tuberculosis and local health campaigns: reinforcing and reshaping health and gender inequalities in Lihir, Papua New Guinea. In Bainton N, McDougal D, Alexeyeff, et al., eds. Unequal Lives: Gender, Race, and Class in the Western Pacific . ANU Press; 2021:131-156. 

AuthorLast FirstInitial (if available). Title of item cited (webpage, etc). Title of Website. Date Published (if available). Date Updated (if available). Date Accessed. URL. 

What happens to the brain in Alzheimers Disease? National Institute on Aging. Updated May 16, 2017. Accessed September 9, 2021. https://www.nia.nih.gov/health/what-happens-brain-alzheimers-disease

• If no title for the website is given, use the name of the organization responsible for the site. 

Government/Organization Author Name. Title of Report. Publication Date. Updated/Revised Date. Accessed Date. URL. 

Reference List Example: 

Office of the Surgeon General. Confronting health misinformation: the U.S. Surgeon General's advisory on building a healthy information environment. 2021. Reviewed July 15, 2021. Accessed September 9, 2021. https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf

• In general, these types of reports are treated much like electronic journal and book references: use the journal style for articles and the book style for monographs. 
• Of the dates published, updated/revised, and accessed, often only the accessed date will be available. 

News Release Basic Format:

Title of news release. Type of document. Organization/Publisher of Release. Date Published. Date Accessed. URL. 

News Release Examples:

Association between exposure characteristics, risk for COVID-19 infection among health care workers with/without Pfizer-BioNTech vaccination. News release. JAMA Network Open. September 1, 2021. Accessed September 13, 2021. https://media.jamanetwork.com/news-item/association-between-exposure-characteristics-risk-for-covid-19-infection-among-health-care-workers-with-without-pfizer-biontech-vaccination/

Changes in life expectancy after allogeneic blood or marrow transplantation. News release. JAMA Oncology. September 9, 2021. Accessed September 13, 2021. https://media.jamanetwork.com/news-item/changes-in-life-expectancy-after-allogeneic-blood-or-marrow-transplantation/

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• A Research Guide
• Research Paper Guide

How to Write a Research Paper in AMA format

• Basic rules of AMA style
• Basic structure
• Margins, font, and spacing
• Title page and abstract
• Body of AMA research paper
• AMA references page
• Citing different sources

Basic rules of AMA style format

Working with an AMA-style format is simple if you have used MLA or APA formatting in the past. The basic citation rules go as follows:

• Your content must be double-spaced within the text of your assignment.
• Using single-spaced text within the abstract section of your research paper, notes, titles, and headings is necessary.
• Use single-spacing for the block quotes, tables, figures, and references page.
• Page number always starts at the title page of your research paper and must be placed in the upper right corner.
• One-inch margins with the 0.5 inches paragraph indents must be provided for each new paragraph that you have.
• It is recommended to keep your main content aligned to the left.
• Avoid formatting your text in columns. While the latest manual has been allowed in the previous AMA format editions, it speaks against it.

It is also required that all AMA references must be cited numerically with the use of consecutive order. It is recommended to use superscript Arabic numerals when using citations. Remember to use numerals outside periods and commas as you cite.

Note: The rules and examples in this AMA guide use the latest 11th edition, available since Spring 2021. Before you start to write AMA research paper, consult your academic advisor and/or your grading rubric to ensure that you follow the required style in formatting and AMA citations.

The basic structure of the AMA research paper

Turning to the AMA style manual, one cannot find specific tips or recommendations regarding how to structure a medical research paper. What it includes, however, is the presence of specific research paper sections that must be included. It means that when the AMA format is used, most colleges and universities in the United States and other English-speaking countries require:

• A title paper with complete information about the course, department, and academic advisors.
• An abstract is formatted according to the rules, depending on whether an author uses a structured or a non-structured abstract.
• An ethical guidelines paragraph that showcases the manuscript preparation and a list of relevant permissions.
• The use of tables and figures.
• Presence of supplementary materials and medical manuals.

Without a doubt, all of it will depend on the format of your research paper and the general requirements provided by the college professor. Other than that, most medical and healthcare papers formatted in AMA style follow the basic structure of an introduction with a thesis statement , three to five body paragraphs , and a conclusion .

As a rule, you may include methodology , samples, annotated bibliography, and other vital elements of research work per necessity. Since most of these rules are specific to the paper type and university, this AMA style guide won’t get too deep into this aspect of research writing and will focus on formatting instead.

How to format an AMA research paper: margins, font, and spacing

Speaking of the formatting of the page layout, the AMA style research paper differs from similar citation styles used by college students in other disciplines. Here is the general set of rules that you must remember and use when working on the page layout:

• AMA 11th style manual does not provide specific information regarding fonts that are allowed, yet it would be safe to use Times New Roman, point 12 or Arial, point 11.
• The page layout must have 1-inch margins for each side of the page.
• Use 0.5 inches indents for each new paragraph.
• All the text content except for the research paper itself must be single-spaced.
• Heading levels of the AMA-style paper can be done in Arial by highlighting them as necessary.
• AMA manual recommends using DOI data or direct URL links instead. To make things work as you format your page layout, do not place a period at the end of the link!
• Sentence-style capitalization must be used for the tables and figures. This rule does not apply to the titles of the tables.
• Using hyphens for a sequence of words like health care system is unnecessary.
• It is recommended to avoid fellowship designation and honorary degrees.
• Using titles and subtitles in AMA style format must always be to the point and reflect the main keywords and/or arguments.
• Lowercase letters must be used for subtitles in the References. This rule does not apply to proper nouns and the first word when you have a complete sentence.
• Quotation marks used must always be double.
• Avoid the use of abbreviations in AMA-style research paper titles.
• The first letter of each major word in titles and subtitles must be capitalized.

Note: Abbreviations like “et al” and “eg” do not use periods, as stated in the AMA manual. Make sure you take a closer look at the AMA citation examples we provide in this guide’s final section.

How to create a title page and abstract according to AMA style?

Speaking of the title page formatting and style, the AMA manual of style does not provide any specific information or strict requirements. It means you must use templates or guidelines offered by your college or university. If you have not been provided with it, remember that:

• A title page in AMA should include the title of your research paper, followed by the name of the author and the institution name.
• The title page elements must be placed in the upper half of the page and centered.
• Do not make this content bold, and do not use any odd fonts or italics for your title.

The title page can be both double-spaced and single-spaced. It will depend on your university.

As you have noticed, we have mentioned the paper with non-structured abstract and those research works that use a structured abstract. A structured abstract format is necessary to present original research or compose a systematic or clinical review. Using a structured abstract is necessary if you are dealing with practical or lab research work. A non-structured abstract must be used when you do not present original work and participate in debates or other types of work. If you are in doubt regarding what type of abstract is appropriate, always consult your academic advisor and/or the grading rubric.

The general AMA guidelines related to abstract writing:

• Do not start an abstract by citing your title.
• No references or citations must be used in the AMA-style abstract.
• No citations of figures and tables are allowed.
• Include your study question and hypothesis (if necessary).
• Do not mention any data that is not included in your text.
• Provide complete spelling of abbreviations when using them for the first time.
• A list of keywords may range from 3 to 10 words.

Working with a structured abstract, it’s necessary to include the following headings in your research paper:

• Importance of Research
• Research Objectives
• Design, Setting, and Participants
• Main Research Outcomes and Measures
• Research Results
• Conclusion and Recommendations

Following these elements in your research will help you narrow things down and understand what to include in each relevant section.

How to format a research paper’s body in AMA style?

The only rule made clear by the AMA style guide is double-spacing for the content of the paper’s body and ½ indents when starting with a new paragraph. Before we continue with the use of headings, the following elements must be included in your AMA research paper:

• An Introduction. You must introduce your main subject in this section and present the main objectives and arguments you wish to deliver. As a rule, using one citation is recommended, especially if you use statistical data or need a citation to support a scientific fact or an assumption.
• Methods. It is where you discuss the methods used to perform your research. It can be a qualitative or quantitative method or a mixture of both.
• Samples. You can also provide a separate section by specifying elements like gender, age, population group, and socio-cultural peculiarities.
• Discussion. This section of an AMA style paper is where you must discuss your research work and provide analytical information. It is also where you have to outline your research outcomes and discuss limitations or specifics necessary to replicate your actions.
• Conclusion. Do not introduce any new ideas in this section, and avoid using citations, as you only have to sum up the main thesis once again. Keep things concise and clear!

The use of headings in AMA:

• AMA style format uses relevant headings to separate research paper sections and specify a hierarchy. It also simplifies information for readers and university professors.
• If your paper is a lengthy one, the use of headings is obligatory!
• All AMA papers must start with Level 1 headings. The general rule is to use at least two other headings if you start with the main heading.
• If you do not plan to divide your writing into smaller subsections, you can use Level 1 headings only.
• All headings in AMA format must be justified to the left.

Here is how AMA sections for subheadings look in practice:

Creating AMA References page and using citations

Working with citations might seem overly complex, but do not let it frighten you! Before we continue with the actual practical examples, have a look at the general References page and citations rules:

• You must use a citation each time when you provide a direct quote or paraphrase an author.
• Citations in AMA 11th style format must be provided in a consecutive order exactly how they appear in your research paper.
• Your citations must be presented with the help of superscript numbers that you place at the end of a sentence. It is exactly how you create and use corresponding numbers on your References page.
• No matter how often you turn to a particular resource, you must use the same number even if it’s cited in your paper more than once.
• Remember to use Arabic superscript numerals outside periods and commas yet inside colons and semicolons.

The word “References” must be placed on the new page and centered. Do not use bold fonts. In most medical papers encountered these days, the References page in AMA research paper format is either double or single-spaced with a 50/50 ratio.

How to cite from different sources in AMA style with examples?

After all, nothing beats seeing a practical example and an MLA-style citation template when you are a confused student trying to make sense of things. Remember that author’s name(s) in AMA formatting go without periods between the last name and the initials.

Citing a website in MLA:

Author or organization’s name. Title of your research paper . Website’s name. URL, Published date, Date of Access.

Jones K. Management of antibiotics among infants in Congo’s rural hospitals. Rural Nursing Ethics Online Archive. http://www.yourwebsite.edu Published May 28, 2019. Accessed June 1, 2023.

In-text citation AMA format template (the same style and rules apply to all citation types):

Jones¹ stated in cultural research that most infants in Congo…

Citing Medical Journals in AMA:

When working on journal articles, you must abbreviate and use italics for the names of journals that you mention in your references by starting with a lowercase letter. If you are unsure what abbreviations to use, consider listings available at the National Center for Biotechnology Information (NCBI) and their database. If you are citing something available in PubMed, you may provide a complete journal name to clarify things. As the AMA writing format example below shows, you must include a year with a semicolon, the volume number, and the issue (in parentheses). Add a colon with the initial page number(s) separated by a hyphen. If there is a DOI, provide it as well. There should be no period after the DOI!

Author’s Last Name Initial(s). Article title. Journal Name abbreviated. Year; Volume (issue): starting page-final page.

Carey BC, Nordstrom, LR, Windsor N. et al. Impact of linguistic challenges in Scandinavian countries and work with the ADHD patients. Am. J. Physiol. 2021; 7(11): 134-139. https://doi.org/10.1182/xxx

Citing a book in print in AMA:

When you have information that is available in a printed source, follow this AMA-style book citation template:

Author’s Last Name Initial(s). Title of research paper: Subtitle. City of Publication, State: Publisher.

Hayes W. Offering Help to Autistic Children: What Medical Scholars Must Know. Cambridge, UK: Cambridge University Press; 2004.

This is the basic information you must know to create an excellent paper in AMA-style format. Remember to use the AMA style templates, check the rules as you work on your medical research paper, and consult your grading rubric. It will help you to avoid plagiarism and provide an excellent research assignment that earns the best grade!

• Writing a Research Paper
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• Bibliography vs Works Cited vs References Page
• Research Paper Types
• What is Qualitative Research

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Grubbs JB , Kraus SW. Binge Drinking Among Sports Gamblers. JAMA Netw Open. 2024;7(4):e245473. doi:10.1001/jamanetworkopen.2024.5473

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Binge Drinking Among Sports Gamblers

• 1 Department of Psychology, Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque
• 2 Department of Psychology, University of Nevada, Las Vegas

Over the past 6 years, sports wagering has become accessible to most individuals in the US via mobile applications or websites. 1 Increasing evidence suggests that sports wagering is associated with greater substance use and misuse, particularly alcohol, and symptoms of alcohol use disorder. 2 - 4 Alcohol consumption is higher among sports gamblers, 3 and sports gamblers often use substances while gambling. 5 Sports gamblers tend to be more inclined toward risk taking, suggesting that sports gambling may be associated with more risky alcohol use behaviors. 4 - 6 Accordingly, we examined whether individuals who wager on sports in the US are at greater risk of binge use of alcohol.

This survey study was approved by the Bowling Green State University Institutional Review Board; informed consent was obtained from all participants. The study followed the AAPOR reporting guideline.

From March 17 to April 6, 2022, we collected a census-matched sample of US adults with an oversample of adults who wager on sports. Full information about this survey is available elsewhere. 1 Race and ethnicity data were collected because they are potential factors in sports gambling likelihood and binge drinking habits. Among those reporting any past year alcohol use, binge drinking was assessed via the National Institute on Drug Abuse Quick Screen, version 1.0, which asks how often respondents consumed an excess of alcohol at a single time (≥5 drinks for men; ≥4 for women). Participants responded on a scale of 1 (never) to 5 (daily or more). Sports betting status was assessed by asking participants whether they had placed bets on sporting events or esports or participated in daily fantasy sports over the past 12 months.

Statistical analyses were conducted in SPSS, version 28. We conducted 2-tailed χ 2 analyses for distributions of past year binge drinking frequency, followed by multinomial logistic regressions estimating binge drinking frequency; P  < .05 was considered statistically significant.

A total of 4363 respondents were included (51.4% men, 46.4% women, and 2.2% nonbinary or other; mean [SD] age, 49.6 [16.2] years) ( Table 1 ). The national census-matched survey consisted of 2806 participants (mean [SD] age, 48.9 [17.2] years; 1365 [48.6%] men and 1441 [51.4%] women; response rate, 2806 of 3203 [87.6%]). The oversample of sports gamblers consisted of 1557 participants (mean [SD] age, 41.7 [15.3] years; 1043 [67.0%] men and 514 [33.0%] women; response rate, 1557 of 1978 [78.7%]), of whom 1474 reported past year sports betting. Additionally, in the national sample, 338 respondents (12.0%) indicated they had gambled on sports in the past 12 months, resulting in a total of 1812 sports gamblers ( Table 1 ). Sports gamblers were disproportionally likely to be men and younger. In these combined samples, 3267 respondents (74.9%) reported past year alcohol use.

Sports wagerers were disproportionately more likely to report binge drinking at monthly or greater frequency over the past 12 months and were also disproportionately less likely to report no binge drinking episodes in the past 12 months ( Table 1 ). Multinomial logistic regressions adjusted for age and race and ethnicity showed that sports gamblers were substantially more likely to report higher levels of binge drinking ( Table 2 ), suggesting that elevated risky drinking episodes among sports gamblers are not due to demographic differences.

In this survey study, binge drinking in both men and women was reported at greater frequency among sports wagering individuals compared with nongamblers and non–sports gamblers. This study is limited by its cross-sectional design and use of nonprobability polling methods. Regardless, with past research showing that sports gamblers are more likely to report symptoms of alcohol use disorder, our results suggest that individuals who wager on sports use alcohol in particularly risky ways. Given the rapid spread of sports wagering in the US over recent years, this finding highlights an immense need for ongoing research, particularly to examine how novel gambling technologies influence the prevalence, presentation, and prevention of alcohol use disorders and related harms.

Accepted for Publication: February 9, 2024.

Published: April 1, 2024. doi:10.1001/jamanetworkopen.2024.5473

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Grubbs JB et al. JAMA Network Open .

Corresponding Author: Joshua B. Grubbs, PhD, Center for Alcohol, Substance Use, and Addiction, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 ( [email protected] ).

Author Contributions: Drs Grubbs and Kraus had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Both authors.

Critical review of the manuscript for important intellectual content: Both authors.

Statistical analysis: Both authors.

Obtained funding: Both authors.

Administrative, technical, or material support: Grubbs.

Conflict of Interest Disclosures: Dr Grubbs reported receiving research grant funding from the Problem Gambling Network of Ohio outside the submitted work. Dr Kraus reported receiving personal fees from New York Council on Problem Gambling, the International Center for Responsible Gaming, the California Council on Problem Gambling, and Massachusetts General Hospital Psychiatry Academy, serving as editor-in-chief for Taylor & Francis journals, and receiving Summer research support from the Nevada Project on Problem Gambling during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by grants from the International Center for Responsible Gaming, the Kindbridge Research Institute, and the Problem Gambling Network of Ohio.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See the Supplement .

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A collection of guides and examples for the Gemini API.

google-gemini/cookbook

Folders and files, repository files navigation, welcome to the gemini api cookbook.

This is a collection of guides and examples for the Gemini API, including quickstart tutorials for writing prompts and using different features of the API, and examples of things you can build.

Get started with the Gemini API

The Gemini API gives you access to Gemini models created by Google DeepMind . Gemini models are built from the ground up to be multimodal, so you can reason seamlessly across text, images, code, and audio. You can use these to develop a range of applications .

Start developing

• Go to Google AI Studio .
• Login with your Google account.
• Create an API key.
• Use a quickstart for Python, or call the REST API using curl .

Capabilities

Learn about the capabilities of the Gemini API by checking out the quickstarts for safety , embeddings , function calling , audio , and more.

Official SDKs

The Gemini API is a REST API. You can call the API using a command line tool like curl , or by using one of our official SDKs:

• Dart (Flutter)

Open an issue on GitHub.

Contributing

Contributions are welcome. See contributing to learn more.

Thank you for developing with the Gemini API! We’re excited to see what you create.

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• Home office

How Do You Get Rid of Shredded Paper? Think Twice Before Recycling.

By Melanie Pinola

Melanie Pinola is a writer focused on home-office gear. To find the best paper shredder, she has shredded enough junk mail to fill several bathtubs.

It turns out, I’ve been recycling all wrong. After the latest round of testing nine paper shredders , I thought I’d put the resulting 65-plus gallons of shredded paper out for recycling. But when I asked my local sanitation department if it would prefer the shreds in clear bags or cardboard boxes, the representatives said neither.

Instead, they instructed me to toss the shredded paper in with the trash.

But wait: Isn’t shredded paper still paper, and thus recyclable? Isn’t throwing away shredded paper wasteful? The answer to both questions is, well, kind of. Here’s what you need to know about the best way to dispose of shredded paper.

Check your local guidelines

The American Forest & Paper Association confirms that shredded paper is indeed recyclable. But whether shredded paper is acceptable for recycling in your town or city is another story.

So it’s best to double-check with your local sanitation or public-works department to see what you’re supposed to do with your shredded paper. Local guidelines vary—and those guidelines may or not be on the publicly accessible website or in published brochures.

For example, San Franciscans are encouraged to either place shredded paper in a stapled brown paper bag labeled “SHREDDED” or compost the shredded paper. But if you live in Rhode Island, shredded paper isn’t accepted for mixed-recycling pickup; residents can compost their shreds, throw them in the trash, or drop off shredded paper at a disposal site in Johnston, Rhode Island.

Why shredded paper isn’t always accepted for recycling

Shredded paper can be a disaster for some recycling facilities. “Shredded bits of paper are too small to be properly sorted by our facility’s machinery,” said Jared Rhodes, director of policy and programs at the Rhode Island Resource Recovery Corporation (RIRRC). They can contaminate other materials and even lead to equipment malfunctions, he added.

An article in The Providence Journal expounds on the problem, noting that when local households sent their shredded paper for recycling in paper bags, the shredding machines ripped the bags, and tiny shreds flew everywhere. When residents tried using plastic bags (or even double-bagging in plastic), the shreds still flew everywhere—and plastic wrapped around the equipment, shutting the facility down for cleaning and repairs.

As a solution, some localities outsource the recycling of shredded paper to dedicated facilities that are equipped for it, but that costs additional time and taxpayer money. You can help reduce the load by composting your shredded paper, taking documents to be shredded to a community’s free shredding event (they’ll know how to dispose of the shreds), and reducing how much you shred in the first place.

Shred only paper containing sensitive information

Paper is most suitable for recycling when it isn’t shredded, because whole pieces are easier for facilities to sort and have longer and stronger fibers ready to be made into new paper. So it’s best to avoid unnecessary shredding.

To protect your privacy, you should still shred anything with sensitive information on it, of course, such as documents with your Social Security number, financial statements, and medical records.

Royal 14MC 14-Sheet Micro Cut Paper Shredder

The best home-office paper shredder.

This high-security shredder offers the best balance of ease of use, sheet capacity, and price.

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However, some information on a document may be personal but not necessarily sensitive enough to need shredding, such as your name and address; your contact information may already be available on public records or services such as White Pages.

“Consider how much junk mail and spam calls you receive; that’s how known your address and phone number are,” says Max Eddy, Wirecutter’s senior staff writer covering privacy and security. Instead of shredding documents that have only your name, address, and phone number on them, you can cover that information with permanent black marker and then put the sheets into the recycling bin.

Bonus: In addition to helping the environment, reducing how much you shred can prolong the life of your paper shredder. Everybody wins.

This article was edited by Ben Keough and Erica Ogg.

Meet your guide

Melanie Pinola

Melanie Pinola covers home office, remote work, and productivity as a senior staff writer at Wirecutter. She has contributed to print and online publications such as The New York Times, Consumer Reports, Lifehacker, and PCWorld, specializing in tech, work, and lifestyle/family topics. She’s thrilled when those topics intersect—and when she gets to write about them in her PJs.

Mentioned above

• We tested top shredders for use at home and in small offices and found easy-to-use workhorses that can help protect your identity. The Best Paper Shredders  

Further reading

How to Recycle Your Used Electronics

by Nick Guy

Are old computers, smartphones, or monitors taking over your closet? We’ll tell you how to recycle your tech, with privacy tips so you can do so safely.

How to Get Rid of a Used Car Seat

by Christine Cyr Clisset

We talked to experts about the best ways to dispose of a used car seat, and recommend you bring your unwanted seat to Target before May 5.

Why It’s So Hard to Get Rid of Used Mattresses

by Kevin Purdy

Getting rid of a used mattress responsibly can be a challenge—one that will likely only get worse as all-foam, bed-in-a-box options become more popular.

Yes, You Can (and Should) Recycle Batteries. Here’s How.

by Sarah Witman

If you have a container of spent batteries in your home that you don’t know what to do with, these are the best battery-recycling methods we’ve found.

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Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Novel Schoolbook-Originated Polynomial Multiplication Accelerators for NTRUbased PQC

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5th PQC Standardization Conference (2024) [in-person]

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Fifth PQC Standardization Conference

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Security and Privacy: post-quantum cryptography

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Gender medicine ‘built on shaky foundations’, Cass review finds

Analysis finds most research underpinning clinical guidelines, hormone treatments and puberty blockers to be low quality

Review of gender services has major implications for mental health services

The head of the world’s largest review into children’s care has said that gender medicine is “built on shaky foundations”.

Dr Hilary Cass, the paediatrician commissioned to conduct a review of the services provided by the NHS to children and young people questioning their gender identity, said that while doctors tended to be cautious in implementing new findings in emerging areas of medicine, “quite the reverse happened in the field of gender care for children”.

Cass commissioned the University of York to conduct a series of analyses as part of her review.

Two papers examined the quality and development of current guidelines and recommendations for managing gender dysphoria in children and young people. Most of the 23 clinical guidelines reviewed were not independent or evidence based, the researchers found.

A third paper on puberty blockers found that of 50 studies, only one was of high quality.

Similarly, of 53 studies included in a fourth paper on the use of hormone treatment, only one was of sufficiently high quality, with little or only inconsistent evidence on key outcomes.

Here are the main findings of the reviews:

Clinical guidelines

Increasing numbers of children and young people experiencing gender dysphoria are being referred to specialist gender services. There are various guidelines outlining approaches to the clinical care of these children and adolescents.

In the first two papers, the York researchers examined the quality and development of published guidelines or clinical guidance containing recommendations for managing gender dysphoria in children and young people up to the age of 18.

They studied a total of 23 guidelines published in different countries between 1998 and 2022. All but two were published after 2010.

Most of them lacked “an independent and evidence-based approach and information about how recommendations were developed”, the researchers said.

Few guidelines were informed by a systematic review of empirical evidence and they lack transparency about how their recommendations were developed. Only two reported consulting directly with children and young people during their development, the York academics found.

“Healthcare services and professionals should take into account the poor quality and interrelated nature of published guidance to support the management of children and adolescents experiencing gender dysphoria/incongruence,” the researchers wrote.

Writing in the British Medical Journal (BMJ) , Cass said that while medicine was usually based on the pillars of integrating the best available research evidence with clinical expertise, and patient values and preferences, she “found that in gender medicine those pillars are built on shaky foundations”.

She said the World Professional Association of Transgender Healthcare (WPATH) had been “highly influential in directing international practice, although its guidelines were found by the University of York’s appraisal to lack developmental rigour and transparency”.

In the foreword to her report, Cass said while doctors tended to be cautious in implementing new findings “quite the reverse happened in the field of gender care for children”.

In one example, she said a single Dutch medical study, “suggesting puberty blockers may improve psychological wellbeing for a narrowly defined group of children with gender incongruence”, had formed the basis for their use to “spread at pace to other countries”. Subsequently, there was a “greater readiness to start masculinising/feminising hormones in mid-teens”.

She added: “Some practitioners abandoned normal clinical approaches to holistic assessment, which has meant that this group of young people have been exceptionalised compared to other young people with similarly complex presentations. They deserve very much better.”

Both papers repeatedly pointed to a key problem in this area of medicine: a dearth of good data.

She said: “Filling this knowledge gap would be of great help to the young people wanting to make informed choices about their treatment.”

Cass said the NHS should put in place a “full programme of research” looking at the characteristics, interventions and outcomes of every young person presenting to gender services, with consent routinely sought for enrolment in a research study that followed them into adulthood.

Gender medicine was “an area of remarkably weak evidence”, her review found, with study results also “exaggerated or misrepresented by people on all sides of the debate to support their viewpoint”.

Alongside a puberty blocker trial, which could be in place by December, there should be research into psychosocial interventions and the use of the masculinising and feminising hormones testosterone and oestrogen, the review found.

Hormone treatment

Many trans people who seek medical intervention in their transition opt to take hormones to masculinise or feminise their body, an approach that has been used in transgender adults for decades.

“It is a well-established practice that has transformed the lives of many transgender people,” the Cass review notes, adding that while these drugs are not without long-term problems and side-effects, for many they are dramatically outweighed by the benefits.

For birth-registered females, the approach means taking testosterone, which brings about changes including the growth of facial hair and a deepening of the voice, while for birth-registered males, it involves taking hormones including oestrogen to promote changes including the growth of breasts and an increase in body fat. Some of these changes may be irreversible.

However, in recent years a growing proportion of adolescents have begun taking these cross-sex, or gender-affirming, hormones, with the vast majority who are prescribed puberty blockers subsequently moving on to such medication.

This growing take-up among young people has led to questions over the impact of these hormones in areas ranging from mental health to sexual functioning and fertility.

Now researchers at the University of York have carried out a review of the evidence, comprising an analysis of 53 previously published studies, in an attempt to set out what is known – and what is not – about the risks, benefits and possible side-effects of such hormones on young people.

All but one study, which looked at side-effects, were rated of moderate or low quality, with the researchers finding limited evidence for the impact of such hormones on trans adolescents with respect to outcomes, including gender dysphoria and body satisfaction.

The researchers noted inconsistent findings around the impact of such hormones on growth, height, bone health and cardiometabolic effects, such as BMI and cholesterol markers. In addition, they found no study assessed fertility in birth-registered females, and only one looked at fertility in birth-registered males.

“These findings add to other systematic reviews in concluding there is insufficient and/or inconsistent evidence about the risks and benefits of hormone interventions in this population,” the authors write.

However, the review did find some evidence that masculinising or feminising hormones might help with psychological health in young trans people. An analysis of five studies in the area suggested hormone treatment may improve depression, anxiety and other aspects of mental health in adolescents after 12 months of treatment, with three of four studies reporting an improvement around suicidality and/or self-harm (one reported no change).

But unpicking the precise role of such hormones is difficult. “Most studies included adolescents who received puberty suppression, making it difficult to determine the effects of hormones alone,” the authors write, adding that robust research on psychological health with long-term follow-up was needed.

The Cass review has recommended NHS England should review the current policy on masculinising or feminising hormones, advising that while there should be the option to provide such drugs from age 16, extreme caution was recommended, and there should be a clear clinical rationale for not waiting until an individual reached 18.

Puberty blockers

Treatments to suppress puberty in adolescents became available through routine clinical practice in the UK a decade ago.

While the drugs have long been used to treat precocious puberty – when children start puberty at an extremely young age – they have only been used off-label in children with gender dysphoria or incongruence since the late 1990s. The rationale for giving puberty blockers, which originated in the Netherlands, was to buy thinking time for young people and improve their ability to smooth their transition in later life.

Data from gender clinics reported in the Cass review showed the vast majority of people who started puberty suppression went on to have masculinising or feminising hormones, suggesting that puberty blockers did not buy people time to think.

To understand the broader effects of puberty blockers, researchers at the University of York identified 50 papers that reported on the effects of the drugs in adolescents with gender dysphoria or incongruence. According to their systematic review, only one of these studies was high quality, with a further 25 papers regarded as moderate quality. The remaining 24 were deemed too weak to be included in the analysis.

Many of the reports looked at how well puberty was suppressed and the treatment’s side-effects, but fewer looked at whether the drugs had their intended benefits.

Of two studies that investigated gender dysphoria and body satisfaction, neither found a change after receiving puberty blockers. The York team found “very limited” evidence that puberty blockers improved mental health.

Overall, the researchers said “no conclusions” could be drawn about the impact on gender dysphoria, mental and psychosocial health or cognitive development, though there was some evidence bone health and height may be compromised during treatment.

Based on the York work, the Cass review finds that puberty blockers offer no obvious benefit in helping transgender males to help their transition in later life, particularly if the drugs do not lead to an increase in height in adult life. For transgender females, the benefits of stopping irreversible changes such as a deeper voice and facial hair have to be weighed up against the need for penile growth should the person opt for vaginoplasty, the creation of a vagina and vulva.

In March, NHS England announced that children with gender dysphoria would no longer receive puberty blockers as routine practice. Instead, their use will be confined to a trial that the Cass review says should form part of a broader research programme into the effects of masculinising and feminising hormones.

• Transgender
• Young people

More on this story

Veteran trans campaigner: ‘Cass review has potential for positive change’

Cass review must be used as ‘watershed moment’ for NHS gender services, says Streeting

‘This isn’t how good scientific debate happens’: academics on culture of fear in gender medicine research

Five thousand children with gender-related distress awaiting NHS care in England

Ban on children’s puberty blockers to be enforced in private sector in England

What Cass review says about surge in children seeking gender services

Adult transgender clinics in England face inquiry into patient care

‘Children are being used as a football’: Hilary Cass on her review of gender identity services

Thousands of children unsure of gender identity ‘let down by NHS’, report finds

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