Titles and Subtitles - Manuscript Preparation for Submission and Publication

AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Titles and Subtitles
Manuscript Preparation for Submission and Publication

Preparation of a scholarly manuscript requires thoughtful consideration of the topic and anticipation of the reader’s needs and questions. Certain elements are standard parts of all manuscripts or are used so often as to merit special discussion and instruction. These elements are discussed in this section in the order in which they appear in the manuscript. References are discussed separately in chapter 3 and tables, figures, and boxes in chapter 4. Some guidance is directed specifically to authors for manuscript preparation and submission, some is directed to editors for manuscript publication, and some to both authors and editors.

The preparation of any manuscript for publication should take the requirements of the intended journal into account, as well as reporting guidelines (EQUATOR Network: http://www.equator-network.org); this may enhance the chances of acceptance and expedite publication. Failure to do so may result in return without review. For the author, manuscript preparation requires familiarity with the journal to which the manuscript is submitted. Journals should publish instructions for authors, which serve as useful guides; some journals’ instructions for authors contain a manuscript checklist. Some publishers also publish style manuals, which provide in-depth instruction (see 23.0, Resources), or rely on in-house guides, the AMA Manual of Style, or a combination of such resources. For journals that follow the International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals,1 as the JAMA Network journals do, adherence to these guidelines will be acceptable, although the individual journal may require more than the ICMJE recommendations or make changes to suit its house style.

Most journals require submission of material through a web-based manuscript submission and peer review system (see 6.2, Editorial Processing).

2.1 Titles and Subtitles.

Titles should be concise, specific, and informative and should contain the key points of the work. Population type should be specified in the title, when possible (eg, Men With Atrial Fibrillation). For scientific manuscripts (eg, reports of research), neither overly general titles nor “cute” titles are desirable; these may be better suited to subtitles of opinion pieces (eg, Early Palliative Care in Advanced Illness: Do Right by Mama) (but see also 2.1.7, Names of Cities, States, Counties, Provinces, and Countries). Avoid the use of causal language in titles of articles reporting the results of observational research; cause-and-effect wording is best reserved for reports of randomized trials and laboratory-based controlled experiments (see 19.1.4, Results). Consult the journal’s instructions for authors regarding any limitations on length of titles.


Cocaine Use and Homicide


Association of Cocaine Use With Homicide Among Men in New York City


Obesity and Severe Obesity Among Children


Prevalence and Trends in Obesity and Severe Obesity Among Children in the United States, 1999-2012


Reliability and Validity of Mobile Teledermatology


Assessment of Reliability and Validity of Mobile Teledermatology in HIV-Positive Patients in Botswana


Trauma Surveillance


Trauma Surveillance in Cape Town, South Africa

Note: The shorter, more general title might be appropriate for an editorial or other opinion piece.

The key terms in a title should be given in order, from (1) exposure to (2) outcome to (3) population to (4) study type, as in the examples below:

Association of Exposure to Antibiotics During the First 6 Months of Life With Weight Gain During Childhood

Effect of Inhaled Xenon on Damage to Cerebral White Matter in Comatose Survivors of Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

Screening Yield of HIV Antigen-Antibody Combination and Pooled HIV RNA Testing for Acute HIV Infection in a High-Prevalence Population

Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial

Similarly, although the subtitle is frequently useful in expanding on the title, it should not contain key elements of the study as a supplement to an overly general title.


Psychiatric Disorders: A Rural-Urban Comparison


Rural-Urban Differences in the Prevalence of Psychiatric Disorders


Multiple Sclerosis: Sexual Dysfunction and Response to Medications


Sexual Dysfunction and Response to Medications in Patients with Multiple Sclerosis


Hospitalization for Congestive Heart Failure: Explaining Racial Differences


Assessment of Racial Differences in Hospitalization Rates for Congestive Heart Failure


Breastfeeding in Children of Women Taking Antiepileptic Drugs: Cognitive Outcomes at 6 Years of Age


Cognitive Outcomes at 6 Years of Age in Children of Breastfeeding Women Taking Antiepileptic Drugs


Health Care at the US Department of Veterans Affairs: Recommendations for Change


Recommendations for Improving Health Care at the US Department of Veterans Affairs


Cardiovascular Evaluation of Competitive Athletes: Medical and Legal Issues


Medical and Legal Issues in the Cardiovascular Evaluation of Competitive Athletes

However, too much detail also should be avoided. Subtitles should complement the title by providing supplementary information that will supply more detail about the content that will also aid in information retrieval. Several examples of informative title and subtitle combinations follow:

Effect of Naltrexone-Bupropion on Major Adverse Cardiovascular Events in Overweight and Obese Patients With Cardiovascular Risk Factors: A Randomized Clinical Trial

Prevalence of Cutaneous Adverse Effects of Hairdressing: A Systematic Review

Subtitles of scientific manuscripts may be used to amplify the title; however, the main title should be able to stand alone (ie, the subtitle should not be a continuation of the title or a substitute for a succinct title):


An Unusual Type of Pemphigus: Combining Features of Lupus Erythematosus


Assessment of an Unusual Type of Pemphigus With Features of Lupus Erythematosus


Von Hippel—Lindau Disease: Affecting 43 Members of a Single Kindred


Von Hippel—Lindau Disease in 43 Members of a Single Kindred

For observational studies in which causation cannot be demonstrated, titles should not include cause-and-effect terms. Other phrases, such as “association of,” are preferred. In randomized clinical trials, in which causality can be demonstrated, the use of such phrases as “effects of” is appropriate.

Effects of Intake of Protein, Monounsaturated Fat, and Carbohydrate on Blood Pressure and Serum Lipids: Results of the OmniHeart Randomized Trial

Effects of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster Randomized Trial

Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis

Declarative sentences are used frequently as titles of news stories and opinion pieces (eg, “World Bank Pledges $200 Million to Stem Ebola Outbreak in West Africa,” “Lifestyle Counseling Advised for Overweight Adults With Other Cardiovascular Risk Factors”). However, declarative sentences or phrases in scientific article titles tend to overemphasize a conclusion and should not be used.


Fibromyalgia Is Common in an Obesity Clinic


Prevalence of Fibromyalgia in Obese Patients

Similarly, questions should not be used for titles of scientific (research) manuscripts.


Is Television Viewing Associated With Social Isolation? Roles of Exposure Time, Viewing Context, and Violent Content


Association Between Television Viewing and Social Isolation: Roles of Exposure Time, Viewing Context, and Violent Content

Questions are generally more appropriate for titles of editorials, commentaries, and opinion pieces, all of which may be less scholarly, and perhaps more provocative, than research articles:

Can the Learning Health Care System Be Educated With Observational Data?

Hospital Consolidation, Competition, and Quality: Is Bigger Necessarily Better?

Why Should High-Income Countries Help Combat Ebola?

Contralateral Prophylactic Mastectomy: Is It a Reasonable Option?

Is Big Data the New Frontier for Academic-Industry Collaboration?

Toward Improved Glycemic Control in Diabetes: What’s on the Horizon?

Postradiotherapy Pelvic Fractures: Cause for Concern or Opportunity for Further Research?

Randomized clinical trials should be described as such in the subtitle because this alerts readers to the level of evidence and the study design and is helpful to readers and researchers:

Effect of Behavioral Interventions on Inappropriate Antibiotic Prescribing Among Primary Care Practices: A Randomized Clinical Trial

Effect of Darapladib on Major Coronary Events After an Acute Coronary Syndrome: The SOLID-TIMI 52 Randomized Clinical Trial

Administrative Data Feedback for Effective Cardiac Treatment: The AFFECT Cluster Randomized Trial

Other aspects of study design or methods may be included in the title or subtitle:

Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism: A Systematic Review and Meta-analysis

Depression, Apolipoprotein E Genotype, and Incidence of Mild Cognitive Impairment: A Prospective Cohort Study

Physician Variation in Management of Low-Risk Prostate Cancer: A Population-Based Cohort Study

Antibiotic Exposure, Infection, and Development of Pediatric Psoriasis: A Nested Case-Control Study

Sometimes a subtitle will contain the name of the group responsible for the study, especially if the study is large and best known by its group name or acronym (this is particularly true in some specialties, such as cardiology, oncology, and ophthalmology) or if it is a part of a series of reports from the same group (see 2.1.5, Abbreviations, and 13.9, Collaborative Groups):

Association of Dietary Intake of Fat and Cholesterol With Elevated Low-Density Lipoprotein Cholesterol Levels in Children: The Dietary Intervention Study in Children (DISC)

Antibiotic Resistance Among Ocular Pathogens in the United States: Five-Year Results From the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study

Antihypertensive Drug Treatment to Prevent Stroke in Older Patients With Isolated Systolic Hypertension: Final Results of the Systolic Hypertension in the Elderly Program (SHEP)

Some journals, such as JAMA, do not include the study name in the title or subtitle for any but the original report of outcomes or secondary analyses that provide unique information.

Low-Fat Dietary Pattern and Risk of Invasive Breast Cancer: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial

However, the JAMA Network specialty journals include the study name in the subtitle if authors prefer to include it. For most secondary analyses, having the study name in the abstract is sufficient for information retrieval.

2.1.1 Quotation Marks.

If quotation marks are required in the title or subtitle, they should be double, not single (see 8.6.3, Titles).

Encouraging Patients to Ask Questions: How to Overcome “White Coat Silence”

Mandatory Extended Searches in All Genome Sequencing: “Incidental Findings” and Patient Autonomy

How Can Errors Be Avoided in Medicine? Above All “Do No Harm”

2.1.2 Numbers.

Follow the style for numbers included in titles as described in 18.0, Numbers and Percentages.

Educational Programs in US Medical Schools, 2012-2013

Three-Day Antimicrobial Regimen for Treatment of Acute Cystitis in Women: A Randomized Clinical Trial

Comparison of 2 Methods to Detect Publication Bias in Meta-analyses

Skin Reactions in Patients With Stage IV Melanoma Treated With T-Lymphocyte Antigen 4 Monoclonal Antibody

Primary and Secondary Prevention in 20 Years of Clinical Practice

If numbers appear at the beginning of a title or subtitle, they—and any unit of measure associated with them—should be spelled out.

Primary and Secondary Prevention Services in Clinical Practice: Twenty Years’ Experience in Development, Implementation, and Evaluation

Two-Year Changes in Refractive Error and Related Biometric Factors in an Adult Chinese Population

Exceptions may be made for years (see 18.2.1, Beginning a Sentence, Title, Subtitle, or Heading).

US Adult Illicit Cannabis Use, Cannabis Use Disorder, and Medical Marijuana Laws: 1991-1992 to 2012-2013

2.1.3 Drugs.

If drug names appear in the title or subtitle, (1) use the approved generic or nonproprietary name, (2) omit the nonbase moiety unless it is required (see 14.4, Nomenclature, Drugs), and (3) avoid the use of proprietary names unless (a) several products are being compared, (b) the article is specific to a particular formulation of a drug (eg, the vehicle, not the active substance, caused adverse reactions), or (c) the number of ingredients is so large that the resulting title would be clumsy and a generic term, such as “multivitamin tablet,” would not do.

Effect of Aliskiren on Progression of Coronary Disease in Patients With Prehypertension: The AQUARIUS Randomized Clinical Trial

Efficacy of Rofecoxib, Celecoxib, and Acetaminophen in Osteoarthritis of the Knee: A Randomized Clinical Trial

Risk of Hospitalization for Myocardial Infarction Among Users of Rofecoxib, Celecoxib, and Other NSAIDs: A Population-Based Case-Control Study

2.1.4 Genus and Species.

Genus and species should be expanded and italicized in the title or subtitle and an initial capital letter should be used for the genus but not the species name, just as in the text (see 14.14.1, Biological Nomenclature).

Reconsidering Isolation Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

Prevalence of Chlamydia trachomatis Genital Infection in Teenaged Girls

Elimination of a Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection in a Nurse With Atopic Dermatitis

In experimental studies in animals, the type of animal studied should be included in the title.

Human Induced Pluripotent Stem Cell—Derived Motor Neuron Transplant for Neuromuscular Atrophy in a Mouse Model of Sciatic Nerve Injury

2.1.5 Abbreviations.

Avoid the use of abbreviations in the title and subtitle, unless space considerations require an exception or unless the title or subtitle includes the name of an entity or a group that is best known by its acronym. In both cases, the abbreviation should be expanded in the abstract and at the first appearance in the text (see 10.6, Acronyms, and 13.0, Abbreviations).

Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After ICU Admission

Accuracy of Airflow Obstruction Thresholds for Predicting COPD-Related Hospitalization and mortality

Reporting of Noninferiority and Equivalence Randomized Trials: An Extension of the CONSORT Statement

Implementing the USPSTF Recommendations on Prevention of Perinatal Depression

2.1.6 Capitalization.

Capitalize the first letter of each major word in titles and subtitles. Do not capitalize subsequent articles (eg, a, an, the), prepositions of 3 or fewer letters, coordinating conjunctions (and, or, for, nor, but, per), or the to in infinitives. Do capitalize a 2-letter verb, such as Is or Be. Exceptions are made for some expressions, such as compound non-English and phrasal verbs. Note the following examples (from opinion pieces and news articles):

Risk Factors for Heart Disease in Rural Uganda Go Up With Urbanization

High Rotavirus Vaccination Rates Continue to Pay Off

Ethical Questions Concerning In Vitro Fertilization

Permanent Duplex Surveillance of In Situ Saphenous Vein Bypasses

Choice of Stents and End Points for Treatment of De Novo Coronary Artery Lesions

Weighing In on Bariatric Surgery

Researchers Size Up the Risks of Nanotechnology

Universal Screening for Tuberculosis Infection: School’s Out!

See 10.0, Capitalization, for overall guidelines. For capitalization of hyphenated compounds, see 10.2, Titles and Headings.

2.1.7 Names of Cities, States, Counties, Provinces, and Countries.

Include cities, states, counties, provinces, or countries in titles only when essential, especially for results that may not be generalizable to other locations (eg, results unique to that site).

Prevalence and Incidence Trends for Diagnosed Diabetes Among Adults Aged 20 to 79 Years, United States, 1980-2012

Providing Conditional Economic Compensation and Uptake of Voluntary Male Circumcision in Kenya: A Randomized Clinical Trial

Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012

Prevalence of War-Related Conditions of Mental Health and Association With Displacement Status in Postwar Jaffna District, Sri Lanka

Equity of Use of Home-Based or Facility-Based Skilled Obstetric Care in Rural Bangladesh

Identification of a New Serogroup Clone of Neisseria meningitidis From Anhui Province, China

Comparison of Stage at Diagnosis of Melanoma Among Hispanic, Black, and White Patients in Miami—Dade County, Florida

Gender Disadvantage and Reproductive Health Risk Factors for Common Mental Disorders in Women: A Community Survey in India

In other cases, include this geographic information in the abstract and the text only (see 13.5, Cities, States, Counties, Territories, Possessions, Provinces, Countries).


Pertussis Infection in Adults With Persistent Cough in Nashville, Tennessee


Pertussis Infection in Adults With Persistent Cough


Hospitalization Charges, Costs, and Income for Trauma-Related Injuries at the University of California, Davis, Medical Center in Sacramento


Hospitalization Charges, Costs, and Income for Trauma-Related Injuries at a University Trauma Center


Prevalence of Erectile Dysfunction in Men Seen by Primary Care Physicians in Canada


Prevalence of Erectile Dysfunction in Men Seen by Primary Care Physicians