1
NIH Style Guide
Contents
Introduction .................................................................................................................................................. 9
Other resources: ....................................................................................................................................... 9
NIH .............................................................................................................................................................. 10
Accelerating Medicines Partnership® ..................................................................................................... 10
Acting (as a job title) ............................................................................................................................... 10
Abbreviations, initialisms, and acronyms ............................................................................................... 11
Agency names and articles ..................................................................................................................... 11
BRAIN Initiative
®
..................................................................................................................................... 12
ClinicalTrials.gov ...................................................................................................................................... 12
Clinician–scientist.................................................................................................................................... 12
Drug names ............................................................................................................................................. 12
Early career scientists ............................................................................................................................. 12
Foreign influence vs. inappropriate foreign government interference .................................................. 13
Grant ....................................................................................................................................................... 13
Humans and other animals ..................................................................................................................... 13
Intramural Research Program ................................................................................................................. 13
MedlinePlus ............................................................................................................................................ 14
NIH HEAL Initiative
®
................................................................................................................................ 14
NIH institutes, centers, and offices ......................................................................................................... 14
Specific ICO naming conventions ............................................................................................................ 15
All of Us Research Program ..................................................................................................................... 15
Eunice Kennedy Shriver National Institute of Child Health and Human Development........................... 15
Fogarty International Center .................................................................................................................. 15
National Heart, Lung, and Blood Institute .............................................................................................. 15
NIH-wide vs. trans-NIH ............................................................................................................................ 15
Nonhuman primates ............................................................................................................................... 15
Notice of funding opportunity ................................................................................................................ 16
Official job titles (director, senator, ambassador, president) ................................................................. 16
Patents .................................................................................................................................................... 16
2
Physician–scientist .................................................................................................................................. 17
Possessive apostrophe and institute names ........................................................................................... 17
Postbacs .................................................................................................................................................. 17
Postdocs .................................................................................................................................................. 17
Program titles .......................................................................................................................................... 17
Titles and degrees ................................................................................................................................... 17
Government ................................................................................................................................................ 18
Advisor .................................................................................................................................................... 18
Agency, agencywide, interagency ........................................................................................................... 18
Appropriation, appropriations, authorization ........................................................................................ 18
Calendar year .......................................................................................................................................... 19
Congress, congressional .......................................................................................................................... 19
Country names ........................................................................................................................................ 19
Federal .................................................................................................................................................... 19
Fiscal year ................................................................................................................................................ 19
Health care .............................................................................................................................................. 20
Nationality and citizenship ...................................................................................................................... 20
Medical Language ....................................................................................................................................... 20
Commonly misspelled names ................................................................................................................. 20
Alzheimer’s disease ................................................................................................................................. 20
Amyotrophic lateral sclerosis .................................................................................................................. 20
Creutzfeldt-Jakob disease ....................................................................................................................... 20
Crohn’s disease ....................................................................................................................................... 20
Down syndrome ...................................................................................................................................... 20
Graves’ disease ....................................................................................................................................... 21
Hashimoto’s disease ............................................................................................................................... 21
Hodgkin lymphoma and non-Hodgkin lymphoma .................................................................................. 21
Mpox ....................................................................................................................................................... 21
Myalgic encephalomyelitis/chronic fatigue syndrome ........................................................................... 21
Parkinson’s disease ................................................................................................................................. 21
COVID-19 ................................................................................................................................................. 21
COVID-19, SARS-CoV-2, coronavirus ....................................................................................................... 21
PASC, Long COVID, MIS-C ........................................................................................................................ 22
3
Vaccine hesitancy vs. anti-vax................................................................................................................. 22
Diabetes .................................................................................................................................................. 22
Blood glucose vs. blood sugar ................................................................................................................. 22
Hypoglycemia .......................................................................................................................................... 22
Insulin ...................................................................................................................................................... 22
Prediabetes ............................................................................................................................................. 22
Type 1, type 2 diabetes ........................................................................................................................... 22
Person-first and Destigmatizing Language ................................................................................................. 23
Brain injury vs. brain damaged ............................................................................................................... 23
Blind ........................................................................................................................................................ 23
Caesarean delivery vs. c-section ............................................................................................................. 23
Caregiver, care partner vs. caretaker ...................................................................................................... 23
Deaf ......................................................................................................................................................... 24
Developing nations vs. third-world countries ......................................................................................... 24
Disproportionately affected vs. vulnerable groups ................................................................................ 24
Diversity .................................................................................................................................................. 25
Diversity, Equity, Inclusion, and Accessibility (DEIA) .............................................................................. 25
Engage, prioritize vs. target, tackle ......................................................................................................... 25
Failed treatment ..................................................................................................................................... 25
Food insecurity ........................................................................................................................................ 25
Health disparities .................................................................................................................................... 25
HIV vs. HIV/AIDS ...................................................................................................................................... 26
Immigrant, refugee vs. illegal aliens, foreigners ..................................................................................... 26
Intimate partner violence vs. domestic violence .................................................................................... 26
Participants vs. subjects .......................................................................................................................... 26
People experiencing homelessness vs. the homeless ............................................................................ 26
People with HIV ....................................................................................................................................... 27
People with lower incomes vs. poverty-stricken, the poor .................................................................... 27
Stakeholder vs. collaborator ................................................................................................................... 27
Suffering from, afflicted with .................................................................................................................. 27
Suicide ..................................................................................................................................................... 27
Underrepresentation .............................................................................................................................. 28
Alcohol and Substance Use ......................................................................................................................... 28
4
Alcohol misuse vs. alcohol abuse ............................................................................................................ 28
Alcohol overdose vs. alcohol poisoning .................................................................................................. 28
Alcohol use disorder vs. alcoholism ........................................................................................................ 28
Alcohol-associated hepatitis, alcohol-associated cirrhosis, and alcohol-associated pancreatitis .......... 29
Alcohol-associated liver disease ............................................................................................................. 29
Baby with neonatal opioid withdrawal syndrome, neonatal abstinence syndrome vs. born addicted . 29
Fetal alcohol spectrum disorders ............................................................................................................ 29
Medications to treat opioid use disorders vs. medication-assisted treatment ...................................... 29
Person in recovery, person in remission ................................................................................................. 30
Person with a substance use disorder, person who uses drugs ............................................................. 30
Person with alcohol use disorder vs. alcoholic ....................................................................................... 30
Person with an opioid use disorder or person with opioid addiction .................................................... 30
Return to use, recurrence vs. relapsed ................................................................................................... 30
Substance use disorder, addiction vs. habit ........................................................................................... 30
Testing positive (on a drug screen) ......................................................................................................... 31
Treatment center vs. rehab .................................................................................................................... 31
Use, misuse vs. abuse ............................................................................................................................. 31
Disabilities ................................................................................................................................................... 31
Attention-Deficit/Hyperactivity Disorder ............................................................................................... 31
Disability vs. handicap ............................................................................................................................. 31
Disability-related metaphors .................................................................................................................. 31
Dyslexia ................................................................................................................................................... 32
Invisible disabilities ................................................................................................................................. 32
Needs, differences vs. deficit, defect ...................................................................................................... 32
Nondisabled person, person without disabilities vs. normal ................................................................. 32
Person who uses a wheelchair vs. wheelchair-bound ............................................................................ 32
Person with disabilities vs. handicapped ................................................................................................ 32
Autism ......................................................................................................................................................... 33
Autism ..................................................................................................................................................... 33
Characteristics vs. symptoms .................................................................................................................. 33
Cure, prevention ..................................................................................................................................... 33
High-support needs vs. high-/low-functioning ....................................................................................... 33
Neurodiversity ........................................................................................................................................ 33
5
Nonspeaking vs. nonverbal ..................................................................................................................... 33
Person with autism, autistic person, person on the autism spectrum ................................................... 33
Likelihood vs. risk .................................................................................................................................... 34
Interventions, services, therapies vs. treatment .................................................................................... 34
Obesity and People with Higher Weight ..................................................................................................... 34
Obesity .................................................................................................................................................... 34
Overweight .............................................................................................................................................. 34
Person with obesity vs. obese ................................................................................................................. 34
Higher weight individual, person with a larger body .............................................................................. 34
Weight, excess weight vs. weight problem, fat, morbidly obese ........................................................... 35
Age .............................................................................................................................................................. 35
Children ................................................................................................................................................... 35
Older adults vs. the elderly ..................................................................................................................... 35
Race and National Origin ............................................................................................................................ 35
General guidance .................................................................................................................................... 35
Alaska Native (Aleuts, Eskimos, Indians of Alaska), Alaskan ................................................................... 36
American Indian / Alaska Native ............................................................................................................. 36
Asian, Asian American ............................................................................................................................. 36
BIPOC ...................................................................................................................................................... 37
Biracial, multiracial, of mixed race .......................................................................................................... 37
Black and African American .................................................................................................................... 37
Latino/a, Latinx, Latine ............................................................................................................................ 37
Hispanic ................................................................................................................................................... 38
Chicano or Chicana ................................................................................................................................. 38
Middle East, MENA, Arab Americans ...................................................................................................... 38
Minoritized populations .......................................................................................................................... 38
Minority health ....................................................................................................................................... 38
Hawaiian ................................................................................................................................................. 39
Pacific Islander ........................................................................................................................................ 39
Indigenous peoples, First peoples, First Nations, Aboriginal peoples, and Native peoples ................... 39
Person of color ........................................................................................................................................ 39
Tribe, Tribal ............................................................................................................................................. 39
White ....................................................................................................................................................... 39
6
Sex, Gender, and Sexuality.......................................................................................................................... 40
Bisexual, bi+ ............................................................................................................................................ 40
Cisgender ................................................................................................................................................ 40
Gender .................................................................................................................................................... 40
Gender affirmation, gender confirmation, transition, transitioning ...................................................... 40
Gender expression .................................................................................................................................. 41
Gender identity ....................................................................................................................................... 41
Gender nonconforming........................................................................................................................... 41
Intersex and variations in sex characteristics ......................................................................................... 41
LGBTQI+ .................................................................................................................................................. 41
Misgender ............................................................................................................................................... 41
Nonbinary ............................................................................................................................................... 41
Pronouns ................................................................................................................................................. 42
Queer ...................................................................................................................................................... 42
Sex, sexual ............................................................................................................................................... 42
Sexual and gender diverse ...................................................................................................................... 42
Sexual and gender minority populations ................................................................................................ 42
Sexual orientation ................................................................................................................................... 43
Transgender ............................................................................................................................................ 43
Two-Spirit ................................................................................................................................................ 43
Inclusive and Gender-Neutral Language ..................................................................................................... 44
All genders vs. both genders ................................................................................................................... 44
Breastfeeding, chestfeeding ................................................................................................................... 44
Chair, chairperson vs. chairman, chairwoman........................................................................................ 44
Everyone vs. ladies and gentlemen or men and women ........................................................................ 44
Parent, parenting, caregiving vs. mothering ........................................................................................... 44
Police officer vs. policeman .................................................................................................................... 44
Pregnant women, pregnant people ........................................................................................................ 45
Spokesperson vs. spokesman ................................................................................................................. 45
Grammar and Punctuation ......................................................................................................................... 45
Action verbs ............................................................................................................................................ 45
Active voice ............................................................................................................................................. 45
Apostrophe ............................................................................................................................................. 45
7
Avoid unnecessary words ....................................................................................................................... 46
Comma, serial comma ............................................................................................................................ 46
Continuous, continual ............................................................................................................................. 46
Dash ........................................................................................................................................................ 47
Ellipsis ...................................................................................................................................................... 47
Geographic terms.................................................................................................................................... 47
Hyphen .................................................................................................................................................... 47
Parallel construction ............................................................................................................................... 47
Period ...................................................................................................................................................... 48
Quotation mark ....................................................................................................................................... 48
Semicolon ................................................................................................................................................ 48
State abbreviations ................................................................................................................................. 48
Subject-verb agreement ......................................................................................................................... 48
Toward .................................................................................................................................................... 49
Unfamiliar terms ..................................................................................................................................... 49
Write short paragraphs ........................................................................................................................... 49
Write shorter sentences whenever possible .......................................................................................... 49
Numerals ..................................................................................................................................................... 49
Decimals .................................................................................................................................................. 49
Fractions .................................................................................................................................................. 50
Ordinals ................................................................................................................................................... 50
Percentages ............................................................................................................................................. 50
Singular and plural .................................................................................................................................. 50
Spacing .................................................................................................................................................... 50
Units of measure ..................................................................................................................................... 50
Structure and Formatting ........................................................................................................................... 50
Alt text ..................................................................................................................................................... 50
Headings.................................................................................................................................................. 51
Links ........................................................................................................................................................ 52
Lists ......................................................................................................................................................... 52
QR codes ................................................................................................................................................. 53
Tables ...................................................................................................................................................... 53
Title casing .............................................................................................................................................. 53
8
Appendix: Biomedical Definitions ............................................................................................................... 53
Acquire, develop ..................................................................................................................................... 53
Association, causation ............................................................................................................................ 54
Biomarkers .............................................................................................................................................. 54
Biopsy ...................................................................................................................................................... 54
Cohort ..................................................................................................................................................... 54
Communicable vs. noncommunicable .................................................................................................... 54
Comorbidity ............................................................................................................................................ 54
Complementary or alternative medicine ................................................................................................ 55
Comprise, compose ................................................................................................................................ 55
Condition ................................................................................................................................................. 55
Congenital vs. heritable .......................................................................................................................... 56
Contagious vs. infectious ........................................................................................................................ 56
Contraception, contraceptive ................................................................................................................. 56
Critical ..................................................................................................................................................... 56
Diagnose .................................................................................................................................................. 56
Die of, die from, die with ........................................................................................................................ 56
Disease .................................................................................................................................................... 56
Disorder ................................................................................................................................................... 57
DNA or genome sequencing ................................................................................................................... 57
Dose vs. dosage ....................................................................................................................................... 57
Endemic, epidemic, pandemic ................................................................................................................ 57
Gene and protein names ........................................................................................................................ 57
Genetics and genomics ........................................................................................................................... 57
Genome ................................................................................................................................................... 58
Genus and species names ....................................................................................................................... 58
Germ, microbe, microorganism, pathogen............................................................................................. 58
Incidence, prevalence ............................................................................................................................. 58
Incurable ................................................................................................................................................. 58
Influenza, avian flu, swine flu, seasonal flu, pandemic flu ..................................................................... 58
Integrative health .................................................................................................................................... 59
Maternal morbidity ................................................................................................................................. 59
Maternal mortality .................................................................................................................................. 59
9
Morbidity ................................................................................................................................................ 59
Mortality, mortality rate, fatality ............................................................................................................ 59
Nonpharmacologic .................................................................................................................................. 59
Precision medicine .................................................................................................................................. 60
Rare disease ............................................................................................................................................ 60
Research subjects, control subjects, study participants ......................................................................... 60
Syndrome ................................................................................................................................................ 60
T cell, B cell .............................................................................................................................................. 60
Toxic, toxicity, toxin, toxicant ................................................................................................................. 60
Vaccinate, inoculate, immunize .............................................................................................................. 61
Variant, Variation, Mutant, Mutation, .................................................................................................... 61
Introduction
The NIH Style Guide is intended for use in writing web content, fact sheets, brochures, newsletters, and
other promotional materials. NIH follows the Associated Press (AP) Stylebook for news releases and
other media products. For items not covered by this guide, please refer to HHS’ style guide and AP.
Whenever we diverge from HHS or AP’s guidance, it is explicitly stated in the style guide.
As language evolves, so will this style guide to reflect current best practices.
Open and read the links to the AP Stylebook found in many entries; the AP guidance for that topic is
primary and anything included here is in addition to AP or providing additional context.
The AP Stylebook is now available to all NIH staff when on the NIH network or VPN through a
custom
link, thanks to the NIH Library.
Note that this style guide is not intended for scientific publications, which typically follow the American
Medical Association, the National Library of Medicine, and other styles.
Other resources:
1. Plain Language: The Plain Writing Act of 2010 (Public Law 111-274) aims to improve clarity and
simplicity in government communication. The law requires federal agencies to use clear
language that the public can understand and use.
2. Science, Health, and the Public Trust webpage: Provides guidelines on communicating science
and health research to the public. Be sure to reference the Understanding Clinical Studies page
when writing about studies and clinical trials.
3. NIH Spanish Style Guide: Provides best practices for communications professionals who
translate and write Spanish health, science, or clinical research materials.
4. NIH Executive Secretariat Style Guide: Provides guidance for controlled correspondence.
List of NIH grant types.
10
6. PubMed and PubMed Central
: Provides information on the National Library of Medicine (NLM)
style for journal abbreviations, date formats, page numbers, and authors, as well as other styles.
a. PubMed is a database hosted by NLM that contains more than 34 million biomedical
literature citations and abstracts.
b. PubMed Central (PMC) is a digital archive hosted by NLM containing millions of freely
accessible, full-text biomedical and life sciences journal articles.
c. These resources are scientific literature databases offered to the public by NLM. NLM is
not a publisher, but rather collects, indexes, and archives scientific literature published
by other organizations. The presence of any article, book, or document in these
databases does not imply an endorsement of, or concurrence with, the contents by
NLM, NIH, or the U.S. Federal Government.
7. CDC’s Health Equity Guiding Principles for Inclusive Communication: Provides guidance for
health communicators to ensure their communication products and strategies adapt to the
specific cultural, linguistic, environmental, and historical situation of each population or
audience of focus.
8. Section508 Guide to Accessible Web Design and Development: Provides guidance
for developers, designers, and content creators to ensure that federal websites and digital
products meet the Revised 508 Standards, part of Section 508 of the Rehabilitation Act of 1973.
NIH
Accelerating Medicines Partnership®
When using the Accelerating Medicines Partnership® and AMP® names, add the superscript
registered R symbol in the first usage on a webpage or print product. For subsequent
references, use the abbreviation AMP without the registered R symbol.
When the registered services marks are used, the website or material in which they appear
should include this attribution statement in a footer on the homepage or at the end of the
material: “ACCELERATING MEDICINES PARTNERSHIP® and AMP® are registered service marks of
the U.S. Department of Health and Human Services.”
When the marks are used in text (e.g., in sentences and paragraphs), use the marks as an
adjective, not as a noun. For example: “The Accelerating Medicines Partnership® Program for
Alzheimer’s Disease (AMP® AD).”
Acting (as a job title)
While AP does not capitalize acting as a job title, Acting is a term of law when applied to a
person holding an HHS position because an acting holder of a position can have different levels
of responsibility than a permanent appointee.
Acting should be capitalized as part of a formal title if a person is officially named to that job.
This is a divergence from AP style. Similarly, if a person is not officially named as acting holder of
a position, avoid using it entirely.
When acting is part of a job title, include it right before the job title and not after the title in
parentheses. Correct: Acting NIH Director. Incorrect: NIH Director (Acting).
11
Abbreviations, initialisms, and acronyms
Always write out the full name and only include the abbreviation in parentheses after the first
reference if the name is referenced again in the story, e.g., the Office of Extramural Research
(OER). Abbreviations can be used for all subsequent references on the same webpage or
document. Do not list an acronym or when something is only once in a
story.
If for an internal audience, NIH can be used without
Follow AP style and use as few acronymized initialisms and acronyms as possible, especially
when they are less well known. Many people recognize FDA, but few people will quickly
recognize the abbreviated form of a specific working group within an NIH institute. For the
latter, using the full name is better even on the second reference, or use a short, contextual
reference like “the working group.”
For clinical trial study names, you can either spell out the full title followed by the acronym /
study name, or use the name alone and then orient the audience by describing the study.
For example: The COMBINE study is the largest pharmacotherapy trial conducted for
alcohol use disorder in the United States.
When a name is long and cumbersome and may not be recognized, this form is acceptable: to
discover the LINGO--rich repeat and immunoglobin-like domain-
–
Some abbreviations, such as HIV or AIDS, are so familiar that they do not need to be spelled out.
The NIH intranet page has a list of Commonly Used Acronyms and Abbreviations
.
Agency names and articles
Do not use the before the acronym NIH (or other ICO acronyms) unless it is in front of a proper
noun. For example, write “The letter was addressed to NIH” instead of “The letter was
addressed to the NIH.” However, you would write “The NIH BRAIN Initiative signals a paradigm
shift for neuroscience” and “The NIH director’s research priorities.”
When NIH or an ICO acronym is used as a noun, the is not needed. For example, “NIH is the
nation’s leading biomedical research institution,” or “Today, NIH announced…”
For other agencies, it varies. Use the before the agency name if the agency commonly is known
by that usage. AP commonly uses the before FDA (e.g., “The FDA announced…”). The does not
typically precede initials of less well-known agencies, such as AHRQ.
Use an before where the sound is a vowel sound. For example, “an
NIH grant.”
12
When U.S. is part of a department or agency’s official name, include it on the first reference. For
example, U.S. Department of Health and Human Services, U.S. Food and Drug Administration,
but not before the Centers for Disease Control and Prevention.
BRAIN Initiative
®
The following are registered trademarks of the U.S. Department of Health and Human
Services: Brain Research Through Advancing Innovative Neurotechnologies
®
and The BRAIN
Initiative
®
.
The following versions are not trademarked and do not require the
registered trademark symbol: BRAIN Initiative, NIH BRAIN Initiative, and the NIH BRAIN
Initiative.
On first reference and within the same sentence, both registered trademarks should appear as
follows: The Brain Research Through Advancing Innovative Neurotechologies® Initiative, or The
BRAIN Initiative®, aims to revolutionize our understanding of the human brain. On subsequent
references, use BRAIN Initiative and NIH BRAIN Initiative without the registered R symbol.
When the registered trademarks are used, the website or material in which they appear should
include this attribution statement in a footer of the homepage or at the end of the material:
Brain Research Through Advancing Innovative Neurotechologies® Initiative and The BRAIN
Initiative® are registered trademarks of the U.S. Department of Health and Human Services.
ClinicalTrials.gov
ClinicalTrials.gov is a database hosted by NLM of privately and publicly funded clinical studies
conducted around the world. It is the world’s largest clinical trial registry and results database.
Never use CT.gov, which links to Connecticut's official state website.
Clinician–scientist
Clinician–scientists are scientists with professional degrees who have training in clinical care and
are engaged in independent biomedical research. Clinician–scientists can be dentist-scientists or
nurse–scientists, for example, while physician–scientists have an M.D. or D.O. degree. When
writing for the public, define the term after the first use.
Drug names
At first mention, give the generic or nonproprietary drug name followed by the drug's brand
name if there is only one in parentheses, such as "imatinib (Gleevec)." Exclude brand name with
generic drugs with multiple brands. Do not capitalize the generic names of drugs. Use an initial
capital for the brand name and omit trademark symbols (® and ™). For subsequent mentions,
use the nonproprietary drug name unless there is a specific need to refer to a brand name.
Early career scientists
Early career scientists are about to transition, or have recently moved, to fully independent
positions as investigators, faculty members, clinician scientists, or scientific team leaders in
13
industry. Early career scientists focus on establishing themselves as the experts in their chosen
research areas.
They are also referred to as early career researchers or early career investigators. Do not use the
term young scientists. A hyphen is not necessary following the word early for these terms.
An , however, has a more narrow definition. An ESI is a program
director / principal investigator (PD/PI) who has completed their terminal research degree or
end of post-graduate clinical training (whichever date is later) within the past 10 years and has
not previously competed successfully as PD/PI for a substantial NIH independent research
award.
Foreign influence vs. inappropriate foreign government interference
When referring to international risks or threats to U.S. biomedical research integrity and
security, use inappropriate foreign government interference instead of foreign influence.
See Protecting U.S. Biomedical Intellectual Innovation for more information.
Grant
Only capitalize grant when it is part of a proper noun, like a formal title.
R,
career development awards start with K, research training grants start with T, fellowships start
with F, program project and center grants start with P, and start with U.
Use the term recipient instead of grantee or awardee when referring to grant recipients. NIH
makes grants to institutions and organizations, not individuals (with the exception of certain
career development grants).
NIH mechanisms refer to the various types of funding mechanisms NIH uses to support research,
both extramurally (grants, contracts, and other transactions) as well as intramurally on our
campuses. R01, R21, U01, are examples of grant types, or activity codes, and not NIH
mechanisms.
Reference the Types of Grant Programs
page for more thoroug
Humans and other animals
Write humans and other animals instead of humans and animals because humans are animals.
Intramural Research Program
The Intramural Research efers to the internal research program at NIH. The
Office of Intramural Research oversees the policies and processes that govern the IRP. Many ICs
use Division of Intramural Research to refer to their own IRP.
14
Intramural research activities are conducted by individuals with a specific type of NIH
appointment called an Intramural Professional Designation, as well as by those who provide
direct support to their research efforts.
The term intramural should only be used to refer to individuals and research within the IRP.
Intramural should not be used for activities being performed or overseen by Office of
Extramural Research or the Office of Management.
MedlinePlus
MedlinePlus is an online health information resource hosted by NLM. It presents high-quality,
relevant health and wellness information that is easy to understand in both English and Spanish.
MedlinePlus is one word in camel case, with no space between Medline and Plus. Camel case is
writing phrases without spaces or punctuation and indicating the separation of words with a
single capitalized letter. Never use Medline, Medline+, or M+.
NIH HEAL Initiative
®
On first reference, both registered service marks should appear: Helping to End Addiction Long-
term® Initiative, or NIH HEAL Initiative®.
On subsequent references, write either the NIH HEAL Initiative (without the registered R
symbol) or the initiative (lowercase, no initial capitalization).
Do not write NIH HEAL (Helping to End Addiction Long-term) Initiative
®
or NIH Helping to End
Addiction Long-term (HEAL) Initiative.
When the registered service marks are used, the website or material in which they appear
should include this attribution statement in a footer of the homepage or at the end of the
material: NIH HEAL Initiative and Helping to End Addiction Long-term are registered service
marks of the U.S. Department of Health and Human Services.
NIH institutes, centers, and offices
NIH is made up of 27 Institutes and Centers (ICs) and many policy and program offices within the
Office of the Director (OD). When referring only to institutes and centers, use the abbreviation
ICs on subsequent references. When referring to ICs and OD offices, use ICOs on subsequent
references (e.g., “All ICO directors have reviewed this report”).
Only use an apostrophe with the abbreviation ICs if it is possessive, e.g., “the ICs’ research
priorities.” Note that the apostrophe would always go after the s because ICs is plural. If it were
a single institute or center, you would not need to use the abbreviation. Do not put an
apostrophe between IC and the letter s when it is simply a plural noun. ICs is correct.
The words institute, center, and office are not capitalized when used generally. Only capitalize
them when used in their title, e.g., The National Cancer Institute, or The Office of Science Policy.
Capitalize Institutes and Centers if writing about the collective 27 and capitalize Institutes,
Centers, and Offices if writing about all ICs and OD offices.
15
For example, use lowercase for institute in subsequent references if not using the
acronym: “The National Cancer Institute is the federal government's principal agency for
cancer research and training. The institute…”
When writing for the public, lead with the largest overall organization: NIH. In subsequent
references, cite the next largest: IC or OD office. Avoid individual lab/office/unit names; that
level of detail is unnecessary and may confuse the media and the public. Remember your
audience; it is not the scientist or the lab members. For example, an NIMH clinical scientist
might be identified simply as “Dr. Sue Smith, a mental health researcher at the National
Institutes of Health” on first reference. On the second reference you could reference the
National Institute of Mental Health.
For directors and deputy directors of ICOs, use their official title and include the ICO name.
Specific ICO naming conventions
All of Us Research Program
The All of Us Research Program always has All of Us in italics and can be
shortened to All of Us or the program in subsequent references.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development
The official name for NICHD is the Eunice Kennedy Shriver National Institute of
Child Health and Human Development, with Eunice Kennedy Shriver in italics.
The acronym remains NICHD.
Fogarty International Center
John E. Fogarty International Center is the official name, but it is rarely used.
The preferred, commonly used name is Fogarty International Center. For
subsequent references, use Fogarty instead of FIC.
National Heart, Lung, and Blood Institute
This institute name contains two commas. Pay attention to punctuation when
writing out the full name.
NIH-wide vs. trans-NIH
To avoid confusion, the term NIH-wide is preferrable to trans-NIH, unless part of a formal name,
e.g., Trans-NIH ME/CFS Working Group. If referring to an NIH initiative that involves two or more
institutes, but not all of NIH, you can refer to it as a multi-institute program, list the institutes, or
write “this program has input from five NIH institutes.”
Nonhuman primates
Write nonhuman as one word, not non-human or non human. As in, nonhuman primates.
16
Notice of funding opportunity
A is a formal announcement of the availability of federal
funding through a financial assistance program from a federal awarding agency, previously
referred to as funding opportunity announcements (FOAs). The notice of funding opportunity
provides information on the award, who is eligible to apply, the evaluation criteria for selection
of a recipient, required components of an application, and how to submit the application.
We recommend referencing funding opportunities rather than NOFOs for the sake of plain
language.
Notice of funding opportunity should not be capitalized.
The plural form is notices of funding opportunities.
Official job titles (director, senator, ambassador, president)
Capitalize official titles in NIH writing, whether it is before or after a name. This is a divergence
from AP style (for media products, follow AP style
). Do not capitalize general or informal
references to titles, such as scientists or grants management specialists.
In materials for a general audience, use a more plain-language description of a person’s role
when possible, especially if their official title is long or complex, e.g., “Dr. Nita Seibel, a
childhood cancer specialist at NIH” instead of “…head of the Pediatric Solid Tumor Therapeutics
in the Clinical Investigations Branch of the Cancer Therapy and Evaluation Program of the
National Cancer Institute.”
Examples:
1. Dr. Gary Gibbons, Director of the National Heart, Lung, and Blood Institute (NHLBI)
2. NHLBI Director Gary Gibbons, M.D.
3. Dr. Katharine Fernandez is a scientist in the Laboratory of Hearing Biology and
Therapeutics. She is also an audiologist.
4. Today, IC grants management staff have a new tool in their arsenal.
5. New guidelines have been implemented for review staff who monitor XYZ grant
applications.
6. NIH ICs are hiring health scientist administrators, grants management specialists,
program analysts, data scientists, and more.
Patents
American Medical style for referencing a patent:
Inventor last name, First initial. (Year). Title of patent (Country/Region Patent
No. Number). Issuing Body. URL
17
Physician–scientist
Physician–scientists are medical doctors who are engaged in independent biomedical research.
They may also hold a Ph.D. and be referred to as an M.D./Ph.D. When the scientist has direct
contact with patients as part of research but does not have an M.D./D.O. degree, they should be
referred to as a [clinical specialty]–scientist or as a clinician–scientist; not as a physician–
scientist. When writing for the public, define the term after the first use.
Possessive apostrophe and institute names
When indicating possession, add an apostrophe s to the end of the institute acronym: NHLBI’s
research. When an ICO ends in the letter s, simply add the apostrophe and not apostrophe s. For
example, NINDS’ not NINDS’s, All of Us’ not All of Us’s.
Postbacs
A postbac (short for postbaccalaureate) is a recent college graduate with a bachelor’s degree
who has come to NIH to spend a year or two doing biomedical research. Write postbac as one
word, not post-bac, and if writing for the public, write out postbaccalaureate trainee and include
postbac in parentheses after the first reference. Postbac can be used for all subsequent
references on the same webpage or document.
Postdocs
A postdoc (short for postdoctoral) is someone with a doctoral degree (Ph.D., M.D., D.D.S., or the
equivalent) who is engaged in a temporary period of mentored research or scholarly training to
acquire the professional skills needed to pursue a certain career path. Write postdoc as one
word, not post-doc. If writing for the public, write out postdoctoral trainee/fellow, as
appropriate, and include postdoc in parentheses after the first reference. Postdoc can be used
for all subsequent references on the same webpage or document.
Program titles
Capitalize names of programs when mentioned formally; lowercase when referred to
generically.
Examples:
1. NIH provides an array of career development and training to trainees at the
undergraduate, graduate, and postdoctoral levels. One of these is the Mentored Patient-
Oriented Research Career Development Award. This award provides support for the
career development of clinically trained professionals who have made a commitment to
patient-oriented research.
2. The NIH Office of Extramural Research holds its Virtual Seminar on Program Funding and
Grants Administration annually. The virtual seminar, which draws people from across
the globe, demystifies the application and review process, clarifies federal regulations
and policies, and highlights current areas of special interest or concern.
Titles and degrees
Doctor is a title applying to those who hold advanced degrees (e.g., Ph.D., D.D.S, D.V.M.).
Physician refers to a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.).
18
Do not use the title (Dr.) and the degree (Ph.D., M.D.) together. Always use periods in the
degree abbreviations as shown below.
Incorrect: Dr. Francis Collins, M.D., Ph.D.
Correct: Dr. Francis Collins
Correct: Francis Collins, M.D., Ph.D.
For NIH web writing, identify people with their full name and degrees on first reference, then Dr.
Last name in all other references. This is a divergence from AP style. For media products and NIH
articles and news stories (e.g., The NIH Record, Research Matters), follow AP style and use last
name only (no Dr.) after the first reference.
If someone has more than one advanced degree, list them in the order they prefer, separated
with commas. If no preference is apparent, list higher degrees first.
Examples:
• M.D., Ph.D.
• D.D.S., Dr.P.H.
Add a comma between last name and each degree, and after the last degree in a series (e.g.,
John Smith, M.D., Ph.D., will speak at the conference).
Do not use periods for postnominal titles (office or honor) or nonacademic degrees that show
membership in an organization, such as CDE, FACEP, FAAFP, FAAP, FACP, FACS, or FACE.
Government
Advisor
Write advisor not adviser. As in, Senior Advisor. This is a divergence from AP style.
Agency, agencywide, interagency
Only capitalize agency when it is part of an official agency name, e.g., the Environmental
Protection Agency.
Agencywide is one word, no space or hyphen. It refers to anything that extends or exists
throughout an entire agency.
Interagency is one word, no hyphen needed. It refers to something occurring between or
involving two or more agencies.
Appropriation, appropriations, authorization
An appropriation is a law of Congress that provides an agency with budget authority.
Appropriations are the funds — either definite (a specific sum of money) or indefinite (an
amount for "such sums as may be necessary").
19
Authorization is an act of Congress that permits a federal program or activity to begin or
continue from year to year. It sets limits on funds that can be appropriated but does not grant
funding which must be provided by a separate congressional appropriation.
Calendar year
The calendar year is January 1 through December 31. This term is often used to differentiate
from the fiscal year and is sometimes shortened to CY. Generally, we should not use this
acronym for NIH writing because it will only confuse the reader. Write with the assumption that
the calendar year is the default.
Congress, congressional
Always capitalize Congress when referring to the U.S. House and Senate together. The adjective
congressional is lowercase. Congressional Justification is the name of a recurring report; do
capitalize congressional when it is part of a proper noun, like the name of a report.
The possessive Congress adds one apostrophe with no additional s: Congress’
Country names
Use a country’s name, not the adjective, as a subject, except when modifying the word
government (e.g., “we hope France will sign the resolution” or “we hope the French government
will sign the resolution,” not “we hope the French will sign the resolution”).
Use both country names when referring to two countries (e.g., U.S.-India relations, not U.S.-
Indian relations).
Use the pronoun it and the relative pronouns which or that for a country, not he/she or who.
Who refers to people; that refers to things.
Federal
Only capitalize federal when it is part of a proper noun, like the Federal Register or the Federal
Bureau of Investigation. General references to federal employees or federal laws, for example,
should remain lowercase.
Fiscal year
The federal government's fiscal year begins on October 1 and ends on September 30 of the
following year. When referencing the fiscal year, write it out the first time and then reference it
by the acronym FY in subsequent references (e.g., “In fiscal year 2022 (FY22), we received x
amount of funds”). Write the acronym with no spacing between FY and the last two digits of the
year (FY21, FY22), and not FY 2021, FY 2022 with a space and the full year.
Use an en dash in a range of years, e.g., fiscal years 2015–2020 (FY15–FY20), not fiscal years
2015 through 2020.
To avoid confusion, always use the term fiscal year and not budget year.
20
Health care
Use AP style, which is two words, not healthcare, even as a compound modifier (e.g., health care
overhaul). Exceptions: The Agency for Healthcare Research and Quality uses one word.
HealthCare.gov uses camel case.
Nationality and citizenship
Avoid using citizen as a generic term for people who live in the United States. How you refer to
the public is largely dependent on context. People, the public, or users could all be appropriate.
Citizens should be used for information directly related to U.S. citizenship, such as when
describing who is eligible to vote in federal elections.
Medical Language
Commonly misspelled names
For a more thorough compilation of eponymous disease names with proper punctation and spelling,
please see the National Human Genome Research Institute’s Genetic Disorders page
.
Alzheimer’s disease
Not Alzheimer disease. Use Alzheimer’s disease on the first reference; just Alzheimer’s
(without the word “disease”) is acceptable for subsequent references on the same
webpage or document. The abbreviation AD is acceptable on second reference if it is
used along with the first reference: Alzheimer’s disease (AD).
Amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS) was once commonly known as Lou Gehrig’s disease,
after the famous ballplayer in the 1940s who retired because of the disease. NIH doesn’t
refer to Lou Gehrig’s disease in our web content. You may write “also known as Lou
Gehrig’s disease” when writing resources intended for the public, e.g., MedlinePlus.
(Some people’s only point of reference to the disease may be through the name Lou
Gehrig's).
Creutzfeldt-Jakob disease
Not Creutzfeldt-Jakob’s disease.
Crohn’s disease
Not Crohns disease, Crohn disease, nor Crohns’ disease.
Down syndrome
Not Down’s syndrome nor Down’s.
Down syndrome is a condition or a syndrome, not a disease. People have Down
syndrome; they do not suffer from it and are not afflicted by it. Use person-first
language: a child with Down syndrome.
21
Graves’ disease
Not Grave’s disease.
Hashimoto’s disease
Not Hashimotos disease or Hashimoto disease.
Hodgkin lymphoma and non-Hodgkin lymphoma
Not Hodgkin’s lymphoma. The abbreviation HL is acceptable on second reference if it is
used along with the first reference: Hodgkin lymphoma (HL). The abbreviation NHL is
acceptable for non-Hodgkin lymphoma.
Mpox
AP Stylebook: mpox
While the virus is still called monkeypox because the International Committee on the
Taxonomy of Viruses has yet to update their entry, use mpox or the virus that causes
mpox, unless scientifically essential. Mpox is not capitalized unless it begins a sentence.
Myalgic encephalomyelitis/chronic fatigue syndrome
Myalgic encephalomyelitis/chronic fatigue syndrome, commonly known by its
abbreviation ME/CFS, is often misspelled, and sometimes referred to as “chronic
fatigue,” which is a symptom but not the name of the disease. Myalgic
encephalomyelitis/chronic fatigue syndrome is not capitalized unless it begins a
sentence.
Parkinson’s disease
Not Parkinson disease. Use Parkinson’s disease on the first reference and then the
acronym PD for subsequent references. Parkinson’s without the word “disease” is rarely
used in NIH writing but is acceptable.
COVID-19
COVID-19, SARS-CoV-2, coronavirus
AP Stylebook: coronaviruses
COVID-19 (coronavirus disease 2019) is an infectious disease caused by SARS-CoV-2
(severe acute respiratory syndrome coronavirus 2). Use COVID-19 when referring to the
disease and SARS-CoV-2, or the virus that causes COVID-19, when referring to the virus
itself. Do not use coronavirus to refer to the disease or as a synonym for COVID-19.
Always capitalize all the letters in COVID-19 (not Covid-19 or covid-19). Do not shorten
COVID-19 to COVID.
Coronaviruses are a large family of viruses that usually cause mild to moderate upper-
respiratory tract illnesses in humans. However, three coronaviruses have caused more
serious and fatal disease in people: SARS-associated coronavirus, MERS-CoV, and SARS-
CoV-2.
22
PASC, Long COVID, MIS-C
PASC stands for post-acute sequelae of SARS-CoV-2 and is a term that scientists are
using to study the potential consequences of a SARS-CoV-2 infection.
One of these consequences is referred to as Long COVID — when COVID-19 symptoms
last weeks or months after the acute infection has passed. Do not use the term long-
haulers when referring to people who have Long COVID. PASC and Long COVID are not
interchangeable terms. Use long COVID for press releases, per AP style, but Long COVID
for all other NIH writing.
- is a condition in which different
body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or
gastrointestinal organs. The cause of MIS-C is not yet known, but many children who
develop MIS-C previously had COVID-19.
Vaccine hesitancy vs. anti-vax
AP Stylebook: anti-vaxxer
Use vaccine hesitant, vaccine hesitancy, or someone opposed to vaccines instead of anti-
vaxxers, anti-vax, or anti-vaccine. If necessary in a direct quote, explain it.
Diabetes
Blood glucose vs. blood sugar
Use blood glucose instead of blood sugar. On first mention of blood glucose, you may
include “also called blood sugar,” offset by commas.
Hypoglycemia
Hypoglycemia, also called low blood glucose, occurs when the level of glucose in your
blood drops below what is healthy for you. Low blood glucose should follow
hypoglycemia, set off with commas. Use hypoglycemia on first reference.
Avoid describing blood glucose as too low or normal. Preferred terms are low for you or
below what is healthy for you.
Example: Your number might be different, so check with your doctor or health
care team to find out what blood glucose level is low for you.
Insulin
Use take insulin instead of use insulin when writing about a person administering or
injecting insulin into the body.
Prediabetes
Always list diabetes first when listing diabetes and prediabetes.
Type 1, type 2 diabetes
Type 1 and type 2 diabetes should be lowercase unless beginning a sentence, per the
American Diabetes Association.
23
Person-first and Destigmatizing Language
Person-first language is a way to emphasize the person and view the disorder, disease, condition, or
disability as only one part of the whole person. Describe what the person “has” rather than what the
person “is.” Person-first language avoids using labels or adjectives to define someone, e.g., a person
with diabetes not a diabetic; or person with cancer not cancer patient; or a person with bipolar disorder
not a person who is bipolar.
Some communities, however, prefer identity-first language because they consider some characteristics
as inseparable parts of their identity. Those who prefer identity-first language consider it a way to show
pride in who they are and their membership in a community of similar people. The deaf and autistic
communities, for example, often show a strong preference for identity-first language. When possible,
ask if a person or group uses identity-first language (deaf students) or person-first language (students
who are deaf). Default to using person-first language if preference is not known or cannot be
determined.
See the CDC’s Health Equity Guiding Principles for Inclusive Communication and the NIH article Writing
Respectfully: Person-First and Identity-First Language for more on person-first language and other
inclusive principles.
Brain injury vs. brain damaged
AP Stylebook: Brain injury
A traumatic brain injury (TBI) can be caused by a forceful bump, blow, or jolt to the head or
body, or from an object that pierces the skull and enters the brain.
A traumatic brain injury should not be referred to as a head injury, which should be reserved for
cases where the head is injured without damaging the brain.
Blind
AP Stylebook: Blind
The National Center on Disability and Journalism (NCDJ) says to use the term blind to describe
someone with complete loss of sight. Use legally blind to describe someone with “almost
complete loss of sight.” Another option is low vision. NCDJ recommends against using the term
visually impaired. Ask your source what they prefer and if they prefer identity-first (blind
students) or person-first (students who are blind) language.
Caesarean delivery vs. c-section
In general, use caesarean delivery, caesarean birth, or abdominal delivery instead of caesarean
section or c-section. This is a divergence from AP style.
Caregiver, care partner vs. caretaker
Use caregiver, rather than caretaker, to describe people providing care. The
term caretaker generally refers to a person who takes care of something, such as a house, when
the owner isn’t present.
24
Both caregiver and care partner are acceptable but consider the situation and individual’s
preference before choosing a term. A caregiver provides care for someone who cannot care for
themselves. A care partner is a partner in care, and this term is sometimes preferred to show
that the person with the disease is able to care for themselves with some assistance.
Deaf
AP Stylebook: Deaf
According to NCDJ: “Deaf and hard of hearing became the official terms recommended by the
World Federation of the Deaf in 1991. Many people in the Deaf community prefer the use of the
lowercase ‘d’ to refer to audiological status and the use of the capital ‘D’ when referring to the
culture and community of Deaf people.” Always ask your source what they prefer; some deaf
people do not consider themselves to be a part of the Deaf community. If writing generally, it’s
best to use what the community at large uses, which is identity-first language (deaf adults).
Avoid the term hearing impaired.
NCDJ says: “When quoting or paraphrasing a person who has signed their responses, it’s
appropriate on first reference to indicate that the responses were signed. It’s acceptable to use
the word ‘said’ in subsequent references.”
Developing nations vs. third-world countries
AP Stylebook: Third World
Use developing nations or developing country instead of third-world countries. The term third-
world country is dehumanizing and offensive. The World Health Organization uses the following
data-based terms instead (abbreviations included because they are commonly used). Whenever
possible, specify the exact country or countries to avoid labeling altogether.
• Low- and middle-income country (LMIC) and low- and middle-income countries (LMICs)
• Upper-middle-income country (UMIC) and upper-middle-income countries (UMICs)
• High-income country (HIC) and high-income countries (HICs)
Disproportionately affected vs. vulnerable groups
Avoid use of terms such as vulnerable, marginalized, and high-risk as adjectives. These terms are
stigmatizing and vague. They also imply that the condition is inherent to the group rather than
referencing the actual causal factors.
If possible, be specific and reference the actual casual factors. For example:
• Disproportionately affected [by climate change]
• Groups that have been [economically/socially] marginalized
• Communities with high [incidence/prevalence/burden]
• People exposed to [HIV]
• Groups experiencing disadvantage
• Groups experiencing a disproportionate impact [of air pollution]
• Population of focus
• Under-resourced communities
• Medically underserved communities
25
• People who lack access to health care services
Diversity
Diversity is a broad, umbrella term and should not be used as a stand-alone buzzword when a
specific term or phrase would be more applicable and meaningful. Diversity includes all aspects
of human identities and encompasses every aspect of difference, including race, ethnicity, sex,
gender, religion, disability, neurodiversity, socio-economic status, education, and much more.
For example, are you using diversity when you really mean minority health and other NIH-
designated populations that experience health disparities in clinical study populations?
Or, when you use the term diversity are you referring to the biomedical research workforce?
While not a complete list, see NIH’s Office for Scientific Workforce Diversity’s page on
Populations Underrepresented in the Extramural Scientific Workforce
for an example of the
groups that have been identified as underrepresented in the workforce.
Diversity, Equity, Inclusion, and Accessibility (DEIA)
Please see the NIH-Wide Strategic Plan for Diversity, Equity, Inclusion, and Accessibility (DEIA).
This term is appropriate to use in the context of NIH or federal workforce diversity, where we
have specific metrics and measurements for structural and organizational change. The term
DEIA is not appropriate for NOFOs or external communications where we couldn’t know or
approximate the metrics institutions outside the federal government are using.
Engage, prioritize vs. target, tackle
Use engage, prioritize, or consider the needs of instead of tackle, target, combat, or other terms
with violent connotation when referring to people, groups, or communities.
These terms are okay to use when referring to disease, e.g., “NIH works to combat Alzheimer’s
disease and related dementias...”
Failed treatment
Do not use the patient failed treatment, which inappropriately blames the patient. Use the
treatment was not effective in the patient or the patient did not respond to treatment, instead.
Food insecurity
Food insecurity, when households lack access to adequate food because of limited money or
other resources, is a leading health and nutrition issue in the United States. Reference the
USDA’s Definitions of Food Security for ranges of food security and use recommendations. These
terms may require brief explanations if the meanings aren't clear from the context.
Food insecurity is related to suboptimal and/or poor diet quality, which increases chronic
disease risk among the socioeconomically disadvantaged.
Health disparities
Please see the National Institute of Minority Health and Health Disparities’ definitions page.
26
A health disparity is a health difference that adversely affects disadvantaged populations in
comparison to a reference population, based on one or more health outcomes. All populations
with health disparities are socially disadvantaged due in part to being subject to racist or
discriminatory acts and are underserved in health care.
Populations that experience health disparities include:
• Racial and ethnic minority groups
• People with lower socioeconomic status (SES)
• Underserved rural communities
• Sexual and gender minority (SGM) groups
• People with disabilities
HIV vs. HIV/AIDS
Please see the National Institute of Allergy and Infectious Diseases’ HIV Language Guide.
HIV stands for human immunodeficiency virus, which is the virus that causes HIV infection. The
abbreviation “HIV” can refer to the virus or to HIV infection.
AIDS stands for acquired immunodeficiency syndrome. AIDS is the most advanced stage of HIV
infection.
Use HIV instead of HIV/AIDS. AIDS evokes suffering and death and should be used only when
describing AIDS specifically. HIV is inclusive of both HIV and AIDS when the reference is not
specific, as in “the HIV epidemic.” HIV and AIDS do not need to be spelled out on first reference.
Immigrant, refugee vs. illegal aliens, foreigners
AP Stylebook: Immigration
Use people with undocumented status, mixed-status households, immigrant, migrant, asylum
seeker, refugee, or non-U.S.-born people (as appropriate and contextually) instead of
stigmatizing terms such as illegals, illegal immigrants, illegal aliens, illegal migrants, foreigners,
or the foreign-born.
Intimate partner violence vs. domestic violence
Use intimate partner violence or gender-based violence instead of domestic violence. The
preferred terms are more specific and include relevant violence outside of a shared home.
Participants vs. subjects
Use participants, people, individuals, or patients, depending on the context, instead of subjects
when referring to clinical trial participants, unless research subjects is specific to a policy or
regulation. Not all study participants are patients, particularly in research involving people who
are generally in good health.
People experiencing homelessness vs. the homeless
AP Stylebook: Homeless
Use people experiencing homelessness, people without housing, or people without homes
instead of the dehumanizing collective noun the homeless.
27
People with HIV
Use people with HIV or people living with HIV instead of HIV-infected people or people infected
with HIV. Infection carries the stigma of being contagious, a threat, or unclean. HIV advocates
frequently highlight the damaging consequences of this word choice. Living with is an
affirmation of life some advocates prefer.
Both PLWH and PLHIV are accepted abbreviations for people living with HIV.
People with lower incomes vs. poverty-stricken, the poor
Use people with lower incomes, people/households with incomes below the federal poverty level,
people experiencing poverty, instead of poverty-stricken, the poor, or poor people.
Do not use underserved when meaning low socioeconomic status. The term people with lower
should only be used when SES is defined (e.g., when income,
education, parental education, and occupation are used as measures).
Stakeholder vs. collaborator
Avoid the term stakeholder when referring to interest groups, working partners, and community
collaborators. Instead, use terms that describe the nature of their influence or involvement.
Stakeholder can be used to reflect a power differential between groups and has a violent
connotation for some Tribes and Tribal members. It also groups all parties into one term,
despite potential differences in the way they are engaged or interact with a project or activity.
Some alternative terms are interest groups, community members, people affected by
[policy/program/practice] or funders, partners, collaborators, allies, community engagement, or
Tribal engagement.
Suffering from, afflicted with
Use caution and context to determine whether phrases like suffering from or afflicted with
condition/disorder are appropriate. The words suffering and afflicted have social and
emotional implications that are unhelpful and can be stigmatizing for groups that have
experienced discrimination. Use specific medical language instead.
The word suffering can be appropriate in certain contexts, however, like when describing a
condition, disorder, or disease with limited treatment options or no cure. E.g., “When patients
are suffering, NIH can never move fast enough to help.”
Suicide
AP Stylebook: Suicide
Use died by suicide or attempted suicide instead of committed suicide.
Suicide attempts should not be described as successful, unsuccessful, or failed. Instead, use
survived a suicide attempt, just as one might describe an individual who has survived a heart
attack.
28
Underrepresentation
Underrepresentation is a workforce term, as opposed to health disparities, which relates to
population health. Underrepresented populations are represented in the workforce in numbers
that are disproportionately low. For example, women now earn more than half of the Ph.D.s
conferred each year in the life sciences, but they make up less than half of assistant professors
and few of full professors in academic institutions; in this way, women are underrepresented at
the assistant and full professor faculty levels.
Underrepresentation in extramural programs is tied to national representation ratios, not
institutional demographic data.
Avoid using the term underrepresentation when discussing study population participants, and
use the term understudied, minority health, health disparity populations, or more specific terms,
if appropriate. See also: Disproportionately affected vs. vulnerable groups.
Alcohol and Substance Use
Please also reference:
• The National Institute on Alcohol Abuse and Alcoholism’s page When It Comes to Reducing
Alcohol-Related Stigma, Words Matter
• The National Institute on Drug Abuse’s page Words Matter – Terms to Use and Avoid When
Talking About Addiction
Alcohol misuse vs. alcohol abuse
Use alcohol misuse instead of alcohol abuse when referring broadly to drinking in a manner,
situation, amount, or frequency that could cause harm to the person who is engaging in drinking
or to those around them.
Alcohol overdose vs. alcohol poisoning
Use alcohol overdose instead of alcohol poisoning, which is not an accurate term. Poisoning
implies death due to toxicity. Alcohol kills by direct neuropharmacological effects on the
brainstem when someone drinks too much (i.e., when they overdose).
Alcohol use disorder vs. alcoholism
Use the term alcohol use disorder rather than alcoholism or alcohol abuse. This is a
divergence from AP style. Alcohol use disorder aligns with the medical community and federal
government’s initiatives to raise awareness that compulsive substance use is a complex brain
disorder rather than a moral failing or personality flaw.
Addiction is not a diagnostic term although it is an acceptable synonym for moderate or severe
substance or alcohol use disorder. NIAAA uses addiction
to refer to the severe sub-classification
of AUD. Alcohol addiction is a chronic relapsing disorder associated with compulsive alcohol
drinking, the loss of control over intake, and the emergence of a negative emotional state when
alcohol is no longer available.
29
For more in-depth information on the criteria for alcohol use disorder, see the National Institute
of Alcohol Abuse and Alcoholism’s page
Alcohol Use Disorder: A Comparison Between DSM–IV
and DSM–5.
Alcohol-associated hepatitis, alcohol-associated cirrhosis, and alcohol-associated
pancreatitis
Use the terms above instead of alcoholic hepatitis, alcoholic cirrhosis, and alcoholic
pancreatitis. While the substitution of alcoholic with alcohol-associated has not been adopted
widely for these health conditions, changing the language may help to reduce stigma for people
diagnosed with these health conditions.
Alcohol-associated liver disease
Use alcohol- instead of alcoholic liver disease. Use of alcoholic as
an adjective may perpetuate stigma for people with ALD and other alcohol-related health
conditions. Alcohol-associated liver disease has been adopted officially in the field of alcohol
research.
Baby with neonatal opioid withdrawal syndrome, neonatal abstinence syndrome
vs. born addicted
Use baby with neonatal opioid withdrawal or baby with neonatal abstinence
syndrome depending on the context, instead of born addicted or addicted baby. Babies
cannot be born with addiction because addiction is a behavioral disorder—they are simply born
manifesting a withdrawal syndrome. Use clinically accurate, non-stigmatizing language the same
way you would for other medical conditions.
NOWS refers to a baby experiencing withdrawal symptoms from in-utero exposure to opioids.
NAS refers to a baby experiencing withdrawal symptoms from in-utero exposure to substances
like cocaine, psychiatric medications, or those substances and opioids.
Fetal alcohol spectrum disorders
The term fetal alcohol spectrum disorders (FASD) refers to the wide range of physical,
behavioral, and cognitive impairments that occur due to alcohol exposure before birth (also
known as prenatal alcohol exposure).
Focus on the fetus and pregnancy, rather than the mother, as this reduces stigma. For example,
use alcohol-exposed pregnancy vs. mother/person who drinks during pregnancy.
Medications to treat opioid use disorders vs. medication-assisted treatment
The widely used term medication- stigmatizes the pharmacotherapies
as less than adequate and distinct from medications for other medical conditions. Use
medications for opioid use disorder, or MOUD, instead of MAT.
30
Person in recovery, person in remission
Use person in recovery or person in recovery from alcohol/substance use disorder instead
of recovering alcoholic/addict. Note personal definitions of recovery vary and not all people in
remission from alcohol or substance use disorder identify as in recovery.
Person with a substance use disorder, person who uses drugs
Use person with a substance use disorder instead of addict, user, junkie, or drug abuser. A
person can have multiple substance use disorders to different substances (alcohol, stimulants,
opioids, etc.). Be thoughtful about when to use a plural version of this term versus the singular
disorder.
Person who uses drugs or person who uses substances are other acceptable terms for people
who may be otherwise be called a user, but do not have an SUD.
Person with alcohol use disorder vs. alcoholic
AP Stylebook: Alcoholic
Use person with alcohol use disorder instead of alcoholic to reduce stigma. Stigma is a significant
barrier in many people’s willingness to seek help for alcohol and other substance use problems
and can affect how they are treated in all aspects of life, including availability and quality of
care.
Some individuals choose to personally use alcoholic to describe themselves as part of their
recovery program, e.g., Alcoholics Anonymous. Writers can differentiate between writing a
personal story and creating general health content.
Person with an opioid use disorder or person with opioid addiction
Use person with an opioid use disorder abbreviated to OUD) or person with opioid addiction
instead of addict, user, junkie, or drug abuser. In general, use the term opioid and not narcotic.
Return to use, recurrence vs. relapsed
Use the terms return to use, return to drinking, or recurrence instead of relapse when referring to
someone who has returned to alcohol or drug use, or a recurrence of substance/alcohol use
disorder symptoms.
Substance use disorder, addiction vs. habit
AP Stylebook: Addiction
Substance use disorders are chronic, treatable medical conditions from which people can
recover. They are defined in part by continued substance use despite negative outcomes.
Substance use disorders may be diagnosed as mild, moderate, or severe based on whether a
person meets defined diagnostic criteria.
Addiction is not a formal diagnosis, and the term is used in many ways. Some people use the
term to describe some substance use disorders, especially more serious presentations.
Use substance or drug addiction instead of habit to avoid trivializing this
medical condition. This is a divergence from AP style.
31
Testing positive (on a drug screen)
Use testing positive when referring to a drug screen, rather than dirty, or failing a drug test. Use
neutral, medically accurate terminology. Also do not use clean to describe negative test results
or abstinence from drug use.
Treatment center vs. rehab
Use treatment center instead of rehab or detox center. The latter terms carry cultural stigmas
and misconceptions.
Use, misuse vs. abuse
When referring to illicit drugs, refer to their use instead of abuse. The term misuse can describe
nonmedical use of substances that have legitimate medical uses when taken as directed, such as
cough syrup or prescription medications. Misuse can also describe adult intake of legal
substances, like alcohol (or, in some states, cannabis), in ways that may negatively affect health
and safety. See also: alcohol misuse vs alcohol abuse.
Disabilities
AP Stylebook: Disabilities
Unless you are referring to any disability type, be specific about which disability you are
referring to.
If data on disability will be reported, please contact the Office of Equity Diversity and Inclusion
for the federally recognized disability categories.
Attention-Deficit/Hyperactivity Disorder
Attention-Deficit/Hyperactivity Disorder (ADHD) is marked by an ongoing pattern of inattention
and/or hyperactivity-impulsivity that interferes with functioning or development. Use person-
first language: person with ADHD, person who has ADHD. Do not use the outdated terms
attention-deficit disorder or ADD.
Disability vs. handicap
Use disability instead of handicap.
Disability-related metaphors
Avoid using disability as a metaphor, which perpetuates negative and disempowering views of
people with disabilities.
Below are some disability-related metaphors and their alternatives:
• Blind to/deaf to willfully ignorant, deliberately ignoring
• Crazy/schizophrenic wild, confusing, unpredictable
• Lame boring, uninteresting, monotonous, uncool
• OCD fastidious, meticulous, hyper-focused
•
32
• Sanity-
• Stutter step, stuttering used as a verb to denote slowness, choppiness
dodge, with hesitation
Dyslexia
Dyslexia is a learning disability that impairs a person's ability to read. Although the disorder
varies from person to person, common characteristics among people with dyslexia are difficulty
with phonological processing (the manipulation of sounds), spelling, and rapid visual-verbal
responding. Use person-first language: person with dyslexia, person who has dyslexia, rather
than dyslexic, unless someone describes themselves that way.
Invisible disabilities
According to the Invisible Disabilities Association, invisible disabilities refer to a range of
symptoms such as debilitating pain, fatigue, dizziness, cognitive dysfunctions, brain injuries,
learning differences, mental health disorders, and hearing and vision impairments. Invisible
disability is therefore a physical, mental, or neurological impairment that is not obvious to
others, but may impact upon a person’s movements, senses, activities and day-to-day life.
Needs, differences vs. deficit, defect
In general, do not use terms like deficit, defect, abnormality, or problem in the context of mental
health. Instead, use needs, differences, or challenges. The term disability is accepted and it may
help to be more specific (e.g., intellectual disability, physical disability, language disability, etc.).
It is acceptable and helpful to use terms like abnormality or problem when referring to
measurable medical incidences like abnormality of the fingers or breathing problems/difficulties.
Nondisabled person, person without disabilities vs. normal
When comparing persons with disabilities to others, use the term nondisabled person or person
without disabilities rather than normal person, because normal is associated with abnormal.
When referring to someone without intellectual disabilities, use without [disorder], or
neurotypical instead of normal.
Person who uses a wheelchair vs. wheelchair-bound
Use person who uses a wheelchair or wheelchair user rather than wheelchair-bound or confined
to a wheelchair. Assistive technologies and services should be portrayed as helping and
accommodating a person rather than making them “correct” or emphasizing limitation.
Person with disabilities vs. handicapped
Use person with disabilities instead of handicapped, handi-capable, differently abled, or the
disabled. While individual preference for person-first (person with disabilities) or identity-first
(disabled person) varies, default to using person-first language if preference is not known or
cannot be determined.
33
Autism
AP Stylebook: autism
Autism
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how
people interact with others, communicate, learn, and behave. ASD should never be referred to
as a mental illness or a disease. Both autism and autism spectrum disorder (or ASD) are
acceptable ways of referring to the disorder, depending on the audience and the context.
Characteristics vs. symptoms
Use the terms characteristics, or traits, instead of symptoms when referring to people with
autism.
Cure, prevention
Avoid using the terms cure and prevention in relation to autism.
High-support needs vs. high-/low-functioning
AP Stylebook: High-functioning, low-functioning
Avoid using the terms high- or low-functioning when referring to a person with autism (or any
condition). This language is stigmatizing, dehumanizing, and vague. Instead, describe the
person’s needs specifically, e.g., high-support needs; person with intellectual disabilities; person
with language disabilities.
Neurodiversity
AP Stylebook: Neurodiversity
Neurodiversity describes the idea that people experience and interact with the world around
them in many ways, with no one "right" way of thinking, learning, and behaving, and differences
are not deficits. Neurodiversity refers to the diversity of all people, but it is often used in the
context of autism spectrum disorder and other neurological or developmental disorders such as
ADHD or dyslexia. This language can be helpful to use when talking about workplace or
classroom accommodations for neurodiverse people. Referring to someone as neurodiverse or
neurodivergent is a way to focus on the positive aspects of their differences and what that can
bring to the group setting.
Nonspeaking vs. nonverbal
Use nonspeaking instead of nonverbal. Many people on the autism spectrum may be
nonspeaking but are able to communicate very well using technology or other means.
Person with autism, autistic person, person on the autism spectrum
The autism community is diverse and while some people prefer person-first language — person
with autism or person on the autism spectrum — others have proudly claimed identity-first
language and prefer autistic person. Generally, person on the autism spectrum is the least
polarizing term. Informally, some NIH ICOs will switch back and forth between person-first and
identity-first language around autism to be inclusive.
34
Likelihood vs. risk
Use increased likelihood for autism instead of terms like risk of autism or at risk for autism.
Likelihood is more specific and less stigmatizing.
Interventions, services, therapies vs. treatment
In relation to ASD specifically, use the terms interventions, services, and/or therapies (as
appropriate) and avoid using treatment.
Obesity and People with Higher Weight
Please see the Obesity Language Communications Plan developed by the Obesity Language Working
Group.
Obesity
Obesity is a chronic disease characterized by excess body fat and is a risk factor for many other
diseases. Currently, the definition of obesity is based on body mass index (BMI), a measure of
weight for height. Although higher BMI levels generally reflect higher levels of body fat on a
population level, BMI does not directly measure body fat. Obesity should be referred to as a
disease, not a condition.
Overweight
Overweight is a defined medical condition according to body mass index, commonly known as
BMI. It may be used as either a noun or an adjective in person-first language. For example,
both people with overweight and people who are overweight are acceptable; overweight people
is not acceptable. Outside of a scientific, clinical, or public health context, more neutral and
inclusive terms can be used (see: higher weight individual, person with a larger body).
Person with obesity vs. obese
Use person with obesity, person affected by obesity, or person who has obesity instead of obese
person or they are obese. Obesity should always be referred to as a disease, not as a condition.
Outside of a scientific, clinical, or public health context, more neutral and inclusive terms can be
used (see: higher weight individual, person with a larger body).
Higher weight individual, person with a larger body
When writing outside of a scientific, clinical, or public health context (or a press release
reporting on a clinical study), use person with higher weight, higher-weight individual, person
with a larger body, or other similar neutral descriptors, rather than person with obesity or
overweight. These terms are less stigmatizing, more inclusive, and would be appropriate for
general health content and internal communications (e.g., employee wellness programs).
In a scientific context, do not use higher body weight or similarly general terms as synonyms for
obesity and overweight.
There is a differentiation between writing public health content and a personal story – people
choose to use many different terms to describe their own bodies. Ask for personal preference if
35
body size is relevant to the story. For example, an individual may choose to reclaim the term fat
as a neutral descriptor.
Weight, excess weight vs. weight problem, fat, morbidly obese
For public health content, use weight or higher weight rather than weight problem, fat, morbidly
obese, or similarly pejorative descriptors. Note that higher weight and similar general terms
should not be used as synonyms for overweight and obesity.
Age
Children
Avoid vague terms such as babies, school-aged children, or teenagers, without first defining
them. For example, “this study enrolled two-week old newborns,” “participants included infants
ages 5 months to 1 year,” or “this study involved children ages 6-12 years.” When possible, use a
specific age or age range.
Age range designations vary among organizations (American Medical Association, American
Academy of Pediatrics, etc.), so ask for specifics and definitions if a general term like adolescents
is used.
Older adults vs. the elderly
Use older adults, people over age X, or people age X to Y instead of the aged, elders, the elderly,
or senior citizens. The word adult affirms agency and personhood, as does person-first language.
When possible, use a specific age or age range. The only exception to this rule might be when
referencing Tribes/American Indian/Alaska Natives, for which the term elders may be preferred
and culturally appropriate.
The National Institute on Aging generally describes older adults as people age 65 or older,
however, definitions of older adulthood vary. When an official or organization uses one of these
terms, ask for specifics.
Race and National Origin
General guidance
AP Stylebook: Race-related coverage
Avoid using Black and White as standalone nouns. Instead of Blacks, use Black people, etc.
Capitalize all references to race, including White. This is a divergence from AP style. Writing
white in the lowercase could give the impression that it is the default, neutral, or a standard.
The capital letter for a racial identity is not intended to elevate, but to situate. NIH follows the
Office of Management and Budget (OMB) standard and capitalizes all references to race equally.
Avoid collective reference to racial and ethnic minority groups as non-White unless it was a
formal category in a database or research document. Instead, indicate the specific groups.
36
Avoid using race/ethnicity because the slash implies that these are interchangeable terms.
Instead use race and ethnicity or race or ethnicity, as appropriate.
Include context when writing about race and other people-related language. Populations should
be described specifically whenever possible, and we should not default to using minorities or
racial and ethnic groups when writing about specific populations. If the language cannot be
made more specific (e.g., Black Americans, Asian Americans), then writing racial and ethnic
minority groups is preferred over minorities alone; there are also sexual and gender minority
communities, etc. See also: minoritized populations.
If race is pertinent to the story, ask your source for their preference on what term(s) to use.
If data on race and ethnicity will be reported, please contact the
Office of Equity Diversity and
Inclusion for the officially recognized Ethnicity and Race Indicator categories.
Alaska Native (Aleuts, Eskimos, Indians of Alaska), Alaskan
An Alaska Native (not Alaskan Native) is a person whose origins are in any of the original peoples
of Alaska and who maintains cultural identification through Tribal affiliation or community
attachment. An Alaskan is anyone who was born in Alaska or who is a long-term resident of
Alaska.
American Indian / Alaska Native
American Indians and Alaska Natives, abbreviated as AI/AN, are people belonging to any
American Indian or Alaska Native Tribe, band, nation, pueblo, village, or community. When
describing an AI/AN person, always use their preferred Tribal affiliation. When unsure, ask. Use
people to describe a single Tribe and peoples to describe multiple Tribes.
Many AI/AN Tribes have multiple names, some of which they did not choose for themselves. To
learn a Tribe’s preference, check their government website or ask a Tribal member directly.
Always capitalize the names of AI/AN Tribes. Examples: Cherokee Nation, Nooksack Indian Tribe,
Oglala Sioux Tribe, Anvik Village.
The terms American Indian and Alaska Native also refer specifically to persons with certain
rights, protections and benefits from the federal government. While the broader term Native
American is generally acceptable to use when referring to American Indians and Alaska Natives,
the specific terms American Indian and Alaska Native may be preferred in certain circumstances.
When unsure of preferences or when speaking broadly about the Indigenous Tribes of the
continental U.S. specifically, the terms American Indian and Alaska Native are preferred in U.S.
government communications.
Asian, Asian American
A person whose origins are in any of the original populations of the Far East, Southeast Asia, or
the Indian subcontinent, including, for example, Cambodia, China, Bangladesh, India, Japan,
Korea, Malaysia, Pakistan, the Philippines, Thailand, and Vietnam. Do not use the word oriental.
37
Use specific terms whenever possible. If race is pertinent to the story, ask your source for their
preference on what term(s) to use. Do not hyphenate Asian American or other dual-heritage
terms.
AAPI, which stands for Asian Americans and Pacific Islanders, is an acronym widely used by
people within these communities but may not be familiar to readers outside of them; spell out
the full term and define when used in quotations.
BIPOC
BIPOC stands for Black, Indigenous, people of color. It is a U.S. term intended to center the
experiences of Black and Indigenous people and demonstrate solidarity between communities
of color. Some argue that the term can also blur the differences between the two groups it is
meant to center. Always use specific racial terms (e.g., Black or Indigenous) on their own instead
of BIPOC if applicable; BIPOC should not be used when referring to an individual or an issue that
affects a specific group of people.
Biracial, multiracial, of mixed race
A person who has parents or ancestors of different racial backgrounds. Some consider using
mixed alone to be stigmatizing, while others claim the term positively. Mixed race is used
frequently in academia and elsewhere, though some say it has stigmatizing potential.
Black and African American
An African American is a person whose origins are in any of the Black racial groups of Africa. If
appropriate, specific terms such as Kenyan or Nigerian may also be used. Black is broader and
more inclusive than African American – someone within your target audience could be born in
Jamaica and live in the U.S. and identify as Black but not African American. Use of the capitalized
Black recognizes that language has evolved and, especially in the United States, the term reflects
a shared identity and culture beyond skin color.
When discussing scientific data, use the term that was used when the research (the source of
the data) was being conducted. Capitalize the word Black when referring to race. Do not
hyphenate African American or other dual-heritage terms.
Latino/a, Latinx, Latine
A person whose origins are in Latin America, including Cuba, Mexico, Puerto Rico, South
America, or Central America. If appropriate, specific terms such as Brazilian or Honduran may
also be used. Latino is reserved for men and Latina for women. The plural Latinas is for a group
of women and Latinos is for a group of men. A mixed gender group of Latin American descent,
however, would use the masculine Latinos.
Latinx is a gender-neutral term used primarily by English-speaking people in the U.S. Latinx is a
research-based designation, rather than community-based language. Only use Latinx if someone
has said they identify that way; it is not accepted or used by many Latinos.
Latine, a term created by LGBTQI+ Spanish speakers, uses the letter "e" to illustrate gender
inclusivity within existing Spanish pronunciation.
38
Not everyone with Latin American heritage uses Latine or Latinx, many continue to use Latino as
a gender-neutral default. Use specific language (e.g., Guatemalan American, if appropriate) and
ask for personal identity preferences whenever possible.
Hispanic
A person descended from Spanish-speaking populations. People who identify their origin as
Hispanic, Latino, or Spanish may be of any race. Most people with origins in Brazil are
considered Latino but not Hispanic because most Brazilians speak Portuguese. Similarly, Spanish
people may be considered Hispanic but not Latino. Because the terms are vague, use the more
specific geographic origin (Colombian, Honduran, Argentinian), if possible.
Chicano or Chicana
Chicano refers to “Mexican Americans in the U.S. Southwest.” The Diversity Style Guide points
out that the terms Chicano and Chicana were originally derogatory, but they were reclaimed “in
response to discrimination against Mexican Americans working under unfair labor and social
conditions.” Chicano/a is a chosen identity; only use it if someone self-identifies as such.
Middle East, MENA, Arab Americans
AP Stylebook: Middle East
When writing about people of Middle Eastern or North African (MENA) descent, allowing
individuals to self-identify is best. State the nation of origin (e.g., Iran, Iraq, Egypt, Lebanon,
Israel) when possible. In some cases, people of MENA descent who claim Arab ancestry and
reside in the United States may be referred to as Arab Americans.
Minoritized populations
Minoritized populations are groups that are marginalized or persecuted because of systemic
oppression. The term emphasizes that something is being done by others to subjugate certain
people, rather than using the permanent label of being a minority.
Minoritized is acceptable as an adjective provided that the noun(s) it modifies are included (e.g.,
racial and ethnic minoritized groups; sexual and gender minoritized groups). Populations should
be described specifically whenever possible, and we should not default to using minoritized
communities generally when writing about specific populations.
Minority health
Please see the National Institute of Minority Health and Health Disparities’ definitions page.
Minority health refers to distinctive health characteristics and attributes of racial and/or ethnic
minority populations who are socially disadvantaged and underserved in health care, in part due
to racist or discriminatory acts. Minority health research is the scientific investigation of singular
and combinations of attributes, characteristics, behaviors, biology, and societal and
environmental factors that influence the health of minority racial and/or ethnic population(s),
including within-group or ethnic sub-populations, with the goals of improving health and
preventing disease.
39
Hawaiian
The Asian American Journalists Association points out that Hawaiian “[r]efers to a person who is
of Polynesia descent. Unlike a term like Californian, Hawaiian should not be used for everyone
living in Hawaii.”
Similarly, the Diversity Style Guide uses the term Native Hawaiian, explaining: “Known as
Kanaka Maoli in Hawaiian, Native Hawaiians trace their lineage and language to Polynesians,
including Tahitians, Maoris and Samoans.”
The term Part-Hawaiian is acceptable when appropriate because it is a legal status. However, do
not capitalize part with other nationalities (example: part-Japanese).
Pacific Islander
The Asian American Journalists Association calls Pacific Islander a “U.S. Census term, referring to
one of eight groups—Fijian, Guamanian, Hawaiian, Northern Mariana Islander, Palauan,
Samoan, Tahitian and Tongan.”
See also: Asian Americans and Pacific Islanders (AAPI).
Indigenous peoples, First peoples, First Nations, Aboriginal peoples, and Native
peoples
These terms refer to people with origins in the original or earliest known inhabitants of an area,
in contrast to groups that have settled, occupied, or colonized the area more recently in human
history. These terms may be useful to describe Indigenous people in a global context.
Person of color
A person of color, commonly abbreviated POC, is someone who is not White or of European
origin. Many prefer this term to racial minorities and consider it inclusive of all non-White races,
while some individuals with non-White identities may not relate to the term. Still others
consider it euphemistic or irrelevant. Do not use people of color when referring to one specific
racial group who doesn’t identify as White; use a term specific to that group.
Tribe, Tribal
Always capitalize the word Tribe or Tribal, even when not referring to a specific Tribe. NIH’s
Tribal Health Research Office
recommends NIH follow the precedent of the U.S. Department of
the Interior and other federal agencies and capitalize Tribal in all instances, even when used as a
common noun.
White
A person whose origins are in any of the original peoples of Europe, the Middle East, or North
Africa. Avoid the term Caucasian because it technically refers to people from the Caucasus
region. Avoid language that frames being White as a default, normal, or “raceless” identity. Non-
Hispanic White is sometimes used to clarify that the described group does not include White
Hispanic people.
40
While there is some debate over whether White should be capitalized, we follow the OMB
standard and will capitalize all references to race, which is a divergence from AP style.
Sex, Gender, and Sexuality
AP Stylebook: Gender, sex, and sexual orientation
For a thorough list of terminology about sexual and gender minority populations, please reference
the
NIH Office of Equity, Diversity, and Inclusion’s LGBTI-SafeZone Terminology page.
Bisexual, bi+
Bisexual people have the potential to be emotionally, romantically, or sexually attracted to
people of the same and different gender—not necessarily at the same time, in the same way, or
to the same degree. Commonly referred to as bi.
Bi+ is an umbrella term that is intended to encompass non-monosexual identities, including but
not limited to bisexual, pansexual, sexually fluid, and queer.
Cisgender
A cisgender person is someone whose gender identity aligns with the sex assigned to them at
birth; sometimes abbreviated as cis. Use cisgender first with cis in parentheses after it if you use
the abbreviation in your writing.
Gender
See the NIH Office of Research on Women’s Health’s page on sex and gender.
Gender is a multidimensional social and cultural construct that includes gender roles,
expressions, behaviors, activities, power dynamics, and/or attributes that a given society
associates with being a woman, man, girl, or boy, as well as relationships with each other. As a
social construct, gender varies from society to society and can change over time.
Gender affirmation, gender confirmation, transition, transitioning
Use the terms above rather than the terms transgendering, sex change, the surgery, or pre-
operative/post-operative. Transition refers to the process—social, legal, and/or medical—one
goes through to affirm one’s gender identity. Transition may include changing hair styles,
clothing, and other forms of gender expression. It may mean changing names, pronouns, and
identification documents. It also encompasses gender-affirming medical care such as taking
puberty blockers, taking hormones, and/or having gender-affirming surgeries. There is no one
way to transition and the term means something unique to each individual who goes through
the process.
Pre-/post-operative may still be used in medical literature but should not be applied to a specific
person without the appropriate context as specified by the individual.
41
Gender expression
Gender expression is how one conveys one’s gender through behavior, clothing, and other
external characteristics. All people have gender expressions, and an individual’s gender
expression does not necessarily provide information about one’s gender identity.
Gender identity
An individual’s internal sense of gender (e.g., being a man, woman, boy, girl, genderqueer,
nonbinary, etc.). This identity is not necessarily visible to others.
Gender nonconforming
A person does not behave or express themselves according to typical gender stereotypes.
Intersex and variations in sex characteristics
Intersex and people with variations in sex characteristics (VSC) are people born
with chromosomal, gonadal, hormonal, and/or anatomical characteristics that may not align
with one another and/or fall outside of what is typically classified as male or female. Intersex is
more frequently used when describing identity. Not all individuals with VSC identify as intersex
as they may not wish to be defined by their biology or biological histories, nor do they think of it
as an identity. There are many ways to be born intersex, and having variations in sex
characteristics is a natural part of biological diversity.
may still be used in medical and clinical
settings. When communicating with the public, however, VSC and intersex are more
appropriate. VSC is a more clinical term and intersex is generally used in the context of identity.
LGBTQI+
LGBTQI+ stands for lesbian, gay, bisexual, transgender, queer, and intersex. The plus sign
includes other members of the community, such as asexual, genderfluid, nonbinary, or two-
spirit, among others.
Use LGBTQI+ when writing about the community outside of research contexts, e.g., community
engagement or Pride month messaging. Use
when referring to LGBTQI+ communities as a singular population in the context of health
research, related activities, and policy.
Misgender
To misgender is to refer to someone, especially a transgender or gender diverse person, using a
word or address that does not correctly reflect their gender identity.
Nonbinary
A nonbinary person identifies beyond the traditional gender binary of man and woman.
Nonbinary people are often considered part of the trans community.
42
Pronouns
Use pronouns that correspond to a person’s gender identity. Because gender identity is an
internal characteristic that should not be assumed, asking for a person’s pronouns is the best
practice. In addition to the binary English pronouns she/her and he/his, some people may use
nonbinary pronouns, including the pronouns they/them used as singular terms, among others.
When using the singular they, still conjugate the verb as a plural, as in, “they are gender
nonbinary.”
When writing about a hypothetical person, like an anonymous participant in a study enrolling
people of all genders, use the singular they rather than he or she.
Please review Gender Pronouns and Their Use in Workplace Communications
for a more in-
depth discussion.
Queer
The term queer is more fluid and inclusive than traditional categories for sexual orientation and
gender identity. Once considered a pejorative term, queer has been reclaimed by some LGBTQI+
people to describe themselves; however, it is not a universally accepted term even within the
LGBTQI+ community. People who identify as queer may think of their sexual orientation and/or
gender identity as characterized by nonbinary constructs of sexual orientation, gender, and/or
sex. Queer should only be used to describe members of the community who themselves identify
with it.
Sex, sexual
See the NIH Office of Research on Women’s Health’s page on sex and gender.
Sex is a biological descriptor based on reproductive, hormonal, anatomical, and genetic
characteristics. Typical sex categories include male, female, and intersex.
Sex is used when describing anatomical, gonadal, chromosomal, hormonal, cellular, and basic
biological phenomena. E.g., sex development, sex hormones, sex characteristics.
Sexual is used when referring to sexual identity, attraction, behavior, and associated
psychological, social, and behavioral processes and constructs. E.g., sexual orientation, sexual
minority, sexual health, sexual behavior.
Sexual and gender diverse
Sexual and gender diverse, abbreviated SGD, describes individuals who identify as lesbian, gay,
bisexual, transgender, queer, intersex, non-binary, or who exhibit attractions and behaviors that
do not align with heterosexual or traditional gender norms.
Sexual and gender minority populations
Sexual and gen populations include, but are not limited to, individuals who
identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex.
Individuals with same-sex or -gender attractions or behaviors and those with variations in sex
43
characteristics are also included. These populations also encompass those who do not self-
identify with one of these terms but whose sexual orientation, gender identity or expression, or
reproductive development is characterized by non-binary constructs of sexual orientation,
gender, and/or sex.
Use populations as a broad, umbrella term when referring to
LGBTQI+ communities broadly in the context of health research, related activities, and policy.
Use LGBTQI+ when identity is important (e.g., community engagement, Pride messaging). When
writing about a specific research project or study, always use the population terms identified
and defined by the investigators for that study. For example, a study could be examining
outcomes among sexual minority women, while another may look at LGB people. In these
instances, using SGM populations or LGBTQI+ would not be appropriate. For more information,
see the Sexual and Gender Research Minority Office’s website.
Do not use the term sexual and gender minorities. Instead, use sexual and gender minority as a
descriptive phrase, e.g., sexual and gender minority communities, populations, groups, etc. This
amplifies the fact that SGM communities have been marginalized and not necessarily that they
are simply numerical minorities.
Sexual orientation
Sexual orientation describes sexual attraction, behavior, and identity. Use sexual orientation
rather than sexual preference. Preference suggests that non-heterosexuality is a choice, a
concept often used to discriminate against the LGBTQI+ community. Preference also suggests a
selection from two or more choices, excluding bisexual people and pansexual people, among
others.
If sexual orientation is a variable under investigation, the specific facet of sexual orientation
under investigation should be explicitly named.
Transgender
AP Stylebook: Transgender Coverage Topical Guide
A transgender person is someone who identifies with a gender other than the one that was
assigned to them at birth. Use the term transgender and not transgendered. Transgendered is a
dated term that suggests a point in time when a person “became” transgender, which diverges
from the lived experiences of most transgender people. Trans is an adjective that helps describe
someone's gender identity, and it should be treated like other adjectives (e.g., trans man, trans
woman). Merging the adjective and the noun risks suggesting that a trans man or woman is
more (or less) than just a man or just a woman, which goes against how many trans people
identify themselves.
Two-Spirit
See the Indian Health Service’s page on the term Two-Spirit.
Two-Spirit is a culture-specific term for AI/AN communities describing the complex and non-
binary nature of gender- and sexuality-related cultural identities, roles, and contributions of the
AI/AN peoples. Due to its specific cultural, spiritual, and historical context, identifying as Two-
44
Spirit is limited to Native Americans. But importantly, not all Native Americans who hold diverse
sexual and gender identities consider themselves Two-Spirit; many identify as LGBTQI+. Only use
this term if someone has said they identify as such.
Various spellings of Two-Spirit exist, including uppercase, lowercase, and hyphenated or with a
number (e.g. 2Spirit, Two Spirit, two-spirit). 2S is the most common abbreviation. Consensus on
spelling isn’t set, but for NIH content, use Two-Spirit.
Inclusive and Gender-Neutral Language
AP Stylebook: Gender-neutral language
All genders vs. both genders
Because there are many different gender identities, avoid using binary language that indicates
there are only two. Use all genders instead of both genders, opposite sex, or either sex. If
referring only to sex, use female, male, or intersex.
Breastfeeding, chestfeeding
The term chestfeeding or bodyfeeding can be used alongside breastfeeding to be more inclusive.
Nonbinary or trans people may not align with the term breastfeeding because of their gender or
may have a dysphoric relationship to their anatomy. Chestfeeding will not replace the word
breastfeeding, or nursing, but it should be included as an option when discussing lactation.
Breastfeed (v.) is one word, as is breastfed (adj.).
Chair, chairperson vs. chairman, chairwoman
AP Stylebook: Chair
Use chair instead of chairman or chairwoman. This is a divergence from the HHS Style Guide.
Everyone vs. ladies and gentlemen or men and women
Avoid unnecessarily gendered language. There are ways to be gender-neutral and inclusive. You
could use everyone or all instead of men and women and distinguished guests or folks instead of
ladies and gentlemen.
Parent, parenting, caregiving vs. mothering
Avoid language that assumes the mother is the primary parent or caregiver. Use parenting
instead of mothering unless referring specifically to a mother-child relationship. You can also use
caregivers and caregiving to be inclusive of non-parents in caregiving roles.
Many practices recommended in pregnancy to women/pregnant people can also be directed to
fathers/non-pregnant partners. Too often, the burden of prenatal care and establishing healthy
habits are directed only at the pregnant person, when a partner can also play an important role.
Police officer vs. policeman
Use police officer instead of policeman. This same rule applies generally: postal worker,
firefighter, etc.
45
Pregnant women, pregnant people
AP Stylebook: Pregnant women, pregnant people
Both pregnant women and pregnant people are acceptable phrases. It is not always necessary to
avoid the word women by substituting phrases like birthing people, or people with uteruses,
especially in public health content. Gender neutral terms like pregnant patients, pregnant
people, birth parent, or other wording as applicable (e.g., pregnant teens), present inclusive
alternatives. Use judgement and context to determine whether to use pregnant women,
pregnant people, pregnant patients, or other inclusive descriptors. Specific phrasing like people
with uteruses can be helpful when writing NOFOs or advertising studies to ensure only eligible
participants are enrolled for the specific research conducted.
Using more limited and specific language is sometimes important. For instance, if discussing a
study that only involves pregnant cisgender women, gender-specific language (pregnant
women) would be most accurate to reference that study’s findings.
Spokesperson vs. spokesman
Use spokesperson instead of spokesman. This guidance diverges from the HHS Style Guide.
Grammar and Punctuation
Action verbs
Action verbs are short and direct. Avoid using the noun form when using the verb is simpler and
clearer. Use does verbs instead of is verbs. Example: He runs instead of He is running.
Incorrect: give consideration to / is applicable to
Correct: consider / applies
Active voice
Use active voice whenever possible and appropriate. In the active voice, the subject of the
sentence acts. In the passive voice, the subject of the sentence is acted upon. Verbs in the active
voice are stronger, enhance clarity, and make a sentence easier to read. Passive voice is
appropriate when the actor is unknown, unimportant, or obvious, e.g., small items are often
stolen.
Passive: The decision has been changed.
Active: NIH changed the decision.
Apostrophe
AP Stylebook: Apostrophes
Apostrophes are used in contractions and with possessive nouns, but never to denote plural.
In contractions, the apostrophe stands for omitted letters or numbers.
Examples: We’re working on a cure.
The disease first appeared in the ’80s.
The possessive case denotes ownership or possession, and the apostrophe replaces the word of
stands for the health of children).
46
Examples: the vaccine’s availability (singular noun)
the virus’ potency (singular noun ending with an s)
the agencies’ policies (plural noun ending with an s)
women’s health issues (plural noun not ending with an s)
the meeting informed Congress’ decision (proper noun ending with an s)
Never use 's to form the plural of an abbreviation or number.
Incorrect: We will issue many RFP’s this year.
Correct: We will issue many RFPs this year.
Incorrect: The disease was eradicated in the 1970’s.
Correct: The disease was eradicated in the 1970s.
Avoid unnecessary words
Below are some frequently used unnecessary words and phrases and their alternatives.
Instead of: Use:
Utilize use
Due to the fact that because
In the event that if
Prior to before
As a result of because
For the purposes of to
In order to to
Reason why reason
Whether or not whether
At the present time now, currently
Has the ability to can
Is able to can
As well as and
Period of time time, period
Eliminate most intensifying modifiers, such as very.
Comma, serial comma
AP Stylebook: Comma
AP style omits the serial comma (the comma before the “and” in a list), so do not include the
serial comma for press releases. For other NIH web writing or publications, the serial comma is
acceptable and can be clarifying.
Example: “ACTIV has launched hundreds of research studies on diagnosis, prevention,
and treatment strategies.”
Continuous, continual
Continuous occurs without interruption, while continual occurs at regular intervals.
47
Dash
AP Stylebook: Dashes
• Em dash
o Em dashes (—) can be used in pairs to mark off additional information that is not essential
to understand the sentence. Here they function similarly to parentheses or a pair
of commas. An em dash is usually written without spaces on either side, but AP style calls
for a space on both sides. With or without spaces is acceptable for NIH web writing.
Example: Dark leafy greens — such as spinach, kale, and chard — are an important
part of a healthy diet.
• En dash
o Use an en dash (–) without spaces on either side to show ranges in numbers and dates and
to express equivalency between two functions in compound terms like clinician–scientist. AP
does not use en dashes, but they are acceptable for NIH web writing.
Example: The bubonic plague pandemic lasted from 1346–1353.
Ellipsis
AP Stylebook: Ellipsis
Geographic terms
AP Stylebook: Geographic Names
Hyphen
AP Stylebook: Hyphen
Use a hyphen between two words that form a compound modifier when that modifier
immediately precedes the noun it modifies. When a compound follows the noun it modifies,
hyphenation is usually unnecessary. Compare:
• Applications undergo a rigorous two-stage review.
• The applications are reviewed in two stages.
Do not use a hyphen in a compound modifier formed by an adverb ending in ly plus an adjective
(such as federally funded). This is true whether the compound modifier precedes or follows the
noun it modifies.
Parallel construction
Parallel structure means using the same pattern of words to show that two or more ideas have
the same level of importance. This can happen at the word, phrase, or clause level. The usual
way to join parallel structures is with the use of coordinating conjunctions such as and or or.
This is especially important when writing lists.
With the -ing form (gerund):
Correct: This program’s funding goes toward predicting, preventing, diagnosing, and
treating blood disorders.
Do not mix forms, for example:
48
Incorrect: …funding goes toward predicting, preventing, diagnosis, and to treat blood
disorders.
Changing to another pattern within a clause or changing the voice of the verb (from active to
passive or vice versa) will break the parallelism. Example of parallelism with clauses:
Parallel: In our classroom, students are expected to be kind, respectful, and prompt.
Not parallel: In our classroom, students are expected to be kind, respectful, and arrive
promptly.
Period
AP Stylebook: Period
Use a single space after a period at the end of a sentence.
Quotation mark
AP Stylebook: Quotation Marks
Always place quotation marks outside periods and commas. Placement of quotation marks with
question marks and exclamation points depends on whether the question or emphasis is part of
the quotation.
Examples: The lecturer asked, "Are there any questions?"
What do you mean, "almost accurate"?
Put quotation marks around a word or words used in irony.
Example: The “debate” turned into a free-for-all.
Semicolon
AP Stylebook: Semicolon
State abbreviations
AP Stylebook: States
Spell out the state names in the body of the story.
Subject-verb agreement
Deciding whether a verb should be singular or plural is difficult sometimes.
Some guidance:
The number of, the total number of: the verb is singular.
Examples: The number of samples was unknown.
The total number of cases was hard to predict.
A number of, a total of: the verb is plural.
Examples: A number of patients were examined.
A total of 50 vials were sent to the laboratory.
As well as, in addition to, along with: the verb agrees with the main subject only.
49
Example: Rubella, as well as chickenpox, is contagious.
Or, neither . . . nor, either . . . or: the verb agrees with the subject closest to the verb.
Examples: The physicians or the nurse has to be present.
The physician or the nurses have to be present.
Neither the medication nor the hospital stays were helpful.
Neither the hospital stays nor the medication was helpful.
None, other quantities: the agreement of the verb is context dependent.
None: None of the medication was taken.
None of the symptoms were present.
Quantities: Half of the pill was enough.
Half of the patients were sent home.
Note: The word data is plural and takes a plural verb form.
Toward
Not towards.
Unfamiliar terms
Writers can use quotation marks or italics to introduce an unfamiliar term on first use. Do not
put subsequent references in quotation marks or italics. Either is acceptable as long as use is
consistent within the same document or webpage.
Example: Energy is measured in “joules.”
Example: Energy is measured in joules.
Write short paragraphs
Short paragraphs are easier to read than long paragraphs. The white space after a paragraph
gives readers a moment to absorb the material they just read before moving to the next
paragraph.
Write shorter sentences whenever possible
Use short sentences to make your point clear on the first reading. People digest short sentences
more easily than long sentences.
Numerals
AP Stylebook: Numerals
In general, spell out one through nine. Use figures for 10 or above and whenever preceding a
unit of measure or referring to ages of people, animals, events, or things.
Decimals
AP Stylebook: Decimals
If a unit of measure follows the numeral, use the decimal format, not fractions.
50
1.75 mg (NOT 1 ) 2.5 kg (NOT 2 )
If the value is less than 1, insert a zero before the decimal point.
0.2 g (NOT .2 g) 0.9 mg/kg
Fractions
AP Stylebook: Fractions
Ordinals
Ordinals generally express ranking rather than quantity, so spell out first through ninth, and use
the numeral for 10th and above. Do not use superscript for ordinals.
Examples: The fourth patient was admitted in critical condition.
The 12th patient died shortly after his arrival.
When you have a mixture of ordinals below and above nine, use numerals. This is a divergence
from AP style.
Example: The 5th and the 12th patients showed similar symptoms.
Percentages
AP Stylebook: Percentages
Singular and plural
When the quantity is less than 1, the unit of measure is singular.
Examples: 0.5 gram (NOT grams) 0.2 second (NOT seconds)
Spacing
Insert a space between the numeral and the symbol, except for %, °C, °F, ° (for angles),
money symbols, fractions, and inches/feet symbols.
25 g 40 mL 60 kg
30% 28.5°C 4”
£250 CHF 50* 5 ½ years
*a space is added because CHF is the abbreviation for the Swiss Franc currency and not a
symbol.
Units of measure
Abbreviated units of measure do not have a period, unless they close a sentence.
Examples: 50 mg (NOT 50 mg.) 2 dL (NOT 2 dL.)
Structure and Formatting
Alt text
Alt text, or alternative text, is a short, written description of an image. Well-written alt text is
important for accessibility and search engine optimization.
51
Your alt text should be descriptive enough that a person who is blind or has low vision has the
same information that a sighted user would get from glancing at the picture. While there is
technically no character limit for alt text, it is best to keep it short. The screen reader will pause
after 150 characters and the user can press the down arrow key to continue reading.
If your photo has a caption that fully describes the picture, then alt text is not required because
it would be redundant. However, there may be parts of the image that are obvious to sighted
users (not needed in the caption) but need to be described in the alt text for people with visual
disabilities.
Some guidelines for describing people in alt text:
o Context will determine whether to mention race, ethnicity, gender, or age.
If the goal of your website is to encourage older patients to ask for help
accessing their online health records, then age is relevant in a photo of a doctor
helping an older patient access health records via an iPad.
Is it relevant that the doctor is African American? Or that she is a woman? Given
the context, this may not be the most important information in this photo.
o If you’re using stock images, you can use the gender, race, or age keywords given by the
photographer.
o If you’re using images of people you know, ask them their preferred pronouns and other
ways they self-identify.
o Otherwise, you can write around it by using job titles (doctor/patient,
p
For more guidance on writing effective alt text, reference
Tips for Writing Meaningful Alt Text -
Level Access.
Headings
Headings help users and search engines to read and understand text. They act as signposts for
readers and make it easier for them to figure out what a post or page is about.
Divide your content into sections and give each section a heading to help readers understand
where they are in the document or on the page. It is good practice to make sure that your
headings are informative to the reader; include a primary keyword or key phrase from the
content of that section in your heading. Headings should generally be limited to 70–80
characters. Headings are in title case and should never be in all caps. This is a divergence from
AP Style; press release headings are in sentence case.
• No end punctuation: Other than question marks, do not use other end punctuation
(such as periods) in headings.
• No ampersands in headings: Use ampersands (&) instead of and only when it is part of a
company’s name or in a composition title
.
• Avoid abbreviations or acronyms in headings when possible. Screen readers rely on
headings, so they should be written to sound natural. Fully capitalized words may be
read letter-by-letter by screen readers.
o Exceptions are abbreviations that are so well-known the full spelling would be
unnecessary, like HIV.
52
Links
Hyperlinks provide users with additional information about a topic and can be used throughout
your content. Links can be headlines, titles, statements, questions, or phrases. Make sure the
linked text is clear, concise, and lets your reader know where you are sending them. Don’t bold
your hyperlink or use any color other than the standard blue for URLs.
Use simple descriptive text for a hyperlink instead of the URL.
Exception: If referring to a particular website that is short and recognizable, you may
use the website name as the link, but drop anything before the name of the site
(http://www...) as in: Vaccines.gov
Avoid using click here or go to this page and instead hyperlink keywords that describe the
information included on the page that readers will be directed to visit. When choosing which
text to hyperlink, find a balance between substance and brevity.
When hyperlinking text that is followed by an acronym, include the acronym in the hyperlink. If
linking to a file instead of a webpage, include the format of the linked item in parentheses as a
part of the linked text. If linking to a video, include “Video” in parentheses as a part of the linked
text. For example, Presentation Slides (PDF) or NIH Peer Review Briefing for Basic Research
Applicants and Reviewers (Video).
Link shorteners: NIH now has our own link shortening service available for NIH staff on the NIH
network or on VPN. Use the NIH link shortener here: https://go-admin.nih.gov/
Lists
AP Stylebook: Lists
Lists make it easy to quickly comprehend complex information, help readers identify steps, save
words and space on each page, and can make your logic and structure clearer.
Numbered lists should be used when the items have an implied sequence (first this, then this).
Bulleted lists should be used when items don't require a particular order.
Keep lists short. A full page of list items can be an indication that the content should be broken
into additional sections or lists.
DO:
• Use periods at the end of items in lists when the item is a complete sentence (like in this
case).
• Use parallel sentence structure when writing list items.
• Capitalize the first word following the bullet, unless the bulleted list is the continuation
of a sentence.
DO NOT:
• Add punctuation when the list items are fragments (this is a divergence from AP style).
53
• Connect list items into a sentence with commas or semicolons. Bullets replace other
sentence punctuation in lists.
• Mix fragments and sentences in the same list.
QR codes
QR codes, or Quick Response codes, are two-dimensional codes on printed materials that are
scanned with a smartphone, connecting individuals to additional online content or
information. Keep in mind that QR codes should lead to mobile-friendly content. For QR code
uses and resources, reference
Digital.gov’s QR Codes Page.
Tables
Tables help convey complex information to users.
To create useful, effective tables:
• Use tables when comparing numbers.
• Use tables when presenting a series of “if, then” sentences.
• Keep tables simple.
• Use short descriptive headings.
When building tables for a website:
• Create the tables within your content management system (e.g., Drupal) — do not
copy and paste from Word or another program.
• Always assign a header row or column for compliance with Section 508 of the
Rehabilitation Act of 1973. Screen readers rely on reading headers.
• See the Section508.gov guidance
for building accessible tables.
Title casing
In title case, the first letter of each primary word is capitalized, including the to be verbs (be, am,
is, etc.). Articles, conjunctions, and prepositions with four or fewer letters are not capitalized.
Use title case on all headings. This is a divergence from AP Style; press release headings are in
sentence case.
Capitalize the second word in a hyphenated term in titles and headings, e.g., “Addressing HIV-
Related Stigma.” Subheadings may be in sentence case.
This Is an Example of Title Case
Appendix: Biomedical Definitions
Acquire, develop
Patients acquire infectious diseases; they do not develop infectious diseases. Noncommunicable
diseases, however, develop in patients – like Alzheimer’s disease or diabetes.
54
Association, causation
An association is a relationship, or correlation. A positive association means as one goes up, so
does the other. A negative association means as one goes up, the other goes down.
Causation is when an event or variable is shown to cause a specific outcome. Whether a study
shows association or causation depends on the study design.
Biomarkers
Biomarkers, or biological markers, are biological substances, characteristics, or images that
provide an indication of the biological state of an organism. Biomarkers can include
physiological indicators (e.g., blood pressure), molecular markers, (e.g., liver enzymes, prostate-
specific antigen), and imaging biomarkers (e.g., those derived from magnetic resonance imaging
and angiography).
An NIH working group defined a biomarker as “a characteristic that is objectively measured and
evaluated as an indicator of normal biological processes, pathogenic processes, or
pharmacological responses to therapeutic intervention.”
Biopsy
Biopsy is the procedure of removing and examining tissue, cells, or fluids from the body. Do not
use it as a verb. Observations are made on the biopsy specimen, not on the biopsy itself.
Cohort
A cohort describes a group of people who have a statistical factor (such as age, class, or medical
condition) in common in a demographic study. A cohort does not refer to one individual. A
cohort study is a longitudinal study that follows research participants with common
characteristics over time.
Cohort is not plain language. When writing for the public, define the term first or consider
referring to the cohort through alternative means, e.g., Researchers found that Asian American
women aged 30-50 have…
Communicable vs. noncommunicable
Communicable diseases can be spread. They are also referred to as transmissible.
Noncommunicable diseases are not transmitted through contact with an infected or afflicted
person. They are, instead, caused by various genetic, physiological, environmental, and
behavioral factors. The World Health Organization identifies four main types of
noncommunicable diseases: cancer, cardiovascular diseases (e.g., heart attacks), chronic
respiratory diseases (e.g., asthma), and diabetes.
Comorbidity
Comorbidity is the co-occurrence of more than one disorder, disease, or condition in the same
individual. The article
Defining Comorbidity: Implications for Understanding Health and Health
55
Services explains that the term and its related constructs, such as multimorbidity, morbidity
burden, and patient complexity, need more precise definitions.
While this term is still used broadly, it is considered stigmatizing by some in the HIV community.
The preferred language is complication, when applicable.
Complementary or alternative medicine
Complementary and alternative approaches are those with origins outside of mainstream or
Western medicine. A nonmainstream health practice used together with conventional medicine
is complementary. A nonmainstream health practice used instead of conventional medicine is
alternative.
Don’t use alternative if the substitution is something conventional doctors would approve of (for
example, if a patient is no longer taking ibuprofen for back pain now that he’s practicing yoga
regularly). When an approach is used for wellness, it’s okay to use complementary even though
the person may not be receiving conventional care (because none is needed).
Complementary and alternative approaches include products, such as herbs or dietary
supplements, as well as hands-on-practices (e.g., acupuncture or spinal manipulation), other
psychological or physical approaches (e.g., meditation, hypnosis, yoga), and even entire systems
of care (such as Ayurvedic medicine or naturopathy). Other acceptable terms for approaches
include health, medicine, and practices. Avoid using the term medicine when referring just to
products. See also integrative health.
Comprise, compose
The whole comprises the parts and the parts compose the whole. Comprise means contain,
consist of, or made up of. For example, the gene comprises
Compose means “to be or a part or element of the whole.
gene.
Comprise and compose have similar meanings, but don’t write comprised of. Use composed of
or instead.
Condition
Condition indicates a state of health, whether well or ill. A condition conferring illness might
further be classified as a disease or disorder, however, condition might be used in place of
disease or disorder when a non-disease-specific term is indicated.
For example: Urinary retention is a condition in which you are unable to empty all the
urine from your bladder. Urinary retention is not a disease, but a condition that may be
related to other health problems, such as prostate problems in men or a prolapsed
bladder in women.
56
Congenital vs. heritable
Congenital and heritable are often confused. Congenital describes conditions or traits that are
acquired, either at birth or during development in the uterus. Most often, congenital indicates
that some factor, such as a drug, chemical, infection, or injury has upset the careful timing and
balance of the developmental process in a way that adversely affects the fetus.
For example: A baby born with spina bifida most likely cannot pass this congenital
condition on to future generations.
Heritable characteristics or conditions are intrinsic to the genetic makeup of an individual and
are capable of being passed from one generation to the next.
For example: A baby born with a heritable disease, such as hemophilia, can pass the
disease on to future generations.
Contagious vs. infectious
Contagious refers to a disease that can be transmitted from one living being to another through
direct contact (as with measles) or indirect contact (as with cholera). The agent responsible for
the contagious character of a disease is described as infectious, the usual culprits being
microorganisms, such as viruses and bacteria, or macroorganisms, such as fungi or parasitic
worms.
COVID-19 is both contagious (easily passing from person to person) and infectious (the
infectious agent is the SARS-CoV-2 virus). Alternatively, the parasite that causes malaria is
infectious, but malaria is not contagious.
Contraception, contraceptive
Contraception is the practice of preventing pregnancy. Contraceptive is the method used
for contraception.
Critical
Patients are not critical, but their status or condition is.
Diagnose
Conditions, diseases, and disorders are diagnosed, not patients. Diagnosis is the process of
identifying a disease, condition, or injury from its signs and symptoms. A health history, physical
exam, and tests, such as blood tests, imaging tests, and biopsies, may be used to help make a
diagnosis.
Die of, die from, die with
People die of, not from, a condition or disease. People can also die with a disease that is not the
immediate cause of death.
Disease
Disease is often used in a general sense when referring to conditions that affect a physical
system (e.g., cardiovascular disease) or a part of the body (e.g., diseases of the eye). The term
also may be used in specific senses, such as Alzheimer’s disease.
57
Disorder
A disorder is a disturbance of normal functioning of the mind or body. Disorders may be caused
by genetic factors, disease, or trauma. For example, a disorder resulting from cardiovascular
disease is an arrhythmia or irregular heartbeat. An arrhythmia is not a disease itself; it’s an
abnormal heartbeat that occurs because of cardiovascular disease. In mental health, the terms
mental disorder, mental illness, and psychiatric disorder are used interchangeably.
DNA or genome sequencing
Specify DNA (or genome) sequencing and DNA (or genome) sequence; do not simply write
sequencing or sequence.
When referring to sequencing, use genome sequencing or genome sequencing data, not
genomic. See also: Genome
Dose vs. dosage
Dose is amount taken at one time. Dosage is the amount to be taken over time.
Endemic, epidemic, pandemic
AP Stylebook: Endemic, epidemic, pandemic
Endemic describes a disease (or characteristic) that is restricted to a particular region, such as
cholera and plague in parts of Asia. A disease is endemic in an area; the area is not endemic.
Sometimes, endemic is used to described when a disease is still among us but relatively under
control, like influenza, e.g., “Although we may be out of the urgent pandemic phase, we’re not
quite ready to call COVID-19 endemic…”
Epidemic refers to a disease that involves many more people than usual in a particular
community or a disease that spreads into regions in which it does not normally occur.
Pandemic is the outbreak of a disease occurring over a wide geographic area and affecting a
large number of people.
Gene and protein names
Gene names should be italicized, whereas related proteins should not be italicized (e.g.,
RAS gene and RAS protein). Human and other primate gene and protein names are given in
capital letters; mouse and rat genes and proteins are presented with an initial capital (e.g.,
human BRCA1 gene but mouse Brca1 gene). Refer to Chicago Manual of Style 8.132: Genes.
Also reference the Guidelines for Human Gene Nomenclature based on the HUGO Gene
Nomenclature Committee.
Genetics and genomics
Genetics is a term that refers to the study of genes and their roles in inheritance—the way that
certain traits or conditions are passed down from one generation to another. Genetics involves
scientific studies of genes and their effects.
58
Genomics is the study of all a person's genes (the genome), including interactions of those genes
with each other and with the person's environment.
The main difference between genomics and genetics is that genetics scrutinizes the functioning
and composition of a single gene, and genomics addresses all genes and their inter-relationships
to identify their combined influence on the growth and development of the organism.
Genome
A genome is the complete set of DNA (genetic material) in an organism. In people, almost every
cell in the body contains a complete copy of the genome. A genome contains all the information
needed for an individual to develop and function.
Genus and species names
Spell out and italicize genus and species names at first use and use an initial capital for the genus
name (e.g., Escherichia coli or Homo sapiens). Abbreviate the genus or species name using the
first letter and a period with subsequent uses (e.g., E. coli, H. sapiens). Refer to
Chicago Manual
of Style 8.120: Genus and specific epithet. Species should ideally be by full common
Drosophila melanogaster), rhesus monkey (Macaca
).
Germ, microbe, microorganism, pathogen
Germ and microbe are nontechnical terms describing a living organism, especially one invisible
to the naked eye, that can cause disease. Generally, use a specific term — virus, bacteria, or
parasite — instead of germ. If writing for a publication aimed at people with lower reading
levels, the term germ is acceptable.
A pathogen is an agent that causes diseases, especially a bacterium, fungus, or other
microorganism.
Microorganism is a general term that describes all one-celled microscopic organisms, both
disease-causing and benign.
Incidence, prevalence
Incidence refers to the number of newly diagnosed cases during a specific time. Prevalence
refers to the number of new and pre-existing cases for people alive on a certain date.
Incurable
An incurable disease, disorder, or condition is one that does not currently have a cure. Incurable
is not synonymous with terminal or fatal. While many incurable diseases are terminal, there are
also many incurable conditions that a person can live with all their life. Medical conditions such
as diabetes or asthma cannot be cured, but they can be managed.
Influenza, avian flu, swine flu, seasonal flu, pandemic flu
See the Web Style Guide | HHS.gov for explanations.
59
Integrative health
Use integrative when writing about incorporating complementary approaches into mainstream
health care. Note: use integrative, not integrated.
Integrative medicine refers to health services, a philosophy that emphasizes treating the whole
person, rather than one organ system or specialty, and an interest in well-coordinated care
between different providers and institutions. The integrative approach seeks to address aspects
of illness and health beyond the biological, such as mental, emotional, functional, spiritual,
social, and community aspects as well.
See also complementary or alternative medicine.
Maternal morbidity
Maternal morbidity describes any short- or long-term health problems that result from being
pregnant and giving birth. Use the term maternal health as a more positive term for general
purposes and limit maternal morbidity for specific problems.
Maternal mortality
Maternal mortality refers to the death resulting from complications of pregnancy or childbirth
that occur during the pregnancy or within six weeks after birth.
For more associated terms, please see the
Eunice Kennedy Shriver National Institute of Child
Health and Human Development’s page on Maternal Morbidity and Mortality.
Morbidity
Morbidity means both “the relative incidence of disease” and “the condition of being diseased.”
Change morbidity to illness, disease, or condition when writing for lay audiences.
Mortality, mortality rate, fatality
Mortality means “the number of deaths per standard unit of population per unit of time.”
Change mortality to death for lay audiences.
Mortality rate means “the number of deaths per number of persons at risk,” as in infant
mortality rate (the ratio of numbers of infant deaths during a calendar year to the total number
of live births during that year). Distinguish mortality from fatality.
Fatality is a death resulting from a disaster.
Nonpharmacologic
The adjectives nonpharmacologic and nonpharmacological refer to therapy that does not
involve drugs, e.g., nonpharmacologic management of pain. It is written without a hyphen.
Nonpharmacologic and nonpharmacological are interchangeable. Similar to economic and
economical, or neurologic and neurological, they may have slightly different colloquial use but
60
functionally the same meaning. At NIH, we use nonpharmacologic more often and should use it
instead of nonpharmacological for consistency.
Precision medicine
Historically, most medical treatments are designed for the "average patient" as a one-size-fits-
all-approach. Precision medicine is an approach that considers individual differences in patients’
genes, environments, and lifestyles. Precision medicine is sometimes referred to as personalized
medicine. NIH writing should use precision medicine rather than personalized medicine.
Rare disease
The Orphan Drug Act defines a rare disease as a disease or condition that affects fewer than
200,000 people in the United States. Only use this terminology when prevalence and/or
incidence data are consistent with this criteria.
See the National Center for Advancing Translational Sciences’
Genetic and Rare Diseases Center
website for more information.
Research subjects, control subjects, study participants
Research subjects have the particular characteristic, engage in the particular behavior,
or are exposed to the particular variable (e.g., a certain drug) under study. Research
subjects are recruited, selected, and observed.
Use patients, participants, or individuals instead of subjects when referring to human clinical
trial participants, unless research subjects is specific to a policy or regulation. See: patients vs.
subjects.
Control subjects make up the control group in a study and are used for comparison to the
research participants. They are as similar as possible to the research participants but are not
exposed to the condition or treatment being tested. Control subjects are recruited, selected,
sometimes exposed to a placebo or standard treatment, and observed.
Study participants can be either research or control subjects.
Syndrome
A syndrome is a recognizable set of symptoms and physical findings that indicate a specific
condition for which a direct cause is not necessarily understood. Once medical science identifies
a causative agent or process with a high degree of certainty, physicians may then refer to the
process as a disease, not a syndrome.
T cell, B cell
Only hyphenate as an adjective: e.g., T-cell therapy, B-cell leukemia.
Toxic, toxicity, toxin, toxicant
Toxic means “pertaining to or caused by a poison or toxin.”
Toxicity means “the quality, state, or degree of being poisonous.”
61
Toxins are natural poisons (e.g., snake venom).
Toxicants are manufactured poisons (e.g., chemical pesticides).
Vaccinate, inoculate, immunize
Of these three words, vaccinate has the narrowest definition: to give a vaccine to someone.
Inoculate is more general and can mean to implant a virus, as is done in vaccines, or even to
implant a toxic or harmful microorganism into something as part of scientific research.
Immunize is the most general of the three words and can mean to grant immunity to a wide
variety of things; it is sometimes used in legal language when referring to protection from
unwanted legal action.
Variant, Variation, Mutant, Mutation,
Variant is the preferred term for any permanent DNA change. Variants in genes can cause
disease, affect fetal development, or result in differences in how people’s bodies look or work,
but they may not cause disease or have any effect at all. Exposure to some types of radiation,
chemicals, or viral infections can produce variants, or they can be generated during cell division
or DNA replication. Variants in egg or sperm cells can be passed on to offspring, while those in
body cells aren't passed on.
Variation describes DNA sequence differences among individuals or populations.
Mutation has often been used to describe a disease-causing variant, if the change in the DNA
sequence that’s described causes disease or if it’s induced during research (if the change is
naturally occurring, use variant). While the term mutation is widely used and generally
acceptable, it is not the preferred term for NIH writing.
Do not use mutant. Saying a gene is mutated or a research organism with a genetic change is a
mutant can imply that a person with a similar genetic change is a mutant person.
