APA Style

and
Format Guide
2010 Edition

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About This Guide

This APA Style and Format Guide serves as Independence University’s official guide to American

Psychological Association or APA style. The university has made every effort to present these guidelines

accurately and fairly. Those responsible for the preparation of this guide and all other public

announcements and documents have made every effort to ensure that the information presented is correct

and up-to-date. This guide supersedes all previous documentation and is subject to change.

Independence University reserves the right to add to, amend, or repeal any information presented in this

guide. The university will not assume responsibility for publication errors beyond its control.

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 Table of Contents

An Introduction to APA Style................................................................................................4

What is APA Style .....................................................................................................4
APA Publication Manual (6th ed.): The Standard Reference ....................................4
What you Will Find in IU’s APA Guide ...................................................................4

How to Organize Your Papers in APA ..................................................................................5

Guidelines for Formatting your Paper .......................................................................5
Formatting Each Section of Your Paper: General Information .................................6
Formatting Each Section of Your Paper: Specific Guidelines...................................6

How to Cite Sources in APA Style: .......................................................................................13

Giving Credit Where Credit is Due ...........................................................................13
Plagiarism and Citing Sources ...................................................................................13
Citing the Source in the Body of Your Paper (In-text Citations) ..............................14
Citing the Source in the Reference List .....................................................................16
Moving Forward with APA Style ..............................................................................17

How to Construct In-Text Citations and a References List in APA Style .............................17
APA Publication Manual (6th ed.).............................................................................17
In-Text Citations ........................................................................................................17
Citing an Idea, Entire Work, or Paraphrase ...............................................................17
Citing a Direct Quotation ...........................................................................................18
Punctuation Rules for In-Text Citations ....................................................................19
Quick Reference: Types of In-Text Citations ............................................................20
Reference List: Basic Rules .......................................................................................22
Basic Rules.................................................................................................................23
Authors/Authors.........................................................................................................23
Periodicals, Books, Newspapers, Government Sources ............................................26
Books .........................................................................................................................26
Newspapers and Government Sources.......................................................................27
Electronic Sources .....................................................................................................28

Example Paper .......................................................................................................................31

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 An Introduction to APA Style
What Is APA Style?
American Psychological Association or APA style is one of several standards for scientific writing
designed to help you write papers that clearly communicate your ideas to readers. As its name suggests,
APA style originally outlined the rules for the preparation of papers and manuscripts in psychology and
behavioral science. However, the style is now widely used throughout the social sciences and related
fields, including the health sciences. APA style covers ethical and legal standards in writing and
publishing, writing style and clarity, mechanics of writing, citation or referencing of outside sources, and
preparation of papers for submission.

APA Publication Manual (6th ed.): The Standard Reference

This APA guide is an internal publication of Independence University and offers highlights from the
Publication Manual of the American Psychological Association: Sixth Edition – the accepted, standard
reference on APA style. The highlights in this guide will help you to quickly understand the fundamentals
needed to write a paper that meets APA guidelines. Although this guide is comprehensive, it is not totally
inclusive and therefore not a substitute for the APA Publication Manual (6th ed.), which is the final word
on matters of APA style.

Refer to the APA Publication Manual (6th ed.) for full explanations and copious examples of APA style.
Because all writing assignments at IU are to be written in APA format, you are encouraged to invest in
the APA Manual, 6th Ed.

What You Will Find in IU's APA Guide

This APA guide is divided into three sections:

1. This section outlines APA’s guidelines for organizing your papers, with instructions on content
and structure, including the title page, body, tables, figures, headings/subheadings, and page
numbering.
2. The next section introduces APA guidelines for using outside sources (articles, books, Web
documents, reports, etc.) into your own work. This section also addresses way to avoid
plagiarism, or the use of other authors’ ideas without properly citing them.
3. The final section provides detailed instructions for citing and referencing outside sources,
offering examples for citing others’ works in the body of your paper (in-text citations) and
preparing your References list.

Take the time to review this APA guide prior to writing your course papers. Then, refer to this guide each
time you complete a writing assignment to ensure that you use APA correctly throughout your
enrollment.

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 How to Organize Your Papers in APA Style
A document that uses APA style is very easy for the reader to follow, thanks to APA’s guidelines for
structuring and organizing a paper or manuscript. Independence University has adopted APA’s
organizational guidelines, with small modifications to suit the university’s needs. All writing assignments
at IU are to be written in APA format unless there are specific instructions within the writing assignments
note otherwise.

Listed below are the sections required in a typical IU writing assignment. The sections are listed in the
order they should appear in the paper. Please note that the sections below are NOT required in ALL
writing assignments. You may be asked to place the sections in a different order or format a section a bit
differently depending on the assignment. If a writing assignment deviates from the APA format, specific
directions will be outlined within the writing assignment instructions.

1. Title Page
2. Abstract (only required in Master's Thesis)
3. Table of Contents (only required in Master's Thesis)
4. Body of the paper
5. References Page
6. Tables
7. Figures
8. Appendices

If you have any questions about how your writing assignment should be formatted/structured, contact
your Contact Specialist before you turn in a paper for a grade.

ASK YOUR COURSE INSTRUCTOR!

Guidelines for Formatting your Paper

This section provides instructions for formatting each area of your paper. In addition to these guidelines,
you should review the instructions in IU's Guidelines for Writing Course Papers, a companion to this
guide that offers further formatting instructions for your IU papers. You will find the Guidelines in your
Capstone Course in IU Online. Please note that although this guide is comprehensive, it is not inclusive.
If you cannot find the formatting information you need here, refer to the APA Publication Manual
(6thed.). You may also ask your Course instructor if you are unsure about deviations from the APA
formatting that are highlighted within a writing assignment.

SEEING IS BELIEVING – SAMPLE PAGES IN APA STYLE

One of the best ways to learn APA style is to see actual pages that follow APA guidelines. At the
end of this guide, you will find sample pages in APA style. Be sure to read the instructions for
formatting your papers.

Then, check out the sample pages to see these guidelines in action.

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Formatting Each Section of Your Paper: General Information
1) Page Numbers: Page numbers should appear on every page of your document. Place the Arabic
numeral (1, 2, 3, etc.) in the upper-right corner of the page, one inch from the right edge of the
page and ½” above the first line of text. Most word processing software has a function called
'header/footer' which allows you to insert page numbers automatically rather than manually
entering them. Using the header function is the preferred method of inserting your page numbers,
because formatting is not lost as you edit through the paper.

2) Page Headers: In the APA Manual, 5th ed, page headers were required. These were placed on
every page of your document on the same line as the page number and was comprised of the first
two or three words of your document’s title. However, in APA Manual, 6th ed., the RUNNING
HEAD is now placed on every page in the header. See RUNNING HEAD for more specifics.

3) Margins/Line Spacing/Alignment: Use one inch margins on each page. Double-space between
all text lines, after the title, headings, within quotations, references, and figure captions. Many
word processing programs have line spacing defaults. Ensure your default is set for 0 before and
0 after the line and set to double-spacing to ensure proper line spacing in your paper. Paragraphs
are indented 5-7 spaces, or ½ an inch. The text should be flush left and not block.

4) Font: Font is also called typeface. APA recommends a standard serif font such as Times New
Roman. APA also requires 12-point font for all pages, unless your assignment directions state
otherwise. Fonts should be consistent throughout your paper, even on the title page, abstract,
tables, headings/ subheadings, etc. The only exceptions to this requirement (standard font of
Times New Roman, 12-point) are for items such as figures and appendices that are imported into
your paper from an original source that uses different fonts. Make sure you have copyright
permission if you are importing original tables, figures, or graphs.

5) Spacing and Punctuation: Type one space after all punctuation as follows:
a. after commas, colons, and semicolons;
b. after punctuation marks at the end of sentences;
c. after periods that separate parts of a References list citation;
d. after the periods of the initials in personal names (J. R. Zhang).

Exception: Do not insert a space after internal periods in abbreviations (for example,
U.S. agency not U. S. agency). Refer to the APA Publication Manual (6th ed.) for proper
spacing of hyphens, dashes, minus signs, etc.

Formatting Each Section of Your Paper: Specific Guidelines

Title Page

Presents the title of the paper, your name, and the university name. The title page is always page 1.

1) Page Number: The title page is always page 1.

2) Running Head: Align the running head at the left margin in the header of the paper flushed left
directly across from the page number. The running head should not exceed 50 characters and
should be in all caps. The words RUNNING HEAD: followed by a colon and a space should

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 precede the shortened portion of the title. The running head should be placed on the title page and
all subsequent pages. Note. The running head described in the sixth edition of the APA Manual
now replaces the page header outlined in the fifth edition of the APA Manual.

3) Title Placement: The title should be at the centered in the page. The recommended length of a
title is 10 to 12 words. Capitalize the initial letter of important words in the title [i.e., initial letter
of first word in the title, initial letter of first word in the subtitle (if subtitle is used), proper names,
etc.].

4) Author Name & Institutional Affiliation: After the title, double-space and center your name.
Then, double-space and center the school name (Independence University). The title, name, and
affiliation should be placed in the top ½ of the page

5) Font: 12-point serif font required; Times New Roman recommended.

Abstract

An abstract is a condensed version of a longer writing assignment that highlights the major points covered
and concisely describes the content and scope of the paper. You may write an abstract two reasons:
selection and indexing. Abstracts allow readers who may be interested in the longer work to quickly
decide whether it is worth their time to read it. Also, many online databases use abstracts to index larger
works. Therefore, abstracts should contain keywords and phrases that allow for easy searching. An
abstract is not an introduction but, rather, a summary of the most important concepts, findings, or
implications of your paper. At IU, the only writing assignments where an abstract is required is in the
Master's Thesis papers where there are scientific findings and implications are subsequently made.

Format the abstract page as follows:

1) Pagination: The Abstract always begins on a new page and immediately follows the title page.

2) Page Number: The abstract, when included in the paper, is always page 2.

3) Running Head: Include a running head on the abstract page.

4) Title: The title of this page is Abstract, typed at the top of the page, centered, on the first double-
spaced line beneath the page number/header. Capitalize the first letter (Abstract).

5) Length: The abstract is only one paragraph long. Begin this paragraph on the first double-spaced
line beneath the title (Abstract). The paragraph should be flush left and not indented. Do NOT
right-justify or fully justify this paragraph. Double-space the paragraph. APA recommends that an
abstract should not exceed 150 to 250 words.

6) Font: New Times Roman, 12-point font required.

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Body of the Paper

This format applies to any page of text in the body of the paper:

1) Pagination: The first page of the body always begins on a new page.

2) Page Numbering: All body pages must be numbered. The first page of the body is NOT page 1.
The title page is page 1, and all page numbers follow consecutively from there. If there is an
abstract and Table of Contents, then they would follow the title page and be placed before the
body of the paper.

3) Running Head: Include the running head on all body pages.

4) Format of First Body Page: Type the full title of your paper on the first page of the body. Center
this title on the first double-spaced line beneath the page number/header. Start the text of your
paper on the first double-spaced line beneath this title. Note. The title is NOT considered a
heading.

5) Margins: All margins equal to one inch.

6) Spacing: All text is double-spaced, unless your assignment directions state otherwise. Make sure
the word processing is set for 0 before and 0 after the line spacing. This will ensure double-
spacing not only between the lines, but the sections and headings.

7) Text Aligned Left: The body of the text should be flush left (left-justified). Do NOT right-
justify or fully justify your text (i.e., the right-hand side of the text should be “ragged” and not
line up with the right margin).

8) Indentation: Indent each new paragraph in the body. New paragraphs are indented about ½” or
5-7 spaces from the left margin.

9) Font: New Times Roman, 12-point font required

Headings and Subheadings in the Body

APA Style has a unique headings system to separate and classify paper sections to help with the
flow of the paper and make it much easier to read and follow. There are 5 heading levels in APA.
The 6th edition of the APA manual revised and simplified previous heading guidelines.
Regardless of the number of levels, always use the headings in order, beginning with level 1. The
format of each level is illustrated in Table 1 below:

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Table 1
APA Headings

Level Format

1 Centered, Boldface, Uppercase and Lowercase Headings

2 Left-aligned, Boldface, Uppercase and Lowercase Heading

3 Indented, boldface, lowercase heading with period.

4 Indented, boldface, italicized, lowercase heading with period.

5 Indented, italicized, lowercase heading with period.

Note. Papers at IU, with the exception of the Master's Thesis will have 1 to 3 headings. However,
if a paper has five sections, some of which have subsection and some of which don’t, use
headings depending on the level of subordination. Section headings receive level one format.
Subsections receive level two format. Subsections of subsections receive level three format, etc.

For example:
Heading 1 (Level 1)

Heading 2 (Level 2)

Heading 3. (level 3)

Heading 4. (Level 4)

Heading 5. (Level 5)

In APA Style, the Introduction section NEVER gets a heading because the beginning of all
papers is the introduction. Headings are not indicated by letters or numbers. Levels of headings
will depend upon the length and organization of your paper. Regardless, always begin with the
level one heading and proceed to level two, etc.

References List

The final section of this APA guide offers instructions for formatting the different types of references that
you use in your paper (articles, books, Web documents, etc.). However, before you can format individual
references, you must know how to format the pages on which these references will appear:

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 1) Pagination & Placement: The first page of the References list always begins on a new page,
immediately following the last page of the body of the text.

2) Page Numbering & Running Head: Continue numbering from the last page of the body.
Include the same running head used in the rest of the document.

3) Title: The title of this page is References, typed at the top of the page, centered, on the first
double-spaced line beneath the page number/running head. Capitalize the first letter (References).

4) Margins: All margins equal to one inch.

5) Font: 12-point font required; serif font (New Times Roman) recommended.

Tables

Tables show data in an easily read format. It is not necessary to present all of your data in table form. If
you only need to present a few numbers, you should do so directly in the text, not in a table. Tables
should only be used for large amounts of data that would be too complicated in the text and if they add
substance to the paper.

Each table should make sense on its own without any further discussion. Design your tables so that they
are easily interpreted. The data presented in the table must allow readers to quickly and accurately make
important comparisons.

When using a table, refer to the table in the body of your paper (See Table 1, As Table 4 indicates, etc.).
Also, point out to readers what they should be looking for in the table. However, only mention the most
significant pieces of information from the table.

Follow APA’s guidelines when formatting your tables:

1) Placement of Tables: In keeping with APA style, place tables after your References list. NOTE.
Read your assignment directions carefully! Certain assignments may ask you to embed tables
within the body of the paper, in an appropriate position following their mention in the text. If in
doubt about where to place tables, ask your Course instructor.

2) Pagination: Begin each table on a new page.

3) Page Numbering & Running Head: Continue numbering from the last page of the previous
section. Include the same running head used in the rest of the document.

4) Spacing: Text is typically double-spaced in tables. However, your assignment directions or

Course instructor may ask you to single-space or use both double and single-spacing.

5) Font: 12-point font required; serif font (New Times Roman) recommended.

6) Numbering of Tables: Identify all tables using Arabic numerals (Table 1, Table 2). Number
tables in the order in which they are mentioned in the text, regardless of whether a more detailed
discussion of a table occurs later in the paper. Do not use suffix letters to label tables (no Table
4a, Table 4b). Each table should have a separate Arabic numeral.

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 7) Titles of Tables: At the top of each table, type the word Table and its Arabic numeral (Table 1,
Table 2). Place this heading at the left margin at the top of the table. On the next line, also at the
left margin, include a brief and clear title. Italicize this title. Use a unique title for each table.

8) Columns: Each column of data in a table must have a heading so the reader can identify the data
beneath the heading.

9) Horizontal & Vertical Lines: APA tables have only horizontal lines and NO vertical lines.

Below is a template for constructing tables in proper APA format:

Table 1

Title of Table 1

Column heading Column heading Column heading Column heading

Table Bod Table Body Table Body Table Body**

a
Table Body Table Body Table Body Table Body

Table Body Table Body Table Body Table Body*

Note. The italicized word Note signals a General Note, which provides information about the
entire table. If necessary, this note identifies the source of your data or table.
a
This superscript, lowercase letter signals a Specific Note, which provides information about a
specific row, column, or cell. Note the superscript “a” in the table above.
* An asterisk signals a Probability Note that discusses statistical findings presented in the table
(for example, *p<0.05. **p<0.001). Note the asterisks in the table above.

Figures

In APA, any type of illustration or graph that is not a table is called a figure. Figures include graphs,
charts, diagrams, drawings, maps, photographs, and similar items. In certain cases, a table may be
preferable to a figure because the reader can find the exact value of a number in a table. Make sure that
each figure provides the reader with an alternative view of the data that could not be achieved with a
table. For example, a table may indicate exact values more effectively, but a line graph is much better
than a table at illustrating trends.

Decide between using a table or a figure based on the needs of your text and the point you are trying to
make with the data. When using a figure, refer to the figure in the body of your paper (See Figure 3,
Figure 5 illustrates that. . . . ). Also, point out to the reader what they should be looking for in the figure.
Use a figure only if it complements the text, but does not duplicate it. Only mention the most important
pieces of information from the figure. If you use figures in your paper, format them as follows:

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 1) Placement of Figures: Place all figures at the end of your document, immediately following
Tables and before the Appendices. Each figure begins on a new page. NOTE. Read your
assignment directions carefully! Certain assignments may ask you to embed figures within the
body of the paper, in an appropriate position following their mention in the text. If in doubt about
where to place figures, ask your Course instructor.

2) Pagination: Begin each figure on a new page.

3) Page Numbering & Running Head: Continue numbering from the last page of the previous
section. Include the same running head used in the rest of the document.

4) Spacing, Font, etc: For your page number, running head, and figure caption, use the same
formatting as in the rest of your document.
5) Numbering of Figures: Identify all figures using Arabic numerals (Figure 1, Figure 2). Number
figures in the order in which they are mentioned in the text, regardless of whether a more detailed
discussion of a figure occurs later in the paper. Do not use suffix letters to label figures (no Figure
4a, Figure 4b). Each figure should have a separate Arabic numeral.

6) Captions/Titles of Figures: Place the figure title or caption beneath the figure. Italicize the
figure label and place a period after the numeral (Figure 1.) After the label, on the same line, type
a brief title for the figure. Use a unique title for each figure. Do NOT italicize the title (Figure 1.
Student health trends from 1999-2005).

7) Figure Legend: If necessary, include a legend that explains all parts of the figure.

Below is an example of a Figure and how it should be formatted:

Figure 3. Course Mapping

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Appendices

Use an appendix to present detailed information (computer program, questionnaire, etc.) that would be
distracting in the body of the paper. Your paper may have one or more appendices, formatted as follows:

1. Pagination & Placement: Appendices appear right after the Figures list. If you do not have any
Tables or Figures, the Appendices appear right after the References page. Begin each appendix on
a new page.

2. Page Numbering, Running Head, Margins, Spacing, Font, etc.: If you will be typing your
appendices yourself, use the same page numbering, running head, margins, spacing, font, etc. as
in the rest of your paper. However, if you wish to include appendixes that are originals from
another source and that cannot be easily worked with in your word processor, contact your
Course instructor for instructions about how to insert these into your paper and what formatting to
use.

3. Titles of Appendixes: If your paper has only one appendix, label it Appendix. If the paper has
more than one appendix, label each with a capital letter (Appendix A, Appendix B, etc.). Center
this label at the top of the first page of the appendix and capitalize the initial letter (Appendix,
Appendix A, etc.). (NOTE. If you cannot type a title onto the appendix, contact your Course
instructor to discuss formatting alternatives.)

How to Cite Sources in APA Style: An Introduction

Giving Credit Where Credit Is Due

When you write papers, you will discover a great deal of information available through many different
sources. It is completely acceptable to use information provided by others, as long as credit is given to the
original source. This practice of giving credit where credit is due is not a meaningless academic exercise.
Rather, it is a primary means of attributing ownership in academic and professional writing. Citation
styles such as APA protect the ideas of their original owners while giving future authors a way to use
others’ ideas appropriately in their writing.

This section offers a brief introduction to citing outside sources in your papers. You will find clear
examples that walk you through the process of incorporating another’s ideas into your writing. Once you
have read this introduction, you will be ready to move to the final section of this guide, which provides
detailed instructions for citing the works of others.

Plagiarism and Citing Sources

Any time you use someone else’s words and ideas in your own written work you MUST give the other
person credit. If appropriate credit is not given, you are guilty of plagiarism, even if the failure to give
appropriate credit is unintentional. Plagiarism is a recognized problem in student writing and is defined as
the presentation of the ideas, works, or thoughts of others as your own without giving credit to those from
whose work you borrowed (Baumgartner & Hensley, 2006). Plagiarism occurs regardless of where or
how information is gathered – on the Web, through books, through journals or magazines, even through
interviews of individuals for their opinions.

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 REMEMBER –
It IS acceptable to use other people’s words and ideas in your writing, but it IS NOT acceptable to
allow readers to believe that another’s words or ideas are your own.

Citing the Source in the Body of Your Paper (In-Text Citations)

APA offers several ways to correctly use and cite the BLS information in your paper’s body. These
citations are called “in-text citations.”

1. Paraphrase or re-state a small portion of the original information:

Elementary school teachers are required to have a bachelor’s degree in order to teach

(Bureau of Labor Statistics, 2009). I am planning to earn my bachelor’s degree in

elementary education.

Note that some of the information from the BLS Web site is used but you have not taken the
words directly from the Web site, and the words are used in a different way. In other words, you
have paraphrased the original information.

To correctly cite this paraphrase in APA format, you would first list the author – in this case, the
“corporate” author Bureau of Labor Statistics – and then the year of publication (Bureau of Labor
Statistics, 2006). You would also include a full reference to the BLS source in the References list
at the end of your paper. (NOTE. Both this guide and the APA Publication Manual (6th ed.) offer
instructions for citing sources in the References list.)

2. Quote a portion of the original information word-for-word:

Elementary school teachers first must have a good education. According to the U.S.

Bureau of Labor Statistics (2009), “all states require general education teachers to have a

bachelor’s degree and to have completed an approved teacher training program with a

prescribed number of subject and education credits, as well as supervised practice

teaching” (p. 3).

According to APA, if you use the BLS’s exact words, the quotation must be shown in quotation
marks. Once again, you would provide the author and date of publication. However, because this
is a direct quotation, APA requires that you also provide the page number of the quotation.
If no page number is available (as is the case with many Web/online sources), you would provide
the paragraph number (para. 1, etc.) or a similar indicator. The APA Publication Manual (5th ed.)
provides instructions on how to indicate location when no page numbers are available. Do NOT
use the page numbers that your printer places on the pages. These are not the source’s page
numbers and vary by printer. Finally, you would place the full citation for the BLS source in the
References section of your paper.

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 3. Quote the entire paragraph from the original source word-for-word:
Let’s say that you decide to include the entire BLS quotation in your paper because, in your
opinion, this section contains important information that should be included in your paper word-
for-word. Your paper’s body may now look like this:

Elementary school teachers must have a good education. Teachers must be licensed by

the state where they live, and before they can be licensed they must receive the proper

education and training. The Occupational Outlook Handbook, published by the U.S.

Bureau of Labor Statistics (2009), states:

Requirements for regular licenses to teach kindergarten through grade 12 vary by

State. However, all States require general education teachers to have a bachelor’s

degree and to have completed an approved teacher training program with a

prescribed number of subject and education credits, as well as supervised practice

teaching. Some States also require technology training and the attainment of a

minimum grade point average. A number of States require that teachers obtain a

master’s degree in education within a specified period after they begin teaching.

(p.3)

I plan to earn a bachelor’s degree in elementary education. I also hope to receive a

master’s degree in education, even if my state does not require it.

In this case, you would indent the quotation from the BLS, in keeping with APA guidelines for
placing long quotations (more than 40 words) in the body of your paper. Note that quotation
marks are NOT used with indented quotations. Also note that the Bureau of Labor Statistics and
the date of publication (2006) are stated in the sentence immediately preceding the long
quotation. Although APA offers other options for citing the author and date of a long quotation,
this technique signals to the reader that what follows is a direct quotation from the BLS’s
Occupational Outlook Handbook.

In the example above, the page number of the quotation (p. 3) is placed at the end of the indented
paragraph, immediately following the period. Finally, complementing this in-text citation would
be a full citation for the BLS source in the References list at the end of the paper.

4. Quote online material without pagination

New APA guidelines use “para” instead of the symbol ¶ to indicate location of direct
quotes of online sources that do not have pagination.

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 5. Long Quotes
Whenever a direct quote has 40 or more words, it needs to be indented. Quotation marks
are not used with indented quotations. The new APA edition has cited information (such
as author, date, and page numbers) listed in parentheses, similar to the previous edition,
with the following changes:
 information in parentheses is given after last punctuation of quote
 there is no punctuation following the parenthesis

Example:

Friedman (2006) draws connections between two seemingly disparate events: November

9 (dismantling of the Berlin Wall) and September 11 (attack on the World Trade Center).

He believes these two dates represent the two competing forms of imagination at work in

the world today: the creative imagination of 11/9 and the destructive imagination of 9/11.

One brought down a wall and opened the windows of the world. . . [the other] putting up

new invisible and concrete walls among people. (p. 543)

Citing the Source in the References List

In addition to citing the BLS source in your paper’s body, you must also cite the source in a separate
References list at the end of the paper. The format for the References list is discussed in more detail in the
final section of this APA guide as well as in the APA Publication Manual (5th ed.). However, to help you
understand what the References citation for the BLS source would look like, we include it here:

Bureau of Labor Statistics. (2006). Occupational Outlook Handbook, (2008-09 Ed.),

Teachers—Preschool, Kindergarten, Elementary, Middle, and Secondary.

(U.S. Labor Department Bulletin No. 2600). Retrieved on July 13, 2009, from

the U.S. Department of Labor, Bureau of Labor Statistics Web site:

http://www.bls.gov/oco/ocos069.htm

Using this citation, your reader would then be able to look up the BLS Web site and verify the
information you provided.

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Moving Forward with APA Style

Now that you understand the basics of citing sources in your papers, you are ready to move to the final
section of this guide, where you will find detailed explanations of APA’s guidelines for citing sources in
the body and References list.

How to Construct In-Text Citations and a

References List in APA Style

APA style requires you to cite your outside sources in two parts of your paper:
1) The body of the paper (in-text citations).
2) A separate References list at the end of the paper.

In-text citations and the References list work closely together. In-text citations reveal how and where you
have incorporated the ideas of others into your writing, while the References list documents these sources
and allows your readers to track down the originals, if they wish. With the exception of personal
communications, any source cited in your text must also be documented in your References list, and vice
versa.

This section of the APA guide explains how to construct both in-text citations and the References list.
Please keep in mind that although specific instructions, formats, and examples are provided, the best
resource on APA style remains the Publication Manual of the American Psychological Association: Sixth
Edition. Use this IU guide as an introduction to APA style, and turn to the APA Publication Manual (6th
ed.) when you are ready for a more in-depth explanation of the style.

APA PUBLICATION MANUAL (6th ed.)

The guidelines in this document are taken from the Publication Manual of the American Psychological
Association: Sixth Edition. If you will be writing many papers during your enrollment, consider investing
in a copy of the APA Publication Manual or using a free copy at your local library.

In-Text Citations

APA style has a series of important rules for using author names as part of the author-date system. In
addition, there are rules for citing indirect sources, electronic sources, and sources without page numbers.

Citing an Idea, Entire Work, or Paraphrase

A correct citation of a paraphrase, idea from a source, or entire work includes two elements:

1) Last name(s) of the author or authors.

17 
 
 2) Date of publication.

Research by Ditmyer and Smith (2008, p. 1) supports...

(Ditmyer & Smith, 2008, p. 1)

NOTE. APA style encourages you to include page numbers with paraphrases, to assist your readers in
finding the original information. APA style allows you to arrange these elements (author, date, page
number) in various ways in your text. Pay close attention to how APA style inserts commas between
elements (2003, p. 83), abbreviates the words “page” and “pages” (p. and pp.), and connects author names
within parentheses with an ampersand (Siegel & Benz) and in the phrase with an “and”. APA has rules
for abbreviations and punctuation in citations. Follow these rules correctly and consistently! Example
below.

Jackson (2003, p. 83) wrote that declining health systems can repair themselves more effectively

when they understand their errors before correcting them. According to Ditmyer (2000), the

quality and effectiveness of communication between an employer and her employee is more

important than efficiency. Unable to think critically about information she received, Joan was

categorized as a perception machine (Cochran, 2003. pp. 856-857).

Citing a Direct Quotation

Correctly cited direct quotations include three elements:

1) Last name(s) of the author or authors.

2) Date of publication.

3) Page number where the quotation can be found in the original source.

NOTE. If no page number is available, you may use the paragraph number (para. 1) or another indicator.
See the APA Publication Manual (6th ed.) for assistance. When using Web documents as sources…DO
NOT use the page numbers that your printer places on the pages. These are not the source’s page numbers
and vary by printer. Example below.

You may arrange the elements (author, date, page number) in various ways in your text. Note the use of
double quotation marks to signal that these are direct, word-for-word quotations from another source:

Delaney (2003) defended his administration's social policy spending by announcing, "Any

government can take money, but a great government uses it to improve the quality of life of its

constituents" (p. 84).

18 
 
 In an article in Science, Cortez describes "excessive demand for new technology" in the area of

software development, supporting the complaint among users that software typically remains

current for no more than five years before becoming obsolete (Cortez, 2003, p. 143).

According to Hong, Zimmerman, Hawke, and Keller (2003), "The primary mission of the

manager wanting to encourage productivity is to create a working environment where a robust

productivity can thrive without interference" (p. 84). The layout and design of working

environments have a "definite and direct influence not only on work culture, but on the speed and

quality of workflow" (Hong et al., 2003, pp. 54-55).

Direct quotations longer than 40 words should be set apart from the text as block quotations indented ½”
or 5-7 spaces from the left margin. Observe that NO quotation marks are used in these long quotations
and that the page number reference (p. 194) follows the final period:

Rachel Carson (1962) was one of the first scientists to describe the problem of identifying

"classic" symptoms of pesticide poisoning: Why does not everyone handling and using

insecticides develop the same symptoms? Here the matter of individual sensitivity enters

in. There is some evidence that women are more susceptible than men, the young very

more than adults, those who lead sedentary, indoor lives more than those who lead a

rugged life of work or exercise in the open. Beyond these differences are others that are

no less real because they are intangible. (p. 194)

Punctuation Rules for In-Text Citations

Connecting Author Names: Connect authors listed within parentheses with an ampersand (&).
However, connect authors with “and” outside parentheses:

(Wilkins & Chen, 2002)

(Meyers, Briggs, & Mathews, 2007)

Wilkins and Chen (2002) state that. . . . .

Meyers, Brigss, and Mathews (2007) posit that. . . .

19 
 
Abbreviating “Page” and “Pages”: Abbreviate as follows:
(Smith, 2008, p. 42)
(Jones et al., 2001, pp. 10-11)

Separating Elements within Citations: Separate the elements of a single citation with commas:

(Smith, 2008, p. 42)

Separating Two or More Works within Parentheses: Separate multiple works listed within parentheses
with semicolons. Order these works in the same way that they appear in the References list (i.e.,
alphabetically):

(Barnes, 2004; Jones, 1999)

(Jones et al., 1999; Smith, 2005; Wilkins & Chen, 2008)

Quick Reference: Types of In-Text Citations

Works with One Author: Cite the author’s last name with the date of publication. Cite the page number
if you are using a direct quotation or wish to add a page number reference to a paraphrase:

(Wilkins, 2009, p. 42)

Wilkins (2009) argues for “evidence-based research is critical” (p. 42)

Works with Two Authors: If a work has two authors, always cite both names each time the reference
occurs in the text:

(Sanchez & Clarke, 2009)

Sanchez and Clarke (2009)

Always cite the first author first (i.e., NEVER re-arrange or alphabetize the names of multiple authors;
follow the order used in the original source).

Works with Three to Five Authors: If a work has three, four, or five authors, cite ALL the authors the
first time the reference occurs. Then, in following references, cite the first author only followed by “et al.”
(Do not italicize “et al.” Place a period after “al.”)

(Smith, Jones, Wilson, & Depp, 2009)…thereafter…(Smith et al., 2002)

Works with Six or More Authors: If a work has six or more authors, cite the first author ONLY
followed by “et al.” (Do not italicize “et al.” Place a period after “al.”) This rule applies each time you
cite the source in the text, including the first time:

(Mobley et al., 2007)

Mobley et al. (2007) contend. . . .

Works with Corporate Author: At times, the author listed sometimes is not a person but an association,
government agency, company, or similar organization. These are known as “corporate” authors. Treat
corporate authors as you would any other type of author:

20 
 
 The Bureau of Labor Statistics (2006) states that. . . .
According to one source (Bureau of Labor Statistics, 2006), requirements for. . . .

The corporate author is usually spelled out each time it appears in the text. However, you may spell out
the name the first time it is mentioned, include an abbreviation/acronym, and then abbreviate the name in
later citations if your reader will be able to decipher the abbreviation and find it in the References list
without difficulty:

The National Institutes of Health (NIH) (2002) warned that more influenza manufacturers were

needed. In its findings, the NIH observed that. . . .

According to one source (Bureau of Labor Statistics [BLS], 2006), requirements for elementary

school teachers vary. The BLS states that. . . .

When in doubt, spell out the full name of the corporate author.

Works with No Author Listed: If a source does not list any author at all (including no corporate author),
use the first few words of the Reference list entry in place of the author name. This is usually the title of
the work. Place the title of an article, chapter, or similar work within quotation marks. Italicize the title of
a book, report, journal/periodical, brochure, pamphlet, or similar work:

A similar study was done of faculty research papers ("Evidence-based Research,” 2009).

In another study of students, it was discovered that faculty who sought out mentors were able to

get more publications (Mentoring for Publications, 2006).

Works with No Date Listed: If no date of publication is given, use the abbreviation "n.d." for "no date".

("Evidence-based Research," n.d.)

Smith (n.d.) states that. . . .

Authors with Same Last Name: To prevent confusion, use first initials with the last names:

(E. Smith, 2002; L. Smith, 2003)

Two or More Works by Same Author in Same Year: If you have two sources published by the same
author in the same year, use lowercase letters (a, b, c) with the year to order the entries in the References
list. Use the lowercase letters with the year in the in-text citation. (Note that you are being asked to
arrange these citations in the References list first and then in the text.)

Smith (2001a) illustrated that the findings were not new. In another study, Smith (2001b)

indicated problems in the research design.

21 
 
Citing Indirect Sources: If you use a source that was cited in another source, name the original source in
your signal phrase. List the secondary source in your reference list and include the secondary source in
the parentheses.

Jones argued that...(as cited in Smith, 2007, p. 102).

Personal Communications: For interviews, letters, e-mails, and other person-to-person communication,
cite the communicator’s name, the fact that it was personal communication, and the date of the
communication. Do not list personal communications in the References list.

(M. Jones, personal communication, January 4, 2009)

Electronic Sources: If possible, cite an electronic document the same as any other document by using the
author-date style.

Wilson (2009) explained...

Unknown Author and Unknown Date: If no author or date is given, use the title in your signal phrase
or the first word or two of the title in the parentheses and use the abbreviation "n.d." (for "no date").

Another study of faculty regarding mentors discovered that faculty succeeded when mentored

("Mentoring for Publications," n.d.).

Sources without Page Numbers: When an electronic source lacks page numbers, you should try to
include information that will help readers find the passage being cited. When an electronic
document has numbered paragraphs, use the ¶ symbol, or the abbreviation "para." followed by
the paragraph number (Ditmyer, 2008, ¶ 5) or (Ditmyer, 2009, para. 5). If the paragraphs are not
numbered and the document includes headings, provide the appropriate heading and specify the
paragraph under that heading.

According to Johnson (2007), ... (Evidence-based Research section, para. 6).

Note: Never use the page numbers of Web pages you print out; different computers print Web
pages with different pagination.

Reference List: Basic Rules

Your reference list should appear at the end of your paper. It provides the information necessary for a
reader to locate and retrieve all the sources you cite in the body of the paper. Each source you cite in the
paper MUST appear in your reference list with the exception of personal communications; likewise, each
entry in the reference list must be cited in your text.

22 
 
Your references should begin on a new page separate from the text of the essay; label this page
References (with no quotation marks, underlining, etc.), centered at the top of the page. It should be
double-spaced just like the rest of your essay.

Basic Rules

1) Use Hanging Indent: All lines after the first line of each entry in your reference list should be
indented one-half inch from the left margin.

2) Authors' names are inverted (last name first); give the last name and initials for all authors of a
particular work unless the work has more than six authors. If the work has more than six authors,
list the first six authors and then use et al. after the sixth author's name to indicate the rest of the
authors.

3) Reference list entries should be alphabetized by the last name of the first author of each work.

4) If you have more than one article by the same author, single-author references or multiple-author
references with the exact same authors in the exact same order are listed in order by the year of
publication, starting with the earliest.

5) When referring to any work that is NOT a journal, such as a book, article, or Web page, capitalize
only the first letter of the first word of a title and subtitle, the first word after a colon or a dash in
the title, and proper nouns. Do not capitalize the first letter of the second word in a hyphenated
compound word.

6) Capitalize all major words in journal titles.

7) Italicize titles of longer works such as books and journals.

8) Do not italicize, underline, or put quotes around the titles of shorter works such as journal articles
or essays in edited collections.

Author/Authors

The following rules for handling works by a single author or multiple authors apply to all APA-style
references in your reference list, regardless of the type of work (book, article, electronic resource, etc.)

Single Author: Last name first, followed by author initials.

Smith, M. J. (2003). Friendship quality and social respect. Current Directions in

Psychological Science, 11, 7-10.

23 
 
Two Authors: List by their last names and initials. Use the ampersand instead of "and."

Wagnor, D. T., & Price, R. E. (1994). Mood management across affective states: The contingency

hypothesis. Journal of Personality & Social Psychology, 66, 1034-1048.

Three to Six Authors: List by last names and initials; commas separate author names, while the last

author name is preceded again by ampersand.

Kernis, M. H., Cornell, D. P., Sun, C. R., Berry, A., & Harlow, T. (1993). There's more to self-

esteem than whether it is high or low: The importance of stability of self-esteem. Journal

of Personality and Social Psychology, 65, 1190-1204.

More Than Six Authors: For references with six or seven authors, list all of them in the reference
citation. For references with eight or more authors, list the first six authors, then insert three ellipses,
and add the last author’s name.

Harris, M., Karper, E., Stacks, G., Hoffman, D., DeNiro, R., Cruz, P., ...Ditmyer, M. (2001).

Writing labs and the Hollywood connection. Journal of Film and Writing, 44(3), 213-

245.

Organization as Author

American Psychological Association. (2009).

Unknown Author

Merriam-Webster's collegiate dictionary (15th ed.). (2005). Springfield, MA: Merriam-Webster.

NOTE: When your essay includes parenthetical citations of sources with no author named, use a
shortened version of the source's title instead of an author's name. Use quotation marks and italics as
appropriate. For example, parenthetical citations of the source above would appear as follows: (Merriam-
Webster's, 2005).

24 
 
Two or More Works by the Same Author: Use the author's name for all entries and list the entries

by the year (earliest comes first).

Smith, T. J. (2001).

Smith, T. J. (2005).

Placement of Sole Author vs. Two or more Authors with the Same First Author. When an author
appears both as a sole author and, in another citation, as the first author of a group, list the one-author
entries first.

Smith, T. J. (2005). Friends' influence on students' adjustment to school. Educational

Psychologist, 34, 15-28.

Smith, T. J., & Jones, K. (2004). Friends' influence on adolescents' adjustment to school. Child

Development, 66, 1312-1329.

Same First Author but different Second and Third Authors. References that have the same first
author and different second and/or third authors are arranged alphabetically by the last name of the second
author, or the last name of the third if the first and second authors are the same.

Smith, D. T., Kerr, N. L., Fleming, M. A., & Petty, R. E. (2006). Flexible corrections of juror

judgments: Implications for jury instructions. Psychology, Public Policy, & Law, 6, 629-

654.

Smith, D. T., Petty, R. E., & Klein, D. J. (2005). Effects of mood on high elaboration attitude

change: The mediating role of likelihood judgments. European Journal of Social

Psychology, 24, 25-43.

Two or More Works by the Same Author in the Same Year: If you are using more than one
reference by the same author (or the same group of authors listed in the same order) published in the same
year, organize them in the reference list alphabetically by the title of the article or chapter. Then assign
letter suffixes to the year. Refer to these sources in your essay as they appear in your reference list, e.g.:
"Smith (2005a) makes similar claims..."

Smith, T. J. (2005a). Age changes and changes over time in prosocial intentions and behavior

between friends. Developmental Psychology, 17, 408-416.

25 
 
 Smith, T. J. (2005b). Effects of friendship on pro-social intentions and behavior. Child

Development, 52, 636-643.

Periodicals, Books, Newspapers, Government Sources

 

APA style dictates that authors are named last name followed by initials; publication year goes between
parentheses, followed by a period. The title of the article is in sentence-case, meaning only the first word
and proper nouns in the title are capitalized. The periodical title is run in title case, and is followed by the
volume number which, with the title, is also italicized or underlined.

Author, A. A., Author, B. B., & Author, C. C. (Year). Title of article. Title of Periodical, volume

number(issue number), pages.

Article in Journal with only Volume Number: Journals that are paginated by volume begin with
page one in issue one, and continue numbering issue two where issue one ended, etc.

Harlow, H. F. (1983). Fundamentals for preparing psychology journal articles. Journal of

Comparative and Physiological Psychology, 55, 893-896.

Article in Journal with both Volume and Issue Number: Journals paginated by issue begin with
page one every issue; therefore, the issue number gets indicated in parentheses after the volume. The
parentheses and issue number are not italicized or underlined.

Scruton, R. (1996). The eclipse of listening. The New Criterion, 15(30), 5-13.

Books
Basic Format for Books

Author, A. A. (Year of publication). Title of work: Capital letter also for subtitle. Location:

Publisher.

Note: For "Location," you should always list the city, but you should also include the state if the city is
unfamiliar or if the city could be confused with one in another state.

Calfee, R. C., & Valencia, R. R. (1991). APA guide to preparing manuscripts for journal

publication. Washington, DC: American Psychological Association.

26 
 
Edited Book, No Author

Williams, G. J., & Gunns, J. (Eds.). (1997). Consequences of socio-economic growth. New York:

Sage Publications.

Edited Book with an Author or Authors

Plath, S. (2000). The unabridged journals (K.V. Kukil, Ed.). New York: Anchor.

Edition Other Than the First

Williams, M. E., Jones, R. S., & Michaels, R. D. (1999). The battered housewife (8th ed.).

Chicago: University of Detroit Press.

Introductions, Prefaces, Forewords, and Afterwards: Cite the publishing information about a
book as usual, but cite Introduction, Preface, Foreword, or Afterward (whatever title is applicable) as the
chapter of the book.

Jones, R. & Rollins, M. (2005). Introduction. In E.W. Ludlow (Ed.), Understanding Spanish

(pp. 1-2). Needham, MA: Allyn and Bacon.

Work Discussed in a Secondary Source

Helth, M., Coats, B., Atkins, P., & Paller, M. (2003). Models of reading fundamentals.

Psychological Review, 99, 589-608.

NOTE: Give the secondary source in the references list; in the text, name the original work, and give a
citation for the secondary source. For example, if Seidenberg and McClelland's work is cited in Coltheart
et al. and you did not read the original work, list the Coltheart et al. reference in the References. In the
text, use the following citation:

In Ditmyer and Mobley’s study (as cited in Helth, Coats, Atkins, & Paller, 2003)...

Newspapers and Government Sources

Article in a Newspaper:
Unlike other periodicals, p. or pp. precedes page numbers for a newspaper reference in APA style. Single
pages take p., e.g., p. B2; multiple pages take pp., e.g., pp. B2, B4 or pp. C1, C3-C4.

Masters, M. (2005, December 28). Calls made to strengthen state Medicare policies. The

New York TImes, pp. 1A, 2A.

27 
 
Government Document

National Institute of Mental Health. (1990). Clinical training in serious mental illness (DHHS

Publication No. ADM 90-1679). Washington, DC: U.S. Government Printing Office.

Electronic Sources
A couple key changes for Online Periodicals on Reference Page:
 no longer include retrieval date unless source information may change over time
 no longer include databases used such as EBSCO or ProQuest

Article from an Online Periodical: Note: In 2007, the APA released several additions/modifications
for documentation of electronic sources in the APA Style Guide to Electronic References. These changes
are reflected in the 6th edition. Please note that there are no spaces used with brackets in APA.
Online articles follow the same guidelines for printed articles. Include all information the online host
makes available, including an issue number in parentheses. Provide a retrieval date only if the information
is likely to be updated or changed at a later date (as in the case of blogs and wikis). Since many online
periodicals appear in their "final" form, a retrieval date is not necessary.

Author, A. A., & Author, B. B. (Date of publication). Title of article. Title of Online Periodical,

volume number(issue number if available). Retrieved month day, year, (if necessary)

from http://www.someaddress.com/full/url/

Wienstein, M. (2009). 10 tips on writing a living Will, 149. Retrieved May 2, 2009, from

http://www.livingwills.com/articles/livingwills

Online Scholarly Journal Article

Since online materials can potentially change URL's, APA recommends providing a Digital Object
Identifier (DOI), when it is available, as opposed to the URL. DOI's are an attempt to provide stable,
long-lasting links for online articles. They are unique to their documents and consist of a long
alphanumeric code. Many-but not all-publishers will provide an article's DOI on the first page of the
document.

Note that some online bibliographies provide an article's DOI but may "hide" the code under a button
which may read "Article" or may be an abbreviation of a vendors name like "CrossRef" or "PubMed."
This button will usually lead the user to the full article which will include the DOI. Find DOI's from print
publications or ones that go to dead links with CrossRef.org's "DOI Resolver," which is displayed in a
central location on their home page.

28 
 
Article from an Online Periodical with DOI Assigned

Author, A. A., & Author, B. B. (Date of publication). Title of article. Title of Journal, volume

number. doi:0000000/000000000000

Brownlie, D. Toward effective poster presentations: An annotated bibliography. European

Journal of Marketing, 41(11/12), 1245-1283. doi:10.1108/03090560710821161

Article from an Online Periodical with no DOI Assigned: Online scholarly journal articles
without a DOI require a URL but do not require a retrieval date. Provide a retrieval date only if the
information is likely to be updated or changed at a later date (as in the case of blogs and wikis). Since
most journal articles appear in their "final" form, a retrieval date is not needed.

Author, A. A., & Author, B. B. (Date of publication). Title of article. Title of Journal, volume

number. Retrieved month day, year, from http://www.someaddress.com/full/url/

Kenneth, I. A. (2000). A Buddhist response to the nature of human rights. Journal of Buddhist

Ethics, 8.Retrieved February 20, 2001, from http://www.cac.psu.edu/jbe/twocont.html

If the article appears as a printed version as well, the URL is not required. Use "Electronic version" in
brackets after the article's title.

Whitmeyer, J. M. (2000). Power through appointment [Electronic version]. Social Science

Research, 29, 535-555.

Article from a Database: When referencing material obtained from an online database (such as a
database in the library), provide appropriate print citation information (formatted just like a "normal"
print citation would be for that type of work). Then add information that gives the date of retrieval and the
proper name of the database. This will allow people to retrieve the print version if they do not have access
to the database from which you retrieved the article. You can also include the item number or accession
number in parentheses at the end, but the APA manual says that this is not required. (For more about
citing articles retrieved from electronic databases, see page 278 of the Publication Manual.)

Smyth, A. M., Parker, A. L., & Pease, D. L. (2002). A study of enjoyment of peas. Journal of

Abnormal Eating, 8(3). Retrieved February 20, 2003, from PsycARTICLES database.

Electronic Newspaper Article

Author, A. A. (Year, Month Day). Title of article. Title of Newspaper. Retrieved from

http://www.someaddress.com/full/url/

Parker-Pope, T. (2008, May 6). Psychiatry handbook linked to drug industry. The New York

Times. Retrieved from http://www.nytimes.com

29 
 
Electronic Books: Electronic books may include books found on personal websites, databases, or even
in audio form. Use the following format if the book you are using is only provided in a digital format or is
difficult to find in print. If the work is not directly available online or must be purchased, use "Available
from," rather than "Retrieved from," and point readers to where they can find it.

De Huff, E.W. (n.d.) Pueblo Indian’s tales: Traditional Pueblo Indian tales. Retrieved from

http://digital.library.upenn.edu/women/dehuff/taytay/taytay.html

Davis, J. Familiar tales of the Northwest. (n.d.). Available from

http://www.ditmyer.com/cgi-bin/biblio?inkey=1-9780931680000-0

Non-periodical Web Document, Web Page, or Report: List as much of the following information
as possible (you sometimes have to hunt around to find the information; don't be lazy. If there is a page
like http://www.somesite.com/somepage.htm, and somepage.htm doesn't have the information you're
looking for, move up the URL to http://www.somesite.com/):

Author, A. A., & Author, B. B. (Date of publication). Title of document. Retrieved month day,

year (only if the text may potentially change over time), from http://Web address

NOTE: When an Internet document is more than one Web page, provide a URL that links to the
home page or entry page for the document. Also, if there isn't a date available for the document
use (n.d.) for no date.

30 
 
 EXAMPLE PAPER

31 
 
Below are excerpts from a published paper. It is not the entire paper, but specific
segments to help you visual what you have reviewed in IU’s APA guide.

Included in this example are a title page, running head and page numbering,
heading formatting and placement, in-text citations and References page,
placement and formatting of tables and figures.

Note the page numbering on the example paper is not in sequential order…that is
because this is just excerpts of the paper and not the entire paper.
RUNNING HEADER: Theoretical Model for Oral Screenings 1

Development of a Theoretical Screening Tool to Assess Caries Risk in Nevada Youth

Marcia M. Ditmyer, PhD, CHES

Independence University
 RUNNING HEADER: Theoretical Model for Oral Screenings 2

Development of a Theoretical Screening Tool to Assess Caries Risk in Nevada Youth

This paper will begin with a brief background on oral disease and dental caries.

Following the background will be details about the methodology of the study including selection

of the participants, oral screening guidelines, selection of the variables and operational definition

of the variables... [the introductory paragraph will describe what is included in the paper to

prepare the reader].

Background

The World Health Organization (WHO) reported that oral disease, including dental

caries, remains a major public health challenge (Peterson, Bourgeois, Ogawa, Estupinan-Day, &

Ndiaye, 2005). In the 1970’s, significant advances were made in oral health; however oral health

disparities continue to be reported (Office of the Surgeon General [OSG], 2006; U.S. Department

of Health and Human Services [HHS], 2007). In 2004, 60-90% of children worldwide ages 10 to

19 had dental caries (Peterson et al., 2005). Dental caries has been described as the most

common childhood disease, occurring 5 times more frequently than asthma and 7 times more

than hay fever (OSG, 2006). The prevalence of caries in children persists in both developed and

underdeveloped countries, particularly among underprivileged groups (Peterson et al., 2005).

Studies have identified associations between numerous factors and dental caries,

supporting agreement that dental caries is a multi-factorial disease modulated by genetics,

behavior, and environment (Peterson et al., 2005; Reisine & Psoter, 2001). Studies have linked

poor oral health with chronic, systemic diseases (e.g., cardiovascular disease and diabetes),

lifestyle, and social conditions (HHS, 2007; OSG, 2006). Low levels of education and lack of

access to dental care have been associated with the unequal distribution of dental caries among

different races/ethnicities (Reisine & Psoter, 2001; Reid, Hyman, & Macek, 2004). Markers of
 RUNNING HEADER: Theoretical Model for Oral Screenings 3

obesity have been correlated with untreated dental caries (Kiess et al, 2001). Understanding the

influence of lifestyle, ethnicity, health status, and social conditions will contribute to the

development of improved prevention and treatment approaches (HHS, 2007; Peterson et al.,

2005). Thus, identifying significant associations and strength of contribution of selected factors

with dental caries provided a rationale for this study.

Methods

Selection and Description of Participants

Researchers have been conducting an ongoing statewide, school-based, oral health

screening initiative annually since 2001 in public/private middle and high schools in Nevada.

Data used for this retrospective cohort study collected during 2005/2006 academic school year

included 9202 adolescents between ages 13 and 18. Inclusion criteria for participation were

parental consent and student assent. The University of Nevada Las Vegas Institutional Review

Board approved this initiative to assure student confidentiality.

Oral Health Screening

Examinations were conducted in dedicated mobile dental clinics (one each in northern

and southern Nevada). Trained and calibrated licensed dental examiners performed oral health

screenings to assess caries prevalence and severity. Inter- and intrarater reliability between

examiners were validated with the interrater correlation coefficient (ICC) (0.81; p<0.001 and

0.98; p<0.001 respectively) (Shrout & Fleiss, 1979).

Examiners following the Radike criteria with modifications established prevalence

(untreated and restored lesions and untreated dental caries) (Radike, 1968). Artificial light and

non-magnifying mirrors were used to perform visual assessments similar to methods used in

NHANES(3). Unlike NHANES, restrictions placed by the funding agency disallowed the use of
 RUNNING HEADER: Theoretical Model for Oral Screenings 4

compressed air and explorers. However, when comparing studies using visual methods without

probe and drying to studies using visual/tactile methods with explorers and compressed air, only

in groups with low caries prevalence were statistical differences observed (Assaf et al, 2007). As

with NHANES, severity was determined using DMFT indices developed by Klein, Palmer and

Knutson (1938). Prevalence and severity of caries, along with prevalence of dental sealants,

were compared to NHANES data (HHS, 2007). The oral screening initiative procedural manual

detailed all diagnostic and coding criteria.

Face-to-Face Interviews

Trained interviewers collected demographic and oral health status information through

face-to-face interviews in the privacy of the mobile clinic setting. Selected self-reported

information identified behaviors, health history, and environmental factors of interest.

Cronbach’s alpha was used to assess internal reliability of the questionnaire (r= 0.79, p<0.001)

(Black, 2005).

Selection of Variables

Thirteen factors identified as variables of interest and those cited as significant

modulators of dental caries in the dental literature comprised an initial exploratory analysis.

These included: sex, age, ethnicity, race, locale (metropolitan vs. rural), family history of

diabetes, dental insurance status, environmental smoke exposure, tobacco status (including

cigarettes, cigars, smokeless tobacco, and marijuana), socioeconomic status (SES), living in an

area with or without fluoridated water, applied dental sealants, and overweight status.

Operational Definitions of Select Variables.

Body Mass Index (BMI) has been correlated with direct measures of body fat and

considered an alternative for direct anthropometric measures of body composition for large
 RUNNING HEADER: Theoretical Model for Oral Screenings 5

group screenings of adolescents (Mei et al., 2002). Overweight status was assessed using a

visual BMI risk

Demographic Characteristics.

Gender.

This study included an equal proportion of males and females (49.2% male; 53.2%

female), with the majority being non-Hispanic (62.4%), non-smokers (87.9%) with dental

insurance (68.24%) who resided in metropolitan areas (75.7%).

Income.

Each year all middle and high schools located in the 17 Nevada school districts are

invited to participate in this oral health screening initiative. In this 2005/2006 academic year,

about one-fourth of all eligible schools (N=50) participated. The majority of those schools

represented children of moderate (55.6%) to high SES status (34.7%). Although invited, 9.1%

of the schools located in lower SES geographic areas participated, which represented a small

portion of those eligible. Table 1 details demographics.

Caries Prevalence and Severity

Participants had an overall mean DMFT of 2.79 (SD=3.21). Study participants presented

with higher prevalence of untreated decay (D-score) and greater mean DMFT indices than what

was reported in NHANES 1999-2004 (HHS, 2007), (Table 2).

Ten of the thirteen variables contributed significantly to DMFT indices (F=98.752,

p=0.0008; R2=0.414) (Table 3). After eliminating SES, ethnicity and family history of Diabetes,

a second analysis confirmed these statistical findings (F=117.617, p<0.0006). The R2 of 0.397

(Adjusted R2=0.395) indicated approximately 40% of the variables combined contributed to

DMFT indices. Beta coefficients placed water fluoridation, exposure to environmental smoke,
 RUNNING HEADER: Theoretical Model for Oral Screenings 6

race, age, and locale as the strongest contributors, respectively. Tobacco use, sex, dental

insurance status, overweight status, and sealants were also significant, but to a lesser extent.

Multivariate logistic regression (F=72.699, p<0.001) was used to calculate OR

(Referent: DMFT<2.6) for each of the ten variables using the Wald statistic to confirm

significance of each variable and Chi-Square to validate the model’s goodness-of-fit (χ =

2

participants.172, p=0.0009) (Table 4).

Discussion

This study confirmed that dental caries remains a common chronic disease among

Nevada youth, presenting higher prevalence rates and greater mean DMFT indices than the

national average (Table 2). Because this sample was assessed using a modified protocol, data for

this study may be an underestimate of caries prevalence and severity compared to NHANES(3).

Ten factors combined contributed to 40% of the variance in DMFT indices in this state sample.

These included (in hierarchal order) exposure to fluoridated water, exposure to environmental

smoke, race, age, locale, smoking status, overweight status, dental insurance status, sex, and

sealant score. Dental professionals should consider these factors when assessing patients’ risk

for future dental caries, when developing educational programs, and/or when designing and

implementing oral health interventions.

Conclusion

All papers should include a summary of the paper.

RUNNING HEADER: Theoretical Model for Oral Screenings 10

References

Assaf, A. V., Meneghim, M. C., Zanin, L., Mialhe, F. L., Pereira, A. C., & Ambrosano, G. M.

(2004). Assessment of different methods for diagnosing dental caries in epidemiological

surveys. Community Dentistry and Oral Epidemiology, 32, 418–25.

Black, T. (2005). Doing Quantitative Research in the Social Sciences. An Integrated Approach

to Research Design, Measurement and Statistics. Thousand Oaks, CA, Sage Publications

Ltd.

Kiess, W., Galler, A., Reich, A., Müller, G., Kapellen, T., Deutscher, J. K... Kratzsch, J. (2001).

Clinical aspects of obesity in childhood and adolescence, Obesity Reviews, 2(1), 29.

Klein, H., Palmer, C. E., & Knutson, J. W. (1938). Studies on dental caries. Dental status and

dental needs of elementary school children. Pubic Health Reports, 53, 751-765.

Mei, Z., Grummer-Strawn, L. M., Pietrobelli, A., Goulding, A., Goran, M. I., & Dietz W. H.

(2002). Validity of body mass index compared with other body-composition screening

indexes for the assessment of body fatness in children and adolescents. American

Journal of Clinical Nutrition, 7(6), 978-985.

Office of the Surgeon General [OSG]. (2005). Oral Health 2000: Facts and Figures.

[monograph on the Internet]. U.S. Department of Health and Human Services’

Resource Library. Retrieved May 2, 2009, from:

http://www.cdc.gov/OralHealth/factsheets/sgr2000-fs1.htm.

Peterson, P. E., Bourgeois, D., Ogawa, H., Estupinan-Day, S., & Ndiaye, C. (2005). The global

burden of oral diseases and risks to oral health. Bulletin of the World Health

Organization, 83(9), 661-669.

Radike, A. W. (1968). Criteria for diagnosing dental caries. In: Proceedings of the Conference
RUNNING HEADER: Theoretical Model for Oral Screenings 11

on the Clinical Testing of Cariostatic Agents. Chicago, IL: American Dental Association,

pp. 87-88.

Reisine, S. T. & Psoter, W. (2001). Socioeconomic status and selected behavioral determinants

as risk factors for dental caries. Journal of Dental Education, 65,1009–1016.

Reid, B. C, Hyman, J. J., & Macek, M. D. (2004). Race/ethnicity and untreated dental caries: the

impact of material and behavioral factors. Community Dentistry and Oral Epidemiology,

32, 329–36.

Shrout, P. E. & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability.

Psychological Bulletin, 86, 420-428.

U.S. Department of Health and Human Services [HHS]. (2007). Trends in Oral Health Status:

United States, 1988-1944 and 1999 to 2004. Preliminary Report. Vital and Health

Statistics, 11(248). (DHHS Publication No. (PHS) 2007-1698).Washington, DC: U.S.

Government Printing Office.

RUNNING HEADER: Theoretical Model for Oral Screenings 12

Table 1.

Demographic and Mean DMFT Scores

Variable Demographic Data DMFT Scores**

% Mean (SD)
(n= 9202)
Sex
Male 52.8% 2.67 (3.18)
Female 47.2% 2.91 (3.23)
Age
13 1.5% 2.92 (2.97)
14 39.3% 2.41 (2.85)
15 30.3% 2.51 (3.04)
16 15.0% 3.26 (2.46)
17 10.4% 3.84 (2.84)
18 3.6% 4.36 (3.99)
Ethnicity
Hispanic 27.8% 2.59 (3.27)
Non-Hispanic 62.4% 3.25 (3.14)
Race*
Caucasian 53.2% 2.47 (3.08)
African American 9.2% 2.99 (3.29)
Asian/Pacific Islander 7.2% 2.84 (3.27)
Native American 2.2% 3.74 (3.59)
Locale
Metro 75.7% 2.70 (3.11)
Rural 24.3% 3.08 (3.50)
BMI Risk
Unlikely 87.4% 2.73 (3.17)
Possible 11.0% 3.19 (3.46)
High 0.8% 2.76 (2.93)
RUNNING HEADER: Theoretical Model for Oral Screenings 13

Table 1 (cont.).
Demographic and Mean DMFT Scores
Variable Demographic Data DMFT Scores**
% Mean (SD)
(n= 9202)
Insured
Yes 68.2% 2.75 (3.21)
No 13.6% 3.23 (3.40)
Not Sure 18.1% 2.63 (3.02)
Self-reported Diabetes History
No 57.9% 2.70 (3.157)
Yes 35.9% 2.87 (3.27)
Not Sure 5.8% 3.09 (3.30)
Tobacco Use
Use Tobacco 10.7% 3.45 (3.60)
Do Not Use Tobacco 87.9% 2.70 (3.14)
Environmental Smoke Exposure
Exposed 32.9% 3.30 (3.50)
Not Exposed 66.9% 2.55 (3.03)
Municipal Water Fluoridation
Clark County Residents 52.8% 2.53 (2.90)
Outside Clark County 47.2% 3.09 (3.50)
Socioeconomic Status (SES)
High SES 34.7% 2.65 (3.15)
Moderate SES 55.6% 2.86 (3.26)
Low SES 9.1% 2.91 (3.17)
Sealants
Sealants Applied 49.7% 3.43 (3.57)
No Sealants Applied 50.3% 2.15 (2.66)
Note. Some percentages do not equal 100% due to missing data. *Race categories are those
used within the oral health screening initiative. ** DMFT scores calculated using number of
decayed, missing, and filled permanent teeth (DMFT) proposed by Klein, et al. (1938).
 RUNNING HEADER: Theoretical Model for Oral Screenings 14

Table 2.

Comparison of Nevada Oral Health Screening Initiative Data to NHANES (1999-2004)

Nevada Oral Health Screening Initiative NHANES (1999-2004)

Variable Decay DMFT Sealants Variable Decay** DMFT Sealants

% (SE) Mean (SE) % (SE) % (SE) Mean (SE) % (SE)

Age Age

13-15 28.4% (1.22) 2.46 (0.03) 49.6% (0.63) 12-15 16.91% (0.99) 1.78 (0.08) 41.04% (1.83)

16-18 38.0% (1.48) 3.60 (0.07) 50.0% (1.10) 16-19 22.24% (1.45) 3.31 (0.09) 34.28% (1.70)

Sex Sex

Males 29.2% (1.03) 2.67 (0.05) 51.1% (0.82) Males 19.89% (1.22) 2.31 (0.09) 36.43% (1.65)

Females 31.0% (1.31) 2.91 (0.05) 48.3% (1.12) Females 19.31% (1.30) 2.79 (0.08) 38.93% (1.51)

Race/Eth* Race/Eth

White, NH 26.4% (1.26) 2.64 (0.05) 58.4% (1.57) White, NH 16.22% (1.45) 2.54 (0.10) 43.90% (1.81)

Black, NH 36.1% (1.74) 2.91 (0.12) 27.4% (1.22) Black, NH 25.66% (1.39) 2.20 (0.10) 25.68% (2.01)

Hispanic 37.5% (1.42) 3.25 (0.06) 37.7% (1.85) Hispanic 28.57% (1.54) 2.82 (0.13) 27.23% (2.34)

Note. Nevada Data: N=9202; *N=8participants0 due to missing data; **Untreated Caries
NHANES (1999-2004) estimates are adjusted to the US 2000 standard population (HHS, 2007);
SE= Standard Error.
Instructions: (1) Using the flow chart, circle one appropriate response for each variable; (2) Add numbers from those circled in the
column on the right hand side; (3) Using the risk category score criteria, determine the appropriate risk category for the patient. RISK
CRITERIA: Low Risk: < 2.6; Moderate Risk: 2.7 – 4.4; High Risk: > 4.5 (1).

NO RISK Variable RISK SCORE

(Based on referent) (Based on Odds Ratios)

Lives in Clark County Fluoridation Does not live in Clark County

0 Water Supply 1.1

No exposure to environ. smoke Environ. Exposed to environ. smoke

0 Smoke Exp. 0.73
African American
0.62
Caucasian Asian/PI
0 Race 0.81
Native American
0.87
Between 13-15 years of age Between 16-18 years of age
0 Age 0.44

Live in metropolitan area Lives in rural area

0 Locale 0.97

Do no use tobacco products Uses tobacco products

0 Tobacco Use 0.88

Possible Risk
0.61
Unlikely Risk
BMI Risk
0 High Risk
0.77

Has dental insurance Does not have dental insurance

0 Insurance 0.44
Status

Male Female
0 Sex 0.84

Have dental sealants Does not have dental sealants

0 Sealant Score 0.67

Total Risk Score: ____________

Figure 1. Theoretical Screening Tool to Assess Caries Risk in Nevada
Youth (based on Odds Ratios of high risk participants)