ASTHO Style Guide

At ASTHO, one aspect of our mission is communicating with a consistent voice to our members, colleagues, partners, funders, and other key stakeholders. Any document you write for internal or external use represents ASTHO, and this guide will help you apply a uniform style to ASTHO’s written materials. Editorial style includes:

• The consistent use of spelling, punctuation, capitalization, numbers, and abbreviations.
• Guidelines for the structure of sentences.
• Alternatives to jargon.

Following the guidelines in this manual will help ensure clarity and consistency in any type of document. For items not covered in this style guide, please refer to the rules contained in The Associated Press Stylebook.

Always use active voice when writing ASTHO products. Writing in active voice creates a concise, clear voice that communicates information efficiently. In active voice, the subject performs the action expressed. For example: “State health agencies improve the health of populations.” In this sentence, the subject, state health agencies, performs the action, improve. In passive voice, the subject is the receiver of the action. The above sentence in passive form would be: “Improving the health of populations is done by state health agencies.” Some more examples of active versus passive voice include:

• Active: Anne Zink (SHO-AK) led a vaccination campaign.
• Passive: A vaccination campaign was led by Anne Zink (SHO-AK).
• Active: ASTHO updated its employee handbook.
• Passive: The employee handbook was updated by ASTHO.

For more information on active versus passive voice, see Purdue University’s online writing lab page.

Below are stylization guidelines for terms frequently used in ASTHO products. For convenience, the terms are listed in order of the frequency in which they typically appear in our content.

Organizational References

Spell out the full name of the association on first mention when writing for external-facing products. Use the acronym when mentioned again.

First reference: Association of State and Territorial Health Officials (ASTHO)
Second reference: ASTHO

Referring to State and Territorial Health Officials

S/THOs is the acronym for state and territorial health officials. SHO is the acronym for state health official, and THO is the acronym for territorial health official. When writing S/THO, always include the slash.

In some instances, it is appropriate to use “SHO” or “THO” as a shorthand way of referencing ASTHO members and the jurisdiction they represent. Typically, we use this approach in targeted communications, such as the Public Health Weekly newsletter, or for internal documents.

Example from Public Health Weekly

• The Washington Post quoted Sonia Angell (SHO-CA) in an article about California’s rising STD rates. (January 2020)

States use different terms—such as “acting” or “interim”—to refer to temporary positions. The term “designee” generally indicates a permanent role, as appointed by a S/THO. We defer to referencing an agency’s lead (e.g., Nilesh Kalyanaraman (SHO Designee-MD), Jennifer Cunico (Acting SHO-AZ)). Check for the latest updates in ASTHO’s membership directory.

Former state and territorial health officials should be referred to as alumni, even when referring to individuals (e.g., Ed Ehlinger (alumni–MN)).

In press releases and communications intended for a broader external audience, ASTHO is generally inclusive and uses the term, “state and territorial health officials.” However, if referencing a single member, write out “state health official” or “territorial health official.”

Referring to States, Territories, and Freely Associated States

ASTHO aims to be inclusive of the relationship between our member jurisdictions and the United States. While the ASTHO name specifically references state and territorial health officials, some of our members represent jurisdictions that are neither states nor territories. Specifically, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are freely associated states.

Accordingly, we encourage staff to reference states, territories, and freely associated states in publications.

Gudiance

• When referencing ASTHO members, refer to state, territorial, and freely associated state health officials. Another acceptable option is “health officials from states, territories, and freely associated states.”
• In external products, refer to state, territorial, and freely associated state health agencies over state and territorial health agencies.
• For clarity, avoid using the term “island jurisdictions” on first reference to territories and freely associated states. Use the full “territories and freely associated states” terminology and, if space allows, explain that we may collectively refer to these areas as “island jurisdictions.” We want our initial terminology choices to be clear for a range of readers.

After first using the states, territories, and freely associated states terminology, the following options can also be used to describe non-state jurisdictions:

• Pacific and Atlantic jurisdictions.
• Island areas or island jurisdictions.
• Territories and freely associated states (T/FAS).
• For the Pacific: U.S.-Affiliated Pacific Islands (USAPIs).

View Appendix B: Referring to States, Territories, and Freely Associated States for additional guidance.

Academic Degrees, Licensures, and Certifications

To keep phrasing consistent and concise, only list an individual’s academic degrees, professional licensures, and certifications in signatures and author by-lines. Only use acronyms without periods: MD, MPH, RN, PhD, MS, MBA, DDS, DO. Do not use the prefixes “Dr.” or “Doctor,” instead use MD or PhD after an individual’s name as appropriate, using commas to separate credentials. Example: Joneigh Khaldun, MD, MPH.

Places and Regions

Do not abbreviate United States when it is used as a noun. Use U.S. only as an adjective.

• The U.S. population is growing.
• Influenza places a substantial burden on the U.S. healthcare system. Influenza vaccination is recommended annually in the United States for all people six months and older.

Washington, D.C. (using comma and periods) is preferred over District of Columbia.

In general, lowercase north, south, west, and east when they indicate a compass direction. Capitalize these words when they designate regions.

• He traveled east to visit family for the holidays.
• The northwestern region of the state is known for its wineries.
• The grantees all reside in the South.

States

Spell out state names when they stand alone, even when they are in a list. The only times you should use a state abbreviation is when listing a public official’s state affiliation (e.g., Steven Stack (SHO–KY)) or when the state follows a city name.

Cities

When a city name precedes a state name, abbreviate the state using the postal code abbreviation.

Example:

• The childhood immunization clinics in Kansas City, MO, provide a range of healthcare services.

Major American Cities

Generally, you can reference the following cities without listing the states in which they are located:

• Atlanta
• Austin
• Baltimore
• Boston
• Chicago
• Cincinnati
• Cleveland
• Dallas
• Denver
• Detroit
• Honolulu
• Houston
• Indianapolis
• Las Vegas
• Los Angeles
• Miami
• Milwaukee
• Minneapolis
• New Orleans
• New York City
• Oklahoma City
• Philadelphia
• Phoenix
• Pittsburgh
• St. Louis
• Salt Lake City
• San Antonio
• San Diego
• San Francisco
• Seattle

Miscellaneous

• Use New York state (lowercase “s”) to distinguish the state from New York City.
• Use Washington state to differentiate the state name from the United States’ capital city, Washington, D.C.

Race and Ethnicity

Capitalize references to race and ethnicity, e.g., Black, Brown, Indigenous, White, Hispanic, or Asian. The preference for “Latino/a” or “Hispanic” is varied and can be different across regions. Consider checking with state or territorial members or stakeholders to inform term usage for a particular resource.

Writing on race and race-related issues requires thoughtfulness and precise use of language. When in doubt, consult with your senior director, vice president, or ASTHO’s Content Development team to inform terminology choices. For more guidance on using equitable language when writing on race, see Appendix A: Communicating with a Health Equity Approach.

Person-Focused Language

Person-centered language is similar to person-first language and allows for flexibility based on how people self-identify. As a general rule, person-focused language refers to an individual’s humanity before referencing a condition they are living with. Examples for implementation:

• Use “people who misuse substances” instead of “addict” or “drug users.”
• Use “people experiencing homelessness” instead of “homeless people.”

For more information on person-centered language, see Appendix A: Communicating with A Health Equity Approach.

Diseases

As a rule of thumb, diseases are neither capitalized nor italicized. However, in the case of diseases that contain a proper noun, that noun is capitalized. There are two exceptions to this rule:

• Diseases that are referred to by their acronym, e.g., HIV/AIDS.
• International scientific names for orders, families, subfamilies, and genera.

Proper Disease Stylization Examples

• syphilis
• cholera
• dengue fever
• West Nile virus
• Zika virus
• Lyme disease
• Type 1 diabetes, Type 2 diabetes

Capacity Building and Technical Assistance (CB/TA) Products

The titles of ASTHO CB/TA product categories should be stylized in the following ways:

• ASTHOBriefs
• ASTHOReports
• ASTHOConnects
• ASTHOExperts
• ASTHOLearning Opportunities
• ASTHOStat
• ASTHOToolkit
• Project ECHO

When referring to a single CB/TA product, make it singular. For example:

• Your ASTHOBrief is ready for posting.
• Our latest ASTHOReport was shared widely among CDC staff.

ASTHOConnects Online Stylization

When promoting an ASTHOConnects on the events page of ASTHO’s website, refer to the event as a webinar in the official posting title. This is to ensure site visitors who are not familiar with ASTHO’s product categories understand the format of the event.

CORRECT: “Webinar: Emerging Strategies to Address Opioid Misuse”
INCORRECT: “ASTHOConnect: Emerging Strategies to Address Opioid Misuse”

Other Commonly Used Terms

Please use the spellings of the common terms shown below to maintain consistency in ASTHO documents.

Administration (capitalized when referring to a political administration (e.g., the Biden Administration, the Administration))

bi-monthly

capacity building (n.) / capacity-building (adj.)

• ASTHO improves public health through capacity building and technical assistance
• ASTHO provides capacity-building services.

decision-maker (n.) / decision-making (n.) / decision-making (adj.)

• Noun: The board’s president is the decision-maker.
• Noun: All board members have a role in decision-making.
• Adjective: The board engaged in a lengthy decision-making process.

email

evidence base (n.) / evidence-based (adj.)

• The evidence base supporting these interventions is growing.
• ASTHO promotes evidence-based interventions.

factsheet

healthcare (one word)

hepatitis A, hepatitis B, hepatitis C

HIV/AIDS

i.e., (use in place of that is or in other words with a comma)

internet (lowercase)

my.ASTHO

nonpartisan

nonprofit

toolkit

web page

website

zipcode

Boilerplate Funding Acknowledgment Language

For products where the funder has expressed interest in being acknowledged, you may use the suggested language below. Please contact ASTHO’s contracts/grants teams with any project-specific questions.

“This work was supported by [Grant or Cooperative Agreement] Number [Number], funded by [Funder]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of [Funder].”

Example: “This work was supported by Cooperative Agreement Number OT18-1802.NU38, funded by CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.”

For more guidance, refer to Appendix C: Funding Acknowledgement Policy.

Titles and Organization Names

Capitalize and spell out formal titles (e.g., executive director, president, chief medical officer) only when they precede a name:

• ASTHO President Nirav Shah delivered the keynote speech.

Titles (including job titles) are lowercase when they follow a name or are used alone. This follows contemporary style and avoids pileups of capital letters.

Examples:

• Michael Fraser is the chief executive officer of ASTHO.
• Alternatively: Michael Fraser is ASTHO’s chief executive officer.
• Steven Stack is the president-elect of ASTHO.

Use last names after the first reference to a complete name.

• Nirav Shah is ASTHO’s president. Shah announced the new policy.

Exception: Capitalizing Titles (Running vs. Standalone Text)

In narrative (i.e., paragraph style) writing, use the rules above and lowercase job titles (i.e., director of state health policy, chief of government affairs, maternal and child health analyst, infectious disease program manager).

• Example: In this webinar, Steven Stack (SHO-KY), commissioner for public health and chief medical officer for the Commonwealth of Kentucky, will discuss how to prevent adverse childhood experiences.
• In standalone text (such as next to photos), capitalize job titles.
• Example:

  
  
  Steven J. Stack, MD, MBA
  Commissioner for Public Health

Referring to Health Departments

Capitalize the full, formal name of the health department (e.g., Nebraska Department of Health and Human Services). Do not capitalize parts of the name (e.g., department, department of health) when used in general statements.

Examples:

• The Nebraska Department of Health and Human Services received a $2 million grant to address the opioid crisis. The department will use the funds to increase access to naloxone.
• In Nebraska, the department of health received funding to address the opioid crisis.
• Nebraska’s health department is using a $2 million grant to address the opioid crisis.

When abbreviating health department names, use the abbreviation recognized and used by the state or territory (e.g., “DHHS”).

Elected or Appointed Officials

When identifying an elected official, lowercase the title except when it directly precedes their name. Use the abbreviation Gov. only when referring to governors by a proper name. Otherwise, lowercase “governor.” Use Rep., Reps., Sen. and Sens. as formal titles before one or more names. Spell out and lowercase representative and senator in other uses. Always list an elected official’s state affiliation, but only list their party affiliation if it’s relevant to a policy stance they are taking. Examples:

CORRECT:

• Abraham Lincoln, the president of the United States, was from Illinois. Before entering politics, President Lincoln was an attorney.
• Gov. Phil Murphy (D-NJ) promised to make healthcare in New Jersey more affordable.
• The governor attended the NCAA Tournament basketball game.
• Of all the senators in Congress, Sen. Bill Cassidy of Louisiana is the only gastroenterologist.

“Acting” should be treated as a part of the formal title.

• Acting Assistant Secretary Steven Wagner previously served as director of the anti-human trafficking program.
• Steven Wagner, former acting assistant secretary of the HHS Administration for Children and Families, previously served as director of the anti-human trafficking program.

Acronyms

Avoid introducing acronyms unless they will be frequently repeated and are important for the reader to know. Spell out the full name on first reference, followed by the acronym in parentheses. After that, use the acronym alone.

• Only list an acronym if the term is used more than twice in the document. If a second reference closely follows first, and the organization will not be mentioned again, consider using second-reference shorthand instead, such as “the center” or “the department.”
• Do not use periods in acronyms.
• Do not insert “the” before acronyms.

Example:

• The American Academy of Pediatrics (AAP) was founded in 1930. Since then, AAP has supported healthcare professionals, scholars, and others interested in child health issues and pediatric medicine.

Certain widely recognized abbreviations and acronyms may be used without spelling them out first: APHA, CDC, EPA, FDA, FEMA, HHS, HRSA, NACCHO, NIH, USDA.

An exception to this rule may occur when writing formal letters to Congress or a presidential administration. Please consult with ASTHO’s government affairs team for additional guidance on official government correspondence.

Times and Dates

Times

In general, use figures. Use a colon to separate hours from minutes. It is acceptable to refer to 12 a.m. as midnight and to 12 p.m. as noon. When listing time zones, do not specify daylight saving time versus standard time; use only “ET,” “CT,” “MT,” “PT,” etc.

Examples:

• She arrived to the convening at 3:30 p.m. ET.
• The board scheduled the meeting at noon.

Use lowercase letters and use periods in a.m. and p.m. Use a space in between the number and a.m. or p.m.

INCORRECT: 5:30 PM, 5:30 pm, 5:30pm, 5:30p.m.
CORRECT: 5:30 p.m. ET or 4:30-5 p.m. ET

For time “on the hour,” do not use zeroes to denote minutes. When listing a range of times, use a hyphen in between the times. Do not insert a space before or after the hyphen.

INCORRECT: 2:00 - 3:00 p.m. ET
CORRECT: 2-3 p.m. ET or 2-3:30 p.m. ET

Dates

Use figures without st, nd, rd, or th. When a phrase refers to a month and day within the current year, do not include the year.

INCORRECT: Registration for the conference begins on May 15th.
CORRECT: Registration for the conference begins on May 15.

Use en dashes (–) when listing a range of dates.

Examples:

• Oct. 20 – 21
• May 22 – June 1, 2020

Days

Capitalize days of the week and do not abbreviate them.

• The event on Thursday, Dec. 20 attracted several new business partners.

When a phrase refers to a month, day, and year, use commas to separate the year.

• The event on Jan. 20, 2020 attracted several new business partners.

Months

Certain months are spelled out in all cases: March, April, May, June, July.

The remaining months should be abbreviated (Jan., Feb., Aug., Sept., Oct., Nov., Dec.) only when they are used with a specific date.

Examples:

• ASTHO was incorporated on March 23, 1942.
• The commissioner was sworn into office on Sept. 5, 2017.
• World AIDS Day is observed on Dec. 1.
• World No Tobacco Day is observed on May 31.

Spell out all names of months when they stand alone or appear only with a year.

• The campaign will run from May to December.
• January 2018 was a cold month.

Years

Use an s without an apostrophe to indicate spans of decades or centuries.

• The 1920s
• The 1800s

Include each entire year when describing a range.

INCORRECT: 2014 – 15
CORRECT: 2014 – 2015

Numbers

Spell out numbers from one to nine. Use numerals for 10 and above. Exceptions to this rule are addresses, percentages, and dimensions or measurements, which always use numerals. Write out first through ninth (instead or writing 1st or 9th, for example), and use numerals thereafter. Do not begin a sentence with a numeral, except for years.

Examples:

• Six hundred people volunteered at the health fair.
• 2018 was a profitable year.

Percentages

Use the numeral and % sign in all copy.

Examples:

• Results showed that 48% prefer blue and 12% prefer orange.
• Twelve participants (52.2%) shared feedback via phone and 11 participants (46.8%) completed a web-based survey.

Fractions

Spell out fractions in text, using hyphens between the words.

Examples:

• One-quarter of the department’s staff will be eligible for retirement by 2020.
• Taxpayers funded nearly two-thirds of all U.S. health expenditures in 2013.

Phone Numbers

When including a phone number in print or online, do not use parentheses around the area code. Use hyphens between all segments of the number.

Example:

202-371-9090

Money

When writing dollar amounts, do not use decimals or zeros for whole dollar amounts.

INCORRECT: $45.00
CORRECT: $45

Italics and Underline

Italics

Use italics for titles of books, journals, webinars, magazines, newspapers, and movies.

• The Washington Post published an article on newborn screening.
• The photos in National Geographic depicted global public health issues.

Use quotation marks to designate titles of chapters, short stories, or magazine or journal articles.

• His article titled “Appropriate Medication for Pediatric Patients” appeared in the Journal of Pediatrics.

Use italics for foreign words and phrases not listed in English-language dictionaries: c’est la vie.

Scientific Nomenclature

Formal scientific names of biological orders, families, subfamilies, and genera are printed in italic type: Escherichia coli or E. coli, Chlamydia trachomatis, Mycobacterium tuberculosis.

Underline

Do not underline. This formatting treatment should be used only for hyperlinks.

Capitalization

Capitalize the full names of organizations, institutions, and groups. Use lowercase when the organization, institution, or group is referenced without the formal name.

Example:

• The American Medical Association is one of the most widely recognized associations in the healthcare industry. Members of the association include physicians who are dedicated to the health of America.

Capitalize common nouns when they are part of the full name for a person, place, or thing. Use lowercase when these nouns are used alone.

Email Addresses

Do not use uppercase letters in URLs or email addresses.

INCORRECT: www.ASTHO.org
CORRECT: www.astho.org

INCORRECT: JohnDoe@astho.org
CORRECT: johndoe@astho.org

Titles

ASTHO uses AP style for title capitalizations. Consider using the free Capitalize My Title tool to check compliance.

Examples:

• Public Health Is All Around You
• Ohio Department of Health Collaborates With Partners To Address Health Disparities
• Florida Health Officials and Informatics Experts Assess Meaningful Use
• Nevada’s Infants-at-Work Program Generates Greater Productivity

When referring to the title of a publication, use “titled” rather than “entitled,” which means having a right to do or have something.

CORRECT: The article was titled, “Calculating State-Level Estimates of Upcoming Older Adult Health Needs.”

Seasons

Lowercase spring, summer, fall, and winter.

• The health official was appointed in spring 2019.

Ampersand (&)

ASTHO discourages use of the ampersand. Spell out “and” instead. Use this symbol only if it is part of an official title or company name.

Apostrophes

Apostrophes are used to show possession. Most singular nouns take a simple ’s.

• The researcher’s methods have been validated.
• The president’s speech was insightful.

With plural nouns ending in s, add only an apostrophe.

• The new funding supported the states’ tobacco regulations.

With plural nouns not ending in s, add ’s.

• State legislatures appear divided on women’s health issues.
• The alumni’s contributions are greatly appreciated.

Apostrophes are not used with figures, with plurals of acronyms, or with multiple letters.

• Interest rates were high in the 1980s.
• Temperatures will be in the 60s.

Commas

ASTHO uses serial commas.

• My class will visit the park, zoo, or museum.
• The team traveled to Guam, Hawaii, and Puerto Rico.

Do not use a comma before Jr., Sr., etc.

• Martin Luther King Jr. was a minister and civil rights activist.

Colons, Semicolons, and Periods

Colons

Colons introduce a list or a series of ideas:

• Before the hurricane, the clinic collected many essential supplies: bottled water, cooking fuel, canned food, clothes, and blankets.

Capitalize the first word after a colon if it is followed by a proper noun or is a complete sentence. Otherwise, use lowercase.

• The focus of the proposal is simple: Ensure that all children have access to healthcare.
• He had only one objective: winning.

Semicolons

Semicolons represent a stronger break between clauses or greater separation of thought than a comma can convey.

• He reviewed the grant proposal; it was lacking essential information.
• In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths; the rate of opioid overdoses has tripled since 2000.

Use semicolons to join two independent clauses connected by linking adverbs (e.g., however, accordingly, therefore, instead).

• The meeting date was set; however, the time and location were changed.

Unless necessary for spacing reasons, do not use semicolons to separate items in a series that contains commas. Instead, format the items out as bullet points.

Example

The study focused on:

• Personal protective measures.
• The spread of disease in healthcare facilities, colleges, and universities.
• The impact of mass gatherings.

Periods

Place only one space after a period at the end of a sentence.

Lists

In lists, put a period after each line or statement unless it is a very short item (i.e., one word). Make lists parallel by using the same sentence construction for each item. Do not use semicolons in lists. No and is needed before the last bullet.

Example:

Public health officials are concerned about new challenges to food safety, such as:

• Changes in our food production and supply.
• Environmental threats leading to food contamination.
• New and emerging bacteria, toxins, and antibiotic resistance.

In running text, it is acceptable to use one or two parentheses to enclose numbers marking a division in a list.

• You will qualify for the study if you (1) are 18 years old, (2) meet certain health requirements, and (3) have completed the training.
• You will qualify for the study if you 1) are 18 years old, 2) meet certain health requirements, and 3) have completed the training.

Dashes and Hyphens

Dashes

Em Dash

Use em dashes (—) with no spaces to denote an abrupt change in thought or an emphatic pause.

• We will fly to France in July—that is, if we have enough vacation time.
• The administration offered a plan—it was unprecedented—to reform the healthcare system.

En Dash

The en dash is longer than a hyphen (-) but shorter than an em dash (—).

Use en dashes to separate months or years in a range of time. Include a space around the dash. Do not use a hyphen.

• 2018 – 2019
• April – August 2019

Hyphens

As a rule, hyphens (-) join words, but do not separate phrases or ideas.

• peer-review process
• fourth- and fifth-graders

Generally, compound nouns do not need a hyphen; compound adjectives do.

• Noun: CDC tracks the spread of flu in real time.
• Adjective: Real-time analysis helps public health officials prevent the spread of flu.

e.g. and i.e.

Follow each with a comma and do not italicize.

• e.g. stands for “for example.”
• i.e. means “that is,” “namely,” or “in other words.”

Quotation Marks

Periods and commas should be placed inside quotation marks.

• “We urge Congress to provide additional funding for treatment services and evidence-based public health interventions to prevent substance misuse in the first place,” says Michael Fraser, ASTHO’s chief executive officer.

Colons or semicolons should be placed outside quotation marks.

• Princeton economists Anne Case and Angus Deaton first pointed out this disturbing trend in a 2015 study that highlighted three “diseases of despair”: drugs, drinking, and suicide.

Question marks can go inside or outside of quotes, depending on meaning.

• The professor asked the class, “How many people are familiar with this study?”
• Was it Benjamin Franklin who said, “Don’t put off tomorrow what you can do today”?

Hyperlinks

Proper link text gives users a description of the page that will load, allowing them to make informed decisions about which path to take. Bad link text, such as nondescriptive “click here” links, forces the user to follow the link to learn its destination. According to the World Wide Web Consortium, when linking text, authors should use brief but meaningful link text that:

• Provides some information when read out of context.
• Explains what the link offers.
• Is not a verb phrase.

Below are examples and guidance to ensure ASTHO documents contain descriptive hyperlinks:

• Needs improvement: Details about ASTHO’s Health Equity Summit are available here.
• Better: Details about ASTHO’s Health Equity Summit are now available.

Try to link on titles or descriptive text instead of action words:

• Needs improvement: This report, “Trends in Reported Vector-Borne Disease Cases—United States and Territories, 2004 – 2016,” examines the transmission dynamics of tickborne and mosquito-borne diseases.
• Better: The report, “Trends in Reported Vector-Borne Disease Cases—United States and Territories, 2004 – 2016,” examines the transmission dynamics of tickborne and mosquito-borne diseases.
• Also acceptable: The report examines the transmission dynamics of tickborne and mosquito-borne diseases.
• Consistent exception: Policy and legislation documents. Health Policy Update blog posts, for example, frequently reference individual state-level bills. In these cases link either the applicable state’s name or the bill number (preferred).

When hyperlinking multiple items in one statement, the following format is acceptable:

• CDC developed toolkits with sample social media posts related to arthritis, breast cancer, and diabetes.

If the material will be shared electronically, avoid using a URL as link text. Instead, use the page title or a description of the page.

• Needs Improvement: Go to ncsddc.org for more information.
• Better: Visit the NCSDDC website for more information.

If the material will be shared in print form, write out the full URL with a period at the end. Do not include “http://” or “www.” at the beginning.

Example:

• CDC released new data on illnesses from mosquito, tick, and flea bites. More information is available at: www.cdc.gov/media/releases/2018/p0501-vs-vector-borne.html.

Endnotes

Use endnotes to cite publications in your work. Endnotes appear at the end of your document. To properly format endnotes, do the following:

• Using the endnotes function in Microsoft Word, number your citations in the order in which they appear within the text. Use only Arabic numerals for endnotes, not roman numerals.
• Use Arabic numerals outside periods and commas, and inside colons and semicolons.
• There should not be any spaces between the superscript numeral/asterisk and the word or punctuation mark preceding it.
• In listed references, the names of all authors should be given. If there are more than six authors, only list the first three, followed by “et al.” Do not use and between names. Authors’ last names come first, and use only initials for first and middle names. Do not use periods between initials.
• Abbreviate and italicize names of journals. Use initial capital letters. Abbreviate according to the listing in the PubMed Journals database.
• You can substitute “Ibid” for a citation if you are citing the same source consecutively. Use this only when citing the identical source as the immediately preceding citation.
• If you are citing a document type not listed below, default to the format for website.

Example:

In text

High rates of tobacco use and obesity make cancer and heart disease our nation’s leading causes of death.¹ Only half of individuals with high blood pressure are appropriately treated and less than two-thirds of adults have been screened for colon cancer.^2,3

End of document

1. CDC. “Health, United States 2015.” Available at https://www.cdc.gov/nchs/data/hus/hus15.pdf. Accessed 6-4-2018.
2. Whelton PK, Carey RM. “The 2017 American College of Cardiology/American Heart Association clinical practice guideline for high blood pressure in adults.” JAMA Cardiol. 2018. 3:352-353.  https://jamanetwork.com/journals/jamacardiology/article-abstract/2672947. Accessed 6-4-2018.
3. American Cancer Society. “Colorectal Cancer. Facts and Figures. 2017 – 2019.” https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf. Accessed 6-4-2018.

Footnotes

Use footnotes when you want to provide additional information, explanation, or comments about the text without interrupting the document’s flow. Using the footnotes function in Microsoft Word, insert a Roman numeral immediately after the section you want to explain.

Example:

According to ASTHO’s survey, state health agencies promote population health by directly providing services such as disease treatment, maternal and child health services, and other clinical services.ⁱ

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ⁱ The ASTHO Profile of State and Territorial Public Health is the only comprehensive source of information on state and territorial public health agency activities, structure, and resources.

ASTHO uses the American Medical Association (AMA) Manual of Style for citations. You can use free resources, such as Citation Machine, to generate references according to AMA, or model your end citations after the following examples:

Using Images

When using images for ASTHO publications, they must either be licensed as free for use under agreements such as Creative Commons (CC) licensing or purchased for use by ASTHO through services like Adobe Stock Images. You can utilize filters on Google Images and other search engines to search for CC-licensed photos by going to Usage Rights under the Tools tab. Consult the Content Development team for any graphic needs or guidance.

When using photography from an event, the best practice is to obtain written consent from participants of the event to use their image in materials for publication. Consult the content development or public relations team for guidance.

Health and racial equity are at the core of ASTHO’s mission to support state and territorial health officials (S/THOs). S/THOs and the agencies they lead aim to create conditions for everyone to live in healthy, thriving, prosperous communities without barriers to realizing full health. As such, ASTHO has acknowledged structural racism and racial discrimination as a public health issue that requires specific focus.

Driving progress in health equity requires intentional communication—and communicating effectively begins with applying a health equity lens to our publications. Embedding equity in everything we produce not only enhances the quality of our work but elevates values of inclusivity and respect to our members, partners, stakeholders, and the public.

To guide these efforts, ASTHO uses national standards provided by CDC to promote equity-focused language choices. Specifically, ASTHO endorses the conventions used in CDC’s Health Equity Guiding Principles for Inclusive Communication—a resource created to foster norms of respect, diversity, and equity in public health communications. Staff are encouraged to familiarize themselves with this guide and reference it as an extension of the ASTHO style guide when creating content.

CDC’s Health Equity Guiding Principles for Inclusive Communication

CDC’s Gateway to Health Communication website has a section for Health Equity Guiding Principles for Inclusive Communication. The purpose of this section is to “emphasize the importance of addressing all people inclusively and respectfully. These principles are intended to help public health professionals, particularly health communicators, within and outside of CDC ensure their communication products and strategies adapt to the specific cultural, linguistic, environmental, and historical situation of each population or audience of focus.”

CDC covers the importance of approaching each communication product with a health equity lens and adhering to the document’s Guiding Principles. These principles recommend using person-first language and avoiding terminologies that are offensive, insensitive, or based in historical biases.

The Guiding Principles are:

• Avoid use of adjectives such as vulnerable, marginalized, and high-risk.
• Avoid dehumanizing language. Use person-first language instead.
• Remember that there are many types of subpopulations.
• Avoid saying target, tackle, combat, or other terms with violent connotation when referring to people, groups, or communities.
• Avoid unintentional blaming.¹

Additional CDC Guidance²

CDC encourages all public health professionals and partners at the federal, state, and local levels to apply these principles across their public health communications work, including when creating information resources and presentations, when engaging with partners, and when developing external and internal materials. This means:

• Using a health equity lens when framing information about health disparities.
• Considering the key principles, such as using person-first language and avoiding unintentional blaming.
• Using preferred terms for select population groups while recognizing that there isn’t always agreement on these terms.
• Considering how communications are developed and looking for ways to develop more inclusive health communications products.
• Exploring other resources and references related to health equity communications.

Support

With this appendix, our style guide incorporates clear guidance on how to write using a health equity lens for CBTA products, newsletters, social media, the web, professional development documents, and general organizational publications. As always, the Content Development team can be reached for assistance at contentdevelopment@astho.org.

¹ Gateway to Health Communication: Key Principles

² Health Equity Guiding Principles for Inclusive Communication

ASTHO aims to be inclusive of the formal relationship between our member jurisdictions and the United States. While our ASTHO brand specifically references state and territorial health officials, some of our members represent jurisdictions that are neither states nor territories. Specifically, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau are freely associated states. These jurisdictions are independent nations that have signed a Compact of Free Association with the United States.

Below are guidelines to enhance inclusivity of these jurisdictions in ASTHO products. There will be many situations when, due to our formal name and acronym, we will refer to members and their agencies using the state and territorial nomenclature. As context allows, however, we strongly encourage staff to reference states, territories, and freely associated states in publications.

Guidance

When referencing ASTHO members, refer to state, territorial, and freely associated state health officials. Another acceptable option is health officials from states, territories, and freely associated states.

• In external products, refer to state, territorial, and freely associated state health agencies over state and territorial health agencies.
• For clarity, avoid using the term Island Jurisdictions on first reference to territories and freely associated states. Use the full territories and freely associated states terminology and, if space allows, explain that we may also collectively refer to these areas as Island Jurisdictions. We want our initial terminology choices to be clear for a broad range of readers.

After first using the states, territories, and freely associated states term, the following options can also be used to describe non-state jurisdictions:

• Pacific and Atlantic jurisdictions.
• Island areas or island jurisdictions.
• Territories and freely associated states (T/FAS).
• For the Pacific: U.S.-Affiliated Pacific Islands (USAPIs).

ASTHO seeks to align our publication standards with CDC to enhance uniform public health language choices. Please refer to the CDC Style for Referring to U.S. Territories and Freely Associated States for additional guidance.

We understand that these guiding principles may not directly speak to every publishing scenario you encounter. For questions on the best approach for your product, please contact the content development team.

When required, ASTHO will acknowledge support provided by any funder (federal or non-federal) in public communications or work resulting from the award. This includes, but is not limited to, CBTA products, publications, multimedia products, peer-reviewed journal articles, conference materials, posters, public-facing training materials, webinars, and other internet-based communications. When possible, the funder program officer should be made aware of planned public communication prior to its release. ASTHO’s product landing pages will house acknowledgement statements. Examples of public acknowledgement statements can be found below.

Some funders (e.g., Robert Wood Johnson Foundation) have additional requirements which can be found on the Notice of Award. Please review the Notice of Award for specific acknowledgement policies and requirements.

Templated Acknowledgement Statements

Grant materials, including products, promotional items, and meeting materials, must acknowledge that funder support, whether in whole or in part. That acknowledgment must be accompanied by a disclaimer indicating that information provided and views expressed do not necessarily reflect the official views of the funder. Use of the following language fulfills this requirement.

Publications and Multimedia Products

“This product was supported by [Grant or Cooperative Agreement] Number [Number], funded by [Funder]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of [Funder].”

Conferences and Meetings

“This convening was supported by [Grant or Cooperative Agreement] Number [Number], funded by [Funder]. The views expressed in conference materials and by speakers and moderators do not necessarily reflect the official policies of [funder] nor does mention of trade names, commercial practices, or organizations imply endorsement.”

Sample Acknowledgement Statement

“This video was supported by Cooperative Agreement Number OT18-1802.NU38, funded by CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.”