research paper published fees

Understanding Journal Publication Fees: A Compact Guide

Table of contents.

As someone who works on academic publishing, I often get a popular question, especially from young and aspiring researchers:

The article discusses the cost of publishing in an academic journal, delving into journal publishing models, revenue generation methods of publishers, and why some publishers charge high journal publication fees that deter authors from submitting.

Introduction to Journal Publishing

Academic journal publishing is an essential part of the scholarly communication process. Its primary purpose is disseminating research findings, ideas, and theories to the global community of scholars, researchers, and practitioners.

By publishing their work in academic journals, authors contribute to the existing body of knowledge in their respective fields, stimulate further research, and advance human understanding.

A publisher running a scholarly journal needs to cover operation costs. These costs cover system maintenance (manuscript management system), archiving host, editorial services, editorial remuneration, salary, bills, etc. Institutional academic publishers may get (some) funding, whereas commercial publishers need to fork money to cover the overhead.

The total cost can vary significantly between journals and depending on the chosen publishing model. Where the journal publishing fees are concerned, this financial aspect of journal publishing can influence an author’s decision on where to submit their work.

When considering journal publication fees and cost, it’s crucial to understand its importance, purpose, and associated costs. These costs enable journals to maintain high editorial standards, manage the peer review process, and ensure the work’s accessibility to readers worldwide.

While these costs may sometimes seem high, they’re integral to ensuring the quality, integrity, and accessibility of published research. Therefore, it’s essential for authors to factor them into their publishing decisions.

Understanding Journal Publishing Models

Delving into the world of journal publishing, you’ll encounter two primary models: traditional and open access. Remember that we are probably talking about more than 30,000 academic journals worldwide.

Traditional Publishing Model

The traditional publishing model, which has existed for centuries, operates on a subscription-based system. In this setup, readers or their institutions pay a fee (subscription) to access the content of the journals. The subscription mechanism has been the primary publishing model, but the number continues declining as many have adopted the open access model.

The revenue from these subscriptions covers production costs, peer review management, and distribution. Authors may or may not be charged to publish in these types of journals, but even when they are, the fees are generally lower than those of open access journals.

Open Access Publishing Model

However, there is a catch.

In between the traditional subscription and open access models, there is the hybrid model, in which a journal offers both options.

Impact on Journal Publication Fees

The choice between traditional and open access models fundamentally influences the cost of publishing. As mentioned earlier, traditional publishing often incurs fewer upfront costs for the authors as reader subscriptions primarily cover the expenses.

Ultimately, the decision of where to publish—and thus how much to pay—lies in the hands of researchers and their institutions. It’s a balancing act between affordability, academic recognition, and the desire for research to reach as broad an audience as possible.

Who Do Publishers Incur Journal Publication Fees?

The cost of publishing a research paper often raises eyebrows, especially among first-time authors. You might ask, “Why do I have to pay to share my hard-earned knowledge with others?” The answer lies in the intricate process that your manuscript goes through before it gets published. This process involves several quality control steps, all meticulously managed by the journal.

Peer Review and Editorial Services

The cornerstone of academic publishing is the peer review process. It ensures that the research being circulated is high quality, robust, and contributes to the existing body of knowledge. Organizing a thorough, unbiased peer review is no small task. Journals must engage experts in the relevant field, often multiple, and manage their feedback efficiently to maintain the integrity of the review process.

In addition to peer review, there are other editorial services like copy-editing, proofreading and typesetting. These processes help refine the language, correct errors, and format the manuscript as per the journal’s guidelines. The outcome is a polished, professional-looking article that reflects well on the author and the journal.

System Management and Digital Hosting

Beyond editorial work , journals also shoulder the responsibility of maintaining a stable digital platform for hosting published articles. This includes developing and updating the online submission system, managing the website, and ensuring 24/7 access to their digital archives. These technical aspects require significant ongoing investment.

Maintaining Quality and Integrity

All these processes collectively play a pivotal role in maintaining the quality and integrity of the published work. By paying the publishing fee, you’re essentially contributing to this meticulous system designed to uphold the highest standards of academic integrity. It’s an assurance that experts are scrutinizing your work, presented professionally, and hosted on a reliable platform.

While the cost may seem daunting initially, consider it an investment towards ensuring that your research reaches your community in the best possible manner. It’s about valuing the rigorous process that safeguards the reputation of scholarly research.

Decoding the Journal Publication Fee Structure

Detailed breakdown of typical journal publishing fees.

Firstly, there is the cost of handling and processing the manuscript. This involves initial assessment, coordinating the peer review process, and editing the manuscript to meet the journal’s guidelines. These processes require skilled professionals who must be paid for their time and expertise.

A reputable journal also uses a reliable manuscript management system from a third party. This also incurs additional costs. When I was handling the journal department, maintaining the manuscript management system incurred one of the highest costs.

Thirdly, there’s the cost of dissemination and archiving. The final article must be hosted on a website, distributed to various databases, and often printed and shipped to libraries or individual subscribers. Plus, the published article needs to be stored and made accessible indefinitely, which also incurs ongoing costs.

Why Some Publishers Charge High Journal Publication Fees to Publish

The fees charged by different journals can vary widely. Some journals charge high publishing fees because they offer more services or higher quality services. For example, they might employ more experienced editors, have more rigorous peer review processes, or provide more extensive marketing and distribution of published articles.

Furthermore, the prestige of a journal can also play a role in its pricing. Publishing in a highly respected journal can significantly increase a researcher’s reputation and career prospects so that these journals can afford higher fees.

It’s also worth noting that open access journals generally charge higher journal publishing fees than traditional subscription-based journals, as they don’t generate revenue from subscriptions or paywalls. We’ll explore this further in the next section.

Open Access Journal Fees

Understanding open access journal publication fees.

The fees or the amount required to publish a paper in open access journals vary widely. Typically, these fees, known as Article Processing Charges (APCs), range from $100-$900 (lower tier), $1000-$5,000 (mid-tier) and over $6,000 (higher tier).

APCs cover the costs of peer review, editorial work, online hosting, and archiving. Additionally, some journals levy charges for supplementary materials, figures, or color pages. It’s important for authors to thoroughly investigate these charges before submitting them to an open access journal.

The Pros and Cons of Open Access Fees

This can particularly appeal to researchers working on time-sensitive or highly relevant topics. Moreover, some studies have suggested that open access articles are more likely to be cited, which could boost your academic profile.

However, the high APCs can present a significant barrier to some researchers, particularly those without institutional support or access to funding. This raises concerns about the accessibility and equity of open access publishing.

Considering these benefits and drawbacks, the decision to publish in an open access journal ultimately depends on your circumstances and research goals. When making this choice, it’s crucial to consider the immediate financial cost and the potential long-term impacts on your research visibility and reputation.

Strategies to Manage Journal Publication Fees

As an academic researcher, you might be troubled by the steep costs of publishing your findings in scholarly journals. But don’t worry. There are several ways through which these costs can be managed effectively. This section will provide practical tips and advice to help you navigate the financial aspects of journal publishing.

Tips for Authors to Afford Publication Costs

Besides grants, many publishers offer waivers or discounts on journal publication fees. These waivers are typically need-based and may be offered to researchers from low-income countries or those experiencing financial hardship. It’s always a good idea to check the journal’s policy on fee waivers before submission.

Finally, while it might not sound like the most glamorous option, choosing lower-cost journals for publication is also a viable strategy. Many reputable publishers charge reasonable journal publication fees without compromising the quality of peer review or exposure.

Balance Between Journal Publication Fees and Prestige

Remember, the main goal of publishing research is to contribute to your field and boost your academic reputation. Hence, the prestige of the journal should also be taken into account.

Publishing in a prestigious journal ensures a wider audience for your work and adds weight to your academic portfolio. Therefore, it’s essential to strike a balance between cost and prestige. If a prestigious academic publisher charges higher journal publication fees, consider it an investment in your academic career and look for ways to secure funding or waivers.

Conclusion: Making Informed Decisions about Journal Publication Fees

As we reach the conclusion of this enlightening journey through the intricacies of journal publication fees, let’s recap the essential insights.

First, we delved into the world of journal publishing models, distinguishing between traditional and open access models, both of which impact the journal publication fees differently.

These services play an instrumental role in maintaining the quality and integrity of published work, ensuring that the scientific community continues to operate on a foundation of rigorous, reliable research.

A comprehensive breakdown of typical journal publication fees was delivered, elucidating why some journals charge higher fees for their publishing services.

Importantly, we also shared practical strategies to manage journal publication fees. Tips ranged from acquiring grants and waivers to selecting lower-cost journals without compromising the prestige associated with your chosen publication. Balancing these factors effectively can alleviate the financial burden while preserving your academic reputation.

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We encourage you, as authors, to carefully weigh all these factors when deciding where to publish your research. Remember, knowledge is power. The more informed you are about the nuances of journal publishing, the better equipped you’ll be to make decisions that align with your financial capabilities and academic goals.

Keep exploring, keep questioning, and keep publishing. Your contribution to the world of knowledge is invaluable.

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Publication fees

AGU is committed to inclusive and equitable scientific publishing. All accepted papers will be published regardless of the author’s ability to pay publication fees. Depending on the journal, there are 3 types of fees that might be associated with the publication of your paper: Base Publication Fee, Excess Page Fee (for overlength articles), or Open Access Article Processing Charge (OA APC). Details on these fees are provided below. If you need any assistance, please contact [email protected] .

To ensure availability of funding is not a barrier to publication, AGU provides various funding options for our authors, including waivers. The options are detailed on our Funding Options  page. The funding options vary depending on the type of journal you choose: hybrid subscription journals (authors are not required to publish as Open Access) or fully gold Open-Access journals (all articles are published as Open Access).

Base Publication Fees

Base Publication Fees are flat fees for papers up to a certain amount of publication units (PU) and are submitted to AGU’s hybrid subscription journals. Overlength papers incur Excess Page Fees (see section below).

The formula for PU = number of words/500 + number of figures + number of tables. Articles exceeding a certain amount of PUs incur excess page fees.

Word count includes abstract, acknowledgements, text (and in-text citations), figure captions, table captions, and appendices. Equations count as one word no matter the size. Equations are not copyedited.

Word count excludes title, author list and affiliations, key words, key points, plain language summary, table text, open research section, references, and supporting information. Supporting information is not copyedited.

Base publication fees and excess page fees are waived for authors publishing their articles as Open Access. Commentaries, Introductions, Viewpoints, Comments, and Replies are free to publish.

Excess page fees

Longer papers are permitted in all journals except Geophysical Research Letters (GRL).

Overlength papers incur excess page fees in addition to the base publication fee due to increased editorial and production costs.

Excess Page Fees apply for papers with more than 25 PUs with the exception of review articles which incur excess page fees after 30 PUs

Open Access Article Processing Charges (OA APCs)

As a part of our mission, AGU is focused on making science available to the widest possible audience. Open Access removes subscription paywalls, which means that more people will have access to your research so they can actively cite, read, and share data with the least possible restrictions. Authors (or their institutions or funders) pay an Open Access Article Processing Charge (APC) and retain copyright of their article which they can publish under a Creative Commons license (choosing among CC-BY, CC-BY-NC, CC-BY-ND, or CC-BY-NC-ND).

For authors choosing to publish as Open Access, there are no base publication fees or excess page fees. The APCs for AGU journals are listed in the tables below.

Publication Fees Tables

See tables below for Base Publication Fees, Excess Page Fees, and Open Access Article Processing Charges (APCs). For funding options and waivers, visit our Funding Options  page for publication fees.

AGU Hybrid Subscription Journals

AGU Fully Gold Open Access Journals

There are no Base Publication Fee or Excess Page Fees for publishing in AGU’s fully gold Open Access journals.

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Elsevier Policies

Transparent price setting.

Elsevier publishes journal articles under two separate models to suit author preferences:

Subscription articles funded by payments for reading made by subscribing individuals or institutions

Open access articles funded by payments for publishing made by authors, their institution or funding bodies, commonly known as Article Publishing Charges (APCs)

We calculate pricing for each of these models separately. Subscription prices are set excluding open access articles; in other words, open access articles are not factored in when setting subscription prices. This fundamental principle is enshrined in our strict no double dipping policy (see below).

At Elsevier, we publish more articles and at higher quality relative to other major publishers, yet our average list price per subscription article remains lower (by 2-3 times) than that of others. Since 2010, the number of articles submitted to Elsevier journals grew by 11%, and the volume of subscription articles published increased by 5% (compound average growth rate 2010-2021). Our average list price per subscription article grew by just 0.2% over that time (2011-2021) across our entire portfolio of journals.

Journal article price

Average list price per subscription article Indexed weighted average of list prices for 2021 subscription year versus articles published in 2021 taking Elsevier as baseline (Source: Publisher websites, Scopus data)

Average list price per subscription article over time 5-year (2017-2021) and 10-year (2012-2021) compound annual growth rates (Source: Publisher websites, Scopus data)

Key facts on article growth, value and quality opens in new tab/window

Frequently asked questions on pricing

What do fees pay for.

The fees that authors pay help to support the extensive work that goes into the editorial review, peer review and publishing process that ensures research is reliable and helps to accelerate progress for society

Our 2,700 journals enhance the record of scientific knowledge by applying high standards of quality in everything they publish and ensuring trusted research can be accessed, shared and built upon by others. In 2021, we received 2.5 million research papers from authors. These were carefully reviewed by our 2,000-strong in-house editorial teams in collaboration with 29,000 editors and 1.4 million expert reviewers around the world, resulting in over 600,000 articles being enhanced, indexed, published and promoted following a peer review.

Can you be more transparent in what you charge?

We are constantly striving to be more transparent in all aspects of what Elsevier does, including pricing. We try to support requests for information within the bounds of financial reporting requirements and competition rules.

How are we transparent for authors?

We provide the price of publishing gold open access on each journal homepage and in 

a central list opens in new tab/window

During the publication process, we automatically notify authors who are entitled to free or discounted gold open access, for example where there is an agreement with their institution or funder

During the publication process, we automatically notify authors who are entitled to free or discounted gold open access because they are in a lower- or middle-income country — our APC waiver policy explains this process

How are we transparent for librarians?

We provide a range of information on our  website opens in new tab/window about our pricing competitiveness; how our pricing corresponds to quality; and publishing model uptake across subscription and open access

We publicly announce significant agreements, including our open access pilots

We provide  a list of our journal subscription prices

We describe the process we follow to calculate list prices

We describe the process to ensure  we do not double dip

We also show the number of articles that are published gold open access, and the number which are financed through subscriptions, on each journal homepage, to allow librarians to validate this

Do you double dip, i.e., charge for the same article twice?

We do not ‘double dip’. We can be reimbursed for an article in two ways — through an Article Publishing Charge (APC) to publish the article and make it available to read by everyone, or a subscription fee to pay for reading the article. We either charge for publishing an article or reading an article but we never charge for the same article twice. We have a strict no double-dipping policy.

How do you help authors who cannot afford to pay to be published?

As part of our commitment to inclusion and diversity in science, we believe it is critical to support researchers from low and middle-income countries to publish gold open access, if they wish to do so. When publishing in fully open access journals, we fully waive all open access charges for authors from 69 countries ( Group A opens in new tab/window ) and give a 50% discount for authors from 57 countries ( Group B opens in new tab/window ).

We offer a choice of journals with open access publishing charges ranging from $150 to $9,900. We will also consider requests for accommodations on a case by case basis for authors who are required to publish open access but do not have the financial means to do so. We provide high-quality subscription publishing options in our journals, so authors always have a choice of how they publish.

If more authors are publishing gold open access, why don’t you reduce your subscription fees?

Subscription fees are based on a range of factors, including the volume of subscription articles, the quality of a journal, journal usage and market and competitive considerations. When calculating subscription prices, we only take into account subscription articles; the number of articles published gold open access has no bearing on the way we set subscription fees.

We publish more articles and at higher quality relative to other major publishers, yet our average list price per subscription article remains lower (by 2-3 times) than that of others. Since 2010, the number of articles submitted to Elsevier journals grew by 11%, and the volume of subscription articles published increased by 5% (compound average growth rate 2010-2021). Our average list price per subscription article grew by just 0.2% over that time (2011-2021) across our entire portfolio.

See here for more information on Elsevier article volumes, value and quality.

Article Publishing Charges (APCs)

Irrespective of the publishing model chosen by the author, our goal is to ensure articles are published as quickly as possible, subject to appropriate quality controls, and widely disseminated.

Where an author has chosen to publish open access, which typically involves the payment of an article publishing charge (APC) by the author, their institution or funding body, we make their article freely available immediately upon publication on ScienceDirect in perpetuity with the author’s chosen user license attached to it.

Elsevier’s APCs are set on a per journal basis, fees range between approximately $200 and $10,400 US Dollars, excluding tax, with prices clearly displayed on our  APC price list opens in new tab/window  and on journal homepages.

Adjustments in Elsevier’s APCs are under regular review and are subject to change. We set APCs based on the following criteria which are applied to open access articles only:

Journal quality (as measured by journal quality Field Weighted Citation Impact Tier);

The journal’s editorial and technical processes;

Competitive considerations;

Market conditions;

Other revenue streams associated with the journal.

A small percentage of titles may support more than one APC, for example when a journal supports one or more article types that require different APCs.

We do not vary the APC prices for our proprietary journals based on the user license chosen by the author. However, we also publish journals on behalf of learned societies or other third parties that reserve the right to determine their own prices and pricing policies. Any deviations in pricing from Elsevier’s standard APC price list per journal will be clearly displayed on the journal’s homepage.

Download APC prices opens in new tab/window

Fee waivers to support researchers

Our goal is to effectively bridge the digital research divide and ensure that publishing in open access journals is accessible for authors in developing countries.

We grant waivers in cases of genuine need, therefore we automatically apply APC waivers or discounts to those articles in gold open access journals for which all author groups are based in a country eligible for the  Research4Life program opens in new tab/window . When publishing in fully open access journals, we fully waive all APCs for authors from 69 countries ( Group A opens in new tab/window ) and give a 50% discount for authors from 57 countries ( Group B opens in new tab/window ).

If an author group from a non-Research4Life country cannot afford the APC to publish an article in a gold open access journal and they can demonstrate they had no research funding, we will consider individual waiver requests on a case-by-case basis.

Our waiving policy does not apply to hybrid journals. Authors publishing in hybrid journals can publish under the subscription model at no cost and make use of the  Elsevier sharing policy .

For patients and caregivers , we will consider individual waiver requests on a case-by-case basis.

Open access agreements and funding body arrangements

Elsevier supports over 2,000 institutions globally to publish open access through transformative agreements .

We have established arrangements to help authors comply with the open access requirements of the major funding bodies and how they can be reimbursed for publication fees when publishing in Elsevier journals.

Reimbursement policy

To ensure Elsevier does not charge twice for the same article, we will fully refund an APC when alternative funding is provided for the open access article. For example, where an open access article is part of a Special Issue which is later made available in its entirety on an open access basis, such as through sponsorship by an organization, we will fully refund individual APCs paid by an author or on their behalf.

Elsevier will offer a credit for use against a future open access publication in the following circumstances:

A delay in delivering open access : When an article is not available open access on ScienceDirect by the time the issue in which the article is included is published in its final version, we will offer a credit for use against a future publication with Elsevier.

Incorrect licensing : When an article is made freely available on Science Direct in final published form but does not display the author’s chosen user license due to our error, we will offer a credit for use against a future publication with Elsevier.

No refund or credit will be offered in the following circumstances:

Article retraction or removal : Elsevier has provided publishing services. The later retraction or removal of the article is typically for reasons beyond our control, and does not detract from the publishing services provided, nor from our ongoing maintenance of the scientific record, e.g., corrections to the record.

Delays resulting from editorial decisions or author changes : These are a standard part of the publishing process.

License changes : Where an author requests a change to the user license they initially chose we will endeavor to respond to these within 5 working days.

Circumstances beyond our control : This may include, for example, where natural or other disasters prevent us from fulfilling our obligations.

Article unavailable on another platform : Elsevier’s responsibility is to ensure that the definitive published versions of articles we publish are available on ScienceDirect, or any successor platform, in ways that are accessible to all.  We provide APIs to enable third party platforms to manage this process themselves, for example to identify and pull gold open access articles or to update their platforms to reflect changes subsequently made to the article, such as author license choice changes, errata, and retractions. Elsevier is not responsible for ensuring third party repositories maintain accurate metadata and full-text.

Subscription prices

Elsevier publishes subscription articles whose publication is funded by payments that are made by subscribing individuals or institutions. Subscription prices are set independent of open access articles and open access articles are not included when calculating subscription prices. Subscription prices are calculated and adjusted based on the following criteria:

Article volume

Journal quality (as measured by journal quality Field Weighted Citation Impact Tier)

Journal usage

Editorial processes

Competitive considerations

Other revenue streams such as commercial contributions from advertising, reprints and supplements

These criteria are applied only to subscription articles, not to open access articles, when setting list prices. For specific information please see our  subscription price list for librarians and agents .

Purchasing options

Elsevier provides a range of purchasing options for subscription articles which are tailored for a wide variety of people. These include:

For libraries and institutions: 

There are a number of subscription options available which are tailored according to the specific customer situation and reflect a number of factors. For customers who purchase collections these considerations include competitive considerations, market conditions, the number of archival rights they purchase, and agreement specific factors like agreement length, currency and payment terms. Collection prices are adjusted on an annual basis, and any adjustment is based on factors including competitive considerations, market conditions, the number, quality, and usage of subscription articles published, and on technical features and platform capabilities. Open access articles are not included in these calculations. Please find more details on pricing .

Individuals:  Researchers who are not affiliated to an institution, or who would simply like convenient access to a title not available from their library, can take advantage of our personal access options. These options include credit card based transactional article sale and article rental.

Please find more information on our free and low-cost access programs .

No double dipping

Elsevier does not charge subscribers for open access articles; when calculating subscription prices, we only take into account subscription articles —  we do not double dip.

Concerns around double dipping are often premised on the expectation that open access articles are replacing the number of subscription articles being published and therefore that prices should be changing to correspond to this. See here for the latest  data on Elsevier article volume growth, value and quality opens in new tab/window .

List prices for journals that publish both open access and subscription articles

Adjustments in individual journal subscription list prices will be based only on criteria applied to  subscription articles . Open access articles will not be considered in the individual journal list price. Similarly, the APC per journal will only be determined based on the criteria applied to  open access articles .

Collections

As with journal list prices, collection prices reflect subscription articles only; they are linked to the prices of individual titles in a collection, which do not count open access articles when setting prices.

Retrospective open access

To ensure we uphold our no double dipping policy and separate calculations regarding list prices from open access articles, we do not offer authors the option to make a subscription article gold open access retrospectively after publication as a general rule.

However, we appreciate that there are sometimes exceptional circumstances and we want to assist authors where possible. In such instances, authors can make a subscription article, published in a hybrid journal, gold open access up until 31 January of the following year. For example, if the article is published in March 2022, the author can make it open access up until the 31 January 2023. This cut-off date is necessary to accurately assess the open access uptake in each individual hybrid journal for the previous year which ensures we do not charge subscribers for open access content. Please contact us to request retrospective open access or for further details opens in new tab/window .

Geographical Pricing for Open Access (GPOA) Pilot details

Elsevier is piloting a program from January 2024 to set APC prices for 143 gold open access journals according to the income level of the country of the corresponding author.

For these pilot journals we will waive the APC for corresponding authors who are based in low-income countries as classified by the World Bank as of July 2024. 

For articles whose corresponding authors are based in lower-middle-countries the geo-price will be 20 percent of the APC global list price. 

Corresponding authors based in upper-middle-income countries and where R&D intensity (domestic expenditure on R&D expressed as a percentage of GDP according to OECD) is below two percent are defined in three different groups based on GNI per capita and will see a different APC geo-price based on the GNI per capita of the country ranging from 45 percent to 90 percent of the APC list price.

GNI Per Capita

*Based on World Bank - 01 July 2024

Elsevier will use GNI per Capita ( Atlas Method) opens in new tab/window as the key indicator for determining the APC pricing tier. This is a widely used economic indicator provided by the World Bank and has proved to be a useful, easily available and annually updated indicator that is closely correlated with other, nonmonetary measures of the quality of life. The  Atlas  method, with three-year average exchange rates adjusted for inflation, lessens the effect of exchange rate fluctuations and abrupt changes.

The GPOA pilot methodology calculates discounts on the list APC as a percentage of the list price differently for each group of countries. To do this, we use the middle point of each group as a reference. This middle point is determined by comparing it to the starting threshold set for high-income countries by the World Bank.

Elsevier may grant additional waivers to countries where full waiver policies are currently in place for specific reasons, or in cases where Elsevier is unable to receive payments due to trade sanctions ( read more ). The article publishing charge that applies is automatically calculated as part of the submission process and will take this into consideration.  If you have any further questions, please contact researcher support.

Country Groups

Based on the most recent GDP per capita available (up to 2023) and the World Bank Country Groups for FY 2025, valid from the 1st of July 2024

View the list of participating journals

Understanding Submission and Publication Fees

• Research Process
• Peer Review

A number of journals charge fees to authors of one kind or another. Pre-publication fees, such as a submission fee or membership fee, are less common. Researchers are more likely to encounter post-publications fees, such as an article processing charge or page fee.

Updated on January 1, 2012

When trying to target the right journal for publication of your manuscript, it is easy to get overwhelmed by the diversity of not only journals but also potential author fees. What are all of these types of fees? Which types of journals generally charge them? When? Why?

Before addressing this slew of questions, it is important to note a common oversimplification: that traditional journals are solely based on a reader-pays model, in which institutional libraries typically pay for access to content, and that open access journals, supporting " unrestricted access and unrestricted reuse ,” are always based on an author-pays model (see our article on open access myths for more information). In other words, as an author, you may have to pay for submission to and/or publication in a subscription-based journal and may not have to do so for an open access one. The latter concept is made possible by alternative sources of revenue that cover the costs of the editorial, peer review, and publication processes, such as paywalled premium content, advertising, or subsidy by a journal's affiliated foundation or society.

Note also that for both traditional and open access publications that do entail so-called “author” charges, you may not have to pay these fees in full because of discounts related to institutional membership programs, your own society membership, or waivers of service (such as if in-house copyediting is not needed). Moreover, you may not have to pay full or even discounted fees due to waivers based on either financial hardship or your country of origin's economic status or due to coverage by your institution, department, or funder/grant; in fact, for open access publication, only 5% to 12% of fees are ever paid using personal funds.

Here, we summarize a few of the most common fees associated with manuscript submission and publication, with a focus on the pre- and post-acceptance charges that may be most relevant to you as an author. Note that all quoted price ranges are rough estimates based on a brief survey, so please check specific journals' and publishers' websites for more accurate information. These sites (e.g., PLOS and BioMed Central ) should provide up-to-date information on journals' specific fee types, discounts, and waivers. Your institution and/or funder may also be able to provide more in-depth explanations about open access mandates, if any, and cost coverage.

Pre-acceptance fees

Submission fees. Both subscription-based and open access journals may charge a fee (typically $50-125) at the time of manuscript submission to help to fund editorial and peer review administration. From an author's standpoint, these fees might deter submission due to the existence of many journals without such charges. However, submission fees thus present the advantage of decreasing competition for review and acceptance, potentially enhancing publication speed . The effect on journal quality, and therefore potentially on impact, may also be positive: the quality of submissions may increase, as only authors with confidence that they are choosing the right journal will be willing to pay a submission fee. Interestingly, it has also been posited that submission fees can increase authors' concern about the quality of peer review and the reasoning behind manuscript rejection, potentially motivating greater accountability on the part of journals.

Membership fees. The open access journal PeerJ is unique in charging a one-time membership fee ($100-350) that covers the editorial process and peer review, as well as the possible publication, of one, two, or a limitless number of manuscripts per year (depending on the level of membership). Each author on a manuscript, up to 12 authors, must pay the fee and a must contribute to the PeerJ community yearly, such as by participating in peer review. It is also possible to pay for membership after acceptance of a manuscript, but this increases the cost. Advantages of this membership approach include relatively rapid publication and avoidance of repeatedly paying pre- and post-acceptance fees. [Editor's note: PeerJ now offers a per-article price , as well.]

Post-acceptance fees

These fees either stand alone or are charged subsequent to a submission fee.

Page/color printing charges. To cover the cost of printing, and particularly color printing, certain traditional journals charge per page (often $100-250 each) and/or per color figure (about $150-1,000 each). In rare cases, supplementary materials may also incur a flat charge or a charge per item or page, with fees usually ranging from $150-500.

Publication fees. These fees, charged by certain open access journals post-acceptance, are also known as author publishing charges or article processing charges (APCs) and range from $8-3,900. APCs may be driven down by submission fees, particularly among open access journals with high rejection rates. In contrast to post-acceptance charges by traditional journals, these APCs are more often flat fees because they primarily fund peer review and online dissemination, which are length independent. In rare cases, post-acceptance, page/color-independent fees may also be billed by traditional journals (e.g., the Journal of Clinical Investigation ) without unrestricted access and/or reuse provisions. Generally, these fees provide both retrospective and prospective coverage, including of peer review management by the editorial staff or board (i.e., identifying and following up with peer reviewers), manuscript preparation (e.g., copyediting), journal production (e.g., layout), open access online publication and hosting, indexing (e.g., in PubMed), and archiving.

Be aware that “predatory” journals may take advantage of the APC-based model to receive payment in return for minimal peer review and processing, so be sure to look for warning signs and consider checking whether your target journal is listed by the Directory of Open Access Journals . A truly open access journal should also meet the two-fold requirement defined above by PLOS : “unrestricted access and unrestricted reuse,” meaning that an open access article must not only be freely accessible to readers but also freely available for copying, distribution, and derivative work, as long as the original author is acknowledged. In particular, open access articles are often associated with a CC-BY license, although certain journals may not support reuse/derivation.

Regarding the value added by submitting to APC-charging journals, a weak correlation between citation-based impact and APCs has been found for open access journals, implying that higher fees are necessitated by higher rejection rates, which in turn imply greater selectivity and prestige. However, note that this analysis did not take submission fees into account.

Conclusions

In sum, when choosing a journal for manuscript submission, the array of pre- and post-acceptance fees should not be an immediate deterrent, especially if the journal's scope and content are a good fit for your work, because of both potential fee assistance and added value. You should thus focus on asking yourself a more personalized question beyond what, who, when, and why: is the journal truly the right fit for my specific research and my own publication goals?

Michaela Panter, PhD

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• Published: 27 March 2013

Open access: The true cost of science publishing

• Richard Van Noorden  

Nature volume  495 ,  pages 426–429 ( 2013 ) Cite this article

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Cheap open-access journals raise questions about the value publishers add for their money.

Michael Eisen doesn't hold back when invited to vent. “It's still ludicrous how much it costs to publish research — let alone what we pay,” he declares. The biggest travesty, he says, is that the scientific community carries out peer review — a major part of scholarly publishing — for free, yet subscription-journal publishers charge billions of dollars per year, all told, for scientists to read the final product. “It's a ridiculous transaction,” he says.

Eisen, a molecular biologist at the University of California, Berkeley, argues that scientists can get much better value by publishing in open-access journals, which make articles free for everyone to read and which recoup their costs by charging authors or funders. Among the best-known examples are journals published by the Public Library of Science (PLoS), which Eisen co-founded in 2000. “The costs of research publishing can be much lower than people think,” agrees Peter Binfield, co-founder of one of the newest open-access journals, PeerJ , and formerly a publisher at PLoS.

But publishers of subscription journals insist that such views are misguided — born of a failure to appreciate the value they add to the papers they publish, and to the research community as a whole. They say that their commercial operations are in fact quite efficient, so that if a switch to open-access publishing led scientists to drive down fees by choosing cheaper journals, it would undermine important values such as editorial quality.

These charges and counter-charges have been volleyed back and forth since the open-access idea emerged in the 1990s, but because the industry's finances are largely mysterious, evidence to back up either side has been lacking. Although journal list prices have been rising faster than inflation, the prices that campus libraries actually pay to buy journals are generally hidden by the non-disclosure agreements that they sign. And the true costs that publishers incur to produce their journals are not widely known.

The past few years have seen a change, however. The number of open-access journals has risen steadily, in part because of funders' views that papers based on publicly funded research should be free for anyone to read. By 2011, 11% of the world's articles were being published in fully open-access journals 1 (see 'The rise of open access'). Suddenly, scientists can compare between different publishing prices. A paper that costs US$5,000 for an author to publish in Cell Reports , for example, might cost just $1,350 to publish in PLoS ONE — whereas PeerJ offers to publish an unlimited number of papers per author for a one-time fee of $299. “For the first time, the author can evaluate the service that they're getting for the fee they're paying,” says Heather Joseph, executive director of the Scholarly Publishing and Academic Resources Coalition in Washington DC.

The variance in prices is leading everyone involved to question the academic publishing establishment as never before. For researchers and funders, the issue is how much of their scant resources need to be spent on publishing, and what form that publishing will take. For publishers, it is whether their current business models are sustainable — and whether highly selective, expensive journals can survive and prosper in an open-access world.

The cost of publishing

Data from the consulting firm Outsell in Burlingame, California, suggest that the science-publishing industry generated $9.4 billion in revenue in 2011 and published around 1.8 million English-language articles — an average revenue per article of roughly $5,000. Analysts estimate profit margins at 20–30% for the industry, so the average cost to the publisher of producing an article is likely to be around $3,500–4,000.

Most open-access publishers charge fees that are much lower than the industry's average revenue, although there is a wide scatter between journals. The largest open-access publishers — BioMed Central and PLoS — charge $1,350–2,250 to publish peer-reviewed articles in many of their journals, although their most selective offerings charge $2,700–2,900. In a survey published last year 2 , economist Bo-Christer Björk of the Hanken School of Economics in Helsinki and psychologist David Solomon of Michigan State University in East Lansing looked at 100,697 articles published in 1,370 fee-charging open-access journals active in 2010 (about 40% of the fully open-access articles in that year), and found that charges ranged from $8 to $3,900. Higher charges tend to be found in 'hybrid' journals, in which publishers offer to make individual articles free in a publication that is otherwise paywalled (see 'Price of prestige'). Outsell estimates that the average per-article charge for open-access publishers in 2011 was $660.

Although these fees seem refreshingly transparent, they are not the only way that open-access publishers can make money. As Outsell notes, the $660 average, for example, does not represent the real revenue collected per paper: it includes papers published at discounted or waived fees, and does not count cash from the membership schemes that some open-access publishers run in addition to charging for articles. Frequently, small open-access publishers are also subsidized, with universities or societies covering the costs of server hosting, computers and building space. That explains why many journals say that they can offer open access for nothing. One example is Acta Palaeontologica Polonica , a respected open-access palaeontology journal, the costs of which are mostly covered by government subsidies to the Institute of Paleobiology of the Polish Academy of Sciences in Warsaw; it charges nothing for papers under 10 pages. Another is eLife , which is covered by grants from the Wellcome Trust in London; the Max Planck Society in Munich, Germany; and the Howard Hughes Medical Institute in Chevy Chase, Maryland. And some publishers use sets of journals to cross-subsidize each other: for example, PLoS Biology and PLoS Medicine receive subsidy from PLoS ONE , says Damian Pattinson, editorial director at PLoS ONE .

Neither PLoS nor BioMed Central would discuss actual costs (although both organizations are profitable as a whole), but some emerging players who did reveal them for this article say that their real internal costs are extremely low. Paul Peters, president of the Open Access Scholarly Publishing Association and chief strategy officer at the open-access publisher Hindawi in Cairo, says that last year, his group published 22,000 articles at a cost of $290 per article. Brian Hole, founder and director of the researcher-led Ubiquity Press in London, says that average costs are £200 (US$300). And Binfield says that PeerJ 's costs are in the “low hundreds of dollars” per article.

The picture is also mixed for subscription publishers, many of which generate revenue from a variety of sources — libraries, advertisers, commercial subscribers, author charges, reprint orders and cross-subsidies from more profitable journals. But they are even less transparent about their costs than their open-access counterparts. Most declined to reveal prices or costs when interviewed for this article.

The few numbers that are available show that costs vary widely in this sector, too. For example, Diane Sullenberger, executive editor for Proceedings of the National Academy of Sciences in Washington DC, says that the journal would need to charge about $3,700 per paper to cover costs if it went open-access. But Philip Campbell, editor-in-chief of Nature , estimates his journal's internal costs at £20,000–30,000 ($30,000–40,000) per paper. Many publishers say they cannot estimate what their per-paper costs are because article publishing is entangled with other activities. ( Science , for example, says that it cannot break down its per-paper costs; and that subscriptions also pay for activities of the journal's society, the American Association for the Advancement of Science in Washington DC.)

Scientists pondering why some publishers run more expensive outfits than others often point to profit margins. Reliable numbers are hard to come by: Wiley, for example, used to report 40% in profits from its scientific, technical and medical (STM) publishing division before tax, but its 2013 accounts noted that allocating to science publishing a proportion of 'shared services' — costs of distribution, technology, building rents and electricity rates — would halve the reported profits. Elsevier's reported margins are 37%, but financial analysts estimate them at 40–50% for the STM publishing division before tax. ( Nature says that it will not disclose information on margins.) Profits can be made on the open-access side too: Hindawi made 50% profit on the articles it published last year, says Peters.

Commercial publishers are widely acknowledged to make larger profits than organizations run by academic institutions. A 2008 study by London-based Cambridge Economic Policy Associates estimated margins at 20% for society publishers, 25% for university publishers and 35% for commercial publishers 3 . This is an irritant for many researchers, says Deborah Shorley, scholarly communications adviser at Imperial College London — not so much because commercial profits are larger, but because the money goes to shareholders rather than being ploughed back into science or education.

But the difference in profit margins explains only a small part of the variance in per-paper prices. One reason that open-access publishers have lower costs is simply that they are newer, and publish entirely online, so they don't have to do print runs or set up subscription paywalls (see 'How costs break down'). Whereas small start-ups can come up with fresh workflows using the latest electronic tools, some established publishers are still dealing with antiquated workflows for arranging peer review, typesetting, file-format conversion and other chores. Still, most older publishers are investing heavily in technology, and should catch up eventually.

Costly functions

The publishers of expensive journals give two other explanations for their high costs, although both have come under heavy fire from advocates of cheaper business models: they do more and they tend to be more selective. The more effort a publisher invests in each paper, and the more articles a journal rejects after peer review, the more costly is each accepted article to publish.

Publishers may administer the peer-review process, which includes activities such as finding peer reviewers, evaluating the assessments and checking manuscripts for plagiarism. They may edit the articles, which includes proofreading, typesetting, adding graphics, turning the file into standard formats such as XML and adding metadata to agreed industry standards. And they may distribute print copies and host journals online. Some subscription journals have a large staff of full-time editors, designers and computer specialists. But not every publisher ticks all the boxes on this list, puts in the same effort or hires costly professional staff for all these activities. For example, most of PLoS ONE 's editors are working scientists, and the journal does not perform functions such as copy-editing. Some journals, including Nature , also generate additional content for readers, such as editorials, commentary articles and journalism (including the article you are reading). “We get positive feedback about our editorial process, so in our experience, many scientists do understand and appreciate the value that this adds to their paper,” says David Hoole, marketing director at Nature Publishing Group.

The costs of research publishing can be much lower than people think.

The key question is whether the extra effort adds useful value, says Timothy Gowers, a mathematician at the University of Cambridge, UK, who last year led a revolt against Elsevier (see Nature http://doi.org/kwd ; 2012 ). Would scientists' appreciation for subscription journals hold up if costs were paid for by the authors, rather than spread among subscribers? “If you see it from the perspective of the publisher, you may feel quite hurt,” says Gowers. “You may feel that a lot of work you put in is not really appreciated by scientists. The real question is whether that work is needed, and that's much less obvious.”

Many researchers in fields such as mathematics, high-energy physics and computer science do not think it is. They post pre- and post-reviewed versions of their work on servers such as arXiv — an operation that costs some $800,000 a year to keep going, or about $10 per article. Under a scheme of free open-access 'Episciences' journals proposed by some mathematicians this January, researchers would organize their own system of community peer review and host research on arXiv, making it open for all at minimal cost (see Nature http://doi.org/kwg ; 2013 ).

These approaches suit communities that have a culture of sharing preprints, and that either produce theoretical work or see high scrutiny of their experimental work — so it is effectively peer reviewed before it even gets submitted to a publisher. But they find less support elsewhere — in the highly competitive biomedical fields, for instance, researchers tend not to publish preprints for fear of being scooped and they place more value on formal (journal-based) peer review. “If we have learned anything in the open-access movement, it's that not all scientific communities are created the same: one size doesn't fit all,” says Joseph.

The value of rejection

Tied into the varying costs of journals is the number of articles that they reject. PLoS ONE (which charges authors $1,350) publishes 70% of submitted articles, whereas Physical Review Letters (a hybrid journal that has an optional open-access charge of $2,700) publishes fewer than 35%; Nature published just 8% in 2011.

The connection between price and selectivity reflects the fact that journals have functions that go beyond just publishing articles, points out John Houghton, an economist at Victoria University in Melbourne, Australia. By rejecting papers at the peer-review stage on grounds other than scientific validity, and so guiding the papers into the most appropriate journals, publishers filter the literature and provide signals of prestige to guide readers' attention. Such guidance is essential for researchers struggling to identify which of the millions of articles published each year are worth looking at, publishers argue — and the cost includes this service.

A more-expensive, more-selective journal should, in principle, generate greater prestige and impact. Yet in the open-access world, the higher-charging journals don't reliably command the greatest citation-based influence, argues Jevin West, a biologist at the University of Washington in Seattle. Earlier this year, West released a free tool that researchers can use to evaluate the cost-effectiveness of open-access journals (see Nature http://doi.org/kwh ; 2013 ).

And to Eisen, the idea that research is filtered into branded journals before it is published is not a feature but a bug: a wasteful hangover from the days of print. Rather than guiding articles into journal 'buckets', he suggests, they could be filtered after publication using metrics such as downloads and citations, which focus not on the antiquated journal, but on the article itself (see page 437).

Alicia Wise, from Elsevier, doubts that this could replace the current system: “I don't think it's appropriate to say that filtering and selection should only be done by the research community after publication,” she says. She argues that the brands, and accompanying filters, that publishers create by selective peer review add real value, and would be missed if removed entirely.

PLoS ONE supporters have a ready answer: start by making any core text that passes peer review for scientific validity alone open to everyone; if scientists do miss the guidance of selective peer review, then they can use recommendation tools and filters (perhaps even commercial ones) to organize the literature — but at least the costs will not be baked into pre-publication charges.

These arguments, Houghton says, are a reminder that publishers, researchers, libraries and funders exist in a complex, interdependent system. His analyses, and those by Cambridge Economic Policy Associates, suggest that converting the entire publishing system to open access would be worthwhile even if per-article-costs remained the same — simply because of the time that researchers would save when trying to access or read papers that were no longer lodged behind paywalls.

The path to open access

But a total conversion will be slow in coming, because scientists still have every economic incentive to submit their papers to high-prestige subscription journals. The subscriptions tend to be paid for by campus libraries, and few individual scientists see the costs directly. From their perspective, publication is effectively free.

Of course, many researchers have been swayed by the ethical argument, made so forcefully by open-access advocates, that publicly funded research should be freely available to everyone. Another important reason that open-access journals have made headway is that libraries are maxed out on their budgets, says Mark McCabe, an economist at the University of Michigan in Ann Arbor. With no more library cash available to spend on subscriptions, adopting an open-access model was the only way for fresh journals to break into the market. New funding-agency mandates for immediate open access could speed the progress of open-access journals. But even then the economics of the industry remain unclear. Low article charges are likely to rise if more-selective journals choose to go open access. And some publishers warn that shifting the entire system to open access would also increase prices because journals would need to claim all their revenue from upfront payments, rather than from a variety of sources, such as secondary rights. “I've worked with medical journals where the revenue stream from secondary rights varies from less than 1% to as much as one-third of total revenue,” says David Crotty of Oxford University Press, UK.

Some publishers may manage to lock in higher prices for their premium products, or, following the successful example of PLoS, large open-access publishers may try to cross-subsidize high-prestige, selective, costly journals with cheaper, high-throughput journals. Publishers who put out a small number of articles in a few mid-range journals may be in trouble under the open-access model if they cannot quickly reduce costs. “In the end,” says Wim van der Stelt, executive vice president at Springer in Doetinchem, the Netherlands, “the price is set by what the market wants to pay for it.”

In theory, an open-access market could drive down costs by encouraging authors to weigh the value of what they get against what they pay. But that might not happen: instead, funders and libraries may end up paying the costs of open-access publication in place of scientists — to simplify the accounting and maintain freedom of choice for academics. Joseph says that some institutional libraries are already joining publisher membership schemes in which they buy a number of free or discounted articles for their researchers. She worries that such behaviour might reduce the author's awareness of the price being paid to publish — and thus the incentive to bring costs down.

And although many see a switch to open access as inevitable, the transition will be gradual. In the United Kingdom, portions of grant money are being spent on open access, but libraries still need to pay for research published in subscription journals. In the meantime, some scientists are urging their colleagues to deposit any manuscripts they publish in subscription journals in free online repositories. More than 60% of journals already allow authors to self-archive content that has been peer-reviewed and accepted for publication, says Stevan Harnad, a veteran open-access campaigner and cognitive scientist at the University of Quebec in Montreal, Canada. Most of the others ask authors to wait for a time (say, a year), before they archive their papers. However, the vast majority of authors don't self-archive their manuscripts unless prompted by university or funder mandates.

As that lack of enthusiasm demonstrates, the fundamental force driving the speed of the move towards full open access is what researchers — and research funders — want. Eisen says that although PLoS has become a success story — publishing 26,000 papers last year — it didn't catalyse the industry to change in the way that he had hoped. “I didn't expect publishers to give up their profits, but my frustration lies primarily with leaders of the science community for not recognizing that open access is a perfectly viable way to do publishing,” he says.

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The scale on the y-axis of ‘The rise of open access’ was originally mislabelled. This has now been corrected.

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This article originally described David Solomon as an economist; he is a psychologist. It also wrongly defined STM as ‘science, technology and mathematics’ instead of ‘scientific, technical and medical’. These errors have been corrected.

Laakso, M. & Björk, B.-C. BMC Medicine 10 , 124 (2012).

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In addition to the above, you may also consider online search engines, which can help generate a list of journals that may be appropriate for the manuscript being submitted:

• JournalFinder
• Springer Nature: Journal suggester
• Enago’s Open Access Journal Finder
• Journal/Author Name Estimator  

Can you submit a paper to multiple journals at once?

No. Submitting a paper to multiple journals at once contravenes publishing guidelines and presents serious ethical concerns.

Is there a uniform format that I should submit my manuscript in?

Make sure to carefully read the manuscript submission instructions available on every journal’s webpage. Although there are certain rules that most journals follow (e.g. formatting in APA Style), each journal provides specific guidelines about certain aspects, for example the information that must be included within the manuscript.

What’s a predatory journal?

A predatory journal is a counterfeit publication that imitates that of a legitimate, respected publisher. Predatory publishers use various techniques to trick scholars into submitting their article for publication. A predatory publisher will usually solicit articles via email, emphasizing a publishing fee and touting a quick turnaround that often omits peer review.

Although the publishing fee is a red flag when it comes to identifying a predatory journal, not all journals that charge a publishing fee are predatory (see next question for more information). For tips on how to identify a predatory journal, see the following resources:

• Scholars beware
• How to avoid predatory publishers

Publishing fees

Does it usually cost money to publish?

It’s important to note that many journals do not charge the author(s) or their institution to publish an article. There are exceptions, however.

Some journals may charge a fee for publishing the article in a particular format. For example, some authors prefer or require their figures to be printed in color. Because printing in color costs more to the publisher, some journals may require a fee for each figure to be printed in color. Other journals may print one color figure for free, but charge for every additional color figure.

An increasing number of journals are also adding open access options which, when chosen, require fees paid by the author or their institution. Further, some reputable journals have recently gone entirely open access and thus require a fee to publish (the fee varies by journal). Open access journals are free to read for all and do not receive revenue from journal subscriptions—therefore, in many cases, an article publishing fee is charged to offset the cost of publishing (e.g., peer review management, production costs).

For example, APA’s open access journal Technology, Mind, and Behavior charges a $1,200 article processing charge (APC), however an author may apply for an APC waiver if they are unable to pay via grant, institutional funding, or by other means outlined on the journal website.

As such, it is important to recognize that journals charging a fee are not necessarily “predatory”—it’s crucial to consider other factors to figure out the legitimacy of the publication.

What is the difference between an open access journal and the open science movement?

Open access is a publishing model in which the author pays a fee to publish; the reader is able to access the article for free. Some journals are entirely open access, while others are “hybrid”—providing both a subscription as well as an open access publishing option.

Open science , on the other hand, is a movement towards increased transparency in publishing. It goes beyond open access, offering guidelines on the type of information that authors should include in their manuscript: for example, APA Style JARS provide guidelines for the details that authors should include in their methods section. Open science initiatives include data sharing, preregistration, preprints, registered reports, and more.  The goals of open science initiatives are to increase openness and collaboration, and to improve reproducibility of science and research discovery.

Licensing and copyright

How does licensing and copyright work?

Authors usually own the copyright of their original work and are free to share, without limitation, any version of their articles prior to the final text (after the journal proofing / copy editing process). However, licensing of article versions and individual publisher stances on sharing of accepted articles vary and change frequently. Fortunately, there are many resources to help authors keep track of individual policies. For example, the Sherpa Romeo website includes a conveniently searchable tool of journals’ copyright and open access policies on a journal-by-journal basis.

The Open Science Knowledge Base provides detailed information and recommendations about licensing content .

Publishing tips

Expert insights on key topics and best practices in publishing.

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• APA Journals ™ Publishing Resource Center
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• APA and Affiliated Journals

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How much does it cost the publisher to publish an academic article?

I am interested to know the cost of publishing an academic article. I do not mean in the simple sense of "what does a given journal charge an author to publish?" or "what does an association or publisher charge a library for access to the journal?"

Instead, I want to know the actual costs of translating a manuscript into a final publication (for web or print). This matters for open science - and open access specifically - because there is an enormous amount of debate about the financing models for open access journals. The two dominant models are one where the end-user pays (library, reader, etc.), which is often seen as antithetical to open science, and one where the author pays a fee after manuscript acceptance. Neither the charges paid by libraries nor the charges paid by authors necessarily illustrate the true cost of publishing an article (due to "prestige", between-publisher variation, profit margins, journal bundling, discounts, etc.).

So, what is the actual cost? And what are components of that cost (e.g., copyediting, typesetting, server space and internet bandwidth, etc.)? In short, if an author (or someone else) were to express academic publishing costs on a per-article basis, what would that number be?

• publications
• open-access

12 Answers 12

Ubiquity Press breaks down their £300 ($500) APC as follows :

• 38% indirect costs for things not related to the publishing of a single paper but which are needed for the business (£114 or $190)
• 34% covers editorial and production aspects, which appears to be the costs associated with producing the paper, managing submissions, responding to authors, preparing proofs, typesetting, XML etc. (£102 or $170)
• 16% is a waiver premium charged so they can offer 0 or low APCs to people who genuinely cannot pay (£48 or $80)
• 8% is used to pay for indexing, archival (in case they go bust), DOI etc (£24 or $40)
• 4% goes towards costs of billing you and taking payment (£12 or $20)

Depending on what you consider to be the actual publishing costs (here probably the 34% editorial & production costs + 8% Indexing & Archiving) you would be looking at ~ £126 or $210.

Ubiquity don't break their indirect costs down into server/platform costs; this all goes into the 38% indirect cost column.

• 15 This is excellent. I'm now left to ponder why APC's at general, high-profile journals (Science, PLoS, etc.) tend to fall in the $1000-$5000 range. –  Thomas Commented Aug 5, 2015 at 20:40
• 10 @Thomas a combination of very high profit margins for the major publishers (30-40%+, higher than almost every other industry) and systematic incompetence and inefficiency. PLoS is a little different: they charge more in order to invest heavily in outreach, campaigning, and waiving fees for those who can't afford them. –  Richard Smith-Unna Commented Aug 16, 2015 at 19:37
• 12 Is it ever written explicitly that those percentages sum up to £300? From what they write, they could sum up to £1, and the other £299 is their profit. –  Federico Poloni Commented May 2, 2018 at 14:31
• 3 According to this breakdown the publisher makes zero profit. Hard to believe. –  henning no longer feeds AI Commented Jun 22, 2019 at 15:40
• 3 @henning well the linked website says "Our fees are fully transparent - you can trust us that every penny goes towards providing a high quality, sustainable publishing service, and not towards sky-high publisher profits." So perhaps, as Gavin says, they reinvest all their profits in the company. In the US this would mean they could potentially attain non-profit status like university presses. But they are British so perhaps they are unable or there is no value in it, since they never actually use the term. –  A Simple Algorithm Commented Jun 24, 2019 at 3:31

I know this doesn't refer strictly to the final version of a paper, but the arXiv pre-print server provides a useful bit of information to contribute to this discussion. According to its website , it receives around 76,000 publications per year. Its operating costs are on the order of $826,000 per year.

You do the maths, and it comes to just over $10/article/year. This is without any of the bells and whistles that come with traditional publishing, but provides a nice baseline estimate of what it takes to publish a research article online.

It depends to an extent on how technically-savvy the author community is, and thus what services they need or do not need to be done for them.

For computer science journals, the cost of production is extremely low because authors can typically be expected to do their own typesetting.

An efficient, peer-reviewed, top quality journal can thus be run at a cost of just $6.50 per paper. There is an excellent, detailed breakdown of this figure given by Stuart Shieber about the Journal of Machine Learning Research (JMLR) here .

• 9 Might be illuminating to get the perspective of the Journal of Statistical Software which has been running out UCLA for well over a decade. AFAIK main cost was a RA running the editorial desk plus custom programming. But JSS is about to move ... –  Dirk Eddelbuettel Commented Aug 15, 2015 at 21:33
• I agree, that would be very illuminating. The more data from a variety of journals and disciplines the better! –  rmounce Commented Aug 17, 2015 at 13:29

The closest thing that I was aware of (before reading the other answers - thanks for these) was a report about SciELO. It states that, for Brazilian journals within their portfolio, it costs about USD 200-600 per article from submission via peer review and publication to dissemination and archiving.

It also gives a more detailed breakdown:

Considering the overall operation of the SciELO Brazilian collection, including the costs related to technical co-operation for the development and interoperation of the other national and thematic collections, the online up-to-date publication of the entire collection averages about US$90 per each new article. This estimate includes the actual publishing of the new article ($56 per article, or 62% of the total cost); the operation of the SciELO network portal ($4.20, or 5%), which provides access and retrieval to all of the collections, journals, and articles; SciELO governance, management, and technical co-operation ($2.90, or 3%); the development and maintenance of the technological platform ($22.70, or 25%); and the marketing, dissemination, and expansion of the network ($4.20, or 5%). Alternatively, if the complete editorial flow, from the reception of manuscripts, the peer-review process, editing, and the online SciELO publication, is taken into account, the total cost for each new SciELO Brazilian collection article is estimated to be between US$200 and $600.

• 1 SciELO also had a blog post blog.scielo.org/en/2013/09/18/… –  Nemo Commented Nov 8, 2018 at 20:08

The cheapest journals are typically those controlled directly by academics themselves, although they're not necessarily the most efficient.

There is now (2019) a more comprehensive study of the costs by Alexander Grossmann and Björn Brembs​ :

Here we provide a granular, step-by-step calculation of the costs associated with publishing primary research articles, from submission, through peer-review, to publication, indexing and archiving. We find that these costs range from less than US$200 per article in modern, large scale publishing platforms using post-publication peer-review, to about US$1,000 per article in prestigious journals with rejection rates exceeding 90%. The publication costs for a representative scholarly article today come to lie at around US$400. We discuss the additional non-publication items that make up the difference between publication costs and final price.

Another article from a while ago, Roger Clarke (2007) , finds that for-profit publishers spend thousands of dollars per article on functions which a fully open access and non-profit journal doesn't need or want:

For–profit publishers have higher cost [...] much greater investment in branding, customer relationship management and content protection. [...] a computed per–article cost of US$3,400 compared with US$730 [for non-profit electronic journal].

However, prominent open science advocate Martin Paul Eve warns about The Problems of Unit Costs Per Article .

The problems are well illustrated by the very transparent article by eLife (2020), eLife Latest: The costs of publishing , which shows the differences between fixed and variable costs and the relationship with acceptance rate. Mind you, eLife is a very particular case because of its high selectivity and expensive ways of functioning, for instance it shells out hundreds of dollars to editors and reviewers (on average by published article, so less than half that for each reviewed article).

My own older summary follows.

Some universities run their own OJS instances, either in house or with some external contractors. Hosting often relies on existing infrastructure and staff time is often borrowed from employees the institution already has, so the costs are rarely easy to calculate, but we can figure out the order of magnitude.

For example, take the University of Bologna and the University of Milano : they publish 28 and 23 journals respectively (mostly in humanities), for a total of over 400 and over 600 articles per year respectively (according to DOAJ). For context, this size is comparable to top 15 publishers of OA Italian publications , where the biggest pure OA publisher has around 600 articles per year and the others vary between 500 and 2000.

They're both run with approximately 1 FTE "reserved" employee or less, as far as I know, which costs around 30 k€/year considering the national contract and pension contributions. Additionally they spend a few thousands euro/year on technical support. Even if you triple that amount to account for inefficiencies and unstated costs, that gives you less than 200 €/article in costs. Of course it's just an example for their case.

Some other publishers (typically public research entities or consortia) are transparent enough that we know their costs to provide certain services. See for instance:

• main fixed and variable costs and costs for a marketing campaign in Open Library of Humanities (OLH), UK;
• costs to implement various features in 11 publishers, like OpenAIRE OAI harvesting, ORCID integration, HTML-JATS-XML, article-level metadata ingested in DOAJ, funder information in metadata.
• Some additional numbers from blog.joss.theoj.org/2019/06/… –  Nemo Commented Jun 4, 2019 at 16:07

"The Cost of Publishing an Electronic Journal" is an old article, but it is still worth a read.

In short: with 5 papers per issue, the cost per paper is around 1000$, for a law journal.

By comment: the price is probably lower for fields where authors are using latex or similar text processing tools.

• 3 Can you include more of the relevant information from the article, such as the cost breakdown? –  HDE 226868 Commented Aug 6, 2015 at 14:34
• 2 Adjusting for inflation, that's 1500 USD today. The paper considers 2 to 5 articles per issue typical -- different from most other disciplines. –  henning no longer feeds AI Commented May 3, 2018 at 7:24
• 1 Why does the number of papers per issue make any difference to electronic journals? (for that matter, what does "issue" even mean...) –  Flyto Commented Aug 28, 2018 at 14:43

Most of these answers deal with small jounrals. Most "glam" journals are much more tight-lipped about where all your money goes.

However, eLife (which aims to be glam publication) has had a go at this here and here .

They divide their costs into "technology and innovation" (22%) and "publishing costs" (78%). They further divide "publishing costs" into fixed and marginal (i.e. per article), and claim that per-article costs are £1,798. They claim that their APC covers only the per-article part of their costs, with the rest coming from the institutional funders (Wellcome Trust, Howard Hughes, Max Planck).

Of this about they say about 50% goes on paying editors. eLife is unusual in that not only do they pay their full time editorial staff, but they also pay 39 senior academic editors and 300 reviewing editors for their time (or actually I suspect they buy that time off their employers). This is about 18hrs per article of a professor level editors time I reckon. Seems generous even if that's 1 hour of a full time editor, 2 hours of a senior academic editor and 15hrs of a reviewing editor.

Then there is "Staff and outsourcing" being non-editorial staff "involved in handling submissions and published articles, and outsourced service providers" at about £350. If they publish 1,400 articles a year, I reckon this works out at about 10 full time staff on a postdoc type salary.

Finally there is "online platforms" and "fee collection and waivers". Each at just over £300.

These numbers are all approximate because I'm putting together stuff from two different articles, dealing with two different years and in some cases estimating from graphs.

Schloss Dagstuhl Leibniz-Zentrum für Informatik publishes several open-access computer science conference proceedings, mostly through their LIPIcs imprint. LIPIcs charges a publication fee of 60 (sixty) EUR per published paper , all of which is used to defray Dagstuhl's direct costs. (Other Dagstuhl imprints charge similar publication fees.)

By far the most significant cost is the human labor of copy-editing and assembling complete proceedings. ( Most of the actual typesetting is done by authors using Dagstuhl's latex templates; however, Dagstuhl staff do edit each paper to enforce their strict formatting guidelines. Similarly, the work of assembling proceedings is split between Dagstuhl and the conference organization.) Smaller costs include DOI acquisition, metadata extraction/maintenance, archiving, and server maintenance. Dagstuhl's publications are also permanently archived by the German National Library.

In reference to @Allure's rather dismissive answer, Dagstuhl does not publish anything on paper; they do significant marketing (compared to competing conference publishers like ACM, IEEE, or Springer); they "attend conferences" only in the sense that its scientific members are themselves active researchers; they use their own document management system (which was developed over many years with the support of European research grants); they do not do plagiarism checks (in part because program committees and reviewers already do that themselves); and they leave the actual content of proceedings (but not the formatting) entirely up to the conference organization. As usual in computer science, all substantive editorial work is done by volunteers.

Notably, LIPIcs does not charge their small publication fee to authors , but rather to conferences , where they are typically covered by registration fees. Conferences have to apply to publish their proceedings through LIPIcs, and their acceptance is decided by the volunteer editorial board , based primarily on the likely quality, impact, and longevity of the conference.

Dagstuhl's primary activity of hosting research workshops (again, largely organized by volunteers) makes significant/expensive marketing unnecessary. Dagstuhl doesn't have to advertise to the research community, because the research community already comes to them.

When LIPIcs was established, these publication costs were heavily subsidised by Dagstuhl's general fund, which primarily comes from the German Federal Ministry for Education and Research. In 2015, Dagstuhl was informed by their primary funding agency that their general fund could no longer be used to support publishing activities , because EU regulations forbid government interference in the private publishing market. So I believe the 60EUR fee is an accurate reflection of Dagstuhl's actual per-paper publication costs.

• 2 This could very well be accurate, but for conference proceedings only. I never dealt with CS proceedings, but in physics, they were really easy to handle because the papers just came to me and I didn't need to do anything other than produce them. In fact management actively encouraged us not to spend time on them because 1) tight deadline and 2) sales are going to be poor anyway. When you write "they "attend conferences" only in the sense that its scientific members are themselves active researchers" that's a sign that the publisher's staff aren't attending, as well. –  Allure Commented Jun 23, 2019 at 21:09
• 1 Again, you're being unnecessarily dismissive. In computer science, conference proceedings are far more important than (dare I say "mere"?) journal articles. In particular, papers at strong conferences are reviewed by multiple peers, sometimes more strictly than journal articles. ACM (the Association for Computing Machinery, the primary professional society for computer science) makes a majority of its publication income from proceedings. –  JeffE Commented Jun 24, 2019 at 0:46
• 2 I don't see how this is being unnecessarily dismissive. We're looking at this from the eyes of the publisher's costs, in which case the details of the peer review process aren't really relevant. The point is that when you handle a proceedings, you don't have to do anything except produce the book (you don't even have to market it, because the contract typically includes a bulk purchase). With journals this isn't the case - unless you are a top journal, you have to market the journal to keep getting new submissions, you have to pay for the EMS, etc. –  Allure Commented Jun 24, 2019 at 1:15
• 1 In the same way the cost to produce an individual article in a review volume isn't the same as the cost to produce an individual article in a journal (at least this is the case for physics). Review volume articles tend to be more expensive than proceedings, because they take more effort. Regardless of how much time the publisher spends on proceedings for example, they're still not going to sell more than a handful of copies outside of the bulk purchase, but that's not the case for review volumes (which typically don't have a bulk purchase either). –  Allure Commented Jun 24, 2019 at 1:17
• 1 Finally if the publisher's staff attend conferences, they'd usually do things like set up booths, talk to authors/reviewers/editorial board members, acquire new projects, and so on. Example from Springer attending the American Physical Society meeting: blogs.springeropen.com/springeropen/2018/02/28/… –  Allure Commented Jun 24, 2019 at 1:19

In June 2019, the editorial team at the Journal of Open Source Software calculated that their total costs were just $2.75 per published article. However, they acknowledged that they'd got certain services, and certain items of fixed capital for free, for which most journals have to pay. They went on to construct an estimate of what their total costs would be if they had to pay the typical rate for those items, and came up with $140 per published article.

As one might expect, the price of publishing depends on how good a job the publisher wants to do.

The absolute minimum is around a few tens of dollars. This means the publisher passes copyediting and typesetting to the author, they don't do marketing, they don't attend conferences, they use Open Journal Systems (a free editorial management system that's rather less powerful and difficult to use compared to commercial ones), they don't do plagiarism checks, they leave running the journal entirely up to the editorial board, and so on. By "leave running the journal entirely up to the editorial board", I mean that they passively wait for instructions from the board and don't do anything on their own initiative. If you see a journal whose website looks like it hasn't been updated in years, that's an example. The publisher's staff-to-journal ratio is very low (or they simply don't have as motivated/confident/educated journal staff).

Including all of the above, the minimum increases to ~$500, still with wide uncertainties because a lot depends on human costs. If a publisher is based in a country like India for example, they can have significantly lower production costs than if they're based in the UK. The UK publisher can still outsource production to India, but they also have to pay their employees in the UK which is usually significantly more expensive than if they had been located in India. Acquisition costs is another big question mark, since again it depends on how good a job you want to do. Having PhD scientists as editorial staff (e.g. Physical Review Letters ) makes things a lot more expensive.

I can't easily provide a source for this since it's based on my experience working in publishing. Still, you can get an indirect indication from article processing charges in open access journals. The absolute lowest non-zero APCs are a few tens of dollars (mostly coming from predatory OA publishers). Among non-predatory publishers the lowest APCs are a few hundred dollars. Ubiquity Press is such a publisher. When I visited them a few years ago they seemed to be taking the middle road, doing all the basic stuff but not doing the more expensive top end.

Note this excludes journals with $0 APCs. Journals that charge nothing generally have external funding. Depending on how much funding that is, they might be able to perform any or all of the activities described above.

• Less powerful than which commercial software exactly? –  Nemo Commented May 3, 2018 at 6:22
• 7 "Leave running the journal entirely up to the editorial board" is a feature, not a bug. –  Nemo Commented May 3, 2018 at 6:27
• 2 Also, I agree on the first line. But for the rest you should at least check that it cannot be easily proven false. Publishers of APC-free open access journals exist, which also take care of marketing etc. The cost is often known. See for instance Open Library of Humanities (OLH): blogs.openaire.eu/?p=2940 –  Nemo Commented May 3, 2018 at 6:27
• @Nemo such as Editorial Manager, which is more powerful than OJS (last I checked). Leaving a journal entirely to the editorial board is in my opinion a bad thing. Of course the publisher does not interfere directly with peer review, but there's also things like choosing which articles to feature on the journal's website, writing editorials, and find topics on for invited reviews. One can leave all these to the editorial board (and risk the editorial board doing nothing) or actively move them along. –  Allure Commented May 3, 2018 at 6:49
• 1 +1 If you see a journal whose website looks like it hasn't been updated in years –  GEdgar Commented Nov 4, 2018 at 13:43

I'm adding another answer because it's fundamentally different from the one I wrote above. All numbers sourced from this article . Note it dates from 2013; the absolute numbers are likely to have changed since.

tl; dr: it is a complex question. Here are some of the most relevant quotes.

First paragraph:

Data from the consulting firm Outsell in Burlingame, California, suggest that the science-publishing industry generated $9.4 billion in revenue in 2011 and published around 1.8 million English-language articles — an average revenue per article of roughly $5,000. Analysts estimate profit margins at 20–30% for the industry, so the average cost to the publisher of producing an article is likely to be around $3,500–4,000.

Second paragraph:

Neither PLoS nor BioMed Central [Ed: these were the largest OA publishers at the time the article was written] would discuss actual costs (although both organizations are profitable as a whole), but some emerging players who did reveal them for this article say that their real internal costs are extremely low. Paul Peters, president of the Open Access Scholarly Publishing Association and chief strategy officer at the open-access publisher Hindawi in Cairo, says that last year, his group published 22,000 articles at a cost of $290 per article. Brian Hole, founder and director of the researcher-led Ubiquity Press in London, says that average costs are £200 (US$300). And Binfield says that PeerJ's costs are in the “low hundreds of dollars” per article.

Third paragraph:

The few numbers that are available show that costs vary widely in this sector, too. For example, Diane Sullenberger, executive editor for Proceedings of the National Academy of Sciences in Washington DC, says that the journal would need to charge about $3,700 per paper to cover costs if it went open-access. But Philip Campbell, editor-in-chief of Nature , estimates his journal's internal costs at £20,000–30,000 ($30,000–40,000) per paper. Many publishers say they cannot estimate what their per-paper costs are because article publishing is entangled with other activities. ( Science , for example, says that it cannot break down its per-paper costs; and that subscriptions also pay for activities of the journal's society, the American Association for the Advancement of Science in Washington DC.)

The article gives some details as to why the numbers are so different (two orders of magnitude between Hindawi/Ubiquity and Nature), but that's beyond the scope of the question. For the interested, I suggest reading the article.

SciPost publishes several entirely free journals (free for authors and readers) in the sciences and mathematics with open refereeing. (See also this question .) In their own words, the business model is

We don't charge authors, we don't charge readers, we don't send bills to anybody for our services, and we certainly don't make any profit; we are an academic community service surviving on donations coming primarily from Organizations which benefit from our activities.

They also take an entirely transparent approach, and provide statistics about the average publication expenditure per article . The current expenditure per publication in their largest journal (SciPost Physics) is currently around €600-€640 (up from €440 in 2019).

They don't quite provide the breakdown of what that expenditure entails. But, as can be seen from e.g. the 2018 Annual Report , the main operation costs are salaries paying for editorial administration (supervising refereeing and production processes) and the production of paper proofs.

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Home » How to Publish a Research Paper – Step by Step Guide

How to Publish a Research Paper – Step by Step Guide

Table of Contents

Publishing a research paper is an important step for researchers to disseminate their findings to a wider audience and contribute to the advancement of knowledge in their field. Whether you are a graduate student, a postdoctoral fellow, or an established researcher, publishing a paper requires careful planning, rigorous research, and clear writing. In this process, you will need to identify a research question , conduct a thorough literature review , design a methodology, analyze data, and draw conclusions. Additionally, you will need to consider the appropriate journals or conferences to submit your work to and adhere to their guidelines for formatting and submission. In this article, we will discuss some ways to publish your Research Paper.

How to Publish a Research Paper

To Publish a Research Paper follow the guide below:

• Conduct original research : Conduct thorough research on a specific topic or problem. Collect data, analyze it, and draw conclusions based on your findings.
• Write the paper : Write a detailed paper describing your research. It should include an abstract, introduction, literature review, methodology, results, discussion, and conclusion.
• Choose a suitable journal or conference : Look for a journal or conference that specializes in your research area. You can check their submission guidelines to ensure your paper meets their requirements.
• Prepare your submission: Follow the guidelines and prepare your submission, including the paper, abstract, cover letter, and any other required documents.
• Submit the paper: Submit your paper online through the journal or conference website. Make sure you meet the submission deadline.
• Peer-review process : Your paper will be reviewed by experts in the field who will provide feedback on the quality of your research, methodology, and conclusions.
• Revisions : Based on the feedback you receive, revise your paper and resubmit it.
• Acceptance : Once your paper is accepted, you will receive a notification from the journal or conference. You may need to make final revisions before the paper is published.
• Publication : Your paper will be published online or in print. You can also promote your work through social media or other channels to increase its visibility.

How to Choose Journal for Research Paper Publication

Here are some steps to follow to help you select an appropriate journal:

• Identify your research topic and audience : Your research topic and intended audience should guide your choice of journal. Identify the key journals in your field of research and read the scope and aim of the journal to determine if your paper is a good fit.
• Analyze the journal’s impact and reputation : Check the impact factor and ranking of the journal, as well as its acceptance rate and citation frequency. A high-impact journal can give your paper more visibility and credibility.
• Consider the journal’s publication policies : Look for the journal’s publication policies such as the word count limit, formatting requirements, open access options, and submission fees. Make sure that you can comply with the requirements and that the journal is in line with your publication goals.
• Look at recent publications : Review recent issues of the journal to evaluate whether your paper would fit in with the journal’s current content and style.
• Seek advice from colleagues and mentors: Ask for recommendations and suggestions from your colleagues and mentors in your field, especially those who have experience publishing in the same or similar journals.
• Be prepared to make changes : Be prepared to revise your paper according to the requirements and guidelines of the chosen journal. It is also important to be open to feedback from the editor and reviewers.

List of Journals for Research Paper Publications

There are thousands of academic journals covering various fields of research. Here are some of the most popular ones, categorized by field:

General/Multidisciplinary

• Nature: https://www.nature.com/
• Science: https://www.sciencemag.org/
• PLOS ONE: https://journals.plos.org/plosone/
• Proceedings of the National Academy of Sciences (PNAS): https://www.pnas.org/
• The Lancet: https://www.thelancet.com/
• JAMA (Journal of the American Medical Association): https://jamanetwork.com/journals/jama

Social Sciences/Humanities

• Journal of Personality and Social Psychology: https://www.apa.org/pubs/journals/psp
• Journal of Consumer Research: https://www.journals.uchicago.edu/journals/jcr
• Journal of Educational Psychology: https://www.apa.org/pubs/journals/edu
• Journal of Applied Psychology: https://www.apa.org/pubs/journals/apl
• Journal of Communication: https://academic.oup.com/joc
• American Journal of Political Science: https://ajps.org/
• Journal of International Business Studies: https://www.jibs.net/
• Journal of Marketing Research: https://www.ama.org/journal-of-marketing-research/

Natural Sciences

• Journal of Biological Chemistry: https://www.jbc.org/
• Cell: https://www.cell.com/
• Science Advances: https://advances.sciencemag.org/
• Chemical Reviews: https://pubs.acs.org/journal/chreay
• Angewandte Chemie: https://onlinelibrary.wiley.com/journal/15213765
• Physical Review Letters: https://journals.aps.org/prl/
• Journal of Geophysical Research: https://agupubs.onlinelibrary.wiley.com/journal/2156531X
• Journal of High Energy Physics: https://link.springer.com/journal/13130

Engineering/Technology

• IEEE Transactions on Neural Networks and Learning Systems: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=5962385
• IEEE Transactions on Power Systems: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=59
• IEEE Transactions on Medical Imaging: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=42
• IEEE Transactions on Control Systems Technology: https://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=87
• Journal of Engineering Mechanics: https://ascelibrary.org/journal/jenmdt
• Journal of Materials Science: https://www.springer.com/journal/10853
• Journal of Chemical Engineering of Japan: https://www.jstage.jst.go.jp/browse/jcej
• Journal of Mechanical Design: https://asmedigitalcollection.asme.org/mechanicaldesign

Medical/Health Sciences

• New England Journal of Medicine: https://www.nejm.org/
• The BMJ (formerly British Medical Journal): https://www.bmj.com/
• Journal of the American Medical Association (JAMA): https://jamanetwork.com/journals/jama
• Annals of Internal Medicine: https://www.acpjournals.org/journal/aim
• American Journal of Epidemiology: https://academic.oup.com/aje
• Journal of Clinical Oncology: https://ascopubs.org/journal/jco
• Journal of Infectious Diseases: https://academic.oup.com/jid

List of Conferences for Research Paper Publications

There are many conferences that accept research papers for publication. The specific conferences you should consider will depend on your field of research. Here are some suggestions for conferences in a few different fields:

Computer Science and Information Technology:

• IEEE International Conference on Computer Communications (INFOCOM): https://www.ieee-infocom.org/
• ACM SIGCOMM Conference on Data Communication: https://conferences.sigcomm.org/sigcomm/
• IEEE Symposium on Security and Privacy (SP): https://www.ieee-security.org/TC/SP/
• ACM Conference on Computer and Communications Security (CCS): https://www.sigsac.org/ccs/
• ACM Conference on Human-Computer Interaction (CHI): https://chi2022.acm.org/

Engineering:

• IEEE International Conference on Robotics and Automation (ICRA): https://www.ieee-icra.org/
• International Conference on Mechanical and Aerospace Engineering (ICMAE): http://www.icmae.org/
• International Conference on Civil and Environmental Engineering (ICCEE): http://www.iccee.org/
• International Conference on Materials Science and Engineering (ICMSE): http://www.icmse.org/
• International Conference on Energy and Power Engineering (ICEPE): http://www.icepe.org/

Natural Sciences:

• American Chemical Society National Meeting & Exposition: https://www.acs.org/content/acs/en/meetings/national-meeting.html
• American Physical Society March Meeting: https://www.aps.org/meetings/march/
• International Conference on Environmental Science and Technology (ICEST): http://www.icest.org/
• International Conference on Natural Science and Environment (ICNSE): http://www.icnse.org/
• International Conference on Life Science and Biological Engineering (LSBE): http://www.lsbe.org/

Social Sciences:

• Annual Meeting of the American Sociological Association (ASA): https://www.asanet.org/annual-meeting-2022
• International Conference on Social Science and Humanities (ICSSH): http://www.icssh.org/
• International Conference on Psychology and Behavioral Sciences (ICPBS): http://www.icpbs.org/
• International Conference on Education and Social Science (ICESS): http://www.icess.org/
• International Conference on Management and Information Science (ICMIS): http://www.icmis.org/

How to Publish a Research Paper in Journal

Publishing a research paper in a journal is a crucial step in disseminating scientific knowledge and contributing to the field. Here are the general steps to follow:

• Choose a research topic : Select a topic of your interest and identify a research question or problem that you want to investigate. Conduct a literature review to identify the gaps in the existing knowledge that your research will address.
• Conduct research : Develop a research plan and methodology to collect data and conduct experiments. Collect and analyze data to draw conclusions that address the research question.
• Write a paper: Organize your findings into a well-structured paper with clear and concise language. Your paper should include an introduction, literature review, methodology, results, discussion, and conclusion. Use academic language and provide references for your sources.
• Choose a journal: Choose a journal that is relevant to your research topic and audience. Consider factors such as impact factor, acceptance rate, and the reputation of the journal.
• Follow journal guidelines : Review the submission guidelines and formatting requirements of the journal. Follow the guidelines carefully to ensure that your paper meets the journal’s requirements.
• Submit your paper : Submit your paper to the journal through the online submission system or by email. Include a cover letter that briefly explains the significance of your research and why it is suitable for the journal.
• Wait for reviews: Your paper will be reviewed by experts in the field. Be prepared to address their comments and make revisions to your paper.
• Revise and resubmit: Make revisions to your paper based on the reviewers’ comments and resubmit it to the journal. If your paper is accepted, congratulations! If not, consider revising and submitting it to another journal.
• Address reviewer comments : Reviewers may provide comments and suggestions for revisions to your paper. Address these comments carefully and thoughtfully to improve the quality of your paper.
• Submit the final version: Once your revisions are complete, submit the final version of your paper to the journal. Be sure to follow any additional formatting guidelines and requirements provided by the journal.
• Publication : If your paper is accepted, it will be published in the journal. Some journals provide online publication while others may publish a print version. Be sure to cite your published paper in future research and communicate your findings to the scientific community.

How to Publish a Research Paper for Students

Here are some steps you can follow to publish a research paper as an Under Graduate or a High School Student:

• Select a topic: Choose a topic that is relevant and interesting to you, and that you have a good understanding of.
• Conduct research : Gather information and data on your chosen topic through research, experiments, surveys, or other means.
• Write the paper : Start with an outline, then write the introduction, methods, results, discussion, and conclusion sections of the paper. Be sure to follow any guidelines provided by your instructor or the journal you plan to submit to.
• Edit and revise: Review your paper for errors in spelling, grammar, and punctuation. Ask a peer or mentor to review your paper and provide feedback for improvement.
• Choose a journal : Look for journals that publish papers in your field of study and that are appropriate for your level of research. Some popular journals for students include PLOS ONE, Nature, and Science.
• Submit the paper: Follow the submission guidelines for the journal you choose, which typically include a cover letter, abstract, and formatting requirements. Be prepared to wait several weeks to months for a response.
• Address feedback : If your paper is accepted with revisions, address the feedback from the reviewers and resubmit your paper. If your paper is rejected, review the feedback and consider revising and resubmitting to a different journal.

How to Publish a Research Paper for Free

Publishing a research paper for free can be challenging, but it is possible. Here are some steps you can take to publish your research paper for free:

• Choose a suitable open-access journal: Look for open-access journals that are relevant to your research area. Open-access journals allow readers to access your paper without charge, so your work will be more widely available.
• Check the journal’s reputation : Before submitting your paper, ensure that the journal is reputable by checking its impact factor, publication history, and editorial board.
• Follow the submission guidelines : Every journal has specific guidelines for submitting papers. Make sure to follow these guidelines carefully to increase the chances of acceptance.
• Submit your paper : Once you have completed your research paper, submit it to the journal following their submission guidelines.
• Wait for the review process: Your paper will undergo a peer-review process, where experts in your field will evaluate your work. Be patient during this process, as it can take several weeks or even months.
• Revise your paper : If your paper is rejected, don’t be discouraged. Revise your paper based on the feedback you receive from the reviewers and submit it to another open-access journal.
• Promote your research: Once your paper is published, promote it on social media and other online platforms. This will increase the visibility of your work and help it reach a wider audience.

Journals and Conferences for Free Research Paper publications

Here are the websites of the open-access journals and conferences mentioned:

Open-Access Journals:

• PLOS ONE – https://journals.plos.org/plosone/
• BMC Research Notes – https://bmcresnotes.biomedcentral.com/
• Frontiers in… – https://www.frontiersin.org/
• Journal of Open Research Software – https://openresearchsoftware.metajnl.com/
• PeerJ – https://peerj.com/

Conferences:

• IEEE Global Communications Conference (GLOBECOM) – https://globecom2022.ieee-globecom.org/
• IEEE International Conference on Computer Communications (INFOCOM) – https://infocom2022.ieee-infocom.org/
• IEEE International Conference on Data Mining (ICDM) – https://www.ieee-icdm.org/
• ACM SIGCOMM Conference on Data Communication (SIGCOMM) – https://conferences.sigcomm.org/sigcomm/
• ACM Conference on Computer and Communications Security (CCS) – https://www.sigsac.org/ccs/CCS2022/

Importance of Research Paper Publication

Research paper publication is important for several reasons, both for individual researchers and for the scientific community as a whole. Here are some reasons why:

• Advancing scientific knowledge : Research papers provide a platform for researchers to present their findings and contribute to the body of knowledge in their field. These papers often contain novel ideas, experimental data, and analyses that can help to advance scientific understanding.
• Building a research career : Publishing research papers is an essential component of building a successful research career. Researchers are often evaluated based on the number and quality of their publications, and having a strong publication record can increase one’s chances of securing funding, tenure, or a promotion.
• Peer review and quality control: Publication in a peer-reviewed journal means that the research has been scrutinized by other experts in the field. This peer review process helps to ensure the quality and validity of the research findings.
• Recognition and visibility : Publishing a research paper can bring recognition and visibility to the researchers and their work. It can lead to invitations to speak at conferences, collaborations with other researchers, and media coverage.
• Impact on society : Research papers can have a significant impact on society by informing policy decisions, guiding clinical practice, and advancing technological innovation.

Advantages of Research Paper Publication

There are several advantages to publishing a research paper, including:

• Recognition: Publishing a research paper allows researchers to gain recognition for their work, both within their field and in the academic community as a whole. This can lead to new collaborations, invitations to conferences, and other opportunities to share their research with a wider audience.
• Career advancement : A strong publication record can be an important factor in career advancement, particularly in academia. Publishing research papers can help researchers secure funding, grants, and promotions.
• Dissemination of knowledge : Research papers are an important way to share new findings and ideas with the broader scientific community. By publishing their research, scientists can contribute to the collective body of knowledge in their field and help advance scientific understanding.
• Feedback and peer review : Publishing a research paper allows other experts in the field to provide feedback on the research, which can help improve the quality of the work and identify potential flaws or limitations. Peer review also helps ensure that research is accurate and reliable.
• Citation and impact : Published research papers can be cited by other researchers, which can help increase the impact and visibility of the research. High citation rates can also help establish a researcher’s reputation and credibility within their field.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Prospective authors are invited to submit original papers not being considered for publishing elsewhere describing new theoretical and/or experimental research. Submissions will be judged on the 10 criteria mentioned in the 6 th step below.

Steps for Submitting and Publishing Research Paper

• Create your research paper document with sections like abstract, introduction, related research work, research methods you used, conclusion, references etc. and format it according to our journal's recommended format. You can download the sample document to follow the formatting.
• Fill the online form to submit your research paper .
• You will get paper submission acknowledgment email after submitting your research paper.
• One of the editorial board members will analyse the research paper briefly and will decide if the research is in accordance with the guidelines and policies of our journal or not.
• The editor will then send the research paper for double-blind peer review to one of the reviewers of our journal.
• Relevance of Title and Research Article
• Scholarly Quality
• Continuity in the Article
• Use of Theory
• Novelty and Originality
• Technical Contents and Correctness
• Understanding and Illustrations
• Critical Qualities
• Quality of References
• Clarity of Conclusions
• It could take 1 or 2 days to review a research paper. A notification email is sent to the 1 st author after reviewing.
• On acceptance of the research paper for publication, you need to pay the publication fee . Take a photo/screenshot of the payment.
• Then, you need to download the copyright permission form and undertaking forms , read the conditions carefully, fill the forms using a PDF reader software if you are agree to the conditions, save the PDF file and submit it to us along with the proof of payment.
• The forms and payment are verified, and research paper is published within 1-2 days.
• When research paper is published, e-certificates (digital certificates) for all the authors are sent along with the publish notification email. You can also download digital certificate of publication of your research paper from the track status page .

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Academic Referencing: How to Cite a Research Paper

Learning how to conduct accurate, discipline-specific academic research can feel daunting at first. But, with a solid understanding of the reasoning behind why we use academic citations coupled with knowledge of the basics, you’ll learn how to cite sources with accuracy and confidence.

When it comes to academic research, citing sources correctly is arguably as important as the research itself. "Your instructors are expecting your work to adhere to these professional standards," said Amanda Girard , research support manager of Shapiro Library at Southern New Hampshire University (SNHU).

With Shapiro Library for the past three years, Girard manages the library’s research support services, which includes SNHU’s 24/7 library chat and email support. She holds an undergraduate degree in professional writing and a graduate degree in library and information science. She said that accurate citations show that you have done your research on a topic and are knowledgeable about current ideas from those actively working in the field.

In other words, when you cite sources according to the academic style of your discipline, you’re giving credit where credit is due.

Why Cite Sources?

Citing sources properly ensures you’re following high academic and professional standards for integrity and ethics.

“When you cite a source, you can ethically use others’ research. If you are not adequately citing the information you claim in your work, it would be considered plagiarism ,” said Shannon Geary '16 , peer tutor at SNHU.

Geary has an undergraduate degree in communication  from SNHU and has served on the academic support team for close to 2 years. Her job includes helping students learn how to conduct research  and write academically.

“In academic writing, it is crucial to state where you are receiving your information from,” she said. “Citing your sources ensures that you are following academic integrity standards.”

According to Geary and Girard, several key reasons for citing sources are:

• Access. Citing sources points readers to original sources. If anyone wants to read more on your topic, they can use your citations as a roadmap to access the original sources.
• Attribution. Crediting the original authors, researchers and experts  shows that you’re knowledgeable about current ideas from those actively working in the field and adhering to high ethical standards, said Girard.
• Clarity. “By citing your sources correctly, your reader can follow along with your research,” Girard said.
• Consistency. Adhering to a citation style provides a framework for presenting ideas within similar academic fields. “Consistent formatting makes accessing, understanding and evaluating an author's findings easier for others in related fields of study,” Geary said.
• Credibility. Proper citation not only builds a writer's authority but also ensures the reliability of the work, according to Geary.

Ultimately, citing sources is a formalized way for you to share ideas as part of a bigger conversation among others in your field. It’s a way to build off of and reference one another’s ideas, Girard said.

How Do You Cite an Academic Research Paper?

Any time you use an original quote or paraphrase someone else’s ideas, you need to cite that material, according to Geary.

“The only time we do not need to cite is when presenting an original thought or general knowledge,” she said.

While the specific format for citing sources can vary based on the style used, several key elements are always included, according to Girard. Those are:

• Title of source
• Type of source, such as a journal, book, website or periodical

By giving credit to the authors, researchers and experts you cite, you’re building credibility. You’re showing that your argument is built on solid research.

“Proper citation not only builds a writer's authority but also ensures the reliability of the work,” Geary said. “Properly formatted citations are a roadmap for instructors and other readers to verify the information we present in our work.”

Common Citation Styles in Academic Research

Certain disciplines adhere to specific citation standards because different disciplines prioritize certain information and research styles . The most common citation styles used in academic research, according to Geary, are:

• American Psychological Association, known as APA . This style is standard in the social sciences such as psychology, education and communication. “In these fields, research happens rapidly, which makes it exceptionally important to use current research,” Geary said.
• Modern Language Association, known as MLA . This style is typically used in literature and humanities because of the emphasis on literature analysis. “When citing in MLA, there is an emphasis on the author and page number, allowing the audience to locate the original text that is being analyzed easily,” Geary said.
• Chicago Manual of Style, known as Chicago . This style is typically used in history, business and sometimes humanities. “(Chicago) offers flexibility because of the use of footnotes, which can be seen as less distracting than an in-text citation,” Geary said.

The benefit of using the same format as other researchers within a discipline is that the framework of presenting ideas allows you to “speak the same language,” according to Girard.

APA Citation for College: A Brief Overview

Are you writing a paper that needs to use APA citation, but don’t know what that means? No worries. You’ve come to the right place.

How to Use MLA Formatting: A Brief Overview

Are you writing a paper for which you need to know how to use MLA formatting, but don’t know what that means? No worries. You’ve come to the right place.

How to Ensure Proper Citations

Keeping track of your research as you go is one of the best ways to ensure you’re citing appropriately and correctly based on the style that your academic discipline uses.

“Through careful citation, authors ensure their audience can distinguish between borrowed material and original thoughts, safeguarding their academic reputation and following academic honesty policies,” Geary said.

Some tips that she and Girard shared to ensure you’re citing sources correctly include:

• Keep track of sources as you work. Writers should keep track of their sources every time an idea is not theirs, according to Geary. “You don’t want to find the perfect research study and misplace its source information, meaning you’d have to omit it from your paper,” she said.
• Practice. Even experienced writers need to check their citations before submitting their work. “Citing requires us to pay close attention to detail, so always start your citation process early and go slow to ensure you don’t make mistakes,” said Geary. In time, citing sources properly becomes faster and easier.
• Use an Online Tool . Geary recommends the Shapiro Library citation guide . You can find sample papers, examples of how to cite in the different academic styles and up-to-date citation requirements, along with information and examples for APA, MLA and Chicago style citations.
• Work with a Tutor. A tutor can offer support along with tips to help you learn the process of academic research. Students at SNHU can connect with free peer tutoring through the Academic Support tab in their online courses, though many colleges and universities offer peer tutoring.

Find Your Program

How to cite a reference in academic writing.

A citation consists of two pieces: an in-text citation that is typically short and a longer list of references or works cited (depending on the style used) at the end of the paper.

“In-text citations immediately acknowledge the use of external source information and its exact location,” Geary said. While each style uses a slightly different format for in-text citations that reference the research, you may expect to need the page number, author’s name and possibly date of publication in parentheses at the end of a sentence or passage, according to Geary.

A longer entry listing the complete details of the resource you referenced should also be included on the references or works cited page at the end of the paper. The full citation is provided with complete details of the source, such as author, title, publication date and more, Geary said.

The two-part aspect of citations is because of readability. “You can imagine how putting the full citation would break up the flow of a paper,” Girard said. “So, a shortened version is used (in the text).”

“For example, if an in-text citation reads (Jones, 2024), the reader immediately knows that the ideas presented are coming from Jones’s work, and they can explore the comprehensive citation on the final page,” she said.

The in-text citation and full citation together provide a transparent trail of the author's process of engaging with research.

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A symptom was included if at least 5% of infected or uninfected participants reported experiencing that symptom. Adjusted odds ratios and risk differences were estimated from models that included infection status as the exposure and the presence of each prolonged symptom as the outcome, with adjustment for sex assigned at birth and race and ethnicity (see eMethods in Supplement 3 ).

A, Least absolute shrinkage and selection operator (LASSO) was used to fit a logistic regression model to identify which symptoms could be used to identify individuals likely to have PASC. Estimated log odds ratios were divided by 0.10 and rounded up to the nearest 0.5 to calculate symptom scores. An individual’s PASC research index is calculated by summing the scores for each prolonged symptom a participant reported (ie, the participant experienced the symptom for 4 weeks since the beginning of the pandemic and is currently experiencing it at the time of the survey). B, The optimal index threshold for PASC was selected using bootstrapping to estimate standard error bars. An approximation of the “elbow” method was used to identify the cutoff where the number of uninfected participants misclassified as PASC-probable stabilized (eMethods in Supplement 3 ). The threshold (index of at least 5.5) can be used to identify school-age children with PASC for research purposes. Using this threshold, the percentage of infected PASC-probable school-age children with each symptom was as follows: headache, 55%; trouble with memory or focusing, 45%; trouble sleeping, 44%; stomach pain, 43%; nausea or vomiting, 34%; back or neck pain, 30%; itchy skin or skin rash, 29%; fear about specific things, 26%; feeling lightheaded or dizzy, 26%; and refusing to go to school, 23%. C, Participant responses to 3 questions from the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10 survey, stratified into 7 groups: participants with a zero PASC research index and no prolonged symptoms, zero PASC research index but at least 1 prolonged symptom, and participants with nonzero PASC index, divided into quintiles. The dark vertical line indicates the index threshold for PASC. Each cell is shaded according to the frequency of each response within each column, ranging from 0% to 100%.

A, Least absolute shrinkage and selection operator (LASSO) was used to fit a logistic regression model to identify which symptoms could be used to identify individuals likely to have PASC. Estimated log odds ratios were divided by 0.10 and rounded up to the nearest 0.5 to calculate symptom scores. An individual’s PASC research index is calculated by summing the scores for each prolonged symptom a participant reported (ie, the participant experienced the symptom for 4 weeks since the beginning of the pandemic and is currently experiencing it at the time of the survey). B, The optimal index threshold for PASC was selected using 95% CIs to estimate error bars. An approximation of the “elbow” method was used to identify the cutoff where the number of uninfected participants misclassified as PASC-probable stabilized (eMethods in Supplement 3 ). The threshold (index of at least 5) can be used to identify adolescents with PASC for research purposes. Using this threshold, the percentage of infected PASC-probable adolescents with each symptom was as follows: daytime tiredness/sleepiness or low energy, 80%; body, muscle, or joint pain, 61%; headache, 56%; trouble with memory or focusing, 47%; tired after walking, 42%; back or neck pain, 40%; feeling lightheaded or dizzy, 39%; and change or loss in smell or taste, 34%. C, Participant responses to 3 questions from the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 10 survey, stratified into 7 groups: participants with a zero PASC research index and no prolonged symptoms, zero PASC research index but at least 1 prolonged symptoms, and participants with nonzero PASC index, divided into quintiles. The dark vertical line indicates the index threshold for PASC (to the left is PASC-unspecified, to the right is PASC-probable). Each cell is shaded according to the frequency of each response within each column, ranging from 0% to 100%.

Symptoms, sorted from most to least common in the study population overall, are in the center column. Left columns correspond to school-age children in 3 groups: uninfected, infected and not meeting the PASC research index threshold (infected, PASC-unspecified), and infected and meeting the PASC research index threshold (infected, PASC-probable). The columns on the right correspond to adolescents with columns in the reverse order. Note that school-age children were not asked about panic attacks. Frequency of each prolonged symptom is indicated by shading, from 0% to 100%.

A and B, Subgroups formed using consensus clustering to group participants with similar symptom profiles (based on prolonged symptoms contributing to the PASC research index only). Four clusters were identified in PASC-probable school-age children and 3 clusters among adolescents. C and D, Frequencies of each prolonged symptom are shown for each cluster, where shading indicates frequency from 0%-100%. Symptoms that contribute to the PASC research index are above the dark horizontal line, and those below do not contribute to the PASC research index, sorted in decreasing frequency among all PASC-probable participants. Symptoms present in <5% of participants in every cluster were omitted. The full set of symptoms is in eFigure 6 in Supplement 3 .

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• Uncovering Pediatric Long COVID JAMA Editorial August 21, 2024 Suchitra Rao, MBBS, MSCS

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Gross RS , Thaweethai T , Kleinman LC, et al. Characterizing Long COVID in Children and Adolescents. JAMA. Published online August 21, 2024. doi:10.1001/jama.2024.12747

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Characterizing Long COVID in Children and Adolescents

• 1 Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York
• 2 Department of Biostatistics, Massachusetts General Hospital, Boston
• 3 Department of Medicine, Harvard Medical School, Boston, Massachusetts
• 4 Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
• 5 Bristol Myers Squibb Children’s Hospital, New Brunswick, New Jersey
• 6 Division of Infectious Diseases, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock
• 7 Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
• 8 Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
• 9 Division of Respiratory Medicine, Department of Pediatrics, UC San Diego School of Medicine, Rady Children’s Hospital, San Diego, California
• 10 Division of Child and Community Health, Department of Pediatrics, UC San Diego School of Medicine, Rady Children’s Hospital, San Diego, California
• 11 Departments of Cognitive Science, Psychiatry, and Radiology, UC San Diego School of Medicine, Rady Children’s Hospital, San Diego, California
• 12 School of Nursing, Virginia Commonwealth University, Richmond
• 13 Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
• 14 Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
• 15 Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
• 16 Department of Cardiology, Harvard Medical School, Boston, Massachusetts
• 17 Boston Children’s Hospital, Boston, Massachusetts
• 18 Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City
• 19 Division of General Pediatrics, Department of Pediatrics, University of California, San Francisco
• 20 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City
• 21 Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Massachusetts General Hospital, Boston
• 22 Brigham and Women’s Hospital, Boston, Massachusetts
• 23 Division of Neurology, Department of Neurology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
• 24 Massachusetts General Hospital, Boston
• 25 Division of Child Study Center, Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York
• 26 Department of Medicine, NYU Grossman School of Medicine, New York
• 27 Division of Pediatric Critical Care Medicine, Department of Pediatrics, NYU Grossman School of Medicine, New York
• 28 Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York
• 29 NYU Grossman School of Medicine, Bellevue Hospital Center, New York
• 30 Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York
• 31 RECOVER Patient, Caregiver, or Community Advocate Representative, New York, New York
• 32 Long Covid Families, Charlotte, North Carolina
• 33 Division of Long COVID, Department of Pandemic Equity, Vermont Center for Independent Living, Montpelier
• 34 Patient Led Research Collaborative, Washington, DC
• 35 CORe Community, Inc (COVID Recovery through Community, a 501c3), New York, New York
• 36 Division of Community Impact, Department of Health Strategies, American Heart Association, Atlanta, Georgia
• 37 Division of Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston
• 38 Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
• 39 Department of Population and Family Health, Mailman School of Public Health, New York-Presbyterian Hospital, New York
• Editorial Uncovering Pediatric Long COVID Suchitra Rao, MBBS, MSCS JAMA

Question   What prolonged symptoms experienced by youth are most associated with SARS-CoV-2 infection?

Findings   Among 5367 participants in the RECOVER-Pediatrics cohort study, 14 symptoms in both school-age children (6-11 years) and adolescents (12-17 years) were more common in those with vs without SARS-CoV-2 infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. Empirically derived indices for PASC research and associated clustering patterns were developed.

Meaning   This study developed research indices for characterizing pediatric PASC. Symptom patterns were similar but distinguishable between school-age children and adolescents, highlighting the importance of characterizing PASC separately in different age groups.

Importance   Most research to understand postacute sequelae of SARS-CoV-2 infection (PASC), or long COVID, has focused on adults, with less known about this complex condition in children. Research is needed to characterize pediatric PASC to enable studies of underlying mechanisms that will guide future treatment.

Objective   To identify the most common prolonged symptoms experienced by children (aged 6 to 17 years) after SARS-CoV-2 infection, how these symptoms differ by age (school-age [6-11 years] vs adolescents [12-17 years]), how they cluster into distinct phenotypes, and what symptoms in combination could be used as an empirically derived index to assist researchers to study the likely presence of PASC.

Design, Setting, and Participants   Multicenter longitudinal observational cohort study with participants recruited from more than 60 US health care and community settings between March 2022 and December 2023, including school-age children and adolescents with and without SARS-CoV-2 infection history.

Exposure   SARS-CoV-2 infection.

Main Outcomes and Measures   PASC and 89 prolonged symptoms across 9 symptom domains.

Results   A total of 898 school-age children (751 with previous SARS-CoV-2 infection [referred to as infected ] and 147 without [referred to as uninfected ]; mean age, 8.6 years; 49% female; 11% were Black or African American, 34% were Hispanic, Latino, or Spanish, and 60% were White) and 4469 adolescents (3109 infected and 1360 uninfected; mean age, 14.8 years; 48% female; 13% were Black or African American, 21% were Hispanic, Latino, or Spanish, and 73% were White) were included. Median time between first infection and symptom survey was 506 days for school-age children and 556 days for adolescents. In models adjusted for sex and race and ethnicity, 14 symptoms in both school-age children and adolescents were more common in those with SARS-CoV-2 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life. The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise–related symptoms in adolescents. Clustering analyses identified 4 PASC symptom phenotypes in school-age children and 3 in adolescents.

Conclusions and Relevance   This study developed research indices for characterizing PASC in children and adolescents. Symptom patterns were similar but distinguishable between the 2 groups, highlighting the importance of characterizing PASC separately for these age ranges.

Long COVID, or postacute sequelae of SARS-CoV-2 infection (PASC), has been broadly defined as symptoms, signs, and conditions that develop, persist, or relapse over time after SARS-CoV-2 infection. 1 , 2 These symptoms can last weeks, months, or years after the acute infection resolves and can have debilitating effects. Some experts believe that worldwide, an estimated 65 million people are living with PASC, 3 with impacts on population-level health anticipated to last for decades. Most research characterizing PASC has focused on adults, 4 leading to misperception that pediatric PASC is rare or presents similarly to PASC in adults. 5 , 6 This may lead clinicians to miss symptoms or misdiagnose children. Consistent with the life course framework in which developmental stage influences health outcomes, 7 PASC may present in both similar and different ways compared with adults.

Studies of pediatric PASC have documented a wide range of symptoms involving every organ system. 8 - 11 Most pediatric research has focused on individual symptoms and either pooled data from different ages or focused on adolescents. Little is known about differences in PASC symptoms between school-age children (6-11 years) and adolescents (12-17 years). 12 , 13 The absence of a consistent analytic approach to objectively identify children with PASC hinders the research needed to identify underlying mechanisms of disease and treatment targets. The National Institutes of Health–funded Researching COVID to Enhance Recovery ( RECOVER ) Initiative aims to fill these gaps by bringing together researchers, clinicians, communities, and families in a comprehensive study of PASC in children. 14 The aims of this analysis of the RECOVER-Pediatrics cohort were to identify (1) common prolonged symptoms experienced by children (6 to 17 years old) after SARS-CoV-2 infection, (2) how these symptoms differ by age (school-age vs adolescents), (3) how symptoms cluster into phenotypes, and (4) what symptoms in combination could be used as an empirically derived index to help researchers consistently assess the likely presence of PASC. These indices, like the one previously developed for the RECOVER-Adult cohort (18 years or older), 15 were intended to be used to identify factors that distinguish children who likely have developed PASC from those who may not have and to help evaluate risk factors for developing PASC, elucidate its pathophysiology, and enable follow-up to analyze recovery and relapse.

The RECOVER Pediatric Observational Cohort Study (RECOVER-Pediatrics) 14 is a combined retrospective and prospective longitudinal study including 4 cohorts. Data presented are from 2 cohorts: the de novo RECOVER cohort, including participants from birth through 25 years with and without SARS-CoV-2 infection history newly recruited from health care and community settings, and the extant National Institutes of Health–funded Adolescent Brain Cognitive Development cohort, 16 - 18 the largest long-term US study of brain development in adolescence. The protocol and statistical analysis plan for RECOVER-Pediatrics were previously described 19 (see Supplements 1 and 2 ). Data were obtained from more than 60 sites (eTable 1 in Supplement 3 ). The study received institutional review board approval from NYU Grossman School of Medicine (de novo cohort) or UC San Diego Human Research Protections Program (Adolescent Brain Cognitive Development cohort), with other institutions relying on these single institutional review boards. Caregiver-child pairs provided informed consent and age-appropriate assent. Strengthening and Reporting of Observational Studies in Epidemiology (STROBE) guidelines were followed.

The analytic sample included individuals aged 6 to 17 years enrolled between March 16, 2022, and December 16, 2023, with and without known SARS-CoV-2 infection history ( infected and uninfected , respectively). Child age was recorded at symptom survey completion.

For these analyses, the infected group included participants who completed their survey about prolonged symptoms at least 90 days after their first infection, reported by their caregivers (eMethods in Supplement 3 ). SARS-CoV-2 antibodies were not required. The uninfected group was defined by caregiver report and required confirmation of negative nucleocapsid antibodies at enrollment. Those thought to be uninfected but found to be antibody-positive (Ab+) within 30 days of survey completion were analyzed separately to understand asymptomatic infection. 20 Throughout, uninfected refers strictly to uninfected participants who were confirmed to be nucleocapsid antibody–negative.

Infected participants with an unknown date for their first infection, participants with history of multisystem inflammatory syndrome in children (because this is a well-characterized entity), 21 - 25 uninfected participants without antibody testing, and participants with missing symptom surveys (defined as <50% of questions completed) were excluded.

Caregivers completed a comprehensive symptom survey remotely (interviewer-administered if needed) assessing 89 prolonged symptoms across 9 domains, using health literacy–informed principles and plain-language descriptions (eTable 2 in Supplement 3 ). 19 , 26 Some symptoms describing a similar phenotype were combined into composites, resulting in 75 symptoms (eMethods in Supplement 3 ): general (12 symptoms), eyes/ears/nose/throat (15 symptoms), heart/lungs (10 symptoms), gastrointestinal (6 symptoms), dermatologic (5 symptoms), musculoskeletal (3 symptoms), neurologic (6 symptoms), behavioral/psychological (14 symptoms), and menstrual (4 symptoms). The same symptoms were assessed in both age groups (except panic attacks, which were assessed in adolescents only). Menstrual symptoms were assessed in those assigned female or intersex at birth and who started menstruating (reported only among adolescents).

The primary outcome was a prolonged symptom lasting for more than 4 weeks that started or became worse since the beginning of the pandemic and was present at the time of survey completion (at least 90 days after infection). If a symptom lasted for more than 4 weeks but was absent at survey completion, it was not counted as a prolonged symptom.

Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scales were assessed, measuring caregiver perception of the child’s overall health, physical health, and quality of life. 27

The main exposure variable was SARS-CoV-2 infection. Other variables included sex, race and ethnicity, geographic origin, time since SARS-CoV-2 infection, calendar time of enrollment, and SARS-CoV-2 vaccination status (eMethods in Supplement 3 ). Like other variables, race and ethnicity were collected via caregiver report based on prespecified categories and measured to enhance understanding of racial and ethnic differences in PASC. Caregiver variables included relationship to child and educational attainment.

Statistical analyses were modeled after those published for RECOVER-Adult and were age-stratified. 15 The analysis calculated the proportion of participants who reported each prolonged symptom and who reported experiencing at least 1 prolonged symptom among infected and uninfected participants separately (eTable 3 in Supplement 3 ). For symptoms present in at least 5% of infected participants (candidate symptoms), the risk difference, odds ratio, and relative risk for infected vs uninfected participants were estimated using linear, logistic, and Poisson regression, respectively, adjusting for sex and race and ethnicity (eMethods in Supplement 3 ). Second, to identify combinations of symptoms that could be used for research, a penalized logistic regression approach (least absolute shrinkage and selection operator [LASSO]) 28 was used to identify what candidate symptoms (predictors) were best at differentiating participants with or without an infection history (outcome). 15 Because all sexes were combined for this analysis, menstrual symptoms were excluded. Based on the model fit, each symptom was assigned a score corresponding to the estimated log odds ratio, where a higher symptom score indicated a stronger association with infection. A total index was calculated for each participant by summing the individual scores for each symptom reported. An optimal index threshold for identifying PASC was selected based on the proportion of uninfected participants who were likely misclassified as having PASC (eMethods in Supplement 3 ). Participants meeting the index threshold were categorized as PASC-probable and others were categorized as PASC-unspecified . PASC rates were reported among infected and uninfected participants separately. Among infected participants, these rates were also reported by whether they were infected by December 1, 2021 (when the Omicron variant became the dominant US strain).

Third, the analysis examined correlations between PASC indices and caregiver-reported overall child health, quality of life, and physical health and symptoms selected by LASSO. Further, the frequency of all symptoms was reported in infected PASC-probable, infected PASC-unspecified, and uninfected participants separately. Fourth, symptom patterns were investigated among infected participants categorized as PASC-probable. Correlations between symptoms contributing to the PASC index among infected PASC-probable participants were calculated. K-means consensus clustering was performed based on symptoms contributing to the PASC index to identify distinct PASC symptom profiles. 29 The number of different systems affected among infected PASC-probable participants was then summarized by counting the systems in which at least 1 prolonged symptom was reported. Fifth, we summarized the characteristics and symptomatology of uninfected participants found to be Ab+.

This study included 751 infected and 147 uninfected school-age children and 3109 infected and 1369 uninfected adolescents (see cohort identification details in eFigure 1 in Supplement 3 ). The Table and eTable 4 in Supplement 3 contain demographic and infection history characteristics, respectively. eTable 5 in Supplement 3 contains demographic characteristics for the adolescent cohort, stratified by recruiting cohort (Adolescent Brain Cognitive Development vs de novo).

Overall, 45% of infected (338/751) and 33% of uninfected (48/147) school-age children and 39% of infected (1219/3109) and 27% of uninfected (372/1369) adolescents reported having at least 1 prolonged symptom. Twenty-six symptoms in infected school-age children and 18 symptoms in infected adolescents were prolonged in at least 5% of participants ( Figure 1 ). The lower 95% confidence bound of the adjusted odds ratio exceeded 0 for 14 symptoms in both school-age children and adolescents, with 4 additional symptoms in school-age children only and 3 in adolescents only ( Figure 1 ). The frequency of each symptom among infected participants did not differ after stratification into quintiles based on time between first infection and symptom survey date (eFigure 2 in Supplement 3 ).

The LASSO analysis identified 10 symptoms in school-age children and 8 in adolescents that were most associated with infection history ( Figures 2 A and 3 A). Optimal index thresholds of 5.5 in school-age children and 5.0 in adolescents were identified ( Figures 2 B and 3 B). Overall, 152 infected (20%) and 6 uninfected (4%) school-age children and 445 infected (14%) and 44 uninfected (3%) adolescents met or exceeded this index threshold (eTable 6 in Supplement 3 ). This percentage was higher for participants infected before vs after the emergence of Omicron (21% vs 14% for school-age children; 17% vs 7% for adolescents). Correlations between symptoms that contributed to the index are shown in eFigure 3 in Supplement 3 . Correlations between these symptoms and those that did not contribute to the index are shown in eTable 7 in Supplement 3 . Some uninfected participants may have met the index threshold due to misclassification or due to having other symptoms.

In both age groups, higher PASC research indices were correlated with worse PROMIS scores ( Figures 2 C and 3 C). The number of systems affected among infected PASC-probable participants (eFigure 4 in Supplement 3 ) indicated substantial multisystem burden.

Figure 4 shows the percentage of participants in each age group experiencing each symptom after stratification into 3 subgroups: infected PASC-probable, infected PASC-unspecified, and uninfected. The most common prolonged symptom among PASC-probable school-age children that also contributed to the PASC research index ( Figures 2 B and 4 ) was headache (57%), followed by trouble with memory/focusing and trouble sleeping (44%) and stomach pain (43%). Among symptoms that did not contribute to the index, body/muscle/joint pain (51%), daytime tiredness/sleepiness or low energy (49%), and feeling anxious (47%) were the most common ( Figure 4 ). The distribution of symptoms was similar between PASC-unspecified and uninfected school-age children.

Among PASC-probable adolescents, the most common prolonged symptoms contributing to the index ( Figures 3 B and 4 ) were daytime tiredness/sleepiness or low energy (80%), body/muscle/joint pain (60%), headaches (55%), and trouble with memory/focusing (47%). Among symptoms that did not contribute to the index, trouble sleeping (47%), feeling anxious (47%), and feeling sad/depressed (38%) were the most common ( Figure 4 ). The distribution of symptoms was similar between PASC-unspecified and uninfected adolescent participants.

Among school-age children, 4 symptom clusters were identified ( Figure 5 ). Cluster 1 had high rates of many symptoms and the highest symptom burden. Cluster 2 was characterized by high rates of headache (95%), body/muscle/joint pain (60%), and daytime tiredness/sleepiness or low energy (52%). Cluster 3 was characterized by higher rates of trouble sleeping (64%) and trouble with memory/focusing (62%). Cluster 4 was characterized predominantly by stomach pain (100%) and nausea/vomiting (61%). Among adolescents, 3 clusters were identified ( Figure 5 ). Cluster 1 had high rates of many symptoms, similar to the first school-age cluster. Cluster 2 was characterized by high rates of daytime tiredness/sleepiness or low energy (89%) and body/muscle/joint pain (87%). Cluster 3 was characterized by having change/loss in smell or taste (100%), with relatively low rates of all other symptoms. The clusters with the most symptoms in both school-age children and adolescents (cluster 1) had the highest mean number of systems affected (eTable 8 in Supplement 3 ) and were correlated with poorer overall health and quality of life (eFigure 5 in Supplement 3 ).

Overall, 64 school-age children and 781 adolescents enrolled as uninfected but were Ab+ (ie, asymptomatically infected; eFigure 1 and eTable 9 in Supplement 3 ). Among school-age children, 6 (9%) met the index threshold whereas 18 (28%) reported experiencing at least 1 prolonged symptom. Among adolescents, 29 (4%) met the index threshold and 175 (22%) reported at least 1 prolonged symptom.

Symptom frequencies for all groups (infected, uninfected, and uninfected Ab+), including estimated risk ratios and odds ratios, are shown in eTable 10 in Supplement 3 .

In this large-scale study, children with probable PASC experienced prolonged symptoms in almost every organ system, with the majority having multisystem involvement. A clear pattern of symptom differences was identified between school-age children and adolescents, underscoring the importance of characterizing PASC separately in these 2 age groups.

This study developed an empirically derived index that can be used to help researchers identify children likely to have PASC, which was associated with overall health, physical health, and quality of life. This PASC research index, distinct for each age group, used combinations of 10 symptoms in school-age children and 8 symptoms in adolescents to indicate the likelihood of PASC. Although many other symptoms were more common in infected compared with uninfected participants, symptoms selected for the index were those that were most associated with infection history. Because these other symptoms were highly associated with the symptoms selected for the index (eTable 7 in Supplement 3 ), it was rare for participants not meeting the index threshold to have these other symptoms ( Figure 4 ). In this cohort, 20% of infected school-age children exceeded the PASC symptom threshold, while 14% of adolescents exceeded the threshold. PASC symptoms clustered into 4 distinct clusters in school-age children and 3 in adolescents.

The PASC research index presents a framework for future studies and can be used as a continuous or binary outcome variable (based on derived thresholds) to determine risk factors for developing PASC and the trajectory of PASC and its resolution (or relapse). Although this provisional index may be used for research, it is not intended for clinical practice, and 1 symptom may be sufficient to indicate PASC in any given child.

This study makes a substantial contribution to the understanding of pediatric PASC. Most research to understand PASC symptoms has focused on adults, potentially due to the misperception that children were not severely affected by COVID-19, leaving childhood symptoms less understood. Most prior pediatric studies have relied on electronic health records. 30 , 31 The current study had the advantage of comprehensively assessing caregiver-reported symptoms across every organ system, examining them in combination, and comparing them directly to an uninfected seronegative control group. The symptoms identified as being related to PASC were associated with infection, not only symptoms that became more common during the pandemic.

This study identified separate PASC research indices for school-age children and adolescents based on symptoms most likely to differentiate between those with and without an infection history. Higher indices were correlated with worse functional outcomes, and those with indices meeting the PASC threshold reported many prolonged symptoms, not just those selected by LASSO. 28 The strongest differentiators of infection history in adults (RECOVER-Adult study) 15 and adolescents overlapped considerably. There was less overlap between adults and school-age children. These findings underscore the need for separate assessments in different age groups. This may be one reason that younger children with PASC are being undercounted in studies and/or undiagnosed clinically, although undercounting may also be due to younger children being less able to recognize and report symptoms. The pathophysiology behind these age-related differences warrants future study, given substantial changes in growth, development, immunological factors, and pubertal hormones that occur across the life course. 11

Among infected participants, there was a wide range of time elapsed between infection and survey completion (median [IQR] time was 501 [297-801] days for school-age children and 518 [333-810] days for adolescents). However, symptom frequency did not change meaningfully when comparing different times between infection and survey completion, underscoring the usefulness of the PASC index for any child in the postacute phase of SARS-CoV-2 infection.

Four symptom clusters in school-age children and 3 in adolescents were identified. In both age groups, there was a single cluster with high symptom burden (as in adults) and a cluster predominated by fatigue and pain symptoms. Other clusters differed by age. School-age children had a cluster with neuropsychological and sleep impacts and another with gastrointestinal predominance. Adolescents had a cluster that was primarily loss of taste and smell, 32 similar to that found in adults, which was not noted in the school-age clusters. Clusters predominated by respiratory symptoms were not identified, possibly related to community recruitment or few participants with severe acute illness. Future research should evaluate whether these pediatric clusters are associated with different pathophysiology from adults, 33 - 35 which will be critical for identifying the treatment targets needed for clinical trials. 36 - 40

This study has limitations. First, the research index is not intended for use in clinical practice to diagnose PASC. Rather it must be considered with clinical judgement because children may have PASC without meeting the index threshold. There are many prolonged symptoms that differ between those previously infected and uninfected with SARS-CoV-2 that are not part of this index. It remains unknown how many children with other diagnoses would have similar prolonged symptoms. This index may evolve over time with changing variants and population immunity. Although children with higher PASC indices report worse quality of life, the cross-sectional analyses preclude causal inference. If a symptom lasted more than 4 weeks but was absent at survey completion, it was not included as a prolonged symptom because this index was not meant to describe incidence. However, it can be used for longitudinal follow-up of recovery and relapse, which would not be possible if resolved symptoms were used in the calculations.

Second, the population prevalence of pediatric PASC cannot be determined with the current design because participants with more prolonged symptoms may have been more inclined to enroll. To mitigate differences that may have resulted from having an extant adolescent cohort, community outreach within the school-age group was encouraged.

Third, some participants in the infected and uninfected groups could have been misclassified. Infected participants were not required to have evidence of SARS-CoV-2 infection; this study relied on caregiver-reported COVID-19 infection history, given variable access to testing. Uninfected children were confirmed to not have SARS-CoV-2 antibodies, but it is possible that some may have been unknowingly infected without developing antibodies or their immunity waned. 41 Uninfected participants may have another postviral syndrome or other conditions that may have symptoms and even pathophysiology that overlaps with PASC. 42 Despite this uncertainty, important differences between infected and uninfected groups were detected.

Fourth, given that symptoms were caregiver-reported, recall bias is possible. In addition, caregiver perceptions of their adolescents’ symptoms may differ from those of the adolescents themselves. However, to enable valid comparisons across age groups, data collection methods were standardized. Future analyses will combine caregiver-reported surveys with objective measures collected during the in-person longitudinal study phase. 19

Fifth, this empirically derived index is a framework that identified commonalities for research purposes. Iterative adaptation of how PASC is assessed may occur as more RECOVER data are collected and as children are followed up. Future analyses will examine PASC symptoms in early childhood (birth to 5 years) and the effects of SARS-CoV-2 on worsening underlying conditions and increasing new conditions, 43 - 45 such as diabetes, 46 autoimmune diseases, 47 neurocognitive disorders, and postinfectious syndromes. 11

In this large-scale study, symptoms that characterized pediatric PASC differed by age group, and several distinct phenotypic PASC presentations were described. The research indices developed here will help researchers identify children and adolescents with high likelihood of PASC. Although these indices will require further research and validation, this work provides an important step toward a clinically useful tool for diagnosis with the ultimate goal of supporting optimal care for youth with PASC.

Accepted for Publication: June 4, 2024.

Published Online: August 21, 2024. doi:10.1001/jama.2024.12747

Corresponding Author: Rachel S. Gross, MD, MS, NYU Grossman School of Medicine, 462 First Ave, New York, NY 10016 ( [email protected] ).

RECOVER-Pediatrics Group Authors: Venkataraman Balaraman, MD; Amanda Bogie, MD; Hulya Bukulmez, MD; Allen J. Dozor, MD; Daniel Eckrich, MS; Amy J. Elliott, PhD; Danielle N. Evans, DHSc, MHA; Jonathan S. Farkas, MD; E. Vincent S. Faustino, MD, MHS; Laura Fischer, MPH; Sunanda Gaur, MD; Ashraf S. Harahsheh, MD; Uzma N. Hasan, MD; Daniel S. Hsia, MD; Gredia Huerta-Montañez, MD; Kathy D. Hummel, MSN; Matt P. Kadish, MD; David C. Kaelber, MD, MPH; Sankaran Krishnan, MD, MPH; Jessica S. Kosut, MD; Jerry Larrabee, MD; Peter Paul C. Lim, MD; Ian C. Michelow, MD; Carlos R. Oliveira, MD, PhD; Hengameh Raissy, PharmD; Zaira Rosario-Pabon, MS; Judith L. Ross, MD; Alice I. Sato, MD, PhD; Michelle D. Stevenson, MD, MS; Maria M. Talavera-Barber, DO; Ronald J. Teufel, MD, MSCR; Kathryn E. Weakley, MD, MSc; Emily Zimmerman, PhD, CCC-SLP; Marie-Abele C. Bind, PhD; James Chan, MA; Zoe Guan, PhD; Richard E. Morse, BA; Harrison T. Reeder, PhD; Natascha Akshoomoff, PhD; Judy L. Aschner, MD; Rakesh Bhattacharjee, MD; Lesley A. Cottrell, PhD; Kelly Cowan, MD; Viren A. D'Sa, MD; Alexander G. Fiks, MD, MSCE; Maria L. Gennaro, MD; Katherine Irby, MD; Manaswitha Khare, MD; Jeremy Landeo Guttierrez, MD, MPH; Russell J. McCulloh, MD, MS; Shalu Narang, MD; Manette Ness-Cochinwala, MD; Sheila Nolan, MD; Paul Palumbo, MD; Julie Ryu, MD; Juan C. Salazar, MD, MPH; Rangaraj Selvarangan, PhD; Cheryl R. Stein, PhD; Alan Werzberger, MD; William T. Zempsky, MD, MPH; Robin Aupperle, PhD; Fiona C. Baker, PhD; Marie T. Banich, PhD; Deanna M. Barch, PhD; Arielle Baskin-Sommers, PhD; James M. Bjork, PhD; Susan Y. Bookheimer, PhD; Sandra A. Brown, PhD; BJ Casey, PhD; Linda Chang, MD; Duncan B. Clark, MD, PhD; Anders M. Dale, PhD; Mirella Dapretto, PhD; Thomas M. Ernst, PhD; Damien A. Fair, PA-C, PhD; Sarah W. Feldstein Ewing, PhD; John J. Foxe, PhD; Edward G. Freedman, PhD; Naomi P. Friedman, PhD; Hugh Garavan, PhD; Dylan G. Gee, PhD; Raul Gonzalez, PhD; Kevin M. Gray, MD; Mary M. Heitzeg, PhD; Megan M. Herting, PhD; Joanna Jacobus, PhD; Angela R. Laird, PhD; Christine L. Larson, PhD; Krista M. Lisdahl, PhD; Monica Luciana, PhD; Beatriz Luna, PhD; Pamela A.F. Madden, PhD; Erin C. McGlade, PhD; Eva M. Müller-Oehring, PhD; Bonnie J. Nagel, PhD; Michael C. Neale, PhD; Martin P. Paulus, PhD; Alexandra S. Potter, PhD; Perry F. Renshaw, MD, PhD; Elizabeth R. Sowell, PhD; Lindsay M. Squeglia, PhD; Susan Tapert, PhD; Lucina Q. Uddin, PhD; Sylia Wilson, PhD; Deborah A. Yurgelun-Todd, PhD.

Affiliations of RECOVER-Pediatrics Group Authors: Department of Biostatistics, Massachusetts General Hospital, Boston (Chan, Guan, Morse, Reeder); Division of Respiratory Medicine, Department of Pediatrics, UC San Diego School of Medicine, Rady Children’s Hospital, San Diego, California (Bhattacharjee, Guttierrez, Ryu); Division of Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston (Bind); Department of Pediatrics, Kapi'olani Medical Center for Women and Children, University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii (Balaraman, Kosut); Department of Pediatrics, Oklahoma University Health Science Center, Oklahoma City (Bogie); Division of Pediatric Rheumatology, Department of Pediatrics, MetroHealth System, Cleveland, Ohio (Bukulmez); Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Boston Children's Health Physicians, New York Medical College, Valhalla (Dozor, Krishnan); Department of Biomedical Research Informatics Center, Nemours Children's Hospital Delaware, Wilmington (Eckrich); Avera Research Institute, Sioux Falls, South Dakota (Elliott); Division of Research, Department of Research Administration, Arkansas Children's Hospital, Little Rock (Evans, Hummel); Department of Pediatrics, NYU Grossman School of Medicine, New York City Health and Hospitals Bellevue, New York (Farkas); Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Faustino); Pediatric Research Office, University of Nebraska Medical Center, Omaha (Fischer); Division of Allergy, Immunology, and Infectious Diseases, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (Gaur); Division of Cardiology, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC (Harahsheh); Division of Infectious Diseases, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey (Hasan); Department of Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, Louisiana (Hsia); Division of Puerto Rico Testsite for Exploring Contamination Threats, Northeastern University, Boston, Massachusetts (Huerta-Montañez); Division of General Pediatrics, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque (Kadish, Larrabee); Departments of Pediatrics, Internal Medicine, and Population and Quantitative Health Sciences, MetroHealth System, Cleveland, Ohio (Kaelber); Division of Infectious Diseases, Department of Pediatrics, University of South Dakota Sanford School of Medicine, Avera Research Institute, Sioux Falls (Lim); Division of Infectious Diseases, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford (Michelow, Salazar); Division of Infectious Diseases, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Oliveira); Division of Pulmonary, Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque (Raissy); Division of Puerto Rico Testsite for Exploring Contamination Threats, Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts (Rosario-Pabon); Division of Pediatrics Administration, Department of Pediatrics, Thomas Jefferson University, Nemours Children's Hospital Delaware, Philadelphia, Pennsylvania (Ross); Division of Infectious Disease, Department of Pediatrics, University of Nebraska Medical Center, Omaha (Sato); Division of Norton Children's Emergency Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Stevenson); Department of Pediatrics, University of South Dakota Sanford School of Medicine, Avera Research Institute, Sioux Falls (Talavera-Barber); Department of Pediatrics, Medical University of South Carolina, Charleston (Teufel); Division of Norton Children's Infectious Diseases, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky (Weakley); Division of Puerto Rico Testsite for Exploring Contamination Threats, Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts (Zimmerman); Department of Psychiatry, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California (Akshoomoff, Jacobus, Tapert); Center for Discovery and Innovation, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, New Jersey (Aschner); Department of Pediatrics, West Virginia University, Morgantown (Cottrell); Division of Pediatric Pulmonology, Department of Pediatrics, University of Vermont, Burlington (Cowan); Department of Developmental Pediatrics, Rhode Island Hospital, Providence (D'Sa); Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (Fiks); Public Health Research Institute, Departments of Medicine, Rutgers Robert Wood Johnson Medical School, Newark, New Jersey (Gennaro); Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Irby); Division of Hospital Medicine, Department of Pediatrics, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California (Khare); Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Nebraska Medical Center, Omaha (McCulloh); Cooperman Barnabas Medical Center, Livingston, New Jersey (Narang); Nicklaus Children's Hospital, Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Miami, Florida (Ness-Cochinwala); Division of Infectious Diseases, Department of Pediatrics, Boston Children's Health Physicians, New York Medical College, Valhalla (Nolan); Divisions of Infectious Disease and International Health, Departments of Pediatrics and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Palumbo); Department of Pediatrics, Children's Mercy Hospital and Clinics, Kansas City, Missouri (Selvarangan); Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York (Stein); Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Best Healthcare Inc, Monroe, New York (Werzberger); Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford (Zempsky); Laureate Institute for Brain Research, Tulsa, Oklahoma (Aupperle, Paulus); Center for Health Sciences, SRI International, Menlo Park, California (Baker, Müller-Oehring); Institute of Cognitive Science and Department of Psychology and Neuroscience, University of Colorado Boulder (Banich); Departments of Psychological & Brain Sciences, Psychiatry, and Radiology, Washington University in St Louis, St Louis, Missouri (Barch); Department of Psychology, Yale University, New Haven, Connecticut (Baskin-Sommers, Gee); Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond (Bjork); Department of Psychiatry and Biobehavioral Sciences, University of Southern California, Children's Hospital Los Angeles (Bookheimer, Dapretto, Uddin); Department of Psychology and Psychiatry, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California (Brown); Department of Psychology, Barnard College - Columbia University, New York, New York (Casey); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Baltimore (Chang, Ernst); Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania (Clark, Luna); Departments of Neurosciences, Radiology, and Psychiatry, UC San Diego School of Medicine, Rady Children's Hospital, San Diego, California (Dale); Institute of Child Development, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Oregon Health & Science University, Minneapolis (Fair); Department of Psychology, University of Rhode Island, Kingston (Feldstein Ewing); Deptartment of Neuroscience, Del Monte Institute for Neuroscience, University of Rochester School of Medicine, Rochester, New York (Foxe, Freedman); Institute for Behavioral Genetics and Department of Psychology and Neuroscience, University of Colorado Boulder (Friedman); Department of Psychiatry, University of Vermont, Burlington (Garavan); Department of Psychology, Florida International University, Miami (Gonzalez); Division of Addiction Sciences, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Gray, Squeglia); Department of Psychiatry, University of Michigan, Ann Arbor (Heitzeg); Department of Population and Public Health Sciences, University of Southern California, Children's Hospital Los Angeles (Herting); Department of Physics, Florida International University, Miami (Laird); Department of Psychology, University of Wisconsin-Milwaukee (Larson, Lisdahl); Department of Psychology, University of Minnesota, Minneapolis (Luciana); Department of Psychiatry, Washington University in St Louis, St Louis, Missouri (Madden); Departments of Psychiatry and Veteran Affairs, MIRECC, University of Utah School of Medicine, Salt Lake City (McGlade, Renshaw, Yurgelun-Todd); Department of Psychiatry, Oregon Health & Science University, Portland (Nagel); Virginia Institute for Psychiatric & Behavioral Genetics, Virginia Commonwealth University, Richmond (Neale); Division of Clinical Neuroscience Research Unit, Department of Psychiatry, University of Vermont, Burlington (Potter); Department of Pediatrics, University of Southern California, Children's Hospital Los Angeles (Sowell); Institute of Child Development, University of Minnesota, Minneapolis (Wilson).

Author Contributions: Drs Thaweethai and Foulkes had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Gross and Thaweethai contributed equally as co–first authors and Drs Foulkes and Stockwell contributed equally as co–senior authors.

Concept and design: Gross, Thaweethai, Kleinman, Snowden, Milner, Tantisira, Rhee, Jernigan, Kinser, Salisbury, Warburton, Mohandas, Flaherman, Metz, Karlson, Chibnik, Pant, Gallagher, Gennaro, Lamendola-Essel, Katz, Yin, Dreyer, Carmilani, Coombs, Fitzgerald, Taylor, Evans, Huerta-Montanez, Kaelber, Oliveira, Raissy, Reeder, Baker, Brown, Dale, D'Sa, Fair, Lisdahl, Luna, McGlade, Renshaw, Foulkes, Selvarangan, Stockwell, Yurgelun-Todd.

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

Drafting of the manuscript: Gross, Thaweethai, Snowden, Kinser, Warburton, Mohandas, Krishnamoorthy, Gallagher, Katz, Carmilani, Coombs, Fitzgerald, Taylor, Eckrich, Raissy, Ross, Sato, Feldstein Ewing, Paulus, Stockwell, Squeglia.

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

Statistical analysis: Fischer, Thaweethai, Chibnik, Pant, Krishnamoorthy, Letts, Sato, Reeder, Teufel, Neale, Bind, Chan, Foulkes.

Obtained funding: Gross, Thaweethai, Kleinman, Rosenzweig, Tantisira, Rhee, Jernigan, Kinser, Salisbury, Warburton, Katz, Elliott, Raissy, Aschner, Baker, Barch, Baskin-Sommers, Bjork, Bookheimer, Casey, Chang, Clark, Dale, Dapretto, Ernst, Fair, Feldstein Ewing, Foxe, Friedman, Gee, Gonzalez, Gray, Herting, Jacobus, Laird, Lisdahl, Luciana, Muller-Oehring, Nagel, Neale, Paulus, Renshaw, Salazar, Selvarangan, Stockwell, Tapert, Wilson.

Administrative, technical, or material support: Fischer, Gross, Hasan, Hsia, Kadish, Kleinman, Kosut, Snowden, Milner, Rhee, Jernigan, Warburton, Wood, Truong, Flaherman, Karlson, Gallagher, Lamendola-Essel, Hasson, Katz, Taylor, Teufel, Eckrich, Evans, Farkas, Faustino, Huerta-Montanez, Jacobus, Kaelber, Krishnan, Raissy, Morse, Cottrell, Fiks, Landeo Guttierrez, Ness-Cochinwala, Ryu, Stein, Baskin-Sommers, Aupperle, Brown, Bukulmez, Chan, Chang, Clark, Dale, Dozor, Ernst, Foxe, Freedman, Garavan, Gee, Laird, Lisdahl, McGlade, Paulus, Renshaw, Salazar, Stevenson, Squeglia, Uddin, Werzberger.

Supervision: Gross, Hsia, Thaweethai, Kleinman, Snowden, Rhee, Jernigan, Kinser, Warburton, Mohandas, Wood, Chibnik, Lamendola-Essel, Katz, Kaelber, Krishnan, Oliveira, Cottrell, Ness-Cochinwala, Akshoomoff, Aschner, Banich, Baskin-Sommers, Brown, Bukulmez, Chan, Chang, Clark, Dozor, Gee, Heitzeg, Herting, Hummel, Larrabee, Lisdahl, McGlade, Nolan, Renshaw, Fiks, Foulkes, Jacobus, Larson, Luciana, Salazar, Sowell, Stockwell, Teufel, Werzberger, Yurgelun-Todd.

Other - discussions of findings: Gallagher.

Other - communication of scientific findings: Fitzgerald.

Other - Contributed experience and knowledge from the patient/caregiver, and Infection Associated Chronic Condition community, perspective: Letts.

Conflict of Interest Disclosures: Dr Kleinman reported receiving grants from New York University via subcontract of NIH during the conduct of the study; owning shares in Amgen, Regeneron, Sanofi, and GLAXF; and being a member of the board of Dartnet Institute and member of the board of health of Borough of Metuchen, Quality Matters, Inc . Dr Snowden reported serving on a Pfizer COVID-19 advisory board, which ended in November 2023. Dr Milner reported serving on a scientific advisory board for Blueprint Medicine and receiving grants from Pharming. Dr Jernigan reported receiving grants from University of California San Diego OTA during the conduct of the study. Dr Salisbury reported receiving grants from NIH and HRSA and donated funds from Anthem outside the submitted work. Dr Newburger reported receiving grants from Pfizer for an observational study on COVID-19 associated myocarditis, serving on a data and safety monitoring committee for BMS, and serving on an independent events adjudication committee for pediatric apixiban study outside the submitted work. Dr Truong reported being co–principal investigator on a Pfizer-funded study to assess long-term sequalae of vaccine-associated myocarditis. Dr Metz reported being a site principal investigator for Pfizer studies of SARS-CoV-2 vaccination in pregnancy, RSV vaccination in pregnancy, and Paxlovid in pregnancy. Dr Dreyer reported receiving grants from NYU Grossman School of Medicine during the conduct of the study. Dr Aschner reported being a stockholder in Gilead Sciences. Dr Bhattacharjee reported serving on an advisory board for Jazz Pharmaceuticals. Dr Werzberger reported receiving funding from Merck for a hepatitis A vaccine immunology study. Dr Zempsky reported affiliations with OmmioHealth, Lundbeck Pharmacueticals, and Editas. Dr Banich reported receiving grants from University of Colorado Boulder during the conduct of the study. Dr Barch reported receiving grants from NIMH and NIDA during the conduct of the study. Dr Bhattacharjee reported consulting for Jazz Pharmaceuticals and Avadel Pharmaceuticals outside the submitted work. Dr Dale reported being a founder of and holding equity in CorTechs Labs, Inc; serving on a scientific advisory board for CorTechs Labs, Inc, Human Longevity, Inc, and the Mohn Medical Imaging and Visualization Centre; and receiving funding through a research agreement with General Electric Healthcare (GEHC). Dr Fair reported being a patent holder for the Framewise Integrated Real-Time Motion Monitoring (FIRMM) software and a cofounder of Turing Medical, Inc. Dr Fiks reported receiving personal fees from Rutgers and salary support from AAP during the conduct of the study; receiving support from American Medical Association for travel and honorarium from Atlantic Health Systems and Boston Medical Center, PCORI, and Emory University; and having a patent for decision support software known as Care Assistant pending. Dr Foulkes reported receiving grants from NIH/NHLBI during the conduct of the study. Dr Gray reported receiving grants from Aelis Farma and personal fees from Indivior and Jazz Pharmaceuticals outside the submitted work. Dr McCulloh reported receiving grants from University of Arkansas for Medical Sciences sub-awardee for the NIH RECOVER grant during the conduct of the study and grants from Merck Foundation for vaccine communication research through the Merck Investigator Studies Program outside the submitted work. Dr McGlade reported receiving salary support from Department of Veteran Affairs outside the submitted work. Dr Neale reported receiving grants from NIH/NIDA during the conduct of the study. Dr Palumbo reported being a member of a data and safety monitoring committee for Gilead and Janssen outside the submitted work. Dr Paulus reported receiving grants from National Institute on Drug Abuse during the conduct of the study, receiving royalties from an article on methamphetamine in UpToDate, and having compensated consulting agreement with Boehringer Ingelheim International GmbH. Dr Ross reported receiving grants from Nemours Children’s Health-DE NIH RECOVER STUDY during the conduct of the study. Dr Stockwell reported receiving grants from CDC to Trustees of Columbia related to SARS-CoV-2 infection and vaccination research and service agreement paid to trustees of Columbia for being associate director of pediatric research in office settings from American Academy of Pediatrics outside the submitted work. Dr Teufel reported receiving grants from HRSA and Duke outside the submitted work. No other disclosures were reported.

Funding/Support: This research was funded by NIH agreements OT2HL161841, OT2HL161847, and OT2HL156812, with additional support from grant R01 HL162373.

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

Group Information: The RECOVER-Pediatrics Consortium appear listed in Supplement 4 .

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Program or the NIH.

Data Sharing Statement: See Supplement 5 .

Additional Contributions: We would like to thank the National Community Engagement Group, all patient, caregiver, and community representatives, and all the participants enrolled in the RECOVER Initiative.

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Nursing Faculty and Alumna Publish Paper on Cognitive Dysfunction in Chronic Illness

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A new study by The University of Texas at Austin School of Nursing researchers, including assistant professors Heather Cuevas, PhD, APRN, ACNS, FCNS , and Beth Heitkemper, PhD, RN , along with alumna Jeeyeon Kim, PhD, explores subjective cognitive dysfunction in nondementia-related chronic illnesses.

Their work, titled " Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis ," was published in the August 2024 edition of the Western Journal of Nursing Research. 

The study systematically reviewed 25 qualitative studies and developed a model to explain how individuals with chronic illnesses experience and adapt to cognitive dysfunction. The findings are organized into four key themes: symptoms, health care, self-perception and relationships. The research highlights the impact of cognitive dysfunction on health care interactions and personal life and suggests that further research is needed to understand its role in chronic illness.

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New research links medical copays to reduced healthcare access in prisons

Using our prior research on prison wages and medical copays, researchers found that higher copays obstruct access to necessary healthcare behind bars, even as prison populations face increasing rates of physical and mental health conditions..

by Emily Widra , August 29, 2024

In most states, people incarcerated in prisons must pay medical copays 1 and fees for physician visits, medications, dental treatment, and other health services. While these copays may be as little as two or five dollars, they still represent massive barriers to healthcare. This is because incarcerated people are disproportionately poor to start with, and those who work typically earn less than a dollar an hour and many don’t work at all. A new report published in JAMA Internal Medicine builds on our analyses of prison copay and wage policies across all state prison systems and the findings are clear: medical copays in prisons are associated with worse access to healthcare behind bars. These unaffordable fees are particularly devastating because they deter necessary care among an incarcerated population that faces many medical conditions — often at higher rates than national averages — and routinely faces inadequate health services behind bars.

In their recent publication, Dr. Lupez and her fellow researchers analyzed nationally representative data from state and federal prison populations published in the Bureau of Justice Statistics’ Survey of Prison Inmates, 2016 . 2 While we previously published our own analysis of the same dataset in 2021, this new research goes further by analyzing changes from the 2004 data and mapping our copays and wages data onto health data from people in prison. The researchers compared the 2004 and 2016 iterations of the Survey and found that, overall, people in prison are facing more chronic physical and mental health conditions than they were in 2004.

Additionally, Dr. Lupez and her colleagues measured the effect of prison medical copays on access to specific healthcare services (including pregnancy-related care), access to clinicians for people with chronic physical conditions, and the continuation of medications for mental health. For each state, 3 they used our 2017 copay and wage data to categorize each survey participant into one of three categories: no copays, copay amounts less than or equal to one week’s prison wage, and copay amounts greater than one week’s prison wage. 4 Their results provide further evidence that medical copays limit access to care among the most vulnerable people in the system.

Many people in prison do not receive even the most basic, necessary healthcare

We already know that prison healthcare regularly falls short of the constitutional duty to care for those in custody. While most people in state prison report having seen a healthcare provider at least once since admission, nearly 1 in 5 have gone without a single health-related visit since entering state prison. Accordingly, the authors first examined general access to healthcare among three groups of people in state and federal prisons: people who were pregnant when admitted to prison, people with chronic physical conditions, and people with mental health conditions. They found that even the most basic care — like obstetric exams for pregnant people or any visit with a healthcare provider for people with chronic conditions — is not provided to surprisingly large portions of the affected population.

Treatment for chronic physical conditions. More than 1 in 10 people (14%) with at least one chronic condition in state and federal prisons had not been seen by a clinician since they were incarcerated. Within their first year of imprisonment, more than a fifth of people with chronic conditions (22%) had not yet been seen by a healthcare provider. Chronic diseases — by definition — require ongoing medical attention, and for the 62% people in state and federal prisons 5 who have them, the lack of consistent, adequate medical treatment can have disastrous and fatal consequences .

Mental healthcare . Among the almost 400,000 people in state and federal prisons with chronic mental health conditions, 6 one third (33%) had not received any clinical mental health treatment since entering prison. Again, those who were within their first year of incarceration were even more likely to report no treatment: 39% had not yet received any mental health treatment compared to 29% of people incarcerated for more than one year. Similarly, more than 41% of people experiencing severe psychological distress 7 in state and federal prisons had not received mental health treatment. 8 And more than one third (34%) of people who had been taking prescription medication for a mental health condition at the time of their offense had not received their medication since entering prison. 9

Pregnancy-related healthcare. Standard prenatal healthcare for pregnant people involves monthly doctor’s appointments at minimum, as well as screenings , tests , vaccinations , and patient education usually conducted by a perinatal specialist. But a shocking proportion of pregnant people in state prisons did not receive so much as an obstetric examination (9%), see any outside providers or specialists (26%), or any pregnancy-education from a healthcare provider (50%) after entering prison.

Medical copays and fees block access to necessary healthcare

When healthcare needs come up against an arduous and expensive sick call process , people are forced to jump through arbitrary hoops just to see a doctor — or delay or forgo medical care altogether — as their health deteriorates. The researchers found that prison systems with more expensive medical copays (relative to prison wages) limit access to necessary healthcare for incarcerated pregnant people and those with chronic conditions more than prisons with no copays or copays equivalent to or less than one week’s prison wage.

Healthcare in prisons is subpar for almost any medical condition, and chronic physical conditions are often more prevalent behind bars than in the general population. The researchers found that medical copays clearly impact access to healthcare for the more than 500,000 people incarcerated in state and federal prisons who have conditions like heart disease, asthma, kidney disease, and hepatitis C. This is particularly alarming considering many of these conditions require regular medical management or can even be cured.

People with chronic conditions in state prisons where copays exceed a week’s wage are less likely to have seen a healthcare clinician while incarcerated than those in prisons that charge no copays or lower copay amounts. Among people with chronic physical conditions who have been incarcerated for more than one year, 12% of incarcerated people who face more unaffordable copays have not seen a clinician. Meanwhile, in prisons with relatively lower copays or no copays, less than 8% of people with chronic physical conditions have not yet seen a clinician after being incarcerated for more than one year.

Similarly, pregnant people in state prisons do not receive standard prenatal care and medical copays make this situation worse. Pregnant people in state prisons without medical copays or with lower copays relative to their wages were more likely to have received an obstetrical examination and clinical pregnancy education than those in prisons with copay amounts more than a week’s prison wage. 10

Copay waivers and exemptions. Researchers also identified prison policies granting copay exemptions for some healthcare services for some people: at least 25 state departments of corrections and the federal prison system have copay waivers for chronic conditions, while 13 states have waivers for pregnancy-related care. However, as correctional health expert Dr. Homer Venters explains: “many chronic care problems aren’t detected when a person arrives [at the jail or prison], so to get treatment… requires the sick call process… Many systems have a practice of requiring two or three nursing sick call encounters before a person sees a doctor.” 11 In other words, someone who meets the exemption criteria likely will still need to pay copays for the initial two or three nursing sick call visits before clinicians identify them as someone who should be exempt from copays.

It’s worth noting that the researchers repeated their analysis of how copays impact access to healthcare services among people without any reported chronic conditions in state prisons. If the chronic care waivers were working as intended, they reasoned, people who do not have chronic conditions would experience even lower rates of healthcare access compared to people with chronic conditions who have their copays waived. Instead, they found people who do not have chronic conditions appear to face similar rates of healthcare access as those who do, suggesting that these waivers are not routinely and consistently applied in a way that actually promotes healthcare access for the most vulnerable people in prison.

From 2004 to 2016, rates of chronic illness and mental illness increased in state and federal prisons

In addition to finding that higher copays restrict healthcare access, the researchers delved into demographic and health-related changes among the prison population between 2004 and 2016.

Demographics. People in prison in 2016 were more likely to be older; identify as Hispanic, multiracial, or some race other than white or Black; 12 and to have been incarcerated multiple times compared to those incarcerated in 2004. These are groups of people that already face significant barriers to healthcare and often have poor health outcomes, even outside of prison. Older adults are more likely to have more medical conditions , which are already more prevalent behind bars. Outside of prison, Hispanic adults report less access to regular medical care and higher rates of uninsurance , while Black, Hispanic, and American Indian or Alaska Native people are less likely to receive necessary mental healthcare and have faced larger declines in life expectancy than their white counterparts. Ultimately, multiple periods of incarceration can negatively affect health status , and experiencing years of limited resources , inaccessibility , and understaffing in prison healthcare creates a situation in which each year spent in prison takes two years off of an individual’s life expectancy.

Chronic physical conditions. As we discussed in our 2021 report, Chronic Punishment: The unmet health needs of people in state prisons , chronic physical conditions and infectious diseases are more prevalent in prisons than among the nation at large. This newest analysis from Dr. Lupez and her colleagues reveals that these chronic conditions are more common in state and federal prisons than they were in 2004. For example, the percentage of the prison population facing at least one chronic condition increased from 56% in 2004 to 62% in 2016, and the percentage facing three or more chronic conditions increased from 12% to 15%. In other words, a larger portion of the prison population is facing chronic illness, and in many cases multiple chronic illnesses.

Mental health conditions. The researchers also found that mental health conditions were more common in 2016 than in 2004. The Bureau of Justice Statistics’ Survey offers data on the proportion of the state and federal prison population who have ever had depression, anxiety, psychotic disorders, manic disorders, posttraumatic stress disorder (PTSD), and personality disorders. The prevalence of every one of these conditions increased in the prison population between 2004 and 2016: in 2004, nearly a quarter of the prison population reported one mental health condition and by 2016, this had increased to more than 40% of people in prison. 13 Not only are mental health conditions more common, but more people are facing chronic mental health conditions in particular: the proportion of people in prison with chronic mental health conditions practically doubled from 2004 to 2016 (14% to 27%).

This study ultimately underscores the urgency of ending medical copays and healthcare fees in prisons and jails, and provides evidence that unaffordable copays put necessary medical care out of reach for far too many incarcerated people. Generally speaking, this study shows that incarcerated people are sicker than ever, the healthcare options available to them are grossly inadequate, and people are not getting the constitutionally-guaranteed care that they need — regardless of whether prisons charge copays or not.

As a final note, we are gratified whenever our work is repurposed by other researchers like this — it’s why we publish our detailed appendix tables and other data collections, many of which can be found in our Data Toolbox . If you are a researcher using our data, we encourage you to reach out with any questions and to let us know how you are using our work.

Unlike non-incarcerated people, people in prison do not have a choice about their medical coverage, nor how “cost sharing” applies to them. There is no “insurance” system that covers them, so the term “copay” is a misnomer for the fee they are charged to request a medical appointment or to obtain a prescription. As the organization Voice of the Experienced argues, the use of this term legitimizes these unaffordable fees, which deter people from seeking needed medical care. They suggest more descriptive terms such as “medical request fees” or “sick call fees.”  ↩

The most recent iteration of the Survey was administered in 2016 and the data were published in 2021 . While the data reflect the prison population in 2016, this study is still the most recent source for the information used in this study.  ↩

The data from the Survey of Prison Inmates is not broken down by the state in which individual respondents are incarcerated, but the researchers used the respondent’s state of residence before incarceration as a proxy for state of incarceration. They excluded states from the sample that did not have a known prison minimum wage or copay amount, including Delaware, Maine, Nevada, and Washington. Because three states — California , Virginia , and Illinois — eliminated copays after the 2016 administration of the Survey , they are still included in this sample, although they no longer charge medical copays.  ↩

For the purposes of calculating an average week’s wage in prison, the authors used our estimate of a 31.75 hour work week (an average workday of 6.35 hours). Not everyone in prison works , but for those that do, incarcerated workers in regular, non-industry prison jobs (i.e., jobs that are directed by the Department of Corrections and support the prison facility) had an average minimum daily wage of 86 cents in our 2017 analysis. Incarcerated people assigned to work for state-owned businesses (i.e., “industry” jobs that produce goods and provide services that are sold to government agencies) earned between 33 cents and $1.41 per hour on average — roughly twice as much as people assigned to regular prison jobs. For state-specific information on prison wages, an explanation of different types of prison work assignments, and more detail on the methodology behind these calculations, see our 2017 publication, How much do incarcerated people earn in each state?  ↩

This study utilized a definition of chronic conditions that included ever having hypertension, heart disease, diabetes, stroke, asthma, cirrhosis, HIV, or cancer or currently having kidney disease, hepatitis B, hepatitis C, or joint disease. The Bureau of Justice Statistics, in their report on health of people in prison based on the 2016 Survey , estimated that 504,000 people in state prisons and 57,700 people in federal prisons currently had at least one chronic physical condition (including cancer, high blood pressure, hypertension, stroke-related problems, diabetes, high blood sugar, heart-related problems, kidney-related problems, arthritis, asthma, or liver cirrhosis). The estimated number of incarcerated people who have ever had a chronic physical condition was upwards of 715,000.  ↩

The researchers categorized psychotic disorders, bipolar/manic disorders, and personality disorders as “chronic” mental health conditions.  ↩

Severe psychological distress was calculated using the Kessler Psychological Distress Scale (K6) that was included in the 2016 Bureau of Justice Statistics’ Survey . The K6 scale is composed of six survey questions regarding one’s mental state in the past 30 days and a composite score of 13 or higher reflects “severe psychological distress.”  ↩

Research has found a robust association between psychological distress and mortality , and higher levels of psychological distress are associated with suicide , which continues to be a growing cause of death in prisons and jails .  ↩

It is widely understood that inconsistent use of prescription medications (often called “medication non-adherence” in medical research) for mental health conditions is associated with poorer outcomes , including diminished treatment efficacy, worsened symptoms, and reduced responsiveness to future treatments.  ↩

The statistical analysis of the effects of copays on access to pregnancy-related healthcare were not statistically significant, likely due — in part — to a small sample size (only 178 pregnant people were in prisons without co-pays).  ↩

This quotation is published in the study’s appendix. Dr. Homer Venters previously served as chief medical officer of the New York City jail system and currently serves as a Federal Court Monitor of health services in jail and prison settings.  ↩

Because of the small sample size, the researchers combined the Survey of Prison Inmates’ non-Hispanic racial categories of American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and “other” race (i.e., a different racial identity that does not fit in the racial categories the Bureau of Justice Statistics uses).  ↩

This increase is not due to a change in definitions between 2004 and 2016, as the authors used the same list of mental health conditions in the 2004 and 2016 iterations of the Bureau of Justice Statistics’ Survey of Prison Inmates : depression, anxiety, psychotic disorders, manic disorders, post-traumatic stress disorder (PTSD), and personality disorder. In 2016, the Bureau of Justice Statistics added an additional mental health measure — severe psychological distress — but since this was not used in the 2004 iteration, it is not included in the change in the number of people reporting mental health conditions.  ↩

Emily Widra is a Senior Research Analyst at the Prison Policy Initiative. ( Other articles | Full bio | Contact )

Related briefings:

• Prison Policy Initiative asks FCC to reject prison phone company’s request for special treatment to peddle “subscription” phone plans  +
• Who’s helping the 1.9 million women released from prisons and jails each year?  +
• Unhoused and under arrest: How Atlanta polices poverty  +

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PFAS-free synthesis of fluorinated pharmaceutical and agrochemical compounds

29 August 2024

The straightforward and effective method was developed at the Flow Chemistry group at the Van ‘t Hoff Institute for Molecular Sciences led by Prof. Timothy Noël, in cooperation with researchers in Italy, Spain and the UK, both from academia and industry. Applying the principles of flow chemistry, where reactions take place in closed systems of small tubes, makes for safe and controlled chemistry. It also offers greater versatility and flexibility over more common procedures using traditional chemical glassware.

Environmentally more friendly

Many pharmaceutical compounds (such as anti-depressants) as well as agrochemical compounds (such as pesticides) benefit from the presence of a trifluoromethyl (-CF 3 ) group. It enhances hydrophobicity and increases metabolic stability, thus improving efficacy and lowering the required dose or concentration.

To introduce the fluorine atoms in these molecules, their synthesis often requires bespoke fluorinated reagents. Many of these are among the family of PFAS compounds and thus will face future legislation. The synthesis protocol now presented in the Science paper provides a viable alternative since it only requires caesium fluoride salt as the fluorine source. Such PFAS-free synthesis of fluorinated agents can provide an environmentally more friendly option for the synthesis of pharmaceutical compounds, which motivated scientists from AstraZeneca to participate in the research.

In addition, the new synthesis protocol enables coupling of the CF 3 group through a sulphur (S), nitrogen (N) or oxygen (O) atom. Such fluorinated motifs confer unique features to drug molecules and agrochemicals, impacting their lipophilicity, oxidation resistance, and acid-base properties.

Integrated flow system

The Science paper presents a versatile microfluidic flow module for generating reactive N–, S– and O–CF 3 anions. These are prepared in a packed bed flow reactor containing the caesium fluoride salt. Appropriate (S, O or N containing) precursors are then led through this reactor.

There, they are fluorinated with high efficiency due to the high surface area of the salt in the packed bed as well and the improved mixing of the organic intermediates. Importantly, this approach also offers enhanced safety as all formed intermediates are contained within the microfluidic system.

Another important feature of the flow system described in Science is the integration of the anion generating module with a downstream reaction module. There, the N–, S– or O–CF 3 anions react with appropriate substrates to achieve pharmaceutical and agrochemical active ingredients as the desired end products.

Implementation in an academic and industrial context

In combination, the anion generator module and the downstream reactor provide a streamlined platform for the derivatization of molecules bearing N–, S– and O–CF 3 motifs. This innovative approach is poised to impact the development of new pharmaceutical drugs by enhancing their properties while improving safety and sustainability in their production processes. In their Science paper, the researchers report the combination of various anions with a range of substrates, resulting in multiple fluorinated products with relevance to pharmaceutical and agrochemical syntheses. In many cases the research team was able to report very satisfactory yields. Moreover, the operational parameters (e.g. reaction times) offer a good prospect for actual implementation in an academic as well as an industrial context.

Paper details

Mauro Spennacchio, Miguel Bernús, Jelena Stanić, Daniele Mazzarella, Marco Colella, James J.  Douglas, Omar Boutureira, Timothy Noël: A unified flow strategy for the preparation and use of trifluoromethyl-heteroatom anions. Science, 385, 6712, p991-996 DOI:  10.1126/science.adq2954

• Research group Flow Chemistry
• Van 't Hoff Institute for Molecular Sciences
• Research Priority Area Sustainable Chemistry

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The Causes and Consequences of U.S. Teacher Strikes

The U.S. has witnessed a resurgence of labor activism, with teachers at the forefront. We examine how teacher strikes affect compensation, working conditions, and productivity with an original dataset of 772 teacher strikes generating 48 million student days idle between 2007 and 2023. Using an event study framework, we find that, on average, strikes increase compensation by 8% and lower pupil-teacher ratios by 0.5 students, driven by new state revenues. We find little evidence of sizable impacts on student achievement up to five years post-strike, though strikes lasting 10 or more days decrease math achievement in the short-term.

Correspondence regarding the manuscript can be sent to Melissa Arnold Lyon: Rockefeller College of Public Affairs and Policy, University at Albany, 135 Western Avenue, Albany, NY 12222 ([email protected]). We are very grateful for research assistance from Zoe Beckman, Eunice Chong, Summer Dai, Stephanie Tu, Sarah Newberger, Hyesang Noh, Adam Shephardson, and Natalie Truong. This research also benefited immensely from the helpful feedback of Jesse Bruhn, Jake Rosenfeld, Sarah Anzia, and the seminar participants at Michigan State University, the 2023 APSA Comparative Labor Politics Workshop, and the 2023 APSA and 2022 AEFP Annual Meetings. This research was supported by a NAEd/Spencer Postdoctoral Fellowship awarded to Lyon. This research was completed before Matthew Kraft joined the Council of Economic Advisers as a senior economist in July of 2024. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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