Journal

International Journal of Public Health

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Health
Public Health, Environmental and Occupational Health
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  • Review of the paper Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting The presented paper is beautifully written and well structured; however, it has a major flaw. The central idea authors are committing is that failure to maintain abstinence predicts greater withdrawal severity among participants in smoking cessation interventions. Stating this, authors overlook an important issue that both withdrawal symptoms and ability or disability to maintain abstinence are manifestations of the same internal characteristic - level of nicotine dependence. Same is true about the depression score which was also included in generalized estimating equations as a predictor. As all these characteristics are the alternative measurements of the same phenomenon--level of nicotine dependence--they cannot be considered as predictors of its symptom--severity of withdrawal. Furthermore, it is known that including in regression models the alternative measurements of either the outcome or the primary predictor is able to disrupt the model and diminish the validity of all other association assessments. Taking into account the significance of the abovementioned problem, I do not list here less important comments and recommend rejecting the paper.

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  • Reviewer Recommendation Term: Minor revisions Overall Reviewer Manuscript Rating: 85 Custom Review Question(s) Response Contains original work that makes a contribution to the field covered by the paper Yes Contains new facts or confirms previously uncertain data Yes Refers to and discusses prior work Yes, outstanding High quality of statistical methods and of data analysis Yes Provides thoughtful interpretation of results Yes, outstanding Overall Scientific Rating Good

    Comments to Editor: Dear Editor:

    Find this is an interesting research paper that could be improved with a minor revision. It includes adding measures of association within the abstract.

    Perhaps they should discuss about the hypothetical "social advantage" of hispanic immigrants in the sense of keeping family and social networks, that is known to help avoiding mortality. - page 7 line 26 the authors found that overweight persons were less likely to die than healthy weight persons. (can they explain this?) 1. title: yes it is correct 2. keywords: are appropriate 3. is the article suitable for Editors' Choice? Why not? ( age at immigration is an interesting issue!!)

    Comments to Author: Comments for the Author(s) (please use as much space as you require):

    Dear author(s)

    I have gone though this interesting research paper and I issue the following recommendations to improve its quality:

    -within the abstract I would include real results with numbers expressing the findings. -Perhaps you could discuss about the hypothetical "social advantage" of hispanic immigrants in the sense of keeping family and social networks, that is known to help avoiding mortality. - page 7 line 26 you have found that overweight persons were less likely to die than healthy weight persons. (can you explain this?) -Thanks, overall it is a very interesting paper.

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  • IJPH-D-14-00437R1 "Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: Findings from the Northern Swedish Cohort" Revision 1

    Ignacio Garitano Gutierrez, M.D., DLSHTM, MSc TM&IH, MSc Epidemiology (Reviewer 2)

    Reviewer Recommendation Term: Accept Overall Reviewer Manuscript Rating: 80 Custom Review Question(s) Response Contains original work that makes a contribution to the field covered by the paper Yes Contains new facts or confirms previously uncertain data Yes Refers to and discusses prior work Yes High quality of statistical methods and of data analysis Yes Provides thoughtful interpretation of results Yes Overall Scientific Rating Good

    Comments to Editor: Accept

    Comments to Author: Comments for the Author(s) (please use as much space as you require): Congratulations. Nice paper

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  • IJPH-D-14-00437 "Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: Findings from the Northern Swedish Cohort" Original Submission

    Ignacio Garitano Gutierrez, M.D., DLSHTM, MSc TM&IH, MSc Epidemiology (Reviewer 2)

    Reviewer Recommendation Term: Minor revisions Overall Reviewer Manuscript Rating: 80 Custom Review Question(s) Response Contains original work that makes a contribution to the field covered by the paper Yes Contains new facts or confirms previously uncertain data Yes Refers to and discusses prior work Yes High quality of statistical methods and of data analysis Yes Provides thoughtful interpretation of results Yes Overall Scientific Rating Good

    Comments to Editor: Comments for the Author(s) (please use as much space as you require):

    I would accept this article after minor changes explained as follows:

    I would shorten the iintroduction. I would also present some results with ORs and 95% CI within the abstract, as recommended by international standards. Why is it an ecological design if you have individual data about a cohort? I miss the software used for statistical analysis. I also miss a comparison amongst models in terms of goodness of fit (like Akaike information Criterion) Thanks

    Comments to Author: Comments for the Author(s) (please use as much space as you require): Dear Author(s) I find it a very interesting piece of research.

    I would shorten the iintroduction. I would also present some results with ORs and 95% CI within the abstract, as recommended by international standards. Why is it an ecological design if you have individual data about a cohort? I miss the software used for statistical analysis. I also miss a comparison amongst models in terms of goodness of fit (like Akaike information Criterion) Thanks

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  • Review of the paper 'Household Smoking Restrictions among Urban Residents in China: Individual and Regional Influences' While the paper is devoted to secondhand smoke exposure which is an important factor able to impact public health, there are many drawbacks which authors are recommended to thoroughly work with. The language of the paper needs profound revision as many authors' ideas may remain unclear to readers due to insufficient clarity of the text. Many other details require authors' attention as well; examples are double brackets, incorrect spelling of some words, abbreviations either non-introduced at all or explained after the first use etc. Introduction Introduction is too long and needs streamlining. Authors are recommended to reconsider the Introduction answering three key questions: (1) what is already known about the issue in focus of the study; (2) which knowledge is missing; (3) how authors plan to cover the revealed knowledge gap. This allows avoiding many unnecessary details now present in the text. Particular phrases that need attention if they are still to be used in the restructured Introduction are as follows: - 'China leads the world...' - 'The home has been identified as ...' - 'However, only about one-third of households completely forbade smoking and showed high smoke pollution in household in China' - I am missing the message here. - '... who lack belief of the harmfulness of SHS' - 'A better understanding of these determinants will improve the design and implementation of public health interventions and policies' - 'variation in mental HSR' - ' analysis combing individual with regional level data' - ' We also hypothesized that smoking in smokefree public venues associated with HSR' Methods. Sampling is generally well described. However, several expressions need either clarification or correction. Writing that 'about 68% provinces were covered' looks bizarre. Please either write just '68%' (without 'about') or, better, 'about two in three provinces' because provinces are not so numerous as to calculate percentages. 'Excluding new building districts and subdistricts' looks unclear as well. Data collection It is not clear whether interviews or self-administered questionnaires were used because you cannot do one through the other. While it is written that data was collected in 21 cities but only in 19 cities same interview protocol was used. So it keeps unclear what happened to the rest two cities. I frankly could not get the idea of the following sentence: 'The data collection procedures had been extensively employed in smoking research in China, possessing acceptable validity characteristics' Independent variables Not clear how 'smoking situation' was operationalized. Mentioning just 'standard methods' without naming them seems insufficient as well. The sentence 'severe stress was operationalized as a score=25' needs to be rewritten showing the interval of measurements considered as 'severe stress' or other categories. The paragraph starting with 'Environmental smoking restrictions' should all be rewritten. First: what are Environmental smoking restrictions? Second: restrictions cannot be 'it'. Third, referencing should be rephrased. In the 'regional level' subsection authors mention two variables but explain three. Data analysis I recommend to substitute the common language expressions mentioning 'independent variables ... statistically significant' and 'significant level'. The sentence 'Forward stepwise regression is the preferred method for exploratory analyses, where analysis begins with a full or saturated model and variables are eliminated from the model in an iterative process' contains a contradiction because variables are eliminated step by step in backward methods, while in forward methods they are added one by one. For a reason unknown to me, much space in the paper is devoted to the weighting procedure, and it takes more of the paper word count than the analysis itself. Results The study obviously included one survey, not 17,124 surveys as mentioned in the text. 'The second hand exposure prevalence' needs to be changed into 'The prevalence of secondhand smoke exposure'. Table 1 is described as showing the bivariate distributions of household smoking restriction. However, the results presented in the table cause doubts whether this very outcome was considered with all independent variables. Managers and professionals are shown to be more likely practicing smoking restrictions than some other occupational groups. We can also hypothesize that managers and professional on average are more educated and earn more money than average 'others', but the table shows that those more educated and earning more money are less likely to restrict smoking in their homes. I strongly recommend the authors to thoroughly check this analysis. Similar doubts arise regarding the results of multivariate analysis. In addition to the abovementioned problems, it is shown that people smoking in smoke-free venues are more likely to restrict smoking at home which is hardly to be true. Some of the inconsistencies of analysis mentioned above (if they were not pure mistakes) could be due to analyzing smokers (who are the object of restriction) and non-smokers (who usually implement restrictions) together. Stratified analysis looking at possible interactions might help. Discussion The overall problem of the paper is that authors try to make causal inferences with regard to the association between independent and dependent variables which in fact can be both under influence of some other third variables. For example, much is devoted to stress and smoking restrictions. However, this association might have nothing to do with causal relation. As people in managerial positions were shown to more likely practice smoking restrictions, these same people could also be exposed to more work-related stress. A sentence 'Children and women’s health are most at risk, and this risk must be taken seriously' looks moralistic rather than research or public health based. I recommend to substitute 'belief of the SHS harmfulness' with 'awareness of SHS harms' or similar across the whole text. The sentence 'Chinese family values emphasize the collective quality in the nature of individual life and behavior' looks unclear. The concept of 'family contracture' is unclear as well. The authors attempt to argue that their study is good enough to make causal conclusions in spite of being cross-sectional seems inappropriate. Conclusion There should be no abbreviations in the conclusion. In both the discussion and the conclusion authors speculate about the possibility to impact household smoking restrictions through public education. While awareness campaigns are generally needed, I would suggest that authors diminish their passionate belief that they can directly influence the situation. An alternative explanation of the association between awareness and smoking restrictions might be that those more educated and having higher SES, on the one hand, more likely have smokefree workplaces, on the other, they more readily pick up new messages popular in the nowadays world including all the tobacco control approaches. Both of these factors might be the cause of their household smoking restrictions practices but not the direct education organized in the community.

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