Effects of an Alcohol-Related Harm Prevention Program among Out-of-School Female Adolescents
Round 1
Reviewer 1 Report
Thankyou for the opportunity to review your manuscript. I have a number of suggestions:
Introduction:
Why was the goal abstinence?
Please explain soju. What is the legal drinking age in Korea?
Please ensure consistent use of alcohol consumption/drinking terminology
Please state the percentage of females school students who consume alcohol.
The manuscript needs to be edited to improve English language, for example 'drinking initiation lowered to 13 years', 'risk drinking', 'thereby impacting childbirth as well'
Please provide a reference for page 2, line 47.
There are likely to be other contributing factors such as trauma, mental health, family support associated with alcohol use, page 2, line 63.
Please define 'alcohol outcome expectancy'
Please describe the M centre.
Methods:
Please move lines 160-163 on page 4 to the top of section 2.2.
Can a description of the literacy level of participants be provided? What is the expected literacy level of the survey tools?
Results:
An introductory table outlining the control group and the experimental group would be useful, including age, age of alcohol initiation, previous education course, drinks per month, needing alcohol abuse treatment.
Discussion:
Please define or reword 'mild drinking'
In my opinion the discussion would benefit form being reduced in length, and aligned with research question, objectives and key findings.
Please check whether programme sessions ran for 2 hours (as per discussion) or 1 hour (as per methods)
Please either remove the section re interviews (page 11, lines 443-455, or outline the method
Conclusion:
The conclusion is too long and not well enough aligned with the key findings.
Author Response
Please see the attachment
Author Response File: 
Author Response.docx
Reviewer 2 Report
This is an informative study conducted on adolescent out- of school girls regarding the effects of a harm prevention program.
This reviewer would suggest the addition of current literature on Fetal Alcohol Spectrum Disorder prevention research by researchers like Phil May in the USA and his South African team who conducted research in the Cape Winelands in South Africa. Most of the sources in this manuscript are dated.
In terms of the theoretical models used TPB and IMB one wonders if an additional hypothesis in terms of follow-up would have enhanced the utility of the study by researching the long- term effects of the prevention program. We know from previous studies, that preventive outcomes are not always sustainable in the long -term.
For future research given adolescent peer relationships, exploration around identity and dating heterosexually, it will be constructive to include males in the study who could also benefit and hopefully support alcohol abstinence. Of course, the opposite is also possible.
Reference was made that Motivational interviewing was attempted. What does this mean? Was motivational interviewing provided by trained persons?
There is also an assumption made that the adolescent girls will become mothers. Is this a cultural expectation or the imposition of heterosexist norms?
Another generalized and I believe an erroneous statement was made about adolescence being the final stage for change (485). Human beings are capable of change at any life stage and this is not only a claim made by those of us who operate from a strength- based perspective but supported in the developmental literature from social work, education and psychology.
Author Response
Please see the attachment
Author Response File: Author Response.docx
Reviewer 3 Report
The aim of the study is interesting and useful for reducing the consequences of alcohol consumption in at-risk populations. The article is well designed, but there are aspects that need to be improved before publication:
-A table should be included to collect data on the sample's consumption and socio-demographic variables (age of onset, drugs consumed, educational level, possible psychopathological disorders...).
-The authors should justify why they use this programme and not others, i.e. justify possible benefits already documented with other drinking populations.
-Were the girls who participated in the study followed up longitudinally? If so, it would be interesting to analyse whether their attitudes towards alcohol changed over time and the positive effect of the intervention was lost.
-Did those who were minors have signed consent from their parents or legal caregivers?
-Due to the small sample size, it may be more advisable to perform a non-parametric analysis of the data.
-For those variables that are significant, the effect size value should be included.
-The standard deviation should be replaced by the standard error of measurement.
Author Response
Please see the attachment
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
I commend the authors for addressing the suggestions so well.
Author Response
Thank you for your contribution.
Reviewer 2 Report
I read the authors' responses to my comments.
I am not entirely satisfied that they responded fully to my observations.
Firstly, I recommended Phil May's seminal research in the area of FASD in South Africa and he was not cited. Other researchers in South Africa in this area, were cited appropriately.
I do not see an elaboration of motivational interviewing(MI) and the the inclusion of the person trained by D Miller in MI.( I was also trained by him).
I do not disagree that changes in adolescence are critical, I was commenting on the authors claiming that stage of life as the final one for changes and transitions implying that there was no room for growth and change after adolescence.
Author Response
Comment: 1. Include citation of Phil May's seminal research in the area of FASD in South Africa.
Response: Thank you for your suggestion. The reference has thus been modified.
Page 14. May PA, Hasken JM, Blankenship J, Marais AS, Joubert B, Cloete M, de Vries MM, Barnard R, Botha I, Roux S, Doms C, Gossage JP, Kalberg WO, Buckley D, Robinson LK, Adnams CM, Manning MA, Parry CD, Hoyme HE, Tabachnick B, Seedat S. Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol. 2016 Aug;63:13-21. doi: 10.1016/j.reprotox.2016.05.002. Epub 2016 May 10. PMID: 27174445; PMCID: PMC4987236.
Comment: 2. Include the information that you have provided in your response to the reviewer re MI training in the actual
Response: Thank you for your comment. The manuscript has thus been modified.
Page 6. For reference, the researchers who participated in this study received MI training from a Korean MI expert who Dr. Miller had taught before.
Comment: 3. Include some text in the manuscript that flags that further growth and change can occur after adolescence. (Re reviewer comment - concern re the authors claiming that stage of life as the final one for changes and transitions implying that there was no room for growth and change after adolescence.)
Response: : Thank you for your comment. The manuscript has thus been modified.
Page 2. Habitual drinking in adolescent girls has the potential to lead to alcohol abuse and dependence in adulthood. If this habitual drinking remains unchanged and drinking behavior continues during pregnancy, it can lead to an irreversible condition known as fetal alcohol syndrome [7,8].
