Susceptibility to Electronic Cigarette and Consumption Patterns in Adolescents

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

While the authors do state that the students were in compulsory secondary schools, I didn't realize they meant 10-12th grades in a 12-grade system until the Results/Discussion sections.  I would use age ranges throughout the manuscript, instead of grades.  It will be more concise.

I have tracked changes, suggestions, questions, etc. in anonymatized Word document and can forward this to either the editor or publisher.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

I have tracked changes, suggestions, questions, etc. in anonymatized Word document and can forward this to either the editor or publisher.

Author Response

We thank you for giving us the opportunity to resubmit a revised version of our manuscript entitled “Susceptibility to electronic cigarette and consumption patterns in adolescents” (Ref: nursrep-2930172).

We added to manuscript the information relative to the question’s reviewers have planned. We hope that you will find the revision satisfactory an the manuscript is now suitable for publication in Nursing Reports.

Please, find below our point-by-point response to Reviewers (changes in the manuscript and responses have been marked in red)

Reviewer 1

We greatly appreciate the reviewer’s comments. 

Commented 1:

Thank you. We corrected this mistake.

Commented 2:

Lack of premeditation is dimensions of impulsivity and refers to the tendency to act without thinking.

Commented 3 and 4:

Thank you for your comment. The sentence has been modified according to the suggestion.

Commented 5.

Thank you for your comment. We have defined the term (negative urgency) in the introduction section.

Commented 6.

Thank you for your comment. We have rewritten it.

Commented 7.

Thank you for your comment. According your recommendation, we have changed “device” by “ECs”

Commented 8 and 9

Thank you for your comment. We have clarified it.

Commented 10

Thank for your comment. Identification data has been included.

The questionnaire included scale that had been validated for adolescent population. The term included in the questionnaire was electronic cigarette and the participants understood the electronic cigarettes term.

Commented 11.

The internal reliability values (Cronbach's alpha) present in the methodology section is those obtained by previous studies, as shown in the references that accompany each entry. The age range was 12-17 years (21).

Commeted 12

Thank you for your comment. We have included information related to the assessment of risk perception.

Commented 13

Thank you for your comment. We clarified that the puberty is refered to hormonal growth, gonadal development and sexual maturation, while the adolescence term involves changes in cognitive, emotional and social skills.

Commented 14

Thank you for your suggestion. We have included the age range in Methods section.

Commented 15, 16

Thank you for your commented. We have added the range of age in the Methods section.

Commented 17

Thank you for your commented. We used median [interquartile range] because continues variable are non-parametric distribution.

Commented 18

Thank you for your commented. The interquartile range include values from percentile 25^th to percentile 75^th while the range includes from minimum value to maximum value. In this case the range of age was from 12 to 16 years and the IQR was from 14 to15 years. These are different concepts.

Commeted 19

Thank you for your comment. We agree. We have clarified in the manuscript.

Commented 20

Thank you for your comment. We evaluated exposures in general. It has been clarified.

Reviewer 2 Report

Comments and Suggestions for Authors

As the authors note, e-cigartette use among youth threatens decades of progress in tobacco prevention and control.  Hence, understanding factors associated with use in this group is especially important to inform future intervention research as well as practice, in healthcare, education and familial settings. The paper presents and important contribution to the literature. Below, several modifications that could be made to strengthen the manuscript are noted.

 

Several established negative health consequences of EC use are noted in the introduction. It should also be noted that research in this area remains relatively new and we likely do not yet understand the full scope of health consequences associated with EC use.

 

The methods section of the paper lacks clarity in a number of areas and minor edits to the presentation of results would likely improve readers' understanding of the information presented.

 

Please clarify how the educational centers that participated in this study were selected. Section 2.3 of the methods section indicates that the centers participated at random, were only 3 centers invited to participate and these were the first 3 invited? Were other centers invited but some refused, were these centers a part of other research? How was the relationship established between the centers and the research team?

 

Please clarify whether both parental consent and minor assent were provided prior to participation in this study. This is the requirement and expectation in the US. If it varies in Spain, please explain.

 

Please indicate how many categories were included in each of the study variables and what labels were included for each category (e.g., 5-categories ranging from definitely no, most likely no, neutral, most likely yes, to definitely yes), in keeping with how the items were specifically asked for this study.

 

Please provide specific details regarding the 59 participants who were excluded. How many declined vs provided missing data vs outlying data?

 

The family composition variables include one labeled brothers. Should this be siblings, or brothers/sisters?

 

Please explain how the family affluence categories were created, and how these relate to the socio-economic status of the general population.

 

Please add labels to the bars included in Figure 1 to indicate which bars correspond to experimenters and which to non-experimenters. This information is provided in the note but would be more helpful to the reader included in the figure.

 

Please provide details related to the assessment of risk perception

 

When cigar smoking is mentioned, should this be traditional cigarettes?  It seems odd to include cigars, hookah and other products but not traditional cigarettes. Likely few youth smoke cigars.

 

Discussion

Higher consumption observed among females as compared with males is an interesting finding and a potentially important public health data point. Similar results ae emerging in recent data collected in the United States as well. The implications of this shift should be discussed.  It may be valuable for future studies to examine factors such as those considered here among samples stratified by sex to better inform potential intervention approaches.

 

 

 

 

Comments on the Quality of English Language

The paper is generally well written and for the most part clear. However, there are a number of instances where edits to the punctuation and language could be improved.

Please proof-read thoroughly to ensure appropriate use of punctuation and use of complete sentences. For example, an unnecessary comma is included on line 13 of page 1; line 19 of page 1 includes the phrase “had a medium-high to susceptibility” which likely should read “had a medium to high susceptibility to.” and line 40 of page 1 includes a sentence that ends with the words “to promote the cessation” which needs to be followed by additional information to indicate the cessation of what, or the word “the” could be deleted to simply state “to promote cessation.”  There are numerous similar instances throughout the manuscript that make it challenging for the reader to understand the information presented.

 

Line 52 on page 2 should be rephrased to read: with respect to intrapersonal factors.
Line 218 on page 6 should be rephrased similarly

 

 

 

Author Response

We thank you for giving us the opportunity to resubmit a revised version of our manuscript entitled “Susceptibility to electronic cigarette and consumption patterns in adolescents” (Ref: nursrep-2930172).

We added to manuscript the information relative to the question’s reviewers have planned. We hope that you will find the revision satisfactory an the manuscript is now suitable for publication in Nursing Reports.

Please, find below our point-by-point response to Reviewers (changes in the manuscript and responses have been marked in red)

As the authors note, e-cigartette use among youth threatens decades of progress in tobacco prevention and control.  Hence, understanding factors associated with use in this group is especially important to inform future intervention research as well as practice, in healthcare, education and familial settings. The paper presents and important contribution to the literature. Below, several modifications that could be made to strengthen the manuscript are noted.

Several established negative health consequences of EC use are noted in the introduction. It should also be noted that research in this area remains relatively new and we likely do not yet understand the full scope of health consequences associated with EC use.

The methods section of the paper lacks clarity in a number of areas and minor edits to the presentation of results would likely improve readers' understanding of the information presented.

We greatly appreciate the reviewer’s comments. 

Please clarify how the educational centers that participated in this study were selected. Section 2.3 of the methods section indicates that the centers participated at random, were only 3 centers invited to participate and these were the first 3 invited? Were other centers invited but some refused, were these centers a part of other research? How was the relationship established between the centers and the research team?

Thank for your comments

Respect for selection centers, we have included information about selection process of the participant centers in section 2.3.

Please clarify whether both parental consent and minor assent were provided prior to participation in this study. This is the requirement and expectation in the US. If it varies in Spain, please explain.

Thank for your commented. We have clarified in 2.3 section. Parental and minor consent were previously obtained.

Please indicate how many categories were included in each of the study variables and what labels were included for each category (e.g., 5-categories ranging from definitely no, most likely no, neutral, most likely yes, to definitely yes), in keeping with how the items were specifically asked for this study.

Thank for your comments

We have included the range of response for the study variables

Please provide specific details regarding the 59 participants who were excluded. How many declined vs provided missing data vs outlying data?

Thank you for your comment. We have included specific details about excluded participants in Results section (first paragraph).

The family composition variables include one labeled brothers. Should this be siblings, or brothers/sisters?

Thank you for your comments. We have modified the category of family members in the text and tables.

Please explain how the family affluence categories were created, and how these relate to the socio-economic status of the general population.

Thank you for your comment. It is poorly explained. We have explained it in 2.5.2 section

Please add labels to the bars included in Figure 1 to indicate which bars correspond to experimenters and which to non-experimenters. This information is provided in the note but would be more helpful to the reader included in the figure.

Thank you for your suggestion. We have corrected it in the figure 1

Please provide details related to the assessment of risk perception

Thank you for your comment. We have included information related to the assessment of risk perception in Methods section (2.5.2)

When cigar smoking is mentioned, should this be traditional cigarettes?  It seems odd to include cigars, hookah and other products but not traditional cigarettes. Likely few youth smoke cigars.

Thank you for your comment. We have clarified the term to avoid confused (we have changed cigar by cigarette)

Discussion

Higher consumption observed among females as compared with males is an interesting finding and a potentially important public health data point. Similar results ae emerging in recent data collected in the United States as well. The implications of this shift should be discussed.  It may be valuable for future studies to examine factors such as those considered here among samples stratified by sex to better inform potential intervention approaches.

Comments on the Quality of English Language

The paper is generally well written and for the most part clear. However, there are a number of instances where edits to the punctuation and language could be improved.

Please proof-read thoroughly to ensure appropriate use of punctuation and use of complete sentences. For example, an unnecessary comma is included on line 13 of page 1; line 19 of page 1 includes the phrase “had a medium-high to susceptibility” which likely should read “had a medium to high susceptibility to.” and line 40 of page 1 includes a sentence that ends with the words “to promote the cessation” which needs to be followed by additional information to indicate the cessation of what, or the word “the” could be deleted to simply state “to promote cessation.”  There are numerous similar instances throughout the manuscript that make it challenging for the reader to understand the information presented.

Line 52 on page 2 should be rephrased to read: with respect to intrapersonal factors.

Line 218 on page 6 should be rephrased similarly

Thank you for your suggestions. We have included all the suggestions.