Multi-Level Protective Factors of Adolescent Smoking and Drinking

Round 1

Reviewer 1 Report

Overall, the manuscript addresses interesting questions. The authors examined the role of potential protective factors for adolescent. Two hundred and seventy-six adolescents participated in this survey, and self-control, self-esteem, resilience, social support, school attachment and mental well-being were measured. The results showed that there were no sex differences in adolescents’ substance use. Factors such as self-control, self-esteem and social support were protective factors, and age and friend support acted as risk factors. However, there are some concerns that need to be clarified.   

1. The sample size of the current study was too small. The authors measured many variables, but the sample size is small.

2. It is suggested that the author supplement the correlation analysis and results among various variables.

There were some clerical errors. For example, there was a redundant half left parenthesis in table 2.

Author Response

Dear Reviewer,

Thank you for your valuable help. We considered your suggestions. All of our corrections/additions are highlighted in the text to make it easy for the editorial team to see what specific changes were made.

Review 1:

Overall, the manuscript addresses interesting questions. The authors examined the role of potential protective factors for adolescent. Two hundred and seventy-six adolescents participated in this survey, and self-control, self-esteem, resilience, social support, school attachment and mental well-being were measured. The results showed that there were no sex differences in adolescents’ substance use. Factors such as self-control, self-esteem and social support were protective factors, and age and friend support acted as risk factors. However, there are some concerns that need to be clarified.   

1. The sample size of the current study was too small. The authors measured many variables, but the sample size is small.

RE: We agree with the Reviewer. We mentioned this as a limitation to the study.

2. It is suggested that the author supplement the correlation analysis and results among various variables.

RE: Thank you for this suggestion, we added a correlation matrix for the scales (Table 4) with a highlight on some relevant correlations in the text.

There were some clerical errors. For example, there was a redundant half left parenthesis in table 2.

RE: Thank you for noting this, we corrected it.

Once again thank you for your suggestions. Best regards, Authors

Reviewer 2 Report

Thank you so very much for giving me opportunity to review this paper. Paper is interesting, informative and is easy read. I do not have any suggestions and I approve it for the publication. 

Over all quality of English language is good.

Author Response

Dear Reviewer,

Review 2:

Thank you so very much for giving me opportunity to review this paper. Paper is interesting, informative and is easy read. I do not have any suggestions and I approve it for the publication.

RE: Thank you very much for this evaluation.  

Comments on the Quality of English Language

Over all quality of English language is good.

Once again, thank you for your nice evaluation. Best regards, Authors

Reviewer 3 Report

Thank you very much for the invitation to review the manuscript entitled "Multi-level protective factors of adolescent smoking and drinking“. This is an interesting study focusing on a topical public health issue that might be of great interest to the readership of EJIHPE. However, I have some remarks as listed below.

 

Overall, the writing is fine but could be improved in some instances (e.g., the second sentence of the introduction or lines 34-36; Line 100: a word is missing (verb = protect?); Line 109: change „meanwhile“ to „while“ etc. => Please check the entire manuscript in this regard

 

Introduction:

Lines 127-129: The authors hypothesize that substance use would not differ between girls and boys. However, in line 49 they mention that the rate of smoking girls is much higher than that of boys. Please elaborate on this discrepancy and adjust if necessary.

 

Methods:

1. How did you define the students‘ financial situation? What categorical classification was made?

 

2. Some of the reliability scores of the Hungarian School Attachment Questionnaire are rather questionable to poor (Cronbach’s alpha 0.54, 0.69, 0.52). How do these values relate to other/ previous surveys? This could be briefly discussed in the limitations of the study.

 

3. For each scale, I assume that higher scores indicate more favorable/ better values. If this is not the case, please indicate for each scale.

 

4. How long did it take to complete the questionnaire (please indicate in the manuscript)? How do you rate the cognitive load of the children (please indicate in the manuscript)? Is it conceivable that fatigue effects affected the results (is this an issue for the section limitations)? Could this also be a point for the limitations of the study?

 

5. How many children declined to participate (please indicate in the text, if available)? Can you rule out a systematic effect on the results (e.g. disproportionately high numbers of young children, financially weak children, or disproportionately many girls)?

 

6. Important: How did you deal with missing values (I don't assume that all children filled in the sheets 100%). Additionally: were any plausibility checks available? Please elaborate (and indicate in the text if possible).

 

Results:

Lines 270-273: redundant (repetition from methods) => can go.

 

Discussion:

The authors have identified protective as well as risk factors for substance use. I miss a paragraph at the end of the discussion that discusses possible intervention strategies for this specific target group based on the results of the study.
=> What are the starting points for possible interventions?
=> What could these look like?
=> Are there already successful interventions published?

It would be important to give practical implications to the readers. Some key points are mentioned in the section conclusions. However, I think the manuscript would benefit from a more comprehensive elaboration on this aspect (in favor of a shortening of the current discussion).

 

Limitations: Please revise this section thoroughly again. The points mentioned are comprehensible and correct. Nevertheless, I think your study has further strengths, but also further weaknesses/ limitations. Starting points for this can be found in the comments above.

 

I think that these remarks can be addressed very well in a revision, and I am looking forward to the revised manuscript version by the authors.

Overall, the writing is fine but could be improved in some instances (please see "Comments and Suggestions for Authors").

Author Response

Dear Reviewer,

Thank you very much for your suggestions to improve the quality of our paper. 

All of our corrections/additions are highlighted in the text to make it easy for the editorial team to see what specific changes were made.

 Reviewer 3:

Thank you very much for the invitation to review the manuscript entitled "Multi-level protective factors of adolescent smoking and drinking“. This is an interesting study focusing on a topical public health issue that might be of great interest to the readership of EJIHPE. However, I have some remarks as listed below.

 Overall, the writing is fine but could be improved in some instances (e.g., the second sentence of the introduction or lines 34-36; Line 100: a word is missing (verb = protect?); Line 109: change „meanwhile“ to „while“ etc. => Please check the entire manuscript in this regard

RE: Thank you for this suggestion. We corrected all these sentences. We also checked the whole text thorougly.

 Introduction:

Lines 127-129: The authors hypothesize that substance use would not differ between girls and boys. However, in line 49 they mention that the rate of smoking girls is much higher than that of boys. Please elaborate on this discrepancy and adjust if necessary.

RE: We agreed with the Reviewer and corrected this hypothesis (lines 130-131) and the Discussion (lines 388-390).

Methods:

1. How did you define the students‘ financial situation? What categorical classification was made?

RE: The students evaluated their own socioeconomic status (SES self-assessment) as lower, lower-middle, middle, upper-middle or upper classed based on previous papers (e.g., Piko, B., Fitzpatrick, K.M. (2001). Does class matter? SES and psychosocial health among Hungarian adolescents. Social Science and Medicine 53(6): 817-830). It was a subjective evaluation, no possibility for objective measurement was feasible from the children. We have added this information to the description.

2. Some of the reliability scores of the Hungarian School Attachment Questionnaire are rather questionable to poor (Cronbach’s alpha 0.54, 0.69, 0.52). How do these values relate to other/ previous surveys? This could be briefly discussed in the limitations of the study.

RE: We agreed with the Reviewer and mentioned it as a limitation in this section.

3. For each scale, I assume that higher scores indicate more favorable/ better values. If this is not the case, please indicate for each scale.

RE: In all cases the higher scores indicated better values – we added this information to the description of each scale.

4. How long did it take to complete the questionnaire (please indicate in the manuscript)? How do you rate the cognitive load of the children (please indicate in the manuscript)? Is it conceivable that fatigue effects affected the results (is this an issue for the section limitations)? Could this also be a point for the limitations of the study?

 RE: Thank you for these questions. The questionnaire took approximately 25-30 minutes to complete. The researchers with the help of teachers made an effort to timing of the survey administration during early school lessons. Thus the children’s cognitive load was acceptable and their fatigue effects did not affect the results.

5. How many children declined to participate (please indicate in the text, if available)? Can you rule out a systematic effect on the results (e.g. disproportionately high numbers of young children, financially weak children, or disproportionately many girls)?

RE: Altogether five children did not complete the questionnaire. There were no disproportionately high numbers of young children, financially weak children (only 1.4 % indicated belonging to the lower class, and 6.5 % to the lower middle class), or disproportionately many girls (boys: 54.7%).

6. Important: How did you deal with missing values (I don't assume that all children filled in the sheets 100%). Additionally: were any plausibility checks available? Please elaborate (and indicate in the text if possible).

RE: When a questionnaire had too many incomplete responses (only very few of them), we skipped them from data analysis.

Results:

Lines 270-273: redundant (repetition from methods) => can go.

RE: We removed these lines and added the following: Table 4 and Table 5 show the results of simple binary logistic regression analyses (Odds Ratios and 95% Confidence Intervals for smoking and drinking (lifetime and three-month prevalence).

Discussion:

The authors have identified protective as well as risk factors for substance use. I miss a paragraph at the end of the discussion that discusses possible intervention strategies for this specific target group based on the results of the study.
=> What are the starting points for possible interventions?
=> What could these look like?

=> Are there already successful interventions published?

It would be important to give practical implications to the readers. Some key points are mentioned in the section conclusions. However, I think the manuscript would benefit from a more comprehensive elaboration on this aspect (in favor of a shortening of the current discussion).

RE: Thank you for the suggestion. We agreed with the Reviewer that giving some insight into practical implications would be extraordinarily important, and therefore at the end of  the Conclusion we added a paragraph on this issue.

 Limitations: Please revise this section thoroughly again. The points mentioned are comprehensible and correct. Nevertheless, I think your study has further strengths, but also further weaknesses/ limitations. Starting points for this can be found in the comments above.

RE: Thank you for this remark, we completed this section.  

I think that these remarks can be addressed very well in a revision, and I am looking forward to the revised manuscript version by the authors.

Comments on the Quality of English Language

Overall, the writing is fine but could be improved in some instances (please see "Comments and Suggestions for Authors").

RE: Thank you for this suggestion, we made a careful proofreading throughout the paper.

We hope that we have addressed all of your comments and recommendations and look forward to seeing a revised version of the manuscript ready for publication in EJIHPE.

 

Best regards, Authors

Round 2

Reviewer 1 Report

I agree to accept this manuscript, and the author has addressed most of my concerns.

Author Response

Thank you very much for your kind response. Sincerely, Bettina F. Piko, corresponding author.

Reviewer 3 Report

Thank you for revising the manuscript and responding to any comments and suggestions. However, even after the substantial revision, there are still certain unresolved issues that were not or were not adequately addressed. Before the manuscript can be accepted for publication, the following remarks should be carefully revised again, as they are fundamental to the interpretation of a scientific publication:

My comment #5 „How many children declined to participate (please indicate in the text, if available)? Can you rule out a systematic effect on the results (e.g. disproportionately high numbers of young children, financially weak children, or disproportionately many girls)?“ referred to any systematic effects of children who denied survey participation - not the entire study population. Although it is unlikely, please re-check whether the group of non-participating children (N=5) differs from the overall sample in key characteristics (e.g., gender, age, socioeconomic status).

 

My comment #6 "How did you deal with missing values (I don't assume that all children filled in the sheets 100%). Additionally: were any plausibility checks available? Please elaborate (and indicate in the text if possible).“
Authors reply in lines 159-160: „When a questionnaire had too many incomplete responses (only very few of them), we skipped them from data analysis.“
=> I am sorry to say, but this is simply too ambiguous and leaves room for speculation as to how the data analysis was carried out. Validated surveys typically provide a maximum number of missing values and instructions for dealing with missing data. This information is completely lacking, however, it is critical for the reader to evaluate the outcomes of the current study. Please add the appropriate information - thank you!

Improved and basically ok. Some linguistic inaccuracies are still present and should be re-checked in a final revision, e.g.:
L. 399: „three-months prevalence“ instead of „three-time prevalence“

 

Author Response

Dear Reviewer;

Please find our replies to your comments as below.

Review 3:

My comment #5 „How many children declined to participate (please indicate in the text, if available)? Can you rule out a systematic effect on the results (e.g. disproportionately high numbers of young children, financially weak children, or disproportionately many girls)?“ referred to any systematic effects of children who denied survey participation - not the entire study population. Although it is unlikely, please re-check whether the group of non-participating children (N=5) differs from the overall sample in key characteristics (e.g., gender, age, socioeconomic status).

RE: We added some more information on this issue, see Lines 141-142 and 245-246.

 My comment #6 "How did you deal with missing values (I don't assume that all children filled in the sheets 100%). Additionally: were any plausibility checks available? Please elaborate (and indicate in the text if possible).“
Authors reply in lines 159-160: „When a questionnaire had too many incomplete responses (only very few of them), we skipped them from data analysis.“
=> I am sorry to say, but this is simply too ambiguous and leaves room for speculation as to how the data analysis was carried out. Validated surveys typically provide a maximum number of missing values and instructions for dealing with missing data. This information is completely lacking, however, it is critical for the reader to evaluate the outcomes of the current study. Please add the appropriate information - thank you!

RE: We added the appropriate information as requested, see Lines 244-258.

Comments on the Quality of English Language

Improved and basically ok. Some linguistic inaccuracies are still present and should be re-checked in a final revision, e.g.:
L. 399: „three-months prevalence“ instead of „three-time prevalence“

RE: Thank you. We did our best to correct all the grammar failures and typos.

We want to say thanks for your continuous help to improve our manuscript.

We hope that this revised version of the manuscript is ready for publication in EJIHPE.

Sincerely,

Bettina F. Piko, corresponding author

 

Round 3

Reviewer 3 Report

Thank you for thoroughly responding to all previous comments.