Reviewer's report
Title:Socio-demographic factors and processes associated with stages of
change for smoking cessation in pregnant versus non-pregnant women.
Version: 1Date:12 July 2010
Reviewer: Cheryl Merzel
Reviewer's report:
Major Compulsory Revisions
1. The research question posed at the end of the Introduction is rather vague and
general. Sharpen the research question to clarify what specifically needs to be
compared between pregnant and non-pregnant women. Clarify the specific
outcome behavior that will be examined for the stage of change model being
applied.
2. Methods - The sample seems to be extremely limited and selective. The
authors should describe in much more detail the sampling methods employed
and the population that the sample represents. Every effort should be made to
use more representative sampling methods for this study.
3. Methods – clarify if the study was limited to current smokers and ex smokers
(i.e., are women who never smoked excluded?)
4. Methods - The authors should explain how they dealt with the potential bias
from self reported smoking status. Did they validate these reports? This is critical
since there is a strong likelihood that current smoking would not be admitted to
by the women.
5. Methods - Identify the specific measures used to identify smoking status.
Identify how each stage of change was measured (i.e., the wording of the
questions).
6. The study would be strengthened by including measures of the degree of
smoking – e.g., frequency, amount, level of dependency.
7. Results, Sample Characteristics – provide some indication as to how these
characteristics compare to the general target population.
8. Results – provide the frequency distributions for smoking status among
pregnant and non pregnant women. Show how these compare to national or
regional data.
9. Results, Stages of Change – clarify how the statistical test was conducted –
percentages for each stage are presented but an overall significance level is
given. Were statistical comparisons made within each stage?
10. Results, Stages of Change- Clarify how stages of change, presumably for
quitting smoking, applies to ex-smokers.
11. Results, Stages of Change - The authors combine smokers and ex-smokers
in their reports; they are very different groups and should be analyzed separately.
This is particularly important since smoking behaviors differ among pregnant and
non-pregnant women.
12. Results – explain the importance of examining the relationship of stages of
change and sociodemographic characteristics.
13. Results, Processes of Change – the definition and meaning of “experiential,
behavioural processes” should be explained. The measures for these variables
should be described in the methods section.
14. Results, Processes of Change, Temptation to Smoke – clarify if these
analyses are limited to current smokers (it seems they must be but throughout
the analysis it is not clear whether both current and ex-smokers are included and
if the analysis is limited to current smokers; this should be clarified).
15. Results, Processes of Change – The analysis makes within group
comparisons but no direct comparisons between pregnant and non pregnant.
The difference between pregnant and non pregnant women in stages of change
should be analyzed directly.
16. Discussion – clarify whether the interpretation of the stages of change
findings is based on findings limited to current smokers. It’s hard to interpret the
findings when the relationship of stage of change to smoking status has not been
clarified and controlled for in the analysis.
17. Discussion – The authors infer differences in processes of change between
pregnant and non pregnant women but the analysis does not seem to be based
on direct comparison of these two groups (see #15 above).
18. Tables – The tables are difficult to follow. Clarify how processes are
measured/quantified. Clarify what the number in each cell is based on.
Minor Essential Revisions
1. Abstract, Methods - Delete question mark at end of the sentence.
2. Methods section, 4th sentence – delete the extra period at the end of the
sentence.
3. Methods, Analysis – in the second sentence, change the word “qualitative” to
“categorical.”
4. Figures and Tables – identify the statistical tests employed. Clarify if the
significance levels refer to within group or between group differences. Indicate if
the cells in the tables are based on percentages or if they are a mean (if so,
include standard deviations).
Discretionary Revisions
1. Methods – explain the term “physiological pregnancy.”
2. The tables use the notation ‘p’ to indicate the number of cases. In the U.S., the
convention is to use the notation ‘n.’
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.