Reviewer's report
Title:How Does Social Integration Influence Breast Cancer Control Among
Urban African-American Women? Results from a Cross-Sectional Survey
Version: 1Date:31 August 2007
Reviewer: Celette Sugg Skinner
Reviewer's report:
General
The question posed by the authors is new and well defined.
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Major Compulsory Revisions (that the author must respond to before a decision
on publication can be reached)
A key part of this work is creation of the indices measuring social roles, networks,
and support. Because they have not been used previously by other researchers,
readers need to know more about these measures, including the exact item
wording (maybe in a table). Readers also need to know more about how they
differed from measures of these three constructs used in previous studies. As
written, there is no justification for or validity information about these newly
created measures. I believe they are fine, but the authors must address these
questions and give more information.
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of
a term, which the author can be trusted to correct)
The authors must mention the limitation of the length of time since data
collection. Due to period and cohort effects, findings from this data set may differ
from the results we would find today.
Several comments that should be in the Discussion section are mixed in with
Results. These include:
- last sentence page 12
- 1st sentence of paragraph 2, page 13
- page 14 - last sentence of paragraph 1, all of paragraph 2, and last sentence
paragraph 3
In both the Results and Discussion sections, the authors sometimes use words
that imply causality rather than association. Example: “education serves to
engage women in more social roles” (page 12); “knowledge is enhanced through
social structures (page 15); “social support positively influenced…attitudes”
(page 17), etc. Change the wording to indicate associations only.
The intervention recommendations in paragraph 2 of page 16 also seem to
assume causality and are too strong. Soften wording.
Second paragraph page 18 is very speculative.
In paragraph 3, page 18, there should be some mention of the success of
previous screening promotion interventions based on peer networks. See work of
Eng, Earp, Enwin, etc. Leveraging peer networks is one of the main tenants of
lay health advisor (LHA) interventions, and the body of literature on LHA
interventions and promotion of breast cancer screening should be mentioned.
First paragraph of page 19 is value-laden. Lumpectomy and radiation is a
somewhat newer choice than mastectomy, but both have been available for quite
some time and neither is clinically considered to be a more or less optimal
choice.
On page 2, the last paragraph in the Abstract should be consistent in listing the
social support variables at the first or the last of the sentence. In the current
submission, social integration is at beginning of first sentence, but emotional
support and church networks are at the end of the next sentence.
The first 5 sentences of the last paragraph of the Introduction better belong in the
Discussion section.
Also on page 5, there is a mention of the importance of understanding pathways
through which “consistent mammography adherence is maintained”. Because
this report neither assesses causal pathways or looks at consistent, repeat
adherence this statement should be removed.
Given that the data were collected in the 1990s, results should be written in past
rather than present tense.
Additional Comments:
The finding described at the top of page 17 is important because conventional
wisdom has assumed that religious belief is associated with fatalism, especially
among African Americans. The authors’ finding challenges this assumption and
deserves more comment.
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Discretionary Revisions (which the author can choose to ignore)
What next?: Accept after minor essential revisions
Level of interest: An article whose findings are important to those with closely
related research interests
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.