Title: Decreasing Reproductive and Abortion Care Barriers:  Findings on Student Health Center
Role from Student Survey
Version: 1 Date: 10 Dec 2022
Reviewer's report:
This study of CA college students' knowledge and attitudes regarding access to reproductive
healthcare and medication abortion provides useful baseline data  before the implementation of
SB24 statewide. The manuscript can be improved by acknowledging the limitation of the small
sample and by editing for clarity and readability. Thank you for the opportunity to review this
manuscript.
Overall language - Check verb tense for consistency, particularly in results where I'd suggest
past tense. The study population "was",  the majority of respondents "experienced", there "was"
a difference.
Also check for passive voice and change to active when possible. For example line 241, change
to "We did not find..." or "The study did not find..." Word has a tool to identify passive voice
which might be helpful.
Check for consistency in use of SHC or school health center (see line 160 for one example)
Line 87 - Superfluous "to". Suggest edit to "with potential to impact the..."
Line 88 - Consider specifying college/university SHCs here, since many SHCs nationwide are
elementary and secondary level. Once defined and specified here, ok to keep SHC throughout.
Line 123 - Consider slight wording change to "self-reported use of and attitudes toward
reproductive and abortion services"
Measures - The variable "sexually active " is listed in the table but not listed in the measures.
Please describe here.
Line 147 - Minor wording preference; consider changing to  "attitudes toward reproductive
health services" or "attitudes about reproductive health services".
Line 148 - Later on the paper defines what "products and services" are, but would be helpful to
have earlier on. Consider edit to: "products and services including pregnancy tests, emergency
contraception, medication abortion."
Line 175 - I'm unclear what this means ": who are thus comparable in terms of relevant
population . " Please  be more specific or remove.
Line 181 - Change to "current U.S. Food and Drug  Administration"
Line 189 - Consider ordering as described earlier for consistency - pregnancy test, emergency
contraception, and medication abortion.
Line 199 - I'm not sure what this means. Without collapsing categories/groups?
"We examined race/ethnicity individually  where we had sufficient data."
Line 207-209 - This is a result and should go in the very beginning of the results section.
Line 212 and Table 2 - Specify "general reproductive healthcare" instead of just "general"
Results - Can you provide more data on how many surveys you received, how many were
ineligible or incomplete – how you arrived at the final analytic sample size?
Line 236, 238, 246, 252 - "very highly significantly" - reword to "significantly  more likely ",
even "significantly more frequently".
Line 284 - Can you provide references? "this extremely safe, highly effective, cost efficient,
increasingly common yet highly stigmatized service "
Limitations - In addition to the sampling limitation as described, a limitation is not just the
recruitment methods introducing sampling bias but also the small sample of students who
completed the survey (273 out of 29K?).  It is helpful that you compare your sample to the study
site population in accounting for this.
Supplemental Table S2 should have total n’s of total student body/study site population and
those completing survey/sample at the top of the columns.
Line 321 - Mention these validated survey instruments in Methods if not done already
Line 336 - If you name the bill specifically here (SB-24), also name earlier in Background.
Lines 342-344 - Add reference/s. "Medication abortion is the most prevalent and growing
method of abortion and is increasingly done without an in-person visit both within (telemedicine)
and outside the confines of the formal healthcare system (self-management)."
Table 1 - suggest just including the number in the n column, like 9 rather than (n=9). I'm also
more used to see the n column on the left of %. You can even combine into one columns n(%),
for example, 9 (3.31).
Tables 1 & 2 - Distance from campus. Should the third category be 21-50 miles?