Reviewer's report
Title:Effect of menstrual phase on tobacco consumption, craving for smoking,
depression and menstrual phase-associated symptoms in young Japanese
female smokers: A prospective study
Version: 1Date:5 November 2012
Reviewer: Elena Toffol
Reviewer's report:
Effect of menstrual phase on tobacco consumption, craving for smoking,
depression and menstrual phase-associated symptoms in young Japanese
female smokers: a prospective study.
Comments to the Author
This manuscript describes the relationship between the menstrual cycle phase
and smoking behaviour in a cohort of 29 young women. The authors report a
significant correlation between smoking behaviour vs. depressive and menstrual
phase-associated symptoms. Symptoms and size of the correlations varied
across the menstrual cycle phases. Even though the study question is
interesting, I have some concerns regarding the study design and interpretation
of the results; moreover, I think a language revision is needed.
Major compulsory revisions
1. The manuscript is quite difficult to read and it is not always obvious what the
authors want to say. I think a language revision is necessary.
2. Title: can the authors really talk about “effect”? Maybe a more neutral term
(relationship, correlation…) would be more appropriate. Also, can you really call
this a “prospective study”? It has a prospective design, but I am wondering if two
months of observation are enough to define a study as prospective. I would
suggest omitting this from the title.
3. Introduction: I would suggest a rearrangement of the text. For instance,
paragraph 4: the results of the authors' previous study could be moved after
paragraph 1. Also, paragraph 1, final sentence (“To provide….menstrual cycle”)
could be omitted or moved to the aims of the study. I would also omit (or
reformulate) the first sentence of paragraph 3. Paragraph 3 in general could be
shortened or rather moved to the method section.
4. Methods: this section in general is too long and confusing. There are too many
detailed descriptions (e.g., “The researcher explained the method of using them
to the subjects for around 15 minutes while demonstrating them” could easily be
omitted) and, at the same time, need for clarification. The whole section would
need rearrangement and language revision. For instance, the section “ethical
considerations” could be shortened; besides, some ethical issues are already
mentioned in the opening paragraph, section “participants”. The instrument used
to assess nicotine dependence (FTMD) needs to be explained more in detail:
later in the results the authors report a mean FTND score, but it is hard to
understand its meaning if we do not know the scoring range and how it is
calculated.
5. Methods, section “procedure”. Was the basal body temperature measured
every morning for two months? Please, clarify. Also, when was the craving for
smoking recorded? Every day? Morning? Evening? How was alcohol
consumption assessed?
6. Methods, section “analysis methods”: the terms of correlations are not clear.
Maybe using “versus” rather than “and” to separate the variables entered in the
correlations would be of help.
7. Results, paragraph 1: I would consider reporting these results in a table.
8. Results, paragraph 4: the description of the correlations is somehow clumsy;
could the authors report it in a simpler way? Also, I would suggest maintaining
the order of the terms presented in the correlation: I mean, number of cigarette
smoked and CO concentration should always be the first terms of the correlation
(or vice-versa).
9. Discussion: in general, a revision of the text is needed. First paragraph could
be shortened and/or made more agile to read.
10. Discussion, end of paragraph 1: “therefore, data on the amount of smoking
for “1.8 ± 1.8” days, in which the subjects drank alcohol or did not smoke all day
for some reason, were excluded in this study.”. What does this mean? This
should be explained in the methods.
11. Discussion: even though CES-D has been used as a diagnostic tool in
several settings, it is not really a diagnostic instrument: therefore, I would suggest
using the word “depressiveness” or “depressive symptomatology” rather than
“depression” throughout the text.
12. Discussion, final paragraph: “Moreover, breath CO (…) menstrual and
follicular phase”. The meaning of this sentence is difficult to understand. Please,
reformulate. Again, I would suggest being more cautious in interpreting the
results in terms of cause-effect.
Discretionary Revisions
1. Introduction: the authors mention repeatedly “urinary cotinine”: would it be of
help just explaining what cotinine is?
2. Introduction, paragraph 3, point 2): what does “The menstrual, follicular, and
luteal phases were clearly defined for subjects with different menstrual cycles”
mean?
3. Introduction, paragraph 3, point 4): maybe the authors want to mention here
that women with dysmenorrhea and history of depression were also excluded.
4. Methods, paragraph “Participants”: “Question items included: (…) menstrual
cycle and duration of menses during the past three months”. Do the authors
mean “duration of menstrual cycle?” Or what else?
5. Methods, paragraph “Participants”, inclusion criteria 4: what do the authors
mean with “low-dose pills”? Were other forms of (hormonal) contraception
allowed? If so, this should be commented in the discussion, since hormonal
contraception may influence the menstrual cycle regularity as well as mood and
psychological well-being (and maybe smoking habits?).
6. Discussion, paragraph 2: the authors cite some studies where “the level of
craving for smoking was higher and the concentration [do you mean CO
concentration?] was decreased more in the menstrual phase compared with the
follicular phase”, and claim that this is in consistent with their results. Isn't the CO
concentration higher in the menstrual than in the follicular phase in the current
study? Similarly, in paragraph 4, the authors cite their previous study, and they
claim the results (of more premenstrual symptoms in smokers compared with
non-smokers) are consistent with those of the current study: I do not see this
point. The results of the current study refer only to smokers, it is just something
else.
7. Discussion, end of paragraph 2: I would suggest reformulating the sentence in
a more tentative way (I would again talk about “relation” or similar rather than
“cause”).
8. Tables: I would suggest merging Table 1 and 2. Also, could the authors
consider some other way to indicate significant results in Table 1 and 2? It was
not easy to understand the meaning of all the superscripts, in particular in Table
2.
Minor Essential Revisions (minor issues not for publication)
1. Methods, section “procedure”: a reference for the CES-D Japanese version is
required. Same when mentioning the reliability of the MDQ, Japanese versions.
2. Discussion, paragraph 4: please, remove (or reformulate) the sentence in
brackets “(different from the level of depression)”. It is not needed.
3. Table 2: please, align headings and columns.
4. Table 3: perhaps the first column would be clearer if the text was centrally
aligned in the cell.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
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