Title: Variations in the patterns of tobacco usage among Indian Females - findings from the
Global Adult tobacco Survey India
Version: 4 Date: 13 Jul 2022
Reviewer's report:
Positive: You have largely addressed all the review comments, as shown in your replies.
Things that still need work:
I note that on page 7, lines 19-25 and on page 8, lines 1-9 you are referring to DHS protocols. On
p 9 you refer to Table 1, which has a line on the number of children. Since I had mentioned the
need to remove mention of DHS in the methods section earlier, I had assumed that this would
be done and that dataset would not be used.
In the GATS 2 report the questionnaire is in Appendix E on pp 279 310. In that questionnaire
I do not see any question on number of children.
The DHS questionnaire for women, however, contains questions on the number of children
living at home.  You have referred to the DHS
In your original manuscript you had stated that you had used DHS data.  However, your title
stated that you were writing about GATS data. These facts raise doubts on which dataset(s)
you analysed for this article. The dataset used should be only one and the title and text should
mention the same one. I note that on page 7 line 20 in your independent variable section, you
have referred to the DHS protocols.
I suggest that either you do your entire data analysis once again and re-do your tables from
scratch (Table 1 also needs to show totals  in the first column after the variables column), and
then revise your text accordingly, or let go of this work for now.
I am also giving my other comments below in case you are still interested in revising your
manuscript:
On page 1 in the first paragraph, it would be nice if you gave a reference for the following
statement:
“The declining trend was foreseen by the tobacco industry in its very initial stages. Hence, they
started shifting their targets.”
Perhaps you think it is general knowledge, but actually I doubt that.  The most recent reference
you can find would be good – even if it just says that as tobacco use declined in the developed
world, the tobacco industry began to shift its focus to the developing world.  In regard to this,
see also the WHO Global Report 2019 pp 9-15. Perhaps this could be one supporting reference
used. However, it does not mention the tobacco industry.
A similar statement is in your discussion section on page 12, lines 7-10 but with no reference.
The statement in the discussion seems more realistic. If you have a reference, best to use it there
and consider having the statement only in one place: Intro or Discussion, wherever you think
best.  If your only available reference is old, you could modify your own statement according
to the latest scenario.
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Also in the first paragraph, a statement has been taken from a news report on a report of the WHO
referred to. However, in view of 1) India’s GATS2 figures (since India makes up a substantial
part of the WHO SEARO) and 2) the contents of the actual WHO report (2019) this statement
you borrowed from the news appears incorrect:
“Furthermore, the WHO Southeast Asian Region has the highest tobacco consumption rates,
with over 45 percent of males and females aged 15 years and above using tobacco.”
I suggest you avoid referring to this news report and instead read and refer to the actual report.
See Table 3 on page 12. Make your own statement based on this and add it to your manuscript.
I am sure you will see the error in the news report.
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In the second paragraph, where you say, “the fifth round of the National Family Health Survey
(NFHS-5) (2019-20), when compared with the GATS-2 depicts that these changes are not
uniform throughout the country,” I am wondering if you have read the entire GATS2 and GATS1
reports, because state-wise data is given there also, like in the NFHS reports.  In the GATS 2
report, see Table 4.36 on page 78 (this is for males and females combined) and text on pp 72-81.
See also table 4.37 on page 79. How do these results compare with what NFHS shows? If it
is not very different, then you can say that the results showing change are comparable or that
one confirms the other. If they are not similar, keep in mind that the survey year of NFHS-5
was several years later than GATS2 and that the year of the previous NFHS survey you are
comparing it with may be very different from the year of GATS 1.  Then you may find it better
to stick to GATS for this paper. Otherwise, there will be confusion.
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On page 4 line 25 you state, “Furthermore, the emphasis on men portrays gender bias”. I think
a good reference here would be helpful (but not at all mandatory).
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On page 2 line 14, the first line of Methods, you say a “similar” sampling method. You have not
stated what it is similar to. Perhaps you meant to that used for GATS 1? Best you clarify.
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In your new manuscript on page 5, line 6 you say "anti-estrogen". You should say "anti-estrogen
effect".
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You need to correct the grammar in this sentence (remove dash; add “and”:
As per Felix AS et al., the relationship between cigarette smoking and endometrial carcinoma
risk is concordant across major endometrial carcinoma risk factors.
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When you state that the details of the variable “Awareness about the adverse effects of tobacco”
are described elsewhere and you refer to one of your own papers, at the same time you could
also refer the readers to the GATS 2 report (Ref 5), in chapter 9 on pp 157-172.  I think this
would only be fair.
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On page 10, line 19, where you say “thought was most potent”, I think it best to say “thinking
about quitting was most common.”
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On page 12, lines 11-12, where you say “this load is diluted” I think you should say, “this load
appears diluted”.
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In your discussion, when you used references from outside of India, it would be useful if you
stated from which country they came because their results may or may not be comparable to
the situation in India.
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On page 13, line 17, you say, “there is substantial evidence that there is a high propensity to
use.” If you meant to state what they use, then state it. I think you meant "SLT".