Reviewer ’s report  
 
Title: The Cedar Project: Using Indigenous -Specific Determinants of Health to Predict 
Substance Use among Young Pregnant -Involved Indigenous Women in Canada  
 
Version: 0 Date: 02 Feb 2017  
 
Reviewer: Eeva Ekholm  
 
Reviewer's report:  
 
The scope of the study is interesting, how social determinants of health influence alcohol and 
drug use during a woman´s life span. The author´s state that the question of substance use during 
pregnancy should be broadened to use before, during and after p regnancy. I agree with the 
author´s view.  The article is interesting and well -written.  
However, there are several methodological limitations in this study.  
The term pregnant involved comprises a methodological problem. How big a share of the women 
14-30 years  in this studied population does this "pregnant involved" include?  
Study question 1 asks what are  the contexts of lives of pregnant -involved young Ab original 
women who use alcohol and drugs?  It would be important to compare these determinants with 
women who have not become pregnant or who do not use drugs. As it is, the manuscript is a 
description of a high risk subpopulation of aboriginal women. How do  the women who have 
stayed clear of drugs differ in relation to the described risk factors? If the research question is the 
life context of this risk group, it would at least be important to know when they were pregnant 
and did they give birth and take car e of the baby. Substance abuse earlier and later in life may 
have different determinants.  
The Cedar project has published  papers this year about social determinants of substance use 
among young pregnant -involved Indigenous women in Canada and  quantitati ve analysis of these 
women's  experiences and self representations. Did these studies serve as a ground for the 
present study with quantitative design? The authors do not, however, refer to these previous 
reports? Also previous findings on these data on p regnant -involved substance abusing women 
would be important to convey to the readers.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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