Reviewer's report
Title:Factors affecting knowledge and perception of women about smoking: a
cross sectional study from a developing country
Version: 1Date:8 December 2010
Reviewer: Joan M Brewster
Reviewer's report:
This report describes results of an interview questionnaire survey of women
attending primary care clinics in slums of Karachi, Pakistan. The questions cover
the women’s demographics, knowledge about the health effects of smoking, and
attitudes toward smoking. The topic is important, as the prevalence of smoking
among women in developing countries is low, and economic forces are working
to increase the smoking rate.
Discretionary Revisions
• Background, second paragraph: Which countries are included in the cited World
Health survey?
• Because education was related to knowledge of tobacco effects, the authors
conclude (among other things) that smoking-related education programs should
be targeted at poorly educated women, and those who cannot read. This seems
reasonable, but is it not appropriate for the authors to take the bolder step of
recommending that basic primary education be increased and made available to
all women in Pakistan? More than half of their participants have no formal
education at all.
Minor Essential Revisions
• Abstract, results: “passive smoking effecting children’s lung …” should be
“passive smoking affecting children’s lungs …”
• Abstract, last line: should be “women’s health.”
• Background, second paragraph, last line: “dependant” should be “dependent.”
• Results, paragraph 3, 4 lines from bottom: should be “affects children’s health
negatively.”
• Tables 2 and 3: Explain what the %’s in the columns represent.
• Tables 2 and 3: The questions need to be identified by something other than
numbers like “Q1” etc. Meaningful labels will make the tables much easier to
read. They could be in a footnote if not in the column headings.
Major Compulsory Revisions
• In the title, “affecting” should be “related to,” as no causal relationship is
examined here.
• The authors do a good job of reviewing the issue of smoking by women in
developing countries. I believe there are more recent references for some of the
global tobacco use data. But what really could use tightening up is the rationale
for concentrating on women in the lowest socioeconomic group. The introductory
review compares women in developing to developed countries, but does not go
into detail about why the poorest women are important, and previous research on
education’s relationship to the outcome variables.
• Background, last paragraph: The authors state that knowledge of tobacco
effects is essential to progress through the states of change in cessation. First, it
is not clear that progression through stages is essential to cessation; an
argument should be made. Then, the statement that knowledge is essential to
this should be supported by references, and more supportive statements. This
comment also applies in the fourth paragraph of the discussion, where the
authors say that knowledge of harmful effects is a determinant of reducing
passive smoke exposure in homes.
• In methods, a list of “questions” is provided, but they are actually statements.
The authors make clear that the questions are asked in an interview format, as
many of the participants are illiterate. However, more detail should be given here.
The results and discussion report knowledge about second-hand smoke (SHS),
but none of the questions listed are specifically about second-hand smoke. Also,
none of the questions address infertility or osteoporosis, which are reported in
the results. The authors need to give more detail about how these things were
asked.
• In the limitations section, the authors note that the findings might not generalize
to rural women. But the findings are also limited to women attending primary care
clinics. Is there any information about the reason for women to attend the clinics,
or whether women who attend the clinics are self-selected in some way? It
seems likely they are not a random sample of women living in these areas.
• Tables 2 and 3: It is not clear how the statistical tests were carried out. For
example, in Table 2, the asterisk indicating significance is placed next to “6-10
years of schooling” for Q1, and next to “no formal education” for Q5 and Q6. For
each independent variable, and each Q, the numbers endorsing and not
endorsing the Q should be tested in a chi-square with all levels of the
independent variable at the same time. Thus, it is the whole picture, of education
vs. Q1, for example, that is significant, not just one level of education. Also, as
chi-square uses frequencies rather than percentages, these should be reported
in the table; percentages can be in brackets.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.