Reviewer's report
Title:Are single mothers' higher smoking rates mediated by dysfunctional coping
styles?
Version:3Date:4 August 2014
Reviewer: Ari Haukkala
Reviewer's report:
Authors have improved manuscript considerably. However, there are still some
issues that need major revision. I think the current problem of the manuscript is
highlighted in the conclusions.
Abstract, Conclusions:
“Single mothers compared to partnered mothers showed a different ability to
cope with stress which in part accounted for their higher smoking rates. Our
findings underline the significance of tackling dysfunctional coping styles in order
to assist single mothers in quitting smoking.”
I think authors make wrong conclusion. Despite single mothers have “adverse”
means in coping styles, except positive self-verbalisation none of the
psychological coping styles were related to heavy smoking or moderate smoking
and there were no indirect effect to smoking in mediating models. Based on
these results I do not understand how “showed a different ability to cope with
stress which in part accounted for their higher smoking rates”. (also page 13 line
2)
Personally I read the results so that psychological coping strategies are not
related to smoking status of mothers (except self-blame only among single
mothers) and therefore they are not “mediating” the association between single
motherhood and higher smoking prevalence.
Coping strategies self-reported information how people think that they solve
imagined stressful situations. We do not know how well they are working in real
life to help in real life problems among these subjects. Therefore also the next
phase of the conclusions is problematic.
“Our findings underline the significance of tackling dysfunctional coping styles in
order to assist single mothers in quitting smoking”
Cross-sectional results between smoking status and coping styles are quite far
from the process of successful smoking cessation. This could be interpreted as
authors are thinking that if we decrease self-blame, or blaming others coping
styles this will lead to smoking cessation. This kind of straightforward concluding
is visible also in discussion (page 11, line 7 and line 14 and page 12, line 3-7). If
stress must be addressed in smoking cessation that will happen much more
comprehensive way than just increasing or decreasing some dimension.
I would suggest that authors conclude the results already in the first paragraph in
discussion (page 9, it is standard that results are already in first paragraph. No
authors only repeat the questions).
1) There were differences in the mean levels of coping styles between single and
partnered mothers (but this study does not tell do single mothers have more
stress or how effective or non-effective these styles are)
2) (psychological) Coping styles did not have impact on smoking status
3) and therefore there was no indirect/mediating effects on smoking status.
After this authors could concentrate is smoking/substance consumption really the
coping strategy for stress. If so, in case of smoking cessation, do mothers need
some support how to cope with stress in general to avoid relapses to smoking.
However, this will go back to question does smoking really helps with stress. that
could be shortly discussed as well eg.
Parrott, A. C. (1999). Does cigarette smoking cause stress?. American
Psychologist, 54(10), 817.
Hajek, Peter, Taylor, Tamara McRobbie, Hayden. (2010) The effect of stopping
smoking on perceived stress levels – Addiction
I think this kind of discussion that is related more how to decrease the high
prevalence of smoking among single mothers is more fruitfull that sudden citation
to Hobfols model (page 10 line 17) in the discussion. The complicate association
between affective states and smoking gives better picture to increase the level of
the discussion and avoid conclusion from cross-sectional associations (page 11,
line 7).
Again, small odds ratio that was significant only between small number of single
moderate smokers and non-smokers is interpreted as finding among all single
mothers (page 11, line 23) and then concluding from this finding that this might
be problem in intervention among all single mothers. In my opinion this could be
random finding.
For table 1:
It would have been convenient to use mean functions for coping styles (mean
over three of two items) and this should give same results but means could have
been comparable between substance consumption and other dimensions.
For table 2:
the number of subjects in all three categories must be shown (non-smoking,
moderate, heavy) among single, partnered and all mothers groups.
Minor comments
p-value is either =0.001 or <.001 but not (p = <0.001)
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.