Reviewer's report
Title:Socio-demographic factors and processes associated with stages of
change for smoking cessation in pregnant versus non-pregnant women.
Version: 1Date:22 June 2010
Reviewer: Ross Barnett
Reviewer's report:
Socio-demographic factors and processes associated with stages of change for
smoking cessation in pregnant versus non-pregnant women
Much has been written on smoking in the last few years and, given my interest in
the former, I welcomed the opportunity to review this article on smoking among
pregnant and non-pregnant women. However, while I found the article interesting
I’m not sure what contribution it has made to our knowledge of women’s
smoking. My particular criticisms are:
1. The study fails to adequately situate the work in the wider context of women’s
smoking and smoking among pregnant women in particular. I would have
preferred to have seen a brief review of the literature on pregnant and
non-pregnant smokers and what particular gap in the research this study
attempts to fill.
2. I would also have liked to have seen some discussion of the importance of
individual versus environmental causes of smoking and the failure of much
smoking cessation policy to address the latter. The abstract mentions the
importance of “social contextual factors”, but these are not really discussed in the
conclusion. Much smoking cessation policy has failed precisely because it has
tended to focus on individual behaviour change and less on the critical
environmental factors which also affect perceptions of risk. Even pregnant
women may continue to smoke in some social environments if the perceived
risks of doing so are less than the other risks they may experience in their day to
day lives.
3. The study design also needs further elaboration:
a. I would have liked to have seen more information on the social composition of
the two samples and how they were chosen. Telling me that “about 85%” of the
women in both groups had a high school education is not that helpful.
b. The familiar TTM is introduced but again telling me that the questionnaire
included both experiental and behavioural process as components of the stage of
change model would have been more useful had the design been more clearly
related to a theoretical framework or some stated hypotheses.
c. Similarly throughout the paper too many issues are just “dropped in” without
adequate explanation eg like the ‘three types of situations’ and ‘precocious
stages’ (p. 7). The Situational Temptation Measure should have been discussed
in more detail in the methods section and again should have been more clearly
related to particular study objectives.
4. The Discussion section provides a useful summary of the findings but it fails
to:
a. Acknowledge the limitations of the study
b. Demonstate what contribution the study has made to the wider literature eg I
would have liked to have seen some discussion of why educational factors were
only important among pregnant smokers, whereas the wider literature on
smoking inequality would suggest that socio-economic status, however
measured, is a very good predictor of smoking cessation for both women and
men.
5. In sum I found this to be a disappointing paper which lacks a clear message
both in a theoretical and policy sense. In its present form I would not recommend
its publication. I would have also appreciated that the authors names not been
included on the manuscript.