Reviewer's report
Title:Effect of menstrual phase on tobacco consumption, craving for smoking,
depression and menstrual phase-associated symptoms in young Japanese
female smokers: A prospective study
Version: 1Date:4 January 2013
Reviewer: Tellervo Korhonen
Reviewer's report:
BMC Womens’ Health
Article title:
Effect of menstrual phase on tobacco consumption, craving for smoking,
depression and menstrual phase-associated symptoms in young Japanese
female smokers: A prospective study
GENERAL COMMENT
This paper has made a valuable effort to improve methodology related to
investigation of menstrual phase and smoking behaviour plus mood related
symptoms. Overall, this paper would provide important contribution to the field.
However, the data is small and representing Japanese women only with
extensive exclusion criteria. Thus, conclusions should be more cautious.
1. Is the question posed by the authors well defined?
NO – Given earlier evidence, hypotheses should have been formulated.
2. Are the methods appropriate and well described?
YES
3. Are the data sound?
YES
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
YES
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
NO
DISCUSSION
CONCLUSION
This is too long. Also, most of the text here is summarizing the results. That part
should be moved to the beginning of discussion where it is appropriate to
summarize the aims and results of the study. Further, I find the conclusions too
strong given that the data is restricted to small number of women (Major
Compulsory Revision)
6. Are limitations of the work clearly stated?
NO – limitations of generalize the results should be discussed. (Major
Compulsory Revision)
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
YES
8. Do the title and abstract accurately convey what has been found?
TITLE – NO
It should be modified; for example as follows:
Association of menstrual phase with smoking behaviour, mood and menstrual
phase-related symptoms: A prospective study among young Japanese female
smokers
(Minor Essential Revision)
ABSTRACT – NO
Minor Essential Revisions:
- Abbreviation should be given after ‘visual analogue scale’ (VAS)
- Before LH it should be written in its complete form
- It should be reported how women were recruited to this study
Major Compulsory Revision:
- Conclusions should be totally re-written to be more cautious.
9. Is the writing acceptable?
NO - English should be checked by a native speaker. (Major Compulsory
Revision)
OTHER COMMENTS
Background
Page 4 , line 14: Before LH it should be written in its complete form
Methods
Instead of ‘survey’ use ‘study’
You should report how use of various contraception methods was taken into
account?
Why were married women excluded?
Page 8: line 14: Reference is needed.
Page 8: line 21: Reference is needed.
Page 9: part ‘Definition of each of the menstrual cycle’ should be moved to page
7: immediately after ‘Procedure’.
Page 9: Subtitle ‘Tobacco consumption’ is enough; delete the other part.
Page 9: Concerning CO measures, was the time since the last cigarette of the
day registered (hours/minutes)
Page 9: Ethical considerations
Were the participants allowed to quit smoking during the study?
Did the participants receive money?
Pages 9-10: Analysis methods
‘Time effect’ should have been estimated to show if the changes in studied
variables were significant. I do not see any estimates of that in the text or in the
tables.
Considering p-values, were they based on 1-sided or 2-sided test?
Results
It would have been nice to see graphic presentations of at least some results.
Now, the results are not very ‘reader friendly’.
Discussion
The authors should add discussion on the potential role of estrogens in metabolic
of nicotine, because the level of estradiol fluctuates during the menstrual cycle.
Would it have any influence on any of these results? Please, look at papers by
Neal Benowitz concerning estrogens and smoking in women.
Page 15: More recent references should be given for the anti-depressive effects
of nicotine.
Here is should be also noted that it is still under debate whether depression leads
to smoking or vice versa, if smoking leads to depression.
line 14: It is said that the previous results were in line with this study. Really?
Please check this.
Conclusion
As said above, this should be totally re-written and more cautious.
Lines 12-14: This sentence is not based on the current study and should not be
included in the conclusion. It should be moved to discussion. I also would like to
make a counter argument here: Could it also be so that quitting smoking would
alleviate the PMS?
Lines 14-17: This concluding remark comes without any evidence. I cannot find
reference to any evidence in discussion or elsewhere in the paper indicating that
depression would make quitting smoking more difficult?
Tables
They need a lot of editing.
Table 1.
It should be clearly indicated that there are means (SD) presented here.
Right column: It should be identified which p-values are shown here. Are these
actually the p-values for the time-effect? If so, also F-value and df should be
shown.
Table 2.
It should be clearly indicated that there are means (SD) presented here.
Left column: I suggest changes as follows:
Craving # Craving (VAS)
CES-D scores # Depression (CES-D)
MDQ scores # Menstrual phase-associated symptoms (MDQ)
One of the rows has ‘jumped’ to the right
Right column: It should be identified which p-values are shown here. Are these
actually the p-values for the time-effect? If so, also F-value and df should be
shown.
Table 3.
95% Confidence Intervals are needed for these correlations.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have served as consult on tobacco dependence for Pfizer in 2011-2012.