Title: Variations in the patterns of tobacco usage among Indian Females - findings from the
Global Adult tobacco Survey India
Version: 5 Date: 21 Sep 2022
Reviewer's report:
My comments:
First I will refer to your "rebuttal letter" below:
I note that you have addressed all my previous comments.
I am very glad to know that you have indeed used GATS2 data.
I  think you could still put total participants in the first column because you are using the same
data set as you used in your other paper. Your study is different so why would it represent
plagiarism? And as you know, GATS data is available  on the CDC website to download for
analysis.  It is just normal to have a column of total participants in Table 1.  I don't think
plagiarism comes into play here, but  I leave the decision up to you - do what is comfortable
for you.
Now secondly, I will refer to the text of your manuscript:
In the ABSTRACT:
I have a comment on your sentence on weighted analysis on lines 19 and 20: I think it would
be best you say something like, “For this particular study, weighted analysis was used through
bivariate and multivariate analysis…….”  Because bivariate and multivariate analysis were not
used in the original GATS study.  However weighted analysis was used in the original study.
Alternatively you could separate these two concepts into two sentences. I suggest you think it
over carefully and see what works best for you.
In the first line of the Results section in the abstract (line 22), you say non-users, but you were
supposed to say never users, right?  And I suggest you give one decimal point: 84.2% as in
the original GATS2 report. I suggest you be consistent - you are giving a percentage with one
decimal place after that number. So do the same with all your percents. Plagiarism does not
come into play here, in case you are worried about that. You need to be accurate and consistent.
In the Conclusion, I suggest you remove "the" before "broader ..." on line 12.
In the MAIN TEXT:
Introduction, line 3 on page 4, where you say, "1.397 billion" add "users".
On line 13 of page 4, also cite reference no.1 along with ref. no. 29 for the sake of consistency.
I also suggest you give one decimal place after your percents always, e.g., here 29.1%.
On line 16 of page 4 where you say, "the tobacco epidemic is slowly declining", say instead,
"the tobacco epidemic in India is slowly declining"  for the sake of clarity.
On line 22 of page 4 where you say, "declining trends are not seen at all over the country,"
delete "at".
I cannot understand the meaning  your sentence on page 5 about Felix et al. on lines 13-15 is
meant to convey  (I have seen your reply in your "rebuttal letter".  I suggest you read Felix
et al., 2014 again). What I have understood from reading Felix et al. (2014) is that the bottom
line is that smoking reduces the risk of endometrial carcinoma in women, because it reduces
their female hormone levels. Of course, that has other repercussions. For that reason, you could
move this up to line 7 after the first sentence: "... the anti-estrogen effect". You could say that
"While this reduces the risk of endometrial cancer as per Felix et al (2014) [xx], it increases the
risk for premature menopause, which in turn enhances the risk of cardiovascular disease and
osteoporotic fractures. []"   (You will have to reorder the numbering of the references a bit).
Delete the full stop before "awareness" on line 18 on page 5.
On line 1 of page 7 I am glad to note that you have used the term "never users". You need to use
the same term consistently throughout the manuscript when refering to your own calculations.
On page 7, line 8, after "illnesses" add "caused by smoking" and  delete "as well as" and replace
it with "including".
On page 7, line 20, add "that" between "variables" and significantly".
On page 8, line 10, delete "and" before "type".
On page 10, line 7,  I suggest you consider replacing the word "depicted" with "showed" and
do the same everywhere else where you use the word "depicted" ("shown" to be used instead
of "showed" where needed).
On page 10, line 9, I suggest you replace "segregation" with "disaggregation". I think it best if
you look up the meaning of both words to see if you are convinced of the need for this change.
On pages 12 and 13, in your discussion begins, I suggest you check for accuracy and
discrepancies. Below I will list what I found:
On page 12:
- On line 14, is the word "diluted the best choice? What about "low"?
- On line 15, you say "Tobacco use among Indian women is 20%" - This is not correct according
to the latest GATS survey (GATS2). In GATS2 total tobacco use among women is 14.2% on p
35 of the GATS2 report. Current smoking among women is 1.5% on the same page. SLT use
among women is You used an old reference of 2002 that predates even GATS1. Also it shows a
prevalence of smoking only which could not have been 20%. I suggest you delete that reference
and that value.
- On lines 17-19,  you have an unclear sentence that reads, "For women, 11 countries out of 22
surveyed by GATS have a prevalence of more than 5%, while India stands at rank 12 with a
recorded prevalence of 3%".  There is no clarity as to which reference is being cited nor to which
product  the prevalence of 3% refers to or which GATS survey is being referred to. In fact in
GATS2 I have not seen any prevalence of 3% for women for any type of tobacco product. It is
best if you be more careful when referring to other articles and reports.
- On lines 19- your sentence, "In India, dual tobacco usage  among women is very high (or
5.3% of all current female tobacco users aged 15 and above) compared to other south-east Asian
countries like Bangladesh, Malaysia, Thailand, and Indonesia [30]" is inaccurate, as 5.3% in
reference 30 does not signify prevalence, but  means 5.3% among all current female tobacco
users aged 15 and above. I suggest you have another look at that page of ref 30 where you will
see that. Up at the right hand corner of the page there is the explanation.  Consider editing the
sentence as follows: "In India, dual tobacco usage at 0.5% among women is high (or 5.3% of all
current female tobacco users aged 15 and above) compared to other south-east Asian countries
like Bangladesh, Malaysia, Thailand, and Indonesia.[30]".
On page 13, :
- On lines 4-6, your sentence reads, "We observed that the prevalence of usage varied
significantly with the socio-demographic characteristics like age of women, marital status,
education, residential status, wealth quintiles, etc. "  I suggest you insert the word "ever" before
usage, because you said that was what you wanted to calculate.
-On  line 23, I suggest you add "and" between the words, "oral health" and "as a treatment".
On page 15, line 4, you have given some data from page 120 of reference 30. I suggest you
include that page no. in the reference along with all the page nos. in that reference that you
referred to: 41 and 120. Delete 128, as that is part of the index.
I suggest that at least two of you read the whole manuscript through from beginning to end
to check for any possible errors or inconsistencies. You will find out if you are satisfied that
my comments are sufficient. Actually this reading and checking should have been done before
submitting the manuscript to the journal. The ones who contribute less of the writing should
be the ones checking the most, in my opinion. That would equal out the responsibilities. The
reviewer should not have to find so many errors.  All the best with your submission.