Reviewer's report
Title:Factors affecting knowledge and perception of women about smoking: a
cross sectional study from a developing country
Version: 1Date:29 October 2010
Reviewer: Brian Flynn
Reviewer's report:
This paper reports on a survey study of women attending primary care clinics in
low-income areas of Karachi Pakistan concerning cigarette smoking risks. The
study is well-targeted. Women suffer the same personal health consequences
from smoking as men, and smoking among women of child-bearing ages carries
additional risks to pregnancy and birth outcomes and to the health of children.
Cigarette smoking rates among women in developing countries are generally
lower than rates for men. More information about educational needs of women in
this regard will assist in development of educational programs that meet their
needs.
Compulsory Revisions
The Methods section is too brief; it needs some more detail.
If the survey was anonymous this should be noted.
It is not clear who recruited the participants and who administered the surveys.
Were these clinic staff or from outside the clinic? What language was used?
Where were the surveys administered?
The questions seem well-focused, but some additional detail about the survey
development would be helpful. What literature was searched? Were some key
papers particularly useful? Some description of the validity checks and
pre-testing should be added.
The description of the survey items should include a description of the response
structures used in each section, e.g. did respondents reply agree/disagree,
yes/no, true/false to each item?
Essential Revisions
Background: Are the prevalence rates for males and females cited in paragraph
2 for Pakistan or for developing countries?
A transition paragraph or sentence is needed to bridge the review of health risks
to the requirements for effective intervention described in the final paragraph of
this section.
A reference should be provided for the stages of change model described in the
final paragraph, such as: Prochaska JO, Redding CA, Evers KE. The
transtheoretical model and stages of change. In: Glanz K, Lewis FM, Rimer BK,
eds. Health Behavior and Health Education – Theory, Research, and Practice.
Second ed. San Francisco: Jossey-Bass; 1997:60-84.
Did the survey measure tobacco use other than cigarette smoking? If
non-cigarette tobacco use is rare in this population this fact could be stated in the
methods section. If non-cigarette tobacco use was measured the results should
be reported.
Tables 2 and 3 should be reformatted so that content of the questions is
indicated by a word or two.
On page 13 it is stated that that “women thought that smoking was not justified”
and similar statements that provide an opening for an interesting discussion
point. If the negative characterization of smokers and smoking by women is
anecdotal it should be labeled so; if measured as part of the survey then these
data should be reported.
The paper should at least mention what is known or not known about the tobacco
use behaviors, knowledge, and attitudes of health care providers in the clinical
settings, since these care-givers can have a strong impact on the perceptions of
their patients, and would be key partners in development of effective educational
programs.
Discretionary Revisions
The Discussion is generally well-organized but the conclusions should be revised
to give a clearer message about the priorities for interventions designed to
educate women about these issues. The range of possibilities is relevant but the
presentation could be organized better.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.