Factors Associated with Changes in E-Cigarette Use and Tobacco Smoking by Adolescents and Young People in Nigeria during the COVID-19 Pandemic
, Omolola T. Alade 5, Heba Sabbagh 6, Afolabi Oyapero 7, Yewande I. Adeyemo 8, Bamidele Olubukola Popoola 9, Abiola A. Adeniyi 10, Jocelyn Eigbobo 11, Maryam Quritum 12, Chioma Nzomiwu 13, Nneka Maureen Chukwumah 14 and Maha El Tantawi 12
Round 1
Reviewer 1 Report
Review
Introduction
-The main objective was stated as changes of tobacco and e-cigarette use during COVID-19, however, the introduction talked about susceptibility of these users to COVID-19 infection (1st 3 para).
- Reasons as to why changes in tobacco and e-cigarette use during COVID-19 was studied was not clearly stated. Please include more literature to support this.
Methods
-How confounders were determined and adjusted for was not explained
-How about those who are dual users (tobacco and e-cigarette). Where will they be categorised?
-Dependant variables- Increase/decrease of use of tobacco and e-cigarette was not quantified, this, made it look quite subjective and respondent dependant.
-Why convenient sampling was chosen should be explained
Results
-Please indicate the response rate
Discussion
-Para2-In my opinion, the study design should be stated as a limitation as no causal effect could be obtained.
-Para 5- citation of previous study needs to be reworded as it implies follow up
-Comparison of findings with studies done in other countries were not clear
-Second last para needs more literature to support
-Can these findings be used to shape policies related to tobacco and e-cigarettes?
Author Response
Thank you very much for your comments, they helped to improve the quality of our work. Please find a below a point by point response to the comments:
Introduction
-The main objective was stated as changes of tobacco and e-cigarette use during COVID-19, however, the introduction talked about susceptibility of these users to COVID-19 infection (1st 3 para).
Response: we thank the reviewer for this observation. We have re-organised the introduction to reduce the volume of the discussion on susceptibility of smokers to COVID-19 infection and improve the focus on changes in tobacco and e-cigarette use. We hope the re-arrangement have helped improve the introduction. Thanks for the observation
- Reasons as to why changes in tobacco and e-cigarette use during COVID-19 was studied was not clearly stated. Please include more literature to support this.
Response: we wrote that: Understanding the factors associated with changes in the use of e-cigarette and tobacco smoking and changes in night smoking may help maximise the opportunities the pandemic presents to institute tobacco cessation strategies for young people.
Methods
-How confounders were determined and adjusted for was not explained
Response: We wrote in lines 173 and 174 that: The confounding variables were age, sex at birth and macro-social vulnerability status. These variables are associated with the dependent and independent variables. These variables were adjusted for in the multivariate logistic regression conducted. We wrote in lines 180 - 182: Multivariate regression analyses were conducted to determine the associations between the dependent and independent variables after adjusting for the confounding variables.
-How about those who are dual users (tobacco and e-cigarette). Where will they be categorised?
Response: As the reviewer rightly identified, there are dual users of the products. We acknowledge this group of people exist in a prior publication from the dataset (doi: 10.3390/ijerph191710509). However, we will face a methodological challenge to analyse increase or decrease in dual use of the product from a dataset that was not designed to do this. We do not have a methodology to handle the analysis for dual users.
-Dependant variables- Increase/decrease of use of tobacco and e-cigarette was not quantified, this, made it look quite subjective and respondent dependant.
Response: We agree with the reviewer and have acknowledged this in the study limitation. Please see lines 277 - 278
-Why convenient sampling was chosen should be explained
Response: This was explained in lines 268 – 273 in the discussion section
Results
-Please indicate the response rate
Response: The response rate is 81% (line 185).
Discussion
-Para2-In my opinion, the study design should be stated as a limitation as no causal effect could be obtained.
Response: Lines 275 - 276, 3rd paragraph of the discussion section addresses this limitation
-Para 5- citation of previous study needs to be reworded as it implies follow up
Response: the citation has been deleted and the entire paragraph edited to improve clarity. Thanks for highlighting this.
-Comparison of findings with studies done in other countries were not clear
Response: Thanks for raising this. As noted in the introduction there is a paucity of literature on the subject matter so we are not able to make comparison.
-Second last para needs more literature to support
Response: what we have done is raise research questions. As noted, we explored a subject matter that had not been explored prior to our study. We do not have answers and we hope our questions can promote future studies.
-Can these findings be used to shape policies related to tobacco and e-cigarettes?
Response: As we noted in the final statement, all we have been able to do is raise a lot more questions than answers. We feel strongly that we are not able to make policy statement from this study. We feel further studies will help to find a lot more concrete evidence. We shall be conducting further studies to explore our findings.
Reviewer 2 Report
In this study, you have tried to examine the factors s associated with changes in e-cigarette use, tobacco smoking and night use of e-cigarette and tobacco smoking during the COVID-19 pandemic by adolescents and young people (AYP) in Nigeria. You have You have used cross sectional data and applied Multivariate logistic regression analyses. This is an interesting study considering the socio-economic settings of Nigeria.
In the introduction, you have discussed the background of the study, but you have not written anything about the study context Nigeria. It is important to answer the question- why Nigeria? In a couple of sentences, you can also highlight how the rest of the study is organised.
In the methodology section, you need to write about sampling and nonresponse biases. As it is based on questionnaire survey, it is important know about the nonresponse or even early response biases.
Results are OK but your discussion section could be better with a few more references from the existing literature.
In the conclusion section, it will be better to see some recommendations for the policy makers and managers.
Author Response
Thank you very much for your comments, they helped to improve the quality of our manuscript. Please find below a point by point response to the comments.
In this study, you have tried to examine the factors associated with changes in e-cigarette use, tobacco smoking and night use of e-cigarette and tobacco smoking during the COVID-19 pandemic by adolescents and young people (AYP) in Nigeria. You have used cross sectional data and applied Multivariate logistic regression analyses. This is an interesting study considering the socio-economic settings of Nigeria.
Response: The summary reflects what we have done.
In the introduction, you have discussed the background of the study, but you have not written anything about the study context Nigeria. It is important to answer the question- why Nigeria? In a couple of sentences, you can also highlight how the rest of the study is organised.
Response: we have revised the manuscript. We have also now included the Nigeria study context. Thanks for raising this very important edit. We have written in a country context in the introduction. Please see lines 82 - 86.
In the methodology section, you need to write about sampling and nonresponse biases. As it is based on questionnaire survey, it is important know about the nonresponse or even early response biases.
Response: thanks for raising this. We have a section that now addresses sampling. Please see lines 120-125. We also have included information on the response rate in the first line of the results. We however are unable to address the issue about non-response bias as we could not collect data on non-respondents through the online survey.
Results are OK but your discussion section could be better with a few more references from the existing literature.
Response: Thanks for the positive feedback. We are also limited with literature reference as we did not find literature on the subject matter. We feel we truly addressed an area where there was a gap in knowledge and where there is a paucity of studies.
In the conclusion section, it will be better to see some recommendations for the policy makers and managers.
Response: Thanks for raising these points. our studies raised a lot more questions than answers. We had recommendations for future studies and felt a lot less comfortable making recommendations for policy makers and managers at this phase of our study. Future studies can help to start teasing out more definitive findings relevant to policy makers and managers
