Conceptualising alcohol consumption in relation to long-term health conditions: Exploring risk in interviewee accounts of drinking and taking medications

Mary Madden; Stephanie Morris; Duncan Stewart; Karl Atkin; Brendan Gough; Jim McCambridge

doi:10.1371/journal.pone.0224706

Peer Review History

Original SubmissionJuly 10, 2019
8 Aug 2019 Decision Letter - Joel Msafiri Francis, Editor Transfer Alert This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present. PONE-D-19-19395 Conceptualising alcohol consumption in relation to long term health conditions: exploring risk in interviewee accounts of drinking and taking medication PLOS ONE Dear Dr Madden, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Sep 22 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Joel Msafiri Francis, MD, MS, PhD Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 1. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. We will update your Data Availability statement on your behalf to reflect the information you provide. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The present paper describes a collection of qualitative interviews with individuals whom drink alcohol recreationally and are prescribed medications for long-term illness, with the aim of further exploring how these individuals understand their alcohol use. This is a relevant and timely topic, with concurrent alcohol and prescription medication use causing significant issues in relation to health outcomes globally. As noted by the authors, qualitative interviews are a good opportunity to explore these issues in-depth. However, I would not recommend this paper for publication without some key changes. Specifically, the structure of the paper (most notably the ‘results’ section) could be refined to improve flow and reader comprehension. I would recommend first explicitly outlining the nature of alcohol use amongst the sample (regarding AUDIT scores, and what this means), then discussing the types of medications being used by interviewees, and finally how these substances exist together. Descriptive statistics (Table 1 and Table 2) would heavily benefit from some expansion (see comments below). Some sections of the manuscript are not clear. At the beginning of each section, I would recommend specifically outlining what the section is about to cover, and in a way that a lay individual would understand. The health intervention implications described in the manuscript could be expanded upon. Please find specific comments below. Abstract: “Risky drinking was located elsewhere”: The meaning of this sentence isn’t immediately clear without having first read the body of the text. Introduction: “experience and understand their use of alcohol, the psychoactive drug ethanol”: Even though it’s fairly obvious which compound is being discussed, if the authors wish to make the clarification I would recommend stating that “ethanol” is the alcohol of focus early in the introduction rather than at the end. Methods: “The interview schedule and recruitment materials were both developed with the input of lay advisors.”: It would help to specify why this was done. “For example, INV-015-M-24-05 means that 119 interviewee number 15 is male with an AUDIT-C score of 5 and a MARS score of 24.”: I would recommend presenting the explanation of these codes respective to their placement within the code. i.e., participant – gender – MARS score – AUDIT score Please include an explanation of measure interpretation (AUDIT and MARS) alongside first description of the measures. Further, it would help to more explicitly explain why these were being collected and their importance in contextualizing interviewee responses. The introduction made explicit reference to older individuals as a susceptible population, but the methods section describes broad demographic selection criteria. Is there a reason why older individuals weren’t specifically targeted? This could use some clarification. Results: 3.1: Table 1: I would highly recommend including, at minimum, standard deviations for all descriptive statistics. There’s also inconsistent punctuation throughout this table. 3.2: Table 2: As above, standard deviations should be included. The appendix noted in text has not been provided. Also, if possible, it would help to refer to specific appendices (e.g., Appendix A) unless they are provided as broader supplementary material. “Many interviewees had AUDIT-C scores ranging 142 between 5 and 10”: How many interviewees specifically? Perhaps the n of AUDIT “groups” could be included in one of the tables? I would recommend restructuring this section to improve clarity. Perhaps you could first discuss alcohol, then medicines/illicit substances (or vice versa), and finally move on to related practices. The structure as it currently stands seems slightly haphazard. 3.4: “Locating risky drinking elsewhere”: This title would benefit from some clarification. Is this section about the identification of risky drinking practices amongst peers? Discussion: “A less one way style of risk communication could be the start of better supporting people to make active and informed connections between medicines, alcohol and potential personal health harms if this is to be perceived as promoting rather than restricting agency/choice/autonomy.”: I think this is a great takeaway from these data, but it would be nice to see an expansion on the types of strategies that could be implemented and the contexts they would exist in. Would this strictly apply to health professionals in a health service context? Or could it be applied more broadly? How could we further research in this area? Reviewer #2: This is a very interesting and important manuscript describing the qualitative findings of interviews conducted with persons taking in North England who take medications for chronic conditions and who are current alcohol users (at least 2 days per week). The topic is very important because health guidelines are given, but not well understood or followed, and alcohol use is a highly prevalent social and self-medicating activity. The findings of the balance of short-term pleasure versus long-term harm and the concept of drinking problems being those of others were particularly illustrative. The manuscript is well-written; suggested revisions are as follows. Please give more detail on how participants were recruited. How were they identified as taking alcohol at least 2 times per week, and what qualified as “eligible for medication reviews”. After being deemed potentially eligible, how were they approached, and asked to participate? Was the recruitment done on site at the pharmacies, and were there any particular hours of the day? How many declined participation and were there any patterns (age, sex, health)? Please provide a description of standard cutoffs for hazardous drinking (via AUDIT-C) and poor adherence (MARS) with references, for those unfamiliar with these scales. The tables should be edited to be in standard format – so that variable names and categories on are the left and numbers on the right. Percentages should be given for categorical variables in addition to the n. Table 1 has n=25, Table 2 has n=24, removing the one person removed from the analyses. I suggest describing that person’s removal in the 1st paragraph of results (along with the suggested data about recruitment and participation). Then present results in the text and tables for n=24. There are a few places where there is a reference to a person, and it is unclear if it refers to the following or preceding person being quoted. Please clarify. Section 3.2.2 is focused on medication side effects, regardless of drinking (except at the very end) and could be dropped. There is also reference to the participants’ past drinking in the Discussion, that is mentioned only in a few of the results in section 3.5. Please provide these results. The recommendations in the discussion are very thin. The authors cite others’ recommendations (Muhlack et al) but do not say whether those are relevant, and their only recommendations are to obtain better knowledge, and state that “something different is needed”. The one recommendation given, that of a less one-way communication style, is not supported by the findings. What about leveraging the strategies already in place (e.g. drinking water, comparing to others’ drinking)? It would be preferable to have a final conclusion rather than end with study limitations. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Judith A. Hahn [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0224706.r001
Revision 1
1 Oct 2019 Author Response Response to Reviewers: PONE-D-19-19395 Conceptualising alcohol consumption in relation to long term health conditions: exploring risk in interviewee accounts of drinking and taking medications. PLOS ONE Thank you to the reviewers for their helpful comments. We have redrafted the paper to improve structure, provide more clarity and make the discussion more substantive. We have taken the opportunity to include some relevant new references including Ahmed on health professionals and risk communication, Khadjesari and colleagues’ recent study on primary care patients’ views on their own drinking and a recent report from Public Health England on dependence and withdrawal associated with some prescribed medicines. We have made minor proofing edits throughout. Responses to points raised by individual reviewers are below. Reviewer #1 The present paper describes a collection of qualitative interviews with individuals whom drink alcohol recreationally and are prescribed medications for long-term illness, with the aim of further exploring how these individuals understand their alcohol use. This is a relevant and timely topic, with concurrent alcohol and prescription medication use causing significant issues in relation to health outcomes globally. As noted by the authors, qualitative interviews are a good opportunity to explore these issues in-depth. However, I would not recommend this paper for publication without some key changes. Specifically, the structure of the paper (most notably the ‘results’ section) could be refined to improve flow and reader comprehension. I would recommend first explicitly outlining the nature of alcohol use amongst the sample (regarding AUDIT scores, and what this means), then discussing the types of medications being used by interviewees, and finally how these substances exist together. Some sections of the manuscript are not clear. At the beginning of each section, I would recommend specifically outlining what the section is about to cover, and in a way that a lay individual would understand. • The manuscript has been amended to improve structure and flow incorporating the specific suggestions above (detail below) The health intervention implications described in the manuscript could be expanded upon. • These have been expanded (see below) Abstract: “Risky drinking was located elsewhere”: The meaning of this sentence isn’t immediately clear without having first read the body of the text. • We have amended this in the abstract and the results to aid clarity. The abstract now reads ‘Risky drinking was located elsewhere, in the drinking of others’ L28. We have also amended heading 3.4 ‘Locating risky drinking in the drinking of others’ L435. Introduction: “experience and understand their use of alcohol, the psychoactive drug ethanol”: Even though it’s fairly obvious which compound is being discussed, if the authors wish to make the clarification I would recommend stating that “ethanol” is the alcohol of focus early in the introduction rather than at the end. • We have introduced this earlier as suggested, in the first paragraph of the introduction L.45-46. Methods: “The interview schedule and recruitment materials were both developed with the input of lay advisors.”: It would help to specify why this was done. • Patient and public involvement in research is expected by the funders of the programme, the National Institute of Health Research. We report on our approach to this elsewhere. Rather than get into the detail here we have inserted, “…as part of the research programme commitment to co-production and patient and public involvement (reported elsewhere).” L102-104 “For example, INV-015-M-24-05 means that 119 interviewee number 15 is male with an AUDIT-C score of 5 and a MARS score of 24.”: I would recommend presenting the explanation of these codes respective to their placement within the code. i.e., participant – gender – MARS score – AUDIT score • Thanks for noticing this, the explanation of the codes has been amended as suggested L154-155 Please include an explanation of measure interpretation (AUDIT and MARS) alongside first description of the measures. Further, it would help to more explicitly explain why these were being collected and their importance in contextualizing interviewee responses. • Detail clarifying the use of AUDIT and MARS measures has been added to the methods section L131-138 The introduction made explicit reference to older individuals as a susceptible population, but the methods section describes broad demographic selection criteria. Is there a reason why older individuals weren’t specifically targeted? This could use some clarification. • The focus of the study is on people with long term conditions rather than age per se. We have provided more detail on our recruitment methods for clarification. As noted in the introduction, the risk of LTCs and the likelihood of taking more medicines increases with age. The sample achieved ranged in age from 41-89 and findings from studies on older and middle aged drinkers and alcohol-medication interactions in older age groups provide relevant context. We have attempted to clarify this and have deleted the phrase ‘older adults’ in the introduction L55 in case this leads to the assumption that (as in some of the studies cited) that age is our primary focus. Results: Descriptive statistics (Table 1 and Table 2) would heavily benefit from some expansion 3.1: Table 1: I would highly recommend including, at minimum, standard deviations for all descriptive statistics. There’s also inconsistent punctuation throughout this table. 3.2: Table 2: As above, standard deviations should be included •Table 1 is now a list of types of pharmacies involved in the study in response to reviewer 2’s comments below. Table 2 presents characteristics of the interview sample. This has been reformatted and includes standard deviations. Additional numerical data has been included in the text e.g. percentages of respondents. The appendix noted in text has not been provided. Also, if possible, it would help to refer to specific appendices (e.g., Appendix A) unless they are provided as broader supplementary material. • S1 Appendix: ‘Types of prescribed medication taken by interviewees’ now provided “Many interviewees had AUDIT-C scores ranging 142 between 5 and 10”: How many interviewees specifically? Perhaps the n of AUDIT “groups” could be included in one of the tables? • Specific scores have been reported for AUDIT-C see L172-174. I would recommend restructuring this section to improve clarity. Perhaps you could first discuss alcohol, then medicines/illicit substances (or vice versa), and finally move on to related practices. The structure as it currently stands seems slightly haphazard. • This section has been restructured for clarity starting with alcohol and moving on to medicines use as suggested L171-213 3.4: “Locating risky drinking elsewhere”: This title would benefit from some clarification. Is this section about the identification of risky drinking practices amongst peers? • We have amended this in the abstract and the results to aid clarity. The abstract now reads ‘Risky drinking was located elsewhere, in the drinking of others’ L28. We have also amended heading 3.4 ‘Locating risky drinking in the drinking of others’ L435. Discussion: “A less one way style of risk communication could be the start of better supporting people to make active and informed connections between medicines, alcohol and potential personal health harms if this is to be perceived as promoting rather than restricting agency/choice/autonomy.”: I think this is a great takeaway from these data, but it would be nice to see an expansion on the types of strategies that could be implemented and the contexts they would exist in. Would this strictly apply to health professionals in a health service context? Or could it be applied more broadly? How could we further research in this area? • The discussion has been expanded. It now includes more on communicating risk and an example of how these findings are being used for intervention development. Reviewer #2 This is a very interesting and important manuscript describing the qualitative findings of interviews conducted with persons taking in North England who take medications for chronic conditions and who are current alcohol users (at least 2 days per week). The topic is very important because health guidelines are given, but not well understood or followed, and alcohol use is a highly prevalent social and self-medicating activity. The findings of the balance of short-term pleasure versus long-term harm and the concept of drinking problems being those of others were particularly illustrative. The manuscript is well-written; suggested revisions are as follows. • Thank you Please give more detail on how participants were recruited. How were they identified as taking alcohol at least 2 times per week, and what qualified as “eligible for medication reviews”. After being deemed potentially eligible, how were they approached, and asked to participate? Was the recruitment done on site at the pharmacies, and were there any particular hours of the day? How many declined participation and were there any patterns (age, sex, health)? • We have added detail on the recruitment process including details of the pharmacies in which recruitment took place L104-143 Please provide a description of standard cutoffs for hazardous drinking (via AUDIT-C) and poor adherence (MARS) with references, for those unfamiliar with these scales. • Detail clarifying the use and interpretation of AUDIT and MARS measures has been added to the methods section L131-138 and throughout. We hope that this clarifies that drinking above the threshold AUDIT-C score of 4/3 for men and women respectively is in some way hazardous The tables should be edited to be in standard format – so that variable names and categories on are the left and numbers on the right. Percentages should be given for categorical variables in addition to the n. Table 1 has n=25, Table 2 has n=24, removing the one person removed from the analyses. I suggest describing that person’s removal in the 1st paragraph of results (along with the suggested data about recruitment and participation). Then present results in the text and tables for n=24. • Table 1 is now a list of types of pharmacies involved in the study in response to reviewer 2’s comments below. Table 2 presents characteristics of the interview sample. This has been edited and amended. Percentages have been included where numbers of responses are mentioned throughout. We have removed the person not included in this study from the tables and explained this earlier as suggested. The abstract has also been amended [n=24] There are a few places where there is a reference to a person, and it is unclear if it refers to the following or preceding person being quoted. Please clarify. • We have made amendments to clarify this throughout. Section 3.2.2 is focused on medication side effects, regardless of drinking (except at the very end) and could be dropped. • The relevance of this section has been clarified by introducing some explanatory text on the contrast in views on medicines and alcohol (as drugs) in relation to a sense of control or autonomy. The section has been re-named L263-269 There is also reference to the participants’ past drinking in the Discussion, that is mentioned only in a few of the results in section 3.5. Please provide these results. • We have included results on levels of past drinking in comparison with present drinking for the full sample L175-178 The recommendations in the discussion are very thin. The authors cite others’ recommendations (Muhlack et al) but do not say whether those are relevant, and their only recommendations are to obtain better knowledge, and state that “something different is needed”. The one recommendation given, that of a less one-way communication style, is not supported by the findings. What about leveraging the strategies already in place (e.g. drinking water, comparing to others’ drinking)? • The discussion has been expanded. It now includes a reference to Ahmed H, Naik G, Willoughby H, Edwards AG. Communicating risk. BMJ. 2012;344:e3996 and to literature on health professionals perceptions about talking about alcohol. In addition to recommendations for further study it includes an explanation of how these findings are being used for intervention development in the context of pharmacy. It would be preferable to have a final conclusion rather than end with study limitations. • A conclusion has been added which makes clear our recommendations Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0224706.r002
21 Oct 2019 Decision Letter - Joel Msafiri Francis, Editor Conceptualising alcohol consumption in relation to long term health conditions: exploring risk in interviewee accounts of drinking and taking medications PONE-D-19-19395R1 Dear Dr. Madden, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Joel Msafiri Francis, MD, MS, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have done a good job at actioning previous comments. I note that the authors are not making data from the manuscript available, but assume they have made a case to the editor for this. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Judith Hahn https://doi.org/10.1371/journal.pone.0224706.r003
Formally Accepted
29 Oct 2019 Acceptance Letter - Joel Msafiri Francis, Editor PONE-D-19-19395R1 Conceptualising alcohol consumption in relation to long-term health conditions: exploring risk in interviewee accounts of drinking and taking medications Dear Dr. Madden: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Joel Msafiri Francis Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0224706.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .