PONE-D-20-00392

The Theory of Planned Behavior as a behavior change model for tobacco control strategies among adolescents in two cities of Botswana.

PLOS ONE

Dear Dr Tapera,

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Academic Editor

PLOS ONE

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Reviewers' comments:

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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: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

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Reviewer #1: No

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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 manuscript entitled “The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana” recruited 2554 adolescents to study whether the theory of planned behavior (TPB) can be a useful theory to examine how far we can understand the behavior of smoking among adolescents inhabiting in Botswana. I applaud for the authors to collect such valuable data on assessing a widely used theory to study a meaningful and important research question. Specifically, the present study has a strong strength in data collection; that is, the authors used a rigorous sampling method to collect a large sample. However, I have following comments for the authors to elevate their work. In addition, I believe that the manuscript needs to be edited by a native English speaker to make it free from grammatical errors (e.g., P5. Our analyses focuses on…)

1. A major and root problem is that the authors do not clearly indicate whether they studied on the smoking behavior. In many descriptions, the authors only talked about smoking intention (e.g., in the Abstract). However, the authors have collected whether the participants are a current smoker and they sometimes reveal the relationship between the TPB elements and a current smoker or not. Therefore, this causes a lot of confusion when I read the manuscript. I cannot know what the authors stand in using the TPB.

2. In the Abstract, the sentence in the Background is unclear. Specifically, it is unclear whose intentions, whose attitudes, whose subjective norms, and whose perceptions that promote/discourage the smoking behavior of an individual. Also, do authors want to say perceived behavioral control when they mention “people’s perceptions”? If yes, then, the authors should not use people’s perceptions to indicate perceived behavioral control; they are different concepts. Following this, the Objective is not in line with what the authors did in the study. Specifically, the authors studied more than “behavioral attitudes” and “intention”, while the authors only mentioned the two factors in the Objective.

3. In the Introduction, the authors said, “The TPB has also been used successfully to predict and explain a wide range of health behaviors including exercise, smoking and drug use, HIV prevention behaviors, among others (Montaño & Kasprzyk, 2002).” I agree. However, please cite more references to support this sentence. Please refer to the following.

Hou, W.-L., Lin, C.-Y., Wang, Y.-M., Tseng, Y.-H., & Shu, B.-C. (2020). Assessing Related Factors of Intention to Perpetrate Dating Violence among University Students Using the Theory of Planned Behavior. International Journal of Environmental Research and Public Health, 17(3), 923.

Fung, X. C. C., Pakpour, A. H., Wu, K.-Y., Fan, C.-W., Lin, C.-Y., Tsang, H. H. W. (2019). Psychosocial variables related to weight-related self-stigma in physical activity among young adults across weight status. International Journal of Environmental Research and Public Health, 17, 64.

Lin, C.-Y., Broström, A., Årestedt, K., Mårtensson, J., Steinke, E. E., & Pakpour, A. H. (2020). Using extended Theory of Planned Behavior to determine factors associated with help-seeking behavior of sexual problems in women with heart failure: A longitudinal study. Journal of Psychosomatic Obstetrics & Gynecology, 41,54-61.

Lin, C.-Y., Broström, A., Nilsen, P., & Pakpour, A. H. (2018). Using extended Theory of Planned Behavior to understand aspirin adherence in pregnant women. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health, 12, 84-89.

Lin, C.-Y., Fung, X. C. C., Nikoobakht, M., Burri, A., & Pakpour, A. H. (2017). Using theory of planned behavior incorporated with perceived barriers to explore sexual counseling services delivered by health professionals in individuals suffering from epilepsy. Epilepsy & Behavior, 74, 124-129.

Strong, C., Lin, C.-Y., Jalilolghadr, S., Updegraff, J. A., Broström, A., & Pakpour, A. H. (2018). Sleep hygiene behaviors in Iranian adolescents: an application of the Theory of Planned Behavior. Journal of Sleep Research, 27(1), 23-31.

Lin, C.-Y., Oveisi, S., Burri, A., & Pakpour, A. H. (2017). Theory of Planned Behavior including self-stigma and perceived barriers explain help-seeking behavior for sexual problems in Iranian women suffering from epilepsy. Epilepsy & Behavior, 68, 123-128.

Lin, C.-Y., Updegraff, J. A., & Pakpour, A. H. (2016). The relationship between the theory of planned behavior and medication adherence in patients with epilepsy. Epilepsy & Behavior, 61, 231-236.

4. The Goals of the study section in the Introduction should be rewritten. Specifically, I cannot see the link between the two paragraphs: the authors said “The current study assessed the effect of peer and parental influences on youth smoking” in the first paragraph and “Our analyses focuses on the four belief-based TPB constructs (attitudes, subjective norms,

perceived behavioral control and intentions) because these are most conducive to change with

persuasive messaging in communication campaigns. The main objective of our study was to

identify the key beliefs underlying these four constructs, that best explain parent, and peer

influences on smoking in Gaborone and Francistown” in the second paragraph. The two paragraphs do not link well. I would suggest the authors use the first paragraph to mention the goal of using TPB constructs directly. Then, they may list some examples on each TPB construct. For example, the peer and parental influences are obvious subjective norms.

5. In the Materials and Methods section, the authors should have a section talking about their assessment on TPB elements. The authors are suggested reading prior TPB studies to know how to describe their TPB elements.

6. The authors mentioned that they exclude missing data. Then, they should report the missing size to let the readers understand to what extent we can trust in the findings.

7. In the Results section, I think that the authors do not need to spell out SD. SD is a commonly and widely understood statistical term. Therefore, please remove “standard deviation”.

8. Table 2 should report both frequency and percentage. Also, I cannot understand the meaning of Yes… at the top left column.

9. The authors should use a (or more) table to summarize their findings on odds ratio. Reading the text in the Results section is very easy to lose the direction. Also, P7. The sentence “Twenty-nine percent (29%) of students had tried smoking” should be changed because the authors need not to mention 29% twice.

10. The authors mentioned adjusted odds ratio in the Results section; however, I did not see the authors describe how they constructed a multivariable logistic regression model in the Data analysis section.

11. Sentences like “Eighty percent (2043) of the students” should be changed to “Eighty percent (n=2043) …” or “Two thousand and forty-three (80%) ….” because it is not intuitive to know that 2043 indicates the number.

12. In the Discussion, please add a limitation for the use of TPB. I agree that TPB is a good theory to explain many behaviors; however, it has been criticized due to its simplicity. That is, some scholars feel that human behaviors are much more complicated than the four elements (attitude, subjective norm, perceived behavioral control, and intention) proposed in the TPB. Therefore, there is a trend of using extended TPB in the realm. Specifically, scholars are encouraged to include other potential factors in the TPB to explain each specific behavior. For example, extended TPB has been used to explain the self-care behaviors among patients with diabetes by adding risk perception and health literacy on the TPB elements; some used extended TPB to explain the weight reduction behaviors by adding weight-related self-stigma. Please refer to the following references.

Lin, C.-Y., Cheung, M. K. T., Hung, A. T. F., Poon, P. K. K., Chan, S. C. C., & Chan, C. C. H. (2020). Can a Modified Theory of Planned Behavior Explain the Effects of Empowerment Education for People with Type 2 Diabetes? Therapeutic Advances in Endocrinology and Metabolism, 11, 1-12.

Cheng, O. Y., Yam, C. L. Y., Cheung, N. S., Lee, P. L. P., Ngai, M. C., & Lin, C.-Y. (2019). Extended Theory of Planned Behavior on eating and physical activity. American Journal of Health Behavior, 43(3), 569-581.

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Reviewer #1: No

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PONE-D-20-00392R1

The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana.

PLOS ONE

Dear Dr Tapera,

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 Jun 15 2020 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,

Amir H. Pakpour, Ph.D.

Academic Editor

PLOS ONE

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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

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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

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: 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: Yes

**********

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

**********

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 revised manuscript is much improved, especially the English presentation. The authors also have answered all my prior comments in a satisfactory way. However, one minor issue needs to be fixed before acceptance. That is, the manuscript contains both British and American spelling (e.g., utilise; behavioral; behavioural). Please use Word function to check whether all the spellings are consistent and correct them in either British spelling or American spelling. Please do not use a mixture. Anyway, good work and I look forward to reviewing a new revision.

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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.

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Reviewer #1: No

[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.]

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The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana.

PONE-D-20-00392R2

Dear Dr. Tapera,

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.

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With kind regards,

Amir H. Pakpour, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: