PONE-D-20-05410

Single and polysubstance use among Adolescents in Malaysia: Finding from the National Health and Morbidity Survey 2017

PLOS ONE

Dear Mrs Rodzlan Hasani,

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 26 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Samantha S. Goldfarb, DrPH

Academic Editor

PLOS ONE

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3. We noticed you have some minor occurrence(s) of overlapping text with the following previous publication(s), which needs to be addressed:

https://doi.org/10.1186/1471-2458-14-1044

https://doi.org/10.1177%2F1010539519865053

https://doi.org/10.1371/journal.pone.0207472

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the Methods section. Further consideration is dependent on these concerns being addressed.

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Additional Editor Comments (if provided):

Thank you for your submission. Please make the revisions suggested by Reviewer 1 and we will reconsider your manuscript for publication.

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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: Partly

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

Reviewer #1: No

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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

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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: 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: Overall, the manuscript examined a topic that is important, timely, and appropriate for the PLOs One. This paper addresses an important topic, which is currently underexplored, in particular, in Southeast Asia. Thus, this is a welcome addition to what we know about the substance use among adolescents. However, I have the following queries/comments.

1. Introduction: What is the impacts of polysubstance use and why is such study important in prevention and treatment of substance users? The information would be mentioned in introduction to help readers to better understand the importance of your study.

In addition, on what basis did you choose those variables/risk factors? Also, in your introduction part, there was a very little usage of literature conducting in Malaysia and the neighboring countries on the similar event.

2. Methods: The authors have not discussed how they built the multivariate regression analysis model they are referring in Table 3 and 4 is not enough.

In page 13, you described “A final model was obtained which included all the factors that were significantly associated at the level of p <0.05.” you need to describe in detail. For example, table 3 presents crude odds ratios using univariate multinomial logistic regression. In cases of some variables, such as parental or guardian never/rarely respect for privacy, anxiety, and stress, showed statistically significances in table 4. but they were not included in the multivariate model. How did you build the multivariate regression analysis?

3. Results and discussion: Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. As it is difficult to understand the table 2, please revise the table readable.

In addition, the estimate in page 13 and 14 (5.1%) is different from that in page 17 (0.5%). I may assume that 0.5% is the prevalence of those who are concurrent use of three substances (alcohol, tobacco and illicit drug)? Please check and clarify the definition respectively.

4. Discussion: The results and discussion are lacking the nuts and bolts to would make the paper relevant to policy and practice.

In addition, in Table 2, other ethnicity compared to Malay, such as Chinese, Indian and others had higher odds of being polysubstance user. In particular, Indians and other ethnicities had much higher odds. However, the authors only mentioned Chinese and others and further failed to explain why it happened among Indians and others rather than Malay.

The authors mentioned that “the current study is the first study to examine self-reported substance use among a nationally representative sample of adolescents to better estimate the prevalence of polysubstance use among Malaysian adolescents.” To my knowledge, there are some studies on polysubstance use, although some evaluated concurrent use of alcohol and tobacco and not include illicit drug use using GSHS. So you may think of what your study can add in the literature.

5. Presentations of tables: I am troubled by table presentation style in Table 3 and 4. For example, in table 3, the estimates of single substance use are not in the same row. Need to revise table presentations properly in table 3 and 4.

Table 3: It would be better if you change some labels.

Polysubstance use of -> Polysubstance use (delete “of”)

Total -> Any substance use

Add one category of “Alcohol and tobacco and illicit drug” and the estimate.

6. Reference format: Please check the appropriate reference format of PlOS One and revise accordingly.

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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

[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.

PONE-D-20-05410R1

Polysubstance use among Adolescents in Malaysia: Finding from the National Health and Morbidity Survey 2017

PLOS ONE

Dear Dr. Rodzlan Hasani,

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.

Please submit your revised manuscript by Nov 28 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Michelle Tye, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

As per Reviewer 2's comment, this manuscript requires significant English language editing to enhance readability.

Some additional information in the Methods section as to how consent for participation in the survey was sought and received would be helpful, as well as the duration of the survey. Was it undertaken during school time, or outside of school hours? Though the authors do note that the methods are reported elsewhere, the key methodological details should still be reported in this manuscript.

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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: (No Response)

Reviewer #2: (No Response)

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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: Partly

Reviewer #2: Partly

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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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: Yes

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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: No

Reviewer #2: No

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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: Thanks for the revision.

First, Introduction: the authors made a revision. Not agree to add the sentences about patterns of polysubstance use in the USA in the first paragraph of the introduction; “In the United States, the most frequently paired of polysubstance use …….both alone and in combination.” you may move to discussion part to discuss the polysubstance use patterns among countries.

Second, the authors added the new variables of "all three substance use(alcohol+ tobacco + drug)." It is surprising that prevalence of alcohol+ tobacco + drug is higher than that of the other polysubstance user group. For example, the prevalence of alcohol+ tobacco + drug (2.2%) is higher compared to that of tobacco and alcohol use (2.0%).

i) why is the prevalence of alcohol+ tobacco + drug higher than that of tobacco and alcohol use (2.0%)? As illicit substance is not common, it seems interesting and also doubtable. Please discuss in discussion part.

ii) in the first paragraph of the discussion, the authors described “Overall, this study showed alcohol and tobacco were the most common pair of substance use.” please clarify the sentences and the estimates in Table 3.

Lastly, regarding the reference formatting, the references should be revised correctly. In particular, the name list of the authors were not well-formatted.

Reviewer #2: This article examines the prevalence of and associated factors related to single-use and polysubstance use among adolescents in Malaysia. I would like to point out that I am reviewing a revised draft of the manuscript (I did not review the initial draft); thus, my comments are relatively minor since the authors seem to have addressed many of the previous reviewers’ concerns. Overall, the subject matter is of great public health importance and the authors have attempted to present a comprehensive profile of juvenile substance use in Malaysia.

1. The introduction, while succinct, can benefit from a slightly more enhanced discussion of the topic at hand. Specifically, the following can be included:

a. Importance of identifying and/or preventing polysubstance use at an early stage.

b. Ease of access to alcohol and drugs within the context of Malaysia, that can explain the rising rates of polysubstance use.

2. I’m a little concerned about the self-reported nature of the truancy variable. Was it not possible to retrieve this information from classroom records? Similarly, the use of single items for peer support, parental bonding and parental respect for privacy, is short-sighted and unreliable.

3. The writing is poor and idiosyncratic. There are multiple instances of sentences that are poorly worded and confusing to read. For example, “polysubstance use between the male and female” sounds odd. This sentence should be reworded as “polysubstance use between males and females. Consider this other statement “For example, Indigenous people (Sabah and Sarawak) is required to drink alcohol during harvest festival and social gathering [43] but Malays where mostly are Muslims are prohibited from drink alcohol according to Malaysia’s sharia law.” I realize that there is likely a language barrier and hence I would encourage the authors to seek the assistance of a copy-writer to make the necessary corrections.

4. One of the most interesting findings that the authors gloss over is the that younger adolescents were more likely to engage in single substance use. How do the authors explain this result? As I mentioned in my first comment, it would be useful to understand the socio-cultural context that either constrains or emboldens substance use at a young age. This would allow for policy or structural changes to address these issues.

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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.

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: 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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-05410R2

Polysubstance use among Adolescents in Malaysia: Finding from the National Health and Morbidity Survey 2017

PLOS ONE

Dear Dr. Rodzlan Hasani,

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.

Thank you for your thorough revisions, Reviewer 1 has noted some additional minor comments to address. 

Please submit your revised manuscript by Jan 25 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Michelle Tye, 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

Reviewer #2: 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

Reviewer #2: Yes

**********

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

Reviewer #1: No

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: Yes

Reviewer #2: 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

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: Thanks for your revision. I found the manuscript improved. I have more minor things to be revised though.

Abstract

“The NHMS utilised a two-stage stratified cluster sampling using.”

Tables

In table 2, the prevalence of the lifetime use of smoking tobacco is supposed to be greater than that of the current use. but in your analysis, the lifetime use (5.1%) vs the current use (6.7%). please check the data.

In Table 3, indicate in the table whether the estimates were crude or weighted values.

In Table 4, the 95% CI of the COR of Chinese need to be checked (COR=1.10 (95% CI=1.71-2.33)). The COR is supposed to be in the range of 95% CI.

Conclusion

Check the full name of “INTIM camp (Kem Kecemerlangan Intelek Murid)”

Reviewer #2: The authors have undertaken a thorough revision based on the comments made by other reviewers and myself. All my comments were addressed, the most significant being extensive copy-editing of the manuscript. I have no problem recommending that the manuscript be accepted for publication.

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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.

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: 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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Review comments_20201204.docx

Polysubstance use among Adolescents in Malaysia: Finding from the National Health and Morbidity Survey 2017

PONE-D-20-05410R3

Dear Dr. Rodzlan Hasani,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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.

Kind regards,

Michelle Tye, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: