PONE-D-20-40626

Smokers’ cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey

PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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: Yes

Reviewer #2: Yes

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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: This is a well-written manuscript showing findings from a cross-sectional study conducted on a sample of tobacco smokers on the potential impact of the coronavirus pandemic on smoking habit during the early phase of the COVID-19 era. Data are original, the issue is interesting and the conclusions are acceptable. Authors should consider the following minor points to improve the presentation of findings.

1) Please save room in the Abstract to clarify the level of the Covid-19 lockdown during the fieldwork in various countries.

2) This study has some limitations, partially addressed in the Discussion section. Although the ITC study is a longitudinal study, at the end within this manuscript Authors considered a cross-sectional analysis, only. Thus, this analysis has the limitations inherent to the cross-sectional studies. Authors “excluded the small number of ex-smokers who quit smoking during COVID-19”. It is not clear to me if this has been due to the fact that the study did not allow Authors to identify all subjects who quit smoking due to the COVID-19 pandemic. In any case, these analyses do not allow Authors to answer to the following research question: did the Covid-19 pandemic reduce or increase smoking prevalence and consumption? In my opinion, this is a limitation of this study.

Reviewer #2: This study examines changes in and reasons for changes in smoking and vaping during the COVID-19 pandemic across four countries. There are several issues with the paper, including those related to novelty, measures, and analyses.

Introduction

• The introduction needs focus and a stronger literature review. There are many studies examining changes in smoking behavior during the pandemic, and a few studies have examined changes in vaping. While these are reviewed, the review is brief and the addition that the current study brings other than across countries isn’t developed well. For example, even just indicating that few studies have examined changes in vaping should be stated (although there are some more recent studies that should be included). The expanse of variables included in studies examining changes in tobacco use during the pandemic isn’t stated as should be. For example, some studies have focused on changes in smoking at all, with many findings within the same publication often showing some smokers increasing, some decreasing and some showing no changes at all. Other studies have shown changes in the number or frequency of use. These findings should be reviewed more in the current paper.

• The paper examines factors associated with changes in smoking and vaping during the pandemic. There are several studies that have included and examined reasons for changes in smoking and vaping, including risk perceptions. These studies are not discussed in the paper, nor are the reasons for this paper articulated.

• The first paragraph of the introduction, while interesting, seems unnecessary and better for the discussion if at all.

• Similarly, much of the discussion in the introduction concerning reasons for including the 4 countries is more of a commentary and better belongs in the discussion. For example, describing that England was overwhelmed or messages being misaligned don’t belong in the introduction. Instead, simply indicating that the 4 countries had different responses and differing messages might contribute to differing perceptions and tobacco use behaviors is all that is needed.

• The introduction offers a hypothesis earlier in the introduction before the research questions are offered, and a second hypothesis later in the introduction. Further, there are 3 supplemental analyses that are interesting and should be included as part of the main questions (especially iii, which is really related to the Health Belief Model).

• Would be good to update the number of COVID-19 cases and deaths given that the numbers change so quickly

Methods

• The survey items are not well developed and worded. For example, “How worried are you that you already have, or that you will get the coronavirus” is “double-barreled” and might result in unreliable responses. People who already have COVID-19 might not be worried especially if they are not that sick; whereas those who don’t have it but are concerned/at-risk might be more worried. The outcome variable concerning thinking about quitting during the pandemic is also problematic, as the survey didn’t first ask about desire to quit before asking if a reason to want to quit has to do with the virus. It is possible that people were heading towards quit anyway. Also, including “don’t know” with “I didn’t think about it…” is an assumption that probably should not be made. Similar issues are seen with some of the other survey questions. Granted, the items cannot be changed, but these issues should be acknowledged.

Results

• In the first set of results, regarding thoughts about quitting, the narrative only discusses 3 of the 4 countries. The data for the US should be stated too.

• Unclear why the variables in the supplemental analyses are supplemental and not part of the main analyses? Understanding why people increased is also very important.

• The results don’t separate out changes in vaping versus smoking. Are there differences worth noting?

Discussion

• The main differences in this study compared to the many other studies examining changes in tobacco use during the pandemic have to do with the vaping findings and the 4 countries. However, very little of the discussion focuses on these more novel aspects of the data.

Figures

• Don’t think Figure 2 is necessary

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Reviewer #1: Yes: Silvano Gallus

Reviewer #2: No

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Smokers’ cognitive and behavioural reactions during the early phase of the COVID-19 pandemic: Findings from the 2020 ITC Four Country Smoking and Vaping Survey

PONE-D-20-40626R1

Dear Dr. Gravely,

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.

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Kind regards,

Stanton A. Glantz, 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

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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: Yes

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: (No Response)

Reviewer #2: The authors have done an outstanding job revising the manuscript. I have no further issues, and thank the authors for an important paper.

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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: Yes: Silvano Gallus

Reviewer #2: No