PONE-D-22-35105Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.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: No

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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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?

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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: Very interesting and useful paper, with a good discussion and proposals for helping reducing the use of pacifier in low income families.

Is using any kind of well baby clinic facility linked with a reduction of use of pacifier ?

Is Early use of pacifier linked with social with drawal behavior in infants?

Reviewer #2: This is a well-written paper that addresses an important topic that has not received much attention.

The major issue is the interpretation of the findings related to the multivariable analyses which then has affected the discussion section as well.

Methods

The authors should indicate in the description of the following variable under the measures section that it was within two weeks or after two weeks of life: “The age of introduction was determined by the question, “When did you start giving 137 pacifiers for your baby?” The response options were “No Pacifier Use,” “Within Two Weeks,” or 138 “After Two Weeks.”

Consider revising this sentence in line 155 as it is missing a verb and it is not complete by ending “based on the (28,34):

“…income (≤$50,000/$50-79,999/$80-99,999/≥$100,000). For the household food insecurity screening, the 152 Hunger Vital Sign™, a validated two-question screening tool based on the (28,34).”

It is not clear what the following statement has to do with the description of the second dependent variable in lines 134-135: “The age of pacifier introduction has been associated with the cessation of breastfeeding at six 136 months (33).”

Is there a possible overlap in the observations for the variables exclusive breastfeeding and bottle feeding? Who is the non bottle-feeding group? Does this group include those who are breastfeeding their babies exclusively and those who may be feeding their infant’s solids?

Results:

For table 2: Show the numerical values (results) for the group that did not use a pacifier as well.

Overall, the models should be indicated in the description of the results associated with the multivariable analyses shown in Tables 4 and 5. For example, the independent variable food insecurity in Table 5, was significant only in Model 1, and once other variables entered the subsequent models, this variable was not significant anymore. Overall, the only variable that remained significant after entering all other independent variables was whether the infant was bottle-fed or not. These results need to be emphasized.

The following finding “Pacifier use was independently associated with households with low income (OR (95% CI) 2.06 235 (0.99-4.27))” was not statistically significant. Income level was significantly associated with pacifier use in the first model only, but not in the subsequent models, especially the last model that included all of the variables. Thus, one cannot claim that pacifier use was independently associated with low income households based on that finding.

The results in Table 4 show that those who did not bottle-feed their infants were more likely to use a pacifier and that is the only significant finding in model 5 which contains all of the covariates. Is this finding correct given the results from the bivariate and multinomial analyses? This could be a typo if the authors accidentally switched the reference group for this variable in Table 4.

Again, the authors need to describe the findings from the hierarchical regression modeling in a way that takes into consideration the addition of different sets of variables in each model and indicate the models from which the described results are obtained. Thus, the authors should revise the results described as “Likewise, infants living in food insecure households (RRR (95% CI) 2.53 244 (1.00-6.58)) and mothers who have more than one child (RRR (95% CI) 2.44 (1.11-5.34)) had a higher 245 risk of introducing a pacifier after two weeks.” because they did not remain significant once all variables are entered in the final model.

Discussion:

The reviewer does not believe based on the results that the following conclusion stated in the discussion is fully correct because once all variables are entered into model 5, only the bottle-fed variable remained significant and this means that pacifier use is not independently associated with maternal ethnicity or parity: “Our study identified that pacifier use is independently associated with maternal ethnicity, parity, 251 and bottle feeding among six-month-old living in Clark County, Nevada.”

The same can be said for a number of other findings that did not remain significant in model #5 once all variables were considered in the analyses. These lead to invalid conclusions.

The limitation section should include limitations in regards to the dependent measures such as the usage of pacifiers in the last 24 hours may have excluded a number of mother-infant dyads that used pacifiers for up to a certain age of infancy, etc.

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Reviewer #1: Yes: Antoine GUEDENEY

Reviewer #2: No

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Socio-demographic, maternal, and infant characteristics associated with pacifier use among six-months old infants in Clark County, Nevada.

PONE-D-22-35105R1

Dear Dr. Buccini,

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.

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Kind regards,

Mona Nabulsi, MD, MS

Academic Editor

PLOS ONE

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 #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 #2: Yes

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

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 #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 #2: Yes

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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 #2: Overall, the authors did a good job in addressing the comments.

The paper has improved considerably.

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

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Reviewer #2: No

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