12-month substance use disorders among first-year university students in Kenya

Florence Jaguga; Muthoni Mathai; Caroline Ayuya; Ongecha Francisca; Catherine Mawia Musyoka; Jasmit Shah; Lukoye Atwoli

doi:10.1371/journal.pone.0294143

Peer Review History

Original SubmissionApril 29, 2023
18 Jun 2023 Decision Letter - Md. Saiful Islam, Editor PONE-D-23-1217212-month substance use disorders among first-year university students in KenyaPLOS ONE Dear Dr. Jaguga, 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 Aug 02 2023 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Md. Saiful Islam, BPH, MPH Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. 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 https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 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 Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: No ****** 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 ****** 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: Data availability Is the data fully available? To my knowledge there are restrictions with regards to sharing data from the World Mental Health International College Student Initiative publicly. Maybe check with Harvard about this. Abstract I think it would be sufficient to say that significant associations were found between SUD and depression, generalized anxiety disorder etc. – rather than including p values. Introduction Line 67 – should say Northern Ireland rather than Ireland as that is where the study was conducted. Line 93 – It is not good practice to say ‘we’. As part of this initiative, we conducted an online survey was conducted to investigate the burden of mental and SUDs among first-year university students across three Kenyan universities. I think that a lot of this research has already been done elsewhere so it is important here to point out what is novel about the study. Is this the first of its kind in Kenya? If so, highlight that. What might be different about the students in Kenya? Methods What do you mean by a parent online cross-sectional survey? I don’t think that you can say that you had a response rate of 15.8% when so many had to be removed from the survey and then go on to say you had a completion rate of 17.9%. 1529 students were removed either because they failed quality control checks, or had missing data, or did not meet inclusion criteria e.g., entered their age as less than 18 years This is a major concern of mine. Why were so many removed? Surely, those who were not eligible to take part should have been detected earlier, perhaps when they were consenting, before taking the survey? From what I know of the survey, the age of participant is asked first, and they are not able to take the survey if they say that they are under 18. If this was the case this needs to be explained clearer in this section. Also, could missing data not have been dealt with? Lines 146 -157. I think this could be cut back somewhat. Line 159 doesn’t read well. The survey used was the World Mental Health…… I don’t think it is necessary to go into details about the parts of the survey that you haven’t included in your analysis. It would be good however to be more specific about how alcohol use and other substance use disorders were measured (scales used) Line 172 – no ‘we’ No identifying information was collected….. Line 176 – For this study….. Results It is important to refer to the corresponding table when reporting the results. It is good to see such a high rate of male participants as many studies tend to have more female participants than males. What is the gender breakdown of students in the colleges? Perhaps there are more males than females in general? I think it would be good to include this when describing the characteristics of the sample. Also were weights not applied in the analysis to account for age and gender characteristics of the student population in the three universities? I know that the World Mental Health College Student Initiatives usually include weights in their studies? In the acknowledgements it mentions weights. If weights were used it should be mentioned in the methodology section. Explain what exactly this is - 12-month substance use disorder (other than alcohol). Is it drug use? If so, describe in details what it covers. This could be described in the methods section. It is important to also report the number/prevalence of those who had any SUD in the text. Perhaps you could include co-morbid prevalence in Table 2. The results are somewhat confusing and I am not sure why you run some of the analysis that you did. I think that it would be better to report the prevalence rates of mental health disorders for all participants and then compare these with the rates for those with SUD. This would be much more informative than what is presented in Table 4. That is the rationale for both the bivariate model and the regression model and why is it described as a multivariate logistic regression? A multivariate logistic regression is a model with more than one dependent variable. It the methodology it states that the dependent variable is just Any SUD. If this is the case, it would be an ordinary binary logistic regression. Also were all the assumptions of a regression considered? This would be important given the small sample size. It is really now clear how this model was run and further detail are required. Were all the IVs entered together? It is important to consider how this would impact on the findings. When reporting findings from a logistic regression it is normal to comment on the odds ratios rather than the p value. For example, students with depression were nearly three time more likely to have SUD (OR= 2.897). It is also normal to use 1.0 rather than reference and then place this below the ORs and Cis. Discussion Again, it isn’t good practice to refer to ‘our’ study. Say this study or something similar. The first few lines are very repetitive of what was said in the introduction. It would be good to re-word. 273 – People rather than persons 275 – typo – remove of before mental illness It would be good to include further implications of the study in your conclusion. Reviewer #2: It is very important for diagnosis by psychiatrists for both mental disorders and substance-related disorders. Thus, all data should be re-categorized and re-analyze to be problematic substance use and "depression", "anxiety", whatever the questionnaire should be interpreted. ****** 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: Chonnakarn Jatchavala M.D.,MSc. ******** [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. https://doi.org/10.1371/journal.pone.0294143.r001
Revision 1
11 Aug 2023 Author Response Response to reviewers’ and Editor’s comments The authors thank the Editor and reviewers for the detailed review and comments. A point-by-point response to the comments has been provided below. Editor’s comments 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: We have aligned our document with the formatting requirements of Plos one formatting requirements. 2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. Response: We have attached the raw data as a Supporting File 1. Reviewer #1: 1. Data availability: Is the data fully available? To my knowledge there are restrictions with regards to sharing data from the World Mental Health International College Student Initiative publicly. Maybe check with Harvard about this. Response: We have attached the raw data as a Supporting File 1. NB: Line numbers indicated in the responses refer to those of the document with tracked changes. Abstract 1. I think it would be sufficient to say that significant associations were found between SUD and depression, generalized anxiety disorder etc. – rather than including p values. Response: Thank you for this comment. We have deleted the p values (line 46-49) Introduction 2. Line 67 – should say Northern Ireland rather than Ireland as that is where the study was conducted. Response: This has been corrected (line 65). 3. Line 93 – It is not good practice to say ‘we’. As part of this initiative, we conducted an online survey was conducted to investigate the burden of mental and SUDs among first-year university students across three Kenyan universities. Response: This has been corrected. (Line 91 and 93) 4. I think that a lot of this research has already been done elsewhere so it is important here to point out what is novel about the study. Is this the first of its kind in Kenya? If so, highlight that. What might be different about the students in Kenya? Response: We have highlighted that our work is novel since work done as part of the WMH ICS has focused on other mental disorders to the exclusion of alcohol and drug use disorders. Further, our work explored the association between substance use disorders and mental disorders, and this has not been explored among College in Kenya (Line 94-99). Methods 5. What do you mean by a parent online cross-sectional survey? Response: The word parent has been removed (line 104). 6. I don’t think that you can say that you had a response rate of 15.8% when so many had to be removed from the survey and then go on to say you had a completion rate of 17.9%. Response: The completion rate to us meant the proportion of those completing the survey out of those who entered the survey. We have removed the completion rate to avoid any confusion to the reader. (line 149). 7. 1529 students were removed either because they failed quality control checks, or had missing data, or did not meet inclusion criteria e.g., entered their age as less than 18 years. This is a major concern of mine. Why were so many removed? Surely, those who were not eligible to take part should have been detected earlier, perhaps when they were consenting, before taking the survey? From what I know of the survey, the age of participant is asked first, and they are not able to take the survey if they say that they are under 18. If this was the case this needs to be explained clearer in this section. Also, could missing data not have been dealt with? Response: The authors agree that 1529 is a large number to remove, and this is a study limitation. Concerning age, we had a question asking participants to confirm that they were 18 years and above before consenting. (see line 136-137) However, some participants confirmed that they were above 18 years, consented, and entered the survey, but went ahead to indicate their age as less than 18 within the questionnaire and thus we had to exclude those. In a future survey, we should add a feature that prevents the rest of the questionnaire from loading if the age is indicated as less than 18 within the questionnaire. That way, the survey does not proceed for underage participants. Other reasons for removal of data included significant amounts of missing data e.g., many participants started the survey but abandoned it after filling out just demographics only. One of the main challenges in survey studies is incomplete responses, especially if variables of interest are not entered. Such incomplete responses thus have to be excluded. In a future survey, we will make sure that important variables are programmed as mandatory so that missing values are minimized for all variables of interest. We have included missing data and recommendations provided above within the limitations section of the manuscript (Line 342-351). 8. Lines 146 -157. I think this could be cut back somewhat. Response: The authors have removed some content to make it clearer. (line 150-160) 9. Line 159 doesn’t read well. The survey used was the World Mental Health…… Response: This sentence has been refined. (line 162-163) 10. I don’t think it is necessary to go into details about the parts of the survey that you haven’t included in your analysis. It would be good however to be more specific about how alcohol use and other substance use disorders were measured (scales used). Response: The authors have removed information on parts of the survey that have not been included in this analysis. (line 167-169) 11. Line 172 – no ‘we’ No identifying information was collected….. Response: This has been corrected. (line 180-181) 12. Line 176 – For this study….. Response: This has been corrected. (line 184) Results 13. It is important to refer to the corresponding table when reporting the results. Response: We have corrected this. (lines 213, 220, 228, 247, 263) 14. It is good to see such a high rate of male participants as many studies tend to have more female participants than males. What is the gender breakdown of students in the colleges? Perhaps there are more males than females in general? I think it would be good to include this when describing the characteristics of the sample. Response: Yes. The sample was mostly male. We have described this on line 141-142. 15. Also were weights not applied in the analysis to account for age and gender characteristics of the student population in the three universities? I know that the World Mental Health College Student Initiatives usually include weights in their studies? In the acknowledgements it mentions weights. If weights were used it should be mentioned in the methodology section. Response: We have described how weighting was done (line 191-192). 16. Explain what exactly this is - 12-month substance use disorder (other than alcohol). Is it drug use? If so, describe in details what it covers. This could be described in the methods section. Response: We have described the substances that were assessed for other than alcohol (i.e. cannabis, cocaine, LSD, opioids, speed, ecstasy, prescription medication). Line 173-174 17. It is important to also report the number/prevalence of those who had any SUD in the text. Perhaps you could include co-morbid prevalence in Table 2. Response: We have added this on Table 2 (line 221) 18. The results are somewhat confusing, and I am not sure why you run some of the analysis that you did. I think that it would be better to report the prevalence rates of mental health disorders for all participants and then compare these with the rates for those with SUD. This would be much more informative than what is presented in Table 4. Response: We have removed Table 4 and left Table 5. 19. That is the rationale for both the bivariate model and the regression model and why is it described as a multivariate logistic regression? A multivariate logistic regression is a model with more than one dependent variable. It the methodology it states that the dependent variable is just Any SUD. If this is the case, it would be an ordinary binary logistic regression. small sample size. Also were all the assumptions of a regression considered? This would be important given the small sample size. Response: The bivariate analysis done is the normal univariate analysis that is done using Fishers Exact test or Chi Squared test for comparing 2 or more groups with categorical data and Students t-test or Kruskal Wallis test for continuous data. Based on the univariate/bivariate analysis, a multivariate logistic regression model was run to identify associations between different mental disorders separately with SUD. For the multivariate logistic regression model, the dependent variable was SUD and the independent variables were all different mental disorders run separately with adjusting for age and gender. All assumptions were considered while running the models. We have further described this on line 198-202 20. It is really now clear how this model was run and further detail are required. Were all the IVs entered together? It is important to consider how this would impact on the findings. Response: For the multivariate logistic regression model, the dependent variable was SUD and the independent variables were all different mental disorders run separately with adjusting for age and gender. We have clarified this on line 198-202 21. When reporting findings from a logistic regression it is normal to comment on the odds ratios rather than the p value. For example, students with depression were nearly three time more likely to have SUD (OR= 2.897). It is also normal to use 1.0 rather than reference and then place this below the ORs and Cis. Response: We have revised and corrected this. (line 250-259) Discussion 22. Again, it isn’t good practice to refer to ‘our’ study. Say this study or something similar. Response: We have reworded and revised it. (Line 271) 23. The first few lines are very repetitive of what was said in the introduction. It would be good to re-word. Response: We have reworded and revised it. (Line 271-289) 24. 273 – People rather than persons Response: We have corrected this. (line 311) 25. 275 – typo – remove of before mental illness. Response: We have corrected this. (line 313) 26. It would be good to include further implications of the study in your conclusion. Response: We have collated all implications into one section and expounded on them. (line 316-341) Reviewer #2: 27. It is very important for diagnosis by psychiatrists for both mental disorders and substance-related disorders. Thus, all data should be re-categorized and re-analyze to be problematic substance use and "depression", "anxiety", whatever the questionnaire should be interpreted. Response: The tool used for the World Mental Health International College Student (WMH-ICS) Initiative is designed to generate accurate epidemiological data on mental, substance, and behavioral disorders among college students. Other studies conducted as part of the initiative have reported on epidemiology of disorders. The authors prefer to keep the diagnoses as disorders in this manuscript. (https://www.hcp.med.harvard.edu/wmh/college_student_survey.php). Attachments Attachment Submitted filename: Jaguga Plos one Response to reviewers Final.docx https://doi.org/10.1371/journal.pone.0294143.r002
4 Sep 2023 Decision Letter - Md. Saiful Islam, Editor PONE-D-23-12172R112-month substance use disorders among first-year university students in KenyaPLOS ONE Dear Dr. Jaguga, 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 Oct 19 2023 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Md. Saiful Islam, BPH, MPH Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Thanks for addressing all comments. Please address the Reviewer 1 comments before accepting the manuscript. [Note: HTML markup is below. Please do not edit.] 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: 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: Did you check with Harvard about the sharing of data? I still don't think you can publically share but can note that. Check English and grammer throughout manuscript - still reference to 'we' e.g. line 94, 136, 185, 262, 292, 303, 333, 335 Note the tables need to be formatted correctly - no vertical lines In response to reviewer 2 it might be good to include something like the following: Good concordance has been found between the WMH-CIDI and clinical assessments Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International journal of methods in psychiatric research. 2006; 15(4):167–80. PMID: 17266013 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: Chonnakarn Jatchavala M.D.,MSc. ******** [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. https://doi.org/10.1371/journal.pone.0294143.r003
Revision 2
15 Oct 2023 Author Response Response to reviewers’ and Editor’s comments The authors thank the Editor and reviewers for the comments. A point-by-point response to the comments has been provided below. Reviewer #1: Did you check with Harvard about the sharing of data? I still don't think you can publically share but can note that. Yes. We did check with Harvard, and they confirmed that since this paper, wasn’t based on cross-national data, but just Kenyan data, it was up to us to decide whether to make the data available or not. The authors have therefore decided to make the data available. Comment: Check English and grammer throughout manuscript - still reference to 'we' e.g. line 94, 136, 185, 262, 292, 303, 333, 335 Response: The authors have restructured the sentences to remove ‘we’ and ensure clarity throughout the document. Comment: Note the tables need to be formatted correctly - no vertical lines Response: The vertical lines have been removed on all tables in the results section Comment: In response to reviewer 2 it might be good to include something like the following: Good concordance has been found between the WMH-CIDI and clinical assessments Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International journal of methods in psychiatric research. 2006; 15(4):167–80. PMID: 17266013 Response: Thank you for this comment. We have revised the response to reviewer 2 to read as follows: The tool used for the World Mental Health International College Student (WMH-ICS) Initiative is designed to generate accurate epidemiological data on mental, substance, and behavioral disorders among college students. Other studies conducted as part of the initiative have reported on epidemiology of disorders. The authors prefer to keep the diagnoses as disorders in this manuscript. (https://www.hcp.med.harvard.edu/wmh/college_student_survey.php). In addition, good concordance has been found between the WMH-CIDI and clinical assessments. (Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, et al. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International journal of methods in psychiatric research. 2006; 15(4):167–80. PMID: 17266013) Attachments Attachment Submitted filename: 2nd Response to reviewers comments College Survey Jaguga.docx https://doi.org/10.1371/journal.pone.0294143.r004
26 Oct 2023 Decision Letter - Md. Saiful Islam, Editor 12-month substance use disorders among first-year university students in Kenya PONE-D-23-12172R2 Dear Dr. Florence Jaguga, 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, Md. Saiful Islam, BPH, MPH 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 #1: 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 ****** 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: I am happy that you addressed my previous comments. I think it would be good to include the reference to Haro et al in the actual manuscript but it's up to you. ****** 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 ******** https://doi.org/10.1371/journal.pone.0294143.r005
Formally Accepted
13 Nov 2023 Acceptance Letter - Md. Saiful Islam, Editor PONE-D-23-12172R2 12-month substance use disorders among first-year university students in Kenya Dear Dr. Jaguga: I'm 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 let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Md. Saiful Islam Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0294143.r006

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 .