PONE-D-24-02812E-cigarettes among University Students in Palestine: Prevalence, Knowledge, and Determinant FactorsPLOS ONE

Dear Dr. Ghanim,

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Mohammed Nasser Alhajj, BDS, MClinDent, PhD

Academic Editor

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

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: 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

Reviewer #3: 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

Reviewer #2: Yes

Reviewer #3: 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: This is a very important research study, and the first or second one to be carried in Palestine. I strongly recommend accepting this manuscript for publication; however, with minor revisions. I have two issues with this manuscript:

1- Methods: the authors need to describe how did they collect the data. It is not clear how did they distribute the survey.

2- Discussion: suggest to add a recent study about waterpipe use among university students:

Al-Jayyousi, G.F., Kurdi, R., Islam, N., Alhussaini, N. Z., Awada, S., & Abdul Rahim, H. (2022). Factors Affecting Waterpipe Tobacco Smoking among University Students in Qatar. Journal of Substance Use and Misuse, 57 (3), p. 392-401. Retrieved from: Doi: 10.1080/10826084.2021.2012695. Epub 2021 Dec 16. PMID: 34913828.

3- The manuscript needs language editing.

Thanks.

Reviewer #2: Thank you for the opportunity to review this manuscript.

This manuscript is mostly well written but needs some major revision which I believe will help to improve the quality of the paper.

1. The authors need to be specific when referring to data collected from a different context. For example US data is quoted without any reference to the US.

2. The title set out to investigate e-cigarette use but, in the manuscript, there is a lot of information about a comparison between e-cigarette use and tobacco smoking. This is confusing as it does not tally with the objective of the paper.

3. The authors used the term ‘e-smoking’ which is not traditionally used in the field. If they decide to use it in this paper, it should be introduced early on in the paper

4. Lines 55 – 61 refer to global data but give examples of only countries from the middle east. The authors can be specific to refer to data from the middle east which is a similar setting to where the data were collected so would be in order.

5. Lines 81 – 84: The author must know that e-cigarettes though usually classified WITH tobacco products, they are not tobacco products but nicotine products and should be referred to as nicotine products

6. Line 88: similarly, the use of e-cigarette is not referred to as “smoking” but just “use”. This should be corrected throughout the work

7. Line 97: the authors say this is the first of its kind research study done in palestine but a simple google search produced at least 2 recent studies with the same sample demographic and same country (see: (1) Jaber ME, Nouri L, Hamed A, et al. The epidemiology of electronic cigarette smoking among university students in the West Bank: Practice, motivation, and dependence of a new emerging hazard. Population Medicine. 2023;5(October):27. doi:10.18332/popmed/174287.; (2) Nazzal Z, Maraqa B, Azizeh R, Darawsha B, AbuAlrub I, Hmeidat M, Al-Jabari F. Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study. BMJ Open. 2024 Feb 17;14(2):e080881. doi: 10.1136/bmjopen-2023-080881. PMID: 38367977; PMCID: PMC10875484.)

8. Methods section: The authors should add information about the number of students which made the final sample, how they were selected and what were the inclusion and exclusion criteria as well as the data collection procedure)

9. There are too many tables in this manuscript. Tables should be consolidated, and the manuscript should only have between 3 to 4 Tables.

10. The length of the manuscript can be reduced by between 10 to 20% to make this work more concise but with relevant information.

11. Line 193: correct table heading (bout to about)

12. Line 195: the authors mentioned negative answers as if they were not worked on before a scaled was consDRomamuli$49tructed. Negatively worded questions ought to have been reversed scored before a scale is formed. Kindly ensure this was done to avoid errors in the computation of the scale.

Reviewer #3: 1. Unify the used term throughout the manuscript: e-cigarettes OR e-cigarette OR e-smoking

Introduction:

1. Lines 51 – 54: The reference 4 is about prevalence of e-cigarette among high school students, not reference 5!!!!

2. Lines 54 – 55: The reference 6 is about prevalence among European countries, not globally!!!!

Methodology:

1. Lines 107 – 108: the sample size calculation is misleading!!!!! It is not indicated whether the response rate and the number of estimates were considered or not, not to mention the “design effects”!!!!! Further, the total population and the population frame were not referred to.

2. Lines 112 – 113: How can an online questionnaire be signed?????

3. Line 122 – 123: Merely mentioning that the questionnaire is translated into Arabic with good Cronbach alpha is not enough to use it on an Arabic population. In order to do so, you have to conduct a study on the psychometric properties of the translated version following very strict steps ahead of using it. This is a major methodological pitfall that jeopardizes the whole study.

4. Regarding the seven items that gauge the knowledge, I am afraid that there is no sound evidence for the correct responses!!!!!

5. What the category “Other” in the “Marital status” means in an Arabic Culture????

6. Based on what you chose the values of the family income as 516$, 516-1033$ and more than 1033$?????

Results:

1. Indicate that the responses to “Reasons for using e-cigarettes” are multiple choices.

2. Table 5: Correct the percentage 991.1%!!!!

3. Why you included the knowledge as a determinant in the logistic regression??? having a lower knowledge might be a consequence of being e-cigarette users, either as a direct association, or indirectly through ignoring and indifference its bad effects.

Discussion:

1. The discussion is superficial. For example, the authors didn’t comment on why there were differences in knowledge between e-cigarette users and non-users!!!!!!!

2. Many of the arguments are not supported by references!!!!!

3. Protrude your study’s strengths, and mention its limitations.

4. The conclusion is not relevant to the study at all.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Esam Halboub

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E-cigarette use among University Students in Palestine: Prevalence, Knowledge, and Determinant Factors

PONE-D-24-02812R1

Dear Dr. Ghanim,

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,

Mohammed Nasser Alhajj, BDS, MClinDent, 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 #3: 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 #3: Yes

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

Reviewer #1: Yes

Reviewer #3: 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 #3: 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: Yes

Reviewer #3: 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 #1: No more comments.

All the comments have been addressed by the authors.

I would recommend accepting the manuscript for publication in the journal .

Reviewer #3: (No Response)

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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 #3: Yes: Esam Halboub

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