Cannabis use, mental health, and problematic Internet use in Quebec: A study protocol

Magaly Brodeur; Didier Jutras-Aswad; Andrée-Anne Légaré; Adèle Morvannou; Eva Monson; Julie-Christine Cotton; Anders Hakansson; Virginie Parent; Catherine Hudon

doi:10.1371/journal.pone.0304697

Peer Review History

Original SubmissionAugust 25, 2023
28 Feb 2024 Decision Letter - Souparno Mitra, Editor PONE-D-23-22618 Cannabis use, mental health, and problematic Internet use in Quebec: A Study Protocol PLOS ONE Dear Dr. Brodeur, 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. Reviewer 1 has some very important points that would improve the protocol and I encourage to submit another revision with these points addressed. Please submit your revised manuscript by Apr 13 2024 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, Souparno Mitra, M.D. 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. Thank you for stating the following in the Competing Interests section: "I have read the journal's policy and the authors of this manuscript have the following competing interests: Magaly Brodeur (MB) is a first-line physician and professor at Université de Sherbrooke. None of her research projects are funded by the gambling industry. She works as a prevention and harm reduction consultant for Loto-Quebec, the crown corporation responsible for state-run gambling in the province of Quebec (Canada). Didier Jutras-Aswad (DJA) holds a clinical scientist career award from Fonds de Recherche du Québec (FRQS). DJA receives investigational products from Cardiol Therapeutics for a clinical trial funded by Quebec Ministry of Health and Social Services." Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: Comments from PLOS Editorial Office: We note that one or more reviewers has recommended that you cite specific previously published works. As always, we recommend that you please review and evaluate the requested works to determine whether they are relevant and should be cited. It is not a requirement to cite these works. We appreciate your attention to this request. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: No Reviewer #2: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 ****** 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 and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I believe that the protocol can be improved with the following comments. 1. ll74-75, the statement “The COVID-19 pandemic has made problematic Internet use a priority issue for many…” needs more citation in addition to the current consensus statement. The following references may work. Alimoradi, Z., Lotfi, A., Lin, C.-Y., Griffiths, M. D., & Pakpour, A. H. (2022). Estimation of behavioral addiction prevalence during COVID-19 pandemic: A systematic review and meta-analysis. Current Addiction Reports, 9, 486-517. Ruckwongpatr, K., Paratthakonkun, C., Ghavifekr, S., Gan, W. Y., Tung, S. E. H., Nurmala, I., Nadhiroh, S. R., Pramukti, I., & Lin, C.-Y. (2022). Problematic Internet Use (PIU) in Youth: A Brief Literature Review of Selected Topics. Current Opinion in Behavioral Sciences, 46, 101150. Chen, I.-H., Chen, C.-Y., Liu, C.-h., Ahorsu, D. K., Griffiths, M. D., Chen, Y.-P., Kuo, Y.-J., Lin, C.-Y., Pakpour, A. H., Wang, S.-M. (2021). Internet addiction and psychological distress among Chinese schoolchildren before and during the COVID-19 outbreak: A latent class analysis. Journal of Behavioral Addictions, 10(3), 731-746. 2. Line 80, I think that (10,13,14) should be [10,13,14]. 3. When the authors propose their first objective (i.e., identify factors associated with problematic Internet use among cannabis users), it is unclear to me if this objective is based on hypotheses or is exploratory. This is important because if the objective will be investigated using hypotheses, the authors should provide theoretical background to support. However, if it is exploratory, the authors do not need to provide theoretical background. But even it is exploratory, the authors should provide some directions regarding what factors are of interests. 4. The authors want to recruit 1500 participants for the first phase of the present project, and the proposed sample size calculation is vague. Specifically, the authors simply said that “Sample size (n = 1500) was determined according to the number of participating individuals needed for the development of a regression model, composed of 10 variables associated with the epidemiological triad "host-agent-environment" [17] to determine the relationship between cannabis use and Internet use”. How exactly the sample size is calculated remains unclear to me. 5. Following the previous comment, I think that “sample size calculation” deserves to be a subsection instead of mentioning in the Data analysis section. 6. It is unclear to me how the authors can recruit the participants to be representative in terms of age, sex and gender, language, and geographic region. Say, what are the proposed sample size for each stratified group? 7. Also, it is unclear how the representativeness of the database in the firm which will help distribute the questionnaire. 8. The authors said, “Problematic Internet use has been associated with cannabis use disorder, especially among adolescent users” in the Abstract. However, the present protocol excludes adolescents. Then, why do the authors want to emphasize the importance among adolescent users? 9. As the data will be collected using two languages (i.e., English and French), I wonder if the authors will make sure the measurement invariance or check the linguistic validity between the two languages. 10. The authors may consider using the ASSIST-11, a shortened ASSIST to assess other psychoactive substance use. The ASSIST-11 has been validated across 42 countries recently. Lee, C. T., Lin, C. Y., Koós, M., Nagy, L., Kraus, S. W., Demetrovics, Z., Potenza, M. N., Ballester-Arnal, R., Batthyány, D., Bergeron, S., Billieux, J., Burkauskas, J., Cárdenas-López, G., Carvalho, J., Castro-Calvo, J., Chen, L., Ciocca, G., Corazza, O., Csako, R. I., Fernandez, D. P., … Bőthe, B. (2023). The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries. Journal of Psychiatric Research, 165, 16–27. https://doi.org/10.1016/j.jpsychires.2023.06.033 11. In the Phase 2 project, I would suggest the authors clearly mention the inclusion and exclusion criteria. Current presentation is not that clear. Also, I wonder if the authors will exclude those who have received treatments for cannabis use or internet use. Or, will the authors exclude those who have severe mental health disorder (e.g., schizophrenia)? 12. Lastly, I may overlook. However, the authors did not mention how and where they will deposit the data. Reviewer #2: This study protocol has been well thought through and very well written/presented. This study is funded by Quebec government and study findings can inform the stakeholders in making public policies regarding adults with problematic Internet use who are also cannabis users. As the authors pointed out - this is one of a kind of the study involving Internet problematic usage and cannabis use, particularly in adult population. The strengths and limitations of this study are acknowledged by the authors adequately. The most challenging aspect of this study is following the mixed method that they are using in obtaining the quantitative and qualitative data, integrating the data and concluding from the qualitative data. It'll be interesting to see the data, results and conclusions. I recommend for this manuscript to be published with no revisions. ****** 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: Tulasi Srinivasa Kumar Goriparthi M.D ******** [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. 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Revision 1
22 Mar 2024 Author Response • The authors said, “Problematic Internet use has been associated with cannabis use disorder, especially among adolescent users” in the Abstract. However, the present protocol excludes adolescents. Then, why do the authors want to emphasize the importance among adolescent users? Thank you for pointing this out. Our intention with this statement was not to emphasize the adolescent population but rather to point out there’s not a lot of evidence of this association other than in research on adolescent populations. The phrasing has been adjusted to express the lack of studies in the adult population instead. • [R1] ll74-75, the statement “The COVID-19 pandemic has made problematic Internet use a priority issue for many…” needs more citation in addition to the current consensus statement. The following references may work. Alimoradi, Z., Lotfi, A., Lin, C.-Y., Griffiths, M. D., & Pakpour, A. H. (2022). Estimation of behavioral addiction prevalence during COVID-19 pandemic: A systematic review and meta-analysis. Current Addiction Reports, 9, 486-517. Ruckwongpatr, K., Paratthakonkun, C., Ghavifekr, S., Gan, W. Y., Tung, S. E. H., Nurmala, I., Nadhiroh, S. R., Pramukti, I., & Lin, C.-Y. (2022). Problematic Internet Use (PIU) in Youth: A Brief Literature Review of Selected Topics. Current Opinion in Behavioral Sciences, 46, 101150. Chen, I.-H., Chen, C.-Y., Liu, C.-h., Ahorsu, D. K., Griffiths, M. D., Chen, Y.-P., Kuo, Y.-J., Lin, C.-Y., Pakpour, A. H., Wang, S.-M. (2021). Internet addiction and psychological distress among Chinese schoolchildren before and during the COVID-19 outbreak: A latent class analysis. Journal of Behavioral Addictions, 10(3), 731-746. Thank you for these suggestions. After examining the proposed references, we decided to cite the reference by Alimoradi et al. (2022) as it gathers a rich body of literature that supports our claim. The other two proposed references have been left out given they are either not specific to the COVID-19 pandemic context (Ruckwongpatr et al. (2022)) or focus exclusively on children (Chen et al. (2021)), while our study is interested in the adult population only. • [R1] Line 80, I think that (10,13,14) should be [10,13,14]. This change has been made. Thank you. • [R1] When the authors propose their first objective (i.e., identify factors associated with problematic Internet use among cannabis users), it is unclear to me if this objective is based on hypotheses or is exploratory. This is important because if the objective will be investigated using hypotheses, the authors should provide theoretical background to support. However, if it is exploratory, the authors do not need to provide theoretical background. But even it is exploratory, the authors should provide some directions regarding what factors are of interests. Thank you for pointing this out. The objectives of our research remain exploratory. We have added a phrase to the first objective to provide more context as to what factors are of interest to us. • [R1] The authors want to recruit 1500 participants for the first phase of the present project, and the proposed sample size calculation is vague. Specifically, the authors simply said that “Sample size (n = 1500) was determined according to the number of participating individuals needed for the development of a regression model, composed of 10 variables associated with the epidemiological triad "host-agent-environment" [17] to determine the relationship between cannabis use and Internet use”. How exactly the sample size is calculated remains unclear to me. More information regarding how sample size was determined for this study has been added in lines 130 through 134. • [R1] Following the previous comment, I think that “sample size calculation” deserves to be a subsection instead of mentioning in the Data analysis section. Thank you for this suggestion. A subsection has been created for “sample size calculation” after the section “Recruitment and sampling.” • [R1] It is unclear to me how the authors can recruit the participants to be representative in terms of age, sex and gender, language, and geographic region. Say, what are the proposed sample size for each stratified group? A phrase has been added to the ‘Recruitment and sampling’ section to better explain how the stratified random sampling is applied to ensure representativeness. • [R1] Also, it is unclear how the representativeness of the database in the firm which will help distribute the questionnaire. A phrase has been added in the ‘Recruitment and sampling’ section stating that the web panels firm in charge of the recruitment has a respondent pool of over 200,000 members in Quebec, to which stratified random sampling is applied to ensure representativeness of this population. • [R1] As the data will be collected using two languages (i.e., English and French), I wonder if the authors will make sure the measurement invariance or check the linguistic validity between the two languages. It has been specified on lines 145 and 203-204 that validated questionnaires used for our data collection are available in both English and French, with the corresponding references provided. • [R1] The authors may consider using the ASSIST-11, a shortened ASSIST to assess other psychoactive substance use. The ASSIST-11 has been validated across 42 countries recently. Lee, C. T., Lin, C. Y., Koós, M., Nagy, L., Kraus, S. W., Demetrovics, Z., Potenza, M. N., Ballester-Arnal, R., Batthyány, D., Bergeron, S., Billieux, J., Burkauskas, J., Cárdenas-López, G., Carvalho, J., Castro-Calvo, J., Chen, L., Ciocca, G., Corazza, O., Csako, R. I., Fernandez, D. P., … Bőthe, B. (2023). The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries. Journal of Psychiatric Research, 165, 16–27. https://doi.org/10.1016/j.jpsychires.2023.06.033 Thank you for this suggestion, we will consider it for future projects. However, the protocol approved by the Research Ethics Committee and the institution providing funding for this research uses the 8-item ASSIST scale. • [R1] In the Phase 2 project, I would suggest the authors clearly mention the inclusion and exclusion criteria. Current presentation is not that clear. Also, I wonder if the authors will exclude those who have received treatments for cannabis use or internet use. Or, will the authors exclude those who have severe mental health disorder (e.g., schizophrenia)? Thank you for your comment. Phase 2 is a qualitative phase that aims to explore the experience of people with problematic Internet use (including those having sought treatment and/or diagnosed with a mental health disorder). We will therefore not exclude them from the interviews as we wish to study a plurality of experiences. To make the recruitment and sampling section clearer, for Phase 2, inclusion criteria has been numbered as such: “1) have participated in Phase 1 of the study, 2) have agreed to be contacted for Phase 2, and 3) present a problematic use of the Internet, according to IAT score during Phase 1, i.e., a score greater than 50”. • [R1] Lastly, I may overlook. However, the authors did not mention how and where they will deposit the data. Data will be stored on the Université de Sherbrooke's secure server and will be accessible upon reasonable request. A statement regarding data availability has been added to the article after the Acknowledgements section. Attachments Attachment Submitted filename: CyberDCannabis_ResponseReviewers.docx https://doi.org/10.1371/journal.pone.0304697.r002
3 May 2024 Decision Letter - Souparno Mitra, Editor PONE-D-23-22618R1Cannabis use, mental health, and problematic Internet use in Quebec: A Study ProtocolPLOS ONE Dear Dr. Brodeur, 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. ============================== ACADEMIC EDITOR: Dear Authors, The reviewers have responded positively with feedback about your paper. There is one comment from one reviewer that encourages you to cite another article. Please do not feel the need to do so. You can feel free to just respond to the reviewers comment and make any changes that you see fit. Following your response to reviewer we will proceed with decisions. Again, to reiterate, any recommendations by reviewers to cite an article is optional and at discretion of the authors. Wishing you the best ============================== Please submit your revised manuscript by Jun 17 2024 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, Souparno Mitra, M.D. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #3: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #3: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #3: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 #3: 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 #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have nicely responded to my previous comments and made great improvement. I only have one more minor suggestion. That is, the authors have cited Alimoradi et al.'s meta-analysis to support this statement, "The COVID-19 pandemic has made problematic Internet use a priority issue for many entities both in Quebec and abroad (government, researchers, health professionals, etc.), as it has led to increased use of the Internet and new technologies". I would suggest they further indicate that such internet use is associated with poor mental health as shown in another recent meta-analysis paper authored by the same team of Alimoradi. Ref: Alimoradi, Z., Broström, A., Potenza, M. N., Lin, C.-Y., & Pakpour, A. H. (2024). Associations between behavioral addictions and mental health concerns during the COVID-19 pandemic: A systematic review and meta-analysis. Current Addiction Reports. https://doi.org/10.1007/s40429-024-00555-1 Reviewer #3: Overall, this is a clear, and well-written manuscript. The introduction is relevant. This is an interesting study and the data will be informative. The study design is interesting. The manuscript is structured. It is appropriate in length. ****** 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: 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. https://doi.org/10.1371/journal.pone.0304697.r003
Revision 2
7 May 2024 Author Response You will find below our response to the point raised by Reviewer 1 [R1]. Introduction • [R1] The authors have nicely responded to my previous comments and made great improvement. I only have one more minor suggestion. That is, the authors have cited Alimoradi et al.'s meta-analysis to support this statement, "The COVID-19 pandemic has made problematic Internet use a priority issue for many entities both in Quebec and abroad (government, researchers, health professionals, etc.), as it has led to increased use of the Internet and new technologies". I would suggest they further indicate that such internet use is associated with poor mental health as shown in another recent meta-analysis paper authored by the same team of Alimoradi. Ref: Alimoradi, Z., Broström, A., Potenza, M. N., Lin, C.-Y., & Pakpour, A. H. (2024). Associations between behavioral addictions and mental health concerns during the COVID-19 pandemic: A systematic review and meta-analysis. Current Addiction Reports. https://doi.org/10.1007/s40429-024-00555-1 Response: Thank you for this suggestion. We have included a phrase in the introduction indicating the association between problematic Internet use and poor mental health, and its corresponding citation. Accordingly, the source has been added to the reference list. Attachments Attachment Submitted filename: CyberDCannabis_ResponseReviewers2.0.docx https://doi.org/10.1371/journal.pone.0304697.r004
17 May 2024 Decision Letter - Souparno Mitra, Editor Cannabis use, mental health, and problematic Internet use in Quebec: A Study Protocol PONE-D-23-22618R2 Dear Dr. Brodeur, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Souparno Mitra, M.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Yes Reviewer #3: Yes ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes Reviewer #3: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes Reviewer #3: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 #3: 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 #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics. You may also provide optional suggestions and comments to authors that they might find helpful in planning their study. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have satisfactorily revised the manuscript with the citation of the latest evidence in this field. The protocol is now very clear and ready for publication. Reviewer #3: Overall, this is a clear, and well-written manuscript. The introduction is relevant. This is an interesting study and the data will be informative. The study design is interesting. The manuscript is structured. It is appropriate in length. ****** 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: No ******** https://doi.org/10.1371/journal.pone.0304697.r005
Formally Accepted
24 May 2024 Acceptance Letter - Souparno Mitra, Editor PONE-D-23-22618R2 PLOS ONE Dear Dr. Brodeur, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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. Souparno Mitra Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0304697.r006

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