A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa

Richard Gyan Aboagye; Bright Opoku Ahinkorah; Irene Esi Donkoh; Joshua Okyere; Sanni Yaya

doi:10.1371/journal.pone.0331738

Peer Review History

Original SubmissionDecember 15, 2024
24 Feb 2025 Decision Letter - Mohammad Rifat Haider, Editor Dear Dr. Abogaye, 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 Apr 04 2025 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. 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'. 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We look forward to receiving your revised manuscript. Kind regards, Mohammad Rifat Haider 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. We notice that your figure is uploaded with the file type ''\Supporting Information''. Please amend the file type to 'Figure'. Please ensure that each Supporting Information file has a legend listed in the manuscript after the references list. 3. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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: Please address the reviewers' comments and resubmit. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: No ****** Reviewer #1: The manuscript titled "A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa" addresses an important public health concern by exploring the rural-urban disparities in tobacco use among women in SSA. The study employs a robust multivariate non-linear decomposition analysis and provides meaningful insights into the factors contributing to tobacco use disparities. The findings have significant implications for policymaking and targeted interventions. However, there are some areas that require improvement/corrections to enhance the clarity and consistency of the study's presentation. Reviewer #2: The study employs a sophisticated analytical method (nonlinear decomposition) to explore an important public health issue. The use of DHS data strengthens the generalizability of findings. Some methodological aspects need further clarification, particularly in explaining decomposition results that exceed 100%. Additionally, more discussion on policy implications would enhance the manuscript’s impact. ****** 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: Mohammad Niaz Morshed Khan ******** [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 Attachments Attachment Submitted filename: Review of manuscript_PONE-D-24-57996.pdf Attachment Submitted filename: Scientific Review of Manuscript PONE-D-24-57996.docx https://doi.org/10.1371/journal.pone.0331738.r001
Revision 1
21 Apr 2025 Author Response Response to Reviewers’ Comments Review of manuscript: A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa General Comments The manuscript titled "A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa" addresses an important public health concern by exploring the rural-urban disparities in tobacco use among women in SSA. The study employs a robust multivariate non-linear decomposition analysis and provides meaningful insights into the factors contributing to tobacco use disparities. The findings have significant implications for policymaking and targeted interventions. However, there are some areas that require improvement/corrections to enhance the clarity and consistency of the study's presentation. Response: Thank you. The authors have addressed all the comments raised during the review. Introduction The introduction is well-structured and provides adequate background information on the topic. Response: Thank you. Methods Page 9, Line 237: “Hence, even if rural residents have some level of”- Is it some or same? The authors should verify and correct if this is an error. Response: The authors have corrected this to read “same”. Results a. Page 9, Line 259 and Page 11, Line 267: The authors refer to "Figure 1" in the main text. However, the supporting information labels this figure as "Figure 2". This inconsistency could confuse readers. The authors should carefully review and align the figure numbering in both the main text and supporting materials to ensure consistency and clarity. Response: The authors have corrected the figure numbering. b. Page 10, line 274-275: “Similarly, being in a female-headed household and having a higher wealth index was associated with lower odds of tobacco use in both rural and urban areas”- According to Table 2, the aOR for the "sex of household head" in urban areas is 1.10 for female headed household, which indicates that being in a female-headed household is associated with higher odds of tobacco use in urban areas, not lower odds. The authors should re-evaluate this statement and revise it to reflect the results accurately. Response: The authors have corrected this error. c. Page 10, line 279: “reading newspapers or magazines [aOR = 1.22; 95%CI: 1.11, 1.25]”- In table 2, it is mentioned as [aOR= 1.22; 95% CI: 1.11, 1.35]. The authors should check this and revise it to reflect the results accurately. Response: The authors have corrected this error. d. Page 10, line 285-286: “tobacco use with women in Southern Africa were more likely to use tobacco [aOR = 2.73; 95%CI: 2.30, 3.24] in urban areas” is actually the pooled value for Southern Africa. In table 2, for urban areas it is “[aOR = 3.30; 95%CI: 2.62, 4.15]”. The authors should check this and revise it to reflect the results accurately. Response: The authors have corrected this error. e. Page10, line 286-287: “whereas in rural areas, women in Eastern Africa reported the highest likelihood of tobacco use [aOR = 3.30; 95%CI: 2.62, 4.15]” is actually the urban value for Southern Africa. According to Table 2, for rural areas in Eastern Africa it is “[aOR = 3.06; 95%CI: 2.59, 3.62]”. The authors should check this and revise it to reflect the results accurately. Response: The authors have corrected this error. Discussion Page 16, line 373-378: The authors could provide a reference for this statement to support it with evidence. Response: The sentence in lines 373-378 only reiterates the finding of our study. Hence, there is no need to add a reference. Page 17, line 414-421: The authors could provide reference for these statements to support with evidence. Response: The authors have supported the sentence in these lines with references. Scientific Review of Manuscript PONE-D-24-57996 Title: A Nonlinear Decomposition Analysis of the Rural-Urban Disparities in Tobacco Use Among Women in Sub-Saharan Africa Reviewer’s Comments Sl# Comment 1 The title accurately reflects the study’s content, but consider specifying "multivariate nonlinear decomposition" for clarity. Response: The authors have provided the meaning of the multivariate nonlinear decomposition in the methods section (statistical analysis). 2 The introduction provides a strong rationale for the study, but it could benefit from a clearer articulation of the research gap. What specific aspect of rural-urban disparities has not been addressed in previous research? Response: The authors clearly provided the research gap in the introduction section. 3 The methodology description is clear, but it would be helpful to justify why a nonlinear decomposition approach was chosen over other decomposition methods. Response: The authors have justified the use of nonlinear decomposition analysis. 4 The results mention that differences in characteristics accounted for 167.48% of the gap in tobacco use. This percentage exceeds 100%, which might need further clarification for readers unfamiliar with decomposition analysis. Response: The authors have clarified this in the results section. 5 The conclusion emphasizes the importance of education and wealth index in reducing tobacco use disparities. However, consider briefly discussing potential policy implications in the conclusion section. Response: The authors discussed the policy implications in a separate subsection and additionally provided a summary of policy and recommendations in the conclusion section. 6 The study design and data source are well described. However, it would be beneficial to discuss any limitations of pooling data from multiple countries in SSA, given potential heterogeneity in tobacco control policies. Response: The authors have indicated this as a limitation in the study. 7 Statistical analysis is robust, but the rationale for choosing specific covariates in the logistic regression model should be expanded. Were there any omitted variables that could influence tobacco use? Response: The authors reviewed the literature and selected potential variables that could influence tobacco use. Also, only the variables that were available in the DHS dataset across all the countries included were finally selected for the study. Hence, there may be other variables that could influence tobacco use that were omitted from the study. The authors have acknowledged this as a limitation. 8 The use of spatial maps to depict tobacco prevalence is an excellent approach. However, the manuscript does not provide information on how spatial variability was statistically tested. Were any spatial regression models considered? Response: Thank you for this comment. The authors only presented the proportion of tobacco use in maps. The authors did not perform any spatial regression analysis. 9 The discussion section is comprehensive, but it would benefit from additional citations comparing findings with studies outside SSA. Are these trends consistent globally? Response: The authors included citations from studies outside SSA in the discussion section. The trends are similar to findings from other countries outside SSA. 10 The limitations section acknowledges key concerns, such as self-reported data and survey year differences. However, there is no mention of potential recall bias or misclassification of tobacco use, which could affect results. Response: The authors have acknowledged this as a limitation. 11 The authorship contributions are well stated, but the manuscript does not mention whether the authors had any conflicts of interest regarding the topic. Response: The authors do not have any competing interests. 12 The ethics statement is clear, but it would be helpful to discuss how data protection and participant confidentiality were maintained, especially given the sensitivity of tobacco use data. Response: The authors have addressed this comment. Overall Evaluation: • Strengths: The study employs a sophisticated analytical method (nonlinear decomposition) to explore an important public health issue. The use of DHS data strengthens the generalizability of findings. Response: Thank you. • Areas for Improvement: Some methodological aspects need further clarification, particularly in explaining decomposition results that exceed 100%. Additionally, more discussion on policy implications would enhance the manuscript’s impact. Response: The authors have addressed these concerns. Attachments Attachment Submitted filename: Response to Reviewers Comments_R1.docx https://doi.org/10.1371/journal.pone.0331738.r002
18 Jun 2025 Decision Letter - Mohammad Rifat Haider, Editor Dear Dr. ABOAGYE, 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 2025 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. 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'. 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We look forward to receiving your revised manuscript. Kind regards, Mohammad Rifat Haider 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: Thank you for addressing the reviewers' comments/feedback. Please address the comments from the Reviewer 1 on correcting any remaining spelling and grammatical errors prior to final publication. For instance, in the track-changed version, there is still a spelling error on page 15, line 354—“uneployed” should be corrected to “unemployed.” [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 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??> 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 Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: I recommend acceptance of the manuscript for publication, as the authors have adequately and appropriately addressed all of my previous comments. However, I encourage the authors to carefully review the manuscript for any remaining spelling and grammatical errors prior to final publication. For instance, in the track-changed version, there is still a spelling error on page 15, line 354—“uneployed” should be corrected to “unemployed.” Reviewer #2: Thank you for your effort and addressing the reviewer comments. Hope this paper will add new knowledge in the respective field. ****** 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: Mohammad Niaz Morshed Khan ******** [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 https://doi.org/10.1371/journal.pone.0331738.r003
Revision 2
26 Jun 2025 Author Response RESPONSE TO REVIEWERS’ COMMENTS 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). Response: Thank you. Reviewer #1: I recommend acceptance of the manuscript for publication, as the authors have adequately and appropriately addressed all of my previous comments. However, I encourage the authors to carefully review the manuscript for any remaining spelling and grammatical errors prior to final publication. For instance, in the track-changed version, there is still a spelling error on page 15, line 354—“uneployed” should be corrected to “unemployed.” Response: Thank you. The authors have corrected all spelling and grammatical errors in the manuscript. Reviewer #2: Thank you for your effort and addressing the reviewer comments. Hope this paper will add new knowledge in the respective field. Response: Thank you. Attachments Attachment Submitted filename: Response to Reviewers Comments_R2.docx https://doi.org/10.1371/journal.pone.0331738.r004
20 Aug 2025 Decision Letter - Mohammad Rifat Haider, Editor A nonlinear decomposition analysis of the rural-urban disparities in tobacco use among women in sub-Saharan Africa PONE-D-24-57996R2 Dear Dr. Abogaye, 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. For questions related to billing, please contact billing support . 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, Mohammad Rifat Haider Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for addressing all reviewers' comments. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 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??> 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 Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: The authors have corrected the identified spelling error as well as reviewed the entire manuscript to ensure spelling and grammatical issues have been addressed. Reviewer #2: The authors addressed all the comments of the reviewer, therefore, the reviewer has no new comments to add. ****** 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: No ******** https://doi.org/10.1371/journal.pone.0331738.r005
Formally Accepted
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