Receipt of healthcare provider advice to quit tobacco use among Indian men

Prakash Babu Kodali; Maya Vijayaraghavan

doi:10.1371/journal.pone.0349022

Peer Review History

Original SubmissionMay 30, 2025
30 Dec 2025 Decision Letter - George Kuryan, Editor -->PONE-D-25-29325-->-->Receipt of healthcare provider advice to quit tobacco use among Indian men-->-->PLOS One Dear Dr. Kodali, 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 Feb 13 2026 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 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. 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This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. 4. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [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? 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 ******** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes ****** -->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 ****** -->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 ****** -->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 manuscript addresses an important and understudied aspect of tobacco control in India—the receipt of healthcare provider (HCP) advice to quit among male smokers, using two large NFHS datasets (4 & 5). The topic aligns well with national and global tobacco control priorities, leveraging high-quality, nationally representative data. The paper is clearly written, the results are relevant, and the public-health implications are important. However, there are methodological limitations, conceptual gaps, and missing clarifications that require attention. Introduction 1. The NFHS questions regarding the HCP visit and advice The definition does not specify which type of HCP (doctor, nurse, AYUSH, dentist, etc.). The study assumes HCPs are comparable. In the Indian context, it is a major oversimplification. Also the study could be biased as the information on the HCPs are based on the information from the patient. It is ideal to categorise the HCPs and might give an input on the variations in the smokers in each category 2. Under the health status subheading, two questions are mentioned “ever had oral cavity examination”, “ever undergone oral cancer screening” These are not equivalent constructs, yet are pooled as one variable for oral cancer screening in the table. This could be seen as a methodological flaw. It can be mentioned as a limitation, or by analysing after excluding this variable Methods 3. NFHS 4 mentions 4 NCDs, and NFHS 5 mentions 6 NCDs; pooling these NCDs can falsely increase the association. Were any corrections made on the same? Results: 4. Figure 1 shows many determinants for the advice to quit. However potential confounders are missed in analysis such as: Frequency of smoking or cigarettes/bidis per day (Heavier smokers are more likely to mention it and to be advised to quit).; Number of healthcare visits (More visits → higher probability of receiving advice); Type of facility (public vs private); Quit advice frequency differs widely across sectors in India. Provider characteristics (gender, training, cadre), although there should not be a difference, some people tend to listen to a male HCP more. 5. Needs clarity on tables and results, need a bit organizing Minor Issues 1. Abstract is strong but could briefly mention limitations. 2. Improve grammar & discussion to reduce repetition. ****** -->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: Yes: Thomas Antony ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0349022.r001
Revision 1
5 Feb 2026 Author Response Reviewer #1: This manuscript addresses an important and understudied aspect of tobacco control in India—the receipt of healthcare provider (HCP) advice to quit among male smokers, using two large NFHS datasets (4 & 5). The topic aligns well with national and global tobacco control priorities, leveraging high-quality, nationally representative data. The paper is clearly written, the results are relevant, and the public-health implications are important. However, there are methodological limitations, conceptual gaps, and missing clarifications that require attention. Author response: We appreciate the reviewer’s comment. We revised the manuscript accordingly. Where suggested revisions were not feasible due to data limitations, we explicitly acknowledged these constraints and reported them in the limitations section. Introduction 1. The NFHS questions regarding the HCP visit and advice The definition does not specify which type of HCP (doctor, nurse, AYUSH, dentist, etc.). The study assumes HCPs are comparable. In the Indian context, it is a major oversimplification. Also the study could be biased as the information on the HCPs are based on the information from the patient. It is ideal to categorise the HCPs and might give an input on the variations in the smokers in each category Author response: We agree that disaggregating Healthcare provider (HCP) by type (e.g., doctors, nurses, AYUSH practitioners, dentists) and reporting advice to quit tobacco by provider category would add important nuance, particularly in the Indian context, where care-seeking is heterogeneous. However, we are unable to undertake such an analysis due to inherent limitations of the National Family Health Survey (NFHS) data. Specifically, advice to quit tobacco use is captured only through the following linked items: (i) “In the last 12 months, have you visited a doctor or other healthcare provider?” and (ii) “During any of these visits, were you advised to quit smoking or using tobacco in any other form.” These items do not specify the type of HCP associated with the advice to quit. While NFHS includes separate questions on interactions with specific provider types (such as doctors, nurses, or AYUSH providers), these items pertain to different recall periods (e.g., last 3 months) or distinct service domains (e.g., family planning or immunization). As a result, these variables could not be harmonized with the tobacco cessation advice variable in a methodologically valid manner. We have recognized this as a major limitation of our study in line 350-352. 2. Under the health status subheading, two questions are mentioned “ever had oral cavity examination”, “ever undergone oral cancer screening” These are not equivalent constructs, yet are pooled as one variable for oral cancer screening in the table. This could be seen as a methodological flaw. It can be mentioned as a limitation, or by analysing after excluding this variable Author response: We agree with the reviewer that “ever had an oral cavity examination” and “ever undergone oral cancer screening” are not strictly equivalent constructs. As the reviewer correctly notes, NFHS-4 captured oral examination using a broader item, whereas NFHS-5 introduced a more specific question on oral cancer screening. To maintain comparability across survey rounds and avoid excluding a potentially relevant oral health–related variable, we retained this measure and operationalized it conservatively as “ever had an oral examination.” We acknowledge that this variable likely captures a heterogeneous set of encounters, ranging from general oral examinations to formal oral cancer screening, and therefore should not be interpreted as a precise measure of oral cancer screening uptake. We considered excluding this variable; however, doing so would have omitted information on prior oral health contact, which may plausibly influence healthcare provider–initiated tobacco cessation advice, particularly in a high-tobacco-burden setting such as India. To minimize misinterpretation, we have avoided referring to this variable as “oral cancer screening” and have explicitly acknowledged the non-equivalence of constructs and potential misclassification as a study limitation (Lines 354–357). Methods 3. NFHS 4 mentions 4 NCDs, and NFHS 5 mentions 6 NCDs; pooling these NCDs can falsely increase the association. Were any corrections made on the same? Author response: To ensure comparability, we restricted the NCD variable to the four conditions common to both survey rounds (diabetes, asthma, heart disease, and cancer). We revised our analysis by applying the updated variable for ‘Diagnosed with an NCD’ and made corresponding changes to our results section [line 276-282] and table 2 in the revision. Results: 4. Figure 1 shows many determinants for the advice to quit. However potential confounders are missed in analysis such as: Frequency of smoking or cigarettes/bidis per day (Heavier smokers are more likely to mention it and to be advised to quit).; Number of healthcare visits (More visits → higher probability of receiving advice); Type of facility (public vs private); Quit advice frequency differs widely across sectors in India. Provider characteristics (gender, training, cadre), although there should not be a difference, some people tend to listen to a male HCP more. Author response: We developed our conceptual framework (figure 1), by reviewing published studies, NFHS survey questionnaires and respective data sets. Based on your suggestion, we included the item ‘Frequency of smoking cigarettes/bidi per day’ by developing it from independent items capturing ‘number of cigarettes smoked per day’ and ‘number of bidis smoked per day’. We captured it as a binary item with responses ‘≤ 10 cigarettes/bidi per day’ and ‘>10 cigarettes/bidi’ per day (Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis - PubMed). We revised our Figure 1, Table 1, Table 2, Results and discussion by including this important variable. With respect to the items such as number of healthcare visits, type of facility, and provider characteristics, we are unable to include them since the NFHS surveys did not capture these items. We have acknowledged this in the limitations, and indicated the need for future studies by including these items in lines 357-359. 5. Needs clarity on tables and results, need a bit organizing Author response: We revised and better organized the tables and Results section in line with the suggested corrections to improve clarity. Specifically, in Table 2, we now present unweighted frequencies for all independent variables alongside weighted percentages for the outcome variable (i.e., receipt of healthcare provider advice to quit), improving clarity and interpretability. Minor Issues 1. Abstract is strong but could briefly mention limitations. Author response: Thank you we have reported the study limitations in the abstract of the manuscript (line 53 & 54). 2. Improve grammar & discussion to reduce repetition. Author response: We improved grammar and reduced repetition in the discussion. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0349022.r002
27 Feb 2026 Decision Letter - George Kuryan, Editor -->PONE-D-25-29325R1-->-->Receipt of healthcare provider advice to quit tobacco use among Indian men-->-->PLOS One Dear Dr. Kodali,-->--> -->-->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 13 2026 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 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, George Kuryan Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.--> Reviewer #2: (No Response) Reviewer #3: 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 #2: Partly Reviewer #3: Yes ****** -->3. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #2: Yes Reviewer #3: 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 #2: 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 #2: Yes Reviewer #3: 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 #2: The current study explores the important topic of tobacco-cessation counseling by way of HCP advice. The use of large-scale representative data, the statistical analysis and the results are acceptable. However, there are gaps in discussion that need to be addressed to make clear recommendations. The points below are noted for the consideration of the authors. 1. Ref: Rayhan Rahman, Illias Sheikh, Yash Merchant, Ankita Mathur, Toufiq Noor, Vini Mehta, Oral cancer screening in India: a secondary analysis of disparities using national family health survey data, Oral Oncology, Volume 169, 2025, 107632, ISSN 1368-8375, https://doi.org/10.1016/j.oraloncology.2025.107632. (https://www.sciencedirect.com/science/article/pii/S1368837525004610) The above study uses NFHS data and explores an important point overlooked in the current study- the prevalence of tobacco usage- smoke/smokeless differs widely between states as observed in the NFHS survey too. It mentions: “Screening participation is directly related to lower tobacco prevalence in the population. The study found that people from high-tobacco-prevalence states were 42 % less likely to be screened (Adjusted Odds Ratio (AOR): 0.58, p < 0.01) than those from low-prevalence states”. This finding has also been noted in the GATS study. This wide variation between the Southern Indian states and Union territories as compared to Northern Indian states can be mentioned and even included in the analysis. 2.Ref: https://www.researchgate.net/publication/368273529_Utilization_of_dental_care_services_among_adult_Indian_population_A_meta-analysis_of_evidence_from_2011-2022 The above is a meta-analysis that estimates dental care seeking among Indian adults and discusses various factors including the North – South divide in oral care seeking, findings worth noting and mentioning in the discussion. 3. The National Oral Health program launched by the MOHFW in 2014 and its scope could be included in the discussion. 4. An important finding from NFHS 4 vs NFHS 5- as noted in a recent study (referenced below) is that “The proportion of men reporting oral cavity examinations was 9% (out of 112,122 interviewed men) in NFHS-4, which reduced to 0.2% (out of 716,443 interviewed men) in NFHS-5” Ref: Learning from the Indian National Family Health Survey to assess population based oral, cervix and breast cancer screening in low-and-middle income countries. Borkotoky, Kakoli et al. The Lancet Regional Health - Southeast Asia, Volume 30, 100483 5. Ref: Ramanadhan S, Xuan Z, Choi J, Mahtani SL, Minsky S, Gupte H, Mandal G, Jagiasi D, Viswanath K. Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset. BMC Public Health. 2022 Nov 18;22(1):2115. doi: 10.1186/s12889-022-14538-2. PMID: 36401241; PMCID: PMC9673333. The findings of the above study, analyzing the GATS-2 dataset, are relevant and would do well to be included in the discussion for the current study 6. The fact that the timing of the NFHS 5 survey was during the pandemic when rampant COVID screening and testing were underway could have impacted health seeking and also contributed to the noticed increase in self-reports of oral examinations during NFHS 5 may be worth mentioning. Reviewer #3: Its a nice piece of work, done on a very pertinent and buring topic of the contemprory times. However, certain aspects needs clarificatrion. 1. The study describes that only 50% of tobaco users attending the health care facility were given advice to quit. In this context it is pertinent to note the primery reason for attending the health care facility. Since it will have a large bearing on giving advice. For instance in case of accidents or emergencies it is unlikely that HCP will provide advice to quit. They will be focused more on stabilizing the patients. Same is the case with attendence for resons which are unrelated to tobacco use, emaple - Surgical conditions etc. 2. Findings will be more reliable if data is provided to demonstarte that the visit to health facility was due to a conditon/ health state which arised due to tobacco use. since such information is not availabe in present study, policy impications becomes unjustifiable. ****** -->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 #2: 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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. --> https://doi.org/10.1371/journal.pone.0349022.r003
Revision 2
20 Mar 2026 Author Response Reviewer #2: The current study explores the important topic of tobacco-cessation counseling by way of HCP advice. The use of large-scale representative data, the statistical analysis and the results are acceptable. However, there are gaps in discussion that need to be addressed to make clear recommendations. The points below are noted for the consideration of the authors. Author response: Dear Reviewer, thank you for your careful review of our manuscript and the suggestions you have made. We agree with the revisions suggested and had made the corrections in the manuscript. We ensured to include the suggested articles in our discussion and strengthen our findings and their interpretation by including a state-level differences in receipt of HCP advice to quit as a supplementary file. We look forward to your positive consideration of our manuscript. 1. Ref: Rayhan Rahman, Illias Sheikh, Yash Merchant, Ankita Mathur, Toufiq Noor, Vini Mehta, Oral cancer screening in India: a secondary analysis of disparities using national family health survey data, Oral Oncology, Volume 169, 2025, 107632, ISSN 1368-8375, https://doi.org/10.1016/j.oraloncology.2025.107632. (https://www.sciencedirect.com/science/article/pii/S1368837525004610) The above study uses NFHS data and explores an important point overlooked in the current study- the prevalence of tobacco usage- smoke/smokeless differs widely between states as observed in the NFHS survey too. It mentions: “Screening participation is directly related to lower tobacco prevalence in the population. The study found that people from high-tobacco-prevalence states were 42 % less likely to be screened (Adjusted Odds Ratio (AOR): 0.58, p < 0.01) than those from low-prevalence states”. This finding has also been noted in the GATS study. This wide variation between the Southern Indian states and Union territories as compared to Northern Indian states can be mentioned and even included in the analysis. Author response: Thank you for the suggestion. We have included the state-wise variations in HCP advise to quit as a supplementary file. We have discussed the variations in HCP advice to quit in connection with the observations made by Rahman et al (2025), and GATS India survey 2016-17. The changes were made to lines 306 to 312 and supplementary file 2 was added. 2.Ref: https://www.researchgate.net/publication/368273529_Utilization_of_dental_care_services_among_adult_Indian_population_A_meta-analysis_of_evidence_from_2011-2022 The above is a meta-analysis that estimates dental care seeking among Indian adults and discusses various factors including the North – South divide in oral care seeking, findings worth noting and mentioning in the discussion. Author response: Thank you for the suggestion. We have revised our discussion section to include the suggested study in the discussion section in lines 350-353. 3. The National Oral Health program launched by the MOHFW in 2014 and its scope could be included in the discussion. Author response: Thank you for the suggestion. We have incorporated a discussion on the scope of the National Oral Health Programme in the revised manuscript (Lines 348–353). 4. An important finding from NFHS 4 vs NFHS 5- as noted in a recent study (referenced below) is that “The proportion of men reporting oral cavity examinations was 9% (out of 112,122 interviewed men) in NFHS-4, which reduced to 0.2% (out of 716,443 interviewed men) in NFHS-5” Ref: Learning from the Indian National Family Health Survey to assess population based oral, cervix and breast cancer screening in low-and-middle income countries. Borkotoky, Kakoli et al. The Lancet Regional Health - Southeast Asia, Volume 30, 100483 Author response: Thank you for the suggestion, we have included the suggested study in our discussion in lines 345-346 5. Ref: Ramanadhan S, Xuan Z, Choi J, Mahtani SL, Minsky S, Gupte H, Mandal G, Jagiasi D, Viswanath K. Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset. BMC Public Health. 2022 Nov 18;22(1):2115. doi: 10.1186/s12889-022-14538-2. PMID: 36401241; PMCID: PMC9673333. The findings of the above study, analyzing the GATS-2 dataset, are relevant and would do well to be included in the discussion for the current study Author response: Thank you for the suggestion, we have included the suggested study in our discussion. 6. The fact that the timing of the NFHS 5 survey was during the pandemic when rampant COVID screening and testing were underway could have impacted health seeking and also contributed to the noticed increase in self-reports of oral examinations during NFHS 5 may be worth mentioning. Author response: Thank you for this important observation. We agree that the timing of NFHS-5 during the COVID-19 pandemic may have influenced health-seeking behaviour, oral examinations, and interactions with healthcare providers. We have acknowledged this as a limitation of the study in the revised manuscript (Lines 378–379). Reviewer #3: Its a nice piece of work, done on a very pertinent and buring topic of the contemprory times. However, certain aspects needs clarificatrion. 1. The study describes that only 50% of tobaco users attending the health care facility were given advice to quit. In this context it is pertinent to note the primery reason for attending the health care facility. Since it will have a large bearing on giving advice. For instance in case of accidents or emergencies it is unlikely that HCP will provide advice to quit. They will be focused more on stabilizing the patients. Same is the case with attendence for resons which are unrelated to tobacco use, emaple - Surgical conditions etc. Author response: Thank you for this valuable observation. We agree that the primary reason for visiting a healthcare facility can significantly influence the likelihood of receiving advice to quit tobacco. However, the NFHS surveys do not capture information on the reason for healthcare visits. We have acknowledged this as a limitation in the revised manuscript (Lines 375–378) and have interpreted our findings with appropriate caution. 2. Findings will be more reliable if data is provided to demonstarte that the visit to health facility was due to a conditon/ health state which arised due to tobacco use. since such information is not availabe in present study, policy impications becomes unjustifiable. Author response: Thank you for this important comment. We acknowledge that the dataset does not include information on the specific reasons for healthcare visits, and therefore we are unable to ascertain whether these visits were related to tobacco use. This has been explicitly recognized as a limitation in the revised manuscript [lines 375 to 378]. Attachments Attachment Submitted filename: Response to Review comments 3.20.26.docx https://doi.org/10.1371/journal.pone.0349022.r004
23 Apr 2026 Decision Letter - George Kuryan, Editor <p>Receipt of healthcare provider advice to quit tobacco use among Indian men PONE-D-25-29325R2 Dear Dr. Kodali 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, George Kuryan 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 #2: All comments have been addressed Reviewer #3: 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 #2: Yes Reviewer #3: Yes ****** -->3. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #2: I Don't Know Reviewer #3: 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 #2: 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 #2: Yes Reviewer #3: 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 #2: The authors have addressed adequately the comments raised by the reviewer. Considering the complexity of the demography under consideration, this study can provide important insights for studies in the future. Reviewer #3: Appreciate the authers work. Meticulously done on very neglected aspect . all comments got adressed I dont have any further comments to make. ****** -->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 #2: No Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0349022.r005
Formally Accepted
Acceptance Letter - George Kuryan, Editor PONE-D-25-29325R2 PLOS One Dear Dr. Kodali, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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 Professor George Kuryan Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0349022.r006

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