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Thank you for your efforts to improve your manuscript.
[# PeerJ Staff Note - this decision was reviewed and approved by Bob Patton, a PeerJ Section Editor covering this Section #]
Your revised manuscript is better in terms of grammar, but it still needs improvement. You also need better justification for presenting 3 models and the reviewer had concerns about the conclusion statement not being part of your analysis.
Some English is still not correct.
Research questions are still broad. More clarity and focus rationale is necessary.
Not clear why three models were presented. Unless you are comparing models, such as, are models 2 or 3 "better" than 1, based on AIC or some other metric. Or unless you have specific hypothesis about the models?
The paper is better, but still needs some improvement. As is, it is not quite a proper scientific report. English language needs more editing and some of the paragraphs are only one sentence long.
Finally, the concluding sentence: "Skin cancer prevention policies are urgently needed to increase awareness and reduce the prevalence of sunburns among at-risk populations, like beachgoers." does not follow from your results. Did you assess awareness of skin cancer, sunburn, or protection behaviors? They were not reported in this study. Please modify your conclusion based on your reported results.
Many of the key details regarding the study design, survey, and analysis methods are omitted. This should be addressed in your revised document. Further, the importance and novelty of this work are not well articulated. Please address these and other reviewer comments. Finally, when you have made your revisions, I would request that you carefully edit the revised document for grammar. I cannot accept a revised version of your work if it does not meet a standard for readability.
[# PeerJ Staff Note: Please ensure that all review comments are addressed in a rebuttal letter and any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate. It is a common mistake to address reviewer questions in the rebuttal letter but not in the revised manuscript. If a reviewer raised a question then your readers will probably have the same question so you should ensure that the manuscript can stand alone without the rebuttal letter. Directions on how to prepare a rebuttal letter can be found at: https://peerj.com/benefits/academic-rebuttal-letters/ #]
[# PeerJ Staff Note: The Academic Editor has identified that the English language must be improved. PeerJ can provide language editing services - please contact us at [email protected] for pricing (be sure to provide your manuscript number and title) #]
The authors describe a sample of beach goers in Peru and look at associations between demographics and self-reported sun behaviors. The authors have noted that while this has been investigated in other populations it has not been done in Peru.
Because the novelty of this paper is the study population I would be interested what characteristics other countries have shown to be associated with sunburns in beachgoers. This could be incorporated into the introduction and/or discussion, with the country specifically mentioned.
The data has been supplied, tables labelled appropriately. I would suggest that the percentages in table one be rounded to the nearest whole number for ease of reading.
The Poisson model with robust error is an appropriate statistical choice. However, the homogeneity of the results for martial status and country of birth, make these variables inappropriate for inclusion in the model. Only 2 people identified as widowers, and < 10 people were from outside Peru. Given the limited data these conclusions cannot be drawn, and effect the generalizability of the model. Therefore, please re-run the model/s excluding nationality and marital status. You could consider including marital status if you re-categorized as married vs. single/divorced/widowed. Also please dichotomize level of education.
Because of the issue with the homogeneity of marital status and nationality, conclusions about these characteristics cannot be drawn. Therefore, as suggested above the model must be re-run in order to present valid findings, and the results, discussion and conclusions updated correspondingly.
Additional Suggestions
1. Line 61 I would suggest strengthening the sentence and state the current evidence has “shown” or “confirmed” the relationship between UV exposure and skin cancer.
2. When you are explaining that something has a low/high level of something, please state the comparison group. For example, in line 64, “beachgoers have a low adherence to the use of sun protection measures…” compared to xyz.
3. Quantify the additional number of sunburns the beachgoers have as part of the highest risk group. Also provide details of the population these studies are being carried out in. I.e. what country and nationality/race/ethnicity.
4. There are some places were the English phrasing could be improved. For example, line 53 remove “one the other hand”. Line 65 remove “Previously”
5. Chi2 should either be spelt out in full, or use symbols (line 110)
6. Please provide a reason as to why 3 models are presented, as opposed to just presenting a final model? Did you compare model performance? Was a variable selection method considered?
7. In the abstract please define aPR.
8. In the results provide the proportion of males/females (line 130)
9. Also include in line 131-132 that the remainder of the participants reported no sunburns.
10. Given the model is presented with a dichotomous outcome, I would also present table 1 as such.
Some grammatical mistakes. Needs work.
Literature review is brief but okay.
Article structure is okay, but most sections are too short.
Not self contained. References a previous study for study and survey details.
A research manuscript briefly reporting on associations between sunburns and other factors in Peru. While potentially a promising contribution, overall, the importance and novelty of this work are not well articulated. Additionally, many of the key details regarding the study design, survey, and analysis methods are omitted. Finally, more work is needed to improve the discussion and better synthesize it with existing knowledge. As it is now, it is generally a recap of the results. Adding a paragraph or two on the importance and novelty of this work and how it may be leveraged, with more specific examples, would be very valuable.
Lines 53-54: How are high temperatures related to UV? There is a disconnect here; suggest that you remove this first sentence.
Line 61: A possible relationship? Suggest rewording, I think the relationship is not so vague.
Appears to be original research.
Research questions are not defined. Knowledge gap not well defined.
Rigorous investigation is not reported in full. Unable to assess technical standard.
Methods not described with sufficient detail; contradictions apparent.
Notes:
Study Population
How many participants were recruited? How many participants were contacted overall?
Lines 87-88: Please briefly provide more information about study population and context. The reader will not likely want to look up another paper to read pertinent information for the present study. For example, were the participants recruited at the beach? How does the sample represent the population it is drawn from? What was the sampling strategy? Convenience? Randomly selected? This paper is quite short and you can really expand this section
Were there any missing variables? Did you delete observations with missing variables?
Specifically, please include much more detail and rationale for key decisions, such as why you chose a Poisson model and not a logistic or a binomial model. Your description of the Poisson model (which is to model count data) is that you used it to model dichotomous data. Please explain this apparent discrepancy.
Results
Tables 1 and 2. In Table 1, there are no widowers who reported any sunburns. Yet, in Table 2, widowers was a significant category associated with any sunburns. How can it be significant if there are no observations to estimate the relationship?
Buried in the limitation section is that these data are not representative of the population where the study was conducted. Please be more transparent earlier and more often (i.e., “in this sample, we found…”) so the reader is not led to believe that these are generalizable findings or that they are free from various biases that may have been introduced by the sampling or analysis methods. Please provide much more detail for each of the steps in this study so the reader may better contextualize and evaluate the strengths of the evidence for the associations reported.
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