Smoking, Nutritional Status, and Their Associations with Hypertension and Hematological Disorders Among Hotel Workers: Implications for Indonesian Occupational Health Nursing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript addresses a relevant occupational health topic by examining smoking, nutritional status, hypertension, and hematological abnormalities among hotel workers. The subject is of interest, but the manuscript requires substantial revision due to methodological and reporting concerns.

1. The statistical analysis is not described consistently. The Methods indicate logistic regression, but the Results refer to multiple linear regression, while the tables show logistic regression parameters. The analytical approach should be clarified and reported consistently across all sections.
2. The regression result for smoking does not match the interpretation in the text. This raises concern about either variable coding or interpretation of the model output. The coding of smoking status should be clearly explained and the results revised accordingly.
3. The exposure variables are oversimplified. Smoking is treated only as a yes/no variable, and nutritional status is limited to BMI categories. These measures do not adequately capture smoking history or broader metabolic and dietary status. This limitation should be stated more clearly.
4. Adjustment for confounding is limited. Important factors such as physical activity, diet, alcohol use, medication, shift work, and existing disease are not considered. The authors should acknowledge the likelihood of residual confounding and interpret the findings more cautiously.
5. The presentation of hematological outcomes is unclear. Leucocytosis and anemia are separate conditions, but their descriptive reporting is confusing. The authors should clearly state how these outcomes were defined and analyzed, and revise the tables for clarity.
6. The age categories are uneven and may weaken comparison across groups. The rationale for this categorization should be explained, or a more balanced grouping should be considered.
7. The Discussion is broader than necessary and includes statements that go beyond the data. It should focus on the study findings, the limits of the cross-sectional design, and the practical implications that can be supported by the results.
8. The manuscript requires substantial language editing. Grammatical and stylistic problems are frequent and affect readability.
9. The Methods section needs clearer and more precise reporting. Some parts are repetitive, while key details such as variable coding and measurement procedures are insufficiently described.
10. The tables should be revised for readability. Titles, labels, and formatting need to be standardized.
11. The Abstract should be aligned with the actual statistical methods and should use more cautious wording.
12. The Conclusion should avoid causal wording and should reflect the limitations of a cross-sectional study from a single workplace setting

Author Response

Please see the attachment below

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript addresses an important topic and would benefit from several clarifications.

1. Introduction

“Hotel workers in the mountain area” is mentioned, but the relevance of this element for the analysis is not explained.

The impact of cardiovascular load among housekeeping staff is mentioned twice through reference [9].

Both “hematologic” and “haematological” are used alternatively. A single variant throughout the manuscript is recommended.

It is recommended that the authors highlight the knowledge gap and the relevance of the study for occupational health.

2. Materials and Methods

It is stated that 366 out of 370 workers were selected through simple random sampling. In this context, the difference from the total population requires clarification regarding the participation rate and the possible reasons for excluding the four individuals.

The questionnaire used for personal variables is not described.

It is not specified whether blood pressure was measured once or through repeated measurements. For the classification of hypertension, this information is relevant.

In the statistical analysis section, both logistic regression and linear regression are mentioned in the subsequent tables. Clarification of the type of model used for each dependent variable is recommended, since hypertension and haematological disorders are binary variables.

It is recommended to explain the reason for using Spearman correlation, given that most variables are categorical and later analyzed through logistic regression.

Adjustment for age, gender, and job level is mentioned. The criteria for including covariates in the model should be specified.

3. Results

The descriptive paragraph of the results from Table 1 contains an unclear formulation. Reformulation is recommended. The detailed percentages from Table 1 should not be fully repeated in the text. Highlighting the main characteristics relevant to the analysis is sufficient.

Multiple linear regression is mentioned in the text, whereas Tables 3 and 4 include indicators specific to logistic regression, such as Exp(B), Wald, and confidence intervals for odds ratios. Clarification of the model type and consistent terminology is recommended.

The text refers to “mean hypertension status,” although hypertension is a binary variable. Reformulation is recommended to reflect the interpretation of the odds ratio correctly.

4. Discussion

The introductory paragraph repeats information already presented in the abstract and in the Materials and Methods section. Moving directly to the interpretation of the results, without restating the study design, is recommended.

It is recommended to organize the interpretations in the Discussion section into distinct thematic domains.

Multiple linear regression is mentioned again in the text, although the results appear to derive from logistic regression. The use of terminology consistent with the Results section is recommended.

Avoiding statements such as “critical risk factors” or “urgent need” in a cross-sectional study is recommended. Formulations that reflect the associative nature of the findings are recommended.

It is recommended to highlight the novel aspects of the study in relation to previous research that has documented similar associations between age, obesity, smoking, and hypertension.

5. Conclusions

Statements regarding “improved cardiovascular health outcomes” and “reducing the burden” go beyond the data of the study, which did not evaluate interventions or long-term effects. It is recommended to keep the conclusion at the level of the identified associations.

Comments on the Quality of English Language

Language issues could be revised by a native English speaker or a qualified editor

Author Response

Please see the attachment 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have taken into account the recommendations and have revised the manuscript

Comments on the Quality of English Language

Language issues could be revised by a native English speaker or a qualified editor

Author Response

Thank you for your review.