Review Reports - Non-Combustible Nicotine Use Among Amateur and University Athletes: Prevalence, Patterns and Reasons—A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Title:

Why two groups i.e., “amateur” and “university” athletes have been considered for this review?

Introduction:

Why the review focuses on “non-combustible nicotine use” when the title mentioned as “nicotine use”.

Lines 73-74: “In the United States, e-cigarette use increased from 8.8% in 2020 to 10.2% in 2022 73” – which age group is this?

The rationale for focusing only on amateur and university athletes may be more strengthened.

Line 118: “strategies by addresses the question” has some grammatical issue.

When reporting some estimates, the proper population or subgroups may be provided.

Methods:

Lines 137-138: “as individuals participating in organised sport who are not engaged in professional or elite competition” This definition is very vague and may be more specific. This mat attract heterogeneity in the study population.

Lines 145-146: “To minimise potential conflicts of interest, publications sponsored or funded by the tobacco or nicotine industry were not included in this review.” Excluding studies only because of this reason may exclude a significant number of studies? May reduce the scope of this review?

Why the cut off of November 2019 was selected for article selection?

Data were extracted by two independent reviewers?

How the thematic categories were derived?

Has this study been registered with prospectively registered with some protocol registration system?

Results:

Line 248: “US study reported higher prevalence among recreational athletes compared with varsity athletes (6.2% vs. 4.9%) 248” these type of findings may not be claimed without proper analysis.

The author should explicitly distinguish “current use” vs “ever use” vs “past 30 days use” vs “experimental use”. All should not be combined together to obtain the estimate.

“nicotine use was generally more prevalent among male athletes” these type of statement should be avoided as no formal analysis was done.

Given that the review reports prevalence estimates across the included studies, please clarify why a quantitative synthesis/meta-analysis was not considered.

Discussion:

The discussion overinterprets the findings relative to the limited and heterogenous evidence base.

Comments on the Quality of English Language

May be improved.

Author Response

Thank you for taking the time to review and comment on our manuscript. Please find the attached file containing our detailed responses to the comments.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript synthesized peer-reviewed literature on nicotine use among amateur and university athletes. While important, this manuscript has some areas for growth that will improve clarity and the written content.

Major comments:

Introduction:

The authors provided a general overview of emerging tobacco use in Western settings. However, it would be clearer and more helpful to summarize the literature within the context of nicotine use in Australia and, if applicable, the age group (adolescents, young adults, or adults) specific to this review.

Lines 66-68: The emergence of alternative nicotine delivery systems, including electronic cigarettes (e-cigarettes), smokeless tobacco products such as snuff or snus (i.e., tobacco used without combustion and consumed orally or nasally). Snuff is an established form of smokeless tobacco and would not generally be considered an emerging nicotine product. I would suggest rephrasing this sentence. Moreover, the citation provided does not appear to adequately support the statement and should be replaced with a more appropriate and relevant reference.

Lines 71-73: "Globally, an estimated 86 million adults use e-cigarettes, with prevalence tripling overall".... Sentence is unclear. Provide the year of the estimate.

Line 73: In the United States, e-cigarette use increased from 8.8% in 2020 to 10.2% in 2022. Is this among adolescents, young adults, or adults? Recent data from the US suggest that EC declined among middle school and high school students from 2023 to 2024. (Jamal A, Park-Lee E, Birdsey J, et al. Tobacco Product Use Among Middle and High School Students — National Youth Tobacco Survey, United States, 2024. MMWR Morb. Mortal. Wkly. Rep. 2024, 73, 917–924).

Materials and methods

Lines 125-126: "Given the fragmented and heterogeneous nature of research in this area...", what do you mean by fragmented? Please provide a clear and succinct rationale for conducting this scoping review (What gaps, inconsistencies, or limitations in the existing literature) and how the findings will address these gaps or advance the field.

Lines 143-144: "Literature reviews, theses, conference abstracts, non-peer-reviewed sources, and
other secondary analyses." It is unclear what other secondary analyses means.

Lines 148–149: The authors report searching six databases, including Ovid MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science. Was there a reason PubMed was excluded from the search? Maybe it is possible that PubMed may have yielded additional studies not indexed in these databases.

Minor comments

Line 357–358: The statement that “several studies noted the convenience and discretion of e-cigarettes and ST noted..." may overstate the evidence, given that only two studies reported these factors. Please revise the wording to accurately reflect the limited number of studies supporting this finding (e.g., “Two studies noted…”).

Lines 85-87: Provide adequate citations to substantiate these claims made.

Please revise citations to ensure that they are relevant to the statements being made (e.g., Lines 70-71).

Author Response

Thank you for taking the time to review and comment on our manuscript. Please find the attached file containing our detailed responses to the comments.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Review for manuscript ijerph-4496296 “Nicotine Use Among Amateur and University Athletes: Prevalence, Patterns and Reasons—A Scoping Review”

Thank you for the opportunity to review manuscript ijerph-4496296. Manuscript reviews important public health issue focusing on non-combustible nicotine use in amateur and university sport, particularly given the rapid uptake of e-cigarettes and oral nicotine products among young people. However, there are some weaknesses that needs to be addressed and revised before publication.

General major comments:

The title refers broadly to “nicotine use,” whereas the eligibility criteria excludes combustible tobacco and focus on non-combustible products. I think authors need to revise the title to explicitly indicate that this is a review of non-combustible nicotine products.
In some cases I noticed inconsistency between exposure and concept criteria. For example, the review is presented as examining patterns of voluntary nicotine-product use. However, the one study (Bartík et al.) looks like an experimental study administered an 8 mg nicotine lozenge to non-smoking athletes. This is an experimental pharmacological exposure, not a study of the prevalence, patterns, or reasons for habitual nicotine use. Therefore, I think its inclusion should be reconsidered or explicitly justified. Also, medicinal nicotine replacement therapy also needs to be distinguished from recreational or consumer nicotine-product use.
Some sentences (lines 65–70) like beginning “The emergence of alternative nicotine delivery systems…” and others sound incomplete. Please revise throughout the text.
Revise the aim sentence (lines 115-120). It currently combines the aim and review question awkwardly.
Please provide justification for limiting the search to studies published from 2019 (lines 148–160). I think restricting the search may therefore miss important evidence and potentially undermine the claim that this is the first “comprehensive” mapping of the literature.
The abstract states that five databases were searched (line 42), while in the methods six databased listed. Please correct it or explain.
Excluding literature reviews, theses, conference abstracts, non-peer-reviewed sources, and other secondary analyses (Lines 144-146) may omit relevant surveillance and sport-organization data which is part of scoping review that supposed to map the breadth of available evidence. I think authors need to justified and acknowledged it as a limitation.
BI guidance recommends developing an a priori protocol for a scoping review. Please provide the registration or publication details.
Please explain how analysis was conducted (lines 181–188), particularly who conducted the coding, whether coding was performed independently, how themes were defined (provide refence to used methodological approach), and how contradictory findings were preserved.

Author Response

Thank you for taking the time to review and comment on our manuscript. Please find the attached file containing our detailed responses to the comments.