Author's response to reviews
Title: Interactions between risky decisions, impulsiveness and smoking in young
tattooed women
Authors:
Semion Kertzman (Kertzman@animascan.com)
Alex Kagan (alex@wupj.org.il)
Michael Vainder (mimvainder@rogers.com)
Rina Lapidus (rina.lapidus@biu.ac.il)
Abraham Weizman (AWeizman@clalit.org.il)
Version: 3 Date: 11 March 2013
Author's response to reviews: see over
Dear Prof. Carlo Rye Chua
Journal Editorial Office
BioMed Central
Title: Interactions between risky decisions, impulsiveness and smoking in young tattooed women (MS:
1120544023812892, Research article).
Thank for your kind letter. The manuscript was revised according to all the referees’ comments as
follows:
First Reviewer's report
Reviewer: Damien Brevers:
General Comment. The authors present data from a study examining risk-taking decision in a sample of
young women with (n = 60) or without tattoo using the well-known Iowa Gambling Task and selfreported measure of impulsivity (Barrat scale). The article addresses an intriguing and interesting topic.
The manuscript is concise and well written, methods and results are clearly presented, and findings
deserve to be included in the scientific literature. However, there are a few drawbacks.
Major Compulsory Revisions:
1. Page 4, paragraph 5: "heterogeneities among diagnostic groups will be partially accounted for by
smoking effects", please explain.
Changed
smoking status may explain the heterogeneities among the study groups in tattooed females.
2. Page 4, paragraph 5: "the multifactorial nature of the BIS", please specify.
Changed
Motor, non-planning and attentional impulsiveness factors of the BIS-11 as expression of
specific facets of impulsivity will be related to specific neuropsychological mechanisms of risky decision in
young tattooed women.
3. Page 8. Authors report that there was no linear relationship between impulsivity and education. With
regard to Table 2, authors omitted to indicate that there was also no relationship between level of
education and IGT scores. With this modification, rationale behind the sentence "Therefore, education
was excluded from the list of potential covariates." is now relevant.
Added Since there was also no relationship between level of education and IGT scores, education
was excluded from the list of potential covariates (page 8).
4. Table 2. Please provide correlations between smoking habit, impulsivity and IGT performance.
Added
5. Page 9. IGT results. Please provide interaction effect between group and IGT blocks, which indicates
that control group, but not tattooed women participants, improved their learning curve during the IGT.
Use t-tests in place of ANOVA for pairwise groups comparisons.
Added new Table 3.
The results showed an effect of block and an effect of group x block interaction: F(4,116)=3.49, p=0.0103,
indicating that task performance increased consecutively from block to block; F(4,116)=3.64, p=0.0081,
indicating that the women with tattoo performed worse than controls (see Fig. 1) on the second, fourth
and fifth blocks of IGT (Table 3).
6. Page 10. The sentence: " Our hypothesis was that both self-reported impulsiveness (BIS-11) and risky
decisions in IGT, can predict independently the tattoo-related behavior." is in contradiction with
hypothesis presented in the introduction and also with the sentence on page 11 (paragraph 4): "The
main hypothesis of the study was that tattooed women make risky decision as a result of their
impulsiveness.".
Corrected
This is the first study, using a neurocognitive measurement of risky decision, showing that, in contrast to
our hypothesis, the risky decision in tattooed women is not a result of self-reported impulsiveness.
7. Page 11. The sentences: "Thus, the high self-reported impulsiveness on the BIS-11 scale is expected to
reflect the risky decision on the IGT. Using multifactorial impulsivity scales, enables detection of specific
facets of impulsivity related to risky decision. This is the first study to show that the risky decision in
tattooed women is not a result of self-reported impulsiveness." are confusing.
See previous response
8. Page 12. The discussion on the association between tattoo and smoking among tattooed women is
not clear. To a broader extent, in this manuscript, the importance of the smoking habit variable is
unclear (see comment for the introduction section).
Rewritten
Non-smoking tattooed women were more impulsive than non-smoking controls as assessed by
the BIS-11. In contrast, in smoking participants, the between-group differences in the BIS-11 scores were
lost. Thus it seems that the smoking status is associated independently with impulsivity and therefore,
can be a confounding factor of impulsivity measured in tattooed women.
Minor essential revisions:
1. Page 6. Remove the title "Procedure" from the IGT description.
Done
2. Page 10. I would not use the terms "associated" or "predicted", which are not suitable with regards to
ANOVA analyses undertaken in the present study.
Changed
3. Page 10. The sentence: "It is unclear why did tattooed women use a disadvantageous decision-making
strategy during the IGT?" is confusing.
Omitted
4. Page 12. "this study was conducted among women with small number of tattoo and without piercing
that may be less impulsive than women with multiple tattoos and piercing.". Any reference(s)?
Added
Second, this study was conducted among women with small number of tattoo and without piercing that
may be less impulsive than women a heavily tattooed or body pierced [71,72].
5. Page 13. "in in decision-making"
Omitted
Level of interest: An article whose findings are important to those with closely related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report
Second Reviewer's report
Reviewer: Michele Poletti:
I have two main concerns about this paper
1. in my opinion, in the introduction authors underlined too much the possible
psychopathological characterization of tattoing; see for example "Tattooing was also found to be
associated with violence, weekly alcohol consumption, illicit drug use, antidepressant and sedatives
treatment, dropping out of school, greater, numbers of lifetime sexual partners, unprotected sex,
suicidal ideation/attempt, death by homicide and depression and shoplifting" It appears to me too
strong
Changed
Tattooing was also found to be associated with wide range of impulsive-related behaviors such as:
violence, weekly alcohol consumption, illicit drug use, dropping out of school, greater numbers of lifetime
sexual partners, unprotected sex, suicidal attempts, death by homicide [20 – 28] and shoplifting [15].
2. Authors should better explain why they investigated this issue only in women
We analyzed only women tattooed population in order to avoid sex differences on the IGT performance
[54]. (page 5)
Level of interest: An article whose findings are important to those with closely related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the statistics.
Sincerely,
Semion Kertzman, MD
Tel Aviv University School of Medicine, Tel Aviv, Israel
Beer Ya’acov-Ness Ziona Mental Health Center