The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

OBJECTIVE: Excessive alcohol consumption in adolescents is one of the most significant public health problems currently facing society. Social and geographical contexts contribute to the development of alcohol-related behavior in adolescents. The aim of this research is to analyze the social pattern related to alcohol consumption in adolescents based on their geographical environment.
METHODOLOGY: We designed a descriptive cross-sectional study based on social network analysis. We recruited 196 high school students between 16 and 18 years of age to participate in the study. The methodology applied was social network analysis by means of transitivity and homophily social triads. The data were analyzed using STATA statistical software. RESULTS AND
CONCLUSIONS: A total of 58.48% of rural adolescents consumed alcohol compared to 49.52% of urban adolescents. These results demonstrate that adolescents who live in rural areas exhibit a greater risk of drinking alcohol than those who live in urban areas. The presence of transitive triads increases the probability of sharing sociodemographic attributes in such a way that it may be considered one of the causes of homophily, contributing to adolescents taking greater risks, such as consuming alcohol.

1. Introduction

The consumption of alcohol constitutes one of the most significant problems in public health [1]. In Europe, 57% of adolescents have consumed alcohol in the past month [2]. In the USA, the data are even more alarming as 11.5% of adolescents aged between 12 and 17 have consumed alcohol to excess (a value established by the World Health Organization (WHO) in which alcohol is defined as having a very harmful effect on health) [2]. Young people are beginning to consume alcohol at a younger age, which is linked to having fun and especially with friends [3].

The social normalization that the consumption of alcohol has in our society means that adolescents do not perceive alcohol as a drug with repercussions in the short or long term and underestimate the physical, psychological, emotional and social consequences brought about by consumption both at a personal level and for society as a whole. Adolescents regard alcohol as normal and not very dangerous [4, 5]. In this sense, some studies have collated how relationships based on a group of friends play a significant role in the consumption of alcohol [4-6]. The peer group constitutes one of the most significant forms of socializing, and its influence gives rise to both voluntary and involuntary stimulation, which leads to the development of different behavioral traits [7, 8]. Consequently, for the adolescent, the consumption of alcohol is a vehicle for socializing and acceptance within the group. This fact is significant given that the adolescent will imitate peers who are socially significant to him or her [7].

The analysis of these diverse factors and the patterns of alcohol consumption have been a starting point in numerous studies. The analysis of the main factors that are associated with increased consumption of alcohol in adolescents have focused on sociodemographic factors, such as the behaviors, values and norms learned from the family and school environment. Adolescents view alcohol as one of the positive aspects in their social lives [9]. International studies have established how adolescents who live in rural areas have a greater propensity to consume alcohol compared with those who live in urban areas [10]. Historically, it has been thought that isolation in rural areas gave rise to a delay in the consumption of any type of drug. However, research shows that the consumption of alcohol is similar between both groups or even greater in a rural environment. However, there are a series of qualitative differences that highlight that the consumption of alcohol by both urban and rural adolescents shows signs of their own identity [10].

Based on the aforementioned information, it is fundamental that we not only place importance on the consumption of alcohol itself but also on the factors that promote it. Diverse sociological research has been performed on the homogeneity of groups based on homophily in different environments [11-13]. Homophily is a concept that means that people tend to have more links with others who have similar social characteristics [11-13]. In this way, homophily may be evidenced as a fundamental mechanism in the constitution of social groups. The adolescent together with his or her friends comprises a social group with their own norms and values, which allows them to satisfy their needs for integration and acceptance [4].

The study of homophily has undergone a significant advance through the theory of social networks [14]. The theory of social networks analyzes the ties that link members of society. Thus, the theory of social networks adapts itself both theoretically and analytically to the concept of homophily as actors feel attracted to forming ties with others who are similar to themselves independently of their structural organization [15, 16].

Network analysts have debated homophily using the language of the Theory of Balance and Transitivity, basic elements that reflect how interpersonal relationships tend towards a state of equilibrium [17]. The motivation for speaking of homophily and the Theory of Balance and Transitivity is relevant because the adolescent is seeking integration into the events surrounding him or her while trying to maintain a constant equilibrium. Empirical studies have confirmed that the principle of equilibrium and transitivity are applied in approximately 70 to 80% of small groups, thus making them the most favorable scenario for a network to remain stable [16, 18].

For many authors, the structure of the relationship in the network begins with triads because they constitute the beginnings of a “society” [19]. A triad is a subset of the social network composed of three actors and the possible ties between them [20]. A transitive triad is one that is established between the nodes with the following sequence: If X connects with Y, and Y connects with Z, then X connects with Z. In contrast, a nontransitive triad involve a greater number of possibilities [20]. The number of people who comprise a network, the number of links that each individual has with the others, the position that each individual occupies within the network, its composition, and the relationships that are established between the members of the network are extremely relevant in revealing the behavior and the environment in which they propagate [21].

From the point of view of Simmel (1950), in the triad, the third individual may be an impartial environment and a mediator, reading “el tertius gaudens”, that is, "the third one that benefits". The third individual may side up with one of the other two individuals and in this way achieve his or her own interests or act as an intermediary to obtain the necessary benefit.

The method used to analyze these data is social network analysis (SNA), and the behavior patterns are specifically analyzed and interpreted [22]. SNA is an emerging research perspective within the social and behavioral spheres that utilizes a series of methods, models and applications expressed in terms of relational concepts, which allows us to determine the types of relationships that are established between adolescents and their peers and how these relationships might influence the development of their habits [23-25].

Based on the aforementioned information, we have become aware that there is a lack of studies that analyze in great detail the type of connections among adolescents and how these connections generate a balance in the small groups that influence and foster the consumption of alcohol. Thus, the objective of this study was to analyze (i) the triad pattern and (ii) the possible guidelines according to the geographical environment of the adolescent. This study seeks to demonstrate that (1) there are criteria for homophily and (2) individuals who possess the same social attributes are more likely to stay in contact with each other and therefore develop similar practices that may include the consumption of alcohol.

The application of the triads within the SNA and their link with the consumption of alcohol among adolescents is useful in investigating the reasons for grouping among the actors and thus research their influence on the formation of subgroups.

2. Materials and methods

Participants

The total population of the different institutes was 270 adolescents. Of these, 195 adolescents or their parents in the case of adolescents under 18 years of age signed the informed consent form.

The sample was composed of 195 adolescents aged between 16 and 19 attending rural and urban public schools in the area of El Bierzo (León, Spain) during the 2015–2016 academic year. The selection was made with the consent of the project from the centers. We also took into account the relationships of the research team with the directors and professors, which facilitated the launch of the research. A search for educational centers in rural and urban settings was performed to obtain a sample of similar size that would allow us to compare both rural and urban areas.

There are various definitions for characterizing rural settings. The Ministry of the Environment defines the proportion and density of the population as the most commonly used criterion. In Spain, rural areas are defined as “A geographic space comprising the aggregation of municipalities or smaller local entities with a population <30,000 inhabitants and a density <100 inhabitants per km2” [26]. Those urban areas with a population of greater than 50,000 are considered urban areas [26, 27]. It should be noted that as the rural areas were more isolated, inhabitants had less access to various drugs [28, 29]. Study recruitment was incidental; that is, participation in the study was voluntary without bias of any kind since not having the informed consent signed by the parents was considered a criterion for exclusion. From the total sample, 53.85% of the students (n = 105) were women, and 46.15% (n = 90) were men. The average age of the group was 17 years (SD: 0.82). Regarding the rural or urban character of the schools participating, 51.28% (n = 100) of the total number of participating students studied at rural schools, whereas 48.72% (n = 95) studied in an urban environment.

Ethical approval

The study was approved by the University Ethics Committee (ETICA-ULE-003-2015).

Instruments

A questionnaire was sent online by means of validated instruments (AUDIT test questionnaire) and other “ad hoc” methods to cover the interest in the research [30, 31]. To collect data related to the adolescent’s consumption of alcohol, the AUDIT test questionnaire was applied [32, 33]. The complete questionnaire used is available at https://doi.org/10.5281/zenodo.3965836.

To connect relational-type data, a question was formulated with respect to the network of friends and consumption drawn up in accordance with revised literature with the SNA methodology. The question related to the network of friends was formulated for each student as follows: “Using the list below, indicate how much time you spend with your classmates” [34, 35]. Thus, the adolescents evaluated the intensity of their contact. Equally, students indicated which of their colleagues consumed alcohol with them when they went out based on the following statement: “Highlight on the following list those colleagues in class with whom you go out and have a drink with”. Thus, it was possible to determine dichotomously the existence of a relationship within a network of contacts for the adolescent’s consumption of alcohol.

Procedure

After receiving the approval of the Bioethical Committee of the University of Leon, contact was made with the academic head of each school to explain the research and request informed consent. The research team coordinated with the teachers. All of the data collected were stored in the electronic file and automated using a method especially created for this research. The data on the identification of each student were encoded instantaneously in the name of the file by means of an online questionnaire platform with the aim of maintaining anonymity in compliance with the Law on the Protection of Personal Data (Constitutional Law 3/2018, on 5 December on the Protection of Personal Data and Guaranteeing digital rights).

Data analysis

To analyze the data, the STATA 14.0 program (StataCorp LLC, 4905 Lakeway Drive, College Station, TX 77845 USA) was used for statistical data, whereas relational data were assessed using the UCINET 6.649 Program [36]. All of the parameters were analyzed based on a confidence interval of 95%, and p<0.05 indicated significant values. The G*Power 3.1.9.6 program was used to perform the power analysis. To determine the correlations, we used Pearson’s correlation coefficient. Age was used as a control variable that had values between 16 and 19 years old.

Regarding the relational character, an initial matrix was established in which, by means of responses assigned to the time frequencies (1: we never coincided, 5: we are always together), three matrices of different proximities were obtained (intensity of minimum, intermediate and maximum contact) on the basis of three criteria of dichotomization (Table 1) [37]. After that, an analysis of the triads together with a transformation of the friendship networks was performed in accordance with the following compositions: a) minimum contact as this signifies the start of a relationship, b) gender, and c) contact with that network for consumption. The establishment of triads in accordance with minimum contact, gender, and contact network for consumption was motivated by the perspective of the concept of homophily and following the recommendations of McPherson et al. (2001) and Louch (2000) [15, 38]. The census of transitive and intransitive triads according to Davis was analyzed [16]. All data are available at https://doi.org/10.5281/zenodo.3968264.

Table 1

Dichotomizations based on the intensity of contact.

Contact Intensity	Values without contact	Values with contact
Minimum contact	1	2, 3, 4 & 5
Intermediate contact	1 & 2	3, 4 & 5
Maximum contact	1, 2 & 3	4, 5

Source: Prepared by authors based on data from Arias (2017).

3. Results

The objective of establishing the existing triads will allow us to know why and how the operation of the complete network works in a group.

Sociodemographic results

We analyzed the consumption of excessive alcohol in the samples studied. It was confirmed that 110 students (56.41%) presented a no risk of consumption compared to 85 students (43.59%) who presented a risk of consumption. The risk of alcohol consumption was significantly associated with female gender. Specifically, we observed that 50.48% of women exhibit a risk of excessive alcohol consumption compared to 49.52% of men who were at risk of excessive alcohol consumption X2 (2, N = 105) = 4.40, p = 0.036. The average age of the sample for alcohol consumption was 13.4 years old.

Regarding geographical location, a statistically significant association is observed in which participants living in the rural environment (53.64%) exhibit a greater rate of alcohol consumption compared with those in the urban environment (46.36%). This finding explains why adolescents who live in rural environments exhibit increased consumption of alcohol X2 (2, N = 100) = 4.50, p = 0.04.

Triad pattern

The calculation of all types of triads, including transitive and intransitive, was performed in each classroom with respect to gender, contact network and contact network of minimum intensity. The most representative data are presented in Table 2.

Table 2

Dichotomizations based on the intensity of contact.

	RURAL	URBAN
Gender Composition	Triad 102 (Intransitive)	Triad 102 (Intransitive)
	68.00%	75.25%
	Triad 300 (Transitive)	Triad 300 (Transitive)
	26.83%	25.50%
Contact network	Triad 12 (Intransitive)	Triad 12 (Intransitive)
	15.33%	29.75%
	Triad 102 (Intransitive)	Triad 102 (Intransitive)
	10.12%	18.00%
Minimum intensity	Triad 102 (Intransitive)	Triad 12 (Intransitive)
	14.50%	21.75%
	Triad 111U (Intransitive)	Triad 102 (Intransitive)
	12.83%	18.5%

Transitive triads exhibit a type of balance in which if X directs a loop to Y and Y directs a loop to Z, then X also directs a loop to Z. Intransitive triads do not exhibit any type of balance between actors.

There are four most representative triads in this study according to the variables studied: T012, T102, T111U and T300. Fig 1 presents the representation and explanation of these four types of triads according to Wasserman.

Fig 1

Description of the four most representative triads in this research (T012, T102, T111U and T300).

Transient triads are a more favorable scenario than a stable network [19]. Based on this notion, the urban environment presents a greater number of transitive triads in the minimum intensity contact networks (1084/10887) and in the composition based on gender (2957/11415); however, in relation to consumption, the number of transitive triads is greater within the rural environment (913/4506).

In the correlation analysis between the transitive triads (which demonstrate a balance) of the contact networks for consumption and the triads of the minimum intensity networks and the friendship network per gender composition (Table 3), we established that the urban environment networks are related in this state of balance. The statistical power for the tests is good in the majority of cases.

Table 3

Logistic regression results.

Transitive triadic correlation of the contact network for consumption with the contact network by minimum intensity and gender composition.

Geographical environment	Contact networks triads for consumption	Current contact network correlation (minimal intensity)		Gender composition correlation
		Pearson Correlation	Power	Pearson Correlation	Power
Rural	CLASSROOM_1A	-0.05	0.11	-0.25	0.94
	CLASSROOM _2A	0.69	>0.99	-0.17	0.66
	CLASSROOM_1B	-0.11	0.34	-0.12	0.39
	CLASSROOM_2B	0.40	>0.99	-0.30	0.99
	CLASSROOM_1C	0.83	>0.99	0.49	>0.99
	CLASSROOM_2C	0.69	>0.99	0.80	>0.99
Urban	CLASSROOM_1AH	0.62	>0.99	0.99	>0.99
	CLASSROOM_1BC	0.77	>0.99	0.99	>0.99
	CLASSROOM_2AH	0.97	>0.99	0.68	>0.99
	CLASSROOM_2BC	0.89	>0.99	0.99	>0.99

4. Discussion and conclusions

The purpose of this study was to analyze the structural pattern of triad relationships in both rural and urban networks. These findings were complimented with other prevailing data given that the methodology emerging from SNA has been conjugated with the most common data focusing on epidemiology.

Our findings with respect to the prevalence of consumption confirm that 86.7% of adolescents had consumed alcohol once in their life. In addition, 43.5% of them drank to excess, while only 13.3% of the adolescents had never tried alcohol. Regarding gender, 62.4% of the female population presented an excessive consumption of alcohol compared to 37.7% of the masculine gender. The average age of first consumption was 13.2 (SD = 1.68) years old for males and 13.6 (SD = 1.34) years old for females. These results are consistent with other similar studies in Europe, such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDD, 2019), which reported that alcohol is the substance most often consumed by adolescents. Regarding gender and the excessive consumption of alcohol, our study demonstrates that females exhibit a greater propensity for behavior leading to the excessive consumption of alcohol compared with males (62.4 vs. 37.6%; χ2 = 4.4; p = 0.04). Our findings are consistent with other studies, which confirm a greater percentage of excessive consumption in females [39, 40]. The actual increase in the incidence of alcohol consumption in women may be justified as peer pressure that females experience. The learning of these roles begins in childhood and continues into adolescence and adulthood as the woman tries to insert herself into a society that is still traditional in many aspects [39].

Regarding the consumption of alcohol and its relationship with rural or urban residence, the results of our study revealed increased consumption in the rural environment, which is consistent with studies that have confirmed that young people who live in rural areas exhibit an increased probability of excessively consuming alcohol compared with those who live in urban areas [10]. It seems that the context of a rural environment could be related to the consumption of alcohol based on the home education of adolescents [10]. Specifically, they live in a situation with less parental control and therefore are used to drinking alcohol both more frequently and in larger amounts.

In relation to the triad pattern, the studies reported in the literature are simple given that the application of transitivity to the analysis of small groups has proven to be an obstacle in its use in sociological research [38]. The theories of triadic transitivity have largely not been applied to the relationship between the structure and content of the relationships. Thus, very few studies have asked whether the triadic transitivity in the networks is affected by the attributes of the members of the network [38]. These types of questions were of interest in this study given that the analysis of the triadic structures might contribute to knowledge on the overall attributes shared by the network [22], such as gender, friendship or consumption.

The results obtained in this work demonstrated that the structural pattern in an urban environment is defined by means of a large number of transitive and complete triads in the minimum intensity contact networks with regard to gender. In other words, it could be said that urban adolescents who wish to consume alcohol exhibit an increased density in their network (measured by gender). Within this density, there are many subsets composed of three actors who have a very strong link to each other.

This aspect is not visible in the pattern of rural adolescents. In interpreting these conclusions, we have paid special attention to homophily and transitivity. The cohesion of the network is considered by studying the number of existing transitional triads and linking this cohesion to the concept of homophily. Thus, it is certified that homophily shapes the existing triads between contacts. In our study, this information allows us to interpret that people with a homophilic relationship share common characteristics, which makes communication and the formation of a relationship much easier.

Continuing along these lines, the work within the SNA that showed the link between the concept of homophily and consumption of alcohol is diverse, defending the criteria of homophily as the basis for the origin of stable networks for consumption [41-43] Regarding geographical differences, the literature reflects that adolescents choose to have relationships with those who have similar social characteristics [15]. In this aspect, the urban environment allows a greater distribution with regard to gender such that adolescents are able to choose their friendships by looking for similarities. However, the rural environment, is characterized by social dependence. The lower population density means that adolescents cannot resort to similarities to choose their friendships and exclusively rely those found in the population with which they interact [41, 44]. The greater presence of complete triads in the urban environment within our study represents nodes that are completely connected to each other. This finding indicates a greater intensity of contacts.

In relation to this aspect, Moody and White (2003) have noted the importance of the presence of complete triads in the origin of networks with better conditions for the dissemination of information [45] or actions [46]. These complete triads relate the fact that the network is highly connected between itself and with aspects of homophily such that this cohesion would permit common expectations or behaviors to be shared. Alshamsi et al. (2015) posited that with regard to the high density of the population, cities have many advantages, including better and easier social interaction and exchange of information [47]. Their results reveal the existence of the hemophiliac community at the urban level with implications on the creation of well-being and the repercussions of an unhealthy lifestyle behaviors, such as the consumption of alcohol.

This question lends support to the facts stated in the results that the significant presence of transitive triads increases the probability of sharing sociodemographic attributes such that one could consider the presence of transitive triads as one of the causes of homophily. Continuing along these lines, the studies have revealed diverse links between the levels of homophily with attributes, such as gender, age, and behavior, such as the consumption of alcohol [48].

The information derived from this discussion may be useful for studying the relationships between adolescence and the propagation and acquisition of the habit of consuming alcohol given that it even deepens the microstructures, such as the triads within the network, in the analysis of the social influence as part of the process of the contagion of risky behavior [49, 50]. Having precise knowledge at the macro level of who is in contact with people who consume alcohol allows us to better understand the relational process at the macro level. This relational process can involve a school, a population, etc. Therefore, the triadic approach in the study of the creation of homophilic subgroups among adolescents and the study of bonding attributes seems to be suitable for addressing the association process between individuals. Finally, the fact that we are able to know how adolescents associate may offer us positive results of a preventative nature.

The SNA is a useful tool for understanding the social patterns of adolescents. Knowledge is critical in determining how the network would facilitate the planning of multifactorial strategies in the environment.

As limitations to the research, we note that this type of transversal study does not allow for the establishment of causal relationships in the results. In addition, the size of the sample is a limitation when generalizing the results. Another limitation is the method of the self-questionnaire used given that we must assume that the individual is telling the truth.

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27 Jul 2020

PONE-D-20-13204

The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

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Reviewer #1: Recommendation: Minor Revisions

Thank you for the opportunity to review for PLoS One. Thank you to the authors for their hard work and interesting study. Overall, there might be a relevant and important paper here, however some sections are unclear and need refining if they are to sell the novelty of the paper fully. I will note that I am not an expert on social network analysis (I only have a basic quantitative understanding of the specific methodologies involved) and the paper should be considered by a relevant statistician before a decision is made.

Strengths

- There are few empirical social network analyses out there due to the difficulty in obtaining data suggesting a potential novel study design

- Potentially interesting analyses on the network structure and how varies by some basic sociodemographic issues

- Well written discussion

Areas for Improvement

- Line 39: ‘In this sense, different research’ doesn’t quite work with the rest of the statement, suggest revise

- Line 44: Drop use of ‘extremely’ as no need to overplay the importance of the issue

- Lines 94-94: Repeated use of (i) for different points is confusing to the reader and suggests overlap when there is not. Please revise.

- The introduction is not structured effectively and jumps about a lot. It would benefit from thinking about the flow of ideas and the content being discussed. It also doesn’t feel like there is much novelty here. I am sure there is, but it is not explained clearly in particular that the premise of the study appears to suggest that we already know a lot of this.

- Line 102: What is ‘DE’, please define in first use

- Line 149: ‘We analysed the la existence’ needs correcting

- Line 153: Unsure what is the point of the statistical test here as the numbers appear to be comparing whether there is a difference between risk and no risk in women. Although a ‘statistically insignificant’ effect is reported, there is a <1% difference here which suggests in reality it isn’t important. I would have expected a comparison of the metric between women and men here instead (i.e. were women more or less at risk compared to men) - this might be what you did but it isn’t clear that it is.

- There are many results to report meaning the section is rather brief. I think this is more an issue in how they are discussed and some of their novelties are not teased out. It might need greater clarity especially to help guide a lay reader which will be important to increase the awareness and reach of your paper

- No discussion of limitations of research in the discussion. What were the major weaknesses or opportunities for future research? How representative were your data? How might you improve on your study? What data could you have collected to make it stronger? We would normally expect some reflection over the strengths and weaknesses of a paper.

- Data and analytical code are not openly available. If possible (more for the former than the latter which should be fine), this should be made available to adhere to PLoS One guidance. This will also improve the impact of your paper.

Reviewer #2: Thank you for the opportunity to the manuscript entitled, The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments submitted to PLOS ONE (PONE-D-20-13204). The study examines alcohol use among a sample of adolescents to better understand the geographic contribution to alcohol consumption. The study also examines the influence of peer groups by assessing triadic relationships. The manuscript has significant grammatical errors and needs copyediting. The introduction is brief and needs additional discussion on the contribution of geographic area on alcohol availability and alcohol consumption. The methods section is most problematic; there are essential details that are missing that limit interpretation of the results. In its current form, the manuscript is not ready for publication. Specific comments are listed below.

Line 37, define risk limits.

Line 38 should be supported by additional citations. Similarly, line 47 should be supported by additional citations. The authors should review the literature on neighborhood environment (and rural/urban) and alcohol availability and consumption.

The language is too causal in some areas “it is important that nowadays”

Line 57 should be rewritten

Line 89 should be rewritten

The last paragraph is vague. The authors should be specific when discussing the aims (e.g. including the outcome measure).

Are state schools similar to public schools in the US? How was rural and urban defined? Differences in alcohol availability?

Were adolescents under 18 able to consent? Was there parental consent?

What does “The recruitment was incidental” mean?

Response rate? Compensation for completing the assessment?

“ad-hoc” ones is too casual. This sentence needs a citation. Which validated instruments were used?

How many questions were included? How was the outcome measure defined?

How were schools and areas selected? The year(s) of data collection should be included.

Inclusion and exclusion criteria?

The data analysis section should be rewritten. Alpha should be less than 0.05, not less than or equal to. Any control variables? What statistical test was used? Any missing data? Power analysis?

There are areas in the results that are not English “la existence” and “consumption de alcohol.”

Line 160 belongs in the methods

Table 4 does not stand alone and is difficult to interpret.

The results cannot be fully evaluated without the missing information in the methods section.

**********

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: No

Reviewer #2: 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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Submitted filename: PONE-D-20-13204.docx

Click here for additional data file.

31 Jul 2020

First, we would like to thank the editorial committee and reviewers for their work on our manuscript. We then answered each of the questions and suggestions from the two reviewers.

Reviewer 1

Reviewer #1: Recommendation: Minor Revisions

Thank you for the opportunity to review for PLoS One. Thank you to the authors for their hard work and interesting study. Overall, there might be a relevant and important paper here, however some sections are unclear and need refining if they are to sell the novelty of the paper fully. I will note that I am not an expert on social network analysis (I only have a basic quantitative understanding of the specific methodologies involved) and the paper should be considered by a relevant statistician before a decision is made.

Strengths

- There are few empirical social network analyses out there due to the difficulty in obtaining data suggesting a potential novel study design

- Potentially interesting analyses on the network structure and how varies by some basic sociodemographic issues

- Well written discussion

Answer 1.0:

We thank reviewer one for his appreciation of the research. We are very happy to know that you find our research interesting. We hope to be able to satisfy all the proposals and comments you indicate in this review.

Areas for Improvement

Q1.1.: Line 39: ‘In this sense, different research’ doesn’t quite work with the rest of the statement, suggest revise

A1.1.: We have changed “different research” to “some studies”.

Q1.2.: Line 44: Drop use of ‘extremely’ as no need to overplay the importance of the issue

A1.2.: It has been removed.

Q1.3.: Lines 94-94: Repeated use of (i) for different points is confusing to the reader and suggests overlap when there is not. Please revise.

A1.3.: It has been changed to (1) and (2) in the second phrase. We hope it's not confusing anymore.

Q1.4.: The introduction is not structured effectively and jumps about a lot. It would benefit from thinking about the flow of ideas and the content being discussed. It also doesn’t feel like there is much novelty here. I am sure there is, but it is not explained clearly in particular that the premise of the study appears to suggest that we already know a lot of this.

A1.4.: We have modified the introduction. We hope that after the proposed changes that have been made in this section, we will have fulfilled this requirement as well.

Q1.5.: Line 102: What is ‘DE’, please define in first use

A1.5.: Sorry, DE is the English translation of SD (Standard Deviation). It has been changed.

Q1.6.: Line 149: ‘We analysed the la existence’ needs correcting

A1.6.: It has been corrected.

Q1.7.: Line 153: Unsure what is the point of the statistical test here as the numbers appear to be comparing whether there is a difference between risk and no risk in women. Although a ‘statistically insignificant’ effect is reported, there is a <1% difference here which suggests in reality it isn’t important. I would have expected a comparison of the metric between women and men here instead (i.e. were women more or less at risk compared to men) - this might be what you did but it isn’t clear that it is.

A1.7.: We have modified the manuscript with the following sentence:

“The risk consumption of alcohol is significantly seen to be associated with the female gender, in which we observed that 50.48% of women has a risk alcohol consumption compared to 49.52% of men who were at risk of alcohol consumption (50.48 Vs 49.52%; X2=4.40; p=0.036).”

Q1.8.: There are many results to report meaning the section is rather brief. I think this is more an issue in how they are discussed and some of their novelties are not teased out. It might need greater clarity especially to help guide a lay reader which will be important to increase the awareness and reach of your paper.

A1.8.: We have modified the discussion. We hope that after the proposed changes that have been made in this section, we will have fulfilled this requirement as well.

Q1.9.: No discussion of limitations of research in the discussion. What were the major weaknesses or opportunities for future research? How representative were your data? How might you improve on your study? What data could you have collected to make it stronger? We would normally expect some reflection over the strengths and weaknesses of a paper.

A1.9.: We have modified the discussion. We hope that after the proposed changes that have been made in this section, we will have fulfilled this requirement as well.

Q1.10.: Data and analytical code are not openly available. If possible (more for the former than the latter which should be fine), this should be made available to adhere to PLoS One guidance. This will also improve the impact of your paper.

A1.10.: Attending to this suggestion, we have uploaded the questionnaires used at zenodo https://doi.org/10.5281/zenodo.3965836 and all database is available at zenodo https://doi.org/10.5281/zenodo.3968264 .

We hope that after all the proposed changes that have been made, we will have fulfilled this requirement as well.

Reviewer 2

Reviewer #2: Thank you for the opportunity to the manuscript entitled, The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments submitted to PLOS ONE (PONE-D-20-13204). The study examines alcohol use among a sample of adolescents to better understand the geographic contribution to alcohol consumption. The study also examines the influence of peer groups by assessing triadic relationships. The manuscript has significant grammatical errors and needs copyediting. The introduction is brief and needs additional discussion on the contribution of geographic area on alcohol availability and alcohol consumption. The methods section is most problematic; there are essential details that are missing that limit interpretation of the results. In its current form, the manuscript is not ready for publication. Specific comments are listed below.

A2.0.: We thank reviewer one for his appreciation of the research. We are very happy to know that you find our research interesting. We hope to be able to satisfy all the proposals and comments you indicate in this review.

Q2.1.: Line 37, define risk limits.

A2.1.: It has been defined in the manuscript:

“alcohol to risk limits (a value established by the WHO in which alcohol is defined as having a very harmful effect on health) [2].”

Q2.2.: Line 38 should be supported by additional citations. Similarly, line 47 should be supported by additional citations. The authors should review the literature on neighborhood environment (and rural/urban) and alcohol availability and consumption.

A2.2.: We have added more references to these paragraphs.

Q2.3.: The language is too causal in some areas “it is important that nowadays”

A2.3.: We have hired a native English translator to review the entire manuscript. We hope this version will be more readable.

Q2.4.: Line 57 should be rewritten

Line 89 should be rewritten

The last paragraph is vague. The authors should be specific when discussing the aims (e.g. including the outcome measure).

A2.4.: We have rewritten lines 57, 89 and the last paragraph of the introduction. In addition, this section was modified following the suggestions of reviewer 1.

Q2.5.: Are state schools similar to public schools in the US?

A2.5.: Yes, state schools are the same as public schools. We've changed the terminology used.

Q2.6.: How was rural and urban defined?

A2.6.: We have added this text to the manuscript:

“The difference between rural and urban is defined by the proportion of the population. Those nuclei with a population of more than 50,000 are considered to be urban areas [26,27]”.

Q2.7.: Differences in alcohol availability?

A2.7.: We have added this text to the manuscript:

“It should be noted that the rural areas being more isolated had less access to various drugs [28,29].”

Q2.8.: Were adolescents under 18 able to consent? Was there parental consent?

A2.8.: We have added this text to the manuscript:

“The initial population was 270 adolescents, 195 of whom signed the informed consent form or their parents in the case of adolescents under 18.”

Q2.9.:What does “The recruitment was incidental” mean?

A2.9.: We have added this text to the manuscript:

“that is, incorporation into the study was voluntary, without bias of any kind.”

Q2.10.: Response rate? Compensation for completing the assessment?

A2.10.: We have added this text to the manuscript:

“The initial population was 270 adolescents, 195 of whom signed the informed consent form or their parents in the case of adolescents under 18.”

Q2.11.: “ad-hoc” ones is too casual. This sentence needs a citation. Which validated instruments were used?

A2.11.: We have changed the word “ones” and we have added two references and we have changed the text to:

“, by means of validated instruments (AUDIT test questionnaire) and other “ad-hoc” ones to cover the interest of the research [27,28]”

Q2.12.: How many questions were included? How was the outcome measure defined?

A2.12.: In relation to the first question

We have added this text to the manuscript:

The complete questionnaire used is available at : https://doi.org/10.5281/zenodo.3965836

With regard to the “outcome measure”, the Alcohol Use Disorder Identification Test (AUDIT) is composed of ten questions that explore three domains: risk consumption, symptoms of dependence, and harmful consumption. Each question is scored from 0 to 4. Cherpitel [https://doi.org/10.1016/0376-8716(95)01199-4] proposes cut-off points to identify risk consumption, harmful consumption and dependence. Using the cut-off point at 8 for men and 6 for women, AUDIT is a sensitive test (51-97%) for detecting harmful alcohol use, abuse or dependence. It is currently the most recommended risk screening technique, based on its simplicity of application and its focus in the recent past (last year).

Q2.13.: How were schools and areas selected? The year(s) of data collection should be included.

A2.13.: We have added this text the manuscript:

“The selection was carried out taking into account the receptivity to the project by the centres, the relations of the research team with the directors and teachers, and the search for educational centres with which to obtain a sample of similar size, which would allow us to compare the rural and urban areas.”

And we have added this text including the year:

"… attending rural and urban state public schools in the area of El Bierzo (León, Spain), during the 2015-2016 academic year.”

Q2.14.: Inclusion and exclusion criteria?

A2.14.: We have added this text to the manuscript:

Since not having the informed consent signed by the parents was considered a criterion for exclusion.

Q2.15.: The data analysis section should be rewritten. Alpha should be less than 0.05, not less than or equal to.

A2.15.: This was a transcription error, the criterion of p<0.05 was used. Therefore, the analysis performed was correct. We have changed it in the manuscript.

Q2.16.: Any control variables?

A2.16.: We have added this text to the manuscript:

Age was used as a control variable, being between 16 and 19 years old.

Q2.17.: What statistical test was used?

A2.17.: We have added this text to the manuscript:

“To determine correlations, we used Pearson’s correlation coefficient.”

Q2.18.: Any missing data?

A2.18.: No data were lost because all participants filled in all the questions.

Q2.19.: Power analysis?

A2.19.: The power analysis has been carried out with the program G*Power 3.1.9.6 and the values obtained in table 4 have been added.

Q2.20.: There are areas in the results that are not English “la existence” and “consumption de alcohol.”

A2.20.: We have corrected these mistakes.

Q2.21.: Line 160 belongs in the methods

A2.21.: We have moved this part sentence to methods.

Q2.22.: Table 4 does not stand alone and is difficult to interpret.

A2.22.: We have modified the names of the "classrooms" that were in Spanish. We hope that now the table is more understandable.

Q2.23.: The results cannot be fully evaluated without the missing information in the methods section.

A2.23.: We hope that after all the proposed changes that have been made, we will have fulfilled this requirement as well.

Submitted filename: Response to Reviewers.pdf

Click here for additional data file.

1 Sep 2020

PONE-D-20-13204R1

The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

PLOS ONE

Dear Dr. Quiroga Sánchez,

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 Oct 16 2020 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 rebuttal 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Joel Msafiri Francis, MD, MS, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Please kindly address the additional reviewer comments carefully.

[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 #1: All comments have been addressed

Reviewer #2: 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 #1: Yes

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

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 #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: No

**********

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 #1: All changes made and the paper is stronger for it. Thank you for your hard work, and well done. Accept.

Reviewer #2: Thank you for the opportunity to review the revised manuscript entitled The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments submitted to PLOS One (PONE-D-20-13204R1). The manuscript has improved but there remains significant problems, mainly related to the language and grammar. Specific comments are below.

The entire abstract needs copyediting. Adolescence is confused with adolescents. Analyse should be analyze. The methodology section should be expanded. Results from the regression models should be added to the abstract.

Similarly, the introduction needs significant copyediting.

The sample population and recruitment should start the methods section. Was assent obtained for minors? What does the initial population refer to (students that expressed interest)? What geographic unit/size for classifying urban/rural, mentioning 50,000 population alone is insufficient. Nuclei? A better description of access between rural and urban areas would be appreciated. The target population described at the end of the first paragraph on page 6 should be moved to the beginning of the methods section and this is unclear. The results of the power analysis should be mentioned in the text. The analyses should be reviewed by a statistician. The entire methods section needs copyediting.

The study overall is not as strong as it could be. The sample size is relatively small and the analyses are not well described.

**********

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 #1: No

Reviewer #2: 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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

16 Sep 2020

Reviewer 1

Reviewer #1: All changes made and the paper is stronger for it. Thank you for your hard work, and well done. Accept.

Answer to reviewer #1: We appreciate the review and are pleased to know that all suggestions have been properly addressed.

Reviewer 2

Reviewer #2: Thank you for the opportunity to review the revised manuscript entitled The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments submitted to PLOS One (PONE-D-20-13204R1). The manuscript has improved but there remains significant problems, mainly related to the language and grammar. Specific comments are below.

Answer to R2 0: We appreciate your review and are pleased to learn that the manuscript has improved following the changes made. We hope to be able to satisfy the new comments indicated in this revision.

R2.1:

The entire abstract needs copyediting. Adolescence is confused with adolescents. Analyse should be analyze. The methodology section should be expanded. Results from the regression models should be added to the abstract.

Answer to R2.1:

Taking into account your suggestions, we have hired a translator who has been responsible for the copyediting of the entire manuscript.

In the manuscript "with tracked changes" it is possible to see the modifications made by the translator.

In addition, we have modified the abstract by adding more information, as suggested.

R2.2:

Similarly, the introduction needs significant copyediting.

Answer to R2.2:

The translator performed this task. We hope that the section will be better written.

R2.3:

The sample population and recruitment should start the methods section. Was assent obtained for minors?

Answer to R2.3:

Following this suggestion, we have added this information to the manuscript in the first paragraph of section 2.

R2.4:

What does the initial population refer to (students that expressed interest)? What geographic unit/size for classifying urban/rural, mentioning 50,000 population alone is insufficient. Nuclei? A better description of access between rural and urban areas would be appreciated.

Answer to R2.4:

In response to this suggestion, we have added more justified information with scientific references.

“The total population of the different institutes was 270 adolescents. Of these, 195 adolescents or their parents in the case of adolescents under 18 years of age signed the informed consent.

In this way, the sample was made up of 195 adolescents aged between 16 and 19, attending rural and urban public schools in the area of El Bierzo (León, Spain), during the 2015-2016 academic year. The selection was with the consent of the project from the centers. We also took into account the relationships of the research team with the directors and professors, which facilitated the launch of the research. A search for educational centers in rural and urban settings was carried out in order to obtain a sample of similar size, which would allow us to compare both rural and urban areas.

There are various definitions for characterising rural settings. The Ministry of the Environment defines the proportion and density of the population as the most used criterion. In Spain, rural areas are defined as "A geographic space comprising the aggregation of municipalities or smaller local entities with a population <30,000 inhabitants and a density <100 inhabitants per Km 2 [26].”

R2.5:

The target population described at the end of the first paragraph on page 6 should be moved to the beginning of the methods section and this is unclear.

Answer to R2.5:

In line with this suggestion, the text has been amended and moved to the position indicated.

R2.6:

The results of the power analysis should be mentioned in the text. The analyses should be reviewed by a statistician. The entire methods section needs copyediting.

Answer to R2.6:

We have included a comment about the power analysis in the text. The results of the statistical analysis have been revised and reported in the text as indicated by the statistician.

R2.7:

The study overall is not as strong as it could be. The sample size is relatively small and the analyses are not well described.

Answer to R2.7:

We hope that after all the proposed changes that have been made, we will have fulfilled this requirement as well.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

5 Oct 2020

PONE-D-20-13204R2

The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

PLOS ONE

Dear Dr. Quiroga Sánchez,

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 Nov 19 2020 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 rebuttal 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Joel Msafiri Francis, MD, MS, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The manuscript will benefit from copy editing. It would be helpful to seek help from the native English speaker.

[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 #1: All comments have been addressed

Reviewer #2: (No Response)

**********

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 #1: Yes

Reviewer #2: (No Response)

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: (No Response)

**********

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 #1: No

Reviewer #2: (No Response)

**********

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 #1: Yes

Reviewer #2: (No Response)

**********

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 #1: I had not requested any further comments so all good on my side and wishing you the best of luck with your paper.

Reviewer #2: The authors have addressed the comments. Grammar and readability continues to be a problem. Methodology/analyses appropriate.

**********

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 #1: No

Reviewer #2: 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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

7 Oct 2020

Additional Editor Comments (if provided):

The manuscript will benefit from copy editing. It would be helpful to seek help from the native English speaker.

Answer to AE:

First of all, I would like to thank the reviewers for their work. We are pleased to have solved all the suggestions indicated in the two reviews by the two reviewers.

Following the suggestions of the reviewers and the editor, we have sent our article to the company American Journal Experts (AJE) for copyediting. I have attached the certificate of review with the code TL4M4QZ6 in the inventory of files of the journal.

Reviewer 1

Reviewer #1: I had not requested any further comments so all good on my side and wishing you the best of luck with your paper.

Answer to R1:

We are glad to know that we have taken care of all your suggestions correctly. Thank you very much for your message.

Reviewer 2

Reviewer #2: The authors have addressed the comments. Grammar and readability continues to be a problem. Methodology/analyses appropriate.

Answer to R2:

We are glad to know that we have taken care of all your suggestions correctly. Thank you very much for your message.

Following your suggestions, we have sent our manuscript to the company American Journal Experts (AJE) for copyediting.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

9 Oct 2020

The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

PONE-D-20-13204R3

Dear Dr. Quiroga Sánchez,

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.

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Joel Msafiri Francis, MD, MS, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

13 Oct 2020

PONE-D-20-13204R3

The consumption of alcohol by adolescent schoolchildren: Differences in the triadic relationship pattern between rural and urban environments.

Dear Dr. Quiroga Sánchez:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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.

If we can help with anything else, please email us at plosone@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

Dr. Joel Msafiri Francis

Academic Editor

PLOS ONE