The same information should be included in the materials and methods section of the manuscript. In all cases, the full name of the IRB must be provided in the manuscript. Please write or insert the page numbers where each item appears in the margin of the checklist.
All persons who contributed to the work reported in the manuscript but are not sufficient to be authors should be. Abbreviations and acronyms should be spelled out the first time they are used in the abstract and again in the body of the manuscript.
To further illustrate the differences in delay between consent types, we have added a categorical representation of delay to Table 1 and discussion of this finding in the manuscript; we have also added
To further illustrate the differences in latency between consent types, we have added a categorical representation of latency to Table 1 and the discussion of this finding in the manuscript; we have also added. 4 in particular.35 Thus, the time required to comply with the judicial bypass process may increase medical risks.
4 particular.35 Thus, the time required to comply with the judicial bypass process may increase the risks of medical
- We have added some of the requested information to Materials and Methods because the journal’s
- Though it would not be impossible for a minor to independently access an attorney, we are not aware of this happening with any frequency nor do we believe it happened for anyone in our cohort. The system in
- We agree with all of the points raised regarding whether minors choose to use insurance or not, which is why we considered Medicaid insurance as a proxy for SES and not to account for how the minor paid for
- This is an excellent question and we realize based on your question that we did not originally report missingness in Table 1 because we expressed self-reported GA only as a mean within each group. There
We added the following to the manuscript, lines 99-100: Within one based on your question. We are aware that in some other states, such as Texas, judicial bypass referral hotlines are completely separate from clinics. We have included the range for “Delay in time to abortion” in the revised Table 1.
Are the uninsured or those who do not report insurance included in "Not Medicaid?" I struggle with the Medicaid metric being used as the sole proxy for lower SES, especially for minors (likely to be on their parents' insurance and may not choose to use it), and it's not clear if. Also, I'm unclear if Medicaid would help pay for these procedures (as above - clarification of Medicaid coverage in Mass. would be helpful), because if so, having Medicaid may actually facilitate access to a uninsured or minors who choose not to report/use their parents' insurance. We agree with all the points raised about whether minors choose to use insurance or not, which is why we considered Medicaid insurance as a proxy for SES rather than accounting for how the minor paid why we considered Medicaid as a proxy for SES and not to account for how the minor actually paid for the abortion.
However, because we considered Medicaid a proxy for socioeconomic status, we coded any patient enrolled as having Medicaid anywhere within the electronic medical record (EMR) within 60 days of the abortion as insured with Medicaid, regardless of payment type. abortion. There was no statistically significant difference in absence by type of consent (17% in parental consent; 19% in judicial override). The same would be true if comparing racial/ethnic minorities with non-Hispanic whites in the parental consent group, but not to the same extent.
Will consider revising wording to emphasize disproportionately more likely to seek judicial bypass than parental consent (as you do in later parts of paper) rather than simply "more likely to occur." (Rules 180-183 compare numbers appropriately between judicial bypass and parental consent.).
6 12. We thank the reviewer for catching this discrepancy and have adjusted our wording and numbers
- Thank you for catching this mistake. We have updated the CI in the main text to match the correct value in the Table
- We have deleted this from the revised manuscript as requested
- Since this sentence refers to both births and abortions, we have deleted “fertility” and simplified as follows (line 249-250 in the revised manuscript): “Adolescents who sought judicial bypass were also
- The large standard deviations relative to the mean indicate that there is variability in the delay in time to abortion in both parental and judicial bypass groups. The variability is taken into account in our two
- This is an important point and similar to some useful feedback from Reviewer 2 above. Please see our responses in points 10 and 14 above
- Page 12: I would caution the authors use of our cohort. These data belong to the patients from whom they were collected
- We have deleted this word
- Page 12: I would caution the authors to use Black race as a risk factor for anything
- Page 13: Use of she in line 268 is purposive in the hypothetical?
- We have added the following lines to the Discussion (lines 256-259)
Note, a nearly 40-year-old legal precedent has made it clear that parental consent cannot be absolutely required, without an option for judicial bypass, according to the US Constitution (see rules 54-58). I am also concerned about public insurance as a proxy for poverty, as this population is likely to be financially constrained due to being adolescent. I know this strategy is used by many studies for adults, I am concerned about using it here.
We agree that this sentence is not well-formed and that we also need to shorten it due to length constraints. The revised sentence can be found in response to point 4 above or in lines 270-274 of the revised manuscript. We used "she" by accident - any young person who is pregnant must obtain parental consent or a judicial bypass for an abortion in any state with such a law, regardless of whether they receive parental consent or a judicial bypass for an abortion in any countries with such a law. , whether they are cisgender women, gender nonconforming or transmasculine.
We did not find any difference in delay related to the distance of the residence to the clinic.
8 Figures
9 Since higher gestational age at first contact also meant longer delays, could you provide more information
We agree this point adds richness to the data. We have added the following to the results section (lines 213-218
STATISTICAL EDITOR COMMENTS
Thank you for these important notes. We have made the required additions
10 model1 Given our substantive concerns with this approach, we have not performed an additional analysis
We do not have data for adult patients as this study was designed specifically to look at abortion among minors. However, in the manuscript we do cite four previously published papers that found delay to care
EDITOR COMMENTS
Thank you for your feedback. As you point out, this comment echoes some feedback from Reviewer 1
11 Minors with parental consent received their abortion a mean of 8.62 days after initial contact, compared to 14.77
To address both of these points in tandem, we have rewritten the first two sentences of the results section of the abstract as follows (lines 37-41 of the revised manuscript)
Thank you, we have removed all instances of this formatting
This change was made
12 - do you have any data to say why the minor continued the pregnancy? Just change her mind, barriers of the
We do not have these data, as reasons for continuing are not documented in a standard fashion in the EMR, nor is planned consent type for the desired abortion necessarily documented because an abortion
This paragraph was revised in response to point 26 from reviewer 4 above. We believe the new text should be substantially clearer
Yes, consent is required to initiate cervical dilation as this is the first step in the
We interpret this comment as asking: What is the typical time from first scheduling call to abortion procedure for a typical patient with no or minimal barriers to abortion? In a 2004 national survey of
13 - For data presented in the text, please provide the raw numbers as well as data such as percentages, effect size
- We have revised this sentence in accordance with this feedback (lines 220-221 of the revised manuscript)
- Thank you for pointing this out. For the sake of brevity we have deleted this point completely
- Please see the response to point 34 above
- We have changed this category name in Table 2 to “ number of prior abortions” as requested
- OPT-IN: Yes, please publish my response letter and subsequent email correspondence related to author queries
- OPT-OUT: No, please do not publish my response letter and subsequent email correspondence related to author queries
- Author Agreement Forms: Please note the following issues with your forms. Updated or corrected forms should be submitted with the revision
- Thank you for pointing out these errors. We have uploaded corrected versions of these forms
- Please see the transparency statement at the beginning of this response
- Please see the response to point 26 above
13 - For data presented in the text, please provide raw numbers as well as data such as percentages, effect size. To ensure that future readers do not think that Figure 2 presents new data, we have slightly modified the sentence to include the word “additional” (lines 237–239 of the revised manuscript): Figure 2 provides an illustration additional to this finding is that the proportion of abortions with judicial override that cross any of the three thresholds is greater than that of abortions with parental consent. This is a distinctly different variable that you do not address in the paper and should be.
This should be called "# of previous abortions", or you can leave the title and rename the outcomes to Yes or No. We changed this category name in Table 2 to “number of previous abortions,” as requested. In your response, please tell us who entered the data and how the accuracy of the database was validated.
All studies must follow the principles set out in the 1975 Declaration of Helsinki, revised in 2013, and manuscripts must be approved by the appropriate authority before submission. Applicable original research studies must be reviewed by an institutional review board (IRB) or ethics committee. This review should be documented in your cover letter as well as in the Materials and Methods section, with an explanation if the study was deemed excluded.
If your research is based on a publicly available dataset that has been approved for exemption by your IRB, please provide documentation of this in your cover letter by submitting the IRB website URL listing the exempt datasets or a letter from a representative of the IRB.
16 Materials and Methods section stating that the study was approved or exempt from approval. In all cases, the
- Responsible reporting of research studies, which includes a complete, transparent, accurate and timely account of what was done and what was found during a research study, is an integral part of good research and publication
- Please see the STROBE checklist attachment uploaded with the resubmission
- Standard obstetric and gynecology data definitions have been developed through the reVITALize initiative, which was convened by the American College of Obstetricians and Gynecologists and the members of the
- Because of space limitations, it is important that your revised manuscript adhere to the following length restrictions by manuscript type: Original Research reports should not exceed 22 typed, double-spaced pages
- Length of the paper is as follows
- We have made this change, and added a description of the study design (retrospective cohort) per STROBE guidelines
- Specific rules govern the use of acknowledgments in the journal. Please edit your acknowledgments or provide more information in accordance with the following guidelines
- We affirm all funding sources are acknowledged. We did realize that a grant number associated with the funding for this study was not in the original submission, so we have added that to line 318 of the revised
- We have named all individuals beyond the authors who assisted with this study in the Acknowledgements
- We provided this information with the original submission, and it remains, on lines 17-18 of the revised manuscript
- Provide a short title of no more than 45 characters, including spaces, for use as a running foot
- We have provided the following running foot immediately under the précis on the title page, line 27 of the revised manuscript (44 characters including spaces): Massachusetts’ abortion parental consent
- The most common deficiency in revised manuscripts involves the abstract. Be sure there are no
- Only standard abbreviations and acronyms are allowed. A selected list is available online
- Thank you. We have removed the virgule symbol
- We have done so, and accordingly made several formatting changes to the Tables
- Figure 1 and 2 may be resubmitted as-is
We have made this change and added a description of the study design (retrospective cohort) according to the STROBE guidelines. Any assistance with manuscript preparation, including but not limited to topic development, data collection, analysis, writing, or editorial assistance, should be included in the acknowledgments. All persons who contributed to the work reported in the manuscript but are not sufficient to be authors should be acknowledged.
Written permission must be obtained from all persons named in the acknowledgment as readers may infer their approval of the data and conclusions. We have named all individuals in addition to the authors who assisted with this study in the Acknowledgments. If all or part of the paper was presented at the Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists or at another organizational meeting, this presentation should be noted (include the exact dates and location of the meeting).
We provided this information with the original submission, and it remains, on lines 17-18 of the revised manuscript. We have provided the following running foot immediately below the precision on the title page, line 27 of the revised manuscript (44 characters including spaces): Massachusetts Parental Consent for Abortion Revised Manuscript (44 characters including spaces): Parental Consent Massachusetts abortion law. Make sure that the abstract does not contain information that does not appear in the main text.
We've double-checked and can confirm that all abbreviations used are standard, except for "PPLM" which stands for "Planned Parenthood League of Massachusetts." Since we do spell it "PPLM" which stands for "Planned Parenthood League of Massachusetts." Since we do spell it out on first use, and since using the abbreviation greatly improves readability, it's us.
Randi Zung
Thanks,
Subject: Re: Your Revised Manuscript 18‐2097R1
Sent: Tuesday, January 15, 2019 10:22 AM To: Janiak, Elizabeth
- Corresponding Author Information: Is this the correct contact information to publish if your paper is accepted?
- Line 114: You indicate that state law “requires the consent of one parent or legal guardian for all never‐
- Abstract‐Results and Results section: In both the abstract and the paper, please provide absolute numbers as well as whichever effect size you are reporting + Confidence intervals, as appropriate for the data being
- Line 214: For clarity, could you consider presenting the data something like this throughout
- Line 251: See my note just below the end of the manuscript about this figure
- Line 253: Please provide statistical evidence that there is a difference. Not sufficient to just say it was
- Table 1: Please correct all weeks data to 1 decimal. We have fixed this
We added a sentence to clarify this (rules This program is available free of charge to minors seeking abortion at any provider anywhere in the state, and serves all minors seeking judicial diversion for abortion at PPLM.” For all the effect estimates ( odds ratios and mean differences), we incorporated this format. The parental consent group disproportionately identified as non-Hispanic white compared to the judicial bypass group at the please provide the statistical evidence to show that this represents a difference between groups.
With regard to data presentation, lines 256-263, following this guidance, now read: “We found significant differences (P < 0.05) by consent type for all demographic and social characteristics (Table 1). Because it would be cumbersome to list every racial/ethnic difference, we have chosen to omit mention of non-Hispanic white race and refer only to the overall difference. We have updated our wording to reflect that the significance findings for the means are indeed confirmed in the figure.
I don't have the figure legend here: is panel A the judicial bypass group and panel B the parental consent group. We have tested this statement statistically and added the formatting suggestion to the text. We have changed the word 'influences' here to 'involved' to clarify that in this sentence we are simply observing that the judicial word 'influences' here is 'involved' to clarify that in this sentence we are simply observing that the judicial bypass group is disproportionately insured by Medicaid (in other words, this sentence refers to the proportions in Table 1, not to multivariable models).
We confirmed that all p-values are correct. days), so the zero in this case is the average difference of 0, not 1.
Best,
Rule 229: We do not allow authors to describe variables or outcomes in terms that imply a difference (such as we use the terms "tendency" or "tendency" or "marginally different") unless there is a statistical difference. Please use the terms "tendency" or "tendency" or "marginally different") unless there is a statistical difference. Rules 298-300 now read: "There was no significant difference in the proportions of abortion procedures that required two visits to achieve adequate cervical dilatation ("two-day procedures") between the judicial bypass and parental consent groups. In Figure 2 , according to the legend, I cannot tell which individual represented by the lines is judicial bypass and which is parent.
We believe that, as formatted here, this figure and legend address all of this feedback. The results here are for a continuous result (average delay in days), so the zero in this case is an average difference of 0, not 1. The information in this email is intended only for the person to whom it is addressed.
If you believe this email has been sent to you in error and it contains patient information, please contact the Partners Compliance HelpLine at http://www.partners.org/complianceline. If the email was sent to you in error but does not contain patient information, contact the sender and delete the email properly.
Subject: RE: O&G Figure Revision: 18-2097
From: Janiak, Elizabeth
Subject: Re: O&G Figure Revision: 18-2097
Subject: O&G Figure Revision: 18-2097
