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Section Editors' Highlights

New Content ItemWelcome to the BMC Public Health Section Editors' Highlights page. Here, the Section Editors have chosen recent papers published in their section of the journal that are of particular importance or interest to highlight to a wider audience.

Chronic disease epidemiology

Severity of depression, anxious distress and the risk of type 2 diabetes – a population-based cohort study in Sweden

Chosen by: Jianguang Ji

The established association between depression and type 2 diabetes calls for clinical attention, especially in recent decades with an increasing prevalence of depression. It is thus necessary to explore whether the observed association is causal and to explore the underlying mechanisms by using prospective longitudinal data and by stratifying the observed association by various severity of depression (dose-response relationship). A total of 10 thousand individuals who lived in Stockholm County, Sweden have answered the postal questionnaires on depression and factors related to mental health in 1998–2000 in which depression was evaluated using the Major Depression Inventory. These individuals were followed until 2015 to identify their subsequent type 2 diabetes by using a few national registers. Deleskog and her colleagues did find that individuals with depression were at 1.48 times higher risk of type 2 diabetes after adjusting for potential confounders. It should be noted that the risk of type 2 diabetes was increased to 1.72 for individuals with severe depression, suggesting a causal association. In addition, they found that individuals with depression and concurrent moderate/severe anxious distress had 1.73 times higher risk. This study added strong evidence that depression is a strong risk factor for developing type 2 diabetes. However, further studies are highly needed to understand underlying mechanisms, as the authors acknowledged.

Energy balance-related behaviors

Social network influences and the adoption of obesity-related behaviours in adults: a critical interpretative synthesis review

Chosen by: Janice Thompson

Obesity is globally recognized as a major public health concern. The risk factors contributing to obesity are numerous and involve a complex interplay between biological, personal, socio-cultural, and environmental factors that affect one’s ability to change obesity-related behaviors. A multitude of interventions targeting individual diet and physical activity behaviors have been implemented to date. Results from these studies indicate that although short-term weight loss is achievable, longer-term sustainability of behavior changes and weight loss remain elusive. Designing and implementing interventions that incorporate an understanding of the complex interactions between the various influences linked with obesity could enhance adherence to health-promoting behaviors and lead to sustained weight loss.  The authors of the present study conducted a critical interpretive synthesis review of qualitative, quantitative and mixed-methods data, using a unique approach to further our understanding of how social network properties and processes, combined with environmental influences, affect the adoption of healthy and unhealthy obesity-related behaviors in adults. The data-driven themes identified included meso-micro network processes, contextual and individual factors, and types of social ties and properties as the key drivers of both healthy and unhealthy obesity-related behaviors. The analyses indicated that these drivers do not act independently. This led to the creation of two mechanisms, developing multi-agent coalitions that consider cross-level influences. As concluded by the authors, the results of this study emphasize the complexities of a dynamic, multi-level set of influences acting across a vast system of social connections that contribute to obesity. These findings can be used to inform the design of future interventions and implementation of policies targeting obesity-related behaviors.   

Systematic review of the impact of nutrition claims related to fat, sugar and energy content on food choices and energy intake

Chosen by: Richard Rosenkranz

Worldwide obesity prevalence has reached all-time highs in recent years, and threatens to increase the risk of premature deaths within the global population due to chronic diseases such as heart disease, cancers, stroke, and diabetes. A range of policy, systems, environmental, and educational interventions have been proposed or implemented to reduce the public health burden of obesity. One set of policy approaches pertains to the application and regulation of nutrition claims and labeling that may educate consumers by providing nutrition information to promote healthier eating behaviors. This systematic review examined the extant evidence that nutrition claims relating to fat, sugar, and energy content influences energy intake and food choices. The authors located 11 studies relevant to the research question, although the methodological quality of these studies was mostly low, with only one study having moderate methodological quality. Results showed that nutrition claims do, in fact, shape consumers' knowledge related to healthfulness of products, and also the expected and experienced tastiness of food products. Interestingly, food products with nutrition claims seem healthier, but also less tasty to consumers. Nutrition claims also can make appropriate portion sizes seem larger or lead to underestimation of energy content, which could unintentionally increase caloric intake. Evidence also revealed that nutrition claims could influence food purchases and ‘consumption guilt’ stemming from eating a food product, and to increase consumption in certain cases. So, this systematic review indicates that nutrition claims relating to fat, sugar, and energy content are likely to increase purchase intentions when food products are perceived as healthier, but they may also have the unintended consequence of leading to energy over-consumption. Further high-quality studies are needed, but caution is warranted among policymakers and intervention research regarding the potential efficacy of nutrition claims for improving dietary intake or reducing obesity within the population. 

Social network influences and the adoption of obesity-related behaviours in adults: a critical interpretative synthesis review

Chosen by: Carol Maher

The rising prevalence of obesity is leading global health challenge, and existing intervention approaches have been insufficient to turn the tide. Evidence suggests that obesity spreads through social networks, and as such, interest is growing in interventions that harness social networks.  

This study set out to synthesise studies of obesity and social networks to improve the understanding of how social network properties and processes influence the adoption of both positive and negative obesity-related behaviours. An extensive search strategy identified twenty-four previous studies, which were then synthesised using a critical interpretative synthesis methodology, a novel approach which encompasses both quantitative and qualitative data sources. A wide variety of social network properties and processes were identified, including social support, social pressure, homophily (the tendency of pairs of individuals to share similar characteristic), diffusion (i.e. spreading of health information via social networks), and social comparison. Overall, the authors arrange the data into three data-driven themes, badged “meso-micro networking processes for the adoption of obesity-related behaviours”, “contextual and individual factors of obesity-related behaviours” and “types of ties and properties that influence the adoption of obesity-related behaviours”.  

The literature regarding social networks and health is complex and spans a wide range of academic disciplines. This novel synthesis offers new insights into the role of social networks in obesity.​

Environmental health

Assessing the micro-scale environment using Google Street View: the Virtual Systematic Tool for Evaluating Pedestrian Streetscapes (Virtual-STEPS)

Chosen by: David Stieb

There is considerable recent interest in the impact of the built environment on physical activity. This study examines the performance of a Google Street-view based tool (Virtual-STEPS) for auditing microscale features of the built environment such as condition of sidewalks, traffic-calming features (e.g. stop signs), building setbacks, bus stops, bicycle lanes, and aesthetic qualities (e.g. graffiti), which have been found to be associated with physical activity in previous studies. The authors focused on these features because they are believed to be more readily amenable to intervention than macroscale features such as connectivity, land-use mix, and population density. Virtual-STEPS was found to be reliable in terms of inter-rater agreement and comparison to field auditing, and more time-efficient by eliminating travel time, based on evaluation of 60 street segments in Montreal, Canada. The tool may provide a cost-effective means of identifying microscale features of the built environment that are readily modifiable with the objective of promoting physical activity.

Global health

The monetary value of human lives lost through Ebola virus disease in the Democratic Republic of Congo in 2019

Chosen by: Tim Mackey

The current Ebola outbreak that originated in the Democratic Republic of Congo in 2018, now with over 3,200 total cases, serves as further example of the continued risks posed by emerging and re-emerging infectious disease outbreaks. Ebola has been particularly deadly with he West Africa 2015-2016 outbreak ending with a total of approximately 28,000 cases and 11,000 deaths across Guinea, Liberia, and Sierra Leone.  Appropriately implementing interventions while also measuring the public health impact of these outbreaks is crucial, but equally important is assessing the economic losses associated with these health emergencies that could have implications for decades to come on economic development.  In Kirigia et al.’s research article published in September, authors estimate the monetary value of human lives lost to Ebola between May 2018- May 2019 using the human capital approach at approximately Intl$17million (International dollars or purchasing power parity) or Intl$13,801 per death.  Though this estimate places Ebola death as having a lower indirect costs per death than other global health issues such as maternal death, tuberculosis death, and child and neglected tropical disease death in Africa, it was larger than the indirect costs associated with NCD death in low-income African countries.  Perhaps more important, the study provides critical evidence that these disease outbreaks can have substantial and lasting implications for already fragile economies and health systems (including disease surveillance systems).  In fact, it is the vulnerability of health systems and other systems that address social determinants of health, that may make a country more susceptible to an outbreak that could have cross-border and even global repercussions.  Further research and advocacy is needed to develop evidence-based policy for disease prevention and prioritizing strengthening of national health systems as a matter of global health security.  

Health policies, systems and management in high-income countries

Impact of an excise tax on the consumption of sugar-sweetened beverages in young people living in poorer neighbourhoods of Catalonia, Spain: a difference in differences study

Chosen by: Summer Hawkins

The World Health Organization considers taxes on sugary beverages an effective, but underutilized policy tool. Royo-Bordonada and colleagues exploited the natural experiment created by an excise tax on sugar-sweetened beverages introduced in Barcelona. A unique aspect of the tax is that it was fully passed through to the price of beverages and paid by consumers. The two ‘tiers’ of taxes were based on sugar content and expected to raise the price of sugar-sweetened beverages between 10 and 20%. Royo-Bordonada and colleagues examined the impact of the excise tax on beverage consumption among 12- to 40-year-olds from low-income neighborhoods in Barcelona (intervention) compared to Madrid (control). This before-after study found that the consumption of taxed beverages by regular consumers fell by 39% in Barcelona compared to Madrid, where consumption remained stable over this one-year period. More than two-thirds of respondents reported they reduced consumption due to the price increase, followed by heightened awareness of their health effects. This study provides further evidence for the value of taxes as a policy intervention to reduce sugar-sweetened beverage consumption and the potential to address obesity.

Infectious disease epidemiology

Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012–2015

Chosen by: Giovanni Rezza

Surveillance systems for seasonal and pandemic influenza are essential in order to monitor annual trends and to identify circulating viruses, drifts, and emerging zoonotic strains. This study reports the evaluation of the “influenza sentinel surveillance system” (ISSS) of the Democratic Republic of Congo (DRC).

The ISSS is based on different sites reporting cases of influenza-like illness (ILI) occurring in outpatients and severe acute respiratory illness (SARI) in hospitalized patients. The data provide interesting information on influenza dynamics in the tropics, showing seasonal increases in the number of cases between December and May, due to the co-circulation of influenza virus type A/H3N2, A/H1N1, and B.

The performance of the surveillance system, based on the Centers for Disease Control and Prevention guidelines results to be satisfactory, proving  reliable and timely data on influenza circulation in DRC. This is encouraging, in the light of the importance of preparedness plans for influenza pandemic in medium/low income countries.  

Mental health

Child marriage and psychological well-being in Niger and Ethiopia

Chosen by: Noriko Cable

Many countries protect their children from entering adulthood prematurely and unprepared, yet some countries impose that children be married even before the age of 18, depriving them of having a crucial transition developmental phase for them to build psychosocial and material resources.  The effects of marrying young has been examined in the Western countries, but limited within the context of African countries. John, Edmeades and Murithi here have looked at adult married women as well as the head of their households in Niger (N=2,764) and Ethiopia (N=4,149) to examine the association between age of marriage and psychological well-being, indicated by the Psychological General Well-Being Index. Qualitative data were also collected from Ethiopian women.

In both countries, women were married earlier than 12 years of age, which was significantly negatively associated with their psychological well-being, reducing their psychological well-being by -7.41 points in Niger and -5.09 points in Ethiopia. Domestic violence also added to their poor psychological well-being, especially the aspects of self-control in both countries.  Qualitative results in Ethiopia revealed unrealistic demands placed upon women as a child bride and their powerlessness over marital arrangement and more importantly how they lacked opportunities to gain education and employment.

Children entering their adolescence are the most vulnerable mentally and physically, not ready for adulthood or responsibilities, especially marriage and family formation. This study adds that early marriage is detrimental to women’s psychological well-being, even though the custom of child marriage is socially accepted in these countries.

Occupational health

Effects of occupational exposure to dust on chest radiograph, pulmonary function, blood pressure and electrocardiogram among coal miners in an eastern province, China

Chosen by: Youcheng Liu

Although coal workers pneumoconiosis is an old occupational disease, it is a big occupational health issue in China given coal mining remains a big industrial sector. While it is a cross-sectional measurement in nature using 2 years of surveillance data, this study has a large sample size (23,658 participants in total); the risk factors identified are therefore more meaningful. Additionally, the study has not only focused on pulmonary health, but also measured cardiovascular health of the participants. The authors find that abnormal lung and cardiovascular functions are most related to age and duration of coal dust exposure. Smoking as a risk factor contributed to the abnormalities. The type of work tasks and mining sizes also contributed to some of the abnormalities. The percentage of coal miners’ pneumoconiosis, 0.34%, for all miners in this study, is much higher than that of US data for underground miners (0.04%) averaged across all age groups) from 2013 to 20171. Although no actual exposure to dust was measured for the study participants, the risk factors identified highlight the need to improve preventive measures in China coal miners, i.e., to reduce dust exposures. In addition, general health promotion to reduce smoking, drinking and overweight in coal miners are also important preventive measures. Future studies should aim to follow up workers with periodic measurements of pulmonary function and cardiovascular health along with dust exposure levels so that the relative risk related to exposure dose can be quantified.


CDC. CWHSP: Percentage of examined underground miners with coal workers' pneumoconiosis (ILO category 1/0+) by tenure in mining, 1970-2017. Available at: Accessed on Oct 20, 2019.

Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study

Chosen by: Isabelle Niedhammer

In a context of increasing life expectancy and raising retirement age, this paper is offering us a highly topical subject. Exploring the associations between psychosocial work exposures, using a working life course approach, and late-life physical function appears indeed particularly pertinent and largely unexplored. The authors showed that exposure and particularly increasing exposure to high strain during working life were associated with limitation in late-life physical function. Although this study was not free from some biases (including residual confounding bias), it suggests that the psychosocial work environment and its exposures to work stress across working life may have an impact on health later in life. As these exposures are modifiable, this study, which is one of the first on this topic, opens the way to other research studies and potential interesting perspectives to improve the health among elderly people.

Social determinants of health

Holding the keys to health? A scoping study of the population health impacts of automated vehicles

Chosen by: David Rehkopf

This scoping review is a systematic survey of the literature on the potential impacts of Autonomous Vehicles (AV) on human health. The study encompasses a range of potential pathways that are rarely considered for social determinants of health, but a range that is necessary for understanding the ways in which AV use will have net positive or negative influences on health. For example, there are important potential pathways related to accessibility, environmental impacts, affordable housing, stress and land use. What is particularly noteworthy about this study is the explicit linking of a new technological development to the ways it may impacts social determinants of health and consequently health equity. It is forward looking in using the literature to help understand what might be done now to improve health as regulatory decisions are being made. The empirical evidence is far from clear, but the article lays out a path for evaluation, and one can imagine some useful approaches as individual U.S. states take different approaches to regulation. The article is also clear to suggest different ways in which AV use may be regulated. The technology is likely not fundamentally good or bad for health on its own, it is instead the specifics of development and regulation that are likely to determine the health impacts. Finally, more broadly, the study is an exemplar demonstrating the ways economic and technological decisions that are evolving rapidly can at any moment be more or less directed to changing myriad social determinants of health. The work demonstrates how public health researchers can play an important role in advising on the regulation and development of new technologies, using evidence on social determinants of health in order to improve health and health equity.