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Purpose: The American College of Epidemiology (ACE) held its 2022 Annual Meeting, September 8-11, with a conference theme of 'Pandemic of Misinformation: Building Trust in Epidemiology'. The ACE Ethics Committee hosted a symposium session in recognition of the global spotlight placed on epidemiology and public health due to the COVID-19 crisis. The ACE Ethics Committee invited previous Chairs of the Ethics Committee and current President of the International Epidemiological Association to present at the symposium session. This paper aims to highlight the ethical challenges presented during the symposium session., Methods: Three speakers with diverse backgrounds representing expertize from the fields of ethics, epidemiology, public health, clinical trials, pharmacoepidemiology, statistics, law, and public policy, covering perspectives from the U.S., Europe, and Southeast Asia were selected to present on the ethical challenges in epidemiology and public health applying a global theme. Dr. D. Weed presented on 'Causation, Epidemiology and Ethics'; Dr. C.M. Pandey presented on the 'Ethical Challenges in the Practice of Digital Epidemiology'; and Dr. J. Acquavella presented on 'Departures from Scientific Objectivity: A Cause of Eroding Trust in Epidemiology.', Results: The collective goal to improve the public's health was a mutually shared theme across the three distinct areas. We highlight the common ethical guidance and principle-based approaches that have served epidemiology and public health in framing and critical analysis of novel challenges, including autonomy, beneficence, justice, scientific integrity, duties to the profession and community, and developing and maintaining public trust; however, gaps remain in how best to address health inequalities and the novel emergence and pervasiveness of misinformation and disinformation that have impacted the health of the global community. We introduce an ethical framework of translational bioethics that places considerations of the social determinants of health at the forefront., Conclusions: The COVID-19 pandemic required an expedited public health response and, at the same time, placed the profession of epidemiology and public health, its system, and structures, under the microscope like never before. This article illustrates that revisiting our foundations in research and practice and orienting contemporary challenges using an ethical lens can assist in identifying and furthering the health of populations globally., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The authors describe an evaluation approach to assess research training that is easy to implement, takes into account individual experience and diversity in research disciplines, and can be adapted to measure various outcomes, depending upon program goals., Method: Using publications as the outcome measure, the authors analyzed data from 66 trainees in the National Cancer Institute's Cancer Prevention Fellowship Program (CPFP) to illustrate this evaluation strategy. For postdoctoral fellows entering the CPFP between 1987 and 1997, the authors considered the three-year period prior to entry in the CPFP (pre-CPFP), the period during training, and the three-year period after completion of the CPFP (post-CPFP). Summary measures for individuals' publications during each of the three time periods were calculated, and the probability of change in total, peer-reviewed, and first-authored publications post-CPFP compared to pre-CPFP was assessed., Results: Compared to pre-CPFP, the CPFP fellows published significantly more total, peer-reviewed, and first-authored publications post-CPFP. Post-CPFP younger individuals published more than older fellows. MDs had a greater increase in publications over time than did PhDs, but both groups had similar overall numbers of publications post-CPFP. Individuals pursuing a master of public health degree during training published more post-CPFP than did those who did not pursue this training in the program., Conclusions: Training programs facing the challenge of evaluating research outcomes will require new evaluation methods that take into account program goals. This easily adaptable, longitudinal evaluation strategy allows for diversity in research disciplines and research experience and can inform programmatic needs and individual progress.

Preparing junior scientists for careers in the health sciences has become an immense challenge for many reasons, including the emerging demand for multidisciplinary approaches to solving problems in the health sciences. For those choosing careers in hybrid and interdisciplinary fields, the "traditional" postdoctoral training model may not perform well, particularly in light of other problems that plague postdoctoral success. New approaches are required. Using the interdisciplinary field of cancer prevention as an example, the authors describe the Cancer Prevention Fellowship Program (CPFP) of the National Cancer Institute, a three-year postdoctoral program of which the goal is to provide its fellows with a strong foundation in cancer prevention through education, mentored research, and structured professional development training activities that emphasize multidisciplinary approaches and leadership skills. Over time, the CPFP has incorporated the best aspects of the traditional postdoctoral training model with newer training approaches in an effort to overcome existing problems in postdoctoral training and to address the additional complexities inherent in training those who seek careers in interdisciplinary science. Many aspects of the CPFP, including an efficient infrastructure, a dedicated staff, a capacity to provide educational activities, and the provision of rich research opportunities, may translate well to other postdoctoral programs that face similar issues.

Applying the Precautionary Principle to public health requires a re-evaluation of the methods of inference currently used to make claims about disease causation from epidemiologic and other forms of scientific evidence. In current thinking, a well-established, near-certain causal relationship implies highly consistent statistically significant results across many different studies, large relative risk estimates, extensive understanding of biological mechanisms and dose-response relationships, positive prevention trial results, a clear temporal relationship between cause and effect, and other conditions spelled out in terms of the widely-used causal criteria. The Precautionary Principle, however, states that preventive measures are to be taken when cause and effect relationships are not fully established scientifically. What evidentiary conditions, as reflected in the causal criteria, will be certain enough to warrant precautionary preventive action? This paper argues that minimum evidentiary requirements for causation need to be articulated if the Precautionary Principle is to be successfully incorporated into public health practice. Two precautionary changes to criteria-based methods of causal inference are examined: reducing the number of criteria and weakening the rules of inference accompanying the criteria. Such changes point in the direction of identifying minimum evidentiary conditions, but would be premature without better understanding how well current methods of causal inference work.

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light of emerging issues and increased scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment.

Purpose: Effects of an aging population in the United States on lifetime and age-conditional risk estimates of developing site-specific cancers are identified and the potential role these statistics play in monitoring disease burden discussed., Methods: Risk estimates were derived by applying cross-sectional population-based incidence rates of cancer and mortality rates from other causes to a hypothetical cohort. The cohort was aged through a double decrement life table to determine the expected proportion of the population that would develop the disease., Results: Despite black men having higher invasive cancer incidence rates than white men, and black and white women having similar rates, because of the better life expectancy among whites lifetime risk estimates of developing cancer are higher for whites than blacks: 45.5% in white men, 40.4% in black men, 39.2% in white women, and 32.4% in black women based on 1995-97 data. White men experience higher 10-year cancer risk than black men in only bladder cancer, non-Hodgkin's lymphomas (NHL), and leukemia. White women tended to show a greater risk than black women for cancers of the breast, corpus uteri, ovary, NHL, and leukemia. For both whites and blacks, the 10-year risk of lung cancer ranks first among men aged 40, ranks second to prostate cancer for men aged 50, 60, and 70, and ranks second to breast cancer for women aged 40, 50, 60, and 70., Conclusions: Lifetime and age-conditional risk measures reflect both changes in the disease incidence rates and age distribution over calendar time such that they are useful for monitoring the disease burden in the population. Even if cancer rates remain stable or fall, it is possible for the cancer burden, as reflected by lifetime and age-conditional risk estimates, to increase due to the aging population.

In the past decade, at least four sets of ethics guidelines for epidemiologists have been prepared by various national and international organizations. None, however, have been officially adopted by the American College of Epidemiology (ACE). Recently, the ACE asked its Ethics and Standards of Practice (ESOP) Committee to produce ethics guidelines. In this paper, we explain the context and rationale for this effort, describe the purpose and content of ethics guidelines in epidemiology, and discuss their strengths and weaknesses. Three issues that are central to the mission of ACE-education, policy, and advocacy-are inadequately addressed in existing ethics guidelines. In addition, ethics guidelines are not static documents; they should reflect the changing role of epidemiologists in society, including issues arising in emerging subspecialty areas. New, more dynamic, guidelines that emphasize core values, obligations, and virtues, may help to further define and legitimize the profession of epidemiology and will provide a foundation for the discussion of specific ethical issues in the classroom and in professional practice. Guidelines however, do not provide the final word on ethical issues. Specific decisions in particular cases require judgments made upon reflection of the core values, obligations, and virtues described in the guidelines. From our review, we conclude that a new set of guidelines is reasonable and warranted.

Two factors help explain increases in the lifetime risk of developing cancer: (a) decreasing overall mortality rates such that people are now living to older ages when cancer rates rise rapidly; and (b) increasing numbers of cancer cases discovered by new medical procedures, screening tests, and changes in the population risk factors. Prostate cancer lifetime risk estimates are particularly influenced by improved mortality rates and increased detection of asymptomatic disease. In this study, we report trends in lifetime risk estimates of developing prostate cancer in white and black men in the United States, from 1975 to 1993, and focus on the effects of changing mortality and screening. For the study period 1975-1977 to 1991-1993, the lifetime risk of developing invasive prostate cancer increased from 7.3 to 19.6% for whites and from 8.5 to 18.6% for blacks. When we recalculated these estimates using age-specific incidence trends from 1975 through 1989 (thereby controlling for the effect of prostate-specific antigen serum testing on prostate cancer incidence rates), the lifetime risk estimates in 1991-1993 fell to 13.8% for whites and 12.5% for blacks. When we made an additional assumption, basing lifetime risk estimates on higher 1975-1977 mortality rates, the lifetime risk estimates in 1991-1993 became 11.3% for whites and 11.8% for blacks. It is also shown that although mortality rates have improved for white and black men over the study period, they are much larger for blacks than whites in younger age groups, when the prevalence of prostate cancer is relatively low. As a result, fewer blacks survive to older ages when age-specific prostate cancer rates are large. It is of note that blacks have higher incidence rates for prostate cancer than do whites at every age-specific interval. Hence, increasing trends in lifetime risk of prostate cancer suggest, in large part, longer life expectancy and better detection methods.

Women's magazines are an important source of health information. To evaluate the relevancy of articles in these publications to known disease risks, seven women's magazines were reviewed to assess their coverage of colon cancer, the third leading cause of cancer mortality in U.S. women. Specifically, the amount of coverage devoted to colon cancer as well as the presentation of issues in the prevention, risks, treatment, diagnosis and genetics of colon cancer were recorded. Twenty articles were published on colon cancer in these magazines during the years 1987-1995. Compared to five other cancers that also affect women, colon cancer was the focus of the fewest articles in the seven magazines analyzed.

This article examines current ethics guidelines for recommendations on advocacy as an acceptable activity for epidemiologists. Three sets of guidelines, those produced by the Industrial Epidemiology Forum (IEF), the International Epidemiological Association (IEA), and the Council of International Organizations of Medical Sciences (CIOMS), appear to endorse the role of advocate, although there are differences in their recommendations. The IEF guidelines hint that advocacy is appropriate, the IEA guidelines recommend separating the roles of scientist and advocate, and the CIOMS guidelines recommend advocacy dependent on the quality of epidemiologic research and on causal interpretations of the data. Advocacy in the form of public health recommendations can be justified in terms of the principle of beneficence found in the guidelines, but is a central obligation only if the aims of the profession are enlarged to include not only the study of disease but also a commitment to disease prevention. An important issue in women's health--alcohol and breast cancer--provides an illustrative example.

NCI's Cancer Prevention Fellowship Program recently initiated a continuing evaluation of the fellows' demographics, fellows' accomplishments in the program, fellow and preceptor expectations and satisfaction, program strengths and weaknesses, current employment for former fellows, and ex-fellows' perceptions of program training. Evaluation shows that the program attracts quality applicants (including minorities and females) nationwide from many disciplines. The program successfully educates about cancer prevention and provides a positive preceptor experience with publication opportunities. Areas for improvement are data access, stipend, office space, job assistance, and networking. Recommendations for other programs include committed enthusiastic staff; adequate budget, space, and support; a formal learning experience in public health fundamentals, research methods, and cancer prevention; individual mentored research within a productive scientific program; aggressive recruitment; competitive admissions policy; defined objectives for fellows; and ongoing formal program evaluation.

Case-control studies have been used in recent years to evaluate the efficacy of cancer screening. However, relatively little work has been done to examine the methodology itself for this purpose. In this paper, it is demonstrated that because of self-selection bias the case-control study can yield a biased estimate of screening efficacy. Further, it is shown how this bias can be assessed using data from a randomized trial. Using data from the HIP breast cancer screening study, the magnitude of the self-selection bias is estimated and is seen to be substantial.

The healthy worker effect is examined in a large population of actively working communications workers. The mortality experience of 338,306 white male workers at the American Telephone and Telegraph Company grouped by age, duration of service, and general cause categories is compared with the mortality experience of US white males in 1976. Observed were statistically significant and often substantial deficits in mortality among these active workers in almost all categories. For cancers and cardiovascular diseases, mortality ratios tended to decrease across age in the subgroups with longer service durations; these ratios consistently increased across duration of service in older ages. In subgroups with long service durations, the secondary selection of the healthy worker effect in this active worker population appears to increase with increasing age.

The strong logicodeductive method of science is applied in an investigation of the mortality of a large population of communications workers (338 306 white men) to explain the mortality deficits so often observed in occupational studies. A theory for the healthy worker effect is proposed, and its predictions are tested in comparisons of mortality curves fitted to Weibull functions using regression techniques. The theory, based on the effect of selection on prevalent chronic disease, successfully predicts that as age increases the mortality rates of an employed population soon after hire will diverge from those of a general population. This new finding was observed for mortality from all causes, all causes minus accidents, cardiovascular diseases, and cancers. The theory successfully predicts the rate of decrease of the healthy worker effect as duration of service increases and the relative magnitudes of the effect by cause. Having survived initial empirical testing, this explanation for the effects of selection on occupational mortality meets at least two criteria (only one being sufficient) for deciding whether an explanation is to be preferred: it has made more precise predictions, and it has made new predictions not previously suggested.