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The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for society, affecting those already subject to unacceptable health inequalities and resulting in vast economic impacts. The pandemic reminds everyone of the value and necessity of public health. In the context of an era that will be shaped by COVID-19, we outline the coming series of challenges and transitions in public health and the needed actions over the next 5 years to reinvent our public health systems. Multiple limitations in current US and global public health systems have been uncovered by the pandemic, including insufficient preparedness and surveillance capabilities complicated by long-standing and worsening health inequalities and the rapid spread of misinformation that needs to be countered. We foresee 3 phases for public health over the next 5 years: (1) reactive crisis management, (2) efforts to maintain initial gains, and (3) efforts to sustain and enhance progress. A reinvented public health system will depend highly on leadership and political will, rethinking how we categorize and address population-level risk, employing 21st-century data sciences, and applying new communication skills.

Purpose. To examine the association between household smoking restrictions and adolescent smoking, controlling for parental smoking, peer smoking, and tobacco marketing. Design. Cross-sectional analysis of 1999 data from the Growing Up Today Study, a longitudinal cohort of adolescents. Setting. Self-report questionnaire. Subjects. 10,593 adolescents aged 12 to 18 years. Measures. The dependent variable was established smoking (smoking ≥ 100 cigarettes). Variables of interest were household smoking restrictions, parental smoking, peer smoking, and tobacco promotional item (TPI) possession. Results. Four percent of participants reported that their households permitted smoking. Parental smoking, peer smoking, and TPI possession were significantly associated with established smoking. In logistic regression models adjusted for age, gender, peer smoking, and TPI possession, adolescent smoking was inversely related to the presence of a restrictive household policy (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48–0.93); however, when parental smoking was added to this model, the association was attenuated (OR = 0.94, CI = 0.65–1.35). When only one parent in the household smoked, smoking restrictions were more common when this parent was the father. Conclusions. Although household smoking restrictions offer health benefits, they do not appear to be associated with adolescent smoking after accounting for other factors. Prior studies did not include parental smoking, peer smoking, and marketing influences. This analytic difference may explain apparent contradictions in the literature.

Cancer screening procedures have brought great benefit to the public's health. However, the science of cancer screening and the evidence arising from research in this field as it is applied to policy is complex and has been difficult to communicate, especially on the national stage. We explore how epidemiologists have contributed to this evidence base and to its translation into policy. Our essay focuses on breast and lung cancer screening to identify commonalities of experience by epidemiologists across two different cancer sites and describe how epidemiologists interact with evolving scientific and policy environments. We describe the roles and challenges that epidemiologists encounter according to the maturity of the data, stakeholders, and the related political context. We also explore the unique position of cancer screening as influenced by the legislative landscape where, due to recent healthcare reform, cancer screening research plays directly into national policy. In the complex landscape for cancer screening policy, epidemiologists can increase their impact by learning from past experiences, being well prepared and communicating effectively.

PurposeCancer screening procedures have brought great benefit to the public's health. However, the science of cancer screening and the evidence arising from research in this field as it is applied to policy is complex and has been difficult to communicate, especially on the national stage. We explore how epidemiologists have contributed to this evidence base and to its translation into policy.MethodsOur essay focuses on breast and lung cancer screening to identify commonalities of experience by epidemiologists across two different cancer sites and describe how epidemiologists interact with evolving scientific and policy environments.ResultsWe describe the roles and challenges that epidemiologists encounter according to the maturity of the data, stakeholders, and the related political context. We also explore the unique position of cancer screening as influenced by the legislative landscape where, due to recent healthcare reform, cancer screening research plays directly into national policy.ConclusionsIn the complex landscape for cancer screening policy, epidemiologists can increase their impact by learning from past experiences, being well prepared and communicating effectively.