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Department of Epidemiology and Health Promotion

Chair: Ralph V. Katz, D.D.S., M.P.H., Ph.D., Professor of Epidemiology and Health Promotion

Associate Chair: Rima Bachiman Sehl, D.D.S., M.P.A., Associate Professor of Epidemiology and Health Promotion

Overview
The Department of Epidemiology and Health Promotion, created in June 2000, has a four-year undergraduate dental school curriculum that focuses on epidemiology, critical thinking, and health promotion as well as on behavioral science, nutrition, geriatric dentistry, professionalism, ethics, and diversity issues.

At the graduate level, the department has a five-year program that trains dentists at the Ph.D. level in epidemiology as well as a program in clinical research, which offers a two-year M.S., or a one-year Certificate, in clinical research to a broad array of post-baccalaureate students, including physicians, nurses, pharmacists, and CRAs from industry as well as dentists and dental hygienists. Graduate students in the Ph.D. program in epidemiology are supported as Postdoctoral Fellows in the NIH-funded (stipends and tuition paid) NYU Oral Epidemiology Postdoctoral Training Grant training (now entering its eleventh year as a funded program). Students obtain their Ph.D. in epidemiology from either Columbia University, Johns Hopkins University, or Yale University and work intensely over the final three years in their program with faculty from the Department of Epidemiology and Health Promotion in the NYU College of Dentistry. The M.S. Degree Program and the Certificate Program in Clinical Research were begun in 2001 and are fully taught within the College of Dentistry.
The department has nine full-time faculty members, including five oral epidemiologists, with other faculty holding advanced degrees in educational psychology, pediatric dentistry, and public health. Additionally, the department has eight part-time faculty members who support both teaching and research activities. Currently the department has nine graduate students. The research activities of the department were quickly established with current departmental grants totaling over $10 million.

Predoctoral Curriculum

First Year
Application of Technology in Health and Health Practice
This course helps students to become skilled managers of information in a dental setting. Students learn how to access information and become astute in evaluating that information. Students have a better understanding of the use of evidence and information in clinical decision making and learn how to frame the parameters of a clinical inquiry. Students gain foundation knowledge in basic Internet skills, word processing, presentation software, and bibliographic database searching as well as technology-based functions that enhance the activities in dental practice. Students develop expertise with the VitalBook™ and its functions.

Epidemiology and Critical Thinking in the Practice of Dentistry
This course, the core foundation course in the epidemiology and health promotion curriculum, introduces the student to the fundamental elements of epidemiology and initiates development of student skills in critically evaluating the dental and medical literature as it relates to the practice of dentistry.

Skills in Assessing the Professional Literature
This course is designed to refine the basic skills initially acquired in the Epidemiology and Critical Thinking in the Practice of Dentistry course, which were then reinforced in the Health Promotion I course and the Health Promotion II course. The course primarily consists of discussion sessions based on assigned readings as analyzed using the Literature Analysis form. Additionally, the course introduces students to the purpose, and evaluation format, of the Journal of Evidence-based Dentistry. The final examination in this course, the application of the Literature Analysis form to an article from the dental literature, also serves as the benchmark of competency as regards skills in assessing the professional literature.

Dentistry as a Science and Profession
Dental students enter the dental profession as they begin their four-year dental education. This course provides a context for the profession by presenting the history of the profession, the structure of the profession, and contemporary issues of importance to the profession. Students explore an issue of their choice and discover facts about it, the nature of the challenge it presents to the profession, and prepare a synopsis. Selected groups are asked to share their findings with the class. In addition, a symposium during the course provides students with the career path of three dentists who have developed careers other than private practice. This course coordinates with the following courses: freshman—Foundation of Professional Ethics; sophomore: Diversity, Attitudes, and Health Beliefs; and sophomore, junior, and senior—Case Studies and Seminars in Professional Ethics.

Ethical Foundation of Dentistry
This course provides the foundation for professional ethics. It defines the five principles of ethics that are valued in the profession and establishes a framework for the discussion of ethical dilemmas. An important part of the course is the NYUCD Code of Ethics and Professional Conduct as a guide for professional life as a dental student. In addition students are guided in the resolution of ethical dilemmas with a hierarchical structure of central values. The book Dental Ethics at Chairside serves as a guide for developing important concepts in professional ethics and their application. During the course, students explores ethical dilemmas faced during their dental education, personal dilemmas, as well as dilemmas commonly encountered by health care professionals in practice. The course seeks to raise students’ awareness about dentistry as a profession, the role of professions in society, and the societal dialogue about the ethics of health care professions. The ADA Principles of Ethics and Code of Professional Conduct, ethical obligations of members of the College of Dentistry community, and other documents are used as resources in this course.

The Dentist-Patient Relationship
This course provides foundation knowledge in behavioral dentistry and is designed to introduce the beginning dental professional to theories, empirical findings, and practical applications, derived from the social and behavioral sciences, relevant to the clinical practice of oral health care promotion and delivery. Each patient’s level of oral health-related behavior, quality of life, and ability to participate in his or her own oral health maintenance is strongly influenced by psychological and emotional developmental factors, cultural and social forces, and the ability of the dentist to understand and communicate effectively with him or her. Providing successful health care and health advice to anxious, demanding, uncomfortable, and, often, low-dental IQ individuals requires more than just common sense, good social skills, and social experience; a dentist who is knowledgeable in the theories and practices of behavioral dentistry is better equipped to encourage patients to accept optimal care, cooperate in their own therapy, establish appropriate preventive health habits, and benefit from their oral health care.

Starting with a biopsychosocial orientation to health care provision, this course enhances the student’s ability to conduct patient interactions in an empathetic and professional manner that is responsive to individual differences in race, ethnicity, age, gender, sexual orientation, cultural and socioeconomic status, and health beliefs. Further, students become grounded in theories and practices related to the nonpharmacological management of stress, anxiety, fear, and pain. On completion of this course, the student has acquired foundation knowledge that supports the attainment of competencies in the behavioral sciences required by the College.

Health Promotion I: Foundations for the Practice of Dentistry
This course serves as the foundation course in health promotion for the two health promotion courses that follow: one is a first year course focused on health promotion within the traditional dentist-patient relationship in the dental office, the other is a second year course which concludes the preparation for health promotion for patients in the NYU dental clinics and in the future dental practice. While the primary perspectives of this foundation course is that of the dentist within the traditional dentist-patient relationship in a dental office, several foundation lectures  present the issue of health promotion from a community perspective.

Additionally, this course continues the process of fostering student’s decision-making skills that is based on an understanding of epidemiology and critical thinking in the practice of dentistry. The skills include evaluating the relevant literature as well as applying patient-centered strategies that are feasible within private practice for the promotion of health, well-being, and enhancing the quality of life of dental patients.

Health Promotion II: Applications in Patient Care
This course continues the study of health promotion that begun in Health Promotion I course. Topics focus entirely on health promotion within the traditional dentist-patient relationship in the dental office, centering around the concept that preventing/controlling disease in patients is the dentist’s primary professional responsibility. This is accomplished by (1) applying foundation knowledge and basic methods, introduced in the course  Health Promotion I: Fundamentals for the Practice of Dentistry, to the clinical practice of preventive dentistry and general health promotion throughout the lifecycle; and (2) introducing, and providing the opportunity to practice interpersonal communication skills that are essential to the student’s ability to effectively communicate with patients.

Second Year

Diversity, Attitude, and Health Beliefs
The impact of factors such as ethnicity, cultural, gender, and sexual orientation on attitudes toward health and health care decision making is well documented. Health beliefs are a fundamental part of the promotion and prevention as well as on access and the demand for care. The rapidly changing demographics of the country, and the importance of health promotion to the well-being of the public, are an incentive for health care practitioners to become knowledgeable and sensitive to these factors because they have an impact on a patient’s health-related behaviors. To be mindful of our obligation to serve the public, the existence of health disparities is further reason for dentists to understand every significant factor that alters the outcome of health promotion strategies and therapies that we provide. The goal of this course is to provide a spectrum of “diversity.” This includes both a definition of the range of diversity as well as insight into examples of how diversity has an impact on health beliefs. During the course, using readings, videotapes, and other methods, we explore the unique qualities of several of the major groups that are part of the population of New York City. In addition, students are challenged to explore their own differences and become increasingly sensitive to the values and beliefs of other groups.

Case Study and Seminars in Ethics
This course continues the study of professional ethics that was initiated in freshman year and provides additional opportunities to apply principles of ethics to dilemmas and develop solutions in a collegial manner. Together, these courses complete the foundation knowledge needed for reflection on ethical issues. In addition, through interaction with peers, faculty, and experienced practitioners, students continue to explore the resolution of ethical dilemmas and come to a consensus with their peers. During the course, students are provided with further information, refinement, and examples of common ethical dilemmas faced by student dentists and practitioners in clinical practice.

The course reinforces a model for ethical reflection that is widely advocated within the profession. The concept of the Central Values of Practice, ethical principles valued by the profession, and the Code of Ethics of component societies are introduced and developed. Students work in small groups to come to a consensus around a case description. One period is facilitated by guest dentists with experience in resolution of ethical dilemmas encountered in private practice.

Health Promotion III: The Clinical Practice
This course is the third in the series of didactic health promotion courses. It is sequenced and designed to complete the training and preparation of the student to enter patient care in the General Dentistry Clinics, and take responsibility for his/her patients’ health and well-being. The successful completion of a 3-hour training session in the Assessment and Treatment of Tobacco Use dependence is a requirement for this course.

Third Year

Seminars in Ethics
This course is the third in the sequence of courses devoted to explore professional ethics and standards of professionalism. The student by the junior year has a firm foundation in the principles of professional ethics and experience in making application of them. This course is devoted to turning from case histories constructed from others and gain experiences from junior-year students in their own clinical experience. In addition, the course examines the peer review system used in the profession to resolve conflicts, the role of the State Board of Dentistry through the Office of Professional Discipline in attempting to protect the public from incompetent practitioners, and the role of the legal system in relation to the profession. During this course, students are introduced to each element in these three major categories. By the end of this course, it is expected that each student can demonstrate his or her competency to label ethical dilemmas and determine if an ethical principle applies to it as well as demonstrate independent knowledge about the mechanisms to assist the dentist and the public in providing and receiving oral health care that meets the professionally determined standard of care and means to resolve conflict that arises between patients and care providers.

Dentist-Patient Relationship II
This course is intended to provide the dental student, who has begun to treat patients in the clinic, with guidelines and behavioral strategies for recognizing and managing dental patients who present behavioral problems that interfere with effective treatment. Students learn how to recognize, anticipate, and diagnose problem behaviors elicited by their patients’ psychosocial condition and/or cognitive, social, or emotional reactions to treatment and the dental setting. Strategies for helping patients to constructively adapt to the demands of treatment and to behave appropriately, based on principles taken from the findings of clinical psychology, psychiatry, and related behavioral sciences, are introduced and discussed. Students are provided guidelines to help them decide when to accept or reject patients for treatment—based on the patient’s ability to cooperate and benefit from treatment—and when to refer the patient to auxiliary mental health personnel for supportive or adjunctive treatment.

Clinical Nutrition
This course is designed to prepare dental students to incorporate diet and nutrition principles and practices relative to oral health into dental practice. The fundamental principles of nutrition and diet as they relate to general and oral health covered in the freshman and sophomore years of the curriculum are built on and further addressed in management of individuals with local, systemic, and chronic disease. Clinically focused discussions on nutrition risk screening, diet evaluation and education for diseases of the oral cavity, and chronic and systemic diseases are included. Weight management, complementary medicine, fitness and nutrition misinformation are also included in the course. The role of the dentist as a multicompetent health provider is addressed via a case-based teaching approach.

Fourth Year
Case Studies in Ethics
This course continues the study of professional ethics that was initiated in freshman through junior years and provides additional opportunities to apply principles of ethics to dilemmas and develop solutions in a collegial manner.

Research
In its first two years, the Department of Epidemiology and Health Promotion has over $10 million in scientific grant funding. In 2001, the department initiated the NYU Oral Cancer RAAHP* Center grant, an NIH seven-year, $8.3 million Center for Research to Reduce Oral Health Disparities. This major health disparities center grant involves the active collaboration of 12 universities and institutions spanning the country from Boston to Puerto Rico and over to Texas with the focused goal of reducing both the incidence and mortality of oral cancer in minority populations. For further details, see the NYU Oral Cancer RAAHP Center Web site: www.nyu.edu/dental.

In addition, the department houses studies addressing a variety of oral health issues including a smoking cessation clinical trial (NIDCR/NIH funded), a New York State Oral Cancer Model grant (NIDCR/NIH funded), a Young Mothers Oral Health Education grant (New York State grant), an educational research grant assessing DVD-enhanced education, and the Tuskegee Legacy Project, a study on factors affecting the willingness of minorities to become research subjects in biomedical studies, with an emphasis on the impact of the Tuskegee syphilis study. Pending grants include a study on the effects of early childhood malnutrition in Haiti on tooth development and dental caries in the permanent dentition as well as a study on the relationship between periodontal disease and preterm, low-weight births events.

For a list of faculty, mission statement and overview, see: https://www.nyu.edu/dental/department/epidemiology/index.html

* Research for Adolescent and Adult Health Promotion.