Faculty Bibliography

BACKGROUND:The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Lack of SDOH training of dental providers on SDOH may result in suboptimal care provided to pediatric dental patients and their families. The purpose of this pilot study is to report the feasibility and acceptability of SDOH screening and referral by pediatric dentistry residents and faculty in the dental clinics of Family Health Centers at NYU Langone (FHC), a Federally Qualified Health Center (FQHC) network in Brooklyn, NY, USA. METHODS:Guided by the Implementation Outcomes Framework, 15 pediatric dentists and 40 pediatric dental patient-parent/guardian dyads who visited FHC in 2020-2021 for recall or treatment appointments participated in this study. The a priori feasibility and acceptability criteria for these outcomes were that after completing the Parent Adversity Scale (a validated SDOH screening tool), ≥ 80% of the participating parents/guardians would feel comfortable completing SDOH screening and referral at the dental clinic (acceptable), and ≥ 80% of the participating parents/guardians who endorsed SDOH needs would be successfully referred to an assigned counselor at the Family Support Center (feasible). RESULTS:The most prevalent SDOH needs endorsed were worried within the past year that food would run out before had money to buy more (45.0%) and would like classes to learn English, read better, or obtain a high school degree (45.0%). Post-intervention, 83.9% of the participating parents/guardians who expressed an SDOH need were successfully referred to an assigned counselor at the Family Support Center for follow-up, and 95.0% of the participating parents/guardians felt comfortable completing the questionnaire at the dental clinic, surpassing the a priori feasibility and acceptability criteria, respectively. Furthermore, while most (80.0%) of the participating dental providers reported being trained in SDOH, only one-third (33.3%) usually or always assess SDOH for their pediatric dental patients, and most (53.8%) felt minimally comfortable discussing challenges faced by pediatric dental patient families and referring patients to resources in the community. CONCLUSIONS:This study provides novel evidence of the feasibility and acceptability of SDOH screening and referral by dentists in the pediatric dental clinics of an FQHC network.

Background/UNASSIGNED:To examine the feasibility and acceptability of integrating a tele-mentoring component into the identification of oral lesions at the dental clinics of a Federally Qualified Health Center network. Design and Methods/UNASSIGNED:General Practice Residency faculty and residents completed research ethics courses and trained dentists to use intra-oral cameras at chairside to photograph oral lesions of patients at routine dental visits. These images were then uploaded into the patient electronic health records (EHRs) with attendant descriptions and an oral surgeon was notified, who reviewed the charts, placed his observations in the EHR, and communicated his findings via secure e-mail to the involved residents, who in turn contacted their patients regarding follow-up actions. Feasibility was assessed via checklists completed by provider participants and semi-structured interviews. Acceptability was assessed via brief exit interviews completed by patient participants. Results/UNASSIGNED:All 12 of the dentist participants reported that they had successfully provided the tele-mentoring intervention, and that the process (from EHR data entry to interaction with the oral surgeon over findings to patient referral) was clear and straightforward. Of 39 patient participants, most strongly agreed or agreed that the use of an intra-oral camera by their dentists helped them to better understand oral cancer screening (94.9%) and that dentists answered their questions about oral cancer and were able to provide them with resources (94.8%). Conclusions/UNASSIGNED:Findings support further implementation research into adapting tele-mentoring using intra-oral cameras for training dental residents to detect and identify oral lesions and educating patients about oral cancer across settings.

Background/UNASSIGNED:The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of understanding the underlying conditions that lead to COVID-19. Oral health has systemic implications in the maintenance of a healthy state. This study aimed to summarize evidence on the prevalence of oral health conditions in participants with COVID-19 and assess the associations between oral health conditions and COVID-19 related outcomes. Methods/UNASSIGNED:Article searches were conducted in five databases and the gray literature from December 1, 2019 to March 1, 2021. Studies that reported oral health conditions for participants with COVID-19 and/or examined associations between oral health and COVID-19 were included. Results/UNASSIGNED:We identified 15 articles that encompassed 5,377 participants with COVID-19 from 10 countries. Dry mouth was the most common oral health condition reported (41.0%), followed by oral lesions (38.8%), orofacial pain (18.3%), and periodontal symptoms (11.7%). Based on the pooled odds ratios (ORs), periodontal symptoms were not associated with COVID-19 positivity (OR = 1.1; 95% confidence intervals [CI], 0.73-1.65) or mortality (OR = 2.71; 95% CI, 0.64-11.51), but were associated with COVID-19 severity (OR = 3.18; 95% CI, 1.81-5.58). Conclusions/UNASSIGNED:Oral health conditions are common in participants with COVID-19 and should be considered in both the onset and progression of this disease. Knowledge in this area is still limited, and the quality of the data extracted was low. Further longitudinal studies are needed to ascertain whether oral health conditions are a consequence of infection with SARS-CoV-2 or whether they predate infection and are risk factors for COVID-19.

Many Chinese Americans experience certain barriers (e.g., low income, English as a second language, lack of insurance, cultural differences, discrimination) when they seek oral healthcare services. These barriers may contribute to health disparities by discouraging use (leading to reduced utilization) of preventive and treatment services. This research adopts a modeling approach to develop theory that accounts for dynamic relationships operating at multiple levels, from individuals to families to communities. A multi-method and multi-level modeling approach allows for the interaction of factors at different levels of aggregation. This research applies spatially explicit agent-based modeling to examine how demographic, socioeconomic, and geographic factors shape access to oral healthcare for low-income Chinese Americans in New York City. The simulation model developed in this research was used to test different intervention scenarios involving community health workers who facilitate care coordination and other health promotion activities. In addition to demographic characteristics and socioeconomic factors, this study also considers geographic factors and spatial behavior, such as distance and activity space. The overarching contribution of this study is to provide a complex systems science framework to better understand access to oral healthcare for urban Chinese Americans, toward adapting it for other racial/ethnic minority groups, by integrating health-seeking behaviors at the individual level, barriers to care at multiple levels, and opportunities for health promotion at the community level.

In New York City, the population of Chinese Americans has grown faster than that of any other minority racial/ethnic group, and now this community constitutes almost half of all Chinese Americans living in the northeastern United States. Nonetheless, scant research attention has been given to Chinese American ethnic enclaves and little is known about the health status of their residents. This study aims to help address this gap in the literature by: (1) improving our understanding of the spatial settlement of Chinese Americans living in New York City from 2000 to 2016; and (2) assessing associations between a New York City resident's likelihood of living in a Chinese American enclave and their access to health care and perceived health status, two measures of community health. In support of this aim, this study establishes a robust criterion for defining ethnic enclaves at the Census tract level in New York City as the communities of interest in this paper. An ethnic enclave is defined as an area at the Census tract level with high dissimilarity and a spatial cluster of Chinese Americans. The spatial findings were that Chinese Americans in New York City were least segregated from other Asian American residents, somewhat segregated from White residents, and most segregated from Black residents. Also, the population density of Chinese Americans increased since 2000, as reflected by their declining exposure index with other Asian Americans. Results from logistic regression indicated that the probability of living in a Chinese American enclave was negatively associated with positive self-perception of general health and positively associated with delays in receiving health care. For Chinese American residents of New York City, living in an ethnic enclave was also associated with both lower socioeconomic status and poorer community health.

OBJECTIVE:To evaluate the acceptability of a community health worker (CHW) intervention designed to improve the oral health of low-income, urban Chinese immigrant adults. BACKGROUND:Given that both dental caries and periodontitis are behaviourally mediated, biofilm-based diseases that are largely preventable with attention to regular oral hygiene practices and preventive dental visits, strategies to arrest or even heal carious lesions and high-quality maintenance care and plaque control without the need to resort to aerosol-generating surgical approaches are evidence-based best practices. Older immigrants have poorer oral health than older US-born natives, motivating the need for delivery of more effective and affordable services to this vulnerable population. MATERIALS AND METHODS/METHODS:CHWs were trained by the NYU College of Dentistry dental hygienist faculty members using dental models and flip charts to instruct patients on proper brushing and flossing techniques. In addition, they discussed the presented oral health promotion information one-on-one with patients, addressed any expressed concerns and encouraged prevention of oral conditions through regular dental visits and brushing with fluoride toothpaste. RESULTS:More than 98% of the 74 older Chinese adult participants strongly agreed/agreed that the CHWs helped them to improve how they take care of their health, the CHWs answered their questions and concerns, the information and topics were informative, and the in-person demonstrations were helpful in improving oral health. CONCLUSION/CONCLUSIONS:The health of all communities depends on access to comprehensive care, including oral health care, in the wake of COVID-19. CHW interventions are acceptable to and may reach marginalised and immigrant communities.

OBJECTIVES/OBJECTIVE:To examine racial/ethnic differences in type of SSB most frequently consumed and in correlates of youth sugar-sweetened beverage (SSB) intake. METHODS:Data were obtained from the National Health and Nutrition Examination Survey (NHANES), 2011-2016, for children and adolescents aged 5-17 years (n = 6507). The main outcome was SSB consumption (i.e., sodas, sweetened fruit drinks, nectars, sports and energy drinks, sweetened coffees and teas, enhanced waters). Mean and proportions of SSB intake were estimated accounting for complex sampling strategy and weighting. Multivariable regression models were developed for each race/ethnicity and age group. RESULTS:Two-thirds of children and adolescents reported consuming SSB on a given day. Among consumers, mean SSB consumption was greatest for Black children and White adolescents and lowest for Asian American children and adolescents. The most popular type of SSB consumed was sweetened fruit drinks among children and soda among adolescents, except among White and Mexican American children for whom soda and Black adolescents for whom sweetened fruit drinks were most popular. Female sex and water intake were negatively associated with SSB consumption across most races/ethnicities. Screen time, dentist visits, nativity, and guardian education were associated with SSB intake among a subset of races/ethnicities. CONCLUSIONS:Associations between covariates and SSB intake as well as types of beverages preferred vary by race/ethnicity, as such chronic disease policies should not be 'one size fits all'. Targeted interventions for specific groups of vulnerable youths hold promise for further reducing SSB consumption, including directing efforts towards reducing sweetened fruit drinks for Black children.

Introduction: Oral cancer remains prevalent, despite being largely preventable. The widespread use of technology at chairside, combined with advances in electronic health record (EHR) capabilities, present opportunities to improve oral cancer screening by dentists, especially for disadvantaged patients with severe health needs. Design and methods: Using a mixed-methods approach, we will evaluate the feasibility and acceptability of integrating a telementoring component into the identification of oral lesions using the following 3 methods: 1) administering provider surveys that consist of a checklist of 10 key components of the intervention based on process, and asking the dental provider subjects if each one was covered; 2) conducting semi-structured interviews informed by the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework with dental resident subjects to assess specific barriers to sustaining the intervention and strategies for addressing these barriers to facilitate integration of the intervention into the routine workflow of the dental clinics; and 3) administering brief exit interviews with patient subjects regarding the acceptability of the intervention to assess satisfaction with the use of intra-oral cameras at chairside to screen for and refer patients with oral lesions and identification of these oral lesions via EHR and secure e-mail tele-mentoring with an oral pathology expert. Expected impact of the study for public health: If successful, then later clinical trials will maximize the external validity of the intervention and facilitate the widespread implementation and dissemination of the model for the teaching of dentists and residents, with the ultimate goal of improving patient care.

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course. Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.