The Establishment of the School of Public Health at the State University of New York,Downstate Medical Center: The First Nationally Accredited School of Public Health in a Public University in New York City

The State University of New York (SUNY), Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve students entered the program in June 2002, and currently some 110 MPH students and 12 Doctor of Public Health (DrPH) students are enrolled. This article describes the long and complex process of transforming the original MPH degree program, with its single focus on urban and immigrant health, with a student enrollment of 12 and 8 full-time faculty, into a school of public health with a large student enrollment of 122 students, 25 full-time faculty, five MPH degree tracks, and four DrPH degree tracks. The process of establishing the SUNY Downstate School of Public Health in 2009 from its inception as an MPH program in 2001 spanned a period of 8 years. This process was guided by a commitment to two basic principles. The first was to maintain the original 2005 program accreditation by the Council on Education for Public Health (CEPH). The second was to sequentially secure accreditation for all subsequent four MPH and four DrPH degree tracks through CEPH’s procedure of substantive change approval. This policy assured continuous national CEPH accreditation of the original Urban and Immigrant Health MPH degree track and all added degree programs. The 5-year period following the initial CEPH accreditation of the MPH program in 2005 was one of intense development during which all of the essential elements for CEPH accreditation of a school of public health were put into place. This rapid development was made possible by the vision and full support of Downstate’s president, John C. LaRosa, MD, FACP, and the dedicated efforts of many. This included the students, faculty, staff, and administrators of the School of Public Health, the school’s Community Advisory Group, several external advisors, and many in the medical center’s Central Administration, College of Medicine, School of Graduate Studies, College of Nursing, College of Health Related Professions, and the University Hospital of Brooklyn. From the very beginning of the planning phase for an MPH program and through the ultimate accreditation of the School of Public Health in 2010, broad participation was solicited from all major units in the medical center. Thus, the MPH program became a center-wide initiative and not merely that of the College of Medicine’s Department of Preventive Medicine and Community Health. This broad participation has been continuously maintained through the involvement of leaders of other medical center academic units and the University Hospital of Brooklyn in the program’s and then the school’s standing and ad hoc committees, and in other activities as well. Similarly, community representation has been maintained, some through formal linkages relevant to the practical field experiences required of all students. In October 2010, the Board of Councilors of CEPH accredited the SUNY Downstate School of Public Health for a 5-year period through 31 December 2015. The accreditation of the school was a major milestone for Downstate, Brooklyn, and New York City. The SUNY Downstate School of Public Health is the first CEPH accredited school of public health in the history of Brooklyn, and only the second such school in New York City. It is also the first CEPH accredited school of public health at a publicly supported university in New York City. The school has already had a major impact on improving the health and well-being of the people of Brooklyn through its numerous collaborative community-based health promotion and disease prevention programs.     

Screening for cervical and breast cancer among Caribbean immigrants

A screening program for cervical and breast cancer, focused on immigrant Caribbean women, was carried out at neighborhood sites (churches, schools, etc.) in a low-income area of Brooklyn, New York.The yield of abnormal Pap tests was 13.3/1000 women screened; the yield of breast cancer was 2.2/1000 women examined. Approximately half of the Haitian immigrants (N=361) had no prior Pap test, compared to one-quarter of the English-speaking Caribbean immigrants (N=228) and one-tenth of the U.S.-born Black women (N=264). Only 47% of Haitian women had a regular source of health care compared to 74% of the English speaking Caribbean women and 83% of the U.S.-born Black women. Haitian women were much less likely to practice breast self-examination or to use contraception than were U.S.-born Black women.This program reveals significant needs for preventive health services among low-income Caribbean immigrant women, and demonstrates that selective neighborhood-site programs can be effective in reaching those in need.Rachel G. Fruchter, MPH, PhD, is Assistant Professor, Department of Obstetrics and Gynecology. Carolyn Wright, MS, is Community Health Educator/Coordinator, Department of Preventive Medicine and Community Health. Barbara Habenstreit, MA, is Assistant to the Chairman, Department of Preventive Medicine and Community Health. Jean Claude Remy, MD, is Assistant Professor, Department of Obstetrics and Gynecology. John G. Boyce, MD, is Professor, Department of Obstetrics and Gynecology. Pascal James Imperato, MD, MPH & TM is Professor and Chairman, Department of Preventive Medicine and Community Health, State University of New York, Downstate Medical Center.This research was supported by grants from the New York Community Trust and the Morgan Guaranty Trust Company of New York Charitable Trust     

The Correlation between Global Health Experiences in Low-Income Countries on Choice of Primary Care Residencies for Graduates of an Urban US Medical School

This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57 % of the students who completed the elective matched to primary care residences, which was significantly higher than the 44 % for the remainder of Downstate''s medical student class (p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed.     

Teaching Public Health Practitioners about Health Communication: The MPH Curriculum Experience

The dissemination of health information to the public often occurs through the mass media. Media strategies as a component of behavior change assume knowledge of communication theories and methods by public health practitioners. We surveyed the curricula of 52 accredited graduate programs leading to the Master's in Public Health (MPH) degree to assess their communication component. Graduate bulletins for admission year 1996 were examined for public health mission statement, goals and objectives of the MPH training program, and for course titles. Courses were identified as having a communication focus if the terms communication, information, marketing or media were used in the title. There were a total of 82 communication courses offered, with 65 courses in 26 Schools of Public Health (SPH), 13 courses in 18 Community Health and Preventive Medicine departments (CHPM), and 4 courses in 8 Community Health Education departments (CHE). The difference in mean number of health communication courses was significant by type of MPH program (p < 0.003) with SPH offering an average of 3 courses, CHPM departments offering an average of 1 course, and CHE offering an average of 0.5 course. The distribution of communication courses ranged from 10 courses to 0 courses per program. Seven SPH offered 3 or more communication courses, whereas 5 SPH offered no health communication courses in the MPH curriculum. These data point to a shortcoming in the training of MPH students in health communication theory and skills as ascertained by course titles in graduate bulletins.     

Health education in Nigerian secondary schools

A survey of 600 secondary school teachers and 120 secondary school administrators was conducted in Oyo State, Nigeria, to identify their attitudes and practices regarding school health education. Nearly all teachers and administrators felt that health education is important and should be an integral part of the curriculum. None-theless, there were few resources and little curriculum time devoted to health education. Since many of the health problems of developing countries can be addressed by enhancing the health knowledge of the populace, health education in the schools of such countries deserves more emphasis.Amos K. Fabiyi, MPH, PhD is Lecturer and Consultant (Health Education), Department of Community Health and Nutrition, Faculty of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria.Daniel S. Blumenthal, MD, MPH is Professor and Chairman, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Dr., Atlanta GA 30310.     

Feasibility of an Extended MPH Degree Program for fully employed practicing health professionals.

This report describes the first four years of operation of the Extended MPH Degree Program of the University of Washington School of Public Health and Community Medicine and the features that might explain its initial success. The format of the curriculum is radically different from the traditional two-year program of studies leading to the master of public health degree. Over a three-year span of intensive, on-campus courses and seminars, students are able to fulfill all academic and institutional requirements necessary for the MPH degree. Many more applicants have enrolled for the Extended Degree Program than for the regular MPH program. The 94 students who have matriculated into the program are employed mainly in government agencies in eight western states and British Columbia; most have their prior professional training in nursing and medicine with a median of nine years professional experience. The academic performance of these students is comparable to that of regular full-time MPH program students. The administrative, fiscal, and instructional problems raised by such a transformation have been overcome and the demand for the program and our experience to date suggest that extended MPH degree programs are both feasible and desirable.     

Epidemiology core competencies for Master of Public Health students

Competency-based education for public health professionals has been recommended by the Institute of Medicine. The Association of Schools of Public Health has developed a set of academic core competencies that it recommends that all Master of Public Health (MPH) students should possess prior to graduation. This article discusses the processes and reasoning used by the workgroup that prepared the epidemiology subset of MPH core competencies that appear in the association's 2006 report. These academic core competencies are complementary to but distinct from the specialist competencies that students should develop in their major field. The authors emphasize the importance of ongoing refinement of the core competency model with participation from both public health academics and public health practitioners.     

Second year medical student opinion about public health and a second year course in preventive medicine and community health

The results of five annual surveys of second year medical students over an eight year period of time (1978–1985) concerning perceptions and attitudes toward public health and a course in preventive medicine and community health are presented. The questionnaire format was a combined fixed alternate and free response type and was structured to require only ten to 15 minutes for its completion. Participation rates were generally high varying from 60.2% (1980) to 93.8% (1985). The majority of students in all years favorably evaluated most components of structure, content and presentation of the course. It was found that opinions about the course can be modified by the introduction of variables that are unrelated to the scope of the quality of the course as occurred in 1979, with a difficult midterm examination. Student anger over this examination was translated and expressed as negative opinion about many other aspects of the course which in other years were highly rated. This finding underscores the vulnerability of surveys of subjective opinion and demonstrates that course evaluations must include other objective aspects in addition to student perceptions.Pascal James Imperato, M.D., M.P.H. & T.M., is Professor and Chairman of the Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Joseph Feldman, Dr. P.H. is Professor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.Kamran Nayeri, B.A. is Instructor, Department of Preventive Medicine and Community Health, State University of New York Health Science Center at Brooklyn.     

Service learning within the University of Connecticut Master of Public Health Program

Since 2005, the University of Connecticut Master of Public Health Program has administered its required service-learning practicum through coordinated activities of second-year students assigned to examine a pressing public health issue in Connecticut. The initiative underscores our program's commitment to preparing students for careers as leaders in applied practice and our emphasis on collaboration. Our thematic approach links content across the core curriculum, provides a venue where students demonstrate mastery of academic principles, and affirms values of public responsibility and common purpose. Projects have focused on public health concerns associated with childhood obesity, health literacy, and living with disabilities. Working together and with community-based preceptors, students estimate service needs, assess available program/service capacity, and recommend policy options. Results are compiled within a written report that accompanies a state legislative hearing. This article presents the rationale and organization of our service-learning practicum, and describes how the experience affects the education and personal growth of students and contributes positively to the community at large.     

Predictors of Partner Notification for C. trachomatis and N. gonorrhoeae: An Examination of Social Cognitive and Psychological Factors

Efforts to control chlamydial and gonococcal infections include notifying eligible sexual partners of possible infection, primarily by asking the diagnosed patient to notify their partners. This approach, known as patient referral, is widely used but poorly understood. The current study examined psychosocial and cognitive factors associated with patient referral among an urban, minority sample of 168 participants recently diagnosed with Chlamydia trachomatis or Neisseria gonorrhoeae. At a follow-up interview 1-month from diagnosis, participants were more likely to have notified all eligible partners if they had greater intention to notify at baseline (OR = 3.72; 95% CI = 1.34, 10.30) and if they had only one partner at baseline (OR = 4.08; 95% CI = 1.61, 10.31). There were also gender differences as well as differences based on type of partner (i.e., regular, casual, one-time). The implications of these findings for the design of programs to promote patient referral for sexually transmitted infections are discussed. Schwartz, Malka, Augenbraun, McCormack, and Wilson are with the State University of New York, Downstate Medical Center, Brooklyn, NY, USA; Rubin is with the New York City Department of Health, Bureau of STD Control, New York, NY, USA; Rubin, Hogben, and Liddon are with the Centers for Disease Control and Prevention, Atlanta, GA, USA; Schwartz is with the Department of Preventive Medicine and Community Health, SUNY Downstate Medical Center, Box 1240, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.     

New Public Health education in the Republic of Macedonia: expectations, experiences and perspectives

Development of a strategy in public health (PH) education is crucial for Macedonia in providing modern education for actual PH practice. Establishing a School of Public Health (SPH) is vital for a country in a health transition with high rates of preventable diseases. The main strategic goals in modern PH education in Macedonia should be capacity building, improving the competencies of PH professionals, serving communities, participating in the policy, and partnership development. Expectations were expressed through two key points: strengthening institutional capacity in the area of PH and institutional development of SPH. The organizational structure of the new Center of Public Health is based on existing human resources and infrastructure. Medical Faculty initiated development of a postgraduate PH teaching program [Master of Public Health (MPH)] provided by the newly formed Center of Public Health within the Medical Faculty Skopje. The Macedonian MPH program has been developed with modular-type courses as a part-time teaching program in four semesters within a 2-year period. This program is designed to cover all the basics of PH sciences and practice, including basic and elective courses, workshops, research forum. and master's thesis with a credit transfer system in PH education. The main assets for SPH development are knowledge and skills of the constantly improving teaching staff. Successful preliminary evaluation of the Macedonian SPH project, being qualified “as a model for SPH development,” led to full Association of Schools of Public Health in the European Region (ASPHER) membership. Sustainability of this program will require continuing support although a remarkable beginning has been achieved. The next strategic goal is continuing development of SPH with fiscal and academic autonomy and preparing formal ASPHER Public Health Education European Review (PEER). This SPH recognized the main communicating message of the New Public Health: “Moving with the time.” New Public Health is determined by a dual approach: to be modern, and to grow and to build the tradition in PH education. The development of Macedonian SPH represents a new orientation toward science, philosophy, culture, and life and promotes new spirit and movement in PH in this region of Europe.     

Development of a Master of Public Health programme in Tirana, Albania

In 2001, two Albanian institutions, the Department of Public Health, Faculty of Medicine, University of Tirana and the National Institute of Public Health obtained membership to the Association of Schools of Public Health for the European Region (ASPHER). Since 2000, these two institutions have been members of the Public Health for South Eastern Europe (PH-SEE) network. Furthermore, in the fall of 2001, the Open Society Institute (OSI) and ASPHER launched a project that culminated in the establishment of a School of Public Health (SPH) and the commencement of the first Master of Public Health (MPH) programme in Tirana. The MPH programme began in December 2005 and enrolled 32 students from different backgrounds. A suitable start for the development of the MPH programme was the implementation of key modules developed by the European MPH programme. In addition, specific modules reflecting the needs of Albania were designed according to the preferences and the heterogeneous lecturing faculty involved in public health training. International guest lecturers delivered other modules, with ASPHER and the PH-SEE network offering an excellent solution for complementary modules in different public health disciplines. However, the newly established SPH in Albania should now strive for other postgraduate teaching programmes, undergraduate programmes, and especially service training and continuing education.     

Enhancing student practicum opportunities: the outbreak investigation option.

An outbreak investigation practicum option for graduate students at the University of Washington School of Public Health and Community Medicine has three goals of education, scientific investigation, and exposure to operations of public health agencies. Over a six-year period, 48 students performed 40 outbreak investigations in collaboration with adjunct faculty based in local public health agencies. An outbreak investigation practicum at Yale University had similar goals, but the rapid-response team approach there generally involved one regular faculty member and a team of graduate students. In either program, the level of faculty involvement necessary for outbreak investigations is sustainable only if the faculty value public health practice as part of the school's mission. Since public health students need to acquire many practical skills, a short outbreak investigation practicum experience should not be viewed in isolation, but rather should be one of a variety of practicum offerings available to students at schools of public health.     

Review of MPH Practicum Requirements in Accredited Schools of Public Health

Accreditation criteria by the Council on Education for Public Health (CEPH) state that prior to graduation, Masters of Public Health (MPH) students must demonstrate the application of knowledge and skills through a practice experience, commonly called the “Practicum.” The purpose of this research was to review those MPH Practicum requirements. Practicum guidelines from US-based schools of public health that were accredited as of October 2011 were reviewed. Data on each Practicum’s level of coordination, timing, and credit and contact hours as well as information about written agreements, preceptors, and how the Practicum was graded were collected. Seventy-four Practicums in 46 accredited schools of public health were reviewed. The majority (85 %) of accredited schools controlled the Practicum at the school-level. Among the Practicums reviewed, most did not require completion of any credit hours or the MPH core courses (57 and 74 %, respectively) prior to starting the Practicum; 82 % required written agreements; 60 % had stated criteria for the approval of preceptors; and 76 % required students to submit a product for grading at the conclusion of the Practicum. The results of this research demonstrate that the majority of accredited schools of public health designed Practicum requirements that reflect some of the criteria established by CEPH; however, issues related to timing, credit and contact hours, and preceptor qualifications vary considerably. We propose that a national dialogue begin among public health faculty and administrators to address these and other findings to standardize the Practicum experience for MPH students.     

Planning the teaching of community health (COPC) in an MPH program

The Community Medicine approach, focussed on an active assessment of health status with a subsequent provision of health care directed to the community as a whole, is recommended today as a means for addressing the fragmentation of health services. In parallel, in recent years the Community Medicine approach has been incorporated in a growing number of health academic institutions. In this paper it is suggested that the teaching of Community Medicine should be an active process in a practical environmental in which students could be involved with real life situations. Our teaching methods are illustrated by the experience of the Community Oriented Primary Care (COPC) Workshop of the School of Public Health and Community Medicine in Jerusalem. This Workshop is included in the curriculum after the core courses in the Israeli and in the International MPH Program at the Braun SPH. The central component of the workshop are the workgroups of 6-8 students with the assistance of a tutor member of the School's staff. The group, resembling a health team, focussed its work in the assignment of planning a proposal for the development of a community health program in the students' communities. The workshop is an illustration of the problem-based learning method carried out by public health workers of different professions background and with diverse practical experience reproducing a real life situation in a classroom environment. Repeated evaluations done by students has shown a positive assessment as measured by a reported adequate acquisition of knowledge, having an useful experience and practicing skills.     

Clinical validation of a nutritional risk index

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.John M. Prendergast, MD, MPH is Medical Director, Program on Aging, Mercy Hospital, Pittsburgh, PA 15219; Rodney M. Coe, PhD is Professor, Department of Community Medicine, St. Louis University School of Medicine and Education Coordinator, Geriatric Research, Education and Clinical Center (GRECC), VA Medical Center, St. Louis, MO 63104; M. Noel Chavez, PhD, RD is Assistant Professor, Department of Community Health Sciences, School of Public Health, University of Illinois, Chicago, IL 60612; James C. Romeis, PhD is Associate Professor, Center for Health Services, Education and Research, St. Louis University and Coordinator, Health Services Research and Development, VA Medical Center, St. Louis, MO 63104; Douglas K. Miller, MD is Assistant Professor, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO 63104; Fredric D. Wolinsky, PhD is Professor, Department of Sociology, Texas A&M University, College Station, TX 77843.This project was supported in part by grant #84-017 from the Veterans Administration and by K07-AG-00302 and K04-AG00328 from the National Institute on Aging.     

Teaching statistics in schools of public health

Biostatistics plays an important role in the education and training of public health students. The aim of this paper is to discuss issues associated with the teaching of biostatistics for master in public health (MPH) students. It characterizes the student body, describes the aims of teaching statistics, and considers how and what should be taught. This paper reflects my experience in both coordinating and teaching biostatistics in the Braun School of Public Health, which is part of the Hebrew University-Hadassah Medical Center. The school runs two MPH programs: an Israeli program and an international one.     

A Third World International Health Elective for U.S. Medical Students: The 25-Year Experience of the State University of New York, Downstate Medical Center

The Department of Preventive Medicine and Community Health at the State University of New York, Downstate Medical Center instituted a 6-8 weeks third world international health elective for fourth year medical students in 1980. Since that time, some 217 students have participated in a score of third world countries. However, the most popular sites have been India, Kenya and Thailand. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a cross-cultural experience. The emphasis in this elective is on public health, preventive medicine and primary care. There are high levels of student competition for this elective. However, interest in it has been affected by world events such as the terrorist attacks of September 11, 2001 and the recent outbreak of Severe Acute Respiratory Syndrome (SARS) in Asia. Recent annual applications for this elective have been twenty-five and more out of a class of two hundred students. Annual acceptance rates vary considerably, ranging from as low as 27.2% in 1995-1996 to a high of 81.8% in 1987-1988. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who overall have performed well at overseas sites. Student rated satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This includes individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced in cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local hospital staff and the medical school class. This Brooklyn experience in cross-cultural understanding has been cited by many participants as having been the best preparation for functioning in a foreign culture. In the late 1990s, we revised our procedures concerning health preparations so as to address the risk of HIV/AIDS and other blood borne diseases. In addition, we also adopted an Agreement and Release form containing 15 provisions requiring risk and responsibility assumption on the part of the student participants. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray travel costs. In 1998, Joshua H. Weiner of the class of 1941 created a sizeable endowment in the Alumni Fund of the College of Medicine to support students participating in this elective. In 2001, Sonja K. Binkhorst, Assistant Professor of Psychiatry at the Downstate Medical Center, arranged for some financial support for women medical students through the LSK Foundation and the American Medical Women's Association. During the years that this elective has been offered, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for students.     

城市公共卫生发展现况及对策——二○○七上海公共卫生国际研讨会报道

2007年12月11-14日,以"城市与公共卫生"为主题的"二○○七上海公共卫生国际研讨会"在上海仕格维丽致酒店召开。此次国际研讨会由上海市卫生局主办;上海市疾病预防控制中心、上海市预防医学研究院和上海市预防医学会承办;《环境与职业医学》杂志编委会、美国加州卫生局、美国《环境与健康展望》杂志、复旦大学公共卫生学院协办。共有来自6个国家的38位中外专家和250多名代表出席会议。与会者就"环境、基因与健康"、"政策、管理与服务"、"疾病预防与控制"等主题进行了深入交流。本次研讨会为各国同道构建了一个卓有成效的公共卫生交流平台,必将对上海乃至全国城市公共卫生事业的可持续发展和最终提高城市居民健康水平产生巨大的影响。