Donna Shelley
Donna Shelley
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Professor of Public Health Policy and Management
Co-Director of the Global Center for Implementation Science
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Professional overview
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Dr. Shelley is a tenured Professor in the Department of Public Health Policy and Management and the founding Co-Director of the Global Center for Implementation Science at the NYU School of Global Public Health. She conducts translational, population-based, and policy-relevant research that aims to accelerate dissemination and implementation of tobacco use treatment in safety net health care delivery systems and implementation of tobacco control policies. This research has been funded by the National Cancer Institute (NCI), National Institute of Drug Abuse, National Heart, Lung, and Blood Institute, the Agency for Healthcare Research and Quality, and the New York State Department of Health.
Dr. Shelley’s implementation research focuses on building the evidence for effective theory-driven strategies that target barriers to implementation and sustainability of evidence-based tobacco use treatment in primary care settings in the U.S. and Viet Nam. Her research is also addressing the growing dual burden of noncommunicable and communicable diseases in LMICs and, specifically, the health impact on people living with HIV/AIDS. Her policy research includes a completed NCI-funded study that evaluated the impact of the US federally mandated smoke-free public housing policy on exposure to secondhand smoke and explored the implementation process to identify strategies with the potential to improve the process and maximize public health impact.
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Education
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BS, University of Pennsylvania, PAMD, Mount Sinai School of Medicine, NYMPH, Health Policy and Management, Columbia University's Mailman School of Public Health, NY
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Areas of research and study
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Health Systems StrengtheningImplementation scienceTobacco CessationTobacco Policy
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Current Research
- Policy
Purtle J, Moucheraud C, Yang LH, Shelley D. Four very basic ways to think about policy in implementation science. Implement Sci Commun. 2023 Sep 12;4(1):11
Shelley D. Kyriakas C, McNeill A, Murray R, Nilan K, Sherman SE, Raw M. Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis. Addiction. 2020;115:527-533
Thorpe L, Anastasiou E, Wyka K, Tovar A, Gill E, Rule A, Elbel B, Kaplan SA, Jiang N, Gordon T, Shelley D. Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy. JAMA Netw Open. 2020 Nov 2;3(11):e2024385
Tobacco cessationHoang THL … Shelley D. Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV: A Systematic Review and Meta‑analysis. AIDS and Behavior. 2024 https://doi.org/10.1007/s10461-024-04279-1
Shelley et al. WHO Knowledge Summary: Tobacco and HIV https://iris.who.int/bitstream/handle/10665/378509/9789240096868-eng.pdf
Ostroff JS, Shelley DR, Chichester LA, King JC, Li Y, Schofield E, Ciupek A, Criswell A, Acharya R, Banerjee SC, Elkin EB, Lynch K, Weiner BJ, Orlow I, Martin CM, Chan SV, Frederico V, Camille P, Holland S, Kenney J. Study protocol of a multiphase optimization strategy trial (MOST) for delivery of smoking cessation treatment in lung cancer screening settings. Trials. 2022 Aug 17;23(1):664.
Health systems improvement and Implementation ScienceNwaozuru U, Murphy P, Richard A, …Shelley D, Airhihenbuwa C, Ogedegbe G, Ezechi O, Iwelunmor J. The sustainability of health interventions implemented in Africa: an updated systematic review on evidence and future research perspectives. Implement Sci Commun. 2025 Apr 8;6(1):39. https://pmc.ncbi.nlm.nih.gov/articles/PMC11980204/
Gaeta Gazzola M, Torsiglieri A, Velez L, Blaufarb S, Hernandez P, O'Grady MA, Blackburn J, Florick J, Cleland CM, Shelley D, Doran KM A community-academic partnership to develop an implementation support package for overdose prevention in permanent supportive housing. J Subst Use Addict Treat. 2025 Jan;168:209533. doi: 10.1016/j.josat.2024.209533. Epub 2024 Oct 9.PMID: 39389548
Kilbourne AM, Geng E, Eshun-Wilson I, Sweeney S, Shelley D, Cohen DJ, Kirchner JE, Fernandez ME, Parchman ML. How does facilitation in healthcare work? Using mechanism mapping to illuminate the black box of a meta-implementation strategy. Implement Sci Commun. 2023 May 16;4(1):53.
Parascandola M, Neta G, Salloum RG, Shelley D, Rositch AF.JCO Glob Oncol. Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control.2022 Aug;8:e2200054.
Shelley D, Alvarez GG, Nguyen T, Nguyen N, Goldsamt L, Cleland C, Tozan Y, Shuter J, Armstrong-Hough M. Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study. Implement Sci Commun. 2022 Oct 17;3(1):112.
Shelley D, Wang VH, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med. 2022 Nov 21;12(11):1076-1083.
Shelley D, Cleland CM, Nguyen T, VanDevanter N, Siman N, Van Minh H, Nguyen N. Nicotine Tob Res. Effectiveness of a Multicomponent Strategy for Implementing Guidelines for Treating Tobacco Use in Vietnam Commune Health Centers 2022 Feb 1;24(2):196-203.
Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health. 2022 Aug-Sep;17(9):1868-1882
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Publications
Publications
Attributes of High-Performing Small Practices in a Guideline Implementation : A Multiple-Case Study
AbstractNguyen, A. M., Cuthel, A. M., Rogers, E. S., Van Devanter, N. L., Pham-Singer, H., Shih, S., Berry, C. A., & Shelley, D. (n.d.).Publication year
2020Journal title
Journal of Primary Care and Community HealthVolume
11AbstractObjective: HealthyHearts NYC was a stepped wedge randomized control trial that tested the effectiveness of practice facilitation on the adoption of cardiovascular disease guidelines in small primary care practices. The objective of this study was to identify was to identify attributes of small practices that signaled they would perform well in a practice facilitation intervention implementation. Methods: A mixed methods multiple-case study design was used. Six small practices were selected representing 3 variations in meeting the practice-level benchmark of >70% of hypertensive patients having controlled blood pressure. Inductive and deductive approaches were used to identify themes and assign case ratings. Cross-case rating comparison was used to identify attributes of high performing practices. Results: Our first key finding is that the high-performing and improved practices in our study looked and acted similarly during the intervention implementation. The second key finding is that 3 attributes emerged in our analysis of determinants of high performance in small practices: (1) advanced use of the EHR; (2) dedicated resources and commitment to quality improvement; and (3) actively engaged lead clinician and office manager. Conclusions: These attributes may be important determinants of high performance, indicating not only a small practice’s capability to engage in an intervention but possibly also its readiness to change. We recommend developing tools to assess readiness to change, specifically for small primary care practices, which may help external agents, like practice facilitators, better translate intervention implementations to context.Attributes of higher- and lower-performing hospitals in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program implementation : A multiple-case study
AbstractStevens, E. R., Fawole, A., Rostam Abadi, Y., Fernando, J., Appleton, N., King, C., Mazumdar, M., Shelley, D., Barron, C., Bergmann, L., Siddiqui, S., Schatz, D., & McNeely, J. (n.d.).Publication year
2025Journal title
Journal of Substance Use and Addiction TreatmentVolume
168AbstractIntroduction: Six hospitals within the New York City public hospital system implemented the Consult for Addiction Treatment and Care in Hospitals (CATCH) program, an interprofessional addiction consult service. A stepped-wedge cluster randomized controlled trial tested the effectiveness of CATCH for increasing initiation and engagement in post-discharge medication for opioid use disorder (MOUD) treatment among hospital patients with opioid use disorder (OUD). The objective of this study was to identify facility characteristics that were associated with stronger performance of CATCH. Methods: This study used a mixed methods multiple-case study design. The six hospitals in the CATCH evaluation were each assigned a case rating according to intervention reach. Reach was considered high if ≥50 % of hospitalized OUD patients received an MOUD order. Cross-case rating comparison identified attributes of high-performing hospitals and inductive and deductive approaches were used to identify themes. Results: Higher-performing hospitals exhibited attributes that were generally absent in lower-performing hospitals, including (1) complete medical provider staffing; (2) designated office space and resources for CATCH; (3) existing integrated OUD treatment resources; and (4) limited overlap between the implementation period and COVID-19 pandemic. Conclusions: Hospitals with attributes indicative of awareness and integration of OUD services into general care were generally higher performing than hospitals that had siloed OUD treatment programs. Future implementations of addiction consult services may benefit from an increased focus on hospital- and community-level buy-in and efforts to integrate MOUD treatment into general care.Barriers and Facilitators in the Recruitment and Retention of More Than 250 Small Independent Primary Care Practices for EvidenceNOW
AbstractCuthel, A., Rogers, E., Daniel, F., Carroll, E., Pham-Singer, H., & Shelley, D. (n.d.).Publication year
2020Journal title
American Journal of Medical QualityVolume
35Issue
5Page(s)
388-396AbstractFew studies have examined factors that facilitate recruitment of small independent practices (SIPs) (Barriers and facilitators to expanding the role of community health workers to include smoking cessation services in Vietnam : A qualitative analysis
AbstractShelley, D., Nguyen, L., Pham, H., VanDevanter, N., & Nguyen, N. (n.d.).Publication year
2014Journal title
BMC health services researchVolume
14Issue
1AbstractBackground: Despite high smoking rates, cessation services are largely unavailable in Vietnam. This study explored attitudes and beliefs of community health workers (CHWs) towards expanding their role to include delivering tobacco use treatment (TUT), and potential barriers and facilitators associated with implementing a strategy in which health centers would refer patients to CHWs for cessation services. Methods: We conducted four focus groups with 29 CHWs recruited from four district community health centers (CHCs) in Hanoi, Vietnam. Results: Participants supported expanding their role saying that it fit well with their current responsibilities. They further endorsed the feasibility of serving as a referral resource for providers in local CHCs expressing the belief that CHWs were "more suitable than their clinical colleagues" to offer cessation assistance. The most frequently cited barrier to routinely offering cessation services was that despite enacting a National Tobacco Control Action plan, cessation is not one of the national prevention priorities. As a result, CHWs have not been "assigned" to help smokers quit by the Ministry of Health. Additional barriers included lack of training and time constraints. Conclusion: Focus groups suggest that implementing a systems-level intervention that allows providers to refer smokers to CHWs is a promising model for extending the treatment of tobacco use beyond primary care settings and increasing access to smoking cessation services in Vietnam. There is a need to test the cost-effectiveness of this and other strategies for implementing TUT guidelines to support and inform national tobacco control policies in Vietnam and other low-and middle-income countries.Barriers to dental services for older adults
AbstractMontini, T., Tseng, T. Y., Patel, H., & Shelley, D. (n.d.).Publication year
2014Journal title
American Journal of Health BehaviorVolume
38Issue
5Page(s)
781-788AbstractObjective: To explore barriers to older adults' accessing dental care. Methods: We performed oral exams on 184 community-dwelling older adults; those who needed dental care were contacted 6-12 weeks later to determine if they were able to access treatment. Those who could not access care were interviewed regarding barriers. Results: Of those examined, 89% needed dental treatment. After 6 weeks, 52% had received treatment, 48% had not. Those unable to access treatment had fewer teeth, were more likely to be referred regarding dentures, and were less likely to have a dentist. Reasons cited for not accessing care among the 35 participants we interviewed included a lack of finances, transportation, or assistance in navigating dental service. Conclusions: Older adults have a high burden of oral disease and access barriers remain.Barriers to engagement in implementation science research : A national survey
AbstractStevens, E. R., Shelley, D., & Boden-Albala, B. M. (n.d.).Publication year
2021Journal title
Translational Behavioral MedicineVolume
11Issue
2Page(s)
408-418AbstractLow levels of engagement in implementation science (IS) among health researchers is a multifaceted issue. With the aim of guiding efforts to increase engagement in IS research, we sought to identify barriers to engagement in IS within the health research community. We performed an online survey of health researchers in the United States in 2018. Basic science researchers were excluded from the sample. IS engagement was measured by self-reported conduct of or collaboration on an IS study in the past 5 years. Potential barriers tested were (a) knowledge and awareness of IS, (b) attitudes about IS research, (c) career benefits of IS, (d) research community support, and (e) research leadership support. We performed simple logistic regressions and tested multivariable logistic regression models of researcher characteristics and potential barriers as predictors of IS engagement. Of the 1,767 health researchers, 49.7% indicated they engaged in an implementation study. Being able to define IS (aOR 3.42, 95%CI 2.68-4.36, pBody weight and length of residence in the US among Chinese Americans
AbstractYeh, M. C., Fahs, M., Burton, D., Yerneni, R., Parikh, N. S., & Shelley, D. (n.d.).Publication year
2009Journal title
Journal of Immigrant and Minority HealthVolume
11Issue
5Page(s)
422-427AbstractBackground: It has been shown that as immigrants' length of residence increases, so does their weight. However, little is known about factors associated with weight status among Chinese Americans, one of the fastest growing immigrant populations in the US. Methods: Baseline datafrom a National Cancer Institute-funded longitudinal study involving a multi-stage probability sample of Chinese Americans residing in two communities in New York City were collected. Results: Chinese Americans had a low BMI (mean = 22.81) and a lower proportion of obese individuals compared with other ethnic groups in the US reported in the literature. While the prevalence of being overweight (21%) and obese (2%) was low, length of residence was positively associated with weight status (P < 0.005). Conclusions: Innovative strategies to help Chinese Americans maintain healthy weight status and to prevent them from becoming overweight and obese are needed.Cardiovascular Disease Guideline Adherence : An RCT Using Practice Facilitation
AbstractShelley, D., Gepts, T., Siman, N., Nguyen, A. M., Cleland, C., Cuthel, A. M., Rogers, E. S., Ogedegbe, O., Pham-Singer, H., Wu, W., & Berry, C. A. (n.d.).Publication year
2020Journal title
American journal of preventive medicineVolume
58Issue
5Page(s)
683-690AbstractIntroduction: Practice facilitation is a promising practice transformation strategy, but further examination of its effectiveness in improving adoption of guidelines for multiple cardiovascular disease risk factors is needed. The objective of the study is to determine whether practice facilitation is effective in increasing the proportion of patients meeting the Million Hearts ABCS outcomes: (A) aspirin when indicated, (B) blood pressure control, (C) cholesterol management, and (S) smoking screening and cessation intervention. Study design: The study used a stepped-wedge cluster RCT design with 4 intervention waves. Data were extracted for 13 quarters between January 1, 2015 and March 31, 2018, which encompassed the control, intervention, and follow-up periods for all waves, and analyzed in 2019. Setting/participants: A total of 257 small independent primary care practices in New York City were randomized into 1 of 4 waves. Intervention: The intervention consisted of practice facilitators conducting at least 13 practice visits over 1 year, focused on capacity building and implementing system and workflow changes to meet cardiovascular disease care guidelines. Main outcome measures: The main outcomes were the Million Hearts’ ABCS measures. Two additional measures were created: (1) proportion of tobacco users who received a cessation intervention (smokers counseled) and (2) a composite measure that assessed the proportion of patients meeting treatment targets for A, B, and C (ABC composite). Results: The S measure improved when comparing follow-up with the control period (incidence rate ratio=1.152, 95% CI=1.072, 1.238, pChallenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment : a qualitative analysis
AbstractShelley, D., Kyriakos, C., McNeill, A., Murray, R., Nilan, K., Sherman, S. E., & Raw, M. (n.d.).Publication year
2020Journal title
AddictionVolume
115Issue
3Page(s)
527-533AbstractAim: To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Design: Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Setting and participants: Survey respondents (n = 127 countries) who completed an open-ended question on the 26-item survey. Measurements: The open-ended question asked the following: ‘In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?’. We conducted thematic analysis of the responses. Findings: The most frequently reported barriers included a lack of health-care system infrastructure (n = 86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n = 66) and lack of funding (n = 51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n = 11), policymakers’ lack of awareness about the effectiveness and affordability of TDT (n = 5), public norms supporting tobacco use (n = 11), a lack of health-care leadership and expertise in the area of TDT (n = 6) and a lack of grassroots and multi-sector networks supporting policy implementation (n = 8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. Conclusion: Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding.Changing the research landscape : The New York City clinical data research network
AbstractKaushal, R., Hripcsak, G., Ascheim, D. D., Bloom, T., Campion, T. R., Caplan, A. L., Currie, B. P., Check, T., Deland, E. L., Gourevitch, M. N., Hart, R., Horowitz, C. R., Kastenbaum, I., Levin, A. A., Low, A. F., Meissner, P., Mirhaji, P., Pincus, H. A., Scaglione, C., … Tobin, J. N. (n.d.).Publication year
2014Journal title
Journal of the American Medical Informatics AssociationVolume
21Issue
4Page(s)
587-590AbstractThe New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants' experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites.CHARTing a Path to Pragmatic Tobacco Treatment Research
AbstractCruvinel, E., Richter, K. P., Stoney, C., Duffy, S., Fellows, J., Harrington, K. F., Rigotti, N. A., Sherman, S., Tindle, H. A., Shireman, T. I., Shelley, D., Waiwaiole, L., & Cummins, S. (n.d.).Publication year
2016Journal title
American journal of preventive medicineVolume
51Issue
4Page(s)
630-636AbstractIntroduction It is important to consider the degree to which studies are explanatory versus pragmatic to understand the implications of their findings for patients, healthcare professionals, and policymakers. Pragmatic trials test the effectiveness of interventions in real-world conditions; explanatory trials test for efficacy under ideal conditions. The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of seven NIH-funded trials designed to identify effective programs that can be widely implemented in routine clinical practice. Methods A cross-sectional analysis of CHART trial study designs was conducted to place each study on the pragmatic-explanatory continuum. After reliability training, six raters independently scored each CHART study according to ten PRagmatic Explanatory Continuum Indicator Summary (PRECIS) dimensions, which covered participant eligibility criteria, intervention flexibility, practitioner expertise, follow-up procedures, participant compliance, practitioner adherence, and outcome analyses. Means and SDs were calculated for each dimension of each study, with lower scores representing more pragmatic elements. Results were plotted on “spoke and wheel” diagrams. The rating process and analyses were performed in October 2014 to September 2015. Results All seven CHART trials tended toward the pragmatic end of the spectrum, although there was a range from 0.76 (SD=0.23) to 1.85 (SD=0.58). Most studies included some explanatory design elements. Conclusions CHART findings should be relatively applicable to clinical practice. Funders and reviewers could integrate PRECIS criteria into their guidelines to better facilitate pragmatic research. CHART study protocols, coupled with scores reported here, may help readers improve the design of their own pragmatic trials.Chinese immigrant smokers’ access barriers to tobacco cessation services and experience using social media and text messaging
AbstractJiang, N., Zhang, Y., Qian, X., Thorpe, L., Trinh-Shevrin, C., & Shelley, D. (n.d.).Publication year
2020Journal title
Tobacco Prevention and CessationVolume
6Issue
SeptemberPage(s)
1-10AbstractINTRODUCTION Smoking rates remain disproportionately high among Chinese immigrants in the US, particularly in males. Community-based smoking cessation services and quitlines have low engagement rates. Social media and text messaging programs can be effective in promoting quit rates and improving treatment engagement. This study examined Chinese immigrant smokers’ barriers to accessing available smoking cessation services and patterns of using social media platforms and mobile phone text messaging. METHODS We conducted in-depth interviews (n=30) and a brief survey (n=49) with adult Chinese immigrant smokers leaving in New York City in 2018. Qualitative interviews explored smokers’ challenges with smoking cessation, barriers to accessing and using smoking cessation services, and experience using social media and text messaging. The quantitative survey assessed smoking and quitting behaviors, and social media and text messaging use patterns. RESULTS Qualitative data revealed that participants faced various barriers to accessing cessation services, including the lack of awareness about services, skepticism about treatment effects, reliance on willpower for cessation, and time constraints. WeChat was mainly used to maintain social networking and acquire information. Participants rarely used text messaging or other social media platforms. Quantitative data showed that 55% of participants had no plan to quit smoking. Among those who reported past-year quit attempts (45%), 55% used cessation assistance. WeChat was the most frequently used platform with 94% users. CONCLUSIONS WeChat has potential to serve as an easily accessible platform for delivering smoking cessation treatment among Chinese immigrant populations. Research is warranted to explore the feasibility and efficacy of employing WeChat in smoking cessation treatment.Clinician perspectives on the benefits of practice facilitation for small primary care practices
AbstractRogers, E. S., Cuthel, A. M., Berry, C. A., Kaplan, S. A., & Shelley, D. (n.d.).Publication year
2019Journal title
Annals of family medicineVolume
17Issue
Suppl 1Page(s)
S17-S23AbstractPURPOSE Small independent primary care practices (SIPs) often lack the resources to implement system changes. HealthyHearts NYC, funded through the EvidenceNOW initiative of the Agency for Healthcare Research and Quality, studied the effectiveness of practice facilitation to improve cardiovascular disease– related care in 257 SIPs. We sought to understand SIP clinicians’ perspectives on the benefits of practice facilitation. METHODS We conducted in-depth interviews with 19 SIP clinicians enrolled in HealthyHearts NYC. Interviews were transcribed and coded using deductive and inductive approaches. To understand whether the perceived benefits of practice facilitation differ based on the availability of internal staff for quality improvement (QI), we compared themes pertaining to benefits between practices with 3 or fewer office staff vs more than 3 office staff. RESULTS Clinicians perceived 2 main benefits of practice facilitation. First, facilitators served as a connection to the external health care environment for SIPs, often through teaching and information sharing. Second, facilitators provided electronic health record (EHR)/data expertise, often by teaching functionality and completing technical assistance and tasks. SIPs with more than 3 office staff felt that facilitators provided benefits primarily through teaching, whereas SIPs with 3 or fewer staff felt that facilitators also provided hands-on support. At the intersections of these benefits, there emerged 3 central practice facilitation benefits: (1) creating awareness of quality gaps, (2) connecting practices to information, resources, and strategies, and (3) optimizing the EHR for QI goals. CONCLUSIONS SIP clinicians perceived practice facilitation to be an important resource for connecting their practice to the external health care environment and resources, and helping their practice build QI capacity through teaching, hands-on support, and EHR-driven solutions.Combining Text Messaging and Telephone Counseling to Increase Varenicline Adherence and Smoking Abstinence Among Cigarette Smokers Living with HIV : A Randomized Controlled Study
AbstractTseng, T. Y., Krebs, P., Schoenthaler, A., Wong, S., Sherman, S., Gonzalez, M., Urbina, A., Cleland, C. M., & Shelley, D. (n.d.).Publication year
2017Journal title
AIDS and BehaviorVolume
21Issue
7Page(s)
1964-1974AbstractSmoking represents an important health risk for people living with HIV (PLHIV). Low adherence to smoking cessation pharmacotherapy may limit treatment effectiveness. In this study, 158 participants recruited from three HIV care centers in New York City were randomized to receive 12-weeks of varenicline (Chantix) either alone as standard care (SC) or in combination with text message (TM) support or TM plus cell phone-delivered adherence-focused motivational and behavioral therapy (ABT). Generalized linear mixed-effect models found a significant decline in varenicline adherence from week 1–12 across treatment groups. At 12-weeks, the probability of smoking abstinence was significantly higher in SC+TM+ABT than in SC. The study demonstrates the feasibility of delivering adherence-focused interventions to PLHIV who smoke. Findings suggest intensive behavioral support is an important component of an effective smoking cessation intervention for this population, and a focus on improving adherence self-efficacy may lead to more consistent adherence and higher smoking abstinence.Community-based participatory research on smoking cessation among Chinese Americans in Flushing, Queens, New York City
AbstractBurton, D., Fahs, M., Chang, J. L., Qu, J., Chan, F., Yen, F., & Shelley, D. (n.d.).Publication year
2004Journal title
Journal of Interprofessional CareVolume
18Issue
4Page(s)
443-445Abstract~Conditioned opponent responses in human tolerance to caffeine
AbstractShelley, D., Rozin, P., Reff, D., Mark, M., & Schull, J. (n.d.).Publication year
1984Journal title
Bulletin of the Psychonomic SocietyVolume
22Issue
2Page(s)
117-120AbstractRegular coffee drinkers show tolerance to the salivation-inducing effects of caffeine. We present evidence indicating that this tolerance results from a conditioned inhibition of salivation, with coffee as the conditioned stimulus. The tolerance disappears when caffeine is presented in an unfamiliar vehicle, and inhibition of salivation occurs when coffee drinkers drink decaffeinated coffee. These two findings are predictions of a conditioned opponent view, which holds that stimuli associated with the administration of caffeine induce physiological conditioned responses that oppose the basic effects of the drug. In contrast with salivation, the alerting effects of caffeine show little tolerance, and no evidence for conditioned opponent processes. Thus, different effects of the same drug can perhaps display totally different conditioning properties.Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study
AbstractNguyen, A. M., Cleland, C. M., Dickinson, L. M., Barry, M. P., Cykert, S., Duffy, F. D., Kuzel, A. J., Lindner, S. R., Parchman, M. L., Shelley, D., & Walunas, T. L. (n.d.).Publication year
2022Journal title
Annals of family medicineVolume
20Issue
3Page(s)
255-261AbstractPURPOSE Despite the growing popularity of stepped-wedge cluster randomized trials (SWCRTs) for practice-based research, the design’s advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings. METHODS The EvidenceNOW: Advancing Heart Health initiative, funded by the Agency for Healthcare Research and Quality, included a large collection of SW-CRTs. We conducted qualitative interviews with 17 key informants from EvidenceNOW grantees to identify the advantages and challenges of using SW-CRT design. RESULTS All interviewees reported that SW-CRT can be an effective study design for largescale intervention implementations. Advantages included (1) incentivized recruitment, (2) staggered resource allocation, and (3) statistical power. Challenges included (1) time-sensitive recruitment, (2) retention, (3) randomization requirements and practice preferences, (4) achieving treatment schedule fidelity, (5) intensive data collection, (6) the Hawthorne effect, and (7) temporal trends. CONCLUSIONS The challenges experienced by EvidenceNOW grantees suggest that certain favorable real-world conditions constitute a context that increases the odds of a successful SW-CRT. An existing infrastructure can support the recruitment of many practices. Strong retention plans are needed to continue to engage sites waiting to start the intervention. Finally, study outcomes should be ones already captured in routine practice; otherwise, funders and investigators should assess the feasibility and cost of data collection.Considerations Before Selecting a Stepped-Wedge Cluster Randomized Trial Design for a Practice Improvement Study
AbstractNguyen, A. M., Cleland, C. M., Dickinson, L. M., Barry, M. P., Cykert, S., Duffy, F. D., Kuzel, A. J., Lindner, S. R., Parchman, M. L., Shelley, D., & Walunas, T. L. (n.d.).Publication year
2022Journal title
Annals of family medicineVolume
20Issue
3Page(s)
255-261AbstractPURPOSE: Despite the growing popularity of stepped-wedge cluster randomized trials (SW-CRTs) for practice-based research, the design's advantages and challenges are not well documented. The objective of this study was to identify the advantages and challenges of the SW-CRT design for large-scale intervention implementations in primary care settings.METHODS: The EvidenceNOW: Advancing Heart Health initiative, funded by the Agency for Healthcare Research and Quality, included a large collection of SW-CRTs. We conducted qualitative interviews with 17 key informants from EvidenceNOW grantees to identify the advantages and challenges of using SW-CRT design.RESULTS: All interviewees reported that SW-CRT can be an effective study design for large-scale intervention implementations. Advantages included (1) incentivized recruitment, (2) staggered resource allocation, and (3) statistical power. Challenges included (1) time-sensitive recruitment, (2) retention, (3) randomization requirements and practice preferences, (4) achieving treatment schedule fidelity, (5) intensive data collection, (6) the Hawthorne effect, and (7) temporal trends.CONCLUSIONS: The challenges experienced by EvidenceNOW grantees suggest that certain favorable real-world conditions constitute a context that increases the odds of a successful SW-CRT. An existing infrastructure can support the recruitment of many practices. Strong retention plans are needed to continue to engage sites waiting to start the intervention. Finally, study outcomes should be ones already captured in routine practice; otherwise, funders and investigators should assess the feasibility and cost of data collection. VISUAL ABSTRACT.Correction to : Unrecognized implementation science engagement among health researchers in the USA: a national survey (Implementation Science Communications, (2020), 1, 1, (39), 10.1186/s43058-020-00027-3)
AbstractStevens, E. R., Shelley, D., & Boden-Albala, B. M. (n.d.).Publication year
2020Journal title
Implementation science communicationsVolume
1Issue
1AbstractFollowing publication of the original article [1], it was reported that a supplemental appendix (Additional file 1) was missing. The missing appendix is included in this Correction article.Correlates of adherence to varenicline among HIV+ smokers
AbstractShelley, D., Tseng, T. Y., Gonzalez, M., Krebs, P., Wong, S., Furberg, R., Sherman, S., Schoenthaler, A., Urbina, A., & Cleland, C. M. (n.d.).Publication year
2015Journal title
Nicotine and Tobacco ResearchVolume
17Issue
8Page(s)
968-974AbstractIntroduction: Low rates of adherence to smoking cessation pharmacotherapy may limit the effectiveness of treatment. However, few studies have examined adherence in smoking cessation trials thus, there is a limited understanding of factors that influence adherence behaviors. This brief report analyzes correlates of adherence to varenicline among people living with HIV/AIDS. Methods: Study participants were recruited from three HIV care centers in New York City and enrolled in a three-arm randomized controlled pilot study in which all subjects received varenicline. At the 1-month study visit, there were no significant differences in adherence by study condition, therefore we combined treatment arms to examine correlates of adherence (n = 127). We used pill counts to assess varenicline adherence, defined as taking at least 80% of the prescribed dose. We conducted a multivariate path analysis to assess factors proposed by the informationmotivation-behavioral skills model to predict adherence. Results: Only 56% of smokers were at least 80% adherent to varenicline at 1 month. Adherencerelated information, self-efficacy, a college degree, and non-Hispanic white race/ethnicity were associated with increased varenicline adherence. In path analysis, information and motivation were associated with increased adherence self-efficacy, and adherence self-efficacy was associated with increased adherence, but with marginal significance. These associations with adherence were no longer significant after controlling for race/ethnicity and education. Conclusions: Further exploration of the role of a modifiable correlates of adherence, such as adherencerelated information, motivation and self-efficacy is warranted. Interventions are needed that can address disparities in these and other psychosocial factors that may mediate poor medication adherence.Correlates of burnout in small independent primary care practices in an urban setting
AbstractBlechter, B., Jiang, N., Cleland, C., Berry, C., Ogedegbe, O., & Shelley, D. (n.d.).Publication year
2018Journal title
Journal of the American Board of Family MedicineVolume
31Issue
4Page(s)
529-536AbstractBackground: Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (Correlates of household smoking bans among Chinese Americans
AbstractShelley, D., Fahs, M. C., Yerneni, R., Qu, J., & Burton, D. (n.d.).Publication year
2006Journal title
Nicotine and Tobacco ResearchVolume
8Issue
1Page(s)
103-112AbstractNo population-based data are available on the degree to which Chinese Americans have adopted smoke-free household policies and whether these policies are effective in reducing environmental tobacco smoke (ETS) exposure. The present study examines the prevalence of smoke-free home rules among Chinese Americans living in New York City, describes predictors of adopting full smoking bans in the home, and explores the association between household smoking restrictions and ETS exposure at home. In-person interviews using a comprehensive household-based survey were conducted with 2,537 adults aged 18-74 years. Interviews were conducted in Mandarin, Cantonese, and other Chinese dialects. A total of 66% of respondents reported that smoking was not allowed inside the home, 22% reported a partial ban on smoking in the home, and 12% reported no smoking ban. Among current smokers, 38% reported a full household smoking ban. Current smoking status was the strongest predictor of less restrictive household smoking policies. Knowledge of the dangers of ETS, support of smoke-free air legislation, years in the United States, gender, income, and marital status also were associated with household smoking bans. Those living with a total household smoking ban were significantly less likely to report 30-day exposure to ETS than were those living in homes with a partial ban or no ban (7% vs. 68% and 73%, respectively). In homes of smokers and nonsmokers alike, exposure to ETS remains high. Smoke-free home rules and interventions among smokers and nonsmokers to raise awareness of the dangers of ETS have the potential to significantly reduce exposure to household ETS among this immigrant population.Cost Analysis of Community-Based Smoking Cessation Services in Vietnam : A Cluster-Randomized Trial
AbstractQuynh Mai, V., Van Minh, H., Truong Nam, N., Thao Anh, H., Minh Van, N., Thi Trang, N., & Shelley, D. (n.d.).Publication year
2021Journal title
Health Services InsightsVolume
14AbstractThe study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention’ activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.Could international human rights obligations motivate countries to implement tobacco cessation support?
AbstractMeier, B. M., Raw, M., Shelley, D., Bostic, C., Gupta, A., Romeo-Stuppy, K., & Huber, L. (n.d.).Publication year
2022Journal title
AddictionAbstractBackground and aims: The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) seeks to realize the right to health through national tobacco control policies. However, few states have met their obligations under Article 14 of the FCTC to develop evidence-based policies to support tobacco cessation. This article examines how human rights obligations could provide a legal and moral basis for states to implement greater support for individuals to overcome their addiction to tobacco. Analysis: The United Nations (UN) has a well-established legal framework for promoting human rights, looking to the right to health to realize health autonomy. Where addiction undermines autonomy, it is widely acknowledged that addiction presents a significant barrier to cessation for individuals who use tobacco, undermining the right to health. The UN human rights system could, therefore, provide a complementary basis for monitoring state obligations under Article 14 of the FCTC, identifying challenges to FCTC implementation and motivating states to support tobacco cessation. Conclusions: The United Nations' human rights system offers a mechanism that could be used to monitor Framework Convention on Tobacco Control implementation in national policy, facilitating accountability for the progressive realization of cessation support.Data envelopment analysis to evaluate the efficiency of tobacco treatment programs in the NCI Moonshot Cancer Center Cessation Initiative
AbstractPluta, K., Hohl, S. D., D’Angelo, H., Ostroff, J. S., Shelley, D., Asvat, Y., Chen, L. S., Cummings, K. M., Dahl, N., Day, A. T., Fleisher, L., Goldstein, A. O., Hayes, R., Hitsman, B., Buckles, D. H., King, A. C., Lam, C. Y., Lenhoff, K., Levinson, A. H., … Salloum, R. G. (n.d.).Publication year
2023Journal title
Implementation science communicationsVolume
4Issue
1AbstractBackground: The Cancer Center Cessation Initiative (C3I) is a National Cancer Institute (NCI) Cancer Moonshot Program that supports NCI-designated cancer centers developing tobacco treatment programs for oncology patients who smoke. C3I-funded centers implement evidence-based programs that offer various smoking cessation treatment components (e.g., counseling, Quitline referrals, access to medications). While evaluation of implementation outcomes in C3I is guided by evaluation of reach and effectiveness (via RE-AIM), little is known about technical efficiency—i.e., how inputs (e.g., program costs, staff time) influence implementation outcomes (e.g., reach, effectiveness). This study demonstrates the application of data envelopment analysis (DEA) as an implementation science tool to evaluate technical efficiency of C3I programs and advance prioritization of implementation resources. Methods: DEA is a linear programming technique widely used in economics and engineering for assessing relative performance of production units. Using data from 16 C3I-funded centers reported in 2020, we applied input-oriented DEA to model technical efficiency (i.e., proportion of observed outcomes to benchmarked outcomes for given input levels). The primary models used the constant returns-to-scale specification and featured cost-per-participant, total full-time equivalent (FTE) effort, and tobacco treatment specialist effort as model inputs and reach and effectiveness (quit rates) as outcomes. Results: In the DEA model featuring cost-per-participant (input) and reach/effectiveness (outcomes), average constant returns-to-scale technical efficiency was 25.66 (SD = 24.56). When stratified by program characteristics, technical efficiency was higher among programs in cohort 1 (M = 29.15, SD = 28.65, n = 11) vs. cohort 2 (M = 17.99, SD = 10.16, n = 5), with point-of-care (M = 33.90, SD = 28.63, n = 9) vs. no point-of-care services (M = 15.59, SD = 14.31, n = 7), larger (M = 33.63, SD = 30.38, n = 8) vs. smaller center size (M = 17.70, SD = 15.00, n = 8), and higher (M = 29.65, SD = 30.99, n = 8) vs. lower smoking prevalence (M = 21.67, SD = 17.21, n = 8). Conclusion: Most C3I programs assessed were technically inefficient relative to the most efficient center benchmark and may be improved by optimizing the use of inputs (e.g., cost-per-participant) relative to program outcomes (e.g., reach, effectiveness). This study demonstrates the appropriateness and feasibility of using DEA to evaluate the relative performance of evidence-based programs.