smoking cessation, health promotion, health services research, implementation research
A. Personal Statement
My work over the last two decades has focused on innovative ways to reach and deliver tobacco use cessation treatment within health care, particularly to populations with low rates of treatment. Initially, consistent with recommendations at that time, I focused on referring all smokers to a multi-disciplinary smoking cessation program. However, I found that approach, despite a higher individual rate of success, had limited impact because of low acceptance of the referral by smokers and poor attendance at the program. As a result, I shifted my studies and policy efforts from a specialty-clinic model (referral to a smoking cessation clinic) to a primary care-based model. I have studied different approaches to increase tobacco use cessation treatment in primary care, such as use of an on-call counselor and simple referral to a telephone care coordination program for smoking. I have also studies use of a similar clinic-based approach in mental health care.
More recently, I have been studying whether a population-based approach is even more successful at helping smokers to quit. We showed that by reaching out and recruiting from the entire population, proactive outreach in primary care led to a higher population-level quit rate in four VA Medical Centers, and we are now studying the same approach for smokers in VA mental health clinics.
I am currently Principal Investigator on seven large grants, with funding from National Institutes of Health, VA Health Services Research and Development Service and others. Based on my interest in and experience with innovative approaches to recruitment of research participants and integrating research into routine clinical care, I was Co-Chair of the Recruitment and Retention Working Group for our Clinical and Translational Science Institute (CTSI) and designed and am now Co-Chair of its Research Recruitment and Retention Unit.
I currently am in Year 5of a K24 mid-career mentoring award from NIDA, and mentoring is a main focus of my career. I will use my experience and expertise from my CTSI recruitment role and my two decades of experience in large scale tobacco use cessation interventions to assist on this proposed training grant.
B. Positions and Honors
Positions and Employment:
1991-2005 Staff Internist, PACE Green Ambulatory Global Care Team
1991-1998 Assistant Professor of Medicine, UCLA
1992-1994 Senior Internist, PACE Green Ambulatory Global Care Team
1992-2005 Director, Smoking Cessation Clinic, Pilot Ambulatory Care & Education (PACE) Center
1993-2005 Sepulveda VA Site Coordinator, VA Center for Study of Healthcare Provider Behavior
1994-1996 Chief, Preventive Medicine and Administrative Medicine, Sepulveda VAMC
1994-1998 Facilitator-in-training, American Academy on Physician & Patient
1998-2004 Associate Professor of Medicine, UCLA
2001-2005 Smoking Cessation Coordinator, VA Greater Los Angeles Healthcare System
2002-2006 Chair, VA Smoking and Tobacco Use Cessation Technical Advisory Group
2004-2005 Professor of Medicine, UCLA
2005-2007 Associate Professor of Medicine, New York University (NYU) School of Medicine
2007-2013 Associate Professor of Medicine and Psychiatry, NYU School of Medicine
2008-2012 Interim Chief, Section of Geriatric Medicine, NYU School of Medicine
2008-2013 Program Director, Fellowship in Geriatric Medicine, NYU School of Medicine
2013-present Co-Chair, Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine
2013-2017 Associate Professor of Population Health, Medicine and Psychiatry, NYU School of Medicine
2013-present Co-Chair, Recruitment and Retention Unit, NYU-HHC Clinical and Transl. Science Institute
2014-2017 Associate Professor of Global Public Health, New York University
2017-present Professor of Population Health, Medicine and Psychiatry, NYU School of Medicine
2017-present Professor of Global Public Health, New York University
1994 - 1996 Career Development Award, UCLA Claude D. Pepper Older Americans Independence Center.
1992 Finalist, Associates Competition, American College of Physicians Annual meeting. Poster Presentation of “Should elderly people exercise?: Results from the Framingham Heart Study.”
1991 Individual National Research Service Award, Agency for Health Care Policy and Research, for “Study of Exercise Counseling by Physicians.”
C. Contribution to Science
- Exercise for health promotion
During my fellowship and the initial few years of my career, I focused on the health benefits of exercise. I published several papers from the Framingham Heart Study, showing that women obtained the same benefits (increased longevity, decreased cardiovascular risk) as men, and that this benefit extended into old age for both men and women. I also showed that what was most important was recent physical activity, not how active a person had been in the distant past. I also studied the exercise counseling practices of internists and found that while many believed exercise to be beneficial, there was much room for improvement in their counseling.
- Sherman SE, D'Agostino RB, Cobb JL, Kannel WB. Does exercise reduce mortality in the elderly?: Results from the Framingham Heart Study. Am Heart J. 1994; 128: 965-72. PMID: 7942491
- Sherman SE, D'Agostino RB, Cobb JL, Kannel WB. Physical activity and mortality in women in the Framingham Heart Study. Am Heart J. 1994; 128: 879-84. PMID: 7942478
- Sherman SE, D'Agostino RB, Silbershatz H, Kannel WB. Comparison of past vs. recent physical activity in the prevention of premature death and coronary artery disease. Am Heart J. 1999; 138: 900-7. PMID: 7942478
- Sherman SE, Hershman WY. Exercise counseling: How do general internists do? J Gen Intern Med. 1993; 8: 243-8. PMID: 8505682
2. Referring smokers to smoking cessation programs
As I shifted to research on smoking cessation, the dominant approach in the field, endorsed by the first Public Health Service Guidelines for Management of Tobacco Use in 1996, was that all smokers should be referred to in-person smoking cessation programs. While I conducted some studies examining the people attending these programs, my first large grant helped to show this was not a fruitful approach at the population level. In an 18-site group randomized trial of evidence-based quality improvement, we helped each facility choose priorities for tobacco control. Despite strong discouragement from study experts, nearly every intervention site chose a strategy focused on increasing referrals to the on-site smoking cessation clinic. As a result, referrals increased but there was no measurable population impact. Based on these data and other studies, we revised the 2004 VA/Department of Defense Clinical Practice Guidelines for Management of Tobacco Use to decrease emphasis on referral to specialty smoking cessation programs, instead saying that smokers should be offered medications, counseling and follow-up in the most intensive setting they would actually attend.
- Sherman SE, Wang M, Nguyen R. Predictors of success in a Department of Veterans Affairs smoking cessation program. J Gen Intern Med. 1996; 11: 702-4.
- Sherman SE, Yano EM, Lanto AB, Simon BF, Rubenstein LV. Smokers’ interest in quitting and services received: Using practice information to plan quality improvement and policy for smoking cessation. Am J Med Qual. 2005; 20: 33-9. PMID: 15782753
- Yano EM, Rubenstein LV, Chernof BA, Mittman BS, Lanto AB, Simon BF, Lee ML, Sherman SE. Evidence-based quality improvement strategies for tailoring implementation of smoking cessation guidelines into routine care: Impact on practice-level quit attempts and smoking cessation. Health Serv Res. 2008; 43 (5 part 1): 1637-61. PMCID: PMC2653889
- Sherman SE, Talcott W (Co-Chair), Veterans Health Administration/Department of Defense Clinical Practice Guideline on Management of Tobacco Use. July, 2003.
3. Identifying alternative approaches to help smokers quit within health care
Since referring to smoking cessation clinics did not seem to be an effective strategy, I studied other approaches to delivering evidence-based treatment. Having an on-call counselor increased referrals, counseling and use of medications. More importantly, creating a telephone care coordination program and making referral from primary care very easy had a profound effect, generating large numbers of referrals and resulting in an excellent cessation rate.
- Sherman SE, Estrada M, Lanto AB, Farmer MM, Aldana I. Effectiveness of an on-call counselor at increasing smoking treatment. J Gen Intern Med., 2007; 22: 1125-31. PMCID: PMC2305728
- Sherman SE, Takahashi N, Kalra P, Gifford E, Finney J, Canfield J, Kelly J, Joseph G, Kuschner W. Care coordination to increase referrals to smoking cessation telephone counseling: A demonstration project. Am J Managed Care., 2008; 14: 141-8. PMID: 18333706
- Sherman SE, Krebs P, York LS, Cummins SE, Kuschner W, Guvenc-Tuncturk S, Zhu SH. Telephone care co-ordination for tobacco cessation: randomised trials testing proactive versus reactive models. Tob Control. 2018 Jan; 27(1): 78-82. PMID: 28190003.
- Sherman SE, Link AR, Roger ES, Krebs P, Ladapo JA, Shelley D, Fang Y, Wang B, Grossman E. Smoking-cessation interventions for urban hospital patients: A randomized comparative-effectiveness trial. Am J Prev Med. 2016; 51(4): 566–77.
4. Helping smokers with mental health disorders quit smoking
As tobacco control efforts have progressed and the prevalence of smoking has declined, it has become increasingly important to identify populations with higher rates of smoking or with special needs. People with mental health disorders smoke at rates two to four times higher than the general population. Rather than focus on people with specific diagnoses (e.g., schizophrenia, depression), I have looked at the special needs of the whole population of people with mental health disorders and whether interventions can successfully be shifted from primary care to mental health care. In general, I have found that – contrary to popular attitudes and beliefs – people with mental health disorders are interested in quitting and are able to quit, and quitting smoking does not make their mental health worse.
- Rogers ES, Sherman SE. Tobacco Use Screening and Treatment by Outpatient Psychiatrists Before and After American Psychiatric Association Treatment Guidelines for Nicotine Dependence. Am J Public Health. 2014; 104: 90-5. PMCID: PMC3910050
- Rogers ES, Gillespie C, Smelson D, Sherman SE. A qualitative evaluation of mental health clinic staff perceptions of barriers and facilitators to treating tobacco use. Nicotine Tob Res. 2018 Sep 4; 20(10): 1223-30. PMID: 29059344.
- Rogers ES, Smelson DA, Gillespie CC, Elbel B, Poole S, Hagedorn H, Kalman D, Krebs PM, Fang Y, Wang B, Sherman SE. Telephone Smoking-Cessation Counseling for Smokers in Mental Health Clinics: A Patient-Randomized Controlled Trial. Am J Prev Med. 2016 Apr; 50(4): 518-27.
5. A population-based approach to care and innovative recruitment strategies
Based on 15 years of practice, research and policy within the VA, I published a paper outlining a framework for how health systems improve their care for smoking (as well as for other conditions). Briefly, systems typically progress through four stages: Stage 1 – no system for smoking cessation; Stage 2 – systematic visit-based screening; Stage 3 – systematic visit-based treatment; and Stage 4 – systematic population-based treatment. My recent and current studies are focused on how to deliver evidence-based care to the entire population, without waiting for them to come in for a visit. This is a central part of the Patient Centered Medical Home or Patient Aligned Care Team model, and it is the one that has been most challenging to implement. This has typically involved identifying the entire population with a specific condition and implementing a program to reach out to them independent of clinic visits. In our panel management study (Schwartz et al), we reached out through the primary care provider, while in our proactive outreach studies (Fu et al; Rogers et al), we are reaching out directly to patients. The proposed study will compare these two different approaches.
- Sherman SE. A Framework for Tobacco Control: Lessons learnt from Veterans Health Administration. BMJ, 2008; 336: 1016-9. PMCID: PMC2364861
- Schwartz MD, Jensen A, Wang B, Bennett B, Dembitzer A, Strauss S, Schoenthaler A, Gillespie C, Sherman S. Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial. J Gen Intern Med. 2015 February 10 PMID: 25666215
- Fu SS, van Ryn M, Sherman SE, Burgess DJ, Noorbaloochi S, Clothier B, Taylor BC, Schlede CM, Burke RS, Joseph AM. Proactive Tobacco Treatment and Population-Level Cessation: A Pragmatic Randomized Controlled Trial. JAMA Intern Med. 2014; 174: 671-7. PMID: 24615217
- Rogers ES, Fu SS, Krebs P, Noorbaloochi S, Nugent SM, Gravely A, Sherman SE. Proactive tobacco treatment for smokers using VA mental health clinics: a randomized controlled trial. Am J Prev Med. 2018 May; 54(5): 620-9. PMID: 29551324.
D. Research Support
Ongoing Research Support
Midcareer Investigator Award in Patient-Oriented Research for Dr. Scott Sherman
1K24DA038345-01 - NIDA - (Sherman) - 07/2014 – 06/2019
This K24 mid-career award supports my time for mentoring junior faculty. It also provides additional training in the economic aspects of alternative tobacco products.
Text Messaging to Engage and Retain Veterans in Smoking Cessation Counseling
IIR 15-297 - VA HSR&D - (Sherman and Krebs) 09/2016 – 08/2020
Goal: This study builds will test the effect of two types of text messaging in combination with telephone cessation counseling: 1) pre-counseling text messages to increase enrollment in counseling, and 2) ongoing texts for those who start counseling that provide appointment reminders and support between sessions to increase adherence to counseling.
A behavioral economic intervention to improve psychiatrist adherence to tobacco treatment guidelines
1R34 DA043059-01A1 NIDA (Rogers and Sherman) 09/2018 – 07/2021
Goal: This study will randomize VA psychiatrists to an opt-out vs. an opt-in approach to smoking cessation. All psychiatrists will receive training and clinical decision support to help their patients quit smoking. The default for clinical decision support will differ between the opt-out and opt-in arms.
NYU/Abu Dhabi Public Health Research Center
NYU/Abu Dhabi Institute - (Sherman and Hayes) - 03/2012 – 03/2019
Institute to foster public health research, in conjunction with NYU’s campus in Abu Dhabi, United Arab Emirates. Comprised of four research centers: smoking cessation/tobacco control, diabetes, genetics of obesity, and oral microbiome/cardiovascular disease. The main project is starting a cohort study of 20,000 Emiratis, looking at determinants of cardiovascular disease and diabetes.
Role: Multiple PI
Center for Alternative Tobacco Product Studies
New York Empire Clinical Research Investigator Program (Sherman and Gordon) 01/2018 – 12/2019
Goal: This Center is funded to train fellow and junior faculty to become independent investigators. The focus of the research is alternative tobacco products (hookah, electronic cigarettes) and smoking. Projects range from epidemiologic (survey of young adults) and to toxicologic (measuring air quality when people use alternative tobacco products).
Role: Multiple Principal Investigator
Integrating Financial Management Counseling and Smoking Cessation Counseling to Reduce Health and Economic Disparities in Low-Income Immigrants
Robin Hood Foundation (Sherman and Rogers) 04/2017 – 04/2019
Goal: This 2-year grant will evaluate the efficacy and acceptability of an intervention that integrates financial counseling with smoking cessation counseling for immigrants receiving care from two safety health care systems in New York City.
Role: Multiple Principal Investigator
Comparing an opt-out to an opt-in approach for smoking cessation in VA primary care clinics
IIR VA HSR&D (Sherman and Fu) 07/2018 – 06/2022
Goal: This study will randomize VA nursing assistants to an opt-out vs. an opt-in approach to smoking cessation. In the opt-in arm, patients will be encouraged to be referred to treatment (state Quitline or the VA national text messaging service). If interested, they will fill out a form for referral. In the opt-out arm, they will be similarly encouraged to be referred but they will need to fill out a form in order to not be referred.
Role: Multiple Principal Investigator
The VA Genomic Medicine Program: The Million Veteran Program (MVP)
CSP G002 - VA HSR&D - (Gaziano and Concato) - 10/2010 – 09/2018
Goal: Vanguard site for the MVP program, a nationwide longitudinal study with a key aim of better understanding the inter-relation of genetic characteristics, behaviors and environmental factors, and veteran health. Now also one of the initial VA sites for the NIH-funded All of US study.
Role: Site Principal Investigator
Completed Research Support
Proactive Outreach for Smokers in VA Mental Health
IIR 11-291-3 - VA HSR&D - (Sherman and Fu) - 10/2013 – 09/2017
Major Goals: 1) Compare the reach and efficacy of a proactive outreach telephone-based tobacco cessation program for patients seen in mental health to usual care advice and referral to local VA and community tobacco cessation resources, and 2) Model longitudinal associations between baseline sociodemographic, medical and mental health characteristics and abstinence at 6 and 12 months in the proactive outreach and usual care conditions.
Role: Multiple PI
Patterns of Communication and Information Transfer Among Hookah Users
3P30CA016087-34S1 - NCI - (Carroll) - 03/2014 – 02/2017
Our main goal is to assess, though quantitative and qualitative methods, risk perceptions, attitudes, and beliefs about water pipe tobacco smoking, intention to use, and patterns of use (alone or in combination with other products), and to explore the nature and extent of communication about these and other emerging products in non-traditional venues (e.g. social media) among a diverse population of young adults. This proposal directly addresses some of the FDA Center for Tobacco Products (CTP) interest areas: 1) other tobacco product (e.g., hookah, pipes, dissolvables) initiation, use, and perceptions, and 2) the impact of tobacco product characteristics on initiation, especially among youth and other vulnerable populations. We have expanded the scope to also include e-cigarettes.
Role: Project Leader
Effectiveness of smoking-cessation interventions for urban hospital patients
1U01HL105229-01/3U01HL105229-04S1 - NHLBI - (PI Sherman) - 09/2010 – 11/2015
Comparing the effectiveness and cost effectiveness of an enhanced inpatient intervention for all smokers plus, one of two post-discharge cessation options among a diverse population of psychiatric and medical/surgical patients at two urban hospitals. Awarded supplemental funding to explore possible mediators of smoking cessation in HIV-seropositive patients, such as medication adherence and attitudes towards nicotine replacement therapy. Also awarded supplemental funding to compensate for effects of Hurricane Sandy.
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