Shivani is a postdoctoral research scholar in the Halpern-Felsher Lab in Adolescent Medicine. Shivani uses mixed-methods experimental and implementation research to develop and evaluate real-world public health education programs and methodologies that lead to healthy behaviors. Her current research focuses on three key areas:
(1) Assessing youth patterns of use and perceptions about electronic cigarettes, new tobacco products and other substances;
(2) Understanding why youth use e-cigarettes vapes as a means to cope with stress and manage mental health problems, such as depression; and
(3) Evaluating school-based educational interventions to reduce e-cigarette use.
In addition to research, Shivani enjoys teaching research methods and mentoring high school and college students.
Through her Ph.D., Shivani developed and evaluated an arts-based educational program to reduce mental-health-related stigma in India. The program had a large, significant and positive effect on participants - they desired greater social proximity to people living with mental health problems. During this time, she also became interested in the intersection between mental health and substance use, a common theme in her interactions with youth. She also refined her skills in statistical analysis, study design and project management. Her interdisciplinary Ph.D. research at the London School of Hygiene and Tropical Medicine was supported by the PHFI-UKC Wellcome Trust Capacity Strengthening Award (2014-18). In 2017, she received the LSHTM Public Engagement Small Grant to strengthen school teachers’ understanding of mental health problems, which resulted in a monthly column in a popular educational magazine, reaching approximately 40,000 Indian teachers every month.
Previously, Shivani designed, implemented and evaluated health communication and behavior change initiatives at the Public Health Foundation of India from 2008-2014. She is especially passionate about designing educational public health programs to break silences around contentious public health issues, using participatory media and entertainment-education. At PHFI, she spearheaded health communication and community engagement programs aimed at changing behavior related to healthy lifestyles, sexual and reproductive health, maternal and neonatal care, menstrual hygiene, avoidable blindness and mental health. In partnership with the Ministry of Health and Family Welfare, Government of India and community-based organizations, she led three educational interventions: a community awareness campaign, which improved treatment-seeking behavior for mental disorders in underserved areas; a website targeting young people to improve their lifestyle; and entertainment-education-based participatory action research to improve sexual and reproductive health.
Member, Maternal & Child Health Research Institute (MCHRI)
Honors & Awards
Chhatra Pratibha Puruskar, Hindi Academy, Government of Delhi, India (2001)
Vinod Dikshit Award for Research (Plants in the world of medicine), Vinod Dikshit Foundation (2002)
PHFI-UKC Capacity Strengthening Award for Doctoral Studies, Public Health Foundation of India and Wellcome Trust Program (2014-2019)
Emerald Literati Network Award for Excellence - Outstanding Paper Award, Emerald Publishing (2015-2016)
Queen’s Young Leaders Runner-Up Award, The Queen Elizabeth Diamond Jubilee Trust with Comic Relief and the University of Cambridge. (2015-2016)
Public Engagement Small Grant Award, London School of Hygiene and Tropical Medicine (2017-2018)
Pilot Grant Award, Advancing Science & Practice in the Retail Environment: An NCI-funded Center (2020-2021)
Travel Award for Society for Research on Nicotine & Tobacco Annual meeting, Society for Research on Nicotine & Tobacco (2021)
Boards, Advisory Committees, Professional Organizations
Member, Information Education and Communication Committee on Developing a Menstrual Hygiene Program, Ministry of Health and Family Welfare, Government of India (2011 - 2012)
Member, National Diabetic Retinopathy Taskforce, Indian Institute of Public Health- Hyderabad (2014 - 2016)
Member, Editorial Board, Community Eye Health Journal of South Asia, Indian Institute of Public Health-Hyderabad with London School of Hygiene and Tropical Medicine, UK (2016 - 2018)
Adjunct Fellow, Public Health Foundation of India (www.phfi.org) (2019 - Present)
Bachelor of Arts, Lady Shri Ram College for Women (2006)
Master of Science, School of Oriental & African Studies (2007)
Doctor of Philosophy, University Of London (2019)
Bonnie Halpern-Felsher, Postdoctoral Faculty Sponsor
Assessment, testing and measurement
Parents and family issues
Poverty and Inequality
Underage Youth and Young Adult e-Cigarette Use and Access Before and During the Coronavirus Disease 2019 Pandemic.
JAMA network open
2020; 3 (12): e2027572
Importance: Understanding patterns of e-cigarette use and access during the coronavirus disease 2019 (COVID-19) pandemic is important because e-cigarettes may put users at risk for more severe respiratory effects and other health problems.Objective: To examine whether underage youth and young adults who ever used e-cigarettes self-reported changes in access and use of e-cigarettes since the COVID-19 pandemic began.Design, Setting, and Participants: A national, cross-sectional online survey study was conducted from May 6 to May 14, 2020. This sample of 4351 participants aged 13 to 24 years across the US included 2167 e-cigarette ever-users. Quota sampling was used to balance for age, sex, race/ethnicity, and 50% having ever used e-cigarettes.Main Outcomes and Measures: Change in e-cigarette use (increase, decrease, quit, no change, and switch to another product) and access to e-cigarettes (easier or harder, and change in point-of-purchase) before and after the COVID-19 pandemic began, reasons for change, number of times e-cigarettes were used, nicotine dependence, and sociodemographic data.Results: This study focused on 2167 e-cigarette ever-users among 4351 participants who completed the survey. Among 2167 e-cigarette users, a total of 1442 were younger than 21 years and 725 were aged 21 years or older; 1397 were female (64.5%) and 438 identified as lesbian, gay, bisexual, transgender, queer (20.2%). The survey completion rate was 40%. Since the COVID-19 pandemic began, 1198 of 2125 e-cigarette users (56.4%) changed their use: 388 individuals (32.4%) quit, 422 individuals (35.3%) reduced the amount of nicotine, 211 individuals (17.6%) increased nicotine use, 94 individuals (7.8%) increased cannabis use, and 82 individuals (6.9%) switched to other products. Participants reported that not being able to go to vape shops and product unavailability were the reasons accessing e-cigarettes was difficult after the pandemic began. Since the COVID-19 pandemic began, individuals reported purchasing from alternative retail stores (disposables, 150 of 632 [23.7%]; pod-based, 144 of 797 [18.1%]; and other e-cigarette, 125 of 560 [22.3%], ie, between 18.1% and 23.7%), purchasing online instead of retail (disposables, 115 of 632 [18.2%]; pod-based, 156 of 797 [19.6%]; and other e-cigarette, 111 of 560 [19.8%], ie, between 18.2% to 19.8%), and shifted to retail instead of online (disposables, 11 of 632 [1.7%]; pod-based, 17 of 797 [2.0%]; and other e-cigarette, 13 of 560 [2.3%], ie, between 1.7%-2.3%). Other individuals reported no change: from retail stores (disposables 262 of 632 [41.5%]; pod-based 344 of 797 [43.2%]; and other e-cigarette, 223 of 560 [39.8%], ie, between 39.8% and 43.2%) and online (disposables 94 of 632 [14.9%]; pod-based 136 of 797 [17.1%]; and other e-cigarette, 88 of 560 [15.8%], ie, between 14.9% and 17.1%). Underage youth reported e-cigarette deliveries from vape shops and/or dealers or friends who received such deliveries, and 63 of 229 (27.5%) self-reported accessing e-cigarettes without age verification. e-Cigarette users were 52% less likely to quit or reduce their use if they previously used e-cigarettes between 11 and 99 times (adjusted odds ratio, 0.48; 95% CI, 0.30-0.78), 68% less likely to quit if they previously used e-cigarettes more than 100 times (adjusted odds ratio, 0.32; 95% CI, 0.20-0.51), and 51% were less likely to quit if they were nicotine dependent (adjusted odds ratio, 0.49; 95% CI, 0.35-0.70).Conclusions and Relevance: During the COVID-19 pandemic, youth e-cigarette users reported changes in e-cigarette use, point-of-purchase, and ability to purchase e-cigarettes without age verification. The US Food and Drug Administration and local policy makers may find these data useful to inform policies to prevent e-cigarette sales to underage youth.
View details for DOI 10.1001/jamanetworkopen.2020.27572
View details for PubMedID 33270127
Stigma associated with mental health problems among young people in India: a systematic review of magnitude, manifestations and recommendations.
2020; 20 (1): 538
BACKGROUND: Globally, 20% of young people experience mental disorders. In India, only 7.3% of its 365 million youth report such problems. Although public stigma associated with mental health problems particularly affects help-seeking among young people, the extent of stigma among young people in India is unknown. Describing and characterizing public stigma among young people will inform targeted interventions to address such stigma in India, and globally. Thus, we examined the magnitude and manifestations of public stigma, and synthesised evidence of recommendations to reduce mental-health-related stigma among young people in India.METHOD: A systematic review and meta-analysis of observational studies was conducted. Nine electronic databases were searched and 30 studies (n=6767) met inclusion criteria.RESULTS: Most studies (66%) focused on youth training to become health professionals. One-third of young people display poor knowledge of mental health problems and negative attitudes towards people with mental health problemsand one in five had actual/intended stigmatizing behavior (I2>=95%). Young people are unable to recognize causes and symptoms of mental health problems and believe that recovery is unlikely. People with mental health problems are perceived as dangerous and irresponsible, likely due to misinformation and misunderstanding of mental health problems as being solely comprised of severe mental disorders (e.g. schizophrenia). However, psychiatric labels are not commonly used/understood.CONCLUSION: Public education may use symptomatic vignettes (through relatable language and visuals) instead of psychiatric labels to improve young people's understanding of the range of mental health problems. Recommended strategies to reduce public stigma include awareness campaigns integrated with educational institutions and content relevant to culture and age-appropriate social roles.
View details for DOI 10.1186/s12888-020-02937-x
View details for PubMedID 33198678
A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs.
Current addiction reports
Purpose: Adolescent use of electronic cigarettes (e-cigarettes) has risen rapidly, which is concerning given the health effects of e-cigarettes and youth susceptibility to nicotine addiction. It is critical that efforts to educate, prevent, and reduce adolescent use of e-cigarettes are developed and evaluated. The purpose of this paper is to review available current prevention and cessation programs.Findings: A web-based search of currently available e-cigarette prevention and cessation/treatment programs was conducted using Google in May of 2020. Programs were then reviewed on whether they included theory- and evidence-based practices of effective adolescent prevention and cessation programs. Eight prevention programs, seven cessation programs, and one program that addressed both prevention and cessation were identified and included in this review. Most prevention programs included the importance of understanding flavored e-cigarette products, addressed industry-targeted marketing, included social learning activities to develop refusal skills, delivered free-of-cost, available online, and explicitly stated their incorporation of theory. Five prevention programs and two cessation programs had empirically evaluated their e-cigarette-related components.Conclusions: Although the programs reviewed largely incorporated theory and included key components known to be effective, there are some gaps in the programs' overall ability to prevent and stop adolescents from using e-cigarettes, such as lack of dedicated e-cigarette materials. More evidence-based tools, resources, and evaluations are needed to best inform adolescent e-cigarette cessation. Addressing the gaps that existing prevention and cessation programs present requires intervening at multiple systematic levels, conducting more rigorous program evaluations, and bolstering the availability of cessation programs.
View details for DOI 10.1007/s40429-020-00345-5
View details for PubMedID 33204602
Pilot Community Mental Health Awareness Campaign Improves Service Coverage in India.
Community mental health journal
PURPOSE: Low community awareness of mental health problems negatively impacts treatment-seeking for such problems. Despite a shortage of mental health providers, there is scope to improve coverage of mental health services in India. In this study, we examined the impact of a multi-statecommunity-based awareness campaign on knowledge, attitude, treatment-seeking behavior and acceptability.METHODS: Campaign activities included educational materials, public meetings, musical announcements, quizzes, and street plays, followed by a mental health screening camp. A rapid, real-world evaluation was conductedusing post-intervention surveys (n=693), field notes and telephonic interviews in five states.RESULTS: The campaign, implemented as a public-private partnership between government service providers and community-based organizations, reached~3000 people in 20 new locations across five states. As a result of the campaign, 1,176 persons sought treatment servicesfor mental disorders and 66% received a preliminary diagnosis. Collectively, campaign activities were the first time that~75% of participants reported learning about mental health problems. Participants expressed knowledge that mental disorders are treatable, listed common symptoms and location of available mental health services and attitudes supporting people with mental health problems.CONCLUSION: The campaign enabled improved coverage for mental health services, potentially by enhancing knowledge, attitude and treatment-seeking behavior. Future research may develop a quasi-experimental evaluation of the current campaign methodology.
View details for DOI 10.1007/s10597-020-00714-4
View details for PubMedID 33052548
- Actor-doctor partnership for theatre-based public health education HEALTH EDUCATION JOURNAL 2020
Association Between Youth Smoking, Electronic Cigarette Use, and Coronavirus Disease 2019.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
PURPOSE: This study aimed to assess whether youth cigarette and electronic cigarette (e-cigarette) use are associated with coronavirus disease 2019 (COVID-19) symptoms, testing, and diagnosis.METHODS: An online national survey of adolescents and young adults (n= 4,351) aged 13-24 years was conducted in May 2020. Multivariable logistic regression assessed relationships among COVID-19-related symptoms, testing, and diagnosis and cigarettes only, e-cigarettes only and dual use, sociodemographic factors, obesity, and complying with shelter-in-place.RESULTS: COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only (95% confidence interval [CI]: 1.82-13.96), seven times more likely among ever-dual-users (95% CI: 1.98-24.55), and 6.8 times more likely among past 30-day dual-users (95% CI: 2.40-19.55). Testing was nine times more likely among past 30-day dual-users (95% CI: 5.43-15.47) and 2.6 times more likely among past 30-day e-cigarette only users (95% CI: 1.33-4.87). Symptoms were 4.7 times more likely among past 30-day dual-users (95% CI: 3.07-7.16).CONCLUSIONS: COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.
View details for DOI 10.1016/j.jadohealth.2020.07.002
View details for PubMedID 32798097
School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try.
2020; 112: 106519
BACKGROUND AND OBJECTIVES: Educational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session.METHODS: We conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects.RESULTS: Surveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes.CONCLUSIONS: A school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.
View details for DOI 10.1016/j.addbeh.2020.106519
View details for PubMedID 32890911
Public Health Considerations for Adolescent Initiation of Electronic Cigarettes.
2020; 145 (Suppl 2): S175–S180
Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.
View details for DOI 10.1542/peds.2019-2056E
View details for PubMedID 32358208
- Escalating Safety Concerns Are Not Changing Adolescent E-Cigarette Use Patterns: The Possible Role of Adolescent Mental Health. The Journal of adolescent health : official publication of the Society for Adolescent Medicine 2020; 66 (1): 3–5
Physical Activity Among Adolescents in India: A Qualitative Study of Barriers and Enablers
HEALTH EDUCATION & BEHAVIOR
2018; 45 (6): 926–34
Inadequate physical activity (PA) levels are reported in Indian youth, with lowest levels among adolescents, particularly girls. We aimed to identify barriers to and enablers of PA among school children in New Delhi and examine potential differences by gender and school type (government vs. private). A total of 174 students (private school students = 88, 47% girls; government school students = 86, 48% girls) aged 12 to 16 years from two Delhi schools participated in 16 focus group discussions (FGDs) conducted by bilingual moderators. We conducted FGDs separately for girls and boys, for students in Grades VIII and IX, and for private and government schools. We conducted FGDs among government school students in Hindi and translated the transcriptions to English for analysis. We coded transcriptions using a combination of inductive and deductive approaches, guided by the "youth physical activity promotion model." We identified various personal, social, and environmental barriers and enablers. Personal barriers: Private school girls cited body image-related negative consequences of PA participation. Social barriers: Girls from both schools faced more social censure for participating in PA. Environmental barriers: Reduced opportunity for PA in schools was commonly reported across all participants. Personal enablers: All participants reported perceived health benefits of PA. Social enablers: Several participants mentioned active parents and sports role models as motivators for increasing PA. Few environmental enablers were identified. This study highlights the need for further investment in physical activity within schools and for gender-sensitive policies for encouraging PA participation among adolescents in India.
View details for DOI 10.1177/1090198118778332
View details for Web of Science ID 000452478900009
View details for PubMedID 29969921
Global treatment costs of breast cancer by stage: A systematic review
2018; 13 (11): e0207993
Published evidence on treatment costs of breast cancer varies widely in methodology and a global systematic review is lacking.This study aimed to conduct a systematic review to compare treatment costs of breast cancer by stage at diagnosis across countries at different levels of socio-economic development, and to identify key methodological differences in costing approaches.MEDLINE, EMBASE, and NHS Economic Evaluation Database (NHS EED) before April 2018.Studies were eligible if they reported treatment costs of breast cancer by stage at diagnosis using patient level data, in any language.Study characteristics and treatment costs by stage were summarised. Study quality was assessed using the Drummond Checklist, and detailed methodological differences were further compared.Twenty studies were included, 15 from high-income countries and five from low- and middle-income countries. Eleven studies used the FIGO staging system, and the mean treatment costs of breast cancer at Stage II, III and IV were 32%, 95%, and 109% higher than Stage I. Five studies categorised stage as in situ, local, regional and distant. The mean treatment costs of regional and distant breast cancer were 41% and 165% higher than local breast cancer. Overall, the quality of studies ranged from 50% (lowest quality) to 84% (highest). Most studies used regression frameworks but the choice of regression model was rarely justified. Few studies described key methodological issues including skewness, zero values, censored data, missing data, and the inclusion of control groups to estimate disease-attributable costs.Treatment costs of breast cancer generally increased with the advancement of the disease stage at diagnosis. Methodological issues should be better handled and properly described in future costing studies.
View details for DOI 10.1371/journal.pone.0207993
View details for Web of Science ID 000451325700098
View details for PubMedID 30475890
View details for PubMedCentralID PMC6258130
'No time for health:' exploring couples' health promotion in Indian slums.
Health promotion international
Joint involvement of couples is an effective strategy to increase contraceptive use and improve reproductive health of women. However, engaging couples to understand how their gender attitudes affect their personal and family health is an idea in search of practice. This mixed-methods study explores opportunities and barriers to couples' participation in health promotion in three slums of Delhi. For each couple, surveys and semi-structured interviews were conducted with husbands and wives individually to contrast self and spousal work, time, interest in health, sources of information related to health and depth of knowledge (n = 62). Urban poverty forces men to work long hours and women to enter part-time work in the informal sector. Paid work induces lack of availability at home, lack of interest in health information and in performing household chores and a self-perception of being healthy among men. These factors inhibit men's' participation in community-based health promotion activities. Women's unpaid work in the household remains unnoticed. Women were expected to be interested in and to make time to attend community-based health-related activities. Men recalled significantly less sources of health information than their spouse. Men and their wives showed similar depth of health-related knowledge, likely due to their spousal communication, with women acting as gatekeepers. Health promotion planners must recognize time constraints, reliance on informal interpersonal communication as a source of health information and the need to portray positive masculinities that address asymmetric gender relations. Innovative, continuous and collaborative approaches may support couples to proactively care about health in low-resource settings.
View details for DOI 10.1093/heapro/day101
View details for PubMedID 30590523
Is India's policy framework geared for effective action on avoidable blindness from diabetes?
Indian journal of endocrinology and metabolism
2016; 20 (Suppl 1): S42–50
The growing burden of avoidable blindness caused by diabetic retinopathy (DR) needs an effective and holistic policy that reflects mechanisms for early detection and treatment of DR to reduce the risk of blindness.We performed a comprehensive health policy review to highlight the existing systemic issues that enable policy translation and to assess whether India's policy architecture is geared to address the mounting challenge of DR. We used a keyword-based Internet search for documents available in the last 15 years. Two reviewers independently assessed retrieved policies and extracted contextual and program-oriented information and components delineated in national policy documents. Using a "descriptive analytical" method, the results were collated and summarized as per themes to present status quo, gaps, and recommendations for the future.Lack of focus on building sustainable synergies that require well laid out mechanisms for collaboration within and outside the health sector and poor convergence between national health programs appears to be the weakest links across policy documents.To reasonably address the issues of consistency, comprehensiveness, clarity, context, connectedness, and sustainability, policies will have to rely more strongly on evidence from operational research to support decisions. There is a need to involve multiple stakeholders from multiple sectors, recognize contributions from not-for-profit sector and private health service providers, and finally bring about a nuanced holistic perspective that has a voice with implementable multiple sector actions.
View details for DOI 10.4103/2230-8210.179773
View details for PubMedID 27144136
View details for PubMedCentralID PMC4847449
- Enhancing mental health literacy in India to reduce stigma: the fountainhead to improve help-seeking behaviour JOURNAL OF PUBLIC MENTAL HEALTH 2014; 13 (3): 146-+