Internet World Health Research
Smoking Cessation Web Study: Tomando Control
The Tobacco Related Disease Research Program funded the establishment
of the Spanish/English Web Site for Smoking Cessation Trials at www.stopsmoking.ucsf.edu
. This project of the University of California, San Francisco/San Francisco
General Hospital Latino Mental Health Research Program is being conducted
in collaboration with the University of California, San Francisco Medical
Effectiveness Research Center for Diverse Populations (MERC) and the University
of California, San Diego. During Phase I of the study, we created the
basic site and tested its ability to 1) recruit participants, 2) obtain
informed consent, 3) obtain initial assessment data, 4) provide one intervention,
and 5) obtain follow-up data, all with minimal human intervention. We
recruited over 4500 smokers, of whom over 1000 were Spanish-speaking.
Tobacco-Related Disease Research Program Grant # 10RT-0326
“Spanish/English web site for smoking cessation trials.”
Principal Investigator: Ricardo F. Muñoz, Ph.D.
During Phase III, we compared four methods to stop smoking via the Web in a randomized control trial. Publications from this phase include:
Muñoz RF, Barrera AZ, Delucchi K, Penilla C, Torres LD, Pérez-Stable EJ. International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at 1 year. Nicotine Tob Res. 2009 Sep;11(9):1025-34. Epub 2009 Jul 29.
Torres LD, Barrera AZ, Delucchi K, Penilla C, Pérez-Stable EJ, Muñoz RF. Quitting smoking does not increase the risk of major depressive episodes among users of Internet smoking cessation interventions. Psychol Med. 2009 Jul 23;:1-9 [Epub ahead of print]
Barrera AZ, Pérez-Stable EJ, Delucchi KL, Muñoz RF. Global reach of an Internet smoking cessation intervention among Spanish- and English- speaking smokers from 157 countries. Int J Environ Res Public Health. 2009 Mar;6(3):927-40. Epub 2009 Feb 26.
Diaz, M. A., Le, H-N., Cooper, B. A., & Muñoz, R. F. (2007). Interpersonal factors and perinatal
Le, H-N., Muñoz, R. F., Soto, J., Delucchi, K., & Ghosh Ippen, C. (2004). Identifying risk for onset of major depressive episodes in a low-income Latinas during pregnancy and postpartum. Hispanic Journal of Behavioral Sciences, 26, 463-482.
Le, H. N., Ramos, M. A., & Munoz, R. F. (2007). The relationship between alexithymia and perinatal depressive symptomatology. Journal of Psychosomatic Research, 62(2), 215-222.
Urizar, G. G., Milazzo, M., Munoz, R. F., Le, H-N., Delucchi, K., & Sotelo, R. (2004). Impact of preventive interventions on the regulation of mood and cortisol during pregnancy. Biological Psychology, 67, 275-282.
Muñoz, R. F., Le H-N., Ghosh Ippen, C., Diaz, M.A., Urizar, G.G., Soto, J. et al. (2007). Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/Mothers and Babies Course. Cognitive and Behavioral Practice, 14, 70-83.
Depression Management Course
Yan Leykin, Ph.D.
Untreated depression accounts for more than 11% of the world total disease burden. Depression is associated with up to 60% of suicide deaths, deteriorating health, and social problems. Most affected individuals are not receiving adequate treatment. The long-term objective of this project is to address the issue of untreated depression by developing and evaluating an effective Web-based intervention for depression, available at no cost and in multiple languages to depressed and dysphoric individuals anywhere in the world.
The current project is the first step towards that goal. We have developed a self-contained, interactive, modular, Web-based self-help intervention for depression. The intervention is based on cognitive-behavioral therapy, an empirically supported treatment for depression. Participants from the Internet community are invited to sign up for a customized eight-lesson intervention. This is a proof-of-concept study, with the goal of assessing the degree of interest in and the demand for Web interventions, and to obtain initial information about the effectiveness of this intervention.
We are currently recruiting participants:https://ihrc.ucsf.edu/
Healthy Mood Management Course
The World Health Organization now recognizes depression as one of the most disabling medical conditions in the world. In 2003, in the US alone, depression costs amounted to 44 billion dollars in lost productivity (Stewart, Ricci, Chee, Hahn, & Morganstein, 2003). It has been estimated that one half of all persons with depression in the US, and 75% worldwide, do not receive adequate treatment (Kessler, Berglund, Demler, Jin, Koretz, Merikangas, et al., 2003). Untreated depression is associated with to up to 60% of suicide deaths, deteriorating health, and social problems, accounting for more than 11% of the total disease burden worldwide, with functional disabilities exceeded only by cardiovascular disease and cancer (Greden, 2001).
The Internet Healthy Mood Course/”Logrando un estado de ánimo saludable” is the Web adaptation of the Depression Prevention Course. The Web-adapted intervention takes advantage of the interactive capabilities of the Web. To increase interest in the site, engage participants, and present information verbally to participants who may have trouble reading, videos and audio messages accompany some of the material presented in each module. The adapted intervention includes self-monitoring tools that are displayed in graphs . For instance, participants are able to indicate their mood levels and activities they find pleasant by clicking on an electronic mood scale and activities scale, respectively, which can produce an individualized list of activities that can then be checked off each day.
Pharmacotherapy and cognitive behavioral therapy are efficacious
The Audio Coach for Depression Project/El Consejero Portátil
With the exception of a few studies on Cognitive Behavioral Therapy (CBT) for Latinos, in general, there is very little research on the utility of other treatment modalities or applications of technology to CBT for Latinos.
Twelve brief psychoeducational sessions that correspond to the Manual for Group Cognitive-Behavioral Therapy of Major Depression (Muñoz, Ghosh Ippen, Rao, Le, and Dwyer, 2000) have been recorded as MP3 files. The will be delivered via an audio intervention during treatment and post treatment. Patients receive an MP3 player with the audio files, a user’s guide, and a tracklisting document. Patients are assigned the files that correspond to the weekly topics presented during each group session. Ultimately, the implementation of the Audio Coach has four aims: (1) It is intended to make the framework of CBT easier to teach before patients initiate group treatment; (2) teach coping skills while patients are in a waitlist condition; (3) augment the impact of treatment in between therapy sessions, and (4) to reduce future risk for relapse. Further, this project hopes to address the need for a further development of depression treatment modalities (e.g. individual, group, workbook, Internet-based treatments) offered to Latinos who may have limited literacy or English language proficiency. The Audio Coach for Depression Project/ El Consejero Portátil was launched during March, 2010 and is currently in the pilot-testing phase. We have used the MP3 adjunct for our Spanish CBT for Depression Groups at San Francisco General Hospital.