UCSF School of Medicine - Latino Mental Health Research Program

Internet World Health Research Center

The mission of the Internet World Health Research Center (IWHRC, pronounced “I work”) is to harness the power of the Internet to reach those most in need with behavioral health interventions that are as effective as traditional interventions and that can be administered directly to them via the World Wide Web.
www.health.ucsf.edu

The Tobacco Related Disease Research Program funded the establishment of the Spanish/English Web Site for Smoking Cessation Trials at www.stopsmoking.ucsf.edu and www.dejardefumar.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.
During Phase II we carried out three sets of studies comparing two smoking cessation conditions to each other. Publications from the first two phases include:

During Phase III, we compared four methods to stop smoking via the Web.
We are currently recruiting participants for this phase of the study, and are in the process of implementing minor changes to our follow up surveys to include feedback at follow up. The purpose of this modification is to evaluate if the addition of feedback may increase the response rate during follow-up. This feedback will be based on the participant responses for the immediate follow-up point and their responses at the previous assessment.

During Phase IV, we will carry out an exploratory smoking cessation study on the Web to estimate smoking cessation rates in a participant's preference outcome study, in which participants will be able to choose among the several self-help elements that we have been testing in the randomized trials described above.
Phase IV is scheduled to launch by the end of the year.

We welcome Spanish and English speaking smokers to join our study.
English site: www.stopsmoking.ucsf.edu
Spanish site: www.dejardefumar.ucsf.edu

Funding Sources
Tobacco-Related Disease Research Program Grant # 10RT-0326
“Spanish/English web site for smoking cessation trials.”
Principal Investigator: Ricardo F. Muñoz, Ph.D.
Co-investigators:

Mothers and Babies: Mood and Health Project
Mamás y Bebés: El Estado de Animo y la Salud

Risk for major depression appears to be transmitted across generations. Pregnancy and the postpartum period are key periods to study because maternal emotion regulation deficits may affect both maternal and child outcomes. Children of parents with emotion regulation problems are at higher risk for developing similar problems over time.
The Mothers and Babies: Mood and Health Project was launched in 1998 by the Latino Mental Health Research Program at the University of California, San Francisco/San Francisco General Hospital. Its aims are: (1) to identify pregnant women at imminent risk for major depressive episodes, and (2) to test whether a cognitive-behavioral intervention reduces risk for maternal depression and improves maternal and child functioning in high risk low-income pregnant English and Spanish-speaking women.

First Stage:
Depression Risk Study

We recruited 100 Spanish and English-speaking, low-income, pregnant women obtaining their prenatal care at the SFGH Women’s Clinic. Beginning in the second trimester of pregnancy and continuing monthly through the first six months postpartum, we assessed their depression level and associated risk factors. We found that women with emotion regulation deficits (“high risk”), but not suffering from clinical depression when recruited, experienced more new major depressive episodes during the one-year prospective study period than those we had categorized as “low-risk” women. Specifically, 24.1% of the “high-risk” group developed a major depressive episode within one year, compared to 2.6% of the “low-risk” group. Our findings indicate that we are able to identify pregnant women at high risk for developing major depressive episodes.

Diaz, M. A., Le, H-N., Cooper, B. A., & Muñoz, R. F. (In press). Interpersonal Factors
and Perinatal Depressive Symptomatology in a Latina Sample. Cultural Diversity and Ethnic Minority Psychology.

Funding Sources
University of California Office of the President
Private donors: Dr. Cloyce L. Duncan and Dr. Gwendolyn Evans-Duncan.
Principal Investigators: Huynh-Nhu Le, Ph.D., and Ricardo F. Muñoz, Ph.D.,

Second Stage:
Intervention Development Study: The Mothers and Babies Course

Building on the results of our Depression Risk Study, we recruited 57 “high-risk” pregnant women for a pilot randomized controlled trial. Our aim was to pilot test the Mothers and Babies Course, an adaptation of our Depression Prevention Course for pregnant women, to see whether difficulties in emotion regulation can be improved with a psycho-educational intervention, and whether promoting optimal levels of emotion regulation produces measurable differences in maternal efficacy. The course includes a 12-week group session that occurs during pregnancy, and 4 booster sessions during the first year postpartum (months 1, 3, 6, and 12). Thirty-four women were randomized to the intervention condition and 23 to a no-intervention control condition. Our results to date indicate that low-income, primarily Latina women found the Mothers and Babies Course useful, attended the course sessions, and are available for follow-up up to 1½ years after birth. We are currently analyzing other study outcomes.

Funding Sources
NIMH R21 MH 596056 Intervention Development Grant (2000-2004)
Principal Investigator: Ricardo F. Muñoz, Ph.D.
Co-investigators: Huynh-Nhu Le, Ph.D., and Chandra Ghosh Ippen, Ph.D.

Third Stage:
First Years Study: Following the babies at 3½ and 1½ years of age

Participants from the Risk and Intervention Development studies were re-contacted to study the socioemotional functioning of the mothers and babies over time. We assessed the children from the Depression Risk Cohort at 3½ years of age, and the children of the Intervention Development Cohort at 1½ years of age. This study's primary aims were (1) to assess the psychosocial and cognitive functioning of each index child, and (2) to examine the relation between the index child's current psychosocial and cognitive development and the mother's depression levels during pregnancy and currently. We collected behavioral and observational data on the children, as well as self-report data from the mothers. This study suggests that we are able to follow up urban, low-income Latinas and their children longitudinally, and that we can reliably measure and document the effects of maternal perinatal depression on the index children's development.

Funding Sources
UC Mexus Grant
Co-principal investigators: Guido Urizar, Ph.D. and Ricardo F. Muñoz, Ph.D.