Volume 2, Issue 2May 2009
El Faro Staff
Liliane Cambraia Windsor, Ph.D., M.S.W., Editor
Sheila Kaupert,
Newsletter Coordinator
National Office
Jane Brooks, M.Sc., C.M.P.
Website Coordinator
National Steering Committee
José Szapocznik, Ph.D., NHSN Chair
Sergio Aguilar-Gaxiola, M.D., Ph.D.
Hortensia Amaro, Ph.D.
Ana Mari Cauce, Ph.D.
Joe Martínez, Ph.D.
Patricia Molina, M.D., Ph.D.
Humberto Nicolini-Sanchez, M.D., Ph.D.
Bryan Page, Ph.D.
Rafaela Robles, Ed.D.
Avelardo Valdez, Ph.D.
Bill Vega, Ph.D.
Current Issue
The International Front
by Ricardo F. Muñoz, Ph.D.
More than 1 billion people smoke and over 5 million die each year across the world from tobacco-related diseases. Tobacco control policies are helping many to quit. In addition, smoking cessation services, whether via pharmacological or behavioral methods, are continually increasing their effectiveness.
One of the limitations of traditional smoking cessation services is that they are consumable. A one-hour smoking cessation group, for example, can only benefit the smokers who attend the group. After the session, no other smoker can ever benefit from the group leaders’ time spent on the group. That therapeutic time is gone forever. Similarly, when smokers use a nicotine patch, at the end of the day they take off the patch and have no alternative but to discard it: they cannot share it with a friend or use it themselves on the following day. Both the smoking cessation groups and the nicotine patch are consumable.
It is unlikely that we will ever train enough smoking cessation counselors to reach all smokers who want to quit. It is also unlikely that we will provide pharmacological aids to all of them. What are needed are interventions that can be used simultaneously by large numbers of people, at any time of the day or night, and at any location. Moreover, it would be very helpful to make the interventions available to smokers at no cost to them. Internet interventions provide a means to administer such services in a way in which the marginal cost of providing the service eventually approaches zero: the Web server can administer an automated self-help intervention to 1000 people for about the same cost as reaching one more person, that is, 1001, 1002, even 10,000 or more people. This allows us to reach smokers much more widely than using traditional interventions.
The Latino Mental Health Research Program of the University of California, San Francisco and San Francisco General Hospital, has, for many years, developed and tested psychological interventions for the treatment and prevention of depression, and for other health problems. Our treatment manuals, in Spanish, English, Chinese, and Japanese, are available for downloading from our site: http://www.medschool.ucsf.edu/latino/ Over the years, one of the limitations of these evidence-based manuals (Muñoz and Mendelson, 2005) became evident to us: There are many locations which do not have trained professionals to administer the interventions, or at least no professionals who speak Spanish, say. We began to consider methods to administer interventions directly to individuals in need of them. Since 1998, we have been conducting randomized control trials in Spanish and English via the Internet. We have begun with smoking cessation studies, and, more recently, started to examine Internet depression intervention studies.
At first, we thought we’d use the Internet studies to reach smokers in California. It soon became clear that the World Wide Web is truly worldwide. We have had over 600,000 visitors to our site so far, from over 200 countries. Over 53,000 have been eligible for our studies and become official participants by signing informed consent forms online. Based on the success of our work, the Latino Mental Health Research Program established a campus-wide Internet World Health Research Center in 2004 (www.health.ucsf.edu).
One of the issues involved in doing this type of work is to determine what would constitute success. We decided that, if we obtained abstinence rates comparable to the nicotine patch (which gets 14% to 22% quit rates at six months) or smoking cessation groups (which get about 24%-27% quit rates), we would feel the Internet interventions were worth continuing. Our first set of randomized trials obtained quit rates as high as 26% at six months (Muñoz et al., 2006). We have recently had a paper accepted reporting 20% quit rates at 12 months.
We are happy to share with the readers of El Faro our recently published article reporting on the characteristics of a subsample of our participants consisting of over 17,000 smokers from 157 countries. We believe the use of the Internet will multiply our reach in terms of helping smokers to quit no matter where they live. For example, tobacco control public health officials could provide our Stop Smoking site to smokers at the state level or at the national level. We welcome their doing so. Our link is www.stopsmoking.ucsf.edu (English) and www.dejardefumar.ucsf.edu (Spanish).
We hope to extend our work to other substance abuse and mental disorders. Our dream is to systematically fill in a grid consisting of columns representing health problems and rows representing languages. We are currently seeking funding to make this dream a reality. Please share this story with potential donors.
Corresponding Author: Ricardo F. Muñoz, Department of Psychiatry, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue, Suite 7M, San Francisco, CA 94110, USA. W: (415) 206-5214; Fax: (415) 206-8942. E-mail address: ricardo.munoz@ucsf.edu