I'm judging you! Influence of depression on moral judgments of COVID-19 infection control behaviors and policies.

Health officials recommended a number of COVID-19 infection control measures, such as social distancing and face covering. This study explores whether depression influences individuals' moral judgments regarding COVID-19 infection control behaviors and policies. In this study, participants (N = 340) were US residents, recruited via Amazon Mechanical Turk in March of 2020. Participants completed several questionnaires, such as demographics, including political affiliation, a depression screener, and a series of questions designed to capture individuals' moral judgments of infection control behaviors and policies. ANCOVA analyses indicated that, controlling for demographics, political affiliation, and the degree of news following, depression symptom level was consistently inversely related to the likelihood of judging infection control in moral terms. Depression symptom level was also inversely related to sensitivity to manipulation of moral judgments for personal behaviors, but not for policies. Individuals with higher levels of depression symptoms may be less willing to advocate for higher personal safety measures, which could lead to a higher likelihood of disease transmission. Outside of the pandemic, the lower propensity for moral judgment could translate into greater acceptance of morally questionable acts and behaviors from others.

Mothers and Babies Online Course: Participant Characteristics and Behaviors in a Web-Based Prevention of Postpartum Depression Intervention.

Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.

Integrating SMS Text Messages Into a Preventive Intervention for Postpartum Depression Delivered via In-Home Visitation Programs: Feasibility and Acceptability Study.

BACKGROUND: The Mothers and Babies (MB) Course is recognized by the US Preventive Services Task Force as an evidence-based preventive intervention for postpartum depression (PPD) that should be recommended to pregnant women at risk for PPD. OBJECTIVE: This report examines the feasibility and acceptability of enhancing the MB 1-on-1 intervention by adding 36 SMS text messages that target 3 areas: reinforcement of skills, between-session homework reminders, and responding to self-monitoring texts (ie, MB Plus Text Messaging [MB-TXT]). METHODS: In partnership with 9 home visiting programs, 28 ethnically and racially diverse pregnant women (mean 25.6, SD 9.0 weeks) received MB-TXT. Feasibility was defined by home visitors' adherence to logging into the HealthySMS platform to enter session data and trigger SMS text messages within 7 days of the in-person session. The acceptability of MB-TXT was measured by participants' usefulness and understanding ratings of the SMS text messages and responses to the self-monitoring SMS text messages. RESULTS: On average, home visitors followed the study protocol and entered session-specific data between 5.50 and 61.17 days following the MB 1-on-1 sessions. A high proportion of participants responded to self-monitoring texts (25/28, 89%) and rated the text message content as very useful and understandable. CONCLUSIONS: This report contributes to a growing body of research focusing on digital adaptations of the MB course. SMS is a low-cost, accessible digital tool that can be integrated into existing interventions. With appropriate resources to support staff, it can be implemented in community-based organizations and health care systems that serve women at risk for PPD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03420755; https://clinicaltrials.gov/ct2/show/NCT03420755.

Leading the charge toward a world without depression: perinatal depression can be prevented.

This manuscript is based on a keynote address presented at the 2020 Marcé Society's Conference celebrating the Society's 40th anniversary. The address described a 50-year perspective on prevention research, current evidence that perinatal depression can be prevented, and how digital tools could be used to disseminate perinatal depression prevention interventions throughout the world. We utilized the Mothers and Babies Course as a case study to illustrate these goals. The article reviews the gradual progress of depression prevention research, from the time when the state of the science was such that it was believed that the onset of major depressive episodes could not be prevented until the present day. In addition, the article recounts the three consensus reports on prevention of mental disorders published by the National Academies of Science, Engineering, and Medicine, culminating in the 2019 report, which calls on the field to implement known interventions for the prevention of depression and other mental disorders, and to scale up their administration to reduce the prevalence of these disorders in the general population. The paper presents the 2019 recommendations of the US Preventive Services Task Force, which instructs the health system to provide routine referrals to perinatal depression prevention interventions (e.g., the Mothers and Babies Course) to perinatal persons at risk for depression. We now have the knowledge to prevent approximately half of episodes of perinatal depression. It is time to implement this knowledge and begin to do research on how to prevent the remaining half.

Development and usability of a Spanish/English smoking cessation website: lessons learned.

BACKGROUND: Smoking cessation Internet interventions have been shown to be comparable in effectiveness to the nicotine patch. The aim of this study was to develop a Spanish/English smoking cessation web app using input from low-income smokers, and to evaluate modifications to the online intervention in terms of its ability to engage smokers. METHODS: Three versions of a smoking cessation web app were developed and tested. Measures of engagement, such as completion of study registration, utilization of cigarette, mood, and craving trackers, and completion of follow-up assessments, were collected to determine whether changes in the website resulted in increased engagement. RESULTS: The third version of the website, which featured improved look-and-feel and fewer barriers to engagement, markedly increased tracker engagement from the first two versions. However, follow-up rates remained low across all three versions. CONCLUSIONS: The increase in engagement was attributed to the following modifications: A more inviting landing page with key intervention elements available immediately; an easily accessible dashboard with users' data; and tracking tools that were more user friendly. We conclude that in addition to adequate and functional elements, design principles are key factors in increasing engagement in online interventions.

Digital Tools for Prevention and Treatment of Depression: Lessons from the Institute for International Internet Interventions for Health / Instrumentos digitales de prevención y tratamiento de la depresión: lecciones del Instituto Internacional de Intervenciones vía Internet para la Salud

There is now substantial evidence that major depressive episodes can be prevented and treated effectively with psychological interventions administered by trained lay and professional providers. There is also evidence that depression can be prevented and treated using self-help digital interventions such as websites and apps, and that their effectiveness increases if these interventions are supported by guides or coaches. In this commentary we describe digital approaches for depression developed and tested across the world by Palo Alto University's Institute for International Internet Interventions for Health. We recommend the creation of digital apothecaries to increase access to in-person interventions by 1) training more providers, and 2) developing tools providers can use to enhance the effectiveness of these interventions, and to provide access to self-help interventions that can be used directly by anyone with 3) either guides or coaches to reduce dropout, or 4) as fully automated interventions

Existen evidencias importantes que demuestran que los episodios depresivos mayores pueden prevenirse y tratarse eficazmente con intervenciones psicológicas administradas tanto por profesionales como por no profesionales debidamente capacitados. También hay evidencia de que la depresión se puede prevenir y tratar mediante intervenciones digitales de autoayuda tales como páginas web y aplicaciones y que su eficacia aumenta si estas intervenciones son apoyadas por guías o coaches. En este comentario describimos enfoques digitales para la depresión desarrollados y probados en todo el mundo por el Instituto de Intervenciones Internacionales en Salud por Internet de la Universidad de Palo Alto. Recomendamos la creación de apotecarias digitales para aumentar el acceso a las intervenciones: 1) capacitando a más proveedores de ayuda y 2) desarrollando herramientas que estos puedan utilizar para mejorar la eficacia de estas intervenciones y para proporcionar acceso a intervenciones de autoayuda que puedan ser utilizadas directamente por cualquier persona con 3) guías o coaches con el objetivo de reducir el abandono o 4) como intervenciones totalmente automatizadas

Who comes to a self-help depression prevention website? Characteristics of Spanish- and English-speaking visitors.

OBJECTIVE: To describe demographic and clinical characteristics of Spanish- and English-speaking visitors to a "Healthy Mood" website. METHODS: An online study intended to prevent depression by teaching users mood management skills recruited participants globally using primarily Google Ads. Those who consented responded to the Patient Health Questionnaire (PHQ-9) and the MDE Screener (Muñoz, 1998) upon entry into the study. RESULTS: 1423 participants consented, 437 English speakers and 986 Spanish speakers. Of the 1271 participants with sufficient depression symptom data, 65% screened positive for a current major depressive episode, 30% were at high risk for onset of a major depressive episode, and 5% were in the low-risk category. CONCLUSION: Websites intended to be preventive appear to attract primarily individuals who are currently experiencing enough symptoms to screen positive for a major depressive episode. Only 30% of participants were appropriate for a depression prevention intervention. Therefore, such sites must be ready to encourage those with current depression to obtain professional help as well as ensure that the online self-help interventions are appropriate for participants who could benefit from both preventive and treatment interventions.

A Systematic Review of Technology-Based Prevention and Treatment Interventions for Perinatal Depression and Anxiety in Latina and African American Women.

INTRODUCTION: Latina and African American women have elevated risk for perinatal depression and anxiety but have low rates of treatment engagement. Amid significant improvements in narrowing the digital divide, the number of technology-based mental health interventions has increased. A technology-based mode of delivery is important to consider because it can increase patient engagement and should inform program development. This review aimed to assess the mode of technology used for preventing and/or treating perinatal depression and anxiety in Latina and African American women, examine symptom management, and describe participant satisfaction. METHODS: We used PubMed, CINAHL, PsycINFO, PsycARTICLES, EBSCO, and Social Services Abstracts to identify studies that used technology (e.g., smartphones) to prevent and/or treat depression and/or anxiety in Latina and/or African American perinatal women. To be eligible for inclusion, studies must have had at least 50% Latina and/or African American samples. The review was conducted between November 2018 and October 2019, with no set publication start date. RESULTS: Of 152 studies reviewed, six met the inclusion criteria. Four studies included African American women; two studies had samples that were mostly composed of Latina women. Three studies used telephone/smartphone (e.g., text messaging) and three implemented internet-based interventions. All studies addressed depression; one focused on anxiety. The findings demonstrated participant satisfaction and promise for symptom management. DISCUSSION: Despite the limited number of studies that used technology to engage Latina and African American perinatal women, the results suggest that these women were willing to participate in digital interventions to address perinatal depression and anxiety.

The Factor Reliability and Convergent Validity of the Patient Health Questionnaire-4 Among an International Sample of Pregnant Women.

Background: Pregnant women are at an increased risk for anxiety and depression, but a majority of women go untreated due to a high rate of undetected symptoms. The 4-item Patient Health Questionnaire (PHQ-4) is an ultrabrief screening instrument for anxiety and depression with sound psychometric properties demonstrated in the general population and primary care, but not among pregnant women. The aim of this study was to provide initial evidence of the validity and reliability of the PHQ-4 among pregnant women. Materials and Methods: Data from an international sample of 1148 pregnant women who participated in an online cross-sectional survey were examined using a confirmatory factor analysis (CFA) and multigroup analysis approaches. Average chronological and gestational ages were 27.7 years old (standard deviation [SD] = 6.5) and 16.8 weeks (SD = 10.6), respectively. Participants were from diverse cultural backgrounds and English and Spanish speaking (n = 587 and n = 561, respectively). Results: CFA reflected two distinct factors, which accounted for 59% of the proportion of variance in the two anxiety items and 50% in the two depression items. Coefficient H values of 0.74 for anxiety and 0.70 for depression suggested good factor reliability. Conclusions: This is the first study demonstrating initial evidence supporting the validity and reliability of the PHQ-4 in pregnant women. Should this study be replicated, a clinical interview, which is the gold standard procedure, should be included. Regardless, the PHQ-4 may be a useful ultrabrief resource for maternal mental health clinicians and health care providers who need to identify potential cases of anxiety and depression in pregnant women using efficient and evidence-based tools.

Content and format preferences of a depression prevention program: A study in perinatal women / Estudio de preferencias sobre contenidos y formatos para un programa de prevención de la depresión: un estudio en mujeres perinatales

BACKGROUND: this study investigated ethnic differences in the preferred content and delivery method of a depression prevention program for perinatal women. METHOD: participants were 163 pregnant (66.9%) and postpartum (33.1%) women. Women identified themselves as Latinas (45.4%) or non-Latinas (54.6%). RESULTS: overall, women preferred individual and onsite therapy across contents. Only when the content was related to improving communication, they were willing to incorporate the partner. There were no ethnic differences in the preferred format. Regarding content, women preferred to receive "information on the pregnancy process including physical and psychological changes".Non-Latinas had a higher preference for "receiving regular checkins on their emotional state" than Latinas. CONCLUSIONS: these results should be considered when developing future perinatal depression prevention programs and evidence that work needs to be done if we want online interventions to be viewed more favorably by perinatal women

ANTECEDENTES: este trabajo explora las diferencias étnicas en preferencias de contenido y formato de un programa preventivo de depresión perinatal. MÉTODO: participaron 163 mujeres en etapa perinatal (66.9% embarazadas; 33.1% en el posparto) que se identificaron como latinas (45.4%) y no latinas (64.6%). RESULTADOS: el formato preferido fue individual y en persona para todos los contenidos. Solo cuando el contenido tenía que ver con la comunicación de pareja, considerarían incluir a la pareja. No se encontraron diferencias significativas en función de la etnia en las preferencias de formato. En cuanto al contenido, las mujeres prefirieron "información sobre el proceso de embarazo, incluyendo cambios físicos y psicológico" Las mujeres no latinas mostraron una mayor preferencia por "realizar evaluaciones regulares sobre su estado emocional" en comparación a las latinas. CONCLUSIONES: estos resultados deberían considerarse a la hora de diseñar futuros programas de prevención para la depresión perinatal y evidencian la necesidad de trabajar más en las intervenciones online si queremos que se valoren más favorablemente por las mujeres perinatales

A preliminary study on the acceptability of a brief SMS program for perinatal women.

This study examined the acceptability of the BabyText program, a Spanish and English textmessaging program adapted from a prevention of postpartum depression group intervention. Ten ethnically and racially diverse pregnant and postpartum women (mean age = 31.3, standard deviation = 5.25) recruited from a metropolitan, urban area of the United States received the BabyText program over a 69-day period (between October 2015 and April 2016). Each tip was assessed for the helpfulness of the content, and all women were invited to provide qualitative feedback about the program. Eighteen of the tips received a positive endorsement of helpfulness from 75 to 100 percent of the women, 12 tips received a positive endorsement of helpfulness from 50 percent of the women, and one tip was rated negatively by those who responded. Qualitative feedback described the need to personalize the tips to reflect the characteristics of women such as planned/unplanned pregnancy status, available economic resources, and current psychological distress. Women in this study favored tips that described stress management skills and emphasized caring for the self (vs only the baby). Data from this study are preliminary but add to the growing sentiment that digital tools should continue to be developed and tested, and personalization of intervention content is important to users.

Facebook for recruiting Spanish- and English-speaking smokers.

BACKGROUND: Recruitment for research is usually expensive and time consuming. Facebook (FB) recruitment has become widely utilized in recent years. The main aim of this study was to assess FB as a recruitment tool in a study for Spanish- and English-speaking smokers. Additionally, the study set out to compare performance of ads by language (Spanish vs. English), location (U.S. vs. San Francisco) and content (self-efficacy ad vs. fear appeal ad). METHODS: Participants of a one-condition smoking cessation webapp study were recruited utilizing FB ads and posts through two phases: a recruitment-focused phase and an experimental phase comparing language, location and content. RESULTS: During the recruitment phase 581 participants in total (U.S. = 540, San Francisco = 41) provided consent. Of the U.S. participants 275 were Spanish-speakers and 265 English-speakers. The cost-per-consent was $25.81 for Spanish-speakers, and $15.49 for English-speakers. During the experimental phase U.S. users performed better (i.e. more clicks, engagement and social reach) than San Francisco users, Spanish-speakers engaged more than English-speakers, and the self-efficacy ad performed better than the fear appeal ad. CONCLUSIONS: This study showed that although there were differences in cost-per-consent for Spanish- and English-speakers, recruitment of Spanish-speakers through Facebook is feasible. Furthermore, comparing performance of ads by location, language, and ad content may contribute to developing more efficient campaigns.

Responding to women's needs and preferences in an online program to prevent postpartum depression.

PURPOSE: Global access to adequate resources to address postpartum depression (PPD) are limited and, at times, not reflective of the needs of pregnant women and new mothers. Gathering information about the preferences and needs of women when designing and implementing Internet-based programs is warranted, especially given the diversity of experiences related to childbirth. Thus, the aim of this study was to obtain user feedback on the content, structural, and cultural factors associated with a fully automated online PPD prevention intervention that, like similar programs, suffered from poor adherence and engagement. METHODS: Following the completion of the Mothers and Babies Internet Course (eMB), an online prevention of PPD trial, a convenience sampling method was used to invite consenting participants to return to the site. Participants provided anonymous feedback on how to improve and adapt the eMB based on screenshots and video content from the Internet intervention. Demographic information and engagement in the online trial were examined as factors influencing participant responses. RESULTS: One hundred nineteen English and Spanish speaking women from 27 countries and territories provided feedback about the eMB. Content-based feedback included requesting additional detail in explanations and simplifying recommended exercises. Structure-based feedback included requests for more visual representations of the materials. In general, participants did not explicitly suggest culturally specific feedback that differed by geographic region, but instead reported similar themes related to motherhood and childrearing. An unexpected finding that only emerged among English-speaking participants was the need for the eMB to address perfectionism and introspection as factors that impact motherhood. Relative to those who did not access the eMB in the parent study, women who did thought the intervention content was acceptable (i.e., no suggested changes) and provided feedback that referenced maternal stress and pregnancy experiences. Age, education, pregnancy status and number of children were not significant factors associated with participants' use of the eMB. CONCLUSIONS: Findings from this study offer preliminary information about the needs and preferences of an international sample of childrearing women who access automated Internet interventions to manage mood changes during the perinatal period.

Perinatal depression among a global sample of Spanish-speaking women: A sequential-process latent growth-curve analysis.

BACKGROUND: Despite high rates of perinatal depression among women from diverse backgrounds, the understanding of the trajectory of depressive symptoms is limited. The aim of this study was to investigate the trajectories of depressive symptoms from pregnancy to postpartum among an international sample of pregnant women. METHODS: Hispanic/Latina (79.2%), Spanish-speaking (81%) pregnant women (N = 1796; Mean age = 28.32, SD = 5.51) representing 78 unique countries/territories participated in this study. A sequential-process latent growth-curve model was estimated to examine general trajectories of depression as well as risk and protective factors that may impact depression levels throughout both the prenatal and postpartum periods. RESULTS: Overall, depression levels decreased significantly across the entire perinatal period, but this decrease slowed over time within both the prenatal and postpartum periods. Spanish-speaking women, those who were partnered, and those with no history of depression reported lower levels of depression during early pregnancy, but this buffer effect reduced over time. Depression levels at delivery best predicted postpartum depression trajectories (i.e., women with higher levels of depression at delivery were at greater risk for depression postpartum). LIMITATIONS: Given the emphasis on language and not country or culture of origin this study was limited in its ability to examine the impact of specific cultural norms and expectations on perinatal depression. CONCLUSIONS: Given these findings, it is imperative that providers pay attention to, and assess for, depressive symptoms and identified buffers for depression, especially when working with women from diverse communities.

Comparing Amazon Mechanical Turk with unpaid internet resources in online clinical trials.

Internet interventions face significant challenges in recruitment and attrition rates are typically high and problematic. Finding innovative yet scientifically valid avenues for attaining and retaining participants is therefore of considerable importance. The main goal of this study was to compare recruitment process and participants characteristics between two similar randomized control trials of mood management interventions. One of the trials (Bunge et al., 2016) was conducted with participants recruited from Amazon's Mechanical Turk (AMT), and the other trial recruited via Unpaid Internet Resources (UIR). METHODS: The AMT sample (Bunge et al., 2016) consisted of 765 adults, and the UIR sample (recruited specifically for this study) consisted of 329 adult US residents. Participants' levels of depression, anxiety, confidence, motivation, and perceived usefulness of the intervention were assessed. The AMT sample was financially compensated whereas the UIR was not. RESULTS: AMT yielded higher recruitment rates per month (p < .05). At baseline, the AMT sample reported significantly lower depression and anxiety scores (p < .001 and p < .005, respectively) and significantly higher mood, motivation, and confidence (all p < .001) compared to the UIR sample. AMT participants spent significantly less time on the site (p < .05) and were more likely to complete follow-ups than the UIR sample (p < .05). Both samples reported a significant increase in their level of confidence and motivation from pre- to post-intervention. AMT participants showed a significant increase in perceived usefulness of the intervention (p < .0001), whereas the UIR sample did not (p = .1642). CONCLUSIONS: By using AMT, researchers can recruit very rapidly and obtain higher retention rates; however, these participants may not be representative of the general online population interested in clinical interventions. Considering that AMT and UIR participants differed in most baseline variables, data from clinical studies resulting from AMT samples should be interpreted with caution.

A proof-of-concept pilot randomized comparative trial of brief Internet-based compassionate mind training and cognitive-behavioral therapy for perinatal and intending to become pregnant women.

OBJECTIVE: Depression is a prevalent and costly mental health problem that affects women as well as their larger communities, with substantial impacts on mother and infant during childbearing years. Face-to-face care has not adequately addressed this global concern due to difficulties in scaling these resources. Internet interventions, which can provide psychological tools to those lacking adequate access, show promise in filling this void. METHOD: We conducted a 2-condition proof-of-concept pilot randomized trial comparing brief Internet-based cognitive behavioural therapy (CBT) and brief Internet-based compassionate mind training (CMT) for women who are currently pregnant, became pregnant within the last year, and intend to become pregnant in the future. RESULTS: We found that, although CMT and CBT demonstrated near equivalence in improving affect, self-reassurance, self-criticism, and self-compassion, CMT showed superiority to CBT in reducing depression and anxiety symptoms. CONCLUSION: These findings provide a compelling initial argument for the use of CMT as an avenue for addressing problems associated with negative affect. Implications, limitations, and future directions along this line of research will also be discussed.

Acknowledgements Correction of: Using Behavioral Intervention Technologies to Help Low-Income and Latino Smokers Quit: Protocol of a Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/resprot.5355.].

Getting It "Right".

Ethical principles in conducting technology-based research require effective and efficient methods of ensuring adequate informed consent. This study examined how well participants understood the informed consent form for an online postpartum depression trial. Pregnant women ( N = 1,179) who consented to the trial demonstrated an understanding of the purpose (86.1%) and procedures of the study (75.8%), and the minimal risks associated with answering sensitive questions online (79%). Almost all (99.6%) understood that psychological treatment was not offered. Participants with current depression incorrectly indicated that participation would replace current psychological treatment relative to participants with a lifetime or no depression history (19.6% vs. 13.5 % vs. 10.4%, respectively) and that there were no associated risks with participation (29.6% vs.17.6% vs. 16.7%, respectively). Findings provide initial evidence that most individuals who seek online psychological resources are informed consumers.

Using Behavioral Intervention Technologies to Help Low-Income and Latino Smokers Quit: Protocol of a Randomized Controlled Trial.

BACKGROUND: The Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically to help low-income English- and Spanish-speaking smokers to quit. Individuals from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status. OBJECTIVE: We plan to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public-sector health care system can significantly improve its acceptability, utilization, and effectiveness. METHODS: Using human-centered development methods, we will involve low-income patients in the design of a Web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will iteratively develop versions of the digital interventions informed by our human-centered approach. The project involves three specific aims: (1) human-centered development of an English/Spanish smoking cessation web app, (2) improvement of dissemination strategies, and (3) evaluation of resulting smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool that is highly responsive to the needs and preferences of the users. Input from participants will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period. We will evaluate the effectiveness of the successive versions of the resulting stop smoking Web app by an online randomized controlled trial. Increased effectiveness will be defined as increased utilization of the Web app and higher abstinence rates than those obtained by a baseline usual care Web app. RESULTS: Recruitment will begin January 2016, the study is intended to be completed by summer 2018, and the results should be available by fall 2019. CONCLUSIONS: This study will provide useful knowledge in developing, testing, and disseminating mobile-based interventions for low-income smokers. CLINICALTRIAL: ClinicalTrials.gov NCT02666482; https://clinicaltrials.gov/ct2/show/NCT02666482 (Archived by WebCite at http://www.webcitation.org/6gtcwaT28).

Are Pregnant and Postpartum Women Interested in Health-Related Apps? Implications for the Prevention of Perinatal Depression.

Recent studies have shown that women are more likely than men to use the Internet to seek health information and that the use of technology is common among perinatal women. Access to the Internet is growing through the global use of mobile phones and apps, in both developed and less developed countries. This pattern is particularly relevant for clinicians and researchers who are interested in the use of technologies to disseminate perinatal depression interventions. In a cross-sectional anonymous online survey for English and Spanish-speaking perinatal women, 509 pregnant (77.6 percent) and postpartum (22.4 percent) women provided demographic and Information and Communication Technologies data. Results indicated that the single device with greatest access was the mobile phone (47.5 percent). The majority of the sample had Internet access through mobile phones, computers, or both. Significant differences in socioeconomic status were found for Internet seeking behavior of health-related information and downloading apps between those with and without Internet access. Ninety percent of respondents (n = 267) searched for health-related information and 72.3 percent had downloaded any kind of app. More than half of respondents (57 percent, n = 188) downloaded a health-related app and 26.9 percent reported having paid for the apps. This study shows preliminary evidence to suggest the need to design, develop, and test apps that aim to disseminate prevention programs for perinatal depression.