Manuel Barrera - Academia.edu (original) (raw)

Papers by Manuel Barrera

Research paper thumbnail of Efficacy, safety and predictive factors of therapeutic success with sildenafil for erectile dysfunction in patients with different spinal cord injuries

Spinal Cord, 2001

Multicenter, open, prospective, before-after study. Objective: To assess the ecacy and safety of ... more Multicenter, open, prospective, before-after study. Objective: To assess the ecacy and safety of sildena®l therapy for erectile dysfunction in patients with spinal cord injury, and the association between the response to sildena®l and factors such as causes and levels of spinal cord injury, grade of ASIA de®cit, time since injury, orgasmic perception, and degree of baseline erection. Setting: Homes of outpatients of 16 spinal cord injury units in Spain. Method: One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury, from whom baseline data were collected on their sexual function, and who started treatment with sildena®l 50 mg. An ecacy assessment was made by the patient and his partner, and the score of the International Index of Erectile Function (IIEF) was recorded. Results: It was reported by 88.2% of the patients and 85.3% of their partners that treatment with sildena®l had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile function. In responders, this improvement was con®rmed by an increase from 12.5 to 24.8 points (P50.001) of the Erectile Function Domain of IIEF. A signi®cant improvement was also seen in patients' satisfaction with sexual activity and general satisfaction derived from sexual life. Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 (P=0.006) were predictors of therapeutic success. No serious adverse events occurred. Conclusion: Sildena®l is an eective, well-tolerated treatment for erectile dysfunction caused by spinal cord injury, regardless of the cause, neurological level, ASIA grade, and time since injury. Sponsorship: Spanish Society of Paraplegia. Spinal Cord (2001) 39, 637 ± 643

Research paper thumbnail of Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease

Annals of Behavioral Medicine, 2005

Background: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavio... more Background: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease (CHD) among postmenopausal women with diabetes.Purpose: Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes.Methods: Participants (N = 279) were randomized to usual care (UC) or Mediterranean Lifestyle Program, a lifestyle change intervention aimed at the behavioral risk factors (eating patterns, physical activity, stress management, and social support) affecting risk for CHD in postmenopausal women with type 2 diabetes.Results: In original and intent-to-treat analyses, Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors, physical activity, stress management, perceived support, and weight loss at 6 months compared to UC.Conclusions: This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes, showed that postmenopausal women could make comprehensive lifestyle changes, and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors.

Research paper thumbnail of A controlled study to assess the clinical efficacy of totally self-administered systematic desensitization

Journal of Consulting and Clinical Psychology, 1976

Highly anxious self-referred snake phobics received either (a) therapist-admin-istered desensitiz... more Highly anxious self-referred snake phobics received either (a) therapist-admin-istered desensitization, (b) self-administered desensitization with weekly thera-pist phone calls, (c) totally self-administered desensitization, (d) a self-admin-istered double-blind placebo control, ...

Research paper thumbnail of The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results

Preventive Medicine, 2003

A prerequisite to translating research findings into practice is information on consistency of im... more A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education. We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users. All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics. The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results.

Research paper thumbnail of Case studies on remediating memory deficits in brain-damaged individuals

Journal of Clinical Psychology, 1977

ABSTRACT

Research paper thumbnail of Do Internet-Based Support Interventions Change Perceptions of Social Support?: An Experimental Trial of Approaches for Supporting Diabetes Self-Management

American Journal of Community Psychology, 2002

Internet-based support groups are a rapidly growing segment of mutual aid programs for individual... more Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self-management coach, (c) a social support intervention, or (d) a personal self-management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long-term effects of Internet-based support for diabetes self-management. The discussion identifies directions for future research.

Research paper thumbnail of Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial

Health Education Research, 2002

This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle mana... more This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle management intervention for 279 postmenopausal women with type 2 diabetes who are at elevated risk for coronary heart disease (CHD). The intervention, called the Mediterranean Lifestyle Trial, is focused on dietary factors, physical activity, social support and stress management. The Mediterranean Lifestyle Trial relies on a synthesis of Social Cognitive Theory and Social Ecologic Theory, as well as goalsystems theory, to explicitly inform the lifestyle intervention and to address maintenance. Thus, the trial should help illuminate the theoretical mechanisms responsible for lifestyle change. Primary outcome variables are dietary, stress management and physical activity behavior change, quality of life, and CHD-related biological risk factors. Hypothesized mediating variables include self-efficacy, coping, and social and environmental support. Following the initial 6-month intervention, participants in the intervention condition are randomized to one of two groups designed to enhance maintenance of effects: either a peer-led support group or a personalized multilevel community resources maintenance condition. Unlike the peer group, the personalized approach focuses on multiple levels of community resources to promote healthful lifestyle change. Because this research focuses on issues of generalization and translation to practice, the RE-AIM evaluation framework is being used to evaluate Reach, Effectiveness, Adoption, Implementation and Maintenance. This framework will help to translate research into practice by directing researchers' attention to important but seldominvestigated strategies for enhancing longerterm maintenance. Specifically, the study tests how long-term maintenance may be improved through the use of existing community resources, an intervention based on multiple environmental factors and multiple lifestyle behaviors, and lay leaders versus personalized professional support.

Research paper thumbnail of Biologic and Quality-of-Life Outcomes From the Mediterranean Lifestyle Program: A randomized clinical trial

Diabetes Care, 2003

Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary... more Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c), BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance. These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.

Research paper thumbnail of Relation of Parental Alcoholism to Early Adolescent Substance Use: A Test of Three Mediating Mechanisms

Journal of Abnormal Psychology, 1993

The current study assessed 3 hypothesized mediating mechanisms underlying the relation between pa... more The current study assessed 3 hypothesized mediating mechanisms underlying the relation between parental alcoholism and adolescent substance use. Using structural equation modeling, we analyzed data obtained from a large community sample of adolescent children of alcoholics and a demographically matched comparison group. Results suggested that parental alcoholism influenced adolescent substance use through stress and negative affect pathways, through decreased parental monitoring, and through increased temperamental emotionality (which was associated with heightened negative affect). Both negative affect and impaired parental monitoring were associated with adolescents' membership in a peer network that supported drug use behavior. The data did not support a link between parental alcoholism and temperamental sociability.

Research paper thumbnail of Effects of parental alcoholism and life stress on hispanic and non-hispanic caucasian adelescents: A prospective study

American Journal of Community Psychology, 1995

Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnera... more Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnerability of adolescents. It extended an initial cross-sectional study of this same sample by adding two annual assessments which allowed for additional cross-sectional analyses and longitudinal tests. Hispanic and Caucasian adolescents (N=306 at Time 1) completed measures of their own life stress, family conflict, and alcohol use. Their parents reported on adolescents' internalizing and externalizing symptoms. Cross-sectional analyses at Time 2, and prospective analyses involving Time 1 and Time 2 measures were, for the most part, consistent with the original study's results. Caucasian adolescents and children of alcoholic parents appeared to be more vulnerable to stress than Hispanic adolescents and children of nonalcoholic parents. Family conflict was a partial explanation for this increased vulnerability.

Research paper thumbnail of Effects of social support and conflict on adolescent children of alcoholic and nonalcoholic fathers

Journal of Personality and Social Psychology, 1993

Studies of positive and negative social ties usually are done in isolation of each other, preclud... more Studies of positive and negative social ties usually are done in isolation of each other, precluding an understanding of their relative contributions to psychological functioning. This research evaluated the effects of adolescents' conflict with and social support from key relationships (parents, siblings, and best friends) on adolescents' self-esteem, substance use, and externalizing symptoms. Ss were 296 adolescents and their parents; 145 families had alcoholic fathers, and 151 had nonalcoholic parents. Support and conflict provided by each network member showed only a mild negative correlation. Support from parents, but not siblings or best friends, was related to adolescents' reports of substance use and externalizing. Conflict with parents was consistently related to externalizing behaviors. There was no evidence that conflict within a relationship neutralizes the effectiveness of the support it provides.

Research paper thumbnail of Substance Use and Symptomatology Among Adolescent Children of Alcoholics

Journal of Abnormal Psychology, 1991

This study assessed the magnitude and specificity of parental alcoholism asa risk factor for inte... more This study assessed the magnitude and specificity of parental alcoholism asa risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.

Research paper thumbnail of Substance use and symptomatology among adolescent children of alcoholics

Journal of Abnormal Psychology, 1991

This study assessed the magnitude and specificity of parental alcoholism asa risk factor for inte... more This study assessed the magnitude and specificity of parental alcoholism asa risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.

Research paper thumbnail of Relation of parental support and control to adolescents' externalizing symptomatology and substance use: A longitudinal examination of curvilinear effects

Journal of Abnormal Child Psychology, 1993

Past research has generated inconsistent findings regarding the relation of parental control and ... more Past research has generated inconsistent findings regarding the relation of parental control and support to adolescent problem behaviors. Using two waves of data collected 1 year apart, the current study examined the influence of parental control and support on adolescents' externalizing symptoms, alcohol use, and illicit substance use. A sample of adolescents and their parents (@#@ N =454) was studied, within which approximately half of the adolescents were at high risk because of parental alcoholism. Multipleregression analyses of crosssectional data showed a negative quadratic relation between parental control and adolescent externalizing symptomatology, and between parental control and adolescent illicit substance use. Parental control had a negative linear relation to adolescent alcohol use. Parental support showed a negative quadratic relation to adolescent illicit substance use, and negative linear relations to adolescent alcohol use and externalizing symptoms. Although longitudinally adjusted contemporaneous results were consistent with crosssectional findings, parental support and control were prospectively related only to adolescent alcohol use. The quadratic relations suggest that adolescents who receive either extreme of parental support or control are at risk for problem behaviors.

Research paper thumbnail of A longitudinal examination of the reciprocal relations between perceived parenting and adolescents' substance use and externalizing behaviors

Developmental Psychology, 1995

Although studies have found an association between adolescent problem behavior and deficits in pa... more Although studies have found an association between adolescent problem behavior and deficits in parental support and control, questions remain concerning the causal nature of these relations. Using longitudinal data, this study explored prospective reciprocal relations ...

Research paper thumbnail of Ethnicity, substance use, and development: Exemplars for exploring group differences and similarities

Development and Psychopathology, 1999

Epidemiological research shows some ethnic-group differences in the prevalence of substance use. ... more Epidemiological research shows some ethnic-group differences in the prevalence of substance use. This approach does not address the question of whether there are ethnic-group differences in the models that are needed to understand the development of substance use. For this question we need to understand the relations between psychological constructs and their trajectories over time. In this paper we describe some approaches to studying ethnic-group differences in the predictors of substance use that illustrate probing for mediators, multisample analyses of structural models, and an experimental trial of a preventive intervention. Our studies found some ethnic-group differences in the structure of constructs and the relations between variables, but many similarities. The challenge for researchers is using appropriate research methods for studying ethnicity, uncovering the basis for ethnic-group differences when they occur, knowing when statistical differences are meaningful, and acknowledging when developmental models are comparable.

Research paper thumbnail of Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial With Hispanic and Non-Hispanic Children

Children's aggressive behavior and reading difficulties during early elementary school years are ... more Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.

Research paper thumbnail of Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth

Journal of Early Adolescence, 2001

... Manuel Barrera, Jr. Anthony Biglan Dennis Ary Fuzhong Li Oregon Research Institute ... Simila... more ... Manuel Barrera, Jr. Anthony Biglan Dennis Ary Fuzhong Li Oregon Research Institute ... Similarly,Swaim, Bates, and Chavez (1998) found that a model of the social influences on substance use held equally for Hispanic and Caucasian school dropouts. ...

Research paper thumbnail of Efficacy, safety and predictive factors of therapeutic success with sildenafil for erectile dysfunction in patients with different spinal cord injuries

Spinal Cord, 2001

Multicenter, open, prospective, before-after study. Objective: To assess the ecacy and safety of ... more Multicenter, open, prospective, before-after study. Objective: To assess the ecacy and safety of sildena®l therapy for erectile dysfunction in patients with spinal cord injury, and the association between the response to sildena®l and factors such as causes and levels of spinal cord injury, grade of ASIA de®cit, time since injury, orgasmic perception, and degree of baseline erection. Setting: Homes of outpatients of 16 spinal cord injury units in Spain. Method: One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury, from whom baseline data were collected on their sexual function, and who started treatment with sildena®l 50 mg. An ecacy assessment was made by the patient and his partner, and the score of the International Index of Erectile Function (IIEF) was recorded. Results: It was reported by 88.2% of the patients and 85.3% of their partners that treatment with sildena®l had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile function. In responders, this improvement was con®rmed by an increase from 12.5 to 24.8 points (P50.001) of the Erectile Function Domain of IIEF. A signi®cant improvement was also seen in patients' satisfaction with sexual activity and general satisfaction derived from sexual life. Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 (P=0.006) were predictors of therapeutic success. No serious adverse events occurred. Conclusion: Sildena®l is an eective, well-tolerated treatment for erectile dysfunction caused by spinal cord injury, regardless of the cause, neurological level, ASIA grade, and time since injury. Sponsorship: Spanish Society of Paraplegia. Spinal Cord (2001) 39, 637 ± 643

Research paper thumbnail of Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease

Annals of Behavioral Medicine, 2005

Background: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavio... more Background: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease (CHD) among postmenopausal women with diabetes.Purpose: Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes.Methods: Participants (N = 279) were randomized to usual care (UC) or Mediterranean Lifestyle Program, a lifestyle change intervention aimed at the behavioral risk factors (eating patterns, physical activity, stress management, and social support) affecting risk for CHD in postmenopausal women with type 2 diabetes.Results: In original and intent-to-treat analyses, Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors, physical activity, stress management, perceived support, and weight loss at 6 months compared to UC.Conclusions: This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes, showed that postmenopausal women could make comprehensive lifestyle changes, and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors.

Research paper thumbnail of A controlled study to assess the clinical efficacy of totally self-administered systematic desensitization

Journal of Consulting and Clinical Psychology, 1976

Highly anxious self-referred snake phobics received either (a) therapist-admin-istered desensitiz... more Highly anxious self-referred snake phobics received either (a) therapist-admin-istered desensitization, (b) self-administered desensitization with weekly thera-pist phone calls, (c) totally self-administered desensitization, (d) a self-admin-istered double-blind placebo control, ...

Research paper thumbnail of The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results

Preventive Medicine, 2003

A prerequisite to translating research findings into practice is information on consistency of im... more A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education. We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users. All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics. The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results.

Research paper thumbnail of Case studies on remediating memory deficits in brain-damaged individuals

Journal of Clinical Psychology, 1977

ABSTRACT

Research paper thumbnail of Do Internet-Based Support Interventions Change Perceptions of Social Support?: An Experimental Trial of Approaches for Supporting Diabetes Self-Management

American Journal of Community Psychology, 2002

Internet-based support groups are a rapidly growing segment of mutual aid programs for individual... more Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self-management coach, (c) a social support intervention, or (d) a personal self-management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long-term effects of Internet-based support for diabetes self-management. The discussion identifies directions for future research.

Research paper thumbnail of Enhancing support for health behavior change among women at risk for heart disease: the Mediterranean Lifestyle Trial

Health Education Research, 2002

This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle mana... more This paper describes a randomized study to evaluate the effects of a comprehensive lifestyle management intervention for 279 postmenopausal women with type 2 diabetes who are at elevated risk for coronary heart disease (CHD). The intervention, called the Mediterranean Lifestyle Trial, is focused on dietary factors, physical activity, social support and stress management. The Mediterranean Lifestyle Trial relies on a synthesis of Social Cognitive Theory and Social Ecologic Theory, as well as goalsystems theory, to explicitly inform the lifestyle intervention and to address maintenance. Thus, the trial should help illuminate the theoretical mechanisms responsible for lifestyle change. Primary outcome variables are dietary, stress management and physical activity behavior change, quality of life, and CHD-related biological risk factors. Hypothesized mediating variables include self-efficacy, coping, and social and environmental support. Following the initial 6-month intervention, participants in the intervention condition are randomized to one of two groups designed to enhance maintenance of effects: either a peer-led support group or a personalized multilevel community resources maintenance condition. Unlike the peer group, the personalized approach focuses on multiple levels of community resources to promote healthful lifestyle change. Because this research focuses on issues of generalization and translation to practice, the RE-AIM evaluation framework is being used to evaluate Reach, Effectiveness, Adoption, Implementation and Maintenance. This framework will help to translate research into practice by directing researchers' attention to important but seldominvestigated strategies for enhancing longerterm maintenance. Specifically, the study tests how long-term maintenance may be improved through the use of existing community resources, an intervention based on multiple environmental factors and multiple lifestyle behaviors, and lay leaders versus personalized professional support.

Research paper thumbnail of Biologic and Quality-of-Life Outcomes From the Mediterranean Lifestyle Program: A randomized clinical trial

Diabetes Care, 2003

Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary... more Few multiple lifestyle behavior change programs have been designed to reduce the risk of coronary heart disease in postmenopausal women with type 2 diabetes. This study tested the effectiveness of the Mediterranean Lifestyle Program (MLP), a comprehensive lifestyle self-management program (Mediterranean low-saturated fat diet, stress management training, exercise, group support, and smoking cessation), in reducing cardiovascular risk factors in postmenopausal women with type 2 diabetes. Postmenopausal women with type 2 diabetes (n = 279) were randomized to either usual care (control) or treatment (MLP) conditions. MLP participants took part in an initial 3-day retreat, followed by 6 months of weekly meetings, to learn and practice program components. Biological end points were changes in HbA(1c), lipid profiles, BMI, blood pressure, plasma fatty acids, and flexibility. Impact on quality of life was assessed. Multivariate ANCOVAs revealed significantly greater improvements in the MLP condition compared with the usual care group on HbA(1c), BMI, plasma fatty acids, and quality of life at the 6-month follow-up. Patterns favoring intervention were seen in lipids, blood pressure, and flexibility but did not reach statistical significance. These results demonstrate that postmenopausal women with type 2 diabetes can make comprehensive lifestyle changes that may lead to clinically significant improvements in glycemic control, some coronary heart disease risk factors, and quality of life.

Research paper thumbnail of Relation of Parental Alcoholism to Early Adolescent Substance Use: A Test of Three Mediating Mechanisms

Journal of Abnormal Psychology, 1993

The current study assessed 3 hypothesized mediating mechanisms underlying the relation between pa... more The current study assessed 3 hypothesized mediating mechanisms underlying the relation between parental alcoholism and adolescent substance use. Using structural equation modeling, we analyzed data obtained from a large community sample of adolescent children of alcoholics and a demographically matched comparison group. Results suggested that parental alcoholism influenced adolescent substance use through stress and negative affect pathways, through decreased parental monitoring, and through increased temperamental emotionality (which was associated with heightened negative affect). Both negative affect and impaired parental monitoring were associated with adolescents' membership in a peer network that supported drug use behavior. The data did not support a link between parental alcoholism and temperamental sociability.

Research paper thumbnail of Effects of parental alcoholism and life stress on hispanic and non-hispanic caucasian adelescents: A prospective study

American Journal of Community Psychology, 1995

Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnera... more Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnerability of adolescents. It extended an initial cross-sectional study of this same sample by adding two annual assessments which allowed for additional cross-sectional analyses and longitudinal tests. Hispanic and Caucasian adolescents (N=306 at Time 1) completed measures of their own life stress, family conflict, and alcohol use. Their parents reported on adolescents' internalizing and externalizing symptoms. Cross-sectional analyses at Time 2, and prospective analyses involving Time 1 and Time 2 measures were, for the most part, consistent with the original study's results. Caucasian adolescents and children of alcoholic parents appeared to be more vulnerable to stress than Hispanic adolescents and children of nonalcoholic parents. Family conflict was a partial explanation for this increased vulnerability.

Research paper thumbnail of Effects of social support and conflict on adolescent children of alcoholic and nonalcoholic fathers

Journal of Personality and Social Psychology, 1993

Studies of positive and negative social ties usually are done in isolation of each other, preclud... more Studies of positive and negative social ties usually are done in isolation of each other, precluding an understanding of their relative contributions to psychological functioning. This research evaluated the effects of adolescents' conflict with and social support from key relationships (parents, siblings, and best friends) on adolescents' self-esteem, substance use, and externalizing symptoms. Ss were 296 adolescents and their parents; 145 families had alcoholic fathers, and 151 had nonalcoholic parents. Support and conflict provided by each network member showed only a mild negative correlation. Support from parents, but not siblings or best friends, was related to adolescents' reports of substance use and externalizing. Conflict with parents was consistently related to externalizing behaviors. There was no evidence that conflict within a relationship neutralizes the effectiveness of the support it provides.

Research paper thumbnail of Substance Use and Symptomatology Among Adolescent Children of Alcoholics

Journal of Abnormal Psychology, 1991

This study assessed the magnitude and specificity of parental alcoholism asa risk factor for inte... more This study assessed the magnitude and specificity of parental alcoholism asa risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.

Research paper thumbnail of Substance use and symptomatology among adolescent children of alcoholics

Journal of Abnormal Psychology, 1991

This study assessed the magnitude and specificity of parental alcoholism asa risk factor for inte... more This study assessed the magnitude and specificity of parental alcoholism asa risk factor for internalizing symptomatology, externalizing symptomatology, and alcohol and drug use in adolescence. We evaluated parents' and children's reports of symptomatology and children's reports of alcohol and drug use in a community sample of 454 adolescents. The results showed that parental alcoholism was a moderate to strong risk factor, with stronger risk associated with recent (rather than remitted) parental alcoholism. Multivariate analyses showed that the specificity of risk varied with the outcome measure. In predicting externalizing symptomatology, the risk associated with parental alcoholism was mediated by co-occurring parental psychopathology and environmental stress. However, in predicting alcohol use, the father's alcoholism was a specific risk factor above and beyond the more generalized effects of stress and family disruption.

Research paper thumbnail of Relation of parental support and control to adolescents' externalizing symptomatology and substance use: A longitudinal examination of curvilinear effects

Journal of Abnormal Child Psychology, 1993

Past research has generated inconsistent findings regarding the relation of parental control and ... more Past research has generated inconsistent findings regarding the relation of parental control and support to adolescent problem behaviors. Using two waves of data collected 1 year apart, the current study examined the influence of parental control and support on adolescents' externalizing symptoms, alcohol use, and illicit substance use. A sample of adolescents and their parents (@#@ N =454) was studied, within which approximately half of the adolescents were at high risk because of parental alcoholism. Multipleregression analyses of crosssectional data showed a negative quadratic relation between parental control and adolescent externalizing symptomatology, and between parental control and adolescent illicit substance use. Parental control had a negative linear relation to adolescent alcohol use. Parental support showed a negative quadratic relation to adolescent illicit substance use, and negative linear relations to adolescent alcohol use and externalizing symptoms. Although longitudinally adjusted contemporaneous results were consistent with crosssectional findings, parental support and control were prospectively related only to adolescent alcohol use. The quadratic relations suggest that adolescents who receive either extreme of parental support or control are at risk for problem behaviors.

Research paper thumbnail of A longitudinal examination of the reciprocal relations between perceived parenting and adolescents' substance use and externalizing behaviors

Developmental Psychology, 1995

Although studies have found an association between adolescent problem behavior and deficits in pa... more Although studies have found an association between adolescent problem behavior and deficits in parental support and control, questions remain concerning the causal nature of these relations. Using longitudinal data, this study explored prospective reciprocal relations ...

Research paper thumbnail of Ethnicity, substance use, and development: Exemplars for exploring group differences and similarities

Development and Psychopathology, 1999

Epidemiological research shows some ethnic-group differences in the prevalence of substance use. ... more Epidemiological research shows some ethnic-group differences in the prevalence of substance use. This approach does not address the question of whether there are ethnic-group differences in the models that are needed to understand the development of substance use. For this question we need to understand the relations between psychological constructs and their trajectories over time. In this paper we describe some approaches to studying ethnic-group differences in the predictors of substance use that illustrate probing for mediators, multisample analyses of structural models, and an experimental trial of a preventive intervention. Our studies found some ethnic-group differences in the structure of constructs and the relations between variables, but many similarities. The challenge for researchers is using appropriate research methods for studying ethnicity, uncovering the basis for ethnic-group differences when they occur, knowing when statistical differences are meaningful, and acknowledging when developmental models are comparable.

Research paper thumbnail of Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial With Hispanic and Non-Hispanic Children

Children's aggressive behavior and reading difficulties during early elementary school years are ... more Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.

Research paper thumbnail of Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth

Journal of Early Adolescence, 2001

... Manuel Barrera, Jr. Anthony Biglan Dennis Ary Fuzhong Li Oregon Research Institute ... Simila... more ... Manuel Barrera, Jr. Anthony Biglan Dennis Ary Fuzhong Li Oregon Research Institute ... Similarly,Swaim, Bates, and Chavez (1998) found that a model of the social influences on substance use held equally for Hispanic and Caucasian school dropouts. ...