Chair of the Department of Social and Behavioral Sciences
Associate Dean of Public Health Innovation
Professor of Social and Behavioral Sciences
Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
A longitudinal examination of African American adolescent females detained for status offenseKim, B. K. E., Quinn, C. R., Logan-Greene, P., DiClemente, R., & Voisin, D.
Journal titleChildren and Youth Services Review
Volume108Introduction: Behaviors like truancy, running away, curfew violation, and alcohol possession fall under the status offense category and can have serious consequences for adolescents. The Juvenile Justice and Delinquency and Prevention Act prohibited detaining status offenders. We explored the degree to which African American adolescent girls were being detained for status offenses and the connections to their behavioral health risks and re-confinement. Methods: 188 African American girls (aged 13–17), recruited from detention facilities, were surveyed at baseline and 3-month follow-ups. Logistic regression models estimated the likelihood of longitudinal re-confinement, controlling for sexual and behavioral health risk factors. Results: One third of the overall sample was detained for a status offense. Status offenders were exposed to higher peer risk profiles. At follow-up, nearly 39% of status offenders reported re-confinement. Compared to youth with other offenses, those who violated a court order (type of status offense) were 3 times more likely to be re-confined. Controlling for sexual and behavioral health risk factors, the odds of re-confinement was not statistically significant. Conclusion: Overall findings suggest that courts and detention facilities must devote specialized resources to addressing the socio-behavioral needs of African American girls with status offenses so as not to use detention as an intervention.
An Exploratory Structural Equation Model of Stress-Related Experiences Among Justice-Involved Youth: A Gender ComparisonDembo, R., Krupa, J. M., Wareham, J., Faber, J., Cristiano, J., Diclemente, R. J., Terminello, A., & Schmeidler, J.
Journal titleCriminal Justice and Behavior
Page(s)127-144Youth involved in the juvenile justice system demonstrate greater risk of exposure to negative life experiences. The present study explores the prevalence of three stress-related experiences (sexual assault victimization, bullying/victimization, and minority sexual orientation) among newly arrested adolescents. Gender (biological sex) differences were examined as well as associations with sociodemographic characteristics, depressive symptoms, substance use, and sexually transmitted infection (STI). Factor analyses found a single factor of stress for both genders. Prevalence rates for bullying/victimization, sexual assault victimization, and sexual minority status were higher for girls than boys. Girls were also more likely than boys to test positive for STIs and experience depressive symptoms, while boys were more likely than girls to test positive for marijuana use. Depression and drug-related problems were associated with the stress construct for girls only. Bivariate comparisons with the three stress measures and sociodemographic characteristics indicated age and race effects. Implications are discussed.
Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?Zullig, K. J., Valois, R. F., Hobbs, G. R., Kerr, J. C., Romer, D., Carey, M. P., Brown, L. K., DiClemente, R. J., & Vanable, P. A.
Journal titleJournal of Happiness Studies
Page(s)417-436Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p =.02, η2 =.03), along with three interactions: between experimental condition and media intervention (F = 7.96, p =.005, η2=.04); experimental condition, sex, and media intervention (F = 6.51, p =.01, η2 =.04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p =.01, η2 =.02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants’ life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.
Compassion Meditation Training for Hospital Chaplain Residents: A Pilot StudyAsh, M. J., Walker, E. R., DiClemente, R. J., Florian, M. P., Palmer, P. K., Wehrmeyer, K., Negi, L. T., Grant, G. H., Raison, C. L., & Mascaro, J. S.
Journal titleJournal of Health Care ChaplaincyThis study examines the effectiveness of incorporating compassion meditation training into a clinical pastoral education (CPE) curriculum to enhance compassion satisfaction and reduce burnout among hospital chaplain residents. Specifically, a longitudinal, quasi-experimental design was used to examine the impact of Cognitively-Based Compassion Training (CBCT), a group-delivered compassion meditation intervention. Hospital chaplain residents (n = 15) were assigned to participate in a CBCT intervention or a waitlist comparison group. Chaplains assigned to CBCT reported significant decreases in burnout and anxiety compared to the waitlist group; effects were not maintained at 4-month follow-up. Other outcomes, including compassion satisfaction, did not differ significantly but were trending in the expected direction. Findings suggest that compassion meditation training incorporated into CPE promotes chaplain wellbeing, although it may be necessary to extend CBCT throughout residency to sustain effects.
Developmental Changes in Sexual Risk and Substance Use Among African American Females: an Integrated Data Analysis Approach Using Time-varying Effect ModelsSwartzendruber, A., Brown, J. L., Sales, J. M., DiClemente, R. J., Windle, M., & Haardörfer, R.
Journal titlePrevention Science
Page(s)182-193The aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14–25 years for behavioral outcomes and 16–25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16–17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.
Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?Zullig, K. J., Valois, R. F., Hobbs, G. R., Romer, D., Brown, L. K., DiClemente, R. J., & Vanable, P. A.
Journal titleJournal of Adolescent Health
Page(s)40-45Purpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787). Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender. Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased −.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males. Conclusions: Although Project iMPPACS was not designed with the intent on improving participants’ life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.
HIV/STI Service Delivery within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth through the HIV Care CascadeElkington, K. S., Robertson, A. A., Knight, D. K., Gardner, S. K., Funk, R. R., Dennis, M. L., Oser, C., & DIclemente, R.
Journal titleAIDS patient care and STDs
Page(s)72-80Justice-involved youth (JIY) are at considerable risk for human immunodeficiency virus (HIV), but are disconnected from treatment and prevention. Juvenile justice agencies providing community supervision (CS) are well positioned to provide HIV prevention, testing, and prompt referral to treatment for JIY. However, we lack an understanding of juvenile CS agency responses to HIV/sexually transmitted infection (STI) needs among JIY. We conducted a nationwide systematic assessment of how juvenile CS agencies identify, refer, and move youth through the HIV care cascade using a nationally representative sample of 195 juvenile CS agencies across 20 states. Two-thirds of CS agencies did not offer any HIV-/STI-related services, and 82% reported no collaboration with health agencies. Screening or referral for HIV risk behaviors was reported by 32% of the CS agencies and 12% for any intervention or prevention for HIV/STI risk behaviors. Between 21% and 30% of agencies were unaware of the location of local HIV/STI services. HIV/STI prevention training was not a priority for directors and was ranked second to last out of 16 training topics. Agencies where staff expressed need for HIV risk training and where specific court programming was available were more likely to provide or refer for HIV/STI screening and/or testing. Agencies were more likely to provide or refer for services if they provided pre-trial/pre-adjudication supervision, parole, or court programming. Considering the low provision of HIV/STI-related services and limited collaboration between health and justice agencies, interventions that promote cross-system collaboration designed to minimize barriers and facilitate identification, referral, and linkage to HIV services for JIY are necessary.
Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?Valois, R. F., Kerr, J. C., Carey, M. P., Brown, L. K., Romer, D., DiClemente, R. J., & Vanable, P. A.
Journal titleApplied Research in Quality of Life
Page(s)273-296This study identified associations between perceived neighborhood stress and adolescents’ perceptions of life satisfaction. African American adolescents aged 13–18 (n = 1658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.
Perceived Neighborhood Violence and Crime, Emotion Regulation, and PTSD Symptoms Among Justice- Involved, Urban African-American Adolescent GirlsSun, S., Crooks, N., DiClemente, R. J., & Sales, J. M.
Journal titlePsychological Trauma: Theory, Research, Practice, and PolicyObjective: African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African- American adolescent girls (n = 85) following their release from detention centers. Method: We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms. Results: The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms. Conclusions: Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms.
Social media as a recruitment platform for a nationwide online survey of COVID-19 knowledge, beliefs, and practices in the United States: Methodology and feasibility analysisAli, S. H., Foreman, J., Capasso, A., Jones, A. M., Tozan, Y., & Diclemente, R. J.
Journal titleBMC Medical Research Methodology
Issue1Background: The COVID-19 pandemic has evolved into one of the most impactful health crises in modern history, compelling researchers to explore innovative ways to efficiently collect public health data in a timely manner. Social media platforms have been explored as a research recruitment tool in other settings; however, their feasibility for collecting representative survey data during infectious disease epidemics remain unexplored. Objectives: This study has two aims 1) describe the methodology used to recruit a nationwide sample of adults residing in the United States (U.S.) to participate in a survey on COVID-19 knowledge, beliefs, and practices, and 2) outline the preliminary findings related to recruitment, challenges using social media as a recruitment platform, and strategies used to address these challenges. Methods: An original web-based survey informed by evidence from past literature and validated scales was developed. A Facebook advertisement campaign was used to disseminate the link to an online Qualtrics survey between March 20-30, 2020. Two supplementary male-only and racial minority- targeted advertisements were created on the sixth and tenth day of recruitment, respectively, to address issues of disproportionate female- and White-oriented gender- and ethnic-skewing observed in the advertisement's reach and response trends. Results: In total, 6602 participant responses were recorded with representation from all U.S. 50 states, the District of Columbia, and Puerto Rico. The advertisements cumulatively reached 236,017 individuals and resulted in 9609 clicks (4.07% reach). Total cost of the advertisement was $906, resulting in costs of .09 per click and .18 per full response (completed surveys). Implementation of the male-only advertisement improved the cumulative percentage of male respondents from approximately 20 to 40%. Conclusions: The social media advertisement campaign was an effective and efficient strategy to collect large scale, nationwide data on COVID-19 within a short time period. Although the proportion of men who completed the survey was lower than those who didn't, interventions to increase male responses and enhance representativeness were successful. These findings can inform future research on the use of social media recruitment for the rapid collection of survey data related to rapidly evolving health crises, such as COVID-19.
A model for cognitively-based compassion training: theoretical underpinnings and proposed mechanismsAsh, M., Harrison, T., Pinto, M., DiClemente, R., & Negi, L. T.
Journal titleSocial Theory and HealthAcross cultures and belief systems, compassion is widely considered to be beneficial for the development of personal and social wellbeing. Research indicates that compassion-training programs have broad health benefits, but how and why compassion-training programs are effective is still relatively unknown. This paper describes the theoretical underpinnings of a specific compassion-training program, CBCT® (Cognitively-Based Compassion Training), and proposes an integrative model that draws on existing health behavior constructs to identify CBCT’s core components and hypothesizes their directionality and interaction. The model includes two primary categories of skill development: (1) intrapersonal skills leading to greater resiliency, and (2) interpersonal skills leading to greater compassion. It is hypothesized that these two pathways are mutually reinforcing and both contribute to greater wellbeing. This model provides a foundation for theory-driven research on the underlying mechanisms in CBCT training. An understanding of CBCT’s mechanisms is a critical step towards optimizing and personalizing the intervention to meet the needs of specific populations.
A multilevel intervention with African American churches to enhance adoption of point-of-care HIV and diabetes testing, 2014-2018Wingood, G. M., Lambert, D., Renfro, T., Ali, M., & DiClemente, R. J.
Journal titleAmerican journal of public health
Page(s)S141-S144We describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.
African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional studyNorris, A. L., Brown, L. K., DiClemente, R. J., Valois, R. F., Romer, D., Vanable, P. A., & Carey, M. P.
Journal titleJournal of the National Medical Association
Page(s)302-309Purpose: To better understand sexual health disparities among African-American sexual minority adolescents. Methods: African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history. Results: Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV. Conclusions: African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.
An Examination of Gender Differences in Bullying among Justice-involved AdolescentsDembo, R., Krupa, J. M., Faber, J., DiClemente, R. J., Wareham, J., & Schmeidler, J.
Journal titleDeviant BehaviorMost studies of bullying rely on school-based samples of youth; however, a few studies of justice-involved populations suggest delinquent youth experience higher rates of bullying than youth in the general population. Little is known about gender differences in bullying among justice-involved youth. Using data from a Health Coach service project for justice-involve youth implemented at two intake facilities, 312 female and 857 male newly arrested youth were included in the current study. The current study sought to determine gender differences in prevalence rates of bullying involvement. Logistic regression was used to explore gender differences in how key covariates of demographic, risk factors, and traumatic experiences related to bullying. Rates of bullying experiences were higher for girls (35%) than boys (17%), and these rates were higher than rates reported in studies using general population or school-based samples. Analysis revealed differences in risk factors of bullying by gender. For both arrested girls and boys, depressive symptoms and sexual assault victimization increased the odds of bullying. Justice-involved youth are at greater risk of bullying and experience multiple problems. Holistic treatment and prevention strategies that recognize the co-occurrence of mental health symptoms, serious victimization, and substance abuse with bullying experiences are needed.
Depressive Symptoms as a Longitudinal Predictor of Sexual Risk Behaviors Among African-American AdolescentsFoley, J. D., Vanable, P. A., Brown, L. K., Carey, M. P., DiClemente, R. J., Romer, D., & Valois, R. F.
Journal titleHealth PsychologyObjective: Understanding individual level factors associated with sexual risk behaviors among African-American adolescents remains an important public health priority. The current secondary data analysis examined the longitudinal association between a baseline assessment of depressive symptoms and sexual risk behaviors reported 6 months later; the purpose was to determine whether the association of depressive symptoms to risky sex varies as a function of gender. A secondary aim was to examine self-efficacy for sex refusal and condom use assessed at a 3-month follow-up as mediators of the depressive symptoms-sexual risk relationship. Methods: The sample consisted of 782 sexually active African-American adolescents (Mage = 15.3 years, SD = 1.08; 54% female) recruited to participate in a sexual health intervention trial. Data analyses focused on vaginal sex, and outcomes included: (a) sexual activity with 2 or more partners in the previous 3 months; (b) the relative frequency of condom use in the previous 3 months; (c) noncondom use at last occasion of sex; and (d) positive sexually transmitted infection (STI) screening. Results: Depressive symptoms predicted sex with 2 more partners for female participants, but no other risk markers for the sample as a whole. However, there was a significant indirect effect of depressive symptoms on condomless sex via decreased condom use self-efficacy for both male and female adolescents. Conclusions: These findings have important implications for HIV/STI prevention, in which behavioral interventions may benefit from modules that include a focus on the influence of mood on self-efficacy for safer sex practices.
Evaluating the Role of Family Context Within a Randomized Adolescent HIV-Risk Prevention TrialBarker, D. H., Hadley, W., McGee, H., Donenberg, G. R., DiClemente, R. J., & Brown, L. K.
Journal titleAIDS and Behavior
Page(s)1195-1209Project STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.
Individual- and Community-Level Factors in the STD Status of Justice-Involved Youth: Multi-Group, Exploratory Two-Level AnalysisDembo, R., Faber, J., Cristiano, J., Wareham, J., Krupa, J., Schmeidler, J., Terminello, A., & DiClemente, R. J.
Journal titleArchives of Sexual Behavior
Page(s)2171-2186Justice-involved youth display higher prevalence rates of sexually transmitted diseases (STDs), in comparison with youth in the general population, highlighting a critical public health concern. Individual factors are important predictors of STDs, but only provide a partial understanding of this public health issue. Communities experiencing higher levels of disorder and lower levels of cohesion tend to have fewer institutional resources available, which may impact sexual risk behavior and STDs. However, few studies have examined the association between community characteristics and STD prevalence among adolescents. The current study examined community-level (n = 106) characteristics and individual-level attributes in explaining STDs among justice-involved youth (n = 1233: n = 515 female; n = 718 male). At the individual level, results showed older males and those with more drug-related problems were more likely to be STD positive, while females with more sexual partners and those with less drug-related problems were more likely to be STD positive. At the community level, females residing in areas with fewer educated residents were more likely to be STD positive. These gender differences were significant, suggesting a gendered perspective is important for understanding STD infection. The justice system represents a critical opportunity in the treatment and prevention of STDs for youth.
Is the Brief Multidimensional Student’s Life Satisfaction Scale Valid and Reliable for African American Adolescents?Valois, R. F., Zullig, K. J., Brown, L. K., Carey, M. P., Vanable, P. A., Romer, D., & DiClemente, R. J.
Journal titleAmerican Journal of Health Education
Page(s)344-355Background: Health promotion/education strive to promote healthful conditions that improve quality of life based on the perceptions of those whose lives are affected Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life. Life satisfaction (LS) has been defined as an individual’s assessment of their quality of life based upon personal criteria and linked to adolescent health risk behaviors and developmental assets. Purpose: We investigated the psychometrics of the Brief Multidimensional Students’ Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N = 1,658) from four mid-sized cities in the United States. Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents. Methods: Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen’s d) and inspecting the scale’s internal structure, reliability, and relationships to other variables. Results: Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined. Translation to Health Education Practice: The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.
Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkageGardner, S. K., Elkington, K. S., Knight, D. K., Huang, S., Diclemente, R. J., Spaulding, A. C., Oser, C. B., Robertson, A. A., & Baird-Thomas, C.
Journal titleHealth and Justice
Issue1Background: While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist). Methods: Juvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items). Results: Confirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff. Conclusions: Establishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.
Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?Kim, B., Callander, D., DiClemente, R., Trinh-Shevrin, C., Thorpe, L. E., & Duncan, D. T.
Journal titleAIDS and Behavior
Page(s)2795-2802Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factorsGause, N. K., Brown, J. L., & DiClemente, R. J.
Journal titleVulnerable Children and Youth Studies
Page(s)1-16Black females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02,.17]), any alcohol use prior to sex through peer norms for risky sex (ab = −.06, 95% CI [−.12, −.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = −.13, 95% CI [−.21, −.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.
Pregnancy Coercion as a Risk Factor for HIV and Other Sexually Transmitted Infections Among Young African American WomenCapasso, A., DiClemente, R. J., & Wingood, G. M.
Journal titleJournal of acquired immune deficiency syndromes (1999)
Page(s)S155-S161BACKGROUND: Pregnancy coercion (PC), defined as a restriction of women's reproductive autonomy, may be associated with increased HIV and sexually transmitted infection (STI) risk. However, there are few empirical studies defining the association between PC and HIV risk, particularly among vulnerable African American women. SETTING AND METHODS: African American women (N = 560), ages 17-24, completed an audio computer-assisted self-interview assessing PC prevalence and its association with HIV/STI risk. Women were screened for prevalent STIs using polymerase chain reaction assays. Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes. RESULTS: Women who had experienced PC in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]. Among women who experienced PC, odds of noncondom use in their last sexual encounter were 3.45-fold greater relative to women not experiencing PC (95% CI = 1.55 to 7.85). Women who experienced PC had lower condom use intentions (coefficient, -1.31, P = 0.002), greater fear of condom negotiation, and perceived more barriers to condom use (coefficients, 3.89 and 5.74, respectively, both P < 0.001). Women who experienced PC had 1.98 (95% CI = 1.22 to 3.21) and 1.82 (95% CI = 1.09 to 3.04) odds of depression and HIV worry relative to women not experiencing PC. CONCLUSION: Among African American women, PC was associated with a range of adverse sexual health outcomes and HIV/STI-related behaviors and attitudes. The findings underscore the need for promoting gender-equitable social norms in HIV prevention interventions.
Prenatal and infancy nurse home visiting and 18-year outcomes of a randomized trialKitzman, H., Olds, D. L., Knudtson, M. D., Cole, R., Anson, E., Smith, J. A., Fishbein, D., DiClemente, R., Wingood, G., Caliendo, A. M., Hopfer, C., Miller, T., & Conti, G.
Issue6OBJECTIVES: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitiverelated outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS: We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18- year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS: The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.
Problem Solving Reduces Sexual Risk Associated with Sensation Seeking, Substance Use, and Depressive Symptoms Among African-American AdolescentsDunne, E. M., Norris, A. L., Romer, D., DiClemente, R. J., Vanable, P. A., Valois, R. F., Brown, L. K., & Carey, M. P.
Journal titleJournal of Child and Adolescent Substance Abuse
Page(s)113-118African-American adolescents experience higher rates of sexually transmitted infections (STIs) compared to same-age Caucasian peers. Substance use, sensation seeking, and depression have all been linked to risky sexual practices. Theory suggests that problem-solving skills may help to buffer against these risk factors. To test this hypothesis, we used data from African-American adolescents (N = 1,018; M age = 16.7, SD = 1.1; 58% female) who participated in a prevention trial. Nearly half of the sample (47%) reported lifetime marijuana use, while 13% reported drug use prior to most recent sexual encounter. Sexual sensation seeking was directly associated with drug use prior to sex (β = 1.13, b = 0.13, SE = 0.02, p <.001) and lower problem-solving skills (β = –0.08, b = –0.06, SE = 0.02, p =.01). Problem-solving skills were associated with drug use prior to sex (β = 0.92, b = −0.08, SE = 0.03, p =.004), such that those with greater problem-solving skills were less likely to report drug use prior to most recent sex. Finally, problem-solving skills mediated the association between sexual sensation seeking and drug use prior to sex, although the effect was small (β = 0.01, 95% CI:.001,.01). Problem-solving skills can have a protective influence on risky behavior for adolescents. Future research might examine the utility of strengthening problem-solving skills in order to reduce STI/HIV risk among African-American adolescents.
When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice systemRaiford, J. L., Seth, P., Fasula, A. M., & DiClemente, R. J.
Journal titleSexual Health
Page(s)331-337Background: HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. Methods: In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. Results: When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. Conclusions: Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.