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
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., & Vanable, P. A.
Journal titleJournal of Happiness StudiesAddressing 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 η 2 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, η 2 =.03), along with three interactions: between experimental condition and media intervention (F = 7.96, p =.005, η 2 =.04); experimental condition, sex, and media intervention (F = 6.51, p =.01, η 2 =.04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p =.01, η 2 =.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.
Need for Innovation in Public Health ResearchDiClemente, R., Nowara, A., Shelton, R., & Wingood, G.
Journal titleAmerican journal of public health
Page(s)S117-S120The recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary, we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technology-based methodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.
A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site studyBecan, J. E., Bartkowski, J. P., Knight, D. K., Wiley, T. R., DiClemente, R., Ducharme, L., Welsh, W. N., Bowser, D., McCollister, K., Hiller, M., Spaulding, A. C., Flynn, P. M., Swartzendruber, A., Dickson, M. F., Fisher, J. H., & Aarons, G. A.
Journal titleHealth and Justice
Issue1Background: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. Methods: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. Discussion: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. Trial registration: NCT02672150. Retrospectively registered on 22 January 2016.
African American Women’s Language Use in Response to Male Partners’ Condom Negotiation TacticsLi, Y., Samp, J. A., Coles Cone, V. B., Mercer Kollar, L. M., DiClemente, R., & Monahan, J. L.
Journal titleCommunication Studies
Page(s)67-84African American women are vulnerable for sexual health risk; thus, condom use is essential. Guided by research linking goals to communicative content, this study explored women’s use of I-, you-, we-, and hedging language during condom negotiation. Female participants (N = 193) engaged in a condom negotiation role play with male confederates, where language use measures were coded. I-language was used the most frequently. Language use differed as a function of men’s tactics, such that women primarily used I-language in response to verbal attacks, you-language in response to seduction, and I- and we-language in response to information seeking. Women who engaged in more recent condom use were more likely to use you-language and, when confederates attacked, they responded with more you-language and less hedging.
African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional studyNorris, A. L., Brown, L. K., DiClemente, R., Valois, R. F., Romer, D., Vanable, P. A., & Carey, M. P.
Journal titleJournal of the National Medical AssociationPurpose: 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.
Ecologies of risk among African American girls in juvenile detentionLogan-Greene, P., Kim, B. K., Quinn, C. R., DiClemente, R., & Voisin, D.
Journal titleChildren and Youth Services Review
Page(s)245-252African American girls are disproportionately represented in juvenile detention, yet less is known about their distinctive and heterogeneous needs, especially regarding their psychosocial contexts. Latent class analysis determined four subgroups based on the adolescent ecology (neighborhood, family, peers) among detained African American girls ages 13–17 (N = 188). The Shielded class (32%) displayed the lowest levels of risk and highest levels of protective factors. The Typical class (24%) was close to the sample average on all indicators, with elevated histories of family incarceration. The Family Distress class (16%) reported the lowest neighborhood risk but was marked by high family risk levels and abuse history. The Highest Risk class (28%) had elevated risk on most indicators but particularly high neighborhood and peer risk. These classes significantly varied by youth social context and mental health. Findings bolster the need to consider the diverse, multidimensional contextual experiences of detained and at-risk African American girls.
HIV and symptoms of depression are independently associated with impaired glucocorticoid signalingBekhbat, M., Mehta, C. C., Kelly, S. D., Vester, A., Ofotokun, I., Felger, J., Wingood, G., Anastos, K., Gustafson, D. R., Kassaye, S., Milam, J., Aouizerat, B., Weber, K., Golub, E. T., Moore, M. F., DiClemente, R., Fischl, M., Kempf, M. C., Maki, P., & Neigh, G. N.
Page(s)118-125Chronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.
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., & Vanable, P. A.
Journal titleApplied Research in Quality of LifeThis 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.
Psychometric Evaluation of a Brief Depression Measure for Justice-Involved Youths: A Multigroup ComparisonDembo, R., Faber, J., Cristiano, J., DiClemente, R., Krupa, J. M., Wareham, J., & Terminello, A.
Journal titleJournal of Child and Adolescent Substance Abuse
Page(s)146-155The Center for Epidemiological Studies Depression Scale (CES-D) is a widely used screening tool for depression among adults and children. However, the validity of the CES-D has yet to be established among justice-involved youths, a population known to have higher levels of depressive symptoms in comparison to samples of community adolescents. The current study examines the psychometric characteristics of the eight-item version of the CES-D among newly arrested youths. Data were obtained through a local health coach service project, designed to provide linkage to treatment for justice-involved youths who are drug involved, test positive for HIV or other STDs, or have high levels of depressive symptoms. A multigroup, confirmatory factor analysis of the depression symptoms for subgroups defined by gender/race self-identification was conducted to assess the psychometric characteristics of the CES-D among these newly arrested youths. Results produced statistical evidence in support of one factor in the eight-item depression data and a similar factor structure across the various gender/racial groups. Criterion-related validity of the depression factor was also explored. Findings support the usefulness of the eight-item CES-D for use among gender-diverse and ethnically diverse youths.
The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual CommunicationHadley, W., Lansing, A., Barker, D. H., Brown, L. K., Hunter, H., Donenberg, G., & DiClemente, R.
Journal titleJournal of Child and Family Studies
Page(s)1098-1109Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.
The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention interventionRenfro, T., Johnson, E., Lambert, D. N., Wingood, G., & DiClemente, R.
Journal titleTranslational Behavioral Medicine
Page(s)815-823As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.
Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation Among African American WomenPainter, J. E., Temple, B. S., Woods, L. A., Cwiak, C., Haddad, L. B., Mulligan, M. J., & DiClemente, R.
Journal titleHealth Education and Behavior
Page(s)444-453Licensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of actual RC in a postlicensure era. This study assessed factors associated with interest in an HIV vaccine for reasons indicative of RC among African American women aged 18 to 55 years, recruited from a hospital-based family planning clinic in Atlanta, Georgia (N = 321). Data were collected using audio-computer–assisted surveys. Survey items were guided by risk homeostasis theory and social cognitive theory. Multivariable logistic regression was used to assess determinants of interest in an HIV vaccine for reasons indicative of RC. Thirty-eight percent of the sample expressed interest in an HIV vaccine for at least one reason indicative of RC. In the final model, interest in an HIV vaccine for reasons indicative of RC was positively associated with higher impulsivity, perceived benefits of sexual risk behaviors, and perceived benefits of HIV vaccination; it was negatively associated with having at least some college education, positive future orientation, and self-efficacy for sex refusal. Results suggest that demographic, personality, and theory-based psychosocial factors are salient to wanting an HIV vaccine for reasons indicative of RC, and underscore the need for risk-reduction counseling alongside vaccination during the eventual rollout of an HIV vaccine.
Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa: Results from a U.S. National samplePainter, J. E., Von Fricken, M. E., Viana De O. Mesquita, S., & DiClemente, R.
Journal titleHuman Vaccines and Immunotherapeutics
Page(s)1665-1671The 2014–2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30–May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1–50; 174 (20.1%) would pay $51–100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.
A Multigroup, Longitudinal Study of Truant Youths, Marijuana Use, Depression, and STD-Associated Sexual Risk BehaviorDembo, R., Krupa, J. M., Wareham, J., Schmeidler, J., & DiClemente, R.
Journal titleJournal of Child and Adolescent Substance Abuse
Page(s)192-204Truant youths are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youths has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youths. Using data collected in a National Institute on Drug Abuse (NIDA)-funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior.
Community trauma as a predictor of sexual risk, marijuana use, and psychosocial outcomes among detained African-American female adolescentsSeth, P., Jackson, J. M., DiClemente, R., & Fasula, A. M.
Journal titleVulnerable Children and Youth Studies
Page(s)353-359Social determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13–17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents’ overall health and standard of living in at-risk communities.
Exploring evidence for behavioral risk compensation among participants in an HIV vaccine clinical trialPainter, J. E., DiClemente, R., Jimenez, L., Stuart, T., Sales, J. M., & Mulligan, M. J.
Page(s)3558-3563Background HIV vaccine trial participants may engage in behavioral risk compensation due to a false sense of protection. We conducted an ancillary study of an HIV Vaccine Trials Network (HVTN) vaccine efficacy trial to explore risk compensation among trial participants compared to persons who were willing to participate but ineligible based on previous exposure to the Ad5 virus (Ad5+) across three timepoints. Methods Participants were drawn from the Atlanta, GA site of the HVTN 505 vaccine trial. From 2011–2013, all persons who met prescreening criteria for the clinical trial and presented for Ad5 antibody testing were invited to participate in the ancillary study. Data were collected from vaccine trial participants (n = 51) and Ad5+ participants (n = 60) via online surveys across three timepoints: baseline, T2 (after trial participants received 2/4 injections) and T3 (after trial participants received 4/4 injections). Data analyses assessed demographic, psychosocial, and behavioral differences at baseline and changes at each timepoint. Results At baseline, Ad5+ participants were less likely to have some college education (p = 0.024) or health insurance (p = 0.008), and were more likely to want to participate in the vaccine trial “to feel safer having unprotected sex” (p = 0.005). Among vaccine trial participants, unprotected anal sex with a casual partner (p = 0.05), HIV transmission worry (p = 0.033), and perceived chance of getting HIV (p = 0.027), decreased across timepoints. Conclusions Study findings suggest that persons with previous exposure to Ad5 may be systematically different from their Ad5-negative peers. Unprotected anal sex with a casual partner significantly decreased among HIV vaccine trial participants, as did HIV worry and perceived chance of getting HIV. Findings did not support evidence of risk compensation among HIV vaccine trial participants compared to Ad5+ participants.
Factors associated with school nurses’ HPV vaccine attitudes for school-aged youthRosen, B. L., DiClemente, R., Shepard, A. L., Wilson, K. L., & Fehr, S. K.
Journal titlePsychology, Health and Medicine
Page(s)535-545School nurses are at the intersection of the healthcare and school communities, thus, they can be considered opinion leaders in providing health advice–including information about the human papillomavirus (HPV) vaccine–to parents and students. This study examined school nurses’ attitudes toward the HPV vaccine based on age, years as a school nurse, geographic location, urban vs. rural work setting, HPV and vaccine knowledge, perception of role as opinion leaders, and school district support in providing health education. Participants (n = 413) were systematically sampled from the National Association of School Nurses’ membership and completed a web-based survey. Multiple regression was used to predict positive HPV vaccine attitudes. The model was statistically significant accounting for 50.8% of the variance (F [9, 400] = 45.96, p <.001). Positive attitudes regarding the HPV vaccine were predicted by higher HPV and vaccine knowledge (β =.096, p <.001) and stronger perceptions of role as opinion leaders for the vaccine (β =.665, p <.001). No other variables were found to be statistically significant. These results suggest knowledge is essential in predicting positive attitudes, but not the strongest predictor as perceptions of role as opinion leaders was more crucial in terms of predicting school nurses’ positive attitudes towards HPV vaccine. Despite school nurses being seen as champions for adolescent vaccines, they need additional professional development to increase their HPV vaccine knowledge and attitudes to encourage parents and adolescents to consider the uptake of HPV vaccination. To engage school nurses’ in promoting HPV vaccine uptake, interventions need to focus on increasing school nurses’ perception of their role as opinion leaders for HPV vaccine and knowledge to increase positive attitudes towards HPV vaccination for youth.
Health Risk Behavior Among Justice Involved Male and Female Youth: Exploratory, Multi-Group Latent Class AnalysisDembo, R., Faber, J., Cristiano, J., DiClemente, R., Krupa, J. M., Terminello, A., & Wareham, J.
Journal titleSubstance Use and Misuse
Page(s)1751-1764Background: Youth involved in the juvenile justice system experience a disproportionate prevalence of serious mental health issues, substance abuse, and are at an increased risk of engaging in risky sexual practices. Gender differences exist, with girls at a markedly greater risk of acquiring a sexually transmitted disease. Objectives: The present study seeks to determine if there are subgroups of male and female youth who differ in their health risk behavior. If so, do any male or female subgroups at different levels of health risk differ in regard to their sociodemographic and psychological factors, and finally, what are intervention/service delivery implications of these differences. Methods: Youth were participants in an innovative health service at a centralized intake facility located in a large southeastern U.S. city. Latent class analysis and multinomial logistic regression is utilized to examine the heterogeneity of health risk behaviors across gender groups in a sample of 777 newly arrested youth. Results: Results indicate a three class solution provided the optimal fit with the data for each gender group: a Lower Health Risk group, a Higher Health Risk group, and a Highest Health Risk group. Multinomial logistic regression analysis identified significant sociodemographic and depression effects among both male and female youth. Conclusions/Importance: Youth characterized by risky sexually behavior, elevated depression, and drug involvement should be the focus of integrated intervention services. This study documents the critical need for front end, juvenile justice intake facilities to provide behavioral and public health screening, with treatment follow-up, on newly arrested youth.
Interest in an Ebola vaccine among a U.S. national sample during the height of the 2014–2016 Ebola outbreak in West AfricaPainter, J. E., DiClemente, R., & Von Fricken, M. E.
Page(s)508-512To better understand the association between Ebola-related attitudes and interest in receiving an Ebola virus vaccine, a survey was administered to a U.S. national sample using GfK's KnowledgePanel®. Among participants (N = 1417), 34.1% expressed interest in an Ebola vaccine for themselves. In the subset of participants with children aged 0–17 (N = 410), 38.1% expressed interest in an Ebola vaccine for their child. In multivariable analyses, vaccine interest for oneself was associated with perceived susceptibility to Ebola (p = 0.009), beliefs that the U.S. government should spend money to control Ebola (p = 0.002), and beliefs Ebola posed a national threat (p = 0.007). Vaccine interest for one's child was associated with perceived severity of Ebola (p = 0.018) and beliefs that the U.S. government should spend money to control Ebola (p = 0.003). Findings highlight the influence of personal and national threat beliefs on vaccine interest. Understanding the impact of threat beliefs may benefit vaccine campaign development during future pandemic threats.
Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol UseLittlefield, A. K., Brown, J. L., DiClemente, R., Safonova, P., Sales, J. M., Rose, E. S., Belyakov, N., & Rassokhin, V. V.
Journal titleAIDS and Behavior
Page(s)1938-1949Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman’s r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.
Semen says: Assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarkerRosenbaum, J. E., Zenilman, J. M., Rose, E., Wingood, G. M., & DiClemente, R.
Journal titleSexually Transmitted Infections
Page(s)145-147Objective Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour. Methods This prospective cohort study uses data from 715 sexually active African-American female adolescents in Atlanta, surveyed at baseline, 6months and 12months. Participants completed a 40min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted Y-chromosome test results from self-reported sexual behaviour using within-subject panel regression. Results Among the participants who reported abstinence from vaginal sex in the past 14days, 9.4% tested positive for semen Y-chromosome. Among item non-respondents, 6.3% tested positive for semen Y-chromosome. Women who reported abstinence and engaged in item non-response regarding their sexual behaviour had respectively 62% and 78% lower odds of testing positive for Y-chromosome (OR 0.38 (0.21 to 0.67), OR 0.22 (0.12 to 0.40)), controlling for smoking, survey wave and non-coital sexual behaviours reported during abstinence. Conclusions Adolescents who report sexual abstinence under-report semen exposure. Research should validate self-reported sexual behaviour with biomarkers. Adolescents who engage in item non-response regarding vaginal sex test positive for semen Y-chromosome at similar rates, which supports the practice of grouping non-respondents with adolescents reporting abstinence in statistical analysis. Trial registration number NCT00633906.
Social Context and Problem Factors among Youth with Juvenile Justice Involvement HistoriesVoisin, D. R., Sales, J. M., Hong, J. S., Jackson, J. M., Rose, E. S., & DiClemente, R.
Journal titleBehavioral Medicine
Page(s)71-78Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.
The association between cigarette smoking, virologic suppression, and CD4+ lymphocyte count in HIV-Infected Russian womenBrown, J. L., Winhusen, T., DiClemente, R., Sales, J. M., Rose, E. S., Safonova, P., Levina, O., Belyakov, N., & Rassokhin, V. V.
Journal titleAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Page(s)1102-1106Cigarette smoking among people living with HIV/AIDS is associated with significant morbidity and mortality, but findings regarding the association between cigarette smoking and HIV viral load and CD4+ lymphocyte counts have been inconsistent. This study characterized the prevalence of cigarette smoking among HIV-infected Russian women and examined the association between smoking frequency and quantity and HIV viral load and CD4+ lymphocyte counts. HIV-infected Russian women (N = 250; M age = 30.0) in St. Petersburg, Russia, completed an audio computer-assisted self-interview survey assessing cigarette use, antiretroviral medication adherence, and provided blood samples assayed for HIV viral load and CD4+ lymphocyte counts. The majority (60.4%) reported cigarette smoking in the past month; 49.0% of recent smokers were classified as moderate or heavy smokers, defined as smoking ≥10 cigarettes daily. Viral load status did not differ between infrequent smokers and regular smokers. However, moderate/heavy smokers (relative to light smokers) were more likely to have a detectable viral load (AOR = 2.3, 95% CI: 1.1, 5.1). There were no significant differences in CD4+ lymphocyte counts by smoking frequency or quantity of cigarettes smoked. Results highlight the need for additional research to examine the association between cigarette smoking and virologic suppression and markers of HIV disease progression. Adverse health consequences of cigarette smoking coupled with a potential link between heavy smoking and poor virologic suppression highlight the need for assessment of cigarette use and provision of evidence-based smoking-cessation interventions within HIV medical care.
Alcohol Use Problems and Sexual Risk Among Young Adult African American MothersSwartzendruber, A., Sales, J. M., Rose, E. S., & DiClemente, R.
Journal titleAIDS and Behavior
Page(s)74-83Studies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41 % (n = 141) of whom were mothers. Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes.
Alcohol use, partner characteristics, and condom use among HIV-infected Russian women: An event-level studyBrown, J. L., DiClemente, R., Sales, J. M., Rose, E. S., Gause, N. K., Safonova, P., Levina, O., Belyakov, N., & Rassokhin, V. V.
Journal titleJournal of Studies on Alcohol and Drugs
Page(s)968-973Objective: Alcohol use is a prominent factor correlated with HIV risk behavior engagement. Hazardous drinking is prevalent among Russian women and may contribute to decreased condom use. Event-based studies suggest that HIV risk behaviors may vary based on situational factors including partner characteristics and alcohol use. This study investigated the effect of situational factors on condom use during the most recent sexual encounter among a sample of HIV-infected Russian women. Method: HIV-infected women (n = 239; mean age = 30.0 years) receiving medical care in St. Petersburg, Russia, completed an audio computer-assisted self-interview that assessed characteristics of their last sexual encounter. Multivariable logistic regression examined the associations between the following situational factors: (a) alcohol use, (b) partner type, (c) partner’s serostatus, and (d) partner’s alcohol use on whether a condom was used for vaginal and/or anal sex during the last sexual encounter. Results: A total of 54.0% engaged in unprotected vaginal and/or anal sex during their last sexual encounter. In an adjusted logistic regression model, unprotected sex did not differ by participants’ alcohol use (adjusted odds ratio [AOR] = 0.72, 95% CI [0.29, 1.8]) but was more likely with partners who had consumed alcohol (AOR = 2.3, 95% CI [1.1, 5.2]) and HIV-infected partners (AOR = 2.8, 95% CI [1.6, 4.9]) and less likely to occur in the context of nonsteady partnerships (AOR = 0.36, 95% CI [0.13, 0.99]). Conclusions: More stable, steady relationships with HIV-infected partners who consumed alcohol were associated with greater likelihood of noncondom use. Results highlight the need to address the intersection of alcohol and sexual risk engagement within the context of HIV-infected women’s relationships.