Ralph DiClemente

Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences

Professional overview

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:

  1. Developing interventions to reduce the risk of HIV/STD among vulnerable populations
  2. Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
  3. Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
  4. 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.

Education

BA, The City College of the City University of New York (CCNY), New York, NY
ScM, Behavioral Sciences, Harvard University, Cambridge, MA
PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA
Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions
Diabetes
HIV/AIDS
Implementation science
Influenza
Psychology

Publications

Publications

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family

Ali, S. H., Cai, J., Kamal, F., Auer, S., Yang, K., Parikh, R. S., Parekh, N., Islam, N. S., Merdjanoff, A. A., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

Behavioral Medicine
Abstract
Abstract
The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other’s persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Concordance of Ethyl Glucuronide, Blood Alcohol Content, and Self-Reported Alcohol Use in Russian Women with HIV and Hepatitis C Virus Co-Infection

Brown, J. L., Capasso, A., Revzina, N., Boeva, E., Rassokhin, V., Sales, J. M., Gutova, L. V., Khalezova, N. B., Hitch, A. E., Twitty, T. D., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

AIDS and Behavior

Volume

27

Issue

12

Page(s)

4062-4069
Abstract
Abstract
Problematic alcohol use is prevalent in Russia and is deleterious for individuals with HIV and Hepatitis C Virus (HCV). Ethyl glucuronide (EtG) and blood alcohol content (BAC) provide objective biomarkers of drinking that can be compared to self-reported alcohol use. This paper describes patterns of alcohol use measured by biomarkers and self-report along with concordance across measures. Participants were Russian women with HIV and HCV co-infection (N = 200; Mean age = 34.9) from two Saint Petersburg comprehensive HIV care centers enrolled in an alcohol reduction intervention clinical trial. Measures were: (a) urine specimen analyzed for EtG; (b) breathalyzer reading of BAC; and (c) self-reported frequency of drinking, typical number of drinks consumed, and number of standard drinks consumed in the past month. At baseline, 64.0% (n = 128) had a positive EtG (> 500 ng/mL) and 76.5% (n = 153) had a positive breathalyzer reading (non-zero reading). There was agreement between EtG and BAC (kappa = 0.66, p <.001; Phi coefficient = 0.69, p <.001); self-reported alcohol measures were positively correlated with positive EtG and BAC (p’s < 0.001). There was concordance between EtG and BAC measures, which have differing alcohol detection windows. Most participants endorsed frequent drinking at high quantities, with very few reporting no alcohol consumption in the past month. Concordance between biomarkers and self-reported alcohol use suggests that underreporting of alcohol use was minimal. Results highlight the need for alcohol screening within HIV care. Implications for alcohol assessment within research and clinical contexts are discussed.

COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study

Williams, M. S., Cigaran, E., Martinez, S., Marino, J., Barbero, P., Myers, A. K., DiClemente, R. J., Goris, N., Gomez, V. C., Granville, D., Guzman, J., Harris, Y. T., Kline, M., Lesser, M. L., Makaryus, A. N., Murray, L. M., McFarlane, S. I., Patel, V. H., Polo, J., … Pekmezaris, R. (n.d.).

Publication year

2023

Journal title

Frontiers in Clinical Diabetes and Healthcare

Volume

4
Abstract
Abstract
Background and aim: During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions. Methods and participants: Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached. Results: Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors. Conclusion: The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.

Crush: A Randomized Trial to Evaluate the Impact of a Mobile Health App on Adolescent Sexual Health

Martínez-García, G., Ewing, A. C., Olugbade, Y., DiClemente, R. J., & Kourtis, A. P. (n.d.).

Publication year

2023

Journal title

Journal of Adolescent Health

Volume

72

Issue

2

Page(s)

287-294
Abstract
Abstract
Purpose: Mobile technology allows delivery of sexual and reproductive health (SRH) information directly to youth. We tested the efficacy of Crush, a mobile application aimed at improving sexual health by promoting the use of SRH services and contraception among female adolescents. Methods: We recruited 1,210 women aged 14–18 years through social media advertising and randomized them into a Crush intervention group and a control group that received a wellness app. At 3 and 6 months post randomization, we compared changes from baseline in behaviors, attitudes, self-efficacy, perceived social norms, birth control knowledge, perceived control and use intentions, and SRH service utilization. Odds ratios were estimated with multivariable logistic regression and adjusted for baseline outcome, age, race/ethnicity, mother's education, and sexual experience. Results: There was no difference in accessing SRH services according to study group. Three months post baseline, Crush users had higher odds (p < .05) than control participants of reporting confidence in accessing SRH services (adjusted odds ratio [aOR] = 1.6, 95% confidence interval [CI]: 1.1–2.3) and of believing that it is a good thing to use birth control consistently (aOR = 2.3, 95% CI: 1.4–3.8). Six months after baseline, Crush users had higher odds than control participants of reporting they can control whether birth control is used every time they have sex (aOR = 1.8, 95% CI: 1.2–2.6) and perceiving they would get pregnant if they did not use birth control (aOR: 1.5, 95% CI: 1.1–2.2). Impacts on other behavioral constructs were also found. Discussion: Crush was associated with improvements in knowledge, attitudes, and self-efficacy related to key SRH behaviors and may be a strategy to deliver SRH education to adolescent women. Studies including larger numbers of sexually active adolescents are needed to demonstrate behavioral impacts.

Digital Communications Technology Use and Feelings of Anxiety, Depression, and Loneliness Among Older Adults During the COVID-19 Pandemic

Robbins, R., DiClemente, R. J., Baig, N., Johnson, A., Chou, A., & Van Den Bulck, J. (n.d.).

Publication year

2023

Journal title

Journal of Applied Gerontology

Volume

42

Issue

9

Page(s)

1911-1920
Abstract
Abstract
Some have touted technology as a panacea for overcoming the isolation associated with COVID-19 mitigation policies; yet, these tools are not widely adopted by older adults. With data from the COVID-19 supplement to the National Health and Aging Trends Survey, we conduct adjusted Poisson regression modeling to examine digital communications use during COVID-19 and feelings of anxiety, depression, and loneliness during the COVID-19 pandemic among older adults (65+ years of age). Adjusted Poisson regression revealed that those who reported frequent use of video calls with friends and family (aPR = 1.22, 95% CI:1.06–1.41) and with healthcare providers (aPR = 1.22, 95% CI:1.03–1.45) were more likely to report feelings of anxiety than those not using these platforms; yet, reports of in-person visits with friends and family (aPR = 0.79, 95% CI: 0.66–0.93) and with healthcare providers (aPR = 0.88, 95% CI: 0.77–1.01) were associated with fewer feelings of depression and loneliness, respectively. Future research is needed to tailor digital technology to support older adults.

Do parental protective factors matter? Predicting HIV/STI risk among a sample of justice-involved African-American girls

Crooks, N., Sun, S., Wise, A., DiClemente, R., & Sales, J. M. D. (n.d.).

Publication year

2023

Journal title

Children and Youth Services Review

Volume

149
Abstract
Abstract
African American adolescent girls are overrepresented in the juvenile justice system and are disproportionately affected by human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Parental protection may play a critical role in the sexual behaviors of African American adolescent girls and help to inform family-based interventions. The current study investigated the impact of parental protective factors (monitoring, sex communication, and authoritarian parenting) on sexual risk-related outcomes in a sample (n = 172) of justice-involved, urban African American adolescent girls aged 13–17 years. Multiple linear regression analyses were conducted to estimate the association between parental protective factors and percentage of consistent condom use, HIV/STI knowledge, fear of condom negation, and condom self-efficacy 3 months after their release from detention centers. Baseline parental protective factors were significantly associated with sexual risk-related outcomes of African American adolescent girls. Parental monitoring was positively associated with consistency of condom use and increased HIV/STI knowledge. Parental communication about sex reduced fear of condom negotiation and increased condom self-efficacy. Authoritarian parenting predicted increased HIV/STI knowledge and fear of condom negotiation following release. Programs, policies, and interventions addressing the sexual health of African American adolescent girls should engage families to enhance protective factors to reduce their sexual risk.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015

Ali, S. H., Parekh, N., Islam, N. S., Merdjanoff, A. A., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

Nutrition and Health
Abstract
Abstract
Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18–35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3–4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

Examining Changes in Sleep Duration Associated with the Onset of the COVID-19 Pandemic: Who is Sleeping and Who is Not?

Batool-Anwar, S., Robbins, R., Ali, S. H., Capasso, A., Foreman, J., Jones, A. M., Tozan, Y., DiClemente, R. J., & Quan, S. F. (n.d.).

Publication year

2023

Journal title

Behavioral Medicine

Volume

49

Issue

2

Page(s)

162-171
Abstract
Abstract
The COVID-19 pandemic has resulted in social isolation and reports of insomnia. However, reports of changes in sleep duration and associated factors are few. To determine the impact of COVID-19 on changes in sleep behavior, data were analyzed from an online survey of adults recruited via social media that included questions asking whether the respondent slept less or more after the onset of the pandemic as well as self-reported sociodemographic and occupational information; beliefs about COVID-19; and responses pertaining to loneliness, anxiety, and depression. There were 5,175 respondents; 53.9% had a change in sleep duration.17.1% slept less and 36.7% slept more. Sleeping more was related to greater education, being single/divorced/separated, unemployed or a student. Being retired, divorced/separated or a homemaker, and living in the Mountain or Central time zones were associated with less sleep. Beliefs that COVID-19 would result in personal adverse consequences was associated with both more and less sleep. However, the strongest associations for both more and less sleep were seen with depression, anxiety, and loneliness. In summary, changes in sleep duration since the start of the COVID-19 pandemic were highly prevalent among social media users and were associated with several sociodemographic factors and beliefs that COVID-19 would have adverse personal impacts. However, the strongest associations occurred with worse mental health suggesting that improvements may occur with better sleep. Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2002800.

Exploring substance misuse behaviors among black girls in detention: Intersections of trauma, sex, and age

Quinn, C. R., Boyd, D. T., Menon, S. E., Mitchell, M., Radney, A., Coker, E. J., Lloyd Allen, J., Simmons-Horton, S., Hughley, A., DiClemente, R. J., & Voisin, D. R. (n.d.).

Publication year

2023

Journal title

Addictive Behaviors

Volume

143
Abstract
Abstract
High risk substance misuse, trauma and gang involvement are prevalent in adolescents and often occur with youth involved with the youth punishment system. Evidence suggests that system involvement is related to trauma histories, substance misuse, as well as gang involvement. This study investigated the associations between individual and peer factors and their relationship to problem drug and alcohol use among Black girls involved with the youth punishment system. Data were collected from 188 Black girls in detention at baseline, as well as 3 and 6 month follow up periods. Measures assessed were abuse history, trauma history, sex while using drugs and alcohol, age, government assistance, and drug use. Significant findings from the multiple regression analyses indicated that younger girls were more likely to have a higher prevalence of having a drug problem than older girls at baseline. Having sex while on drugs and alcohol at the 3 month follow up period was correlated with drug use. These findings highlight how individual and peer factors can influence problem substance misuse, their behavior and peer relationships among Black girls in detention.

Family connectedness and sexual minority Asian Americans' eating behavior regulation

Le, T. P., Ali, S. H., Atkin, A. L., Ching, T. H., Csizmadia, A., Tran, N. K., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

Eating Behaviors

Volume

51
Abstract
Abstract
To date, psychosocial and interpersonal protective factors such as family connectedness have received little attention in studies of eating behaviors among sexual minority Asian Americans. Therefore, we investigated associations of family connectedness and two types of eating behavior regulation motives and the moderating role of individualism in these associations among 134 sexual minority Asian American young adults. Linear regression models assessed the main and interaction effects of family connectedness and individualism on introjected and identified eating behavior regulation motives. We observed a significant interaction effect between family connectedness and individualism only on introjected regulation. For participants with low levels of individualism, those who reported high levels of family connectedness had lower scores for introjected regulation of eating behavior. The findings of this study highlight the importance of examining strengths related to sexual minority Asian Americans by demonstrating the important role family connectedness plays in eating behavior regulation motives, particularly for those with lower individualism.

Family Involvement in Asian American Health Interventions: A Scoping Review and Conceptual Model

Ali, S. H., Mohsin, F. M., Rouf, R., Parekh, R., Dhar, B., Kaur, G., Parekh, N., Islam, N. S., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

Public Health Reports

Volume

138

Issue

6

Page(s)

885-895
Abstract
Abstract
Family members play a crucial role in the health of Asian American communities, and their involvement in health interventions can be pivotal in optimizing impact and implementation. To explore how family members can be effectively involved in Asian American health interventions and develop a conceptual framework of methods of involvement at the stages of intervention development, process, and evaluation, this scoping review documented the role of Asian American family members in interventions (across any health objective). Of the 7175 studies identified through database and manual searches, we included 48 studies in the final analysis. Many studies focused on Chinese (54%) or Vietnamese (21%) populations, were conducted in California (44%), and involved spouses (35%) or parents/children (39%). We observed involvement across 3 stages: (1) intervention development (formative research, review process, material development), (2) intervention process (recruitment, receiving the intervention together, receiving a parallel intervention, enlisting support to achieve goals, voluntary intervention support, agent of family-wide change, and participation gatekeepers), and (3) intervention evaluation (received evaluation together, indirect impact evaluation, and feedback during intervention). Impact of family member involvement was both positive (as sources of encouragement, insight, accountability, comfort, and passion) and negative (sources of hindrance, backlash, stigma, obligation, and negative influence). Suggestions for future research interventions include (1) exploring family involvement in South Asian or young adult interventions, (2) diversifying types of family members involved (eg, extended family), and (3) diversifying methods of involvement (eg, family members as implementation agents).

Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program: A Randomized Trial

Kissinger, P. J., Green, J., Latimer, J., Schmidt, N., Ratnayake, A., Madkour, A. S., Clum, G., Wingood, G. M., Diclemente, R. J., & Johnson, C. (n.d.).

Publication year

2023

Journal title

Sexually Transmitted Diseases

Volume

50

Issue

6

Page(s)

329-335
Abstract
Abstract
Background Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. Methods Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. Results Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. Conclusion and Relevance The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.

Interpersonal abuse and alcohol use among African American young women: the mediating role of emotion dysregulation

Hitch, A. E., Brown, J. L., & DiClemente, R. J. (n.d.).

Publication year

2023

Journal title

Journal of Ethnicity in Substance Abuse

Volume

22

Issue

2

Page(s)

433-452
Abstract
Abstract
African American women experience a high prevalence of alcohol-related consequences, and no studies have explicitly examined the associations among lifetime interpersonal abuse, emotion dysregulation, and alcohol-related outcomes during the critical period of young adulthood within this population. This study used baseline data from a sample of African American young women (N = 560) who use alcohol, aged 18 to 24, enrolled in an HIV prevention intervention trial to examine whether emotion dysregulation mediated the relation between lifetime history of abuse and problematic alcohol use. Further, we sought to examine whether there were potential differential levels of problematic alcohol use based on the number of abuse types experienced. Multiple regression analyses showed that exposure to two or more forms of abuse was associated with problematic alcohol use, β =.24, p <.001, and heavy alcohol consumption, β =.23, p <.001, whereas history of a single form was not. Indirect effects of both single and multiple forms of abuse on problematic alcohol use (95% confidence interval [CI] [.16, 1.02]; [.46, 1.64]) and heavy alcohol consumption (95% CI [.02,.26]; [.05,.45]) via emotion dysregulation severity were found. Abuse and emotion dysregulation were associated with frequency of alcohol use and binge drinking, but not typical amount consumed. Hazardous alcohol consumption was prevalent among this sample of African American young women who use alcohol. This study provides preliminary evidence that emotion dysregulation may be an important mechanism buttressing the association between lifetime history of interpersonal abuse and problematic alcohol use among African American young women who use alcohol.

Perceptions of Sexual Risk and HIV/STI Prevention Among Black Adolescent Girls in a Detention Center: an Investigation of the Role of Parents and Peers

Quinn, C. R., Boyd, D. T., Beaujolais, B., Hughley, A., Mitchell, M., Allen, J. L., DiClemente, R. J., & Voisin, D. (n.d.).

Publication year

2023

Journal title

Journal of Racial and Ethnic Health Disparities

Volume

10

Issue

3

Page(s)

1224-1233
Abstract
Abstract
Black American adolescent girls constitute approximately one third of the US youth legal system population. Their overrepresentation in the youth punishment system is an indicator of significant physical, sexual, and/or behavioral health needs. Since less is known about perceptions of HIV/STI risk among Black girls with juvenile justice histories, we used intersectionality theory to explore the following: (1) how a sample of Black girls in detention endorse their perceptions of sexual safety given the multiple intersections of their race, gender, and SES and (2) how their endorsements align with interlocking systems of social inequality for system-involved Black at the social structural level. We examined relational and behavioral factors associated perceived HIV/STI risk. Among a sample of 188 Black girls (ages 13–17 years), we examined parent and partner sexual communication, fear of condom negotiation, a positive STI test, and partner risk profile as significant correlates. Major findings indicated that greater partner communication was associated with higher perceived HIV/STI risk, whereas having had a risky sexual partner, fear of condom negotiation, and having had a positive STI test were correlated with lower perceived risk. The significant factors identified in this study can be the focus of STI prevention and intervention programs for Black girls with youth punishment histories.

Pivoting from in-person to phone survey assessment of alcohol and substance use: effects on representativeness in a United States prospective cohort of women living with and without HIV

Tierney, H. R., Ma, Y., Bacchetti, P., Adimora, A. A., Chandran, A., Kempf, M. C., Collins, L. F., DeHovitz, J., DiClemente, R. J., French, A. L., Jones, D. L., Sharma, A., Spence, A. B., Hahn, J. A., Price, J. C., & Tien, P. C. (n.d.).

Publication year

2023

Journal title

American Journal of Drug and Alcohol Abuse
Abstract
Abstract
Background: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women. Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women’s Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV. Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April–September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August–September 2020) phone survey. Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33–0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41–0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02–2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24–2.43). Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.

Social Media Utilization Within Asian American Families and Its Role in Healthy Lifestyle Behavioral Influence: Results From a Nationwide Survey

Mohsin, F. M., Ali, S. H., Chong, S. K., Parikh, R. S., DiClemente, R. J., & Hu, L. (n.d.).

Publication year

2023

Journal title

Social Media and Society

Volume

9

Issue

3
Abstract
Abstract
Objective: Social media platforms are effective tools for promoting public health and implementing impactful health interventions. This study explored social media utilization patterns among young Asian American adults and their effect on perceived family influence on lifestyle behaviors. Methods: The study analyzes data from Asian American young adults (aged 18–35 years) participating in an online survey in March 2021. Results: A total of 739 Asian Americans participated in the survey: 45.6% East Asian, 23.4% Southeast Asian, and 22.7% South Asian. Common social media platforms include Facebook Messenger (60.9%) and Instagram (57.0%). US-born Asian Americans reported higher odds of using Instagram (adjusted odds ratio [AOR]: 1.64, 95% CI: [1.09, 2.46]) than foreign-born Asian Americans. Higher acculturation was associated with lower odds of using Instagram among South Asians (AOR:.46, 95% CI: [.24,.83]) and greater odds of using Instagram among East Asians (AOR: 1.72, 95% CI: [1.09, 2.75]). Interacting with mothers using Facebook and Instagram had a higher perceived influence on one’s ability to improve sleep (AOR: 2.08, 95% CI: [1.19, 3.65]; AOR: 2.53, 95% CI: [1.15, 5.55]) and develop stress-management strategies (AOR: 1.73, 95% CI: [1.02, 2.96]; AOR: 4.05, 95% CI: [1.83, 9.49]). With one’s siblings, Facebook was associated with a lower perceived influence on avoiding risky substances (AOR:.48, 95% CI: [.23,.97]), and WhatsApp was associated with a higher perceived influence on one’s ability to develop stress-management strategies (AOR: 3.10, 95% CI: [1.26, 7.78]) and form/maintain relationships (AOR: 2.58, 95% CI: [1.02, 6.58]). No significant findings with father interactions were observed. Conclusion: Findings provide evidence for researchers seeking to tailor social media–based interpersonal health interventions to address the unique needs of diverse Asian American communities.

Teen pregnancy in the US

Choi, J., Capasso, A., & DiClemente, R. (n.d.). In Encyclopedia of Child and Adolescent Health, First Edition: Overview and opportunities for prevention (1–).

Publication year

2023

Volume

2

Page(s)

455-464
Abstract
Abstract
Teen pregnancy, while declining, remains a significant and persistent public health, social, and clinical challenge. Pregnant teens are a vulnerable population, at increased risk for adverse health, social, and psychological outcomes. Adequately confronting this challenge requires a multi-factorial approach – engaging youth themselves, family, peers, social networks, schools, and clinicians. One key contextual factor is public health policy. Thus, teen pregnancy may be more effectively addressed when a social-ecological framework is used to guide the development and implementation of programs. Single, isolated, and fragmented programmatic strategies are suboptimal. Only marshaling all our resources, and promoting teen friendly health policy, can we optimize our response to teen pregnancy.

Causally Interpretable Meta-analysis: Application in Adolescent HIV Prevention

Barker, D. H., Dahabreh, I. J., Steingrimsson, J. A., Houck, C., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).

Publication year

2022

Journal title

Prevention Science

Volume

23

Issue

3

Page(s)

403-414
Abstract
Abstract
Endowing meta-analytic results with a causal interpretation is challenging when there are differences in the distribution of effect modifiers among the populations underlying the included trials and the target population where the results of the meta-analysis will be applied. Recent work on transportability methods has described identifiability conditions under which the collection of randomized trials in a meta-analysis can be used to draw causal inferences about the target population. When the conditions hold, the methods enable estimation of causal quantities such as the average treatment effect and conditional average treatment effect in target populations that differ from the populations underlying the trial samples. The methods also facilitate comparison of treatments not directly compared in a head-to-head trial and assessment of comparative effectiveness within subgroups of the target population. We briefly describe these methods and present a worked example using individual participant data from three HIV prevention trials among adolescents in mental health care. We describe practical challenges in defining the target population, obtaining individual participant data from included trials and a sample of the target population, and addressing systematic missing data across datasets. When fully realized, methods for causally interpretable meta-analysis can provide decision-makers valid estimates of how treatments will work in target populations of substantive interest as well as in subgroups of these populations.

Correlates of depression among Black girls exposed to violence

Waller, B., Quinn, C. R., Boyd, D., DiClemente, R., & Voisin, D. R. (n.d.).

Publication year

2022

Journal title

Journal of Racial and Ethnic Health Disparities

Volume

9

Issue

1

Page(s)

146-155
Abstract
Abstract
Depression rates for youth remanded to juvenile detention is double that of the general population and Black girls are especially vulnerable. A dearth of literature analyzes the factors that are correlated with depression among system-involved Black girls, ages 12–17 years old. We utilized personal agency to examine the relationship between risk factors (i.e., abuse history, and fear of condom negotiation) and protective factors (i.e., condom self-efficacy, and perceived social support) that might correlate with depression among Black girls exposed to violence. Findings indicate that fear of condom negotiation, abuse history and low condom self-efficacy are correlated with depressive symptomology while self-esteem and perceived social support are protective factors that may serve as a buffer against girls’ feelings of helplessness and hopelessness. The findings of this study suggest several implications for prevention and intervention efforts to reduce the depression-related risks among justice-involved Black females, including strategies that promote healing within their social support networks.

Development of an Integrated Approach to Virtual Mind-Mapping: Methodology and Applied Experiences to Enhance Qualitative Health Research

Ali, S. H., Merdjanoff, A. A., Parekh, N., & DiClemente, R. J. (n.d.).

Publication year

2022

Journal title

Qualitative Health Research

Volume

32

Issue

3

Page(s)

571-580
Abstract
Abstract
There is a growing need to better capture comprehensive, nuanced, and multi-faceted qualitative data while also better engaging with participants in data collection, especially in virtual environments. This study describes the development of a novel 3-step approach to virtual mind-mapping that involves (1) ranked free-listing, (2) respondent-driven mind-mapping, and (3) interviewing to enhance both data collection and analysis of complex health behaviors. The method was employed in 32 virtual interviews as part of a study on eating behaviors among second-generation South Asian Americans. Participants noted the mind-mapping experience to be (1) helpful for visual learners, (2) helpful in elucidating new ideas and to structure thoughts, as well as (3) novel and interesting. They also noted some suggestions that included improving interpretability of visual data and avoiding repetition of certain discussion points. Data collection revealed the adaptability of the method, and the power of mind-maps to guide targeted, comprehensive discussions with participants.

Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study): Protocol for a Randomized Controlled Trial

Trent, M., Yusuf, H. E., Rowell, J., Toppins, J., Woods, C., Huettner, S., Robinson, C., Fields, E. L., Marcell, A. V., DiClemente, R., & Matson, P. (n.d.).

Publication year

2022

Journal title

JMIR Research Protocols

Volume

11

Issue

5
Abstract
Abstract
Background: Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs. Objective: This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting. Methods: A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc. Results: So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up. Conclusions: Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk.

Editorial: The outbreak and sequelae of the increase in opioid use in the United States, Canada, and beyond

Friedman, S. R., Perlman, D. C., & DiClemente, R. J. (n.d.).

Publication year

2022

Journal title

Frontiers in Sociology

Volume

7

Employment conditions as barriers to the adoption of COVID-19 mitigation measures: how the COVID-19 pandemic may be deepening health disparities among low-income earners and essential workers in the United States

Capasso, A., Kim, S., Ali, S. H., Jones, A. M., DiClemente, R. J., & Tozan, Y. (n.d.).

Publication year

2022

Journal title

BMC public health

Volume

22

Issue

1
Abstract
Abstract
Background: The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic. Methods: Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM). Results: Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene. Conclusions: Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Feasibility, acceptability, and short-term impact of a brief sexually transmitted infection intervention targeting U.S. Military personnel and family members

Kunz, A., Moodley, A., Colby, D. J., Soltis, M., Robb-McGrath, W., Fairchok, A., Faestel, P., Jungels, A., Bender, A. A., Kamau, E., Wingood, G., DiClemente, R., & Scott, P. (n.d.).

Publication year

2022

Journal title

BMC public health

Volume

22

Issue

1
Abstract
Abstract
Background: Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18–30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention. Methods: The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state. Results: A total of 79 participants aged 18–30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention. Conclusions: The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation. Trial Registration: Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413, “Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries—Execution Phase”.

Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey

DiClemente, R. J., Capasso, A., Ali, S. H., Jones, A. M., Foreman, J., & Tozan, Y. (n.d.).

Publication year

2022

Journal title

Zeitschrift fur Gesundheitswissenschaften

Volume

30

Issue

8

Page(s)

2069-2079
Abstract
Abstract
AIM: Given the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults.SUBJECT AND METHODS: In the period March 20-30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18-39 years, 40-59 years and ≥ 60 years) were tested using Pearson's chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models.RESULTS: Approximately half of the sample ( N Total  = 6391) were 50-69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p  < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33). CONCLUSIONS: In spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19.SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10389-021-01564-4.

Contact

rjd438@nyu.edu 708 Broadway New York, NY, 10003