Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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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.
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Education
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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
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
A system-level intervention to encourage collaboration between juvenile justice and public health agencies to promote hiv/sti testing
AbstractElkington, K. S., Spaulding, A., Gardner, S., Knight, D., Belenko, S., Becan, J. E., Robertson, A. A., Oser, C., & DiClemente, R. (n.d.).Publication year
2020Journal title
AIDS Education and PreventionVolume
32Issue
4Page(s)
337-355AbstractJustice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.Abstinence and safer sex among adolescents [1] (multiple letters)
AbstractBerman, S. M., Gunn, R. A., Aral, S. O., Cameron, P., Cameron, K., Panzer, R. A., Moore, T. L., Masdeu, J. C., Jemmott, J. B., Jemmott, L. S., Fong, G. T., & DiClemente, R. (n.d.).Publication year
1999Journal title
Journal of the American Medical AssociationVolume
281Issue
16Page(s)
1485-1488Abstract~Abuse Impedes Prevention : The Intersection of Intimate Partner Violence and HIV/STI Risk Among Young African American Women
AbstractSeth, P., Wingood, G. M., Robinson, L. S., Raiford, J. L., & DiClemente, R. (n.d.).Publication year
2015Journal title
AIDS and BehaviorVolume
19Issue
8Page(s)
1438-1445AbstractIntimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18–29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs.Accelerating the Evolution of Health Promotion Research : Broadening Boundaries and Improving Impact
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Issue
S2Page(s)
S116Abstract~Acceptability of condoms, circumcision and PrEP among young black men who have sex with men : A descriptive study based on effectiveness and cost
AbstractCrosby, R. A., Geter, A., DiClemente, R., & Salazar, L. F. (n.d.).Publication year
2014Journal title
VaccinesVolume
2Issue
1Page(s)
129-137AbstractThe current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.Acceptability of medical male circumcision and improved instrument sanitation among a traditionally circumcising group in East Africa
AbstractSiegler, A. J., Mbwambo, J. K., & DiClemente, R. (n.d.).Publication year
2012Journal title
AIDS and BehaviorVolume
16Issue
7Page(s)
1846-1852AbstractBy removing the foreskin, medical male circumcision (MMC) reduces female to male heterosexual HIV transmission by approximately 60 %. Traditional circumcision has higher rates of complications than MMC, and reports indicate unsanitized instruments are sometimes shared across groups of circumcision initiates. A geographically stratified, cluster survey of acceptability of MMC and improved instrument sanitation was conducted among 368 eligible Maasai participants in two Northern Districts of Tanzania. Most respondents had been circumcised in groups, with 56 % circumcised with a shared knife rinsed in water between initiates and 16 % circumcised with a knife not cleaned between initiates. Contrasting practice, 88 % preferred use of medical supplies for their sons' circumcisions. Willingness to provide MMC to sons was 28 %; however, provided the contingency of traditional leadership support for MMC, this rose to 84 %. Future interventions to address circumcision safety, including traditional circumciser training and expansion of access to MMC, are discussed.Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls
AbstractRicks, J. N., Swartzendruber, A. L., Sales, J. M., Boyce, L. S., DiClemente, R., & Rose, E. (n.d.).Publication year
2015Journal title
Sexual HealthVolume
12Issue
4Page(s)
364-368AbstractBackground The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. Methods: Ninety-five detained African-American girls (aged 13-17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n≤51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. Results: EPT was offered 69 times, accepted by 70% (n≤37) girls and provided to 68% (n≤36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR≤3.2, 95% CI: 1.0,-10.1, P≤0.048) and≥4 lifetime sex partners (OR≤3.3, 95% CI: 1.0-11.0, P≤0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. Conclusions: Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.Accounting for failures may improve precision : Evidence supporting improved validity of self-reported condom use
AbstractCrosby, R., Salazar, L. F., DiClemente, R., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).Publication year
2005Journal title
Sexually Transmitted DiseasesVolume
32Issue
8Page(s)
513-515AbstractObjectives: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. Methods: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. Results: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. Conclusion: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.Activity of African-American female teenagers in black organisations is associated with STD/HIV protective behaviours : A prospective analysis
AbstractDiClemente, R., Crosby, R. A., DiClemente, R. J., Wingood, G. M., Harrington, K., Davies, S., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Epidemiology and Community HealthVolume
56Issue
7Page(s)
549-550Abstract~Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States : An application of the ADAPT-ITT framework
AbstractSullivan, P. S., Stephenson, R., Grazter, B., Wingood, G., DiClemente, R., Allen, S., Hoff, C., Salazar, L., Scales, L., Montgomery, J., Schwartz, A., Barnes, J., & Grabbe, K. (n.d.).Publication year
2014Journal title
SpringerPlusVolume
3Issue
1Page(s)
1-13AbstractTo respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male-female couples in the United States.Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes : an acceptability and feasibility study
AbstractPekmezaris, R., Williams, M. S., Pascarelli, B., Finuf, K. D., Harris, Y. T., Myers, A. K., Taylor, T., Kline, M., Patel, V. H., Murray, L. M., McFarlane, S. I., Pappas, K., Lesser, M. L., Makaryus, A. N., Martinez, S., Kozikowski, A., Polo, J., Guzman, J., Zeltser, R., … Granville, D. (n.d.).Publication year
2020Journal title
BMC Medical Informatics and Decision MakingVolume
20Issue
1AbstractBackground: Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes. Methods: A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides. Results: Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors “who look like me”); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse. Conclusions: These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes. Trial registration: NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1Added benefits : reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention
AbstractBrown, J. L., Sales, J. M., Swartzendruber, A. L., Eriksen, M. D., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2014Journal title
Journal of Behavioral MedicineVolume
37Issue
5Page(s)
912-920AbstractAdolescents experience elevated depressive symptoms which health promotion interventions may reduce. This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Adolescents (N = 701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Participants reported a 2.7 % decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6 % decrease in depressive symptoms (p = 0.058). Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents’ mental health needs.Adjudication history and African American adolescents' risk for acquiring sexually transmitted diseases : An exploratory analysis
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Levine, D. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
8Page(s)
634-638AbstractBackground: Little is known about sexually transmitted disease (STD) risk behavior among adjudicated African American adolescents. Goal: The goal of the study was to compare STD-associated risk profiles of African American adolescents reporting a history of adjudication and those not reporting adjudication. Study Design: A cross-sectional survey of 304 African American adolescent males and females (aged 15-21 years) was conducted. Adolescents were recruited from primary care clinics and through outreach activities. Results: Twenty-six percent of the adolescents reported adjudication. After adjusting for gender, adjudicated adolescents were about 3.6 and 4.5 times, respectively, more likely than nonadjudicated adolescents to report ever having one of three STDs (gonorrhea, chlamydia, and trichomoniasis) or to report having one of these in the past 90 days. Reporting recent sex with someone known or suspected of having an STD was about nine times more likely among adjudicated adolescents, and they were about 2.6 times more likely than their nonadjudicated counterparts to report using drugs or alcohol during their last sexual experience and 2.2 times more likely to report frequent sex in the past 90 days. Conclusions: African American adolescents with a history of adjudication may have greater risk for acquisition of STDs than their peers not reporting adjudication.Adolescent attitudes toward influenza vaccination and vaccine uptake in a school-based influenza vaccination intervention : A mediation analysis
AbstractPainter, J. E., Sales, J. M., Pazol, K., Wingood, G. M., Windle, M., Orenstein, W. A., & DiClemente, R. (n.d.).Publication year
2011Journal title
Journal of School HealthVolume
81Issue
6Page(s)
304-312AbstractBACKGROUND: School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake. METHODS: Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N = 337). Data were collected from surveys distributed to adolescents at pre- and post-intervention time points and from documents indicating vaccine uptake. Guided by the Health Belief Model and the Integrated Behavioral Model, surveys assessed demographic, behavioral, and psychosocial variables. A mediation analysis was used to test whether changes in psychosocial variables from baseline to follow-up mediated the relationship between study condition and influenza vaccine uptake. RESULTS: Controlling for background variables, step 1 of the mediation analysis revealed a significant relationship between study condition and vaccine uptake (odds ratio = 1.77, p = .038). Step 2 of the mediation analysis revealed a significant relationship between study condition and changes in psychosocial variables from baseline to follow-up. Steps 3 and 4 of the mediation analysis revealed that there was full mediation of the relationship between study condition and receipt of an influenza vaccination by intention to receive an influenza vaccination. CONCLUSION: Findings suggest that the success of our school-based influenza vaccination intervention in increasing vaccine uptake was mediated by adolescents' intention to receive an influenza vaccination. Future influenza vaccination efforts geared toward rural adolescents may benefit from addressing adolescent attitudes toward influenza vaccination, particularly increasing intention to receive a vaccine.Adolescents' ambivalence about becoming pregnant predicts infrequent contraceptive use : A prospective analysis of nonpregnant African American females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Davies, S. L., & Harrington, K. (n.d.).Publication year
2002Journal title
American Journal of Obstetrics and GynecologyVolume
186Issue
2Page(s)
251-252AbstractThis study prospectively investigated the hypothesis that ambivalence about becoming pregnant is associated with comparatively less frequent use of contraception. Findings from a sample of sexually active African American adolescent, nonpregnant females (n = 375) supported this hypothesis. Prevention programs may benefit from content designed to redress adolescents' positive beliefs about early parenthood.Adolescents and AIDS : A survey of knowledge, attitudes and beliefs about AIDS in San Francisco
AbstractDiClemente, R., DiClemente, R. J., Zorn, J., & Temoshok, L. (n.d.).Publication year
1986Journal title
American journal of public healthVolume
76Issue
12Page(s)
1443-1445AbstractTo assess adolescents' knowledge, attitudes, and beliefs about AIDS in San Francisco, data were obtained from 1,326 adolescents. There was marked variability in knowledge across informational items, particularly about the precautionary measures to be taken during sexual intercourse which may reduce the risk of infection. We conclude that development and implementation of school health education programs on AIDS and other sexually transmitted diseases are needed in this population.Adolescents and HIV : Theory-based approaches to education of nurses
AbstractStewart, K. E., DiClemente, R., & Ross, D. (n.d.).Publication year
1999Journal title
Journal of Advanced NursingVolume
30Issue
3Page(s)
687-696AbstractHIV infection is increasingly prevalent in adolescents, and primary prevention programmes have been most effective when based on existing theories, including social cognitive theory (SCT). Nurses play an important role in assessing adolescents' risk for HIV infection and in recommending preventive behaviour change, if their comfort with these activities is increased. Practising nurses (n = 88, mean age = 40-8) from a university medical centre and surrounding hospitals participated in either a didactic or SCT-based workshop and a vignette-based assessment. Utilizing a randomized controlled design, this study compared the effectiveness of the two types of workshops by measuring HIV-related knowledge and attitudes, as well as comfort with and intent to perform HIV-related risk assessments. Differences in comfort and intent based on target patients' cultural descriptors were also evaluated. The SCT-based workshops yielded more positive results for all four outcome variables at the 8-week follow-up (F2,71 = 4.27, P < 0.02). Cultural stereotyping also appeared to play a role in nurses' intent to perform assessments (F2,74 = 11.81, P < 0-001). Suggestions for improving the workshops and incorporating other theory-based approaches are discussed.Adolescents' attitudes toward vaccinations : A systematic review
AbstractPainter, J. E., Gargano, L. M., Sales, J. M., Perez, A. J., Wingood, G. M., Windle, M., & DiClemente, R. (n.d.).Publication year
2010Journal title
Current Pediatric ReviewsVolume
6Issue
4Page(s)
237-249AbstractAdolescent immunization coverage remains sub-optimal. Although parental consent is required for most vaccinations, adolescents' own attitudes may impact vaccine uptake. The current study sought to review the literature regarding adolescents' attitudes toward vaccination to inform efforts toward increasing vaccination rates. Two researchers searched five databases for literature published in English from 1999-2009, and coded included articles for demographics, methodological information, type of attitudes assessed, and significant associations. Of 1,348 titles and abstracts screened, 28 studies met inclusion criteria. Most studies assessed attitudes toward HPV or other STI vaccines. No studies assessed attitudes towards influenza vaccination. Most studies were cross-sectional, and many analyzed adolescent data combined with young adult data. Existing research suggests that perceived risk of disease, benefits and barriers to vaccination, and normative beliefs may be salient factors in adolescents' vaccine acceptance. Future research should expand the evidencebase regarding adolescents' attitudes toward all recommended vaccines, particularly non-STI vaccines.Adolescents' experience with sex on the web : Results from online focus groups
AbstractCameron, K. A., Salazar, L. F., Bernhardt, J. M., Burgess-Whitman, N., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2005Journal title
Journal of AdolescenceVolume
28Issue
4Page(s)
535-540AbstractTo discover adolescent Internet users' experiences with, exposure to, and perceptions of sexually oriented websites (SOW) and sexually explicit websites (SEW), four web-based focus groups (N = 40) were conducted. Participants (ages 14-17) reported high levels of exposure to SEW and SOW, which was intentional for some and unsolicited for others. Female adolescents found SEW to be socially distasteful; some adolescent males avoided SEW while others were willing consumers. Participants believed exposure to SEW had no influence on them, and reported that their parents were unaware of what they view online. Future research should explore the effects of exposure to SEW and to SOW and mediating factors.Adolescents with psychiatric disorders and the risk of HIV
AbstractBrown, L. K., Danovsky, M. B., Lourie, K. J., DiClemente, R., & Ponton, L. E. (n.d.).Publication year
1997Journal title
Journal of the American Academy of Child and Adolescent PsychiatryVolume
36Issue
11Page(s)
1609-1617AbstractObjective: To review literature relevant to human immunodeficiency virus (HIV)-associated risk behaviors among adolescents with psychiatric disorders and psychological influences on risk behaviors. Method: This report is based on review of 66 articles, which comprise all of the relevant literature in the English language. Results: Although the sero-prevalence of HIV in adolescents with psychiatric disorders is unknown, studies indicate that adolescents with psychiatric disorders are at greater risk than their peers because of increased rates of unsafe sexual practices, impulsivity, self- destructive attitudes, cognitive immaturity, high rates of substance use, self-cutting behavior, and the sequelae of sexual abuse. Conclusion: Directions are proposed for the design of developmentally appropriate, clinically oriented HIV prevention interventions based on the relationships between psychological dysfunction, social stressors, and HIV risk behaviors.Adoption and implementation of a computer-delivered HIV/STD risk-reduction intervention for African American adolescent females seeking services at county health departments : Implementation optimization is urgently needed
AbstractDiClemente, R., Bradley, E., Davis, T. L., Brown, J. L., Ukuku, M., Sales, J. M., Rose, E. S., & Wingood, G. M. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S66-S71AbstractAlthough group-delivered HIV/sexually transmitted disease (STD) risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across 8 participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding, and surmounting barriers that hamper timely and efficient implementation of technology- delivered HIV/STD risk-reduction interventions in county public health clinics.Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters
AbstractWingood, G. M., DiClemente, R., & Raj, A. (n.d.).Publication year
2000Journal title
American journal of preventive medicineVolume
19Issue
4Page(s)
270-275AbstractObjective: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. Methods: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. Results: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. Conclusions: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment. (C) American Journal of Preventive Medicine.Adverse factors associated with forced sex among southern adolescent girls
AbstractDiClemente, R., Nagy, S., DiClemente, R., & Adcock, A. G. (n.d.).Publication year
1995Journal title
PediatricsVolume
96Issue
5 IPage(s)
944-946AbstractObjective. To identify adverse behavioral and psychological factors associated with forced sex experiences of adolescent girls compared with their sexually active counterparts. Method. An anonymous self-report survey examining an array of psychosocial items, to which 3124 grade 8 and grade 10 female students responded. Results. Sexually abused girls were more likely to have been pregnant, to have initiated sexual intercourse at a younger age, to indicate illegal drug use, to have feelings of depression, to express more frequent suicidal ideation, and to have been physically abused. Conclusions. Behaviors such as gateway drug use, truancy, binge drinking of alcohol, and participation in violent episodes that were previously identified as indicators of sexual abuse did not distinguish between sexually active adolescents and those who had been sexually abused. Physicians should consider carefully a structured series of questions relating to behaviors as one approach in determining the risk of sexual abuse. Positive responses to young sexual initiation, pregnancy, illegal drug use, negative mental health states, and evidence of physical abuse are potential markers of sexual abuse in adolescent female clients.Adverse health consequences that co-occur with depression : A longitudinal study of black adolescent females
AbstractDiClemente, R., Wingood, G. M., Lang, D. L., Crosby, R. A., Salazar, L. F., Harrington, K., & Hertzberg, V. S. (n.d.).Publication year
2005Journal title
PediatricsVolume
116Issue
1Page(s)
78-81AbstractObjective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.African American adolescents and new media : Associations with HIV/STI risk behavior and psychosocial variables
AbstractWhiteley, L. B., Brown, L. K., Swenson, R. R., Romer, D., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., & Valois, R. F. (n.d.).Publication year
2011Journal title
Ethnicity and DiseaseVolume
21Issue
2Page(s)
216-222AbstractObjectives: Cell phones and online media are used frequently but we know little about their use among African American adolescents. This study examines the frequency of such use and its relationship to psychosocial variables and STI/HIV risk behavior. Setting/Participants: 1,518 African American, aged 13-18 years, from 2 Northeast US cities (Providence, RI; Syracuse, NY) and 2 Southeast US cities (Columbia, SC; Macon, GA), were assessed from 2008-2009. Design: Participants were assessed on frequency of cell phone and Internet use, psychological constructs (ie, depression, life satisfaction, impulsivity) and HIV/STI risk behaviors (ie, history of intercourse, sexual sensation seeking attitudes, peer sexual risks norms) with reliable scales and measures using an audio computer-assisted self-interview. Results: Over 90% of African American adolescents used cell phones every day or most days and 60% used social networking sites every day or most days (96% used Myspace). Greater frequency of cell phone use was associated with sexual sensation seeking (P=.000), riskier peer sexual norms (P=.000), and impulsivity (P=.016). Greater frequency of Internet use was associated with a history of oral/vaginal/anal sex (OR=1.03, CI=1.0-1.05) and sexual sensation seeking (P=.000). Conclusion: These findings suggest that riskier youth are online and using cell phones frequently. The Internet and cell phones may be useful platforms for targeted health promotion and prevention efforts with AA adolescents.