Ralph DiClemente
Ralph DiClemente
Scroll
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:
- 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.
-
Education
-
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
-
Areas of research and study
-
Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
-
Publications
Publications
Predictors of consistent condom use among young African American Women
AbstractCrosby, R. A., DiClemente, R., Salazar, L. F., Wingood, G. M., McDermott-Sales, J., Young, A. M., & Rose, E. (n.d.).Publication year
2013Journal title
AIDS and BehaviorVolume
17Issue
3Page(s)
865-871AbstractThe purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.Predictors of repeat chlamydia trachomatis and/or neisseria gonorrhoeae infections among african-american adolescent women
AbstractSwartzendruber, A., Sales, J. M., Brown, J. L., Davis, T. L., DiClemente, R., & Rose, E. (n.d.).Publication year
2013Journal title
Sexually transmitted infectionsVolume
89Issue
1Page(s)
76-82AbstractBackground Young African-American women have the highest rates of Chlamydia trachomatis and Neisseria gonorrhoeae in the USA. The objective was to identify baseline predictors of repeat chlamydia and/or gonorrhoea infections among African-American adolescent women. Methods Sociodemographic, psychosocial and behavioural data were collected at baseline and every 6 months for 2 years from 701 African-American women (14-20 years) enrolled in an HIV prevention trial. Vaginal swabs were self-collected at each visit and assayed for chlamydia and gonorrhoea using DNA amplification. Among participants testing positive for chlamydia and/or gonorrhoea at baseline, logistic regression analyses assessed baseline predictors of repeat infection. Results Of 618 (88%) participants with ≥1 follow-up assessment, 123 (20%) had a positive chlamydia and/or gonorrhoea test result at baseline; 49 (40%) had a repeat infection during the study period. Of those with a repeat infection, 30 (61%) were positive at one follow-up visit, 18 (37%) at two visits and 1 (2%) at three follow-up visits. Controlling for age and intervention condition, impulsivity (AOR: 1.71, p=0.018) was associated with an increased likelihood, and having a boyfriend (AOR: 0.21, p=0.006) was associated with a decreased likelihood of repeat infection. Conclusions Repeat chlamydia and/or gonorrhoea infections are common among African-American adolescent women. Among young African-American women who test positive for chlamydia and/or gonorrhoea, tailored interventions for more impulsive adolescents and those not in a relationship may reduce risk of repeat infections. Given the high numbers of repeat infections after receipt of an evidence-based intervention, enhanced screening and treatment services for young men may be warranted. Clinical Trials Registration http://www.clinicaltrials. gov (NCT00279799).Preventing HIV among young people : Research priorities for the future
AbstractPettifor, A., Bekker, L. G., Hosek, S., DiClemente, R., Rosenberg, M., Bull, S. S., Allison, S., Delany-Moretlwe, S., Kapogiannis, B. G., & Cowan, F. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 2Page(s)
S155-S160AbstractObjective: To review the current state of knowledge on the prevention of sexual transmission of HIV in adolescents and to highlight the existing gaps and priority areas for future research. Background: A disproportionate burden of HIV infections falls on adolescents, a developmental stage marked by unique neural, biological, and social transition. Successful interventions are critical to prevent the spread of HIV in this vulnerable population. Methods: We summarized the current state of research on HIV prevention in adolescents by providing examples of successful interventions and best practices, and highlighting current research gaps. Results: Adolescent interventions fall into 3 main categories: biomedical, behavioral, and structural. The majority of current research has focused on individual behavior change, whereas promising biomedical and structural interventions have been largely understudied in adolescents. Combination prevention interventions may be particularly valuable to this group. Conclusions: Adolescents have unique needs with respect to HIV prevention, and, thus, interventions should be designed to most effectively reach out to this population with information and services that will be relevant to them.Racial differences and correlates of potential adoption of preexposure prophylaxis : Results of a national survey
AbstractWingood, G. M., Dunkle, K., Camp, C., Patel, S., Painter, J. E., Rubtsova, A., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S95-S101AbstractObjective: To examine the association between sociodemographic factors, sexual behaviors, and social factors on potential uptake of preexposure prophylaxis (PrEP) among African American and White adult women in the United States. Methods: Participants were recruited through a nationally representative, random-digit dial telephone household survey. Participants comprised a nationally representative, random sample of unmarried African American (N = 1042) and White women (N = 411) aged 20-44 years. Interviews were conducted using computer-assisted telephone interviewing technology. Bivariate and multivariate analyses examined the relationship between sociodemographics, sexual behaviors, and social influences on women's potential uptake of PrEP. Results: In multivariate analyses, women with lower educational status, greater lifetime sexual partners, provider recommendations supportive of PrEP, and peer norms supportive of PrEP use were more likely to report potential PrEP uptake. Racial analyses revealed that compared with White women, African American women were significantly more likely to report potential use of PrEP [adjusted odds ratio (aOR) = 1.76, P ≤ 0.001], more likely to report use of PrEP if recommended by a health-care provider (aOR = 1.65, P ≤ 0.001), less likely to report that they would be embarrassed to ask a health-care provider for PrEP (aOR = 0.59, P ≤ 0.05), and more likely to report use of PrEP if their female friends also used PrEP (aOR = 2.2, P ≤ 0.001). The potential cost for PrEP was identified as a barrier to adoption by both African American and White women. Conclusions: Findings suggest that women at increased risk for HIV, including those with less education and greater number of sexual partners, may be more likely to use PrEP, although cost may serve as a barrier.Rate of decay in proportion of condom-protected sex acts among adolescents after participation in an HIV risk-reduction intervention
AbstractDiClemente, R., Brown, J. L., Sales, J. M., & Rose, E. S. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S85-S89AbstractObjective: HIV risk-reduction interventions have demonstrated efficacy in enhancing the proportion of condom-protected sex (CPS) acts among diverse populations. Although postintervention exposure increase in CPS are often observed, there is scant empirical data quantifying decay of intervention efficacy (declines in CPS after cessation of the intervention among participants reporting an initial postintervention increase in CPS). Thus, the objective of this study was to quantify the rate of decay in intervention efficacy over a 24-month follow-up. Design: African American adolescent females (ages: 14-20; n = 349) completed a baseline audio computer-assisted self-administered interview, participated in an HIV risk-reduction intervention, and were assessed at 6-month intervals for 24 months postintervention. Intervention efficacy was conceptualized as an increase in participants' CPS relative to baseline. Methods: Analyses focused on the subset of participants who reported an initial increase in CPS from baseline to the 6-month postintervention assessment (n = 121) to quantify the rate of decay in intervention efficacy over a 24-month follow-up period. Results: CPS increased markedly from baseline to 6-month followup assessment. However, from 6 to 12 months, a marked decline in CPS was observed. Further CPS declines, though not statistically significant, were observed from 12 to 18 months and 18 to 24 months. Cumulative reductions in CPS over the entire 24-month follow-up resulted in no statistical difference between baseline and 24-month follow-up; indicative of a nonsignificant intervention effect at 24-month assessment. Conclusions: Innovative postintervention optimization strategies are needed to minimize CPS decay over protracted time periods by reinforcing, sustaining, and potentially amplifying initial gains in condom use.Relational correlates of unprotected oral and vaginal sex and among African-American adolescent females
AbstractCrosby, R. A., Voisin, D. R., DiClemente, R., Wingood, G. M., Salazar, L. F., Head, S., Rose, E., & McDermott-Sales, J. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
3Page(s)
284-286AbstractObjectivesTo identify relational correlates of unprotected oral sex (UOS) and vaginal intercourse (UVI) among African-American females. Methods: Participants (n≤715) provided data on demographics, sexual communication self efficacy (SCSE), sexual communication frequency, condom self-efficacy, power in sexual relationships, fear of negotiating condom use, UOS and UVI. Results: Participants reporting low SCSE were 2.5 and 1.6 times more likely to report UOS and UVI respectively. Additionally, participants who reported fear of condom negotiation were 3.1 times more likely to report UVI. Conclusions: Interventions promoting stronger SCSE may be a protective factor against having UOS and UVI among African-American females.Reliability and Validity of the Dyadic Observed Communication Scale (DOCS)
AbstractHadley, W., Stewart, A., Hunter, H. L., Affleck, K., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2013Journal title
Journal of Child and Family StudiesVolume
22Issue
2Page(s)
279-287AbstractWe evaluated the reliability and validity of the Dyadic Observed Communication Scale (DOCS) coding scheme, which was developed to capture a range of communication components between parents and adolescents. Adolescents and their caregivers were recruited from mental health facilities for participation in a large, multi-site family-based HIV prevention intervention study. Seventy-one dyads were randomly selected from the larger study sample and coded using the DOCS at baseline. Preliminary validity and reliability of the DOCS was examined using various methods, such as comparing results to self-report measures and examining interrater reliability. Results suggest that the DOCS is a reliable and valid measure of observed communication among parent-adolescent dyads that captures both verbal and nonverbal communication behaviors that are typical intervention targets. The DOCS is a viable coding scheme for use by researchers and clinicians examining parent-adolescent communication. Coders can be trained to reliably capture individual and dyadic components of communication for parents and adolescents and this complex information can be obtained relatively quickly.Safer sex media messages and adolescent sexual behavior : 3-year follow-up results from project iMPPACS
AbstractHennessy, M., Romer, D., Valois, R. F., Vanable, P., Carey, M. P., Stanton, B., Brown, L., Ralph DiClemente, D., Salazar, L. F., & DiClemente, R. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
1Page(s)
134-140AbstractObjectives. We estimated the long-term (36-month) effects of Project iMPPACS, a multisite randomized controlled trial of mass media and smallgroup intervention for African American adolescents. Methods. We collected 6 waves of longitudinal data on program participants aged 14 to 17 years (n = 1139) in Providence, Rhode Island; Syracuse, New York; Columbia, South Carolina; and Macon, Georgia, 36 months (December 2009- December 2010) after the intervention began (August 2006-January 2008). Seemingly unrelated regressions at each wave estimated the effects of 3 types of mass media messages (the thematic mediators: selection, pleasure, and negotiation) on condom use intention and self-reported unprotected vaginal sex events. Results. All 3 mediators of behavior change that were introduced during the media intervention were sustained at the follow-up assessments at least 18 months after the intervention ended, with intention having the largest correlation. Unprotected vaginal sex increased with each wave of the study, although cities receiving media exposure had smaller increases. Conclusions. Project iMPPACS demonstrates that mass media influence delivered over an extended period, when adolescents were beginning to learn patterns of behavior associated with sex, persisted after the media program ended.Sexual concurrency among young African American women
AbstractWaldrop-Valverde, D. G., Davis, T. L., Sales, J. M., Rose, E. S., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2013Journal title
Psychology, Health and MedicineVolume
18Issue
6Page(s)
676-686AbstractYoung African-American women are disproportionately affected by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) sexually transmitted infections (STI), and engage in greater sexual concurrency than other race/ethnicities. It is important to evaluate behaviors and characteristics associated with the risk of sexual concurrency, so that interventions can target factors most likely to affect positive change. An emphasis on correlates of concurrency beyond individual-level factors has been suggested. The purpose of this study, therefore, was to identify individual-and partner-level characteristics associated with sexual concurrency among high-risk, young African-American women. Data were collected from 570 African-American adolescent women (aged 15-21) recruited from a STI clinic, a family planning clinic, and a teen clinic located in Atlanta, GA from March 2002 through August 2004. Logistic regression analysis was conducted in 2012 to evaluate correlates of sexual concurrency. Results show that almost one-quarter of participants reported sexually concurrent partnerships and 28.4% suspected male partner concurrency. Logistic regression results indicated the number of lifetime sexual partners and relationship factors were the primary contributors to engaging in concurrency in this sample. These findings suggest relationship factors may be important contributors to the prevalence of sexual concurrency among young African-American women. Interventions targeted toward sexual health among young African-American women may need to specifically address partner/relationship factors. Through these findings, we hope to better understand sexual risk taking and develop strategies that would overcome barriers to existing interventions aimed at improving the sexual health outcomes of young African-American women.State of the evidence : Intimate partner violence and HIV/STI risk among adolescents
AbstractSeth, P., Di Clemente, R. J., Lovvorn, A. E., & DiClemente, R. (n.d.).Publication year
2013Journal title
Current HIV ResearchVolume
11Issue
7Page(s)
528-535AbstractThis paper provides a critical narrative review of the scientific literature on intimate partner violence (IPV) and risky sexual behavior as well as sexually transmitted infections (STIs) among adolescents, aged 14-24 years. Intimate partner violence has been associated with a number of high risk sexual behavior, including inconsistent condom use, multiple sexual partners, earlier sexual debut, consuming substances while engaging in sexual behavior, and sexually transmitted infections among adolescents. An electronic search of the literature was performed using PubMed/MEDLINE, PsycINFO, and Web of Science and articles from January 2000 - June 2013 were reviewed. Search terms included a combination of keywords for IPV, HIV/STI risk, and adolescents. The findings from the review indicated that IPV was associated with inconsistent condom use, STIs, early sexual debut, multiple sexual partners, and other HIV/STI-associated risk factors among adolescents. HIV/STI interventions for female adolescents often focus on increasing behavioral and cognitive skills, specifically condom negotiation. However, within the context of an abusive relationship, it becomes challenging for adolescents to enact these skills, where this behavior could potentially place them at greater risk. Components that address violence are necessary within HIV prevention programming. Additionally, integration of IPV screening within healthcare settings is important along with a combined approach that merges resources from healthcare, social, and community-level settings.Targeting STD/HIV prevention interventions for heterosexual male adolescents in North and Central America : A review
AbstractLomotey, M., Brown, J. L., & DiClemente, R. (n.d.).Publication year
2013Journal title
Current Pediatric ReviewsVolume
9Issue
4Page(s)
376-382AbstractBackground: Adolescents experience elevated rates of STDs and HIV. STD/HIV prevention interventions for young men are crucial to decrease their STD/HIV rates and reduce disease transmission to female partners. To advance sexual health promotion interventions for young men, this paper reviewed the efficacy of STD/HIV prevention interventions conducted in North and Central America in the past 20 years. Method: PubMed, Google Scholar, and EBSCO Host databases were used to locate STD/HIV interventions. Eligible interventions were limited to STD/HIV interventions for young men between the ages of 10 and 18. We review 8 STD/HIV prevention interventions targeting heterosexual adolescent males and summarize key intervention components and content, overview intervention efficacy outcome data, and provide directions for future research. Results: The majority of interventions were guided by health behavior change theory. Interventions employed interactive group-based education and behavioral skills training to reduce risky sexual behaviors. All interventions used a randomized controlled trial design with a comparison or control group. Follow-up times varied markedly, ranging from 3 weeks to 36 months. All but one intervention improved at least one behavioral outcome (e.g., increased frequency of condom use). Conclusions: Findings suggest that male adolescent interventions can effectively curtail the STD/HIV epidemic. Major weaknesses of the reviewed studies include the reliance on self-report behavioral measures, lack of biological endpoints, and short follow-ups. Study strengths include use of randomized control trial design and theory-based content. Future research should increase the dissemination of effective sexual risk reduction interventions to decrease STD/HIV among adolescent males and their female partners.The concrete jungle : City stress and substance abuse among young adult African American men
AbstractSeth, P., Murray, C. C., Braxton, N. D., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
2Page(s)
307-313AbstractSubstance use is prevalent among African American men living in urban communities. The impact of substance use on the social, psychological, and physical health of African American men has important public health implications for families, communities, and society. Given the adverse consequences of alcohol and drug abuse within communities of color, this study evaluated the relationship between city stress, alcohol consumption, and drug use among African American men. Eighty heterosexual, African American men, 18 to 29 years old, completed psychosocial risk assessments that assessed substance use and city stress. Multiple logistic regression analyses, controlling for age, indicated that participants reporting high levels of urban stress, relative to low levels of urban stress, were more likely to report a history of marijuana use (AOR = 5.19, p =.05), history of ecstasy and/or GHB use (AOR = 3.34, p =.04), having family/friends expressing strong concerns about their illicit drug use (AOR = 4.06, p =.02), and being unable to remember what happened the night before due to drinking (AOR = 4.98, p =.01). African American men living within the confines of a stressful urban environment are at increased risk for exposure to and utilization of illicit substances. Culturally competent public health interventions for substance use/abuse should address psychological factors, such as stress and neighborhood violence.The relationship between ethnic identity and Chlamydia and Gonorrhea infections among low-income detained African American adolescent females
AbstractVoisin, D. R., Salazar, L. F., Crosby, R., & DiClemente, R. (n.d.).Publication year
2013Journal title
Psychology, Health and MedicineVolume
18Issue
3Page(s)
355-362AbstractThis study explored the relationship between ethnic identity and Chlamydia and Gonorrhea infections among detained African American female adolescents. A cross-sectional survey was conducted among 123 African American female adolescents within eight detention facilities in Georgia. Using audio-computer assisted self-interviewing technology, data were collected on demographics, ethnic identity, laboratory-confirmed Chlamydia and Gonorrhea, and other known correlates for sexually transmitted infections (STIs), such as socioeconomic status, parental monitoring, and risky sexual behaviors. Rates of Chlamydia and Gonorrhea testing yielded incidence rates of 22.6% and 4.3%, respectively. Findings indicated that, controlling for STI correlates, participants who indicated high ethnic identity were 4.3 times more likely to test positive for an STI compared to those scoring low on the measure of ethnic identity.The social and behavioral sciences research network : Translational research to reduce disparities in HIV
AbstractBlank, M. B., Metzger, D. S., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S1-S3Abstract~Turning the Corner on the HIV Epidemic Among Adolescents : Prioritizing Directions for Future Prevention Research
AbstractDiClemente, R. (n.d.).Publication year
2013Journal title
Journal of HIV/AIDS and Social ServicesVolume
12Issue
3-4Page(s)
258-265Abstract~Understanding reasons for participating in a school-based influenza vaccination program and decision-making dynamics among adolescents and parents
AbstractHerbert, N. L., Gargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2013Journal title
Health Education ResearchVolume
28Issue
4Page(s)
663-672AbstractInfluenza remains a significant cause of morbidity and mortality in the United States. Vaccinating school-aged children has been demonstrated to be beneficial to the child and in reducing viral transmission to vulnerable groups such as the elderly. This qualitative study sought to identify reasons parents and students participated in a school-based influenza vaccination clinic and to characterize the decision- making process for vaccination. Eight focus groups were conducted with parents and students. Parents and students who participated in the influenza vaccination clinic stated the educational brochure mailed to their home influenced participation in the program. Parents of non-participating students mentioned barriers, such as the lengthy and complicated consent process and suspicions about the vaccine clinic, as contributing to their decision not to vaccinate their child. Vaccinated students reported initiating influenza vaccine discussion with their parents. Parental attitudes and the educational material influenced parents' decision to allow their child to receive influenza vaccine. This novel study explored reasons for participating in a school-based vaccination clinic and the decision-making process between parents and child(ren). Persons running future school-based vaccination clinics may consider hosting an 'information session with a question and answer session' to address parental concerns and assist with the consent process.What girls won't do for love : Human immunodeficiency virus/sexually transmitted infections risk among young african-american women driven by a relationship imperative
AbstractRaiford, J. L., Seth, P., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Adolescent HealthVolume
52Issue
5Page(s)
566-571AbstractPurpose: Rates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors. Methods: Participants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing. Results: Multivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive. Conclusion: These results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk.Young adult women and correlates of potential adoption of pre-exposure prophylaxis (PrEP) : Results of a national survey
AbstractRubtsov, A., Wingood, G. M., Dunkle, K., Camp, C., & DiClemente, R. (n.d.).Publication year
2013Journal title
Current HIV ResearchVolume
11Issue
7Page(s)
543-548AbstractWe examine potential use of pre-exposure prophylaxis (PrEP) among young adult women, based on nationally representative random-digit dial telephone household survey of 1,453 US African-American and white women. The hypotheses were generated based on Health Belief Model. Our analyses showed that, as compared to women of 30-45 years old, young women of 20-29 years old experienced stronger social influences on PrEP uptake. However, as compared to older women, young women did not report higher potential PrEP uptake or adherence, despite their greater risk of HIV. For PrEP to be an effective method of prevention for young adult women, interventions are needed to increase HIV risk awareness.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.African american adolescents meeting sex partners online : Closing the digital research divide in STI/HIV prevention
AbstractWhiteley, L. B., Brown, L. K., Swenson, R. R., Valois, R. F., Vanable, P. A., Carey, M. P., Di Clemente, R., Salazar, L. F., Romer, D., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Primary PreventionVolume
33Issue
1Page(s)
13-18AbstractMinority adolescents are affected disproportionately by HIV and STIs, and the Internet is a popular venue to meet sex partners. Little is known about the risks of this behavior for minority adolescents. The majority of studies that have examined sexual risk behavior online or STI/HIV prevention programs online have been among adult MSM. In this study, data from 1,045 African American youth found that 6% met sex partners online and in chat rooms. Odds ratios, adjusting for gender, found this behavior was associated with alcohol (AOR = 2.33, 95% CI [1.1, 4.7]) and drug use (AOR = 3.45, 95% CI [1.9, 6.1]), unprotected vaginal (AOR = 4.71, 95% CI [1.9, 8.4]) and anal sex (AOR = 4.77, 95% CI [1.3,17.1]) in the last 90 days, more lifetime vaginal (AOR = 3.65, 95% CI [2.0, 6.8]) and anal sex (AOR = 2.74, 95% CI [1.5, 4.8]), greater sexual sensation seeking (AOR = 2.92, 95% CI [1.5, 5.7]) and greater depression (AOR = 2.06, 95% CI [1.2, 3.6]. A final multiple logistic regression analyses found that male gender (AOR = 3.13, 95% CI [1.7, 5.8]), drug use at last sex (AOR = 2.41, 95% CI [1.3, 4.5]), lifetime history of vaginal (AOR = 2.90, 95% CI [1.5, 5.5]) and anal sex (AOR = 2.09, 95% CI [1.2, 3.6]), and cocaine use (AOR = 8.53, 95% CI [2.7, 27.3]) were independently associated with having sex with a partner met online. Meeting sex partners online is associated with a variety of risks among African American youth; however, the Internet may be an opportunity for intervention.Age differences in STDs, sexual behaviors, and correlates of risky sex among sexually experienced adolescent African-American females
AbstractSales, J. M., Brown, J. L., DiClemente, R., Davis, T. L., Kottke, M. J., & Rose, E. S. (n.d.).Publication year
2012Journal title
Journal of pediatric psychologyVolume
37Issue
1Page(s)
33-42AbstractObjective To explore age differences in factors associated with positive sexually transmitted diseases (STD) status among a sample of African-American adolescent females. Methods Data were collected via ACASI from 701 African-American adolescent females (14-20 years) seeking services at reproductive health clinics. Adolescents provided self-collected vaginal swabs assayed using NAAT to assess the prevalence of three STDs. Results Younger adolescents (14-17 years) had significantly higher rates of STDs than older adolescents (18-20 years), but older adolescents had significantly higher levels of STD-associated risk behavior. In controlled analysis, having a casual sex partner was the only variable significantly associated with a positive STD test for younger adolescents, and prior history of STD and higher impulsivity were significantly associated with testing STD positive among older adolescents. Conclusions These findings suggest that developmentally tailored STD/HIV prevention interventions are needed for younger and older subgroups of adolescent females to help reduce their risk of infection.Blocking the benefit of group-based HIV-prevention efforts during adolescence : The problem of HIV-related stigma
AbstractBarker, D. H., Swenson, R. R., Brown, L. K., Stanton, B. F., Vanable, P. A., Carey, M. P., Valois, R. F., DiClemente, R., Salazar, L. F., & Romer, D. (n.d.).Publication year
2012Journal title
AIDS and BehaviorVolume
16Issue
3Page(s)
571-577AbstractHIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.Build it and they will come. or will they? Overcoming barriers to optimizing delivery of seasonal influenza vaccine to US adolescents
AbstractDiClemente, R., Painter, J. E., Sales, J. M., & Gargano, L. M. (n.d.).Publication year
2012Journal title
Expert Review of VaccinesVolume
11Issue
4Page(s)
387-389Abstract~Cash, cars, and condoms : Economic factors in disadvantaged adolescent women's condom use
AbstractRosenbaum, J., Zenilman, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
51Issue
3Page(s)
233-241AbstractEvaluate whether adolescent women who received economic benefits from their boyfriends were more likely never to use condoms. Data are obtained from a longitudinal HIV prevention intervention study with 715 African American adolescent women in urban Atlanta surveyed at baseline, 6 months, and 12 months. The primary outcome was never using condoms in the past 14 and 60 days at 6 and 12 months. The primary predictor was having a boyfriend as primary spending money source at baseline. Analysis minimized confounding using propensity weighting to balance respondents on 81 variables. A boyfriend was the primary spending money source for 24% of respondents, who did not differ in neighborhood or family context but had lower education, more abuse history, riskier sex, and more sexually transmitted infections. After propensity score weighting, no statistically significant differences for 81 evaluated covariates remained, including age distributions. Women whose boyfriend was their primary spending money source were 50% more likely never to use condoms at 6 and 12 months and less likely to respond to the intervention at 12 months. Women whose boyfriend had been their primary spending money source but found another spending money source were more likely to start using condoms than women who continued. Women whose boyfriends owned cars were more likely never to use condoms. Receiving spending money from a boyfriend is common among adolescent women in populations targeted by pregnancy and sexually transmitted infection prevention interventions, and may undermine interventions' effectiveness. Clinicians and reproductive health interventions need to address females' economic circumstances.Characteristics of African American adolescent females who perceive their current boyfriends have concurrent sexual partners
AbstractBrown, J. L., Sales, J. M., DiClemente, R., Latham Davis, T. P., & Rose, E. S. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
50Issue
4Page(s)
377-382AbstractPurpose: Perceived partner concurrency, reporting that a current sexual partner has other sexual partners, may pose sexual health risks to adolescents. We examined the contextual characteristics of African American female adolescents who reported their current boyfriend was having concurrent sexual relationships. Methods: Participants were African American adolescent females (N = 511; mean age = 17.6) recruited from sexual health clinics. Before participating in an STD/HIV prevention trial, the participants completed audio computer-assisted self-interviews with measures of perceived partner concurrency and individual- (e.g., depression, substance use), interpersonal- (e.g., social support, interpersonal stress), and community-level factors (i.e., neighborhood quality). Results: Twenty-seven percent of participants reported their belief that their current boyfriend had concurrent sexual partners during their relationship. In a logistic regression analysis, participants endorsing perceived partner concurrency reported less relational power (adjusted odds ratio [AOR] =.94, 95% confidence interval [CI] =.89.98, p