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
Family-centered program deters substance use, conduct problems, and depressive symptoms in black adolescents
AbstractBrody, G. H., Chen, Y. F., Kogan, S. M., Yu, T., Molgaard, V. K., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2012Journal title
PediatricsVolume
129Issue
1Page(s)
108-115AbstractOBJECTIVES: The present research addressed the following important question in pediatricmedicine: Can participation in a new family-centered preventive intervention, the Strong African American Families-Teen (SAAF-T) program, deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents across 22 months? METHODS: Data were collected from 502 black families in rural Georgia, assigned randomly to SAAF-T or an attention control condition. The prevention condition consisted of 5 consecutive meetings at community facilities with separate, concurrent sessions for caregivers and adolescents followed by a caregiver-adolescent session in which families practiced skills they learned in the separate sessions. Adolescents self-reported conduct problem behaviors, substance use, substance use problems, and depressive symptoms at ages 16 years (pretest) and 17 years 10 months (long-term assessment). RESULTS: Adolescents who participated in SAAF-T evinced lower increases in conduct problem behavior, substance use, substance use problems, and depressive symptom frequencies than did adolescents in the attention control condition across the 22 months between pretest and long-term assessment. CONCLUSIONS: This is the first study to demonstrate efficacy in a prevention program designed to deter conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents. Because SAAF-T is a manualized, structured program, it can be easily disseminated to public health agencies, schools, churches, boys' and girls' clubs, and other community organizations.Gender differences in sexual risk behaviours and sexually transmissible infections among adolescents in mental health treatment
AbstractSeth, P., Lang, D. L., DiClemente, R., Braxton, N. D., Crosby, R. A., Brown, L. K., Hadley, W., & Donenberg, G. R. (n.d.).Publication year
2012Journal title
Sexual HealthVolume
9Issue
3Page(s)
240-246AbstractBackground Adolescents with a history of psychiatric disorder(s) are particularly vulnerable to contracting sexually transmissible infections (STIs) as a result of psychological and emotional states associated with higher rates of risky sexual behaviour. The present study examined gender differences in sexual risk behaviours and STI among adolescents in mental health treatment. Methods: Three hundred and seventy nine sexually active adolescents, aged 1318 years, from a larger multisite study, who received mental health treatment during the past year, completed an audio computer-assisted self interview assessing sociodemographics, psychiatric symptomatology and HIV/STI risk behaviours, and provided urine specimens tested for STI. Results: After controlling for covariates, multivariate logistic regression models indicated that female adolescents were more likely to have had an HIV test (adjusted odds ratio (AOR)≤3.2, P≤0.0001), obtain their HIV test results (AOR≤2.9, P≤0.03), refuse sex out of fear for STI acquisition (AOR≤1.7, P≤0.04), or avoid a situation that might lead to sex (AOR≤2.4, P≤0.001), and were less likely to have a casual sex partner (AOR≤0.40, P≤0.002). Additionally, females were more likely to report inconsistent condom use (AOR≤2.60, P≤0.001) and have a STI (AOR≤9.1, P≤0.0001) than their male counterparts. Conclusions: Female adolescents receiving mental health treatment were more than nine times as likely to have an STI and more likely to use condoms inconsistently. The standard of care for mental health practice for adolescents should include referrals for STI screening and treatment as well as assessment and discussion of risky sexual behaviours as part of the treatment plan when indicated. Effective programs should address gender-specific communication and behavioural skills.Human papillomavirus vaccine intention among college men : What's oral sex got to do with it?
AbstractCrosby, R. A., DiClemente, R., Salazar, L. F., Nash, R., Younge, S., & Head, S. (n.d.).Publication year
2012Journal title
Journal of American College HealthVolume
60Issue
1Page(s)
8-12AbstractObjective: To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance. Methods: Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview. Results: With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors. Conclusion: Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.Incentivizing drug-using women's long-term contraceptive use : Some answers, more questions
AbstractDiClemente, R., & Young, A. (n.d.).Publication year
2012Journal title
AddictionVolume
107Issue
6Page(s)
1042-1043Abstract~Integrating condom skills into family-centered prevention : Efficacy of the strong african american families-teen program
AbstractKogan, S. M., Yu, T., Brody, G. H., Chen, Y. F., DiClemente, R., Wingood, G. M., & Corso, P. S. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
51Issue
2Page(s)
164-170AbstractPurpose: The Strong African American Families-Teen (SAAF-T) program, a family-centered preventive intervention that included an optional condom skills unit, was evaluated to determine whether it prevented unprotected intercourse and increased condom efficacy among rural African American adolescents. Ancillary analyses were conducted to identify factors that predicted youth attendance of the condom skills unit. Methods: Sixteen-year-old African American youths (N = 502) and their primary caregivers were randomly assigned to SAAF-T (n = 252) or an attention control (n = 250) intervention. SAAF-T families participated in a 5-week family skills training program that included an optional condom skills unit. All families completed in-home pretest, posttest, and long-term follow-up interviews during which adolescents reported on their sexual behavior, condom use, and condom efficacy. Because condom use was addressed only in an optional unit that required caregiver consent, we analyzed efficacy using complier average causal effect analyses. Results: Attendance in both SAAF-T and the attention control intervention averaged 4 of 5 sessions; 70% of SAAF-T youth attended the condom skills unit. Complier average causal effect models indicated that SAAF-T was efficacious in reducing unprotected intercourse and increasing condom efficacy among rural African American high school students. Exploratory analyses indicated that religious caregivers were more likely than nonreligious caregivers to have their youth attend the condom skills unit. Conclusions: Results suggest that brief condom skills educational modules in the context of a family-centered program are feasible and reduce risk for sexually transmitted infections and unplanned pregnancies.Mania Symptoms and HIV-Risk Behavior Among Adolescents in Mental Health Treatment
AbstractStewart, A. J., Theodore-Oklota, C., Hadley, W., Brown, L. K., Donenberg, G., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Clinical Child and Adolescent PsychologyVolume
41Issue
6Page(s)
803-810AbstractThis study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.Predicting discordance between self-reports of sexual behavior and incident sexually transmitted infections with african american female adolescents : Results from a 4-city study
AbstractBrown, J. L., Sales, J. M., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Brown, L. K., Romer, D., Valois, R. F., & Stanton, B. (n.d.).Publication year
2012Journal title
AIDS and BehaviorVolume
16Issue
6Page(s)
1491-1500AbstractThis study examined correlates of the discordance between sexual behavior self-reports and Incident Sexually Transmitted Infections. African American adolescent females (N = 964) from four U.S. cities were recruited for an HIV/STI prevention trial. Self-reported sexual behaviors, demographics, and hypothesized psychosocial antecedents of sexual risk behavior were collected at baseline, 6-, 12-, and 18-month follow-up assessments. Urine specimens were collected and tested for three prevalent STIs (chlamydia, gonorrhea, trichomonas) at each assessment. Seventeen percent of participants with a laboratory-confirmed STI reported either lifetime abstinence or recent abstinence from vaginal sex (discordant self-report). Lower STI knowledge, belief that fewer peers were engaging in sex, and belief that more peers will wait until marriage to have sex were associated with discordant reports. Discordance between self-reported abstinence and incident STIs was marked among African American female adolescents. Lack of STI knowledge and sexual behavior peer norms may result in underreporting of sexual behaviors.Prevalence and Correlates of Recent Vaginal Douching among African American Adolescent Females
AbstractDiClemente, R., DiClemente, R. J., Young, A. M., Painter, J. L., Wingood, G. M., Rose, E., & Sales, J. M. (n.d.).Publication year
2012Journal title
Journal of Pediatric and Adolescent GynecologyVolume
25Issue
1Page(s)
48-53AbstractStudy Objective: To describe the prevalence and correlates of vaginal douching among urban African American adolescents and to examine the association between douching and sexually transmitted infection (STI) status. Design: Demographic, psychosocial, and behavioral data were collected through cross-sectional, self-administered surveys. Self-collected vaginal swabs were assayed using nucleic acid amplification tests for trichomoniasis, chlamydia, and gonorrhea. Setting: Sexual health clinic in a large metropolitan area of the southeastern United States. Participants: African American females (N = 701), ages 14-20, participating in a human immunodeficiency virus prevention intervention. Main Outcome Measure: The outcome of interest was the association between vaginal douching (lifetime, past 90 days, and past 7 days) with demographic characteristics (eg, age, education, and socioeconomic status), physical and mental health status, STI status, sexual behavior (eg, number of vaginal sexual partners, age of sex partners, consistent condom use in the past 90 days, sex while self/partner was high on drugs or alcohol), and psychosocial characteristics (eg, sexual adventurism, social support, peer norms, sexual satisfaction, self-efficacy for sex refusal, self-esteem, relationship power, risk avoidance). Results: Forty-three percent reported ever douching, and 29% reported douching in the past 90 days. In bivariate analyses, recent douching was associated with demographic, behavioral, and psychosocial variables, but not current STI status. In multivariate analyses, recent douching was associated with age (odds ratio [AOR] = 1.13, confidence interval [CI] = 1.02-1.25), lower socioeconomic status (AOR = 1.25, CI = 1.05-1.47), and having sex with much older partners (AOR = 1.87, CI = 1.22-2.86). Conclusion: Increased age, lower socioeconomic status, and older partners may be salient risk factors for douching behavior among African American young women.Prevalence and predictors of complementary and alternative medicine use in African-Americans with acquired immune deficiency syndrome
AbstractOwen-Smith, A., McCarty, F., Hankerson-Dyson, D., & DiClemente, R. (n.d.).Publication year
2012Journal title
Focus on Alternative and Complementary TherapiesVolume
17Issue
1Page(s)
33-42AbstractThe use of CAM among human immunodeficiency virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardise the efficacy of conventional HIV medication, making it critical to understand CAM use among this population. The objective of this study was to investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner. African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants' CAM use and various psychosocial and socio-demographic characteristics. Participants' most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use. A total of 182 subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female gender, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use. The implications of these findings are discussed and suggestions for future research are provided.Racial identity and risky sexual behaviors among black heterosexual men
AbstractOparanozie, A., Sales, J. M., DiClemente, R., & Braxton, N. D. (n.d.).Publication year
2012Journal title
Journal of Black PsychologyVolume
38Issue
1Page(s)
32-51AbstractThe purpose of this study was to examine the relationship between racial identity and risky sexual behaviors among young Black heterosexual men to better inform future HIV prevention interventions. A community sample of 80 self-identified African American heterosexual men aged 18 to 29 years completed an audio computer-assisted self-interview survey. Bivariate analyses were performed to assess the associations among variables related to demographics, racial identity, and sexual behaviors. Multivariate linear and logistic regression analyses were employed to determine the relationship between racial identity and risky sexual behaviors. Results indicate that more positive feelings toward African Americans and positive attitudes toward being Black predicted fewer sexual partners. The centrality of race was associated with a decrease in the odds of having concurrent sexual partners and marginally predicted increased condom use with a main female partner. Findings suggest that future HIV prevention interventions designed for African American heterosexual men should seek to strengthen their sense of racial identity.Recruiting and Retaining High-Risk Adolescents into Family-Based HIV Prevention Intervention Research
AbstractKapungu, C. T., Nappi, C. M., Thakral, C., Miller, S. A., Devlin, C., McBride, C., Hasselquist, E., Coleman, G., Drozd, D., Barve, C., Donenberg, G., DiClemente, R., & Brown, L. (n.d.).Publication year
2012Journal title
Journal of Child and Family StudiesVolume
21Issue
4Page(s)
578-588AbstractThe purpose of this study was to examine the effectiveness of evidence-based recruitment and retention strategies for a longitudinal, family-based HIV prevention intervention study targeting adolescents in psychiatric care by (1) determining consent rate (recruitment), rate of participation at the first intervention session (retention), and follow-up attendance rate (retention); and (2) examining socio-demographic factors, family-level processes, sexual risk-related indices, and intervention factors (i.e., treatment arm) associated with study retention. Only one-third of the families contacted ultimately enrolled in the study. 81% of those enrolled participated in the workshop and 72% attended the booster sessions with no significant differences between families on any variable based on attendance. Retention over 1 year was 85% and did not differ by treatment arm. Strategies employed were successful at retaining families once they were enrolled. Findings highlight barriers to enrollment for adolescents in psychiatric care and suggest that it may be critical to integrate HIV prevention programs within community-based mental health services in order to counteract recruitment challenges.Rural African American Parents' Knowledge and Decisions About Human Papillomavirus Vaccination
AbstractThomas, T. L., Strickland, O. L., DiClemente, R., Higgins, M., & Haber, M. (n.d.).Publication year
2012Journal title
Journal of Nursing ScholarshipVolume
44Issue
4Page(s)
358-367AbstractPurpose: To identify predictors of human papillomavirus (HPV) vaccination among rural African American families. Design: Cross-sectional descriptive study in schools in three rural counties in southeastern United States. The sample consisted of African American parents or caregivers with children 9 to 13 years of age who attended elementary or middle school in 2010-2011. Methods: Using an anonymous, 26-item survey, we collected descriptive data during parent-teacher events from African American parents with children in elementary or middle school. The main outcome was measured as a response of "yes" to the statement "I have or will vaccinate my child with the HPV vaccine." In addition, composite scores of knowledge and positive attitudes and beliefs were compared. No interventions were conducted. Findings: We identified predictors of HPV vaccination and found that religious affiliation had a correlation with vaccinating or planning to vaccinate a child. Conclusions: Results indicate a need for further research on the role of local culture, including religion and faith, in rural African Americans' decisions about giving their children the HPV vaccination. Clinical Relevance: This study emphasizes the importance of understanding rural African American parents' knowledge, attitudes, and spiritual beliefs when designing health education programs and public health interventions to increase HPV vaccination uptake among African American boys and girls living in rural areas.Sexual sensation seeking, drug use and risky sex among detained youth
AbstractVoisin, D. R., King, K., Schneider, J., DiClemente, R., & Tan, K. (n.d.).Publication year
2012Journal title
Journal of AIDS and Clinical ResearchVolume
3Issue
SPL ISSUE1AbstractSexual sensation seeking has been correlated with drug use and risky sex in a number of populations. However, these relationships have had limited examination among adolescents, and to date, have not been explored among detained youth, a group with some of the highest rates of illicit drug use and STIs. To better understand these relationships we utilized A-CASI to collect data on sociodemographics, sexual sensation seeking, drug use and risky sexual behaviors among a sample of 550 detained youth. A series of multivariable regression models controlling for age, gender, race/ethnicity, socioeconomic status and risky peer networks indicated that sexual sensation seeking was associated with alcohol and ecstasy use; having sex while high on drugs; having sex with a partner who was high on drugs; having more sexual partners; having engaged in unprotected vaginal sex; and less condom use during oral sex, all in the 2 months prior to being detained. In addition, sexual sensation seeking was also associated with ever having exchanged sex for drugs or money. These data have important implications for STI/drug use prevention interventions among detained adolescents.Sexually Transmitted Infections, Sexual Risk Behavior, and Intimate Partner Violence among African American Adolescent Females with a Male Sex Partner Recently Released from Incarceration
AbstractSwartzendruber, A., Brown, J. L., Sales, J. M., Murray, C. C., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
51Issue
2Page(s)
156-163AbstractPurpose: Social networks directly and indirectly influence sexually transmitted infections (STIs) risk. The objective was to explore associations between sex with a male recently released from incarceration and sexual risk and intimate partner violence (IPV) among African American adolescent females. Methods: Sociodemographic, psychosocial, and sexual behavior data were collected at baseline, 6, and 12 months from African American females, aged 15-21 years, participating in an HIV/STI prevention trial. Among 653 participants withSmoking as a risk factor for STI diagnosis among African American females
AbstractBerg, C. J., Painter, J. E., Sales, J. M., Mays, D., Rose, E., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2012Journal title
American Journal of Health BehaviorVolume
36Issue
4Page(s)
505-512AbstractObjectives: To examine the relationship of smoking to sexual risk outcomes among African American adolescent females. Methods: We analyzed baseline data from an HIV intervention trial, including sexual risk (older sex partners, number of vaginal sex partners, sex while high on drugs/alcohol, STI diagnosis) and smoking status among 715 participants. Results: Smoking prevalence was 23.1%. Controlling for covariates, smoking predicted having older partners (P=.001), having sex while high on alcohol or drugs (PThe association between alcohol use and sexual risk behaviors among African American women across three developmental periods : A review
AbstractSales, J. M., Brown, J. L., Vissman, A. T., & DiClemente, R. (n.d.).Publication year
2012Journal title
Current Drug Abuse ReviewsVolume
5Issue
2Page(s)
117-128AbstractBackground: African American women experience increased rates of sexually transmitted diseases and HIV. The use of alcohol may increase sexual risk behaviors among this population. Purpose: This paper provides a review and critique of the literature examining the association etween alcohol use and sexual risk behaviors among African American females including a: (a) synthesis of research findings from adolescent, college-aged/early adulthood, and adult samples; (b) methodological critique of the literature; and (c) guidance for future research. Methods: We reviewed 32 studies examining the association between alcohol use and sexual risk behaviors among African American females across developmental periods. Results: Similar to previous association studies, results suggest that increased use of alcohol is associated with increased sexual risk practices among African American females. Further, even non-abuse levels of drinking among African American females, at all ages, were related to increased sexual risk-taking. Conclusions: Future studies should seek to recruit samples that more fully reflect the diversity of African American women's experiences across the lifespan. Given the association between alcohol use and/or abuse and the prevalence of STI/HIV-associated risk behaviors and adverse biological outcomes (i.e., STIs, including HIV) among African American females across the lifespan, there is a clear need to develop and evaluate prevention research efforts tailored for this subgroup.The mediating role of partner communication frequency on condom use among African American adolescent females participating in an HIV prevention intervention
AbstractSales, J. M., Lang, D. L., DiClemente, R., Latham, T. P., Wingood, G. M., Hardin, J. W., & Rose, E. S. (n.d.).Publication year
2012Journal title
Health PsychologyVolume
31Issue
1Page(s)
63-69AbstractObjective: Although effective HIV prevention interventions have been developed for adolescents, few interventions have explored whether components of the intervention are responsible for the observed changes in behaviors postintervention. This study examined the mediating role of partner communication frequency on African American adolescent females' condom use postparticipation in a demonstrated efficacious HIV risk-reduction intervention. Methods: As part of a randomized controlled trial, African American adolescent females (N = 715), 15-21 years, seeking sexual health services, completed a computerized interview at baseline (prior to intervention) and again 6 and 12 months follow-up post-intervention participation. The interview assessed adolescents' sexual behavior and partner communication skills, among other variables, at each time point. Using generalized estimating equation (GEE) techniques, both logistic and linear regression models were employed to test mediation over the 12-month follow-up period. Additional tests were conducted to assess the significance of the mediated models. Results: Mediation analyses observed that partner communication frequency was a significant partial mediator of both proportion of condom-protected sex acts (p = .001) and consistent condom use (p = .001). Conclusion: Partner communication frequency, an integral component of this HIV intervention, significantly increased as a function of participating in the intervention, partially explaining the change in condom use observed 12 months postintervention. Understanding what intervention components are associated with behavior change is important for future intervention development.The Strong African American Families-Teen Trial : Rationale, Design, Engagement Processes, and Family-Specific Effects
AbstractKogan, S. M., Brody, G. H., Molgaard, V. K., Grange, C. M., Oliver, D. A., Anderson, T. N., DiClemente, R., Wingood, G. M., Chen, Y. f., & Sperr, M. C. (n.d.).Publication year
2012Journal title
Prevention ScienceVolume
13Issue
2Page(s)
206-217AbstractThis study addresses two limitations in the literature on family-centered intervention programs for adolescents: ruling out nonspecific factors that may explain program effects and engaging parents into prevention programs. The Rural African American Families Health project is a randomized, attention-controlled trial evaluating the efficacy of the Strong African American Families-Teen (SAAF-T) program, a family-centered risk-reduction intervention for rural African American adolescents. Rural African American families (n = 502) with a 10th-grade student were assigned randomly to receive SAAF-T or a similarly structured, family-centered program that focused on health and nutrition. Families participated in audio computer-assisted self-interviews at baseline and 6-month follow-up. Program implementation procedures yielded a design with equivalent doses, five sessions of family-centered intervention programming for families in each condition. Of eligible families screened for participation, 76% attended four or five sessions of the program. Consistent with our primary hypotheses, SAAF-T youth, compared to attention-control youth, demonstrated higher levels of protective family management skills, a finding that cannot be attributed to nonspecific factors such as aggregating families in a structured, interactive setting.A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant latino men
AbstractRhodes, S. D., McCoy, T. P., Vissman, A. T., DiClemente, R., Duck, S., Hergenrather, K. C., Foley, K. L., Alonzo, J., Bloom, F. R., & Eng, E. (n.d.).Publication year
2011Journal title
AIDS and BehaviorVolume
15Issue
8Page(s)
1764-1775AbstractThis randomized controlled trial tested the efficacy of an HIV prevention intervention to increase condom use and HIV testing among Spanish-speaking, heterosexually active immigrant Latino men. A community- based participatory research partnership developed the intervention and selected the study design. Following baseline data collection, 142 immigrant Latino men were randomized to the HIV prevention intervention or the cancer education intervention. Three-month follow-up data were collected from 139 participants, for a 98% retention rate. Mean age of participants was 31.6 years and 60% reported being from Mexico. Adjusting for baseline behaviors, relative to their peers in the cancer education comparison, participants in the HIV prevention intervention were more likely to report consistent condom use and receiving an HIV test. Community-based interventions for immigrant Latino men that are built on state of the art prevention science and developed in partnership with community members can greatly enhance preventive behaviors and may reduce HIV infection.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.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.Alcohol Use as a Marker for Risky Sexual Behaviors and Biologically Confirmed Sexually Transmitted Infections Among Young Adult African-American Women
AbstractSeth, P., Wingood, G. M., DiClemente, R., & Robinson, L. S. (n.d.).Publication year
2011Journal title
Women's Health IssuesVolume
21Issue
2Page(s)
130-135AbstractIntroduction: Previous research has primarily focused on the relationship between illicit drug use and HIV/sexually transmitted infection (STI) risk behavior among African-American women. Very few studies have solely reviewed the role of alcohol use on risky sexual behavior. The present study examined the relationship between alcohol use at non-abuse levels and risky sexual behaviors and STIs among young adult African-American women. Methods: Eight hundred forty-eight African American women, ages 18 to 29, participated at baseline, with 669 and 673 women at 6 and 12 months follow-up, respectively. Participants completed an Audio Computer Assisted Survey Interview assessing sociodemographics, alcohol use, and risky sexual behaviors. Subsequently, participants provided two vaginal swab specimens for STIs. Results: Multivariate logistic regression analyses were conducted for cross-sectional analyses, with illicit drug use as a covariate. Women who consumed alcohol were more likely to have multiple partners and risky partners. Binary generalized estimating equation models assessed the impact of alcohol use at baseline on risky sexual behavior and STIs over a 12-month period. Illicit drug use, intervention group, and baseline outcome measures were entered as covariates. Alcohol consumption predicted positive results for chlamydia, positive results for any STI, and never using a condom with a casual partner over a 12-month follow-up period. Discussion: Frequency of alcohol use at non-abuse levels was correlated with and predicted risky sexual behaviors and STIs. Prevention programs for African-American women should incorporate education regarding the link between alcohol and HIV/STI risk behaviors and the potential negative health consequences.Application of condoms on male clients by female sex workers in Yerevan, Armenia : Prevalence and correlates
AbstractDarbinyan, N., Lang, D. L., DiClemente, R., Joseph, J. B., & Markosyan, K. (n.d.).Publication year
2011Journal title
Journal of Biosocial ScienceVolume
43Issue
5Page(s)
575-585AbstractThis study sought to assess the prevalence of consistent condom application on male clients by female sex workers (FSWs) in Armenia and its association with demographic, psychosocial and behavioural factors. In this cross-sectional study, 120 street-based FSWs aged 20-52 completed an interviewer-administered questionnaire. The primary outcome measure was consistent application of condoms by FSWs on their male clients. A total of 21.7% of participants reported consistently applying condoms on clients. Logistic regression analysis demonstrated that higher condom use self-efficacy (Adjusted Odds Ratio, AOR=1.1; p=0.01), lower perceived condom use barriers (AOR=0.9; p=0.04) and not using douching as a method to prevent STI/HIV (AOR=4.8; p=0.04) significantly predicted consistent condom application. Higher HIV/AIDS knowledge was a marginally significant predictor of condom application (AOR=1.3; p=0.05). Future interventions should address these modifiable factors to encourage FSWs to apply condoms on clients themselves, which may reduce condom failure and exposure to HIV transmission.Association between sexually transmitted diseases and young adults' self-reported abstinence
AbstractDiClemente, R., Sales, J. M., Danner, F., & Crosby, R. A. (n.d.).Publication year
2011Journal title
PediatricsVolume
127Issue
2Page(s)
208-213AbstractOBJECTIVE: Self-reported behavior has been the cornerstone of sexual health research and clinical practice, yet advances in sexually transmitted disease (STD) screening provide researchers with the opportunity to objectively quantify sexual risk behaviors. However, the extent to which young adults' laboratory-confirmed STD results and selfreported sexual behaviors are consistent has not been assessed in a nationally representative sample. PATIENTS AND METHODS: Data are derived from participants who completed wave 3 in the National Longitudinal Study of Adolescent Health. Young adults (N = 14 012) completed an audio computer-assisted self-interviewing survey and provided a urine specimen to detect the presence of Chlamydia trachomatis and Neisseria gonorrhoeae, and a polymerase chain reaction assay to detect Trichomonas vaginalis. RESULTS: More than 10% of young adults with a laboratory-confirmed positive STD result reported abstaining from sexual intercourse in the 12 months before assessment and STD testing. After controlling for several sociodemographic factors, self-reported sex (versus those who reported abstinence) in the previous 12 months was significantly associated with testing positive, but the odds of testing positive were only slightly more than twofold (adjusted odds ratio: 2.11 [95% confidence interval: 2.097-2.122]). CONCLUSIONS: Findings indicate discrepancy between young adults' positive STD status and self-reported sexual behavior. No significant correlates of discrepant reporting were identified. From a clinical standpoint, the discrepancies between STD positivity and self-reported sexual behavior observed in this nationally representative sample suggest that routine STD screening may be beneficial and necessary to reduce STD morbidity among young adults.Bias in Online recruitment and retention of racial and ethnic minority men who have sex with men
AbstractSullivan, P. S., Khosropour, C. M., Luisi, N., Amsden, M., Coggia, T., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2011Journal title
Journal of medical Internet researchVolume
13Issue
2Page(s)
e38AbstractBackground: The Internet has become an increasingly popular venue for men who have sex with men (MSM) to meet potential sex partners. Given this rapid increase in online sex-seeking among MSM, Internet-based interventions represent an important HIV (human immunodeficiency virus) prevention strategy. Unfortunately, black and Hispanic MSM, who are disproportionately impacted by the HIV epidemic in the United States, have been underrepresented in online research studies. Objective: Our objective was to examine and quantify factors associated with underrecruitment and underretention of MSM of color in an online HIVbehavioral risk research study of MSM recruited from an online social networking site. Methods: Internet-using MSM were recruited through banner advertisements on MySpace.com targeted at men who reported in their MySpace profile their age as at least 18 and their sexual orientation as gay, bisexual, or unsure. Multivariable logistic regression models were used to estimate the odds stratified by race and ethnicity of the MySpace user clickingthrough the banner advertisement. To characterize survey retention, Kaplan-Meier survivalcurves and multivariable Cox proportional hazards models identified factors associated with survey dropout. Results: Over 30,000 MySpace users clicked on the study banner advertisements (click-through rate of 0.37%, or 30,599 clicks from 8,257,271 impressions). Black (0.36% or 6474 clicks from 1,785,088 impressions) and Hispanic (0.35% or 8873 clicks from 2,510,434 impressions) MySpace users had a lower click-through rate compared with white (0.48% or 6995 clicks from 1,464,262 impressions) MySpace users. However, black men had increased odds of click-through for advertisements displaying a black model versus a white model (adjusted odds ratio [OR] = 1.83, 95% confidence interval [CI] 1.72 - 1.95), and Hispanic participants had increased odds of click-through when shown an advertisement displaying an Asian model versus a white model (adjusted OR = 1.70, 95% CI 1.62 - 1.79). Of the 9005 men who consented to participate, 6258 (69%) completed the entire survey. Among participants reporting only male sex partners, black non-Hispanic and Hispanic participants were significantly more likely to drop out of the survey relative to white non-Hispanic participants (hazard ratio [HR] = 1.6, 95% CI 1.4 - 1.8 and HR = 1.3, 95% CI 1.1 - 1.4, respectively). Men with a college-level of education were more likely to complete the survey than those with a high-school level of education (HR = 0.8, 95% CI 0.7 - 0.9), while men who self-identified as heterosexual were more likely to drop out of the survey compared with men who self-identified as gay (HR = 2.1, 95% CI 1.1 - 3.7).Conclusions: This analysis identified several factors associated with recruitment and retention of MSM in an online survey. Differential click-through rates and increased survey dropout by MSM of color indicate that methods to recruit and retain black and Hispanic MSM in Internet-based research studies are paramount. Although targeting banner advertisements to MSM of color by changing the racial/ethnic composition of the advertisements may increase click-through, decreasing attrition of these study participants once they are engaged in the survey remains a challenge.