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
College Graduation Reduces Vulnerability to STIs/HIV among African-American Young Adult Women
AbstractPainter, J. E., Wingood, G. M., DiClemente, R., DePadilla, L. M., & Simpson-Robinson, L. S. (n.d.).Publication year
2012Journal title
Women's Health IssuesVolume
22Issue
3Page(s)
e303-e310AbstractAfrican-American women are disproportionately affected by sexually transmitted infections (STIs), including HIV. The Theory of Gender and Power (TGP) posits that socioeconomic exposures, including educational attainment, place women at increased risk for STIs/HIV. This study examined the association between educational attainment and vulnerability to STIs/HIV, as well as potential TGP-driven mediators of this association, among African-American women. Baseline data were assessed from an STI/HIV prevention intervention for African-American women (n = 848) aged 18 to 29 recruited from three Kaiser Permanente Centers in Atlanta, Georgia. Data collection included a survey of demographic, psychosocial, and behavioral measures and self-collected, laboratory-confirmed vaginal swabs for STIs (trichomoniasis, chlamydia, gonorrhea, and human papillomavirus). Multiple regression analyses and multivariate mediation analyses were used to examine the association between educational attainment with a laboratory-confirmed STI and potential TGP mediators. Controlling for age and receipt of public assistance, the odds of an STI diagnosis were 73% lower among participants with a college degree or greater compared with participants who had not completed high school. There were also significant associations between educational attainment and multiple TGP mediators from the sexual division of power and the structure of cathexis. TGP constructs did not mediate the association between educational attainment and laboratory-confirmed STI. The current study suggests that graduating from college may lead to a beneficial reduction in vulnerability to STIs/HIV among African-American women. Findings from this study support expanding structural-level interventions, emphasizing both high school and college graduation, as a means of reducing vulnerability to STIs/HIV among African-American women.Condoms "contain worms" and "cause HIV" in Tanzania : Negative Condom Beliefs Scale development and implications for HIV prevention
AbstractSiegler, A. J., Mbwambo, J. K., McCarty, F. A., & DiClemente, R. (n.d.).Publication year
2012Journal title
Social Science and MedicineVolume
75Issue
9Page(s)
1685-1691AbstractCondom promotion remains a key component of HIV prevention programs, complimenting recent successes in biomedical HIV prevention. Although condom use has increased in much of East Africa, it remains substantially below optimal levels. Negative rumors about condoms have been documented in East Africa, yet the prevalence and effects of belief in the negative rumors have not been explored. This study evaluated levels of belief in negative rumors about condoms, developed a Negative Condom Beliefs Scale, and assessed its accuracy in predicting willingness to use condoms. A cross-sectional, cluster survey (n = 370) was conducted representing adults in two rural districts in Northern Tanzania in 2008. Item agreement ranged from 35 to 53% for the following rumors regarding condoms: causing cancer, having holes, containing HIV, having worms, and the worms causing HIV. Items loaded on a single latent factor and had high internal consistency and convergent validity. In a multivariate model, negative condom score (AOR = 0.67, 95% CI = 0.6, 0.8) was the strongest single predictor of willingness to use condoms, followed by greater perceived anonymity in acquiring condoms (AOR = 4.36, 95% CI = 2.2, 8.6) and higher condom self-efficacy (AOR = 4.24, 95% CI = 2.0, 8.9). Our findings indicate high levels of subscription to negative beliefs about condoms, with two out of three respondents affirming belief in at least one negative condom rumor. This study highlights the relation between condom rumor beliefs and willingness to use condoms, and indicates avenues for future research and means for improving the design of HIV prevention programs.Correlates of sexually transmitted infection prevention knowledge among African American girls
AbstractVoisin, D. R., Tan, K., Salazar, L. F., Crosby, R., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
51Issue
2Page(s)
197-199AbstractPurpose: To identify significant factors that distinguish African American girls who have high sexually transmitted infection (STI) prevention knowledge from those lacking such knowledge. Methods: We recruited a sample of 715 African American girls from three public health clinics in downtown Atlanta. Using audio computer-assisted self-interviewing (A-CASI) technology, we assessed for age, self-mastery, employment status, attendance at sex education classes, socioeconomic status, and STI prevention knowledge. Results: Slightly more than one-third of the girls did not know that females are more susceptible to STI infections than males; and that having an STI increases the risk of contracting HIV. Almost half of the girls did not know if a man has an STI he will not have noticeable symptoms; and that most people who have AIDS look healthy. Logistic regression findings indicated that being older, having greater self-mastery, and being employed significantly predicted high STI knowledge. Conclusions: Health educators may especially target African American girls who are younger, unemployed, and experiencing low self-mastery for more tailored STI heath education.Dating Violence Victimization and Unprotected Sex Acts Among Adolescents in Mental Health Treatment
AbstractRizzo, C. J., Hunter, H. L., Lang, D. L., Oliveira, C., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2012Journal title
Journal of Child and Family StudiesVolume
21Issue
5Page(s)
825-832AbstractThe objective of this study was to explore the relationship between dating violence victimization and unprotected sex acts among youth in mental health treatment. Sexually-active adolescents (n = 261; ages 13-18) enrolled in mental health treatment completed an audio-assisted computerized self-interview (ACASI) to assess recent dating violence victimization, unprotected sex acts, depression symptoms, and recent alcohol use. Path analysis revealed that dating violence victimization was related to unprotected sex acts both directly and indirectly via its association with depression and condom use self-efficacy. These findings suggest that in order to reduce HIV-related risk behaviors among dating violence victims, treatment providers should consider depressive symptomatology and associated affect around sexual situations.Dual protection use to prevent STIs and unintended pregnancy
AbstractSales, J. M., Whiteman, M. K., Kottke, M. J., Madden, T., & DiClemente, R. (n.d.).Publication year
2012Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2012Abstract~Employing a teen advisory board to adapt an evidence-based HIV/STD intervention for incarcerated African-American adolescent women
AbstractLatham, T. P., Sales, J. M., Renfro, T. L., Boyce, L. S., Rose, E., Murray, C. C., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2012Journal title
Health Education ResearchVolume
27Issue
5Page(s)
895-903AbstractThis manuscript assesses priorities and challenges of adolescent females by conducting a meeting with teen advisory board (TAB) members to collect information regarding their lives and experiences pre-, during and post-incarceration in a juvenile detention facility. Multiple themes emerged regarding the impact of incarceration on young African-American females, including experiencing a loss of personal liberties, the importance of making money upon release, unfaithfulness by partners on the 'outside', substance use and lack of control over their environment upon release, including parents, peers and male sexual partners. Based on feedback from TAB members, unique barriers and challenges were identified that suggested areas where adaptations to an evidenced-based HIV/sexually transmitted disease (STD) intervention would be justified to more adequately meet the needs of this particular subgroup of young African-American women. Adaptations to the evidence-based interventions included enhancing activities related to goal setting, emotion regulation skills, decision-making, recognizing and utilizing support networks and addressing the relationship between substance use and risky sexual behavior. Future health education efforts focusing on either the creation of new HIV/STD interventions or adaptations to existing interventions should consider utilizing advisory boards with members of the priority population at the earliest stages of intervention planning.Examining interest in secondary abstinence among young African American females at risk for HIV or STIs
AbstractBradley, E. L., Sales, J. M., Murray, C. C., & DiClemente, R. (n.d.).Publication year
2012Journal title
Health Education ResearchVolume
27Issue
6Page(s)
1120-1128AbstractSexually active African American females are at increased risk for acquiring HIV or STIs. However, some reduce their risk by abstaining from sex for various periods of time following initiation, a practice known as secondary abstinence. Although this may be a valuable mechanism for reducing HIV or STI rates in this population, little is known about those interested in secondary abstinence. Baseline data were obtained from a sample of African American adolescent females, ages 14-20 years, prior to participation in an HIV-risk reduction intervention trial (N = 701). Differences in individual-level and interpersonal-level factors, as well as sociodemographic variables were examined between participants who reported strong interest in secondary abstinence and those who did not. 144 (20.5%) participants reported strong interest in secondary abstinence. Young women with strong interest in abstinence had higher odds of reporting a history of STIs and feeling negative emotions following sex because of their religious beliefs. They also had higher odds of believing their partner may be interested in abstaining and being less invested in their relationship with their main partner. Additionally, adolescents reported less interpersonal stress and more social support. African American females who are interested in practicing secondary abstinence and those who are not differ in their sexual health education needs. Findings from this study characterizing young women interested in secondary abstinence can help researchers provide more targeted health education by identifying those who may be more responsive to abstinence-promoting messages.Examining Parental Monitoring as a Pathway From Community Violence Exposure to Drug Use, Risky Sex, and Recidivism Among Detained Youth
AbstractVoisin, D. R., Tan, K., Tack, A. C., Wade, D., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Social Service ResearchVolume
38Issue
5Page(s)
699-711AbstractThis study examined whether parental monitoring mediated the relationship between community violence exposure and a spectrum of behaviors such as recidivism, risky sex, and drug use among youth with a history of being detained. It also explored whether risk pathways differed by gender. Adolescents (n = 550) who were detained or previously detained were recruited from eight regional detention facilities in Georgia. Audio computer-assisted self-interviewing technology was used to assess demographic factors (i.e., age, race, and socioeconomic status), risky sex, drug use, and recidivism prior to being detained. Major findings indicated direct relationships between community violence exposures and risky sex and drug use in the 2 months prior to being detained. Findings also indicated that parental monitoring mediated these relationships for both adolescent males and females. These findings document that parental monitoring is an important element even for troubled youth across a broad spectrum of risk factors. Consequently, it is recommended that intervention programs examine the differential effects of monitoring behaviors by a variety of groups such as parental figures, teachers, and peer mentors.Exploring factors associated with nonchange in condom use behavior following participation in an STI/HIV prevention intervention for African-American adolescent females
AbstractSales, J. M., Brown, J. L., DiClemente, R., & Rose, E. (n.d.).Publication year
2012Journal title
AIDS Research and TreatmentVolume
2012AbstractTo enhance future STI/HIV prevention efforts, this study examined factors associated with adolescents' failure to improve their condom use behaviors after participating in an STI/HIV prevention intervention. African-American adolescent females (N=205; M age = 17.9) in an STI/HIV prevention intervention trial completed ACASI interviews and provided self-collected vaginal swabs to assess two prevalent STIs at baseline and 6 months after intervention. Analyses compared those who increased condom use after intervention (change group) to those whose condom use did not increase (nonchange group). 43.4% did not increase their condom use after the intervention and were more likely to have an STI at followup (χ 2 = 4.64, P =. 03). In a multivariate logistic regression model, the nonchange group was more likely to have (a) higher sensation seeking (AOR =.91, P=.023), (b) a boyfriend (AOR =.32, P=.046), and/or (c) a physical abuse history (AOR =.56, P=.057). There were also differences in the extent to which psychosocial mediators changed between the two groups. Findings highlight the need to tailor STI/HIV interventions to adolescents with a greater degree of sensation seeking and address key relationship characteristics and trauma histories to bolster intervention efficacy.Exploring why young African American women do not change condom-use behavior following participation in an STI/HIV prevention intervention
AbstractSales, J. M., Diclemente, R. J., Davis, T. P., Sullivan, S., & DiClemente, R. (n.d.).Publication year
2012Journal title
Health Education ResearchVolume
27Issue
6Page(s)
1091-1101AbstractHuman immunodeficiency virus (HIV) interventions can significantly reduce risky sexual behaviors among vulnerable populations. However, not everyone exposed to an intervention will reduce their sexual risk behavior. This qualitative study sought to identify factors associated with young African American females' lack of increase in condom use post-participation in an HIV prevention intervention. Semi-structured interviews were conducted with 50 young African American women (18-23 years; approximately half were mothers) after participating in a demonstrated effective HIV prevention intervention; 24 did not increase condom use post-intervention. Interviews were thematically coded for barriers to condom-use post-intervention. Although nearly all young women reported partner-associated challenges to using condoms, there were relational differences observed among those who changed their condom use versus those who did not. Many 'non-changers' were engaged in non-stable 'on and off' relationships, with high rates of infidelity, often with the father of their child, in which they were fearful of requesting condom use. 'Non-changers' also reported more substance use, feeling incapable of change and not thinking about condom use. Thus, future HIV prevention efforts may benefit from incorporating strategies on how young mothers can maintain a non-sexual relationship with their child's father, as well as elaborating on the intersection of substance use and risky sexual decision-making.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. J., Young, A. M., Painter, J. L., Wingood, G. M., Rose, E., Sales, J. M., & DiClemente, R. (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 (P