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
Challenges in addressing depression in HIV research : Assessment, cultural context, and methods
AbstractSimoni, J. M., Safren, S. A., Manhart, L. E., Lyda, K., Grossman, C. I., Rao, D., Mimiaga, M. J., Wong, F. Y., Catz, S. L., Blank, M. B., DiClemente, R., & Wilson, I. B. (n.d.).Publication year
2011Journal title
AIDS and BehaviorVolume
15Issue
2Page(s)
376-388AbstractDepression is one of the most common co-morbidities of HIV infection. It negatively impacts self-care, quality of life, and biomedical outcomes among people living with HIV (PLWH) and may interfere with their ability to benefit from health promotion interventions. State-of-the-science research among PLWH, therefore, must address depression. To guide researchers, we describe the main diagnostic, screening, and symptom-rating measures of depression, offering suggestions for selecting the most appropriate instrument. We also address cultural considerations in the assessment of depression among PLWH, emphasizing the need to consider measurement equivalence and offering strategies for developing measures that are valid cross-culturally. Finally, acknowledging the high prevalence of depression among PLWH, we provide guidance to researchers on incorporating depression into the theoretical framework of their studies and employing procedures that account for participants with depression.Condom Use Among Young Women : Modeling the Theory of Gender and Power
AbstractDepadilla, L., Windle, M., Wingood, G., Cooper, H., & DiClemente, R. (n.d.).Publication year
2011Journal title
Health PsychologyVolume
30Issue
3Page(s)
310-319AbstractObjective: This study sought to articulate pathways between constructs from the theory of gender and power and their associations with sexual behavior. Design: The data were collected preintervention during a randomized controlled HIV prevention trial. Participants were 701 sexually active, unmarried African American females, aged 14-20, who were not pregnant, and were recruited from three health clinics in a southeastern US city. Structural equation modeling was used for the analyses. Main Outcome Measure: Self-reported condom use. Results: Theoretical associations yielded a well-fitting structural model across initial and cross-validation samples. A significant amount of variance was explained for the variables of condom use (R2 = .31, .18), partner communication (R2 = .30, .26), substance use during sex (R2 = .32, .51), and negative personal affect (R2 = .36, .48). Partner communication (.35, .38) was the strongest predictor of condom use, negative personal affect (-41, -37) was the strongest predictor of partner communication, and physical risk (.54, .54) was the strongest predictor of negative personal affect. Conclusion: This model provides evidence to support both direct and indirect associations between social and behavioral risk factors and condom use. Associations between theory of gender and power constructs and condom use can facilitate future development and analyses of interventions based on this theory.Correlates of 2009 H1N1 influenza vaccine acceptability among parents and their adolescent children
AbstractPainter, J. E., Gargano, L. M., Sales, J. M., Morfaw, C., Jones, L. M., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
Health Education ResearchVolume
26Issue
5Page(s)
751-760AbstractSchool-aged children were a priority group for receipt of the pandemic (2009) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-school students and their parents in two counties in rural Georgia. Multivariable logistic regression analyses were conducted to assess correlates of parental acceptance of H1N1 influenza vaccination for their children and adolescents' acceptance of vaccination for themselves. Concordance analyses were conducted to assess agreement between parent-adolescent dyads regarding H1N1 influenza vaccine acceptance. Parental acceptance of H1N1 influenza vaccination for their children was associated with acceptance of the vaccine for themselves and feeling motivated by the H1N1 influenza pandemic to get a seasonal influenza vaccine for their child. Adolescents' acceptance was associated with receipt of a seasonal influenza vaccine in the past year, fear of getting H1N1 influenza, feeling comfortable getting the vaccine and parental acceptance of H1N1 influenza vaccine. Half (50%) of parent-adolescent pairs included both a parent and child who expressed H1N1 influenza vaccine acceptance, and 19% of pairs would not accept the vaccine. This research highlights the need for interventions that target factors associated with H1N1 influenza vaccine acceptance among both parents and adolescents.Correlates of 2009 pandemic H1N1 influenza vaccine acceptance among middle and high school teachers in rural Georgia
AbstractGargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Jones, L. M., Weiss, P., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
Journal of School HealthVolume
81Issue
6Page(s)
297-303AbstractBACKGROUND: Teachers play an essential role in the school community, and H1N1 vaccination of teachers is critical to protect not only themselves but also adolescents they come in contact within the classroom through herd immunity. School-aged children have a greater risk of developing H1N1 disease than seasonal influenza. The goal of this study was to assess the relationship between attitudes toward H1N1 vaccination and vaccine acceptance among middle and high school teachers in rural Georgia. METHODS: Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention in rural Georgia. Data were collected from surveys distributed to middle and high school teachers in participating counties in September 2009 prior to implementing the interventions to increase vaccination against seasonal influenza. Multivariate logistic regression was used to assess the association between teachers' attitudes toward H1N1 vaccination and H1N1 vaccine acceptance, controlling for demographic variables. RESULTS: Among participants, 52.9% indicated that they would get the H1N1 vaccine. In multivariate analyses, H1N1 vaccine acceptance was associated with male gender (odds ratio[OR] = 3.67, p = .016), fear of contracting H1N1 (OR = 3.18, p = .025), and receipt of a seasonal influenza vaccine in the past year (OR = 3.07, p = .031). H1N1 vaccine acceptance was not significantly associated with age, race, perceived severity of H1N1, belief that the H1N1 vaccine would cause illness, or talking about H1N1 with friends. CONCLUSIONS: Teachers may play a pivotal role in school-based H1N1 vaccinations. Understanding and addressing teachers' attitudes toward H1N1 vaccination may assist in future immunization efforts.Determinants of multimethod contraceptive use in a sample of adolescent women diagnosed with psychological disorders
AbstractLang, D. L., Sales, J. M., Salazar, L. F., DiClemente, R., Crosby, R. A., Brown, L. K., & Donenberg, G. R. (n.d.).Publication year
2011Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2011AbstractObjective. Despite recommendations for concurrent use of contraceptives and condoms to prevent unintended pregnancy and STIs, multimethod contraceptive use among women is poor. This study examined individual-, interpersonal-, and environmental-level factors that predict multimethod use among sexually active adolescent women diagnosed with psychological disorders. Methods. This multisite study analyzed data from 288 sexually active adolescent women who provided sociodemographic, psychosocial, and behavioral data related to birth control and condom use. Results. 34.7% of the participants reported multimethod use in the past three months. Controlling for empirically and theoretically relevant covariates, a multivariable logistic regression identified self-efficacy, multiple partners, pregnancy history, parental communication, parental norms about sex, and neighborhood cohesion as significant predictors of multimethod use. Conclusions. While continued targeted messages about multi-method contraceptive use are imperative at the individual level, an uptake in messages targeting interpersonal- and environmental-level factors such as adolescents' parents and the broader community is urgently needed.Differences between African-American adolescent females with and without human papillomavirus infection
AbstractSeth, P., Wingood, G. M., DiClemente, R., Crosby, R. A., Salazar, L. F., Rose, E. S., & Sales, J. M. (n.d.).Publication year
2011Journal title
Sexual HealthVolume
8Issue
1Page(s)
125-127AbstractBackground: An important policy question is whether high-risk populations can be identified and prioritised for human papillomavirus (HPV) immunisation. Methods: Data collection included an audio computer-assisted survey interview and testing of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and HPV among 295 African-American adolescent females. Results: The results indicated that 43.1% tested positive for HPV. Logistic regression analyses indicated that HPV prevalence was not associated with other sexually transmissible infections (prevalence ratio (PR)=0.85, 95% confidence interval (CI)=0.51-1.41), unprotected vaginal sex (PR=1.04, 95% CI=0.56-1.92), having sex with an older male partner (PR=1.12, 95% CI=0.64-1.96), and having a casual partner (PR=0.89, 95% CI=0.54-1.48). Additionally, t-tests indicated that HPV prevalence was not associated with frequency of vaginal sex (t=0.17, P=0.87), protected sex (t=0.16, P=0.87), number of recent (t=0.40, P=0.69) or lifetime (t=1.45, P=0.15) sexual partners. However, those testing positive for HPV were younger (t=1.97, P=0.05) and reported current use of birth control pills (PR=2.38, 95% CI=1.00-5.63). Conclusions: It may not be possible to identify those with elevated risk of HPV acquisition. Thus, HPV vaccination, regardless of risk indicators, may be the most efficacious public health strategy.Efficacy of a health educator-delivered HIV prevention intervention for Latina women : A randomized controlled trial
AbstractDiClemente, R., Wingood, G. M., Di Clemente, R. J., Villamizar, K., Er, D. L., De Varona, M., Taveras, J., Painter, T. M., Lang, D. L., Hardin, J. W., Ullah, E., Stallworth, J., Purcell, D. W., & Jean, R. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
12Page(s)
2245-2252AbstractObjectives: We developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. Methods: We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. Results: Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR]=4.81; PErratum : Associations between sexually transmitted diseases and young adults' self-reported abstinence (Pediatrics (2011) 127, 2, (208-213) DOI:10.1542/peds.2009-0892)
AbstractDiClemente, R., & DiClemente, R. J. (n.d.).Publication year
2011Journal title
PediatricsVolume
127Issue
4Page(s)
805Abstract~Examining the relationship between psychotropic medication use and testing positive for Chlamydia and Gonorrhea among detained adolescents
AbstractVoisin, D. R., Harris, T. T., Crosby, R. A., Salazar, L. F., & DiClemente, R. (n.d.).Publication year
2011Journal title
Children and Youth Services ReviewVolume
33Issue
9Page(s)
1527-1530AbstractObjective: We examined whether psychotropic medication (PTM) use was related to testing positive for Chlamydia and Gonorrhea among detained adolescents. Methods: A convenience sample of 550 detained adolescents ages 14-18. years were recruited from eight youth detention centers in Georgia. Using A-CASI technology, data was collected on demographic factors, use of PTM, and sexual risk behaviors. Chlamydia and Gonorrhea diagnoses were assessed by laboratory testing. Results: Thirteen percent (13.1%) of adolescents not using PTMs tested positive for STIs compared to only 4.9% of those reporting PTM use. PTM users had a 62% smaller odds ratio for testing positive for Chlamydia or Gonorrhea. Conclusion: Findings suggest that use of psychotropic medication, if deemed useful by detained youth, may be a protective factor against engaging in behaviors which may culminate in contracting some STDs. The practice implications are discussed within the context of these findings.Gardasil for guys : Correlates of intent to be vaccinated
AbstractCrosby, R. A., DiClemente, R., Salazar, L. F., Nash, R., & Younge, S. (n.d.).Publication year
2011Journal title
Journal of Men's HealthVolume
8Issue
2Page(s)
119-125AbstractBackground: The lack of post Food and Drug Administration (FDA)-approval acceptance studies among males aged 18-26 years is problematic relative to the design of human papillomavirus (HPV) vaccine promotion programs designed to target males. Accordingly this study identified correlates of intention to receive the HPV vaccine among young men. Methods: Young men (n= 150) were recruited from two university campuses in the southern United States. Men completed an audio computer-assisted self administered interview assessing their beliefs, attitudes, and intent to receive the vaccine, newly approved for males. Bivariate associations between various measures and men's intent to be vaccinated in the next 12 months were assessed using t-tests. Measures achieving bivariate significance were entered into a regression model. Results: In the regression model, those reporting oral-genital sex were more likely to have positive intent (β = 0.32, t= 4.20, P= 0.0001). Those classified as having a relatively higher perceived susceptibility to HPV were more likely to have positive intent (β = 0.19, t= 2.53, P= 0.013). Finally, intent was associated with agreement/disagreement to the statement that " the HPV vaccine is so new that I should wait awhile before deciding about getting vaccinated" (β = 0.19, t= 2.49, P= 0.014). Those not agreeing were more likely to have positive intent. Conclusion: Young men who have had oral-genital sex and those with greater perceptions of susceptibility to HPV may have greater intent to receive the HPV vaccine. A barrier reducing their intention for vaccination may be the relatively new introduction of this vaccine to the male population.Is male intent to be vaccinated against HPV a function of the promotion message?
AbstractDiClemente, R., DiClemente, R. J., Crosby, R. A., Salazar, L. F., Nash, R., & Younge, S. (n.d.).Publication year
2011Journal title
International Journal of STD and AIDSVolume
22Issue
6Page(s)
332-334AbstractWe aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.Long term effects of community-based STI screening and mass media HIV prevention messages on sexual risk behaviors of African American adolescents
AbstractSznitman, S., Stanton, B. F., Vanable, P. A., Carey, M. P., Valois, R. F., Brown, L. K., DiClemente, R., Hennessy, M., Salazar, L. F., & Romer, D. (n.d.).Publication year
2011Journal title
AIDS and BehaviorVolume
15Issue
8Page(s)
1755-1763AbstractWe examined the long-term effects of two interventions designed to reduce sexual risk behavior among African American adolescents. African American adolescents (N = 1383, ages 14-17) were recruited from community-based organizations over a period of 16 months in two northeastern and two southeastern midsized U.S. cities with high rates of sexually transmitted infection (STI). Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted attitude, intention, and behavior self-interview. Youth who tested positive for an STI (8.3%) received treatment and risk reduction counseling. In addition, television and radio HIV-prevention messages were delivered during the recruitment period and 18 months of follow-up in one randomly selected city in each region. Analyses determined effects of the media program for those receiving a positive versus negative STI test result on number of sexual partners and occurrence of unprotected sex. Adolescents who tested STI-positive reduced their number of vaginal sex partners and the probability of unprotected sex over the first 6 months. However, in the absence of the mass media program, adolescents returned to their previously high levels of sexual risk behavior after 6 months. Adolescents who tested STI-positive and received the mass media program showed more stable reductions in unprotected sex. Community- based STI treatment and counseling can achieve significant, but short-lived reductions in sexual risk behavior among STI-positive youth. A culturally sensitive mass media program has the potential to achieve more stable reductions in sexual risk behavior and can help to optimize the effects of community-based STI screening.Longitudinal examination of alcohol use : A predictor of risky sexual behavior and trichomonas vaginalis among African-American female adolescents
AbstractSeth, P., Sales, J. M., DiClemente, R., Wingood, G. M., Rose, E., & Patel, S. N. (n.d.).Publication year
2011Journal title
Sexually Transmitted DiseasesVolume
38Issue
2Page(s)
96-101AbstractBackground: Alcohol use has been linked to risky sexual practices among adolescents. However, limited research on alcohol use and risky sexual behavior has been conducted on African-American female adolescents. This study examined high quantity of alcohol as a longitudinal predictor of risky sexual behavior and sexually transmitted diseases (STDs) among African-American female adolescents, a high-risk population for STDs. Methods: Three hundred ninety-three adolescent females, 15 to 21 years, were assessed on sociodemographics, alcohol use, and risky sexual behaviors. Participants also provided 2 swab specimens that were assayed for STDs. High quantity of alcohol use was defined as 3 drinks in 1 sitting. Results: Binary generalized estimating equation models were conducted assessing the impact of alcohol use at baseline on risky sexual behavior and STDs over a 12-month period. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high quantity of alcohol use predicted positive TV test results, inconsistent condom use, high sexual sensation seeking, multiple sexual partners, sex while high on alcohol or drugs, and having anal sex over a 12-month follow-up period. Conclusions: These findings suggest that HIV/STD-related behavioral interventions for African-American adolescents should discuss the link between alcohol and HIV/STD-risk behavior. A deeper understanding is paramount to the development of efficacious prevention programs at individual and community levels.Monitoring Challenges : A Closer Look at Parental Monitoring, Maternal Psychopathology, and Adolescent Sexual Risk
AbstractHadley, W., Hunter, H. L., Tolou-Shams, M., Lescano, C., Thompson, A., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2011Journal title
Journal of Family PsychologyVolume
25Issue
2Page(s)
319-323AbstractThe present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.Multicomponent interventions to enhance influenza vaccine delivery to adolescents
AbstractGargano, L. M., Pazol, K., Sales, J. M., Painter, J. E., Morfaw, C., Jones, L. D., Weiss, P., Buehler, J. W., Murray, D. L., Wingood, G. M., Orenstein, W. A., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
PediatricsVolume
128Issue
5Page(s)
e1092-e1099AbstractOBJECTIVE: To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia. METHODS: We used a nonrandomized, 3-armed design: (1) a middle-and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents. RESULTS: During the 2008-2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR] school: 2.4 [95% confidence interval (CI): 1.7-3.2]; RR provider: 1.9 [95% CI: 1.4 -2.5]). During 2009 -2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RR school: 2.3 [95% CI: 1.9 -2.9]; RR provider: 1.2 [95% CI: 0.97-1.5]). CONCLUSIONS: Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.Multiple method contraception use among African American adolescents in four US cities
AbstractBrown, J. L., Hennessy, M., Sales, J. M., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Romer, D., Valois, R. F., Brown, L. K., & Stanton, B. (n.d.).Publication year
2011Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2011AbstractWe report on African American adolescents' (N = 850; M age = 15.4) contraceptive practices and type of contraception utilized during their last sexual encounter. Respondents completed measures of demographics, contraceptive use, sexual partner type, and ability to select safe sexual partners. 40 endorsed use of dual or multiple contraceptive methods; a total of 35 different contraceptive combinations were reported. Perceived ability to select safe partners was associated with not using contraception (OR = 1.25), using less effective contraceptive methods (OR = 1.23), or hormonal birth control (OR = 1.50). Female gender predicted hormonal birth control use (OR = 2.33), use of less effective contraceptive methods (e.g., withdrawal; OR = 2.47), and using no contraception (OR = 2.37). Respondents' age and partner type did not predict contraception use. Adolescents used contraceptive methods with limited ability to prevent both unintended pregnancies and STD/HIV. Adolescents who believed their partners posed low risk were more likely to use contraceptive practices other than condoms or no contraception. Reproductive health practitioners are encouraged to help youth negotiate contraceptive use with partners, regardless of the partner's perceived riskiness.Personal and social influences regarding oral sex among African American female adolescents
AbstractSalazar, L. F., Head, S., Crosby, R. A., DiClemente, R., Sales, J. M., Wingood, G. M., & Rose, E. (n.d.).Publication year
2011Journal title
Journal of Women's HealthVolume
20Issue
2Page(s)
161-167AbstractObjective: To identify personal and social factors associated with performing oral sex among female adolescents. Methods: Sexually active African American female adolescents (n=715) recruited from sexually transmitted infection (STI) clinics were assessed for self-esteem, sexual sensation seeking, unprotected vaginal sex (UVS), self-efficacy to communicate about sex and to refuse sex, fear of negotiating condoms, relationship power, peer norms surrounding risky sexual behavior, ever having performed oral sex, and three vaginally acquired STIs. Results: Prevalence for at least one STI was 29%. More than half reported performing oral sex. Controlling for age, performing oral sex was associated with relatively higher sexual sensation seeking, any UVS in past 60 days, relatively lower self-efficacy to refuse sex, and having peer norms supportive of risky sexual behaviors. Conclusions: Given the potential for epidemic spread of orally acquired STIs to populations of female adolescents residing in communities with high rates of STI prevalence, this initial research provides guidance for intervention development and expanded research efforts.Planning models are critical for facilitating the development, implementation, and evaluation of dental health promotion interventions
AbstractDiClemente, R. (n.d.).Publication year
2011Journal title
Journal of public health dentistryVolume
71Issue
SUPPL. 1Page(s)
S16Abstract~Predictors of condom errors among sex workers in Armenia
AbstractDiClemente, R., Lang, D. L., Salazar, L. F., DiClemente, R. J., Markosyan, K., & Darbinyan, N. (n.d.).Publication year
2011Journal title
International Journal of STD and AIDSVolume
22Issue
3Page(s)
126-130AbstractThis cross-sectional study identified the prevalence and correlates of condom-use errors among female sex workers (FSWs) in Armenia. One hundred and seventeen street-based FSWs aged 20-52 years completed an interviewer-administered questionnaire. Condom-use errors were reported by 78.0% of participants. Number of clients, higher frequency of condom application on clients by FSWs, greater perceived barriers to condom use, elevated depressive symptomatology and having sex while drinking alcohol were significantly associated with higher number of condom-use errors. History of sexually transmitted infections (STIs) was marginally significant while consistent condom use was not significant in the final model. The multiple regression model accounted for 32.5% of the variance in condom-use errors. Condom-use errors are prevalent in this population, thus attenuating the intended protective effects of condoms. Interventions with FSWs in Armenia should specifically address the factors identified in this study toward the goal of reducing condom errors and ultimately preventing acquisition of STIs including HIV.Preliminary efficacy of a computer-based HIV intervention for African-American women
AbstractWingood, G. M., Card, J. J., Er, D., Solomon, J., Braxton, N., Lang, D., Seth, P., Cartreine, J., & DiClemente, R. (n.d.).Publication year
2011Journal title
Psychology and HealthVolume
26Issue
2Page(s)
223-234AbstractThis study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA.Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR=5.9; pPrevalence and correlates of inconsistent condom use among female sex workers in Armenia
AbstractMarkosyan, K., Lang, D. L., Darbinyan, N., DiClemente, R., & Salazar, L. F. (n.d.).Publication year
2011Journal title
Sexual HealthVolume
8Issue
2Page(s)
259-261Abstract~Rape victimization and high risk sexual behaviors : Longitudinal study of African-American adolescent females
AbstractLang, D. L., Sales, J. M., Salazar, L. F., Hardin, J. W., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2011Journal title
Western Journal of Emergency MedicineVolume
12Issue
3Page(s)
333-342AbstractObjectives: African-American women are affected by disproportionately high rates of violence and sexually transmitted infections (STI)/human immunodeficiency virus (HIV) infection. It is imperative to address the intersection of these two urgent public health issues, particularly as these affect African-American adolescent girls. This study assessed the prevalence of rape victimization (RV) among a sample of African-American adolescent females and examined the extent to which participants with a history of RV engage in STI/HIV associated risk behaviors over a 12-month time period. Methods: Three hundred sixty-seven African-American adolescent females ages 15-21, seeking sexual health services at three local teenager-oriented community health agencies in an urban area of the Southeastern United States, participated in this study. Participants were asked to complete an audio computer-assisted self-interview (ACASI) at baseline, 6- and 12-month follow-up. We assessed sociodemographics, history of RV and sexual practices. At baseline, participants indicating they had experienced forced sex were classified as having a history of RV. Results: Twenty-five percent of participants reported a history of RV at baseline. At 6- and 12-months, victims of RV had significantly lower proportions of condom-protected sex (p=.008), higher frequency of sex while intoxicated (p=.005), more inconsistent condom use (p=.008), less condom use at last sex (p=.017), and more sex partners (p=.0001) than non-RV victims. Over the 12-month follow-up period, of those who did not report RV at baseline, 9.5% reported that they too had experienced RV at some point during the 12-month time frame. Conclusion: African-American adolescent females who experience RV are engaging in more risky sexual behaviors overtime than non-RV girls, thereby placing themselves at higher risk for contracting STIs. In light of the results from this unique longitudinal study, we discuss considerations for policies and guidelines targeting healthcare, law enforcement and educational and community settings. The complexities of RV screening in healthcare settings are examined as is the need for tighter collaboration between healthcare providers and law enforcement. Finally, we consider the role of prevention and intervention programs in increasing awareness about RV as well as serving as an additional safe environment for screening and referral.Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention
AbstractSales, J. M., Painter, J. E., Pazol, K., Gargano, L. M., Orenstein, W. A., Hughes, J. M., & DiClemente, R. (n.d.).Publication year
2011Journal title
Human VaccinesVolume
7Issue
11Page(s)
1146-1152AbstractObjective: This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. Results: Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared with control parents. Significant differences were observed post intervention in perceived barriers and benefits of vaccination. Methods: Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline n = 324; follow-up n = 327). Data were collected pre- and post-intervention from phone surveys with parents' with children attending middle- and high-school. Attitudes, beliefs, vaccination history and intention to vaccinate were assessed. Conclusions: These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination.Seasonal and 2009 H1N1 influenza vaccine uptake, predictors of vaccination and self-reported barriers to vaccination among secondary school teachers and staff
AbstractGargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Jones, L. D., Murray, D., Wingood, G. M., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
Human VaccinesVolume
7Issue
1Page(s)
89-95AbstractObjective: Teachers, like healthcare workers, may be a strategic target for influenza immunization programs. Influenza vaccination is critical to protect both teachers and the students they come into contact with. This study assessed factors associated with seasonal and H1N1 influenza vaccine uptake among middle- and high-school teachers. Results: Seventy-eight percent of teachers who planned to receive seasonal influenza vaccine and 36% of those who planned to receive H1N1 influenza vaccine at baseline reported that they did so. Seasonal vaccine uptake was significantly associated with perceived severity (odds ratio [OR] 1.57, p = 0.05) and self-efficacy (OR 4.46, p = 0.006). H1N1 vaccine uptake was associated with perceived barriers (OR 0.7, p = 0.014) and social norms (OR 1.39, p = 0.05). The number one reason for both seasonal and H1N1 influenza vaccine uptake was to avoid getting seasonal/H1N1 influenza disease. The number one reason for seasonal influenza vaccine refusal was a concern it would make them sick and for H1N1 influenza vaccine refusal was concern about vaccine side effects. Methods: Participants were recruited from two counties in rural Georgia. Data were collected from surveys in September 2009 and May 2010. Multivariate logistic regression was used to assess the association between teachers' attitudes toward seasonal and H1N1 influenza vaccination and vaccine uptake. Conclusions: There is a strong association between the intention to be vaccinated against influenza (seasonal or 2009 H1N1) and actual vaccination uptake. Understanding and addressing factors associated with teachers' influenza vaccine uptake may enhance future influenza immunization efforts.Secondary HIV prevention : Novel intervention approaches to impact populations most at risk
AbstractBrown, J. L., & DiClemente, R. (n.d.).Publication year
2011Journal title
Current HIV/AIDS ReportsVolume
8Issue
4Page(s)
269-276AbstractThis paper reviews recent secondary prevention interventions designed to reduce sexual risk behaviors among people living with HIV/AIDS (PLWHA). A summary of findings from previous meta-analyses and narrative reviews of interventions is provided. Next, novel HIV prevention approaches for PLWHA are reviewed. The review reports on the efficacy of interventions delivered in primary care settings or by technology-formats, interventions that also address mental health difficulties, and programs to address particular at-risk populations (eg, men who have sex with men). A critique of recent interventions for people living with HIV/AIDS is provided as well as suggestions for future research.