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
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
AbstractLang, D. L., Salazar, L. F., DiClemente, R. J., Markosyan, K., Darbinyan, N., & DiClemente, R. (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.Self-regulatory problems mediate the association of contextual stressors and unprotected intercourse among rural, African american, young adult men
AbstractKogan, S. M., Brody, G. H., Chen, Y. F., & DiClemente, R. (n.d.).Publication year
2011Journal title
Journal of health psychologyVolume
16Issue
1Page(s)
50-57AbstractIn this brief report, the hypothesis that self-regulatory problems would mediate the association between contextual stressors and unprotected intercourse among rural African American young adult men was investigated. Family support and religiosity were hypothesized to ameliorate the influence of contextual stressors on self-regulatory problems. Hypotheses were tested on 79 sexually active men from a sample recruited with Respondent Driven Sampling; episodes of unprotected intercourse constituted the criterion variable. Analyses supported the mediating role of self-regulatory problems in linking young adult men's contextual stressors with a heightened likelihood of unprotected intercourse. Religious involvement and family support interacted with contextual stressors to predict diminished associations with self-regulatory problems.The assessment of complementary and alternative medicine use among individuals with HIV : A systematic review and recommendations for future research
AbstractOwen-Smith, A., Depadilla, L., & DiClemente, R. (n.d.).Publication year
2011Journal title
Journal of Alternative and Complementary MedicineVolume
17Issue
9Page(s)
789-796AbstractObjectives: The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use. Design: A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria. Results: Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed. Conclusions: CAM assessment-regardless of the specific study population-is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.The impact of depressive symptomatology on risky sexual behavior and sexual communication among African American female adolescents
AbstractSeth, P., Patel, S. N., Sales, J. M., DiClemente, R., Wingood, G. M., & Rose, E. S. (n.d.).Publication year
2011Journal title
Psychology, Health and MedicineVolume
16Issue
3Page(s)
346-356AbstractAdolescents, particularly African American adolescents, are at high risk for sexually transmitted infections (STIs). The association between psychosocial factors and risky sexual behavior has been well established. However, only a small number of studies have examined the relationship between depressive symptomatology among African American female adolescents, specifically over time. The present study examined depressive symptoms as a predictor of risky sexual behavior, sexual communication, and STIs longitudinally among African American female adolescents between the ages 15 and 21. Binary generalized estimating equation models were conducted assessing the impact of depressive symptoms at baseline on risky sexual behavior and STIs over six- and 12-months follow-up. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high levels of depressive symptoms predicted no condom use during last sexual encounter and multiple sexual partners over six-months follow-up. Depressive symptoms also predicted having a main partner with concurrent partners, high fear of communication about condoms, and sex while high on alcohol or drugs over six- and 12-months follow-up. These findings could be used to inform HIV/STI prevention intervention programs and clinicians providing regular health care maintenance to African American female adolescents engaging in risky sexual behavior.Translating an effective group- based hiv prevention program to a program delivered primarily by a computer : Methods and outcomes
AbstractCard, J. J., Kuhn, T., Solomon, J., Benner, T. A., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2011Journal title
AIDS Education and PreventionVolume
23Issue
2Page(s)
159-174AbstractWe describe development of SAHARA (SISTAS Accessing HIV/AIDS Resources At-a-click), an innovative HIV prevention program that uses a computer to deliver an updated version of SiSTA, a widely used, effective group-level HIV prevention intervention for African American women ages 18-29. Fidelity to SiSTA's core components was achieved using: (1) video clips featuring group discussions and modeling of appropriate sexual- and contraceptive-related behavior; and (2) interactive Flash modules facilitating cognitive rehearsal, providing learning experiences through games and quizzes, and providing opportunities for simulated role-play. A preliminary outcome study of SAHARA conducted at Planned Parenthood, Atlanta, found that SAHARA, when followed by a brief 20-minute wrap-up group session facilitated by a health educator, was effective in promoting consistent condom use for vaginal sex. We discuss the potential advantages and challenges of an intervention like SAHARA delivered by computer to an individual, versus one like SiSTA delivered by a health educator to a small group.Using culturally sensitive media messages to reduce HIV-associated sexual behavior in high-risk African American adolescents : Results from a randomized trial
AbstractSznitman, S., Vanable, P. A., Carey, M. P., Hennessy, M., Brown, L. K., Valois, R. F., Stanton, B. F., Salazar, L. F., DiClemente, R., Farber, N., & Romer, D. (n.d.).Publication year
2011Journal title
Journal of Adolescent HealthVolume
49Issue
3Page(s)
244-251AbstractPurpose: To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents. Methods: Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 1417 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346). Results: The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 1617 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities. Conclusion: Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.A network-individual-resource model for HIV prevention
AbstractJohnson, B. T., Redding, C. A., DiClemente, R., Mustanski, B. S., Dodge, B., Sheeran, P., Warren, M. R., Zimmerman, R. S., Fisher, W. A., Conner, M. T., Carey, M. P., Fisher, J. D., Stall, R. D., & Fishbein, M. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
SUPPL. 2Page(s)
S204-S221AbstractHIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.A qualitative case study examining intervention tailoring for minorities
AbstractMier, N., Ory, M. G., Toobert, D. J., Smith, M. L., Osuna, D., McKay, J. R., Villarreal, E. K., DiClemente, R., & Rimer, B. K. (n.d.).Publication year
2010Journal title
American Journal of Health BehaviorVolume
34Issue
6Page(s)
822-832AbstractObjectives: To explore issues of intervention tailoring for ethnic minorities based on information and experiences shared by researchers affiliated with the Health Maintenance Consortium (HMC). Methods: A qualitative case study methodology was used with the administration of a survey (n=17 principal investigators) and follow-up telephone interviews. Descriptive and content analyses were conducted, and a synthesis of the findings was developed. Results: A majority of the HMC projects used individual tailoring strategies regardless of the ethnic background of participants. Followup interview findings indicated that key considerations in the process of intervention tailoring for minorities included formative research; individually oriented adaptations; and intervention components that were congruent with participants' demographics, cultural norms, and social context. Conclusions: Future research should examine the extent to which culturally tailoring long-term maintenance interventions for ethnic minorities is efficacious and should be pursued as an effective methodology to reduce health disparities.A randomized controlled trial of an HIV prevention intervention for street-based female sex workers in Yerevan, Armenia : Preliminary evidence of efficacy
AbstractMarkosyan, K., Lang, D. L., Salazar, L. F., DiClemente, R., Hardin, J. W., Darbinyan, N., Joseph, J. B., & Khurshudyan, M. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
3Page(s)
530-537AbstractThis study evaluated the efficacy of an HIV intervention among female sex workers (FSWs) randomized to an intervention or wait-list control. FSWs (N = 120) completed baseline, 3-and 6-month assessments. A health educator implemented 2-hour intervention emphasized gender-empowerment, self-efficacy to persuade clients to use condoms, condom application skills, and eroticizing safer sex. Over the 6-month follow-up, FSWs in the intervention reported more consistent condom use with clients (P =.004) and were more likely to apply condoms on clients (P =.0001). Intervention effects were observed for other psychosocial mediators of safer sex. Brief, gender and culturally congruent interventions can enhance HIV-preventive behaviors among FSWs.Adolescents' attitudes toward vaccinations : A systematic review
AbstractPainter, J. E., Gargano, L. M., Sales, J. M., Perez, A. J., Wingood, G. M., Windle, M., & DiClemente, R. (n.d.).Publication year
2010Journal title
Current Pediatric ReviewsVolume
6Issue
4Page(s)
237-249AbstractAdolescent immunization coverage remains sub-optimal. Although parental consent is required for most vaccinations, adolescents' own attitudes may impact vaccine uptake. The current study sought to review the literature regarding adolescents' attitudes toward vaccination to inform efforts toward increasing vaccination rates. Two researchers searched five databases for literature published in English from 1999-2009, and coded included articles for demographics, methodological information, type of attitudes assessed, and significant associations. Of 1,348 titles and abstracts screened, 28 studies met inclusion criteria. Most studies assessed attitudes toward HPV or other STI vaccines. No studies assessed attitudes towards influenza vaccination. Most studies were cross-sectional, and many analyzed adolescent data combined with young adult data. Existing research suggests that perceived risk of disease, benefits and barriers to vaccination, and normative beliefs may be salient factors in adolescents' vaccine acceptance. Future research should expand the evidencebase regarding adolescents' attitudes toward all recommended vaccines, particularly non-STI vaccines.Application of ADAPT-ITT : Adapting an Evidence-Based HIV Prevention Intervention for Incarcerated African American Adolescent Females
AbstractLatham, T. P., Sales, J. M., Boyce, L. S., Renfro, T. L., Wingood, G. M., DiClemente, R., & Rose, E. (n.d.).Publication year
2010Journal title
Health promotion practiceVolume
11Issue
3_supplPage(s)
53S-60SAbstractAfrican American adolescent females are disproportionately affected by the HIV epidemic. Recent findings suggest that gender- and culturally appropriate HIV prevention interventions can significantly reduce HIV-associated sexual risk behaviors among this vulnerable population. Currently, there are no evidence-based interventions (EBIs) for this vulnerable subgroup. Thus, interventions specifically tailored for this subgroup are urgently needed. Effective interventions that reduce HIV risk behaviors remain one of the most powerful tools in curbing the HIV epidemic. The selected intervention (Horizons) was adapted using a coordinated and systematically guided adaptation process based on the ADAPT-ITT framework. This article serves as a starting point to support using the ADAPT-ITT model, which was beneficial when using an EBI in an alternative setting than originally created. Using this prescriptive method for adapting Horizons for incarcerated young girls proved to be a time- and cost-effective method.Applying ecological perspectives to adolescent sexual health in the United States : Rhetoric or reality?
AbstractSalazar, L. F., Bradley, E. L., Younge, S. N., Daluga, N. A., Crosby, R. A., Lang, D. L., & DiClemente, R. (n.d.).Publication year
2010Journal title
Health Education ResearchVolume
25Issue
4Page(s)
552-562AbstractThis study sought to determine the perspective taken toward understanding adolescent sexual risk behaviors and related biological outcomes (i.e. pregnancy, sexually transmitted diseases) since 1990. We content analyzed 324 abstracts representing observational research published between January 1990 and December 2007 for inclusion of ecological (environmental) factors, level of analysis, sample composition and type of behavioral and biological outcomes. A majority (95%) of studies included individual characteristics; half were void of any environmental factors. Of those including environmental factors, 27% included familial, 23% community, 13% relational and 3% societal factors. Most (80%) were positioned at the individual level of analysis. Samples were diverse (43%) and of mixed gender (71%). Biomarkers of sexually transmitted diseases (7.5%) or pregnancy outcomes (2%) were rare. Ecological inclusion was not related to year of publication. Despite the rhetoric highlighting, the importance of an ecological perspective in understanding adolescent sexual risk behavior, much published research, excludes environmental influences.Balancing rigor against the inherent limitations of investigating hard-to-reach populations
AbstractCrosby, R. A., Salazar, L. F., DiClemente, R., & Lang, D. L. (n.d.).Publication year
2010Journal title
Health Education ResearchVolume
25Issue
1Page(s)
1-5AbstractMaintaining rigor in research is critical; however, this need must be balanced by the necessity of conducting studies in populations where inherent barriers exist relative to key issues such as recruitment, attrition, sampling, sample size, assessment techniques, psychometric rigor, the identification of mediators and moderators and the practical relevance of the research question itself. Ultimately, the value of a study in health promotion should be judged on the practicality of the research question within the context of the target population. Striking the perfect balance between rigor and practicality to the field is a question that health promotion researchers and professionals need to determine through ongoing dialogue and debate.Barriers to adolescents' participation in HIV biomedical prevention research
AbstractDiClemente, R., Ruiz, M. S., & Sales, J. M. (n.d.).Publication year
2010Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
54Issue
SUPPL. 1Page(s)
S12-S17AbstractObjectives: The inclusion of adolescents in HIV prevention clinical research has the potential to improve the current understanding of the safety and efficacy of biomedical prevention technologies in younger populations that are at increasing risk of HIV infection. However, there are significant individual, operational, and community-level barriers to engaging adolescents in clinical prevention trials. Methods: This paper identifies and addresses individual, operational, and community-level barriers to adolescents participation in HIV biomedical prevention research. Results: Barriers identified and addressed in this paper include: (1) insufficient understanding of clinic prevention research, (2) self-presentation bias, (3) issues surrounding parental consent, (4) access to clinical trials, (5) mistrust of research, and (6) stigma associated with participation in clinical trials. Examples of programs where adolescents have been successfully engaged in prevention research are highlighted and the lessons learned from these programs indicate that establishing collaborations with key stakeholders in the community are essential for conducting biomedical research with vulnerable populations, including adolescents. Conclusions: Given the importance of understanding adolescents reactions, acceptability, and utilization of new biomedical prevention technologies it is imperative that researchers acknowledge and address these barriers to enhance adolescents participation and retention in HIV biomedical prevention research.Concordant and discordant reports on shared sexual behaviors and condom use among african american serodiscordant couples in four cities
AbstractEl-Bassel, N., Wingood, G., Wyatt, G. E., Jemmott, J. B., Pequegnat, W., Landis, J. R., Bellamy, S., Gilbert, L., Remien, R. H., Witte, S., Wu, E., DiClemente, R., Myers, H., Jemmott, L. S., Metzger, D., Ballard, S., Brown, T., Greene, Q., Helker, C., … Wyatt, C. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
5Page(s)
1011-1022AbstractThis paper examines the concordance of reported shared sexual behaviors, including condom use, among 535 heterosexual, African American, serodiscordant couples and identifies factors that might predict discordant reports. Percentages of agreement, Kappa and McNemar's statistics and conditional probability indices are used to measure concordance. Logistic regression models identify predictors of couples' discordant sexual reports. Analyses revealed Kappa statistics for reporting anal sex, fellatio and cunnilingus indicated moderate to substantial agreement. The effects of demographics and the couples' relationship contexts on concordance of reported sexual behaviors were found to vary somewhat by gender and type of sexual behavior. Findings showed that concordance of reporting between the couples was consistent for the past 90 and 30 days. Findings from this paper provide new scientific insights into the knowledge base of self-reported couples' data and suggest that these data can be used to evaluate their accuracy and serve as a proxy for validity.Development and evaluation of a complementary and alternative medicine use survey in African-Americans with acquired immune deficiency syndrome
AbstractOwen-Smith, A., Sterk, C., Mccarty, F., Hankerson-Dyson, D., & DiClemente, R. (n.d.).Publication year
2010Journal title
Journal of Alternative and Complementary MedicineVolume
16Issue
5Page(s)
569-577AbstractObjectives: The purpose of the current study was to develop and evaluate the psychometric properties of a culturally- and stage-of-disease-appropriate measure of complementary and alternative medicine (CAM) use among a population of African-American individuals with acquired immune deficiency syndrome (AIDS) using a mixed-method design. Design: Data were collected in two phases. In phase 1, qualitative data were used to refine an existing CAM measure for the specific study population in the present study. In phase 2, this refined instrument was implemented in a larger sample. The resulting numeric data were analyzed to evaluate the psychometric properties of the revised CAM instrument. Setting: Data were collected from patients who were receiving care from the infectious disease clinic of a large, public, urban hospital in the Southeastern United States. Subjects: Patients were eligible to participate if they (1) were receiving their care from the clinic, (2) had an AIDS diagnosis, (3) were identified as African-American, (4) were ≥21 years of age, (5) spoke English, and (6) were not cognitively impaired. Measures: Focus groups in phase 1 were conducted with a semistructured focus group guide. Participants also completed a basic sociodemographic survey. Phase 2 participants used programmed laptops to answer questions about their CAM use and several sociodemographic questions. Results: Information from the focus groups prompted some substantive revisions in the already-existing CAM survey. The revised instrument had satisfactory face validity and adequate test-retest reliability (r=0.79). Furthermore, the instrument factored in a manner that was interpretable and consistent with prior findings. Conclusions: In order for human immunodeficiency virus health care providers to provide the best care to their patients, they need to be informed about the types and frequency of CAM use among their patients. This can be accomplished by methodologically developing CAM instruments, rigorously implementing and assessing these instruments, and then disseminating the findings to researchers and practitioners.