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
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. J., 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. J. (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. J., 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
14Page(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. J., & 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. J., 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. J. (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. J., & Rose, E. (n.d.).Publication year
2010Journal title
Health promotion practiceVolume
11Issue
3Page(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. J. (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. J., & 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. J., Ruiz, M. S., & Sales, J. M. D. (n.d.).Publication year
2010Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
54Page(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.Development of the sexual sensation-seeking scale for African American adolescent women
AbstractDiclemente, R., Milhausen, R. R., Salazar, L. F., Spitalnick, J., Sales, J. M., Crosby, R. A., Younge, S. N., & Wingood, G. M. (n.d.).Publication year
2010Journal title
International Journal of Sexual HealthVolume
22Issue
4Page(s)
248-261AbstractWe used data derived from two independent studies to examine the psychometric properties of a new scale to measure adolescents' willingness to engage in sexual sensation-seeking behavior. In Study 1, the Sexual Sensation-Seeking Scale for Adolescents (SSSA) was administered to a sample of 715 African American adolescents ranging in age from 15 to 21 years. The SSSA demonstrated strong internal consistency, moderate stability, and satisfactory construct validity. In Study 2, the SSSA data from a subsample of African American adolescent women detained in youth detention centers were analyzed (N = 103). Strong internal consistency was demonstrated with this sample as well. The results indicate that the SSSA is a reliable and valid measure of sexual sensation seeking for African American adolescent women.Development, Theoretical Framework, and Lessons Learned From Implementation of a School-Based Influenza Vaccination Intervention
AbstractPainter, J. E., Sales, J. M., Pazol, K., Grimes, T., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2010Journal title
Health promotion practiceVolume
11Issue
3Page(s)
42S-52SAbstractThe Advisory Committee on Immunization Practices (ACIP) recently recommended that all children 6 months to 18 years old be vaccinated annually against influenza. School-based influenza vaccination interventions may potentially increase influenza vaccination rates among hard-to-reach populations, particularly rural adolescents. This article describes the theoretical framework, intervention development, and lessons learned from 1st-year implementation of a multicomponent intervention aimed to promote influenza vaccine acceptance among multiethnic (predominantly African American) adolescents attending middle and high school in rural Georgia. Adolescents, parents, and school administrators were active participants in the development and implementation of the intervention. The educational intervention, which consisted of a brochure and a school skit/ presentation, was guided by constructs from the Health Belief Model and social norms. Process evaluation results indicated that our intervention development methods were successful in creating a low-cost, theory-based educational intervention that garnered community investment and met the cultural relevance and literacy needs of our target audience. To our knowledge, this study is the first to extensively engage middle- and high-school students and parents in the design and implementation of key educational components of a theory-based influenza vaccination intervention.Differences between dual-method and non-dual-method protection use in a sample of young African American women residing in the Southeastern United States
AbstractSales, J. M., Latham, T. P., DiClemente, R. J., & Rose, E. (n.d.).Publication year
2010Journal title
Archives of Pediatrics and Adolescent MedicineVolume
164Issue
12Page(s)
1125-1131AbstractObjectives: To characterize dual-method protection users and report the prevalence of dual-method use among young adult African American women residing in the Southeastern United States. Design: Analysis of baseline data from a randomized controlled trial. Setting: A clinic-based sample of young women enrolled in a randomized trial of a human immunodeficiency virus (HIV)-prevention program in Atlanta, Georgia, from June 2005 to June 2007. Participants: African American women aged 14 to 20 years who reported unprotected sexual activity in the past 6 months. Of the eligible adolescents, 94% (N=701) were enrolled in the study and completed baseline assessments. Outcome Measures: Dual-method protection use as well as sociodemographic, individual-level, interpersonal-level, and community-level factors and interpersonal communication skills. Only data from the baseline assessment, before randomization, were used for the analysis. Results: A total of 102 participants (14.6%) were classified as dual-method protection users. After controlling for age and clinic, significant differences between dual-method users and non-dual-method users were found for impulsivity, self-esteem, social support, relationship style, partner communication self-efficacy, and fear of condom negotiation. Conclusions: Dual-method protection use is low. Identification of factors that differentiate dual-method users from non-dual-method users at the individual, interpersonal, and community levels in this young African American sample suggests that HIV, sexually transmitted disease, and unintended pregnancy risk-reduction programs should address factors at each level, not simply the individual level, and that this may involve structural and/or clinical counseling practice changes in clinics that serve young women, to optimally facilitate dual-method protection use among young African American women in the Southeastern United States.Differentiating between precursor and control variables when analyzing reasoned action theories
AbstractHennessy, M., Bleakley, A., Fishbein, M., Brown, L., DiClemente, R., Romer, D., Valois, R., Vanable, P. A., Carey, M. P., & Salazar, L. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
1Page(s)
225-236AbstractThis paper highlights the distinction between precursor and control variables in the context of reasoned action theory. Here the theory is combined with structural equation modeling to demonstrate how age and past sexual behavior should be situated in a reasoned action analysis. A two wave longitudinal survey sample of African-American adolescents is analyzed where the target behavior is having vaginal sex. Results differ when age and past behavior are used as control variables and when they are correctly used as precursors. Because control variables do not appear in any form of reasoned action theory, this approach to including background variables is not correct when analyzing data sets based on the theoretical axioms of the Theory of Reasoned Action, the Theory of Planned Behavior, or the Integrative Model.Economically motivated relationships and transactional sex among unmarried African American and white women: Results from a U.S. national telephone survey
AbstractDunkle, K. L., Wingood, G. M., Camp, C. M., & DiClemente, R. J. (n.d.).Publication year
2010Journal title
Public Health ReportsVolume
125Page(s)
90-100AbstractObjective. We explored links among economically motivated relationships, transactional sex, and risk behavior for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) among unmarried African American and white women. Methods. We drew on data from 1,371 unmarried African American and white women aged 20 to 45 years that we collected via a random-digit-dial telephone survey in the U.S. Results. Of all respondents, 33.3% (95% confidence interval 28.8, 38.0) reported staying in a relationship longer than they wanted to because of economic considerations. African American women were more likely than white women to report starting a relationship due to economic considerations (21.6% vs. 10.5%) and having transactional sex with someone who was not a regular partner (13.1% vs. 2.9%). These behaviors were all associated with lack of education, experience of economic hardship, need to care for dependents, and increased levels of HIV/STI risk. All three behaviors were associated with having more sexual partners. Staying in a sexual relationship because of economic considerations was also associated with anal sex, reduced condom use, and concurrent sexual partnerships. Transactional sex with non-regular partners was associated with concurrent sexual partnerships, binge drinking, drug use, perceived concurrency by main partner, and having high-risk sexual partners. Conclusion. HIV/STI risk-reduction policies and programs in the U.S. need to explicitly address overall economic disempowerment among women, as well as racial disparities in poverty. These economic disparities likely contribute both to increasing rates of HIV among women in the U.S. and to the extraordinary racial disparities in HIV/STI risk among American women.Efficacy of a Motivational Behavioral Intervention to Promote Chlamydia and Gonorrhea Screening in Young Women: A Randomized Controlled Trial
AbstractChacko, M. R., Wiemann, C. M., Kozinetz, C. A., Von Sternberg, K., Velasquez, M. M., Smith, P. B., & DiClemente, R. (n.d.).Publication year
2010Journal title
Journal of Adolescent HealthVolume
46Issue
2Page(s)
152-161AbstractBackground: Seeking screening and treatment for chlamydia (CT) and gonorrhea (GC) by young women is critical to reduction of asymptomatic cervicitis and its complications. Objectives: To evaluate the efficacy of a client-centered motivational behavioral intervention (MBI), to promote seeking of sexually tranmitted infection (STI) checkups by young women. Methods: Three hundred seventy-six of 770 eligible sexually active, nonpregnant, English-speaking women (mean age 18.5 years) were recruited from an urban reproductive health clinic and randomized to two groups: intervention plus standard care (MBI) or standard care alone (SC). MBI (two sessions plus booster) was based on the Transtheoretical Model of Change and employed motivational interviewing. Outcome measures monitored for 12 months included: client-initiated clinic visits for STI checkups in response to seven high-risk sexual behaviors by self-report (primary), consistent condom use, number of CT and GC episodes, and movement along the stages of change obtained at baseline and 6- and 12-month follow-up assessments (secondary). Analyses included chi-square, logistic regression, and generalized estimating equations. Results: At baseline, more than 70% endorsed the action stage of change for seeking STI checkups for three of seven high-risk sexual behaviors. No significant differences were noted between the two groups for the primary or secondary outcomes. Across groups, having multiple partners and being pregnant or thinking one might be pregnant were associated with STI checkups. Conclusions: This is the first known client-centered clinical trial to promote STI screening. Risk-taking and health-seeking behaviors are complex and interrelated with STI and pregnancy concerns. The intervention may have an effect if it is targeted to women in a less medically connected community-based sample.Efficacy of an HIV prevention program among African American female adolescents reporting high depressive symptomatology.
AbstractSales, J. M., Lang, D. L., Hardin, J. W., Diclemente, R. J., & Wingood, G. M. (n.d.).Publication year
2010Journal title
Journal of women's health (2002)Volume
19Issue
2Page(s)
219-227AbstractWe examined the efficacy of an HIV prevention intervention among African American adolescent females reporting at or above threshold depressive symptomatology. In this analysis, a subgroup of participants (n = 245) reporting at or above threshold depressive symptoms involved in a randomized controlled trial were assessed at 6-month and 12-month follow-ups on condom use and psychosocial mediators associated with HIV prevention behaviors. The intervention emphasized HIV knowledge, condom attitudes, communication self-efficacy, and condom use skills. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, engaged in a greater proportion of condom protected intercourse acts, had fewer episodes of unprotected vaginal sex, were more likely to use a condom at last sex, and had higher HIV knowledge, favorable attitudes toward condoms, condom use self-efficacy, and condom use skills. Overall, the pattern of effects found strengthen our confidence in the efficacy of the HIV intervention assessed for a broad range of young women, including those with high levels of depressive symptoms. Although young women with high depressive symptoms benefited from this HIV intervention, future studies employing interventions that specifically address the affective needs of this population might be even more effective in terms of sexual risk reduction and amelioration of depressive symptoms.Emotional victimization and sexual risk-taking behaviors among adolescent African American women
AbstractYounge, S. N., Salazar, L. F., Sales, J. M., Diclemente, R. J., Wingood, G. M., & Rose, E. (n.d.).Publication year
2010Journal title
Journal of Child and Adolescent TraumaVolume
3Issue
2Page(s)
79-94AbstractPrevious research has demonstrated that a history of gender-based victimization is associated with higher rates of sexual risk-taking behaviors among adolescents. Victimization can occur in various forms. To date, no published studies have examined the relationship between the different forms of victimization and sexual risk-taking behaviors among African American adolescent women. This study explored the association between different forms of victimization and sexual risk behaviors using baseline data from participants (N = 715) with a mean age of 17.9 (SD = 1.7), who were enrolled in a larger intervention study. The results revealed that a history of any form of victimization was associated with some form of sexual risk behaviors.Evaluation of an HIV/STD Sexual Risk-Reduction Intervention for Pregnant African American Adolescents Attending a Prenatal Clinic in an Urban Public Hospital: Preliminary Evidence of Efficacy
AbstractDiClemente, R. J., Wingood, G. M., Rose, E., Sales, J. M., & Crosby, R. A. (n.d.).Publication year
2010Journal title
Journal of Pediatric and Adolescent GynecologyVolume
23Issue
1Page(s)
32-38AbstractStudy Objective: To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents. Design: A randomized controlled trial. Participants completed baseline and follow-up assessments. Setting: An urban public hospital in the Southeastern U.S. Participants: Pregnant African-American adolescents (N = 170), 14-20 years of age, attending a prenatal clinic. Intervention: Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition. Main Outcome Measures: Consistent condom use. Results: Intervention participants reported greater condom use at last intercourse (adjusted odds ratio = 3.9, P = 0.05) and consistent condom use (AOR = 7.9, P = 0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex. Conclusions: Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.HIV knowledge and its contribution to sexual health behaviors of low-income African American adolescents
AbstractSwenson, R. R., Rizzo, C. J., Brown, L. K., Vanable, P. A., Carey, M. P., Valois, R. F., DiClemente, R. J., & Romer, D. (n.d.).Publication year
2010Journal title
Journal of the National Medical AssociationVolume
102Issue
12Page(s)
1173-1182AbstractObjectives: Although many factors contribute to racial disparities in human immunodeficiency virus (HIV)/AIDS among young African Americans, knowledge is a particularly modifiable factor. However, little information has been published about the current HIV knowledge of African American teens or to what extent knowledge independently contributes to their sexual behavior and health. This study aimed to describe the level of knowledge among this at-risk population and determine whether knowledge contributes to variance in sexual behavior and health beyond that of sociodemographic and psychological factors. Methods: African American adolescents (n = 1658) were recruited in 2 northeastern and 2 southeastern US cities (74% eligible for free or reduced-price school lunch). Analyses utilized data gathered from adolescents using an audio computer-assisted self-interview program. Results: On average, participants answered only 50% of HIV knowledge items correctly and were least accurate concerning effective condom use and HIV testing. Controlling for associated sociodemographic and psychological factors, greater knowledge was associated with sexual experience and, among experienced adolescents, with sexually transmitted infection/HIV testing and - unexpectedly - less condom use. Conclusions: HIV knowledge, which is modifiable, is limited among at-risk African American adolescents and is an important contributor to sexual behavior and health. Findings indicate a need for more comprehensive HIV/AIDS education, particularly with regard to condom use and the benefits of routine sexually transmitted infection/HIV testing. Although knowledge might not be sufficiently protective in and of itself, having accurate information about HIV may benefit sexual health by impacting health-promoting attitudes necessary for successful engagement in health care-seeking behavior.HIV prevention for heterosexual African-American women
AbstractWingood, G. M., & Di Clemente, R. J. (n.d.). In African Americans and HIV/AIDS (1–).Publication year
2010Page(s)
211-221AbstractEarly in the epidemic, HIV infection and AIDS were diagnosed among relatively few women and female adolescents. Currently, women account for more than 25% of all new HIV/AIDS diagnoses. Historically, African-American women have been disproportionately affected by the HIV epidemic. In 2002, the most recent year for which data are available, HIV infection was the leading cause of death for African-American women 25-34 years old; the third leading cause of death for African-American women aged 35-44 years old and the fourth leading cause of death for African-American women 45-54 years old. In this same year, HIV infection was the fifth leading cause of death among all women 35-44 years of age and the six leading cause of death among all women aged 25-34 year old. The only diseases causing more death of women were cancer and heart disease (Anderson & Smith, 2005).Intimate partner violence and other partner-related factors: Correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women
AbstractSeth, P., Raiford, J. L., Robinson, L. S., Wingood, G. M., & Diclemente, R. J. (n.d.).Publication year
2010Journal title
Sexual HealthVolume
7Issue
1Page(s)
25-30AbstractBackground: Intimate partner violence and other partner-related factors have been associated with acquiring sexually transmissible infections (STIs) and engaging in risky sexual behaviour. The present study examined partner-related risk factors for STIs and risky sexual behaviours among an urban sample of African American women. Methods: African American women, between 18 and 29 years (n = 848), participated in the study at baseline. Participants completed a 40-min Audio Computer Assisted Survey Interview assessing sociodemographics, partner-related factors and HIV/STI-associated sexual risk behaviours. Subsequently, participants provided two vaginal swab specimens for STIs. Results: The findings indicated that risky sexual behaviours and STIs were prevalent in this sample: 35.6% reported a risky sexual partner, 65.4% reported inconsistent condom use and 17% tested positive for a laboratory-confirmed STI. Women reporting a history of intimate partner violence were more likely to report risky sexual partners (adjusted odds ratio (AOR)=2.00; 95% confidence interval (CI)=1.52.8), inconsistent condom use (AOR=1.60; 95% CI=1.12.3) and test positive for an STI (AOR=1.46; 95% CI=0.992.1). Women reporting high partner-related barriers to condom use were more likely to report risky sexual partners (AOR=1.69; 95% CI=1.22.3), inconsistent condom use (AOR=2.13; 95% CI=1.53.0) and test positive for an STI (AOR=1.98; 95% CI=1.33.0). Finally, women with older partners were more likely to report risky sexual partners (AOR=1.53; 95% CI=1.12.1) and test positive for an STI (AOR=1.46; 95% CI=1.02.2). Conclusions: This study examines partner-related risk factors for STIs and risky sexual behaviours among African American women. These findings underscore the need for combined intimate partner violence and HIV/STI prevention programs for this disproportionately affected high-risk group.