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
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.Neighborhood Environment, Sexual Risk Behaviors and Acquisition of Sexually Transmitted Infections Among Adolescents Diagnosed with Psychological Disorders
AbstractLang, D. L., Salazar, L. F., Crosby, R. A., DiClemente, R. J., Brown, L. K., & Donenberg, G. R. (n.d.).Publication year
2010Journal title
American journal of community psychologyVolume
46Issue
3Page(s)
303-311AbstractThe association between neighborhood environment and prevalence of STIs, sexual partner variables and condom use among adolescents with psychological disorders was examined. Cross-sectional data in three urban areas of the US (Southeast, Northeast and Midwest) were obtained from 384 sexually active male and female participants who provided urine samples for laboratory-confirmed testing of Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. A total of 15.4% of participants tested positive for one of the three STIs. Results indicated that relative to adolescents living in low risk neighborhood environments, those living in high risk environments were significantly more likely to have a STI and to report having casual partners. Findings suggest that in high risk neighborhoods, STI acquisition may be less dependent on condom use and more dependent on other contextual factors. The importance of expanding public health research to include assessment of neighborhood context as a determinant of sexual risk-taking is emphasized.Prevalence of child and adult sexual abuse and risk taking practices among HIV serodiscordant african-american couples
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)
1032-1044AbstractThis study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIVnegative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.Psychiatric disorders and sexual risk among adolescents in mental health treatment
AbstractBrown, L. K., Hadley, W., Stewart, A., Lescano, C., Whiteley, L., Donenberg, G., Diclemente, R., & Project Style Study Group, S. S. G. (n.d.).Publication year
2010Journal title
Journal of consulting and clinical psychologyVolume
78Issue
4Page(s)
590-597AbstractObjective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56 female, 58 African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment.Psychosocial correlates of intention to receive an influenza vaccination among rural adolescents
AbstractPainter, J. E., Sales, J. M., Pazol, K., Wingood, G. M., Windle, M., Orenstein, W. A., & Diclemente, R. J. (n.d.).Publication year
2010Journal title
Health Education ResearchVolume
25Issue
5Page(s)
853-864AbstractThe Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recently expanded annual influenza vaccination recommendations to include all children 6 months through 18 years of age. Adolescent attitudes toward influenza vaccination may play a key role in reaching this newly added age group. This study examined the association between attitudes toward influenza vaccination and intention to be vaccinated among rural adolescents. Data were collected from baseline surveys distributed to adolescents in September/October 2008, prior to the H1N1 influenza pandemic, in two counties participating in a school-based influenza vaccination intervention trial in rural Georgia (N=337). Survey items were based on constructs from the Health Belief Model and the Integrated Behavioral Model. Approximately one-third of participants (33.8%) intended to receive an influenza vaccination, 33.5% did not intend to be vaccinated and 28.8% were unsure. Controlling for background factors, intention to receive an influenza vaccination was associated with low perceived barriers [odds ratio (OR)=0.77, P < 0.001], injunctive norms (OR=1.23, P=0.002) and receipt of influenza vaccination in the past year (OR=6.21, P < 0.001). Findings suggest that perceived barriers and injunctive social norms may influence vaccination acceptance among rural adolescents. Future influenza vaccination efforts geared toward rural middle and high school students may benefit from addressing adolescent attitudes toward influenza vaccination.Risk and protective factors for unprotected intercourse among rural African American young adults
AbstractKogan, S. M., Brody, G. H., Chen, Y. F., Grange, C. M., Slater, L. T. M., & DiClemente, R. J. (n.d.).Publication year
2010Journal title
Public Health ReportsVolume
125Issue
5Page(s)
709-717AbstractObjectives. Despite increasing risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), few data are available concerning the factors associated with risky sexual behavior among African American young adults who do not attend college. Additionally, the possibility that different risk mechanisms affect men and women remains understudied. This article reports on the risk and protective factors associated with unprotected intercourse and gender differences in these factors' influence among this group. Predictors were derived from ecological and self-regulatory theories of risk behavior. Methods. African Americans aged 18-21 years were recruited via respondentdriven sampling (RDS) from seven contiguous rural counties. Risk and protective factors for unprotected intercourse were analyzed for 214 of 292 participants who reported sexual intercourse during the past three months. Results. Among sexually active participants, 62.6% used condoms inconsistently. The influence of leaving the parental home, perceived discrimination, risk-taking peers, family relationships, risk-taking propensity, and binge drinking on unprotected intercourse were moderated by gender. Positive attitudes toward condom use were associated with less unprotected intercourse controlling for the influence of risk variables for both men and women. Conclusions. Men and women have unique STI prevention needs. Additional research addressing these needs is necessary, particularly for rural African American men.Risky sexual behavior and correlates of std prevalence among african american hiv serodiscordant couples
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)
1023-1031AbstractThis paper reports baseline behavioral and biological data collected from a cohort of 535 African American HIV serodiscordant couples enrolled in the Eban study across four urban metro areas. Data were collected on (1) the prevalence of risky sexual behaviors that occur within a couple and with concurrent sexual partners, (2) the STD prevalence for each member of the couple and (3) the correlates of STDs in the male partner as well as in the female partner. Presentation of the sociodemographic characterization and HIV risk behavior profiles of African American HIV serodiscordant couples represents an important initial description of a hidden, vulnerable population. Future research should be conducted with diverse samples of African American couples (i.e., younger couples, non-stable couples) to explore other potential correlates of STD prevalence.The contribution of male and female partners' substance use to sexual risks and stds among african american hiv serodiscordant couples
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)
1045-1054AbstractGrowing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks.The Health and Recovery Peer (HARP) Program: A peer-led intervention to improve medical self-management for persons with serious mental illness
AbstractDruss, B. G., Zhao, L., Von Esenwein, S. A., Bona, J. R., Fricks, L., Jenkins-Tucker, S., Sterling, E., DiClemente, R., & Lorig, K. (n.d.).Publication year
2010Journal title
Schizophrenia ResearchVolume
118Issue
1Page(s)
264-270AbstractObjectives: Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions. Methods: The study team developed and pilot-tested the Health and Recovery Program (HARP), an adaptation of the Chronic Disease Self-Management Program (CDSMP) for mental health consumers. A manualized, six-session intervention, delivered by mental health peer leaders, helps participants become more effective managers of their chronic illnesses. A pilot trial randomized 80 consumers with one or more chronic medical illness to either the HARP program or usual care. Results: At six month follow-up, participants in the HARP program had a significantly greater improvement in patient activation than those in usual care (7.7% relative improvement vs. 5.7% decline, p=0.03 for group time interaction), and in rates of having one or more primary care visit (68.4% vs. 51.9% with one or more visit, p=0.046 for group time interaction). Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence, and, and though not statistically significant, had similar effect sizes as those seen for the CDSMP in general medical populations. Improvements in HRQOL were largest among medically and socially vulnerable subpopulations. Conclusions: This peer-led, medical self-management program was feasible and showed promise for improving a range of health outcomes among mental health consumers with chronic medical comorbidities. The HARP intervention may provide a vehicle for the mental health peer workforce to actively engage in efforts to reduce morbidity and mortality among mental health consumers.The Impact of Community-Based Sexually Transmitted Infection Screening Results on Sexual Risk Behaviors of African American Adolescents
AbstractSznitman, S. R., Carey, M. P., Vanable, P. A., DiClemente, R. J., Brown, L. K., Valois, R. F., Hennessy, M., Farber, N., Rizzo, C., Caliendo, A., Salazar, L. F., Stanton, B. F., & Romer, D. (n.d.).Publication year
2010Journal title
Journal of Adolescent HealthVolume
47Issue
1Page(s)
12-19AbstractPurpose: To examine the effect of a community-based sexually transmitted infection (STI) screening program on sexual risk behavior among African American adolescents. We hypothesized that adolescents testing positive for an STI and receiving post-test counseling would reduce risky sexual practices, whereas STI-negative adolescents would show little or no change in protective sexual behavior after screening. Methods: From August 2006 to January 2008, we recruited 636 sexually active African American adolescents (age, 14-17) from community-based organizations in two mid-sized U.S. cities with high STI prevalence. Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted self-interview. Youth who tested positive for an STI (6.6%) received treatment and counseling. Youth testing negative received no further intervention. Approximately 85% of participants completed 3- and 6-month follow-up assessments. Generalized estimating equations determined the effects of STI screening on adolescents' number of sexual partners and occurrence of unprotected sex. Results: Adolescents who tested positive for an STI reduced their number of vaginal and oral sex partners and the probability of unprotected sex. STI-negative adolescents demonstrated no change for numbers of partners or unprotected sex. Conclusions: Community-based STI screening can help to reduce sexual risk behavior in youth who test positive for STIs. Alternative approaches will be needed to reduce risk behavior in youth who test negative but who are nevertheless at risk for acquiring an STI.Wanted: A theoretical roadmap to research and practice across individual, interpersonal, and structural levels of analysis
Albarracin, D., Rothman, A. J., Di Clemente, R., & Del Rio, C. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Page(s)
S185-S188A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD: a randomized controlled trial.
AbstractCrosby, R., DiClemente, R. J., Charnigo, R., Snow, G., & Troutman, A. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Page(s)
S96-103AbstractOBJECTIVE: We evaluated the efficacy of a brief, clinic-based, safer sex program administered by a lay health adviser for young heterosexual African American men newly diagnosed with a sexually transmitted disease (STD). METHODS: Subsequent to STD diagnosis, eligible men (N = 266; aged 18-29 years) were randomized to either a personalized, single-session intervention (delivered by a lay health adviser) or standard of care. We conducted behavioral assessments at baseline and 3 months postintervention (retention was 74.1%). We also conducted a 6-month clinic record review. RESULTS: Compared to men randomized to the control condition, those receiving the intervention were significantly less likely to acquire subsequent STDs (50.4% vs 31.9%; P = .002) and more likely to report using condoms during last sexual intercourse (72.4% vs 53.9%; P = .008). They also reported fewer sexual partners (mean 2.06 vs 4.15; P < .001) and fewer acts of unprotected sex (mean 12.3 vs 29.4; P = .045). Based on a 9-point rating scale, men in the intervention group had higher proficiency scores for condom application skills (mean difference = 3.17; P < .001). CONCLUSION: A brief clinic-based intervention delivered by a lay health adviser may be an efficacious strategy to reduce incident STDs among young heterosexual African American men.African-American female adolescents who engage in oral, vaginal and anal sex: "Doing it all" as a significant marker for risk of sexually transmitted infection
AbstractSalazar, L. F., Crosby, R. A., DiClemente, R. J., Wingood, G. M., Rose, E., McDermott-Sales, J., & Caliendo, A. M. (n.d.).Publication year
2009Journal title
AIDS and BehaviorVolume
13Issue
1Page(s)
85-93AbstractAfrican-American female adolescents who engaged in vaginal sex only (N = 272) were compared to adolescents who engaged in two types (vaginal plus oral or anal; N = 295) and three types (vaginal, oral and anal; N = 144) on a constellation of other sexual risk behaviors (SRBs) and on sexually transmitted infections (STIs). Adjusted contrasts among groups revealed that adolescents who engaged in two and in three types of sex as compared to those who engaged in vaginal sex only were more likely to engage in six of the seven SRBs, but were just as likely to have a STI. One SRB, having ≥ 4 lifetime sex partners, was in turn associated with STI. Two-way interactions indicated that having a casual sex partner and having multiple sex partners in the last 60 days increased the likelihood of STI, but only for adolescents who engaged in all three types.Anal sex is a behavioural marker for laboratory-confirmed vaginal sexually transmissible infections and HIV-associated risk among African-American female adolescents
AbstractDiclemente, R. J., Wingood, G. M., Crosby, R. A., Salazar, L. F., Head, S., Rose, E., Sales, J. M. D., & Caliendo, A. M. (n.d.).Publication year
2009Journal title
Sexual HealthVolume
6Issue
2Page(s)
111-116AbstractBackground: African-American females are disproportionately affected by HIV and sexually transmissible infections (STIs). The prevalence of anal sex and its association with other sexual risk behaviours is understudied in this population. Methods: Participants were 715 African-American females, 15 to 21 years old, who had reported sexual activity in the previous 60 days. Data collection included an audiocomputer assisted self-interview (ACASI) and a self-collected vaginal swab specimen assayed using nucleic acid amplification tests to detect the presence of Chlamydia trachomatis and Neisseria gonorrhoeae, and real-time polymerase chain reaction assay to detect Trichomonas vaginalis. Results: Approximately 10.5% reported anal sex, at least once, during the 60 days before completing the computerised baseline assessment. The prevalence of any STI was significantly greater among adolescents reporting recent anal sex (40% tested positive for at least one of three laboratory-confirmed STIs) relative to those adolescents not reporting anal sex (27.5% STI prevalence). Of the 10 outcomes comprising the sexual risk profile, seven achieved bivariate significance, with each of the differences indicating greater risk for those recently engaging in anal sex. In multivariable controlled analyses, six of the seven measures retained statistical significance. Conclusions: African-American adolescent females who engage in penile-anal sex may experience an elevated risk of vaginally-acquired STIs. The findings suggest that, among those having penile-anal sex, several HIV/STI-associated sexual risk behaviours are significantly more prevalent. Thus, penile-anal sex may be an important proxy of overall sexual risk behaviours and can be readily assessed during paediatrician visits as part of a sexual history.Association of sexual abuse with incident high-risk human papillomavirus infection among young African-American women
AbstractWingood, G. M., Seth, P., Diclemente, R. J., & Robinson, L. S. (n.d.).Publication year
2009Journal title
Sexually Transmitted DiseasesVolume
36Issue
12Page(s)
784-786AbstractBackground: Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Noticeably absent from the known risk factors for HPV infection is history of sexual abuse. The current study examined the association between sexual abuse and incident high-risk HPV among young adult black women. Methods: This longitudinal study was part of a larger HIV/STI randomized controlled behavioral trial that randomly recruited eligible participants from October 2002 through March 2006. At baseline and 12-month follow-up, 665 black women, aged between 18 and 29, completed a survey assessing known HPV risk factors and history of sexual abuse, and provided specimens that were assayed for high-risk HPV. Incident high-risk HPV infection was defined as a laboratory-confirmed test for high-risk HPV at 12-month follow-up after testing HPV-negative at baseline. Results: The prevalence of high-risk HPV was 38.9%. Age-stratified multiple regression analyses examined sexual abuse that occurred during the 12-month follow-up and acquisition of high-risk HPV; known risk factors for HPV were entered as covariates. Women aged between 18 and 24 with a history of sexual abuse in the past year, compared with participants without a history, were 4.5 times more likely to test positive for an incident high-risk HPV infection (P <0.007). This relationship was not significant for the overall sample or for women aged between 25 and 29 years. DISCUSSION: This is one of the first analyses demonstrating exposure to sexual abuse as a predictor of high-risk HPV. HPV vaccination recommendations for black women, 18 to 24 years of age, with a history of sexual abuse warrant special consideration.Condom failure: Examining the objective and cultural meanings expressed in interviews with African American adolescents
AbstractSznitman, S. R., Horner, J., Salazar, L. F., Romer, D., Vanable, P. A., Carey, M. P., Diclemente, R. J., Valois, R. F., & Stanton, B. F. (n.d.).Publication year
2009Journal title
Journal of Sex ResearchVolume
46Issue
4Page(s)
309-318AbstractThe purpose of this study was to explore the meaning and context of self-reported "condom failure" among sexually active African American adolescents. Semistructured interviews regarding methods of protection from pregnancy and sexually transmitted disease (STD) with 124 youth (ages 14-19 years) were content analyzed. The findings suggested three meanings of condom failure. First, condom failure represents a legitimate and important risk related to sexual activity. Second, it can serve as an excuse repertoire for adolescents who engaged in unprotected sex and later experienced either pregnancy or a STD. Third, it may serve as an explanation for males who deceive their partners into having unprotected sex. The findings are discussed with regard to their implications for HIV or STD prevention and research.Correlates of Consistent Condom Use with Main-New and Main-Old Sexual Partners
AbstractWiemann, C. M., Chacko, M. R., Kozinetz, C. A., DiClemente, R., Smith, P. B., Velasquez, M. M., & Von Sternberg, K. (n.d.).Publication year
2009Journal title
Journal of Adolescent HealthVolume
45Issue
3Page(s)
296-299AbstractAn exploratory study identified correlates of consistent condom use for young women reporting Main-new or Main-old partners in the past 3 months: frequency of vaginal sex (across partner types); perceived likelihood of getting a STI (Main-new); age and STI history (Main-old). To enhance programmatic efficacy in community clinics, these key correlates of condom use for main partner types should be incorporated in STI risk reduction counseling.Correlates of correct condom use among high-risk African American men attending an Urban STD clinic in the South
AbstractCrosby, R., DiClemente, R. J., & Yarber, W. L. (n.d.).Publication year
2009Journal title
International Journal of Sexual HealthVolume
21Issue
3Page(s)
183-191AbstractThe purpose of this cross-sectional study was to assess prevalence and correlates of correct condom use among high-risk African American men attending a publicly funded sexually transmitted disease (STD) clinic. Men 18 through 29 years of age and newly diagnosed with an STD were further assessed for study eligibility. Of 296 meeting eligibility criteria, 271 agreed to participate, thereby yielding a participation rate of 91.5%. Correct use, assessed by an index, was reported by 38%. Correct use was associated with having sex with three or fewer female sex partners, being in an exclusive relationship, not indicating problems with the fit or feel of condoms, and not being drunk/high while using condoms. The correct use of condoms among young African American men newly diagnosed with an STD may be a function of situational factors. These factors could potentially be addressed in the context of clinic-based behavioral intervention programs.Correlates of heterosexual anal intercourse among at-risk adolescents and young adults
AbstractLescano, C. M., Houck, C. D., Brown, L. K., Doherty, G., DiClemente, R. J., Fernandez, M. I., Pugatch, D., Schlenger, W. E., & Silver, B. J. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1131-1136AbstractObjectives. We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. Methods. Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. Results. Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. Conclusions. Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women
AbstractRaiford, J. L., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1067-1071AbstractObjectives. We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. Methods. We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. Results. Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; χ2=4.32; P≤.04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; χ2=8.06; P≤.01). Conclusions. Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women.Efficacy of sexually transmitted disease/human immunodeficiency virus sexual risk-reduction intervention for African American adolescent females seeking sexual health services: A randomized controlled trial
AbstractDiClemente, R. J., Wingood, G. M., Rose, E. S., Sales, J. M., Lang, D. L., Caliendo, A. M., Hardin, J. W., & Crosby, R. A. (n.d.).Publication year
2009Journal title
Archives of Pediatrics and Adolescent MedicineVolume
163Issue
12Page(s)
1112-1121AbstractObjectives: To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)-preventive behaviors and psychosocial mediators. Design: A randomized controlled trial of an HIV prevention program. Setting: Clinic-based sample in Atlanta, Georgia. Participants: African American adolescent females (N=715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computerassisted self-interview and provided self-collected vaginal specimens for STD testing. Intervention: Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment. Main Outcome Measure: Incident chlamydial infections. Results: Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P=.04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P=.02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; P<.001) and less frequent douching (mean difference, -0.76; 95% CI, -1.15 to -0.37; P=.001). Adolescents in the intervention were also more likely to report consistent condom use in the 60 days preceding follow-up assessments (RR, 1. 41; 95% CI, 1.09 to 1.80; P=.01) and condom use at last intercourse (RR, 1.30; 95% CI, 1.09 to 1.54; P=.005). Intervention effects were observed for psychosocial mediators of STD/HIV-preventive behaviors. Conclusion: Interventions for African American adolescent females can reduce chlamydial infections and enhance STD/HIV-preventive behaviors and psychosocial mediators of STD/HIV-preventive behaviors. Trial Registration: clinicaltrials.gov Identifier: NCT00633906.Exploring the mediating mechanism between gender-based violence and biologically confirmed chlamydia among detained adolescent girls
AbstractSalazar, L. F., Crosby, R. A., & Diclemente, R. J. (n.d.).Publication year
2009Journal title
Violence Against WomenVolume
15Issue
3Page(s)
258-275AbstractThe study examined several behavioral mechanisms that link gender-based violence (GBV) to STD among detained, sexually active adolescent girls. Girls (N = 198) were recruited from eight youth detention facilities. Measures were assessed using audiocomputerĝ€"assisted self-interviewing. DNA amplification was conducted to assess for chlamydia. Thirty-one percent had experienced GBV and 15% tested positive for chlamydia. GBV was related to chlamydia directly and indirectly through condom failures and through having sexual intercourse while high on drugs and/or alcohol. The study found that sexual risk reduction programs may benefit this population by addressing the role of GBV and its association with STD-associated behaviors.Exposure to High-Risk Genital Human Papillomavirus and Its Association with Risky Sexual Practices and Laboratory-Confirmed Chlamydia Among African-American Women
AbstractSeth, P., Wingood, G. M., Robinson, L. S. S., & DiClemente, R. J. (n.d.).Publication year
2009Journal title
Women's Health IssuesVolume
19Issue
5Page(s)
344-351AbstractBackground: Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States and African-American women have the highest prevalence of high-risk HPV. This study examined exposure to high-risk HPV in African-American women and its relation to risky sexual practices and laboratory-confirmed chlamydia. Methods: A sample of 665 African-American women between 18 and 29 years old, recruited from October 2002 to March 2006 in Atlanta, Georgia, completed an Audio Computer-Assisted Survey Interview assessing sociodemographics, health practices, and risky sexual practices. Participants also provided vaginal swab specimens assayed for STIs and high-risk HPV. Results: The overall prevalence of high-risk HPV was 38.9%. Among women 18 to 24 years old, it was 42.4%; it was 31% among women 25 to 29 years old. Age-stratified logistic regression analyses indicated that women between the ages of 18 and 29 and 18 and 24 who had multiple male sexual partners did not use a condom during their last casual sexual encounter and tested positive for chlamydia were significantly more likely to test positive for high-risk HPV. Women 18 to 24 years old who reported having a casual or risky sexual partner were significantly more likely to test positive for high-risk HPV. No significant correlates were identified among women 25 to 29 years old. Conclusions: Programs should aim to educate, decrease risky sexual practices, and increase screening and treatment for STIs among women with high-risk HPV infections. HPV vaccination recommendations for young adult African-American women warrant special consideration.