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
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. (n.d.).Publication year
2010Journal title
Health promotion practiceVolume
11Issue
3_supplPage(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., & 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. (n.d.).Publication year
2010Journal title
Public Health ReportsVolume
125Issue
SUPPL. 4Page(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., & 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., 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., & DiClemente, R. (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., & 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.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. (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., 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. (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. (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., & DiClemente, R. (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
1-3Page(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., 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
AbstractAlbarracin, D., Rothman, A. J., Di Clemente, R., Del Rio, C., & DiClemente, R. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
SUPPL. 2Page(s)
S185-S188Abstract~A brief, clinic-based, safer sex intervention for heterosexual African American men newly diagnosed with an STD : a randomized controlled trial.
AbstractCrosby, R., DiClemente, R., Charnigo, R., Snow, G., & Troutman, A. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99 Suppl 1Page(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., 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., Wingood, G. M., Crosby, R. A., Salazar, L. F., Head, S., Rose, E., Sales, J. M., & 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., & 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