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
Internalizing symptoms and safe sex intentions among adolescents in mental health treatment : Personal factors as mediators
AbstractDiClemente, R. (n.d.).Publication year
2014Journal title
Children and Youth Services ReviewVolume
46Page(s)
177-185AbstractLittle is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N. =. 893, M age. =. 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program : A Randomized Trial
AbstractKissinger, P. J., Green, J., Latimer, J., Schmidt, N., Ratnayake, A., Madkour, A. S., Clum, G., Wingood, G. M., DiClemente, R., & Johnson, C. (n.d.).Publication year
2023Journal title
Sexually Transmitted DiseasesVolume
50Issue
6Page(s)
329-335AbstractBackground Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. Methods Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. Results Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. Conclusion and Relevance The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.Interpersonal- and community-level predictors of intimate partner violence perpetration among African American men
AbstractRaiford, J. L., Seth, P., Braxton, N. D., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
4Page(s)
784-795AbstractIntimate partner violence (IPV) has been associated with adverse physical, psychoemotional, and sexual health, and African American women are at higher risk for experiencing IPV. Considering African American women predominantly have African American male partners, it is essential to identify factors associated with IPV perpetration among African American men. The present study examined attitudes toward IPV, ineffective couple conflict resolution, exposure to neighborhood violence, and the interplay of these factors as predictors of IPV perpetration. A community sample of 80 single, heterosexual, African American men between 18 and 29 years completed measures assessing sociodemographics, attitudes towards IPV, perceived ineffective couple conflict resolution, exposure to neighborhood violence, and IPV perpetration during the past 3 months. Hierarchical multiple linear regression analyses, with age, education, and public assistance as covariates, were conducted on 65 men who reported being in a main relationship. Couple conflict resolution and exposure to neighborhood violence moderated the relation between attitudes supporting IPV and IPV perpetration. Among men who reported high ineffective couple conflict resolution and high exposure to neighborhood violence, IPV perpetration increased as attitudes supporting IPV increased. The findings indicated that interpersonal- and community-level factors interact with individual level factors to increase the risk of recent IPV perpetration among African American men. While IPV prevention should include individual-level interventions that focus on skills building, these findings also highlight the importance of couple-, community-, and structural-level interventions.Interventions to reduce alcohol use among HIV-Infected individuals : A review and critique of the literature
AbstractBrown, J. L., Demartini, K. S., Sales, J. M., Swartzendruber, A. L., & DiClemente, R. (n.d.).Publication year
2013Journal title
Current HIV/AIDS ReportsVolume
10Issue
4Page(s)
356-370AbstractAlcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.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.Is male intent to be vaccinated against HPV a function of the promotion message?
AbstractDiClemente, R., DiClemente, R. J., Crosby, R. A., Salazar, L. F., Nash, R., & Younge, S. (n.d.).Publication year
2011Journal title
International Journal of STD and AIDSVolume
22Issue
6Page(s)
332-334AbstractWe aimed to determine whether the type of outcome expectation, stemming from HPV vaccination, would have any effect on young men's HPV vaccine intent. We recruited young men (18-24 years of age) from two university campuses (n = 150). After answering a series of questions they were randomly assigned to one of three information conditions (all delivered by computer): (1) how women may benefit from men's HPV vaccination, (2) preventing genital warts and (3) preventing head and neck cancers. Intent to be vaccinated against HPV in the next 12 months was assessed before and after receiving the informational session corresponding to the assigned condition. A repeated-measures t-test indicated that a significant increase in young men's intent to be vaccinated after they received the assigned information (t = 9.48, [147], P = 0.0001). However, the increase in intent to be vaccinated did not vary by group assignment as there were no significant differences in mean intent scores between the three groups (F = 0.59, [2/144], P = 0.56). Information that promotes the outcome expectations of protecting women from cervical cancer, preventing genital warts for men and preventing head and neck cancers for men may be equally effective in promoting increased intent for HPV vaccine acceptance among young university men.Is the Brief Multidimensional Student’s Life Satisfaction Scale Valid and Reliable for African American Adolescents?
AbstractValois, R. F., Zullig, K. J., Brown, L. K., Carey, M. P., Vanable, P. A., Romer, D., & DiClemente, R. (n.d.).Publication year
2019Journal title
American Journal of Health EducationVolume
50Issue
6Page(s)
344-355AbstractBackground: Health promotion/education strive to promote healthful conditions that improve quality of life based on the perceptions of those whose lives are affected Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life. Life satisfaction (LS) has been defined as an individual’s assessment of their quality of life based upon personal criteria and linked to adolescent health risk behaviors and developmental assets. Purpose: We investigated the psychometrics of the Brief Multidimensional Students’ Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N = 1,658) from four mid-sized cities in the United States. Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents. Methods: Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen’s d) and inspecting the scale’s internal structure, reliability, and relationships to other variables. Results: Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined. Translation to Health Education Practice: The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative."Islands of risk" : Subgroups of adolescents at risk for HIV
AbstractHouck, C. D., Lescano, C. M., Brown, L. K., Tolou-Shams, M., Thompson, J., DiClemente, R., Fernandez, M. I., Pugatch, D., Schlenger, W. E., & Silver, B. J. (n.d.).Publication year
2006Journal title
Journal of pediatric psychologyVolume
31Issue
6Page(s)
619-629AbstractObjective: To use cluster analysis to determine profiles of adolescents at risk for HIV. Methods: Adolescents 15-21 years old (N = 1153) with a history of unprotected sex were assessed in five domains of risk (unprotected sex, alcohol/marijuana use, other drug use, mental health crises, and arrest/school dropout) as well as demographic, contextual, and behavioral variables. Results: Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk. Cluster membership was associated with secondary variables related to sexual risk. Conclusions: Even within populations of high-risk adolescents, subgroups exist for which specific risk factors co-occur, particularly unprotected sex, mental health crises, and substance use. These patterns suggest that effective HIV prevention interventions may need to target the association between mental health and/or substance abuse with sexual risk for some adolescents.It takes 2 : Partner attributes associated with sexually transmitted infections among adolescents
AbstractSwartzendruber, A., Zenilman, J. M., Niccolai, L. M., Kershaw, T. S., Brown, J. L., DiClemente, R., & Sales, J. M. (n.d.).Publication year
2013Journal title
Sexually Transmitted DiseasesVolume
40Issue
5Page(s)
372-378AbstractOBJECTIVES: The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. DESIGN: The design of this study was systematic review. METHODS: We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. RESULTS: Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. CONCLUSIONS: Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies.Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkage
AbstractGardner, S. K., Elkington, K. S., Knight, D. K., Huang, S., DiClemente, R., Spaulding, A. C., Oser, C. B., Robertson, A. A., & Baird-Thomas, C. (n.d.).Publication year
2019Journal title
Health and JusticeVolume
7Issue
1AbstractBackground: While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist). Methods: Juvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items). Results: Confirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff. Conclusions: Establishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) : A cluster randomized trial targeting system-wide improvement in substance use services
AbstractDiClemente, R. (n.d.).Publication year
2016Journal title
Implementation ScienceVolume
11Issue
1AbstractBackground: The purpose of this paper is to describe the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan. Methods/design: The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Discussion: Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project. Trial registration:NCT02672150.Lack of recent condom use among detained adolescent males : A multilevel investigation
AbstractDiClemente, R., Crosby, R., Salazar, L. F., & DiClemente, R. J. (n.d.).Publication year
2004Journal title
Sexually transmitted infectionsVolume
80Issue
6Page(s)
425-429AbstractObjective: To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities. Methods: A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal. Results: Nine correlates achieved bivariate significance (pLanguage and Love : Generation Y Comes of Age Online
AbstractJenssen, B. P., Gray, N. J., Harvey, K., DiClemente, R., & Klein, J. D. (n.d.).Publication year
2014Journal title
SAGE OpenVolume
4Issue
1AbstractSocial networking sites (SNS) provide adolescents with opportunities for content generation on a wide range of social issues, providing unique insight into the psychosocial development of adolescence. We explored SNS webpages viewed by a random sample of adolescents during the initial uptake of SNS use (2005) to describe their general language use. Adolescents aged 14 to 17 with home Internet access were recruited using list-assisted random digit dialing methods. All SNS (MySpace) webpages viewed by participants were captured, and a large, structured set of texts (text corpus) was created from the profiles and message boards therein. Using concordance software, word frequency and keyword associations were analyzed. The 346 participants viewed approximately 28,000 MySpace pages, yielding a 1,147,432-word text corpus. Profile sections presented information about the content creator, while message boards focused more on short conversations with recipients. The most common content word was the term love. Profile owners would profess their love for activities, such as dancing, partying, or shopping, followed by their love for family, friends, and significant others. SNS offer teens an opportunity to describe and share feelings about people, places, and things connected to a range of activities and social contacts within their online and offline environments. Better understanding of SNS can offer strategies to adolescents and health care providers for insight into what connects young people in a community.Lessons Learned From Delivering Imara, an HIV/STI Risk Reduction Intervention for African American Girls in Juvenile Detention
AbstractDavis, T. L., Boyce, L. S., Rose, E., Swartzendruber, A., DiClemente, R., Gelaude, D., Fasula, A. M., & Carry, M. (n.d.).Publication year
2016Journal title
Health promotion practiceVolume
17Issue
1Page(s)
31-39AbstractA critical need exists for efficacious interventions to reduce sexual risk and sexually transmitted infections (STIs) among African American girls in juvenile detention. Adapting evidence-based interventions is one strategy for developing interventions that might protect detained African American girls from adverse sexual health outcomes. To support development and implementation of evidence-based HIV/STI prevention interventions for this population, this qualitative study describes lessons learned from delivering Imara, an adapted HIV/STI prevention intervention for detained African American girls. Program implementation includes one-on-one sessions in the detention facility that offer logistical advantages; provide intervention contact inside the facility, soon after release, and frequently thereafter; address STI treatment for girls and their sexual partners; tailor intervention content based on individual risk and learning needs; and identify and acknowledge girls’ competing priorities. These lessons are discussed in the context of challenges encountered and solutions for addressing the challenges, and in terms of the structure and content of the intervention. The lessons learned from delivering Imara exemplify the continuous process of adapting an existing intervention for a new population and setting.Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods : Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?
AbstractKim, B., Callander, D., DiClemente, R., Trinh-Shevrin, C., Thorpe, L. E., & Duncan, D. T. (n.d.).Publication year
2019Journal title
AIDS and BehaviorVolume
23Issue
10Page(s)
2795-2802AbstractDespite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.Long term effects of community-based STI screening and mass media HIV prevention messages on sexual risk behaviors of African American adolescents
AbstractSznitman, S., Stanton, B. F., Vanable, P. A., Carey, M. P., Valois, R. F., Brown, L. K., DiClemente, R., Hennessy, M., Salazar, L. F., & Romer, D. (n.d.).Publication year
2011Journal title
AIDS and BehaviorVolume
15Issue
8Page(s)
1755-1763AbstractWe examined the long-term effects of two interventions designed to reduce sexual risk behavior among African American adolescents. African American adolescents (N = 1383, ages 14-17) were recruited from community-based organizations over a period of 16 months in two northeastern and two southeastern midsized U.S. cities with high rates of sexually transmitted infection (STI). Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted attitude, intention, and behavior self-interview. Youth who tested positive for an STI (8.3%) received treatment and risk reduction counseling. In addition, television and radio HIV-prevention messages were delivered during the recruitment period and 18 months of follow-up in one randomly selected city in each region. Analyses determined effects of the media program for those receiving a positive versus negative STI test result on number of sexual partners and occurrence of unprotected sex. Adolescents who tested STI-positive reduced their number of vaginal sex partners and the probability of unprotected sex over the first 6 months. However, in the absence of the mass media program, adolescents returned to their previously high levels of sexual risk behavior after 6 months. Adolescents who tested STI-positive and received the mass media program showed more stable reductions in unprotected sex. Community- based STI treatment and counseling can achieve significant, but short-lived reductions in sexual risk behavior among STI-positive youth. A culturally sensitive mass media program has the potential to achieve more stable reductions in sexual risk behavior and can help to optimize the effects of community-based STI screening.Longitudinal examination of alcohol use : A predictor of risky sexual behavior and trichomonas vaginalis among African-American female adolescents
AbstractSeth, P., Sales, J. M., DiClemente, R., Wingood, G. M., Rose, E., & Patel, S. N. (n.d.).Publication year
2011Journal title
Sexually Transmitted DiseasesVolume
38Issue
2Page(s)
96-101AbstractBackground: Alcohol use has been linked to risky sexual practices among adolescents. However, limited research on alcohol use and risky sexual behavior has been conducted on African-American female adolescents. This study examined high quantity of alcohol as a longitudinal predictor of risky sexual behavior and sexually transmitted diseases (STDs) among African-American female adolescents, a high-risk population for STDs. Methods: Three hundred ninety-three adolescent females, 15 to 21 years, were assessed on sociodemographics, alcohol use, and risky sexual behaviors. Participants also provided 2 swab specimens that were assayed for STDs. High quantity of alcohol use was defined as 3 drinks in 1 sitting. Results: Binary generalized estimating equation models were conducted assessing the impact of alcohol use at baseline on risky sexual behavior and STDs over a 12-month period. Age, intervention group, and baseline outcome measures were entered as covariates. The results indicated that high quantity of alcohol use predicted positive TV test results, inconsistent condom use, high sexual sensation seeking, multiple sexual partners, sex while high on alcohol or drugs, and having anal sex over a 12-month follow-up period. Conclusions: These findings suggest that HIV/STD-related behavioral interventions for African-American adolescents should discuss the link between alcohol and HIV/STD-risk behavior. A deeper understanding is paramount to the development of efficacious prevention programs at individual and community levels.Looking forward : Future directions for prevention of HIV among adolescents
AbstractDiClemente, R. (n.d.).Publication year
2022Page(s)
189-199Abstract~Low parental monitoring predicts subsequent pregnancy among African-American adolescent females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Pediatric and Adolescent GynecologyVolume
15Issue
1Page(s)
43-46AbstractStudy Objective: Accumulating evidence suggests that parental monitoring is associated with adolescents' sexual risk behaviors. However, evidence associating low parental monitoring with greater odds of becoming pregnant has not been reported. The objective of this study was to prospectively assess the relationship of low perceived parental monitoring with incidence of biologically confirmed pregnancy among a sample of low-income African-American adolescent females. Design: A prospective study. Setting and Participants: African-American females 14-18 years of age were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and interview at baseline and 6 months later. The study achieved an 85.7% baseline participation rate (n = 522) and 92% (n = 482) returned at follow-up. Only adolescents who initially tested negative for pregnancy were included in the analysis (n = 410). Main Outcome Measure: Incidence of biologically assessed pregnancy. Results: In controlled analyses, among adolescents testing negative for pregnancy at baseline, those who reported less parental monitoring were 2.5 times more likely to become pregnant in the 6-month follow-up period (AOR = 2.50, 95% CI = 1.1-5.9, P < .04). Conclusion: Low parental monitoring was prospectively associated with incidence of biologically confirmed pregnancy among minority adolescent females. This finding adds to a growing body of empirical literature that supports the value of parental monitoring as a protective factor in adolescents' lives. Interventions designed to increase parental monitoring or adolescent females' perceptions of their parents' monitoring may be effective components of pregnancy prevention programs designed for minority youth.Mania Symptoms and HIV-Risk Behavior Among Adolescents in Mental Health Treatment
AbstractStewart, A. J., Theodore-Oklota, C., Hadley, W., Brown, L. K., Donenberg, G., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Clinical Child and Adolescent PsychologyVolume
41Issue
6Page(s)
803-810AbstractThis study explored whether adolescents with elevated symptoms of mania (ESM+) engage in more HIV risk behaviors than those with other psychiatric disorders and examined factors associated with HIV risk behavior among ESM+ adolescents. Eight hundred forty adolescents (56% female, 58% African American, M age = 14.9 years) who received mental health treatment completed private, computer-based assessments of psychiatric disorders and of sexual and substance use behaviors and provided urine to screen for sexually transmitted infections (STI). Eighty-seven percent met criteria for a psychiatric disorder, and among these youth 21% were considered ESM+. Compared to those with other psychiatric disorders, ESM+ were more likely to be sexually active (61.6% vs. 53.6%), have multiple sexual partners (58.6% vs. 37.5%), have unprotected sex (38.4% vs. 28.0%), exchange sex for money (4.7% vs. 1.2%), and test positive for an STI (14.0% vs. 6.3%). Among ESM+ youth, sexual risk behaviors were primarily associated with individual factors (e.g., self-efficacy, impulsivity, and substance use) and varied depending on the type of sexual behavior (e.g., onset of sex, number of partners, and condom use). Adolescents with ESM should be regularly screened for sexual risk behaviors and receive HIV prevention skills. Efforts to increase self-efficacy for safer sex, reduce impulsivity, and decrease substance use may be effective targets for sexual risk reduction among adolescents with ESM.Mapping drivers of second-generation South Asian American eating behaviors using a novel integration of qualitative and social network analysis methods
AbstractAli, S. H., Gupta, S., Tariq, M., Penikalapati, R., Vasquez-Lopez, X., Auer, S., Hanif, C., Parekh, N., Merdjanoff, A. A., & DiClemente, R. (n.d.).Publication year
2022Journal title
Ecology of Food and NutritionVolume
61Issue
4Page(s)
503-521AbstractThis study explores a novel, mixed qualitative method to deconstruct the diet of second-generation South Asian Americans (SAAs). Online interviews of 32 second-generation SAAs were conducted usingintegrated free-listing and mind-mapping. Ranked free-lists were aggregated to identify salient drivers, while connections made within mind-maps were analyzed using social network analysis (SNA) methods. Overall, 34 distinct drivers and 247 unique connections were identified. Taste, family, and health had the highest adjusted rankings, while health displayed the strongest network centrality. Interventions aimed at second-generation SAA dietary behaviors may benefit from family-based or multi-level interventions, which consider the complex, unique dietary norms identified.Masculinity and HIV : Dimensions of Masculine Norms that Contribute to Men’s HIV-Related Sexual Behaviors
AbstractFleming, P. J., DiClemente, R., & Barrington, C. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Issue
4Page(s)
788-798AbstractNumerous studies have documented a relationship between masculine norms and men’s HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men’s sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men’s HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men’s sexual behavior: (1) uncontrollable male sex drive, (2) capacity to perform sexually, and (3) power over others. While the existing literature does help explain the relationship between masculine norms and men’s sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts.Masculinity, condom use self-efficacy and abusive responses to condom negotiation : The case for HIV prevention for heterosexual African-American men
AbstractRaiford, J. L., Seth, P., Braxton, N. D., & DiClemente, R. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
5Page(s)
467-469AbstractBackground This study explored the role of masculinity and perceived condom use skills in African-American men's abusive response to female partners' condom requests. Methods: Eighty African-American men aged 18-29 years completed measures on sexual behaviour, responses to condom requests, condom use self-efficacy and other masculine constructs. Men also were tested for sexually transmissible infections. Results: Men's condom use self-efficacy explained 16.5% of the variance in abusive response to condom requests, beyond demographics and masculine constructs. The full model accounted for 63% of the variance. Conclusions: Many HIV interventions with women encourage condom negotiation. Findings highlight the need to address men's condom use skills and masculine norms.Mass media as an HIV-prevention strategy : Using culturally sensitive messages to reduce HIV-associated sexual behavior of at-risk African American youth
AbstractRomer, D., Sznitman, S., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Hennessy, M., Brown, L. K., Valois, R. F., Stanton, B. F., Fortune, T., & Juzang, I. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
12Page(s)
2150-2159AbstractThe evidence base and theoretical frameworks for mass media HIV-prevention campaigns in the United States are not well-developed. We describe an intervention approach using culturally sensitive mass media messages to enhance protective beliefs and behavior of African American adolescents at risk for HIV. This approach exploits the potential that mass media messages have, not only to reach a large segment of the adolescent population and thereby support normative change, but also to engage the most vulnerable segments of this audience to reduce HIV-associated risk behaviors. The results from an ongoing HIV-prevention trial implemented in 2 medium-sized cities in the United States illustrate the effectiveness of this intervention approach.Measurement of the role of families in prevention and adaptation to HIV/AIDS
AbstractPequegnat, W., Bauman, L. J., Bray, J. H., DiClemente, R., DiIorio, C., Hoppe, S. K., Jemmott, L. S., Krauss, B., Miles, M., Paikoff, R., Rapkin, B., Rotheram-Borus, M. J., & Szapocznik, J. (n.d.).Publication year
2001Journal title
AIDS and BehaviorVolume
5Issue
1Page(s)
1-19AbstractHIV is a family disease. Family research in HIV is challenging because of complexities of family measurement, the range of family constellations across cultures, and the issues specific to HIV-affected families. A Consortium of NIMH-funded investigators is conducting HIV research on families - defined as networks of mutual commitments. A procedure for identifying the "family" is proposed. This article reviews assessment strategies from two research traditions, both of which have been greatly concerned with social context: family assessment tradition - family membership, parenting, and interactional dynamics; HIV/AIDS research tradition - HIV-relevant constructs generalized to minority families. Initially, a systematic procedure for defining family membership is provided. Constructs and measures derived from the family assessment tradition are described, including self-report and observational procedures. Constructs and measures of relevance to family research that originated in the HIV/AIDS research tradition are described: HIV knowledge, stigma, disclosure, and social support. Constructs presented derive from the Consortium's research on the role of families in prevention and adaptation to HIV/AIDS. Most of the research conducted by the Consortium has taken place with inner-city, minority, heterosexual families. By informing the selection of constructs and measures relevant to investigating the role of families in HIV prevention, and adaptation to living with HIV/AIDS, it is the Consortium's intention to enhance the quality and quantity of research at the intersection of families and HIV/AIDS.