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
Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors
AbstractGause, N. K., Brown, J. L., & DiClemente, R. (n.d.).Publication year
2019Journal title
Vulnerable Children and Youth StudiesVolume
14Issue
1Page(s)
1-16AbstractBlack females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02,.17]), any alcohol use prior to sex through peer norms for risky sex (ab = −.06, 95% CI [−.12, −.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = −.13, 95% CI [−.21, −.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.Minorities and AIDS : Knowledge, attitudes, and misconceptions among Black and Latino adolescents
AbstractDiClemente, R., DiClemente, R. J., Boyer, C. B., & Morales, E. S. (n.d.).Publication year
1988Journal title
American journal of public healthVolume
78Issue
1Page(s)
55-57AbstractWhite adolescents in San Francisco high schools were more knowledgeable than Black adolescents about the cause, transmission, and prevention of AIDS (acquired immunodeficiency syndrome), and Black adolescents were more knowledgeable than their Latino peers. Black and Latino adolescents were approximately twice as likely as White adolescents to have misconceptions about the casual transmission of AIDS. Less knowledge about AIDS and prevalent misconceptions were associated with greater levels of perceived risk of contracting AIDS.Monetary incentives : A useful strategy for enhancing enrolment and promoting participation in HIV/STD risk reduction interventions
AbstractDiClemente, R., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
1998Journal title
Sexually transmitted infectionsVolume
74Issue
4Page(s)
239-240Abstract~Monitoring Challenges : A Closer Look at Parental Monitoring, Maternal Psychopathology, and Adolescent Sexual Risk
AbstractHadley, W., Hunter, H. L., Tolou-Shams, M., Lescano, C., Thompson, A., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2011Journal title
Journal of Family PsychologyVolume
25Issue
2Page(s)
319-323AbstractThe present study sought to examine associations between maternal psychopathology, parental monitoring, and adolescent sexual activity among adolescents in mental health treatment. Seven hundred ninety mother-adolescent dyads recruited from adolescent mental health treatment settings completed audio computer-assisted structured interview assessments examining parent psychiatric symptoms, parental monitoring, and adolescent sexual risk behavior. Path analysis was used to examine the associations between variables of interest. Maternal caregivers who reported more mental health symptoms were more likely to have adolescents who reported recent sex and this relationship was mediated by less parental monitoring. These findings suggest that maternal caregivers with mental health symptoms may need specific interventions that provide assistance and support in monitoring their teens in order to reduce sexual risk taking among adolescents in mental health treatment.Monitoring knowledge among family, sexually transmitted infections, and sexual partnership characteristics of African American adolescent females
AbstractSteiner, R. J., Swartzendruber, A. L., Rose, E., & DiClemente, R. (n.d.).Publication year
2014Journal title
Sexually Transmitted DiseasesVolume
41Issue
10Page(s)
601-604AbstractAmong 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.Moral reasoning and unprotected sex among young men
AbstractHernandez, J., & DiClemente, R. (n.d.).Publication year
1992Journal title
Journal of Health EducationVolume
23Issue
6Page(s)
347-351AbstractThis study examined the influence of moral reasoning on young men’s HIV-related sexual risk behaviors, specifically unprotected sexual intercourse. It was hypothesized that those with higher stage moral reasoning will be more likely to practice safe sex. Male college students completed a measure of moral reasoning and a self-report questionnaire assessing sexual behavior. Those scoring high on moral reasoning reported significantly fewer incidents of unprotected sex and more respect for partners who wanted to practice safe sex. They also had fewer sex partners, reported fewer pick-ups, and their sexual motivation on dates was lower (the latter comparisons did not reach levels of significance). That students engage in risky sexual practices less when they use higher levels of moral reasoning is important to the health education discipline’s effort to promote safer sex. It speaks to incorporating training in higher levels of moral reasoning into sex education curricula, for example, by presenting moral sexual dilemmas for classroom discussion. The moral dilemma approach stimulates students to progress more rapidly through their own natural course of moral development, and summarily provides them with the tools to make responsible decisions about sexual behaviors.Motivations for Secondary Abstinence Among African American Females at Risk for HIV/Sexually Transmitted Infections
AbstractBradley, E. L., Sales, J. M., Elifson, K. W., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Black PsychologyVolume
39Issue
4Page(s)
355-374AbstractSome sexually experienced African American females abstain from sexual activity for various reasons and periods of time following sexual debut (secondary abstinence), reducing their risk of HIV/sexually transmitted infection (STI) acquisition. However, few studies have sought to understand secondary abstinence motivations. Furthermore, the scope of existing knowledge may be limited by the quantitative approaches employed. Thus, the purpose of this qualitative study was to investigate secondary abstinence motivations among African American females using a grounded theory approach. Interviews were conducted with 20 young women, aged 18 to 23 years, who recently completed a sexual risk-reduction intervention. Motivations for secondary abstinence not identified in previous studies included feeling used for sex, partner infidelity, and abuse or sexual assault. Also, young women were motivated to abstain to focus on improving certain aspects of their lives. Other motivations similar to those previously identified included not being married or in a committed relationship, separation from one's partner, and STI and pregnancy experiences or fears. Insight from this investigation can be used to improve measurement of motivations and to develop and refine HIV/STI interventions for this population.Multi-level factors associated with pregnancy among urban adolescent women seeking psychological services
AbstractLang, D. L., Rieckmann, T., DiClemente, R., Crosby, R. A., Brown, L. K., & Donenberg, G. R. (n.d.).Publication year
2013Journal title
Journal of Urban HealthVolume
90Issue
2Page(s)
212-223AbstractThe purpose of this study was to examine the prevalence of pregnancy as well as multi-level factors (i.e., individual, family, and environment) associated with history of pregnancy among a sample of urban adolescent women seeking psychological services. Data were collected from a total of 264 sexually active, 13-18-year-old, adolescent women who participated in a larger HIV prevention study. Adolescents and one participating parent completed an audio computer-assisted self-interviewing survey. A total of 17.4 % of participants reported a history of pregnancy. A multivariable logistic regression model suggests that after controlling for empirically derived sociodemographic and behavioral covariates, absence of father in the home, family support and cohesion, and neighborhood risk were positively related to pregnancy. This study is among the first to examine multi-level factors associated with pregnancy among adolescent women diagnosed with psychological disorders. Consideration of such factors is crucial both in terms of clinical practice and in the design of pregnancy prevention programs. Collaboration between physicians and mental health providers working with adolescent women is crucial and represents an ideal opportunity to promote parental involvement and access to supportive community resources, including pregnancy prevention programs for this vulnerable population of adolescents.Multicomponent interventions to enhance influenza vaccine delivery to adolescents
AbstractGargano, L. M., Pazol, K., Sales, J. M., Painter, J. E., Morfaw, C., Jones, L. D., Weiss, P., Buehler, J. W., Murray, D. L., Wingood, G. M., Orenstein, W. A., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
PediatricsVolume
128Issue
5Page(s)
e1092-e1099AbstractOBJECTIVE: To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia. METHODS: We used a nonrandomized, 3-armed design: (1) a middle-and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents. RESULTS: During the 2008-2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR] school: 2.4 [95% confidence interval (CI): 1.7-3.2]; RR provider: 1.9 [95% CI: 1.4 -2.5]). During 2009 -2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RR school: 2.3 [95% CI: 1.9 -2.9]; RR provider: 1.2 [95% CI: 0.97-1.5]). CONCLUSIONS: Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.Multidimensional family therapy HIV/STD risk-reduction intervention : An integrative family-based model for drug-involved juvenile offenders
AbstractMarvel, F., Rowe, C. L., Colon-Perez, L., DiClemente, R., & Liddle, H. A. (n.d.).Publication year
2009Journal title
Family ProcessVolume
48Issue
1Page(s)
69-84AbstractDrug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies (). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.Multiple drug use and depression : Gender differences among African-Americans in a high-risk community
AbstractWang, M. Q., Collins, C. B., DiClemente, R., Wingood, G., & Kohler, C. L. (n.d.).Publication year
1997Journal title
Journal of Alcohol and Drug EducationVolume
43Issue
1Page(s)
87-96AbstractThis study compared gender differences associated with depression and multiple drug use (alcohol, marijuana, and cocaine) among African-Americans in a high-risk community. A street sample (N= 553) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug-use behavior in the past 30 days, as well as about their depressive symptoms during the past week. Two-way factorial analysis of variance and follow-up tests showed that depression scores were significantly higher for women than for men among all levels of drug use. This difference was greatest when drug use involved cocaine and/or crack.Multiple method contraception use among African American adolescents in four US cities
AbstractBrown, J. L., Hennessy, M., Sales, J. M., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Romer, D., Valois, R. F., Brown, L. K., & Stanton, B. (n.d.).Publication year
2011Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2011AbstractWe report on African American adolescents' (N = 850; M age = 15.4) contraceptive practices and type of contraception utilized during their last sexual encounter. Respondents completed measures of demographics, contraceptive use, sexual partner type, and ability to select safe sexual partners. 40 endorsed use of dual or multiple contraceptive methods; a total of 35 different contraceptive combinations were reported. Perceived ability to select safe partners was associated with not using contraception (OR = 1.25), using less effective contraceptive methods (OR = 1.23), or hormonal birth control (OR = 1.50). Female gender predicted hormonal birth control use (OR = 2.33), use of less effective contraceptive methods (e.g., withdrawal; OR = 2.47), and using no contraception (OR = 2.37). Respondents' age and partner type did not predict contraception use. Adolescents used contraceptive methods with limited ability to prevent both unintended pregnancies and STD/HIV. Adolescents who believed their partners posed low risk were more likely to use contraceptive practices other than condoms or no contraception. Reproductive health practitioners are encouraged to help youth negotiate contraceptive use with partners, regardless of the partner's perceived riskiness.Mutual capacity building model for adaptation (MCB-MA) : a seven-step procedure bidirectional learning and support during intervention adaptation
AbstractJack, H. E., Giusto, A., Rose, A. L., Mwamuka, R., Brown, I., Bere, T., Verhey, R., Wainberg, M., Myers, B., Kohrt, B., Wingood, G., DiClemente, R., & Magidson, J. F. (n.d.).Publication year
2024Journal title
Global Health Research and PolicyVolume
9Issue
1AbstractGlobal health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of “development aid” or “reverse innovation”. Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.Need for innovation in public health research
AbstractDiClemente, R., Nowara, A., Shelton, R., & Wingood, G. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Page(s)
S117-S120AbstractThe recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary,we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technologybasedmethodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.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.Neighborhood Stress and Life Satisfaction : Is there a Relationship for African American Adolescents?
AbstractValois, R. F., Kerr, J. C., Carey, M. P., Brown, L. K., Romer, D., DiClemente, R., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Applied Research in Quality of LifeVolume
15Issue
1Page(s)
273-296AbstractThis study identified associations between perceived neighborhood stress and adolescents’ perceptions of life satisfaction. African American adolescents aged 13–18 (n = 1658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.New sexual partners and readiness to seek screening for chlamydia and gonorrhoea : Predictors among minority young women
AbstractDiClemente, R., Chacko, M. R., Wiemann, C. M., Kozinetz, C. A., DiClemente, R. J., Smith, P. B., Velasquez, M. M., & Von Sternberg, K. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
1Page(s)
75-79AbstractObjectives: To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner. Methods: Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner. Results: The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% Cl 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78) Conclusions: Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.Older partners and STD prevalence among pregnant African American teens
AbstractBegley, E., Crosby, R. A., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
3Page(s)
211-213AbstractBackground: Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition. Goal: The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners. Study Design: Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays. Results: Approximately 65% of adolescents reported that their male sex partners were ≥2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners. Conclusion: In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.Operationalizing a Behavioral Health Services Cascade of Care Model : Lessons Learned from a 33-Site Implementation in Juvenile Justice Community Supervision1
AbstractDennis, M. L., Smith, C. N., Belenko, S., Knight, D., McReynolds, L., Rowan, G., Dembo, R., DiClemente, R., Robertson, A., & Wiley, T. (n.d.).Publication year
2019Journal title
Federal ProbationVolume
83Issue
2Page(s)
52-64Abstract~Oral contraceptive use may not preclude condom use : A study of non-pregnant African-American adolescent females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).Publication year
2007Journal title
Sexually transmitted infectionsVolume
83Issue
3Page(s)
216-218AbstractObjective: To determine the association between oral contraceptive and condom use, and laboratory-confirmed sexually transmitted infection (STI) among African-American adolescent females at a high risk of STI acquisition. Methods: A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included (a) an audio-computer-assisted self-interview and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. Results: The age-adjusted odds ratio (AOR) indicated a modest protective effect of oral contraceptive use against unprotected vaginal sex (UVS) using a 60-day recall period (AOR = 0.66; 95% CI 0.43 to 0.99). The age-adjusted difference in mean frequency of UVS in the past 60 days was non-significant (p = 0.23) as was condom use at last sex (p = 0.34). The age-AOR relative to STI prevalence also showed a protective effect (AOR = 0.60; 95% CI 0.36 to 0.98) for those using oral contraceptives. Conclusion: The findings suggest that the use of oral contraceptives may not preclude safer sex practices for the prevention of STIs among high-risk African-American adolescent females.Overcoming barriers to HPV vaccination : A randomized clinical trial of a culturally-tailored, media intervention among African American girls
AbstractDiClemente, R., Murray, C. C., Graham, T., & Still, J. (n.d.).Publication year
2015Journal title
Human Vaccines and ImmunotherapeuticsVolume
11Issue
12Page(s)
2883-2894AbstractAlthough genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14-18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.Overcoming the triad of rural health disparities : How local culture, lack of economic opportunity, and geographic location instigate health disparities
AbstractThomas, T. L., DiClemente, R., & Snell, S. (n.d.).Publication year
2014Journal title
Health Education JournalVolume
73Issue
3Page(s)
285-294AbstractObjective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas. Methods: We critically profile each component of the deterministic triad in shaping current healthrelated disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice. Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants. Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.Overweight and obesity in Native-American adolescents : Comparing nonreservation youths with African-American and Caucasian peers
AbstractDiClemente, R., Gruber, E., Anderson, M. M., Ponton, L., & DiClemente, R. (n.d.).Publication year
1995Journal title
American journal of preventive medicineVolume
11Issue
5Page(s)
306-310AbstractPrevious studies have consistently shown that, compared to national standards, Native Americans across all age groups are disproportionately overweight or obese. Although most available data on rates of obesity in this group come from studies conducted on reservations, the proportion of Native Americans residing on reservation lands is rapidly declining. This study examines the prevalence of overweight and obesity in a population of Midwestern adolescents in public school settings and contrasts Caucasian and African-American adolescents with Native-American youths of the same age. Data were derived from a secondary analysis of an anonymous health-risk survey. Height, weight, and ethnicity were ascertained through self-report. The results call into question whether rates of overweight or obesity in Native-American adolescents are disproportionate relative to those for Caucasian and African-American adolescents. Cumulative comparisons of all overweight and obese adolescents in the sample (n = 5,655) show significant differences among ethnic groups, but age-specific comparisons do not yield a consistent pattern, especially for Native-American girls. To compare the entire sample to national weight standards, we plotted mean body mass index (BMI) for each ethnic group by age against NHANES II reference data. Age- specific BMI means for Native-American and Caucasian girls fell largely below the NHANES II reference data. We present several explanations for these results. Given the study limitations, further objective study of the weight status of Native-American children and adolescents in direct comparison with other ethnic groups is recommended.Parent-adolescent communication and sexual risk behaviors among African American adolescent females
AbstractDiClemente, R., Wingood, G. M., Crosby, R., Cobb, B. K., Harrington, K., & Davies, S. L. (n.d.).Publication year
2001Journal title
Journal of PediatricsVolume
139Issue
3Page(s)
407-412AbstractObjective: To examine associations between parent-adolescent communication about sex-related topics and the sex-related communication and practices of African American adolescent females with partners, as well as their perceived ability to negotiate safer sex. Design: A theory-guided survey and structured interview were administered to 522 sexually active African American females 14 to 18 years old. Recruitment sites were neighborhoods with high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Multivariate analyses, controlling for observed covariates, were used to identify the association of less frequent parent-adolescent communication with multiple assessed outcomes. Results: Less frequent parent-adolescent communication (scores below the median) was associated with adolescents' non-use of contraceptives in the past 6 months (adjusted odds ratio [AOR] = 1.7) and non-use of contraceptives during the last 5 sexual encounters (AOR = 1.6). Less communication increased the odds of never using condoms in the past month (AOR = 1.6), during the last 5 sexual encounters (AOR = 1.7), and at last intercourse (AOR = 1.7). Less communication was also associated with less communication between adolescents and their sex partners (AOR = 3.3) and lower self-efficacy to negotiate safer sex (AOR = 1.8). Conclusions: The findings demonstrate the importance of involving parents in human immunodeficiency virus/sexually transmitted disease and pregnancy prevention efforts directed at female adolescents. Pediatricians and other clinicians can play an important role in facilitating parent-adolescent communication about sexual activity.Parent-adolescent communication scale
AbstractSales, J. M., Mülhausen, R. R., & DiClemente, R. (n.d.).Publication year
2019Page(s)
225-227Abstract~