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
Condom failure : Examining the objective and cultural meanings expressed in interviews with African American adolescents
AbstractSznitman, S. R., Horner, J., Salazar, L. F., Romer, D., Vanable, P. A., Carey, M. P., DiClemente, R., Valois, R. F., & Stanton, B. F. (n.d.).Publication year
2009Journal title
Journal of Sex ResearchVolume
46Issue
4Page(s)
309-318AbstractThe purpose of this study was to explore the meaning and context of self-reported "condom failure" among sexually active African American adolescents. Semistructured interviews regarding methods of protection from pregnancy and sexually transmitted disease (STD) with 124 youth (ages 14-19 years) were content analyzed. The findings suggested three meanings of condom failure. First, condom failure represents a legitimate and important risk related to sexual activity. Second, it can serve as an excuse repertoire for adolescents who engaged in unprotected sex and later experienced either pregnancy or a STD. Third, it may serve as an explanation for males who deceive their partners into having unprotected sex. The findings are discussed with regard to their implications for HIV or STD prevention and research.Correlates of Consistent Condom Use with Main-New and Main-Old Sexual Partners
AbstractWiemann, C. M., Chacko, M. R., Kozinetz, C. A., DiClemente, R., Smith, P. B., Velasquez, M. M., & von Sternberg, K. (n.d.).Publication year
2009Journal title
Journal of Adolescent HealthVolume
45Issue
3Page(s)
296-299AbstractAn exploratory study identified correlates of consistent condom use for young women reporting Main-new or Main-old partners in the past 3 months: frequency of vaginal sex (across partner types); perceived likelihood of getting a STI (Main-new); age and STI history (Main-old). To enhance programmatic efficacy in community clinics, these key correlates of condom use for main partner types should be incorporated in STI risk reduction counseling.Correlates of correct condom use among high-risk African American men attending an Urban STD clinic in the South
AbstractCrosby, R., DiClemente, R., & Yarber, W. L. (n.d.).Publication year
2009Journal title
International Journal of Sexual HealthVolume
21Issue
3Page(s)
183-191AbstractThe purpose of this cross-sectional study was to assess prevalence and correlates of correct condom use among high-risk African American men attending a publicly funded sexually transmitted disease (STD) clinic. Men 18 through 29 years of age and newly diagnosed with an STD were further assessed for study eligibility. Of 296 meeting eligibility criteria, 271 agreed to participate, thereby yielding a participation rate of 91.5%. Correct use, assessed by an index, was reported by 38%. Correct use was associated with having sex with three or fewer female sex partners, being in an exclusive relationship, not indicating problems with the fit or feel of condoms, and not being drunk/high while using condoms. The correct use of condoms among young African American men newly diagnosed with an STD may be a function of situational factors. These factors could potentially be addressed in the context of clinic-based behavioral intervention programs.Correlates of heterosexual anal intercourse among at-risk adolescents and young adults
AbstractLescano, C. M., Houck, C. D., Brown, L. K., Doherty, G., DiClemente, R., Fernandez, M. I., Pugatch, D., Schlenger, W. E., & Silver, B. J. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1131-1136AbstractObjectives. We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. Methods. Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. Results. Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. Conclusions. Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women
AbstractRaiford, J. L., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1067-1071AbstractObjectives. We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. Methods. We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. Results. Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; χ2=4.32; P≤.04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; χ2=8.06; P≤.01). Conclusions. Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women.Efficacy of sexually transmitted disease/human immunodeficiency virus sexual risk-reduction intervention for African American adolescent females seeking sexual health services : A randomized controlled trial
AbstractDiClemente, R., Wingood, G. M., Rose, E. S., Sales, J. M., Lang, D. L., Caliendo, A. M., Hardin, J. W., & Crosby, R. A. (n.d.).Publication year
2009Journal title
Archives of Pediatrics and Adolescent MedicineVolume
163Issue
12Page(s)
1112-1121AbstractObjectives: To evaluate the efficacy of an intervention to reduce incident sexually transmitted disease (STD) and enhance STD/human immunodeficiency virus (HIV)-preventive behaviors and psychosocial mediators. Design: A randomized controlled trial of an HIV prevention program. Setting: Clinic-based sample in Atlanta, Georgia. Participants: African American adolescent females (N=715), aged 15 to 21 years, seeking sexual health services. Participants completed an audio computerassisted self-interview and provided self-collected vaginal specimens for STD testing. Intervention: Intervention participants received two 4-hour group sessions and 4 telephone contacts over a 12-month period, targeting personal, relational, sociocultural, and structural factors associated with adolescents' STD/HIV risk, and were given vouchers facilitating male partners' STD testing/treatment. Main Outcome Measure: Incident chlamydial infections. Results: Over the 12-month follow-up, fewer adolescents in the intervention had a chlamydial infection (42 vs 67; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.42 to 0.98; P=.04) or recurrent chlamydial infection (4 vs 14; RR, 0.25; 95% CI, 0.08 to 0.83; P=.02). Adolescents in the intervention also reported a higher proportion of condom-protected sex acts in the 60 days preceding follow-up assessments (mean difference, 10.84; 95% CI, 5.27 to 16.42; PExploring the mediating mechanism between gender-based violence and biologically confirmed chlamydia among detained adolescent girls
AbstractSalazar, L. F., Crosby, R. A., & DiClemente, R. (n.d.).Publication year
2009Journal title
Violence Against WomenVolume
15Issue
3Page(s)
258-275AbstractThe study examined several behavioral mechanisms that link gender-based violence (GBV) to STD among detained, sexually active adolescent girls. Girls (N = 198) were recruited from eight youth detention facilities. Measures were assessed using audiocomputerĝ€"assisted self-interviewing. DNA amplification was conducted to assess for chlamydia. Thirty-one percent had experienced GBV and 15% tested positive for chlamydia. GBV was related to chlamydia directly and indirectly through condom failures and through having sexual intercourse while high on drugs and/or alcohol. The study found that sexual risk reduction programs may benefit this population by addressing the role of GBV and its association with STD-associated behaviors.Exposure to High-Risk Genital Human Papillomavirus and Its Association with Risky Sexual Practices and Laboratory-Confirmed Chlamydia Among African-American Women
AbstractSeth, P., Wingood, G. M., Robinson, L. S., & DiClemente, R. (n.d.).Publication year
2009Journal title
Women's Health IssuesVolume
19Issue
5Page(s)
344-351AbstractBackground: Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States and African-American women have the highest prevalence of high-risk HPV. This study examined exposure to high-risk HPV in African-American women and its relation to risky sexual practices and laboratory-confirmed chlamydia. Methods: A sample of 665 African-American women between 18 and 29 years old, recruited from October 2002 to March 2006 in Atlanta, Georgia, completed an Audio Computer-Assisted Survey Interview assessing sociodemographics, health practices, and risky sexual practices. Participants also provided vaginal swab specimens assayed for STIs and high-risk HPV. Results: The overall prevalence of high-risk HPV was 38.9%. Among women 18 to 24 years old, it was 42.4%; it was 31% among women 25 to 29 years old. Age-stratified logistic regression analyses indicated that women between the ages of 18 and 29 and 18 and 24 who had multiple male sexual partners did not use a condom during their last casual sexual encounter and tested positive for chlamydia were significantly more likely to test positive for high-risk HPV. Women 18 to 24 years old who reported having a casual or risky sexual partner were significantly more likely to test positive for high-risk HPV. No significant correlates were identified among women 25 to 29 years old. Conclusions: Programs should aim to educate, decrease risky sexual practices, and increase screening and treatment for STIs among women with high-risk HPV infections. HPV vaccination recommendations for young adult African-American women warrant special consideration.Exposure to tobacco on the internet : Content analysis of adolescents' internet use
AbstractJenssen, B. P., Klein, J. D., Salazar, L. F., Daluga, N. A., & DiClemente, R. (n.d.).Publication year
2009Journal title
PediatricsVolume
124Issue
2Page(s)
e180-e186AbstractOBJECTIVE: We performed a content analysis of all Web pages viewed by a random sample of adolescents to describe exposure to tobaccoand smoking-related text and images. METHODS: Adolescents (14-17 years of age) with home Internet access were recruited. Internet-tracking software was installed on home computers used by 346 eligible consenting participants. All Web pages viewed by adolescent participants were captured during a 30-day period for each subject. Keywords on smoking and tobacco were used to identify tobacco images or text. RESULTS: The 346 participants viewed 1.2 million Web pages, of which 8702 (0.72%) contained tobacco or smoking content. Exposure to tobacco content did not vary according to smoking status. Content was protobacco on 1916 pages, antitobacco on 1572, and complex or unclear on 5055. Social networking sites, mainly MySpace, represented 53% of pages (n = 4612) on which tobacco content was found. All pages with smoking content contained references in text, and 256 (3%) contained images. Many (43%) of the adolescents were exposed to protobacco imagery (median: 3 pages per month). Cigarettes were mentioned on 20% of pages. Tobacco products were sold on 50 pages, and 242 pages contained links to tobacco products sold on other pages. On social networking sites, 4121 pages included a mention of smoking status in the authors' individual profiles, with 23% of authors identifying themselves as smokers. CONCLUSIONS: Many adolescents are consistently exposed to tobacco content on the Internet, but the volume of exposure is limited and not all content represents protobacco content.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.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.Parent-adolescent sexual communication : Associations of condom use with condom discussions
AbstractHadley, W., Brown, L. K., Lescano, C. M., Kell, H., Spalding, K., DiClemente, R., & Donenberg, G. (n.d.).Publication year
2009Journal title
AIDS and BehaviorVolume
13Issue
5Page(s)
997-1004AbstractThis study investigated the relationship between parent-teen sexual communication, discussion of condoms, and condom use among adolescents in mental health treatment. Adolescents with a history of sexual intercourse and their parents completed questionnaires assessing adolescent sexual risk behavior, sexual communication, and discussion of sexual topics. Greater condom use by adolescents was associated with parent-adolescent condom discussion but was not associated with openness in sexual communication. Seventy-six percent of adolescents reported that parents had discussed condoms with them and these discussions were significantly associated with protected sexual acts. In a logistic regression, accounting for age, gender, race, and psychiatric diagnosis teens that discussed condoms with their parent were more likely to report condom use at last sex. Increasing direct communication about condoms may be an important step in increasing adolescent's safer sex behavior. Mental health disorders and family distress may make such discussions challenging but are not an insurmountable barrier to direct discussions about condoms.Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care
AbstractNappi, C. M., Thakral, C., Kapungu, C., Donenberg, G. R., DiClemente, R., & Brown, L. (n.d.).Publication year
2009Journal title
AIDS and BehaviorVolume
13Issue
5Page(s)
1012-1020AbstractAuthors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality-sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent's sexual health.Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities
AbstractSwenson, R. R., Rizzo, C. J., Brown, L. K., Payne, N., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Valois, R. F., Romer, D., & Hennessy, M. (n.d.).Publication year
2009Journal title
Sexually Transmitted DiseasesVolume
36Issue
9Page(s)
584-591AbstractBACKGROUND: Routine HIV testing is recommended for all adolescents ages 13 years and older. This study aims to report the prevalence of HIV testing among black adolescents, describe characteristics of adolescents who have been tested, and identify potentially modifiable factors associated with greater likelihood of testing across gender. METHODS: Black adolescents ages 13 to 18 were recruited from community-based outreach in 4 US cities. Present analyses include sexually active participants (N = 990; 52.3% female). RESULTS: Twenty-nine percent of adolescents had ever been tested for HIV. In a multivariate logistic regression adjusted for significant demographics, the strongest predictor of HIV testing among girls was prior STI testing (OR = 88.39) followed by pregnancy (OR = 2.75), risk reduction self-efficacy (OR = 2.28), and STI knowledge (OR = 2.25). Among boys, having had an STI test (OR = 38.09), having talked about testing with partners (OR = 3.49), and less religiosity (OR = 2.07) were associated with HIV testing. CONCLUSIONS: Blacks adolescents are disproportionately at risk for HIV/AIDS, yet less than one-third of participants reported being tested. Those receiving sexual or reproductive healthcare services were most likely to be tested, but many teens at risk for HIV do not seek available services and others may face barriers to accessing healthcare. Findings provide support for increasing school-based educational programs due to the low rates of STI/HIV knowledge among teens. Additionally, culturally-sensitive programs promoting HIV testing among teens should foster skill-building for preventive behaviors and increase partner communication about testing.Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among african-american adolescents
AbstractSznitman, S. R., Romer, D., Brown, L. K., DiClemente, R., Valois, R. F., Vanable, P. A., Carey, M. P., & Stanton, B. (n.d.).Publication year
2009Journal title
Sexually Transmitted DiseasesVolume
36Issue
4Page(s)
218-220Abstract~Preventing HIV Among Adolescents in Sub-Saharan Africa
AbstractDiClemente, R., & Crosby, R. A. (n.d.).Publication year
2009Journal title
Journal of Adolescent HealthVolume
44Issue
2Page(s)
101-102Abstract~Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents
AbstractSeth, P., Raiji, P. T., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2009Journal title
Psychology, Health and MedicineVolume
14Issue
3Page(s)
291-300AbstractPrevious research has established the association between psychosocial factors and risky sexual behaviour. However, few studies have examined the relationship between psychological distress and sexually transmitted infection (STI)/HIV-associated behaviours in African-American youth. The present study examined the association of psychological distress with STI/HIV-risk behaviour and psycho-social mediators of HIV-preventive behaviours. A sample of 715 African-American female adolescents, 15-21 years old, completed an audio computer assisted self-interviewing (ACASI) assessing sociodemographics, psychological distress, self-efficacy, communication and STI/HIV-associated sexual behaviours. Participants also provided self-collected vaginal swab specimens, which were assayed for STIs. High levels of psychological distress were defined as having a score of 7 on the eight-item Centre for Epidemiological Studies-Depression Scale. The overall prevalence of high levels of psychological distress was 44.5%. Logistic regression analyses revealed that adolescents with high psychological distress, relative to those with low psychological distress, were more likely to have a biologically confirmed STI (adjusted odd ratio (AOR)=1.40), use condoms inconsistently (AOR=1.50), not use condoms during their last casual sexual encounter (AOR=1.89), have sex while high on alcohol or drugs (AOR=1.47), have male sexual partners with concurrent female sexual partners (AOR=1.98), have low condom use self-efficacy (AOR=1.54), partner sexual communication self-efficacy (AOR=1.77), refusal self-efficacy (AOR=2.05) and be more fearful of communicating with their partners (AOR=1.98). These findings, although preliminary, could be used to inform HIV intervention programs and physicians/clinicians providing regular health care maintenance to African-American female adolescents engaging in risky sexual behaviour.Test-Retest Reliability of Self-Reported HIV/STD-Related Measures Among African-American Adolescents in Four U.S. Cities
AbstractVanable, P. A., Carey, M. P., Brown, J. L., DiClemente, R., Salazar, L. F., Brown, L. K., Romer, D., Valois, R. F., Hennessy, M., & Stanton, B. F. (n.d.).Publication year
2009Journal title
Journal of Adolescent HealthVolume
44Issue
3Page(s)
214-221AbstractPurpose: To evaluate the test-retest reliability of self-reported sexuality-related data in a sample of African American adolescents residing in four U.S. cities. Methods: Using audio computer-assisted self-interviewing (ACASI), 156 African American teens (mean age = 15.5 years) provided data on lifetime and recent sexual behavior, HIV/sexually transmitted disease (STD) testing, and theoretical antecedents of sexual risk behavior on two occasions separated by 2 weeks. Results: Most self-reports of lifetime sexual behavior and STD/HIV testing were stable across the two assessment points. Test-retest agreement was substantial for dichotomous indices of lifetime sexual behaviors and STD testing (kappas ranging from .61-.87), and for 3-month recall of vaginal sex (kappa = .72) and number of sexual partners (intraclass correlation coefficient [ICC] = .68). Lower reliability estimates emerged for count data of unprotected vaginal sex occasions (ICC = .44). Test-retest reliability estimates for antecedents of sexual risk behavior were highest for a validated measure of HIV-related knowledge (r = .73), but somewhat lower for peer norms (r = .58) and condom use self-efficacy (r = .50). Conclusions: Although variability in the stability of self-report data was observed, findings confirm that most sexual behavior, STD and HIV testing history, and psychosocial measures can be assessed reliably among adolescents. Research should continue to identify strategies to enhance the reliability of self-report sexual behavior data from youth at risk for HIV and other sexually transmitted infections.The validity of teens' and young adults' self-reported condom use
AbstractRose, E., DiClemente, R., Wingood, G. M., Sales, J. M., Latham, T. P., Crosby, R. A., Zenilman, J., Melendez, J., & Hardin, J. (n.d.).Publication year
2009Journal title
Archives of Pediatrics and Adolescent MedicineVolume
163Issue
1Page(s)
61-64AbstractObjective: To examine the concordance between teens' and young adults' self-reported condom use, assessed by audio-computer-assisted self-interviewing, and Y-chromosome polymerase chain reaction (Yc-PCR) assay, a nondisease marker for detecting the presence of sperm in vaginal fluid for 14 days after unprotected vaginal sex. Design: Randomized trial of a human immunodeficiency virus prevention program. Only data from baseline (before randomization) were used for this analysis. Setting: A clinic-based sample in Atlanta, Georgia. Participants: Eligible teens and young adults were African American female teens and young adults 15 to 21 years old who had reported sexual activity in the previous 60 days. Of 1558 teens and young adults screened from March 1, 2002, through August 31, 2004, 847 were eligible and 715 (84.4%) participated at baseline. Main Outcome Measures: Self-reported consistent condom use in the 14 days before baseline and Yc-PCR results. Results: Of participants who reported vaginal sex in the past 14 days, 186 reported consistent condom use, defined as 100% condom use. Of these, 63 had a positive Yc-PCR result, indicating detection of the Y chromosome in the vaginal fluid. Participants who reported consistent condom use with a self-reported history of sexually transmitted diseases were 2.4 times more likely to have a positive Yc-PCR result (adjusted odds ratio, 2.4; 95% confidence interval, 1.2-4.8; P =.01). Conclusions: A significant degree of discordance between self-reports of consistent condom use and Yc- PCR positivity was observed. Several rival explanations for the observed discordance exist, including (1) teens and young adults inaccurately reported condom use; (2) teens and young adults used condoms consistently but used them incorrectly, resulting in user error; and (3) teens and young adults responded with socially desirable answers. Using an objective biological measure may provide one strategy for validating teens' and young adults' self-reported condom use.Threats of cross-contamination on effects of a sexual risk reduction intervention : Fact or fiction
AbstractLang, D. L., DiClemente, R., Hardin, J. W., Crosby, R. A., Salazar, L. F., & Hertzberg, V. S. (n.d.).Publication year
2009Journal title
Prevention ScienceVolume
10Issue
3Page(s)
270-275AbstractThis study sought to empirically evaluate the extent and impact of cross-contamination on the effects of a STI/HIV intervention trial previously shown to be effective in reducing high-risk sexual behaviors among African-American adolescent females. Participants were recruited through community health agencies in the Southeastern United States and comprised 522 sexually active 14- to 18- year-old African-American females who completed self-administered questionnaires and face-to-face interviews at baseline, 6- and 12-month time points. Participants were randomized to a STI/HIV risk reduction group or a general health promotion groups. The STI/HIV intervention group participated in four group sessions addressing constructs such as HIV knowledge, communication, condom use self-efficacy and condom use behaviors. The control group participated in four group sessions focused on general health topics. The study setting afforded multiple opportunities for cross-talk between intervention and control group participants. Consistent condom use, defined as condom use during every vaginal sex act, was the primary outcome measure. Other outcome measures included various sexual behaviors, observed condom application skills and psychosocial variables associated with HIV preventive behaviors. Approximately 73% of participants reported some level of cross-talk. Linear and binary GEE models assessing the impact of the STI/HIV intervention on contaminated vs. uncontaminated control group participants indicated no differential effects of the intervention. Furthermore, equivalence tests demonstrated that contaminated and uncontaminated control groups were equivalent. Findings from this study provide empirical evidence suggesting that behavioral and psychosocial outcomes may be resistant to cross-contamination in randomized controlled trials testing safer sex interventions among African-American adolescent females.Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females
AbstractSales, J. M., Spitalnick, J., Milhausen, R. R., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2009Journal title
Health Education ResearchVolume
24Issue
1Page(s)
140-152AbstractThis study examined the psychometric properties of a new scale to measure adolescents' worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was administered to a sample of 522 African-American female adolescents ranging in age from 14 to 18, residing in the southeast United States and participating in a sexual risk reduction intervention. The WASO demonstrated internal consistency across multiple administrations and yielded satisfactory construct validity. Worry was found to negatively correlate with sexual communication self-efficacy (with a new male partner and a steady male partner), frequency of sexual communication with male partner, attitudes about condom use and social support; worry was positively correlated with perceived barriers to condom use, condom negotiation, locus of control and depression. Overall, the results indicate that the WASO is a reliable and valid measure of assessing adolescents' worry about STIs, HIV and pregnancy. The WASO represents a brief self-administered instrument that can be easily integrated into sexual risk reduction assessments and interventions. Future studies employing the WASO might consider testing it with more diverse samples in terms of gender, race/ethnicity, age and sexual orientation.Withdrawal (Coitus Interruptus) as a sexual risk reduction strategy : Perspectives from African-American adolescents
AbstractHorner, J. R., Salazar, L. F., Romer, D., Vanable, P. A., DiClemente, R., Carey, M. P., Valois, R. F., Stanton, B. F., & Brown, L. K. (n.d.).Publication year
2009Journal title
Archives of Sexual BehaviorVolume
38Issue
5Page(s)
779-787AbstractThis study examined adolescents' beliefs about the benefits and risks of withdrawal (coitus interruptus) with respect to both pregnancy and sexually transmitted infections (STIs). In the course of qualitative interviews with African-American youth aged 14-19 (n = 124) about sexuality and risk, 24 adolescents spontaneously introduced the subject of withdrawal as a sexual risk reduction strategy. Eighteen percent of the sexually experienced adolescents mentioned their own use of withdrawal as a contraceptive method. From adolescents' accounts of their own and their peers' use of withdrawal, we learned that the cultural meanings of withdrawal within the context of adolescent relationships were multifaceted. Using withdrawal could signal sexual prowess in male youth, was seen as promoting trust and caring within a stable relationship, and was seen as mitigating the risk of pregnancy. However, adolescents also recognized that withdrawal did not protect against most STIs. Beliefs about withdrawal as a gendered skill and as a sign of trust may undermine some adolescents' attempts to negotiate condom use for protection against STIs.An event-specific analysis of condom breakage among African American men at risk of HIV acquisition
AbstractCrosby, R., DiClemente, R., Yarber, W. L., Snow, G., & Troutman, A. (n.d.).Publication year
2008Journal title
Sexually Transmitted DiseasesVolume
35Issue
2Page(s)
174-177AbstractBACKGROUND: African American men are at high risk of human immunodeficiency virus acquisition. Condom breakage is an understudied aspect of their sexual protective behavior. This study identified user errors leading to condom breakage using an event-specific analysis among young African American men newly diagnosed with a sexually transmitted disease (STD). METHODS: Recruitment occurred in a publicly funded STD clinic located in a metropolitan area of the Southern United States. Of 296 African American men screened as eligible, 271 (91.5%) agreed to participate. Men completed a self-administered questionnaire. Men reporting condom use with men were excluded from the analysis, leaving an analytic sample of 264 men. The recall period was for the last time men used condoms for penile-vaginal sex (within the past 3 months). RESULTS: More than one-fifth (21.2%) reported condom breakage. Each year of advancing age decreased the odds of breakage by 10% [adjusted odds ratio (AOR) = 0.90, 95% confidence interval (CI) = 0.81-0.99, P = 0.028]. Men who had used an oil-based lubricant were more than 3 times as likely to report breakage (AOR = 3.21, 95% CI = 1.48-7.00, P = 0.003) and those who completely unrolled the condom before putting it on were also about 3 times more likely to report breakage (AOR = 3.34, 95% CI = 1.76-6.50, P = 0.0001). The breakage rate for men indicating both errors, i.e., use of an oil-based lubricant and unrolling the condom before application, was 54.5% compared with 33.3% among those indicated either error, and 12.8% among those indicating neither error. Attributable risk for the 2 errors combined was 39%. CONCLUSIONS: Condom breakage among this sample of men at high risk for human immunodeficiency virus infection was common. This problem could be mitigated by counseling men to avoid the use of oil-based lubricants and by teaching them basic condom application skills.Co-occurrence of intoxication during sex and sexually transmissible infections among young African American women : Does partner intoxication matter?
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Lang, D., Rose, E., & McDermott-Sales, J. (n.d.).Publication year
2008Journal title
Sexual HealthVolume
5Issue
3Page(s)
285-289AbstractBackground: The co-occurrence of a behaviour (being intoxicated on alcohol/drugs during sex) with a disease outcome [laboratory-confirmed sexually transmissible infection (STI) prevalence] among young African American women and their male sex partners was studied. Methods: A cross-sectional study was conducted. Recruitment and data collection occurred in three clinics located in a metropolitan city of the Southern USA. A total of 715 African American adolescent females (15-21 years old) were enrolled (82% participation rate). The primary outcome measure was the analysis of self-collected vaginal swabs using nucleic acid amplification assays for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Results: After controlling for age and self-efficacy to negotiate condom use, young women's alcohol/drug use while having sex was not significantly associated with STI prevalence [adjusted odds ratios (AOR):≤:1.29, 95% confidence interval (CI):≤:0.90-1.83]. However, using the same covariates, the association between male partners' alcohol/drug use and sexually transmitted disease prevalence was significant (AOR:≤:1.44, 95% CI:≤:1.03-2.02). Young women reporting that their sex partners had been drunk or high while having sex (at least once in the past 60 days) were ∼1.4 times more likely to test positive for at least one of the three assessed STIs. Conclusion: Young African American women reporting a male sex partner had been intoxicated during sex were significantly more likely to have an STI. The nature of this phenomenon could be a consequence of women's selection of risky partners and lack of condom use possibly stemming from their intoxication or their partners' intoxication.Condom use among high-risk adolescents : Anticipation of partner disapproval and less pleasure associated with not using condoms
AbstractBrown, L. K., DiClemente, R., Crosby, R., Fernandez, M. I., Pugatch, D., Cohn, S., Lescano, C., Royal, S., Murphy, J. R., Silver, B., & Schlenger, W. E. (n.d.).Publication year
2008Journal title
Public Health ReportsVolume
123Issue
5Page(s)
601-607AbstractObjective. We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. Methods. We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. Results. Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median 5 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. Conclusions. Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.