Ralph DiClemente

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Professor of Social and Behavioral Sciences

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.

Education

BA, The City College of the City University of New York (CCNY), New York, NY

ScM, Behavioral Sciences, Harvard University, Cambridge, MA

PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA

Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions

Diabetes

HIV/AIDS

Implementation science

Influenza

Psychology

Publications

Parent-adolescent sexual communication : Associations of condom use with condom discussions

Hadley, W., Brown, L. K., Lescano, C. M., Kell, H., Spalding, K., DiClemente, R., & Donenberg, G. (n.d.).

Publication year

2009

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

997-1004

10.1007/s10461-008-9468-z

Abstract

Abstract

This 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 human papillomavirus vaccine survey (PHPVS) : Nurse-led instrument development and psychometric testing for use in research and primary care screening

Thomas, T. L., Strickland, O. L., DiClemente, R., Higgins, M., Williams, B., & Hickey, K. (n.d.).

Publication year

2013

Journal title

Journal of nursing measurement

Volume

Issue

Page(s)

96-109

10.1891/1061-3749.21.1.96

Abstract

Abstract

Background and Purpose: Human papillomavirus (HPV) vaccine was approved for girls aged 9-24 years in 2006 to prevent HPV infection and cervical cancer. The Parental Human Papillomavirus Survey (PHPVS) was framed on theoretical constructs of the health belief model (HBM) and developed to survey parents regarding their HPV knowledge, attitudes, and intent to vaccinate. Methods: We evaluated the psychometric properties of the PHPVS using classical item analysis and exploratory factor analysis (EFA) among a sample of 200 parents/caregivers. Results: The EFA yielded a 4-factor unidimensional model that explained between 62% and 68% of the total variance depending on the extraction method used. The estimated Cronbach's alpha for the PHPVS was .96. Conclusions: The PHPVS is a reliable measure of HPV knowledge, attitudes, and intent to vaccinate.

Parental monitoring : Association with adolescents' risk behaviors

DiClemente, R., Wingood, G. M., Crosby, R., Sionean, C., Cobb, B. K., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).

Publication year

2001

Journal title

Pediatrics

Volume

107

Issue

Page(s)

1363-1368

10.1542/peds.107.6.1363

Abstract

Abstract

Context. Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, few studies have examined the impact of parental monitoring. Objective. To examine the influence of less perceived parental monitoring on a spectrum of adolescent health-compromising behaviors and outcomes. Design. Survey. Setting. A family medicine clinic. Participants. To assess eligibility, recruiters screened a sample of 1130 teens residing in low-income neighborhoods. Adolescents were eligible if they were black females, between the ages of 14 and 18 years, sexually active in the previous 6 months, and provided written informed consent. Most teens (n = 609) were eligible, with 522 (85.7%) agreeing to participate. Main Outcome Measures. Variables in 6 domains were assessed, including: sexually transmitted diseases, sexual behaviors, marijuana use, alcohol use, antisocial behavior, and violence. Results. In logistic regression analyses, controlling for observed covariates, adolescents perceiving less parental monitoring were more likely to test positive for a sexually transmitted disease (odds ratio [OR]: 1.7), report not using a condom at last sexual intercourse (OR: 1.7), have multiple sexual partners in the past 6 months (OR: 2.0), have risky sex partners (OR: 1.5), have a new sex partner in the past 30 days (OR: 3.0), and not use any contraception during the last sexual intercourse episode (OR: 1.9). Furthermore, adolescents perceiving less parental monitoring were more likely to have a history of marijuana use and use marijuana more often in the past 30 days (OR: 2.3 and OR: 2.5, respectively); a history of alcohol use and greater alcohol consumption in the past 30 days (OR: 1.4 and OR: 1.9, respectively); have a history of arrest (OR: 2.1); and there was a trend toward having engaged in fights in the past 6 months (OR: 1.4). Conclusions. The findings demonstrate a consistent pattern of health risk behaviors and adverse biological outcomes associated with less perceived parental monitoring. Additional research needs to focus on developing theoretical models that help explain the influence of familial environment on adolescent health and develop and evaluate interventions to promote the health of adolescents.

Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care

Nappi, C. M., Thakral, C., Kapungu, C., Donenberg, G. R., DiClemente, R., & Brown, L. (n.d.).

Publication year

2009

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1012-1020

10.1007/s10461-008-9495-9

Abstract

Abstract

Authors 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.

Participation by African-American adolescent females in social organization : Associations with HIV-protective behaviors

Crosby, R. A., DiClemente, R., Wingwood, G. M., Harrington, K., Davies, S., & Malow, R. (n.d.).

Publication year

2002

Journal title

Ethnicity and Disease

Volume

Issue

Page(s)

186-192

Abstract

Abstract

Background: African-American adolescent females are disproportionately affected by the HIV epidemic in the United States. One important potential, yet understudied, protective influence that may reduce African-American adolescents' HIV risk behavior is their involvement in social organizations. Objective: To examine the association between high-risk African-American adolescent females' activity in social organizations and their recent HIV-associated sexual risk behavior. Methods: Sexually active, African-American females (N = 522) were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Adolescents' participation in Black social organizations was assessed. Measures of HIV protective behavior were also assessed. Bivariate analysis was followed by logistic regression to calculate adjusted odds ratios (AOR) for the outcomes. Results: Adolescents not belonging to social organizations were about 1.6 times more likely to report recent acquiescence to unwanted sex without a condom, 1.9 times more likely to report that their current steady sex partner had other partners, and 1.9 times more likely to score low on the measure of sex-related communication with parents. Discussion: Findings from controlled analyses suggest that community-based Black social organizations may be an important venue for protecting African-American adolescent females from having sex with a partner who has concurrent partners, and from having unwanted sex without a condom. Participation in Black social organizations was also associated with more frequent interaction between adolescents and their parents about sex-related issues such as HIV prevention. Models of HIV prevention that promote community involvement may be an under-utilized intervention modality with high potential impact.

Partner communication scale

Mülhausen, R. R., Sales, J. M., & DiClemente, R. (n.d.).

Publication year

2019

Page(s)

230-232

Abstract

Abstract

Partner influences and gender-related factors associated with noncondom use among young adult african american women

Wingood, G. M., & DiClemente, R. (n.d.).

Publication year

1998

Journal title

American journal of community psychology

Volume

Issue

Page(s)

29-51

10.1023/A:1021830023545

Abstract

Abstract

We examined the partner influences and gender-related correlates of noncondom use among African American women. The prevalence of noncondom use was 45.3%. Women whose sexual partners were noncondom users were four times more likely to believe that asking their partner to use a condom implied he was unfaithful, three times as likely to have a partner who resisted using condoms, three times more likefy to receive AFDC, twice as likefy to be sexually nonassertive, three times more likefy to believe that it was not difficult to find an "eligible" African American man, and three times as likefy to have had one sexual partner. HIV prevention tailored towards African American women should address these partner influences and gender-related factors.

Pathways to drug and sexual risk behaviors among detained adolescents

Voisin, D. R., Neilands, T. B., Salazar, L. F., Crosby, R., & DiClemente, R. (n.d.).

Publication year

2008

Journal title

Social Work Research

Volume

Issue

Page(s)

147-157

10.1093/swr/32.3.147

Abstract

Abstract

This study recruited 559 youths from detention centers (mean age was 15.4 years; 50.1% of detainees were girls) to investigate pathways that link witnessing community violence in the 12 months before detainment to drug and sexual risk behaviors in the two months preceding detainment. Through the use of audio-computer-assisted technology, data were collected on demographics, family factors, peer influences, religiosity, witnessing community violence, and drug and sexual risk behaviors. When controlling for demographics and family variables, the authors found positive associations between witnessing community violence and drug and sexual risk behaviors. Witnessing community violence was directly linked to sexual risk behaviors and indirectly associated with these risk behaviors and substance use through gang membership and perceived risky peer norms. Findings suggest that interventions targeting change in peer affiliations and perceived norms may be an effective strategy for reducing risky drug and sexual behaviors among detained youths.

Patient delay in the diagnosis of cancer, emphasizing malignant melanoma of the skin.

DiClemente, R., DiClemente, R. J., Temoshok, L., Pickle, L. W., Barro, A. R., & Ehlke, G. (n.d.).

Publication year

1982

Journal title

Progress in clinical and biological research

Volume

Page(s)

185-194

Abstract

Abstract

Patient–Provider Health Communication Strategies : Enhancing HPV Vaccine Uptake among Adolescents of Color

Xu, M. A., Choi, J., Capasso, A., & DiClemente, R. (n.d.).

Publication year

2023

Journal title

Healthcare (Switzerland)

Volume

Issue

10.3390/healthcare11121702

Abstract

Abstract

Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient–provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient–provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.

Perceived Difficulty of Performing Selected HIV/AIDS Preventive Behaviors and Life Satisfaction : Is there a Relationship for African American Adolescents?

Valois, R. F., Kerr, J. C., Hennessy, M., DiClemente, R., Brown, L. K., Carey, M. P., Vanable, P. A., Farber, N. B., Salazar, L. F., & Romer, D. (n.d.).

Publication year

2015

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1288-1297

10.1007/s10461-014-0900-2

Abstract

Abstract

Research on the relationship between adolescent health risk behaviors, sexual risk behaviors in particular, and perceived life satisfaction is emerging. Some researchers suggest that life satisfaction has been a neglected component of adolescent health research. African American adolescents aged 13–18 (n = 1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire via Audio Computer Assisted Self-Interview. Analyses were conducted to examine relationships between perceived difficulty in performing HIV/AIDS preventive behavior and perceived life satisfaction, while controlling for socioeconomic status. Results suggest that perceived life satisfaction is related to perceived difficulty in performing HIV/AIDS preventive behaviors, for both males and females, with variability in the magnitude of associations by gender. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived difficulty in performing HIV/AIDS preventive behavior to develop gender-appropriate and culturally-sensitive quality of life/health promotion programs.

Perceived neighborhood violence and crime, emotion regulation, and PTSD symptoms Among Justice-Involved, Urban African-American adolescent girls

Sun, S., Crooks, N., DiClemente, R., & Sales, J. M. (n.d.).

Publication year

2020

Journal title

Psychological Trauma: Theory, Research, Practice, and Policy

Volume

Issue

Page(s)

1-6

10.1037/tra0000562

Abstract

Abstract

Objective: African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African-American adolescent girls (n = 85) following their release from detention centers. Method: We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms. Results: The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms. Conclusions: Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms.

Personal and social influences regarding oral sex among African American female adolescents

Salazar, L. F., Head, S., Crosby, R. A., DiClemente, R., Sales, J. M., Wingood, G. M., & Rose, E. (n.d.).

Publication year

2011

Journal title

Journal of Women's Health

Volume

Issue

Page(s)

161-167

10.1089/jwh.2010.2247

Abstract

Abstract

Objective: To identify personal and social factors associated with performing oral sex among female adolescents. Methods: Sexually active African American female adolescents (n=715) recruited from sexually transmitted infection (STI) clinics were assessed for self-esteem, sexual sensation seeking, unprotected vaginal sex (UVS), self-efficacy to communicate about sex and to refuse sex, fear of negotiating condoms, relationship power, peer norms surrounding risky sexual behavior, ever having performed oral sex, and three vaginally acquired STIs. Results: Prevalence for at least one STI was 29%. More than half reported performing oral sex. Controlling for age, performing oral sex was associated with relatively higher sexual sensation seeking, any UVS in past 60 days, relatively lower self-efficacy to refuse sex, and having peer norms supportive of risky sexual behaviors. Conclusions: Given the potential for epidemic spread of orally acquired STIs to populations of female adolescents residing in communities with high rates of STI prevalence, this initial research provides guidance for intervention development and expanded research efforts.

Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females

Salazar, L. F., Crosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).

Publication year

2007

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

761-766

10.1097/01.olq.0000264496.94135.ac

Abstract

Abstract

OBJECTIVES: To identify risk factors for laboratory confirmed sexually transmitted disease (STD) prevalence among low-income African American adolescent females living in a high-risk urban area of the Southern United States. METHODS: Participants were 715 African American adolescent females recruited from urban clinics. Data collection occurred from 2002 to 2004 and included an audio-computer assisted self-interview lasting about 60 minutes and a self-collected vaginal swab for NAAT to detect Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Ten personal-level risk factors were assessed as well as 8 risk factors involving either peer or relational factors. RESULTS: Adolescents (28.8%) tested positive for at least 1 STD. Six personal-level and 4 social-level measures achieved a bivariate screening level of significance. In the multivariate model, only 3 measures achieved significance: gang involvement, social support from peers, and fear of condom use negotiation. Compared to those who had never belonged to a gang, those who had were about 4.2 times more likely (95% CI = 2.16-9.44) to test positive. Adolescents' who had higher levels of fear pertaining to condom use negotiation were more likely to test positive as were adolescents who perceived higher levels of social support from their peers. CONCLUSIONS: This finding suggests and supports the utility of designing interventions for high-risk African American adolescent females that incorporate objectives to modify the significant social influences related to STD acquisition.

Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women : Comparison to Self-Report Assessments of Alcohol Use

Littlefield, A. K., Brown, J. L., DiClemente, R., Safonova, P., Sales, J. M., Rose, E. S., Belyakov, N., & Rassokhin, V. V. (n.d.).

Publication year

2017

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1938-1949

10.1007/s10461-017-1769-7

Abstract

Abstract

Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman’s r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.

Pivoting from in-person to phone survey assessment of alcohol and substance use : effects on representativeness in a United States prospective cohort of women living with and without HIV

Tierney, H. R., Ma, Y., Bacchetti, P., Adimora, A. A., Chandran, A., Kempf, M. C., Collins, L. F., DeHovitz, J., DiClemente, R., French, A. L., Jones, D. L., Sharma, A., Spence, A. B., Hahn, J. A., Price, J. C., & Tien, P. C. (n.d.).

Publication year

2023

Journal title

American Journal of Drug and Alcohol Abuse

10.1080/00952990.2023.2267745

Abstract

Abstract

Background: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women. Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women’s Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV. Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April–September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August–September 2020) phone survey. Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33–0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41–0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02–2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24–2.43). Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.

Pivoting from in-person to telephone survey assessment of alcohol and substance use: effects on representativeness in a United States prospective cohort of women living with and without HIV

DiClemente, R., Tierney, H., Ma, Y., Bacchetti, P., Adimora, A., Chandran, A., Kempf, M., Collins, L., DeHovitz, J., French, A., Jones, D., Sharma, A., Spence, A., & Hahn, J. (n.d.). (1st ed.).

Publication year

2024

Volume

American Journal Drug Alcohol Abuse 50

Abstract

Abstract

Planning models are critical for facilitating the development, implementation, and evaluation of dental health promotion interventions

DiClemente, R. (n.d.).

Publication year

2011

Journal title

Journal of public health dentistry

Volume

Issue

SUPPL. 1

Page(s)

S16

10.1111/j.1752-7325.2011.00218.x

Abstract

Abstract

Predicting discordance between self-reports of sexual behavior and incident sexually transmitted infections with african american female adolescents : Results from a 4-city study

Brown, J. L., Sales, J. M., DiClemente, R., Salazar, L. F., Vanable, P. A., Carey, M. P., Brown, L. K., Romer, D., Valois, R. F., & Stanton, B. (n.d.).

Publication year

2012

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1491-1500

10.1007/s10461-012-0163-8

Abstract

Abstract

This study examined correlates of the discordance between sexual behavior self-reports and Incident Sexually Transmitted Infections. African American adolescent females (N = 964) from four U.S. cities were recruited for an HIV/STI prevention trial. Self-reported sexual behaviors, demographics, and hypothesized psychosocial antecedents of sexual risk behavior were collected at baseline, 6-, 12-, and 18-month follow-up assessments. Urine specimens were collected and tested for three prevalent STIs (chlamydia, gonorrhea, trichomonas) at each assessment. Seventeen percent of participants with a laboratory-confirmed STI reported either lifetime abstinence or recent abstinence from vaginal sex (discordant self-report). Lower STI knowledge, belief that fewer peers were engaging in sex, and belief that more peers will wait until marriage to have sex were associated with discordant reports. Discordance between self-reported abstinence and incident STIs was marked among African American female adolescents. Lack of STI knowledge and sexual behavior peer norms may result in underreporting of sexual behaviors.

Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power

Rosenbaum, J. E., Zenilman, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).

Publication year

2016

Journal title

Journal of Urban Health

Volume

Issue

Page(s)

493-510

10.1007/s11524-016-0047-8

Abstract

Abstract

Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15–21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.

Predictors of condom errors among sex workers in Armenia

DiClemente, R., Lang, D. L., Salazar, L. F., DiClemente, R. J., Markosyan, K., & Darbinyan, N. (n.d.).

Publication year

2011

Journal title

International Journal of STD and AIDS

Volume

Issue

Page(s)

126-130

10.1258/ijsa.2009.009418

Abstract

Abstract

This cross-sectional study identified the prevalence and correlates of condom-use errors among female sex workers (FSWs) in Armenia. One hundred and seventeen street-based FSWs aged 20-52 years completed an interviewer-administered questionnaire. Condom-use errors were reported by 78.0% of participants. Number of clients, higher frequency of condom application on clients by FSWs, greater perceived barriers to condom use, elevated depressive symptomatology and having sex while drinking alcohol were significantly associated with higher number of condom-use errors. History of sexually transmitted infections (STIs) was marginally significant while consistent condom use was not significant in the final model. The multiple regression model accounted for 32.5% of the variance in condom-use errors. Condom-use errors are prevalent in this population, thus attenuating the intended protective effects of condoms. Interventions with FSWs in Armenia should specifically address the factors identified in this study toward the goal of reducing condom errors and ultimately preventing acquisition of STIs including HIV.

Predictors of condom use in sexually active adolescents

Brown, L. K., DiClemente, R., & Park, T. (n.d.).

Publication year

1992

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

651-657

10.1016/1054-139X(92)90058-J

Abstract

Abstract

Unprotected sexual intercourse places a substantial number of adolescents at risk for sexually transmitted disease (STD) and human immunodeficiency virus (HIV) infection. While the most effective means of preventing STD/ HIV infection among sexually active adolescents is consistent condom use, little is known about the factors that influence their consistent use among adolescents. This study of adolescents (n = 1049, mean age = 16.2 years) found that of the 266 teens who recently became sexually active, only 29% reported using condoms consistently. Consistent condom use was more frequent in males, those with little history of risk behavior and those with stronger intentions to use condoms in the future. Fear and anxiety of HIV, attitudes about risks other than HIV, and other safe behavior intentions were not significantly related to consistent condom use. Although intentions and recent behavior were significantly related, a different group of factors was found to predict intention to use condoms (e.g., perception of condom use by friends, general impulsive attitudes). Identifying and understanding the factors that influence adolescent sexual behavior and intentions is important for developing maximally effective HIV education/prevention programs.

Predictors of consistent condom use among young African American Women

Crosby, R. A., DiClemente, R., Salazar, L. F., Wingood, G. M., McDermott-Sales, J., Young, A. M., & Rose, E. (n.d.).

Publication year

2013

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

865-871

10.1007/s10461-011-9998-7

Abstract

Abstract

The purpose of this study was to determine the predictive value of selected factors to the consistent use of condoms among high-risk young African American women. A clinic-based, prospective, study of 242 young, African-American women (ages 15-21) was conducted. In multivariate analysis, consistent condom use was predicted by having greater perceptions of condom negotiation self-efficacy, lower fear of negotiating condom use, and having communicated with sex partners (during the recall period) about condom use. Relational variables were predictive of consistent condom use among young African American women. STD/HIV preventive interventions should target these factors, perhaps in dyad-level interventions.

Predictors of HIV-preventive sexual behavior in a high-risk adolescent population : The influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms

DiClemente, R. (n.d.).

Publication year

1991

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

385-390

10.1016/0197-0070(91)90052-N

Abstract

Abstract

Data were collected from 112 sexually active adolescents incarcerated in a juvenile detention facility to identify predictors of consistent use of condoms during sexual intercourse. Adolescents completed an anonymous epidemiologic survey instrument developed by the Centers for Disease Control. The self-report survey assessed, demographic, psychosocial, and behavioral factors. Three factors were identified as associated with consistent condom use. These significant bivariate factors were entered into a multivariate logistic regression model to identify the independent contribution of each factor. Non-Black adolescents, adolescents who communicate with their sex partners about AIDS, and those who perceive peer norms as supporting condom use were significantly more likely to be consistent condom users. The findings suggest that Human Immunodeficiency Virus (HIV) prevention programs for incarcerated adolescents that emphasize training in communication skills and modifying perceptions off peer normative behavior may be more effective in increasing the adoption and maintenance of condom use.

Predictors of Inconsistent Contraceptive Use among Adolescent Girls : Findings from a Prospective Study

Davies, S. L., DiClemente, R., Wingood, G. M., Person, S. D., Dix, E. S., Harrington, K., Crosby, R. A., & Oh, K. (n.d.).

Publication year

2006

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

43-49

10.1016/j.jadohealth.2005.10.011

Abstract

Abstract

Purpose: To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females. Methods: Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test. Results: Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors. Conclusions: Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.

Ralph DiClemente