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
Stability of Trichomonas vaginalis DNA in urine specimens
AbstractIngersoll, J., Bythwood, T., Abdul-Ali, D., Wingood, G. M., DiClemente, R., & Caliendo, A. M. (n.d.).Publication year
2008Journal title
Journal of Clinical MicrobiologyVolume
46Issue
5Page(s)
1628-1630AbstractTrichomonas vaginalis is an important pathogen in both men and women. Culture is considered the diagnostic gold standard, although studies have shown that PCR is more sensitive than either culture or wet mount for the diagnosis of T. vaginalis infections. We sought to identify a simple method for stabilizing T. vaginalis DNA in urine samples that could be easily applied to molecular testing. The stability of T. vaginalis DNA in 40 urine samples was assessed by storage for various times at either 4°C or room temperature with or without the Becton Dickinson urine preservative transport (UPT) kit. Overall, there was better stability of T. vaginalis DNA when specimens were stored at 4°C than when they were stored at 20 to 22°C and when the UPT system was used. T. vaginalis DNA was stable in specimens stored without using the UPT at 4°C for about 3 days and at room temperature for only 1 day. For specimens placed in the UPT within 24 h (times of 1, 6, and 24 h) of collection, the DNA was stable for up to 30 days when stored at 4°C. For specimens stored at room temperature, the urine should be added to the UPT ideally within 1 hour of collection, and in this case the DNA remained stable for up to 30 days. When storing specimens at room temperature, a delay of 24 h prior to adding to UPT led to an unacceptably high loss of assay sensitivity.The ADAPT-ITT model : A novel method of adapting evidence-based HIV interventions
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
2008Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
47Issue
SUPPL. 1Page(s)
S40-S46AbstractThe Institute of Medicine (IOM) recommends the use of HIV prevention interventions with proven efficacy to avert new infections. Given the time and cost associated with the development, implementation and evaluation of efficacious HIV interventions, adapting existing evidence-based interventions (EBIs) to be appropriate for a myriad of at-risk populations may facilitate the efficient development of new EBIs. Unfortunately, few models of theoretic frameworks exist to guide the adaptation of EBIs. Over the past few years, the authors have systematically developed a framework for adapting HIV-related EBIs, known as the "ADAPT-ITT" model. The ADAPT-ITT model consists of 8 sequential phases that inform HIV prevention providers and researchers of a prescriptive method for adapting EBIs. The current article summarizes key components of the ADAPT-ITT model and illustrates the use of the model in several case studies.The first national scientific meeting of the Social and Behavioral Science Research Network
AbstractBlank, M. B., Metzger, D. S., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2008Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
47Issue
SUPPL. 1Page(s)
S1-S4Abstract~The influence of role status on risky sexual behavior among African Americans during the transition to adulthood
AbstractKogan, S. M., Brody, G. H., Gibbons, F. X., Murry, V. M., Cutrona, C. E., Simons, R. L., Wingood, G., & DiClemente, R. (n.d.).Publication year
2008Journal title
Journal of Black PsychologyVolume
34Issue
3Page(s)
399-420AbstractLittle research has examined the links between role status changes during the transition to adulthood and sexual behaviors that place African Americans at risk for sexually transmitted infections. Moreover, the mediating processes that explain these links, or protective factors that may buffer young adults from risky sexual behavior, are unknown. African American young adults who had either completed or dropped out of high school (ages 18 to 21, N = 186) provided information regarding their sexual behavior, role status, substance use, peer affiliations, religiosity, and receipt of protective family processes. Anticipated school attendance, part-time rather than full-time employment, and residence in a dorm or barracks rather than with peers or alone were negatively associated with risk behavior. Parenthood was positively associated with risk behavior; affiliation with peers who encourage risky sex partially accounted for this effect. Substance use fully accounted for the effect of part-time versus full-time employment on sexual risk behavior. Protective family processes and religiosity moderated the association of parenthood with sexual risk behavior. Prospective studies on these processes are warranted.The mediating role of partner communication skills on HIV/STD-associated risk behaviors in young African American females with a history of sexual violence
AbstractSales, J. M., Salazar, L. F., Wingood, G. M., DiClemente, R., Rose, E., & Crosby, R. A. (n.d.).Publication year
2008Journal title
Archives of Pediatrics and Adolescent MedicineVolume
162Issue
5Page(s)
432-438AbstractObjectives: To examine the prevalence of sexual violence among young African American females and to explore the mediating role that partner communication plays on human immunodeficiency virus (HIV)/sexually transmitted disease-associated risk behaviors among youth with a history of sexual violence relative to those without. Design: Only data from baseline, before randomization, were used for this analysis. Setting: A clinic-based sample of young females enrolled in a randomized trial of an HIV-prevention program in Atlanta, Georgia, from March 2002 to August 2004. Participants: African American females aged 15 to 21 years who reported sexual activity in the previous 60 days. Of 1558 screened, 874 females were eligible and 82% (n=715) participated at baseline. Outcome Measures: History of sexual violence as well as (1) sexual partner communication skills, (2) current sexual behaviors, and (3) psychological well-being. Results: Lifetime prevalence of sexual violence was 26%. Communication skills partially mediated the relationship between sexual violence and psychological well-being and sexual behavior outcomes. Conclusions: Given the lifetime prevalence of sexual violence and its adverse sexual, psychological, and relational sequelae, it is paramount that effective interventions are developed. Based on our findings, improving partner communications skills is one particularly important area for HIV/sexually transmitted disease risk-reduction interventions for youths with a history of sexual violence.Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents
AbstractHorner, J. R., Romer, D., Vanable, P. A., Salazar, L. F., Carey, M. P., Juzang, I., Fortune, T., DiClemente, R., Farber, N., Stanton, B., & Valois, R. F. (n.d.).Publication year
2008Journal title
Journal of Health CommunicationVolume
13Issue
4Page(s)
309-325AbstractThe need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify "competing narratives" that support healthy behavior despite the dominance of messages that favor risk-taking behavior. The method is illustrated using qualitative analysis of semistructured interviews with 124 adolescents. Analysis focuses on two barriers to sexual risk reduction: (a) social pressure for early initiation of sexual intercourse and (b) perceptions that condoms reduce sexual pleasure. We demonstrate how competing narratives identified in the analysis can be featured in radio and television messages advocating healthy behavior by modeling risk-reducing negotiation skills.Validation of a Parent-Adolescent Communication Scale for use in STD/HIV prevention interventions
AbstractSales, J. M., Milhausen, R. R., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2008Journal title
Health Education and BehaviorVolume
35Issue
3Page(s)
332-345AbstractThis study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.Young African American men having sex with multiple partners are more likely to use condoms incorrectly : A clinic-based study
AbstractCrosby, R. A., DiClemente, R., Yarber, W. L., Snow, G., & Troutman, A. (n.d.).Publication year
2008Journal title
American Journal of Men's HealthVolume
2Issue
4Page(s)
340-343AbstractThis study tested the research hypothesis that men's errors using condoms would be associated with having multiple sex partners. Specifically, men engaging in sex with three or more women were compared with those having sex with two or fewer women. Recruitment (N = 271) occurred in a publicly funded sexually transmitted disease (STD) clinic located in a metropolitan area of the Southern United States. All men were clinically diagnosed with an STD. They completed a self-reported questionnaire (using a 3-month recall period). Those reporting sex with men were excluded from the analysis. About one half of the men (48.5%) reported penetrative sex with three or more women. The authors found that among young African American men, newly diagnosed with an STD, reporting recent (past 3 months) sex with multiple partners may be emblematic of condom errors. These men may benefit from clinic-based, targeted counseling and education designed to foster improved quality of condom use.Young Women's Perspective of the Pros and Cons to Seeking Screening for Chlamydia and Gonorrhea : An Exploratory Study
AbstractChacko, M. R., von Sternberg, K., Velasquez, M. M., Wiemann, C. M., Smith, P. B., & DiClemente, R. (n.d.).Publication year
2008Journal title
Journal of Pediatric and Adolescent GynecologyVolume
21Issue
4Page(s)
187-193AbstractStudy Objective: To identify young women's pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening. Design: Prospective, cross sectional study. Setting: Community-based reproductive health clinic. Participants: 192 young women (66% African American; mean age 18.9 years). Main Outcome Measures: Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated. Results: Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner trust issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness of the body, being healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic factors. Conclusions: A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young woman's decision-making to seek screening.A review of STD/HIV preventive interventions for adolescents : Sustaining effects using an ecological approach
AbstractDiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2007Journal title
Journal of pediatric psychologyVolume
32Issue
8Page(s)
888-906AbstractObjective: Behavioral intervention programs to reduce adolescent sexual risk behaviors have shown statistically significant reductions in the short-term; however, longer-term follow-up has demonstrated that effects diminish. One criticism has been the reliance on individual-level models. We review the research that has shaped this narrow perspective and propose that a broader, ecological perspective is needed to amplify and extend the efficacy of sexual risk reduction interventions. Methods: We summarize adolescent sexual risk research and outline intervention research that is suggestive of an ecological perspective. Examples from the published literature that have investigated antecedents or conceptualized preventive interventions using a multilevel approach are provided. Results: Adolescents are exposed to diverse sources of influence transecting different levels of causation. To adequately prevent, reduce, and maintain the likelihood of adolescents' adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation. This approach has been implemented in Brazil and was shown to be effective. Conclusion: Research should cross manifold levels of causation so that programs will be more effective at promoting adolescents' adoption and maintenance of STD/HIV preventive behaviors.Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women
AbstractLang, D. L., Salazar, L. F., Wingood, G. M., DiClemente, R., & Mikhail, I. (n.d.).Publication year
2007Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
46Issue
2Page(s)
216-221AbstractBACKGROUND: This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices. METHODS: A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected. RESULTS: A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs. CONCLUSIONS: The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.Brief report : Sexual sensation seeking and its relationship to risky sexual behaviour among African-American adolescent females
AbstractSpitalnick, J. S., DiClemente, R., Wingood, G. M., Crosby, R. A., Milhausen, R. R., Sales, J. M., McCarty, F., Rose, E., & Younge, S. N. (n.d.).Publication year
2007Journal title
Journal of AdolescenceVolume
30Issue
1Page(s)
165-173AbstractThe relationship between sexual sensation seeking and sexual risk taking has been investigated among adult populations. There are limited data, however, regarding this relationship for adolescents. Since African-American adolescent females continue to be disproportionately diagnosed with STDs, including HIV, we examined this association among a clinic-based sample of African-American adolescent females (N=715) enrolled in an STD/HIV prevention intervention. Participants (ages 15-21) endorsing higher levels of sexual sensation seeking reported higher levels of sexual risk-taking behaviours (e.g. frequency of vaginal intercourse, number of sexual partners, and poorer condom use). Results remained significant after controlling for known covariates associated with sexual risk-taking behaviours. Results are consistent with the adult literature and highlight the need for future investigations examining sexual sensation seeking among adolescents. These results, though preliminary, could be used to better inform prevention interventions and clinicians/health educators who provide direct services to adolescents.Complementary and alternative medicine use decreases adherence to HAART in HIV-positive women
AbstractDiClemente, R., Owen-Smith, A., Diclemente, R., & Wingood, G. (n.d.).Publication year
2007Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
19Issue
5Page(s)
589-593AbstractThe use of complementary and alternative medicine (CAM) to treat chronic illnesses, especially HIV, is becoming increasingly widespread. Given this popularity, it is critical to understand how HIV-positive individuals use CAM and, more specifically, whether CAM use impacts their adherence to prescribed antiretroviral regimens (HAART). The present study examined the relationship between CAM use and HAART adherence among HIV+ women. Data were analysed from 366 HIV-positive, mostly African-American women, aged 18-50 years in Alabama and Georgia who were enrolled in an intervention to reduce high-risk sexual behaviour. At enrolment data were collected describing use of CAM and HAART use. Women were classified as CAM users if they reported taking herbal/natural immunity boosters (Chinese herbs, mushrooms, garlic, ginseng or algae) or multivitamins, or reported using religious/psychic health or bodywork to treat HIV. Women were classified as non-adherent if they reported missing any doses of their HAART medication in the 30 days preceding baseline assessment. Logistic regressions models, adjusted for potential confounders, were used to investigate the relationship between CAM use and HAART adherence. Women using CAM (immunity boosters or vitamins), relative to non-CAM users, were 1.69 times more likely to report missing HAART doses in the last 30 days (CI: 1.02-2.80; P=.041) even after adjusting for age, education, race, religion and income. The findings provide preliminary evidence that patients using CAM may be doing so as an alternative to traditional medicine as opposed to complementing prescribed HARRT treatment regimens. The inconsistent use of HAART is problematic given its association with drug resistance. Therefore, health care providers and patients should have explicit dialogues about how to effectively integrate CAM practices into traditional treatment regimens so that the safety and health of HIV-positive patients is not compromised.Condom Misuse Among Adjudicated Girls : Associations with Laboratory-Confirmed Chlamydia and Gonorrhea
AbstractCrosby, R., Salazar, L. F., DiClemente, R., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).Publication year
2007Journal title
Journal of Pediatric and Adolescent GynecologyVolume
20Issue
6Page(s)
339-343AbstractObjectives: To identify the prevalence of condom use errors among detained female teens and to test two inter-related hypotheses concerning condom failure. Methods: A cross-sectional survey of 134 female teens recruited within eight detention facilities. Measures were collected using audio-computer assisted self-interviewing. Assessment for the presence of C. trachomatis and N. gonorrhoeae was also conducted. Results: Five forms of condom use errors/problems were common: not discussing condom use with the partner (34.3%), not having a condom when one was desired (48.5%), starting sex before application (21.6%), removing condoms before sex concludes (26.9%), and breakage (32.8%). Significant, associations were found between condom errors/problems and drug/alcohol use. Errors/problems with condom use were significantly higher among teens diagnosed with an sexually transmitted disease (STD) (P = 0.039 for an index measure; P = 0.022 for a single-item measure). Conclusions: Findings suggest that detained female teens may have experienced multiple condom use error and problems thereby increasing their vulnerability to STD acquisition.Conducting internet-based HIV/STD prevention survey research : Considerations in design and evaluation
AbstractPequegnat, W., Rosser, B. R., Bowen, A. M., Bull, S. S., DiClemente, R., Bockting, W. O., Elford, J., Fishbein, M., Gurak, L., Horvath, K., Konstan, J., Noar, S. M., Ross, M. W., Sherr, L., Spiegel, D., & Zimmerman, R. (n.d.).Publication year
2007Journal title
AIDS and BehaviorVolume
11Issue
4Page(s)
505-521AbstractThe aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.Correlates of consistent condom use among HIV positive African American women
AbstractRaiford, J. L., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2-3Page(s)
41-58AbstractIntroduction: African American women are the fastest growing group at risk of contracting HIV, as over 68% of women diagnosed with HIV are African American. The present study used social-cognitive theory and the theory of gender and power to identify correlates of consistent condom use among African American women living with HIV. Methods: We recruited 366 women, 18-50 years of age and living with HIV from several HIV/AIDS clinics in the southeastern United States. The majority of women, 84.2% (N = 308), were African American. Women completed a baseline interview assessing sociodemographic, psychosocial, and partner-related factors potentially associated with consistent condom use, defined as reported use of condoms during every vaginal sex episode with a male sexual partner in the past 30 days. Results: Among those HIV-positive African American women reporting use of a condom in the past 30 days (n = 234, 70%), consistent condom use was reported by 67.1% of women. This rate was lower (51.6%) among women having an HIV-positive male sexual partner; the rate was higher (74.1%) among women having an HIV-negative male sexual partner. Compared to women who were inconsistent condom users, women with HIV were more likely to use condoms if they: had high partner communication self-efficacy (OR = 7.77, 95% CI = 3.3-18.6, p = .001), had a HIV-negative male sex partner (OR = 4.62, 95% CI = 1.9-11.5, p = 0.001), had low partner-related barriers to condom use (OR = 4.68, 95% CI = 1.8-12.2, p = 0.001), and had perceived peer norms supportive of condom use (OR = 2.38, 95% CI = 1.0-5.7, p = 0.03). Conclusion: These findings suggest that HIV interventions may enhance consistent condom use among African American women living with HIV by targeting women's self-efficacy to communicate with their partners and women's perception of personal and partner-related barriers to condom use.Correlates of HIV risk and preventive behaviors in Armenian female sex workers
AbstractMarkosyan, K. M., Babikian, T., DiClemente, R., Hirsch, J. S., Grigoryan, S., & Del Rio, C. (n.d.).Publication year
2007Journal title
AIDS and BehaviorVolume
11Issue
2Page(s)
325-334AbstractThis study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.HIV discrimination and the health of women living with HIV
AbstractWingood, G. M., DiClemente, R., Mikhail, I., McCree, D. H., Davies, S. L., Hardin, J. W., Harris Peterson, S., Hook, E. W., & Saag, M. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2-3Page(s)
99-112AbstractWomen living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/ AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.HSV-2 serologic testing in an HMO population : Uptake and psychosocial sequelae
AbstractRichards, J., Scholes, D., Caka, S., Drolette, L., Magaret, A. M., Yarbro, P., Lafferty, W., Crosby, R., DiClemente, R., & Wald, A. (n.d.).Publication year
2007Journal title
Sexually Transmitted DiseasesVolume
34Issue
9Page(s)
718-725AbstractOBJECTIVES: To prospectively measure the uptake of Herpes simplex virus Type 2 (HSV-2) testing and psychosocial response to a new serologic diagnosis of HSV-2 in a health maintenance organization (HMO) population. STUDY DESIGN: Randomly selected urban HMO enrollees were invited to be tested for HSV-2 antibody at a research clinic. Participants had blood drawn and completed demographic and psychosocial questionnaires. RESULTS: Of 3111 eligible enrollees contacted, 344 (11%) were tested. Eighty-seven (26%) tested HSV-2 seropositive, and 44 (51%) of these did not report a prior genital herpes diagnosis. Distress, measured by the total mood disturbance, was 6.5 points higher on average following a new genital herpes diagnosis relative to baseline (actual range = 109 points, P = 0.003) but not statistically different from HSV-2 negative or previously diagnosed participants. CONCLUSIONS: HMO enrollees unexpectedly testing HSV-2 positive showed short-term psychosocial distress that resolved during 6-month follow-up. Findings suggest that concerns about psychosocial burden should not deter voluntary serologic HSV-2 testing in primary care settings.Images of sexual stereotypes in rap videos and the health of African American female adolescents
AbstractPeterson, S. H., Wingood, G. M., DiClemente, R., Harrington, K., & Davies, S. (n.d.).Publication year
2007Journal title
Journal of Women's HealthVolume
16Issue
8Page(s)
1157-1164AbstractObjective: This study sought to determine whether perceiving portrayals of sexual stereotypes in rap music videos was associated with adverse health outcomes among African American adolescent females. Methods: African American female adolescents (n = 522) were recruited from community venues. Adolescents completed a survey consisting of questions on sociodemographic characteristics, rap music video viewing habits, and a scale that assessed the primary predictor variable, portrayal of sexual stereotypes in rap music videos. Adolescents also completed an interview that assessed the health outcomes and provided urine for a marijuana screen. Results: In logistic regression analyses, adolescents who perceived more portrayals of sexual stereotypes in rap music videos were more likely to engage in binge drinking (OR 3.8, 95% CI 1.32-11.04, p = 0.01), test positive for marijuana (OR 3.4, 95% CI 1.19-9.85, p = 0.02), have multiple sexual partners (OR 1.9, 95% CI 1.01-3.71, p = 0.04), and have a negative body image (OR 1.5, 95% CI 1.02-2.26, p = 0.04). This is one of the first studies quantitatively examining the relationship between cultural images of sexual stereotypes in rap music videos and a spectrum of adverse health outcomes in African American female adolescents. Conclusions: Greater attention to this social issue may improve the health of all adolescent females.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.Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females
AbstractSalazar, L. F., Crosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).Publication year
2007Journal title
Sexually Transmitted DiseasesVolume
34Issue
10Page(s)
761-766AbstractOBJECTIVES: 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.Prevalence, incidence, and predictors of dating violence : A longitudinal study of African American female adolescents
AbstractRaiford, J. L., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2007Journal title
Journal of Women's HealthVolume
16Issue
6Page(s)
822-832AbstractBackground: Few longitudinal studies have examined predictors of dating violence, a public health issue that may be more prevalent among African Americans. Our objective was to examine the prevalence, incidence, and predictors of dating violence in an African American sample using the theory of gender and power. Methods: A longitudinal design with a 1-year follow-up period was used. Recruiters screened adolescents from a variety of venues, including school health classes, county health department clinics, and adolescent health clinics. Study participants were 522 African American females 14-18 years of age. This study achieved an 85.7% participation rate. Dating violence was defined as ever having experienced verbal or physical abuse perpetrated by a boyfriend. Results: At baseline, 28% of adolescents reported a history of dating violence. To calculate the 1-year incidence of dating violence, adolescents reporting a history of dating violence at baseline were excluded from subsequent longitudinal analyses. In longitudinal analyses, the 1-year incidence of dating violence was 12%. Logistic regression analyses identified four factors at baseline that were predictive of dating violence. This four-factor model correctly classified 87.6% of adolescents according to whether or not they experienced dating violence during the 1-year follow-up. Controlling for public financial assistance, relative to adolescents not experiencing dating violence, those who did were 2.0 times more likely to report less understanding of healthy relationships (CI = 1.1-3.9, p = 0.02), 2.0 times more likely to report using drugs (CI = 1.0-3.7, p = 0.02), and 1.9 times more likely to have viewed X-rated movies (CI = 1.0-3.7, p = 0.03). Conclusions: These findings suggest that secondary prevention of dating violence necessitates educating clinicians on the importance of screening and training practitioners in clinical settings on how to effectively screen adolescents for dating violence, including risk factors for victimization.Refining self-reported condom use among young men at risk of HIV acquisition
AbstractCrosby, R., DiClemente, R., Yarber, W. L., Snow, G., & Troutman, A. (n.d.).Publication year
2007Journal title
Sexual HealthVolume
4Issue
3Page(s)
211-212AbstractThis descriptive study evaluated the validity of self-reported condom use among young African American men. Thirty percent (n = 79) of the men reported consistent condom use. After accounting for late application and/or early removal of condoms, slippage, and breakage, 26 men remained classified as consistent users. Among the 79 men initially classified as consistent condom users, 695 sexual episodes were reported as 'condom-protected;' however, after correcting for user error, 29.6% of the sexual episodes were actually not protected. Studies assessing self-reported condom use among young African American men should assess user errors as well as frequency of condom use.Relationship of STD-Related Shame and Stigma to Female Adolescents' Condom-Protected Intercourse
AbstractSales, J. M., DiClemente, R., Rose, E. S., Wingood, G. M., Klein, J. D., & Woods, E. R. (n.d.).Publication year
2007Journal title
Journal of Adolescent HealthVolume
40Issue
6Page(s)
573.e1-573.e6AbstractPurpose: Shame and stigma associated with sexually transmitted diseases (STDs) are barriers to adolescents seeking prompt and appropriate diagnosis and treatment. However, little is known about how these constructs are related to STD-protective behaviors, such as condom-protected intercourse. Thus, we prospectively examined the relationship between shame and stigma and condom use in adolescent females. Methods: There were 192 African American females age 17.4 ± 1.7 years (range 15-21 years) recruited for the study from local teen-oriented health clinics. At baseline, participants completed demographic and psychosocial measures (including STD-related shame and stigma), and chart- or laboratory-confirmed history of STDs was obtained. At 6 months follow-up, rate of condom-protected intercourse in past 14 days was assessed. Participants' baseline shame and stigma scores, prior history of STDs, and select demographic and theoretically important psychosocial variables were entered into a hierarchical linear regression model to predict condom-protected intercourse in the 14 days prior to the 6-month follow-up assessment. Results: After controlling for variables identified in bivariate correlations, STD-related shame was significantly predictive of condom-protected intercourse in the 14 days prior to follow-up, with higher shame predicting higher rates of condom-protected intercourse. Conclusions: Future prevention efforts attempting to reduce adolescents' risks for STDs and HIV may benefit from addressing STD-related shame and stigma in addition to explicitly linking health-promoting behavior changes (condom use) to a decreased likelihood of future infection with STDs.