Ralph DiClemente
Ralph DiClemente
Scroll
Professor of Social and Behavioral Sciences
-
Professional overview
-
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, 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
-
Areas of research and study
-
Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
-
Publications
Publications
Condom use at last sex as a proxy for other measures of condom use : Is it good enough?
AbstractYounge, S. N., Salazar, L. F., Crosby, R. F., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2008Journal title
AdolescenceVolume
43Issue
172Page(s)
927-931AbstractCondom use at last sex is a widely used indicator in sexual behavior research; however, there is little empirical research validating this indicator. This study examined whether a single-event recall period (the last time coitus occurred) was consistent with longer recall periods (14 days and 60 days) for a sample of African American adolescent females (N = 566). The findings from this study demonstrate that condom use at last coitus is a valid proxy for condom use behaviors spanning longer time periods.Do protective behaviors follow the experience of testing positive for herpes simplex type 2?
AbstractCrosby, R. A., Head, S., DiClemente, R., Meyerson, B., & Troutman, A. (n.d.).Publication year
2008Journal title
Sexually Transmitted DiseasesVolume
35Issue
9Page(s)
787-790AbstractOBJECTIVE: To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). METHODS: Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). RESULTS: Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group × time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. CONCLUSIONS: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.Exposure to alcohol problems and its association with sexual behaviour and biologically confirmed Trichomonas vaginalis among women living with HIV
AbstractSeth, P., Wingood, G. M., DiClemente, R. J., & DiClemente, R. (n.d.).Publication year
2008Journal title
Sexually transmitted infectionsVolume
84Issue
5Page(s)
390-392AbstractObjectives: Only a small number of studies have examined the association between alcohol use and risky sexual behaviour among women living with HIV, particularly African-American women. The present study examined the association between alcohol problems, sexual behaviour and biologically confirmed sexually transmitted infections (STI) among a sample of predominantly African-American women living with HIV. Methods: A sample of 366 women living with HIV between the ages of 18 and 50 years participated in the study. The majority of women were African-American (84.2%). Participants completed a face-to-face interview assessing sociodemographics, sexual behaviour, other substance use and alcohol problems using the CAGE (Cut down, Annoyed, Guilty, Eye opener), a screening measure for alcohol abuse. Participants also provided self-collected vaginal swab specimens that were assayed for STI. Results: The prevalence of high scores on the CAGE was 54.5% and 15% of women tested positive for Trichomonas vagínalis. Multivariate logistic regression analyses, with age and other substance use as covariates, indicated that women who scored higher on the CAGE, relative to those who scored lower, were more likely to test positive for T vaginalis, have sex with their spouse or steady partner when only they had been drinking and have sex with their spouse or steady partner when they had both been drinking. Conclusions: These findings suggest that alcohol assessment should be included in regular healthcare maintenance among women living with HIV. Intervention programmes should be tailored to address alcohol use/ abuse among African-American women living with HIV.Frequency of sex after an intervention to decrease sexual risk-taking among African-American adolescent girls : Results of a randomized, controlled clinical trial
AbstractMilhausen, R. R., DiClemente, R., Lang, D. L., Spitalnick, J. S., Sales, J. M., & Hardin, J. W. (n.d.).Publication year
2008Journal title
Sex EducationVolume
8Issue
1Page(s)
47-57AbstractMany controversies surround sex education in the United States. One particular issue of contention is whether comprehensive sexuality education increases frequency of sexual intercourse among program participants. The current investigation examined frequency of vaginal sexual intercourse in a sample of 522 sexually experienced African-American adolescent females between the ages of 14 and 18 (mean = 16.0 years, standard deviation = 1.22). Participants were a part of a randomized, controlled trial evaluating the efficacy of a comprehensive sexuality education intervention. Data collection occurred at baseline and at 6-month and 12-month follow-up. Participants were recruited from four community health agencies in the Birmingham, Alabama area. Results indicate no significant differences in the frequency of sex between the HIV intervention group and the general health-promotion comparison group at any time point: baseline to 6-month assessment, 6-month to 12-month assessment, or over the entire 12-month follow-up period. These findings reiterate the value of hierarchical messages in sex education curricula that inform adolescents that abstinence is the most effective way to prevent sexually transmitted disease infection, while encouraging adolescents who choose to have sex to use condoms correctly and consistently, and teaching them the skills to do so.Future directions for HIV prevention research : Charting a prevention science research agenda
AbstractDiClemente, R., Wingood, G. M., Blank, M. B., & Metzger, D. S. (n.d.).Publication year
2008Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
47Issue
SUPPL. 1Page(s)
S47-S48Abstract~HIV Stigma and mental health status among women living with HIV in the Western Cape, South Africa
AbstractWingood, G. M., Reddy, P., Peterson, S. H., DiClemente, R., Nogoduka, C., Braxton, N., & MBewu, A. D. (n.d.).Publication year
2008Journal title
South African Journal of ScienceVolume
104Issue
5-6Page(s)
237-240AbstractSince the beginning of the epidemic, people living with HIV and the social groups to which they belong have been stigmatized worldwide. This cross-sectional study, conducted between July and November 2003, investigated the association between HIV stigma and mental health status among black women living with HIV in the Western Cape province of South Africa. Eligible participants completed a questionnaire that assessed HIV stigma, sociodemographic, and mental health status measures. Participants were recruited from one of five primary health care clinics in the rural Western Cape. Recruiters screened 177 women to assess their eligibility. Of those screened, 68% (n = 120) were eligible because they were black South Africans, between the ages of 18 and 45, were living with HIV/AIDS, sought primary health care from one of the five study clinics, spoke Xhosa, and provided written informed consent. A priori hypotheses postulated that women reporting more HIV stigma would experience more consequences for mental health sequelae. The main outcome measures were mental health status variables, including depressive symptomatology, stress of HIV discrimination, quality of life, post-traumatic stress, suicidal ideation and fear of HIV disclosure. In linear regression models, more reports of HIV stigma were associated with significantly more depressive symptomatology (P = 0.03) and a lower quality of life (P = 0.00). The findings from this study indicate that HIV stigma is associated with adverse mental health sequelae among black Xhosa women living with HIV. Educational and legal efforts are required to reduce HIV stigma. Moreover, a public health infrastructure that integrates HIV/AIDS treatment and mental health services may be a promising strategy for reducing the adverse mental health consequences of HIV stigma.Pathways to drug and sexual risk behaviors among detained adolescents
AbstractVoisin, D. R., Neilands, T. B., Salazar, L. F., Crosby, R., & DiClemente, R. (n.d.).Publication year
2008Journal title
Social Work ResearchVolume
32Issue
3Page(s)
147-157AbstractThis 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.Prevalence, correlates, and efficacy of selective avoidance as a sexually transmitted disease prevention strategy among African American adolescent females
AbstractDiClemente, R., Wingood, G. M., Crosby, R. A., Salazar, L. F., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).Publication year
2008Journal title
Archives of Pediatrics and Adolescent MedicineVolume
162Issue
1Page(s)
60-65AbstractObjectives: To identify the prevalence and correlates of selective avoidance (SA) of sexual intercourse among African American adolescent females at risk for sexually transmitted disease (STD) acquisition and transmission. Design: Cross-sectional study. Setting: Health clinics. Participants: African American females (N=715) between the ages of 15 and 21 years. Main Outcome Measures: Self-reported sexual behaviors and laboratory-confirmed STDs. Results: Among the participants, 35.4% used SA as a strategy to prevent STD acquisition; 25.7% used SA to prevent STD transmission. Use of SA was not associated with current STD status. In multivariable analyses, adolescents who had sexual intercourse with 2 or more partners in the past 60 days, those who had high fear related to condom use negotiation, and those who discussed STD prevention with their sexual partners were 2.05 times more likely (95% confidence interval [CI], 1.31-3.20), 1.55 times more likely (95% CI, 1.09-2.19), and 2.00 times more likely (95% CI, 1.38-2.90), respectively, to use SA to prevent STD acquisition, and the same groups were 2.62 times more likely (95% CI, 1.62-4.24), 1.60 times more likely (95% CI, 1.10-2.32), and 2.13 times more likely (95% CI, 1.39-3.26), respectively, to use SA to prevent STD transmission. Conclusions: This study provides initial evidence suggesting that SA as a risk-reduction strategy specifically used to prevent STD acquisition and/or transmission may be common among African American adolescent females. Based on a lack of differences in STD prevalence, we recommend that clinicians and prevention programs discourage the use of SA as an STD prevention strategy and encourage adolescent females to use condoms consistently and correctly with all male sexual partners.Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection : What works and what doesn't work?
AbstractDiClemente, R., Crittenden, C. P., Rose, E., Sales, J. M., Wingood, G. M., Crosby, R. A., & Salazar, L. F. (n.d.).Publication year
2008Journal title
Psychosomatic MedicineVolume
70Issue
5Page(s)
598-605AbstractThe HIV epidemic among adolescents in the United States is inherently tied to individual, psychosocial, and cultural phenomena. Expanding intervention development and implementation to incorporate a broader spectrum of determinants of adolescents' sexual risk for sexually transmitted infections (STIs)/HIV acquisition may provide an opportunity to prevent disease transmission more effectively. To address the STI/HIV prevention needs of adolescents, we highlight research assessing adolescents' sexual risk behavior and place the findings in the context of the diverse array of psychosocial factors influencing adolescents. This synthesis provides an opportunity to examine why adolescents engage in risky sexual behavior and to review the effectiveness of theory-based prevention programs. Subsequently, we offer recommendations for improving future programs aimed at reducing the incidence of STI/HIV infection among adolescents.Sexual agency versus relational factors : A study of condom use antecedents among high-risk young African American women
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Head, S., Rose, E., & McDermott-Sales, J. (n.d.).Publication year
2008Journal title
Sexual HealthVolume
5Issue
1Page(s)
41-47AbstractBackground: The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. Methods: A cross sectional study of 713 young, African American women (aged 15-21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Results: Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. Conclusion: The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.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
AbstractOwen-Smith, A., Diclemente, R., Wingood, G., & DiClemente, R. (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.