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

Predictors of infection with Trichomonas vaginalis : A prospective study of low income African-American adolescent females

DiClemente, R., Crosby, R., DiClemente, R. J., Wingood, G. M., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).

Publication year

2002

Journal title

Sexually transmitted infections

Volume

Issue

Page(s)

360-364

10.1136/sti.78.5.360

Abstract

Abstract

Objectives: To identify psychosocial predictors of Trichomonas vaginalis infection among low income African-American adolescent females living in a high risk urban area of the United States. Methods: Baseline plus 6 and 12 month follow up data collected as part of an HIV prevention intervention trial were utilised. The baseline sample consisted of 522 African-American females, 14-18 years of age. Recruitment sites were located in low income neighbourhoods of Birmingham, Alabama, characterised by high rates of unemployment, substance abuse, violence, teenage pregnancy, and sexually transmitted infections. Self administered vaginal swab specimens were cultured for T vaginalis. Baseline measures collected as part of a self administered survey and face to face interviews were used to predict subsequent infection with T vaginalis at any of the three assessment periods conducted over the span of 1 year. Results: At baseline, 12.9% were diagnosed with T vaginalis. At the 6 and 12 month follow ups, T vaginalis was diagnosed in 8.9% and 10.2%, respectively. The strongest multivariate predictor of T vaginalis infection was biologically confirmed marijuana use; those using marijuana were more than six times as likely to test positive for T vaginalis (adjusted odds ratio (AOR) = 6.2, p = 0.0003). Other multivariate predictors were reporting that typical sex partners were at least 5 years older (AOR = 2.6; p = 0.005), reporting sex with non-steady partners (AOR = 1.9; p = 0.02), and history of delinquency (AOR = 1.3; p = 0.02). The odds of testing positive increased by 31% for every one unit increase on a six item scale measure of delinquency. Conclusions: Infection with T vaginalis was common and significant multivariate predictors comprised a constellation of problem behaviours, each of which are potentially amenable to behavioural intervention.

Predictors of repeat chlamydia trachomatis and/or neisseria gonorrhoeae infections among african-american adolescent women

Swartzendruber, A., Sales, J. M., Brown, J. L., Davis, T. L., DiClemente, R., & Rose, E. (n.d.).

Publication year

2013

Journal title

Sexually transmitted infections

Volume

Issue

Page(s)

76-82

10.1136/sextrans-2012-050530

Abstract

Abstract

Background Young African-American women have the highest rates of Chlamydia trachomatis and Neisseria gonorrhoeae in the USA. The objective was to identify baseline predictors of repeat chlamydia and/or gonorrhoea infections among African-American adolescent women. Methods Sociodemographic, psychosocial and behavioural data were collected at baseline and every 6 months for 2 years from 701 African-American women (14-20 years) enrolled in an HIV prevention trial. Vaginal swabs were self-collected at each visit and assayed for chlamydia and gonorrhoea using DNA amplification. Among participants testing positive for chlamydia and/or gonorrhoea at baseline, logistic regression analyses assessed baseline predictors of repeat infection. Results Of 618 (88%) participants with ≥1 follow-up assessment, 123 (20%) had a positive chlamydia and/or gonorrhoea test result at baseline; 49 (40%) had a repeat infection during the study period. Of those with a repeat infection, 30 (61%) were positive at one follow-up visit, 18 (37%) at two visits and 1 (2%) at three follow-up visits. Controlling for age and intervention condition, impulsivity (AOR: 1.71, p=0.018) was associated with an increased likelihood, and having a boyfriend (AOR: 0.21, p=0.006) was associated with a decreased likelihood of repeat infection. Conclusions Repeat chlamydia and/or gonorrhoea infections are common among African-American adolescent women. Among young African-American women who test positive for chlamydia and/or gonorrhoea, tailored interventions for more impulsive adolescents and those not in a relationship may reduce risk of repeat infections. Given the high numbers of repeat infections after receipt of an evidence-based intervention, enhanced screening and treatment services for young men may be warranted. Clinical Trials Registration http://www.clinicaltrials. gov (NCT00279799).

Predictors of sun exposure in adolescents in a southeastern U.S. population

Reynolds, K. D., Blaum, J. M., Jester, P. M., Weiss, H., Soong, S. J., & DiClemente, R. (n.d.).

Publication year

1996

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

409-415

10.1016/S1054-139X(96)00050-X

Abstract

Abstract

Purpose: With the increase in melanoma incidence, the sun exposure and protective behaviors of adolescents are of great concern. Limited data are available on the prevalence and predictors of risk behavior in adolescents in the southeastern United States. This study examined the levels of sun exposure and variables predictive of sun exposure among adolescents in two Alabama middle schools. Methods: A total of 509 sixth-graders completed a self-administered survey assessing: (a) their knowledge, attitudes, and beliefs about malignant melanoma; and (b) their sun exposure and sunburns for a specific weekend and for the summer. Results: Levels of sun exposure and frequency of sunburn were high. Regression models determined the predictors of weekend and summer sun exposure, and weekend sunburn. Significant predictors varied by outcome and included gender, perceived importance of a suntan, parent and peer modeling, and sunscreen use. Conclusions: Reducing the risk of melanoma will require a three-pronged intervention strategy with efforts directed at adolescents, their parents, and the broader community.

Preexisting chronic health conditions and health insurance status associated with vaccine receipt among adolescents

Seib, K., Underwood, N. L., Gargano, L. M., Sales, J. M., Morfaw, C., Weiss, P., Murray, D., Vogt, T. M., DiClemente, R., & Hughes, J. M. (n.d.).

Publication year

2016

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

148-153

10.1016/j.jadohealth.2015.10.009

Abstract

Abstract

Purpose: Four vaccines are routinely recommended for adolescents: tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); meningococcal-conjugate (MCV4); and a yearly seasonal influenza vaccine. Vaccination promotion and outreach approaches may need to be tailored to certain populations, such as those with chronic health conditions or without health insurance. Methods: In a controlled trial among middle and high school students in Georgia, 11 schools were randomized to one of three arms: no intervention, parent education brochure, or parent education brochure plus a student curriculum on the four recommended vaccines. Parents in all arms were surveyed regarding their adolescent's vaccine receipt, chronic health conditions, and health insurance status. Results: Of the 686 parents, most (91%) reported their adolescent had received at least one of the four vaccines: Tdap (82%), MCV4 (59%), current influenza vaccine (53%) and HPV (48%). Twenty three percent of parents reported that their adolescent had asthma. Most parents reported that their adolescent's insurance was Medicaid (60%) or private insurance (34%), and 6% reported no insurance. More adolescents with a chronic health condition received any adolescent vaccine than adolescents without a chronic health condition (p < .0001). Among those with no insurance, fewer had received any adolescent vaccine than those with Medicaid or private insurance (p < .0001). Conclusions: The federal Vaccines for Children program offers recommended vaccines free to eligible children (including those without health insurance). Our findings suggest that parents may not be aware of this program or eligibility for it, thus revealing a need for education or other fixes.

Preface

DiClemente, R. (n.d.).

Publication year

1988

Journal title

Health Education Research

Volume

Issue

10.1093/her/3.1.1

Abstract

Abstract

Pregnancy Coercion as a Risk Factor for HIV and Other Sexually Transmitted Infections Among Young African American Women

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

Publication year

2019

Journal title

Journal of acquired immune deficiency syndromes (1999)

Volume

Page(s)

S155-S161

10.1097/QAI.0000000000002174

Abstract

Abstract

BACKGROUND: Pregnancy coercion (PC), defined as a restriction of women's reproductive autonomy, may be associated with increased HIV and sexually transmitted infection (STI) risk. However, there are few empirical studies defining the association between PC and HIV risk, particularly among vulnerable African American women. SETTING AND METHODS: African American women (N = 560), ages 17-24, completed an audio computer-assisted self-interview assessing PC prevalence and its association with HIV/STI risk. Women were screened for prevalent STIs using polymerase chain reaction assays. Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes. RESULTS: Women who had experienced PC in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]. Among women who experienced PC, odds of noncondom use in their last sexual encounter were 3.45-fold greater relative to women not experiencing PC (95% CI = 1.55 to 7.85). Women who experienced PC had lower condom use intentions (coefficient, -1.31, P = 0.002), greater fear of condom negotiation, and perceived more barriers to condom use (coefficients, 3.89 and 5.74, respectively, both P < 0.001). Women who experienced PC had 1.98 (95% CI = 1.22 to 3.21) and 1.82 (95% CI = 1.09 to 3.04) odds of depression and HIV worry relative to women not experiencing PC. CONCLUSION: Among African American women, PC was associated with a range of adverse sexual health outcomes and HIV/STI-related behaviors and attitudes. The findings underscore the need for promoting gender-equitable social norms in HIV prevention interventions.

Pregnancy desire among disadvantaged African American adolescent females

Davies, S. L., DiClemente, R., Wingood, G. M., Harrington, K. F., Crosby, R. A., & Sionean, C. (n.d.).

Publication year

2003

Journal title

American Journal of Health Behavior

Volume

Issue

Page(s)

55-62

10.5993/AJHB.27.1.6

Abstract

Abstract

Objective: To examine the prevalence and correlates of wanting to become pregnant among a sample of 462 sexually active nonpregnant African American adolescent females. Methods: Multivariate logistic regression was used to calculate adjusted odds ratios, their 95% confidence intervals, and respective P values. Results: Significant correlates with pregnancy desire included having a male partner who desired pregnancy, having a boyfriend at least 5 years older, having low self-esteem, perceiving greater perceived barriers to condom use, and perceiving low family support. Conclusions: Pregnancy prevention programs designed for economically disadvantaged African American adolescent females should address these correlates of their pregnancy desire.

Pregnant African-American teens are less likely than their nonpregnant peers to use condoms

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

Publication year

2002

Journal title

Preventive Medicine

Volume

Issue

Page(s)

524-528

10.1006/pmed.2002.1014

Abstract

Abstract

Objective. The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition. Methods. Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded. Results. Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%). Conclusions. Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.

Preliminary efficacy of a computer-based HIV intervention for African-American women

Wingood, G. M., Card, J. J., Er, D., Solomon, J., Braxton, N., Lang, D., Seth, P., Cartreine, J., & DiClemente, R. (n.d.).

Publication year

2011

Journal title

Psychology and Health

Volume

Issue

Page(s)

223-234

10.1080/08870446.2011.531576

Abstract

Abstract

This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA.Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR=5.9; p

Prevalence and correlates of Chlamydia trachomatis among sexually active African-American adolescent females

Williams, K. M., Wingood, G. M., DiClemente, R., Crosby, R. A., McCree, D. H., Liau, A., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).

Publication year

2002

Journal title

Preventive Medicine

Volume

Issue

Page(s)

593-600

10.1006/pmed.2002.1112

Abstract

Abstract

Background. Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the United States and disproportionately affects African-American adolescents. The objectives of this study are to determine the prevalence of C. trachomatis and to identify correlates of infection among African-American adolescent females. Methods. Sexually active African-American adolescent females (n = 522) completed a self-administered survey and structured interview and provided vaginal swab specimens for laboratory assessment of STDs. The relationship among selected psychosocial, behavioral, and biologically confirmed STDs and C. trachomatis was assessed. Results. The prevalence of C. trachomatis was 17.4%. Results of multiple logistic regression revealed that adolescents testing positive for C. trachomatis infection were significantly more likely to test positive for gonorrhea (OR = 5.0; 95% confidence interval (CI) 1.69-14.83); to report nonuse of condoms with a steady partner (OR = 2.4; 95% CI 1.23-4.76); to be in shorter relationships (OR = 2.2, 95% CI 1.13-4.30); and to perceive less parental monitoring (OR = 2.1; 95% CI 1.08-4.15). Conclusions. Study findings emphasize the need for assessing psychosocial factors, behavioral factors, and the presence of other STDs when determining risk for C. trachomatis. Several of the constructs identified are particularly amenable to behavioral interventions designed to prevent infection.

Prevalence and correlates of cutting behavior : Risk for HIV transmission

DiClemente, R., Ponton, L. E., & Hartley, D. (n.d.).

Publication year

1991

Journal title

Journal of the American Academy of Child and Adolescent Psychiatry

Volume

Issue

Page(s)

735-739

10.1016/S0890-8567(10)80007-3

Abstract

Abstract

The prevalence of cutting behavior among a population of 76 psychiatrically hospitalized adolescents was found to be 61.2%. The frequency ranged from a single occasion to over 50 instances, with a mean of 9.9 occasions. Increased self-mutilation was not found to be associated with gender, age, ethnicity, or primary psychiatric diagnosis. A significant association was identified between adolescents who report forced sex and those who report cutting behavior. Approximately 26.7% of those reporting this behavior also report sharing cutting implements with other adolescents. This article raises concern about this behavior as it relates to the transmission of human immunodeficiency virus and makes recommendations for clinicians treating this population.

Prevalence and correlates of HIV testing among sexually active African American adolescents in 4 US cities

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

Publication year

2009

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

584-591

10.1097/OLQ.0b013e3181b4704c

Abstract

Abstract

BACKGROUND: Routine HIV testing is recommended for all adolescents ages 13 years and older. This study aims to report the prevalence of HIV testing among black adolescents, describe characteristics of adolescents who have been tested, and identify potentially modifiable factors associated with greater likelihood of testing across gender. METHODS: Black adolescents ages 13 to 18 were recruited from community-based outreach in 4 US cities. Present analyses include sexually active participants (N = 990; 52.3% female). RESULTS: Twenty-nine percent of adolescents had ever been tested for HIV. In a multivariate logistic regression adjusted for significant demographics, the strongest predictor of HIV testing among girls was prior STI testing (OR = 88.39) followed by pregnancy (OR = 2.75), risk reduction self-efficacy (OR = 2.28), and STI knowledge (OR = 2.25). Among boys, having had an STI test (OR = 38.09), having talked about testing with partners (OR = 3.49), and less religiosity (OR = 2.07) were associated with HIV testing. CONCLUSIONS: Blacks adolescents are disproportionately at risk for HIV/AIDS, yet less than one-third of participants reported being tested. Those receiving sexual or reproductive healthcare services were most likely to be tested, but many teens at risk for HIV do not seek available services and others may face barriers to accessing healthcare. Findings provide support for increasing school-based educational programs due to the low rates of STI/HIV knowledge among teens. Additionally, culturally-sensitive programs promoting HIV testing among teens should foster skill-building for preventive behaviors and increase partner communication about testing.

Prevalence and correlates of inconsistent condom use among female sex workers in Armenia

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

Publication year

2011

Journal title

Sexual Health

Volume

Issue

Page(s)

259-261

10.1071/SH10139

Abstract

Abstract

Prevalence and Correlates of Recent Vaginal Douching among African American Adolescent Females

DiClemente, R., DiClemente, R. J., Young, A. M., Painter, J. L., Wingood, G. M., Rose, E., & Sales, J. M. (n.d.).

Publication year

2012

Journal title

Journal of Pediatric and Adolescent Gynecology

Volume

Issue

Page(s)

48-53

10.1016/j.jpag.2011.07.017

Abstract

Abstract

Study Objective: To describe the prevalence and correlates of vaginal douching among urban African American adolescents and to examine the association between douching and sexually transmitted infection (STI) status. Design: Demographic, psychosocial, and behavioral data were collected through cross-sectional, self-administered surveys. Self-collected vaginal swabs were assayed using nucleic acid amplification tests for trichomoniasis, chlamydia, and gonorrhea. Setting: Sexual health clinic in a large metropolitan area of the southeastern United States. Participants: African American females (N = 701), ages 14-20, participating in a human immunodeficiency virus prevention intervention. Main Outcome Measure: The outcome of interest was the association between vaginal douching (lifetime, past 90 days, and past 7 days) with demographic characteristics (eg, age, education, and socioeconomic status), physical and mental health status, STI status, sexual behavior (eg, number of vaginal sexual partners, age of sex partners, consistent condom use in the past 90 days, sex while self/partner was high on drugs or alcohol), and psychosocial characteristics (eg, sexual adventurism, social support, peer norms, sexual satisfaction, self-efficacy for sex refusal, self-esteem, relationship power, risk avoidance). Results: Forty-three percent reported ever douching, and 29% reported douching in the past 90 days. In bivariate analyses, recent douching was associated with demographic, behavioral, and psychosocial variables, but not current STI status. In multivariate analyses, recent douching was associated with age (odds ratio [AOR] = 1.13, confidence interval [CI] = 1.02-1.25), lower socioeconomic status (AOR = 1.25, CI = 1.05-1.47), and having sex with much older partners (AOR = 1.87, CI = 1.22-2.86). Conclusion: Increased age, lower socioeconomic status, and older partners may be salient risk factors for douching behavior among African American young women.

Prevalence and correlates of relationship abuse among a community-based sample of low-income African American women

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

Publication year

1999

Journal title

Violence Against Women

Volume

Issue

Page(s)

272-291

10.1177/10778019922181220

Abstract

Abstract

This study examined the relationship between social and economic power and incidence of male-perpetrated abuse among low-income African American women with partners (N = 102). Relationship abuse was common among participants; 48% reported verbal abuse, threats of physical abuse, or physical abuse in the past 3 months. Findings also illustrated that disempowerment of women, particularly in relationships, increases female vulnerability to abuse. Regression analyses revealed lower education, partner jealousy, and lower partner empathy account for significant variance in relationship abuse in the past 3 months. Results suggest that social and contextual issues must be included in our examination of male abuse of female partners.

Prevalence and incidence of human papillomavirus infection in women in the USA : A systematic review

DiClemente, R., Revzina, N. V., & DiClemente, R. J. (n.d.).

Publication year

2005

Journal title

International Journal of STD and AIDS

Volume

Issue

Page(s)

528-537

10.1258/0956462054679214

Abstract

Abstract

A systematic review of studies published in the last decade was conducted to summarize data on the epidemiology of human papillomavirus (HPV) in the USA. A structured protocol was used to screen studies for review. Studies had to meet the following criteria: (1) the study was conducted in the USA, (2) the study population was predominantly adolescent women, (3) the description of the study's methodological and statistical methods is provided, and (4) the prevalence and/or incidence of HPV were clearly stated. The prevalence of HPV reported in the assessed studies ranged from 14% to more than 90%. The highest prevalence of HPV was identified among women attending sexually transmitted diseases (STD) clinics and college students, identifying them as target populations for prevention interventions. Conversely, the lowest HPV prevalence was among women in the general population. The review also revealed that HPV prevalence in African Americans is understudied, and the results of a few studies in this area are inconclusive.

Prevalence and predictors of complementary and alternative medicine use in African-Americans with acquired immune deficiency syndrome

Owen-Smith, A., McCarty, F., Hankerson-Dyson, D., & DiClemente, R. (n.d.).

Publication year

2012

Journal title

Focus on Alternative and Complementary Therapies

Volume

Issue

Page(s)

33-42

10.1111/j.2042-7166.2011.01140.x

Abstract

Abstract

The use of CAM among human immunodeficiency virus (HIV)-positive individuals is becoming increasingly widespread. Unfortunately, some CAM therapies may jeopardise the efficacy of conventional HIV medication, making it critical to understand CAM use among this population. The objective of this study was to investigate the prevalence and predictors of CAM use in a theory-driven, multidimensional manner. African-American individuals who had received a diagnosis of acquired immune deficiency syndrome (AIDS) were recruited. The computer-administered survey asked questions about participants' CAM use and various psychosocial and socio-demographic characteristics. Participants' most recent CD4+ cell counts and HIV RNA levels were abstracted from medical records. Linear regression analyses, adjusted for potential confounders, were conducted to assess the independent contribution of various factors in explaining frequency of CAM use. A total of 182 subjects participated in the survey. Results indicate that most (94%) participants used at least one type of CAM therapy. The majority of participants (79.7%) used CAM therapies as a complement (rather than an alternative) to their HIV medications though half had not discussed these therapies with their healthcare providers. Female gender, high yearly income, high health literacy and high HIV RNA levels were associated with a greater frequency of CAM use, while stronger emotional well-being was associated with a lower frequency of CAM use. The implications of these findings are discussed and suggestions for future research are provided.

Prevalence of child and adult sexual abuse and risk taking practices among HIV serodiscordant african-american couples

El-Bassel, N., Wingood, G., Wyatt, G. E., Jemmott, J. B., Pequegnat, W., Landis, J. R., Bellamy, S., Gilbert, L., Remien, R. H., Witte, S., Wu, E., DiClemente, R., Myers, H., Jemmott, L. S., Metzger, D., Ballard, S., Brown, T., Greene, Q., Helker, C., … Wyatt, C. (n.d.).

Publication year

2010

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1032-1044

10.1007/s10461-010-9700-5

Abstract

Abstract

This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or since age 18 or both (32.6%). HIV-positive men (34.9%) were significantly more likely to report CSA than HIVnegative men (22.0%). Overall, 72% of couples reported that one or both had CSA histories. These findings underscore the heightened emotional vulnerability, and STI and HIV transmission risk taking practices, associated with sexual abuse. Sexual abuse histories among couples should be assessed to better understand how these histories may contribute to couples dynamics and risk-taking practices.

Prevalence, correlates, and efficacy of selective avoidance as a sexually transmitted disease prevention strategy among African American adolescent females

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

Publication year

2008

Journal title

Archives of Pediatrics and Adolescent Medicine

Volume

162

Issue

Page(s)

60-65

10.1001/archpediatrics.2007.5

Abstract

Abstract

Objectives: 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.

Prevalence, correlates, and sexually transmitted infection risk related to coitus interruptus among african-american adolescents

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

Publication year

2009

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

218-220

10.1097/OLQ.0b013e3181901c8f

Abstract

Abstract

Prevalence, incidence, and predictors of dating violence : A longitudinal study of African American female adolescents

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

Publication year

2007

Journal title

Journal of Women's Health

Volume

Issue

Page(s)

822-832

10.1089/jwh.2006.0002

Abstract

Abstract

Background: 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.

Preventing HIV Among Adolescents in Sub-Saharan Africa

DiClemente, R., & Crosby, R. A. (n.d.).

Publication year

2009

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

101-102

10.1016/j.jadohealth.2008.12.001

Abstract

Abstract

Preventing HIV among young people : Research priorities for the future

Pettifor, A., Bekker, L. G., Hosek, S., DiClemente, R., Rosenberg, M., Bull, S. S., Allison, S., Delany-Moretlwe, S., Kapogiannis, B. G., & Cowan, F. (n.d.).

Publication year

2013

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

SUPPL. 2

Page(s)

S155-S160

10.1097/QAI.0b013e31829871fb

Abstract

Abstract

Objective: To review the current state of knowledge on the prevention of sexual transmission of HIV in adolescents and to highlight the existing gaps and priority areas for future research. Background: A disproportionate burden of HIV infections falls on adolescents, a developmental stage marked by unique neural, biological, and social transition. Successful interventions are critical to prevent the spread of HIV in this vulnerable population. Methods: We summarized the current state of research on HIV prevention in adolescents by providing examples of successful interventions and best practices, and highlighting current research gaps. Results: Adolescent interventions fall into 3 main categories: biomedical, behavioral, and structural. The majority of current research has focused on individual behavior change, whereas promising biomedical and structural interventions have been largely understudied in adolescents. Combination prevention interventions may be particularly valuable to this group. Conclusions: Adolescents have unique needs with respect to HIV prevention, and, thus, interventions should be designed to most effectively reach out to this population with information and services that will be relevant to them.

Preventing HIV/AIDS Among Adolescents : Schools as Agents of Behavior Change

DiClemente, R. (n.d.).

Publication year

1993

Journal title

JAMA: The Journal of the American Medical Association

Volume

270

Issue

Page(s)

760-762

10.1001/jama.1993.03510060106042

Abstract

Abstract

Although adolescents currently account for less than 1% of acquired immunodeficiency syndrome (AIDS) cases in the United States, recent data indicate that the rate of adolescent AIDS cases has increased markedly,1 especially among African-American adolescents.2 Moreover, given the long latency period between infection with the human immunodeficiency virus (HIV) and clinical symptoms, reliance on AIDS case surveillance data severely underestimates the serious health threat to adolescents posed by the AIDS epidemic. More relevant indices, such as HIV seroprevalence in selected adolescent populations2 and the high prevalence of sexually transmitted diseases and sexual risk behaviors,3,4 emphasize the need for the urgent development and implementation of programs that effectively reduce HIV-related risk behaviors, particularly unprotected sexual intercourse. See also p 725. Although sexual abstinence is the most effective method to prevent transmission of HIV and other sexually transmitted diseases, many adolescents are sexually active, with the age.

Preventing sexually transmitted infections among adolescents : A clash of ideology and science

DiClemente, R., & DiClemente, R. J. (n.d.).

Publication year

1998

Journal title

Journal of the American Medical Association

Volume

279

Issue

Page(s)

1574-1575

10.1001/jama.279.19.1574

Abstract

Abstract

Ralph DiClemente