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
Sexual behaviors and their correlates among young people in Mauritius : A cross-sectional study
AbstractNishimura, Y. H., Ono-Kihara, M., Mohith, J. C., NgMansun, R., Homma, T., DiClemente, R., Lang, D. L., & Kihara, M. (n.d.).Publication year
2007Journal title
BMC International Health and Human RightsVolume
7AbstractBackground. Little is known about the HIV/AIDS epidemic in the Indian Ocean region, including Mauritius. National records suggest a prevalence of HIV in Mauritius of < 1% in the general population, which is one of the lowest prevalence rates in southern Africa. However, HIV-positive cases have been increasing recently in Mauritius. We conducted a cross-sectional survey in January 2003 to assess the prevalence of HIVrelated sexual behaviors and their correlates among young people aged 15-24 years in Mauritius. Methods. We identified 1200 participants using two-stage cluster sampling. Demographic, social, sexual, and knowledge of HIV/AIDS data were obtained in face-to-face interviews using a structured questionnaire administered by trained interviewers. The prevalence of sexual behaviors was described in relation to gender, and the correlates of ever having had sex and nonuse of condom at last sex were analyzed using logistic regression. Results. In the target population, 30.9% of males and 9.7% of females reported a history of sexual intercourse. Of the currently sexually active participants, 50.6% of men and 71.2% of women did not use condoms at their last sexual encounter. Logistic regression revealed that work experience and marijuana use were significantly associated with men's sexual experience, whereas being out of school and drinking experience were significantly associated with women's sexual experience. For both men and women, being Christian and visiting nightclubs were associated with having ever had sexual intercourse (P < 0.05). In addition, not using a condom at the first sexual encounter and lack of exposure to a nongovernmental organization (NGO) dealing with HIV/AIDS were associated with the nonuse of condoms at the last sexual encounter (P < 0.05). Conclusion. Young people in Mauritius are at risk of a future HIV epidemic because behaviors predisposing to HIV infection are prevalent among sexually experienced youth. A focused prevention program targeting young people should be reinforced as part of the National AIDS Control Program, taking into account the predictors of sexual behaviors identified here.The protective value of school enrolment against sexually transmitted disease : A study of high-risk African American adolescent females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., & Sales, J. M. (n.d.).Publication year
2007Journal title
Sexually transmitted infectionsVolume
83Issue
3Page(s)
223-227AbstractObjective: To identify whether school enrolment is protective against laboratory-confirmed diagnosis of sexually transmitted diseases (STDs) and against a spectrum of sexual risk factors. Methods: A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included an audio-computer-assisted self-interview lasting about 60 min and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. Results: In total, 65% were enrolled in school. After adjusting for age and whether adolescents resided with a family member, those not enrolled were twice as likely to test positive for one of the three STDs compared with those enrolled (adjusted OR2; 95% CI 1.38 to 2.91). Similarly, school enrolment was protective against risk factors contributing to STD acquisition. The measures of sexual risk behaviour of 8 of 10, retained significance after adjusting for the covariates, and 2 of the 3 psychosocial mediators retained significance. Conclusion: This study provides initial evidence suggesting that keeping high-risk African-American adolescent females in school (including forms of school that occur after high-school graduation) may be important from a public health standpoint.The role of spirituality in sustaining the psychological well-being of HIV-positive black women
AbstractBraxton, N. D., Lang, D. L., Sales, J. M., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2-3Page(s)
113-129AbstractHistorically, spirituality has been an instrumental component to the survival of Black women. In an era when the HIV epidemic disproportionately compromises their health, it is imperative to explore spirituality's role in sustaining the psychological health of Black women living with HIV. This study examined the relationship between spirituality and self-reported depression among Black women living with HIV. A sample of 308 HIV-positive Black women were recruited from HIV/ AIDS clinics in the Southeastern United States. Participants completed an interview assessing demographics, quality of life, depression, coping, and spirituality. A hierarchical multiple regression was used to determine the association between spirituality and depression. The results suggest that in our sample, spirituality accounted for a small, yet significant proportion of variance in reducing depressive symptoms, above and beyond variance accounted for by demographic variables and other theoretically important psychosocial factors. In light of these findings, future studies with HIV-positive Black women should assess spirituality as a salient factor affecting psychological health. Developing interventions that address spirituality may serve to enhance women's psychological adjustment to living with HIV.Understanding motivations for sex among detained youth : Implications for HIV prevention programs
AbstractVoisin, D. R., Salazar, L. F., Crosby, R. A., & DiClemente, R. (n.d.).Publication year
2007Journal title
Journal of HIV/AIDS and Social ServicesVolume
6Issue
3Page(s)
29-41AbstractThis investigation examined reasons for having sex among a sample of 369 African-American and White adolescent detainees, aged 14-18. Using A-CASI technology, sociodemographic variables and motivations for having sex were assessed among this population. Findings indicated that adolescents hold underlying motivations for having sex and that these differ to some degree by gender, SES, but less by race. For programs to be optimally effective, program goals should address gender and SES differentials for having sex.Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions
AbstractMilhausen, R. R., McDermott Sales, J., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2007Journal title
Journal of HIV/AIDS Prevention in Children and YouthVolume
8Issue
1Page(s)
11-33AbstractThis paper reports on three studies in which the Partner Communication Scale (PCS) is validated. The PCS assesses African American adolescent females' frequency of sexual communication with male sex partners. The PCS was administered to three samples of African American female adolescents (N = 522; N= 280; N= 715) ranging in age from 14 to 21. The PCS demonstrated strong internal consistency and acceptable stability over 6-month and 12-month follow-up periods. Scores on the PCS were correlated with frequency of parent communication, sexual communication self-efficacy, sexual refusal self-efficacy, fear of communication about condoms, partner-related barriers to condom use, relationship satisfaction, self-esteem, exposure to communication-related sex education in schools and condom use, particularly with nonsteady male sex partners. The present investigation indicates that the PCS is a reliable and valid measure of frequency of sexual communication for female adolescents with their male sex partners. Future research with the PCS with more diverse samples in terms of race/ethnicity, gender, age and sexual orientation will be useful to establish its reliability and validity for these adolescent subgroups.Witnessing Community Violence and Health-Risk Behaviors Among Detained Adolescents
AbstractVoisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R., Yarber, W. L., & Staples-Horne, M. (n.d.).Publication year
2007Journal title
American Journal of OrthopsychiatryVolume
77Issue
4Page(s)
506-513AbstractThis study examines whether witnessing community violence, in the 12 months prior to juvenile detention, is related and health-related outcomes in the 2 months prior to being detained among 550 youth. Participants answered survey questions using audio-computer assisted self-interviewing procedures, which assessed demographic, problem, and drug and sexual risk behaviors. Multiple logistic regression analyses, controlling for significant covariates, indicated that adolescents, in the last 12 months, who reported witnessing community violence, relative to their peer witnessing no violence, were in the last 2 months prior to being detained, twice more likely to have suicidal threats, 2 times more likely to use marijuana and alcohol, 2 times more likely to get high on alcohol or other drugs during sexual intercourse, and 2 times more likely to have sex with a partner who was high on alcohol or other drugs. Finding suggest that detained youth, many of whom may not access traditional helath care, should be offered prevention and intervention services dring detention, which provides a critical window of opportunity for needed services."Islands of risk" : Subgroups of adolescents at risk for HIV
AbstractHouck, C. D., Lescano, C. M., Brown, L. K., Tolou-Shams, M., Thompson, J., DiClemente, R., Fernandez, M. I., Pugatch, D., Schlenger, W. E., & Silver, B. J. (n.d.).Publication year
2006Journal title
Journal of pediatric psychologyVolume
31Issue
6Page(s)
619-629AbstractObjective: To use cluster analysis to determine profiles of adolescents at risk for HIV. Methods: Adolescents 15-21 years old (N = 1153) with a history of unprotected sex were assessed in five domains of risk (unprotected sex, alcohol/marijuana use, other drug use, mental health crises, and arrest/school dropout) as well as demographic, contextual, and behavioral variables. Results: Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk. Cluster membership was associated with secondary variables related to sexual risk. Conclusions: Even within populations of high-risk adolescents, subgroups exist for which specific risk factors co-occur, particularly unprotected sex, mental health crises, and substance use. These patterns suggest that effective HIV prevention interventions may need to target the association between mental health and/or substance abuse with sexual risk for some adolescents.A decade in review : Building on the experiences of past adolescent STI/HIV interventions to optimise future prevention efforts
AbstractDiClemente, R., Sales, J. M., Milhausen, R. R., & DiClemente, R. J. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
6Page(s)
431-436AbstractThe major purpose of this article is to systematically review and synthesise empirical findings from selected adolescent STI/HIV interventions conducted in the United States between 1994 and 2004. Specifically, the most current adolescent STI risk reduction interventions conducted in diverse venues, such as in the community, schools, clinics, and specialised adolescent centres (that is, detention homes and drug programmes) were examined for reported efficacy, and were assessed for programmatic and methodological strengths and weaknesses. Next, a subset of programmatic characteristics was identified that were associated with the efficacy of STI risk reduction programmes both within a particular venue, as well as across all venues. Finally, we discuss the research and practice implications of these findings for optimising future evidence based STI risk reduction programmes for adolescents in the United States.Biologically confirmed sexually transmitted infection and depressive symptomatology among African-American female adolescents
AbstractDiClemente, R., Salazar, L. F., DiClemente, R. J., Wingood, G. M., Crosby, R. A., Lang, D. L., & Harrington, K. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
1Page(s)
55-60AbstractObjective: To determine prospectively the relation between sexually transmitted infection (STI) diagnosis and depressive symptomatology. Methods: Secondary data analyses were performed on 175 sexually active African-American female adolescents, who were recruited from high risk neighbourhoods in Birmingham, Alabama, United States. Results: ANCOVA was used to compare adolescents who tested positive with adolescents who tested negative on three waves of depressive symptom scores, controlling for age. The STI positive group had higher depressive symptom levels at 6 months relative to the STI negative group. This result was moderated by baseline depressive symptom levels: for adolescents above the clinical threshold, the STI negative group experienced a decrease in symptoms at 6 months whereas the STI positive group maintained the same level. For adolescents below the clinical threshold, there were no changes in depressive symptom levels regardless of diagnosis. Conclusions: Receiving an STI diagnosis may affect depressive symptomatology for those at risk for depression. Screening for depression in settings that provide STI testing and treatment may be warranted for this population.Development of a new Adolescent Patient-Provider Interaction Scale (APPIS) for youth at risk for STDs/HIV
AbstractWoods, E. R., Klein, J. D., Wingood, G. M., Rose, E. S., Wypij, D., Harris, S. K., & DiClemente, R. (n.d.).Publication year
2006Journal title
Journal of Adolescent HealthVolume
38Issue
6Page(s)
753.e1-753.e7AbstractPurpose: Although an adult model of patient-provider mutual exchange of information has been proposed, there is no guiding model for adolescents or measurement methodology. Our purpose was to develop a new scale of patient-provider interaction for adolescents accessing reproductive health care and at risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV), and assess the reliability and validity of the scale. Methods: The Adolescent Patient-Provider Interaction Scale (APPIS) was developed from the Roter and Hall theory of doctor-patient relationships, previously validated adolescent satisfaction and communication scales, and focus group and individual elicitation interviews. To assess construct validity, the new nine-item APPIS was compared with the satisfaction scale used by the Young Adult Health Care Survey (YAHCS), and Kahn's Provider Communication Scale. Pearson correlation coefficients were used to examine convergence across scales, and factor analysis of the APPIS was performed. Results: The study recruited 192 African American girls aged 17.9 ± 1.7 years (range 15-21 years) from three sites: a county STD clinic (n = 51), urban adolescent clinic (n = 99), and a family planning clinic (n = 42). Most participants (85%) rated their overall health care highly (≥ 7 on a 10-point scale); 49% felt that both the provider and patient were "in charge" of the visit, and 88% "strongly agreed" or "agreed" that there was an equal "exchange of information" during the visit. The APPIS showed good internal consistency (Cronbach alpha = .75), and moderate convergence with the six-item YAHCS scale (r = .57, p < .001) and seven-item Kahn scale (r = .48, p < .001). Three factors emerged from exploratory factor analyses, supporting our conceptualization of patient-provider interaction as being multi-dimensional. Conclusions: A new theory-based scale of adolescent patient-provider interaction compares favorably with previous scales of health care satisfaction and communication. The new APPIS may be useful for evaluating approaches to improve health care outcomes for adolescents at-risk for STDs and HIV.Ecological factors associated with STD risk behaviors among detained female adolescents
AbstractVoisin, D. R., DiClemente, R., Salazar, L. F., Crosby, R. A., & Yarber, W. L. (n.d.).Publication year
2006Journal title
Social WorkVolume
51Issue
1Page(s)
71-79AbstractThe authors used Bronfenbrenner's conceptual framework of an ecological systems model to examine factors that are independently associated with sexually transmitted disease (STD) risk behaviors among 280 sexually active detained female adolescents. Using computer-assisted self-interviewing procedures, the authors assessed individual characteristics, peer relations, community factors, and media influences and their association to STD risk behaviors. Findings indicated that factors such as greater substance use, stronger risk-taking attitudes, lower perceived parental monitoring and familial support, gender roles supporting male dominance, risky peer norms, and lower student-teacher connectedness, were independently associated with increased STD risk behaviors. Findings suggest a multisystemic approach to STD prevention among this population.Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence
AbstractWingood, G. M., DiClemente, R., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., Oh, M. K., & Hardin, J. W. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
6Page(s)
1085-1090AbstractObjectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.Enhancing adoption of evidence-based HIV interventions : Promotion of a suite of HIV prevention interventions for African American women
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
2006Journal title
AIDS Education and PreventionVolume
18Issue
SUPPL. APage(s)
161-170AbstractThe Centers for Disease Control and Prevention (CDC) currently promotes an HIV prevention intervention for young adult African American women, known as SISTA, through the Diffusion of Effective Behavioral Interventions (DEBI) program. Nationally, more than 700 agencies have completed a 1-week CDC-funded training to implement SISTA. Agencies that have been trained in SISTA are also eligible to receive training in a newly published HIV prevention intervention for African American adolescent females, known as SiHLE (Sistering, Informing, Healing, Living, and Empowering), as well as to receive training in a newly published prevention intervention for women living with HIV, known as WiLLOW (Women Involved in Life Learning From Other Women). All three of these HIV prevention interventions, target African American females, are designed to reduce HIV sexual risk behaviors and share similar theoretical, core, and methodological elements. The diffusion of innovation paradigm suggests that if potential adopters perceive one innovation as being closely related to another innovation, it may be useful to promote a cluster of innovations, rather than to treat each new innovation separately. This article examines how promotion of a suite of HIV interventions for African American females may facilitate adoption of the three evidence-based HIV interventions for this population.Family influences and biologically confirmed sexually transmitted infections among detained adolescents
AbstractCrosby, R., Voisin, D., Salazar, L. F., DiClemente, R., Yarber, W. L., & Caliendo, A. M. (n.d.).Publication year
2006Journal title
American Journal of OrthopsychiatryVolume
76Issue
3Page(s)
389-394AbstractData from a convenience sample of 476 detained adolescents were used to examine the relationship between family influences and biologically confirmed sexually transmitted diseases (STDs). Results indicated that frequent parental monitoring was negatively associated with STD infection and that this relationship was modified by age, gender, and race. Findings suggest that STD prevention efforts for detained adolescents (particularly high-risk minority females older than age 16) might focus on increasing monitoring by a parent or parental figure.Family influences on adolescents' sexual health : Synthesis of the research and implications for clinical practice
AbstractDiClemente, R., Crosby, R. A., & Salazar, L. F. (n.d.).Publication year
2006Journal title
Current Pediatric ReviewsVolume
2Issue
4Page(s)
369-373AbstractEmerging empirical evidence indicates that parenting strategies can have a substantial impact on their adolescents' sexual health. Three critical parenting strategies: monitoring their adolescents, engaging them in frequent communication about sex, and, providing familial support may afford protection against their adolescents engaging in sexual risk behaviors, and consequently, reducing adolescents' risk of adverse sexual health outcomes such as unintended pregnancy and sexually transmitted diseases including human immunodeficiency virus infection. Family-based interventions can successfully enhance the adoption of all of these protective strategies; however, pediatricians routinely come into contact with parents and their adolescents. Pediatricians can therefore serve as an authoritative source of information and motivation by encouraging parents to monitor their children more closely, enhance parent-adolescent communication about sexual health and encourage a more supportive family environment to enhance the likelihood that adolescents will adopt and maintain sexual health promotion practices. In addition, pediatricians can provide parents with an information prescription (IP) to assist them in acquiring information via the Internet on adolescent sexual health and risks, and on the three critical parenting protective strategies. Thus, pediatricians represent an important and, perhaps, cost-effective intervention point with parents who in turn can protect the sexual health of their adolescents.HIV/AIDS knowledge and beliefs among Haitian adolescents in Miami-Dade County, Florida
AbstractHerns Marcelin, L., McCoy, H. V., & DiClemente, R. (n.d.).Publication year
2006Journal title
Journal of HIV/AIDS Prevention in Children and YouthVolume
7Issue
1Page(s)
121-138AbstractThis study examined HIV/AIDS knowledge and beliefs in Haitian adolescents in an HIV epicenter, Miami-Dade Florida. This study examined survey data from 300 Haitian adolescents, aged 13 through 18, from both low- and middle-income neighborhoods. A subsample of 80 adolescents was selected for in-depth interviews and continuous observations with their families and networks of friends, which added rich descriptions to the quantitative data. Overall knowledge about HIV/AIDS was high with the majority of adolescents identifying unprotected sex and sharing injection drug needles as HIV transmission routes. Moreover, approximately 75% of the adolescents reported condom use as an effective preventive strategy. However, misconceptions that could reduce adolescents' adoption ofHIVpreventive strategieswere also identified. The adolescents' sources for information about HIV/AIDS as well as implications for prevention interventions are discussed.New sexual partners and readiness to seek screening for chlamydia and gonorrhoea : Predictors among minority young women
AbstractDiClemente, R., Chacko, M. R., Wiemann, C. M., Kozinetz, C. A., DiClemente, R. J., Smith, P. B., Velasquez, M. M., & Von Sternberg, K. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
1Page(s)
75-79AbstractObjectives: To determine (1) level of readiness and (2) demographic and behavioural predictors of readiness to seek chlamydia (CT) and gonorrhoea (NGC) screening in the absence of symptoms after sex with a "new" partner. Methods: Baseline data, obtained as part of a larger randomised controlled clinical trial in young women, were analysed. Readiness to seek screening for CT and NGC after sex with a "new" partner was assessed using the stages of change framework from the transtheoretical model of change-precontemplation, contemplation, preparation, and action. Ordinal logistic regression, using the proportional odds model, was used to determine predictors of being in action for or having already been screened for CT and NGC after sex with a "new" partner. Results: The sample consisted of 376 predominantly African American (67%) young women (mean age 18.5 (SD 1.4) years). The distribution of readiness to seek CT and NGC screening was 4% precontemplation, 11% contemplation, 28% preparation, and 57% action. The best fitting logistic model that predicted being in action for seeking screening after sex with a "new" partner included high perceived seriousness of acquiring a sexually transmitted infection (OR = 2.02, 95% Cl 1.05 to 3.89), and having "other" (not steady) partners in the last 6 months (OR = 0.50, 95% C.I. 0.32 to 0.78) Conclusions: Many young women report that they were not getting screened for CT and NGC after sex with a "new" partner and therefore may be at increased risk of an untreated STI. Enhancing level of perceived seriousness of acquiring an STI from a "new" partner may increase a young woman's readiness to seek screening after initiating a new sexual relationship.Predictors of Inconsistent Contraceptive Use among Adolescent Girls : Findings from a Prospective Study
AbstractDavies, S. L., DiClemente, R., Wingood, G. M., Person, S. D., Dix, E. S., Harrington, K., Crosby, R. A., & Oh, K. (n.d.).Publication year
2006Journal title
Journal of Adolescent HealthVolume
39Issue
1Page(s)
43-49AbstractPurpose: To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females. Methods: Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test. Results: Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors. Conclusions: Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.Preventing sexually transmitted infections among adolescents : 'the glass is half full'
AbstractDiClemente, R., & Crosby, R. A. (n.d.).Publication year
2006Journal title
Current Opinion in Infectious DiseasesVolume
19Issue
1Page(s)
39-43AbstractPurpose of review: Given the disproportionate burden of sexually transmitted infections for adolescents, there is an urgent need to identify effective prevention programs. Recent findings: This review documents the efficacy of recent sexually transmitted infection-prevention programs. Overall, the review identified few sexually transmitted infection-prevention trials published since 2000. Moreover, considerable variability in program efficacy was observed across studies. Some studies observed changes in sexually transmitted infection-associated risk behaviors, while only a few identified reductions in biologically confirmed sexually transmitted infections. In general, few programs demonstrated consistency of effects and a significant magnitude of effects across a broad range of outcomes. Summary: New and innovative approaches are needed to amplify sexually transmitted infection intervention effects. Program development and evaluation needs to continue in a coordinated, scientifically rigorous fashion to optimize impact and, as important, to sustain effects over protracted periods. Furthermore, for interventions with demonstrated efficacy, a critical challenge is to translate them into sustainable programs that are widely disseminated. Ultimately, preventing sexually transmitted infections in adolescents does not only depend on the development of effective interventions alone, but on how effectively these interventions can be translated and integrated into self-sustaining components of clinic, school or community programs, particularly in those areas and among adolescent populations most adversely impacted by the epidemic of sexually transmitted infection.A programmatic and methodologic review and synthesis of clinic-based risk-reduction interventions for sexually transmitted infections : Research and practice implications
AbstractDiClemente, R., Milhausen, R., McDermott Sales, J., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2005Journal title
Seminars in Pediatric Infectious DiseasesVolume
16Issue
3Page(s)
199-218AbstractThe overarching goal of this article is to systematically review and synthesize empirical findings for sexually transmitted disease risk-reduction programs that were developed and implemented specifically for adolescents seeking health care services at clinical venues. The objective is to examine the reported efficacy of these programs in reducing adolescents' sexually transmitted infection (STI)-associated behavior, in enhancing theoretically and empirically important psychosocial mediators associated with the adoption of STI-preventive behaviors, and, most important, in reducing adolescents' risk of acquiring an STI. In addition, our review assesses program and methodologic characteristics of the studies, determines compliance with standardized reporting guidelines, identifies a subset of program characteristics that are related to efficacy in terms of modifying adolescents' sexual risk behaviors, and examines the research and practice implications of these findings for implementing evidence-based STI risk-reduction programs in clinics.Accounting for failures may improve precision : Evidence supporting improved validity of self-reported condom use
AbstractCrosby, R., Salazar, L. F., DiClemente, R., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).Publication year
2005Journal title
Sexually Transmitted DiseasesVolume
32Issue
8Page(s)
513-515AbstractObjectives: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. Methods: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. Results: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. Conclusion: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.Adolescents' experience with sex on the web : Results from online focus groups
AbstractCameron, K. A., Salazar, L. F., Bernhardt, J. M., Burgess-Whitman, N., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2005Journal title
Journal of AdolescenceVolume
28Issue
4Page(s)
535-540AbstractTo discover adolescent Internet users' experiences with, exposure to, and perceptions of sexually oriented websites (SOW) and sexually explicit websites (SEW), four web-based focus groups (N = 40) were conducted. Participants (ages 14-17) reported high levels of exposure to SEW and SOW, which was intentional for some and unsolicited for others. Female adolescents found SEW to be socially distasteful; some adolescent males avoided SEW while others were willing consumers. Participants believed exposure to SEW had no influence on them, and reported that their parents were unaware of what they view online. Future research should explore the effects of exposure to SEW and to SOW and mediating factors.Adverse health consequences that co-occur with depression : A longitudinal study of black adolescent females
AbstractDiClemente, R., Wingood, G. M., Lang, D. L., Crosby, R. A., Salazar, L. F., Harrington, K., & Hertzberg, V. S. (n.d.).Publication year
2005Journal title
PediatricsVolume
116Issue
1Page(s)
78-81AbstractObjective. The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. Methods. Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. Results. Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. Conclusions. The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.Condom failure among adolescents : Implications for STD prevention
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., Levine, D., Brown, L., Lescano, C., Pugatch, D., Flanigan, T., Fernandez, I., Schlenger, W., & Silver, B. J. (n.d.).Publication year
2005Journal title
Journal of Adolescent HealthVolume
36Issue
6Page(s)
534-536AbstractThis study of 921 adolescents found condom failure (past 90 days) was experienced by at least one-third of the sample, regardless of gender. Frequency of condom failure was positively associated with STD diagnosis (AOR = 1.22, 95% CI = 1.01-1.48), with the odds of testing positive increasing 22% for each added event of failure.Correlates of condom failure among adolescent males : An exploratory study
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., Levine, D., Brown, L., Lescano, C., Pugatch, D., Flanigan, T., Fernandez, I., Schlenger, W., & Silver, B. J. (n.d.).Publication year
2005Journal title
Preventive MedicineVolume
41Issue
5-6Page(s)
873-876AbstractObjective. To identify the prevalence and correlates of condom failure (defined as breakage or slipping off in the past 90 days) among a sample of adolescent males (15 to 21 years of age). Design. A cross-sectional study of 481 condom-using males residing in three US cities (Atlanta, GA, Providence RI, Miami FL). Data were collected, in the years 2000 and 2001, using audio computer-assisted self-interviewing technology. Prevalence ratios were used to determine the strength and significance of bivariate associations between ten assessed correlates and condom failure. Correlates achieving a screening level of significance were entered into a multivariate model that was used to calculate adjusted odds ratios (AOR). Results. Recent condom failure was reported by 34.1%. Younger adolescents were about one-third less likely to report condom failure (AOR = 0.66; P = 0.4). Adolescents reporting multiple sex partners were about 80% more likely to report failure (AOR = 1.84; P = 0.09). Adolescents indicating they had sex with someone on the same day they met the person were about 80% more likely to report failure (AOR = 1.77; P = 0.02). Finally, adolescents indicating recent problems obtaining condoms were about 70% more likely to report failure (AOR = 1.69; P = 0.1). Failure was not less common among those reporting a history of STD infection or those ever impregnating a partner. Conclusion. Because adolescent males may commonly experience condom failure, targeted clinic- and community-based programs designed to reduce user error could be an important aspect of preventing pregnancy and the spread of STDs.