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
Condom Misuse Among Adjudicated Girls: Associations with Laboratory-Confirmed Chlamydia and Gonorrhea
AbstractCrosby, R., Salazar, L. F., DiClemente, R. J., 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. J., Bockting, W. O., Elford, J., Fishbein, M., Gurak, L., Horvath, K., Konstan, J., Noar, S. M., Ross, M. W., Sherr, L., Spiegel, D., & Zimmerman, R. (n.d.).Publication year
2007Journal title
AIDS and BehaviorVolume
11Issue
4Page(s)
505-521AbstractThe aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.Correlates of consistent condom use among HIV positive African American women
AbstractRaiford, J. L., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2Page(s)
41-58AbstractIntroduction: African American women are the fastest growing group at risk of contracting HIV, as over 68% of women diagnosed with HIV are African American. The present study used social-cognitive theory and the theory of gender and power to identify correlates of consistent condom use among African American women living with HIV. Methods: We recruited 366 women, 18-50 years of age and living with HIV from several HIV/AIDS clinics in the southeastern United States. The majority of women, 84.2% (N = 308), were African American. Women completed a baseline interview assessing sociodemographic, psychosocial, and partner-related factors potentially associated with consistent condom use, defined as reported use of condoms during every vaginal sex episode with a male sexual partner in the past 30 days. Results: Among those HIV-positive African American women reporting use of a condom in the past 30 days (n = 234, 70%), consistent condom use was reported by 67.1% of women. This rate was lower (51.6%) among women having an HIV-positive male sexual partner; the rate was higher (74.1%) among women having an HIV-negative male sexual partner. Compared to women who were inconsistent condom users, women with HIV were more likely to use condoms if they: had high partner communication self-efficacy (OR = 7.77, 95% CI = 3.3-18.6, p = .001), had a HIV-negative male sex partner (OR = 4.62, 95% CI = 1.9-11.5, p = 0.001), had low partner-related barriers to condom use (OR = 4.68, 95% CI = 1.8-12.2, p = 0.001), and had perceived peer norms supportive of condom use (OR = 2.38, 95% CI = 1.0-5.7, p = 0.03). Conclusion: These findings suggest that HIV interventions may enhance consistent condom use among African American women living with HIV by targeting women's self-efficacy to communicate with their partners and women's perception of personal and partner-related barriers to condom use.Correlates of HIV risk and preventive behaviors in Armenian female sex workers
AbstractMarkosyan, K. M., Babikian, T., DiClemente, R. J., Hirsch, J. S., Grigoryan, S., & Del Rio, C. (n.d.).Publication year
2007Journal title
AIDS and BehaviorVolume
11Issue
2Page(s)
325-334AbstractThis study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.HIV discrimination and the health of women living with HIV
AbstractWingood, G. M., DiClemente, R. J., Mikhail, I., McCree, D. H., Davies, S. L., Hardin, J. W., Harris Peterson, S., Hook, E. W., & Saag, M. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2Page(s)
99-112AbstractWomen living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/ AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.HSV-2 serologic testing in an HMO population: Uptake and psychosocial sequelae
AbstractRichards, J., Scholes, D., Caka, S., Drolette, L., Magaret, A. M., Yarbro, P., Lafferty, W., Crosby, R., Diclemente, R., & Wald, A. (n.d.).Publication year
2007Journal title
Sexually Transmitted DiseasesVolume
34Issue
9Page(s)
718-725AbstractOBJECTIVES: To prospectively measure the uptake of Herpes simplex virus Type 2 (HSV-2) testing and psychosocial response to a new serologic diagnosis of HSV-2 in a health maintenance organization (HMO) population. STUDY DESIGN: Randomly selected urban HMO enrollees were invited to be tested for HSV-2 antibody at a research clinic. Participants had blood drawn and completed demographic and psychosocial questionnaires. RESULTS: Of 3111 eligible enrollees contacted, 344 (11%) were tested. Eighty-seven (26%) tested HSV-2 seropositive, and 44 (51%) of these did not report a prior genital herpes diagnosis. Distress, measured by the total mood disturbance, was 6.5 points higher on average following a new genital herpes diagnosis relative to baseline (actual range = 109 points, P = 0.003) but not statistically different from HSV-2 negative or previously diagnosed participants. CONCLUSIONS: HMO enrollees unexpectedly testing HSV-2 positive showed short-term psychosocial distress that resolved during 6-month follow-up. Findings suggest that concerns about psychosocial burden should not deter voluntary serologic HSV-2 testing in primary care settings.Images of sexual stereotypes in rap videos and the health of African American female adolescents
AbstractPeterson, S. H., Wingood, G. M., DiClemente, R. J., Harrington, K., & Davies, S. (n.d.).Publication year
2007Journal title
Journal of Women's HealthVolume
16Issue
8Page(s)
1157-1164AbstractObjective: This study sought to determine whether perceiving portrayals of sexual stereotypes in rap music videos was associated with adverse health outcomes among African American adolescent females. Methods: African American female adolescents (n = 522) were recruited from community venues. Adolescents completed a survey consisting of questions on sociodemographic characteristics, rap music video viewing habits, and a scale that assessed the primary predictor variable, portrayal of sexual stereotypes in rap music videos. Adolescents also completed an interview that assessed the health outcomes and provided urine for a marijuana screen. Results: In logistic regression analyses, adolescents who perceived more portrayals of sexual stereotypes in rap music videos were more likely to engage in binge drinking (OR 3.8, 95% CI 1.32-11.04, p = 0.01), test positive for marijuana (OR 3.4, 95% CI 1.19-9.85, p = 0.02), have multiple sexual partners (OR 1.9, 95% CI 1.01-3.71, p = 0.04), and have a negative body image (OR 1.5, 95% CI 1.02-2.26, p = 0.04). This is one of the first studies quantitatively examining the relationship between cultural images of sexual stereotypes in rap music videos and a spectrum of adverse health outcomes in African American female adolescents. Conclusions: Greater attention to this social issue may improve the health of all adolescent females.Oral contraceptive use may not preclude condom use: A study of non-pregnant African-American adolescent females
AbstractCrosby, R. A., DiClemente, R. J., Wingood, G. M., Salazar, L. F., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).Publication year
2007Journal title
Sexually transmitted infectionsVolume
83Issue
3Page(s)
216-218AbstractObjective: To determine the association between oral contraceptive and condom use, and laboratory-confirmed sexually transmitted infection (STI) among African-American adolescent females at a high risk of STI acquisition. Methods: A cross-sectional study of 715 African-American adolescent females (15-21 years old) was conducted. Data collection included (a) an audio-computer-assisted self-interview and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. Results: The age-adjusted odds ratio (AOR) indicated a modest protective effect of oral contraceptive use against unprotected vaginal sex (UVS) using a 60-day recall period (AOR = 0.66; 95% CI 0.43 to 0.99). The age-adjusted difference in mean frequency of UVS in the past 60 days was non-significant (p = 0.23) as was condom use at last sex (p = 0.34). The age-AOR relative to STI prevalence also showed a protective effect (AOR = 0.60; 95% CI 0.36 to 0.98) for those using oral contraceptives. Conclusion: The findings suggest that the use of oral contraceptives may not preclude safer sex practices for the prevention of STIs among high-risk African-American adolescent females.Personal, relational, and peer-level risk factors for laboratory confirmed STD prevalence among low-income African American adolescent females
AbstractSalazar, L. F., Crosby, R. A., Diclemente, R. J., Wingood, G. M., Rose, E., Sales, J. M., & Caliendo, A. M. (n.d.).Publication year
2007Journal title
Sexually Transmitted DiseasesVolume
34Issue
10Page(s)
761-766AbstractOBJECTIVES: To identify risk factors for laboratory confirmed sexually transmitted disease (STD) prevalence among low-income African American adolescent females living in a high-risk urban area of the Southern United States. METHODS: Participants were 715 African American adolescent females recruited from urban clinics. Data collection occurred from 2002 to 2004 and included an audio-computer assisted self-interview lasting about 60 minutes and a self-collected vaginal swab for NAAT to detect Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Ten personal-level risk factors were assessed as well as 8 risk factors involving either peer or relational factors. RESULTS: Adolescents (28.8%) tested positive for at least 1 STD. Six personal-level and 4 social-level measures achieved a bivariate screening level of significance. In the multivariate model, only 3 measures achieved significance: gang involvement, social support from peers, and fear of condom use negotiation. Compared to those who had never belonged to a gang, those who had were about 4.2 times more likely (95% CI = 2.16-9.44) to test positive. Adolescents' who had higher levels of fear pertaining to condom use negotiation were more likely to test positive as were adolescents who perceived higher levels of social support from their peers. CONCLUSIONS: This finding suggests and supports the utility of designing interventions for high-risk African American adolescent females that incorporate objectives to modify the significant social influences related to STD acquisition.Prevalence, incidence, and predictors of dating violence: A longitudinal study of African American female adolescents
AbstractRaiford, J. L., Wingood, G. M., & Diclemente, R. J. (n.d.).Publication year
2007Journal title
Journal of Women's HealthVolume
16Issue
6Page(s)
822-832AbstractBackground: Few longitudinal studies have examined predictors of dating violence, a public health issue that may be more prevalent among African Americans. Our objective was to examine the prevalence, incidence, and predictors of dating violence in an African American sample using the theory of gender and power. Methods: A longitudinal design with a 1-year follow-up period was used. Recruiters screened adolescents from a variety of venues, including school health classes, county health department clinics, and adolescent health clinics. Study participants were 522 African American females 14-18 years of age. This study achieved an 85.7% participation rate. Dating violence was defined as ever having experienced verbal or physical abuse perpetrated by a boyfriend. Results: At baseline, 28% of adolescents reported a history of dating violence. To calculate the 1-year incidence of dating violence, adolescents reporting a history of dating violence at baseline were excluded from subsequent longitudinal analyses. In longitudinal analyses, the 1-year incidence of dating violence was 12%. Logistic regression analyses identified four factors at baseline that were predictive of dating violence. This four-factor model correctly classified 87.6% of adolescents according to whether or not they experienced dating violence during the 1-year follow-up. Controlling for public financial assistance, relative to adolescents not experiencing dating violence, those who did were 2.0 times more likely to report less understanding of healthy relationships (CI = 1.1-3.9, p = 0.02), 2.0 times more likely to report using drugs (CI = 1.0-3.7, p = 0.02), and 1.9 times more likely to have viewed X-rated movies (CI = 1.0-3.7, p = 0.03). Conclusions: These findings suggest that secondary prevention of dating violence necessitates educating clinicians on the importance of screening and training practitioners in clinical settings on how to effectively screen adolescents for dating violence, including risk factors for victimization.Refining self-reported condom use among young men at risk of HIV acquisition
AbstractCrosby, R., Diclemente, R. J., Yarber, W. L., Snow, G., & Troutman, A. (n.d.).Publication year
2007Journal title
Sexual HealthVolume
4Issue
3Page(s)
211-212AbstractThis descriptive study evaluated the validity of self-reported condom use among young African American men. Thirty percent (n = 79) of the men reported consistent condom use. After accounting for late application and/or early removal of condoms, slippage, and breakage, 26 men remained classified as consistent users. Among the 79 men initially classified as consistent condom users, 695 sexual episodes were reported as 'condom-protected;' however, after correcting for user error, 29.6% of the sexual episodes were actually not protected. Studies assessing self-reported condom use among young African American men should assess user errors as well as frequency of condom use.Relationship of STD-Related Shame and Stigma to Female Adolescents' Condom-Protected Intercourse
AbstractSales, J. M., DiClemente, R. J., Rose, E. S., Wingood, G. M., Klein, J. D., & Woods, E. R. (n.d.).Publication year
2007Journal title
Journal of Adolescent HealthVolume
40Issue
6Page(s)
573.e1-573.e6AbstractPurpose: Shame and stigma associated with sexually transmitted diseases (STDs) are barriers to adolescents seeking prompt and appropriate diagnosis and treatment. However, little is known about how these constructs are related to STD-protective behaviors, such as condom-protected intercourse. Thus, we prospectively examined the relationship between shame and stigma and condom use in adolescent females. Methods: There were 192 African American females age 17.4 ± 1.7 years (range 15-21 years) recruited for the study from local teen-oriented health clinics. At baseline, participants completed demographic and psychosocial measures (including STD-related shame and stigma), and chart- or laboratory-confirmed history of STDs was obtained. At 6 months follow-up, rate of condom-protected intercourse in past 14 days was assessed. Participants' baseline shame and stigma scores, prior history of STDs, and select demographic and theoretically important psychosocial variables were entered into a hierarchical linear regression model to predict condom-protected intercourse in the 14 days prior to the 6-month follow-up assessment. Results: After controlling for variables identified in bivariate correlations, STD-related shame was significantly predictive of condom-protected intercourse in the 14 days prior to follow-up, with higher shame predicting higher rates of condom-protected intercourse. Conclusions: Future prevention efforts attempting to reduce adolescents' risks for STDs and HIV may benefit from addressing STD-related shame and stigma in addition to explicitly linking health-promoting behavior changes (condom use) to a decreased likelihood of future infection with STDs.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. J., 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. J., 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. J. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2Page(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. J. (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.Using communication strategies in an HIV prevention curriculum to enhance african-american adolescents' adoption of HIV-preventive behaviors
DiClemente, R. J., Braxton, N. D., Sales, J. M. D., & Wingood, G. M. (n.d.). In Communication Perspectives on HIV/AIDS for the 21st Century.Publication year
2007Page(s)
389-394Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions
AbstractMilhausen, R. R., McDermott Sales, J., Wingood, G. M., DiClemente, R. J., 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. J., 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
AbstractSales, J. M. D., 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
AbstractSalazar, 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. J. (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. J., 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. J., 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.