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
Enhancing recruitment and retention of minority young women in community-based clinical research
AbstractWiemann, C. M., Chacko, M. R., Tucker, J. C., Velasquez, M. M., Smith, P. B., DiClemente, R., & Von Sternberg, K. (n.d.).Publication year
2005Journal title
Journal of Pediatric and Adolescent GynecologyVolume
18Issue
6Page(s)
403-407AbstractWomen are disproportionately affected by the sexually transmitted infections (STI) epidemic, with African-Americans and Latinos at significantly higher risk for STIs than Caucasians. Successful recruitment and retention strategies used with young minority women in community-based STI prevention or intervention research have not been previously reported. This communication presents eight key strategies learned in the recruitment and retention of 16- to 21-year-old urban women participating in a 12-month randomized clinical trial designed to promote STI screening to decrease the duration of untreated chlamydia and gonorrhea infection. Strategies learned include: (1) Educate clinic staff on the rigors of study design; (2) Facilitate a team effort between clinical and research staff; modify recruitment procedures, as needed; (3) Provide prospective participants the option of enrolling by return appointment; (4) Anticipate a diminishing recruitment pool over time; (5) Set positive recruitment tone at the beginning of each clinic session; (6) Consider participants' mothers as important points of contact; (7) Match communication styles to participant contacts; and (8) Consider a variety of retention techniques. Together, these strategies helped to reinforce participant's commitment to the project, facilitated their attendance at interviews, and encouraged them to adhere to the treatment protocol.Environmental barriers to HIV prevention among incarcerated adolescents : A qualitative assessment
AbstractFreedman, D., Salazar, L. F., Crosby, R. A., & DiClemente, R. (n.d.).Publication year
2005Journal title
AdolescenceVolume
40Issue
158Page(s)
333-343AbstractThe purpose of this research was to identify environmental factors that influence incarcerated adolescents' risk for HIV/STDs. Based on data from six gender-stratified focus groups consisting of 28 incarcerated adolescents from three detention centers in Georgia, the following salient environments emerged: schools, families, peer groups, neighborhoods, malls, and detention centers. These environments represent places in which factors related to sexual decision-making are embedded for this high-risk population. Within these environments, five factors influence their risk for HIV/STDs: (1) hierarchical messages that promote abstinence and risk reduction, (2) availability and accessibility of condoms, (3) acceptability of condoms, (4) availability of comprehensive sex education, and (5) parental communication about sex and risk reduction. Increased understanding of the role of these factors may contribute to the development of integrated interventions designed to prevent HIV/STDs among incarcerated adolescents.Prevalence and incidence of human papillomavirus infection in women in the USA : A systematic review
AbstractDiClemente, R., Revzina, N. V., & DiClemente, R. J. (n.d.).Publication year
2005Journal title
International Journal of STD and AIDSVolume
16Issue
8Page(s)
528-537AbstractA 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.Prevention and control of sexually transmitted infections among adolescents : The importance of a socio-ecological perspective - A commentary
AbstractDiClemente, R., DiClemente, R. J., Salazar, L. F., Crosby, R. A., & Rosenthal, S. L. (n.d.).Publication year
2005Journal title
Public HealthVolume
119Issue
9Page(s)
825-836AbstractThe sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and re-inforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.Real-time PCR improves detection of Trichomonas vaginalis infection compared with culture using self-collected vaginal swabs
AbstractDiClemente, R., Caliendo, A. M., Jordan, J. A., Green, A. M., Ingersoll, J., Diclemente, R. J., & Wingood, G. M. (n.d.).Publication year
2005Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
13Issue
3Page(s)
145-150AbstractObjective. To compare a real-time polymerase chain reaction (PCR) assay with broth culture for the detection of Trichomonas vaginalis using self-collected vaginal swabs. Methods. Self-collected vaginal swabs were obtained from adolescent and young adult African-American women participating in HIV-1 prevention programs. T. vaginalis culture was performed using the InPouch TV System. Samples for the real-time PCR assay were collected using the BDProbeTec ET Culturette Direct Dry Swab system and tested in a laboratory-developed assay which targeted a repeated sequence of the genome. Discrepant samples that were culture negative and positive in the real-time PCR assay were tested in a confirmatory PCR which targeted a different region of the T. vaginalis genome, the 18S ribosomal DNA gene. Results. Of the 524 specimens tested by both culture and real-time PCR, 36 were culture positive and 54 were positive in the real-time PCR assay; 16 of the 18 discrepant specimens were also positive in the confirmatory PCR assay. Using a modified gold standard of positive by culture or positive in both PCR assays, the sensitivity of the real-time PCR assay was 100% and the specificity was 99.6%, whereas culture had a sensitivity of 69.2% and a specificity of 100%. Conclusions. The real-time PCR assay was sensitive and specific for the detection of T. vaginalis DNA from self-collected vaginal swab specimens. The ability to use the BDProbeTec dry swab system for the real-time PCR testing allowed for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and T. vaginalis from a single specimen.Reducing risk exposures to zero and not having multiple partners : Findings that inform evidence-based practices designed to prevent STD acquisition
AbstractDiClemente, R., Crosby, R. A., Wingood, G. M., Lang, D. L., Salazar, L. F., & Broadwell, S. D. (n.d.).Publication year
2005Journal title
International Journal of STD and AIDSVolume
16Issue
12Page(s)
816-818AbstractOur objective was to assess prospectively the relative contribution of reducing penile-vaginal risk exposure to zero and limiting the number of sex partners to one, on the acquisition of biologically confirmed sexually transmitted disease (STD) among African American women adolescents. Data from a prospective cohort of 522 African American women adolescents enrolled in an HIV prevention trial were used. Baseline STD testing and single-dose directly observable treatment provided an infection-free cohort, who were followed and assessed at six-month intervals. Self-administered vaginal swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline, six, 12, and 18 months. Frequency of having multiple sex partners and unprotected vaginal sex over each six-month assessment interval was measured. Adolescents who reported multiple sex partners, relative to only one partner, were more likely to test positive for an STD (adjusted odds ratio (AOR)=2.9; P=0.0001). Adolescents who reported unprotected vaginal sex relative to those reporting protected vaginal sex also had greater odds of testing positive for an STD (AOR=1.5; P=0.0001). Prospective findings suggest that having multiple sex partners and engaging in unprotected vaginal sex both remain significant risk factors for STD acquisition among African American adolescent women. STD prevention programmmes need to target both risk factors to achieve optimal risk-reduction effectiveness.Self-esteem and theoretical mediators of safer sex among African American female adolescents : Implications for sexual risk reduction interventions
AbstractSalazar, L. F., Crosby, R. A., DiClemente, R., Wingood, G. M., Lescano, C. M., Brown, L. K., Harrington, K., & Davies, S. (n.d.).Publication year
2005Journal title
Health Education and BehaviorVolume
32Issue
3Page(s)
413-427AbstractTheories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.Teacher connectedness and health-related outcomes among detained adolescents
AbstractVoisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R., Yarber, W. L., & Staples-Horne, M. (n.d.).Publication year
2005Journal title
Journal of Adolescent HealthVolume
37Issue
4Page(s)
337.e17-337.e23AbstractPurpose: Data were collected from a convenience sample of 550 detained adolescents (ages 14-18 years) to explore the association between adolescents' perception of teacher connectedness and a range of health risk behaviors, such as gang membership, use of in alcohol, drugs, and tobacco, and engagement in sexual risk behaviors prior to detainment. Methods: Participants answered survey questions using audio-computer assisted self-interviewing procedures that assessed demographic, pro-social, problem, and drug and sexual risk behaviors. Results: Multiple logistic regression analyses controlling for demographic and socioeconomic status, truancy, number of days in the detention center, and family factors indicated that adolescents who reported low teacher connectedness, relative to their peers reporting high teacher connectedness, were twice as likely to use marijuana and amphetamines, and twice as likely to be sexually active, have sex while high on alcohol or drugs, have a partner who was high on alcohol or other drugs during sex, and have multiple sexual partners. Conclusions: The association between teacher connectedness and adolescents' health risk behaviors prior to detainment suggests that school-based interventions that enhance the school environment, particularly teachers' skills and training to enhance and maximize the effectiveness of their student interactions, may be one strategy for reducing health risk behaviors and their associated adverse health outcomes among youth at high risk.The psychosocial impact of serological herpes simplex type 2 testing in an urban HIV clinic
AbstractDiClemente, R., Meyer, J. L., Crosby, R. A., Whittington, W. L., Carrell, D., Ashley-Morrow, R., Meier, A. S., Harrington, R. D., DiClemente, R., & Wald, A. (n.d.).Publication year
2005Journal title
Sexually transmitted infectionsVolume
81Issue
4Page(s)
309-315AbstractBackground/objectives: Herpes simplex virus type 2 (HSV-2) is a common infection among HIV infected people. HSV type specific serologies permit the diagnosis of previously unrecognised HSV-2 infection. While substantial psychosocial morbidity has been associated with a clinical diagnosis of genital herpes, the burden associated with a serological diagnosis of HSV-2 is unclear. This study prospectively measured the psychosocial response to a new serological HSV-2 diagnosis in patients receiving care at an urban HIV clinic. Methods: At entry, sera were tested for HSV-1 and HSV-2 antibodies by western blot. Participants completed a 90 item psychosocial and life quality questionnaire at enrolment, and at 2 weeks, 3 months, and 6 months after receiving test results. Results: Of 248 HIV infected participants, 172 (69.4%) were HSV-2 seropositive and 116 (67.4%) seropositive people did not have a previous history of genital herpes. After correction for multiple comparisons, no statistically significant differences were detected on the psychosocial and life quality scales between those who received a new HSV-2 serological diagnosis compared with those who were HSV-2 seropositive with a history of genital herpes, or those who tested HSV-2 seronegative. Additionally, no significant changes in scores were observed during follow up. Conclusions: HSV-2 was a common but often unrecognised infection in this urban HIV clinic and participants coped well with a positive HSV-2 result. Concerns about psychosocial burden should not deter serological testing for HSV-2. Given the epidemiological and clinical interaction between HSV-2 and HIV, these data support routine HSV-2 testing of HIV infected people.Trends in alcohol, drug and cigarette use among Haitian youth in Miami-Bade County, Florida
AbstractDiClemente, R., Marcelin, L. H., Vivian, J., Dilemente, R., Shultz, J., & Bryan Page, J. (n.d.).Publication year
2005Journal title
Journal of Ethnicity in Substance AbuseVolume
4Issue
1Page(s)
105-131AbstractThe objective of this article is to report on prevalence of drug and cigarette use among a segment of Haitian youth in the United States. The article is an argument in favor of contextualizing knowledge about drug use among young people across socioethnic lines. Because initiation of licit and illicit drugs tends to occur during adolescence, ethnic differentiation is crucial if we are to understand the drug experience among young people in the United States. Immigration, acculturation, and identity processes are critical in refuting the conventional racial categorization commonly used for interpretation of risks and behaviors among youth in the United States. The task of bringing empirical evidence to bear on drug use and drug choices by young people from different contexts will lead to the re-examination of patterns of drug use as well as to creative ways of conceptualizing these patterns.A descriptive analysis of STD prevalence among urban pregnant african-american teens : Data from a pilot study
AbstractDiClemente, R., Wingood, G. M., Crosby, R. A., Rose, E., Lang, D., Pillay, A., Papp, J., & Faushy, C. (n.d.).Publication year
2004Journal title
Journal of Adolescent HealthVolume
34Issue
5Page(s)
376-383AbstractObjective To assess the prevalence of sexually transmitted diseases (STDs) among a sample of African-American adolescent females at the time of their first prenatal visit and to assess key characteristics of those testing positive for sexually transmitted diseases. The study also determined differences in these characteristics between adolescents who were and those who were not diagnosed with an STD. Methods One-hundred-and-seventy pregnant African-American adolescents (aged 14-20 years; mean = 17.5 years) receiving their first prenatal visit were recruited at a prenatal clinic located in a large urban hospital. Biological assessment included nucleic acid amplification testing for gonococcal, chlamydial, and trichomonal infections. Rapid plasma reagin testing assessed infection with syphilis. A self-administered survey and in-depth face-to-face interview were used to collect detailed information assessing adolescents' sociodemographic characteristics, psychosocial indices, and their recent sexual risk behaviors. Data were analyzed using Student's t-tests and contingency table analyses, respectively, for continuous and categorical variables. Results Overall, 23.5% tested positive for one of the four STDs. Thirteen percent were infected with Chlamydia trachomatis, 1.2% with Neisseria gonorrhoeae, 8.9% with Trichomonas vaginalis, and 1.2% with Treponema pallidum. More than one-half reported recent (past 6 months) treatment for an STD, 30% of these tested positive for at least one of the four STDs assessed. Adolescents testing positive for STDs held favorable attitudes toward condom use, but levels of sexual risk were generally high. There were no sociodemographic, psychosocial, and sexual-risk differences between those testing positive and negative. Conclusion Findings support STD screening efforts targeting pregnant adolescents. Providing clinic-based counseling and prevention education programs to pregnant adolescents regardless of apparent risk factors may also be warranted.A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV : The WiLLOW Program.
AbstractWingood, G. M., DiClemente, R., Mikhail, I., Lang, D. L., McCree, D. H., Davies, S. L., Hardin, J. W., Hook, E. W., & Saag, M. (n.d.).Publication year
2004Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
37 Suppl 2Page(s)
S58-67AbstractOBJECTIVE: To evaluate the efficacy of an intervention to reduce HIV transmission risk behaviors and sexually transmitted diseases (STDs) and enhance HIV-preventive psychosocial and structural factors among women living with HIV. DESIGN: A randomized controlled trial of 366 women living with HIV in Alabama and Georgia. INTERVENTION: The intervention emphasized gender pride, maintaining current and identifying new network members, HIV transmission knowledge, communication and condom use skills, and healthy relationships. PRIMARY OUTCOME: Unprotected vaginal intercourse. OTHER OUTCOMES: Proportion never used condoms, incident STDs, psychosocial factors, and number of supportive network members. RESULTS: Over the 12-month follow-up, women in the WiLLOW intervention, relative to the comparison, reported fewer episodes of unprotected vaginal intercourse (1.8 vs. 2.5; P = 0.022); were less likely to report never using condoms (odds ratio [OR] = 0.27; P = 0.008); had a lower incidence of bacterial infections (Chlamydia and gonorrhea) (OR = 0.19; P = 0.006); reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, and fewer partner-related barriers to condom use; and demonstrated greater skill in using condoms. CONCLUSION: This is the first trial to demonstrate reductions in risky sexual behavior and incident bacterial STDs and to enhance HIV-preventive psychosocial and structural factors among women living with HIV.An Assessment of HIV/AIDS Risk in Higher Education Students in Yerevan, Armenia
AbstractBabikian, T., Freier, M. C., Hopkins, G. L., DiClemente, R., McBride, D., & Riggs, M. (n.d.).Publication year
2004Journal title
AIDS and BehaviorVolume
8Issue
1Page(s)
47-61AbstractArmenia's current sociopolitical and economic instability and the alarming HIV incidence rates in neighboring countries amplify its risk for a national epidemic. The goals of this study were to assess HIV/AIDS knowledge and risk behaviors among higher education students in Yerevan. Knowledge of HIV transmission through sexual intercourse was markedly higher than that on intravenous transmission and prevailing myths; however, HIV/AIDS knowledge was not related to risk behaviors. Tobacco and alcohol prevalence was relatively high. Students reported risky sexual behaviors, including inconsistent condom use, casual sex, and multiple partners. In addition to descriptive statistics delineating gender differences across the target behavioral domains, bivariate and multivariate statistical analyses were used to understand factors that contributed to increased risk, including early age of initiation and the relationship between substance use and risky sexual activity. The study results provide much-needed information for the development of school- and community-based AIDS prevention programs in Armenia.Association of complementary and alternative medicines with HIV clinical disease among a cohort of women living with HIV/AIDS
AbstractMikhail, I. S., DiClemente, R., Person, S., Davies, S., Elliott, E., Wingood, G., & Jolly, P. E. (n.d.).Publication year
2004Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
37Issue
3Page(s)
1415-1422AbstractTo assess the association between the use of complementary and alternative medicine (CAM) and HIV clinical disease indicators, CD4+ T-cell counts, viral load, number of HIV-related infections, Centers for Disease Control and Prevention categories, and Karnofsky scores. Data were collected from 391 HIV-positive women aged 18 to 50 years in Alabama and Georgia. A survey examining CAM use and other sociodemographic variables was used. Multiple logistic regression analyses were used to identify predictors of CAM use. Approximately 60% of study participants used 1 or more type of CAM. Predictors of CAM use included higher educational level (odds ratio [OR] = 2.4; P = 0.0008), absence of health insurance (OR = 0.49; P = 0.0055), longer disease duration (OR = 2.21; P = 0.0006), and higher number of infections (OR = 0.58; P = 0.017). Vitamins were the most commonly used CAM (∼36%). Sociodemographic variables associated with vitamin use included higher educational level (OR = 2.34; P = 0.0055), longer disease duration (OR = 1.87; P = 0.026), and higher use among white women than among African-American women (OR = 0.41; P = 0.017). The use of CAM is prevalent among HIV-positive women, and vitamins are the most commonly used CAM among our study population. Several sociodemographic and clinical factors predicted CAM use. These findings have implications for improvement of care for HIV-positive women.Associations between Sexually Transmitted Disease Diagnosis and Subsequent Sexual Risk and Sexually Transmitted Disease Incidence among Adolescents
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
2004Journal title
Sexually Transmitted DiseasesVolume
31Issue
4Page(s)
205-208AbstractBackground: Empiric evidence is lacking in regard to the subsequent sexually transmitted disease (STD)-associated risk behaviors of adolescents diagnosed and treated for an STD. Goal: The goal of this study was to prospectively identify associations between STD diagnosis and subsequent sexual risk and STD incidence among a sample of U.S. adolescents. Study Design: A cohort of 455 adolescents (age 15-21 years) was followed for 3 months. Adolescents were recruited from primary care clinics and through outreach activities. Results: A total of 10.8% were initially diagnosed with at least one STD. After adjusting for observed covariates, these adolescents (compared with those testing negative) were 2.8 times (P = 0.0001) more likely to be abstinent from sex and 2.2 times more likely to report always using condoms (P = 0.04). However, during the ensuing 3 months, they were approximately 2.4 times more likely to report having sex with multiple partners (P = 0.01), 8.9 times more likely to test positive for trichomonas (P = 0.009), and 3.0 times more likely to test positive for chlamydia (P = 0.04). Conclusions: Compared with those testing negative, adolescents diagnosed with an STD may subsequently adopt safer sex behaviors, including abstinence. However, perhaps in part as a result of having sex with multiple partners, they might fail to practice safer sex behaviors stringently enough to avoid subsequent STD acquisition.Condom use among low-income African American males attending an STD clinic
AbstractGrimley, D. M., Hook, E. W., DiClemente, R., & Lee, P. A. (n.d.).Publication year
2004Journal title
American Journal of Health BehaviorVolume
28Issue
1Page(s)
33-42AbstractObjective: To evaluate condomuse attitudes and behaviors among low-income, primarily African American, male patients seeking care at an urban sexually transmitted disease (STD) clinic. Methods: Via face-to-face interviews, 224 males completed a theory-based questionnaire regarding condom use. Results: The results show that although respondents had obvious signs and symptoms of infection and that 65% were "repeaters" at the clinic, 66% of the sample reporting a main partner and 33% of those with other types of sexual partners were not motivationally ready to use condoms consistently. Conclusion: Based on their STD clinic attendance, these men obviously perceive themselves at risk for STDs, but appear to cope with this risk by choosing to engage in secondary rather than primary preventive behaviors.Correlates of having unprotected vaginal sex among detained adolescent females : An exploratory study of sexual factors
AbstractCrosby, R., Salazar, L. F., DiClemente, R., & Yarber, W. L. (n.d.).Publication year
2004Journal title
Sexual HealthVolume
1Issue
3Page(s)
151-155AbstractBackground: Erotophilia, motivations for engaging in sex, and pleasure-related barriers to using condoms may all be important determinants of whether high-risk adolescent females have sex unprotected by a condom. This exploratory study identified associations between these factors and engaging in unprotected vaginal sex (UVS) among a sample of adolescent females recruited from short-term detention facilities in the USA. Methods: A cross-sectional survey of 211 adolescent females (14-18 years of age) was conducted. Only those indicating they had sex within the past 2 months were included in the analysis. Adolescents were recruited within eight detention facilities. Measures were assessed using audio-computer assisted self-interviewing (A-CASI). Results: In race-adjusted analyses, adolescents indicating greater pleasure-associated barriers to using condoms were more than 4.3 times more likely than those indicating fewer barriers to report having UVS in the past 2 months (AOR = 4.36; 95% CI = 2.15-8.86). Similarly, those scoring higher in erotophilia (compared with those scoring lower) were more than twice as likely to report UVS (AOR = 2.08; 95% CI = 1.02-4.24). Finally, adolescents who had ever been pregnant were ∼2.5 times more likely to report having recent UVS (AOR = 2.48; 95% CI = 1.1-5.34). With the exception of having five or more sex partners in the past 2 months (P = 0.08), none of the remaining correlates approached multivariate significance. Conclusions: Constructs such as erotophilia and pleasure-related barriers to condom use may be important correlates of UVS among this population of high-risk adolescents.Efficacy of an HIV prevention intervention for African American adolescent girls : A randomized controlled trial
AbstractDiClemente, R., Wingood, G. M., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., Oh, M. K., Crosby, R. A., Hertzberg, V. S., Gordon, A. B., Hardin, J. W., Parker, S., & Robillard, A. (n.d.).Publication year
2004Journal title
Journal of the American Medical AssociationVolume
292Issue
2Page(s)
171-179AbstractContext: African American adolescent girls are at high risk for human immunodeficiency virus (HIV) infection, but interventions specifically designed for this population have not reduced HIV risk behaviors. Objective: To evaluate the efficacy of an intervention to reduce sexual risk behaviors, sexually transmitted diseases (STDs), and pregnancy and enhance mediators of HIV-preventive behaviors. Design, Setting, and Participants: Randomized controlled trial of 522 sexually experienced African American girls aged 14 to 18 years screened from December 1996 through April 1999 at 4 community health agencies. Participants completed a self-administered questionnaire and an interview, demonstrated condom application skills, and provided specimens for STD testing. Outcome assessments were made at 6- and 12-month follow-up. Intervention: All participants received four 4-hour group sessions. The intervention emphasized ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison condition emphasized exercise and nutrition. Main Outcome Measures: The primary outcome measure was consistent condom use, defined as condom use during every episode of vaginal intercourse; other outcome measures were sexual behaviors, observed condom application skills, incident STD infection, self-reported pregnancy, and mediators of HIV-preventive behaviors. Results: Relative to the comparison condition, participants in the intervention reported using condoms more consistently in the 30 days preceding the 6-month assessment (unadjusted analysis, intervention, 75.3% vs comparison, 58.2%) and the 12-month assessment (unadjusted analysis, intervention, 73.3% vs comparison, 56.5%) and over the entire 12-month period (adjusted odds ratio, 2.01; 95% confidence interval [CI], 1.28-3.17; P=.003). Participants in the intervention reported using condoms more consistently in the 6 months preceding the 6-month assessment (unadjusted analysis, intervention, 61.3% vs comparison, 42.6%), at the 12-month assessment (unadjusted analysis, intervention, 58.1% vs comparison, 45.3%), and over the entire 12-month period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.50; PHealth risk factors among detained adolescent females
AbstractCrosby, R., Salazar, L. F., DiClemente, R., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).Publication year
2004Journal title
American journal of preventive medicineVolume
27Issue
5Page(s)
404-410AbstractTo identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (pHIV testing among detained youth
AbstractVoisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R., Yarber, W. L., & Staples-Home, M. (n.d.).Publication year
2004Journal title
Journal of HIV/AIDS Prevention in Children and YouthVolume
6Issue
2Page(s)
83-96AbstractPublished reports have not investigated the issue of voluntary HIV testing among detained youth, a population disproportionately infected with HIV compared to other adolescent groups. Data were collected from 467 sexually active detained adolescents in Georgia on demographic, environmental, and drug and sexual history variables, to explore differences between those who ever tested for HIV and those who never tested for HIV prior to being detained. Among the total sample, testing was associated with living in a rural area, having received school or community-based sex education classes, causing a pregnancy or having been pregnant, having had an STD diagnosis, and recently having sex with a partner who was high on drugs. However, there were significant gender differences with respect to these findings. Results suggest that a significant number of detained adolescents (especially males) engage in risky sexual behaviors, but have never been tested for HIV: Consequently, strongly promoting HIV testing at detention centers may serve as a significant best baseline care practice for detained youth.Lack of recent condom use among detained adolescent males : A multilevel investigation
AbstractDiClemente, R., Crosby, R., Salazar, L. F., & DiClemente, R. J. (n.d.).Publication year
2004Journal title
Sexually transmitted infectionsVolume
80Issue
6Page(s)
425-429AbstractObjective: To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities. Methods: A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal. Results: Nine correlates achieved bivariate significance (pRelationship characteristics and sexual practices of African American adolescent girls who desire pregnancy.
AbstractDavies, S. L., DiClemente, R., Wingood, G. M., Person, S. D., Crosby, R. A., Harrington, K. F., & Dix, E. S. (n.d.).Publication year
2004Journal title
Health education & behavior : the official publication of the Society for Public Health EducationVolume
31Issue
4 SupplPage(s)
85S-96SAbstractThis study examined associations between African American adolescent girls' desire to become pregnant and their sexual and relationship practices. Odds ratios and 95% confidence intervals were used to detect significant associations between pregnancy desire and the assessed correlates. Of 522 participants (14 to 18 years old), 67 (12.8%) were pregnant and were thus excluded from this analysis. Of the remaining 455 adolescents, 107 (23.6%) expressed some desire to be pregnant at the time of assessment. Adolescents who desired pregnancy were significantly more likely to report having had sex with a casual partner and to use contraception inconsistently. Factors involving an adolescent girl's relationship with her partner (e.g., being in a relationship, length of relationship, time spent with boyfriend, or satisfaction with boyfriend) were not significantly associated with the desire for pregnancy. Effective pregnancy and sexually transmitted disease prevention programs for female adolescents should address their level of pregnancy desire.Self-concept and adolescents' refusal of unprotected sex : A test of mediating mechanisms among African American girls
AbstractSalazar, L. F., DiClemente, R., Wingood, G. M., Crosby, R. A., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2004Journal title
Prevention ScienceVolume
5Issue
3Page(s)
137-149AbstractDuring adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.Substance use among students attending a christian university that strictly prohibits the use of substances
AbstractHopkins, G. L., Freier, M. C., Babikian, T., Helm, H. W., McBride, D. C., Boward, M., Gillespie, S., & DiClemente, R. (n.d.).Publication year
2004Journal title
Journal of Research on Christian EducationVolume
13Issue
1Page(s)
23-39AbstractThis study examines substance use at a church-affiliated university which prohibits the use of alcohol, tobacco, and drug substances. The purpose was to investigate the prevalence of substance use, the prevention efforts put forth by the university, and whether religious beliefs, which prohibit substance use, are protective. While the findings indicate that alcohol, tobacco and other drugs were used in varying degrees by this student sample, the overall use was significantly lower relative to a national comparison group. The data suggests that religion is a protective factor concerning substance use. However, since students use substances even at church-affiliated campuses with prohibitive substance use beliefs, the problem of how to deal with substance use remains.The association between gang involvement and sexual behaviours among detained adolescent males
AbstractDiClemente, R., Voisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R. J., Yarber, W. L., & Staples-Horne, M. (n.d.).Publication year
2004Journal title
Sexually transmitted infectionsVolume
80Issue
6Page(s)
440-442AbstractObjective: Data were collected from 270 detained male adolescents (aged 14-18 years) to determine the association between ever having been in a gang and a range of sexual behaviours such as sexual activity, male condom use, sex with multiple partners, and drug use during sex. Methods: Participants answered survey questions using audio computer assisted self interviewing (A-CASI) procedures, which assessed demographic, family factors, history of gang membership, and sexual behaviours. Results: Multiple logistic regression analyses, controlling for demographic, socioeconomic status, and family factors, indicated that adolescents who reported having been in a gang, relative to their peers reporting no gang involvement, were 5.7 times more likely to have had sex, 3.2 times more likely to have got a girl pregnant, and almost four times more likely to have been "high" on alcohol or other drugs during sexual intercourse, have had sex with a partner who was "high" on alcohol or other drugs, or have had sex with multiple partners concurrently. Conclusions: Findings suggest that having been in a gang can discriminate between levels of STI associated risk behaviours among an otherwise high risk population-detained adolescent males.