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 adoption of evidence-based HIV interventions: Promotion of a suite of HIV prevention interventions for African American women
AbstractWingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2006Journal title
AIDS Education and PreventionVolume
18Page(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. J., 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. J., 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. J. (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
AbstractChacko, 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. J., 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. J., & 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. J., 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. J., 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. J. (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. J., 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. J., 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. J., 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
5Page(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.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. J., & 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. J. (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
AbstractRevzina, 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. 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
AbstractCaliendo, 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. J., 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. J., 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. J., 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
AbstractMeyer, 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
AbstractMarcelin, 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. J., 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. J., 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
37Page(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.