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
The role of social support in the psychological well-being of African American girls who experience dating violence victimization
AbstractSalazar, L. F., Wingood, G. M., DiClemente, R., Lang, D. L., & Harrington, K. (n.d.).Publication year
2004Journal title
Violence and VictimsVolume
19Issue
2Page(s)
171-187AbstractThe goals of this study were to test the relationship between dating violence victimization (i.e., verbal, emotional, and physical abuse) and psychological well-being (i.e., depressive symptomatology, self-esteem, and body image) among 522 African American girls, and to determine whether social support acted as a buffer of negative effects (moderator) or as an intervening factor (mediator) in the relationship between dating violence victimization and psychological well-being. Results from structural equation modeling indicated that dating violence victimization was associated with negative psychological outcomes. Although social support did not moderate this relationship, it served as a mediator of the relationship between dating violence victimization and psychological well-being. Dating violence programs for African American girls should consider how to incorporate family, church, and other networks in the community to foster support, and allow adolescent girls to discuss their abusive experiences in a nonblaming environment. If programs are able to buoy girls who experience dating violence, then they may be able to ameliorate the associated negative psychological sequelae.Use of recreational Viagra among men having sex with men
AbstractDiClemente, R., Crosby, R., & DiClemente, R. J. (n.d.).Publication year
2004Journal title
Sexually transmitted infectionsVolume
80Issue
6Page(s)
466-468AbstractObjective: Given the potential for Viagra (sildenafil) use to foster greater friction during sex (owing to enlarged erection size) and prolonged sex, the recreational use of this substance warrants investigation in the context of STI risk. Thus, an exploratory study was conducted to identify bivariate correlates of recreational (non-prescription) Viagra use among men who have sex with men (MSM) attending a popular sex resort for men located in the southern United States. Methods: A cross sectional study was conducted. Behavioural measures, including Viagra use, were assessed using a 3 month recall period. Results: Of 164 men asked to participate, 91% completed a self administered questionnaire. Men resided in 14 states, most of which were located in the southern United States. Their average age was 40 years. Most (93%) men self identified as white. The median annual income interval was $25 000 to $50 000. One sixth (16.7%) reported being HIV positive. 16% reported using non-prescription Viagra. Age (p = 0.41), income (p = 0.32), and HIV serostatus (p = 0.85) were not associated with Viagra use. Of men recently using ecstasy during sex, 35% reported Viagra use compared to 13% among those not using ecstasy (p = 0.01). Of men recently using cocaine during sex, 37% reported Viagra use compared to 13% among those not using cocaine (p = 0.009). Use of "poppers" approached, but did not achieve, statistical significance as a correlate of Viagra use (p = 0.06). Recent frequency of unprotected anal sex (p = 0.79), fisting (p = 0.10), rimming (p = 0.64), and having five or more sex partners (p = 0.09) were not associated with Viagra use. Conclusion: Recreational Viagra use was relatively common among men, regardless of age or HIV serostatus. Viagra use was associated with men's substance abuse behaviours rather than their sexual risk behaviours.A prospective study of exposure to rap music videos and African American female adolescents' health
AbstractWingood, G. M., DiClemente, R., Bernhardt, J. M., Harrington, K., Davies, S. L., Robillard, A., & Hook, E. W. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
3Page(s)
437-439Abstract~Adjudication history and African American adolescents' risk for acquiring sexually transmitted diseases : An exploratory analysis
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Levine, D. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
8Page(s)
634-638AbstractBackground: Little is known about sexually transmitted disease (STD) risk behavior among adjudicated African American adolescents. Goal: The goal of the study was to compare STD-associated risk profiles of African American adolescents reporting a history of adjudication and those not reporting adjudication. Study Design: A cross-sectional survey of 304 African American adolescent males and females (aged 15-21 years) was conducted. Adolescents were recruited from primary care clinics and through outreach activities. Results: Twenty-six percent of the adolescents reported adjudication. After adjusting for gender, adjudicated adolescents were about 3.6 and 4.5 times, respectively, more likely than nonadjudicated adolescents to report ever having one of three STDs (gonorrhea, chlamydia, and trichomoniasis) or to report having one of these in the past 90 days. Reporting recent sex with someone known or suspected of having an STD was about nine times more likely among adjudicated adolescents, and they were about 2.6 times more likely than their nonadjudicated counterparts to report using drugs or alcohol during their last sexual experience and 2.2 times more likely to report frequent sex in the past 90 days. Conclusions: African American adolescents with a history of adjudication may have greater risk for acquisition of STDs than their peers not reporting adjudication.Associations between internet sex seeking and STI associated risk behaviours among men who have sex with men
AbstractDiClemente, R., Mettey, A., Crosby, R., DiClemente, R. J., & Holtgrave, D. R. (n.d.).Publication year
2003Journal title
Sexually transmitted infectionsVolume
79Issue
6Page(s)
466-468AbstractObjective: This exploratory study identified associations between internet sex seeking and HIV associated risk behaviours among a high risk sample of men who have sex with men (MSM). Methods: A cross sectional survey of men attending a sex resort was conducted. Of 164 men asked to participate, 91% completed a self administered questionnaire. The questionnaire assessed demographic variables and (using a 3 month recall period) men's HIV associated sexual risk behaviours. Potential confounding variables were assessed and controlled, as needed, by multivariate analysis. Results: Men currently resided in 14 states. One sixth reported being HIV positive. 57% of the men reported using the internet to seek sex. Differences in critical behaviours (unprotected anal sex and number of partners) were not found. However, compared to those not seeking sex by internet, men using the internet to meet sex partners were more likely to report fisting (adjusted odds ratio=3.3, p=0.04), having group sex (prevalence ratio (PR)=1.2, p=0.0001), using poppers during sex (PR=1.94, p=0.0001), and using ecstasy during sex (PR=2.7, p=0.04). Internet sex seeking men were also significantly more likely to report meeting sex partners in bathhouses (PR=2.2, p=0.0001), bars (PR=1.5, p=0.001), parks (PR=3.2, p=0.006), and circuit parties (PR=8.9, p=0.007). Conclusion: Among MSM attending a sex resort, those using the internet to seek sex partners may have modestly elevated risks for acquiring or transmitting sexually transmitted infections. Subsequent studies should investigate the utility of using the internet as forum for promoting safer sex behaviours among high risk MSM.Correlates of continued risky sex among pregnant African American teens : Implications for STD prevention
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Lang, D. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
1Page(s)
57-63AbstractBackground: African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic. Objective: This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy. Study Design: Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance. Results: Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P < 0.02), primiparity (P < 0.03), not being enrolled in school (P < 0.02), not residing with at least one parent (P < 0.001), reported infrequent sexual communication (communicating about sex) with the boyfriend (P < 0.01), spending at least 30 hours each week with the boyfriend (P < 0.001), reporting that the age of the current relationship was at least 2 years (P < 0.04), and using marijuana in the past 30 days (P < 0.03). Three correlates retained significance in the multivariate model not residing with at least one parent (adjusted odds ratio [AOR] = 2.24; P < 0.04), spending at least 30 hours with the boyfriend each week (AOR = 3.70; P < 0.002), and infrequent sexual communication with the boyfriend (AOR = 2.88; P < 0.008). Conclusion: Given the potential of STDs to complicate pregnancy outcomes, clinic-based and community-based programs addressing relational dynamics and relational obstacles to safer sex may be warranted, particularly for adolescents not residing with parents.Correlates of Recent Unprotected Anal Sex among Men Having Sex with Men Attending a Large Sex Resort in the South
AbstractCrosby, R., DiClemente, R., & Mettey, A. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
12Page(s)
909-913AbstractBackground: Published studies have not investigated sexually transmitted disease-associated risk behaviors among men who have sex with men (MSM) attending U.S. sex resorts. Goal: We conducted an exploratory study to identify demographic and behavioral correlates of recently engaging in unprotected anal sex (UAS) among MSM attending a sex resort in the southern United States. Study Design: A cross-sectional survey of 150 men. Results: In multivariate analyses, men were more likely to practice risky sex if they also recently engaged in the practices of having group sex (adjusted odds ratio [AOR], 3.0), rimming (AOR, 2.0), or if they used public restrooms to meet potential sex partners (AOR, 2.6). UAS was also more likely among men vaccinated against hepatitis B (AOR, 1.9). Men who reported having primary partners and men who reported being HIV-positive were no less likely than other men in the sample to report recent UAS. Conclusion: Sex resorts can be an important venue for sexually transmitted disease and HIV prevention among MSM. Tailored prevention messages could be warranted for men who report group sex, rimming, meeting partners in public restrooms, or being vaccinated against hepatitis B.Correlates of unplanned and unwanted pregnancy among African-American female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Lang, D. (n.d.).Publication year
2003Journal title
American journal of preventive medicineVolume
25Issue
3Page(s)
255-258AbstractBackground: Evidence suggests that unplanned/unwanted pregnancy may be an important antecedent of negative birth outcomes, such as low birth weight. This study identified correlates of perceiving a current pregnancy as both unplanned and unwanted among unmarried African-American adolescents aged 14-20 years. Methods: One hundred seventy pregnant adolescents were recruited during their first prenatal visit. Adolescents completed a face-to-face interview administered in private examination rooms. Adolescents also completed an in-depth self-administered survey. Measures were selected based on two potential influences: (1) relationships with boyfriends and (2) parent/family involvement. Age and parity were also assessed. Contingency table analyses were used to identify significant bivariate associations. Correlates achieving bivariate significance were entered into a forward stepwise logistic regression model. Results: Pregnancy was reported as unplanned and unwanted by 51.2% of the study population. In a multivariate analysis, adolescents indicating lower levels of parental involvement were about twice as likely (adjusted odds ratio [AOR]=2.05; 95% confidence interval [CI], 1.1-3.9, pHuman immunodeficiency virus prevention for adolescents : Windows of opportunity for optimizing intervention effectiveness
AbstractDiClemente, R., & Wingood, G. M. (n.d.).Publication year
2003Journal title
Archives of Pediatrics and Adolescent MedicineVolume
157Issue
4Page(s)
319-320Abstract~Identification of strategies for promoting condom use : A prospective analysis of high-risk African American female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Harrington, K., Davies, S. L., & Oh, M. K. (n.d.).Publication year
2003Journal title
Prevention ScienceVolume
4Issue
4Page(s)
263-270AbstractCondom promotion strategies for adolescents typically include provision of STD/HIV-associated knowledge, fostering favorable attitudes toward condom use, promoting positive peer norms regarding condom use, improving condom-related communication skills and self-efficacy, and overcoming barriers to condom use. The purpose of this study was to identify which of these constructs were prospectively associated with condom use among a high-risk sample of African American adolescent females reporting sexual activity with a steady male partner. Adolescents, 14-18 years old, were recruited from schools and health clinics. Adolescents completed an in-depth survey and interview at baseline and again 6 months later. Analyses were limited to adolescents with steady partners who reported sexual activity between the baseline and 6-month follow-up assessment periods (N = 179). At baseline, five-scale measures and a single-item measure were used to assess predictive constructs. At follow-up, adolescents were asked about their frequency of condom use over various periods of recall. Multivariate models were created to control for the confounding influence of pregnancy status. The findings were remarkably distinct. The evidence strongly supported the predictive role of perceived barriers toward condom use and peer norms. The measure of sexual communication achieved significance for two of the six assessed outcomes. Alternatively, measures of attitudes toward condom use, condom negotiation self-efficacy, and knowledge about STD/HIV-prevention were consistently nonsignificant. The findings suggest that to improve effectiveness of individual-level STD/HIV prevention programs, designed for this population, program emphasis should be on reducing barriers to condom use, teaching partner communication skills, and fostering positive peer norms relevant to condom use.Infrequent parental monitoring predicts sexually transmitted infections among low-income African American female adolescents
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Lang, D. L., & Harrington, K. (n.d.).Publication year
2003Journal title
Archives of Pediatrics and Adolescent MedicineVolume
157Issue
2Page(s)
169-173AbstractObjective: To prospectively determine (using an 18-month follow-up period) the association between African American female adolescents' perceptions of parental monitoring and their acquisition of biologically confirmed infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Design: A prospective cohort study of 217 African American female adolescents enrolled in the control arm of a randomized trial of a human immunodeficiency virus prevention intervention program. Setting and Participants: A volunteer sample of adolescents (aged 14-18 years) recruited from low-income neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Main Outcome Measures: Adolescents provided 2 self-collected vaginal swab specimens. One was tested for C trachomatis and N gonorrhoeae DNA with ligase chain reaction. The other was used to inoculate culture medium for T vaginalis. Identical assay procedures were repeated at the 6-month, 12-month, and 18-month follow-up intervals. Results: Adjusted odds ratios indicated that adolescents who perceived infrequent parental monitoring at baseline were 1.8 (95% confidence interval, 1.01-3.21) and 2.4 (95% confidence interval, 1.22-4.87) times more likely to acquire chlamydia or trichomoniasis, respectively, compared with their counterparts who perceived greater levels of monitoring. Similarly, adolescents who perceived infrequent parental monitoring were 2.1 (95% confidence interval, 1.16-3.74) times more likely to test positive for a sexually transmitted infection during the course of the 18-month follow-up period. Conclusions: Adolescents' perceptions of their parental-monitoring levels predicted subsequent acquisition of biologically confirmed chlamydia and trichomoniasis infections. These findings suggest that expanded efforts leading toward effective clinic- and community-based sexually transmitted infection intervention programs involving parents may be warranted.Older partners and STD prevalence among pregnant African American teens
AbstractBegley, E., Crosby, R. A., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
3Page(s)
211-213AbstractBackground: Several recent studies have addressed the question of whether adolescent females who have sex with older partners have a greater risk of sexually transmitted disease (STD) acquisition. Goal: The goal was to identify differences in STD prevalence and selected measures of behavioral risk between unmarried pregnant African American adolescent females reporting sex with older partners and those reporting sex with similar-age partners. Study Design: Adolescents (n = 169) were recruited during their first prenatal visit. Adolescents completed a self-administered survey and a face-to-face interview and provided urine specimens for nucleic acid amplification assays. Results: Approximately 65% of adolescents reported that their male sex partners were ≥2 years older, while 35% reported having similar-age male sex partners. In age-adjusted analyses, adolescents with older partners were four times more likely to test positive for chlamydia (P < 0.04) and were more than twice as likely to report that their partner was also having sex with other women (P < 0.04). With use of a 30-day recall period, the mean number of unprotected vaginal sexual encounters among adolescents with older partners was 4.1, as compared to a mean of 6.9 among those reporting similar-age partners; this difference approached significance (P = 0.051). Prevalence of trichomoniasis as well as scale measures of adolescents' self-efficacy for condom negotiation and frequency of sexual communication with partners did not differ between those adolescents with older or similar-age male sex partners. Conclusion: In resource-constrained clinical settings, one implication of these findings is that pregnant adolescents reporting older partners may be a priority for targeted delivery of partner services. More frequent screening for chlamydia may also be cost-effective for pregnant adolescents with older partners.Pregnancy desire among disadvantaged African American adolescent females
AbstractDavies, S. L., DiClemente, R., Wingood, G. M., Harrington, K. F., Crosby, R. A., & Sionean, C. (n.d.).Publication year
2003Journal title
American Journal of Health BehaviorVolume
27Issue
1Page(s)
55-62AbstractObjective: To examine the prevalence and correlates of wanting to become pregnant among a sample of 462 sexually active nonpregnant African American adolescent females. Methods: Multivariate logistic regression was used to calculate adjusted odds ratios, their 95% confidence intervals, and respective P values. Results: Significant correlates with pregnancy desire included having a male partner who desired pregnancy, having a boyfriend at least 5 years older, having low self-esteem, perceiving greater perceived barriers to condom use, and perceiving low family support. Conclusions: Pregnancy prevention programs designed for economically disadvantaged African American adolescent females should address these correlates of their pregnancy desire.Psychosocial impact of serological diagnosis of herpes simplex virus type 2 : A qualitative assessment
AbstractDiClemente, R., Melville, J., Sniffen, S., Crosby, R., Salazar, L., Whittington, W., Dithmer-Schreck, D., DiClemente, R., & Wald, A. (n.d.).Publication year
2003Journal title
Sexually transmitted infectionsVolume
79Issue
4Page(s)
280-285AbstractObjectives: To assess the emotional and psychosocial responses to a serological diagnosis of HSV-2 infection in individuals without previous history of genital herpes. Methods: 24 individuals who had a positive HSV-2 serology by western blot and no clinical history of disease were recruited from four clinics (sexually transmitted disease, maternal and infant care, family medicine, and virology research) over a 10 month period. In-depth qualitative interviews were conducted to elicit an individual's responses to the HSV-2 diagnosis. Results: Three categories of themes were identified from the interviews. Short term emotional responses included surprise, denial, confusion, distress, sadness, disappointment, and relief to know. Short term psychosocial responses included fear of telling sex partners, anger at the source partner, guilt about acquiring or transmitting, and concern about transmitting to a child. Perceived ongoing responses included fear of telling future partners, concern about transmitting to a sex partner, feeling sexually undesirable, feeling socially stigmatised, feeling like "damaged goods," sex avoidance due to social responsibility, fear of transmitting to a newborn, and relationship concerns relating to the diagnosis. Conclusions: Individuals exhibit strong emotional and psychosocial responses to a serological diagnosis of HSV-2 infection. Many of the negative responses may be time limited and influenced by factors that are potentially amenable to counselling.Psychosocial predictors of hepatitis B vaccination among young African-American gay men in the deep south
AbstractRhodes, S. D., & DiClemente, R. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
5Page(s)
449-454AbstractBackground: Despite recommendations for vaccination against hepatitis B virus (HBV) of men who have sex with men (MSM), most remain unvaccinated. Goal: The goal of this study was to identify attitudes and beliefs associated with vaccination against HBV among black MSM. Study Design: The Birmingham Vaccine Acceptance Questionnaire was used to collect data from gay bar patrons. Results: Of the 143 participants, nearly 42% reported at least one dose of HBV vaccine. In multivariable analysis, characteristics associated with vaccination were a decreased perception of barriers to HBV vaccination (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.22-0.61; P = 0.001); increased perceived medical severity (OR, 5.34; 95% CI, 2.38-11.96; P = 0.001) and personal severity (OR, 2.22; 95% CI, 1.38-3.56; P = 0.006) of HBV infection; and increased perceived general medical self-efficacy (OR, 9.22; 95% CI, 3.52-24.11; P = 0.0001) and personal self-efficacy (OR, 2.3; 95% CI, 1.14-4.63; P = 0.008) to complete the three-dose series. Conclusions: Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing perceived severity of HBV infection and self-efficacy to complete the vaccine series.Religiosity and risky sexual behavior in African-American adolescent females
AbstractMcCree, D. H., Wingood, G. M., DiClemente, R., Davies, S., & Harrington, K. F. (n.d.).Publication year
2003Journal title
Journal of Adolescent HealthVolume
33Issue
1Page(s)
2-8AbstractPurpose: To examine the association between religiosity (defined by frequency of engaging in religious/spiritual activities) and African-American adolescent females' sexual behaviors, attitudes toward sex, and ability to negotiate safer sex. Methods: Between December 1996 and April 1999, 1130 female adolescents were screened for eligibility in a sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention trial. Data collection was achieved through a confidential self-administered questionnaire that examined religiosity and a structured interview regarding sexual behavior. Descriptive statistics were used to characterize the sociodemographics of the sample and logistic regression was used to measure the association between religiosity and the outcome variables. Results: In the study sample (n = 522), 64% of the adolescents had higher religiosity scores based on a 4-item scale (α = .68). Results indicate that adolescents who had higher religiosity scores were significantly more likely to have higher self-efficacy in communicating with new, as well as steady male partners about sex; about STDs, HIV, and pregnancy prevention; and in refusing an unsafe sexual encounter. These adolescents were also more likely to have initiated sex at a later age, used a condom in the past 6 months, and possess more positive attitudes toward condom use. Conclusions: Results from this study indicate a relationship between religiosity and sexual behaviors, attitudes toward sex, and ability to negotiate safer sex.Rural and nonrural African American high school students and STD/HIV sexual-risk behaviors
AbstractMilhausen, R. R., Crosby, R., Yarber, W. L., DiClemente, R., Wingood, G. M., & Ding, K. (n.d.).Publication year
2003Journal title
American Journal of Health BehaviorVolume
27Issue
4Page(s)
373-379AbstractObjective: To determine differences between African American adolescents on STD/HIV sexual-risk behaviors and precursors to these risk behaviors. Methods: Six hundred sixty-three rural and 3313 nonrural adolescents who completed the 1999 YRBS Survey were selected. Results: Rural females and males were more likely to report ever having coitus and not using a condom during last coitus. Rural females were also more likely to report early coistus, having 3 or more lifetime coital partners, and having more than 1 coital partner in the last 3 months. Conclusions: African American rural adolescents, particularly females, may have greater risk for STD/HIV infection than do their nonrural counterparts.Social capital as a predictor of adolescents' sexual risk behavior : A state-level exploratory study
AbstractCrosby, R. A., Holtgrave, D. R., DiClemente, R., Wingood, G. M., & Gayle, J. A. (n.d.).Publication year
2003Journal title
AIDS and BehaviorVolume
7Issue
3Page(s)
245-252AbstractThis exploratory study assessed the state-level association between social capital, poverty, and income inequality and adolescents' sexual risk and protective behaviors. A cross-sectional design using state-level correlations was employed. Seven outcome measures from the national 1999 Youth Risk Behavior Surveillance Survey were used. For females and males, social capital was significantly associated with five of the seven outcome measures (all associations p < .01). For females, the amount of variance explained by these correlations ranged from 23% to 45%; the range for males was 20% to 52%. Poverty was not a significant predictor of any outcome variable. Income inequality was a significant predictor of birth control usage among females, but in multivariate regression analyses, only social capital retained significance. Findings provide preliminary evidence that social capital may have a profound influence of adolescents' sexual risk and protective behaviors. Social capital was inversely correlated with sexual risk behaviors and positively correlated with protective sexual behaviors. Further and more comprehensive research involving social capital and adolescents is warranted.Testing for HSV-2 infection among pregnant teens : Implications for clinical practice
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).Publication year
2003Journal title
Journal of Pediatric and Adolescent GynecologyVolume
16Issue
1Page(s)
39-41AbstractObjectives: To pilot test the feasibility of screening pregnant teens for HSV-2 infection during their first prenatal visit. Study Design: A cross-sectional study of 127 African-American adolescent females recruited during their first attendance to a prenatal clinic in a large urban hospital. A rapid serologic test (POCkit, manufactured by Diagnology Inc.) was used to assess HSV-2. The test uses a membrane-based immunoassay to detect circulating IgG antibodies to a specific antigen obtained from HSV-2 (semi-purified glycoprotein G2). Results: More than one-fifth (21.3%) of the adolescents tested positive for HSV-2; only 1 adolescent was previously aware of her infection. Older adolescents and those reporting a history of other STDs were significantly more likely to test positive for HSV-2. Conclusions: Testing for HSV-2 in early pregnancy may be an efficient strategy for (1) initiating patient education designed to promote adoption of protective behaviors among adolescents at risk of HSV-2 acquisition during the remainder of their pregnancy and (2) teaching those who test positive how to recognize symptoms of HSV-2 outbreaks; patients reporting recurrent outbreaks during pregnancy may benefit from predelivery assessment.Utility of the AIDS risk assessment for crack cocaine and sex risk behaviours among homeless persons addicted to crack undergoing behavioural day treatment
AbstractSchumacher, J. E., Ross, D., Milby, J. B., Sekar, P., DiClemente, R., & Wallace, D. (n.d.).Publication year
2003Journal title
Journal of Substance UseVolume
8Issue
4Page(s)
205-214AbstractThe primary aim of this study was to assess the impact of an HIV and drug addiction intervention on reported sexual transmission HIV risk and drug use among homeless persons in two treatments for cocaine addiction. The ARA-C study (n = 104) included 74 (71.2%) men and 30 (28.8%) women with an average age of 37.8 (SD = 6.9) years. Most participants were African American (90, 86.5%) and the remainder were Caucasian (14, 13.5%). All participants met criteria for homelessness, nonpsychotic mental distress, and admitted to smoking crack cocaine within the 2 weeks prior to treatment. It appears that, overall, behavioural day treatment for cocaine disorders among homeless persons can have a short- and long-term impact on the reduction of sexual transmission HIV risk among this population with a minimal sexual transmission HIV risk intervention. The causal factors of this outcome still remain unclear. Treatment group differences did not sufficiently explain sexual transmission risk reductions and the impact of the HIV risk education programme was impossible to explain because it was provided to all participants and was only a small part of the overall programme. There did seem to be a small contribution of drug abstinence in the reduction of sexually transmitted risk, but this was at one time point for the Sex and Crack subscale only. This study demonstrates that there may be promise in providing drug addiction treatment combined with sexual transmission HIV risk reduction prevention programming for this extremely vulnerable group, and that future interventions should be better designed and tested using more robust research.Value of Consistent Condom Use : A Study of Sexually Transmitted Disease Prevention among African American Adolescent Females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Lang, D., & Harrington, K. F. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
6Page(s)
901-902Abstract~Activity of African-American female teenagers in black organisations is associated with STD/HIV protective behaviours : A prospective analysis
AbstractDiClemente, R., Crosby, R. A., DiClemente, R. J., Wingood, G. M., Harrington, K., Davies, S., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Epidemiology and Community HealthVolume
56Issue
7Page(s)
549-550Abstract~Adolescents' ambivalence about becoming pregnant predicts infrequent contraceptive use : A prospective analysis of nonpregnant African American females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Davies, S. L., & Harrington, K. (n.d.).Publication year
2002Journal title
American Journal of Obstetrics and GynecologyVolume
186Issue
2Page(s)
251-252AbstractThis study prospectively investigated the hypothesis that ambivalence about becoming pregnant is associated with comparatively less frequent use of contraception. Findings from a sample of sexually active African American adolescent, nonpregnant females (n = 375) supported this hypothesis. Prevention programs may benefit from content designed to redress adolescents' positive beliefs about early parenthood.Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status : A case for intensifying clinic-based prevention efforts
AbstractDiClemente, R., Wingood, G. M., Sionéan, C., Crosby, R., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
9Page(s)
503-509AbstractBackground: Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable sub-group is African American females. The association between adolescents' previous experience of STD and recent sexual risk behaviors has been ill-defined. Goal: The goal was to examine the associations between adolescents' self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status. Study Design: This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates. Results: Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93; P = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79; P = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51; P < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28; P = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09-9.89; P = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09-5.23; P = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59; P = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45-1.37; P = 0.38). Conclusion: Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.Associations between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases among African American adolescent females
AbstractLiau, A., DiClemente, R., Wingood, G. M., Crosby, R. A., Williams, K. M., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
7Page(s)
387-390AbstractBackground: Numerous studies have examined the association between adolescents' marijuana use and their high-risk sexual behaviors and sexually transmitted diseases (STDs). However, the validity of the findings is questionable because most of the studies relied on self-reporting for measurement of marijuana use and key outcome (i.e., STDs). Goal: The goal was to investigate associations between biologically confirmed marijuana use and laboratory-confirmed STDs and condom use. Study Design: African American females adolescents (n = 522) completed a self-administered survey and face-to-face interview. The adolescents provided urine and vaginal swab specimens that were analyzed for marijuana metabolites and STDs, respectively. Results: Among the study subjects, 5.4% tested positive for marijuana. These adolescents were more likely to test positive for Neisseria gonorrhoeae (adjusted odds ratio [AOR] = 3.4) and Chlamydia trachomatis (AOR = 3.9). They were more likely to have never used condoms in the previous 30 days (AOR = 2.9) and to have not used condoms consistently in the previous 6 months (AOR = 3.6). Conclusion: The findings represent unique biologic evidence that STDs and sexual risk behavior may co-occur with marijuana use. Interventions designed to reduce adolescents' risk of STDs and HIV infection should address marijuana use.