Ralph DiClemente

Professor of Social and Behavioral Sciences

Professional overview

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:

1. Developing interventions to reduce the risk of HIV/STD among vulnerable populations
2. Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
3. Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
4. 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.

Education

BA, The City College of the City University of New York (CCNY), New York, NY

ScM, Behavioral Sciences, Harvard University, Cambridge, MA

PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA

Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions

Diabetes

HIV/AIDS

Implementation science

Influenza

Psychology

Publications

Publications

Efficacy of an HIV prevention intervention for African American adolescent girls: A randomized controlled trial

DiClemente, R. J., 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

2004

Journal title

JAMA

Volume

292

Issue

2

Page(s)

171-179

10.1001/jama.292.2.171

Abstract

Abstract

Context: 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; P<.001). Using generalized estimating equation analyses over the 12-month follow-up, adolescents in the intervention were more likely to use a condom at last intercourse, less likely to have a new vaginal sex partner in the past 30 days, and more likely to apply condoms to sex partners and had better condom application skills, a higher percentage of condom-protected sex acts, fewer unprotected vaginal sex acts, and higher scores on measures of mediators. Promising effects were also observed for chlamydia infections and self-reported pregnancy. Conclusion: Interventions for African American adolescent girls that are gender-tailored and culturally congruent can enhance HIV-preventive behaviors, skills, and mediators and may reduce pregnancy and chlamydia chlamyclia infection.

Health risk factors among detained adolescent females

Crosby, R., Salazar, L. F., DiClemente, R. J., Yarber, W. L., Caliendo, A. M., & Staples-Horne, M. (n.d.).

Publication year

2004

Journal title

American journal of preventive medicine

Volume

27

Issue

5

Page(s)

404-410

10.1016/j.amepre.2004.07.017

Abstract

Abstract

To 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 (p <0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0). Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

HIV testing among detained youth

Voisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R. J., Yarber, W. L., & Staples-Home, M. (n.d.).

Publication year

2004

Journal title

Journal of HIV/AIDS Prevention in Children and Youth

Volume

6

Issue

2

Page(s)

83-96

10.1300/J499v06n02_06

Abstract

Abstract

Published 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

Crosby, R., Salazar, L. F., & DiClemente, R. J. (n.d.).

Publication year

2004

Journal title

Sexually transmitted infections

Volume

80

Issue

6

Page(s)

425-429

10.1136/sti.2004.009639

Abstract

Abstract

Objective: 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 (p<0.05). Of these, the personal level correlates were particularly important in a multivariate model. The motivation subscale from the Condom Barriers Scale was the strongest multivariate correlate of recent condom use. Adolescents scoring below the median were about 3.4 times more likely to report lack of recent condom use (p = 0.0006). Adolescents indicating they had ever caused a pregnancy were about 2.5 times more likely to report lack of condom use (p = 0.02). Finally, those reporting their peers did not use condoms were about twice as likely to report lack of use (p = 0.048). Conclusion: Upon investigating multiple levels of potential influence on condom use, the multivariate findings suggest that personal level factors may be the most important determinant of non-use among adolescent males in short term detention facilities. Although structural changes may be needed to influence some forms of safer sex behaviour, direct intervention with adolescent males may be justified to favourably alter determinants of condom use.

Relationship characteristics and sexual practices of African American adolescent girls who desire pregnancy.

Davies, S. L., DiClemente, R. J., Wingood, G. M., Person, S. D., Crosby, R. A., Harrington, K. F., & Dix, E. S. (n.d.).

Publication year

2004

Journal title

Health education & behavior : the official publication of the Society for Public Health Education

Volume

31

Issue

4

Page(s)

85S-96S

10.1177/1090198104266037

Abstract

Abstract

This 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

Salazar, L. F., Diclemente, R. J., Wingood, G. M., Crosby, R. A., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).

Publication year

2004

Journal title

Prevention Science

Volume

5

Issue

3

Page(s)

137-149

10.1023/B:PREV.0000037638.20810.01

Abstract

Abstract

During 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

Hopkins, G. L., Freier, M. C., Babikian, T., Helm, H. W., McBride, D. C., Boward, M., Gillespie, S., & DiClemente, R. (n.d.).

Publication year

2004

Journal title

Journal of Research on Christian Education

Volume

13

Issue

1

Page(s)

23-39

10.1080/10656210409484958

Abstract

Abstract

This 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

Voisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R. J., Yarber, W. L., & Staples-Horne, M. (n.d.).

Publication year

2004

Journal title

Sexually transmitted infections

Volume

80

Issue

6

Page(s)

440-442

10.1136/sti.2004.010926

Abstract

Abstract

Objective: 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.

The role of social support in the psychological well-being of African American girls who experience dating violence victimization

Salazar, L. F., Wingood, G. M., DiClemente, R. J., Lang, D. L., & Harrington, K. (n.d.).

Publication year

2004

Journal title

Violence and Victims

Volume

19

Issue

2

Page(s)

171-187

10.1891/vivi.19.2.171.64100

Abstract

Abstract

The 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

Crosby, R., & DiClemente, R. J. (n.d.).

Publication year

2004

Journal title

Sexually transmitted infections

Volume

80

Issue

6

Page(s)

466-468

10.1136/sti.2004.010496

Abstract

Abstract

Objective: 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

Wingood, G. M., DiClemente, R. J., Bernhardt, J. M., Harrington, K., Davies, S. L., Robillard, A., & Hook, E. W. (n.d.).

Publication year

2003

Journal title

American journal of public health

Volume

93

Issue

3

Page(s)

437-439

10.2105/AJPH.93.3.437

Adjudication history and African American adolescents' risk for acquiring sexually transmitted diseases: An exploratory analysis

Crosby, R. A., Diclemente, R. J., Wingood, G. M., Rose, E., & Levine, D. (n.d.).

Publication year

2003

Journal title

Sexually Transmitted Diseases

Volume

30

Issue

8

Page(s)

634-638

10.1097/01.OLQ.0000085183.54900.B6

Abstract

Abstract

Background: 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

Mettey, A., Crosby, R., DiClemente, R. J., & Holtgrave, D. R. (n.d.).

Publication year

2003

Journal title

Sexually transmitted infections

Volume

79

Issue

6

Page(s)

466-468

10.1136/sti.79.6.466

Abstract

Abstract

Objective: 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

Crosby, R. A., DiClemente, R. J., Wingood, G. M., Rose, E., & Lang, D. (n.d.).

Publication year

2003

Journal title

Sexually Transmitted Diseases

Volume

30

Issue

1

Page(s)

57-63

10.1097/00007435-200301000-00012

Abstract

Abstract

Background: 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

Crosby, R., Diclemente, R. J., & Mettey, A. (n.d.).

Publication year

2003

Journal title

Sexually Transmitted Diseases

Volume

30

Issue

12

Page(s)

909-913

10.1097/01.OLQ.0000088342.49343.B0

Abstract

Abstract

Background: 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

Crosby, R. A., DiClemente, R. J., Wingood, G. M., Rose, E., & Lang, D. (n.d.).

Publication year

2003

Journal title

American journal of preventive medicine

Volume

25

Issue

3

Page(s)

255-258

10.1016/S0749-3797(03)00192-2

Abstract

Abstract

Background: 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, p<0.03) to report that their pregnancy was unplanned and unwanted. Adolescents who already had a child (AOR=2.3; 95% CI, 1.3-5.7, p<0.009) and those younger than 18 years old (AOR=2.3; 95% CI, 1.1-4.5, p<0.02) were more than twice as likely to report that their pregnancy was unplanned and unwanted. A variable assessing whether each adolescent's current boyfriend conceived the pregnancy approached significance (AOR=2.33; 95% CI, 0.99-5.46, p=0.052). Conclusions: Findings provide initial evidence for specifically targeting intensified prenatal care programs to teens perceiving their pregnancy as unplanned and unwanted.

Human immunodeficiency virus prevention for adolescents: Windows of opportunity for optimizing intervention effectiveness

DiClemente, R. J., & Wingood, G. M. (n.d.).

Publication year

2003

Journal title

Archives of Pediatrics and Adolescent Medicine

Volume

157

Issue

4

Page(s)

319-320

10.1001/archpedi.157.4.319

Identification of strategies for promoting condom use: A prospective analysis of high-risk African American female teens

Crosby, R. A., DiClemente, R. J., Wingood, G. M., Salazar, L. F., Harrington, K., Davies, S. L., & Oh, M. K. (n.d.).

Publication year

2003

Journal title

Prevention Science

Volume

4

Issue

4

Page(s)

263-270

10.1023/A:1026020332309

Abstract

Abstract

Condom 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

Crosby, R. A., DiClemente, R. J., Wingood, G. M., Lang, D. L., & Harrington, K. (n.d.).

Publication year

2003

Journal title

Archives of Pediatrics and Adolescent Medicine

Volume

157

Issue

2

Page(s)

169-173

10.1001/archpedi.157.2.169

Abstract

Abstract

Objective: 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

Begley, E., Crosby, R. A., DiClemente, R. J., Wingood, G. M., & Rose, E. (n.d.).

Publication year

2003

Journal title

Sexually Transmitted Diseases

Volume

30

Issue

3

Page(s)

211-213

10.1097/00007435-200303000-00006

Abstract

Abstract

Background: 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

Davies, S. L., DiClemente, R. J., Wingood, G. M., Harrington, K. F., Crosby, R. A., & Sionean, C. (n.d.).

Publication year

2003

Journal title

American Journal of Health Behavior

Volume

27

Issue

1

Page(s)

55-62

10.5993/AJHB.27.1.6

Abstract

Abstract

Objective: 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

Melville, J., Sniffen, S., Crosby, R., Salazar, L., Whittington, W., Dithmer-Schreck, D., DiClemente, R., & Wald, A. (n.d.).

Publication year

2003

Journal title

Sexually transmitted infections

Volume

79

Issue

4

Page(s)

280-285

10.1136/sti.79.4.280

Abstract

Abstract

Objectives: 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

Rhodes, S. D., & Diclemente, R. J. (n.d.).

Publication year

2003

Journal title

Sexually Transmitted Diseases

Volume

30

Issue

5

Page(s)

449-454

10.1097/00007435-200305000-00013

Abstract

Abstract

Background: 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

McCree, D. H., Wingood, G. M., DiClemente, R., Davies, S., & Harrington, K. F. (n.d.).

Publication year

2003

Journal title

Journal of Adolescent Health

Volume

33

Issue

1

Page(s)

2-8

10.1016/S1054-139X(02)00460-3

Abstract

Abstract

Purpose: 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

Milhausen, R. R., Crosby, R., Yarber, W. L., DiClemente, R. J., Wingood, G. M., & Ding, K. (n.d.).

Publication year

2003

Journal title

American Journal of Health Behavior

Volume

27

Issue

4

Page(s)

373-379

10.5993/AJHB.27.4.9

Abstract

Abstract

Objective: 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.