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
Family connectedness and sexual minority Asian Americans' eating behavior regulation
AbstractLe, T. P., Ali, S. H., Atkin, A. L., Ching, T. H., Csizmadia, A., Tran, N. K., & DiClemente, R. (n.d.).Publication year
2023Journal title
Eating BehaviorsVolume
51AbstractTo date, psychosocial and interpersonal protective factors such as family connectedness have received little attention in studies of eating behaviors among sexual minority Asian Americans. Therefore, we investigated associations of family connectedness and two types of eating behavior regulation motives and the moderating role of individualism in these associations among 134 sexual minority Asian American young adults. Linear regression models assessed the main and interaction effects of family connectedness and individualism on introjected and identified eating behavior regulation motives. We observed a significant interaction effect between family connectedness and individualism only on introjected regulation. For participants with low levels of individualism, those who reported high levels of family connectedness had lower scores for introjected regulation of eating behavior. The findings of this study highlight the importance of examining strengths related to sexual minority Asian Americans by demonstrating the important role family connectedness plays in eating behavior regulation motives, particularly for those with lower individualism.Internet-Delivered Sexually Transmitted Infection and Teen Pregnancy Prevention Program : A Randomized Trial
AbstractKissinger, P. J., Green, J., Latimer, J., Schmidt, N., Ratnayake, A., Madkour, A. S., Clum, G., Wingood, G. M., DiClemente, R., & Johnson, C. (n.d.).Publication year
2023Journal title
Sexually Transmitted DiseasesVolume
50Issue
6Page(s)
329-335AbstractBackground Black older-teenaged women have disproportionately high rates of sexually transmitted infections (STI) and unintended pregnancy (UTP). Internet-based interventions can be delivered to large groups of people in a relatively inexpensive manner. In this randomized trial, we examine the efficacy of an evidence-based STI/UTP prevention intervention adapted for older teens and for Internet delivery. Methods Black women aged 18-19 years who were not pregnant/seeking to become pregnant were enrolled (n = 637) and randomized to an 8-session intervention or attention control and were followed up at 6/12 months postintervention. The primary outcome was defined as uptake of reliable contraceptives. Other secondary outcomes were examined, including intention to use condoms, intention to use reliable contraception, and STI or pregnancy rates. Results Overall, at baseline, reliable contraception was 54.8% and dual protection was 29.4%, and the prevalence of STI was 11.1%. Participants were similar by arm for most factors considered. Participation and follow-up rates were excellent (60.9% and 80.3%). There was no statistically significant difference in uptake of reliable contraception for intervention versus controls at 6 months (1.45 [0.99-2.12]) or 12 months (1.33 [0.92-1.91]). At 6 months, several secondary outcomes were improved/trended toward improvement in intervention compared with control, but this effect waned by 12 months, except for intention to use condoms which remained improved. Conclusion and Relevance The intervention was efficacious for increasing some self-reported UTP and STI prevention behaviors, which waned over time, and the intervention had minimal impact on STI or pregnancy rates suggesting that this type of online intervention may need additional components.Patient–Provider Health Communication Strategies : Enhancing HPV Vaccine Uptake among Adolescents of Color
AbstractXu, M. A., Choi, J., Capasso, A., & DiClemente, R. (n.d.).Publication year
2023Journal title
Healthcare (Switzerland)Volume
11Issue
12AbstractCervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient–provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient–provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.Pivoting from in-person to phone survey assessment of alcohol and substance use : effects on representativeness in a United States prospective cohort of women living with and without HIV
AbstractTierney, H. R., Ma, Y., Bacchetti, P., Adimora, A. A., Chandran, A., Kempf, M. C., Collins, L. F., DeHovitz, J., DiClemente, R., French, A. L., Jones, D. L., Sharma, A., Spence, A. B., Hahn, J. A., Price, J. C., & Tien, P. C. (n.d.).Publication year
2023Journal title
American Journal of Drug and Alcohol AbuseAbstractBackground: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women. Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women’s Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV. Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April–September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August–September 2020) phone survey. Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33–0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41–0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02–2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24–2.43). Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.Social Media Utilization Within Asian American Families and Its Role in Healthy Lifestyle Behavioral Influence : Results From a Nationwide Survey
AbstractMohsin, F. M., Ali, S. H., Chong, S. K., Parikh, R. S., DiClemente, R., & Hu, L. (n.d.).Publication year
2023Journal title
Social Media and SocietyVolume
9Issue
3AbstractObjective: Social media platforms are effective tools for promoting public health and implementing impactful health interventions. This study explored social media utilization patterns among young Asian American adults and their effect on perceived family influence on lifestyle behaviors. Methods: The study analyzes data from Asian American young adults (aged 18–35 years) participating in an online survey in March 2021. Results: A total of 739 Asian Americans participated in the survey: 45.6% East Asian, 23.4% Southeast Asian, and 22.7% South Asian. Common social media platforms include Facebook Messenger (60.9%) and Instagram (57.0%). US-born Asian Americans reported higher odds of using Instagram (adjusted odds ratio [AOR]: 1.64, 95% CI: [1.09, 2.46]) than foreign-born Asian Americans. Higher acculturation was associated with lower odds of using Instagram among South Asians (AOR:.46, 95% CI: [.24,.83]) and greater odds of using Instagram among East Asians (AOR: 1.72, 95% CI: [1.09, 2.75]). Interacting with mothers using Facebook and Instagram had a higher perceived influence on one’s ability to improve sleep (AOR: 2.08, 95% CI: [1.19, 3.65]; AOR: 2.53, 95% CI: [1.15, 5.55]) and develop stress-management strategies (AOR: 1.73, 95% CI: [1.02, 2.96]; AOR: 4.05, 95% CI: [1.83, 9.49]). With one’s siblings, Facebook was associated with a lower perceived influence on avoiding risky substances (AOR:.48, 95% CI: [.23,.97]), and WhatsApp was associated with a higher perceived influence on one’s ability to develop stress-management strategies (AOR: 3.10, 95% CI: [1.26, 7.78]) and form/maintain relationships (AOR: 2.58, 95% CI: [1.02, 6.58]). No significant findings with father interactions were observed. Conclusion: Findings provide evidence for researchers seeking to tailor social media–based interpersonal health interventions to address the unique needs of diverse Asian American communities.Teen pregnancy in the US : Overview and opportunities for prevention
AbstractChoi, J., Capasso, A., & DiClemente, R. (n.d.).Publication year
2023Volume
2Page(s)
455-464AbstractTeen pregnancy, while declining, remains a significant and persistent public health, social, and clinical challenge. Pregnant teens are a vulnerable population, at increased risk for adverse health, social, and psychological outcomes. Adequately confronting this challenge requires a multi-factorial approach – engaging youth themselves, family, peers, social networks, schools, and clinicians. One key contextual factor is public health policy. Thus, teen pregnancy may be more effectively addressed when a social-ecological framework is used to guide the development and implementation of programs. Single, isolated, and fragmented programmatic strategies are suboptimal. Only marshaling all our resources, and promoting teen friendly health policy, can we optimize our response to teen pregnancy.Causally Interpretable Meta-analysis : Application in Adolescent HIV Prevention
AbstractBarker, D. H., Dahabreh, I. J., Steingrimsson, J. A., Houck, C., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2022Journal title
Prevention ScienceVolume
23Issue
3Page(s)
403-414AbstractEndowing meta-analytic results with a causal interpretation is challenging when there are differences in the distribution of effect modifiers among the populations underlying the included trials and the target population where the results of the meta-analysis will be applied. Recent work on transportability methods has described identifiability conditions under which the collection of randomized trials in a meta-analysis can be used to draw causal inferences about the target population. When the conditions hold, the methods enable estimation of causal quantities such as the average treatment effect and conditional average treatment effect in target populations that differ from the populations underlying the trial samples. The methods also facilitate comparison of treatments not directly compared in a head-to-head trial and assessment of comparative effectiveness within subgroups of the target population. We briefly describe these methods and present a worked example using individual participant data from three HIV prevention trials among adolescents in mental health care. We describe practical challenges in defining the target population, obtaining individual participant data from included trials and a sample of the target population, and addressing systematic missing data across datasets. When fully realized, methods for causally interpretable meta-analysis can provide decision-makers valid estimates of how treatments will work in target populations of substantive interest as well as in subgroups of these populations.Correlates of depression among Black girls exposed to violence
AbstractWaller, B., Quinn, C. R., Boyd, D., DiClemente, R., & Voisin, D. R. (n.d.).Publication year
2022Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
9Issue
1Page(s)
146-155AbstractDepression rates for youth remanded to juvenile detention is double that of the general population and Black girls are especially vulnerable. A dearth of literature analyzes the factors that are correlated with depression among system-involved Black girls, ages 12–17 years old. We utilized personal agency to examine the relationship between risk factors (i.e., abuse history, and fear of condom negotiation) and protective factors (i.e., condom self-efficacy, and perceived social support) that might correlate with depression among Black girls exposed to violence. Findings indicate that fear of condom negotiation, abuse history and low condom self-efficacy are correlated with depressive symptomology while self-esteem and perceived social support are protective factors that may serve as a buffer against girls’ feelings of helplessness and hopelessness. The findings of this study suggest several implications for prevention and intervention efforts to reduce the depression-related risks among justice-involved Black females, including strategies that promote healing within their social support networks.Development of an Integrated Approach to Virtual Mind-Mapping : Methodology and Applied Experiences to Enhance Qualitative Health Research
AbstractAli, S. H., Merdjanoff, A. A., Parekh, N., & DiClemente, R. (n.d.).Publication year
2022Journal title
Qualitative Health ResearchVolume
32Issue
3Page(s)
571-580AbstractThere is a growing need to better capture comprehensive, nuanced, and multi-faceted qualitative data while also better engaging with participants in data collection, especially in virtual environments. This study describes the development of a novel 3-step approach to virtual mind-mapping that involves (1) ranked free-listing, (2) respondent-driven mind-mapping, and (3) interviewing to enhance both data collection and analysis of complex health behaviors. The method was employed in 32 virtual interviews as part of a study on eating behaviors among second-generation South Asian Americans. Participants noted the mind-mapping experience to be (1) helpful for visual learners, (2) helpful in elucidating new ideas and to structure thoughts, as well as (3) novel and interesting. They also noted some suggestions that included improving interpretability of visual data and avoiding repetition of certain discussion points. Data collection revealed the adaptability of the method, and the power of mind-maps to guide targeted, comprehensive discussions with participants.Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study) : Protocol for a Randomized Controlled Trial
AbstractTrent, M., Yusuf, H. E., Rowell, J., Toppins, J., Woods, C., Huettner, S., Robinson, C., Fields, E. L., Marcell, A. V., DiClemente, R., & Matson, P. (n.d.).Publication year
2022Journal title
JMIR Research ProtocolsVolume
11Issue
5AbstractBackground: Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs. Objective: This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting. Methods: A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc. Results: So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up. Conclusions: Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk.Editorial : The outbreak and sequelae of the increase in opioid use in the United States, Canada, and beyond
AbstractFriedman, S. R., Perlman, D. C., & DiClemente, R. (n.d.).Publication year
2022Journal title
Frontiers in SociologyVolume
7Abstract~Feasibility, acceptability, and short-term impact of a brief sexually transmitted infection intervention targeting U.S. Military personnel and family members
AbstractKunz, A., Moodley, A., Colby, D. J., Soltis, M., Robb-McGrath, W., Fairchok, A., Faestel, P., Jungels, A., Bender, A. A., Kamau, E., Wingood, G., DiClemente, R., & Scott, P. T. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: Over the past 10 years, incidence of sexually transmitted infections (STIs) has increased to record numbers in the United States, with the most significant increases observed among adolescents and young adults. The US military, where the majority of active duty personnel are 18–30 years old, has seen similar increases. However, the US military does not yet have a standardized, service-wide program for STI education and prevention. Methods: The KISS intervention (Knocking out Infections through Safer-sex and Screening) was adapted from an evidence-based intervention endorsed by the US Centers for Disease Control and Prevention and consisted of a one-time, small group session. Content included STI/HIV knowledge and prevention, condom use skills, and interpersonal communication techniques. The intervention was pilot tested for feasibility and acceptability among a population of service members and medical beneficiaries at Joint Base Lewis-McChord in Washington state. Results: A total of 79 participants aged 18–30 years were consented to participate in the pilot study and met entry criteria, 66/79 (82.5%) attended the intervention session, and 46/66 (69.7%) returned at 3 months for the final follow-up assessment. The intervention sessions included 31 male (47.0%) and 35 female (53.0%) participants. Almost all participants felt comfortable discussing sexual issues in the group sessions, reported that they intended to practice safer sex after the intervention, and would also recommend the intervention to friends. Knowledge about STI/HIV prevention significantly increased after the intervention, and intervention effects were maintained at 3 months. About one-fifth of participants tested positive for N. gonorrhea or C. trachomatis infection at enrollment, while none had recurrent STIs at the final visit. Use of both male and female condoms increased after the intervention. Conclusions: The KISS intervention was feasible to implement in the military setting and was acceptable to the active duty service members and other medical beneficiaries who participated in the pilot project. Further studies are needed to determine if the KISS intervention, or others, effectively decrease STI incidence in active duty personnel and would be appropriate for more widespread implementation. Trial Registration: Retrospectively registered as the pilot phase of clinicaltrials.gov NCT04547413, “Prospective Cohort Trial to Assess Acceptability and Efficacy of an Adapted STI/HIV Intervention Behavioral Intervention Program in a Population of US Army Personnel and Their Medical Beneficiaries—Execution Phase”.Looking forward : Future directions for prevention of HIV among adolescents
AbstractDiClemente, R. (n.d.).Publication year
2022Page(s)
189-199Abstract~Mapping drivers of second-generation South Asian American eating behaviors using a novel integration of qualitative and social network analysis methods
AbstractAli, S. H., Gupta, S., Tariq, M., Penikalapati, R., Vasquez-Lopez, X., Auer, S., Hanif, C., Parekh, N., Merdjanoff, A. A., & DiClemente, R. (n.d.).Publication year
2022Journal title
Ecology of Food and NutritionVolume
61Issue
4Page(s)
503-521AbstractThis study explores a novel, mixed qualitative method to deconstruct the diet of second-generation South Asian Americans (SAAs). Online interviews of 32 second-generation SAAs were conducted usingintegrated free-listing and mind-mapping. Ranked free-lists were aggregated to identify salient drivers, while connections made within mind-maps were analyzed using social network analysis (SNA) methods. Overall, 34 distinct drivers and 247 unique connections were identified. Taste, family, and health had the highest adjusted rankings, while health displayed the strongest network centrality. Interventions aimed at second-generation SAA dietary behaviors may benefit from family-based or multi-level interventions, which consider the complex, unique dietary norms identified.Situational and motivational factors associated with unhealthy alcohol use among Russian women with HIV and hepatitis C Virus co-infection
AbstractKhalezova, N. B., Capasso, A., Boeva, E. V., Gutova, L. V., Rassokhin, V. V., Neznanov, N. G., Belyakov, N. A., Brown, J. L., DiClemente, R. J., & DiClemente, R. (n.d.).Publication year
2022Journal title
Drug and Alcohol Dependence ReportsVolume
3AbstractIntroduction: Alcohol use is prevalent among Russian women with HIV and hepatitis C Virus (HCV) co-infection despite alcohol's known harmful health effects for this population. Identifying factors that facilitate continued unhealthy alcohol use is critical to developing effective alcohol reduction interventions. This study assessed situational and motivational factors associated with unhealthy alcohol use among HIV/HCV co-infected women in clinical care in St. Petersburg, Russia. Methods: Guided by the motivational model for alcohol use, we conducted 30 semi-structured interviews with women living with HIV/HCV co-infection to identify situational and motivational factors associated with unhealthy drinking and barriers and facilitators to abstaining. Interviews were recorded and analyzed using a thematic analysis approach. Results: Despite awareness of the health risks associated with alcohol use, many women reported heavy episodic drinking, particularly in social situations. A key motive for drinking was coping with negative emotions triggered by stressful situations, such as work- and family-related conflicts. Key situational factors included drinking with family and friends and in social situations. Women who endorsed negative drinking coping motives were the most motivated to stop drinking. Health concerns were also cited as reasons to stop drinking; however, few women reported that their doctors recommended that they abstain. Conclusions: Several situational and motivational facilitators of alcohol use and barriers to alcohol reduction were identified, as well as some opportunities for prevention, among women in care for HIV in Russia. Awareness-raising and training regarding the adverse consequences of alcohol use among persons with HIV/HCV co-infection should include clinicians, patients and relatives.Socioeconomic predictors of COVID-19- related health disparities among United States workers : A structural equation modeling study
AbstractCapasso, A., Kim, S., Ali, S. H., Jones, A. M., DiClemente, R., & Tozan, Y. (n.d.).Publication year
2022Journal title
PLOS global public healthVolume
2Issue
2AbstractThe COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID- 19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID- 19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (β) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than nonessential workers and non-rural residents, respectively. Women (β = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (β = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID- 19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.What predicts people’s belief in COVID-19 misinformation? A retrospective study using a nationwide online survey among adults residing in the United States
AbstractKim, S., Capasso, A., Ali, S. H., Headley, T., DiClemente, R., & Tozan, Y. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in misinformation. Methods: Data was used from an online survey that was administered in April 2020 to 6518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of belief in each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. Results: About 30% of our sample reported believing in at least one type of COVID-19-related misinformation. Belief in one type of misinformation was not strongly associated with belief in other types. We also identified 58 demographic and socioeconomic factors that predicted people’s susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. Conclusion: Our findings confirm the existence of groups with unique characteristics that believe in different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.A Pilot Study to Adapt a Trauma-Informed, Mindfulness-Based Yoga Intervention for Justice-Involved Youth
AbstractOwen-Smith, A., Black, H., Emerson, D., Cotner, M., Smith, H., Jackson, D., Ford, J. D., DeBar, L., DiClemente, R., & Hayat, M. J. (n.d.).Publication year
2021Journal title
International journal of yoga therapyVolume
31Issue
1AbstractThe purpose of the present study was to adapt and pilot a trauma-informed, mindfulness-based yoga (TIMBY) intervention focused on enhancing self-regulation among youth in the Georgia Department of Juvenile Justice system. In this article we (1) describe the process by which we systematically adapted an evidence-based protocol specifically for this population, (2) describe the nature of and rationale for those adaptations, (3) present some preliminary qualitative findings based on interviews with youth participants, and (4) briefly summarize how the adapted protocol will be evaluated in the subsequent feasibility trial. The iterative drafting and revision process involved modifications to a well-established, protocolized Trauma-Informed Yoga program and was identified by the project advisory board and t h rough formal interviews with intervention staff. Qualitative interviews were conducted with youth participants concerning intervention impact, credibility, and satisfaction. Several needed modifications were identified so that the intervention would be contextually appropriate for justice-involved youth. Thirty youth were enrolled in the pilot study: 77% we re Non - Hispanic Black/African-American, 18% were Non-Hispanic White, and 5% were Hispanic White. The average age was 16.45 years (range 14-20). The youth consistently reported satisfaction with the sessions and positive beliefs about how the sessions were helping them with a range of physical and psychological/ emotional challenges. Adaptations to the protocol in the present study highlight how mindfulness-based interventions for justice-involved youth need to consider what is both developmentally suitable for youth and appropriate in a justice setting. A feasibility study using this revised TIMBY protocol is underway at four Georgia Department of Juvenile Justice facilities to formally identify the barriers and facilitators to implementation for the present study and a future, larger-scale trial.An Examination of Gender Differences in Bullying among Justice-involved Adolescents
AbstractDembo, R., Krupa, J. M., Faber, J., DiClemente, R., Wareham, J., & Schmeidler, J. (n.d.).Publication year
2021Journal title
Deviant BehaviorVolume
42Issue
2Page(s)
268-287AbstractMost studies of bullying rely on school-based samples of youth; however, a few studies of justice-involved populations suggest delinquent youth experience higher rates of bullying than youth in the general population. Little is known about gender differences in bullying among justice-involved youth. Using data from a Health Coach service project for justice-involve youth implemented at two intake facilities, 312 female and 857 male newly arrested youth were included in the current study. The current study sought to determine gender differences in prevalence rates of bullying involvement. Logistic regression was used to explore gender differences in how key covariates of demographic, risk factors, and traumatic experiences related to bullying. Rates of bullying experiences were higher for girls (35%) than boys (17%), and these rates were higher than rates reported in studies using general population or school-based samples. Analysis revealed differences in risk factors of bullying by gender. For both arrested girls and boys, depressive symptoms and sexual assault victimization increased the odds of bullying. Justice-involved youth are at greater risk of bullying and experience multiple problems. Holistic treatment and prevention strategies that recognize the co-occurrence of mental health symptoms, serious victimization, and substance abuse with bullying experiences are needed.Behavioral counseling associated with STI prevention
AbstractDiClemente, R. (n.d.).Publication year
2021Journal title
Journal of PediatricsVolume
228Page(s)
310-313Abstract~Changing the landscape of South Asian migrant health research by advancing second-generation immigrant health needs
AbstractAli, S. H., DiClemente, R., & Parekh, N. (n.d.).Publication year
2021Journal title
Translational Behavioral MedicineVolume
11Issue
6Page(s)
1295-1297AbstractSouth Asian immigrants confront a growing non-communicable disease burden, a significant issue in countries such as the USA. While efforts have slowly begun to address South Asian migrant health, second-generation communities remain underserved and understudied despite facing many of the same non-communicable disease concerns. The aim of this commentary is to highlight unique health disparities contributing to the current South Asian migrant health status and identify pathways for further formative research needed to inform subsequent development, implementation, and evaluation of health interventions targeting this community. Extant peer-reviewed literature addressing second-generation South Asian health issues was used to identify key research pathways needed to address existing gaps. Specifically, we call for (a) enhancing targeted surveillance and recruitment in research and (b) collecting data to help characterize behavioral and cultural patterns that may contribute to disease onset and progression. Expanding research on second-generation South Asian migrant health may help to develop tailored and targeted interventions.Consumer Informatics and COVID-19 Pandemics : Challenges and Opportunities for Research Findings from the Yearbook 2020 Section on Education and Consumer Health Informatics
Abstractthe IMIA Yearbook Section on Consumer Health Informatics, A., Staccini, P., Lau, A. Y., Ali, S. H., Foreman, J., Tozan, Y., Capasso, A., Jones, A. M., DiClemente, R. J., Picone, M., Inoue, S., DeFelice, C., Naujokas, M. F., Sinrod, J., Cruz, V. A., Stapleton, J., Sinrod, E., Diebel, S. E., Wassman, J., … DiClemente, R. (n.d.).Publication year
2021Journal title
Yearbook of medical informaticsVolume
30Issue
1Page(s)
210-218AbstractObjective: To summarise the state of the art during the year 2020 in consumer health informatics and education, with a special emphasis on “Managing Pandemics with Health Informatics - Successes and Challenges”. Methods: We conducted a systematic search of articles published in PubMed using a predefined set of queries, which identified 147 potential articles for review. These articles were screened according to topic relevance and 15 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers were discussed in a consensus meeting. Three papers received the highest score from the expert panel, and these papers were selected to be representative papers on consumer informatics for managing pandemics in the year 2020. Results: Bibliometrics analysis conducted on words found in abstracts of the candidate papers revealed 4 clusters of articles, where the clustering outcomes explained 77.04% of the dispersion. The first cluster composed of articles related to the use of mobile apps for video consultation and telehealth during the pandemic. The second revealed studies reporting the lived experience of healthcare workers and patients during COVID-19. The third focused on ways people used the internet to seek for health information during the pandemic and the dissemination of fake news. The last cluster composed of articles reporting the use of social listening methods (e.g., via tweet hashtags) to explore the spread of the virus around the world. Conclusions: The pandemic outbreak of the novel coronavirus disease (COVID-19) constitutes a grave risk to the global community and sparks a significant increase in public interest and media coverage, especially on social media. Consumers are facing a new set of challenges that were not considered before COVID-19, often finding themselves in a world that is constantly changing—blended with facts and fake information—and unable to decide what to do next. Despite most people understanding the good will behind public health policies, one must not forget it is individuals we are supporting and that their personal circumstances may affect how they perceive and comply with these policies. Consumers more than ever need help to make sense of the uncertainty and their situation and we need to help them navigate the best option in a world that is constantly evolving.Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV
AbstractBrown, J. L., Anastasakis, I., Revzina, N., Capasso, A., Boeva, E., Rassokhin, V., Crusey, A., Sales, J. M., Hitch, A., Renfro, T., & DiClemente, R. (n.d.).Publication year
2021Journal title
Journal of the International Association of Providers of AIDS CareVolume
20AbstractBackground: There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection. Methods: The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed. Results: We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components. Discussion: Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use : An individual patient data meta-analysis
AbstractHahn, J. A., Murnane, P. M., Vittinghoff, E., Muyindike, W. R., Emenyonu, N. I., Fatch, R., Chamie, G., Haberer, J. E., Francis, J. M., Kapiga, S., Jacobson, K., Myers, B., Couture, M. C., DiClemente, R., Brown, J. L., So-Armah, K., Sulkowski, M., Marcus, G. M., Woolf-King, S., … Saitz, R. (n.d.).Publication year
2021Journal title
Alcoholism: Clinical and Experimental ResearchVolume
45Issue
6Page(s)
1166-1187AbstractBackground: Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption. Methods: We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index—BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score. Results: One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. Conclusions: Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.Food insecurity among households with children during the COVID-19 pandemic : results from a study among social media users across the United States
AbstractParekh, N., Ali, S. H., O’Connor, J., Tozan, Y., Jones, A. M., Capasso, A., Foreman, J., & DiClemente, R. (n.d.).Publication year
2021Journal title
Nutrition JournalVolume
20Issue
1AbstractBackground: In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. Methods: This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. Results: Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09–2.80), high school or lower education (AOR:2.25, 95%CI:1.29–3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35–10.37; AOR[< $30,000]:10.61, 95%CI:5.50–20.80) were associated with higher odds of food insecurity in multivariable models among households with children (and the whole sample). Conclusions: These data indicate exacerbation of food insecurity during the pandemic. The study will be instrumental in guiding additional research and time-sensitive interventions targeted towards vulnerable food insecure subgroups.