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
Computer-based alcohol reduction intervention for alcohol-using HIV/HCV co-infected Russian women in clinical care: study protocol for a randomized controlled trial
AbstractDiClemente, R. J., Brown, J. L., Capasso, A., Revzina, N., Sales, J. M., Boeva, E., Gutova, L. V., Khalezova, N. B., Belyakov, N., & Rassokhin, V. (n.d.).Publication year
2021Journal title
TrialsVolume
22Issue
1AbstractBackground: Russia has a high prevalence of human immunodeficiency virus (HIV) infections. In 2018, over one million persons were living with HIV (PLWH); over a third were women. A high proportion of HIV-infected women are co-infected with hepatitis C virus (HCV), and many consume alcohol, which adversely affects HIV and HCV treatment and prognosis. Despite the triple epidemics of alcohol use, HIV and HCV, and the need for interventions to reduce alcohol use among HIV/HCV co-infected women, evidence-based alcohol reduction interventions for this vulnerable population are limited. To address this gap, we developed a clinical trial to evaluate the efficacy of a computer-based intervention to reduce alcohol consumption among HIV/HCV co-infected women in clinical care. Methods: In this two-arm parallel randomized controlled trial, we propose to evaluate the efficacy of a culturally adapted alcohol reduction intervention delivered via a computer for HIV/HCV co-infected Russian women. The study population consists of women 21–45 years old with confirmed HIV/HCV co-infection who currently use alcohol. Intervention efficacy is assessed by a novel alcohol biomarker, ethyl glucuronide (EtG), and biomarkers of HIV and HCV disease progression. Women are randomized to trial conditions in a 1:1 allocation ratio, using a computer-generated algorithm to develop the assignment sequence and concealment of allocation techniques to minimize assignment bias. Women are randomized to either (1) the computer-based alcohol reduction intervention or (2) the standard-of-care control condition. We will use an intent-to-treat analysis and logistic and linear generalized estimating equations to evaluate intervention efficacy, relative to the standard of care, in enhancing the proportion of women with a laboratory-confirmed negative EtG at each research study visit over the 9-month follow-up period. Additional analyses will evaluate intervention effects on HIV (viral load and CD4+ levels) and HCV markers of disease progression (FibroScan). Discussion: The proposed trial design and analysis provides an appropriate conceptual and methodological framework to assess the efficacy of the computer-based intervention. We propose to recruit 200 participants. The intervention, if efficacious, may be an efficient and cost-effective alcohol reduction strategy that is scalable and can be readily disseminated and integrated into clinical care in Russia to reduce women’s alcohol consumption and enhance HIV/HCV prognosis. Trial registration: ClinicalTrials.gov NCT03362476.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. J. (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.Examining Mother-Reported Poor Sleep and Blood Pressure in Black/African American Mother-Child Dyads
AbstractRobbins, R., Diclemente, R. J., Ejikeme, C., Crusto, C. A., & Taylor, J. Y. (n.d.).Publication year
2021Journal title
Journal of Cardiovascular NursingVolume
36Issue
2Page(s)
116-123AbstractBackground Poor sleep is a confirmed risk factor for hypertension (HTN), and Black/African American (AA) women have among the highest rates of HTN in the United States. Objective We examined the relationship between sleep and blood pressure (BP) among Black/AA mother-child dyads using data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Methods Data for this study were derived from 250 Black/AA mother-child dyads from low-income neighborhoods, collected via 4 home visits over 2 years. Mothers reported poor sleep, including reports of sleeping worse than usual and nighttime awakenings. Recordings of BP were obtained for mother and child. Mother BP was scored as normal (<120/<80 mm Hg), elevated (120-129/<80 mm Hg), stage 1 HTN (130-139/80-89 mm Hg), or stage 2 HTN (systolic ≥140 or diastolic ≥90 mm Hg). Generalized linear models examined the relationships between mother-reported poor sleep variables and both mother and child BP. Adjusted models examining mother BP controlled for the mother's age, education, marital status, smoking, body mass index, and depression symptoms. Results In adjusted models, nighttime awakenings were associated with stage 2 HTN (b = 2.70, 95% confidence interval [CI], 0.54-4.86, P <.05). Compared with children whose mother who had normal BP, children whose mother had elevated BP had higher diastolic BP (b = 0.37; 95% CI, 0.19-0.54; P <.001). Mother elevated BP was associated with both child systolic BP (b = 2.49; 95% CI, 0.44-4.53; P <.05) and diastolic BP (b = 2.07; 95% CI, 0.39-3.76; P <.05). Mother stage 1 HTN was associated with both child systolic BP (b = 2.16; 95% CI, 0.29-4.03; P <.05) and diastolic BP (b = 3.91; 95% CI, 2.40-5.42; P <.001). We detected a significant interaction between mother stage 2 HTN and mother nighttime awakenings in predicting higher child diastolic BP (b = 8.16; 95% CI, 0.65-15.68; P <.05). Conclusions We found evidence for an association between mothers' nighttime awakenings and very high BP. Our study also illuminated a strong relationship between high mother BP and high child BP. Finally, our study found preliminary support for the potentially mediating role of mothers' nighttime awakenings in predicting the relationship between mother stage 2 HTN and child BP.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. J., 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. J. (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.Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis
AbstractCapasso, A., Brown, J. L., Safonova, P., Belyakov, N., Rassokhin, V., & DiClemente, R. J. (n.d.).Publication year
2021Journal title
AIDS and BehaviorVolume
25Issue
11Page(s)
3734-3742AbstractAlcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18–35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = − 81, − 2; z = − 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.Heterogeneity of Sexual Risk Profiles Among Juvenile Justice-Involved African American Girls
AbstractLogan-Greene, P., Bascug, E. W., DiClemente, R. J., & Voisin, D. R. (n.d.).Publication year
2021Journal title
Child and Youth Care ForumVolume
50Issue
4Page(s)
653-677AbstractBackground: Juvenile justice-involved African American girls are considered uniformly high-risk for adverse sexual health outcomes such as sexually transmitted infections (STIs) and pregnancy; however, their sexual health statuses may be more complex. Objective: The present study assessed whether diverse subgroups of sexual risk exist and explored variations by socio-contextual indicators and sexual health outcomes. Method: The sample consisted of 188 detained African American adolescent girls. Six key sexual risk model indicators were selected for latent class analysis: early sex initiation, unprotected sex, high number of sex partners, sex while intoxicated, having sex with a recently incarcerated partner, and trading sex. Results: Results revealed a four-class solution: “Lowest Risk” (40.3%), with relatively low endorsement of sexual risk items; “Precocious Debut” (19.5%), with early sexual initiation and highest number of sex partners; “Delayed Risk” (30.3%), with later sexual debut but elevated unprotected sex and number of sex partners; and “Highest Risk” (9.9%), with the highest proportions on most indicators, but lower numbers of sex partners compared to Precocious Debut. Classes differed significantly on sexual health outcomes and demographic, neighborhood, peer, family, and individual factors. High Risk, Precocious Debut, and Delayed Risk were associated with greater prevalence of STIs. Lowest Risk and Precocious Debut classes had fewer prior pregnancies. Lowest Risk girls were significantly lower on a range of risk outcomes. Conclusions: Heterogeneous profiles of sexual risk may inform future prevention and interventions for at-risk or detained African American girls.Horizons and Group Motivational Enhancement Therapy: HIV Prevention for Alcohol-Using Young Black Women, a Randomized Experiment
AbstractDiClemente, R. J., Rosenbaum, J. E., Rose, E. S., Sales, J. M., Brown, J. L., Renfro, T. L., Bradley, E. L., Davis, T. L., Capasso, A., Wingood, G. M., Liu, Y., West, S. G., Hardin, J. W., Bryan, A. D., & Feldstein Ewing, S. W. (n.d.).Publication year
2021Journal title
American journal of preventive medicineVolume
60Issue
5Page(s)
629-638AbstractIntroduction: Black women are at disproportionately greater risk for HIV and sexually transmitted infections than women of other ethnic/racial backgrounds. Alcohol use may further elevate the risk of HIV/sexually transmitted infection acquisition and transmission. Study Design: A random-assignment parallel-group comparative treatment efficacy trial was conducted with random assignment to 1 of 3 conditions. Setting/participants: The sample comprised 560 Black or African American women aged 18–24 years who reported recent unprotected vaginal or anal sex and recent alcohol use. Participants were recruited from community settings in Atlanta, Georgia, from January 2012 to February 2014. Intervention: A Group Motivational Enhancement Therapy module was designed to complement a Centers for Disease Control and Prevention–designated evidence-based intervention (Horizons) to reduce sexual risk behaviors, alcohol use, and sexually transmitted infections, with 3 comparison groups: (1) Horizons + Group Motivational Enhancement Therapy intervention, (2) Horizons + General Health Promotion intervention, and (3) enhanced standard of care. Main outcome measures: Outcome measures included safe sex (abstinence or 100% condom use); condom nonuse; proportion of condom use during sexual episodes; incident chlamydia, gonorrhea, and trichomonas infections; and problematic alcohol use measured by Alcohol Use Disorders Identification Test score. Treatment effects were estimated using an intention-to-treat protocol‒generalized estimating equations with logistic regression for binomial outcomes and Poisson regression for count outcomes. Analyses were conducted between October 2018 and October 2019. Results: Participants assigned to Horizons + Group Motivational Enhancement Therapy had greater odds of safe sex (AOR=1.45, 95% CI=1.04, 2.02, p=0.03), greater proportion of condom use (AOR=1.68, 95% CI=1.18, 2.41, p=0.004), and lower odds of condom nonuse (AOR=0.57, 95% CI=0.38, 0.83, p=0.004). Both interventions had lower odds of problematic alcohol use (Horizons: AOR=0.57, 95% CI=0.39, 0.85, p=0.006; Horizons + Group Motivational Enhancement Therapy: AOR=0.61, 95% CI=0.41, 0.90, p=0.01). Conclusions: Complementing an evidence-based HIV prevention intervention with Group Motivational Enhancement Therapy may increase safer sexual behaviors and concomitantly reduce alcohol use among young Black women who consume alcohol. Trial registration: This study is registered at www.clinicaltrials.gov NCT01553682.Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information
AbstractKim, S., Capasso, A., Cook, S. H., Ali, S. H., Jones, A. M., Foreman, J., DiClemente, R. J., & Tozan, Y. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
11AbstractThis study assessed the modifying role of primary source of COVID-19 information in the association between knowledge and protective behaviors related to COVID-19 among adults living in the United States (US). Data was collected from 6,518 US adults through an online cross-sectional self-administered survey via social media platforms in April 2020. Linear regression was performed on COVID-19 knowledge and behavior scores, adjusted for sociodemographic factors. An interaction term between knowledge score and primary information source was included to observe effect modification by primary information source. Higher levels of knowledge were associated with increased self-reported engagement with protective behaviors against COVID-19. The primary information source significantly moderated the association between knowledge and behavior, and analyses of simple slopes revealed significant differences by primary information source. This study shows the important role of COVID-19 information sources in affecting people's engagement in recommended protective behaviors. Governments and health agencies should monitor the use of various information sources to effectively engage the public and translate knowledge into behavior change during an evolving public health crisis like COVID-19.Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S.
AbstractCapasso, A., Jones, A. M., Ali, S. H., Foreman, J., Tozan, Y., & DiClemente, R. J. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
145AbstractThe COVID-19 pandemic has triggered a public health crisis of unprecedented scale. Increased alcohol use has been extensively documented during other crises, particularly among persons with anxiety and depression. Despite COVID-19's differential impact by age, the association of age, mental health and alcohol use during the pandemic has not been explored. This study aimed to examine whether age modified the association of anxiety and depressive symptoms with alcohol use during the COVID-19 pandemic. Two online surveys were administered to U.S. adult social media users in March and April 2020. Generalized linear models were conducted in 2020 among 5850 respondents (52.9% female; 22.0% aged 18–39 years, 47.0% aged 40–59 years, and 31.0% aged ≥60 years) to examine if age modified the association of anxiety and depression symptomatology and alcohol use. Overall, 29% of respondents reported increased alcohol use. Adjusted odds ratios of reporting increased alcohol use were 1.41 (95% CI = 1.20–1.66) among respondents with anxiety symptoms and 1.64 (95% CI = 1.21–2.23) among those with depressive symptoms compared to those without such symptoms. Whereas respondents aged 18–39 years had the highest probability of reporting increased alcohol use, the probability of older persons (40–59 and ≥60 years) reporting increased drinking was much greater among those with symptoms of anxiety and depression, compared to those without symptoms. These findings warrant age-differentiated public health messaging on the risks of excessive alcohol use and scale-up of substance use services for middle-aged and older adults with symptoms of depression and anxiety.Regional and socioeconomic predictors of perceived ability to access coronavirus testing in the United States: results from a nationwide online COVID-19 survey
AbstractAli, S. H., Tozan, Y., Jones, A. M., Foreman, J., Capasso, A., & DiClemente, R. J. (n.d.).Publication year
2021Journal title
Annals of EpidemiologyVolume
58Page(s)
7-14AbstractPurpose: Access to COVID-19 testing remained a salient issue during the early months of the pandemic, therefore this study aimed to identify 1) regional and 2) socioeconomic predictors of perceived ability to access Coronavirus testing. Methods: An online survey using social media-based advertising was conducted among U.S. adults in April 2020. Participants were asked whether they thought they could acquire a COVID-19 test, along with basic demographic, socioeconomic and geographic information. Results: A total of 6,378 participants provided data on perceived access to COVID-19 testing. In adjusted analyses, we found higher income and possession of health insurance to be associated with perceived ability to access Coronavirus testing. Geographically, perceived access was highest (68%) in East South Central division and lowest (39%) in West North Central. Disparities in health insurance coverage did not directly correspond to disparities in perceived access to COVID-19 testing. Conclusions: Sex, geographic location, income, and insurance status were associated with perceived access to COVID-19 testing; interventions aimed at improving either access or awareness of measures taken to improve access are warranted. These findings from the pandemic's early months shed light on the importance of disaggregating perceived and true access to screening during such crises.Sleep medication use and incident dementia in a nationally representative sample of older adults in the US
AbstractRobbins, R., DiClemente, R. J., Troxel, A. B., Jean-Louis, G., Butler, M., Rapoport, D. M., & Czeisler, C. A. (n.d.).Publication year
2021Journal title
Sleep MedicineVolume
79Page(s)
183-189AbstractBackground: Sleep difficulties are common among older adults, and clinical management of sleep difficulties commonly includes sleep medication (pharmacological and non-pharmacological). Our research examines sleep medication use and incident dementia over 8 years using nationally representative data from older adults ages 65 years and older in the United States. Methods: We used data collected from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of Medicare beneficiaries. Routine sleep medication use (pharmacological and non-pharmacological) was defined as use “most nights” or “every night.” Participants were screened for dementia with validated instruments that assessed memory, orientation, and executive function. We conduct prospective analyses to examine the relationship between routine sleep medication use and incident dementia using Cox proportional hazards modeling and estimated survival curves. Analyses controlled for age, sex, marital status, education, and chronic conditions. Results: Among respondents at baseline (n = 6373), most participants (21%) were age 70–74 years of age. Participants were 59% female and the sample comprised non-Hispanic White (71%). At baseline, 15% of our study sample reported using sleep medication routinely, which is representative of 4.6 million older adults in the US. Covariate adjusted proportional hazard models revealed that routinely using sleep medication was associated with incident dementia (HR = 1.30, 95%CI: 1.10 to 1.53, p < 0.01). Conclusions: Our study observed, in a nationally representative study of older adults in the US across 8 years of data that 15% of older adults report routinely using sleep medication, yet routine use of sleeping medication was associated with incident dementia across the follow-up interval. Future research may examine behavioral approaches to improving sleep among older adults.Social Media Versus Traditional Clinic-Based Recruitment for a Dyadic Sexually Transmitted Infection Prevention Trial: Results From the Sexperience Study
AbstractWoods, C., Yusuf, H., Matson, P., Marcell, A. V., DiClemente, R., Fields, E., & Trent, M. (n.d.).Publication year
2021Journal title
Journal of Adolescent HealthVolume
69Issue
4Page(s)
668-671AbstractBackground: The enrollment of youth in clinical trials has generally been achieved through conventional in-person recruitment but is evolving with the surge in the use of social media and presents an alternative resource for research recruitment for sexually transmitted infection (STI) prevention trials. Purpose: To compare the direct costs and performance of social media recruitment versus clinic-based recruitment method for a dyadic behavioral intervention for STI among heterosexual couples. Methods: In the clinic-based recruitment arm spanning 60 weeks, patients aged 16–25 years were recruited through an adolescent/young adult clinic. Social media adverts targeting college students within the city were also posted online over 23 weeks, using Facebook ad software. We compared the direct costs and performance of both recruitment methods to assess feasibility. Results: Three hundred eighty-one individuals were approached, of which 21 completed the dyadic intervention (11 from social media–based recruitment and 10 from clinic-based recruitment). Clinic-based recruitment accounted for 91.0% of total recruitment cost and 9.9% of the total cost was spent on social media recruitment via Facebook ad. Conclusions: Recruitment of adolescents and young adults for a dyadic behavioral STI intervention trial using social media is feasible, has lower direct costs, and results in similar outcomes compared to clinic-based recruitment.The Influence of Familial and Peer Social Support on Post-Traumatic Stress Disorder Among Black Girls in Juvenile Correctional Facilities
AbstractQuinn, C. R., Boyd, D. T., Kim, B. K. E., Menon, S. E., Logan-Greene, P., Asemota, E., Diclemente, R. J., & Voisin, D. (n.d.).Publication year
2021Journal title
Criminal Justice and BehaviorVolume
48Issue
7Page(s)
867-883AbstractBlack girls bear a higher burden of juvenile justice involvement in the United States, relative to other racial/ethnic female groups. Emerging evidence suggests that system involvement is related to trauma histories and post-traumatic stress disorder (PTSD). This study investigated the associations between individual, family, and peer factors, and their relationship to PTSD among Black girls with juvenile justice involvement. Cross-sectional data were collected from 188 Black girls in detention. Measures assessed were history of abuse, negative peer norms, future orientation, caregiver support, self-esteem, age, and PTSD symptoms. Major regression findings indicated that higher rates of caregiver support, higher negative peer norms, lower self-esteem rates, and lower future orientation rates were correlated with greater PTSD symptoms. Treatment programs for this population warrant a multisystemic approach, which includes caregivers and peers, and bolstering important constructs such as self-esteem and hopefulness.A longitudinal examination of African American adolescent females detained for status offense
AbstractKim, B. K. E., Quinn, C. R., Logan-Greene, P., DiClemente, R., & Voisin, D. (n.d.).Publication year
2020Journal title
Children and Youth Services ReviewVolume
108AbstractIntroduction: Behaviors like truancy, running away, curfew violation, and alcohol possession fall under the status offense category and can have serious consequences for adolescents. The Juvenile Justice and Delinquency and Prevention Act prohibited detaining status offenders. We explored the degree to which African American adolescent girls were being detained for status offenses and the connections to their behavioral health risks and re-confinement. Methods: 188 African American girls (aged 13–17), recruited from detention facilities, were surveyed at baseline and 3-month follow-ups. Logistic regression models estimated the likelihood of longitudinal re-confinement, controlling for sexual and behavioral health risk factors. Results: One third of the overall sample was detained for a status offense. Status offenders were exposed to higher peer risk profiles. At follow-up, nearly 39% of status offenders reported re-confinement. Compared to youth with other offenses, those who violated a court order (type of status offense) were 3 times more likely to be re-confined. Controlling for sexual and behavioral health risk factors, the odds of re-confinement was not statistically significant. Conclusion: Overall findings suggest that courts and detention facilities must devote specialized resources to addressing the socio-behavioral needs of African American girls with status offenses so as not to use detention as an intervention.A system-level intervention to encourage collaboration between juvenile justice and public health agencies to promote hiv/sti testing
AbstractElkington, K. S., Spaulding, A., Gardner, S., Knight, D., Belenko, S., Becan, J. E., Robertson, A. A., Oser, C., & Diclemente, R. (n.d.).Publication year
2020Journal title
AIDS Education and PreventionVolume
32Issue
4Page(s)
337-355AbstractJustice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes: an acceptability and feasibility study
AbstractPekmezaris, R., Williams, M. S., Pascarelli, B., Finuf, K. D., Harris, Y. T., Myers, A. K., Taylor, T., Kline, M., Patel, V. H., Murray, L. M., McFarlane, S. I., Pappas, K., Lesser, M. L., Makaryus, A. N., Martinez, S., Kozikowski, A., Polo, J., Guzman, J., Zeltser, R., … Granville, D. (n.d.).Publication year
2020Journal title
BMC Medical Informatics and Decision MakingVolume
20Issue
1AbstractBackground: Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes. Methods: A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides. Results: Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors “who look like me”); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse. Conclusions: These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes. Trial registration: NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1An Exploratory Structural Equation Model of Stress-Related Experiences Among Justice-Involved Youth: A Gender Comparison
AbstractDembo, R., Krupa, J. M., Wareham, J., Faber, J., Cristiano, J., Diclemente, R. J., Terminello, A., & Schmeidler, J. (n.d.).Publication year
2020Journal title
Criminal Justice and BehaviorVolume
47Issue
2Page(s)
127-144AbstractYouth involved in the juvenile justice system demonstrate greater risk of exposure to negative life experiences. The present study explores the prevalence of three stress-related experiences (sexual assault victimization, bullying/victimization, and minority sexual orientation) among newly arrested adolescents. Gender (biological sex) differences were examined as well as associations with sociodemographic characteristics, depressive symptoms, substance use, and sexually transmitted infection (STI). Factor analyses found a single factor of stress for both genders. Prevalence rates for bullying/victimization, sexual assault victimization, and sexual minority status were higher for girls than boys. Girls were also more likely than boys to test positive for STIs and experience depressive symptoms, while boys were more likely than girls to test positive for marijuana use. Depression and drug-related problems were associated with the stress construct for girls only. Bivariate comparisons with the three stress measures and sociodemographic characteristics indicated age and race effects. Implications are discussed.Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?
AbstractZullig, K. J., Valois, R. F., Hobbs, G. R., Kerr, J. C., Romer, D., Carey, M. P., Brown, L. K., DiClemente, R. J., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Journal of Happiness StudiesVolume
21Issue
2Page(s)
417-436AbstractAddressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p =.02, η2 =.03), along with three interactions: between experimental condition and media intervention (F = 7.96, p =.005, η2=.04); experimental condition, sex, and media intervention (F = 6.51, p =.01, η2 =.04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p =.01, η2 =.02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants’ life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.Developmental Changes in Sexual Risk and Substance Use Among African American Females: an Integrated Data Analysis Approach Using Time-varying Effect Models
AbstractSwartzendruber, A., Brown, J. L., Sales, J. M., DiClemente, R. J., Windle, M., & Haardörfer, R. (n.d.).Publication year
2020Journal title
Prevention ScienceVolume
21Issue
2Page(s)
182-193AbstractThe aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14–25 years for behavioral outcomes and 16–25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16–17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?
AbstractZullig, K. J., Valois, R. F., Hobbs, G. R., Romer, D., Brown, L. K., DiClemente, R. J., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Journal of Adolescent HealthVolume
67Issue
1Page(s)
40-45AbstractPurpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787). Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender. Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased −.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males. Conclusions: Although Project iMPPACS was not designed with the intent on improving participants’ life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.HIV/STI Service Delivery within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth through the HIV Care Cascade
AbstractElkington, K. S., Robertson, A. A., Knight, D. K., Gardner, S. K., Funk, R. R., Dennis, M. L., Oser, C., & DIclemente, R. (n.d.).Publication year
2020Journal title
AIDS patient care and STDsVolume
34Issue
2Page(s)
72-80AbstractJustice-involved youth (JIY) are at considerable risk for human immunodeficiency virus (HIV), but are disconnected from treatment and prevention. Juvenile justice agencies providing community supervision (CS) are well positioned to provide HIV prevention, testing, and prompt referral to treatment for JIY. However, we lack an understanding of juvenile CS agency responses to HIV/sexually transmitted infection (STI) needs among JIY. We conducted a nationwide systematic assessment of how juvenile CS agencies identify, refer, and move youth through the HIV care cascade using a nationally representative sample of 195 juvenile CS agencies across 20 states. Two-thirds of CS agencies did not offer any HIV-/STI-related services, and 82% reported no collaboration with health agencies. Screening or referral for HIV risk behaviors was reported by 32% of the CS agencies and 12% for any intervention or prevention for HIV/STI risk behaviors. Between 21% and 30% of agencies were unaware of the location of local HIV/STI services. HIV/STI prevention training was not a priority for directors and was ranked second to last out of 16 training topics. Agencies where staff expressed need for HIV risk training and where specific court programming was available were more likely to provide or refer for HIV/STI screening and/or testing. Agencies were more likely to provide or refer for services if they provided pre-trial/pre-adjudication supervision, parole, or court programming. Considering the low provision of HIV/STI-related services and limited collaboration between health and justice agencies, interventions that promote cross-system collaboration designed to minimize barriers and facilitate identification, referral, and linkage to HIV services for JIY are necessary.Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?
AbstractValois, R. F., Kerr, J. C., Carey, M. P., Brown, L. K., Romer, D., DiClemente, R. J., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Applied Research in Quality of LifeVolume
15Issue
1Page(s)
273-296AbstractThis study identified associations between perceived neighborhood stress and adolescents’ perceptions of life satisfaction. African American adolescents aged 13–18 (n = 1658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.Perceived neighborhood violence and crime, emotion regulation, and PTSD symptoms Among Justice-Involved, Urban African-American adolescent girls
AbstractSun, S., Crooks, N., Diclemente, R. J., & Sales, J. M. (n.d.).Publication year
2020Journal title
Psychological Trauma: Theory, Research, Practice, and PolicyVolume
12Issue
6Page(s)
1-6AbstractObjective: African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African-American adolescent girls (n = 85) following their release from detention centers. Method: We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms. Results: The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms. Conclusions: Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms.Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions: A systematic review
AbstractAli, S. H., Misra, S., Parekh, N., Murphy, B., & DiClemente, R. J. (n.d.).Publication year
2020Journal title
Preventive Medicine ReportsVolume
20AbstractEthnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.