Ralph DiClemente

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Professor of Social and Behavioral Sciences

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.

Education

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

ScM, Behavioral Sciences, Harvard University, Cambridge, MA

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

Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions

Diabetes

HIV/AIDS

Implementation science

Influenza

Psychology

Publications

Rural parents' vaccination-related attitudes and intention to vaccinate middle and high school children against influenza following educational influenza vaccination intervention

Sales, J. M., Painter, J. E., Pazol, K., Gargano, L. M., Orenstein, W. A., Hughes, J. M., & DiClemente, R. (n.d.).

Publication year

2011

Journal title

Human Vaccines

Volume

Issue

Page(s)

1146-1152

10.4161/hv.7.11.17891

Abstract

Abstract

Objective: This study examined changes in parental influenza vaccination attitudes and intentions after participating in school-based educational influenza vaccination intervention. Results: Parents who participated in the intervention conditions reported significantly higher influenza vaccination rates in their adolescents, relative to a control group, as well as increased vaccination rates post-intervention participation relative to their baseline rates. Intervention participants reported greater intention to have their adolescent vaccinated in the coming year compared with control parents. Significant differences were observed post intervention in perceived barriers and benefits of vaccination. Methods: Participants were drawn from three counties participating in a school-based influenza vaccination intervention in rural Georgia (baseline n = 324; follow-up n = 327). Data were collected pre- and post-intervention from phone surveys with parents' with children attending middle- and high-school. Attitudes, beliefs, vaccination history and intention to vaccinate were assessed. Conclusions: These findings suggest that a school-delivered educational influenza vaccination intervention targeting parents and teens may influence influenza vaccination in rural communities. Future influenza vaccination efforts geared toward the parents of rural middle- and high-school students may benefit from addressing barriers and benefits of influenza vaccination.

Safer sex media messages and adolescent sexual behavior : 3-year follow-up results from project iMPPACS

DiClemente, R., Hennessy, M., Romer, D., Valois, R. F., Vanable, P., Carey, M. P., Stanton, B., Brown, L., Ralph DiClemente, D., & Salazar, L. F. (n.d.).

Publication year

2013

Journal title

American journal of public health

Volume

103

Issue

Page(s)

134-140

10.2105/AJPH.2012.300856

Abstract

Abstract

Objectives. We estimated the long-term (36-month) effects of Project iMPPACS, a multisite randomized controlled trial of mass media and smallgroup intervention for African American adolescents. Methods. We collected 6 waves of longitudinal data on program participants aged 14 to 17 years (n = 1139) in Providence, Rhode Island; Syracuse, New York; Columbia, South Carolina; and Macon, Georgia, 36 months (December 2009- December 2010) after the intervention began (August 2006-January 2008). Seemingly unrelated regressions at each wave estimated the effects of 3 types of mass media messages (the thematic mediators: selection, pleasure, and negotiation) on condom use intention and self-reported unprotected vaginal sex events. Results. All 3 mediators of behavior change that were introduced during the media intervention were sustained at the follow-up assessments at least 18 months after the intervention ended, with intention having the largest correlation. Unprotected vaginal sex increased with each wave of the study, although cities receiving media exposure had smaller increases. Conclusions. Project iMPPACS demonstrates that mass media influence delivered over an extended period, when adolescents were beginning to learn patterns of behavior associated with sex, persisted after the media program ended.

Safety and acceptability of couples HIV testing and counseling for us men who have sex with men : A randomized prevention study

Sullivan, P. S., White, D., Rosenberg, E. S., Barnes, J., Jones, J., Dasgupta, S., O'Hara, B., Scales, L., Salazar, L. F., Wingood, G., DiClemente, R., Wall, K. M., Hoff, C., Gratzer, B., Allen, S., & Stephenson, R. (n.d.).

Publication year

2014

Journal title

Journal of the International Association of Providers of AIDS Care

Volume

Issue

Page(s)

135-144

10.1177/2325957413500534

Abstract

Abstract

We tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P =.4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P =.6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P =.5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.

School-located vaccination clinics for adolescents : Correlates of acceptance among parents

Gargano, L. M., Weiss, P., Underwood, N. L., Seib, K., Sales, J. M., Vogt, T. M., Rask, K., Morfaw, C., Murray, D. L., DiClemente, R., & Hughes, J. M. (n.d.).

Publication year

2015

Journal title

Journal of Community Health

Volume

Issue

Page(s)

660-669

10.1007/s10900-014-9982-z

Abstract

Abstract

Four vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95 % confidence interval (CI) 2.44-22.31], MCV4 (AOR 2.97; 95 % CI 1.67-5.28), and HPV vaccines (AOR 7.61; 95 % CI 3.43-16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95 % CI 1.12-1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination.

Seasonal and 2009 H1N1 influenza vaccine uptake, predictors of vaccination and self-reported barriers to vaccination among secondary school teachers and staff

Gargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Jones, L. D., Murray, D., Wingood, G. M., DiClemente, R., & Hughes, J. M. (n.d.).

Publication year

2011

Journal title

Human Vaccines

Volume

Issue

Page(s)

89-95

10.4161/hv.7.1.13460

Abstract

Abstract

Objective: Teachers, like healthcare workers, may be a strategic target for influenza immunization programs. Influenza vaccination is critical to protect both teachers and the students they come into contact with. This study assessed factors associated with seasonal and H1N1 influenza vaccine uptake among middle- and high-school teachers. Results: Seventy-eight percent of teachers who planned to receive seasonal influenza vaccine and 36% of those who planned to receive H1N1 influenza vaccine at baseline reported that they did so. Seasonal vaccine uptake was significantly associated with perceived severity (odds ratio [OR] 1.57, p = 0.05) and self-efficacy (OR 4.46, p = 0.006). H1N1 vaccine uptake was associated with perceived barriers (OR 0.7, p = 0.014) and social norms (OR 1.39, p = 0.05). The number one reason for both seasonal and H1N1 influenza vaccine uptake was to avoid getting seasonal/H1N1 influenza disease. The number one reason for seasonal influenza vaccine refusal was a concern it would make them sick and for H1N1 influenza vaccine refusal was concern about vaccine side effects. Methods: Participants were recruited from two counties in rural Georgia. Data were collected from surveys in September 2009 and May 2010. Multivariate logistic regression was used to assess the association between teachers' attitudes toward seasonal and H1N1 influenza vaccination and vaccine uptake. Conclusions: There is a strong association between the intention to be vaccinated against influenza (seasonal or 2009 H1N1) and actual vaccination uptake. Understanding and addressing factors associated with teachers' influenza vaccine uptake may enhance future influenza immunization efforts.

Secondary HIV prevention : Novel intervention approaches to impact populations most at risk

Brown, J. L., & DiClemente, R. (n.d.).

Publication year

2011

Journal title

Current HIV/AIDS Reports

Volume

Issue

Page(s)

269-276

10.1007/s11904-011-0092-6

Abstract

Abstract

This paper reviews recent secondary prevention interventions designed to reduce sexual risk behaviors among people living with HIV/AIDS (PLWHA). A summary of findings from previous meta-analyses and narrative reviews of interventions is provided. Next, novel HIV prevention approaches for PLWHA are reviewed. The review reports on the efficacy of interventions delivered in primary care settings or by technology-formats, interventions that also address mental health difficulties, and programs to address particular at-risk populations (eg, men who have sex with men). A critique of recent interventions for people living with HIV/AIDS is provided as well as suggestions for future research.

Selected risk and protective factors associated with two or more lifetime sexual intercourse partners and non-condom use during last coitus among U.S rural high school students

DiClemente, R., Yarber, W. L., Milhausen, R., Crosby, R. A., & Di Clemente, R. J. (n.d.).

Publication year

2002

Journal title

American Journal of Health Education

Volume

Issue

Page(s)

206-215

10.1080/19325037.2002.10603509

Abstract

Abstract

This analysis determined the association between 13 selected health risk and protective factors and reporting two or more lifetime sexual intercourse partners and non-condom use for last coitus among sexually experienced U.S rural high school students. The sample was 569 sexually experienced adolescent females and 561 sexually experienced adolescent males who participated in the national 1999 Youth Risk Behavior Survey and who attended rural high schools. For females, coital debut before age 15, forced sexual intercourse, physical abuse, and marijuana use were associated with having two or more lifetime sexual intercourse partners. Coital debut before 15, binge drinking, and marijuana use were associated with having two or more sexual intercourse partners for males. Coital debut before age 15, forced sexual intercourse, and regular cigarette smoking were associated with non-condom use at last coital episode for females. Forced sexual intercourse and cocaine use were associated with non-condom use at last coital episode for males. A greater number of correlates were identified for females as opposed to males. The findings suggest that rural adolescents who initiate sexual activity at an early age are at markedly greater risk of engaging in subsequent sexual risk behaviors, such as having multiple sex partners and non-condom use. Further, substance use and a history of forced sex were also prominent determinants of sexual risk-taking. The findings portend that there is value in delaying the onset of coitus until adolescents are older. Thus, risk reduction programs should encourage the postponement of sexual initiation. Finally, the findings suggest that programs that address the key role of substance use and the psychological sequelae of sexual abuse might be more effective at reducing sexual risk-taking among rural adolescents.

Self-concept and adolescents' refusal of unprotected sex : A test of mediating mechanisms among African American girls

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

Publication year

2004

Journal title

Prevention Science

Volume

Issue

Page(s)

137-149

10.1023/B:PREV.0000037638.20810.01

Abstract

Abstract

During adolescence, girls form self-concepts that facilitate the transition to adulthood. This process may entail engaging in risky sexual behaviors resulting in STD infection and pregnancy. This study assessed the relation between self-concept and unwanted, unprotected sex refusal among 335 African American adolescent girls. The second aim was to determine whether attributes of partner communication about sex would act as a mediating mechanism on this hypothesized relationship. These assessments were made within the context of several theoretical models (social cognitive theory and theory of gender and power). Self-concept was composed of self-esteem, ethnic identity, and body image, whereas attributes of partner communication about sex was conceptualized as frequency of communication, fear of condom use negotiation, and self-efficacy of condom use negotiation. Structural equation modeling was used to analyze data. The results showed that self-concept was associated with partner communication attributes about sex, which in turn, was associated with frequency of unprotected sex refusal. The hypothesized mediating role of partner communication was also supported. STD-HIV preventive interventions for this population may be more effective if they target self-concept as opposed to only self-esteem, incorporate an Afrocentric approach, and focus on enhancing several attributes of partner communication about sex.

Self-control and ego identity development as predictors of unprotected sex in late adolescent males

Hernandez, J. T., & DiClemente, R. (n.d.).

Publication year

1992

Journal title

Journal of Adolescence

Volume

Issue

Page(s)

437-447

10.1016/0140-1971(92)90073-E

Abstract

Abstract

Male college students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, moral development, personality factors and behaviors. Bivariate analyses were used to identify factors associated with high-risk sexual intercourse. Significant demographic psychosocial and behavioral predictors were entered into a logistic regression analysis to evaluate the independent influence of each predictor on unprotected sexual intercourse. Behavioral factors were the most powerful predictors of unprotected sexual intercourse. Adolescents reporting multiple sex partners, drinking and picking-up sex partners were significantly more likely to engage in sex without condoms. Examining psychosocial factors alone, it was found that adolescents who had low scores for ego-development (goal-directedness) and self-control were significantly more likely to engage in sex without condoms. Identification of two personality constructs as underlying predictors of high-risk behavior, while potentially important for the development of effective HIV prevention programs, needs corroboration to further define the interrelationships between these factors and other psychosocial constructs.

Self-esteem and theoretical mediators of safer sex among African American female adolescents : Implications for sexual risk reduction interventions

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

Publication year

2005

Journal title

Health Education and Behavior

Volume

Issue

Page(s)

413-427

10.1177/1090198104272335

Abstract

Abstract

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

Self-obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls

Smith, K., Harrington, K., Wingood, G., Kim Oh, M., Hook, E. W., & DiClemente, R. (n.d.).

Publication year

2001

Journal title

Archives of Pediatrics and Adolescent Medicine

Volume

155

Issue

Page(s)

676-679

10.1001/archpedi.155.6.676

Abstract

Abstract

Objective: To ascertain the acceptability of testing and prevalence of 3 readily treatable sexually transmitted diseases (STDs) (infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis) with the use of patient-obtained vaginal swabs. Study Design: Study participants at each initial session were asked to provide self-obtained vaginal swabs for ligase chain reaction testing to detect N gonorrhoeae and C trachomatis, and for culture of T vaginalis. Setting: Behavioral intervention sessions with African American adolescent girls in a nonclinical program to reduce risk of STDs, human immunodeficiency virus infection, and pregnancy. Results: All study participants were offered their choice of STD screening in the context of a traditional pelvic examination or using self-obtained vaginal swabs. All eligible participants chose self-administered vaginal swabs. Of the 512 participants examined at their initial study visit, 28.7% were found to be infected with 1 or more treatable STDs (5.3% with N gonorrhoeae, 17.8% with C trachomatis, and 12.9% with T vaginalis). Conclusions: With the use of newer detection systems, STDs can be readily detected in nonclinical settings with the use of self-obtained vaginal swabs, providing new opportunities for efforts to control STDs.

Self-regulatory problems mediate the association of contextual stressors and unprotected intercourse among rural, African american, young adult men

Kogan, S. M., Brody, G. H., Chen, Y. F., & DiClemente, R. (n.d.).

Publication year

2011

Journal title

Journal of health psychology

Volume

Issue

Page(s)

50-57

10.1177/1359105310367831

Abstract

Abstract

In this brief report, the hypothesis that self-regulatory problems would mediate the association between contextual stressors and unprotected intercourse among rural African American young adult men was investigated. Family support and religiosity were hypothesized to ameliorate the influence of contextual stressors on self-regulatory problems. Hypotheses were tested on 79 sexually active men from a sample recruited with Respondent Driven Sampling; episodes of unprotected intercourse constituted the criterion variable. Analyses supported the mediating role of self-regulatory problems in linking young adult men's contextual stressors with a heightened likelihood of unprotected intercourse. Religious involvement and family support interacted with contextual stressors to predict diminished associations with self-regulatory problems.

Semen says : Assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker

Rosenbaum, J. E., Zenilman, J. M., Rose, E., Wingood, G. M., & DiClemente, R. (n.d.).

Publication year

2017

Journal title

Sexually transmitted infections

Volume

Issue

Page(s)

145-147

10.1136/sextrans-2016-052605

Abstract

Abstract

Objective Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour. Methods This prospective cohort study uses data from 715 sexually active African-American female adolescents in Atlanta, surveyed at baseline, 6months and 12months. Participants completed a 40min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted Y-chromosome test results from self-reported sexual behaviour using within-subject panel regression. Results Among the participants who reported abstinence from vaginal sex in the past 14days, 9.4% tested positive for semen Y-chromosome. Among item non-respondents, 6.3% tested positive for semen Y-chromosome. Women who reported abstinence and engaged in item non-response regarding their sexual behaviour had respectively 62% and 78% lower odds of testing positive for Y-chromosome (OR 0.38 (0.21 to 0.67), OR 0.22 (0.12 to 0.40)), controlling for smoking, survey wave and non-coital sexual behaviours reported during abstinence. Conclusions Adolescents who report sexual abstinence under-report semen exposure. Research should validate self-reported sexual behaviour with biomarkers. Adolescents who engage in item non-response regarding vaginal sex test positive for semen Y-chromosome at similar rates, which supports the practice of grouping non-respondents with adolescents reporting abstinence in statistical analysis. Trial registration number NCT00633906.

Sexual agency versus relational factors : A study of condom use antecedents among high-risk young African American women

Crosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Head, S., Rose, E., & McDermott-Sales, J. (n.d.).

Publication year

2008

Journal title

Sexual Health

Volume

Issue

Page(s)

41-47

10.1071/SH07046

Abstract

Abstract

Background: The influence that female partners exert regarding condom use is not well known. In the present study, the relative roles of personal sexual agency and relational factors in determining whether young African American women engaged in unprotected vaginal sex (UVS) were studied. Methods: A cross sectional study of 713 young, African American women (aged 15-21 years) was conducted. Data were collected using an audio-computer assisted self-interview. Three measures of sexual agency were assessed and three relational factors were assessed. To help assure validity in the outcome measure, condom use was assessed in five different ways. Multivariate analyses were used to determine whether variables independently predicted UVS. Results: Two of the six predictor variables achieved multivariate significance with all five measures of condom use: (1) fear of negotiating condom use with male partners, and (2) indicating that stopping to use condoms takes the fun out of sex. A relational factor (male-dominated power imbalances) achieved multivariate significance for four of the five measures of UVS. A sexual agency factor (whether young women greatly enjoyed sex) achieved multivariate significance for three of the five measures. Conclusion: The results suggest that young African American women at high-risk of sexually transmissible infections (STI)/HIV acquisition may experience male-dominated power imbalances and also fear the process of negotiating condom use with their male partners. Although these factors were independently associated with UVS, two factors pertaining to sexual agency of these young women were also important predictors of UVS. Intervention efforts designed to avert STI/HIV acquisition among young African American women should therefore include programs to address both sexual agency and relational factors.

Sexual behaviors and their correlates among young people in Mauritius : A cross-sectional study

Nishimura, Y. H., Ono-Kihara, M., Mohith, J. C., NgMansun, R., Homma, T., DiClemente, R., Lang, D. L., & Kihara, M. (n.d.).

Publication year

2007

Journal title

BMC International Health and Human Rights

Volume

10.1186/1472-698X-7-8

Abstract

Abstract

Background. Little is known about the HIV/AIDS epidemic in the Indian Ocean region, including Mauritius. National records suggest a prevalence of HIV in Mauritius of < 1% in the general population, which is one of the lowest prevalence rates in southern Africa. However, HIV-positive cases have been increasing recently in Mauritius. We conducted a cross-sectional survey in January 2003 to assess the prevalence of HIVrelated sexual behaviors and their correlates among young people aged 15-24 years in Mauritius. Methods. We identified 1200 participants using two-stage cluster sampling. Demographic, social, sexual, and knowledge of HIV/AIDS data were obtained in face-to-face interviews using a structured questionnaire administered by trained interviewers. The prevalence of sexual behaviors was described in relation to gender, and the correlates of ever having had sex and nonuse of condom at last sex were analyzed using logistic regression. Results. In the target population, 30.9% of males and 9.7% of females reported a history of sexual intercourse. Of the currently sexually active participants, 50.6% of men and 71.2% of women did not use condoms at their last sexual encounter. Logistic regression revealed that work experience and marijuana use were significantly associated with men's sexual experience, whereas being out of school and drinking experience were significantly associated with women's sexual experience. For both men and women, being Christian and visiting nightclubs were associated with having ever had sexual intercourse (P < 0.05). In addition, not using a condom at the first sexual encounter and lack of exposure to a nongovernmental organization (NGO) dealing with HIV/AIDS were associated with the nonuse of condoms at the last sexual encounter (P < 0.05). Conclusion. Young people in Mauritius are at risk of a future HIV epidemic because behaviors predisposing to HIV infection are prevalent among sexually experienced youth. A focused prevention program targeting young people should be reinforced as part of the National AIDS Control Program, taking into account the predictors of sexual behaviors identified here.

Sexual communication is associated with condom use by sexually active incarcerated adolescents

Rickman, R. L., Lodico, M., DiClemente, R., Morris, R., Baker, C., & Huscroft, S. (n.d.).

Publication year

1994

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

383-388

10.1016/1054-139X(94)90261-5

Abstract

Abstract

Purpose: Incarcerated adolescents are at increased risk for infection by sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Moreover, condom use by this population is extremely low. Although interpersonal variables such as sexual communication have been found to be associated with condom use in other populations, few researchers have investigated this relationship among adolescents requiring detention in juvenile facilities. The present study investigated the relationship between communication about sexual history and incarcerated adolescents' condom use. Methods: We used multivariate logistic regression techniques to analyze interview data from a predominantly Latino sample of 2,132 sexually active adolescents detained in Los Angeles County Juvenile Hall. Results: Despite high numbers of lifetime sexual partners, a substantial majority of respondents (67%) reported that they never used condoms during sexual intercourse. Respondents who communicated with their sex partner(s) about each others' sexual history were significantly more likely to use condoms during sexual intercourse. Adolescents who reported that they knew someone with AIDS were also more likely to use condoms. Conclusions: Interventions designed to increase condom use among sexually active incarcerated adolescents should include a component addressing sexual communication practices. More research is needed on the ways in which adolescents learn to communicate about sex.

Sexual communication self-efficacy scale

Quinn-Nilas, C., Mülhausen, R. R., Breuer, R., Bailey, J. V., Pavlou, M., DiClemente, R., & Wingood, G. M. (n.d.).

Publication year

2019

Page(s)

233-235

Abstract

Abstract

Sexual concurrency among young African American women

Waldrop-Valverde, D. G., Davis, T. L., Sales, J. M., Rose, E. S., Wingood, G. M., & DiClemente, R. (n.d.).

Publication year

2013

Journal title

Psychology, Health and Medicine

Volume

Issue

Page(s)

676-686

10.1080/13548506.2013.764462

Abstract

Abstract

Young African-American women are disproportionately affected by human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) sexually transmitted infections (STI), and engage in greater sexual concurrency than other race/ethnicities. It is important to evaluate behaviors and characteristics associated with the risk of sexual concurrency, so that interventions can target factors most likely to affect positive change. An emphasis on correlates of concurrency beyond individual-level factors has been suggested. The purpose of this study, therefore, was to identify individual-and partner-level characteristics associated with sexual concurrency among high-risk, young African-American women. Data were collected from 570 African-American adolescent women (aged 15-21) recruited from a STI clinic, a family planning clinic, and a teen clinic located in Atlanta, GA from March 2002 through August 2004. Logistic regression analysis was conducted in 2012 to evaluate correlates of sexual concurrency. Results show that almost one-quarter of participants reported sexually concurrent partnerships and 28.4% suspected male partner concurrency. Logistic regression results indicated the number of lifetime sexual partners and relationship factors were the primary contributors to engaging in concurrency in this sample. These findings suggest relationship factors may be important contributors to the prevalence of sexual concurrency among young African-American women. Interventions targeted toward sexual health among young African-American women may need to specifically address partner/relationship factors. Through these findings, we hope to better understand sexual risk taking and develop strategies that would overcome barriers to existing interventions aimed at improving the sexual health outcomes of young African-American women.

Sexual Risk Among African American Women : Psychological Factors and the Mediating Role of Social Skills

Curran, T. M., Monahan, J. L., Samp, J. A., Coles, V. B., DiClemente, R., & Sales, J. (n.d.).

Publication year

2016

Journal title

Communication Quarterly

Volume

Issue

Page(s)

536-552

10.1080/01463373.2015.1132241

Abstract

Abstract

Prior research demonstrates a positive association between mental health problems and sexual risk for African American women. Using the social skills deficit hypothesis, we proposed that social skills mediate this relationship. African American women (n = 557, M age = 20.58) completed measures of depression, stress, emotional dysregulation, sexual risk behaviors, and perceptions of their social skills with their primary sexual partner. Social skills mediated the link between the mental health assessments and a composite sexual risk index. Theoretical implications of extending the social skill deficit hypothesis are discussed as well as implications for interventions.

Sexual risk behaviors associated with having older sex partners : A study of black adolescent females

DiClemente, R., Wingood, G. M., Crosby, R. A., Sionean, C., Cobb, B. K., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).

Publication year

2002

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

20-24

10.1097/00007435-200201000-00004

Abstract

Abstract

Background: Volunteer black adolescent females from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted disease were studied to determine the frequency of condom use and unprotected vaginal sex with steady, older partners during various time periods over the previous 6 months. Goal: To examine associations between having male sex partners who were typically older (by at least 2 years) and adolescent females' sexually transmitted disease (STD)/HIV-associated sexual risk behaviors. Study Design: In this cross-sectional study, 522 sexually active black adolescent females completed a questionnaire and a structured interview, of which a portion assessed the age difference between the adolescents and their typical sex partners. The adolescents' ages, length of relationship and their use of hormonal contraception were identified as covariates. Adjusted odds ratios (AOR), their 95% confidence intervals, and respective P values were calculated to detect significant associations. Results: Sixty-two percent of the adolescents reported their typical sex partners were at least 2 years older. These adolescents were more likely to report never using condoms during the most recent sexual encounter (AOR = 2.0), during the last five sexual encounters (AOR = 2.0), and during the past month (AOR = 2.2). Similarly, having older partners was associated with greater odds of reporting any unprotected vaginal sex in the past 30 days (AOR = 1.7) or the past 6 months (AOR = 1.5). Conclusion: Our findings suggest that many adolescent females have sex partners who are at least 2 years older and that their relationship dynamics do not favor the adoption and maintenance of behavior protective against STD or HIV infection. Prevention programs could include training designed to help adolescent females overcome barriers to safer sex with older male partners.

Sexual sensation seeking, drug use and risky sex among detained youth

Voisin, D. R., King, K., Schneider, J., DiClemente, R., & Tan, K. (n.d.).

Publication year

2012

Journal title

Journal of AIDS and Clinical Research

Volume

Issue

SPL ISSUE1

10.4172/2155-6113.S1-017

Abstract

Abstract

Sexual sensation seeking has been correlated with drug use and risky sex in a number of populations. However, these relationships have had limited examination among adolescents, and to date, have not been explored among detained youth, a group with some of the highest rates of illicit drug use and STIs. To better understand these relationships we utilized A-CASI to collect data on sociodemographics, sexual sensation seeking, drug use and risky sexual behaviors among a sample of 550 detained youth. A series of multivariable regression models controlling for age, gender, race/ethnicity, socioeconomic status and risky peer networks indicated that sexual sensation seeking was associated with alcohol and ecstasy use; having sex while high on drugs; having sex with a partner who was high on drugs; having more sexual partners; having engaged in unprotected vaginal sex; and less condom use during oral sex, all in the 2 months prior to being detained. In addition, sexual sensation seeking was also associated with ever having exchanged sex for drugs or money. These data have important implications for STI/drug use prevention interventions among detained adolescents.

Sexually transmitted diseases, unintended pregnancy, and adolescent health promotion.

DiClemente, R., Santelli, J. S., DiClemente, R. J., Miller, K. S., & Kirby, D. (n.d.).

Publication year

1999

Journal title

Adolescent medicine (Philadelphia, Pa.)

Volume

Issue

Page(s)

87-108, vi

Abstract

Abstract

Adolescence is a critical period in the development of sexual behaviors that may lead to acquiring sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and to unintended pregnancy. Understanding adolescent sexual behavior is essential for understanding adolescents' risk of pregnancy and STD/HIV infection and for planning and evaluating health promotion activities. This chapter reviews the sexual behaviors and psychosocial factors associated with STDs and unintended pregnancy among adolescents as well as school-, community-, and clinic-based interventions designed to reduce risk behaviors and promote adolescent sexual health.

Sexually Transmitted Infections, Sexual Risk Behavior, and Intimate Partner Violence among African American Adolescent Females with a Male Sex Partner Recently Released from Incarceration

Swartzendruber, A., Brown, J. L., Sales, J. M., Murray, C. C., & DiClemente, R. (n.d.).

Publication year

2012

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

156-163

10.1016/j.jadohealth.2011.11.014

Abstract

Abstract

Purpose: Social networks directly and indirectly influence sexually transmitted infections (STIs) risk. The objective was to explore associations between sex with a male recently released from incarceration and sexual risk and intimate partner violence (IPV) among African American adolescent females. Methods: Sociodemographic, psychosocial, and sexual behavior data were collected at baseline, 6, and 12 months from African American females, aged 15-21 years, participating in an HIV/STI prevention trial. Among 653 participants with

Sleep medication use and incident dementia in a nationally representative sample of older adults in the US

Robbins, R., DiClemente, R., Troxel, A. B., Jean-Louis, G., Butler, M., Rapoport, D. M., & Czeisler, C. A. (n.d.).

Publication year

2021

Journal title

Sleep Medicine

Volume

Page(s)

183-189

10.1016/j.sleep.2020.11.004

Abstract

Abstract

Background: 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.

Smoking as a risk factor for STI diagnosis among African American females

Berg, C. J., Painter, J. E., Sales, J. M., Mays, D., Rose, E., Wingood, G. M., & DiClemente, R. (n.d.).

Publication year

2012

Journal title

American Journal of Health Behavior

Volume

Issue

Page(s)

505-512

10.5993/AJHB.36.4.7

Abstract

Abstract

Objectives: To examine the relationship of smoking to sexual risk outcomes among African American adolescent females. Methods: We analyzed baseline data from an HIV intervention trial, including sexual risk (older sex partners, number of vaginal sex partners, sex while high on drugs/alcohol, STI diagnosis) and smoking status among 715 participants. Results: Smoking prevalence was 23.1%. Controlling for covariates, smoking predicted having older partners (P=.001), having sex while high on alcohol or drugs (P

Ralph DiClemente