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
Body image and African American females' sexual health
AbstractWingood, G. M., DiClemente, R., Harrington, K., & Davies, S. L. (n.d.).Publication year
2002Journal title
Journal of Women's HealthVolume
11Issue
5Page(s)
433-439AbstractObjectives: This study examines the association between African American adolescent females' body image and their sexual health. Methods: African American adolescent females (n = 522) completed a survey that assessed body image using a 7-item scale (α = 0.71) and a face-to-face interview that assessed sexual behaviors. Results: In logistic regression analyses, controlling for depression, self-esteem and body mass index (BMI), adolescents who were more dissatisfied with their body image were more likely to fear abandonment as a result of negotiating condom use (adjusted odds ratio [AOR] = 3.3, p = 0.02), more likely to perceive that they had fewer options for sexual partners (AOR = 2.4, p = 0.001), more likely to perceive themselves as having limited control in their sexual relationships (AOR = 2.0, p = 0.002), and more likely to worry about acquiring HIV(AOR = 1.5, p = 0.04). There was an association between having a greater dissatisfaction with one's body image and never using condoms during sexual intercourse in the past 30 days (AOR = 1.6, p = 0.04) and more likely to engage in unprotected vaginal sex in the prior 6 months (AOR = 1.6, p = 0.04). Conclusions: Prior research has demonstrated an association between African American women's body image and greater obesity risk, lower self-esteem, and greater depression. The present study has shown an association between body image dissatisfaction and a range of sexual attitudes, beliefs, and behaviors. Women who are more dissatisfied with their body image may be at greater risk for unintended pregnancy, sexually transmitted infections (STIs), and HIV infection.Condom use and correlates of African American adolescent females' infrequent communication with sex partners about preventing sexually transmitted diseases and pregnancy
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Cobb, B. K., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Health Education and BehaviorVolume
29Issue
2Page(s)
219-231AbstractThis study of 522 African American female adolescents, ages 14 to 18, investigated associations between condom use and infrequently communicating with sex partners about sexually transmitted diseases (STDs) and pregnancy prevention. Correlates of infrequent communication were identified. Sexually active adolescents were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Communication frequency was assessed using a five-item scale. Infrequent communication was significantly associated with lower odds of condom use. Multivariate correlates of infrequent communication were less frequent communication with parents about STD/pregnancy prevention, recent sex with a nonsteady partner, low perceived ability to negotiate condom use and fear of this negotiation, and low motivation to use condoms. Given the importance of partner communication in promoting safer sex behaviors. STD and pregnancy prevention programs may benefit adolescents by addressing the identified psychosocial correlates of infrequent communication with their partners.Design, measurement, and analytical considerations for testing hypotheses relative to condom effectiveness against non-viral STIs
AbstractDiClemente, R., Crosby, R., DiClemente, R. J., Holtgrave, D. R., & Wingood, G. M. (n.d.).Publication year
2002Journal title
Sexually transmitted infectionsVolume
78Issue
4Page(s)
228-231Abstract~Enhancing STD/HIV prevention among adolescents : The importance of parental monitoring
AbstractDiClemente, R., Diclemente, R. J., Crosby, R. A., & Wingood, G. M. (n.d.).Publication year
2002Journal title
Minerva PediatricaVolume
54Issue
3Page(s)
171-177AbstractThe risk of acquiring sexually transmitted diseases (STDs) and HIV infection is one of the most significant and immediate risks to the health and well being of adolescents. One promising strategy to protect adolescents from STD/HIV infection is to promote parental monitoring. In this article, we first review selected observational studies that provide evidence supporting the value of parental monitoring in reducing adolescents' risk of STD/HIV acquisition. Subsequently, we discuss the potential implications of the research in regards to clinic-and community-based STD/HIV prevention programs for adolescents.Family-related correlates of sexually transmitted disease and barriers to care : A pilot study of pregnant African American adolescents
AbstractCrosby, R. A., Wingood, G. M., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2002Journal title
Family and Community HealthVolume
25Issue
2Page(s)
16-27AbstractThis study explored associations between family-related measures and sexually transmitted disease (STD) history among 170 pregnant African American adolescent females, 14 to 20 years of age, attending prenatal care clinics in a large urban area of the South. Measures of low family support and infrequent mother-daughter communication were significant bivariate correlates of having at least one STD. Mother-daughter communication about preventing acquired immune deficiency syndrome remained significant in a multivariate model. The study also explored barriers to STD care-seeking behavior and found that few adolescents perceived access or financial issues as reasons to delay entry into the medical system. Low perceived family support was marginally associated with greater perceived barriers to STD care.Gang involvement and the health of African American female adolescents.
AbstractWingood, G. M., DiClemente, R., Crosby, R., Harrington, K., Davies, S. L., & Hook, E. W. (n.d.).Publication year
2002Journal title
PediatricsVolume
110Issue
5Page(s)
e57AbstractOBJECTIVE: To examine the association between gang involvement and female adolescents' health. METHODS: African American adolescent females (N = 522) completed a survey that assessed their history of gang involvement and health behaviors and provided specimens that were analyzed for marijuana use and sexually transmitted diseases. RESULTS: In logistic regression analyses, adolescents with a history of gang involvement were more likely to have been expelled from school (odds ratio [OR]: 3.6), be a binge drinker (OR: 3.3), have a positive toxicologic test for marijuana (OR: 2.6), have been in 3 or more fights in the past 6 months (OR: 3.8), have a nonmonogamous partner (OR: 2.4), and test positive for Trichomonas vaginalis (OR: 2.2) and Neisseria gonorrhoeae (OR: 3.6). CONCLUSION: This study extends the current research on risk behaviors associated with gang involvement to include biological markers for substance use and sexual health outcomes, namely, marijuana use and sexually transmitted diseases.HIV prevention for adolescents : Identified gaps and emerging approaches
AbstractDiClemente, R., Crosby, R. A., & Wingood, G. M. (n.d.).Publication year
2002Journal title
ProspectsVolume
32Issue
2Page(s)
135-153Abstract~HIV-associated histories, perceptions, and practices among low-income African American women : Does rural residence matter?
AbstractCrosby, R. A., Yarber, W. L., DiClemente, R., Wingood, G. M., & Meyerson, B. (n.d.).Publication year
2002Journal title
American journal of public healthVolume
92Issue
4Page(s)
655-659AbstractObjectives. This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. Methods. A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. Results. Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P = .001), that a sex partner had not been tested for HIV (P = .005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P = .02), not using condoms (P = .009), and a belief that their partner was HIV negative, despite lack of testing (P = .04). Conclusions. This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.HIV/STD prevention benefits of living in supportive families : A prospective analysis of high risk African-American female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., & Harrington, K. (n.d.).Publication year
2002Journal title
American Journal of Health PromotionVolume
16Issue
3Page(s)
142-145AbstractThe relationship between family and sexual activity-related factors were measured among 522 African American adolescent girls recruited from schools and clinics in Birmingham, Alabama. Girls living with a mother in a supportive family were more likely to use condoms when having sex, less likely to have recent emotional abuse from their sex partners, less fear and higher self-efficacy in negotiating use of a condom, and fewer partner-related barriers to safer sex.Low parental monitoring predicts subsequent pregnancy among African-American adolescent females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Pediatric and Adolescent GynecologyVolume
15Issue
1Page(s)
43-46AbstractStudy Objective: Accumulating evidence suggests that parental monitoring is associated with adolescents' sexual risk behaviors. However, evidence associating low parental monitoring with greater odds of becoming pregnant has not been reported. The objective of this study was to prospectively assess the relationship of low perceived parental monitoring with incidence of biologically confirmed pregnancy among a sample of low-income African-American adolescent females. Design: A prospective study. Setting and Participants: African-American females 14-18 years of age were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and interview at baseline and 6 months later. The study achieved an 85.7% baseline participation rate (n = 522) and 92% (n = 482) returned at follow-up. Only adolescents who initially tested negative for pregnancy were included in the analysis (n = 410). Main Outcome Measure: Incidence of biologically assessed pregnancy. Results: In controlled analyses, among adolescents testing negative for pregnancy at baseline, those who reported less parental monitoring were 2.5 times more likely to become pregnant in the 6-month follow-up period (AOR = 2.50, 95% CI = 1.1-5.9, P < .04). Conclusion: Low parental monitoring was prospectively associated with incidence of biologically confirmed pregnancy among minority adolescent females. This finding adds to a growing body of empirical literature that supports the value of parental monitoring as a protective factor in adolescents' lives. Interventions designed to increase parental monitoring or adolescent females' perceptions of their parents' monitoring may be effective components of pregnancy prevention programs designed for minority youth.Participation by African-American adolescent females in social organization : Associations with HIV-protective behaviors
AbstractCrosby, R. A., DiClemente, R., Wingwood, G. M., Harrington, K., Davies, S., & Malow, R. (n.d.).Publication year
2002Journal title
Ethnicity and DiseaseVolume
12Issue
2Page(s)
186-192AbstractBackground: African-American adolescent females are disproportionately affected by the HIV epidemic in the United States. One important potential, yet understudied, protective influence that may reduce African-American adolescents' HIV risk behavior is their involvement in social organizations. Objective: To examine the association between high-risk African-American adolescent females' activity in social organizations and their recent HIV-associated sexual risk behavior. Methods: Sexually active, African-American females (N = 522) were recruited from schools and adolescent medicine clinics in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a self-administered survey and face-to-face interview. Adolescents' participation in Black social organizations was assessed. Measures of HIV protective behavior were also assessed. Bivariate analysis was followed by logistic regression to calculate adjusted odds ratios (AOR) for the outcomes. Results: Adolescents not belonging to social organizations were about 1.6 times more likely to report recent acquiescence to unwanted sex without a condom, 1.9 times more likely to report that their current steady sex partner had other partners, and 1.9 times more likely to score low on the measure of sex-related communication with parents. Discussion: Findings from controlled analyses suggest that community-based Black social organizations may be an important venue for protecting African-American adolescent females from having sex with a partner who has concurrent partners, and from having unwanted sex without a condom. Participation in Black social organizations was also associated with more frequent interaction between adolescents and their parents about sex-related issues such as HIV prevention. Models of HIV prevention that promote community involvement may be an under-utilized intervention modality with high potential impact.Predictors of infection with Trichomonas vaginalis : A prospective study of low income African-American adolescent females
AbstractDiClemente, R., Crosby, R., DiClemente, R. J., Wingood, G. M., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually transmitted infectionsVolume
78Issue
5Page(s)
360-364AbstractObjectives: To identify psychosocial predictors of Trichomonas vaginalis infection among low income African-American adolescent females living in a high risk urban area of the United States. Methods: Baseline plus 6 and 12 month follow up data collected as part of an HIV prevention intervention trial were utilised. The baseline sample consisted of 522 African-American females, 14-18 years of age. Recruitment sites were located in low income neighbourhoods of Birmingham, Alabama, characterised by high rates of unemployment, substance abuse, violence, teenage pregnancy, and sexually transmitted infections. Self administered vaginal swab specimens were cultured for T vaginalis. Baseline measures collected as part of a self administered survey and face to face interviews were used to predict subsequent infection with T vaginalis at any of the three assessment periods conducted over the span of 1 year. Results: At baseline, 12.9% were diagnosed with T vaginalis. At the 6 and 12 month follow ups, T vaginalis was diagnosed in 8.9% and 10.2%, respectively. The strongest multivariate predictor of T vaginalis infection was biologically confirmed marijuana use; those using marijuana were more than six times as likely to test positive for T vaginalis (adjusted odds ratio (AOR) = 6.2, p = 0.0003). Other multivariate predictors were reporting that typical sex partners were at least 5 years older (AOR = 2.6; p = 0.005), reporting sex with non-steady partners (AOR = 1.9; p = 0.02), and history of delinquency (AOR = 1.3; p = 0.02). The odds of testing positive increased by 31% for every one unit increase on a six item scale measure of delinquency. Conclusions: Infection with T vaginalis was common and significant multivariate predictors comprised a constellation of problem behaviours, each of which are potentially amenable to behavioural intervention.Pregnant African-American teens are less likely than their nonpregnant peers to use condoms
AbstractCrosby, R., DiClemente, R., Wingood, G. M., Sionean, C., Harrington, K., Davies, S. L., Oh, K., & Hook, E. (n.d.).Publication year
2002Journal title
Preventive MedicineVolume
34Issue
5Page(s)
524-528AbstractObjective. The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition. Methods. Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded. Results. Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%). Conclusions. Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.Prevalence and correlates of Chlamydia trachomatis among sexually active African-American adolescent females
AbstractWilliams, K. M., Wingood, G. M., DiClemente, R., Crosby, R. A., McCree, D. H., Liau, A., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Preventive MedicineVolume
35Issue
6Page(s)
593-600AbstractBackground. Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the United States and disproportionately affects African-American adolescents. The objectives of this study are to determine the prevalence of C. trachomatis and to identify correlates of infection among African-American adolescent females. Methods. Sexually active African-American adolescent females (n = 522) completed a self-administered survey and structured interview and provided vaginal swab specimens for laboratory assessment of STDs. The relationship among selected psychosocial, behavioral, and biologically confirmed STDs and C. trachomatis was assessed. Results. The prevalence of C. trachomatis was 17.4%. Results of multiple logistic regression revealed that adolescents testing positive for C. trachomatis infection were significantly more likely to test positive for gonorrhea (OR = 5.0; 95% confidence interval (CI) 1.69-14.83); to report nonuse of condoms with a steady partner (OR = 2.4; 95% CI 1.23-4.76); to be in shorter relationships (OR = 2.2, 95% CI 1.13-4.30); and to perceive less parental monitoring (OR = 2.1; 95% CI 1.08-4.15). Conclusions. Study findings emphasize the need for assessing psychosocial factors, behavioral factors, and the presence of other STDs when determining risk for C. trachomatis. Several of the constructs identified are particularly amenable to behavioral interventions designed to prevent infection.Prevention interventions for HIV positive individuals
AbstractDiClemente, R., Wingood, G. M., del Rio, C., & Crosby, R. A. (n.d.).Publication year
2002Journal title
Sexually transmitted infectionsVolume
78Issue
6Page(s)
393-395Abstract~Protease inhibitor combination therapy and decreased condom use among gay men
AbstractDiClemente, R., Funkhouser, E., Wingood, G., Fawal, H., Holmberg, S. D., & Vermund, S. H. (n.d.).Publication year
2002Journal title
Southern Medical JournalVolume
95Issue
4Page(s)
421-425AbstractBackground. The objective of the study was to determine whether treatment with protease inhibitors is associated with unprotected sexual behavior. Methods. A total of 592 HIV-infected persons recruited from statewide public clinics in nonurban Alabama communities completed an assessment that, among other variables, elicited information on demographics, current sexual practices, health status, and medication use. Associations of treatment with protease inhibitors and high-risk sexual behavior were estimated, adjusting for potential confounders. Results. Treatment with protease inhibitors was not associated with whether a person was sexually active or with high-risk practices among sexually active heterosexual men and women. Among men who had sex with men, however, treatment with protease inhibitors was associated with never using condoms and with inconsistent use of condoms. Conclusions. Clinicians treating patients with protease inhibitors should consider providing risk-reduction counseling.Psychosocial and behavioral correlates of refusing unwanted sex among African-American adolescent females
AbstractSionéan, C., DiClemente, R., Wingood, G. M., Crosby, R., Cobb, B. K., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Adolescent HealthVolume
30Issue
1Page(s)
55-63AbstractPurpose: To identify psychosocial and behavioral correlates of refusing unwanted sex among African-American female adolescents. We hypothesized that greater power in relationships, less concern about negative emotional consequences, supportive family and peers, positive self-perceptions, greater perceived risk, and fewer sexual risk behaviors would be associated with increased odds of refusing unwanted sex. Methods: Data regarding demographics, sexual behaviors, communication with parents, and psychosocial factors relevant to romantic and sexual partnerships were collected both via self-administered questionnaire and structured interview from a clinic- and school-based sample of 522 African-American adolescent females ages 14-18 years in Birmingham, Alabama. Adjusted odds ratios were calculated using logistic regression. Results: Of those who had experienced pressure for unwanted sex (n = 366), 69% consistently refused to engage in unwanted sex. Adolescents with high safer sex self-efficacy and low perceived partner-related barriers (i.e., concerns about partners' negative emotional reactions) to condom negotiation were over 2.5 times more likely to consistently refuse unwanted sex than were those reporting low safer sex self-efficacy and high partner-related barriers. Adolescents who spoke more frequently with their parents about sexual issues were nearly twice as likely to consistently refuse unwanted sex than were those who spoke less frequently with their parents. Conclusions: Sexual-risk reduction efforts directed toward adolescent females should seek to build self-efficacy to negotiate safer sex and provide training in social competency skills that may help to reduce or eliminate partner barriers to condom use. Further, sexual risk-reduction programs may be more effective if they include parents as advocates of safer sexual behaviors.Psychosocial predictors of pregnancy among low-income African-American adolescent females : A prospective analysis
AbstractDiClemente, R., Wingood, G. M., DiClemente, R., Crosby, R. A., DiClemente, R., Harrington, K., & Davies, S. (n.d.).Publication year
2002Journal title
Journal of Pediatric and Adolescent GynecologyVolume
15Issue
5Page(s)
293-299AbstractObjective: To prospectively identify psychosocial predictors of pregnancy among African-American adolescent females. Methods: African-American females, 14-18 yrs old, were recruited from schools and health clinics in low-income neighborhoods. Adolescents completed an in-depth survey and provided urine specimens for pregnancy testing at baseline and 6-month intervals for 1.5 years. Selected problem behaviors, demographic, and psychosocial variables were tested for bivariate and multivariate significance relative to biologically confirmed pregnancy during the follow-up period. Only adolescents who initially tested negative for pregnancy were included (n = 241). Results: About 26% (n = 63) of the adolescents became pregnant over the follow-up period. Although a broad spectrum of variables achieved bivariate significance, few retained significance in the multivariate model. Multivariate predictors of pregnancy were biologically confirmed marijuana use (adjusted odds ratios [AOR] = 12.4, P = 0.0003) and perceiving that the sex partner desired pregnancy (AOR = 1.27, P = 0.01). A protective effect was observed for adolescents who reported that a family member received welfare benefits; these adolescents were about 60% less likely to become pregnant (AOR = 0.38, P = 0.04). Conclusions: Pediatricians and other health professionals who participate in community efforts to prevent first and subsequent adolescent pregnancies may benefit from recognizing that marijuana use and pregnancy may be co-occurring problems. Adolescents' perceptions of their boyfriends' level of desire for conception may also be an important predictor of pregnancy risk. The findings also suggest a possible protective effect of receiving TANF (Temporary Assistance to Needy Families) benefits; adolescent recipients of these programs may be more vigilant in their pregnancy prevention practices than those who are not recipients.Risk among men who have sex with men in the united states : A comparison of an Internet sample and a conventional outreach sample
AbstractRhodes, S. D., DiClemente, R., Cecil, H., Hergenrather, K. C., & Yee, L. J. (n.d.).Publication year
2002Journal title
AIDS Education and PreventionVolume
14Issue
1Page(s)
41-50AbstractThis study compared the demographics and risk behaviors of two samples of men who have sex with men (MSM), using cross-sectional data that were collected via the Internet and through conventional bar-based outreach. The Internet sample was significantly older, more likely to identify as "bisexual," and less educated than the bar sample. After controlling for age and education, few differences were observed between the samples. However, three variables that markedly differentiated the samples were history of sexually transmitted disease infection, HIV serostatus, and sources utilized to obtain health information. No difference in Internet use was found. Based on the possible decreased social desirability promoted by the use of electronic data collection methodologies, these findings provide preliminary evidence that Internet and bar respondents are similar and that the Internet may serve as an expedient as well as reliable methodology to increase understanding of risk among MSM.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
AbstractDiClemente, R., Yarber, W. L., Milhausen, R., Crosby, R. A., & Di Clemente, R. J. (n.d.).Publication year
2002Journal title
American Journal of Health EducationVolume
33Issue
4Page(s)
206-215AbstractThis 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.Sexual risk behaviors associated with having older sex partners : A study of black adolescent females
AbstractDiClemente, 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
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
1Page(s)
20-24AbstractBackground: 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.A prospective study of psychological distress and sexual risk behavior among black adolescent females.
AbstractDiClemente, R., DiClemente, R. J., Wingood, G. M., Crosby, R. A., Sionean, C., Brown, L. K., Rothbaum, B., Zimand, E., Cobb, B. K., Harrington, K., & Davies, S. (n.d.).Publication year
2001Journal title
PediatricsVolume
108Issue
5Page(s)
E85AbstractOBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.Condom carrying is not associated with condom use and lower prevalence of sexually transmitted diseases among minority adolescent females
AbstractDiClemente, R., Wingood, G. M., Crosby, R., Sionean, C., Cobb, B. K., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2001Journal title
Sexually Transmitted DiseasesVolume
28Issue
8Page(s)
444-447AbstractBackground: Most of the studies associated with condom carrying and use have been conducted with adults. Because minority teenage females are particularly at risk for STD/HIV infection, further investigations specifically focusing on this population are warranted. Goal: To determine whether observed condom carrying among adolescent females was associated with multiple measures of self-reported condom use, self-reported history of sexually transmitted diseases, and prevalence of biologically confirmed sexually transmitted diseases. Methods: For this study, 522 sexually active African American adolescent females were recruited from low-income neighborhoods in Birmingham, Alabama. Measures of self-reported condom use, STD history, and condom carrying were collected. Adolescents were also tested for three prevalent sexually transmitted diseases. Results: At the time of the assessment, 8% of the adolescents were observed to have a condom with them. Condom carrying was not found to be significantly associated with condom use and prevalence of sexually transmitted diseases. Conclusion: Condom carrying may not be an important outcome of sexually transmitted disease/HIV prevention programs designed to reduce HIV/sexually transmitted disease risk among adolescent females.Correct condom application among African-American adolescent females : The relationship to perceived self-efficacy and the association to confirmed STDs
AbstractCrosby, R., DiClemente, R., Wingood, G. M., Sionean, C., Cobb, B. K., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2001Journal title
Journal of Adolescent HealthVolume
29Issue
3Page(s)
194-199AbstractPurpose: To assess condom application ability and the relationship between perceived ability and demonstrated ability. Also, to examine the association between high-demonstrated condom application ability and recent sexual risk behaviors and laboratory-diagnosed sexually transmitted diseases (STDs) among African-American adolescent females. Methods: A purposeful sample of sexually active African-American females (n = 522) completed a structured interview and provided vaginal swab specimens for STD testing. Subsequent to the interview, adolescents demonstrated their condom application skills using a penile model. A 9-item scale assessed adolescents' perceived self-efficacy to apply condoms. Sexual risk behaviors assessed by interview were noncondom use at last intercourse and the last five intercourse occasions for steady and casual sex partners as well as any unprotected vaginal sex in the past 30 days and the past 6 months.Results: Approximately 28% of the sample tested positive for at least one STD and nearly 26% self-reported a history of STDs. Controlled analyses indicated that adolescents' self-efficacy for correct use was not related to demonstrated skill. Adolescents' demonstrated ability was not related to any of the sexual risk behaviors. Likewise, recent experience applying condoms to a partner's penis and demonstrated ability were not related to laboratory-diagnosed STDs or self-reported STD history. Conclusions: Adolescents may unknowingly be at risk for human immunodeficiency virus and STD infection owing to incorrect condom application. Further, high-demonstrated ability to apply condoms was not related to safer sex or STDs. Reducing sexual risk behaviors may require more than enhancing adolescent females' condom application skills and may require addressing other relational skills.Correlates of Adolescent Females' Worry About Undesired Pregnancy : The Importance of Partner Desire for Pregnancy
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Sionean, C., Cobb, B. K., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2001Journal title
Journal of Pediatric and Adolescent GynecologyVolume
14Issue
3Page(s)
123-127AbstractStudy Objective: The purpose of this study was to determine correlates of worry about pregnancy among a high-risk sample of low-income African-American adolescent females. Specifically, we tested the hypothesis that perceived male partner desire for pregnancy and level of sexual communication would be independently associated with adolescent females' worry about becoming pregnant. Design: A survey of sexually active African-American adolescent females, 14-18 years of age. Setting: Recruitment was conducted in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and teen pregnancy. Participants: Adolescents (N = 522) completed a survey and a face-to-face interview, and provided a urine specimen for pregnancy testing. Main Outcome Measure: Nonpregnant adolescents reporting steady relationships with a male sex partner (over the past 6 months) and indicating no immediate desire to become pregnant were included in the analysis (n = 196). Two questionnaire items assessed level of worry about becoming pregnant. Results: Compared to adolescent females reporting their partner did not desire pregnancy, those perceiving their partner desired pregnancy were nearly three times more likely to experience high worry about becoming pregnant (AOR = 2.85; P = .009). Engaging in sex unprotected by a condom was an equally important correlate of high worry (AOR = 2.84; P = .013). Level of communication between partners about pregnancy prevention was not significant. Conclusions: Adolescent females may experience high worry about becoming pregnant due to desires of their male partner as well as their recent sexual risk behavior.