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
Pregnancy desire among disadvantaged African American adolescent females
AbstractDavies, S. L., DiClemente, R. J., Wingood, G. M., Harrington, K. F., Crosby, R. A., & Sionean, C. (n.d.).Publication year
2003Journal title
American Journal of Health BehaviorVolume
27Issue
1Page(s)
55-62AbstractObjective: To examine the prevalence and correlates of wanting to become pregnant among a sample of 462 sexually active nonpregnant African American adolescent females. Methods: Multivariate logistic regression was used to calculate adjusted odds ratios, their 95% confidence intervals, and respective P values. Results: Significant correlates with pregnancy desire included having a male partner who desired pregnancy, having a boyfriend at least 5 years older, having low self-esteem, perceiving greater perceived barriers to condom use, and perceiving low family support. Conclusions: Pregnancy prevention programs designed for economically disadvantaged African American adolescent females should address these correlates of their pregnancy desire.Psychosocial impact of serological diagnosis of herpes simplex virus type 2: A qualitative assessment
AbstractMelville, J., Sniffen, S., Crosby, R., Salazar, L., Whittington, W., Dithmer-Schreck, D., DiClemente, R., & Wald, A. (n.d.).Publication year
2003Journal title
Sexually transmitted infectionsVolume
79Issue
4Page(s)
280-285AbstractObjectives: To assess the emotional and psychosocial responses to a serological diagnosis of HSV-2 infection in individuals without previous history of genital herpes. Methods: 24 individuals who had a positive HSV-2 serology by western blot and no clinical history of disease were recruited from four clinics (sexually transmitted disease, maternal and infant care, family medicine, and virology research) over a 10 month period. In-depth qualitative interviews were conducted to elicit an individual's responses to the HSV-2 diagnosis. Results: Three categories of themes were identified from the interviews. Short term emotional responses included surprise, denial, confusion, distress, sadness, disappointment, and relief to know. Short term psychosocial responses included fear of telling sex partners, anger at the source partner, guilt about acquiring or transmitting, and concern about transmitting to a child. Perceived ongoing responses included fear of telling future partners, concern about transmitting to a sex partner, feeling sexually undesirable, feeling socially stigmatised, feeling like "damaged goods," sex avoidance due to social responsibility, fear of transmitting to a newborn, and relationship concerns relating to the diagnosis. Conclusions: Individuals exhibit strong emotional and psychosocial responses to a serological diagnosis of HSV-2 infection. Many of the negative responses may be time limited and influenced by factors that are potentially amenable to counselling.Psychosocial predictors of hepatitis B vaccination among young African-American gay men in the deep south
AbstractRhodes, S. D., & Diclemente, R. J. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
5Page(s)
449-454AbstractBackground: Despite recommendations for vaccination against hepatitis B virus (HBV) of men who have sex with men (MSM), most remain unvaccinated. Goal: The goal of this study was to identify attitudes and beliefs associated with vaccination against HBV among black MSM. Study Design: The Birmingham Vaccine Acceptance Questionnaire was used to collect data from gay bar patrons. Results: Of the 143 participants, nearly 42% reported at least one dose of HBV vaccine. In multivariable analysis, characteristics associated with vaccination were a decreased perception of barriers to HBV vaccination (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.22-0.61; P = 0.001); increased perceived medical severity (OR, 5.34; 95% CI, 2.38-11.96; P = 0.001) and personal severity (OR, 2.22; 95% CI, 1.38-3.56; P = 0.006) of HBV infection; and increased perceived general medical self-efficacy (OR, 9.22; 95% CI, 3.52-24.11; P = 0.0001) and personal self-efficacy (OR, 2.3; 95% CI, 1.14-4.63; P = 0.008) to complete the three-dose series. Conclusions: Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing perceived severity of HBV infection and self-efficacy to complete the vaccine series.Religiosity and risky sexual behavior in African-American adolescent females
AbstractMcCree, D. H., Wingood, G. M., DiClemente, R., Davies, S., & Harrington, K. F. (n.d.).Publication year
2003Journal title
Journal of Adolescent HealthVolume
33Issue
1Page(s)
2-8AbstractPurpose: To examine the association between religiosity (defined by frequency of engaging in religious/spiritual activities) and African-American adolescent females' sexual behaviors, attitudes toward sex, and ability to negotiate safer sex. Methods: Between December 1996 and April 1999, 1130 female adolescents were screened for eligibility in a sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention trial. Data collection was achieved through a confidential self-administered questionnaire that examined religiosity and a structured interview regarding sexual behavior. Descriptive statistics were used to characterize the sociodemographics of the sample and logistic regression was used to measure the association between religiosity and the outcome variables. Results: In the study sample (n = 522), 64% of the adolescents had higher religiosity scores based on a 4-item scale (α = .68). Results indicate that adolescents who had higher religiosity scores were significantly more likely to have higher self-efficacy in communicating with new, as well as steady male partners about sex; about STDs, HIV, and pregnancy prevention; and in refusing an unsafe sexual encounter. These adolescents were also more likely to have initiated sex at a later age, used a condom in the past 6 months, and possess more positive attitudes toward condom use. Conclusions: Results from this study indicate a relationship between religiosity and sexual behaviors, attitudes toward sex, and ability to negotiate safer sex.Rural and nonrural African American high school students and STD/HIV sexual-risk behaviors
AbstractMilhausen, R. R., Crosby, R., Yarber, W. L., DiClemente, R. J., Wingood, G. M., & Ding, K. (n.d.).Publication year
2003Journal title
American Journal of Health BehaviorVolume
27Issue
4Page(s)
373-379AbstractObjective: To determine differences between African American adolescents on STD/HIV sexual-risk behaviors and precursors to these risk behaviors. Methods: Six hundred sixty-three rural and 3313 nonrural adolescents who completed the 1999 YRBS Survey were selected. Results: Rural females and males were more likely to report ever having coitus and not using a condom during last coitus. Rural females were also more likely to report early coistus, having 3 or more lifetime coital partners, and having more than 1 coital partner in the last 3 months. Conclusions: African American rural adolescents, particularly females, may have greater risk for STD/HIV infection than do their nonrural counterparts.Social capital as a predictor of adolescents' sexual risk behavior: A state-level exploratory study
AbstractCrosby, R. A., Holtgrave, D. R., DiClemente, R. J., Wingood, G. M., & Gayle, J. A. (n.d.).Publication year
2003Journal title
AIDS and BehaviorVolume
7Issue
3Page(s)
245-252AbstractThis exploratory study assessed the state-level association between social capital, poverty, and income inequality and adolescents' sexual risk and protective behaviors. A cross-sectional design using state-level correlations was employed. Seven outcome measures from the national 1999 Youth Risk Behavior Surveillance Survey were used. For females and males, social capital was significantly associated with five of the seven outcome measures (all associations p < .01). For females, the amount of variance explained by these correlations ranged from 23% to 45%; the range for males was 20% to 52%. Poverty was not a significant predictor of any outcome variable. Income inequality was a significant predictor of birth control usage among females, but in multivariate regression analyses, only social capital retained significance. Findings provide preliminary evidence that social capital may have a profound influence of adolescents' sexual risk and protective behaviors. Social capital was inversely correlated with sexual risk behaviors and positively correlated with protective sexual behaviors. Further and more comprehensive research involving social capital and adolescents is warranted.Testing for HSV-2 infection among pregnant teens: Implications for clinical practice
AbstractCrosby, R. A., DiClemente, R. J., Wingood, G. M., & Rose, E. (n.d.).Publication year
2003Journal title
Journal of Pediatric and Adolescent GynecologyVolume
16Issue
1Page(s)
39-41AbstractObjectives: To pilot test the feasibility of screening pregnant teens for HSV-2 infection during their first prenatal visit. Study Design: A cross-sectional study of 127 African-American adolescent females recruited during their first attendance to a prenatal clinic in a large urban hospital. A rapid serologic test (POCkit, manufactured by Diagnology Inc.) was used to assess HSV-2. The test uses a membrane-based immunoassay to detect circulating IgG antibodies to a specific antigen obtained from HSV-2 (semi-purified glycoprotein G2). Results: More than one-fifth (21.3%) of the adolescents tested positive for HSV-2; only 1 adolescent was previously aware of her infection. Older adolescents and those reporting a history of other STDs were significantly more likely to test positive for HSV-2. Conclusions: Testing for HSV-2 in early pregnancy may be an efficient strategy for (1) initiating patient education designed to promote adoption of protective behaviors among adolescents at risk of HSV-2 acquisition during the remainder of their pregnancy and (2) teaching those who test positive how to recognize symptoms of HSV-2 outbreaks; patients reporting recurrent outbreaks during pregnancy may benefit from predelivery assessment.Utility of the AIDS risk assessment for crack cocaine and sex risk behaviours among homeless persons addicted to crack undergoing behavioural day treatment
AbstractSchumacher, J. E., Ross, D., Milby, J. B., Sekar, P., Diclemente, R., & Wallace, D. (n.d.).Publication year
2003Journal title
Journal of Substance UseVolume
8Issue
4Page(s)
205-214AbstractThe primary aim of this study was to assess the impact of an HIV and drug addiction intervention on reported sexual transmission HIV risk and drug use among homeless persons in two treatments for cocaine addiction. The ARA-C study (n = 104) included 74 (71.2%) men and 30 (28.8%) women with an average age of 37.8 (SD = 6.9) years. Most participants were African American (90, 86.5%) and the remainder were Caucasian (14, 13.5%). All participants met criteria for homelessness, nonpsychotic mental distress, and admitted to smoking crack cocaine within the 2 weeks prior to treatment. It appears that, overall, behavioural day treatment for cocaine disorders among homeless persons can have a short- and long-term impact on the reduction of sexual transmission HIV risk among this population with a minimal sexual transmission HIV risk intervention. The causal factors of this outcome still remain unclear. Treatment group differences did not sufficiently explain sexual transmission risk reductions and the impact of the HIV risk education programme was impossible to explain because it was provided to all participants and was only a small part of the overall programme. There did seem to be a small contribution of drug abstinence in the reduction of sexually transmitted risk, but this was at one time point for the Sex and Crack subscale only. This study demonstrates that there may be promise in providing drug addiction treatment combined with sexual transmission HIV risk reduction prevention programming for this extremely vulnerable group, and that future interventions should be better designed and tested using more robust research.Value of Consistent Condom Use: A Study of Sexually Transmitted Disease Prevention among African American Adolescent Females
Crosby, R. A., DiClemente, R. J., Wingood, G. M., Lang, D., & Harrington, K. F. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
6Page(s)
901-902Activity of African-American female teenagers in black organisations is associated with STD/HIV protective behaviours: A prospective analysis
Crosby, R. A., DiClemente, R. J., Wingood, G. M., Harrington, K., Davies, S., & Oh, M. K. (n.d.).Publication year
2002Journal title
Journal of Epidemiology and Community HealthVolume
56Issue
7Page(s)
549-550Adolescents' ambivalence about becoming pregnant predicts infrequent contraceptive use: A prospective analysis of nonpregnant African American females
AbstractCrosby, R. A., DiClemente, R. J., Wingood, G. M., Davies, S. L., & Harrington, K. (n.d.).Publication year
2002Journal title
American Journal of Obstetrics and GynecologyVolume
186Issue
2Page(s)
251-252AbstractThis study prospectively investigated the hypothesis that ambivalence about becoming pregnant is associated with comparatively less frequent use of contraception. Findings from a sample of sexually active African American adolescent, nonpregnant females (n = 375) supported this hypothesis. Prevention programs may benefit from content designed to redress adolescents' positive beliefs about early parenthood.Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status: A case for intensifying clinic-based prevention efforts
AbstractDiclemente, R. J., Wingood, G. M., Sionéan, C., Crosby, R., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
9Page(s)
503-509AbstractBackground: Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable sub-group is African American females. The association between adolescents' previous experience of STD and recent sexual risk behaviors has been ill-defined. Goal: The goal was to examine the associations between adolescents' self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status. Study Design: This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates. Results: Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93; P = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79; P = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51; P < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28; P = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09-9.89; P = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09-5.23; P = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59; P = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45-1.37; P = 0.38). Conclusion: Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.Associations between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases among African American adolescent females
AbstractLiau, A., Diclemente, R. J., Wingood, G. M., Crosby, R. A., Williams, K. M., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
7Page(s)
387-390AbstractBackground: Numerous studies have examined the association between adolescents' marijuana use and their high-risk sexual behaviors and sexually transmitted diseases (STDs). However, the validity of the findings is questionable because most of the studies relied on self-reporting for measurement of marijuana use and key outcome (i.e., STDs). Goal: The goal was to investigate associations between biologically confirmed marijuana use and laboratory-confirmed STDs and condom use. Study Design: African American females adolescents (n = 522) completed a self-administered survey and face-to-face interview. The adolescents provided urine and vaginal swab specimens that were analyzed for marijuana metabolites and STDs, respectively. Results: Among the study subjects, 5.4% tested positive for marijuana. These adolescents were more likely to test positive for Neisseria gonorrhoeae (adjusted odds ratio [AOR] = 3.4) and Chlamydia trachomatis (AOR = 3.9). They were more likely to have never used condoms in the previous 30 days (AOR = 2.9) and to have not used condoms consistently in the previous 6 months (AOR = 3.6). Conclusion: The findings represent unique biologic evidence that STDs and sexual risk behavior may co-occur with marijuana use. Interventions designed to reduce adolescents' risk of STDs and HIV infection should address marijuana use.Body image and African American females' sexual health
AbstractWingood, G. M., DiClemente, R. J., 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. J., 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
Crosby, R., DiClemente, R. J., Holtgrave, D. R., & Wingood, G. M. (n.d.).Publication year
2002Journal title
Sexually transmitted infectionsVolume
78Issue
4Page(s)
228-231Enhancing STD/HIV prevention among adolescents: The importance of parental monitoring
AbstractDiclemente, 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. J., & 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. J., 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
Diclemente, R. J., Crosby, R. A., & Wingood, G. M. (n.d.).Publication year
2002Journal title
ProspectsVolume
32Issue
2Page(s)
135-153HIV-associated histories, perceptions, and practices among low-income African American women: Does rural residence matter?
AbstractCrosby, R. A., Yarber, W. L., DiClemente, R. J., 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. J., 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. J., 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. J., 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
AbstractCrosby, 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.