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

Social and psychological mediators of sexual and physical male-perpetrated intimate partner violence against young African American women: the role of alcohol use and drinking context

DiClemente, R., Capasso, A., Pahl, K., & Tozan, Y. (n.d.). (Journal of Interpersonal Violence).

Publication year

2025

Abstract

Abstract

Capasso A, Pahl K, Tozan Y, DiClemente R. Social and psychological mediators of sexual and physical male-perpetrated intimate partner violence against young African American women: the role of alcohol use and drinking context. Journal of Interpersonal Violence.

Social capital as a predictor of adolescents' sexual risk behavior : A state-level exploratory study

Crosby, R. A., Holtgrave, D. R., DiClemente, R., Wingood, G. M., & Gayle, J. A. (n.d.).

Publication year

2003

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

245-252

10.1023/A:1025439618581

Abstract

Abstract

This 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.

Social Context and Problem Factors among Youth with Juvenile Justice Involvement Histories

Voisin, D. R., Sales, J. M., Hong, J. S., Jackson, J. M., Rose, E. S., & DiClemente, R. (n.d.).

Publication year

2017

Journal title

Behavioral Medicine

Volume

Issue

Page(s)

71-78

10.1080/08964289.2015.1065789

Abstract

Abstract

Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.

Social discrimination and resiliency are not associated with differences in prevalent HIV infection in black and white men who have sex with men

Peterson, J. L., Bakeman, R., Sullivan, P., Millett, G. A., Rosenberg, E., Salazar, L., DiClemente, R., Cooper, H., Kelley, C. F., Mulligan, M. J., Frew, P., & Del Rio, C. (n.d.).

Publication year

2014

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

Page(s)

538-543

10.1097/QAI.0000000000000203

Abstract

Abstract

OBJECTIVES: To examine the associations of homophobia, racism, and resiliency with differences in prevalent HIV infection in black and white men who have sex with men (MSM). METHODS: The Involve[ment]t study is a cohort of black and white MSM aged 18-39 years in Atlanta, GA, designed to evaluate individual, dyadic, and community level factors that might explain racial disparities in HIV prevalence. Participants were recruited irrespective of HIV serostatus from community-based venues and from Internet advertisements and were tested for HIV. We assessed respondents' demographics, whether they had engaged in unprotected anal intercourse (UAI) within the past 6 months, and attitudes about perceived homophobia, perceived racism, and personal resiliency. RESULTS: Compared with white MSM, black MSM were less likely to report UAI in the past 6 months [odds ratio (OR): 0.59, confidence interval (CI): 0.44 to 0.80], more likely to be HIV positive (OR: 5.05, CI: 3.52 to 7.25), and - among those HIV positive - more likely to report not being aware of their HIV infection (OR: 2.58, CI: 1.18 to 5.65). Greater perceived racism was associated with UAI in the black sample (partial odds ratio: 1.48, CI: 1.10 to 1.99). Overall, perceived homophobia, perceived racism, and resilience were not associated with prevalent HIV infection in our samples. Greater resilience was associated with less perceived homophobia in both black and white samples (Spearman r = -0.27, P < 0.001, for both). CONCLUSION: Future studies of social discrimination at the institutional and network level, than at the individual level, may explain differences in HIV infection in black and white MSM.

Social media as a recruitment platform for a nationwide online survey of COVID-19 knowledge, beliefs, and practices in the United States : Methodology and feasibility analysis

Ali, S. H., Foreman, J., Capasso, A., Jones, A. M., Tozan, Y., & DiClemente, R. (n.d.).

Publication year

2020

Journal title

BMC Medical Research Methodology

Volume

Issue

10.1186/s12874-020-01011-0

Abstract

Abstract

BACKGROUND: The COVID-19 pandemic has evolved into one of the most impactful health crises in modern history, compelling researchers to explore innovative ways to efficiently collect public health data in a timely manner. Social media platforms have been explored as a research recruitment tool in other settings; however, their feasibility for collecting representative survey data during infectious disease epidemics remain unexplored.OBJECTIVES: This study has two aims 1) describe the methodology used to recruit a nationwide sample of adults residing in the United States (U.S.) to participate in a survey on COVID-19 knowledge, beliefs, and practices, and 2) outline the preliminary findings related to recruitment, challenges using social media as a recruitment platform, and strategies used to address these challenges.METHODS: An original web-based survey informed by evidence from past literature and validated scales was developed. A Facebook advertisement campaign was used to disseminate the link to an online Qualtrics survey between March 20-30, 2020. Two supplementary male-only and racial minority- targeted advertisements were created on the sixth and tenth day of recruitment, respectively, to address issues of disproportionate female- and White-oriented gender- and ethnic-skewing observed in the advertisement's reach and response trends.RESULTS: In total, 6602 participant responses were recorded with representation from all U.S. 50 states, the District of Columbia, and Puerto Rico. The advertisements cumulatively reached 236,017 individuals and resulted in 9609 clicks (4.07% reach). Total cost of the advertisement was $906, resulting in costs of $0.09 per click and $0.18 per full response (completed surveys). Implementation of the male-only advertisement improved the cumulative percentage of male respondents from approximately 20 to 40%.CONCLUSIONS: The social media advertisement campaign was an effective and efficient strategy to collect large scale, nationwide data on COVID-19 within a short time period. Although the proportion of men who completed the survey was lower than those who didn't, interventions to increase male responses and enhance representativeness were successful. These findings can inform future research on the use of social media recruitment for the rapid collection of survey data related to rapidly evolving health crises, such as COVID-19.

Social Media Utilization Within Asian American Families and Its Role in Healthy Lifestyle Behavioral Influence : Results From a Nationwide Survey

Mohsin, F. M., Ali, S. H., Chong, S. K., Parikh, R. S., DiClemente, R., & Hu, L. (n.d.).

Publication year

2023

Journal title

Social Media and Society

Volume

Issue

10.1177/20563051231196544

Abstract

Abstract

Objective: Social media platforms are effective tools for promoting public health and implementing impactful health interventions. This study explored social media utilization patterns among young Asian American adults and their effect on perceived family influence on lifestyle behaviors. Methods: The study analyzes data from Asian American young adults (aged 18–35 years) participating in an online survey in March 2021. Results: A total of 739 Asian Americans participated in the survey: 45.6% East Asian, 23.4% Southeast Asian, and 22.7% South Asian. Common social media platforms include Facebook Messenger (60.9%) and Instagram (57.0%). US-born Asian Americans reported higher odds of using Instagram (adjusted odds ratio [AOR]: 1.64, 95% CI: [1.09, 2.46]) than foreign-born Asian Americans. Higher acculturation was associated with lower odds of using Instagram among South Asians (AOR:.46, 95% CI: [.24,.83]) and greater odds of using Instagram among East Asians (AOR: 1.72, 95% CI: [1.09, 2.75]). Interacting with mothers using Facebook and Instagram had a higher perceived influence on one’s ability to improve sleep (AOR: 2.08, 95% CI: [1.19, 3.65]; AOR: 2.53, 95% CI: [1.15, 5.55]) and develop stress-management strategies (AOR: 1.73, 95% CI: [1.02, 2.96]; AOR: 4.05, 95% CI: [1.83, 9.49]). With one’s siblings, Facebook was associated with a lower perceived influence on avoiding risky substances (AOR:.48, 95% CI: [.23,.97]), and WhatsApp was associated with a higher perceived influence on one’s ability to develop stress-management strategies (AOR: 3.10, 95% CI: [1.26, 7.78]) and form/maintain relationships (AOR: 2.58, 95% CI: [1.02, 6.58]). No significant findings with father interactions were observed. Conclusion: Findings provide evidence for researchers seeking to tailor social media–based interpersonal health interventions to address the unique needs of diverse Asian American communities.

Socioeconomic predictors of COVID-19- related health disparities among United States workers : A structural equation modeling study

Capasso, A., Kim, S., Ali, S. H., Jones, A. M., DiClemente, R., & Tozan, Y. (n.d.).

Publication year

2022

Journal title

PLOS global public health

Volume

Issue

10.1371/journal.pgph.0000117

Abstract

Abstract

The COVID-19 pandemic has disproportionately impacted the physical and mental health, and the economic stability, of specific population subgroups in different ways, deepening existing disparities. Essential workers have faced the greatest risk of exposure to COVID- 19; women have been burdened by caretaking responsibilities; and rural residents have experienced healthcare access barriers. Each of these factors did not occur on their own. While most research has so far focused on individual factors related to COVID-19 disparities, few have explored the complex relationships between the multiple components of COVID-19 vulnerabilities. Using structural equation modeling on a sample of United States (U.S.) workers (N = 2800), we aimed to 1) identify factor clusters that make up specific COVID-19 vulnerabilities, and 2) explore how these vulnerabilities affected specific subgroups, specifically essential workers, women and rural residents. We identified 3 COVID- 19 vulnerabilities: financial, mental health, and healthcare access; 9 out of 10 respondents experienced one; 15% reported all three. Essential workers [standardized coefficient (β) = 0.23; unstandardized coefficient (B) = 0.21, 95% CI = 0.17, 0.24] and rural residents (β = 0.13; B = 0.12, 95% CI = 0.09, 0.16) experienced more financial vulnerability than nonessential workers and non-rural residents, respectively. Women (β = 0.22; B = 0.65, 95% CI = 0.65, 0.74) experienced worse mental health than men; whereas essential workers reported better mental health (β = -0.08; B = -0.25, 95% CI = -0.38, -0.13) than other workers. Rural residents (β = 0.09; B = 0.15, 95% CI = 0.07, 0.24) experienced more healthcare access barriers than non-rural residents. Findings highlight how interrelated financial, mental health, and healthcare access vulnerabilities contribute to the disproportionate COVID- 19-related burden among U.S. workers. Policies to secure employment conditions, including fixed income and paid sick leave, are urgently needed to mitigate pandemic-associated disparities.

Socioeconomic status and self-reported gonorrhea among African American female adolescents

Sionéan, 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

2001

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

236-239

10.1097/00007435-200104000-00009

Abstract

Abstract

Background: Socioeconomic status is often used to explain race differences in sexually transmitted diseases (STDs), yet the independent association of socioeconomic status and STDs among adolescents has been understudied. Objective: To examine the associations between socioeconomic status and self-reported gonorrhea among black female adolescents, after controlling for sexual risk behaviors. Methods: Interviews and surveys were completed by 522 sexually active black adolescent females residing in low-income urban neighborhoods. Results: Adolescents whose parents were unemployed were more than twice as likely to report a history of gonorrhea, compared with those with employed parents. Adolescents living with two parents were less likely to report a history of gonorrhea. Conclusions: The results of this study indicate that gonorrhea is associated with low socioeconomic status among black adolescent females regardless of the level of sexual risk behaviors. Lower socioeconomic status may be an marker for risky sociosexual environments.

Socioeconomic-related risk and sexually transmitted infection among African-American adolescent females

Sales, J. M., Smearman, E. L., Swartzendruber, A., Brown, J. L., Brody, G., & DiClemente, R. (n.d.).

Publication year

2014

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

698-704

10.1016/j.jadohealth.2014.05.005

Abstract

Abstract

Purpose Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up.Methods Six hundred twenty-seven African-American female adolescents, ages 14-20 years, recruited from sexual health clinics in Atlanta, GA, participated in a randomized controlled HIV prevention trial and returned for at least one follow-up assessment. Following baseline assessment, six waves of data collection occurred prospectively over 36 months. Chronic SES-related risk was assessed as a sum of yes-no exposure to seven risk indicators. Laboratory-confirmed tests for Chlamydia trachomatis and Neisseria gonorrhoeae were performed at each follow-up.Results In multivariable regression analysis, SES-related risk significantly predicted STI acquisition over 36 months (adjusted odds ratio = 1.22) and STI reinfection (adjusted odds ratio = 1.16) above and beyond other known correlates of STI.Conclusions Findings demonstrate that SES-related risk was predictive of both STI acquisition and reinfection among young African-American females. They are consistent with propositions that some health disparities observed in adulthood may be linked to earlier chronically stress-inducing life experiences, particularly experiences associated with low SES conditions. Although various explanations exist for the observed connection between SES-related risk and subsequent STI acquisition and/or reinfection across 36 months of follow-up, these findings highlight the need for further research to elucidate the exact pathway(s) by which SES-related risk influences later STI acquisition to refine STI prevention interventions for this population.

Stability of Trichomonas vaginalis DNA in urine specimens

Ingersoll, J., Bythwood, T., Abdul-Ali, D., Wingood, G. M., DiClemente, R., & Caliendo, A. M. (n.d.).

Publication year

2008

Journal title

Journal of Clinical Microbiology

Volume

Issue

Page(s)

1628-1630

10.1128/JCM.02486-07

Abstract

Abstract

Trichomonas vaginalis is an important pathogen in both men and women. Culture is considered the diagnostic gold standard, although studies have shown that PCR is more sensitive than either culture or wet mount for the diagnosis of T. vaginalis infections. We sought to identify a simple method for stabilizing T. vaginalis DNA in urine samples that could be easily applied to molecular testing. The stability of T. vaginalis DNA in 40 urine samples was assessed by storage for various times at either 4°C or room temperature with or without the Becton Dickinson urine preservative transport (UPT) kit. Overall, there was better stability of T. vaginalis DNA when specimens were stored at 4°C than when they were stored at 20 to 22°C and when the UPT system was used. T. vaginalis DNA was stable in specimens stored without using the UPT at 4°C for about 3 days and at room temperature for only 1 day. For specimens placed in the UPT within 24 h (times of 1, 6, and 24 h) of collection, the DNA was stable for up to 30 days when stored at 4°C. For specimens stored at room temperature, the urine should be added to the UPT ideally within 1 hour of collection, and in this case the DNA remained stable for up to 30 days. When storing specimens at room temperature, a delay of 24 h prior to adding to UPT led to an unacceptably high loss of assay sensitivity.

STAND : A peer educator training curriculum for sexual risk reduction in the rural south

Smith, M. U., & DiClemente, R. (n.d.).

Publication year

2000

Journal title

Preventive Medicine

Volume

Issue

Page(s)

441-449

10.1006/pmed.2000.0666

Abstract

Abstract

Background. The incidence of AIDS in rural areas continues to increase rapidly, with teenagers continuing to report high rates of sexual risk behaviors. Unfortunately, there is a dearth of effective HIV prevention programs targeting youth in rural settings where there are often formidable barriers to sex education programs. This paper describes a theoretically based intervention designed to meet the needs of rural youth. Methods. Students Together Against Negative Decisions (STAND) is a 28-session teen peer educator training program implemented in a rural county in a southeastern state, promoting both abstinence and sexual risk reduction. The theoretical foundation of the curriculum includes both Diffusion of Innovations Theory and the Transtheoretical Model, focusing on both individual and community norm change. STAND is teen-centered and skills- based; activities focus on active learning. Educator trainees are selected on the basis of their opinion leadership within their peer group, resulting in a training group of both virgin and sexually active teens, balanced for gender and matched to the racial proportions of the school. Results. Acceptance and participation in STAND suggest that adolescents in rural communities can be accessed through community-based interventions, that they are willing to participate in such intensive programs, and that they perceive the intervention as valuable and enjoyable. Moreover, the STAND program has thrived in a relatively conservative rural environment, and has had a positive impact on adolescents' sexual risk taking. Results from a pilot study showed significantly greater increases in condom use self-efficacy (16% vs a 1% decrease among controls) and in consistent condom use (+28% vs +15%). Adolescent trainees also reported a sevenfold larger increase in condom use (+213% vs +31%) and a 30% decrease in unprotected intercourse compared to a 29% increase among controls. Conclusions. STAND represents a new genre of HIV prevention program, one that utilizes complementary theoretical models to develop a program that targets both individual- and community-level change for rural adolescents. (C) 2000 American Foundation and Academic Press.

State of the evidence : Intimate partner violence and HIV/STI risk among adolescents

DiClemente, R., Seth, P., Di Clemente, R. J., & Lovvorn, A. E. (n.d.).

Publication year

2013

Journal title

Current HIV Research

Volume

Issue

Page(s)

528-535

10.2174/1570162X12666140129103122

Abstract

Abstract

This paper provides a critical narrative review of the scientific literature on intimate partner violence (IPV) and risky sexual behavior as well as sexually transmitted infections (STIs) among adolescents, aged 14-24 years. Intimate partner violence has been associated with a number of high risk sexual behavior, including inconsistent condom use, multiple sexual partners, earlier sexual debut, consuming substances while engaging in sexual behavior, and sexually transmitted infections among adolescents. An electronic search of the literature was performed using PubMed/MEDLINE, PsycINFO, and Web of Science and articles from January 2000 - June 2013 were reviewed. Search terms included a combination of keywords for IPV, HIV/STI risk, and adolescents. The findings from the review indicated that IPV was associated with inconsistent condom use, STIs, early sexual debut, multiple sexual partners, and other HIV/STI-associated risk factors among adolescents. HIV/STI interventions for female adolescents often focus on increasing behavioral and cognitive skills, specifically condom negotiation. However, within the context of an abusive relationship, it becomes challenging for adolescents to enact these skills, where this behavior could potentially place them at greater risk. Components that address violence are necessary within HIV prevention programming. Additionally, integration of IPV screening within healthcare settings is important along with a combined approach that merges resources from healthcare, social, and community-level settings.

Substance use among students attending a christian university that strictly prohibits the use of substances

Hopkins, G. L., Freier, M. C., Babikian, T., Helm, H. W., McBride, D. C., Boward, M., Gillespie, S., & DiClemente, R. (n.d.).

Publication year

2004

Journal title

Journal of Research on Christian Education

Volume

Issue

Page(s)

23-39

10.1080/10656210409484958

Abstract

Abstract

This study examines substance use at a church-affiliated university which prohibits the use of alcohol, tobacco, and drug substances. The purpose was to investigate the prevalence of substance use, the prevention efforts put forth by the university, and whether religious beliefs, which prohibit substance use, are protective. While the findings indicate that alcohol, tobacco and other drugs were used in varying degrees by this student sample, the overall use was significantly lower relative to a national comparison group. The data suggests that religion is a protective factor concerning substance use. However, since students use substances even at church-affiliated campuses with prohibitive substance use beliefs, the problem of how to deal with substance use remains.

Substance Use Patterns of HIV-Infected Russian Women with and Without Hepatitis C Virus Co-infection

Brown, J. L., DiClemente, R., Sales, J. M., Rose, E. S., Safonova, P., Levina, O. S., Belyakov, N., & Rassokhin, V. V. (n.d.).

Publication year

2016

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

2398-2407

10.1007/s10461-016-1362-5

Abstract

Abstract

Individuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin: AOR: 13.2, 95 % CI 4.9, 35.3, p < .001), problem drinking (β = 1.2, p = .05), substance use problems (β = 1.3, p = .009), and increased likelihood of past injection drug use (AOR: 26.4, 95 % CI 8.5, 81.9, p < .001) relative to HIV mono-infected individuals. HIV/HCV co-infection was prevalent and associated with increased substance use and problematic drug use. Findings highlight the need for ongoing substance use and HIV/HCV risk behavior assessment and treatment among HIV/HCV co-infected Russian women.

Taking mhealth forward : Examining the core characteristics

Davis, T. L., DiClemente, R., & Prietula, M. (n.d.).

Publication year

2016

Journal title

JMIR mHealth and uHealth

Volume

Issue

10.2196/mhealth.5659

Abstract

Abstract

The emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular.

Targeting STD/HIV prevention interventions for heterosexual male adolescents in North and Central America : A review

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

Publication year

2013

Journal title

Current Pediatric Reviews

Volume

Issue

Page(s)

376-382

10.2174/157339630904131223113203

Abstract

Abstract

Background: Adolescents experience elevated rates of STDs and HIV. STD/HIV prevention interventions for young men are crucial to decrease their STD/HIV rates and reduce disease transmission to female partners. To advance sexual health promotion interventions for young men, this paper reviewed the efficacy of STD/HIV prevention interventions conducted in North and Central America in the past 20 years. Method: PubMed, Google Scholar, and EBSCO Host databases were used to locate STD/HIV interventions. Eligible interventions were limited to STD/HIV interventions for young men between the ages of 10 and 18. We review 8 STD/HIV prevention interventions targeting heterosexual adolescent males and summarize key intervention components and content, overview intervention efficacy outcome data, and provide directions for future research. Results: The majority of interventions were guided by health behavior change theory. Interventions employed interactive group-based education and behavioral skills training to reduce risky sexual behaviors. All interventions used a randomized controlled trial design with a comparison or control group. Follow-up times varied markedly, ranging from 3 weeks to 36 months. All but one intervention improved at least one behavioral outcome (e.g., increased frequency of condom use). Conclusions: Findings suggest that male adolescent interventions can effectively curtail the STD/HIV epidemic. Major weaknesses of the reviewed studies include the reliance on self-report behavioral measures, lack of biological endpoints, and short follow-ups. Study strengths include use of randomized control trial design and theory-based content. Future research should increase the dissemination of effective sexual risk reduction interventions to decrease STD/HIV among adolescent males and their female partners.

Teacher connectedness and health-related outcomes among detained adolescents

Voisin, D. R., Salazar, L. F., Crosby, R., DiClemente, R., Yarber, W. L., & Staples-Horne, M. (n.d.).

Publication year

2005

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

337.e17-337.e23

10.1016/j.jadohealth.2004.11.137

Abstract

Abstract

Purpose: Data were collected from a convenience sample of 550 detained adolescents (ages 14-18 years) to explore the association between adolescents' perception of teacher connectedness and a range of health risk behaviors, such as gang membership, use of in alcohol, drugs, and tobacco, and engagement in sexual risk behaviors prior to detainment. Methods: Participants answered survey questions using audio-computer assisted self-interviewing procedures that assessed demographic, pro-social, problem, and drug and sexual risk behaviors. Results: Multiple logistic regression analyses controlling for demographic and socioeconomic status, truancy, number of days in the detention center, and family factors indicated that adolescents who reported low teacher connectedness, relative to their peers reporting high teacher connectedness, were twice as likely to use marijuana and amphetamines, and twice as likely to be sexually active, have sex while high on alcohol or drugs, have a partner who was high on alcohol or other drugs during sex, and have multiple sexual partners. Conclusions: The association between teacher connectedness and adolescents' health risk behaviors prior to detainment suggests that school-based interventions that enhance the school environment, particularly teachers' skills and training to enhance and maximize the effectiveness of their student interactions, may be one strategy for reducing health risk behaviors and their associated adverse health outcomes among youth at high risk.

Teen pregnancy in the US : Overview and opportunities for prevention

Choi, J., Capasso, A., & DiClemente, R. (n.d.).

Publication year

2023

Volume

Page(s)

455-464

10.1016/B978-0-12-818872-9.00169-2

Abstract

Abstract

Teen pregnancy, while declining, remains a significant and persistent public health, social, and clinical challenge. Pregnant teens are a vulnerable population, at increased risk for adverse health, social, and psychological outcomes. Adequately confronting this challenge requires a multi-factorial approach – engaging youth themselves, family, peers, social networks, schools, and clinicians. One key contextual factor is public health policy. Thus, teen pregnancy may be more effectively addressed when a social-ecological framework is used to guide the development and implementation of programs. Single, isolated, and fragmented programmatic strategies are suboptimal. Only marshaling all our resources, and promoting teen friendly health policy, can we optimize our response to teen pregnancy.

Telling truth from Ys : An evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy

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

Publication year

2014

Journal title

Sexually transmitted infections

Volume

Issue

Page(s)

479-484

10.1136/sextrans-2013-051315

Abstract

Abstract

Results At the 3 surveys, 30%, 20% and 15% of adolescents who reported always using condoms tested positive for semen exposure. At 6 month follow-up, 20.4% and 16.2% of the adolescents who underreported semen exposure reported pregnancy, a higher pregnancy rate than accurate reporters of semen exposure, even accurate reporters who reported never using condoms (14.2% and 11.8%). Under-reporters of semen exposure were 3.23 (95% CI (1.61, 6.45)) times as likely to become pregnant at 6-month follow-up and 2.21 (0.94, 5.20) times as likely to become pregnant at 12-month follow-up as accurate reporters who reported not using contraception, adjusting for self-reported coital frequency.Conclusions Adolescents who under-report semen exposure may be at uniquely high risk for unplanned pregnancy and STIs, and may also under-report coital frequency. Condom efficacy trials that rely on self-report may yield inaccurate results. Adapted to a clinical setting, the Y-chromosome PCR could alert women to incorrect or inconsistent condom use.Objectives Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy.Methods The sample comprised 715 sexually active African-American female adolescents, ages 15-21 years. At baseline, 6 months and 12 months, participants completed a 40-min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted pregnancy from semen exposure under-report using multivariate regression controlling for oral contraception, reported condom use and coital frequency.

Test-Retest Reliability of Self-Reported HIV/STD-Related Measures Among African-American Adolescents in Four U.S. Cities

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

Publication year

2009

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

214-221

10.1016/j.jadohealth.2008.09.002

Abstract

Abstract

Purpose: To evaluate the test-retest reliability of self-reported sexuality-related data in a sample of African American adolescents residing in four U.S. cities. Methods: Using audio computer-assisted self-interviewing (ACASI), 156 African American teens (mean age = 15.5 years) provided data on lifetime and recent sexual behavior, HIV/sexually transmitted disease (STD) testing, and theoretical antecedents of sexual risk behavior on two occasions separated by 2 weeks. Results: Most self-reports of lifetime sexual behavior and STD/HIV testing were stable across the two assessment points. Test-retest agreement was substantial for dichotomous indices of lifetime sexual behaviors and STD testing (kappas ranging from .61-.87), and for 3-month recall of vaginal sex (kappa = .72) and number of sexual partners (intraclass correlation coefficient [ICC] = .68). Lower reliability estimates emerged for count data of unprotected vaginal sex occasions (ICC = .44). Test-retest reliability estimates for antecedents of sexual risk behavior were highest for a validated measure of HIV-related knowledge (r = .73), but somewhat lower for peer norms (r = .58) and condom use self-efficacy (r = .50). Conclusions: Although variability in the stability of self-report data was observed, findings confirm that most sexual behavior, STD and HIV testing history, and psychosocial measures can be assessed reliably among adolescents. Research should continue to identify strategies to enhance the reliability of self-report sexual behavior data from youth at risk for HIV and other sexually transmitted infections.

Testing for HSV-2 infection among pregnant teens : Implications for clinical practice

Crosby, R. A., DiClemente, R., Wingood, G. M., & Rose, E. (n.d.).

Publication year

2003

Journal title

Journal of Pediatric and Adolescent Gynecology

Volume

Issue

Page(s)

39-41

10.1016/S1083-3188(02)00204-8

Abstract

Abstract

Objectives: 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.

The ADAPT-ITT model : A novel method of adapting evidence-based HIV interventions

Wingood, G. M., & DiClemente, R. (n.d.).

Publication year

2008

Journal title

Journal of Acquired Immune Deficiency Syndromes

Volume

Issue

SUPPL. 1

Page(s)

S40-S46

10.1097/QAI.0b013e3181605df1

Abstract

Abstract

The Institute of Medicine (IOM) recommends the use of HIV prevention interventions with proven efficacy to avert new infections. Given the time and cost associated with the development, implementation and evaluation of efficacious HIV interventions, adapting existing evidence-based interventions (EBIs) to be appropriate for a myriad of at-risk populations may facilitate the efficient development of new EBIs. Unfortunately, few models of theoretic frameworks exist to guide the adaptation of EBIs. Over the past few years, the authors have systematically developed a framework for adapting HIV-related EBIs, known as the "ADAPT-ITT" model. The ADAPT-ITT model consists of 8 sequential phases that inform HIV prevention providers and researchers of a prescriptive method for adapting EBIs. The current article summarizes key components of the ADAPT-ITT model and illustrates the use of the model in several case studies.

The assessment of complementary and alternative medicine use among individuals with HIV : A systematic review and recommendations for future research

Owen-Smith, A., Depadilla, L., & DiClemente, R. (n.d.).

Publication year

2011

Journal title

Journal of Alternative and Complementary Medicine

Volume

Issue

Page(s)

789-796

10.1089/acm.2010.0669

Abstract

Abstract

Objectives: The use of complementary and alternative medicine (CAM), a group of health care practices and products that are not considered part of conventional medicine, has increased in recent years, particularly among individuals with human immune deficiency virus (HIV). Assessing the prevalence and predictors of CAM use among HIV-positive populations is important because some CAM therapies may adversely affect the efficacy of conventional HIV medications. Unfortunately, CAM use is not comprehensively or systematically assessed among HIV-positive populations. Therefore, the aim of the present study was to evaluate the quality of the instruments employed in observational studies assessing CAM use among HIV-positive populations by examining the degree to which these studies (1) evaluated the psychometric properties of their CAM instruments and (2) assessed the multidimensional nature of CAM use. Design: A systematic review of studies was undertaken and specific review criteria were used to guide the inclusion of studies. Specifically, articles were included that were published in English and in a peer-reviewed journal between 1997 and 2007, recruited HIV-positive study participants, and assessed CAM use. Thirty-two (32) studies met these inclusion criteria. Results: Results suggest that CAM assessment among HIV-positive populations continues to be problematic. For example, approximately 20% of the studies assessed the reliability and 3% assessed the validity of the CAM instrument employed. Conclusions: CAM assessment-regardless of the specific study population-is a complex and challenging task. However, CAM instruments will not become more refined over time in the absence of rigorous psychometric evaluation. Future research must assess reliability and validity and report these data in a clear and nuanced manner.

The association between alcohol use and sexual risk behaviors among African American women across three developmental periods : A review

Sales, J. M., Brown, J. L., Vissman, A. T., & DiClemente, R. (n.d.).

Publication year

2012

Journal title

Current Drug Abuse Reviews

Volume

Issue

Page(s)

117-128

10.2174/1874473711205020117

Abstract

Abstract

Background: African American women experience increased rates of sexually transmitted diseases and HIV. The use of alcohol may increase sexual risk behaviors among this population. Purpose: This paper provides a review and critique of the literature examining the association etween alcohol use and sexual risk behaviors among African American females including a: (a) synthesis of research findings from adolescent, college-aged/early adulthood, and adult samples; (b) methodological critique of the literature; and (c) guidance for future research. Methods: We reviewed 32 studies examining the association between alcohol use and sexual risk behaviors among African American females across developmental periods. Results: Similar to previous association studies, results suggest that increased use of alcohol is associated with increased sexual risk practices among African American females. Further, even non-abuse levels of drinking among African American females, at all ages, were related to increased sexual risk-taking. Conclusions: Future studies should seek to recruit samples that more fully reflect the diversity of African American women's experiences across the lifespan. Given the association between alcohol use and/or abuse and the prevalence of STI/HIV-associated risk behaviors and adverse biological outcomes (i.e., STIs, including HIV) among African American females across the lifespan, there is a clear need to develop and evaluate prevention research efforts tailored for this subgroup.

The Association Between Childhood Sexual Abuse and Prevalence of HIV-Related Risk Behaviors

Lodico, M. A., & DiClemente, R. (n.d.).

Publication year

1994

Journal title

Clinical Pediatrics

Volume

Issue

Page(s)

498-502

10.1177/000992289403300810

Abstract

Abstract

Ralph DiClemente