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

Protease inhibitor combination therapy and decreased condom use among gay men

DiClemente, R., Funkhouser, E., Wingood, G., Fawal, H., Holmberg, S. D., & Vermund, S. H. (n.d.).

Publication year

2002

Journal title

Southern Medical Journal

Volume

Issue

Page(s)

421-425

10.1097/00007611-200295040-00010

Abstract

Abstract

Background. 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

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

2002

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

55-63

10.1016/S1054-139X(01)00318-4

Abstract

Abstract

Purpose: 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

DiClemente, R., Wingood, G. M., DiClemente, R., Crosby, R. A., DiClemente, R., Harrington, K., & Davies, S. (n.d.).

Publication year

2002

Journal title

Journal of Pediatric and Adolescent Gynecology

Volume

Issue

Page(s)

293-299

10.1016/S1083-3188(02)00195-X

Abstract

Abstract

Objective: 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

Rhodes, S. D., DiClemente, R., Cecil, H., Hergenrather, K. C., & Yee, L. J. (n.d.).

Publication year

2002

Journal title

AIDS Education and Prevention

Volume

Issue

Page(s)

41-50

10.1521/aeap.14.1.41.24334

Abstract

Abstract

This 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

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

Publication year

2002

Journal title

American Journal of Health Education

Volume

Issue

Page(s)

206-215

10.1080/19325037.2002.10603509

Abstract

Abstract

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

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

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

Publication year

2002

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

20-24

10.1097/00007435-200201000-00004

Abstract

Abstract

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

A prospective study of psychological distress and sexual risk behavior among black adolescent females.

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., & DiClemente, R. (n.d.).

Publication year

2001

Journal title

Pediatrics

Volume

108

Issue

Page(s)

E85

10.1542/peds.108.5.e85

Abstract

Abstract

OBJECTIVE: 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

DiClemente, 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

2001

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

444-447

10.1097/00007435-200108000-00003

Abstract

Abstract

Background: 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

Crosby, 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

2001

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

194-199

10.1016/S1054-139X(01)00273-7

Abstract

Abstract

Purpose: 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

Crosby, 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

2001

Journal title

Journal of Pediatric and Adolescent Gynecology

Volume

Issue

Page(s)

123-127

10.1016/S1083-3188(01)00089-4

Abstract

Abstract

Study 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.

Correlates of casual sex among African-American female teens

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

Publication year

2001

Journal title

Journal of HIV/AIDS Prevention and Education for Adolescents and Children

Volume

Issue

Page(s)

55-67

10.1300/J129v04n04_05

Abstract

Abstract

This study identified correlates of reporting voluntary sex with casual partner (VS-CP) among African American adolescent females. Sexually active African-American female teens (N = 522) were recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence and STDs. Of the 609 eligible adolescents, 522 (85.7%) agreed to participate in the study. VS-CP was reported by 15.9% of adolescents. Identified correlates of VS-CP were acquiescing to unwanted sex, living with a non-parent relative, never being pregnant, rejecting messages about the value of condoms for disease prevention, low parental supervision, and dissatisfaction with body image. These correlates may be important in the targeting and design of STD/HIV prevention programs for African -American adolescent females.

Correlates of hepatitis B vaccination in a high-risk population : An internet sample

Rhodes, S. D., DiClemente, R., Yee, L. J., & Hergenrather, K. C. (n.d.).

Publication year

2001

Journal title

American Journal of Medicine

Volume

110

Issue

Page(s)

628-632

10.1016/S0002-9343(01)00706-9

Abstract

Abstract

PURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men. SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month. RESULTS: The mean (± SD) age of the 336 respondents was 38 ± 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001). CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.

Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk african-american female teens

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

Publication year

2001

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

410-414

10.1016/S1054-139X(00)00210-X

Abstract

Abstract

Purpose: To identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy. Methods: A convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents' communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents' desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use. Results: Seventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users. Conclusions: The findings suggest the need for research to examine the efficacy of interventions building on adolescent females' desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents' use of dual methods for STD and pregnancy prevention.

Dating violence and the sexual health of black adolescent females.

Wingood, G. M., DiClemente, R. J., McCree, D. H., Harrington, K., Davies, S. L., & DiClemente, R. (n.d.).

Publication year

2001

Journal title

Pediatrics

Volume

107

Issue

Page(s)

E72

10.1542/peds.107.5.e72

Abstract

Abstract

OBJECTIVE: This study examines the association between having a history of dating violence and the sexual health of adolescent females. METHODS: Black adolescent females (n = 522) completed a survey that assessed dating violence, defined as ever having a physically abusive boyfriend, and an interview that assessed sexual behaviors. RESULTS: Dating violence was reported by 18.4% of adolescents (n = 96). Adolescents with a history of dating violence were, in the past 6 months, 2.8 times more likely to have a sexually transmitted disease, 2.8 times more likely to have nonmonogamous male partners, and half as likely to use condoms consistently. Furthermore, adolescents with a history of dating violence were significantly more likely to fear the perceived consequences of negotiating condom use (odds ratio [OR] = 2.8); fear talking with their partner about pregnancy prevention (OR = 2.6); have a higher perceived risk of acquiring a sexually transmitted disease (OR = 2.1); perceive less control over their sexuality (OR = 2.4); have peer norms nonsupportive of using condoms (OR = 3.1); and have norms nonsupportive of having a healthy relationship (OR = 2.1). CONCLUSIONS: Adolescents who have experienced dating violence are more likely to exhibit a spectrum of unhealthy sexual behaviors, attitudes, beliefs, and norms.

Development of programmes for enhancing sexual health : Commentary

DiClemente, R. (n.d.).

Publication year

2001

Journal title

Lancet

Volume

358

Issue

9296

Page(s)

1828-1829

10.1016/S0140-6736(01)06878-7

Abstract

Abstract

Exposure to X-rated movies and adolescents' sexual and contraceptive-related attitudes and behaviors

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

Publication year

2001

Journal title

Pediatrics

Volume

107

Issue

Page(s)

1116-1119

10.1542/peds.107.5.1116

Abstract

Abstract

Objectives. To examine the association between exposure to X-rated movies and teens' contraceptive attitudes and behaviors. Methods. Black females, 14 to 18 years old (n = 522) were recruited from adolescent medicine clinics, health departments, and school health clinics. Results. Exposure to X-rated movies was reported by 29.7% of adolescents. Exposure to X-rated movies was associated with being more likely to have negative attitudes toward using condoms (odds ratio [OR]: 1.4), to have multiple sex partners (OR: 2.0), to have sex more frequently (OR: 1.8), to not have not used contraception during the last intercourse (OR: 1.5), to have not used contraception in the past 6 months (OR: 2.2), to have a strong desire to conceive (OR: 2.3), and to test positive for chlamydia (OR: 1.7). Conclusions. Additional research is needed to understand the impact of X-rated movies on adolescents' sexual and contraceptive health.

Factors associated with testing for hepatitis C in an internet-recruited sample of men who have sex with men

Rhodes, S. D., DiClemente, R., Yee, L. J., & Hergenrather, K. C. (n.d.).

Publication year

2001

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

515-520

10.1097/00007435-200109000-00007

Abstract

Abstract

Background: Nearly 4 million individuals in the United States (1.8%) have been infected with hepatitis C virus, yet few are aware of their infection. Goal: To identify correlates associated with hepatitis C virus testing among a sample of men who have sex with men. Study Design: Internet communications were used for solicitation and collection of data, using a 31-question survey. Results: When the study was restricted to men who have sex with men in the United States (n = 381), 95% of the respondents (n - 361) reported at least one risk factor for hepatitis C virus transmission, 39% of these respondents (n = 140) reported having been tested for hepatitis C virus. Testing was associated with a history of nonsexual risk behavior, increased knowledge of the hepatitis C virus, and health care provider communication. Conclusion: A significant proportion of at-risk respondents had not been tested. Interventions are needed to increase hepatitis C virus knowledge in the community of men who have sex with men, and to encourage providers to communicate about hepatitis to the men in this group who screen as high risk on the basis of their risk behaviors.

HIV/STD-protective benefits of living with mothers in perceived supportive families : A study of high-risk African American female teens

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

Publication year

2001

Journal title

Preventive Medicine

Volume

Issue

Page(s)

175-178

10.1006/pmed.2001.0868

Abstract

Abstract

Background. The joint influence of living with the mother in a perceived supportive family may be an important HIV/STD-protective factor among sexually active female adolescents. Methods. Sexually active African American female adolescents (N = 522) completed a self-administered survey and structured interview. Adolescents scoring high on family support and reporting that their mother lived with them were compared with the remaining adolescents in respect to unprotected vaginal sex (past 30 days), sex with a non-steady partner (past 6 months), communication with sex partners, attitudes toward condoms, and perceived ability to negotiate condom use. Logistic regression analyses controlled for the influence of parent-adolescent communication about sex and parental monitoring. Results. Adolescents residing with their mothers in a perceived supportive family were more likely to communicate with their sex partners about sexual risk (OR = 1.53). They were less likely to report sex with a non-steady partner (OR = 0.51) or having unprotected sex with a steady partner (OR = 0.52) or any partner (OR = O.55). Conclusions. Controlled analyses suggest that living with the mother in a perceived supportive family is an important HIV/STD-protective factor among female adolescents. HIV/STD prevention programs for female adolescents that include the mothers may promote positive and lasting effects.

Measurement of the role of families in prevention and adaptation to HIV/AIDS

Pequegnat, W., Bauman, L. J., Bray, J. H., DiClemente, R., DiIorio, C., Hoppe, S. K., Jemmott, L. S., Krauss, B., Miles, M., Paikoff, R., Rapkin, B., Rotheram-Borus, M. J., & Szapocznik, J. (n.d.).

Publication year

2001

Journal title

AIDS and Behavior

Volume

Issue

Page(s)

1-19

10.1023/A:1009557103659

Abstract

Abstract

HIV is a family disease. Family research in HIV is challenging because of complexities of family measurement, the range of family constellations across cultures, and the issues specific to HIV-affected families. A Consortium of NIMH-funded investigators is conducting HIV research on families - defined as networks of mutual commitments. A procedure for identifying the "family" is proposed. This article reviews assessment strategies from two research traditions, both of which have been greatly concerned with social context: family assessment tradition - family membership, parenting, and interactional dynamics; HIV/AIDS research tradition - HIV-relevant constructs generalized to minority families. Initially, a systematic procedure for defining family membership is provided. Constructs and measures derived from the family assessment tradition are described, including self-report and observational procedures. Constructs and measures of relevance to family research that originated in the HIV/AIDS research tradition are described: HIV knowledge, stigma, disclosure, and social support. Constructs presented derive from the Consortium's research on the role of families in prevention and adaptation to HIV/AIDS. Most of the research conducted by the Consortium has taken place with inner-city, minority, heterosexual families. By informing the selection of constructs and measures relevant to investigating the role of families in HIV prevention, and adaptation to living with HIV/AIDS, it is the Consortium's intention to enhance the quality and quantity of research at the intersection of families and HIV/AIDS.

Parent-adolescent communication and sexual risk behaviors among African American adolescent females

DiClemente, R., Wingood, G. M., Crosby, R., Cobb, B. K., Harrington, K., & Davies, S. L. (n.d.).

Publication year

2001

Journal title

Journal of Pediatrics

Volume

139

Issue

Page(s)

407-412

10.1067/mpd.2001.117075

Abstract

Abstract

Objective: To examine associations between parent-adolescent communication about sex-related topics and the sex-related communication and practices of African American adolescent females with partners, as well as their perceived ability to negotiate safer sex. Design: A theory-guided survey and structured interview were administered to 522 sexually active African American females 14 to 18 years old. Recruitment sites were neighborhoods with high rates of unemployment, substance abuse, violence, and sexually transmitted diseases. Multivariate analyses, controlling for observed covariates, were used to identify the association of less frequent parent-adolescent communication with multiple assessed outcomes. Results: Less frequent parent-adolescent communication (scores below the median) was associated with adolescents' non-use of contraceptives in the past 6 months (adjusted odds ratio [AOR] = 1.7) and non-use of contraceptives during the last 5 sexual encounters (AOR = 1.6). Less communication increased the odds of never using condoms in the past month (AOR = 1.6), during the last 5 sexual encounters (AOR = 1.7), and at last intercourse (AOR = 1.7). Less communication was also associated with less communication between adolescents and their sex partners (AOR = 3.3) and lower self-efficacy to negotiate safer sex (AOR = 1.8). Conclusions: The findings demonstrate the importance of involving parents in human immunodeficiency virus/sexually transmitted disease and pregnancy prevention efforts directed at female adolescents. Pediatricians and other clinicians can play an important role in facilitating parent-adolescent communication about sexual activity.

Parental monitoring : Association with adolescents' risk behaviors

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

Publication year

2001

Journal title

Pediatrics

Volume

107

Issue

Page(s)

1363-1368

10.1542/peds.107.6.1363

Abstract

Abstract

Context. Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, few studies have examined the impact of parental monitoring. Objective. To examine the influence of less perceived parental monitoring on a spectrum of adolescent health-compromising behaviors and outcomes. Design. Survey. Setting. A family medicine clinic. Participants. To assess eligibility, recruiters screened a sample of 1130 teens residing in low-income neighborhoods. Adolescents were eligible if they were black females, between the ages of 14 and 18 years, sexually active in the previous 6 months, and provided written informed consent. Most teens (n = 609) were eligible, with 522 (85.7%) agreeing to participate. Main Outcome Measures. Variables in 6 domains were assessed, including: sexually transmitted diseases, sexual behaviors, marijuana use, alcohol use, antisocial behavior, and violence. Results. In logistic regression analyses, controlling for observed covariates, adolescents perceiving less parental monitoring were more likely to test positive for a sexually transmitted disease (odds ratio [OR]: 1.7), report not using a condom at last sexual intercourse (OR: 1.7), have multiple sexual partners in the past 6 months (OR: 2.0), have risky sex partners (OR: 1.5), have a new sex partner in the past 30 days (OR: 3.0), and not use any contraception during the last sexual intercourse episode (OR: 1.9). Furthermore, adolescents perceiving less parental monitoring were more likely to have a history of marijuana use and use marijuana more often in the past 30 days (OR: 2.3 and OR: 2.5, respectively); a history of alcohol use and greater alcohol consumption in the past 30 days (OR: 1.4 and OR: 1.9, respectively); have a history of arrest (OR: 2.1); and there was a trend toward having engaged in fights in the past 6 months (OR: 1.4). Conclusions. The findings demonstrate a consistent pattern of health risk behaviors and adverse biological outcomes associated with less perceived parental monitoring. Additional research needs to focus on developing theoretical models that help explain the influence of familial environment on adolescent health and develop and evaluate interventions to promote the health of adolescents.

Psychosocial correlates of adolescents' worry about STD versus HIV infection : Similarities and differences

Crosby, R., DiClemente, R., Wingood, G. M., Sionéan, C., 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)

208-213

10.1097/00007435-200104000-00004

Abstract

Abstract

Background: Adolescents' worry (perceived threat) of sexually transmitted diseases (STDs) and HIV infection may have different correlates. This study examined associations between selected psychosocial and behavioral constructs and adolescents' worry about STD and HIV infection. Goal: To assess levels and correlates of worry about STD and HIV among a high-risk sample of black adolescent females. Study Design: High-risk black females (n = 522), enrolled in a randomized, controlled HIV and STD prevention trial, completed a questionnaire and structured interview at baseline. Worry about STD and HIV infection, recent risk behaviors, and several measures potentially related to worry were assessed. Results: Levels of worry for both STD and HIV were low. Recent history of STD infection was associated with STD worry (OR, 4.6) and HIV worry (OR, 2.0). Infrequent communication about sex (OR, 2.0) and low perceived ability to negotiate condom use (OR, 2.0) were related to STD worry; whereas, only partner-specific barriers were related to HIV worry (OR, 1.9). Conclusions: Despite high risk, adolescents were generally complacent about the threat of infection with STD and HIV. Adolescents' worry about STD and HIV infection had different sets of correlates.

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

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

Publication year

2001

Journal title

Archives of Pediatrics and Adolescent Medicine

Volume

155

Issue

Page(s)

676-679

10.1001/archpedi.155.6.676

Abstract

Abstract

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

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.

Validity of self-reported sexually transmitted diseases among african american female adolescents participating in an HIV/STD prevention intervention trial

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

Publication year

2001

Journal title

Sexually Transmitted Diseases

Volume

Issue

Page(s)

468-471

10.1097/00007435-200108000-00009

Abstract

Abstract

Background: Studies assessing the validity attributed to self-reported measures of sexually transmitted diseases (STDs) clearly are needed, particularly those used for high-risk populations such as female adolescents, in whom STD prevention is a priority. Goal: To determine the accuracy of self-reported STD test results in female adolescents over a relatively brief period (≈28 days). Study Design: A prospective, randomized, controlled clinical trial of STD/HIV prevention for African American females, ages 14 to 18, was conducted. Study participants were recruited from medical clinics and school health classes in low-income neighborhoods of Birmingham, Alabama, that had high rates of unemployment, substance abuse, violence, STDs, and teenage pregnancy. Results: Of the 522 adolescents enrolled in the trial, 92% (n = 479) completed baseline STD testing and follow-up surveys. At baseline, 28% had positive test results for at least one disease: 4.8 % for Neisseria gonorrhoeae, 17.1% for Chlamydia trachomatis, and 12.3% for Trichomonas vaginalis. Of the adolescents with negative STD test results, 98.8% were accurate in their self. report of STD status, as compared with 68.7% of the adolescents with positive results. Underreporting varied by type of STD. Adolescents who accurately reported their positive STD status were significantly more likely to report their receipt of treatment accurately (P < 0.001). Conclusions: The substantial underreporting of STD incidence in this study suggests that reliance on self-reports of STD history may introduce misclassification bias, potentially leading to false conclusions regarding the efficacy of prevention interventions. This observation highlights the importance of using biologic indicators as outcome measures.

Ralph DiClemente