Ralph DiClemente
Ralph DiClemente
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Professor of Social and Behavioral Sciences
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Professional overview
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Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.
Dr. DiClemente’s research has four key foci:
- Developing interventions to reduce the risk of HIV/STD among vulnerable populations
- Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
- Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
- Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.
He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.
Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.
Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.
Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.
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Education
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BA, The City College of the City University of New York (CCNY), New York, NYScM, Behavioral Sciences, Harvard University, Cambridge, MAPhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CAPostdoctoral Fellow, University of California, San Francisco, CA
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Areas of research and study
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Community InterventionsDiabetesHIV/AIDSImplementation scienceInfluenzaPsychology
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Publications
Publications
Turning the Corner on the HIV Epidemic Among Adolescents : Prioritizing Directions for Future Prevention Research
AbstractDiClemente, R. (n.d.).Publication year
2013Journal title
Journal of HIV/AIDS and Social ServicesVolume
12Issue
3-4Page(s)
258-265Abstract~Understanding motivations for sex among detained youth : Implications for HIV prevention programs
AbstractVoisin, D. R., Salazar, L. F., Crosby, R. A., & DiClemente, R. (n.d.).Publication year
2007Journal title
Journal of HIV/AIDS and Social ServicesVolume
6Issue
3Page(s)
29-41AbstractThis investigation examined reasons for having sex among a sample of 369 African-American and White adolescent detainees, aged 14-18. Using A-CASI technology, sociodemographic variables and motivations for having sex were assessed among this population. Findings indicated that adolescents hold underlying motivations for having sex and that these differ to some degree by gender, SES, but less by race. For programs to be optimally effective, program goals should address gender and SES differentials for having sex.Understanding racial HIV/STI disparities in black and white men who have sex with men : A multilevel approach
AbstractSullivan, P. S., Peterson, J., Rosenberg, E. S., Kelley, C. F., Cooper, H., Vaughan, A., Salazar, L. F., Frew, P., Wingood, G., DiClemente, R., Del Rio, C., Mulligan, M., & Sanchez, T. H. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
3AbstractBackground:The reasons for black/white disparities in HIV epidemics among men who have sex with men have puzzled researchers for decades. Understanding reasons for these disparities requires looking beyond individual-level behavioral risk to a more comprehensive framework. Methods and Findings:From July 2010-Decemeber 2012, 803 men (454 black, 349 white) were recruited through venuebased and online sampling; consenting men were provided HIV and STI testing, completed a behavioral survey and a sex partner inventory, and provided place of residence for geocoding. HIV prevalence was higher among black (43%) versus white (13% MSM (prevalence ratio (PR) 3.3, 95% confidence interval (CI): 2.54.4). Among HIV-positive men, the median CD4 count was significantly lower for black (490 cells/μL) than white (577 cells/μL) MSM; there was no difference in the HIV RNA viral load by race. Black men were younger, more likely to be bisexual and unemployed, had less educational attainment, and reported fewer male sex partners, fewer unprotected anal sex partners, and less non-injection drug use. Black MSM were significantly more likely than white MSM to have rectal chlamydia and gonorrhea, were more likely to have racially concordant partnerships, more likely to have casual (one-time) partners, and less likely to discuss serostatus with partners. The census tracts where black MSM lived had higher rates of poverty and unemployment, and lower median income. They also had lower proportions of male-male households, lower male to female sex ratios, and lower HIV diagnosis rates. Conclusions:Among black and white MSM in Atlanta, disparities in HIV and STI prevalence by race are comparable to those observed nationally. We identified differences between black and white MSM at the individual, dyadic/sexual network, and community levels. The reasons for black/white disparities in HIV prevalence in Atlanta are complex, and will likely require a multilevel framework to understand comprehensively.Understanding reasons for participating in a school-based influenza vaccination program and decision-making dynamics among adolescents and parents
AbstractHerbert, N. L., Gargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2013Journal title
Health Education ResearchVolume
28Issue
4Page(s)
663-672AbstractInfluenza remains a significant cause of morbidity and mortality in the United States. Vaccinating school-aged children has been demonstrated to be beneficial to the child and in reducing viral transmission to vulnerable groups such as the elderly. This qualitative study sought to identify reasons parents and students participated in a school-based influenza vaccination clinic and to characterize the decision- making process for vaccination. Eight focus groups were conducted with parents and students. Parents and students who participated in the influenza vaccination clinic stated the educational brochure mailed to their home influenced participation in the program. Parents of non-participating students mentioned barriers, such as the lengthy and complicated consent process and suspicions about the vaccine clinic, as contributing to their decision not to vaccinate their child. Vaccinated students reported initiating influenza vaccine discussion with their parents. Parental attitudes and the educational material influenced parents' decision to allow their child to receive influenza vaccine. This novel study explored reasons for participating in a school-based vaccination clinic and the decision-making process between parents and child(ren). Persons running future school-based vaccination clinics may consider hosting an 'information session with a question and answer session' to address parental concerns and assist with the consent process.Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women
AbstractKottke, M., Whiteman, M. K., Kraft, J. M., Goedken, P., Wiener, J., Kourtis, A. P., & DiClemente, R. (n.d.).Publication year
2015Journal title
Journal of Pediatric and Adolescent GynecologyVolume
28Issue
6Page(s)
543-548AbstractStudy Objective: To characterize factors associated with dual method contraceptive use in a sample of adolescent women. Design, Setting, Participants, Interventions, and Main Outcome Measures: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics. Results: Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use. Conclusion: Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.Use of recreational Viagra among men having sex with men
AbstractDiClemente, R., Crosby, R., & DiClemente, R. J. (n.d.).Publication year
2004Journal title
Sexually transmitted infectionsVolume
80Issue
6Page(s)
466-468AbstractObjective: Given the potential for Viagra (sildenafil) use to foster greater friction during sex (owing to enlarged erection size) and prolonged sex, the recreational use of this substance warrants investigation in the context of STI risk. Thus, an exploratory study was conducted to identify bivariate correlates of recreational (non-prescription) Viagra use among men who have sex with men (MSM) attending a popular sex resort for men located in the southern United States. Methods: A cross sectional study was conducted. Behavioural measures, including Viagra use, were assessed using a 3 month recall period. Results: Of 164 men asked to participate, 91% completed a self administered questionnaire. Men resided in 14 states, most of which were located in the southern United States. Their average age was 40 years. Most (93%) men self identified as white. The median annual income interval was $25 000 to $50 000. One sixth (16.7%) reported being HIV positive. 16% reported using non-prescription Viagra. Age (p = 0.41), income (p = 0.32), and HIV serostatus (p = 0.85) were not associated with Viagra use. Of men recently using ecstasy during sex, 35% reported Viagra use compared to 13% among those not using ecstasy (p = 0.01). Of men recently using cocaine during sex, 37% reported Viagra use compared to 13% among those not using cocaine (p = 0.009). Use of "poppers" approached, but did not achieve, statistical significance as a correlate of Viagra use (p = 0.06). Recent frequency of unprotected anal sex (p = 0.79), fisting (p = 0.10), rimming (p = 0.64), and having five or more sex partners (p = 0.09) were not associated with Viagra use. Conclusion: Recreational Viagra use was relatively common among men, regardless of age or HIV serostatus. Viagra use was associated with men's substance abuse behaviours rather than their sexual risk behaviours.Using ADAPT-ITT to modify a telephone-based HIV prevention intervention for SMS delivery : Formative study
AbstractDavis, T., DiClemente, R., & Prietula, M. (n.d.).Publication year
2020Journal title
JMIR Formative ResearchVolume
4Issue
10AbstractBackground: African American adolescent females are disproportionately affected by sexually transmitted infections (STIs) and HIV. Given the elevated risk of STIs and HIV in African American women, there is an urgent need to identify innovative strategies to enhance the adoption and maintenance of STI and HIV preventive behaviors. Texting is a promising technology for creating preventive maintenance interventions (PMIs) that extend the efficacy of the original intervention. However, little guidance in public health literature is available for developing this type of application. Objective: This paper describes a formative pilot study that incorporates user experience methods to design and test PMI texts for Afiya, an original evidence-based intervention (EBI) specifically designed for African American adolescent females. This study aims to describe the adaptation process of health educator-led phone calling to text-based communication. Methods: The formative process followed the assessment, decision, adaptation, production, topical experts-integration, training, testing (ADAPT-ITT) framework for adapting EBIs and using them in a new setting, for a new target population or a modified intervention strategy. This study presents the details of how the phases of the ADAPT-ITT framework were applied to the design of the adaptation. An advisory board was constituted from the target population, consisting of 6 African American women aged 18-24 years, participating in formative activities for 12 weeks, and involving components of the PMI design. As Afiya included a telephone-based PMI, developers of the original Afiya phone scripts crafted the initial design of the SMS-based texts and texting protocol. The advisory board participated in the 1-day Afiya workshop, followed by 4 weeks of texting PMI messages and a midcourse focus group, followed by 4 more weeks of texting PMI messages, ultimately ending with a final focus group. At the advisory board's request, this phase included an optional, additional week of text-based PMI messages. Results: The methods provided a rich source of data and insights into the fundamental issues involved when constructing SMS-based PMI for this target population and for this EBI. Prior contact and context are essential as the health educator was identified as a key persona in the process and the messages were situated in the original (workshop) context. Narrative adaptations for personas emerged from advisory board discussions. Suggestions on how to expand the PMI to current, specific social contexts indicated that the use of narrative analysis is warranted. Conclusions: The use of existing EBIs incorporating telephone-based PMI scripts facilitated the initial design of the texts, with a subsequent narrative analysis of the advisory board data providing additional adjustments given the actual context. Additional examination of the advisory board feedback revealed that personas would offer insight into and opportunities for a persona-specific modification of texting narratives.Using culturally sensitive media messages to reduce HIV-associated sexual behavior in high-risk African American adolescents : Results from a randomized trial
AbstractSznitman, S., Vanable, P. A., Carey, M. P., Hennessy, M., Brown, L. K., Valois, R. F., Stanton, B. F., Salazar, L. F., DiClemente, R., Farber, N., & Romer, D. (n.d.).Publication year
2011Journal title
Journal of Adolescent HealthVolume
49Issue
3Page(s)
244-251AbstractPurpose: To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents. Methods: Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 1417 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346). Results: The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 1617 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities. Conclusion: Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.Using culture-centered qualitative formative research to design broadcast messages for HIV prevention for African American adolescents
AbstractHorner, J. R., Romer, D., Vanable, P. A., Salazar, L. F., Carey, M. P., Juzang, I., Fortune, T., DiClemente, R., Farber, N., Stanton, B., & Valois, R. F. (n.d.).Publication year
2008Journal title
Journal of Health CommunicationVolume
13Issue
4Page(s)
309-325AbstractThe need for formative research in designing mass media health-education messages is widely accepted; however, distinct methodologies for developing such messages are less well documented. This article describes a culture-centered approach for developing messages to promote sexual risk reduction in urban African American adolescents. The method uses qualitative formative research to identify "competing narratives" that support healthy behavior despite the dominance of messages that favor risk-taking behavior. The method is illustrated using qualitative analysis of semistructured interviews with 124 adolescents. Analysis focuses on two barriers to sexual risk reduction: (a) social pressure for early initiation of sexual intercourse and (b) perceptions that condoms reduce sexual pleasure. We demonstrate how competing narratives identified in the analysis can be featured in radio and television messages advocating healthy behavior by modeling risk-reducing negotiation skills.Using the Knocking Out Infections through Safer Sex and Screening (KISS) adapted behavioral intervention to reduce sexually transmitted infections in U.S. Army medical beneficiaries: Study protocol for a randomized controlled trial
AbstractDiClemente, R., Cebula, B., Walling, A., Reynolds, A., Yates, A., Follen, H., Clark, S., Sevilla, M., Faestel, P., Wingood, G., Crowell, T., Ake, J., Calvano, T., Kunz, A., & Colby, D. (n.d.). (14th eds.).Publication year
2024Volume
J Clin TrialsPage(s)
568Abstract~Utility of the AIDS risk assessment for crack cocaine and sex risk behaviours among homeless persons addicted to crack undergoing behavioural day treatment
AbstractSchumacher, J. E., Ross, D., Milby, J. B., Sekar, P., DiClemente, R., & Wallace, D. (n.d.).Publication year
2003Journal title
Journal of Substance UseVolume
8Issue
4Page(s)
205-214AbstractThe primary aim of this study was to assess the impact of an HIV and drug addiction intervention on reported sexual transmission HIV risk and drug use among homeless persons in two treatments for cocaine addiction. The ARA-C study (n = 104) included 74 (71.2%) men and 30 (28.8%) women with an average age of 37.8 (SD = 6.9) years. Most participants were African American (90, 86.5%) and the remainder were Caucasian (14, 13.5%). All participants met criteria for homelessness, nonpsychotic mental distress, and admitted to smoking crack cocaine within the 2 weeks prior to treatment. It appears that, overall, behavioural day treatment for cocaine disorders among homeless persons can have a short- and long-term impact on the reduction of sexual transmission HIV risk among this population with a minimal sexual transmission HIV risk intervention. The causal factors of this outcome still remain unclear. Treatment group differences did not sufficiently explain sexual transmission risk reductions and the impact of the HIV risk education programme was impossible to explain because it was provided to all participants and was only a small part of the overall programme. There did seem to be a small contribution of drug abstinence in the reduction of sexually transmitted risk, but this was at one time point for the Sex and Crack subscale only. This study demonstrates that there may be promise in providing drug addiction treatment combined with sexual transmission HIV risk reduction prevention programming for this extremely vulnerable group, and that future interventions should be better designed and tested using more robust research.Validation of a Parent-Adolescent Communication Scale for use in STD/HIV prevention interventions
AbstractSales, J. M., Milhausen, R. R., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2008Journal title
Health Education and BehaviorVolume
35Issue
3Page(s)
332-345AbstractThis study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions
AbstractMilhausen, R. R., McDermott Sales, J., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2007Journal title
Journal of HIV/AIDS Prevention in Children and YouthVolume
8Issue
1Page(s)
11-33AbstractThis paper reports on three studies in which the Partner Communication Scale (PCS) is validated. The PCS assesses African American adolescent females' frequency of sexual communication with male sex partners. The PCS was administered to three samples of African American female adolescents (N = 522; N= 280; N= 715) ranging in age from 14 to 21. The PCS demonstrated strong internal consistency and acceptable stability over 6-month and 12-month follow-up periods. Scores on the PCS were correlated with frequency of parent communication, sexual communication self-efficacy, sexual refusal self-efficacy, fear of communication about condoms, partner-related barriers to condom use, relationship satisfaction, self-esteem, exposure to communication-related sex education in schools and condom use, particularly with nonsteady male sex partners. The present investigation indicates that the PCS is a reliable and valid measure of frequency of sexual communication for female adolescents with their male sex partners. Future research with the PCS with more diverse samples in terms of race/ethnicity, gender, age and sexual orientation will be useful to establish its reliability and validity for these adolescent subgroups.Validation of the Sexual Communication Self-Efficacy Scale
AbstractQuinn-Nilas, C., Milhausen, R. R., Breuer, R., Bailey, J., Pavlou, M., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2015Journal title
Health Education and BehaviorVolume
43Issue
2Page(s)
165-171AbstractThis study assessed a newly developed Sexual Communication Self-Efficacy Scale designed to measure the sexual communication self-efficacy of adolescent men and women. Three-hundred and seventy-four U.K. adolescents completed this new scale, along with several other validity measures. Factor analysis revealed that the Sexual Communication Self-Efficacy Scale consisted of five underlying factors: contraception communication, positive sexual messages, negative sexual messages, sexual history, and condom negotiation. These factors demonstrated high internal consistency and presents evidence to support construct validity. This scale may have utility in assessing the effectiveness of interventions designed to enhance sexual communication and sexual health behaviors among young people.Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females
AbstractSales, J. M., Spitalnick, J., Milhausen, R. R., Wingood, G. M., DiClemente, R., Salazar, L. F., & Crosby, R. A. (n.d.).Publication year
2009Journal title
Health Education ResearchVolume
24Issue
1Page(s)
140-152AbstractThis study examined the psychometric properties of a new scale to measure adolescents' worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was administered to a sample of 522 African-American female adolescents ranging in age from 14 to 18, residing in the southeast United States and participating in a sexual risk reduction intervention. The WASO demonstrated internal consistency across multiple administrations and yielded satisfactory construct validity. Worry was found to negatively correlate with sexual communication self-efficacy (with a new male partner and a steady male partner), frequency of sexual communication with male partner, attitudes about condom use and social support; worry was positively correlated with perceived barriers to condom use, condom negotiation, locus of control and depression. Overall, the results indicate that the WASO is a reliable and valid measure of assessing adolescents' worry about STIs, HIV and pregnancy. The WASO represents a brief self-administered instrument that can be easily integrated into sexual risk reduction assessments and interventions. Future studies employing the WASO might consider testing it with more diverse samples in terms of gender, race/ethnicity, age and sexual orientation.Validity of Self-reported Sexual Behavior Among Adolescents : Where Do We Go from Here?
AbstractDiClemente, R. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Page(s)
215-217AbstractAdolescents have high rates of sexually transmitted infections (STIs). Adolescents consuming alcohol and using drugs have markedly greater HIV/STI risk and are a priority population for intervention. Accurate measurement of sexual risk behavior is critical for understanding individual’s risk for HIV/STI, transmission dynamics of HIV/STI, and evaluating the efficacy of interventions designed reduce HIV/STI risk. However, significant challenges to accurately measuring adolescents’ self-reported sexual behavior are well-documented. Recent advances in microbiology, such as the use of less invasive specimen collection for DNA assays, can assist researchers in more accurately measuring adolescents’ sexual risk behavior. However, the majority of studies of adolescents’ sexual risk rely solely on self-reported behavior; therefore, methods to improve the validity of adolescents’ self-reported sexual behavior are needed. In addition, integrating biologic measures to complement self-reported measures are recommended, when appropriate and feasible.Validity of self-reported sexually transmitted diseases among african american female adolescents participating in an HIV/STD prevention intervention trial
AbstractHarrington, K. F., DiClemente, R., Wingood, G. M., Crosby, R. A., Person, S., Oh, M. K., & Hook, E. W. (n.d.).Publication year
2001Journal title
Sexually Transmitted DiseasesVolume
28Issue
8Page(s)
468-471AbstractBackground: 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.Value of Consistent Condom Use : A Study of Sexually Transmitted Disease Prevention among African American Adolescent Females
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Lang, D., & Harrington, K. F. (n.d.).Publication year
2003Journal title
American journal of public healthVolume
93Issue
6Page(s)
901-902Abstract~Wanted : A theoretical roadmap to research and practice across individual, interpersonal, and structural levels of analysis
AbstractDiClemente, R., Albarracin, D., Rothman, A. J., Di Clemente, R., & Del Rio, C. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
SUPPL. 2Page(s)
S185-S188Abstract~What girls won't do for love : Human immunodeficiency virus/sexually transmitted infections risk among young african-american women driven by a relationship imperative
AbstractRaiford, J. L., Seth, P., & DiClemente, R. (n.d.).Publication year
2013Journal title
Journal of Adolescent HealthVolume
52Issue
5Page(s)
566-571AbstractPurpose: Rates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors. Methods: Participants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing. Results: Multivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive. Conclusion: These results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk.What predicts people’s belief in COVID-19 misinformation? A retrospective study using a nationwide online survey among adults residing in the United States
AbstractKim, S., Capasso, A., Ali, S. H., Headley, T., DiClemente, R., & Tozan, Y. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in misinformation. Methods: Data was used from an online survey that was administered in April 2020 to 6518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of belief in each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. Results: About 30% of our sample reported believing in at least one type of COVID-19-related misinformation. Belief in one type of misinformation was not strongly associated with belief in other types. We also identified 58 demographic and socioeconomic factors that predicted people’s susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. Conclusion: Our findings confirm the existence of groups with unique characteristics that believe in different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice system
AbstractRaiford, J. L., Seth, P., Fasula, A. M., & DiClemente, R. (n.d.).Publication year
2017Journal title
Sexual HealthVolume
14Issue
4Page(s)
331-337AbstractBackground: HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. Methods: In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. Results: When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. Conclusions: Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.Will HIV vaccination reshape HIV risk behavior networks? A social network analysis of drug users' anticipated risk compensation
AbstractYoung, A. M., Halgin, D. S., DiClemente, R., Sterk, C. E., & Havens, J. R. (n.d.).Publication year
2014Journal title
PloS oneVolume
9Issue
7AbstractBackground: An HIV vaccine could substantially impact the epidemic. However, risk compensation (RC), or post-vaccination increase in risk behavior, could present a major challenge. The methodology used in previous studies of risk compensation has been almost exclusively individual-level in focus, and has not explored how increased risk behavior could affect the connectivity of risk networks. This study examined the impact of anticipated HIV vaccine-related RC on the structure of high-risk drug users' sexual and injection risk network. Methods: A sample of 433 rural drug users in the US provided data on their risk relationships (i.e., those involving recent unprotected sex and/or injection equipment sharing). Dyad-specific data were collected on likelihood of increasing/ initiating risk behavior if they, their partner, or they and their partner received an HIV vaccine. Using these data and social network analysis, a "post-vaccination network" was constructed and compared to the current network on measures relevant to HIV transmission, including network size, cohesiveness (e.g., diameter, component structure, density), and centrality. Results: Participants reported 488 risk relationships. Few reported an intention to decrease condom use or increase equipment sharing (4% and 1%, respectively). RC intent was reported in 30 existing risk relationships and vaccination was anticipated to elicit the formation of five new relationships. RC resulted in a 5% increase in risk network size (n = 142 to n = 149) and a significant increase in network density. The initiation of risk relationships resulted in the connection of otherwise disconnected network components, with the largest doubling in size from five to ten. Conclusions: This study demonstrates a new methodological approach to studying RC and reveals that behavior change following HIV vaccination could potentially impact risk network connectivity. These data will be valuable in parameterizing future network models that can determine if network-level change precipitated by RC would appreciably impact the vaccine's population-level effectiveness.Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa : Results from a U.S. National sample
AbstractPainter, J. E., von Fricken, M. E., Viana de O. Mesquita, S., & DiClemente, R. (n.d.).Publication year
2018Journal title
Human Vaccines and ImmunotherapeuticsVolume
14Issue
7Page(s)
1665-1671AbstractThe 2014–2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30–May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1–50; 174 (20.1%) would pay $51–100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.Withdrawal (Coitus Interruptus) as a sexual risk reduction strategy : Perspectives from African-American adolescents
AbstractHorner, J. R., Salazar, L. F., Romer, D., Vanable, P. A., DiClemente, R., Carey, M. P., Valois, R. F., Stanton, B. F., & Brown, L. K. (n.d.).Publication year
2009Journal title
Archives of Sexual BehaviorVolume
38Issue
5Page(s)
779-787AbstractThis study examined adolescents' beliefs about the benefits and risks of withdrawal (coitus interruptus) with respect to both pregnancy and sexually transmitted infections (STIs). In the course of qualitative interviews with African-American youth aged 14-19 (n = 124) about sexuality and risk, 24 adolescents spontaneously introduced the subject of withdrawal as a sexual risk reduction strategy. Eighteen percent of the sexually experienced adolescents mentioned their own use of withdrawal as a contraceptive method. From adolescents' accounts of their own and their peers' use of withdrawal, we learned that the cultural meanings of withdrawal within the context of adolescent relationships were multifaceted. Using withdrawal could signal sexual prowess in male youth, was seen as promoting trust and caring within a stable relationship, and was seen as mitigating the risk of pregnancy. However, adolescents also recognized that withdrawal did not protect against most STIs. Beliefs about withdrawal as a gendered skill and as a sign of trust may undermine some adolescents' attempts to negotiate condom use for protection against STIs.