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

Overweight and obesity in Native-American adolescents: Comparing nonreservation youths with African-American and Caucasian peers

Gruber, E., Anderson, M. M., Ponton, L., & DiClemente, R. (n.d.).

Publication year

1995

Journal title

American journal of preventive medicine

Volume

Issue

Page(s)

306-310

10.1016/s0749-3797(18)30435-5

Abstract

Abstract

Previous studies have consistently shown that, compared to national standards, Native Americans across all age groups are disproportionately overweight or obese. Although most available data on rates of obesity in this group come from studies conducted on reservations, the proportion of Native Americans residing on reservation lands is rapidly declining. This study examines the prevalence of overweight and obesity in a population of Midwestern adolescents in public school settings and contrasts Caucasian and African-American adolescents with Native-American youths of the same age. Data were derived from a secondary analysis of an anonymous health-risk survey. Height, weight, and ethnicity were ascertained through self-report. The results call into question whether rates of overweight or obesity in Native-American adolescents are disproportionate relative to those for Caucasian and African-American adolescents. Cumulative comparisons of all overweight and obese adolescents in the sample (n = 5,655) show significant differences among ethnic groups, but age-specific comparisons do not yield a consistent pattern, especially for Native-American girls. To compare the entire sample to national weight standards, we plotted mean body mass index (BMI) for each ethnic group by age against NHANES II reference data. Age- specific BMI means for Native-American and Caucasian girls fell largely below the NHANES II reference data. We present several explanations for these results. Given the study limitations, further objective study of the weight status of Native-American children and adolescents in direct comparison with other ethnic groups is recommended.

The developmental implications of prenatal and/or postnatal crack cocaine exposure in preschool children: A preliminary report

Bender, S. L., Word, C. O., DiCLEMENTE, R. J., Crittenden, M. R., Persaud, N. A., & Ponton, L. E. (n.d.).

Publication year

1995

Journal title

Journal of Developmental and Behavioral Pediatrics

Volume

Issue

Page(s)

418-424

Abstract

Abstract

Previous studies examining the development of prenatally cocaine-exposed children through 3 years of age have found no significant differences between exposed and control groups. This study explored the developmental correlates of prenatal and/or postnatal crack cocaine exposure in children between 4 and 6 years of age. Three groups were studied: Group 1, 18 prenatally—exposed children whose mothers continue to use crack; Group II, 28 children without prenatal exposure whose mothers presently use crack; and Group III, 28 children whose mothers never used crack. Mothers were street-recruited and were comparable in race and socioeconomic status. The three groups of children did not differ on neurological gross motor and expressive language measures. However, prenatally exposed children performed significantly worse than others on receptive language and visual motor drawing tests. Prenatal crack exposure predicted poor visual motor performance even after control for intrauterine alcohol and marijuana exposure, age, birth weight, and duration of maternal crack use.

Expanding the Pediatrician's Role in HIV Prevention for Adolescents

Diclemente, R. J., & Brown, L. K. (n.d.).

Publication year

1994

Journal title

Clinical Pediatrics

Volume

Issue

Page(s)

235-240

10.1177/000992289403300409

Sexual communication is associated with condom use by sexually active incarcerated adolescents

Rickman, R. L., Lodico, M., Diclemente, R. J., Morris, R., Baker, C., & Huscroft, S. (n.d.).

Publication year

1994

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

383-388

10.1016/1054-139X(94)90261-5

Abstract

Abstract

Purpose: Incarcerated adolescents are at increased risk for infection by sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Moreover, condom use by this population is extremely low. Although interpersonal variables such as sexual communication have been found to be associated with condom use in other populations, few researchers have investigated this relationship among adolescents requiring detention in juvenile facilities. The present study investigated the relationship between communication about sexual history and incarcerated adolescents' condom use. Methods: We used multivariate logistic regression techniques to analyze interview data from a predominantly Latino sample of 2,132 sexually active adolescents detained in Los Angeles County Juvenile Hall. Results: Despite high numbers of lifetime sexual partners, a substantial majority of respondents (67%) reported that they never used condoms during sexual intercourse. Respondents who communicated with their sex partner(s) about each others' sexual history were significantly more likely to use condoms during sexual intercourse. Adolescents who reported that they knew someone with AIDS were also more likely to use condoms. Conclusions: Interventions designed to increase condom use among sexually active incarcerated adolescents should include a component addressing sexual communication practices. More research is needed on the ways in which adolescents learn to communicate about sex.

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

Lodico, M. A., & Diclemente, R. J. (n.d.).

Publication year

1994

Journal title

Clinical Pediatrics

Volume

Issue

Page(s)

498-502

10.1177/000992289403300810

A Pilot Study of Sexual Communication and Negotiation Among Young African American Women: Implications for HIV Prevention

Wingood, G. M., Hunter-Gamble, D., & DiClemente, R. J. (n.d.).

Publication year

1993

Journal title

Journal of Black Psychology

Volume

Issue

Page(s)

190-203

10.1177/00957984930192008

Abstract

Abstract

Recent epidemiological studies indicate that African American female adolescents are at a markedly higher riskfor diagnoses with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) than their White female counterparts. Although epidemiologic data are informatve with respect to monitoring the course of the epidemic and quantifying the differential riskfor AIDSIHIV infection among young Afican American women in relation to other populations, they provide less insight into the influence of the diverse cultural, gender, andpsychosocial determinants ofHIV-associated risk behaviors. Afactor ofparticular importance is communication between sexual partners about condom use. Focus groups were conducted with African American women aged 18 to 25, to explore the process ofsexual communication and barriers toward sexual negotiation of condom use. HlVprevention programs tailored to African American women should emphasize training in sexual negotiation, conflict resolution, and refusal skills.

Changes in adolescents' knowledge and attitudes about AIDS over the course of the AIDS epidemic

Zimet, G. D., Diclemente, R. J., Lazebnik, R., Anglin, T. M., Ellick, E. M., & Williams, P. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

85-90

10.1016/1054-139X(93)90090-C

Abstract

Abstract

We compared AIDS-related attitudes of junior and senior high school students from 1988 to 1991 and across grade level to examine how effectively schools are addressing AIDS. Attitudes measured included knowledge and social anxiety about AIDS, as well as perceptions of vulnerability to HIV infection. Junior high school students (grades 7-9) were sampled three times, from 1989 to 1991. High school students (grades 10-12) were sampled four times, from 1988 to 1991. The 1991 junior high school sample had lower AIDS knowledge scores than the 1989 sample. Conversely, the 1991 high school sample had more accurate knowledge than earlier groups. With respect to grade level, 9th graders had more accurate knowledge than 7th and 8th graders, but knowledge did not increase from 10th through 12th grade. Anxiety about interacting with a person with AIDS and perceptions of vulnerability to HIV infection were unrelated to either sampling time or grade level. It is concluded that it will be important to redouble efforts to educate adolescents about AIDS and that particular attention needs to be paid to young adolescents.

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities

DiClemente, R. J., Brown, L. K., Beausoleil, N. I., & Lodico, M. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

231-236

10.1016/1054-139X(93)90011-D

Abstract

Abstract

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Confronting the Challenge of AIDS among Adolescents: Directions for Future Research

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

Publication year

1993

Journal title

Journal of Adolescent Research

Volume

Issue

Page(s)

156-166

10.1177/074355489382002

Abstract

Abstract

To effectively combat the AIDS health crisis among adolescents, future research must address three key issues: (a) the risk of disease for culturally differing adolescent populations, particularly African-American adolescents; (b) the need for empirical investigations to identify and understand the variables influencing adolescents ‘adoption of HIV-preventive sexual practices; and (c) the development of more effective prevention programs to reduce adolescents’ existing HIV-associated risk behaviors. This article reviews the relevance of these issues for prevention research and suggests policy recommendations. These recommendations argue for: (a) expanded funding for basic behavioral surveys to identify the prevalence of risk-taking behavior among adolescents in general, and among high-risk adolescent subgroups, for example, incarcerated and homeless adolescents; (b) encouraging more epidemiologic and ethnographic research to understand the psychosocial and cultural variables associated with high and low-risk behavior among understudied and underserved racial/ethnic populations such as African-American adolescents; and (c) urging that evaluation of HIV prevention programs include multisite trials and larger samples in ethnically and geographically diverse populations.

Factors associated with multiple sex partners among junior high school students

Durbin, M., DiClemente, R. J., Siegel, D., Krasnovsky, F., Lazarus, N., & Camacho, T. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

202-207

10.1016/1054-139X(93)90006-B

Abstract

Abstract

Twenty-one percent of a sample of inner-city junior high school students were found to be sexually active (n = 403). Only 31% of them reported a single lifetime sexual partner, 25% reported two partners, and 43% reported three or more partners. Logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on the adolescents' lifetime number of sex partners. Respondents whose sexual debut occurred before age 13 years were nine times more likely to report three or more sex partners compared with those whose first sexual intercourse was at age 15 or 16 years, blacks were four times more likely than non-Hispanic whites to report three or more sex partners; and males were four times as likely as females to report this number of sexual partners. Factors not independently associated with the number of sex partners included: age, Asian or Hispanic ethnicity, human immunodeficiency virus (HIV) knowledge, self-efficacy (belief that one can protect oneself from the virus), condom use, and alcohol and drug use. We conclude that a significant proportion of school-based middle adolescents are sexually active and that most of these are at risk for contracting HIV because of behaviors such as having multiple sexual partners. Topics often stressed in school-based HIV education, such as factual knowledge about HIV, avoiding drugs and alcohol, and condom use are not associated with adolescents' choice about their number of sex partners. Intervention programs will have to identify and then target each specific HIV risk behavior and its motivations in order to reduce adolescents' risks of contracting and transmitting the disease.

HIV knowledge, communication, and risk behaviors among white, Chinese-, and Filipino-American adolescents in a high-prevalence AIDS epicenter: a comparative analysis.

Horan, P. F., & DiClemente, R. J. (n.d.).

Publication year

1993

Journal title

Ethnicity & disease

Volume

Issue

Page(s)

97-105

Abstract

Abstract

We conducted a comparative analysis of human immunodeficiency virus (HIV) knowledge, communication, and risk behaviors among 1272 white, Chinese-, and Filipino-American 10th and 11th graders in San Francisco, California, a high-prevalence AIDS epicenter. We performed principal components analysis on an epidemiologic survey instrument, and we identified five factors: HIV prevention knowledge, sexual behavior risk index, drug use risk index, HIV misconceptions, and communication about HIV. White students had higher HIV prevention scores than did Chinese and Filipino students, and whites had significantly greater ability to communicate with others about HIV disease and prevention. Chinese- and Filipino-American students had fewer misconceptions about HIV than did white students. Ethnicity did not have a significant influence on sexual behavior or drug use risk indices. Findings are discussed with reference to culturally sensitive HIV education.

HIV-related risk behaviors among psychiatrically hospitalized adolescents and school-based adolescents

DiClemente, R. J., & Ponton, L. E. (n.d.).

Publication year

1993

Journal title

American Journal of Psychiatry

Volume

150

Issue

Page(s)

324-325

Abstract

Abstract

The authors compared the responses of 76 adolescents on an inpatient psychiatric service with those of 802 school-based adolescents in the same city regarding HIV risk behaviors. The psychiatrically hospitalized adolescents reported a significantly higher rate of sexual and drug-related behaviors that involve a risk for contracting sexually transmitted disease, including HIV-related illnesses.

Preventing HIV/AIDS Among Adolescents: Schools as Agents of Behavior Change

Diclemente, R. J. (n.d.).

Publication year

1993

Journal title

JAMA: The Journal of the American Medical Association

Volume

270

Issue

Page(s)

760-762

10.1001/jama.1993.03510060106042

Abstract

Abstract

Although adolescents currently account for less than 1% of acquired immunodeficiency syndrome (AIDS) cases in the United States, recent data indicate that the rate of adolescent AIDS cases has increased markedly,1 especially among African-American adolescents.2 Moreover, given the long latency period between infection with the human immunodeficiency virus (HIV) and clinical symptoms, reliance on AIDS case surveillance data severely underestimates the serious health threat to adolescents posed by the AIDS epidemic. More relevant indices, such as HIV seroprevalence in selected adolescent populations2 and the high prevalence of sexually transmitted diseases and sexual risk behaviors,3,4 emphasize the need for the urgent development and implementation of programs that effectively reduce HIV-related risk behaviors, particularly unprotected sexual intercourse. See also p 725. Although sexual abstinence is the most effective method to prevent transmission of HIV and other sexually transmitted diseases, many adolescents are sexually active, with the age.

The effects of child abuse and race on risk-taking in male adolescents.

Hernandez, J. T., Lodico, M., & DiClemente, R. J. (n.d.).

Publication year

1993

Journal title

Journal of the National Medical Association

Volume

Issue

Page(s)

593-597

Abstract

Abstract

This study explores the effects of abuse on the risk-taking behaviors of 2973 black and white adolescent males, 412 of whom were sexually or physically abused. Surveys on mental and physical health, risk-taking behaviors and attitudes, and family living were administered to 9th and 12th graders in an urban midwestern state. The surveys included questions on past history of sexual and physical abuse. More black than white males reported experiencing incest, extrafamilial sexual abuse, and physical abuse. As for outcome risk-taking behaviors, blacks were more likely to use illegal substances, run away, skip school, attempt suicide, force partners into sex, and commit violent acts; however, the racial effects decreased when abuse histories were taken into consideration. Whites were more likely to drink and drive, and to drink before having sex; abuse history did not decrease this racial effect. Abuse but not race was predictive of drinking and of having serious drinking problems. The results point to the importance of pediatricians, psychologists, and other healthcare workers, as well as those in the legal and criminal justice system screening for a history of abuse among adolescents who demonstrate these or other risk-taking behaviors.

The Relationship of Magic Johnson's Announcement of HIV Infection to the AIDS Attitudes of Junior High School Students

Zimet, G. D., Lazebnik, R., Anglin, T. M., Williams, P., DiClemente, R. J., & Ellick, E. M. (n.d.).

Publication year

1993

Journal title

The Journal of Sex Research

Volume

Issue

Page(s)

129-134

10.1080/00224499309551692

Abstract

Abstract

One month after Magic Johnson announced that he had tested positive for human immunodeficiency virus (HIV), 103 junior high school students were surveyed about the impact of his announcement on their desire to learn about acquired immunodeficiency syndrome (AIDS), their worries about vulnerability to HIV infection, and their anxiety about interacting with a person with AIDS (PWA). Students also were administered established AIDS-related scales of knowledge, vulnerability worries, and social anxiety. Their scores on these scales were compared to the scores of different students from the same school sampled at three previous times. As expected, 58% of the students reported a desire to know more about AIDS, and 40% reported increased worries about vulnerability to HIV infection because of Magic Johnson's announcement. Contrary to expectations, 21% reacted with a report of increased anxiety about interacting with a PWA, whereas 12% reported less anxiety. Also contrary to expectations, when compared with the pre-announcement groups, the post-announcement students had lower scores on the vulnerability worry scale, indicating less worry about personal vulnerability to HIV infection. Results are discussed in terms of the possible influences of social desirability bias and perceptions of personal risk.

Child Sexual Abuse of Asians Compared with Other Populations

RAO, K., DICLEMENTE, R. J., & PONTON, L. E. (n.d.).

Publication year

1992

Journal title

Journal of the American Academy of Child and Adolescent Psychiatry

Volume

Issue

Page(s)

880-886

10.1097/00004583-199209000-00016

Abstract

Abstract

This retrospective chart review study of a child sexual abuse clinic compared a consecutive sample of substantiated sexual abuse cases of Asian victims with random samples of black, white, and Hispanic victims. The findings suggest that there are clinically relevant differences between Asians and the other three populations. Asian victims showed a distinct demographic profile, suffered less physically invasive forms of abuse, were more likely to express suicidality, less likely to display anger and sexual acting out, and had less supportive primary caretakers than non-Asians. Awareness of such ethnic differences will help clinicians better evaluate and treat minority victims.

Comparison of human immunodeficiency virus related knowledge, attitudes, intentions, and behaviors among sexually active and abstinent young adolescents

Brown, L. K., DiClemente, R. J., & Beausoleil, N. I. (n.d.).

Publication year

1992

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

140-145

10.1016/1054-139X(92)90081-L

Abstract

Abstract

Although young sexually active adolescents are at greater risk for human immunodeficiency virus (HIV) acquisition than their abstinent peers, little is known about their respective HIV-related knowledge, attitudes, and general risk behaviors. This study of middle school adolescents (n = 1379; mean age, 13.2 years) found that the sexually active boys, compared with their peers, were less knowledgeable about HIV, less fearful of HIV, less tolerant of people with acquired immunodeficiency syndrome (AIDS), riskier in non-HIV-related attitudes and had a greater history of other risk behavior. A similar, but less marked pattern, was found for girls. It is suggested that physicians counsel all adolescents about HIV and sexuality during office visits and that early adolescent sexuality should prompt special efforts in HIV education/ counseling.

Confronting the challenge of AIDS in the African-American community.

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

Publication year

1992

Journal title

Ethnicity & disease

Volume

Issue

Page(s)

358-360

Cultural, gender, and psychosocial influences on HIV-related behavior of African-American female adolescents: implications for the development of tailored prevention programs.

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

Publication year

1992

Journal title

Ethnicity & disease

Volume

Issue

Page(s)

381-388

Abstract

Abstract

This paper presents epidemiologic data describing the risk of HIV/AIDS and sexually transmitted diseases for African-American female adolescents relative to their white peers. Diverse cultural, psychosocial, and gender influences affect behavior; these should be considered in the development and implementation of culturally sensitive HIV prevention interventions tailored toward African-American female adolescents. These influences include sex-role socialization issues, the African-American family; issues related to racial identity; communication styles common among African-American youth; normative influences in adolescent heterosexual relationships; and factors affecting feelings of self-efficacy, empowerment, and gender rules in the African-American female adolescent. Strategies for incorporating cultural, psychosocial, and gender influences into the development of HIV risk-reduction interventions are suggested. Culturally specific interventions tailored toward this population may be more effective at motivating the adoption and maintenance of HIV-preventive behaviors.

Determinants of condom use among junior high school students in a minority, inner-city school district

DiClemente, R. J., Durbin, M., Siegel, D., Krasnovsky, F., Lazarus, N., & Comacho, T. (n.d.).

Publication year

1992

Journal title

Pediatrics

Volume

Issue

Page(s)

197-202

Abstract

Abstract

Condoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.

Epidemiology of AIDS, HIV Prevalence, and HIV Incidence Among Adolescents

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

Publication year

1992

Journal title

Journal of School Health

Volume

Issue

Page(s)

325-330

10.1111/j.1746-1561.1992.tb01251.x

Abstract

Abstract

ABSTRACT: Health educators, policy analysts, and public health officials are becoming more aware of the serious threat HIV poses to the health of U.S. adolescents. While AIDS among adolescents remains relatively uncommon, considerable data indicates this age group has alarmingly high HIV infection rates and that minority adolescents are at disproportionately greater risk of HIV infection relative to their White peers. Recent seroconversion studies of active duty military personnel indicate that the number of new HIV infections (incident cases) are especially high among Black adolescents. Findings suggest the urgent need for more tailored HIV prevention programs, especially gender‐ and ethnic‐specific programs. 1992 American School Health Association

HIV/AIDS education and prevention among African-Americans: A focus on culture

Airhihenbuwa, C. O., DiClemente, R. J., Wingood, G. M., & Lowe, A. (n.d.).

Publication year

1992

Journal title

AIDS Education and Prevention

Volume

Issue

Page(s)

267-276

Abstract

Abstract

African-Americans have emerged as the 'second wave' of the AIDS epidemic. Epidemiologic evidence indicates that African-Americans adults as well as adolescents have a disproportionately higher risk of AIDS and human immunodeficiency virus (HIV) infection. While programs designed to increase self-protective behaviors are urgently needed to avert a further increase in HIV infection among this population, there is little understanding of African-American sociocultural factors that may influence the acceptance of HIV information and the adoption of HIV-preventive behaviors. This paper describes African-American cultural values and mores which may be related to risk-taking behavior. Barriers to the effective dissemination of HIV prevention education are identified and strategies that may be effective in surmounting these barriers and implementing culturally-appropriate HIV behavioral modification programs are described.

Moral reasoning and unprotected sex among young men

Hernandez, J., & Diclemente, R. J. (n.d.).

Publication year

1992

Journal title

Journal of Health Education

Volume

Issue

Page(s)

347-351

10.1080/10556699.1992.10616314

Abstract

Abstract

This study examined the influence of moral reasoning on young men’s HIV-related sexual risk behaviors, specifically unprotected sexual intercourse. It was hypothesized that those with higher stage moral reasoning will be more likely to practice safe sex. Male college students completed a measure of moral reasoning and a self-report questionnaire assessing sexual behavior. Those scoring high on moral reasoning reported significantly fewer incidents of unprotected sex and more respect for partners who wanted to practice safe sex. They also had fewer sex partners, reported fewer pick-ups, and their sexual motivation on dates was lower (the latter comparisons did not reach levels of significance). That students engage in risky sexual practices less when they use higher levels of moral reasoning is important to the health education discipline’s effort to promote safer sex. It speaks to incorporating training in higher levels of moral reasoning into sex education curricula, for example, by presenting moral sexual dilemmas for classroom discussion. The moral dilemma approach stimulates students to progress more rapidly through their own natural course of moral development, and summarily provides them with the tools to make responsible decisions about sexual behaviors.

Predictors of condom use in sexually active adolescents

Brown, L. K., Diclemente, R. J., & Park, T. (n.d.).

Publication year

1992

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

651-657

10.1016/1054-139X(92)90058-J

Abstract

Abstract

Unprotected sexual intercourse places a substantial number of adolescents at risk for sexually transmitted disease (STD) and human immunodeficiency virus (HIV) infection. While the most effective means of preventing STD/ HIV infection among sexually active adolescents is consistent condom use, little is known about the factors that influence their consistent use among adolescents. This study of adolescents (n = 1049, mean age = 16.2 years) found that of the 266 teens who recently became sexually active, only 29% reported using condoms consistently. Consistent condom use was more frequent in males, those with little history of risk behavior and those with stronger intentions to use condoms in the future. Fear and anxiety of HIV, attitudes about risks other than HIV, and other safe behavior intentions were not significantly related to consistent condom use. Although intentions and recent behavior were significantly related, a different group of factors was found to predict intention to use condoms (e.g., perception of condom use by friends, general impulsive attitudes). Identifying and understanding the factors that influence adolescent sexual behavior and intentions is important for developing maximally effective HIV education/prevention programs.

Self-control and ego identity development as predictors of unprotected sex in late adolescent males

Hernandez, J. T., & Diclemente, R. J. (n.d.).

Publication year

1992

Journal title

Journal of Adolescence

Volume

Issue

Page(s)

437-447

10.1016/0140-1971(92)90073-E

Abstract

Abstract

Male college students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, moral development, personality factors and behaviors. Bivariate analyses were used to identify factors associated with high-risk sexual intercourse. Significant demographic psychosocial and behavioral predictors were entered into a logistic regression analysis to evaluate the independent influence of each predictor on unprotected sexual intercourse. Behavioral factors were the most powerful predictors of unprotected sexual intercourse. Adolescents reporting multiple sex partners, drinking and picking-up sex partners were significantly more likely to engage in sex without condoms. Examining psychosocial factors alone, it was found that adolescents who had low scores for ego-development (goal-directedness) and self-control were significantly more likely to engage in sex without condoms. Identification of two personality constructs as underlying predictors of high-risk behavior, while potentially important for the development of effective HIV prevention programs, needs corroboration to further define the interrelationships between these factors and other psychosocial constructs.

Ralph DiClemente