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
Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV : A Multilevel Analysis
AbstractCapasso, A., Brown, J. L., Safonova, P., Belyakov, N., Rassokhin, V., & DiClemente, R. (n.d.).Publication year
2021Journal title
AIDS and BehaviorVolume
25Issue
11Page(s)
3734-3742AbstractAlcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18–35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = − 81, − 2; z = − 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.Heterogeneity of Sexual Risk Profiles Among Juvenile Justice-Involved African American Girls
AbstractLogan-Greene, P., Bascug, E. W., DiClemente, R., & Voisin, D. R. (n.d.).Publication year
2021Journal title
Child and Youth Care ForumVolume
50Issue
4Page(s)
653-677AbstractBackground: Juvenile justice-involved African American girls are considered uniformly high-risk for adverse sexual health outcomes such as sexually transmitted infections (STIs) and pregnancy; however, their sexual health statuses may be more complex. Objective: The present study assessed whether diverse subgroups of sexual risk exist and explored variations by socio-contextual indicators and sexual health outcomes. Method: The sample consisted of 188 detained African American adolescent girls. Six key sexual risk model indicators were selected for latent class analysis: early sex initiation, unprotected sex, high number of sex partners, sex while intoxicated, having sex with a recently incarcerated partner, and trading sex. Results: Results revealed a four-class solution: “Lowest Risk” (40.3%), with relatively low endorsement of sexual risk items; “Precocious Debut” (19.5%), with early sexual initiation and highest number of sex partners; “Delayed Risk” (30.3%), with later sexual debut but elevated unprotected sex and number of sex partners; and “Highest Risk” (9.9%), with the highest proportions on most indicators, but lower numbers of sex partners compared to Precocious Debut. Classes differed significantly on sexual health outcomes and demographic, neighborhood, peer, family, and individual factors. High Risk, Precocious Debut, and Delayed Risk were associated with greater prevalence of STIs. Lowest Risk and Precocious Debut classes had fewer prior pregnancies. Lowest Risk girls were significantly lower on a range of risk outcomes. Conclusions: Heterogeneous profiles of sexual risk may inform future prevention and interventions for at-risk or detained African American girls.Impact of COVID-19-related knowledge on protective behaviors : The moderating role of primary sources of information
AbstractKim, S., Capasso, A., Cook, S. H., Ali, S. H., Jones, A. M., Foreman, J., DiClemente, R., & Tozan, Y. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
11AbstractThis study assessed the modifying role of primary source of COVID-19 information in the association between knowledge and protective behaviors related to COVID-19 among adults living in the United States (US). Data was collected from 6,518 US adults through an online cross-sectional self-administered survey via social media platforms in April 2020. Linear regression was performed on COVID-19 knowledge and behavior scores, adjusted for sociodemographic factors. An interaction term between knowledge score and primary information source was included to observe effect modification by primary information source. Higher levels of knowledge were associated with increased self-reported engagement with protective behaviors against COVID-19. The primary information source significantly moderated the association between knowledge and behavior, and analyses of simple slopes revealed significant differences by primary information source. This study shows the important role of COVID-19 information sources in affecting people's engagement in recommended protective behaviors. Governments and health agencies should monitor the use of various information sources to effectively engage the public and translate knowledge into behavior change during an evolving public health crisis like COVID-19.Increased alcohol use during the COVID-19 pandemic : The effect of mental health and age in a cross-sectional sample of social media users in the U.S.
AbstractCapasso, A., Jones, A. M., Ali, S. H., Foreman, J., Tozan, Y., & DiClemente, R. (n.d.).Publication year
2021Journal title
Preventive MedicineVolume
145AbstractThe COVID-19 pandemic has triggered a public health crisis of unprecedented scale. Increased alcohol use has been extensively documented during other crises, particularly among persons with anxiety and depression. Despite COVID-19's differential impact by age, the association of age, mental health and alcohol use during the pandemic has not been explored. This study aimed to examine whether age modified the association of anxiety and depressive symptoms with alcohol use during the COVID-19 pandemic. Two online surveys were administered to U.S. adult social media users in March and April 2020. Generalized linear models were conducted in 2020 among 5850 respondents (52.9% female; 22.0% aged 18–39 years, 47.0% aged 40–59 years, and 31.0% aged ≥60 years) to examine if age modified the association of anxiety and depression symptomatology and alcohol use. Overall, 29% of respondents reported increased alcohol use. Adjusted odds ratios of reporting increased alcohol use were 1.41 (95% CI = 1.20–1.66) among respondents with anxiety symptoms and 1.64 (95% CI = 1.21–2.23) among those with depressive symptoms compared to those without such symptoms. Whereas respondents aged 18–39 years had the highest probability of reporting increased alcohol use, the probability of older persons (40–59 and ≥60 years) reporting increased drinking was much greater among those with symptoms of anxiety and depression, compared to those without symptoms. These findings warrant age-differentiated public health messaging on the risks of excessive alcohol use and scale-up of substance use services for middle-aged and older adults with symptoms of depression and anxiety.Sleep medication use and incident dementia in a nationally representative sample of older adults in the US
AbstractRobbins, R., DiClemente, R., Troxel, A. B., Jean-Louis, G., Butler, M., Rapoport, D. M., & Czeisler, C. A. (n.d.).Publication year
2021Journal title
Sleep MedicineVolume
79Page(s)
183-189AbstractBackground: Sleep difficulties are common among older adults, and clinical management of sleep difficulties commonly includes sleep medication (pharmacological and non-pharmacological). Our research examines sleep medication use and incident dementia over 8 years using nationally representative data from older adults ages 65 years and older in the United States. Methods: We used data collected from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of Medicare beneficiaries. Routine sleep medication use (pharmacological and non-pharmacological) was defined as use “most nights” or “every night.” Participants were screened for dementia with validated instruments that assessed memory, orientation, and executive function. We conduct prospective analyses to examine the relationship between routine sleep medication use and incident dementia using Cox proportional hazards modeling and estimated survival curves. Analyses controlled for age, sex, marital status, education, and chronic conditions. Results: Among respondents at baseline (n = 6373), most participants (21%) were age 70–74 years of age. Participants were 59% female and the sample comprised non-Hispanic White (71%). At baseline, 15% of our study sample reported using sleep medication routinely, which is representative of 4.6 million older adults in the US. Covariate adjusted proportional hazard models revealed that routinely using sleep medication was associated with incident dementia (HR = 1.30, 95%CI: 1.10 to 1.53, p < 0.01). Conclusions: Our study observed, in a nationally representative study of older adults in the US across 8 years of data that 15% of older adults report routinely using sleep medication, yet routine use of sleeping medication was associated with incident dementia across the follow-up interval. Future research may examine behavioral approaches to improving sleep among older adults.The Influence of Familial and Peer Social Support on Post-Traumatic Stress Disorder Among Black Girls in Juvenile Correctional Facilities
AbstractQuinn, C. R., Boyd, D. T., Kim, B. K., Menon, S. E., Logan-Greene, P., Asemota, E., DiClemente, R., & Voisin, D. (n.d.).Publication year
2021Journal title
Criminal Justice and BehaviorVolume
48Issue
7Page(s)
867-883AbstractBlack girls bear a higher burden of juvenile justice involvement in the United States, relative to other racial/ethnic female groups. Emerging evidence suggests that system involvement is related to trauma histories and post-traumatic stress disorder (PTSD). This study investigated the associations between individual, family, and peer factors, and their relationship to PTSD among Black girls with juvenile justice involvement. Cross-sectional data were collected from 188 Black girls in detention. Measures assessed were history of abuse, negative peer norms, future orientation, caregiver support, self-esteem, age, and PTSD symptoms. Major regression findings indicated that higher rates of caregiver support, higher negative peer norms, lower self-esteem rates, and lower future orientation rates were correlated with greater PTSD symptoms. Treatment programs for this population warrant a multisystemic approach, which includes caregivers and peers, and bolstering important constructs such as self-esteem and hopefulness.A system-level intervention to encourage collaboration between juvenile justice and public health agencies to promote hiv/sti testing
AbstractElkington, K. S., Spaulding, A., Gardner, S., Knight, D., Belenko, S., Becan, J. E., Robertson, A. A., Oser, C., & DiClemente, R. (n.d.).Publication year
2020Journal title
AIDS Education and PreventionVolume
32Issue
4Page(s)
337-355AbstractJustice-involved youth are at high risk for HIV and STIs, and justice agencies are uniquely poised to offer HIV/STI testing. However, testing in these settings is not routine and represents a missed opportunity. This study describes a system-level implementation intervention designed to increase access to HIV/STI testing through juvenile justice (JJ) and public health agency collaboration across six counties in six states in the United States. Local change teams, active facilitation, and training were utilized to facilitate agency partnerships and development of HIV/STI practice change protocols. Five counties established health and JJ partnerships and four counties successfully implemented their protocols. Sites with HIV/STI education and testing protocols behaviorally screened 98.5% of youth and tested 41.2% of those youth; 0% were HIV+ and 43.2% had an STI. The intervention provides a feasible, scalable solution, through promoting partnerships between JJ and health agencies, to link youth to testing and treatment services.Adapting a home telemonitoring intervention for underserved Hispanic/Latino patients with type 2 diabetes : an acceptability and feasibility study
AbstractPekmezaris, R., Williams, M. S., Pascarelli, B., Finuf, K. D., Harris, Y. T., Myers, A. K., Taylor, T., Kline, M., Patel, V. H., Murray, L. M., McFarlane, S. I., Pappas, K., Lesser, M. L., Makaryus, A. N., Martinez, S., Kozikowski, A., Polo, J., Guzman, J., Zeltser, R., … Granville, D. (n.d.).Publication year
2020Journal title
BMC Medical Informatics and Decision MakingVolume
20Issue
1AbstractBackground: Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes. Methods: A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides. Results: Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors “who look like me”); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse. Conclusions: These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes. Trial registration: NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1An Exploratory Structural Equation Model of Stress-Related Experiences Among Justice-Involved Youth : A Gender Comparison
AbstractDembo, R., Krupa, J. M., Wareham, J., Faber, J., Cristiano, J., DiClemente, R., Terminello, A., & Schmeidler, J. (n.d.).Publication year
2020Journal title
Criminal Justice and BehaviorVolume
47Issue
2Page(s)
127-144AbstractYouth involved in the juvenile justice system demonstrate greater risk of exposure to negative life experiences. The present study explores the prevalence of three stress-related experiences (sexual assault victimization, bullying/victimization, and minority sexual orientation) among newly arrested adolescents. Gender (biological sex) differences were examined as well as associations with sociodemographic characteristics, depressive symptoms, substance use, and sexually transmitted infection (STI). Factor analyses found a single factor of stress for both genders. Prevalence rates for bullying/victimization, sexual assault victimization, and sexual minority status were higher for girls than boys. Girls were also more likely than boys to test positive for STIs and experience depressive symptoms, while boys were more likely than girls to test positive for marijuana use. Depression and drug-related problems were associated with the stress construct for girls only. Bivariate comparisons with the three stress measures and sociodemographic characteristics indicated age and race effects. Implications are discussed.Can a Multilevel STI/HIV Prevention Strategy for High Risk African American Adolescents Improve Life Satisfaction?
AbstractZullig, K. J., Valois, R. F., Hobbs, G. R., Kerr, J. C., Romer, D., Carey, M. P., Brown, L. K., DiClemente, R., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Journal of Happiness StudiesVolume
21Issue
2Page(s)
417-436AbstractAddressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected (F = 5.19, p =.02, η2 =.03), along with three interactions: between experimental condition and media intervention (F = 7.96, p =.005, η2=.04); experimental condition, sex, and media intervention (F = 6.51, p =.01, η2 =.04); and experimental condition, sex, assessment point, and media intervention (F = 3.23, p =.01, η2 =.02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants’ life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males.Developmental Changes in Sexual Risk and Substance Use Among African American Females : an Integrated Data Analysis Approach Using Time-varying Effect Models
AbstractSwartzendruber, A., Brown, J. L., Sales, J. M., DiClemente, R., Windle, M., & Haardörfer, R. (n.d.).Publication year
2020Journal title
Prevention ScienceVolume
21Issue
2Page(s)
182-193AbstractThe aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14–25 years for behavioral outcomes and 16–25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16–17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?
AbstractZullig, K. J., Valois, R. F., Hobbs, G. R., Romer, D., Brown, L. K., DiClemente, R., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Journal of Adolescent HealthVolume
67Issue
1Page(s)
40-45AbstractPurpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787). Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender. Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased −.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males. Conclusions: Although Project iMPPACS was not designed with the intent on improving participants’ life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.Neighborhood Stress and Life Satisfaction : Is there a Relationship for African American Adolescents?
AbstractValois, R. F., Kerr, J. C., Carey, M. P., Brown, L. K., Romer, D., DiClemente, R., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Applied Research in Quality of LifeVolume
15Issue
1Page(s)
273-296AbstractThis study identified associations between perceived neighborhood stress and adolescents’ perceptions of life satisfaction. African American adolescents aged 13–18 (n = 1658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.Perceived neighborhood violence and crime, emotion regulation, and PTSD symptoms Among Justice-Involved, Urban African-American adolescent girls
AbstractSun, S., Crooks, N., DiClemente, R., & Sales, J. M. (n.d.).Publication year
2020Journal title
Psychological Trauma: Theory, Research, Practice, and PolicyVolume
12Issue
6Page(s)
1-6AbstractObjective: African-American adolescent girls in urban areas are overrepresented in the juvenile justice system, and they are also disproportionately impacted by neighborhood violence and crime (NVC), which has been shown to positively associate with posttraumatic stress disorder (PTSD) symptoms. Guided by an ecological (individual X context) perspective, the present study aimed to examine the main and interactive effects of perceived NVC and emotion regulation (ER) strategies in a sample of justice-involved, urban African-American adolescent girls (n = 85) following their release from detention centers. Method: We investigated this research question longitudinally. Multiple linear regression models were conducted. PTSD symptoms at 3 months after release was used as the outcome variable, predicted by ER strategies, perceived NVC, and their interactions before release, controlling for PTSD symptoms and a brief screening of trauma events assessed beforen release. Simple slope analysis was used to probe significant interaction terms. Results: The main effects of perceived NVC and dysfunctional ER were significant. A significant interaction effect was found between perceived NVC and internal dysfunction ER at baseline to predict PTSD symptoms at 3 months after release. High levels of internal dysfunctional ER intensified the positive association of baseline perceived NVC and PTSD symptoms. Conclusions: Justice-involved African-American adolescent girls who report high NVC and use dysfunctional ER strategies are particularly vulnerable to the development of PTSD symptoms. Interventions with this population may benefit from targeting dysfunctional ER strategies to mitigate or prevent neighborhood violence related PTSD symptoms.Preventing type 2 diabetes among South Asian Americans through community-based lifestyle interventions : A systematic review
AbstractAli, S. H., Misra, S., Parekh, N., Murphy, B., & DiClemente, R. (n.d.).Publication year
2020Journal title
Preventive Medicine ReportsVolume
20AbstractEthnic South Asian Americans (SAAs) have the highest relative risk of type 2 diabetes mellitus (T2DM) in the United States (US). Culturally tailored lifestyle interventions have the potential to promote South Asian diabetes prevention; however, the extent of their use and evaluation in US settings remains limited. This systematic review characterizes and evaluates outcomes of community-based lifestyle interventions targeted towards T2DM indicators among South Asians living in the US. A PRISMA-informed search of Pubmed, Embase, Cochrane, Web of Science, and clinical trial registry databases using key words pertaining to South Asians migrants and diabetes indicators (glucose and insulin outcomes) was conducted of community-based lifestyle interventions published up until October, 31 2019. Of the eight studies included in the final synthesis, four interventions focused on cultural and linguistic adaptations of past chronic disease prevention curricula using group-based modalities to deliver the intervention. Hemoglobin A1c (A1c) was the most common outcome indicator measured across the interventions. Three of the five studies observed improvements in indicators post-intervention. Based on these findings, this review recommends 1) greater exploration of community-based lifestyle interventions with high quality diabetes indicators (such as fasting blood glucose) in ethnic SAA communities, 2) expanding beyond traditional modalities of group-based lifestyle interventions and exploring the use of technology and interventions integrated with passive, active, and individualized components, and 3) development of research on diabetes prevention among second generation SAAs.Social media as a recruitment platform for a nationwide online survey of COVID-19 knowledge, beliefs, and practices in the United States : Methodology and feasibility analysis
AbstractAli, S. H., Foreman, J., Capasso, A., Jones, A. M., Tozan, Y., & DiClemente, R. (n.d.).Publication year
2020Journal title
BMC Medical Research MethodologyVolume
20Issue
1AbstractBACKGROUND: The COVID-19 pandemic has evolved into one of the most impactful health crises in modern history, compelling researchers to explore innovative ways to efficiently collect public health data in a timely manner. Social media platforms have been explored as a research recruitment tool in other settings; however, their feasibility for collecting representative survey data during infectious disease epidemics remain unexplored.OBJECTIVES: This study has two aims 1) describe the methodology used to recruit a nationwide sample of adults residing in the United States (U.S.) to participate in a survey on COVID-19 knowledge, beliefs, and practices, and 2) outline the preliminary findings related to recruitment, challenges using social media as a recruitment platform, and strategies used to address these challenges.METHODS: An original web-based survey informed by evidence from past literature and validated scales was developed. A Facebook advertisement campaign was used to disseminate the link to an online Qualtrics survey between March 20-30, 2020. Two supplementary male-only and racial minority- targeted advertisements were created on the sixth and tenth day of recruitment, respectively, to address issues of disproportionate female- and White-oriented gender- and ethnic-skewing observed in the advertisement's reach and response trends.RESULTS: In total, 6602 participant responses were recorded with representation from all U.S. 50 states, the District of Columbia, and Puerto Rico. The advertisements cumulatively reached 236,017 individuals and resulted in 9609 clicks (4.07% reach). Total cost of the advertisement was $906, resulting in costs of $0.09 per click and $0.18 per full response (completed surveys). Implementation of the male-only advertisement improved the cumulative percentage of male respondents from approximately 20 to 40%.CONCLUSIONS: The social media advertisement campaign was an effective and efficient strategy to collect large scale, nationwide data on COVID-19 within a short time period. Although the proportion of men who completed the survey was lower than those who didn't, interventions to increase male responses and enhance representativeness were successful. These findings can inform future research on the use of social media recruitment for the rapid collection of survey data related to rapidly evolving health crises, such as COVID-19.Trends and predictors of COVID-19 information sources and their relationship with knowledge and beliefs related to the pandemic : Nationwide cross-sectional study
AbstractAli, S. H., Foreman, J., Tozan, Y., Capasso, A., Jones, A. M., & DiClemente, R. (n.d.).Publication year
2020Journal title
JMIR Public Health and SurveillanceVolume
6Issue
4AbstractBackground: During the COVID-19 pandemic, there is a heightened need to understand health information seeking behaviors to address disparities in knowledge and beliefs about the crisis. Objective: This study assessed sociodemographic predictors of the use and trust of different COVID-19 information sources, as well as the association between information sources and knowledge and beliefs about the pandemic. Methods: An online survey was conducted among US adults in two rounds during March and April 2020 using advertisement-based recruitment on social media. Participants were asked about their use of 11 different COVID-19 information sources as well as their most trusted source of information. The selection of COVID-related knowledge and belief questions was based on past empirical literature and salient concerns at the time of survey implementation. Results: The sample consisted of 11,242 participants. When combined, traditional media sources (television, radio, podcasts, or newspapers) were the largest sources of COVID-19 information (91.2%). Among those using mainstream media sources for COVID-19 information (n=7811, 69.5%), popular outlets included CNN (24.0%), Fox News (19.3%), and other local or national networks (35.2%). The largest individual information source was government websites (87.6%). They were also the most trusted source of information (43.3%), although the odds of trusting government websites were lower among males (adjusted odds ratio [AOR] 0.58, 95% CI 0.53-0.63) and those aged 40-59 years and ≥60 years compared to those aged 18-39 years (AOR 0.83, 95% CI 0.74-0.92; AOR 0.62, 95% CI 0.54-0.71). Participants used an average of 6.1 sources (SD 2.3). Participants who were male, aged 40-59 years or ≥60 years; not working, unemployed, or retired; or Republican were likely to use fewer sources while those with children and higher educational attainment were likely to use more sources. Participants surveyed in April were markedly less likely to use (AOR 0.41, 95% CI 0.35-0.46) and trust (AOR 0.51, 95% CI 0.47-0.56) government sources. The association between information source and COVID-19 knowledge was mixed, while many COVID-19 beliefs were significantly predicted by information source; similar trends were observed with reliance on different types of mainstream media outlets. Conclusions: COVID-19 information source was significantly determined by participant sociodemographic characteristics and was also associated with both knowledge and beliefs about the pandemic. Study findings can help inform COVID-19 health communication campaigns and highlight the impact of using a variety of different and trusted information sources.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.A multilevel intervention with African American churches to enhance adoption of point-of-care HIV and diabetes testing, 2014-2018
AbstractWingood, G. M., Lambert, D., Renfro, T., Ali, M., & DiClemente, R. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Page(s)
S141-S144AbstractWe describe a multilevel intervention to enhance adoption of point-of-care HIV and diabetes testing at church health fairs in Atlanta, Georgia. Church leaders viewed a leadership video and subsequently conducted social activities that support testing. After the multilevel intervention, a third of churches hosted HIV and diabetes health fairs, and church leaders engaged in more social activities. Of 193 attendees receiving health services, 56.6% received HIV testing and 92.7% received diabetes testing. This implementation science approach could reduce HIV and diabetes disparities among African Americans.Accelerating the Evolution of Health Promotion Research : Broadening Boundaries and Improving Impact
AbstractWingood, G. M., & DiClemente, R. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Issue
S2Page(s)
S116Abstract~African-American sexual minority adolescents and sexual health disparities : An exploratory cross-sectional study
AbstractNorris, A. L., Brown, L. K., DiClemente, R., Valois, R. F., Romer, D., Vanable, P. A., & Carey, M. P. (n.d.).Publication year
2019Journal title
Journal of the National Medical AssociationVolume
111Issue
3Page(s)
302-309AbstractPurpose: To better understand sexual health disparities among African-American sexual minority adolescents. Methods: African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history. Results: Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV. Conclusions: African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.Behavioral Health and the Juvenile Justice System
AbstractDembo, R., Faber, J., Cristiano, J., DiClemente, R., & Terminello, A. (n.d.).Publication year
2019Page(s)
163-182AbstractThis chapter describes a case study conducted within an innovative juvenile assessment facility that examined the relationships among depression, age, race/ethnicity, age at first arrest, drug involvement, and sexual behaviors among youth in the criminal justice system. After a thorough discussion of the results, implications for larger services and practices are presented.Evaluating the Role of Family Context Within a Randomized Adolescent HIV-Risk Prevention Trial
AbstractBarker, D. H., Hadley, W., McGee, H., Donenberg, G. R., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2019Journal title
AIDS and BehaviorVolume
23Issue
5Page(s)
1195-1209AbstractProject STYLE is a multi-site 3-arm RCT comparing family-based, adolescent-only, and general health promotion interventions with 721 adolescents in mental health treatment. This study reports 12-month outcomes for family context and sexual risk behaviors, and explores the role of baseline family context in modifying treatment response. Using the full sample, there were sustained benefits for parent-reported sexual communication (d = 0.28), and adolescent-reported parental monitoring (d = 0.24), with minimal differences in risk behaviors. Latent profile analysis identified four family context classes: struggling (n = 177), authoritative (n = 183), authoritarian (n = 175), and permissive (n = 181). The authoritarian and permissive classes were also distinguished by disagreement between parent and adolescent report of family context. Classes differed in terms of baseline mental health burden and baseline sexual risk behavior. Classes showed different patterns of treatment effects, with the struggling class showing consistent benefit for both family context and sexual risk. In contrast, the authoritarian class showed a mixed response for family context and increased sexual risk.Individual- and Community-Level Factors in the STD Status of Justice-Involved Youth : Multi-Group, Exploratory Two-Level Analysis
AbstractDembo, R., Faber, J., Cristiano, J., Wareham, J., Krupa, J., Schmeidler, J., Terminello, A., & DiClemente, R. (n.d.).Publication year
2019Journal title
Archives of Sexual BehaviorVolume
48Issue
7Page(s)
2171-2186AbstractJustice-involved youth display higher prevalence rates of sexually transmitted diseases (STDs), in comparison with youth in the general population, highlighting a critical public health concern. Individual factors are important predictors of STDs, but only provide a partial understanding of this public health issue. Communities experiencing higher levels of disorder and lower levels of cohesion tend to have fewer institutional resources available, which may impact sexual risk behavior and STDs. However, few studies have examined the association between community characteristics and STD prevalence among adolescents. The current study examined community-level (n = 106) characteristics and individual-level attributes in explaining STDs among justice-involved youth (n = 1233: n = 515 female; n = 718 male). At the individual level, results showed older males and those with more drug-related problems were more likely to be STD positive, while females with more sexual partners and those with less drug-related problems were more likely to be STD positive. At the community level, females residing in areas with fewer educated residents were more likely to be STD positive. These gender differences were significant, suggesting a gendered perspective is important for understanding STD infection. The justice system represents a critical opportunity in the treatment and prevention of STDs for youth.Is the Brief Multidimensional Student’s Life Satisfaction Scale Valid and Reliable for African American Adolescents?
AbstractValois, R. F., Zullig, K. J., Brown, L. K., Carey, M. P., Vanable, P. A., Romer, D., & DiClemente, R. (n.d.).Publication year
2019Journal title
American Journal of Health EducationVolume
50Issue
6Page(s)
344-355AbstractBackground: Health promotion/education strive to promote healthful conditions that improve quality of life based on the perceptions of those whose lives are affected Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life. Life satisfaction (LS) has been defined as an individual’s assessment of their quality of life based upon personal criteria and linked to adolescent health risk behaviors and developmental assets. Purpose: We investigated the psychometrics of the Brief Multidimensional Students’ Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N = 1,658) from four mid-sized cities in the United States. Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents. Methods: Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen’s d) and inspecting the scale’s internal structure, reliability, and relationships to other variables. Results: Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined. Translation to Health Education Practice: The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.