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
Reproductive coercion sometimes works: evaluating whether young African-American women who experience reproductive coercion or birth control sabotage are more likely to become pregnant
AbstractRosenbaum, J. E., & DiClemente, R. J. (n.d.).Publication year
2020Journal title
Health Services and Outcomes Research MethodologyVolume
20Issue
4Page(s)
265-282AbstractMen engaging in reproductive coercion may coerce, force, or deceive female partners into pregnancy. This study evaluates whether the 3-month incidence of pregnancy is higher among women reporting reproductive coercion than similar women reporting no reproductive coercion. We tested this hypothesis in longitudinal data from a sample of African-American women ages 18–24 recruited from community settings in Atlanta, Georgia, US, in 2012–2014 (n = 560). Participants were surveyed at baseline, 3 months, 6 months, 9 months, and 12 months. To reduce selection bias, we used full matching on 22 baseline variables related to demographics, economic power, risky alcohol use, and gender-based power inequality. We used logistic regression in the matched sample with outcome pregnancy 3 months later, controlling for baseline fertility intentions (n = 482, n = 458, n = 452 at respectively 3, 6, 9 months). At 3 months, 15% of women reported reproductive coercion. At 6 months, 11.3% of women reporting coercion were pregnant vs. 4.6% of matched women reporting no coercion (p = 0.06). Women reporting coercion had 3 times the odds of pregnancy as matched women reporting no coercion (AOR 2.95, 95% CI (1.16, 6.98), p = 0.02). Among women pregnant after coercion, only 15% wanted to be pregnant then or sooner. Women reporting reproductive coercion are at greater risk of unwanted or mistimed pregnancies, and the semen exposure that caused these pregnancies could also transmit STI/HIV. Clinicians should screen patients for reproductive coercion; consider using semen exposure biomarkers such as PSA or Yc-PCR to identify condom sabotage or stealthing; and refer women experiencing reproductive coercion to supportive services.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. J. (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. J. (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. J., & 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. J. (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
Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Page(s)
S116African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study
AbstractNorris, A. L., Brown, L. K., DiClemente, R. J., 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. J., & Terminello, A. (n.d.). In Foundations of Behavioral Health (1–).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.Depressive Symptoms as a Longitudinal Predictor of Sexual Risk Behaviors Among African-American Adolescents
AbstractFoley, J. D., Vanable, P. A., Carey, M. P., Romer, D., Brown, L. K., DiClemente, R. J., & Valois, R. F. (n.d.).Publication year
2019Journal title
Health PsychologyVolume
38Issue
11Page(s)
1001-1009AbstractOBJECTIVE: Understanding individual level factors associated with sexual risk behaviors among African-American adolescents remains an important public health priority. The current secondary data analysis examined the longitudinal association between a baseline assessment of depressive symptoms and sexual risk behaviors reported 6 months later; the purpose was to determine whether the association of depressive symptoms to risky sex varies as a function of gender. A secondary aim was to examine self-efficacy for sex refusal and condom use assessed at a 3-month follow-up as mediators of the depressive symptoms-sexual risk relationship.METHODS: The sample consisted of 782 sexually active African-American adolescents ( M age = 15.3 years, SD = 1.08; 54% female) recruited to participate in a sexual health intervention trial. Data analyses focused on vaginal sex, and outcomes included: (a) sexual activity with 2 or more partners in the previous 3 months; (b) the relative frequency of condom use in the previous 3 months; (c) noncondom use at last occasion of sex; and (d) positive sexually transmitted infection (STI) screening. RESULTS: Depressive symptoms predicted sex with 2 more partners for female participants, but no other risk markers for the sample as a whole. However, there was a significant indirect effect of depressive symptoms on condomless sex via decreased condom use self-efficacy for both male and female adolescents.CONCLUSIONS: These findings have important implications for HIV/STI prevention, in which behavioral interventions may benefit from modules that include a focus on the influence of mood on self-efficacy for safer sex practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).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. J., & 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. J. (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. J. (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.Juvenile justice staff endorsement of HIV/STI prevention, testing, and treatment linkage
AbstractGardner, S. K., Elkington, K. S., Knight, D. K., Huang, S., Diclemente, R. J., Spaulding, A. C., Oser, C. B., Robertson, A. A., & Baird-Thomas, C. (n.d.).Publication year
2019Journal title
Health and JusticeVolume
7Issue
1AbstractBackground: While involvement in the legal system offers an opportunity to educate, screen, and treat high-risk youth, research shows that staff attitudes toward these practices can serve as barriers to implementation. The current study investigates the degree to which JJ staff endorse HIV prevention, testing, and treatment linkage practices with youth under community supervision and examines differences between individuals who supervise youth (e.g., juvenile probation officer) and those working in non-supervisory roles (e.g., case manager, assessment specialist). Methods: Juvenile justice staff consenting to participation in JJ-TRIALS completed an initial staff survey (N = 501). Survey items measured perceived importance of HIV/STI prevention (4 items); perceived importance of HIV/STI testing (7 items); and perceived importance of HIV/STI treatment linkage (8 items). Results: Confirmatory Factor Analysis (CFA) was computed (SAS CALIS procedure) for each of the three domains. Findings suggest that while staff recognize that youth are at risk for HIV/STIs and require provision of HIV/STI prevention and treatment linkage, attitudes concerning the importance of procuring or providing testing services for youth is substantially lower. Furthermore, analytic models comparing staff with and without supervision responsibilities (computed using SAS PROC MIXED) indicated that attitudes differed by site and staff responsible for supervision rated HIV treatment linkage practices as less important compared to non-supervising staff. Conclusions: Establishing partnerships with health agencies equipped with resources and skillsets to provide HIV/STI testing and related services may be an effective model to promote greater awareness and use of best practices among JJ staff and more effectively address the unmet needs of this high-risk population of youth.Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?
AbstractKim, B., Callander, D., DiClemente, R., Trinh-Shevrin, C., Thorpe, L. E., & Duncan, D. T. (n.d.).Publication year
2019Journal title
AIDS and BehaviorVolume
23Issue
10Page(s)
2795-2802AbstractDespite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors
AbstractGause, N. K., Brown, J. L., & DiClemente, R. J. (n.d.).Publication year
2019Journal title
Vulnerable Children and Youth StudiesVolume
14Issue
1Page(s)
1-16AbstractBlack females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02,.17]), any alcohol use prior to sex through peer norms for risky sex (ab = −.06, 95% CI [−.12, −.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = −.13, 95% CI [−.21, −.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.Need for innovation in public health research
AbstractDiClemente, R., Nowara, A., Shelton, R., & Wingood, G. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Page(s)
S117-S120AbstractThe recent conference Turning the Tide: A New Generation of Public Health Interventions highlighted the need to utilize innovative and emergent methodologies to confront increasingly complex public health challenges. In this commentary,we discuss three dominant themes from the conference: addressing multiple levels of causality in reducing health problems; technologybasedmethodologies to enhance health promotion; and improving translation and sustainment of effective health promotion programs. The subsequent articles, included in this supplement issue of AJPH, provide compelling examples and arguments supporting these progressive approaches to public health promotion. We recommend that public health researchers draw inspiration from these examples and embrace interdisciplinary, innovative methods within their future work.Operationalizing a Behavioral Health Services Cascade of Care Model: Lessons Learned from a 33-Site Implementation in Juvenile Justice Community Supervision1
Dennis, M. L., Smith, C. N., Belenko, S., Knight, D., McReynolds, L., Rowan, G., Dembo, R., DiClemente, R., Robertson, A., & Wiley, T. (n.d.).Publication year
2019Journal title
Federal ProbationVolume
83Issue
2Page(s)
52-64Parent-adolescent communication scale
Sales, J. M. D., Mülhausen, R. R., & Diclemente, R. J. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2019Page(s)
225-227Partner communication scale
Mülhausen, R. R., Sales, J. M., & Diclemente, R. J. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2019Page(s)
230-232Pregnancy Coercion as a Risk Factor for HIV and Other Sexually Transmitted Infections Among Young African American Women
AbstractCapasso, A., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
2019Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
82Page(s)
S155-S161AbstractBACKGROUND: Pregnancy coercion (PC), defined as a restriction of women's reproductive autonomy, may be associated with increased HIV and sexually transmitted infection (STI) risk. However, there are few empirical studies defining the association between PC and HIV risk, particularly among vulnerable African American women. SETTING AND METHODS: African American women (N = 560), ages 17-24, completed an audio computer-assisted self-interview assessing PC prevalence and its association with HIV/STI risk. Women were screened for prevalent STIs using polymerase chain reaction assays. Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes. RESULTS: Women who had experienced PC in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]. Among women who experienced PC, odds of noncondom use in their last sexual encounter were 3.45-fold greater relative to women not experiencing PC (95% CI = 1.55 to 7.85). Women who experienced PC had lower condom use intentions (coefficient, -1.31, P = 0.002), greater fear of condom negotiation, and perceived more barriers to condom use (coefficients, 3.89 and 5.74, respectively, both P < 0.001). Women who experienced PC had 1.98 (95% CI = 1.22 to 3.21) and 1.82 (95% CI = 1.09 to 3.04) odds of depression and HIV worry relative to women not experiencing PC. CONCLUSION: Among African American women, PC was associated with a range of adverse sexual health outcomes and HIV/STI-related behaviors and attitudes. The findings underscore the need for promoting gender-equitable social norms in HIV prevention interventions.Prenatal and infancy nurse home visiting and 18-year outcomes of a randomized trial
AbstractKitzman, H., Olds, D. L., Knudtson, M. D., Cole, R., Anson, E., Smith, J. A., Fishbein, D., DiClemente, R., Wingood, G., Caliendo, A. M., Hopfer, C., Miller, T., & Conti, G. (n.d.).Publication year
2019Journal title
PediatricsVolume
144Issue
6AbstractOBJECTIVES: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitiverelated outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS: We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18- year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS: The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.Problem Solving Reduces Sexual Risk Associated with Sensation Seeking, Substance Use, and Depressive Symptoms Among African-American Adolescents
AbstractDunne, E. M., Norris, A. L., Romer, D., DiClemente, R. J., Vanable, P. A., Valois, R. F., Brown, L. K., & Carey, M. P. (n.d.).Publication year
2019Journal title
Journal of Child and Adolescent Substance AbuseVolume
28Issue
2Page(s)
113-118AbstractAfrican-American adolescents experience higher rates of sexually transmitted infections (STIs) compared to same-age Caucasian peers. Substance use, sensation seeking, and depression have all been linked to risky sexual practices. Theory suggests that problem-solving skills may help to buffer against these risk factors. To test this hypothesis, we used data from African-American adolescents (N = 1,018; M age = 16.7, SD = 1.1; 58% female) who participated in a prevention trial. Nearly half of the sample (47%) reported lifetime marijuana use, while 13% reported drug use prior to most recent sexual encounter. Sexual sensation seeking was directly associated with drug use prior to sex (β = 1.13, b = 0.13, SE = 0.02, p <.001) and lower problem-solving skills (β = –0.08, b = –0.06, SE = 0.02, p =.01). Problem-solving skills were associated with drug use prior to sex (β = 0.92, b = −0.08, SE = 0.03, p =.004), such that those with greater problem-solving skills were less likely to report drug use prior to most recent sex. Finally, problem-solving skills mediated the association between sexual sensation seeking and drug use prior to sex, although the effect was small (β = 0.01, 95% CI:.001,.01). Problem-solving skills can have a protective influence on risky behavior for adolescents. Future research might examine the utility of strengthening problem-solving skills in order to reduce STI/HIV risk among African-American adolescents.Sexual communication self-efficacy scale
Quinn-Nilas, C., Mülhausen, R. R., Breuer, R., Bailey, J. V., Pavlou, M., Diclemente, R. J., & Wingood, G. M. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2019Page(s)
233-235The Social and Behavioral Sciences Research Network: Shaping a Contemporary Agenda for Research in HIV
Blank, M. B., Metzger, D. S., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
2019Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
82Page(s)
S81-S83Worry about sexual outcomes scale
Sales, J. M., Mülhausen, R. R., Spitalnick, J., & Diclemente, R. J. (n.d.). In Handbook of Sexuality-Related Measures (1–).Publication year
2019Page(s)
106-108