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
Applying the Dynamic Social Systems Model to HIV Prevention in a Rural African Context : The Maasai and the Esoto Dance
AbstractSiegler, A. J., Mbwambo, J. K., & DiClemente, R. (n.d.).Publication year
2013Journal title
Health Education and BehaviorVolume
40Issue
6Page(s)
683-693AbstractThis study applied the Dynamic Social Systems Model (DSSM) to the issue of HIV risk among the Maasai tribe of Tanzania, using data from a cross-sectional, cluster survey among 370 randomly selected participants from Ngorongoro and Siha Districts. A culturally appropriate survey instrument was developed to explore traditions reportedly coadunate with sexual partnership, including "wife sharing", fertility rituals, and various traditional dances. One dance, esoto, accounted for more than two thirds of participants' lifetime sexual partners (n = 10.5). The DSSM, combining structural and systems theories, was applied to systematize complex multilevel factors regarding esoto practice. Participants reported multifaceted beliefs regarding esoto; a majority viewed the dance as exciting and essential, yet most men feared social stigma and three quarters of women had experienced physical punishment for nonattendance. In multivariate logistic regression, esoto attendance was predicted by female gender (adjusted odds ratio [AOR] = 4.67, 95% confidence interval [CI] = 1.6-13.2), higher positive beliefs regarding esoto (AOR = 2.84, 95% CI = 1.9-4.2), and Maasai life cycle events (AOR = 0.06, 95% CI = 0.01-0.47). The DSSM proved useful for characterizing esoto and for revealing feedback loops that maintain esoto, thus indicating avenues for future interventions.Arousability as a predictor of sexual risk behaviours in African-American adolescent women
AbstractWood, J. R., Milhausen, R. R., Sales, J. M., Graham, C. A., Sanders, S. A., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2013Journal title
Sexual HealthVolume
10Issue
2Page(s)
160-165AbstractThis study examined the impact of sexual excitation (arousability) on sexual risk-taking behaviours in a community sample of African-American adolescent women. A sample of 701 African-American adolescent women completed measures examining their propensity for sexual arousal, impulsivity and sexual behaviour. Compared with women with a lower propensity for sexual arousability, women with a higher propensity reported a greater number of sexual partners, more inconsistent condom use, a greater likelihood of having engaged in sexual intercourse with 'risky' partners, and sex while high on alcohol or drugs. These results indicate that women who have a greater propensity to become sexually aroused in a variety of situations may be at a greater risk for contracting HIV or sexually transmissible infections relative to women with a lower propensity for arousal. This suggests that individual differences in the propensity to become sexually aroused should be considered when developing intervention approaches targeting young African-American women.Assessing the importance of theory-based correlates of future HIV vaccine intentions among Black men who have sex with men
AbstractDiClemente, R., Zimmerman, R., Wonderly, K., Abdul-Kadr, H., Turner, M., Xu, M., & Rosenberger, J. (n.d.). (5th eds.).Publication year
2024Volume
AIDS Educ Prevention, Vol 36Page(s)
354-368Abstract~ASSESSING THE IMPORTANCE OF THEORY-BASED CORRELATES OF FUTURE HIV VACCINE INTENTIONS AMONG BLACK MEN WHO HAVE SEX WITH MEN
AbstractZimmerman, R. S., Wonderly, K., Abdul-Kadr, H., DiClemente, R., Turner, M. M., Xu, M. A., & Rosenberger, J. G. (n.d.).Publication year
2024Journal title
AIDS Education and PreventionVolume
36Issue
5Page(s)
354-368AbstractIn the United States, Black men who have sex with men (BMSM) represent the most vulnerable population for HIV infection. A potential vaccine could ultimately be the most effective HIV prevention strategy. Understanding the factors that may adversely affect HIV vaccine acceptance among BMSM is critical. We conducted two online surveys with BMSM; one recruited 432 respondents, and another recruited 204. Respondents completed a demographic assessment and questions derived from health behavior change theories and the relevant empirical literature. The two surveys yielded similar results. The findings indicate that vaccine uptake self-efficacy, perceived likelihood of important others receiving the vaccine, and susceptibility to HIV were related to intentions to receive a future HIV vaccine. Other potentially important variables include perceived HIV stigma, response efficacy, how much one conceals one’s sexual orientation, and perceived HIV discrimina-tion. Future research and health communication campaigns should consider these factors in potential HIV vaccine programs.Association between sexually transmitted diseases and young adults' self-reported abstinence
AbstractDiClemente, R., Sales, J. M., Danner, F., & Crosby, R. A. (n.d.).Publication year
2011Journal title
PediatricsVolume
127Issue
2Page(s)
208-213AbstractOBJECTIVE: Self-reported behavior has been the cornerstone of sexual health research and clinical practice, yet advances in sexually transmitted disease (STD) screening provide researchers with the opportunity to objectively quantify sexual risk behaviors. However, the extent to which young adults' laboratory-confirmed STD results and selfreported sexual behaviors are consistent has not been assessed in a nationally representative sample. PATIENTS AND METHODS: Data are derived from participants who completed wave 3 in the National Longitudinal Study of Adolescent Health. Young adults (N = 14 012) completed an audio computer-assisted self-interviewing survey and provided a urine specimen to detect the presence of Chlamydia trachomatis and Neisseria gonorrhoeae, and a polymerase chain reaction assay to detect Trichomonas vaginalis. RESULTS: More than 10% of young adults with a laboratory-confirmed positive STD result reported abstaining from sexual intercourse in the 12 months before assessment and STD testing. After controlling for several sociodemographic factors, self-reported sex (versus those who reported abstinence) in the previous 12 months was significantly associated with testing positive, but the odds of testing positive were only slightly more than twofold (adjusted odds ratio: 2.11 [95% confidence interval: 2.097-2.122]). CONCLUSIONS: Findings indicate discrepancy between young adults' positive STD status and self-reported sexual behavior. No significant correlates of discrepant reporting were identified. From a clinical standpoint, the discrepancies between STD positivity and self-reported sexual behavior observed in this nationally representative sample suggest that routine STD screening may be beneficial and necessary to reduce STD morbidity among young adults.Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status : A case for intensifying clinic-based prevention efforts
AbstractDiClemente, R., Wingood, G. M., Sionéan, C., Crosby, R., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
9Page(s)
503-509AbstractBackground: Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable sub-group is African American females. The association between adolescents' previous experience of STD and recent sexual risk behaviors has been ill-defined. Goal: The goal was to examine the associations between adolescents' self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status. Study Design: This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates. Results: Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93; P = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79; P = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51; P < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28; P = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09-9.89; P = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09-5.23; P = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59; P = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45-1.37; P = 0.38). Conclusion: Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.Association of complementary and alternative medicines with HIV clinical disease among a cohort of women living with HIV/AIDS
AbstractMikhail, I. S., DiClemente, R., Person, S., Davies, S., Elliott, E., Wingood, G., & Jolly, P. E. (n.d.).Publication year
2004Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
37Issue
3Page(s)
1415-1422AbstractTo assess the association between the use of complementary and alternative medicine (CAM) and HIV clinical disease indicators, CD4+ T-cell counts, viral load, number of HIV-related infections, Centers for Disease Control and Prevention categories, and Karnofsky scores. Data were collected from 391 HIV-positive women aged 18 to 50 years in Alabama and Georgia. A survey examining CAM use and other sociodemographic variables was used. Multiple logistic regression analyses were used to identify predictors of CAM use. Approximately 60% of study participants used 1 or more type of CAM. Predictors of CAM use included higher educational level (odds ratio [OR] = 2.4; P = 0.0008), absence of health insurance (OR = 0.49; P = 0.0055), longer disease duration (OR = 2.21; P = 0.0006), and higher number of infections (OR = 0.58; P = 0.017). Vitamins were the most commonly used CAM (∼36%). Sociodemographic variables associated with vitamin use included higher educational level (OR = 2.34; P = 0.0055), longer disease duration (OR = 1.87; P = 0.026), and higher use among white women than among African-American women (OR = 0.41; P = 0.017). The use of CAM is prevalent among HIV-positive women, and vitamins are the most commonly used CAM among our study population. Several sociodemographic and clinical factors predicted CAM use. These findings have implications for improvement of care for HIV-positive women.Association of depressive symptoms and substance use with risky sexual behavior and sexually transmitted infections among African American female adolescents seeking sexual health care
AbstractJackson, J. M., Seth, P., DiClemente, R., & Lin, A. (n.d.).Publication year
2015Journal title
American journal of public healthVolume
105Issue
10Page(s)
2137-2142AbstractObjectives. We examined how depression and substance use interacted to predict risky sexual behavior and sexually transmitted infections (STIs) among African American female adolescents. Methods. We measured depressive symptoms, substance use, sexual behavior, and STIs in 701 African American female adolescents, aged 14 to 20 years, at baseline and at 6-month intervals for 36 months in Atlanta, Georgia (2005?2007). We used generalized estimating equation models to examine effects over the 36-month follow-up period. Results. At baseline, more than 40% of adolescents reported significant depressive symptoms; 64% also reported substance use in the 90 days before assessment. Depression was associated with recently incarcerated partner involvement, sexual sensation seeking, unprotected sex, and prevalent STIs (all P < .001). In addition, adolescents with depressive symptoms who reported any substance use (i.e., marijuana, alcohol, Ecstasy) were more likely to report incarcerated partner involvement, sexual sensation seeking, unprotected sex, and have an incident STI over the 36-month follow-up (all P < .05). Conclusions. African American female adolescents who reported depressive symptoms and substance use weremore likely to engage in risky behavior and acquire incident STIs. This populationmight benefit from future prevention efforts targeting the intersection of depression and substance use.Association of sexual abuse with incident high-risk human papillomavirus infection among young African-American women
AbstractWingood, G. M., Seth, P., DiClemente, R., & Robinson, L. S. (n.d.).Publication year
2009Journal title
Sexually Transmitted DiseasesVolume
36Issue
12Page(s)
784-786AbstractBackground: Genital human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Noticeably absent from the known risk factors for HPV infection is history of sexual abuse. The current study examined the association between sexual abuse and incident high-risk HPV among young adult black women. Methods: This longitudinal study was part of a larger HIV/STI randomized controlled behavioral trial that randomly recruited eligible participants from October 2002 through March 2006. At baseline and 12-month follow-up, 665 black women, aged between 18 and 29, completed a survey assessing known HPV risk factors and history of sexual abuse, and provided specimens that were assayed for high-risk HPV. Incident high-risk HPV infection was defined as a laboratory-confirmed test for high-risk HPV at 12-month follow-up after testing HPV-negative at baseline. Results: The prevalence of high-risk HPV was 38.9%. Age-stratified multiple regression analyses examined sexual abuse that occurred during the 12-month follow-up and acquisition of high-risk HPV; known risk factors for HPV were entered as covariates. Women aged between 18 and 24 with a history of sexual abuse in the past year, compared with participants without a history, were 4.5 times more likely to test positive for an incident high-risk HPV infection (PAssociations Between a Dopamine D4 Receptor Gene, Alcohol Use, and Sexual Behaviors Among Female Adolescent African Americans
AbstractSales, J. M., Smearman, E. L., Brown, J. L., Brody, G. H., Philibert, R. A., Rose, E., & DiClemente, R. (n.d.).Publication year
2015Journal title
Journal of HIV/AIDS and Social ServicesVolume
14Issue
2Page(s)
136-153AbstractYoung female adolescent African Americans are disproportionately impacted by HIV infection. There is a clear need to understand factors associated with increased HIV-risk behaviors among this vulnerable population. We sought to explore the association between a dopamine D4 receptor gene (DRD4), a genetic marker associated with natural variations in rewarding behaviors, and self-reported alcohol use and sexual risk behaviors, while controlling for other known correlates of risk-taking such as impulsivity, sensation-seeking, and peer norms, among a group of high-risk female adolescent African Americans to evaluate whether this biological factor enhances understanding of the patterns of risk in this vulnerable group.Associations between biologically confirmed marijuana use and laboratory-confirmed sexually transmitted diseases among African American adolescent females
AbstractLiau, A., DiClemente, R., Wingood, G. M., Crosby, R. A., Williams, K. M., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2002Journal title
Sexually Transmitted DiseasesVolume
29Issue
7Page(s)
387-390AbstractBackground: Numerous studies have examined the association between adolescents' marijuana use and their high-risk sexual behaviors and sexually transmitted diseases (STDs). However, the validity of the findings is questionable because most of the studies relied on self-reporting for measurement of marijuana use and key outcome (i.e., STDs). Goal: The goal was to investigate associations between biologically confirmed marijuana use and laboratory-confirmed STDs and condom use. Study Design: African American females adolescents (n = 522) completed a self-administered survey and face-to-face interview. The adolescents provided urine and vaginal swab specimens that were analyzed for marijuana metabolites and STDs, respectively. Results: Among the study subjects, 5.4% tested positive for marijuana. These adolescents were more likely to test positive for Neisseria gonorrhoeae (adjusted odds ratio [AOR] = 3.4) and Chlamydia trachomatis (AOR = 3.9). They were more likely to have never used condoms in the previous 30 days (AOR = 2.9) and to have not used condoms consistently in the previous 6 months (AOR = 3.6). Conclusion: The findings represent unique biologic evidence that STDs and sexual risk behavior may co-occur with marijuana use. Interventions designed to reduce adolescents' risk of STDs and HIV infection should address marijuana use.Associations between internet sex seeking and STI associated risk behaviours among men who have sex with men
AbstractDiClemente, R., Mettey, A., Crosby, R., DiClemente, R. J., & Holtgrave, D. R. (n.d.).Publication year
2003Journal title
Sexually transmitted infectionsVolume
79Issue
6Page(s)
466-468AbstractObjective: This exploratory study identified associations between internet sex seeking and HIV associated risk behaviours among a high risk sample of men who have sex with men (MSM). Methods: A cross sectional survey of men attending a sex resort was conducted. Of 164 men asked to participate, 91% completed a self administered questionnaire. The questionnaire assessed demographic variables and (using a 3 month recall period) men's HIV associated sexual risk behaviours. Potential confounding variables were assessed and controlled, as needed, by multivariate analysis. Results: Men currently resided in 14 states. One sixth reported being HIV positive. 57% of the men reported using the internet to seek sex. Differences in critical behaviours (unprotected anal sex and number of partners) were not found. However, compared to those not seeking sex by internet, men using the internet to meet sex partners were more likely to report fisting (adjusted odds ratio=3.3, p=0.04), having group sex (prevalence ratio (PR)=1.2, p=0.0001), using poppers during sex (PR=1.94, p=0.0001), and using ecstasy during sex (PR=2.7, p=0.04). Internet sex seeking men were also significantly more likely to report meeting sex partners in bathhouses (PR=2.2, p=0.0001), bars (PR=1.5, p=0.001), parks (PR=3.2, p=0.006), and circuit parties (PR=8.9, p=0.007). Conclusion: Among MSM attending a sex resort, those using the internet to seek sex partners may have modestly elevated risks for acquiring or transmitting sexually transmitted infections. Subsequent studies should investigate the utility of using the internet as forum for promoting safer sex behaviours among high risk MSM.Associations Between Psychiatric Impairment and Sexual Risk Behavior Among Teens in Mental Health Treatment
AbstractHadley, W., Barker, D. H., Lescano, C. M., Stewart, A. J., Affleck, K., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2014Journal title
Journal of HIV/AIDS and Social ServicesVolume
13Issue
2Page(s)
198-213AbstractThe authors' aims were to assess the associations of sexual risk behavior with psychiatric impairment and individual, peer, and partner attitudes among adolescents receiving mental health treatment. Adolescents (N = 893, 56% female, 67% African American) completed assessments of psychiatric impairment, rejection sensitivity, peer norms, HIV knowledge, perceived vulnerability, self-efficacy, and condom use intentions. Two structural equation models were used to test the study hypotheses: one for sexually active youth and one for nonactive youth. For nonactive youth, psychiatric impairment influenced self-efficacy and condom use intentions via peer norms, rejection sensitivity, and perceived vulnerability. Among the sexually active youth, sexual risk was related to impairment and previous condom use. These results suggest that individual, peer, and partner factors are related to impairment and to sexual risk attitudes but depend on previous sexual experience.Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women
AbstractLang, D. L., Salazar, L. F., Wingood, G. M., DiClemente, R., & Mikhail, I. (n.d.).Publication year
2007Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
46Issue
2Page(s)
216-221AbstractBACKGROUND: This study sought to document the prevalence of recent gender-based violence (rGBV) among seropositive women and to determine the association between rGBV and pregnancy, sexually transmitted infections (STIs), condom use, and negotiation of sexual practices. METHODS: A total of 304 seropositive women recruited from HIV clinics in the southeastern United States who reported being sexually active in the previous 6 months with 1 partner were included in analyses. Gender-based violence during the previous 3 months, condom use, and negotiation of sexual practices were assessed. Biologic samples for pregnancy and STI testing were collected. RESULTS: A total of 10.2% of women reported a history of rGBV. rGBV was related to inconsistent condom use practices, pregnancy, and abuse stemming from requests for condom use. No associations were found between rGBV and negotiation of sexual practices and STIs. CONCLUSIONS: The prevalence of rGBV among HIV-positive women emphasizes the need for screening of abuse and highlights the need for the design and implementation of integrated intervention approaches necessary in addressing the needs of this population.Associations between Sexually Transmitted Disease Diagnosis and Subsequent Sexual Risk and Sexually Transmitted Disease Incidence among Adolescents
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., Levine, D., Brown, L., Lescano, C., Pugatch, D., Flanigan, T., Fernandez, I., Schlenger, W., & Silver, B. J. (n.d.).Publication year
2004Journal title
Sexually Transmitted DiseasesVolume
31Issue
4Page(s)
205-208AbstractBackground: Empiric evidence is lacking in regard to the subsequent sexually transmitted disease (STD)-associated risk behaviors of adolescents diagnosed and treated for an STD. Goal: The goal of this study was to prospectively identify associations between STD diagnosis and subsequent sexual risk and STD incidence among a sample of U.S. adolescents. Study Design: A cohort of 455 adolescents (age 15-21 years) was followed for 3 months. Adolescents were recruited from primary care clinics and through outreach activities. Results: A total of 10.8% were initially diagnosed with at least one STD. After adjusting for observed covariates, these adolescents (compared with those testing negative) were 2.8 times (P = 0.0001) more likely to be abstinent from sex and 2.2 times more likely to report always using condoms (P = 0.04). However, during the ensuing 3 months, they were approximately 2.4 times more likely to report having sex with multiple partners (P = 0.01), 8.9 times more likely to test positive for trichomonas (P = 0.009), and 3.0 times more likely to test positive for chlamydia (P = 0.04). Conclusions: Compared with those testing negative, adolescents diagnosed with an STD may subsequently adopt safer sex behaviors, including abstinence. However, perhaps in part as a result of having sex with multiple partners, they might fail to practice safer sex behaviors stringently enough to avoid subsequent STD acquisition.Balancing rigor against the inherent limitations of investigating hard-to-reach populations
AbstractCrosby, R. A., Salazar, L. F., DiClemente, R., & Lang, D. L. (n.d.).Publication year
2010Journal title
Health Education ResearchVolume
25Issue
1Page(s)
1-5AbstractMaintaining rigor in research is critical; however, this need must be balanced by the necessity of conducting studies in populations where inherent barriers exist relative to key issues such as recruitment, attrition, sampling, sample size, assessment techniques, psychometric rigor, the identification of mediators and moderators and the practical relevance of the research question itself. Ultimately, the value of a study in health promotion should be judged on the practicality of the research question within the context of the target population. Striking the perfect balance between rigor and practicality to the field is a question that health promotion researchers and professionals need to determine through ongoing dialogue and debate.Barriers to adolescents' participation in HIV biomedical prevention research
AbstractDiClemente, R., Ruiz, M. S., & Sales, J. M. (n.d.).Publication year
2010Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
54Issue
SUPPL. 1Page(s)
S12-S17AbstractObjectives: The inclusion of adolescents in HIV prevention clinical research has the potential to improve the current understanding of the safety and efficacy of biomedical prevention technologies in younger populations that are at increasing risk of HIV infection. However, there are significant individual, operational, and community-level barriers to engaging adolescents in clinical prevention trials. Methods: This paper identifies and addresses individual, operational, and community-level barriers to adolescents participation in HIV biomedical prevention research. Results: Barriers identified and addressed in this paper include: (1) insufficient understanding of clinic prevention research, (2) self-presentation bias, (3) issues surrounding parental consent, (4) access to clinical trials, (5) mistrust of research, and (6) stigma associated with participation in clinical trials. Examples of programs where adolescents have been successfully engaged in prevention research are highlighted and the lessons learned from these programs indicate that establishing collaborations with key stakeholders in the community are essential for conducting biomedical research with vulnerable populations, including adolescents. Conclusions: Given the importance of understanding adolescents reactions, acceptability, and utilization of new biomedical prevention technologies it is imperative that researchers acknowledge and address these barriers to enhance adolescents participation and retention in HIV biomedical prevention research.Behavioral counseling associated with STI prevention
AbstractDiClemente, R. (n.d.).Publication year
2021Journal title
Journal of PediatricsVolume
228Page(s)
310-313Abstract~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.Bias in Online recruitment and retention of racial and ethnic minority men who have sex with men
AbstractSullivan, P. S., Khosropour, C. M., Luisi, N., Amsden, M., Coggia, T., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2011Journal title
Journal of medical Internet researchVolume
13Issue
2Page(s)
e38AbstractBackground: The Internet has become an increasingly popular venue for men who have sex with men (MSM) to meet potential sex partners. Given this rapid increase in online sex-seeking among MSM, Internet-based interventions represent an important HIV (human immunodeficiency virus) prevention strategy. Unfortunately, black and Hispanic MSM, who are disproportionately impacted by the HIV epidemic in the United States, have been underrepresented in online research studies. Objective: Our objective was to examine and quantify factors associated with underrecruitment and underretention of MSM of color in an online HIVbehavioral risk research study of MSM recruited from an online social networking site. Methods: Internet-using MSM were recruited through banner advertisements on MySpace.com targeted at men who reported in their MySpace profile their age as at least 18 and their sexual orientation as gay, bisexual, or unsure. Multivariable logistic regression models were used to estimate the odds stratified by race and ethnicity of the MySpace user clickingthrough the banner advertisement. To characterize survey retention, Kaplan-Meier survivalcurves and multivariable Cox proportional hazards models identified factors associated with survey dropout. Results: Over 30,000 MySpace users clicked on the study banner advertisements (click-through rate of 0.37%, or 30,599 clicks from 8,257,271 impressions). Black (0.36% or 6474 clicks from 1,785,088 impressions) and Hispanic (0.35% or 8873 clicks from 2,510,434 impressions) MySpace users had a lower click-through rate compared with white (0.48% or 6995 clicks from 1,464,262 impressions) MySpace users. However, black men had increased odds of click-through for advertisements displaying a black model versus a white model (adjusted odds ratio [OR] = 1.83, 95% confidence interval [CI] 1.72 - 1.95), and Hispanic participants had increased odds of click-through when shown an advertisement displaying an Asian model versus a white model (adjusted OR = 1.70, 95% CI 1.62 - 1.79). Of the 9005 men who consented to participate, 6258 (69%) completed the entire survey. Among participants reporting only male sex partners, black non-Hispanic and Hispanic participants were significantly more likely to drop out of the survey relative to white non-Hispanic participants (hazard ratio [HR] = 1.6, 95% CI 1.4 - 1.8 and HR = 1.3, 95% CI 1.1 - 1.4, respectively). Men with a college-level of education were more likely to complete the survey than those with a high-school level of education (HR = 0.8, 95% CI 0.7 - 0.9), while men who self-identified as heterosexual were more likely to drop out of the survey compared with men who self-identified as gay (HR = 2.1, 95% CI 1.1 - 3.7).Conclusions: This analysis identified several factors associated with recruitment and retention of MSM in an online survey. Differential click-through rates and increased survey dropout by MSM of color indicate that methods to recruit and retain black and Hispanic MSM in Internet-based research studies are paramount. Although targeting banner advertisements to MSM of color by changing the racial/ethnic composition of the advertisements may increase click-through, decreasing attrition of these study participants once they are engaged in the survey remains a challenge.Biologically confirmed sexually transmitted infection and depressive symptomatology among African-American female adolescents
AbstractDiClemente, R., Salazar, L. F., DiClemente, R. J., Wingood, G. M., Crosby, R. A., Lang, D. L., & Harrington, K. (n.d.).Publication year
2006Journal title
Sexually transmitted infectionsVolume
82Issue
1Page(s)
55-60AbstractObjective: To determine prospectively the relation between sexually transmitted infection (STI) diagnosis and depressive symptomatology. Methods: Secondary data analyses were performed on 175 sexually active African-American female adolescents, who were recruited from high risk neighbourhoods in Birmingham, Alabama, United States. Results: ANCOVA was used to compare adolescents who tested positive with adolescents who tested negative on three waves of depressive symptom scores, controlling for age. The STI positive group had higher depressive symptom levels at 6 months relative to the STI negative group. This result was moderated by baseline depressive symptom levels: for adolescents above the clinical threshold, the STI negative group experienced a decrease in symptoms at 6 months whereas the STI positive group maintained the same level. For adolescents below the clinical threshold, there were no changes in depressive symptom levels regardless of diagnosis. Conclusions: Receiving an STI diagnosis may affect depressive symptomatology for those at risk for depression. Screening for depression in settings that provide STI testing and treatment may be warranted for this population.Blocking the benefit of group-based HIV-prevention efforts during adolescence : The problem of HIV-related stigma
AbstractBarker, D. H., Swenson, R. R., Brown, L. K., Stanton, B. F., Vanable, P. A., Carey, M. P., Valois, R. F., DiClemente, R., Salazar, L. F., & Romer, D. (n.d.).Publication year
2012Journal title
AIDS and BehaviorVolume
16Issue
3Page(s)
571-577AbstractHIV-related stigma has been shown to impede HIV-antibody testing and safer sexual practices in adults. Less is known about its effects on prevention programs among at-risk youth. This study examined the longitudinal relationships between HIV-stigma and HIV-knowledge following completion of a validated group-based intervention. Data were provided by 1,654 African-American adolescents who participated in a large multi-city prevention trial (Project iMPACCS). Participants were randomly assigned to an empirically-validated skill-based intervention or a general health promotion control group. Both stigma and knowledge were assessed at baseline and post-intervention. Results suggested that adolescents participating in the intervention showed improvements in knowledge and decreases in stigma when compared to controls. Improvements in stigma appeared to be partly driven by improvements in knowledge. Higher baseline stigma was shown to reduce gains in knowledge in both the treatment and control groups. Results suggest that HIV-stigma can interfere with how youth identify with and internalize messages from group-based prevention trials.Body image and African American females' sexual health
AbstractWingood, G. M., DiClemente, R., Harrington, K., & Davies, S. L. (n.d.).Publication year
2002Journal title
Journal of Women's HealthVolume
11Issue
5Page(s)
433-439AbstractObjectives: This study examines the association between African American adolescent females' body image and their sexual health. Methods: African American adolescent females (n = 522) completed a survey that assessed body image using a 7-item scale (α = 0.71) and a face-to-face interview that assessed sexual behaviors. Results: In logistic regression analyses, controlling for depression, self-esteem and body mass index (BMI), adolescents who were more dissatisfied with their body image were more likely to fear abandonment as a result of negotiating condom use (adjusted odds ratio [AOR] = 3.3, p = 0.02), more likely to perceive that they had fewer options for sexual partners (AOR = 2.4, p = 0.001), more likely to perceive themselves as having limited control in their sexual relationships (AOR = 2.0, p = 0.002), and more likely to worry about acquiring HIV(AOR = 1.5, p = 0.04). There was an association between having a greater dissatisfaction with one's body image and never using condoms during sexual intercourse in the past 30 days (AOR = 1.6, p = 0.04) and more likely to engage in unprotected vaginal sex in the prior 6 months (AOR = 1.6, p = 0.04). Conclusions: Prior research has demonstrated an association between African American women's body image and greater obesity risk, lower self-esteem, and greater depression. The present study has shown an association between body image dissatisfaction and a range of sexual attitudes, beliefs, and behaviors. Women who are more dissatisfied with their body image may be at greater risk for unintended pregnancy, sexually transmitted infections (STIs), and HIV infection.Brief report : Sexual sensation seeking and its relationship to risky sexual behaviour among African-American adolescent females
AbstractSpitalnick, J. S., DiClemente, R., Wingood, G. M., Crosby, R. A., Milhausen, R. R., Sales, J. M., McCarty, F., Rose, E., & Younge, S. N. (n.d.).Publication year
2007Journal title
Journal of AdolescenceVolume
30Issue
1Page(s)
165-173AbstractThe relationship between sexual sensation seeking and sexual risk taking has been investigated among adult populations. There are limited data, however, regarding this relationship for adolescents. Since African-American adolescent females continue to be disproportionately diagnosed with STDs, including HIV, we examined this association among a clinic-based sample of African-American adolescent females (N=715) enrolled in an STD/HIV prevention intervention. Participants (ages 15-21) endorsing higher levels of sexual sensation seeking reported higher levels of sexual risk-taking behaviours (e.g. frequency of vaginal intercourse, number of sexual partners, and poorer condom use). Results remained significant after controlling for known covariates associated with sexual risk-taking behaviours. Results are consistent with the adult literature and highlight the need for future investigations examining sexual sensation seeking among adolescents. These results, though preliminary, could be used to better inform prevention interventions and clinicians/health educators who provide direct services to adolescents.Build it and they will come. or will they? Overcoming barriers to optimizing delivery of seasonal influenza vaccine to US adolescents
AbstractDiClemente, R., Painter, J. E., Sales, J. M., & Gargano, L. M. (n.d.).Publication year
2012Journal title
Expert Review of VaccinesVolume
11Issue
4Page(s)
387-389Abstract~