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
African American Women’s Language Use in Response to Male Partners’ Condom Negotiation Tactics
AbstractLi, Y., Samp, J. A., Coles Cone, V. B., Mercer Kollar, L. M., DiClemente, R. J., & Monahan, J. L. (n.d.).Publication year
2018Journal title
Communication StudiesVolume
69Issue
1Page(s)
67-84AbstractAfrican American women are vulnerable for sexual health risk; thus, condom use is essential. Guided by research linking goals to communicative content, this study explored women’s use of I-, you-, we-, and hedging language during condom negotiation. Female participants (N = 193) engaged in a condom negotiation role play with male confederates, where language use measures were coded. I-language was used the most frequently. Language use differed as a function of men’s tactics, such that women primarily used I-language in response to verbal attacks, you-language in response to seduction, and I- and we-language in response to information seeking. Women who engaged in more recent condom use were more likely to use you-language and, when confederates attacked, they responded with more you-language and less hedging.Applying behavioral and social science theory to HIV prevention
AbstractCrosby, R. A., & DiClemente, R. J. (n.d.). In Structural Interventions for HIV Prevention: The need for structural- level approaches (1–).Publication year
2018Page(s)
13-30AbstractSet in the context of high-impact prevention, this chapter provides a brief historical account of how theory application to HIV prevention has evolved from individual-level models to structural-level approaches. The chapter describes the value and limitations of applying behavioral science and social science theories to the pandemic and describes several models and theory-based approaches. It then proceeds to identify emerging, structural-level approaches to achieving population-level HIV prevention in developing and developed countries. The chapter distinguishes structural-level interventions from multilevel interventions, and it describes strengths and weaknesses of structural-level approaches to achieving high-impact prevention. In so doing, several critical principles of structural-level approaches are identified.Ecologies of risk among African American girls in juvenile detention
AbstractLogan-Greene, P., Kim, B. K., Quinn, C. R., DiClemente, R., & Voisin, D. (n.d.).Publication year
2018Journal title
Children and Youth Services ReviewVolume
85Page(s)
245-252AbstractAfrican American girls are disproportionately represented in juvenile detention, yet less is known about their distinctive and heterogeneous needs, especially regarding their psychosocial contexts. Latent class analysis determined four subgroups based on the adolescent ecology (neighborhood, family, peers) among detained African American girls ages 13–17 (N = 188). The Shielded class (32%) displayed the lowest levels of risk and highest levels of protective factors. The Typical class (24%) was close to the sample average on all indicators, with elevated histories of family incarceration. The Family Distress class (16%) reported the lowest neighborhood risk but was marked by high family risk levels and abuse history. The Highest Risk class (28%) had elevated risk on most indicators but particularly high neighborhood and peer risk. These classes significantly varied by youth social context and mental health. Findings bolster the need to consider the diverse, multidimensional contextual experiences of detained and at-risk African American girls.Global burden of HIV/AIDS
AbstractDiClemente, R. J., Crosby, R. A., & Sims, J. P. (n.d.). In Structural Interventions for HIV Prevention: A diverse pandemic (1–).Publication year
2018Page(s)
1-12AbstractBeginning with the observation that AIDS has a tendency to invade subpopulations within a nation that are the most marginalized, this chapter provides case examples of the epidemic within five different nations. Specifically, the authors discuss Lesotho, the United Kingdom, Thailand, Ukraine, and India. The chapter characterizes the vast differences that exist across the national HIV epidemics that comprise the AIDS pandemic. The authors examine specific vulnerable populations, such as sex workers, intravenous drug users, transgendered people, and men who have sex with other men. They also discuss the role of social conditions and social norms, such as women’s rights, not only in the spread of but also the treatment of HIV.HIV and symptoms of depression are independently associated with impaired glucocorticoid signaling
AbstractBekhbat, M., Mehta, C. C., Kelly, S. D., Vester, A., Ofotokun, I., Felger, J., Wingood, G., Anastos, K., Gustafson, D. R., Kassaye, S., Milam, J., Aouizerat, B., Weber, K., Golub, E. T., Moore, M. F., Diclemente, R., Fischl, M., Kempf, M. C., Maki, P., & Neigh, G. N. (n.d.).Publication year
2018Journal title
PsychoneuroendocrinologyVolume
96Page(s)
118-125AbstractChronic inflammation caused by HIV infection may lead to deficient glucocorticoid (GC) signaling predisposing people living with HIV to depression and other psychiatric disorders linked to GC resistance. We hypothesized that comorbid HIV and depressive symptoms in women would synergistically associate with deficits in GC signaling. This cross-sectional study used samples obtained from the Women's Interagency HIV Study (WIHS). The Centers for Epidemiological Studies (CES-D) was used to define depression in four groups of women from the Women's Interagency HIV Study (WIHS): 1) HIV-negative, non-depressed (n = 37); 2) HIV-negative, depressed (n = 34); 3) HIV-positive, non-depressed (n = 38); and 4) HIV-positive, depressed (n = 38). To assess changes in GC signaling from peripheral blood mononuclear cells (PBMCs), we examined baseline and dexamethasone (Dex)-stimulated changes in the expression of the GC receptor (GR, gene: Nr3c1) and its negative regulator Fkbp5 via quantitative RT-PCR. GR sensitivity was evaluated in vitro by assessing the Dex inhibition of lipopolysaccharide (LPS)-stimulated IL-6 and TNF-α levels. Depressive symptoms and HIV serostatus were independently associated with elevated baseline expression of Fkbp5 and Nr3c1. Depressive symptoms, but not HIV status, was independently associated with reduced LPS-induced release of IL-6. Counter to predictions, there was no interactive association of depressive symptoms and HIV on any outcome. Comorbid depressive symptoms with HIV infection were associated with a gene expression and cytokine profile similar to that of healthy control women, a finding that may indicate further disruptions in disease adaptation.Psychometric Evaluation of a Brief Depression Measure for Justice-Involved Youths: A Multigroup Comparison
AbstractDembo, R., Faber, J., Cristiano, J., DiClemente, R. J., Krupa, J. M., Wareham, J., & Terminello, A. (n.d.).Publication year
2018Journal title
Journal of Child and Adolescent Substance AbuseVolume
27Issue
3Page(s)
146-155AbstractThe Center for Epidemiological Studies Depression Scale (CES-D) is a widely used screening tool for depression among adults and children. However, the validity of the CES-D has yet to be established among justice-involved youths, a population known to have higher levels of depressive symptoms in comparison to samples of community adolescents. The current study examines the psychometric characteristics of the eight-item version of the CES-D among newly arrested youths. Data were obtained through a local health coach service project, designed to provide linkage to treatment for justice-involved youths who are drug involved, test positive for HIV or other STDs, or have high levels of depressive symptoms. A multigroup, confirmatory factor analysis of the depression symptoms for subgroups defined by gender/race self-identification was conducted to assess the psychometric characteristics of the CES-D among these newly arrested youths. Results produced statistical evidence in support of one factor in the eight-item depression data and a similar factor structure across the various gender/racial groups. Criterion-related validity of the depression factor was also explored. Findings support the usefulness of the eight-item CES-D for use among gender-diverse and ethnically diverse youths.Social conditions and the AIDS pandemic
AbstractCrosby, R. A., DiClemente, R. J., & Sims, J. P. (n.d.). In Structural Interventions for HIV Prevention: A proposed framework for structural- level in terventions (1–).Publication year
2018Page(s)
377-390AbstractThis chapter describes the AIDS pandemic as being intimately linked with inequitable social conditions. The case is made that these social inequities must be the primary “target” of HIV prevention efforts. The five pillar model is introduced and used as guide for illustrating the inherent value of structural-level interventions to the goal of ending AIDS. The chapter further makes the case that rectifying social inequities is the basis for going beyond the goal of ending AIDS and moving toward global health for all people. The chapter describes the social drivers of the pandemic, a prevention paradigm, and a proposed framework for structural-level interventions.Structural interventions for HIV prevention: Optimizing strategies for reducing new infections and improving care
AbstractCrosby, R. A., & DiClemente, R. J. (n.d.). (1–).Publication year
2018AbstractParallel to the evolution of biomedical approaches to addressing the AIDS pandemic, social science approaches to the prevention of HIV acquisition and transmission have evolved. This evolution is characterized by an increasing emphasis on the use of structural-level intervention methods. By definition, structural-level methods function at the outer-most “layers” of influence in a socio-ecological framework. This volume begins by demonstrating the diversity of HIV epidemics in various nations, thus suggesting that singularly focused prevention approaches are unlikely to succeed. The volume then describes the evolution of social science approaches into the current paradigm of structural-level approaches. Subsequently, the chapters provide in-depth case studies that describe and demonstrate how various forms of structural-level programs may become paramount in the global vision of ending AIDS. Collectively, based on the changes made to social conditions, these various approaches provide far more benefit to humankind than a strictly biomedical approach. The volume further provides useful guidance regarding community mobilization, the evaluation of structural-level intervention approaches to ending AIDS, and the evolving field of theory relative to structural-level interventions targeting HIV/AIDS.The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication
AbstractHadley, W., Lansing, A., Barker, D. H., Brown, L. K., Hunter, H., Donenberg, G., & DiClemente, R. J. (n.d.).Publication year
2018Journal title
Journal of Child and Family StudiesVolume
27Issue
4Page(s)
1098-1109AbstractParents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11 h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention
AbstractRenfro, T., Johnson, E., Lambert, D. N., Wingood, G., & Diclemente, R. J. (n.d.).Publication year
2018Journal title
Translational Behavioral MedicineVolume
8Issue
6Page(s)
815-823AbstractAs human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P 4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.Theory-Based Analysis of Interest in an HIV Vaccine for Reasons Indicative of Risk Compensation Among African American Women
AbstractPainter, J. E., Temple, B. S., Woods, L. A., Cwiak, C., Haddad, L. B., Mulligan, M. J., & DiClemente, R. J. (n.d.).Publication year
2018Journal title
Health Education and BehaviorVolume
45Issue
3Page(s)
444-453AbstractLicensure of an HIV vaccine could reduce or eliminate HIV among vulnerable populations. However, vaccine effectiveness could be undermined by risk compensation (RC), defined by an increase in risky behavior due to a belief that the vaccine will confer protection. Interest in an HIV vaccine for reasons indicative of RC may serve as an indicator of actual RC in a postlicensure era. This study assessed factors associated with interest in an HIV vaccine for reasons indicative of RC among African American women aged 18 to 55 years, recruited from a hospital-based family planning clinic in Atlanta, Georgia (N = 321). Data were collected using audio-computer–assisted surveys. Survey items were guided by risk homeostasis theory and social cognitive theory. Multivariable logistic regression was used to assess determinants of interest in an HIV vaccine for reasons indicative of RC. Thirty-eight percent of the sample expressed interest in an HIV vaccine for at least one reason indicative of RC. In the final model, interest in an HIV vaccine for reasons indicative of RC was positively associated with higher impulsivity, perceived benefits of sexual risk behaviors, and perceived benefits of HIV vaccination; it was negatively associated with having at least some college education, positive future orientation, and self-efficacy for sex refusal. Results suggest that demographic, personality, and theory-based psychosocial factors are salient to wanting an HIV vaccine for reasons indicative of RC, and underscore the need for risk-reduction counseling alongside vaccination during the eventual rollout of an HIV vaccine.Willingness to pay for an Ebola vaccine during the 2014–2016 ebola outbreak in West Africa: Results from a U.S. National sample
AbstractPainter, J. E., Von Fricken, M. E., Viana De O. Mesquita, S., & DiClemente, R. J. (n.d.).Publication year
2018Journal title
Human Vaccines and ImmunotherapeuticsVolume
14Issue
7Page(s)
1665-1671AbstractThe 2014–2016 Ebola virus outbreak in West Africa led to advances in the development of vaccines against Ebola. This study examined factors associated with willingness to pay for an Ebola vaccine among a U.S. national sample during the recent Ebola outbreak. From April 30–May 8, 2015, a national survey was conducted using the GfK Group's KnowlegePanel®. Main outcome measures included willingness to pay at least $1; more than $50; and more than $100 for an Ebola vaccine. Analyses were conducted using weighted multivariable logistic regression. Among participants (N = 1,447), 583 (40.3%) would not pay for an Ebola vaccine; 864 (59.7%) would pay at least $1. Among those willing to pay at least $1: 570 (66.0%) would pay $1–50; 174 (20.1%) would pay $51–100; and 120 (13.9%) would pay more than $100. Willingness to pay at least $1 for an Ebola vaccine was associated with international travel; interest in getting an Ebola vaccine; and beliefs that the U.S. government should spend money to control Ebola and assume worldwide leadership in confronting emerging epidemics. Willingness to pay more than $50 was associated with similar variables. Willingness to pay more than $100 was associated with international travel; interest in getting an Ebola vaccine; information seeking; and beliefs that the U.S. government should assume worldwide leadership in confronting emerging epidemics. International travel and interest in an Ebola vaccine were key predictors of willingness to pay across all price points. Understanding willingness to pay for vaccines against emerging infectious diseases remains critical.A Multigroup, Longitudinal Study of Truant Youths, Marijuana Use, Depression, and STD-Associated Sexual Risk Behavior
AbstractDembo, R., Krupa, J. M., Wareham, J., Schmeidler, J., & DiClemente, R. J. (n.d.).Publication year
2017Journal title
Journal of Child and Adolescent Substance AbuseVolume
26Issue
3Page(s)
192-204AbstractTruant youths are likely to engage in a number of problem behaviors, including sexual risky behaviors. Previous research involving non-truant youths has found sexual risk behaviors to be related to marijuana use and depression, with differential effects for male and female youths. Using data collected in a National Institute on Drug Abuse (NIDA)-funded, prospective intervention project, results are reported of a male-female, multi-group, longitudinal analysis of the relationships among truant youth baseline sexual risk behavior, marijuana use, and depression, and their sexual risk behavior over four follow-up time points. Results indicated support for the longitudinal model, with female truants having higher depression scores, and showing stronger relationships between baseline depression and future engagement in sexual risk behavior, than male truants. Findings suggest that incorporating strategies to reduce depression and marijuana use may decrease youth sexual risk behavior.Community trauma as a predictor of sexual risk, marijuana use, and psychosocial outcomes among detained African-American female adolescents
AbstractSeth, P., Jackson, J. M., DiClemente, R. J., & Fasula, A. M. (n.d.).Publication year
2017Journal title
Vulnerable Children and Youth StudiesVolume
12Issue
4Page(s)
353-359AbstractSocial determinants contribute to health disparities. Previous research has indicated that community trauma is associated with negative health outcomes. This study examined the impact of community trauma on sexual risk, marijuana use and mental health among African-American female adolescents in a juvenile detention center. One hundred and eighty-eight African-American female adolescents, aged 13–17 years, were recruited from a short-term detention facility and completed assessments on community trauma, sexual risk behavior, marijuana use, symptoms of posttraumatic stress disorder and psychosocial HIV/STD risk factors. Findings indicate that community trauma was associated with unprotected sex, having a sex partner with a correctional/juvenile justice history, sexual sensation seeking, marijuana use, affiliation with deviant peers and posttraumatic stress disorder symptoms at baseline and longitudinally. Findings reinforce the impact of community-level factors and co-occurring health issues, particularly in high-risk environments and among vulnerable populations. Structural and community-level interventions and policy-level changes may help improve access to resources and improve adolescents’ overall health and standard of living in at-risk communities.Dibattiti. Ripensare le priorità nei finanziamenti della ricerca sulla salute mentale
AbstractLewis-Fernández, R., Rotheram-Borus, M. J., Betts, V. T., Greenman, L., Essock, S. M., Escobar, J. I., Barch, D., Hogan, M. F., Areán, P. A., Druss, B. G., DiClemente, R. J., McGlashan, T. H., Jeste, D. V., Proctor, E. K., Ruiz, P., Rush, A. J., Canino, G. J., Bell, C. C., Henry, R., & Iversen, P. (n.d.).Publication year
2017Journal title
Psicoterapia e Scienze UmaneVolume
51Issue
1Page(s)
119-124AbstractMental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritizing one area of science over others risks reduced returns on the entire scientific portfolio. (This article is an editorial that appeared in issue no. 6/2016 of The British Journal of Psychiatry, and in this Italian translation it is followed by three discussions, respectively by Giovanni de Girolamo, Andrea Fagiolini, and Giacomo Rizzolatti).Exploring evidence for behavioral risk compensation among participants in an HIV vaccine clinical trial
AbstractPainter, J. E., DiClemente, R. J., Jimenez, L., Stuart, T., Sales, J. M., & Mulligan, M. J. (n.d.).Publication year
2017Journal title
VaccineVolume
35Issue
28Page(s)
3558-3563AbstractBackground HIV vaccine trial participants may engage in behavioral risk compensation due to a false sense of protection. We conducted an ancillary study of an HIV Vaccine Trials Network (HVTN) vaccine efficacy trial to explore risk compensation among trial participants compared to persons who were willing to participate but ineligible based on previous exposure to the Ad5 virus (Ad5+) across three timepoints. Methods Participants were drawn from the Atlanta, GA site of the HVTN 505 vaccine trial. From 2011–2013, all persons who met prescreening criteria for the clinical trial and presented for Ad5 antibody testing were invited to participate in the ancillary study. Data were collected from vaccine trial participants (n = 51) and Ad5+ participants (n = 60) via online surveys across three timepoints: baseline, T2 (after trial participants received 2/4 injections) and T3 (after trial participants received 4/4 injections). Data analyses assessed demographic, psychosocial, and behavioral differences at baseline and changes at each timepoint. Results At baseline, Ad5+ participants were less likely to have some college education (p = 0.024) or health insurance (p = 0.008), and were more likely to want to participate in the vaccine trial “to feel safer having unprotected sex” (p = 0.005). Among vaccine trial participants, unprotected anal sex with a casual partner (p = 0.05), HIV transmission worry (p = 0.033), and perceived chance of getting HIV (p = 0.027), decreased across timepoints. Conclusions Study findings suggest that persons with previous exposure to Ad5 may be systematically different from their Ad5-negative peers. Unprotected anal sex with a casual partner significantly decreased among HIV vaccine trial participants, as did HIV worry and perceived chance of getting HIV. Findings did not support evidence of risk compensation among HIV vaccine trial participants compared to Ad5+ participants.Factors associated with school nurses’ HPV vaccine attitudes for school-aged youth
AbstractRosen, B. L., DiClemente, R., Shepard, A. L., Wilson, K. L., & Fehr, S. K. (n.d.).Publication year
2017Journal title
Psychology, Health and MedicineVolume
22Issue
5Page(s)
535-545AbstractSchool nurses are at the intersection of the healthcare and school communities, thus, they can be considered opinion leaders in providing health advice–including information about the human papillomavirus (HPV) vaccine–to parents and students. This study examined school nurses’ attitudes toward the HPV vaccine based on age, years as a school nurse, geographic location, urban vs. rural work setting, HPV and vaccine knowledge, perception of role as opinion leaders, and school district support in providing health education. Participants (n = 413) were systematically sampled from the National Association of School Nurses’ membership and completed a web-based survey. Multiple regression was used to predict positive HPV vaccine attitudes. The model was statistically significant accounting for 50.8% of the variance (F [9, 400] = 45.96, p <.001). Positive attitudes regarding the HPV vaccine were predicted by higher HPV and vaccine knowledge (β =.096, p <.001) and stronger perceptions of role as opinion leaders for the vaccine (β =.665, p <.001). No other variables were found to be statistically significant. These results suggest knowledge is essential in predicting positive attitudes, but not the strongest predictor as perceptions of role as opinion leaders was more crucial in terms of predicting school nurses’ positive attitudes towards HPV vaccine. Despite school nurses being seen as champions for adolescent vaccines, they need additional professional development to increase their HPV vaccine knowledge and attitudes to encourage parents and adolescents to consider the uptake of HPV vaccination. To engage school nurses’ in promoting HPV vaccine uptake, interventions need to focus on increasing school nurses’ perception of their role as opinion leaders for HPV vaccine and knowledge to increase positive attitudes towards HPV vaccination for youth.Health Risk Behavior Among Justice Involved Male and Female Youth: Exploratory, Multi-Group Latent Class Analysis
AbstractDembo, R., Faber, J., Cristiano, J., DiClemente, R. J., Krupa, J. M., Terminello, A., & Wareham, J. (n.d.).Publication year
2017Journal title
Substance Use and MisuseVolume
52Issue
13Page(s)
1751-1764AbstractBackground: Youth involved in the juvenile justice system experience a disproportionate prevalence of serious mental health issues, substance abuse, and are at an increased risk of engaging in risky sexual practices. Gender differences exist, with girls at a markedly greater risk of acquiring a sexually transmitted disease. Objectives: The present study seeks to determine if there are subgroups of male and female youth who differ in their health risk behavior. If so, do any male or female subgroups at different levels of health risk differ in regard to their sociodemographic and psychological factors, and finally, what are intervention/service delivery implications of these differences. Methods: Youth were participants in an innovative health service at a centralized intake facility located in a large southeastern U.S. city. Latent class analysis and multinomial logistic regression is utilized to examine the heterogeneity of health risk behaviors across gender groups in a sample of 777 newly arrested youth. Results: Results indicate a three class solution provided the optimal fit with the data for each gender group: a Lower Health Risk group, a Higher Health Risk group, and a Highest Health Risk group. Multinomial logistic regression analysis identified significant sociodemographic and depression effects among both male and female youth. Conclusions/Importance: Youth characterized by risky sexually behavior, elevated depression, and drug involvement should be the focus of integrated intervention services. This study documents the critical need for front end, juvenile justice intake facilities to provide behavioral and public health screening, with treatment follow-up, on newly arrested youth.Interest in an Ebola vaccine among a U.S. national sample during the height of the 2014–2016 Ebola outbreak in West Africa
AbstractPainter, J. E., DiClemente, R. J., & Von Fricken, M. E. (n.d.).Publication year
2017Journal title
VaccineVolume
35Issue
4Page(s)
508-512AbstractTo better understand the association between Ebola-related attitudes and interest in receiving an Ebola virus vaccine, a survey was administered to a U.S. national sample using GfK's KnowledgePanel®. Among participants (N = 1417), 34.1% expressed interest in an Ebola vaccine for themselves. In the subset of participants with children aged 0–17 (N = 410), 38.1% expressed interest in an Ebola vaccine for their child. In multivariable analyses, vaccine interest for oneself was associated with perceived susceptibility to Ebola (p = 0.009), beliefs that the U.S. government should spend money to control Ebola (p = 0.002), and beliefs Ebola posed a national threat (p = 0.007). Vaccine interest for one's child was associated with perceived severity of Ebola (p = 0.018) and beliefs that the U.S. government should spend money to control Ebola (p = 0.003). Findings highlight the influence of personal and national threat beliefs on vaccine interest. Understanding the impact of threat beliefs may benefit vaccine campaign development during future pandemic threats.Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol Use
AbstractLittlefield, A. K., Brown, J. L., DiClemente, R. J., Safonova, P., Sales, J. M., Rose, E. S., Belyakov, N., & Rassokhin, V. V. (n.d.).Publication year
2017Journal title
AIDS and BehaviorVolume
21Issue
7Page(s)
1938-1949AbstractAlcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman’s r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.Semen says: Assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker
AbstractRosenbaum, J. E., Zenilman, J. M., Rose, E., Wingood, G. M., & Diclemente, R. J. (n.d.).Publication year
2017Journal title
Sexually transmitted infectionsVolume
93Issue
2Page(s)
145-147AbstractObjective Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour. Methods This prospective cohort study uses data from 715 sexually active African-American female adolescents in Atlanta, surveyed at baseline, 6months and 12months. Participants completed a 40min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted Y-chromosome test results from self-reported sexual behaviour using within-subject panel regression. Results Among the participants who reported abstinence from vaginal sex in the past 14days, 9.4% tested positive for semen Y-chromosome. Among item non-respondents, 6.3% tested positive for semen Y-chromosome. Women who reported abstinence and engaged in item non-response regarding their sexual behaviour had respectively 62% and 78% lower odds of testing positive for Y-chromosome (OR 0.38 (0.21 to 0.67), OR 0.22 (0.12 to 0.40)), controlling for smoking, survey wave and non-coital sexual behaviours reported during abstinence. Conclusions Adolescents who report sexual abstinence under-report semen exposure. Research should validate self-reported sexual behaviour with biomarkers. Adolescents who engage in item non-response regarding vaginal sex test positive for semen Y-chromosome at similar rates, which supports the practice of grouping non-respondents with adolescents reporting abstinence in statistical analysis. Trial registration number NCT00633906.Social Context and Problem Factors among Youth with Juvenile Justice Involvement Histories
AbstractVoisin, D. R., Sales, J. M., Hong, J. S., Jackson, J. M., Rose, E. S., & DiClemente, R. J. (n.d.).Publication year
2017Journal title
Behavioral MedicineVolume
43Issue
1Page(s)
71-78AbstractYouth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.The association between cigarette smoking, virologic suppression, and CD4+ lymphocyte count in HIV-Infected Russian women
AbstractBrown, J. L., Winhusen, T., DiClemente, R. J., Sales, J. M., Rose, E. S., Safonova, P., Levina, O., Belyakov, N., & Rassokhin, V. V. (n.d.).Publication year
2017Journal title
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIVVolume
29Issue
9Page(s)
1102-1106AbstractCigarette smoking among people living with HIV/AIDS is associated with significant morbidity and mortality, but findings regarding the association between cigarette smoking and HIV viral load and CD4+ lymphocyte counts have been inconsistent. This study characterized the prevalence of cigarette smoking among HIV-infected Russian women and examined the association between smoking frequency and quantity and HIV viral load and CD4+ lymphocyte counts. HIV-infected Russian women (N = 250; M age = 30.0) in St. Petersburg, Russia, completed an audio computer-assisted self-interview survey assessing cigarette use, antiretroviral medication adherence, and provided blood samples assayed for HIV viral load and CD4+ lymphocyte counts. The majority (60.4%) reported cigarette smoking in the past month; 49.0% of recent smokers were classified as moderate or heavy smokers, defined as smoking ≥10 cigarettes daily. Viral load status did not differ between infrequent smokers and regular smokers. However, moderate/heavy smokers (relative to light smokers) were more likely to have a detectable viral load (AOR = 2.3, 95% CI: 1.1, 5.1). There were no significant differences in CD4+ lymphocyte counts by smoking frequency or quantity of cigarettes smoked. Results highlight the need for additional research to examine the association between cigarette smoking and virologic suppression and markers of HIV disease progression. Adverse health consequences of cigarette smoking coupled with a potential link between heavy smoking and poor virologic suppression highlight the need for assessment of cigarette use and provision of evidence-based smoking-cessation interventions within HIV medical care.When a relationship is imperative, will young women knowingly place their sexual health at risk? A sample of African American adolescent girls in the juvenile justice system
AbstractRaiford, J. L., Seth, P., Fasula, A. M., & DiClemente, R. J. (n.d.).Publication year
2017Journal title
Sexual HealthVolume
14Issue
4Page(s)
331-337AbstractBackground: HIV and other sexually transmissible infections (HIV/STIs) are significant contributors to adolescent girls' morbidity in the US. Risks for HIV/STIs are increased among adolescent girls involved in the juvenile justice system, and African American adolescent girls comprise nearly 50% of adolescent girls in detention centres. Although HIV prevention programs focus on HIV/STI knowledge, increased knowledge may not be sufficient to reduce sexual risk. The present study examined the interactive effects of HIV/STI knowledge and the importance of being in a relationship (a relationship imperative) on sexual risk behaviours in a sample of detained African American adolescent girls. Methods: In all, 188 African American adolescent girls, 13-17 years of age, were recruited from a short-term detention facility in Atlanta, Georgia, and completed assessments on sexual risk behaviours, relationship characteristics, HIV/STI knowledge and several psychosocial risk factors. Results: When girls endorsed a relationship imperative, higher HIV/STI knowledge was associated with low partner communication self-efficacy, inconsistent condom use and unprotected sex, when controlling for demographics and self-esteem. Conclusions: Young girls with high HIV/STI knowledge may have placed themselves at risk for HIV/STIs given the importance and value they place on being in a relationship. Contextual factors should be considered when developing interventions.Alcohol Use Problems and Sexual Risk Among Young Adult African American Mothers
AbstractSwartzendruber, A., Sales, J. M., Rose, E. S., & DiClemente, R. J. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Page(s)
74-83AbstractStudies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41 % (n = 141) of whom were mothers. Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes.