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
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., & 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., 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., 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, pHealth Risk Behavior Among Justice Involved Male and Female Youth : Exploratory, Multi-Group Latent Class Analysis
AbstractDembo, R., Faber, J., Cristiano, J., DiClemente, R., 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.HIV Prevention Among Youth : Designing Effective Evidence-Based HIV Risk-Reduction Programs for Adolescents
AbstractDiClemente, R., & Patel, N. (n.d.).Publication year
2017Page(s)
273-295AbstractThe purpose of this chapter is to describe both primary and secondary prevention efforts among youth. The HIV epidemic among adolescents in the United States is inherently tied to individual, psychosocial, and cultural phenomena. Expanding intervention development and implementation to incorporate a broader spectrum of determinants of adolescents’ risk for sexually transmitted infections (STIs)/HIV acquisition may provide an opportunity to more effectively prevent disease transmission. This chapter will first highlight adolescents’ sexual risk behavior followed by a review of evidence-based high-impact HIV prevention programs. Future directions for research in the area of primary and secondary HIV prevention also will be discussed.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., & 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., 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. (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. (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., 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. (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. (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.Alcohol use, partner characteristics, and condom use among HIV-infected Russian women : An event-level study
AbstractBrown, J. L., DiClemente, R., Sales, J. M., Rose, E. S., Gause, N. K., Safonova, P., Levina, O., Belyakov, N., & Rassokhin, V. V. (n.d.).Publication year
2016Journal title
Journal of Studies on Alcohol and DrugsVolume
77Issue
6Page(s)
968-973AbstractObjective: Alcohol use is a prominent factor correlated with HIV risk behavior engagement. Hazardous drinking is prevalent among Russian women and may contribute to decreased condom use. Event-based studies suggest that HIV risk behaviors may vary based on situational factors including partner characteristics and alcohol use. This study investigated the effect of situational factors on condom use during the most recent sexual encounter among a sample of HIV-infected Russian women. Method: HIV-infected women (n = 239; mean age = 30.0 years) receiving medical care in St. Petersburg, Russia, completed an audio computer-assisted self-interview that assessed characteristics of their last sexual encounter. Multivariable logistic regression examined the associations between the following situational factors: (a) alcohol use, (b) partner type, (c) partner’s serostatus, and (d) partner’s alcohol use on whether a condom was used for vaginal and/or anal sex during the last sexual encounter. Results: A total of 54.0% engaged in unprotected vaginal and/or anal sex during their last sexual encounter. In an adjusted logistic regression model, unprotected sex did not differ by participants’ alcohol use (adjusted odds ratio [AOR] = 0.72, 95% CI [0.29, 1.8]) but was more likely with partners who had consumed alcohol (AOR = 2.3, 95% CI [1.1, 5.2]) and HIV-infected partners (AOR = 2.8, 95% CI [1.6, 4.9]) and less likely to occur in the context of nonsteady partnerships (AOR = 0.36, 95% CI [0.13, 0.99]). Conclusions: More stable, steady relationships with HIV-infected partners who consumed alcohol were associated with greater likelihood of noncondom use. Results highlight the need to address the intersection of alcohol and sexual risk engagement within the context of HIV-infected women’s relationships.Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females
AbstractSwartzendruber, A., Sales, J. M., Brown, J. L., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2016Journal title
Archives of Sexual BehaviorVolume
45Issue
1Page(s)
63-72AbstractAfrican American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14–20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.Do As I Say : Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention
AbstractMercer Kollar, L. M., Davis, T. L., Monahan, J. L., Samp, J. A., Coles, V. B., Bradley, E. L., Sales, J. M., Comer, S. K., Worley, T., Rose, E., & DiClemente, R. (n.d.).Publication year
2016Journal title
Health Education and BehaviorVolume
43Issue
6Page(s)
691-698AbstractSexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET’s efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one’s sexual partner as an assertive communication behavior within sexual health contexts.Factors Associated with HIV Testing among African American Female Adolescents in Juvenile Detention Centers
AbstractSeth, P., Raiford, J., & DiClemente, R. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Issue
9Page(s)
2010-2013AbstractBackground: Little is known about sexual and psychosocial factors associated with HIV testing among detained African American female adolescents—an understudied group at risk for HIV. Methods: 188 detained African American female adolescents completed assessments on HIV testing, sexual risk behaviors, and psychosocial factors. Results: Unprotected vaginal sex, history of STI-positivity or pregnancy, higher STI knowledge, and lower partner availability were associated with a higher likelihood of ever being tested for HIV. Discussion: HIV testing is the gateway to important services for high-risk HIV-positive and HIV-negative adolescents. More research is needed to address barriers and to inform programmatic changes to increase testing among youth.Human Immunodeficiency Virus Prevention
AbstractDavis, T. L., & DiClemente, R. (n.d.).Publication year
2016Journal title
Child and Adolescent Psychiatric Clinics of North AmericaVolume
25Issue
2Page(s)
283-295AbstractWith no available cure for HIV, primary prevention to reduce the likelihood of HIV transmission and secondary prevention to reduce the severity of HIV by identifying cases early and quickly engaging people in the care continuum are key factors to reducing morbidity. Evidence-based and evidence-informed interventions are available to reduce disease incidence and disease burden. Although there are evidence-driven interventions available for people who are drug users, heterosexual adults, MSM, highrisk adolescents and young adults, and people living with HIV/AIDS, there are not currently any curricula addressing people with SMI. The next steps in HIV prevention must include disseminating and implementing evidence-based interventions to reduce HIV risk behavior, increase medication adherence, and link people with HIV/ AIDS to the care continuum.Incorporating Communication into the Theory of Planned Behavior to Predict Condom Use Among African American Women
AbstractGuan, M., Coles, V. B., Samp, J. A., Sales, J. M., DiClemente, R., & Monahan, J. L. (n.d.).Publication year
2016Journal title
Journal of Health CommunicationVolume
21Issue
9Page(s)
1046-1054AbstractThe present research extends the theory of planned behavior (TPB) to investigate how communication-related variables influence condom use intention and behavior among African American women. According to the TPB, attitudes, subjective norms, and self-efficacy are associated with behavioral intent, which predicts behavior. For women, it was argued that condom negotiation self-efficacy was more important than condom use self-efficacy in predicting consistent condom use. Moreover, an important environmental factor that affects condom use for African American women is fear or worry when negotiating condom use because the sex partners might leave, threaten, or abuse them. Fears associated with negotiating condom use were predicted to be negatively associated with attitudes, subjective norms, and self-efficacy. African American women (N = 560; M age = 20.58) completed assessments of TPB variables at baseline and condom use 3 months later. Condom negotiation self-efficacy was a significant indicator of behavioral intent, while condom use self-efficacy was not. Fear of condom negotiation was negatively associated with all TPB components, which was in turn significantly associated with behavioral intent and condom use. Implications for the TPB, safer sex literature, and sexually transmitted infection prevention intervention design are discussed.Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) : A cluster randomized trial targeting system-wide improvement in substance use services
AbstractDiClemente, R. (n.d.).Publication year
2016Journal title
Implementation ScienceVolume
11Issue
1AbstractBackground: The purpose of this paper is to describe the Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented with fidelity across the cooperative can be challenging. This paper describes (a) the study background and rationale, including the juvenile justice context and best practices for substance use disorders, (b) the selection and use of an implementation science framework to guide study design and inform selection of implementation components, and (c) the specific study design elements, including research questions, implementation interventions, measurement, and analytic plan. Methods/design: The JJ-TRIALS primary study uses a head-to-head cluster randomized trial with a phased rollout to evaluate the differential effectiveness of two conditions (Core and Enhanced) in 36 sites located in seven states. A Core strategy for promoting change is compared to an Enhanced strategy that incorporates all core strategies plus active facilitation. Target outcomes include improvements in evidence-based screening, assessment, and linkage to substance use treatment. Discussion: Contributions to implementation science are discussed as well as challenges associated with designing and deploying a complex, collaborative project. Trial registration:NCT02672150.Lessons Learned From Delivering Imara, an HIV/STI Risk Reduction Intervention for African American Girls in Juvenile Detention
AbstractDavis, T. L., Boyce, L. S., Rose, E., Swartzendruber, A., DiClemente, R., Gelaude, D., Fasula, A. M., & Carry, M. (n.d.).Publication year
2016Journal title
Health promotion practiceVolume
17Issue
1Page(s)
31-39AbstractA critical need exists for efficacious interventions to reduce sexual risk and sexually transmitted infections (STIs) among African American girls in juvenile detention. Adapting evidence-based interventions is one strategy for developing interventions that might protect detained African American girls from adverse sexual health outcomes. To support development and implementation of evidence-based HIV/STI prevention interventions for this population, this qualitative study describes lessons learned from delivering Imara, an adapted HIV/STI prevention intervention for detained African American girls. Program implementation includes one-on-one sessions in the detention facility that offer logistical advantages; provide intervention contact inside the facility, soon after release, and frequently thereafter; address STI treatment for girls and their sexual partners; tailor intervention content based on individual risk and learning needs; and identify and acknowledge girls’ competing priorities. These lessons are discussed in the context of challenges encountered and solutions for addressing the challenges, and in terms of the structure and content of the intervention. The lessons learned from delivering Imara exemplify the continuous process of adapting an existing intervention for a new population and setting.Masculinity and HIV : Dimensions of Masculine Norms that Contribute to Men’s HIV-Related Sexual Behaviors
AbstractFleming, P. J., DiClemente, R., & Barrington, C. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Issue
4Page(s)
788-798AbstractNumerous studies have documented a relationship between masculine norms and men’s HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men’s sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men’s HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men’s sexual behavior: (1) uncontrollable male sex drive, (2) capacity to perform sexually, and (3) power over others. While the existing literature does help explain the relationship between masculine norms and men’s sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts.Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power
AbstractRosenbaum, J. E., Zenilman, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).Publication year
2016Journal title
Journal of Urban HealthVolume
93Issue
3Page(s)
493-510AbstractReproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15–21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.Preexisting chronic health conditions and health insurance status associated with vaccine receipt among adolescents
AbstractSeib, K., Underwood, N. L., Gargano, L. M., Sales, J. M., Morfaw, C., Weiss, P., Murray, D., Vogt, T. M., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2016Journal title
Journal of Adolescent HealthVolume
58Issue
2Page(s)
148-153AbstractPurpose: Four vaccines are routinely recommended for adolescents: tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); meningococcal-conjugate (MCV4); and a yearly seasonal influenza vaccine. Vaccination promotion and outreach approaches may need to be tailored to certain populations, such as those with chronic health conditions or without health insurance. Methods: In a controlled trial among middle and high school students in Georgia, 11 schools were randomized to one of three arms: no intervention, parent education brochure, or parent education brochure plus a student curriculum on the four recommended vaccines. Parents in all arms were surveyed regarding their adolescent's vaccine receipt, chronic health conditions, and health insurance status. Results: Of the 686 parents, most (91%) reported their adolescent had received at least one of the four vaccines: Tdap (82%), MCV4 (59%), current influenza vaccine (53%) and HPV (48%). Twenty three percent of parents reported that their adolescent had asthma. Most parents reported that their adolescent's insurance was Medicaid (60%) or private insurance (34%), and 6% reported no insurance. More adolescents with a chronic health condition received any adolescent vaccine than adolescents without a chronic health condition (p < .0001). Among those with no insurance, fewer had received any adolescent vaccine than those with Medicaid or private insurance (p < .0001). Conclusions: The federal Vaccines for Children program offers recommended vaccines free to eligible children (including those without health insurance). Our findings suggest that parents may not be aware of this program or eligibility for it, thus revealing a need for education or other fixes.Recommendations for Structure and Content for a School-Based Adolescent Immunization Curriculum
AbstractSalazar, K. R., Seib, K. G., Underwood, N. L., Gargano, L. M., Sales, J. M., Morfaw, C., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2016Journal title
Health promotion practiceVolume
17Issue
4Page(s)
512-520AbstractDespite high utilization of childhood vaccinations, adolescent immunization coverage rates lag behind recommended coverage levels. The four vaccines recommended for adolescents ages 11 to 18 years are tetanus, diphtheria, and pertussis vaccine; human papillomavirus vaccine; meningococcal conjugate vaccine; and an annual influenza vaccine. The Healthy People 2020 goal is 80% coverage for each recommended immunization, but coverage rates in Georgia among adolescents fall below those goals for all but the tetanus, diphtheria, and pertussis vaccine. We developed a multicomponent intervention that included a school-based, teacher-delivered educational curriculum to increase adolescent vaccination coverage rates in Richmond County, Georgia. We facilitated focus group discussions with middle- and high school science teachers who delivered the immunization curriculum in two consecutive school years. The objective of the focus group was to understand teachers’ perspectives about the curriculum impact and to synthesize recommendations for optimal dissemination of the curriculum content, structure, and packaging. Teachers provided recommendations for curriculum fit within existing classes, timing of delivery, and dosage of delivery and recommended creating a flexible tool kit, such as a downloadable online package. Teachers also recommended increasing emphasis on disease transmission and symptoms to keep students engaged. These findings can be applied to the development of an online, cost-effective tool kit geared toward teaching adolescents about the immune system and adolescent vaccinations.