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
Alcohol use, partner characteristics, and condom use among HIV-infected Russian women: An event-level study
AbstractBrown, J. L., Diclemente, R. J., 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. J., & 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. D., Comer, S. K., Worley, T., Rose, E., & DiClemente, R. J. (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. J. (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. D., DiClemente, R. J., & 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
Failed generating bibliography.AbstractPublication 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. J., & 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. J., & 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. J., & 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.Rethinking funding priorities in mental health research
AbstractLewis-Fernández, R., Rotheram-Borus, M. J., Betts, V. T., Greenman, L., Essock, M. S., Escobar, I. J., 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., John Rush, A., Canino, J. G., Bell, C. C., Henry, R., & Iversen, P. (n.d.).Publication year
2016Journal title
British Journal of PsychiatryVolume
208Issue
6Page(s)
507-509AbstractMental 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. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.Risk Communication
AbstractDiClemente, R. J., & Jackson, J. M. (n.d.). In International Encyclopedia of Public Health (1–).Publication year
2016Page(s)
378-382AbstractA crucial function of public health is how to effectively disseminate information about a community's risk. Risk communication involves the effective and accurate exchange of information about health risks and hazards - often during an emergency - that advances risk awareness and understanding and promotes health-protective behaviors among individuals, communities, and institutions. Although forged through decades of applied experience in response to infectious disease outbreaks, industrial accidents, and natural disasters, contemporary public health risk communication is predicated on fundamental principles and practices of behavioral, health, and social science theory and research. Increasingly, risk communication concepts are proving instrumental to pursuits in noncrisis contexts such as health care and health promotion. Examples from the most recent Ebola and Zika epidemics are also included.Sexual Risk Among African American Women: Psychological Factors and the Mediating Role of Social Skills
AbstractCurran, T. M., Monahan, J. L., Samp, J. A., Coles, V. B., DiClemente, R. J., & Sales, J. (n.d.).Publication year
2016Journal title
Communication QuarterlyVolume
64Issue
5Page(s)
536-552AbstractPrior research demonstrates a positive association between mental health problems and sexual risk for African American women. Using the social skills deficit hypothesis, we proposed that social skills mediate this relationship. African American women (n = 557, M age = 20.58) completed measures of depression, stress, emotional dysregulation, sexual risk behaviors, and perceptions of their social skills with their primary sexual partner. Social skills mediated the link between the mental health assessments and a composite sexual risk index. Theoretical implications of extending the social skill deficit hypothesis are discussed as well as implications for interventions.Substance Use Patterns of HIV-Infected Russian Women with and Without Hepatitis C Virus Co-infection
AbstractBrown, J. L., DiClemente, R. J., Sales, J. M., Rose, E. S., Safonova, P., Levina, O. S., Belyakov, N., & Rassokhin, V. V. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Issue
10Page(s)
2398-2407AbstractIndividuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin: AOR: 13.2, 95 % CI 4.9, 35.3, p < .001), problem drinking (β = 1.2, p = .05), substance use problems (β = 1.3, p = .009), and increased likelihood of past injection drug use (AOR: 26.4, 95 % CI 8.5, 81.9, p < .001) relative to HIV mono-infected individuals. HIV/HCV co-infection was prevalent and associated with increased substance use and problematic drug use. Findings highlight the need for ongoing substance use and HIV/HCV risk behavior assessment and treatment among HIV/HCV co-infected Russian women.Taking mhealth forward: Examining the core characteristics
AbstractDavis, T. L., Diclemente, R., & Prietula, M. (n.d.).Publication year
2016Journal title
JMIR mHealth and uHealthVolume
4Issue
3AbstractThe emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular.Validity of Self-reported Sexual Behavior Among Adolescents: Where Do We Go from Here?
AbstractDiClemente, R. J. (n.d.).Publication year
2016Journal title
AIDS and BehaviorVolume
20Page(s)
215-217AbstractAdolescents have high rates of sexually transmitted infections (STIs). Adolescents consuming alcohol and using drugs have markedly greater HIV/STI risk and are a priority population for intervention. Accurate measurement of sexual risk behavior is critical for understanding individual’s risk for HIV/STI, transmission dynamics of HIV/STI, and evaluating the efficacy of interventions designed reduce HIV/STI risk. However, significant challenges to accurately measuring adolescents’ self-reported sexual behavior are well-documented. Recent advances in microbiology, such as the use of less invasive specimen collection for DNA assays, can assist researchers in more accurately measuring adolescents’ sexual risk behavior. However, the majority of studies of adolescents’ sexual risk rely solely on self-reported behavior; therefore, methods to improve the validity of adolescents’ self-reported sexual behavior are needed. In addition, integrating biologic measures to complement self-reported measures are recommended, when appropriate and feasible.Abuse Impedes Prevention: The Intersection of Intimate Partner Violence and HIV/STI Risk Among Young African American Women
AbstractSeth, P., Wingood, G. M., Robinson, L. S. S., Raiford, J. L., & DiClemente, R. J. (n.d.).Publication year
2015Journal title
AIDS and BehaviorVolume
19Issue
8Page(s)
1438-1445AbstractIntimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18–29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs.Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls
AbstractRicks, J. N. M., Swartzendruber, A. L., Sales, J. M., Boyce, L. S., Diclemente, R. J., & Rose, E. (n.d.).Publication year
2015Journal title
Sexual HealthVolume
12Issue
4Page(s)
364-368AbstractBackground The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. Methods: Ninety-five detained African-American girls (aged 13-17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n≤51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. Results: EPT was offered 69 times, accepted by 70% (n≤37) girls and provided to 68% (n≤36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR≤3.2, 95% CI: 1.0,-10.1, P≤0.048) and≥4 lifetime sex partners (OR≤3.3, 95% CI: 1.0-11.0, P≤0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. Conclusions: Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.Adolescent sex offenders
AbstractRicks, J. N. M., & DiClemente, R. J. (n.d.). In Handbook of Adolescent Behavioral Problems (1–).Publication year
2015Page(s)
577-593AbstractIn the United States, law enforcement and judicial systems and mental health professionals continue to struggle to deal with the rise in the number of juvenile sex offenders. The consequences of sex offending are substantial for victims, society, perpetrators, and their families, involving significant human (emotional and physical suffering) and financial costs. Adolescent sexual offending is a complex phenomenon that cannot be easily explained. Many theories have been proposed to explain why some children and teens sexually abuse others. However, to date there is no empirically derived and tested model to explain what motivates adolescents to perpetrate sexual crimes. This chapter provides an overview of biological, individual, familial, social, and behavioral characteristics of adolescents who have sexually offended. This chapter also reviews common approaches to treating and preventing recurrent sexually aggressive behavior in juveniles.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. J., & 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.Associations 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. J. (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.Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study
AbstractSullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., Diclemente, R. J., Wingood, G. M., Frew, P. M., Salazar, L. F., Del Rio, C., Mulligan, M. J., & Peterson, J. L. (n.d.).Publication year
2015Journal title
Annals of EpidemiologyVolume
25Issue
6Page(s)
445-454AbstractPurpose: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. Methods: In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. Results: Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. Conclusions: Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM.Focusing national institutes of health HIV/AIDS research for maximum population impact
AbstractWalensky, R. P., Carpenter, C. J., Auerbach, J. D., Agosto-Rosario, M., Averitt, D., Bartlett, J. G., Curran, J. W., DiClemente, R. J., El-Sadr, W., Haase, A., Hillier, S., Holmes, K. K., & Volberding, P. A. (n.d.).Publication year
2015Journal title
Clinical Infectious DiseasesVolume
60Issue
6Page(s)
937-940AbstractProgress in advancing research on the pathophysiology, prevention, treatment, and impact of human immunodeficiency virus (HIV) is threatened by the decaying purchasing power of National Institutes of Health (NIH) dollars. A working group of the NIH Office of AIDS Research Advisory Council was charged by the NIH Director with developing a focused and concise blueprint to guide the use of limited funding over the next few years. Science priorities outlined by the working group and reported here are intended to maximally address individuals, groups, and settings most affected by the epidemic, and to redress shortcomings in realizing population- level HIV prevention, treatment, and eradication goals. Optimizing these priorities requires that traditional silos-defined by topic focus and by scientific discipline-be dissolved and that structural issues affecting the pipeline of new investigators and the ability of the Office of AIDS Research to fulfill its role of steward of the NIH HIV/AIDS research program be directly addressed.