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
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.Genetic sensitivity to emotional cues, racial discrimination and depressive symptoms among African–American adolescent females
AbstractSales, J. M., Brown, J. L., Swartzendruber, A. L., Smearman, E. L., Brody, G. H., & DiClemente, R. (n.d.).Publication year
2015Journal title
Frontiers in PsychologyVolume
6AbstractPsychosocial stress, including stress resulting from racial discrimination (RD), has been associated with elevated depressive symptoms. However, individuals vary in their reactivity to stress, with some variability resulting from genetic differences. Specifically, genetic variation within the linked promoter region of the serotonin transporter gene (5-HTTLPR) is related to heightened reactivity to emotional environmental cues. Likewise, variations within this region may interact with stressful life events (e.g., discrimination) to influence depressive symptoms, but this has not been empirically examined in prior studies. The objective of this study was to examine whether variation in the 5-HTTLPR gene interacts with RD to predict depressive symptoms among a sample of African–American adolescent females. Participants were 304 African–American adolescent females enrolled in a sexually transmitted disease prevention trial. Participants completed a baseline survey assessing psychosocial factors including RD (low vs. high) and depressive symptomatology (low vs. high) and provided a saliva sample for genotyping the risk polymorphism 5-HTTLPR (s allele present vs. not present). In a logistic regression model adjusting for psychosocial correlates of depressive symptoms, an interaction between RD and 5-HTTLPR group was significantly associated with depressive symptomatology (AOR = 3.79, 95% CI: 1.20–11.98, p = 0.02). Follow-up tests found that high RD was significantly associated with greater odds of high depressive symptoms only for participants with the s allele. RD and 5-HTTLPR status interact to differentially impact depressive symptoms among African–American adolescent females. Efforts to decrease depression among minority youth should include interventions which address RD and strengthen factors (e.g., coping, emotion regulation, building support systems) which protect youth from the psychological costs of discrimination.Hiv risk and prevention among adjudicated adolescents
AbstractDavis, T. L., & DiClemente, R. J. (n.d.). In The Development of Criminal and Antisocial Behavior (1–).Publication year
2015Page(s)
491-505AbstractJustice-involved youth face numerous challenges and engage in riskier behaviors compared to their nondetained counterparts. Juvenile arrests have been on the decline. In 2011, juvenile arrests decreased eleven percent from 2010. There are racialand gender-based disparities in juvenile arrests. African Americans and women are over-represented in the juvenile justice system. In the past decade while the overall crime rate has declined, the incarceration rate for girls, relative to boys, grew at a much faster rate for all categories of crimes. Adolescents in juvenile detention facilities have a higher prevalence of substance use, preexisting mental health disorders, STI/HIV, and unplanned pregnancy. There is a lack of evidence-based, behavioral interventions for incarcerated African American girls. Future research must develop and test interventions addressing co-occurrence of risk behaviors and multiple levels of intervention, beyond individual level intervention alone, among adjudicated adolescents need to be developed and tested for efficacy.HIV Risk Interventions
AbstractRicks, J. N. M., DiClemente, R. J., & Seth, P. (n.d.). In International Encyclopedia of the Social & Behavioral Sciences: Second Edition (1–).Publication year
2015Page(s)
138-144AbstractHuman Immunodeficiency Virus (HIV) infection, the cause of Acquired Immune Deficiency Syndrome (AIDS), has become a significant threat to global public health, faster than any previous epidemic. Recent decades have seen significant progress in the global HIV/AIDS response, largely due to increased availability of treatment and targeted efforts to decrease transmission and incidence. This article highlights HIV risk prevention strategies that have been developed, implemented, and demonstrated efficacy in reducing the risk of HIV infection among adolescents, women, men who have sex with men, and heterosexually active men.Human papillomavirus vaccination among adolescents in Georgia
AbstractUnderwood, N. L., Weiss, P., Gargano, L. M., Seib, K., Rask, K. J., Morfaw, C., Murray, D., DiClemente, R. J., Hughes, J. M., & Sales, J. M. (n.d.).Publication year
2015Journal title
Human Vaccines and ImmunotherapeuticsVolume
11Issue
7Page(s)
1703-1708AbstractHuman papillomavirus (HPV) vaccination coverage for adolescent females and males remains low in the United States. We conducted a 3-arm randomized controlled trial (RCT) conducted in middle and high schools in eastern Georgia from 2011–2013 to determine the effect of 2 educational interventions used to increase adolescent vaccination coverage for the 4 recommended adolescent vaccines: Tdap, MCV4, HPV and influenza. As part of this RCT, this article focuses on: 1) describing initiation and completion of HPV vaccine series among a diverse population of male and female adolescents; 2) assessing parental attitudes toward HPV vaccine; and 3) examining correlates of HPV vaccine series initiation and completion. Parental attitude score was the strongest predictor of HPV vaccine initiation among adolescents (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.80, 2.39). Other correlates that significantly predicted HPV series initiation were gender, study year, and intervention arm. Parental attitudes remained a significant predictor of receipt of 3 doses of HPV vaccine along with gender, race, school type and insurance type. This study demonstrates that positive parental attitudes are important predictors of HPV vaccination and critical to increasing coverage rates. Our findings suggest that more research is needed to understand how parental attitudes are developed and evolve over time.Identifying psychosocial and social correlates of sexually transmitted diseases among black female teenagers
AbstractKraft, J. M., Whiteman, M. K., Carter, M. W., Snead, M. C., DiClemente, R. J., Murray, C. C., Hatfield-Timajchy, K., & Kottke, M. (n.d.).Publication year
2015Journal title
Sexually Transmitted DiseasesVolume
42Issue
4Page(s)
192-197AbstractBackground: Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors.We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers. Methods: Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers. Results: More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is theworst thing that could happen (aOR, 0.50), and believing shewould feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD. Conclusions: Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers.Influence of sexual arousability on partner communication mediators of condom use among African American female adolescents
AbstractSwartzendurber, A., Murray, S. H., Sales, J. M., Milhausen, R. R., Sanders, S. A., Graham, C. A., Diclemente, R. J., & Wingood, G. M. (n.d.).Publication year
2015Journal title
Sexual HealthVolume
12Issue
4Page(s)
322-327AbstractBackground Ample evidence shows that partner sexual communication is related to condom use. Although communication about safer sex may often occur when sexual arousal is high, no studies have examined arousability, one's propensity for sexual arousal and partner sexual communication. The purpose of this study was to examine associations between sexual arousability and partner-related mediators of condom use among African American female adolescents, who have disproportionate risk for HIV and sexually transmissible infections (STIs). Methods: The study analysed self-reported baseline data from 701 African American females aged 14-20 years participating in a HIV/STI trial. Linear regression models examined associations between arousability and partner-related mediators of condom use (partner sexual communication self-efficacy, partner sexual communication frequency, sex refusal self-efficacy and condom use self-efficacy), controlling for age, impulsivity and relationship power. Results: Greater arousability was significantly associated with reduced levels of each partner communication outcome assessed (partner sexual communication self-efficacy, partner sexual communication frequency and sex refusal self-efficacy) but was not associated with condom use self-efficacy. Conclusions: Arousal and other positive aspects of sex have largely been ignored by HIV/STI prevention efforts, which primarily focus on individual behaviour. A population-level sexual health approach focusing on sexual wellbeing may reduce stigma, facilitate partner sexual communication and be more effective at reducing HIV/STI rates than traditional approaches.Influence of sources of information about influenza vaccine on parental attitudes and adolescent vaccine receipt
AbstractGargano, L. M., Underwood, N. L., Sales, J. M., Seib, K., Morfaw, C., Murray, D., DiClemente, R. J., & Hughes, J. M. (n.d.).Publication year
2015Journal title
Human Vaccines and ImmunotherapeuticsVolume
11Issue
7Page(s)
1641-1647AbstractIn 2011–2012, only 34% of 13–17 years olds in the United States (US) received seasonal influenza vaccine. Little is known about the link between parents' sources of health information, their vaccine-related attitudes, and vaccination of their adolescent against influenza. This study seeks to determine the relationship between number of sources of information on influenza vaccine, parental attitudes toward influenza vaccine, and influenza vaccine uptake in adolescents. We conducted a telephone and web-based survey among US parents of students enrolled in 6 middle and 5 high schools in Georgia. Bivariate and multivariable analyses were conducted to examine associations between the number of information sources about influenza vaccine and vaccine receipt and whether parent vaccine-related attitudes act as a mediator. The most commonly reported sources of information were: a physician/medical professional (95.0%), a family member or friend (80.6%), and television (77.2%). Parents who had higher attitude scores toward influenza vaccine were 5 times as likely to report their adolescent had ever received influenza vaccine compared to parents who had lower attitude scores (adjusted odds ratio (aOR) 5.1; 95% confidence intervals (CI) 3.1–8.4; P < 0.01). Parent vaccine-related attitudes were a significant mediator of the relationship between sources of information and vaccine receipt. In light of the low response rate and participation in an adolescent vaccination intervention, findings may not be generalizable to other populations. This study shows the importance of multiple sources of information in influencing parental decision-making about influenza vaccine for adolescents. Harnessing the power of mass media and family members and friends as health advocates for influenza vaccination can potentially help increase vaccination coverage of adolescents.Overcoming barriers to HPV vaccination: A randomized clinical trial of a culturally-tailored, media intervention among African American girls
AbstractDiclemente, R. J., Murray, C. C., Graham, T., & Still, J. (n.d.).Publication year
2015Journal title
Human Vaccines and ImmunotherapeuticsVolume
11Issue
12Page(s)
2883-2894AbstractAlthough genital HPV is the most prevalent STI in the US, rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African American adolescent females (ages 14-18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.Perceived Difficulty of Performing Selected HIV/AIDS Preventive Behaviors and Life Satisfaction: Is there a Relationship for African American Adolescents?
AbstractValois, R. F., Kerr, J. C., Hennessy, M., DiClemente, R. J., Brown, L. K., Carey, M. P., Vanable, P. A., Farber, N. B., Salazar, L. F., & Romer, D. (n.d.).Publication year
2015Journal title
AIDS and BehaviorVolume
19Issue
7Page(s)
1288-1297AbstractResearch on the relationship between adolescent health risk behaviors, sexual risk behaviors in particular, and perceived life satisfaction is emerging. Some researchers suggest that life satisfaction has been a neglected component of adolescent health research. African American adolescents aged 13–18 (n = 1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire via Audio Computer Assisted Self-Interview. Analyses were conducted to examine relationships between perceived difficulty in performing HIV/AIDS preventive behavior and perceived life satisfaction, while controlling for socioeconomic status. Results suggest that perceived life satisfaction is related to perceived difficulty in performing HIV/AIDS preventive behaviors, for both males and females, with variability in the magnitude of associations by gender. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived difficulty in performing HIV/AIDS preventive behavior to develop gender-appropriate and culturally-sensitive quality of life/health promotion programs.School-located vaccination clinics for adolescents: Correlates of acceptance among parents
AbstractGargano, L. M., Weiss, P., Underwood, N. L., Seib, K., Sales, J. M., Vogt, T. M., Rask, K., Morfaw, C., Murray, D. L., Diclemente, R. J., & Hughes, J. M. (n.d.).Publication year
2015Journal title
Journal of Community HealthVolume
40Issue
4Page(s)
660-669AbstractFour vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95 % confidence interval (CI) 2.44-22.31], MCV4 (AOR 2.97; 95 % CI 1.67-5.28), and HPV vaccines (AOR 7.61; 95 % CI 3.43-16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95 % CI 1.12-1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination.Sibling incest
AbstractDiClemente, R. J., & Ricks, J. N. M. (n.d.). In Handbook of Adolescent Behavioral Problems (1–).Publication year
2015Page(s)
595-608AbstractIncest is a taboo and a neglected social problem that has only started to receive significant attention in the United States in the last 30 years. Sibling sexual abuse has been identified as the most common form of incest; however, the origins and scope of incest are still not well understood and existing research literature is laden with definitional inconsistencies, data limitations, and inadequate research methodology. The discussion to follow in this chapter moves beyond common discourse of sibling incest as "normal" sexual exploration and explores the phenomenon as a complex combination of biological and sociological concerns and knowledge of the psychological child development.The association between stress, coping, and sexual risk behaviors over 24 months among African-American female adolescents
AbstractHulland, E. N., Brown, J. L., Swartzendruber, A. L., Sales, J. M., Rose, E. S., & Diclemente, R. J. (n.d.).Publication year
2015Journal title
Psychology, Health and MedicineVolume
20Issue
4Page(s)
443-456AbstractHeightened psychosocial stress coupled with maladaptive coping may be associated with greater sexual risk engagement. This study examined the association between stress levels and coping strategy use as predictors of sexual risk behavior engagement over 24 months among African-American adolescent females (N = 701; M = 17.6 years) enrolled in an STI/HIV risk-reduction intervention program. Participants completed audio computer assisted self-interview (ACASI) measures of global stress, interpersonal stress, coping strategy use, and sexual behaviors prior to intervention participation. Follow-up ACASI assessments were conducted at 6, 12, 18, and 24 months post-intervention. Generalized estimated equation models examined associations between baseline stress levels and coping strategy use as predictors of condom use (past 90 days, last sex) and multiple partners during follow-up. Global stress and individual coping strategy usage were not associated with differences in condom use. Higher interpersonal stress was associated with lower proportion condom use (p =.018), inconsistent condom use (p =.011), and not using a condom at last sex (p =.002). There were no significant associations between stress levels, coping strategy use, and multiple partners. Future research should explore mechanisms that may underlie the association between elevated interpersonal stress and decreased condom use among this population.The effect of high rates of bacterial sexually transmitted infections on hiv incidence in a cohort of black and white men who have sex with men in Atlanta, Georgia
AbstractKelley, C. F., Vaughan, A. S., Luisi, N., Sanchez, T. H., Salazar, L. F., Frew, P. M., Cooper, H. L., Diclemente, R., Del Rio, C., Sullivan, P. S., & Rosenberg, E. S. (n.d.).Publication year
2015Journal title
AIDS Research and Human RetrovirusesVolume
31Issue
6Page(s)
587-592AbstractData reporting sexually transmitted infection (STI) incidence rates among HIV-negative U.S. men who have sex with men (MSM) are lacking. In addition, it is difficult to analyze the effect of STI on HIV acquisition given that sexual risk behaviors confound the relationship between bacterial STIs and incident HIV. The InvolveMENt study was a longitudinal cohort of black and white HIV-negative, sexually active MSM in Atlanta who underwent routine screening for STI and HIV and completed behavioral questionnaires. Age-adjusted incidence rates were calculated for urethral and rectal Chlamydia (CT), gonorrhea (GC), and syphilis, stratified by race. Propensity-score-weighted Cox proportional hazards models were used to estimate the effect of STI on HIV incidence and calculate the population attributable fraction (PAF) for STI. We included 562 HIV-negative MSM with 843 person-years of follow-up in this analysis. High incidence rates were documented for all STIs, particularly among black MSM. Having a rectal STI was significantly associated with subsequent HIV incidence in adjusted analyses (aHR 2.7; 95% CI 1.2, 6.4) that controlled for behavioral risk factors associated with STI and HIV using propensity score weights. The PAF for rectal STI was 14.6 (95% CI 6.8, 31.4). The high incidence of STIs among Atlanta MSM and the association of rectal STI with HIV acquisition after controlling for behavioral risk underscore the importance of routine screening and treatment for STIs among sexually active MSM. Our data support targeting intensive HIV prevention interventions, such as preexposure chemoprophylaxis (PrEP), for Atlanta MSM diagnosed with rectal STIs.The effects of a mass media HIV-risk reduction strategy on HIV-related stigma and knowledge among African American adolescents
AbstractKerr, J. C., Valois, R. F., Diclemente, R. J., Carey, M. P., Stanton, B., Romer, D., Fletcher, F., Farber, N., Brown, L. K., Vanable, P. A., Salazar, L. F., Juzang, I., & Fortune, T. (n.d.).Publication year
2015Journal title
AIDS patient care and STDsVolume
29Issue
3Page(s)
150-156AbstractHIV-related stigma undermines HIV prevention, testing, and treatment. Multipronged risk-reduction strategies may reduce stigma among African American adolescents. To test the effectiveness of a risk-reduction strategy in addressing stigma, 1613 African American adolescents from four mid-sized cities participated in a randomized control trial. Participants received a sexual-risk reduction [Focus on Youth (FOY)] or general health curriculum [Promoting Health Among Teens (PHAT)]. Two cities received a culturally-tailored media intervention. Participants completed baseline, 3-, 6-, and 12-month surveys to measure HIV-related stigma and knowledge. Analysis of covariance tested for stigma and knowledge differences by media city status and curriculum/media city status (PHAT media vs. PHAT non-media, FOY media vs. FOY non-media; FOY media vs. PHAT media; FOY non-media vs. PHAT non-media) at each measurement. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over time. Media participants demonstrated greater HIV-related knowledge (p<0.10) at 6 months and lower stigma at 3 months (p<0.10). FOY media participants had lower 3-month (p<0.05) and 12-month (p<0.10) stigma scores than non-media FOY participants. FOY media and non-media participants had greater knowledge than PHAT for all intervals after baseline. FOY media had lower stigma than PHAT media after baseline for all intervals after baseline. HLM indicated greater knowledge slopes for the media group (p<0.05). FOY media participants had greater knowledge slopes (p<0.05) relative to non-media FOY participants and media PHAT participants (p<0.01). A combination of a HIV risk-reduction curriculum and culturally-tailored media demonstrated some effectiveness in reducing stigma. Future use of media in HIV-prevention should include and evaluate effects on stigma.The moderating role of parental psychopathology on response to a family-based HIV prevention intervention among youth in psychiatric treatment
Failed generating bibliography.AbstractPublication year
2015Journal title
Journal of Family StudiesVolume
21Issue
2Page(s)
178-194AbstractPrevious research suggests parents with mental health concerns are more likely to engage in maladaptive parenting practices and are less likely to benefit from parenting interventions. The current study examined the moderating influence of parent mental health problems on response to a family HIV prevention program delivered to youth in mental health treatment and their caregivers. The family intervention targeted parentadolescent communication and parental monitoring. Study hypotheses were tested using general linear models at three- and six-month follow-ups. Tests of moderation were conducted by modeling the interaction between treatment condition (family versus control) and parental psychopathology controlling for other relevant psychosocial factors (i.e., single parenthood, income, and education). Parents with elevated psychiatric symptoms demonstrated greater improvements in sexual communication (three and six months) and parental monitoring (three months) following the familybased intervention. These results suggest that parents with mental health problems can benefit from a brief family HIV prevention program.The need for biological outcomes to complement self-report in adolescent research
Brown, J. L., & DiClemente, R. J. (n.d.).Publication year
2015Journal title
PediatricsVolume
136Issue
3Page(s)
e551-e553The Relationship Between Male Gang Involvement and Psychosocial Risks for their Female Juvenile Justice Partners with Non-gang Involvement Histories
AbstractKing, K. M., Voisin, D. R., & Diclemente, R. J. (n.d.).Publication year
2015Journal title
Journal of Child and Family StudiesVolume
24Issue
9Page(s)
2555-2559AbstractThis article examines whether adolescent females involved in the juvenile justice system, who were never gang members but have had boyfriends who were gang members, are at higher risk for negative psychological, relationship and sexual risk outcomes compared to their counterparts. Data were collected from a convenience sample of African American adolescent females involved in the juvenile justice system, age 13–17, currently incarcerated in a short-term detention facility in Georgia (N = 137). Multiple logistic regression models controlling for age and SES documented that having a gang-involved boyfriend was associated with a greater risk for emotional and physical abuse, depression, PTSD, drug use, diminished perceived life chances and a variety of sexual risk predictors, such as decreased relationship control, partner infidelity, shorter time to sex with a casual sexual partner and reduced likelihood of HIV testing. These findings suggest that these women should be included in early prevention and intervention initiatives traditionally targeted at youth involved in gangs.Use of Dual Methods for Protection from Unintended Pregnancy and Sexually Transmitted Diseases in Adolescent African American Women
AbstractKottke, M., Whiteman, M. K., Kraft, J. M., Goedken, P., Wiener, J., Kourtis, A. P., & DiClemente, R. (n.d.).Publication year
2015Journal title
Journal of Pediatric and Adolescent GynecologyVolume
28Issue
6Page(s)
543-548AbstractStudy Objective: To characterize factors associated with dual method contraceptive use in a sample of adolescent women. Design, Setting, Participants, Interventions, and Main Outcome Measures: We conducted a cross-sectional survey of sexually active African American women aged 14-19 years who attended an urban Title X clinic in Georgia in 2012 (N = 350). Participants completed a computerized survey to assess contraceptive and condom use during the past 2 sexual encounters with their most recent partner. Dual method use was defined as use of a hormonal contraceptive or intrauterine device and a condom. We applied multinomial logistic regression, using generalized estimating equations, to examine the adjusted association between dual method use (vs use of no methods or less effective methods alone; eg, withdrawal) and select characteristics. Results: Dual methods were used by 20.6% of participants at last sexual intercourse and 23.6% at next to last sexual intercourse. Having a previous sexually transmitted disease (adjusted odds ratio [aOR], 2.30; 95% confidence interval [CI], 1.26-4.18), negative attitude toward pregnancy (aOR, 2.25; 95% CI, 1.19-4.28), and a mother who gave birth as a teen (aOR, 2.34; 95% CI, 1.21-4.52) were associated with higher odds of dual method use. Having no health insurance (aOR, 0.39; 95% CI, 0.18-0.82), 4 or more lifetime sexual partners (aOR, 0.42; 95% CI, 0.22-0.78), sex at least weekly (aOR, 0.54; 95% CI, 0.29-0.99), and agreeing to monogamy with the most recent partner (aOR, 0.40; 95% CI, 0.16-0.96) were associated with decreased odds of dual method use. Conclusion: Dual method use was uncommon in our sample. Efforts to increase use of dual methods should address individual and relationship factors.Validation of the Sexual Communication Self-Efficacy Scale
AbstractQuinn-Nilas, C., Milhausen, R. R., Breuer, R., Bailey, J., Pavlou, M., DiClemente, R. J., & Wingood, G. M. (n.d.).Publication year
2015Journal title
Health Education and BehaviorVolume
43Issue
2Page(s)
165-171AbstractThis study assessed a newly developed Sexual Communication Self-Efficacy Scale designed to measure the sexual communication self-efficacy of adolescent men and women. Three-hundred and seventy-four U.K. adolescents completed this new scale, along with several other validity measures. Factor analysis revealed that the Sexual Communication Self-Efficacy Scale consisted of five underlying factors: contraception communication, positive sexual messages, negative sexual messages, sexual history, and condom negotiation. These factors demonstrated high internal consistency and presents evidence to support construct validity. This scale may have utility in assessing the effectiveness of interventions designed to enhance sexual communication and sexual health behaviors among young people.Acceptability of condoms, circumcision and PrEP among young black men who have sex with men: A descriptive study based on effectiveness and cost
AbstractCrosby, R. A., Geter, A., Diclemente, R. J., & Salazar, L. F. (n.d.).Publication year
2014Journal title
VaccinesVolume
2Issue
1Page(s)
129-137AbstractThe current study examined and compared the willingness of young Black men who have sex with men (YBMSM) to accept pre-exposure prophylaxis (PrEP), adult male circumcision, and condoms for reducing their risk of HIV acquisition. The majority (67%) reported unprotected receptive anal sex in the last six months. About three-quarters (71%) would accept using PrEP if it was 100% effective. Cost influenced PrEP acceptance with 19% indicating acceptance at $100 per month co-pay. Of those not circumcised, 50% indicated willingness if circumcision was 100% effective. Acceptance of circumcision decreased markedly to 17% with co-pays of $100. About 73% of men were willing to use condoms if they were 100% effective and 50% indicated a willingness at the cost of $10 per month. The findings suggest that condom use promotion strategies should remain at the forefront of public health efforts to control HIV incidence among YBMSM.Adaptation of the African couples HIV testing and counseling model for men who have sex with men in the United States: An application of the ADAPT-ITT framework
AbstractSullivan, P. S., Stephenson, R., Grazter, B., Wingood, G., Diclemente, R., Allen, S., Hoff, C., Salazar, L., Scales, L., Montgomery, J., Schwartz, A., Barnes, J., & Grabbe, K. (n.d.).Publication year
2014Journal title
SpringerPlusVolume
3Issue
1Page(s)
1-13AbstractTo respond to the need for new HIV prevention services for men who have sex with men (MSM) in the United States, and to respond to new data on the key role of main partnerships in US MSM epidemics, we sought to develop a new service for joint HIV testing of male couples. We used the ADAPT-ITT framework to guide our work. From May 2009 to July 2013, a multiphase process was undertaken to identify an appropriate service as the basis for adaptation, collect data to inform the adaptation, adapt the testing service, develop training materials, test the adapted service, and scale up and evaluate the initial version of the service. We chose to base our adaptation on an African couples HIV testing service that was developed in the 1980s and has been widely disseminated in low- and middle-income countries. Our adaptation was informed by qualitative data collections from MSM and HIV counselors, multiple online surveys of MSM, information gathering from key stakeholders, and theater testing of the adapted service with MSM and HIV counselors. Results of initial testing indicate that the adapted service is highly acceptable to MSM and to HIV counselors, that there are no evident harms (e.g., intimate partner violence, relationship dissolution) associated with the service, and that the service identifies a substantial number of HIV serodiscordant male couples. The story of the development and scale-up of the adapted service illustrates how multiple public and foundation funding sources can collaborate to bring a prevention adaptation from concept to public health application, touching on research, program evaluation, implementation science, and public health program delivery. The result of this process is an adapted couples HIV testing approach, with training materials and handoff from academic partners to public health for assessment of effectiveness and consideration of the potential benefits of implementation; further work is needed to optimally adapt the African couples testing service for use with male-female couples in the United States.Added benefits: reduced depressive symptom levels among African-American female adolescents participating in an HIV prevention intervention
AbstractBrown, J. L., Sales, J. M., Swartzendruber, A. L., Eriksen, M. D., DiClemente, R. J., & Rose, E. S. (n.d.).Publication year
2014Journal title
Journal of Behavioral MedicineVolume
37Issue
5Page(s)
912-920AbstractAdolescents experience elevated depressive symptoms which health promotion interventions may reduce. This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Adolescents (N = 701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Participants reported a 2.7 % decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6 % decrease in depressive symptoms (p = 0.058). Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents’ mental health needs.