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
Correlates of 2009 H1N1 influenza vaccine acceptability among parents and their adolescent children
AbstractPainter, J. E., Gargano, L. M., Sales, J. M., Morfaw, C., Jones, L. M., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
Health Education ResearchVolume
26Issue
5Page(s)
751-760AbstractSchool-aged children were a priority group for receipt of the pandemic (2009) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-school students and their parents in two counties in rural Georgia. Multivariable logistic regression analyses were conducted to assess correlates of parental acceptance of H1N1 influenza vaccination for their children and adolescents' acceptance of vaccination for themselves. Concordance analyses were conducted to assess agreement between parent-adolescent dyads regarding H1N1 influenza vaccine acceptance. Parental acceptance of H1N1 influenza vaccination for their children was associated with acceptance of the vaccine for themselves and feeling motivated by the H1N1 influenza pandemic to get a seasonal influenza vaccine for their child. Adolescents' acceptance was associated with receipt of a seasonal influenza vaccine in the past year, fear of getting H1N1 influenza, feeling comfortable getting the vaccine and parental acceptance of H1N1 influenza vaccine. Half (50%) of parent-adolescent pairs included both a parent and child who expressed H1N1 influenza vaccine acceptance, and 19% of pairs would not accept the vaccine. This research highlights the need for interventions that target factors associated with H1N1 influenza vaccine acceptance among both parents and adolescents.Correlates of 2009 pandemic H1N1 influenza vaccine acceptance among middle and high school teachers in rural Georgia
AbstractGargano, L. M., Painter, J. E., Sales, J. M., Morfaw, C., Jones, L. M., Weiss, P., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2011Journal title
Journal of School HealthVolume
81Issue
6Page(s)
297-303AbstractBACKGROUND: Teachers play an essential role in the school community, and H1N1 vaccination of teachers is critical to protect not only themselves but also adolescents they come in contact within the classroom through herd immunity. School-aged children have a greater risk of developing H1N1 disease than seasonal influenza. The goal of this study was to assess the relationship between attitudes toward H1N1 vaccination and vaccine acceptance among middle and high school teachers in rural Georgia. METHODS: Participants were recruited from 2 counties participating in a school-based influenza vaccination intervention in rural Georgia. Data were collected from surveys distributed to middle and high school teachers in participating counties in September 2009 prior to implementing the interventions to increase vaccination against seasonal influenza. Multivariate logistic regression was used to assess the association between teachers' attitudes toward H1N1 vaccination and H1N1 vaccine acceptance, controlling for demographic variables. RESULTS: Among participants, 52.9% indicated that they would get the H1N1 vaccine. In multivariate analyses, H1N1 vaccine acceptance was associated with male gender (odds ratio[OR] = 3.67, p = .016), fear of contracting H1N1 (OR = 3.18, p = .025), and receipt of a seasonal influenza vaccine in the past year (OR = 3.07, p = .031). H1N1 vaccine acceptance was not significantly associated with age, race, perceived severity of H1N1, belief that the H1N1 vaccine would cause illness, or talking about H1N1 with friends. CONCLUSIONS: Teachers may play a pivotal role in school-based H1N1 vaccinations. Understanding and addressing teachers' attitudes toward H1N1 vaccination may assist in future immunization efforts.Correlates of Adolescent Females' Worry About Undesired Pregnancy : The Importance of Partner Desire for Pregnancy
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Sionean, C., Cobb, B. K., Harrington, K., Davies, S., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2001Journal title
Journal of Pediatric and Adolescent GynecologyVolume
14Issue
3Page(s)
123-127AbstractStudy Objective: The purpose of this study was to determine correlates of worry about pregnancy among a high-risk sample of low-income African-American adolescent females. Specifically, we tested the hypothesis that perceived male partner desire for pregnancy and level of sexual communication would be independently associated with adolescent females' worry about becoming pregnant. Design: A survey of sexually active African-American adolescent females, 14-18 years of age. Setting: Recruitment was conducted in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and teen pregnancy. Participants: Adolescents (N = 522) completed a survey and a face-to-face interview, and provided a urine specimen for pregnancy testing. Main Outcome Measure: Nonpregnant adolescents reporting steady relationships with a male sex partner (over the past 6 months) and indicating no immediate desire to become pregnant were included in the analysis (n = 196). Two questionnaire items assessed level of worry about becoming pregnant. Results: Compared to adolescent females reporting their partner did not desire pregnancy, those perceiving their partner desired pregnancy were nearly three times more likely to experience high worry about becoming pregnant (AOR = 2.85; P = .009). Engaging in sex unprotected by a condom was an equally important correlate of high worry (AOR = 2.84; P = .013). Level of communication between partners about pregnancy prevention was not significant. Conclusions: Adolescent females may experience high worry about becoming pregnant due to desires of their male partner as well as their recent sexual risk behavior.Correlates of casual sex among African-American female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Sionean, C., Cobb, B. K., Harrington, K., Davies, S. L., Edward Hook, I. I., & Kim Oh, M. (n.d.).Publication year
2001Journal title
Journal of HIV/AIDS Prevention and Education for Adolescents and ChildrenVolume
4Issue
4Page(s)
55-67AbstractThis study identified correlates of reporting voluntary sex with casual partner (VS-CP) among African American adolescent females. Sexually active African-American female teens (N = 522) were recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence and STDs. Of the 609 eligible adolescents, 522 (85.7%) agreed to participate in the study. VS-CP was reported by 15.9% of adolescents. Identified correlates of VS-CP were acquiescing to unwanted sex, living with a non-parent relative, never being pregnant, rejecting messages about the value of condoms for disease prevention, low parental supervision, and dissatisfaction with body image. These correlates may be important in the targeting and design of STD/HIV prevention programs for African -American adolescent females.Correlates of condom failure among adolescent males : An exploratory study
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Salazar, L. F., Rose, E., Levine, D., Brown, L., Lescano, C., Pugatch, D., Flanigan, T., Fernandez, I., Schlenger, W., & Silver, B. J. (n.d.).Publication year
2005Journal title
Preventive MedicineVolume
41Issue
5-6Page(s)
873-876AbstractObjective. To identify the prevalence and correlates of condom failure (defined as breakage or slipping off in the past 90 days) among a sample of adolescent males (15 to 21 years of age). Design. A cross-sectional study of 481 condom-using males residing in three US cities (Atlanta, GA, Providence RI, Miami FL). Data were collected, in the years 2000 and 2001, using audio computer-assisted self-interviewing technology. Prevalence ratios were used to determine the strength and significance of bivariate associations between ten assessed correlates and condom failure. Correlates achieving a screening level of significance were entered into a multivariate model that was used to calculate adjusted odds ratios (AOR). Results. Recent condom failure was reported by 34.1%. Younger adolescents were about one-third less likely to report condom failure (AOR = 0.66; P = 0.4). Adolescents reporting multiple sex partners were about 80% more likely to report failure (AOR = 1.84; P = 0.09). Adolescents indicating they had sex with someone on the same day they met the person were about 80% more likely to report failure (AOR = 1.77; P = 0.02). Finally, adolescents indicating recent problems obtaining condoms were about 70% more likely to report failure (AOR = 1.69; P = 0.1). Failure was not less common among those reporting a history of STD infection or those ever impregnating a partner. Conclusion. Because adolescent males may commonly experience condom failure, targeted clinic- and community-based programs designed to reduce user error could be an important aspect of preventing pregnancy and the spread of STDs.Correlates of condom use among incarcerated adolescents in a rural state
AbstractBarthlow, D. J., Horan, P. F., DiClemente, R., & Lanier, M. M. (n.d.).Publication year
1995Journal title
Criminal Justice and BehaviorVolume
22Issue
3Page(s)
295-306AbstractAn anonymous self-report survey was completed by 335 sexually active, incarcerated adolescents in a southern rural state. Multivariate logistic regression analysis was used to identify correlates of condom use during sexual intercourse. Four variables were identified as associated with frequent condom use: Nonuse of marijuana, nonuse of beer, asking sexual partners about their sexual history, and feeling worried about friends contracting AIDS. This four-variable model was highly significant, correctly classifying 70% of the adolescents in their condom-use categories. The intersecting nature of substance use and the HIV epidemic is discussed, as well as the importance of teaching substance refusal skills and sexual communication and negotiation skills to incarcerated adolescents.Correlates of consistent condom use among HIV positive African American women
AbstractRaiford, J. L., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2007Journal title
Women and HealthVolume
46Issue
2-3Page(s)
41-58AbstractIntroduction: African American women are the fastest growing group at risk of contracting HIV, as over 68% of women diagnosed with HIV are African American. The present study used social-cognitive theory and the theory of gender and power to identify correlates of consistent condom use among African American women living with HIV. Methods: We recruited 366 women, 18-50 years of age and living with HIV from several HIV/AIDS clinics in the southeastern United States. The majority of women, 84.2% (N = 308), were African American. Women completed a baseline interview assessing sociodemographic, psychosocial, and partner-related factors potentially associated with consistent condom use, defined as reported use of condoms during every vaginal sex episode with a male sexual partner in the past 30 days. Results: Among those HIV-positive African American women reporting use of a condom in the past 30 days (n = 234, 70%), consistent condom use was reported by 67.1% of women. This rate was lower (51.6%) among women having an HIV-positive male sexual partner; the rate was higher (74.1%) among women having an HIV-negative male sexual partner. Compared to women who were inconsistent condom users, women with HIV were more likely to use condoms if they: had high partner communication self-efficacy (OR = 7.77, 95% CI = 3.3-18.6, p = .001), had a HIV-negative male sex partner (OR = 4.62, 95% CI = 1.9-11.5, p = 0.001), had low partner-related barriers to condom use (OR = 4.68, 95% CI = 1.8-12.2, p = 0.001), and had perceived peer norms supportive of condom use (OR = 2.38, 95% CI = 1.0-5.7, p = 0.03). Conclusion: These findings suggest that HIV interventions may enhance consistent condom use among African American women living with HIV by targeting women's self-efficacy to communicate with their partners and women's perception of personal and partner-related barriers to condom use.Correlates of Consistent Condom Use with Main-New and Main-Old Sexual Partners
AbstractWiemann, C. M., Chacko, M. R., Kozinetz, C. A., DiClemente, R., Smith, P. B., Velasquez, M. M., & von Sternberg, K. (n.d.).Publication year
2009Journal title
Journal of Adolescent HealthVolume
45Issue
3Page(s)
296-299AbstractAn exploratory study identified correlates of consistent condom use for young women reporting Main-new or Main-old partners in the past 3 months: frequency of vaginal sex (across partner types); perceived likelihood of getting a STI (Main-new); age and STI history (Main-old). To enhance programmatic efficacy in community clinics, these key correlates of condom use for main partner types should be incorporated in STI risk reduction counseling.Correlates of continued risky sex among pregnant African American teens : Implications for STD prevention
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Lang, D. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
1Page(s)
57-63AbstractBackground: African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic. Objective: This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy. Study Design: Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance. Results: Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P < 0.02), primiparity (P < 0.03), not being enrolled in school (P < 0.02), not residing with at least one parent (P < 0.001), reported infrequent sexual communication (communicating about sex) with the boyfriend (P < 0.01), spending at least 30 hours each week with the boyfriend (P < 0.001), reporting that the age of the current relationship was at least 2 years (P < 0.04), and using marijuana in the past 30 days (P < 0.03). Three correlates retained significance in the multivariate model not residing with at least one parent (adjusted odds ratio [AOR] = 2.24; P < 0.04), spending at least 30 hours with the boyfriend each week (AOR = 3.70; P < 0.002), and infrequent sexual communication with the boyfriend (AOR = 2.88; P < 0.008). Conclusion: Given the potential of STDs to complicate pregnancy outcomes, clinic-based and community-based programs addressing relational dynamics and relational obstacles to safer sex may be warranted, particularly for adolescents not residing with parents.Correlates of correct condom use among high-risk African American men attending an Urban STD clinic in the South
AbstractCrosby, R., DiClemente, R., & Yarber, W. L. (n.d.).Publication year
2009Journal title
International Journal of Sexual HealthVolume
21Issue
3Page(s)
183-191AbstractThe purpose of this cross-sectional study was to assess prevalence and correlates of correct condom use among high-risk African American men attending a publicly funded sexually transmitted disease (STD) clinic. Men 18 through 29 years of age and newly diagnosed with an STD were further assessed for study eligibility. Of 296 meeting eligibility criteria, 271 agreed to participate, thereby yielding a participation rate of 91.5%. Correct use, assessed by an index, was reported by 38%. Correct use was associated with having sex with three or fewer female sex partners, being in an exclusive relationship, not indicating problems with the fit or feel of condoms, and not being drunk/high while using condoms. The correct use of condoms among young African American men newly diagnosed with an STD may be a function of situational factors. These factors could potentially be addressed in the context of clinic-based behavioral intervention programs.Correlates of depression among Black girls exposed to violence
AbstractWaller, B., Quinn, C. R., Boyd, D., DiClemente, R., & Voisin, D. R. (n.d.).Publication year
2022Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
9Issue
1Page(s)
146-155AbstractDepression rates for youth remanded to juvenile detention is double that of the general population and Black girls are especially vulnerable. A dearth of literature analyzes the factors that are correlated with depression among system-involved Black girls, ages 12–17 years old. We utilized personal agency to examine the relationship between risk factors (i.e., abuse history, and fear of condom negotiation) and protective factors (i.e., condom self-efficacy, and perceived social support) that might correlate with depression among Black girls exposed to violence. Findings indicate that fear of condom negotiation, abuse history and low condom self-efficacy are correlated with depressive symptomology while self-esteem and perceived social support are protective factors that may serve as a buffer against girls’ feelings of helplessness and hopelessness. The findings of this study suggest several implications for prevention and intervention efforts to reduce the depression-related risks among justice-involved Black females, including strategies that promote healing within their social support networks.Correlates of gang involvement and health-related factors among African American females with a detention history
AbstractVoisin, D. R., King, K. M., DiClemente, R., & Carry, M. (n.d.).Publication year
2014Journal title
Children and Youth Services ReviewVolume
44Page(s)
120-125AbstractBackground: Prior studies have assessed relationships between gang membership and health-related factors. However, the existing literature has largely failed to consider how individual and broader social contextual factors might be related to such gang involvement among African American females. Thus, the aim of the present study was to identify empirically driven correlates of gang involvement and then better understand the relationship between gang membership and health-related behaviors for African American females, after controlling for covariates of gang involvement. Methods: Data were collected from a convenience sample of detained African American adolescents females, between the ages of 13-17, currently incarcerated in a short-term detention facility in Atlanta, Georgia (n= 188). After obtaining written informed assent and parental permission, participants answered survey questions using A-CASI procedures that assessed socio-contextual factors and health-related behaviors. Results: Multiple logistic regression models controlling for age and SES documented that low self-esteem, emotional dysregulation, trauma history, deviant peers, low parental monitoring, infrequent parental communication, housing instability and poor neighborhood quality were correlates of gang involvement. In addition, multiple linear and logistic regression models, controlling for these constructs, revealed that gang involvement was independently associated with lower STD prevention knowledge, a higher likelihood of having a gang-involved boyfriend, a greater risk of having current casual sexual partnerships, higher rates of substance abuse, higher incidences of condom misuse and a lower likelihood of ever having been tested for HIV. Conclusions: These results provide information that can help service providers target certain profiles of African American females who may be at risk for joining gangs and address the health risk behaviors that may be associated with such memberships.Correlates of having unprotected vaginal sex among detained adolescent females : An exploratory study of sexual factors
AbstractCrosby, R., Salazar, L. F., DiClemente, R., & Yarber, W. L. (n.d.).Publication year
2004Journal title
Sexual HealthVolume
1Issue
3Page(s)
151-155AbstractBackground: Erotophilia, motivations for engaging in sex, and pleasure-related barriers to using condoms may all be important determinants of whether high-risk adolescent females have sex unprotected by a condom. This exploratory study identified associations between these factors and engaging in unprotected vaginal sex (UVS) among a sample of adolescent females recruited from short-term detention facilities in the USA. Methods: A cross-sectional survey of 211 adolescent females (14-18 years of age) was conducted. Only those indicating they had sex within the past 2 months were included in the analysis. Adolescents were recruited within eight detention facilities. Measures were assessed using audio-computer assisted self-interviewing (A-CASI). Results: In race-adjusted analyses, adolescents indicating greater pleasure-associated barriers to using condoms were more than 4.3 times more likely than those indicating fewer barriers to report having UVS in the past 2 months (AOR = 4.36; 95% CI = 2.15-8.86). Similarly, those scoring higher in erotophilia (compared with those scoring lower) were more than twice as likely to report UVS (AOR = 2.08; 95% CI = 1.02-4.24). Finally, adolescents who had ever been pregnant were ∼2.5 times more likely to report having recent UVS (AOR = 2.48; 95% CI = 1.1-5.34). With the exception of having five or more sex partners in the past 2 months (P = 0.08), none of the remaining correlates approached multivariate significance. Conclusions: Constructs such as erotophilia and pleasure-related barriers to condom use may be important correlates of UVS among this population of high-risk adolescents.Correlates of hepatitis B vaccination in a high-risk population : An internet sample
AbstractRhodes, S. D., DiClemente, R., Yee, L. J., & Hergenrather, K. C. (n.d.).Publication year
2001Journal title
American Journal of MedicineVolume
110Issue
8Page(s)
628-632AbstractPURPOSE: We sought to identify factors associated with hepatitis B virus vaccination, including knowledge and attitudes about hepatitis vaccination, and sexual and nonsexual risk behaviors among at-risk homosexual and bisexual men. SUBJECTS AND METHODS: Internet electronic communications were used to collect data from homosexual and bisexual men from the United States, using a 31-item online questionnaire accessible for 1 month. RESULTS: The mean (± SD) age of the 336 respondents was 38 ± 11 years. Nearly 42% (142) reported at least one dose of vaccine; the remainder were completely unvaccinated. About 21% (n = 71) reported having no information about hepatitis. Approximately 72% (242) of respondents reported never using condoms during oral intercourse, and 26% (n = 87) reported using condoms during less than half of their episodes of anal intercourse. In multivariate analysis, variables associated with vaccination were younger age (odds ratio [OR] 0.7 per 10-year increase in age; 95% confidence interval [CI] 0.59 to 0.84, P = 0.002), high level of knowledge about the vaccine (OR 1.4; 95% CI: 1.03 to 1.83, P = 0.007), communication with a health-care provider about hepatitis (OR 1.98; 95% CI 1.31 to 2.98, P = 0.006), and professional training that included hepatitis education (OR 2.77; 95% CI 1.7 to 4.5, P = 0.001). CONCLUSIONS: Our findings underscore the need for health care providers to emphasize vaccine efficacy and safety, and to encourage high-risk patients to receive vaccination, particularly among men at high risk based on sexual and drug use behaviors.Correlates of heterosexual anal intercourse among at-risk adolescents and young adults
AbstractLescano, C. M., Houck, C. D., Brown, L. K., Doherty, G., DiClemente, R., Fernandez, M. I., Pugatch, D., Schlenger, W. E., & Silver, B. J. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1131-1136AbstractObjectives. We sought to learn what factors are associated with anal intercourse among adolescents and young adults. We examined demographic, behavioral, relationship context, attitudinal, substance use, and mental health correlates of recent heterosexual anal intercourse among adolescents and young adults who reported engaging in recent unprotected sex. Methods. Among 1348 at-risk adolescents and young adults aged 15 to 21 years in 3 US cities, we assessed sexual risk behavior with each sexual partner in the past 90 days. Data were collected from 2000 to 2001. Results. Recent heterosexual anal intercourse was reported by 16% of respondents. Females who engaged in anal intercourse were more likely to be living with a sexual partner, to have had 2 or more partners, and to have experienced coerced intercourse. For males, only a sexual orientation other than heterosexual was a significant predictor of engaging in heterosexual anal intercourse. Conclusions. Our findings document the prevalence of heterosexual anal intercourse among adolescents and young adults who had recent unprotected sex. Among females, the variables associated with anal intercourse relate to the context and power balance of sexual relationships. Different influences for males and females suggest different foci for interventions.Correlates of HIV risk and preventive behaviors in Armenian female sex workers
AbstractMarkosyan, K. M., Babikian, T., DiClemente, R., Hirsch, J. S., Grigoryan, S., & Del Rio, C. (n.d.).Publication year
2007Journal title
AIDS and BehaviorVolume
11Issue
2Page(s)
325-334AbstractThis study describes HIV risk and preventive behaviors and their correlates among Armenian female commercial sex workers (CSWs) as a prerequisite to developing gender and culturally appropriate interventions. Ninety-eight CSWs from three Armenian cities were interviewed using a structured questionnaire. Quantitative findings were further elaborated by focus group discussions (N = 25) and key informant interviews (N = 8). Inconsistent condom use with all types of sexual partners was reported, as were condom tear/slippage, alcohol and drug use, and sex with drug injecting clients. Prominent misconceptions regarding HIV transmission, prevention and disease manifestations were noted. Correlates of condom use intentions included history of substance use, attitudes regarding condom use, risk perception, and comfort negotiating condom use. Intentions to use condoms were strongly associated with recent frequency of condom use. Understanding the relationship between condom use and its determinants is critical in the design and implementation of effective prevention programs tailored for Armenian CSWs.Correlates of incident trichomonas vaginalis infections among African American female adolescents
AbstractSwartzendruber, A., Sales, J. M., Brown, J. L., DiClemente, R., & Rose, E. S. (n.d.).Publication year
2014Journal title
Sexually Transmitted DiseasesVolume
41Issue
4Page(s)
240-245AbstractBACKGROUND: Trichomonas vaginalis is the most common curable sexually transmitted infection associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident T. vaginalis infections among African American adolescent girls. METHODS: Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American girls (14-20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching, and other sexually transmitted infections. RESULTS: Of 605 (86.3%) participants who completed at least 1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n = 121). Factors associated with incident infection in adjusted analysis included the following: cigarette smoking (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.04-2.64), using alcohol on an increasing number of days in the past 3 months (AOR, 1.02; 95% CI, 1.00-1.04), acquisition of C. trachomatis (AOR, 2.27; 95% CI, 1.40-3.69) or N. gonorrhoeae (AOR, 5.71; 95% CI, 2.97-11.02), and T. vaginalis infection at the previous assessment (AOR, 3.16; 95% CI, 1.96-5.07). CONCLUSIONS: Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of rescreening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae, and associations between substance use and T. vaginalis acquisition warrant further investigation.Correlates of inconsistent refusal of unprotected sex among Armenian female sex workers
AbstractMarkosyan, K., Lang, D. L., & DiClemente, R. (n.d.).Publication year
2014Journal title
AIDS Research and TreatmentVolume
2014AbstractThis cross-sectional study assessed the prevalence and correlates of inconsistent refusal of unprotected sex among female sex workers (FSWs) in Armenia. One hundred and eighteen street-based FSWs between the ages of 20 and 52 completed a questionnaire assessing FSWs' demographic, psychosocial, and behavioral characteristics. A total of 52.5% (n = 62) of FSWs reported inconsistent refusal of unprotected sex with clients in the past 3 months. Logistic regression analysis controlling for participants' age and education revealed that perceiving more barriers toward condom use (AOR = 1.1; P < 0.01), reporting more types of abuse (AOR = 2.1; P < 0.01), and setting lower fees for service (AOR = 0.9; P = 0.02) significantly predicted inconsistent refusal of unprotected sex. HIV-risk-reduction behavioral interventions tailored to FSWs working in Yerevan Armenia should address the factors identified in this study toward the goal of enhancing refusal of unprotected sex and ultimately preventing acquisition of sexually transmitted infections (STIs) including HIV.Correlates of Recent Unprotected Anal Sex among Men Having Sex with Men Attending a Large Sex Resort in the South
AbstractCrosby, R., DiClemente, R., & Mettey, A. (n.d.).Publication year
2003Journal title
Sexually Transmitted DiseasesVolume
30Issue
12Page(s)
909-913AbstractBackground: Published studies have not investigated sexually transmitted disease-associated risk behaviors among men who have sex with men (MSM) attending U.S. sex resorts. Goal: We conducted an exploratory study to identify demographic and behavioral correlates of recently engaging in unprotected anal sex (UAS) among MSM attending a sex resort in the southern United States. Study Design: A cross-sectional survey of 150 men. Results: In multivariate analyses, men were more likely to practice risky sex if they also recently engaged in the practices of having group sex (adjusted odds ratio [AOR], 3.0), rimming (AOR, 2.0), or if they used public restrooms to meet potential sex partners (AOR, 2.6). UAS was also more likely among men vaccinated against hepatitis B (AOR, 1.9). Men who reported having primary partners and men who reported being HIV-positive were no less likely than other men in the sample to report recent UAS. Conclusion: Sex resorts can be an important venue for sexually transmitted disease and HIV prevention among MSM. Tailored prevention messages could be warranted for men who report group sex, rimming, meeting partners in public restrooms, or being vaccinated against hepatitis B.Correlates of sexually transmitted infection prevention knowledge among African American girls
AbstractVoisin, D. R., Tan, K., Salazar, L. F., Crosby, R., & DiClemente, R. (n.d.).Publication year
2012Journal title
Journal of Adolescent HealthVolume
51Issue
2Page(s)
197-199AbstractPurpose: To identify significant factors that distinguish African American girls who have high sexually transmitted infection (STI) prevention knowledge from those lacking such knowledge. Methods: We recruited a sample of 715 African American girls from three public health clinics in downtown Atlanta. Using audio computer-assisted self-interviewing (A-CASI) technology, we assessed for age, self-mastery, employment status, attendance at sex education classes, socioeconomic status, and STI prevention knowledge. Results: Slightly more than one-third of the girls did not know that females are more susceptible to STI infections than males; and that having an STI increases the risk of contracting HIV. Almost half of the girls did not know if a man has an STI he will not have noticeable symptoms; and that most people who have AIDS look healthy. Logistic regression findings indicated that being older, having greater self-mastery, and being employed significantly predicted high STI knowledge. Conclusions: Health educators may especially target African American girls who are younger, unemployed, and experiencing low self-mastery for more tailored STI heath education.Correlates of unplanned and unwanted pregnancy among African-American female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Rose, E., & Lang, D. (n.d.).Publication year
2003Journal title
American journal of preventive medicineVolume
25Issue
3Page(s)
255-258AbstractBackground: Evidence suggests that unplanned/unwanted pregnancy may be an important antecedent of negative birth outcomes, such as low birth weight. This study identified correlates of perceiving a current pregnancy as both unplanned and unwanted among unmarried African-American adolescents aged 14-20 years. Methods: One hundred seventy pregnant adolescents were recruited during their first prenatal visit. Adolescents completed a face-to-face interview administered in private examination rooms. Adolescents also completed an in-depth self-administered survey. Measures were selected based on two potential influences: (1) relationships with boyfriends and (2) parent/family involvement. Age and parity were also assessed. Contingency table analyses were used to identify significant bivariate associations. Correlates achieving bivariate significance were entered into a forward stepwise logistic regression model. Results: Pregnancy was reported as unplanned and unwanted by 51.2% of the study population. In a multivariate analysis, adolescents indicating lower levels of parental involvement were about twice as likely (adjusted odds ratio [AOR]=2.05; 95% confidence interval [CI], 1.1-3.9, pCorrelates of unprotected vaginal sex among African American female adolescents : Importance of relationship dynamics
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Sionéan, C., Cobb, B. K., & Harrington, K. (n.d.).Publication year
2000Journal title
Archives of Pediatrics and Adolescent MedicineVolume
154Issue
9Page(s)
893-899AbstractObjective: To determine the associations between the frequency of unprotected vaginal sex (UVS) and female adolescents' perceptions, particularly their perceptions of relationship dynamics. Design: Cross-sectional study of 522 African American female adolescents enrolled in a sexually transmitted disease (STD) and human immunodeficiency virus prevention intervention trial. Setting and Participants: A volunteer sample of adolescents recruited from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and STDs; 28% tested positive for STDs as assessed by DNA amplification or culture. Main Outcome Measure: Frequency of UVS assessed by interview using a 6-month recall period. Results: Among adolescents having steady relationships, those spending more time with their boyfriends and having longer relationships reported a significantly greater frequency of UVS. Other significant correlates included perception of more girlfriends using condoms, no history of STDs, stronger normative beliefs favoring male decision making in relationships, greater pregnancy worry, and greater perceived invulnerability to STDs. For adolescents reporting casual relationships, personal barriers to condom use, no history of STDs, and reporting that their boyfriends typically decide when to have sex were associated with more frequent UVS. Conclusions: Adolescents' perceptions, particularly their perceptions of relationship dynamics, played an integral role in explaining female adolescents' frequency of UVS with both steady and casual partners. Female adolescents in steady relationships differ from those in casual relationships relative to their prevention needs. These findings have implications for clinic- or community-based STD and human immunodeficiency virus prevention programs.Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk african-american female teens
AbstractCrosby, R. A., DiClemente, R., Wingood, G. M., Sionean, C., Cobb, B. K., Harrington, K., Davies, S. L., Hook, E. W., & Oh, M. K. (n.d.).Publication year
2001Journal title
Journal of Adolescent HealthVolume
28Issue
5Page(s)
410-414AbstractPurpose: To identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy. Methods: A convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents' communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents' desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use. Results: Seventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users. Conclusions: The findings suggest the need for research to examine the efficacy of interventions building on adolescent females' desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents' use of dual methods for STD and pregnancy prevention.COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes : a qualitative study
AbstractWilliams, M. S., Cigaran, E., Martinez, S., Marino, J., Barbero, P., Myers, A. K., DiClemente, R., Goris, N., Gomez, V. C., Granville, D., Guzman, J., Harris, Y. T., Kline, M., Lesser, M. L., Makaryus, A. N., Murray, L. M., McFarlane, S. I., Patel, V. H., Polo, J., … Pekmezaris, R. (n.d.).Publication year
2023Journal title
Frontiers in Clinical Diabetes and HealthcareVolume
4AbstractBackground and aim: During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions. Methods and participants: Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached. Results: Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors. Conclusion: The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.Cultural, gender, and psychosocial influences on HIV-related behavior of African-American female adolescents : implications for the development of tailored prevention programs.
AbstractDiClemente, R., Wingood, G. M., & DiClemente, R. J. (n.d.).Publication year
1992Journal title
Ethnicity & diseaseVolume
2Issue
4Page(s)
381-388AbstractThis paper presents epidemiologic data describing the risk of HIV/AIDS and sexually transmitted diseases for African-American female adolescents relative to their white peers. Diverse cultural, psychosocial, and gender influences affect behavior; these should be considered in the development and implementation of culturally sensitive HIV prevention interventions tailored toward African-American female adolescents. These influences include sex-role socialization issues, the African-American family; issues related to racial identity; communication styles common among African-American youth; normative influences in adolescent heterosexual relationships; and factors affecting feelings of self-efficacy, empowerment, and gender rules in the African-American female adolescent. Strategies for incorporating cultural, psychosocial, and gender influences into the development of HIV risk-reduction interventions are suggested. Culturally specific interventions tailored toward this population may be more effective at motivating the adoption and maintenance of HIV-preventive behaviors.