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
Culturally Congruent Latino-Adapted Telemonitoring of Underrepresented Adults With Type 2 Diabetes : The CULTURA-DM2 Trial
AbstractPekmezaris, R., Martinez, S., Gomez, V. C., Marino, J., Goris, N., Williams, M. S., Cigaran, E., Nouryan, C. N., Patel, V. H., Myers, A. K., Barbero, P., Granville, D., Murray, L. F., Guzman, J., Makaryus, A. N., McFarlane, S. I., Zeltser, R., Pena, M., Sison, C., … Harris, Y. T. (n.d.).Publication year
2025Journal title
Clinical DiabetesVolume
43Issue
1Page(s)
79-91AbstractThis study reports on the development and testing of a comprehensive diabetes telemonitoring program tailored to meet the needs of underserved Hispanic/ Latino patients with diabetes. Individuals participating in the culturally tailored program had significantly better 6-month outcomes than those receiving comprehensive outpatient management for A1C, blood pressure, and diabetes self-efficacy, with no differences between groups in quality of life, medication adherence, emotional functioning, patient activation, or unscheduled physician visits. These findings suggest that culturally congruent diabetes telemonitoring may be effective for this underserved population.Dating violence and the sexual health of black adolescent females.
AbstractDiClemente, R., Wingood, G. M., DiClemente, R. J., McCree, D. H., Harrington, K., & Davies, S. L. (n.d.).Publication year
2001Journal title
PediatricsVolume
107Issue
5Page(s)
E72AbstractOBJECTIVE: This study examines the association between having a history of dating violence and the sexual health of adolescent females. METHODS: Black adolescent females (n = 522) completed a survey that assessed dating violence, defined as ever having a physically abusive boyfriend, and an interview that assessed sexual behaviors. RESULTS: Dating violence was reported by 18.4% of adolescents (n = 96). Adolescents with a history of dating violence were, in the past 6 months, 2.8 times more likely to have a sexually transmitted disease, 2.8 times more likely to have nonmonogamous male partners, and half as likely to use condoms consistently. Furthermore, adolescents with a history of dating violence were significantly more likely to fear the perceived consequences of negotiating condom use (odds ratio [OR] = 2.8); fear talking with their partner about pregnancy prevention (OR = 2.6); have a higher perceived risk of acquiring a sexually transmitted disease (OR = 2.1); perceive less control over their sexuality (OR = 2.4); have peer norms nonsupportive of using condoms (OR = 3.1); and have norms nonsupportive of having a healthy relationship (OR = 2.1). CONCLUSIONS: Adolescents who have experienced dating violence are more likely to exhibit a spectrum of unhealthy sexual behaviors, attitudes, beliefs, and norms.Dating Violence Victimization and Unprotected Sex Acts Among Adolescents in Mental Health Treatment
AbstractRizzo, C. J., Hunter, H. L., Lang, D. L., Oliveira, C., Donenberg, G., DiClemente, R., & Brown, L. K. (n.d.).Publication year
2012Journal title
Journal of Child and Family StudiesVolume
21Issue
5Page(s)
825-832AbstractThe objective of this study was to explore the relationship between dating violence victimization and unprotected sex acts among youth in mental health treatment. Sexually-active adolescents (n = 261; ages 13-18) enrolled in mental health treatment completed an audio-assisted computerized self-interview (ACASI) to assess recent dating violence victimization, unprotected sex acts, depression symptoms, and recent alcohol use. Path analysis revealed that dating violence victimization was related to unprotected sex acts both directly and indirectly via its association with depression and condom use self-efficacy. These findings suggest that in order to reduce HIV-related risk behaviors among dating violence victims, treatment providers should consider depressive symptomatology and associated affect around sexual situations.Depressive symptoms as correlates of polydrug use for blacks in a high- risk community
AbstractWang, M. Q., Collins, C. B., DiClemente, R., Wingood, G., & Kohler, C. L. (n.d.).Publication year
1997Journal title
Southern Medical JournalVolume
90Issue
11Page(s)
1123-1128AbstractBackground. This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community. Methods. A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the past 30 days, as well as about their depressive symptoms during the past week. Results. Odds ratios and logistic regressions, adjusted for age and sex, were used to assess the relationship between depressive symptoms and drug and polydrug use (drug use involving cocaine). Results showed that depressive symptoms are significantly associated with polydrug use. However, depressive symptoms were not associated with alcohol use or with the combination of alcohol and marijuana use. Conclusions. Depressive symptoms are related to polydrug use involving cocaine, though the causal relationship is uncertain. Previous reports on depressive symptoms and alcohol or marijuana may be inconclusive.Design, measurement, and analytical considerations for testing hypotheses relative to condom effectiveness against non-viral STIs
AbstractDiClemente, R., Crosby, R., DiClemente, R. J., Holtgrave, D. R., & Wingood, G. M. (n.d.).Publication year
2002Journal title
Sexually transmitted infectionsVolume
78Issue
4Page(s)
228-231Abstract~Determinants of an HIV Preventive Vaccine among a Highly Vulnerable Population : African American Men Who Have Sex with Men
AbstractXu, M. A., Choi, J., Rosenberger, J. G., Zimmerman, R. S., & DiClemente, R. (n.d.).Publication year
2024Journal title
VaccinesVolume
12Issue
3AbstractAfrican American men who have sex with men (MSM) are disproportionately impacted by HIV and may benefit from the development of an HIV vaccine. African American MSM are adversely affected by discrimination as a function of both their race and sexual behaviors. This may further increase the challenges associated with persuading them to adopt an HIV vaccine. Developing a knowledge base characterizing African American MSM HIV vaccine perceptions, attitudes, and concerns may help strengthen how healthcare providers and other health stakeholders describe and discuss the advent of an HIV vaccine. This study assessed the knowledge, attitudes, beliefs, and intentions related to HIV vaccination among African American MSM. This study comprised 432 African American MSM, 18–64 years, residing in the United States. Vaccine intention was defined as how likely it is that an individual would adopt an HIV vaccine if a vaccine was available and it was 90% effective against HIV, easy to obtain, free, and had few side effects. Relative to African American MSM who intend to delay receiving an HIV vaccination, controlling for age, education, and income, early vaccine adopters who had received ≥ 2 COVID-19 vaccinations and who had high WHO HIV Vaccine Positive Attitude Scale scores were, respectively, 3.2 times and 2.4 times more likely to report the intention to vaccinate within one year. Early vaccine adopters were also 2.4 times more likely to feel that HIV prevention support discriminates against African American MSM. Those reporting three or more sexual partners and medical mistrust were, respectively, 60% and 59% more likely to report the intention to delay HIV vaccination. The lack of a knowledge base on HIV vaccine perceptions and acceptability is a missed opportunity to provide guidance on how stakeholders, such as health providers and policymakers, should address HIV vaccine hesitancy once this crucial vaccine is licensed. The key factors affecting vaccine adoption are valuable in developing and implementing campaigns to enhance the HIV vaccine coverage in this vulnerable population.Determinants of an HIV preventive vaccine among a highly vulnerable population: African American men who have sex with men
AbstractDiClemente, R., Xu, M., Choi, J., Rosenberger, J., & Zimmerman, R. (n.d.).Publication year
2024Volume
Vaccines, 12Page(s)
1-14Abstract~Determinants of condom use among junior high school students in a minority, inner-city school district
AbstractDiClemente, R., DiClemente, R. J., Durbin, M., Siegel, D., Krasnovsky, F., Lazarus, N., & Comacho, T. (n.d.).Publication year
1992Journal title
PediatricsVolume
89Issue
2Page(s)
197-202AbstractCondoms reduce the risk of human immunodeficiency virus (HIV) transmission; however, their use among adolescents has been inconsistent. Little is known about factors which motivate consistent condom use, particularly among younger adolescents. In a study designed to identify such factors, 1899 inner-city junior high school students were surveyed. In June 1988, students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, and behaviors. Among sexually active students (N = 403), logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on frequency of condom use. Respondents who believe condoms are effective in preventing HIV transmission were 2.2 times more likely to report using condoms consistently during sexual intercourse; those with low perceived costs associated with condom use were 1.9 times more likely to be consistent users. Number of lifetime sexual partners was inversely related to frequency of condom use. Respondents with a history of three or more sex partners were half as likely to use condoms consistently. Factors not associated with consistent condom use include age, age at sexual debut, ethnicity, HIV knowledge, perceived efficacy to avoid HIV infection, and alcohol and drug use. School- and community-based HIV prevention programs will have to go beyond the didactic transfer of factual information and include more interactive teaching strategies to improve adolescents' attitudes toward condoms are self-efficacy to increase condom use and to counter negative peer influences and adolescents' perceptions of invulnerability. Physicians are an underutilized source of HIV prevention information. They have an important role in counseling adolescents about effective HIV-prevention methods and dispelling misperceptions which hinder consistent condom use.Determinants of multimethod contraceptive use in a sample of adolescent women diagnosed with psychological disorders
AbstractLang, D. L., Sales, J. M., Salazar, L. F., DiClemente, R., Crosby, R. A., Brown, L. K., & Donenberg, G. R. (n.d.).Publication year
2011Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2011AbstractObjective. Despite recommendations for concurrent use of contraceptives and condoms to prevent unintended pregnancy and STIs, multimethod contraceptive use among women is poor. This study examined individual-, interpersonal-, and environmental-level factors that predict multimethod use among sexually active adolescent women diagnosed with psychological disorders. Methods. This multisite study analyzed data from 288 sexually active adolescent women who provided sociodemographic, psychosocial, and behavioral data related to birth control and condom use. Results. 34.7% of the participants reported multimethod use in the past three months. Controlling for empirically and theoretically relevant covariates, a multivariable logistic regression identified self-efficacy, multiple partners, pregnancy history, parental communication, parental norms about sex, and neighborhood cohesion as significant predictors of multimethod use. Conclusions. While continued targeted messages about multi-method contraceptive use are imperative at the individual level, an uptake in messages targeting interpersonal- and environmental-level factors such as adolescents' parents and the broader community is urgently needed.Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV
AbstractBrown, J. L., Anastasakis, I., Revzina, N., Capasso, A., Boeva, E., Rassokhin, V., Crusey, A., Sales, J. M., Hitch, A., Renfro, T., & DiClemente, R. (n.d.).Publication year
2021Journal title
Journal of the International Association of Providers of AIDS CareVolume
20AbstractBackground: There is elevated prevalence of problem drinking among Russian women living with HIV and HCV co-infection. This paper describes the development and cultural adaptation of a multi-component alcohol reduction intervention incorporating a brief, computer-delivered module for Russian women living with HIV and HCV co-infection. Methods: The format and content of the intervention were adapted to be linguistic-, cultural-, and gender-appropriate using the ADAPT-ITT framework. A computer-delivered module and brief clinician-delivered individual and telephone sessions were developed. Results: We describe the theoretical foundations of the intervention, the cultural adaptation of the intervention, and overview the content of the intervention’s multiple components. Discussion: Interventions to reduce alcohol use that can be integrated within Russian HIV treatment centers are urgently needed. If efficacious, the culturally-adapted intervention offers the promise of a cost-effective, easily disseminated intervention approach for Russian women living with HIV/HCV co-infection engaging in problematic alcohol use.Development and evaluation of a complementary and alternative medicine use survey in African-Americans with acquired immune deficiency syndrome
AbstractOwen-Smith, A., Sterk, C., Mccarty, F., Hankerson-Dyson, D., & DiClemente, R. (n.d.).Publication year
2010Journal title
Journal of Alternative and Complementary MedicineVolume
16Issue
5Page(s)
569-577AbstractObjectives: The purpose of the current study was to develop and evaluate the psychometric properties of a culturally- and stage-of-disease-appropriate measure of complementary and alternative medicine (CAM) use among a population of African-American individuals with acquired immune deficiency syndrome (AIDS) using a mixed-method design. Design: Data were collected in two phases. In phase 1, qualitative data were used to refine an existing CAM measure for the specific study population in the present study. In phase 2, this refined instrument was implemented in a larger sample. The resulting numeric data were analyzed to evaluate the psychometric properties of the revised CAM instrument. Setting: Data were collected from patients who were receiving care from the infectious disease clinic of a large, public, urban hospital in the Southeastern United States. Subjects: Patients were eligible to participate if they (1) were receiving their care from the clinic, (2) had an AIDS diagnosis, (3) were identified as African-American, (4) were ≥21 years of age, (5) spoke English, and (6) were not cognitively impaired. Measures: Focus groups in phase 1 were conducted with a semistructured focus group guide. Participants also completed a basic sociodemographic survey. Phase 2 participants used programmed laptops to answer questions about their CAM use and several sociodemographic questions. Results: Information from the focus groups prompted some substantive revisions in the already-existing CAM survey. The revised instrument had satisfactory face validity and adequate test-retest reliability (r=0.79). Furthermore, the instrument factored in a manner that was interpretable and consistent with prior findings. Conclusions: In order for human immunodeficiency virus health care providers to provide the best care to their patients, they need to be informed about the types and frequency of CAM use among their patients. This can be accomplished by methodologically developing CAM instruments, rigorously implementing and assessing these instruments, and then disseminating the findings to researchers and practitioners.Development and preliminary evaluation of a behavioural HIV-prevention programme for teenage girls of Latino descent in the USA
AbstractDavidson, T. M., Lopez, C. M., Saulson, R., Borkman, A. L., Soltis, K., Ruggiero, K. J., de Arellano, M., Wingood, G. M., DiClemente, R., & Danielson, C. K. (n.d.).Publication year
2014Journal title
Culture, Health and SexualityVolume
16Issue
5Page(s)
533-546AbstractNational data suggests that teenage girls of Latino descent in the USA are disproportionately affected by HIV, with the US Centers for Disease Control and Prevention reporting the rate of new infections being approximately four times higher compared to White women of comparable age. This paper highlights the need for an effective single-sex HIV-prevention programme for teenage girls of Latino descent and describes the development and preliminary evaluation of Chicas Healing, Informing, Living and Empowering (CHILE), a culturally-tailored, HIV-prevention programme exclusively for teenage girls of Latino descent that was adapted from Sisters Informing, Healing, Living and Empowering (SiHLE), an evidence-based HIV- prevention program that is culturally tailored for African American young women. Theatre testing, a pre-testing methodology to assess consumer response to a demonstration of a product, was utilised to evaluate the relevance and utility of the HIV programme as well as opportunities for the integration of cultural constructs. Future directions for the evaluation of CHILE are discussed.Development of a new Adolescent Patient-Provider Interaction Scale (APPIS) for youth at risk for STDs/HIV
AbstractWoods, E. R., Klein, J. D., Wingood, G. M., Rose, E. S., Wypij, D., Harris, S. K., & DiClemente, R. (n.d.).Publication year
2006Journal title
Journal of Adolescent HealthVolume
38Issue
6Page(s)
753.e1-753.e7AbstractPurpose: Although an adult model of patient-provider mutual exchange of information has been proposed, there is no guiding model for adolescents or measurement methodology. Our purpose was to develop a new scale of patient-provider interaction for adolescents accessing reproductive health care and at risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV), and assess the reliability and validity of the scale. Methods: The Adolescent Patient-Provider Interaction Scale (APPIS) was developed from the Roter and Hall theory of doctor-patient relationships, previously validated adolescent satisfaction and communication scales, and focus group and individual elicitation interviews. To assess construct validity, the new nine-item APPIS was compared with the satisfaction scale used by the Young Adult Health Care Survey (YAHCS), and Kahn's Provider Communication Scale. Pearson correlation coefficients were used to examine convergence across scales, and factor analysis of the APPIS was performed. Results: The study recruited 192 African American girls aged 17.9 ± 1.7 years (range 15-21 years) from three sites: a county STD clinic (n = 51), urban adolescent clinic (n = 99), and a family planning clinic (n = 42). Most participants (85%) rated their overall health care highly (≥ 7 on a 10-point scale); 49% felt that both the provider and patient were "in charge" of the visit, and 88% "strongly agreed" or "agreed" that there was an equal "exchange of information" during the visit. The APPIS showed good internal consistency (Cronbach alpha = .75), and moderate convergence with the six-item YAHCS scale (r = .57, p < .001) and seven-item Kahn scale (r = .48, p < .001). Three factors emerged from exploratory factor analyses, supporting our conceptualization of patient-provider interaction as being multi-dimensional. Conclusions: A new theory-based scale of adolescent patient-provider interaction compares favorably with previous scales of health care satisfaction and communication. The new APPIS may be useful for evaluating approaches to improve health care outcomes for adolescents at-risk for STDs and HIV.Development of an Integrated Approach to Virtual Mind-Mapping : Methodology and Applied Experiences to Enhance Qualitative Health Research
AbstractAli, S. H., Merdjanoff, A. A., Parekh, N., & DiClemente, R. (n.d.).Publication year
2022Journal title
Qualitative Health ResearchVolume
32Issue
3Page(s)
571-580AbstractThere is a growing need to better capture comprehensive, nuanced, and multi-faceted qualitative data while also better engaging with participants in data collection, especially in virtual environments. This study describes the development of a novel 3-step approach to virtual mind-mapping that involves (1) ranked free-listing, (2) respondent-driven mind-mapping, and (3) interviewing to enhance both data collection and analysis of complex health behaviors. The method was employed in 32 virtual interviews as part of a study on eating behaviors among second-generation South Asian Americans. Participants noted the mind-mapping experience to be (1) helpful for visual learners, (2) helpful in elucidating new ideas and to structure thoughts, as well as (3) novel and interesting. They also noted some suggestions that included improving interpretability of visual data and avoiding repetition of certain discussion points. Data collection revealed the adaptability of the method, and the power of mind-maps to guide targeted, comprehensive discussions with participants.Development of programmes for enhancing sexual health : Commentary
AbstractDiClemente, R. (n.d.).Publication year
2001Journal title
LancetVolume
358Issue
9296Page(s)
1828-1829Abstract~Development of the sexual sensation-seeking scale for African American adolescent women
AbstractDiClemente, R., Milhausen, R. R., Salazar, L. F., Spitalnick, J., Sales, J. M., Crosby, R. A., Younge, S. N., & Wingood, G. M. (n.d.).Publication year
2010Journal title
International Journal of Sexual HealthVolume
22Issue
4Page(s)
248-261AbstractWe used data derived from two independent studies to examine the psychometric properties of a new scale to measure adolescents' willingness to engage in sexual sensation-seeking behavior. In Study 1, the Sexual Sensation-Seeking Scale for Adolescents (SSSA) was administered to a sample of 715 African American adolescents ranging in age from 15 to 21 years. The SSSA demonstrated strong internal consistency, moderate stability, and satisfactory construct validity. In Study 2, the SSSA data from a subsample of African American adolescent women detained in youth detention centers were analyzed (N = 103). Strong internal consistency was demonstrated with this sample as well. The results indicate that the SSSA is a reliable and valid measure of sexual sensation seeking for African American adolescent women.Development, Theoretical Framework, and Evaluation of a Parent and Teacher–Delivered Intervention on Adolescent Vaccination
AbstractGargano, L. M., Herbert, N. L., Painter, J. E., Sales, J. M., Vogt, T. M., Morfaw, C., Jones, L. D., Murray, D., DiClemente, R., & Hughes, J. M. (n.d.).Publication year
2014Journal title
Health promotion practiceVolume
15Issue
4Page(s)
556-567AbstractThe Advisory Committee on Immunization Practices recommended immunization schedule for adolescents includes three vaccines (tetanus, diphtheria, and acellular pertussis [Tdap]; human papillomavirus [HPV] vaccine; and meningococcal conjugate vaccine [MCV4]) and an annual influenza vaccination. Given the increasing number of recommended vaccines for adolescents and health and economic costs associated with nonvaccination, it is imperative that effective strategies for increasing vaccination rates among adolescents are developed. This article describes the development, theoretical framework, and initial first-year evaluation of an intervention designed to promote vaccine acceptance among a middle and high school–based sample of adolescents and their parents in eastern Georgia. Adolescents, parents, and teachers were active participants in the development of the intervention. The intervention, which consisted of a brochure for parents and a teacher-delivered curriculum for adolescents, was guided by constructs from the health belief model and theory of reasoned action. Evaluation results indicated that our intervention development methods were successful in creating a brochure that met cultural relevance and the literacy needs of parents. We also demonstrated an increase in student knowledge of and positive attitudes toward vaccines. To our knowledge, this study is the first to extensively engage middle and high school students, parents, and teachers in the design and implementation of key theory-based educational components of a school-based, teacher-delivered adolescent vaccination intervention.Development, Theoretical Framework, and Lessons Learned From Implementation of a School-Based Influenza Vaccination Intervention
AbstractPainter, J. E., Sales, J. M., Pazol, K., Grimes, T., Wingood, G. M., & DiClemente, R. (n.d.).Publication year
2010Journal title
Health promotion practiceVolume
11Issue
3_supplPage(s)
42S-52SAbstractThe Advisory Committee on Immunization Practices (ACIP) recently recommended that all children 6 months to 18 years old be vaccinated annually against influenza. School-based influenza vaccination interventions may potentially increase influenza vaccination rates among hard-to-reach populations, particularly rural adolescents. This article describes the theoretical framework, intervention development, and lessons learned from 1st-year implementation of a multicomponent intervention aimed to promote influenza vaccine acceptance among multiethnic (predominantly African American) adolescents attending middle and high school in rural Georgia. Adolescents, parents, and school administrators were active participants in the development and implementation of the intervention. The educational intervention, which consisted of a brochure and a school skit/ presentation, was guided by constructs from the Health Belief Model and social norms. Process evaluation results indicated that our intervention development methods were successful in creating a low-cost, theory-based educational intervention that garnered community investment and met the cultural relevance and literacy needs of our target audience. To our knowledge, this study is the first to extensively engage middle- and high-school students and parents in the design and implementation of key educational components of a theory-based influenza vaccination intervention.Developmental Changes in Sexual Risk and Substance Use Among African American Females : an Integrated Data Analysis Approach Using Time-varying Effect Models
AbstractSwartzendruber, A., Brown, J. L., Sales, J. M., DiClemente, R., Windle, M., & Haardörfer, R. (n.d.).Publication year
2020Journal title
Prevention ScienceVolume
21Issue
2Page(s)
182-193AbstractThe aim of this study was to describe age-related changes in sexual risk and substance use using existing data from three HIV/sexually transmitted infection (STI) prevention trials conducted in Atlanta, Georgia, that enrolled young African American women. We used two novel analysis methods: integrative data analysis (IDA) and time-varying effect models (TVEM). Each trial collected self-reported behavioral data and vaginal swab specimens assayed for chlamydia, gonorrhea, and trichomonas. Baseline data from all participants and follow-up data from participants not randomized to an active intervention arm were integrated in a pooled dataset using an IDA approach. The pooled dataset included observations for 1974 individuals, aged 14–25 years for behavioral outcomes and 16–25 years for STI outcomes. We used TVEM to model age-related changes in sexual risk and substance use behaviors and STI acquisition, adjusting for trial as a fixed effect. Coital frequency and condomless sex increased through the early 20s while multiple partnerships remained fairly steady. Alcohol use and cigarette smoking increased through about age 24 years before declining. Marijuana use peaked at age 16–17 years and thereafter generally declined. STI acquisition was highest at age 16 years. This study demonstrates the feasibility and utility of innovative methodological techniques to address novel questions related to adolescent development using existing data from multiple trials. The results suggest that mid-adolescence and the early 20s may be periods of particular risk. The findings may be useful for timing culturally and developmentally relevant prevention interventions for young African American women.Dibattiti. Ripensare le priorità nei finanziamenti della ricerca sulla salute mentale
AbstractLewis-Fernández, R., Rotheram-Borus, M. J., Betts, V. T., Greenman, L., Essock, S. M., Escobar, J. I., Barch, D., Hogan, M. F., Areán, P. A., Druss, B. G., DiClemente, R., McGlashan, T. H., Jeste, D. V., Proctor, E. K., Ruiz, P., Rush, A. J., Canino, G. J., Bell, C. C., Henry, R., & Iversen, P. (n.d.).Publication year
2017Journal title
Psicoterapia e Scienze UmaneVolume
51Issue
1Page(s)
119-124AbstractMental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritizing one area of science over others risks reduced returns on the entire scientific portfolio. (This article is an editorial that appeared in issue no. 6/2016 of The British Journal of Psychiatry, and in this Italian translation it is followed by three discussions, respectively by Giovanni de Girolamo, Andrea Fagiolini, and Giacomo Rizzolatti).Differences between African-American adolescent females with and without human papillomavirus infection
AbstractSeth, P., Wingood, G. M., DiClemente, R., Crosby, R. A., Salazar, L. F., Rose, E. S., & Sales, J. M. (n.d.).Publication year
2011Journal title
Sexual HealthVolume
8Issue
1Page(s)
125-127AbstractBackground: An important policy question is whether high-risk populations can be identified and prioritised for human papillomavirus (HPV) immunisation. Methods: Data collection included an audio computer-assisted survey interview and testing of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, and HPV among 295 African-American adolescent females. Results: The results indicated that 43.1% tested positive for HPV. Logistic regression analyses indicated that HPV prevalence was not associated with other sexually transmissible infections (prevalence ratio (PR)=0.85, 95% confidence interval (CI)=0.51-1.41), unprotected vaginal sex (PR=1.04, 95% CI=0.56-1.92), having sex with an older male partner (PR=1.12, 95% CI=0.64-1.96), and having a casual partner (PR=0.89, 95% CI=0.54-1.48). Additionally, t-tests indicated that HPV prevalence was not associated with frequency of vaginal sex (t=0.17, P=0.87), protected sex (t=0.16, P=0.87), number of recent (t=0.40, P=0.69) or lifetime (t=1.45, P=0.15) sexual partners. However, those testing positive for HPV were younger (t=1.97, P=0.05) and reported current use of birth control pills (PR=2.38, 95% CI=1.00-5.63). Conclusions: It may not be possible to identify those with elevated risk of HPV acquisition. Thus, HPV vaccination, regardless of risk indicators, may be the most efficacious public health strategy.Differences between dual-method and non-dual-method protection use in a sample of young African American women residing in the Southeastern United States
AbstractSales, J. M., Latham, T. P., DiClemente, R., & Rose, E. (n.d.).Publication year
2010Journal title
Archives of Pediatrics and Adolescent MedicineVolume
164Issue
12Page(s)
1125-1131AbstractObjectives: To characterize dual-method protection users and report the prevalence of dual-method use among young adult African American women residing in the Southeastern United States. Design: Analysis of baseline data from a randomized controlled trial. Setting: A clinic-based sample of young women enrolled in a randomized trial of a human immunodeficiency virus (HIV)-prevention program in Atlanta, Georgia, from June 2005 to June 2007. Participants: African American women aged 14 to 20 years who reported unprotected sexual activity in the past 6 months. Of the eligible adolescents, 94% (N=701) were enrolled in the study and completed baseline assessments. Outcome Measures: Dual-method protection use as well as sociodemographic, individual-level, interpersonal-level, and community-level factors and interpersonal communication skills. Only data from the baseline assessment, before randomization, were used for the analysis. Results: A total of 102 participants (14.6%) were classified as dual-method protection users. After controlling for age and clinic, significant differences between dual-method users and non-dual-method users were found for impulsivity, self-esteem, social support, relationship style, partner communication self-efficacy, and fear of condom negotiation. Conclusions: Dual-method protection use is low. Identification of factors that differentiate dual-method users from non-dual-method users at the individual, interpersonal, and community levels in this young African American sample suggests that HIV, sexually transmitted disease, and unintended pregnancy risk-reduction programs should address factors at each level, not simply the individual level, and that this may involve structural and/or clinical counseling practice changes in clinics that serve young women, to optimally facilitate dual-method protection use among young African American women in the Southeastern United States.Differences in Sexual Risk Behaviors Between Lower and Higher Frequency Alcohol-Using African-American Adolescent Females
AbstractSales, J. M., Monahan, J. L., Brooks, C., DiClemente, R., Rose, E., & Samp, J. A. (n.d.).Publication year
2014Journal title
Current HIV ResearchVolume
12Issue
4Page(s)
276-281AbstractBackground: To examine differences between lower and higher frequency alcohol users in sexual behaviors and psychosocial correlates of risk for HIV among young African-American females. Methods: Data were collected from sexually active African-American females aged 15-20 years, seeking services at a STD clinic in Atlanta, GA, to assess sexual behavior, correlates of risk, and a non-disease biological marker of unprotected vaginal sex. Results: Number of drinking occasions was significantly related to three of four psychosocial correlates and with all selfreporting sexual behavior measures. Also, heavier drinking per occasion was associated with the presence of semen in vaginal fluid. Conclusion: Non-abuse levels of drinking were related to increased sexual risk-taking in this sample of young African- American females. Incorporating messages about the intersection of alcohol use and sexual decision making into HIV/STD prevention programs would strengthen STD prevention messaging in this vulnerable population.Differential sensitivity to prevention programming : A dopaminergic polymorphism-enhanced prevention effect on protective parenting and adolescent substance use
AbstractBrody, G. H., Chen, Y. f., Beach, S. R., Kogan, S. M., Yu, T., DiClemente, R., Wingood, G. M., Windle, M., & Philibert, R. A. (n.d.).Publication year
2014Journal title
Health PsychologyVolume
33Issue
2Page(s)
182-191AbstractObjective: The purpose of this study was to investigate a genetic moderation effect of dopamine receptor-4 gene (DRD4) alleles that have 7 or more repeats on the efficacy of a preventive intervention to deter rural African American adolescents' substance use. Methods: Adolescents (N = 502, M age = 16 years) were assigned randomly to the Strong African American Families-Teen (SAAF-T) program or to a control condition and were followed for 22 months. Adolescents provided data on substance use, and both adolescents and their primary caregivers provided data on intervention-targeted protective parenting practices. Results: Male adolescents who carried at least one allele of DRD4 with 7 or more repeats who were assigned to the control condition evinced more substance use across 22 months than did (a) carriers of at least one allele of DRD4 with 7 or more repeats who were assigned to SAAF-T or (b) adolescents assigned to either condition who carried two alleles of DRD4 with 6 or fewer repeats. These findings were mediated by DRD4 × SAAF-T interaction effects on increases in intervention-targeted protective parenting practices, a mediated moderation effect. Conclusions: The results imply that prevention effects on health-relevant outcomes for genetically susceptible individuals, such as carriers of at least one allele of DRD4 with 7 or more repeats, may be underestimated.Differentiating between precursor and control variables when analyzing reasoned action theories
AbstractHennessy, M., Bleakley, A., Fishbein, M., Brown, L., DiClemente, R., Romer, D., Valois, R., Vanable, P. A., Carey, M. P., & Salazar, L. (n.d.).Publication year
2010Journal title
AIDS and BehaviorVolume
14Issue
1Page(s)
225-236AbstractThis paper highlights the distinction between precursor and control variables in the context of reasoned action theory. Here the theory is combined with structural equation modeling to demonstrate how age and past sexual behavior should be situated in a reasoned action analysis. A two wave longitudinal survey sample of African-American adolescents is analyzed where the target behavior is having vaginal sex. Results differ when age and past behavior are used as control variables and when they are correctly used as precursors. Because control variables do not appear in any form of reasoned action theory, this approach to including background variables is not correct when analyzing data sets based on the theoretical axioms of the Theory of Reasoned Action, the Theory of Planned Behavior, or the Integrative Model.