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
Digital Communications Technology Use and Feelings of Anxiety, Depression, and Loneliness Among Older Adults During the COVID-19 Pandemic
AbstractRobbins, R., DiClemente, R., Baig, N., Johnson, A., Chou, A., & Van den Bulck, J. (n.d.).Publication year
2023Journal title
Journal of Applied GerontologyAbstractSome have touted technology as a panacea for overcoming the isolation associated with COVID-19 mitigation policies; yet, these tools are not widely adopted by older adults. With data from the COVID-19 supplement to the National Health and Aging Trends Survey, we conduct adjusted Poisson regression modeling to examine digital communications use during COVID-19 and feelings of anxiety, depression, and loneliness during the COVID-19 pandemic among older adults (65+ years of age). Adjusted Poisson regression revealed that those who reported frequent use of video calls with friends and family (aPR = 1.22, 95% CI:1.06–1.41) and with healthcare providers (aPR = 1.22, 95% CI:1.03–1.45) were more likely to report feelings of anxiety than those not using these platforms; yet, reports of in-person visits with friends and family (aPR = 0.79, 95% CI: 0.66–0.93) and with healthcare providers (aPR = 0.88, 95% CI: 0.77–1.01) were associated with fewer feelings of depression and loneliness, respectively. Future research is needed to tailor digital technology to support older adults.Do As I Say : Using Communication Role-Plays to Assess Sexual Assertiveness Following an Intervention
AbstractMercer Kollar, L. M., Davis, T. L., Monahan, J. L., Samp, J. A., Coles, V. B., Bradley, E. L., Sales, J. M., Comer, S. K., Worley, T., Rose, E., & DiClemente, R. (n.d.).Publication year
2016Journal title
Health Education and BehaviorVolume
43Issue
6Page(s)
691-698AbstractSexual risk reduction interventions are often ineffective for women who drink alcohol. The present study examines whether an alcohol-related sexual risk reduction intervention successfully trains women to increase assertive communication behaviors and decrease aggressive communication behaviors. Women demonstrated their communication skills during interactive role-plays with male role-play partners. Young, unmarried, and nonpregnant African American women (N = 228, ages 18-24) reporting unprotected vaginal or anal sex and greater than three alcoholic drinks in the past 90 days were randomly assigned to a control, a sexual risk reduction, or a sexual and alcohol risk reduction (NLITEN) condition. Women in the NLITEN condition significantly increased assertive communication behavior compared to women in the control condition, yet use of aggressive communicative behaviors was unchanged. These data suggest assertive communication training is an efficacious component of a sexual and alcohol risk reduction intervention. Public health practitioners and health educators may benefit from group motivational enhancement therapy (GMET) training and adding a GMET module to existing sexual health risk reduction interventions. Future research should examine GMET’s efficacy in combination with other evidence-based interventions within other populations and examine talking over and interrupting one’s sexual partner as an assertive communication behavior within sexual health contexts.Do Jobs Work? Risk and Protective Behaviors Associated with Employment among Disadvantaged Female Teens in Urban Atlanta
AbstractRosenbaum, J., Zenilman, J., Rose, E., Wingood, G., & DiClemente, R. (n.d.).Publication year
2014Journal title
Journal of Women, Politics and PolicyVolume
35Issue
2Page(s)
155-173AbstractAdolescent employment research has focused on middle-class rather than disadvantaged adolescents. We identified risks and benefits of adolescent employment in a 12-month study of 715 low-socioeconomic-status female African American adolescents using nearest-neighbor Mahalanobis matching on baseline factors including substance use and socioeconomic status. Employed adolescents were more likely to graduate high school and less likely to depend on boyfriends for spending money, but they were more likely to use marijuana, alcohol, and have sex while high or drunk. Employment may help female adolescents avoid potentially coercive romantic relationships, but increase access to drugs or alcohol.Do parental protective factors matter? Predicting HIV/STI risk among a sample of justice-involved African-American girls
AbstractCrooks, N., Sun, S., Wise, A., DiClemente, R., & Sales, J. M. (n.d.).Publication year
2023Journal title
Children and Youth Services ReviewVolume
149AbstractAfrican American adolescent girls are overrepresented in the juvenile justice system and are disproportionately affected by human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Parental protection may play a critical role in the sexual behaviors of African American adolescent girls and help to inform family-based interventions. The current study investigated the impact of parental protective factors (monitoring, sex communication, and authoritarian parenting) on sexual risk-related outcomes in a sample (n = 172) of justice-involved, urban African American adolescent girls aged 13–17 years. Multiple linear regression analyses were conducted to estimate the association between parental protective factors and percentage of consistent condom use, HIV/STI knowledge, fear of condom negation, and condom self-efficacy 3 months after their release from detention centers. Baseline parental protective factors were significantly associated with sexual risk-related outcomes of African American adolescent girls. Parental monitoring was positively associated with consistency of condom use and increased HIV/STI knowledge. Parental communication about sex reduced fear of condom negotiation and increased condom self-efficacy. Authoritarian parenting predicted increased HIV/STI knowledge and fear of condom negotiation following release. Programs, policies, and interventions addressing the sexual health of African American adolescent girls should engage families to enhance protective factors to reduce their sexual risk.Do protective behaviors follow the experience of testing positive for herpes simplex type 2?
AbstractCrosby, R. A., Head, S., DiClemente, R., Meyerson, B., & Troutman, A. (n.d.).Publication year
2008Journal title
Sexually Transmitted DiseasesVolume
35Issue
9Page(s)
787-790AbstractOBJECTIVE: To test the hypothesis that individuals attending a sexually transmitted disease (STD) clinic would adopt sexual protective behaviors after receiving a positive test for herpes simplex virus 2 (HSV-2). METHODS: Recruitment (N = 360) occurred in a publicly funded STD clinic located in a metropolitan area of the southern United States. Participants were tested for HSV-2 using a rapid test manufactured by Biokit (Lexington, MA) and they completed a self-administered questionnaire before and 3 months after being tested for HSV-2. Follow-up questionnaires were completed by 256 participants (71.1%). RESULTS: Of those completing follow-up, 43.4% (n = 111) tested positive for HSV-2 at enrollment. Significant differences between participants testing positive and those testing negative (at baseline) for HSV-2 over the follow-up period were not observed for frequency of sex, frequency of condom use, avoiding sex, and number of sex partners. Controlling for statistically identified covariates did not alter the null findings for these between group analyses. When analyzing change (baseline to follow-up) among only those testing positive, significant differences were not found with the exception of reporting greater frequency of condom use with steady (P = 0.037) and nonsteady partners at follow-up (P = 0.017). However, repeated measures analyses yielded only 1 significant group × time interaction; this indicated a greater increase in condom use frequency with steady partners among persons testing negative compared with those testing positive. CONCLUSIONS: Among STD clinic attendees, diagnosis of HSV-2 was unrelated to the adoption of sexual behaviors protective against further acquisition and transmission of STDs. In the absence of education beyond posttest counseling, becoming aware of HSV-2 positive serostatus may not be sufficient to motivate the adoption of safer sex behaviors among this population.Does Initiating Vaginal Sexual Intercourse During a Safer Sex Media Campaign Influence Life Satisfaction Among African American Adolescents?
AbstractZullig, K. J., Valois, R. F., Hobbs, G. R., Romer, D., Brown, L. K., DiClemente, R., & Vanable, P. A. (n.d.).Publication year
2020Journal title
Journal of Adolescent HealthVolume
67Issue
1Page(s)
40-45AbstractPurpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787). Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender. Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased −.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males. Conclusions: Although Project iMPPACS was not designed with the intent on improving participants’ life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time.Drug use and HIV risk-related sex behaviors : A street outreach study of black adults
AbstractWang, M. Q., Collins, C. B., Kohler, C. L., DiClemente, R., & Wingood, G. (n.d.).Publication year
2000Journal title
Southern Medical JournalVolume
93Issue
2Page(s)
186-190AbstractBackground. Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex. Methods. Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey. Results. High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users. Conclusions. Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.Drug users' willingness to encourage social, sexual, and drug network members to receive an HIV vaccine : A social network analysis
AbstractDiClemente, R., Young, A. M., Diclemente, R. J., Halgin, D. S., Sterk, C. E., & Havens, J. R. (n.d.).Publication year
2014Journal title
AIDS and BehaviorVolume
18Issue
9Page(s)
1753-1763AbstractThis study examined feasibility of peer-based promotion of HIV vaccination and dyadic correlates to vaccine encouragement in risk- and non-risk networks of drug users (n = 433) in the US. Data were collected on HIV vaccine attitudes, risk compensation intentions, likelihood of encouraging vaccination, and recent (past 6 months) risk (i.e. involving sex and/or injecting drugs) and non-risk (i.e. involving co-usage of noninjected drugs and/or social support) relationships. Willingness to encourage HIV vaccination was reported in 521 and 555 risk- and non-risk relationships, respectively. However, 37 % expressed hesitancy, typically due to fear of side effects or social concerns. Encouragement was often motivated by perceived HIV risk, though 9 % were motivated by risk compensation intentions. In non-risk partnerships, encouragement was associated with drug co-usage, and in risk relationships, with perceived vaccine acceptability and encouragement by the partner. Network-based HIV vaccine promotion may be a successful strategy, but risk compensation intentions should be explored.Dual protection use to prevent STIs and unintended pregnancy
AbstractSales, J. M., Whiteman, M. K., Kottke, M. J., Madden, T., & DiClemente, R. (n.d.).Publication year
2012Journal title
Infectious Diseases in Obstetrics and GynecologyVolume
2012Abstract~Dyadic Intervention for Sexually Transmitted Infection Prevention in Urban Adolescents and Young Adults (The SEXPERIENCE Study) : Protocol for a Randomized Controlled Trial
AbstractTrent, M., Yusuf, H. E., Rowell, J., Toppins, J., Woods, C., Huettner, S., Robinson, C., Fields, E. L., Marcell, A. V., DiClemente, R., & Matson, P. (n.d.).Publication year
2022Journal title
JMIR Research ProtocolsVolume
11Issue
5AbstractBackground: Adolescents and young adults (AYA) aged younger than 25 years have the highest rates of sexually transmitted infections (STIs) in the United States. Current STI prevention strategies for AYA rely primarily on individual approaches, leaving sexual partners with significant unmet sexual and reproductive health care and health education needs. Dyadic interventions may hold promise for harnessing the power of communal coping within relationship dynamics to enhance sexual decision making, communication, and behavior changes that reduce the future risk of STIs. Objective: This paper describes the protocol and research methods of a dyad-based behavioral intervention that augments individual evidence-based interventions with joint health education counseling for heterosexual AYA dyads within a primary care setting. The trial aims to improve partner communication and collaborative sexual decision making and promote the adoption of sexual behaviors such as consistent condom use. The primary objective of this study is to assess the feasibility, acceptability, and effectiveness of a dyadic intervention targeted at preventing STIs in heterosexual couples in an urban setting. Methods: A total of 100 AYA (50 dyads) aged 16 to 25 years, engaged in heterosexual intercourse, who reside in the city and are willing to recruit their main sexual partner for the study will be recruited and randomized into 2 groups, an intervention arm and a control arm. Participants will be recruited from an AYA medicine clinic and by using social media (Facebook and Instagram). The index participant and partner will complete a single individual session separately (Sister to Sister or Focus on the Future) with a gender-matched health educator. Dyads will then be randomized to receive an additional joint debriefing session together to discuss relationship dynamics, condom negotiation, etc. Participants will separately complete a telephone interview 6 weeks postintervention to determine the feasibility, acceptability, and impact of the intervention on mutual sexual negotiation, consistency of condom use, and communal coping skills, etc. Results: So far, 25.4% (44/173) of eligible participants have been enrolled and randomized. Participants are mostly female (20/22, 91%), with at least a high school diploma (19/22, 86%), and 9 average lifetime sexual partners. Acceptability is high, with 98% (43/44) of participants expressing satisfaction with their study experience; 100% of dyads recruited were still together at 6-week follow-up. Conclusions: Findings from this study will add to the current literature on the approaches to STI prevention, and its success will inform its application in risk reduction counseling for youth who are most at risk.Early drinking onset and its association with alcohol use and problem behavior in late adolescence
AbstractGruber, E., DiClemente, R., Anderson, M. M., & Lodico, M. (n.d.).Publication year
1996Journal title
Preventive MedicineVolume
25Issue
3Page(s)
293-300AbstractObjective. To examine the relationship between age of drinking onset and patterns of use, abuse of other substances, and the prevalence of other alcohol-related problems in a population of midwestern high school seniors. Design. We analyzed self-report survey data on public school students' history of alcohol and other drug use and related problems from the Minnesota Student Survey conducted in 1969. The sample consisted of 2,650 male and female seniors, representing a 10% random sample of all white seniors in the study. Results. The findings suggest that early onset of alcohol use (by age 12) is associated with subsequent abuse of alcohol and related problem behaviors in later adolescence, including alcohol-related violence, injuries, drinking and driving, and absenteeism from school or work, as well as increased risks for using other drugs. Conclusion. This paper identifies the preadolescent years from age 10 to 12 as a particularly vulnerable period for the development of early alcohol dependence and abuse. Delaying alcohol use onset to age 13 may significantly reduce the risk of severe alcohol abuse in later adolescence.Ecological factors associated with STD risk behaviors among detained female adolescents
AbstractVoisin, D. R., DiClemente, R., Salazar, L. F., Crosby, R. A., & Yarber, W. L. (n.d.).Publication year
2006Journal title
Social WorkVolume
51Issue
1Page(s)
71-79AbstractThe authors used Bronfenbrenner's conceptual framework of an ecological systems model to examine factors that are independently associated with sexually transmitted disease (STD) risk behaviors among 280 sexually active detained female adolescents. Using computer-assisted self-interviewing procedures, the authors assessed individual characteristics, peer relations, community factors, and media influences and their association to STD risk behaviors. Findings indicated that factors such as greater substance use, stronger risk-taking attitudes, lower perceived parental monitoring and familial support, gender roles supporting male dominance, risky peer norms, and lower student-teacher connectedness, were independently associated with increased STD risk behaviors. Findings suggest a multisystemic approach to STD prevention among this population.Ecologies of risk among African American girls in juvenile detention
AbstractLogan-Greene, P., Kim, B. K., Quinn, C. R., DiClemente, R., & Voisin, D. (n.d.).Publication year
2018Journal title
Children and Youth Services ReviewVolume
85Page(s)
245-252AbstractAfrican American girls are disproportionately represented in juvenile detention, yet less is known about their distinctive and heterogeneous needs, especially regarding their psychosocial contexts. Latent class analysis determined four subgroups based on the adolescent ecology (neighborhood, family, peers) among detained African American girls ages 13–17 (N = 188). The Shielded class (32%) displayed the lowest levels of risk and highest levels of protective factors. The Typical class (24%) was close to the sample average on all indicators, with elevated histories of family incarceration. The Family Distress class (16%) reported the lowest neighborhood risk but was marked by high family risk levels and abuse history. The Highest Risk class (28%) had elevated risk on most indicators but particularly high neighborhood and peer risk. These classes significantly varied by youth social context and mental health. Findings bolster the need to consider the diverse, multidimensional contextual experiences of detained and at-risk African American girls.Economically motivated relationships and transactional sex among unmarried African American and white women : Results from a U.S. national telephone survey
AbstractDunkle, K. L., Wingood, G. M., Camp, C. M., & DiClemente, R. (n.d.).Publication year
2010Journal title
Public Health ReportsVolume
125Issue
SUPPL. 4Page(s)
90-100AbstractObjective. We explored links among economically motivated relationships, transactional sex, and risk behavior for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) among unmarried African American and white women. Methods. We drew on data from 1,371 unmarried African American and white women aged 20 to 45 years that we collected via a random-digit-dial telephone survey in the U.S. Results. Of all respondents, 33.3% (95% confidence interval 28.8, 38.0) reported staying in a relationship longer than they wanted to because of economic considerations. African American women were more likely than white women to report starting a relationship due to economic considerations (21.6% vs. 10.5%) and having transactional sex with someone who was not a regular partner (13.1% vs. 2.9%). These behaviors were all associated with lack of education, experience of economic hardship, need to care for dependents, and increased levels of HIV/STI risk. All three behaviors were associated with having more sexual partners. Staying in a sexual relationship because of economic considerations was also associated with anal sex, reduced condom use, and concurrent sexual partnerships. Transactional sex with non-regular partners was associated with concurrent sexual partnerships, binge drinking, drug use, perceived concurrency by main partner, and having high-risk sexual partners. Conclusion. HIV/STI risk-reduction policies and programs in the U.S. need to explicitly address overall economic disempowerment among women, as well as racial disparities in poverty. These economic disparities likely contribute both to increasing rates of HIV among women in the U.S. and to the extraordinary racial disparities in HIV/STI risk among American women.Editorial : The outbreak and sequelae of the increase in opioid use in the United States, Canada, and beyond
AbstractFriedman, S. R., Perlman, D. C., & DiClemente, R. (n.d.).Publication year
2022Journal title
Frontiers in SociologyVolume
7Abstract~Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women
AbstractRaiford, J. L., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2009Journal title
American journal of public healthVolume
99Issue
6Page(s)
1067-1071AbstractObjectives. We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. Methods. We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. Results. Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; χ2=4.32; P≤.04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; χ2=8.06; P≤.01). Conclusions. Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women.Effects of Promoting Health Among Teens on Dietary, Physical Activity, and Substance Use Knowledge and Behaviors for African American Adolescents
AbstractKerr, J. C., Valois, R. F., Farber, N. B., Vanable, P. A., DiClemente, R., Salazar, L., Brown, L. K., Carey, M. P., Romer, D., Stanton, B., Jemmott, J. B., Jemmott, L. S., Spencer, A. M., & Annang, L. (n.d.).Publication year
2013Journal title
American Journal of Health EducationVolume
44Issue
4Page(s)
191-202AbstractAfrican Americans are disproportionately affected by cardiovascular disease and cancer. Health promotion interventions hold promise for reducing health disparities. Purpose Promoting Health Among Teens (PHAT) is a brief, culturally tailored health education intervention to decrease cardiovascular disease and cancer risk for African Americans. This study evaluated the effects of PHAT for African American adolescents ages 14 to 17 in 4 eastern cities in the United States. Methods A randomized controlled design (N = 1654) was used to determine differences in health knowledge, diet, physical activity, and substance use behaviors between PHAT participants and a sexual health promotion control group. Data were collected at baseline and at 3, 6, and 12 months postintervention. Growth curve modeling was used to detect differences in health knowledge, dietary behaviors, physical activity, and substance use between PHAT and control group participants. Results PHAT participants had significantly greater knowledge gains but modest behavior changes compared to control group participants. Discussion PHAT is a promising intervention to increase knowledge and address selected health behaviors in African American youth. Translation to Health Education Practice Future attempts to execute PHAT should continue its emphasis on knowledge building while increasing intervention dosage and modifying length of time for intervention sessions.Efficacy of a health educator-delivered HIV prevention intervention for Latina women : A randomized controlled trial
AbstractDiClemente, R., Wingood, G. M., Di Clemente, R. J., Villamizar, K., Er, D. L., De Varona, M., Taveras, J., Painter, T. M., Lang, D. L., Hardin, J. W., Ullah, E., Stallworth, J., Purcell, D. W., & Jean, R. (n.d.).Publication year
2011Journal title
American journal of public healthVolume
101Issue
12Page(s)
2245-2252AbstractObjectives: We developed and assessed AMIGAS (Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. Methods: We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. Results: Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR]=4.81; PEfficacy of a Motivational Behavioral Intervention to Promote Chlamydia and Gonorrhea Screening in Young Women : A Randomized Controlled Trial
AbstractChacko, M. R., Wiemann, C. M., Kozinetz, C. A., von Sternberg, K., Velasquez, M. M., Smith, P. B., & DiClemente, R. (n.d.).Publication year
2010Journal title
Journal of Adolescent HealthVolume
46Issue
2Page(s)
152-161AbstractBackground: Seeking screening and treatment for chlamydia (CT) and gonorrhea (GC) by young women is critical to reduction of asymptomatic cervicitis and its complications. Objectives: To evaluate the efficacy of a client-centered motivational behavioral intervention (MBI), to promote seeking of sexually tranmitted infection (STI) checkups by young women. Methods: Three hundred seventy-six of 770 eligible sexually active, nonpregnant, English-speaking women (mean age 18.5 years) were recruited from an urban reproductive health clinic and randomized to two groups: intervention plus standard care (MBI) or standard care alone (SC). MBI (two sessions plus booster) was based on the Transtheoretical Model of Change and employed motivational interviewing. Outcome measures monitored for 12 months included: client-initiated clinic visits for STI checkups in response to seven high-risk sexual behaviors by self-report (primary), consistent condom use, number of CT and GC episodes, and movement along the stages of change obtained at baseline and 6- and 12-month follow-up assessments (secondary). Analyses included chi-square, logistic regression, and generalized estimating equations. Results: At baseline, more than 70% endorsed the action stage of change for seeking STI checkups for three of seven high-risk sexual behaviors. No significant differences were noted between the two groups for the primary or secondary outcomes. Across groups, having multiple partners and being pregnant or thinking one might be pregnant were associated with STI checkups. Conclusions: This is the first known client-centered clinical trial to promote STI screening. Risk-taking and health-seeking behaviors are complex and interrelated with STI and pregnancy concerns. The intervention may have an effect if it is targeted to women in a less medically connected community-based sample.Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents : A randomized clinical trial
AbstractDiClemente, R., Wingood, G. M., Sales, J. M., Brown, J. L., Rose, E. S., Davis, T. L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2014Journal title
JAMA PediatricsVolume
168Issue
10Page(s)
938-946AbstractIMPORTANCE: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.OBJECTIVE: To evaluate the efficacy of a telephone counseling prevention maintenance intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs during a 36-month follow-up.DESIGN, SETTING, AND PARTICIPANTS: In a 2-arm randomized supplemental treatment trial at 3 clinics serving predominantly minority adolescents in Atlanta, Georgia, 701 African American adolescent girls aged 14 to 20 years received a primary treatment and subsequently received a different (supplemental) treatment (PMI) to enhance effects of the primary treatment.INTERVENTIONS: Participants in the experimental condition (n = 342) received an adapted evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief telephone contacts every 8 weeks over 36 months to reinforce and complement prevention messages. Comparison-condition participants (n = 359) received HORIZONS and a time- and dose-consistent PMI focused on general health.CONCLUSIONS AND RELEVANCE: Sustaining the long-term impact of an STI/HIV intervention is achievable with brief, tailored telephone counseling.RESULTS: During the 36-month follow-up, fewer participants in the experimental condition than in the comparison condition had incident chlamydial infections (94 vs 104 participants, respectively; risk ratio = 0.50; 95%CI, 0.28 to 0.88; P = .02) and gonococcal infections (48 vs 54 participants, respectively; risk ratio = 0.40; 95%CI, 0.15 to 1.02; P = .06). Participants completing more telephone contacts had a lower risk of chlamydial infection (risk ratio = 0.95; 95%CI, 0.90 to 1.00; P = .05). Participants in the experimental condition reported a higher proportion of condom-protected sexual acts in the 90 days (mean difference = 0.08; 95%CI, 0.06 to 0.11; P = .02) and 6 months (mean difference = 0.08; 95%CI, 0.06 to 0.10; P = .04) prior to assessments and fewer episodes of sexual acts while high on drugs and/or alcohol (mean difference = -0.61; 95%CI, -0.98 to -0.24; P < .001).MAIN OUTCOMES AND MEASURES: The primary outcomeswere percentage of participants with a laboratory-confirmed incident chlamydial infection and percentage of participants with a laboratory-confirmed gonococcal infection during the 36-month follow-up. Behavioral outcomes included the following: (1) proportion of condom-protected sexual acts in the 6 months and 90 days prior to assessments; (2) number of sexual episodes during the past 90 days in which participants engaged in sexual intercourse while high on drugs and/or alcohol; and (3) number of vaginal sex partners in the 6 months prior to assessments.Efficacy of a telephone-delivered sexually transmitted infection/human immunodeficiency virus prevention maintenance intervention for adolescents : A randomized clinical trial
AbstractDiClemente, R., Wingood, G. M., Sales, J. M., Brown, J. L., Rose, E. S., Davis, T. L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2014Journal title
Obstetrical and Gynecological SurveyVolume
69Issue
12Page(s)
737-739Abstract~Efficacy of an HIV intervention in reducing high-risk human papillomavirus, nonviral sexually transmitted infections, and concurrency among African American women : A randomized-controlled trial
AbstractWingood, G. M., DiClemente, R., Robinson-Simpson, L., Lang, D. L., Caliendo, A., & Hardin, J. W. (n.d.).Publication year
2013Journal title
Journal of Acquired Immune Deficiency SyndromesVolume
63Issue
SUPPL. 1Page(s)
S36-S43AbstractObjective: This trial evaluated the efficacy of an HIV-intervention condition, relative to a health-promotion condition, in reducing incidence of nonviral sexually transmitted infections (STIs; Chlamydia, gonorrhea, and trichomoniasis), oncogenic human papillomavirus (HPV) subtypes 16 and 18, sexual concurrency, and other HIV-associated behaviors over a 12-month period. Design: Randomized-controlled trial. Data analysts blinded to treatment allocation. Setting: Kaiser Permanente, GA. Subjects: A random sample of 848 African American women. Intervention: The two 4-hour HIV intervention sessions were based on Social Cognitive Theory and the Theory of Gender and Power. The intervention was designed to enhance participants' selfsufficiency and attitudes and skills associated with condom use. The HIV intervention also encouraged STI testing and treatment of male sex partners and reducing vaginal douching and individual and male partner concurrency. Main Outcome Measure: Incident nonviral STIs. Results: In generalized estimating equations' analyses, over the 12-month follow-up, participants in the HIV intervention, relative to the comparison, were less likely to have nonviral incident STIs (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.40 to 0.96; P = 0.033) and incident high-risk HPV infection (OR = 0.37; 95% CI: 0.18 to 0.77; P = 0.008) or concurrent male sex partners (OR = 0.55; 95% CI: 0.37 to 0.83; P = 0.005). In addition, intervention participants were less likely to report multiple male sex partners, more likely to use condoms during oral sex, more likely to inform their main partner of their STI test results, encourage their main partner to seek STI testing, report that their main partner was treated for STIs, and report not douching. Conclusions: This is the first trial to demonstrate that an HIV intervention can achieve reductions in nonviral STIs, high-risk HPV, and individual concurrency.Efficacy of an HIV prevention intervention for African American adolescent girls : A randomized controlled trial
AbstractDiClemente, R., Wingood, G. M., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., Oh, M. K., Crosby, R. A., Hertzberg, V. S., Gordon, A. B., Hardin, J. W., Parker, S., & Robillard, A. (n.d.).Publication year
2004Journal title
Journal of the American Medical AssociationVolume
292Issue
2Page(s)
171-179AbstractContext: African American adolescent girls are at high risk for human immunodeficiency virus (HIV) infection, but interventions specifically designed for this population have not reduced HIV risk behaviors. Objective: To evaluate the efficacy of an intervention to reduce sexual risk behaviors, sexually transmitted diseases (STDs), and pregnancy and enhance mediators of HIV-preventive behaviors. Design, Setting, and Participants: Randomized controlled trial of 522 sexually experienced African American girls aged 14 to 18 years screened from December 1996 through April 1999 at 4 community health agencies. Participants completed a self-administered questionnaire and an interview, demonstrated condom application skills, and provided specimens for STD testing. Outcome assessments were made at 6- and 12-month follow-up. Intervention: All participants received four 4-hour group sessions. The intervention emphasized ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison condition emphasized exercise and nutrition. Main Outcome Measures: The primary outcome measure was consistent condom use, defined as condom use during every episode of vaginal intercourse; other outcome measures were sexual behaviors, observed condom application skills, incident STD infection, self-reported pregnancy, and mediators of HIV-preventive behaviors. Results: Relative to the comparison condition, participants in the intervention reported using condoms more consistently in the 30 days preceding the 6-month assessment (unadjusted analysis, intervention, 75.3% vs comparison, 58.2%) and the 12-month assessment (unadjusted analysis, intervention, 73.3% vs comparison, 56.5%) and over the entire 12-month period (adjusted odds ratio, 2.01; 95% confidence interval [CI], 1.28-3.17; P=.003). Participants in the intervention reported using condoms more consistently in the 6 months preceding the 6-month assessment (unadjusted analysis, intervention, 61.3% vs comparison, 42.6%), at the 12-month assessment (unadjusted analysis, intervention, 58.1% vs comparison, 45.3%), and over the entire 12-month period (adjusted odds ratio, 2.30; 95% CI, 1.51-3.50; PEfficacy of an HIV prevention program among African American female adolescents reporting high depressive symptomatology.
AbstractSales, J. M., Lang, D. L., Hardin, J. W., DiClemente, R., & Wingood, G. M. (n.d.).Publication year
2010Journal title
Journal of women's health (2002)Volume
19Issue
2Page(s)
219-227AbstractWe examined the efficacy of an HIV prevention intervention among African American adolescent females reporting at or above threshold depressive symptomatology. In this analysis, a subgroup of participants (n = 245) reporting at or above threshold depressive symptoms involved in a randomized controlled trial were assessed at 6-month and 12-month follow-ups on condom use and psychosocial mediators associated with HIV prevention behaviors. The intervention emphasized HIV knowledge, condom attitudes, communication self-efficacy, and condom use skills. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, engaged in a greater proportion of condom protected intercourse acts, had fewer episodes of unprotected vaginal sex, were more likely to use a condom at last sex, and had higher HIV knowledge, favorable attitudes toward condoms, condom use self-efficacy, and condom use skills. Overall, the pattern of effects found strengthen our confidence in the efficacy of the HIV intervention assessed for a broad range of young women, including those with high levels of depressive symptoms. Although young women with high depressive symptoms benefited from this HIV intervention, future studies employing interventions that specifically address the affective needs of this population might be even more effective in terms of sexual risk reduction and amelioration of depressive symptoms.Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence
AbstractWingood, G. M., DiClemente, R., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., Oh, M. K., & Hardin, J. W. (n.d.).Publication year
2006Journal title
American journal of public healthVolume
96Issue
6Page(s)
1085-1090AbstractObjectives. We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. Methods. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Results. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Conclusions. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.