Biomedical subjects

Ralph J DiClemente

Publications and source records attributed to Ralph J DiClemente.

At least 19 recordsLinked to original sources

PubMed2007

Correlates of HIV risk and preventive behaviors in Armenian female sex workers.

This 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.

Adolescent↗

PubMed2006

Brief report: sexual sensation seeking and its relationship to risky sexual behaviour among African-American adolescent females.

The relationship between sexual sensation seeking and sexual risk taking has been investigated among adult populations. There are limited data, however, regarding this relationship for adolescents. Since African-American adolescent females continue to be disproportionately diagnosed with STDs, including HIV, we examined this association among a clinic-based sample of African-American adolescent females (N=715) enrolled in an STD/HIV prevention intervention. Participants (ages 15-21) endorsing higher levels of sexual sensation seeking reported higher levels of sexual risk-taking behaviours (e.g. frequency of vaginal intercourse, number of sexual partners, and poorer condom use). Results remained significant after controlling for known covariates associated with sexual risk-taking behaviours. Results are consistent with the adult literature and highlight the need for future investigations examining sexual sensation seeking among adolescents. These results, though preliminary, could be used to better inform prevention interventions and clinicians/health educators who provide direct services to adolescents.

Adolescent↗

PubMed2006

Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation.

The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

HIV Infections↗

PubMed2006

Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence.

OBJECTIVES: 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.

Adolescent↗

PubMed2006

Predictors of inconsistent contraceptive use among adolescent girls: findings from a prospective study.

PURPOSE: To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females. METHODS: Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test. RESULTS: Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors. CONCLUSIONS: Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.

Adolescent↗

PubMed2006

Family influences and biologically confirmed sexually transmitted infections among detained adolescents.

Data from a convenience sample of 476 detained adolescents were used to examine the relationship between family influences and biologically confirmed sexually transmitted diseases (STDs). Results indicated that frequent parental monitoring was negatively associated with STD infection and that this relationship was modified by age, gender, and race. Findings suggest that STD prevention efforts for detained adolescents (particularly high-risk minority females older than age 16) might focus on increasing monitoring by a parent or parental figure.

Adolescent↗

PubMed2006

Ecological factors associated with STD risk behaviors among detained female adolescents.

The 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.

Adolescent↗

PubMed2006

Preventing sexually transmitted infections among adolescents: 'the glass is half full'.

PURPOSE OF REVIEW: Given the disproportionate burden of sexually transmitted infections for adolescents, there is an urgent need to identify effective prevention programs. RECENT FINDINGS: This review documents the efficacy of recent sexually transmitted infection-prevention programs. Overall, the review identified few sexually transmitted infection-prevention trials published since 2000. Moreover, considerable variability in program efficacy was observed across studies. Some studies observed changes in sexually transmitted infection-associated risk behaviors, while only a few identified reductions in biologically confirmed sexually transmitted infections. In general, few programs demonstrated consistency of effects and a significant magnitude of effects across a broad range of outcomes. SUMMARY: New and innovative approaches are needed to amplify sexually transmitted infection intervention effects. Program development and evaluation needs to continue in a coordinated, scientifically rigorous fashion to optimize impact and, as important, to sustain effects over protracted periods. Furthermore, for interventions with demonstrated efficacy, a critical challenge is to translate them into sustainable programs that are widely disseminated. Ultimately, preventing sexually transmitted infections in adolescents does not only depend on the development of effective interventions alone, but on how effectively these interventions can be translated and integrated into self-sustaining components of clinic, school or community programs, particularly in those areas and among adolescent populations most adversely impacted by the epidemic of sexually transmitted infection.

Adolescent↗

PubMed2006

Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women.

The Centers for Disease Control and Prevention (CDC) currently promotes an HIV prevention intervention for young adult African American women, known as SISTA, through the Diffusion of Effective Behavioral Interventions (DEBI) program. Nationally, more than 700 agencies have completed a 1-week CDC-funded training to implement SISTA. Agencies that have been trained in SISTA are also eligible to receive training in a newly published HIV prevention intervention for African American adolescent females, known as SiHLE (Sistering, Informing, Healing, Living, and Empowering), as well as to receive training in a newly published prevention intervention for women living with HIV, known as WiLLOW (Women Involved in Life Learning From Other Women). All three of these HIV prevention interventions, target African American females, are designed to reduce HIV sexual risk behaviors and share similar theoretical, core, and methodological elements. The diffusion of innovation paradigm suggests that if potential adopters perceive one innovation as being closely related to another innovation, it may be useful to promote a cluster of innovations, rather than to treat each new innovation separately. This article examines how promotion of a suite of HIV interventions for African American females may facilitate adoption of the three evidence-based HIV interventions for this population.

Adult↗

PubMed2005

Adolescents' experience with sex on the web: results from online focus groups.

To discover adolescent Internet users' experiences with, exposure to, and perceptions of sexually oriented websites (SOW) and sexually explicit websites (SEW), four web-based focus groups (N=40) were conducted. Participants (ages 14-17) reported high levels of exposure to SEW and SOW, which was intentional for some and unsolicited for others. Female adolescents found SEW to be socially distasteful; some adolescent males avoided SEW while others were willing consumers. Participants believed exposure to SEW had no influence on them, and reported that their parents were unaware of what they view online. Future research should explore the effects of exposure to SEW and to SOW and mediating factors.

Adolescent↗

PubMed2005

Condom failure among adolescents: implications for STD prevention.

This study of 921 adolescents found condom failure (past 90 days) was experienced by at least one-third of the sample, regardless of gender. Frequency of condom failure was positively associated with STD diagnosis (AOR = 1.22, 95% CI = 1.01-1.48), with the odds of testing positive increasing 22% for each added event of failure.

Adolescent↗

PubMed2005

Enhancing recruitment and retention of minority young women in community-based clinical research.

Women are disproportionately affected by the sexually transmitted infections (STI) epidemic, with African-Americans and Latinos at significantly higher risk for STIs than Caucasians. Successful recruitment and retention strategies used with young minority women in community-based STI prevention or intervention research have not been previously reported. This communication presents eight key strategies learned in the recruitment and retention of 16- to 21-year-old urban women participating in a 12-month randomized clinical trial designed to promote STI screening to decrease the duration of untreated chlamydia and gonorrhea infection. Strategies learned include: (1) Educate clinic staff on the rigors of study design; (2) Facilitate a team effort between clinical and research staff; modify recruitment procedures, as needed; (3) Provide prospective participants the option of enrolling by return appointment; (4) Anticipate a diminishing recruitment pool over time; (5) Set positive recruitment tone at the beginning of each clinic session; (6) Consider participants' mothers as important points of contact; (7) Match communication styles to participant contacts; and (8) Consider a variety of retention techniques. Together, these strategies helped to reinforce participant's commitment to the project, facilitated their attendance at interviews, and encouraged them to adhere to the treatment protocol.

Adolescent↗

PubMed2005

A programmatic and methodologic review and synthesis of clinic-based risk-reduction interventions for sexually transmitted infections: research and practice implications.

The over-arching goal of this article is to systematically review and synthesize empirical findings for sexually transmitted disease risk-reduction programs that were developed and implemented specifically for adolescents seeking health care services at clinical venues. The objective is to examine the reported efficacy of these programs in reducing adolescents' sexually transmitted infection (STI)-associated behavior, in enhancing theoretically and empirically important psychosocial mediators associated with the adoption of STI-preventive behaviors, and, most important, in reducing adolescents' risk of acquiring an STI. In addition, our review assesses program and methodologic characteristics of the studies, determines compliance with standardized reporting guidelines, identifies a subset of program characteristics that are related to efficacy in terms of modifying adolescents' sexual risk behaviors, and examines the research and practice implications of these findings for implementing evidence-based STI risk-reduction programs in clinics.

Adolescent↗

PubMed2005

Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use.

OBJECTIVES: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. METHODS: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. RESULTS: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. CONCLUSION: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.

Adolescent↗

PubMed2005

Self-esteem and theoretical mediators of safer sex among African American female adolescents: implications for sexual risk reduction interventions.

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

Adolescent↗

PubMed2005

Reducing risk exposures to zero and not having multiple partners: findings that inform evidence-based practices designed to prevent STD acquisition.

Our objective was to assess prospectively the relative contribution of reducing penile-vaginal risk exposure to zero and limiting the number of sex partners to one, on the acquisition of biologically confirmed sexually transmitted disease (STD) among African American women adolescents. Data from a prospective cohort of 522 African American women adolescents enrolled in an HIV prevention trial were used. Baseline STD testing and single-dose directly observable treatment provided an infection-free cohort, who were followed and assessed at six-month intervals. Self-administered vaginal swab specimens were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis at baseline, six, 12, and 18 months. Frequency of having multiple sex partners and unprotected vaginal sex over each six-month assessment interval was measured. Adolescents who reported multiple sex partners, relative to only one partner, were more likely to test positive for an STD (adjusted odds ratio (AOR) = 2.9; P = 0.0001). Adolescents who reported unprotected vaginal sex relative to those reporting protected vaginal sex also had greater odds of testing positive for an STD (AOR = 1.5; P = 0.0001). Prospective findings suggest that having multiple sex partners and engaging in unprotected vaginal sex both remain significant risk factors for STD acquisition among African American adolescent women. STD prevention programmmes need to target both risk factors to achieve optimal risk-reduction effectiveness.

Adolescent↗

PubMed2005

Adverse health consequences that co-occur with depression: a longitudinal study of black adolescent females.

OBJECTIVE: The purpose of this study was to identify adverse health consequences that may co-occur with depression among black female adolescents. METHODS: Adolescents were recruited from high-risk neighborhoods in Birmingham, Alabama. The sample comprised 460 black female adolescents (aged 14-18 years) who completed assessments at baseline and at 6 and 12 months. Only adolescents who consistently scored above the threshold for depression at all 3 assessments (n = 76) or below the threshold at all 3 assessments (n = 174) were included (N = 250) in the data analysis. Within this sample, adolescents who were depressed were compared with those who were not depressed with respect to the following health consequences: low self-esteem, emotional abuse, physical abuse, verbal abuse, poor body image, and antisocial behavior. RESULTS: Using generalized estimating equations and controlling for covariates, depressed adolescents were 5.3 times more likely to report low self-esteem, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Furthermore, depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors. CONCLUSIONS: The findings suggest that a broad range of adverse health consequences may accompany depression among black female adolescents. Physicians need to be alert to the co-occurrence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among this population.

Adolescent↗

PubMed2005

Environmental barriers to HIV prevention among incarcerated adolescents: a qualitative assessment.

The purpose of this research was to identify environmental factors that influence incarcerated adolescents' risk for HIV/STDs. Based on data from six gender-stratified focus groups consisting of 28 incarcerated adolescents from three detention centers in Georgia, the following salient environments emerged: schools, families, peer groups, neighborhoods, malls, and detention centers. These environments represent places in which factors related to sexual decision-making are embedded for this high-risk population. Within these environments, five factors influence their risk for HIV/STDs: (1) hierarchical messages that promote abstinence and risk reduction, (2) availability and accessibility of condoms, (3) acceptability of condoms, (4) availability of comprehensive sex education, and (5) parental communication about sex and risk reduction. Increased understanding of the role of these factors may contribute to the development of integrated interventions designed to prevent HIV/STDs among incarcerated adolescents.

Adolescent↗