Ralph J DiClemente

Emory University, Atlanta, Georgia, United States

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Publications (274)596.28 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up.
    The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 06/2014;
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    ABSTRACT: A vaccine could substantially impact the HIV epidemic, but inadequate uptake is a serious concern. Unfortunately, people who use drugs, particularly those residing in rural communities, have been underrepresented in previous research on HIV vaccine acceptability. This study examined HIV vaccine acceptability among high-risk drug users in a rural community in the United States.
    BMC Public Health 05/2014; 14(1):537. · 2.08 Impact Factor
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    ABSTRACT: Abstract Background: Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Methods: Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Results: Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Conclusions: Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.
    Journal of Women s Health 04/2014; · 1.42 Impact Factor
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    ABSTRACT: National 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.
    Culture Health & Sexuality 04/2014; · 1.55 Impact Factor
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    ABSTRACT: Trichomonas vaginalis is the most common curable sexually transmitted infection associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident T. vaginalis infections among African American adolescent girls. Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American girls (14-20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching, and other sexually transmitted infections. Of 605 (86.3%) participants who completed at least 1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n = 121). Factors associated with incident infection in adjusted analysis included the following: cigarette smoking (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.04-2.64), using alcohol on an increasing number of days in the past 3 months (AOR, 1.02; 95% CI, 1.00-1.04), acquisition of C. trachomatis (AOR, 2.27; 95% CI, 1.40-3.69) or N. gonorrhoeae (AOR, 5.71; 95% CI, 2.97-11.02), and T. vaginalis infection at the previous assessment (AOR, 3.16; 95% CI, 1.96-5.07). Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of rescreening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae, and associations between substance use and T. vaginalis acquisition warrant further investigation.
    Sexually transmitted diseases 04/2014; 41(4):240-5. · 2.58 Impact Factor
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    ABSTRACT: We examine potential use of pre-exposure prophylaxis (PrEP) among young adult women, based on nationally representative random-digit dial telephone household survey of 1,453 US African-American and white women. The hypotheses were generated based on Health Belief Model. Our analyses showed that, as compared to women of 30-45 years old, young women of 20-29 year old experienced stronger social influences on PrEP uptake. However, as compared to older women, young women did not report higher potential PrEP uptake or adherence, despite their greater risk of HIV. For PrEP to be an effective method of prevention for young adult women, interventions are needed to increase HIV risk awareness.
    Current HIV research 01/2014; · 1.98 Impact Factor
  • Puja Seth, Ralph J Diclemente, Amy Lovvorn
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    ABSTRACT: This paper provides a critical narrative review of the scientific literature on intimate partner violence (IPV) and risky sexual behavior as well as sexually transmitted infections (STIs) among adolescents, aged 14-24 years. Intimate partner violence has been associated with a number of high risk sexual behavior, including inconsistent condom use, multiple sexual partners, earlier sexual debut, consuming substances while engaging in sexual behavior, and sexually transmitted infections among adolescents. An electronic search of the literature was performed using PubMed/MEDLINE, PsycINFO, and Web of Science and articles from January 2000 - June 2013 were reviewed. Search terms included a combination of keywords for IPV, HIV/STI risk, and adolescents. The findings from the review indicated that IPV was associated with inconsistent condom use, STIs, early sexual debut, multiple sexual partners, and other HIV/STI-associated risk factors among adolescents. HIV/STI interventions for female adolescents often focus on increasing behavioral and cognitive skills, specifically condom negotiation. However, within the context of an abusive relationship, it becomes challenging for adolescents to enact these skills, where this behavior could potentially place them at greater risk. Components that address violence are necessary within HIV prevention programming. Additionally, integration of IPV screening within healthcare settings is important along with a combined approach that merges resources from healthcare, social, and community-level settings.
    Current HIV research 01/2014; · 1.98 Impact Factor
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    ABSTRACT: The 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.
    Health Promotion Practice 01/2014;
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    ABSTRACT: HIV-related stigma inhibits optimal HIV prevention and treatment among African-Americans. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Baseline data (N = 1,606) from an HIV prevention intervention were used to investigate regional differences in HIV-related stigma and knowledge among African-American adolescents in four midsized cities in the Northeastern and Southeastern US. Analyses indicated greater HIV-related stigma among adolescents from the Southeast relative to adolescents from the Northeast (F = 22.23; p < 0.0001). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b = -0.65; p < 0.0001). Addressing HIV/AIDS in high prevalence locales should include efforts to reduce HIV-related stigma.
    AIDS and Behavior 01/2014; · 3.49 Impact Factor
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    ABSTRACT: OBJECTIVE The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment. METHODS A randomized controlled trial (RCT) with 721 adolescents (ages 13-18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention. RESULTS Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05). CONCLUSIONS This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.
    Psychiatric services (Washington, D.C.) 01/2014; · 2.81 Impact Factor
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    ABSTRACT: Background Prior studies have assessed relationships between gang membership and health- related factors. However, the existing literature has largely failed to consider how individual and broader social contextual factors might be related to such gang involvement among African American females. Thus, the aim of the present study was to identify empirically driven correlates of gang involvement and then better understand the relationship between gang membership and health related behaviors for African American females, after controlling for covariates of gang involvement. Methods Data were collected from a convenience sample of detained African American adolescents females, between the ages of 13-17, currently incarcerated in a short-term detention facility in Atlanta, Georgia (N = 188). After obtaining written informed assent and parental permission, participants answered survey questions using A-CASI procedures that assessed socio-contextual factors and health related behaviors. Results Multiple logistic regression models controlling for age and SES documented that low self-esteem, emotional dysregulation, trauma history, deviant peers, low parental monitoring, infrequent parental communication, housing instability and poor neighborhood quality were correlates of gang involvement. In addition, multiple linear and logistic regression models, controlling for these constructs, revealed that gang involvement was independently associated with lower STD prevention knowledge, a higher likelihood of having a gang involved boyfriend, a greater risk of having current casual sexual partnerships, higher rates of substance abuse, higher incidences of condom misuse and a lower likelihood of ever having been tested for HIV. Conclusions These results provide information that can help service providers target certain profiles of African American females who may be at risk for joining gangs and address the health risk behaviors that may be associated with such memberships.
    Children and Youth Services Review 01/2014; · 1.27 Impact Factor
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    ABSTRACT: An HIV vaccine could substantially impact the epidemic. However, risk compensation (RC), or post-vaccination increase in risk behavior, could present a major challenge. The methodology used in previous studies of risk compensation has been almost exclusively individual-level in focus, and has not explored how increased risk behavior could affect the connectivity of risk networks. This study examined the impact of anticipated HIV vaccine-related RC on the structure of high-risk drug users' sexual and injection risk network.
    PLoS ONE 01/2014; 9(7):e101047. · 3.73 Impact Factor
  • Journal of Adolescent Health. 01/2014; 54(2):S5.
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    ABSTRACT: Purpose Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up. Methods Six hundred twenty-seven African-American female adolescents, ages 14–20 years, recruited from sexual health clinics in Atlanta, GA, participated in a randomized controlled HIV prevention trial and returned for at least one follow-up assessment. Following baseline assessment, six waves of data collection occurred prospectively over 36 months. Chronic SES-related risk was assessed as a sum of yes–no exposure to seven risk indicators. Laboratory-confirmed tests for Chlamydia trachomatis and Neisseria gonorrhoeae were performed at each follow-up. Results In multivariable regression analysis, SES-related risk significantly predicted STI acquisition over 36 months (adjusted odds ratio = 1.22) and STI reinfection (adjusted odds ratio = 1.16) above and beyond other known correlates of STI. Conclusions Findings demonstrate that SES-related risk was predictive of both STI acquisition and reinfection among young African-American females. They are consistent with propositions that some health disparities observed in adulthood may be linked to earlier chronically stress-inducing life experiences, particularly experiences associated with low SES conditions. Although various explanations exist for the observed connection between SES-related risk and subsequent STI acquisition and/or reinfection across 36 months of follow-up, these findings highlight the need for further research to elucidate the exact pathway(s) by which SES-related risk influences later STI acquisition to refine STI prevention interventions for this population.
    Journal of Adolescent Health. 01/2014;
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    ABSTRACT: Adolescents experience elevated depressive symptoms which health promotion interventions may reduce. This study investigated whether HIV prevention trial participation decreased depressive symptoms among African-American female adolescents. Adolescents (N = 701; M age = 17.6) first received a group-delivered HIV prevention intervention and then either 12 sexual health (intervention condition) or 12 general health (comparison condition) phone counseling contacts over 24 months. ACASI assessments were conducted at baseline, and at 6-, 12-, 18-, and 24-months post-baseline. Linear generalized estimating equations were used to detect percent relative change in depressive symptoms. Participants reported a 2.7 % decrease in depressive symptoms (p = 0.001) at each assessment. Intervention participants endorsed an additional 3.6 % decrease in depressive symptoms (p = 0.058). Trial participation was associated with reduced depressive symptomatology, particularly among those receiving personalized sexual health counseling. HIV prevention interventions may benefit from incorporating additional content to address adolescents' mental health needs.
    Journal of Behavioral Medicine 12/2013; · 3.10 Impact Factor
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    ABSTRACT: Background Sexuality-related constructs, such as sexual arousal, sexual sensation seeking (SSS) and sexual satisfaction, have been related to sexual behaviours that place one at risk of adverse consequences, such as sexually transmissible infections, HIV and unintended pregnancy. The biopsychosocial model posits an array of factors, ranging from social environmental factors to biological and psychological predispositions, that may be associated with these sexuality constructs in adolescents. Methods: Female African Americans aged 14-20 years were recruited from reproductive health clinics for an HIV intervention. Baseline survey and follow-up DNA data (n=304) were used to assess biological, psychological and social environmental associations with the sexuality constructs of arousal, SSS and sexual satisfaction. Results: Multivariate linear regression analysis revealed that a higher depressive symptom rating was associated with higher arousability, whereas short serotonin transporter gene allele(s) status was associated with lower arousability. Impulsivity and perceived peer norms supportive of unsafe sexual behaviours were associated with increased SSS, whereas short serotonin transporter gene allele(s) status was associated with lower SSS. Higher social support was associated with higher levels of sexual satisfaction, whereas short serotonin transporter gene allele(s) status was associated with lower satisfaction. The sexuality constructs were also significantly related to the number of sex partners, the frequency of vaginal sex and the number of unprotected vaginal sex acts in the past 6 months. Conclusions: The findings emphasise the importance of understanding biopsychosocial factors, including the role of serotonin as an indicator of natural variations in sexual inclination and behaviours, that influence sexuality constructs, which, in turn, are associated with sexual behaviours, to allow further refinement of sexual health clinical services and programs and promote the development of healthy sexuality.
    Sexual Health 11/2013; 10(6):512-521. · 1.65 Impact Factor
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    ABSTRACT: Objectives. We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. Methods. We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention-defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. Results. Both SISTA and P4 for Women had statistically significant effects on this study's primary outcome-consistent condom use in the past 90 days-as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. Conclusions. P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women. (Am J Public Health. Published online ahead of print October 17, 2013: e1-e8. doi:10.2105/AJPH.2013.301386).
    American Journal of Public Health 10/2013; · 3.93 Impact Factor
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    ABSTRACT: Alcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.
    Current HIV/AIDS Reports 08/2013;
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    ABSTRACT: The impact of alcohol use on the efficacy of an HIV/STI intervention designed for young African-American women in predicting STIs was examined. Eight hundred forty-eight African-American women, 18-29 years, were randomly assigned to either the HIV/STI intervention or a control condition. Participants were assessed on alcohol use and provided two vaginal swab specimens for STI testing. Women in the intervention who consumed alcohol were less likely to test STI-positive than women in the control and abstainers (AOR = 2.47, 95 % CI = 1.01-6.22). STI risk factors may vary across different populations. Further research on heavy drinking and HIV intervention efficacy is needed.
    AIDS and Behavior 08/2013; · 3.49 Impact Factor
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    ABSTRACT: Four vaccines are recommended by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices for adolescents. Parental attitudes may play a key role in vaccination uptake in this age group. In 2011, we conducted a cross-sectional survey among parents of adolescents in one county in Georgia to identify parental attitudes toward adolescent vaccination, reasons for vaccine acceptance or refusal, and impact of a physician recommendation for vaccination. Physician recommendation was reported as one of the top reasons for receipt or intent to receive any of the vaccines. Physician recommendation of any of the four vaccines was associated with receipt of Tdap (p < 0.001), MCV4 (p < 0.001), and HPV (p = 0.03) and intent to receive Tdap (p = 0.05), MCV4 (p = 0.005), and HPV (p = 0.05). Compared with parents who did not intend to have their adolescent vaccinated with any of the vaccines, parents who did intend reported higher perceived susceptibility (3.12 vs. 2.63, p = 0.03) and severity of disease (3.89 vs. 3.70, p = 0.02) and higher perceived benefit of vaccination (8.48 vs. 7.74, p = 0.02). These findings suggest that future vaccination efforts geared toward parents may benefit from addressing the advantages of vaccination and enhancing social norms. Physicians can play a key role by providing information on the benefits of adolescent vaccination.
    Human vaccines & immunotherapeutics. 07/2013; 9(12).

Publication Stats

3k Citations
596.28 Total Impact Points


  • 2001–2014
    • Emory University
      • • Department of Behavioral Sciences and Health Education
      • • Department of Internal Medicine
      Atlanta, Georgia, United States
  • 2013
    • Johns Hopkins Medicine
      Baltimore, Maryland, United States
    • Texas Tech University
      • Department of Psychology
      Lubbock, TX, United States
    • Emory Hospitals
      Atlanta, Georgia, United States
  • 2005–2012
    • University of Chicago
      • School of Social Service Administration
      Chicago, IL, United States
    • Northwestern University
      • Division of General Internal Medicine and Geriatrics
      Evanston, IL, United States
  • 2002–2012
    • Centers for Disease Control and Prevention
      Atlanta, Michigan, United States
  • 2011
    • Harvard Medical School
      Boston, Massachusetts, United States
    • Sociometrics Corporation
      Los Altos, California, United States
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2010–2011
    • University of Georgia
      • Department of Family and Consumer Development
      Athens, GA, United States
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, RI, United States
  • 2004–2011
    • University of Kentucky
      • • College of Public Health
      • • Department of Health Behavior
      Lexington, KY, United States
  • 2008–2010
    • University of Pennsylvania
      • • Annenberg Public Policy Center
      • • Department of Psychiatry
      Philadelphia, PA, United States
    • Morehouse College
      Atlanta, Georgia, United States
  • 2009
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
  • 2007
    • Lexington College
      Lexington, Kentucky, United States
  • 2006
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
    • Boston Children's Hospital
      • Division of Adolescent Medicine
      Boston, MA, United States
  • 2003–2004
    • Georgia Department of Public Health
      Marietta, Georgia, United States
    • Wake Forest School of Medicine
      • Division of Public Health Sciences
      Winston-Salem, NC, United States