Ralph J DiClemente

Indiana University Bloomington, Bloomington, Indiana, United States

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Publications (510)1054.84 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. Methods: Ninety-five detained African-American girls (aged 13-17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n = 51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. Results: EPT was offered 69 times, accepted by 70% (n = 37) girls and provided to 68% (n = 36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR = 3.2, 95% CI: 1.0,-10.1, P = 0.048) and ≥ 4 lifetime sex partners (OR = 3.3, 95% CI: 1.0-11.0, P = 0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. Conclusions: Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.
    Sexual Health 06/2015; DOI:10.1071/SH15050 · 1.58 Impact Factor
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    ABSTRACT: Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (i.e., a combined index score comprised of living in public housing, being a recipient of free school lunch and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N=489). Questions assessed demographics, social context, depression, gang-involved networks and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment and family social support, indicated that participants who reported poorer social context had a 2 times higher odds of reporting being depressed; 3 times higher odds of being in a gang; 3 times higher odds of personally knowing a gang member; and 2 times higher odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.
    Behavioral Medicine 06/2015; · 1.14 Impact Factor
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    ABSTRACT: Young female adolescent African Americans are disproportionately impacted by HIV infection. There is a clear need to understand factors associated with increased HIV-risk behaviors among this vulnerable population. We sought to explore the association between a dopamine D4 receptor gene (DRD4), a genetic marker associated with natural variations in rewarding behaviors, and self-reported alcohol use and sexual risk behaviors, while controlling for other known correlates of risk-taking such as impulsivity, sensation-seeking, and peer norms, among a group of high-risk female adolescent African Americans to evaluate whether this biological factor enhances understanding of the patterns of risk in this vulnerable group.
    Journal of HIV/AIDS & Social Services 06/2015; 14(2):136-153. DOI:10.1080/15381501.2014.920759
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    ABSTRACT: Background: Ample evidence shows that partner sexual communication is related to condom use. Although communication about safer sex may often occur when sexual arousal is high, no studies have examined arousability, one's propensity for sexual arousal and partner sexual communication. The purpose of this study was to examine associations between sexual arousability and partner-related mediators of condom use among African American female adolescents, who have disproportionate risk for HIV and sexually transmissible infections (STIs). Methods: The study analysed self-reported baseline data from 701 African American females aged 14-20 years participating in a HIV/STI trial. Linear regression models examined associations between arousability and partner-related mediators of condom use (partner sexual communication self-efficacy, partner sexual communication frequency, sex refusal self-efficacy and condom use self-efficacy), controlling for age, impulsivity and relationship power. Results: Greater arousability was significantly associated with reduced levels of each partner communication outcome assessed (partner sexual communication self-efficacy, partner sexual communication frequency and sex refusal self-efficacy) but was not associated with condom use self-efficacy. Conclusions: Arousal and other positive aspects of sex have largely been ignored by HIV/STI prevention efforts, which primarily focus on individual behaviour. A population-level sexual health approach focusing on sexual wellbeing may reduce stigma, facilitate partner sexual communication and be more effective at reducing HIV/STI rates than traditional approaches.
    Sexual Health 05/2015; DOI:10.1071/SH15019 · 1.58 Impact Factor
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    ABSTRACT: In 2011-2012, only 34% of 13-17 years olds in the United States (U.S.) received seasonal influenza vaccine. Little is known about the link between parents' sources of health information, their vaccine-related attitudes, and vaccination of their adolescent against influenza. This study seeks to determine the relationship between number of sources of information on influenza vaccine, parental attitudes toward influenza vaccine, and influenza vaccine uptake in adolescents. We conducted a telephone and web-based survey among U.S. parents of students enrolled in 6 middle and 5 high schools in Georgia. Bivariate and multivariable analyses were conducted to examine associations between the number of information sources about influenza vaccine and vaccine receipt and whether parent vaccine-related attitudes act as a mediator. The most commonly reported sources of information were: a physician/medical professional (95.0%), a family member or friend (80.6%), and television (77.2%). Parents who had higher attitude scores toward influenza vaccine were five times as likely to report their adolescent had ever received influenza vaccine compared to parents who had lower attitude scores (adjusted odds ratio (aOR) 5.1; 95% confidence intervals (CI) 3.1-8.4; p<0.01). Parent vaccine-related attitudes were a significant mediator of the relationship between sources of information and vaccine receipt. In light of the low response rate and participation in an adolescent vaccination intervention findings may not be generalizable to other populations. This study shows the importance of multiple sources of information in influencing parental decision-making about influenza vaccine for adolescents. Harnessing the power of mass media and family members and friends as health advocates for influenza vaccination can potentially help increase vaccination coverage of adolescents.
    Human Vaccines & Immunotherapeutics 05/2015; DOI:10.1080/21645515.2015.1038445 · 3.64 Impact Factor
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    ABSTRACT: African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14-20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.
    Archives of Sexual Behavior 05/2015; DOI:10.1007/s10508-015-0518-0 · 3.53 Impact Factor
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    ABSTRACT: Human papillomavirus (HPV) vaccination coverage for adolescent females and males remains low in the United States. We conducted a three-arm randomized controlled trial (RCT) conducted in middle and high schools in eastern Georgia from 2011-2013 to determine the effect of two educational interventions used to increase adolescent vaccine coverage for the four recommended adolescent vaccines: Tdap, MCV4, HPV and influenza. As part of this RCT, this article focuses on: 1) describing initiation and completion of HPV vaccine series among a diverse population of male and female adolescents; 2) assessing parental attitudes toward HPV vaccine; and 3) examining correlates of HPV vaccine series initiation and completion. Parental attitude score was the strongest predictor of HPV vaccine initiation among adolescents (adjusted odds ratio (aOR): 2.08; 95% confidence interval (CI): 1.80, 2.39). Other correlates that significantly predicted HPV series initiation were gender, study year, and intervention arm. Parental attitudes remained a significant predictor of receipt of three doses of HPV vaccine along with gender, race, school type and insurance type. This study demonstrates that positive parental attitudes are important predictors of HPV vaccination and critical to increase coverage rates. Our findings suggest that more research is needed to understand how parental attitudes are developed and evolve over time.
    Human Vaccines & Immunotherapeutics 04/2015; DOI:10.1080/21645515.2015.1035848 · 3.64 Impact Factor
  • Jerrold M Jackson, Puja Seth, Ralph J DiClemente, Anne Lin
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    ABSTRACT: We examined how depression and substance use interacted to predict risky sexual behavior and sexually transmitted infections (STIs) among African American female adolescents. We measured depressive symptoms, substance use, sexual behavior, and STIs in 701 African American female adolescents, aged 14 to 20 years, at baseline and at 6-month intervals for 36 months in Atlanta, Georgia (2005-2007). We used generalized estimating equation models to examine effects over the 36-month follow-up period. At baseline, more than 40% of adolescents reported significant depressive symptoms; 64% also reported substance use in the 90 days before assessment. Depression was associated with recently incarcerated partner involvement, sexual sensation seeking, unprotected sex, and prevalent STIs (all P < .001). In addition, adolescents with depressive symptoms who reported any substance use (i.e., marijuana, alcohol, Ecstasy) were more likely to report incarcerated partner involvement, sexual sensation seeking, unprotected sex, and have an incident STI over the 36-month follow-up (all P < .05). African American female adolescents who reported depressive symptoms and substance use were more likely to engage in risky behavior and acquire incident STIs. This population might benefit from future prevention efforts targeting the intersection of depression and substance use. (Am J Public Health. Published online ahead of print April 23, 2015: e1-e6. doi:10.2105/AJPH.2014.302493).
    American Journal of Public Health 04/2015; DOI:10.2105/AJPH.2014.302493 · 4.23 Impact Factor
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    ABSTRACT: Black teenagers have relatively high rates of sexually transmitted diseases (STDs), and recent research suggests the role of contextual factors, as well as risk behaviors. We explore the role of 4 categories of risk and protective factors on having a biologically confirmed STD among black, female teenagers. Black teenage girls (14-19 years old) accessing services at a publicly funded family planning clinic provided a urine specimen for STD testing and completed an audio computer-assisted self-interview that assessed the following: risk behaviors, relationship characteristics, social factors, and psychosocial factors. We examined bivariate associations between each risk and protective factor and having gonorrhea and/or chlamydia, as well as multivariate logistic regression among 339 black female teenagers. More than one-fourth (26.5%) of participants had either gonorrhea and/or chlamydia. In multivariate analyses, having initiated sex before age 15 (adjusted odds ratio [aOR], 1.87) and having concurrent sex partners in the past 6 months (aOR, 1.55) were positively associated with having an STD. Living with her father (aOR, 0.44), believing that an STD is the worst thing that could happen (aOR, 0.50), and believing she would feel dirty and embarrassed about an STD (aOR, 0.44) were negatively associated with having an STD. Social factors and attitudes toward STDs and select risk behaviors were associated with the risk for STDs, suggesting the need for interventions that address more distal factors. Future studies should investigate how such factors influence safer sexual behaviors and the risk for STDs among black female teenagers.
    Sex Transm Dis 04/2015; 42(4):192-197. DOI:10.1097/OLQ.0000000000000254 · 2.75 Impact Factor
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    ABSTRACT: To describe factors associated with racial disparities in HIV (human immunodeficiency virus) incidence among men who have sex with men (MSM) in the United States. In a longitudinal cohort of black and white HIV-negative MSM in Atlanta, HIV incidence rates were compared by race. Incidence hazard ratios (HRs) between black and white MSM were estimated with an age-scaled Cox proportional hazards model. A change-in-estimate approach was used to understand mediating time-independent and -dependent factors that accounted for the elevated HR. Thirty-two incident HIV infections occurred among 260 black and 302 white MSM during 843 person-years (PY) of follow-up. HIV incidence was higher among black MSM (6.5/100 PY; 95% confidence interval [CI]: 4.2-9.7) than white MSM (1.7/100 PY; CI: 0.7-3.3) and highest among young (18-24 years) black MSM (10.9/100 PY; CI: 6.2-17.6). The unadjusted hazard of HIV infection for black MSM was 2.9 (CI: 1.3-6.4) times that of white MSM; adjustment for health insurance status and partner race explained effectively all of the racial disparity. Relative to white MSM in Atlanta, black MSM, particularly young black MSM, experienced higher HIV incidence that was not attributable to individual risk behaviors. In a setting where partner pool risk is a driver of disparities, it is also important to maximize care and treatment for HIV-positive MSM. Copyright © 2015 Elsevier Inc. All rights reserved.
    Annals of Epidemiology 03/2015; 25(6). DOI:10.1016/j.annepidem.2015.03.006 · 2.15 Impact Factor
  • JaNelle Ricks, Ralph J. DiClemente, Puja Seth
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    ABSTRACT: Human Immunodeficiency Virus (HIV) infection, the cause of Acquired Immune Deficiency Syndrome (AIDS), has become a significant threat to global public health, faster than any previous epidemic. Recent decades have seen significant progress in the global HIV/AIDS response, largely due to increased availability of treatment and targeted efforts to decrease transmission and incidence. This article highlights HIV risk prevention strategies that have been developed, implemented, and demonstrated efficacy in reducing the risk of HIV infection among adolescents, women, men who have sex with men, and heterosexually active men.
    The International Encyclopedia of the Social & Behavioral Sciences, 2nd edited by James D. Wright, 03/2015: chapter HIV risk interventions: pages 138-144; Oxford:Elsevier.
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    ABSTRACT: Four vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95 % confidence interval (CI) 2.44–22.31], MCV4 (AOR 2.97; 95 % CI 1.67–5.28), and HPV vaccines (AOR 7.61; 95 % CI 3.43–16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95 % CI 1.12–1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination.
    Journal of Community Health 12/2014; DOI:10.1007/s10900-014-9982-z · 1.28 Impact Factor
  • Julia Still, Colleen Crittenden Murray, Ralph J. DiClemente
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    ABSTRACT: Issue: Human Papillomavirus (HPV) prevalence among African American adolescents is disproportionately high in comparison with other age and ethnic groups. HPV vaccination series initiation and completion rates remain low among this population, despite the availability of a safe and effective vaccine. Previous theoretical frameworks have been unable to successfully integrate all factors involved in HPV vaccine uptake. Innovative theoretically grounded strategies are needed to enhance overall understanding and intervention design for those at highest risk of infection. Description: Using ACASI, 216 surveys were completed with African American females 14-18 years of age. The items measured in the ACASI were mapped to the Diffusion of Innovations (DOI) Theory Innovation-Decision Process Model. A cross-sectional analysis was conducted to examine correlates of HPV knowledge and intention to vaccinate against HPV within the context of DOI. Lessons Learned: While DOI has never been used to explain HPV vaccine decision-making, application of this model accounts for all variables that influence HPV vaccine uptake. The DOI Innovation-Decision Process Model successfully integrates all correlates of HPV vaccination and provides an optimal framework through which to explain HPV knowledge and intent to vaccinate among African American adolescent females. Recommendations: Subsequent research must be conducted to test the application of DOI to predict HPV vaccine series initiation and completion among African American adolescents. DOI should be used to frame future HPV vaccine uptake intervention strategies to increase the diffusion of the vaccine among this at-risk population.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Jerrold M. Jackson, Ralph J. DiClemente
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    ABSTRACT: Background: Seroprevalent environments can significantly increase the risk of poor mental health outcomes, particularly for young black females also impacted by neighborhood exposures (i.e. crime and violence). However, certain individual-, peer-, and family-level factors may serve as protective against inherent risks posed by the multiplicative effects of living in highly underserved communities. Methods: Analyses were performed on a sample (N=701, mean age: 18 years) of African American females involved in a HIV prevention trial. Mean differences were assessed in baseline depression and stress by level of neighborhood crime and violence exposure, and two multivariate GEE models were constructed to examine risk and protective factors of stress and depression over a 36-month follow-up period. Results:Differences existed in baseline stress [t(699)=4.5, p<.0001] and depression [t(699)=2.97, p=0.003] by level of neighborhood crime and violence exposure, with level of neighborhood exposures associated with levels of stress and depression. Additionally, the baseline prevalence of high neighborhood exposures and simultaneous biologically confirmed STI (chlamydia, gonorrhea, or trichomonas) was 24.9%. A multivariate GEE model associated risky partner involvement, peer norms, and neighborhood exposures as risk factors for depression over time; sex refusal self-efficacy and social support were protective. Comparably, sexual sensation seeking, peer norms, and neighborhood exposures were risk factors for stress over time, and social support as a protective factor. Conclusion: Increased understanding of the association between multi-level, co-occurring mental health and sexual health risk factors can inform the development and implementation of complex, multi-modal prevention strategies tailored precisely for at-risk young black women.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: HIV-related stigma decreases HIV-prevention, testing, and treatment in general and increases risk of poor mental health outcomes for persons living with HIV/AIDS. Given the elevated prevalence of HIV among African-Americans and the disproportionate impact of HIV on young people (ages 13-24), identifying factors related to HIV-related stigma among African-American youth has implications for national HIV risk-reduction priorities. Regional differences in HIV/AIDS prevalence may be related to stigma among young African-Americans. Methods: Baseline data (N=1,606) from an HIV prevention intervention were used to investigate regional and sex differences in HIV-related stigma and knowledge among African-American adolescents (age 14-17 years) in four midsized cities in the Northeastern and Southeastern US. Analysis of variance determined differences in HIV-related stigma and HIV-related knowledge by region and gender. Results: Analyses indicated greater HIV-related stigma among adolescents from the southeast relative to adolescents from the northeast (F=22.23;p<0.0001). Males demonstrated higher stigma scores than females (F=30.94;p<0.0001). Knowledge scores were higher for females (F=13.9,p<0.01) but there were no significant differences by region (F=3.2,p<0.07). Linear regression indicated a negative relationship between HIV stigma and HIV knowledge (b=-0.65;p<0.0001). Conclusions: Addressing HIV/AIDS in high prevalence locales should include efforts to increase knowledge and reduce HIV-related stigma. Targeted stigma-reduction efforts should consider gender and region.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objective:To evaluate the efficacy of a brief, phone counseling Prevention Maintenance Intervention (PMI) to sustain STI/HIV-preventive behaviors and reduce incident STIs over a 36-month follow-up. Design:A two-arm randomized controlled supplemental treatment trial Setting:Three clinics in Atlanta, Georgia. Participants:African-American adolescent females, 14-20 years, (N=701). Intervention:Participants in the experimental condition received an adapted CDC-defined evidence-based STI/HIV intervention (HORIZONS) and a PMI consisting of brief, tailored phone counseling every 8 weeks over 36-months. Comparison condition participants received HORIZONS and a time- and dose-consistent PMI focused on general health. Main Outcome Measure(s):Primary outcomes were proportion of participants with a laboratory-confirmed chlamydial or gonococcal infection. Behavioral outcomes include: (1) proportion of condom-protected sex acts (2) number of sexual episodes in which participants engaged in sexual intercourse while high on drugs/alcohol, and (3) number of vaginal sex partners. Results: Over 36-months follow-up, fewer participants in the experimental condition had incident chlamydial (94 versus 104; RR = 0.47; 95%CI 0.25 to 0.89; p=.02) and gonococcal infections (48 versus 54; RR = 0.39; 95%CI 0.14 to 1.04; p=.060). A dose effect was observed; participants completing more phone contacts had a lower risk of chlamydial infection (RR= 0.94, 95%CI 0.89, 0.99; p=0.049). Participants in the experimental condition reported a higher proportion of condom-protected sex acts (mean difference6 months=.08; 95%CI 0.06, 0.10; p=0.036), and fewer episodes of sex while high on alcohol/drugs (mean difference=-0.61; 95%CI -0.98,-0.24; p=0.0001). Conclusions and Relevance: Sustaining the long-term impact of HIV interventions is achievable with brief, tailored phone counseling.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Puja Seth, Jerrold M. Jackson, Ralph J. DiClemente
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    ABSTRACT: Background: Social determinants of health are key factors that contribute to health disparities, with one being experiences of community trauma. Exposure to community stressors can be associated with substance use/abuse, risky sex, and mental health issues. This study aims to better understand the impact of community trauma on these factors among detained African American adolescent females. Methods: Baseline, 3-month, and 6-month data from a prevention study involving African American female adolescents (13-17 years) recruited from a youth detention center (n=188) were used. Logistic regression examined community trauma (i.e., neighborhood crime, deviance, multiple traumatic neighborhood exposures) and its association with substance use, sexual risk, deviant peers, and PTSD at baseline. Generalized estimating equations (GEE) assessed population-averaged effects of community trauma on these same factors over time. Results: Baseline associations revealed that 47.87% reported high community trauma exposure and co-occurring substance use (OR=4.39, 95% CI=2.12-9.09). Community trauma also was associated with deviant peers, risky partner involvement, sexual sensation seeking, unprotected sex, and PTSD at baseline (p<.05). In GEE models, baseline community trauma, with age, living situation, and study condition as covariates, significantly predicted substance use (p=0.0003), deviant peers (p<.0001), risky partner involvement (p=0.0008), sexual sensation seeking (p=0.003), unprotected sex (p=0.02), and PTSD (p=0.0008) over time. Conclusion: Findings reinforce the impact of social determinants of health on multiple factors. Integration of health services is needed to address co-occurring substance use, sexual health, and mental health issues, particularly in high-risk environments and among vulnerable populations, such as African American adolescents involved in juvenile justice.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Introduction: One of the goals of Healthy People 2020 is to reduce the proportion of females with human papillomavirus (HPV) infection. Although there are effective vaccines available, the proportion of U.S. adolescent girls who have completed the vaccine series remains less than optimal. Current research has yielded mixed results but suggests there are disparities in HPV vaccination, with African American girls being less likely than Caucasian girls to receive all doses. Since African American women in the U.S. bear a disproportionately high burden of HPV disease, it is imperative to understand how their rate of vaccine initiation and series completion can best be improved. Methods: Using ACASI, 216 interviews were completed with African American girls, 14-18 years of age, who were recruited in family planning and STI public health clinics in the Atlanta metro area. Interviews were conducted from February 2010 to November 2012. Results: Most girls (n = 177) believed their doctor would think it was a good idea for them to receive the HPV vaccine. This number was higher than those who reported most people important to them, their best friend, or parent would have the same belief. Conclusion: Previous research has shown that the provider plays an important role in vaccine initiation. The current findings support the importance of understanding the patient-provider relationship and how it influences the decision to get vaccinated. Strategies should be implemented to train providers on how best to educate their patients on vaccination.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Introduction:Although genital HPV is the most prevalent STI in the U.S., rates of vaccination uptake among high-risk subgroups remain low. Investigations of vaccine compliance have mainly targeted mother-daughter dyads, which in some settings may prove difficult. This research examines an innovative approach that is culturally tailored to the individual. Lessons learned specific to vaccination initiation are presented. Methods:Data, inclusive of sociodemographics, sexual behaviors, and knowledge, attitudes, and beliefs about HPV and vaccination were collected via ACASI from 216 African-American adolescent females (ages 14-18 years) seeking services in family planning and STI public health clinics in metropolitan Atlanta. Data were obtained prior to randomization and participation in an interactive media-based intervention to increase HPV vaccination uptake. Medical record abstraction was conducted 7-months post-randomization to assess initial uptake and compliance. Results:While 82% of participants believed their doctor would think it was a “good idea” to get vaccinated only 19% “believed they were at risk for getting HPV”. Intervention participants were more compliant to vaccination relative to controls (26 doses vs. 17 doses, p = .12). However, vaccine initiation remained lower than the national average. Conclusion: While this study was among the first to focus solely on young African-American adolescents in a clinical setting, remove all financial barriers associated with vaccination, and provide a culturally tailored intervention experience grounded in formative research, results were less than optimal. Thorough evaluation is needed to better understand perceived susceptibility and how it changes post-intervention and to determine what occurs during the patient-provider encounter.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: HIV-related stigma reduces HIV-prevention behaviors, testing, and optimal treatment behavior. African-Americans demonstrate greater HIV-related stigma than other races/ethnicities. Given the elevated HIV- prevalence of African-Americans, identifying effective stigma reduction strategies has implications for national testing and prevention goals among this group. This study examines the the effectiveness of a culturally-tailored media (radio and television) HIV-risk reduction intervention in reducing HIV-related stigma. Methods: A total of 1613 African-American adolescents (age 14-17) from four mid-sized cities in the Northeastern and Southeastern US participated in a randomized control trial to determine the impact of media in reducing HIV risk behavior. Two cities (one Northeastern and one Southeastern) received the media intervention. Participants completed audio computer assisted self-interviews at baseline, 3, 6 and 12 months to determine HIV-related stigma and HIV-related knowledge differences. Analysis of variance determined stigma and knowledge differences at each measurement interval. Hierarchical linear modeling (HLM) determined stigma and knowledge differences over the entire study. Results: Mean stigma scores decreased over time while knowledge increased. There were no stigma differences at baseline but there were significant differences between intervention and control cities at three months (p<0.05). These differences diminished by 6-months. HLM did not detect stigma differences. Conversely, there were no significant knowledge differences between the experimental groups at any measurement interval, but HLM indicates greater knowledge scores for the intervention group over the entire study (p<0.05). Conclusions: A coordinated media strategy to reduce HIV risk behavior demonstrated short term benefit in reducing stigma and longer-term benefit in increasing knowledge.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014

Publication Stats

10k Citations
1,054.84 Total Impact Points


  • 2007–2014
    • Indiana University Bloomington
      • Rural Center for AIDS/STD Prevention
      Bloomington, Indiana, United States
  • 1998–2014
    • Emory University
      • • Department of Behavioral Sciences and Health Education
      • • Department of Pediatrics
      Atlanta, Georgia, United States
  • 2013
    • Emory Hospitals
      Atlanta, Georgia, United States
  • 2006–2012
    • University of Chicago
      • • STI and HIV Intervention Network
      • • School of Social Service Administration
      Chicago, Illinois, United States
    • University of Miami
      كورال غيبلز، فلوريدا, Florida, United States
  • 2011
    • Sociometrics Corporation
      Los Altos, California, United States
  • 1992–2011
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2010
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, RI, United States
  • 2009
    • University of Pennsylvania
      • Annenberg Public Policy Center
      Philadelphia, PA, United States
  • 2004–2009
    • University of Kentucky
      • • Department of Health Behavior
      • • College of Public Health
      Lexington, KY, United States
  • 2008
    • Morehouse College
      Atlanta, Georgia, United States
  • 2005–2007
    • University of Rochester
      • Division of Adolescent Medicine
      Rochester, New York, United States
  • 1994–2005
    • University of Alabama at Birmingham
      • • Department of Pediatrics
      • • Department of Health Behavior
      • • School of Public Health
      Birmingham, Alabama, United States
  • 2003–2004
    • Georgia Department of Public Health
      Marietta, Georgia, United States
    • Wake Forest School of Medicine
      • Department of Social Sciences and Health Policy
      Winston-Salem, North Carolina, United States
  • 2001
    • U.S. Army Medical Research Institute of Infectious Diseases
      Фредерик, Maryland, United States
  • 2000
    • West Virginia University
      • Department of Community Medicine
      Morgantown, WV, United States
    • Boston University
      • School of Public Health
      Boston, Massachusetts, United States
  • 1997
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 1991–1996
    • University of California, San Francisco
      • • Department of Psychiatry
      • • Center for AIDS Prevention Studies
      San Francisco, CA, United States
  • 1992–1994
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 1993
    • North Carolina State University
      • Department of Psychology
      Raleigh, NC, United States
  • 1992–1993
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States