Ralph J DiClemente

Emory University, Atlanta, Georgia, United States

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Publications (386)644.71 Total impact

  • 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
  • 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: 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
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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
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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: Parental monitoring is associated with reduced adolescent sexual risk. Other household family members’ knowledge about adolescents’ activities may also influence their sexual health. Methods:African American females (n=701) aged 14-20 years participating in an HIV trial provided baseline self-reported data and a self-collected vaginal swab specimen assayed for chlamydia and gonorrhea. Among 284 participants aged 14-17 years who reported a resident family member had the most knowledge about their activities, we assessed associations between family monitoring frequency and sexually transmitted infections (STIs). Frequent family monitoring was defined as the resident family member with the most knowledge usually or always knows where the participant is and who she is with. Adjusted logistic regression models controlled for age and bivariate differences significant at p<0.1 among participants reporting frequent and infrequent monitoring. Results:Over half (57%) reported frequent family monitoring. Proportions positive for gonorrhea (5.0% vs. 14.6%, p=0.005) and both gonorrhea and chlamydia (19.3% vs. 28.5%, p=0.069) were significantly lower among participants reporting frequent monitoring; no significant difference in chlamydia prevalence was observed. Adjusting for age, parental communication about sex, physical abuse history, and alcohol use, frequent monitoring was associated with significantly decreased odds of testing positive for gonorrhea (AOR=0.25, 95% CI=0.10, 0.63) and either STI (AOR=0.55, 95% CI= 0.31, 0.99). Conclusions: Extending the literature on parental monitoring and sexual risk, the findings suggest frequent family monitoring may be associated with reduced STI likelihood among African American adolescent females. Family monitoring may offer an additional HIV/STI prevention opportunity for this vulnerable population.
    11/2014
  • Jerrold M. Jackson, Ralph J. DiClemente, Erikka J. Woolfolk
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    ABSTRACT: Background: Studies need to explore young African-American women’s condom negotiation relating to co-factors including self-efficacy and risky partner involvement. Furthermore, there is insufficient literature on social support for condom negotiation in this population. Methods: Demographic statistics and logistic regressions were completed on N=701 African-American women (mean age: 17.63), assessing baseline associations between refusal self-efficacy, condom self-efficacy, condom use, STI status, and fear of condom negotiation. Generalized estimating equations (GEE) assessed whether refusal self-efficacy, condom self-efficacy, condom use, and STI status were associated with fear of condom negotiation over time. Further analysis was conducted to determine protective factors against fear of condom negotiation. Results: Logistic regression (adjusting for age, intervention condition) examined baseline associations between fear of condom negotiation and refusal self-efficacy (AOR=0.84, 95% CI=0.8, 0.87), condom self-efficacy (AOR=1.04, 95% CI=1.02, 1.06), STI status (AOR=1.8, 95% CI=1.29,2.47), and unprotected sex (insignificant). A multivariate GEE examined fear of condom negotiation over time (adjusting for age and intervention condition). Two covariates demonstrated statistically significant effects across 36-months of follow-up: refusal self-efficacy (p<0.0001) and STI status (p=0.003). Condom self-efficacy and unprotected sex were not statistically significant predictors. Next, ‘social support’ was added to the GEE model and demonstrated significant effects (p=0.02), suggesting family and friends’ support and high levels of refusal self-efficacy may protect against fears of condom negotiation. Conclusion: Refusal self-efficacy, social support and STI status influence fear of condom negotiation over time. Future studies should examine how individual, peer, and family influences may protect against fear of condom negotiation in this population.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Four vaccines for adolescents are on the U.S. routine immunization schedule: Tdap, HPV, MCV4 and seasonal flu. We surveyed parents’ (n=686) attitudes, beliefs and behaviors in a multi-faceted study designed to promote vaccine acceptance among adolescents attending 11 middle and high-schools in eastern Georgia. Though the vast majority of parents surveyed (98%) indicated that their child’s routine vaccinations were up to date, only 22% reported that their teen had received all four vaccines (Tdap, MCV4, at least one dose of HPV and the current season’s flu vaccine.) While 80% of parents agreed that “immunizations are always proven safe before they are approved for use”, 60% reported believing that their child could get sick from a vaccine and 28% reported that their child’s immune system could be weakened by too many immunizations. About 37% of parents reported that teens should only be immunized against serious diseases and 31% said they would only vaccinate their child if it was required for school entry. For MCV4 only, a higher proportion of parents who believe vaccines are safe reported their child receiving the vaccine (60%) than those parents who believe vaccines are unsafe (45%) (p=0.0004). There are incongruent beliefs among parents in this study regarding the safety of vaccines that may impact vaccine acceptance for their adolescents. While overall vaccine acceptance is a societal norm for infant vaccines, momentum in this important area appears to wane by the time these children reach their teen years and has important public health implications for improving adolescent vaccination.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Intimate partner violence (IPV) is associated with risky sexual behavior and STIs among diverse groups of women. IPV was examined as a moderator of efficacy for an HIV/STI intervention. 848 African American women, 18-29, were randomly assigned to an HIV/STI intervention or control condition. Participants completed measures on sociodemographics, IPV, risky sexual behavior and received STI testing. IPV predicted inconsistent condom use and a risky sexual partner over 12-month follow-up. A significant interaction indicated that among women who experienced IPV, those in the intervention were more likely to test positive for Trichomonas vaginalis (TV). Among intervention participants, those who experienced IPV were more likely to test TV-positive than those who did not. In an HIV intervention that did not specifically address IPV, women in the control condition were less likely to acquire TV than those in the intervention. Consideration of contextual/interpersonal factors is essential when developing HIV intervention programs.
    AIDS and Behavior 11/2014; · 3.49 Impact Factor
  • Sexual health. 10/2014;
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    ABSTRACT: Among 284 African American girls aged 14 to 17 years, frequent family monitoring knowledge was associated with a reduced likelihood of sexually transmitted infections (STIs) and having a casual sex partner but was not associated with other partnership characteristics. Family monitoring may offer an additional STI prevention opportunity for this vulnerable population.
    Sex Transm Dis 10/2014; 41(10):601-604. · 2.59 Impact Factor
  • Karin K. Coyle, Ralph J. DiClemente
    Journal of Adolescent Health. 10/2014; 55(4):465–466.
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    ABSTRACT: Research on the relationship between adolescent health risk behaviors, sexual risk behaviors in particular, and perceived life satisfaction is emerging. Some researchers suggest that life satisfaction has been a neglected component of adolescent health research. African American adolescents aged 13-18 (n = 1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire via Audio Computer Assisted Self-Interview. Analyses were conducted to examine relationships between perceived difficulty in performing HIV/AIDS preventive behavior and perceived life satisfaction, while controlling for socioeconomic status. Results suggest that perceived life satisfaction is related to perceived difficulty in performing HIV/AIDS preventive behaviors, for both males and females, with variability in the magnitude of associations by gender. Further research is necessary to identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived difficulty in performing HIV/AIDS preventive behavior to develop gender-appropriate and culturally-sensitive quality of life/health promotion programs.
    AIDS and Behavior 09/2014; · 3.49 Impact Factor
  • Jennifer L Brown, Jessica M Sales, Ralph J DiClemente
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    ABSTRACT: Combination HIV prevention interventions that integrate efficacious behavioral and biomedical strategies offer the potential to reduce new HIV infections. We overview the efficacy data for three biomedical HIV prevention approaches, namely microbicides, pre-exposure prophylaxis (PrEP), and HIV vaccination; review factors associated with differential acceptability and uptake of these methods; and suggest strategies to optimize the effectiveness and dissemination of combination HIV prevention approaches. A narrative review was conducted highlighting key efficacy data for microbicides, PrEP, and an HIV vaccination and summarizing acceptability data for each of the three biomedical HIV prevention approaches. Recommendations for the integration and dissemination of combined behavioral and biomedical HIV prevention approaches are provided. To date, microbicides and an HIV vaccination have demonstrated limited efficacy for the prevention of HIV. However, PrEP has demonstrated efficacy in reducing HIV incident infections. A diverse array of factors influences both hypothetical willingness and actual usage of each biomedical prevention method. Strategies to effectively integrate and evaluate combination HIV prevention interventions are urgently needed.
    Current HIV/AIDS Reports 09/2014;
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    ABSTRACT: ABSTRACT Background: Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. Objective: The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. Methods: We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N=188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. Intervention: The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment and counseling. Results: At the 6-month assessment (3-months post-intervention) Imara participants reported higher condom use self-efficacy (p<0.001), HIV/STI knowledge (p<0.001), and condom use skills (p<0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Conclusions: Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.
    Women & health. 09/2014;
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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 09/2014; · 1.27 Impact Factor
  • Ralph J. DiClemente, Jerrold M. Jackson
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    ABSTRACT: For decades, the HIV epidemic has exacted an enormous toll worldwide. However, trend analyses have discerned significant declines in the overall prevalence of HIV over the last two decades. More recently, advances in biomedical, behavioural, and structural interventions offer considerable promise in the battle against generalised epidemics. Despite advances in the prevention of transmission and new infections, morbidity and mortality of HIV among young people remains a considerable concern for individuals, couples, families, communities, practitioners, and policy-makers around the globe. To accelerate the end of the global HIV epidemic among young people, we must merge existing efficacious interventions with more novel, cost-effective implementation strategies to develop integrated, multi-level combination interventions. The benefits of conceptualising the HIV epidemic more broadly and adopting ecological frameworks for the development of HIV prevention programmes are critical.
    Sex Education 09/2014; 14(5).

Publication Stats

3k Citations
644.71 Total Impact Points

Institutions

  • 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
    • Emory Hospitals
      Atlanta, Georgia, United States
    • Texas Tech University
      • Department of Psychology
      Lubbock, TX, United States
  • 2005–2013
    • 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
    • Rhode Island Hospital
      Providence, Rhode Island, United States
    • Sociometrics Corporation
      Los Altos, California, 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