Ralph Joseph DiClemente

Background The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. Methods This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient’s preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment …

ObjectiveYoung Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population.MethodsData were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables.ResultsChildhood physical …

Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders’ and members’ perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the …

Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents’ dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents’ dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and …

Background: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women.Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women’s Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV.Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April–September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early …

African American men who have sex with men (MSM) are disproportionately impacted by HIV and may benefit from the development of an HIV vaccine. African American MSM are adversely affected by discrimination as a function of both their race and sexual behaviors. This may further increase the challenges associated with persuading them to adopt an HIV vaccine. Developing a knowledge base characterizing African American MSM HIV vaccine perceptions, attitudes, and concerns may help strengthen how healthcare providers and other health stakeholders describe and discuss the advent of an HIV vaccine. This study assessed the knowledge, attitudes, beliefs, and intentions related to HIV vaccination among African American MSM. This study comprised 432 African American MSM, 18–64 years, residing in the United States. Vaccine intention was defined as how likely it is that an individual would adopt an HIV vaccine if a vaccine was available and it was 90% effective against HIV, easy to obtain, free, and had few side effects. Relative to African American MSM who intend to delay receiving an HIV vaccination, controlling for age, education, and income, early vaccine adopters who had received ≥ 2 COVID-19 vaccinations and who had high WHO HIV Vaccine Positive Attitude Scale scores were, respectively, 3.2 times and 2.4 times more likely to report the intention to vaccinate within one year. Early vaccine adopters were also 2.4 times more likely to feel that HIV prevention support discriminates against African American MSM. Those reporting three or more sexual partners and medical mistrust were, respectively, 60% and 59% more likely …

African American women have a higher likelihood of experiencing lifetime trauma compared to other racial/ethnic groups. Trauma exposure may be associated with higher substance misuse and greater adverse sexual and mental health outcomes. This study expands upon previous empirical findings to characterize the effect of trauma history on substance use, sexual health, and mental health among young African American women. This study included 560 African American women aged 18–24 years in Atlanta, Georgia. Trauma history was defined as having ever experienced a traumatic event based on the Traumatic Events Screening Inventory (TESI). Relative to women not reporting a trauma history and controlling for age, education, and employment, women who experienced trauma were over 2.5 and 2.3 times, respectively, more likely to report alcohol misuse and marijuana misuse. They were 3.0 times more likely to experience peer normative pressure for substance use. Women who experienced trauma were 2.1 times more likely to have multiple sex partners, 2.9 times more likely to have peer norms for risky sex, 1.8 times more likely to perceive barriers to using condoms with sex partners, 2.1 times more likely to report lower communication frequency about sex, 2.0 times more likely to report lower self-efficacy for refusing sex, and 1.9 times more likely to report less relationship control. Women with a trauma history were also 5.0 times more likely to have experienced intimate partner violence, 2.1 times more likely to report high depression symptomatology, 4.0 times more likely to report high overall stress, 3.2 times more likely to have …

The relationship between family dynamics and health has been extensively studied, but the specific pathways involved are not yet fully understood. The role of intimate partner relationships in promoting and maintaining healthy lifestyle behaviors remains understudied, particularly in minority populations. This study addressed this gap by examining how frequent spousal and familial interactions affect healthy lifestyle behaviors in young Asian Americans. Survey data from Asian American adults aged 18 to 35, collected in March 2021, is used to compare two groups: one interacting most with an intimate partner and the other interacting most with other non-intimate family members. The results showed that young Asian Americans interact most with their spouses/partners and mothers. Participants who interacted most frequently with their spouses/partners reported a greater influence in maintaining a healthy lifestyle …