Ralph J DiClemente

Emory University, Atlanta, Georgia, United States

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Publications (279)605.17 Total impact

  • [Show abstract] [Hide abstract]
    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.
    Sexually transmitted diseases. 10/2014; 41(10):601-604.
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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: Heightened psychosocial stress coupled with maladaptive coping may be associated with greater sexual risk engagement. This study examined the association between stress levels and coping strategy use as predictors of sexual risk behavior engagement over 24 months among African-American adolescent females (N = 701; M = 17.6 years) enrolled in an STI/HIV risk-reduction intervention program. Participants completed audio computer assisted self-interview (ACASI) measures of global stress, interpersonal stress, coping strategy use, and sexual behaviors prior to intervention participation. Follow-up ACASI assessments were conducted at 6, 12, 18, and 24 months post-intervention. Generalized estimated equation models examined associations between baseline stress levels and coping strategy use as predictors of condom use (past 90 days, last sex) and multiple partners during follow-up. Global stress and individual coping strategy usage were not associated with differences in condom use. Higher interpersonal stress was associated with lower proportion condom use (p = .018), inconsistent condom use (p = .011), and not using a condom at last sex (p = .002). There were no significant associations between stress levels, coping strategy use, and multiple partners. Future research should explore mechanisms that may underlie the association between elevated interpersonal stress and decreased condom use among this population.
    Psychology Health and Medicine 08/2014; · 1.38 Impact Factor
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    ABSTRACT: Behavioral change interventions have demonstrated short-term efficacy in reducing sexually transmitted infection (STI)/human immunodeficiency virus (HIV) risk behaviors; however, few have demonstrated long-term efficacy.
    JAMA Pediatrics 08/2014; · 4.28 Impact Factor
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    ABSTRACT: Background: To examine differences between lower and higher frequency alcohol users in sexual behaviors and psychosocial correlates of risk for HIV among young African-American females. Methods: Data were collected from sexually active African-American females ages 15-20 years, seeking services at a STD clinic in the Atlanta, GA, to assess sexual behavior, correlates of risk, and a non-disease biological marker of unprotected vaginal sex. Results: Number of drinking occasions was significantly related to three of four psychosocial correlates and with all self-report sexual behavior measures. Also, heavier drinking per occasion was associated with the presence of semen in vaginal fluid. Conclusion: Non-abuse levels of drinking were related to increased sexual risk-taking in this sample of young African-American females. Incorporating messages about the intersection of alcohol use and sexual decision making into HIV/STD prevention programs would strengthen STD prevention messaging in this vulnerable population.
    European Journal of Marketing 07/2014; · 0.96 Impact Factor
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    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; · 0.55 Impact Factor
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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. · 3.53 Impact Factor
  • Journal of Adolescent Health. 01/2014; 54(2):S5.

Publication Stats

3k Citations
605.17 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
    • 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