Ralph J DiClemente

Emory University, Atlanta, Georgia, United States

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Publications (525)1178.04 Total impact

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    ABSTRACT: Although genital HPV is the most prevalent STI in the US, 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 study examines an innovative culturally tailored, computer-delivered media-based strategy to promote HPV vaccine uptake. Data, inclusive of sociodemographics, sexual behaviors, 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 designed to increase HPV vaccination uptake. Medical record abstraction was conducted 7 month post-randomization to assess initial vaccine uptake and compliance. Participants in the intervention were more compliant to vaccination relative to a placebo comparison condition (26 doses vs. Seventeen doses; p=0.12). However, vaccination series initiation and completion were lower than the national average. Thorough evaluation is needed to better understand factors facilitating HPV vaccine uptake and compliance, particularly perceived susceptibility and the influence of the patient-provider encounter in a clinical setting.
    Human Vaccines & Immunotherapeutics 09/2015; DOI:10.1080/21645515.2015.1070996 · 2.37 Impact Factor
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  • Kelly M. King · Dexter R. Voisin · Ralph J. Diclemente
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    ABSTRACT: This article examines whether adolescent females involved in the juvenile justice system, who were never gang members but have had boyfriends who were gang members, are at higher risk for negative psychological, relationship and sexual risk outcomes compared to their counterparts. Data were collected from a convenience sample of African American adolescent females involved in the juvenile justice system, age 13–17, currently incarcerated in a short-term detention facility in Georgia (N = 137). Multiple logistic regression models controlling for age and SES documented that having a gang-involved boyfriend was associated with a greater risk for emotional and physical abuse, depression, PTSD, drug use, diminished perceived life chances and a variety of sexual risk predictors, such as decreased relationship control, partner infidelity, shorter time to sex with a casual sexual partner and reduced likelihood of HIV testing. These findings suggest that these women should be included in early prevention and intervention initiatives traditionally targeted at youth involved in gangs.
    Journal of Child and Family Studies 09/2015; 24(9). DOI:10.1007/s10826-014-0057-7 · 1.42 Impact Factor
  • Jennifer L Brown · Ralph J DiClemente
    PEDIATRICS 08/2015; 136(3). DOI:10.1542/peds.2015-0239 · 5.47 Impact Factor
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    ABSTRACT: This study assessed a newly developed Sexual Communication Self-Efficacy Scale designed to measure the sexual communication self-efficacy of adolescent men and women. Three-hundred and seventy-four U.K. adolescents completed this new scale, along with several other validity measures. Factor analysis revealed that the Sexual Communication Self-Efficacy Scale consisted of five underlying factors: contraception communication, positive sexual messages, negative sexual messages, sexual history, and condom negotiation. These factors demonstrated high internal consistency and presents evidence to support construct validity. This scale may have utility in assessing the effectiveness of interventions designed to enhance sexual communication and sexual health behaviors among young people. © 2015 Society for Public Health Education.
    Health Education & Behavior 08/2015; DOI:10.1177/1090198115598986 · 2.23 Impact Factor
  • Journal of Family Studies 07/2015; DOI:10.1080/13229400.2015.1020984 · 0.25 Impact Factor
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    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 · 1.37 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; DOI:10.1080/08964289.2015.1065789 · 1.00 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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    Annals of Epidemiology 06/2015; 25(6):445-454. · 2.00 Impact Factor
  • Annals of Epidemiology 06/2015; 25(6):445-454. · 2.00 Impact Factor
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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; 12(4). DOI:10.1071/SH15019 · 1.37 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; 11(7). DOI:10.1080/21645515.2015.1038445 · 2.37 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; 11(7). DOI:10.1080/21645515.2015.1035848 · 2.37 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; 105(10):e1-e6. DOI:10.2105/AJPH.2014.302493 · 4.55 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 · 2.84 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 · 2.00 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; 40(4). DOI:10.1007/s10900-014-9982-z · 1.28 Impact Factor

Publication Stats

11k Citations
1,178.04 Total Impact Points


  • 1998–2015
    • Emory University
      • • Department of Behavioral Sciences and Health Education
      • • Department of Pediatrics
      Atlanta, Georgia, United States
  • 2007–2014
    • Indiana University Bloomington
      • Rural Center for AIDS/STD Prevention
      Bloomington, Indiana, United States
  • 2013
    • Emory Hospitals
      Atlanta, Georgia, United States
    • University of Georgia
      Атина, Georgia, United States
  • 2006–2012
    • University of Chicago
      • • STI and HIV Intervention Network
      • • School of Social Service Administration
      Chicago, Illinois, 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
  • 2003–2004
    • Georgia Department of Public Health
      Marietta, Georgia, United States
  • 1994–2002
    • University of Alabama at Birmingham
      • • Department of Pediatrics
      • • Department of Medicine
      • • Department of Health Behavior
      Birmingham, Alabama, 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
  • 1999
    • Centers for Disease Control and Prevention
      • Division of Reproductive Health
      Druid Hills, GA, United States
  • 1997
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 1992–1996
    • 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
  • 1992–1993
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States