Ralph J. DiClemente

University of Guelph, XIA, Ontario, Canada

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Publications (553)1204.22 Total impact

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    ABSTRACT: Purpose: Four vaccines are routinely recommended for adolescents: tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); meningococcal-conjugate (MCV4); and a yearly seasonal influenza vaccine. Vaccination promotion and outreach approaches may need to be tailored to certain populations, such as those with chronic health conditions or without health insurance. Methods: In a controlled trial among middle and high school students in Georgia, 11 schools were randomized to one of three arms: no intervention, parent education brochure, or parent education brochure plus a student curriculum on the four recommended vaccines. Parents in all arms were surveyed regarding their adolescent's vaccine receipt, chronic health conditions, and health insurance status. Results: Of the 686 parents, most (91%) reported their adolescent had received at least one of the four vaccines: Tdap (82%), MCV4 (59%), current influenza vaccine (53%) and HPV (48%). Twenty-three percent of parents reported that their adolescent had asthma. Most parents reported that their adolescent's insurance was Medicaid (60%) or private insurance (34%), and 6% reported no insurance. More adolescents with a chronic health condition received any adolescent vaccine than adolescents without a chronic health condition (p < .0001). Among those with no insurance, fewer had received any adolescent vaccine than those with Medicaid or private insurance (p < .0001). Conclusions: The federal Vaccines for Children program offers recommended vaccines free to eligible children (including those without health insurance). Our findings suggest that parents may not be aware of this program or eligibility for it, thus revealing a need for education or other fixes.
    No preview · Article · Feb 2016 · Journal of Adolescent Health
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    Paul J. Fleming · Ralph J. DiClemente · Clare Barrington
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    ABSTRACT: Numerous studies have documented a relationship between masculine norms and men's HIV-related sexual behaviors, but intervening upon this relationship requires a nuanced understanding of the specific aspects of masculine norms that shape men's sexual behaviors. We integrate theories on masculinities with empirical HIV research to identify specific dimensions of masculine norms that influence men's HIV-related sexual behaviors. We identify three major dimensions of masculine norms that shape men's sexual behavior: (1) uncontrollable male sex drive, (2) capacity to perform sexually, and (3) power over others. While the existing literature does help explain the relationship between masculine norms and men's sexual behaviors several gaps remain including: a recognition of context-specific masculinities, an interrogation of the positive influences of masculinity, adoption of an intersectional approach, assessment of changes in norms and behaviors over time, and rigorous evaluations of gender-transformative approaches. Addressing these gaps in future research may optimize prevention efforts.
    Full-text · Article · Dec 2015 · AIDS and Behavior
  • Andrea Swartzendruber · Jessica M Sales · Eve S Rose · Ralph J DiClemente
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    ABSTRACT: Studies have documented high levels of alcohol use and sexual risk among young mothers. We examined parenting satisfaction and self-efficacy in relation to alcohol use problems and sexual risk among 346 young African American women enrolled in an HIV prevention trial, 41 % (n = 141) of whom were mothers. Among mothers, greater parenting satisfaction was associated with a reduced likelihood of problematic alcohol use, having multiple sex partners, and testing positive for Trichomonas vaginalis. Relative to non-parenting women, mothers reported lower condom use. Compared to non-parenting women, mothers with the highest parenting satisfaction reported fewer alcohol use problems; mothers with the lowest parenting satisfaction reported lower condom use and were more likely to have multiple partners and test positive for T. vaginalis. Parenting self-efficacy was not associated with the outcomes examined. Future research investigating relationships between parenting satisfaction, alcohol use and sexual risk may be useful for improving multiple maternal health outcomes.
    No preview · Article · Oct 2015 · AIDS and Behavior
  • Ralph J DiClemente
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    ABSTRACT: Adolescents have high rates of sexually transmitted infections (STIs). Adolescents consuming alcohol and using drugs have markedly greater HIV/STI risk and are a priority population for intervention. Accurate measurement of sexual risk behavior is critical for understanding individual's risk for HIV/STI, transmission dynamics of HIV/STI, and evaluating the efficacy of interventions designed reduce HIV/STI risk. However, significant challenges to accurately measuring adolescents' self-reported sexual behavior are well-documented. Recent advances in microbiology, such as the use of less invasive specimen collection for DNA assays, can assist researchers in more accurately measuring adolescents' sexual risk behavior. However, the majority of studies of adolescents' sexual risk rely solely on self-reported behavior; therefore, methods to improve the validity of adolescents' self-reported sexual behavior are needed. In addition, integrating biologic measures to complement self-reported measures are recommended, when appropriate and feasible.
    No preview · Article · Oct 2015 · AIDS and Behavior
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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.
    Full-text · Article · Sep 2015 · Human Vaccines & Immunotherapeutics
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    Full-text · Dataset · Sep 2015
  • 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.
    No preview · Article · Sep 2015 · Journal of Child and Family Studies
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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.
    Full-text · Article · Aug 2015 · Health Education & Behavior
  • Jennifer L Brown · Ralph J DiClemente

    No preview · Article · Aug 2015 · PEDIATRICS
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    Preview · Article · Aug 2015 · Implementation Science

  • No preview · Article · Jul 2015 · Journal of Family Studies
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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.
    No preview · Article · Jun 2015 · Sexual Health
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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.
    Full-text · Article · Jun 2015 · Behavioral Medicine
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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.
    No preview · Article · Jun 2015 · Journal of HIV/AIDS & Social Services
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    Full-text · Article · Jun 2015 · Annals of Epidemiology

  • No preview · Article · Jun 2015 · Annals of Epidemiology
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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.
    Full-text · Article · May 2015 · Sexual Health
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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.
    No preview · Article · May 2015 · Human Vaccines & Immunotherapeutics
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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.
    No preview · Article · May 2015 · Archives of Sexual Behavior
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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.
    Full-text · Article · Apr 2015 · Human Vaccines & Immunotherapeutics

Publication Stats

12k Citations
1,204.22 Total Impact Points


  • 2015
    • University of Guelph
      XIA, Ontario, Canada
  • 1998-2015
    • Emory University
      • • Department of Behavioral Sciences and Health Education
      • • School of Medicine
      • • Department of Pathology and Laboratory Medicine
      Atlanta, Georgia, United States
  • 2007-2014
    • Indiana University Bloomington
      • Rural Center for AIDS/STD Prevention
      Bloomington, Indiana, United States
  • 2013
    • Morehouse School of Medicine
      Atlanta, Georgia, United States
  • 2012-2013
    • United States Army Medical Research Institute for Infectious Diseases
      Фредерик, Maryland, United States
  • 2006-2012
    • University of Chicago
      • • STI and HIV Intervention Network
      • • School of Social Service Administration
      Chicago, Illinois, United States
  • 2011
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2010
    • University of Georgia
      • Center for Family Research
      Атина, 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
  • 1994-2003
    • University of Alabama at Birmingham
      • • Department of Pediatrics
      • • Department of Medicine
      • • Department of Health Behavior
      Birmingham, Alabama, United States
    • University of California, Los Angeles
      Los Ángeles, California, 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
  • 1991-1997
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 1996
    • University of Alabama
      Tuscaloosa, Alabama, United States
  • 1992-1993
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States
    • University of California, San Francisco
      • Center for AIDS Prevention Studies
      San Francisco, California, United States