Ralph DiClemente

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Professor of Social and Behavioral Sciences

Dr. Ralph DiClemente was trained as a Health Psychologist at the University of California, San Francisco where he received his PhD in 1984 after completing a ScM at the Harvard School of Public Health. He earned his undergraduate degree at the City University of New York.

Dr. DiClemente’s research has four key foci:

Developing interventions to reduce the risk of HIV/STD among vulnerable populations
Developing interventions to enhance vaccine uptake among high-risk adolescents and women, such as HPV and influenza vaccine
Developing implementation science interventions to enhance the uptake, adoption and sustainability of HIV/STD prevention programs in the community
Developing diabetes screening and behavior change interventions to identify people with diabetes who are unaware of their disease status as well as reduce the risk of diabetes among vulnerable populations.

He has focused on developing intervention packages that blend community and technology-based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability.

Dr. DiClemente is the author of ten CDC-defined, evidence-based interventions for adolescents and young African-American women and men. He is the author of more than 540 peer-review publications, 150 book chapters, and 21 books. He serves as a member of the Office of AIDS Research Advisory Council.

Previously, Dr. DiClemente served as the Charles Howard Candler Professor of Public Health at the Rollins School of Public Health at Emory University. He was also Associate Director of the Center for AIDS Research, and was previously Chair of the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health.

Dr. DiClemente is Past President of the Georgia chapter of the Society for Adolescent Health & Medicine. He previously served as a member of the CDC Board of Scientific Counselors, and the NIMH Advisory Council.

Education

BA, The City College of the City University of New York (CCNY), New York, NY

ScM, Behavioral Sciences, Harvard University, Cambridge, MA

PhD, Health Psychology, University of California San Francisco Center for Behavioral Sciences, San Francisco, CA

Postdoctoral Fellow, University of California, San Francisco, CA

Areas of research and study

Community Interventions

Diabetes

HIV/AIDS

Implementation science

Influenza

Psychology

Publications

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities

DiClemente, R. J., Brown, L. K., Beausoleil, N. I., & Lodico, M. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

231-236

10.1016/1054-139X(93)90011-D

Abstract

Abstract

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Confronting the Challenge of AIDS among Adolescents: Directions for Future Research

DiClemente, R. J. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Research

Volume

Issue

Page(s)

156-166

10.1177/074355489382002

Abstract

Abstract

To effectively combat the AIDS health crisis among adolescents, future research must address three key issues: (a) the risk of disease for culturally differing adolescent populations, particularly African-American adolescents; (b) the need for empirical investigations to identify and understand the variables influencing adolescents ‘adoption of HIV-preventive sexual practices; and (c) the development of more effective prevention programs to reduce adolescents’ existing HIV-associated risk behaviors. This article reviews the relevance of these issues for prevention research and suggests policy recommendations. These recommendations argue for: (a) expanded funding for basic behavioral surveys to identify the prevalence of risk-taking behavior among adolescents in general, and among high-risk adolescent subgroups, for example, incarcerated and homeless adolescents; (b) encouraging more epidemiologic and ethnographic research to understand the psychosocial and cultural variables associated with high and low-risk behavior among understudied and underserved racial/ethnic populations such as African-American adolescents; and (c) urging that evaluation of HIV prevention programs include multisite trials and larger samples in ethnically and geographically diverse populations.

Factors associated with multiple sex partners among junior high school students

Durbin, M., DiClemente, R. J., Siegel, D., Krasnovsky, F., Lazarus, N., & Camacho, T. (n.d.).

Publication year

1993

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

202-207

10.1016/1054-139X(93)90006-B

Abstract

Abstract

Twenty-one percent of a sample of inner-city junior high school students were found to be sexually active (n = 403). Only 31% of them reported a single lifetime sexual partner, 25% reported two partners, and 43% reported three or more partners. Logistic regression analysis evaluated the influence of demographic, psychosocial, and behavioral factors on the adolescents' lifetime number of sex partners. Respondents whose sexual debut occurred before age 13 years were nine times more likely to report three or more sex partners compared with those whose first sexual intercourse was at age 15 or 16 years, blacks were four times more likely than non-Hispanic whites to report three or more sex partners; and males were four times as likely as females to report this number of sexual partners. Factors not independently associated with the number of sex partners included: age, Asian or Hispanic ethnicity, human immunodeficiency virus (HIV) knowledge, self-efficacy (belief that one can protect oneself from the virus), condom use, and alcohol and drug use. We conclude that a significant proportion of school-based middle adolescents are sexually active and that most of these are at risk for contracting HIV because of behaviors such as having multiple sexual partners. Topics often stressed in school-based HIV education, such as factual knowledge about HIV, avoiding drugs and alcohol, and condom use are not associated with adolescents' choice about their number of sex partners. Intervention programs will have to identify and then target each specific HIV risk behavior and its motivations in order to reduce adolescents' risks of contracting and transmitting the disease.

HIV knowledge, communication, and risk behaviors among white, Chinese-, and Filipino-American adolescents in a high-prevalence AIDS epicenter: a comparative analysis.

Horan, P. F., & DiClemente, R. J. (n.d.).

Publication year

1993

Journal title

Ethnicity & disease

Volume

Issue

Page(s)

97-105

Abstract

Abstract

We conducted a comparative analysis of human immunodeficiency virus (HIV) knowledge, communication, and risk behaviors among 1272 white, Chinese-, and Filipino-American 10th and 11th graders in San Francisco, California, a high-prevalence AIDS epicenter. We performed principal components analysis on an epidemiologic survey instrument, and we identified five factors: HIV prevention knowledge, sexual behavior risk index, drug use risk index, HIV misconceptions, and communication about HIV. White students had higher HIV prevention scores than did Chinese and Filipino students, and whites had significantly greater ability to communicate with others about HIV disease and prevention. Chinese- and Filipino-American students had fewer misconceptions about HIV than did white students. Ethnicity did not have a significant influence on sexual behavior or drug use risk indices. Findings are discussed with reference to culturally sensitive HIV education.

HIV-related risk behaviors among psychiatrically hospitalized adolescents and school-based adolescents

DiClemente, R. J., & Ponton, L. E. (n.d.).

Publication year

1993

Journal title

American Journal of Psychiatry

Volume

150

Issue

Page(s)

324-325

Abstract

Abstract

The authors compared the responses of 76 adolescents on an inpatient psychiatric service with those of 802 school-based adolescents in the same city regarding HIV risk behaviors. The psychiatrically hospitalized adolescents reported a significantly higher rate of sexual and drug-related behaviors that involve a risk for contracting sexually transmitted disease, including HIV-related illnesses.

Preventing HIV/AIDS Among Adolescents: Schools as Agents of Behavior Change

The effects of child abuse and race on risk-taking in male adolescents.

The Relationship of Magic Johnson's Announcement of HIV Infection to the AIDS Attitudes of Junior High School Students

Child Sexual Abuse of Asians Compared with Other Populations

RAO, K., DICLEMENTE, R. J., & PONTON, L. E. (n.d.).

Publication year

1992

Journal title

Journal of the American Academy of Child and Adolescent Psychiatry

Volume

Issue

Page(s)

880-886

10.1097/00004583-199209000-00016

Abstract

Abstract

This retrospective chart review study of a child sexual abuse clinic compared a consecutive sample of substantiated sexual abuse cases of Asian victims with random samples of black, white, and Hispanic victims. The findings suggest that there are clinically relevant differences between Asians and the other three populations. Asian victims showed a distinct demographic profile, suffered less physically invasive forms of abuse, were more likely to express suicidality, less likely to display anger and sexual acting out, and had less supportive primary caretakers than non-Asians. Awareness of such ethnic differences will help clinicians better evaluate and treat minority victims.

Comparison of human immunodeficiency virus related knowledge, attitudes, intentions, and behaviors among sexually active and abstinent young adolescents

Brown, L. K., DiClemente, R. J., & Beausoleil, N. I. (n.d.).

Publication year

1992

Journal title

Journal of Adolescent Health

Volume

Issue

Page(s)

140-145

10.1016/1054-139X(92)90081-L

Abstract

Abstract

Although young sexually active adolescents are at greater risk for human immunodeficiency virus (HIV) acquisition than their abstinent peers, little is known about their respective HIV-related knowledge, attitudes, and general risk behaviors. This study of middle school adolescents (n = 1379; mean age, 13.2 years) found that the sexually active boys, compared with their peers, were less knowledgeable about HIV, less fearful of HIV, less tolerant of people with acquired immunodeficiency syndrome (AIDS), riskier in non-HIV-related attitudes and had a greater history of other risk behavior. A similar, but less marked pattern, was found for girls. It is suggested that physicians counsel all adolescents about HIV and sexuality during office visits and that early adolescent sexuality should prompt special efforts in HIV education/ counseling.

Confronting the challenge of AIDS in the African-American community.

Cultural, gender, and psychosocial influences on HIV-related behavior of African-American female adolescents: implications for the development of tailored prevention programs.

Wingood, G. M., & DiClemente, R. J. (n.d.).

Publication year

1992

Journal title

Ethnicity & disease

Volume

Issue

Page(s)

381-388

Abstract

Abstract

This paper presents epidemiologic data describing the risk of HIV/AIDS and sexually transmitted diseases for African-American female adolescents relative to their white peers. Diverse cultural, psychosocial, and gender influences affect behavior; these should be considered in the development and implementation of culturally sensitive HIV prevention interventions tailored toward African-American female adolescents. These influences include sex-role socialization issues, the African-American family; issues related to racial identity; communication styles common among African-American youth; normative influences in adolescent heterosexual relationships; and factors affecting feelings of self-efficacy, empowerment, and gender rules in the African-American female adolescent. Strategies for incorporating cultural, psychosocial, and gender influences into the development of HIV risk-reduction interventions are suggested. Culturally specific interventions tailored toward this population may be more effective at motivating the adoption and maintenance of HIV-preventive behaviors.

Determinants of condom use among junior high school students in a minority, inner-city school district

Epidemiology of AIDS, HIV Prevalence, and HIV Incidence Among Adolescents

DiClemente, R. J. (n.d.).

Publication year

1992

Journal title

Journal of School Health

Volume

Issue

Page(s)

325-330

10.1111/j.1746-1561.1992.tb01251.x

Abstract

Abstract

ABSTRACT: Health educators, policy analysts, and public health officials are becoming more aware of the serious threat HIV poses to the health of U.S. adolescents. While AIDS among adolescents remains relatively uncommon, considerable data indicates this age group has alarmingly high HIV infection rates and that minority adolescents are at disproportionately greater risk of HIV infection relative to their White peers. Recent seroconversion studies of active duty military personnel indicate that the number of new HIV infections (incident cases) are especially high among Black adolescents. Findings suggest the urgent need for more tailored HIV prevention programs, especially gender‐ and ethnic‐specific programs. 1992 American School Health Association

HIV/AIDS education and prevention among African-Americans: A focus on culture

Airhihenbuwa, C. O., DiClemente, R. J., Wingood, G. M., & Lowe, A. (n.d.).

Publication year

1992

Journal title

AIDS Education and Prevention

Volume

Issue

Page(s)

267-276

Abstract

Abstract

African-Americans have emerged as the 'second wave' of the AIDS epidemic. Epidemiologic evidence indicates that African-Americans adults as well as adolescents have a disproportionately higher risk of AIDS and human immunodeficiency virus (HIV) infection. While programs designed to increase self-protective behaviors are urgently needed to avert a further increase in HIV infection among this population, there is little understanding of African-American sociocultural factors that may influence the acceptance of HIV information and the adoption of HIV-preventive behaviors. This paper describes African-American cultural values and mores which may be related to risk-taking behavior. Barriers to the effective dissemination of HIV prevention education are identified and strategies that may be effective in surmounting these barriers and implementing culturally-appropriate HIV behavioral modification programs are described.

Moral reasoning and unprotected sex among young men

Hernandez, J., & Diclemente, R. J. (n.d.).

Publication year

1992

Journal title

Journal of Health Education

Volume

Issue

Page(s)

347-351

10.1080/10556699.1992.10616314

Abstract

Abstract

This study examined the influence of moral reasoning on young men’s HIV-related sexual risk behaviors, specifically unprotected sexual intercourse. It was hypothesized that those with higher stage moral reasoning will be more likely to practice safe sex. Male college students completed a measure of moral reasoning and a self-report questionnaire assessing sexual behavior. Those scoring high on moral reasoning reported significantly fewer incidents of unprotected sex and more respect for partners who wanted to practice safe sex. They also had fewer sex partners, reported fewer pick-ups, and their sexual motivation on dates was lower (the latter comparisons did not reach levels of significance). That students engage in risky sexual practices less when they use higher levels of moral reasoning is important to the health education discipline’s effort to promote safer sex. It speaks to incorporating training in higher levels of moral reasoning into sex education curricula, for example, by presenting moral sexual dilemmas for classroom discussion. The moral dilemma approach stimulates students to progress more rapidly through their own natural course of moral development, and summarily provides them with the tools to make responsible decisions about sexual behaviors.

Predictors of condom use in sexually active adolescents

Self-control and ego identity development as predictors of unprotected sex in late adolescent males

Hernandez, J. T., & Diclemente, R. J. (n.d.).

Publication year

1992

Journal title

Journal of Adolescence

Volume

Issue

Page(s)

437-447

10.1016/0140-1971(92)90073-E

Abstract

Abstract

Male college students completed an anonymous self-report questionnaire assessing HIV-related knowledge, attitudes, moral development, personality factors and behaviors. Bivariate analyses were used to identify factors associated with high-risk sexual intercourse. Significant demographic psychosocial and behavioral predictors were entered into a logistic regression analysis to evaluate the independent influence of each predictor on unprotected sexual intercourse. Behavioral factors were the most powerful predictors of unprotected sexual intercourse. Adolescents reporting multiple sex partners, drinking and picking-up sex partners were significantly more likely to engage in sex without condoms. Examining psychosocial factors alone, it was found that adolescents who had low scores for ego-development (goal-directedness) and self-control were significantly more likely to engage in sex without condoms. Identification of two personality constructs as underlying predictors of high-risk behavior, while potentially important for the development of effective HIV prevention programs, needs corroboration to further define the interrelationships between these factors and other psychosocial constructs.

An AIDS education and Prevention Program for hospitalized adolescents

Ponton, L. E., DiClemente, R. J., & McKenna, S. (n.d.).

Publication year

1991

Journal title

Journal of the American Academy of Child and Adolescent Psychiatry

Volume

Issue

Page(s)

729-734

10.1016/S0890-8567(10)80006-1

Abstract

Abstract

This paper describes the development of a human immunodeficiency virus Prevention Program for a University-based adolescent psychiatric unit. The intervention spans 8 days with components in school, activity therapies, and a specific group that teaches sexual education. Important aspects that have contributed to the success of this intervention include its integration into a general sex education program, the utilization of the psychiatric milieu for promotion of the intervention, the participation of a person with acquired immune deficiency syndrome (AIDS) in the educational process, “high tech” components, such as attractive well-designed videos, and assessment and evaluation. The importance of AIDS education for psychiatrically hospitalized adolescents will be further elaborated.

Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public school sample in San Francisco

DiClemente, R. J., Lanier, M. M., Horan, P. F., & Lodico, M. (n.d.).

Publication year

1991

Journal title

American journal of public health

Volume

Issue

Page(s)

628-630

10.2105/AJPH.81.5.628

Abstract

Abstract

Data collected from incarcerated youth (n = 113) and a public school sample (n = 802) demonstrate that both adolescent groups have a high level of AIDS knowledge. Incarcerated youth are less aware of HIV risk-reduction behaviors and report markedly higher rates of HIV risk behaviors. Incarcerated youth are at substantially increased risk of HIV infection relative to their school-based counterparts and should be a primary target of HIV prevention programs.

HIV knowledge and behaviors of incarcerated youth: A comparison of high and low risk locales

Lanier, M. M., Diclemente, R. J., & Horan, P. F. (n.d.).

Publication year

1991

Journal title

Journal of Criminal Justice

Volume

Issue

Page(s)

257-262

10.1016/0047-2352(91)90004-F

Abstract

Abstract

Incarcerated adolescents comprise a group at high risk of HIV infection because they engage in substantially more HIV-related sexual and drug behaviors than the general adolescent population. There is, however, little information on similarities and differences between adolescents incarcerated in high AIDS-prevalence geographic areas with those from low AIDS-prevalence areas. This study compared adolescents incarcerated in juvenile detention facilities in San Francisco (N = 113) and Alabama (N = 393) with respect to HIV-related knowledge, attitudes, and risk behaviors. While findings indicated that the two groups' overall knowledge levels were relatively similar, adolescents in San Francisco reported a higher prevalence of risk behaviors. These findings are discussed in terms of the development and implementation of HIV prevention programs specifically targeted toward incarcerated youths and stressing adoption of realistic risk-reduction strategies.

HIV prevention for adolescents: Utility of the health belief model

Brown, L. K., DiClemente, R. J., & Reynolds, L. A. (n.d.).

Publication year

1991

Journal title

AIDS Education and Prevention

Volume

Issue

Page(s)

50-59

Abstract

Abstract

The Health Belief Model (HBM) has been applied to diverse sets of health behaviors. Research that suggests difficulties of the HBM in predicting future behaviors, especially HIV-related, is reviewed. Prominent features of adolescence that influence HIV-related risk behaviors are discussed including: cognitive immaturity, struggle for psychological autonomy, peer influences, and physical development. It is suggested that a model is needed to guide prevention efforts, and that these adolescent-specific factors need to be incorporated into any such model.

Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: The influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms

Prevalence and correlates of cutting behavior: Risk for HIV transmission

DiClemente, R. J., Ponton, L. E., & Hartley, D. (n.d.).

Publication year

1991

Journal title

Journal of the American Academy of Child and Adolescent Psychiatry

Volume

Issue

Page(s)

735-739

10.1016/S0890-8567(10)80007-3

Abstract

Abstract

The prevalence of cutting behavior among a population of 76 psychiatrically hospitalized adolescents was found to be 61.2%. The frequency ranged from a single occasion to over 50 instances, with a mean of 9.9 occasions. Increased self-mutilation was not found to be associated with gender, age, ethnicity, or primary psychiatric diagnosis. A significant association was identified between adolescents who report forced sex and those who report cutting behavior. Approximately 26.7% of those reporting this behavior also report sharing cutting implements with other adolescents. This article raises concern about this behavior as it relates to the transmission of human immunodeficiency virus and makes recommendations for clinicians treating this population.

Ralph DiClemente