Safe in the City: Intervention for STD Clinics and Prevention Programs
In this podcast, Dr. John Douglas talks with Dr. Mary McFarlane about the importance of the Safe in the City intervention for STD clinics and STD prevention programs. Created: 6/17/2008 by National Center for HIV/AIDS, Viral Hepatitis STD and TB Prevention (NCHHSTP).
Date Released: 7/11/2008. Series Name: CDC Featured Podcasts.
This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.
[Mary McFarlane, PhD] Recently PLoS Medicine Published a report by the Safe in the City Project demonstrating that a 23-minute video shown in STD clinic waiting rooms was able to reduce new sexually transmitted diseases by close to 10 percent. The video is comprised of three soap opera-style vignettes of couples negotiating condom use, and also has two cartoons about the proper use and selection of condoms. The study involved close to 40,000 STD clinic patients in three STD clinics in the United States and took three years to complete. We discuss the study with Dr. John Douglas, who is the director of the Division of STD Prevention at the Centers for Disease Control and Prevention in Atlanta. Dr. Douglas, why is this an important study?
[John Douglas, MD] This is really an important study because it’s one of our first and most careful looks at a commonly available technology which are video tapes being played in settings where patients are collected, i.e., a waiting room, and documenting that something that is, in most circumstances, this easy to implement, actually has a measurable and significant impact in a very carefully done trial. This is an intervention that is low-cost, easily implementable, and potentially has high levels of coverage in one of the most important target populations for STD prevention programs, individuals seeking care in STD clinics. We have previously known that more complicated interventions, such as those combining videos and waiting room discussion can have an impact, but those are really cumbersome to implement. And to have proof that something that is this simple, that’s really within the reach of most STD clinics, can have this kind of impact, is really a remarkable finding.
[Mary McFarlane, PhD] Were you surprised that just showing a brief video like this in a waiting room could have this effect?
[John Douglas, MD] Well, yes and no. No, because we have had data from other studies that a more complicated intervention involving videos could have an impact, and also no because vignettes like this are used in various forms for marketing, and there is plenty of marketing research in other settings that these sorts of ways of communicating to target audiences can be impactful. But I think the surprise was that something that was this simple and short - it was 23 minutes or so - actually could be documented to have an impact this large. This is not the equivalent of a vaccine by any means, but to have something that was this broadly active in people exposed to the intervention is really striking.
[Mary McFarlane, PhD] On the other hand, the overall effect size of the intervention, of about 9%, seems to be rather small. Still, do you think this is important from a public health perspective, and if you think so, why?
[John Douglas, MD] Well, as I just alluded to, yeah, when we think of, you know, major interventions like vaccines, we expect them to be much more impactful than this. But, this is really analogous in some ways to what's been seen with interventions like doctors talking to patients about smoking. They're brief, they certainly don't convince everyone and convert everyone, but the fact that they can have this much of an impact when you multiply times the people exposed to it, I think is really the remarkable feature. And, from a public health perspective, where effectiveness times the coverage is really what measures the impact in the population, the easy implementability of this, I think, really enhances that multiplier effect.
[Mary McFarlane, PhD] What is your division planning to do with the video?
[John Douglas, MD] Well we're, we're really excited about it, and we're planning a number of processes to first communicate the results to our partners in the field, specifically STD prevention programs who work with STD clinics. We're encouraging our programs to look into the purchases of the minimum technology needed to implement this, partnering with colleagues in the HIV Prevention Division, the videos, or rather, the DVD's themselves, are going to be made widely available, and our staff is prepared to provide both technical assistance and logistical support to try to implement these things.
[Kees Rietmeijer, MD, PhD] Mary MacFarlane spoke with Dr. John Douglas, the Director of the Division of STD Prevention, in his office at the Centers for Disease Control and Prevention in Atlanta. In a separate STD podcast on this site, we interview Dr. Lee Warner, the lead author of the PLoS Medicine article reporting on the Safe in the City study.
More information about the Safe in the City project can be found on this site, and also on www.safeinthecity.org.
The producer of this STD podcast is Ben Westergaard, at the Internet and STD Center of Excellence.
Thanks for your interest, and see you again soon on STD Prevention Online.
[Announcer] For the most accurate health information, visit www.cdc.gov or call 1-800-CDC-INFO, 24/7.