STD Prevention Online Podcast (Hosted by Kees Rietmeijer, MD, PhD)

Participants: Mary McFarlane, PhD

John Douglas, MD

Safe in the City Video Intervention

Intro Music

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%. 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 its 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 with something that is, in most circumstances, this easy to 

implement, actually has a measurable and significant impact at a very carefully 

done trial. This is an intervention that is low-cost, easily implimentable, 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 is 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 are more complicated interventions involving videos that 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 is 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 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, you know, when we think of 

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 uh, we're really excited about it, and we're planning a 

number of processes to first communicate the results to our partners in the fields, 

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 website, 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."

Outro Music

5:06