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

Participants: Kees Rietmeijer, MD, PhD

Lee Warner, PhD

Safe in the City Video Intervention

Intro Music

Kees Rietmeijer, MD, PhD: "The latest issue of Plos Medicine features an article that 

reports on the outcomes of a large STD prevention trial called 'Safe in the City.' 

This study evaluates the efficacy of a specially designed video to be shown in 

STD clinic waiting rooms. Here to discuss the study intervention and the study 

results is the article's lead author, Dr. Lee Warner. Dr. Warner is a senior scientist 

at the division for reproductive health at the Centers for Disease Control and 

Prevention in Atlanta.

"Welcome, Lee."

Lee Warner, PhD: "Thank you for having me, Kees."

Kees Rietmeijer, MD, PhD: "First, tell us a little bit more about the intervention and 

how it was developed."

Lee Warner, PhD: "The intervention is called 'Safe in the City,' it's a 23 minute video 

designed for STD clinic waiting rooms. And when we first decided to do this 

project, we were trying to think of what type of intervention could be 

implemented in waiting rooms that did not require any clinician's time, required 

minimal resources, and could be easily implemented."

Kees Rietmeijer, MD, PhD: "And so how did you go about, sort of, developing the 

video?"

Lee Warner, PhD: "Well once we decided to develop a video, what we did was 

contracted with a producer in New York, and given that the video was going to be 

the entire intervention, this thing had to look good...had to be visually appealing 

and entertaining, yet impart STD prevention messages for patients." 

Kees Rietmeijer, MD, PhD: "You also did focus groups, right? With STD clinic 

patients?"

Lee Warner, PhD: "We did 15 focus groups with nearly 200 patients. Running story 

lines by them, ideas for characters, as well as the final production cut."

Kees Rietmeijer, MD, PhD: "So, what's the content of the video?"
Lee Warner, PhD: "In the 23 minute video, there are three vignettes that portray 

characters in different types of sexual relationships. Some are new dating 

relationships, some are casual dating relationships, and there are characters of 

different racial and ethnic backgrounds, and different sexual orientations trying to 

negotiate condom use."

Kees Rietmeijer, MD, PhD: "So these are kind of soap opera-type vignettes, right?"

Lee Warner, PhD: "That's correct. And the way we've constructed the video, there's 

three...the three vignettes are each around five to 10 minutes in length, such that if 

a patient were to come into the waiting room in the middle, they could see part of 

the video, yet still benefit from it."

Kees Rietmeijer, MD, PhD: "And there are also two cartoons that are also sort of 

interspersed within these storylines...."

Lee Warner, PhD: "And these are almost like commercials, you're right. The first 

cartoon character, showing and demonstrating the types of condoms that are 

available in different retail stores throughout the US, so patients can learn about 

the different types of condoms and varieties that are available to them. And the 

second cartoon shows how to use a condom, where the cartoon character, in an 

animated sense shows, how one would be used on himself."

Kees Rietmeijer, MD, PhD: "So when you put the video together, it was actually 

evaluated in a large scale study. Could you say something about how this 

intervention was evaluated?"

Lee Warner, PhD: "Once we developed the intervention, and felt like we had a good 

product that would be a stand-alone video and would be effective, we had to 

figure out how to evaluate it. And what we did was followed nearly 40,000 STD 

clinic patients in three cities, Denver, San Francisco, and Long Beach, and in 

which, the video was shown in alternating months in the clinic. So the first 

month, there would be whatever was typically in the waiting room. That might be 

CNN; it might be nothing on TV or music. And in the alternating month, we'd 

show 'Safe in the City' in the waiting room, on a TV for patients to view."

Kees Rietmeijer, MD, PhD: "How did you then follow these patients?"

Lee Warner, PhD: "Well, once we'd repeated that cycle of showing and not showing it, 

approximately a dozen times, we followed all those patients up passively, to find 

out what the rates of STD's were in both groups."

Kees Rietmeijer, MD, PhD: "So, what did you find?"

Lee Warner, PhD: "Well, one other point that I'd like to make is that this is really a 

structural intervention, and this is the real-world effectiveness of the study. This 
is what would happen if you showed it in a clinic atmosphere - no patients were 

actually enrolled in the study. We followed them up passively, and what we 

found was that patients that were exposed to the video had approximately a 10 

percent reduction in their rates of STD's compared with those exposed to the 

standard waiting room condition, with most of the reductions being in Gonorrhea 

and Chlamydia."

Kees Rietmeijer, MD, PhD: "So, that's pretty significant finding...."

Lee Warner, PhD: "It is for just showing a brief 23 minute video that requires no 

clinician interaction, no group counseling or individual sessions."

Kees Rietmeijer, MD, PhD: "Congratulations - That's phenomenal! What are the next 

steps?"

Lee Warner, PhD: "I think our next step is, now that we have a great product that we 

think can be easily implemented, is to get the product out. We've got scientific 

evidence that not only do we have a great video, that this video is effective at 

reducing incident STD's. And so we're planning to roll this video out, by having 

STD clinic in the United States having a copy of this. And we're working to set 

up technical assistance and training, so there are able to show this video in their 

clinics."

Kees Rietmeijer, MD, PhD: "Well, good luck with that, and thank you for being with 

us."

Lee Warner, PhD: "Thank you very much, Kees."

Outro Music

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