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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
STD clinic patients Goals of Intervention
- Prevent new STD infections
Brief Description
Safe in the City is a
single-session, video-based
intervention for diverse STD clinic
patients. The intervention involves
the presentation of a 23-minute
STD/HIV prevention video to patients
in an STD clinic waiting room. The
video contains key prevention
messages aimed at increasing
knowledge and perception of STD/HIV
risk, promoting positive attitudes
toward condom use, and building
self-efficacy and skills to
facilitate partner treatment, safer
sex, and the acquisition,
negotiation, and use of condoms. The
video contains three interwoven
vignettes that model negotiating
safer sexual behaviors among young
couples of diverse racial/ethnic
backgrounds and sexual orientations.
Animated segments demonstrate proper
condom use and the variety of
condoms available. Movie-style
posters in the waiting room and exam
rooms direct patients’ attention to
the video and reinforce key
messages. Condoms and educational
pamphlets on STD prevention are made
available to patients in the
clinics. |
Theoretic Basis
- Information-Motivation-Behavioral
Skills (IMB) Model
- Social Cognitive Theory
- Theory of Planned Behavior
Intervention Duration
A 23-minute video
Intervention Setting
Waiting rooms in public STD clinics
Deliverer
Video and posters
Delivery Methods
- Posters
- Printed materials
- Risk reduction supplies
(condoms)
- Video
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Intervention Package Information
The intervention package and training are
available through CDC’s
Diffusion of Effective Behavioral
Interventions (DEBI) project.
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Evaluation Study and Results
The original evaluation study was conducted in Denver, Colorado, and Long
Beach and San Francisco, California between, 2003 and 2005.
Key Intervention Effects
- Reduced new STD infections
Study Sample
The analytic study sample of 38,635
STD clinic patients is characterized by the
following:
- 46% White, 25% Hispanic, 18%
African American; 11% Other/missing
- 70% Male, 30% female
- 22% MSM, 31% of men are MSM
- 31% < 25 years old, 69% > 25
years old
Recruitment Settings
Waiting rooms in public STD clinics
Eligibility Criteria
Patients were eligible if they were
attending the STD clinics during the study
period.
Assignment Method
4-week blocks of time (N = 22) were assigned
to 1 of 2 groups: Safe in the City
Intervention (n = 11 blocks; 19073 patients)
or Standard STD Care comparison (n = 11
blocks; 19562 participants). Over 22 months,
11 identical eight-week cycles (4 weeks for
comparison and 4 weeks for intervention)
were conducted. The order of condition
assignment for the first cycle (i.e.,
Standard STD Care followed by Safe in the
City intervention) was randomly determined
by a coin toss. This order was maintained
throughout the trial in each clinic.
Comparison Group
The comparison group received the standard
STD clinic waiting room experience, in the
absence of the video and posters. This
condition differed by site and included
television programming, music or both.
Condoms and educational pamphlets on STD
prevention were available to all patients
throughout the study period.
Relevant Outcomes Measured and Follow-up Time
Incident STDs (including gonorrhea,
chlamydia, trichomoniasis [females only],
primary or secondary syphilis, and HIV
infection) were confirmed by laboratory
tests and measured between 4 to 24 months,
with an average of 14.8 months.
Participant Retention
Passive follow-up was conducted by reviewing patient’s clinic records
for incident STDs in follow-up clinic visits
and by matching patient record information
to county STD surveillance registries, which
suggested approximately 100% success rate of
matching medical records.
Significant Findings
- During the 14.8 months of follow-up,
significantly fewer new STDs were
diagnosed for patients receiving the
Safe in the City intervention than
patients receiving the standard STD care
(p < .05). The largest reductions in the
number of new infections were observed
for gonorrhea and Chlamydia.
- Significant intervention effects
were also found for the following
subgroups: male patients, patients > 25
years old, heterosexual men, and
patients with STD diagnoses at baseline
(all p's < .05).
Considerations
- Planned subgroup analyses did not
show any significant intervention effect
for females.
- This study was not powered to find
significant changes in number of new
STDs in each site when data were
analyzed by site.
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References and Contact Information
- Warner, L., Klausner, J. D.,
Rietmeijer, C. A., Malotte, C. K.,
O'Donnell, L., Margolis, A., et al.
(2008). Effect of a brief video
intervention on incident infection among
patients attending sexually transmitted
disease clinics. PLoS Medicine, 5(6),
919-927.
- Myint-U., A., Bull, S., Greenwood,
G. L., Reitmeijer, C. A., Vrungos, S.,
Warner, L., et al. (2008).
Safe in the City: Developing an
effective video-based intervention for
STD clinic waiting rooms.
Health Promotion Practice, in press.
Epub ahead of print retrieved June 12,
2008.
Researcher: Lee Warner
Centers for Disease Control and
Prevention, Division of Reproductive
Health
4770 Buford Highway, NE, MS
K-34
Atlanta, GA 30341
email:
dlw7@cdc.gov
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