An Outcome Evaluation of the Internet Alert Project

1. An Outcome Evaluation of the Internet Alert Project Rachel Kachur Mary McFarlane Steve Middlekauff Centers for Disease Control & Prevention 2004 National STD Prevention Conference Philadelphia, PA

2. Description of an Alert Compilation of sexually explicit information Events Couples seeking couples XXX Bookstores, Arcades & Theatres Cruising sites Bath houses, sex clubs, private parties, and backrooms Support groups, social organizations, CBOs

3. Background • 2000 JAMA article identified the Internet as a newly emerging venue for STD transmission* • Creation of project to provide other wise restricted information to CDC & in-field staff about high-risk sexual behaviors advertised on-line • Alerts provided to 19 project areas across the country and on an as-needed basis *McFarlane, M, Bull, S & Rietmeijer, C. (2000). The Internet as a newly emerging risk environment for sexually transmitted diseases. JAMA, 284 (4), 443-446.

4. Information to be found on the Internet • “…try chaps for raunchy, dirty sex - all ages, races, sizes. prefer pretty boy types for sex - try eagle prefer stand and model [s+m] try the ramrod. like raunchy but restrained, try boots...” • “…bathhouse on oakland park - raunchy, a bit dirty, a lot of hot sex…” • “…avoid park in wilton manors - homophobic gay mayor has the place conrolled [sic] by hidden videos.”

5. Main Objectives of the Evaluation • Usefulness of the alerts • Knowledge change among recipients • Change in awareness

6. Secondary Objectives • Public health activities • Ways to improve/tailor the alerts • Impact if project were discontinued

7. Methods • 19 item quantitative survey with open-ended questions • Qualitative interview with field staff • Survey was provided either as a Word document or as an on-line survey • Survey was emailed to 26 alert recipients (CDC=11, Field Staff = 15) with instructions to pass the survey on to relevant people • Quantitative data analyzed using SPSS • Qualitative data analyzed for salient themes

8. Survey results N=14 (~54%) CDC HQ = 4 Field staff = 10 Although not every city was represented, at least one person responded from each of the six states that receive alerts Qualitative follow – up 15 field staff contacted 6 (40%) responded and completed the interview Results

9. Results - Usefulness • N = 13 (~93%) found the alerts useful • Current events and activities • Access to restricted information • Target outreach & testing • Pinpoint outbreaks • Collaborations

10. “ The alerts provide detailed information that is useful for DIS and outreach workers to become desensitized to the activities and to become more knowledgeable to be able to increase trust and credibility with clients. If one can ‘talk the talk’, they have a much easier time working with clients.”

11. Results – Knowledge Change • N = 12 (~86%) reported an increase in knowledge “The alerts indicated that there was quite a bit more club sex going on in our area than we had previously believed. The fact that the alert came from the CDC added more validity to the report, and made our health commissioner regard it as more than our whim.”

12. Results - Awareness • All respondents were aware of the Internet as a sexual venue “I was not aware of some of the specific locales of anonymous venues – like a particular JC Penny store, or a specific bank building.”

13. Results – caveat • One city did not find the alerts to be useful or helpful due to: • Full internet access • Use of internet as a public health tool • Aware and informed staff • Liberal political environment • Extremely active community

14. Results – How the information is being used • Raises awareness of and sensitizes the DIS and outreach workers to the behaviors and activities of target populations • Increases knowledge increases credibility revealed information • Drives outreach & counseling and testing to previously unknown venues • Establishment of collaborations • Recommendations for funding • Checks & balances • Credibility

15. Results - Impact • N = 10 (~71%) would be negatively impacted if they were to stop receiving the alerts • Stated reasons: • Inability to access pertinent information • Loss of valuable & useful information • One less tool available

16. Changes made to the Project • 3 month calendar • Alerts-at-a-glance • Tailoring information to a target population • Potential action steps

17. Conclusions • The Alert project is useful to its participants • Increases knowledge of participants • Drives public health efforts • The project is meeting its intended objectives • If the project were to be discontinued, participants would be negatively impacted

18. Recommendations • Continue the project until local & state level can implement a similar project • Advocate for computers • Advocate for full-internet access and monitoring at the local level • Train local level officials in computer and Internet use • Provide additional trainings and technical support

19. Contact Information • Rachel E. Kachur • rlk4@cdc.gov • (404) 639-2387