The International Electronic Journal of Health Education

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IEJHE, Vol. 1(3), 151-156, July 1, 1998, Copyright 1998

Go Ask Alice!

Billie J. Lindsey, EdD, CHES1; Janet Kim, MS, MPH2
1 Lynchburg College
2 Columbia University

Corresponding author: Billie J. Lindsey, Ed.D, CHES, Department of Health, Movement Science, and Recreation, Lynchburg College, Lynchburg, VA; 24501; 804.544.8493 (phone), 804.544.8365 (fax), LINDSEY_B@MAIL.LYNCHBURG.EDU. Received June 15, 1998

Introduction
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"Powerhouse!" (American College of Physicians) "The Dear Abby of Health Care." (The Online Consumer Guide to Healthcare and Wellness) "Best of the Net for Content." (Global Network Navigator) One of "the 100 Internet sites no college student should live without." (Link: The College Magazine)


Little did any of us know during the first few months following Go Ask Alice!'s birth in August 1993 that she would grow to experience such wide popularity and respect, receiving accolades from the medical community, the health education profession, and countless individuals who link to Alice! and recommend her to their friends. In the beginning, it was early netizens who noticed and raved about Alice!, which was one of the first, if not the first, on-line health question and answer service in the country. In 1995, the site was nominated, in a company of four, for Best of the Net for Content by Global Network Navigator. It has remained in the Top 5% of all web sites year after year. To date, Alice! is accessed over 2 million times each month.

Since the early days of the web, Alice! has been recommended by the Harvard Health Letter, Consumer Reports, Dr. Tom Ferguson's Health On-line, Dr. Tom Linden's Guide to On-line Medicine, the Wall Street Journal, the New York Times, USA Today, Newsweek, Vogue, Men's Health, Details, and, strangely enough, Architectural Digest, to name a few. She was also featured on "NBC Nightly News" and "Good Morning America" and noted in the first college textbooks which recommended health-related web-sites. The following are examples of reviewers' comments:

"Although created for Columbia University students, the "Go Ask Alice" feature... is worthy of any young person's attention. This e-mail-based health question and answer forum focuses on common concerns, such as sex, drugs and alcohol, stress, body image, and other emotional issues with a refreshing lack of jargon or shyness. Site includes a searchable archive of past questions and answers." (A Health Explorer Best Site <http://medic.med.uth.tmc.edu>, January 1997)

"Apparently, this "Alice" person has been around the block a few times. This Health Q&A Service from Columbia University answers questions on sexuality, sexual health, and relationships. Users post their own questions... which are answered and stored here. Concise and forthright, this site is a strong interactive presence." (Link: The College Magazine <http://www.linkmag.com>, January - February 1997)

"Alice fields questions on health, relationships, stress, drugs, and other topics, and no inquiry is too sensitive, too sick, or too stupid: She's smart, funny, nonjudgmental, and serves it straight." <http://www.swoon.com/mag_rack/det ails.html>(Details May 1997)

"You have to admire a woman like Alice. She answers questions on everything from low protein diets to heroin use to the adverse effects of tattoo ink. Readers can submit questions on all sorts of health-related topics for Alice to answer. Alice does an excellent job of providing accurate responses to nutrition and fitness questions in an engaging manner." (Tufts University Health & Nutrition Letter and Nutrition Navigator Website <http://navigator.tufts.edu>, November 1997)

Alice! Is Born
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The idea for Go Ask Alice! germinated one late spring day in 1993 when the Columbia University Health Education staff (Richard Jazwinski, Deborah Levine, Judith Steinhart, and Director Billie Lindsey) discussed ways to utilize the Internet, which would become available to many students on the Columbia campus that fall. At that brainstorming meeting, we generated a list of possibilities: posting announcements about special health education events and on-going programs; promoting the medical and psychological services of the University Health Service; reprinting brochures, pamphlets, and our newsletter; and beginning a question and answer service, similar to Cornell University's "Ask Uncle Ezra," a student affairs service that responded to students' questions about the university.

The Columbia University Health Education home page did all of these things, but what became known as the sweetheart of the university, and our main focus, was the question and answer service, Go Ask Alice! Labeled irreverent by some, Alice! was, by nature and nurture, liberal, experienced, and sassy, as well as compassionate, caring, and humorous. In reality, Alice! was a composite of individuals who shared many of these traits. (By the way, naming the site Go Ask Alice! came to Billie Lindsey one summer night in Pennsylvania, and as much as we would like to credit the Jefferson Airplane, in reality, we simply liked the sound of "Ask Alice!" and had not thought of anything better when it was time to go on-line.)

Following the May brainstorming meeting, Deborah Levine worked with Columbia's Academic Information Systems (Ben Beecher, David Millman, and Steve van Leeuwen) to establish the Internet site and the anonymous question capability. By August, a system was devised and we had created Columbia University's Health Education Program home page. To get the ball rolling, we "planted" three questions on Alice!. (This was the last time our office ever needed to make up a question.) See "Two virgins--Use condoms?" <http://www.goaskalice.columbia.edu/ 0001.html>, "First-year fifteen--Can it be avoided?" <http://www.goaskalice.columbia.edu/ 0002.html>, and "Drinking addiction--Psychological or physical?" <http://www.goaskalice.columbia.edu/ 0003.html>.

As already mentioned, a critical feature of Alice!, which attracts her readers, is anonymity (unless they choose to identify themselves in their letters). Alice!'s readers have a variety of health questions on their minds, many which they feel too uncomfortable to ask a health care provider, family member, partner, or friend. Since e-mail addresses are scrambled before being sent to Alice!'s mailbox, readers are assured that questions which are important to them, no matter how personal or embarrassing, can be asked anonymously.

During Alice!'s first month, she received ten questions. (We were very excited about this.) Five years later, Alice! receives over 3000 questions each month. (We are overwhelmed, in awe, and challenged by this.) Sounds unbelievable. It is! To date, Alice! has answered over 1300 questions.

Alice! Grows
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Deborah Levine was the staff member who took Go Ask Alice! under her wing and set the tone for the Alice! personality, who candidly speaks in the third person. Following Alice!'s debut on the World Wide Web in the fall of 1994 (a year after she went on-line on ColumbiaNet), questions increased considerably, and we hired graduate students to assist with researching and answering questions. We also hired a talented graduate student from the Columbia School of Architecture, Matthew Pietras, to design Alice!'s graphics.

At this point, we subdivided the growing list of Alice! questions and answers into seven categories: Personal Relationships <http://www.goaskalice.columbia.edu/ Cat8.html>, Sexual Health (contraception and STDs) <http://www.goaskalice.columbia.edu/ Cat7.html>, Sexuality (anatomy and physiology and human sexual response) <http://www.goaskalice.columbia.edu/ Cat6.html>, Emotional Well-being <http://www.goaskalice.columbia.edu/ Cat4.html>, Fitness and Nutrition <http://www.goaskalice.columbia.edu/ Cat3.html>, Alcohol, Tobacco, and Other Drugs (ATOD) <http://www.goaskalice.columbia.edu/ Cat2.html>, and General Health/Wellness <http://www.goaskalice.columbia.edu/ Cat5.html>. As the questions and answers became more medical, we also began to call on the health care providers at the University Health Service for assistance, fact-checking, and updates. The amount of time and money devoted to Alice! was considerable. When we answered ten to twelve questions a week, total staff hours approached 100 per week.

Alice! Makes a Plan
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A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

The Columbia University Health Education staff continuously reads Alice!'s e-mail. Since Alice!'s birth in August 1993, she has received thousands and thousands of questions, making only a small fraction possible to answer. Fortunately, some of these questions are repetitive. When Alice! selects questions to answer, she looks for variety, as well as interests and concerns pertaining to college students, giving priority to questions sent in by Columbia students (if identified in their letters). The list of inquiries is narrowed further based on whether or not the question has already been answered. However, a previously answered question may be worth re-addressing as a Classic Alice!, in which past answers are re-posted as new answers with new readers' questions. See "More tattoo guidelines [Classic Alice!]" <http://www.goaskalice.columbia.edu/ 1318.html> and "More about melanoma (Skin cancer) [Classic Alice!]" <http://www.goaskalice.columbia.edu/ 1313.html> to get a better idea of the Classic Alice! answer format.

The health information provided on Go Ask Alice! is researched and written by health educators and other health professionals. Before being posted on the Web, answers go through a careful review process (fact-checking and updating information) by a health care provider or other health care professional expert in the question's field. Jordan Friedman, the new Director of the Health Education Program, serves as editor-in-chief and works closely with health educator, Janet Kim, coordinator and editor of the Alice! site, as well as with Richard Carlson, M.D., Director of the Columbia University Health Service.

At the present time, three health educators (Jordan Friedman, Janet Kim, and Judith Steinhart); a staff of health care providers from the Columbia University Health Service, including physicians, nurse practitioners, therapists, and nutritionists; a pre-medical and/or graduate student intern (in particular, Amy Burke); and, occasionally, health care consultants outside of Columbia University, answer questions for Go Ask Alice!. Billie Lindsey, former director and editor-in-chief of Alice! and now Assistant Professor of Health Promotion at Lynchburg College in Virginia, continues to contribute to Alice! by requiring students enrolled in her nutrition classes to assist with the research and composition of nutrition and fitness related questions as part of their course assignments.

Alice! Moves Onward
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A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

Go Ask Alice! is a time-consuming and demanding effort. To accommodate staff changes and time constraints, we now answer about three to five questions per week. We also keep questions and answers up on Alice!'s New Questions and Answers of the Week web page < http://www.goaskalice.columbia.edu/newtext.html> for two weeks (as this week's and last week's questions), in case readers do not log on every week. Use of Classic Alice!'s, as mentioned earlier, have also been helpful in saving time and re-addressing important and/or popular health topics, while still maintaining Alice!'s devotion to new readers' queries.

Alice! will also soon become available as a book entitled, The Go Ask Alice Book of Answers: A Guide to Good Physical, Sexual, and Emotional Health, to be published by Henry Holt & Company, Inc. in September 1998. The book will serve as a health information primer for both new and old Alice! readers. One hundred seventy of Alice!'s most popular questions and answers, which have been revised and updated, are included. An extensive health-related resource list, which includes organizations, links, books, and movies, is an added bonus, especially for academicians.

Alice! Is Hot
Introduction Is Born Grows Makes A Plan Onward Is Hot
A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

With all of the e-mails Alice! receives, you may wonder about the most popular queries. Not surprisingly, sex-related questions make up the bulk of Alice!'s mail, followed by general health/medical-related issues. Within the sex realm, year after year, queries about penises (i.e., size, bumps, lumps, etc.) and masturbation are the most often asked.

The most frequently read Alice! questions and answers are also sex-related. (We've been collecting weekly statistics for about three years.) The top three opened questions and answers, according to the Columbia University Web Server Usage Statistics for the week of May 30, 1998, were "More on sex with animals--Bestiality and STDs?" <http://www.goaskalice.columbia.edu/ 1056.html> "Information About What Is Bestiality" <http://www.goaskalice.columbia.edu/ 0707.html>, and "Where is the clitoris?" <http://www.goaskalice.columbia.edu/ 0704.html>. Without making any personal judgments, we've been aware that the two bestiality questions and answers have had the majority of first and second place hits for a few years now. We assume that most of this phenomenon can be attributed to bestiality-oriented web discussion groups; search engines which list these Alice! questions and answers near the top of their search result pages when bestiality is entered as the key word; and/or, general curiosity about the topic, whether or not the interest is personally tied to people's own related behaviors.

Alice! Makes a Difference
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A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

Although no formal research has been done to evaluate Go Ask Alice!'s impact as an effective health education tool, readers' e-mails provide some optimistic clues about Alice!'s importance and speak for themselves. Here are some of Alice!'s readers' responses:

"Dear Alice, Thanks for being so on target with the "questions" you select to answer and so accurate and sincere in your information and analysis. To whoever you consist of, and your "staff," Thanks, Thanks, Thanks!!!!"

"While searching for information pertaining to the effects of paternal alcoholism on child and adolescent development, I was led to your website. I would like to commend you, whomever "you" is/are on an incredibly helpful and useful website. I think you are offering a very helpful service to those who need answers but would like to remain anonymous, yet you are also helpful to anyone needing bits and pieces of information."

"Great Site Alice! I've learned more in the last 20 minutes than I did in the last 5 years."

"Not a question - just a thank you for your wonderful reply to a query about bursitis. Best advice I've received in 2 hours of surfing the net!"

"I realized I forgot to thank you for the information you have provided me in the past and for your services. Thanks so much."

"I just found your site. I haven't been impressed by too many of the info sites that I have looked at, but yours is a wonderful exception. It's the only info site that I will recommend without hesitation."

"Hi Alice, I think your site is one of the best I've ever seen. Unlike other Health sites, you use these medical terms in a way that anybody can understand and you are open minded about it. Keep up the good work."

"Great site! It's nice that people can ask such questions without being judged."

"I just want you to know I'm so glad that you can help so many people with questions that they're too embarrassed to ask about."

"I THINK YOU'RE GREAT TO HAVE THIS Q&A PAGE FOR SO MANY YOUNG ADULTS OUT THERE WHO ARE SCARED AND CONFUSED."

"Dear Alice, First let me say that I am not a Columbia student though I have been to your campus. Very nice. This is a wonderful service also I found it through a reference in a magazine. I wish it was available when I was in school a few years ago."

"Dear Alice, I want to first thank you for such a fantastic service you offer. I've been reading and I'm Much Happier now."

"Just a quick note of thanks for your great advice. It gave me great peace of mind!"

"Hi Alice, Love your column, it has really shed light on a lot of areas that I was curious about."

"Alice: I have enjoyed reading the stories and responses on your web site. Some are touching and wrenching at the same time."

"HI I HAVE JUST DISCOVERED YOUR SITE ABOUT AN HOUR AGO. YOU ARE INFORMATIVE AND SOMETIMES BRING QUITE A CHUCKLE. I HAVE FOUND MANY ANSWERS IN JUST AN HOUR. I WANT TO SAY THANK YOU."

"Just wanna say that you've got quite the wonderful site here! Very educational."

"... thanks and good work on your service, it has to be the best health resource and Q&A service around."

"Alice -- I think you're really great and probably helping a lot of people. I send my commendations to the developers/maintainers of this site."

Alice! Is Challenged
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A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

Although Go Ask Alice! has received much praise from the media and her readers, she has not been able to please everyone. Go Ask Alice! recently has been targeted by Oklahomans for Children and Families and the National Coalition for the Protection of Children who labeled Alice! as either pornography/erotica or inappropriate for young adult readers. Although everyone has a right to her/his opinion, Alice!'s mission as a health education resource is misrepresented in these cases as titillating and objectionable. Alice! follows the Code of Ethics of the Society for Public Health Education (SOPHE) when answering questions (read "Does Alice smoke pot?" <http://www.goaskalice.columbia.edu /0825.html> for more information).

Alice! Goes to Court
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A Difference Is Challenged Goes to Court Looks Ahead An Invitation Thanks You

A 1996 landmark ruling by the U.S. Supreme Court helps validate Go Ask Alice! as a valuable source of health information on the Internet and protects it from being categorized and mislabeled as pornography. This case could have limited or restricted discussions about sexual health and sexuality on the Internet. Alice!, along with several other sites, was used to convince the Justices of the value of this type of information. Fortunately, freedom of speech for the Internet was protected. This is one of the far-reaching impacts of Alice! of which we are most proud.

Alice! Looks Ahead
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To keep up with appearances of the ever evolving Internet, Go Ask Alice! will be undergoing a make-over this summer, the results of which will be unveiled this Fall. Changes to make Alice! look more current and uniform in design and layout will also make her more user friendly, which is an important goal for a website of Alice!'s size and popularity. Category pages will be reorganized into subcategories and be more streamlined. New webpages on the Go Ask Alice! staff, important health-related resources, the Alice! book, and what readers and reviewers are saying about Alice! are also being discussed and in the works. Archived questions and answers, starting with the ones included in the upcoming Alice! book and then those written before 1996, will be undergoing revisions and updating as part of an ongoing quality assurance initiative. Come September 1998, return to Go Ask Alice! and reacquaint yourself with her. Although Alice! may have a new look, she's still the same Alice! readers have grown to respect, appreciate, and admire.

Alice! Invites You to Visit Her
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To review Go Ask Alice!, scroll down the home page: <http://www.goaskalice.columbia.edu>

To send a question to Alice!, click on Ask Alice!: < http://www.goaskalice.columbia.edu/#ask>

To read more, including the Alice! disclaimer, click on About Alice!: <http://www.goaskalice.columbia.edu/ about.html>

To make a comment to the authors, send an e-mail to: Billie Lindsey <Lindsey_B@mail.lynchburg.edu> and/or Janet Kim <jyk11@columbia.edu>

Alice! Says Thank You
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We would like to take this opportunity to say thank you to all of Alice!'s past, present, and future supporters and admirers. It is the open, honest, and articulate readers, describing their problems, concerns, and questions, who continuously motivate a very busy staff of health educators to research replies and respond. We hope that in some small, or big, way, Alice! has made a positive impact on your life. Thanks again.


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Copyright 1998 by IEJHE.