It can never be said enough: Government's job isn't easy.

Catering to less concerned and more disillusioned constituents and communicating with others who are more demanding and less forgiving is no simple task.

But when it comes to health -- especially adolescents' well being -- giving up or failing to connect with constituents aren't options.

In California, when the San Francisco Department of Public Health (SFDPH) noticed an increase in certain sexually transmitted diseases (STDs) among African-American youths in a particular city neighborhood, the department looked into every possible way to reach this population and curb the beginnings of an epidemic.

Because of its popularity among teenagers and young adults, the SFDPH chose short message service (SMS) to spearhead its sexual education outreach.

Text 4 Help

The SFDPH launched SexInfo, as the text messaging service is known, on April 24, 2006. The project was created after epidemiology results indicated an alarming increase in gonorrhea -- 102 percent from 2005 -- as well as chlamydia cases among 15- to 19-year-old African-Americans. Most of these cases occurred in Bayview/Hunter's Point, a low-income San Francisco neighborhood.

"We took the increase in gonorrhea rates seriously because the long-term effect is infertility," said Jacqueline McCright, community-based STD service manager for the SFDPH. "We do not want that to happen to young women."

Though curable, if untreated, gonorrhea can cause scarring to the carrier's reproductive organs, leading to infertility in males and females. The disease can also spread to the blood and joints, and weaken one's immune system, making a person more susceptible to other diseases, such as HIV/AIDS. To make matters worse, gonorrhea -- like many other STDs -- is nearly asymptomatic in some cases, quietly causing irreversible health damage before one knows it.

In the face of these consequences, McCright and her team, who had long been educating the neighborhood on STD prevention, decided the situation warranted new methods. "We're currently conducting outreach, and distributing condoms in the streets, in community-based agencies, and in the community that a majority of [those affected] reside in," she said. "Something more needed to be done."

The SFDPH partnered with San Francisco-based Internet Sexuality Information Services Inc. (ISIS), a nonprofit organization specializing in delivering sexual health information via a range of Internet-related technologies.

After several focus groups with youths and health professionals pointed to cell phones -- particularly text messages -- as the target population's preferred means of communication, ISIS developed SexInfo as a free service.

Though potentially obscure to those with little text messaging experience, SexInfo is a straightforward service for regular texters. First, users enter a numerical code into their cell phones -- for Metro PCS users, the code is 917-957-4280, and for other users it's a five-digit number, 61827 -- type in SexInfo and send the message.

Within seconds of texting SexInfo, users receive a text message with a choice of 11 answers, each bearing a letter and a number. They choose the entry that matches their concern and enter the corresponding letter and number.

For instance, if a user has pregnancy concerns, she can choose B2 from the 11 options -- which corresponds to "if u think ur pregnant" -- and hit reply. After a short wait, she will receive the names, addresses and/or phone numbers of two local resources from which she can request assistance.

ISIS turned to Hip Cricket, an Australian mobile phone marketing company, to create the codes and numbers users enter on their keypads to access the service.

Hearing the Youths

The decision to use a text messaging service was collaborative, said Deb Levine, director and founder of ISIS.

"We did all of our research and said, 'A Web site is not the best

Corine Stofle  |  Staff Writer