Thus, despite their interest in sex and intimate relationships, young adults can be difficult for programs to reach. Society's confusing messages make young adults wary. They quickly perceive and reject messages about sexual behavior that are hypocritical, and they distrust adults who try to conceal the positive aspects of sexuality. They have begun to learn about sex from experiment and experience rather than by listening to their elders. They are willing to take risks in order to test out their ability to make choices, and they often try or adopt unhealthy behavior such as drinking, smoking, or unsafe sex. Furthermore, they are usually healthy and may not see sex as posing any health problems. Therefore, listening to young adults to understand their points of view and learning how to talk with them are especially crucial to programs and providers that seek to serve these clients.

Determine unmet needs. A first step in attracting young people is working with them to find out what they need. Their unmet needs often differ, even among young adults of similar age and the same gender (see Chapter 1, Growing Numbers, Diverse Needs). For example, many young adults need support in delaying sexual intercourse. Others are only sporadically sexually active and need to know how to protect themselves from unwanted pregnancy and disease. Others are unmarried and having sex regularly, in some cases with members of their own sex, and need comprehensive reproductive health services. Some are sexually abused or forced into sex and need treatment and protection. Many young women are married and need much the same health services that older married women need. Some are having children and need maternal health services to bear children safely and care for them.

One good way to find out young adults' needs is to ask them. Thus surveys, focus-group discussions, and in-depth interviews are standard starting points for designing youth programs, as they should be for all service programs (see sidebar, Do Adults and Youth Have Differing Views?). Still more useful can be involving young adults themselves in the program—for example, developing messages, reviewing program materials, evaluating program impact, working as peer educators or in other jobs, serving on program planning or advisory boards, and working in advocacy campaigns. Their insights help to ensure that the program is appealing. Also, their participation may interest other young people in the program and help to legitimate it in their eyes.

African youth organizations working with the World Health Organization (WHO) have used an innovative narrative method to gather information about young adults' lives and then to plan programs (549). In 11 countries young leaders, meeting in workshops, developed stories about a young man and woman who notice each other, meet, become friendly, and face decisions about their relationship. Through role-playing, the participants determined how these events would take place in their communities. Also, they suggested various paths that the story could take at crucial points. For example, if the girl discovers that she is pregnant, she might tell her mother, seek an abortion, or run away with her boyfriend. Later, some 13,000 young people in the 11 countries reviewed these stories. They chose the paths in the narrative that they thought most typical (548). The young adults involved in this research used the completed narratives to develop messages, training materials, and role-playing exercises (549).

Design communication that speaks to young people. Programs for young adults find themselves pulling against a tide of misinformation and unhealthy attitudes, trying to present balanced, believable messages about what it means to be a sexual human being. Accomplishing this requires offering young adults informationthat they need and want—about how sexuality affects the course of their lives and their relationships with others. Because learning this is a gradual process, programs must make their messages appropriate to the various stages of young adults' lives. A key challenge for programs is audience segmentation—reaching young people who have widely differing needs with the specific messages and services appropriate to each. Here again, programs need to work with young people to design messages that are appealing, meet their information needs, and encourage healthy behavior. Adults and young people may see issues very differently, but, by collaborating, they may be able to create messages and materials that adults find acceptable and young people find relevant.

To reach young people, an appealing message must be combined with an appealing format. Because young people enjoy music, videos, films, dramas, and other entertainment media, these can be good formats for messages about reproductive health. Young adults already rely on the mass media as sources of information about sexual relationships (see sidebar, Where Do Young People Learn About Sex), but much of what they see and hear is incorrect, incomplete, misleading, or misguided and depicts irresponsible behavior as exciting and even rewarding. Now some health programs have begun using the entertainment media and entertaining formats to reach young adults with messages about reproductive health. Some programs use broadcast formats, such as popular songs on radio or music videos on television, which can reach all young adults. Others address the needs of specific groups of young adults with videos, dramas, comics, telephone hotlines, and other media materials (109, 235, 270, 368, 414, 480) (see supplement, "Reaching Young Adults Through Entertainment").

Reach out to young people wherever they are. Even more so than adults, young people may be embarrassed to come to clinics or may not know how to get medical care of any kind. Programs may reach more young people if they set up clinics or employ outreach workers in schools, factories, sports facilities, or on street corners. Street Kids International, for example, uses video vans to reach homeless young people living on the streets in cities such as Colombo, Nairobi, Manila, New York, Rio de Janeiro, and Toronto (107). In Romania a program opened a clinic at a popular beach resort during the summer holiday season (509).

Peer educators can reach young adults wherever they gather. For example, the Christian Health Association of Kenya trains young people as "adulthood teachers," who use discussions, lectures, films, school visits, and club activities to reach young people (313). In Mexico young workers circulate at schools, factories, military bases, bars, or sports events—anywhere that they can talk with other young people (309, 408). Peer workers often provide condoms, a method that does not require a clinic visit.

Many communication media, of course, also can reach young people wherever they are. Soap operas, videos, television spots, billboards at sports events, telephone hotlines, songs, tee shirts, and theater performances all have reached young people with health messages.

Link communication efforts with health services. Programs often succeed in informing young adults about reproductive health, but young people cannot act on this information if they do not know where to get more information or services (see sidebar, Contraceptive Choices for Sexually Active Young Adults). Young people need various resources. Sexually inactive young people may want to know where they can get guidance or protection if they fear unwanted sexual advances. Sexually active young people and pregnant girls need health services. Information about using community health and social resources is a key but often neglected part of FLE programs.

Youth programs can keep a directory of services for referrals, but they serve better when they also reach out to young people with offers of referrals. In Peru Apoyo a Programas de Poblacion (APROPO) has staged street theater performances that bridge the gap between information and services in several ways. Street performers distribute pamphlets and present 15-minute humorous vignettes on contraceptive methods. The actors invite questions from the audience and sometimes direct members of the audience to counseling kiosks, where they can meet privately with a counselor. Performers and counselors also give out clinic addresses and advertise a telephone hotline staffed by counselors who provide information and further referrals (387). The Philippine Multi Media Campaign for Young People promotes and operates a telephone hotline that refers callers to any of 40 agencies offering a wide variety of services (414).