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UTHSCSA
DEAN’S MESSAGE
UT School of Medicine Update:
It’s About Teen Health
By Francisco González-Scarano, MD
Between 1991 and 2013, the teen birth rate in the United States
declined by an impressive 57 percent. The rate has declined in the
50 states and among all racial/ethnic groups, and is credited to de-
creased sexual activity among teens as well as increased access to
contraceptives. However, though there is progress throughout, it
has been uneven.. In Texas, the rate has decreased, but as of 2013,
Texas was ranked 5th in the nation for most teen births per 1,000
females aged 15-19. New Hampshire is ranked 51st (out of the 50
states plus the District of Columbia) with the fewest teen births.
Despite the mediocre ranking for Texas, San Antonio’s teen birth
rate has been on a significant downward trend, especially during
the last five years. A great deal of the local credit goes to our own
UT Teen Health led by Kristen Plastino, MD, Associate Professor
of Obstetrics and Gynecology, and to the many community part-
ners she and her team have recruited in their quest to reduce teen
pregnancy. The Department of Obstetrics and Gynecology has cre-
ated a comprehensive support system for teens called UT Teen
Health, which has led to a significant reduction in teen birth rates
on the south side of San Antonio.
Teenage births are associated with higher school dropout, poverty,
and incarceration. According to the San Antonio Metropolitan Health
District, in 2012 Bexar County residents spent nearly $60 million on
the associated costs of teen childbearing including child welfare, health youth. They also have multiple advisory boards that include teens
care, lost revenue and incarceration expenses. Reducing the teen birth
rates has been a goal at all levels of government.
In 2010, Dr. Plastino was awarded a $10 million 5-year grant
from the Centers for Disease Control and Prevention (CDC) and
the Department of Health and Human Services, Office of Adoles-
cent Health (DHHS/OAH) to lead a community-wide initiative
with the goal of reducing teen pregnancy on the south side of San
Antonio and evaluating educational approaches to changing ado-
lescent sexual behavior. She put together a ‘dream team’ of nurses
and education specialists who set out on a mission of discovery and
development to assess the need, plan, pilot, and execute evidence-
based practices that would accomplish these goals.
The south side community-wide initiative collaborated with gov-
ernment, non-profit and community partners, setting the goal to
reduce the teen birth rate in the catchment area by 10 percent by
2015. What they actually achieved was a 24 percent reduction. Dr.
Plastino is quick to credit the community and the partnerships that
it took to achieve such a difficult accomplishment. The community
includes many different groups: schools, churches, Bexar County,
42 San Antonio Medicine • October 2015
the City of San Antonio and many other organizations, including
University Health System and the San Antonio Metropolitan
Health District, which embraced their approach and became trusted
and effective partners in this effort.
Dr. Plastino’s focus is to create and sustain evidence-based programs,
practices and systems, for addressing the issue of teen birth. They are
on the right path. To continue this trajectory, she was recently awarded
two additional federal grants totaling $13.75 million over the next five
years from the Department of Health and Human Services.
There is no doubt in Dr. Plastino’s voice when she describes why
she thinks they have been so successful, noting that access to pre-
ventive care is one of the most crucial aspects of their work. She
also emphasizes having an open mind and working with the stake-
holders to address their needs. This is in contrast to many programs
that simply dictate curricula and do not consider the needs of a spe-
cific population, system, or culture.
Dr. Plastino’s team spent a full year on needs assessment - talking
to people, conducting focus groups with parents and teenagers, and
asking community leaders and teachers for their opinions. The team
works with everyone involved in the process of providing education
to adolescents: school boards, administrators, teachers, parents and
and members of the more than 20 community partners, to build
community support and provide end user and stakeholder feedback.
It has been a grassroots effort from the ground up, with Dr. Plastino
and the School of Medicine’s guidance providing accurate medical
advice, evaluation and continuous quality improvement.
The team has provided this guidance using a five-pronged ap-
proach that focuses on community mobilization, evidence-based
programs, stakeholder engagement and education, sustainability
and access to clinical preventive care for teens. The program truly
encompasses and supports the lives of teens. Helping teens to iden-
tify their own dreams and goals and to discover the pathway to ac-
complish those goals is as much a part of the program as explaining
the myths and facts of sexually transmitted infections. In 2014, Dr.
Plastino received an award from the CDC for reaching the highest
number of youth with evidence-based programs: approximately
12,500 teens.
Dr. Plastino cites that another important component is the trust
she has with the different groups and community partners. This
foundation has been built through transparency and collaboration.
Her team is open about what they are doing and how they plan to