Transcription of Episode 2: Being a Teenager Can Be Tough.

It’s not easy being a teenager. Welcome to SBH Bronx Health Talk, produced by SBH
Health System and broadcast from the beautiful studios at St. Barnabas Hospital the
Bronx hello I’m Stephen Clark, The Adolescent Health Program at SBH helps teenagers
and young adults from the ages of 12 to 21 face unique challenges at a time when their
bodies, their personal relationships and their emotions are constantly changing. With us
today is Dr. Kanani Kitchen, A fellowship-trained adolescent medicine physician and
Director of Adolescent Health Services at SBH. Welcome Dr. Titchen.

Thank you

Let’s begin by discussing what some of the issues are that bring teens to your
adolescent health center.

Teens do have very specific issues, they tend to as you just said be relational, many of
them. Teens are at a point in their lives where they are naturally breaking out on their
own and they’re forging relationships with their peers more than their parents, more than
their families and this is normal developmentally, it’s healthy. The issues that tend to
stem from those relationships can include bullying as we’ve seen in the press broadly as
well as dating relationships that can become very complicated and sometimes even
violent. We do tend to see some of those issues in our clinic too. As far as physical
problems that adolescents experience, many of them are related to their changing
bodies so hormones that are changing and maybe some of them are becoming out of
balance, things like polycystic ovarian syndrome for girls. A lot of sports injuries because
this is a time when kids start to become extremely active and even competitive in sports
and so we do see some routine overuse injuries and just injuries from certain chronic
movement or similar movement over and over and over again, so that repetitive use
injury. We also tend to see some issues with body image and perception, so eating
disorders anorexia and bulimia and these are common problems in adolescents. I would
say also what we see a lot in the clinic has to do more with the environment that
adolescents live in and that’s very specific to the Bronx and so we do see a lot of teens
who come in who live in a very stressful environment, sometimes an unstable
environment or they have been witness to violence themselves, So we do see some
post traumatic stress disorder and teens depression anxiety. This is really a time when
teenagers are starting to grapple with issues that are very adult and yet they don’t yet
quite have the adult brain to be able to think about some of these complex issues.

Dr. Titchen, if you’re a parent of a teen and you live in the Bronx are there certain signs
that you should be aware of?

Sure, so if I’m a parent of a teen in the Bronx, I’d be looking out for making sure that my
child is going to school, so truancy, making sure that my child is succeeding in school,
Those are some obvious signs that something is going right or it could be going wrong.
I’d also take a look at whom my child’s friends are. I know that’s not always so easy to
discern but ask your teenager about their friends and what they’re like and making sure
that you’re talking with your teen, keeping those lines of communication open, both
talking with your teenager but also listening and trying to hear what ideas your teen has
about how life appears to them.

When a teen comes to you is it typically because they’ve initiated it or their parents have

Typically teens come in for their annual well child visit, the physical exam that’s required
of them every year and any necessary vaccines for school. At those visits, I have the
privilege of being able to talk with teenagers privately and that’s usually when issues
arise that parents may or may not be aware of and that gives me an opportunity to forge
a professional medical relationship with my patient and to have an honest discussion
about what are some of the issues that they’re grappling with on their own, and it gives
me the opportunity to try to bridge that gap in communication between my patients and
their parents.

I guess, it seems that privacy and confidentiality are key elements of what you offer so I
assume the parent is asked to leave the room?

Yes, so that’s New York state law that mandates that teens be offered private health
rights for every teenager that I see between the ages of 12 and 21. I do state to parents
that there will be a portion of the interview that will require that I meet with their child
alone. Some parents are rightfully uncomfortable with this idea and so I assure them
that all we’re going to do at this point is talk and certainly while I do the physical exam, I
offer the option of having the parent in the room or a nurse in the room as a chaperone.
I assume also that contraception is an issue that comes up relatively frequently, right?
Contraception is an issue that comes up all the time. The majority of the time I would
say my patients are not disclosing to their parents that they are becoming sexually
active and so this becomes a place for them to be able to discuss it with a responsible
adult and to receive guidance that’s mature medical guidance. I will say again that my
role is to bridge gaps in communication, so, while I can’t infringe on my patients rights I
can really encourage my patients to disclose to their parents that they’re becoming
adults and beginning to behave like adults. Contraception also becomes important
because some forms of contraception can be used to regulate the menstrual cycle and
are used as medical treatment for certain conditions. So, contraception really plays two
roles one is the to prevent pregnancy but another would be to maintain healthy

I would guess that within your patient audience, education is a big part of it, right?

Yes, I educate, I provide education to my patients. Probably a good portion of the visit,
may be a quarter or even half of the visit is spent discussing issues with them and
providing websites and informational pamphlets to my patients as well as just asking
them what are their beliefs and maybe dispelling some of the myths that they come to
clinic with.

Is teenage pregnancy still a major issue in the Bronx?

It is. Teenage pregnancy continues to be an issue nationwide. The rates have stabilized
or even decreased somewhat but we are starting to see perhaps an upswing because
of the resistance to providing contraception in some cases so again pointing out the
importance of contraception. I do have teens who come in who are pregnant and I offer
options counseling to them and we can provide them with guidance and how to disclose
to their families and find the support that they need for whatever their choice is.

It seems to me there’s no question that the internet is adding stress to the life of many
teenagers what do you say?

Definitely, the Internet is providing connection for some teenagers so they relate to
each other a lot through social media but that also creates some distance as well and
as we have been seeing increasingly, sexting, which is sending nude images via text or
email is becoming an issue with teenagers. Perhaps not healthy, some evidence points
out that sexting can be a sign of a teenager in distress or a teenager who has a history
of abuse. Social media can be all-consuming. I see a lot of gaming especially
adolescent boys come in and they spend hours a day gaming and that means that
they’re not getting outside they’re not getting sunlight, they’re not getting vitamin D,
they’re not getting exercise that they need in order to keep their bodies and their minds

Another area I want to touch on which I know you’re very much involved in is something
called human trafficking. Let’s discuss that first. What is it?

Human trafficking is the exchange of people for purpose of exploitation and under force,
fraud or coercion, except if the patient is under the age of 18 and the explicit purpose is
for sex trafficking, then we do not need to prove force, fraud, coercion. We believe as a
nation, that children under the age of 18, do not have the capacity to offer consent for
transactional sex, for sex in exchange for money. So we do deem sex trafficking as a
crime no matter what for any minor. Human trafficking can take many forms. Labor
trafficking is one of them. Labor trafficking is all around us in the Bronx that may be
occurring in fast-food restaurants that we frequent, even in the healthcare industry in
some instances, agriculture certainly, and it’s occurring throughout our nation so it’s a
very large problem and it’s more present than people would like to acknowledge.

Do you see it here? I mean among your patients.

I see human trafficking among my patients and I also see human trafficking among the
parents of my patients which can then cause a secondary distress. I actually have seen
a few teens in my clinic who seemed to be experiencing post-traumatic stress disorder
or anxiety or both as a consequence of one of their parents participating in what we
used to call prostitution which we now refer to more as human trafficking or sex

If you’re an educator or you’re an employer or a colleague of a teen are there certain
signs that would indicate a possibility of sex trafficking?

Yes, some of the signs that I see in clinic include somebody coming in who has a very
nervous or depressed affect, who really doesn’t want to make a connection with me,
who doesn’t want to make eye contact. Sometimes that person may be accompanied by
another person, whether another teenager or an adult who does not want to leave the
room, that may also take the form of a teenager coming in with a cell phone that they
hold in front of them that may be used to have their trafficker monitor during their clinic
visit. More often, the physical signs that I see are repeated pregnancy, repeated
sexually transmitted infection, sometimes injuries such as bruises in places that are less
likely to be seen or even chronic illness that goes untreated for a very long time can be
a sign of human trafficking. In the school I would say human trafficking has been most
noted by kids who seem withdrawn from their peers, who start to experience isolation
and who other kids in the school may notice are not quite acting like themselves. Maybe
they’re overly sexual or they leave after school with an adult that does not appear to be
a parent or they disappear for a time after school and the parents don’t know where
their kids are. These all can be signs of human trafficking.

You told me that an example or a sign that you often see is when they are accompanied
by either a parent or a friend or a boyfriend and with the interaction between the two of
them. Why don’t you talk about that?

Yes, so that interaction may appear to be normal, maybe they appear to be in a
significant relationship with another person whether a female or male and they come in
maybe for birth control or for counseling regarding an unwanted pregnancy. In those
instances, it can be really tricky because the person accompanying them may not want
to leave the room and the victim may not want that person to leave the room. They may
actually view their trafficker as a boyfriend and you can imagine if a victim is being
trafficked by his or her mom or dad there’s going to be a real conflict in in feelings there
of not wanting to be exploited but maybe not wanting to break ties with their family
because these are the only people they know. So, they feel a real pull in recognizing
that something is wrong with the way that their traffickers using them but also feeling a
real loyalty to their trafficker so it can be very tricky to work with patients who don’t
themselves recognize that they are victims

Dr. Titchen we are running out of time now but is there any place where people can get
more information on human trafficking?

Yes, so the definitive online site for human trafficking is the Polaris Project which is That would be a great way to start learning about human
trafficking and you can look up state statistics and also facts about identifying victims,
whether in the school setting or in a healthcare setting or elsewhere.

If you want more information or to make an appointment at the adolescent health

Yes, if you’d like more information about health care in general, so for reproductive
healthcare,, for young women’s health,
and for adolescent men’s health, to make an
appointment with Adolescent Medicine, (718) 960-3730.

Okay, great thank you Dr. Titchen for joining us on SBH Health Talk. Again for more
information on adolescent health services or any services at SBH Health System, visit Thank You.

Thank you for having me