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Prevention Health Series Part 4: Teens

Asaf Cohen, M.D. discusses preventive health for teens. He shares important information regarding how parents are involved in teen annual health visits. He gives tips on how to help teens discuss important topics openly with their doctors. He also gives advice to parents on how to help teens deal with peer pressure and develop healthy habits early on.
Prevention Health Series Part 4: Teens
Featured Speaker:
Asaf Cohen, MD
Dr. Asaf Cohen received his undergraduate degree from the University of Pennsylvania. He obtained his MD degree from Baylor College of Medicine in Houston, Texas, and completed his residency in Family Medicine at the Mount Sinai Beth Israel Residency in Urban Family Medicine in 2006. Dr. Cohen then practiced as a primary care physician and eventually also as a site medical director at Open Door, a federally qualified health center in Westchester County. He is board-certified in Family Medicine.

Dr. Cohen is excited to provide comprehensive primary care to both adults and children of all ages. 

Learn more about Dr. Asaf Cohen 
Prevention Health Series Part 4: Teens

Melanie Cole (Host):  There’s no handbook for your child’s health. But we do have a podcast, featuring world class clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I’m Melanie Cole. And our topic today is preventive health for teens. Joining me is Dr. Asaf Cohen. He’s an Assistant Professor of Clinical Pediatrics and Clinical Medicine at Weill Cornell Medicine and an Assistant Attending Physician at New York Presbyterian Weill Cornell Medical Center. Dr. Cohen, I’m so glad to have you join us today. And as a parent of two teens; this is really a great topic. When we bring our teens in for their annual well visit; what are you talking to them about? What might you check at that annual teen health visit?

Asaf Cohen, MD (Guest):  Well thank you so much for having me and I’m so excited to talk about such a great topic. The teen visit can be scary both for the parent and absolutely for the teenager themselves. The main goals for us as doctors, is to make sure that the teen is healthy both in their physical health, mental health and their social health. And one thing I would say before coming to the doctor, really like any other visit, but even more so with the teen; it’s something that should be discussed with the teen prior and hopefully this is something the teen will be already expecting and know about. So, that when they come meet their physicians, they will be aware of what’s going to happen.

And that’s why I’m so happy to be talking because we are going to be discussing some topics that are sensitive to some parents and so it’s important for parents to know if they can breach these topics before the visit; and we actually recommend they breach some of these topics all throughout the teen’s lives that will make my job as a doctor, and other doctors too, will make our job easier to take care of your teen.

Host:  Well that’s certainly true. So, what are some of the most common health related concerns? I know acne and weight and stress of course. When you are talking to teens, what do they come to you with as their most pressing issues?

Dr. Cohen:  Right, so I will address that question, but I just want to reiterate that many teens come to us and they are silent. They don’t want to say a word. They don’t want to be there. They are embarrassed. So, while they have many issues, it’s hard to bring it out from them. So, I would just want to again, preface that parents should let them know that the doctor will be discussing things and also, even help the teen make a list of things that they may want to discuss so that they don’t draw a blank when they see us.

You could also send us a list prior and let us know what you want to make sure we address with your teen. The teens themselves, usually have concerns that have to do with their own health. Things like acne and you said weight, stress, peer pressure, sometimes they will discuss substance abuse, sex. We as doctors, also want to make sure that they are healthy physically. That they are – look for depression. We want to discuss risky behaviors. Are they wearing seatbelts? Are they wearing bicycle helmets? It all is encompassed in the teen visit.

Host:  One of the things that threw me at one of my well visits for my teen was that the doctor asked me to step out of the room. How are the parents involved in that teen health well visit Dr. Cohen and what do you tell the parents and the teen about that involvement, the communication and sometimes the parent not being in the room, so that you can have an open discussion with the teen?

Dr. Cohen:  That is a great, great question. Some parents are not aware that we as doctors, really insist on having individual time with the teen. And really the reason is, twofold, one is that we allow the teen to breach topics that they may not want the parents to necessarily be involved in or maybe they have not involved their parents in sharing their concerns about that topic. But two, it also makes the teenager more responsible for their own health. So, often, a parent has been helping their teen or their child throughout their life and taking control and taking over and really, when they get to their teen years; we are trying to get the teenager to take responsibility for their own health and by having the parents step out of the room; that makes that much more possible.

Really, a teen visit without the parents stepping out of the room would be an unsuccessful visit because often, topics that come up are things that the teenager is not sharing with their parent or not willing to quite yet share with them.

Host:  Good point and I’m glad you cleared that up for parents. So, now let’s talk about some of those maybe uncomfortable things; Gardasil being one of them and people have a lot of questions. How do we as parents, let our teens know heh or our preteens that you are going to get this and we’re going to discuss what it means because that opens up that whole discussion about sex and safety and so, guide us Dr. Cohen, in how we bring this up and how you bring it up with the teens.

Dr. Cohen:  Yeah so, first, I do want to say – that I didn’t mention with the visit, in terms of the parent being in the room; an ideal visit would be when a parent comes into the room with the teenager, we discuss things together and the parent usually will raise their concerns in front of the teenager, the teenager may speak themselves and then we have a visit just with the teenager. So, it’s not just a teen visit. It’s a teen visit for the family and then it becomes just a private teen visit.

Gardasil is an extremely important subject to discuss. People have varying misconceptions. But the main focus of Gardasil is that it’s a wonderful vaccine that is really the only vaccine we have that can protect against cancer. While most vaccines we have prevent infections; Gardasil is really a cancer preventing vaccine. And Gardasil helps us to guard against the HPV virus, the human papilloma virus. We do like to give that vaccine before teens get sexually active. We actually can start giving that vaccine at nine years of age. So, sometimes we start that conversation or at least discussing the possibility of having that conversation even before the child is a teenager.

Myself, in my practice, I generally start around 11 years old. And at that point, we certainly hope the teenager has not been sexually active and that makes the vaccine even more effective. For women, it’s really a no brainer or young girls. Because it can guard against cervical cancer and then also vaginal cancer. It also can guard against warts. With young men, often parents will be asking why they need to get that vaccine because they don’t get cervical cancer. But it can also help against penile cancer, throat cancer, rectal cancer and certainly can help to stop the spread of the virus to other people in the community.

Host:  Well thank you for that answer and as some of these discussions, as we said, are difficult to discuss; when you are talking about drugs, and safety, driving, teen driving contracts, not texting while driving, peer pressure, bullying; there’s so much that goes on with our teens Dr. Cohen. How can you help us with that? How do you speak to the parents and to the teen about whether it’s a contract or that communication that’s required so that we know what our teen is doing?

Dr. Cohen:  Wow. Great question. This is – there is no easy answer to these questions. And I will say that you have teenagers yourself, I have my own teenagers and really every teenager is different. And there’s not one way to discuss these topics with them. I’ll say that the most important thing is really, the one thing that makes the biggest difference is if the parent is open with the teen, ask questions, does good modeling, starts discussing these topics when they are young; so, it’s important to really be talking to your teen all throughout their childhood and their adolescence so that these topics don’t become strange when we discuss them later on at the doctor visits. So, really the parents have a crucial role in preparing the teen to be able to discuss these things.

And like I said, often at a doctor visit, especially the first doctor visit, if the teenager does not know the doctor well; even if they have questions, they’ll be shy and quiet. But sometimes after the second or third visit, when they are coming in either yearly or for other things; as they get more comfortable with the doctor, they will open up a little bit more about some of these subjects. So, there’s not one way to breach these topics. It’s really just about being open, being nonjudgmental is very important so that the teen feels that they can tell you confidential and private questions and then also, making space for them to talk about it.

Host:  That’s great advice. And communication with our teens and with our doctors is absolutely essential to getting that honesty out of those teens. Another thing Dr. Cohen, that parents struggle with is sleep. These teens are on their phones and they sit up late at night watching TV or Tic Tok or Instagram, whatever it is. And so they don’t fall asleep and they don’t go to sleep until late and then they have to get up early for school and the whole thing becomes this vicious cycle. What do you tell teens about the importance of getting into that routine and getting a good night’s sleep?

Dr. Cohen:  Wow. Another great question. Teenagers and sleep is notoriously difficult. And thank you for bringing that up too. One thing I will say, it is not true that all teenagers don’t sleep. There’s plenty of teenagers who get plenty of sleep and so it’s not a fact that your teenager won’t sleep. So, a few things about sleep and teenagers. Really, one thing is that time management. So, teenagers are notoriously not good about being adults quite yet. And they don’t really manage their time. So, it’s important to go help a teenager look through their daily schedule, see where it is that they are filling in time that’s not efficient and therefore at 10 p.m. of even 11 p.m. they can start thinking about sleep rather than having to do their two hours of homework.

Besides that, there’s a lot of other tips that I can share. One is definitely try to make a schedule. You want to try to count backwards from when the teenager is going to wake up. So, if they have a 7 a.m. wakeup, and you want them to get about eight hours of sleep; you count back eight hours and you get to 11 p.m. and then you know that that’s when they should be going to sleep. You want to try to have them limit their naps during the day. Certainly avoid energy drinks. Those are always difficult as many teenagers use those especially to try to stay awake and we’re trying to get them to sleep.

And finally, there is always the sleep hygiene that I discuss with the adults as well sometimes. But it’s trying not to do your homework in bed, turning your phone off. In my household, my two teenagers, we actually have plugs for their phones outside of the room in the hallway and they are obligated at night to check out with their phones and plug it in outside of their room. So, no phone would be great. You really want to foster that the bed is just for sleeping. And then if they do get up and can’t sleep; you can tell them to go to a quiet space, not on their bed, to sit, in a dimly lit area and do something boring like read a book they have already read that they know that they don’t like or anything that they are not really too interested in. I know it sounds crazy. And then once their eyelids start dropping and they just kind of get bored; to just jump right back in bed and try again.

But I will say that it’s not easy. Again, with my own teenagers, sometimes it works, sometimes it doesn’t. we do what we can. No teenager is perfect. No parent is perfect. We can only try every day.

Host:  We certainly can. What a great answer and what great advice. Before we wrap up, children and depression, teenagers and depression. Teenagers are moody Dr. Cohen and how can we tell is our teenager is just being a moody teenager, going through hormonal fluctuations or is something really is clinically wrong? As you wrap up, please discuss that for us and then give us your best advice on getting our teens to improve their health overall, nutrition, exercise, all of it. It’s a big ask. But you can do it, I’m sure.

Dr. Cohen:  I will try. About depression. It is quite difficult as you mentioned. Adults usually you can tell sometimes when they are not doing well. And even younger kids. With teens, it may be very difficult because they can be so moody and so changeable that it’s hard to tell. Really, if you are worried, the one thing to look for is if there’s change from the usual self, meaning if they have been moody for the last two years and they are moody; that’s probably just who they are at that point. But if it’s a change where they become more moody and it’s a persistent change; then we get more nervous.

If they are no longer enjoying things that they used to do. For example, yes, they’re moody but they always went to their soccer games and enjoyed their soccer team. If they are not doing that anymore; that could be a red flag. And of course if you find that they’re doing anything scary like looking up on the web or you find that on their social media there is some talk that’s dangerous; please, please let us know, talk to them, and let’s jump on it quickly.

Okay so if we’re going to wrap up, I just do want to say a couple of things. One, I will say that the teenage years are just extremely difficult both for teens and for parents. I sometimes tell parents this sort of joke that you have this lovely wonderful child who listens to you, who loves you, who really seems to thrive and then suddenly as they become teenagers; something happens. It’s almost as if some alien force starts to possess them and take over them. Sort of like the movie the Exorcist. And then after they turn into their 20s, that alien force leaves and you get your beautiful child back. And that’s sort of something to think about as you are going through these teen years. These teens are going through so much. All you can do is be there to support them, help them and talk to them. Talk to them, don’t ignore them. Discuss safety, drugs, discuss sex. Have them meet their doctor more than just once every couple of years. Come, have them see us often as you want. Let us get to know them. If they know us, and we know them; it leaves much more room for them to be comfortable enough to talk to us. It’s a conversation between us and the teens, between parents and doctors and the teens and there’s a whole community at large that is responsible in helping as well. So, if we all work together, parents, doctors, community; I think we can give our teenagers the ideal situation to grow in a positive light and become wonderful citizens in our country.

Host:  That was wonderful. Dr. Cohen, thank you so much for joining us and sharing your incredible expertise. What great advice for parents of teens to hear from you. Thank you again to our guest Dr. Asaf Cohen and to our listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on your social channels. I’m Melanie Cole.