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Pediatrics. 2016 Jul;138(1). pii: e20154571. doi: 10.1542/peds.2015-4571. Epub 2016 Jun 8.

Comparison of Clinical, Maternal, and Self Pubertal Assessments: Implications for Health Studies.

Author information

1
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Herbert Irving Comprehensive Cancer Center and mt146@columbia.edu.
2
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York;
3
Columbia University College of Physicians and Surgeons, New York, New York;
4
Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, Utah;
5
Herbert Irving Comprehensive Cancer Center and Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York;
6
Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania;
7
Division of Hematology and Oncology, University of California (UC) Davis School of Medicine, and UC Davis Comprehensive Cancer Center, Sacramento, California;
8
Department of Molecular Genetics and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada;
9
Departments of Medicine and Hematology/Oncology, Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
10
Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
11
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
12
Cancer Prevention Institute of California, Fremont, California; and Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, and Stanford Cancer Institute, Stanford, California USA.

Abstract

BACKGROUND:

Most epidemiologic studies of puberty have only 1 source of pubertal development information (maternal, self or clinical). Interpretation of results across studies requires data on reliability and validity across sources.

METHODS:

The LEGACY Girls Study, a 5-site prospective study of girls aged 6 to 13 years (n = 1040) collected information on breast and pubic hair development from mothers (for all daughters) and daughters (if ≥10 years) according to Tanner stage (T1-5) drawings. At 2 LEGACY sites, girls (n = 282) were also examined in the clinic by trained professionals. We assessed agreement (κ) and validity (sensitivity and specificity) with the clinical assessment (gold standard) for both the mothers' and daughters' assessment in the subcohort of 282. In the entire cohort, we examined the agreement between mothers and daughters.

RESULTS:

Compared with clinical assessment, sensitivity of maternal assessment for breast development was 77.2 and specificity was 94.3. In girls aged ≥11 years, self-assessment had higher sensitivity and specificity than maternal report. Specificity for both mothers and self, but not sensitivity, was significantly lower for overweight girls. In the overall cohort, maternal and daughter agreement for breast development and pubic hair development (T2+ vs T1) were similar (0.66, [95% confidence interval 0.58-0.75] and 0.69 [95% confidence interval 0.61-0.77], respectively), but declined with age. Mothers were more likely to report a lower Tanner stage for both breast and pubic hair compared with self-assessments.

CONCLUSIONS:

These differences in validity should be considered in studies measuring pubertal changes longitudinally when they do not have access to clinical assessments.

PMID:
27279647
PMCID:
PMC4925080
DOI:
10.1542/peds.2015-4571
[Indexed for MEDLINE]
Free PMC Article

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