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



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.



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.



These differences in validity should be considered in studies measuring pubertal changes longitudinally when they do not have access to clinical assessments.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Herbert Irving Comprehensive Cancer Center and mt146@columbia.edu.
Mary Beth
MB
Terry
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York;
Mandy
M
Goldberg
Columbia University College of Physicians and Surgeons, New York, New York;
Sarah
S
Schechter
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York;
Lauren C
LC
Houghton
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York;
Melissa L
ML
White
Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, Utah;
Karen
K
O'Toole
Herbert Irving Comprehensive Cancer Center and Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York;
Wendy K
WK
Chung
Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania;
Mary B
MB
Daly
Division of Hematology and Oncology, University of California (UC) Davis School of Medicine, and UC Davis Comprehensive Cancer Center, Sacramento, California;
Theresa H M
TH
Keegan
Department of Molecular Genetics and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada;
Irene L
IL
Andrulis
Departments of Medicine and Hematology/Oncology, Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
Angela R
AR
Bradbury
Department of Pediatrics, Division of Oncology, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
Lisa
L
Schwartz
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
Julia A
JA
Knight
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.
Esther M
EM
John
Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, Utah;
Saundra S
SS
Buys
D000293:Adolescent; D002648:Child; D002657:Child Development; D005260:Female; D006801:Humans; D009035:Mothers; D011446:Prospective Studies; D011627:Puberty; D015203:Reproducibility of Results; D012647:Self-Assessment; D012741:Sexual Maturation