When I was growing up, all the girls read Are you There God? It's Me Margaret., by Judy Blume. Its main character, Margaret, looks forward to developing breasts and getting her first menstrual period. When these finally occur she feels triumphant! More recently, Hello Flo advertisements also portray puberty as something that girls desire: they are upset if menstruation doesn't start quickly enough. Of course, fiction writing and advertisements may not reflect the full story of girls' puberty as witnessed by these memes:
Keenan, Culbert, Grimm, Hipwell, and Stepp (2014) investigated the relationship between African-American and European-American girls' pubertal timing (what age things happen), pubertal tempo (how much time passes between stages of puberty; how long puberty lasts), and depression symptoms. Their sample was part of the longitudinal Pittsburgh Girls Study, so it was large (more than 2,000 girls of diverse backgrounds), data were collected at age 10 and then each year for up to a decade, and the participants were more likely to come from low-income homes. Each year the girls completed a depression inventory; their caregivers (mostly mothers) completed the same depression inventory about their daughters. From this Keenan et al. could learn how many depression symptoms were common at each age and see how they related to the other variables of ethnicity and puberty. Overall, depression symptoms were highest at age 10 and declined at various rates after that. Even so, across the decade the girls reported that only one or two symptoms on average. The authors maintained that even "minor depression" like this can put individuals at risk for other problems. The girls provided data on pubertal timing and tempo by matching themselves to standard pictures that portrayed different stages of breast and pubic hair development, and by indicating if they had gotten their first period. One of these scales was also completed by the caregivers in reference to their daughters' development. The results replicated past research in that the earliest maturing girls (early pubertal timing for breast and pubic hair development) reported more depression symptoms at age 10 than later maturing girls (late pubertal timing). A new finding was that girls who were late to develop breasts (late pubertal timing) and also had a slow pubertal tempo (change progressed slowly) also reported more depression symptoms. There was no effect on depression related to the development of pubic hair and pubertal tempo. Similar to past research, African-American girls reported slightly higher depression symptoms. For example, at age 10 African-American girls reported one extra depression symptom compared to European-American girls. Likewise, African-American girls demonstrated earlier pubertal timing: pubic hair development occurred almost nine months earlier and breast development began about eleven months earlier than what was reported by European-American girls. Keenan et al. added to the literature by suggesting a trend: African-American girls demonstrated a little slower pubertal tempo, meaning that they took just ever so slightly longer to pass through the stages of puberty compared to the European-American girls. This trend requires further investigation in future research. New and most importantly, the relationship between depression, ethnicity, and pubertal timing was significant. The ethnic difference in depression symptoms at age 10 (their peak) was reduced up to 32% when pubertal timing was factored in. Pubertal tempo did not have a similar effect. Thus, a considerable portion of the ethnic difference in depression can be explained by African-American girls' earlier entry into puberty compared to European-American girls. In explaining their findings Keenan et al. suggested that sex hormones might be to blame for at least some of the low level depression seen in preteen girls. Girls with an earlier pubertal timing have higher levels of sex hormones like estrogen compared to girls who have not yet begun pubertal development. This biological argument would, at least in part, explain African-American girls' slightly higher rates of depression.
On the other hand, the authors predicted that a slow pubertal tempo would also predict higher levels of depression because it would mean exposure to high levels of hormones for an extended period of time. In this study, only for girls with later breast development (which implies lower hormone levels) did slow pubertal tempo predict slightly higher depression symptoms. As well, slow pubertal tempo did not explain any of the differences in depression between African- and European-American girls. So hormones cannot be the only explanation for girls' depression symptoms during puberty.
One possibility is that girls receive feedback based on their development that makes them self-conscious. Increases in estrogen cause weight gain so an early maturing girl may feel overweight compared to other girls. Breast development, a sign of puberty that is visible to others, may be desired to attract dating partners - so later maturing girls (especially those with a slow tempo) might be embarrassed by smaller breasts (but not care about lacking pubic hair, a trait that is not socially visible). Conversely, early breast development may bring with it unwanted sexual attention and comments that are uncomfortable for a young girl to navigate. It is also possible that early development of breasts and early menarche may lead parents to treat girls differently: for example, fathers may be less affectionate with their daughters once puberty begins. Parents, fearing sexual experimentation, sexually transmitted infections, teen pregnancy, or sexual assault may also impose new limits on what an early maturing girl can wear, where she can go, and whom she can be with. These sorts of social factors could also explain some of the low level depression seen in preteen girls. FURTHER READING: The Keenan et al. (2014) article is available online and through your local college library. Parents are not the only ones who may regulate girls bodies once puberty begins. Read an article in The Atlantic magazine by Li Zhou: "The Sexism of School Dress Codes." Starting at puberty, girls and women are twice as likely as boys and men to suffer from depression. This also means that depression symptoms might be missed in males because we are not expecting them to be depressed. Counselor and writer, Michael Gurian, explains some possible symptoms to look for in boys:
In the United States we have higher rates of teen pregnancy than in many other Western countries. We also know that our teenagers are at high risk for STIs, sexually transmitted infections. To combat these problems, we often require teens to participate in sexual education programs. However, the type of program that is most effective is still debated. This week's meme offers a humorous suggestion:
Because even the most mature adult parents can be worn down by incessant crying and endless repetition, the joke implies that if teenagers experienced these things it would be unforgettable and they would abstain from sex. The joke also implies that teaching statistics like, "six week old babies spend 30% of their awake time crying," is not necessary; instead teenagers will remember a take home message like, "babies cry a lot." This emphasis on gist, or take home message, over specific quantitative facts is applied more formally to sexual education by Reyna and Mills (2014). These authors investigated if concepts from Fuzzy Trace Theory could make a pre-existing sex ed. curriculum more effective. Past research on Fuzzy Trace Theory suggests that better memory of ideas and better decision-making comes from understanding the the gist, the take home message, as opposed to weighing the pros and cons based on detailed facts or figures that are more forgettable. Because these gist-based thoughts are related to one's emotions and values, they allow for very rapid decision-making. Their experiment followed more than 700 adolescents, ages 14-19, during a 16 session intervention period and for one year after its completion. The participants were randomly assigned to three types of interventions: an existing sexual education program called Reducing the Risk (RTR); a version of Reducing the Risk that had been modified to add ideas from Fuzzy Trace Theory (RTR+); a Control group focusing on communication skills unrelated to sexuality. Reducing the Risk (RTR) teaches teens how to recognize situations of sexual risk, how to resist pressure to have sex, and how to reduce risk of pregnancy with contraception and infection by using condoms. Teens enrolled in this program should come to realize that they are personally at risk and that they possess the ability to avoid or reduce sexually related risk. The sessions usually include a factual presentation by an adult leader followed by activities such as guided role playing. For example, the leader might present detailed factual data like, "60% of teenagers report that they used condoms during their most recent sexual experience," followed by guided role play of how to reason with a partner who does not want to use a condom. This program is considered to be effective at delaying first sexual experiences and increasing the use of birth control and infection protection. However, Reyna and Mills note that there is little evidence to show if these effects are lasting. Because Fuzzy Trace Theory predicts that gist thinking should have a lasting effect on decision making, the authors modified RTR with ideas from this theory to create RTR+. This version is identical to RTR with two additions that emphasize gist. First, at the end of every lesson students are presented with one line summaries of the take home ideas of risk from the lesson. For example, "You should use a condom every time you have sex." Second, the participants in RTR+ receive a checklist of possible values, such as, "I will use condoms every time I have sex," that they are asked to rate themselves on after every lesson. Because gist related decision making is closely influenced by our values, asking students to repeatedly clarify their values should also provoke attention to generalized risks related to sex. All participants' sexual experience, and beliefs about sex and disease prevention were measured during the intervention, and at three months, six months, and 12 months after the intervention ended. The results demonstrated that the teenagers who had been randomly assigned to RTR and RTR+ showed overall lower risk in their behavior and beliefs than the teenagers who had been assigned to the Control condition. When the results from RTR and RTR+ were compared, overall RTR+ was considered to be more successful. RTR+, that included Fuzzy Trace Theory's emphasis on gist, was related to: *a lower rate of students who started having sex during that 12 month period. *the lowest increase in the number of sexual partners during that 12 month period. *the smallest increase in positive attitude toward sex (thinking that having sex at this age is a good idea). *the smallest increase in beliefs that parents and peers think sex was okay for them to experience at this age. *the highest belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it is not surprising that the teens in RTR+ demonstrated more of this. *the highest knowledge of sex related risks lasting up to six months after the intervention. *the highest recognition of warning signals of sexual risk. On the other hand, RTR, the original sexual education program, was related to: *more favorable attitudes toward condom use during that 12 month period. *more agreement with gist-based summaries of sexual risk as measured three months after the intervention. This is another measure of gist thinking - so it IS surprising that the teens in RTR demonstrated more of this The results were further influenced when the participants' races were taken into account. Reyna and Mills compared results from the three most prominent groups represented in their sample: African American; Hispanic; and White. Curiously, the authors decided to add data from Asian participants into the category White because the responses from those groups were similar. So data reported in relation to White participants should be understood as White and Asian. However, an improvement to this study would have been to further diversify the sample so that Asian adolescents were properly represented. How did race influence the results? For example, RTR+: *initially improved African American participants' attitudes toward condoms, but that effect disappeared after the intervention was over. *increased White participants' beliefs that they could successfully use condoms. *was related to higher sexual risk knowledge for Hispanic and White teens. *increased African American and White participants' belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it is not surprising that some teens in RTR+ demonstrated more of this. However, it is surprising that Hispanic participants did not demonstrate more of this in RTR+. Race also influenced the results of the other intervention. For example, RTR: *increased Hispanic and White participants' belief that parents and peers think condoms should be used when having sex. *increased Hispanic and White participants' belief that they were at risk for generalized (take home message) risks associated with sex. This is a measure of gist thinking - so it IS surprising that some of the teens in RTR demonstrated more of this. Taken together, the results suggest that including an emphasis on the gist of sex related risks could be a positive addition to sexuality education if we want to encourage teenagers to delay sexual experience and to use condoms to prevent infection. This statement is based on results that reached statistical significance, meaning that the differences between teens assigned to RTR and RTR+ were not simply due to chance. Some of these differences seem substantial. For example, Reyna and Mills note that being enrolled in RTR+ was 84% more effective at delaying the start of sexual activity when compared to the Control condition. At the same time some the differences were often very small even though they reached statistical significance. For example, teens assigned to RTR+ had fewer sexual partners than teens assigned to the regular RTR program. This result seems less impressive when you read that the teens in RTR+ reported an average of 2.15 partners while the teens in RTR reported an average of 2.21. In terms of a practical difference that would be of interest to parents and educators, this is almost nothing: both groups had about two sexual partners during that year. Another issue is that interventions need to be tailored to the characteristics of the audience to be effective. The influence of race in the present study is especially important to note because teenagers from different racial groups differ in: how old they are when they start having sex; their risk of pregnancy (or getting somebody pregnant); and their risk of contracting a sexually transmitted infection (STI). Reyna and Mills also acknowledge that further research needs to focus on how and why concepts from Fuzzy Trace Theory may impact the sexual behaviors and beliefs of adolescents from diverse backgrounds. Further Reading:
Watch a lecture by Dr. Valerie Reyna (one of the authors of this week's article) on "Risky Decision Making in Adolescence." This talk, given at Cornell University, covers, "...developmental differences in the way adolescents make decisions and
reviews her research regarding why adolescents perceive risks and
benefits and yet take more risks."
If you are interested in decreasing adolescent pregnancy and STIs, The National Campaign to Prevent Teen and Unplanned Pregnancy website includes statistics (state and national) and an excellent comparison of effective programs aimed at decreasing these problems. BONUS: The Reyna and Mills (2014) article includes a particularly cringe-worthy example used in RTR (and RTR+) as a warning sign that, "...unsafe sex may be imminent...": "being alone with a significant other, lights low and soft music playing..." (p. 1631). As goofy as that might sound to a modern teenager, I suppose that we do have evidence of its truth from the classic 1955 Disney film, "Lady and the Tramp."
