Are there short cuts to pubertal assessments? Self-reported and assessed group differences in pubertal development in African adolescents
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The purpose of this article is the self-rating of pubertal development using the Pubertal Development Scale (PDS) as is recommended as a noninvasive assessment of puberty in large community-based surveys of adolescent development and behavior. The objective of this study was to assess the reliability of the PDS for the first time among urban, Black South African youth. The concordance between adolescents' self-assessment of sexual maturation using the PDS and those of an expert rating by a trained health professional using the Sexual Maturation Scale (SMS) were determined in a group (182; 49% female) of Black South African youth aged between 10 and 18 years recruited from schools in Soweto, South Africa. Furthermore, the concordance between adolescents' self-assessment of puberty using the PDS and a previously validated self-assessment technique using SMS was also determined in a large group (1388; 53% female) of young adolescents aged 13 years old participating in a birth cohort from Soweto-Johannesburg. The convergent validity of PDS proved to be poor with several PDS items (facial hair, skin change, and growth) proving unreliable both within the school survey across the different age groups when compared to SMS (kappa coefficient of 0.34 for females and undetermined for males), as well as, within the cohort of 13-year-olds (kappa coefficient of 0.16 for females and 0.19 for males). The results suggest that there may be as yet undocumented differences in pubertal manifestations and awareness of these manifestations, especially facial hair and skin change (acne), among urban, Black South African youth that make the PDS self-assessment less reliable as a pubertal assessment tool in multiethnic community-based research.