Journal of Youth and Adolescence, VoL 19, No. 5, 1990
Overcoming Barriers to Adolescent Research Pubertal and Reproductive Development
on
Jeanne Brooks-Gunn I
Received February 9, 1989; acceptedFebruary 6, 1990 Perhaps the greatest barriers to conducting adolescent research on pubertal and reproductive behavior involve obtaining permission from schools and parents to conduct the study in the first place. This article addresses these barriers, focusing on (a) possible reasons why such research has languished, with a focus on the discomfort of adults and on negative societal messages; (b) design of reproductively oriented adolescent studies; (c) strategies for recruiting schools and families; (d) procedures for testing in the schools; and (e) methodological considerations of such barriers.
INTRODUCTION O n e of the m a n y valuable c o n t r i b u t i o n s o f the recent interest in adolescent d e v e l o p m e n t is a better u n d e r s t a n d i n g o f p u b e r t a l a n d sexual r e p r o d u c tive events (and the m e a n i n g of such events). The adolescent experience includes physical a n d reproductive growth, e x p l o r a t i o n o f sexual feelings, a n d increasingly, the i n i t i a t i o n of sexual b e h a v i o r a n d the c o n t r o l o f fertili-
This article was prepared while the author was a Visiting Scholar at the Russell Sage Foundation. The foundation's support and the generous assistance of the National Institutes of Health (NICHD), and the W. T. Grant Foundation, are appreciated. ljob title, Educational Testing Service, Princeton, NJ 08541. Received PLD from University of Pennsylvania. Research interests are girl's psychologicaladaptation to pubertal change, biosocial aspects of female reproductive events, development of biological and socially at risk children and adolescents. Correspondence should be sent to Dr. Brooks-Gunn, Educational Testing Service, Princeton, NJ 08541. 425 0047-2891/90/10004)425506.00/0 9 Plenum Publishing Corporation
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ty. Researchers are exploring: (a) how girls and boys make sense of these events; (b) how they incorporate them into their self-definition as adults (and as women and men); (c) how others, especially parents and peers, perceive and respond to these events; (d) what relational changes occur as a consequence of self- and other-perspectives; and (e) whether such changes translate into particular modes of adaptation and whether these are linked to gender (Brooks-Gunn, 1988; Brooks-Gunn and Petersen, 1983; Brooks-Gunn and Reiter, 1990; Gunnar and Collins, 1988; Lerner and Foch, 1987; Petersen, 1988). While fascinating and critical topics, they also are difficult ones, in part because of obtaining consent from schools, parents, and sometimes teenagers themselves. Indeed, reproductive subjects may be understudied because of concerns about recruitment and because schools are often reluctant to launch such studies, although this state of affairs is changing because of HIV and AIDS (Brooks-Gunn et al., 1988; Brooks-Gunn and Furstenberg, 1989, 1990; Sondheimer et al., 1990). This article originated after the urging of several colleagues who asked me to recount how I was able to convince schools and families to participate in studies of young adolescents that focus on puberty and sexual behavior. These topics are of increasing concern for young adolescents. High percentages of teenagers 16 years of age and younger have had intercourse, making it imperative to learn about their pubertal and sexual experiences (Brooks-Gunn and Furstenberg, 1989; Hofferth and Hayes, 1987). Contraceptive use is sporadic in sexually active teenagers 16 years of age and younger. Compared to most Western European countries that have similar ages of sexual initiation, the United States has relatively high teenage birth rates (Jones et al., 1985; Jones et al., 1988). School districts (three-quarters) offer some type (although often inadequate) of pubertal and sex education instruction (Kirby, 1984; Kirby and Scales, 1981). However, ignorance about reproduction such as the time of cycle in which women are likely to conceive is still widespread, and programs that enhance reproductive knowledge still are few and far between (Paikoff and Brooks-Gunn, in press). Indeed, the vast majority (i.e. 75 ~ of parents want pubertal sex education taught in schools. And almost all (94%) parents want AIDS education in the schools (Harris Poll, 1988), which virtually requires pubertal and sex education (Brooks-Gunn et al., 1988). This article focuses on pubertal research. Reasons why such research has languished are recounted, with a focus on the discomfort of adults and negative societal messages. The design of reproductively oriented studies is considered to highlight the study requirements that sometimes concern school staff. Strategies for recruiting schools and families are outlined as are procedures for testing in the schools. My hope is that such information will be of help to others who are frustrated in their attempts to work with schools, or even worse, have avoided initiating such research because of recruitment
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concerns (I have seen colleagues' initial euphoria over obtaining grant funds to study puberty dampened all too quickly by recruitment worries).
ADULT DISCOMFORT WITH PUBERTY As early adolescent research comes into its own, we might ask why it was neglected, especially in the face of negative stereotypes (rebellious, tumultuous, stormy) and the concerns o f parents, pediatricians, and educators about the pubertal years (Holmbeck and Hill, 1987). Several conditions may be important, one of which involves what puberty means to most adults and how our society treats the onset of reproductive maturity (see Brooks-Gunn, 1989a, for a discussion of more conceptual reasons for the "stepchild" status of pubertal research). First, many adults are uncomfortable discussing the physical aspects of growth, probably because of cultural taboos about considering such topics and because the changes are associated with sexuality. Discomfort may lead to a denial of the importance of early physical changes (Brooks-Gunn and Warren, 1988). For example, in some of our research, we encountered initial concern about asking 5th graders questions relating to breast buds. School personnel believed young girls either were not concerned about such changes or did not notice these changes in others. Pointing out that one-half of their young students had breast buds, that these changes were certainly observed by teachers and students alike, and that even 5th graders knew about possible menstrual cycle changes in behaviors helped alter their reluctance to have us ask about early physical changes. Second, the pubertal experiences of many adults were not pleasant. For example, over 40% of women who are now over 60 were not prepared for menarche (Larsen, 1961). Being unprepared has been shown to be a particularly unsettling experience, influencing feelings about one's body and menstrual experiences into late adolescence and adulthood (Koff et al., 1982; Shainess, 1961). Given that only a small proportion of girls (less than 15% in White American lower to upper middle-class samples) have no information provided to them prior to the onset of menstruation today, negative experiences are less likely to occur for cohorts today than previously (Brooks-Gun and Ruble, 1982; Whisnant and Zegans, 1975). Men may be even less prepared for their own puberty, especially since ejaculation may be a more taboo subject than menarche, given the former's overt links with sexuality. In a small study of boys in 8th and 9th grade, less than 15% had discussed ejaculation with anyone prior to its occurrence (Gaddis and Brooks-Gunn, 1985). As recently as 1968, two-thirds of a sample of older adolescents reported having no initial information about ejaculation (Shipman, 1971). Indeed, boys and young men may be more knowledgeable about menarche than about some of the events that they are about to experience or have experienced (Clarke and
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Ruble, 1978; Brooks-Gunn and Ruble, 1986). Thus, adult males may find it even more difficult than adult women to discuss their pubertal experiences. Third, given that physical changes are universal and occur within a specific time frame, it is sometimes presumed that any possible effects on behavior would be transient; that is, since almost all adolescents complete most of the pubertal process by age 15 or 16, effects of tempo variations would be minimal since the end state is universal. However, experiences occurring in one life phase, such as puberty, may influence how an individual responds to subseqeunt experiences occurring in other life phases. Choices made in early to middle adolescence may set in motion events that influence choices made later on. One such example is the emersion in athletics of many early maturing boys, and the enhanced social status associated with such behavior throughout adolescence and early adulthood (Clausen, 1975; Livson and Peskin, 1980). Another example would be the long-lasting effects of early maturational timing on girls (Stattin and Magnusson, 1990; Petersen et al., in press). A final illustration is young teenage parenthood, which clearly sets into motion a series of events influencing the later life course (Furstenberg eta/., 1987; Lancaster and Hamburg, 1986). Fourth, from a societal point of view, pubertal growth is not celebrated or even formally acknowledged in the United States as is the case in most world societies (Paige, 1983). Instead, it is not commented upon or is treated with secrecy, even within the family. For example, in the late 1970s in Central New Jersey, only less than 20% of junior and senior high school girls told their father when they began to menstruate (although almost all told their mothers; Brooks-Gunn, 1987). In a small sample of boys from the same area, none told their mothers and only one told his father that he had experienced an ejaculation (Gaddis and Brooks-Gunn, 1985). More anecdotally, very few parents tell us that they celebrate their daughter's change of status. While probably stemming directly from societal beliefs concerning the "appropriateness" of talking about puberty, parents' and children's reluctance to talk about these events may further strengthen beliefs that they are not particularly salient or even critical to emerging self-definitions (cf. social cognitive theory on distinctiveness of events and perceived co-occurrence of events; Ruble and Brooks-Gunn, 1979; Tversky and Kahneman, 1974).
DESIGN CONSIDERATIONS Our group has conducted four sets of pubertal studies in the last decade. The first set focused on m e n a r c h e - h o w girls experienced this event, how this initial experience became the context in which subsequent feelings about one's body developed, and how socialization influenced the menarcheal experience (Brooks-Gunn and Ruble, 1982; Ruble and Brooks-Gunn,
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1982). The second set did not focus on one pubertal event, but looked at the meaning of various events to the young girl, as well as how the timing and sequencing of these events influenced self-definitions, depression, school functioning, and physical health (Brooks-Gunn, 1989b). The third set considered the emergence of eating problems and depression from middle school through college (Attie and Brooks-Gunn, 1989; Paikoff et al., 1990). The final set, focusing on 7th- and 9th-grade girls, examined the process by which mothers and daughters separate from one another, how this process might relate to subsequent autonomy and gender identity formation in adolescent girls, and what role puberty might play in this process (Brooks-Gunn and Zahaykevich, 1989). The design of the menarche studies was fairly straightforward. In order to examine, on a broad scale, developmental changes in symptom reports, expectations, and feelings associated with menarche, a large cross-sectional study was conducted, including late elementary school, junior high, senior high, and college students. Then, to look at changes occurring at the time of menarche, over 100 premenarcheal 5th and 6th graders were followed and reinterviewed after they had had their first menstruation. A matched comparison sample of girls who were still premenarcheal was used to control for repeated testing and time-dependent changes (a same-aged premenarcheal girl was drawn from the longitudinal pool for each menarcheal girl; both girls were reinterviewed in the same time period). Thus, menarche, rather than age, grade in school, or time interval, was the "anchor point" in this study, given our interest in changes that might be a function of this specific pubertal event. Few studies have employed this design (Brooks-Gunn, 1984; Grief and Ulman, 1982), even though it is common in studies of pregnancy, early motherhood, marriage, and divorce, all events that may occur at various times in a woman's life. Given how little was known about puberty, we also wished to examine the "large picture" in the second set of studies vis-a-vis differences as a function of age, pubertal status, and maturational timing. Again, 5th-12th graders were seen cross sectionally. To examine change, 5th-7th graders were seen yearly, four times. Unlike the previous menarche longitudinal study, grade in school, rather than pubertal status, was used to define the timing of visits given our interest in multiple measures of puberty (so that using any one as an anchor point would be problematic). All of the girls recruited for this study had been in the original cross-sectional study, making it possible to compare those who did and did not choose to participate, a nice design feature. In the third and fourth sets, girls who were in 7th-9th grades were seen, given interests in eating problems and changes in mother-daughter relationships, respectively. Previous research suggested that eating problems may occur at the time of most rapid weight gain (between Tanner Stages 3 and 5) and that mother-daughter conflicts reach an apex at this time, which natur-
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ally led to a focus on the 13- to 15-year-old (Blos, 1979; Crisp, 1984; Dornbusch et al., 1984; Josselson, 1980; Paikoff and Brooks-Gunn, 1990).
APPROACHING
THE SCHOOLS
Obtaining samples of girls for these studies was difficult. Since our objective across all studies has been to chart the course of girls' development, we did not wish to use clinic or medical practice "convenience" samples, but to contact girls within communities. Schools were the obvious choice for young adolescents, as drop-out rates are low during the first half of adolescence and for middle- to upper middle-class samples, generally. But many school administrators were wary about asking questions on pubertal development, in part because of their own discomfort discussing puberty and from their belief that young adolescents do not discuss such changes. In our menarche studies, conducted in the middle 1970s, principals in two Central New Jersey school districts approved our protocal (with three other school districts declining our invitation). To augment the sample, we finally turned to the Central New Jersey Girl Scouts, whose support and enthusiasm were deeply appreciated. While not the "perfect" sample in terms of representativeness, no discernable differences surfaced between the school and Girl Scout samples. Generally, we discovered that male school administrators and staff were much more wary about our research than their female counterparts. In the 1980s, our protocols were expanded to include questions on breast and pubic hair development, the growth spurt, weight changes, feelings about such pubertal changes, and responses of parents and peers to such changes. In addition, Tanner ratings of physical development were added to obtain more precise estimates of rate and tempo changes in pubertal growth (BrooksGunn and Warren, 1985). These topics were considered far more sensitive than just asking about menarcheal experience. Indeed, no one even questioned the appropriateness of asking about menarche (either adult attitudes had changed from the middle 1970s to the 1980s, or given the content of our protocols, menarche was considered the least sensitive pubertal event). Given our previous experience, we first contacted schools that had a high likelihood of having females running them and that were committed to girls' education: These were single-sex private schools. Later on, we included coeducational private schools, with no recruitment difficulties (although, of course, by this time we had a "track record" and a host of references). Four schools were the "core" of our program, with six others participating in various studies (another two were contacted; one declined and one had to cancel testing because of a serious fire the week prior to our sessions). Two others have been added in the last year. All are private, are concerned about the
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difficulties that girls have today with growing up, and are sympathetic and supportive of the need for pubertal research. While our sample is not representative of a cross section of youth, it is similar to samples drawn from primarily White, middle to upper middle-class suburbs (such as Petersen's Chicago suburb sample, 1984). This may be due to the fact that the "core" schools are in Manhattan, where almost all professional families send their children to private schools or move out of the city when their children are school age. Principals
Typically, we approach the principal first. In some cases he or she directed us to the superintendent or the head of the school board, but in the majority of cases the principal, if interested in our work, managed these relationships for us. Elementary school principals tend to see pubertal concerns as outside their mandate (Brooks-Gunn et al., 1982), even though by 5th grade approximately half of all girls have developed breast buds (Harlan et al., 1980; Tanner et al., 1966). If one wishes to study the onset of puberty, beginning in middle school is too late, and elementary school principals (and parents) have to be educated as to the necessity of interviewing students in late childhood. In general, male principals had difficulty discussing specific pubertal changes; they focused on general changes, such as the growth spurt and the more generic appellation of the "body changing." Given that 70~ of public elementary school and 90~ of public high school principals are male, discomfort, when it occurs, is a major research obstacle (Feistritzer, 1988). Additionally, males also may be uncomfortable talking about boys' changes (Gaddis and Brooks-Gunn, 1985), so that it may not be easier to do studies on boys than girls. In the second set of studies, we had very little difficulty discussing both menarche and other changes with the principals. However, in private schools, the majority of whose principals are female (nationwide, only 48~ of private school principals are male; Feistritzer, 1988). However, even the three male principals were enthusiastic. It is difficult to know whether private school principals find the pubertal topics, or perceive their parent constituency to find these topics, less objectionable than public school principals, or whether societal changes occurred in the acceptability of discussing pubertal changes between the 1970s and 1980s. Almost all principals felt that most research projects were not helpful to their students and took away from the important taks of education. In many schools, we provided brief lessons and lectures to the student body on pubertal change after the study was completed, and an explanation of behavioral science and medical research in order to render the study more educationally meaningful.
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I suggest that a researcher not approach a school with a new principal. The principal will not have learned about how to handle different beliefs of parents, nor the minority who will disapprove of the research. For example, in one private school, we postponed testing for nine months until a new principal became established. Principals who are preparing to leave a school district may not wish to take responsibility for a pubertal study. Principals deluged with m a n y problems may see a study either as a nuisance or a relief. One principal told us that our study was a bright note in a period of difficult financial cutbacks. Another said that given current levels of teacher dissatisfaction, he could not possibly introduce a study that might add, or be perceived to add, to the teacher's work load. In both cases, our study was put into perspective: No matter how important the study is to researchers, it is not particularly relevant to the everyday ongoing concerns o f school staff. S c h o o l Boards
We do not contact school board members directly, allowing the principal to decide how to initiate the approval process. In about half of the schools, I eventually met with or talked to school board representatives officially or informally. Researchers testing in their own community should expect to be contacted by some board members individually, even if board approval is not required. This occurred in our four core schools. Parents
I have found parents to be our most enthusiastic supporters. A b o u t 5% or less of parents seem to disapprove of a study of puberty. The vast majority of parents are concerned about how to teach their children about puberty and sexual behavior in a responsible manner. To answer questions, parents are encouraged to call us rather than school staff. Since this is not always successful, a contact person in the school is usually designated to field calls from parents; we work directly with this person to see if we can help in answering questions or m a y contact a parent directly (depending on how the school wishes to handle parents' questions). I find that talking with parents is extremely helpful. If I cannot justify a particular study to parents, then perhaps I should not be doing it at all. Feedback to S c h o o l s
In the first set of studies, I did not take the principals' requests for feedback as seriously as I should have. Indeed, our staff conducted few teacher
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workshops, student assemblies, or student classes. By the time of the second set of studies, Michelle Warren and I felt more strongly that we had a responsibility to provide research information to school communities. We always offered to talk to teachers or to children on social, psychological, and physiological aspects of puberty or on more specific topics associated with young adolescents. Student summer internships in our adolescent study program were offered at our four core schools. On a yearly basis, our schools are sent copies of all articles and chapters that we have written on adolescence. We offer to talk about the work in student assemblies, even though our studies have ended, given the time line for longitudinal work. Not only does this procedure serve an educational function, but it recognizes school personnel as part of the collaborative team.
TESTING P R O C E D U R E S Logistics
Testing is always tailored to the second schedule. We have tested during lunch, during gym class, after school, on Saturdays, and in biology class. A contact person, often the teacher overseeing curriculum, is designated to remind teachers and students that the consent forms were being sent home (via assembly or memo), and that their parents needed to sign it and to talk with our senior research assistant daily. On testing days, typically, 5%-10070 of girls appear without consent forms. We arrange for a second testing time for these girls to give them a chance to bring the consent forms from their mothers and offer to speak to their mothers.
Informed Consent
We always offer to mail parental consent forms and explanations directly to the parent. We do not have access to names and addresses from student lists; either a student does the mailings from the school site or we obtain labels but not lists from the schools. In the peer review process, we have been criticized for not knowing which parents agreed to participate and which did not; this is an indefensible position given NIH informed consent guidelines for minors. Schools are often happy to provide the number of students enrolled per grade so that response rates may be calculated. In addition, schools often will provide basic demographic background on their population, so that one may see in a very general sort of way whether those who participated are representative of the school body.
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The NIH requirement of prior informed parental consent is helpful. Most parents who have concerns about pubertal topics do not allow their children to participate. The only problem arises when certain parents decide to act as a "watchdog" for all other children, and complain about the study being done at all even when their children are not participating (underscoring the importance of NIH guidelines requiring signed parental consent, not so-called negative consent). In anticipation of this unlikely outcome (although it has happened to me once), I recommend talking to members of the school board as well as to the principal. Some schools have set up their own institutional review boards; others require school board review of the consent forms and questionnaires.
Response Rates Response rates for studies of young adolescents vary, depending on the ways that subjects are recruited. The rates tend to vary from 60~ to 85~ when parental written permission is required. Even using the procedures outlined earlier, our response rates vary by school. Response rates tend to be positively associated with presenting teacher workshops, conducting student assemblies on adolescent development, enthusiasm of the contact teacher, commitment of the principal, and testing during the school day (even at lunch) rather than after school.
Reviewing the Questionnaire School staff always review our questionnaire at a point when changes are possible. Teachers often target sensitive areas, and discussions about altering questions, omitting them, or explaining why they should be included are helpful. When approaching other schools about the study, having gone through this process provides some face validity about the acceptability of a questionnaire to teachers.
Quelling Rumors No matter how careful the researcher is with regard to study explanations, some students will misconstrue it. In one school, rumors circulated at the beginning of the study that girls would have to undress (when, in fact, they were being weighed and measured while in clothes). In another school, a few girls believed that their mothers would be shown pictures of them unclothed (parents were being given schematic drawings of the Tanner stages;
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Brooks-Gunn et al., 1987). In both instances, good relationships with the teachers allowed us to hear about the rumors immediately and discuss them with the students.
M E A S U R E M E N T ISSUES Pubertal Measures
Many schools will not allow Tanner staging to be done. Solutions include the following: First, schematic drawings of Tanner stages with written descriptions have been used in several studies. In medically based studies, girls rate themselves (Brooks-Gunn et al., 1987; Duke et al., 1980; Morris & Udry, 1980). In our school-based studies, mothers rated a Tanner staging schematic, as school staff felt that it would be too sensitive for children to do so. Almost all mothers are able to rate their daughters' current physical status, with the reliability being as high as daughter ratings, as determined in a validity study (Brooks-Gunn et al., 1987). Second, a study could be conducted that is a combination school-based, medically-based study. Schools may be less reluctant to consider a physical exam if students recruited at their schools were seen at a neighborhood health center, a hospital, or a clinic, as we have done in one study. Such a procedure might allow researchers to draw a more representative sample than is possible using clinics or physicians, while alleviating concerns about physical examinations and instrusiveness. Third, children themselves may be reluctant to have Tanner staging done, if that is the sole purpose of the exam and if they have not had Tanner staging done before. Staging is more acceptable if done as part of a complete physical examination, as is commonly done by a pediatrician. Even then, children may not wish to have an unfamiliar physician or nurse-practitioner conduct a physical exam; if the cooperation of pediatricians in the community can be obtained, more students may participate in such studies. Refresher courses on Tanner staging for physicians and nurse-practitioners would be necessary if this procedure were initiated. Whether a majority of pediatricians in the community would be enthusiastic enough about such a study to participate is not known. In addition, it is not feasible in large communities in which students see many different physicians or in disadvantaged communities in which health care is fragmented or inaccessible (Egbuonu and Starfield, 1982). Fourth, while I have worried about collecting Tanner staging data, our well-educated families readily accept it. Finally, schools are reassured by the fact that we collect Tanner data on an already standardized scale used in other school settings.
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How reluctant are girls to answer pubertal questions? Very few omit items on self-report questionnaires (although girls are reminded repeatedly throughout our questionnaires that they may skip items, in accordance with NIH guidelines). From a clinical perspective, about 10~ of the girls seem to be embarrassed during the Tanner staging examination. At the same time, they also are pleased when they have completed the examination and interview, as many seem to see it as a major milestone (in that such physical examinations are a part of recommended medical practice). In personal interviews, many girls seem eager to share their pubertal experiences; given the pervasiveness of such conversations with peers and the meagerness of such talks with parents, having an interested adult woman may be comforting. Whether embarrassment in discussing puberty prevents some girls from participating in such studies is not known. In our second set of studies, girls who volunteered for the longitudinal study were similar to those who did not (i.e., on measures of body image, emotional tone, family relationships, and pubertal status). About one-fourth of girls who did not participate in one study told us that they did not like having their blood drawn (in the study including a hormonal workup; Brooks-Gunn and Warren, 1989). Multimethod Approach
We have used a multimethod approach, depending on the specific research question of interest. Self-reports were used in the cross-sectional studies, augmented with maternal reports for specific topics, as in the Tanner stage of ratings discussed earlier. We use structured and semistructured interviews to probe girls' reactions to pubertal events. For example, with regard to menarche, different approaches yield varying intensities of responses. Typically, girls describe both positive and negative feelings-excited and pleased, scared and upset; however, these feelings are not particularly intense (Whisnant and Zegans, 1975; Petersen, 1983). Less direct measures of emotional reactions elicit different responses. In one study, girls were asked what they would tell a sister their age in order to prepare her for the experience. Girls were quite pragmatic when it came to telling their "hypothetical sister" about m e n a r c h e giving her information about hygiene and supplies. Few girls mentioned negative aspects of menstruation (Ruble and Brooks-Gunn, 1982). Rierdan and Koff (1985) gave a small sample of girls in 7th and 8th grades a sentence completion task, starting with the phrase "Ann just got her period for the first time." Responses were almost all negative, unlike the findings just reported. Girls may be more reluctant to discuss negative feelings in interviews. At the same time, projective techniques may elicit girls' feelings about the event in general, not their specific reaction to the event. For example, adult and adolescent females report that women in general experience more severe symptoms than they themselves experience (Parlee, 1974; Brooks et al., 1977).
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Similar findings are cropping up for pubertal events other than menarche. We are examining 5th- to 7th-grade responses to breast growth, using a semistructured format (e.g., "How do you feel about breast growth?" "What physical change do you feel is most important?" "Who have you talked to about physical changes?") and a TAT format (a picture of an adult woman, adult man, and teenage girl in which the adult woman is taking a bra out of a shopping bag; Tobin-Richards et al., 1983). Reactions to the latter are more intense than to the former (Brooks-Gunn et al., 1990). I do not believe that the responses from one method are more valid, but that they represent different aspects of girls' experience of puberty (see Kagan, 1988, for a discussion of the meaning of results devised from different methods). A final example of the usefulness of multimethod approaches in this series of studies comes from the third set of studies. Mothers', but not daughters', ratings of the family environment were associated with girls' report of eating problems (Attie and Brooks-Gunn, 1989). The discrepancy between findings using mother and daughter ratings suggests differences in their perceptions of the family's functioning, or in mothers' and daughters' willingness to report them. Not only is denial a salient feature of adolescents with eating disorders (Fairburn, 1984), so is the tendency for family members to avoid conflict (Minuchin et al., 1978). In a new set of analyses, motherdaughter disagreements vis-~t-vis family issues are associated with girls' wellbeing (Carlton-Ford et al., in press). Such findings highlight the importance of obtaining information from multiple informants.
CONCLUSION The most difficult aspect of conducting pubertal research for me is to keep a sense of perspective. In all of our studies, I worry about school cooperation. Remembering that the school staff has its own concerns has helped; teachers and principals are very busy and often their work is not appreciated as much as it should be. Most surprisingly, I have found that being passionate about one's research and having a sense of humor have helped overcome barriers. The field has moved a long way since Lipsitz (1977) referred to adolescence as Growing Up Forgotten; it can only expand further if researchers, schools, and families learn how to ask difficult but relevant questions associated with reproduction and sexual maturity.
ACKNOWLEDGMENTS I would also like to thank my collaborators, Michelle Warren and Diane Ruble, and my students and colleagues. Roberta Paikoff deserves special
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t h a n k s f o r her c a r e f u l r e v i e w o f t h e m a n u s c r i p t . M y h e a r t f e l t t h a n k s g o t o t h e s c h o o l p r i n c i p a l s a n d t e a c h e r s , as well as t h e a d o l e s c e n t girls a n d t h e i r p a r e n t s , w i t h o u t w h o m this a r t i c l e c o u l d n o t h a v e b e e n w r i t t e n .
REFERENCES
Attie, I., and Brooks-Gunn, J. (1989). Development of eating problems in adolescent girls: Longitudinal study. Develop. Psychol. 64:88-112. Blos, P. (1979). The Adolescent Passage. International Universities Press, New York. Brooks, J., Ruble, D. N., and Clarke, A. (1977). College women's attitudes and expectations concerning menstrual related changes. Psychosom. Med. 39: 288-298. Brooks-Gunn, J. (1984). The psychological significance of different pubertal events to young girls. J. Early Adoles. 4: 315-327. Brooks-Gunn, J. (1987). Pubertal processes and girls' psychological adaptation. In Lerner, R., and Foch, T. T. (eds.), Biological-Psychosocial Interactions in Early Adolescence: A Life-Span Perspective. Lawrence Erlbaum Associates, Hillsdale, NJ. Brooks-Gunn, J. (1988). Transition to early adolescence. In Gunnar, M., and Collins, W. A. (eds.), Development During Transition" to Adolescence: Minnesota Symposia on Child Psychology, Volume 21. Erlbaum, Hillsdale, NJ. Brooks-Gunn, J. (1989a). Pubertal processes and the early adolescent transition. In Damon, W. (ed.), Child Development Today and Tomorrow. Jossey-Bass, San Francisco. Brooks-Gunn, J. (1989b). Adolescents as children and as parents: A developmental perspective. In Sigel, I. E., and Brody, G. H. (eds.), Methods of Family Research: Biographies of Research Projects, Volume I: Normal Families. Erlbaum, Hillsdale, NJ. Brooks-Gunn, J., and Furstenberg, F. F., Jr. (1989). Adolescent sexual behavior. Am. Psychol. 44: 249-257. Brooks-Gunn, J., and Petersen, A. C. (eds.). (1983). Girls at Puberty." Biological and Psychosocial Perspectives. Plenum Press, New York. Brooks-Gunn, J., and Reiter, E. O. (1990). The role of pubertal processes in the early adolescent transition. In Feldman, S., and Elliott, G. (eds.), A t the Threshold: The Developing Adolescent. Harvard University Press, Cambridge, MA.. Brooks-Gunn, J., and Ruble, D. N. (1982). The development of menstrual-related beliefs and behaviors during early adolescence. Child Develop. 53: 1567-1577. Brooks-Gunn, J., and Ruble, D. N. (1986). Men's and women's attitudes and beliefs about the menstrual cycle. Sex Roles 14: 287-299. Brooks-Gunn, J., and Warren, M. P. (1985). Measuring physical status and timing in early adolescence: A developmental perspective. J. Youth Adoles. 14: 163-189. Brooks-Gunn, J., and Warren, M. P. (1988). The psychological significance of secondary sexual characteristics in 9- to 11-year old girls. Child Develop. 59: 161-169. Brooks-Gunn, J., and Warren, M. P. (1989). Biological contributions to affective expression in young adolescent girls. Child Develop. 60: 372-385. Brooks-Gunn, J., and Zahaykevich, M. (1989). Parent-child relationships in early adolescence: A developmental perspective. In Kreppner, K., and Lerner, R. LM. (eds.), Family Systems and Life-Span Development. Erlbaum, Hillsdale, NJ. Brooks-Gunn, J., Boyer, C. B., and Hein, K. (1988). Preventing HIV infection and AIDS in children and adolescents: Behavioral research and intervention strategies. Am. PsychoL 43: 958-964. Brooks-Gunn, J., Kirsh, B., and Merson, E. M. (1982). A principal's eye-view of family-school relationships. National Association of Elementary School Principals. Brooks-Gunn, J., Newman, D., and Warren, M. P. (1990). Significance of breast growth. Unpublished manuscript, Educational Testing Service, Princeton, NJ. Brooks-Gunn, J., Warren, M. P., Rosso, J., and Gargiulo, J. (1987). Validity of self-report measures of girls' pubertal status. Child Develop. 58: 829-841.
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Carlton-Ford, S., Paikoff, R. L., and Brooks-Gunn, J. (in press). Models for assessing effects of disagreement on adolescents and their parents. In R. L. Paikoff and W. A. Collins, (eds.), New directions f o r child development: Implications o f disagreements about family functioning f o r adolescents and their parents. San Francisco: Jossey-Bass. Clarke, A. E., and Ruble, D. N. (1978). Young adolescents' beliefs concerning menstruation. ChiM Develop. 49: 231-234. Clausen, J. A. (1975). The social meaning of differential physical and sexual maturation. In Dragastin, S. E., and Elder, G. H. Jr., (eds.) Adolescence in the Life Cycle: Psychological Change and Social Context. Hemisphere, Washington, DC. Crisp, A. H. (1984). The psychopathology of anorexia nervosa: Getting the "heat" out of the system. In Stunkard, A. J., and Stellar, E. (eds.), Eating and Its Disorders. Raven Press, New York. Dornbusch, S. M., Carlsmith, J. M., Duncan, P. D., Gross, R. T., Martin, J. A., Ritter, P. L., and Siegel-Gornick, B. (1984). Sexual maturation, social class, and the desire to be thinner among adolescent females. Develop. Behav. Pediat. 5: 308-314. Duke, P. M., Litt, I. F., and Gross, R. T. (1980). Adolescents' self-assessment of sexual maturation. Pediatrics 66: 918-920. Egbuonu, L., and Starfield, B. (1982). Child health and social status. Pediatrics 69: 550-557. Fairburn, C. G. (1984). Bulimia: Its epidemiology and management. In A. J. Stunkard, A. J., and Stellar, E. (eds.), Eating and Its Disorders. Raven Press, New York. Feistritzer, C. E. (1988). Profile o f School Administrators in the United States. National Center for Education Information, Washington, DC. Furstenberg, F. F. Jr., Brooks-Gunn, J., & Morgan, P. (1987). Adolescent Mothers in Later Life. Cambridge University Press, New York. Gaddis, A., and Brooks-Gunn, J. (1985). The male experience of pubertal change. J. Youth Adoles. 14: 61-69. Grief, E. B., and Ulman, K. J. (1982). The psychological impact of menarche on early adolescent females: A review of the literature. Child Develop. 53: 1413-1430. Gunnar, M. R., and Collins, W. A. (eds.). (1988). Transitions in Adolescence: Minnesota Symposia on Child Psychology, Volume 21. Erlbaum, Hillsdale, NJ. Harlan, W. R., Harlan, E. A., and Grillo, G. P. (1980). Secondary sex characteristics of girls 12 to 16 years of age: The U.S. Health Examination Survey. J. Pediat. 96: 1074-1078. Harris Poll. (1988). When AIDS comes to school. Children's Mag. 1-20. Hofferth, S. L., and Hayes, C. D. (Eds.). (1987). Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing, Volume II. National Academy of Sciences Press, Washington, DC. Holmbeck, G. N., and Hill, J. P. (1988). Storm and stress beliefs about adolescence: Prevalence, self-reported antecedents, and effects of an undergraduate course. J. Youth Adoles. 17: 285-306. Jones, E., Forrest, J. D., Goldman, N., Henshaw, S., Lincoln, R., Rosoff, J., Westoff, C., and Wulf, D. (1985). Teenage pregnancy in developed countries: Determinants and policy implicatons. Family Plan. Perspect. 17: 53-65. Jones, E., Forrest, J. D., Silverman, J., and Torres, A. (1988). Unintended pregnancy, contraceptive practice and family planning services in developed countries. Family Plan. Perspect. 20: 53-67. Josselson, R. L. (1980). Psychodynamic aspects of identity formation in college women. J. Youth Adoles. 2: 3-52. Kagan, J. (1988). The meaning of personality predicates. Am. Psychol. 43(8): 614-620. Kirby, D. (1984). Sexuality Education: An Evaluation o f Programs and Their Effects. Network Publications, Santa Cruz, CA. Kirby, D., and Scales, P. (1981). An analysis of state guidelines for sex education instruction in public schools. Family Relat. 30: 229-237. Koff, E., Rierdan, J., and Sheingold, K. (1982). Memories of menarche: Age, preparation, and prior knowledge as determinants of initial menstrual experience. J. Youth Adoles. 11: 1-9. Lancaster, J. B., and Hamburg, B. A. (eds.). (1986). School-Age Pregnancy and Parenthood: Biosocial Dimensions. Aldine-De Gruyter, New York.
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Larsen, V. L. (1961). Sources of menstrual information: A comparison of age groups. Family Life Coordin. 10: 41-43. Lerner, R. M., and Foch, T. T. (Eds.). (1986). Biological-Psychosocial Interactions in Early Adolescence: A Life Span Perspective. Erlbaum, Hillsdale, NJ. Lipsitz, J. (1977). Growing Up Forgotten: A Review o f Research and Programs Concerning Young Adolescents. Heath, Lexington, MA. Livson, N., and Peskin, H. (1980). Perspectives on adolescence from longitudinal research. In Adelson, J. (ed.), Handbook o f Adolescent Psychology. Wiley, New York. Minuchin, S., Rosman, B. L., and Baker, L. (1978). Psychosomatic Families: Anorexia Nervosa in Context. Harvard University Press, Cambridge, MA. Morris, N. M., and Udry, J. R. (1980). Validation of a self-administered instrument to assess stage of adolescent development. J. Youth Adoles. 9: 271-280. Paige, K. E. (1983). A bargaining theory of menarcheal responses in preindustrial cultures. In Brooks-Gunn, J., and Petersen, A. C. (eds.), Girls at Puberty: Biological and Psychosocial Perspectives. Plenum Press, New York. Paikoff, R., and Brooks-Gunn, J. (in press). Taking fewer chances: Teenage pregnancy prevention programs. Am. PsychoL Paikoff, R., Carlton-Ford, S., and Brooks-Gunn, J. (1990). Variation in mother-daughter disagreement about the family: Association with girls' well-being. Unpublished manuscript, Educational Testing Service, Princeton, NJ. Parlee, M. B. (1974). Stereotypic beliefs about menstruation: A methodological note on the Moos Menstrual Distress Questionnaire and some new data. Psychosom. Med. 36: 229-240. Petersen, A. C. (1983). Menarche: Meaning of measures and measuring meaning. In Golub, S. (ed.), Menarche. Heath, Lexington, MA. Petersen, A. C. (1984). The early adolescence study: An overview. J. EarlyAdoles. 4: 103-106. Petersen, A. C. (1988). Adolescent development. Ann. Rev. Psychol. 39: 583-607. Petersen, A. C., Sarigiani, P. A., and Kennedy, R. E. (in press). Adolescent depression: Why more girls? J. Youth Adoles.. Rierdan, J., and Koff, E. (1985). Timing of menarche and initial menstrual experience. J. Youth Adoles. 14: 237-234. Ruble, D. N., and Brooks-Gunn, J. (1979). Menstrual symptoms: A social cognitive analysis. J. Behav. Med. 2: 171-194. Ruble, D. N., and Brooks-Gunn, J. (1982). The experience of menarche. Child. Develop. 53: 1557-1566. Shainess, N. (1961). A re-evaluation of some aspects of femininity through a study of menstruation: A preliminary report. Comp. P sychiat. 2: 20-26. Shipman, G. (1971). The psychodynamics of sex education. In Muuss, R. E. (ed.), Adolescent Behavior and Society: A Book o f Readings. Random House, New York. Sondheimer, D. L., Hein, K., Brooks-Gunn, J., and Novello, A. (1990). Human immunodeficiency virus (HIV) in adolescents: Setting a national research agenda for the 1990s. Unpublished manuscript. Stattin, H., and Magnusson, D. (1990). Paths Through L i f e - Volume 2: Pubertal Maturation in Female Development. Erlbaum, Hillsdale, NJ. Tanner, J. M., Whitehouse, R. H., and Takaishi, M. (1966). Standards from birth to maturity for height, weight, height velocity and weight velocity: British children, 1965. Arch. Dis. Child. 41: 454-471,613-635. Tobin-Richards, M., Boxer, A., and Petersen, A. C. (1983). Early adolescents' perceptions of their physical development. In Brooks-Gunn, J., and Petersen, A. C. (eds.), Girls at Puberty: Biological and Psychosocial Perspectives. Plenum Press, New York. Tversky, A., and Kahneman, D. (1974). Judgment under certainty: Hueristics and biases. Science 185: 1124-1131. Whisnant, L., and Zegans, L. (1975). A study of attitudes toward menarche in white middle-class American adolescent girls. Am. J. Psychiat. 132: 809-814.
Overcoming Barriers to Adolescent Research Pubertal and Reproductive Development
on
Jeanne Brooks-Gunn I
Received February 9, 1989; acceptedFebruary 6, 1990 Perhaps the greatest barriers to conducting adolescent research on pubertal and reproductive behavior involve obtaining permission from schools and parents to conduct the study in the first place. This article addresses these barriers, focusing on (a) possible reasons why such research has languished, with a focus on the discomfort of adults and on negative societal messages; (b) design of reproductively oriented adolescent studies; (c) strategies for recruiting schools and families; (d) procedures for testing in the schools; and (e) methodological considerations of such barriers.
INTRODUCTION O n e of the m a n y valuable c o n t r i b u t i o n s o f the recent interest in adolescent d e v e l o p m e n t is a better u n d e r s t a n d i n g o f p u b e r t a l a n d sexual r e p r o d u c tive events (and the m e a n i n g of such events). The adolescent experience includes physical a n d reproductive growth, e x p l o r a t i o n o f sexual feelings, a n d increasingly, the i n i t i a t i o n of sexual b e h a v i o r a n d the c o n t r o l o f fertili-
This article was prepared while the author was a Visiting Scholar at the Russell Sage Foundation. The foundation's support and the generous assistance of the National Institutes of Health (NICHD), and the W. T. Grant Foundation, are appreciated. ljob title, Educational Testing Service, Princeton, NJ 08541. Received PLD from University of Pennsylvania. Research interests are girl's psychologicaladaptation to pubertal change, biosocial aspects of female reproductive events, development of biological and socially at risk children and adolescents. Correspondence should be sent to Dr. Brooks-Gunn, Educational Testing Service, Princeton, NJ 08541. 425 0047-2891/90/10004)425506.00/0 9 Plenum Publishing Corporation
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ty. Researchers are exploring: (a) how girls and boys make sense of these events; (b) how they incorporate them into their self-definition as adults (and as women and men); (c) how others, especially parents and peers, perceive and respond to these events; (d) what relational changes occur as a consequence of self- and other-perspectives; and (e) whether such changes translate into particular modes of adaptation and whether these are linked to gender (Brooks-Gunn, 1988; Brooks-Gunn and Petersen, 1983; Brooks-Gunn and Reiter, 1990; Gunnar and Collins, 1988; Lerner and Foch, 1987; Petersen, 1988). While fascinating and critical topics, they also are difficult ones, in part because of obtaining consent from schools, parents, and sometimes teenagers themselves. Indeed, reproductive subjects may be understudied because of concerns about recruitment and because schools are often reluctant to launch such studies, although this state of affairs is changing because of HIV and AIDS (Brooks-Gunn et al., 1988; Brooks-Gunn and Furstenberg, 1989, 1990; Sondheimer et al., 1990). This article originated after the urging of several colleagues who asked me to recount how I was able to convince schools and families to participate in studies of young adolescents that focus on puberty and sexual behavior. These topics are of increasing concern for young adolescents. High percentages of teenagers 16 years of age and younger have had intercourse, making it imperative to learn about their pubertal and sexual experiences (Brooks-Gunn and Furstenberg, 1989; Hofferth and Hayes, 1987). Contraceptive use is sporadic in sexually active teenagers 16 years of age and younger. Compared to most Western European countries that have similar ages of sexual initiation, the United States has relatively high teenage birth rates (Jones et al., 1985; Jones et al., 1988). School districts (three-quarters) offer some type (although often inadequate) of pubertal and sex education instruction (Kirby, 1984; Kirby and Scales, 1981). However, ignorance about reproduction such as the time of cycle in which women are likely to conceive is still widespread, and programs that enhance reproductive knowledge still are few and far between (Paikoff and Brooks-Gunn, in press). Indeed, the vast majority (i.e. 75 ~ of parents want pubertal sex education taught in schools. And almost all (94%) parents want AIDS education in the schools (Harris Poll, 1988), which virtually requires pubertal and sex education (Brooks-Gunn et al., 1988). This article focuses on pubertal research. Reasons why such research has languished are recounted, with a focus on the discomfort of adults and negative societal messages. The design of reproductively oriented studies is considered to highlight the study requirements that sometimes concern school staff. Strategies for recruiting schools and families are outlined as are procedures for testing in the schools. My hope is that such information will be of help to others who are frustrated in their attempts to work with schools, or even worse, have avoided initiating such research because of recruitment
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concerns (I have seen colleagues' initial euphoria over obtaining grant funds to study puberty dampened all too quickly by recruitment worries).
ADULT DISCOMFORT WITH PUBERTY As early adolescent research comes into its own, we might ask why it was neglected, especially in the face of negative stereotypes (rebellious, tumultuous, stormy) and the concerns o f parents, pediatricians, and educators about the pubertal years (Holmbeck and Hill, 1987). Several conditions may be important, one of which involves what puberty means to most adults and how our society treats the onset of reproductive maturity (see Brooks-Gunn, 1989a, for a discussion of more conceptual reasons for the "stepchild" status of pubertal research). First, many adults are uncomfortable discussing the physical aspects of growth, probably because of cultural taboos about considering such topics and because the changes are associated with sexuality. Discomfort may lead to a denial of the importance of early physical changes (Brooks-Gunn and Warren, 1988). For example, in some of our research, we encountered initial concern about asking 5th graders questions relating to breast buds. School personnel believed young girls either were not concerned about such changes or did not notice these changes in others. Pointing out that one-half of their young students had breast buds, that these changes were certainly observed by teachers and students alike, and that even 5th graders knew about possible menstrual cycle changes in behaviors helped alter their reluctance to have us ask about early physical changes. Second, the pubertal experiences of many adults were not pleasant. For example, over 40% of women who are now over 60 were not prepared for menarche (Larsen, 1961). Being unprepared has been shown to be a particularly unsettling experience, influencing feelings about one's body and menstrual experiences into late adolescence and adulthood (Koff et al., 1982; Shainess, 1961). Given that only a small proportion of girls (less than 15% in White American lower to upper middle-class samples) have no information provided to them prior to the onset of menstruation today, negative experiences are less likely to occur for cohorts today than previously (Brooks-Gun and Ruble, 1982; Whisnant and Zegans, 1975). Men may be even less prepared for their own puberty, especially since ejaculation may be a more taboo subject than menarche, given the former's overt links with sexuality. In a small study of boys in 8th and 9th grade, less than 15% had discussed ejaculation with anyone prior to its occurrence (Gaddis and Brooks-Gunn, 1985). As recently as 1968, two-thirds of a sample of older adolescents reported having no initial information about ejaculation (Shipman, 1971). Indeed, boys and young men may be more knowledgeable about menarche than about some of the events that they are about to experience or have experienced (Clarke and
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Ruble, 1978; Brooks-Gunn and Ruble, 1986). Thus, adult males may find it even more difficult than adult women to discuss their pubertal experiences. Third, given that physical changes are universal and occur within a specific time frame, it is sometimes presumed that any possible effects on behavior would be transient; that is, since almost all adolescents complete most of the pubertal process by age 15 or 16, effects of tempo variations would be minimal since the end state is universal. However, experiences occurring in one life phase, such as puberty, may influence how an individual responds to subseqeunt experiences occurring in other life phases. Choices made in early to middle adolescence may set in motion events that influence choices made later on. One such example is the emersion in athletics of many early maturing boys, and the enhanced social status associated with such behavior throughout adolescence and early adulthood (Clausen, 1975; Livson and Peskin, 1980). Another example would be the long-lasting effects of early maturational timing on girls (Stattin and Magnusson, 1990; Petersen et al., in press). A final illustration is young teenage parenthood, which clearly sets into motion a series of events influencing the later life course (Furstenberg eta/., 1987; Lancaster and Hamburg, 1986). Fourth, from a societal point of view, pubertal growth is not celebrated or even formally acknowledged in the United States as is the case in most world societies (Paige, 1983). Instead, it is not commented upon or is treated with secrecy, even within the family. For example, in the late 1970s in Central New Jersey, only less than 20% of junior and senior high school girls told their father when they began to menstruate (although almost all told their mothers; Brooks-Gunn, 1987). In a small sample of boys from the same area, none told their mothers and only one told his father that he had experienced an ejaculation (Gaddis and Brooks-Gunn, 1985). More anecdotally, very few parents tell us that they celebrate their daughter's change of status. While probably stemming directly from societal beliefs concerning the "appropriateness" of talking about puberty, parents' and children's reluctance to talk about these events may further strengthen beliefs that they are not particularly salient or even critical to emerging self-definitions (cf. social cognitive theory on distinctiveness of events and perceived co-occurrence of events; Ruble and Brooks-Gunn, 1979; Tversky and Kahneman, 1974).
DESIGN CONSIDERATIONS Our group has conducted four sets of pubertal studies in the last decade. The first set focused on m e n a r c h e - h o w girls experienced this event, how this initial experience became the context in which subsequent feelings about one's body developed, and how socialization influenced the menarcheal experience (Brooks-Gunn and Ruble, 1982; Ruble and Brooks-Gunn,
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1982). The second set did not focus on one pubertal event, but looked at the meaning of various events to the young girl, as well as how the timing and sequencing of these events influenced self-definitions, depression, school functioning, and physical health (Brooks-Gunn, 1989b). The third set considered the emergence of eating problems and depression from middle school through college (Attie and Brooks-Gunn, 1989; Paikoff et al., 1990). The final set, focusing on 7th- and 9th-grade girls, examined the process by which mothers and daughters separate from one another, how this process might relate to subsequent autonomy and gender identity formation in adolescent girls, and what role puberty might play in this process (Brooks-Gunn and Zahaykevich, 1989). The design of the menarche studies was fairly straightforward. In order to examine, on a broad scale, developmental changes in symptom reports, expectations, and feelings associated with menarche, a large cross-sectional study was conducted, including late elementary school, junior high, senior high, and college students. Then, to look at changes occurring at the time of menarche, over 100 premenarcheal 5th and 6th graders were followed and reinterviewed after they had had their first menstruation. A matched comparison sample of girls who were still premenarcheal was used to control for repeated testing and time-dependent changes (a same-aged premenarcheal girl was drawn from the longitudinal pool for each menarcheal girl; both girls were reinterviewed in the same time period). Thus, menarche, rather than age, grade in school, or time interval, was the "anchor point" in this study, given our interest in changes that might be a function of this specific pubertal event. Few studies have employed this design (Brooks-Gunn, 1984; Grief and Ulman, 1982), even though it is common in studies of pregnancy, early motherhood, marriage, and divorce, all events that may occur at various times in a woman's life. Given how little was known about puberty, we also wished to examine the "large picture" in the second set of studies vis-a-vis differences as a function of age, pubertal status, and maturational timing. Again, 5th-12th graders were seen cross sectionally. To examine change, 5th-7th graders were seen yearly, four times. Unlike the previous menarche longitudinal study, grade in school, rather than pubertal status, was used to define the timing of visits given our interest in multiple measures of puberty (so that using any one as an anchor point would be problematic). All of the girls recruited for this study had been in the original cross-sectional study, making it possible to compare those who did and did not choose to participate, a nice design feature. In the third and fourth sets, girls who were in 7th-9th grades were seen, given interests in eating problems and changes in mother-daughter relationships, respectively. Previous research suggested that eating problems may occur at the time of most rapid weight gain (between Tanner Stages 3 and 5) and that mother-daughter conflicts reach an apex at this time, which natur-
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ally led to a focus on the 13- to 15-year-old (Blos, 1979; Crisp, 1984; Dornbusch et al., 1984; Josselson, 1980; Paikoff and Brooks-Gunn, 1990).
APPROACHING
THE SCHOOLS
Obtaining samples of girls for these studies was difficult. Since our objective across all studies has been to chart the course of girls' development, we did not wish to use clinic or medical practice "convenience" samples, but to contact girls within communities. Schools were the obvious choice for young adolescents, as drop-out rates are low during the first half of adolescence and for middle- to upper middle-class samples, generally. But many school administrators were wary about asking questions on pubertal development, in part because of their own discomfort discussing puberty and from their belief that young adolescents do not discuss such changes. In our menarche studies, conducted in the middle 1970s, principals in two Central New Jersey school districts approved our protocal (with three other school districts declining our invitation). To augment the sample, we finally turned to the Central New Jersey Girl Scouts, whose support and enthusiasm were deeply appreciated. While not the "perfect" sample in terms of representativeness, no discernable differences surfaced between the school and Girl Scout samples. Generally, we discovered that male school administrators and staff were much more wary about our research than their female counterparts. In the 1980s, our protocols were expanded to include questions on breast and pubic hair development, the growth spurt, weight changes, feelings about such pubertal changes, and responses of parents and peers to such changes. In addition, Tanner ratings of physical development were added to obtain more precise estimates of rate and tempo changes in pubertal growth (BrooksGunn and Warren, 1985). These topics were considered far more sensitive than just asking about menarcheal experience. Indeed, no one even questioned the appropriateness of asking about menarche (either adult attitudes had changed from the middle 1970s to the 1980s, or given the content of our protocols, menarche was considered the least sensitive pubertal event). Given our previous experience, we first contacted schools that had a high likelihood of having females running them and that were committed to girls' education: These were single-sex private schools. Later on, we included coeducational private schools, with no recruitment difficulties (although, of course, by this time we had a "track record" and a host of references). Four schools were the "core" of our program, with six others participating in various studies (another two were contacted; one declined and one had to cancel testing because of a serious fire the week prior to our sessions). Two others have been added in the last year. All are private, are concerned about the
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difficulties that girls have today with growing up, and are sympathetic and supportive of the need for pubertal research. While our sample is not representative of a cross section of youth, it is similar to samples drawn from primarily White, middle to upper middle-class suburbs (such as Petersen's Chicago suburb sample, 1984). This may be due to the fact that the "core" schools are in Manhattan, where almost all professional families send their children to private schools or move out of the city when their children are school age. Principals
Typically, we approach the principal first. In some cases he or she directed us to the superintendent or the head of the school board, but in the majority of cases the principal, if interested in our work, managed these relationships for us. Elementary school principals tend to see pubertal concerns as outside their mandate (Brooks-Gunn et al., 1982), even though by 5th grade approximately half of all girls have developed breast buds (Harlan et al., 1980; Tanner et al., 1966). If one wishes to study the onset of puberty, beginning in middle school is too late, and elementary school principals (and parents) have to be educated as to the necessity of interviewing students in late childhood. In general, male principals had difficulty discussing specific pubertal changes; they focused on general changes, such as the growth spurt and the more generic appellation of the "body changing." Given that 70~ of public elementary school and 90~ of public high school principals are male, discomfort, when it occurs, is a major research obstacle (Feistritzer, 1988). Additionally, males also may be uncomfortable talking about boys' changes (Gaddis and Brooks-Gunn, 1985), so that it may not be easier to do studies on boys than girls. In the second set of studies, we had very little difficulty discussing both menarche and other changes with the principals. However, in private schools, the majority of whose principals are female (nationwide, only 48~ of private school principals are male; Feistritzer, 1988). However, even the three male principals were enthusiastic. It is difficult to know whether private school principals find the pubertal topics, or perceive their parent constituency to find these topics, less objectionable than public school principals, or whether societal changes occurred in the acceptability of discussing pubertal changes between the 1970s and 1980s. Almost all principals felt that most research projects were not helpful to their students and took away from the important taks of education. In many schools, we provided brief lessons and lectures to the student body on pubertal change after the study was completed, and an explanation of behavioral science and medical research in order to render the study more educationally meaningful.
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I suggest that a researcher not approach a school with a new principal. The principal will not have learned about how to handle different beliefs of parents, nor the minority who will disapprove of the research. For example, in one private school, we postponed testing for nine months until a new principal became established. Principals who are preparing to leave a school district may not wish to take responsibility for a pubertal study. Principals deluged with m a n y problems may see a study either as a nuisance or a relief. One principal told us that our study was a bright note in a period of difficult financial cutbacks. Another said that given current levels of teacher dissatisfaction, he could not possibly introduce a study that might add, or be perceived to add, to the teacher's work load. In both cases, our study was put into perspective: No matter how important the study is to researchers, it is not particularly relevant to the everyday ongoing concerns o f school staff. S c h o o l Boards
We do not contact school board members directly, allowing the principal to decide how to initiate the approval process. In about half of the schools, I eventually met with or talked to school board representatives officially or informally. Researchers testing in their own community should expect to be contacted by some board members individually, even if board approval is not required. This occurred in our four core schools. Parents
I have found parents to be our most enthusiastic supporters. A b o u t 5% or less of parents seem to disapprove of a study of puberty. The vast majority of parents are concerned about how to teach their children about puberty and sexual behavior in a responsible manner. To answer questions, parents are encouraged to call us rather than school staff. Since this is not always successful, a contact person in the school is usually designated to field calls from parents; we work directly with this person to see if we can help in answering questions or m a y contact a parent directly (depending on how the school wishes to handle parents' questions). I find that talking with parents is extremely helpful. If I cannot justify a particular study to parents, then perhaps I should not be doing it at all. Feedback to S c h o o l s
In the first set of studies, I did not take the principals' requests for feedback as seriously as I should have. Indeed, our staff conducted few teacher
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workshops, student assemblies, or student classes. By the time of the second set of studies, Michelle Warren and I felt more strongly that we had a responsibility to provide research information to school communities. We always offered to talk to teachers or to children on social, psychological, and physiological aspects of puberty or on more specific topics associated with young adolescents. Student summer internships in our adolescent study program were offered at our four core schools. On a yearly basis, our schools are sent copies of all articles and chapters that we have written on adolescence. We offer to talk about the work in student assemblies, even though our studies have ended, given the time line for longitudinal work. Not only does this procedure serve an educational function, but it recognizes school personnel as part of the collaborative team.
TESTING P R O C E D U R E S Logistics
Testing is always tailored to the second schedule. We have tested during lunch, during gym class, after school, on Saturdays, and in biology class. A contact person, often the teacher overseeing curriculum, is designated to remind teachers and students that the consent forms were being sent home (via assembly or memo), and that their parents needed to sign it and to talk with our senior research assistant daily. On testing days, typically, 5%-10070 of girls appear without consent forms. We arrange for a second testing time for these girls to give them a chance to bring the consent forms from their mothers and offer to speak to their mothers.
Informed Consent
We always offer to mail parental consent forms and explanations directly to the parent. We do not have access to names and addresses from student lists; either a student does the mailings from the school site or we obtain labels but not lists from the schools. In the peer review process, we have been criticized for not knowing which parents agreed to participate and which did not; this is an indefensible position given NIH informed consent guidelines for minors. Schools are often happy to provide the number of students enrolled per grade so that response rates may be calculated. In addition, schools often will provide basic demographic background on their population, so that one may see in a very general sort of way whether those who participated are representative of the school body.
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The NIH requirement of prior informed parental consent is helpful. Most parents who have concerns about pubertal topics do not allow their children to participate. The only problem arises when certain parents decide to act as a "watchdog" for all other children, and complain about the study being done at all even when their children are not participating (underscoring the importance of NIH guidelines requiring signed parental consent, not so-called negative consent). In anticipation of this unlikely outcome (although it has happened to me once), I recommend talking to members of the school board as well as to the principal. Some schools have set up their own institutional review boards; others require school board review of the consent forms and questionnaires.
Response Rates Response rates for studies of young adolescents vary, depending on the ways that subjects are recruited. The rates tend to vary from 60~ to 85~ when parental written permission is required. Even using the procedures outlined earlier, our response rates vary by school. Response rates tend to be positively associated with presenting teacher workshops, conducting student assemblies on adolescent development, enthusiasm of the contact teacher, commitment of the principal, and testing during the school day (even at lunch) rather than after school.
Reviewing the Questionnaire School staff always review our questionnaire at a point when changes are possible. Teachers often target sensitive areas, and discussions about altering questions, omitting them, or explaining why they should be included are helpful. When approaching other schools about the study, having gone through this process provides some face validity about the acceptability of a questionnaire to teachers.
Quelling Rumors No matter how careful the researcher is with regard to study explanations, some students will misconstrue it. In one school, rumors circulated at the beginning of the study that girls would have to undress (when, in fact, they were being weighed and measured while in clothes). In another school, a few girls believed that their mothers would be shown pictures of them unclothed (parents were being given schematic drawings of the Tanner stages;
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Brooks-Gunn et al., 1987). In both instances, good relationships with the teachers allowed us to hear about the rumors immediately and discuss them with the students.
M E A S U R E M E N T ISSUES Pubertal Measures
Many schools will not allow Tanner staging to be done. Solutions include the following: First, schematic drawings of Tanner stages with written descriptions have been used in several studies. In medically based studies, girls rate themselves (Brooks-Gunn et al., 1987; Duke et al., 1980; Morris & Udry, 1980). In our school-based studies, mothers rated a Tanner staging schematic, as school staff felt that it would be too sensitive for children to do so. Almost all mothers are able to rate their daughters' current physical status, with the reliability being as high as daughter ratings, as determined in a validity study (Brooks-Gunn et al., 1987). Second, a study could be conducted that is a combination school-based, medically-based study. Schools may be less reluctant to consider a physical exam if students recruited at their schools were seen at a neighborhood health center, a hospital, or a clinic, as we have done in one study. Such a procedure might allow researchers to draw a more representative sample than is possible using clinics or physicians, while alleviating concerns about physical examinations and instrusiveness. Third, children themselves may be reluctant to have Tanner staging done, if that is the sole purpose of the exam and if they have not had Tanner staging done before. Staging is more acceptable if done as part of a complete physical examination, as is commonly done by a pediatrician. Even then, children may not wish to have an unfamiliar physician or nurse-practitioner conduct a physical exam; if the cooperation of pediatricians in the community can be obtained, more students may participate in such studies. Refresher courses on Tanner staging for physicians and nurse-practitioners would be necessary if this procedure were initiated. Whether a majority of pediatricians in the community would be enthusiastic enough about such a study to participate is not known. In addition, it is not feasible in large communities in which students see many different physicians or in disadvantaged communities in which health care is fragmented or inaccessible (Egbuonu and Starfield, 1982). Fourth, while I have worried about collecting Tanner staging data, our well-educated families readily accept it. Finally, schools are reassured by the fact that we collect Tanner data on an already standardized scale used in other school settings.
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How reluctant are girls to answer pubertal questions? Very few omit items on self-report questionnaires (although girls are reminded repeatedly throughout our questionnaires that they may skip items, in accordance with NIH guidelines). From a clinical perspective, about 10~ of the girls seem to be embarrassed during the Tanner staging examination. At the same time, they also are pleased when they have completed the examination and interview, as many seem to see it as a major milestone (in that such physical examinations are a part of recommended medical practice). In personal interviews, many girls seem eager to share their pubertal experiences; given the pervasiveness of such conversations with peers and the meagerness of such talks with parents, having an interested adult woman may be comforting. Whether embarrassment in discussing puberty prevents some girls from participating in such studies is not known. In our second set of studies, girls who volunteered for the longitudinal study were similar to those who did not (i.e., on measures of body image, emotional tone, family relationships, and pubertal status). About one-fourth of girls who did not participate in one study told us that they did not like having their blood drawn (in the study including a hormonal workup; Brooks-Gunn and Warren, 1989). Multimethod Approach
We have used a multimethod approach, depending on the specific research question of interest. Self-reports were used in the cross-sectional studies, augmented with maternal reports for specific topics, as in the Tanner stage of ratings discussed earlier. We use structured and semistructured interviews to probe girls' reactions to pubertal events. For example, with regard to menarche, different approaches yield varying intensities of responses. Typically, girls describe both positive and negative feelings-excited and pleased, scared and upset; however, these feelings are not particularly intense (Whisnant and Zegans, 1975; Petersen, 1983). Less direct measures of emotional reactions elicit different responses. In one study, girls were asked what they would tell a sister their age in order to prepare her for the experience. Girls were quite pragmatic when it came to telling their "hypothetical sister" about m e n a r c h e giving her information about hygiene and supplies. Few girls mentioned negative aspects of menstruation (Ruble and Brooks-Gunn, 1982). Rierdan and Koff (1985) gave a small sample of girls in 7th and 8th grades a sentence completion task, starting with the phrase "Ann just got her period for the first time." Responses were almost all negative, unlike the findings just reported. Girls may be more reluctant to discuss negative feelings in interviews. At the same time, projective techniques may elicit girls' feelings about the event in general, not their specific reaction to the event. For example, adult and adolescent females report that women in general experience more severe symptoms than they themselves experience (Parlee, 1974; Brooks et al., 1977).
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Similar findings are cropping up for pubertal events other than menarche. We are examining 5th- to 7th-grade responses to breast growth, using a semistructured format (e.g., "How do you feel about breast growth?" "What physical change do you feel is most important?" "Who have you talked to about physical changes?") and a TAT format (a picture of an adult woman, adult man, and teenage girl in which the adult woman is taking a bra out of a shopping bag; Tobin-Richards et al., 1983). Reactions to the latter are more intense than to the former (Brooks-Gunn et al., 1990). I do not believe that the responses from one method are more valid, but that they represent different aspects of girls' experience of puberty (see Kagan, 1988, for a discussion of the meaning of results devised from different methods). A final example of the usefulness of multimethod approaches in this series of studies comes from the third set of studies. Mothers', but not daughters', ratings of the family environment were associated with girls' report of eating problems (Attie and Brooks-Gunn, 1989). The discrepancy between findings using mother and daughter ratings suggests differences in their perceptions of the family's functioning, or in mothers' and daughters' willingness to report them. Not only is denial a salient feature of adolescents with eating disorders (Fairburn, 1984), so is the tendency for family members to avoid conflict (Minuchin et al., 1978). In a new set of analyses, motherdaughter disagreements vis-~t-vis family issues are associated with girls' wellbeing (Carlton-Ford et al., in press). Such findings highlight the importance of obtaining information from multiple informants.
CONCLUSION The most difficult aspect of conducting pubertal research for me is to keep a sense of perspective. In all of our studies, I worry about school cooperation. Remembering that the school staff has its own concerns has helped; teachers and principals are very busy and often their work is not appreciated as much as it should be. Most surprisingly, I have found that being passionate about one's research and having a sense of humor have helped overcome barriers. The field has moved a long way since Lipsitz (1977) referred to adolescence as Growing Up Forgotten; it can only expand further if researchers, schools, and families learn how to ask difficult but relevant questions associated with reproduction and sexual maturity.
ACKNOWLEDGMENTS I would also like to thank my collaborators, Michelle Warren and Diane Ruble, and my students and colleagues. Roberta Paikoff deserves special
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t h a n k s f o r her c a r e f u l r e v i e w o f t h e m a n u s c r i p t . M y h e a r t f e l t t h a n k s g o t o t h e s c h o o l p r i n c i p a l s a n d t e a c h e r s , as well as t h e a d o l e s c e n t girls a n d t h e i r p a r e n t s , w i t h o u t w h o m this a r t i c l e c o u l d n o t h a v e b e e n w r i t t e n .
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