Racial differences in accuracy of self-assessment of sexual maturation among young black and white girls.

Purpose: To examine the validity of maturation self-assessments and to investigate the association between race and validity of self-assessments among young black and white girls.
Methods: Self-assessments and examiner-assessments of areolar and pubic hair development using line drawings were compared at three visits among a cohort of 11- to 14-year-old girls enrolled in the National Heart, Lung, and Blood Institute's Growth and Health Study. Accuracy rates and kappa coefficients were calculated to measure the agreement between girls and examiners. Logistic regression models were used to assess the racial differences in the accuracy of self-assessments while adjusting for possible confounders.
Results: Fair to moderate agreement was found between self- and examiner-assessments (areolar self-assessments: adjusted accuracy rates: 60.7-69.9%, kappa: 0.32-0.51; pubic hair self-assessments: adjusted accuracy rates: 57.9-70.7%, kappa: 0.36-0.55). While there were indications of racial differences in the ability to perform self-assessment with black girls tending to self-assess less accurately, most of the differences disappeared after adjusting for nurse-assessed stage.
Conclusions: These findings suggest that self-assessment can substitute for examiner evaluations only when crude estimates of maturation are needed. However, when accurate maturation stage data are required, examiner-assessments are necessary. Because black girls are usually more pubertally advanced and tend to underestimate their development, the value of self-assessment is questionable for assessing populations with young black and white girls. Use of self-assessment might present biased estimates of maturation and confound research findings.