January 15, 2025-- Young girls in the New York metropolitan area given a book on puberty and periods were more likely to have increased knowledge related to these topics after reading the book according to a new study at Columbia University Mailman School of Public Health. Girls in this group were also more likely to report positive shifts in beliefs and attitudes towards physical activity during their period and about asking questions about menstruation compared to a control group of girls who were given an alternate book on healthy eating. The study is the first to evaluate learning outcomes associated with reading an illustrated educational book on puberty and periods written for girls in the U.S. The findings are published in the journal BMC Public Health.
"Our aim was to evaluate the immediate impacts of an illustrated book on puberty and periods for girls and to explore a simple approach for delivering puberty content sin after-school programs that would not require a significant influx of resources or capacity.," said Angela-Maithy Nguyen, a former postdoctoral student in sociomedical sciences at Columbia Mailman School, and first author. "The study contributes to filling the gap in understanding the utility of puberty education in the U.S. and underscores the importance of appropriately timed puberty education."
Findings from the illustrated book, which integrated first period stories and experiences of low income and underrepresented girls, showed that the girls who were randomly assigned to read the puberty book -- independently and without instruction -- experienced an overall increase in knowledge, specifically related to physical body changes, types of period products, and safety of exercise during one's period.
"We know that during puberty, girls experience particular challenges. Black and Hispanic girls, and girls from socioeconomically disadvantaged backgrounds, often experience earlier pubertal onset which particularly is associated with poorer body image, lower self-esteem, psychological distress, and poor academic performance," observes Marni Sommer, DrPH, RN, professor of Sociomedical Sciences at Columbia University's Mailman School of Public Health, and senior author. "Inadequate knowledge of early menstruation may also lead to adverse health outcomes. Unfortunately, puberty education is falling short in the U.S. with puberty topics taught in less than half of elementary and middle schools."
Using a randomized trial approach, the researchers conducted an educational intervention between February-May 2023, and studied 123 girls ages 9-12 years in after-school programs in the New York metropolitan area. Girls were assigned to read a book on puberty and periods or an alternative book on healthy eating. The authors further examined changes in knowledge, beliefs/attitudes, and comfort in communicating about puberty and periods between treatment groups using pre- and post-test surveys. They also assessed if changes in knowledge about puberty and periods differed by menarchal status.
The majority of participants were 11 years old (27 percent) and in the sixth grade (28 percent). Nearly 40 percent of girls self-identified as Hispanic or Latina and approximately 30 percent of girls self-identified as Non-Hispanic Black. Slightly over 50 percent of participants had not had their first period at the time of study. Nearly half of participants expressed interest in learning more about topics related to puberty and menstruation (48 percent).
On average, girls who read the puberty book had an 8 percent increase in an overall knowledge score compared to those who read the alternative book. Those who had not yet had their period had an average 12 percent increase in knowledge, a significant difference compared to those who already had their period.
"Our study's novel findings contribute to the limited research on supplemental puberty education and its impacts on girls' knowledge and attitudes towards puberty, and while a plethora of related books written for girls in the U.S. have existed in the last few decades, there have been few, if any, rigorous evaluations conducted of their content or delivery," noted Nguyen.
"Findings from our educational intervention support our main hypothesis that a simple distribution of an illustrated puberty and period book among girls ages 9–12 years, without the support of formal instruction, had positive impacts on girls' knowledge, beliefs and attitude shifts," said Sommer, who also leads the Gender, Adolescent Transitions and Environment (GATE) Program at Columbia Mailman. "The intervention was effectual in improving knowledge, particularly among girls who had not yet experienced their first period and underscores the importance of targeting earlier learning for pubertal health education. We recommend continued assessment of the long-term health and social impacts of this simple delivery of pubertal content to adolescents."
A co-author is Micaela Camozzi, Columbia Mailman School of Public Health.
Funding to support the study was provided by the Sid and Helaine Lerner MHM Faculty Support Fund.
Columbia University Mailman School of Public Health
