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Reliability of pubertal self-assessment in Hong Kong Chinese children


  • Noel PT Chan, RN, RM, MSc in Epidemiology and Biostatistics, PhD candidate in Social Medicine of the School of Public Health, The Chinese University of Hong Kong.

Noel PT Chan, Rm 621, 6th floor, Esther Lee Building, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Fax: +852 2603 5269; email:


Aim:  To validate a Tanner stages self-assessment questionnaire using gender-specific line drawings and brief explanatory text in Chinese.

Methods: Design: A cross sectional study design. Setting: One primary and two secondary schools. Participants: 172 boys and 182 girls aged between 8 and 18 years. Main outcome measures: Students' self-assessments of pubertal maturation were compared with assessments made by a same gender rater using visual depiction physical examination. Raters' physical examinations were performed after the children had answered the self-assessment questionnaire individually and in private. Raters were blinded to the self-assessment results. Accuracy rates and weighted kappa statistic were used to evaluate the degree of agreement between children and raters.

Results:  Substantial to almost perfect agreement was found between self- and rater's assessments of breast development and pubic hair growth in girls [weighted kappa 0.72 (P < 0.0001, 95% CI 0.66, 0.79) and 0.83 (P < 0.0001, 95% CI 0.78, 0.87) respectively]. Moderate to substantial agreement was found between self- and rater's assessments of male genital development and pubic hair growth [weighted kappa 0.58 (P < 0.0001, 95% CI 0.48, 0.68) and 0.80 (P < 0.0001, 95% CI 0.74, 0.86) respectively]. Most agreements between self- and rater's assessments differed by only one Tanner stage. Agreement was higher for girls than boys. Girls tended to overestimate their breast stages and boys tended to underestimate their genitalia development.

Conclusion:  This study confirms that a Tanner pubertal self-assessment questionnaire with line drawings and explanatory Chinese text can reliably estimate sexual maturation status in Hong Kong Chinese children.