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home > research > bcerc > understanding the cultural context

Understanding the Cultural Context of Adolescent Girls’ Perception of Puberty

Know your audience.

Effective communication efforts take into account cultural differences.

Each of the four centers within the BCERC program includes a Community Outreach and Translation Core (COTC) that is refining strategies to communicate the results of scientific findings to the public. An essential part of each COTC’s task is to understand how to reach girls during puberty, a period of time that may be pivotal in their later risk for developing breast cancer.

At the 2005 conference on “Emerging Topics in Breast Cancer and the Environment Research,” three speakers discussed how cultural difference can affect girls’ perceptions of puberty and provide clues about the best ways to communicate with them.

Family and Other Social Relationships

Lisa Mills, Ph.D., Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center, began by describing culture as neither the biological features of race nor the nationality or ethnicity of individuals, but as the customs, norms, values and styles of living that a group of people share.

Within a culture, she said, the family influence is key, and this is especially true as a girl transitions through puberty. She referred to a research study of girls’ experiences with menarche (their first period). “In this study, the girls who knew what to do described themselves as being capable when it came to practical aspects of menarche, and they were comfortable handling the transitions that involved having menstruating bodies. Most of the girls who had these types of perceptions were from higher-income families and represented the range of ethnic diversity that was in the sample, which was Caucasian and African American,” she said. The same study identified another population of girls who were unprepared and tried to cope with what they viewed as unpredictable bodily changes. These girls were almost exclusively from lower-income families.

“So you can see that there are cultural differences from girls of different economic backgrounds in terms of preparing girls for pubertal changes,” Mills said. The study suggested girls who felt poorly prepared for menarche perceived their pubertal processes and their development much more negatively than the well-prepared girls, she added.

In addition, the study showed that families emphasizing an association between menarche and the ability to have babies prompted reactions from the girls that ranged from fear to anger to acceptance.

Based on other research results, Dr. Mills said, urban girls—particularly those who are African American—feel their bodily development affords them a new social status of maturity. In the study, even much younger girls who had developed breasts or had already started their periods felt they could associate with older girls, she said. “The girls also felt they were expected to give up childhood friendships with boys, including physical contact with male relatives, and dress modestly to deemphasize their physical development.”

In summary, she said, communication directed at pre-teen and teenage girls should “consider how social relationships and interactions with significant people, like family and friends, influence their perceptions of puberty.”

Latinas and Puberty

Pamela J. Maraldo, Ph.D., executive director of Girls Inc. of New York City, focused on puberty in Latinas, who with Asians and American Indians, have a lower rate of breast cancer than either white or African American women. “When we look at cultural and environmental risk factors for Latinas, the first thing in the literature that strikes you is that Latina culture places a very strong emphasis on family and child-bearing, and since early pregnancy is a protector of breast cancer risk, this may play a role in the lower rate of breast cancer in Latinas,” she said.

Conversely, Latina girls in America experience considerable stressors that typically are associated with higher breast cancer risk. For example, she said, when compared to girls of other cultural groups, Latina girls have a higher rate of depression and suicide attempts. They also must weigh traditional family beliefs that place women in a submissive role against Western culture’s ideals of societal equality between the sexes.

“So the question remains: If puberty is such an impressionable stage of life in terms of development of breast cancer later on, why don’t these emotional factors in puberty result in a higher rate of breast cancer later on, as is hypothesized often to be the case?” Maraldo asked. The answer lies in several areas, she said:

Strong family ties may have a buffering effect on stress and other environmental factors later in life.
“Latinas are emotional, and in terms of developing cancer, this is often a good thing,” Dr. Maraldo said. “There is evidence that resilience to stress is associated with how people handle their emotions. This includes the ability to express emotions, even negative emotions. Though Latinas experience high levels of depression during puberty, they usually learn to express their anger very effectively by watching others, including their mothers.”
The church is another factor. “Prayer and the ability to listen to the church’s edict of forgiveness has been shown recently in some studies to have a salubrious effect that may well help mitigate the effects of more difficult emotional factors,” she said.

The Asian Perspective

Asians are a widely disparate group from a vast geographical area and varying cultures. They do, however, share some similarities, said Kathleen Burklow, Ph.D., Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology.

“Although Asian groups represent a large number of religions, many of the religions share philosophical principles of Confuscianism. Those principles highlight social order, hierarchy, loyalty, and respect for and deference to older family members,” she said. “As a result, Asian groups typically adhere to collective goals over individual goals, so they will make decisions based on what is best for their families or their communities.”

In most Asian cultures, which favor their sons as the perceived future caretakers of family, communication about puberty or sexual health issues related to women and girls is not a priority, Burklow said. “For women in Asian groups, modesty is emphasized, as is sexual restraint. Relative to other U.S. ethnic groups, Asian American adolescents and young adults tend to show more sexually conservative attitudes, date at an older age, and initiate sexual intercourse at a later age. It’s also normative not to talk about personal sexual health issues, which again reflects the sexually conservative attitudes.”

The lesser attention placed on female health in Asian societies can affect a woman’s treatment, she said. “Even though Asian women may be at lower risk for breast cancer, we do know from research that when they do get treatment, it’s at more advanced stages.” Often, she said, they focus on curative rather than preventive measures, and frequently exhaust folk medicine first before seeking assistance from a Western medical professional.

Reaching girls in Asian American groups may present a special challenge, because of the wide generational gap between parents, who most often are immigrants holding on to traditional Asian values, and their children who may hold more Westernized values, Dr. Burklow asserted. Child-directed communication efforts presented in school or other settings rarely have any impact, because the parents pay them little attention and are the ones who ultimately make the health-related decisions relating to their children.

Communication with the parents is also problematic, she said. “There is a preference among Asians toward informal social support networks, so they will ask advice and go to family and friends before they will go to a professional, and that is really important when you’re trying to get information out. You can’t always do it in a professional arena; you really need to infiltrate family and friends.”

Whether a communicator is trying to reach an Asian population or any other cultural group, he or she must consider the target audience’s values, beliefs and norms, Dr. Burklow concluded. “This is true whether you are talking about pubertal development; breast cancer prevention, treatment and intervention; or health care promotion. Understanding culture is critical to translating bench-lab results to the community.”