Impacts of a puberty and period education intervention among 9- to 12-year-old girls in the New York metropolitan area: a randomized trial

Objectives: To evaluate the immediate impacts of an illustrated book on puberty and periods for girls in the United States (US).

Methods: We conducted a randomized educational intervention between February-May 2023 among girls ages 9-12 years in after-school programs in the New York metropolitan area (n = 123). Girls were assigned to read a book on puberty and periods or an alternative book on healthy eating. We conducted multivariate linear and logistic models to examine changes in knowledge, beliefs/attitudes, and comfort in communicating about puberty and periods between treatment groups using pre- and post-test surveys. We also examined for effect measure modification to assess if changes in knowledge about puberty and periods significantly differed by menarchal status.

Results: The intervention produced an increase in knowledge score (p < 0.05). Girls in the treatment group compared to the control group were more likely to report positive shifts in beliefs/attitudes towards physical activity during their period and asking questions about periods. Knowledge scores were significantly higher among girls of pre-menarche status compared to girls who had already experienced their first period (p = 0.05).

Conclusion: Findings from our educational intervention demonstrated that a simple distribution of an illustrated puberty and period book, without the support of formal instruction, had positive attitude shifts and educational impacts among girls ages 9-12 years. The intervention was efficacious in improving knowledge, particularly among girls who had not yet experienced their first period. Follow-up is needed to assess long-term health and social impacts of simple delivery of pubertal content to adolescents. Our study contributes to filling the gap in understanding the utility of puberty education in the US and our findings underscore the importance of appropriately timed puberty education.