Family composition and age at menarche: Findings from the international Health Behaviour in School-aged Children study

Martin Steppan,Candace Currie,Ross Whitehead,Juliet Mceachran

doi:10.1186/s12978-019-0822-6

Abstract

BackgroundEarly menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. This article assesses the association of different family compositions with the age at menarche. Pathways are explored which may explain any association between family characteristics and pubertal timing.MethodsCross-sectional, international data on the age at menarche, family structure and covariates (age, psychosomatic complaints, media consumption, physical activity) were collected from the 2009–2010 Health Behaviour in School-aged Children (HBSC) survey. The sample focuses on 15-year old girls comprising 36,175 individuals across 40 countries in Europe and North America (N = 21,075 for age at menarche). The study examined the association of different family characteristics with age at menarche. Regression and path analyses were applied incorporating multilevel techniques to adjust for the nested nature of data within countries.ResultsLiving with mother (Cohen’s d = .12), father (d = .08), brothers (d = .04) and sisters (d = .06) are independently associated with later age at menarche. Living in a foster home (d = −.16), with ‘someone else’ (d = −.11), stepmother (d = −.10) or stepfather (d = −.06) was associated with earlier menarche. Path models show that up to 89% of these effects can be explained through lifestyle and psychological variables.ConclusionsEarlier menarche is reported amongst those with living conditions other than a family consisting of two biological parents. This can partly be explained by girls’ higher Body Mass Index in these families which is a biological determinant of early menarche. Lower physical activity and elevated psychosomatic complaints were also more often found in girls in these family environments.

Highlights

Menarche has been associated with father absence, stepfather presence and adverse health consequences in later life
Intraclass correlations (ICC) showed that only family affluence was clustered within countries, whereas for the other variables the within-country variation was higher than the betweencountry variation
Some authors have argued that this might be due to reduced nutrition in families with many children [34] – a mediation path which could not be identified via Body Mass Index (BMI) in our study

Summary

Introduction

Menarche has been associated with father absence, stepfather presence and adverse health consequences in later life. Age at menarche is considered to be reliable indicator of pubertal timing [1], especially when reported soon after its occurrence [2]. It is a critical event in girls’ pubertal development representing a biological, psychological and social transition within their developmental trajectory [3]. Early menarche in girls has been associated with mental health problems, e.g. depression, eating disorders and body dissatisfaction [4]. Early menarche has been associated with a wide range of somatic risks and conditions, e.g. cardiovascular disease, all-cause mortality especially among smokers, breast cancer, type 2 diabetes, obesity, gynaecological, obstetric, gastrointestinal, musculoskeletal, and neurocognitive disorders [6]. The secular decline in age at menarche charted by various studies in recent years [7] could be understood as a cause for public health concern

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Conclusion