Longitudinal Associations of Pubertal Timing and Tempo With Adolescent Mental Health and Risk Behavior Initiation in Urban South Africa

PURPOSE: In high-income countries, early and rapid pubertal development is consistently associated with poor adjustment and increased risk behavior in adolescence. This study contributes to the meager knowledge of these associations in lower income countries. METHODS: We used longitudinal data from 1,784 urban black South Africans in the Birth to Twenty Plus cohort. We used regression analyses to assess associations between age at menarche and latent classes of pubertal timing and tempo and adolescent internalizing and externalizing emotional and behavioral problems, eating attitudes, and patterns of health risk behavior initiation. RESULTS: Relatively earlier and faster pubertal timing and tempo were associated with increased health risk behavior initiation (e.g., adjusted odds ratio [95% confidence interval] high- vs. low-risk pattern = 5.7 [1.7, 19.06] for male genital development; adjusted odds ratio = 3.45 [1.13, 10.49] for female breast development). Among males, earlier and faster pubertal timing and tempo were associated with increased externalizing problems in early adolescence and increased oppositional defiant problems in midadolescence, whereas later and slower pubertal timing and tempo were associated with decreases. Among females, earlier and faster pubertal timing and tempo were associated with increased internalizing and externalizing problems in midadolescence and increased dieting behaviors in early and late adolescence (β [95% confidence interval] = 2.51 [.87, 4.15] for pubic hair development), whereas later and slower pubertal timing and tempo were associated with decreases. CONCLUSIONS: In this urban South African cohort, relatively earlier and faster pubertal development was detrimental to mental health and risk behavior activity, whereas later and slower maturation was somewhat protective.