Marcia E Herman-Giddens

University of North Carolina at Chapel Hill, Chapel Hill, NC, United States

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Publications (18)142.32 Total impact

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    ABSTRACT: BACKGROUND:Data from racially and ethnically diverse US boys are needed to determine ages of onset of secondary sexual characteristics and examine secular trends. Current international studies suggest earlier puberty in boys than previous studies, following recent trend in girls.METHODS:Two hundred and twelve practitioners collected Tanner stage and testicular volume data on 4131 boys seen for well-child care in 144 pediatric offices across the United States. Data were analyzed for prevalence and mean ages of onset of sexual maturity markers.RESULTS:Mean ages for onset of Tanner 2 genital development for non-Hispanic white, African American, and Hispanic boys were 10.14, 9.14, and 10.04 years and for stage 2 pubic hair, 11.47, 10.25, and 11.43 years respectively. Mean years for achieving testicular volumes of ≥3 mL were 9.95 for white, 9.71 for African American, and 9.63 for Hispanic boys; and for ≥4 mL were 11.46, 11.75, and 11.29 respectively. African American boys showed earlier (P < .0001) mean ages for stage 2 to 4 genital development and stage 2 to 4 pubic hair than white and Hispanic boys. No statistical differences were observed between white and Hispanic boys.CONCLUSIONS:Observed mean ages of beginning genital and pubic hair growth and early testicular volumes were 6 months to 2 years earlier than in past studies, depending on the characteristic and race/ethnicity. The causes and public health implications of this apparent shift in US boys to a lower age of onset for the development of secondary sexual characteristics in US boys needs further exploration.
    PEDIATRICS 10/2012; · 4.47 Impact Factor
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    ABSTRACT: Few studies have systematically assessed the reliability of pubertal markers; most are flawed by limited numbers of markers and ages studied. To conduct a comprehensive examination of inter-rater reliability in the assessment of boys' sexual maturity. Eight pairs of practitioners independently rated 79 consecutive boys aged 8-14 years. Two raters in each of eight practices independently rated boys aged 8-14 years, presenting for physical examinations, on key pubertal markers: pubic hair and genitalia (both on 5-point Tanner scales), testicular size (via palpation and comparison with a four-bead Prader orchidometer), and axillary hair (via a three-point scale). Intraclass correlations assessing degree of inter-rater reliability for pubertal markers ranged from 0.61 to 0.94 (all significant at p < 0.001). Rater Kappas for signs of pubertal initiation ranged from 0.49 to 0.79. Practitioners are able to reliably stage key markers of male puberty and identify signs of pubertal initiation.
    Journal of pediatric endocrinology & metabolism: JPEM 04/2009; 22(4):291-9. · 0.75 Impact Factor
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    ABSTRACT: Whether children, especially girls, are entering and progressing through puberty earlier today than in the mid-1900s has been debated. Secular trend analysis, based on available data, is limited by data comparability among studies in different populations, in different periods of time, and using different methods. As a result, conclusions from data comparisons have not been consistent. An expert panel was asked to evaluate the weight of evidence for whether the data, collected from 1940 to 1994, are sufficient to suggest or establish a secular trend in the timing of puberty markers in US boys or girls. A majority of the panelists agreed that data are sufficient to suggest a trend toward an earlier breast development onset and menarche in girls but not for other female pubertal markers. A minority of panelists concluded that the current data on girls' puberty timing for any marker are insufficient. Almost all panelists concluded, on the basis of few studies and reliability issues of some male puberty markers, that current data for boys are insufficient to evaluate secular trends in male pubertal development. The panel agreed that altered puberty timing should be considered an adverse effect, although the magnitude of change considered adverse was not assessed. The panel recommended (1) additional analyses of existing puberty-timing data to examine secular trends and trends in the temporal sequence of pubertal events; (2) the development of biomarkers for pubertal timing and methods to discriminate fat versus breast tissue, and (3) establishment of cohorts to examine pubertal markers longitudinally within the same individuals.
    PEDIATRICS 03/2008; 121 Suppl 3:S172-91. · 4.47 Impact Factor
  • Marcia E Herman-Giddens
    Journal of Adolescent Health 04/2007; 40(3):201-3. · 2.97 Impact Factor
  • Marcia E Herman-Giddens
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    ABSTRACT: Tracking secular trends in the pubertal development of a country's children is important for social and public health reasons. Although comparable studies are largely lacking for US children over the last half century, existing data on girls, particularly that for menarche, indicate that the trend for earlier sexual maturatin has continued and that racial differences are significant, with African-American girls developing earlier than white girls. Data on boys, though less reliable, suggest that they may be beginning maturation earlier as well. More studies on boys with reliable methodologies are needed. Earlier development may not be healthy and may indicate environmental problems that need to be further researched and addressed.
    International Journal of Andrology 03/2006; 29(1):241-6; discussion 286-90. · 3.37 Impact Factor
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    Marcia E Herman-Giddens, Paul B Kaplowitz, Richard Wasserman
    PEDIATRICS 05/2004; 113(4):911-7. · 4.47 Impact Factor
  • Marcia E Herman-Giddens
    Child Abuse & Neglect 02/2004; 28(1):7-8. · 2.47 Impact Factor
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    ABSTRACT: Interest in the discarding or killing of newborns by parents has increased due to wide news coverage and efforts by states to provide Safe Haven legislation to combat the problem. To describe the characteristics of these cases in North Carolina. Case series derived from data on all deaths among liveborn infants 0 to 4 days of age reported to the North Carolina medical examiner from 1985 through 2000. Incidence of newborns known to have been killed or discarded by a parent; epidemiological characteristics of newborns and parents. There were 34 newborns known to have been killed or discarded by a parent, comprising 0.002% of all liveborn infants during the 16-year study period, giving a rate of 2.1 per 100 000 per year. A total of 58.8% were male, 41.1% were white, and 52.9% were black. For 29 cases, the perpetrator was determined to be the mother. Among mothers, 50% were single and 20.6% were married (marital status of the remainder was unknown). Thirty-five percent had had other children. Eight mothers (23.5%) were known to have received some prenatal care. The mean age of the mothers was 19.1 years (range, 14-35 years) and more than half were aged 18 years or older. The most common causes of death were asphyxiation/strangulation (41.1%) and drowning (26.5%). In North Carolina, at least 2.1 per 100 000 newborns are known to be killed or left to die per year, usually by their mothers. It is unknown how many of these deaths might be prevented by Safe Haven laws. Efforts to educate the public about these laws need to target the general public. Where resources are limited, the focus should be on on adolescent pregnancy prevention programs, young adults, prenatal care clinics, and married women.
    JAMA The Journal of the American Medical Association 04/2003; 289(11):1425-9. · 29.98 Impact Factor
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    ABSTRACT: To compare the development of secondary sexual characteristics in children with cerebral palsy (CP) of moderate to severe motor impairment to children in the general population and to relate their sexual maturation to a measure of their body fat. A multicenter, cross-sectional survey of 207 children who were 3 to 18 years of age and had CP of moderate to severe motor impairment (Gross Motor Functional Classification System [GMFCS] levels 3, 4, and 5) was conducted at 6 geographic sites; attempts were made to identify all eligible children through multiple methods and enroll them in the study. Trained research assistants performed anthropometric measurements, including subscapular skinfold thickness, determined GMFCS level, and assessed sexual maturation by Tanner stage. Secondary sexual characteristics were compared with the general population of children using cross-sectional surveys of the American Academy of Pediatrics Pediatric Research in Office Settings network and of the National Center for Health Statistics National Health and Nutrition Examination Survey (NHANES) III. Girls were classified as having begun puberty when they were at Tanner stage 2 or greater for pubic hair and breast development and to have completed puberty when they were at Tanner stage 4 or greater for pubic hair and breast development. Boys were classified as having begun puberty when they were at Tanner stage 2 or greater for pubic hair and genital development and to have completed puberty when they were at Tanner stage 4 or greater for pubic hair and genital development. The mean age (standard deviation) of subjects was 9.6 (4.6) years. Of the 207 subjects, 71% were white, 21% were black, and 8% were of other races; 59% were boys, and 41% were girls. Girls with CP (n = 84) entered puberty earlier than did boys with CP (n = 123). In contrast, girls with CP tended to complete puberty later than did boys with CP. Black boys and girls with CP (n = 43) entered puberty earlier than did white boys and girls with CP (n = 147). No difference between races was found in completion of puberty. Only for white children with CP were there a sufficient number of subjects for comparisons of sexual maturation to race-matched children in the general population, using data from the American Academy of Pediatrics Pediatric Research in Office Settings network and the NHANES III study. White girls with CP initiated pubic hair development (Tanner stage 2 or greater) earlier than in the general population, but the age of onset of breast development was similar to the general population, although the age distribution was different. A greater proportion of white girls with CP had early onset of breast development (Tanner stage 2 or greater), and a greater proportion had delayed onset of breast development than in the general population. White girls with CP completed breast development later than in the general population but not pubic hair development. For white boys ages 8 to 18 years with CP (n = 75), pubic hair and genital development both began earlier than in the general population, but genital development was completed later. The estimated median age of menarche for white girls with CP was 14.0 years, which was 1.3 years later (95% confidence interval: 0.7-2.3) than for the general population (estimated median age: 12.8 years; NHANES III). Relationships between sexual maturation and nutritional state, as assessed by subscapular skinfold thickness z score, were determined separately in white boys and in white girls with CP, between the ages of 8 and 18 years. For white girls with CP, more advanced sexual maturation was associated with more body fat, adjusting for age and GMFCS level (Spearman partial correlation: 0.41). In contrast, for white boys with CP, the opposite relationship pertained: more advanced sexual maturation was associated with less body fat (-0.29). The pattern of sexual maturation in children with CP of moderate to severe motor impairment differs from that of children in the general population. Puberty begins earlier but ends later in white children with CP, compared with white children in the general population. In addition, menarche occurs later in white girls with CP. More advanced sexual maturation was associated with more body fat in girls but less body fat in boys.
    PEDIATRICS 12/2002; 110(5):897-902. · 4.47 Impact Factor
  • M E Herman-Giddens, L Wang, G Koch
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    ABSTRACT: Descriptive data on pubertal stages for a representative population of racially and ethnically diverse boys in the United States have not been published to our knowledge. To determine at what ages boys in the United States reach each of the 5 sexual maturity stages for genital and pubic hair growth. Cross-sectional survey from the National Health and Nutrition Examination Survey III (NHANES III), 1988-1994. A population-based sample of 2114 boys aged 8 to 19 years representing 16 575 753 boys according to NHANES III sampling strategies. The sample included white, African American, and Mexican American boys. Sexual maturity stages for genital maturation and pubic hair growth. The median (equivalent mean) ages at stage 2 for pubic hair development of white, African American, and Mexican American boys were 12.0 (95% confidence interval [CI], 11.7-12.3), 11.2 (95% CI, 10.9-11.4), and 12.3 (95% CI, 12.1-12.6) years, respectively, and at stage 2 for genital growth were 10.1 (95% CI, 9.6-10.6), 9.5 (95% CI, 8.9-10.0), and 10.4 (95% CI, 9.6-11.1) years, respectively. All 3 groups were significantly taller and heavier than boys in previous NHANES reports and showed earlier genital maturation and pubic hair growth than previous studies based on Tanner staging. Statistically significant differences among the 3 racial/ethnic groups were found in the median ages of onset of pubic hair growth and genital development at stage 5 with and without controlling for height and weight, indicating an earlier age of attainment for the African American boys. The median (mean) ages at the onset of genital and pubic hair growth were younger than in past studies. Additional studies are required to further evaluate these findings and to explore the public health implications.
    Archives of Pediatrics and Adolescent Medicine 10/2001; 155(9):1022-8. · 4.28 Impact Factor
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    ABSTRACT: A recent study conducted by the Pediatric Research in Office Settings network provided evidence that girls in the United States, especially black girls, are starting puberty at a younger age than earlier studies had found, but the reasons for this are not known. Because nutritional status is known to affect timing of puberty and there is a clear trend for increasing obesity in US children during the past 25 years, it was hypothesized that the earlier onset of puberty could be attributable to the increasing prevalence of obesity in young girls. Therefore, the objective of this study was to reexamine the Pediatric Research in Office Settings puberty data by comparing the age-normalized body mass index (BMI-ZS; a crude estimate of fatness) of girls who had breast or pubic hair development versus those who were still prepubertal, looking at the effects of age and race. For white girls, the BMI-ZS were markedly higher in pubertal versus prepubertal 6- to 9-year-olds; for black girls, a smaller difference was seen, which was significant only for 9-year-olds. Higher BMI-ZS also were found in girls who had pubic hair but no breast development versus girls who had neither pubic hair nor breast development. A multivariate analysis confirms that obesity (as measured by BMI) is significantly associated with early puberty in white girls and is associated with early puberty in black girls as well, but to a lesser extent. The results are consistent with obesity's being an important contributing factor to the earlier onset of puberty in girls. Factors other than obesity, however, perhaps genetic and/or environmental ones, are needed to explain the higher prevalence of early puberty in black versus white girls.
    PEDIATRICS 09/2001; 108(2):347-53. · 4.47 Impact Factor
  • M E Herman-Giddens, C Bourdony, E Slora, R Wasserman
    PEDIATRICS 04/2001; 107(3):609-10. · 4.47 Impact Factor
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    ABSTRACT: Mortality figures in the United States are believed to underestimate the incidence of fatal child abuse. To describe the true incidence of fatal child abuse, determine the proportion of child abuse deaths missed by the vital records system, and provide estimates of the extent of abuse homicides in young children. Retrospective descriptive study of child abuse homicides that occurred over a 10-year period in North Carolina from 1985-1994. The Medical Examiner Information System was searched for all cases of children younger than 11 years classified with International Classification of Diseases, Ninth Revision codes E960 to E969 as the underlying cause of death and homicide as the manner of death. A total of 273 cases were identified in the search and 259 cases were reviewed after exclusion of fetal deaths and deaths of children who were not residents of North Carolina. Child abuse homicide. Of the 259 homicides, 220 (84.9%) were due to child abuse, 22 (8.5%) were not related to abuse, and the status of 17 (6.6%) could not be determined. The rate of child abuse homicide increased from 1.5 per 100000 person-years in 1985 to 2.8 in 1994. Of all 259 child homicides, the state vital records system underrecorded the coding of those due to battering or abuse by 58.7%. Black children were killed at 3 times the rate of white children (4.3 per 100000 vs 1.3 per 100000). Males made up 65.5% (133/203) of the known probable assailants. Biological parents accounted for 63% of the perpetrators of fatal child abuse. From 1985 through 1996, 9467 homicides among US children younger than 11 years were estimated to be due to abuse rather than the 2973 reported. The ICD-9 cause of death coding underascertained abuse homicides by an estimated 61.6%. Using medical examiner data, we found that significant underascertainment of child abuse homicides in vital records systems persists despite greater societal attention to abuse fatalities. Improved recording of such incidences should be a priority so that prevention strategies can be appropriately targeted and outcomes monitored, especially in light of the increasing rates.
    JAMA The Journal of the American Medical Association 09/1999; 282(5):463-7. · 29.98 Impact Factor
  • T Coyne-Beasley, V J Schoenbach, M E Herman-Giddens
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    ABSTRACT: Rates of homicides by adolescents under age 18 years tripled from 1984 to 1994. Most studies report data on urban adolescents and young adults as a single age group (age 15-24 years), but homicide characteristics among adolescents, especially those younger than 15 years, may differ from those of young adults. To describe the homicide characteristics among adolescents age 11 to 18 years in North Carolina from 1990 to 1995. A retrospective, descriptive analysis of adolescent homicides using the medical examiner database. Police interviews provided additional information for cases from 1993 to 1995. There were 419 victims from 1990 to 1995 (average annual rate: 9.7 per 100000 adolescents; 9.9 in urban counties, 7.1 in rural). Victims were mostly ages 15 to 18 years (85%), male (79%), and black (76%); 48% lagged behind in school, and, by police report, 40% had a criminal record. Only 23% of the identified perpetrators were strangers. Firearms (59% were handguns) were used in 83% of homicides. Proportionally more younger adolescents (age 11-14 years) were killed by means other than firearms than 15- to 18-year-olds (chi2 = 24.2, P = .007). Drug-related motives (23%) were most common, followed by non-drug-related altercations (20%) and retaliations (17%). Proportionally more North Carolina adolescents than urban young adults (ages 15-24 years) were killed by firearms (83% vs. 75%). Proportionally fewer adolescents were killed by police, strangers, or intimate partners. Interventions should include reducing access to firearms and drugs, and helping adolescents develop nonviolent strategies to resolve disputes. Efforts should be focused on adolescents who lag behind in school and have criminal records.
    Archives of Pediatrics and Adolescent Medicine 05/1999; 153(4):349-56. · 4.28 Impact Factor
  • Tamera Coyne-Beasley, Victor Schoenbach, Marcia Herman-Giddens
    Journal of Adolescent Health 01/1998; 22(2):139-139. · 2.97 Impact Factor
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    ABSTRACT: To determine the current prevalence and mean ages of onset of pubertal characteristics in young girls seen in pediatric practices in the United States. A cross-sectional study was conducted by 225 clinicians in pediatric practices belonging to Pediatric Research in Office Settings, a practice-based research network. After standardized training in the assessment of pubertal maturation, practitioners rated the level of sexual maturation on girls 3 through 12 years who were undergoing complete physical examinations. Data were analyzed for 17,077 girls, of whom 9.6% were African-American and 90.4% white. At age 3, 3% of African-American girls and 1% of white girls showed breast and/or pubic hair development, with proportions increasing to 27.2% and 6.7%, respectively, at 7 years of age. At age 8, 48.3% of African-American girls and 14.7% of white girls had begun development. At every age for each characteristic, African-American girls were more advanced than white girls. The mean ages of onset of breast development for African-American and white girls were 8.87 years (SD, 1.93) and 9.96 years (SD, 1.82), respectively; and for pubic hair development, 8.78 years (SD, 2.00) and 10.51 years (SD, 1.67), respectively. Menses occurred at 12.16 years (SD, 1.21) in African-American girls and 12.88 years (SD, 1.20) of age in white girls. These data suggest that girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms. Practitioners may need to revise their criteria for referral of girls with precocious puberty, with attention to racial differences.
    PEDIATRICS 05/1997; 99(4):505-12. · 4.47 Impact Factor
  • Marcia E. Herman-Giddens, Lily Wang, Gary Koch
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    ABSTRACT: and Mexican American boys were 12.0 (95% confi- dence interval (CI), 11.7-12.3), 11.2 (95% CI, 10.9- 11.4), and 12.3 (95% CI, 12.1-12.6) years, respectively, and at stage 2 for genital growth were 10.1 (95% CI, 9.6- 10.6), 9.5 (95% CI, 8.9-10.0), and 10.4 (95% CI, 9.6- 11.1) years, respectively. All 3 groups were significantly taller and heavier than boys in previous NHANES re- ports and showed earlier genital maturation and pubic hair growth than previous studies based on Tanner stag- ing. Statistically significant differences among the 3 racial/ ethnic groups were found in the median ages of onset of pubic hair growth and genital development at stage 5 with and without controlling for height and weight, indicat- ing an earlier age of attainment for the African Ameri- can boys. Conclusions: The median (mean) ages at the onset of genital and pubic hair growth were younger than in past studies. Additional studies are required to further evalu- ate these findings and to explore the public health im- plications. Arch Pediatr Adolesc Med. 2001;155:1022-1028
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    ABSTRACT: Context Interest in the discarding or killing of newborns by parents has increased due to wide news coverage and efforts by states to provide Safe Haven legislation to combat the problem.Objective To describe the characteristics of these cases in North Carolina.Design, Setting, and Population Case series derived from data on all deaths among liveborn infants 0 to 4 days of age reported to the North Carolina medical examiner from 1985 through 2000.Main Outcome Measures Incidence of newborns known to have been killed or discarded by a parent; epidemiological characteristics of newborns and parents.Results There were 34 newborns known to have been killed or discarded by a parent, comprising 0.002% of all liveborn infants during the 16-year study period, giving a rate of 2.1 per 100 000 per year. A total of 58.8% were male, 41.1% were white, and 52.9% were black. For 29 cases, the perpetrator was determined to be the mother. Among mothers, 50% were single and 20.6% were married (marital status of the remainder was unknown). Thirty-five percent had had other children. Eight mothers (23.5%) were known to have received some prenatal care. The mean age of the mothers was 19.1 years (range, 14-35 years) and more than half were aged 18 years or older. The most common causes of death were asphyxiation/strangulation (41.1%) and drowning (26.5%).Conclusions In North Carolina, at least 2.1 per 100 000 newborns are known to be killed or left to die per year, usually by their mothers. It is unknown how many of these deaths might be prevented by Safe Haven laws. Efforts to educate the public about these laws need to target the general public. Where resources are limited, the focus should be on on adolescent pregnancy prevention programs, young adults, prenatal care clinics, and married women. The risk of homicide on the first day of life (neonaticide) is 10 times greater than the rate during any other time of life.1 Neonaticide has been attributed to motives and circumstances associated with the mother's perceived need to keep the pregnancy and birth unknown to her family and associates.2- 3 Theories about the causes of this behavior include shame about an unwanted or illegitimate infant and/or the obvious sexual activity, mental illness,4 difficult relationships with parents,2 immaturity,5 and a culture that promotes self-destructive impulses.6 The mother may deny to herself that she was pregnant, and thus be surprised by the birth.5,7- 8 Public and professional conceptions of the situations involving these cases are often based on the stereotype of the unwed adolescent girl, especially one who is from a religious family or feels she cannot confide in her parents.2,9 As of 2002, 42 states have passed "Safe Haven" or "Safe Surrender" laws to prevent neonaticide (William L. Pierce, PhD, written communication, February 21, 2003).10 These laws allow parents to anonymously transfer an unwanted newborn to certain persons or authorities, such as hospitals, without being charged with infant abandonment.11- 12 To estimate the incidence of newborn infants killed or discarded and left to die, we investigated all deaths of newborns 0 to 4 days of age in North Carolina and characterized the perpetrators and circumstances of these deaths to inform Safe Haven policy.
    JAMA The Journal of the American Medical Association 289(11):1425-1429. · 29.98 Impact Factor