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Principal Investigator: Julia Acker
Organization: UNIVERSITY OF CALIFORNIA BERKELEY
Fiscal Year: 2024
Award: $46,614
Funding agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
PROJECT SUMMARY
Early puberty is associated with adverse health outcomes over the life course, including psychopathology
in adolescence, and reproductive cancers, diabetes, and cardiovascular disease in adulthood. The age of
pubertal onset has declined dramatically over the past 40 years in the United States (US), with alarming
racial/ethnic disparities. These disparities may amplify future health inequities in chronic conditions, yet remain
poorly understood. During the COVID-19 pandemic, pediatric endocrinology centers across twelve countries
reported large increases in the incidence of central precocious puberty (CPP), a rare condition characterized by
developing secondary sexual characteristics before age eight in girls and nine in boys. However, existing studies
are subject to limitations such as small samples from specialty care settings, insufficient power to examine trends
in boys, and reliance on diagnostic criteria for CPP. In addition to CPP, it is important to examine normative
timing of early pubertal milestones, including onset of pubic hair and breasts/testes development, because they
represent the earliest observable markers of underlying hormones and may play differential roles in the etiology
of health outcomes. Moreover, no studies have investigated whether the pandemic exacerbated pre-existing
racial/ethnic or neighborhood-level disparities in pubertal timing. To fill gaps in current knowledge, this study will
leverage electronic health records from Kaiser Permanente Northern California (KPNC) to conduct the first
population-based study on the pandemic and pubertal timing in the US. KPNC comprises ~32% of the northern
California population and has 4.4 million members. In 2010, KPNC began systematically documenting routine
pubertal development assessments for all children aged 6 years and older, thereby facilitating the study of trends
in both CPP incidence and normative pubertal timing in a population with considerable racial/ethnic,
socioeconomic, and geographic diversity. First, we will estimate pre–post pandemic changes in incident CPP
diagnoses at KPNC medical centers using an interrupted time series design, using data from 2017–2023 (Aim
1). Second, we will use survival analysis techniques to estimate pre–post pandemic changes in the timing of
normative pubertal milestones (including onset of pubic hair development, breast/testes development, and
menses) in a representative population cohort of approximately 103,000 boys and 72,000 girls (Aim 2). Finally,
we will examine the differential impact of the pandemic on CPP and normative pubertal timing across diverse
racial/ethnic groups and neighborhood conditions (Aim 3). Study strengths and innovations include the use of a
robust quasi-experimental design, longitudinal assessment of a large and representative population of boys and
girls, and investigation of several important hallmarks of puberty. Examination of racial/ethnic and place-based
disparities will guide the design of upstream health equity interventions and inform both clinical practice and
future pandemic response. This study also provides a foundation for future research to determine whether earlier
puberty has lasting health consequences for today’s children as they transition to adulthood.
Terms: <0-11 years old><12-20 years old><21+ years old><6 year old><6 years of age><Acceleration><Address><Adolescence><Adolescent><Adolescent Youth><Adult><Adult Human><Adult-Onset Diabetes Mellitus><Age><Appearance><Binding><Birth><Black><Black race><Breast><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><California><Cancers><Cardiovascular Diseases><Caring><Causality><Characteristics><Child><Child Youth><Childhood><Children (0-21)><Chronic><Color><Communities><Coronavirus Infectious Disease 2019><Country><Data><Development><Diabetes Mellitus><Diagnosis><Disparities><Disparity><Economics><Electronic Health Record><Endocrine><Endocrine Gland Secretion><Endocrinology><Entire hair of pubis><Epidemiologic trend><Epidemiological data><Epidemiological trend><Epidemiology data><Epidemiology trend><Ethnic Group><Ethnic Origin><Ethnic People><Ethnic Population><Ethnic individual><Ethnicity><Ethnicity People><Ethnicity Population><Etiology><Follow-Up Studies><Followup Studies><Foundations><Future><General Population><General Public><Generations><Geography><Health><Health Inequity><History><Hormones><Incidence><Inequalities in Health><Inequities in Health><Inequity><Integrated Health Care Systems><Interruption><Intervention><Intervention Strategies><Investigation><Ketosis-Resistant Diabetes Mellitus><Knowledge><Life Cycle><Life Cycle Stages><Link><Malignant Neoplasms><Malignant Tumor><Maturity-Onset Diabetes Mellitus><Measures><Medical><Medical center><Menarche><Menses><Menstruation><Mental Health><Mental Hygiene><Metabolism and Endocrinology><Molecular Interaction><NIDDM><Neighborhoods><Non-Hispanic><Non-Insulin Dependent Diabetes><Non-Insulin-Dependent Diabetes Mellitus><Nonhispanic><Noninsulin Dependent Diabetes><Noninsulin Dependent Diabetes Mellitus><Not Hispanic or Latino><Outcome><Parturition><Play><Population><Population Study><Precocious Puberty><Psychological Health><Psychopathology><Puberty><Pubic Hair><Publishing><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Race><Races><Racial Group><Recording of previous events><Reporting><Research><Research Resources><Resources><Risk><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sample Size><Sampling><Series><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Site><Slow-Onset Diabetes Mellitus><Specialty><Stable Diabetes Mellitus><Structural Racism><Study Subject><Subgroup><Survival Analyses><Survival Analysis><T2 DM><T2D><T2DM><Techniques><Testicles><Testis><Therapeutic Hormone><Time><Type 2 Diabetes Mellitus><Type 2 diabetes><Type II Diabetes Mellitus><Type II diabetes><United States><abnormal psychology><adolescence (12-20)><adult onset diabetes><adulthood><adulthood transition><age 6 years><ages><boys><cardiovascular disorder><causation><clinical practice><cohort><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 pandemic consequence><coronavirus disease 2019 pandemic 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inequalities><histories><impact of the SARS-CoV-2 pandemic><inequality due to race><inequity due to race><infection rate><innovate><innovation><innovative><integrated health system><integrated healthcare systems><integrated system of care><interventional strategy><juvenile><juvenile human><ketosis resistant diabetes><kids><life course><malignancy><marginalization><maturity onset diabetes><medical specialties><member><menstrual period><monthly period><monthly periods><mortality><multi-ethnic><multiethnic><neoplasm/cancer><next pandemic><pandemic><pandemic containment><pandemic control><pandemic disease><pandemic effect><pandemic impact><pandemic mitigation><pandemic outcome><pandemic repercussions><pandemic response><pediatric><physical conditioning><physical health><population based><population-based study><population-level study><post-pandemic><pubertal timing><race based differences><race based disparity><race based inequality><race based inequity><race differences><race disparity><race related differences><race related disparity><race related inequality><race related inequity><racial><racial background><racial difference><racial disparity><racial diversity><racial inequality><racial inequity><racial origin><racial population><racial subgroup><racially different><racially diverse><racially unequal><rare condition><rare syndrome><rate of infection><reproductive><response><segregation><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><sex><six year old><six years of age><social role><socio-economic><socio-economically><socioeconomically><socioeconomics><studies of populations><study of the population><transition from adolescence to adulthood><transition into adulthood><transition to adulthood><trend><type 2 DM><type II DM><type two diabetes><youngster>