Living through private time : African American females at Menarche

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Living through private time : African American females at Menarche
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Hawthorne, Dorothy Jean, 1952-
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LIVING THROUGH PRIVATE TIME:
AFRICAN AMERICAN FEMALES AT MENARCHE
















By

DOROTHY JEAN HAWTHORNE


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA


1999
































Copyright 1999

by

Dorothy Jean Hawthorne


































Dedicated to
The Loving Memories
of my Father

NATHANIEL HAWTHORNE, SR.















ACKNOWLEDGEMENTS


I wish to acknowledge the young girls and their mothers

for sharing their life-lived experiences about a private and

sensitive topic, menarche. I am especially grateful to my

early maturing daughter, Nathan'ette Burdine, for inspiring

my interest in menarche as a research focus. I thank my

family and friends for their continued support throughout

this lengthy doctoral process.

My deepest sincere thank you is extended to Dr. Richard

Lutz and the members of my supervisory committee including

Dr. Hossein Yarandi, Dr. Faye Gary, Dr. Sharleen Simpson,

Dr. Felix Berardo, and Dr. Joe Feagin. Often I encountered

one obstacle after another as I struggled to maintain my

focus on the goal of completing this task. Abandoning this

project, however, was impossible with the strong support

offered by the University of Florida's Graduate School

through Dr. Richard Lutz and the members of my supervisory

committee. I thank you.

Dr. Hossein Yarandi served as my mentor long before

officially assuming the advisor and supervisory chair roles.

I wish to acknowledge his years of kind guidance, patience,

and friendship. Dr. Faye Gary has been my shining light at

the end of a lonely and dark tunnel for the final twelve








weeks of this project. It has been an honor to work closely

with a graceful and focused professor as Dr. Gary. She is a

joy, and I am deeply indebted to her.

I wish to acknowledge Dr. Felix Berardo as my

counselor-of-reality. He is a person of wisdom, and he

served as my voice of reason throughout my doctoral

experience at the University of Florida. I appreciated his

direct and taciturn ways of sharpening my insight into

issues that truly mattered.

There is no question that most African Americans know

what it means to be black while living in the United States.

Of course I knew this, at least I thought I did, until I met

Dr. Joe R. Feagin. I wish to acknowledge Joe's professional

and candid analysis of racial-ethnic situations that have

either directly and/or indirectly influenced my personal and

professional lives. Joe helped to hone my critical thinking

about how the literature and media portray African American

females. With Joe's help, I was able to critically evaluate

and present literature that addressed the life of African

American females at menarche.

Lastly, I dedicate this work to my father, Nathaniel

Hawthorne, Sr., and all that he stood for. Only through

memories of his image as a strong, loving, and devoted

father was I able to persevere to the completion of this

task. I wish to acknowledge my love for him, and my

commitment to making him proud of having me as a daughter.















TABLE OF CONTENTS

page

ACKNOWLEDGMENTS......................................... iv

LIST OF TABLES ......................................... ix

ABSTRACT................................................ ... x

CHAPTERS

1 INTRODUCTION....................................... 1

Background of the Problem........................... 2
White Females................................... 3
African American Females......................... 6
Parents ............................................ 8
Statement of the Problem ............................ 11
Purpose of the Study.............................. 13
Research Questions................................ 14
Theoretical Perspectives............................ 15
Symbolic Interactionism.......................... 16
Phenomenologic Humanism......................... 19
Significance of the Study .......................... 22
Definition of Terms............................... 24
Origin of the Study............................... 25
Assumptions...... ............................... ... 29
Scope of the Study................................ 30
Delimitations.................................. 30
Limitations.................................... 31
Overview of the Remaining Four Chapters........... 32

2 LITERATURE REVIEW................................. 33

Age of Menarche Onset................................ 33
Chronological Age at Menarche................... 34
Biophysiological Thesis......................... 37
Sociobiological Thesis......................... 39
Cognition in the Child............................ 42
Information Processing .......................... 43
Storage and Use of Information.................. 44
Educational Preparation............................ 45
Limited Educational Preparation................ 46
Mothers as Teachers About the Menarche......... 47









Responses to Menstruation.......................... 49
Psychological Responses .......................... 50
Self-Concept................................... 57
Personality Characteristics
of Maturing Females ............................ 59
Familial Status................................ 61
Menarche to Sex and Pregnancy.................. 62
Peer Relationships............................. 65
Summary........................................... 67

3 METHODS AND PROCEDURES............................. 68

Research Design................................... 68
Sample............................................ 71
Feasibility Study.............................. 71
Family Types................................... 72
Socioeconomic Status (SES) ...................... 73
Sampling Procedures ............................ 75
Demographic Information......................... 79
Scientific Integrity and Rigor..................... 82
Protection of Human Subjects....................... 91
Data Collection................................... 92
Data Analysis and Verification..................... 95
Summary........................................... 97

4 LIVING THROUGH PRIVATE TIME........................ 98

Organization of the Chapter........................ 98
Symbolic Bleeding................................. 99
Philosophical Beliefs.......................... 99
Emotional Responses ............................ 108
At Another Time................................ 119
Sexual Sensuality .............................. 126
Private Business............................... 132
Regulating Sexual Behavior......................... 137
Gender Sexuality Scripting...................... 138
Cross-Sex Segregation .......................... 142
Parental Supervision........................... 147
Good Company................................... 153
Managing Menstrual Flow............................ 156
Mother's Significance .......................... 156
Comfort Measures............................... 162
Hygienic Measures .............................. 165
Preparation for Subsequent Flows............... 171
Summary........................................... 173

5 SUMMARY, DISCUSSION, RECOMMENDATIONS.............. 176

Organization of the Remainder of the Chapter...... 178
Living Through Private Time........................ 178
Symbolic Bleeding .............................. 180
Regulating Sexual Behavior...................... 183
Managing Menstrual Flow......................... 184


vii








Self-Concept........................................ 186
Self-Image....................................... 187
Self-Esteem...................................... 190
Recommendations................... ................... 194
Implications for the African American
Family Literature............................. 194
Implications for Nursing ....................... 196
Implications for Further Research............... 197

APPENDICES

A INFORMED CONSENT..................................... 200

B DEMOGRAPHICAL DATA ................................. 209

C INTERVIEW GUIDES: CHILD AND MOTHER.................. 210

D STATISTICAL ANALYSIS SERIES (SAS) .................. 213

REFERENCES ............................................. 214

BIOGRAPHICAL SKETCH...................................... 232


viii















LIST OF TABLES


Table paoe

3-1 Profile of Feasibility Sample's Types of
Families and Socioeconomic Classes.............. 74

3-2 Demographic Profile of the Young Girls
Indicating ID Number, Age, Tanner's Stage,
Time in Study, and Height and Weight............ 83

3-3 Demographic Profile of the Parents Including
ID Number, Mother's Age, Father's Age,
Mother's Education, Father's Education,
and Household Income ............................ 84

3-4 Profile of the Young Girls' Families
Including Family Type, Socioeconomic
Status and Number in Household.................. 85

3-5 Profile of Family Types and Socioeconomic
Classes According to Hollingshead's Index
(Gilbert & Kahl, 1993) .......................... 86

3-6 Profile of Biological Father's Presence
and Absence in the Home and Socioeconomic
Class Stratification............................ 86

3-7 Frequency and Percent of Variables Tanner's
Stage, Family Type, and Socioeconomic
Status (SES) .................................... 87

3-8 Summary Measures of the Demographic Variables..... 88














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctorate of Philosophy

LIVING THROUGH PRIVATE TIME:
AFRICAN AMERICAN FEMALES AT MENARCHE

By

Dorothy Jean Hawthorne

August 1999

Chairperson: Hossein Yarandi, PhD
Major Department: College of Nursing

A female's first menstrual flow (menarche) is not only

a physical experience, but an influential social,

psychological and familial event. The social psychological

responses of individuals from various ethnocultural and

socioeconomic backgrounds to influential events are

significant to the professional practice of mental health

nursing. The positive, negative, and mixed effects of

menarche in middle-class European (White) American females

have been well researched as compared to other ethnocultural

and socioeconomic groups. Theoretical formulations for the

social psychological responses of African (Black) American

females at menarche were prepared. The qualitative case

study approach was used to: (1) discern the thoughts,

feelings, beliefs, practices, and social interactive








behaviors of African American females at the time of their

menarche; (2) learn the social psychological responses and

practices of African American mothers to the onset of their

daughters' menarche; and (3) posit a core theme to

substantially describe and explain the social psychological

and familial responses of menarcheal aged females belonging

to the African American ethnocultural group.

Thirty participants (15 mother-daughter dyads) were

interviewed. The 9/10-year-old female was the invited age

group of young girls for this study. Participants were

informally interviewed in a 45- to 60-minute audiotaped

mother-daughter session. The data were analyzed by

performing a cross comparison of the interview responses for

evolving themes from the multiple case studies. Living

through private time was the substantial theme inductively

discovered from the data. It is anticipated that the

results of this study will add to the knowledge of nurses

and all other health care professionals about the social

psychological and familial status of 9- and 10-year-old

African American females at the time of their menarche.















CHAPTER 1
INTRODUCTION

An increasing number of African American females are

menstruating by ages 9 and 10 years old (Doswell & Millor,

1993; Herman-Giddens et al., 1997; MacMahon, 1973; Marshall

& Tanner, 1969). However, scientific data collection on the

social psychological and familial experiences of young

African American females after their menarche is rare (Grief

& Ulman, 1982; Lee, 1994; Lee & Sasser-Coen, 1996).

Most investigators collect behavioral data from

menstruating females several months and years beyond the

actual onset of menarche (Amann-Gainotti, 1986; Caspi &

Moffitt, 1991; Du Toit, 1987; Holmbeck & Hill, 1991; Lee &

Sasser-Coen, 1996; McGrory, 1990; Phinney, Jensen, Olsen, &

Cundick, 1990; Rierdan & Koff, 1991; Scott, Danette, Panizo,

& Roger, 1989). One barrier to data collection is that once

young girls have had their first menstrual flow, they move

further away from this initial event and other childhood

experiences (Belsky, Steinberg, & Draper, 1991; Brooks-Gunn,

Warren, Rosso, & Gargiulo, 1987; Bullough, 1996). As time

passes, girls will gain increasing cognitive skills

(Flavell, Miller, & Miller, 1993; Klahr & Wallace, 1976;

Piaget and Inhelder, 1996; Siegler, 1996) and other










sociocultural forces interact to shape their life

experiences (Bronfenbrenner, 1989; Gilligan & Murphy, 1996;

Hetherington, 1972;). Menarche, as a unique experience,

will blend with other life events as it takes on different

meanings for each individual (Berger & Luckmann, 1966;

Blumer, 1969; Hewitt, 1994). As a result of physiological

life changes, the "self" of postmenarcheal females is

reconstructed, and is based on repeated social psychological

life experiences with menstruation. Other life events and

an increasing cognitive development help to shape young

girls' perceptions about the world around them.

A greater repertoire of knowledge about the physical,

social, psychological, and familial effects of menarche as

perceived by African American menarcheal females is needed.

Nurse researchers can contribute to this knowledge base by

qualitatively studying the phenomenological worlds of

younger African American girls ages 9 to 10 years at

menarche. Further, this knowledge can contribute to

improving the physical and social psychological health

outcomes of African American females.

Background of the Problem

The background information of the problem relative to

this study is presented under three subheadings: (1) White

females, (2) African American females, and (3) Parents.

Literature on the social psychological experiences of the

White female is presented first. Overtime, researchers have










investigated the social psychological experiences of White

females; that literature is more extensive.

White Females

The secular trend shows a decline in age at the onset

of menarche for many European (White) American females.

Over the last 100 years the age of menarche onset decreased

from 17 to about 12.8 years of age (Golub, 1992; Herman-

Giddens et al., 1997; Tanner, 1978). Previously, this early

age of menarcheal onset was associated with "superior racial

stock and physical traits" (Stone & Barker, 1939, p. 29) and

"the most favorable living circumstances" (Smart & Smart,

1972, p. 496). More recent sociobiological reports suggest

environmental life stressors in the middle-class White

female are associated with early menarcheal onset (Belsky,

Steinberg, & Draper, 1991; Surbey, 1990; Wierson, Long, &

Forehand, 1993).

For many White middle-class American girls 9 and 10

years of age, the first menstrual flow (menarche) is an

emotionally traumatic and a private life event (Chadwick,

1992; Lee, 1994; Logan, 1980; Stattin & Magnusson, 1990;

Williams, 1990). As a normal response to the increased

levels of gonadotropin (reproductive and sex) hormones

during the late stage of puberty, menarche involves pain and

vaginal blood flow (Guyton & Hill, 1996). The condition or

state of a female's reproductive body part is a private

matter (McKinney, 1998). Privacy and secrecy are major










issues for families (Berardo, 1998; Brown-Smith, 1998;

Weigel-Garrey, Cook, & Brotherson, 1998) and their

developing daughters of ages 9/10 years (Smith, 1997; Van

Manen & Levering, 1996). As a tradition, in the United

States, sexual body parts are considered private and are not

publicly exposed or discussed (Berardo, 1998; McKinney,

1998; McKinney & Sprecher, 1989).

Seldom do schoolage girls discuss their menarche with

individuals. The exceptions, however, are those young girls

who will discuss menarche with parents, a favorite sister,

or a close friend (Notman, 1992; Petersen, 1983). For the

middle-class White American schoolage girl, it is common

practice to refrain from joyfully celebrating or publicly

broadcasting menarche arrival, since it is a private matter

imbued with sensitive emotions (Caspi, Lynam, Moffitt, &

Silva, 1993; Golub, 1992; Hyde, 1996).

Several empirical reports exist on younger 9/10-year-

old White girls' negative emotions to menarche including

fear, disgust, nervousness, shame, embarrassment, and

humiliation (Grief & Ulman, 1982; Notman, 1992; Stattin &

Magnusson, 1990; Williams, 1990). A manifestation of

negative emotions to menarche onset in younger age, or early

maturing, girls support the thesis that menarche is a

stressful and traumatic developmental event (Clark & Ruble,

1978; Jones & Mussen, 1958; Kornfield 1990; Malmquist, 1972;

Rierdan & Koff, 1980; Surbey, 1990).








5

The self-esteem and self-image of White girls less than

12 years old is lower at menarche as compared to older age

White girls at the time of their initial menstruation

(Delaney, Lupton, & Toth, 1988; Papini & Sebby, 1987;

Richards, Boxer, Petersen, & Albrecht, 1990; Slap, Khalid,

Paikoff, Brooks-Gunn, & Warren, 1994). There are research

reports that show middle-class White girls are more

accepting of menarche when they understand it, and that they

experience less negative emotions at its onset if it is

cognitively understood (Danza, 1983; Lee, 1994; Moffitt,

Caspi, Belsky, & Silva, 1992; Petersen, 1983; Rierdan &

Koff, 1985; Simmons, Blyth, VanCleave, & Bush, 1979; Grief &

Ulman, 1982). These young girls may not be ready to

understand the physiological processes of menstruation and

are less likely to have cognitive awareness about the

sociocultural meaning of menstruation (Chi & Klahr, 1975;

Flavell, Miller, & Miller, 1993; Kail, 1990).

White girls who menstruate at an age less than 12

years, early-maturers, tend to initiate sexual intercourse

sooner than older age menarcheal girls (Bagley, 1997; Costa,

Jessor, Donovan, & Fortenberry, 1995; Phinney, Jensen,

Olsen, & Cundick, 1990). Girls of 9 to 10 years of age have

not yet developed higher levels of cognitive reasoning

(Piaget & Inhelder, 1996), which places them at risk during

their sexual decision-making (Ward & Overton, 1990).










Young girls who engage in sexual intercourse risk

becoming pregnant. The highest pregnancy rate in the United

States is reported among those girls who start menstruating

at an early age (Jaccard, Dittus, & Gordon, 1998; Leite,

Everardo, Buoncompagno, Leite, Battistori, 1994; Millstein

et al., 1992; Morgan, Chapar, & Fisher, 1995; Rodriquez &

Moore, 1995). Early childbearing can be a traumatic

experience for developing schoolage girls. Generally, there

is a disruption in education, income is meager, and health

complications are not unusual (Freeman & Rickels, 1993).

Also, higher rates of premarital sex increase the risk for

contracting sexually transmitted diseases (Dean, Ducey, &

Malsk, 1997).

African American Females

A recent national study done by the American Academy of

Pediatrics shows African American girls start menstruating

at the average age of 12.16 years (Herman-Giddens et al.,

1997). Moreover, many are experiencing menarche as early as

8 and 9 years of age (Herman-Giddens et al., 1997; Powers,

Hauser, & Kilner, 1996) and are initiating sexual

intercourse earlier than their White counterparts (DuRant &

Seymour, 1990; Vinovskis, 1988; Williams, 1991; Zabin &

Hayward, 1993).

The biophysiological model attributes the early age of

menarcheal onset in African American girls to genetics and

improved nutrition and living conditions (Herman-Giddens et










al., 1997). A few sociobiological investigators, however,

use results from correlational research studies carried out

with middle-class White females of divorced parents to

report that the early onset of menarche is associated with

environmental stressors (i.e., absent-biological-father,

low-income homes, uneducated parents; poor parenting skills)

as compared to biologically determined changes (Belsky,

Steinberg, & Draper, 1991; Wierson, Long, & Forehand, 1993).

Many African American children are raised by a single-

parent, in underresourced homes, and in impoverished

conditions (Beeber, Hendrix, Taylor, & Wykle, 1993; Feagin &

Feagin, 1996; Hacker, 1992). Their environmental conditions

are unlike those of most White females (Comer & Poussaint,

1992; Feagin & Feagin, 1996). Also, the "culture-of-

poverty" thesis (Moynihan, 1967) and adverse social

psychological results obtained from correlational research

studies carried out on middle-class White samples can

sometimes be inappropriately applied to African American

children and their families (Billingsley, 1992; Demos, 1990;

Feagin & Feagin, 1996; Graham, 1992; Taylor, Chatters,

Tucker, & Lewis, 1990; Willie, 1985). Lastly, qualitative

empirical reports from the voices of young African American

girls and their parents that describe their emotional

responses to menarche are yet to be researched.

African American, and other non-White, schoolage girls

are less likely to be prepared for menarche as compared to










Whites (Amann-Gainotti, 1986; Doswell & Millor, 1993; Du

Toit, 1987; Scott, Danette, Panizo, & Roger, 1989).

Empirical data collected on White samples suggest that the

less informed girls experience more negative feelings about

menarche than the more informed girls. Yet, the empirical

reporting of menarche for African American females as a

negative, stressful, or traumatic emotional event is not

documented in the literature (Doswell, Millor, Thompson, &

Braxter, 1998; Grief & Ulman, 1982; Scott, Danette, Panizo,

& Roger, 1989). Further, little has been written about how

African American females approach the onset of menarche

regarding privacy and secrecy (Dashiff, 1992; Doswell &

Millor, 1993; Grief & Ulman, 1982; Scott, Danette, Panizo, &

Roger, 1989). Based on these findings, then, there is a

need for nurses to empirically study the social

psychological responses of young African American girls to

their first menstrual flow, menarche.

Parents

Parents tend to be emotionally stressed by the

appearance of menarche in their child of 9 to 10 years of

age (Bullough, 1996; Chadwick, 1992; Hill, Holmbeck, Marlow,

Green, & Lynch, 1985; Holmbeck & Hill, 1991). For many

parents, menarche means reproductive capabilities and sexual

sensuality and eroticism. The expected behavior for a 9/10-

year-old girl is that she lives with her parents, attends

elementary school, and participates in nonsexual activities








9

(Baumrind, 1993; Bronfenbrenner, 1997). However, there is a

challenge to such expectations when physiological production

of gonadotropin hormones stimulates puberty and the

menstrual flow begins, breasts are evident, pubic hair

appears, and the sensual curving of waist and hips is easily

observed. Most parents are aware that early maturers are

capable of producing babies even though these young girls

are not prepared to care for the baby nor themselves. These

physical changes tend to trouble parents as they observe

their young female child's body transcend to womanhood.

Menarche, in most cultures of the world, symbolizes a

transition from girlhood to womanhood (Lee, 1994; Weideger,

1998). Womanhood implies maturity, heterosexual sensuality

as well as availability, and reproductive capability (Hyde,

1996; Rubin, 1990). However, a focus on the young girl,

reveals a different set of practices. A person of 9 to 10

years of age is a child, not an adult or a woman (Rubin,

1990). After all, childhood is equated with sexual

inactivity and nonreproductive capability (Bronfenbrenner,

1997; Dean, Ducey, Malsk, 1997; Freud, 1933/1964; Hyde,

1996).

Some researchers note that sexual urges and desires of

young girls are not latent or quiet as Freud would have many

to believe (Jaccard, Dittus, & Gordon, 1998). Further,

Erikson's (1963) psychosocial axioms support the position

that young girls are busy, industrious people, working to










receive rewards from significant adults. They are more

likely to experience a sense of success and avoid feelings

of inferiority and failure if they are successful at their

industriousness (Erikson 1963). These theoretical

formulations can be challenging when menarche appears before

age 12 years.

Developing children look for adults to direct, guide,

and set limits on their activities and behaviors (Baumrind,

1993; Bronfenbrenner, 1997). At the onset of menarche,

developing females tolerate less behavioral control and

limit-settings (Doswell & Vandestienne, 1996; Holmbeck &

Hill, 1991). As the newly menstruating female struggles for

independence, parents' fears of dating, sexual pressure, and

pregnancy force them to place greater restrictions on their

activities outside of the home environment. This increased

parental control and restrictions at the critical time of

menstrual onset can create parent-child conflict (Doswell &

Millor, 1993; Holmbeck & Hill, 1991; Steinberg, 1988).

Mother-daughter relationships have the potential to suffer

the longest with negative impact (Gilligan & Murphy, 1996;

Hill, Holmbeck, Marlow, Green, & Lynch, 1985).

However, some mother-daughter relationships are not

always jeopardized (Rich, 1990). Parents who are not

threatened by their daughter's emotional need to

differentiate and to become independent tend to have a

stronger relationship with their daughters, show affectional








11

bonding, and use effective problem-solving skills (Doswell &

Millor, 1993; Holmbeck & Hill, 1991). The onset of

menstruation as an indisputable sign of maturity, erotic

interest, and reproductive capability of the young female

challenges past health and mental health knowledge and

approaches. Inasmuch as parents may react positively or

negatively to their early maturing daughter's menarche,

contemporary theoretical knowledge of human behavior

supported by empirical data is essential for more accurate

formulations about young girls (Meleis, 1997).

Statement of the Problem

Although there are insightful research reports about

the influence of menarche on White females' social,

psychological, and familial behavior, most earlier

investigators failed to include African American females and

their parents in conceptual domains. African American

females were not, as a rule, included in their samples.

Research suggests that younger age White girls are more

likely to experience negative emotional responses toward

menarche, and are less cognitively prepared than the older

girls. On the other hand, African American girls who

experience menarche at a young age are also poorly prepared

cognitively for its onset. However, little research exists

that explicates experiences and emotional responses of

African American girls to this normal and universal

developmental event. The life experiences surrounding










menarche and mental health issues of young non-White

developing girls and their parents from other ethnocultural,

socioeconomic, and family types have received little

attention from previous investigators.

Researchers who studied menarcheal experiences most

frequently used the quantitative correlational design with

questionnaires for data collection (Kornfield, 1990; Belsky,

Steinberg, & Draper, 1991; Grief & Ulman, 1982). These

researchers collected data from their subjects anywhere from

2 months to 64 years after the onset of menarche. Further,

many reported studies focused on the meaningful menarcheal

experiences of middle-class White American girls living in

nuclear-family settings with their biological parents and

siblings. Results from correlational studies, which operate

under the positivistic paradigm, are used by many

researchers to report a cause-effect of human behavior

(Kuhn, 1962). Confounding of age, cohort, onset of

menarche, and time period of data collection are major

problems with these correlational designs (Lincoln & Guba,

1985; Marshall & Rossman, 1999).

Theorists tend to formulate concepts that are congruent

with their personal lives and/or the sociopolitical climax

of their time (Meleis, 1997; Morrison, 1992; Priest, 1991).

Widely used theoretical perspectives that were developed

prior to the 1960s reflect a masculine-dominate

philosophical belief and life-practices (Best & Kellner,










1991). Before the 1960s, theoretical underpinnings often

included Freud's (1933/1964) psychoanalytical theory of

psychosexual development, which was used by many researchers

and scholars to present empirical findings and discussions

about females' mental health issues related to menstruation

(Fenichel, 1945). Emphasis was placed on Freud's castration

complex (Deutsch, 1944) and penis-envy theme (Thompson,

1942) in order to describe the emotionally ill-state of

women during menstruation. Steinem (1983) noted that male

humans have grounded entire cultures on the thesis that

penis-envy is natural for women.

The 1990s is a different time-period with varied groups

of theoreticians who espouse multiple theories about mental

health in general and behavioral responses to menarche in

particular. As a result, contemporary researchers and

thinkers use other perspectives, such as feminism to present

information about females' issues (Gary, Sigsby, & Campbell,

1998). Nevertheless, few scholars use symbolic

interactionism and phenomenologic humanism to describe the

verbal reports of the life-lived experiences of young

African American females under the extended qualitative case

study approach at the time of their first menstrual flow.

PurDose of the Study

The purpose of this study is to (1) capture the social

psychological responses of African American girls aged 9/10

years to their first menstrual flow, menarche, (2)










articulate the social psychological responses of African

American parents to their young daughter's menstruation, (3)

construct a core social psychological theme to substantively

describe lived experiences of African American families to

young girls' menarche, and (4) recommend suggestions for

culturally sensitive interventions that could be developed

for and tested among African American girls, ages 9/10, who

are at menarche.

Discovery of a core social psychological theme for

theoretical formulations around menarche was a major aim of

this study. While theoretical knowledge is essential to

nursing science and practice Meleis (1997) asserts that

clinical data gleaned from nursing practice is one of the

most significant, but neglected source for theory

development.

Research Questions

The major focus of the qualitative researcher using the

case study method is on "how" or "why" questions about a

human life event (Yin, 1994). Once data collection starts,

however, many questions may surface as the study grows and

as various topics evolve around the original phenomenon of

interest. The major research questions of interest at the

outset of this project were:

1. How do African American girls ages 9 and 10 years

old think and feel about starting their first menstrual

flow?










2. How do African American parents react to the

menarcheal onset and reproductive capability in their

daughters who are 9 and 10 years old?

3. How do 9/10-year-old African American girls manage

the care of their first menstrual flow?

4. What changes manifest in African American family

members' relationships with each other around the onset of

menarche in girls ages 9 and 10 years?

Theoretical Perspectives

"Living through private time" was the core social

psychological theme uncovered from the data for a set of

theoretical formulations. This core theme is supported by

the conceptual domains of symbolic bleeding, managing

menstrual flow, and regulating sexual behavior. Living

through private time was developed from interview data of

the phenomenological lived experiences of African American

families with newly menstruating 9/10-year-old daughters.

Only after the perceptions, behaviors, and lived experiences

of African American girls to menarche are clearly understood

can theories be formulated for a set of cannons needed to

develop context-specific interventions by nurses and other

health care providers.

Symbolic interactionism and phenomenologic humanism are

the two major theoretical perspectives used to help

interpret participants' interview responses about their

life-lived experiences surrounding menarcheal onset in the










9/10 year old African American females. Qualitative

researchers often use more than one theoretical framework to

descriptively present participants' statements (Marshall &

Rossman, 1999).

Specifically, symbolic interactionism is a social

psychological theory often used by researchers to illuminate

the meanings research participants assign to interested

phenomena (Blumer, 1969; Gubrium & Holstein, 1997). On the

other hand, phenomenologic humanism, with roots in Heidegger

philosophical thoughts, is a type of third-force personality

theory (DeCarvalho, 1991; Rahilly, 1993) used to

qualitatively describe participants' lived experiences about

an event or an occasion.

Blumer's (1969) symbolic interactionism and

phenomenologic humanism grounded in Heidegger's (1962)

philosophical thoughts are qualitative research approaches

as well as theoretical perspectives. In this study,

symbolic interactionism and phenomenologic humanism are used

as philosophical positions for theoretical underpinnings of

participants' meaningful experiences to menarche, a normal,

though stressful developmental life-event in 9/10-year-old

African American girls.

Symbolic Interactionism

Symbolic interactionism is an American sociological

perspective with roots in the philosophy of pragmatism

(Shalin, 1986). According to Hewitt (1994) pragmatist










scholars such as Charles S. Pierce, William James, John

Dewey, and George Herbert Mead view living things as

attempting to make practical adjustments to their

surroundings. That is, all living organisms are oriented to

meeting the demands of their environments in practical ways.

Pragmatists see knowledge as continually confronting tests

of its usefulness. Knowing and acting are intimately

linked; that is, humans act on the basis of their ideas or

knowledge about the world. The reality of the world is not

merely something that is out there and waiting to be

discovered; instead, it is actively created as people act in

and toward the world.

For Herbert Blumer (1969), symbolic interactionism is a

social psychological theory of human social interaction.

Symbolic interactionism, also, is an approach to the study

of human life and conduct in response to objects, events,

situations, conditions, and circumstances. Blumer gives

four central conceptions of symbolic interactionism. The

first states that humans behave toward things based on their

ascribed meanings of things. The second premise supports

the theme that the meanings of things are learned through

social interaction with one's fellow humans. Third, humans

modify learned meanings through an individual interpretative

process as they use and deal with encountered things,

people, objects, and events. The fourth conception states

that the complex interlinkages of human acts are nonstatic.








18
These premises are guided by the belief that individuals are

active organisms who cope with and handle "meanings" as they

adjust to their particular surroundings and environments.

In social interactions, people use language, symbols, and

gestures to create meanings within their sociocultural

context.

A major central concept in symbolic interactionism is

the self (Blumer, 1969; Mead, 1934). The self emerges from

social experience, is dynamic, and is capable of change.

The self, then, is not merely a passive reflection of social

norms. Social experience, however, is the exchange of

symbols and is essential to the development of the self.

According to Mead (1934), the self is composed of two

components, the I and the me. The self is subject in that

it can initiate social action. Mead claims humans are

innately active and spontaneous, and he calls this

subjective element of the self the I. Second, the self is

object because, taking the role of another, humans form

impressions of themselves. Mead refers to this objective

element of the self as the me. All social experience begins

with someone initiating action (the I-phase of self) and

then guiding the action (the me-phase of self) through

reflectively taking the role of the other. The fact that

people are able to see themselves through others produces

evidence that the self has two components (Hartup, 1992;

Hewitt, 1994; Mead, 1934).










As many selves exist in a society as there are human

beings (Harter, 1990). A group of humans contribute to the

general meanings of the human condition within their

sociocultural context (Scarr & McCartney, 1983). However,

meanings ascribed by the group may change from one person to

another, from one time period to another, and from one

context to another. As a result, a general agreement about

meanings within any given group of individuals does not stop

a person from acting toward objects or things based on a

different set of meanings. Therefore, it is essential that

nurses empirically secure contemporary knowledge and

understanding of the various meanings attributed to menarche

by individuals in a multicultural society.

Phenomenological Humanism

Phenomenological humanism is a post-1950s "third-force"

personality theory and an American brand of existential

psychology (DeCarvalho, 1991). Dissatisfied with the study

of human life experiences through the psychoanalytic and

behavioral learning theories, Gordon Allport (cited in

DeCarvalho, 1991) called for a new and broader type of

humanistic psychology. Along with Allport, phenomenological

humanism is exemplified in the work of Carl Rogers, Abraham

Maslow, and Rollo May (Polkinghorne, 1989; Rahilly, 1993).

As a philosophy, phenomenology was founded by Edmund

Husserl at the turn of the century and furthered developed

as an existential philosophy by his student, Martin








20

Heidegger (1962). The subject matter of phenomenology began

with consciousness and experience, but Heidegger expanded it

to include the human life world. For Heidegger (1962),

phenomenology is a philosophical school of thought that

focuses on subjective experience and seeks to make visible

the nature and meaning of Being. Being is the being of

whatever is and human being is just one presentation of

Being.

Humans come to understand some of the possible meanings

of Being through their experiences of the world and being

within it. Everyday lived experience is the focus of

attention. The concern is to clearly present human lived

experience since this is the place where "meaning" resides

that individuals give to events. Because human lived

experience is "everyday" and seems ordinary, much of its

meaning remains hidden, and may even be characterized as

insignificant.

Heideggerian phenomenology holds that individuals'

foundational mode of existing as persons is in the

interpretation and understanding of the reality that

surrounds them. Understanding is grasping one's own

possibilities for being, within the context of the world in

which one lives. Understanding, then, is a mode of being.

Understanding is rendered explicit by interpretation, that

is, in language. Language does not merely represent a

person's way of being, it discloses what it is to "be."

Language is a mode used by human beings which unveils Being.










The Association of Humanistic Psychology, founded in

1962, adopted four interrelated principles to guide their

pursuits (DeCarvalho, 1991). The first states the

experiencing person is of primary interest. Humans are the

subjects in real-life events and circumstances, rather than

mere objects of study.

The second principle deals with human choice,

creativity, and self-actualization as the preferred topics

of investigation. Phenomenological humanists argue that the

study of psychologically crippled people has led to a

crippled psychology, while the study of lower organisms has

yielded an incomplete psychology, devoid of consciousness.

It is believed that the focus should be on wholesome and

healthy individuals, people who are creative and fully

functioning. Growth, rather than mere adjustment, is the

criterion of health.

Third, meaningfulness must precede objectivity in the

selection of research problems. Previously, much research

was centered more on methods rather than broad problems.

Research topics were often selected because objective and

convenient methods became available. However, research

projects should be undertaken because they are significant

and pertinent to human life issues. There is a need to

study the important issues of people's lives.

The fourth and last principle is that the ultimate

value is placed on the dignity of the person. Humans are to










be accepted as unique. Researchers must understand people.

Phenomenology is interested in elucidating both that which

appears and the manner in which it appears. It studies the

subjects' perspectives on their world. Also, it attempts to

describe in detail the content and structure of the

subjects' consciousness, to grasp the qualitative diversity

of their experiences, and to explicate their essential

meanings.

Significance of the Study

A female's first menstrual flow, menarche, is a major

health and mental health issue. Several scholars have

described menarche as a highly significant event in the

social psychological and physiological development of young

White girls (Chadwick, 1992; Doswell, Millor, Thompson, &

Braxter, 1998; Golub, 1992; Grief & Ulman, 1982; Rierdan &

Koff, 1991; Ruble & Brooks-Gunn, 1982; Simmons, Blyth, &

McKinney, 1983; Stattin & Magnusson, 1990). Yet, the

research literature is scarce about the social psychological

health of African American females during menarcheal onset.

Nursing is a profession that deals with the bio-psycho-

socio-spiritual behavior and well-being of all humans of all

ages across the life span. Meleis (1997) states:


Nursing as a human science is concerned with the
experiences of human beings and with health and
illness matters. Because these experiences are
shaped by history, significant others, politics,
social structures, gender, and culture, nurses also
are concerned with how these perspectives shape
actions and reactions of human beings. (p. 94)










The effectiveness of nursing as a discipline is

dependent upon the knowledge and skills that nurses possess.

Its effectiveness is also linked to the capacity to

sensitively and sensibly respond to the health care needs of

all people including African American females. This study

will generate new knowledge about the social psychological

responses of young African American girls to the onset of

menarche. It also describes parental reactions to their

child's initial menstrual flow. With knowledge on hand

about human reactions to this specific event, nurses can

begin to devise and implement appropriate interventions.

Thus, nurses and other health professionals can benefit from

the reports offered by the African American girls and their

parents about menarche.

Theory and theory development are significant to the

field of nursing. Nursing as a discipline has only recently

begun to develop theories (Meleis, 1997). Theory allows

individuals in a discipline to describe, explain, and make

predictions about interested phenomena. A major aim of this

research study was to develop a substantive theory that

could be used to describe emotional responses and social

psychological practices of young 9/10 year old menstruating

African American girls and their parents. A substantive

theory could be a beginning point for building a formal

theory (Glaser & Strauss, 1967; Strauss & Corbin, 1990).

This study can be used as a guide to qualitative theory










development, generate nursing interest toward research and

theory development, and it can also serve as a backdrop for

the development of culturally sensitive interventions.

Definition of Terms

Significant terms for use in this research study

include:

Early-maturer is a female child between the ages of

9/10 who experiences pubertal characteristics, such as

growth spurt, axillary and pubic hair, breast development,

and menarche.

Stressor is environmental for the child relative to an

absent-biological-father, low-income home, and uneducated

parents.

Late-maturer is a female whose pubertal (growth spurt,

axillary and pubic hairs, breast development, and menarche)

characteristics become manifested after the age of 12 years,

with the first menstrual flow occurring after age 13.

Menarche refers to the female's first menstrual blood

flow, which can appear between the ages of 9/10. The blood

flow tends to last 3 to 7 days. Subsequent menstrual flows

are called menstruation or "period," indicating the

completion of a biologically determined hormonal cycle

(Golub, 1992; Guyton & Hill, 1996).

Parents are persons serving in the female-gender role

of mother and the male-gender role of father for six or more

consecutive months or the individuals with whom the child is










presently living and receiving guidance and discipline.

Today's typical American family is no longer of the nuclear

type or one that consists of biological mother and father

with their offspring (Berardo, 1991; Staples & Johnson,

1993). Many African American children live in single-parent

female-headed households, extended families, adoptive

families, foster-care families, or with fictive kins

(Billingsley, 1992; Hill, 1998; St. Jean & Feagin, 1998;

Taylor, Chatters, Tucker, & Lewis, 1990). Thus, an adult

who is the young girl's biological birth parent, a fictive

kin, a foster-care or an adopted parent, a grandparent, or a

close relative may occupy the role of "mother" or "father".

Secular trend is a term used to describe the declining

age of pubertal growth and sexual maturity in boys and girls

(Tanner 1969, 1978, 1981).

Origin of the Study

The origin of this study is linked to a 2-step

discovery process. At the first step, within the context of

a phenomenological experience, my 9-year-old daughter and I

discovered that we experienced initial feelings of happiness

and joy at the onset of her menarche. We celebrated by

eating out and shopping for her personal supply of menstrual

products. However, our moment of shared joy abruptly ended

by the second day of her first menstrual flow. For me, the

joy ended on the third day of her menarche.








26

As a divorced, single parent since her second birthday,

our mother-daughter closeness strengthened over time. I was

able to cognitively prepare her for menstruation. Our home

is a place where "the girls live" and educating her about

menstruation often times took place as she observed me

changing sanitary pads. However, I failed to inform her of

the physical discomforts associated with menstruation, such

as headaches, abdominal cramps, and pain in the legs and

lower back. She reacted to the physical discomfort of

menstruation to the point of tears. She became embarrassed

and did not want anyone else to know she was menstruating.

She refused to associate with neighborhood children. She

envisioned that her playmates could see the print of the

sanitary napkin and detect the odor emanating from her

bloody flow; she feared they would learn of her menstrual

status. She reported that, based on her lived-experience,

the first menstrual flow was "nasty, smelly, and painful."

No longer was she smiling about having another physical

symbol to add to breasts and pubic hairs that showed

"womanhood," a similarity that she would share with all

women.

I responded. Within a few days, I sought medical

advice from her private pediatrician about what

pharmacological agent was available to temporarily halt

menstruation for 3 or 4 more years until she was older and

better able to handle the physical discomforts. I was










assured that no such medical drug existed and that many

young girls of my daughter's age were experiencing menarche.

Even this bit of knowledge about the prevalence of menarche

in younger aged girls did not comfort me. I wanted to know

if other parents and girls were reacting to menarche as my

daughter and I had experienced it.

At the second step, I discovered from a review of the

research literature, which included Stone's and Barker's

1939 study that information on the emotional responses of

African American girls and their parents ranged from sparse

to nonexistent. Using a final sample of 1,000 American-born

girls of middle and northern European stock from two large

junior high schools in Berkeley, California, Stone and

Barker (1939) wrote:


All records from Hebrews, Orientals, South
Europeans, Negroes, and Mexicans were discarded.
The elimination of these racial stocks appeared to
be desirable as it is commonly believed that
American-born children of such racial groups
differ in age at menarche and in physical traits
from those of middle and north European stock.
(p. 28)


In a review of the research literature from 1930 to

1981, regarding the social psychological responses of

females to menarche, Grief and Ulman (1982) found non-Whites

were seldom included in research samples. Most

investigators, including Stone and Barker, reported that

African American females started menstruating at a later age

than Whites and to research the early menarcheal behaviors








28

in a racial group of females who menstruated at an older age

would be nonsensical. These statements were made without

definitive research data. The prevalent belief was that

African American girls, and other non-Whites, had an

inferior nutritional status and a sociocultural lifestyle

that failed to support the onset of menarche at an early

age. White females, on the other hand, were perceived as

early menstruators, in part, because of their superior

nutritional status and socioeconomic lifestyle. African

Americans and other non-Whites failed to meet the middle-

class White standards needed to be research participants in

studies dealing with a female's social psychological health

at menarche.

The general knowledge base about African Americans in

psychology has been steadily declining rather than

increasing. In a content analysis of 14,542 empirical

articles in 6 major American Psychological Association (APA)

journals during the 1970-1989 publication period, Graham

(1992) found a growing exclusion of research about African

Americans. There was a steady decrease in both number and

percentage of articles over the years. As Graham stated in

the title of her article, "Most of the subjects were white

and middle class" (p. 629). The dearth of research articles

on females of color has also been documented by Reid and

Kelly (1994), who examined Silver Platter, the CD-ROM

library database for psychology, for the 1987-1994








29

publication period. They found extremely low frequencies of

research on African American and Hispanic American females.

Reid and Kelly concluded that the "psychology of women

implies the psychology of White women" (p. 480).

The pattern continues and few present day researchers

have addressed the social psychological health of non-White

middle class females at menarche (Amann-Gainotti, 1986;

Scott, Danette, Panizo, & Roger, 1989; Doswell &

Vandestienne, 1996). Albeit some attention is now being

given to the earlier age at menarcheal onset seen in the

African American-born female (Herman-Giddens et al., 1997),

there remains a need to examine the social psychological

health of early maturing African American females.

The impetus for this research study, then, grew out of

my phenomenological personal experience with a 9-year-old

menstruating daughter, and a review of the research

literature that revealed an embarrassingly limited amount of

knowledge regarding the social psychological responses of

young menarcheal African American females and their parents.

Assumptions

Three major assumptions for this study follow:

1. Mothers are the major source of knowledge about

menarche for African American girls ages 9/10 years old.

2. Menarcheal onset in early maturing girls is an

important developmental life event that triggers certain

social psychological responses in the girl and among her

family members.










3. Communication is essential between mothers and

girls ages 9/10 years when confronted with an emotionally-

laden event, such as menarche.

Scope of the Study

The scope of this study is narrow. A total of five

delimitations and two limitations are described below.

Delimitations

This study was delimited in five ways. First, only

9/10-year-old girls and their parents who identified

themselves as native-born African Americans were invited to

participate. Girls with parents born in countries other

than the United States were not included as participants.

Racial-ethnic scholars report that the trend for U.S.

national reports is to label all Black people as African

Americans (Feagin & Feagin, 1996). Black individuals

recently from other countries bring cultural beliefs and

practices that are generally not similar to native-born

African Americans (Billingsley, 1992; Feagin & Feagin,

1996).

The focus of this study was the newly menstruating

9/10-year-old female and her parents. Young girls older or

younger than this age group were not invited to participate.

Data were collected between 2 to 5 days after the 9/10 year

olds' first menstrual flow. Therefore, this study was not

opened to 9- and 10-year-old girls who were 5 days beyond

the completion of menarche and those who had seen one or

more flows after menarche.








31

This study was delimited to one County located in south

central Florida. Data collection in extended qualitative

case studies tend to be costly, time-consuming, and some

extend over a lengthy time period (Marshall & Rossman,

1999). Therefore, the geographical regions for data

collection included one county.

All participants in this study were volunteers.

Participants were also invited to participate based on their

willingness to participate and provide insightful responses

in an in-depth interview session. Thus, a purposeful, or

nonprobability, sample delimits the findings of this study.

Finally, young girls receiving health care for acute or

chronic health or mental health problems were not invited as

participants.

Limitations

Mothers were contacted on a weekly basis to learn if

their daughters had started to menstruate. Girls were in

the study 17 days to 13 months before menarche appeared. It

is probable that this frequent contact encouraged parents,

and the girls, to focus on knowledge and preparation for

menarche when they normally might not have done so.

The openness and richness of the girls' responses to

interview questions may have been limited by their mothers'

presence. The original plan for this study was to interview

the young girl and her mother in separate sessions.

However, when this type of interview session was presented










to potential participants during the feasibility study,

mothers said they would prefer to be present when their

daughters were interviewed.

Overview of the Remaining Four Chapters

Chapter 2 is a description of the theoretical

perspectives and a review of related literature that

addresses the major themes and concerns expressed by the

African American girls and their parents. Chapter 3

discusses the methods and procedures, which include the

research design, sampling procedure, participants'

demographic profiles, data collection, scientific integrity

and rigor, protection of human subjects, and data analysis.

In Chapter 4, "living through private time" is discussed as

the core social psychological theme at menarcheal onset for

9/10-year-old African American girls and their parents.

Interpretations of participants' statements illuminate the

core theme and its three conceptual domains (symbolic

bleeding, regulating sexual behavior, and managing menstrual

flow). Chapter 5 contains a summary and discussion of the

findings. Also, included are recommendations for the

African American family literature, nursing, and future

research. Suggestions for context-specific interventions

that could be developed to address health and mental health

concerns of 9/10-year-old African American girls at menarche

are included; this is an anticipated outcome.














CHAPTER 2
LITERATURE REVIEW

This chapter contains a critical review of the

literature related to the social psychological responses and

practices of early-maturing African American females to the

onset of their first menstrual flow, menarche. The breath

of this research undertaking is exemplified by the varying

subjects areas addressed in this review of pertinent

literature. The review in this chapter is organized into

sections: (1) age of menarcheal onset, (2) cognition in the

Child, (3) educational preparation, (4) responses to

menstruation, and (5) summary.

Age of Menarcheal Onset

Current knowledge of the age at menarche in African

American girls is critical to understanding girls'

behavioral responses toward the menstrual event and the

reactions of their parents (Doswell & Millor, 1993; Herman-

Giddens et al., 1997; Phinney, Jensen, Olsen, & Cundick,

1990). Biophysiological (Guyton & Hill, 1996) and

sociobiological (Belsky, Steinberg, & Draper, 1991) theories

offer explanations about "how" or "why" mediating factors

influence the age at which the first menstrual flow starts.

The topics covered in this section include chronological age

at menarche and biophysiological and sociobiological theses.










Chronological Age at Menarche

Notable authors (Dalton, 1990; Delaney, Lupton, & Toth,

1988; Golub, 1992) have written books focusing exclusively

on menstruation. Their data indicate that the average age

of menarche for girls in the United States is now 12.8

years. What many authors fail to mention is that the

average age of 12.8 years represents the time at menarche,

since 1952, for White American females (Doswell & Millor,

1993; Herman-Giddens et al., 1997; Marshall & Tanner, 1969;

Phinney, Jensen, Olsen, & Cundick, 1990; Wierson, Long &

Forehand, 1993). Apparently, and according to research

data, the age of menarcheal onset for White American girls

have remained stable for at least 45 years. Based on the

limited available data, African American girls, on the other

hand, have seen a decrease in the age of onset for menarche.

Earlier data about the onset of menses in African American

girls are found in MacMahon's (1973) analysis of HANES cycle

II (1963-1965) and cycle III (1966-1970) findings. This

analysis showed that African American girls began to

menstruate at 12.52 years of age, which is still younger

than the 12.8 years seen among White girls.

The American Academy of Pediatrics (AAP) Pediatric

Research in Office Settings (PROS) recently conducted a

national cross-sectional study using 225 clinicians of its

632 members to establish the current prevalence and mean

ages of the onset of pubertal characteristics in young girls










seen in 65 practice settings across the United States

(Herman-Giddens et al., 1997). The impetus for this study

grew out of the reality that no large-scale studies on

sexual maturation were published on racially diverse groups

of girls in the United States younger than 12 years of age.

Importantly, many scholars use the 12.8 years seen among

White females as a norm for menarche onset in all American

girls.

Results of the 1992/1993 data from the PROS' (Herman-

Giddens et al., 1997) study suggest that African American

girls begin menstruating at a younger age than the currently

used national norm of 12.8 years. The PROS investigators

also found many African American females began menarche at

age 8 years while White females did not start until age 9

years. Hence, contrary to earlier formulations, African

American girls obtain physiological maturity more quickly

than their White counterparts (Herman-Giddens et al., 1997)

Other recent reports (Doswell & Millor, 1993; Phinney,

Jensen, Olsen, & Cundick, 1990) show the mean age of

menarcheal onset is earlier than 12.8 years. Rees (1993)

cited the average age of menarche in western, industrial

societies as 12.8 years, with a normal range of between 10

and 14 years. Doswell & Millor (1993) examined a cross-

sectional sample of 75 African American girls ages 9 to 13

years old at well-child clinics in Harlem, New York. These

investigators found that 28 percent of their sample were










menstruating. The reported mean age at menarche was 11.9

years, which is younger than the 12.16 years of age reported

by Herman-Giddens et al. (1997) and the 12.8 norm used to

describe all U.S. girls (Tanner, 1969, 1978, 1981).

Phinney, Jensen, Olsen, and Cundick (1990) used a

sample of 581 African American girls and 1,253 non-African

Americans (Whites and Hispanics) from the data files of

Cycle III National Survey of Family Growth. The subjects in

this study were 15- to 44-year-old females. The most

commonly reported ages at menarche for African Americans

were 12 and 13 years and a mean age of 12.60. The mean age

at menarche for non-African American subjects in this study

was 12.83 years. These investigators also found that

menarche occurred between the ages of 8 to 11 years in 150

of the African American population studied, which

represented 26 percent of their African American sample.

Researchers and health-care providers ask, "Why does

menarche appear at an early age for some girls and a later

age for others?" Biophysiologists provide a hormonal

feedback theory that is mediated by genetics, nutrition, and

health (Guyton & Hill, 1996). Sociobiologists give a

"simulated" Charles Darwin's survival-of-the-fittest

evolutionary theory mediated by environmental stressors to

explain the early age at menarche (Belsky, Steinberg, &

Draper, 1991; Wierson, Long, Forehand, 1993). The next two

subtopics presented in this section describe the










biophysiological and sociobiological theoretical positions

on the early age of menarche.

Biophvsiological Thesis

Menarche is an objective indicator that a female's

menstrual, or sexual, cycle is functional (Golub, 1992). A

female's major menstrual and reproductive organs are the

ovaries, the fallopian tubes, the uterus, and the vagina.

Guyton and Hill (1996) noted that the menstrual cycle is

initiated and controlled by a complex hormone-feedback

system and is comprised of four phases (follicular,

ovulatory, luteal, and menstrual). The hormone-feedback

system involves the central nervous system and is

hierarchial in nature starting with hormones from the

hypothalamus, then the anterior lobe of the pituitary gland,

and finalizing with the ovaries.

The hypothalamus secrets a gonadotropin-releasing

hormonal (GnRH) factor. GnRH causes the secretion of the

luteinizing hormone (LH) and follicle-stimulating hormone

(FSH) from the anterior lobe of the pituitary gland. FSH

stimulates the complete development of a single Graafian

follicle in the ovary for the follicular phase of the

menstrual cycle. This phase extends over the first 14 days

of the cycle. The ovulatory phase is triggered by LH and is

identified by the release of the ovum from the Graafian

follicle which travels down the fallopian tube to the

uterus. During the luteal phase, the corpus luteum develops










in the ovary and secretes progesterone and estrogen

Progesterone helps to further prepare the uterus'

endometrium to receive a fertilized egg. In the absence of

fertilization of the ovum for pregnancy, the corpus luteum

regresses, estrogen and progesterone levels decline, and the

uterus' endometrium begins to slough away, and menstruation

begins. From these characteristics, a phase in the

menstrual cycle, is identified by the condition of the

follicles and ovum. Once the hypothalamus detects low

levels of estrogen in the blood, FSH production from the

anterior lobe of the pituitary gland increases and the

menstrual cycle begins once again.

Guyton and Hill (1996) cited genetics, nutrition, and

health as mediating factors influencing the age of menarche

for developing young girls. Studies of identical twin

sisters growing up together indicated that they reached

menarche about two months apart and fraternal twins differed

by about 12 months. Mother-daughter and sister-sister

correlations were reported by Chern, Gatewood, and Anderson

(1980). Tanner (1978) noted from a genetic view that a

late-maturing girl is as likely to have a late-maturing

father as a late-maturing mother. Fathers, then, can also

exert an equal influence on a girl's growth rate and

menstrual maturation.

Malnutrition retards growth and delays menarche. Young

females who are undernourished do not menstruate as early as








39

those who are not undernourished (Guyton & Hill, 1996). The

drop in age at menarche from 1830 and 1960 for White

American females coincided with the increased availability

of protein in the diet. In those countries where nutrition

remained inadequate during this period, age of menarche is

high. For example, in contrast to the average age of

menarche in the United States, which is cited as 12.8 years

(Tanner, 1978), in Bangladesh it is just under 16 years, and

among certain New Guinea tribes, it is about 18 years

(Menkin, Watkins, & Trussel, 1980).

A young girl's health can impact her menstrual ability

(Golub, 1992; Guyton & Hill, 1996). Menstruation will not

occur in girls with Turner's Syndrome since they are without

ovaries. Menarche can be delayed if a young girl has

ulcerative colitis, regional enteritis, cystic fibrosis,

congenital heart disease, uremia, diabetes mellitus and

other health conditions. Some health conditions can cause

menarche to occur at a later age. These conditions include

hypothyroidism, central nervous system tumors, encephalitis,

and head trauma. Girls who are inactive, mentally retarded,

or bedridden tend to experience menarche at an earlier age

than their counterparts (Golub, 1992).

Sociobioloqical Thesis

Belsky, Steinberg, and Draper (1991) posed the

sociobiological theory from their study of middle-class

White postmenarcheal females. This theory espouses that

children raised in biological-father-absent households do










not develop expectations for enduring heterosexual pair

bonds and marital stability as prerequisites for

childbearing and childrearing. Rather, these children as

adolescents and young adults engage in early-for-age and

opportunitistic sexual intercourse. This chain of events,

according to Belsky et al. (1991), conditional upon low or

nonexistent paternal involvement during early childhood, is

not proposed as a conscious process. Instead, it is a

sociobiological phenomenon, an unconsciously motivated

reproductive strategy adaptive to the environment.

Nevertheless, according to Belsky et al., early menarcheal

onset is a human survival and adaptive response when there

is a scarcity of available males to copulate with females

for reproductive purposes.

Using data from a longitudinal New Zealand study of 16-

year-old White upper-class girls, Moffitt, Caspi, Belsky,

and Silva (1992) noted that family conflict and father

absence in childhood predicted an earlier age of menarche.

A self-report of menarche was taken within 1 to 5 years of

the girls' menarche. There was a mean age of 13 years at

menarche for their sample of 402 girls. Family conflict was

assessed by having the mother and the girl complete the

nine-item Moos Family Relations conflict scale. This scale

measured the degree to which the family was characterized by

conflictual interactions and included items related to

yelling and hitting each others. Presence of the biological










father in the home environment was determined by a self-

report from the mother and the young girl; fathers were

absent prior to age 11 years for the child.

Moffitt et al. (1992) found no significant correlation

between limited family financial resources and early age at

menarche, r(372) = .07. There was a significant correlation

between family conflict at age 7 and menarcheal onset,

r(379) = -.13, p < .01. Also, a significant correlation was

associated with a greater number of years of father absence,

r(143) = -.12, p < .01. However, they found that the best

predictor of menarche was the young girl's weight, r(345) =

-.28, p < .001.

Wierson, Long, and Forehand (1993) used a sample of 71

middle-class White adolescent girls and their mothers to

examine two family stressors, divorce and interparental

conflict, in light of Belsky et al.'s (1991) sociobiological

theory on age at menarche. Forty four girls resided with

both their biological parents in a nuclear family situation,

and 27 lived with their mothers in divorced families. The

age range for this sample of girls was 11 to 18 years.

Interparental conflict was assessed using the 10-item

O'Leary-Porter Scale. This scale included items relative to

arguments over disciplinary actions in the child's presence.

The researchers found that the onset of menarche for girls

from divorced families was six months earlier than for girls

from families in which parents were married.










In summary, empirical data show that when African

American females are used as sample members in studies

dealing with age at menarche, investigators report that the

commonly used 12.8 median age at menarche in the United

States as a norm for all females is not consistent with

their findings for African American females. Data from

recent research findings suggests early menarche has

resulted in an ever-increasing proportion of African

American females attaining reproductive capacity at younger

ages. Hence researchers suggest the physical capacity for

sexual and reproductive activity is earlier in African

American females than in White and Hispanic females

(Doswell, Millor, Thompson, & Braxter, 1998; Herman-Giddens,

1997; Phinney, Jensen, Olsen, & Cundick, 1990).

Cognition in the Child

Piaget and Inhelder (1996) maintained that children

between the ages of 7 and 11 years are in the concrete

operational period of intellectual development and are

unable to think and reason about abstract concepts.

Similarly, Klahr (1982) argued that children are limited in

the amount of information they can remember; the presence of

concrete objects makes problem-solving easier simply because

the objects serve as aids to memory. The specific deficit,

according to Klahr, rests with memory, not with a

qualitatively distinct way of viewing the world.










Information Processing

In the 1960s when Piaget's theory of cognition became

popular, American psychologists begun to view thinking as a

kind of information processing activity (Chi & Koeske,

1983). This view held that an important part of cognition

is the taking in of information and processing it into a

meaningful and useful form, much like the function of a

computer. By making comparisons and adjustments, drawing on

information already stored in memory, the individual learns

about problem-solving and decision-making (Siegler, 1996).

Klahr (1982), a leading figure in the information-processing

approach to human thinking, expressed his dissatisfaction

with Piagetian theory about development by stating:


For 40 years now we have had assimilation and
accommodation, the mysterious and shadowy forces
of equilibration, the "Batman and Robin" of the
developmental processes. What are they? How do
they operate? Why is it after all this time, we
know no more about them than when they first
sprang upon the scene? What we need is a way to
get beyond vague verbal statements of the nature
of the developmental process (p. 80).


Most psychologists who adopt the information-processing

thesis, focus on the ways in which psychological processes

are modified as the result of patterns of input from the

environment (Case, 1992; Massaro & Cowan, 1993). Following

the environmental-learning path, many believe that cognition

is a continuous process in which limitations on cognitive

capacity are gradually overcome, long-term memory capacity










gradually increases, behaviors are routinized, and

strategies are developed to link input more effectively to

output (Klahr & Wallace, 1976; Siegler, 1996).

Storage and Use of Information

The amount of information that young children take in

and their ability to store and manipulate it is limited.

Chi and Klahr (1975) found that 5-year-olds could perceive

no more than three objects flashed simultaneously on a

screen, whereas older adolescents and adults could take in

six or seven objects at a glance. Thus, older children and

adults can work through various steps in complex problems

without losing track of what they are doing, but young

children cannot (Kail, 1990).

Also, older children and adults have generally

accumulated more knowledge than young children, process

information more rapidly, and have more effective strategies

for dealing with problems (Chi & Koeske, 1983; Siegler,

1996). Siegler (1996) and Flavell, Miller, and Miller

(1993) posit that performance improves in the course of

development because of maturation of the brain (Case, 1992;

Fischer & Rose, 1995) and the development of more effective

information-processing routines (Vurpillot, 1968; Zinchenko,

Chzhi-Tsin, & Tarakanov 1963). As a consequence, older

children have more information available in long-term memory

storage that can be swiftly applied to new problems as they

arise. Case, Marini, McKeough, Dennis, and Goldberg (1986)










noted that young children take longer to repeat a number

such as 10 or 2 than older children. They also reported

that older children named individual numbers quickly, which

reduced the time interval between numbers and increased the

likelihood of retaining the numbers in memory.

The ability of older children to repeat digits more

quickly appears to be just one instance of a more general

tendency for older children and adults to carry out

cognitive operations faster than younger aged children. In

comparison with young adults, 4- to 5-year olds generally

responded 300 percent more slowly, 8-year-olds responded 200

percent more slowly, and ll-year-olds took 50 percent more

time to respond to visual cues. As a consequence of this

increase in mental processing speed, older children and

adults can be expected to execute more cognitive operations

in a given time span than younger children. Therefore, they

tend to demonstrate increased intellectual effectiveness

(Kail and Park, 1994).

Educational PreDaration

Early maturing girls need a Knowledge base about

menarche prior to its onset. At the early signs of

impending menarche, young girls can benefit from a mental

store of knowledge upon which to govern their behavioral

responses relative to the menstrual event. On the other

hand, menarche can be a traumatic experience for young girls

who have received little or no information about

menstruation (Amann-Gainotti, 1986).










Limited Educational Preparation

Informational sources about the menarche usually

consist of mother, peer-friend, and other relatives.

Education preparation about menstruation in the public

schools, however, generally does not include young girls in

the third grade or their parents (Swenson, Foster, & Asay,

1995). Many African American females start menstruating

while in the third grade, or by 9/10 years of age (Herman-

Giddens et al., 1997), but information from school health

nurses is minimum to nonexistent for this grade level.

Consequently, these young females may not receive any

education about their impending menarche.

Swenson, Foster, and Asay (1995) found that few

classroom teachers and nurses employed by the public schools

and health departments include educational material about

menstruation at grade four. Also, no school nurse from a

sample of N=39 offered information to students in the third

grade about the developmental event, menarche. Grade five

(82%) was the most frequently reported grade by nurses for

teaching menstrual content. The nurses reported that they

were the persons (85%) who most often taught information in

the schools about menstruation. The content that nurses

provided students in the public schools were related to

menstruation, reproduction, and sexuality.

Important sources of information for pre- and

postmenarcheal girls are mothers and friends, and to a








47

lesser extent other relatives and teachers. Amann-Gainotti

(1986) also found this to be a concern in Italy. On the

whole, the study of 176 randomly selected Italian females,

ages 11 to 14 years, showed fathers were minimally involved

for 2% of the 91 premenarcheal girls and not at all involved

in providing information to 85 postmenarcheal girls. Also,

Amann-Gainotti found that this sample of working-class

families reported that few books or magazines (4% for pre-

and 8% for postmenarcheal girls) on menstruation were used

to obtain information, which could had been partly related

to the subjects' middle to low socioeconomic lifestyle.

Mothers as Teachers about the Menarche

In a study conducted by a nurse, (Dashiff, 1992),

mothers were the primary source of information about

menarche for 23 African American girls who had not started

menstruating. Data were collected through individual

audiotape interviews using open-ended questions with a

sample of 38 fifth-grade African American girls ages 10 to

14 years. This sample of young girls came from three middle

schools in the same district. Friends, older sisters, and

teachers were also mentioned as sources about menstruation.

Girls who learned first from their mothers in private talks

or who received directions from their mothers about the use

of menstrual products and hygiene measures rated the

educational experience as pleasant.










Girls who felt the most educationally prepared,

reported positive feelings about starting menstruation

(Brooks-Gunn & Ruble, 1980; Clark & Ruble, 1978; Hill,

Holmbeck, Marlow, Green, & Lynch, 1985; Kieren, 1992;

McGrory, 1990; Scott, Danette, Panizo, & Roger, 1989).

Scott et al. (1989) reported in their study comparing 67

postmenarcheal African American Girl Scout girls to Brooks-

Gunn & Ruble's (1980) sample of White Girl Scouts that the

less prepared the girls perceived themselves to be, the more

negative feelings they expressed about menarche. Also, they

found a tendency existed for the girls who felt more

prepared to express more positive feelings. Another issue

Scott et al. (1989) addressed was the relationship between

the girls' age at menarche and their feelings of

preparedness. Scott et al. (1989) found that those girls

who experienced menarche early, age younger than 12 years,

felt less prepared than those whose menarche occurred later,

after age 12.

Koff and Rierdan (1995) asked 157 White, middle-to

upper-middle-class 9th-grade girls in a longitudinal study

how they would prepare younger girls for the menarcheal

event, and how they would advise parents to prepare their

daughters. The girls emphasized the need for emotional

support and assurance that menstruation was normal and

healthy. They discussed the practical aspects of menstrual

hygiene and the subjective experience of how one actually










feels; they felt that these feelings should not be kept a

secret from a young girl expecting menarche to arrive soon.

Ninety per cent of the girls talked about menstruation with

their mothers, but few had discussed it with their fathers

and other male sources. Fathers were expected to be

supportive, but silent. A few girls believed fathers should

be excluded completely. Responses from this sample of girls

suggested early preparation should include a shift in focus

from the biology of menstruation to the more personal,

subjective, and immediate aspects of the experience. The

young girls also supported a conceptualization of menstrual

education as a long-term, continuous process, beginning well

before menarche and continuing long after its onset. This

sample of girls also suggested that mothers should keep the

fact that they have started to menstruate a secret.

Responses to Menstruation

The age of young girls at menarche is relevant and can

influence their social psychological behavior, and how

others respond to them. Menarche brings a host of changes

influencing the young girl's physiological, psychological,

social, and familial status. As a physiologic event,

menarche has irrevocable implications for the young girl's

female gender (Lee, 1994). Through menarche, she is

transformed into a sexual being capable of becoming pregnant

(Lee & Sasser-Coen, 1996). The physical changes (increase

in height and weight; redistribution of body fat; bodily










proportions transformation; emergence of secondary sex

characteristics and menarche) associated with puberty

trigger a chain reaction of psychological changes concerning

how the young girl perceives herself (Richards, Boxer,

Petersen, & Albrecht, 1990; Slap, Khalid, Paikoff, Brooks-

Gunn, & Warren, 1994) and how others perceive her (Delaney,

Lupton, & Toth, 1988). The responses to menarche, a normal

developmental event, are presented in this section under

three domains: psychological responses, relationships with

peers, and familial status and relationship.

Psychological Responses

Several theories have been used by investigators over

the years to present psychological responses of females to

the menstrual process. The dominant theory discerned by

Grief and Ulman's (1982) review showed that previous

researchers relied on Freud's psychoanalytical thoughts

about penis-envy and castration to describe females'

behavior at menstruation. Few investigators used Benedict's

(1954) and Mead's (1952) thoughts about the meaning of the

menarcheal event in a particular culture. Grief and Ulman

reported that Stone and Barker (1939) used the

biopsychosocial model about menarche to stress the superior

lifestyle and racial-ethnic qualities of White American

females over other groups of females. From the 1930s to the

1980s, according to Grief and Ulman's review, the

psychological health of non-White females was virtually not

considered from a theoretical position.










By the mid-1980s and the start of the 1990s, a few

investigators (Dashiff, 1992; Doswell & Millor, 1993;

Doswell & Vandestienne, 1996; Du Toit, 1987; Phinney,

Jensen, Olsen, & Cundick, 1990; Scott, Danette, Panizo, &

Roger, 1989; Skandhan, Pandya, Shandhan, & Mehta, 1988)

conducted research studies on menarche with non-White

females. Research scholars sought the feminist perspective

(Lee, 1994), the childhood ecological model (Baumrind, 1993;

Bronfenbrenner, 1997), and the sociobiological model

(Belsky, Steinberg, & Draper, 1991; Moffitt, Caspi, Belsky,

& Silva, 1992; Wierson, Long, & Forehand, 1993) as

theoretical positions on which to present empirical data

about menarche.

Negative responses

A review of the literature done by Grief and Ulman

(1982) from the 1930s to 1981 showed that investigators

reported middle-class White American female responded to

their menarcheal onset with shame, embarrassment, fear,

disgust, nervousness, humiliation, and increased self-

consciousness. Many White females reported menarche was a

nuisance and physically uncomfortable; this lead to a

limitation on many routine childhood play activities and

peer interaction. Grief and Ulman learned from their review

that the parent-child relationship suffered. The mother-

daughter relationship suffered the most with increased

arguments and distance. These authors wrote that some of










the researchers concluded that White females treated

menarcheal onset as a hygienic crisis rather than a

maturational milestone. For many White females, then,

Menarche was viewed as a negative and traumatic experience

that served to lower their self-esteem.

Amann-Gainotti (1986) observed that girls' knowledge

deficit and negative beliefs about menstruation were

reflected in their responses to the question, "Can you tell

me what menstruation is" (p. 705)? For premenarcheal

girls, 42% stated that "menstruation is monthly bleeding"

and 9% gave no response. Few young girls in Amann-

Gainotti's sample had any understanding about the physiology

of menstruation. Here is an example. A 13.2-year-old

postmenarcheal girl stated:


Menstruation is a flow of blood, but I don't know
whether it is an arterial or a venous one.
However, in my opinion, it starts from the heart,
goes around the whole body, and comes directly
into the stomach. When it arrives in the stomach,
the blood knocks violently against the ovaries and
they break, and that's why we lose blood from the
vagina (p. 706).


Amann-Gainotti also noted that girls without educational

preparation voiced menarche as a traumatic experience, which

was further exemplified through such remarks as, "I didn't

know what was happening. I thought I had to die" (p.709).

"I got terribly afraid. I didn't know what to do" (p. 709).

McGrory (1990) noted that embarrassment was most often

the response to the 6-factor Menstrual Attitude










Questionnaire (MAQ) by premenarcheal girls with a mean age

of 13.34 years. Seventy participants in a sample of 95

middle-class White girls from biological-mother-father homes

provided incomplete, or partial, responses for data on the

MAQ. Further, McGrory (1990) noted that 67 of 162 parents

refused to consent to their daughters' participation in the

study. McGrory wrote that parents thought it was "a much

too personal topic" (p. 268). McGrory surmised that the

refusals suggested the sensitive and embarrassing nature of

menstruation as a topic of discussion for many young girls

and their parents.

Topics used by Lee (1994) from a feminist perspective

to describe the menarcheal experience of females with an age

span of 18 to 80 years included contaminating bodies,

alienated bodies, anxious bodies, and bodies and boys.

According to Lee, these titles represent the negative

position females find themselves at the onset of their

menstrual flow in a patriarchal society that devalues women.

A White working-class woman in her thirties responded to

contaminating bodies by stating:

When I first started menstruating (the very first
time) I had experienced incredible stomach pains
the night before. I stayed in bed all night and
was the first one up in the morning. I went to
the bathroom and lo and behold there was blood. I
felt mortified because I knew what had happened.
I felt incredibly ashamed and didn't tell anyone
for a year (I used tissue paper). Now I was like
my mother, a woman who had a bad smelly part of
her. This, for the most part, is also how men see
menstruation, as something filthy belonging to a
woman that makes them mentally unstable (p. 347).








54

For Lee's sample, menarche was something that invaded their

"self," something that happened to them, and the disdain

affiliated with the blood encouraged many women to go to

lengths to hide the evidence of their contamination. Many

of the women reported fears during childhood of showing

proof of wearing pads or staining cloth garnments or bed

sheets. They learned early that they must hide all evidence

of menstruation from boys and men, brothers and fathers.

This, according to Lee (1994) contributed to a self-

consciousness for girls who were used to playing with boys.

One young lady stated, "When I didn't have my period I

didn't mind playing with the guys, but when I did, I was

afraid someone would see me, like something might leak

through" (p. 353).

Results from several studies (Brooks-Gunn & Ruble,

1980; Clark & Ruble, 1978; Hill, Holmbeck, Marlow, Green, &

Lynch, 1985; Koff & Rierdan, 1995; McGrory, 1990) using

middle-class White samples and various measures showed

postmenarcheal girls have more negative attitudes towards

menstruation than premenarcheal girls, and that they

experience more negative emotions than those girls who have

not yet experienced menarcheal onset. These differences

occurred despite educational preparation.

Results from an all African American Girl Scout sample

of 67 postmenarcheal girls with a mean age of 13.5 showed

negative feelings about starting their menstrual flow








55

(Scott, Danette, Panizo, & Roger, 1989). Ten percent of the

girls identified fear, discomfort, and pain as responses on

the Ruble and Brooks-Gunn (1982) questionnaire that was used

with White Girl Scouts from similar biological mother-father

homes and socioeconomic class strata. Twenty-four percent

of Scott et al.'s (1989) sample reported that menarche meant

"nothing" (p. 365).

A cohort longitudinal study done by Caspi and Mofitt

(1991) with an all White middle-class sample of 1,037 girls

tested the early-timing hypotheses of early-maturing girls'

adjustment difficulties in adolescence. The researchers

noted that early maturing girls exhibited adjustment

problems at age 13 years. Additionally, the early onset of

menarche magnified behavioral problems from earlier

childhood.

Positive responses

Grief and Ulman (1982) showed in their literature

review that a few investigators reported positive menarcheal

responses by the White female, which consisted of being

surprised, but happy and proud about the womanly

similarities to their mothers. Proximity of mothers and

daughters grew closer and openness in communication was

enhanced. Young White females, according to Grief and

Ulman's review, with positive experiences to menarche were

previewed about its onset and what to expect.










Amann-Gainotti (1986) noted that forty-one percent of

the postmenarcheal girls reported positive feelings about

their first menstrual flow in that it made them feel more

mature, more adult, and similar to their friends. However,

47% made a negative judgment, and 12% were ambivalent. The

negative responses were related to feelings of annoyance

with the physical discomfort and pain, limitations of

liberty from parents, and feelings of shame in front of boys

and male family members.

Amann-Gainotti (1986) also reported a significant

relationship between girls' positive responses to their

initial menstrual flow and the family's attitudes toward

menstruation (x2 = 32.34, p < .001). Also, there was a

significant relationship between positive responses and

menarcheal education (X2 = 13.04, p < .001).

In a longitudinal study of growth carried out by Jones

and Mussen (1958) with a sample of 34 White middle-class

subjects, 16 girls were labelled early-maturers and 18 were

labelled late-maturers from measurements of their wrists and

hands. In response to menarche, early-maturers indicated a

greater need for recognition. The 18 item Thematic

Apperception Test (TAT) was administered individually to the

girls during their last year in high school. Results from

the TAT permitted Jones and Mussen (1958) to conclude that

because early-maturing girls were out-of-phase with their

peers, they had a tendency to have greater difficulty in










personal-social relations at first. Eventually, early-

maturers' personal-social relations improved in later

adolescent years which put them in step with their peers.

Self-Concept

A young girl's self-concept is comprised of her self-

esteem and self-image (Erikson, 1963; Harter, 1990). Early

menarche may make African American girls vulnerable to low

self-esteem and self-image (Scott, Danette, Panizo, & Roger,

1989). The manner in which an early maturer views her

personal transition and physical body image at menarche may

give rise to her integration of a revised self-image. Fears

of being different or out of developmental synchrony with

same-age peers in this physical aspect may shape the

unfolding of negative body images and a devalued self-hood

(Blos, 1962; Rierdan, Koff, & Stubbs, 1987).

The onset of puberty and menarche may precipitate

changes in self-esteem and self-image, making girls

vulnerable for high-risk behaviors (Caspi & Moffitt, 1991).

This has particularly significant ramifications for many

African American girls because of their documented early age

of puberty and menarche. It has traditionally been asserted

that African-American children and adolescents are more

likely to have low self-esteem because of their membership

in a stigmatized racial group, although many researches who

make this assertion rely on the racial preference findings

rather than measured self-esteem (Cross, 1991; Spencer &










Markstrom-Adams, 1990; Tuck, 1997). Contrary to the

stigmatization viewpoint, other recent research suggests

that African-American children have self-esteem equal to or

higher than that of their White counterparts (Simmons,

Brown, Bush, & Blyth, 1978; Tashakkori & Thompson, 1991).

Tashakkori (1993) found that when compared with White

students, African-American middle school students held more

positive self-beliefs regarding physical appearance and

attractiveness, and reading ability. They, however, have

more negative self-beliefs regarding self-efficacy and

situational control. Regarding gender, the dramatic changes

in physical appearance that indicate pubertal maturation may

have a greater effect on self-esteem in girls because

attractiveness and satisfaction with appearance are more

strongly associated with positive self-appraisal and well-

being in girls than boys (Fox, Page, Armstrong, & Kirby,

1994). Hence, girls may be at greater risk for poor self-

esteem, particularly if their pubertal growth and

development pattern are perceived as out of synchrony with

same-age peers (Amann-Gainotti, 1986; Rierdan & Koff, 1985).

Research literature supports the idea that self-esteem

is fragile, changing, and on the low end during the pubertal

period (Simmons, Rosenberg, & Rosenberg, 1973). Further

research by Simmons, Blyth, VanCleave, and Bush (1979)

showed that early-maturing girls were more likely to have

lower self-esteem compared with on-time maturers. Other










studies observed changes in self-esteem as a function of

time rather than pubertal onset. One such study measured

self-esteem in three racially diverse adolescent age groups:

pre- (8 to 11 years), early (12 to 14 years), and late ( 15

years) adolescence (Simmons, Rosenberg, & Rosenberg, 1973).

The investigators reported that the preadolescent group

demonstrated positive self-esteem. However, 12-year-old

subjects showed significantly lower self-esteem scores,

suggesting perhaps that as children enter early puberty and

adolescence, self-esteem declines.

Body-image in children during puberty across cultural

groups have been less frequently documented. Data from a

larger study examining cardiovascular health in African-

American children suggest racial differences in satisfaction

with body image. Brown, Schreiber, McMahon, Crawford, and

Ghee (1995) found that prepubertal (9/10-year-old) African-

American girls had higher body-image scores and greater

tolerance for higher body mass index than prepubertal White

girls.

Personality Characteristics of Maturing Females

A number of researchers have examined differences in

personality characteristics or behaviors of pre-and post

menarcheal girls to determine the impact of menarche on

personality functioning (Grief & Ulman, 1982). Stone and

Barker (1939) used a sample of 1,000 White American-born

girls of middle and north European stock to compare pre- and










postmenarcheal girls. Questionnaires were administered to

7th 8th, and 9th grade girls. It was noted that the

postmenarcheal girls gave mature responses more frequently

than the premenarcheal girls as determined by Pressey and

the Sullivan tests. The groups differed in items measuring

their responses to personal appearance, heterosexual

interests and attitudes, avoidance of physical exertion,

daydreaming, and home conflicts. Because same-aged girls

differed on the personality and interest measure, Stone and

Barker (1939) concluded that the girls' personality changes

were associated with physiological maturity and were related

to their changes in attitudes and interests. As expressed

by Stone and Barker, "the results of this study are not to

be generalized to other racial groups, because of

differences in biological makeup and in cultural practices"

(p. 28).

Rierdan and Koff (1980) investigated the impact of

menarche on body image and psychological functioning. The

authors administered the Draw-a-Person test and a

questionnaire regarding developmental changes to a sample of

94 seventh and eighth grade girls. The drawings were

analyzed and scored according to Haworth and Normington's

four-level Sexual Differentiation Scale, and the Saarni and

Azara's criteria for aggression-hostility and insecurity-

lability. Results showed no difference in the girl's

anxiety before and after menarche.










Familial Status

The onset of puberty and menarche can cause dramatic

and turbulent changes within the family structure. Some

researchers suggested that menarche triggers a re-definition

in family relationships that influences both the emotional

communications and behavioral patterns of the family

(Holmbeck & Hill, 1991; Rich, 1990). One reason why the

onset of puberty and menarche cause such turmoil is because

developmental changes are the matrix from which the ultimate

separation-individuation from the family emerges

(Bronfenbrenner, 1997).

Menarche brings with it a host of implications that

have a serious impact on the family. Parents must now

recognize their daughter's burgeoning sexuality. With

menstruation comes the possibility that the girl will act in

a sexual manner. Thus, for the first time, then, the young

girl is vulnerable to AIDS, sexually transmitted diseases,

and pregnancy (DuRant & Seymour, 1990; Doswell, Millor,

Thompson, & Braxter, 1998).

Holmbeck and Hill (1991) investigated the influence of

the young girl's menarcheal status on the emotional

relationships within the family. These researchers found

that interactions imbued with conflict and assertiveness

between the child and her parents are most pronounced at

menarche, especially between the child and her mother.

Mothers and daughters became increasingly argumentative










about limitations and restrictions placed on the newly

menstruating young girls. These findings were similar to

the data from a study carried out by Papini and Sebby

(1987), which found that relations between mother and the

young girl deteriorated as the mother perceived that she

lost control over the early maturer.

Menarche to Sex and Pregnancy

Children are sexual beings (Goldman & Goldman, 1988)

and sexual curiosity rise markedly with the onset of

menarche (Rutler, 1997). Early menarche may contribute to

the early initiation of sexual behaviors, putting the early

maturer at risk for pregnancy and sexually transmitted

diseases. Around menarcheal, then, girls are likely to

become much more sexually active, both because of the

symbolic significance of secondary sexual characteristics

(breast development etc.), and a hormonally driven interest

in fuller sexual relationships.

Menarche is a symbolically significant time in many

societies when girls are ritually separated from the company

of boys (Delaney, Lupton, & Toth, 1988). But in modern

societies such segregation rarely takes place, and sexual

relationships between young adolescents (within the context

of a private peer culture, quite separate from the world of

adult control) are common (Blos, 1962).

Vinovskis (1988) reported data from the 1983 National

Longitudinal Survey of Youth (NLSY) that showed 59.4% of










African American female adolescents were sexually active

prior to marriage by age 18 years compared with 41.6% of

White females. The data also showed that unmarried young

African American females from poorer socioeconomic

backgrounds with uneducated mothers were more likely to be

sexually active than those from middle- or upper-class

homes.

DuRant and Seymour (1990) studied sexual behaviors in

Hispanic females in the United States. A range in onset of

menarche of 9.1 years to 14.2 years was recorded. The

earlier the age at sexual maturity, the more likely it was

that a young girl would engage in regular intercourse by age

14. At that age, 80% of urban girls with onset of menarche

before age 12 had engaged in sexual intercourse. Somewhat

similar findings came from Leite, Everardo, Buoncompagno,

Leite, Battistori (1994) who surveyed college Brazilian

middle-class females. This survey showed that 28% of the

females had achieved sexual intercourse by age 16. Further,

they reported that 9% Nine per cent had experienced menarche

at age 10 or younger, and 58% by age 12. Research reports

suggest that earlier menarche is linked to a young age at

commencement of sexual intercourse.

Children in all cultures take pleasure in fondling and

masturbating themselves from an early age (Kinsey, Pomeroy,

Martin, & Gebhard, 1953; Langfeldt, 1981). These activities

do not decline in what Freud termed the 'latency' period










(ages 7 to 11) but continue with increasing frequency

throughout childhood. It is atypical for children to engage

in oral exploration of a friend's genitals (Friedrich,

Gramsch, Broughton, Kuiper, & Beilker, 1991). But, about

10% of children attempt or achieve some form of heterosexual

coitus by the age of 12 (Masters, Johnson, & Kolodney,

1992), while a smaller number engage in repeated sexual

contacts with a child of the same sex.

Prendergast (1993) reported that it is quite common in

America for White children 10 and 11-year-olds to begin

dating and to become sexually experienced with intercourse.

A comparison of surveys of American teenagers from 1981 to

1990 indicates that rates of sexual activity in early

adolescence, including the frequencies of intercourse, and

the number of different partners involved, have increased

slightly with about seven per cent of children now having

had their first experience of completed sexual intercourse

by age 13 (Miller, Christopherson, & King, 1993).

In Barone's (1995) American survey of 119 inner-city

6th and 7th graders (average 12.4 years) 19% of girls had

engaged in high-risk sex, which was defined as intercourse

without the use of condoms. In another American study,

Farrell, Danish, and Howard (1992) reported sexual

intercourse rates of 35% in girls by age 14. In a survey

done by Orr, Breiter, and Ingersol (1991) with 1,750

students attending schools in stable, working class urban










areas in America, 37% of 13-year-old girls had achieved

intercourse at least once, with 4% having intercourse at

least weekly.

American research (Elliott & Morse, 1989; Farrell,

Danish, & Howard, 1992; Barone, 1995) suggests that deviant

behaviors and poor school work precede sexual activities

with peers up to age 13. In other words, precocious sexual

activity can be part of a general sub-culture of rejecting

mainstream values, and seems to form part of a drop-out,

hedonistic counter-culture. It should be noted, however,

that the Calgary study completed by Meikle, Peitchinis, and

Pearce (1984) did not confirm this finding. Promiscuous 13-

year-olds in that study did not come from disadvantaged

backgrounds.

Peer Relationships

The average age of 12.16 years at menarche for the

African-American female is a developmental epoch during

which peer relations begin to assume prominence over the

young girl's status in the family (Koff, Rierdan, &

Jacobson, 1981). This is a time when many girls have best

friends and begin to assimilate into a regular group of

peers. Many put a high value on the opinions of their

friends, and it is argued that those who value their

friends' opinions more than their parents' are more sexually

active (Newcomer, Udry, & Cameron, 1983). As such, it is

appropriate to ask whether the menarche influences peer










relationships. In addition, since the menarche is

associated with changes in the girl's physical appearance

and body-image perception, it is worth-while asking how the

event enables the girl to further assimilate with peers.

A major dilemma for the postmenarcheal girl concerns

whether or not to tell one's best friend about the onset of

menstruation. Investigators' survey showed more pre- as

opposed to postmenarcheal girls expected to tell their close

friends about the beginning of their period (Koff, Rierdan &

Jacobson, 1981). The responses of many of the girls in the

survey revealed heightened self-consciousness close to

anguish. These girls seemed obsessed about whether or not

others at school knew of their changed status. One of the

girls in the survey wondered if everyone would still like

her when her secret was discovered. These findings are

consistent with earlier patterns reported by Whisnant and

Zegans (1975) in which premenarcheal girls seemed more

excited and enthusiastic about the prospect of menstruation.

Postmenarcheal girls, however, were cautious and anxious

about embarrassment and about the opinions of others

concerning their menstrual status. The theme of secrecy is

prominent with postmenarcheal girls, who confessed a desire

to conceal and hide their menarche as if it were an event

that triggered shame.

Newcomer, Udry, and Cameron (1983) used a questionnaire

to examine the association between peer popularity and










sexual behavior in a sample of 1405 White and African

Americans from several junior high schools in a Southern

urban area. Sample members were 11 to 17 years old with an

average age of 13.6. White females comprised 38% of the

sample and 13% were African American females. The results

showed that those White girls who were most popular with

boys reported the most sexual experience. African American

females, however, showed the opposite. That is, African

American females' popularity with their opposite-peer-sex

was not associated with more intercourse or with more sexual

experience. Further, unlike White girls, African American

girls who were most popular with same-sex-peers were less

sexually experienced than those girls who had just one

friend.

Summary

A review of the literature and related theories about

menarche were presented in this chapter. The topics

included age of menarcheal onset, cognition in the child,

educational preparation, and responses to menarche. The

next chapter discusses the methods and procedures used to

conduct the study.














CHAPTER 3
METHODS AND PROCEDURES

This chapter presents a review of the methods and

procedures used in the study. The components of this

chapter include a description of the (1) research design,

(2) sample, (3) scientific integrity and rigor, (4)

protection of human subjects, (5) data collection, (6) data

analysis and verification, and (7) summary.

Research Design

The qualitative case study approach was the primary

methodological research design used to recruit research

participants and to collect, analyze, and present the data.

This is a naturalistic design that is emergent, recursive,

and useful for illuminating basic social and psychological

processes (Burawoy et al., 1991; Morse, 1992) essential to

inductively (re)constructing theory (Yin, 1994). The

naturalistic design is also referred to as the qualitative

method (Marshall & Rossman, 1999). A distinct feature of

this design is that the researcher has no intent to

introduce interventions. Its aim is to describe events as

they occur, naturally.

Case study research under the qualitative paradigm is a

detailed examination of one setting, or one single subject,

or one single depository of documents, or one particular

68










event (Bogden & Biklen, 1982; Yin, 1994). It is the

preferred research method for answering "how" or "why"

questions, or for examining events over which the

investigator has little or no control. It is also used for

focusing on a contemporary phenomenon within some real-life

context. The qualitative case study design is driven by the

belief that reality is complex, constructed, and ultimately

subjective (Burawoy et al., 1991; Duffy, 1987; Leininger,

1985). As a result, the case study approach allows an

investigator to retain the holistic and meaningful qualities

of real-life events. Thus, menarche was the one particular

event on which data were collected from 30 African American

females to answer "how" or "why" questions regarding their

menarcheal experiences.

Sandelowski, Davis, and Harris (1989) noted the case

study design is selected when there is an apparent knowledge

deficit about a phenomenon because of perceived biases or

omissions concerning what is known. Previously, several

researchers omitted 9/10-year-old African American females

from empirical studies concerning menarche (Belsky,

Steinberg, & Draper, 1991; Grief & Ulman, 1982; Jones &

Mussen, 1958; McGrory, 1990; Moffitt, Caspi, Belsky, &

Silva, 1992; Moore, 1995; Stone & Barker, 1939). A few

contemporary researchers have made efforts to address this

knowledge deficit about the menarcheal experiences of

African American females (Dashiff, 1992; Lee, 1994; Scott,










Danette, Panizo, & Roger, 1989) and other non-White girls

(Du Toit, 1987). Further, the qualitative case study

approach has never been used as the primary method of data

collection with 9/10-year-old African American females at

the time of their menarche to answer the "how" or "why"

questions about their social and psychological responses.

Lastly, many research scholars commonly confuse

qualitative case studies with ethnographies (Fetterman,

1989) or with participant-observation studies (Jorgensen,

1989). The word ethnography is derived from the Greek word

ethno, which means portrait of people; thus, ethnography is

the study of a cultural scene, group, or setting (Burns &

Groves, 1997). The purpose is to describe a folkway and

mores through examining various cultural characteristics

(Burns & Groves, 1997). Generally, ethnographies command

that investigators spend considerable time in the "field"

while recording observational evidence (Burawoy et al.,

1991).

Participant-observation also commands a hefty

contribution of "field" efforts, but the investigator acts

as a participant while observing and recording data. On the

other hand, the case study approach does not depend solely

on ethnographic or participant-observer data. Depending on

the topic, a valid and quality case study could be done

through a telephone interview or the theoretical examination

of a research instrument. These approaches are not possible










with ethnographic or participant-observer qualitative

studies (Yin, 1994).

Sample

The population for this study included a sample of 30

African American females in a rural Southern community in

central Florida. Purposive sampling permitted the

investigator to locate participants who were able to

communicate in a "focused conversation" about their

experiences to menarcheal onset. The demographics of the

final sample of participants are indicated in Table 3-2.

But before the recruitment of final participants, a

feasibility study was conducted.

Feasibility Study

A feasibility study was done from July to September,

1996 to learn if an adequate number of qualifiable

participants would be available. This study revealed that

57 of 83 mother-daughter dyads in the selected community met

the research inclusion criteria. Of the 57 mother-daughter

dyads that met the criteria, only one individual verbalized

her disinterest in the study. She was not included in the

sample. McGrory (1990) found 67 of 162 mother-daughters

refused (42%) to participate in a questionnaire survey about

menarche in the early adolescent.

It was originally intended that the fathers of the

young girls would also be participants in the study.

However, all fathers rejected the investigator's invitation










during this feasibility study. One father stated, "Don't

talk about that stuff around me." Most fathers acknowledged

the conversation was "woman's talk" and quietly excused

themselves. Other researchers also found it difficult to

gain fathers' participation in a "focused conversation"

about menstruation as a research topic (Amann-Gainotti,

1986; Moffitt, Caspi, Belsky, & Silva, 1992). Usually

mothers are the first to know from their daughters that they

have started to menstruate and seldom do fathers learn

first-hand from young girls about their menstrual onset

(Holmbeck & Hill, 1991; Notman, 1992). Nevertheless, the

feasibility study for the availability of an adequate sample

size determined that this Southern rural central Florida

community was an appropriate site to conduct this

naturalistic study.

Family Types

Family types in the feasibility sample resembled the

diversified models of families found in present day United

States (Berardo, 1991; Billingsley, 1992; Willie, 1985). A

heterogeneity of socioeconomic classes, family-member

compositions, and marital statuses for this sample are

contained in Table 3-1. Thirty (54%) of the 56 females

lived in a nuclear or traditional family structure with both

biological parents. There were 9 (16%) females living in

the adopted family design. Two females were legally adopted

by their maternal grandparents, one by her paternal










grandparents, one by her maternal aunt, and five by non-

relatives. The single-parent female-headed household family

pattern belonged to 13 (20%) females. Only 4 (7%) of the

females lived in an unofficial foster family structure.

This type of foster family group consisted of fictive kins,

which are individuals who have no blood ties to the female

but are viewed by the child as being close relatives

(Kornblum, 1997). Of this foster family type, one female

lived with her mother's protestant pastor and his wife,

another lived with her mother's friend, and two of the

females were "taken in" by families in their neighborhoods

and were living with them for 3 or more years.

Socioeconomic Status (SES)

Socioeconomical status of American families are

determined by the education and occupation of the head of

the family and the family's total yearly income

(Hollingshead, 1949, 1957; Gilbert & Kahl, 1993). The SES

for the 56 families in this feasibility study consisted of 4

(7%) at the upper-middle class strata, 13 (20%) with a

middle class lifestyle, 22 (39%) in the working class, and

17 (30%) at the working poor level.

All 4 families at the upper middle class strata were

nuclear. Parents in this group were professionals with

college degrees and a combined yearly income over $90,000.

Middle class families were 4 nuclear, 5 adopted, 1 single-

parent, and 3 foster. The middle class families had a










yearly income of at least $40,000, and they worked in lower

management and semiprofessional positions. The yearly

income of families in the working group was about $25,000 to

$30,000 for clerical and low-paid sales/craft work. There

were 1 foster, 7 nuclear, 4 adoptive, and 10 single-parent

families in the working class group. Fifteen (50%) of the

nuclear families were working poor in service and low-paid

clerical jobs with a yearly income below $20,000. Also,

there were 2 single-parent female-headed families at the

working poor stratification level.


Table 3-1


Profile of Feasibility Sample's Types
of Families and Socioeconomic Classes


S.E.S. NUCLEAR ADOPTIVE SINGLE FOSTER TOTAL


UPPER 4 0 0 0 4


MIDDLE 4 5 1 3 13


WORKING 7 4 10 1 22


POOR 15 0 2 0 17


TOTAL 30 9 13 4 56










Sampling Procedures

After this research study was approved by the Committee

for the Protection of Human Subjects at the University of

Florida on April, 1997, the researcher began its

implementation. Sampling procedures in this research were

conducted in 3 phases.

Phase 1. In phase 1, the community's County School

Board was contacted for a copy of the "Directory of

Information" (See Appendix A). This directory was used to

secure the names and addresses of 9- and 10-year-old African

American females. Assistance from the elementary school

counselors was obtained in identifying females who were

members of the African American racial-ethnic group, which

was necessary because demographic data about race and

ethnicity were not included in the school's Directory of

Information.

Phase 2. At phase 2, the investigator made every

attempt to contact the mothers of young girls by telephone

to inform them of the study and to set up an appointment

with them to discuss its purposes in greater detail. In

situations where the mothers did not have telephones, the

investigator visited the homes of potential participants.

The investigator presented the purpose of the research and

discussed its components with the mothers. These discussion

ranged from 30 minutes to 2 hours. Importantly, the nature

of the study, its purpose, the interview session, the









76

recording of information, and data storage and analysis were

explicated. Both the young girl and her mother participated

in these discussions about the study. After the mother and

daughter had agreed to participate, and signed the consent

and assent forms, the researcher presented the Demographic

Data Form (Appendix B) that was completed by the mother-

daughter as requested. Only 22 of the 56 mother-daughter

dyads from the feasibility study proceeded to this phase of

the study.

Attrition of participants occurred, because several of

the girls were in Tanner's (1978) fourth stage of puberty

development and had started menstruating before UFIRB was

secured in April, 1997. Potential early maturing

participants from the feasibility study were also lost due

to their families moving from the area. Lastly, some of the

girls had birthdays that placed them out of the age period

for this study.

To continue as potential participants, 9- and 10-year-

old African American females must have had been in Tanner's

(1978) puberty stage 3, 4 or 5. Tanner's stages of puberty

are generally viewed as predictive of menarche readiness and

are based on physiologic changes, such as growth of pubic

hair and breast development. In most healthy girls,

menarche follows 6 to 12 months after the height spurt and

after breasts and pubic hair have developed to Tanner's

fourth stage. With the aid of pictures of genital hair










growth, the appearance and amount of hair in a female's

genital region was determined by self-report and validated

by the mother.

The criteria for inclusion of the 9/10-year-old female

participant were: (1) Signs of first menstruation

readiness, such as protruding or bulging breasts and an

ample amount of pubertal hair development in the genital and

armpit regions; (2) a consistent mother figure or female

guardian for at least six months and one who was willing to

participate in the study; and (3) the absence of a self-

reported known or diagnosed health disorder that might have

contributed to the delay or early onset of menstruation.

Snowball sampling, a chain-referral, was used by asking

Young girls and their mothers to provide the investigator

with names of their friends, schoolmates, or other relatives

who might qualify for inclusion in the study (Biernacki &

Waldorf, 1981; Feagin, 1992; Lee & Sasser-Coen, 1996).

Phase 3. Phase 3 was the final stage of the sampling

procedure. Potential participants were contacted by phone

or in person at their homes on a weekly basis to learn of

the young girl's menarcheal status. Also, potential

participants were encouraged to call the investigator at the

onset of the young girl's menarche. Participant recruitment

ceased when a total of 30 interviews were completed and a

core social psychological theme (living through private

time) was discovered. The information gathered from the










participants reached redundancy and saturation of the

conceptual domains (symbolic bleeding, regualting sexual

behaviors, and managing menstrual flow) once a core theme

evolved.

Sample size. The study consisted of 30 participants

(15 mothers and 15 daughters). Quantitative approaches

often require the use of a large sample size for statistical

purposes (Yin, 1994). Qualitative research, on the other

hand, employs sample sizes that are small and may range from

a single subject case study to fewer than 30 participants

(Marshall & Rossman, 1999; Strauss & Corbin, 1990).

Several nurses reported the use of fewer than 30

participants in qualitative research reports. In Iceland,

Sveinbjarnardottir and de Casterle (1997) used "a sample of

9 families, 18 family members that is, 2 members in each

family" (p. 47) to study the qualitative experiences of

family members of the seriously mentally ill. Lee (1994)

used a feminist approach in interviewing 28 postmenarcheal

women of 18 to 80 years old while exploring meanings they

attributed to menarche. Through the use of the Heideggerian

phenomenological approach, Rather's (1992) sample of 15

registered nurses completing their baccalaureate degrees

described their education experiences. Wilkinson & Pierce

(1997) used a sample of 8 depressed 55/75-year-old women to

examine aloneness through face-to-face interviews. A

qualitative dissertation at the University of Florida's










College of Nursing (UFCN) completed by Nwoga (1997)

consisted of "8 mother-daughter dyads formed out of 11

mothers and 9 adolescent daughters" (p. 96). Other UFCN's

qualitative dissertations were also implemented with small

sample sizes (Devers, 1994; Martin, 1995). Based on the

traditional and contemporary use of the qualitative study

design, and the purposes of this research, it was determined

that 30 research participants were adequate (Burns & Groves,

1997; Marshall & Rossman, 1999; Yin, 1994).

Demographic Information

A profile of the final sample of African American girls

and their parents are provided in seven Tables. Fifteen

young girls and their mothers (15) comprised the study's

final sample of 30 participants. Fathers' demographic data

and responses were obtained from the young girls and their

mothers. A four-digit identification (ID) number is used to

identify a participant. ID numbers in Tables 3-2, 3-3, and

3-4 are the same. This ID numbering system enables a reader

to identify a young girl in Table 3-2 and relate those data

with her parents' data in Table 3-3 and her family type in

Table 3-4. Table 3-5 provides a profile of the young girls'

family types and socioeconomic grouping according to

Hollingshead's Index (1949, 1957). Gilbert and Kahl (1993)

also use Hollingshead's Index to describe present day

America's class structure.










Table 3-6 presents a comparison profile of biological

fathers' presence and absence in the home to the family's

socioeconomic classification. Frequencies and percentages

of the young girls' Tanner's stage of pubertal development

and their family types are presented in Table 3-7. A

summary of the demographic variables are provided in Table

3-8 and includes the mean, standard deviation, minimum, and

maximum. The summary, frequencies, and percentages were

done with the Statistical Analysis Series, Windows, 6.12

(See Appendix D).

Early maturing girls

Table 3-2 presents a profile of the 15 African American

female participants who are ages 9 and 10 years old. Four

of the young girls experienced menarche by age 9 years. In

most healthy girls, menarche follows 6 to 12 months after

the height spurt and breasts and pubic hair have developed

to Tanner's fourth stage (Tanner, 1978). Eleven (73%) girls

reported puberty development was at Tanner's stage four on

entry into the study; they were in the study from 2 to 12

months. The length of time young girls were in the study

for menarcheal appearance ranged from 17 days to 13 months.

One (7%) girl, age 10 years, at Tanner's stage 5 with a

height of 65 inches and a weight of 110 pounds had the

shortest stay in the study which was 17 days. Table 3-7

shows that 7.2 months was the average length of stay in the

study among the sample of young girls. The young girls'










averaged an height of 60 inches and a weight of 97 pounds.

Three (75%) of the four girls who were 9 years old at

menarche lived in nuclear families with their biological

mothers and fathers.

Mothers and fathers

Demographic data about the mothers and fathers of the

young girls are listed in Table 3-3. The mothers ranged in

age 26 to 55 years. The age range for fathers was 29 to 59

years. Most mothers (93%) completed the first 12 years of

education and earned a high school diploma. One of the

mothers had an earned master's degree and one year of

doctoral education. Two mothers achieved 2 to 3 years of

college education beyond the high school level. Ten (67%)

of the fathers had high school diplomas and two completed

their baccalaureate degrees at four-year universities.

Table 3-7 lists mothers with a mean age of 38.4 years and a

mean education of 12.7 years. The mean age for fathers in

Table 3-7 is 44.5 years and their mean education is 11.7

years. The yearly household income for this sample of

participants ranged from as little as $4,000 to as much as

$107,000. The sample's average household income is

presented in Table 3-7 as $39,800.

Family characteristics

A profile of the young girls' families is contained in

Tables 3-4, 3-5, 3-6 and 3-7. Nine (60%) of the young girls

(See Tables 3-4 and 3-7) lived with both of their biological










parents in nuclear families. One (7%) of the nuclear

families, biological parents and two children, was at

Hollingshead's socioeconomic level for the upper-middle

class. Of the remaining nuclear families, 4 (27%) had

middle-class incomes, 3 (20%) had incomes at the working-

poor status, and 1 (7%) was at the poor income

stratification. The number of individuals living in a

nuclear family household ranged from 4 to 6 members.

Families in Table 3-4 with absent-biological-fathers in

the home environment were of various types. Two (13%) young

girls lived with their maternal grandparents as adopted

children at the middle-class income level. There were 3

(20%) mothers who lived as single-parent families, 2 lived

on what Hollingshead considered poor incomes and 1 was at

the working-poor income level. Both of the poor income,

single-parent families, lived in households with

multigenerational family members, one with 12 members and

the other with 9 other dwellers. The third single-parent

lived with her male-friend as a cohabitation family on a

working-poor income. One foster-care family with four

household members lived on a working-poor income.

Scientific Integrity and Rigor

Empirical reports must respond to canons of quality

(Burns, 1989; Yin, 1994). For many research scholars, the

qualitative case study is a less desirable form of inquiry











Table 3-2

DemoaraDhic Profile of the Youna Girls Indicating ID Number,
Age. Tanner's Stage. Time in Study, and Height and Weight


ID Age Tanner's Time in Height Weight
Number Stage Study (Inches) (Pounds)


9533

2750

7784

5569

0201

6837

4520

9156

1057

1776

1844

6289

5483

1000

1234


2 mos.

7 mos.

5 mos.

11 mos.

12 mos.

2 mos.

3 mos.

7 mos.

7 mos.

13 mos.

17 days

12 mos.

8 mos.

9 mos.

10 mos.


71

88

108

84

107

78

130

81

83

102

110

98

101

129

86











Table 3-3

Demographic Profile of the Parents Including ID Number,
Mother's Age. Father's Age. Mother's Education, Father's
Education and Household Income


ID Mother's Father's Mother's Father's Household
Number Age Age Education Education Income


9533 40 39 18 16 $107,000

2750 35 49 15 16 65,000

7784 33 34 12 12 45,000

5569 33 38 14 12 52,000

0201 38 40 12 12 55,000

6837 29 34 12 10 25,000

4520 42 54 12 04 27,000

9156 35 39 12 12 30,000

1057 45 47 12 12 22,000

1776# 55 58 11 12 42,000

1844# 55 55 12 12 47,000

6289* 27 34 12 12 4,000

5483* 26 29 12 12 15,000

1000+ 37 58 12 10 35,000

12340 46 59 12 12 26,000

Code:
#: Legally adopted by maternal grandparents. Data represent maternal
grandparents' profiles.

*: Multigeneration of family members living in same household. Data
represent ages and grade levels of biological fathers who are not living
with the mothers and girls. SES is based on mother's income.

+: Cohabitational family; mother living with male-friend. Data represent
age and grade level of mother's male friend.

0: Foster-care family; data represent foster parents.










Table 3-4

Profile of the Young Girls' Families Including Family Type,
Socioeconomic Status, and Number in Household


ID Family Socioeconomic Number in
Number Type Status Household


9533 Nuclear Upper 4

2750 Nuclear Middle 4

7784 Nuclear Middle 6

5569 Nuclear Middle 4

0201 Nuclear Middle 5

6837 Nuclear Working-Poor 6

4520 Nuclear Working-Poor 4

9156 Nuclear Working-Poor 6

1057 Nuclear Poor 5

1776-ABF Adopted# Middle 3

1844-ABF Adopted# Middle 7

6289-ABF Single* Poor 12

5483-ABF Single* Poor 9

1000-ABF Single+ Working-Poor 3

1234-ABF FosterO Working-Poor 4

Code:
#: Legally adopted by maternal grandparents.
*: Multigeneration of family members living in household. SES is
based on mother's income.

+: Cohabitational family; mother living with male-friend.

0: Foster-care family.

ABF: Absent-biological-father.










Table 3-5


Profile of Family Types and Socioeconomic Classes According
to Hollinqshead's Index (Gilbert & Kahl, 1993)


S.E.S. NUCLEAR ADOPTIVE SINGLE FOSTER TOTAL


UPPER 1 0 0 0 1
MIDDLE 4 2 0 0 6
WORKING 3 0 1 1 5
POOR 1 0 2 0 3
TOTAL 9 2 3 1 15


Table 3-6

Profile of Biological Father's Presence and Absence


in the Home and Socioeconomic Class Stratification


SOCIOECONOMIC BIOLOGICAL FATHERS BIOLOGICAL FATHERS
CLASS PRESENT ABSENT
(Nuclear Families) (Non-Nuclear Families)
UPPER 1 (7%) 0 (0%)
MIDDLE 4 (27%) 2 (13%)
WORKING 3 (20%) 2 (13%)

POOR 1 (7%) 2 (13%)
TOTAL 9 (61%) 6 (39%)










Table 3-7

Frequency and Percent of Variables Tanner's Stage.
Family Type, and Socioeconomic Status (SES)



Variables Frequency Percent


Tanner's Stage

3 3 20.0

4 11 73.3

5 1 6.7



Family Type

Adopted 2 13.3

Foster 1 6.7

Nuclear 9 60.0

Single 3 20.0


Socioeconomic
Status (SES)

Upper 1 6.7

Middle 6 40.0

Working-Poor 5 33.3

Poor 3 20.0











Table 3-8

Summary Measures of the Demographic Variables


Variable Mean Standard Minimum Maximum
Deviation



Age 9.7 0.46 9.00 10.00


Time in
Study 7.23 3.97 1.00 13.00


Height
(Inches) 60.00 2.60 56.00 65.00


Weight
(Pounds) 97.10 17.74 71.00 130.00


Mother's
Age 38.40 8.96 26.00 55.00


Father's
Age 44.50 10.34 29.00 59.00


Mother's
Education 12.70 1.76 11.00 18.00


Father's
Education 11.70 2.71 4.00 16.00


Yearly
Income $39,800 $24,671 $4,000 $107,000


Number in
Household 5.5 2.42 3.00 12.00










than experimental and correlational quantitative studies

(Lincoln & Guba, 1985; Yin, 1994). A group of five

prominent statisticians at Harvard University stated:


most people feel that they can prepare a case
study, and nearly all of us believe we can
understand one. Since neither view is well
founded, the case study receives a good deal of
approbation it does not deserve (Hoaglin, Light,
McPeek, Mosteller, & Stoto, 1982, p. 134).


Most researchers recognize the politics of knowledge, or the

ways certain knowledge is privileged and gains credence,

thereby marginalizing other forms or sources of knowledge.

Nevertheless, Lincoln and Guba (1985) point out that

qualitative researchers must establish the "truth value" (p.

290) of the study, its applicability, consistency, and

neutrality, which are terms matching the positivistic

paradigm's internal validity, external validity,

reliability, and objectivity. To assure rigor, Yin (1994)

agrees that case study investigators must maximize these

four aspects of a research design.

Several measures to ensure the overall integrity and

rigor of the study were employed, and they included:

(1) Triangulation of types of information (attitudes

and perceptions, symptoms and mood, and behaviors) and data

collection that involved (face-to-face interviews with the

9/10-year olds and their mothers).

(2) Continuous validation with the mother-daughter dyad

and members of the dissertation supervisory committee