Improved estimates of the benefits of breastfeeding using sibling comparisons to reduce selection bias
Open accessAbstract
OBJECTIVE: Better measurement of the health and cognitive benefits of breastfeeding by using sibling comparisons to reduce sample selection bias. DATA: We use data on the breastfeeding history, physical and emotional health, academic performance, cognitive ability, and demographic characteristics of 16,903 adolescents from the first (1994) wave of the National Longitudinal Study of Adolescent Health. The sample includes 2,734 sibling pairs. STUDY DESIGN: We examine the relationship between breastfeeding history and 15 indicators of physical health, emotional health, and cognitive ability, using ordinary least squares and logit regression. For each indicator, we estimate, in addition to the usual between-family model, a within-family model to see whether differences in siblings' outcomes are associated with differences in the siblings' breastfeeding histories. PRINCIPAL FINDINGS: Nearly all of the correlations found in the between-family model become statistically insignificant in the within-family model. The notable exception is a persistent positive correlation between breastfeeding and cognitive ability. These findings hold whether breastfeeding is measured in terms of duration or as a Yes/No variable. CONCLUSIONS: This study provides persuasive evidence of a causal connection between breastfeeding and intelligence. However, it also suggests that nonexperimental studies of breastfeeding overstate some of its other long-term benefits, even if controls are included for race, ethnicity, income, and education.
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The within-sibship analyses in both studies were imprecisely estimated and not reliably different from the results of analyses between unrelated individuals.
“though the within-sibship analyses in both studies were imprecisely estimated and not reliably different from the results of analyses between unrelated individuals.62–64”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
The largest of the two within-sibship comparisons suggested that any associations observed between unrelated individuals were explained by shared familial confounding.
“The largest62,63 of the two within-sibship comparisons suggested that any associations observed between unrelated individuals were explained by shared familial confounding”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
Three studies were identified which examined associations of being breastfed with BMI.
“Three studies were identified which examined associations of being breastfed with BMI.”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
The study that focused on mean BMI included 2734 sib-pairs aged 12-18.
“we present results from the study that focused on mean BMI (2734 sib-pairs; ages 12–18).62”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
Two of the identified studies used the same data from the US National Longitudinal Study of Adolescent Health (Add Health) and had similar results.
“Two of these used the same data from the US National Longitudinal Study of Adolescent Health (Add Health) and had similar results;62,63”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
Neither within-sibship study had adequate statistical power to detect a difference between the effect estimates from the within-sibship analyses and that of unrelated participants in the cohorts.
“Neither study had adequate statistical power to detect a difference between the effect estimates from the within-sibship analyses and that of unrelated participants in the cohorts”
From Triangulation in aetiological epidemiology (2017) · cites this paper as [62]
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Background
- Authors
- Evenhouse, E., & Reilly, S.
- Affiliations
- Mills College (US)
- Corresponding author
- Evenhouse, Eirik
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2005-08-15
- Volume
- 40
- Issue
- 6p1
- Pages
- 1781-1802
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- PMC
- PMC1361236
- OpenAlex
- W2141542301
- Cited by
- 159
- References
- 52
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 6 · 2023: 8 · 2022: 3 · 2021: 8 · 2020: 7 · 2019: 20 · 2018: 6 · 2017: 9 · 2016: 8 · 2015: 8 · 2014: 12 · 2013: 11 · 2012: 8
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Services Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (T32HS000086, 5 T32 HS00086)
- University of California, San Francisco
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01- HD31921, P01HD031921)
- Topics
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Keywords
- breastfeeding, sibling comparison, selection bias, cognitive ability, intelligence, adolescent health, emotional well-being, physical health, academic performance, breastfeeding duration, Add Health
- MeSH terms
- Adolescent, Body Weights and Measures, Breast Feeding, Chronic Disease, Female, Humans, Intelligence, Longitudinal Studies, Socioeconomic Factors, Selection Bias, Siblings
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