Much of the reason for this centers around limitations in several key aspects of study design that have possibly
confounded study outcomes.
Not exact matches
By design, that
study minimized
confounding by measured and unmeasured factors; however, nonblinding of clinicians assessing the cognitive
outcomes to participant breastfeeding status suggests the potential for bias.
Studies of the relation between breast feeding and illnesses are subject to possible limitation by misclassification of exposure and
outcome and by
confounding.
To correct for limitations, Bauchner et al suggested four standards for breast feeding
studies.22 These include avoidance of detection bias, clear definition of the
outcome event, clear definition of breast feeding, and adjustment for potential
confounding variables.
Although reanalysis of the available evidence is important, the ability to properly control for bias and
confounding [factors that can influence
outcomes] in observational
studies is often limited, and without randomized controlled trials specifically designed to test the hypothesis, the issue of nonspecific effects of vaccines may remain subject to continuing debate.»
For each
study, we extracted data on baseline characteristics (age, sex, histology, stage, grade, and smoking history) of the
study population that could potentially
confound the link between smoking and the
outcome.
The mechanism of this association is unclear and could reflect chance or residual
confounding, although similar results were reported in the Nurses» Health
Study and the Kaiser Permanente Multiphasic Health Checkup cohorts.19, 20 In contrast to other
outcomes, a modest borderline positive association was observed in men for coffee consumption and mortality from cancer, with a null association observed in women.
Furthermore, the paradoxical protective effects of antenatal parental alcohol use found in some
studies [9,17,18] are most likely explained by 1) misclassification of the exposure or
outcome, 2) residual
confounding, or 3) small sample size [6,19].
One strength of the current
study involves the use of multiple informants; parents and caregivers reported on
outcome measures, and youth reported on friendship qualities, thus reducing the potential
confounds of shared - method variance.
The findings for emotional symptoms are in line with
studies from New Zealand showing that the number of depressive episodes in adolescence was associated with later self - reported welfare dependence after adjustment for
confounding factors and comorbidity.17 In a
study with an
outcome measure similar to that of our
study, Pape et al16 reported that anxiety and depression symptoms in adolescence increased the susceptibility of receiving medical benefits in early adulthood in a Norwegian sample.
Although more
studies are certainly needed to replicate and extend these findings (particularly given the cross-sectional design and limited measurement of sleep and
outcome domains), this
study offers an important reminder to researchers to not overstate findings from any single
study that is unable to consider all potential
confounds.