Bio IA Sample 2

Investigation 17 (annotated)
An investigation into the distinct effects of breastfeeding and formula feeding on the
incidence of autoimmune diseases (asthma, rheumatoid arthritis, diabetes) and allergies
Introduction:
Breastfeeding is a method of nursing in which milk produced by mammary glands nurture
offspring. Mammary glands refers to exocrine glands in mammals that produces milk to feed
young offspring (New World Encyclopedia, 2008). Breastfeeding is an inherent, evolutionary
practice that is performed by all mammals to nurture their young, however this investigation will
only focus on the implications of human breastfeeding.
Breastfeeding has strong evolutionary correlates, in which lactation (the secretion of milk) is an
ancient reproductive trait that predates the origin of mammals. Mammary glands are adaptations
of hair follicle-associated glands, and were co-opted to provide sustenance for offspring and
subsequently aid in their immune system development (Smithsonian National Zoological Park,
2002). Underlying this complex process of nursing is the primal need to successfully pass on
one’s genes. In doing so, the nurturing of one’s offspring as carriers of said genes using the
natural production of breast milk is imperative in their health and development (Smithsonian
National Zoological Park, 2002).
Breast milk is uniquely suited to human infants’ nutritional needs, in which it has unparalleled
immunological and anti-inflammatory properties that protect against potential diseases (Office of
the Surgeon General (US), 2011). Breast milk contains essential proteins such as antibodies,
which are also called immunoglobulins. They take on five basic forms, denoted as IgG, IgA, Com: Abbreviations
IgM, IgD and IgE. All have been linked to human milk, however the most abundant type is IgA explained.
(Immunoglobulin A) specifically the form known as secretory IgA (SIgA) (Newman, 2018).
SIgA serves as the first line of defense in protecting the intestinal epithelium from toxins and Com: In text citations
pathogenic microorganisms. Through immune exclusion, SIgA promotes the expelling of used.
antigens and pathogenic microorganisms by blocking their access to epithelial receptors,
entrapping them in mucus, and facilitating their removal by a peristaltic motion (Mantis et al.,
2011). Hence, SIgA, a class of antibodies which occurs naturally in breast milk, plays a crucial
role in the protection of the immune system.
There are an abundance of other molecules in breast milk that also prevent microbes and
antigens from attaching to mucosal surfaces. Oligosaccharides, are simple sugars which often
contain domains that resemble the binding the active sites by which bacteria gain entry into the
cells, which line the intestinal tract (Mantis et al., 2011). Thus, these simple sugars can intercept
these bacteria, which are later excreted. Human milk contains numerous molecules, all of which
aid in providing sustenance for a baby, and providing necessary antibodies to combat antigens,
strengthening the immune system preventing infectious diseases, in specific autoimmune
diseases (Mantis et al., 2011).
The immune system is characterized by the presence of white blood cells, antibodies, and other
proteins that attack and destroy foreign pathogens (Healthwise staff, 2017). Autoimmune
diseases occur when the immune system mistakens the body’s tissue as pathogens. The
antibodies produced by a variety of lymphocytes are unable to recognize foreign substances and
their antigens, thus rendering the immune system vulnerable to infectious diseases that would
otherwise be prevented by specific antibodies (Janeway et al., 2001). Autoantibodies are also
developed, these are a type of antibody directed against one or more of the individual's own
proteins (Janeway et al., 2001). In specific, the autoimmune disease rheumatoid arthritis is
Com: Terminology
catalyzed by the autoantibody rheumatoid factor (RF), which is made by B cells present in
defined.
lymphoid follicles. The autoantigens recognized by these autoantibodies include cartilage
components, chaperones, enzymes, nuclear proteins and citrullinated proteins (Janeway et al.,
2001). Ultimately, the antibodies and nutrients found in breast milk may play an integral role in
strengthening the immune system, and protecting babies from developing later autoimmune
Biology teacher support material 1

diseases. This investigation will isolate for the autoimmune diseases of rheumatoid arthritis,
diabetes, and asthma, alongside allergies, which are closely linked.
It is suggested that there are overflowing benefits of breast milk, as slogans such as “breast is
PE: Real-world problem
best” have circulated and have become popularized in the media. Although the WHO states that addressed.
“breastfeeding is the normal way of providing young infants with the nutrients they need [and]
virtually all mothers can breastfeed” there is a growing percentage of women, due to underlying
health problems (i.e: hypoplastic breasts, polycystic ovary syndrome, hypothyroidism) who may
experience lactation failure (Mayo Clinic Staff, 2018). As well, due to personal lifestyle choices,
women may choose to use an artificial formula version of breast milk. Most infant formula is
made with cow's milk that's been altered to resemble breast milk (Mayo Clinic Staff, 2018). Soy-
based, or protein hydrolysate formulas may also be used as substitutes (Mayo Clinic Staff, 2018).
There is a large body of pre-existing scientific research done on the detrimental effects of
formula feeding in comparison to breastfeeding. The American Academy of Pediatrics (AAP)
strongly recommends exclusive breastfeeding for the first six months of life and that
breastfeeding continues for at least 12 months, as do many other institutions. Formula fed babies
could be missing vital hormones and immune factors from breast milk and must contend with
artificial ingredients in the alternative. This leaves them theoretically, more susceptible to
autoimmune disorders, and allergies, in which allergies are caused by the immune system
mistakenly reacting to innocuous molecules, known as allergens.
Research Question:
The extensive preliminary research done leads to my research question: How do different nursing
methods (breastfeeding versus bottle feeding) affect the incidence of autoimmune diseases and
allergies? The aim of this investigation is to determine if there is a positive
correlation between formula feeding and autoimmune diseases and allergies, or a negative Ex: Needs more focus.
correlation between breastfeeding and autoimmune diseases and allergies. I hypothesize that, due What population? During
what period? Which
to the extensive theories and background information on the importance of breast milk in
autoimmune diseases?
strengthening the immune system, there will be a correlation between breastfeeding as protective
Which allergies?
against autoimmune diseases and allergies, in comparison with formula feeding. Ultimately, I
hypothesize that my results will cohere with the already established, pre-existing body of
research that proves there are distinct effects on the health and development of those that were
breastfed versus formula fed.
Materials:
- Survey Monkey software (Survey Monkey Inc, 2019).
- Microsoft Excel 2017
- Social media platforms: Instagram, Facebook, and Reddit
Method:
Initial Exploration and Considerations
Before the survey was designed, I hypothesized that I would find a relationship of breastfeeding
protecting from autoimmune diseases. Before designing my survey, I verbally asked friends and Ex: Preliminary survey.
family both their method of nursing, and any autoimmune diseases they have. I immediately
discovered that nursing methods are not absolute, in which many of my friends were both
breastfed and formula fed in different amounts. I dealt with this problem later when designing
my survey. After thoroughly discussing my topic with my friends, family, and advisor, I
observed a causal relationship between the type of nursing method and autoimmune diseases,
aligned with my hypothesis. This catalyzed my subsequent research, and led me to outline my
variables:

Table displaying control variables and their explanations used in this investigation
What type of variable is it? What was controlled?
Independent variable The method of nursing:

- Strictly and mostly breastfed
- Strictly and mostly formula fed
Dependent variable The prevalence of autoimmune diseases:

- Asthma
- Diabetes (type 1 and type 2)
- Rheumatoid arthritis
The prevalence of allergies:

- Drug allergies
- Food allergies
- Seasonal allergies
- Environmental allergies
Control variable(s) 1. The cohort group/population

- The survey was only shared with Canadian residents.
Ex: Target population
- This was done to restrict the confounding variable of specified.
geographical placement.
- There are extraneous factors such as differences in
climate, public health care systems, and social progress
affecting the prevalence or detection of autoimmune
diseases.
2. Biological sex
- Biological sex was controlled, in which differences
between sexes could be seen.
3. Age
- Age was controlled, in which differences between age
Ex: Not clear. The
groups could be seen.
sample sheet implies
- There are some autoimmune diseases that only maifest at that only the age was
a certain age. asked for.
Before designing the survey questions, I took into account safety ethics. There are also no
significant ethical/safety or environmental issues involved in this investigation. Typically when
using online surveys in which data contingent on the participants are collected, there is an Ex: What about
unofficial, unspoken agreement that the data will remain confidential, in circumstances where no informed consent?
personal tags are collected such as in this online survey. However, the safety ethics were still
outlined, in which a paragraph stating the purpose and use of the data was written to preface the
investigation. This included stating that all data collected will remain anonymous, the data will Ex: Some informed
consent, though it
solely be used for academic purposes, minimal amounts of data will be collected, and the data
would be better to know
will not be profited from. As well, and the raw data will be destroyed after the graded assessment what information this
is provided by IB. Due to the developed SurveyMonkey software, the option of IP addresses paragraph contained.
were given. This option was turned off and ignored immediately, for the purpose of keeping all
data confidential. As well, this research was conducted solely online. This methodological choice
has environmental implications, in which the use of a mass amount of paper for the consent
Ex: Environmental
forms, the survey, and envelopes was avoided. Thus both economically and environmentally
impact considered.
resources were conserved.
Situational Questions Design

After clear variables were defined, I outlined the general scope of questions I wanted to ask. This
included questions meant to test the relationship between my independent and dependent
variables. Following this I brainstormed supplementary questions in hopes to further refine my
variables and focus my research question. At first, I thought of questions that may be points of
considerations such as demographic questions:
1. What is your race?

2. Were you born in Canada, if not, where were you born, and when did you immigrate
here?
3. What is your residential status?
Although these demographic questions are all valid and may be confounding variables in my
research, I ultimately decided to not use them in my survey. This was done because of the
contentious, invasive nature of these questions. I thought they would detract from my focused
research question. These questions potentially provide too much identifying information in
which the ethical guideline of anonymity is threatened. I also brainstormed other questions
regarding situational factors.
1. Did you grow up in an urban area (city) or a rural area (small town, farm)
2. Did you grow up with pets, or were/are you frequently surrounded by animals?
3. Do you have a genetic predisposition towards this autoimmune disease?
4. If you have asthma: Do you smoke cigarettes routinely (or have in the past) or are you
exposed to a significant amount of secondhand smoke?
These situational factors all have a considerable effect on the studied relationship. However, they
Ex: Ethics considered.
were ultimately not used in the final draft of the survey because they were thought to detract
from the actual relationship being studied (method of nursing and incidence of autoimmune
diseases). As well, to create the most efficient, and effective survey, I wanted to collect as little
as data as possible, and avoid redundant, intrusive questions that the population would likely not
want to answer.
After careful consideration question 4 regarding the routine use of cigarettes was used in the
final draft of the survey. It was used to further refine, and possibly draw further correlations
between asthma and smoking. This was also done to avoid drawing a false correlation between
formula feeding and asthma, if the paramount underlying cause is the routine use of smoke or
habitual exposure to secondhand smoke.
Survey Design Ex: The process of the

While carrying out my initial casual exploration, I faced the problem that oftentimes peoples’ survey design is clearly
nursing methods are not absolutely one or the other. To adapt to this setback, I used a explained and justified.
modification of the Likert scale. Likert scales are widely used to measure attitudes and opinions
with a greater degree of nuance than a simple “yes/no” question (Jamieson, 2017). The options
for the nursing method followed this format:
- Strictly breastfed
- Mostly breastfed
- Both in approximately equal amounts
- Mostly formula fed
- Strictly formula fed
This was done to receive a range of answers that effectively demonstrate the variation in nursing
method, broadening the scope of data analysis and better reflecting the nuances seen in real life.

When designing the questions to investigate the incidence of autoimmune diseases, I also
decided to also use a modification of the Likert scale, to collect data not only on the prevalence
of the disease but the intensity of it, in which there are discrepancies between the intensities, or
levels of a certain autoimmune disease. This was done by creating a subsequent question asking
for the severity of their autoimmune disease, on a Likert scale of mild, moderate, and severe.
As well, while designing the survey, the sentence structure was intentionally chosen to avoid the
effects of leading questions and possible researcher bias, in which I am looking for a specific
correlation. Leading questions and the subsequent projection of my own wants was avoided
through the deliberate consideration of language.
After finalizing my survey, my advisor and I shared it amongst the school, community, and on
social media platforms such as Instagram, Facebook, and Reddit.
Raw Data:
The tables below present the raw data of one participant. There were 192 online participants in
total, in which 173 of the participant’s data was used (only the extremes of strictly or mostly
being breast or formula fed). The middle ground was ignored, in which the research question
Ex: IV range justified.
strived to find a correlation between the extremes of nursing methods. Thus, only breastfeeding
and formula feeding were isolated and used in subsequent data processing.
Table displaying the raw data (questions and answers) for one participant Ex: An example of a
survey questionnaire is
Question Answer provided.
What is your age (in years) as of this month? 97
An: Sample of raw data
What is your biological sex? Male is provided.
What was your method of nursing? Mostly formula fed
If you know, approximately when were you 24

weaned? (please state numerical values only, in
months)

Do you have asthma? No
If you have asthma: What is the severity of it? N/A
If you have asthma: Do you smoke cigarettes N/A

routinely (or have in the past) or are you exposed
to a significant amount of secondhand smoke?
Do you have rheumatoid arthritis (RA)? Yes
If you have RA: What is the severity of it? Moderate
If you have RA: At what age approximately did 63

your RA begin to develop? (please state your
answer in numerical values only, in years)
Do you have diabetes? No
If you have diabetes: What is the severity of it? N/A
Do you have allergies? If yes, what type(s)? Yes, food allergies

Yes, environmental allergies (i.e: pets, dust
mites)
Yes, drug allergies
If you have allergies: What is the severity of Severe

them?
Do you have any other autoimmune diseases not N/A

mentioned above? If yes, state them below.
The table above displays the raw data for one participant. The rest of the raw data for the other
191 participant follows the same format, but due to the sheer amount of participants the complete
set of raw data is unable to be displayed efficiently.
As well, because this data set is mostly qualitative and lacks quantitative measurements, there is
no measurement uncertainty. Since the quality of the data collection is almost entirely dependent
An: Uncertainties
on the participants and their honesty, there is a certain level of warranted trust, and thus an
discussed.
immeasurable level of uncertainty that comes with this data set, due to response bias.
Processed Data:
Chi-Square
An: Appropriate analysis.
In order to process the raw data, the statistical test chi-square was used. The chi-square
independence test is a procedure for testing if two categorical variables are related in a data set
(SPSS Tutorials, 2018). A chi-squared test seeks to distinguish between two distinct possibilities
and hence uses two hypotheses.
1. Null hypothesis (H0): There is no significant correlation between two variables (i.e.
distribution is random)
2. Alternative hypothesis (H1): There is a significant correlation between two variables (i.e.
variables are associated)

Following this, a table of observed values and a table of expected frequencies must be
constructed. To find the expected frequencies, the following formula may be used:
- Expected frequency = (Row total × Column total) ÷ Grand total
These frequencies, both observed and expected are then imputed into the chi-square formula:
(SPSS Tutorials, 2018).

Where: ∑ = Sum ; O = Observed frequency ; E = Expected frequency
Next, in order to determine if the chi-squared value is statistically significant a degree of freedom
must be identified. The degree of freedom is a mathematical restriction that designates what
range of values fall within each significance level (SPSS Tutorials, 2018). The degree of freedom
is calculated from the table of frequencies according to the following formula:
df = (m – 1) (n – 1)
Where: m = number of rows and n = number of columns.
The final step is to apply the calculated value to a chi-squared distribution table (shown below)
to determine if the results are statistically significant. A value is considered significant if there is
less than a 5% probability (p < 0.05).
Image (i)
(Research Gate, 2015).

This image displays the chi-squared distribution table.
Com: Not necessary.
If the calculated chi-square value is smaller than the critical value, the results are attributable to
chance, or random distribution with there being no correlation between variables. Thus we
accept the null hypothesis. If the calculated chi-square value is larger than the critical value, we
reject the null hypothesis and accept the alternate hypothesis, in which the difference between
observed and expected frequencies are statistically significant. In this investigation, the chi-
square test was performed on Microsoft Excel 2017. This was done instead of using the formula
by hand, to conserve time.
Processed Data:
The statistical test of chi-square (X2 test) was applied in order to determine if there is a
significant difference between the prevalence of autoimmune diseases among breastfed and
formula fed participants. For the majority of the comparisons, 2 general hypotheses were used:
Null Hypothesis (H0): Method of nursing does not affect the presence of autoimmune diseases.
Alternate hypothesis: (H1): Method of nursing does affect the presence of autoimmune diseases.

As well, since only 2 by 2 tables were used:

Degrees of freedom = (rows – 1) x (columns – 1) = (2-1) x (2-1) = 1
Thus, degree of freedom=1, the X2crit= 3.84 for p=0.05.
The processed data below displays tables of observed values and their respective expected
frequencies, for each experimental control. Following this is the chi-square value calculated
through Microsoft Excel 2017
Figure 1a) Figure 1b)

Table of observed values displaying Table of expected frequencies displaying
biological sex and method of nursing the proposed correlation between
Female Male Total biological sex and method of nursing
Female Male Total
Breast 70 33 103
Breast 69.06 33.94 103
Formula 46 24 70
Formula 46.94 23.06 70
Total 116 57 173
Total 116 57 173
2
X calc= 0.095
Null Hypothesis (H0): There is no correlation between biological sex and the method of nursing
Alternate hypothesis: (H1): There is a correlation between biological sex and the method of
nursing
Since the test value X2calc= 0.09524 is less than the critical value X2crit= 3.84, we must accept the
null hypothesis, in which there is no statistical correlation between biological sex and the method
of nursing.
An: Each test is correctly
Figure 2b)
interpreted.
Figure 2a) Table of expected frequencies displaying
Table of observed values displaying the the proposed correlation between the Com: It could have
presence of asthma and method of presence of asthma and method of been more efficiently
nursing nursing presented.
Yes No Total Yes No Total
Breast 9 94 103 Breast 15.48 87.52 103
Formula 17 53 70 Formula 10.52 59.48 70

Total 26 147 173 Total 26 147 173
2
X calc= 7.889
Null Hypothesis (H0): Method of nursing does not affect the presence of asthma.
Alternate hypothesis: (H1): Method of nursing does affect the presence of asthma.
Since the test value X2calc = 7.88917 is greater than the critical value X2crit = 3.84, we must reject
the null hypothesis and accept the alternative hypothesis. Method of nursing affects the presence
of autoimmune diseases, in which breastfeeding protects against asthma, and formula feeding is
correlated to a higher prevalence of asthma.
Figure 3a)

Table of observed values displaying the Table of expected frequencies displaying

presence of asthma and exposure to the proposed correlation between the
smoke presence of asthma and exposure to
smoke
Yes No Total
Yes No Total
SmokeYe 4 35 39
s SmokeYe 5.86 33.14 39
s
SmokeNo 22 112 134
SmokeNo 20.14 113.86 134
Total 26 147 173
Total 26 147 173
2
X calc= 0.898
Figure 3b)
Null Hypothesis (H0): Extended exposure to smoke does not affect the presence of asthma
Alternate hypothesis: (H1): Prolonged exposure to smoke does affect the presence of asthma
null hypothesis. There is no statistical difference between smokers with asthma and non-smokers
with asthma. Prolonged exposure to smoke does not affect the presence of asthma.
Formula 8 62 70
Total 10 163 173
Figure 4b)
Table of expected frequencies displaying
the proposed correlation between the
presence of RA and method of nursing
RAYes RANo Total
Figure 4a)
Table of observed values displaying the Breast 5.95 97.05 103
presence of RA and method of nursing
Formula 4.05 65.95 70
RAYes RANo Total
Total 10 163 173
Breast 2 101 103 2
X calc= 6.887
Null Hypothesis (H0): Method of nursing does not affect the presence of RA.
Alternate hypothesis: (H1): Method of nursing does affect the presence of RA.
the null hypothesis and accept the alternative hypothesis. The method of nursing affects the
presence of autoimmune diseases, in which breastfeeding protects against RA and formula
feeding is correlated to a higher prevalence of RA.


presence of diabetes and method of the proposed correlation between the
nursing presence of diabetes and method of
nursing
Yes No Total
Yes No Total
Breast 3 100 103
Breast 4.76 98.24 103
Formula 5 65 70
Formula 3.24 66.76 70
Total 8 165 173
Total 8 165 173
2
X calc= 1.691
Null Hypothesis (H0): Method of nursing does not affect the presence of diabetes.
Alternate hypothesis: (H1): Method of nursing does affect the presence of diabetes.
Since the test value X2calc= 1.690972 is less than the critical value X2crit= 3.84, we must accept
the null hypothesis. There is no statistical relationship between method of nursing and the
presence of diabetes (both type 1 and type 2)

presence of type 1 diabetes and method of the proposed correlation between the
nursing presence of type 1 diabetes and method of
nursing
T1 Yes T1 No Total
T1 Yes T1 No Total
Breast 2 101 103
Breast 1.19 101.81 103
Formula 0 70 70
Formula 0.81 69.19 70
Total 2 171 173
Total 2 171 173
2
X calc= 1.375
Null Hypothesis (H0): Method of nursing does not affect the presence of type 1 diabetes.
Alternate hypothesis: (H1): Method of nursing does affect the presence of type 1 diabetes.
null hypothesis. There is no statistical relationship between method of nursing and the presence
of type 1 diabetes.
10

Table 7a) Table 7b)

presence of type 2 diabetes and method of the proposed correlation between the
nursing presence of type 2 diabetes and method of
nursing
T2 Yes T2 No Total
T2 Yes T2 No Total
Breast 1 102 103
Breast 3.57 99.42 103
Formula 5 65 70
Formula 2.42 67.57 70
Total 6 167 173
Total 6 167 173
2
X calc= 4.742
Null Hypothesis (H0): Method of nursing does not affect the presence of type 2 diabetes.
Alternate hypothesis: (H1): Method of nursing does affect the presence of type 2 diabetes.
the null hypothesis and accept the alternative hypothesis. The method of nursing affects the
presence of autoimmune diseases, in which breastfeeding protects against type 2 diabetes and
formula feeding is correlated to a higher prevalence of type 2 diabetes.
Figure 8b)
Figure 8a) Table of expected frequencies displaying
Table of observed values displaying the the proposed correlation between the
presence of allergies and method of presence of allergies and method of
nursing nursing
Yes No Total Yes No Total
Breast 48 55 103 Breast 55.96 47.03 103
Formula 46 24 70 Formula 38.03 31.96 70
Total 94 79 173 Total 94 79 173

2
X calc= 6.135
Null Hypothesis (H0): Method of nursing does not affect the presence of allergies.
Alternate hypothesis: (H1): Method of nursing does affect the presence of allergies.
Since the test value X2calc = 6.135556 is greater than the critical value X2crit = 3.84, we must
reject the null hypothesis and accept the alternative hypothesis. The method of nursing affects
the presence of allergies, in which breastfeeding is correlated with fewer allergies, and formula
feeding correlated with more allergies.
11


presence of life threatening allergies (food the proposed correlation between the
and drug) and method of nursing presence of life threatening allergies (food
and drug) and method of nursing
Yes No Total
Yes No Total
Breast 20 37 57
Breast 22.60 34.39 57
Formula 26 33 59
Formula 23.39 35.60 59
Total 46 70 116
Total 46 70 116
2
X calc= 0.976
Null Hypothesis (H0): Method of nursing does not affect the presence of life threatening
allergies.
Alternate hypothesis: (H1): Method of nursing does affect the presence of life threatening
allergies.
null hypothesis. There is no statistical correlation between method of nursing and the presence of
life threatening allergies (food and drug allergies).

presence of non-life threatening allergies the proposed correlation between the
(environmental and seasonal) and method presence of non-life threatening allergies
of nursing (environmental and seasonal) and method
of nursing
Yes No Total
Yes No Total
Breast 37 20 57
Breast 34.39 22.60 57
Formula 33 26 59
Formula 35.60 23.39 59
Total 70 46 116
Total 70 46 116
2
X calc= 0.976
Null Hypothesis (H0): Method of nursing does not affect the presence of non-life threatening
allergies.
Alternate hypothesis: (H1): Method of nursing does affect the presence of non-life threatening
allergies.
null hypothesis. There is no statistical correlation between method of nursing and the presence of
non-life threatening allergies (seasonal and environmental allergies).
Discussion:
To conclude on the research question, there is a positive correlation between formula feeding and
An: Not a correlation,
autoimmune diseases and allergies. The opposite is also true, in which there is a negative more an association here.
correlation between breastfeeding and autoimmune diseases and allergies. This means that in this
sample group, generally breastfeeding protects against the development of diseases and allergies,
12

while bottle feeding did the opposite, it intensified it. Formula fed participants had more diseases
and allergies. These conclusions are statistically significant, and are supported by the chi-square
independence test. Ev: Conclusion
supported by the data.
Despite there generally being a strong positive correlation between formula feeding and
autoimmune diseases and allergies, there are a few discrepancies, in which there is no statistical
significant correlation between method of nursing and diabetes (both type 1 and 2). However,
upon further data analysis, it was found there is a statistically significant relationship between
method of nursing and type 2 diabetes (X2calc = 4.74202 > X2crit = 3.84). In type 1 diabetes, the
body’s own immune system attacks and destroys the beta cells that make insulin, in which the
body does not effectively produce insulin, a hormone used to control blood-glucose levels (NIH,
2018). In type 2 diabetes, the body does not produce a sufficient amount of insulin, or the body’s
cells are insulin resistant (NIDDK, 2017). The reasoning for the discrepancies between type 1 Ev: Scientific context
and type 2 diabetes in relation to method of nursing may be due to the limitation of small sample used with sources cited.
size. According to the CDC, approximately 95% of people with diabetes have type 2 diabetes,
while 5% have type 2 diabetes (CDC, 2018). These statistics are generally reflected in the data,
in which 75% of people with diabetes have type 2, while 25% have type 1. Due to the differences
and the very small amount of observed frequencies, the X2calc value could have been skewed,
showing both a non-significant value for type 1 and a significant value for type 2.
As well, in this sample there is no correlation between smoking or exposure to secondhand

smoke and asthma (X2calc= 0.89804 > X2crit= 3.84). I hypothesized that there would be an effect
of exposure of smoking on the incidence of asthma, due to the widely known detrimental effects
of cigarettes on one’s health and development. However, there is no statistical difference
between participants with exposure to smoke and asthma, and participants with no exposure to
smoke and asthma. This datapoint was collected in order to refine the relationship between
method of nursing and asthma, as there are many situational factors affecting this disease. This is
an interesting point of research for further study.
Ev: Extension proposed.
There is a plethora of pre-existing research done on the effects of formula feeding on health and
development which cohere with my results. A meta-analysis study done by the Agency for
Healthcare Research and Quality screened over 9,000 abstracts, and approximately 400
individual studies were included in their investigation (Chung et al., 2009). Results demonstrated
that a history of breastfeeding was associated with a reduction in the risk of many diseases,
including nonspecific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis,
asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, and sudden infant
death syndrome (Chung et al., 2009). These results, in accordance with my data analysis support
the scientific theory of the importance of breast milk in providing vital nutrients and antibodies
crucial in fighting off foreign antigens and thus infectious diseases in infants (WebMD, 2017).
Although a strong correlation between formula feeding and higher incidences of autoimmune
diseases and allergies may be drawn, there are other situational factors that should be considered.
The development of autoimmune diseases is an interplay of genetics, and environmental factors
(Shomon, 2018). Diet, stress, previous infections, and toxic chemicals may affect the
malfunctioning of the immune system (Shomon, 2018). There are also socio-cultural
implications of this piece of research, in which there is a prevalent stigma surrounding women
who formula feed. This stigma, demonizing women who chose to formula feed is a social
situational factor with serious consequences for infant health. Ev: Not entirely relevant
to this study. This
A 2016 study published in Maternal & Child Nutrition aimed to describe the emotional and considers why women
practical experiences of mothers who formula feed (Komninou et al., 2017). Predictors of are breast feeding their
emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant babies or not, rather
than the impact of it
on the infant’s health
13 regardless of socio-
cultural forces.

feeding choices. Practical predictor variables included support received from health
professionals, respect displayed by their everyday environment, and main sources of infant
feeding information (Komninou et al., 2017). Qualitative results from this survey research
showed that a ‘worryingly high percentage’ of mothers experienced negative emotions as a result
of their decision to use formula (Komninou et al., 2017). From this study and a body of research
cohering with these results, this pervading social stigma demonizing formula feeding as
‘unnatural’ and women who chose to use formula as ‘self-serving’ or ‘indolent’, affects the
disparity between nursing methods.
Alongside the pervading stigma demeaning women who chose to formula feed, there is a
pervasive social perception of breastfeeding in public spaces as ‘inappropriate.’ Embarrassment
remains a barrier to breastfeeding, however embarrassment about breastfeeding is not limited to
public settings. Women may find themselves excluded from social situations when they are
breastfeeding because others are reluctant to be in the same room while they breastfeed (Office
of the Surgeon General (US), 2011). For many women, the feeling of embarrassment restricts
their activities and is cited as a reason for choosing to feed supplementary formula or to give up
breastfeeding altogether (Office of the Surgeon General (US), 2011). Thus, the environmental
factor of social stigma and social perception surrounding different nursing methods greatly affect
a woman’s decision to breastfeed or formula feed. These underlying social factors should be
considered when studying the effects nursing methods have on infant health and development.
Evaluation:
There are a number of limitations or possible points of weaknesses in this investigation that may
be modified for future replications. The primary limitation is the lack of a large, holistic sample
size. In total there were 192 participants, 173 of which were used in the data processing. The 19 An: Explains why certain
participants omitted claimed to be both breastfed and bottle fed in approximately equal amounts, data was omitted.
and since they did not align on either extreme they were omitted from the study. From the 173
participants’ data used approximately 15% had asthma, 6% had rheumatoid arthritis, 5% had
diabetes, and 54% had at least one type of allergy. Due to the small sample size of participants
with an autoimmune disease or allergy, it is difficult to definitively conclude there is a direct
correlation between breastfeeding and fewer diseases and allergies.
A sample size that is too small increases the chance of a type II error skewing the results, which
decreases the statistical power of the results (ref). In specific, the X2 test is highly sensitive to
Ev: Weaknesses
sample size. The smaller the frequencies, the less accurate the test. This is because with a larger evaluated.
data set we can be more certain about the effect size not being attributable to random
distribution. As well, as the sample size increases, absolute differences become a smaller
proportion of the expected frequency in which a strong association may not come up as
significant if the sample size is too small. Due to the limitation of a small sample size the
subsequent application of the X2 statistical test becomes erroneous, thus subjecting the
conclusions drawn to further scrutiny. To minimize these effects in future replications, a larger,
holistic population should be aimed for. As well, a specific demographic group susceptible to
certain autoimmune diseases (i.e: elderly people who are more likely to develop and have
rheumatoid arthritis) should be targeted. If this is unable to be effectively done and a very small
population is used, an alternate independence test may be used specifically for smaller data sets,
such as Fisher’s exact test. Fisher’s exact test is an alternate statistical test to X2, it it used to
compare two proportions that is conditional on the marginal frequencies (CTSPEDIA, 2011). Ev: An improvement
is proposed, but there
Another limitation is the design, in which an online survey was used to collect primary data. is no indication as to
There are several advantages to using surveys. Surveys are easy to administer, can reach a wide why this test was not
variety of people due to mass globalization, are relatively cost-effective, and allow for a broad carried out.
range of data to be collected. Despite this, there are still many innate limitations making it
14

difficult to draw distinct conclusions. Due to the anonymity and lack of personalization of online
surveys, it is impossible to confirm all participants are giving conscientious and honest
responses, in which response bias is prevalent. Response bias may be due to a participant’s
desire for social inclusion, their lack of personal engagement with the study, or their desire to
reinstate online privacy. In specific to this investigation, a brief, personal medical history was
collected, and specifics regarding infantile nursing methods. These invasive questions may have
prompted participants to safeguard their personal information by manipulating their information,
skewing the results of the survey. Thus, there is an immeasurable level of uncertainty that comes
with a data set, innate to the limitations of survey research.
Due to this innate flaw of survey research, other designs, such as a longitudinal study would be
Ev: Improvement/
more effective for this particular investigation. Longitudinal studies are described as employing extension proposed.
continuous or repeated measures to follow individuals over prolonged periods of time—often
years or decades. This study type is particularly useful for evaluating the relationship between
risk factors and the development of disease (Caruana et al., 2015). This holistic, observational
research technique studying the same group of individuals over an extended period would be
effective at being able to draw correlations between nursing methods and the development of
autoimmune diseases and allergies. Limitations of longitudinal studies include that they can be
very expensive and time consuming. Despite this, if the money, resources, and time was
disposable, conducting a longitudinal study instead of a survey would yield reliable, credible
results, which would be able to conclude on and extrapolated with little to no skepticism.
Conclusion:
In conclusion, this piece of research discovered a positive correlation between formula feeding Com: Association.
and the prevalence of autoimmune diseases and allergies, and a negative correlation between
breastfeeding and the prevalence of autoimmune diseases and allergies. This means that
participants who were formula fed had a higher incidence of autoimmune disorders, while those
who were breastfed had a lower incidence of autoimmune disorders. These results are Ev: The candidate does
statistically significant, in which the chi-square independence test was applied to verify this. not fall in the trap of
These results are only statistically significantly for this sample population, in which these results directly equating cause
cannot be easily extrapolated to any other population. However, despite the limitations and and effect.
possible extraneous variables discussed thoroughly in this report, these findings support pre-
existing bodies of literature and scientific theory, stating the importance of breast milk in
providing an infant with vital nutrients and antibodies to combat antigens and subsequent
diseases, and autoimmune disorders.
Com: References
Bibliography: correctly presented.
AAP. (2012, February 27). AAP-Reaffirms-Breastfeeding-Guidelines. Retrieved January 2,
2019, from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP- Com: Retrieval dates
Reaffirms-Breastfeeding-Guidelines.aspx given.
Caruana, E. J., Roman, M., Sanchez, J., & Solli, P. (2015, November 7). Longitudinal studies.
Retrieved January 7, 2019, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669300/
CDC. (2018, August 15). Diabetes Home. Retrieved December 25, 2018, from
https://www.cdc.gov/diabetes/basics/type2.html
Chi Square versus Fisher's Exact. (2011). Retrieved December 29, 2018, from
https://www.ctspedia.org/do/view/CTSpedia/ChiVersusFisher
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Healthwise Staff. (2017, October 9). Components of the Immune System (G. E. Thompson
MD, Ed.). Retrieved November 8, 2018, from
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Agency for Healthcare Research and Quality's evidence report on breastfeeding in
developed countries. Retrieved January 1, 2019, from
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https://www.britannica.com/topic/Likert-Scale
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against self antigens. Retrieved November 29, 2018, from
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14). The emotional and practical experiences of formula‐feeding mothers. Retrieved
December 20, 2018, from https://onlinelibrary.wiley.com/doi/pdf/10.1111/mcn.12392
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immunity and mucosal homeostasis in the gut. Retrieved December 15, 2018, from
https://www.nature.com/articles/mi201141
Mayo Clinic Staff. (2018, December 20). Infant formula: Your questions answered. Retrieved
from https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-
depth/infant-formula/art-20045782
New World Encyclopedia writers. (2008, April 3). Mammary gland. Retrieved from
http://www.newworldencyclopedia.org/entry/Mammary_gland
Newman, J., MD. (2018, January 02). How Breast Milk Protects Newborns. Retrieved
December 10, 2018, from https://kellymom.com/pregnancy/bf-
prep/how_breastmilk_protects_newborns/
NIDDK. (2017, May 01). Type 2 Diabetes. Retrieved December 20, 2018, from
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-
diabetes
NIH. (2018, January 30). Does infant formula affect development of type 1 diabetes?
Retrieved December 8, 2018, from https://www.nih.gov/news-events/nih-research-
matters/does-infant-formula-affect-development-type-1-diabetes
Office of the Surgeon General (US). (2011, January 01). The Importance of Breastfeeding.
Retrieved December 11, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK52687/
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United States. Retrieved January 11, 2018, from
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16

RsearchGate. (2015). Table 7. Retrieved December 1, 2018, from

https://www.researchgate.net/figure/Excerpts-from-the-Chi-square-distribution-
table_tbl1_277935900
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December 28, 2018, from https://www.verywellhealth.com/what-are-the-causes-of-
autoimmune-diseases-3232655
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7, 2018, from https://www.spss-tutorials.com/chi-square-independence-test/
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https://www.who.int/topics/breastfeeding/en/
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Investigation 17 (annotated)

Biology teacher support material 1

Biology teacher support material 2

Independent variable The method of nursing:

Dependent variable The prevalence of autoimmune diseases:

The prevalence of allergies:

Control variable(s) 1. The cohort group/population

Situational Questions Design

Biology teacher support material 3

1. What is your race?

Survey Design Ex: The process of the

Biology teacher support material 4

What was your method of nursing? Mostly formula fed

If you know, approximately when were you 24

Biology teacher support material 5

Do you have asthma? No

If you have asthma: What is the severity of it? N/A

If you have asthma: Do you smoke cigarettes N/A

Do you have rheumatoid arthritis (RA)? Yes

If you have RA: What is the severity of it? Moderate

If you have RA: At what age approximately did 63

Do you have diabetes? No

If you have diabetes: What is the severity of it? N/A

Do you have allergies? If yes, what type(s)? Yes, food allergies

If you have allergies: What is the severity of Severe

Do you have any other autoimmune diseases not N/A

Biology teacher support material 6

- Expected frequency = (Row total × Column total) ÷ Grand total

(SPSS Tutorials, 2018).

(Research Gate, 2015).

Biology teacher support material 7

As well, since only 2 by 2 tables were used:

Figure 1a) Figure 1b)

Breast 9 94 103 Breast 15.48 87.52 103

Formula 17 53 70 Formula 10.52 59.48 70

Biology teacher support material 8

Table of observed values displaying the Table of expected frequencies displaying

Total 10 163 173

Biology teacher support material 9

Figure 5a) Figure 5b)

Figure 6a) Figure 6b)

Biology teacher support material 10

Table 7a) Table 7b)

Breast 48 55 103 Breast 55.96 47.03 103

Formula 46 24 70 Formula 38.03 31.96 70

Total 94 79 173 Total 94 79 173

Biology teacher support material 11

Figure 9a) Figure 9b)

Figure 10a) Figure 10b)

Biology teacher support material 12

As well, in this sample there is no correlation between smoking or exposure to secondhand

Biology teacher support material 13

Biology teacher support material 14

Biology teacher support material 15

Biology teacher support material 16

RsearchGate. (2015). Table 7. Retrieved December 1, 2018, from

Survey Monkey Inc. (2019, January). Retrieved from www.surveymonkey.com

Biology teacher support material 17

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