ArticlePloS one2017
Gender differences in first and secondhand smoke exposure, spirometric lung function and cardiometabolic health in the old order Amish: A novel population without female smoking.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review.BMC public health · 2023Pooled it
- Oral Health Status and Cardinal Symptoms of Depression in the Old Order Amish: a cross-sectional study.Research square · 2026Article
- Sex inequality in disease burden attributable to smoking, secondhand smoke and chewing tobacco: A systematic analysis for the Global Burden of Disease Study 2023.EClinicalMedicine · 2026Article
- Do youth e-cigarette users perceive smoking as attractive? The dynamics of demographics and contextual factors.International journal of public health · 2026Article
- Exonic Variation and Its Clinical Impact in 7221 Old Order Amish.American journal of medical genetics. Part A · 2025Article
- Article
- Physical health conditions of the Amish and intervening social mechanisms: an exhaustive narrative review.Ethnicity & health · 2022Review
- Aortic Valve Calcification Score in Patients with Arterial Hypertension Environmentally Exposed to Tobacco Smoke.Cardiovascular toxicology · 2021Article
- Effects of Chronic Secondhand Smoke (SHS) Exposure on Cognitive Performance and Metabolic Pathways in the Hippocampus of Wild-Type and Human Tau Mice.Environmental health perspectives · 2021Article
- Living with a Smoker and Multiple Health-Risk Behaviors.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2021Observational
- Research Trends in Amish Population Health, a Growing Literature about a Growing Rural Population.Journal of rural social sciences · 2021Article
- Living with a smoker, health risk behaviors, and adiposity: an analysis with middle-aged and older women.Journal of behavioral medicine · 2020Observational
- Living With a Smoker and General and Central Adiposity in Middle-Aged and Older Women.American journal of health promotion : AJHP · 2019Article
- Polyherbal dietary supplementation for prediabetic adults: study protocol for a randomized controlled trial.Trials · 2019Article
- Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway.BMC public health · 2018Article
- Mechanisms of vascular comorbidity in autoimmune diseases.Current opinion in rheumatology · 2018Review
- Association of smoking with prevalence of common diseases and metabolic abnormalities in community-dwelling Japanese individuals.Biomedical reports · 2017Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
Abstract
Due to their relatively homogeneous lifestyle and living environment, the Amish offer a novel opportunity to study the health associations of tobacco smoke exposure, particularly secondhand smoke. We hypothesized that secondhand smoke exposure is associated with worse pulmonary and cardiometabolic health. We examined cross-sectional data on 3568 Amish study participants, including tobacco use and secondhand smoke exposure from family members included in the study. Thirty-four percent of Amish men reported ever smoking. Of this proportion, 64% used cigars, 46% cigarettes, and 21% pipes. Less than 1% of women reported ever smoking. Smoking was associated with lower spirometric lung function, higher body mass index, lower HDL cholesterol, higher heart rate, lower ankle-brachial index, and larger aortic diameter in men. A greater number of sources of secondhand smoke exposure (defined from the total of spouses, parents, and siblings who smoke) was associated with higher body mass index (p = 0.03) and with higher fasting glucose in men (p = 0.01), but not in women (p = 0.007 for sex*secondhand smoke interaction). Secondhand smoke exposure was also associated with reduced HDL cholesterol only in women (p = 0.002) and a lower heart rate only in men (p = 0.006). Smoking habits among the Old Order Amish are notable for the absence of female participation and a high proportion of cigar and pipe use. Smoking is associated with decreased spirometric indices of lung function and increased cardiovascular risk in this population and secondhand smoke exposure is associated with a greater burden of risk factors for cardiovascular disease. Sex differences in correlations could reflect differences in exposure patterns, mechanisms, or susceptibilities.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.