title: Tobacco use among the Amish in Holmes County, Ohio.
abstract: OBJECTIVE
  The objective of this study was to estimate tobacco use prevalence among the Amish in Holmes County, Ohio, using both self-report and a biochemical marker of nicotine exposure.
  
  
  METHODS
  Amish adults (n=134) were interviewed as part of a lifestyle study. Self-reported tobacco use was measured using standardized questions, and cotinine was measured from a saliva sample. The prevalence of smoking, total tobacco use, and misclassification were estimated separately by gender, and then compared to 2 non-Amish groups. One group was selected from 2 counties contained within the Holmes County Amish settlement (n=154) and the other was representative of non-Hispanic whites in the United States (n=4,099).
  
  
  RESULTS
  No Amish women reported current tobacco use and only 2 reported former use. This was significantly different (P<.0001) from the patterns observed among non-Amish in the settlement counties (15.7%) and US white (23.3%) women. The prevalence of tobacco use among Amish men was 17.6% and this was significantly lower than estimates from non-Amish in the settlement counties (38.8%, P=.04) and US white (32.2%, P=.005) men. No Amish women and only 2 Amish men underreported tobacco use and misclassification was similar in the comparison groups.
  
  
  CONCLUSIONS
  Tobacco use is significantly lower among adults in the largest Amish settlement in the world compared to their non-Amish neighbors in Appalachia Ohio and US whites. A strength of this study is that self report was verified with a marker of nicotine, a critical measure to include in any study conducted in a group that stigmatizes tobacco use.
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio 43210, USA. aferketich@sph.osu.edu
authors.forename: Amy K
authors.initials: AK
authors.lastname: Ferketich
authors.forename: Mira L
authors.initials: ML
authors.lastname: Katz
authors.forename: Ross M
authors.initials: RM
authors.lastname: Kauffman
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: Stanley
authors.initials: S
authors.lastname: Lemeshow
authors.forename: Judith A
authors.initials: JA
authors.lastname: Westman
authors.forename: Steven K
authors.initials: SK
authors.lastname: Clinton
authors.forename: Clara D
authors.initials: CD
authors.lastname: Bloomfield
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Wewers
mesh_terms: D000368:Aged; D003466:Cultural Characteristics; D003469:Culture; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012067:Religion; D012907:Smoking / Q000453:epidemiology*