title: 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.
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.
authors.affiliation: University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States of America.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Reed
authors.affiliation: University of Alabama School of Medicine, Division of Pulmonary and Critical Care Medicine, Birmingham, Alabama, United States of America.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
authors.affiliation: University of Iowa School of Medicine, Division of Pulmonary and Critical Care Medicine, Iowa City, Iowa, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Eberlein
authors.affiliation: University of Maryland School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Baltimore, Maryland, United States of America.|Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC), Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Miller
authors.affiliation: University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.affiliation: University of Maryland School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Mary
authors.initials: M
authors.lastname: Pavlovich
authors.affiliation: University of Maryland School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Toni I
authors.initials: TI
authors.lastname: Pollin
authors.affiliation: University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland, United States of America.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Scharf
authors.affiliation: University of Maryland School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Baltimore, Maryland, United States of America.|Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC), Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Shuldiner
authors.affiliation: University of British Columbia Respiratory Medicine; Vancouver, British Columbia, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Sin
authors.affiliation: University of Maryland School of Medicine, Division of Endocrinology, Diabetes, and Nutrition, Baltimore, Maryland, United States of America.|Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC), Baltimore, Maryland, United States of America.|University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, United States of America.
authors.forename: Braxton D
authors.initials: BD
authors.lastname: Mitchell
mesh_terms: D061365:Amish; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects; D008297:Male; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D064424:Tobacco Use / Q000009:adverse effects
chemical_list: D014028:Tobacco Smoke Pollution