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.

Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway

“…A study from China assessed lung function among 1033 adults aged 40–69 years and included both ever- and never-smokers, and found a reduction in lung function associated with SHS among women only [ 6 ]. A recent study among 3568 old-order Amish in the U.S. found that exposure to second-hand tobacco smoke was associated with a 2.7% lower forced expiratory volume in 1 sec (FEV 1 ) percentage in women [ 24 ].…”

The relation of environmental tobacco smoke (ETS) to chronic bronchitis and mortality over two decades

“…ETS exposure in non-smokers has also increased mortality from lung cancer and COPD [33,34]. Additionally, ETS has been associated with a greater burden of cardiovascular risk factors [35], such as higher BMI and fasting glucose [36], and with endothelial dysfunction and increased plasma fibrinogen levels [37].…”

Association of smoking with prevalence of common diseases and metabolic abnormalities in community-dwelling Japanese individuals

“…These findings may be associated with differences in the quantity of smoking between the two sexes. Notably, numerous previous studies revealed sex differences in the effect of smoking on metabolic parameters (50)(51)(52). One longitudinal study of non-diabetic individuals demonstrated that smoking was associated with improved insulin sensitivity in women, but reduced insulin sensitivity in men (50).…”

“…Reed et al (51) reported the association of passive smoking with greater BMIs and fasting plasma glucose levels in men, and with reduced HDL-cholesterol levels in women among the Old Order Amish population. In late adolescence, passive smoking was also associated with lower HDL-cholesterol in girls, demonstrating a sex difference in the findings (52).…”