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Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

Amish and Mennonite (Plain) communities have increased prevalence of many recessively inherited disorders due to founder variants that can be identified using next-generation sequencing (NGS). We assessed newborn screening (NBS) utilization, prior genetic testing, and perceptions of genetic testing among Wisconsin Plain communities to guide implementation and utilization of a population-specific NGS gene panel testing. A mailed paper survey (N = 959) of demographics, NBS utilization, prior genetic testing, and preferences for categorical genetic disorder and defined clinical context testing was developed. Overall response rate was 39% (N = 378; 183 Amish, 193 Mennonite; 2 not Amish/Mennonite). Mennonites were more likely to respond in favor of carrier screening for metabolic disorders and other surgical conditions and less likely to respond in favor of asymptomatic testing for neurologic disorders and lethal disorders compared to Amish. Reported utilization of NBS was positively associated with stated interest in genetic testing for an asymptomatic child. Reported prior genetic testing was positively associated with stated interest in carrier screening and negatively associated with testing a symptomatic child. Although Plain community members share many common outward characteristics, our survey responses suggest diversity in their views of genetic testing and support laboratory methods that can be flexible to varied needs of individuals. [ABSTRACT FROM AUTHOR]

Estimating the lethal impact of a pandemic on a religious community with significant barriers to outsiders can be exceedingly difficult. Nevertheless, Stein and colleagues (2021) developed an innovative means of arriving at such an estimate for the lethal impact of COVID-19 on the Amish community in 2020 by counting user-generated death reports in the widely circulated Amish periodical The Budget. By comparing monthly averages of reported deaths before and during the COVID-19 pandemic, Stein and colleagues were able to arrive at a rough estimate of "excess deaths" during the first year of the pandemic. Our research extends the same research method, applying it to the years during and immediately preceding the global influenza pandemic of 1918. Results show similarly robust findings, including three notable "waves" of excess deaths among Amish and conservative Mennonites in the USA in 1918, 1919, and 1920. Such results point to the promise of utilizing religious periodicals like The Budget as a relatively untapped trove of user-generated data on public health outcomes among religious minorities more than a century in the past. [ABSTRACT FROM AUTHOR]

This paper uses proportional hazards techniques and population data from a directory of the Old Order Amish of the Lancaster, PA settlement. It examines the effect of death of the immediately prior sibling on the risk of childbearing for up to 11 children. Prior research typically has pooled data for maternal cohorts. In contrast, separate models are estimated for each maternal cohort. The results are based on all reported first marriages of Amish women born between 1884–1973 (N = 4066). Hazard models run separately for children of each birth order reveal that net of maternal age and length of the prior birth interval (and other statistical and design controls), the death of the prior sib significantly increases the risk of a subsequent birth for the lower birth orders. Separate models by maternal cohort show that sib death increases the risk primarily for later cohorts. The pattern of effects from child mortality and other variables suggests changes in fertility behavior among the Amish, who have strong, traditional norms opposing contraception and favoring large families. [ABSTRACT FROM AUTHOR]

The article presents a paper on model for estimating fecundability and sterility. The paper presents a new method for estimating fecundability and sterility simultaneously, based on a multistate hazards model. The most important features of the model are: one, the presence of distinct sterile and nonsterile states; two, a clear distinction between preexisting sterility and sterility that begins after initiation of follow-up; and three, a log-normally distributed hazard of conception among nonsterile couples. These features allow the investigators to address several important biological questions about fecundability and sterility. Application of the model to data on first birth intervals from Taiwan, Sri Lanka, and the Amish shows that heterogeneity in fecundability is statistically significant at most ages, but that preexisting sterility and new sterility are unimportant before age 40. These results suggest that sterility may not be an important determinant of natural fertility until later reproductive ages.

Identifying the genetic determinants of inter-individual variation in lipid species (lipidome) may provide deeper understanding and additional insight into the mechanistic effect of complex lipidomic pathways in CVD risk and progression beyond simple traditional lipids. Previous studies have been largely population based and thus only powered to discover associations with common genetic variants. Founder populations represent a powerful resource to accelerate discovery of previously unknown biology associated with rare population alleles that have risen to higher frequency due to genetic drift. We performed a genome-wide association scan of 355 lipid species in 650 individuals from the Amish founder population including 127 lipid species not previously tested. To the best of our knowledge, we report for the first time the lipid species associated with two rare-population but Amish-enriched lipid variants: APOB_rs5742904 and APOC3_rs76353203. We also identified novel associations for 3 rare-population Amish-enriched loci with several sphingolipids and with proposed potential functional/causal variant in each locus including GLTPD2_rs536055318, CERS5_rs771033566, and AKNA_rs531892793. We replicated 7 previously known common loci including novel associations with two sterols: androstenediol with UGT locus and estriol with SLC22A8/A24 locus. Our results show the double power of founder populations and detailed lipidome to discover novel trait-associated variants. A GWAS of 355 lipid species in the Old Order Amish founder population reveals associations between Amish-enriched loci and several sphingolipids. [ABSTRACT FROM AUTHOR]

"Excess deaths" is a means to estimate the lethality of COVID-19 (directly and indirectly). Assessing "excess death" in closed religious communities provides information on how COVID-19 impacted these communities. We use obituary information published in an Amish/Mennonite newspaper to examine excess death among the Amish/Mennonites in 2020. Our results indicate the Amish/Mennonite excess death rates are similar to the national trends in the USA. The excess death rate for Amish/Mennonites spiked with a 125% increase in November 2020. The impact of COVID-19 on this closed religious community highlights the need to consider religion to stop the spread of COVID-19. [ABSTRACT FROM AUTHOR]

As Amish and Old Order and Conservative Mennonite (i.e., Plain) farmers increase their presence in the agricultural sector, it is crucial for public sector agricultural professionals to effectively work with them to mediate nonpoint source pollution and address issues like the hypoxic zone in the Gulf of Mexico. However, there is a dearth of research on how public sector agricultural professionals can better work with Plain producers on environmental management. There are also few training resources for those working with this key, yet hard to reach, population. Additionally, due to their religious doctrines, Plain communities strive to live apart from the “world” and may be discouraged from working with government entities and attending non-Plain people events. This study analyzes interview data from 23 Amish farmers in one region of Indiana and 18 public sector agricultural professionals from a variety of backgrounds and geographies in areas of the U.S. with heavy Plain populations. Public sector agricultural professionals identified some key agronomic challenges on Plain farms related to issues like poor pasture and manure management as well as socio-cultural challenges such as restrictions on electronic and phone communication. Educators should design outreach strategies that take into consideration that faith convictions and conservation concerns may vary greatly based on the specificities of the particular Plain church group. By better understanding this population and how to work with them, public sector agricultural professionals can more effectively work towards addressing environmental problems with this under-served group. [ABSTRACT FROM AUTHOR]

Our objective was to develop, deliver, and evaluate a cancer screening intervention focused on rural Anabaptist communities in Ontario, Canada, to increase routine cancer screenings among women. We carried out three cancer prevention and screening interventions with Old Order Anabaptist women. Each intervention consisted of: transportation to the site, pre-arranged screening services, health teachings, fellowship and shopping, and an evaluative survey. Seventy five women total participated over three interventions. 85% of participants were under or never screened for cancer. This was the first breast screen for 26% of those who completed a mammogram and the first colon screen for 29% of the women who took home an FOBT collection kit. Reviews of the intervention were positive. Integration and community based planning were the primary reasons for the success of this cancer screening intervention. Intervention days were best timed in the early spring before planting or late fall after canning. [ABSTRACT FROM AUTHOR]

Motivated by compelling, but scant, literature on high rates of breast cancer mortality among the United States Amish, a survey was conducted to examine mammography-seeking practices among Amish women. Inclusion criteria included age 40-70 years and membership of the Arthur, Illinois Amish community. Data were collected from this unique, socially isolated group through a mail questionnaire focusing on health history, mammography practices, and beliefs surrounding breast health. Sample mammography adherence and 'ever mammogram' rates were compared with both the general population of the United States (U.S.) and other Amish communities in the U.S. Logistic regression on the 'ever mammogram' variable showed that Amish women with knowledge of screening guidelines experienced an adjusted odds ratio (OR) of 5.26 [confidence interval (CI) 1.79, 15.45] for mammography screening compared to those without that knowledge. Participants who believed nutrition/diet causes breast cancer experienced an OR of 4.27 (CI 1.39, 13.11) for mammography and those who believed physical injury caused breast cancer had an OR of 3.86 (CI 1.24, 12.04) compared to women who do not hold these beliefs. Future research is needed to confirm and extend these results. [ABSTRACT FROM AUTHOR]

We performed a health needs assessment for three Plain communities in Lancaster County, Pennsylvania from a random sample of households. Compared with the general population of adults, Plain respondents were more likely to be married, to have children, and they had large families; they were more likely to drink well water, to eat fruit and vegetables, to drink raw milk, and to live on a farm. Plain respondents had better physical and mental health and were less likely to have been diagnosed with various medical conditions compared with the general population of adults in Lancaster County but Old Order Mennonite respondents were more likely to have been diagnosed compared with Old Order Amish respondents. Plain respondents usually have a regular doctor and often receive preventive care but Old Order Mennonite respondents were more likely to have a regular doctor, to receive preventive care, to have had their children vaccinated, and to receive routine dental care compared with Old Order Amish respondents. Despite their relative geographic and genetic isolation, and despite the small, relative differences noted, the health of Plain communities in Lancaster County is similar to that of other adults in the County. [ABSTRACT FROM AUTHOR]

Old Order Amish and Mennonites, or Plain populations, are a growing minority in North America with unique health care delivery and access challenges coupled with higher frequencies of genetic disorders. The objective of this study was to determine newborn screening use and attitudes from western Wisconsin Plain communities. A cross-sectional survey, with an overall response rate of 25 %, provided data representing 2010 children. In households with children (n = 297), the rate of newborn screening was 74 % and all children were screened in 40 % of these households. Lack of access to testing was the most common reason for not screening all children and parental age was inversely associated with testing. The majority of respondents reported some or more knowledge of screening, viewed screening as important, and had access to screening in their communities. Households with children who had never received newborn screening (26 %) reported lower frequencies of favorable responses in all categories compared to households that had at least one child screened. The difference in access to newborn screening was less marked between the groups compared to differences on knowledge and consideration of its importance. Moreover, 55 % of households who had never screened any of their children reported being unlikely or unsure of screening any future children. A focus on improving access to newborn screening alongside establishing approaches to change parental perceptions on the importance of newborn screening is necessary for increasing newborn screening in these Plain communities. [ABSTRACT FROM AUTHOR]

Purpose: The acute host response to histoplasma capsulatum infection varies according to exposure and susceptibility. Late sequelae include calcifications in the lung, thoracic lymphatics, and spleen. Determinants of calcified granuloma formation are poorly studied and may differ from those affecting acute response. We examined the occupational associations and familial aggregation of radiographic calcified granulomatous disease to characterize the determinants of calcified granuloma formation. Methods: We analyzed prospectively collected cross-sectional data including computed tomograms from 872 adult members of the Old Order Amish of Lancaster County. Results: Granulomas were present in 71 % of participants. Granulomas were present in the lung of 57 % of participants, in the hilar or mediastinal lymph nodes of 55 % of participants, and in the spleen of 29 % of participants. No significant differences were observed in the presence of granulomas between men and women. Each year of age was associated with 4 % higher odds of splenic calcifications, and a primary occupation of farming was associated with an 84 % higher odds of splenic calcifications. A compelling pattern of familial aggregation was not observed. Conclusions: Calcified granulomatous disease does not appear to aggregate in families. Determinants influencing patterns of granulomatous disease include occupation, age, and geographic location. [ABSTRACT FROM AUTHOR]

The Amish have cultural practices that include formal education through the 8th grade. This study's purpose was to compare the health literacy among Amish to non-Amish adults living in Ohio Appalachia to understand its potential contribution to poorer health behaviors (e.g. lower cancer screening rates). Amish (n = 143) and non-Amish (n = 154) adults completed interviews as part of a lifestyle study. The rapid estimate of adult literacy in medicine (REALM) instrument (score range 0-66) was used and mean REALM scores were compared ( t test) and correct pronunciation of each word was compared (Chi square test). Significance was considered at p < 0.001 because of multiple comparisons. Mean REALM scores among Amish males (53.3 ± 13.1) and females (56.2 ± 8.6) were significantly ( p < 0.001) lower compared to non-Amish males (61.2 ± 9.8) and females (63.0 ± 6.2). Twelve percent of Amish participants read at or lower than a 6th grade level compared to 2.6 % of non-Amish participants. This study provides a glimpse into how culture may influence health literacy. Many Amish participants had limited or marginal health literacy. Innovative strategies that address inadequate health literacy and specific cultural characteristics are needed to improve health-related behaviors and outcomes among the Amish. [ABSTRACT FROM AUTHOR]

To understand the behavioral lifestyle factors that may contribute to lower cancer incidence rates among the Amish population, this study evaluated differences in physical activity (PA) levels between Amish and non-Amish adults living in Ohio Appalachia. Amish ( n = 134) and non-Amish ( n = 154) adults completed face-to-face interviews as part of a cancer-related lifestyle study. Self-report of PA level was measured by the International Physical Activity Questionnaire (IPAQ) and by a diary of steps/day (pedometer: Digi-Walker SW-200). Total metabolic equivalent tasks (MET) minutes was calculated from the IPAQ and average number of steps/day from a pedometer diary. Amish males walked more steps/day (mean ± standard error (SE): 11,447 ± 611 vs. 7,605 ± 643; P < 0.001) and had a higher IPAQ score (MET min/week) (mean ± SE: 8,354 ± 701 vs. 5,547 ± 690; P < 0.01) than non-Amish males. In addition, Amish farmers walked significantly more steps/day than Amish non-farmers (mean ± SE: 15,278 ± 1,297 vs. 10,742 ± 671; P < 0.01). There was a trend for Amish females to walk more steps/day (mean ± SE: 7,750 ± 477 vs. 6,547 ± 437; P = 0.06) and to have higher IPAQ scores (mean ± SE: 4,966 ± 503 vs. 3,702 ± 450; P = 0.06) compared to non-Amish females. Two measures of PA demonstrated a higher PA level among Amish males, especially farmers, and a trend for higher PA level among Amish females. Higher levels of PA warrants further investigation as one factor potentially contributing to lower cancer incidence rates documented among the Amish. [ABSTRACT FROM AUTHOR]

Cardiovascular disease is a heterogeneous disease caused by the interaction of multiple pathologies affecting various systems, genetic predisposition, and environmental factors. Recently, novel 'non-classic' risk factors have been recognized to play, together with well-characterized risk factors, a role in the pathophysiology of cardiovascular disease. The heterogeneity of causative factors makes identifying the genetic background along with the contribution of environmental influences on the development and progression of cardiovascular disease a major challenge. The Old Order Amish of Lancaster County, Pennsylvania, a close founder population with a very traditional and uniform lifestyle and well-traceable genealogy, is a unique and valuable source of information with respect to the genetic contribution of risk factors that potentially lead to the development of cardiovascular disease. In this review, the major findings from studies of the Old Order Amish are described along with the relevance of these findings to larger population groups. [ABSTRACT FROM AUTHOR]

A qualitative study using McCracken’s (The long interview, 1988) multistage process for data analysis examined how traditional women in Amish, Appalachian, and Mormon cultures express generativity through quilting. Using Slater’s (Journal of Adult Development, 10(1), 53–65, 2003) description of epigenetic areas of development within middle adulthood, quilting was studied as a facilitator in the process of negotiating Erikson’s stage of generativity versus stagnation. In semi-structured interviews, 30 women discussed the ways they expressed caring, pride, inclusivity, and effectiveness through quilting. Results show that quilting was used to work through each of the epigenetic areas and also show how art forms such as quilting may be used to promote development from middle adulthood on into old age. [ABSTRACT FROM AUTHOR]

Diener and Diener (1996; Psychological Science 7: 181–185) suggested that most people are happy, and offered support for this claim from surveys in industrialized societies. We extend their findings to include people who lead materially simple lives and live in cultures far removed from those of typical survey respondents. We found that the Kenyan Maasai, the United States Amish, and the Greenlandic Inughuit, all reported positive levels of life satisfaction, domain satisfaction, and affect balance (more frequent positive emotions than negative ones). Across satisfaction and affect measures, including methods in addition to global self-reports, our 358 respondents from these cultures were one average, positive on all 54 scales, and significantly above neutral on 53 of them. Across all measures and samples 84% of participants scored above neutral. However, nobody was perfectly happy and satisfied, and the groups reported unique configurations of satisfaction and affect. Although all three groups were high in satisfaction with so cial domains, the Amish reported lower satisfaction with self-related domains, and the Maasai and Inughuit were relatively lower in satisfaction with material domains. All three groups reported frequent positive emotions, but only the Maasai reported frequent feelings of pride. Thus, the fact that most people tend to be moderately happy does not mean that they are ecstatic, or that there is no variation across cultures in happiness. [ABSTRACT FROM AUTHOR]

Daniel Callahan's concept of a “sustainable medicine” is examined by looking at experiences Old Order Amish communities have had with organ and bone marrow transplantation. The Amish possess many characteristics that might make them embrace limits on the use of expensive, life-prolonging medical treatments: they believe that the good of the individual should be subordinated to the good of the community, they are suspicious of progress as a goal, and they are more comfortable with dying than many other modern Americans. However, the Amish actively pursue these treatments without the benefit of private or government insurance. Although the Amish affective response to sick individuals is worthy of emulating, their commitment to help individuals obtain and pay for transplants has had negative financial and cultural effects on some Amish communities. The Amish experience can thus teach us lessons about how to care for one another when we are sick and dying, but it can also teach us how difficult but important it is to limit some forms of expensive care for the good of our communities. [ABSTRACT FROM AUTHOR]

An unresolved issue in research on child survival is the extent to which familial mortality risk in infancy is due to biological influences net of sociodemographic and economic factors. We examine the effect of consanguinity on early childhood mortality in an Old Order Amish settlement by using the inbreeding coefficient, an explicit measure of the degree of relatedness in one's ancestry. Inbreeding has a net positive effect on neonatal and postneonatal deaths. We find social, demographic, and population-based sociocultural explanations for this effect among the Amish population which is known to experience certain genetically transmitted defects associated with mortality. [ABSTRACT FROM AUTHOR]