Vitamin and Supplement Use among Old Order Amish: Sex-Specific Prevalence and Associations with Use

Abstract

Background Complementary and alternative medicine (CAM) in the form of vitamin and supplement use is increasingly prevalent in the United States. The interplay between CAM use and use of conventional medications is not well studied. We examined this issue in the Old Order Amish (OOA), a population lacking several factors known to influence supplement use, whose culture and barriers to conventional medications may result in high rates of supplement use. Objective We characterized the patterns of supplement use in the OOA, including the extent to which CAM use aggregates in families, and assessed whether higher use of supplements is associated with lower medication use. Design We conducted a cross-sectional study of conventional medications and supplements in 2,372 adult Amish from the Lancaster County, PA area. Data were collected through face-to-face interviews. Supplements were subcategorized as herbal versus vitamin/mineral supplements. Results Seventy-seven percent of all Amish adults reported current supplement use, whereas 22% reported medication use. Women used supplements more often and used more supplements than men, and familial aggregation of supplement use was stronger in family pairs involving women. Supplement use was associated with lower medication use after controlling for age, sex, BMI, and self-reported histories of hypertension, diabetes, and hyperlipidemia (adjusted OR 0.96, 95% CI 0.92 to 1.00, p=0.047). This association was driven primarily by use of herbal supplements (adjusted OR 0.94, 05% CI 0.89 to 0.99, p=0.025) as vitamin/mineral supplements were not associated with different use of medication (adjusted OR 0.99, 95% CI 0.90 to 1.09, p=0.8). In analyses limited to cardiovascular medications and cardiovascular supplements in participants with hyperlipidemia, hypertension, or diabetes, supplement use was not associated with conventional medication use. Conclusions The Old Order Amish take dietary supplements much more frequently than they use conventional medications, particularly women. Use of herbal supplements is associated with less use of conventional medications whereas vitamin/mineral supplement use is not.

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

“…The observation of paradoxically lower heart rates in men in and absence of association women exposed to secondhand smoke is not easily explained, although a murine model has shown estrogen to modulate chronotropic effects of nicotine[39]. Notably, the possibility of confounding attributable to use of medications that would affect the heart rate is possible but unlikely in our cohort as medication use is not common in the Amish, with rates of beta blocker use under 5%[40]. Smoking has been associated with insulin resistance and increased risk for the development of type 2 diabetes in both men and women[6, 32, 41, 42]with an apparent dose-reponse relationship.…”

Health Priorities and Health-Seeking Behaviors of Old Order Anabaptists in Southern Ontario With Emphasis on Cancer Screening

“…Little is known about the reason(s) for low cancer-screening rates among the Old Order Anabaptists. One possibility is low health literacy (Katz, Ferketich, Paskett, & Bloomfield, 2013) and reduced “English” health care–seeking behaviors given the unique health beliefs of Old Order Anabaptists (Dabrowska & Bates, 2010; Gillum et al, 2011; Reed et al, 2015; Sharpnack, Griffin, Benders, & Fitzpatrick, 2010; Sharpnack, Quinn Griffin, Benders, & Fitzpatrick, 2011). For example, Old Order Mennonites do not utilize the Ontario Health Insurance Program (universal health care program), and instead pay for health services “out-of-pocket” because they believe accessing any insurance undermines their core socioreligious value of mutual assistance (Gesink et al, 2014).…”

“…However, they also have worse physical health (Fisher, Newbold, Eyles, & Elliott, 2013) and more childhood injuries (Forward et al, 2010; Jones & Field, 2002; Kraybill & Gilliam, 2012) than the general population, the latter likely due to farm living. Many communities have developed injury prevention interventions in response to childhood injuries (Burgus & Rademaker, 2007; Jones & Field, 2002), many Old Order Anabaptists use vitamin supplements (Reed et al, 2015; Sharpnack et al, 2010) and complementary and alternative medicine (Reed et al, 2015; Sharpnack et al, 2010; Sharpnack et al, 2011) to stay healthy, and will participate in targeted Older Order Anabaptist women’s health and integrated cancer-screening interventions (McBride et al, 2016).…”

Long-term exposure to particulate air pollution and brachial artery flow-mediated dilation in the Old Order Amish

“…Further details of the HAPI Heart Study are available elsewhere [16]. Briefly, the HAPI Heart Study was a community-wide study of clinically healthy individuals aged 20 years and older with the following major exclusions: currently pregnant or < 6 months post-partum, blood pressure at the time of screening > 180/105 mmHg, and unable or unwilling to safely discontinue medications potentially affecting study outcomes (prescription medication use has been documented to be lower among this population than the general population [24]). A total of 868 participants were enrolled in the HAPI Study from 2003 to 2006, of whom endothelial function was assessed on the exam day by FMD in 615 participants (some of whom in family groups) in the present analysis.…”