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Running Head: THE AMISH OF LANCASTER COUNTY

The Amish of Lancaster County

Annette Ramos, Patricia Luisi, Chinenye Okonkwo
Cedar Crest College

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THE AMISH OF LANCASTER COUNTY
Abstract
Three nursing students from Cedar Crest College performed an epidemiological study on the
Amish Community of Lancaster County, PA. The information contained herein is divided into
three sections: 1) Windshield Survey, 2) Data Collection, and 3) Epidemiology. A nursing
diagnosis was created in response to the information gathered and preventative primary,
secondary, and tertiary nursing interventions were created to address this problem.
Keywords: Amish, Lancaster County, PA, Windshield Survey, Epidemiology

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THE AMISH OF LANCASTER COUNTY
Windshield Survey
Community health nursing grants the professional nurse the opportunity to work with a
tremendous variety if individuals and families. While performing in any community setting,
different aspects of care may be approached from many levels depending on the individuals
primary language, environment, level of intelligence, or cultural background. As such, it is
important that nurses analyze each communitys strengths and weaknesses. A tool used to
achieve this analysis is a Windshield Survey, which is a head-to-toe assessment describing
details about 18 specific components of a particular community.
Overall Impression
Lancaster County presented itself as a pleasantly serene environment. There were many
acres of green, grassy farmland and cornfields surrounding the area. The aroma of the
environment was a mix of fresh air, vegetation, and manure. Families were made up of the young
and the elderly. The area was filled with beautiful colonial-looking homes, large dairy farms, and
farmers markets. The sounds of the environment consisted of wind rustling leaves, chirping
birds, and the occasional sound of a moving vehicle.
Boundaries
Lancaster County is bounded to the west by the Susquehanna River Water Trail; north by
Interstate 76; east by Chester County; and south by the Mason-Dixon line. Most notably, U.S.
Route 30 is the main artery running through Lancaster County followed by I-76, U.S. Route 222,
322, and 340. Strasburg Township situated in the southeastern portion of the county contains
most of Lancasters railroad stations.

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THE AMISH OF LANCASTER COUNTY
Housing
Most homes were brick, while others contained a more updated appearance with exterior
vinyl siding. Large, colonial family homes which looked about a century old (if not older) were
well maintained with perfectly manicured lawns. Non-Amish homes are modern and easily
identifiable by the vehicles which sit in their driveways and the power lines running from street
poles to the houses. Conversely, Amish homes were distinguished by the car-less driveways, lack
of electrical power cables, and clean clothes hanging on clotheslines outside.
Open Space
The Amish areas within Lancaster County are filled with wide open spaces, green, grassy
rolling hills, cornfields, and farmlands, interspersed with pockets of trees spread throughout
different areas of the community. The atmosphere was peaceful and quiet. It appears to be a safe
environment that is perfect for tourism, and an ideal location to raise a family. The roads were
paved black-top that rolled and turned with the contours of the many hills. While the roads were
open and easily traveled by car, traveling on foot is another story, as there were few sidewalks or
crosswalks for pedestrians to safely travel.
Commons
Recreation takes place most evenings after dinner. Families congregate to relax after the
days hard work, with the children running and playing outside. Visitation amongst friends and
family is prevalent in the Amish community.
Transportation
The most apparent modes of transportation for the Amish were horse-drawn buggies,
push-scooters, and walking (although one Amish family was seen entering a taxicab at a local
hospital during this survey). Encountering a horse-and-buggy vehicle is not uncommon while

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THE AMISH OF LANCASTER COUNTY
driving in the area. Bus and train services seen in the area were the Red Rose Transit Authority
and Amtrak, respectively.
Social Services
Leisure activities range from telling stories, card playing, reading, sports, and quilting.
Should residents wish to go hunting or fishing, there are several PA State Game Lands within the
vicinity. Nestled along the Susquehanna River, the Susquehannock State Park provides plenty of
activities by which people can get in touch with nature.
Lancaster General Health and Ephrata Community Hospital are located within the
vicinity. A local Amish newspaper contained an advertisement for the Ronald McDonald House
Charities mobile dental unit, which was said to provide annual pediatric dental care for Amish
community members.
Stores
Traveling through town, many small Amish stores can be found selling such things as
handmade furniture and crafts, and fresh farm produce. There are several bed-and-breakfasts,
and stores which sell home-cooked meals. Personal gardens were abundant, and produce is
grown, seemingly for sale as well as personal consumption. Millers grocery was located within
easy distance of many Amish residents, and seemed like a popular store among them.
People and Animals
Men, women, and children can be found working on the farmlands, or traveling about on
the roads performing other daily activities. Horses are the prevalent animals seen on the streets
due to their use in transportation. Typical farm animals such as cows, goats, donkeys, lambs, and
hens can be seen within fenced areas of farmlands.

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THE AMISH OF LANCASTER COUNTY
Condition of the area
In general, the community is clean and well-kept, although horse droppings are common
on the roads. There are no abandoned cars or dilapidated buildings. Signs are present in front of
some houses indicating that the owners of that house have items for sale. Street signs such as
Horse and Buggy Crossing were present, as were historical landmark placards. Within the
densely populated Amish settlements, billboards are few and far between. Those which are
present advertise the local buggy rides and restaurants.
Race and Ethnicity
The Amish are 100% Caucasian of German descent. Their languages include
Pennsylvania Dutch, English, and High German. Throughout the county, the most prevalent
races observed include: Caucasian, Hispanic, African American, and a diminutive Asian
population. All roadway and personal signage are posted in English.
Religion
While many churches were seen throughout the area, we could identify none which
appeared outwardly and specifically Amish.
Heath Indicators
Lancaster General Health and Ephrata Community Hospital are the two health centers
residents utilize when needed. Mental health services can be obtained at Philhaven in Mount
Gretna, PA, which is a local Mennonite-based facility. Local midwives provide family planning
and women's health services. The Clinic for Special Children in Strasburg, PA provides primary
care to Amish children with genetic disorder.

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Politics
Little to no evidence of any type of political action or affiliation could be identified.
Media
It seems the Amish believe in leading a simple life; electricity, televisions, radios,
telephones, or other electronic devices were not seen in our travels amongst them. Popular
reading material found was the local Amish newspaper Die Botschaft (The Message), The
Dairy, Amish Country News, and The Budget. Library books are available through an Amish
messenger service.
Business/Industry
The majority of the areas industry is light industry. Crops commonly include corn,
tobacco, alfalfa, and various grains. Entrepreneurs have started small businesses such as mobile
carpentry crews, farmers markets, and boutiques selling quilts, shoo-fly-pies, jam, and
homemade tchotchkes.
School System
No specific school system for Amish children was apparent. Whether they attend public
school (or whether they have their own system) could not be ascertained from our visit.
Health Hazards
As with any laborious enterprise, family farming harbors much potential for injury. Silos,
water tanks, milk vats, grain bins, and manure pits present many hazards, saucy as poisoning,
drowning, or suffocation. Highway traffic through town poses a significant threat to safety where
there are no sidewalks or streetlights. Air quality appeared normal and no evidence was found of
garbage cans or dumpsters.

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THE AMISH OF LANCASTER COUNTY
Safety
Police and fire stations are located in each township. Roadway signs caution drivers to be
alert for horse and buggy crossing. To improve safety when traveling, reflective stickers, slowmoving-vehicle signs, and caution lights are required on all horse-drawn vehicles. Speed limit
signs, stop signs, and traffic lights were visible and seemed appropriately placed.

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THE AMISH OF LANCASTER COUNTY
Data Collection
Nursing students conducted a data collection on the residents of the Amish community
residing in Lancaster County, Pennsylvania. Analysis of data will provide an in-depth look into
the health of the residents and the environment in which they live, subsequently enhancing the
ability to provide high quality, patient-centered care. Additionally, the statistical reporting
contained herein may be addressed in varying ways to provide the most inclusive, recent, and
relevant statistics for the Amish community in Lancaster County. In the event statistics for the
community were not available, comparisons are made between the Lancaster County general
population and the State of Pennsylvania.
Biophysical
The median age for the residents in Lancaster County is 38.0 years and the median age
for the residents of Pennsylvania is 40.1 years. In comparison, the statistics are relatively close.
Table 1 provides an in-depth analysis between the age of the population of Lancaster County and
that of the State of Pennsylvania. Quantitative data regarding the age of the Amish population is
not available.
The birth rate among women of all ages in Lancaster County is 70.0 per 1000 births and
the birthrate among women of all ages in Pennsylvania is 58.3 per 1000 births (Pennsylvania
Depth of Health, 2012). It shows that the birth rate in Lancaster County is higher.
The death rate per 1000 deaths is 9.7 in the State of Pennsylvania and the death rate for
Lancaster County per 1000 deaths is 8.4 (Pennsylvania Department of Health, 2012). There is a
slight difference in the death rate, with Pennsylvania death rate being higher than Lancaster
County. Quantitative data regarding birth and death rates of the Amish population are not
available.

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Table 1
Age of Population in Lancaster County, PA versus the State of Pennsylvania
Age

Lancaster County

Pennsylvania

Under 18 years

24.8

22.0

18 to 24 years

9.7

9.9

25 to 44 years

24.0

24.6

45 to 64 years

26.4

28.0

65 years and over

15.0

15.4

Source: U.S. Census Bureau (2012a)

Table 2 indicates that the largest racial group of people living in Lancaster County is
Caucasian. Quantitative data regarding the racial makeup of the Amish population is not
available.
Table 2
Population by Race in Lancaster County, PA versus the State of Pennsylvania
Race and Ethnicity

Lancaster County

Pennsylvania

White alone

91.0

83.2

Black /African American alone

4.7

11.5

American Indian/Alaskan

0.4

0.3

Asian alone

2.1

3.1

Native Hawaiian

1.8

1.8

Hispanic or Latino

9.5

6.3

White not Hispanic or Latino

83.6

78.4

Source: US Census Bureau (2012a)

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Lancaster County has a gender ratio of 95.6 males per 100 females and the state of
Pennsylvania has 95.1 males per 100 females. In summary, there are more females than males in
the state of Pennsylvania as a whole (US Census, 2012b, 2012c). Quantitative data regarding the
gender rates of the Amish population are not available.
The Pennsylvania Department of Health (2012) reports that Lancaster County had high
incidences of Chlamydia (233.5), Lyme disease (5.9) and Varicella (17.8) per 100,000 people
with selected reportable diseases; while Pennsylvania experienced fewer rates per 100,000 with
Chlamydia (108.6) and higher rates of Lyme disease (81.7), and Varicella (21.3). Quantitative
data regarding incidence of reportable diseases of the Amish are not available.
The infant mortality rate for Lancaster County is 7.0 per 1000 live births and for the State
of Pennsylvania is 7.3 per 1000 live births. The mortality rate is lower in Lancaster County.
Psychological
Founded in the 1700s, Lancaster County (otherwise known as the Pennsylvania Dutch
Country) is the oldest existing Amish settlement in the country. The Amish roots can be traced
back to the 16th century Europe (Amish Studies, 2014). A group of people known as the
Anabaptists broke off from the Catholic and Protestant churches in Europe due to disparity in
beliefs. Religious persecution from the Catholic and Protestant churches eventually led to the
migration of the Anabaptists to Lancaster County in Pennsylvania in the 1720s (Amish Studies,
2014). Jakob Amman, founder of the Amish, broke off from the Mennonites stemming from the
belief that they were not stringent enough in their principles. Jakob Amman believed that the
Mennonites should wash each others feet, embrace simple grooming, and practice strict humility
(Byers, 2008). The conviction of his belief in spiritual purity led to the birth of the Amish
community.

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Partnerships with the local hospitals and doctors offices are fostered, but they are under
utilized because the Amish generally do not encourage health visits until they are very ill. This is
at least partially due to the cost of healthcare, which is a concern to the Amish. Farming has
been the Amish way of life since the days of their European predecessors; it is deeply rooted in
their cultural psyche (Byers, 2008). As such, any forces that threaten to disrupt this lifestyle
would count as major stressors within their community. As Lancaster County continues to
urbanize, the ratio of agriculturally fertile land diminishes, leaving the younger generations to be
forced to find work elsewhereeven among society at large (Amish Health Focus Groups
Summary of Findings, 2009). Furthermore, as the Amish population grows, existing farms are
often divided up to accommodate the needs of younger generations. If a family farm is too small
to divide, then families may split apart, with the break-away members potentially forming a
community elsewhereeven in a different state (P. Luisi, personal communication, September
12, 2014). Another stressor comes in the form of ever-increasing government regulations that
place a financial burden on some Amish farms by forcing expensive modernization and
upgrades.
Protective services for the community include volunteer firefighter units (some of which
are staffed by Amish men) and a number of EMTs (Lancaster online, 2012). The Amish
volunteer their time and service to their local ambulance and fire stations. Funds for running
these services are generated by mud sales, which are major fundraisers for the volunteer fire
companies throughout Amish communities. (Lancaster County, 2014) The Amish utilize the
local police department.
The Amish community is very close knit with several generations living together in a
home and practice looking out for each other (Amish Country News, 2006). In the event of a

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flood or fire, the Amish community reaches out to the victim by helping with clean up and
rebuilding. The traditional Amish barn-raising illustrates the power and meaning of community
in practical ways as hundreds of people converge to erect a new structure in a single day (Amish
Studies, 2014).
Communication within the Amish community differs from that of mainstream culture.
Their beliefs do not permit the ownership of a phone line in individual homes. The ban on
telephone ownership was established due to the Amish belief that it conflicts with the spirit of
humility, contributes to pride and individualism, is not a necessity, and is a link to the outside
world. There was also concern that the phone removed people from the physical, face-to-face
communication so important in Amish society (Lancaster County, 2014). The ban is limited to
telephone ownership, as the Amish are not restricted from telephone use. Telephones are placed
in community buildings and used strictly for important calls and not as a means to socialize.
Quantitative data regarding the specific crime rates of the Amish population are not
available. However, some sources report Amish people committing such crimes as DUI offenses
(biking or buggy driving while intoxicated) and killing endangered animals (Hambright, 2014).
One Amish man was sent to jail for a three year sexual relationship with a minor (Hambright,
2011). Sometimes, Amish communities are victimized by the criminal acts of others, such as the
2006 shooting of 11 people and killing 5 girls in a public school in the Amish community in
Lancaster County (Kocieniewski & Gately, 2006) shook the entire community.
Table 3 lists crime rates in Lancaster County compared to the state of Pennsylvania in
number of incidents per 100000 population.

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Table 3
Crime rate in Lancaster County, PA versus the State of Pennsylvania
Crime Rates

Lancaster County

Pennsylvania

2.1

5.4

Robbery

445.0

142.4

Assaults

2830.1

2166.3

Criminal homicide

Source: U.S Department of Justice (2012).

Environmental
Lancaster County is located in the southeastern portion of the state and is approximately
27.2% urban and 72.8% rural (U.S. Census Bureau, 2012b). According to Kraybill, Nolt, and
Johnson-Weiner (2014), Pennsylvania has 67,045 Amish residents, of which 32,900 reside
within Lancaster County. Although statistics vary slightly, Kraybill et al. (2014), find that the
Amish population doubles every 20 years and [they] dont expect this to change any time soon.
Family size and the retention of its members are thought to explain this continued growth
(Kraybill et al., 2014).
In comparison, the State of Pennsylvania has 12,702,379 total residents, of which
519,445 reside in Lancaster County, with an expected increase of 0.6% and 2% respectively
(U.S. Census Bureau, 2012b, 2012c). Persons per square mile in Lancaster County and the state
respectively are 550.4 and 283.9 (U.S. Census Bureau, 2012b, 2012c).
Situated at 40.067669N and -76.281219W, Lancaster County is 368 feet above sea
level, and makes up an area approximately 946 square miles (U.S. Geographic Survey, 2013).
Peaks, low broad hills, and karst valleys that range between 60 to 700 feet above sea level
characterize this area. Underlying rock is predominantly limestone and dolomite, and its

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structure is complexly folded and faulted (U.S.G.S., 2013). The surface drainage is dendritic,
meaning that it has a branched form resembling a tree. Lancaster County lies almost entirely
within the Lower Susquehanna Sub-basin (which forms part of the Susquehanna/Chesapeake
Basin), where the Susquehanna River drains all but a small portion of the county.
Climate fluctuates seasonally. On average, the warmest month is July with temperatures
climbing as high as 103F (City Data, 2013). Conversely, January is the coldest month averaging
22 F (City Data, 2013). Precipitation is highest between July and September averaging 4.6
inches per month (City Data, 2013). Humidity level is 75% on average yearly with wind speeds
cresting in March at 10 MPH (City Data, 2013). Snowfall accumulation peaks around 9 inches in
late-January, while sunshine averages 58-69% throughout the year (City Data, 2013).
The usual and customary appearances of homes amongst the Amish are large, colonial
farmhouses and are differentiated from English homes (as the Amish would call them) by the
lack of utilities servicing the property (A. Ramos, personal conversation, September 12, 2014);
not to mention the occasional horse and buggy in the driveway. Quantitative data regarding
housing was not available for the Amish community. In Lancaster County the median home
value is $193,200 compared to $164,700 for the State (U.S. Census Bureau, 2012b). Median
gross rent values in Lancaster are $853 compared to $794 for the State (U.S. Census Bureau,
2012b, 2012c). Table 4 provides an in-depth comparison of housing between Lancaster County
and the State.
Lancaster County Water & Sewer District (LCWSD) and Catawba Water Treatment Plant
provide over 90% of water services to the area. The 2014 annual drinking water report performed
by LCWSD revealed no violations during January 2013 through December 2013. Trace levels of
fluoride 0.7 parts per million (ppm), nitrate 1.1ppm, lead 4.0ppm, copper 0.12ppm, and chlorite

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THE AMISH OF LANCASTER COUNTY
0.34ppm, all of which are within normal range (LCWSD, 2014). For residents without the
aforementioned service, independent wells, local water systems, and onsite sewage disposal are
utilized. Much of the regions water supply originates from ground water sources, the
Susquehanna River, and the Conestoga River.
Table 4
Housing Units in Lancaster County, PA versus the State of Pennsylvania
Housing Units

Lancaster County

Pennsylvania

Total Housing Units

202,800

5,563,832

Occupied

193,306

4,959,633

Owner

135,310

3,478,602

Renter

57,996

1,481,031

Vacant

9,494

604,199

% Renter Occupied

30%

29.9%

% Owner Occupied

70%

70.1%

Source: U.S. Census Bureau (2012a)

The 2013 American Lung Associations State of the Air report gave Lancaster county an
F for ground-level ozone pollution, with the weighted average number of unhealthy air quality
days being eight over the sampling period, and a 24-hr Particle Pollution grade of D, with a
weighted average number of unhealthy air quality days totaling three.
Nuisances within the community mainly revolve around farming practices such as odor,
noise, dust, and slow moving farm vehicles. As Amish families continue to expand, the amount
of land available for use decreases. Conflicts with neighbors arise when the Amish need to build
larger horse boarding facilities, barns, and add additions to their homes. Although they are

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THE AMISH OF LANCASTER COUNTY
building on private land, zoning ordinances determine how large and where they can build.
Farmers also have problems with carrion fowl stealing their free-range chickens, which leads to
farmers taking matters into their own hands by hunting down the scavengers for themselves
(Crable, 2013).
Potential natural disasters include floods, winter storms, hurricanes, and severe storms
(City Data, 2013). Out of 13 natural disasters recorded in the countys history, 10 were
presidentially declared, with the remaining three declared by the local authority (City Data,
2013). Tornado activity is above the state average with 31 recorded from 1950 until 2012 (Leitz,
2014). Earthquakes are also above the state average with a total of six occurring between 1990
and the present day (City Data, 2013).
Sociocultural
The Amish community believes in the separation of church and state (Kraybill et al.,
2014). They do not believe in receiving subsidized help from the government, nor do they
believe in purchasing any form of insurance. This community feels that relying on government
aid contradicts the belief that god will care for their community (Kraybill et al., 2014). Like all
Americans, the Amish are required to pay state, federal, real estate, and public school taxes;
however, they are not required to pay social security taxes since (to the Amish) this is considered
a form of insurance. Voting is very low in this community, however members of the Amish
community will vote if there is an issue that relates to their population (Kraybill et al., 2014).
Amish people speak in a dialect known as Pennsylvania German (also known as
Pennsylvania Dutch); they also speak English (Wesner, 2010). Only 10-15% of Pennsylvania
Dutch vocabulary is derived from the English language (Kraybill et al., 2014). The Amish are
said to speak Pennsylvania Dutch during church sermons and amongst their own community;

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however, reading and writing is done mostly in English. The Dutch dialect is important to the
Amish because they believe it distinguishes them from the outside world (Wesner, 2010).
Amish beliefs are centered on Christian faith. This community places high importance on
their religious rituals of baptism and communion. Baptism usually occurs between the ages of
18- 22 years of age (Kraybill et al., 2014). Individuals who decide to move forward with Baptism
are committing themselves to a higher form of Christianity known as the Ordung (Wesner,
2010). Ordung is the German word for order or discipline, which serves as the guidelines of
Amish Christian values (Wesner, 2010). The Amish hold their religious services in the comfort
of their own homes. The community members take turns rotating between homes, while meeting
every other Sunday of the week (Kraybill et al., 2014).
In 1972 it was determined by the Supreme Court that Amish communities could not be
forced into receiving a high school education. This would allow the community members to end
their education by the 8th grade. The Amish of Lancaster have church-funded schoolhouses that
are within walking distance of their residences. Children are educated on basic skills such as
reading, writing, spelling, basic math, English, and German (Lancaster County, 2014). The
Amish believe that an education above the 8th grade may cause their youth to think outside of the
traditional Amish faith. It is also more practical for them since the majority of their work is craft
or agricultural in nature (Wesner, 2010). No quantitative data regarding the education of the
Amish community was found. However, information on the percentages of education levels in
Lancaster County and Pennsylvania (as a whole) are presented in Table 5.

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Table 5
Education Levels of Lancaster County, PA versus the State of Pennsylvania
Education Level

Lancaster County,
Percent %

Pennsylvania, Percent %

General College

23.8

28.5

Elementary School (1-8)

46.1

39.4

High School (9-12)

20.3

21.1

Completed High School

83.6

89.2

Completed Bachelors

26.1

28.7

Completed Graduate School

8.9

11.2

Source: U.S. Census American Fact Finder (2013)

The Amish of Lancaster County earn their income through farming, light manufacturing
(such as crafts & repairs), furniture shops, carpentry, and retail stores (Lancaster County, 2014).
Many of them work on crop farms or dairy farms, making farming one of the most prevalent
forms of income for the Amish (Wesner, 2010). In Lancaster County, Amish families may
generate income by other means than farming, such as through farmers markets, Amish tourist
gift shops, or carpentry work. There was no available data on the average annual incomes for the
Amish communities of Lancaster County or Pennsylvania. A general breakdown on the annual
incomes for the populations in Lancaster County and Pennsylvania are provided instead.
Farming is not always the vocation of choice for individuals in the Amish Community.
Many members own their own shops or small family businesses. The men may own businesses
related to wood products such as for furniture or small barns, and women may own small
quilting businesses. Being a construction worker is not uncommon among Amish men (Kraybill
et al., 2014). In Lancaster County Amish construction workers typically build homes, barns, or
other small houses for their community. Quantitative data regarding the Amish communities of

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THE AMISH OF LANCASTER COUNTY
Lancaster and Pennsylvania were not available. The percentages of general employment rates for
Lancaster County and Pennsylvania State populations are presented in Table 7.
Table 6
Income Distribution for Lancaster County, PA versus the State of Pennsylvania
Income Bracket per 1,000

Lancaster County, PA,

Percent %

Pennsylvania, Percent %

Income >200K

3.0

4.0

150-200K

3.8

4.3

100-150K

13.1

12.4

75-100K

14.5

12.5

50-75K

21.5

18.7

35-50K

15.0

13.9

25-35K

10.1

10.6

15-25K

10.0

11.0

< 10K

4.6

7.0

Median Income (dollars)

$56,172

$52,267

Mean Income (dollars)

$69,459

$70,243

Source: U.S. Census Bureau (2012c)

Due to religious beliefs, Amish residents are prohibited from owning any form of
motorized vehicle (they may, however use public transportation). The horse and buggy is the
most popular form of travel for the Amish of Lancaster County. To the Amish, the buggy is
another symbol that sets them apart from modern society (Wesner, 2010). Families typically own
at the least one buggy. Owning a car is not welcomed in the Amish community; however,
traveling as a passenger may be permitted if necessary for long trips or emergencies (Wesner,

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THE AMISH OF LANCASTER COUNTY
2010). Lastly, the scooter is a popular means for short distance trips within the Amish
community of Lancaster County (Wesner, 2010).
Table 7
Employment by Industry for Lancaster County versus the State of Pennsylvania
Industry

Lancaster County, Percent %

Pennsylvania, Percent %

Construction

7.0

5.7

Manufacturing

17.0

12.2

Financial

4.3

6.5

Retail

13.1

11.9

Administration

7.7

9.9

Warehouse

4.2

5.0

Education, Health, Social

Services

23.7

25.7

Source: City Data (2013)

Family is very important to the Amish. Families are usually large; having 7-8 children is
very common (Lancaster County, 2014). It is said that four out of five Amish children commit in
moving forward with baptism, making this one of the reasons Amish have such large families
(Lancaster County, 2014). Gender roles are another major factor in family structure. Husbands
take on most of the financial responsibilities, and manage religious matters, while the wives
handle the housekeeping and children (Kraybill et al., 2014). Data regarding the family structures
of the Amish communities in Lancaster County and Pennsylvania (as a whole) were unavailable.
Table 8 compares the different family structures for Lancaster County and Pennsylvania.

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THE AMISH OF LANCASTER COUNTY
Table 8
Family Structure for Lancaster County, PA versus the State of Pennsylvania
Family Structure

Lancaster County, PA,

Percent %

Pennsylvania, Percent %

Have Children

28.0

25.4

Married

58.3

47.7

Live with Non-Family

29.7

36.2

Live Alone

10.1

12.9

Never Married

29.3

33.6

Now Married

55.7

47.6

Separated

1.7

2.2

Widowed

5.6

6.9

Divorced

7.6

9.7

Average Household Size

2.65 persons

2.50 persons

Average Family Size

3.17 persons

3.13 persons

Source: U.S. Census Bureau (2012a)

The Amish of Lancaster County offer a variety of goods and services to their community
members, public consumers and tourists. Amish-made furniture, quilts, and other forms of
crafted materials are among the most popular products sold for profit (Lancaster County, 2014).
Organic produce sold in the farmers markets throughout the Lancaster area is another example
of goods offered to their community members, as well as the general public (Wesner, 2010).
Behavioral
The Amish diet consists of many home-grown fruits and vegetables. Animals such as
chickens, cows, and pigs (commonly owned by the Amish) are also sources of protein consumed
by this population (Wesner, 2010). Meals are described as hearty and filling with Dutch

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THE AMISH OF LANCASTER COUNTY
styled foods known as pot pies, butter noodles, and chicken corn soups (Wesner, 2010).
Baked goods such as shoofly pies, whoopie pies, cookies, and breads are a few other important
desserts enjoyed by the Amish community (Wesner, 2010). Quantitative data regarding nutrition
amongst the Amish is not available.
Some members of the Amish community enjoy making their own wines (Wesner, 2010).
Most of the individuals of this community drink wine during their religious communion rituals.
Wine can be consumed for health benefits or simple enjoyment. Generally speaking, the Amish
are open to the consumption of alcoholic beverages (Wesner, 2010). Quantitative data regarding
alcohol use amongst the Amish is not available.
It is said that few individuals in the Amish community smoke; the ones who do are
usually known as conservative Amish (Wesner, 2010). Still, smoking is considered very
uncommon among the Amish, and as for the ones who do smoke, they are typically said to
smoke from a pipe or cigar. Cigarette smoking among the Amish is very unusual because such
an activity is considered too worldly for their beliefs (Wesner, 2010). Tobacco is a common
buffering crop grown by Amish during the winter; however, it is a controversial topic within the
Amish community (Wesner, 2010). Quantitative data regarding tobacco use amongst the Amish
is not available. Although, through personal observations made by the nursing students, tobacco
products are sold at the local grocery stores.
Forms of exercise can be expressed through sports activities such as softball, volleyball,
basketball, and street hockey (Wesner, 2010). Many among the Amish community appreciate
different sports, while others feel that such activities are childish behaviors (Wesner, 2010).
Outdoor activities are another form of exercise enjoyed by the Amish. Such activities consist of

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THE AMISH OF LANCASTER COUNTY
things such as birding, nature walks, and hunting among Amish men (Kraybill et al., 2014).
Quantitative data relating to exercise is not available for the Amish residing in Lancaster County.
Recreational activities are usually centered on the outdoors (Kraybill et al., 2014). Once
again, sports are a common activity enjoyed by the Amish, and mainly by the younger males.
Amish women enjoy quilting as a past time, and as a form of work (Lancaster County, 2014).
The most enjoyable form of leisure is socializing and visiting friends and family members
(Kraybill et al., 2014). Amish families may also treat themselves out to a local restaurant on
certain special occasions (Kraybill et al., 2014). Quantitative data relating to leisure activities
was not available for this population.
Horse drawn buggy safety is one of the most common concerns among the Amish
community in Lancaster and throughout Pennsylvania. For the protection of the Amish buggy
drivers (and automobile drivers) the buggies are marked with what is known as an SMV
triangle, which alerts other drivers to stay cautious (Wesner, 2010). Another safety concern
regards Amish attitudes towards telephone use. Some communities allow for the presence of a
communal phone to be used for emergencies, but others do not. Those who allow it install them
in small houses that are similar to personal telephone booths (Lancaster County, 2014). Partnered
with the Amish Safety committee and the Lancaster County Safe Kids Coalition, Lancaster
General Health provides free farm safety camps twice a year.
Health Systems
Lacking healthcare professionals amongst themselves, illness is generally treated with
rest and herbs (personal conversation with local Amish resident). Lancaster General Health and
Ephrata Community Hospital are centrally located to the majority of Amish settlements and have
built trusting partnerships with the Amish residents. The Pennsylvania Department of Health

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THE AMISH OF LANCASTER COUNTY
provides bi-annual outreach programs within the Amish community on topics such as safety,
health promotion, and nutrition. Ronald McDonald House Charities mobile dental unit provides
pediatric dental care annually at no cost. Quantitative data is unavailable to represent the
accessibility to health services for Amish residents of Lancaster County. Mental health services
can be accessed at Philhaven in Mount Gretna, PA, a local Mennonite-based facility. Local
midwives provide family planning and womens health services. The Clinic for Special Children
in Strasburg, PA is a non-profit organization that provides primary care to Amish children with
genetic disorders.

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THE AMISH OF LANCASTER COUNTY
Amish Epidemiology
Populations that are secluded from outside communities are said to have an increased
incidence of genetic disorders (Strauss & Puffenberger, 2009). These populations have a higher
chance of inbreeding ultimately causing a low genetic diversity within their community
(Strauss & Puffenberger, 2009). The narrow gene pool within the Amish residents of Lancaster
County Pennsylvania cause for a higher incidence of genetic mutations, some of which are
unidentifiable in nature. Utilization of primary, secondary, and tertiary nursing interventions can
have a positive impact on the overall health and future within this group of individuals.
Nursing Diagnosis
In order to identify the proper nursing interventions within the Amish residents of
Lancaster County, Pennsylvania, a nursing diagnosis has been recognized. The priority nursing
diagnosis identified within this community is:

Risk of congenital anomalies among Amish children in Lancaster, Pennsylvania related

to intermarriage amongst the same genetic pool.
Effect of the Problem on the Community
The effects genetic disorders have within the Amish of Lancaster range depending on the

severity of the medical condition. Among the Amish, more than 100 separate genetic disorders
have been identified (Cross & Crosby, 2008). The extent of these genetic disorders do not only
affect Amish individuals, but they can also affect outside (non-Amish) communities when Amish
children leave their families allowing mutations to disburse into outbred populations (Strauss
& Puffenberger, 2009 pp. 525).
Many Amish children with genetic disorders remain without diagnosis (Strauss &
Puffenberger, 2009). Forty percent of genetic disorders are labeled as nonspecific medical

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THE AMISH OF LANCASTER COUNTY
problems by physicians who are unable to diagnose the condition, and only 12% of disorders are
actually recognized by state newborn screening (Strauss & Puffenberger, 2009). This alone
causes a problem in identifying and treating the medical conditions. Of the known genetic
defects, glutaric aciduria type 1 (GA1), which is an autosomal recessive metabolic disorder, is
the most common. The GA1 disorder sparked the interest of Dr. Holmes Morton, a geneticist
who was intrigued enough about the severity of the disease in the Amish of Lancaster County
that he opened up a clinic in Lancaster County, PA (Tell, 2012). Even though these disorders are
individually rare, in the aggregate they account for a significant amount of pain and suffering
(Cross & Crosby, 2008). The Amish are relatively slow to seek out care and do not practice
adequate preventive medicine; this can also be attributed to the long commute via horse and
buggy to the clinics and hospitals, as well as the high cost of medical services for the Amish
(Tell, 2012). Having to embark on the long commute to the clinics and hospitals would often
affect economic productivity since the Amish would not be able to participate in the farm
activities of the day. The Amish believe it is the religious communitys responsibility to care for
the sick (Tell, 2012).
Babies who are born at home have an increased risk of disorders associated with vitamin
K deficiency, many of which can be prevented by a simple vitamin K vaccine (Strauss &
Puffenberger). The cost of testing for genetic conditions is expensive for Amish residents who do
not have medical insurance. Overall, this can affect the normal family processes for Amish
residents economically, emotionally, and spiritually.

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THE AMISH OF LANCASTER COUNTY
Nursing Preventative Interventions
Primary
Recognizing the community at risk is an important primary intervention related to genetic
disorders (Jenkins, 2008). It is important to recognize the groups or communities at risk as well
as recognizing ones own attitude and feelings about genetic disorders (Jenkins, 2008). When the
nurse is able to recognize his or her attitude related to genetic disorders he or she can establish a
trusting relationship with the patient. Explaining your role to the patient, introducing the roles of
the other healthcare workers, and listening to the patients thoughts and concerns will help to
facilitate a more trusting and professional, nurse/patient relationship. Educating the community
on the importance of seeking medical attention is another key primary intervention. Key aspects
on educating the family consist of providing families with accurate and credible information
regarding genetics and genetic mutations (Jenkins, 2008). Ensuring that the client understands all
information is another important aspect in educational interventions.
Secondary
The goal of secondary intervention is to prevent the spread of infection and/or disease
once it occurs (Stanhope & Lancaster, 2013). Rapid identification of potential contacts reported
would warrant secondary interventions. Some examples of secondary intervention include
screening for diseases, testing for diseases and post exposure immunization (Stanhope &
Lancaster, 2013). Secondary interventions for the Amish community of Lancaster, PA would
include newborn screening and genetic testing at birth. Prenatal diagnosis is not typically done
because Amish women would not end pregnancies if any anomaly is detected but midwives
collect amniotic fluid once a womans water breaks, and send urine samples from diapers of
hours-old babies (Lewis, 2013). The earlier the diagnosis, the more likely a child can grow up

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THE AMISH OF LANCASTER COUNTY
without the disease encoded in his or her genes. Newborn screening (NBS) programs administer
an infants first biochemical screening test from a dried blood spot (DBS) specimen for 30 to 50
severe genetic disorders for which public health interventions exist, and thus these programs are
successful in preventing mortality or life-long debilitation. However, positive results require
complex second-tier confirmation to address false-positive results (Bhattacharjee et al. 2014).
Genetic testing is routinely used for second-tier confirmation of newborn sequencing results to
rule out false positives and to confirm diagnoses in newborns undergoing inpatient and
outpatient care (Bhattacharjee et al. 2014). Carrier testing carried out on couples also help
establish carriers of certain genetic diseases (Lewis, 2013).
Breakthrough genetic testing in the Amish community of Lancaster, PA happened
between 1989 and 1993, when a gas chromatograph - mass spectrometer donated by HewlettPackard was used to screen 1232 Amish children for GA1 (Strauss & Puffenberger, 2009). In
1990, two Mennonite churches donated a high-performance liquid chromatograph for the
diagnosis and management of maple syrup urine disease (MSUD), a genetic disease prevalent in
the Amish community (Strauss & Puffenberger, 2009). The availability of these instruments
meant that GA1 could be diagnosed within a few hours of life from amniotic fluid obtained at
delivery and MSUD could be detected in asymptomatic newborns less than1-day-old (Strauss &
Puffenberger, 2009). These methods were a crucial first step toward disease prevention, allowing
affected newborns to start therapy (Strauss & Puffenberger, 2009).
Screening for bile salt disorders and neonatal vitamin K administration are pressing
public health concerns against this genetic background due to two recessive alleles that disrupt
bile salt metabolism, result in vitamin K malabsorption, and could lead to sudden infant death
(Strauss & Puffenberger, 2009). Taking steps to implement a screening program in the Amish

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THE AMISH OF LANCASTER COUNTY
community would begin with consultation with the head of the Amish community to inform the
community of the purpose of the screening program and to crave the communitys indulgence in
participating in the screening program. Steps to implementation would also include consultation
with the Clinic for Special Children to provide a venue in the clinic for the screening of bile salt
disorder and Vitamin K deficiency. Community awareness would be raised by conducting an
awareness drive that would include production of pamphlets with simplified texts and mostly
visuals showing the negative effects of progression of bile salt disorder and vitamin K deficiency
if screening was declined, and the positive effects of having the screening performed and the
disease diagnosed to prevent long term disability or sudden death (Strauss & Puffenberger,
2009).
Pamphlets would be provided to parents who already visit the clinic regularly and have
established a close rapport with the physicians and staff. The parents would be educated on the
contents of the pamphlets and encouraged to share the pamphlets with relatives, neighbors, and
friends in the community, as word of mouth dominates in the Amish community (Tell, 2012).
Visiting retail shops owned by the Amish for the purpose of leaving pamphlets in prime areas
within public view so as to attract attention of the members of the community would be the
target of the awareness drive. Collaboration with local transport services and community leaders
to provide free transportation to and from the clinic enabling parents and their newborn children
unrestricted access to the clinic for testing.
Tertiary
As discussed, many genetic disorders cannot be prevented, thus it is of utmost importance
that the preclusion of subsequent complications be addressed. Preventative tertiary interventions
are identified after an illness or injury has occurred, with interventions geared towards correcting

33
THE AMISH OF LANCASTER COUNTY
genetic defects, improving quality of life, and restoring normal activities of daily living
(Stanhope & Lancaster, 2013). Normally, this would come with a steep price tag. However, an
initiative was created by the Clinic for Special Children and leaders of the community to raise
funds to cover these costs. Four annual public auctions taking place throughout Pennsylvania
where Amish goods such as quilts, homemade furniture, and the like are sold (Strauss et al.,
2012). Profits are then gifted to The Clinic for Special Children to assist in covering expenses in
running such a facility. Nurses at the facility provide both acute care and maintenance care,
which includes traveling to various farms throughout the county to visit patients. With the
collaboration of support from specialized dieticians, nurses offer nutritional classes at the center
and a monthly class in the community at one of the patients family farm where fellow patients
come together for support and socialization.
A collaborative effort exists between the public health department, the Amish bishops
that govern Lancaster County, Lancaster General Hospitals educational liaison, and three lay
midwives to identify areas of anticipatory guidance such as cognitive decline support, amino acid
deficiency, subsequent need for increased supplementation, rehabilitation support, and proper
interventions to avert complications (P. Luisi & J. McFarland, personal conversation, November
22, 2014). If appropriate, parents of affected children should be referred for genetic counseling at
the center to help understanding of the possibilities with future pregnancies. In helping families
cope with these situations, culturally sensitive mental health providerswhich include nurse
practitioners, nurses, social workers, and licensed counselorsare available to offer support and
guidance after a genetic defect is diagnosed.
An area seemingly lacking in resources is the rehabilitation of mental, motor, and sensory
disorders. Although the CSC provides many services, at home rehabilitation is left to caregivers

34
THE AMISH OF LANCASTER COUNTY
to perform such exercise functions. Research into available grants for vulnerable populations
may help to allay costs in providing this community these services.
As mentioned earlier, the Amish lean towards taking care of their own, so it is part of the
nurses role to ensure that the medical home provides the necessary functions for the patient to
return home from hospital care. Additionally, educating parents in the care functions necessary
to manage their loved ones illness is of utmost importance in ensuring the forward progression of
health. Furthermore, assessing their abilities to complete these functions will ensure that the
education provided was understood.
Conclusion
The Amish community might be known for its separatist beliefs, but they seem to live a
life that is nevertheless very much intertwined with their non-Amish neighbors. As such, their
community is subject to many of the same health concerns as a typical rural American
community. Health hazards related to their laborious work seem prevalent, as do dangers posed
by slower modes of transport on roads shared with speeding vehicles. And though they appear to
shun many modern conveniences, they are not isolated from the world at large. The larger
community seems to support their needs as much as any other group in the area.
Patterns can be found where overall health condition and environmental deficits can be
improved upon. Although there seems to be a deficit of certain quantitative data for the Amish of
Lancaster County, ample evidence exists to create a picture of the current health status of the
community. Furthermore, this analysis of the Amish community brought forward the importance
of identifying special populations and evaluating their needs in order to implement interventions
with hope in effecting change.

35
THE AMISH OF LANCASTER COUNTY
References
American Lung Association. (2013). State of the air report: Lancaster County, PA. Retrieved
from: http://www.stateoftheair.org/2013/states/pennsylvania/lancaster-42071.html
Amish Studies. (2014). Young center for Anabaptist and Pietist studies, Elizabeth College.
Retrieved from: http://www2.etown.edu/amishstudies/Mutual_Aid.asp
Bhattacharjee, A., Sokolsky, T., Wyman, S., Reese, M., Puffenberger, E., Strauss, K.,
Naylor, E. (2014). Development of DNA confirmatory and high-risk diagnostic testing
for newborns using targeted next-generation DNA sequencing. Genetics in Medicine.
Advance online publication. doi:10.1038/gim.2014.1117.
Byers, B. (2008). Amish victimization and offending: A rural subcultures experiences and
responses to crime and justice. Southern Rural Sociology, 23(2), 226-251.
Center for Opinion Research. (2009). Amish health focus groups summary of findings. Retrieved
from: http://www.lancastergeneralhealth.org/LGH/ECommerceSite/files/7d/7d718e3b6a83-49ea-8157-e677e72abd23.pdf
City Data. (2013). Lancaster County, PA. Retrieved from:
http://www.portal.state.pa.us/portal/server.pt?open=514&objID=596007&mode=2
Crable, A. (2013, January 22). Amish farmer charged with killing young eagle. Lancaster
Online. Retrieved from: http://lancasteronline.com/news/amish-farmer-charged-withkilling-young-eagle/article_7d23b59f-0d00-5b9a-b44b-f97d17cb6fa0.html
Cross, H., & Crosby, A., (2008). Amish contributions to medical genetics. The Mennonite
Quarterly Review. Retrieved from: http://www.wohproject.org/pdfs/MQR.pdf
Greska, P., & Korbin, J., (2004). Amish. Overview of the Culture. Retrieved from:
http://www.case.edu/artsci/anth/documents/Amish.pdf

36
THE AMISH OF LANCASTER COUNTY
Gura, T. (2012). Rare diseases: Genomics, plain and simple. Nature international weekly journal
of science. Retrieved from: http://www.etown.edu/centers/young-center/files/hmortonreferences/Nature_CSC_feature%202012.pdf
Hambright, B. (2011). Amish man goes to jail for sex crimes. Lancaster Online. Retrieved from:
http://lancasteronline.com/news/amish-man-goes-to-jail-for-sexcrimes/article_e51bfb9c-c469-5536-b5c3-7c76dd84ffc5.html
Hambright, B. (2014). How 100 Amish and Old Order Mennonites live on parole in Lancaster
County. Lancaster Online. Retrieved from: http://lancasteronline.com/news/local/howamish-and-old-order-mennonites-live-on-parole-in/article_02ca41ce-30ad-11e4-a1ca001a4bcf6878.html
Jenkins, F. (2008). Essentials of Genetic and Genomic Nursing: Competencies, Curricula
Guidelines and Outcome Indicators. Consensus Panel, Retrieved from
http://nursingworld.org
Kraybill, D., Nolt, G., & Johnson-Weiner, K. (2014). Amish population by state. Young Center
for Anabaptist and Pietist studies, Elizabethtown College. Retrieved from:
http://www2.etown.edu/amishstudies/Largest_Settlements_2014.asp.
Kocieniewski, D., & Gately, G. (2003, October 6). Man shoots 11, killing 5 girls in Amish
school. New York Times. Retrieved from:
http://www.nytimes.com/2006/10/03/us/03amish.html?pagewanted=all&_r=0
Lietz, J. (2014). Tornado history project. Retrieved from:
http://www.tornadohistoryproject.com/tornado/Pennsylvania/Lancaster

37
THE AMISH OF LANCASTER COUNTY
Lancaster County. (2014). Lancaster, PA. Amish Mud Sale. Pennsylvania Dutch Convention &
Visitors Bureau. Retrieved from: http://www.padutchcountry.com/towns-andheritage/amish-country/amish-mud-sales.asp#sthash.1oiI9IAY.dpuf
Lancaster County. (2014). Lancaster, PA Amish education and work. Pennsylvania Dutch
Convention & Visitors Bureau. Retrieved from:
http://www.padutchcountry.com/towns-and-heritage/amish-country/amish-educationand-work.asp
Lancaster County Water and Sewer District. (2014). Annual drinking water report.
Retrieved from: http://www.lcwasd.org/wpcontent/uploads/2014/CCR%202014/Water%20System%20Annual%20Report%2
02014.pdf
Lewis, R. (2013). An advocate for the Amish at a very special Clinic. PLOS Blogs. Retrieved
from: http://blogs.plos.org/dnascience/2013/12/12/an-advocate-for-the-amish-at-a-veryspecial-clinic/
Pennsylvania Department of Environmental Protection. (2009). Source water assessment public
summary: The City of Lancaster Bureau of Water. Retrieved from:
http://www.elibrary.dep.state.pa.us/dsweb/Get/Document59455/RS7360058001%20City%20of%20Lancaster%20BofW.pdf
Pennsylvania Department of Health. (2012). Bureau of Health Statistics and Research, County
health Profiles. Retrieved from:
https://www.portal.state.pa.us/portal/.../2012_county_health_profiles_pdf
Pennsylvania State Police. (2014). Pennsylvania uniform crime reporting system.

38
THE AMISH OF LANCASTER COUNTY
Retrieved from:
http://ucr.psp.state.pa.us/ibi_apps/WFServlet?IBIF_ex=RUREP01&MAPAREA=36
Philadelphia Inquirer, (2014). At a clinic in a cornfield, doctors cure children with rare diseases.
Newsela. Retrieved from: https://newsela.com/articles/amish-health/id/5627/
Rutter, J. (2012, July 8). Amish, other Plain, fill ranks of fire and ambulance companies.
Lancaster Online. Retrieved from: http://lancasteronline.com/news/amish-other-plainfill-ranks-of-fire-and-ambulance-companies/article_00cc4190-9020-5475-936a8ce41a75258a.htm
Stanhope, M., & Lancaster, J. (2012). Public health nursing: Population centered health care in
the community. Maryland Heights, MI. Elsevier.
Strauss, K. A., & Puffenberger, E. G. (2009). Genetics, Medicine, and the Plain People. AR
Journals, pp. 513-536. Retrieved from http://arjournals.annualreviews.org
Strauss, K., & Puffenberger, E., (2009). Genetics, Medicine and the plain people. Reviews in
advance. 27 June 2009. Retrieved from: http://www.etown.edu/centers/youngcenter/files/hmortonreferences/Annual%20Review%20Gen%20and%20Hum%20Gen%2
02009.pdf
Szokan, N. (2014). Pennsylvania clinic treats genetic disorders in Amish and Mennonite people.
Washington Post. October 21, 2014. Retrieved from:
http://www.washingtonpost.com/national/health-science/pennsylvania-clinic-treatsgenetic-disorders-in-amish-and-mennonite-people/2014/10/20/941b4e34-53bc-11e4809b-8cc0a295c773_story.html

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Tell, S. (2012). Medical genetic research on the Amish: From genetic tourism to community
health centers. The Einstein Journal of Biology and Medicine. Retrieved from:
https://www.einstein.yu.edu/uploadedFiles/Pulications/EJBM/28.1_18-24_Tell.pdf
United States Census Bureau. (2012a). American Community Survey. Retrieved from:
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk
United States Census Bureau. (2012b). American fact finder: Lancaster County, Pennsylvania
Retrieved from:
http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none
United States Census Bureau. (2012c). American fact finder: Pennsylvania. Retrieved from:
http://factfinder2.census.gov/faces/nav/jsf/pages/community_facts.xhtml#none
United States Department of Justice. (2012). Uniform Crime Reporting Statistics. Retrieved
from: http://www.bjs.gov/ucrdata/Search/Crime/State/RunCrimeStatebyState.cfm
United Stated Geological Survey. (2013). Lancaster County, Pennsylvania. Retrieved from:
http://viewer.nationalmap.gov/viewer/
Wesner, E. (2010). Amish America: Exploring Amish culture and communities. Retrieved
from: http://amishamerica.com/#head2011

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Appendix
Picture 1. Typical Amish home with clean clothes hanging to dry.

Picture 2. Bales of alfalfa drying in the sun awaiting shipment.

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THE AMISH OF LANCASTER COUNTY
Picture 3. Amish farmers market in Intercourse, PA.

Picture 4. Amish resident riding a push-scooter to get through town.

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THE AMISH OF LANCASTER COUNTY
Picture 5. Amish resident feeding his horses before tours begin.

Picture 6. Amish resident preparing to till the land on his farm.

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THE AMISH OF LANCASTER COUNTY
Picture 7. U.S. Route 30. Also known as The Highway.

Picture 8. Amish community of Lancaster County, Pennsylvania.

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THE AMISH OF LANCASTER COUNTY
Picture 9. Tobacco hung from rafters during the drying process. Will be removed after the New
Year as their winter crop revenue.

Picture 10. Department of Transportation roadway signage throughout the county.

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THE AMISH OF LANCASTER COUNTY
Picture 11. View of the agricultural industry in Smoketown, PA.

Picture 12. Amish residents walking down Orchard Rd in Bird-In-Hand, PA.

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THE AMISH OF LANCASTER COUNTY
Picture 13. Dairy Farm in Bird-In-Hand, PA.

Picture 14. Inside view of the dairy farmhouse in Bird-In-Hand, PA.

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THE AMISH OF LANCASTER COUNTY
Picture 15. Amish school house in Strasburg Township, Lancaster County, PA.