CITIES AND WOMEN’S HEALTH: GLOBAL PERSPECTIVES

The aim of the Penn-ICOWHI 18th Congress, Cities and Women’s Health: Global Perspectives, is to deconstruct urban planning in terms of its potential to better support women’s health. When structuring an urban environment conducive to promoting and preserving women’s health, we must give up the assumption that the needs of women are the same as for men in order to understand the health needs of women in cities. In fact, there are remarkable opportunities to have profound impact on meeting the unique needs of urban women by bringing together professionals from all facets of health care, health policy and urban design, among others, to open interdisciplinary discussions about their work.

Penn-ICOWHI 18th International Congress on Women’s Health
Wednesday, April 7- Saturday, April 10, 2010
UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA, USA

Program information, abstract specifics and submission guidelines are available via the ICOWHI website – http://www.icowhi.org.

Health and the urban environment: revolutions revisited

Health and the urban environment: revolutions revisited. (pdf, 158KB)

Gordon McGranahan, May 2009 – IIED

From cholera pandemics to smog episodes, urban development driven by narrow economic interests has shown itself to be a serious threat to human health and wellbeing. Past revolutions in sanitation and pollution control demonstrate that social movements and governance reforms can transform an urban health penalty into a health advantage. But many environmental problems have been displaced over time and space, and never truly resolved. Health concerns need once again to drive an environmental agenda – but this time it must be sustainable over the long haul, and globally equitable. With the global economic crisis raising the ante, what’s needed is no less than a revolution in environmental justice that puts health, not economics, at the core of its values.

Social captial and health in Botswana

Does Level of Social Capital Predict Perceived Health in a Community?—A Study of Adult Residents of Low income Areas of Francistown, Botswana, in forthcoming issue of the Journal of Health, Population and Nutrition. (pdf, 184KB)

Tirelo Modie-Moroka

This study explores and describes the relationships among neighbourhood characteristics, social capital, and health outcomes among low-income urban residents in Francistown, Botswana. Using an explanatory correlational research design to explore the relationships among the study variables, data were collected from 388 low-income urban residents in Francistown, Botswana. The study further examined the role of social capital on the environmental quality for the overall health and quality of life and the psychological, physical and level of independence domains of health. Several studies have explored these relationships but currently no study has explored this relationship in Africa and Botswana in particular. Selected concepts from social capital theory and stress theory were used as a conceptual framework. Using linear and multiple regression models, results of the study showed that social capital did not correlate with the overall health and quality of life and the level of independence domain of health but positively correlated with psychological well-being. Social capital negatively predicted physical health. Hierarchical moderated multiple-regression analyses were conducted to examine the moderating role of social capital. To the contrary, social capital did not moderate the effects of chronic community stressors on all health outcomes. Social capital, however, moderated the effects of the poor environmental quality on level of independence and physical health outcomes but not on the psychological and overall health and quality of life. These results underscore the importance of considering the role of social capital, especially in low-income communities.

Strategies to reduce exclusion among urban poor in Bangladesh

Strategies to Reduce Exclusion among Populations Living in Urban Slum Settlements in Bangladesh, forthcoming article in the Journal of Health, Population and Nutrition. (pdf, 158KB)

Authors: Sabina Faiz Rashid

The health and rights of populations living in informal or slum settlements are key development issues of the twenty-first century. As of 2007, the majority of the world’s population lives in urban areas. More than one billion of these people, or one in three city-dwellers, live in inadequate housing with no or a few basic resources. In Bangladesh, urban slum settlements tend to be located in low-lying, flood-prone, poorly drained areas, having limited formal garbage disposal and minimal access to safe water and sanitation. These areas are severely crowded, with 4-5 people living in houses of just over 100 sq feet. These conditions of high density of population and poor sanitation exacerbate the spread of diseases. People living in these areas experience social, economic and political exclusion, which bars them from society’s basic resources. This paper overviews policies and actions that impact the level of exclusion of people living in urban slum settlements in Bangladesh, with a focus on improving the health and rights of the urban poor. Despite some strategies adopted to ensure better access to water and health, overall, the country does not have a comprehensive policy for urban slum residents, and the situation remains bleak.

Siddarth Agarwal editorial on the urban poor of India

Off the map

by Siddharth Agarwal, executive director of the Urban Health Resource Centre

July 20, 2009 – Indian Express

The urban poor, although one of the most disadvantaged sections of the country, is also among the hardest to target for government. While the new government, as visible in the recent Budget, has paid some attention to enhancing services and attempted to increase the provision of facilities for the urban poor, the success of all these social welfare schemes will hinge on what Finance Minister Pranab Mukherjee highlighted in his speech as a challenge: “re-energising government and improving delivery mechanisms.” This is doubly problematic when it comes to our cities.

India has been rapidly urbanising; the urban poor, who number 100 million, are the fastest growing segment of India’s population. Living mostly in temporary (and hence frequently undocumented) settlements, they lack access to water supply, sanitation and healthcare services. The poor living standards and suboptimal healthcare is reflected in high child mortality rates — one in 14 children do not live to see their fifth birthday, according to the 2005-06 National Family Health Survey.

Several of the newly-announced social welfare schemes have the potential to positively impact living conditions of the urban poor. The Jawaharlal Nehru National Urban Renewal Mission, for example, has set aside — under the heading “Basic Services for the Urban Poor” — an allocation for housing and amenities of Rs 3,973 crore, including the provision for Rajiv Awas Yojana announced recently. The problem this will take on is vast: there is currently a shortage of 2.6 crore housing units in cities, almost all of which is for low- income groups. It will be critical to ensure that these provisions reach the most disadvantaged city dwellers.

Initiatives towards food security and the increase in outlay — by 17 per cent — for the National Rural Health Mission may not be directly targeted at the urban poor. A specific allocation was not announced, for example, for the National Urban Health Mission. Our cities will continue to hope that the government’s commitment to launching the NUHM will be turned into action. (Almost the entire increase in health outlays has been focused on rural areas.)

But the question is: will increased spending alone be enough? While the government has certainly upped the spending on schemes for marginalised populations their implementation — as has been signalled by several within government — will need a sense of purpose, urgency, capacity and efficiency if optimal outcomes are to be obtained. And this will be particularly true when the needs of the urban poor are taken into account. Why? Because the temporary nature of many settlements of the urban poor means they fall into the cracks in any government programme.

Nearly 49 per cent of slums in India are unlisted, according to National Sample Survey Organisation data. It would be necessary, therefore, to extend all essential services to unidentified sections of urban poor by mapping unlisted and hidden slum clusters, and other temporary settlements. Any effective, speedy and honest implementation of policies will require efficient management, convergence and coordination among all departments at national, state and city levels, to reach vulnerable communities.

Then there is the question of manpower. Whether or not there are enough well-trained people to administer programmes for the vulnerable in urban areas is a matter of serious concern. When designing the propagation mechanism of welfare schemes, care should be taken to expeditiously recruit a reasonable number of people with expertise from outside; and training or re-training personnel in government departments on the provisions of the new schemes, with a special focus on how policy provisions can reach the most disadvantaged, should not be forgotten either.

Finally, government alone cannot do everything. State intervention can be made more effective by force-multipliers from outside. Several successfully implemented interventions have shown that the involvement of civil society in planning, delivery, progress review and addressing operational bottlenecks can enhance accountability of well-intentioned policy initiatives. Their efficiency and reach would also improve. Strengthening community level partnerships by building sustainable community-based organisations in slum clusters, to improve their institutional and financial capacity, should be a priority; that will enhance demand for and utilisation of the planned programmes.

The government has said it is concerned about the well-being of the least-privileged sections of society. The rest of us must ensure the translation of words into action.

Annotated bibliography on household water treatment & safe storage, 2009

Environmental Health at USAID has compiled an annotated bibliography of 21 journal articles on household water treatment and safe storage that were published from January-July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf (pdf, 70KB)

Below are 3 of the 21 studies from the bibliography:

1 – Am J Trop Med Hyg. 2009 May; 80(5):819-23.
Laboratory assessment of a gravity-fed ultra-filtration water treatment device designed for household use in low-income settings.

Clasen T, Naranjo J, Frauchiger D, Gerba C.

Interventions to improve water quality, particularly when deployed at the household level, are an effective means of preventing endemic diarrheal disease, a leading cause of mortality and morbidity in the developing world. We assessed the microbiologic performance of a novel water treatment device designed for household use in low-income settings. The device employs a backwashable hollow fiber ultrafiltration cartridge and is designed to mechanically remove enteric pathogenic bacteria, viruses, and protozoan cysts from drinking water without water pressure or electric power. In laboratory testing through 20,000 L (approximately 110% of design life) at moderate turbidity (15 nephelometric turbidity unit [NTU]), the device achieved log(10) reduction values of 6.9 for Escherichia coli, 4.7 for MS2 coliphage (proxy for enteric pathogenic viruses), and 3.6 for Cryptosporidium oocysts, thus exceeding levels established for microbiological water purifiers. With periodic cleaning and backwashing, the device produced treated water at an average rate of 143 mL/min (8.6 L/hour) (range 293 to 80 mL/min) over the course of the evaluation. If these results are validated in field trials, the deployment of the unit on a wide scale among vulnerable populations may make an important contribution to public health efforts to control intractable waterborne diseases.

4 – Environ Sci Technol. 2009 Feb 15; 43(4):986-92.
Household water treatment in poor populations: is there enough evidence for scaling up now?

Schmidt WP, Cairncross S.
Point-of-use water treatment (household water treatment, HWT) has been advocated as a means to substantially decrease the global burden of diarrhea and to contribute to the Millennium Development Goals. To determine whether HWT should be scaled up now, we reviewed the evidence on acceptability, scalability, adverse effects, and nonhealth benefits as the main criteria to establish how much evidence is needed before scaling up. These aspects are contrasted with the evidence on the effect of HWT on diarrhea. We found that the acceptability and scalability of HWT is still unclear, and that there are substantial barriers making it difficult to identify populations that would benefit most from a potential effect. The nonhealth benefits of HWT are negligible. Health outcome trials suggest that HWT may reduce diarrhea by 30-40%. The problem of bias is discussed. There is evidence that the estimates may be strongly biased. Current evidence does not exclude that the observed diarrhea reductions are largely or entirely due to bias. We conclude that widespread promotion of HWT is premature given the available evidence. Further acceptability studies and large blinded trials or trials with an objective health outcome are needed before HWT can be recommended to policy makers and implementers.

7 – Int J Epidemiol. 2009 Jul 2.

Evaluation of a pre-existing, 3-year household water treatment and handwashing intervention in rural Guatemala.

Arnold B, Arana B, Mäusezahl D, Hubbard A, Colford JM Jr.

BACKGROUND: The promotion of household water treatment and handwashing with soap has led to large reductions in child diarrhoea in randomized efficacy trials. Currently, we know little about the health effectiveness of behaviour-based water and hygiene interventions after the conclusion of intervention activities.

METHODS: We present an extension of previously published design (propensity score matching) and analysis (targeted maximum likelihood estimation) methods to evaluate the behavioural and health impacts of a pre-existing but non-randomized intervention (a 3-year, combined household water treatment and handwashing campaign in rural Guatemala). Six months after the intervention, we conducted a cross-sectional cohort study in 30 villages (15 intervention and 15 control) that included 600 households, and 929 children <5 years of age.

RESULTS: The study design created a sample of intervention and control villages that were comparable across more than 30 potentially confounding characteristics. The intervention led to modest gains in confirmed water treatment behaviour [risk difference = 0.05, 95% confidence interval (CI) 0.02-0.09]. We found, however, no difference between the intervention and control villages in self-reported handwashing behaviour, spot-check hygiene conditions, or the prevalence of child diarrhoea, clinical acute lower respiratory infections or child growth.

CONCLUSIONS: To our knowledge this is the first post-intervention follow-up study of a combined household water treatment and handwashing behaviour change intervention, and the first post-intervention follow-up of either intervention type to include child health measurement. The lack of child health impacts is consistent with unsustained behaviour adoption. Our findings highlight the difficulty of implementing behaviour-based household water treatment and handwashing outside of intensive efficacy trials.

Annotated bibliography on household water treatment

Environmental Health at USAID has compiled an annotated bibliography of 19 journal articles on Household Water Treatment and Safe Storage that were published from January – July 2009.

Link: http://www.ehproject.org/PDF/ehkm/bibliography-hwt_july2009.pdf

Typhoid Vaccines Ready for Implementation

Editorial – Typhoid Vaccines Ready for Implementation, IN: NEJM, Volume 361:403-405 July 23, 2009 Number 4

Myron M. Levine, M.D., D.T.P.H.

Enteric fevers encompass typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) and paratyphoid fever caused by serotype Paratyphi A or B (S. Paratyphi). These human-restricted pathogens are acquired by ingesting contaminated water or food, and in the individual patient, one cannot differentiate clinically which agent is causing illness. S. Typhi expresses a capsular “Vi” (for virulence) polysaccharide, whereas S. Paratyphi A and B cannot synthesize Vi.

Before the use of antibiotics, typhoid fever had a case fatality rate of 10 to 20%. Transmission of enteric fever is minimized or eliminated if populations have access to treated water supplies and sanitation to remove human fecal matter. Where such amenities are unavailable, the risk of typhoid fever can be substantially diminished by immunization with typhoid vaccines.

Early typhoid vaccines (heat-inactivated whole S. Typhi organisms preserved in phenol) were developed in the 1890s. Six decades later, the World Health Organization (WHO) sponsored large-scale, randomized, controlled field trials, in which investigators found that similar killed whole-cell vaccines conferred substantial protection against typhoid.1 However, because these vaccines commonly elicited debilitating adverse reactions (fever and malaise), they were rarely used to control endemic typhoid fever.1

After a report in 1948 that chloramphenicol drastically ameliorated enteric fevers and reduced the case fatality rate to less than 1%, the treatment of patients with oral chloramphenicol became the mainstay of typhoid control in developing countries for the next quarter century. A rude awakening came in the 1970s, when epidemics of chloramphenicol-resistant typhoid occurred in Mexico and Vietnam. These outbreaks stimulated a search for alternative oral antibiotic therapies and accelerated efforts to develop a new generation of better-tolerated, efficacious typhoid vaccines. The efforts bore fruit when live oral S. Typhi vaccine strain Ty21a and parenteral Vi polysaccharide vaccine were licensed in the late 1980s and early 1990s. Despite extensive data documenting the safety, efficacy, and practicality of the Vi and Ty21a vaccines, they have not been widely applied programmatically in developing countries.

In the late 1980s, strains of S. Typhi that were resistant to multiple clinically relevant antibiotics began to emerge. In response, in 1999, the WHO recommended that typhoid vaccines be used for immunization of school-age children in areas where antibiotic-resistant typhoid was endemic. In 2008, the WHO and the Global Alliance for Vaccines and Immunization took more active steps to encourage programmatic use of these vaccines where typhoid is a health problem.

In most of the world, the incidence of enteric fever peaks among school-age children. However, in some South Asian urban slums, S. Typhi bacteremic infections peak in preschoolers, particularly when cases are detected by active household surveillance2,3; such infections are uncommon in infants. Since the WHO’s Expanded Program on Immunization does not typically include routine visits for toddlers or preschool children, protecting these age groups requires innovative strategies. One approach would be to administer typhoid vaccines in infancy, if efficacy could persist through the preschool and school years. Alternatively, preschool children could be targeted for mass campaigns. The current licensed typhoid vaccines are not compatible with infant immunization, since the unconjugated Vi vaccine is poorly immunogenic in infants, and the use of Ty21a in enteric-coated capsules is impractical.

In this issue of the Journal, Sur et al.4 report results of a well-executed field study showing that the Vi vaccine conferred an adjusted vaccine effectiveness of 80% in preschool children, thereby providing a biologic basis for including preschoolers in mass typhoid-immunization campaigns. However, organizing mass immunizations of so-called noncaptive populations such as preschoolers is more demanding than conducting campaigns among schoolchildren.

Sur et al. showed a trend for a lower adjusted Vi-vaccine effectiveness in older subjects (56% in children between the ages of 5 and 14 years and 46% in persons 15 years of age or older), although the differences in efficacy were not significant. These findings are the opposite of the trend observed in field trials of killed whole-cell parenteral vaccines and of the oral Ty21a vaccine, in which vaccine effectiveness was higher in older children.

A fascinating secondary analysis performed by Sur et al. indicated that control subjects who did not receive the Vi vaccine but lived in clusters with vaccinated subjects had substantial protection against typhoid fever. This is important new information. The indirect protection of nonvaccinated persons by the Vi vaccine further bolsters the case for school-based immunization to control endemic typhoid, since one might expect some indirect protection of preschool children as well. Indirect protection has also been observed with the oral Ty21a vaccine.1 Both Vi5 and Ty21a6 vaccines have been logistically practical and effective when administered to scores of thousands of schoolchildren through large-scale, school-based immunization projects.

An advantage of parenteral Vi vaccine is its single-dose regimen; unconjugated Vi does not elicit immunologic memory, so serum Vi titers are not boosted by additional doses. However, mass administration of the Vi vaccine by needle and syringe creates challenges for ensuring injection safety and for disposing of material that is potentially contaminated with bloodborne viruses. The use of needle-free injection devices could avert this problem. A drawback of the Ty21a vaccine is that it requires a three-dose regimen with an every-other-day interval. Nevertheless, oral immunization is logistically very practical in schoolchildren.

The Vi vaccine does not protect against S. Paratyphi A or B, since these strains do not express the Vi polysaccharide. Thus, countries with high rates of paratyphoid fever cannot expect reductions from the use of the Vi vaccine. The Ty21a vaccine confers substantial cross-protection (vaccine effectiveness, 49%) against S. Paratyphi B7 but not against S. Paratyphi A.8

In computer models, disease incidence and duration of protection greatly affect cost-effectiveness of typhoid vaccination in endemic settings. Field trials of the Vi vaccine have incorporated relatively short follow-up (17 months to 3 years),9,10 as compared with trials of the Ty21a vaccine (5 to 7 years).11 Klugman et al.10 reported a vaccine effectiveness of 55% during 3 years of follow-up. Investigation of a typhoid outbreak among Vi-immunized French soldiers in Africa showed that those who had received the vaccine more than 3 years before exposure had twice the risk of disease, as compared with those who had received the vaccine within the previous 3 years.12 Three doses of the Ty21a vaccine in enteric-coated capsules conferred a vaccine effectiveness of 62% during 7 years of follow-up.11

Two different “flavors” of licensed typhoid vaccine, parenteral unconjugated Vi and oral Ty21a, are available for use by public health practitioners. The time has come to implement use of these vaccines vigorously and monitor the effect of such intervention.

Read More

Urban Health Bulletin, May/June 2009

The latest Urban Health Bulletin contains citations and abstracts to 20 recently published studies that were reviewed and selected by Anthony Kolb, USAID’s Urban Health Advisor,
Email: akolb@usaid.gov

Link – http://www.ehproject.org/PDF/ehkm/urban_health-may_jun09.pdf

Below are citations to the studies in this issue:

Urban Health Analysis

1 – Am J Hum Biol. 2009 Jun 16. Children’s work, earnings, and nutrition in urban Mexican shantytowns.

2 – Arch Dis Child. 2009 Jul 1. The effects of social variables on symptom-recognition and medical care-seeking behaviour for acute respiratory infections in infants in urban Mongolia.

3 – BMC Cardiovasc Disord. 2009 Jun 8; 9:23. The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT Study.

4 – BMC Public Health. 2009 May 22;9:149. Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison.

5 – International Journal of Drug Policy, Volume 20, Issue 3, Risk Environment and Drug Harms, May 2009, Pages 237-243. The social context of initiation into injecting drugs in the slums of Makassar, Indonesia

6 – Int J Equity Health. 2009 Jun 5;8:21. Inequalities in maternity care and newborn outcomes: one-year surveillance of births in vulnerable slum communities in Mumbai.

7 – Int J Health Geogr. 2009 Jun 8;8:32. The 2005 census and mapping of slums in Bangladesh: design, select results and application.

8 – Reprod Health. 2009 Jun 16;6(1):9. Maternal health in resource-poor urban settings: how does women’s autonomy influence the utilization of obstetric care services?

Urban Environmental Health

9 – Cities, Volume 26, Issue 3, June 2009, Pages 125-132. Community-led infrastructure provision in low-income urban communities in developing countries: A study on Ohafia, Nigeria

10 – International Journal of Hygiene and Environmental Health, Volume 212, Issue 4, July 2009, Pages 387-397. Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia

11 – Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 103, Issue 5, May 2009, Pages 506-511. Improved sanitation and income are associated with decreased rates of hospitalization for diarrhoea in Brazilian infants

12 – Water Sci Technol. 2009;59(12):2341-50. Community-focused greywater management in two informal settlements in South Africa.

Urban Vector Disease

13 – Cad Saude Publica. 2009 Jul; 25(7):1543-51. Factors associated with the incidence of urban visceral leishmaniasis: an ecological study in Teresina, Piauí State, Brazil.

14 – Ethn Dis. 2009 Spring;19(1 Suppl 1):S1-37-41. Leptospirosis: a worldwide resurgent zoonosis and important cause of acute renal failure and death in developing nations.

15 – Geospat Health. 2009 May; 3(2):189-210. Urban agriculture and Anopheles habitats in Dar es Salaam, Tanzania.

16 – Malar J. 2009 Jun 24;8(1):138. Highly focused anopheline breeding sites and malaria transmission in Dakar.

17 – Malar J. 2009 May 14; 8:103. Development of vegetable farming: a cause of the emergence of insecticide resistance in populations of Anopheles gambiae in urban areas of Benin.

18 – Trop Med Int Health. 2009 Jun 28. Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR.

Urban HIV/AIDS

19 – AIDS Care. 2009 May;21(5):615-21. Factors influencing consent to HIV testing among wives of heavy drinkers in an urban slum in India.

20 – BMC Public Health. 2009 May 27;9:153. HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey.

Air pollution in womb linked to lower IQ

(AP) Researchers for the first time have linked air pollution exposure before birth with lower IQ scores in childhood, bolstering evidence that smog may harm the developing brain.

The results are in a study of 249 children of New York City women who wore backpack air monitors for 48 hours during the last few months of pregnancy. They lived in mostly low-income neighborhoods in northern Manhattan and the South Bronx. They had varying levels of exposure to typical kinds of urban air pollution, mostly from car, bus and truck exhaust.

At age 5, before starting school, the children were given IQ tests. Those exposed to the most pollution before birth scored on average four to five points lower than children with less exposure.

That’s a big enough difference that it could affect children’s performance in school, said Frederica Perera, the study’s lead author and director of the Columbia Center for Children’s Environmental Health.

Dr. Michael Msall, a University of Chicago pediatrician not involved in the research, said the study doesn’t mean that children living in congested cities “aren’t going to learn to read and write and spell.”

But it does suggest that you don’t have to live right next door to a belching factory to face pollution health risks, and that there may be more dangers from typical urban air pollution than previously thought, he said.

“We are learning more and more about low-dose exposure and how things we take for granted may not be a free ride,” he said.

While future research is needed to confirm the new results, the findings suggest exposure to air pollution before birth could have the same harmful effects on the developing brain as exposure to lead, said Patrick Breysse, an environmental health specialist at Johns Hopkins’ school of public health.

And along with other environmental harms and disadvantages low-income children are exposed to, it could help explain why they often do worse academically than children from wealthier families, Breysse said.

“It’s a profound observation,” he said. “This paper is going to open a lot of eyes.”

The study in the August edition of Pediatrics was released Monday.

In earlier research, involving some of the same children and others, Perera linked prenatal exposure to air pollution with genetic abnormalities at birth that could increase risks for cancer; smaller newborn head size and reduced birth weight. Her research team also has linked it with developmental delays at age 3 and with children’s asthma.

The researchers studied pollutants that can cross the placenta and are known scientifically as polycyclic aromatic hydrocarbons. Main sources include vehicle exhaust and factory emissions. Tobacco smoke is another source, but mothers in the study were nonsmokers.

A total of 140 study children, 56 percent, were in the high exposure group. That means their mothers likely lived close to heavily congested streets, bus depots and other typical sources of city air pollution; the researchers are still examining data to confirm that, Perera said. The mothers were black or Dominican-American; the results likely apply to other groups, researchers said.

The researchers took into account other factors that could influence IQ, including secondhand smoke exposure, the home learning environment and air pollution exposure after birth, and still found a strong influence from prenatal exposure, Perera said.

Dr. Robert Geller, an Emory University pediatrician and toxicologist, said the study can’t completely rule out that pollution exposure during early childhood might have contributed. He also noted fewer mothers in the high exposure group had graduated from high school. While that might also have contributed to the high-dose children’s lower IQ scores, the study still provides compelling evidence implicating prenatal pollution exposure that should prompt additional studies, Geller said.

The researchers said they plan to continuing monitoring and testing the children to learn whether school performance is affected and if there are any additional long-term effects.

Source – CBS News