Maternal and Child Health Journal

, Volume 18, Issue 5, pp 1155–1168 | Cite as

Environmental Risks and Children’s Health: What can PRAMS Tell Us?

  • Katrina Smith Korfmacher
  • Barbara J. Suter
  • Xueya Cai
  • Susan A. Brownson
  • Ann M. Dozier


Environmental exposures during pregnancy have a lasting impact on children’s health. We combined environmental and maternal risk factor survey data to inform efforts to protect children’s health. We made recommendations for future use of such data. A modified version of the Pregnancy Risk Assessment Monitoring System (PRAMS) mail survey was conducted based on weighted sampling design with low-income and non-low income women in Monroe County, NY (1,022 respondents). A series of environmental questions were included in the questionnaire. Data were analyzed using Chi square tests and Poisson loglinear regression model to identify patterns in environmental health risk and sociodemographic characteristics. We identified women who rented their homes, had lower incomes, and lived in inner city zip codes as “high environmental health risk” (HEHR). HEHR respondents were more likely to report that a health care provider talked with them about lead and on average reported more behaviors to protect their children from lead poisoning. Combining environmental and perinatal risk factor data could yield important recommendations for medical practice, health education, and policy development. However, at present PRAMS gathers only limited and inconsistent environmental data. We found that existing PRAMS environmental questions are insufficient. Further work is needed to develop updated and more comprehensive environmental health survey questions and implement them consistently across the country.


Environmental health PRAMS Maternal risk factors Perintal health 


  1. 1.
    Bellinger, D., Leviton, A., Waternaux, C., Needleman, H., & Rabinowitz, M. (1987). Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development. New England Journal of Medicine, 316(17), 1037–1043.PubMedCrossRefGoogle Scholar
  2. 2.
    Goyer, R. A. (1996). Results of lead research: Prenatal exposure and neurological consequences. Environmental Health Perspectives, 104(10), 1050–1054.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Mahaffey, K. R. (1999). Methylmercury: A new look at the risks. Public Health Reports, 114(5), 396–399. 402-13.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Weiss, B. (2000). Vulnerability of children and the developing brain to neurotoxic hazards. Environmental Health Perspectives, 108(Suppl 3), 375–381.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Landrigan, P. J., Schechter, C. B., Lipton, J. M., Fahs, M. C., & Schwartz, J. (2002). Environmental pollutants and disease in American children: Estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environmental Health Perspectives, 110(7), 721–728.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Mozaffarian, D., & Rimm, E. B. (2006). Fish intake, contaminants, and human health: Evaluating the risks and the benefits. JAMA, 296(15), 1885–1899.PubMedCrossRefGoogle Scholar
  7. 7.
    Swan, S. H., Main, K. M., Liu, F., Stewart, S. L., Kruse, R. L., Calafat, A. M., et al. (2005). Decrease in anogenital distance among male infants with prenatal phthalate exposure. Environmental Health Perspectives, 113(8), 1056.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Canfield, R. L., Kreher, D. A., Cornwell, C., & Henderson, C. R., Jr. (2003). Low-level lead exposure, executive functioning, and learning in early childhood. Child Neuropsychology, 9(1), 35–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Lanphear, B. P., Hornung, R., Khoury, J., Yolton, K., Baghurst, P., Bellinger, D. C., et al. (2005). Low-level environmental lead exposure and children’s intellectual function: An international pooled analysis. Environmental Health Perspectives, 113(7), 894–899.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Mead, M. N. (2008). Contaminants in human milk: Weighing the risks against the benefits of breastfeeding. Environmental Health Perspectives, 116(10), A427–A434.PubMedGoogle Scholar
  11. 11.
    Kraft, M. E., & Scheberle, D. (1995). Environmental justice and the allocation of risk: The case of lead and public health. Policy Studies Journal, 23(1), 113.CrossRefGoogle Scholar
  12. 12.
    Mott, L. (1995). The disproportionate impact of environmental health threats on children of color. Environmental Health Perspectives, 103(Suppl 6), 33.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Corburn, J. (2005). Street science: Community knowledge and environmental health justice. Cambridge, MA: MIT.Google Scholar
  14. 14.
    Kjellstrom, T., Friel, S., Dixon, J., Corvalan, C., Rehfuess, E., Campbell-Lendrum, D., et al. (2007). Urban environmental health hazards and health equity. Journal of Urban Health, 84(3 Suppl), i86–i97.PubMedCrossRefGoogle Scholar
  15. 15.
    Claudio, L., Torres, T., Sanjurjo, E., Sherman, L. R., & Landrigan, P. J. (1998). Environmental health sciences education—A tool for achieving environmental equity and protecting children. Environmental Health Perspectives, 106(Suppl 3), 849–855.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Trasande, L., Boscarino, J., Graber, N., Falk, R., Schechter, C., Galvez, M., et al. (2006). The environment in pediatric practice: A study of New York pediatricians’ attitudes, beliefs, and practices towards children’s environmental health. Journal of Urban Health, 83(4), 760–772.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Chepesiuk, R. (2007). Environmental literacy: Knowledge for a healthier public. Environmental Health Perspectives, 115(10), A494–A499.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Sutton, P., Woodruff, T. J., Perron, J., Stotland, N., Conry, J. A., Miller, M. D., et al. (2012). Toxic environmental chemicals: The role of reproductive health professionals in preventing harmful exposures. American Journal of Obstetrics and Gynecology, 207(3), 164–173.PubMedCrossRefGoogle Scholar
  19. 19.
    Gilbert, B. C., Shulman, H. B., Fischer, L. A., & Rogers, M. M. (1999). The Pregnancy Risk Assessment Monitoring System (PRAMS): Methods and 1996 response rates from 11 states. Maternal and Child Health Journal, 3(4), 199–209.PubMedCrossRefGoogle Scholar
  20. 20.
    Shulman, H. B., Gilbert, B. C., Msphbrenda, C. G., & Lansky, A. (2006). The Pregnancy Risk Assessment Monitoring System (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.PubMedCentralPubMedGoogle Scholar
  21. 21.
    PRAMS: Methodology [Internet] 2012. Available from
  22. 22.
    PRAMS phase five questionnaire topic reference [Internet] 2012. Available from
  23. 23.
    PRAMS: Phase six questionnaire topic reference [Internet] 2012. Available from
  24. 24.
    Dozier, A., Brownell, E., Guido, J., Yang, H., Howard, C. & Doniger, A. et al. Adapting the pregnancy risk assessment monitoring survey to enhance locally available data: Methods. Submitted to MCHJ.Google Scholar
  25. 25.
    Jacobs, D. E., Clickner, R. P., Zhou, J. Y., Viet, S. M., Marker, D. A., Rogers, J. W., et al. (2002). The prevalence of lead-based paint hazards in US housing. Environmental Health Perspectives, 110(10), A599–A606.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Private drinking water wells [Internet] 2012. Available from
  27. 27.
    Petersen, R., Connelly, A., Martin, S. L., & Kupper, L. L. (2001). Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS). American Journal of Preventive Medicine, 20(4), 245–250.PubMedCrossRefGoogle Scholar
  28. 28.
    Bachman, J. G., & O’Malley, P. M. (1984). Yea-saying, nay-saying, and going to extremes: Black-white differences in response styles. Public Opinion Quarterly, 48(2), 491–509.CrossRefGoogle Scholar
  29. 29.
    Boyce, S & Hood K. (2002). Lead poisoning among young children in Monroe County, NY: A needs assessment, projection model, and next steps. Center for Governmental Research.Google Scholar
  30. 30.
  31. 31.
    Korfmacher, K. S. (2008). Collaborating for primary prevention: Rochester’s new lead law. Journal of Public Health Management and Practice, 14(4), 400–406.PubMedCrossRefGoogle Scholar
  32. 32.
    Korfmacher, K. S., Ayoob, M., & Morley, R. (2012). Rochester’s lead law: Evaluation of a local environmental health policy innovation. Environmental Health Perspectives, 120(2), 309–315.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Levin, R., Brown, M. J., Kashtock, M. E., Jacobs, D. E., Whelan, E. A., Rodman, J., et al. (2008). Lead exposures in US children, 2008: Implications for prevention. Environmental Health Perspectives, 116(10), 1285–1293.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Katrina Smith Korfmacher
    • 1
  • Barbara J. Suter
    • 2
  • Xueya Cai
    • 3
  • Susan A. Brownson
    • 4
  • Ann M. Dozier
    • 2
  1. 1.Department of Environmental Medicine, Environmental Health Sciences CenterUniversity of RochesterRochesterUSA
  2. 2.Department of Public Health SciencesUniversity of RochesterRochesterUSA
  3. 3.Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterUSA
  4. 4.The College at BrockportState University of New YorkRochesterUSA

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