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Pregnant women living in industrially contaminated sites (ICSs) are exposed to environmental contaminants through different pathways, and thus children's health may be affected by pollutants. We created the Neonatal Environment and Health Outcomes (NEHO) longitudinal birth cohort in three ICSs in the Mediterranean area of southern Italy, collecting comprehensive information on personal data and lifestyles by questionnaire. Through multiple correspondence analysis, we identified possible clusters of enrolled women, and a neural network classifier analysis (NNCA) was performed to identify variables capable of predicting the attrition rate of the study. NEHO recruited 845 mother-child pairs over two years. The mothers' mean age was 31.1 ± 5.2 SD years. We found significant differences in socioeconomic status (SES) among the three evaluated ICS, and an overall 11.1% prevalence of mothers who actively smoked during pregnancy. Active smoking during pregnancy was strongly associated with the lowest socioeconomic level ( p < 0.0001). By means of the NNCA, we found that smoking during pregnancy and the lowest education level characterized the cluster with the highest attrition rate ( p < 0.001). Our results demonstrate that reason for public health concern still exists regarding smoking during pregnancy and that SES influences both lifestyles, producing negative pregnancy outcomes and a higher survey attrition rate.

The communities residing close to industrially contaminated sites are often affected by several fragilities, particularly of a socioeconomic nature. The disadvantaged conditions have often resulted from their marginalization in the decision-making related to the industrialization processes and may persist even when action is taken to limit the harmful consequences for the natural and social environment. Exposure to contaminants and the resulting health risks often regard socioeconomic deprived communities or the most disadvantaged subgroups, generating conditions of environmental injustice. This paper reports the results of a multidisciplinary reflection focusing on the Italian context. It describes how the national epidemiological surveillance system of communities residing close to industrially contaminated sites (named SENTIERI) and local epidemiological surveillance systems can be implemented to document local conditions of distributive injustice (inequalities in harmful exposures and consequent health risks). Furthermore, it analyses the mechanisms for generating and maintaining marginalities that prevent local communities from participating in decision-making processes (procedural injustice). Finally, after having identified and described the dimensions of community capacity, which concern both to the understanding of the adverse effects of environmental contamination and to the capability of promoting interventions against environmental injustices, it proposes an environmental justice promotion approach that starts from mapping the dimensions of community capacity as a premise to the identification of interventions for community empowerment.