[' ', ' ', 'pounds,', 'and', 'while', 'nicotine', 'is', 'primarily', 'responsible', 'for', 'the', 'pharmacological', 'response', 'to', 'smoking,.', 'vir-', 'tually', 'all', 'of', 'these', 'compounds', 'affect', 'the', 'smoker', 'to', 'some', 'degree.*?', 'Tobacco', 'smoke', 'may', 'influence', 'the', 'developing', 'fetus.', 'either', 'by', 'alterations', 'in', 'maternal', 'physiology', 'that', 'limit', 'oxygen', 'and', 'nutrient', 'flow', 'to', 'the', 'fetus', 'or', 'by', 'transpla-', 'cental', 'passage', 'of', 'components', 'of', 'cigarette', 'smoke', 'that', 'may', 'have', 'a', 'direct', 'effect', 'on', 'the', 'fetus.', 'Maternal', 'smok-', 'ing', 'during', 'pregnancy', 'impairs', 'uteroplacental', 'circula-', 'tion', 'due', 'to', 'the', 'vasoconstrictive', 'action', 'of', 'nicotine', 'and', 'this', 'has', 'been', 'shown', 'to', 'contribute', 'to', 'fetal', 'hypoxia', 'and', 'reduced', 'access', 'to', 'nutrients.***', 'Fetal', 'hypoxia', 'also', 'results', 'from', 'increased', 'fetal', 'carboxyhemoglobin', 'due', 'to', 'rapid', 'transplacental', 'passage', 'of', 'carbon', 'monoxide®', 'which', 'is', 'twice', 'as', 'high', 'in', 'the', 'fetal', 'circu-', 'lation', 'as', 'in', 'maternal', 'circulation', 'among', '‘pregnant', 'smokers.**', 'Nicotine', 'or', 'other', 'components', 'of', 'cigarette', 'smoke', 'may', 'also', 'directly', 'injure', 'the', 'developing', 'brain.', 'Nicotine', 'is', 'readily', 'soluble', 'both', 'in', 'water', 'and', 'lipid', 'and', 'concentrates', 'in', 'the', 'brain,', 'adrenal', 'medulla,', 'and', 'pitui-', 'tary', 'gland.', 'Nicotine', 'and', 'its', 'metabolites', 'can', 'be', 'iden-', 'tified', 'in', 'fetal', 'rat', 'tissue', 'within', '5', 'minutes', 'following', 'maternal', 'injection,', 'and', 'nicotine', 'actually', 'penetrates', 'the', 'preimplantation', 'blastocyst', 'which', 'then', 'has', 'a', 'con-', 'centration', 'of', 'nicotine', 'twice', 'as', 'great', 'as', 'that', 'in', 'mater-', 'nal', 'serum.”', 'There', 'are', 'specific', 'nicotine', 'binding', 'sites', 'within', 'the', 'brain', 'with', 'regional', 'variations', 'in', 'their', 'density', 'by', '12', 'weeks’', 'gestation.', 'The', 'density', 'of', 'these', 'binding', 'sites', 'increase', 'from', '12', 'to', '19', 'weeks’', 'gesta-', 'tion,', 'with', 'the', 'greatest', 'concentrations', 'in', 'the', 'nucleus', 'basalis,', 'globus', 'pallidus,', 'caudate-putamen,', 'and', 'thal-', 'amus.*”', 'These', 'findings', 'may.', 'also', 'suggest', 'a', 'possible', 'psy-', 'choactive', 'effect', 'on', 'children', 'of', 'passive', 'exposure', 'to', 'cigarette', 'smoke', 'after', 'birth', 'and', 'during', 'childhood.', 'Children', 'receive', 'a', 'significant', 'dose', 'of', 'nicotine', 'and', 'other', 'constituents', 'of', 'cigarette', 'smoke', 'to', 'which', 'they:', 'are', 'passively', 'exposed', 'as:evidenced', 'by', 'elevated', 'sali-', 'vary,', 'cotinine', 'levels', 'among', 'children', 'whose', 'mothers', "smoke.'**8", 'Nicotine', 'is', 'a', 'central', 'nervous', 'system', 'stim-', 'ulant', 'that', 'affects', 'autonomic', 'ganglion', 'cells', 'by:', 'stimu-', 'lating', 'acetylcholine-like', 'depolarization', 'of', 'cholinergic', 'receptors', 'and', 'by', 'stimulating', 'release', 'of', 'catechol-', 'amines', 'from', 'the', 'adrenal', 'medulla,', 'nerve', 'cells,', 'and', 'chromaffin', 'tissues', 'of', 'various', 'organs.', 'Alternatively,', 'it', 'is', 'possible', 'that', 'maternal!', 'smoking', 'alters', 'maternal', 'behavior', 'in', 'such', 'a', 'way.as', 'to:result', 'in', 'increased', 'rates', 'of', 'children’s', 'behavior', 'problems,', 'or', 'it', 'may', 'not', 'alter', 'children’s', 'behavior', 'at', 'all,', 'but', 'rather', 'maternal', 'smok-', 'ing', 'may', 'alter', 'maternal', 'perceptions', 'and', 'make', 'mothers', 'more', 'intolerant', 'of', 'children’s', 'behavior', 'and', 'thus', 'more', 'likely', 'to', 'report', 'their', 'behavior', 'as', 'bothersome.', 'Lastly,', 'the', 'observed', 'association', 'between', 'maternal', 'smoking', 'andi', 'children’s', 'behavior', 'problems', 'may,', 'sim-', 'ply', 'be', 'a', 'result', 'of', 'confounding', 'of', 'maternal!', 'smoking', 'with:some', 'other', 'child,', 'maternal,', 'or', 'family', 'character-', 'istic', 'that', 'we', 'did', 'not.', 'investigate.', 'For', 'example,', 'it', 'ap-', 'pears', 'that', 'mothers', 'who', 'smoke', 'are', 'more', 'likely:', 'to', 'be', 'depressed,', 'anxious,', 'or', 'have', 'other', 'mental', 'health', 'problems*’~?', 'that', 'result', 'in', 'altered', 'parent-child', 'inter-', 'action', 'or', 'decreased', 'tolerance', 'for', 'children’s.', 'behav-', 'ior.“', 'In', 'the', 'analyses', 'reported', 'in', 'this', 'paper,', 'one', 'domain', 'of', 'maternal', 'mental', 'health', 'was', 'controlled', 'for,', ' ', 'namely', 'self-esteem.', 'Low.', 'maternal', 'self-esteem', 'was', 'a', 'potent', 'independent', 'predictor', 'of', 'increased', 'behavior', 'problems,', 'yet', 'controlling', 'for', 'this', 'aspect', 'of', 'maternal', 'mental', 'health', 'did', 'not', 'explain', 'or', 'diminish', 'the', 'inde-', 'pendent', 'association', 'demonstrated:', 'between', 'maternal', 'smoking', 'and', 'children’s', 'behavior', 'problems..', 'Although', 'self-esteem', 'is', 'closely:', 'related', 'to', 'depression,', 'and', 'ma-', 'ternal', 'depression', 'has', 'been', 'shown', 'to', 'exert', 'a', 'strong', 'influence', 'on', 'children’s', 'behavior,', 'self-esteem', 'is:', 'not', 'an', 'accepted', 'proxy', 'measure', 'of', 'depression', 'and', 'the', 'measure', 'of', 'self-esteem', 'used', 'may', 'not', 'have', 'been', 'sen-', 'sitive', 'to', 'other', 'aspects', 'of', 'maternal', 'mental', 'health', 'and', 'functioning', 'that', 'are', 'both', 'more', 'common', 'in', 'women', 'who', 'smoke', 'and', 'that', 'influence', 'child-rearing', 'behaviors', 'or', 'maternal', 'perceptions', 'of', 'children’s', 'behavior.', 'De-', 'spite', 'this.caution,.it', 'deserves', 'mentioning', 'again', 'that', 'controlling', 'for', 'a', 'host', 'of', 'other', 'maternal', 'and', 'family', 'characteristics—including', 'maternal', 'education,', 'labor', 'force', 'participation,', 'chronic', 'disabling', 'conditions,', 'and', 'an', 'indicator', 'of', 'maternal', 'intelligence;', 'family', 'income,', 'family', 'structure,', 'recent', 'divorces,', 'and', 'parental', 'sepa-', 'rations;', 'and’', 'a', 'measure', 'of', 'the', 'quality', 'of', 'the', 'home', 'environment', 'and', 'parent-child', 'interaction—did', 'not', 'appreciably', 'alter', 'or', 'attenuate', 'the', 'observed', 'relation-', 'ship.', 'between:', 'maternal', 'smoking', 'and', 'children’s:', 'be-', 'havior', 'problems.', 'There', 'are', 'a', 'number', 'of', 'other', 'limitations', 'to:', 'this', 'study', 'that', 'should', 'be', 'acknowledged.', 'The', 'measure', 'of', 'children’s', 'exposure', 'to', 'cigarette', 'smoke', 'is', "imperfect'in", 'that', 'it', 'is', 'parent', 'reported', 'rather', 'than', 'being', 'based', 'on', 'nicotine', 'levels,', 'and', 'no', 'information', 'is', 'available', 'about', 'the', 'brand', 'of', 'cigarette', 'smoked', 'so', 'that', 'the', 'quantity', 'of', 'nicotine', 'consumed', 'per', 'day', 'cannot', 'be', 'estimated.', 'Moreover,', 'no', 'data.', 'are', 'available', 'about', 'changes', 'in', 'maternal', 'smoking', 'habits', 'during', 'pregnancy,', 'between', 'the', 'pregnancy', 'and', '1984,', 'or', 'between', '1984', 'and', '1986', 'so', 'that', 'categorization', 'of', 'women’s', 'prenatal', 'and', 'post-', 'natal', 'smoking', 'status', 'is', 'probably', 'not', 'accurate', 'in', 'all', 'cases.', 'The', 'age', 'of', 'mothers', 'atientry', 'into', 'the', 'NLSY', 'was', '14', 'through', '22', 'years,', 'and', 'all', 'mothers', 'interviewed', 'in', '1986', 'were', 'thus', '21', 'through', '29', 'years.', 'of', 'age.', 'It', 'was', 'therefore', 'not', 'possible', 'to', 'investigate', 'the', 'relationship.', 'between', 'maternal', 'cigarette', 'smoking', 'and', 'children’s', 'behavior', 'problems', 'among', 'older', 'mothers.', 'Since', 'all', 'information', 'about', 'children’s', 'behavior', 'problems', 'is', 'based', 'on', 'parent', 'reports,', 'the', 'possibility', 'of', 'reporting', 'bias', 'must', 'not', 'be', 'overlooked.', 'Measures', 'of', 'children’s', 'behavior', 'problems', 'based', 'on', 'the', 'reports', 'of', 'independ-', 'ent', 'observers,', 'such', 'as', 'teachers,', 'not', 'available', 'in', 'data.', 'from', 'the', 'NLSY,', 'would', 'have', 'reduced', 'the', 'possibility:', 'of', 'reporting', 'bias.', 'Although', 'a', 'number', 'of', 'previous', 'studies', 'have', 'dem-', 'onstrated', 'modest', 'impairments', 'in', 'school!', 'performance', 'and', 'intellectual', 'achievementiof', 'children', 'whose', 'moth-', 'ers', 'smoked', 'during', 'pregnancy,”*"*°', 'at', 'least', 'one', 'study:', 'has', 'not', 'found.', 'impaired', 'cognitive', 'functioning,”', 'an-', 'other', 'found', 'cognitive', 'associations', 'at', '12,', 'but', 'not', "24'", 'months,“', 'and', 'there', 'is', 'no', 'evidence', 'that', 'smoking', 'during', 'pregnancy', 'is', 'associated', 'with', 'increased', 'rates', 'of', 'cerebral', 'palsy,', 'mental', 'retardation,', 'or', 'seizures.', 'A', 'small', 'number', 'of', 'studies:', 'with', 'small', 'samples', 'have', 'demonstrated', 'findings', 'suggesting', 'that’', 'children', 'whose', 'mothers', 'smoked', 'during', 'pregnancy', 'have', 'in-', 'creased', 'rates', 'of', 'behaviors', 'frequently', 'associated', 'with', 'ARTICLES', '347', '8S69CPS8202']