, 1980) and interfere with quit attempts in nonpregnant populations (Richter, Ahluwalia, Mosier, Nazir, & Ahluwalia, 2002; Stapleton, Keaney, & Sutherland, 2009), although marijuana use has Vorinostat solubility not been demonstrated to do so (Nemeth-Coslett, Henningfield, O��Keeffe, & Griffiths, 1986). However, we know of one study where marijuana use was correlated with failure to quit smoking during pregnancy (Haskins, Bertone-Johnson, Pekow, Carbone, & Chasan-Taber, 2010). While not examined in this study, a major concern about drug use during pregnancy is adverse fetal effects. While marijuana was the most common drug seen in this study effects of marijuana use on birth outcomes are not well established. Indeed, when potentially confounding influences of sociodemographic variables and cigarette smoking are controlled for, marijuana use may have no discernible adverse effects on birth outcomes (Bada et al.

, 2002; Bailey, McCook, Hodge, & McGrady, 2012). Cigarette smoking during pregnancy continues to be the strongest predictor of adverse fetal effects of drug use. In a large, multisite trial cigarette smoking was shown to have greater adverse effects on birth weight, intrauterine growth restriction, and premature birth than illicit drug use (Bada et al., 2005). Abolishing maternal smoking appears to be the most effective way to improve fetal health, especially when the higher prevalence of maternal smoking, compared with maternal drug use, is considered (Burstyn, Kapur, & Cherry, 2010). A few limitations of this study merit mention.

We were not able to test the samples for buprenorphine, which is abused in the study area; therefore, the number of opioid users may be an underestimation. Additionally, this sample consists of treatment-seeking pregnant smokers, which may be inherently different than the general population of pregnant smokers (e.g., perhaps less likely to use other drugs). As this study was retrospective, we could only examine a limited number of characteristics as potential predictors of drug use. Overall, considering the relatively high prevalence of illicit drug use in this pregnant smoker population, as well as possible adverse consequences of such use on smoking cessation, it may be prudent for those providing smoking-cessation therapy to be prepared to assist pregnant women with obtaining services for other drug use as well.

The American College of Obstetricians and Gynecologists (ACOG) provides guidelines regarding screening, assessment, and brief intervention in this population (ACOG, 2008). FUNDING This study was supported by research grant DA14028 and training grant DA007242 from the National Institutes of Brefeldin_A Health, National Institute on Drug Abuse.
Secondhand smoke (SHS), the tobacco smoke generated by active smokers, remains a widespread health hazard worldwide (U.S. Department of Health and Human Services, 2006).