Although the percentage of smoking in the general population is declining, the rate of this is slowest among women of childbearing age. The recent National Household Survey on Drug Abuse reported that among women of reproductive age, approximately onethird smoke cigarettes on a regular basis. These figures for the United States are within one or two percentages of those noted in Canada and Sweden. In five surveys throughout the U.S., the extent of cigarette use by women during pregnancy in nonghetto, urban regions has been reported to be between 22 and 30. An additional recent statistic that bears upon the issue of smoking habits and pregnancy is that the proportion of heavy smokers has increased in the past decade, particularly among women. In Sweden, the proportion of heavy smokers has almost doubled while in Canada, the increase of heavy smokers was 57 among females versus 31 among males. This has important implications because the relationship between the consequences of maternal smoking and effects on the offspring appears to be dose related. Also of concern is that it is estimated by the Office of Smoking and Health that onethird to onehalf of nonsmoking pregnant women are exposed to significant levels of involuntary or second hand smoke. Demonstrating the increased toxic insults today’s developing child has from cigarette smoke, figures show smoking has increased 3 to 4fold from 1940 to the beginning of the 1980’s, although it has since then decreased somewhat 6.It’s of interest to point out that textbooks written in the 1940’s and 50’s make very little reference to the hyperkinetic syndrome in school age children. In fact, Henderson and Gillespie 1 characterized hyperkinetic disease as one of the very rare psychoses of childhood. In other early textbooks, Kanner 2 gave only five sentences to the restless, fidgety, hyperkinetic child, and did not even discuss hyperactivity as a possible cause for scholastic problems. In contrast, textbooks beginning in the 1970’s give estimates that persistent, disruptive hyperactivity occurs in from five to 10 percent of North American elementary school children 3,4 and Wender 5, describes hyperactivity as the single most common behavioral disorder seen by child psychiatrists. Regarding these observations, the current authors stated:

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