Future research is needed to determine optimal pharmacotherapy for Black smokers new product and smokers of menthol cigarette
Tobacco use is a significant health concern in the United States. According to the 2004 Surgeon General Report, smoking-attributable health care costs exceed $150 billion annually, including nearly $500 million on neonatal care (U.S. Department of Health and Human Services, 2004b). Despite long-established health consequences and federally mandated warnings, 16.4% of American women continue to smoke while pregnant (Substance Abuse and Mental Health Services Administration, 2009). Identifying affected infants is critical to establishing social, behavioral, and educational interventions.

Biological monitoring of maternal and/or neonatal specimens can identify affected children and offers a more objective measurement than maternal self-report (Boyd, Windsor, Perkins, & Lowe, 1998; Britton, Brinthaupt, Stehle, & James, 2004; Markovic et al., 2000; Owen & McNeill, 2001; Webb, Boyd, Messina, & Windsor, 2003). Multiple matrices are available for testing, with maternal urine, oral fluid, and hair and neonatal urine, hair, and meconium among the most popular (Florescu et al., 2009). Meconium, the first neonatal feces, is an important matrix offering several advantages over other neonatal matrices, including a longer window of drug detection, easy collection, and larger specimen volume (Gray & Huestis, 2007). While meconium analysis is well established for other drugs of abuse, including opiates and cocaine, testing for nicotine and metabolites is less prevalent, and many questions remain regarding the disposition of tobacco biomarkers in meconium and the utility of quantitative concentration data.

It is not yet clear if meconium biomarker presence or a specific concentration can unequivocally differentiate active exposure (through smoking), passive exposure (through secondhand smoke), or nonexposure. Our previous research proposed a 10 ng/g nicotine, cotinine, or trans-3��-hydroxycotinine (OHCOT) concentration cutoff (Gray, Magri, Shakleya, & Huestis, 2008), but this has not yet been validated in a second independent cohort. In addition to identifying exposed children, quantitative biomarker determinations may directly reflect the magnitude of maternal cigarette consumption or, more importantly, predict neonatal outcomes, such as weight, height, head circumference, or developmental deficits later in childhood.

The existing literature correlating tobacco biomarkers in meconium, particularly with nicotine and OHCOT, and neonatal parameters is limited. Meconium is currently thought to reflect maternal substance use Dacomitinib during the second and third trimester; however, prospective clinical data monitoring maternal opioid and cocaine use by thrice weekly urine specimens suggest that the detection window is shorter, predominantly the last 3 months of pregnancy (Kacinko, Jones, Johnson, Choo, & Huestis, 2008).