Recreational Cannabis Legalization and Disparities in Prenatal Use and Co-use of Cannabis and Tobacco

• In Event: Substance Exposure and Children's Health

Abstract

Introduction: Prenatal cannabis use is rising, along with evidence that prenatal use and co-use of tobacco and cannabis are associated with increases in preterm births, low birth-weight, and infant mortality. Although growing evidence finds that recreational cannabis legalization has led to increased adult cannabis use, whether recreational cannabis legalization is driving changes in the prenatal co-use of tobacco and cannabis separately from cannabis-only use remains unknown. We evaluated the associations between legalization and use and co-use of tobacco and cannabis during pregnancy overall and across demographic and higher-risk strata.

Aims and Methods: We linked data on 95,569 women from 21 states and DC who participated in the 2016-2021 Pregnancy Risk Assessment Monitoring System, which collected self-reported tobacco and cannabis use during pregnancy, with state recreational cannabis legalization and retail sales availability. Using difference-in-differences multinomial logit regression models, we examined whether recreational cannabis legalization and initiation of retail sales were associated with changes in use and co-use of tobacco and cannabis overall and across demographic (race and ethnicity, education, age) and higher-risk (depression pre-pregnancy, alcohol use pre-pregnancy) strata, with demographic and policy controls and state and year fixed effects.

Results: While prenatal tobacco-only use declined from 8.5% to 5.4% between 2016 and 2021, co-use of tobacco and cannabis remained relatively stable at 2.4% and cannabis-only use at 3.4%. The likelihood of cannabis-only use (aRRR 1.45; 95% CI: 1.05, 1.99) increased post-legalization and co-use of tobacco and cannabis (aRRR 1.48; 95% CI: 1.02, 2.14) increased after initiation of retail sales. There was some evidence that White women and those who reported light and moderate/heavy alcohol use increased cannabis-only use post-legalization and retail sales. 

Conclusions: Results suggest that recreational cannabis legalization and the introduction of retail sales increased cannabis-only use and co-use of tobacco and cannabis during pregnancy, with stronger patterns among White women and alcohol users. While professional organizations and public health professionals recommend screening for substance use, prenatal substance use laws vary across states and patient disclosure of cannabis use during pregnancy could result in punitive action. Revisiting state prenatal substance use laws during the legislative process is a necessary component to addressing prenatal substance use. Our results suggest that expanding recreational cannabis legalization across states could result in rising prenatal cannabis use, including co-use of cannabis and tobacco, highlighting the need for monitoring the longer-term effects of legalization and research on how these policies are influencing patterns of prenatal substance use.  

Authors

• Rebekah Levine Coley, Boston College
  Presenting Author

• Christopher F Baum, Boston College
  Non-Presenting Co-Author

• Summer Sherburne Hawkins, Boston College
  Non-Presenting Co-Author