What topics does this cannabis study cover?

This study covers research on: Addiction.

How cannabis legalization is changing pregnancy substance use

Q: Where was this research published?

Published in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco on June 19, 2026.

Associations Between Recreational Cannabis Legalization and Disparities in Prenatal Tobacco and Cannabis Use.

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco • June 19, 2026 • Moderately Relevant

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AI Summary

This groundbreaking study examined how recreational cannabis legalization affects substance use during pregnancy by analyzing data from nearly 96,000 pregnant women across 21 states from 2016 to 2021. Researchers tracked prenatal tobacco and cannabis use before and after legalization, controlling for demographic factors and state policies. While prenatal tobacco-only use declined during this period, cannabis use—both alone and combined with tobacco—significantly increased following legalization and the opening of retail cannabis sales.

The findings reveal substantial public health concerns. Legalization was associated with a 45% increase in cannabis-only use and a 42% increase in combined tobacco and cannabis use during pregnancy. When retail sales became available, increases were even more dramatic: a 91% increase in cannabis-only use and a 48% increase in combined use. Notably, White women and those with light-to-moderate alcohol use patterns showed the highest rates of post-legalization cannabis adoption, highlighting important disparities in how legalization affects different populations.

These findings underscore a critical gap in clinical care and public health messaging. The study emphasizes the urgent need for enhanced screening for both tobacco and cannabis use during pregnancy, improved patient counseling about prenatal risks, and targeted prevention strategies for at-risk populations. As more states legalize recreational cannabis, healthcare providers must adapt their screening protocols and policymakers should consider public health campaigns addressing substance use in pregnancy, particularly given ongoing research into potential developmental effects of prenatal cannabis exposure.

📄 Original Abstract

Although prenatal cannabis use is rising, whether recreational cannabis legalization is driving changes in use of both cannabis and tobacco use remains unknown. We evaluated the associations between legalization and tobacco and cannabis use during pregnancy overall and across demographic and higher-risk strata. 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 the associations between recreational cannabis legalization and tobacco and cannabis use overall and by demographic (race and ethnicity, education, age) and higher-risk (pre-pregnancy depression, pre-pregnancy alcohol use) strata, with demographic and policy controls and state and year fixed effects. While prenatal tobacco-only use declined from 8.5% to 5.4% from 2016 to 2021, tobacco and cannabis use remained relatively stable at 2.4% and cannabis-only use at 3.4%. Recreational cannabis legalization was associated with increases in cannabis-only use (aRRR 1.45; 95% CI: 1.05, 1.99) and tobacco and cannabis use (aRRR 1.42; 95% CI: 0.96, 2.10). The start of retail sales was also associated with increases in cannabis-only use (aRRR 1.91; 95% CI: 1.41, 2.60) and tobacco and cannabis use (aRRR 1.48; 95% CI: 1.02, 2.14). There was some evidence of increases in cannabis-only use post-legalization and post-retail sales among White women and those who reported light and moderate/heavy alcohol use. Recreational cannabis legalization and the introduction of retail sales were associated with increases in cannabis-only use and tobacco and cannabis use during pregnancy. We evaluated the associations between recreational cannabis legalization and tobacco and cannabis use during pregnancy and found that cannabis-only use and use of both substances increased post-legalization and post-retail sales availability. These findings highlight the importance of screening for both tobacco and cannabis use in clinical settings and through population-level surveillance. Continued monitoring of cannabis legalization's public health impacts is critical to guide targeted outreach and prevention strategies to address substance use during pregnancy.