Effects of recreational cannabis laws on disparities in prenatal substance use

About This Grant

Project Summary Cannabis use among pregnant women has increased more than 60% over the past decade. Up to 15% of women use cannabis prior to pregnancy and 6% prenatally, with disparities by socio-demographics, mental health symptoms, and polysubstance use. The cannabis policy context has been evolving rapidly with 24 states and DC having legalized recreational cannabis. Significant gaps remain in understanding the effects of legalization on prenatal cannabis use and spillover effects on other substances, birth outcomes, and provider assessment of use as well as variations in policy effects by demographic and higher-risk strata. The overarching goals of the study are toexamine the effects of state recreational cannabis laws on disparities in women's use of cannabis, tobacco, and alcohol (referred to as substance use) during pregnancy as well as health care providers' assessment of prenatal substance use. We will evaluate the 2016-2023 Pregnancy Risk Assessment Monitoring System (PRAMS), the only state-representative data on prenatal cannabis use, which asks new mothers in 25 states and DC (15 have legalized cannabis) about their substance use and providers' assessment of use. Differences in state cannabis laws linked to monthly PRAMS data creates a natural experiment, which can be rigorously evaluated. This project has two Specific Aims. Aim 1 will evaluate the effects of state recreational cannabis laws on women's substance use preconception, prenatally, and postpartum as well as the downstream effects on birth outcomes. Aim 2 will evaluate the effects of state laws on women's self-reports of health care providers' assessment of prenatal substance use. Across Aims 1 and 2, the project will assess the overall effects of recreational cannabis legalization as well as differential effects of state laws by demographic (race/ethnicity, education, age) and higher-risk (mental health symptoms, polysubstance use) strata. The cannabis policy landscape is evolving rapidly. Study findings will (a) fill critical gaps in understanding the unintended consequences of emerging recreational cannabis laws on disparities in prenatal substance use, birth outcomes, and providers' assessment of prenatal use; and (b) inform public health responses in states with current cannabis laws or states contemplating legislation and clinical practice, including assessment of prenatal substance use, with the ultimate aim to improve the health of vulnerable mothers and infants.