{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:12:09Z","timestamp":1790244729850,"version":"4.1.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although prenatal cannabis use is rising, whether recreational cannabis legalization (RCL) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We linked data on 95\u2009569 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 RCL and retail sales availability. Using difference-in-differences multinomial logit regression models, we examined the associations between RCL 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%. RCL 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RCL and the introduction of retail sales were associated with increases in cannabis-only use and tobacco and cannabis use during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>We evaluated the associations between RCL 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\u2019s public health impacts is critical to guide targeted outreach and prevention strategies to address substance use during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag138","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:46:52Z","timestamp":1781783212000},"page":"1713-1721","source":"Crossref","is-referenced-by-count":1,"title":["Associations between recreational cannabis legalization and disparities in prenatal tobacco and cannabis use"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1099-362X","authenticated-orcid":false,"given":"Summer Sherburne","family":"Hawkins","sequence":"first","affiliation":[{"name":"School of Social Work, Boston College , Chestnut Hill, MA, 02467 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah Levine","family":"Coley","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston College , Chestnut Hill, MA, 02467 ,","place":["United States"]},{"name":"Lynch School of Education and Human Development, Boston College , Chestnut Hill, MA, 02467 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher F","family":"Baum","sequence":"additional","affiliation":[{"name":"School of Social Work, Boston College , Chestnut Hill, MA, 02467 ,","place":["United States"]},{"name":"Department of Economics, Boston College , Chestnut Hill, MA, 02467 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"issue":"2","key":"2026092405570623000_ref1","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1001\/jama.2016.17383","article-title":"Trends in marijuana use among pregnant and nonpregnant reproductive-aged women, 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