{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T20:00:26Z","timestamp":1783195226140,"version":"3.54.6"},"reference-count":69,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000034","name":"Institute of Neurosciences, Mental Health and Addiction","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000034","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R01 DA054106, R01 DA054980, and U01 DA041089"],"award-info":[{"award-number":["R01 DA054106, R01 DA054980, and U01 DA041089"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canada First Research Excellence Fund for Healthy Brains for Healthy Lives"},{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cannabis legalization has triggered an increase in prenatal cannabis use. Given that tobacco is commonly co-used with cannabis, determining outcomes associated with prenatal cannabis and tobacco co-exposure is crucial. While literature exists regarding the individual effects of prenatal cannabis and tobacco exposure on childhood behaviour, there is a gap regarding their combined use, which may have interactive effects. Therefore, we investigated whether prenatal cannabis and tobacco co-exposure was associated with greater externalizing and internalizing problems in middle childhood compared to prenatal exposure to either substance alone or no exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9\u201311) were used to explore differences in externalizing and internalizing scores derived from the Childhood Behavior Checklist across four groups: children with prenatal cannabis and tobacco co-exposure (CT, n\u2009=\u2009290), children with prenatal cannabis-only exposure (CAN, n\u2009=\u2009225), children with prenatal tobacco-only exposure (TOB, n\u2009=\u2009966), and unexposed children (CTL, n\u2009=\u20098,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Adjusting for covariates, a 2\u2009\u00d7\u20092 ANCOVA revealed significant main effects for prenatal cannabis ( p\u2009=\u20090.03) and tobacco exposure ( p\u2009&lt;\u20090.001), and a significant interaction effect on externalizing scores ( p\u2009=\u20090.032); no significant main effects or interactions were found for internalizing scores. However, interactions between daily quantity of cannabis and tobacco exposure significantly predicted both externalizing and internalizing scores ( p\u2009&lt;\u20090.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings indicate that co-exposure is associated with greater externalizing problems than exposure to either substance alone, which did not differ from each other. Further, greater tobacco exposure may amplify the negative effect of cannabis exposure on both externalizing and internalizing behaviours in children. These findings underscore the need for interventions that target cannabis and tobacco co-use in pregnant women to circumvent their adverse impact on middle childhood behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary Title<\/jats:title>\n                    <jats:p>Prenatal Cannabis and Tobacco Co-exposure and its Association with Middle Childhood Behaviours<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437241271696","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T10:04:44Z","timestamp":1723629884000},"page":"41-53","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Prenatal Cannabis and Tobacco Co-Exposure and Its Association with Behavioural Outcomes in Middle Childhood: Co-exposition pr\u00e9natale au cannabis et au tabac et son association avec les r\u00e9sultats comportementaux au cours de l'enfance interm\u00e9diaire"],"prefix":"10.1177","volume":"70","author":[{"given":"Emma","family":"Nadler","sequence":"first","affiliation":[{"name":"McGill University, Montreal, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Jacobus","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of California San Diego, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6530-0288","authenticated-orcid":false,"given":"Rachel A.","family":"Rabin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, McGill University and The Douglas Mental Health University Institute, Montreal, 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