Mixed-methods research found pregnant women who co-used tobacco and cannabis treated them as separate behaviors with different motivations and cessation patterns, contrary to prior research treating them as a single behavior.
Prenatal health providers, substance use cessation researchers, maternal mental health specialists
Women viewed tobacco and cannabis cessation as separate decisions
What the researchers found
Findings from 46 surveys and 19 interviews with pregnant women who co-used tobacco and cannabis revealed key differences in use intentions and cessation patterns for each substance. Participants tended to view tobacco and cannabis as distinct behaviors, not a unified co-use pattern. Mental health and stress were interconnected with co-use, suggesting cessation interventions need to address each substance separately while also addressing underlying mental health factors.
Why it matters
Most prenatal substance use interventions treat tobacco and cannabis as a package, but pregnant women themselves see them as separate. This disconnect between clinical approaches and lived experience may explain why co-use interventions have limited success.
The numbers in context
46 surveys and 19 interviews; participants were enrolled in a Wisconsin community-based program 2022-2023; cannabis and tobacco viewed as distinct behaviors
How the study worked
Mixed-methods convergent parallel design. Surveys (n=46) and semi-structured interviews (n=19) with adults who reported tobacco-cannabis co-use during pregnancy, enrolled in a community-based program in Wisconsin (2022-2023). Quantitative analysis used Fisher's Exact Tests and logistic regression; qualitative data analyzed using reflexive thematic analysis.
What this study cannot tell us
Small sample (46 surveys, 19 interviews) from one community program in Wisconsin. Self-selected participants may not represent all pregnant co-users. Qualitative findings cannot be generalized to broader populations.
How to read the evidence
Mixed-methods design provides rich qualitative insight but small sample size, single community program, and self-selection limit generalizability.
When this study was published
2025 publication; data collected 2022-2023
The bigger picture
As prenatal cannabis use rises while prenatal tobacco use declines, understanding why women make different decisions about each substance during pregnancy is critical. The finding that mental health and stress drive co-use patterns points toward intervention targets beyond substance-specific messaging.
Questions still open
- Would substance-specific cessation interventions be more effective than combined approaches for pregnant co-users? What role do differing perceptions of harm between tobacco and cannabis play in cessation decisions?
Common questions
Why did pregnant women treat tobacco and cannabis differently?
What drove continued use during pregnancy?
Read the original research
Prenatal tobacco-cannabis co-use: A mixed-methods, convergent parallel study.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Citation
Alaniz, Kristine; Ngui, Emmanuel; Cho, Young; Laestadius, Linnea; Vance, Tessa. (2025). Prenatal tobacco-cannabis co-use: A mixed-methods, convergent parallel study.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. https://doi.org/10.1093/ntr/ntaf251
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide