Prenatal Tobacco Alone vs. With Cannabis Led to Different Behavioral Problems in Kids
Children exposed to both tobacco and cannabis before birth developed externalizing problems through emotion regulation difficulties, while tobacco-only exposure worked through different pathways involving maternal mood and temperament.
Quick Facts
What This Study Found
Prenatal tobacco-cannabis co-exposure (PTCE) was associated with externalizing problems through an emotion regulation pathway, while prenatal tobacco exposure (PTE) alone was associated through a combined maternal negative mood and temperament pathway. Both exposures led to heightened externalizing problems at school age, but through distinct developmental mechanisms.
Key Numbers
293 mother-child dyads (48% Black, 27% White, 14% Hispanic). PTE group: n=89. PTCE group: n=105. Controls: n=99. 64.8% WIC recipients. Externalizing problems assessed via maternal and teacher report at school age.
How They Did This
Longitudinal study of 293 diverse mother-child dyads (89 tobacco-exposed, 105 tobacco-cannabis co-exposed, 99 unexposed controls) assessed from infancy through early school age using physiological, observational, and parent/teacher reports.
Why This Research Matters
This is the first study to show that tobacco alone versus tobacco-plus-cannabis exposure lead to behavioral problems through entirely different developmental pathways. This means prevention and intervention approaches may need to be tailored based on what a child was exposed to prenatally.
The Bigger Picture
Most prenatal substance exposure research treats tobacco and cannabis use together or focuses on one substance. Demonstrating distinct mechanistic pathways for each type of exposure could fundamentally change how pediatric interventions are designed for exposed children.
What This Study Doesn't Tell Us
Cannot fully separate the effects of cannabis from those of tobacco in the co-exposure group. Self-reported substance use may be inaccurate. The sample, while diverse, was drawn from a specific geographic area.
Questions This Raises
- ?Would the emotion regulation pathway be present in cannabis-only prenatal exposure?
- ?Could early interventions targeting emotion regulation specifically help children exposed to both substances prenatally?
Trust & Context
- Key Stat:
- Different exposure types = different developmental pathways
- Evidence Grade:
- Well-designed longitudinal cohort with diverse sample, multiple assessment methods, and appropriate controls, though cannot isolate cannabis effects from co-exposure.
- Study Age:
- 2026 study.
- Original Title:
- Developmental Cascades From Prenatal Tobacco, Tobacco-cannabis Co-exposure to Early school-age externalizing Problems.
- Published In:
- Research on child and adolescent psychopathology, 54(1), 28 (2026)
- Authors:
- Perry, Kristin J(3), Schuetze, Pamela(4), Eiden, Rina D(8)
- Database ID:
- RTHC-08551
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does prenatal cannabis exposure cause behavioral problems in children?
This study found that combined tobacco-cannabis exposure was associated with childhood externalizing problems through emotion regulation difficulties. However, cannabis effects cannot be fully separated from tobacco effects in co-exposed children.
Why do the different exposures matter?
Because the developmental pathways are different, interventions may need to be tailored. Children exposed to both substances may benefit most from emotion regulation support, while tobacco-only exposed children may need different approaches.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08551APA
Perry, Kristin J; Schuetze, Pamela; Eiden, Rina D. (2026). Developmental Cascades From Prenatal Tobacco, Tobacco-cannabis Co-exposure to Early school-age externalizing Problems.. Research on child and adolescent psychopathology, 54(1), 28. https://doi.org/10.1007/s10802-025-01407-w
MLA
Perry, Kristin J, et al. "Developmental Cascades From Prenatal Tobacco, Tobacco-cannabis Co-exposure to Early school-age externalizing Problems.." Research on child and adolescent psychopathology, 2026. https://doi.org/10.1007/s10802-025-01407-w
RethinkTHC
RethinkTHC Research Database. "Developmental Cascades From Prenatal Tobacco, Tobacco-cannab..." RTHC-08551. Retrieved from https://rethinkthc.com/research/perry-2026-developmental-cascades-from-prenatal
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.