Prenatal Tobacco-Cannabis Co-Use: A Mixed-Methods, Convergent Parallel Study

Abstract Introduction Tobacco-cannabis co-use among vulnerable populations, particularly pregnant people, is a growing public health concern. While prenatal tobacco use has been declining, rates of prenatal cannabis use have more than doubled in recent years. Although there is growing evidence around the health effects of prenatal co-use, little is known about reasons for co-use or cessation behaviors during pregnancy. Methods This descriptive, mixed-methods study aimed to discern reasons for co-use and cessation patterns among birthing people. Surveys and interviews were conducted with adults who reported tobacco-cannabis co-use during pregnancy and were enrolled in a community-based program in Wisconsin between 2022 and 2023. Quantitative data were analyzed using Fisher’s Exact Tests and logistic regression. Qualitative data were analyzed using reflexive thematic analysis. A mixed methods convergent parallel design integrated the findings. Results Findings from 46 surveys and 19 interviews revealed key differences in cannabis and tobacco use intentions and cessation during pregnancy. Results also indicated that individuals tend to view tobacco and cannabis use as distinct behaviors, contrary to previous research. Findings underscore the interconnectedness of mental health, stress, and co-use. Conclusions Future efforts should partner with communities to identify strategies that empower pregnant people to make informed decisions about co-use during pregnancy. Implications The development of tailored, evidence-based tobacco-cannabis-co-use interventions is crucial, as the study highlights divergent experiences and intentions in quitting tobacco versus cannabis. A better understanding of tobacco and cannabis co-use mechanisms during pregnancy is also needed. Furthermore, the study emphasizes the necessity of integrating mental health and substance use in both research and clinical practice to more effectively support pregnant individuals. Centering the experiences of birthing people in this work will ensure that efforts align with the needs and priorities of community members.