Nadler Emma, Jacobus Joanna, Rabin Rachel A
McGill University, Montreal, Canada.
Department of Psychiatry, University of California San Diego, San Diego, California, USA.
Can J Psychiatry. 2025 Jan;70(1):41-53. doi: 10.1177/07067437241271696. Epub 2024 Aug 14.
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.
Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9-11) 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, = 290), children with prenatal cannabis-only exposure (CAN, = 225), children with prenatal tobacco-only exposure (TOB, = 966), and unexposed children (CTL, = 8,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes.
Adjusting for covariates, a 2 × 2 ANCOVA revealed significant main effects for prenatal cannabis ( = 0.03) and tobacco exposure ( < 0.001), and a significant interaction effect on externalizing scores ( = 0.032); 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 ( < 0.01).
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.
Prenatal Cannabis and Tobacco Co-exposure and its Association with Middle Childhood Behaviours.
大麻合法化导致产前大麻使用量增加。鉴于烟草常与大麻共同使用，确定产前大麻和烟草共同暴露相关的后果至关重要。虽然有关于产前大麻和烟草暴露对儿童行为的个体影响的文献，但关于它们的联合使用存在空白，联合使用可能具有交互作用。因此，我们调查了与单独产前暴露于任何一种物质或无暴露相比，产前大麻和烟草共同暴露是否与童年中期更多的外化和内化问题相关。
使用青少年大脑认知发展（ABCD）研究（收集于9至11岁儿童）的基线数据，探讨来自儿童行为清单的外化和内化得分在四组中的差异：产前大麻和烟草共同暴露的儿童（CT，=290）、仅产前大麻暴露的儿童（CAN，=225）、仅产前烟草暴露的儿童（TOB，=966）和未暴露儿童（CTL，=8311）。我们还研究了每日烟草暴露量是否调节大麻暴露对结果的影响。
调整协变量后，2×2协方差分析显示产前大麻（=0.03）和烟草暴露（<0.001）有显著主效应，对外化得分有显著交互效应（=0.032）；内化得分未发现显著主效应或交互效应。然而，大麻和烟草暴露的每日量之间的交互作用显著预测了外化和内化得分（<0.01）。
这些发现表明，与单独暴露于任何一种物质相比，共同暴露与更多的外化问题相关，而单独暴露于两种物质之间没有差异。此外，更多的烟草暴露可能会放大大麻暴露对儿童外化和内化行为的负面影响。这些发现强调了针对孕妇中大麻和烟草共同使用的干预措施的必要性，以规避其对童年中期行为的不利影响。
产前大麻和烟草共同暴露及其与童年中期行为的关联。
