Perceived racial discrimination and tobacco and cannabis use in pregnant Black Americans: The mediating role of depressive symptoms.

The objective of the current study was to assess the relationships between perceived racial discrimination, symptoms of depression, and tobacco and cannabis use in a sample of pregnant Black Americans. We collected data from 668 pregnant participants, in Atlanta, GA, once at 8- to 14- weeks' gestation and again at 24- to 30-weeks' gestation. We administered the Timeline Follow-back Interview to assess self-reported tobacco and cannabis use and measured metabolites of nicotine (cotinine) and cannabis (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) from urine samples. Participants described depressive symptoms using the Edinburgh Postnatal Depression Scale. They also reported instances of racial discrimination throughout their lifetimes via the Krieger Experiences of Discrimination scale. Self-perceived racial discrimination was significantly related to increased tobacco use and urinary cotinine levels during pregnancy, while controlling for potential confounds. Race-based discrimination also impacted self-reported tobacco and cannabis use later in pregnancy through increased depressive symptoms. To our knowledge, this study is the first to investigate whether depressive symptoms mediate the influence of racial discrimination on substance use among pregnant Black people. Our findings have significant implications for smoking-cessation interventions, which should account for the interconnection between racial stress and mental health.