Cannabis warning sign policies not linked to reduced use during pregnancy

Key takeaways:

• Among cannabis users, living in states with cannabis warning signs was linked to believing use was safe and users should not be punished.
• Warning signs were not associated with cannabis use during pregnancy.

Policies on mandatory cannabis warning sign were not associated with reduced use during pregnancy or with users believing use during pregnancy was less safe, according to study results published in JAMA Network Open.

As the legalization of recreational cannabis use has become more widespread in the U.S., some states have enacted policies mandating warning signs that require businesses to post point-of-sale signs, including warnings about the harms of cannabis use during pregnancy. In the U.S., only Arizona, Colorado, Illinois, Oregon and Washington have mandatory warning signs policies.

“Mandatory warning signs about cannabis use during pregnancy do not appear effective. Pregnant people who use cannabis do not trust the information in these signs, and exposure to these signs is not associated with reduced cannabis use during pregnancy,” Sarah Roberts, DrPH, professor in the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, told Healio. “Exposure to these signs may relate to increased stigma regarding pregnant people’s cannabis use in the broader community, though.”

In a cross-sectional study, Roberts and colleagues utilized data from a population-based online survey conducted from May to June 2022 and identified 2,063 pregnant or recently pregnant women (mean age, 32 years). All women were members of the national probability KnowledgePanel and nonprobability samples in all U.S. states and territories where recreational cannabis use is legal.

The primary outcomes were self-reported beliefs that cannabis use during pregnancy is not safe, that use should be punished and that use is stigmatized.

Overall, 17.2% of participants reported using cannabis during pregnancy, and 14.3% of women reported having seen cannabis warning signs.

Among women who used cannabis during pregnancy, living in states with mandatory warning signs was associated with beliefs that cannabis use during pregnancy was safe and that cannabis users should not be punished. Among women who did not use cannabis before or during pregnancy, living in states with mandatory warning signs was associated with beliefs that cannabis use was unsafe, that users should be punished and that use was stigmatized.

Living in states with mandatory cannabis warning signs was not associated with cannabis use during pregnancy overall (adjusted OR = 1.11; 95% CI, 0.22-5.67) or when restricted to women who used cannabis before or during pregnancy (aOR = 1.49; 95% CI, 0.47-4.69).
mandatory warning signs for cannabis and alcohol use during pregnancy and are consistent with broader research regarding policies related to alcohol and drug use in pregnancy.

“Rather than continuing to use the same ineffective policy approaches to pregnant people’s substance use, we need research to understand what policies, health care and community resources meet the needs of pregnant people who use cannabis,” Roberts said.

For more information:

Sarah Roberts, DrPH, can be reached at sarah.roberts@ucsf.edu.