Are policies mandating warning signs regarding the harms of cannabis use during pregnancy associated with beliefs and behaviors?

In a recent study published in the JAMA Network Open Journal, researchers investigated the potential correlation between encounters with cannabis warning signs and cannabis-related use, beliefs, and stigma.

Study: Association of Mandatory Warning Signs for Cannabis Use During Pregnancy With Cannabis Use Beliefs and Behaviors. Image Credit: nerudol/Shutterstock.com

Background

States with legal recreational cannabis have implemented mandatory warning sign policies. Businesses must display point-of-sale signs that warn about the dangers of using cannabis while pregnant. However, it is unclear if the warning signs are based on evidence.

The use of cannabis among pregnant individuals is on the rise, but it is uncertain whether this trend is linked to the legalization of the substance. Using drugs during pregnancy is linked to negative outcomes for the child, such as low birth weight and psychological issues.

The reasons behind the unintended negative effects of warning signs for cannabis use during pregnancy are still unclear.

About the study

The study included noninstitutionalized English- and Spanish-speaking persons aged between 18 and 49 years who were assigned female at the time of birth, currently pregnant or recently pregnant, and living in one of 36 US states or Washington, DC.

The survey covered all states and Washington, DC, where recreational cannabis is legal. This includes 15 states without and five states with warning signs policies. A subset without legal cannabis or warning signs guidelines was intentionally selected for the survey.

Almost 3,571 valid responses were received for the survey. The survey questions contained questions that had lower chances of being answered positively by pregnant or recently pregnant individuals, such as inquiring about their residence in a community where adults aged at least 55 resided.

The study measured exposure to warning signs in two dichotomous ways: residing in a state having warning signs guidelines and being exposed to a warning sign in the previous year.

The study’s primary outcomes included beliefs about warning signs and cannabis use during pregnancy (CUDP). These included beliefs that usage is unsafe, support for punishment, perceived community stigma, perspectives on warning signs, and message fatigue.

Results

Approximately 2,063 pregnant or recently pregnant individuals reside in states where recreational cannabis is legal. The study involved participants from different states with a mean weighted age of 32 years.

Out of the total participants, 1,421 had recently given birth, 494 were currently pregnant, and 148 had a recent pregnancy that did not lead to birth. The study involved 418 persons who reported using cannabis before pregnancy, while 585 used cannabis during pregnancy. Also, 417 individuals claimed to have seen warning signs related to cannabis.

There was no association between warning sign policies and beliefs outcomes in the unadjusted models. Residing in a state having a warning signs policy was found to be associated with the belief that cannabis use during pregnancy (CUDP) was safe and less support for punishment among those reporting CUDP. At the same time, no such association was observed for community stigma.

Furthermore, among non-users of cannabis, residing in a state with a warning signs policy was related to a belief that CUDP was unsafe, more support for punishment, and more perceived stigma.

Furthermore, no significant associations were found between warning signs guidelines and beliefs outcomes among individuals who reported using cannabis before but not during pregnancy.

Only one association was found to be statistically significant in unadjusted models between individuals who reported CUDP and their support for punishment when exposed to warning signs.

Also, observing warning signs was linked to the perception that using cannabis during pregnancy was safe among individuals who reported using cannabis before but not during pregnancy. The presence of warning signs did not impact belief outcomes for individuals who reported CUDP and those who reported no use.

Residing in a state with a warning signs guideline did not show any association with CUDP in both unadjusted and adjusted models, including when the analysis was limited to individuals who used cannabis before or during pregnancy.

The presence of warning signs was linked to CUDP in both adjusted and unadjusted models. However, this association was not observed in individuals who reported using substances before or during pregnancy.

Conclusion

The present study revealed that policy warning signs were not associated with reduced cannabis use during pregnancy.

Non-users were more likely to believe that cannabis use during pregnancy was unsafe and that those who used it should be punished. Additionally, there was greater community stigma around pregnant people’s cannabis use among non-users in these states. Living in a state with a warning signs policy may increase stigma and punishment support among the general population.