Study reveals perceived risk of weekly cannabis use among women of childbearing age with disabilities

A growing number of states and territories in the United States have legalized medical and recreational cannabis use. As such, recreational cannabis has been associated with a lower perception of risk of harm in the general U.S. population.

However, in women of childbearing age, evidence has shown that cannabis use may increase the risk of adverse reproductive and perinatal health outcomes. Furthermore, research on the perception of risk from using cannabis among vulnerable populations such as those with disabilities is lacking.

Using data from the 2021 National Survey on Drug Use and Health, researchers from Florida Atlantic University's Schmidt College of Medicine conducted a study to assess the perceived risk of harm associated with weekly cannabis use in a sample of 20,234 women ages 18 to 49 by disability status.

Disabilities included sensory (hearing and vision), cognitive (difficulty remembering and concentrating) and daily activities (e.g., walking and self-care). Researchers included race/ethnicity, age, marital status, federal poverty level, past-year health insurance gap, and whether the state of residence legalized medical cannabis. They also assessed perceived overall health status, past-year major depressive episode, past-month tobacco/alcohol use, and illicit drug use.

Results of the study, published in the journal Cannabis and Cannabinoid Research, showed that approximately 60% of women with disabilities who used cannabis in the past 12 months perceived no risk of harm from weekly cannabis use. A significantly higher percentage of women with any disability perceived no risk associated with weekly cannabis use (37.9%) compared to those with no disabilities (26.1%).

More than one-quarter (27.4%) of women perceived no risk of harm associated with weekly cannabis use. Overall, perceiving no risk associated with weekly cannabis use was evident among women ages 21 to 29 (34.4%), those who were never married (32%), were non-Hispanic Black (32.2%), living in poverty (31%), perceiving their health as fair/poor (35.1%), and experienced a past 12-month major depressive episode (36.4%). The likelihood of perceiving no risk also was higher among women using tobacco and those using both alcohol and tobacco.

Given women's attitudes toward cannabis as a harmless drug, the increasing rates of its use among those with disabilities, and the potential adverse health outcomes, it is imperative to monitor and understand perceptions of risk of harm from cannabis use among women with disabilities."

Panagiota "Yiota" Kitsantas, Ph.D., senior author, professor and chair, Department of Population Health and Social Medicine, FAU Schmidt College of Medicine 

Overall, women with disabilities and cannabis use in the past 12 months had 2.9 times higher odds of perceiving no risk associated with weekly use of cannabis compared to women without any disability and no cannabis use. The odds also were higher for those who did not have a disability but used cannabis in the past year, which indicates that cannabis exposure, in general, may increase a woman's likelihood of not perceiving any harm to her health from weekly use.

Exposure to cannabis use during pregnancy has been associated with adverse birth outcomes including low birth weight, preterm delivery, small for gestational age, admission to the neonatal intensive care unit and infant death. Cannabis use also may affect sex hormones essential to fertility and the timing of ovulation in reproductive age. 

"As legalization of cannabis use becomes more prevalent across states, attitudes regarding the risk of cannabis use are changing," said Lea Sacca, Ph.D., co-author and an assistant professor in the Department of Population Health and Social Medicine, FAU Schmidt College of Medicine. "A multi-pronged approach to address cannabis use among vulnerable populations such as women of childbearing age with disabilities will require clinical guidance, provider and patient education and evidence-based public health programs."

Although research evidence shows that residents in states where cannabis is legal are more likely to believe that cannabis has benefits than those living in states with just medically legal cannabis or nonlegal states, this study suggests that living in a state that has legalized medical cannabis was associated with a decreased likelihood of perceiving no risk from using weekly cannabis relative to states with no legalized use of medical cannabis.

"There is an urgent need for effective cannabis screening and subsequent dissuasion of cannabis use for reproductive-aged women at risk of substance use. Obstetrician-gynecologists can play an important role by informing patients about healthy behaviors and encouraging long-term adoption as well as identifying patients abusing drugs for proper referral to addiction treatment professionals," said Kitsantas. "Importantly, health policies should include holistic programs to proactively educate the population, pharmacists, medical and public health professionals of the associated benefits and risks of cannabis use among reproductive-aged women with disabilities."

Study co-author is Salman M. Aljoudi, a health data analyst, a Ph.D. researcher and an instructor at George Mason University.