Urban-rural and racial/ethnic disparities in modes of preconception cannabis use among insured patients receiving prenatal care at an integrated healthcare system in Northern California from 2020 to 2023.

OBJECTIVES

To examine joint associations between race/ethnicity and urbanicity in any cannabis use and modes of cannabis use during preconception.

METHODS

In this cross-sectional study, insured pregnant patients (N = 146,166) were screened for cannabis use at prenatal care entry between February, 2020 and September, 2023 at a large integrated healthcare system in Northern California and answered questions about preconception cannabis use (any cannabis use and modes of use [smoking, blunts, edibles, vaping, dabs and topicals]). Multivariable Poisson regression models examined associations between race/ethnicity and urbanicity in preconception cannabis use.

RESULTS

The prevalence of any cannabis use was 17%, smoking was the most common mode (67%). Preconception cannabis use was often highest in cities and lowest in town/rural areas. The magnitude of place-based differences was often greatest among non-Hispanic (NH) Black patients and patients from NH multi-racial/other/unknown racial/ethnic groups. For example, while the prevalence of any cannabis use and smoking was highest in cities and lowest in town/rural areas among each racial/ethnic group, the adjusted prevalence ratio (aPR) (1.55; 95% confidence interval [CI]=1.27-1.90) for any cannabis use comparing cities to town/rural areas was higher among NH Black patients; and the aPR for smoking (1.55; 95% CI=1.07-2.24) was highest for patients from NH multi-racial/other/unknown racial/ethnic groups.

CONCLUSIONS

Living in cities is often associated with increased preconception cannabis use. The greater magnitude of place-based differences in use among NH Black patients and patients from NH multi-racial/other/unknown racial/ethnic groups indicates that where these patients live potentially matters more in preconception cannabis use.