Cigarette use declines among U.S. young women, but marijuana blunt use rises

(Reuters Health) - Cigarette use decreased among young women - including pregnant women - during the past decade in the U.S., according to a new study. But, researchers found, use of marijuana blunts rose.

A blunt is a cigar that’s been hollowed out and filled with marijuana. Although researchers aren’t sure about the health implications of the increase, they want to know more given the rapid changes in state marijuana laws, the study authors wrote in the American Journal of Public Health.

“Everyone knows that smoking is bad for you. Everyone knows that women should not smoke while pregnant,” said lead study author Victoria Coleman-Cowger of the University of Maryland School of Medicine in Baltimore, in an email to Reuters Health. “But until recently, research in this area has focused primarily on the prevalence and impact of smoking tobacco cigarettes during pregnancy. We now recognize that use of tobacco products and multiple substances is not uncommon, and pregnant women who smoke tobacco cigarettes are often using other tobacco products as well.”

Coleman-Cowger and colleagues analyzed data from the 2006-2016 National Survey on Drug Use and Health to understand how women of reproductive age used cigarettes, cigars, and marijuana blunts during the past month. Altogether, they had survey responses from about 8,700 pregnant women and 162,000 nonpregnant women, ages 18 to 44.

Overall, cigarette use was more prevalent than cigar or blunt use for both pregnant and nonpregnant women, with higher prevalence of all products for nonpregnant women. About 15 percent of pregnant women smoked cigarettes in the previous month, as well as two percent who smoked blunts and one percent who smoked cigars. Between 2006-2016, the likelihood of smoking cigarettes decreased from 18 percent to 10 percent for pregnant women, and the likelihood of smoking blunts increased from less than 1 percent to 2.5 percent.

“It is promising to see less cigarette use during pregnancy because we know that it will positively impact public health,” Coleman-Cowger said. “However, this decline could mean pregnant women are turning to alternative tobacco products or marijuana due to perceptions of lower risk.”

Researchers don’t yet fully understand the implications of marijuana use during pregnancy, as well as the combined impact of tobacco and marijuana, she added. In a previous small study, Coleman-Cowger and colleagues found an association between birth defects and substance use, but many questions remain.

“We need to understand not only the health effects of blunt use during pregnancy but also why pregnant women are choosing to smoke them,” she said. “Could flavors available in cigars but not in cigarettes be a factor? Do pregnant women think that blunts are safer?”

Researchers also want to better understand which women of reproductive age are at greater risk for cigarette, cigar and marijuana blunt use, including age, socioeconomic status and racial/ethnic groups, said Qiana Brown of Rutgers University in New Brunswick, New Jersey. Brown, who wasn’t involved with this study, has researched marijuana use among pregnant and nonpregnant women.

Brown and colleagues reported last year in JAMA that between 2002 and 2014, marijuana use rose more among 18-to-25-year-old women than among 26-to-44-year-old women. They also found that insurance coverage was associated with a reduction in tobacco use among reproductive-age women, but not necessarily pregnant women. (

“Tobacco use remains a major public health problem,” Brown told Reuters Health by email. “We must keep our fingers on the pulse of vulnerable populations to prevent health disparities.”

SOURCE: American Journal of Public Health, online June 21, 2018.