Exploring the relationship between avoidance coping and cannabis use among black pregnant women.

Toso C.; Al-Sahab B.; Neelam H.; Hussen S.; Misra D.; Giurgescu C. · Addictive behaviors · 2026

**Background & Methods** This prospective cohort study examined the association between avoidance coping strategies and prenatal cannabis use among Black pregnant women (n=1,066, ages 18-45) enrolled in the Biosocial Impact on Black Births (BIBB) study across three U.S. cities (Detroit, Columbus, Orlando) from 2017-2022. Participants completed validated measures of coping strategies (Revised Prenatal Coping Inventory) and self-reported cannabis use during pregnancy, with logistic regression analysis adjusted for maternal age, household income, education, marital status, social support, gestational age, and state of residence. **Key Findings** • Prenatal cannabis use was reported by 21.3% of participants; avoidance coping was significantly associated with increased cannabis use, with odds ratios of 1.80 (95% CI: 1.19-2.76) in the second tertile and 2.45 (95% CI: 1.61-3.76) in the third tertile compared to the lowest tertile of avoidance coping scores. • Perceived stress mediated the relationship between avoidance coping and prenatal cannabis use, accounting for 36.4% of the total effect (p < 0.05), suggesting that individuals using avoidance coping strategies may rely on cannabis to manage stress. • The findings emphasize the importance of developing culturally responsive health interventions that promote adaptive coping mechanisms and address psychological stress to reduce prenatal cannabis use in Black pregnant populations. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study represents observational evidence (prospective cohort) with moderate limitations. The cross-sectional assessment of cannabis use relies on self-report, which may introduce recall bias and social desirability bias, particularly regarding substance use during pregnancy. The study's focus on a specific racial demographic and geographic regions limits generalizability. Strengths include a relatively large sample size, validated psychological instruments, rigorous statistical adjustment for potential confounders, and formal mediation analysis. The 36.4% mediation effect suggests additional unmeasured mechanisms may explain the relationship. The study provides Level 3 evidence regarding associations but cannot establish causality. Future research should employ prospective assessment of both coping and cannabis use and incorporate objective biomarkers of cannabis exposure.

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