Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.

Marijuana is the most commonly used illicit drug during pregnancy, and its use is increasing. From 2002 to 2014, the prevalence of self-reported, past-month marijuana use among US adult pregnant women increased from 2.4% to 3.9%.¹ In aggregated 2002-2012 data, 14.6% of US pregnant adolescents reported past-month use.² However, studies are limited to self-reported surveys and likely underestimate use due to social desirability bias and underreporting, leaving the scope of the problem unclear. We investigated trends of prenatal marijuana use from 2009-2016 using data from a large California health care system with universal screening via self-report and urine toxicology.

Cannabis use during pregnancy may adversely affect the health of pregnant mothers and the developing fetus. A growing body of literature suggests that prenatal cannabis use is associated with lower offspring birthweight, and there is evidence of possible adverse effects on other fetal and neonatal outcomes, as well as worse neuropsychological functioning among children exposed to cannabis in utero.^1-5 While much is still unknown, national guidelines recommend that pregnant women abstain from cannabis use in the perinatal period owing to concerns about the negative health outcomes of cannabis use in pregnancy.³

Introduction: Adverse childhood experiences (ACEs) are common among pregnant women and contribute to increased risk for negative perinatal outcomes, yet few clinicians screen prenatal patients for ACEs. The purpose of this study was to evaluate the feasibility and acceptability of screening for ACEs in standard prenatal care. Methods: We evaluated a 4-month pilot (March 2016–June 2016) to screen pregnant women (at ∼14–23 weeks of gestation) for ACEs and resiliency in two Kaiser Permanente Northern California medical centers (N = 480). We examined the acceptability of the screening to patients through telephone surveys (N = 210) and to clinicians through surveys and focus groups (N = 26). Results: Most eligible patients (78%) were screened. Patients who received the screening were significantly more likely to be non-Hispanic White, Asian, or of “Other” or “Unknown” race/ethnicity than African American or Hispanic race/ethnicity (p = 0.02). Among those screened, 88% completed the questionnaires; 54% reported 0 ACEs, 28% reported 1–2 ACEs, and 18% reported ≥3 ACEs. Most patients were somewhat or very comfortable completing the questionnaires (91%) and discussing ACEs with their clinician (93%), and strongly or somewhat strongly agreed that clinicians should ask their prenatal patients about ACEs (85%). Clinicians reported significant pre- to postpilot increases in comfort discussing ACEs, providing education, and offering resources (ps < 0.01). Clinicians' willingness to screen for ACEs was contingent on adequate training, streamlined workflows, inclusion of resilience screening, and availability of mental health, parenting, and social work resources. Conclusion: ACEs screening as part of standard prenatal care is feasible and generally acceptable to patients. Women's health clinicians are willing to screen patients for ACEs when appropriately trained and adequate behavioral health referral resources are available.

Cannabis use among pregnant women is common and has increased in recent years in the US, from an estimated 3.4% in 2002 to 7.0% in 2017.¹ Pregnant women report using cannabis to relieve stress and anxiety,² and prenatal cannabis use may have risen during the COVID-19 pandemic as pregnant women faced general and pregnancy-specific COVID-related stressors (eg, social isolation, financial and psychosocial distress, increased burden of childcare, changes in prenatal care, and concerns about heightened risks of COVID-19).^3,4