Sex differences in cannabis- and alcohol-related motor vehicle collisions in three U.S. states with legalized cannabis: A multicenter observational study

Similar prevalence of cannabis use among injured drivers concealed distinct sex-specific pathways to MVC risk. Among men, alcohol co-use and high-risk driving behaviors represented established mechanisms of crash severity and health-care utilization. Among women, cannabis use more often occurred within a mental health context, suggesting different pathways linking substance use to traffic injury risk. Traffic injury prevention strategies in legalized cannabis environments should incorporate sex- and gender-responsive approaches, including targeted interventions addressing polysubstance use and hazardous driving behaviors, and integration of mental health considerations into impaired-driving prevention.