Vaping Nicotine and Cannabis Across Adolescence and Young Adulthood

2015年，有证据表明，青少年和年轻人（AYAs）使用电子烟（“vaping”） 增加，并与吸烟开始的风险增加有关， 在公共卫生界。随后的研究给该领域留下了几个关键的 问题，包括：（1）vaping是否真的对吸烟有因果关系，或者仅仅反映了一个 有情绪或行为问题的“高风险”AYA之间的共同倾向，（2） 是否出现了一波新的电子烟产品，包括新的尼古丁产品，如JUUL， 专用于蒸发大麻植物、油和蜡的日益多样化的产品类别可以 增加vaping的吸引力和成瘾潜力，以及（3）是否存在特定的 电子烟产品的特征和AYA风险的生物心理社会机制 vaping的开始，进展和过渡到其他形式的药物使用，可以有针对性 在预防工作中。关于AYA vaping影响的不确定性已经离开了政策 官员们几乎没有证据来确定AYA vaping是否应该优先考虑公共卫生 方案，如果是，最有效的预防策略。 满足证据需求并为未来研究的影响提供灵活的框架 各种电子烟产品对AYA烟草产品和大麻使用负担的影响，我们将测试一种新的 AYA vaping的“催化剂模型”。催化剂模型提出了两个步骤，我们将在 本提案的目标1和2。步骤1（AIM 1）。（a）确定是否有（a） 情绪行为危险因素，他们以前在传统的药物使用中被阻止 （非汽化）形式存在汽化引发的风险，（B）独特的品质和产品 电子烟的特征（例如，隐蔽性，风味，吸引人的技术，社会可接受性，低 感知伤害）增加AYA vaping的风险，以及（c）vaping产品的特征 不成比例地增加低风险AYA的vaping启动风险。步骤2（AIM 2）.到 确定（a）吸电子烟是否会增加涉及启动的交叉产品转换的风险 其他vaping产品，或可燃尼古丁或大麻，以及增加的风险， 进展为有问题的药物使用结果，包括依赖、多种药物使用和慢性药物使用 （B）暴露于尼古丁、大麻素的奖励效应，以及 其他产品成分（例如调味品）增加了交叉产品转换的风险， 有问题的药物使用结果，和（c）产品特性改变这种关联。测试 模型，我们将利用从14-19岁（2013-2018）的参与者收集的数据， 现有队列和随访参与者进入成年早期（20-23，从2019- 20 - 23年; N~2000）。我们 还将在同一所学校招募一批新的14岁9年级学生（N=2500）， 一个队列序贯设计，将应用因果推理分析方法来确定 观察到的关联是否可能是因果关系。总的来说，这个项目将提供关键的 关于旨在减少艾滋病毒/艾滋病的公共卫生工作的优先事项和潜在目标的信息 AYA vaping造成的潜在不利公共卫生影响，包括与烟草相关的 癌

In 2015, evidence that e-cigarette use ("vaping") in adolescents and young adults (AYAs) had increased and was associated with increased risk of cigarette smoking initiation generated concern in the public health community. Subsequent research has left the field with several critical questions, including: (1) whether vaping truly has a causal effect on smoking or merely reflects a common liability toward deviancy among 'high-risk' AYAs with emotional or behavioral problems, (2) whether an emerging wave of new vaping products, including new nicotine products such as JUUL, and an increasingly diverse class of products dedicated to vaping cannabis plant, oils, and waxes, may increase the appeal and addictive potential of vaping, and (3) whether there exist particular characteristics of vaping products and biopsychosocial mechanisms that underlie the risk of AYA vaping initiation, progression, and transition to other forms of drug use that could be targeted in prevention efforts. The uncertainties regarding the impact of AYA vaping have left policy officials with little evidence to determine if AYA vaping should be prioritized in public health programs, and if so, the most effective strategies for prevention. To address the evidence needs and provide a flexible framework for future study of the impact of various vaping products on the AYA tobacco product and cannabis use burden, we will test a novel 'catalyst model' of AYA vaping. The catalyst model proposes two steps, which we will evaluate in Aims 1 and 2 of this proposal. Step 1 (AIM 1). To determine whether (a) AYAs with fewer emotional-behavioral risk factors who have been previously deterred from drug use in traditional (non-vaporized) forms are at risk of vaping initiation, (b) the unique qualities and product features of vaping (e.g., concealability, flavors, appealing technology, social acceptability, low perceived harm) increase risk of AYA vaping, and (c) features of vaping products disproportionately increase the risk of vaping initiation for low-risk AYAs. Step 2 (AIM 2). To determine whether (a) vaping increases the risk of cross-product transitions involving initiation of other vaping products, or combustible nicotine or cannabis, as well as increases risk of progression to problematic drug use outcomes, including dependence, poly-drug use, and chronic drug use through early adulthood, (b) rewarding effects from exposure to nicotine, cannabinoids, and other product components (e.g. flavorings) increases risk of cross-product transitions and problematic drug use outcomes, and (c) product characteristics modify this association. To test the model, we will leverage data collected from participants from age 14-19 (2013-2018) from our existing cohort and follow participants into early adulthood (20-23, from 2019-2023; N~2000). We will also recruit a new cohort of 9ᵗʰ grade students at age 14 (N=2500) at the same schools as part of a cohort-sequential design that will apply causal inference analytic approaches to determine whether observed associations are likely causal. Collectively, this project will provide critical information regarding the priority and potential targets of public health efforts aimed at reducing the potential adverse public health effects resulting from AYA vaping, including tobacco-related cancer.