Leveraging Social Media to Develop the Cannabis Exposure Index (CEI), A Standardized Measure of Cannabis Use

美国人越来越相信大麻是一种具有治疗益处的无害物质;大麻是一种 在美国越来越法律的;一个新兴的行业已经推出了新的，高效的产品; 吸毒和大麻使用障碍的流行率有所上升。科学界和公共卫生界 一直在努力跟上确定这种不断变化的大麻景观的影响。一个重要障碍 阻碍取得进展的一个因素是缺乏对大麻消费的适当衡量。与酒精使用的测量不同， 可以区分高风险和低风险的饮酒模式，目前的大麻措施不足以调查 大麻的风险和益处，政策变化的影响以及临床试验的结果。开发有效 措施面临挑战，例如，数量估计;从足够大和多样化的数据收集 用于验证的样品。利用我们在大麻研究、测量开发和社交媒体方面的专业知识 调查方法，我们建议通过严格的混合方法研究来解决这些挑战， 测试大麻暴露的一系列措施：大麻暴露清单（CEI;时间框架，过去30年 天）、短格式（CEI-S）和每日格式（CEI-D;时间范围，过去24小时）。目标1：编制初始CEI。我们 一个专家小组将使用新的项目和图像来组装和编程CEI的初始版本，以估计 使用.通过认知访谈和初步的重测研究，我们将研究用户如何理解 项目和响应类别，并迭代地调整CEI。目标2：初步审查CEI的有效性。我们 将与CEI、验证者（例如，CUD严重程度）和3，000种大麻的协变量 用户使用久经考验的社会媒体调查方法和研究小组。分析将评估关联 不同暴露项目域之间（结构效度），并确定项目的组合最 与外部验证器（收敛有效性）相关联，以通知CEI的进一步细化。一个决定性的测试- 重新测试子研究（n=600）将表明可靠性。目标3：在当前用户的大样本中确认CEI的有效性; 开发CEI-S。我们将对12，000名用户进行CEI，以确认结构和收敛效度， 总体和跨主要子组（例如，性别、种族/民族）。我们将推导出CEI-S用于研究 时间不允许完整的CEI。我们将进行一项生物学验证子研究，n=150名受试者， 检查THCCOOH。目标4：编制和验证CEI-D。我们将创建CEI-D，调整CEI-S 将时间框架调整为前24小时，用作每日测量，并在目标3的子样本中检查其有效性 （n=400）。他们将完成CEI-S，然后完成CEI-D，功能和情绪项目，为期30天， 移动终端。与FDA关于证明结局指标有效性的指导方针一致，我们将测试如何 CEI-D评分、功能和情绪随时间变化。实现这些目标将为该领域提供一套 大大改善了大麻使用的措施，这将加强临床和流行病学研究，并导致 向临床医生、卫生教育工作者和决策者提供更多有关大麻的信息。

Americans increasingly believe cannabis to be a harmless substance with therapeutic benefits; cannabis is increasingly legal in the U.S.; a burgeoning industry has introduced novel, high potency products; and the prevalence of use and cannabis use disorder (CUD) has increased. The scientific and public health communities have struggled to keep pace in determining the impact of this changing cannabis landscape. An important barrier to progress is the lack of an adequate measure of cannabis consumption. Unlike measures of alcohol use that can discriminate high and low risk drinking patterns, current cannabis measures are inadequate to investigate cannabis risks and benefits, the impact of policy changes, and the outcomes of clinical trials. Developing valid measures faces challenges, e.g., estimation of quantity; data collection from sufficiently large and diverse samples for validation. Leveraging our expertise in cannabis research, measure development, and social media survey methods, we propose to address these challenges via a rigorous mixed-methods study to develop and test a family of measures of cannabis exposure: The Cannabis Exposure Inventory (CEI; timeframe, past 30 days), a short form (CEI-S), and a daily form (CEI-D; timeframe, last 24 hours). Aim 1: Prepare initial CEI. Our expert team will assemble and program an initial version of the CEI using novel items and images to estimate use. Through cognitive interviewing and a preliminary test-retest study, we will examine how users understand the items and response categories, and iteratively adjust the CEI. Aim 2: Initial examination of CEI validity. We will administer an on-line survey with the CEI, validators (e.g., CUD severity) and covariates to 3,000 cannabis users using well-tested social media survey methods and research panels. Analyses will assess associations between the different exposure item domains (construct validity) and identify the combination of items most associated with external validators (convergent validity) to inform further refinement of the CEI. A definitive test- retest substudy (n=600) will indicate reliability. Aim 3: Confirm CEI validity in a large sample of current users; develop the CEI-S. We will administer the CEI to 12,000 users to confirm construct and convergent validity, overall and across major subgroups (e.g., gender, race/ethnicity). We will derive the CEI-S for use in studies where time does not permit the full CEI. We will conduct a biological validation substudy with n=150 participants, examining THCCOOH. Aim 4: Prepare and validate the CEI-D. We will create the CEI-D, adjusting the CEI-S timeframe to the prior 24 hours for use as a daily measure, and examine its validity in a subsample from Aim 3 (n=400). They will complete the CEI-S, then complete the CEI-D, functioning, and mood items for 30 days on a mobile device. Consistent with FDA guidelines on demonstrating validity of outcome measures, we will test how CEI-D scores, functioning and mood covary over time. Accomplishing these aims will provide the field with a set of greatly improved measures of cannabis use that will enhance clinical and epidemiologic research, and lead to more informed communication about cannabis to clinicians, health educators and policy makers.