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无害的物质，有治疗作用；大麻是 在美国越来越合法；一个新兴的行业推出了新颖、高效的产品；以及 使用和大麻使用障碍(CUD)的流行率有所增加。科学界和公共卫生界 都在努力跟上步伐，以确定这一不断变化的大麻格局的影响。一个重要的障碍 取得进展的关键是缺乏适当的大麻消费衡量标准。与酒精不同的是，使用 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。发展有效 衡量标准面临挑战，例如，估计数量；从足够大和多样化的数据收集 用于验证的样本。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，以开发和 测试一系列大麻暴露指标：大麻暴露清单(CEI；时间范围，超过30 日)、缩写(CEI-S)和日表(CEI-D；时间范围，过去24小时)。目标1：准备初始CEI。我们的 专家团队将使用新的项目和图像来估计CEI的初始版本，并对其进行组装和编程 使用。通过认知访谈和初步重测研究，我们将考察用户如何理解 项目和回答类别，并迭代调整CEI。目的2：CEI效度的初步检验。我们 将与CEI、验证者(例如，CUD严重性)和协变量一起进行一项在线调查，以减少3,000支大麻 用户使用经过充分测试的社交媒体调查方法和研究小组。分析将评估关联 在不同的暴露项目领域(结构效度)之间，并确定项目的组合最多 与外部验证器关联(收敛有效性)，以通知CEI的进一步细化。一个决定性的考验-- 重测亚组研究(n=600)将表明可靠性。目的3：在大样本的当前用户中确认CEI的有效性； 发展CEI-S。我们将向12,000名用户管理CEI，以确认构造和收敛的有效性， 总体和跨主要分组(例如，性别、种族/族裔)。我们将推导出用于研究的CEI-S 在时间不允许的情况下，全面的CEI。我们将进行一项生物验证子研究，参与者为n=150人， 检测THCCOOH。目的4：编制和验证CEI-D。我们将创建CEI-D，调整CEI-S 用于日常测量的前24小时的时间框架，并在目标3的子样本中检查其有效性 400例。他们将完成CEI-S，然后在30天内完成CEI-D、功能和情绪项目 移动设备。与FDA关于证明结果测量有效性的指南一致，我们将测试如何 CEI-D评分、功能和情绪随着时间的推移而变化。实现这些目标将为这一领域提供一套 大大改进大麻使用措施，这将加强临床和流行病学研究，并导致 向临床医生、健康教育工作者和政策制定者提供更多关于大麻的信息交流。

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.