Role of depression and anxiety in the tobacco epidemic

描述（由申请人提供）： 吸烟和尼古丁依赖目前被认为是全球最紧迫的公共卫生问题之一。吸烟是美国可预防死亡的主要原因，也是全球发病率和过早死亡的最重要的可避免原因。与其他精神疾病不同（例如，精神分裂症），尼古丁依赖的发作和慢性化可以在很大程度上预防或减少。遗传和环境因素在尼古丁依赖中起作用是公认的，但迄今为止确定的因素似乎不能完全解释这种流行病的范围或难治性。最近的证据有力地表明，在尼古丁依赖的发病和持续存在的共病精神病理学的重要性。因此，该项目的总体目标是研究焦虑症和抑郁症与尼古丁依赖之间的关系，研究这种关联的潜在机制，并确定其在多大程度上可推广到成年人群中各种未充分研究的部分。 这项调查有两个主要的具体目标： 目标1：研究焦虑症和抑郁症对社区成年人尼古丁依赖的发作、病程、持续性、发病率和抵消的影响。 目标二：确定社区成年人中焦虑症和抑郁症与尼古丁依赖之间关联的可能机制（例如，父母的精神病理学是否增加了对抑郁和尼古丁依赖的脆弱性）。 虽然吸烟的流行率在过去几十年中有所下降，但这种下降并没有在人口的所有部分都是平等的，尼古丁依赖性也没有普遍下降。尽管有关于与吸烟有关的健康风险的信息，但成年人继续开始吸烟并继续吸烟，特别是人口中的弱势群体，包括女性和年轻人。从拟议的调查中获得的信息将使我们能够利用现有的精神病治疗工具制定更好的干预计划，旨在通过对焦虑症和抑郁症的一级和二级预防来减少吸烟和尼古丁依赖的发作和持续。使用NESARC提供了一个独特的机会来分析一个大型的，纵向的，流行病学数据集。

DESCRIPTION (provided by applicant): Cigarette use and nicotine dependence are currently considered among the most pressing public health problems worldwide. Smoking is the leading cause of preventable death in the United States and the single most important avoidable cause of morbidity and premature mortality worldwide. Unlike other mental disorders (e.g., schizophrenia), the onset and chronicity of nicotine dependence could be largely prevented or diminished. It is accepted that genetic and environmental factors play a role in nicotine dependence, yet factors identified to date do not seem to completely explain this epidemic in scope or intractability. Recent evidence strongly suggests the importance of comorbid psychopathology in the onset and persistence of nicotine dependence. The overarching goal of this project is therefore to examine the relationship between anxiety disorders and depression and nicotine dependence, to examine potential mechanisms of this association, and to determine the extent to which it is generalizable to various understudied segments of the adult population. This investigation has two main Specific Aims: Aim 1: To examine the influence of anxiety disorders and depression on the onset, course, persistence, morbidity, and offset of nicotine dependence among adults in the community. Aim 2: To determine possible mechanisms of the association between anxiety disorders and depression and nicotine dependence among adults in the community (e.g., does parental psychopathology increase vulnerability to both depression and nicotine dependence). While the prevalence of cigarette smoking has declined over the past several decades, this decline has not been equal across all segments of the population and nicotine dependence has not declined as universally. Despite available information on the health risks associated with cigarette use, adults continue to initiate smoking and continue smoking, especially vulnerable segments of the population, including as females and young adults. Information gained from the proposed investigation would allow us to develop better intervention programs using existing psychiatric treatment tools aimed to reduce onset and persistence of cigarette use and nicotine dependence through both primary and secondary prevention of anxiety disorders and depression. Use of the NESARC offers a unique opportunity to analyze a large, longitudinal, epidemiologic dataset.