Natural Course of Cannabis Use Disorders from Childhood Through Early Adulthood

描述（由申请人提供）：在许多国家，大麻是使用最广泛的非法药物。在美国，青春期和成年早期是开始使用大麻和发展为大麻使用障碍的特别关键时期。例如，最近对高中生的一项调查表明，超过五分之二的12年级学生使用过大麻。同样，根据最近一项全国调查的结果，研究人员估计，去年有240万12岁或以上的美国居民开始吸食大麻，而在同样的12个月里，约有430万居民（占美国人口的1.7%）滥用大麻或依赖大麻。尽管CUDs作为一个公共卫生问题具有重要意义，但关于一般人群中CUDs的发展和过程的知识仍然存在重大差距。为了解决这些差距，拟议的研究将记录与冠心病自然过程相关的几个重要特征。为了实现这些研究目标，将分析俄勒冈州青少年抑郁症项目（OADP）的现有数据集。OADP是一项以社区为基础的多代纵向研究，涵盖了从青春期到成年早期出现持续危险大麻使用模式的高峰期。本应用程序中描述的研究将解决先前OADP出版物中未解决的几个与大麻相关的主题。强调了整合OADP的纵向和发展特征的五个广泛领域。(1)将报告OADP样本中CUDs的患病率，并提供描述从初始CUDs发作恢复时间，复发概率和疾病复发时间的危害函数。(2)根据CUDs的发展历程划分不同的亚组，并报告不同亚组的儿童危险因素和成人社会心理结局。(3)对CUD的亲代传播风险进行评估和记录。(4)采用比例风险函数和logistic回归方法评估儿童和青少年后期CUDs的精神危险因素。(5)采用比例风险模型和逻辑回归方法评价CUD发作的精神结局。这项研究的发现有可能为CUDs的流行病学理论提供信息，有助于开发筛查工具来识别未来有CUDs风险的青少年，促进有针对性的预防计划和治疗干预的发展，并在有益的行为改变发生后减少复发的可能性。

DESCRIPTION (provided by applicant): In many countries cannabis is the most widely used illicit drug. In the United States, adolescence and early adulthood are particularly critical periods for the initiation of cannabis use and the development of cannabis use disorders (CUDs). A recent survey of high school youth, for example, indicated that more than 2 out of 5 12th grade students have used cannabis. Similarly, based on findings from a recent national survey, researchers estimated that 2.4 million U.S. residents aged 12 years or older initiated cannabis during the prior year, and that during the same 12-month period about 4.3 million residents (or 1.7% of the U.S. population) either abused or were dependent on cannabis. Despite the importance of CUDs as a public health concern, important gaps in knowledge remain concerning the development and course of CUDs in the general population. To address these gaps, the proposed research will document several important features associated with the natural course of CUDs. To accomplish these research aims, an existing data set from the Oregon Adolescent Depression Project (OADP) will be analyzed. The OADP is a community-based and multi- generational longitudinal study that spans the peak period for the emergence of sustained patterns of hazardous cannabis use, from adolescence through early adulthood. The research described in this application will address several cannabis-related topics not previously addressed in prior OADP publications. Five broad areas are emphasized that integrate OADP's longitudinal and developmental features. (1) The prevalence of CUDs in the OADP sample will be reported, and hazards functions that describe the time to recovery from the initial CUDs episode, the probability of relapse, and the time to disorder recurrence will also be provided. (2) Subgroups of persons will be identified based on the developmental course of CUDs over the lifetime, and childhood risk factors and adult psychosocial outcomes associated with distinct trajectory subgroups will be reported. (3) The parental transmission of CUD risk will be evaluated and documented. (4) Childhood and adolescent psychiatric risk factors for later CUDs will be evaluated with proportional hazards functions and logistic regression approaches. (5) Proportional hazards modeling and logistic regression approaches will be used to evaluate the psychiatric outcomes of CUD episodes. Findings from this proposed research have the potential to inform theories of the epidemiology of CUDs, aid the development of screening tools to identify youth who are at risk for future CUDs, facilitate the development of targeted prevention programs and therapeutic interventions, and reduce the likelihood of relapse once beneficial behavior change has occurred. PUBLIC HEALTH RELEVANCE: The proposed research is consistent with two strategic goals of the National Institute on Drug Abuse (NIDA). (1) To prevent the initiation of cannabis use and the development of cannabis use disorders (CUDs) by identifying patterns of abuse and associated psychosocial risk factors, including family factors. (2) To evaluate the potential influence of other psychiatric disorders in the development of CUDs.