Natural Course of Cannabis Use Disorders from Childhood Through Early Adulthood

说明(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，青春期和成年期早期是开始使用大麻和发展成大麻使用障碍的关键时期。例如，最近对高中青年的一项调查表明，超过2/5的12年级学生吸食过大麻。同样，根据最近一项全国性调查的结果，研究人员估计，前一年有240万12岁或12岁以上的美国居民开始吸食大麻，而在同一12个月期间，约有430万居民(占美国人口的1.7%)滥用或依赖大麻。尽管慢性阻塞性肺病作为一个公共卫生问题很重要，但在一般人群中对慢性阻塞性肺病的发展和病程的认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CUD自然过程相关的几个重要特征。为了实现这些研究目标，将对俄勒冈州青少年抑郁项目(OADP)的现有数据集进行分析。OADP是一项以社区为基础的、跨越多代人的纵向研究，从青春期到成年早期，跨越了危险大麻持续使用模式出现的高峰期。本申请中描述的研究将涉及以前的OADP出版物中没有涉及的几个与大麻有关的主题。强调了五个广泛的领域，这些领域整合了OADP的纵向和发展特点。(1)将报告OADP样本中CUDS的患病率，并提供描述从最初的CUDS发作中恢复的时间、复发的概率和疾病复发的时间的危险函数。(2)将根据CUDS在一生中的发展历程确定不同的人群亚组，并报告与不同轨迹亚组相关的儿童风险因素和成人心理社会结果。(3)将对CUD风险的父母传播进行评估和记录。(4)采用比例风险函数和Logistic回归方法对儿童青少年精神障碍的危险因素进行评估。(5)比例风险模型和Logistic回归方法将被用来评估CUD发作的精神结局。这项拟议研究的结果有可能为CUD的流行病学理论提供信息，帮助开发筛查工具来识别哪些年轻人面临未来CUD的风险，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降低复发的可能性。

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.