The Changing Epidemiology of Lung Health: Opportunities for Research on Cannabis and HIV Disease (The ORCHID Study)

项目摘要/摘要 在美国，大麻产品的消费正在增加。过去一个月的使用率 成年人的比例从2007年的5.8%增长到2019年的11.5%。这一增长的原因包括不断演变的 监管环境，大麻行业的产品创新，以及更大的文化趋势 放任自流。接触大麻产品对肺部健康的影响还没有完全了解，所以 不能充分认识到大麻消费增加对公共健康的影响。在最近的一份报告中， 美国国家科学、工程和医学研究院强调，迫切需要更多的研究来 确定长期接触大麻是否会导致慢性肺部疾病。这样做的总体目标是 该提案的目的是研究暴露于大麻对肺部健康的影响。这项提议充分利用了 由NHLBI资助的长期、多中心的艾滋病毒感染或有感染风险的成年人队列- MACS/WIHS联合队列研究--在该研究中，终身大麻暴露流行率超过70%。 该提案的具体目标是：(1)衡量自我报告的累积暴露与 艾滋病毒携带者或非艾滋病毒携带者的大麻对肺功能的影响；(2)用生化方法衡量大麻的影响- 经核实的大麻暴露对艾滋病毒携带者和非艾滋病毒携带者肺功能变化的影响；以及(3)试点a 一种新型仪器，用于测量有无生活的人接触不同大麻产品的情况 爱滋病毒。这项提议的目的和目的与NHLBI的战略目标是一致的，即减少人类 通过临床研究，促进预测、预防、抢占、治疗和 治疗人类[肺部]疾病的方法。“特别是，这项提案回应了令人信服问题2.CQ.03， …的生物标志物是什么？环境暴露能预示疾病的发生或发展吗？“也很关键 挑战3.CC.04，“评估和表征暴露的方法和模型的进展是 需要了解不同人群之间的健康差异。拟议研究的好处是 预计将广泛惠及当前和未来美国人的公共健康和福利。本次K23大奖 支持理查德·王的指导职业发展，医学硕士，医学助理教授 加州大学旧金山分校(UCSF)。王博士的长期职业目标是成为一名独立的 临床医生调查员专注于改善脆弱人群的呼吸健康，包括 艾滋病毒携带者。他的短期目标是更好地了解快速呼吸疾病对呼吸健康构成的风险 改变美国公众中大麻消费的流行率和做法。本次K23大奖 支持王博士在以下方面发展专业知识：从复杂观测中进行因果推断的统计方法 数据；生物样品中大麻代谢物的生化测量；以及 大麻与调查仪器一起使用。王博士受益于一支出色的指导团队， 加州大学旧金山分校的科学专业知识和充满活力的科学环境，以进行严格的多学科研究和培训。

Project Summary / Abstract Consumption of cannabis products is increasing in the United States. The prevalence of past month use among adults has grown from 5.8% in 2007 to 11.5% in 2019. Causes of this increase include an evolving regulatory environment, product innovations by the cannabis industry, and cultural trends towards greater permissiveness. The effect of exposure to cannabis products on lung health are not fully understood, so the public health impact of increased cannabis consumption cannot be fully appreciated. In a recent report, the National Academy of Science, Engineering, and Medicine highlighted the critical need for more research to determine whether long term exposure to cannabis leads to chronic lung disease. The overall objective of this proposal is to examine the effects of cannabis exposure on lung health. This proposal leverages a longstanding, NHLBI-funded multi-center cohort of adults living with or at risk for HIV infection—the MACS/WIHS Combined Cohort Study—in which the lifetime prevalence of cannabis exposure exceeds 70%. The specific aims of the proposal are to: (1) measure the association of self-reported cumulative exposure to cannabis with lung function in persons living with or without HIV; (2) measure the effect of biochemically- verified cannabis exposure on the change in lung function in persons living with and without HIV; and (3) pilot a novel instrument for measuring exposure to different cannabis products among persons living with and without HIV. The objective and aims of this proposal are in line with the NHLBI’s Strategic Goal to “reduce human disease” through “clinical investigations that advance the prediction, prevention, preemption, treatment, and cures of human [lung] diseases.” In particular, this proposal is responsive to Compelling Question 2.CQ.03, “What biomarkers of… environmental exposure are predictive of disease onset or progression?” and Critical Challenge 3.CC.04, “Advances in methods and models for assessing and characterizing exposures are needed to understand differences in health among populations.” The benefits of the proposed research are expected to accrue broadly to the public health and welfare of current and future Americans. This K23 award supports mentored career development for Richard Wang, MD MAS, Assistant Professor of Medicine at the University of California San Francisco (UCSF). Dr. Wang’s long-term career goal is to become an independent clinician investigator focused on improving the respiratory health of vulnerable populations, including persons with HIV. His short-term goal is to better understand the risks to respiratory health posed by the rapidly changing prevalence and practices of cannabis consumption among the American public. This K23 award supports Dr. Wang to develop expertise in: statistical methods for causal inference from complex observational data; the biochemical measurement of cannabis metabolites in biological samples; and the measurement of cannabis use with survey instruments. Dr. Wang benefits from a superb mentoring team with complementary scientific expertise and a vibrant scientific milieu at UCSF for rigorous multi-disciplinary research and training.