Vaping Nicotine and Cannabis Across Adolescence and Young Adulthood

好了！ 项目总结 2015年，有证据表明，电子烟在青少年和年轻人中的使用(“电子烟”)有所增加， 与吸烟风险增加有关的问题引起了公共卫生界的关注。随后的研究给该领域留下了几个关键问题，包括：(1)蒸发是否真的 对吸烟有因果影响，或者只是反映了在高风险的AYA中有异常行为的共同倾向 有情绪或行为问题，(2)新兴的蒸发产品浪潮，包括新的 尼古丁产品，如Juul，以及致力于蒸发大麻的日益多样化的产品 植物、油和蜡，可能会增加蒸发的吸引力和成瘾潜力，以及(3)是否存在 蒸发产品的特殊特性和生物心理社会机制构成了蒸发的启动、进展和过渡到其他形式的药物使用的风险，而这些其他形式的药物使用可作为预防工作的目标。 关于阿亚蒸发影响的不确定性让政策官员几乎没有证据来确定 在公共卫生计划中，应优先考虑阿亚蒸发，如果是，则应将其列为最有效的预防策略。 满足证据需求，并为未来研究各种蒸发的影响提供灵活的框架 产品对阿亚烟草产品和大麻的使用负担，我们将测试一种新型的阿亚‘催化剂模型’ 蒸发。催化剂模型提出了两个步骤，我们将在本提案的目标1和2中对其进行评估。步骤1 (目标1)。以确定(A)情绪-行为危险因素较少的AYA是否 被阻止以传统(非汽化)形式使用毒品有引发汽化的风险，(B)独特的性质 而蒸发的产品特征(例如，隐蔽性、风味、吸引人的技术、社会可接受性、低感知危害)增加了Aya蒸发的风险，以及(C)蒸发产品的特征不成比例地增加了 低风险AYA启动蒸发的风险。第二步(目标2)。以确定(A)蒸发是否会增加 涉及启动其他蒸发产品或可燃尼古丁或大麻的跨产品过渡，如 以及增加进展为有问题的药物使用结果的风险，包括依赖、多药使用、 和成年期早期的长期吸毒，(B)暴露于尼古丁、大麻类物质的奖励作用， 和其他产品成分(如调味品)会增加跨产品过渡和问题药物的风险 使用结果，以及(C)产品特性改变了这种关联。为了测试该模型，我们将利用数据 从我们现有的队列中收集14-19岁(2013-2018)的参与者，并跟踪参与者进入早期 成年期(20-23岁，2019-2023岁；N~2000岁)。我们还将招募一批14岁的新的9年级学生 (n=2500)，作为队列序贯设计的一部分，将应用因果推理分析 确定观察到的关联是否可能是因果关系的方法。总体而言，该项目将提供 关于公共卫生努力的优先事项和潜在目标的关键信息，旨在减少阿亚挥发造成的潜在公共卫生不利影响，包括与烟草有关的癌症。

! PROJECT SUMMARY In 2015, evidence that e-cigarette use (“vaping”) in adolescents and young adults (AYAs) had increased and was associated with increased risk of cigarette smoking initiation generated concern in the public health community. Subsequent research has left the field with several critical questions, including: (1) whether vaping truly has a causal effect on smoking or merely reflects a common liability toward deviancy among ‘high-risk’ AYAs with emotional or behavioral problems, (2) whether an emerging wave of new vaping products, including new nicotine products such as JUUL, and an increasingly diverse class of products dedicated to vaping cannabis plant, oils, and waxes, may increase the appeal and addictive potential of vaping, and (3) whether there exist particular characteristics of vaping products and biopsychosocial mechanisms that underlie the risk of AYA vaping initiation, progression, and transition to other forms of drug use that could be targeted in prevention efforts. The uncertainties regarding the impact of AYA vaping have left policy officials with little evidence to determine if AYA vaping should be prioritized in public health programs, and if so, the most effective strategies for prevention. To address the evidence needs and provide a flexible framework for future study of the impact of various vaping products on the AYA tobacco product and cannabis use burden, we will test a novel ‘catalyst model’ of AYA vaping. The catalyst model proposes two steps, which we will evaluate in Aims 1 and 2 of this proposal. Step 1 (AIM 1). To determine whether (a) AYAs with fewer emotional-behavioral risk factors who have been previously deterred from drug use in traditional (non-vaporized) forms are at risk of vaping initiation, (b) the unique qualities and product features of vaping (e.g., concealability, flavors, appealing technology, social acceptability, low perceived harm) increase risk of AYA vaping, and (c) features of vaping products disproportionately increase the risk of vaping initiation for low-risk AYAs. Step 2 (AIM 2). To determine whether (a) vaping increases the risk of cross-product transitions involving initiation of other vaping products, or combustible nicotine or cannabis, as well as increases risk of progression to problematic drug use outcomes, including dependence, poly-drug use, and chronic drug use through early adulthood, (b) rewarding effects from exposure to nicotine, cannabinoids, and other product components (e.g. flavorings) increases risk of cross-product transitions and problematic drug use outcomes, and (c) product characteristics modify this association. To test the model, we will leverage data collected from participants from age 14-19 (2013-2018) from our existing cohort and follow participants into early adulthood (20-23, from 2019-2023; N~2000). We will also recruit a new cohort of 9th grade students at age 14 (N=2500) at the same schools as part of a cohort-sequential design that will apply causal inference analytic approaches to determine whether observed associations are likely causal. Collectively, this project will provide critical information regarding the priority and potential targets of public health efforts aimed at reducing the potential adverse public health effects resulting from AYA vaping, including tobacco-related cancer.