Mobile health applications in adolescent marijuana use: assessing the interplay among sleep, pain and inhibitory control

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ABSTRACT This Mentored Research Career Development Award (K01) proposal includes a coordinated training plan and research project that will facilitate the candidate's transition to independent investigator at the intersection of adolescent substance use, in particular marijuana use, sleep disturbances and chronic pain. Adolescent marijuana exposure predicts many negative outcomes, particularly for early, heavy users. Chronic pain is an under-recognized, yet highly prevalent adolescent health problem. Evidence suggests that chronic pain potentiates risk factors for substance use, in particular those related to sleep disturbances and diminished inhibitory control. However, the interplay among sleep, pain, and inhibitory control, as it relates to marijuana use in adolescence, remains minimally explored, which is significant given the unique risk for frequent and heavy marijuana use in this population. The proposed research project utilizes mobile health (mHealth) measurement techniques, combining mobile phones and wearable devices, to enhance our understanding of the longitudinal interplay among these mechanisms in patient’s natural settings. The long-term goal of this K01 award is for the candidate to establish an independent research career aimed at developing and implementing mechanistically informed interventions for marijuana use disorders in youth with chronic pain and sleep disturbances using mHealth approaches. To do so, specific short-term training is required in: 1) conducting adolescent substance use research, with a focus on marijuana use; 2) conducting randomized controlled trials; 3) sleep and circadian biology and sleep measurement techniques; 4) the use of mHealth technologies and protocols and 5) the responsible conduct of research. Two independent, yet related studies are proposed to characterize the relation among sleep, pain, inhibitory control, and marijuana use in an adolescent chronic pain population. A first study will interrogate a large cross-sectional sample of youth with chronic pain to understand the association that particular pain dimensions (i.e. intensity, frequency and interference) show with marijuana use, both directly and through associations with sleep and inhibitory control. Given the potentially complex interplay among factors, a longitudinal assessment is vital to map the unfolding of pathophysiological processes. The second study will therefore combine ecological momentary assessments, mobile app-based cognitive tests, and passive collection of sleep data to provide time-sensitive and ecologically valid models of the longitudinal interplay among risk factors within the context of the individual’s daily life. Such methods are vital for mapping temporal sequences of events and developing specific interventions to interrupt this perpetual cycle and reduce risks, which will be the goal of a subsequent R01 grant.