Depressive Symptoms and Tobacco Use Trajectories and Transitions across Young Adulthood

项目摘要：在美国，年轻人过去一年的抑郁症患病率和目前的烟草使用率最高。在青春期，抑郁和烟草使用并存的问题尤其严重，因为尼古丁成瘾在这一发育期固化，抑郁症状的增加促进了持续的烟草使用，并破坏了戒烟。然而，对年轻人的研究有限，抑郁症状和烟草使用之间联系的强度和方向的证据也没有定论。不确定的发现表明，在不同的青年群体中，抑郁症状和烟草使用之间的关联模式可能存在异质性。然而，很少有研究检验这种异质性。此外，大多数研究侧重于香烟，尽管其他产品，如电子尼古丁输送系统日益普遍，同时使用两种或两种以上产品(即使用多种烟草)在年轻人中比单一使用产品更普遍。使用新引进的蒸汽舱，如JUUL，越来越令人担忧。但是，电子烟使用在抑郁症状中的作用-烟草使用联系尚不清楚。迫切需要进行纵向研究，以确定抑郁症状与所有类型烟草的使用以及从当前烟草使用到不使用烟草以及从当前烟草使用到不使用烟草的过渡有关，以及在何种情况下，抑郁症状与谁有关。本R01的主要目标是确定：1)抑郁症状在烟草使用轨迹和转变中的作用是否在18-34岁的青壮年亚组中不同；2)关联的强度和方向不同。我们将确定捕捉异质性的调节因素，并确定抑郁症状对谁以及在什么条件下与烟草使用结果纵向相关。我们将研究社会人口学、个人内部和背景调节因素，以及所有类型的烟草产品和结果，包括开始、持续使用、成瘾、戒烟、复合烟草使用和使用中的转变。为此，我们将使用2014-2019年收集的8波现有数据，这些数据来自5482名最初年龄在18-29岁的大学生。具体目的是：1)确定抑郁症状在纵向烟草使用轨迹和过渡中的作用，并阐明抑郁症状和烟草使用之间的时间关联；2)检查社会人口、个人和环境因素在纵向轨迹、过渡和时间关联中的调节作用；以及3)确定VAPE豆荚，如JUUL，在纵向烟草使用轨迹、过渡和时间关联中的作用。预期的结果是，鉴于抑郁症状的增加，确定最容易受到开始和持续使用烟草影响的亚群。结果可用于定制烟草干预措施，并确定它们应针对谁。

PROJECT SUMMARY Young adults have the highest prevalence of past-year depression and current tobacco use in the United States. Co-occurrence of depression and tobacco use is particularly problematic during young adulthood as nicotine addiction is solidified in this developmental period, and elevated levels of depressive symptoms promote sustained tobacco use and undermine quitting. Yet, there is limited research on young adults and evidence for the strength and direction of associations between depressive symptoms and tobacco use is inconclusive. Inconclusive findings indicate there may be heterogeneity in the patterns of associations between depressive symptoms and tobacco use across subgroups of young adults. Yet, few studies examine this heterogeneity. Further, most studies focus on cigarettes, although other products, such as electronic nicotine delivery systems, are increasingly prevalent and the concurrent use of two or more products (i.e., poly tobacco use) is more prevalent than single product use among young adults. Use of newly introduced vape pods, such as JUUL, is increasingly concerning. But, the role of vape pod use in the depressive symptoms-tobacco use association is not known. There is a critical need for longitudinal studies that identify for whom and under what conditions depressive symptoms are associated with use of all types of tobacco, and with transitions in use, such as from current to no tobacco use and vice versa. The primary objectives of this R01 are to determine if: 1) the role of depressive symptoms in tobacco use trajectories and transitions vary for subgroups across young adulthood, ages 18-34 and 2) the strength and direction of associations vary. We will identify moderating factors that capture the heterogeneity, and define for whom and under what conditions depressive symptoms are longitudinally associated with tobacco use outcomes. We will examine sociodemographic, intrapersonal, and contextual moderating factors, and all types of tobacco products and outcomes, including initiation, sustained use, addiction, cessation, poly tobacco use, and transitions in use. To do so, we will use eight waves of existing data collected in 2014-2019 from 5,482 initially 18-29 year old college students. The Specific Aims are to: 1) Identify the role of depressive symptoms in longitudinal tobacco use trajectories and transitions, and elucidate the temporal associations between depressive symptoms and tobacco use; 2) Examine the moderating roles of sociodemographic, intrapersonal, and contextual factors in the longitudinal trajectories, transitions, and temporal associations; and 3) Determine the role of vape pods, like JUUL, in the longitudinal tobacco use trajectories, transitions, and temporal associations. The expected outcome is identification of subgroups most vulnerable to initiating and continuing tobacco use, given elevated depressive symptoms. Results can be used to tailor tobacco interventions and determine to whom they should be targeted.