PREVENTION OF CIGARETTE SMOKING IN ADHD YOUTH

描述：(申请人的描述)毫无疑问，香烟 吸烟是发病率和过早发病率的主要来源。 美国。每年，吸烟导致大约30到40人 冠心病死亡的百分比和癌症的30% 死亡，导致每年近50万人死亡。然而，尽管 这些统计数据显示，全国有5400多万烟民。 其中400万是青少年，3000多名年轻人开始吸烟 每一天。如果青少年吸烟率继续保持下去， 社会将是巨大的。 吸烟在年轻人中已经变得如此普遍，以至于 被美国食品和药物管理局认定为“儿科疾病”。 研究表明，大多数成年人可以避免成为 如果烟草使用者能够在青春期保持无烟状态。 这一发现表明，预防工作的重点是青春期， 已知的吸烟风险期。 这项提议寻求应用精神药理学的高风险范例 预防青春期经常吸烟和尼古丁依赖。这个 Work有三个创新特点：1)使用流行病学数据 定义一组吸烟的高危青少年；2)使用 禁烟药物，也针对临床特征的 高危人群和3)实施程序，以促进 对研究参与者进行长期随访。这些功能包括 由我们提案的三个主要目标定义。 先前的研究表明，患有注意力缺陷多动的儿童 精神障碍(ADHD)，也有共同的行为、情绪或焦虑 经常吸烟和尼古丁依赖的风险很高。 因此，我们的首要目标是招募一批这样的青少年加入一个 预防性治疗方案，在他们启动常规治疗之前 抽烟。我们的第二个目标是完成一项双盲临床试验 安非他酮预防高危ADHD患者吸烟 青少年。安非他酮是这一组治疗的合适药物 有几个原因。它对治疗抑郁症是有效的，一 高危人群中最常见的合并症。此外， 先前的研究还表明，它可以减少ADHD症状，是一种 有效的戒烟治疗。此外，其推定的 作用机制影响神经系统，据信调节ADHD 还有抽烟。除了这些主要目标外，我们还将评估影响 安非他酮对ADHD和抑郁症症状的影响并将实施 程序，使我们能够研究这个样本的结果在 未来的建议，如果这是有必要的。 我们将采用平衡、双盲、安慰剂对照的研究设计。 65名高危青少年和65名高危青少年将接受安慰剂治疗 安非他酮。受试者将在3个月内招募，并将 根据他们是在什么时候被招募到 这项研究。这项研究的设计使每个受试者都有 至少一年的随访数据。一些受试者会有多达 三年半的随访资料。 安非他酮等药理制剂的使用尚未得到 在预防吸烟方面进行了探索。因为这种药 已经被用于治疗多动症和吸烟，它 可以帮助在这种高危人群中预防吸烟 人口。他可以阻止的案件数量不是微不足道的。 因为据估计有350万儿童患有ADHD，其中20% 已经被证明是吸烟者，针对这一群体可能 影响到70万儿童和青少年。

DESCRIPTION: (Applicant's Description) There is no doubt that cigarette smoking is a substantial source of morbidity and premature morbidity the United States. Each year, cigarette smoking causes about 30 to 40 percent of coronary heart disease deaths and 30 percent of cancer deaths, leading to nearly half a million deaths each year. Yet, despite these statistics, there are more than 54 million smokers in the nation. Four million of these are adolescents and over 3,000 youth start smoking each day. If these rates of teenage smoking continue, the costs to society will be enormous. Cigarette smoking has become so widespread in youth that it is considered a "pediatric disease" by the Food and Drug Administration. Studies suggest that most adults could be prevented from becoming tobacco users if they could be kept tobacco-free during adolescence. This finding suggests that preventive efforts focus on adolescence, a known risk period for the initiation of smoking. This proposal seeks to apply a psychopharmacologic high risk paradigm to prevent regular smoking and nicotine dependence in adolescence. The work has three innovative features: 1) use of epidemiologic data to define a group of adolescents at high risk for smoking; 2) use of an anti-smoking medication that also addresses clinical features of the high-risk group and 3) implementation of procedure to facilitate the long-term follow-up of research participants. These features are defined by the three main aims of our proposal. Prior work shows that children with attention deficit hyperactivity disorder (ADHD), who also have comorbid conduct, mood or anxiety disorders, are at high risk for regular smoking and nicotine dependence. Thus, our first aim is to recruit a group of these adolescents into a preventative treatment protocol, before they have initiated regular smoking. Our second aim is to complete a double-blind clinical trial of bupropion for the prevention of smoking in high-risk ADHD adolescents. Bupropion is an appropriate agent for this group for several reasons. It is efficacious for the treatment of depression, one of the most common comorbid disorders in the high risk group. Moreover, prior research also shows that it reduces ADHD symptoms and is an effective treatment for smoking cessation. Moreover, its putative mechanism of action affects neural systems believed to mediate both ADHD and smoking. In addition to these main aims, we will assess the effects of bupropion on symptoms of ADHD and depression and will implement procedures that will allow us to study the outcome of this sample in future proposals, should that be warranted. We will use a balanced, double-blind, placebo-controlled study design. Sixty-five high risk adolescents will be given placebo and sixty-five bupropion. Subjects will he recruited over a 3-month period and will have varying lengths of follow-up based on when they were recruited into the study. The study is designed so that each subject will have at least one year of follow-up data. Some subjects will have as much as 3.5 years of follow-up data. The use of pharmacological agents, such as Bupropion, have not been explored in the prevention of cigarette smoking. Since this medication has been used for both the treatment of ADHD and cigarette smoking, it could aid in the prevention of cigarette smoking in this high-risk population. The number of cases that could he prevented is not trivial. Since there are estimated to be 3.5 million children with ADHD and 20% have been shown to be smokers, targeting this group could potentially impact 700,000 children and adolescents.