Transition to Nicotine Dependence in Adolescence

对1998年10月1日最初提交的一份提案的这一修订要求提供五年的支持(2006年10月1日至2006年9月30日)，以调查白人、非裔美国人和西班牙裔青少年从实验性吸烟向日常吸烟的转变和尼古丁依赖以及潜在的风险和保护因素。这项研究有五个主要目标：(1)确定青少年从实验性吸烟过渡到日常吸烟和尼古丁依赖的时间和顺序。(2)找出促进日常吸烟和依赖的心理、社会和生物因素，并降低风险。将特别注意(A)抑郁症状，(B)行为问题，(C)对烟草的最初敏感性差异，(D)可替宁水平，以及(E)产前吸烟。(3)明确日常吸烟、尼古丁依赖和精神障碍之间的共病和排序。(4)确定从实验性吸烟到尼古丁依赖和使用非法药物的发展途径。(5)确定白人、非裔美国人和西班牙裔青年在目标1-4方面的性别和种族差异。这些目标将通过对1,275名6-10年级学生及其母亲进行为期5波、为期2年的纵向跟踪来实现。将实施两个阶段的研究设计。在第一阶段，来自选定公立学校的大约17,000名6-10年级的学生将接受一项简短的调查。调查结果将被用来选择1300名实验吸烟者和200名不吸烟者的目标样本，这些人平均分布在三个种族中。在第二阶段，将每年进行3次电脑化访问，访问1,275名参与访问的青少年及其母亲，以及在第一次和第二次访问后6个月进行2次电话访问。在每一次年度访谈中，将对青少年和家长进行关于孩子的精神评估；将收集唾液样本，以确定可替宁水平，验证吸烟的自我报告，并预测进展为日常吸烟和尼古丁依赖。这项研究是一次难得的尝试，旨在前瞻性地调查青少年尼古丁依赖的风险时期、从发病到依赖的持续时间，以及解释向依赖转变的因素。这项研究在关注吸烟、尼古丁依赖和不同种族青少年精神障碍之间的共病方面是独一无二的。这项研究将对年轻人中尼古丁依赖的自然历史、病因和后果产生独特的理解。

This revision of a proposal submitted initially on 10/1/98 requests five years of support (10/1/01-9/30/06) to investigate the transition from experimental smoking to daily smoking and nicotine dependence and the underlying risk and protective factors among white, African-American and Hispanic adolescents. The research has five major goals: (1) To identify the timing and sequence of the transition from experimental smoking to daily smoking and nicotine dependence among adolescents. (2) To identify the psychological, social and biological factors that promote the progression to daily smoking and dependence and reduce the risk. Special attention will be paid to (a) depressive symptoms, (b) conduct problems, (c) initial differences in sensitivity to tobacco, (d) cotinine levels, and (e) exposure to prenatal smoking. (3) To specify the comorbidity and sequencing between daily smoking, nicotine dependence and psychiatric disorders. (4) To identify pathways of progression from experimental smoking to nicotine dependence and the use of illicit drugs. (5) To identify gender and ethnic differences among white, African-American and Hispanic youths with respect to Aims number 1-number 4. These aims will be achieved by conducting a five-wave two-year longitudinal follow-up of 1,275 6th-10th graders and their mothers. A two-stage research design will be implemented. In Phase I, approximately 17,000 students in grades 6-10 from selected public schools will be administered a brief survey. Responses will be used to select a target sample of 1,300 experimental smokers and 200 non-smokers, evenly divided among the three ethnic groups. In Phase II, 3 annual computerized household interviews will be conducted with 1,275 participating youths and their mothers, and 2 telephone interviews with the youths six months after the first and second household interviews. At each annual interview, a psychiatric assessment will be administered to the youth and the parent about the child; a saliva sample will be collected to determine cotinine levels, validate self-reports of smoking and predict progression to daily smoking and nicotine dependence. This study represents a rare attempt to investigate prospectively the periods of risk for nicotine dependence in adolescence, the duration from onset to dependence, and the factors that explain the transition to dependence. The study is unique in focusing on the comorbidity between smoking, nicotine dependence, and psychiatric disorders among adolescents of different ethnicity. The study will generate a unique understanding of the natural history, etiology and consequences of nicotine dependence among young people.