The Transition to Nicotine Dependence in Adolescence

这份最初于1998年10月1日提交的提案的修订版要求五年的支持（10月1日至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到日常吸烟和尼古丁依赖的转变，以及潜在的风险和保护因素。本研究有五个主要目标：(1)确定青少年从实验吸烟到日常吸烟和尼古丁依赖转变的时间和顺序。(2)识别促进日常吸烟和依赖的心理、社会和生物学因素，降低风险。将特别注意(a)抑郁症状，(b)行为问题，(c)对烟草敏感性的初始差异，(d)可替宁水平，以及(e)产前吸烟暴露。(3)明确日常吸烟、尼古丁依赖与精神障碍的共病及先后顺序。(4)确定从实验性吸烟到尼古丁依赖和非法药物使用的发展途径。(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1275名6年级至10年级学生及其母亲进行为期两年的五波纵向随访来实现。将实施两阶段的研究设计。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。回答将用于选择1300名实验吸烟者和200名非吸烟者的目标样本，平均分配给三个种族群体。在第二阶段，每年将对1,275名参与的青少年及其母亲进行3次计算机家庭访谈，并在第一次和第二次家庭访谈的六个月后对青少年进行2次电话访谈。在每次年度面谈中，将对青少年和家长进行关于孩子的精神病学评估；将收集唾液样本以确定可替宁水平，验证吸烟的自我报告，并预测每日吸烟和尼古丁依赖的进展。本研究是一项罕见的尝试，旨在前瞻性地调查青少年尼古丁依赖的危险期、从开始到依赖的持续时间，以及解释向依赖过渡的因素。这项研究的独特之处在于关注不同种族的青少年吸烟、尼古丁依赖和精神疾病之间的共病。这项研究将对年轻人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.