The Transition to Nicotine Dependence in Adolescence

对最初于1998年10月1日提交的一项提案的修订要求提供5年的支持（2001年10月1日至2006年9月30日），以调查白色、非洲裔美国人和西班牙裔青少年从实验性吸烟向每日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的：（1）确定青少年从实验性吸烟转变为日常吸烟和尼古丁依赖的时间和顺序。 (2)确定促进每日吸烟和依赖进展并降低风险的心理，社会和生物因素。 将特别关注（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，（e）产前吸烟暴露。(3)明确每日吸烟、尼古丁依赖与精神疾病的共病关系及排序。 (4)确定从实验性吸烟到尼古丁依赖和使用非法药物的进展途径。 (5)确定白色、非洲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两年的五波纵向随访来实现。 将实施两阶段研究设计。 在第一阶段，将对选定的公立学校大约17 000名6-10年级的学生进行简短调查。回答将用于选择1，300名实验吸烟者和200名非吸烟者的目标样本，在三个种族群体中平均分配。 在第二阶段，我们会每年进行三次电脑访问，访问一千二百七十五名参与调查的青少年及其母亲，并在第一次和第二次访问后六个月，以电话访问两次。 在每次年度访谈中，将对青少年和父母进行有关儿童的精神评估;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每日吸烟和尼古丁依赖的进展。这项研究代表了一种罕见的尝试，前瞻性地调查青少年尼古丁依赖的风险期，从发作到依赖的持续时间，以及解释过渡到依赖的因素。 这项研究是独特的，重点是吸烟，尼古丁依赖和精神疾病之间的共病在不同种族的青少年。这项研究将对年轻人尼古丁依赖的自然史、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.