The impact of cannabis and tobacco/nicotine product co-use in young adults: Prospective cessation evaluation and substitution

项目摘要/摘要 尼古丁/烟草产品和大麻在年轻人中的共同使用很普遍，而且在 使用方式和产品的术语。在这个年龄段中联合使用尼古丁和大麻可能会对 治疗和其他临床结果，但对尼古丁之间的潜在关系知之甚少 和大麻以及由此产生的治疗影响，特别是在试图戒除或减少使用大麻期间 或者两种物质都有。关于联合使用的治疗影响的先前文献，包括我们小组的结果， 然而，对于同时使用这两种产品的一组人来说，大麻是尼古丁戒断的障碍 文学作品喜忧参半。过去的研究也受到重要限制，导致我们的 了解，从青年烟草试验中只发表了两项关于联合使用影响的二级分析。至 到目前为止，还没有前瞻性研究考察尼古丁-大麻联合治疗的影响。 青少年戒烟时使用物质或物质之间的潜在关系。 [因此，本项目的总体目标是描述和评价 尼古丁/烟草和大麻及其通过行为经济学框架对尼古丁戒断的影响。 这项研究将确定共同使用大麻对尼古丁戒断的影响程度，以及哪些人 共同使用的人实现戒烟的难度更大。为了实现这一目标，我们提出了一种完全 来自全国各地的年轻人(年龄18-25岁；N=350)进行了为期12周的远程前瞻性尼古丁戒断试验 经常使用尼古丁(蒸气、香烟或两者)和大麻产品的美国人。我们将利用 我们与DynamiCare Health的持续合作，将远程应急管理(CM)作为 尼古丁/烟草治疗干预，而大麻使用将不会得到解决。生化验证 将收集药物使用情况的自我报告(通过口服液样本)和自我报告(流动每日日记)。目标 这项拟议的研究的目的是：1)评估行为经济衍生实体措施的影响 治疗结束时尼古丁戒断的替代性(目标1)；2)确定治疗是否导致尼古丁戒断 戒除、减少和/或戒断(A)与大麻需求和/或戒断同时发生的变化有关 使用和(B)物质替代性是否改变了这种关系(目标2)；和3)评估互惠 尼古丁治疗期间尼古丁模式和大麻使用之间的预期关系(目标3)。 通过行为经济学评估尼古丁-大麻联合使用作为前瞻性治疗研究的一部分 框架从来没有进行过，并且将对告知关于个人共同的文献很重要 使用模式差异、补偿性大麻使用和治疗成功。]尼古丁戒断治疗 越来越多的年轻人正在研究大麻的共同使用和作用，以及拟议的研究结果， 将为临床护理提供信息并指导量身定制的治疗建议，以促进成功和持续 禁欲。

PROJECT SUMMARY/ABSTRACT The co-use of nicotine/tobacco products and cannabis among young adults is prevalent and varies widely in terms of patterns and products of use. Nicotine-cannabis co-use among this age group may adversely affect treatment and other clinical outcomes, yet little is known regarding the underlying relationship between nicotine and cannabis and the resulting treatment implications, particularly during an attempt to quit or reduce use of one or both substances. Prior literature on the treatment implications of co-use, including results from our group, suggest that cannabis serves as an obstacle to nicotine cessation for a sub-set who use both products, though the literature is mixed. Past studies also suffer from important limitations, resulting in critical gaps in our understanding, with only 2 secondary analyses published from youth tobacco trials on the impact of co-use. To date, there are no prospective studies that have examined the treatment implications of nicotine-cannabis co- use or the underlying relationship between substances among young adults when engaged in a quit attempt. [[[Therefore, the overall goal of this project is to characterize and evaluate the underlying relationship between nicotine/tobacco and cannabis and its impact on nicotine cessation through a behavioral economics framework. This study will determine how impactful cannabis co-use may be on nicotine cessation and which individuals who co-use experience greater difficulty achieving cessation. To accomplish this goal, we propose a completely remote, prospective, 12-week nicotine cessation trial among young adults (ages 18-25; N=350) from across the United States who use nicotine (vaping, cigarettes or both) and cannabis products regularly. We will leverage our ongoing collaboration with DynamiCare Health to administer remote contingency management (CM) as the nicotine/tobacco treatment intervention, while cannabis use will not be addressed. Biochemical verification (through oral fluid samples) and self-reports (mobile daily diaries) of substance use will be collected. The aims of this proposed study are to: 1) evaluate the impact of behavioral economically derived measures of substance substitutability on end of treatment nicotine abstinence (Aim 1); 2) determine if treatment-induced nicotine abstinence, reduction, and/or withdrawal (a) is associated with co-occurring changes in cannabis demand and use and (b) if substance substitutability modifies this relationship (Aim 2); and 3) assess the reciprocal prospective relationship between patterns of nicotine and cannabis use during nicotine treatment (Aim 3). Evaluating nicotine-cannabis co-use as part of a prospective treatment study through a behavioral economics framework has never been conducted and will be important to informing the literature regarding individual co- use pattern differences, compensatory cannabis use, and treatment success.]]] Nicotine cessation treatment in young adults is a growing body of work and the role of cannabis co-use, and results from the proposed study, will inform clinical care and guide tailored treatment recommendations to promote successful and sustained abstinence.