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Introduction: Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed., Aims and Methods: A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status., Results: Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids., Conclusions: Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions., Implications: Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Objectives: The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs' impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model., Methods: Canada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012-2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available., Results: Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060., Conclusion: Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking., (© 2023. The Author(s).)

Introduction: Polysubstance use--the use of multiple substances on the same or different occasions--is a risk factor for substance use disorder. However, national surveillance of substance use in Canada has often focused on use of a single substance. To better understand and address polysubstance use, this study characterized the use of vaping products, cigarettes, inhaled cannabis, and alcohol among Canadians aged 15 years and older., Methods: Nationally representative data from the 2020 Canadian Tobacco and Nicotine Survey were analyzed. Polysubstance use was assessed as use of at least two of the following in the past 30 days: smoking cigarettes, using vaping products (containing nicotine or flavours), using cannabis (in smoked and/or vaped form) and drinking alcohol (daily or weekly frequency)., Results: In 2020, past-30-day use of the examined substances was 4.7% for vaping products (1.5 million), 10.3% for cigarettes (3.2 million), 11.0% for inhaled cannabis (3.4 million), and 37.6% for weekly or daily use of alcohol (11.7 million). Polysubstance use was reported by 12.2% of Canadians (3.8 million) and was more prevalent among young Canadians, men and those who vaped. The most common combination of substances among polysubstance users included inhaled cannabis and weekly or daily use of alcohol (29.0%, or 1.1 million)., Conclusion: The use of vaping products, cigarettes, inhaled cannabis, and alcohol-individually and in combination-is substantial among Canadians. Frequent consumption of alcohol was most prevalent overall and, in contrast to the other examined substances, was common among Canadians of all ages. Findings may inform a polysubstance use approach for prevention policies and programs.

Background: The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL ; however, the implications for youth vaping remain unclear., Methods: Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16-19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content., Results: In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all)., Conclusions: The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including JUUL and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA., Competing Interests: Competing interests: DH and JT have served as paid expert witnesses in legal challenges against tobacco and vaping companies. MLG has received research grants from Pfizer and served as a member of a scientific advisory board to Johnson&Johnson. The other authors have no competing interests relevant to this article to disclose., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Robust surveillance of vaping product use (with or without nicotine) in Canada has been limited by the use of multiple tools with varying designs and content. The objective of the current study was to examine trends over time in vaping prevalence and to examine associated factors using data from the Canadian Community Health Survey (CCHS)., Data and Methods: Trends in the prevalence of past-30-day vaping over time were examined using data available from optional modules of the CCHS for Ontario from 2015 to 2018 and for Quebec from 2017 to 2019. Multiple logistic regression models were used to examine correlates of vaping in Quebec (2019) and Ontario (2018)., Results: Vaping increased in Quebec from 3.4% (233,000) in 2017 to 4.2% (296,000) in 2018 and 4.7% (333,000) in 2019. In Ontario, vaping remained stable in the years 2015 (3.1% or 357,000), 2016 (2.7% or 311,000) and 2017 (2.7% or 309,000), then increased in 2018 (3.4% or 404,000). Increases in vaping in both provinces were driven by youth. Vaping was significantly associated with young age and cigarette smoking in both provinces, as well as with cannabis use in the past 12 months among Quebec respondents., Interpretation: In both provinces, increases in youth vaping were observed in recent years, and this is consistent with national trends. Study findings further our understanding of vaping behaviour and highlight the utility of the CCHS as an additional tool for surveillance of vaping product use among Canadians.

Background: Vaping is more prevalent among younger than older Canadians. While vaping is less harmful than combustible tobacco, it is not without health risk., Data and Methods: Data from the 2019 Canadian Health Survey on Children and Youth were used to estimate vaping prevalence. Logistic regression models assessed the association of sociodemographic, youth, parenting and peer factors with vaping. The 2020 Canadian Community Health Survey identified adolescents who reported vaping before tobacco smoking. Data from the 2019 Canadian Tobacco and Nicotine Survey were used to examine vaping of e-liquids containing nicotine and flavours., Results: Vaping rates for 15- to 17-year-olds were nearly four times (21.3%) higher than those of 12- to 14-year-olds (5.4%). Two-thirds (66.1%) of 12- to 17-year-olds who had used both tobacco and e-cigarettes reported trying e-cigarettes first. E-liquids containing nicotine were used by 89.3% of 15- to 19-year-olds who reported vaping in the past 30 days; comparable with older adults. For both younger and older adolescents, having friends who engaged in negative behaviours, having been employed, and having consumed alcohol increased the odds. For 12- to 14-year-olds, attention deficit hyperactivity disorder was a risk factor, whereas having parents who usually knew who they were with and higher relatedness scores were protective. Among older adolescents, being male, being Canadian-born, having lower grades, and using tobacco or cannabis increased the odds of vaping., Interpretation: An adolescent's risk of vaping was most strongly correlated with other substance use, although other youth, parenting and peer characteristics also mattered. Because most of the data presented were collected before the COVID-19 pandemic and new vaping regulations, ongoing monitoring remains important.

Introduction: The majority of e-cigarette vaping youth use nicotine when vaping. Some then become dependent on the nicotine, which can result in subsequent health effects. There has been limited evaluation of convergent validity of e-cigarette dependence measures for use specifically in youth. The aim of this study was to investigate and validate various e-cigarette dependence measures for use in youth populations., Aims and Methods: One thousand two hundred and five Canadian youth aged 16-24 who completed a cross-sectional online survey reported vaping at least monthly and were thus included in the analysis. E-cigarette dependence was assessed using a modified Penn State Electronic Cigarette Dependence Index (PS-ECDI), the E-Cigarette Dependence Scale (EDS), a self-perceived vaping dependence question, and time to first vape after waking. Internal consistency, convergent validity, and concurrent validity of the measures were assessed., Results: Both the PS-ECDI and the EDS exhibited a good degree of internal consistency (α = 0.8472 and 0.8405, respectively). All measures exhibited convergent validity against each other and against time to first vape upon waking (p < .001), as well as concurrent validity against vaping frequency and nicotine concentration (p < .001). The PS-ECDI was inferior to the EDS, self-perceived measure, and time from waking when predicting daily vaping frequency, but, along with the self-perceived measure, was superior to the EDS and time from waking when predicting monthly vaping., Conclusions: All measures exhibit convergent and concurrent validity, as well as internal consistency. Depending on the needs of the study, it would be appropriate to use any of these measures when assessing e-cigarette dependence in adolescent and young-adult populations., Implications: The PS-ECDI and the self-perceived measure are equally effective in predicting monthly vaping, but the self-perceived measure was superior in predicting daily vaping. Thus, the one-item self-perceived measure of dependence is appropriate for use and preferable to the 11-item PS-ECDI or the 4-item EDS in situations of limited time or where subjects are at risk of respondent fatigue, and is superior to time to first vape after waking to predict vaping frequency., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Some jurisdictions have implemented nicotine vaping product (NVP) flavor restrictions because of concerns about rising adolescent use. However, little is known how these restrictions may impact adult vapers. This study describes the level of support and predictive behavioral responses to a hypothetical NVP ban on non-tobacco flavors among regular adult vapers who only use flavors that would be banned., Methods: Data came from 851 regular vapers (all current or ex-smokers) participating in the 2020 ITC Four Country Smoking and Vaping Survey in Canada, England, and the United States (US). A random sample of respondents in each country received and completed the questions about flavor bans: (1) do you support or oppose a ban on all non-tobacco flavors; and (2) what would you do if all flavors were banned, with the exception of tobacco in the US, and tobacco and menthol in Canada and England. Those who used tobacco-flavored or unflavored NVPs were excluded from all analyses, and additionally, vapers of menthol flavor in Canada and England were excluded from Aim 2., Results: Overall, 53.6% of vapers were strongly opposed to flavor bans, 28.2% were opposed, 9.3% were in support, 3.6% were in strong support, and 5.2% did not know. Predicted behavioral responses were: 28.8% would continue vaping an available flavor, 28.3% would find a way to get their banned flavor(s), 17.1% would stop vaping and smoke instead, 12.9% said that they would stop vaping and not smoke, and 12.9% do not know what they would do. Responses to a potential flavor ban largely varied by smoking and vaping status, and by the level of support of a flavor restriction policy., Conclusions: At this time, it is not clear what net population-level consequences would occur if non-tobacco flavored NVPs were prohibited. While a majority of vapers in this study opposed this policy, and many vapers would not be willing to switch to available flavors, there was considerable variability in predicted behavioral responses., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The e-cigarette market in Canada has rapidly evolved following the implementation of the Tobacco and Vaping Products Act in May 2018, which liberalized the promotion and sale of vaping products. To date, there is little data on the market profile of key product attributes, including nicotine content, labelling practices and flavours., Methods: An online scan of vaping product retailers (manufacturer, two national, five provincial) was conducted in 2020 to assess the e-liquids available on the Canadian market. Data were extracted from websites and product images regarding the nicotine content, labelling and flavours of e-liquids., Results: We identified 1746 e-liquids, with a total of 4790 different nicotine concentrations. Approximately half of the e-liquids were offered with salt-base nicotine (46.6%) and half with freebase nicotine (53.2%); the remainder were hybrids (0.2%). The mean nicotine concentration of salt-base e-liquids (3.4%) was higher than freebase e-liquids (0.5%) (p < 0.001). Labels indicating the presence of nicotine were visible on twothirds of e-liquid packaging displayed online (63.2%) while three-quarters of packaging displayed the nicotine concentration (73.7%), and more than half of packaging displayed health warnings (58.9%). A variety of flavours were also identified, with fruit being the most common (43.6%), followed by candy/desserts (27.6%) and non-alcoholic drinks (12.5%)., Conclusion: Findings demonstrate the diversity of the online e-cigarette market in Canada, including the availability of higher-concentration salt-base nicotine products. Flavour restrictions have the potential to dramatically reduce the number of e-liquid flavours on the market, while restricting nicotine concentrations to < 20 mg/mL will predominantly restrict salt-based e-liquids., Competing Interests: DH has served as a paid expert witness in legal challenges against tobacco and vaping companies. All other authors have no conflicts of interest to declare.

Introduction: Changes to federal legislation allowed nicotine-based e-cigarettes legal entry into the Canadian market in 2018. This included pod-type e-cigarettes (pods), such as JUUL, that were later found to be associated with steeply increasing prevalence and greater frequency of e-cigarette use among US and Canadian youth. Multiple studies of risk factors of JUUL use and use initiation have been conducted among various population groups in the US, but little evidence exists pointing to similar risk factors of pod use among Canadian youth and young adults. Understanding these risk factors can inform use prevention and intervention strategies in Canadian and other jurisdictions., Methods: A total of 668 Canadian youth and young adults recruited by the 2018-19 Youth and Young Adult Panel Study were provided a baseline survey 3 months before and a follow-up survey 9 months after the relaxation of federal nicotine e-cigarette regulations. We used multivariable logistic regression to understand and rank importance of baseline predictors of future pod use among respondents., Results: Past-month cannabis use (OR [odds ratio] = 2.66, 95% CI: 1.66-4.21, p < 0.001), established cigarette use (OR = 3.42, 1.53-7.65, p < 0.01), past cigarette experimentation (OR = 2.40, 1.34-4.31, p < 0.01), having many friends who vaped (OR = 2.15, 1.37-3.34, p < 0.001), age below 18 compared to age over 22 (OR = 5.26, 2.63-10.00, p < 0.001) and male sex (OR = 1.69, 1.16-2.50, p < 0.01) were significant and the most influential predictors of future pod use., Conclusion: Similar factors drove pod use among Canadian and US youth and young adults. Appropriate preventive strategies can benefit from considering polysubstance use among high school-aged youth., Competing Interests: None to be declared.

Background and Aims: In May 2017, black-and-white text nicotine addiction warning labels ('warnings') and health and safety leaflets ('leaflets') became mandatory for nicotine vaping products (NVPs) in England, in accordance with the European Union's Tobacco Products Directive. We compared changes over time in noticing warnings and leaflets, recall of warnings about nicotine and concerns about using NVP due to noticing warnings in England, compared with Canada, the US and Australia, where no warnings and leaflets were mandated., Design: 19 005 adult (aged 18+) NVP users, smokers and quitters of cigarettes and NVP from the 2016 and 2018 International Tobacco Control Four Country Smoking and Vaping Surveys in England, Canada, the US and Australia, recruited via probability and non-probability sampling., Findings: Noticing warnings increased in England from 4.9% (2016) to 9.4% (2018) (adjusted OR/AOR=1.64, 95% CI=1.15-2.36); this change was larger than changes in Canada (AOR=2.51, 95% CI=1.71-3.69) and the US (AOR=2.22, 95% CI=1.45-3.39). Recall of a nicotine warning increased in England from 86% (2016) to 94.9% (2018) (AOR=5.50, 95% CI=1.57-19.27) but not significantly elsewhere. Noticing leaflets increased in England from 14.6% (2016) to 19.1% (2018) (AOR=1.42, 95% CI=1.15-1.74); this change was larger than in Canada (AOR=1.42, 95% CI=1.12-1.79), the US (AOR=1.55, 95% CI=1.17-2.06) and Australia (AOR=1.51, 95% CI=1.02-2.22). Among those noticing warnings, concern about NVP use did not change significantly between 2016 and 2018 (all countries p>0.081)., Conclusions: Introduction of mandatory NVP warnings and leaflets in England was associated with small increases in noticing them but not with changes in concerns about NVP use., Competing Interests: Competing interests: MC has received payment as a consultant to Pfizer for service on an external advisory panel to assess ways to improve smoking cessation delivery in healthcare settings. MC also has served as paid expert witness in litigation filed against the tobacco industry. GTF, DH and JT have served as expert witnesses on behalf of governments in litigation involving the tobacco industry. AM is a UK National Institute for Health Research (NIHR) Senior Investigator., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms among youth by vaping behaviours. Methods: Participants (n = 39,214) aged 16–19 from the 2020 and 2021 International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys (Canada, England, US). Weighted multivariable logistic regression assessed associations between reporting any of five respiratory symptoms in the past week (shortness of breath, wheezing, chest pain, phlegm, cough) and: past 30-day smoking and/or vaping; lifetime/current vaping. Among past-30-day vapers (n = 4644), we assessed associations between symptoms and vaping frequency, use of nicotine salts, usual flavour and device type(s). Results: Overall, 27.8% reported experiencing any of the five respiratory symptoms. Compared with youth who had only vaped, those who had only smoked had similar odds of symptoms [adjusted odds ratio, OR (95% confidence interval, CI): 0.97 (0.85–1.10)], those who both smoked and vaped had higher odds [1.26 (1.12–1.42)], and those who had done neither, lower odds [0.67 (0.61–0.72)]. Compared with those who had never vaped, past use, experimentation and current regular or occasional use were all associated with higher odds. Reporting usually using nicotine salts was associated with higher odds of symptoms [1.43 (1.22–1.68)] than non-salt but was often uncertain. Compared with tobacco flavour (including with menthol), menthol/mint and sweets flavours were associated with similar odds; fruit [1.44 (1.07–1.93)], multiple [1.76 (1.30–2.39)] and 'other' [2.14 (1.45–3.16)] flavours with higher odds. All device types were associated with similar odds. Conclusions: Among youth, vaping was associated with increased reporting of past-week respiratory symptoms. Among those who vaped, some flavour types and potentially nicotine salts were associated with respiratory symptoms. [ABSTRACT FROM AUTHOR]

Youth vaping is a public health concern in Canada. Researchers have explored factors associated with vape use, but rarely differentiated between types of use. This study estimates the prevalence and correlations among past-month nicotine vaping, nicotine-free vaping, and dual-use vaping (nicotine and nicotine-free) in grades 9–12 high school students. Data came from the 2019 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS). The total sample consisted of 38,229 students. We used multinomial regression to assess for the correlations among different categories of vape use. Approximately 12% of the students reported past-month vape use exclusively with nicotine, 2.8% reported exclusively nicotine-free vape use, and 14% reported both nicotine vaping and nicotine-free vaping. Substance use (smoking, alcohol, cannabis) and being male were associated with membership in every category of vape use. Age was associated with vape use, but in different directions. Grade 10 and 11 students were more likely than grade 9 students to vape exclusively with nicotine (aOR 1.36; 95% CI: 1.05, 1.77 and aOR 1.46; 95% CI: 1.09, 1.97), while grade 9 students were more likely than grade 11 and 12 students to vape with both nicotine and nicotine-free vapes (aOR 0.82; 95% CI: 0.67, 0.99 and aOR 0.49; 95% CI: 0.37, 0.64). The prevalence of nicotine and nicotine-free vaping is high, with many students reporting the use of both. [ABSTRACT FROM AUTHOR]

Aims: To measure the prevalence and changes in smokers' discussions with health professionals (HPs) about nicotine vaping products (NVPs) and HPs' recommendations about NVPs between 2016 and 2020, and their associations with tobacco product use transitions. Design: Cohort study using multinomial logistic regression analyses on data from waves 1 (2016), 2 (2018) and 3 (2020) from the International Tobacco Control Four Country Smoking and Vaping Surveys. Setting: Four countries with varying NVP regulatory environments: 'most restrictive' (Australia), 'somewhat restrictive' (Canada) and 'less restrictive' (England and the United States). Participants: Adult exclusive daily smokers who did not report NVP use at the time of their baseline survey and had visited a HP in the last 12–24 months. Prevalence data came from 4125, 4503 and 4277 respondents, respectively, for each year. Longitudinal data were from 4859 respondents who participated in at least two consecutive surveys. Measurements Prevalence of self‐reported discussions with HPs and recommendations from HPs about NVPs. Longitudinal transitions from smoking to vaping (either exclusively or concurrently with smoking) and quitting (regardless of NVP uptake). Findings The prevalence of NVP discussions was low among countries with varying regulatory environments and study waves (range = 1.4–6.2%). In 2020, a low percentage of smokers who discussed NVPs with a HP reported that their HPs recommended they use NVPs in the United States (14.7%), Australia (20.2%), Canada (25.7%), with a higher percentage in England (55.7%) where clinical guidelines for smoking cessation include NVPs. Compared with 12.0% of smokers who reported no discussion, 37.0% of those whose HPs recommended NVPs transitioned to vaping at follow‐up. Transition to quitting was 9.6% with HPs' recommendation of NVPs versus 13.5% without discussion, a non‐significant difference. Conclusions: In Australia, Canada, England and the United States between 2016 and 2020, health professionals' discussions with smokers about nicotine vaping products (NVPs) were infrequent. NVP discussions were associated with NVP uptake, but not with quitting smoking. [ABSTRACT FROM AUTHOR]

Introduction: Changes to federal legislation allowed nicotine-based e-cigarettes legal entry into the Canadian market in 2018. This included pod-type e-cigarettes (pods), such as JUUL, that were later found to be associated with steeply increasing prevalence and greater frequency of e-cigarette use among US and Canadian youth. Multiple studies of risk factors of JUUL use and use initiation have been conducted among various population groups in the US, but little evidence exists pointing to similar risk factors of pod use among Canadian youth and young adults. Understanding these risk factors can inform use prevention and intervention strategies in Canadian and other jurisdictions. Methods: A total of 668 Canadian youth and young adults recruited by the 2018-19 Youth and Young Adult Panel Study were provided a baseline survey 3 months before and a follow-up survey 9 months after the relaxation of federal nicotine e-cigarette regulations. We used multivariable logistic regression to understand and rank importance of baseline predictors of future pod use among respondents. Results: Past-month cannabis use (OR [odds ratio] = 2.66, 95% CI: 1.66-4.21, p < 0.001), established cigarette use (OR = 3.42, 1.53-7.65, p < 0.01), past cigarette experimentation (OR = 2.40, 1.34-4.31, p < 0.01), having many friends who vaped (OR = 2.15, 1.37-3.34, p < 0.001), age below 18 compared to age over 22 (OR = 5.26, 2.63-10.00, p < 0.001) and male sex (OR = 1.69, 1.16-2.50, p < 0.01) were significant and the most influential predictors of future pod use. Conclusion: Similar factors drove pod use among Canadian and US youth and young adults. Appropriate preventive strategies can benefit from considering polysubstance use among high school-aged youth. [ABSTRACT FROM AUTHOR]