1 This timing provided us a unique opportunity to identify risk factors of pod use in a population that was relatively nave to pod-type e-cigarettes, and to compare them with findings about high-risk population groups in the US. The legislative changes occurred in May 2018, during the period between the administration of the baseline and follow-up surveys. The Youth and Young Adult Panel Study collected data from Canadian youth and young adult e-cigarette users and non-users in March 2018 and again in a follow-up survey in March 2019. 20 Exposure to advertisements, cigarette use and lower perception of harm have been identified as predictors of future JUUL use in a 2018 cohort of young adults enrolled in colleges in North Carolina and Virginia. Peer tobacco use and cannabis use have been identified as predictors of JUUL and other e-cigarette initiation in a 2017/18 cohort of Texas adolescents. 14, 18 However, cross-sectional studies cannot assess the temporality of risk factor and outcome association where it is relevant and make it difficult to identify risk factors of future use. Previous studies of the correlates of JUUL use among US youth and subpopulations have identified cigarette use, 10, 14, 15 lower harm perception, 14, 16 sensation seeking, 10, 14 peers’ and household members’ use, 10, 14, 17 flavour appeal, 17 higher socioeconomic status, 14, 15, 18 younger age, 14, 15 male sex 15 and White ethnic background. Understanding predictors of initiation of pod use can help identify groups of youth at high risk of frequent exposure to nicotine via e-cigarettes. These links are well demonstrated for cigarette smoking 11, 12 and increasingly demonstrated with e-cigarettes. Daily use of psychoactive or rewarding substances and use on a high proportion of days are associated with dependence, decreased probability of quitting and increased risk of any adverse health effect due to dose. Upward trends in frequency of vaping add to the severity of the risks e-cigarettes pose to youth and young adults. 10 Similar findings resulted from repeat national samples of Canadian adolescents, wherein 17.7% of past-30-day e-cigarette users indicated using JUUL in 2019, compared to 10.3% in 2018. 9 In a nationally representative longitudinal sample of US youth and young adults, JUUL use and more frequent e-cigarette use both increased significantly between 20. 7, 8 The most well-known pod brand, JUUL, accounted for nearly 80% of the retail e-cigarette market in the United States by the end of 2018. 6 A combined free-nicotine and nicotine salt–based formulation helps increase efficiency of nicotine delivery by reducing its harsh impact on the upper respiratory system, potentially enabling repeated and increased nicotine intake and facilitating dependence.

With its lightweight and ultraportable design, the latest-generation e-cigarette device, namely the pod-type e-cigarette (“pod”), is engineered for convenient use. 3 The proportion of Canadians aged 15 to 19, 20 to 24 and 25 and up indicating they vaped in the past month remained roughly constant between 20. 2 It also coincided with the beginning of sharp increases in the prevalence and frequency of e-cigarette use: in 2019, the proportion of a national sample of Canadian youth aged 16 to 19 who indicated vaping for 20 days or more in the past month was more than three times the proportion in 2017. 1 Market liberalization was accompanied by increased exposure to e-cigarette promotion among Canadian youth between 20. In May 2018, the Tobacco and Vaping Products Act allowed nicotine-based e-cigarettes legal entry into the Canadian market without requiring premarket approval.

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