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Background: Vaping is an increasingly popular mode of cannabis use. Few studies have characterized the role of flavors in cannabis e-liquids. Objectives: To explore the prevalence of flavored vaping liquids, including differences between countries and correlates of use. Methods: Data were from Wave 4 (2021) of the International Cannabis Policy Study with national samples aged 16-65 in Canada, the United States (US), Australia, and New Zealand. The sample comprised 52,938 respondents, including 6,265 who vaped cannabis e-liquids in the past 12-months (2,858 females, 3,407 males). Logistic regression models examined differences in the use of flavored e-liquids between countries and sociodemographic characteristics. Results: The prevalence of vaping cannabis e-liquids was highest in the US (15.3%) and Canada (10.7%) compared to Australia (4.0%) and New Zealand (3.7%). Among past 12-month cannabis consumers, 57.5% reported using flavored vaping liquids, 34.2% used unflavored vaping products and 8.3% did not know. People who vape in Australia were most likely to report using flavored liquids compared to New Zealand (OR = 2.29), Canada (OR = 3.14), and the US (OR = 3.14) (p < .05 for all). Fruit was the most reported vaping flavor (40.8%), followed by candy/dessert (20.4%) and vanilla (15.2%). Use of flavored vapes was greater among younger, ethnic minorities, female, higher education and income adequacy, and more frequent consumers (p < .05). Conclusion: Many cannabis consumers reported using flavored e-liquids, with highest levels among young people aged 16-35. Given the high prevalence of vaping in legal markets, regulators should consider the role of flavored vaping products in promoting cannabis use among this group. [ABSTRACT FROM AUTHOR]

Introduction: Initiating cannabis use at an early age elevates risk of harm. Cannabis vaping is an emerging issue, and it is unknown whether the patterning and correlates of early‐onset cannabis vaping differ from those of cannabis smoking. Methods: We used repeat cross‐sectional data from a nationally representative biennial survey (2012–2018) of students aged 14–15 years in New Zealand (N = 11,405), response rate 65% (2012), 64% (2014–2016) and 59% (2018). Results: Between 2012 and 2018 lifetime cannabis use decreased, but regular use (past month, weekly, daily) was stable. Prevalence of past month, weekly and daily use in 2016–2018 (pooled) was 8.6%, 3.4% and 1.5%, respectively. Cannabis vaping was reported by 24% of past month cannabis users. The demographic profile of early‐onset cannabis smokers and vapers was similar, with elevated use of both modes among Māori (Indigenous), same‐ or both‐sex attracted students and those in low decile (high‐deprivation) schools. Correlates were similar for both modes. Cannabis use was strongly associated with tobacco and alcohol use. The next strongest associations (after adjustment) were exposure to second‐hand smoke at home, student income >$50/week and low parental monitoring of whereabouts. Past week social media use, psychological distress and low parental monitoring of spending were also associated with both modes. Discussion and conclusions: Early‐onset cannabis use is much higher in structurally disadvantaged groups, and among those who use tobacco and alcohol. Comprehensive multisubstance approaches to prevention are indicated in this age group. Efforts to reduce socio‐economic inequity and exposure to other risk factors may reduce cannabis‐related harm. [ABSTRACT FROM AUTHOR]

Aims: This paper presents updated prevalence estimates of awareness, ever‐use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. Design, Setting, Participants and Measurements: A cross‐sectional analysis of adult (≥ 18 years) current smokers and ex‐smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013–17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country‐specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non‐daily). Findings NVP awareness and use were lowest in NRP countries. Generally, ever‐ and current use of NVPs were lower in MRP countries (ever‐use = 7.1–48.9%; current use = 0.3–3.5%) relative to LRP countries (ever‐use = 38.9–66.6%; current use = 5.5–17.2%) and RP countries (ever‐use = 10.0–62.4%; current use = 1.4–15.5%). NVP use was highest among high‐income countries, followed by upper–middle‐income countries, and then by lower–middle‐income countries. Conclusions: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products. [ABSTRACT FROM AUTHOR]