Introduction:
The use of electronic nicotine delivery systems (ENDS), or "electronic cigarettes" has skyrocketed among youth. There is an emerging scientific consensus on the harmful effects relating to ENDS use and evidence that ENDS use is a risk factor for future cigarette experimentation. In the Western Pacific Region, only 6 countries have banned ENDS; while, 8 countries have regulated ENDS (as of October 2019).

Objectives:
To gauge the awareness of ENDS existence, determine the prevalence of ENDS use, and to explore the relationship between tobacco and ENDS use among Western Pacific youth.

Methods:
Global Youth Tobacco Survey (GYTS), a nationally representative survey of students aged 13-15, was administered between 2015-2019 in 12 countries/areas in the Western Pacific Region using a globally standardized protocol (Cambodia, Cook Islands, Fiji, Guam, Kiribati, Lao PDR, Macao, Marshall Islands, Niue, Papua New Guinea, Samoa, and Vanuatu).

Results:
Guam had the highest percentage of students who had heard of ENDS (81.2%), followed by Niue (74.5%), and Macao (68.7%); Cambodia had the lowest (7.3%). Niue had the highest percentage of students who used ENDS (37.5%), followed by Guam (34.6%), and Marshall Islands (16.7%); Cambodia had the lowest (2.3%). Tobacco use/smoking was associated with increased ENDS use, compared to non-tobacco use/smoking in the majority of the countries/areas.

Conclusion(s):
Students' use of ENDS varies widely throughout the Western Pacific Region. Interventions targeting ENDS should consider that the majority of youth are dual users (ENDS and tobacco). ENDS are not harmless; therefore, the need to regulate these products is necessary, as highlighted in the WHO Regional Action Plan for Tobacco Control in the Western Pacific (2020-2030). A limitation was the respondents’ ability to understand the definition of ENDS. Only 12 out of 37 countries/areas reported data; therefore, results are not representative of the entire region. Further investigation is needed. The authors have no known conflicts of interest.