A Comparative Study of Vape, Pouch, and Cigarette Related Beliefs and Behaviors and their Determinants

Background: Youth use of vaping and nicotine pouches has risen alongside declining cigarette smoking, yet comparative evidence on social-structural and psychological determinants remains limited. Purpose: This study examined how socio-structural factors and an extended theory of planned behavior (TPB) model predict vaping, nicotine pouch use, and cigarette smoking among Finnish youth.Methods: A cross-sectional online survey of 1200 individuals aged 15–25 years in Finland assessed socioeconomic status, health literacy, TPB constructs (affective and instrumental attitudes; subjective and descriptive norms from friends and family; perceived behavioral control), behavioral intentions, past behavior, and nicotine addiction. Mean differences in survey constructs across behaviors were analyzed, and predictive pathways were estimated using robust structural equation modelling.Results: Nicotine pouches were viewed more favorably than vapes or cigarettes. Nicotine use was more common among older youth, though less so for vaping. Male gender was more strongly associated with pouch use than with vaping or smoking. Health literacy, but not socioeconomic status, was consistently associated with all behaviors. Across products, affective attitudes were the strongest correlates, while instrumental attitudes showed no significant effects. Friend-group subjective and descriptive norms exerted stronger effects than family norms, with friend norms especially predictive of smoking.Conclusions: Some determinants generalized across behaviors, while others varied by product. Affective attitudes and friend-group norms emerged as key cross-cutting influences, whereas gendered patterns and normative salience differed by product. Tailored prevention and harm-reduction strategies should address both shared and behavior-specific determinants of youth nicotine use.