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Vaping use has rapidly increased. In this final report from the Wisconsin and Illinois departments of public health, a severe respiratory illness in otherwise healthy young people is described. Of the 98 case patients identified in this investigation, 95% were hospitalized, 26% were intubated, and 2 persons died.

The early twenty-first century’s warming trend of the full-depth global ocean is calculated by combining the analysis of Argo (top 2000 m) and repeat hydrography into a blended full-depth observing system. The surface-to-bottom temperature change over the last decade of sustained observation is equivalent to a heat uptake of 0.71 ± 0.09 W m−2 applied over the surface of Earth, 90% of it being found above 2000-m depth. The authors decompose the temperature trend pointwise into changes in isopycnal depth (heave) and temperature changes along an isopycnal (spiciness) to describe the mechanisms controlling the variability. The heave component dominates the global heat content increase, with the largest trends found in the Southern Hemisphere’s extratropics (0–2000 m) highlighting a volumetric increase of subtropical mode waters. Significant heave-related warming is also found in the deep North Atlantic and Southern Oceans (2000–4000 m), reflecting a potential decrease in deep water mass renewal rates. The spiciness component shows its strongest contribution at intermediate levels (700–2000 m), with striking localized warming signals in regions of intense vertical mixing (North Atlantic and Southern Oceans). Finally, the agreement between the independent Argo and repeat hydrography temperature changes at 2000m provides an overall good confidence in the blended heat content evaluation on global and ocean scales but also highlights basin-scale discrepancies between the two independent estimates. Those mismatches are largest in those basins with the largest heave signature (Southern Ocean) and reflect both the temporal and spatial sparseness of the hydrography sampling.

Smokeless tobacco (SLT) use is associated with multiple adverse health effects. It is prominent in Bangladesh, India, and Pakistan, but disparities in use within and across these countries are not well documented or understood. This study assessed the prevalence, patterns, and correlates of SLT use in these three countries. Data came from the Global Adult Tobacco Survey, a household survey of adults aged ≥15 years. Data were collected in 2014 (Pakistan), 2017 (Bangladesh), and India (2016-2017). Current SLT use (nasal or oral use) was defined as reported SLT use daily or less than daily at the time of the survey. Prevalence of both overall and specific SLT types were assessed. Multivariate logistic regression was used to assess correlates of SLT use. Overall, SLT use among adults ≥15 years of age was 20.6% in Bangladesh, 21.4% in India, and 7.7% in Pakistan, corresponding to 22.0 million SLT users in Bangladesh, 199.4 million in India, and 9.6 million in Pakistan. Among current tobacco users overall, the percentage of those who used SLT was 58.4% (CI: 56.0-60.7) in Bangladesh, 74.7% (CI: 73.4-76.0) in India, and 40.3% (CI: 36.2-44.5) in Pakistan. The most commonly used oral SLT product was Zarda (14.5%) in Bangladesh, Khaini (11.2%) in India, and Naswar (5.1%) in Pakistan. Females had greater odds of SLT use than males in Bangladesh, but lower odds of SLT use than males in India and Pakistan. In all three countries, the odds of SLT use was higher among those 25 years and older, lower education, lower wealth index, and greater exposure to SLT marketing. An estimated 231 million adults aged 15 years or older currently use SLT in Bangladesh, India, and Pakistan, comprising 40.3%-74.7% of overall tobacco product use in these countries. Moreover, marked variations in SLT use exist by population groups. Furthermore, exposure to pro-SLT marketing was found to be associated with higher SLT use compared to non-exposed. It is important that tobacco control strategies address all forms of tobacco product use, including SLT.

The use of any tobacco product by youths is unsafe, including electronic cigarettes (e-cigarettes) (1). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs (1). E-cigarette use has increased considerably among U.S. youths since 2011 (1,2). Multiple factors have contributed to this increase, including youth-appealing flavors and product innovations (1-3). Amid the widespread use of e-cigarettes and popularity of certain products among youths, on February 6, 2020, the Food and Drug Administration (FDA) implemented a policy prioritizing enforcement against the manufacture, distribution, and sale of certain unauthorized flavored prefilled pod or cartridge-based e-cigarettes (excluding tobacco or menthol).The use of any tobacco product by youths is unsafe, including electronic cigarettes (e-cigarettes) (1). Most e-cigarettes contain nicotine, which is highly addictive, can harm the developing adolescent brain, and can increase risk for future addiction to other drugs (1). E-cigarette use has increased considerably among U.S. youths since 2011 (1,2). Multiple factors have contributed to this increase, including youth-appealing flavors and product innovations (1-3). Amid the widespread use of e-cigarettes and popularity of certain products among youths, on February 6, 2020, the Food and Drug Administration (FDA) implemented a policy prioritizing enforcement against the manufacture, distribution, and sale of certain unauthorized flavored prefilled pod or cartridge-based e-cigarettes (excluding tobacco or menthol).

In June 2020, Massachusetts implemented a law prohibiting the sale of all flavored tobacco products, including menthol cigarettes. This law was associated with significant declines in overall cigarette and menthol cigarette sales in Massachusetts, however it is unknown whether the law has increased cross-border sales in neighboring states where menthol cigarettes are still sold. U.S. cigarette retail scanner data were licensed from the IRi Company. Cigarette pack sales were summed in 4-week periods during January 2020-December 2021 (n = 832). Outcomes were state-level pack sales per 1000 population, overall and by flavor status (menthol and non-flavored). A difference-in-differences analysis was used to examine adjusted sales for Massachusetts border states (New Hampshire, Connecticut, Vermont, and Rhode Island) before (January 2020-May 2020) and after (June 2020-December 2021) the Massachusetts's law, compared to 28 non-border states. Control variables included state and time fixed effects; real price per pack; tobacco control policies; COVID-19 cases and deaths, and related statewide closure; and state sociodemographic characteristics. Following the law, unadjusted sales of menthol, non-flavored, and overall cigarettes trended upward in border states; however, these increases were not statistically significant or different from sales patterns in non-border states. This finding persisted after accounting for product prices, tobacco control policies, the COVID-19 pandemic, sociodemographic factors, and fixed effects. Laws prohibiting the sale of flavored tobacco products, including menthol products, reduce access to these products, while having no significant impact on cross-border sales in neighboring states where menthol cigarettes are sold.

Increases in EVALI were identified in 2019. Using the National Syndromic Surveillance Program, which includes about 70% of U.S. EDs, researchers found a gradual increase in ED visits associated with shortness of breath and e-cigarette use from January 2017 through early June 2019. A sharp increase was identified in June, peaking in September. A subsequent decrease was observed.

The first continuous estimates of freshwater flux across 26.5°N are calculated using observations from the RAPID–MOCHA–Western Boundary Time Series (WBTS) and Argo floats every 10 days between April 2004 and October 2012. The mean plus or minus the standard deviation of the freshwater flux (FW ) is −1.76 ± 0.20 Sv (1 Sv ≡ 10⁶m³ s−1; negative flux is southward), implying a freshwater divergence of −0.37 ± 0.20 Sv between the Bering Strait and 26.5°N. This is in the sense of an input of 0.37 Sv of freshwater into the ocean, consistent with a region where precipitation dominates over evaporation. The sign and the variability of the freshwater divergence are dominated by the overturning component (−0.78 ± 0.21 Sv). The horizontal component of the freshwater divergence is smaller, associated with little variability and positive (0.35 ± 0.04 Sv). A linear relationship, describing 91% of the variance, exists between the strength of the meridional overturning circulation (MOC) and the freshwater flux (−0.37 − 0.047 Sv ofFW per Sverdrups of MOC). The time series of the residual to this relationship shows a small (0.02 Sv in 8.5 yr) but detectable decrease in the freshwater flux (i.e., an increase in the southward freshwater flux) for a given MOC strength. Historical analyses of observations at 24.5°N are consistent with a more negative freshwater divergence from 2−0.03 to −0.37 Sv since 1974. This change is associated with an increased southward freshwater flux at this latitude due to an increase in the Florida Straits salinity (and therefore the northward salinity flux).

The lower limb of the Atlantic overturning circulation is resupplied by the sinking of dense Antarctic Bottom Water (AABW) that forms via intense air–sea–ice interactions next to Antarctica, especially in the Weddell Sea1. In the last three decades, AABW has warmed, freshened and declined in volume across the Atlantic Ocean and elsewhere2–7, suggesting an ongoing major reorganization of oceanic overturning8,9. However, the future contributions of AABW to the Atlantic overturning circulation are unclear. Here, using observations of AABW in the Scotia Sea, the most direct pathway from the Weddell Sea to the Atlantic Ocean, we show a recent cessation in the decline of the AABW supply to the Atlantic overturning circulation. The strongest decline was observed in the volume of the densest layers in the AABW throughflow from the early 1990s to 2014; since then, it has stabilized and partially recovered. We link these changes to variability in the densest classes of abyssal waters upstream. Our findings indicate that the previously observed decline in the supply of dense water to the Atlantic Ocean abyss may be stabilizing or reversing and thus call for a reassessment of Antarctic influences on overturning circulation, sea level, planetary-scale heat distribution and global climate2,3,8.

Over the past decade, the landscape of youth e-cigarette use has been dynamic.1,2 E-cigarettes have been the most commonly used tobacco product among US youths since 2014,1 and in 2019, current (past30-day) e-cigarette use prevalence reached a peak among middle-school (10.5%) and high-school (27.5%) students.3 During 2020 to 2021, the COVID-19 pandemic resulted in virtual learning for students, which impacted youth access to e-cigarettes, including from social sources; in 2020, before COVID-19 was declared a pandemic, more than half of youths who currently used e-cigarettes reported getting their e-cigarettes from a friend.3 Nonetheless, in 2021, more than 2 million US middle- and high-school students used e-cigarettes.

Recent decadal changes in Southern Hemisphere climate have driven strong responses from the cryosphere. Concurrently, there has been a marked freshening of the shelf and bottom waters across a wide sector of the Southern Ocean, hypothesized to be caused by accelerated glacial melt in response to a greater flux of warm waters from the Antarctic Circumpolar Current onto the shelves of West Antarctica. However, the circumpolar pattern of changes has been incomplete: no decadal freshening in the deep layers of the Atlantic sector has been observed. In this study, the authors document a significant freshening of the Antarctic Bottom Water exported from the Weddell Sea, which is the source for the abyssal layer of the Atlantic overturning circulation, and trace its possible origin to atmospheric-forced changes in the ice shelves and sea ice on the eastern flank of the Antarctic Peninsula that include an anthropogenic component. These findings suggest that the expansive and relatively cool Weddell gyre does not insulate the bottom water formation regions in the Atlantic sector from the ongoing changes in climatic forcing over the Antarctic region.