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An alternative hypothesis is depicted on the right, in which inhalation of chemicals common in e-cigarette aerosols (propylene glycol, glycerin, nicotine, or THC) alters the inflammatory state of the lungs, including changing alveolar macrophages to a proinflammatory phenotype with the release of inflammatory cytokines (indicated by yellow circles), such that a second hit causes a pathologic inflammatory response

The National Health Interview Survey put adult cigarette smoking at 9.9% in 2024, the first time it fell below 10%, and 9.1% in 2025, down from a peak of 42.4% in 1965

2.3 Manufacturing Compatibility Tensile Strength : 3.8 cN/denier (dry state), 3.0 cN/denier (wet state)

21 Other research has identified damage linked to the nanoparticles contained in the vapor, 49,66 with one study showing ENDS users reporting mouth irritation, oral ulcers, sore throat, and coughing