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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

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Other top shows across platforms featured youth and teens using tobacco, including some as young as 10, in The Simpsons, Family Guy, Rick and Morty, Big Mouth, Law & Order SVU, The Queens Gambit, and Sex Education. Streaming is up and continuing to grow, accounting for more than a quarter (26%) of all time spent on TV in 2021up from 20% in 2020