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Scientists have long understood that menthol flavor can make cigarettes more addictive than tobacco-flavored ones

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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