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Toxicants: Despite the water filtration, shisha smoke contains high levels of toxic substances like carbon monoxide, heavy metals, and carcinogens

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One reason for this higher number is that as smokers get pushed outside of buildings and off premises altogether in Western countries, including Japan, there is a tendency for butts to be discarded wherever, and they end up into the streams, rivers, lakes, and elsewhere

[PubMed: 1728734] Wasserman J, Manning WG, Newhouse JP, Winkler JD The effects of excise taxes and regulations on cigarette smoking