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Carbon filter effectiveness depends on three factors: amount of carbon (more carbon captures more chemicals), carbon quality (activated properly with optimal pore distribution), and contact time (slower air flow allows more adsorption)

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The charcoal used to heat the shisha also can increase health risks by exposing the user to high levels of carbon monoxide, metals, and cancer-causing chemicals and by exposing both users and non-users to the carcinogens in secondhand smoke that remains in the area