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This symbol doesnt always relate to literal smoking

The liver is sensitive to toxins, regardless of whether they come directly from a cigarette or from the surrounding air

in the sample as a whole, the prevalences did not differ significantly between sexes, but were higher in Southern Brazil and lower in Northeastern Brazil, in addition to being higher among those who had paid work, lived with only one parent, and reported contact with smokers inside or outside the home

That's also hard to know, but there are some interesting ideas, Volkow says

However, no data exist yet on the association between hookah smoking and acute stroke [187]