Researchers collected urine samples from 105 hookah smokers before and after they smoked from a hookah.
    
They also collected urine samples from 103 people who did not smoke hookah tobacco but attended events where they would be exposed to hookah smoke.
    
The study found that those who smoke a hookah or inhale secondhand hookah smoke may be breathing in the chemical benzene, a substance that previous research has linked with an increased risk of leukemia.
    
The researchers found that urine levels of a compound called S-phenylmercapturic acid (SPMA), which forms when benzene is broken down in the body, increased more than fourfold in the hookah smokers who smoked at a hookah lounge, and increased almost two fold in the people who smoked hookah tobacco at home.
    
Moreover, levels of SPMA in the urine of people who were at a hookah lounge but had not smoked were 2.6 times higher after they were exposed to the hookah smoke in lounges.
    
"This is the first study to find higher exposures to benzene in hookah smokers after smoking hookah tobacco in social events either in private homes or hookah lounges," said study author Nada Kassem, an associate director at the Center for Behavioral Epidemiology and Community Health at San Diego State University.
    
"In contrast to what is believed [by many people], hookah tobacco smoking is not a safe alternative to smoking other forms of tobacco," Kassem said.
    
Benzene is present in both hookah tobacco smoke and the emissions from the burning charcoal in a hookah that is used to heat the tobacco, Kassem said.
    
"In addition to inhaling toxicants and carcinogens found in the hookah tobacco smoke, hookah smokers and nonsmokers who socialise with hookah smokers also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions," she added.
    
The Centers for Disease Control and Prevention says that "long-term exposure to high levels of benzene in the air can cause leukemia."
    
Previous research has particularly linked benzene with acute myeloid leukemia, a type of cancer of the blood and bone marrow, Kassem said.

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