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Study Links Hookah Smoke to Higher Risk of Leukemia

Nov 25, 2014

According to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, smoking hookah may increase the risk of leukemia. The San Diego University study found that people who smoke hookah have double the exposure to benzene, a known carcinogen.

The U.S. National Toxicology Program classifies benzene as a Group 1 carcinogen. This designation means that benzene is proven to cause cancer in humans, There is no safe level of exposure, according to the World Health Organization (WHO).

Researchers analyzed levels of a benzene metabolite, S phenylmercapturic acid (SPMA) in urine samples from 105 hookah smokers versus 103 nonsmokers who attended an event at a hookah bar or a private home. Samples were collected the morning of the event as well as the morning after. There was a 4.2-fold increased risk in participants who smoked hookah in a lounge and a 1.9-fold increased risk among those who smoked in a private home.

Researchers also found a 2.6-fold increased risk in non-smoking participants. Author Dr. Nada Kassem, associate director at the Center for Behavioral Epidemiology and Community Health at San Diego State University, told that she was not surprised by this finding. “Non-smokers who socialize with hookah smokers also inhale large quantities of charcoal combustion-generated toxic and carcinogenic emissions,” she said. “Benzene is present in both tobacco smoke and burning charcoal emissions.”

Kassem also said that many hookah smokers do not realize the adverse effects, commonly believing them to be safer than cigarettes. “There are very few comprehensive health education programs in schools, colleges and communities at the national level on the harmful effects of hookah use,” said Kassem, according to

“Because there is no safe level of exposure to benzene, our results call for regulatory actions to limit toxicants including benzene in hookah tobacco and charcoal products,”

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