Abstract
<div>Abstract<p><b>Background:</b> Benzene is a human hematotoxicant and a leukemogen that causes lymphohematopoietic cancers, especially acute myelogenous leukemia. We investigated uptake of benzene in hookah smokers and non-smokers attending hookah social events in naturalistic settings where hookah tobacco was smoked exclusively.</p><p><b>Methods:</b> We quantified <i>S</i>-phenylmercapturic acid (SPMA), a metabolite of benzene, in the urine of 105 hookah smokers and 103 non-smokers. Participants provided spot urine samples the morning of and the morning after attending an indoor hookah-only smoking social event at a hookah lounge or in a private home.</p><p><b>Results:</b> Urinary SPMA levels in hookah smokers increased significantly following a hookah social event (<i>P</i> < 0.001). This increase was 4.2 times higher after hookah lounge events (<i>P</i> < 0.001) and 1.9 times higher after home events (<i>P</i> = 0.003). In non-smokers, urinary SPMA levels increased 2.6 times after hookah lounge events (<i>P</i> = 0.055); however, similar urinary SPMA levels were detected before and after home events, possibly indicating chronic exposure to benzene (<i>P</i> = 0.933).</p><p><b>Conclusions:</b> Our data provide the first evidence for uptake of benzene in hookah smokers and non-smokers exposed to hookah tobacco secondhand smoke at social events in private homes compared with their counterparts in hookah lounges. Hookah tobacco smoke is a source of benzene exposure, a risk factor for leukemia.</p><p><b>Impact:</b> Because there is no safe level of exposure to benzene, our results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, initiate labeling of hookah-related products, and include hookah smoking in clean indoor air legislation. <i>Cancer Epidemiol Biomarkers Prev; 23(12); 2793–809. ©2014 AACR</i>.</p></div>
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