Hookah smoking is no less safer than cigarette smoking. It consists of a water pipe along with a smoke chamber, a bowl, pipe and a hose. The only difference to be noted is that the tobacco becomes less toxic in the hookah pipe and the water that is seen inside the hookah does not filter out the toxins contained in the tobacco smoke. One smoking session has much more amount of smoke contained in it than that of cigarette smoking. So eventually, hookah smokers may actually inhale more tobacco than cigarette smokers.

Researchers analyzed levels of S-phenylmercapturic acid (SPMA), a metabolite (byproduct) of benzene, in the urine of 105 hookah smokers and 103 nonsmokers exposed to smoke from the water pipes. After an event in a hookah lounge, SPMA levels were four times higher than normal in hookah smokers and 2.6 times higher than normal among people who had attended but hadn't puffed on a hookah.

After a hookah-smoking event in a private home, SPMA levels were two times higher among hookah smokers, but normal among nonsmokers. Many of us believe that because there is no safe level of exposure to benzene, their results call for interventions to reduce or prevent hookah tobacco use, regulatory actions to limit hookah-related exposure to toxicants including benzene, and include hookah smoking in clean indoor air legislation.