More and more teens appear to be spending their high school years in a fog.

According to a new study published in the journal Pediatrics, nearly one in five U.S. students availed themselves of a hookah in the last year.

The research suggests smoking from a hookah — essentially a water pipe that uses charcoal to heat up tobacco, called shisha — is among the very hottest high school trends.

Data for the study came from the University of Michigan's Monitoring the Future survey — which suggests hookah usage among high-school seniors in the past year rose to 21 per cent.

Which could spell a heap of health issues — especially with prevailing attitudes that the hookah is somehow less harmful than cigarettes.

"The fact is, studies from Mayo Clinic show that, if anything, you get more exposure than cigarette smoking by smoking hookah, and the water in the hookah actually does not necessarily filtrate all these poisons," Dr. Zyad Kafri, a hematologist-oncologist at St. John Providence Hospital, told CBS affiliate, WWJ Detroit. "And in general you get more exposure to toxic chemicals than cigarette smoking."

The likeliest candidates for taking up the pipe? Males, people who lived in the city and those with more disposable income, the study notes.

A study funded by the National Institutes of Health notes a single hookah session delivers 1.7 times the nicotine, 6.5 times the carbon monoxide and 46.4 times the tar of a single cigarette. Or, as Alex B. Berezow notes in a blog at Real Clear Science, it's like "smoking 40 cigarettes and kissing everyone."

"In other words, this is one of the most toxic things you could do to your body in the span of about 60 minutes."

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