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.

Kids, apparently, are drawn to the smooth taste of the flavoured tobacco.

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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  • Don't smoke ... anything

    Smoking is, hands down, the worst thing you can do to your lungs on a regular basis. There's no safe threshold when it comes to smoking, Dr. Edelman says; the more you smoke, the greater your risk of lung cancer and COPD, which includes emphysema and chronic bronchitis. Secondhand smoke is harmful, too, and there's mounting evidence that even thirdhand smoke -- or just being in an environment where people have smoked -- is dangerous. It's not enough to skip only cigarettes. Pipes, cigars, or marijuana can harm lungs too. <strong>More from Health.com:</strong> <a href="http://www.health.com/health/gallery/0,,20474799,00.html" target="_hplink">10 Myths and Facts About COPD</a> <a href="http://www.health.com/health/wp/0,,20460859,00.html" target="_hplink">3 Ways to Manage COPD</a> <a href="http://www.health.com/health/gallery/0,,20443619,00.html" target="_hplink">The Worst Jobs for Your Lungs</a>

  • Don't smoke ... anything

    Smoking is, hands down, the worst thing you can do to your lungs on a regular basis. There's no safe threshold when it comes to smoking, Dr. Edelman says; the more you smoke, the greater your risk of lung cancer and COPD, which includes emphysema and chronic bronchitis. Secondhand smoke is harmful, too, and there's mounting evidence that even thirdhand smoke -- or just being in an environment where people have smoked -- is dangerous. It's not enough to skip only cigarettes. Pipes, cigars, or marijuana can harm lungs too. <strong>More from Health.com:</strong> <a href="http://www.health.com/health/gallery/0,,20474799,00.html" target="_hplink">10 Myths and Facts About COPD</a> <a href="http://www.health.com/health/wp/0,,20460859,00.html" target="_hplink">3 Ways to Manage COPD</a> <a href="http://www.health.com/health/gallery/0,,20443619,00.html" target="_hplink">The Worst Jobs for Your Lungs</a>

  • Fight for clean air

    While U.S. air is cleaner than in the past, more than 154 million Americans still live in areas where air pollution is a threat to health, according to the <a href="http://www.stateoftheair.org/" target="_hplink">ALA's annual State of the Air report.</a> "Air pollution can not only make diseases like COPD and asthma worse, [but] it can also kill people," Dr. Edelman says. You can make a difference by supporting clean air laws and opposing efforts to cut regulation. On the individual level, cut your electricity use, drive less and avoid burning wood or trash.

  • Exercise more

    Exercise in itself won't make your lungs stronger, Dr. Edelman says, but it will help you get more out of them. The better your cardiorespiratory fitness, the easier it is for your lungs to keep your heart and muscles supplied with oxygen. Regular exercise is particularly important if you have chronic lung disease; your lungs need all the help they can get. If cold air triggers your asthma symptoms, use a scarf or face mask to warm the air before it hits your lungs.

  • Beware of outdoor air pollution

    In some areas, especially in the summer, ozone and other pollutants can make working out or even spending time outdoors an unhealthy proposition. People with a lung disease are particularly sensitive to air pollution. The U.S. government's <a href="http://www.airnow.gov/" target="_hplink">AIRNow web site</a>, provides up-to-date information on air quality, as well as an explanation of Air Quality Index (AQI) numbers. Sign up for <a href="http://www.enviroflash.info/" target="_hplink">EnviroFlash</a>, email alerts on your local air quality.

  • Improve indoor air

    Air pollution isn't just an outdoor problem. There are a number of <a href="http://www.health.com/health/gallery/thumbnails/0,,20368815,00.html" target="_hplink">indoor sources</a>, including fireplaces and wood-burning stoves, mold, pet dander, construction materials and even air fresheners and some candles. The Environmental Protection Agency recommends a three-pronged approach: Eliminate sources, improve ventilation and use <a href="http://www.health.com/health/gallery/0,,20307209_1,00.html" target="_hplink">air cleaners</a>. Air cleaners remove particulate matter, but won't impact gases. For more info, check the <a href="http://www.epa.gov/iaq/" target="_hplink">EPA's Indoor Air Quality website</a>.

  • Eat right

    There is evidence that antioxidant-rich foods are good for your lungs. (Research suggests it has to be food, not supplements.) A 2010 study found that people who consumed the most cruciferous vegetables (broccoli, cauliflower, cabbage, bok choy, kale and more) had almost half the risk of lung cancer compared to those who consumed the least. "All those nice, leafy green vegetables that have lots of antioxidants do seem to have a protective effect," says Dr. Edelman

  • Protect yourself on the job

    Many jobs can put your lungs at risk, from construction work to styling hair. (Here are some of the <a href="http://www.health.com/health/gallery/0,,20443619,00.html" target="_hplink">worst jobs for your lungs</a>.) In fact, occupational asthma accounts for approximately 15 percent of cases, says Dr. Edelman. Potential culprits include dust; particles; diacetyl, a chemical that adds a buttery flavor to food; paint fumes; and diesel exhaust, among others. If your employer provides protective equipment, wear it. If not, Dr. Edelman says, contact your union representative, the <a href="http://www.osha.gov/" target="_hplink">Occupational Safety and Health Administration</a>, or any state or local agency with the same function as OSHA.

  • Don't skimp on shots

    Respiratory infections can be particularly devastating if you have COPD or other lung problems. Get the flu shot in time for flu season, and if you're 65 or older, get the pneumococcal vaccine too. Also, take steps to avoid infection: Wash your hands frequently, avoid crowds during peak flu season, get plenty of rest, eat well and keep your stress levels under control, too.

  • Stick to safe products

    Many at-home activities -- cleaning, hobbies, home improvement -- can expose your lungs to harmful particles or gases. Protect yourself by choosing safer products, working in a well-ventilated area, and using a dust mask. (The ALA <a href="http://www.lungusa.org/healthy-air/home/resources/fiberglass.html" target="_hplink">offers tips</a> for working with fiberglass.) Avoid oil-based paints, which release volatile organic compounds (VOCs), and choose water-based paint instead. Cleaning products can contain harmful chemicals too, like VOCs, ammonia, and bleach; read labels before you buy. (The ALA <a href="http://www.healthhouse.org/tipsheets/TS_HealthyCleaning.pdf" target="_hplink">provides suggestions</a> for safer cleaning products.)

  • Check for radon

    Radon is a naturally occurring radioactive gas produced by the breakdown of uranium in the ground. It typically leaks into a house through cracks in the foundation and walls. Radon is the main cause of lung cancer in nonsmokers, and the second-leading cause of the disease after smoking. Get your home tested; if radon levels are between 2 and 4 pCi/L, consider <a href="http://www.epa.gov/radon/pubs/consguid.html" target="_hplink">radon reduction</a>. There are no known safe levels of radon, so the lower, the better.

  • Know the warning signs

    If you have a cough for more than a month, or if you have a hard time breathing with little or no physical exertion, you should see a doctor, according to the ALA. Wheezing, coughing up blood or coughing up phlegm for more than a month are also problematic, and if you have chest pain lasting a month or longer, get it checked out, particularly if breathing in or coughing makes it worse.

  • Control your condition

    If you've got asthma or COPD, do your best to keep it under control. Preventive medications, such as inhaled corticosteroids, can cut your risk of asthma attacks, and rescue medications, such as albuterol inhalers, can stop symptoms like coughing or wheezing. Other <a href="http://www.health.com/health/condition/library/0,,20324390,00.html" target="_hplink">medications can control COPD</a>. Know your triggers and avoid them, if possible. Also do your best to stave off respiratory infections, which can exacerbate both conditions. <strong>More from Health.com:</strong> <a href="http://www.health.com/health/gallery/0,,20474799,00.html" target="_hplink">10 Myths and Facts About COPD</a> <a href="http://www.health.com/health/wp/0,,20460859,00.html" target="_hplink">3 Ways to Manage COPD</a> <a href="http://www.health.com/health/gallery/0,,20443619,00.html" target="_hplink">The Worst Jobs for Your Lungs</a>