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Researchers have warned of an impending health epidemic caused by a huge rise in the number of students smoking hookah pipes.

A new study found 18% of high school seniors have reported engaging in behavior researchers describe as 'equivalent to smoking 10-40 cigarettes in a single sitting, and then kissing everybody as well'.

Researchers say the students are unaware of the potential health risks - and believe new, small hookah 'pens' similar to e-cigarettes could lead to major health problems.

A new study found 18% of high school seniors have smoked hookahs - and say it could lead to a health epidemic

The new study by researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR), in the August 2014 edition of Pediatrics identifies how prevalent Hookah use is and which teens are most likely to be using it.

The researchers found the annual prevalence (use in the last 12 months) of hookah use was nearly 1 in 5 high school seniors.

'What we find most interesting is that students of higher socioeconomic status appear to be more likely to use hookah,' said Joseph Palamar of NYU Langone Medical Center. 

'Surprisingly, students with more educated parents or higher personal income are at high risk for use. 

'We also found that hookah use is more common in cities, especially big cities.

'So hookah use is much different from cigarette use, which is more common in non-urban areas.'

The study, 'Hookah Use Among U.S. High School Seniors,' used data from Monitoring the Future (MTF), a nation-wide ongoing annual study of the behaviors, attitudes, and values of American secondary school students.

The MTF survey is administered in approximately 130 public and private schools throughout 48 states in the US.

Studies estimate one hookah session can be the equivalent of smoking from 10 to 40 cigarettes.

Roughly 15,000 high school seniors are assessed annually.

This study examined data from the 5,540 students (modal age = 18) who were asked about Hookah use from 2010-2012.

The researchers found those students who smoked cigarettes, and those who had ever used alcohol, marijuana or other illicit substances were more likely to use hookah.

'However, times are beginning to change,' said Dr. Palamar. 

'Now something called hookah pens, which are similar to e-cigarettes, are gaining popularity. 

'While not all hookah pens contain nicotine, this new delivery method might normalize hookah use in everyday settings and bring use to a whole new level.'

Researchers conclude increased normalization might lead to increases in use, and possibly adverse consequences associated with repeated use. 

'Tobacco use and exposure to secondhand smoke are the leading preventable causes of morbidity and mortality in the US,' said a study co-author Michael Weitzman, MD, a professor of Pediatrics and of Environmental Medicine at the NYULMC. 

'Cigarette use has decreased by 33% in the past decade in the US, while the use of alternative tobacco products such as hookahs has increased an alarming 123%. 

'This is especially worrisome given the public misperception that hookahs are a safe alternative to cigarettes whereas evidence suggests that they are even more damaging to health than are cigarettes.

'This portends a potential epidemic of a lethal habit growing among upper and middle class adolescents.