"Choking Game" Awareness and Participation among 8th Graders — Oregon, 2008

From Morbidity & Mortality Weekly Report
SK Ramowski, MSW; RJ Nystrom, MA; NR Chaumeton, PhD; KD Rosenberg, MD; J Gilchrist, MD

02/26/2010; Morbidity & Mortality Weekly Report. 2010;59(1):1-5. © 2010 Centers for Disease Control and Prevention (CDC)

Introduction
The "choking game" is an activity in which persons strangulate themselves to achieve euphoria through brief hypoxia.

It is differentiated from autoerotic asphyxiation. The activity can cause long-term disability and death among youths.
In 2008, CDC reported 82 deaths attributed to the choking game and other strangulation activities during the period 1995–2007; most victims were adolescent males aged 11–16 years.

To assess the awareness and prevalence of this behavior among 8th graders in Oregon, the Oregon Public Health Division added a question to the 2008 Oregon Healthy Teens survey concerning familiarity with and participation in this activity.
This report describes the results of that survey, which indicated that 36.2% of 8th-grade respondents had heard of the choking game, 30.4% had heard of someone participating, and 5.7% had participated themselves. Youths in rural areas were significantly more likely (6.7%) to have participated than youths in urban areas (4.9%). Choking game participation was higher among 8th graders who reported mental health risk factors (4.0%), substance use (7.9%), or both (15.8%), compared with those who reported neither (1.7%).
Public health surveillance of these strangulation activities among youths should be expanded to better quantify the risks and understand the motives and circumstances surrounding participation. Parents, educators, counselors, and others who work with youths should be aware of strangulation activities and their serious health effects; they should watch for signs of participation in strangulation activities, especially among youths with suspected substance use or mental health risk factors.

Parents, educators, counselors, health-care providers, and others who work with youths should become aware of strangulation activities and the signs of participation (e.g., mention of the choking game [or the game by its other names]; bloodshot eyes; marks on the neck; frequent, severe headaches; disorientation after spending time alone; and ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor).

Nearly one third of 163 pediatricians and family practitioners recently surveyed were not aware of the choking game or the signs indicating that a patient might be participating in this activity.

Finally, to identify participating youths, health and mental health practitioners should consider adding a question about strangulation activities to clinical screening tools, especially for youths identified as having substance use or mental health risks