By Nancy Walsh, Staff Writer, MedPage Today
Published: April 16, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Youth participation in the "choking game" -- applying pressure to the carotid artery to limit oxygen to the brain as a means of getting high -- is often accompanied by other risky behaviors, a survey of eighth graders revealed.
Among girls, those who had previously had intercourse had a four-fold greater likelihood of participating in the choking game (OR 3.97, 95% CI 2.4 to 6.6) compared with those not having sex, according to Nigel R. Chaumeton, PhD, of the Oregon Health Authority in Portland, and colleagues.
Among boys, substance use within the previous month had the strongest association with the game (OR 3.87, 95% CI 1.9 to 7.7), the researchers reported online in Pediatrics.
Between 1995 and 2007, 82 deaths from this form of recreational strangulation were reported among U.S. youth, which is likely to be an underestimation because of a widespread lack of awareness and understanding of the activity.
Estimates of participation in a few studies have suggested a prevalence of approximately 5% to 11%, but little is known about the teens who engage in this activity.
So the researchers conducted a population-based survey of more than 5,300 eighth graders in Oregon, in which they asked about various health behaviors.
A total of 6.1% of the responders reported having played the choking game at least once, and of those, 3.4% had done so more than once and 26.6% had done so more than five times.
In addition, 22% said they had heard of someone else playing the game, which has also been referred to as "knock out," "flatlining," and the fainting game.
Among girls, factors associated with participation other than sexual activity included:
- Poor nutrition, OR 2.42 (95% CI 1.3 to 4.5)
- Substance use within the previous month, OR 2.11 (95% CI 1.4 to 3.3)
- Gambling, OR 1.72 (95% CI 1.3 to 2.3)
Associated factors for boys included:
- Sexual activity, OR 3.01 (95% CI 1.9 to 4.7)
- Exposure to violence, OR 2.14 (95% CI 1.5 to 3.1)
Differences also were seen for race and ethnicity, although the researchers cautioned that the numbers were small.
Compared with whites, a greater likelihood for participation was seen in boys who were black (OR 3.47, 95% CI 2 to 6.1) or Pacific Islanders (OR 4.95, 95% CI 1.8 to 13.5).
Pacific Islander girls also were more at risk (OR 5.77, 95% CI 1.9 to 17.3).
"Many youth have a limited understanding of the potential risks and dangers of the choking game, [which] illustrates the importance of health education messaging. Clear, youth-friendly messages about the possible consequences of this activity are warranted," the researchers stated.
They suggested that clinicians consider asking about this during the adolescent well-visit in addition to asking questions about other health behaviors such as sexual activity and substance use. These questions are particular important among those with other risk factors identified in this survey, the authors said.
They acknowledged the time pressure in a comprehensive teen well-visit, when multiple issues need to be addressed.
"However, we hope that some anticipatory guidance may be a first step toward reducing youth participation in the choking game and its associated injury and death," they concluded.
Limitations of the study included the limited numbers of nonwhites surveyed, and the cross-sectional nature of the data.
Moreover, the survey questions had not been validated and the student understanding of the topics addressed remains uncertain.
The authors reported no relevant financial relationships.
Primary source: Pediatrics
Source reference:
Ramowski S, et al "Health risks of Oregon eighth-grade participants in the 'choking game': results from a population-based survey" Pediatrics 2012; DOI: 10.1542/peds.2011-2482.
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