Risk behaviors can indicate participation in the "choking game"

A study of new data from the latest Oregon Healthy Teens (OHT) survey adds knowledge of behaviors associated with the “choking game” that clinicians could use in a risk assessment as part of a comprehensive adolescent well visit.

In the choking game, pressure is applied to the neck and carotid artery to limit oxygen and blood flow. When the pressure is released, a “high” or euphoric feeling occurs as blood and oxygen rush back to the brain. More a strangulation activity than a “game,” the practice can lead to serious injury and death.

The survey of 5,348 eighth graders in Oregon questioned lifetime prevalence and frequency of participation in the choking game and asked about physical and mental health, gambling, sexual activity, nutrition, physical activity, body image, exposure to violence, and substance use.

Data showed the prevalence of lifetime participation was 6.1%, with no differences between boys and girls. Of those ever having participated, 64% had engaged in the activity more than once, and 26.6% had engaged in the practice 5 or more times. Among boys, black students were more likely to participate than white students. Choking game participation was significantly associated with sexual activity and substance use for both boys and girls.

The researchers suggest that during the adolescent well visit and examination providers look for signs of unexplained bruising or red marks on the throat, petechiae, and frequent headaches. If providers identify such risk markers, they may want to ask the patient about his or her awareness of the choking game and offer participatory guidance about avoiding the practice and the risks of injury and death associated with it.

Another survey of pediatricians and family practitioners found that nearly one-third were unaware of strangulation practices such as the choking game among an estimated 5% to 11% of adolescents, or the signs indicating that a patient might be participating in the activity.

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