Asphyxial Games in Children and Adolescents

Andrew, Tom W.; Fallon, Kim

doi:10.1097/paf.0b013e318148bdb2

Cited by 63 publications

(55 citation statements)

References 13 publications

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“…6 Contributing to the lack of accurate mortality statistics is the fact that adolescent deaths due to asphyxial games, such as the choking game, are often misclassified as suicides or accidental deaths. 7 -9 Contrary to early hypotheses that participation in the choking game was more common among youth with low rates of other health risks, 10 more recent research has established that participation in the choking game is far more common among youth who experience substance use, poor mental health, violence, early-onset sexual activity, and other health risk behaviors, 4,6,11 as well as those who have a thrill-seeking personality. 12 Awareness of the choking game and its risks is limited among youth, 3, 13 parents, 14,15 and providers.…”

Section: What This Study Addsmentioning

confidence: 61%

Solitary Participation in the “Choking Game” in Oregon

et al. 2016

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OBJECTIVE: The purpose of this study was to compare characteristics of youth who participate in the choking game alone versus those who participate in a group.METHODS: Lifetime prevalence estimates were obtained from the 2011 (n = 5682) and 2013 (n = 15 150) Oregon Healthy Teens survey. The 2011 and 2013 data sets were merged (N = 20 832) to compare youth who participate alone versus those who participate in a group in the choking game. Multivariate modeling was conducted to examine individual characteristics of young people who engaged in the choking game alone versus those who engaged in the game in a group. RESULTS:In 2011, 3.8% of eighth-grade participants reported a lifetime prevalence of choking game participation; 3.7% reported lifetime prevalence of participation in 2013. In the merged 2011/2013 data set, 17.6% (n = 93) of choking game participants indicated that they had participated alone. Compared with those who reported participating in a group, youth who participated alone had significantly higher rates of suicide contemplation (odds ratio: 4.58; P < .001) and poor mental health (odds ratio: 2.13; P < .05). CONCLUSIONS:Youth who participate alone in the choking game are a particularly high risk group, exhibiting substantially higher rates of suicidal ideation and poorer mental health compared with youth who participate in the choking game in a group. Adolescent health care providers should be aware of these associations, assess whether prevention messaging is appropriate, and be prepared to explain the high risks of morbidity and mortality associated with participation.a Hawaii State Department of Health, Honolulu, Hawaii; b Oregon Public Health Division, Portland, Oregon; c Western Kentucky University, Bowling Green, Kentucky; and d Cairn Guidance, Portland, Oregon Ms Ibrahim conducted the data analysis and drafted the initial manuscript; Ms Knipper conceptualized and designed the study, supervised the data analysis, and reviewed and revised the manuscript; Dr Brausch critically reviewed and revised the manuscript; and Ms Thorne helped conceptualize the study and reviewed and revised the manuscript; all authors approved the fi nal manuscript as submitted.

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Section: What This Study Addsmentioning

confidence: 61%

Solitary Participation in the “Choking Game” in Oregon

et al. 2016

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“…This is a nonsexual activity and therefore distinct from autoerotic asphyxiation (AEA) in its underlying motivations. 4,5 Participation in this activity can lead to serious injury or death.…”

mentioning

confidence: 99%

“…A handful of studies of youth conducted over the past few years have illustrated lifetime prevalence of between 5% to 11%. [6][7][8][9] Some estimates have shown an increased likelihood of participation among males, older youth, 4 and those living in rural areas. 8 In the United States, between 1995 and 2007, there were 82 deaths in children ages 6 to 19 years attributed to participation in the choking game and identified through newspaper and other media accounts.…”

mentioning

confidence: 99%

Health Risks of Oregon Eighth-Grade Participants in the “Choking Game”: Results From a Population-Based Survey

et al. 2012

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OBJECTIVE: To examine the risk behaviors associated with participation in the “choking game” by eighth-graders in Oregon. METHODS: We obtained data from the 2009 Oregon Healthy Teens survey, a cross-sectional weighted survey of 5348 eighth-graders that questioned lifetime prevalence and frequency of choking game participation. The survey also included questions about physical and mental health, gambling, sexual activity, nutrition, physical activity/body image, exposure to violence, and substance use. RESULTS: Lifetime prevalence of choking game participation was 6.1% for Oregon eighth-graders, with no differences between males and females. Of the eighth-grade choking game participants, 64% had engaged in the activity more than once and 26.6% >5 times. Among males, black youth were more likely to participate than white youth. Among both females and males, Pacific Islander youth were much more likely to participate than white youth. Multivariate logistic regression revealed that sexual activity and substance use were significantly associated with choking game participation for both males and females. CONCLUSIONS: At >6%, the prevalence of choking game participation among Oregon youth is consistent with previous findings. However, we found that most of those who participate will put themselves at risk more than once. Participants also have other associated health risk behaviors. The comprehensive adolescent well visit, as recommended by the American Academy of Pediatrics, is a good opportunity for providers to conduct a health behavior risk assessment and, if appropriate, discuss the dangers of engaging in this activity.

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“…Several reports have acknowledged the difference between AEA and the choking game and other asphyxial activities among youths, stating that AEA, although similar, should be considered a separate entity because its participants are almost exclusively adult and the choking game does not necessarily include masturbation. 11 Because of this, AEA was excluded from the analysis of alternative names for the choking game. The median number of alternative names identified by physicians aware of the choking game was 2 (range: 0 -10 names).…”

Section: Choking Game Awarenessmentioning

confidence: 99%

“…9,10 The full extent of the injuries and deaths caused by the choking game is likely underrepresented by these accounts, because many of the cases are never reported or may be misclassified as suicides. 11 A variety of warning signs suggest that an adolescent may be participating in the choking game. These signs include headaches, unexplained bruising around the neck, bloodshot eyes, facial petechiae, disorientation after being alone, ligatures tied in strange knots or in unusual places, and wear marks on furniture.…”

mentioning

confidence: 99%

The Choking Game: Physician Perspectives

McClave¹,

Russell

Lyren

et al. 2010

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Reports in the popular media and case reports have described the choking game activity and its consequences. The incidence of the activity has been described. WHAT THIS STUDY ADDS:We report on physician awareness of the choking game and opinions on including discussion of its dangers in anticipatory guidance for adolescents. abstract OBJECTIVE: The goal was to assess awareness of the choking game among physicians who care for adolescents and to explore their opinions regarding its inclusion in anticipatory guidance. METHODS:We surveyed 865 pediatricians and family practitioners. The survey was designed to assess physicians' awareness of the choking game and its warning signs, the suspected prevalence of patients' participation in the activity, and the willingness of physicians to include the choking game in adolescent anticipatory guidance. Information on the general use of anticipatory guidance also was collected. RESULTS:The survey was completed by 163 physicians (response rate: 21.8%). One-hundred eleven (68.1%) had heard of the choking game, 68 of them (61.3%) through sources in the popular media. General pediatricians were significantly more likely to report being aware of the choking game than were family practitioners or pediatric subspecialists (P ϭ .004). Of physicians who were aware of the choking game, 75.7% identified Ն1 warning sign and 52.3% identified Ն3. Only 7.6% of physicians who were aware of the choking game reported that they cared for a patient they suspected was participating in the activity, and 2 (1.9%) reported that they include the choking game in anticipatory guidance for adolescents. However, 64.9% of all respondents agreed that the choking game should be included in anticipatory guidance. CONCLUSIONS:Close to one third of physicians surveyed were unaware of the choking game, a potentially life-threatening activity practiced by adolescents. Despite acknowledging that the choking game should be included in adolescent anticipatory guidance, few physicians reported actually discussing it. To provide better care for their adolescent patients, pediatricians and family practitioners should be knowledgable about risky behaviors encountered by their patients, including the choking game, and provide timely guidance about its dangers.

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Asphyxial Games in Children and Adolescents

Cited by 63 publications

References 13 publications

Solitary Participation in the “Choking Game” in Oregon

Solitary Participation in the “Choking Game” in Oregon

Health Risks of Oregon Eighth-Grade Participants in the “Choking Game”: Results From a Population-Based Survey

The Choking Game: Physician Perspectives

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