At least 82 youth have died as a result of playing what has been called "the choking game," according to a study released by the Centers for Disease Control and Prevention in today's Morbidity and Mortality Weekly Report. The choking game involves intentionally trying to choke oneself or another in an effort to obtain a brief euphoric state or "high." Death or serious injury can result if strangulation is prolonged.

Eighty-seven percent of these deaths were among males, and most fatalities occurred among those 11 years to 16 years old; the average age was 13, the report said. Choking game deaths were identified in 31 states, it said.

CDC found that most of the deaths occurred when a child engaged in the choking game alone, and that most parents were unaware of the choking game prior to their child's death.

"Because most parents in the study had not heard of the choking game, we hope to raise awareness of the choking game among parents, health care providers, and educators, so they can recognize warning signs of the activity," said Robin L. Toblin, Ph.D., M.P.H., the study's lead author. "This is especially important because children themselves may not appreciate the dangers of this activity."

Three or fewer choking game-related deaths per year were reported in the news media from 1995 to 2004, the report said. However, 22 deaths occurred in 2005, and 35 in 2006. Nine deaths occurred in the first 10 months of 2007; the explanation for this decrease is unclear. The researchers said the study probably underestimates the number of deaths.

For this study, CDC analyzed media reports of deaths attributed to the choking game. Deaths were not included unless the report provided evidence that they were a result of the choking game.

"This report is an important first step in identifying the choking game as a public health problem," said Ileana Arias, Ph.D., director of CDC's Injury Center. "More research is needed to identify risk factors that may contribute to kids playing the choking game and to determine what may help to reduce this type of behavior."

Signs that a child may be engaging in the choking game include

-- discussion of the game --including other terms used for it, such as "pass-out game'' or "space monkey";

  -- bloodshot eyes;
  -- marks on the neck;
  -- severe headaches;
  -- disorientation after spending time alone;

-- ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor;

-- unexplained presence of things like dog leashes, choke collars and bungee cords

If parents believe their child is playing the choking game, they should speak to them about the life-threatening dangers associated with the game and seek additional help if necessary.

For more information about CDC's work in injury and violence prevention, please link to: http://www.cdc.gov/injury.