Primary research and resources herein currently pertain to pass out challenges. 
For other online/social media harms, CLICK HERE


Decades of substance abuse prevention training and research provide the model for how we how we feel we can most effectively reach kids about the dangers of the choking game.  Research has demonstrated that the fear-based approaches to prevention training has proven less effective over the long-term and in some cases counter-productive.  Skills-based interactive models have been proven to be more effective.   Below are links to research discussing the pros of skills-based training vs. the cons of fear-based training:

  1. CDC:  Characteristics of an Effective Health Education Curriculum
  2. Prevention First:  The Ineffectiveness of Fear Appeals
  3. Prevention of the Choking Game: Parent Perspectives
  4. Project ALERT
    Summary on Impact
  5. Promising Practices:  This site offers a menu of programs which focus on prevention. 
    All have at least promising data level, if not proven data. 
    Suggested Samples:
        Guiding Good Choices
        Coping with Stress 


  1. Official Guidelines for Coding and Reporting FY 2017 (chapter 20, p. 81, para. c)
  2. 2017 Tabular List of Diseases and Injuries, p. 1837:  Code Y93.85 "Activity, choking game" 


(courtesy of

  1. Guilheri J, Andronikof A, Yazigi L. The "Choking Game": A new craze among Brazilian children and young people. Psychophysiological, behavioral and epidemiological characteristics of 'asphyxial games'. Cien Saude Colet. 2017 Mar; 22(3):867-878. English and Portuguese.
  2. Ibrahim AP, Knipper Sh, Brausch AM, Thorne EK. Solitary Participation of the "Choking Game" in Oregon. Pediatrics. 2016 Dec:138(6).
  3. Impact of Education on School-aged Children’s Knowledge of and Participation in “The Choking Game”, Journal of Nursing & Health Sciences, Butler, K., Raingruber, B., et al., RRJNHS, Volume 2, Issue 2, June 2016.
  4. The Choking Game and YouTube:  An Update, Global Pediatric Health, Defenderfer, E., Austin, J., Davies, W.H., January-December 2016, vol. 3, March 2016,
  5. Cortes C, Godeau E, Ehlinger V, Brehin C, Claudet I. [Choking games among 2nd and 3rd graders]. Arch Pediatr. 2016 Jan 23(1); 45-52. Epub Ahead of Print: 28 Nov, 2015.
  6. Albuhairan F, AlMutairi A, Naeem M, Almneef M. Non-sucidal self-strangulation among adolescents in Saudi Arabia. Case series of the choking game. J Forensic Leg Med. 2015 Feb; 30: 43-45.
  7. Re L, Birkhoff JM, Sozzi M, Andrello L, Osculati AM. The choking game: A deadly game. Analysis of two cases of "self-strangulation" in young boys and review of the literature. J Forensic Leg Med. 2015 Feb; 30: 29-33. 
  8. Macnab AJ, Triviax D, Andrew . Risk - taking behavior in adolescents. `Chance only favors the prepared mind'. Arch Dis Child 2015; 100:1101-1102. Epub Ahead of Print: 14 Aug, 2015. 
  9. Body Electric: The art of healthy choices, East Central Illinois teen survey report. 2012
  10. Prevalence and associated harm of engagement in self-asphyxial behaviors in young people ("choking game") a systematic reviewArchives of Disease in Childhood, Busse H, Harrop T, Gunnell D, doi 10.1136/archdischild 2015-308187
  11. The Choking Game. Crime Victim’s Institute. Criminal Justice Center. Sam Houston State University. January 2012
  12. Ulrich NJ, Goodkin HP. The choking game and other strangulation activites in children and adolescents. In: UpToDate, Middleman, AB (Ed), UpToDate, Waltman, MA, 2011.
  13. Noirhomme-Renard F, Gosset C. [The "choking game" and asphyxial games: epidemiological and clinical data]. Rev Med Liege. 2011 Sep;66(9):485-90.
  14. Maine Integrated Youth Health Survey. 2011 MYIS high school report. July, 2012. Available at: (pg 15).
  15. Ramowski SK, Nystrom  RJ, Rosenberg KD, Gilchrist J, Chaumeton NR. Health risks of eighth-grade participants in the "choking game": Results from a population-based survey. Pediatrics. 2012 May; 129 (5): 846-51
  16. Baquero F, Mosqueira M, Fotheringham M, Wahren C, Catsicaris C. [The choking game in adolescence, between experimentation risk.] Arch Argent Pediatr. 2011 Feb; 109(1): 59-61
  17. Brausch AM, Decker, Kristina M, Hadley AG. Risk of suicidal ideation in adolescents with both self-asphyxial risk-taking behavior and non-suicidal sel-injury. Suicide Life Threat Behav. 2011 Aug; 41(4): 424-34.
  18. Bernacki JM, Davies, WH. Prevention of the choking game: parent perspectives. J Inj Violence Res. 2011 Jul; 4(2): 73-8.
  19. Ashraf G, Sathyranarayan S. Cross-section study on awareness of choking game among primary care and emergency physicians. Pediatric and Human Development, Michigan State University. Pediatric Academic Societies and Asian Society for Pediatric Research. 2011 Apr; Abstr # 236.
  20. Baquero F, Mosqueira M, Fotheringham M, Wahren C, Catsicaris C. [The choking game in adolescence, between experimentation and risk.] Arch Argent Pediatr. 2011 Feb; 109(1): 59-61. 
  21. Sauvageau A. The choking game: a misnomer. Pediatr Emerg Care. 2010 Dec; 25(12): 965.
  22. Dake JA, Price JH, Kolm-Valdivia N, Wielinski M. Association of adolescent choking game activity with selected risk behaviors. Acad Pediatr 2010 Nov-Dec; 10(6): 410-416.
  23. Galloway, D. Parent’s Role in Improving the Health of Adolescents. N C Med J. 2010; 71(4):383-385.
  24. Barbería-Marcalain E, Corrons-Perramon J, Suelves JM, Crespo Alonso S, Castellá-García J, Medallo-Muñiz J. [The choking game: a potentially lethal game.] An Pediatr (Barc) 2010 Jul 31. [Epub ahead of print]
  25. Merrick J, Merrick-Kenig E. The choking game revisited. Int J Adolesc Med Health. 2010 Apr-Jun;22(2):173-5.
  26. Egge MK, Berkowitz CD, Toms C, Sathyavagiswaran L. The choking game: A cause of unintentional strangulation. Pediatr Emerg Care. 2010 Mar;26(3): 206-208.
  27. CDC. “Choking Game” awareness and participation among 8th graders---Oregon, 2008. MMWR 2010 Jan 15; 59(01); 1-5.
  28. Language matters: unintentional strangulation, strangulation activity, and the “choking game”. Arch Pediatr Adolesc Med Katz, KA, Toblin RL. 2009; 163:93.
  29. Ontario Student Drug and Health Survey, 2009. Centre for Addiction and Mental Health. CAMH
  30. McClave JL, Russell PJ, Lyren A, O’Riordan MA, Bass NE. The choking game: physician perspectives. Pediatrics 2010; 125:82-7 [E Pub-ahead of print December 14, 2009].
  31. Andrew TA, Macnab A, Russell P. Update on "the choking game". J Pediatr. 2009 Dec;155(6):777-80.
  32. The Choking Game and YouTube: A Dangerous Combination. Clin Ped Linkletter M, Gordon K, Dooley J., 2009; [E Pub-ahead of print July 13, 2009].
  33. Asphyxial games or “the choking game”: a potentially fatal risk behavior. Inj Prev Macnab AJ, Gagnon F, Cannon WG, Andrew TA, 2009; 15(1): 45-9.
  34. Williams County Youth Health Risk Behavioral Survey, 2009, Bryan, OH; Williams County Family and Children First Council (see page 34 of the pdf file)
  35. Thomas, SP. A deadly game for boys. Issues Ment Health Nurs. 2009 May; 30(5):287.
  36. Ulrich NJ, Bergin AM, Goodkin HP. The choking game: self-induced hypoxia presenting as recurrent seizurelike events. Epilepsy & Behavior 2008; 12(3): 486-488.
  37. Toblin RL, Paulozzi LJ, Gilcrist J, Russell PJ. Unintentional strangulation deaths from the “choking game” among youths aged 6-19 years- United States, 1995-2007. J safety Res 2008;39(4):445-8.
  38. CDC. Unintentional Strangulation deaths from the “choking game” among youths aged 6-19 years: United States, 1995-2007. MMWR Morb Mortal Wkly Rep. 2008; 57(6):141-144.
  39. Andrew TA, Fallon KK. Asphyxial games in children and adolescents Am J of Forensic Med and Pathology 2007 Dec; 28 (4): 303-307.
  40. Ontario Student Drug and Health Survey, 2007. Centre for Addiction and Mental Health. CAMH Available at:
  41. Ho LY, Abdelghani WN. Valsalva retinopathy associated with the choking game. Semin Ophthalmol. 2007 Apr-June; 22(2): 63-5.
  42. Hageman, Jr The choking game and autoerotic Asphyxiation. Illinois Pediatrician, spring, 2006; 24: 8-9.
  43. Lynch DA. The “Choking Game” A deadly fame is resurfacing. Adolescent Shorts. 2006 May-June; 8(3).
  44. Urkin J, Merrick J. The choking game or suffocation roulette in adolescence. Int J Adolesc Med Health 2006, Apr-June; 18 (2): 207-208.
  45. The choking game”: self strangulation with a belt and a clothes rack. Ceylon Med J, Senanayake MP, Chandraratne KA, de Silva DU, Weerasuriya DC. 2006, Sept; 51(3):120.
  46. Williams County Youth Health Risk Behavioral Survey, Fall 2006. Bryan, OH: Williams County Partnerships for Success; 2007 (page 23 document/28 PDF file)
  47. Gicequel JJ, Bouhamida K, Dighiero P. Ophthalmologic complications of the asphyxiophylic scarf game in a 12 year old child J Fr Ophthalmol 2004; 27: 1153-5.
  48. Chow, KM. Deadly game among children and adolescents. Ann Emerg Med 2003; 42(2): 310.
  49. Shlamovit GZ, Assia A, Ben-Sira L, Tachmel A. “Suffocation roulette”: a case of recurrent syncope in an adolescent boy. Ann Emerg Med 2003; 41(2): 223-6.
  50. Le D, Macnab AJ. Self strangulation by hangingfrom cloth towel dispensers in Canadian schools. Inj Prev 2001; 7(3) 231-233
  51. "Choking Game" Awareness and Participation Among 8th Graders --- Oregon, 2008
  52. Howard P, Leathart GL, Dornhorst AC, Sharpey-Schafer EP. The “Mess Trick” and the “Fainting Lark”. Br Med J 1951, Sept 1; 2(4730): 548-549
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commented 2013-12-21 14:42:18 -0800 · Flag
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