{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:51:49Z","timestamp":1790682709180,"version":"4.1.0"},"reference-count":36,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>To examine the demographic and health risk factors associated with participation in the choking game (CG), a dangerous and potentially fatal strangulation activity in which pressure is applied to the carotid artery to temporarily limit blood flow and oxygen.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We obtained data from 2 cross-sectional studies realized respectively in 2009 and 2013 among French middle school students. The 2009 (n = 746) and 2013 (n = 1025) data sets were merged (N = 1771), and multivariate modeling was conducted to examine demographic and clinical characteristics of youth reporting a lifetime participation in the CG. The 2 studies included questions about risk-taking behaviors and substance use, and standardized assessments were used to collect conduct disorder symptoms and depressive symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>In the merged 2009 and 2013 data set, the lifetime prevalence of CG participation was 9.7%, with no statistically significant differences between boys and girls. A multivariate logistic regression revealed that higher levels of conduct disorder symptoms (odds ratio: 2.33; P &amp;lt; .001) and greater rates of depressive symptoms (odds ratio: 2.18; P &amp;lt; .001) were both significantly associated with an increased likelihood of reporting CG participation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>The significant relationship between elevated levels of depressive symptoms and participation in the CG sheds new light on the function of self-asphyxial activities. However, with the finding that higher rates of conduct disorder symptoms were the most important predictor of CG participation, it is suggested that the profile and the underlying motivations of youth who engage in this activity should be reexamined.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2017-3963","type":"journal-article","created":{"date-parts":[[2019,1,28]],"date-time":"2019-01-28T13:53:08Z","timestamp":1548683588000},"source":"Crossref","is-referenced-by-count":17,"title":["Adolescent Mental Health and the Choking Game"],"prefix":"10.1542","volume":"143","author":[{"given":"Gr\u00e9gory","family":"Michel","sequence":"first","affiliation":[{"name":"Inserm U1219, Team Healthy, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Garcia","sequence":"additional","affiliation":[{"name":"Inserm U1219, Team Healthy, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Aubron","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Tours, Tours, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Bernadet","sequence":"additional","affiliation":[{"name":"Bordeaux Hospital University Center, Bordeaux, France; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Salla","sequence":"additional","affiliation":[{"name":"Inserm U1219, Team Healthy, Bordeaux Population Health Center, University of Bordeaux, Bordeaux, France;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane","family":"Purper-Ouakil","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2019,2,1]]},"reference":[{"issue":"4","key":"2021121013282646200_B1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jsr.2008.06.002","article-title":"Unintentional strangulation deaths from the \u201cchoking game\u201d among youths aged 6-19 years - United States, 1995-2007.","volume":"39","author":"Toblin","year":"2008","journal-title":"J Safety Res"},{"issue":"6","key":"2021121013282646200_B2","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.jpeds.2009.06.043","article-title":"Update on \u201cthe choking game\u201d.","volume":"155","author":"Andrew","year":"2009","journal-title":"J Pediatr"},{"issue":"2","key":"2021121013282646200_B3","first-page":"73","article-title":"Prevention of the choking game: parent perspectives.","volume":"4","author":"Bernacki","year":"2012","journal-title":"J Inj Violence Res"},{"issue":"1","key":"2021121013282646200_B4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1136\/ip.2008.018523","article-title":"Asphyxial games or \u201cthe choking game\u201d: a potentially fatal risk behaviour.","volume":"15","author":"Macnab","year":"2009","journal-title":"Inj Prev"},{"issue":"3","key":"2021121013282646200_B5","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1136\/ip.7.3.231","article-title":"Self strangulation by hanging from cloth towel dispensers in Canadian schools.","volume":"7","author":"Le","year":"2001","journal-title":"Inj Prev"},{"issue":"3","key":"2021121013282646200_B6","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1520\/JFS12684J","article-title":"500 psychological autopsies.","volume":"34","author":"Litman","year":"1989","journal-title":"J Forensic Sci"},{"issue":"3","key":"2021121013282646200_B7","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1177\/0009922809339203","article-title":"The choking game and YouTube: a dangerous combination.","volume":"49","author":"Linkletter","year":"2010","journal-title":"Clin Pediatr (Phila)"},{"issue":"12","key":"2021121013282646200_B8","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1136\/archdischild-2015-308187","article-title":"Prevalence and associated harm of engagement in self-asphyxial behaviours (\u2018choking game\u2019) in young people: a systematic review.","volume":"100","author":"Busse","year":"2015","journal-title":"Arch Dis Child"},{"key":"2021121013282646200_B9","first-page":"2333794X15622333","article-title":"The choking game on YouTube: an update [published correction appears in Glob Pediatr Health. 2016;3:2333794X16651782].","volume":"3","author":"Defenderfer","year":"2016","journal-title":"Glob Pediatr Health"},{"issue":"6","key":"2021121013282646200_B10","first-page":"141","article-title":"Unintentional strangulation deaths from the \u201cchoking game\u201d among youths aged 6-19 years\u2013United States, 1995-2007.","volume":"57","author":"Centers for Disease Control and Prevention (CDC)","year":"2008","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2021121013282646200_B11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jflm.2014.12.008","article-title":"The choking game: a deadly game. 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