Kids who play the so-called “choking game” are more likely to engage in other risky behaviors, including sex, substance use and gambling, a new study of middle schoolers finds.

The results suggest doctors should consider asking children who exhibit risky behaviors whether they are aware of and have participated in the choking game, a dangerous activity, the researchers said.

In the choking game, pressure is applied to the neck — with a belt, rope or other object — to limit oxygen and blood flow to the brain. When the pressure is released, a “high” or euphoric feeling is sometimes achieved as blood rushes back to the brain.

Sarah Ramowski, of the Oregon Health Authority in Portland, and colleagues surveyed more than 5,300 eighth-graders in Oregon, asking whether they had heard of the choking game, and if so, whether they had participated.

Twenty-two percent of children said they had heard of the game, and 6 percent had participated in it, the study found. These numbers match closely with earlier studies of the activity's prevalence, findings that between 5 and 11 percent of youth have participated in it.

Among those who had participated in the game, 64 percent said they had tried it more than once, and 26 percent said they had tried it more than five times, the researchers said.

Eighth-grade girls who had become sexually active were four times more likely to have participated in the choking game compared with those who had never had sex. Girls who had gambled were nearly twice as likely to have participated in the choking game compared with those who had not gambled.

Boys who had used alcohol in the past month were about four times more likely to have participated in the choking game, compared with those who had not used alcohol in the last month, the researchers said.

The study was limited in that it was conducted in kids in one region, and relied on self-reports of behaviors.

Increasing awareness of the choking game among pediatricians is important because doctors can look for signs of the activity (such as red markers on the throat) and counsel patients about it, the researchers said.

“Clinicians who see adolescents are in a unique position to offer clear messaging about the risks and consequences of choking game participation,” the researchers wrote in the April 16 issue of the journal Pediatrics.

Eighty-two children are known to have died from the choking game between 1995 and 2007, though this is likely an underestimation because it includes only deaths covered by the media, the study said.

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Pass it on: Doctors should consider asking kids about participation in the choking game, a dangerous activity that can result in death.