The choking game has been America's deadly secret gasping for official attention.
And now it has it.
With deaths on the rise in recent years, the U.S. Centers for Disease Control and Prevention has issued its first study on the choking game, along with warnings.
At least 82 youths have died playing the choking game since 1995. The game involves self-strangulation or strangulation by another person to achieve a brief euphoric state caused when blood rushes into an oxygen-depleted brain. It's also known as the pass-out game, blackout game, scarf game and space monkey, among other names.
Of those 82 documented choking game deaths, 66 occurred in the past three years, with 22 in 2005 and a peak of 35 in 2006. Last year the incidences dropped to nine.
Most deaths occurred in boys 11 to 16 years old, with an average age of 13, the CDC reported.
The CDC said its totals may be understated.
Under the guidance of Mark Lepore, Chatham University assistant professor of counseling psychology, a team of graduate students has done extensive research on the game and gives 15 to 20 presentations a year to scare the choking game out of the shadows.
While praising the CDC effort, Dr. Lepore said it grossly underestimates the size of the problem.
He said his students have documented more than 300 deaths from experimental asphyxiation since 1998.
"I can say unabashedly that there could be 1,000 or more," he said.
The decline in deaths last year could reflect growing awareness of the problem, he said, noting that the CDC sought his advice in preparing its study.
Awareness often comes only after a death occurs. That happened in early 2006, when an eighth-grade boy in Jefferson Middle School in Mt. Lebanon died. It was believed to be the first documented choking game case in Allegheny County.
In an editorial note, the CDC said its report marks a first attempt to assess the national death rate from the choking game. Youngsters have played asphyxial games for generations, it said, but the trend has turned ever more deadly with adolescents doing it alone.
What often starts as a social activity can prompt adolescents to try it alone, Dr. Lepore said. Of 70 deaths for which sufficient details were reported, 67 occurred while the child was alone, the CDC report states.
The CDC advocates that medical examiners and coroners work to distinguish choking game deaths from accidents and suicides.
It also recommends more research to gauge prevalence and risk factors and help spawn interventions to prevent participation, chronic brain damage and deaths.
David Templeton can be reached at firstname.lastname@example.org or 412-263-1578.