At least 82 youths have died playing “the choking game” since 1995, the U.S. Centers for Disease Control and Prevention revealed in its first study on this game.

The game involves self-strangulation or strangulation by another to achieve a brief euphoric state caused when blood rushes into an oxygen-depleted brain. Other names that the game goes by includes “space monkey,” “the scarf game” and “the pass-out or blackout game.”

“The choking game involves intentionally trying to choke oneself or someone else with one’s hand or a noose to attain a brief euphoric state or high. If the strangulation is prolonged, which is something that can happen very quickly, death or a serious injury can result,” explains Robin Toblin, PhD, MPH, of the CDC’s National Center for Injury Prevention and Control.

The CDC started the study after receiving a letter last year from a doctor in Tacoma, Washington, who said her 13-year old son died from playing the game in 2005. She found him in the corner of his bedroom with a belt around his neck and the first thought was that he had committed suicide. Later she learned that he had talked to a friend about the choking game.

The CDC found 82 media reports of choking-game deaths in the U.S. from 1995 to 2007. The kids who died were 13 years old, on average, and 87 percent were boys. The CDC did not include deaths in which it was unclear if the death was from the choking game or if it was a suicide. Nearly none of their parents was aware of the choking game before their child died.

Three of fewer deaths were reported from 1995 through 2004. They increased to 22 in 2005, 35 in 2006, and at least 9 in 2007. Investigators are not sure what drove the increase in recent years.

However, the number of choking-game fatalities is probably underreported and there is no way to get an accurate national total since they are not regularly reported to the government or listed on death certificates, Toblin said.

Similar games have been probably been played for generation, Toblin said. “What is new is that youth are playing alone and using ligatures which are risk factors that make them more likely to die from this activity.”

The CDC urges parents, teachers, and health care workers to learn the possible warning signs of the choking game. Sings include discussion of the game, bloodshot eyes, marks eyes, marks of the neck, severe headaches, disorientation after spending time alone, ropes, scarves, and belts tied to bedroom furniture or doorknobs of found knotted on the floor, and the unexplained presence of dog leashes, choke collars, and bungee cords.

“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. This is especially important because children themselves may not appreciate the dangers of this activity,” said Toblin.

The findings appear in the February 15 edition of the CDC’s Morbidity and Mortality Weekly Report.