title: The choking game: physician perspectives.
abstract: OBJECTIVE
  The goal was to assess awareness of the choking game among physicians who care for adolescents and to explore their opinions regarding its inclusion in anticipatory guidance.
  
  
  METHODS
  We surveyed 865 pediatricians and family practitioners. The survey was designed to assess physicians' awareness of the choking game and its warning signs, the suspected prevalence of patients' participation in the activity, and the willingness of physicians to include the choking game in adolescent anticipatory guidance. Information on the general use of anticipatory guidance also was collected.
  
  
  RESULTS
  The survey was completed by 163 physicians (response rate: 21.8%). One-hundred eleven (68.1%) had heard of the choking game, 68 of them (61.3%) through sources in the popular media. General pediatricians were significantly more likely to report being aware of the choking game than were family practitioners or pediatric subspecialists (P = .004). Of physicians who were aware of the choking game, 75.7% identified >or=1 warning sign and 52.3% identified >or=3. Only 7.6% of physicians who were aware of the choking game reported that they cared for a patient they suspected was participating in the activity, and 2 (1.9%) reported that they include the choking game in anticipatory guidance for adolescents. However, 64.9% of all respondents agreed that the choking game should be included in anticipatory guidance.
  
  
  CONCLUSIONS
  Close to one third of physicians surveyed were unaware of the choking game, a potentially life-threatening activity practiced by adolescents. Despite acknowledging that the choking game should be included in adolescent anticipatory guidance, few physicians reported actually discussing it. To provide better care for their adolescent patients, pediatricians and family practitioners should be knowledgeable about risky behaviors encountered by their patients, including the choking game, and provide timely guidance about its dangers.
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA. julie.mcclave@uhhospitals.org
authors.forename: Julie L
authors.initials: JL
authors.lastname: McClave
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Russell
authors.forename: Anne
authors.initials: A
authors.lastname: Lyren
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Riordan
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Bass
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000523:psychology*; D001291:Attitude of Health Personnel; D016001:Confidence Intervals; D003376:Counseling; D005194:Family Practice / Q000592:standards / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000592:standards / Q000639:trends; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011336:Probability; D012309:Risk-Taking; D014481:United States