Young people’s engagement in dangerous behaviours

Heide Busse shares her impressions of the ‘dangerous games’ symposium in France.

In October 2014 I had the chance to give an oral presentation at a conference with the title ‘Dangerous games, violence and bullying in a school setting and outside of school: knowing, understanding, preventing’, which took place in Paris, France. This conference was organised by APEAS (Association de Parents d’Enfants Accidentés par Strangulation), a French association for parents who have lost their children to strangulation activities. Such activities include self-asphyxial risk-taking behaviour (SAB), defined as ‘self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia’ and also known as the ‘choking game’ in the UK. APEAS aims to warn, prevent, train and also conduct research about dangerous games played by young people and has been active in doing so for over 10 years.

Unlike the first APEAS conference in December 2009, which focussed solely on SAB, the 2014 conference also included other dangerous or risky behaviours such as bullying and violence, aggression games, and challenge games (dares). Throughout the conference it became clear that these risk behaviours have certain factors in common, are interlinked, and might potentially benefit from the same type of intervention/prevention approaches and strategies.

Different to standard academics-only conferences, the 350 delegates came from a variety of backgrounds. These included representatives from the public and education sector (government, schools and police), international academics, practitioners (paediatricians, nurses, A&E staff), lawyers, and active campaigners on these issues. I was looking forward to presenting my work, engaging with others about these issues, and learning more about the preventative approaches taken in other countries.

dangerous games conference materials

Returning from the conference with a bag full of impressions, materials and food for thought.


Day 1: Knowing and understanding

The first day began with a speech by the representative for the Minister of Social Affairs, Health and Women’s Rights, who highlighted that dangerous games in schools in France are common and that these behaviours are a major public health concern. It was emphasised that individuals and professionals at all levels and in all areas, particularly in schools, will need to work together in prevention and intervention. Efforts are currently being undertaken to set up a national school health curriculum in France.

The morning then focussed on the current state of knowledge about dangerous behaviours in young people. As part of this, Jean Lavaud, President of the French National Committee for Children and coordinator of the APEAS scientific council, referred to findings from a representative survey carried out in France in 2011. This revealed that about 10% of young people reported engaging in self-aspyxial risk-taking behaviour, with the majority not being aware of the potentially fatal outcomes of this behaviour.

After a break for lunch and a press conference with French TV stations and radio reporters, the conference continued with sessions on understanding risk and protective factors for dangerous behaviours. The focus was on bullying, which the latest UNICEF report found was very common in a variety of countries. I found out that a law was passed in 2013 in France which makes it mandatory for all schools to put in place bullying prevention strategies and measures. Presenters also spoke about the dangers of cyberbullying, referring to a recent survey in which 40% of middle school students said they had been a victim of cyberbullying. Eric Debarbieux, a French ministerial delegate in charge of school violence prevention, pointed out that helping to prevent bullying may also act to prevent SAB, as children who are bullied are more likely to also engage in SAB. This highlights how violent and dangerous behaviours are linked to one another and reminded me of recently published research led by DECIPHer colleague Adam Fletcher, which found that aggressive behaviours in school were linked to cyberbullying other children.

Throughout the first day, speakers often referred to the fact that our understanding and knowledge of the dangerous behaviours such as SAB is based on the cases that we know about, but that these are likely to represent only the “tip of the iceberg”. Due to underreporting of engagement in these behaviours, a lack of awareness among professionals, and a lack of data on injuries and accidents related to dangerous behaviours, there are likely to be many more cases.


Our knowledge on dangerous behaviours is often based on what is visible and reported, but there are likely to be many more hidden cases.


Day 2: International prevention/intervention efforts

The second day focussed on approaches to prevent or tackle dangerous and violent behaviours. It was proposed that awareness raising should not just include young people, parents and school staff members (such as school nurses) but should also include individuals from other professions (such as medicine and police).

Thomas Andrew, the Chief Medical Examiner of New Hampshire, talked about the Child Fatality Review process that takes place in the US (as it does in the UK but not in France). This involves a multi-disciplinary team reviewing each death of a child, to identify strategies that could be put into place to prevent future deaths. This review process has led to 48,000 recommendations and 11,000 specific interventions in the US. The necessity for thorough reviews of child deaths was highlighted by a detective from the US who shared his story of how he re-classified a cause of death of a child.

Professor Andrew Macnab, a Canadian paediatrician and epidemiologist, then went on to present on the World Health Organisation’s ‘Health Promoting Schools‘ framework (explained by DECIPHer’s Beki Langford in a previous blog). Professor Macnab discussed the potential of using this approach in targeting risk behaviours by not only providing knowledge to children, but looking at the wider school environment and involving parents and the community.

Prof. Andrew Macnab presenting on the prevention opportunities of the WHO “Health Promoting School” framework.

Prof. Andrew Macnab presenting on the prevention opportunities of the WHO ‘Health Promoting Schools’ framework.

I then shared the initial findings of the systematic review that I am currently undertaking with colleagues on the prevalence and awareness of self-asphyxial risk-taking behaviour in young people. My presentation stressed the need for more thorough research on these behaviours, both to increase our knowledge about the outcomes of such behaviours and to evaluate the effectiveness of current prevention approaches.

The rest of the second day was devoted to the discussion of intervention strategies for reducing SAB, drawing on lessons from prevention efforts from around the world. Key questions arose relating to the best settings and approaches for such strategies, such as whether to focus on parents or peers in prevention, whether or not to include vivid materials, and how individuals should be best approached and educated on this behaviour. South African campaigner Gavin Cocks, founder of the organisation Games Adolescents Shouldn’t Play (G.A.S.P.), explained that whereas he focuses on the consequences of engaging in SAB when going into schools and talking to adolescents, he concentrates more on the symptoms and signs when talking to parents. American and Canadian delegates from the organisation Erik’s Cause presented their educational approach and manual for students and parents. This both teaches students self-confidence skills, and discusses the oxygen pathway and the physiological processes that are interrupted by SAB, which is why this behaviour is so dangerous.


French prevention material on the oxygen pathway within the human body.

French prevention material on the oxygen pathway within the human body.

In summary, the conference highlighted the great need for more research into ‘dangerous games’ and the effectiveness of current preventative approaches, to find out what works, for whom, why, and whether findings can be transferred to other settings and countries.

Learning more about this area and reflecting on the range of individuals affected made me realise how important it is to involve the public and other sectors in discussions and learning about topics of shared interest and to work collaboratively not only across disciplines, but also across sectors, regions and countries to build on the existing knowledge and best practices.


About the author: Heide Busse is a Research Assistant in Public Health at DECIPHer, based at the University of Bristol. 

Image of iceberg: NOAA’s National Ocean Service, via All other images are taken by the author.

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