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Teenagers who play a risky activity called the “choking game” to get high are more likely to engage in other kinds of high-risk behavior, such as drug abuse and sex, than their peers who do not play the game, a new study suggests.

An estimated 5 percent to 11 percent of teens have tried the choking game, the Los Angeles Times reports. Teens who play the game either choke each other, or use a noose to choke themselves. After a short time, they can pass out, which may lead to serious injury or even death from hanging or strangulation, according to the Centers for Disease Control and Prevention (CDC), which conducted the study.

The CDC reports at least 82 children between the ages of 6 and 19 are known to have died from the choking game. Because there is no reliable system for counting these deaths, the real number is likely higher.

The study, published in Pediatrics, found teens who played the choking game were more likely than those who did not to use drugs, to be sexually active, have poor mental health, and to have been exposed to violence. They also were more likely to be involved in gambling and to have poor nutrition.

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