A population-level metric for gambling-related harm

Prior estimates of the population-level impact of gambling have relied on economic costings. Recent work has derived disability weights for the Problem Gambling Severity Index, which measure per-person impact of gambling on quality of life on a scale of zero to one. This provided scope for the present study to calculate the ‘burden of gambling harm’, which captures the aggregate impact of harms arising from gambling on quality of life in a population. Gambling-related harm was associated with 101,675 years of life lost in Victoria, Australia: approximately two-thirds that of alcohol use and dependence, and major depressive disorder. Problem gamblers suffer more individually (disability weight = .44) compared to those in moderate (.29) and low (.13) risk categories. Nevertheless, moderate and low-risk gamblers account for 85% of population-level harm, due to greater prevalence of these groups. Overall, the scale of gambling-related harm is large relative to other significant health issues, with milder yet non-negligible harm accruing to a relatively broad segment of the gambling population. The article suggests that the tendency to conflate the (typically low) prevalence of problem gambling with total gambling impact is misleading, and argues for a broader population-health based measure.     

Validation of the Short Gambling Harm Screen (SGHS): A Tool for Assessment of Harms from Gambling

It is common for jurisdictions tasked with minimising gambling-related harm to conduct problem gambling prevalence studies for the purpose of monitoring the impact of gambling on the community. However, given that both public health theory and empirical findings suggest that harms can occur without individuals satisfying clinical criteria of addiction, there is a recognized conceptual disconnect between the prevalence of clinical problem gamblers, and aggregate harm to the community. Starting with an initial item pool of 72 specific harms caused by problematic gambling, our aim was to develop a short gambling harms scale (SGHS) to screen for the presence and degree of harm caused by gambling. An Internet panel of 1524 individuals who had gambled in the last year completed a 72-item checklist, along with the Personal Wellbeing Index, the PGSI, and other measures. We selected 10 items for the SGHS, with the goals of maximising sensitivity and construct coverage. Psychometric analysis suggests very strong reliability, homogeneity and unidimensionality. Non-zero responses on the SGHS were associated with a large decrease in personal wellbeing, with wellbeing decreasing linearly with the number of harms indicated. We conclude that weighted SGHS scores can be aggregated at the population level to yield a sensitive and valid measure of gambling harm.     

Defining a threshold of harm from gambling for population health surveillance research

The measurement of harm in the context of non-problem gambling has received little attention from researchers in the field. Using the combined data from six provincial gambling surveys conducted in Canada between 2001 and 2005 (N = 12,285), we compared how different thresholds of defining gambling-related harm impacts prevalence, the relationship with indicators of gambling intensity and the characteristics of non-pathological gamblers who report experiencing below threshold symptoms of problem gambling. Survey items defining harm were drawn from the Problem Gambling Severity Index (PGSI) of the Canadian Problem Gambling Index. Three definitions of harm – reporting one or more problem gambling symptoms, reporting two or more problem gambling symptoms and having a PGSI score ≥ 3 – demonstrated a strong relationship with indicators of gambling intensity, and reliably differentiated low-threshold and zero symptom problem gamblers in terms of gambling characteristics and other risk factors.     

Chinese Beliefs in Luck are Linked to Gambling Problems via Strengthened Cognitive Biases: A Mediation Test

Problematic patterns of gambling and their harms are known to have culturally specific expressions. For ethnic Chinese people, patterns of superstitious belief in this community appear to be linked to the elevated rates of gambling-related harms; however, little is known about the mediating psychological mechanisms. To address this issue, we surveyed 333 Chinese gamblers residing internationally and used a mediation analysis to explore how gambling-related cognitive biases, gambling frequency and variety of gambling forms (‘scope’) mediate the association between beliefs in luck and gambling problems. We found that cognitive biases and scope were significant mediators of this link but that the former is a stronger mediator than the latter. The mediating erroneous beliefs were not specific to any particular type of cognitive bias. These results suggest that Chinese beliefs in luck are expressed as gambling cognitive biases that increase the likelihood of gambling problems, and that biases that promote gambling (and its harms) are best understood within their socio-cultural context.     

Analysis of EGM licensing decisions by the gambling regulator,Victoria, Australia

Gambling expansion is commonly justified in public discourse by claims of community benefit, increased employment and capital investment. Compared to other jurisdictions, the Electronic Gambling Machine (EGM) license process in Victoria, Australia, is relatively transparent and amenable to analysis. This article describes research that assessed factors relevant to EGM license decisions made by Victoria’s gambling regulator between 2007 and 2014. During the period under review, the regulator granted 144 of 154 applications, finding that approving these applications would not be detrimental to relevant communities. Most commonly cited factors supporting approvals were commitments to undertake capital works, contribute to community purposes and increase employment. The regulator overwhelmingly agreed that supportive factors would balance harms, such as problem gambling, high levels of expenditure or socio-economic disadvantage. This research demonstrates the difficulty of balancing apparently quantifiable benefits against less readily measurable gambling-related harms in regulatory decision-making. The study found that harms were poorly conceived and understood inadequately and supportive factors frequently overstated. This process may lead to unnecessarily high levels of community harm, contradicting the purposes of the relevant legislation. The article suggests that better, more consistently applied principles are required to ensure the more rigorous scrutiny of supportive factors and improved understanding of gambling harms.     

A Science-Based Framework for Responsible Gambling: The Reno Model

As social observers increasingly identify gambling-related problems as a public health issue, key stakeholders need to join together to reduce both the incidence and prevalence of gambling-related harm in the community. This position paper describes a strategic framework that sets out principles to guide industry operators, health service and other welfare providers, interested community groups, consumers and governments and their related agencies in the adoption and implementation of responsible gambling and harm minimization initiatives.     

Gambling-Related Harms Among Adolescents: A Population-Based Study

Internationally, and also in Europe, adolescent gambling is increasingly recognized as an important public health issue. Most research on adolescent gambling, however, is prevalence-focused and population-based studies are scarce. Few studies have examined gambling-related harms among adolescents. In a national sample, we examined self-experienced harms related to gambling and the relationship between reported harms and gambling behavior among Finnish adolescents. A national survey of 12–18-year-olds was conducted in Finland in 2011 (N = 4,566). Main measures were frequency of gambling and gambling-related harms reported during the past 6 months. The relationship between reported harms and gambling behavior was assessed using logistic regression analysis. Overall, 44% had gambled during the past 6 months. Of the sample, 12% were frequent gamblers (at least weekly) and 32% were occasional gamblers (monthly or less often). Compared to occasional gamblers, frequent gamblers were more likely to experience harms. The most commonly reported harms among frequent gamblers were “felt guilty or shameful due to gambling” (17%) followed by “problems with relationships” (13%) and “disruptions of daily rhythm” (10%). In age and gender-adjusted analysis, daily gamblers were significantly more likely to report all different types of harms when compared to other groups. These findings suggest that when planning and targeting youth gambling prevention and harm reduction strategies the nature and extent to which gambling may contribute to the different types of harms are important to consider.     

Association between gambling harms and game types: Finnish population study

Understanding of the harmfulness of game types is needed when planning harm minimization and prevention strategies. Adult data (N = 3555) from the Finnish Gambling 2015 survey was used to investigate the associations between different game types and gambling-related harms. A negative binomial regression model was used to analyse the effects of demographics, gambling involvement factors, and engaging in different game types on the number of gambling-related harms, which were evaluated by PGSI and SOGS. Age of 18–24, gambling several times a week, high relative expenditure, online gambling and engaging weekly either in scratch games, betting games or slot machine gambling were associated with a higher number of gambling harms. Chasing losses was the most typical harm among online poker players and fast-paced daily lottery game players, while poor self-control was the most typical harm with other game types, although some of the results were not statistically significant. Multiple factors were associated with gambling harms, including young age and gambling intensity. Games that provide a possibility for high-frequency gambling are more linked to harms. Recommendations should be implemented to incorporate effective harm-minimizing strategies in the regulation of specific game types both at the legislative level (provision and supply) and at the public health level.     

Adaptation and validation of the Gambling Motives Questionnaire-Financial (GMQ-F) in a sample of French-speaking gamblers

Previous research has identified specific gambling motives and linked them with both healthy and disordered gambling. The Gambling Motives Questionnaire (GMQ) is currently the most widely used measure for these motives. The present study aimed to offer a French validation of the latest version of this scale, the GMQ-Financial (GMQ-F), which measures four distinct motives (enhancement, social, coping, financial). The French GMQ-F was completed by 278 gamblers from the community and 22 treatment-seeking pathological gamblers, along with scales assessing gambling cognitions, impulsivity, disordered gambling symptoms and psychopathological symptoms. Confirmatory factor analysis supported the expected four-factor model. The GMQ-F subscales have good internal reliability. Validity of the GMQ-F is supported by specific correlations with the other constructs measured. Pathological gamblers differed from gamblers from the community on all but one (social) of the GMQ-F subscales. The French GMQ-F presents good psychometric properties and constitutes a reliable instrument for measuring gambling motives in research and clinical practice.     

Measuring Self-efficacy in Gambling: The Gambling Refusal Self-Efficacy Questionnaire

This paper reports on the development and psychometric properties of a Gambling Refusal Self-Efficacy Questionnaire (GRSEQ). Two hundred and ninety-seven gamblers from both normal and clinical populations completed an initial set of 31-items of which 26 were selected for inclusion in the final version of the GRSEQ. A series of factor analyses showed four clear factors accounting for 84% of the variance. These factors can be summarised as situations and thoughts associated with gambling, the influence of drugs on gambling, positive emotions associated with gambling and negative emotions associated with gambling. The GRSEQ total score and factors scores showed high internal consistency (Cronbach’s alpha ranging from 0.92 to 0.98). Participants experiencing problems with gambling scored significantly lower on the GRSEQ, and discriminant analyses showed that the scale is able to correctly classify the non-problem (i.e., community and student samples) and problem gamblers (i.e., clinical sample). Furthermore, the GRSEQ showed significant negative relationships with other gambling-related variables (gambling urge and gambling-related cognitions) and negative mood states (depression, anxiety and stress) and was shown to be sensitive to change in treatment of pathological gambling. The results suggest that the GRSEQ is a useful measure of gambling refusal self-efficacy that is suitable for assessment of gamblers from both normal and clinical populations.     

Understanding end-user perspectives to enhance perceived value uptake of harm-minimization tools: considering gambler’s views of a pre-commitment system

Harm-minimization strategies reduce the experience of gambling-related harms for individuals and those close to them. Most policies and particularly discussions of tool design and implementation fail to involve end users and consider their concerns and needs. This study aimed to investigate the best way to introduce a harm-minimization tool for electronic gaming machines (EGMs) that will maximize the perceived value and subsequent uptake by the intended audience of gamblers. Focus groups were conducted with 31 Australian regular EGM gamblers experiencing a range of gambling problems. Participants were asked their perspectives of a pre-commitment system (features including accessing activity statements, setting limits, viewing dynamic messages, taking breaks), including concerns, and how to enhance perceived value and usefulness. Positive attitudes about the system were expressed; however, many gamblers saw the tool as relevant only for problem gamblers. Participants indicated that value could be enhanced by making the system flexible and customizable, but still easy to use. Design and implementation strategies such as incorporating flexibility in features, ease of use, appropriate terminology, and educational efforts may address gamblers’ concerns, particularly regarding privacy and potential stigma. This would enhance user perception of harm-minimization tools as relevant and may subsequently enhance effectiveness.     

Impulsivity and predictive control are associated with suboptimal action-selection and action-value learning in regular gamblers

Heightened impulsivity and cognitive biases are risk factors for gambling problems. However, little is known about precisely how these factors increase the risks of gambling-related harm in vulnerable individuals. Here, we modelled the behaviour of 87 community-recruited regular, but not clinically problematic, gamblers during a binary-choice reinforcement-learning game, to characterize the relationships between impulsivity, cognitive biases and the capacity to make optimal action selections and learn about action-values. Impulsive gamblers showed diminished use of an optimal (Bayesian-derived) probability estimate when selecting between candidate actions, and showed slower learning rates and enhanced non-linear probability weighting while learning action values. Critically, gamblers who believed that it is possible to predict winning outcomes (as ‘predictive control’) failed to use the game's reinforcement history to guide their action selections. Extensive evidence attests to the ease with which gamblers can erroneously perceive structure in the reinforcement history of games when there is none. Our findings demonstrate that the generic and specific risk factors of impulsivity and cognitive biases can interfere with the capacity of some gamblers to utilize structure when it is available in the reinforcement history of games, potentially increasing their risks of sustaining gambling-related harms.     

Gambling-related embezzlement in the workplace: a qualitative study

People with severe gambling problems typically first spend all their available money on gambling and then resort to borrowing, selling personal property and other ways of procuring more money for gambling. Some problem gamblers commit economic crimes. This investigation examined gambling-related embezzlement in the workplace, an aspect of problem gambling that may severely harm the gambler, significant others and the employer. The methods used are the study of newspaper articles and qualitative interviews with 18 informants, including professionals in workplace security and drug-use prevention, therapists specializing in problem gambling treatment, counsellors from mutual support societies, and recovered problem gamblers who had embezzled. Gambling-related embezzlement often progresses in a characteristic sequence shaped by specific processes in which the gambler’s thoughts and emotions interact systemically with the monetary losses caused by participating in commercial gambling and the opportunity to embezzle money in the workplace. In this study, criminological theory of white collar crime usefully complemented psychological theories of problem gambling. It is concluded that a processual perspective, in addition to consideration of psychological and environmental factors, is valuable for understanding the progression to severe problem gambling.     

Household experience of gambling-related harm by socio-economic deprivation in New Zealand: increases in inequality between 2008 and 2012

Although problem gamblers make up a small proportion of the New Zealand population, those who are living in more deprived areas at higher risk of harm from their own or someone else's gambling. The global financial crisis in 2008 has been linked with changes in gambling behaviour and with increases in inequality between areas of relative deprivation. Nationally representative datasets from in-home face-to-face health surveys in 2008, 2010 and 2012 were analysed to investigate changes in gambling behaviour, experiences of household-level harm related to gambling, and the association with economic deprivation. Although overall gambling participation had dropped, the experience of gambling harm at the household level was significantly higher in 2012 compared with 2008 and 2010. The increase in harm was experienced disproportionately by those in more deprived areas, who were 4.5 times as likely to experience gambling-related arguments or money problems. We consider possible explanations including more harmful gambling behaviour as a response to financial stresses, decreasing household resilience to financial stresses, and the concentration of more harmful forms of gambling product in more deprived areas. Causes of gambling harm in deprived communities, and the vulnerability of households in these communities, should be addressed if inequalities are to be reduced.     

Reduced inhibitory control predicts persistence in laboratory slot machine gambling

Impairments in inhibitory control characterize a range of addictive behaviours including gambling disorder. This study investigated the relationship between a neuropsychological measure of inhibitory control and behaviour on a simulated slot machine that included a measure of gambling persistence, in a non-clinical sample of regular gamblers. Regular gamblers (n = 75) performed a laboratory slot machine task for 30 trials where they could win real money, followed by a persistence phase under extinction (i.e. without wins). Participants also completed a stop-signal task, along with measures of gambling-related cognitions, social desirability, and symptoms of disordered gambling. In hierarchical regression models, reduced inhibitory control was found to predict greater persistence and a higher subjective desire to play again after both wins and near-misses (i.e. unsuccessful outcomes close to the jackpot). These data illustrate the impact of low inhibitory control on relevant behavioural tendencies in a group of regular gamblers. Our results help elucidate a cognitive process that may contribute to problem gambling, with implications for screening and treatment.     

Gambling and Problem Gambling Among Recently Sentenced Women in New Zealand Prisons

Ninety-four recently sentenced women prisoners were interviewed to assess aspects of their gambling involvement, problem gambling and relationships between gambling and criminal offending. A third of the women, on the basis of their SOGS-R scores, were assessed as lifetime probable pathological gamblers and just under a quarter were assessed as probable pathological gamblers during the 6 months prior to imprisonment. For women prisoners, a preference for non-casino gaming machines and housie were predictive of problem gambling. Relative to non-problem gamblers, problem gamblers experienced higher rates of childhood conduct disorder and current non-psychotic mental disorder. Just over a quarter of prisoners and a half of the problem gamblers had committed a crime to obtain money to gamble. Few women said their early offending or convictions related to gambling. It was concluded that most women were “criminals first and problem gamblers second” rather than people whose offending careers commenced as a consequence of problem gambling. However, the extent of problem gambling-related offending among the women prisoners highlights the potential for comprehensive assessment and treatment programs in prison to reduce recidivism and other adverse impacts of problem gambling and gambling-related offending.     

Gambling and Problem Gambling among Recently Sentenced Male Prisoners in Four New Zealand Prisons

Recently sentenced inmates in four New Zealand male prisons (N = 357) were interviewed to assess their gambling involvement, problem gambling and criminal offending. Frequent participation in and high expenditure on continuous forms of gambling prior to imprisonment were reported. Nineteen percent said they had been in prison for a gambling-related offence and most of this offending was property-related and non-violent. On the basis of their SOGS-R scores, 21% were lifetime probable pathological gamblers and 16% were probable pathological gamblers during the six months prior to imprisonment. Of the “current” problem gamblers, 51% reported gambling-related offending and 35% had been imprisoned for a crime of this type. Gambling-related offending increased with problem gambling severity. However, only five percent of problem gamblers said their early offending was gambling-related. The large majority reported other types of offending at this time. Few men had sought or received help for gambling problems prior to imprisonment or during their present incarceration. This highlights the potential for assessment and treatment programs in prison to reduce recidivism and adverse effects of problem gambling and gambling-related offending.     

Gender Differences in Characteristics of Chinese Treatment-Seeking Problem Gamblers

A total of 952 (841 men and 111 women) Chinese treatment-seeking problem gamblers completed self-report assessment forms. Female in contrast to male gamblers were more likely to be older, married, less educated, and without employment. Female gamblers also started gambling at an older age, had a shorter gambling history, preferred casino and mahjong gambling, and reported more somatic complaints and suicidal thoughts. Male and female gamblers accumulated similar amount of gambling debt and reported an average of 12 gambling-related problems on the Chinese version of the South Oaks Gambling Screen [Lesieur and Blume (Am J Psychiatry 144:1184–1188, 1987)]. Both groups were similarly troubled by their indebtedness, inability to control gambling, and gambling-related interpersonal problems. However, female gamblers had fewer means to pay their gambling debt. Given that significant gender-related differences were observed in Chinese problem gamblers, prevention and treatment services should attend to specific needs of male and female gamblers.     

The Gambling Motives Questionnaire financial: factor structure,measurement invariance,and relationships with gambling behaviour

Items assessing financial motives were recently integrated with the Gambling Motives Questionnaire (GMQ), resulting in a revised measure that assesses coping, enhancement, social and financial motives for gambling (GMQ-F). The aim of this research was to test the proposed four-factor structure of the GMQ-F, determine if GMQ-F responses were invariant across sex, and test a structural model that specifies links between motives, gambling frequency and problem gambling severity. Telephone surveys were conducted with 932 adult gamblers from across Manitoba, Canada, who responded to items from the GMQ-F and reported their frequency of gambling and levels of problem gambling severity. Confirmatory factor analysis yielded strong support for the four-factor structure of GMQ-F scores, and invariance testing provided evidence of measurement invariance across sex. Finally, support was found for the hypothesized structural model in which each gambling motive predicted gambling frequency, which in turn predicted problem gambling severity. Coping motives also directly predicted problem gambling severity. These results provide strong evidence in support of the validity of GMQ-F responses, offer further support for the integration of financial motives with the GMQ, and delineate relationships between gambling motives, gambling frequency and gambling-related harm.     

Gambling Participation and Problems Among Employees at a University Health Center

This study evaluated the frequency and intensity of gambling behaviors among employees at an academic health center. Employees were sent an anonymous questionnaire assessing demographic characteristics, participation in gambling activities, and gambling-related problems. Of the 904 respondents, 96% reported gambling in their lifetimes, with 69% gambling in the past year, 40% in the past two months, and 21% in the past week. The most common forms of gambling were lottery and scratch tickets, slot machines, card playing, sports betting, bingo, and track. Only 1.2% of the sample reported gambling on the internet. Using scores on the South Oaks Gambling Screen, 3.0% of the respondents were classified as Level 2 (or problem) gamblers, and an additional 1.8% were Level 3 (or pathological) gamblers. Compared to Level 1 (non-problem) gamblers, Level 2 and Level 3 gamblers were more likely to be male, single, and employed full-time, and to have lower income and education. About half of the Level 2 and Level 3 gamblers reported interest in an evaluation of their gambling behaviors and treatment interventions. These data suggest the need to screen for gambling problems in health care professionals and to provide gambling-specific treatments.