Problem gambling and policy advice: The mutability and relative effects of structural,associational and attitudinal variables

Research on gambling has the double mandate of public service and the advancement of science. This paper is meant to carry forward that mandate. Latent in research on the causes of problem gambling is the policy insight that these causes represent different types of phenomena and are unequally mutable to practitioners' efforts to prevent and/or treat problem gambling. By making the issue of mutability manifest in research, findings from research would have more policy relevance and practical import. Data from a 1989 Iowa survey on lottery play and problem gambling are analyzed to illustrate this point. 1,226 respondents were contacted by phone and phone interviews were completed with 1,011 of these 1,226 eligible respondents. With multiple regression, we assessed the contributions of mutable and immutable variables to the explained variance in problem gambling. The results show mutable correlates explain enough variance in problem gambling to recommend their consideration in treatment/prevention. The results also suggest a social as well as a psychological etiology to problem gambling. Future research should, however, do a more complete comparison of social and psychological causes of problem gambling.This research was partially supported by the Iowa Department of Human Services and the National Institute of Mental Health (1 R01 MH50369-01A1). The authors wish to thank Willis Goudy, anonymous readers and the editor of this journal for helpful comments.     

A review of two measures of pathological gambling in the United States

This paper addresses a debate that has emerged in the field of pathological gambling research. This debate concerns measurement of the prevalence of pathological gambling in the general population. Two instruments have been used to measure prevalence in the United States, the South Oaks Gambling Screen and the Cumulative Clinical Signs Method. These instruments are described and several problems with the statistical properties of the Cumulative Clinical Signs Method are discussed. The authors conclude with a call for continued research in the area of prevalence studies of pathological gambling.This research was partly funded by the Antisocial and Violent Behavior Branch of the National Institute of Mental Health (MH-44295).The authors would like to acknowledge the contribution of Henry J. Steadman, Ph.D. to the initial formulation of the ideas presented here.     

“Minnesota slots”: An observational study of pull tab gambling

A study of pull tab gambling in Minnesota was undertaken to describe the state's most popular form of gambling. The study also focused on the detection of any abuses or addictive problems that might be associated with it. Pull tab gambling is similar to slot machine gambling. The game, fundamentals of play, and some of the behaviors of pull tab gamblers are described. Various playing patterns and strategies, pull tab etiquette, the numbers and types of players, amounts of money bet, player's wins and losses, house profits, gambling abuses, behaviors which may indicate problem gambling, and dealer/player relationships are discussed. The study concludes with suggestions to help minimize some of the actual and potential problems and abuses that accompany pull tab gambling.This study was supported by funding from the Minnesota Department of Human Services, Mental Health Division. The information presented here is based on a report (Schaefer & Aasved, 1990) submitted to that agency.The authors would like to thank Drs. Sue Fisher and Mark Griffiths for their helpful suggestions and comments on an earlier draft of this paper.     

Gender,gambling and problem gambling

With data from a 1989 Iowa survey (N=1,011), adult male and female respondents are compared on their problem gambling, its correlates, as well as their gambling behavior. Gambling behavior means its scope, frequency, wagering and leisure time spent at gambling. Women's gambling behavior was lower than that of men, due to their having a narrower scope of gambling behavior, but the genders were not significantly different on frequency, wagering and time spent at gambling. Women and men did not differ significantly on problem gambling. Problem gambling is measured as loss of control over gambling, and consequences due to gambling as well as gambling behavior. Women and men did differ significantly, however, on several predictors of problem gambling. Women's estrangement from a conventional lifestyle and integration into a social world of gambling appeared to help explain their problem gambling. Alcohol consumption appeared to be a more important predictor for men than women. The genders shared the attitude that the odds can be beat as well as being big spenders as predictors of their problem gambling. The results are interpreted with practitioners' efforts to prevent and treat problem gambling in mind.This research was partially supported by the Iowa Department of Human Services and the Na tional Institute of Mental Health (1 RJ01 MH50369-01A1). The authors are grateful to anonymous re viewers and the editor of this journal for many helpful suggestions.     

Sexual standards and activity: Adolescents' perceptions

This paper reports on findings from in-depth interviews with a small sample of white and black teenage mothers from diverse socio-economic backgrounds about their sexual standards and their feelings about their sexual initiation and subsequent sexual activity. The comparisons across race and across class suggest that there are significant differences across classes among black teens in standards about and personal evaluation of their sexual activity while no class difference among white teens are evident.This research was partially supported by a National Research Service Award from the National Institute of Mental Health, Department of Health and Human Services, grant no. 1-F31-MH09368-O1A1 from July 1986 to July 1987.     

Lottery play and problem gambling

This study sought to determine if lottery play along with other possible causes engenders problem gambling. Problem gambling was defined as a progression and measured by three scales: Gambling behavior, loss of control over gambling and gambling consequences. Possible causes of problem gambling included lottery play, personality traits, exposure to gambling, leisure pursuits, marital status, residence, and other background characteristics of respondents. Respondents are a stratified random sample of adult residents of Iowa contacted by telephone in May–June, 1989. It was found that lottery play is a predictor of gambling behavior, as well as loss of control and gambling consequences when previous stages of problem gambling were deleted from the analysis as predictor variables. Other predictors of the latter stages of problem gambling include its earlier stages, as well as personality traits and various background characteristics of respondents. The relevance of the findings for theory and future research on gambling are discussed.This research was partially supported by the Iowa Department of Human Services. We also wish to acknowledge the helpful comments of reviewers from this journal.     

Table of Contents

South Dakota Counselors Cry Foul in State ‘Takeover’ by Mental Health Common‐Sense Efforts Improve Access, Revenues at Maine Center South Dakota Stats MedMark Expansion Underscores Trend to For‐Profit OTPs Spirituality: The Other Elephant, in a Different Room Briefly Noted In the States Resources Coming up     

Gambling behaviors and perceived health among incarcerated older adults

The proliferation of lotteries and casinos has led to increased participation in gambling. Older adults who have opportunities to gamble may be vulnerable to gambling problems, and incarcerated older adults may be the most vulnerable. Furthermore, research has linked decreased health to gambling problems. This study compared perceived health and gambling problems among 43 incarcerated older adults from two county jails in the midwestern United States. Results from the South Oaks Gambling Screen indicated 48.83% of the sample scored in the problem or pathological range. Short Form-36 results were compared with U.S. norms for ages 55 to 64 and showed significantly lower perceived health scores on Role-Physical, Bodily Pain, Mental Health, Social Functioning, and Role-Emotional subscales. The problem and pathological gamblers showed significantly lower social functioning than the recreational gamblers. Assessment of health conditions and gambling behaviors is important for quantifying current and anticipated burdens of these conditions on correctional health care systems and the community.     

The prevalence of pathological gambling in Canada

This paper critically reviews prevalence estimates of problem and pathological gambling in Canada. Populations studied are adults, adolescents and primary school children. The proportions of pathological gamblers found in Canadian studies (ranging from 1.2% to 1.9% for adults) are similar to prevalence rates reported in the United States. Given the apparent link between gambling availability and increases in the prevalence of problem and pathological gambling, it is hoped that provincial and federal authorities in Canada will make investments in research and treatment of pathological gambling in the future.The author wishes to thank Mark Freeston for his helpful comments. Portions of this paper were written while the author had grants from Counseil de Recherche en Sciences Humaines du Canada (410-91-1514) and from Loto-Quebec.     

The New Zealand national survey of problem and pathological gambling

In New Zealand, awareness of gambling-related problems has increased in association with the legalization of new forms of gambling. This paper presents the methods and selected results from a national survey of gambling and problem gambling completed in New Zealand in 1991. While the primary aim of the study was to determine the extent of problem gambling in New Zealand, the study included a second phase intended to assess the validity and reliability of the widely-used South Oaks Gambling Screen as well as to examine other aspects of problematic involvement in gambling. The results of the two-phase study in New Zealand show that problem gamblers in different countries are remarkably similar in demographic terms as well as with regard to other risk factors associated with problematic gambling involvement. The New Zealand study of problem gambling points the way toward important research topics that will require further exploration in the future.This research was funded by the New Zealand Department of Internal Affairs and by the US National Institute of Mental Health (MH-44295).     

Toward the development of an adolescent gambling problem severity scale

The development and initial psychometric properties of an adolescent gambling problem severity measure are described. The scale, based on a revision of the South Oaks Gambling Screen (Lesieur & Blume, 1987), was administered to 1,101 older (ages 15 to 18) Minnesota adolescents as part of a state-wide gambling survey. Study results indicated that the scale had moderate internal consistency reliability and was significantly related to alternate measures of problem severity for male subjects. Because the rate and severity of gambling among females was very low, the psychometric adequacy of the scale for females is not known at this time. The implications of study findings to the conceptual understanding of adolescent gambling problem severity as well as study limitations and future research needs, are discussed.Support for the study was provided by the Minnesota Department of Human Services and the Center for Addiction Studies, University of Minnesota, Duluth. The authors gratefully acknowledge the assistance from Robert Blum, Linda Harris, Durand Jacobs, J. Laundergan, Alan Mathiason, Brenda Miller, James Schaefer, school officials from the participating high schools, and interviewers who assisted with the telephone survey.     

Juvenile Gambling in North America: An Analysis of Long Term Trends and Future Prospects

Long term trends, based on findings from twenty independent prevalence studies surveying middle and high school youth in North America, suggest that within the past year two out of three legally underage youth have gambled for money. In the United States and Canada as many as 15.3 million 12–17 year olds have been gambling with or without adult awareness or approval, and 2.2 million of these are experiencing serious gambling-related problems. Lottery play dominates legalized forms of gambling among juveniles in both the United States and Canada. Trends between 1984–1999 indicate a substantial increase in the proportion of juveniles who report gambling within the past year, and a parallel increase in the proportion of juveniles reporting serious gambling-related problems. Yet, there continues to be little public awareness or concern about the extent, or the potential hazards associated with juvenile gambling. A composite profile of juveniles reporting numerous gambling problems is contrasted with their peers who reported few or none. Future prospects concerning this growing problem are offered.     

Patterns and characteristics of adolescent gambling

Minnesota youth (15 to 18-years of age) were surveyed regarding their gambling experiences and psychosocial risk status. Gambling was reported by most of the subjects, with 8.7% classified as problem gamblers. Correlates of problem gambling included school difficulties, regular drug use, delinquency, parental gambling, and being male. Adolescent gambling is conceptualized as a normal experience of youth, yet those in the problem gambling group may be particularly vulnerable to future gambling problems.The authors would like to express their gratitude to the Minnesota Department of Human Services for their funding support of the study and to several colleagues, particularly Linda Harris, J. Clark Laundergan and Durand Jacobs, and anonymous reviewers for their helpful comments.     

Prevalence of Adult Problem and Pathological Gambling between 2000 and 2005: An Update

Background Excessive gambling is a prominent Public Health problem with high prevalence rates in many countries. Substance abuse and other co-morbidities often constitute a major health hazard for the person which gambles with a loss of material and social resources, as well as being a major concern for his or her significant others. The present study updates and extends prevalence data to include work published between 2000 and 2005 in English and other European languages. Methods In a three-step search and exclusion process, studies with current adult prevalence rates were gathered. Results Almost all studies fulfil basic research standards. The weighted mean prevalence rates for excessive gambling (problem and pathological) are 3.0% for the South Oaks Gambling Survey (problem 1.2%; pathological 1.8%), 3.3% for the Canadian Problem Gambling Index (problem 2.4%; pathological 0.8%) and 3.1% for the DSM-IV (problem 1.9%; pathological 1.2%). Conclusion The prevalence rates are comparable and relatively stable between countries and across survey instruments, and do not differ from earlier reviews. The regular epidemiological monitoring of excessive gambling remains a major Public Health issue although the distinction between pathological and problem gambling is not appropriate for epidemiological research. Further studies are needed with respect to concomitant lifestyle characteristics.     

Estimating the prevalence of adolescent gambling disorders: A quantitative synthesis and guide toward standard gambling nomenclature

This article reviews the extant published and unpublished studies that estimate the prevalence of adolescent gambling problems in North America. The nine nonduplicative studies identified by our literature search included data collected from more than 7700 adolescents from five different regions of the United States and Canada. In addition to comparing the conceptual and methodological differences that exist among these studies, this article employed a meta-analytic strategy to synthesize prevalence estimates from the existing studies. This analysis revealed that within a 95 percent confidence interval, between 9.9% and 14.2% of adolescents are at risk of developing or returning to serious gambling problems. Similarly, between 4.4% and 7.4% of adolescents exhibit seriously adverse compulsive or pathological patterns of gambling activity. Finally, the discussion proposes a generic multi-level classification scheme to reconcile the divergent classification methods and data reporting strategies. This new multi-level approach to reporting gambling prevalence will facilitate interstudy comparisons among existing estimates of gambling prevalence and help to provide a general data reporting system for future research.     

Home care reimbursement for technology-dependent children: Its impact on parental distress

The distress of 52 parents with a technology-dependent child at home is measured using a standardized psychological inventory. Fifty-eight percent of these parents report enough symptoms to classify them as needing psychiatric intervention. Cost savings to third-party payers are accelerating the trend toward home care (rather than institutionalized care). Yet, these findings point to an underestimated cost to families in terms of parents' psychological well-being. One factor associated with less distress for mothers is having services reimbursed through the Medicaid Model Waiver Program, which provides a comprehensive plan for home care services. In contrast, services reimbursed by private third-party payers are more variable, placing greater financial strain and uncertainty on parents, which is associated with greater psychological distress. These results suggest the need for further study of the long-term impact on parents caring for technology-dependent children at home.Reprint requests to Barbara J. Leonard, R.N., Ph.D., Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, Box 197 UMHC, University of Minnesota, Minneapolis, MN 55455, (612) 625-3660.This study was supported in part by BRSG Number 2-S07-RR05448-25 awarded to the University of Minnesota, School of Public Health by the Biomedical Research Grant Program, Division of Research and Resources, National Institute of Health. Additional support was provided by the Department of Health and Human Services, State of Minnesota, Academic Computing Services and Systems, University of Minnesota and special project funds from the University of Minnesota School of Public Health.Barbara J. Leonard is an Assistant Professor and Chair of the Maternal and Child Health Major, Division of Human Development and Nutrition, School of Public Health, University of Minnesota, MN 55455. Her research interests include children with developmental disabilities, their parents, and siblings. She received her Ph.D. from the University of Minnesota.Janny Dwyer Brust is a Research Fellow in the Maternal and Child Health Major at the University of Minnesota. Her research interests include issues related to the care of chronically ill children and sexually abused children. She received her M.P.H. from the University of Minnesota.Joan Patterson is an Assistant Professor in the Maternal and Child Health Major and Associate Director of the Center for Children with Chronic Illness and Disability at the University of Minnesota. Her research interests include family adaptation to chronic illness and family stress and coping. She received her Ph.D. from the University of Minnesota.     

SAMHSA urges treatment programs to test for HIV

Last month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) called on public health and substance use disorder (SUD) treatment providers to help make sure patients who are negative for human immunodeficiency virus (HIV) stay that way, and that those who are HIV‐positive are tested, receive antiretroviral treatment and stay “adherent” to the treatment. The directive came in the form of a “Dear Colleague Letter” from SAMHSA Director Elinore F. McCance‐Katz, M.D., Ph.D., assistant secretary for mental health and substance use for the Department of Health and Human Services.     

Texas pharmacist works with harm reduction on STR naloxone distribution

Legislatively, Texas may have its problems in addressing opioid overdoses and evidence‐based treatment, but the Texas Targeted Opioid Response (TTOR) grant, from the Opioid State Targeted Response (STR) from the Substance Abuse and Mental Health Services Administration (SAMHSA), is changing all of that. “We have amazing folks in the TTOR department at the Texas Health and Human Services department who are aggressively minded and are focused on trying to do the right things with the money,” said Lucas Hill, Pharm.D., clinical assistant professor in the University of Texas at Austin College of Pharmacy and director of Operation Naloxone, which is funded by TTOR.     

Developing and Maintaining Foster Family Identity Through Foster Parents’ Identity Work

There are hundreds of thousands of children in foster care in the United States, nearly a majority of whom are placed with nonrelative foster parents (U.S. Department of Health and Human Services, 2015). Few scholars (e.g., Nelson, 2014) have explored the communicative process through which a sense of family is created and maintained in foster families, despite the potential positive impact that developing a foster family identity may have on foster family functioning. The purpose of the present study was to understand the communicative strategies that foster parents use to create family identity. Data from interviews with 18 current and former foster parents revealed that through their talk inside and outside of the family, foster parents engaged in integrating biological and foster families, ritualizing, explaining, labeling family roles, and reframing. I discuss the importance of these findings for foster families.     

Maternal morbidity and maternal mortality in the United States

The following interview with Dr. Donna Strobino on maternal morbidity and mortality in the United States was conducted in May 2008. Dr. Strobino is Professor and Vice Chair of Education in the Department of Population, Family and Reproductive Health at The Johns Hopkins Bloomberg School of Public Health. She received a PhD from Johns Hopkins University and a BA from Western Connecticut State University. Dr. Strobino is Director of the Maternal and Child Health Leadership Training Program, a core training program in the Department of Population and Family Health Sciences at the Women's and Children's Health Policy Center. Dr. Strobino's recent research includes studies of the social, psychosocial, and biologic risk factors for preterm birth among African American women, the impact of the Healthy Steps Program for Young Children, and the effect of maternal depressive symptoms on the growth of their young children.