Mapping the proportional distribution of gambling-related harms in a clinical and community sample

Excessive gambling results in a range of diverse harms experienced by individuals and their family members. However, little consideration has been given to specifically assessing such harms. Despite recent attempts to comprehensively ‘list’ and describe the ‘wide net’ of specific harms, what remains particularly unclear is the best way to measure the presence of harm and quantify its relationship to gambling. This article proposes a two-step method for quantifying gambling-related harm. From the literature, 104 questions assessing 48 items of harm were categorized into seven domains. Items were administered to 391 clinical and 151 community gamblers. Results suggest that while high-impact harms such as suicide and divorce are commonly associated with problem gambling, the reported frequency is low. Most gamblers sustain low-impact harms such as reduced savings and worry. This study presents the evaluation of specific gambling-related harms distributed in a clinical and community sample taking into account severity and its relationship to gambling behaviours. It is concluded that gambling-related harms negatively impact on quality of life with a minority suffering more severe harms. It is argued that the proposed two-step methodology provides a basis for developing a psychometrically valid measure of gambling-related harm.     

A definition and set of principles for responsible consumption of gambling

Responsible consumption of gambling (RCG) is now a major paradigm driving industry, government and public health measures that aim to prevent or minimize gambling-related harm. This is reflected in the pervasive message to ‘gamble responsibly’. However, few attempts have been made to define the concept or identify its foundation principles, resulting in substantial ambiguity over what RCG means and its essential characteristics. This study addresses this void by synthesizing findings from a systematic literature review, website analysis and online survey of 107 experts – to develop a set of underlying principles and a definition of RCG. These tasks were facilitated by the reasonably consistent principles found to underpin RCG in the three data sources, despite wide variations in how the construct has previously been defined. Thus, the set of principles of RCG developed in this study (affordability, balance, informed choice, control, enjoyment, harm-free) should attract wide acceptance, as should the definition given that it combines and summarizes these principles. Adopting a consistent definition and set of RCG principles will provide a basis for developing consistent guidelines for consumers, offer direction for public health efforts for gambling harm minimization, and inform government policies and industry measures aiming to support safe 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.     

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.     

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.     

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.     

Could EGM player-tracking systems help link gamblers to treatment services in Australia: a thematic analysis of counsellor and community educators’ perspectives

There are a number of different pathways to care that people experiencing problems with gambling may pursue. The current research examined the potential of player-tracking systems, such as pre-commitment technology or loyalty cards, to improve the delivery of links to treatment. Thirty-three key informants from gambling treatment and community education in Australia were interviewed about the potential contributions of these technologies to helping link gamblers with problems to treatment services. Thematic analysis revealed three broad considerations for effective links to treatment using these technologies. First, links need to be appropriate in terms of the multitude of problems (other than gambling) that people might face with customized links appropriate to a gambler’s circumstances. Second, the presentation of the links should make them easy to notice and appropriately timed. Third, links should be provided as part of a broader strategy of harm minimization; by recognizing where people are in terms of behavioural change; providing positively framed guidance; and maintaining consistency with public health approaches. This research provides guidance based on informed expert opinion on what features of technology-driven links-to-treatment are likely to meet with greatest success.     

Determining optimal placement for pop-up messages: evaluation of a live trial of dynamic warning messages for electronic gaming machines

Dynamic warning messages are a harm minimization strategy aimed at preventing or reducing gambling-related problems by assisting individuals to make informed choices about their gambling. Laboratory studies have demonstrated the efficacy of dynamic warnings in facilitating responsible gambling. This article presents the results of a trial of the related effectiveness of dynamic warnings appearing either in the middle or on the periphery of electronic gaming machines (EGMs) screens in commercial gambling venues. Regular gamblers (n = 667) were surveyed to assess their recall of warning messages and the perceived impact of message placement on thoughts and behaviours. Messages appearing in the middle of screens were recalled to a greater extent, and respondents reported that these were more impactful and useful than messages on the periphery of screens. As one of the first trials of dynamic warning messages in operating EGM venues, the results provide important verification and validation of previous laboratory research. Results demonstrate that dynamic warning messages appearing in the middle of an EGM screen during play are likely to be a more effective harm minimization intervention than messages on the periphery of EGM screens.     

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.     

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.     

Trends in Bio-Behavioral Gambling Studies Research: Quantifying Citations

Both the National Gambling Impact Study Commission and the National Academy of Sciences have evaluated the current state of gambling studies research in general while making specific suggestions for future efforts in the psychological and biomedical areas in particular. Recognizing the importance of evaluating the state of the field on a macro level, this paper considers and categorizes several decades of psychological and biomedical gambling research. By examining the number of references to gambling in two major bibliographic databases, quantifiable trends and observations are presented about gambling-related psychological and biomedical research. Two trends in particular are salient: the rate at which gambling-related articles are published in scholarly journals is increasing, and the plurality of these articles deals with issues of cognition and personality as related to gambling.     

Screening for college problem gambling in Chinese societies: psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS)

A total of 979 Chinese college students were recruited in order to examine the psychometric properties of the Chinese version of the South Oaks Gambling Screen (C-SOGS). The C-SOGS was internally consistent and correlated with gambling-related problems and negative mental health status. Results of likelihood ratios (LRs) and receiver operating characteristic (ROC) curve supported the C-SOGS as a valid screening instrument for probable pathological gambling. Using the DSM-IV criteria for pathological gambling, the conventional cut score of 5 on the C-SOGS showed satisfactory sensitivity, specificity and false negative rates. This cut score identified 85% of the true positives and 95% of the true negatives. In general, the C-SOGS overestimated the number of pathological gamblers relative to DSM-IV criteria. Future research on Chinese gambling should build on current empirical work on the SOGS to refine the C-SOGS for use with Chinese populations.     

Awareness of Gambling-Related Problems, Policies and Educational Programs Among High School and College Administrators

This brief report summarizes a survey of high school and college representatives and their awareness toward gambling-related problems. The Massachusetts Council on Compulsive Gambling developed a survey instrument to review the policies and training programs of 20 high schools and 10 colleges that were located within the catchment areas of Massachusetts Department of Public Health state-sponsored gambling treatment programs. The results revealed that there is an important discrepancy between the prevalence of gambling-related problems among young people and the awareness of these problems among educators. High school and colleges evidence a paucity of existing gambling-related regulations or policies. There is little opportunity for students and educators to learn within the school setting about gambling and its potential hazards. Without sufficient in-service education and training for faculty and staff, there is little likelihood that this group of educators can engage in the early identification or prevention efforts that are so vital to advancing the health and welfare of young people.     

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.     

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.     

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 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.     

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.     

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.     

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.