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.     

Review of Self-exclusion from Gambling Venues as an Intervention for Problem Gambling

Self-exclusion programs are required to be provided by gambling operators in many international jurisdictions in an attempt to provide an option for those who have gambling problems to avoid further gambling. However, minimal robust and comprehensive research has been conducted to evaluate the effectiveness of self-exclusion programs. There is much scope for reform and greater cohesion between jurisdictions, particularly neighbouring jurisdictions that would offer greater protection to individuals and industry bodies. This review outlines the evidence surrounding existing self-exclusion strategies, the benefits and limitations of such programs, and provides potential recommendations for an effective intervention program. Research suggests that self-exclusion programs are under-utilised by problem gamblers and are not completely effective in preventing individuals from gambling in venues from which they have excluded, or on other forms. Nonetheless, self-report indicates that self-excluders generally experience benefits from programs, including decreased gambling and increased psychological wellbeing and overall functioning. There are many areas in which existing programs could be improved, such as providing more resources for excluded individuals and reducing barriers to program entry, and more research is needed. However, self-exclusion programs are an important component of any public health strategy that aims to minimise gambling-related harms and these should be based as far as possible on empirical evidence for effective program components.     

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.     

Gambling and the Health of the Public: Adopting a Public Health Perspective

During the last decade there has been an unprecedented expansion of legalized gambling throughout North America. Three primary forces appear to be motivating this growth: (1) the desire of governments to identify new sources of revenue without invoking new or higher taxes; (2) tourism entrepreneurs developing new destinations for entertainment and leisure; and (3) the rise of new technologies and forms of gambling (e.g., video lottery terminals, powerball mega-lotteries, and computer offshore gambling). Associated with this phenomenon, there has been an increase in the prevalence of problem and pathological gambling among the general adult population, as well as a sustained high level of gambling-related problems among youth. To date there has been little dialogue within the public health sector in particular, or among health care practitioners in general, about the potential health impact of gambling or gambling-related problems. This article encourages the adoption of a public health perspective towards gambling. More specifically, this discussion has four primary objectives:1. Create awareness among health professionals about gambling, its rapid expansion and its relationship with the health care system;2. Place gambling within a public health framework by examining it from several perspectives, including population health, human ecology and addictive behaviors;3. Outline the major public health issues about how gambling can affect individuals, families and communities;4. Propose an agenda for strengthening policy, prevention and treatment practices through greater public health involvement, using the framework of The Ottawa Charter for Health Promotion as a guide.By understanding gambling and its potential impacts on the public's health, policy makers and health practitioners can minimize gambling's negative impacts and appreciate its potential benefits.     

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.     

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.     

A Critical Review of the Harm-Minimisation Tools Available for Electronic Gambling

The increasing sophistication of gambling products afforded by electronic technologies facilitates increased accessibility to gambling, as well as encouraging rapid and continuous play. This poses several challenges from a responsible gambling perspective, in terms of facilitating player self-awareness and self-control. The same technological advancements in gambling that may facilitate a loss of control may also be used to provide responsible gambling tools and solutions to reduce gambling-related harm. Indeed, several harm-minimisation strategies have been devised that aim to facilitate self-awareness and self-control within a gambling session. Such strategies include the use of breaks in play, ‘pop-up’ messaging, limit setting, and behavioural tracking. The present paper reviews the theoretical argument underpinning the application of specific harm-minimisation tools, as well as providing one of the first critical reviews of the empirical research assessing their efficacy, in terms of influencing gambling cognitions and behaviour.     

Responsible Gambling: General Principles and Minimal Requirements

Many international jurisdictions have introduced responsible gambling programs. These programs intend to minimize negative consequences of excessive gambling, but vary considerably in their aims, focus, and content. Many responsible gambling programs lack a conceptual framework and, in the absence of empirical data, their components are based only on general considerations and impressions. This paper outlines the consensus viewpoint of an international group of researchers suggesting fundamental responsible gambling principles, roles of key stakeholders, and minimal requirements that stakeholders can use to frame and inform responsible gambling programs across jurisdictions. Such a framework does not purport to offer value statements regarding the legal status of gambling or its expansion. Rather, it proposes gambling-related initiatives aimed at government, industry, and individuals to promote responsible gambling and consumer protection. This paper argues that there is a set of basic principles and minimal requirements that should form the basis for every responsible gambling program.     

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.     

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.     

A taxonomy of gambling-related crime

Gambling and crime represent two common behaviours that occur, to varying degrees and in myriad forms, across most societies. Keeping gambling free from crime has also emerged to become an important policy objective in many jurisdictions, particularly where commercial gambling has proliferated. Yet research exploring the interconnections between gambling and crime is sporadic, stymied, in part, by the need for a comprehensive, detailed and systematic approach to categorizing the variety of offences that may be linked to wagering activities. In response, this article reviews the extant literature exploring gambling and crime and the ways in which it has been sorted and classified, before outlining a taxonomy through which to examine and better comprehend different types of gambling-related crime. The proposed taxonomy represents a policy-oriented framework through which gambling-related crime research and knowledge may be organized in order to aid risk analysis, regulatory review and crime prevention strategies.     

Gender differences in gambling preferences and problem gambling: a network-level analysis

Most gambling studies have a gender-blind research approach, although a large body of scientific evidence suggests that gambling in females is on the rise and that males and females have different gambling behaviours and experience specific gambling-related harm. This study addressed these gender differences using a network analysis, an innovative approach considering disorders/concepts as dynamic systems of interacting symptoms/items. Data on gambling activities, problem gambling, substance use and mental health were collected in a representative sample of French adult gamblers (n = 8805). The study capitalized on the network analysis directly to compare associations of specific gambling activities with gambling disorder symptoms separately for both genders. The network analysis revealed that problem gambling was strongly associated with gambling machines among females, whereas it was related to sports betting, poker and casino games among males. The networks that included substance use and mental health showed that substance use was related to specific gambling activities. These findings confirm the links between various gender-specific gambling patterns and problem gambling and suggest a need to consider these gender differences to improve prevention efforts. More broadly, the present study further supports the importance of gender differences for gambling research and policy.     

Excessive Gambling and Online Gambling Communities

The Internet provides an accessible context for online gambling and gambling-related online communities, such as discussion forums for gamblers. These communities may be particularly attractive to young gamblers who are active Internet users. The aim of this study was to examine the use of gambling-related online communities and their relevance to excessive gambling among 15–25-year-old Finnish Internet users (N?=?1200). Excessive gambling was assessed by using the South Oaks Gambling Screen. Respondents were asked in a survey about their use of various kinds of gambling-related online communities, and sociodemographic and behavioral factors were adjusted. The results of the study revealed that over half (54.33%) of respondents who had visited gambling-related online communities were either at-risk gamblers or probable pathological gamblers. Discussion in these communities was mainly based on sharing gambling tips and experiences, and very few respondents said that they related to gambling problems and recovery. In three different regression models, visiting gambling-related online communities was a significant predictor for excessive gambling (with 95% confidence level) even after adjusting confounding factors. The association of visiting such sites was even stronger among probable pathological gamblers than among at-risk gamblers. Health professionals working with young people should be aware of the role of online communities in terms of development and persistence of excessive gambling. Monitoring the use of online gambling communities as well as utilizing recovery-oriented support both offline and online would be important in preventing further problems. Gambling platforms should also include warnings about excessive gambling and provide links to helpful sources.     

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.     

‘Risky Places?’: Mapping Gambling Machine Density and Socio-Economic Deprivation

The aims of this project were to map the location and density of gambling machines in Britain; to explore whether geographic areas with higher densities of machines exist and to examine the socio-economic characteristics of these areas relative to others. Using geospatial analysis of premises records, we identified 8861 Machine Zones which were areas with a 400 meter radius around gambling machine venue and 384 High Density Machine Zones (HDMZ) with 1 or more gambling machine per hectare. There was a significant correlation between machine density and socio-economic deprivation. HDMZs had greater levels of income deprivation, more economically inactive people and a younger age profile than other areas; 37 % of those living in HDMZs were economically inactive compared with 33 % of those in non-machine areas. HDMZs were in seaside locations but also New Towns or satellite towns to major urban areas. Area affluence explains some of this pattern; of the New Towns with HDMZs, 78 % were in New Towns with a high proportion of low income areas. We therefore concluded that the distribution of gambling machines in Great Britain, in line with other international jurisdictions, displays a significant association with areas of socio-economic deprivation. The profile of the resident population living in HDMZs mirrors the profile of those most at-risk of experiencing harm from gambling. This spatial pattern has important implications for assessing the relationship between gambling availability and gambling-related harm, and for the future development of policy, harm-prevention and treatment strategies.     

Gambling Harms and Gambling Help-Seeking Amongst Indigenous Australians

This paper aimed to analyze the harms arising from gambling and gambling-related help-seeking behaviour within a large sample of Indigenous Australians. A self-selected sample of 1,259 Indigenous Australian adults completed a gambling survey at three Indigenous sports and cultural events, in several communities and online. Based on responses to the problem gambling severity index (PGSI), the proportions of the sample in the moderate risk and problem gambler groups were higher than those for the population of New South Wales. Many in our sample appeared to face higher risks with their gambling and experience severe gambling harms. From PGSI responses, notable harms include financial difficulties and feelings of guilt and regret about gambling. Further harms, including personal, relationship, family, community, legal and housing impacts, were shown to be significantly higher for problem gamblers than for the other PGSI groups. Most problem gamblers relied on family, extended family and friends for financial help or went without due to gambling losses. Nearly half the sample did not think they had a problem with gambling but the results show that the majority (57.7 %) faced some risk with their gambling. Of those who sought gambling help, family, extended family, friends and respected community members were consulted, demonstrating the reciprocal obligations underpinning traditional Aboriginal culture. The strength of this finding is that these people are potentially the greatest source of gambling help, but need knowledge and resources to provide that help effectively. Local Aboriginal services were preferred as the main sources of professional help for gambling-related problems.     

Gender Differences in the Presentation of Observable Risk Indicators of Problem Gambling

In many countries where gambling is legalised, there has been a strong public policy focus on the need for strategies to reduce gambling related harm. These have often included policies requiring staff in gambling venues to identify and/or assist people who might be experiencing gambling-related harm. To facilitate this process, researchers have developed visible behavioural indicators that might be used to profile potentially problematic gambling. Few of these studies have, however, examined whether such indicators or ‘warning signs’ might differ between men and women. In this study, we describe the results of an analysis of data drawn from 1185 fortnightly gamblers that included 338 problem gamblers as classified by the Problem Gambling Severity Index. Indicators of problem gambling were similar between males and females with a few key exceptions. Indicators reflecting emotional distress were more commonly reported by females with gambling problems, whereas problem gambling males were more likely to display aggressive behaviour towards gambling devices and others in the venue. Amongst males, signs of emotional distress as well as attempts to conceal their presence in venues from others most strongly differentiated between problem and non-problem gamblers. Amongst females, signs of anger, a decline in grooming and those attempts to access credit were the most distinguishing indicators. These findings have implications for the refinement of identification policies and practices.     

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.     

Prevalence of Adolescent Problem Gambling,Related Harms and Help-Seeking Behaviours Among an Australian Population

Epidemiological studies have consistently reported prevalence rates ranging between 0.9 and 23.5% for problem gambling among young people. With such a large range reported in the literature, it is clear that more research in this area would be of value. The current study investigated the prevalence rate of adolescent gambling and problem gambling and explored types of harm-related and help-seeking behaviours associated with gambling specific to this population in an Australian setting. A self-administered battery of questionnaires was distributed to 252 students aged 12–18 years, attending four private schools in the Eastern suburbs of Sydney, Australia. The battery included a self-administered socio-gambling demographic questionnaire, the Diagnostic and Statistical Manual Fourth Edition Multiple Response Juvenile (DSM-IV-MR-J) diagnostic instrument to assess problem gambling status, the Gambling Attitudes Scale, and questionnaires using a Likert scale to measure gambling-related harms and help-seeking behaviours. The prevalence rate among this group was found to be 6.7%. The study found further support for previous findings suggesting that a significant proportion of young people meet criteria for problem gambling, that males are at-risk and that few adolescents are able to recognise when gambling is problematic or access mental health professionals for assistance.