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.     

Suicidality and depression among youth gamblers: a preliminary examination of three studies

Both suicide and problem gambling among youth are two growing areas of public health concern, though studies have yet to characterise the relationship between these issues. Youth report higher prevalence rates of problem gambling than adults, but no studies to date have investigated whether they are likewise prone to higher risks of gambling‐related suicidality. This article explores the relationship of depression, suicidality, and problem gambling in youth in three studies of middle and high‐school students (total N = 3,941; males n = 1,937, females n = 2,004) conducted in 1996, 2000, and 2001 in Quebec and Ontario. All studies reported significantly higher rates of suicidality among problem and pathological gamblers as compared to non‐gamblers and social gamblers, irrespective of gender, grade, or level of depression. The implications for future investigations are discussed.     

Framing public policy towards a public health paradigm for gambling

This paper examines the public policy value of looking at gambling from a public health perspective. The manner in which social issues are framed will either expand or curtail public policy debates. The existing and traditional frames for gambling (e.g. gambling as a matter of individual freedom, gambling as a form of recreation) fail to consider research on the social and economic impacts of gambling. Because a public health frame offers a broad viewpoint of society, it encompasses a number of social and economic impacts not considered in traditional frames. However, the existing gambling frames enjoy varying degrees of cultural, economic, and political support and, as a result, creating a higher profile for a public health framework will encounter a number of barriers. Research can play a decisive role in overcoming these barriers, as it has in a number of related fields (e.g., tobacco use, addiction and product liability, the epidemiology of AIDS). The paper concludes that research that identifies and quantifies the public health factors of gambling will substantially contribute to a public shift toward a public health frame.     

Gambling activities of young Australians: developing a model of behaviour

As more gambling venues open in Australia, youth gambling as problem behaviour has been identified. The aim of this study was to assess youth gambling in a population with easy access to gambling, and to evaluate the adequacy of a model for predicting adolescent gambling frequency and problem gambling. The model comprised a combination of the Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980), personality variables (venturesomeness, impulsiveness), and cognitive bias variables derived from Weinstein's (1980) propositions concerning unrealistic optimism about future life events. A sample of 1017 school- and university-based adolescents indicated relatively low frequencies of gambling and low scores on the problem gambling scale, with males scoring higher than females on both measures. The TRA was supported with about 30% of the variance of each of gambling behaviour and problem gambling accounted for by intentions, attitudes, and subjective norms. Personality factors added significantly to the prediction of gambling. The cognitive bias variables, although independently not statistically significant, further contributed to prediction.     

Youth Gambling Problems: Examining Risk and Protective Factors

This study examined the relationship between several pre-examined risk factors for youth problem gambling, a number of potential protective factors for youth problem gambling, and the development of adolescent problem gambling. The sample consisted of 2179 students, ages 11–19. The results of analyses of variance revealed that lower family and school connectedness are associated with adolescent problem gambling. Further, an examination of the effect of potential protective factors on a set of risk factors predictive of adolescent problem gambling suggests that lack of family cohesion plays a role in predicting at-risk and problem gamblers. The results are framed in terms of a general model of risky behaviour and implications for prevention are outlined.     

Adolescent gambling and problem gambling: examination of an extended theory of planned behaviour

Adolescent problem gambling is acknowledged as a public health concern. To better understand adolescent gambling and problem gambling behaviour, the present study investigated the relationships between psychological correlates of gambling frequency and problem gambling using an extended theory of planned behaviour (TPB; i.e. intentions, attitudes, subjective norms, perceptions of behavioural control) that includes negative anticipated emotions as a factor associated with gambling intentions. Four hundred and nineteen high school students were surveyed in the Montreal (Canada) region. The findings generally support the applicability of an extended TPB model for explaining gambling behaviour frequency and gambling problems among adolescents. The results reveal that negative anticipated emotions, attitudes and perceptions of behavioural control influence gambling intentions. The results further reveal that intentions and attitudes have a direct relationship with gambling frequency, while intentions and perceptions of behavioural control are directly related to problem gambling behaviours. These findings suggest that adolescent problem gambling prevention and intervention efforts should consider targeting negative anticipated emotions and other TPB components in order to postpone initiation to gambling (a risk factor for problem gambling) and to promote gambling decision-making.     

Public opinion towards gambling and gambling regulation in Australia

In recent years, public opinion towards gambling has become a more important factor in shaping public policy. Using a national public opinion survey conducted in Australia in 2011, this paper examines public opinion towards gambling in general and towards the government regulation of gambling in particular. Australia is an important case study because of the internationally high prevalence of gambling among the public, combined with a strong regulatory framework. Public opinion is measured by a reduced form of a scale first developed in Britain. The results confirm the generally negative views that the public holds towards gambling, which have been found internationally. In addition, the Australian public is open to the introduction of further restrictions on gambling. Overall, the public views the liberalization of gambling as having moved as far as most citizens find acceptable; to meet public expectations, future policies need to address more adequately the negative social consequences associated with problem gambling.     

The Public Stigma of Problem Gambling: Its Nature and Relative Intensity Compared to Other Health Conditions

Problem gambling attracts considerable public stigma, with deleterious effects on mental health and use of healthcare services amongst those affected. However, no research has examined the extent of stigma towards problem gambling within the general population. This study aimed to examine the stigma-related dimensions of problem gambling as perceived by the general public compared to other health conditions, and determine whether the publicly perceived dimensions of problem gambling predict its stigmatisation. A sample of 2000 Australian adults was surveyed, weighted to be representative of the state population by gender, age and location. Based on vignettes, the online survey measured perceived origin, peril, concealability, course and disruptiveness of problem gambling and four other health conditions, and desired social distance from each. Problem gambling was perceived as caused mainly by stressful life circumstances, and highly disruptive, recoverable and noticeable, but not particularly perilous. Respondents stigmatised problem gambling more than sub-clinical distress and recreational gambling, but less than alcohol use disorder and schizophrenia. Predictors of stronger stigma towards problem gambling were perceptions it is caused by bad character, is perilous, non-recoverable, disruptive and noticeable, but not due to stressful life circumstances, genetic/inherited problem, or chemical imbalance in the brain. This new foundational knowledge can advance understanding and reduction of problem gambling stigma through countering inaccurate perceptions that problem gambling is caused by bad character, that people with gambling problems are likely to be violent to other people, and that people cannot recover from problem gambling.     

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.     

Meeting the mental health needs of homeless students in schools: A Multi-Tiered System of Support framework

The number of homeless youth in the U.S. has reached an all-time high and this represents a growing social problem. Research indicates that homeless youth are significantly at-risk for experiencing a range of negative life-outcomes such as school dropout, the development of mental health problems, use/abuse of illicit substances, suicidality, and even early mortality. Thus, effective interventions and mental health supports are needed to help address their complex mental health needs. Fortunately, however, many homeless youth regularly attend school, especially younger youth (i.e., under 13 years old) and youth who are members of homeless families. Therefore, as important members of school communities, school-based mental health professionals can help support these students. With this aim in mind, this paper discusses the use of a Multi-Tiered System of Support (MTSS) framework to meet the mental health needs of homeless students in schools. More specifically, following a public health service delivery model, service delivery is discussed at universal, selective, and indicated levels. Lastly, to address the diverse needs of homeless students, integrated service-delivery across various systems of care is discussed.     

Recommendations for International Gambling Harm-Minimisation Guidelines: Comparison with Effective Public Health Policy

Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.     

Legitimate concerns about industry involvement in gambling research: response to Delfabbro and King (2017)

This paper provides a response to the commentary by Delfabbro and King (2017), which describes major criticisms of articles situated in a ‘political economy’ conceptual framework. The current paper argues that these criticisms obfuscate legitimate concerns about industry involvement in gambling research, and disregard important evidence about activities of hazardous-consumption industries which provide grounds for strong concern about commercial practices of the gambling industry. Although many aspects of the commentary by Delfabbro and King (2017) are contentious, the current paper summarizes conceptual and empirical literature which supports concern about (a) agency and collaboration in practices of the gambling industry, which make assertions of equivalence with a conspiracy theory both inappropriate and misleading, and (b) the role of research on problem gambling behaviours and pathologies in supporting agendas that may undermine public health. This indicates the need for the scientific community to take seriously its role in improving awareness of the hazards of commercial involvement in gambling research, and thus helping researchers to make informed decisions about these risks and their own manner of engagement with the gambling industry.     

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.     

The Population Mean and the Proportion of Frequent Gamblers: Is the Theory of Total Consumption Valid for Gambling?

The study looks at three representative samples of Norwegians in different age groups with the aim of finding evidence for the validity of the total consumption model for the area of gambling. The results show that gambling was distributed in the population in a way consistent with the predictions of the total consumption theory. Populations with a low mean gambling frequency had a lower proportion of frequent gamblers than populations with a high mean gambling frequency. It was also shown that in a population with a low mean gambling frequency, consumers along the whole consumption continuum gambled less frequently, than in a population with a high mean gambling frequency. It is concluded that the total consumption model seems to be valid for gambling, and that gambling consequently needs to be understood as a public health issue. The actions and behaviours of the normal majority can then not be regarded as irrelevant for the development in problem gambling prevalences.     

Developing the DSM-IV-DSM-IV Criteria to Identify Adolescent Problem Gambling in Non-Clinical Populations

This paper presents a revised version of DSM-IV-J criteria for youth, the DSM-IV-MR-J, together with psychometric data stemming from its use in a major prevalence study of adolescent gambling and problem gambling. The case is made for further development and testing of current and emerging instruments to screen for problem gambling in youth, with the aim of establishing one internationally accepted gold standard measure.     

A review of Australian classification practices for commercial video games featuring simulated gambling

This paper reviews Australian classification practices for commercial video games that contain simulated gambling. In the last decade, over 100 video games featuring gambling simulations have been classified as suitable for commercial sale to youth in Australia, with 69 of these video games rated ‘PG’ for Parental Guidance Recommended (i.e. suitable for ages 8+years) and the remaining 33 rated ‘G’ for General (i.e. suitable for all ages). A review of the literature suggests that consumer advice and warnings related to video game material are often inconsistent and/or not adequately provided. A public health approach suggests that the presence of gambling content in video games may present risks to younger players unfamiliar with how gambling operates. It is argued that there is a need for further academic debate on social responsibility issues of early childhood and adolescent exposure to, and involvement in, simulated gambling activities available in interactive gaming technologies.     

Prevalence of Adolescent Problem Gambling: A Systematic Review of Recent Research

Previous research has shown that gambling is a popular activity among adolescents. Following a rapid expansion of legalized gambling opportunities and the emergence of new forms of gambling, many researchers have carried out studies on adolescent gambling and problem gambling. The present paper reviews studies that have been conducted worldwide since 2000, and then presents a more detailed picture of adolescent gambling research in Europe, by providing a country-by country analysis. After an extensive search on academic databases and following an exclusion process, 44 studies were identified. The findings showed that 0.2–12.3 % of youth meet criteria for problem gambling, notwithstanding differences among assessment instruments, cut-offs, and timeframes. However, despite this variability, several demographic characteristics were associated with adolescent gambling involvement and problem gambling. It is concluded that a small but significant minority of adolescents have gambling-related problems. Such findings will hopefully encourage more research into youth gambling to further understand the determinants of this phenomenon.     

Prevalence Rates of Youth Gambling Problems: Are the Current Rates Inflated?

While there is a general consensus in the literature that it is common for youth to gamble, considerable variability in the reported prevalence rates of youth problem gambling has been found. More recently, issues concerning the possible overestimation of these rates have been raised. Arguments underlying the proposition that problem gambling rates for youth are inflated are examined. It is acknowledged that more rigorous research is required, including the need for the development and refinement of current adolescent instruments and screening tools, agreement upon a gold standard criterion for adolescent problem gambling, and clarity of nomenclature issues. The advancement of scientific knowledge concerning the underlying risk factors associated with the onset and course of youth gambling involvement and the role of effective adolescent prevention and treatment programs will require these fundamental research questions to be addressed.     

A Cross-Cultural Study of Gambling Behaviour Among Adolescents

This study investigated whether the prevalence of weekly and problem gambling among youth varied according to cultural affiliation. A convenience sample of 1,265 Quebec high school students aged 12–18 was divided into three linguistic groupings: Anglophone (English), Francophone (French), and Allophone (other). Results revealed that the Allophone grouping contained the highest proportion of youth who gambled on a weekly basis and who reported gambling problems, followed by the Anglophone, and finally the Francophone groupings. Acculturation difficulties were associated with problem gambling. Few meaningful between-group differences were found with respect to factors related to problem gambling (i.e., comorbidity with other risk factors, coping, family functioning and resiliency). The results are discussed with respect to the influence of cultural background on gambling behavior.     

Online gambling participation and problem gambling severity: is there a causal relationship?

Studies of Internet gambling have consistently shown that online gamblers are more likely to report disordered gambling behaviour than offline gamblers. However, little research has focused on whether this is a causal relationship or whether this risk factor is capturing a relationship with one or more missing variables. To address whether there is a strong causal argument for the effect of online gambling participation on problem gambling severity, we use a secondary data method that corrects for potential omitted variable bias. Once this issue is addressed, we find that past-year participation in online gambling is related to a decrease in problem gambling severity, which is the opposite of the popular view in current literature. The estimates in this study are found to be robust to various forms of online gambling, control variables and problem gambling measurement instruments. The findings were also consistent when using a representative sample from the United Kingdom and when using an online research panel from Ontario, Canada. As a primary force against the widespread adoption of Internet gambling has been public health concern over problem gambling, this study provides evidence that such decisions should be more closely considered by policymakers.