The prevalence of problem and pathological gambling: A critical analysis

The correction for bias in prevalence estimation with screening tests

The concern that the South Oaks Gambling Screen (SOGS) and other screening tests have a relatively high rate of false positive errors which results in overestimation of the true prevalence in general population studies is shown to be unfounded. False positives are seen to be a necessary but not sufficient condition for overestimation. It is demonstrated that the proper research question is whether the sample prevalence estimator is biased, and, if so, in which direction. One solution to the problem of bias is shown to depend on the availability of estimates of the error rates of the test.

Problem Gambling Within a Chinese Speaking Community

The purpose of this study was to obtain preliminary data on pathological gambling rates within a metropolitan Chinese community to determine if more costly extensive epidemiological surveys were justified. Two thousand survey questionnaires were distributed to parents through children attending a local Chinese speaking school. A response rate of 27.4% was obtained. Over a quarter of respondents were born overseas in either Mainland China or Hong Kong. Results indicated that gambling was not a popular activity with 60.0% of respondents stating that they never gambled. Of those who gambled, a third of respondents identified lotto as the preferred form. Using a Chinese translation version of the SOGS and a cut-off score of 10, a prevalence estimate of 2.9% for pathological gambling was found with males showing a higher rate (4.3%) as compared to females (1.6%). Respondents reporting a prior history of gambling in their country of origin were more likely to be classified as probable pathological gamblers. Despite the use of a sample of convenience, changes to the wording of two items in the Chinese translation of the SOGS and the possibility of false positive cases in the present study, it is concluded that further research into problem gambling in this community should be undertaken.

The Social Costs of Gambling: An Economic Perspective

Much of the opposition to legalized gambling is based on analyses of the social costs that occur as a result of pathological gambling. It is our contention that many, if not most, authors who have contributed to this literature are either unclear or misguided in what they define as social costs. Instead of starting with a clear definition of what constitutes a social cost, these authors have adopted an ad hoc approach-using "common sense" to determine what constitutes losses to society and then attempting to quantify the impact of those activities. We believe this is not, as some suggest, simply a matter of semantics. Rather, it is a serious problem in the gambling literature. How do we differentiate between a consequence of pathological gambling that is a "social cost" and one that is not? Which of the consequences of addictive behaviors that are associated with gambling arise when gambling is legal, and which will be manifest in some form whether or not gambling is legal? In this article we explain the economic perspective on social costs. An understanding of this paradigm removes the subjectivity in the classification of pathological gambling's social costs. The paper has three major components. First, we introduce the economic notion of social costs. Using this paradigm, we differentiate between the "true" social costs related to pathological gambling, and other negative consequences that cannot legitimately be classified as social costs. Second, we evaluate a recent social cost study using the economics social cost paradigm. Third, we discuss two types of social costs that have been largely overlooked in the gambling literature. One is caused by gambling prohibition. The other occurs as a result of "rent seeking" that is related to the political process surrounding the legalization of gambling.

Gambling and related mental disorders: a public health analysis

This article reviews the prevalence of gambling and related mental disorders from a public health perspective. It traces the expansion of gambling in North America and the psychological, economic, and social consequences for the public's health, and then considers both the costs and benefits of gambling and the history of gambling prevalence research. A public health approach is applied to understanding the epidemiology of gambling-related problems. International prevalence rates are provided and the prevalence of mental disorders that often are comorbid with gambling problems is reviewed. Analysis includes an examination of groups vulnerable to gambling-related disorders and the methodological and conceptual matters that might influence epidemiological research and prevalence rates related to gambling. The major public health problems associated with gambling are considered and recommendations made for public health policy, practice, and research. The enduring value of a public health perspective is that it applies different 'lenses' for understanding gambling behaviour, analysing its benefits and costs, as well as identifying strategies for action. Harvey A. Skinner (160, p. 286)

The South Oaks Gambling Screen: a review with reference to Australian use

The South Oaks Gambling Screen (SOGS) is a psychometric instrument widely used internationally to assess the presence of pathological gambling. Developed by Lesieur and Blume (1987) in the United States of America (USA) as a self-rated screening instrument, it is based on DSM-III and DSM-III-R criteria. This paper describes the origins and psychometric development of the SOGS and comments critically in relation to its construct validity and cutoff scores. Reference is made to the use of the SOGS in the Australian setting, where historically gambling has been a widely accepted part of the culture, corresponding to one of the highest rates of legaliZed gambling and gambling expenditure in the world. An alternative approach to the development of an instrument to detect people who have problems in relation to gambling is proposed.

Pathological gambling. A comprehensive review

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling. (2) Almost all of the studies in the gambling literature are Western-based and the results are often generalized to other ethnic and cultural groups. There is now an urgent need to close this gap. (3) Future studies need to address methodological problems in the current gambling/PG literature. (4) Almost all of the gambling literature has focused on the issue of why people start gambling. It is suggested that looking at variables as to why people stop gambling in a single episode may be a more fruitful area of research then why people start gambling. This is because what motivates one to continue gambling, despite losses in a session and across sessions, is a characteristic that distinguishes nonproblem gamblers from problem gamblers and pathological gamblers (PGs).

An assessment of the validity and reliability of the SOGS-RA

The present is a validation study seeking to determine the degree of confidence that can be placed on inferences about problem gambling among adolescents in the Atlantic provinces, based on their South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) scores. The major source of data was a 1998 survey of 13,549 students in junior and high school of the public school systems of the 4 Atlantic provinces of Canada. The SOGS-RA was found to have adequate stability and internal consistency reliability. Statistically significant gender differences were demonstrated relative to endorsement and construct validity. Regarding the latter, this study shows that the existing cut-point of the SOGS-RA score for problem gambling identifies as problem gamblers, markedly different proportions of male than female daily gamblers. Regarding construct validity in relation to the Atlantic Alcohol and Drug Risk Continua, this study suggests that while statistically highly significant, the association between problem gambling and substance-related problems may be of low clinical significance. Regarding criterion validity, there is an urgent need to perform the types of enquiry that will allow clarification about how adolescent problem gambling is conceptualized, by adults versus adolescents, by males versus females, and from a clinical versus a public or population health perspective.

The Biopsychosocial Approach to Gambling: Contextual Factors in Research and Clinical Interventions

Objective This paper argues that adherence to a single, specialised theory of gambling is largely untenable. It highlights limitations of existing theories of gambling at three increasingly specific levels of analysis; namely, the social, psychological and biological. Method An overview of each level of analysis (social, psychological and biological) is provided by critically evaluating the contemporary literature on gambling. This is followed by discussions of the limitations and interdependence of each theoretical approach and the implications for research and clinical interventions. Results While several recent critiques of gambling research have provided considerable insight into the methodological limitations of many gambling studies, another problem is seldom acknowledged - the inadequacy and insular nature of many research paradigms. It is argued that gambling is a multifaceted behaviour, strongly influenced by contextual factors that cannot be encompassed by any single theoretical perspective. Such contextual factors include variations in gambling involvement and motivation across different demographic groups, the structural characteristics of activities and the developmental or temporal nature of gambling behaviour. Conclusion This paper suggests that research and clinical interventions are best served by a biopsychosocial approach that incorporates the best strands of contemporary psychology, biology and sociology.

Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada

BACKGROUND

This study updates prevalence estimates of gambling-related disorders in the United States and Canada, identifies differences in prevalence estimates among population segments, and identifies changes in prevalence over the past 25 years.

METHOD

A meta-analytic strategy guided the synthesis of 180 estimates derived from 146 prevalence studies.

RESULTS

Prevalence estimates among adolescent samples were significantly higher than estimates among adult samples for both clinical (level 3) and sub-clinical (level 2) measures of disordered gambling within both lifetime and past-year time frames. Among adults, level 3 prevalence estimates continue to increase significantly.

CONCLUSIONS

Membership in youth, treatment, and prison population segments is significantly associated with experiencing gambling-related disorders. Understanding sub-clinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Prospective studies of incidence are necessary to determine whether the prevalence of disordered gambling continues to increase among the adult general population and how adolescent gambling experiences change as this cohort ages.

Epidemiology of problem gambling in Prince Edward Island: a Canadian microcosm?

OBJECTIVES

To gather information that describes the extent of gambling and problem gambling in Prince Edward Island (PEI), to rigorously analyze the relation between gambling activities and problem gambling, to document cognitive and emotional correlates of problem gambling, and to identify an at-risk gambling group.

METHOD

We selected a random, stratified sample (n = 809) to represent the adult population of PEI. We administered both the South Oaks Gambling Screen (SOGS) and an early version of the Canadian Problem Gambling Index (CPGI) to participants who had gambled.

RESULTS

The current rate of problem gambling was 3.1%. Problem gamblers were likely to be under age 30 years, to be single, and to report cognitive, emotional, and substance abuse correlates. Multiple-regression analysis identified a unique and substantial relation between problem gambling and video lottery terminal (VLT) use. We identified a group of at-risk gamblers (scoring 1 or 2 on the SOGS), comprising 14% of the sample.

CONCLUSIONS

Gambling and problem gambling patterns in PEI resemble those in most other provinces. The relation found between problem gambling, VLT use, and cognitive, emotional, and substance use correlates should apply to the greater population as well.

Problem and probable pathological gambling: considerations from a community survey

OBJECTIVE

To investigate the nature and extent of gambling problems in a region of Canada in which legalized gambling activities were expanded during the 1990s.

METHOD

A standardized telephone interview was conducted with a random sample of 738 community-dwelling adults (response rate 74%) in Winnipeg, Manitoba.

RESULTS

According to traditional classification criteria, the lifetime prevalence of "probable pathological gambling" was 2.6%. A further 3.0% of the sample met criteria for traditionally defined "problem gambling," and evidence suggests that both types of gamblers share several characteristics. Social or recreational gamblers significantly differed on several variables from individuals who reported gambling problems.

CONCLUSIONS

The 2.6% prevalence figure is the highest yet reported in a Canadian epidemiological survey and was obtained in a region that developed a more liberal attitude toward gambling in the 1990s. Further, a continuum of severity was demonstrated by scores on the South Oaks Gambling Screen (SOGS), and a clear and consistent distinction between problem and probable pathological gambling was not apparent. Frequenting casinos and using video poker and slot machines, rather than buying lottery tickets, distinguishes problem or pathological gamblers from recreational gamblers.

Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis

OBJECTIVES

This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years.

METHODS

A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study.

RESULTS

Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years.

CONCLUSIONS

Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages.

Gambling and problem gambling among indigenous peoples

This paper compares results from studies of gambling and problem gambling among indigenous groups in New Zealand and in North Dakota. The samples for each of these studies included substantial numbers of indigenous respondents, and the methods used in these studies were similar enough to allow comparisons of Caucasian and indigenous groups from these two distinct cultures. Analysis shows that gambling involvement, gambling expenditures, and gambling-related problems are far higher among indigenous respondents than among Caucasian respondents in both New Zealand and North Dakota. These comparisons suggest that differences between indigenous peoples and Caucasians in gambling behaviors may be due to factors distinct from culture or milieu.

Pathological gambling in Spanish children and adolescents: an emerging problem

Several studies have shown a high prevalence of pathological gamblers among adults in Spain (between 1.5% and 1.7%) of the population (18 years and older). In other countries the prevalence of pathological gambling in children and adolescents has been higher than in adults. Here some results of the first studies conducted in Spain concerning the prevalence of pathological gambling in school children and adolescents (11-16 years) are presented for two cities located in different northern regions of Spain, A Coruña (Galicia) and Gijon (Asturias), with representative samples of school children. The prevalence was 2.2% (n = 1,200) and 1.6% (n = 2,185), respectively, for the use of slot machines, using the 1993 DSM-IVJ Questionnaire of Fisher, and 2.4% in the first city with the South Oaks Gambling Screen-Revised Adolescent for all types of gambling. The analyses suggest there is an emerging problem among children and adolescents in Spain perhaps leading to an increased number of pathological gamblers as adults.