Mahjong gambling in the Chinese-Australian community in Sydney: a prevalence study

Stressful Life Events and Problem Gambling Among Chinese Lottery Gamblers: The Mediating Effects of Coping Strategies and Magical Thinking

Problem gambling poses serious harm to individuals and societies worldwide. This study aims to investigate the relationship between stressful life events and problem gambling, and further explore the mediating role of coping strategies and magical thinking. Currently, the research on problem gambling is widely conducted worldwide. However, due to the unique characteristics of China's gambling industry, research on problem gambling conducted in the Chinese mainland has always been an underrepresented area in international gambling research. This study recruited participants from a province in central China, and data from 483 of them were ultimately analyzed. The data analysis results indicate that task-oriented coping, emotion-oriented coping, avoidance-oriented coping, and magical thinking all serve as mediators in the relationship between stressful life events and problem gambling. Emotion-oriented coping and magical thinking, avoidance-oriented coping and magical thinking, all serve as serial mediators in the relationship between stressful life events and problem gambling. Task-oriented coping and magical thinking did not act as serial mediators in this relationship. This study demonstrates that helping problem gamblers develop effective coping strategies and reduce their level of magical thinking is crucial for treating their problem gambling.

Longitudinal associations between the frequency of playing Mahjong and cognitive functioning among older people in China: evidence from CLHLS, 2008-2018

Background

Cognitive decline is prevalent among older adults, often resulting in decreased capabilities for self-care and a diminished quality of life. Mahjong, a culturally cherished and extensively played intellectual game in China, demands considerable cognitive function. While the cognitive benefits of playing Mahjong have been widely accepted, this study investigates an under explored aspect and aimed to ascertain the game's potential contributions toward bolstering self-care abilities, enhancing overall quality of life, and mitigating against rising societal healthcare costs.

Methods

The data analyzed in the study is collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with cognitive functioning being assessed through the Mini-Mental State Examination (MMSE). The frequency of playing Mahjong was measured through a self-reported questionnaire. Multiple linear regression models, latent variable growth models, and cross-lagged models were used to investigate the longitudinal relationship between game frequency and cognitive function in older people.

Results

Of the 7,535 participants, the mean (SD) age was 81.96 (10.53) years. There were 7,308 (97%), 4,453 (59%), and 1,974 (26%) participants in 2011, 2014, and 2018, respectively. The results showed that Mahjong players had significantly higher MMSE scores compared to non-players from 2008 to 2018 (β = 0.893; p < 0.001), and non-players had significantly lower scores in 2011, 2014, and 2018 than in 2008 (β = -1.326, -0.912, -0.833; Ps > 0.05). Moreover, the frequency of playing Mahjong was associated with improved various cognitive domains. The declining frequency of playing Mahjong was substantially associated with the declining rate of MMSE scores (r = 0.336; p < 0.001). Mahjong frequency showed positive effects on MMSE scores, while the influence of Mahjong on MMSE scores were not significant.

Conclusion

Playing Mahjong has a positive influence on the cognitive functioning among older people. It can help buffer against the decline in cognitive function and maintain cognitive function levels. The higher frequency of playing Mahjong is associated with improved reaction, attention and calculation, and self-coordination. A decline in the frequency of playing Mahjong was associated with a declining rate of cognitive function. The higher frequency of playing Mahjong among older people unilaterally influenced the improvement of cognitive function levels in older people in China.

Culturally and Linguistically Diverse Gamblers of East Asian Descent in Australia: A Comprehensive Review of Current Evidence

As a country with one of the highest per capita gambling losses per year in the world, and an evolving multicultural profile, Australia has become an important setting in which to examine the harms and benefits related to gambling. The Australian population includes people from East Asian cultural backgrounds who are a key demographic of interest for gambling operators planning to grow revenue. However, Australian gambling research has concentrated primarily on those belonging to the dominant cultural group. Most of the previous and limited number of studies to examine gambling among culturally and linguistically diverse (CALD) residents have focused on people of Chinese descent, and much of the literature is now becoming relatively old. This review examines the current evidence around cultural variations in gambling prevalence, motivations, beliefs, behaviours, and help service utilisation, focusing on gamblers with an East Asian cultural background. Numerous domains in which gambling motivations and behaviours vary across cultural groups are identified, and methodological considerations related to ethnographic gambling research are discussed. This review found that while barriers and predictors to help-seeking for CALD gamblers have been studied extensively, contemporary evidence of help service utilisation and effectiveness in Australia is lacking. Further research providing an accurate assessment of the impacts of gambling for CALD gamblers is needed to ensure that harm minimisation resources are effective for those most vulnerable to harm.

Pathological Gambling, Gambling Disorder, and Problem Gambling Among the Chinese Ethnic Population Living in Western Countries: Is Culture a Sufficient Explanation for the Reported Excess Rates?

A significant gap remains in the understanding of the psychosocial and cultural factors and processes in the development and maintenance of pathological gambling, gambling disorder, and problem gambling among the Chinese ethnic population living in the Western countries. This narrative reviews papers on gambling and pathological gambling among the Chinese ethnic group in Western countries to provide a deeper understanding of the cultural and psychosocial factors and processes that lead to the development and maintenance of pathological gambling, gambling disorder, and problem gambling. The factors leading to development of problem gambling, which also carry distinctive cultural differences, include acculturation process among Chinese migrants to western countries, their social learning patterns in gambling, the patterns and motivation seen in Chinese gamblers, their gambling-related cognitive bias and distortions as well as barriers to their help-seeking behaviours. The collectivistic oriental culture may explain for intrafamilial development of gambling behaviour and this strong male authority in the traditional Chinese family set-up also reinforces this influence. The Chinese culture is associated with increased risk-taking behaviour. Superstitious thinking is more prevalent in the Chinese culture and this can be manifested in individuals' perceptions of fate and luck. Future research projects studying pathological gambling and ethnic minorities in the UK should seek greater understanding and improved management of this condition in a small but highly relevant population.

Playing Mahjong for 12 Weeks Improved Executive Function in Elderly People With Mild Cognitive Impairment: A Study of Implications for TBI-Induced Cognitive Deficits

Background: Mild cognitive impairment (MCI) is common among elderly people. So far, effective treatment that can stabilize or reverse the cognitive decline associated with MCI is lacking. Recent studies suggest that playing mahjong may improve attention and memory in elderly people. However, its effect on executive function remains unknown.

Methods: 56 elderly people (74.3 ± 4.3 years of age) with MCI from the First Social Welfare the First Nursing Home of Nanchong were randomized into mahjong and control groups (N = 28, each group). Subjects in the mahjong group played mahjong three times a week for 12 weeks, while people in the control group assumed normal daily activity. Executive function was evaluated using the Montreal Cognitive Assessment—Beijing (MoCA-B), the Shape Trail Test (STT), and the Functional Activities Questionnaire (FAQ) before the study and then at 6 and 12 weeks after mahjong administration.

Results: There were no baseline differences in MoCA-B, STT, and FAQ scoring between the two groups. The MoCA-B, STT, and FAQ scores, however, improved significantly in the mahjong group but not in the control group after the 12-week mahjong administration. Significant correlations were also found between STT and FAQ scores.

Conclusions: Playing Mahjong for 12 weeks improved the executive function of elderly people with MCI. Because Mahjong is a simple, low-cost entertainment activity, it could be widely applied to slow down or reverse the progression of cognitive decline in people with MCI, including those with traumatic brain injury.

Multi-Level Factors Associated with Social Participation among Stroke Survivors: China's Health and Retirement Longitudinal Study (2011-2015)

Background: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. Methods: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. Results: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with going to a community club to play table games. Conclusion: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.

Effects of selected leisure activities on preventing loneliness among older Chinese

This study examined three types of leisure activities (playing cards/mahjong, watching TV/listening to the radio, and participation in social activities) among the older segment of the Chinese population, and the effects of these activities in preventing the feelings of loneliness. Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted in 2005, 2008, and 2011. The males, those who were educated, the young-old (aged between 65 and 74 years), urban dwellers, and living in institutions were more likely to participate in all three activities frequently. Frequent or occasional participation in these three activities was negatively associated with feelings of loneliness. The longitudinal study from 2005 to 2011 showed that respondents who frequently played cards/mahjong at baseline were less likely to feel persistent loneliness at the end of the 2011 wave. Instead, frequently watching TV/listening to the radio in 2008 was associated with lower odds in feeling persistent loneliness at the end of 2011. Hence, active participation in playing cards/mahjong and TV/radio entertainment can be effective treatment intervention against persistent loneliness among older Chinese. For the Chinese, a leisure activity steeped in a nation's culture and heritage, such as playing mahjong, may be used as an intervention strategy to prevent and alleviate chronic loneliness among older adults.

ADHD Symptoms in Pathological and Problem Gamblers in Singapore

Background: There is relatively little research examining the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) and gambling addiction. This study seeks to explore for ADHD symptoms in adult gambling addiction patients and to evaluate their gambling-related cognitions. Materials and Methods: A cross-sectional survey was conducted at National Addictions Management Service, Institute of Mental Health, in Singapore. Patients presenting for gambling treatment were screened for ADHD symptoms and assessed for severity of gambling-related cognitions. The primary objective was to observe the rate of patients screening positive for ADHD. Results: 20% of the sample screened positive for ADHD. These individuals also had lower levels of gambling-related cognitions. No significant correlation was noted between ADHD symptoms and gambling-related cognition scores. Conclusions: Positive screening results for ADHD occurred frequently in our sample of Pathological Gambling (PG) and Problem Gambling patients and these affected individuals also exhibited lower levels of gambling-related cognitions. This finding may suggest that the gambling behavior in patients with ADHD-PG comorbidity is driven by impulsivity rather than gambling-related cognitions, which has implication on treatment considerations. Further research with a larger sample size is indicated.

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.

Practical Treatments Considering the Role of Sociocultural Factors on Problem Gambling

Reviews of problem gambling (PG) literature increasingly recognize the ways in which different ethnic groups are affected by gambling behaviors, yet discourse, which considers sociocultural factors within PG, remains limited. Literature on this topic is influenced by large inconsistencies amongst research studies, overlapping terminology, and variability in the validity of research studies, making conclusions difficult to draw. Despite these discrepancies, this paper explores how sociocultural factors influence PG among diverse cultural groups and provides specific practical implications for treating PG disorders in culturally diverse populations. Notable factors that exacerbate PG behavior cross-culturally include substance abuse, low socioeconomic status, lack of social activities, and geographic location. Culturally sensitive treatment options such as Motivational Interviewing and Cognitive Behavioral Therapy have been identified as effective treatments for PG with culturally diverse populations. This paper extends current thought by providing practical treatment recommendations that consider the subtle nuances of diverse populations. It explains how treatment providers and behavioral addiction professionals can increase their understanding and skills when conceptualizing PG clients from a diverse background.

National Helpline for Problem Gambling: A Profile of Its Users' Characteristics

Gambling has seen a significant increase in Italy in the last 10 years and has rapidly become a public health issue, and for these reasons the first National Helpline for Problem Gambling (GR-Helpline) has been established. The aims of this study are to describe the GR-Helpline users' characteristics and to compare the prevalence rates of the users with those of moderate-risk/problematic gamblers obtained from the national survey (IPSAD 2010-2011). Statistical analysis was performed on data obtained from the counselling sessions (phone/e-mail/chat) carried out on 5,805 users (57.5% gamblers; 42.5% families/friends). This confirms that the problems related to gambling concern not only the gamblers but also their families and friends. Significant differences were found between gamblers and families/friends involving gender (74% of gamblers were male; 76.9% of families/friends were female), as well as age-classes and geographical area. Female gamblers had a higher mean age (47.3 versus 40.2 years) and preferred nonstrategy-based games. Prevalence rates of GR-Helpline users and of moderate risk/problematic gamblers were correlated (Rho = 0.58; p = 0.0113). The results highlight the fact that remote access to counselling can be an effective means of promoting treatment for problem gamblers who do not otherwise appeal directly for services.

Culture and age influences upon gambling and problem gambling

Objective

This study aimed to (i) examine the prevalence and types of gambling, (ii) establish prevalence of ‘pathological’ gambling, (iii) explore the correlates of gambling, and (iv) establish psychiatric and physical comorbidity in a sample of older adult gamblers (≥ 60 years) in contrast to younger gamblers in a representative population sample in Singapore.

Method

This paper reports the results of a secondary analysis of data from a representative community survey of 6616 participants, of which 2252 had engaged in gambling activities at least once in their lifetime.

Results

48.9% of older adults reported lifetime gambling. Older gamblers were more likely to be males, married or widowed (vs. never married), with pre-primary, primary and secondary education (vs. university), economically inactive (vs. employed) and had personal annual income of SGD $19,999 and below (vs. SGD $50,000 and above). Older gamblers had significantly higher rates of betting on horses, playing numbers or betting on lotteries, and playing Mahjong. After adjusting for demographic variables in multiple logistic regression analyses, gamblers aged 60 years and older had significantly lower odds of having pathological gambling than those in the younger age group (OR = 0.4). Older gamblers had significantly higher odds of having diabetes (OR = 3.2), hypertension (OR = 4.9), and any comorbid chronic physical condition assessed in this study.

Conclusions

For the majority of older adults, gambling remains a recreational activity that is entertaining and a way of socialization. However, one must remain cognizant of the possible risks for some to develop disordered gambling.

•

48.9% of older adults in Singapore reported lifetime gambling.

•

Older gamblers were more likely to be males, married or widowed, and had lower education.

•

Older gamblers had significantly lower odds of having pathological gambling.

The mediating effect of depression between superstitious beliefs and problem gambling: a cross-cultural study of Chinese and Caucasians residing in the United States

The purpose of this study was to address the mediational role of depression in the association between superstitions and problem gambling and to test whether this mediating process is significantly different between Chinese and Caucasian Americans. Eight items assessing superstitious beliefs, the 21-item Beck Depression Inventory-II, and the 20-item South Oaks Gambling Screen (SOGS) were completed by 115 Chinese gamblers and 187 Caucasian gamblers residing in the United States, and the responses between tests and between groups compared. Path analysis results showed that superstitious beliefs had a significant effect on both Chinese and Caucasian gamblers' SOGS scores (i.e., problem gambling symptoms). In both groups, depression played a significant mediating role between the superstitious beliefs variable and the problem gambling variable. Future clinical research might use the findings of this study to develop specific prevention and treatment approaches focusing on a gambler's cognitive bias and negative mood.

Chinese attitudes, norms, behavioral control and gambling involvement in Macao

This study tested the applicability of the theory of planned behavior (TPB) on gambling intention and involvement in a representative Chinese sample in Macao, recruited by a random residential number dialing method. We successfully interviewed 685 respondents, with about one-third of them reporting that they had participated in gambling activities during the 12 months prior to the interview. The results of structural equation modeling suggested that favorable attitudes toward superstition and techniques, poor sense of perceived behavioral control over gambling refusal, and high gambling intention increased vulnerability to excessive gambling involvement. These findings generally support the efficacy of the TPB in explaining gambling intention and involvement among both Chinese gamblers and non-gamblers. Some practical implications of the findings are discussed within the Chinese context.

An assessment of the psychometric properties of Italian version of CPGI

The aim of this study was to adapt to the Italian context a very commonly used international instrument to detect problem gambling, the canadian problem gambling index (CPGI), and assess its psychometric properties. Cross-cultural adaptation of CPGI was performed in several steps and the questionnaire was administered as a survey among Italian general population (n = 5,292). Cronbach's alpha reliability coefficient was 0.87 and can be considered to be highly reliable. Construct validity was assessed first by means of a principal component analysis and then by means of confirmatory factor analysis, showing that only one factor, problem gambling, was extracted from the CPGI questionnaire (an eigenvalues of 4,684 with percentage of variance 52 %). As far as convergent validity is concerned, CPGI was compared with Lie/Bet questionnaire, a two-item screening tool for detecting problem gamblers, and with both depression and stress scales. A short form DSM-IV CIDI questionnaire was used for depression and VRS scale, a rating scale, was used for rapid stress evaluation. A strong convergent validity with these instruments was found and these findings are consistent with past research on problem gambling, where another way to confirm the validity is to determine the extent to which it correlates with other qualities or measures known to be directly related to problem gambling. In sum, despite the lack of a direct comparison with a classic gold-standard such as DSM-IV, the Italian version of CPGI exhibits good psychometric properties and can be used among the Italian general population to identify at-risk problem gamblers.

Examining the gambling behaviors of Chinese online lottery gamblers: are they rational?

In this research, we explore a unique Chinese peer to peer (P2P) online lottery gambling data (n = 388,123) and examine the rationality of Chinese online lottery gamblers. We show that Chinese online lottery gamblers are irrational in the sense that they are significantly affected by the lottery winning history of others even though this winning history is shown to be merely an exogenous random shock. Specifically, in this Chinese P2P online lottery gambling game, some of the lottery gamblers (named the proposers) propose lottery packages first, and then, other lottery gamblers (named the followers) will follow by choosing among the different packages and deciding on how much to purchase. The past lottery winning return rate of each proposer is provided as public information and calculated as the ratio between her past winning money and wager. It is shown that this past return rate is merely a random shock because winning in the past cannot predict anything about the performance in the future. However, we find that Chinese online P2P lottery gamblers are significantly more likely to join a lottery package if it is proposed by proposers with higher return rates.

Complex factors and behaviors in the gambling population of Italy

Gambling has seen significant growth globally, and particularly in Italy: it has rapidly evolved from a simple recreational activity to represent 4% of Italian GDP in 2010.A sample of 4.494 gamblers was drawn from IPSAD-Italia(®)2007-2008 (Italian Population Survey on Alcohol and Drugs) in order to examine different gambling patterns (assessed using the Canadian Problem Gambling Index Short form scale).Separate analysis was performed on young adults, age 15-24 (n = 1,241; male 56.2%), and adults, age 25-64 (n = 3,253; male 53.8%): compared with adults, Italian youth, although they gambled less (35.7% vs. 45.3%), appeared to have higher prevalence of low risk gambling (6.9% vs. 5.8%) and moderate risk or problem gambling (2.3% vs. 2.2%). Males are more likely to be moderate-risk or problem gamblers. Those with only a primary education are more likely to be moderate-risk or problem gamblers (young adults: RRR = 5.22; adults: RRR = 3.23) than those with a university education, just like those youth who use depressants, but only among younger (RRR = 3.38).A fundamental issue, "do not disapprove of gambling", seems to relate to problematic gambling: a specific Italian legislation, the Abruzzi Decree Law, could have influenced the perception that gambling may contribute positively to provide additional funds to the government for social good as well as to add needed jobs. Regardless of such potential social benefits, gambling is a social epidemic and if this association should be confirmed by more focused studies, policy makers should evaluate ways to affect this perception as soon as possible.

Gambling behavior and problems among older adults: a systematic review of empirical studies

OBJECTIVES

With the rapid aging of the population and the increased availability of gambling facilities over the past three decades, older adults may gamble more and may be increasingly at risk for problem gambling (PG) or pathological gambling disorder (PGD). To facilitate a better understanding of gambling behavior among older adults that will inform preventive strategies, this article systematically examined empirical studies on issues related to older adults' gambling.

METHOD

This article reviewed 75 empirical studies including data on the distribution and determinants of PG and PGD and the outcomes of gambling.

RESULTS

This review used the broad term of "disordered gambling" as a means to explain a continuum of problems caused by PG and PGD. The analyses covered seven topics concerning older adults' gambling behaviors: Participation rates for gambling, prevalence rates of disordered gambling, motivation for initially beginning to gamble, risk and protective factors for disordered gambling, and negative and positive health outcomes from gambling.

DISCUSSION

Based on research gaps identified in the review, this article proposes six recommendations for future studies focusing on well-being of older adults who gamble, research method issues, and taking into account older adults' inspirations and adjustment to the aging process in the 21st century.