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Tran LT, Wardle H, Colledge-Frisby S, Taylor S, Lynch M, Rehm J, Volberg R, Marionneau V, Saxena S, Bunn C, Farrell M, Degenhardt L. The prevalence of gambling and problematic gambling: a systematic review and meta-analysis. Lancet Public Health 2024; 9:e594-e613. [PMID: 39025095 DOI: 10.1016/s2468-2667(24)00126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Gambling behaviours have become of increased public health interest, but data on prevalence remain scarce. In this study, we aimed to estimate for adults and adolescents the prevalence of any gambling activity, the prevalence of engaging in specific gambling activities, the prevalence of any risk gambling and problematic gambling, and the prevalence of any risk and problematic gambling by gambling activity. METHODS We performed a systematic review and meta-analysis. We systematically searched for peer-reviewed literature (on MEDLINE, Embase, and PsycInfo) and grey literature to identify papers published between Jan 1, 2010, and March 4, 2024. We searched for any gambling, including engagement with individual gambling activities, and problematic gambling data among adults and adolescents. We included papers that reported the prevalence or proportion of a gambling outcome of interest. We excluded papers of non-original data or based on a biased sample. Data were extracted into a bespoke Microsoft Access database, with the Joanna Briggs Institute Critical Appraisal Tool used to identify the risk of bias for each sample. Representative population survey estimates were firstly meta-analysed into country-level prevalence estimates, using metaprop, of any gambling, any risk gambling, problematic gambling, and by gambling activity. Secondly, population-weighted regional-level and global estimates were generated for any gambling, any risk gambling, problematic gambling, and specific gambling activity. This review is registered on PROSPERO (CRD42021251835). FINDINGS We screened 3692 reports, with 380 representative unique samples, in 68 countries and territories. Overall, the included samples consisted of slightly more men or male individuals, with a mean age of 29·72 years, and most samples identified were from high-income countries. Of these samples, 366 were included in the meta-analysis. Globally, 46·2% (95% CI 41·7-50·8) of adults and 17·9% (14·8-21·2) of adolescents had gambled in the past 12 months. Rates of gambling were higher among men (49·1%; 45·5-52·6) than women (37·4%; 32·0-42·5). Among adults, 8·7% (6·6-11·3) were classified as engaging in any risk gambling, and 1·41% (1·06-1·84) were engaging in problematic gambling. Among adults, rates of problematic gambling were greatest among online casino or slots gambling (15·8%; 10·7-21·6). There were few data reported on any risk and problematic gambling among adolescent samples. INTERPRETATION Existing evidence suggests that gambling is prevalent globally, that a substantial proportion of the population engage in problematic gambling, and that rates of problematic gambling are greatest among those gambling on online formats. Given the growth of the online gambling industry and the association between gambling and a range of public health harms, governments need to give greater attention to the strict regulation and monitoring of gambling globally. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Lucy T Tran
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Heather Wardle
- School of Social and Political Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia; National Drug Research Institute Melbourne, Curtin University, Melbourne, VIC, Australia
| | - Sophia Taylor
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Lynch
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Volberg
- School of Public Health and Health Science, University of Massachusetts, Amherst, MA, USA
| | - Virve Marionneau
- Centre for Research on Addiction, Control, and Governance, University of Helsinki, Helsinki, Finland
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Manu E, Acquah F, Douglas M, Akitty E, Zanu EP, Ampomah MA, Adoma PO. Betting high, feeling low: a cross-sectional examination of gambling severity and psychological distress among Ghanaian youth. BMC Public Health 2024; 24:2032. [PMID: 39075355 PMCID: PMC11287856 DOI: 10.1186/s12889-024-19550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Little is known about the nexus between online gambling and psychological distress among youth, especially in Ghana. This study aimed to investigate the effects of online sports betting on psychological distress, focusing on depression, anxiety, and stress among young individuals in the Volta region of Ghana. METHODS A cross-sectional study was carried out at various betting centers in the Volta region of Ghana. Four hundred and three (403) participants were selected using a multi-stage sampling method. The study used a standardized questionnaire to assess psychological distress with the Depression, Anxiety, and Stress Scale (DASS 21) and problematic gambling with the Problem Gambling Severity Index (PGSI). The analysis included both descriptive and inferential methods. These include the implementation of the bootstrap technique within multiple regression models using the current versions of Jeffreys's Amazing Statistics Program (JASP) [0.18.2], Statistical Package for the Social Sciences (SPSS) [29.0.2], and Microsoft Excel (2019). RESULTS The study found a prevalence of 40% for problematic gambling and 44% for moderate gambling problems among participants, resulting in an overall gambling prevalence of 84%. Regarding psychological distress, the estimated prevalence of depression among participants was 43.6%, with stress reported at 31.1% and anxiety at 68.8%. The overall prevalence of psychological distress was 48%. When analyzing the link between gambling and psychological distress, the study noted that males were more prone to gambling-related psychological distress than females (β = 2.036, p = 0.025). Furthermore, individuals with problem gambling showed the highest probability of experiencing more significant psychological distress compared to other groups (β = 9.228, p = 0.002), followed by those with moderate gambling levels (β = 3.283, p = 0.002). CONCLUSION We recommend that the mental health unit of the Ghana Health Service, in collaboration with the Gaming Commission of Ghana, should develop youth-friendly interventions to address the prevalence and onset of problematic gambling among the youth, especially males. This could, in turn, reduce the prevalence of psychological distress among youth engaged in online gambling in Ghana.
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Affiliation(s)
- Emmanuel Manu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Francis Acquah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Mbuyiselo Douglas
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
| | - Emmanuel Akitty
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Emefa Priscilla Zanu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Mary Akua Ampomah
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Prince Owusu Adoma
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
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Gambling in Sub-Saharan Africa: Traditional Forms and Emerging Technologies. CURRENT ADDICTION REPORTS 2022; 9:373-384. [PMID: 36312763 PMCID: PMC9595076 DOI: 10.1007/s40429-022-00449-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/18/2022]
Abstract
Purpose of Review The gambling industry in Africa has seen substantial growth and evolution over recent years with a growing body of literature describing these shifts. Here, we provide a narrative synthesis of the extant literature on the origins, trends and consequences of the expansion and intensification of the commercial gambling industry in sub-Saharan Africa with a reference for future research on gambling as a growing public health concern. Recent Findings The historical shift and permeation of gambling in sub-Saharan Africa is diverse with evidence of certain countries following a neo-colonial logic. Advances in technology have made gambling more accessible and created new markets in Africa. A key motive driving gambling on the continent is a lack of stable employment. While the intensification and growth of Africa’s gambling industry has brought economic benefits to some African investors and individuals, this has been accompanied by a range of gambling harms. Legislation and policies designed to better regulate the gambling industry and redress these harms are needed. In this context, a small number of services and campaigns designed to mitigate gambling harms demonstrate promise, but more research is needed in this area. Summary The gambling industry in sub-Saharan Africa has undergone a dramatic transformation. While it is true that the growth of the African gambling industry has provided an additional revenue stream to governments, it is also necessary to acknowledge the concurrent rise in gambling addiction and the health-related and social harms that it elicits. As such, designing effective regulatory measures and policy interventions that can reduce the public health burden of gambling harms is vital. However, these interventions need to take in to account the significance of cultural differences that exist among countries on the continent.
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Prevalence and Determinants of Problem Gambling among Internal Migrants in Muse, Myanmar, near the Border with China. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-019-00061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nabifo SC, Izudi J, Bajunirwe F. Alcohol consumption and sports-betting among young male motorcycle taxi boda boda riders in urban southwestern Uganda. BMC Public Health 2021; 21:363. [PMID: 33593353 PMCID: PMC7885426 DOI: 10.1186/s12889-021-10406-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background The popularity of sports-betting is growing globally and may be associated with alcohol consumption among young adults. In this study, we examine the relationship between alcohol consumption plus other substances with sports-betting in a group of young adult males in Uganda. Methods We conducted a cross-sectional study and interviewed male motorcycle taxi boda boda riders in the southwestern Uganda town of Mbarara. We asked questions about alcohol consumption, smoking plus history and frequency of sports-betting. Results We enrolled 401 riders. The median age was 29.0 years, interquartile range 25–32 years. Seventy four (18.5%) had engaged in sports-betting in the past 30 days. Among those that reported sports-betting, 16(21.6%) engaged daily or almost daily. Alcohol use was significantly associated with sports-betting with an adjusted risk ratio (aRR) of 2.08(95% CI 1.36, 3.18) among moderate drinkers but not among heavy drinkers in comparison to low or non-drinkers. Cigarette smoking was significantly associated with sports-betting with an aRR 1.85(95% CI 1.13, 3.01). Conclusion Sports-betting is common among these young male motorcycle riders, and is associated with both alcohol consumption and cigarette smoking. Interventions to regulate sports-betting may be co-packaged with those to reduce alcohol consumption and cigarette smoking among young adult males. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10406-7.
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Affiliation(s)
- Stella Cheryl Nabifo
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, P.O.BOX 1410, Mbarara, Uganda.
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Gambling Patterns and Problem Gambling Among Youth in Sub-Saharan Africa: A Systematic Review. J Gambl Stud 2021; 37:723-745. [PMID: 33484393 DOI: 10.1007/s10899-021-10001-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
Mounting evidence suggests that youth in sub-Saharan Africa (SSA) find themselves increasingly drawn to gambling related activities; an issue, that if left unchecked, can lead to adverse consequences including financial difficulties, crime and mental health problems. To better understand the psychosocial mechanisms underlying problem gambling, there is a pressing need to conduct more research on gambling related disorders amongst this vulnerable stratum of society. Against this background, the present review explores gambling patterns, attitudes and behaviors among youth in SSA-in a manner aligning with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched 8 databases including PubMed, Science Direct, Scopus, ProQuest, Wiley Online, Google Scholar, PsycINFO and PsycARTICLES for published research articles up until July 2019. A total of 1624 articles were screened, of which, only 13 studies met inclusion criteria. All of these studies were cross-sectional in nature and the quality of each study was evaluated using the Newcastle-Ottawa Scale. Studies varied considerably ranging from neuropsychological and personality trait assessment to application of item response theory. Due to this study heterogeneity we could not conduct a meta-analysis. The results presented here suggest that the existing body of evidence pertaining to patterns of gambling-related harm among youth in SSA is weak. This study highlights the need for additional good quality studies focusing on gambling related behaviors and prevalence levels among the continent's youth. Additionally, the findings reported herein emphasise the need for implementing social policies alongside effective public health interventions to tackle gambling addiction.
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Odame SK, Quarshie ENB, Oti-Boadi M, Andoh-Arthur J, Asante KO. Adolescent Problem Gambling in Rural Ghana: Prevalence and Gender Differentiation. J Gambl Stud 2020; 37:83-105. [PMID: 33179195 PMCID: PMC7882566 DOI: 10.1007/s10899-020-09987-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
Problem gambling among young people is now a public health challenge in sub-Saharan Africa. However, the behaviour remains understudied, particularly, among rural-dwelling young people in countries within the subregion. We aimed to estimate the 12 months prevalence of problem gambling and to describe the overall and gender differences and commonalities in personal factors and social adversities associated with problem gambling among adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana; we used the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) questionnaire to assess problem gambling during the previous 12 months. Personal lifestyle and psychosocial variables were assessed using adopted items from the 2012 WHO–Global School-based Student Health Survey. Overall, three in 10 adolescents (3 in 10 females; 4 in 10 males) in rural Ghana reported problem gambling in the previous 12 months. Female adolescents who experienced problem gambling were more likely to report family-related social adversities, while adolescent male problem gambling was associated with school-related factors and interpersonal factors outside the family context. Regardless of gender, sexual abuse victimisation was associated with three times increase in the odds of experiencing problem gambling. Relative to the prevalence of gambling among adolescents in urban contexts in other countries within sub-Saharan Africa, the estimates of problem gambling among in-school rural adolescents in Ghana are higher. Although further studies are needed to understand the nuances of the behaviour, the evidence of this study underscores the need for general and targeted health promotion, intervention and prevention efforts to mitigate the family, school, and interpersonal social adversities associated with adolescent problem gambling in rural Ghana.
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Affiliation(s)
| | - Emmanuel Nii-Boye Quarshie
- School of Psychology, University of Leeds, Lifton Place, Leeds, LS2 9JT, West Yorkshire, UK. .,Department of Psychology, University of Ghana, Legon, Accra, Ghana.
| | - Mabel Oti-Boadi
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
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Bunn C, Mtema O, Songo J, Udedi M. The growth of sports betting in Malawi: corporate strategies, public space and public health. Public Health 2020; 184:95-101. [PMID: 32466981 DOI: 10.1016/j.puhe.2020.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/09/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Gambling is increasingly positioned as a public health issue, with links to a wide range of harms for individuals, communities and societies. Malawi has experienced a rapid rise in the availability of high street and online sports betting services, situated in a context of extreme inequality and poverty. We aim to document the strategies through which a leading sports betting firm have established a market worth MK2.1bn, to inform future initiatives to mitigate gambling-related harm. STUDY DESIGN A case study of strategies deployed by a leading firm to grow a sports betting market in Malawi. METHODS We undertook a qualitative media analysis of articles from six major Malawian news outlets and combined this with photographic evidence relating to company advertising and presence in Malawian public space. Data were analysed thematically and triangulated to generate a typology of corporate strategies. RESULTS We collected 39 articles and 15 photographs. After we screened the articles, we analysed 27 and identified seven corporate strategies: adopt a mobile network franchise model; use media coverage; purchase high-visibility advertising; sponsor locally; build association with (European) football; appeal to aspects of hegemonic masculinity; construct narratives of individual and collective benefit. CONCLUSION Malawi has been exposed to a sophisticated set of corporate strategies aimed at growing a sports betting market. These strategies have been successful, and it is likely that a range of foreseeable gambling-related harms are affecting Malawi. We offer suggestions for how policy-makers and public health professionals might respond.
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Affiliation(s)
- C Bunn
- College of Social Sciences, University of Glasgow, United Kingdom; Malawi Epidemiology and Intervention Research Unit, Malawi.
| | | | - J Songo
- Malawi Epidemiology and Intervention Research Unit, Malawi
| | - M Udedi
- Non-Communicable Diseases Unit, Ministry of Health, Malawi
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9
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Ross D. Addiction is socially engineered exploitation of natural biological vulnerability. Behav Brain Res 2020; 386:112598. [PMID: 32184156 DOI: 10.1016/j.bbr.2020.112598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 11/26/2022]
Abstract
Interdisciplinary study of addiction is facilitated by relative unification of the concept. What should be sought is not formal unification through literal analytic definition, which would undermine practical flexibility within disciplines and intervention practices. However, leading controversies around whether addiction should be conceived as a 'disease', and over whether addiction is 'chosen' behavior, are made more difficult to resolve by failure to apply philosophical reflection on these general concepts. Such reflection should be sensitive to two kinds of constraint: coherence in description of empirical, including neuroscientific, observation, and utility in framing normative goals in treatment and policy design. Following review of various interpretations of addiction, disease, and choice across contributing disciplines, it is concluded that addiction is most plausibly viewed as a disease at the scale of public health research and policy, but not personal (e.g. clinical) management and intervention. Addicts must make choices to recover, and in that respect addiction is a 'disorder of choice'. However, it is concluded that the most relevant sense of 'disorder' arises at the social rather than the personal scale.
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Affiliation(s)
- Don Ross
- School of Society, Politics, and Ethics, University College Cork, 4 Elderwood, College Road, Cork, T12 AW89, Ireland; School of Economics, University of Cape Town, Private bag, Rondebosch, 7701, South Africa; Center for Economic Analysis of Risk, Georgia State University, Robinson College of Business, 35 Broad Street, 11th Floor, Atlanta, GA 30303 USA
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Ssewanyana D, Bitanihirwe B. Problem Gambling among Young People in Sub-Saharan Africa. Front Public Health 2018; 6:23. [PMID: 29479527 PMCID: PMC5811642 DOI: 10.3389/fpubh.2018.00023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/23/2018] [Indexed: 12/30/2022] Open
Abstract
Gambling is a cross-cultural and global activity which typically involves the wagering of money or an item of monetary value on an outcome that is governed by chance. Although gambling is positioned as a legitimate recreational and leisure activity within sub-Saharan Africa (SSA), there is widespread recognition among healthcare professionals and policy-makers that gambling has the capacity to become dysfunctional in a minority. Emerging knowledge suggests that problem gambling is rapidly evolving in to a public health concern in SSA, especially among youth. This article focuses on problem gambling among young people in SSA with an emphasis on three key themes: (1) gambling behavior and patterns in SSA; (2) public health and socioeconomic implications of gambling in SSA; and (3) public health policies and interventions for addressing this issue. We believe that collaborative efforts between government, prevention specialists, legislators, researchers, treatment providers, and other stake holders can influence the uptake of research findings necessary to implement social policies and design effective public health intervention options to combat problem gambling and its associated implications among young people in SSA.
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Affiliation(s)
- Derrick Ssewanyana
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.,Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands
| | - Byron Bitanihirwe
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, United States
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11
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Skaal L, Sinclair H, Stein DJ, Myers B. Problem Gambling Among Urban and Rural Gamblers in Limpopo Province, South Africa: Associations with Hazardous and Harmful Alcohol Use and Psychological Distress. J Gambl Stud 2016; 32:217-30. [PMID: 25631703 DOI: 10.1007/s10899-015-9522-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about the mental health correlates of problem gambling in low- and-middle-income countries such as South Africa and whether these correlates vary by urbanicity. To address this gap, we examined mental health factors associated with problem gambling among gamblers in Limpopo Province, South Africa disaggregated by rural, peri-urban and urban location. A survey of gambling behaviour and mental health was conducted among 900 gamblers. Overall, 28.3 % were at high risk and 38.1 % were at moderate risk for problem gambling. For the entire sample, hazardous/harmful alcohol use was associated with almost twofold increased chance of being at moderate risk (AOR 1.83; 95 % CI 1.08, 3.11) and almost sevenfold greater odds (AOR 6.93; 95 % CI 4.03-11.93) of being at high risk for problem gambling. Psychological distress was associated with being at high risk for problem gambling only (AOR 1.18; 95 % CI 1.14-1.22). After stratifying by urbanicity, hazardous/harmful alcohol use and psychological distress remained associated with high risk gambling across all locations. We found little knowledge of a free gambling helpline and other gambling services-particularly in less urbanised environments [χ(2) (2), 900 = 40.4; p < 0.001]. These findings highlight the need to increase awareness of free helpline services among gamblers and to ensure gambling services include screening and treatment for common mental disorders.
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Affiliation(s)
- Linda Skaal
- Department of Public Health, University of Limpopo, Turfloop Campus, University Road, Mankweng, 0727, South Africa.
| | - Heidi Sinclair
- Department of Psychiatry and Mental Health, University of Cape Town, J2 Groote Schuur Hospital, Anzio Road, Observatory, South Africa.
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, J2 Groote Schuur Hospital, Anzio Road, Observatory, South Africa.
| | - Bronwyn Myers
- Department of Psychiatry and Mental Health, University of Cape Town, J2 Groote Schuur Hospital, Anzio Road, Observatory, South Africa. .,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa.
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Urban MF, Olivier L, Viljoen D, Lombard C, Louw JG, Drotsky LM, Temmerman M, Chersich MF. Prevalence of fetal alcohol syndrome in a South African city with a predominantly Black African population. Alcohol Clin Exp Res 2015; 39:1016-26. [PMID: 25941030 DOI: 10.1111/acer.12726] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) and fetal alcohol syndrome (FAS) are common in some South African populations, notably those of mixed ancestry descent in rural areas and small towns. Little is known about FAS/FASD prevalence in the majority of South Africans: city dwellers of Black African ethnicity. This study describes the prevalence of FAS in a South African city, comparing 2 suburbs with predominantly mixed ancestry (Roodepan) and Black African (Galeshewe) populations that house over 60% of the city population. METHODS We conducted a tiered, active case ascertainment study for the prevalence of FAS and also detected some less clinically specific FASD cases. All first-grade learners in the 2 suburbs were eligible for anthropometric screening, and screen-positive learners were assessed for dysmorphic features of FAS. Those with suggestive clinical features received neurocognitive assessment, and maternal or collateral interview. Final diagnosis was made following a case conference. RESULTS Complete ascertainment of FAS status was made in 1,503 (94.7%) of 1,587 eligible learners (435 in Roodepan and 1,152 in Galeshewe). Overall, FAS was diagnosed in 83 (5.5%, 95% confidence interval [CI] = 4.4 to 6.8) learners and FASD in 96 (6.4%, 95% CI = 5.2 to 7.7). Levels of FAS were high in both areas: 26 (6.3%, 95% CI = 4.2 to 9.2) learners from Roodepan, compared to 57 (5.2%, 95% CI = 4.0 to 6.7) from Galeshewe (p = 0.39). No cases were previously diagnosed. The mortality rate for mothers of FASD children from Galeshewe was 19 of 65 (29%), compared to 3 of 31 (9.7%; p = 0.03) for Roodepan. Interviewed mothers in Galeshewe were older and had higher body mass index. CONCLUSIONS Prevalence of FAS is high in both Galeshewe and Roodepan, and the lack of prior diagnoses indicates that awareness remains low. The maternal mortality rate was especially high in Galeshewe. The unexpectedly high burden of FAS in an urban area with predominantly Black African population mandates extension of surveillance and intervention measures in southern Africa.
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Affiliation(s)
- Michael F Urban
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Leana Olivier
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Denis Viljoen
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Chanelle Lombard
- Division of Molecular Biology and Human Genetics, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.,Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | - Jacobus G Louw
- Foundation for Alcohol Related Research (FARR), Cape Town, South Africa
| | | | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium
| | - Matthew F Chersich
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Ghent, Belgium.,Wits Reproductive Health and HIV Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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