Relationship Between Gambling Severity and Attitudes in Adolescents: Findings from a Population-Based Study

The prevalence of gambling and problematic gambling: a systematic review and meta-analysis

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.

Income Inequality and the Odds of Online Gambling Among a Large Sample of Adolescents in Canada

Consistent evidence points to the detrimental effects of income inequality on population health. Income inequality may be associated with online gambling, which is of concern since gambling is a risk factor for adverse mental health conditions, such as depression and suicide ideation. Thus, the overall objective of this study is to study the role of income inequality on the odds of participating in online gambling. Data from 74,501 students attending 136 schools participating in the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) survey were used. The Gini coefficient was calculated based on school census divisions (CD) using the Canada 2016 Census linked with student data. We used multilevel modeling to explore the association between income inequality and self-reported participation in online gambling in the last 30 days, while controlling for individual- and area-level characteristics. We examined whether mental health (depressive and anxiety symptoms, psychosocial wellbeing), school connectedness, and access to mental health programs mediate this relationship. Adjusted analysis indicated that a standardized deviation (SD) unit increase in Gini coefficient (OR = 1.17, 95% CI 1.05, 1.30) was associated with increased odds of participating in online gambling. When stratified by gender, the association was significant only among males (OR = 1.12, 95% CI 1.03, 1.22). The relationship between higher income inequality and greater odds for online gambling may be mediated by depressive and anxiety symptoms, psychosocial well-being, and school connectedness. Evidence points to further health consequences, such as online gambling participation, stemming from exposure to income inequality.

Differences in problem and pathological gambling: A narrative review considering sex and gender

Background and aim

A wide range of studies indicates that men and women with Problem (PrG) and Pathological Gambling (PG) differ in several clinical and sociodemographic characteristics. However, evidence for sex differences, such as the telescoping effect, is contradictory, and it is still unclear whether sex differences observed in offline gambling can also be found for online gambling. Furthermore, reviews have so far focused on binary sex differences but neglect gender aspects. In this study, an updated literature survey of sex- and gender-related differences in PrG and PG was conducted.

Methods

We searched PsyInfo, Medline/Pubmed, and the Web of Science databases from 2005 to 2020 for studies investigating sex and gender differences in gambling. A total of 126 papers were included in the literature survey.

Results

We are presenting our findings according to the categories 'prevalence' (offline, online, LGBTQI*), 'sociodemographic factors', 'preferred gambling type', 'gambling motives', 'severity', 'progression of gambling problems', 'use of professional help/motivation for treatment', 'comorbidity', 'trauma', 'violence and criminality/delinquency'. The studies indicate that, despite some robust sex differences (e.g., concerning prevalence rates), results for most areas were mixed or suggest no sex differences (e.g., violence, gambling motives).

Discussion and conclusion

To date, there is a lack of studies assessing gender, and not only sex, warranting further research in this area.

Gambling Among Finnish 14-16-Year-Old Adolescents Before (2008-2009), During (2010-2011), and After (2013-2017) Setting the Legal Age Limit of 18 for Gambling and the Role of Socio-Economic Status

Legislation prohibiting minors from engaging in gambling is a gambling policy measure set to protect adolescents from the harmful effects of gambling. The Finnish gambling system is based on a state monopoly, regulated by the Lotteries Act. After an amendment to the Lotteries Act, the new minimum legal gambling age was raised to 18 years old between 2010 and 2011. The main purpose of this study was to discover how the amendment to the act altered adolescents' gambling (14-16-year-olds) and to examine whether the amendment decreased socio-economic differences. Adolescents gambling was studied before (2008-2009), during (2010-2011), and after (2013-2017) the age limit of gambling was raised in Finland. The study based on five waves (2008-2009, 2010-2011, 2013, 2015, 2017) of the national repeated cross-sectional School Health Promotion Study. Cross-tabulations where gambling was studied by study year and socio-economic status (SES) were formulated, and the statistical differences were studied by using χ²-tests. Percentage change in gambling frequency was also examined by study year and SES. Study years were analyzed separately to model the weekly gambling via logistic regression models. Adolescent gambling significantly decreased over time. It appears that raising the legal gambling age had a permanent effect on under-aged gambling. However, differences in gambling by adolescents' family's SES increased during the study period, indicating widening inequalities in gambling among adolescents. Diminishing inequalities in adolescent gambling is likely to require both societal action and consensus on adolescent gambling being a significant social and public health concern.

Attitudes, Risk Factors, and Behaviours of Gambling among Adolescents and Young People: A Literature Review and Gap Analysis

Gambling is occurring in a rapidly changing landscape, with new trends and technologies affecting gambling behaviour and problem gambling across a range of populations. Gambling activity among adolescents and young people has received considerable research attention due to a high prevalence of gambling reported among these groups in recent years. Despite legislation worldwide to constrain gambling among adolescents and young people, modern technology, such as online gaming apps and online gambling venues, has significantly increased their exposure to the risks of problem gambling. It is important, therefore, to have up to date information about what is currently known about gambling and to explore gaps in our knowledge. This gap analysis presents the results of a systematic approach to reviewing the current literature on gambling behaviour, attitudes, and associated risk factors for gambling and problem gambling among adolescents and young adults (aged 10-25 years). The review included studies published between January 2015 and August 2020 and included 85 studies for final synthesis. Findings reveal further research is needed on the implications for young people of emerging technologies and new trends in gambling in the digital age. The current gap analysis reveals that this should include more research on the development and impact of both treatment and intervention strategies, and policy and regulatory frameworks from a public health perspective.

Interaction of Socioeconomic Status with Risky Internet Use, Gambling and Substance Use in Adolescents from a Structurally Disadvantaged Region in Central Europe

BACKGROUND AND AIMS

The current level of knowledge concerning the effect of socioeconomic status (SES) on internet use, gambling, and substance use in structurally disadvantaged regions is scarce. The objective of this study was an investigation of the relationship between SES and risky internet use, gambling and substance use in a structurally disadvantaged region in Central Europe.

METHODS

A cross-sectional survey was conducted among high school students (n = 1063) in a Czech structurally disadvantaged region in autumn 2017. Binary Logistic Regression models were applied to data from the modified Excessive Internet Use scale (mEIUS), a standard tool for measuring the risk of addictive behavior on the internet and the risk of excessive gaming. Other data were collected using the Lie/Bet (problematic gambling), CAGE (acronym of the key words: cut, angry, guilty and eye-opener), and the Cannabis Abuse Screening Test (CAST) (problematic alcohol/cannabis use) tools.

RESULTS

There were statistically significant differences between at-risk and not-at-risk groups in addictive behavior on the internet and gaming, while none were found in problematic gambling. Individual dimensions of SES showed significant effects on substance use. Regarding parenting styles, significant differences were found only in the risk of addictive behavior on the internet or gaming between the authoritarian and authoritative styles. Being engaged in behavioral addictions with one´s parents increased the odds of the behavioral addiction risk and decreased the odds of the substance addiction risk. Engagement with one´s parents in substance addictions decreased the odds of the behavioral addiction risk and increased the odds of the substance addiction risk.

DISCUSSION AND CONCLUSIONS

The results point at specific relations between SES and the risk of addictive behaviors on the internet and gaming within structurally disadvantaged regions. The results of SES and/or structurally disadvantaged region measures obtained in research, policy-making, and care-provision may improve the focus of actions taken.

The Impact of Addictive Behaviors on Adolescents Psychological Well-Being: The Mediating Effect of Perceived Peer Support

Studies exploring excessive Internet use and gambling are rapidly expanding concerns regarding its impact on mental health, especially in young people due to the increased prevalence of Internet and gambling addictions. Research suggests that perceived peer support plays a significant role in adolescents' psychological well-being. However, no empirical study has dealt with the mediating effect of perceived peer support on the relationship between Internet and gambling addictions and psychological well-being. Thus, the present study aimed to examine whether perceived peer support mediates the relation between Internet and gambling addictions and psychological well-being of adolescents. A sample of 347 Iranian adolescents aged 14 to 18 (Mean age 16.14, 50.4% male) who were studying in Kuala Lumpur, Malaysia participated in this study. Subjective Vitality Scale (SVS), Compulsive Internet Use Scale (CIUS), Six-item Social Support Questionnaire (SSQ6), and The South Oaks Gambling Screen (SOGS) were used to collect data. Mediation analyses showed a significant indirect effect of compulsive Internet use and problem gambling on psychological well-being through perceived peer support. The total effects of compulsive Internet use and problem gambling on psychological well-being were negative. This study implies the significance of strengthening the knowledge about the impact of peer relationships among adolescents.

Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations

BACKGROUND

Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored.

METHODS

To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups.

RESULTS

Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group.

CONCLUSION

Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.

Prevalence of youth gambling and potential influence of substance use and other risk factors throughout 33 European countries: first results from the 2015 ESPAD study

BACKGROUND AND AIMS

Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross-country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on-/off-line mode and to examine the association with individual and family characteristics and substance use.

DESIGN

Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study, a survey using self-administered anonymous questionnaires.

SETTING

Thirty-three European countries.

PARTICIPANTS

Sixteen-year-old-year-old students (n = 93 875; F = 50.8%).

MEASUREMENTS

The primary outcome measure was prevalence of past-year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring).

FINDINGS

A total of 22.6% of 16-year-old students in Europe gambled in the past year: 16.2% on-line, 18.5% off-line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39-1.53), life-time use of inhalants (OR = 1.57, 95% CI = 1.47-1.68) and other substances (OR = 1.78, 95% CI = 1.65-1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18-1.35), going out at night (OR = 1.32, 95% CI = 1.26-1.38), participating in sports (OR = 1.30, 95% CI = 1.24-1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79-0.86), parents' monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77-0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84-0.94).

CONCLUSIONS

Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

Relationships Between Perceived Family Gambling and Peer Gambling and Adolescent Problem Gambling and Binge-Drinking

The study systematically examined the relative relationships between perceived family and peer gambling and adolescent at-risk/problem gambling and binge-drinking. It also determined the likelihood of at-risk/problem gambling and binge-drinking as a function of the number of different social groups with perceived gambling. A multi-site high-school survey assessed gambling, alcohol use, presence of perceived excessive peer gambling (peer excess-PE), and family gambling prompting concern (family concern-FC) in 2750 high-school students. Adolescents were separately stratified into: (1) low-risk, at-risk, and problem/pathological gambling groups; and, (2) non-binge-drinking, low-frequency-binge-drinking, and high-frequency-binge-drinking groups. Multinomial logistic regression showed that relative to each other, FC and PE were associated with greater likelihoods of at-risk and problem/pathological gambling. However, only FC was associated with binge-drinking. Logistic regression revealed that adolescents who endorsed either FC or PE alone, compared to no endorsement, were more likely to have at-risk and problem/pathological gambling, relative to low-risk gambling. Adolescents who endorsed both FC and PE, compared to PE alone, were more likely to have problem/pathological gambling relative to low-risk and at-risk gambling. Relative to non-binge-drinking adolescents, those who endorsed both FC and PE were more likely to have low- and high-frequency-binge-drinking compared to FC alone or PE alone, respectively. Family and peer gambling individually contribute to adolescent at-risk/problem gambling and binge-drinking. Strategies that target adolescents as well as their closely affiliated family and peer members may be an important step towards prevention of harm-associated levels of gambling and alcohol use in youths.

Adolescent Gambling-Oriented Attitudes Mediate the Relationship Between Perceived Parental Knowledge and Adolescent Gambling: Implications for Prevention

Although substantial research has provided support for the association between parental practices and adolescent gambling, less is known about the role of adolescent attitudes in this relationship. The primary purpose of this study was to test an integrative model linking perceived parental knowledge (children's perceptions of their parents' knowledge of their whereabouts and companions) with adolescent gambling while evaluating the mediating effects of adolescents' own gambling approval, risk perception of gambling, and descriptive norms on gambling shared with friends. The data were drawn from the ESPAD® Italia 2012 (European School Survey Project on Alcohol and Other Drugs) study, which is based on a nationally representative sample of Italian adolescent students aged 15-19. The analysis was carried out on a subsample of 19,573 subjects (average age 17.11, 54 % girls). Self-completed questionnaires were administered in the classroom setting. The results revealed that adolescents who perceived higher levels of parental knowledge were more likely to disapprove of gambling and show higher awareness of its harmfulness, which were in turn negatively related to gambling frequency. They were also less likely to perceive their friends as gamblers, which was also negatively related to gambling frequency. These findings suggest that gambling prevention efforts should consider perceived parental knowledge and gambling-oriented attitudes (self-approval, risk perception, and descriptive norms) as factors that may buffer adolescent gambling behavior in various situations.

Income Inequality and Adolescent Gambling Severity: Findings from a Large-Scale Italian Representative Survey

Background: Studies have shown that problems related to adult gambling have a geographical and social gradient. For instance, adults experiencing gambling-related harms live in areas of greater deprivation; are unemployed, and have lower income. However, little is known about the impact of socioeconomic inequalities on adolescent problem gambling. The main purpose of the present study was to investigate the contextual influences of income inequality on at-risk or problem gambling (ARPG) in a large-scale nationally representative sample of Italian adolescents. A secondary aim was to analyze the association between perceived social support (from family, peers, teachers, and classmates) and ARPG. Methods: Data from the 2013-2014 Health Behavior in School-aged Children Survey (HBSC) Study was used for cross-sectional analyses of ARPG. A total of 20,791 15-year-old students completed self-administered questionnaires. Region-level data on income inequality (GINI index) and overall wealth (GDP per capita) were retrieved from the National Institute of Statistics (Istat). The data were analyzed using the multi-level logistic regression analysis, with students at the first level and regions at the second level. Results: The study demonstrated a North-South gradient for the prevalence of ARPG, with higher prevalence of ARPG in the Southern/Islands/Central Regions (e.g., 11% in Sicily) than in Northern Italy (e.g., 2% in Aosta Valley). Students in regions of high-income inequality were significantly more likely than those in regions of low-income inequality to be at-risk or problem gamblers (following adjustment for sex, family structure, family affluence, perceived social support, and regionale wealth). Additionally, perceived social support from parents and teachers were negatively related to ARPG. Conclusions: Income inequality may have a contextual influence on ARPG. More specifically, living in regions of highest income inequality appeared to be a potential factor that increases the likelihood of becoming an at-risk or problem gambler. Findings of the study suggest that wealth distribution within societies affected by economic policies may indirectly have an influence adolescent gambling behaviors.

Gender Invariance of the Gambling Behavior Scale for Adolescents (GBS-A): An Analysis of Differential Item Functioning Using Item Response Theory

As there is a lack of evidence attesting the equivalent item functioning across genders for the most employed instruments used to measure pathological gambling in adolescence, the present study was aimed to test the gender invariance of the Gambling Behavior Scale for Adolescents (GBS-A), a new measurement tool to assess the severity of Gambling Disorder (GD) in adolescents. The equivalence of the items across genders was assessed by analyzing Differential Item Functioning within an Item Response Theory framework. The GBS-A was administered to 1,723 adolescents, and the graded response model was employed. The results attested the measurement equivalence of the GBS-A when administered to male and female adolescent gamblers. Overall, findings provided evidence that the GBS-A is an effective measurement tool of the severity of GD in male and female adolescents and that the scale was unbiased and able to relieve truly gender differences. As such, the GBS-A can be profitably used in educational interventions and clinical treatments with young people.

Social support as a mediator between problem behaviour and gambling: a cross-sectional study among 14-16-year-old Finnish adolescents

BACKGROUND

During the adolescent period, risk-taking behaviour increases. These behaviours can compromise the successful transition from adolescence to adulthood. The purpose of this study was to examine social support as a mediator of the relation between problem behaviour and gambling frequency among Finnish adolescents.

METHODS

Data were obtained from the national School Health Promotion Study (SHPS) from the years 2010 and 2011 (N=102 545). Adolescents were classified in the most homogeneous groups based on their problem behaviour via latent class analysis.

RESULTS

Path analysis indicated that social support was negatively associated with problem behaviour, and problem behaviour and social support were negatively related (except for social support from friends among boys) to gambling. Social support from parents and school mediated, albeit weakly, the relations between problem behaviour and gambling among girls and boys.

CONCLUSIONS

Problem behaviour may affect gambling through social support from school and parents. Thus prevention and intervention strategies should focus on strengthening adolescents' social support. In addition, because of the clustering of different problem behaviours instead of concentrating on a single form of problem behaviour multiple-behaviour interventions may have a much greater impact on public health.

Experience with Gambling in Late Childhood and Early Adolescence: Implications for Substance Experimentation Behavior

OBJECTIVE

Previous research among late adolescents suggests an additive association between levels of engagement in gambling and vulnerability to substance use disorder. The aim of our research was to investigate the frequency of gambling experience in childhood and early adolescence and to examine the association between alcohol/cigarette/energy drink consumption and gambling in this young population.

METHODS

A survey called "Pinocchio" was conducted during the 2013 to 2014 school year at primary and secondary schools in Padua (north-eastern Italy) on a sample of 1325 students in sixth to eighth grade (11-13 year olds). Multilevel analysis, taking the school-level variance into account, established an adjusted association between gambling and attitude to risk-taking among early adolescents.

RESULTS

Among eighth graders, 45.8% of the boys and 35.4% of the girls reported at least 1 type of gambling. In a fully-adjusted model, having experience of gambling confers a higher likelihood of being consumers (at least once a month) of other substances (alcohol, cigarettes, energy drinks, or marijuana).

CONCLUSION

Gambling behavior is widespread among adolescents. An association with other risk-taking behavior was found in this study, and this provides further evidence of the need for a greater awareness of gambling behavior in early adolescence.

Correlates of gambling on high-school grounds

OBJECTIVE

This study examined adolescent gambling on school grounds (GS+) and how such behavior was associated with gambling-related attitudes. Further, we examined whether GS+ moderated associations between at-risk problem-gambling (ARPG) and gambling behaviors related to gambling partners.

METHOD

Participants were 1988 high-school students who completed survey materials. Demographic, perceptions, attitudes, and gambling variables were stratified by problem-gambling severity (ARPG versus recreational gambling) and GS+ status. Chi-square and adjusted logistic regression models were used to examine relationships among study variables.

RESULTS

Nearly 40% (39.58%) of students reported past-year GS+, with 12.91% of GS+ students, relative to 2.63% of those who did not report gambling on school grounds (GS-), meeting DSM-IV criteria for pathological gambling (p<0.0001). In comparison to GS- students, GS+ students were more likely to report poorer academic achievement and more permissive attitudes towards gambling behaviors. Weaker links in GS+ students, in comparison with GS-, students, were observed between problem-gambling severity and gambling with family members (interaction odds ratio (IOR)=0.60; 95% CI=0.39-0.92) and gambling with friends (IOR=0.21; 95% CI=0.11-0.39).

CONCLUSIONS

GS+ is common and associated with pathological gambling and more permissive attitudes towards gambling. The finding that GS+ (relative to GS-) youth show differences in how problem-gambling is related to gambling partners (friends and family) warrants further investigation regarding whether and how peer and familial interactions might be improved to diminish youth problem-gambling severity. The high frequency of GS+ and its relationship with ARPG highlights a need for school administrators and personnel to consider interventions that target school-based gambling.