Public Awareness and Practice of Responsible Gambling in Macao

Gambling-specific metacognitions, depression, and responsible gambling in Macao, China

The Self-regulatory Executive Function model elucidates how metacognitions link to the development and maintenance of gambling disorder, however whether, and how, metacognitions explain responsible gambling remains unknown. This study is the first to address this knowledge gap by: (a) examining whether both generic and gambling-specific metacognitions explain variances in responsible gambling; and (b) testing the mediating role of depression between generic/gambling-specific metacognitions and responsible gambling. A two-stage cluster random sampling method was used to obtain a probability sample of 837 Chinese adult gamblers (48.5 % men, mean age = 41.11, SD = 14.31) in Macao, China. Hierarchical regression analysis indicated that gambling-specific metacognitions contributed to an additional 23 % variance explained in responsible gambling after considering generic metacognitions and demographics. Path analysis further showed that the direct paths from generic, positive and negative gambling-specific metacognitions to responsible gambling were all significant while the positive type showing a stronger effect. Moreover, depression partially mediated the effects of both generic and gambling-specific metacognitions on responsible gambling. Findings suggest that responsible gambling campaigns should consider improving the awareness of metacognitions and emotion regulation in depression among Chinese adult gamblers.

Who is Getting the Message? Sociodemographic Factors and Gambling Behavior Associated with Awareness of the Swedish National Self-Exclusion Registry Spelpaus.se

Awareness and utilization of health interventions can be influenced by sociodemographic factors. These factors play a role in information processing, particularly regarding health messaging. The aim of this study is to analyze how different sociodemographic factors and gambling behaviors are associated with awareness of a (Swedish) gambling self-exclusion register. The study used data from the Swedish longitudinal gambling study (Swelogs) and analyzed n = 6720 participants from a stratified random sample of the Swedish population aged 18-84 years. Logistic regressions were conducted to analyze associations between sociodemographic characteristics, gambling behavior and awareness. Males with middle (OR = 1.70, 95% CI = 1.32-2.19) and high income (OR = 1.58, 95% CI = 1.19-2.09) and females with high (OR = 1.35, 95% CI = 1.03-1.76) and middle-level education (OR = 1.35, CI = 1.04-1.76), had higher awareness of Spelpaus.se. Online gamblers with problematic gambling behavior were three times (OR = 3.69, 95% CI = 2.15-6.37) more likely to be aware than non-gamblers. Online gamblers born in Sweden were twice (OR = 1.95, 95% CI = 1.19-3.19) as likely to be aware compared to those born outside of Europe. Males with high level of awareness had higher PGSI scores compared to women. Education could increase awareness of potential health risks and opportunities for intervention, particularly among women. Future interventions should be tailored to cater to the specific needs of individuals with lower levels of awareness, to facilitate enhancing their awareness and ultimately promoting a more equitable utilization of self-exclusion measures.

Effect of Responsible Gaming Policy and Practice on Casino Gaming Behavior

Casino gaming is considered as an entertainment but it may cause financial and psychological burdens to some individuals and their families. Therefore, casino operators have established and deployed responsible gaming policy and practice to mitigate such negative effects. This study explores whether and how responsible gaming policy and practice influences people's casino gaming intention and behavior. Data were collected from 644 Chinese adults in Macao. Results showed that responsible gaming policy and practice significantly influenced people's attitude towards casino gaming (as a legal activity and hobby), subjective norm (for disapproval of casino gaming), and perceived behavior control (for not engaging in casino gaming). Casino gaming intention was positively affected by attitude and negatively affected by subjective norm and perceived behavior control. Casino gaming behavior was positively affected by intention and negatively affected by perceived behavior control. As a whole, responsible gaming policy and practice had a small, negative but significant indirect effect on casino gaming behavior. Implications of the study were given.

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.

What is known about population level programs designed to address gambling-related harm: rapid review of the evidence

BACKGROUND

Gambling and gambling-related harm attract significant researcher and policy attention. The liberalisation of gambling in most western countries is strongly associated with a marked rise in gambling activity and increases in gambling-related harm experienced at the population level. Programs to address gambling-related harm have traditionally focused on individuals who demonstrate problematic gambling behaviour, despite clear evidence of the effectiveness of a public health approach to high-risk activities like gambling. Little is known about the availability or efficacy of programs to address gambling-related harm at a population level.

METHODS

The Victorian Responsible Gambling Foundation commissioned a rapid evidence review of the available evidence on programs designed to reduce gambling-related harm at a population level. The review was conducted using a public health and harm reduction lens. MEDLINE, ProQuest Central and PsychInfo databases were searched systematically. Included studies were published in English between 2017 - 2023 from all countries with gambling policy contexts and public health systems comparable to Australia's; included primary data; and focused on primary and/or secondary prevention of gambling-related harm or problems.

RESULTS

One hundred and sixty-seven articles were eligible for inclusion. Themes identified in the literature included: risk and protective factors; primary prevention; secondary prevention; tertiary prevention; target population group; and public health approach. The evidence review revealed a gap in empirical evidence around effective interventions to reduce gambling-related harm at the population level, particularly from a public health perspective.

CONCLUSIONS

Addressing gambling-related harm requires a nuanced, multi-layered approach that acknowledges the complex social, environmental, and commercial nature of gambling and associated harms. Moreover, evidence demonstrates community programs to reduce gambling-related harm are more successful in reducing harm when based on sound theory of co-design and address the social aspects that contribute to harm.

The Role of Self-Esteem and Self-Efficacy in Responsible Gambling

Responsible gambling (RG) refers to a set of protective strategies aiming at containing the negative consequences associated with gambling. To improve the effectiveness of RG, it is essential to understand factors influencing gamblers' adherence to RG. Past literatures on addictive behaviors have demonstrated that one's self-efficacy and self-esteem are associated with the adherence to protective behaviors of the specific addictive behaviors. The present study aims to test whether gamblers' self-esteem and RG self-efficacy can be applied to explain their adherence to protective gambling behaviors. Two hundred and thirty-six past-year gamblers were randomly selected to take part in a phone survey. Path analysis showed that both gamblers' RG self-efficacy and self-esteem were positively associated with gamblers' RG behaviors, while RG behaviors were negatively linked to the problem gambling tendency. The findings provided insight into potential promotion and intervention strategies based on self-esteem and self-efficacy and those strategies may be adopted in the primary prevention of gambling disorder.

Profiling of Gamblers and Problem Gamblers Among Casino Patrons in Macao SAR

The study is one of the first prevalence studies of gambling and problem gambling among casino patrons in Macao. It aims to identify the demographic profile of gamblers and evaluate the extent of problem gambling among casino patrons. Using a convenience sampling approach, over 6,000 people were intercepted in the proximity of casinos and were invited to answer a structured questionnaire anonymously and voluntarily. Among these people 1,352 respondents indicated that they gambled in casinos at least once in the past 12 months. Over 90% (1,228) of the respondents reported that they gambled in Macao's casinos and slot lounges. The three most popular forms of casino gambling were baccarat, Sic Bo, and slot machines. The monthly median expenditure on gambling was HKD 1,845 with a range from HKD 2 to HKD 375,175. The prevalence rates for problem gambling and pathological gambling were 15.1% and 7.1%, respectively. Implications of the study's findings are given.

Employee Perceptions of Responsible Gambling in Macao: Concepts, Indicators, and Intervention Barriers

Despite the importance of venue employees in identifying problem gamblers and making interventions, little is known concerning what role venue employees play in responsible gambling practices in Macao. This study examined what venues employees' perceptions of responsible gambling are, how they detect problem gamblers, and what barriers are impeding them from taking action. Semi-structured interviews with 49 venue staff in Macao yielded a wealth of in-depth data that were then thematically analyzed. The results indicated that employees generally understand what responsible gambling entails. While they are all confident in their ability to recognize the signs of problem gambling and provide adequate assistance to problem gamblers when asked, the majority of them rarely approach problem gamblers proactively. The barriers that prevent them from intervening were probed. The findings shed light on how to encourage venue employees to intervene on their own initiative in order to improve responsible gambling practices in Macao.

Qualitative Experience of Self-Exclusion Programs: A Scoping Review

Gambling disorder is a major public health issue in many countries. It has been defined as a persistent, recurrent pattern of gambling and is associated with substantial distress or impairment, lower quality of life, and living with a plurality of psychiatric problems. Many people suffering from gambling disorder seek help in ways other than formal treatment seeking, including self-management strategies. One example of responsible gambling tools that has gained popularity in recent years is self-exclusion programs. Self-exclusion entails individuals barring themselves from a gambling venue or a virtual platform. The aim of this scoping review is to summarize the literature on this topic and to explore participants' perceptions and experiences with self-exclusion. An electronic literature search was conducted on 16th May 2022 in the following databases: Academic Search Complete, CINAHL Plus with Full Text, Education Source, ERIC, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, APA PsychInfo, Social Work Abstracts, and SocINDEX. The search yielded a total of 236 articles, of which 109 remained after duplicates were removed. After full-text reading, six articles were included in this review. The available literature shows that although there are many barriers and limitations to the current self-exclusion programs, self-exclusion is generally viewed as an effective responsible gambling strategy. There is a clear need to improve the current programs by increasing awareness, publicity, availability, staff training, off-site venue exclusion, and technology-assisted monitoring, as well as by adopting more holistic management approaches to gambling disorders in general.

Satisfaction of Basic Psychological Needs and Adherence to Responsible Gambling Practices: The Mediating Role of Flourishing

Responsible gambling (RG) is a practical approach to contain potential gambling-associated harms to an acceptable level. However, few studies have proposed a theoretical framework to account for significant individual differences in RG adherence, which hinders an effective RG promotion in public. To address this missing link, the current study aims to identify psychological need factors associated with adherence to RG practices. We applied the self-determination theory (SDT) to explore the association between the satisfaction of basic psychological needs (i.e., relatedness, competency, and autonomy) and RG adherence in a probability Chinese community adult sample (N = 1002; 55.7% women and M _age = 44.28 years), acquired from a telephone survey conducted in the 2018 fall with a two-stage cluster random sampling method. We found that the three types of basic needs satisfaction were significantly and positively related to RG adherence via a full mediation of flourishing. The findings provide practical insights to understanding individual differences in RG adherence and designing corresponding SDT-based interventions for gambling communities globally.

The prospective effect of purpose in life on gambling disorder and psychological flourishing among university students

BACKGROUND AND AIMS

Gambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.

METHODS

In this study, a total of 283 university students (39.6% females; age = 18-27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.

RESULTS

The results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = -0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.

CONCLUSION

The findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

The prospective effect of purpose in life on gambling disorder and psychological flourishing among university students

BACKGROUND AND AIMS

Gambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.

METHODS

In this study, a total of 283 university students (39.6% females; age = 18-27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.

RESULTS

The results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = -0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.

CONCLUSION

The findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

Validation and Application of the Positive Play Scale Adapted for Chinese Gamblers: Its Relation to Disordered Gambling and Gambling Attitudes

The Positive Play Scale (PPS) was designed to track the effectiveness of responsible gambling (RG) policy, with a focus on positive changes in beliefs and behaviors instead of the absence of problem gambling symptoms. The current study aimed to (1) validate the Positive Play Scale Adapted for Chinese gamblers (PPS-AC) using a probability Chinese community sample in Macao, (2) explore the relationships between the PPS-AC and symptoms of gambling disorder (GD), and (3) evaluate the associations of gambling attitudes with the PPS-AC. Through a two-step random sampling procedure, we interviewed 1,002 locally dwelling Macao Chinese adults (44.3% males; M_age = 44.28 years, SD_age = 17.35 years) by phone, in which 237 were past-year gamblers (49.8% males; M_age = 40.76 years, SD_age = 15.78 years). Results showed that a two-dimension structure fitted the data well for both the positive play behaviors scale and the positive play beliefs scale of the PPS-AC among past-year gamblers. In addition to findings of satisfactory internal consistency, the convergent validity of the PPS-AC was supported by its significant association with RG self-efficacy. All four PPS-AC constructs were negatively correlated with GD symptoms, whereas two behavior constructs of the PPS-AC significantly explained the variance of GD symptoms with negative valences. All gambling attitude dimensions were associated with at least one PPS-AC construct. The current study was the first to adapt the PPS on a probability Chinese community sample and extended its applicability. The findings support the PPS-AC as a reliable and valid tool for assessing positive play, which was negatively associated with symptoms of disordered gambling. Further, the significant associations between gambling attitudes and the PPS-AC provide insights for RG policies.

Application of Health Belief Model to Practice of Responsible Gambling

Responsible gambling (RG) strategies seem to be effective only to some people and it is unclear why some gamblers are more likely to adhere to RG practices (e.g., self-exclusion and setting limits). The current study investigated whether cognitive factors, including RG awareness and Health Belief Model (HBM) factors (i.e., perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cue to action, and self-efficacy), accounted for individual differences in adherence to ten common RG practices. Eight hundred and ninety-six community-dwelling adults were recruited to participate in a telephone poll in Macao, China, in November 2016. We found that only 56.1% of the respondents had heard of RG, and there was a positive relation between RG awareness and RG practices. Moreover, HBM factors were also shown to explain one's adherence to RG practices in general but the effectiveness of HBM factors varied across RG practices. The findings provided practical implications that there is a need to target different cognitive beliefs for promoting different RG practices in designing intervention.