Challenges in the Conceptualisation and Measurement of Gambling-Related Harm

Gambling Harm Experienced by Children Exposed to Parental Gambling: An Online Survey of Australians

Although child wellbeing is known to be negatively affected by gambling, relatively little is known about the specific harms experienced by children exposed to parental gambling problems. The current study aimed to better understand gambling harm directly attributed to regular parental gambling in key areas of child wellbeing: financial, psychological, interpersonal wellbeing and intergenerational transmission of problem gambling. Using data from a national survey of Australian adults exposed to parental gambling under the age of 18 (n = 211), the results show that parental gambling was related significant levels of financial harm, abuse, neglect as well as relational and psychological problems as a direct result of parental gambling. The likelihood of experiencing gambling harms was positively associated with parental problem gambling severity. Harmful impacts of parental gambling as a child were also associated with a range of psychological problems in adulthood including depression, anxiety, Post-Traumatic Stress Disorder and intimate partner violence victimisation. Parental problem gambling severity was negatively associated with own lifetime gambling problems, suggesting a specific pattern of intergenerational transmission of problem gambling in children of regular, or heavy, gamblers. This research highlights the need for more supports for families with children in which at least one parent gambles regularly.

US Taxation of Gambling Winnings and Incentives to Bet

Sports betting is growing rapidly in the US after its legalization by the Supreme Court in 2018. This paper describes the treatment of gambling winnings and losses in the federal tax code and shows how the system may incentivize some gamblers to substantially increase the scale of their betting in order to have a chance to win. This incentive stems from the fact that gambling losses can only be deducted if taxpayers are filing for itemized deductions, meaning the scale of gambling losses has to be large enough to push a taxpayer's eligible deductions over the standard deduction. This incentive to engage in large-scale betting applies mostly to lower and middle-income households.

Designing Improved Safer Gambling Messages for Race and Sports Betting: What can be Learned from Other Gambling Formats and the Broader Public Health Literature?

Safer gambling messages are one potential input to a public health approach toward reducing gambling-related harm, and yet there is no strong evidence supporting current messages such as "gamble responsibly" or "keep the fun in the game". Furthermore, sports betting is increasing in popularity in multiple jurisdictions, such as Australia and the US, increasing the need to design effective messaging campaigns for race and sports betting. Compared to other gambling formats, such as electronic gambling machines, the level of potential skill involved in race and sports betting may raise unique issues regarding the design of effective messages. This review first highlights research from the related public health domains of alcohol and tobacco. Then, five potential areas for further messaging-based research in race and sports betting are discussed: teaching safer gambling practices, correcting gambling misperceptions, boosting conscious decision making, norm-based messages, and emotional messages. A broad approach to message design is encouraged, given the potential for individual differences in message receptivity, and for frequently-repeated messages to be ignored or cause negative psychological reactance.

Separating problem gambling behaviors and negative consequences: Examining the factor structure of the PGSI

There is some uncertainty on how to best conceptualise and measure problem gambling and debate as to whether it is helpful to differentiate the behavioral features of problematic gambling from the negative consequences of gambling. The current study explores this issue by examining the factor structure of a commonly-used problem gambling measure, the Problem Gambling Severity Index (PGSI), as administered to respondents in the 2018 Northern Territory Gambling Prevalence and Wellbeing Survey (n = 3,740 gamblers). Confirmatory factor analyses revealed a two-factor solution offered significant improvement in fit over the one-factor model. Further, the two factors explained unique variance in the number of gambling-related harms experienced by respondents. Although the two factors were highly correlated, the current findings indicate problem gambling behaviors are related to the negative consequences of gambling, but these are not necessarily synonymous. This suggests isolating behavioral and consequential elements of gambling may have utility in public health interventions for gambling that, while concerning, falls below a clinically-significant threshold. Similarly, clinically-oriented research may benefit by measuring the behavioral features, as these components are important targets for individual-level interventions.

The Modified Yale Food Addiction Scale May Be Simplified and Diagnostically Improved: The Same Prevalence but Different Severity and Risk Factors of Food Addiction among Female and Male Students

The Yale Food Addiction Scale (YFAS) is the most commonly used scale for measuring food addiction (FA). The previous approach to the YFAS and its subsequent versions assumed dichotomization of items, separating addiction symptoms and clinical significance items, and factorial validity testing on a subset of items. In this paper, we discuss the drawbacks associated with these procedures. In addition, we present a different analytical approach to investigate the validity of the modified YFAS (mYFAS) along with an alternative scoring method that overcomes limitations related to the previous approach. After establishing the structure of the mYFAS, we investigated the potential antecedents and consequences of FA separately for men and women. The sample consisted of 1182 Polish undergraduate students (613 women, 559 men, 10 missing values on gender) with a mean age of 20.33 years (SD = 1.68; range: 18–36). They were asked to complete self-report questionnaires measuring FA, personality traits (Big Five), self-esteem, narcissism, self-efficacy, social anxiety, loneliness, and well-being indicators. Due to the low content, factorial, and clinical validity, the first three items were excluded from the Polish version of the mYFAS. The six-item mYFAS demonstrated measurement invariance, allowing for meaningful comparisons between genders and yielded almost identical prevalence rates for men and women. The hierarchical multiple regression analysis showed that, narcissism, and social anxiety predicted FA in both genders, whereas important gender differences in antecedents were also noted. In addition, FA was associated with body mass index (BMI) and most of the well-being indicators, even after controlling for relevant variables. The findings suggest that our modified analytical approach allows researchers to measure FA using a valid, useful, and simple tool.

Development and validation of a prediction model for online gambling problems based on players' account data

BACKGROUND AND AIMS

Gambling disorder is characterized by problematic gambling behavior that causes significant problems and distress. This study aimed to develop and validate a predictive model for screening online problem gamblers based on players' account data.

METHODS

Two random samples of French online gamblers in skill-based (poker, horse race betting and sports betting, n = 8,172) and pure chance games (scratch games and lotteries, n = 5,404) answered an online survey and gambling tracking data were retrospectively collected for the participants. The survey included age and gender, gambling habits, and the Problem Gambling Severity Index (PGSI). We used machine learning algorithms to predict the PGSI categories with gambling tracking data. We internally validated the prediction models in a leave-out sample.

RESULTS

When predicting gambling problems binary based on each PGSI threshold (1 for low-risk gambling, 5 for moderate-risk gambling and 8 for problem gambling), the predictive performances were good for the model for skill-based games (AUROCs from 0.72 to 0.82), but moderate for the model for pure chance games (AUROCs from 0.63 to 0.76, with wide confidence intervals) due to the lower frequency of problem gambling in this sample. When predicting the four PGSI categories altogether, performances were good for identifying extreme categories (non-problem and problem gamblers) but poorer for intermediate categories (low-risk and moderate-risk gamblers), whatever the type of game.

CONCLUSIONS

We developed an algorithm for screening online problem gamblers, excluding online casino gamblers, that could enable the setting of prevention measures for the most vulnerable gamblers.

Benchmarking gambling screens to health-state utility: the PGSI and the SGHS estimate similar levels of population gambling-harm

BACKGROUND

Both the Problem Gambling Severity Index (PGSI) and the Short Gambling Harms Screen (SGHS) purport to identify individuals harmed by gambling. However, there is dispute as to how much individuals are harmed, conditional on their scores from these instruments. We used an experienced utility framework to estimate the magnitude of implied impacts on health and wellbeing.

METHODS

We measured health utility using the Short Form Six-Dimension (SF-6D), and used this as a benchmark. All 2603 cases were propensity score weighted, to balance the affected group (i.e., SGHS 1+ or PGSI 1+ vs 0) with a reference group of gamblers with respect to risk factors for gambling harm. Weighted regression models estimated decrements to health utility scores attributable to gambling, whilst controlling for key comorbidities.

RESULTS

We found significant attributable decrements to health utility for all non-zero SGHS scores, as well as moderate-risk and problem gamblers, but not for PGSI low-risk gamblers. Applying these coefficients to population data, we find a similar total burden for both instruments, although the SGHS more specifically identified the subpopulation of harmed individuals. For both screens, outcomes on the SF-6D implies that about two-thirds of the 'burden of harm' is attributable to gamblers outside of the most severe categories.

CONCLUSIONS

Gambling screens have hitherto provided nominal category membership, it has been unclear whether moderate or 'at-risk' scores imply meaningful impact, and accordingly, population surveys have typically focused on problem gambling prevalence. These results quantify the health utility decrement for each category, allowing for tracking of the aggregate population impact based on all affected gamblers.

Gambling Outlets Location in Urban Areas: A Case Study of Madrid

Cities are certainly a key factor in the location of gambling facilities. This paper aims to map the location of gambling outlets in urban areas and to examine potential links between neighborhoods socioeconomic and demographic characteristics and gambling supply, taking into account spatial dependencies of neighboring areas. This correlation is of interest because neighborhood characteristics may attract sellers, and because the presence of gambling sellers may cause changes in neighborhood demographics. Using detailed official data from the city of Madrid for the year 2017, three spatial econometric approaches are considered: spatial autoregressive (SAR) model, spatial error model (SEM) and spatial lag of X (explicative variables) model (SLX). Empirical analysis finds a strong correlation between neighborhoods characteristics and co-location of gambling outlets, highlighting a specific geographic patterning of distribution within more disadvantaged urban areas. This may have interesting implications for gambling stakeholders and for local governments when it comes to the introduction and/or increase of gambling availability.

Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men

Background

Sexual minority men (SMM) often experience stressful social environments dominated by stigma and discrimination. SMM are typically more likely than heterosexual men to engage in certain risky behaviours such as problem gambling. This study aimed to compare gambling behaviour among SMM and examine potential risk factors (erroneous gambling cognitions, gambling outcome expectancies, hazardous alcohol use, impulsivity, and psychological distress; as well as perceived stigma and discrimination for the SMM participants) and potential protective factors (resilience, social support, and community connectedness) for problem gambling severity and gambling-related harms among SMM living in Australia.

Methods

An online survey, with an over-representation of SMM participants and problem, moderate-risk, and low-risk gamblers, was completed by 101 SMM (mean age = 28.5) and 207 heterosexual men (mean age = 26.4).

Results

SMM were found to have significantly lower levels of problem gambling severity compared with heterosexual men, and report significantly lower gambling participation, frequencies and expenditure on any gambling activity, casino table games, horse racing/greyhound betting, sports betting, and keno. However, in the SMM group, 38.3% were classified in the problem gambling category of the Problem Gambling Severity Index and 27.6% were classified in the moderate-risk gambling category. There were no significant differences between groups in gambling-related harms. Multiple regression analyses revealed that problem gambling severity and related harms were independently predicted by higher levels of impulsivity and erroneous gambling cognitions for both groups.

Conclusions

Lower frequency of gambling behaviours among SMM and similar risk factors predicting problem gambling severity/harms for both groups suggests that problem gambling is not pronounced among SMM. This study adds new evidence to the gambling literature which can be used as comparative benchmarks for future research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00597-4.

Measuring Gambling Harm: The Influence of Response Scaling on Estimates and the Distribution of Harm Across PGSI Categories

Recent research has shown that harm is not just a feature of problem gambling, but can also be observed in other lower risk categories. Some debates exist, however, as to the distribution of harm across these categories and how harm should be best measured. This study was designed to examine how estimates of self-reported harm are affected by the methodology used. A particular focus was on how harm estimates for low and higher risk gambling (as classified by the PGSI) varied when respondents were able to make more graded attributions of their harm to gambling. An online panel sample of 554 gamblers responded to a brief survey that included the PGSI, measures of gambling harm drawn from Browne et al. (Assessing gambling-related harm in Victoria: a public health perspective, Victorian Responsible Gambling Foundation, Melbourne, 2016) as well as questions about demographics and gambling habits. The recruitment was designed to obtain good representation of each PGSI group, with 23% found to be problem gamblers; 36% moderate risk and 21% low risk gamblers. In support of Browne et al. (2016), the findings showed that higher proportions of harm in low risk gamblers is likely to be identified when one uses binary or 'any harm' scoring, but that this effect mostly disappears when more graded scoring or attribution of harm measures are used. Higher risk PGSI groups consistently reported more harms and more serious harms than lower risk groups. It was concluded that the measurement of gambling harm and its estimated distribution over PGSI categories is quite sensitive to how it is measured.

Predictors of gambling and problem gambling in Canada

OBJECTIVES

The purpose of this study is to provide an updated profile of gamblers and problem gamblers in Canada and to identify characteristics most strongly associated with problem gambling.

METHODS

An assessment of gambling participation and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 23,952 individuals 18 years and older. Descriptive statistics provided a demographic profile for each type of gambling involvement as well as category of gambler (non-gambler, non-problem gambler, at-risk gambler, problem gambler). A logistic regression identified characteristics that best distinguished problem from non-problem gamblers.

RESULTS

Gambling participation and problem gambling both varied as a function of gender, income, educational attainment, and race/ethnicity. However, multivariate analysis identified electronic gambling machine (EGM) participation to be the primary predictor of problem gambling status, with race/ethnicity, presence of a mood disorder, male gender, casino table game participation, older age, a greater level of smoking, participation in speculative financial activity, instant lottery participation, lower household income, and lottery or raffle ticket participation providing additional predictive power. Provincial EGM density and EGM participation rates are also very strong predictors of provincial rates of at-risk and problem gambling.

CONCLUSION

Problem gambling has a biopsychosocial etiology, determined by personal vulnerability factors combined with the presence of riskier types of gambling such as EGMs. Effective prevention requires a multifaceted approach, but constraints on the availability and operation of EGMs would likely have the greatest single public health benefit.

The Evolution of Gambling-Related Harm Measurement: Lessons from the Last Decade

Jurisdictions around the world have a self-declared mandate to reduce gambling-related harm. However, historically, this concept has suffered from poor conceptualisation and operationalisation. However, recent years have seen swift advances in measuring gambling harm, based on the principle of it being a quantifiable decrement to the health and wellbeing of the gambler and those connected to them. This review takes stock of the background and recent developments in harm assessment and summarises recent research that has validated and applied the Short Gambling Harms Screen and related instruments. We recommend that future work builds upon the considerable psychometric evidence accumulated for the feasibility of direct elicitation of harmful consequences. We also advocate for grounding harms measures with respect to scalar changes to public health utility metrics. Such an approach will avoid misleading pseudo-clinical categorisations, provide accurate population-level summaries of where the burden of harm is carried, and serve to integrate gambling research with the broader field of public health.

The identification of Australian low-risk gambling limits: A comparison of gambling-related harm measures

BACKGROUND AND AIMS

Problem gambling severity and gambling-related harm are closely coupled, but conceptually distinct, constructs. The primary aim was to compare low-risk gambling limits when gambling-related harm was defined using the negative consequence items of the Problem Gambling Severity Index (PGSI-Harm) and the Short Gambling Harms Scale items (SGHS-Harm). A secondary aim was compare low-risk limits derived using a definition of harm in which at least two harms across different domains (e.g. financial and relationship) were endorsed with a definition of harm in which at least two harms from any domain were endorsed.

METHODS

Data were collected from dual-frame computer-assisted telephone interviews of 5,000 respondents in the fourth Social and Economic Impact Study (SEIS) of Gambling in Tasmania. Receiver operating characteristic (ROC) curve analyse were conducted to identify low-risk gambling limits.

RESULTS

PGSI-Harm and SGHS-Harm definitions produced similar overall limits: 30-37 times per year; AUD$510-$544 per year; expenditure comprising no more than 10.2-10.3% of gross personal income; 400-454 minutes per year; and 2 types of gambling activities per year. Acceptable limits (AUC ≥0.70) were identified for horse/dog racing, keno, and sports/other betting using the PGSI definition; and electronic gaming machines, keno, and bingo using the SGHS definition. The requirement that gamblers endorse two or more harms across different domains had a relatively negligible effect.

DISCUSSION AND CONCLUSIONS

Although replications using alternative measures of harm are required, previous PGSI-based limits appear to be robust thresholds that have considerable potential utility in the prevention of gambling-related harm.

The Gambling Consumption Mediation Model (GCMM): A Multiple Mediation Approach to Estimate the Association of Particular Game Types with Problem Gambling

Bivariate associations of problem gambling with participation in particular game types often decrease when adjusting for demographics or consumption behavior (e.g., number of game types played). A summary of 14 peer-reviewed studies showed inconsistencies as well as conceptual and methodological challenges. The aim of this study was to expand previous research by a combination of (1) sophisticated feature-engineering, which disaggregates gambling intensity into facets within and beyond a game type of interest, and (2) the application of mediation models. Data comprised last year gamblers of three merged cross sectional Icelandic gambling surveys of 2007, 2011, and 2017 (N = 4422). For each of 15 game types (12-month time frame), a parallel multiple mediation model was applied to disaggregate bivariate associations of last year game type participation and problem gambling (Problem Gambling Severity Index) by six mediating mechanisms: (1) demographic problem gambling propensity, (2) number of game types played, (3) gambling frequency within the type, (4) maximum gambling frequency across all types beyond, (5) usual spending within the type, (6) maximum usual spending across all types beyond. Games showed two distinct profiles via which mediator they mostly impacted problem gambling: Electronic gaming machines offline, scratch cards offline, live betting online, and poker offline as well as online impacted problem gambling mostly via gambling frequency within, whereas all other types mostly impacted via the number of game types played. The applied mediation models answer the question by which mechanism game types impact problem gambling in a more exhaustive way than previous research.

Is there a health inequality in gambling related harms? A systematic review

Background

Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.

Primary and secondary outcome measures

Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article.

Methods

We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.

Results

A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.

Conclusion

Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10337-3.

The association between gambling and financial, social and health outcomes in big financial data

Gambling is an ordinary pastime for some people, but is associated with addiction and harmful outcomes for others. Evidence of these harms is limited to small-sample, cross-sectional self-reports, such as prevalence surveys. We examine the association between gambling as a proportion of monthly income and 31 financial, social and health outcomes using anonymous data provided by a UK retail bank, aggregated for up to 6.5 million individuals over up to 7 years. Gambling is associated with higher financial distress and lower financial inclusion and planning, and with negative lifestyle, health, well-being and leisure outcomes. Gambling is associated with higher rates of future unemployment and physical disability and, at the highest levels, with substantially increased mortality. Gambling is persistent over time, growing over the sample period, and has higher negative associations among the heaviest gamblers. Our findings inform the debate over the relationship between gambling and life experiences across the population.

Opportunity Costs or Not? Validating the Short Gambling Harm Screen against a Set of "Unimpeachable" Negative Impacts

Assessing the harmful consequences of gambling is an area of active investigation. One measure intended to capture gambling-related harm is the 10-item short gambling harm screen (SGHS). Although good psychometric properties have been reported, it has been suggested that the screen's less severe probes may not represent genuinely harmful consequences, but rather may reflect rational opportunity costs. Consequently, it has been argued that the screen may lead to overestimation of the extent of gambling-related harm in the population. The current study sought to examine the psychometric performance of three less severe suspect items in the SGHS. Associations between each of these items and a specially constructed scale of relatively severe "unimpeachable" gambling harms were calculated from archival data from 5551 Australian and New Zealand gamblers. All three suspect items, both individually and upon aggregation, predicted greater endorsement of "unimpeachable" harms, and indicated the presence of gambling problems. Moreover, the SGHS as a whole is highly correlated with "unimpeachable" gambling harms. Including suspect items in the SGHS was found to improve predictions of low- and moderate-risk gambling status, but slightly decreased predictions of severe gambling problems. The results are inconsistent with the notion that SGHS harm probes capture either inconsequential consequences or opportunity costs. They confirm prior findings that harm symptomatology is unidimensional, and that the report of multiple more prevalent, but less severe, harms serves as an effective indicator of the spectrum of experienced harm.

Charting a path towards a public health approach for gambling harm prevention

Aim

Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model.

Methods

A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally.

Results

The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance.

Conclusion

Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development.

The Development of Empirically Derived Australian Low-Risk Gambling Limits

This study derived a set of Australian low-risk gambling limits and explored the relative and absolute risk associated with exceeding these limits. Secondary analysis of population-representative Tasmanian and Australian Capital Territory (ACT) cross-sectional (11,597 respondents) and longitudinal studies (2027 respondents) was conducted. Balancing sensitivity and specificity, the limits were: gambling frequency of 20–30 times per year; gambling expenditure of AUD $380–$615 per year (USD $240–$388 per year); gambling expenditure comprising 0.83–1.68% of gross personal income; and two types of gambling activities per year. All limits, except number of activities, predicted subsequent harm, with limits related to gambling expenditure consistently the best-performing. Exceeding the limits generally conferred a higher degree of relative and absolute risk, with gamblers exceeding the limits being 3–20 times more likely to experience harm than those who do not, and having a 5–17% risk of experiencing harm. Only 7–12% of gamblers exceeding the limits actually experienced harm. Gambling consumption lower than the limits also conferred a considerable amount of harm. Using a relative risk method, this study derived similar limits from disparate Australian states and territories. These limits can serve as working guidelines for the consideration of researchers, clinicians, and policy makers, but need to be subject to further rigorous empirical investigation.

A framework for indirect elicitation of the public health impact of gambling problems

Gambling problems are increasingly understood as a health-related condition, with harms from excessive time and money expenditure contributing to significant population morbidity. In many countries, the prevalence of gambling problems is known with some precision. However, the true severity of gambling problems in terms of their impact on health and wellbeing is the subject of ongoing debate. We firstly review recent research that has attempted to estimate harm from gambling, including studies that estimate disability weights using direct elicitation. Limitations of prior approaches are discussed, most notably potential inflation due to non-independent comorbidity with other substance use and mental health conditions, and potential biases in the subjective attribution of morbidity to gambling. An alternative indirect elicitation approach is outlined, and a conceptual framework for its application to gambling is provided. Significant risk factors for propensity to develop gambling problems are enumerated, and relative risks for comorbidities are calculated from recent meta-analyses and reviews. Indirect elicitation provides a promising alternative framework for assessing the causal link between gambling problems and morbidity. This approach requires implementation of propensity score matching to estimate the counterfactual, and demands high quality information of risk factors and comorbid conditions, in order to estimate the unique contribution of gambling problems. Gambling harm is best understood as a decrement to health utility. However, achieving consensus on the severity of gambling problems requires triangulation of results from multiple methodologies. Indirect elicitation with propensity score matching and accounting for comorbidities would provide an important step towards full integration of gambling within a public health paradigm.

Use of Self-control Strategies for Managing Gambling Habits Leads to Less Harm in Regular Gamblers

There is little research on the control strategies used by the general public to self-manage gambling habits and avoid harmful consequences. The current study sought to identify the most common self-control strategies of people who gamble regularly, the characteristics of those who use them, and assess the effectiveness of limit-setting strategies in reducing gambling-related harm. We recruited a large sample (N = 10,054) of Canadian adults who reported gambling activity in the past 12 months. Participants completed a survey that assessed gambling habits, use of control strategies including quantitative limit setting, and gambling related harm. The most common control strategies were setting predetermined spending limits, tracking money spent, and limiting alcohol consumption. The number of self-control strategies used by gamblers was positively associated with gambling involvement, annual income, problem gambling severity and playing electronic gaming machines. Approximately 45% of respondents failed to adhere to self-determined quantitative limits for spending, frequency, and time spent gambling. People who stayed within their gambling limits were less likely to report harm even after controlling for other risk factors. However, the effectiveness of remaining within one's personal spending limit decreased for those whose limits exceed $200CAN monthly. The findings support public health interventions that promote lower-risk gambling guidelines aimed at helping gamblers stay within spending, frequency and duration limits.

The Frantic Seeking of Credit during Poker Machine Problem Gambling: A Public Health Perspective

(1) Background: Financial harms associated with problem gambling are substantial and result in suicidal ideation, depression, anxiety and relationship damage, causing distress for problem gamblers and their families. This paper examines Electronic Gaming Machine gamblers’ frantic use of credit during episodes of gambling as a substantial public health burden. (2) Methods: This qualitative study comprised 29 participants purposefully selected who participated in either focus groups or in-depth interviews, which were analysed using thematic, textual analysis. (3) Results: Ready access to credit in the gambling venues enabled problem gamblers to engage in desperate credit transactions to continue to gamble. Many showed frantic, repeated patterns of e-credit withdrawal, which may be typical of gambling while “in the zone”, when it is highly likely that the gamblers are not able to make informed decisions about the use of credit. This pattern of the electronic withdrawal of cash may well be recognisable electronically by financial institutions in real-time, as part of a duty of care potentially owed by banks to their customers. It would provide an opportunity for the identification of people at financial risk due to gambling and systemic intervention to limit the financial harm at a time when financial decision-making is impaired. (4) Conclusions: Although this finding needs further confirmation, there are significant implications for harm minimisation and early intervention for affected PGs. It also raises the issue of the ‘duty of care’ owed to PG customers by financial institutions.

The Conceptual Framework of Harmful Gambling: A revised framework for understanding gambling harm

BACKGROUND AND AIMS

The Conceptual Framework of Harmful Gambling moves beyond a symptoms-based view of harm and addresses a broad set of factors related to the risks and effects of gambling harmfully at the individual, family, and community levels. Coauthored by international research experts and informed by multiple stakeholders, Gambling Research Exchange (GREO) facilitated the framework development in 2013 and retains responsibility for regular updates and mobilization. This review article presents information about the revised version of the Conceptual Framework of Harmful Gambling completed in late 2018.

METHODS

We describe eight interrelated factors depicted in the framework that represent major themes in gambling ranging from the specific (gambling environment, exposure, gambling types, and treatment resources) to the general (cultural, social, psychological, and biological influences). After outlining the framework development and collaborative process, we highlight new topics for the recent update that reflect changes in the gambling landscape and prominent discourses in the scientific community. Some of these topics include social and economic impacts of gambling, and a new model of understanding gambling related harm.

DISCUSSION AND CONCLUSIONS

We address the relevance of the CFHG to the gambling and behavioral addictions research community. Harm-based frameworks have been undertaken in other areas of addiction that can both inform and be informed by a model dedicated to harmful gambling. Further, the framework brings a multi-disciplinary perspective to bear on antecedents and factors that co-occur with harmful gambling.

Face validity evaluation of screening tools for gaming disorder: Scope, language, and overpathologizing issues

AIM

Critics of gaming disorder (GD; i.e., Internet gaming disorder in the DSM-5; Gaming disorder in the ICD-11) have expressed concerns about the potential risks of misclassification (e.g., false positives). An important consideration of relevance to this discussion is the extent to which commonly used screening instruments contain appropriate, sensible, and relevant items. The aim of this review was to evaluate the face validity of items within current tools for GD.

METHODS

A systematic review of databases identified 29 instruments. An item bank (n = 417 items) was independently evaluated by three professional raters (i.e., a senior academic in clinical psychology, a senior psychometrician, and an academic/clinical psychologist) according to guidelines for defining and measuring addiction and gaming disorder.

FINDINGS

Evaluation of the item bank identified issues related to: scope (i.e., "scope creep" or items of questionable relevance); language (i.e., confusing language, unusual wording or syntax); and overpathologizing (i.e., pathologizing typical and/or beneficial aspects or consequences of gaming). A total of 71 items across 23 tools had at least one face validity issue.

CONCLUSIONS

Most items (83%) demonstrated satisfactory face validity and were consistent with either the DSM-5 or ICD-11 GD classification. However, many tests contain at least one item that may pathologize normal gaming behaviors. Such items refer to basic changes in mood when gaming, a desire to play or continue playing games, and experiencing immersion when gaming. This analysis highlights the challenges of screening for problematic behaviors that are thought to arise within the context of normal recreational activities.