Application of Health Belief Model to Practice of Responsible Gambling

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.

The protective effects of cognitive empathy and emotional empathy on gambling disorder are mediated by risk aversion and responsible gambling attitude

BACKGROUND

Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link.

METHODS

A convenience sample of 580 past-year lottery gamblers (Mage = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude.

RESULTS

Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude.

CONCLUSION

Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude.

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.

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.

Predictors of stockpiling behavior during the COVID-19 pandemic in Germany

Aim

With the COVID-19 pandemic, we witnessed an increase in purchases of certain products, such as toilet paper, disinfectants, or groceries. In the present study, we examined the individual and socio-psychological determinants of stockpiling behavior. For this purpose, we defined an explanatory model based on the Health Belief Model (HBM), which includes threat perceptions, barriers and benefits, and self-efficacy beliefs as main predictors of health-related behaviors, and extended the model to include social norms.

Subject and methods

Participants were recruited via social media platforms and data collection was conducted via an online survey. The final sample included 861 German respondents (male = 199, female = 642, mean age = 36.76, SD = 12.38).

Results

Perceived barriers of stockpiling, such as financial constraints or regulations in supermarkets, turned out to be the strongest predictors of stockpiling. Regarding the role of threat perception, the perceived severity of the disease in particular was positively related to stockpiling behavior. Finally, our results suggest a significant impact of social cues, showing that descriptive normative beliefs are associated with stockpiling behavior.

Conclusion

Based on these findings, we propose targeted interventions to a) reduce perceived benefits of stockpiling and severity beliefs related to COVID-19, b) emphasize disadvantages of stockpiling, and c) reduce media exposure of stockpiling behavior to prevent panic buying.

Health Inequities Among East and South Asian Gamblers During COVID-19: Key Risk Factors and Comorbidities

Online gambling during COVID-19 has been associated with a variety of risk factors and comorbidities, such as co-occurring substance use, mental health problems, and financial concerns and gambling motives. Far less is known about these impacts on ethno-cultural populations, including East and South Asian gamblers. The present study has attempted to explore the health inequities related to these comorbidities and risk factors among East and South Asian gamblers. A cross-sectional online survey of gamblers in Ontario, Canada, was carried out in August 2020-a time when most land-based gambling venues were not operating at full capacity. Descriptive statistical analyses, odds ratios, and negative binomial regression (NBR) were used to compare East and South Asian gamblers to other online gamblers in Ontario. The total survey sample of 2,012 gamblers included sub-samples of East Asian (n = 206) and South Asian gamblers (n = 107). Compared to other gamblers in Ontario, East and South Asians reported higher likelihood of severe gambling problems, risky financially focused gambling motives, gambling under the influence of alcohol, and elevated levels of mental health problems. An adjusted NBR analysis noted that East Asians were more highly involved in online gambling during the pandemic, compared to non-East Asian gamblers. This study has presented an array of factors representing potential health inequities among East and South Asian gamblers during the pandemic. These findings merit further investigation and replication in order to inform the development of appropriate support resources.

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.

Factors Influencing Gambling Behavior Among Employees in Macau Gambling Industry

Casino staff of the gambling industry seem to have a higher risk of pathological gambling than the general public because they share many previously identified risk factors, such as easy access to gambling activities. The studies in western countries reported casino staff have a higher prevalence of problematic gambling than the general public. However, some studies in Macau revealed gambling behavior among casino staff is not more common than among other residents there. A quantitative study was conducted with employees of Macau's casinos (N = 714) to understand gambling behavior among casino staff. Structural equation modeling was developed with time spent on gambling as a dependent variable, and awareness of responsible gambling, sensation-seeking tendency, psychological distress, demographic factors, peer/family pressure against gambling, and perception of expected rewards as independent variables. T-test, ANOVA, and correlations were computed for analyzing the obtained data. The structural equation modelling with the time spent on gambling as a dependent variable showed an acceptable model fit (The Chi-square = 5.567, Probability level = .696, CMIN/DF 0.696; NFI = 0.976; NNFI = 1.072; CFI = 1.000; RMSEA = 0.000). Psychological distress, sensation-seeking tendency, peer/family pressure against gambling all have significant effects on time spent on gambling. Perception of expected rewards showed the highest R square in the structural equation modeling and accounted for 77.9% cases of variance for the time spent on gambling. It is predicted that protective factors against pathological gambling include prohibition of gambling in the working venue, a satisfactory salary, and exposure to negative impacts of gambling via their job duties. Given that a high proportion of staff share most risk factors and less than 30% of respondents participated in gambling in the past year, further exploration of the protective factors from casino employees' point of view and further research on casino workers' "expected rewards" are recommended to generate ideas for improving the effectiveness of responsible gambling campaigns in future.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

The Relationship Between the Implementation of Statutory Preventative Measures, Perceived Susceptibility of COVID-19, and Personality Traits in the Initial Stage of Corona-Related Lockdown: A German and Austrian Population Online Survey

Background: Particularly during the early and middle stages of the COVID-19 pandemic, a population's compliance with precautionary measures (e.g., hygiene rules, smart working, travel restrictions, and quarantine) is paramount in preventing the virus from spreading. Objective: The investigation and documentation of different socio-demographic and personality-specific factors in regards to preventative measures and consequent specific health behaviors during the COVID-19 pandemic, based on the Health Belief Model. Method: An online survey was conducted on N = 3,006 individuals living in Germany and Austria during the early stages of lockdown. The questionnaire consisted of a self-administered section, exploring the dimensions posited in the Health Belief Model: perceived severity, perceived susceptibility, perceived barriers, perceived benefits of health-promoting measures, and engagement in health-promoting behaviors. Additionally, the following standardized scales were used to record personality determinants: the Stress Coping Style Questionnaire SVF 78 to evaluate coping and processing strategies in stressful circumstances, the Positive and Negative Affect Schedule (PANAS) to assess the emotional state induced by the coronavirus crisis, the UI-18 scale to diagnose the intolerance of uncertainty, and the State-Trait Anxiety Inventory (STAI) to assess anxiety. Results: In line with the Health Belief model, four groups were created based on perceived susceptibility and engagement in health-promoting behaviors, and consequently studied in relation to personality determinants. Those four groups differed significantly in regards to almost all personality dimensions (p ≤ 0.005). Group 1 (n = 450) shows a reduced engagement with protective measures and displays underestimation of the COVID-19-pandemic. Group 2 (n = 984) displays many positive personality variables and high compliance with protective measures. Group 3 (n = 468) perceives the subjective risk of disease as high, but high emotional discomfort and stress caused by the protective measures leads to the activation of a complex fear defense. Group 4 (n = 1,004) is highly anxious and therefore compliant. Conclusion: This typification has implications for establishing the appropriate support systems. This is particularly important to encourage compliance with preventive regulations within the groups, which showed poor abidance for several reasons. For Group 1, further education on the realistic threat and efficient protective measures is as central as the fostering of empathy for others; with its resource-conscious exemplary behavior Group 2 could be used as a positive social role model. Group 3 would benefit from promoting self-care, while Group 4 requires information on psychosocial assistance availability in order to mitigate the high stress to which the group members are subjected.

Adherence to COVID-19 Precautionary Measures: Applying the Health Belief Model and Generalised Social Beliefs to a Probability Community Sample

Background

In the face of the global pandemic of coronavirus disease‐2019 (COVID‐19), people’s adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID‐19 precautionary measures.

Methods

We conducted a telephone survey with a two‐step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18–87 years old; 60.9% women) in April 2020.

Results

Our participants showed stronger adherence to some COVID‐19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education.

Conclusions

The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID‐19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.

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.