Do EGMs have a Stronger Association with Problem Gambling than Racing and Casino Table Games? Evidence from a Decade of Australian Prevalence Studies

Brief Report: The Rise of Online Betting in Ontario

In this paper we examine the nature of calls for the Ontario Problem Gambling Helpline from June 2021 to Jan 2023 to determine if the increased marketing of online and sports gambling has changed the nature of calls to the helpline. An interrupted time series model comparing the monthly calls before and after the expansion of online gambling and advertising (April 2023), found a significant effect. Calls related to the other games examined did not have a significant interrupted time series effect of from the expansion and advertising of online gambling. The results of this analysis clearly indicate an association between the expansion of legalized gambling and gambling advertising with the number of people who call the helpline for problem related to online gambling.

Behavioural Tracking and Profiling Studies Involving Objective Data Derived from Online Operators: A Review of the Evidence

Studies involving the analysis of objective data from online operators attempt to address common concerns about biases in self-report research. This paper surveys the progress in this area of research over the last 15 years. The findings highlight many areas of achievement, including: the development of a set of behavioural markers that reliably differentiate variations in gambler risk. Online gamblers can be grouped into clusters based on the intensity and frequency of gambling; behavioural variability; or, signs of over-commitment (e.g., deposit frequency or expenditure patterns). Behavioural indicators have also been successfully used to predict proxies of harm such as self-exclusion or account closures. However, relatively few studies have combined objective data with self-report data to achieve independent validation of the risk-status of gamblers. Evidence also supports the potential value of short-term responsible gambling interventions involving the use of voluntary and mandatory limits, messages and behavioural feedback. Less work has, on the other hand, addressed the comparative risk of different online gambling products. The findings suggest the need for further validation of findings against independent measures of gambling risk; consistent definitions of indicators; a greater focus on the differentiation of product risk; and, on the long-term impact of RG interventions.

Skill-Based Electronic Gaming Machines: Features that Mimic Video Gaming, Features that could Contribute to Harm, and Their Potential Attraction to Different Groups

New gambling products have been developed over time as technology permits. For example, early mechanical slot machines were later replaced by electronic gaming machines (EGMs), which enabled a faster speed of play and more immersive experience. EGMs have in the decades since their invention become one of the main drivers of gambling expenditure worldwide and are one of the gambling products most strongly associated with harm. This literature review considers research relevant to a new subcategory of EGM, 'skill-based' EGMs, termed 'SGMs' here. SGMs can be highly varied in content, with some representing a minimal departure from EGMs, where the typical bonus round is replaced by some skill-based activity, such as a simple video game, which could increase the machine's appeal. Other SGMs feature more radical departures from conventional EGMs, such as multiplayer games using intellectual property from popular TV shows or video games. These skill-based elements could tap into common gambling fallacies such as the illusion of control, and therefore facilitate harmful engagement. SGMs could also be less harmful than current EGMs, if skill-based elements break the dissociative states associated with EGM gambling. The intellectual property used in SGMs may increase their appeal among people who generally do not gamble, and the skill-based elements could increase their interest among gamblers who predominately prefer skill-based gambling formats such as sports betting. The novelty and varied content of SGMs present many open questions, which research should aim to address in future.

The Mediating Effect of Danger Invulnerability in the Relationship Between Sensation Seeking and Gambling Among University Students

The association between sensation-seeking and gambling is well established, yet the research on mediators of this relationship is limited. The proposed model of the present study includes sensation seeking as an antecedent variable, danger invulnerability as a mediator, and gambling frequency as an outcome variable.Self-report data obtained from a convenient sample of 641 university students aged 18-40 years (Mage = 21.25; F = 52.7%, M = 47.3%) were analysed. This study supported proposed hypothesis that both sensation seeking and danger invulnerability are in significant positive relation with the frequency of gambling. Moreover, the results show that tested mediation model fit the data well, and that danger invulnerability completely mediates the relationship between sensation seeking and gambling frequency, such that higher sensation seeking is related to higher danger invulnerability and higher danger invulnerability is related to higher gambling frequency. The model explained 42.4% of the variance in danger invulnerability and 32.7% of the variance in gambling frequency. This study underscores the importance of examining both the direct and indirect effects of different variables on gambling behaviour.

'Odds Are: They Win': a disruptive messaging innovation for challenging harmful products and practices of the gambling industry

OBJECTIVE

This paper presents an evidence informed rationale for focussing on harmful gambling products and industry practices in public health messaging through the example of a recent innovation called 'Odds Are: They Win'.

METHODS

'Odds Are: They Win' was initially developed through coproduction involving public health professionals and people with lived experience of gambling harms and implemented across a city-region area. A review of relevant evidence was undertaken, upon which the research team reflected to draw out the implications of 'Odds Are: They Win' for gambling harms messaging.

RESULTS

Evidence is mounting that safer gambling campaigns framed in terms of individual responsibility are ineffective and can generate stigma. 'Odds Are: They Win' presents an alternative focus that is not anti-gambling but raises awareness of industry manipulation of the situational and structural context of gambling. This is in-keeping with historical lessons from the stop smoking field and emerging research in critical health literacy. The latter highlights the potential of education on the social and commercial determinants of health to stimulate behaviour change and collective action.

CONCLUSION

'Odds Are: They Win' is a potentially disruptive innovation for the gambling harms field. Research is required to robustly evaluate this intervention across diverse criteria, target audiences, and delivery settings.

Perspectives from gambling expert stakeholders in relation to electronic gaming machines in New Zealand

Electronic gaming machines (EGMs) are one of the most addictive and harmful forms of gambling. Gaming machine characteristics, easy accessibility of EGMs and normalisation of gambling behaviour have exacerbated these effects. We conducted a pilot study investigating the perspectives of gambling expert stakeholders on gambling harm and effective harm-minimisation policies regarding EGMs. In-depth individual interviews were undertaken with 14 health professionals working in the addiction sector, academics in the field of gambling and individuals from a range of government and non-government organisations who have an impact on gambling policy making in New Zealand. Five major themes were identified: the need to shift focus from problematic people to the problematic product, the need for a holistic approach to gambling intervention, focus on creating an empowered population, and improving protective factors and refining public health initiatives to gambling harm. The results suggest the need to challenge current narratives of EGM-related gambling harm and have wide-ranging implications for EGM harm minimisation and health promotion policies.

Culturally and Linguistically Diverse Gamblers of East Asian Descent in Australia: A Comprehensive Review of Current Evidence

As a country with one of the highest per capita gambling losses per year in the world, and an evolving multicultural profile, Australia has become an important setting in which to examine the harms and benefits related to gambling. The Australian population includes people from East Asian cultural backgrounds who are a key demographic of interest for gambling operators planning to grow revenue. However, Australian gambling research has concentrated primarily on those belonging to the dominant cultural group. Most of the previous and limited number of studies to examine gambling among culturally and linguistically diverse (CALD) residents have focused on people of Chinese descent, and much of the literature is now becoming relatively old. This review examines the current evidence around cultural variations in gambling prevalence, motivations, beliefs, behaviours, and help service utilisation, focusing on gamblers with an East Asian cultural background. Numerous domains in which gambling motivations and behaviours vary across cultural groups are identified, and methodological considerations related to ethnographic gambling research are discussed. This review found that while barriers and predictors to help-seeking for CALD gamblers have been studied extensively, contemporary evidence of help service utilisation and effectiveness in Australia is lacking. Further research providing an accurate assessment of the impacts of gambling for CALD gamblers is needed to ensure that harm minimisation resources are effective for those most vulnerable to harm.

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.

18 Years of Changing Trends: Swiss Data on the Clinical Characteristics and Game Types Associated with Problem Gambling

Recent changes in the Swiss gambling context include the introduction of a new gambling policy (Swiss Federal Act on Gambling; GA), and the associated opening of the online gambling market. Within this context it is important to observe evolving trends in gambling behavior. This study therefore aims to identify the gambling behavior and clinical characteristics of a treatment-seeking population over an 18-year period (2001 to 2018). Specifically, the proportion of referrals relating to the three most popular game-types; VLT play, slot machines and online gambling, and associated socio-demographic characteristics, gambling-related spending and clinical features. The results indicate the high addictive potential for VLT and slot-machine use, over the 18-year period with an increasing use of online gambling from 2012 to 2018 (even before the official opening of the market). Problem-gambling vulnerability factors such as low income, unemployment and debts as well as self-reported suicidal ideation, were also over-represented in the sample. This longitudinal overview provides a detailed picture of treatment-seeking referrals, for future comparisons and can be used to tailor clinical interventions.

The Identification of Low-risk Gambling Limits for Specific Gambling Activities

An emerging literature has identified optimal low-risk gambling limits in an effort to reduce gambling-related harm. Concerns have, however, been raised about the construction of aggregate low-risk limits that are applied to all gambling activities and there is support from gambling experts and the general public in Australia for the identification of low-risk limits for specific gambling activities. The study's aim was to identify and evaluate a set of empirically-based activity-specific limits (gambling frequency, gambling expenditure, gambling expenditure as a proportion of gross personal income, session expenditure, session duration) in a secondary analysis of Social and Economic Impact Studies of Gambling in Tasmania and the 2014 Survey on Gambling, Health and Wellbeing in the ACT. Balancing sensitivity and specificity, limits were identified for all gambling activities: EGMs (10 times per year, AUD$300/year, 0.63-1.04% of personal income, AUD$35 per session, 40 min/session), horse/dog racing (0.55% of personal income), instant scratch tickets (AUD$45/year), lotteries (0.45% of personal income), keno (4-13 times/year, AUD$45-$160/year), casino table games (AUD$345/year, 0.36-0.76% of personal income), bingo (AUD$150/year, 0.49% of personal income, AUD$17/session, 90 min/session), and sports/other event betting (14 times/year, AUD$400/year, 0.55-0.86% of personal income). These limits were exceeded by one-quarter to one-half of gamblers on these specific activities and were generally good predictors of gambling-related harm in subgroups of gamblers participating in these gambling activities and in the overall gambling sample. The limits provide gamblers, regulators, prevention workers, and researchers with simple rules of thumb in prevention efforts to reduce gambling-related harm in specific contexts.

Online self-exclusion from multiple gambling venues: Stakeholder co-design of a usable and acceptable self-directed website

Gambling self-exclusion programs are under-utilised and barriers to entry include shame and embarrassment with face-to-face registration, and complex and effortful procedures. The current study aimed to facilitate self-exclusion from gambling venues via an online self-directed website. A co-design approach was used to elicit key stakeholders' perspectives on required website features, functionality, and to identify variables potentially impacting on development and implementation. Semi-structured focus groups and interviews were conducted across four stakeholders (N = 25): self-exclusion end users (consumers, n = 5), gambling counsellors (n = 7), venue staff (n = 6), and policy makers (n = 7). Overall, stakeholder perspectives were consistent with content analysis indicating the importance of website user-friendliness, flexibility, supportiveness, and trustworthiness. Importantly, these attributes were linked to target end users': perceived vulnerabilities, diverse backgrounds and individual expectations. Participants believed that the entire self-exclusion process should be conducted online, including identity verification, whilst expecting high-level data security measures to protect their personal privacy. A separate webpage was also suggested containing relevant information and links to additional help services, such as counselling. This study describes an adaptable co-design framework for developing a usable and acceptable self-exclusion website. Future studies should empirically test system usability and acceptability to refine and maximise system uptake upon implementation. Findings may have broader implications for digital health intervention design.

A meta-analysis of problem gambling risk factors in the general adult population

BACKGROUND AND AIMS

Few meta-analyses have been conducted to pool the most constant risk factors for problem gambling. The present meta-analysis summarizes effect sizes of the most frequently assessed problem gambling risk factors, ranks them according to effect size strength and identifies any differences in effects across genders.

METHOD

A random-effects meta-analysis was conducted on jurisdiction-wide gambling prevalence surveys on the general adult population published until March 2019. One hundred and four studies were eligible for meta-analysis. The number of participants varied depending on the risk factor analyzed, and ranged from 5327 to 273 946 (52% female). Weighted mean odds ratios were calculated for 57 risk factors (socio-demographic, psychosocial, gambling activity and substance use correlates), allowing them to be ranked from largest to smallest with regard to their association with problem gambling.

RESULTS

The highest odds ratio (OR) was for internet gambling [OR = 7.59, 95% confidence interval (CI) = 5.24, 10.99, P < 0.000] and the lowest was for employment status (OR = 1.03, 95% CI = 0.87, 1.22, P = 0.718). The largest effect sizes were generally in the gambling activity category and the smallest were in the socio-demographic category. No differences were found across genders for age-associated risk.

CONCLUSIONS

A meta-analysis of 104 studies of gambling prevalence indicated that the most frequently assessed problem gambling risk factors with the highest effect sizes are associated with continuous-play format gambling products.

Heart rate variability and interoceptive accuracy predict impaired decision-making in Gambling Disorder

BACKGROUND AND AIMS

Gambling Disorder (GD) entails maladaptive patterns of decision-making. Neurophysiological research points out the effect of parasympathetic arousal, including phasic changes in heart rate variability (HRV), and interoceptive accuracy (IA, i.e., the ability to track changes in bodily signals), on decision-making. Nevertheless, scarce evidence is available on their role in GD. This is the first study exploring the impact in GD of respiratory sinus arrhythmia (RSA), an index of HRV, and IA on decision-making, as measured by the Iowa Gambling Task (IGT).

METHODS

Twenty-two patients experiencing problems with slot-machines or video lottery terminals gambling and 22 gender- and age-matched healthy controls (HC) were recruited. A resting ECG was performed before and after the completion of the IGT. IA was assessed throughout the heartbeat detection task. We conducted a MANCOVA to detect the presence of significant differences between groups in RSA reactivity and IA. A linear regression model was adopted to test the effect of factors of interest on IGT scores.

RESULTS

Patients with GD displayed significantly decreased RSA reactivity (P = 0.002) and IA (P = 0.024) compared to HCs, even after controlling for affective symptoms, age, smoking status, and BMI. According to the linear regression model, cardiac vagal reactivity and IA significantly predict decision-making impairments on the IGT (P = 0.008; P = 0.019).

DISCUSSION AND CONCLUSIONS

Although the exact pathways linking HRV and IA to impaired decision-making in GD remain to be identified, a broader exploration relying upon an embodiment-informed framework may contribute to shed further light on the clinical phenomenology of the disorder.

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.

An Evaluation of Gaming-Related Harms in Relation to Gaming Disorder and Loot Box Involvement

The specific nature of harm and functional impairment in the context of gaming disorder (GD) has received limited attention. In this study, we present one of the first concerted attempts to measure the types and degree of harm experienced by people displaying signs of problem gaming. Attempts were made to assess the extent to which types of harm were attributable to gaming as opposed to other factors. The study also investigated potential behavioural indicators of harmful involvement, including exposure to loot boxes. A sample of 471 regular gamers (M = 380, F = 73), recruited through the online platform Prolific, completed a survey where problem gaming was identified using Petry et al.’s (2014) checklist. Individuals who met the cut-off for gaming disorder scored higher than the non-problem group on most dimensions of harm, with physical and psychological types being the most common issues. Loot box expenditure was low (M = $25 in 3 months, for the 10.8% of respondents who played loot boxes) but significantly positively associated with the degree of gaming-related financial harm. This study shows that problem gaming is most strongly associated with physical or psychological harm and that financial harms may manifest in gaming activities that facilitate continuous spending options.

Empirical Evidence Relating to the Relative Riskiness of Scratch-Card Gambling

Scratch cards (SCs) or tickets are lottery-based games which are played by scratching to reveal numbers, letters or symbols to win prizes. Such activities have sometimes been likened to paper-based slot-machines, but relatively little systematic analyses have been conducted to examine the risk or harm associated with these activities. In this paper, we provide a narrative review of the peer-reviewed literature relating to the potential association between SCs and problem gambling and what is known from publically available data sources (e.g., prevalence studies and treatment data). Evidence is analysed within the context of the Bradford Hill Criteria. Both prevalence and peer reviewed literature suggest that SCs are less strongly associated with problem gambling than most other gambling activities. We argue that this difference is due to the nature of the products. SC gambling differs from slot-machine gambling in a number of structural ways; it is less continuous; has a slower event frequency; and, emerging literature suggests that near-miss design features are unlikely to have a significant impact upon behaviour. Thus, in our view, and based on the empirical evidence, it appears that earlier parallels between SCs and slot-machines now appear more tenuous. Nevertheless, we encourage further investigation into the potential impact of new and emerging online lottery products because of the more immersive, faster and more technology-based nature of these products.

Structural characteristics of fixed-odds sports betting products

BACKGROUND AND AIMS

A literature exists on the structural characteristics of electronic gambling machines (EGMs), which are design innovations that can promote spending excessive time and money on these games. Fixed-odds sports betting products, where bettors place sports bets against a bookmaker, have also seen significant innovations in recent years. Despite some differences between these gambling products, similar structural characteristics could also be relevant to sports betting. The aim was to review previous research on contemporary fixed-odds sports betting products, and to identify whether structural characteristics from the EGM literature are also relevant to sports betting.

METHODS

Structural characteristics uncovered by two influential reviews of EGMs were identified, and their relevance to fixed-odds sports betting products discussed via a narrative review.

RESULTS

Structural characteristics of payout interval and potential betting frequency (in-play betting), multiplier potential (accumulators, complex bets, multis), win probability and payout ratio (all bets), bettor involvement (custom sports betting products, cash out), skill required (all bets), and near-misses (accumulators, complex bets, multis) were all identified in modern fixed-odds sports betting products.

DISCUSSION AND CONCLUSIONS

Fixed-odds sports betting products have increasingly incorporated structural characteristics previously found in EGMs. Future research could further assess the extent to which these structural characteristics contribute to fixed-odds sports bettors spending excessive amounts of time and money while betting. These findings can help guide further sports betting research, contribute to an improved understanding of the potential universality of gambling product design, and inform policy.

Overconfidence in Understanding of How Electronic Gaming Machines Work Is Related to Positive Attitudes

Previous research has demonstrated that attitudes are a primary determinant of intention to gamble on electronic gaming machines (EGMs) consistent with the Theory of Reasoned Action. This paper aims to address how biases in judgment can contribute to attitudes and subsequently behavior, including maladaptive problematic gambling behavior. We take a novel approach by viewing overconfidence in one's understanding of how outcomes are determined on EGMs as an indication of cognitive distortions. The novelty of this paper is further increased as we compare attitudes to existing EGMs with novel EGMs which include a skill component, referred to as skill-based gaming machines (SGMs), which enables a better controlled comparison between actual and perceived skill. In Study 1, 232 US-based participants were recruited online who were shown various slot machines and SGMs and asked a series of questions about perceived skill and chance in determining outcomes to assess their understanding, then were asked their confidence in their understanding, attitudes toward the machines and they completed the Problem Gambling Severity Index. In Study 2, 246 Australian participants were recruited through community and university student samples; they attended a laboratory where they were randomly allocated to play a real EGM or SGM without money and completed the same measures as in Study 1. In Study 2, participants were randomly told that the outcomes on the machine they would play were determined entirely by chance, skill, or a mixture of both. In both studies, our findings suggest that there are more extreme values in overconfidence in how EGMs work, whereas individuals are more similar in their confidence in understanding SGMs. We also find a relationship between overconfidence in EGM understanding and positive attitudes toward EGMs, but no such relationship with SGMs. There was no impact from controlling for demographics, problem gambling severity, or labeling of machines on these relationships.