Stacked Deck: an effective, school-based program for the prevention of problem gambling

Evaluation of Effectiveness of the Unplugged Program on Gambling Behaviours among Adolescents: Study Protocol of the Experimental Controlled Study "GAPUnplugged"

Gambling risk behaviour is an emerging problem among adolescents. "Unplugged" is an effective Social Influence curriculum for preventing substance use among students. This study aims to develop and test a new component focused on gambling added to the Unplugged program. Schools of Piedmont region and Rome city were invited to participate in the study. A self-completed anonymous questionnaire including questions on socio-demographic characteristics, addictive behaviours, beliefs, attitudes and risk perceptions about gambling, normative perceptions, parental practices, school climate, refusal skills, impulsiveness, self-esteem, antisocial behaviours and sensation seeking was prepared for baseline and follow-up surveys. The protocol of the study was submitted and approved by the Novara Ethical Committee and registered in ClinicalTrials.gov (NCT05630157, Protocol ID: 080.742, 11/17/2022). Twenty-nine schools accepted to participate in the study. Sixty-three classes (1325 students) satisfied the eligibility criteria for intervention and were allocated to the intervention arm, and the other 61 (1269 students) were allocated to the control arm. Because of drop-out, absentees, refusals, and invalid questionnaires, data on 1874 students (998 in the intervention and 876 in the control arm), were available for the analysis at baseline. Data management of follow-up questionnaires is in progress. Results of the present study will be useful to clarify the effectiveness of prevention interventions in reducing gambling behaviours among adolescents. Moreover, this will be the first experience of evaluating a new component focused on a different risk behaviour, added to a curriculum previously shown as effective on other risk behaviours.

A Content Analysis of Problematic Gambling Prevention Interventions in the United States

Gambling revenue in the United States is at all-time highs while recent and forthcoming legislation relaxes constraints on casino gaming, sports betting, and fantasy sports betting. Increased gambling will result in increased problematic gambling, highlighting the need to study the impact of our problematic gambling prevention interventions. To address this, we conducted a content analysis of problematic gambling prevention messages in the U.S. Results reveal that although there is overlap between theoretically-based messaging appeals recommended by research and those used in actual prevention interventions, health behavior theory is inconsistently applied and there are numerous examples of potential backfire effects. Results are discussed in terms of their impact on theory development and their noteworthy practical application.

How can we measure gambling craving among adolescent gamblers? Psychometric properties of the Gambling Craving Scale

BACKGROUND

Craving plays an important role in behavioural addictions such as Gambling Disorder (GD). However, it has only been included as a diagnostic criterion for substance addiction. Moreover, research on craving has focused mainly on adults, leaving out adolescents who can also be heavily involved in gambling behaviour. The purpose of this study was to investigate the psychometric properties of the most widely used craving assessment scale, the Gambling Craving Scale (GACS), in adolescent gamblers.

METHOD

For the current study, 1246 adolescent gamblers attending secondary school were recruited to complete a self-report questionnaire online. The psychometric properties of the GACS were examined: Confirmatory factor analysis was conducted; reliability was examined using the internal consistency method; in terms of validity, the relationship between the GACS total and subscale scores with some risk factors for problem gambling, gambling frequency and gambling problem severity was analyzed.

RESULTS

The factor analysis supported the three-factor structure, and good internal consistency was found for the GACS total scale and its three subscales. As regards validity, the GACS subscales resulted to be significantly and positively associated with economic perception of gambling and outcome expectancy, gambling-related cognitive distortions, gambling frequency, and problem gambling.

LIMITATIONS

The findings of this study were based on self-report data and only criterion validity was analyzed.

CONCLUSIONS

The GACS is a valid and rapid self-report measure of gambling craving in adolescent gamblers. In terms of prevention, the multidimensionality of the GACS is important for interventions. Clinical samples of adolescents are needed to confirm the validity of the scale.

Red Light or Green Light? Netflix Series' Squid Game Influence on Young Adults' Gambling-Related Beliefs, Attitudes and Behaviors, and the Role of Audience Involvement

Media exposure for dark consumption products mostly shows glamorized and positive portrayals, rarely showing the negative consequences of consuming those products. However, the Netflix series Squid Game addresses the issue of gambling in its most extreme forms and shows the negative consequences related to it in a shocking manner, which begs the question whether watching the series could act as a preventive tool to increase risk perceptions, de-normalize gambling and reduce gambling behavior. A pre-registered survey study (N = 271) examined whether watching the Netflix series Squid Game affected young adults' (18 to 35 years old) gambling intentions and play behavior through risk perceptions, subjective norms and attitudes toward gambling, and what role audience involvement plays. Although the results show that watching Squid Game increased young adults' subjective norms of gambling (i.e. belief that significant others approve of the behavior in question) and further increased their positive attitudes toward gambling and gambling intention, the study also found an important impact of audience involvement. Audiences who were more involved with the series saw greater risks of gambling and perceived gambling to be less common. This resulted in more negative attitudes toward gambling and further less gambling intention and more motivation to change gambling behavior due to watching Squid Game.

Preventive Gambling Programs for Adolescents and Young Adults: A Systematic Review

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

Parental gambling frequency and adolescent gambling: A cross-sectional path model involving adolescents and parents

INTRODUCTION

Nowadays, most of the research studies in the field of adolescent gambling are focused on individual factors related to problem gambling. The aim of this study was to test an integrated model to explain adolescent problem gambling involving both individual (i.e., correct gambling knowledge, superstitious thinking, and gambling-related cognitive distortions) and environmental factors (i.e., parental gambling frequency). In detail, the aim was to better understand the role of parental gambling behavior on adolescents' gambling frequency and problem gambling severity, to draw indications for prevention.

METHODS

Participants were 680 parents (36% men; Mage = 48.32, SD = 6.14 years) of 680 high school students (51% boys; Mage = 15.51, SD = .55 years) attending the second year of different high schools in Tuscany (Italy). Data collection occurred within the school prevention program PRIZE (Prevention of gambling risk among adolescents).

RESULTS

A path model showed was conducted to detect direct and indirect effects from individual and environmental factors to gambling problem severity. Analyses showed that correct gambling knowledge and superstitious thinking were directly related-respectively in a negative and a positive direction-both to gambling-related cognitive distortions and adolescents' gambling frequency. Parental gambling frequency was directly associated with adolescents' gambling frequency. Correct gambling knowledge and superstitious thinking were indirectly related to adolescents' gambling problem severity through the mediational role of gambling-related cognitive distortions and gambling frequency. Parental gambling frequency was indirectly linked to gambling problem severity by passing through adolescents' gambling frequency.

CONCLUSIONS

The current cross-sectional results confirm that parental gambling behavior has an important role for adolescents' gambling behavior and severity. Thus, results highlight the need for innovative prevention programs which involve adolescents' adult reference figures and integrate the individual risk and protective factors with the environmental ones.

Pictograms to aid laypeople in identifying the addictiveness of gambling products (PictoGRRed study)

The structural addictive characteristics of gambling products are important targets for prevention, but can be unintuitive to laypeople. In the PictoGRRed (Pictograms for Gambling Risk Reduction) study, we aimed to develop pictograms that illustrate the main addictive characteristics of gambling products and to assess their impact on identifying the addictiveness of gambling products by laypeople. We conducted a three-step study: (1) use of a Delphi consensus method among 56 experts from 13 countries to reach a consensus on the 10 structural addictive characteristics of gambling products to be illustrated by pictograms and their associated definitions, (2) development of 10 pictograms and their definitions, and (3) study in the general population to assess the impact of exposure to the pictograms and their definitions (n = 900). French-speaking experts from the panel assessed the addictiveness of gambling products (n = 25), in which the mean of expert's ratings was considered as the true value. Participants were randomly provided with the pictograms and their definitions, or with a standard slogan, or with neither (control group). We considered the control group as representing the baseline ability of laypeople to assess the addictiveness of gambling products. Each group and the French-speaking experts rated the addictiveness of 14 gambling products. The judgment criterion was the intraclass coefficients (ICCs) between the mean ratings of each group and the experts, reflecting the level of agreement between each group and the experts. Exposure to the pictograms and their definition doubled the ability of laypeople to assess the addictiveness of gambling products compared with that of the group that read a slogan or the control group (ICC = 0.28 vs. 0.14 (Slogan) and 0.14 (Control)). Laypeople have limited awareness of the addictive characteristics of gambling products. The pictograms developed herein represent an innovative tool for universally empowering prevention and for selective prevention.

Cognitive Factors that Predict Gambling Fallacy Endorsement

Gambling fallacies are a collection of error-stricken beliefs about gambling and how gambling works. Gambling fallacies, while common in the general public, appear to increase as a function of gambling severity. This being the case, many interventions have focused on reducing gambling fallacies as a means of treating problem-gambling. Less research, however, has investigated what factors contributes to gambling fallacy susceptibility in the first place. Available studies have identified associations between gambling fallacy susceptibility and isolated individual differences in, for example, statistical reasoning/understanding, intelligence, or cognitive ability. The current study aimed to assess these cognitive factors in conjunction, and their relative predictive potential for gambling fallacy susceptibility. In an Australian university student sample (n = 90) it was found that there were moderate to strong association between gambling fallacy endorsement and general intelligence, probabilistic reasoning ability, rational cognitive style and the ability to suppress intuitive thought, however, only probabilistic reasoning, rational cognitive style and the ability to suppress intuitive thinking contributed to the prediction of fallacy endorsement. Importantly, each of these factors are malleable. Interventions for the correction of gambling-specific fallacious beliefs should focus on these factors.

Systematic Review: Preventive Intervention to Curb the Youth Online Gambling Problem

This systematic review focuses on all the gambling addiction prevention programs carried out in schools, with the intention of making their effectiveness known and encouraging the creation of more such programs. During the third quarter of 2021, an exhaustive search was conducted using the databases of Scopus, Medline (via Pubmed), WOS, and PsycINFO. The search strategy was based on a combination of specific search terms: “Gambling Disorder [Mesh]”, “Online Gambling Disorder [Mesh]”, and “Prevention Programs [Mesh]”. A total of 15 articles were chosen for systematic review. All the programs analyzed show effective results, although there are several methodological shortcomings in the way they are conducted. Effective programs need to focus more on long-term results and the emotional aspects of gambling. We need professionals who can convey the causal nature of the problem the youth are facing.

Optimizing large-scale gambling prevention with adolescents through the development and evaluation of a training course for health professionals: The case of PRIZE

In the field of adolescent gambling prevention, there is a lack of intervention studies reporting and assessing training courses for the intervention providers. The present work fills this gap by realizing a dissemination study inside the PRIZE program aimed at modifying a set of cognitive protective factors and affective risk factors. The purpose of this work was twofold: To develop and evaluate a training course with the intervention providers (Study 1), and to assess the short- and long-term effects of the intervention itself (Study 2). The training course was delivered to 44 health professionals (32 females, M_age = 39.34 years). Results showed a significant increase of correct knowledge about gambling and a significant reduction of their susceptibility to probabilistic reasoning biases. Participants also actually learnt the main competencies to conduct the educational activities, they were satisfied for the training course received, and they felt high levels of self-efficacy. The intervention was implemented with 1894 high school students (61% males; M_age = 15.68 years). In the short term, we found a significant increase of adolescents’ correct gambling knowledge, random events knowledge, and probabilistic reasoning ability, and a significant decrease of superstitious thinking, monetary positive outcome expectation, and gambling-related erroneous thoughts and fallacious behavioral choices. In the long-term, a significant decrease of gambling frequency, gambling versatility, and gambling problem severity was obtained. Overall, this work highlights the importance to train prevention program providers in order to optimize the effectiveness of large-scale gambling intervention programs towards adolescents.

Behavior Change Techniques and Delivery Modes in Interventions Targeting Adolescent Gambling: A Systematic Review

BACKGROUND

Adolescent gambling can lead to significant harms, yet participation rates continue to rise. Interventions targeting gambling reduction have been implemented in this population. However, it is not clear which behavior change techniques (BCTs) and modes of delivery (MOD) are most effective at reducing gambling.

OBJECTIVE

The objective of the study was to identify 'promising' BCTs and MODs by systematically reviewing interventions targeting adolescent gambling behavior. 'Promising' was defined as those present in at least 25% of all interventions and in at least two effective interventions.

METHODS

Three databases were searched (PsycINFO, Medline, and Scopus) from database inception to May 2021. Interventions were eligible if they were randomized controlled trials; targeting adolescents (aged 10-25 years); and assessing gambling behavior post-intervention. BCTs were identified using the Behavior Change Technique Taxonomy v1.

RESULTS

From the initial 3,315 studies, the removal of duplicates and ineligible articles resulted in sixteen studies included in the review. Eleven of these reported successfully reducing gambling behavior. Eighteen BCTs and six MODs were used across the interventions. The BCTs identified as promising were '4.2. Information about antecedents', '4.4. Behavioral experiments', '5.3. Information about social and environmental consequences', and '5.6. Information about emotional consequences'. Promising MODs were 'face-to-face', 'computer', and 'playable electronic storage'.

CONCLUSIONS

The study reviewed the content of interventions targeting adolescent gambling behavior. Four BCTs were identified as promising and should therefore be adopted in future interventions. To facilitate the delivery of these techniques, the study also identified three promising MODs. Interventions developed using these BCTs and MODs may successfully reduce adolescent gambling behavior.

Short-Term Effectiveness of the Youth Gambling Prevention Program "Who Really Wins?"-Results from the First National Implementation

As a response to significant adolescent gambling involvement, a Croatian team of researchers and practitioners developed a universal, comprehensive, evidence-based youth gambling prevention program called "Who Really Wins?". This study presents the results on its short-term effectiveness following the first national implementation in 18 Croatian cities, with a total of 629 high school students (66.5% male) who completed the program. A design with two measurement sessions (pre-test and post-test) was used to explore the short-term effects of the program on gambling-related knowledge and cognition, frequency of gambling, and various socio-emotional skills. The results showed significant effects when it comes to knowledge, cognitive distortions, and the frequency of sports betting and playing lottery games. Furthermore, the program had no harmful effects on any of the measured variables. The results are interpreted in terms of methodological challenges in measuring effects, possible improvements of the program, and implications for future evaluation research.

Ludens: A Gambling Addiction Prevention Program Based on the Principles of Ethical Gambling

Gambling is legal in most countries. However, despite having some economic benefits, certain characteristics of gambling can have health consequences, rendering it a public health issue. The effects can be summarized according to the following three "laws" of ethical gambling: "Gambling Dynamics Law": companies' economic gains come directly from players' losses; "Expected Loss Law": the more one gambles, the greater the probability of losing; and "Addiction Law": the more one gambles, the greater the need to play again, leading to further losses. Ludens is a gambling addiction prevention program that has four goals: inform participants about gambling and gambling addiction; sensitize participants to the risk of gambling for health, especially addiction; promote a change in attitudes toward gambling; and alert participants to risky behaviors that can lead to addiction. The prevention program was implemented during 2017 to 2019. Fourteen psychologists presented it to 2372 adolescents (48.8% females, 51.2% males) aged 14-19 years, none of whom were university students, recruited from 42 Spanish high schools in 132 groups taking different courses. The main dependent variables analyzed were the monthly frequencies of gambling, at-risk gambling, and gambling addiction (as measured by the National Opinion Research Center DSM-IV Screen for Gambling Problems, adapted to diagnose gambling disorder according to DSM-5, in which pathological gambling is considered an addictive disorder). Given that all of the gamblers were adolescents (most were minors), fulfilment of 1-3 the DSM-5 diagnostic criteria was considered to indicate a risk of problem gambling. After the administration of Ludens, statistically significant reductions were observed in the three variables of interest: monthly frequency of gambling, percentage of adolescents with risky gambling, and percentage of adolescents with gambling disorder. The results were analyzed according to sex and age (minors vs. adolescents between 18 and 19 years old). The results obtained after applying the prevention program indicate that Ludens is effective as a universal prevention program for gambling addiction.

Using the Risk-Return Model to Explain Gambling Disorder Symptoms in Youth: An Empirical Investigation with Italian Adolescents

Historically, individual differences research has sought to explain problem-gambling severity in adolescence by means of unitary "risk-taking" traits, such as sensation seeking and impulsivity, implying that these personality traits account for risk-taking tendencies across different types of behaviors and situations. However, increasing empirical evidence suggests that risk taking seems to be better conceptualized as a domain-specific construct. In the current study, we adopted a psychological risk-return framework, which posits that perceptions of perceived risks and benefits predict gambling risk attitudes, which in turn, account for variance in Gambling Disorder (GD) symptoms in adolescents. The study involved 296 Italian adolescents (68% boys, M_age = 17.76, SD = 1.17). Participants completed the risk-taking, risk perception, and expected benefits scales from the Adolescent Domain Specific Risk Taking (DOSPERT) scale (Barkley-Levenson et al. in Dev Cognitive Neurosci 3: 72-83, 2013), as well as the Gambling Behavior Scale for Adolescents (GBS-A; as reported (Primi et al. in Gambling Behavior Scale for Adolescents in, Hogrefe, Florence, 2015) were administered. Consistent with predictions, risk-taking scores for the Gambling domain predicted adolescent gambling outcomes, relative to the other DOSPERT risk-domains (Ethical, Health/Safety, Recreational, Social). Additionally, we found that greater Gambling risk perceptions were associated with lower risk-taking scores, whereas greater perceived expected benefits were associated with higher risk-taking scores. Moreover, we found significant indirect effects between perceived risks and benefits and problem-gambling severity, mediated via Gambling risk-taking scores, though expected benefits demonstrated a stronger indirect effect. These results have important implications for practice as they emphasize that specific interventions aimed at preventing problem gambling in adolescents should address their perceptions about gambling benefits.

The Efficacy of a Gambling Prevention Program Among High-School Students

Youth problem gambling has become an emergent public health issue, and adolescents constitute a vulnerable age group for the development of gambling-related problems. Although there is research concerning the risk factors of youth problem gambling, rigorous evaluations of the effectiveness of preventive initiatives is still rare. The present study evaluated the efficacy of an integrative intervention to prevent youth problem gambling based on a multidimensional set of factors including gambling-related knowledge, misconceptions, attitudes, gambling frequency, amount of money spent, total hours spent gambling per week, and sensation seeking. A pre- and post-test design was performed with 111 Portuguese high-school students randomly assigned to two groups (experimental and control). The findings demonstrated that the intervention was effective in improving correct knowledge about gambling, reducing misconceptions and attitudes, and in decreasing the total hours spent gambling per week. The intervention was also effective in reducing the number of at-risk/problem gamblers during the study period. Furthermore, these findings were stable after a 6-week follow-up. Overall, the intervention program appeared to be effective in correcting some gambling-related behaviours, and provides suggestions for future interventions.

Enhancing the Relevance and Effectiveness of a Youth Gambling Prevention Program for Urban, Minority Youth: A Pilot Study of Maryland Smart Choices

Youth with problem gambling behaviors are susceptible to serious academic, behavioral, and mental health consequences including school failure, criminal involvement, and depression. Coupled with increased exposure to gambling formats, issues related to youth gambling have been deemed a serious public health issue requiring increased prevention efforts. However, the literature is limited in terms of evidence-based gambling prevention programs warranting the development of The Maryland Smart Choices Program (MD-Smart Choices), a gambling prevention program for middle and high school youth. This 3-session, 45-min program was developed for implementation in Baltimore City Public Schools, an urban and predominately African American district with specific aims to engage students, encourage positive behavior, and facilitate learning related to gambling disorder. Pre-post program participation assessments were collected from 72 students across 5 different schools. Results yielded significant increases in student awareness and knowledge following participation in MD-Smart Choices. Focus group data collected from program facilitators suggested high student engagement and participation, program feasibility, and ease of implementation. Study implications and future directions are discussed.

Social Representations of People with Gambling Problems: The Influence of Prevention Classes on Non-gamblers

In the present study, we examine the impact of prevention classes on non-gambling males. Specifically, we measure whether attending a prevention class influences how non-gambling participants perceive people who gamble problematically. Participants (N = 545) were all lifetime non-gamblers, and were all conscripts attending a two-day military recruitment program. On the first day participants either attended or did not attend a gambling prevention class. On the second day, they all completed a questionnaire that contained questions on how they perceived people who gamble problematically. Results showed that their representations were organized in terms of mental status (i.e. mentally disordered or not) and person-centeredness (i.e. self-centered or not). Results also showed that participants who attended the gambling prevention class saw problem-gambling individuals as more mentally disordered and self-centered than those who did not attend the class. The implications of these results are discussed in terms of social support and their applicability to problem gambling prevention programs.

Long-term effectiveness of a gambling intervention program among children in central Illinois

Youth gambling is an increasing concern. As a response, the “Don’t Gamble Away our Future (DGAOF)” program has been implemented among children in central Illinois. We aim to assess the long-term effectiveness of this school-based youth gambling prevention program in Illinois using the data from 2005 to 2009. The intervention included interactive PowerPoint presentations and prevention materials in parent packets. Students aged 8 to 18 years were eligible to participate in the intervention and the questionnaire pre-post knowledge tests (total score 0–9). Students in 5th grade and above also received a gambling behavior screen test using the Modified South Oaks Gambling Screening for Teens (MSOGST) for identifying probable gamblers. Multivariable generalized mixed models were conducted to detect the effects of a 5-year youth gambling prevention program as controlling potential confounders. A total of 16,262 and 16,421 students completed pre-post tests and MSOGST tests, respectively. Of 16,262, half were female, the majority (76.1%) were from senior high school, and 21.3% received the intervention at least twice. The median gap between interventions was 368 days. Students receiving multiple interventions had higher scores on the pre-test as compared to those receiving a single intervention (P<0.001 for all comparisons among groups), and they demonstrated an increasing trend of awareness about gambling over time (P<0.001 for multiple interventions; P = 0.538 for single intervention). The prevalence of problem gambling had decreased among students receiving the intervention twice as compared to receiving the intervention once (7.9% versus 9.4%; OR = 0.89, 95% CL: 0.82–0.97). However, this effect was not confirmed among students receiving the intervention three or more times. In conclusion, the DGAOF program has demonstrated a positive long-term impact on increasing gambling knowledge and partially reducing pathological gamblers through direct training. It suggests that multiple repeated interventions are important for youth gambling prevention.

Who Really Wins? Efficacy of a Croatian Youth Gambling Prevention Program

This paper reports on the development and pilot evaluation of a Croatian school-based youth gambling prevention program "Who really wins?". The program is aimed at minimizing risk and enhancing protective factors related to youth gambling. A short-term evaluation of the program was conducted with a sample of 190 first and second year high-school students (67.6% boys, aged 14-17 years; average age 15.61). An experimental design with two groups (Training vs. No Training) and two measurement sessions (pre-test and post-test sessions) was used to evaluate change in problem gambling awareness, cognitive distortions, knowledge of the nature of random events as well as in social skills. Results showed significant changes in the post-test sessions, which can be attributed to changes in the Training group. We observed a decrease in risk factors, namely better knowledge about gambling and less gambling related cognitive distortions. Immediate effects on protective factors such as problem solving skills, refusal skills, and general self-efficacy were not observed. Findings also show program effects to be the same for both boys and girls, students from different types of schools, for those with different learning aptitudes, as well as for those at different risk levels with regard to their gambling, which speaks in favour of the program's universality. The program had no iatrogenic effects on behaviour change and shows promise as an effective tool for youth gambling prevention. Future research and a long-term evaluation are needed to determine whether the observed changes are also linked to behavioural change.

Effectiveness of school- and family-based interventions to prevent gaming addiction among grades 4-5 students in Bangkok, Thailand

Purpose

This study aimed to assess the effectiveness of Participatory Learning School and Family Based Intervention Program for Preventing Game Addiction by Developing Self-Regulation of gaming addiction among students of grades 4 and 5 in Bangkok.

Methods

A quasi-experimental study was implemented among students of grades 4 and 5 at primary schools in Bangkok selected through multistage random sampling. Two comparable schools were randomly assigned to either the intervention or control group. Then, 310 students in the randomly selected classrooms were allocated to each group. The intervention group received the self-regulation program with school and family involvement to prevent gaming addiction. Master teachers attended in-house training on prevention of gaming addiction in children. Parents of these children received a gaming addiction prevention manual and guidelines. The program lasted 8 weeks. The control group received no intervention. Knowledge and Attitude About Gaming Questionnaire, Game Addiction Screening Test (GAST), and Game Addiction Protection Scale were utilized to assess subjects at baseline, immediately after, and 3 months post-intervention. Descriptive statistics, chi-square, and independent t-test were used to describe characteristics of the participants, and repeated measures ANOVA was analyzed to test the effectiveness of the intervention.

Results

The findings revealed that there were significant differences in knowledge, attitude, self-regulation, and gaming addiction behaviors (p < 0.05) immediately and 3 months post-intervention. Positive effects of the intervention included increase in knowledge, attitude, and self-regulation, whereas the GAST score was significantly decreased (p < 0.05) immediately and 3 months after the program.

Conclusion

The program based on self-regulation and school and family participation is effective for preventing gaming addiction in students of grades 4 and 5 in Bangkok, Thailand.

A Pilot Evaluation of a Tutorial to Teach Clients and Clinicians About Gambling Game Design

This paper describes the pilot evaluation of an Internet-based intervention, designed to teach counselors and problem gamblers about how electronic gambling machines (EGMs) work. This study evaluated the tutorial using assessment tools, such as rating scales and test of knowledge about EGMs and random chance. The study results are based on a number of samples, including problem gambling counselors (n = 25) and problem gamblers (n = 26). The interactive tutorial was positively rated by both clients and counselors. In addition, we found a significant improvement in scores on a content test about EGM games for both clients and counselors. An analysis of the specific items suggests that the effects of the tutorial were mainly on those items that were most directly related to the content of the tutorial and did not always generalize to other items. This tutorial is available for use with clients and for education counselors. The data also suggest that the tutorial is equally effective in group settings and in individual settings. These results are promising and illustrate that the tool can be used to teach counselors and clients about game design. Furthermore, research is needed to evaluate its impact on gambling behavior.

Gambling-Related Distortions and Problem Gambling in Adolescents: A Model to Explain Mechanisms and Develop Interventions

Although a number of gambling preventive initiatives have been realized with adolescents, many of them have been developed in absence of a clear and explicitly described theoretical model. The present work was aimed to analyze the adequacy of a model to explain gambling behavior referring to gambling-related cognitive distortions (Study 1), and to verify the effectiveness of a preventive intervention developed on the basis of this model (Study 2). Following dual-process theories on cognitive functioning, in Study 1 we tested a model in which mindware gap, i.e., susceptibility to the gambler's fallacy, and contaminated mindware, i.e., superstitious thinking, were the antecedents of gambling-related cognitive distortions that, in turn, affect gambling frequency and problem gambling. Participants were 306 male adolescents (Mage = 17.2 years). A path analysis indicated that cognitive distortions have a mediating role in the relationship that links probabilistic reasoning fallacy and superstitious thinking with problem gambling. Following these findings, in Study 2 we developed a school-based intervention aimed to reduce gambling-related cognitive distortions acting on the above cited mindware problems. A pre- and post-test design - with a 6 months follow-up - was performed with 34 male adolescents (Mage = 16.8), randomly assigned to two groups (Training and No Training), and their baseline equivalence was verified. A Mixed 2 × 2 ANOVA attested a significant Time X Group interaction, indicating a significant reduction of the cognitive distortions from pre-test to post-test only in the Training group. The follow-up attested to the stability of the training effects and the reduction of gambling frequency over time. These findings suggest that prevention strategies should address mindware problems, which can be considered as predictors of gambling-related cognitive distortions.

Effects of a workplace prevention programme for problem gambling: study protocol for a cluster randomised controlled trial

INTRODUCTION

Despite being considered a public health problem, no prevention programme for problem gambling in workplace settings has been scientifically evaluated. This study aims to fill a critical gap in the field of problem gambling by implementing and evaluating a large-scale prevention programme in organisations.

METHODS AND ANALYSIS

Ten organisations, with a total of n=549 managers and n=8572 employees, will be randomised to either receiving a prevention programme or to a waitlist control condition. Measurements will be collected at the baseline and 3, 12 and 24 months after intervention. The primary outcome of interest is the managers' inclination to act when worried or suspicious about an employee's problem gambling or other harmful use. Additional outcomes of interest include the Problem Gambling Severity Index and gambling habits in both managers and employees. Furthermore, qualitative analyses of the responses from semistructured interviews with managers will be performed.

ETHICS AND DISSEMINATION

This study has been approved by the regional ethics board of Stockholm, Sweden, and it will contribute to the body of knowledge concerning prevention of problem gambling. The findings will be published in peer-reviewed, open-access journals.

TRIAL REGISTRATION NUMBER

NCT02925286; Pre-results.

A review of educational-based gambling prevention programs for adolescents

Educational-based problem gambling prevention programs are important avenues in targeting at-risk behaviors among adolescents to prevent an escalation of problematic behaviors into adulthood. The aim of this review is to examine features pertinent to effective educational-based programs in the area of adolescent problem gambling prevention in hopes of providing a foundation and future suggestions for preventive efforts. A stronger understanding of this research area will be essential in ensuring that past practical and theoretical advancements are integrated into the development of future programs.

Systematic Review of Empirically Evaluated School-Based Gambling Education Programs

Adolescent problem gambling prevalence rates are reportedly five times higher than in the adult population. Several school-based gambling education programs have been developed in an attempt to reduce problem gambling among adolescents; however few have been empirically evaluated. The aim of this review was to report the outcome of studies empirically evaluating gambling education programs across international jurisdictions. A systematic review following guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement searching five academic databases: PubMed, Scopus, Medline, PsycINFO, and ERIC, was conducted. A total of 20 papers and 19 studies were included after screening and exclusion criteria were applied. All studies reported intervention effects on cognitive outcomes such as knowledge, perceptions, and beliefs. Only nine of the studies attempted to measure intervention effects on behavioural outcomes, and only five of those reported significant changes in gambling behaviour. Of these five, methodological inadequacies were commonly found including brief follow-up periods, lack of control comparison in post hoc analyses, and inconsistencies and misclassifications in the measurement of gambling behaviour, including problem gambling. Based on this review, recommendations are offered for the future development and evaluation of school-based gambling education programs relating to both methodological and content design and delivery considerations.

Theory of Planned Behavior in School-Based Adolescent Problem Gambling Prevention: A Conceptual Framework

Given its serious implications for psychological and socio-emotional health, the prevention of problem gambling among adolescents is increasingly acknowledged as an area requiring attention. The theory of planned behavior (TPB) is a well-established model of behavior change that has been studied in the development and evaluation of primary preventive interventions aimed at modifying cognitions and behavior. However, the utility of the TPB has yet to be explored as a framework for the development of adolescent problem gambling prevention initiatives. This paper first examines the existing empirical literature addressing the effectiveness of school-based primary prevention programs for adolescent gambling. Given the limitations of existing programs, we then present a conceptual framework for the integration of the TPB in the development of effective problem gambling preventive interventions. The paper describes the TPB, demonstrates how the framework has been applied to gambling behavior, and reviews the strengths and limitations of the model for the design of primary prevention initiatives targeting adolescent risk and addictive behaviors, including adolescent gambling.

Parent problem gambling: A systematic review of prevention programs for children

Parent problem gambling (PG) has pervasive adverse effects on children. These children experience considerable losses such as loss of trust, loss of safety and stability, as well as financial and emotional losses. They are at greater risk for maltreatment and mental health disorders, and they are also at risk for intergenerational transmission of PG. These children are two to four times more likely to develop PG than children of non-PG parents. To date, there has been a dearth of research examining the impact of parent PG on children, and even less research focusing on reducing risks in children of PG parents. The goal of this systematic review was to identify PG prevention programs for children and examine the types of prevention used and whether these programs target specific subgroups. Our search retained 16 studies examining PG prevention programs for children. Results indicated that all of the PG prevention programs in the selected studies are universal and do not target children of PG parents or any other specific subgroups. A large gap is the absence of secondary and tertiary PG prevention programs for children. Another gap is the lack of family focused prevention strategies which the substance use literature has shown to be the most effective form of prevention. Further research is needed on parent PG and ways of reducing risks and increasing protective factors in children and families. A public health framework must be adopted to delay onset, reduce risks and minimize consequences in children of PG parents.

Prevention of problematic gambling behavior among adolescents: testing the efficacy of an integrative intervention

This study aimed at testing the efficacy of an integrative intervention to prevent adolescent problem gambling acting on a multidimensional set of factors including gambling related knowledge and misconceptions, economic perception of gambling, and superstitious thinking. A pre- and post-test design was performed with 181 Italian adolescents (64% boys; Mean age = 15.95) randomly assigned to two groups (Training and No Training). Results revealed that the intervention was effective in improving correct knowledge about gambling and reducing misconceptions, perception of gambling's profitability, and superstitious thinking. Except for misconceptions, these effects were obtained both in participants who were classified as Non-problem and At-Risk/Problem gamblers at the beginning of the intervention. Findings attested also that the training effects were stable over time, and that some changes in gambling behavior were produced. Findings were discussed referring to indications for future research aiming at confirming and extending the present results.

At-risk and problem gambling among adolescents: a convenience sample of first-year junior high school students in Finland

Background

Adolescent gambling and substance use are viewed as a public health concern internationally. The early onset age of gambling is a known risk factor for developing gambling problems later in life. The aims of this study are: to evaluate the internal consistency reliability, factorial validity and classification accuracy of the Finnish version of DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) criteria measuring at-risk/problem gambling (ARPG); to examine gender differences in gambling participation, ARPG and substance use among first-year junior high school students; and to investigate the association of gambling and gaming (video game playing) participation, substance use and social variables with ARPG.

Methods

This study examined 988 adolescents (mean age 13.4 years) at 11 public schools in Finland between October-December 2013. The response rate was 91.6%. Chi-squared test and binary logistic regression analysis were used.

Results

‘Illegal acts’ was the most endorsed and sensitive, but the least specific criteria identifying ARPG. During the past year, 51.6% of the respondents had gambled, 7.9% were identified as at-risk/problem gamblers (DSM-IV-MR-J score ≥ 2), 8.0% had smoked and 8.9% had been drinking for intoxication, and the first three were significantly more common among boys than girls. The odds ratio of being a male past-year at-risk/problem gambler was 2.27, 5.78 for gambling often or sometimes, 2.42 for video game playing weekly or more often and 6.23 for having peer gamblers.

Conclusions

Overall, the Finnish version of the DSM-IV-MR-J had acceptable internal consistency reliability and factorial validity. None of the DSM-IV-MR-J criteria were accurate enough to screen ARPG per se. ARPG past-year prevalence was relatively high with males gambling more than females. ARPG was as common as drinking alcohol for intoxication and smoking. Peer gambling was strongly associated with ARPG. Efficient strategies to minimise the risks of gambling problems, tools for prevention and identification of ARPG among the underage are needed.

Short-term effects of a school-based program on gambling prevention in adolescents

PURPOSE

To evaluate short-term effects of a school-based media education program for sixth- and seventh-grade adolescents on gambling knowledge, attitudes, and behavior.

METHODS

A two-wave cluster randomized control trial with two arms (intervention vs. control group) was conducted in the German Federal State of Schleswig-Holstein. The intervention group received a four-unit media education program, which contained one unit on gambling. The program was implemented by trained teachers during class time. The control group attended regular classes without any specific intervention. Survey data from 2,109 students with a mean age (SD) of 12.0 (.85) years was collected before and shortly after the intervention.

RESULTS

Thirty percent of the sample reported lifetime gambling; 6.7% were classified as current gamblers. Results of multilevel mixed-effects regression analyses revealed significant program effects in terms of an increased gambling knowledge (d = .18), decreased problematic gambling attitudes (d = .15), as well as a decrease of current gambling (d = .02) in the intervention group compared to the control group. The program had no significant influence on lifetime gambling.

CONCLUSIONS

A 90-minute lesson about gambling can improve gambling knowledge and change attitudes toward gambling and gambling behavior among adolescents. Studies with a longer follow-up period are needed to test the long-term effects of such an intervention.