Effects of Different Screening and Scoring Thresholds on PGSI Gambling Risk Segments

Gambling in Victoria: Changes in Participation, Problem Gambling and Gambling Environment Between 2008 and 2018

Gambling and its impacts are an important public health issue. The relationship between gambling, problem gambling and gambling harm is complex and dynamic. Replicate prevalence studies are useful for surveillance and monitoring gambling impacts within jurisdictions. The purpose of this study was to compare changes in gambling and problem gambling in the Victorian adult population between 2008 and 2018 by investigating individual gambling activities and exploring their relationship with the Victorian gambling ecosystem. Gambling participation has decreased; problem gambling prevalence has not. Investigation beyond these summary measures reveals important details: (a) Electronic Gaming Machines (EGMs), casino table games, race and sports betting ('high-risk activities'), informal private betting, and Keno, and their associations with problem gambling endure. Further, the strength of this association is unaffected by changes in product technology, delivery, or the Victorian environment in which they reside, (b) participation in high-risk activities, excluding EGMs, increased while for other activities they decreased, (c) EGMs continue to pose the greatest risk for Victorians, (d) males and young adults continue having a higher problem gambling prevalence rate and preferring both online gambling and high-risk activities (excluding racing favoured by an ageing, older cohort, and Keno, by all ages), and (e) gambling access and exposure proliferated enabling single site multiple gambling opportunities on high-risk activities. Young adults represented a new vulnerable group as they reach the legal gambling age. The most effective interventions (based on major falls in real expenditure (losses) on EGMs, the highest risk activity) were the smoking bans, removal of ATMs from venues and decreases in bet size. There is great potential for prevention, intervention, and minimising harm in the gambling environment.

Correlates of Problematic Gambling in Emerging Adult University Students in Ireland

INTRODUCTION

Understanding the correlates of problematic gambling among emerging adult university students is crucial for developing effective approaches to minimise harm.

METHODS

This cross-sectional survey study reports on 397 18-25 year old emerging adults studying at Irish universities who completed an online survey about problematic gambling and a range of biopsychosocial variables. Chi-square and binary logistic regression analyses explored the relationships between problematic gambling and the biopsychosocial variables measured.

RESULTS

Chi-square analyses showed that being male, having an online gambling account, having a mobile gambling app, novelty seeking (impulsivity), harm avoidance (fear of uncertainty), and high alcohol volume consumption were significantly associated with problematic gambling. Regression analyses showed that individuals were more likely to report problematic gambling if they were male (OR = 9.57 times), had an online gambling account (OR = 17.05 times), had a mobile gambling app (OR = 20.37 times), scored high in impulsivity (OR = 7.79 times), and reported high alcohol volume consumption (OR = 4.66 times). Individuals were less likely to report problematic gambling if they scored high in fear of uncertainty (OR = 0.26 times).

CONCLUSIONS

A high rate of problematic gambling was observed among the current study sample. Participants were more likely to reported problematic gambling if they were male, had online gambling accounts, mobile gambling apps, scored high in impulsivity, scored low in fear of uncertainty, or consumed high volumes of alcohol in typical drinking sessions. These findings have implications for Irish legislation and policy-makers, Irish higher education institutions, and young adult Irish university students.

The social value of gambling: surplus estimates by gambling types for France

We estimate the social surplus of gambling in France by adding three components: consumer surplus, producer surplus and taxation revenue. To estimate consumer surplus, we use the rational benchmark approach, which attributes a loss of welfare (i.e. a negative surplus) to problem gamblers depending on their level of excess spending compared with recreational gamblers. Using data for the year 2019 and considering only legal gambling, we find that the consumer surplus is negative for the gambling activity as a whole. When we add the producer surplus and the taxation revenue to the consumer surplus, we find that the social surplus is more likely to be negative, ranging from - 45 billion euros in the pessimistic scenario to + 6 billion euros in the optimistic scenario. There are, however, important differences between gambling types. The social surplus is negative in all scenarios for poker and sports betting. Conversely, it is positive in all scenarios for draw lotteries and scratch cards.

Using machine learning to retrospectively predict self-reported gambling problems in Quebec

BACKGROUND AND AIMS

Participating in online gambling is associated with an increased risk for experiencing gambling-related harms, driving calls for more effective, personalized harm prevention initiatives. Such initiatives depend on the development of models capable of detecting at-risk online gamblers. We aimed to determine whether machine learning algorithms can use site data to detect retrospectively at-risk online gamblers indicated by the Problem Gambling Severity Index (PGSI).

DESIGN

Exploratory comparison of six prominent supervised machine learning methods (decision trees, random forests, K-nearest neighbours, logistic regressions, artificial neural networks and support vector machines) to predict problem gambling risk levels reported on the PGSI.

SETTING

Lotoquebec.com (formerly espacejeux.com), an online gambling platform operated by Loto-Québec (a provincial Crown Corporation) in Quebec, Canada.

PARTICIPANTS

N = 9145 adults (18+) who completed the survey measure and placed at least one bet using real money on the site.

MEASUREMENTS

Participants completed the PGSI, a self-report questionnaire with validated cut-offs denoting a moderate-to-high-risk (PGSI 5+) or high-risk (PGSI 8+) for experiencing past-year gambling-related problems. Participants agreed to release additional data about the preceding 12 months from their user accounts. Predictor variables (144) were derived from users' transactions, apparent betting behaviours, listed demographics and use of responsible gambling tools on the platform.

FINDINGS

Our best classification models (random forests) for the PGSI 5+ and 8+ outcome variables accounted for 84.33% (95% CI = 82.24-86.41) and 82.52% (95% CI = 79.96-85.08) of the total area under their receiver operating characteristic curves, respectively. The most important factors in these models included the frequency and variability of participants' betting behaviour and repeat engagement on the site.

CONCLUSIONS

Machine learning algorithms appear to be able to classify at-risk online gamblers using data generated from their use of online gambling platforms. They may enable personalized harm prevention initiatives, but are constrained by trade-offs between their sensitivity and precision.

Basic psychological needs in gambling and gaming problems

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Need frustration was related to the severity of gambling and gaming problems.

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Need satisfaction was not related to the absence of gambling or gaming problems.

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Higher mental health problems were related to the risk of any gaming problems.

Background and Aims

Studies on self-determination theory (SDT) have placed satisfaction of basic psychological needs (autonomy, relatedness, and competence) at the core of well-being, whereas frustration of these needs results in multiple potentially unhealthy mental and behavioral patterns. This study analyzed how need satisfaction and frustration relate to the severity of gambling and gaming problems.

Methods

A survey study with 18–75-year-old Finnish participants (N = 1530; 50.33% male) was conducted in April 2021. Basic psychological needs were measured with the Basic Psychological Need Satisfaction and Frustration Scale, mental health issues with the five-item Mental Health Inventory, gambling problems with the Problem Gambling Severity Index, and gaming problems with the Internet Gaming Disorder Test. Zero-inflated negative binomial analyses were conducted to examine how satisfaction and frustration of basic psychological needs, together with mental health issues, are associated with gaming and gambling problems.

Results

Mental health issues were associated with gambling and gaming problems, but this association became nonsignificant when basic psychological needs were added to the model. However, better mental health still was associated with the absence of gaming problems. While need satisfaction had no association with the absence of gaming or gambling problems, need frustration was associated with increases in the severity of both gaming and gambling problems.

Discussion

Frustration of basic psychological needs for autonomy, relatedness, and competence is associated with both gambling and gaming problems and should be considered when developing treatment and support for those who experience such problems.

Gambling problems and associated harms in United Kingdom Royal Air Force personnel

International evidence indicates that currently serving and former military personnel may be at heightened vulnerability to problem gambling. The aim of the present study was to undertake the first survey of gambling experience and potential problems among serving United Kingdom Royal Air Force (RAF) personnel. Our objectives were to survey the frequency of gambling problems, types of gambling activities, examine mental health, alcohol use, and COVID-19-related associations with gambling, and identify potential risk factors for problem gambling among RAF personnel. A cross-sectional online survey was distributed to all serving RAF personnel in January 2021 and the final dataset consisted of n = 2119 responses. The Problem Gambling Severity Index (PGSI) identified gambling severity, the Patient Health Questionnaire (PHQ-9) assessed depression, the Generalized Anxiety Disorder assessment (GAD-7) measured anxiety, and alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT). Questions relating to COVID-19 asked whether the pandemic had impacted one's gambling, mental health, and alcohol use. Findings indicated that 12.5% of personnel reported gambling problems, which included 8.0% with PGSI scores indicating low-risk gambling (1-2), 2.9% with moderate-risk gambling scores (3-4), and 1.6% with scores indicating problem gambling (≥8). Most personnel had no symptoms of depression or anxiety, and most experienced lower risk drinking levels. The likelihood of any gambling problem (PGSI ≥ 1) in RAF personnel was associated with age (18-24 years old), male gender, and Non-Commissioned ranks. Most participants reported a deterioration in their mental health due to COVID-19 and increased risky gambling. These findings indicate that gambling problems and associated harms are significant concerns for serving RAF personnel.

Validation of a Swedish translation of the gamblers’ beliefs questionnaire

The 20-item Gamblers’ Beliefs Questionnaire (GBQ) is used to identify cognitive distortions commonly had by gamblers. There is a great need for psychometrically validated instruments for both treatment and research purposes in the field of gambling addiction in Sweden. The purpose of this study was to validate a Swedish translation of the GBQ by assessing internal consistency, convergent validity, known-groups validity, the two-factor structure of the GBQ, and scaling success. The GBQ was translated into Swedish (GBQ-SE) and validated in a sample of 402 Swedish speaking women (47.9%) and men (52.1%) between 18–86 years, representing undergraduates, a working population, and people with current or historical gambling problems. The GBQ-SE showed excellent internal consistency and moderate relationships with instruments of problem gambling severity. We also showed that problem gamblers tend to endorse more gambling related distortions than non-problem gamblers by finding a significantly higher level of cognitive distortions in the problem gambler group. We were not able to confirm the two-factor structure in our sample. When assessing scaling success an overlap for eight of twenty of the items between the subscales was found. We conclude that the GBQ-SE is valid as a general instrument of gambling related cognitive distortions. It can be used to aid in treatment planning with gambling addicted clients, to evaluate treatment outcome, and for research purposes.

Predictors of gambling and problem gambling in Canada

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Gambling and Problem Gambling in Canada in 2018: Prevalence and Changes Since 2002

OBJECTIVE

The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002.

METHOD

An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18+).

RESULTS

A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant interprovincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan. The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant interprovincial variation in problem gambling rates. The interprovincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling.

CONCLUSIONS

Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other Western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in large parts of the population.

Indigenous Gambling and Problem Gambling in Canada

The present study provides a profile of Canadian Indigenous gambling and problem gambling using the 2018 Canadian Community Health Survey (CCHS) (n = 23,952 adults; 1,324 Indigenous) and an online panel survey of 10,199 gamblers (n = 589 Indigenous). The relative popularity of different types of gambling was similar between Indigenous and non-Indigenous samples. However, there was higher Indigenous participation in electronic gambling machines (EGMs), bingo, instant lotteries, overall gambling and a higher rate of problem gambling (2.0% versus 0.5%). Variables predictive of Indigenous problem gambling were EGM participation, gambling fallacies, having a mental or substance use disorder, sports betting, and male gender. Compared to non-Indigenous problem gamblers, Indigenous problem gamblers had higher substance use and lower impulsivity. In general, variables predictive of Indigenous problem gambling were the same ones predictive of problem gambling in all populations, with elevated Indigenous problem gambling rates primarily being due to elevated rates of these generic risk factors. Many of these risk factors are modifiable. Particular consideration should be given to reducing the disproportionate concentration of EGMs in geographic areas having the highest concentration of Indigenous people and ameliorating the disadvantageous social conditions in this population that are conducive to mental health and substance use problems.

Predicting future harm from gambling over a five-year period in a general population sample: a survival analysis

BACKGROUND

There is little longitudinal evidence on the cumulative risk of harm from gambling associated with excess spending and frequency of play. The present study sought to assess the risk of gambling problems over a five-year period in adults who exceed previously derived low-risk gambling limits compared to those who remain within the limits after controlling for other modifiable risk factors.

METHODS

Participants were adults (N = 4212) drawn from two independent Canadian longitudinal cohort studies who reported gambling in the past year and were free of problem gambling at time 1. Multivariate Cox regression was employed to assess the impact over time of gambling above low-risk gambling thresholds (frequency ≥ 8 times per month; expenditure ≥75CAD per month; percent of household income spent on gambling ≥1.7%) on developing moderate harm and problem gambling. Covariates included presence of a DSM5 addiction or mental health disorder at time 1, irrational gambling beliefs, number of stressful life events in past 12 months, number of game types played each year, and playing electronic gaming machines or casino games.

RESULTS

In both samples, exceeding the low-risk gambling limits at time 1 significantly increased the risk of moderate harm (defined as ≥2 consequences on the Problem Gambling Severity Index [PGSI]) within 5 years after controlling for other modifiable risk factors. Other significant predictors of harm were presence of a mental disorder at time 1, cognitive distortions about gambling, stressful life events, and playing electronic gaming machines or casino games. In one sample, the five-year cumulative survival rate for moderate harm among individuals who stayed below all the low-risk limits was 95% compared to 83% among gamblers who exceeded all limits. Each additional low-risk limit exceeded increased the cumulative probability of harm by 30%. Similar results were found in models when the outcome was problem gambling.

CONCLUSIONS

Level of gambling involvement represents a highly modifiable risk factor for later harm. Staying below empirically derived safe gambling thresholds reduces the risk of harm over time.

A Composite Measure of Gambling Exposure: Availability, Accessibility or Both?

Measures of availability and accessibility are often used separately or interchangeably to assess gambling exposure. This study examined the advantages of assessing gambling exposure using availability, accessibility, and a composite measure. Logistic and poisson regression analyses were used to determine the relative importance of these measures in predicting problem gambling using data from the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta (SEIGA) surveys. The composite measure of gambling exposure predicted both the risk and severity of problem gambling better than the availability or accessibility measures alone. These results demonstrate that individual differences in problem gambling are better predicted by a composite measure of exposure.

Gamblers' (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study

The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications.

Aims:

To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours.

Methods:

Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis.

Results:

Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account.

Conclusions:

Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.

Disordered Gambling Prevalence: Methodological Innovations in a General Danish Population Survey

We study Danish adult gambling behavior with an emphasis on discovering patterns relevant to public health forecasting and economic welfare assessment of policy. Methodological innovations include measurement of formative in addition to reflective constructs, estimation of prospective risk for developing gambling disorder rather than risk of being falsely negatively diagnosed, analysis with attention to sample weights and correction for sample selection bias, estimation of the impact of trigger questions on prevalence estimates and sample characteristics, and distinguishing between total and marginal effects of risk-indicating factors. The most significant novelty in our design is that nobody was excluded on the basis of their response to a 'trigger' or 'gateway' question about previous gambling history. Our sample consists of 8405 adult Danes. We administered the Focal Adult Gambling Screen to all subjects and estimate prospective risk for disordered gambling. We find that 87.6% of the population is indicated for no detectable risk, 5.4% is indicated for early risk, 1.7% is indicated for intermediate risk, 2.6% is indicated for advanced risk, and 2.6% is indicated for disordered gambling. Correcting for sample weights and controlling for sample selection has a significant effect on prevalence rates. Although these estimates of the 'at risk' fraction of the population are significantly higher than conventionally reported, we infer a significant decrease in overall prevalence rates of detectable risk with these corrections, since gambling behavior is positively correlated with the decision to participate in gambling surveys. We also find that imposing a threshold gambling history leads to underestimation of the prevalence of gambling problems.

A meta-regression analysis of 41 Australian problem gambling prevalence estimates and their relationship to total spending on electronic gaming machines

BACKGROUND

Many jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016.

METHODS

A Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost.

RESULTS

Money lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models (I ² ≥ 0.97; R ² ≤ 0.01).

CONCLUSIONS

The present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.

Gambling Harm and Crime Careers

Incarcerated populations across the world have been found to be consistently and significantly more vulnerable to problem gambling than general populations in the same countries. In an effort to gain a more specific understanding of this vulnerability the present study applied latent class analysis and criminal career theory to gambling data collected from a sample of English and Scottish, male and female prisoners (N = 1057). Theoretical links between gambling and crime were tested through three hypotheses: (1) that prisoners in the UK would have higher rates of problem gambling behaviour than the national population; (2) that if the link between gambling and crime is coincidental, gambling behaviour would be highly prevalent in an offending population, and (3) if connections between gambling behaviour and offending are co-symptomatic a mediating factor would show a strong association. The first of these was supported, the second was not supported and the third was partially supported. Latent class analysis found six gambling behaviour clusters measured by responses to the Problem Gambling Severity Index, primarily distinguished by loss chasing behaviour. Longitudinal offending data drawn from the Police National Computer database found four criminal career types, distinguished by frequency and persistence over time. A significant association was found between higher level loss chasing and high rate offending in criminal careers suggesting that impulse control may be a mediating factor for both gambling harm and criminal careers.

Gambling and Problem Gambling in Victoria, Australia: Changes over 5 years

Rates of gambling and gambling-related harm fluctuate over time, influenced by availability, adaptation and demographic change, among other things. Assessing change is compromised by methodological variation. The main aim of this paper is to assess change in gambling participation and problems in adult Victorians over a 5-year period. Data are from the Victorian Gambling Study (VGS) 2008-2012 (n = 15,000) and the 2003 Victorian Longitudinal Attitudes Survey (n = 8479). An additional aim was to determine the impact of methodological differences on prevalence estimates. Despite gambling availability increasing and more activities being included participation rates declined substantially. Decreases occurred across almost all demographic groups and gambling activities. When adjustments were made for methodological differences there were no significant changes in problem, moderate risk and low risk gambling. Males and people with lower education had higher rates in both surveys. In the latter survey, two groups that experienced large participation reductions, namely young adults and metropolitan residents, emerged as additional groups with higher rates of problem and moderate-risk gambling. Further research is required to discover why overall rates of harm may have plateaued when participation continues to fall and why some groups with reduced participation experience increased harm. The findings suggest that availability and total consumption models are over-simplistic. They further suggest that to be effective prevention programmes will need to extend beyond gambling availability to include interventions directed towards individuals at risk and wider environmental determinants of vulnerability and harm. Additionally this study found that restricting administration of the problem gambling measure to subsets of gamblers generate significantly lower prevalence estimates, implying that many previous surveys under-portray gambling-related harm and that without appropriate adjustment for methodological variation findings cannot be validly compared across studies.