Marital Status and Problem Gambling among Older Adults: An Examination of Social Context and Social Motivations

What is known about population level programs designed to address gambling-related harm: rapid review of the evidence

BACKGROUND

Gambling and gambling-related harm attract significant researcher and policy attention. The liberalisation of gambling in most western countries is strongly associated with a marked rise in gambling activity and increases in gambling-related harm experienced at the population level. Programs to address gambling-related harm have traditionally focused on individuals who demonstrate problematic gambling behaviour, despite clear evidence of the effectiveness of a public health approach to high-risk activities like gambling. Little is known about the availability or efficacy of programs to address gambling-related harm at a population level.

METHODS

The Victorian Responsible Gambling Foundation commissioned a rapid evidence review of the available evidence on programs designed to reduce gambling-related harm at a population level. The review was conducted using a public health and harm reduction lens. MEDLINE, ProQuest Central and PsychInfo databases were searched systematically. Included studies were published in English between 2017 - 2023 from all countries with gambling policy contexts and public health systems comparable to Australia's; included primary data; and focused on primary and/or secondary prevention of gambling-related harm or problems.

RESULTS

One hundred and sixty-seven articles were eligible for inclusion. Themes identified in the literature included: risk and protective factors; primary prevention; secondary prevention; tertiary prevention; target population group; and public health approach. The evidence review revealed a gap in empirical evidence around effective interventions to reduce gambling-related harm at the population level, particularly from a public health perspective.

CONCLUSIONS

Addressing gambling-related harm requires a nuanced, multi-layered approach that acknowledges the complex social, environmental, and commercial nature of gambling and associated harms. Moreover, evidence demonstrates community programs to reduce gambling-related harm are more successful in reducing harm when based on sound theory of co-design and address the social aspects that contribute to harm.

Too Young to Gamble: Long-term Risks from Underage Gambling

The increasing availability of gambling opportunities worldwide has the potential to impact youth gambling behavior and the prevalence of gambling-related harm. This paper studies whether starting gambling at an early age (i.e., below the minimum legal gambling age) increases an individual's likelihood of suffering some kind of gambling-related harm in the future. Data taken from the Study on the Prevalence, Behavior and Characteristics of Gamblers in Spain provide information on respondents' gambling starting age and assess gambling risk based on criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Estimates from an ordered probit model suggest that starting to gamble while under the minimum legal age is associated with a higher likelihood of problem gambling.

Predictors of pathological gambling behaviours in parents population in Nigeria

The increasing incidence of psychological pains, burnout, and anxiety among gamblers in Nigeria is high. This is because pathological gambling (PG) is on the rise and it is linked to many social vices such as stealing, drug abuse, and sexual abuse. It is important to investigate the trajectories of PG in Nigeria. A cross-sectional survey design was employed in our study with 197 participants sampled from 28 gambling venues in Nigeria made up the study's sample size. Of the 197, 131 (66.5%) were males and 66 (33.5%) were females. 50 (25.4%) were within the age range of 20-30 years, 42 (21.3%) were within 31-40 years, 40 (20.3%) were within 41-50 years, 35 (17.8%) were within 51-60 years, and 30 (15.2%) were within 61 and above. Using the hierarchical regression analysis, our finding revealed a significant association between psychological distress and our respondents' pathological gambling behaviour whereas none of the sociodemographic variables made a significant contribution to their pathological gambling behaviour. We concluded that gamblers' psychological well-being is crucial to understanding their problematic gambling behaviours in the context of a developing nation such as Nigeria, and that this could be similar among our respondents. Implications of our findings were highlighted.

The Price of Gambling: Examining Gambling Disorders

Gambling disorders are a serious public health problem. This manuscript will provide a comprehensive overview on this topic. Gambling disorder involves repeated patterns of gambling behaviors, that result in significant distress or impairment in a person's interpersonal relationships, employment, educational/career opportunities, and finances over a period of 12 months. Gambling is defined as an activity that involves risking something of value with the hopes of acquiring something of greater value. Comparable to substance use disorders, individuals with a gambling disorder may be unsuccessful in exercising control over their problematic behavior, engage in the behavior despite negative consequences, and have preoccupations/cravings to gamble. Gambling disorder has higher comorbidity rates of mental disorders including depression, anxiety, substance use, and personality disorders. Gamblers rarely seek treatment. Treatments must be tailored to the individual which may include psychological interventions, cognitive behavioral therapy, gamblers anonymous, and psychopharmacological agents such as selective serotonin reuptake inhibitors, mood stabilizers, and opioid antagonists to treat clinical symptoms.

A scoping review of the individual, socio-cultural, environmental and commercial determinants of gambling for older adults: implications for public health research and harm prevention

Gambling is a global public health issue that can cause harm to individuals, families, and communities. Older adults are vulnerable to gambling harm due to life-stage experiences. This study aimed to examine current research relating to individual, socio-cultural, environmental, and commercial determinants of gambling among older adults. A scoping review was conducted (PubMed, PsycInfo, SocIndex, CINAHL Complete, Web of Science, Social Science and Sociology databases available in ProQuest, Google Scholar, citation searching), with peer reviewed studies included that were published between 1 December 1999 and 28 September 2022. Included studies were published in English in peer-reviewed journals that examined the determinants of gambling in adults aged 55 and over. Records were excluded if they were experimental studies, prevalence studies or had a population wider than the required age group. Methodological quality was assessed using JBI critical appraisal tools. Data was extracted using a determinants of health framework and common themes were identified. Forty-four were included. Most literature examined individual and socio-cultural determinants including reasons for gambling, risk management strategies, and social motivations for gambling. Few studies investigated environmental or commercial determinants, and those that did focused on accessibility of venues or promotions as pathways to gambling. Further research is needed to understand the impact of gambling environments and industry, and effective public health responses for older adults.

Examination of the Problem Gambling Severity Index for Use with Older Adults: A Rasch Model Approach

Research and prevalence studies commonly use the nine-item Problem Gambling Severity Index (PGSI; Ferris and Wynne in The Canadian Problem Gambling Index, 2001) to measure problem gambling severity in older adults. However, the appropriateness of the PGSI for use with older adults must be evaluated to ensure accurate interpretation of scores. This study evaluated the PGSI with older adults that gamble using a Rasch model approach, which has not yet been examined in the literature. Data from the Quinte Longitudinal Study (Wiiliams et al. in The Quinte Longitudinal Study of Gambling and Problem Gambling 2006-2011, Bay of Quinte region, Ontario [Canada] (V28), 2014) were utilized, accessed through the Gambling Research Exchange of Ontario (GREO). Using WINSTEPS.V5, a Rasch rating scale model was applied to an older adult sample from Ontario, Canada (n = 571, M_age = 66, range = 60-80 +) to assess: (1) the dimensionality and fit between individual PGSI items and the underlying latent construct of problem gambling; (2) utility of items and response options; and (3) potential differential item functioning (DIF) between genders. Using a larger sample (N = 3206, M_age = 45, range = 18-80 +), DIF was examined across three age subgroups. Results supported unidimensionality of the PGSI and item polarity (r_pm range = 0.42-0.85). Infit and outfit statistics showed mixed model misfit for three items. The use of three response options were deemed productive for measurement, but almost always was not frequently endorsed. Model-person separation (1.00) and reliability (0.50) were poor, and model-item separation (6.12) and reliability (0.97) were excellent. There was no significant DIF between older adults by gender. Three items showed significant DIF between older and younger adults. Possible modifications to improve the PGSI for use with older adults are discussed.

Emerging Gambling Problems and Suggested Interventions: A Systematic Review of Empirical Research

The goal of the present systematic review is to identify emerging gambling problems and the harm minimization strategies proposed to address them. Our interdisciplinary research team conducted this systematic literature review in 5 nations between which there is significant gambling research exchange. A keyword search of the Scopus and Web of Science databases followed by filtering using inclusion criteria identified 1292 empirical gambling studies from peer-reviewed journals. The data obtained from the articles were analyzed using the content analysis technique. We then used a unique approach to identify relationships between harm minimization strategies and gambling problems. The findings reveal that the most frequently reported gambling problems are related to young gamblers, online gambling, electronic gaming machines, and children and adolescents (underage gamblers). Harm minimization strategies to address these included creating educational and awareness programs, further restrictions on gambling advertising, developing an intervention mechanism for online gambling, and remote gambling-related help (i.e., online counseling, online treatment).

Associations Between Gambling and Cognitive Function among U.S. Chinese Older Adults

This study aims to examine the associations between gambling participation, problem gambling, and cognition. Data were derived from the PINE study. Gambling participation was measured by Modified South Oaks Gambling Screen. Problem gambling was assessed with Problem Gambling Severity Index. Cognition was measured by East Boston Memory Test, Digit Span Backward, Symbol Digit Modalities Test, and Mini-Mental State Examination. Of all participants, 41.940% were male. Higher gambling participation was significantly associated with higher global cognition (b = .008, SE = .003, p < .05), executive function (b = .118, SE = .049, p < .05), and episodic memory (b = .009, SE = .004, p < .05). Higher problem gambling was significantly related to lower Mini-Mental State Examination (b = -.105, SE = .031, p < .001). Guiding older adults' gambling behaviors and intervening in problem gambling timely might be crucial for their cognitive function.

Is a sense of community belonging associated with problem gambling in Canada?

PURPOSE

Despite the increasing demand for public health measures to prevent problem gambling, few studies have examined the association between community characteristics and problem gambling. The aim of this nationally representative cross-sectional study was to investigate the relationship between a sense of community belonging and problem gambling in Canada. We also examined whether this relationship was modified by sex and marital status.

METHODS

Canadian Community Health Survey (2013-2014) data from 38,968 residents of Quebec, Saskatchewan, Manitoba, and British Columbia were analyzed. Problem gambling was assessed using the Canadian Problem Gambling Index. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for problem gambling.

RESULTS

The prevalence of problem gambling was 1.4% (1.9% among males; 0.9% among females). We observed an inverse dose-response relationship between a sense of community belonging and problem gambling. Compared with those with a very strong sense of community belonging, the adjusted ORs for problem gambling were 1.07 (95% CI 0.65-1.76) for a somewhat strong sense, 1.27 (95% CI 0.77-2.11) for a somewhat weak sense, and 2.32 (95% CI 1.34-4.02) for a very weak sense of community belonging. The association was more prominent among females (except for those widowed/divorced/separated), whereas no clear association was found among males, irrespective of marital status.

CONCLUSION

When implementing public health measures to reduce problem gambling, it would be useful to account for possible differential impacts of a sense of community belonging by sex and marital status, which may reflect significant social contexts among residents.

Contribution of stressful life events to gambling activity in older age

Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.

Moderator effect of sex in the clustering of treatment-seeking patients with gambling problems

BACKGROUND

There are no studies based on a person-centered approach addressing sex-related differences in the characteristics of treatment-seeking patients with gambling disorder (GD). The main objective of the current study is to identify empirical clusters of GD based on several measures of the severity of gambling behavior, and considering the potential role of patient sex as a moderator.

METHODS

An agglomerative hierarchical clustering method was applied to an adult sample of 512 treatment-seeking patients (473 men and 39 women) by using a combination of the Schwarz Bayesian Information Criterion and log-likelihood function.

RESULTS

Three clusters were identified in the subsample of men: cluster M1 (low-mild gambling severity level, 9.1%), cluster M2 (moderate level, 60.9%), and cluster M3 (severe level, 30.0%). In the women subsample, two clusters emerged: cluster W1 (mild-moderate level, 64.1%), and cluster W2 (severe level, 35.9%). The most severe GD profiles were related to being single, multiple gambling preference for nonstrategic plus strategic games, early onset of the gambling activity, higher impulsivity levels, higher dysfunctional scores in the personality traits of harm avoidance, and self-directedness, and higher number of lifespan stressful life events (SLE). Differences between the empirical men and women clusters were found in different sociodemographic and clinical measurements.

CONCLUSIONS

Men and women have distinct profiles regarding gambling severity that can be identified by a clustering approach. The sociodemographic and clinical characterization of each cluster by sex may help to establish specific preventive and treatment interventions.

The influence of chronological age on cognitive biases and impulsivity levels in male patients with gambling disorder

BACKGROUND AND AIMS

Due to the contribution of age to the etiology of gambling disorder (GD), there is a need to assess the moderator effect of the aging process with other features that are highly related with the clinical profile. The objective of this study is to examine the role of the chronological age into the relationships between cognitive biases, impulsivity levels and gambling preference with the GD profile during adulthood.

METHODS

Sample included n = 209 patients aged 18-77 years-old recruited from a Pathological Gambling Outpatients Unit. Orthogonal contrasts explored polynomial patterns in data, and path analysis implemented through structural equation modeling assessed the underlying mechanisms between the study variables.

RESULTS

Compared to middle-age patients, younger and older age groups reported more impairing irrational beliefs (P = 0.005 for interpretative control and P = 0.043 for interpretative bias). A linear trend showed that as people get older sensation seeking (P = 0.006) and inability to stop gambling (P = 0.018) increase. Path analysis showed a direct effect between the cognitive bias and measures of gambling severity (standardized effects [SE] between 0.12 and 0.17) and a direct effect between impulsivity levels and cumulated debts due to gambling (SE = 0.22).

CONCLUSION

Screening tools and intervention plans should consider the aging process. Specific programs should be developed for younger and older age groups, since these are highly vulnerable to the consequences of gambling activities and impairment levels of impulsivity and cognitive biases.

The Association of Problematic Internet Shopping with Dissociation among South Korean Internet Users

Background: This study examined patterns of problematic shopping behavior by South Korean internet users to investigate the association between problematic internet shopping (PIS) and dissociative experiences.; Methods: Five hundred and ninety eight participants from 20–69 years old were recruited through an online panel survey. We gathered information about sociodemographic characteristics, alcohol use, caffeine intake, and online shopping behaviors. Psychopathological assessments included Korean version of dissociative experience scale (DES-K), Canadian Problem Gambling Index (CPGI-K), the modified Stress Response Inventory (SRI-MF), the Barratt Impulsive Scale-11-Revised (BIS-K). We used multiple logistic regression analysis with the Richmond compulsive buying scale (RCBS-K) as the dependent variable.; Results: The prevalence of shoppers with internet-based problem shopping was 12.5%. The amount of time spent on online shopping was correlated with PIS severity (OR = 1.008, p < 0.01). The risk of PIS was related to an increased tendency toward dissociation (OR = 1.044, p < 0.001) and impulsivity (OR = 1.046, p < 0.05). Conclusions: PIS participants with dissociation showed higher levels of perceived stress, gambling problems, and impulsivity than did PIS participants without dissociation. This study suggests that dissociation was associated with a higher burden of PIS as it was connected to poor mental health problems.

Psychosocial risk factors in disordered gambling: A descriptive systematic overview of vulnerable populations

BACKGROUND

Gambling is a behaviour engaged in by millions of people worldwide; for some, gambling can become a severely maladaptive behaviour, and previous research has identified a wide range of psychosocial risk factors that can be considered important for the development and maintenance of disordered gambling. Although risk factors have been identified, the homogeneity of risk factors across specific groups thought to be vulnerable to disordered gambling is to date, unexplored.

METHODS

To address this, the current review sought to conduct a systematic overview of literature relating to seven vulnerable groups: young people and adolescents, older adults, women, veterans, indigenous peoples, prisoners, and low socio-economic/income groups.

RESULTS

Multiple risk factors associated with disordered gambling were identified; some appeared consistently across most groups, including being male, co-morbid mental and physical health conditions, substance use disorders, accessibility and availability of gambling, form and mode of gambling, and experience of trauma. Further risk factors were identified that were specific to each vulnerable group.

CONCLUSION

Within the general population, certain groups are more vulnerable to disordered gambling. Although some risk factors are consistent across groups, some risk factors appear to be group specific. It is clear that there is no homogenous pathway in to disordered gambling, and that social, developmental, environmental and demographic characteristics can all interact to influence an individual's relationship with gambling.