Problem gambling among adolescent students in the atlantic provinces of Canada

An Item Response Theory-Based Scoring of the South Oaks Gambling Screen-Revised Adolescents

The South Oaks Gambling Screen-Revised Adolescent (SOGS-RA) is one of the most widely used screening tools for problem gambling among adolescents. In this study, item response theory was used for computing measures of problem gambling severity that took into account how much information the endorsed items provided about the presence of problem gambling. A zero-inflated mixture two-parameter logistic model was estimated on the responses of 4,404 adolescents to the South Oaks Gambling Screen-Revised Adolescent to compute the difficulty and discrimination of each item, and the problem gambling severity level (θ score) of each respondent. Receiver operating characteristic curve analysis was used to identify the cutoff on the θ scores that best distinguished daily and nondaily gamblers. This cutoff outperformed the common cutoff defined on the sum scores in identifying daily gamblers but fell behind it in identifying nondaily gamblers. When screening adolescents to be subjected to further investigations, the cutoff on the θ scores must be preferred to that on the sum scores.

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.

Problem gambling in adolescents: what are the psychological, social and financial consequences?

BACKGROUND

The paper examines the roles of sociodemographic traits, family quality and risk behaviour in adolescent problem gambling, with focus on the psychological, social and financial consequences from the socio-ecological model approach. This model emphasizes the most important risk-protective factors in the development and maintenance of problem gambling on an individual level, a relationship level, as well as a community and societal level.

METHODS

The research was done using the Canadian Adolescent Gambling Inventory with a sample of 366 participants, 239 females (65.3%) using descriptive statistics and t-test, ANOVA, correlation and hierarchical regression analysis.

RESULTS

Males reported significantly higher gambling consequences on all scales (p < .001) and significantly more risk behaviour (p < .05). Age was significant for psychological consequences (p < .01), problem gambling (p < .01) and risk behaviour (p < .001) with older participants scoring higher. Students with lower school success reported significantly higher psychological consequences of gambling (p < .01), higher risk behaviour activity (p < .001) and lower family life satisfaction (p < .001). The psychological, financial and social consequences were positively correlated with problem gambling (p < .001). Age (p < .05), gender (p < .001), school success (p < .01) and the father's education level (p. < 05) were significant predictors of problem gambling, with older male adolescents who struggle academically and have lower educated fathers being at greater risk.

CONCLUSIONS

Results indicate an important relation between adolescent gambling behaviour and very serious psychological, social and financial consequences. There is a constellation of risk factors that likely place certain individuals at high risk for problem gambling.

Reliability of Instruments Measuring At-Risk and Problem Gambling Among Young Individuals: A Systematic Review Covering Years 2009-2015

This review aims to clarify which instruments measuring at-risk and problem gambling (ARPG) among youth are reliable and valid in light of reported estimates of internal consistency, classification accuracy, and psychometric properties. A systematic search was conducted in PubMed, Medline, and PsycInfo covering the years 2009-2015. In total, 50 original research articles fulfilled the inclusion criteria: target age under 29 years, using an instrument designed for youth, and reporting a reliability estimate. Articles were evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies tool. Reliability estimates were reported for five ARPG instruments. Most studies (66%) evaluated the South Oaks Gambling Screen Revised for Adolescents. The Gambling Addictive Behavior Scale for Adolescents was the only novel instrument. In general, the evaluation of instrument reliability was superficial. Despite its rare use, the Canadian Adolescent Gambling Inventory (CAGI) had a strong theoretical and methodological base. The Gambling Addictive Behavior Scale for Adolescents and the CAGI were the only instruments originally developed for youth. All studies, except the CAGI study, were population based. ARPG instruments for youth have not been rigorously evaluated yet. Further research is needed especially concerning instruments designed for clinical use.

An examination of internet and land-based gambling among adolescents in three Canadian provinces: results from the youth gambling survey (YGS)

Background

With the rapid proliferation of new gambling technology and online gambling opportunities, there is a concern that online gambling could have a significant impact on public health, particularly for adolescents. The aim of this study is to examine online and land-based gambling behaviour among adolescents in 3 Canadian provinces (Ontario, Newfoundland and Labrador, Saskatchewan) prior to the implementation of legalized online gambling.

Methods

Data are from 10,035 students in grades 9 to 12 who responded to the 2012–2013 Youth Gambling Survey (YGS) supplement, a questionnaire administered as part of the Canadian Youth Smoking Survey (YSS, 2012) in 3 provinces: Newfoundland and Labrador (n = 2,588), Ontario (n = 3,892), and Saskatchewan (n = 3,555).

Results

Overall, 41.6 % of adolescents (35.9 % of females and 47.4 % of males) had gambled in the past 3 months. 9.4 % of adolescents had gambled online in the past 3 months alone (3.7 % of females and 15.3 % of males). The most popular form of online gambling was online sports betting. Adolescents also engaged in online simulated gambling including internet poker (9.1 %) and simulated gambling on Facebook (9.0 %). Few adolescents participated in online gambling exclusively and online gamblers were more likely than land-based gamblers to engage in multiple forms of gambling. A higher proportion of adolescent online gamblers scored “high” or “low to moderate” in problem gambling severity compared to land-based only gamblers.

Conclusions

Despite restrictions on online gambling at the time of the study, adolescents were engaging in online gambling at a significantly higher rate than has been previously found. Adolescents were also using technology such as video games to gamble and free online gambling simulations.

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.

Italian Adolescent Gambling Behaviour: Psychometric Evaluation of the South Oaks Gambling Screen: Revised for Adolescents (SOGS-RA) among a sample of Italian students

Since no Italian validated instrument focuses specifically on the measurement of pathological gambling in very young people, with this study, we aim to adapt an international instrument (SOGS-RA) and assess its psychometric properties in a sample (n = 14.910) of young Italian students aged between 15 and 19 years. Cross-cultural adaptation of the instrument was performed through translation, synthesis of translation, back-translation, expert committee review, and pre-testing. The kappa statistic for test-retest concordance ranged from 0.53 to 0.80. Internal validity was assessed by the MCA that identified one principal component with eigenvalue equal to 3,875: the Divgi index and very simple structure analysis also pointed out one common factor, so uni-dimensionality of the SOGS-RA was accepted. Moreover the SOGS-RA was found to have acceptable internal consistency (α = 0.780). Cronbach's alpha was also assessed separately among males and females (respectively 0.786 and 0.707). The SOGS-RA was assessed in relation to gambling frequency, alcohol and drug use: Chi squared test revealed a strong association both for males and females with gambling frequency (p value ≤ 0.0001), frequent use of illicit drugs (for each drug p value ≤ 0.0001) and having had 3 or more occasions of binge drinking in the last month (p value ≤ 0.0001). At the end we can say that, the results of our study suggest that the SOGS-RA screen may be useful to assess at-risk or problem gambling for both genders in comprehensive youth surveys.

Differences in pathological gambling prevalence estimates: facts or artefacts?

The paper aims at investigating whether survey methodology has recently converged to justify the common practice of comparing prevalence estimates and interpreting differences within and between countries. To this end, prevalence studies of problem (PrG) and pathological gambling (PG) published in peer-reviewed journals between 2000 and 2010 were critically reviewed. A systematic computer-based literature search was conducted within various databases and major gambling journals. In a two-step search process, a total of 39 studies reporting current prevalence data of non-clinical national samples from different countries were identified. Analyses revealed wide ranges in estimated PrG/PG rates for adults, adolescents, and college students, whereas similar estimates were reported in two studies on PrG/PG in seniors. Despite the discussion on methodological consistency in the field of gambling research, comparability of the reported estimates was found to be still highly limited by major variation between studies with regard to survey description, administration format, exclusion criteria, assessment instrument, cut-off scores, sample frame, and reference period. The interpretation of differences in PrG and PG prevalence estimates within and between countries may be improved by using valid and reliable instruments and by applying comparable survey methodology in well-defined populations.

Adolescent gambling: a review of an emerging field of research

PURPOSE

The purpose of this review was to summarize the research on adolescent gambling with implications for research and prevention or intervention.

METHOD

The methodology involved a comprehensive and systematic search of "adolescent or youth gambling" in three diverse electronic databases (MedlineAdvanced, PsycINFO, and Sociological Abstracts) and three peer-reviewed journals (International Journal of Gambling Studies, International Journal of Mental Health and Addiction, and Journal of Gambling Issues).

RESULTS

The search resulted in 137 articles (1985-2010) focusing on gambling among youth aged between 9 and 21 years: 103 quantitative, 8 qualitative, and 26 non-empirical. The study of adolescent gambling can be summarized as follows: (a) it is conducted by a relatively small group of researchers in Britain, Canada, and the United States; (b) it is primarily prevalence-focused, quantitative, descriptive, school-based, and atheoretical; (c) it has most often been published in the Journal of Gambling Studies; (d) it is most often examined in relation to alcohol use; (e) it has relatively few valid and reliable screening instruments that are developmentally appropriate for adolescents, and (f) it lacks racially diverse samples.

CONCLUSION

Four recommendations are presented for both research and prevention or intervention which are as follows: (1) to provide greater attention to the development and validation of survey instruments or diagnostic criteria to assess adolescent problem gambling; (2) to begin to develop and test more gambling prevention or intervention strategies; (3) to not only examine the co-morbidity of gambling and alcohol abuse, but also include other behaviors such as sexual activity; and (4) to pay greater attention to racial and ethnic differences in the study of adolescent gambling.

The convergence of gambling and digital media: implications for gambling in young people

Adolescents' use of the Internet and other digital media for the purpose of gambling represents a serious concern in modern society. This paper overviews some of the available monetary and non-monetary forms of gambling within new digital and online media and monetary forms of games with gambling-like experiences. With reference to current psychological knowledge on the risk factors that promote adolescent gambling, it is suggested that new gambling technologies may: (a) make gambling more accessible and attractive to young people, (b) may promote factually incorrect information about gambling, (c) provide an easy escape from real world problems such as depression and social isolation, (d) create a gambling environment that easily facilitates peer pressures to gamble, (e) ease parental transmission of gambling attitudes and beliefs, and (f) make gambling more ubiquitous and socially acceptable. The unique risks of Internet gambling for young people are critically discussed, as well as the lack of restricted classification for video games and other media that feature interactive, non-monetary forms of gambling.

Prevalence estimates of gambling participation and problem gambling among 16-18-year-old students in Iceland: a comparison of the SOGS-RA and DSM-IV-MR-J

The aim of this study was to estimate gambling participation and problem gambling among Icelandic adolescents. Participants were 750 16-18-year-old students, 371 girls and 379 boys. The rate of problem gambling was estimated with the SOGS-RA and DSM-IV-MR-J. Results indicated that 96% of adolescents had gambled in their lifetime, 79% at least once in the preceding year and about 10% gamble at least once a week. A psychometric evaluation of the two screening scales revealed satisfactory reliabilities and factor structures for both scales. The DSM-IV-MR-J identified 2% of the participants as problem gamblers while SOGS-RA identified 2.7%, and problem gambling was more common among boys than girls. It was concluded that problem gambling among adolescents is an area of concern for the Icelandic community that needs to be further investigated.

Gambling screens: does shortening the time frame affect their psychometric properties?

Gambling screening tools such as the South Oaks Gambling Screen (SOGS) and a DSM-IV Screen for Gambling Problems (NODS) developed by the National Opinion Research Council have psychometrically validated lifetime and past-year versions. As research questions often dictate shorter time intervals, researchers have adapted the time frames of these instruments to their specific purposes without examining whether changing the time frame affects the psychometric properties. In this study, 3-month versions of SOGS and NODS were administered to a sample of 80 pathological gamblers (59 men, 21 women, mean age 44) seeking treatment at a state-funded facility. The 3-months versions had good internal consistency, good convergent validity with each other, with gambling behaviors assessed via the timeline followback method, and with measures of impulsivity. The 3-month versions also showed good discriminant validity with demographic variables and a measure of verbal IQ. Together the data indicate that shortening the time frame to 3 months does not seem to have adverse effects on the psychometric properties of SOGS and NODS. Thus these adapted versions could profitably be used for shorter time intervals, including as pre/post-treatment and follow-up measures in treatment outcome studies.

A study of differences in Canadian university students' gambling and proximity to a casino

Gambling behavior and problem gambling of college students were investigated in universities far from and close to a large casino. A survey of 17 gambling activities was given and the South Oaks Gambling Screen was completed by 1579 students. Approximately half of the students were enrolled in universities near a casino and the other half far from a major casino. Gender and proximity differences were hypothesized and observed. Males engaged in more gambling activities than females. Students close to a casino manifested more serious problem gambling than students far from a casino. Gender by proximity interactions are reported. This investigation supports the idea that context and proximity to gaming venues may have exposure or accessibility effects on university students' gambling behavior.

The South Oaks Gambling Screen-revised Adolescent (SOGS-RA) Revisited: A Cut-point Analysis

The lack of a criterion validity gold standard defining adolescent pathological gambling represents a major limitation of the adolescent gambling literature. The present study employed Receiver Operating Characteristic curve analysis (ROC) to examine the performance of the South Oaks Gambling Screen-Revised Adolescent (SOGS-RA) recommended cut-point of 4 against two-proxy gold standards: self-identified need for, or receipt of, help for gambling. Logistic regression analysis examined the correlates of self-identified need for help with gambling. The sample was comprised of 12990 adolescents from Atlantic Canada whose average age was 15 years and 50% of whom were male. The SOGS-RA performed as well or better with these proxy gold standards than with proxies used in previous studies. We concluded that the proxy gold standards based on self-identified need for or receipt of help represent a pragmatic solution to the lack of an adolescent-specific definition of problem or pathological gambling. Students in grade seven and SOGS-RA scores of 4 or greater were independent predictors of self-identifying a need for help.

Prevalence estimates of gambling and problem gambling among 13- to 15-year-old adolescents in Reykjavík: An examination of correlates of problem gambling and different accessibility to electronic gambling machines in Iceland

This paper reports the main findings from a prevalence study of adolescent gambling and problem gambling among Icelandic adolescents. The final sample consisted of 3,511 pupils aged 13 to 15 in 25 primary schools in Reykjavík. The results indicated that 93% of adolescents had gambled some time in their life and 70% at least once in the preceding year. Problem gambling prevalence rates were evaluated with two gambling screens, American Psychological Association Diagnostic and Statistical Manual, 4th edition, Multiple-Response-Junior (DSM-IV-MR-J) and the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA). The DSM-IV-MR-J identified 1.9% as problem gamblers, while SOGS-RA identified 2.8% as problem gamblers. The results also showed that problem gamblers reported more difficulties in school and used alcohol and other drugs more frequently than adolescents who gambled socially or not at all. Finally, evaluation of electronic gambling machine (EGM) accessibility revealed that gambling on low-stakes EGMs in public places was more common than on EGMs in arcades or bars and restaurants. The potential implications of these findings are discussed.

Do Predictors of Gambling Involvement Differ Across Male and Female Adolescents?

We examined gender-specific factors, which might be related to adolescent gambling behavior, using a comprehensive set of predictors from neighborhood, school, family, peer, and intrapersonal domains. Discriminate function analyses revealed a unique pattern of results for each gender. The noteworthy predictors for males were similar to what is found to be predictors of other risk behaviors, suggesting that there may be a similar etiology to gambling participation as found with other risk behaviors. Compared to males, the model for females suggests that parents and peers may have a greater influence on engagement in gambling behavior. Participation in unstructured activities, and risk attitudes/perceptions were the only consistent noteworthy predictors across both males and females. Implications are discussed.

Video lottery terminal access and gambling among high school students in Montréal

BACKGROUND

Gambling is a risky behaviour that involves uncertain financial outcomes, can be addictive, and has been associated with strongly adverse social and public health outcomes. We wanted to assess whether socio-economic and gambling-related-opportunity environments of neighbourhoods affected the uptake of video lottery terminal (VLT) gambling among Montréal youth.

METHODS

Spatial and statistical analyses were conducted to examine geographical patterns of neighbourhood socio-economic conditions, VLT sites (n=407), and high school locations (n=305) within the Montréal Census Metropolitan Area (CMA). VLT concentration within high school neighbourhoods was measured to examine how the number of VLT opportunities varies according to socio-economic status of the school neighbourhood. A student survey was analyzed using logistic regression analysis to explore the role of individual (student) characteristics and environmental (neighbourhood) characteristics in predicting the VLT gambling behaviours reported among a sample (n=1206) of high school students.

RESULTS

Video lottery gambling opportunities are more prevalent near schools located in socio-economically deprived neighbourhoods compared with schools located in more affluent neighbourhoods. The principal individual risk factors for VLT gambling were shown to be male sex, peer VLT-use, substance use, as well as the after-school routines of youth.

INTERPRETATION

The spatial distribution of VLTs reflects local geographies of socio-economic disadvantage and may have a pronounced impact on students attending schools in lower income neighbourhoods, especially those with individual risk factors. Efforts to reduce gambling-related public health costs may want to take into account the socio-spatial distribution of gambling opportunities, particularly in the local environments that youth frequent.

Concordance between the SOGS-RA and the DSM-IV criteria for pathological gambling among youth

This study assessed the possible differences in the classification of adolescent gamblers when using the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA; K. C. Winters, R. D. Stinchfield, & J. Fulkerson, 1993) versus a clinical interview that was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) criteria for pathological gambling. A total of 631 adolescents ages 15-17 years participated in the two phases of the study. Results revealed that of the 93 adolescents who had been screened as problem gamblers according to the SOGS-RA, only 7 could be clinically confirmed as pathological gamblers according to the criteria used at present to define pathological gambling. The need to clarify the construct of pathological gambling among youth is discussed.

Where is the syndrome? Examining co-occurrence among multiple problem behaviors in adolescence

The authors examined co-occurrence among a wide range of adolescent problem behaviors: alcohol, smoking, marijuana, hard drugs, sexual activity, major and minor delinquency, direct and indirect aggression, and gambling. Using a large self-report survey of high school students, confirmatory factor analysis was used to test the problem syndrome model proposed by problem behavior theory. A 3-factor model provided better overall fit than did a single problem syndrome factor model. Contingency table analyses were used to examine the co-occurrence of problem behaviors at different levels of involvement within individuals, as well as relative risk ratios. Analyses offered modest support for a limited problem syndrome encompassing the report of high-risk involvement with alcohol, minor delinquency, direct aggression, and, to a lesser extent, marijuana. For each problem behavior, the majority of adolescents did not report high-risk involvement, and only a minority reported any involvement with multiple behaviors.

Modifying youths' perception toward pathological gamblers

This study evaluates the effectiveness of a video specifically designed to provide relevant information on gambling and to correct the perceptions that adolescents have about pathological gamblers. Results indicate that the video significantly improved participants' knowledge about gambling and corrected their misconceptions toward excessive gamblers. The implications of these results for the prevention of gambling problems are discussed.

Gambling and related mental disorders: a public health analysis

This article reviews the prevalence of gambling and related mental disorders from a public health perspective. It traces the expansion of gambling in North America and the psychological, economic, and social consequences for the public's health, and then considers both the costs and benefits of gambling and the history of gambling prevalence research. A public health approach is applied to understanding the epidemiology of gambling-related problems. International prevalence rates are provided and the prevalence of mental disorders that often are comorbid with gambling problems is reviewed. Analysis includes an examination of groups vulnerable to gambling-related disorders and the methodological and conceptual matters that might influence epidemiological research and prevalence rates related to gambling. The major public health problems associated with gambling are considered and recommendations made for public health policy, practice, and research. The enduring value of a public health perspective is that it applies different 'lenses' for understanding gambling behaviour, analysing its benefits and costs, as well as identifying strategies for action. Harvey A. Skinner (160, p. 286)

Pathological gambling. A comprehensive review

Due to recent changes of gambling laws, accessibility to gambling has become more widespread and thus, there has also been an increase in the prevalence of pathological gambling (PG). The wide range of social, economic, and psychological problems associated with PG are well known. There is a need for better understanding of PG and this review attempts to do so. Literature searches using the Medline and PsycINFO databases were used. Critical examining of the literature showed that familial/genetic, sociological, and individual factors (e.g., an individual's personality, biochemistry, psychological states, and cognitions) are implicated in the development and maintenance of PG, yet at present, the evidences are not solid. Similarly, there have been a lot of theories for PG but again, none of them are solid enough to provide a clear understanding of PG. Recent psychological-based theories seem to provide some solid ground for further research. We highlight four areas for future consideration for research. (1) Most studies have generalized findings from one form of gambling to another. It is suggested that it is now not tenable to consider gambling as a single phenomenon that can explain all forms of gambling. (2) Almost all of the studies in the gambling literature are Western-based and the results are often generalized to other ethnic and cultural groups. There is now an urgent need to close this gap. (3) Future studies need to address methodological problems in the current gambling/PG literature. (4) Almost all of the gambling literature has focused on the issue of why people start gambling. It is suggested that looking at variables as to why people stop gambling in a single episode may be a more fruitful area of research then why people start gambling. This is because what motivates one to continue gambling, despite losses in a session and across sessions, is a characteristic that distinguishes nonproblem gamblers from problem gamblers and pathological gamblers (PGs).

An assessment of the validity and reliability of the SOGS-RA

The present is a validation study seeking to determine the degree of confidence that can be placed on inferences about problem gambling among adolescents in the Atlantic provinces, based on their South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) scores. The major source of data was a 1998 survey of 13,549 students in junior and high school of the public school systems of the 4 Atlantic provinces of Canada. The SOGS-RA was found to have adequate stability and internal consistency reliability. Statistically significant gender differences were demonstrated relative to endorsement and construct validity. Regarding the latter, this study shows that the existing cut-point of the SOGS-RA score for problem gambling identifies as problem gamblers, markedly different proportions of male than female daily gamblers. Regarding construct validity in relation to the Atlantic Alcohol and Drug Risk Continua, this study suggests that while statistically highly significant, the association between problem gambling and substance-related problems may be of low clinical significance. Regarding criterion validity, there is an urgent need to perform the types of enquiry that will allow clarification about how adolescent problem gambling is conceptualized, by adults versus adolescents, by males versus females, and from a clinical versus a public or population health perspective.

A comparison of gambling by Minnesota public school students in 1992, 1995, and 1998

The purpose of this study was to compare rates of gambling among Minnesota public school students between 1992, 1995, and 1998. The three samples included 75,806 students in the 9th and 12th grades in 1992; 73,897 9th and 12th grade students in 1995; and 78,564 9th and 12th grade students in 1998. Students were administered the Minnesota Student Survey, a 121-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple behavioral domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in 1992, 1995, and 1998 to students in their classrooms by the Minnesota Department of Education. The results showed two opposite trends. On the one hand, fewer students gambled in 1998 than in 1995 and 1992. On the other hand, there was a small, but growing number of 12th grade students who gambled frequently. In terms of trends over time for specific games, the lottery showed a significant decline in the number of 9th grade students who played at all. There was also a significant increase in the number of 12th grade students who played the lottery weekly or more often. The findings that frequent lottery gambling has increased among 12th grade students and that underage gambling continues among these students, are both cause for concern. This is the first generation of youth to be exposed to widespread accessability to legalized gambling venues and gambling advertising. Legalized gambling may be a new "rite of passage" for some of today's youth. It will be important to continue to monitor youth gambling and to provide information and resources to assist youth in making healthy decisions about their gambling behavior.

Examining Gambling Issues From a Public Health Perspective

Public health has a tradition of addressing emerging and complex health matters that affect the whole population as well as specific groups. AIDS, environmental tobacco smoke and violence are examples of contemporary health concerns that have benefited from public health analysis and involvement. This article encourages the adoption of a public health perspective on gambling issues. Gambling has been studied from a number of perspectives, including economic, moral, addiction and mental health. The value of a public health viewpoint is that it examines the broad impact of gambling rather than focusing solely on problem and pathological gambling behavior in individuals. It takes into consideration the wider health, social and economic costs and benefits; it gives priority to the needs of vulnerable and disadvantaged people; and it emphasizes prevention and harm reduction. This paper looks at the public health foundations of epidemiology, disease control and healthy public policy, and applies them to gambling. Major public health issues are analyzed within a North American context, including problem gambling trends amongst the general adult population and youth, and their impact on other specific populations. There is significant opportunity for public health to contribute its skills, methodologies and experience to the range of gambling issues. By understanding gambling and its potential impacts on the public's health, policy makers, health practitioners and community leaders can minimize gambling's negative impacts and optimize its benefits.