Developing the DSM-IV-DSM-IV criteria to identify adolescent problem gambling in non-clinical populations

How Does Religiosity Influence Gambling? A Cross-Cultural Study Between Portuguese and English Youth

Research has shown that religion can play a protective role in diverse risky behaviors among young people. However, very little is known about the effect of religion in gambling, especially among young problem gamblers. A strong moral belief regarding gambling may prevent adolescents and young adults engaging in gambling and developing problems. Nevertheless, some evidence suggests that religion might have an influence on gambling cognitive distortions (i.e., some religious beliefs might influence the conceptions of chance and luck, which may contribute to an increase in gambling participation). The present study examined the different effects that religion can have on gambling behavior, in two different cultural contexts (i.e., Portugal and England), characterized by different religious affiliations. A sample (n = 725) comprising Portuguese (n = 312) and English (n = 413) adolescents and young adults completed an online survey. The findings indicated that Portuguese youth were more religious than their English counterparts. Moreover, religiosity was associated with lower gambling engagement among participants in both samples. Mediation analyses also showed that the cognitive distortion of illusion of control mediated the relationship between religiosity and problem gambling among the Portuguese participants, and the interpretative bias was a significant mediator in the English sample. The study's findings suggest that religion can have a protective role on gambling behaviors. However, further research is needed to explore the interactive role of religion and cognitive distortions.

The Role of Attachment in Gambling Behaviors and Gambling Disorder: A Systematic Review

In recent years, a growing number of attachment-based studies have contributed to the understanding of both substance and behavioral addictions. Although gambling is a form of addictive behavior widespread all over the world, both among young people and adults, the evidence on the association between attachment-related phenomena and gambling has not yet been systematized in literature. The aim of the present study, therefore, is to provide a systematic literature review aimed at summarizing the empirical evidence on this topic. Following the updated 2020 PRISMA guidelines, a systematic search in four electronic scientific databases (Scopus, PubMed, PsycInfo and Web of Science) was conducted. After removing duplicates, 146 records were double-screened, with 12 articles meeting the inclusion criteria. Additionally, by means of a backward search a further article was selected. Altogether, 13 articles were selected for the present systematic review. With few exceptions, the results underline the significant role played by attachment-related phenomena in gambling behaviors, highlighting that specific attachment contexts have a different influence on gambling, also depending on whether gamblers are youths or adults. In particular, while secure attachment has proven to be a protective factor for the onset of gambling behavior, insecure attachment has emerged to be a vulnerability factor in two ways. On the one hand, it directly favors gambling behaviors; on the other, it affects coping strategies and the individual's ability to identify and regulate emotions, which in turn predict gambling. Limitations, strengths, and implications of the present systematic review are discussed.

Severity of behavioral addiction symptoms among young adults using non-prescribed sedatives/hypnotics

Introduction

Young adulthood is considered a critical period in terms of non-medical use of sedatives/hypnotics (NMUSH) as well as different types of behavioral addictions (BAs). However, the relationship between these behaviors has received scarce attention among young adult samples. Therefore, the aim of the present study was to investigate the association between NMUSH and symptoms of distinct BAs among young adults.

Materials and methods

Analyses were conducted based on the data of two large sample studies (including a representative sample) carried out with young adult samples. The following BAs were assessed: problematic internet use, problematic video gaming, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior, problematic mobile phone use, work addiction, and hair pulling. Symptoms of distinct BAs were analyzed in three groups formed based on the NMUSH: non-users, lifetime users, and current users.

Results

The symptoms of problematic internet use, problematic social media use, problem gambling, exercise addiction, eating disorders, compulsive buying behavior and work addiction were significantly more severe among lifetime and/or current non-medical sedative and hypnotic users, compared to the non-user participants. The symptoms of problematic mobile phone use were the most severe in the non-user group.

Conclusions

The results suggest co-occurrence between NMUSH and distinct BAs among young adults. These findings draw attention to the need for preventive interventions for this high-risk population.

Understanding adolescent esports bettors: Are they a homogeneous group?

With the rapid rise of competitive video gaming (esports), increased attention has been placed on understanding the profiles of youth who wager on esports. With adolescents being at increased risk of gambling problems and endorsing high rates of past year engagement in video games, there is a need for research investigating psychological and social correlates of adolescent esports bettors and to identify whether youth who engage in esports betting are a homogenous group. Survey responses were collected from 5,997 high-school students (48.4 % male, Mage = 14.7 years [SD = 1.6], age range 12-17) from Wood County, Ohio, United States. A latent class analysis was conducted to identify subgroups of esports bettors based on self-reported measures of gambling frequency, risk for problem gambling, gaming frequency, disordered gaming, preference for virtual life and risky loot box use. Results indicated that 5.5 % of the sample reported esports betting over the past year. Four classes of esports bettors were identified which were indicative of a group of low-risk esports bettors, a group of esports bettors at risk of gaming problems, a group of esports bettors at risk of gambling problems, and a group of esports bettors at high risk of both gambling and gaming problems. Although no significant differences based on sex and age were noted between the classes, differences were noted in experienced childhood adversity, mental health symptoms and problem behavior severity. Results are discussed in line with previous findings relevant to adolescent and adult esports betting.

Problem Gambling Among Adolescents in Uganda: A Cross-sectional Survey Study

In recent years, gambling has evolved and grown substantially with new gambling activities and facilities being introduced, making gambling products and opportunities more available than ever before in Uganda. While the growth of gambling industry is considered to have a beneficial impact on the economy, it is increasingly becoming a social and public health issue especially among a minority of young people who experience problem gambling, which can damage personal, family, vocational, and academic pursuits. The present study estimated the prevalence of problem gambling and identified the socio-demographic, school, environmental and health risks of problem gambling among secondary school students in Mbarara Municipality, Uganda. A cross-sectional study was conducted among secondary school students in Mbarara Municipality. A total of 921 students from 12 schools were recruited using cluster sampling. An ordinal logistic regression model was used to explore the relationship between problem gambling and the socio-demographic, academic, environmental and health variables. Of 905 participants, 362 reported having ever gambled (40%), and 160 were classified as problem gamblers (17.7%; 44.2% among those who had ever gambled). Problem gambling was significantly associated with being male, being non-religious, other religion (African traditional religion), having employment (outside of school), distance to nearest gambling venue, parental gambling, peer gambling, substance use, risky sexual behavior, and psychological distress. The present study found a very high prevalence of problem gambling among Ugandan secondary school students. Therefore, there is need to institute public health measures towards raising awareness, prevention and treatment of problem gambling among Ugandan adolescents.

Annual Research Review: Emergence of problem gambling from childhood to emerging adulthood: a systematic review

BACKGROUND

The risk for problematic gambling and associated high-risk behaviors is elevated during adolescence and emerging adulthood. Activities with gambling-like features and novel forms of gambling may place youth at an increased risk for problem gambling.

AIM AND METHOD

The aim of this review is to provide an overview of the association between both activities with gambling-like features and novel gambling activities and problem gambling among youth while examining the role of psychopathology and cognitive processes. Six databases (PsychINFO, MEDLINE, PubMed, Social Work Abstracts, Technology Collection, and Scopus) were searched in November 2021 for peer-reviewed articles investigating the association between the aforementioned variables among youth up to the age of 25 years. Risk of bias was assessed using the Observational Study Quality Evaluation.

FINDINGS

Forty-five articles were included in the review. Positive associations were observed between engagement in activities with gambling-like features (e.g., video games, social casino games, loot boxes) and problem gambling. Increased involvement with novel forms of gambling (e.g., online sports betting, fantasy sports, and esports betting) were also associated with a greater risk for problematic gambling. Males reported higher rates of engagement in these activities and a greater risk of problem gambling than females. Impulsivity, risk taking, cognitive distortions, and specific emotional vulnerabilities were associated with an increased risk of problem gambling.

CONCLUSIONS

Despite the need for additional longitudinal research controlling for relevant confounders, these findings underline how engagement in activities with gambling-like features are relevant in the developmental trajectory toward problem gambling.

Exposure to gambling promotions and gambling behaviours in Australian secondary school students

Background

Young people's gambling behaviours are associated with a range of individual, interpersonal and community factors. This study explored the association between exposure to types of gambling advertising and promotions and adolescent gambling behaviours.

Methods

Students from two states answered gambling questions as part of the 2017 Australian Secondary Students' Alcohol and Drug (ASSAD) Survey. Students reported gambling behaviours (gambling in the last month, types of gambling activities), exposure to gambling promotions during the last 30 days (e.g. ads for gambling on TV, online, live studio crosses), and were assessed for problem gambling. Principal Component Analysis suggested four groups of gambling promotion exposure. Logistic regression analyses examined the association between gambling promotion exposure and student gambling, engagement in hard gambling activities in the last month, and problem or at risk gambling, controlling for a range of student characteristics.

Results

Most students (81%) had been exposed to some form of gambling promotion or advertisement in the last month, most commonly TV, social media and sporting event advertisements. Exposure to online gambling ads (including websites, pop-ups on websites, and social media) in the last month was significantly associated with gambling in the last month, and being classified as an at risk or problem gambler; but not with participating in hard gambling activities. After adjusting for exposure to gambling advertising across categories, no other advertising exposure types were associated with adolescent gambling behaviours.

Conclusions

Study findings point to the need to impose restrictions on gambling advertisements and promotions, particularly those presented online.

The Prevalence and Correlates of Gambling in Australian Secondary School Students

Youth gambling is associated with a range of harms. This study aimed to examine, among Australian adolescents, the prevalence of gambling (ever, in the last month, at-risk and problem), the most frequent gambling types and modalities, and to explore the student characteristics associated with gambling in the last month and with at-risk or problem gambling. Students aged 12-17 years from Victoria and Queensland answered gambling questions as part of the Australian Secondary School Alcohol and Drug (ASSAD) Survey in 2017. The ASSAD also included a series of questions about smoking, alcohol and other drug use, and mental health. A total of 6377 students from 93 schools were included in analysis. The prevalence of ever gambling and gambling in the last month was 31% and 6% respectively. Of students who had gambled in the last month, 34% were classified as at-risk and 15% were classified as problem gamblers. The most frequent types of gambling in the last month were horse or dog race and sports betting. Students who gambled in the last month did so most frequently via a parent or guardian purchasing or playing for them, at home or at a friends' house, and online or using an app. Regression analysis indicated that male gender, having money available to spend on self, alcohol consumption in the last seven days, the number of types of advertisements seen in the last month, and the number of peer or family members who gambled in the last month, were significantly associated with the likelihood of students gambling in the last month. Male gender, some age categories, and exposure to more types of gambling advertising were also significant predictors of being classified as an at-risk or problem gambler. This large study of youth gambling provides data on gambling behaviours and related variables from a large sample of Australian secondary school students. Student characteristics, including male gender and exposure to more types of gambling advertising, were associated with an increased likelihood of gambling in the last month and of being classified as an at-risk or problem gambler. Further implications of the study findings are discussed.

Psychometric Properties of the South Oaks Gambling Screen Revised for Adolescents in Chinese Adolescent Gamblers

Objectives: Adolescent gambling is a public health concern of increasing importance. The lack of comprehensive evaluations on adolescent gambling disorder (GD) assessment tools hinders the timely detection of Chinese adolescents with gambling problems. This study aimed to evaluate the psychometric properties of South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) and determine its optimal screening cutoff score among Chinese adolescent gamblers to address this gap.

Methods: We surveyed 1407 Chinese secondary school students aged 11–19 years in Macao, China, among which 258 past-year gamblers’ data was used for assessing SOGS-RA’s performance in detecting risk for adolescent GD.

Results: SOGS-RA displayed satisfactory reliability and validity for assessing probable GD among Chinese adolescent gamblers. Under the DSM-5 GD framework, we proposed ≥4 as SOGS-RA’s optimal cutoff score of screening for probable GD and further identified 5.8% of past-year gamblers prone to probable GD in the present study.

Conclusion: SOGS-RA can provide a reliable and valid assessment of adolescent’ GD risk in the Chinese context, facilitate early identification of probable GD cases, and alleviate the public health concern for Chinese adolescents.

Adolescents Who Play and Spend Money in Simulated Gambling Games Are at Heightened Risk of Gambling Problems

Simulated gambling, such as playing a virtual slot machine for points rather than money, is increasingly part of the online gaming experience for youth. This study aimed to examine (1) if youth participation in simulated gambling games is associated with participation in monetary gambling; (2) if youth participation in simulated gambling games is associated with increased risk of problematic gambling when controlling for breadth of monetary gambling (i.e., number of gambling forms); and (3) if monetary expenditure and time spent playing simulated gambling games increase the risk of problematic gambling. Two samples of Australians aged 12-17 years were recruited-826 respondents through an online panel aggregator (mean age 14.1 years) and 843 respondents through advertising (mean age 14.6 years). Aim 1 was addressed using chi-square and correlation analyses. Linear multiple regression analyses were conducted to address Aims 2 and 3. The findings in both samples supported the study's hypotheses-that (1) youth who play simulated gambling games are more likely to participate in monetary gambling, and that (2) participation and (3) time and money expenditure on simulated gambling are positively and independently associated with risk of problematic gambling when controlling for the number of monetary gambling forms, impulsivity, age and gender. To better protect young people, simulated gambling should, at minimum, emulate the consumer protection measures required for online gambling.

Adolescent betting on esports using cash and skins: Links with gaming, monetary gambling, and problematic gambling

Adolescents can easily access esports betting sites and place bets using cash or skins. This descriptive cross-sectional study examined the characteristics of adolescent esports bettors and relationships between their esports betting, video gaming activities, monetary gambling participation, and at-risk/problem gambling. Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 841) and online panel providers (n = 826). In both samples, gender and parents' living situation did not differ by past-month esports cash and skin betting, but recent esports betting was associated with engaging in esports gaming activities such as playing and watching esports, and in monetary gambling activities. Past-month esports betting using cash and skins was significantly associated with at-risk/problem gambling. After controlling for recent monetary gambling, recent esports skin bettors were over 3 times more likely to meet criteria for at-risk/problem gambling. Esports betting using skins appears to pose risks for young people and is easily accessible through unlicensed operators.

FOXN3 and GDNF Polymorphisms as Common Genetic Factors of Substance Use and Addictive Behaviors

Epidemiological and phenomenological studies suggest shared underpinnings between multiple addictive behaviors. The present genetic association study was conducted as part of the Psychological and Genetic Factors of Addictions study (n = 3003) and aimed to investigate genetic overlaps between different substance use, addictive, and other compulsive behaviors. Association analyses targeted 32 single-nucleotide polymorphisms, potentially addictive substances (alcohol, tobacco, cannabis, and other drugs), and potentially addictive or compulsive behaviors (internet use, gaming, social networking site use, gambling, exercise, hair-pulling, and eating). Analyses revealed 29 nominally significant associations, from which, nine survived an FDRbl correction. Four associations were observed between FOXN3 rs759364 and potentially addictive behaviors: rs759364 showed an association with the frequency of alcohol consumption and mean scores of scales assessing internet addiction, gaming disorder, and exercise addiction. Significant associations were found between GDNF rs1549250, rs2973033, CNR1 rs806380, DRD2/ANKK1 rs1800497 variants, and the “lifetime other drugs” variable. These suggested that genetic factors may contribute similarly to specific substance use and addictive behaviors. Specifically, FOXN3 rs759364 and GDNF rs1549250 and rs2973033 may constitute genetic risk factors for multiple addictive behaviors. Due to limitations (e.g., convenience sampling, lack of structured scales for substance use), further studies are needed. Functional correlates and mechanisms underlying these relationships should also be investigated.

Loot box purchasing is linked to problem gambling in adolescents when controlling for monetary gambling participation

Background and aims

Purchasing loot boxes in digital games is akin to gambling as it involves risking money for a chance-based reward of uncertain value. Research has linked buying loot boxes to problem gambling amongst adolescents, but has not examined co-occurring gambling participation. This study examined links between loot box purchasing and problem gambling amongst adolescents while controlling for monetary gambling participation.

Methods

Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 843) and online panels (n = 826). They included n = 421 and n = 128 adolescents, respectively, who met criteria for problem gambling.

Results

Past-month loot box purchasing was significantly related to gambling problems in bivariate analyses. When including age, gender and past-month monetary gambling, loot box purchases were still associated with at-risk and problem gambling in both samples. As expected, these other predictors attenuated the predictive value of recent loot box purchases in relation to gambling problems. The odds-ratios, nevertheless, were still in the predicted direction and remained significant. When controlling for monetary gambling, age and gender, recent loot box purchasing increased the odds of problem gambling 3.7 to 6.0 times, and at-risk gambling 2.8 to 4.3 times.

Discussion and conclusions

While causal relationships between loot box purchasing and problem gambling remain unclear, the results indicate that loot boxes disproportionately attract adolescents experiencing gambling problems, adding to the financial stress already caused by gambling. Consumer protection measures, youth and parental education, and age restrictions on loot box games are needed to protect young people.

Skin gambling predicts problematic gambling amongst adolescents when controlling for monetary gambling

BACKGROUND AND AIMS

Skin gambling uses in-game items (skins) acquired in video games, to gamble on esports, games of chance, other competitive events and privately with friends. This study examined characteristics of adolescent skin gamblers, their engagement in monetary gambling, and relationships between skin gambling and at risk/problem gambling.

METHODS

Two samples of Australian adolescents aged 12-17 years were recruited to an online survey through advertisements (n = 843) and an online panel provider (n = 826).

RESULTS

In both samples, past-month skin gamblers (n = 466 advertisements sample; n = 185 online panel sample) were more likely to have lower wellbeing, score as having an internet gaming disorder on the IGD, engage in more types of monetary gambling, and meet criteria for problem gambling on the DSM-IV-MR-J. Past-month skin gambling uniquely predicted problem gambling when controlling for past-month gambling on 11 monetary forms and the total number of monetary gambling forms.

DISCUSSION AND CONCLUSIONS

Underage participation in skin gambling is a growing concern. The strong convergence between engagement in skin gambling and monetary gambling suggests common risk factors may increase the propensity of some adolescents to gamble on these multiple forms. Nonetheless, past-month skin gambling predicted problem gambling even when controlling for past-month monetary gambling, indicating its unique contribution to gambling problems and harm. While the study was based on non-probability samples, its results strengthen the case for regulatory reforms, age restrictions and public health education to prevent underage skin gambling and its potentially harmful consequences for children and young people.

Contentious Issues and Future Directions in Adolescent Gambling Research

Background. There is currently considerable public policy and regulatory interest in the nature and prevalence of underage gambling. Research in this area has purported to show that adolescents are at elevated risk of problem gambling and that early exposure to gambling or gambling-like activities could be a potential precursor to future harm. Method. In this commentary, we provide a critical appraisal of these arguments with reference to major studies in the field of gambling studies. It is argued that adolescent gambling research is a contentious area. Some questions remain concerning the validity of adolescent problem gambling measures, the strength of the association between adolescent and adult gambling and the impact of simulated gambling activities. Results. The paper summarises the conceptual and methodological issues that should be considered and addressed in future studies to strengthen the validity of research in this area. Conclusion. The paper encourages the greater use of harm-based measures, longitudinal and individual-level transition analyses and questions that capture the influence of activities rather than just their temporal sequencing.

Problematic online gambling among adolescents: A systematic review about prevalence and related measurement issues

BACKGROUND AND AIMS

Despite its illegality among adolescents, online gambling is a common practice, which puts their mental health and well-being at serious risk. This systematic review summarises international scientific literature from the last 20 years on problematic online gambling among adolescents (11-21 years old) to determine its prevalence and to analyse related measurement issues.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and a protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, IC: CRD42020162932). Five academic databases were consulted, which resulted in an initial sample of 658 papers.

RESULTS

Sixteen studies met the inclusion criteria for this review. All studies were cross-sectional and targeted students from elementary school, secondary school or university. Most followed a convenience sampling procedure. The primary measurement instruments used were the DSM-IV-MR-J and SOGS-RA. Between 0.77% and 57.5% of adolescents present some degree of problematic online gambling (problem, pathological or disordered) depending on the instruments used, the study samples and the timeframe analysed. Between 0.89% and 1% of adolescents exhibited an online gambling disorder.

DISCUSSION AND CONCLUSION

There is a great heterogeneity in the methodology of the reviewed studies (samples, measurement instruments, cut-off points and criteria applied). The limited number of studies and the limited generalizability of their results suggest the need for further research and for development of specific instruments to assess different levels of problematic online gambling in representative samples of adolescents based on clinical 'gold standard' criteria and more accurate cut-off points.

The Relationship Between Gambling Problems and the Five-Factor Model of Personality: A Systematic Review and Meta-Analysis

Objectives: The aim of the present meta-analysis was to synthesize results from the association between problem gambling (PG) and dimensions of the five factor model of personality and to identify potential moderators (gambling diagnosis: yes/no, comorbidity: yes/no and trait assessment: four or fewer items vs. five items or more) of these associations in meta-regressions. Methods: Searches were conducted in six databases; Medline, Web of Science, PsychInfo, Google Scholar, OpenGrey, and Cochrane Library (conducted on February, 22, 2021). Included studies: (1) reported a relationship between PG and at least one of the personality traits in the five-factor model, (2) contained information of zero-order correlations or sufficient data for such calculations, and (3) were original articles published in any European language. Case-studies, qualitative studies, and reviews were excluded. All articles were independently screened by two authors. Final agreement was reached through discussion or by consulting a third author. Risk of bias of the included studies was assessed by the Newcastle-Ottawa Scale. Data were synthesized using a random effects model. Results: In total 28 studies, comprising 20,587 participants, were included. The correlations between PG and the traits were as follows: Neuroticism: 0.273 (95% CI = 0.182, 0.358), conscientiousness -0.296 (95% CI = -0.400, -0.185), agreeableness -0.163 (95% CI = -0.223, -0.101), openness -0.219 (95% CI = -0.308, -0.127), and extroversion -0.083 (95% CI = -0.120, -0.046). For all meta-analyses the between study heterogeneity was significant. Presence of gambling diagnosis was the only moderator that significantly explained between-study variance showing a more negative correlation to extroversion when participants had a gambling diagnosis compared to when this was not the case. Discussion: The results indicated some publication bias. Correcting for this by a trim-and-fill procedure showed however that the findings were consistent. Clinicians and researchers should be aware of the associations between personality traits and PG. Previous studies have for example showed neuroticism to be related to treatment relapse, low scores on conscientiousness to predict treatment drop-out and agreeableness to reduce risk of treatment drop-out. Systematic Review Registration: PROSPERO (CRD42021237225).

Adolescent Problem Gambling in Rural Ghana: Prevalence and Gender Differentiation

Problem gambling among young people is now a public health challenge in sub-Saharan Africa. However, the behaviour remains understudied, particularly, among rural-dwelling young people in countries within the subregion. We aimed to estimate the 12 months prevalence of problem gambling and to describe the overall and gender differences and commonalities in personal factors and social adversities associated with problem gambling among adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana; we used the DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) questionnaire to assess problem gambling during the previous 12 months. Personal lifestyle and psychosocial variables were assessed using adopted items from the 2012 WHO–Global School-based Student Health Survey. Overall, three in 10 adolescents (3 in 10 females; 4 in 10 males) in rural Ghana reported problem gambling in the previous 12 months. Female adolescents who experienced problem gambling were more likely to report family-related social adversities, while adolescent male problem gambling was associated with school-related factors and interpersonal factors outside the family context. Regardless of gender, sexual abuse victimisation was associated with three times increase in the odds of experiencing problem gambling. Relative to the prevalence of gambling among adolescents in urban contexts in other countries within sub-Saharan Africa, the estimates of problem gambling among in-school rural adolescents in Ghana are higher. Although further studies are needed to understand the nuances of the behaviour, the evidence of this study underscores the need for general and targeted health promotion, intervention and prevention efforts to mitigate the family, school, and interpersonal social adversities associated with adolescent problem gambling in rural Ghana.

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.

Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review

BACKGROUND AND AIMS

Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors.

RESULTS

Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors.

DISCUSSION AND CONCLUSIONS

Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.

Gambling in adolescence: a narrative review of the last 20 years

BACKGROUND

Gambling has increasingly become a problem in adolescence over the last 20 years. Previous research has failed to identify exactly the level of involvement of adolescents in gambling, yet a relevant presence of addictive behaviors was noticed.

OBJECTIVE

This narrative review highlights the implications of adolescent gambling, taking into consideration the main risk and protection factors aimed at limiting gambling activity, as well as the main links with the impulse-control disorder, addiction, and behavioral addiction.

METHODS

The review process was conducted through Medline, Scopus, Web of Science and Google Scholar search engines. The considered keywords were "Gambling" AND "Adolescence," "Behavioral addiction," AND "Adolescence." The articles related to gambling and adolescence in the last 20 years were included in compliance with inclusion and exclusion criteria, to perform a consistent analysis of the phenomenon and the related maintenance factors.

RESULTS

Starting from 1067 articles, 107 were selected to denote the main thematic areas involved in the gambling problem. The online search was completed on December 13, 2019.

CONCLUSIONS

The narrative review of literature can facilitate the analysis of gambling problems in adolescence, as the main studies in the last 20 years showed the complexity of the problem, the links between addiction, and the most effective methods of prevention and treatment.

Co-occurrences of substance use and other potentially addictive behaviors: Epidemiological results from the Psychological and Genetic Factors of the Addictive Behaviors (PGA) Study

BACKGROUND AND AIMS

Changes in the nomenclature of addictions suggest a significant shift in the conceptualization of addictions, where non-substance related behaviors can also be classified as addictions. A large amount of data provides empirical evidence that there are overlaps of different types of addictive behaviors in etiology, phenomenology, and in the underlying psychological and biological mechanisms. Our aim was to investigate the co-occurrences of a wide range of substance use and behavioral addictions.

METHODS

The present epidemiological analysis was carried out as part of the Psychological and Genetic Factors of the Addictive Behaviors (PGA) Study, where data were collected from 3,003 adolescents and young adults (42.6% males; mean age 21 years). Addictions to psychoactive substances and behaviors were rigorously assessed.

RESULTS

Data is provided on lifetime occurrences of the assessed substance uses, their co-occurrences, the prevalence estimates of specific behavioral addictions, and co-occurrences of different substance use and potentially addictive behaviors. Associations were found between (i) smoking and problematic Internet use, exercising, eating disorders, and gambling (ii) alcohol consumption and problematic Internet use, problematic online gaming, gambling, and eating disorders, and (iii) cannabis use and problematic online gaming and gambling.

CONCLUSIONS

The results suggest a large overlap between the occurrence of these addictions and behaviors and underlies the importance of investigating the possible common psychological, genetic and neural pathways. These data further support concepts such as the Reward Deficiency Syndrome and the component model of addictions that propose a common phenomenological and etiological background of different addictive and related behaviors.

The Same or Different? Convergence of Skin Gambling and Other Gambling Among Children

There is increasing attention on the introduction of gambling-like practices within video games. Termed convergence, this has been explored from the viewpoint of the product, examining similarities in game/gambling mechanics. Understanding convergence of practice is essential to map the epidemiology of these behaviours, especially among children. This paper focuses on the betting of skins within video games to explore co-occurrence with other forms of gambling among British children aged 11–16. Analysing the British Youth Gambling Survey showed that 39% of children who bet on skins in the past month had also gambled on other activities. Betting on skins and other forms of gambling increased with age and concordance of skin gambling/betting was greatest for those who also gambled online. Among gamblers, those who bet skins had higher rates of at-risk and problem gambling than those who did not (23% vs. 8%), though they had a greater breath of gambling involvement. Skin gambling alone was not significantly associated with at-risk gambling when other forms of gambling activity were taken into account. Skin betting and gambling on other activities cluster together, especially where the medium underpinning the behaviours is the same. Children who engage in both skin gambling/betting and other forms of gambling should be considered at-risk for the experience of harms because of their heightened engagement in gambling and gambling-like activities.

Behavioral Addictions: Excessive Gambling, Gaming, Internet, and Smartphone Use Among Children and Adolescents

The introduction of behavioral addictions is a relatively new concept in psychiatry. It was not until 2010 that the term behavioral addictions was added to the official classification of psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Gambling, typically thought to be an adult behavior, has become commonplace among adolescents. Although technological advances have made accessing information and communication easier, excessive use of the Internet and smartphones can result in multiple mental and physical health issues. Gambling disorders, gaming disorders, Internet use disorder, and excessive smartphone use often begin during childhood and adolescence.

Problem gambling and concurrent emotional/behavioral problems among Greek adolescents

Aim:

Problem gambling in adolescents constitutes a major health problem. Very few studies have investigated the relationship of adolescent gambling with emotional/behavioral problems. The aim of this study was to examine the association between adolescent problem gambling and emotional/behavioral problems using data from a school survey in the greater Athens area.

Material and Methods:

The total sample consisted of 2159 high school students (45.4% males and 54.6% females) from a random and representative sample of public and private schools in the greater Athens area. Data were collected in the form of self-reported questionnaires during one school hour. To access problem gambling the Diagnostic and Statistical Manual of Mental Disorders-IV Multiple Response Adapted for Juveniles questionnaire was administered to the study population. The presence of emotional/behavioral problems was assessed via the Strengths and Difficulties Questionnaire. Full data from 2141 participants were analyzed. Eighteen questionnaire with incomplete data were excluded.

Results:

Problem gambling in adolescence is in line with the presence of emotional/behavioral problems. All Strengths and Difficulties Questionnaire subscales were significantly associated with problem gambling. Specifically, emotional symptoms, conduct problems, attention/hyperactivity, and social dysfunction were all significantly and independently associated with adolescent pathologic gambling. The prosocial scale had lower scores in problem gamblers.

Conclusion:

This article aims to highlight and discuss the coexistence of adolescent problem gambling with other symptoms. The significant association of emotional/behavioral problems among adolescents with problem gambling indicates a need to screen for these symptoms and for their subsequent treatment among adolescents with problem gambling.

Gambling disorder

Gambling disorder is characterized by a persistent, recurrent pattern of gambling that is associated with substantial distress or impairment. The prevalence of gambling disorder has been estimated at 0.5% of the adult population in the United States, with comparable or slightly higher estimates in other countries. The aetiology of gambling disorder is complex, with implicated genetic and environmental factors. Neurobiological studies have implicated cortico-striato-limbic structures and circuits in the pathophysiology of this disorder. Individuals with gambling disorder often go unrecognized and untreated, including within clinical settings. Gambling disorder frequently co-occurs with other conditions, particularly other psychiatric disorders. Behavioural interventions, particularly cognitive-behavioural therapy but also motivational interviewing and Gamblers Anonymous, are supported in the treatment of gambling disorder. No pharmacological therapy has a formal indication for the treatment of gambling disorder, although placebo-controlled trials suggest that some medications, such as opioid-receptor antagonists, may be helpful. Given the associations with poor quality of life and suicide, improved identification, prevention, policy and treatment efforts are needed to help people with gambling disorder.

Consistency of Adolescents' Self-Report of Gambling Age of Onset: A Longitudinal Study

Studies suggest that youth who are exposed to their first gambling experience at an earlier age are at increased risk of developing problems. However, studies reporting age of onset of gambling exposure as a risk factor for gambling problems are cross-sectional by design and the relationship between both variables are sometimes inferred over extending periods of time. Methodologically speaking, it could induce a recall bias, a fact already documented in numerous areas of research related to high-risk conducts in adolescence. Thus, the goal of this study was twofold: to longitudinally describe, among adolescents, the level of discrepancy between reports of age of initiation to gambling activities, and to assess if the discrepancies could be associated with a certain number of known predictors of gambling participation. Additionally, recall period effect (e.g. time passed between answering the same question) was also assessed. Data were collected from a large longitudinal study on gambling among youth and four measurement times at 1-year interval were used, with only young people who have been introduced to gambling retained in the analyses (n =297; 63.3% boys; mean age = 15.25 years). Results revealed significant inconsistencies about age of initiation to gambling activity between measurement times. Moreover, results also revealed that age (e.g. being older) and time passed are significantly associated to the level of inconsistencies of self-reported age of initiation of gambling activity. Theoretical and practical implications of these findings are discussed.

The psychological and genetic factors of the addictive behaviors (PGA) study

OBJECTIVES

Most of the addiction studies focus on very specific aspects of addictions, often with contradictory results, and integrated studies are quite rare. Experimental studies comparing underlying mechanisms of addictions and analyzing data from an integrative psychological and genetic perspective are almost nonexistent. The aim of the present paper is to describe the research protocol of the Psychological and Genetic Factors of Addictive Behaviors (PGA) study, which applies an integrative approach to understanding the acquisition, development, and maintenance of addictive behaviors.

METHODS

A wide-spectrum national study was carried out. Data were collected from 3,003 adolescents. Addictions to both psychoactive substances and behaviors were thoroughly assessed via psychometrically robust scales, which also included assessment related to a wide range of related psychological dimensions. Additionally, a DNA sample was also collected from participants.

RESULTS

The paper presents the detailed methodology of the PGA study. Data collection procedures, instrumentation, and the analytical approach used to attain the research objectives are described.

CONCLUSIONS

Future plans, along with potential contributions of the PGA study, are also discussed. It is envisaged that the study will provide a unique opportunity to test possible mechanisms and causal pathways mediating the associations of genetic factors, psychological characteristics, and addictions.

[Clinical profile of adolescents being treated for problematic internet use]

OBJECTIVES

This study highlights the clinical profile of adolescents having consulted with an addiction treatment center (ATC) in Québec for a problematic internet use (PIU) to develop knowledge about these specific clients and precisely target their needs relative to treatment.

METHOD

The study was conducted with 80 adolescents between ages 14 and 17 (M = 15.59) who had consulted with an ACT for a PIU. Adolescents have participated in an interview documenting internet use patterns and their consequences, mental health disorder co-occurrence, and family and social relationships.

RESULTS

The sample was constituted of 75 boys (93.8%) and 5 girls (6.3%), who spent an average of 55.8 hours (SD = 27.22) per week on internet for non-school or professional activities. Almost all of these youths (97.5%) presented a co-occurring mental health disorder, and more than 70% had seeked help last year for a psychological problem. Results show that 92.6% feel their internet use significantly hinders their family relationships, and 50% feel it impedes their social relationships.

CONCLUSIONS

This study shows the multiple difficulties experienced by adolescents in need of a treatment for their PIU. The presence of co-occurring mental health disorders and relational difficulties among them underlines the need to develop and implement in ACTs integrated assessments and treatments that target not only online activities, but also all of life domains that can be affected by PIU.

CLINICAL IMPLICATIONS

- PIU adolescents are mainly boys who report problematic use of video games. - Almost all young people who consult for PIU have comorbid mental health problems and difficulties in their relation. - The study highlights the need to offer to this clientele an integrated assessment and treatment services that target all areas of their lives who are likely to be affected, to contribute or maintain the PIU.

LIMITATIONS

- This study was conducted with a convenience sample and the results are representative of young people who have visited a treatment center for addiction. The generalization of results to all adolescents with PIU is limited. - Considering that PIU are subject to cultural influence, the scope of this study is limited to populations living in a culture similar to that of Quebec and Canada.

A contextually relevant approach to assessing health risk behavior in a rural sub-Saharan Africa setting: the Kilifi health risk behavior questionnaire

BACKGROUND

Health risk behavior (HRB) is of concern during adolescence. In sub-Saharan Africa, reliable, valid and culturally appropriate measures of HRB are urgently needed. This study aims at assembling and psychometrically evaluating a comprehensive questionnaire on HRB of adolescents in Kilifi County at the coast of Kenya.

METHODS

The Kilifi Health Risk Behavior Questionnaire (KRIBE-Q) was assembled using items on HRB identified from a systematic review and by consulting 85 young people through 11 focus group discussions and in-depth interviews with 10 key informants like teachers and employees of organizations providing various services to young people in Kilifi County. The assembled list of HRB items were back and forward translated from English to Swahili and harmonized by a panel of experts. A total of 164 adolescents completed the assembled Swahili questionnaire at baseline and two weeks later 85 of them completed the questionnaire again. A classical test theory approach was utilized for psychometric evaluation. We computed the amount of missing data at item-level to verify data quality. Scaling evaluation was assessed by spread of responses across options at an item-level. Using Gwet's AC1 coefficient, test-retest reliability was assessed using data from the 85 adolescents who answered the questionnaire twice. Observations and completion of a brief questionnaire were done for non-psychometric evaluation of the KRIBE-Q administered via audio-computer assisted self-interview (ACASI) in Swahili language to 40 adolescents.

RESULTS

The KRIBE-Q showed high data quality, good spread of responses across options and a very good test-retest reliability (Gwet's AC1 = 0.82). It comprised 8 components with acceptable test-retest reliability: behavior resulting in unintentional injury and violence (0.85); tobacco use (0.85); alcohol and drug use (0.96); sexual behaviors (0.94); dietary behaviors (0.60); physical activity (0.74); gambling (0.73); and hygiene behavior (0.89). About 96% of the adolescents found the ACASI private and easy to use. Prevalence of bullying (32%), physical fights (40%) and engagement in gambling (26%) was high.

CONCLUSION

The KRIBE-Q assembled in this study is a psychometrically sound instrument for adolescents in rural coastal Kenya and feasible to administer via ACASI. This measure may be useful for surveys and planning interventions in similar settings.

Prevalence, risk factors, and psychosocial adjustment of problematic gambling in adolescents: Results from two representative German samples

Background and aims Gambling disorder is a significant public health concern. Especially, male minors have been shown to gamble in a problematic way, despite legal prohibitions. Methods We examined representative samples of students aged from 12 to 18 years (N = 9,309) in two German federal states to provide prevalence data and clinical description of risk factors for problematic gambling. Results We found that about 40% of the adolescents reported engaging in gambling activities within the past 12 months and found prevalence rates of 1.7% and 2.2% for problematic gambling. Especially, use of online gambling and slot machines was found to be related to problematic gambling. Male adolescents with a migration background were of higher risk for problematic gambling and psychopathological symptoms were significantly elevated among that group. Discussion The results indicate that participation in gambling activities is common among underaged adolescents and that prevalence of problematic gambling exceeds rates of adults. Similarly, problematic gambling is associated with increased psychopathological strain. Conclusion Given that a high proportion of adult gamblers report having started gambling in adolescents, our data emphasize the need for prevention and early intervention strategies for problematic gambling.

How coping styles, cognitive distortions, and attachment predict problem gambling among adolescents and young adults

Background and aims Recent research suggests that youth problem gambling is associated with several factors, but little is known how these factors might influence or interact each other in predicting this behavior. Consequently, this is the first study to examine the mediation effect of coping styles in the relationship between attachment to parental figures and problem gambling. Methods A total of 988 adolescents and emerging adults were recruited to participate. The first set of analyses tested the adequacy of a model comprising biological, cognitive, and family variables in predicting youth problem gambling. The second set of analyses explored the relationship between family and individual variables in problem gambling behavior. Results The results of the first set of analyses demonstrated that the individual factors of gender, cognitive distortions, and coping styles showed a significant predictive effect on youth problematic gambling, and the family factors of attachment and family structure did not reveal a significant influence on this behavior. The results of the second set of analyses demonstrated that the attachment dimension of angry distress exerted a more indirect influence on problematic gambling, through emotion-focused coping style. Discussion This study revealed that some family variables can have a more indirect effect on youth gambling behavior and provided some insights in how some factors interact in predicting problem gambling. Conclusion These findings suggest that youth gambling is a multifaceted phenomenon, and that the indirect effects of family variables are important in estimating the complex social forces that might influence adolescent decisions to gamble.

Adolescent gambling in greater Athens area: a cross-sectional study

PURPOSE

Problem gambling in adolescents has recently emerged as a pressing public health concern. In this context and in light of the pervasive financial crisis in Greece, the present study aimed to explore adolescents' gambling involvement in Athens region to estimate the prevalence of its problematic form and to identify its risk/protective factors.

METHODS

A total of 2141 students were recruited from a representative sample of 51 schools located in greater Athens area. The presence of problem gambling was assessed through the use of the DSM-IV-MR-J questionnaire. Data were collected in the form of a self-reported questionnaire during one school hour.

RESULTS

Results indicate that 1-year prevalence of high severity problem gambling was found to be 5.6%. Regarding the risk factors for problem gambling; male gender, parental engagement with gambling activities, living without the parents, low grades at school, foreign nationality and the referent absence of availability of food in the household, increased the risk of suffering from the disorder.

CONCLUSION

Gambling behavior among adolescents constitutes a problem in Greece and highlights the need for designing and implementing appropriate preventive interventions, especially amid the ongoing financial crisis.

The intergenerational transmission of at-risk/problem gambling: The moderating role of parenting practices

BACKGROUND AND OBJECTIVES

Although parenting practices are articulated as underlying mechanisms or protective factors in several theoretical models, their role in the intergenerational transmission of gambling problems has received limited research attention. This study therefore examined the degree to which parenting practices (positive parenting, parental involvement, and inconsistent discipline) moderated the intergenerational transmission of paternal and maternal problem gambling.

METHODS

Students aged 12-18 years (N = 612) recruited from 17 Australian secondary schools completed a survey measuring parental problem gambling, problem gambling severity, and parenting practices.

RESULTS

Participants endorsing paternal problem gambling (23.3%) were 4.3 times more likely to be classified as at-risk/problem gamblers than their peers (5.4%). Participants endorsing maternal problem gambling (6.9%) were no more likely than their peers (4.0%) to be classified as at-risk/problem gamblers. Paternal problem gambling was a significant predictor of offspring at-risk/problem gambling after controlling for maternal problem gambling and participant demographic characteristics. The relationship between maternal problem gambling and offspring at-risk/problem gambling was buffered by parental involvement.

DISCUSSION AND CONCLUSIONS

Paternal problem gambling may be important in the development of adolescent at-risk/problem gambling behaviours and higher levels of parental involvement buffers the influence of maternal problem gambling in the development of offspring gambling problems. Further research is therefore required to identify factors that attenuate the seemingly greater risk of transmission associated with paternal gambling problems.

SCIENTIFIC SIGNIFICANCE

Parental involvement is a potential candidate for prevention and intervention efforts designed to reduce the intergenerational transmission of gambling problems. (Am J Addict 2017;26:707-712).

Gambling and Video Game Playing Among Youth

Gambling and video game playing represent two leisure activities in which adolescents and young adults participate. There are psychological and behavioural parallels between some forms of gambling (e.g., slot machines, video lottery terminals, electronic gambling machines) and some types of video games (e.g., arcade games). Both activities operate on behavioural principles of variable reinforcement schedules in order to reward and prolong play and use exciting and stimulating sound and light effects within game play. Additionally, both activities have similar negative effects associated with excessive play (e.g., poor academic performance, moodiness, loss of interest in activities previously enjoyed, and interpersonal conflict). Thus, there is concern that children and adolescents who are attracted to video games, for both psychological rewards and the challenge, may be at greater risk to gamble. We examined the gambling and video game playing behaviour among 1,229 adolescents and young adults. Results indicate that gamblers, relative to non-gamblers, were more likely to play video games. Video game players were more likely than non-players to gamble. Both social and problem gamblers had higher rates of video game playing than did non-gamblers, and addicted gamers had higher rates of gambling than did social and non-gamers. Results from the current study suggest significant overlap in youth participation in both gambling activities and video game playing. These results have implications for future research and the treatment of problem gambling and video game addiction.Les jeux de hasard et les jeux vidéo sont deux loisirs auxquels s’adonnent les adolescents et les jeunes adultes. Il existe des parallèles psychologiques et comportementaux entre certaines formes des jeux de hasard (p. ex., les appareils à sous, les appareils de loterie vidéo, les machines de jeux électroniques) et certains jeux vidéo (p. ex., les jeux d’arcade). Ces deux types de jeux exploitent les principes comportementaux du programme variable de renforcement pour récompenser le joueur et l’amener à jouer plus longtemps et utilisent des effets lumineux et sonores stimulants et excitants pour accroître l’attrait de l’expérience de jeu. De plus, ces deux activités entraînent des effets négatifs similaires chez les joueurs excessifs (p. ex., mauvais résultats scolaires, instabilité émotive, perte d’intérêt pour des activités qui autrefois procuraient du plaisir, conflits interpersonnels). On craint donc que les enfants et les adolescents qui sont attirés par les jeux vidéo, en raison des défis qu’ils proposent et des récompenses psychologiques qu’ils procurent, soient plus à risque de s’adonner aux jeux de hasard. La présente recherche a examiné les comportements de jeu de 1229 adolescents et jeunes adultes relativement aux jeux de hasard et aux jeux vidéo. Les résultats indiquent que les joueurs de jeux de hasard, par rapport aux non-joueurs, étaient plus susceptibles de jouer à des jeux vidéo, et que les joueurs de jeux vidéo étaient pareillement plus susceptibles de s’adonner aux jeux de hasard que les sujets ne jouant pas aux jeux vidéo. Le groupe des joueurs sociaux et celui des joueurs à problèmes présentaient tous deux un taux plus élevé de pratique des jeux vidéo que celui des non-joueurs, et les sujets ayant une dépendance aux jeux vidéo s’adonnaient également en plus forte proportion aux jeux de hasard que les sujets ne pratiquant par les jeux vidéo ou les pratiquant de manière sociale uniquement. Les résultats de la présente étude donnent à croire qu’il y a un chevauchement important entre la pratique des jeux de hasard et celle des jeux vidéo chez les jeunes. Ces résultats ont des incidences sur les futures recherches et le traitement de la dépendance aux jeux de hasard et aux jeux vidéo. 

Gender Invariance of the Gambling Behavior Scale for Adolescents (GBS-A): An Analysis of Differential Item Functioning Using Item Response Theory

As there is a lack of evidence attesting the equivalent item functioning across genders for the most employed instruments used to measure pathological gambling in adolescence, the present study was aimed to test the gender invariance of the Gambling Behavior Scale for Adolescents (GBS-A), a new measurement tool to assess the severity of Gambling Disorder (GD) in adolescents. The equivalence of the items across genders was assessed by analyzing Differential Item Functioning within an Item Response Theory framework. The GBS-A was administered to 1,723 adolescents, and the graded response model was employed. The results attested the measurement equivalence of the GBS-A when administered to male and female adolescent gamblers. Overall, findings provided evidence that the GBS-A is an effective measurement tool of the severity of GD in male and female adolescents and that the scale was unbiased and able to relieve truly gender differences. As such, the GBS-A can be profitably used in educational interventions and clinical treatments with young people.

DSM-5 diagnosis of Internet Gaming Disorder: Some ways forward in overcoming issues and concerns in the gaming studies field

Background and aims The current DSM-5 diagnosis of Internet Gaming Disorder (IGD; American Psychiatric Association [APA], 2013) has led to a number of issues and concerns that we highlighted in our recent paper (Kuss, Griffiths, & Pontes, 2017). Experts in the field responded to our evaluation of these issues resulting in six commentaries. Methods In this paper, we offer responses to the six commentaries to move the scientific field forward. All of the responses to our original paper highlighted many conceptual, theoretical, and/or methodological problems with the proposed IGD diagnosis as outlined in the DSM-5. We outline some ways forward in overcoming issues and concerns in the gaming studies field. Results We argue that rather than stigmatizing gaming per se, the role of scientists and practitioners is to establish a clear-cut distinction between someone who may use games excessively but non-problematically and someone who is experiencing significant impairment in their daily lives as a consequence of their excessive gaming. This responsibility needs to be shared by popular media who are often quick to build a moral panic around gaming behaviors, often based on cherry-picking specific case studies and pieces of research which support their headlines. Conclusion Researchers, practitioners, gaming developers, and the media need to work together and collaboratively to build a realistic and comprehensive understanding of gaming as a normal, enjoyable, and often beneficial sociocultural practice, which for a small minority of excessive users may be associated with the experience of addiction-related symptoms that may require professional support.

Problem Gambling among Adolescent Girls in Croatia-The Role of Different Psychosocial Predictors

Although, compared to boys, adolescent girls gamble less often and less problematically, prevalence studies still show significant numbers of at risk/problem gamblers among girls. However, girl gambling has been on the sidelines of adolescent gambling research. The available studies usually focus only on a narrow set of correlates often ignoring that adolescent gambling is a complex phenomenon determined by various factors. Also, they often measure gambling related consequences with instruments that are not specifically developed for use on adolescents. In order to contribute to a better understanding of adolescent gambling this study focuses on problem gambling among girls. We consider different social, cognitive, motivational and behavioral factors as predictors of girl problem gambling. A total of 1,372 high-school girls from 7 Croatian cities participated in the study. They provided data on their gambling activities, peer gambling, cognitive distortions related to gambling, motivation for gambling, and levels of general risky behavior. As the only instrument developed specifically for use on adolescents, the Canadian Adolescent Gambling Inventory was used to examine adverse gambling consequences. Results show 7.4% of girls can be considered regular gamblers, and out of those who gambled at least once in their lifetime (n = 862), 11.2% already experience mild adverse consequences because of their gambling (at risk gamblers), with 3.2% experiencing serious consequences (problem gamblers). In general, girls seem to prefer lotto and scratch cards, but sports betting seems to be the preferred game of choice among regular girl gamblers. A hierarchical regression model confirmed the importance of much the same factors identified as risky for the development of problem gambling among adolescent boys—cognitive distortions, motives to earn money, to be better at gambling and to relax, the experiences of winning large and the drive to continue gambling, together with social factors such as having friends who also gamble, being involved in other risky and delinquent behavior and higher gambling frequency. Results call into question the importance of the motive to feel better for adolescent girls problem gambling. We discuss implications of our findings for both universal and indicated youth gambling prevention 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.

Reliability, Validity, and Classification Accuracy of the DSM-5 Diagnostic Criteria for Gambling Disorder and Comparison to DSM-IV

The DSM-5 was published in 2013 and it included two substantive revisions for gambling disorder (GD). These changes are the reduction in the threshold from five to four criteria and elimination of the illegal activities criterion. The purpose of this study was to twofold. First, to assess the reliability, validity and classification accuracy of the DSM-5 diagnostic criteria for GD. Second, to compare the DSM-5-DSM-IV on reliability, validity, and classification accuracy, including an examination of the effect of the elimination of the illegal acts criterion on diagnostic accuracy. To compare DSM-5 and DSM-IV, eight datasets from three different countries (Canada, USA, and Spain; total N = 3247) were used. All datasets were based on similar research methods. Participants were recruited from outpatient gambling treatment services to represent the group with a GD and from the community to represent the group without a GD. All participants were administered a standardized measure of diagnostic criteria. The DSM-5 yielded satisfactory reliability, validity and classification accuracy. In comparing the DSM-5 to the DSM-IV, most comparisons of reliability, validity and classification accuracy showed more similarities than differences. There was evidence of modest improvements in classification accuracy for DSM-5 over DSM-IV, particularly in reduction of false negative errors. This reduction in false negative errors was largely a function of lowering the cut score from five to four and this revision is an improvement over DSM-IV. From a statistical standpoint, eliminating the illegal acts criterion did not make a significant impact on diagnostic accuracy. From a clinical standpoint, illegal acts can still be addressed in the context of the DSM-5 criterion of lying to others.

Teacher Awareness and Attitudes Regarding Adolescent Risk Behaviours: a Sample of Finnish Middle and High School Teachers

Empirical evidence has shown that youth gamble on both regulated and unregulated games, despite legislative prohibitions. This study assesses middle and high school teachers' awareness and attitudes regarding adolescent gambling and other potentially high-risk behaviours in Finland. A convenience sample of teachers (N = 157) from 13 provinces participated in the survey. The results suggest that teachers in Finland were more knowledgeable of the age limits of other adolescent high-risk behaviours than the legal age for gambling. Teachers were somewhat familiar with the behaviours and consequences associated with adolescent gambling. All other risk behaviours were perceived as being more important than gambling. Teachers' awareness about gambling prevention material in Finnish schools was limited. Results suggest that initiatives are required to enhance teachers' knowledge of adolescent problem gambling and its harmful short- and long-term consequences. School policies and guidelines including gambling behavior should be implemented in middle and high schools globally.

Validation of the Portuguese DSM-IV-MR-J

Youth problem gambling is viewed as an emergent public health issue in many countries, and is also an emerging area of public concern in Portugal. However, there is currently no Portuguese instrument that focuses specifically on the measurement of problem gambling among young people. Consequently, the present study aimed to validate the DSM-IV-MR-J for use among Portuguese adolescents and to examine its’ psychometric properties. A cross-cultural adaption of this instrument to the Portuguese language was performed using the translation and back translation method. The final version of the instrument was administered to 753 Portuguese high school and first year college students. The findings revealed an acceptable internal reliability and replicated the one-factor structure of this scale. Based on these findings, the Portuguese DSM-IV-MR-J appears to be a valid and reliable instrument, and provides a much needed psychometric tool for the development of more research on youth gambling in Portugal.

Assessment of High School Students’ Understanding of DSM-IV-MR-J Items

The current study examines the understanding of the DSM-IV-MR-J items to assess pathological gambling among adolescents aged 12 to 15, and explores its accuracy. The DSM-IV-MR-J was first administered in the classroom. Participants were assigned to either an experimental or a control group. Participants in the first group were asked to explain the meaning of each DSM-IV-MR-J item during an individual interview. If the item was not properly understood, the investigator corrected the participant’s understanding of the item. The questionnaire was then administered a second time. The control group was only submitted to a test-retest procedure. The results showed that 22% of the items were misunderstood. Changes in diagnostic categories emerged on the second administration for both groups. A 20% and 29.4% decrease in the number of problem/pathological gamblers was observed in the experimental and control group. The implications of these results are discussed in terms of the reliability of the DSM-IV-MR-J as a measure of problem gambling among adolescents.