Indicated prevention of problem gambling among college students

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

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

Preventive Interventions and Harm Reduction in Online and Electronic Gambling: A Systematic Review

Gambling possess both entertaining and potentially harmful aspects. It remains a challenge for public health authorities and gambling operators to recommend and implement effective evidence-based interventions to reduce gambling-related harm and prevent problematic gambling behavior. This systematic review examined studies on randomized controlled trials in this field, aiming to describe and evaluate the effect of preventive and harm-reducing interventions for online gambling and electronic gaming machines. A systematic literature search was performed in PsycINFO, PubMed, Embase, and SCOPUS. Study selection, risk of bias assessment, and data extraction were conducted by two reviewers independently, and a synthesis was performed. A total of 18 studies were included, of which the majority were limited by quality issues. The applied interventions focused on restraining gambling, providing feedback, delivering therapeutic and informative content, and priming analytical thinking. The studies varied greatly in terms of specific intervention content, study setting, participants, and outcome measures, and no consistent patterns could be detected between study characteristics and related effects. Although research in the field is growing, there is still a need for further methodologically rigorous investigation and consensus on outcome measures sensitive to effects of preventive and harm-reducing interventions.

Minors and Online Gambling: Prevalence and Related Variables

Substantial access to the Internet by minors has brought about consequences that are not always positive. The increase of online gambling or betting is one of those. Although in most cases online gambling by minors does not result in a disorder, it does imply a higher probability of developing a gambling disorder in adulthood, and it can cause economic, family, school and social problems. The aim of this study, carried out in the Galician region of Spain with a sample of 3772 students aged between 12 and 17 years, was to estimate the prevalence of online gambling in minors; to characterize the profile of online gamblers; to explore the differences in Internet and smartphone usage habits, online risky practices, problematic Internet use and parental involvement between online gamblers and non-online gamblers; and to analyse the relation between online gambling and academic performance. The results revealed that 6.5% of Galician adolescents are online gamblers, a figure that has more than tripled over seven years. 9 out of 10 online gamblers are male, and their mean age is 15. Online gamblers had significantly higher rates of problematic Internet use, active sexting, cyberbullying, or contacting strangers through the Internet. Furthermore, online gamblers had higher scores on impulsiveness, lower scores on assertiveness, and were lacking parental control. These data show that online gambling is not an isolated problem, so prevention should be understood in a comprehensive manner.

Systematic Review of Preventive Programs for Reducing Problem Gambling Behaviors Among Young Adults

Young adulthood is a developmental period from late adolescence to one's late twenties or early thirties. Prevalence studies internationally have reported that individuals in this age group tend to have the highest rates of problem gambling. However, much of the prevention work designed to minimize the risk of problem and disordered gambling has been primarily focused on school settings and aimed at high school students. The objective of this study was to summarize the existing literature on the effectiveness of prevention programs aimed at reducing the prevalence of gambling problems in young adults. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic academic databases were consulted in order to examine the studies conducted during the last 20 years. After removing duplicates and adhering to the inclusion and exclusion criteria, nine studies were included in this review. All studies targeted college or university students and followed a selective or indicated prevention strategy. A Personalized Normative Feedback approach was incorporated in most of the studies, which had generally good results in reducing and/or minimizing at-risk or problem gambling. The limited number of studies included in this review highlights the need to address scientific quality standards before proceeding with the design, implementation and widespread dissemination of these preventive programs as well as the need to ensure the program's efficacy prior to implementation.

Efficacy of face-to-face versus self-guided treatments for disordered gambling: A meta-analysis

Background and aims In the light of growing traditional and novel forms of gambling, the treatment of disordered gambling is gaining increasing importance and practical relevance. Most studies have examined face-to-face treatments. Although trials implementing self-guided treatments have recently been conducted, these options have not yet been systematically examined. The primary objective of this meta-analysis, therefore, was to analyze the efficacy of all types of psychological face-to-face and self-guided treatments. Methods A multilevel literature search yielded 27 randomized controlled studies totaling 3,879 participants to provide a comprehensive comparative evaluation of the short- and long-term efficacies of face-to-face and self-guided treatments for disordered gambling. Results As expected, the results revealed significantly higher effect sizes for face-to-face treatments (16 studies with Hedges's g ranging from 0.67 to 1.15) as compared with self-guided treatments (11 studies with Hedges's g ranging from 0.12 to 0.30) regarding the reduction of problematic gambling behavior. The intensity of treatment moderated the therapy effect, particularly for self-guided treatments. Discussion and Conclusions The results of this meta-analysis favor face-to-face treatments over self-guided treatments for the reduction of disordered gambling. Although the findings broaden the scope of knowledge about psychological treatment modalities for disordered gambling, further research is needed to identify the reasons for these differences with the goal to optimize the treatment for this disabling condition.

The role of social and cognitive factors in individual gambling: An empirical study on college students

Most of the studies on the determinants of individual gambling behaviour rely on cognitive theories. In our study, we argue that, besides cognitive factors, several social factors might play an important role as well. We analyse data from an ad hoc webmail survey conducted on about 2000 undergraduate students enrolled in a large public university in the Northern Italy in the academic year 2012-13. Using a variety of statistical techniques (standard regression models, boosted regression trees and structural equations models), we show that social variables affect both participation in gambling in the past year and latent gambling propensity. In particular, controlling for several proxies for individual cognitive ability and understanding of probability, gambling propensity is positively affected by the degree of gambling in the social surrounding (parents, peers, neighbourhood) and the acceptability of gambling activities to the individual. Moreover, in our sample of college students the role of social factors appears to be larger than that of cognitive factors, and this is consistent across different types of models and specifications.

Examining personalized feedback interventions for gambling disorders: A systematic review

Background and aims Personalized feedback interventions (PFI) have shown success as a low-cost, scalable intervention for reducing problematic and excessive consumption of alcohol. Recently, researchers have begun to apply PFI as an intervention method for problematic gambling behaviors. A systematic review of the literature on PFI as an intervention/prevention method for gambling behaviors was performed. Methods Studies were included if they met the following criteria: the design included both a PFI group and a comparison group, and the interventions focused on gambling prevention and/or reduction. Six relevant studies were found meeting all criteria. Results Results revealed that PFI treatment groups showed decreases in a variety of gambling behaviors as compared to control groups, and perceived norms on gambling behaviors significantly decreased after interventions as compared to control groups. Conclusions Overall, the research suggests that while PFI applied to gambling is still in its infancy, problematic gamblers appear to benefit from programs incorporating PFIs. Further, PFI may also be used as a promising source of preventative measures for individuals displaying at-risk gambling behaviors. While, evidence is still limited, and additional research needs to be conducted with PFI for gambling problems, the preliminary positive results along with the structure of PFI as a scalable and relatively inexpensive intervention method provides promising support for future studies.

The prevalence of pathological gambling among college students: a meta-analytic synthesis, 2005-2013

The problem of gambling addiction can be especially noteworthy among college and university students, many of whom have the resources, proximity, free time, and desire to become involved in the myriad options of gambling now available. Although limited attention has been paid specifically to college student gambling in the body of literature, there have been two published meta-analyses estimating the prevalence of probable pathological gambling among college students. This present study aims to be the third, presenting an up-to-date proportion of those students exhibiting gambling pathology, and is the first to include international studies from outside the United States and Canada. The purpose of this study was to use the most up-to-date meta-analytical procedures to synthesize the rates of probable pathological gambling for college and university students worldwide. A thorough literature review and coding procedure resulted in 19 independent data estimates retrieved from 18 studies conducted between 2005 and 2013. To synthesize the studies, a random effects model for meta-analysis was applied. The estimated proportion of probable pathological gamblers among the over 13,000 college students surveyed was computed at 10.23%, considerably higher than either of the two previously published meta-analyses, and more than double the rate reported in the first meta-analysis of this type published in 1999. Implications and recommendations for future practice in dealing with college students and gambling addiction are outlined and described for both administrators and mental health professionals.

Examining the efficacy of a personalized normative feedback intervention to reduce college student gambling

OBJECTIVE

To evaluate the efficacy of a stand-alone personalized normative feedback (PNF) intervention targeting misperceptions of gambling among college students.

PARTICIPANTS

Undergraduates (N = 136; 55% male) who reported gambling in the past 30 days were recruited between September 2011 and March 2012.

METHODS

Using a randomized clinical trial design, participants were assigned to receive either PNF or an attention control task. In addition to self-report, this study used 2 computer-based risk tasks framed as "gambling opportunities" to assess cognitive and behavioral change at 1 week post intervention.

RESULTS

After 1 week, participants receiving PNF showed a marked decrease in perception of other students' gambling, and evinced lower risk-taking performance on 2 analog measures of gambling.

CONCLUSIONS

Changes in both self-reported perceived norms and analog gambling behavior suggest that a single, stand-alone PNF intervention may modify gambling among college students. Whether it can impact gambling outside of the laboratory remains untested.

Problem gambling of Chinese college students: application of the theory of planned behavior

The present study, using the theory of planned behavior (TPB), investigated psychological correlates of intention to gamble and problem gambling among Chinese college students. Nine hundred and thirty two Chinese college students (aged from 18 to 25 years) in Hong Kong and Macao were surveyed. The findings generally support the efficacy of the TPB in explaining gambling intention and problems among Chinese college students. Specifically, the results of the path analysis indicate gambling intention and perceived control over gambling as the most proximal predictors of problem gambling, whereas attitudes, subjective norms, and perceived control, which are TPB components, influence gambling intention. Thus, these three TPB components should make up the core contents of the prevention and intervention efforts against problem gambling for Chinese college students.

Brief motivational feedback and cognitive behavioral interventions for prevention of disordered gambling: a randomized clinical trial

AIMS

The purpose of the current study was to evaluate feasibility and efficacy of two promising approaches to indicated prevention of disordered gambling in a college population.

DESIGN

Randomized clinical trial with assignment to a personalized feedback intervention (PFI), cognitive-behavioral intervention (CBI) or assessment-only control (AOC). PFI was delivered individually in a single session and included feedback regarding gambling behavior, norms, consequences and risk-reduction tips, delivered in a motivational interviewing style. CBI was delivered in small groups over four to six sessions and included functional analysis and brief cognitive correction, as well as identification of and alternatives for responding to gambling triggers.

SETTING

College campus.

PARTICIPANTS

At-risk or probable pathological gamblers (n = 147; 65.3% male; group assignment: PFI, n = 52; CBI, n = 44; AOC, n = 51).

MEASUREMENTS

Self-reported gambling quantity, frequency, consequences, psychopathology, normative perceptions and beliefs.

FINDINGS

Relative to control, results at 6-month follow-up indicated reductions in both interventions for gambling consequences (PFI d = 0.48; CBI d = 0.39) and DSM-IV criteria (PFI d = 0.60; CBI d = 0.48), reductions in frequency for PFI (d = 0.48). CBI was associated with reduced illusions of control, whereas PFI was associated with reduced perceptions of gambling frequency norms. Reductions in perceived gambling frequency norms mediated effects of PFI on gambling frequency.

CONCLUSIONS

A single-session personalized feedback intervention and a multi-session cognitive-behavioral intervention may be helpful in reducing disordered gambling in US college students.

A randomized controlled trial of a personalized feedback intervention for problem gamblers

Background

Personalized feedback is a promising self-help for problem gamblers. Such interventions have shown consistently positive results with other addictive behaviours, and our own pilot test of personalized normative feedback materials for gamblers yielded positive findings. The current randomized controlled trial evaluated the effectiveness, and the sustained efficacy, of the personalized feedback intervention materials for problem gamblers.

Methodology/Principal Findings

Respondents recruited by a general population telephone screener of Ontario adults included gamblers with moderate and severe gambling problems. Those who agreed to participate were randomly assigned to receive: 1) the full personalized normative feedback intervention; 2) a partial feedback that contained all the feedback information provided to those in condition 1 but without the normative feedback content (i.e., no comparisons provided to general population gambling norms); or 3) a waiting list control condition. The primary hypothesis was that problem gamblers who received the personalized normative feedback intervention would reduce their gambling more than problem gamblers who did not receive any intervention (waiting list control condition) by the six-month follow-up.

Conclusions/Significance

The study found no evidence for the impact of normative personalized feedback. However, participants who received, the partial feedback (without norms) reduced the number of days they gambled compared to participants who did not receive the intervention. We concluded that personalized feedback interventions were well received and the materials may be helpful at reducing gambling. Realistically, it can be expected that the personalized feedback intervention may have a limited, short term impact on the severity of participants' problem gambling because the intervention is just a brief screener. An Internet-based version of the personalized feedback intervention tool, however, may offer an easy to access and non-threatening portal that can be used to motivate participants to seek further help online or in person.

Trial Registration

ClinicalTrials.govNCT00578357

Effects of alcohol and initial gambling outcomes on within-session gambling behavior

Concurrent drinking and gambling is prevalent among young adults and may increase negative consequences associated with each behavior. The effects of alcohol, initial gambling outcomes, gambling-related cognitions, and impulsivity on gambling behavior were evaluated. Initial gambling outcomes, gambling-related cognitions, and impulsivity were also assessed as potential moderators of the relation between alcohol and gambling behavior. Participants (N = 130) were randomly assigned to receive active placebo or alcohol (0.84 g/kg and 0.76 g/kg for men and women, respectively) and were invited to wager on a simulated slot machine programmed to produce 1 of 3 initial outcomes (win, breakeven, or loss) before beginning a progressive loss schedule. Alcohol consumption was associated with larger average bets and more rapid loss of all available funds, though no evidence was found for predicted main effects and interactions for gambling persistence. The effect of impulsivity was moderated by beverage condition, such that higher levels of impulsivity were associated with larger average bets for participants in the placebo but not the alcohol group. Results have direct implications for individual-focused and public-health interventions.

CBT for adolescent pathological gambling - lessons from adult research

OBJECTIVES

Features of gambling, particularly among young people have changed over the past decade and, while there are no data from Ireland, there are suggestions from those working in the field that pathological gambling is increasing among adolescents. Relatively little is known about the effective treatment of pathological gambling in adolescents. This paper aims to review research in cognitive behavioural treatments with a view to their application in adolescents. Research among adolescence is given prominence when this is available.

METHODS

The methodology comprised a literature search of Medline, Psycinfo, and EMBASE databases, using the search terms: 'cognitive behavioural therapy'; 'gambling; 'psychology'; 'epidemiology'; 'adolescent'; 'motivation'; 'effectiveness'; 'outcome'; 'relapse'; and 'internet'. In addition, a hand search of Clinical Psychological Reviews, Journal of Gambling Studies, Addiction, Psychology of Addictive Behaviors, and International Gambling Studies (1997-2007) was performed.

RESULTS

A total of 23 studies comprising various cognitive and behavioural approaches were identified, all but three of them confined to adult subjects. Study methodology and quality varied greatly, with many case studies or small case series, and only three randomised control trials. None used an intention-to-treat analysis, and there was little long-term follow-up. Almost ail indicated, with more or less evidence, that cognitive behavioural strategies might be beneficial.

CONCLUSIONS

Many varieties and modifications of cognitive behavioural therapy have been applied to pathological gambling, though there are few studies of any psychological treatments for adolescent gamblers. Methodological problems surround much of the research. Notwithstanding these reservations cognitive behavioural approaches seem to offer promise in managing this serious problem.

Pilot study of a personalized feedback intervention for problem gamblers

A pilot study was conducted of a personalized feedback intervention for problem gamblers. Respondents (N=61) were recruited from an ongoing gambling research study to take part in another study to help us "develop and evaluate self-help materials for gamblers." Respondents were randomly assigned to receive a personalized feedback summary or to a waiting list control. At 3-month follow-up (80.3% follow-up rate, N=49), after controlling for baseline demographic characteristics and gambling severity, respondents in the feedback condition displayed some evidence that they were spending less money on gambling than those in the control condition. Further, ratings of the usefulness of the feedback summary were positive and most recipients (96%) recommended that they be made available to other gamblers interested in evaluating or modifying their gambling. Given these promising pilot results, a full-scale evaluation of these personalized feedback materials would appear justified. An online version of the intervention is now also available at www.CheckYourGambling.net.

Brief motivational interventions for college student problem gamblers

AIMS

College students experience high rates of problem and pathological gambling, yet little research has investigated methods for reducing gambling in this population. This study sought to examine the efficacy of brief intervention strategies.

DESIGN

Randomized trial.

SETTING

College campuses.

PARTICIPANTS

A total of 117 college student problem and pathological gamblers.

INTERVENTIONS

Students were assigned randomly to: an assessment-only control, 10 minutes of brief advice, one session of motivational enhancement therapy (MET) or one session of MET, plus three sessions of cognitive-behavioral therapy (CBT). The three interventions were designed to reduce gambling.

MEASUREMENTS

Gambling was assessed at baseline, week 6 and month 9 using the Addiction Severity Index-gambling (ASI-G) module, which also assesses days and dollars wagered.

FINDINGS

Compared to the assessment-only condition, those receiving any intervention had significant decreases in ASI-G scores and days and dollars wagered over time. The MET condition decreased significantly ASI-G scores and dollars wagered over time, and increased the odds of a clinically significant reduction in gambling at the 9-month follow-up relative to the assessment-only condition, even after controlling for baseline indices that could impact outcomes. The Brief Advice and MET+CBT conditions had benefits on some, but not all, indices of gambling. None of the interventions differed significantly from one another. Conclusions These results suggest the efficacy of brief interventions for reducing gambling problems in college students.

A Canadian population level analysis of the roles of irrational gambling cognitions and risky gambling practices as correlates of gambling intensity and pathological gambling

Using population data (N = 11,562) drawn from five Canadian gambling prevalence surveys conducted between 2000 and 2005, the current study investigated the relationship between irrational gambling cognitions and risky gambling practices upon (a) gambling intensity, as measured by percent of income spent on gambling and (b) tolerance, a diagnostic indicator of pathological gambling. First, we found irrational gambling cognitions and risky gambling practices to be positively related. Second, irrational gambling cognitions moderated the relationship between risky gambling practices and gambling intensity. Specifically, people engaging in risky practices, spent less of their income on gambling when they had fewer irrational gambling cognitions compared to those with more irrational cognitions. Third, irrational gambling cognitions moderated the relationship between risky gambling practices and tolerance. Of the people engaging in risky practices, those with no irrational cognitions reported lower levels of tolerance than those with at least one irrational cognition. Interactions with gender are reported and discussed. These findings demonstrate the importance of both gambling cognitions and gambling practices upon the intensity of gambling and pathological gambling.

Intimate partner violence perpetration and problem drinking among college students: The roles of expectancies and subjective evaluations of alcohol aggression

OBJECTIVE

The present research examined the effect of alcohol aggression expectancies and subjective evaluations of alcohol's effects on aggression in intimate partner violence (IPV) perpetration among college students. We were interested in determining the extent to which these relationships differed across gender.

METHOD

A total of 780 (57.3% female) incoming heavy drinking college freshmen who were between the ages of 18 and 25 years completed self-reported measures of IPV perpetration, alcohol use and problems, and alcohol aggression expectancies and subjective evaluations of those expectancies as part of the baseline assessment for a larger social norms alcohol intervention study. Analyses evaluated the effect of alcohol aggression expectancies and subjective evaluations of those expectancies on IPV perpetration.

RESULTS

Results indicated that problem drinking was positively associated with IPV perpetration for those who were lower (beta = .32, p < .001) versus those who were higher (beta = .07, p = ns) in alcohol aggression expectancies. Among men, there was a significantly stronger relationship between problem drinking and IPV perpetration among those who evaluated alcohol's effects on aggression more favorably (beta = .41, p < .001) versus less favorably (beta = .11, p = ns). Among women, there was not a significantly stronger relationship between problem drinking and IPV perpetration at less favorable (beta = .17, p < .05) versus more favorable (beta = .11, p < .06) evaluations of alcohol's effects on aggression.

CONCLUSIONS

Findings suggest that, in understanding IPV perpetration, it may not be sufficient to evaluate expected alcohol effects without also including whether those effects are viewed as good or bad. Findings also suggest that the relationship between alcohol problems and IPV perpetration may be stronger and more straightforward for men than for women.

Disordered gambling among college students: a meta-analytic synthesis

The purpose of this study was to use a meta-analytic procedure to synthesize the rates of disordered gambling for college students that have been reported in the research literature. In order to identify all possible studies that met stringent inclusion criteria, Medline, PsychINFO, and SocioIndex databases were searched with the terms "gambling," and "college student". This process resulted in 15 studies concerning gambling among college students that were published through July 2005. To synthesize the 15 studies, a random effects model for meta-analysis was applied. The estimated proportion of disordered gamblers among college students was 7.89%. This estimate is noteworthy because it is higher than that reported for adolescents, college students or adults in a previous study using meta-analytic procedures with studies conducted prior to 1997.

Injunctive norms and problem gambling among college students

Two studies examined the relationships among injunctive norms and college student gambling. In study 1 we evaluated the accuracy of perceptions of other students' approval of gambling and the relationship between perceived approval and gambling behavior. In study 2 we evaluated gambling behavior as a function of perceptions of approval of other students, friends, and family. In study 1, which included 2524 college students, perceptions of other students' approval of gambling were found to be overestimated and were negatively associated with gambling behavior. The results of study 2, which included 565 college students, replicated the findings of study 1 and revealed positive associations between gambling behavior and perceived approval of friends and family. Results highlight the complexity of injunctive norms and the importance of considering the reference group (e.g., peers, friends, family members) in their evaluation. Results also encourage caution in considering the incorporation of injunctive norms in prevention and intervention approaches.

Does learning about the mathematics of gambling change gambling behavior?

The present research examined the influence of improved knowledge of odds and mathematical expectation on the gambling behavior of university students. A group of 198 students in an introductory statistics class received instruction on probability theory using examples from gambling. A comparison group of 134 students received generic instruction on probability, and another group of 138 students in classes on unrelated topics received no mathematical instruction. Students receiving the intervention demonstrated superior ability to calculate gambling odds as well as resistance to gambling fallacies 6 months after the intervention. Unexpectedly, this improvement in knowledge and skill was not associated with any decreases in actual gambling behavior. The implication of this research is that enhanced mathematical knowledge on its own may be insufficient to change gambling behavior.

Using motivational interviewing to promote HIV testing at an American Indian substance abuse treatment facility

Alcohol and drug use are associated with increased risk of HIV/AIDS. American Indians and Alaska Natives (AI/AN) have high rates of alcohol and other drug use, as well as a high incidence of unsafe sex behaviors and injection drug use practices. Indicators of AI/AN HIV risks involving sexual activity include high rates of STDs, such as gonorrhea, chlamydia, and syphilis. Despite these facts, the prevalence of HIV infection among AI/AN is not well known. The present study is part of a HRSA-funded SPNS HIV/AIDS health initiative, one goal of which is to increase the number of HIV-positive individuals who know their HIV status. To meet the goal of the SPNS project, patients in an inpatient alcohol and drug treatment center were provided with an HIV prevention educational presentation followed by one-on-one HIV counseling. Motivational interviewing was used in the counseling sessions to aid participants in recognizing their risk status and making a decision to be HIV tested. Results show that of the 134 who agreed to one-on-one HIV counseling and 105 (78%) returned for their results.