Young adults' gambling and its association with mental health and substance use problems

Offline and Online Gambling in a Swiss Emerging-Adult Male Population

Faced with the rapid expansion of the online gambling offer, a growing number of jurisdictions around the world are developing legislation to regulate online gambling. The new Swiss Act on gambling extends legalization of online gambling from already authorized lottery-type to casino-type gambling. In this context, the present study examines offline and online gambling behaviors in emerging-adult males as a particularly at-risk population for gambling addiction. A sample of 1,869 young males completed a questionnaire assessing offline and online gambling behaviors as well as severity of problem gambling. Results show that 62.1% of the respondents were lifetime gamblers while 46.7% were past-year gamblers. Among the latter, 76.4% had gambled only within offline venues, 21.4% had gambled at both offline and online sites, and 2.2% had gambled online only. Furthermore, 17.6% of past-year gamblers were at moderate-risk of developing problem gambling whilst 3.6% were problem gamblers. Association analysis showed that, compared to non-problem gamblers, at-risk and problem gamblers played online at higher rates. These findings contribute to the growing literature on youth gambling behaviors and on offline-online transitions. In the context of the growing online gambling supply, the evolution of youth gambling behaviors should be monitored through periodical assessments.

A Comparison of Two GameSense Implementation Approaches: How Program Awareness and Engagement Relate to Gambling Beliefs and Behaviors

Despite the size and scope of responsible gambling (RG) programs in the U.S., relatively few studies have evaluated these programs. Using survey data from 4795 subscribers to a casino loyalty program, we examined respondents' awareness of and engagement with the GameSense RG program, and gambling beliefs and behaviors. We compared how differences in the implementation structure and visibility of the GameSense program (i.e., state-regulated with a standalone, branded GameSense center vs. corporate-integrated as part of loyalty program desks) was associated with GameSense awareness and engagement, perceptions of gambling operator RG practices, three Positive Play subscales (i.e., behavior, personal responsibility, and gambling literacy), understanding of gambling concepts, and use of RG strategies. More respondents who had visited the property with a state-regulated, branded center were aware of GameSense (36.5%), compared to respondents who visited other properties (7.4%). Perceptions of the operator's RG practices were generally high for all respondents. Multivariate analyses revealed no relationship between GameSense awareness and gambling belief or behavior outcomes, yet showed that respondents who picked up a GameSense brochure used slightly more RG strategies. Our findings suggest that the visibility of an RG program might influence program awareness and engagement but not certain RG-related behavioral outcomes.

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.

Associations between Problematic Gambling, Gaming, and Internet Use: A Cross-Sectional Population Survey

Background

While pathological gambling, or gambling disorder, is an established diagnosis, a link to other potential behavioural addictions has been suggested. The present study aimed to investigate whether signs of problem gaming and problematic internet use are related to problem gambling in the general population, while including other potential risk factors.

Methods

A cross-sectional study design, using an electronical questionnaire, administered through a marketing survey company for relative representativeness with respect to age and gender. Potential correlates of problem gambling were measured in binary analyses, and significant associations were entered in a logistic regression analysis controlling them for one another. Problem gambling, gaming, and internet use were measured through established screening instruments (the CLiP, the GAS, and the PRIUSS).

Results

Statistically significant associations were found between problem gambling and both problem gaming and problematic internet use, as well as with male gender. In logistic regression, problem gaming, problematic internet use, and male gender remained associated with problem gambling.

Conclusion

After controlling for potential demographic risk factors, problem gaming and problematic internet use may be related to problem gambling, suggesting that these constructs may interact or may share similar risk factors. More research is needed to clarify factors mediating the links between these conditions.

Problem gambling among Czech adolescents: An exploration of its relationship to early initiation of tobacco smoking

BACKGROUND AND AIMS

Gambling in adolescence is often related to licit and illicit substance use. Some evidence shows that teenage smokers gamble more than non-smokers. The aim of the study is to analyze the relationship between problem gambling and smoking among Czech adolescents.

METHODS

Data on 6,082 adolescents (50.1% boys and 49.9% girls) aged 15-19 years were collected as part of the ESPAD study in the Czech Republic in 2015. Logistic regression and linear regression models were used to test the hypothesis that the early onset of daily smoking increases the risk of problem gambling.

RESULTS

The age of initiation of daily smoking seems to be a more reliable marker of the risk of problem gambling than smoking status or intensity of smoking. More than 20% of smokers who started smoking daily at the age of 12 years or earlier are at risk of problem gambling, which shows a significantly increased probability compared to non-smokers (OR = 2.7). Other factors that increase the chances of becoming a problem gambler include being male, of higher age, and a student of a secondary school.

DISCUSSION AND CONCLUSIONS

The relationship between adolescent smoking and gambling is complex and is likely to be influenced by other underlying factors. Early daily smokers and at-risk gamblers tend in a similar way to risky behavior as a result of impulsivity. Interventions targeting early smoking and other substance-use behavior should not only aim at quitting smoking but could also include preventing smokers from developing problem gambling.

Co-development of Problem Gambling and Depression Symptoms in Emerging Adults: A Parallel-Process Latent Class Growth Model

This study examines whether there are multiple joint trajectories of depression and problem gambling co-development in a sample of emerging adults. Data were from the Manitoba Longitudinal Study of Young Adults (n = 679), which was collected in 4 waves across 5 years (age 18-20 at baseline). Parallel process latent class growth modeling was used to identified 5 joint trajectory classes: low decreasing gambling, low increasing depression (81%); low stable gambling, moderate decreasing depression (9%); low stable gambling, high decreasing depression (5%); low stable gambling, moderate stable depression (3%); moderate stable problem gambling, no depression (2%). There was no evidence of reciprocal growth in problem gambling and depression in any of the joint classes. Multinomial logistic regression analyses of baseline risk and protective factors found that only neuroticism, escape-avoidance coping, and perceived level of family social support were significant predictors of joint trajectory class membership. Consistent with the pathways model framework, we observed that individuals in the problem gambling only class were more likely using gambling as a stable way to cope with negative emotions. Similarly, high levels of neuroticism and low levels of family support were associated with increased odds of being in a class with moderate to high levels of depressive symptoms (but low gambling problems). The results suggest that interventions for problem gambling and/or depression need to focus on promoting more adaptive coping skills among more "at-risk" young adults, and such interventions should be tailored in relation to specific subtypes of comorbid mental illness.

Compulsory school achievement and gambling among men and women aged 18-29 in Finland

AIMS

This study aims to explore the associations between final compulsory school grades and gambling and their relation to substance use and perceived mental health among people aged 18-29 in Finland (N = 831).

METHODS

Cross-sectional random sample data, weighted on the basis of age, gender and region of residence, were collected in 2015. The data were analysed using logistic regression models adjusted for sociodemographic variables, risky alcohol use, daily smoking, and perceived mental health.

RESULTS

Weekly gambling and at-risk and problem gambling (ARPG) were more common among men. Weekly gambling was linked to smoking and risky alcohol use among men and smoking among women. Additionally, ARPG was linked to risky alcohol use among men. ARPG was associated with moderate/poor mental health among men and women, but this was not the case with weekly gambling. Among men, low and average final school grades at age 16 were associated with weekly gambling later in life, even when adjusting for other variables. Among women, low and average final school grades were not associated with weekly gambling when adjusting for substance use. Lower final school grades were associated with ARPG among women but not among men when all potential confounders were adjusted for.

CONCLUSIONS

Adolescents with lower final school grades are more likely to gamble weekly later in life. Lower final school grades are also linked with ARPG among women. It is important therefore for schools to have clear policies on gambling and to implement early prevention programmes.

Gambling Risk Amongst Adolescents: Evidence from a School-Based Survey in the Malaysian Setting

There has been emerging evidence regarding gambling experiences of young people in Asia recently, but to date, none in Malaysia. This study aimed to estimate the prevalence of gambling, and to identify individual, familial and high-risk behaviours factors among Malaysian adolescents. A cross-sectional study was conducted over 4 months at randomly selected secondary schools in Seremban in Negeri Sembilan state. A total of 2265 self-administered, anonymous questionnaires were distributed to the students. The students completed the questionnaire consisting of sociodemographic and family background, gambling behaviours, high risk behaviours and mental health questions. Approximately 29.6 % (95 % CI 27.7-31.5) of respondents reported participating in some forms of gambling activities in the previous 12 months. Among these, 3.6 % (95 % CI 2.8-4.3) of them were problem gamblers. Parental gambling was the strongest correlate with adolescent gambling behaviour. Signification association was found between gambling behaviour and gender (being males), but interestingly, not with ethnicity. Adolescents who reported engaging in high risk behaviours (such as smoking, alcohol consumption, involvement in physical fights, illegal vehicular racing) were also more likely to gamble. Gambling is not an uncommon phenomenon amongst Malaysian adolescents. Public awareness campaign, health education to targeted groups, revision of existing laws, and screening at primary care level should be implemented to address the issue of gambling among adolescents. This study also highlights the need to examine the national scope of the problem in Malaysia.

Problem Gambling and the Youth-to-Adulthood Transition: Assessing Problem Gambling Severity Trajectories in a Sample of Young Adults

In this study, using four wave longitudinal data, we examined problem gambling severity trajectories in a sample of young adults. Using latent growth curve modeling, we examined how initial level of problem gambling severity and the rate of change were affected by 11 time-invariant predictors: gender, age of onset of gambling, experiencing a big win early in gambling career, experiencing a big loss early in gambling career, alcohol dependence, drug dependence, anxiety, depression, perceived social support, illusion of control, and impulsiveness. Five of the eleven predictors affected initial levels of problem gambling severity; however only impulsiveness affected the rate of change across time. The mean trajectory was negative (lessening of problem gambling risk severity across time), but there was significant inter-individual variation in trajectories and initial levels of problem gambling severity. The main finding of problem gambling risk diminishing over time challenges the conventional picture of problem gambling as an inevitable "downward spiral," at least among young adults, and suggests that targeted prevention campaigns may be a cost-effective alternative for reaching treatment resistant youth.

Gambling among European professional athletes. Prevalence and associated factors

In Europe, the prevalence of gambling disorders in the general population ranges from 0.15 to 6.6%. Professional athletes are known for having risk factors for addictive behaviors, such as young age or sensation seeking, though no study has yet tried to evaluate the prevalence of gambling and gambling disorders among this specific population. The goals of this study were to estimate the prevalence of gambling, problematic or not, among European professional athletes and to explore the factors that are associated with gambling practice and gambling problems in professional athletes. A self-completion questionnaire was specifically designed for this study. The questionnaires were distributed by European Union athletes to professional ice hockey, rugby, handball, basketball, football, indoor football, volleyball, and cricket teams in Spain, France, Greece, Ireland, Italy, Sweden, and the United Kingdom. Socio-demographic variables (age, sex, education, marital and parental status, sport, country of birth, and country of practice), variables linked to gambling (gambling habits, screening of gambling problems with the Lie/Bet questionnaire, and gambling related cognitions), and impulsive behavior data (urgency, premeditation, perseverance, and sensation seeking [UPPS]-Short Form questionnaire) were gathered. There were 1,236 questionnaires filled out. The percentage of professional athletes that had gambled at least once during the previous year was 56.6%. The prevalence of problem gambling, current or past, was 8.2%. A certain number of variables were associated with the gambling status. In particular, betting on one's own team (OR = 4.1, CI_95% [1.5-11.5]), betting online (OR = 2.9, CI_95% [1.6-5.4]), gambling regularly (OR = 4.0, CI_95% [2.1-7.6]), and having a high positive urgency score (OR = 1.5, CI_95% [1.3-1.7]) were associated with gambling problems, current or past, among professional athletes. Professional athletes are particularly exposed to both gambling and problem gambling.

Gambling behaviors and attitudes in adolescent high-school students: Relationships with problem-gambling severity and smoking status

BACKGROUND AND AIMS

Smoking is associated with more severe/extensive gambling in adults. The purpose of this study was to examine relationships between smoking and gambling in adolescents.

METHODS

Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by gambling (Low-Risk Gambling [LRG], At Risk/Problem Gambling [ARPG]) and smoking (current smoker, non-smoker). The main effects of smoking and the smoking-by-gambling interactions were examined for gambling behaviors (e.g., type, location), and gambling attitudes. Data were analyzed using chi-square and logistic regression; the latter controlled for gender, race/ethnicity, grade, and family structure.

RESULTS

For APRG adolescents, smoking was associated with greater online, school, and casino gambling; gambling due to anxiety and pressure; greater time spent gambling; early gambling onset; perceived parental approval of gambling; and decreased importance of measures to prevent teen gambling. For LRG adolescents, smoking was associated with non-strategic gambling (e.g., lottery gambling); school gambling; gambling in response to anxiety; gambling for financial reasons; greater time spent gambling; and decreased importance of measures to prevent teen gambling. Stronger relationships were found between smoking and casino gambling, gambling due to pressure, earlier onset of gambling, and parental perceptions of gambling for ARPG versus LRG adolescents.

DISCUSSION

Smoking is associated with more extensive gambling for both low- and high-risk adolescent gamblers.

CONCLUSION

Smoking may be a marker of more severe gambling behaviors in adolescents and important to consider in gambling prevention and intervention efforts with youth.

Cigarette smoking, problem-gambling severity, and health behaviors in high-school students

Introduction

Smoking and gambling are two significant public health concerns. Little is known about the association of smoking and gambling in adolescents. The current study of high-school adolescents examined: (1) smoking behavior by problem-gambling severity and (2) health-related variables by problem-gambling severity and smoking status.

Methods

Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by problem-gambling severity (Low-Risk Gambling [LRG], At-Risk/Problem Gambling [ARPG]) and smoking status (current smoker, non-smoker). Analyses examined the smoking behavior of ARPG versus LRG adolescents as well as the smoking-by-problem-gambling-severity interactions for health and well-being measures (e.g., grades, substance use). Chi-square and logistic regression analyses were used; the latter controlled for gender, race/ethnicity, school grade, and family structure.

Results

More adolescents with ARPG than LRG reported regular smoking, heavy smoking, early smoking onset, no smoking quit attempts, and parental approval of smoking. ARPG and LRG adolescents who smoked were more likely to report poor grades, lifetime use of marijuana and other drugs, current heavy alcohol use, current caffeine use, depression, and aggressive behaviors and less likely to report participation in extracurricular activities. The association between not participating in extracurricular activities and smoking was statistically stronger in the LRG compared to the ARPG groups. Post-hoc analyses implicated a range of extracurricular activities including team sports, school clubs, and church activities.

Conclusions

Smoking was associated with poorer health-related behaviors in both ARPG and LRG groups. Interventions with adolescents may benefit from targeting both smoking and gambling.

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We examined adolescent health behaviors by smoking status and gambling severity.

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Smoking was associated with poorer health behaviors for adolescent gamblers.

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Considering smoking may be helpful in interventions with adolescent gamblers.

A Study Design to Evaluate Association between Smoking and Intracranial Atherosclerotic Stenosis

Purpose

Smoking is a well known risk factor for stroke. The cerebral arteries may be uniquely susceptible to the atherosclerotic effects of smoking, such that it has a different risk profile for stroke compared with other atherosclerosis risk factors. It remains uncertain whether smoking is associated specifically with intracranial (IC) or extracranial (EC) atherosclerotic cerebrovascular disease. The aim of this study design will be to evaluate the association between smoking and severe IC stenosis, adjusting for other atherosclerosis risk factors, particularly age distribution.

Study design

This is a retrospective cohort study design. Participants are patients (n=1714) with severe atherosclerotic stenosis undergoing cerebral catheter angiography because of stroke or transient ischaemic attack. All atherosclerotic steno-occlusive lesions are described in terms of location (anterior versus posterior circulation, IC versus EC, or intradural versus extradural). The atherosclerotic or stroke risk factors for analysis include age, gender, smoking history, number of lesions (single versus multiple), cardiac disease, diabetes mellitus, hypertension, family history, dyslipidemia, history of previous stroke, alcohol intake, metabolic syndrome and body mass index. Statistical analysis includes univariate analysis followed by multivariate logistic regression. The relationship between IC atherosclerotic stenosis and smoking will be assessed. Differences in risk factor distribution is analysed according to age at intervals of 10 years. Significant risk factors associated with IC atherosclerotic stenosis will also be assessed by multivariate logistic regression analysis.

Summary

This is an analytical study design that intends to measure the association between IC or EC atherosclerotic stenosis and smoking and other risk factors. We anticipate that it will have the power to detect any relationship between smoking and IC atherosclerotic lesions especially in younger patients.

An overview of and rationale for changes proposed for pathological gambling in DSM-5

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is scheduled for publication in 2013. It will include several changes to the diagnosis of pathological gambling: the name of the disorder will be altered, the threshold for diagnosis will decrease, and one criterion will be removed. This paper reviews the rationale for these changes and addresses how they may impact diagnosis and treatment of the disorder, as well as potential for future research in the field.