A mapping review of research on gambling harm in three regulatory environments

Problem Gambling and Suicidal Behaviours in Young Adult men in Ghana: A Moderated Mediation Model of Psychological Distress and Social Support : Journal of Gambling Studies

Problem gambling has been recognised as an important public health issue because of its harmful consequences at the personal, interpersonal, and societal levels. There is a proliferation of gambling activities in Ghana owing to increased access to the internet, soaring smartphone penetration, and an influx of sports betting companies. Yet, very little research has addressed the harm associated with problem gambling in Ghana. This study assessed if the effect of problem gambling severity on suicidal behaviours (ideation, planning, and attempts) through psychological distress is contingent on the level of perceived social support. A total of 350 young adult men in the Greater Accra Region of Ghana provided the data for the current analysis. The data were analysed using a moderated mediation approach. The results showed that psychological distress is an important intervening mechanism through which problem gambling severity influences suicidality. In addition, the positive association between psychological distress and suicidal behaviours was found to be conditional on the levels of perceived social support. In other words, our results showed that problem gambling may first trigger episodes of psychological distress, which, in turn, can lead to suicidality among problem gamblers who report low to moderate levels of perceived social support. Our findings suggest that young adult problem gamblers require higher levels of social support from family, friends, and significant others to prevent those experiencing psychological distress from engaging in suicidal behaviours.

Exploring the relationships between psychological variables and loot box engagement, part 1: pre-registered hypotheses

Loot boxes are purchasable randomized rewards in video games that share structural and psychological similarities with gambling. Systematic review evidence has established reproducible associations between loot box purchasing and both problem gambling and problem video gaming, perhaps driven by a range of overlapping psychological processes (e.g. impulsivity, gambling-related cognitions, etc.) It has also been argued that loot box engagement may have negative influences on player financial and psychological wellbeing. We conducted a pre-registered survey of 1495 loot box purchasing gamers (LB cohort) and 1223 gamers who purchase other, non-randomized game content (nLB cohort). Our survey confirms 15 of our 23 pre-registered hypotheses against our primary outcome (risky loot box engagement), establishing associations with problem gambling, problem gaming, impulsivity, gambling cognitions, experiences of game-related 'flow' and specific 'distraction and compulsion' motivations for purchase. Results with hypotheses concerning potential harms established that risky loot box engagement was negatively correlated with wellbeing and positively correlated with distress. Overall, results indicate that any risks from loot boxes are liable to disproportionately affect various 'at risk' cohorts (e.g. those experiencing problem gambling or video gaming), thereby reiterating calls for policy action on loot boxes.

Gender disparity in prestigious speaking roles: A study of 10 years of international conference programming in the field of gambling studies

The objective of this study was to examine the distribution of prestigious speaking roles by gender at gambling studies conferences to better understand the state of gender representation within the field. Keyword searches were conducted in the fall of 2019. A total of 16 conferences that occurred between 2010-2019 and comprising 882 prestigious speaking opportunities were included. Quantitative analysis (i.e., t-tests, chi-squared posthoc tests) was undertaken to evaluate the representation of women speakers and if proportions were the same across genders for speakers. There were significantly less women than men within prestigious speaking roles at gambling studies conferences with only 30.2% of speakers being women (p < .001). This underrepresentation of women was consistent across conference location, speaker continent, speaker role, time, and across the majority of conferences. Women held prestigious speaking roles less frequently than men (M = 1.48 vs. 1.76; p < .001). A 9 to 1 (p < .001) ratio of men to women was found among top 10 most frequent prestigious speakers. While there was a higher proportion of women than men among student speakers and there was no significant gender disparity among early career researchers, there was a significantly lower proportion of women than men among speakers who hold more senior academic positions. There is an issue of gender disparity in prestigious speaking roles at conferences within the gambling studies field. This study highlights the need to counteract gender disparities and make room for diversity within the field.

Mapping reviews, scoping reviews, and evidence and gap maps (EGMs): the same but different- the "Big Picture" review family

Scoping reviews, mapping reviews, and evidence and gap maps are evidence synthesis methodologies that address broad research questions, aiming to describe a bigger picture rather than address a specific question about intervention effectiveness. They are being increasingly used to support a range of purposes including guiding research priorities and decision making. There is however a confusing array of terminology used to describe these different approaches. In this commentary, we aim to describe where there are differences in terminology and where this equates to differences in meaning. We demonstrate the different theoretical routes that underpin these differences. We suggest ways in which the approaches of scoping and mapping reviews may differ in order to guide consistency in reporting and method. We propose that mapping and scoping reviews and evidence and gap maps have similarities that unite them as a group but also have unique differences. Understanding these similarities and differences is important for informing the development of methods used to undertake and report these types of evidence synthesis.

Understanding gambling in the United Kingdom: A qualitative study on the experiences of gamblers' families

This study focuses on understanding the experiences of family members of problem gamblers in the United Kingdom and the gambling consequences in their lives. Family members of problem gamblers, even though they suffer from gambling consequences, the impacts of gambling are under-researched. Qualitative research through in-depth interviews was employed. Thematic analysis was used to gain a deeper insight into gambling. Nine female participants were interviewed based on a semi-structured questionnaire. The results of this study indicated that close family members of problem gamblers had suffered not only financial devastation but also harsh psychological and mental health damages. Furthermore, family members suffer from gamblers' abusive and violent behaviors. Addiction was a key factor of gamblers' habit; fear, anxiety, and depression were some of the health issues derived from gambling. Overall, gambling addiction leads to further addiction, crime, and severe, family-relation sufferings. The study results suggest that the London Gambling Commission and regulating authority should change gambling policy, reduce gambling points, and limit gambling slot machines in food markets and community areas. More support is needed for family members affected by gamblers' addictive gambling behaviors.

Legacy gambling harms: What are they and how long do they last?

BACKGROUND AND AIMS

Legacy gambling harms are negative consequences of gambling that extend past periods of low risk, moderate risk and problem gambling. Gambling harm is typically measured within a 12-month timeframe and is often restricted to examining harm amongst active gamblers. The present research aimed to explore whether people experienced gambling harms 12 months or more after the resolution of at-risk or problem gambling, and how long these legacy harms lasted.

METHODS

An online survey was conducted in New Zealand with past and current gamblers and concerned significant others (CSOs) of gamblers, N = 1,240 (50.8% female), that asked them about both past and current gambling harms.

RESULTS

A majority of both gamblers and CSOs of gamblers indicated that they still suffered from gambling harm even after most of their behavioural issues with gambling had been resolved, 12+ months ago. Legacy gambling harms reduced over time, with harms diminishing most quickly in the early years, and having an average half-life of 4 years. Harms involving community-relationships, church involvement, and domestic and other violence resolved more quickly than others.

DISCUSSION AND CONCLUSIONS

Legacy harms are common among ex-problem gamblers and should be considered in any full accounting of the impacts of gambling.

CONCLUSION

Understanding the time course and persistence of legacy harms from gambling can provide gamblers, treatment professionals and public health experts with insights into how to address gambling's long-term consequences.

Legacy Gambling Harms: What Happens Once the Gambling Stops?

Purpose of Review

Legacy gambling harm refers to adverse consequences that extend past the period where people are actively gambling at harmful levels. These harms can affect the gambler, people close to them and the wider community. This article reviews current research that investigates legacy harms; the types of legacy harm, how long they last and whether evidence suggests these harms are real or instead imagined injuries or reflections on past regrets.

Recent Findings

Legacy harms to individuals can be broadly categorised as including financial, relationship, emotional/psychological, health, culture, work/study and criminal/deviance harms. In addition, legacy harms affect entire communities by drawing funds and social capital away from vulnerable communities, leaving them socially, culturally and materially impoverished. Most legacy harms that accrue to gamblers have a half-life of 4 years, although financial harms last somewhat longer at 5 years. Greater distance in time from a past gambling issue is reliably and positively related to health and well-being indicators, including the Health Utility Index and the Australian Unity Wellbeing Index, which suggests that legacy gambling harms are real and have a lasting impact on well-being, rather than just imagined hardship from prior gambling difficulties.

Summary

These findings suggest programme and policy development to support gamblers in reducing and managing their legacy harms, rather than focusing only on relapse prevention.

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

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

The effect of gambling problems on the subjective wellbeing of gamblers' family and friends: Evidence from large-scale population research in Australia and Canada

BACKGROUND AND AIMS

Excessive time and money spent on gambling can result in harms, not only to people experiencing a gambling problem but also to their close family and friends ("concerned significant others"; CSOs). The current study aimed to explore whether, and to what extent, CSOs experience decrements to their wellbeing due to another person's gambling.

METHODS

We analysed data from The Household Income and Labour Dynamics in Australia Survey (HILDA; N = 19,064) and the Canadian Quinte Longitudinal Study (QLS; N = 3,904). Participants either self-identified as CSOs (QLS) or were identified by living in a household with a person classified in the problem gambling category by the PGSI (HILDA). Subjective well-being was measured using the Personal Wellbeing Index and single-item questions on happiness and satisfaction with life.

RESULTS

CSOs reported lower subjective wellbeing than non-CSOs across both countries and on all three wellbeing measures. CSO status remained a significant predictor of lower wellbeing after controlling for demographic and socio-economic factors, and own-gambling problems. There were no significant differences across various relationships to the gambler, by gender, or between household and non-household CSOs.

DISCUSSION AND CONCLUSIONS

Gambling-related harms experienced by CSOs was reliably associated with a decrease in wellbeing. This decrement to CSO's wellbeing was not as strong as that experienced by the person with the first-order gambling problem. Nevertheless, wellbeing decrements to CSOs are not limited to those living with a person with gambling problems in the household and thus affect many people.

18-Item Version of the Short Gambling Harm Screen (SGHS-18): Validation of Screen for Assessing Gambling-Related Harm among Finnish Population

Background and aims: It is common for gambling research to focus on problem and disordered gambling. Less is known about the prevalence of gambling-related harms among people in the general population. This study aimed to develop and validate the 18-item version of the Short Gambling Harms Screen (SGHS-18). Methods: Population-representative web-based and postal surveys were conducted in the three geographical areas of Finland (n = 7186, aged 18 or older). Reliability and internal structure of SGHS-18 was assessed using coefficient omega and via confirmatory factor analysis (CFA). Four measurement models of SGHS-18 were compared: one-factor, six-factor, a second-ordered factor model and a bifactor model (M4). Results: The analysis revealed that only the bifactor model had adequate fit for SGHS-18 (CFI = 0.953, TLI = 0.930, GFI = 0.974, RMSEA = 0.047, SRMR = 0.027). The general factor explained most of the common variance compared to specific factors. Coefficient omega hierarchical value for global gambling harm factor (0.80) was high, which suggested that SGHS-18 assessed the combination of general harm constructs sufficiently. The correlation with the Problem and Pathological Gambling Measures (PPGM) was 0.44, potentially reflecting that gambling harms are closely—although not perfectly—aligned with the mental health issue of problem gambling. SGHS-18 scores were substantially higher for participants who gambled more often, who spent more money or who had gambling problems, demonstrating convergent validity for the screen. Discussion: The SGHS-18 comprehensively measures the domains of gambling harm, while demonstrating desirable properties of internal consistency, and criterion and convergent validity.

How Do State Gambling Monopolies Affect Levels of Gambling Harm?

Purpose of Review

This systematic literature review evaluates the potential of gambling monopolies to affect gambling harms. It compares the occurrence of gambling harms in jurisdictions with gambling monopolies to jurisdictions with license-based regimes.

Recent Findings

The review identified 21 publications concerning three gambling-related harm indicators: problem gambling prevalence, total consumption, and the appearance of conflicts of interest. Due to the dearth of literature, concept papers and older publications were also included.

Summary

Results show that there is a paucity of empirical research on the effectiveness of different regulatory regimes in affecting gambling harms. Available research demonstrates that monopolistic regimes appear to perform somewhat better in terms of problem gambling prevalence and total consumption but may also be more prone to conflicts of interest than license-based regimes. Monopolistic configurations also differ between themselves, and issues such as availability, accessibility, product range, scope of preventive work, monitoring, as well as the recognition of the public health approach may better predict the levels of harm in society than the existence of a monopoly.

The Evolution of Gambling-Related Harm Measurement: Lessons from the Last Decade

Jurisdictions around the world have a self-declared mandate to reduce gambling-related harm. However, historically, this concept has suffered from poor conceptualisation and operationalisation. However, recent years have seen swift advances in measuring gambling harm, based on the principle of it being a quantifiable decrement to the health and wellbeing of the gambler and those connected to them. This review takes stock of the background and recent developments in harm assessment and summarises recent research that has validated and applied the Short Gambling Harms Screen and related instruments. We recommend that future work builds upon the considerable psychometric evidence accumulated for the feasibility of direct elicitation of harmful consequences. We also advocate for grounding harms measures with respect to scalar changes to public health utility metrics. Such an approach will avoid misleading pseudo-clinical categorisations, provide accurate population-level summaries of where the burden of harm is carried, and serve to integrate gambling research with the broader field of public health.

Charting a path towards a public health approach for gambling harm prevention

Aim

Gambling harm is a serious public health issue affecting the health, financial security, and social well-being of millions of people and their close relations around the world. Despite its population health implications, gambling harm is not typically viewed and treated as a public health policy issue. This paper critically reviews the evolution of the public health perspective on gambling harm. It also considers how gambling harm can be operationalized within a public health model.

Methods

A critical historical review of the emerging public health perspective on gambling harm was conducted. Key documents covering three decades of development were reviewed and appraised through a process of deliberation and debate over source impact in the fields of research, policy, and programming internationally.

Results

The first decade mainly focused on identifying gambling harm and framing the public health issue. The second decade featured the expansion of health assessment and emerging areas of policy and program development. The third decade saw an increased focus on public health frameworks that advanced understanding of harm mechanics and impact. As reflected by the essential functions of a general public health model, gambling harm prevention efforts emphasize health promotion over other key functions like health assessment and surveillance.

Conclusion

Gambling harm is a public health issue requiring greater attention to health assessment and surveillance data development.

The prevention paradox applies to some but not all gambling harms: Results from a Finnish population-representative survey

BACKGROUND AND AIMS

The Prevention Paradox (PP) suggests that a large proportion of aggregate harm from gambling occurs to people who do not have a gambling disorder. However, it has not yet been tested using a population-representative sample. We aimed to test whether the PP applies to gambling in Finland. The prevalence rates of diverse harmful consequences from gambling were surveyed amongst a population-representative sample of past-year gamblers.

METHODS

The study used first wave data (N = 7,186) of Finnish Gambling Harms survey, collected via online and postal surveys in 2017. A subset of 3,795 adults (≥18 years), who had gambled at least monthly in 2016, were selected for analysis.

MEASUREMENTS

Gambling-related harms were evaluated with the 72-item Harms Checklist. Problem and Pathological Gambling Measure (PPGM) measured respondents' probable disordered gambling from the subset of items for impaired control (4 questions) and other issues (3 questions).

FINDINGS

Consistent with previous findings, the majority of harms were reported by those in the less severe PPGM categories (i.e. scoring <5). However, considering each domain separately, this was true only for financial, emotional/psychological, and work/study harms. The PP was not supported for health, relationship, or social deviance harms.

CONCLUSIONS

The population prevalence of the most serious harms (e.g. unsafe living conditions) is concentrated among those with severe impaired control issues. However, even excluding the ∼15% of harms occurring to occasional gamblers, most financial, emotional and work/study impacts occur to those with lower levels of control issues. Efforts at harm reduction should focus on the entire spectrum of issues that people experience from their gambling.

The Conceptual Framework of Harmful Gambling: A revised framework for understanding gambling harm

BACKGROUND AND AIMS

The Conceptual Framework of Harmful Gambling moves beyond a symptoms-based view of harm and addresses a broad set of factors related to the risks and effects of gambling harmfully at the individual, family, and community levels. Coauthored by international research experts and informed by multiple stakeholders, Gambling Research Exchange (GREO) facilitated the framework development in 2013 and retains responsibility for regular updates and mobilization. This review article presents information about the revised version of the Conceptual Framework of Harmful Gambling completed in late 2018.

METHODS

We describe eight interrelated factors depicted in the framework that represent major themes in gambling ranging from the specific (gambling environment, exposure, gambling types, and treatment resources) to the general (cultural, social, psychological, and biological influences). After outlining the framework development and collaborative process, we highlight new topics for the recent update that reflect changes in the gambling landscape and prominent discourses in the scientific community. Some of these topics include social and economic impacts of gambling, and a new model of understanding gambling related harm.

DISCUSSION AND CONCLUSIONS

We address the relevance of the CFHG to the gambling and behavioral addictions research community. Harm-based frameworks have been undertaken in other areas of addiction that can both inform and be informed by a model dedicated to harmful gambling. Further, the framework brings a multi-disciplinary perspective to bear on antecedents and factors that co-occur with harmful gambling.