The identification of Australian low-risk gambling limits: A comparison of gambling-related harm measures

Behavioural Tracking and Profiling Studies Involving Objective Data Derived from Online Operators: A Review of the Evidence

Studies involving the analysis of objective data from online operators attempt to address common concerns about biases in self-report research. This paper surveys the progress in this area of research over the last 15 years. The findings highlight many areas of achievement, including: the development of a set of behavioural markers that reliably differentiate variations in gambler risk. Online gamblers can be grouped into clusters based on the intensity and frequency of gambling; behavioural variability; or, signs of over-commitment (e.g., deposit frequency or expenditure patterns). Behavioural indicators have also been successfully used to predict proxies of harm such as self-exclusion or account closures. However, relatively few studies have combined objective data with self-report data to achieve independent validation of the risk-status of gamblers. Evidence also supports the potential value of short-term responsible gambling interventions involving the use of voluntary and mandatory limits, messages and behavioural feedback. Less work has, on the other hand, addressed the comparative risk of different online gambling products. The findings suggest the need for further validation of findings against independent measures of gambling risk; consistent definitions of indicators; a greater focus on the differentiation of product risk; and, on the long-term impact of RG interventions.

The Dual Burden of Emerging Adulthood: Assessing Gambling Severity, Gambling-Related Harm, and Mental Health Challenges

Growing concerns over gambling problems across age groups have sparked research in public health and psychology. During emerging adulthood, individuals are more susceptible to mental health problems and more likely to develop gambling problems than in other age groups. This study explored the potential differences between emerging adults and adults aged 30+ in terms of problem gambling severity (PGS), gambling-related harm (GRH), depression and anxiety, and the mediating role of depression and anxiety in the association between age, PGS, and GRH. A representative online sample of 3244 Israelis aged 18 and over was divided into two groups: 740 emerging adults aged 18-29 and 2504 adults aged 30+. Gambling behaviors, the Problem Gambling Severity Index, the Short Gambling Harm Screen, and the Patient Health Questionnaire-4 assessing depression and anxiety were administered. Emerging adults had significantly higher levels of GRH, PGS, and depression-anxiety than their older counterparts, above and beyond gender and education. Depression-anxiety fully mediated the associations between age and gambling-related outcomes. These findings underscore the importance of considering psychological well-being in efforts to address problem gambling and gambling-related harms, especially in emerging adults.

A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.

Gambling, tobacco use, and health among individuals in substance use disorder treatment

BACKGROUND AND OBJECTIVES

Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care.

METHODS

Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health.

RESULTS

Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling.

DISCUSSION AND CONCLUSIONS

Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling.

SCIENTIFIC SIGNIFICANCE

This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.

Electronic gaming machine accessibility and gambling problems: A natural policy experiment

Background

Electronic gaming machines (EGMs) are one of the most harmful forms of gambling at an individual level. It is unclear whether restriction of EGM functions and accessibility results in meaningful reductions in population-level gambling harm.

Methods

A natural policy experiment using a large (N = 15,000) national dataset weighted to standard population variables was employed to compare estimates of gambling problems between Australian residents in Western Australia (WA), where EGMs are restricted to one venue and have different structural features, to residents in other Australian jurisdictions where EGMs are widely accessible in casinos, hotels and clubs. Accessibility of other gambling forms is similar across jurisdictions.

Results

Gambling participation was higher in WA, but EGM participation was approximately half that of the rest of Australia. Aggregate gambling problems and harm were about one-third lower in WA, and self-reported attribution of harm from EGMs by gamblers and affected others was 2.7× and 4× lower, respectively. Mediation analyses found that less frequent EGM use in WA accounted for the vast majority of the discrepancy in gambling problems (indirect path = -0.055, 95% CI -0.071; -0.038). Moderation analyses found that EGMs are the form most strongly associated with problems, and the strength of this relationship did not differ significantly across jurisdictions.

Discussion

Lower harm from gambling in WA is attributable to restricted accessibility of EGMs, rather than different structural features. There appears to be little transfer of problems to other gambling forms. These results suggest that restricting the accessibility of EGMs substantially reduces gambling harm.

One size does not fit all. Should gambling loss limits be based on income?

Background

Previous research has suggested empirically based gambling loss limits, with the goal of preventing gambling related harm in the population. However, there is a lack of studies relating gambling loss limits to individual factors such as income. The current study examines whether gambling loss limits should be income-specific.

Materials and methods

The dataset was derived from three representative cross-sectional surveys of the Norwegian population and consisted of 14,630 gamblers. Four income groups, based on a quartile approximation, were formed. Gambling related harm was measured with the Problem Gambling Severity Index (PGSI), and precision-recall (PR) analyses were used to identify loss limits for the different income groups at two levels of gambling severity: moderate-risk gambling and problem gambling.

Results

For both levels of gambling severity, we found the lowest income group to have the lowest gambling loss limits, and the highest income group to have the highest loss limits, which compared to the loss limits for the total sample, were lower and higher, respectively. Calculating the cut-offs for moderate-risk gamblers, we found a consistently ascending pattern from the lowest to the highest income group. Calculating the cut-offs for problem gamblers, we found a similar pattern except for the two middle income groups.

Conclusion

The results suggest that income moderates empirically derived gambling loss limits. Although replication is required, income-based gambling loss limits may have higher applied value for preventing gambling related harm, compared to general loss limits aimed at the entire population.

Development and validation of a prediction model for online gambling problems based on players' account data

BACKGROUND AND AIMS

Gambling disorder is characterized by problematic gambling behavior that causes significant problems and distress. This study aimed to develop and validate a predictive model for screening online problem gamblers based on players' account data.

METHODS

Two random samples of French online gamblers in skill-based (poker, horse race betting and sports betting, n = 8,172) and pure chance games (scratch games and lotteries, n = 5,404) answered an online survey and gambling tracking data were retrospectively collected for the participants. The survey included age and gender, gambling habits, and the Problem Gambling Severity Index (PGSI). We used machine learning algorithms to predict the PGSI categories with gambling tracking data. We internally validated the prediction models in a leave-out sample.

RESULTS

When predicting gambling problems binary based on each PGSI threshold (1 for low-risk gambling, 5 for moderate-risk gambling and 8 for problem gambling), the predictive performances were good for the model for skill-based games (AUROCs from 0.72 to 0.82), but moderate for the model for pure chance games (AUROCs from 0.63 to 0.76, with wide confidence intervals) due to the lower frequency of problem gambling in this sample. When predicting the four PGSI categories altogether, performances were good for identifying extreme categories (non-problem and problem gamblers) but poorer for intermediate categories (low-risk and moderate-risk gamblers), whatever the type of game.

CONCLUSIONS

We developed an algorithm for screening online problem gamblers, excluding online casino gamblers, that could enable the setting of prevention measures for the most vulnerable gamblers.

The Identification of Low-risk Gambling Limits for Specific Gambling Activities

An emerging literature has identified optimal low-risk gambling limits in an effort to reduce gambling-related harm. Concerns have, however, been raised about the construction of aggregate low-risk limits that are applied to all gambling activities and there is support from gambling experts and the general public in Australia for the identification of low-risk limits for specific gambling activities. The study's aim was to identify and evaluate a set of empirically-based activity-specific limits (gambling frequency, gambling expenditure, gambling expenditure as a proportion of gross personal income, session expenditure, session duration) in a secondary analysis of Social and Economic Impact Studies of Gambling in Tasmania and the 2014 Survey on Gambling, Health and Wellbeing in the ACT. Balancing sensitivity and specificity, limits were identified for all gambling activities: EGMs (10 times per year, AUD$300/year, 0.63-1.04% of personal income, AUD$35 per session, 40 min/session), horse/dog racing (0.55% of personal income), instant scratch tickets (AUD$45/year), lotteries (0.45% of personal income), keno (4-13 times/year, AUD$45-$160/year), casino table games (AUD$345/year, 0.36-0.76% of personal income), bingo (AUD$150/year, 0.49% of personal income, AUD$17/session, 90 min/session), and sports/other event betting (14 times/year, AUD$400/year, 0.55-0.86% of personal income). These limits were exceeded by one-quarter to one-half of gamblers on these specific activities and were generally good predictors of gambling-related harm in subgroups of gamblers participating in these gambling activities and in the overall gambling sample. The limits provide gamblers, regulators, prevention workers, and researchers with simple rules of thumb in prevention efforts to reduce gambling-related harm in specific contexts.

The shape of gambling risk-curves for frequency, expenditure and proportion of income in Australia

BACKGROUND AND AIM

Examining risk-curves is important to understanding the degree to which indices of gambling consumption are associated with gambling-related harm. Risk-curves have largely been described as J-shaped, suggesting that at low levels of consumption harm remain constant but then increase sharply at a certain threshold. Alternative methods in recent work, however, have described risk-curves as linear and R-shaped, indicating that risk of harm increases as consumption increases at all levels of consumption. The aim of the current study is to estimate the shape of gambling risk-curves using competing methods.

DESIGN

Systematic comparison of gambling risk-curves using categorical (via plots) and continuous (via bootstrapped regression analyses) operationalizations of gambling consumption. Setting and participants Data were 2873 gamblers (1417 women) from the fourth Social and Economic Impact Study of Gambling in Tasmania.

MEASUREMENTS

Gambling-related harm was assessed using the Problem Gambling Severity Index (PGSI) and Short Gambling Harm Screen (SGHS). Gambling consumption was assessed as annual frequency, expenditure and expenditure as a proportion of income.

FINDINGS

Categorical gambling consumption data plotted with equal magnitudes evidenced J-shaped risk-curves. When the magnitude of gambling categories was re-scaled to the mid-points, risk-curves no longer appeared J-shaped. Additionally, bootstrapped regression analyses using the continuous gambling consumption data did not provide evidence for J-shaped risk-curves.

CONCLUSIONS

Gambling risk-curves in Tasmania appear not to be J-shaped, but rather suggest that risk of gambling-related harm increases with even small increases in gambling consumption.

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.