The risk and development of work disability among individuals with gambling disorder: a longitudinal case-cohort study in Sweden

BACKGROUND

This longitudinal register study aimed to investigate the association between gambling disorder (GD) and work disability and to map work disability in subgroups of individuals with GD, three years before and three years after diagnosis.

METHODS

We included individuals aged 19-62 with GD between 2005 and 2018 (n = 2830; 71.1% men, mean age: 35.1) and a matched comparison cohort (n = 28 300). Work disability was operationalized as the aggregated net days of sickness absence and disability pension. Generalized estimating equation models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the risk of long-term work disability (>90 days of work disability/year). Secondly, we conducted Group-based Trajectory Models on days of work disability.

RESULTS

Individuals with GD showed a four-year increased risk of long-term work disability compared to the matched cohort, peaking at the time of diagnosis (AOR = 1.89; CI 1.67-2.13). Four trajectory groups of work disability days were identified: constant low (60.3%, 5.6-11.2 days), low and increasing (11.4%, 11.8-152.5 days), medium-high and decreasing (11.1%, 65.1-110 days), and constant high (17.1%, 264-331 days). Individuals who were females, older, with prior psychiatric diagnosis, and had been dispensed a psychotropic medication, particularly antidepressants, were more likely to be assigned to groups other than the constant low.

CONCLUSION

Individuals with GD have an increased risk of work disability which may add financial and social pressure and is an additional incentive for earlier detection and prevention of GD.

Predictors of pathological gambling behaviours in parents population in Nigeria

The increasing incidence of psychological pains, burnout, and anxiety among gamblers in Nigeria is high. This is because pathological gambling (PG) is on the rise and it is linked to many social vices such as stealing, drug abuse, and sexual abuse. It is important to investigate the trajectories of PG in Nigeria. A cross-sectional survey design was employed in our study with 197 participants sampled from 28 gambling venues in Nigeria made up the study's sample size. Of the 197, 131 (66.5%) were males and 66 (33.5%) were females. 50 (25.4%) were within the age range of 20-30 years, 42 (21.3%) were within 31-40 years, 40 (20.3%) were within 41-50 years, 35 (17.8%) were within 51-60 years, and 30 (15.2%) were within 61 and above. Using the hierarchical regression analysis, our finding revealed a significant association between psychological distress and our respondents' pathological gambling behaviour whereas none of the sociodemographic variables made a significant contribution to their pathological gambling behaviour. We concluded that gamblers' psychological well-being is crucial to understanding their problematic gambling behaviours in the context of a developing nation such as Nigeria, and that this could be similar among our respondents. Implications of our findings were highlighted.

Severity of gambling behaviors: exploring associations with venues, legality, and substance use

INTRODUCTION

The COVID-19 pandemic has been linked to an increase in gambling behaviors, potentially leading to Gambling Disorder (GD) and adverse health and social consequences. Problematic gambling has received little research attention over the years in Israeli society and the issue of gambling is not high on the list of priorities of Israeli policymakers. The present study examined gambling behavior in Israel on a continuum of severity and its association with venues where the gambling occurs, legality, attitude toward the legalization of casinos and poker, and substance use.

METHODS

The study questionnaires were distributed to approximately 15,000 Jewish-Israeli adults via internet panel. From 3,088 Israeli adults who answered the questionnaire, 1,251 (40.5%) reported gambling in the last year and were included in the analyses.

RESULTS

Based on the Problem Gambling Severity Index, 60% of participants were classified as non-problem gamblers, 25% as at low-risk for a gambling problem, 11% as at moderate risk, and 4% as having a gambling problem. Most online gambling was practiced by non-problem gamblers (40%) and most illegal gambling was by low-risk gamblers (34%). The more severe the gambling behavior was on the continuum, the more it was associated with illegal substance use and positive attitudes toward legalized casinos in Israel. Logistic regression showed the odds of developing moderate and problem gambling were 3.8 times higher for online gamblers (OR = 3.8; CI 2.6-5.4; p < 0.000) and 3.3 times higher for illegal gamblers (OR = 3.3; CI 2.2-4.9; p < 0.000).

CONCLUSION

Though more research attention should be paid to gambling behaviors, harm reduction gambling interventions should be made available to all categories on the continuum of severity of gambling behaviors. The present study provides evidence-based information to promote health policies that aim to prevent and reduce harm for Israeli gamblers.

Intersection of gambling with smoking and alcohol use in Great Britain: a cross-sectional survey in October 2022

OBJECTIVES

Gambling is associated with cigarette smoking and alcohol consumption. We explored the intersection of gambling across all risk levels of harm with smoking and alcohol use among adults in Great Britain.

DESIGN

A nationally representative cross-sectional survey in October 2022.

SETTING

Great Britain.

PARTICIPANTS

A weighted total of 2398 adults (18+ years).

OUTCOME MEASURES

We examined the prevalence of past-year gambling and, among those reporting gambling, assessed the associations between the outcome of any risk of harm from gambling (scoring >0 on the Problem Gambling Severity Index) and the binary predictor variables of current cigarette smoking and higher risk alcohol consumption (AUDIT-C score≥4). We also explored data on weekly expenditure on gambling with smoking and alcohol use among those categorised at any-risk of harm from gambling.

RESULTS

Overall, 43.6% (95% CI 41.2% to 45.9%) of adults gambled in the past year. Among these, 7.3% (95% CI 5.3% to 9.3%) were classified at any-risk of harm from gambling, 16.0% (95% CI 13.2% to 18.8%) were currently smoking and 40.8% (95% CI 37.2% to 44.4%) were drinking at increasing and higher risk levels. There were no associations between any risk of harm from gambling and current smoking (OR adjusted=0.80, 95% CI 0.35 to 1.66) or drinking at increasing and higher risk levels (OR adjusted=0.94, 95% CI 0.52 to 1.69), respectively. Analyses using Bayes factors indicated that these data were insensitive to distinguish no effect from a range of associations (OR=95% CI 0.5 to 1.9). The mean weekly spend on gambling was £7.69 (95% CI £5.17 to £10.21) overall, £4.80 (95% CI £4.18 to £5.43) among those classified as at no risk and £45.68 (95% CI £12.07 to £79.29) among those at any risk of harm from gambling.

CONCLUSIONS

Pilot data in a population-level survey on smoking and alcohol use yielded similar estimates to other population-level surveys on gambling participation and at-risk gambling. Further data are needed to elucidate the intersections more reliably between gambling, smoking and alcohol use and inform population-level approaches to reduce harm.

Gambling among indebted individuals: an analysis of bank transaction data

BACKGROUND

Gambling is connected to important financial harms, including debt. Most existing research has investigated the relationship between gambling and debt using self-reported data. Only a few studies have used objective data. The current study focuses on the gambling of indebted individuals. It investigates the amounts and types of gambling consumed by indebted individuals, and the amounts of unsecured debt among heavy gamblers.

METHODS

We use past-year banking data of Finnish individuals (N = 23 231) collected between 2018 and 2021 among applicants to a debt consolidation service. The transactions consist of deposits to, and winnings paid by gambling operators, distinguished by type of gambling (sports betting, casino, lottery) as well as active loans divided into secured and unsecured loans.

RESULTS

Gambling is widespread among indebted individuals in Finland. In terms of gambling types, casino-type gambling is the most popular among indebted individuals. Gambling spending is highly concentrated. Nearly half (49.5%) of all gambling deposits are concentrated among the highest spending 5% of indebted individuals. Individuals with unsecured loans have higher median losses than those without unsecured loans.

CONCLUSIONS

The results suggest that gambling and indebtedness are strongly linked. The connection is stronger for individuals with unsecured debt. This has implications for prevention and treatment. Easy access to unsecured credit is likely to worsen gambling harms. Debt counselling services routinely encounter gambling-related harms and need to be equipped to manage these issues.

Harmful types of gambling: changes and emerging trends in longitudinal helpline data

BACKGROUND

Gambling products differ in terms of their harm potential. Products are also constantly developing and changing. However, little research has addressed changes and trends in the types of gambling that are associated with harms. The current study explores trends in the gambling product categories identified as harmful in longitudinal helpline data from three Nordic countries.

METHODS

We use data collected by national helplines in Denmark (StopSpillet), Finland (Peluuri) and Sweden (Stödlinjen) in their daily operations (N = 46 646). The data consist of information collected on gamblers and concerned significant others who have contacted these helplines between January 2019 and December 2022. We analyse which gambling products are mentioned as harmful by clients. The analysis uses linear regression with the interaction term (country) times time regressed over the outcome variable (proportion per month).

RESULTS

The results show that an increased share of contacts concern online gambling. Online casino products have become the most harmful category across contexts. The share of reported harms from online betting and new emerging online forms is also increasing. The share of land-based products as a reported source of harms has decreased across 2019-22.

CONCLUSIONS

The results suggest that online gamlbing environments, and particularly online casino products, are associated with increasing harms to help-seekers. The harmfulness of different gambling products may not be stable, but change over time. Further harm prevention efforts are needed to address the online gambling field, including emerging formats.

Binge Drinking Among Sports Gamblers

This survey study examines whether or not individuals who wager on sports are at greater risk of binge use of alcohol.

[Substance use and the usage of social media, computer games, and gambling among apprentices at vocational schools]

BACKGROUND

The aim of the current study was to assess the prevalence of the (problematic) consumption of alcohol, tobacco, and cannabis as well as the (problematic) use of social media, e‑products, computer games, and gambling among apprentices.

METHOD

Cross-sectional survey of 4591 apprentices at 17 vocational schools from Bavaria, Schleswig-Holstein, and Hamburg. Data was collected using questionnaires between March 2021 and April 2022. The primary endpoints were the 30-day prevalence and the problematic consumption and usage behavior of the mentioned substances/behaviors using screening instruments.

RESULTS

Among the assessed substances/behaviors, social media were used most frequently by the apprentices with a 30-day prevalence of 97.7%, followed by alcohol (64.3%) and computer games (55.8%). Cigarettes were consumed by 35.1%, e‑products by 17.9%, and cannabis by 15.4% of the apprentices. Of the apprentices, 12.2% reported having gambled in the past 30 days. Rates of problematic use were 47.4% for alcohol, 18.0% for tobacco, 6.2% for e‑products, and 1.6% for cannabis. Problematic use of social media was indicated by 45.0% of the apprentices, of gambling by 2.2%, and of computer games by 0.7%.

DISCUSSION

These results suggest that apprentices constitute a risk group for problematic substance use, indicating increased need for intervention. In particular, secondary prevention efforts in the areas of alcohol and social media should be taken into consideration due to their widespread prevalence in the vocational school setting.

The prevalence of gambling problems in prison populations: A systematic review and meta-analysis

Introduction

The overall prevalence of gambling problems across prison populations is currently unknown. The objective of the present study was therefore to quantitatively synthetize prevalence estimates of gambling problems in prison populations using a random effects meta-analytic model and to investigate if the estimates were moderated by time frame, cut-off levels, and sample size.

Methods

To be included the studies had to report original data on the prevalence of gambling problems in a prison sample and to be written in a European language, whereas data based on abstracts or qualitative reports were excluded. The search ended on December 1, 2023 and were conducted in Web of Science, PubMed, Cinahl, PsycINFO, Embase, Google Scholar, Grey Literature Report, and GreyNet. Risk of bias was assessed with a standardized 10-item measure for epidemiological studies.

Results

A total of 26 studies comprising 9,491 participants were included. The vast majority of the participants were males. The most commonly used instrument for assessment of gambling problems was the South Oaks Gambling Screen. The pooled random-effects gambling problems prevalence estimate was 30.8% (95% CI = 25.1-37.3). The meta-regression analysis showed that none of the three moderator variables (criteria, timeframe, sample size) were related to the gambling problems prevalence. Common limitations of the included studies entailed not being representative nationally or for the target population, lack of randomization, and low response rate. The meta-analysis was restricted to studies published in a European language.

Conclusions

Overall, the studies show that 1 in 3 prisoners has gambling problems and suggests that more emphasis on relevant prevention and treatment is warranted for this population. The study was funded by the Norwegian Competence Center for Gambling and Gaming Research and pre-registered at PROSPERO (CRD42023390552).

Towards a conceptual framework for the prevention of gambling-related harms: Findings from a scoping review

The global gambling sector has grown significantly over recent years due to liberal deregulation and digital transformation. Likewise, concerns around gambling-related harms-experienced by individuals, their families, their local communities or societies-have also developed, with growing calls that they should be addressed by a public health approach. A public health approach towards gambling-related harms requires a multifaceted strategy, comprising initiatives promoting health protection, harm minimization and health surveillance across different strata of society. However, there is little research exploring how a public health approach to gambling-related harms can learn from similar approaches to other potentially harmful but legal sectors such as the alcohol sector, the tobacco sector, and the high in fat, salt and sugar product sector. Therefore, this paper presents a conceptual framework that was developed following a scoping review of public health approaches towards the above sectors. Specifically, we synthesize strategies from each sector to develop an overarching set of public health goals and strategies which-when interlinked and incorporated with a socio-ecological model-can be deployed by a range of stakeholders, including academics and treatment providers, to minimise gambling-related harms. We demonstrate the significance of the conceptual framework by highlighting its use in mapping initiatives as well as unifying stakeholders towards the minimization of gambling-related harms, and the protection of communities and societies alike.

Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation

Background

Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities.

Methods

Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender.

Results

The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change.

Conclusion

After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

Keeping you connected or keeping you addicted? Weekly use of social media platforms is associated with hazardous alcohol use and problem gambling among adults

AIMS

A wide variety of social media platforms exist, each offering tailored solutions to attract specific target audiences based on their social media needs and interests. This diversity may pose a risk factor for the development or perpetuation of harmful behaviors. Research has established a connection between social media use and increased health risk behaviors. This six-wave exploratory longitudinal study investigated the associations between active social media use, hazardous alcohol use, and problem gambling among adult social media users.

METHODS

Data were collected via surveys in 6-month intervals, starting in March-April 2021 (T1: N = 1530; Mage = 46.67; SD = 16.42; 50.33% male). Of the T1 respondents, 58.10% participated in T6 (n = 889). Measures included the frequency of use of different social media platforms, the 3-item Alcohol Use Disorders Identification Test (AUDIT-C), and the Problem Gambling Severity Index (PGSI). Hybrid multilevel regression models were used for analyses.

RESULTS

We found positive within-person effects of weekly Facebook use and between-person effects of weekly use of Facebook, TikTok, and gambling-related online communities on drinking. These results suggest an increase in hazardous alcohol consumption over time among the platforms' active users. Weekly Instagram use had a negative between-person effect on hazardous alcohol use. Individuals using TikTok or gambling communities weekly were more prone to problem gambling compared to non-weekly users.

CONCLUSIONS

There are risks involved in the active use of some social media services among adult users. Prevention work, including digital health interventions, should be targeted according to the appropriate user group.

Availability restrictions and mandatory precommitment in land-based gambling: effects on online substitutes and total consumption in longitudinal sales data

BACKGROUND

Gambling causes important harms in societies. According to the public health approach, the most effective policies to reduce harms target full populations. Availability restrictions and mandatory precommitment are among the most effective measures. However, restrictions on the availability of some gambling products or channels may also be offset by increased consumption in other products. Substitution effects can have negative public health impacts due to differing harm potential across different gambling products. This paper uses longitudinal sales data (2019-2022) from the Finnish gambling monopoly Veikkaus. During the observation period, the availability of gambling was restricted in Finland due to subsequent waves of Covid-19-related restrictions. In addition, the gambling monopoly introduced mandatory precommitment to land-based EGMs. We focus on how these restrictive policy changes impacted the total consumption of gambling and possible substitution effects.

METHODS

The Finnish gambling monopoly provided weekly theoretical loss data per gambling product category and gambling channel (online, land-based) for the period of January 2019 - July 2022 based on a statutory obligation. We analysed the effects of availability restrictions and other public health measures on the consumption of different products using descriptive time series and regression analyses. We compared the sale of land-based products to online equivalents at product category level and included main policy change periods in the models.

RESULTS

Total consumption of gambling declined during 2019-2022 mainly due to reduced land-based electronic gambling machine (EGM) consumption. Declines in land-based EGM sales were not offset by online alternatives or other close substitutes in the long term. However, during the first wave of Covid-19, there was an observable substitution of land-based table games by online alternatives and land-based horse betting and possibly sports betting by online horse betting. Overall, the results also show that Covid-19 functioned as a boost to an already existing trend of increasing digitalisation of gambling.

CONCLUSIONS

The study provides empirical support for the effectiveness of public health-oriented policies in reducing the total consumption of gambling. Availability restrictions and mandatory precommitment are therefore likely to also reduce the burden of harms of gambling to individuals and societies.

Psychosocial Factors Associated With Past Month Gambling Among Adolescents: Results From the 2016-2020 PRIDE Survey

The present study sought to identify psychosocial factors associated with recent gambling (gambling within the past 30 days). The 2016, 2018, and 2020 Parents' Institute for Drug Education (PRIDE) data sets were pooled and analyzed, consisting of 108,690 adolescents in 13 local public schools. A sizable percentage (13.1%) of adolescents reported gambling in the past 30 days. Multiple logistic regression analyses found differences based on demographic factors, previous substance use, and psychosocial factors. Adolescents at highest risk were male, non-White, in high school; sold drugs; and participated in violent activities in the past 30 days. The study also found worrying rates of substance use. Findings from the present study can inform harm reduction efforts, prevention messaging, and clinical interventions related to adolescent gambling.

Gambling in Ireland: profile of treatment episodes from a national treatment reporting system

OBJECTIVES

Globally, problem gambling prevalence is estimated at between 0.1% and 5.8%. Problem gambling can have many negative consequences; including on physical, and psychological health, and social functioning. There is a need to better understand treatment uptake as only a small proportion seek treatment. This is the first Irish national study using routinely gathered health surveillance data to describe treated problem gambling. Results will inform service policy and planning.

METHODS

An analysis of episodes treated for problem gambling collected by the National Drug Treatment Reporting System was undertaken. Included were episodes entering treatment between 2008 and 2019 (n = 2999). Variables of interest included service types accessed, demographics, socioeconomic information, referral and assessment details, current problems (up to five) and treatment history.

RESULTS

The majority (93.8%) were male. One fifth (20.9%) lived with dependent children, 7.4% were homeless. There were high levels of employment (35.4%) and formal education qualifications; half (53.8%) had completed second or third level education. Problem gambling frequently co-occurred with problem use of other substances (47.3%), which was most commonly alcohol (85.6%), followed by cannabis (32.3%), cocaine (28.0%) and benzodiazepines (10.9%). The majority were treated at inpatient settings (56.1%) with many self-referrals (46.3%).

CONCLUSIONS

This study provides insights into treated problem gambling nationally. Monitoring and surveillance can play a crucial role in measuring the successful efforts and help inform planning and treatment. The findings may have implications for treatment pathways.

The association between health-related quality of life and problem gambling severity: a cross-sectional analysis of the Health Survey for England

BACKGROUND

Problem gambling can lead to health-related harms, such as poor mental health and suicide. In the UK there is interest in introducing guidance around effective and cost-effective interventions to prevent harm from gambling. There are no estimates of the health state utilities associated with problem gambling severity from the general population in the UK. These are required to determine the cost-effectiveness of interventions. This study aims to use an indirect elicitation method to estimate health state utilities, using the EQ-5D, for various levels of problem gambling and gambling-related harm.

METHODS

We used the Health Survey for England to estimate EQ-5D-derived health state utilities associated with the different categories of the Problem Gambling Severity Index (PGSI), PGSI score and a 7-item PGSI-derived harms variable. Propensity score matching was used to create a matched dataset with respect to risk factors for problem gambling and regression models were used to estimate the EQ-5D-derived utility score and the EQ-5D domain score whilst controlling for key comorbidities. Further exploratory analysis was performed to look at the relationship between problem gambling and the individual domains of the EQ-5D.

RESULTS

We did not find any significant attributable decrements to health state utility for any of the PGSI variables (categories, score and 7-item PGSI derived harms variable) when key comorbidities were controlled for. However, we did find a significant association between the 7-item PGSI derived harms variable and having a higher score (worse health) in the anxiety/depression domain of the EQ-5D, when comorbidities were controlled for.

CONCLUSIONS

This study found no significant association between problem gambling severity and HRQoL measured by the EQ-5D when controlling for comorbidities. There might be several reasons for this including that this might reflect the true relationship between problem gambling and HRQoL, the sample size in this study was insufficient to detect a significant association, the PGSI is insufficient for measuring gambling harm, or the EQ-5D is not sensitive enough to detect the changes in HRQoL caused by gambling. Further research into each of these possibilities is needed to understand more about the relationship between problem gambling severity and HRQoL.

Changes in some health and lifestyle behaviours are significantly associated with changes in gambling behaviours: Findings from a longitudinal New Zealand population study

Although a large number of studies have investigated associations between risky gambling behaviours and health, lifestyle and social factors, research has not focused on changes in these factors and associations with changes in gambling risk level. This study utilised existing data from the four waves of the longitudinal New Zealand National Gambling Study to examine associations between changes in substance use, mental and physical health, and quality of life and deprivation with changes in gambling risk level over time. A Markov chain transition model was used to perform these analyses using data from participants who had completed all four waves (11,080 data transitions). Although changes in various covariates were associated with changes in all gambling risk levels, the highest number of significant factors was for transitioning into risky gambling from non-problematic gambling, including development, or continuation, of several negative health and lifestyle factors that may possibly be alleviated by transitioning out of risky gambling. These findings highlight the importance of screening for gambling behaviours when assisting people with substance use, health issues, or social situations or conditions in order to provide appropriate and effective social, health and treatment supports for people whose gambling behaviour increases over time.

Duration of untreated illness in gambling disorder

OBJECTIVE

Gambling disorder is common, affects 0.5-2% of the population, and is under-treated. Duration of untreated illness (DUI) has emerged as a clinically important concept in the context of other mental disorders, but DUI in gambling disorder, has received little research scrutiny.

METHODS

Data were aggregated from previous clinical trials in gambling disorder with people who had never previously received any treatment. DUI was quantified, and clinical characteristics were compared as a function of DUI status.

RESULTS

A total of 298 individuals were included, and the mean DUI (standard deviation) was 8.9 (8.4) years, and the median DUI was 6 years. Longer DUI was significantly associated with male gender, older age, earlier age when the person first started to gamble, and family history of alcohol use disorder. Longer DUI was not significantly associated with racial-ethnic status, gambling symptom severity, current depressive or anxiety severity, comorbidities, or disability/functioning. The two groups did not differ in their propensity to drop out of the clinical trials, nor in overall symptom improvement associated with participation in those trials.

CONCLUSIONS

These data suggest that gambling disorder has a relatively long DUI and highlight the need to raise awareness and foster early intervention for affected and at-risk individuals. Because earlier age at first gambling in any form was strongly linked to longer DUI, this highlights the need for more rigorous legislation and education to reduce exposure of younger people to gambling.

A 5-year longitudinal examination of the co-occurring patterns of gambling and other addictive behaviors

OBJECTIVE

We examined the co-occurring patterns of problem gambling and substance/behavioral addiction severity over a five-year period and the predictors of the different co-occurring patterns of problem gambling and addiction severity.

METHODS

We conducted a secondary analysis of the Quinte Longitudinal Study (QLS) data. The QLS is a 5-year prospective longitudinal study of gambling and problem gambling in the Quinte Region in Southern Ontario. The QLS consists of a total of 4,121 participants, including a sample of participants at risk of developing problem gambling. Severity of problem gambling, substance use, and behavioral addictions were used to examine their co-occurring patterns over time. Predictors of the co-occurring patterns included the presence of mental health disorders, personality, stress, happiness, lifesatisfaction, social support, family history, and demographics.

RESULTS

Six co-occurring patterns of problem gambling and addiction severity were identified. The largest co-occurring pattern was characterized by concurrent decrease in gambling and other addictive behaviors. Several co-occurring patterns were characterized by moderate-to-severe problem gambling and other addiction severity that remained stable over time. No co-occurring pattern represented a decrease in gambling followed by increase in other addictive behaviors (e.g., addiction substitution). The presence of mental health disorders, stress, and lifesatisfaction significantly predicted the different co-occurring patterns.

CONCLUSIONS

Taken together, the results suggest that in a non-clinical sample, gambling and other co-occurring addictive behaviors are likely to simultaneously decrease over time. Comorbidity of mental health disorders significantly influences co-occurring patterns of gambling and other addictive behaviors.

Online Gambling Patterns and Predictors of Problem Gambling Among Korean Adolescents During the COVID-19 Pandemic: A Cross-sectional Study

PURPOSE

This study examined online gambling patterns among Korean adolescents during the COVID-19 pandemic and identified predictors of problem gambling based on a socio-ecological model.

METHODS

It used nationally representative data from the 2020 National Survey on Youth Gambling Problems conducted by the Korea Center on Gambling Problems. This study selected a sample of 780 adolescents aged 13-18 years who reported having gambled online at least once in the last three months from the raw data of respondents. They were classified as the non-problem group and problem group according to the Gambling Problems Severity Scale (GPSS) of the Canadian Adolescent Gambling Inventory (CAGI). The predictive factors of problem gambling were analyzed by logistic regression analysis.

RESULTS

The prevalence of problem gambling was 24.6 %. Its predictors included intrapersonal [male (odds ratios, OR = 1.67); gambling prior to COVID-19 (OR = 2.08)] and interpersonal factors [frequent gamblers in peers (OR = 4.34); peer pressure (OR = 2.34)]. Social factors, such as gambling in online community (OR = 5.60), sports betting (OR = 53.24), and lotteries (OR = 17.03) were associated with problem gambling.

CONCLUSIONS

The major predictors of problem gambling among adolescent online gamblers included peer gambling and specific types of gambling. To prevent problem gambling, strategies targeting peer groups are essential. In addition, nurses need to share with families, schools, communities, and policymakers that online gambling, such as lotteries and sports betting, are high-risk of adolescent problem gambling, and recommend them to collaborate for stricter regulatory measures.

Moderating effect of alexithymia between problem gambling and psychotic experiences in university students

BACKGROUND

Most of the young individuals with problem gambling (PG) or psychotic experiences (PEs) are less prone to seek medical help. Therefore, community-based studies investigating the relationship between these entities in non-clinical young people across a continuum of severity are warranted. To this end, the present study proposes to advance knowledge on the mechanisms that potentially underlie the association between PG and PEs, by examining the role of a potential moderator, i.e. alexithymia, in this relationship.

METHODS

A total of 399 participants enrolled in this study (mean age = 21.58 ± 3.20 years) participated in an online cross-sectional survey. The South Oaks Gambling Screen (SOGS), the Prodromal Questionnaire-Brief (PQ-B), and the Toronto alexithymia scale (TAS-20) were used.

RESULTS

Thirty-three (8.3%) participants had problem-gambling, whereas 13 (3.3%) were probable pathological gamblers. Moderation analysis results adjusted over confounders (age, household crowding index, marital status, personal history of mental disorder, other illegal drug use) showed that the interaction PG by alexithymia (p = .018) was significantly associated with PEs scores. At moderate (Beta = 1.93) and high (Beta = 3.38) levels of alexithymia, more PG was significantly associated with more PEs scores.

CONCLUSION

Findings suggest that GP may have a different impact on PEs depending on the individual's level of alexithymia. As such, both alexithymia and gambling behavior should be considered in the clinical assessment of young people who present with PEs, which can help in implementing more tailored and individualized treatment plans.

Public health approaches to gambling: a global review of legislative trends

The public health community has called for governments to recognise the harms associated with gambling, and for gambling policies to include population-based harm prevention approaches. This Health Policy explores the translation of this call into global policy action by systematically reviewing legislation of jurisdictions that introduced major gambling legislation change (ie, restricting or extending gambling provision) between Jan 1, 2018, and Dec 31, 2021. We mapped the global availability of legal gambling and changes in its provision, and conducted critical frame analysis on a sample of 33 jurisdictions introducing major policy change to assess the extent to which the protection of health and wellbeing was embedded within legislation. More than 80% of countries worldwide now legally permit gambling. Harmful gambling was recognised as a health and wellbeing issue in most of the analysed jurisdictions, but near-exclusive focus was given to individual-level harms rather than to wider social and economic harms, or harms to others. Most of the proposed prevention measures focused on individual responsibility. Gambling policies worldwide are changing, but addressing gambling as a public health issue is not yet translating into comprehensive policy action across jurisdictions.

Cluster analysis in gambling disorder based on sociodemographic, neuropsychological, and neuroendocrine features regulating energy homeostasis

BACKGROUND

The heterogeneity of gambling disorder (GD) has led to the identification of different subtypes, mostly including phenotypic features, with distinctive implications on the GD severity and treatment outcome. However, clustering analyses based on potential endophenotypic features, such as neuropsychological and neuroendocrine factors, are scarce so far.

AIMS

This study firstly aimed to identify empirical clusters in individuals with GD based on sociodemographic (i.e., age and sex), neuropsychological (i.e., cognitive flexibility, inhibitory control, decision making, working memory, attention, and set-shifting), and neuroendocrine factors regulating energy homeostasis (i.e., leptin, ghrelin, adiponectin, and liver-expressed antimicrobial peptide 2, LEAP-2). The second objective was to compare the profiles between clusters, considering the variables used for the clustering procedure and other different sociodemographic, clinical, and psychological features.

METHODS

297 seeking-treatment adult outpatients with GD (93.6% males, mean age of 39.58 years old) were evaluated through a semi-structured clinical interview, self-reported psychometric assessments, and a protocolized neuropsychological battery. Plasma concentrations of neuroendocrine factors were assessed in peripheral blood after an overnight fast. Agglomerative hierarchical clustering was applied using sociodemographic, neuropsychological, and neuroendocrine variables as indicators for the grouping procedure. Comparisons between the empirical groups were performed using Chi-square tests (χ2) for categorical variables, and analysis of variance (ANOVA) for quantitative measures.

RESULTS

Three-mutually-exclusive groups were obtained, being neuropsychological features those with the greatest weight in differentiating groups. The largest cluster (Cluster 1, 65.3%) was composed by younger males with strategic and online gambling preferences, scoring higher on self-reported impulsivity traits, but with a lower cognitive impairment. Cluster 2 (18.2%) and 3 (16.5%) were characterized by a significantly higher proportion of females and older patients with non-strategic gambling preferences and a worse neuropsychological performance. Particularly, Cluster 3 had the poorest neuropsychological performance, especially in cognitive flexibility, while Cluster 2 reported the poorest inhibitory control. This latter cluster was also distinguished by a poorer self-reported emotion regulation, the highest prevalence of food addiction, as well as a metabolic profile characterized by the highest mean concentrations of leptin, adiponectin, and LEAP-2.

CONCLUSIONS

To the best of our knowledge, this is the first study to identify well-differentiated GD clusters using neuropsychological and neuroendocrine features. Our findings reinforce the heterogeneous nature of the disorder and emphasize a role of potential endophenotypic features in GD subtyping. This more comprehensive characterization of GD profiles could contribute to optimize therapeutic interventions based on a medicine of precision.

Do attention-deficit/hyperactivity symptoms influence treatment outcome in gambling disorder?

BACKGROUND AND AIMS

Numerous studies point to the comorbidity between gambling disorder (GD) and attention deficit hyperactivity disorder (ADHD). However, there is a lack of research exploring how ADHD symptoms might influence psychological treatment outcomes for GD. Therefore, we aimed to explore differences between patients with GD with and without self-reported ADHD symptoms regarding psychopathology, personality, sociodemographic and treatment outcome measures.

METHOD

This longitudinal study included 170 patients with GD receiving cognitive behavioral therapy. Multiple self-reported instruments were used to assess clinical variables and sociodemographic measures prior to treatment.

RESULTS

A clinical profile characterized by greater GD severity, higher psychopathology and impulsivity, and less adaptive personality features was observed in patients with self-reported ADHD symptoms compared to those without. No significant differences in treatment response (measured by dropout and relapse rates) were observed between the two groups. However, patients with self-reported ADHD symptoms experienced more severe relapses (i.e., gambled more money) and GD patients who relapsed scored higher on measures of ADHD, particularly inattention.

CONCLUSION

Individuals with GD and self-reported symptoms of ADHD may experience more severe relapses following treatment, suggesting a need for more vigilant follow-up and interventions for patients with this comorbidity.

Suicidality among individuals with gambling problems: A meta-analytic literature review

Gambling problems have consistently been linked to suicidality, including suicidal ideation, attempts, and suicide. However, the magnitude of the relationship has varied significantly across studies and the potential causal link between gambling problems and suicidality is currently unclear. A meta-analytic literature review was conducted to (a) synthesize pooled prevalence rates of suicidality among individuals with gambling problems; (b) determine if individuals with gambling problems had an increased likelihood of reporting suicidality compared to individuals without gambling problems; and (c) review evidence on causality and directionality. A search in Web of Science, APA PsycInfo, APA PsycNet, Medline, CINAHL, ProQuest, Embase, and Google Scholar electronic databases identified 107 unique studies (N = 4,691,899) that were included for review. Studies were included if they were available in any European language and provided sufficient data for the calculation of prevalence rates or effect sizes. Two researchers extracted the data independently using a predefined coding schema that included the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analyses yielded pooled prevalence rates of 31.6% (95% CI [29.1%, 34.3%]) for lifetime suicidal ideation and 13.2% (95% CI [11.3%, 15.5%]) for lifetime suicide attempts. Individuals with gambling problems had significantly increased odds of reporting lifetime suicidal ideation (OR = 2.17, 95% CI [1.90, 2.48]) and lifetime suicide attempts (OR = 2.81, 95% CI [2.23, 3.54]) compared to individuals without gambling problems. Two studies reported that individuals with pathological gambling had an increased risk of dying by suicide. Metaregression analyses suggested that the risk of study bias was positively related to the prevalence rates of suicidal ideation. Sex proportions were found to moderate the odds of suicidal ideation, but the direction of the effect was inconsistent. For suicide attempts, psychiatric comorbidity and sample size were positively and inversely, respectively, associated with prevalence rates. The synthesis indicates that suicidality is common among individuals with gambling problems and hence should be addressed by help agencies. Inferences on causality and directionality are hampered by a lack of longitudinal studies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Tracking online searches for gambling activities and operators in the United Kingdom during the COVID-19 pandemic: A Google Trends™ analysis

Background

Whilst some research has explored the impact of COVID-19 on gambling behaviour, little is yet known about online search behaviours for gambling during this period. The current study explored gambling-related online searches before, during and after the outbreak of the COVID-19 pandemic in the UK. We also assessed whether search trends were related to Gambling Commission behavioural data over the same period.

Methods

Google Trends™ search data, covering thirty months from January 2020 to June 2022, for five gambling activities and five gambling operators were downloaded. Graphical displays of the weekly relative search values over this period were then produced to visualise trends in search terms, with key dates in COVID-19 policy and sporting events highlighted. Cross-correlations between seasonally adjusted monthly search data and behavioural indices were conducted.

Results

Sharp increases in internet searches for poker, slots, and bingo were evident during the first lockdown in the UK, with operator searches sharply decreasing over this period. No changes in gambling activity searches were highlighted during subsequent lockdowns, although small increases in operator-based searches were detected. Strong positive correlations were found between search data and industry data for sports betting and poker but not for slots.

Conclusions

Google Trends™ data may act as an indicator of population-level gambling behaviour. Substitution of preferred gambling activities for others may have occurred during the first lockdown when opportunities for sports betting were limited. Further research is needed to assess the effectiveness of internet search data in predicting gambling-related harm.

[Conceptual framework of gambling and gambling-related harms]

Gambling is a legitimate leisure activity in many countries that many people use. However, some of them suffer significant harm because of gambling. This may involve economic, social, physical or mental harm. These harms are not only suffered by the individual gambler, but affect the family, the community and society. The aim of this text is to propose a conceptual framework for understanding the determinants of gambling and its related harms and thus, contribute to the development of prevention policies to reduce its impact on health. The framework proposed in this manuscript places present evidence in the model of health inequalities, analyzing the effect of the socioeconomic and political context, the axes of inequalities, individual and social factors, and the health system in generating the health inequalities of gambling suffered by the most vulnerable groups. The evidence gathered in this framework suggests that health determinants lead to health inequality in relation to gambling and its associated harms.

Demographic, gambling, and psychological characteristics of sports bettors in a stratified sample of adults who gamble regularly

OBJECTIVE

Sports betting accounts for the greatest proportion of online gambling behavior globally and has been linked to various harms. Few studies have examined the average sports bettor profile using stratified samples of adults who gamble regularly. The present study builds upon existing research on the demographic variables of sports bettors and provides an in-depth examination of the clinical and gambling-related factors associated with sports betting.

METHOD

Participants (N = 10,039; 53.6% female) consisted of a stratified sample of Canadian adults who endorsed participating in gambling at least once per month in the past year. Participants completed standardized measures assessing demographics, gambling behavior, problem gambling severity, gambling-related harms, gambling motives, and psychological characteristics (e.g., substance use, mental health).

RESULTS

About 1,816 participants (18.1%) reported engaging in sports betting in the past year. Sports bettors tended to be younger, male, and employed full-time compared to nonsports bettors. Sports bettors endorsed different patterns of clinical comorbidities and greater substance use. Sports betting was also associated with unique gambling motives and greater time and money spent on gambling. Among participants who endorsed problem gambling, sports betting was associated with greater impulsivity and likelihood of using illicit substances while gambling.

CONCLUSIONS

The results highlight the characteristics of individuals who bet on sports, as well as the characteristics of sports bettors with problem gambling which may help to inform the development of targeted prevention and intervention efforts to mitigate the potential harms of sports betting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comorbid psychiatric diagnoses and gaming preferences in US armed forces veterans receiving inpatient treatment for gambling disorder

Armed Forces Veterans are uniquely vulnerable to problem gambling and gambling disorder. Even so, research regarding the full clinical profile of veterans with gambling problems lags. Gambling activities vary widely from each other, but most gambling activities can be understood as either strategic (i.e., involving some measure of skill and decision-making as a part of the gambling practice) or non-strategic (i.e., gambling activities that are entirely based on chance). Prior works have found that gamblers that prefer strategic gambling activities and those that prefer nonstrategic gambling activities often differ from each other in key ways, with the two preferences being linked to varying motivations for gambling, varying cognitions about gambling, and the course of gambling disorder. The present work sought to examine how preferences for strategic vs. nonstrategic gambling might be related to psychiatric comorbidities among U.S. Armed Forces Veterans receiving inpatient treatment for Gambling Disorder. Data from U.S. Armed Forces Veterans (N = 401) receiving residential treatment for GD between the years of 2010-2016 were analyzed. Results demonstrated that gamblers that preferred strategic gambling, as opposed to non-strategic gambling, were more likely to be younger, more likely to be men, less likely to have a nicotine use disorder, and less likely to have PTSD. Such findings suggest that gamblers with PTSD are likely to prefer nonstrategic games and may imply a unique vulnerability to gambling problems related to non-strategic gambling among armed forces veterans.

Gambling characteristics in Galicia: A Public Health problem

Due to the increase in gambling, gambling disorders have become a major social problem of importance for public health, affecting both adults and adolescents. The main objectives of this study were to assess the prevalence of the Galician population who spent money on gambling in the last year and the prevalence of people with, or at risk of, gambling disorder. Data was obtained from a cross-sectional survey carried out in 2017 by the Galician Information System on Risk Behaviors (SICRI). The SICRI conducts annual telephone surveys of Galician residents who were at least 16 years of age, with the sample equidistributed over a 12-month period.  A total of 7,841 participants were selected using stratified random sampling. In order to estimate the prevalence of gambling disorder or at-risk gambling, The South Oaks Gambling Screen (SOGS) questionnaire by Lesieur and Blume was applied. The prevalence of gambling and having or being at risk of gambling disorder was estimated and regression models were adjusted to identify variables associated with gambling disorder or being at risk. Of the Galician population aged 16 years and older, 58.1% (95% CI: 57.0-59.2) spent money on gambling in the 12 months previous to this study, with the highest prevalence of gambling found in men (64.6% vs. 52.2%) in all age groups. The prevalence of gambling disorder or at-risk gambling at the population level is 1.6% (95% CI 1.3-1.9), and is higher among men and younger gamblers. The prevalence obtained signals to gambling as a major public health concern, with young males being at greater risk of developing a gambling problem.

Setting the scene: a scoping review of gambling research in Ghana

Ghana, like many other African countries, has seen a rapid expansion in gambling industry activity in the last decade with sports betting becoming a popular pastime among young Ghanaian males. The proliferation of land based, and online gambling operations presents a significant public health threat to the citizenry. Yet little is known about gambling participation and harms, the size of the gambling market and the role of the gambling industry in influencing and perpetuating gambling behaviour in Ghana. The aim of this study was to contribute to understanding the extent of gambling research in Ghana by mapping out what the current literature indicates. Six databases were searched for peer-reviewed journal articles that focused on gambling in Ghana. The findings from this review demonstrate gambling research in Ghana is in a nascent state with a predominant focus on individual factors and limited consideration of public health. The implications for future research are highlighted, including the requirement for a nationally representative study to understand the prevalence of gambling participation and harm, and the role of the gambling industry. Public health action grounded in sound evidence is urgently required to address the individual and community level problems associated with this harmful commodity.

Young male athletes at risk for problem gambling: Findings from a cross-sectional study in Sweden

Previous research has shown that male athletes at the elite level in Sweden have a higher proportion of gambling problems than the average male population in the country. However, there is a knowledge gap in the prevalence of gambling problems among young athletes. To address this gap, this study aimed to explore gambling behavior among young athletes and to examine the associations between individual and environmental factors and problem gambling. The cross-sectional survey comprised questions from the Problem Gambling Severity Index and the Alcohol Use Disorders Identification Test, in addition to self-constructed items on individual and environmental factors. The data were derived from a sample of 1,636 students from the National Sports Education Program (NIU) and 816 grassroots athletes of the same age (16-20 years old). The results showed that male athletes had a higher prevalence of problem gambling compared to female athletes, and that a large proportion of male athletes had gambled during school hours. The prevalence of problem gambling was almost zero for women. The prevalence of problem gambling among male athletes over 18 years of age was 9% in NIU athletes and 3.6% in grassroots athletes, while for men under 18 years of age, the prevalence was 4.9% in NIU athletes and 1.3% in grassroots athletes. The study highlights the importance of considering contextual factors such as the school and team environment in preventing problem gambling among young male athletes.

Using geospatial mapping to predict and compare gambling harm hotspots in urban, rural and coastal areas of a large county in England

BACKGROUND

Disordered gambling is a public health problem with interconnections with health and social inequality, and adverse impacts on physical and mental health. Mapping technologies have been used to explore gambling in the UK, though most were based in urban locations.

METHODS

We used routine data sources and geospatial mapping software to predict where gambling related harm would be most prevalent within a large English county, host to urban, rural and coastal communities.

RESULTS

Licensed gambling premises were most concentrated in areas of deprivation, and in urban and coastal areas. The aggregate prevalence of disordered gambling associated characteristics was also greatest in these areas.

CONCLUSIONS

This mapping study links the number of gambling premises, deprivation, and risk factors for disordered gambling, and highlights that coastal areas see particularly high density of gambling premises. Findings can be applied to target resources to where they are most needed.

A meta-analytic investigation of problem gambling and self-harm: A causal inference perspective

OBJECTIVE

Problem gambling may be an underappreciated treatment target for reducing self-harm. Multivariate studies examining the relationship between problem gambling and self-harm have returned inconsistent results, perhaps due to insufficient power or differences in study quality.

METHOD

We conducted a series of meta-analyses examining the effect of problem gambling on self-harm outcomes of varying severity. We assessed the sensitivity of results to study characteristics, publication bias, and influential cases. To highlight threats to causal inference, we evaluated each study for residual confounding bias.

RESULTS

In total, two types of meta-analyses were adequately powered: those assessing (a) the effect of problem gambling (binary) on suicide ideation and (b) problem gambling (binary) on suicide attempt (k = 14 unique studies between the two meta-analyses). For both meta-analyses, we found a positive, statistically significant average effect of problem gambling on the respective self-harm outcome. We did not detect any influential studies among these two meta-analyses, nor residual confounding. However, these findings are limited by the overall quality of included literature. PET-PEESE analysis detected substantial potential publication bias in the main results, with both meta-analytic effects being reduced to statistical nonsignificance. All included studies also used a cross-sectional design for their analysis of interest, thus simultaneity bias cannot be ruled out.

CONCLUSION

While these findings suggest there is an appreciable relationship between problem gambling and at least two forms of self-harm (suicide ideation and attempts), well-designed longitudinal research is needed to make more firm conclusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dissociative experiences reduce online problem gambling treatment effectiveness

AIMS

To determine whether dissociative experiences moderate online problem gambling treatment effectiveness, and to characterize the temporal persistence of the relationship between dissociation and problem gambling.

DESIGN

Repeatedly measured self-report data on a guided online cognitive behavioral therapy for problem gambling collected on four occasions: before treatment, after treatment, and at 6- and 12-month follow-ups.

SETTING AND PARTICIPANTS

The data (N = 1243, 59.2% males) were collected in Finland between 2019 and 2021.

MEASUREMENTS

The primary outcome variable was the self-reported level of problem gambling. The predictors were the treatment phase and dissociative experiences, their interaction, and the demographic covariates of age, education, income, and gender.

FINDINGS

Problem gambling scores and dissociative experiences declined significantly following treatment and remained low through the follow-ups (retention rates: 52.6% [post-treatment], 26.3% [at the 6-month follow-up], and 16.1% [at the 12-month follow-up]). However, the treatment was significantly less effective in reducing problem gambling for individuals who kept experiencing dissociation after the treatment.

CONCLUSIONS

Dissociation is an integral sign of problem gambling severity and sustained dissociative experiences may significantly reduce the long-term effectiveness of online problem gambling treatments. Treatment efforts should be customized to account for individual differences in dissociative tendencies, and future research should broaden the study of dissociative experiences to other behavioral addictions.

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.

Odds of gambling among adolescents: a secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs

BACKGROUND

Gambling among adolescents is associated with gambling disorder in adulthood. This study investigated factors associated with gambling and excessive gambling in adolescents.

METHODS

This secondary analysis of the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) used nationally representative data from the Irish cohort of the 2019 ESPAD wave. Data were collected between March and May 2019. We included 1949 students aged 15-16 years (946 [48·5%] male, 1003 [51·5%] female), with a response rate of 85%. We calculated past year gambling prevalence as the rate of those who had gambled for money on at least one of four games of chance (slot machines, cards or dice, the lottery, betting on sports or animals) in the past 12 months. An adapted version of the three-item Consumption Screen for Problem Gambling was used to identify excessive gambling (score ≥4). We carried out descriptive and logistic regression analyses using binary covariates with Stata v16.1. We included 19 variables in the multivariable analysis. Ethics approval was granted by Dublin Institute of Technology's Ethics Committee. Non-consent forms were issued to all parents to opt out.

FINDINGS

Overall, 447 (23%) of 1949 students gambled in the past year, of whom 45 (10%) engaged in excessive gambling. Using a mutually adjusted multivariable logistic regression analysis, past year gambling was associated with alcohol use (adjusted odds ratio [aOR] 1·6, 95% CI 1·1-2·2), experiencing serious arguments (aOR 1·4, 1·1-1·9), and trouble with the police (aOR 1·9, 1·2-2·8). Female gender was a protective factor (aOR 0·6, 0·4-0·9). In the univariable analysis, excessive gambling was associated with gaming (OR 2·3, 1·0-5·1), tobacco use (2·1, 1·1-4·2), e-cigarette use (2·1, 1·1-4·1), heavy episodic drinking (2·7, 1·4-5·1), trouble with the police (2·8, 1·5-5·4, p<0·01), and deliberately hurting themselves (2·8, 1·4-5·6). Female gender (OR 0·3, 0·1-0·6) and social media use (0·4, 0·2-0·8) were protective factors. Excessive gambling was also associated with betting on sports and animals (OR 3·6, 1·6-8·4), slot machines (2·9, 1·5-5·8), card or dice (2·4, 1·2-4·6), and online gambling (4·2, 2·0-8·0).

INTERPRETATION

A large proportion of 15-16 year olds in Ireland have gambled for money in the past year, with one in ten of those having engaged in excessive gambling. This number is likely to be underestimated due to recall and social desirability bias. Reducing the availability, access, and appeal of gambling products in Ireland should be addressed through ongoing gambling reform.

FUNDING

Institute of Public Health.

The relative risks of different forms of sports betting in a U.S. sample: A brief report

BACKGROUND

The 21st century has brought substantial changes to the manners in which people gamble and the types of things on which people gamble. These changes are particularly stark in the United States, where, over the past five years, sports betting has gone from being legal in only one location to being legal throughout the majority of the country, often via mobile applications and online betting websites.

METHOD

In March of 2022, a sample of the U.S. population (n = 2806, Mage[SD] = 48.9[17.2]; 1365[48.6%] men; response rate = 87.6%) and an oversample of sports-wagering adults in the U.S. (n = 1557, Mage[SD] = 41.7[15.3]; 1043[67%] men; response rate = 78.7%) were recruited via YouGov. Participants completed measures of gambling activities, including various forms of sports betting, as well as measures of problem gambling activities.

RESULTS

In general, people who gamble on sports, when compared to people who do not bet on sports, reported greater frequency of gambling engagement (averaging between monthly and weekly play),a wider variety of gambling activities (with the majority reporting past year engagement in four or more gambling activities), and higher rates of problem gambling. Multinomial logistics regression revealed no distinct associations between any specific form of sports gambling and higher risk, instead demonstrating that breadth and depth of gambling engagement were the best predictors of high-risk gambling behaviors.

CONCLUSIONS

In general, sports gambling is broadly associated with greater engagement in both breadth of gambling activities and frequency of gambling play. Additionally, people who gamble on sports seem to be at higher risk of problem gambling than people who do not bet on sports. However, in analyses controlling for breadth and depth of gambling activities, these links are attenuated, suggesting that the risks associated with sports gambling behaviors are related to the greater degree of gambling engagement.

Ethnicity as a risk factor for gambling disorder: a large-scale study linking data from the Norwegian patient registry with the Norwegian social insurance database

BACKGROUND

The study investigated ethnicity as a risk factor for gambling disorder (GD), controlling for demographics, citizenship, and years of residency in Norway.

METHODS

The sample comprised 65,771 individuals from a national patient registry (n = 35,607, age range 18-88 years) and a national social insurance database in Norway (n = 30,164, age rage 18-98 years). The data covered the period from 2008 to 2018.

RESULTS

The results showed that when controlling for age and sex, ethnic minorities were overall less likely than those born in Norway to be diagnosed with GD (odds ratio [OR] ranging from 0.293 to 0.698). After controlling for citizenship and years of residency in Norway, the results were reversed and indicated that ethnic minorities were overall more likely to be diagnosed with GD (OR ranging from 1.179 to 3.208).

CONCLUSION

The results suggest that citizenship and years of residency are important variables to account for when assessing the relationship between ethnicity and being diagnosed with GD. Our results may be explained by people from ethnic minority groups being more likely to experience gambling problems but less likely to seek contact with healthcare services for gambling problems.

Public opinions and attitudes toward a state monopoly: a study of the finnish gambling system

BACKGROUND

Gambling regulated through a state monopoly is often justified for reasons of public health, that is, that monopolies are a more effective means of reducing potential harm. This focus on harm prevention has increased in recent years, particularly as a result of pressures arising from the growth of online gambling and of legislation designed to promote competition. While prior works have examined the role of stakeholders in influencing policy decisions and in public discussions of the monopoly systems, attention has been focused on those with direct financial interests; the opinions of the public have largely been absent from these discussions. In 2017 Finland restructured its monopoly order to improve efficacy of addressing gambling related harms; this restructuring offers a valuable insight into public perceptions of and attitudes toward the suitability of the Finnish system to address gambling-related harm.

METHODS

This work uses Structural Equation Modelling and compares attitudes toward the Finnish system between 2015 (pre-restructuring) and 2019 (post-restructuring).

RESULTS

Overall public opinion of the Finnish system as being suitable for addressing gambling harms declined between 2015 and 2019, despite the restructuring. Several predictors of attitudes were identified, however, the majority had small effect sizes, while the model explained little variance.

CONCLUSION

This work concludes that existing approaches to examining public opinions of gambling regulation should be amended to include additional predictors. Furthermore, it is likely that context-specific predictors should be included in models, in order to reflect the socio-cultural history of the population being investigated. Such predictors should be determined in respect to the population of interest but, for example, could include items measuring trust in authority, political orientation, cultural acceptance of gambling, or religious affiliation.

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.

Longitudinal joint trajectories of gambling disorder and hypomentalization: A latent class growth analysis among young adults

INTRODUCTION

Only a few studies have investigated the relationship between risk for gambling disorder (GD) and mentalization difficulties. However, these results on positive correlations were all from cross-sectional studies; therefore, it would be important to investigate the longitudinal relationship between the constructs.

AIMS

It was aimed to identify subgroups of gamblers with different joint growth trajectories of risk for GD and hypomentalization (i.e., uncertainty of understanding own and others' mental states) and to compare the identified latent classes along impulsivity, sensation seeking and depression.

METHODS

Data from waves 1-3 of the Budapest Longitudinal Study were used. The final sample included 219 young adult gamblers who completed the study questionnaire and reported past-year gambling in all three waves (Females: N = 93 [42.29%]; Mean age: 28.36 years [SD = 4.29]). Standardized questionnaires were administered to measure the main constructs.

RESULTS

A four-class model was retained based on latent class growth analysis. Class 1 had consistently moderately high risk for GD and hypomentalization, and Class 4 presented consistently low risk for GD and hypomentalization. Classes 2-3 were characterized by low risk for GD and increasing hypomentalization. Class 1 had significantly higher sensation seeking and depression compared with the other subgroups in multiple cases. Class 4 showed significantly lower impulsivity and sensation seeking than the other classes.

CONCLUSIONS

Elevated hypomentalization was presented among individuals with risk for GD. However, there is little empirical evidence to support that the two constructs have convergently changing trajectories. A cautious interpretation of the results is recommended due to low symptom presence.

Emotional dependence as a predictor of emotional symptoms and substance abuse in individuals with gambling disorder: differential analysis by sex

INTRODUCTION

Emotional dependence, anxious-depressive symptoms and substance use have been associated with gambling disorder (GD). Although anxiety and depression have been predominantly related to female gamblers and substance abuse to male gamblers, the role of emotional dependence in GD is unknown. Moreover, sex differences remain underexplored.

OBJECTIVES

First, to explore possible differences in emotional dependence, anxious-depressive symptoms and substance abuse by group (GD and non-GD) and sex (women vs men). Second, to analyse the predictive role of emotional dependence in alcohol and drug abuse and anxious-depressive symptoms in patients with GD as a function of sex.

METHODS

Instruments to measure gambling (SOGS), emotional dependence (CDE), anxious-depressive symptoms (SCL-90-R) and substance abuse (MULTICAGE CAD-4) were administered to 108 people with GD diagnosis (60 women and 48 men) and 429 without GD (342 women and 87 men).

STUDY DESIGN

The research is an analytical cross-sectional study.

RESULTS

The results showed that the group with GD scored significantly higher than the non-GD group on alcohol abuse, symptoms of depression and anxiety, and emotional dependence, but not on drug abuse. In the group with GD, emotional dependence predicted alcohol and drug abuse in women, and emotional dependence predicted anxiety and depressive symptoms in men.

CONCLUSION

The findings suggest that women with GD who consume alcohol or drugs would benefit from therapies addressing loneliness, borderline expression, attention-seeking and affective expression. Men with GD who report anxious-depressive symptomatology would benefit from therapeutic strategies to deal with separation anxiety and attention-seeking.

Social and economic costs of gambling problems and related harm among UK military veterans

INTRODUCTION

Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans' Health and Gambling Study.

METHODS

An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint.

RESULTS

Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI -£1016 to -£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status.

CONCLUSIONS

Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.

COVID-19 SAFETY MEASURES AND THEIR EFFECTS ON GAMBLING HABITS: AN INVESTIGATIVE STUDY

This study looked at the way COVID-19 was starting to affect gambling during first six weeks of emergency actions. The following factors were evaluated: the economic effect of COVID-19 on internet gambling, according to COVID-19, psychological issues, addiction to drugs, and risky gambling habits and intentions. Online survey with cross-sectional data of 2015 gamblers was conducted, with a subsample of 1048 people who gambled online (age 18 and older). Numerous metrics of correlation and probability ratio analyses were performed. The Issue of Gambling Intensity Index's extremely dangerous gamblers and those who have gambled online are more likely to engage in gambling online, according to the outcomes, even though there was an obvious transition toward physical gaming. The most predicted indicators for high-risk gamblers on the internet were moderate to severe depression and anxiety, reduced work weeks, convincing themselves to gamble by COVID-19, gambling under the effects of alcohol or cannabis, and dangerous gambling motivations related to psychological disorders, such as gambling to relieve anxiety and depressive disorders, chasing gambling damages, and trying to make money from gambling. This research has validated numerous risk connections associated with gambling risk, psychological issues, and substance use reported in previous studies on the worldwide recession and upcoming COVID-19-related investigations. In contrast to many other inquiries, the current research considers each component comprehensively. It offers more information on the risk factors associated with online gambling throughout the epidemic.

Problem gambling severity in a nationally representative sample of the Israeli population: the moderating role of ethnonational affiliation

Introduction

Gambling is a public health concern. Problem gambling is related to a range of psycho-social risk factors including ethnonational affiliation. Israel is an insightful case to probe problem gambling, given the socio-economic marginalization of Israeli Arabs, the continued exposure of Israelis to stress and the conservative Israeli gambling market. This study aimed to estimate problem gambling severity in Israeli society, characterize the sociodemographic, environmental, mental health, and gambling-related risk factors associated with problem gambling severity, and examine the role of ethnonational affiliation (Israeli Jewish/Arab) as a moderating factor in the associations between these risk factors and problem gambling severity.

Methods

A cross-sectional study based on a representative sample of 3,244 Israelis was conducted in 2022, of whom 1,626 had gambled in the previous year. Measurements included Problem Gambling Severity Index, Gambling Behaviors, Perceived Neighborhood Cohesion, Stress, the Patient Health Questionnaire-4, and sociodemographic variables.

Results

Low-risk, moderate-risk and problem gambling were reported by 16.7% of the total sample. The main risk factors for problem gambling were being an Israeli Arab, traditional, residing in a low socio-economic cluster, reporting anxiety symptoms, and higher gambling behaviors, specifically in legal/illegal online gambling. Ethnonational affiliation (Israeli Jewish/Arab) moderated the associations between gambling, illegal online gambling, and problem gambling severity. Higher neighborhood cohesion emerged as a risk factor for problem gambling solely for Israeli Arabs.

Discussion

As an excluded minority, Israeli Arabs may turn to gambling as a method to access the core republican community, thus, exposing themselves to a higher risk of developing problem gambling.

Mapping the links between sexual addiction and gambling disorder: A Bayesian network approach

Contemporary literature and recent classification systems have expanded the field of addictions to include problematic behaviours such as gambling and sexual addiction. However, conceptualisation of behavioural addictions is poorly understood and gender-based differences have emerged in relation to how these behaviours are expressed. The current research conducted partial-correlation and Bayesian network analyses to assess the symptomatic structure of gambling disorder and sexual addiction. Convenience community sampling recruited 937 adults aged 18 to 64 years (315 females, Mage = 30.02; 622 males, Mage = 29.46). Symptoms of problematic behaviours were measured using the Online Gambling Disorder Questionnaire (OGDQ) and the Bergen Yale Sex Addiction Scale (BYSAS). Results indicate distinct gender-based differences in the symptom networks of sexual addiction and gambling disorder, with a more complex network observed amongst men for both conditions. Addiction salience, withdrawal and dishonesty/deception were important components of the addictive network. Interpersonal conflict was more central for women while intrapsychic conflict a more prominent issue for men. Differences in the two symptom networks indicate separate disorders as opposed to a single underlying construct. Treating practitioners and community initiatives aimed at addressing sexual addiction and disordered gambling should consider gender, when designing educational or therapeutic interventions.