Spatial distribution of gambling: two indexes in support of the reduction of health inequalities

Background

Many studies have showed that disadvantaged areas residents have greater access to gambling sites and are more affected by gambling. Our research proposes an innovative method to characterize gambling environments in Quebec and addresses social inequality with respect to gambling exposure.

Methods

This cross-sectional ecological study was carried out in 3 stages: a Gambling Exposure Index (GEI) was built and is composed of 3 dimensions: spatial accessibility to gambling sites, density of gambling places, and relative risk associated with the types of game. The two-step floating catchment area (2SFCA) method was used to combine these dimensions into an overall GEI index. Data was retrieved from a geocoded directory of gambling sites and commercial databases. The relative risk of games is expressed by prevalence rates for those specific games in a Quebec population prevalence survey. A Vulnerability to Gambling Index (VGI) was produced based on 6 socio-economic proxies of problem gambling from the 2016 Canadian census, which were weighted and aggregated at the dissemination area (DA) level. Spatial and descriptive statistical analyses were conducted to explore the relationship between VGI and GEI, and to identify highly exposed and vulnerable areas.

Results

Our analyzes reveal significant associations between the GEI and the VGI in 2 599 out of 13 420 Quebec DAs (p < 0.05). Sectors with a high GEI show an average distance to the closest gambling sites of 2.8 km compared with 13.5 km for more advantaged sectors.

Conclusions

The interactive online mapping of the two indexes and statistical analysis of the results are beneficial to the professionals working in several fields such as risk monitoring, management of zoning, licensing and gambling distribution, prevention and treatment services. The method and the associated tools can be adapted to address the problem of increased accessibility to other unhealthy products in vulnerable neighborhoods.

Key messages

Two innovative ecological indexes show that increased accessibility to gambling correlates with a higher vulnerability to gambling in many Quebec regions. The online interactive map on gambling exposure and vulnerability provides reliable criteria to municipal, regional and governmental bodies for a safer distribution of gambling offer.

[Assessment of daily quality of life in children surviving cancer]

INTRODUCTION

The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment.

PATIENTS AND METHOD

Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2).

RESULTS

The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2.

DISCUSSION

The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering.