RESEARCH QUESTIONS
How do different thresholds of defining gambling- related harm impact prevalence? What is the relationship between varying definitions of harm and indicators of gambling intensity? What are the harms of gambling experienced by gamblers with behaviour not severe enough to be characterized as problem or pathological gamblers?
PURPOSE
Research in gambling has typically focused on the prevention of problem gambling, rather than on gambling related harm. Prevention of gambling- related harm represents a broader goal that could potentially impact a much larger segment of the general population. This study focuses on harm influencing the gambler and his or her family. The purpose of this study was to compare within a large general population how different thresholds of defining harm impact problem gambling prevalence and are related to indicators of gambling intensity. In addition, the characteristics of gamblers who report experiencing low threshold levels of harm from their gambling were examined.
HYPOTHESIS None stated.
PARTICIPANTS
The study sample was drawn by merging data from gambling prevalence surveys conducted in Alberta, British Columbia, Ontario, Manitoba and Newfoundland. The sample was restricted to individuals who reported gambling at least once in the past year. The final sample consisted of 12,285 adults with a mean age of 45; 52% female, 48% male.
PROCEDURE
Data was merged from gambling prevalence surveys in AB, BC, ON, MB and NL. Each survey employed similar methodology in that data were collected via computer-assisted telephone interviewing systems.
Random digit dialing was used to select cases at the household level and the adult resident with the most
recent birthday was selected to be interviewed. Since electronic gaming machines (EGM) and casino gambling are regarded as having the greatest risk of harm, a two-group classification system was implemented. The first group consisted of all individuals reporting engagement in either of these forms of gambling at least once in the past year. The second group consisted of individuals reporting involvement in any other type of gambling (i.e. instant win tickets, lottery tickets, bingo, horse betting, and raffle tickets) but not EGM and casino gambling.
Three different definitions (i.e., thresholds) of harm were evaluated: Reporting that at least one symptom on the Problem Gambling Severity Index (PGSI);
reporting two symptoms, or reporting three or more.
Data was analyzed to assess: prevalence of harm according to the three different definitions; the strength of the relationship between the four measures of gambling intensity (frequency, total expenditure, percent of income spent on gambling and total number of gambling activities played in the last 12 months) and definitions of harm; and the characteristics of gamblers who scored positively for the three definitions of harm.
MAIN OUTCOME MEASURES
The Problem Gambling Severity Index (PGSI) is a nine item index that rates negative consequences or behaviours resulting from gambling (e.g., financial, health, emotional, and social problems); it was used to classify problem gambling. Two additional indicators of gambling were created for the purpose of this investigation including: percentage of income spent on gambling, calculated by dividing the total gambling expenditures by the respondent’s estimated gross family income, and the total number of game types played at least once in the past 12 months.
KEY RESULTS
Prevalence of harm according to different definitions:
Using the most liberal definition of harm (i.e., endorsing 1 symptom on the PGSI) indicated that 16% of the gambling population surveyed experienced harm, although they do not meet criteria for problem gambling. When the definition of harm was two symptoms, the prevalence dropped to 7%,
RESEARCH SYNOPSIS
Currie, S. R., Miller, N., Hodgins, D. C., & Wang, J. (2009). Defining a threshold of harm from gambling for population health surveillance research. International Gambling Studies, 9(1), 19‐
38. doi:10.1080/14459790802652209
and the most conservative definition of harm (i.e., 3 or more symptoms), the prevalence was only 5% of the gambling population.
Impact of varying the definition of harm on the relationship with measures of gambling intensity: Two definitions, two symptoms on the PGSI or three or more, were highly related to measures of gambling intensity. The strongest relationship was evident for the two indicators of expenditure (dollars and percentage of income spent on gambling) and the various definitions of harm.
Comparison of EGM and casino gamblers with other forms of gambling: The proportion of the sample who met each definition of harm differed between the two broad categories of gambler type. Individuals who played EGM or casino games were on average three to five times more likely than individuals who played other games, to experience harm regardless of the definition of harm used.
Characteristics of gamblers who met different definitions of harm: Gamblers reporting zero symptoms of harm were on average more likely to be older, female, and to report a higher average family income. People who reported two or more problem gambling symptoms had a PGSI score of more than 5 and more than 65% were EGM or casino gamblers.
Smoking was more prevalent in all harm categories compared to zero-symptom gamblers. The prevalence of gamblers under a doctor’s care for a mental health problem was highest in the two or more negative consequences group.
LIMITATIONS
Since the measure of ‘threshold of harm’ was based on a minimum number of symptoms being present, the results of the characteristics of gamblers meeting different definitions of harm could be skewed by the inclusion of problem and pathological gamblers at the upper ranges of each category. Accuracy of gambling expenditure data obtained from self-report surveys is of concern since question wording is often vague.
There was a low response rate in some of the provincial surveys, raising a concern about the possibility of biased samples.
CONCLUSIONS
Studies in gambling prevention have focused almost exclusively on reporting the prevalence and characteristics of the population who meet criteria for problem or pathological gambling. These findings indicate that a larger proportion of the population report subthreshold levels of problem gambling that nonetheless result in negative consequences.
Prevention efforts may have greater impact if targeted at the prevention of harm rather than the prevention of problem gambling.
KEYWORDS: population health, problem gambling, prevalence, harm, assessment
URL:
http://www.tandfonline.com/doi/abs/10.1080/1445979080 2652209