A critical qualitative inquiry of the social practices of older adult gamblers: implications for public health risk prevention

Background Older adults' participation in gambling is increasing internationally. Older adults have been identified as a group at greater risk of gambling harm. This may be due to their increased vulnerability due to life circumstances, such as retiring from paid work and social isolation. Current literature has focused on individual characteristics that may influence older adults gambling attitudes, behaviours, and experiences of harm, however, there has been little qualitative research that has explored other factors such as the influence of social practices surrounding gambling. This study explored how social practices influenced older adults' participation in gambling, and how these social practices may contribute to gambling risk. Methods A critical qualitative inquiry was conducted and involved semi-structured phone interviews with 40 Australian adults aged 55 years and over. A Constructivist Grounded Theory approach was taken, and Social Practice Theory guided the thematic analysis of the data. Results Two major themes were generated from the data. The first theme demonstrated that gambling was often embedded within older adults' social practices. For example, older adults would attend gambling venues with their social networks and engage in gambling as a way of building their social connection. Sometimes gambling occurred to try to meet the expectations of the wider social group, potentially increasing the risk of harm. Second, it was evident that gambling had become part a routine activity for older adults' everyday life. Conclusions Older adults social practices related to gambling were linked with the accessibility and availability of gambling products in community environments. Interventions aimed at preventing and reducing gambling harm in older adults need to shift away from the individual and instead focus on disrupting social practices, including the routines associated with gambling. Key messages Gambling was used by older adults to consolidate social connections and strengthen their sense of belonging within social groups and often involved routines around gambling. To prevent further harm from gambling to older adults, strategies should focus on the social context of older adults gambling rather than the individual characteristics of gamblers.

Emerging adults (ages 18–29) display higher prevalence of gambling participation and problem gambling as well as co-occurrence with other risk behaviors compared to other age groups. Consequences of these co-occurring conditions may lead to psychological symptoms, behavioral problems, and socioeconomic and medical costs. Depressive symptoms, antisocial behaviors, and alcohol use are known risk factors for gambling participation and problem gambling. However, scarce research has examined the co-occurrence of those adolescent risk factors and later gambling behaviors in emerging adulthood longitudinally. Using multiple waves of National Longitudinal Study of Adolescent to Adult Health (Add Health) data, we examined the relationship between earlier depressive symptoms, antisocial behaviors, alcohol use, and gambling behaviors at wave III, and later gambling participation and problem gambling (wave IV) in emerging adults ages 18–29, using multinomial logistic regression. Our findings suggest that earlier antisocial behaviors and gambling behaviors increased later risk for gambling participation and problem gambling. Past-year alcohol use and heavy drinking were associated with the increased risk of gambling participation but not problem gambling. Earlier depressive symptoms decreased the risk of gambling participation later among those who endorsed antisocial behaviors. Emerging adulthood may be a critical developmental period in the development of comorbid conditions of gambling and other risk behaviors. The results contribute evidence supporting the importance of early prevention and intervention for the co-occurrence of gambling and other risk behaviors in emerging adulthood.

This study aims to examine the associations between gambling participation, problem gambling, and cognition. Data were derived from the PINE study. Gambling participation was measured by Modified South Oaks Gambling Screen. Problem gambling was assessed with Problem Gambling Severity Index. Cognition was measured by East Boston Memory Test, Digit Span Backward, Symbol Digit Modalities Test, and Mini-Mental State Examination. Of all participants, 41.940% were male. Higher gambling participation was significantly associated with higher global cognition (b = .008, SE = .003, p < .05), executive function (b = .118, SE = .049, p < .05), and episodic memory (b = .009, SE = .004, p < .05). Higher problem gambling was significantly related to lower Mini-Mental State Examination (b = -.105, SE = .031, p < .001). Guiding older adults' gambling behaviors and intervening in problem gambling timely might be crucial for their cognitive function.

This study investigates the association of public, private and intrinsic religiosity and chance beliefs (superstition, illusion of control) with gambling behavior in a longitudinal follow-up study of younger and older adult subjects with DSM-IV pathological gambling (PG) and an older adult comparison group without PG. One-hundred sixty-three subjects were enrolled including 60 younger adults with PG (≥ 18/< 40years), 53 older adults with PG (≥ 60years), and 50 older adults without PG (≥ 60). Subjects were assessed at baseline and every 6months thereafter. The Duke University Religion Index for Religious Assessment and the Drake Beliefs About Chance scales were administered at baseline. Follow-up was a mean (SD) of 2.6 (1.4) years. Older adults with PG scored lower on measures of public and intrinsic aspects of religiosity than older adults without PG, and scored higher on superstition and illusion of control. Older adults with PG also scored higher than younger adults with PG on private and intrinsic religiosity, but not public religiosity. Superstition predicted intrinsic, but not other aspects of religiosity. Importantly, during follow-up, higher levels of public and intrinsic religiosity were protective against problematic (levels 2, 3) gambling; were protective against chronic PG; and were predictive of PG remission status. Lower illusion of control ratings were protective against problematic gambling and chronic PG; lower superstition ratings were predictive of remission. We conclude that higher levels of public and intrinsic religiosity and lower levels of chance beliefs are associated with a more benign PG course.

With the rapid aging of the population and the increased availability of gambling facilities over the past three decades, older adults may gamble more and may be increasingly at risk for problem gambling (PG) or pathological gambling disorder (PGD). To facilitate a better understanding of gambling behavior among older adults that will inform preventive strategies, this article systematically examined empirical studies on issues related to older adults' gambling. This article reviewed 75 empirical studies including data on the distribution and determinants of PG and PGD and the outcomes of gambling. This review used the broad term of "disordered gambling" as a means to explain a continuum of problems caused by PG and PGD. The analyses covered seven topics concerning older adults' gambling behaviors: Participation rates for gambling, prevalence rates of disordered gambling, motivation for initially beginning to gamble, risk and protective factors for disordered gambling, and negative and positive health outcomes from gambling. Based on research gaps identified in the review, this article proposes six recommendations for future studies focusing on well-being of older adults who gamble, research method issues, and taking into account older adults' inspirations and adjustment to the aging process in the 21st century.

The proliferation of lotteries and casinos has led to increased participation in gambling. Older adults who have opportunities to gamble may be vulnerable to gambling problems, and incarcerated older adults may be the most vulnerable. Furthermore, research has linked decreased health to gambling problems. This study compared perceived health and gambling problems among 43 incarcerated older adults from two county jails in the midwestern United States. Results from the South Oaks Gambling Screen indicated 48.83% of the sample scored in the problem or pathological range. Short Form-36 results were compared with U.S. norms for ages 55 to 64 and showed significantly lower perceived health scores on Role-Physical, Bodily Pain, Mental Health, Social Functioning, and Role-Emotional subscales. The problem and pathological gamblers showed significantly lower social functioning than the recreational gamblers. Assessment of health conditions and gambling behaviors is important for quantifying current and anticipated burdens of these conditions on correctional health care systems and the community.

While previous research has suggested the potential importance of gambling outcome expectancies in determining gambling behaviour among adolescents, the predictive ability of gambling outcome expectancies has not yet been clearly delineated for college-aged youth. The current study aims to explore the relationships between gender and outcome expectancies in the prediction of gambling severity among college student-athletes. Data from the National Collegiate Athletic Association (NCAA) study assessing gambling behaviours and problems among U.S. college student-athletes were utilized. Complete data was available for 7,517 student-athletes. As expected, male college student-athletes reported more gambling participation as well as greater gambling problems than their female counterparts. Findings showed positive relationships between the outcome expectancies of financial gain, and negative emotional impacts and gambling problems. That is, those who endorsed more items on the outcome expectancy scales for financial gain and negative emotional impacts also tended to endorse more gambling-related problems. Findings also showed a negative relationship between outcome expectancies of fun and enjoyment, and gambling problems over and above the variance accounted for by gender. Those with gambling problems were less likely to have the expectation that gambling would be fun than those without gambling problems. Despite NCAA efforts to curb gambling activity, the results suggest that college student-athletes are at risk for over-involvement in gambling. Therefore, it is important to explore gambling outcome expectancies within this group since the motivations and reasons for gambling might be able to inform treatment initiatives.

Cognitive abilities, non-cognitive skills, and gambling behaviors

Increasing numbers of retirees spend their leisure time in the ever-growing number of gambling casinos in this country. For most older adults, casino gambling is a new form of excitement and entertainment. However, for some retirees, especially those vulnerable to depression from the changes and losses that can occur in aging, casino gambling can become disordered, problematic, and/or an addiction. Although prevalence studies have examined the incidence of problem gambling in other age groups, little attention has been directed to the impact of casino gambling on older adults. The authors discuss problem and pathological gambling in retired older adults, and provide clinical case examples of a growing number of older adults with problem gambling behaviors seen in an outpatient geriatric psychiatry clinic. Finally, they urge that an evaluation of gambling behaviors be a routine portion of geriatric clinical evaluations.

Background Pathological gambling (PG) is an important public health problem. We assessed the prevalence of PG and problem (at-risk) gambling in a random sample of Iowa adults and compared the results to survey data collected in 1989 and 1995. The goal of this study was to examine whether continued expansion of gambling venues is associated with increased rates of problematic gambling behavior. Methods A random digit dialing telephone screening was conducted in eastern Iowa of men and women age =18. Respondents were administered the South Oaks Gambling Screen (SOGS) to assess lifetime gambling behavior. Demographic and clinical variables were collected. Results A total of 356 respondents (147 men, 209 women) completed the SOGS, and all reported lifetime gambling participation. PG (SOGS =5) was found in 5 (1.4%) and problem gambling (SOGS = 3, 4) in 8 (2.2%) respondents. Disordered gambling (SOGS =3) was found in 13 (3.6%) respondents. Risk factors for disordered gambling included age (odds ratio [OR] = 0.64 per 10-year age increase), income (OR = 0.82 per $10,000 increase), minority group status (OR = 5.75), number of lifetime gambling activities (OR = 1.27), and having ever gambled =$100 (OR = 13.3). Overall gambling participation was significantly less in the current sample, compared with data collected in 1995. Conclusions Recent gambling participation was less than in 1995, despite the continued expansion of gaming opportunities. Disordered gambling was associated with younger age, lower income, and minority group status. The results are consistent with Shaffer's “adaptation” hypothesis, which posits that following an initial increase in gambling participation, problematic gambling stabilizes at a lower level.

Gambling in primary care patients: why should we care and what can we do about it?

Although age-related differences have been reported in gambling disorder, prior studies have not examined how age may influence recovery in gambling disorder. Recovery may be influenced by positive factors (e.g., spirituality and recovery capital) and negative factors (e.g., depression, anxiety, and stressful life events). The current study examined associations between these positive and negative factors and gambling disorder DSM-5 symptom improvement in younger and older adults. Younger (less than 55years of age; n = 86) and older (55years or older; n = 54) adults, with lifetime gambling disorder treated currently or within the past 5years in five treatment centers in Israel were assessed using structured scales on past-year and lifetime DSM-5 gambling disorder, intrinsic spirituality, recovery capital, anxiety, depression and stressful life-events. Among younger adults, recovery capital and intrinsic spirituality were associated with gambling disorder symptom improvement. Among older adults, only recovery capital was associated with gambling disorder symptom improvement. Correlations between recovery capital and spirituality (z = 2.34, p = 0.02) and recovery capital and stressful life events (z = 2.29, p = 0.02) were stronger in younger than in older adults. Recovery capital is an important resource that should be considered across older and younger adults with gambling disorder. Spirituality and stressful life events may operate differently across age groups in gambling disorder. Future studies should investigate whether the findings may extend to other groups and the extent to which promoting recovery capital should be integrated into treatments for gambling disorder.

This study aimed to explore changes in gambling behaviours and gambling disorder (GD) treatment uptake during the COVID-19 pandemic among those with a heightened vulnerability to gambling-related harm. This was a single-center, cross-sectional, retrospective case series study assessing gambling behaviours and GD counselling participation among a vulnerable population sector following the COVID-19 shutdown. The clinical records of clients at a community substance use disorder (SUD) treatment center were explored (N = 67). Eight clients (n = 8) had satisfied the objective criteria, and were qualified for data exploration and analysis of gambling activities and GD treatment participation following the COVID-19 shutdown. All clients in the study belonged to subgroups at an elevated risk for gambling-related harm, with a mean duration of gambling problems of 9.5 years. Following the COVID-19 shutdown, an increase in gambling activities was noted in five cases. Migration to online gambling was noted in three cases. In two cases, no change in gambling activities was noted, and a reduction of gambling activities was noted in one case. In seven cases, no screening for gambling problems prior to current SUD program was noted. None had a history of, nor were currently engaged in counselling for gambling problems. The COVID-19 crisis and associated increase in gambling participation, coupled with a diminutive gambling counselling uptake during the pandemic, present an opportunity to rethink current behavioural addictions service delivery model for those with an increased vulnerability to gambling-related harm. Further investigation of the changes in gambling participation, and a closer look at optimizing GD service delivery among vulnerable population sectors during the COVID-19 crisis is warranted.

Despite the well-documented comorbidity between disordered alcohol use and problem gambling, little is known about the co-occurrence of drinking and gambling in gambling venues. This paper appears to be the first to investigate the association between drinking and gambling behaviour among a large sample of gamblers during a specific, non-laboratory gambling episode. We conducted a mail survey of all available households in the Northern Territory of Australia, including questions on drinking and gambling behaviour on the last visit to a gambling venue. We estimate the effect of moderate (1-4 standard drinks) and risky (>4 standard drinks) alcohol consumption on gambling participation and gambling duration for both problem and non-problem gamblers using regression analysis of 7044 survey responses. The probability of participating in electronic gaming machine (EGM) gambling decreased with alcohol consumption for non-problem gamblers, while the probability of participating in TAB (Totalisator Agency Board, off-course totalisator) gambling increased with risky alcohol consumption for all gamblers. Alcohol consumption was not associated with EGM gambling participation for problem gamblers. Moderate alcohol consumption was negatively associated with EGM gambling duration, with a stronger effect observed for problem gamblers. Moderate alcohol consumption is inversely correlated with both the duration of play and probability of participation for EGM gambling. Current laboratory studies do not predict the drinking-gambling behaviour of the general population in non-laboratory settings. Future research on alcohol and gambling co-occurrence must explicitly consider the drinking and gambling environment in order to produce policy-relevant findings.

In this article, the results of the national survey of adult gambling behavior in North Cyprus (NC) in 2012 are presented. The aim of this study is to investigate the characteristics of adults' participation in gambling, and to determine the prevalence of 'problem and pathological gambling' in NC. The population of this study was formed from all the people living permanently in NC, speaking Turkish, and within the age group 18-65. Household interviews were conducted with 966 people. To obtain data, a 30 item questionnaire prepared by the researchers and a Turkish version of the Revised South Oaks Gambling Screen were used. Prevalence rates are compared with the results of the study conducted in 2007 using the same methodology and survey form. The lifetime prevalence of participating at least once in any of the 17 gambling activities investigated in the survey was 66.4%. 3.5% of the respondents scored as lifetime probable pathological gamblers and 9.2% as probable problem gamblers. Risk factors for becoming probable problem and pathological gamblers include being male, being in the 19-28 age group, having a high education level, having a job and being born in Cyprus. This study shows that the prevalence of problem gambling is high in NC and increasing gradually. NC has socio-cultural features such as a history of colonization, socioeconomic problems and high unemployment, similar to other high prevalence gambling regions, which is suggestive of the importance of socio-cultural factors on gambling behavior.