Impact of casinos on key dimensions of health and nutrition: qualitative findings from American Indian gaming communities in California

Abstract

ObjectiveThree decades ago, casino gaming on sovereign American Indian lands was legalized with differential economic and social implications. While casinos have indeed improved the incomes of tribal communities, there have been both positive and negative findings in relation to impacts on health. We sought to understand the perceived mechanisms and pathways by which casinos might impact individual and community health through the voices of the tribal community.MethodsWe conducted semi‐structured, in‐depth interviews with tribal leaders (n =12) and trial members (n =24) from gaming and non‐gaming tribal communities of California. We inductively analyzed textual data drawing from Grounded Theory, first using line‐by‐line coding to identify analytic categories from emergent themes in consideration of the study objective and research questions. Then, focused codes were applied to identify salient themes, which we represented through exemplar quotes and an overall figure illustrating pathways of casino impacts on health. Data were managed and coded with Dedoose software.ResultsAmerican Indian‐owned casinos are perceived to influence several dimensions of health through a variety of factors that can be organized into economic, social, and environmental pathways. Economic stimulation, including casino revenue generation and job creation, is perceived by tribal members with ambivalence due to its positive impacts on financial stability, but its many associated social problems that stem from consequences of per capita payouts and unhealthy casino environments. Tribal members described positive changes to the build environment resulting from casinos, indicating more and better physical activity opportunities, especially for children. Perceptions of casino impact on the food environment varied, as tribal members reported increased healthy food access thanks to additional income, but also noted the availability of more unhealthy foods and eating out establishments at casinos.ConclusionsThrough these three primary pathways, casinos are perceived to impact physical, emotional, and social dimensions of tribal health. Casino environments are perceived to improve the economic conditions of tribal communities, but present important social and public health challenges. Public policy makers at federal, state, and tribal levels should consider the local perceptions of tribal members and leaders when designing social and public health policies in light of casino development. Findings can be used for addressing salient community health concerns and developing culturally‐appropriate intervention strategies as a result.Support or Funding InformationSupported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (4R00HD073327).