Gambling Harm Research Articles

Discourses of responsible gambling and gambling harm: observations from Victoria, Australia

Within a neo-liberal economic orthodoxy, the gambling industry has succeeded in the discursive feat of transforming gambling from its previous pariah pastime status to normalized entertainment. This contemporary discourse of gambling as entertainment has repositioned gambling as harmless fun. The comfortable orthodoxy of ‘responsible gambling’ adopts language emphasizing concepts such as ‘personal responsibility’. A focus on the lack of self-control of delinquent users deflects attention away from harmful products, diminishing scrutiny of industry failure to appropriately address gambling harms. We analyzed data derived from interviews with stakeholders familiar with the gambling licensing process in Victoria, Australia, in order to identify if and how the discursive structures of this comfortable orthodoxy manifest in discussions on gambling. Data were derived from thematic analysis of 21 interviews with decision makers, industry advocates, and other stakeholders. Evidence highlights multiple recurring discursive structures of the ‘comfortable orthodoxy’, including the narrative of gambling as legalized recreation, personal choice and self-responsibility. Highlighting the pervasiveness of this discourse, these narratives were evident across the spectrum of informants. This research illustrates the way in which multiple gambling stakeholders deploy the discursive structures underpinning gambling regulation and operations. Discourses establish understanding of the nature of specific issues, and can influence responses to public health or other policy problems. In this instance, a discourse overwhelmingly favoring industry interests, has the potential to entrench and support harmful systems of exploitation and harm creation. Transforming the responsible gambling discourse is an important focus for public health activity concerned with reducing gambling related harm.

Is there a health inequality in gambling related harms? A systematic review

BackgroundHere we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency.Primary and secondary outcome measuresInclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article.MethodsWe conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria.ResultsA total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours.ConclusionHarms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.

Financially Focused Self-concept in Disordered Gambling

People can place preponderant importance on a single life domain (e.g., relationships, appearance, financial success). The result is that success (or failure) in that domain has significant influence on the self-concept and thus judgments of self-worth. A focused self-concept has also been shown to be a core feature of various psychiatric disorders, including depression, body image disorders, and obsessive-compulsive and related disorders. Herein, we summarize mounting evidence indicating that a self-concept focused on financial success is important for understanding the etiology and maintenance of disordered gambling. The review indicates that a financially focused self-concept is moderately and positively associated with disordered gambling severity. Specifically, we outline research that has examined how and why financially focused self-concept proliferates and maintains disordered gambling. Based on this research, we put forth the idea that having a financially focused self-concept is an etiological factor that is common to the different gambling disorder subtypes outlined in the Pathways Model—arguably the leading biopsychosocial model of gambling addiction and gambling harm. More research is needed that assesses the antecedents and consequences of possessing a financially focused self-concept. We call on researchers to assess sociocultural, psychological, and environmental factors that may cultivate a financially focused self-concept as well as factors that may help people expand their domains of self-worth. The recovery process from any psychiatric disorder that includes a financial focus as an etiological factor should be aided by an expansion of the life domains from which self-worth is garnered.

Banking transactions and gambling harms.

To date, studies of gambling harms have been limited by reliance on small samples and self-reports of behaviour. Analysis of banking transactions provides unique insights into the scope and sequencing of gambling harms at the individual and population levels, with implications for gambling policy, regulation, and harm minimization.

Affected Others Responsivity to Gambling Harm: An International Taxonomy of Consumer-Derived Behaviour Change Techniques.

Affected others impacted by someone else’s gambling utilise numerous behaviour change strategies to minimise gambling-related harm but knowledge on what these strategies are and how they are implemented is limited. This study aimed to develop a comprehensive data-driven taxonomy of the types of self-help strategies used by affected others, and to categorize these into high-level behaviour change techniques (BCTs). Two taxonomies were developed using an inductive and deductive approach which was applied to a dataset of online sources and organised into the Rubicon model of action phases. These taxonomies were family-focused (how to reduce the impact of gambling harm on families) and gambler-focused (how to support the gambler in behaviour change). In total, 329 online sources containing 3536 different strategies were identified. The family-focused classification contained 16 BCTs, and the most frequent were professional support, financial management and planned consequences. The gambler-focused classification contained 11 BCTs, and the most frequent were feedback on behaviours, professional support and financial management. The majority of family- and gambler-focused BCTs fell under the actional phase of the Rubicon model. Grounded in lived experience, the findings highlight the need for intervention and resource development that includes a wide range of specific techniques that affected others can utilise.

Opportunity Costs or Not? Validating the Short Gambling Harm Screen against a Set of "Unimpeachable" Negative Impacts.

Assessing the harmful consequences of gambling is an area of active investigation. One measure intended to capture gambling-related harm is the 10-item short gambling harm screen (SGHS). Although good psychometric properties have been reported, it has been suggested that the screen’s less severe probes may not represent genuinely harmful consequences, but rather may reflect rational opportunity costs. Consequently, it has been argued that the screen may lead to overestimation of the extent of gambling-related harm in the population. The current study sought to examine the psychometric performance of three less severe suspect items in the SGHS. Associations between each of these items and a specially constructed scale of relatively severe “unimpeachable” gambling harms were calculated from archival data from 5551 Australian and New Zealand gamblers. All three suspect items, both individually and upon aggregation, predicted greater endorsement of “unimpeachable” harms, and indicated the presence of gambling problems. Moreover, the SGHS as a whole is highly correlated with “unimpeachable” gambling harms. Including suspect items in the SGHS was found to improve predictions of low- and moderate-risk gambling status, but slightly decreased predictions of severe gambling problems. The results are inconsistent with the notion that SGHS harm probes capture either inconsequential consequences or opportunity costs. They confirm prior findings that harm symptomatology is unidimensional, and that the report of multiple more prevalent, but less severe, harms serves as an effective indicator of the spectrum of experienced harm.

A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming.

Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as “age-restricted” may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.

How Do People With Intellectual Disability Engage With and Understand Gambling? A Qualitative Study of Adults in Victoria, Australia.

Objective: This study aimed to understand the factors that may influence how and why people with intellectual disability may engage in gambling.Method: Nineteen people with intellectual disability were recruited from a disability advocacy organization and participated in face to face, semi-structured qualitative interviews. Open ended questions were used to explore participants' gambling participation, recall of, and attitudes toward, different gambling products, understanding of gambling harm, and awareness of responsible gambling messages.Results: All participants could remember gambling in their lifetime and some participants had recently engaged in gambling. Many participants were aware of different gambling products, and a few participants could describe in detail the technical aspects of electronic gambling machines. Most participants did not specifically recall seeing gambling harm minimization messages, however some described engaging in individual responsibility measures, such as limits and control, as they perceived this reduced the risks of experiencing harm.Conclusions: People with intellectual disability are engaging with gambling products in a similar way to the general community. Therefore, it is important to understand the different pathways that may lead people with intellectual disability to initiate and continue gambling and to ensure that they are aware of and protected from the potential risk.Implications for Public Health: Policy makers and practitioners should seek to understand and implement a range of strategies to reduce and prevent the harms associated with particular gambling products and environments for this population sub-group.

\u201cIt started 30\u2009years ago, and it still haunts me\u201d: an exploratory investigation of Territorians\u2019 gambling behaviours, harm, and help-seeking for gambling issues in an Australian jurisdiction

BackgroundThere is a lack of qualitative gambling research on lived experience, help-seeking, and gamblers and affected others’ views on the regulatory environment in the Northern Territory (NT), Australia. This study provides 1) lived experience of individuals who reported experiencing harms from gambling, 2) insights into help-seeking for gambling issues, 3) and people’s views on current legislation on gambling in the NT. The results of this study begin to establish an evidence base that could be used to inform targeted interventions for people experiencing harms from gambling in the NT.MethodsSemi-structured interviews were conducted with a targeted selection of respondents from the 2015 and 2018 NT Gambling Prevalence and Wellbeing Surveys. The sample (n = 27; age 18+ years; Aboriginal (The term of ‘Aboriginal’ has used been used throughout the manuscript to reflect Aboriginal and Torres Strait Islander, Indigenous, or First Nations people for purposes of brevity. We respect the diversity among these populations.) and Non-Aboriginal) included weekly (online and venue-based electronic gambling machine (EGM)) gamblers, non-regular gamblers, and those negatively affected by others’ gambling. A Framework Analysis approach was used for data analysis. Appropriate ethics approval was obtained.ResultsNegative impacts and harms from gambling were experienced by both gamblers and non-gamblers. These included monetary losses, relationship conflicts, emotional distress, and decrements to health. A lack of self-realisation of gambling issues and awareness of the available services, shame, and embarrassment, were reported as the main barriers to help-seeking. Where help was sought, it was primarily informal (e.g., family) and was rarely preventive. In many instances, self-help strategies were successful in controlling one’s own gambling. Gamblers suggested regulations should set limits on the daily number of hours of playing, the bet size, and reduced access to EGM. The need for strengthening the existing awareness and education interventions was emphasised.ConclusionsViewing the findings from a public health lens, targeted approaches based on specific circumstances may have the potential to minimise harms from gambling, but only for those already experiencing harms. The treatment, policy, and regulatory approaches need to be tailored to address the causes and impacts of harms experienced by people.

Whose Responsibility Is It to Prevent or Reduce Gambling Harm? A Mapping Review of Current Empirical Research

This study presents a large-scale mapping review of how the literature on gambling identifies suggested solutions to prevent or reduce gambling harm and whose responsibility it is to implement them. The purpose of this is to provide a concise reference for stakeholders who must make critical decisions regarding the enhancement of consumer protection and harm minimization measures. Two databases, Scopus and Web of Science, were searched to identify relevant studies. The initial search yielded 5135 results, from which a total of 1292 empirical studies published between 2014 and 2018 were selected for analysis. Inductive content analysis was performed to identify suggested solutions reported in each study. The results indicate that commonly suggested solutions are the creation of educational and awareness programs (e.g., information on the risks of gambling, resources for help seekers, how games really work) and further restrictions on gambling advertising. We found that health service providers are mostly given the responsibility to implement various strategies, followed by policy makers. Numerous empirically proven suggestions for health service providers, policy makers, gambling industry operators, educational institutions, consumers, and families are discussed in detail.

"You don't really see the dangers of it at the time." Risk perceptions and behaviours of older female gamblers.

Older women are vulnerable to the risks associated with some forms of gambling. While research has examined how individuals functionally interact with gambling products, very limited research has investigated how individuals conceptualise and interpret the risks associated with these products. Theorists suggest that risk-taking is not based on a lack of knowledge but on the different ways people make sense of their lives. As such, this study aimed to understand the factors that may influence how older women who gamble on electronic gambling machines (EGMs) perceive the risks associated with gambling on these products. It examined how risk perceptions interacted with a range of complex social factors in women's everyday lives to influence their risk behaviours. Semi-structured interviews were conducted with 20 Australian women aged 55 and over who had been negatively impacted by EGM gambling. This study found that older women's risk perceptions of gambling were shaped by their early recreational experiences with gambling, rather than their current regular and harmful gambling behaviours. Risk perceptions of EGMs were often downplayed or ignored as women sought to maintain valued social identities within the venues. Women went through a process of risk negotiation whereby the benefits of this social interaction outweighed the potential harms associated with the machines. This also led them to deflect or ignore risk minimisation messaging which was completely focused on individual behaviours. This study signals the importance of moving away from individualised responsible gambling messages towards risk information about gambling products. This research also provides evidence of the need for regulation addressing the design features of EGMs that ultimately may make products safer and protect the most vulnerable from gambling harm.

The Lancet Public Health Commission on gambling

The Lancet Public Health Commission on gambling

Reducing Internet Gambling Harms Using Behavioral Science: A Stakeholder Framework.

Internet gambling provides a unique environment with design mechanics and data-driven opportunities that can impact gambling-related harms. Some elements of Internet gambling including isolation, lack of interruption, and constant, easy access have been argued to pose specific risks. However, identifiable player accounts enable identification of behavioral risk markers and personalized private interfaces to push customized messages and interventions. The structural design of the Internet gambling environment (website or app) can have a strong influence on individual behavior. However, unlike land-based venues, Internet gambling has few specific policies outlining acceptable and unacceptable design practices. Harm minimization including responsible gambling frameworks typically include roles and responsibilities for multiple stakeholders including individual users, industry operators, government regulators, and community organizations. This paper presents a framework for how behavioral science principles can inform appropriate stakeholder actions to minimize Internet gambling-related harms. A customer journey through internet gambling demonstrates how a multidisciplinary nexus of collaborative effort may facilitate a reduction in harms associated with Internet gambling for consumers at all stages of risk. Collaborative efforts between stakeholders could result in the implementation of appropriate design strategies to assist individuals to make decisions and engage in healthy, sustainable behaviors.

Perspective of Internet Poker Players on Harm-Reduction Strategies: A Cross-Sectional Study.

Background: Internet gambling may increase rates of gambling harm. This current study aimed to assess Internet poker players’ views on various harm-reduction (HR) strategies. It also examined differences in these views according to the games played (poker only vs. poker plus other gambling activities), indebtedness, and problem gambling severity. Methods: Internet poker players (n = 311; 94.2% Male) recruited online between 2012 and 2014 were included in the analyses and completed a survey on indebtedness, problem gambling severity index, and ten statements regarding HR features. Results: Among the whole sample, the most frequently endorsed HR strategy was setting money limits, specialized online help, and peer support forums. People who play poker only (70%) are less prone to endorse the utility of information on excessive gambling and specialized healthcare centers. No differences were found between those people with debt versus those without regarding HR assessment. Participants with severe problem gambling were more skeptical about HR strategies based on information on specialized healthcare centers. Conclusion: Setting money limits, online help, and peer support forums are the most commonly endorsed strategies. Future research is needed to evaluate the effectiveness of online harm reduction strategies.

Statistical risk warnings in gambling

AbstractGambling is considered a public health issue by many researchers, similarly to alcohol or obesity. Statistical risk warnings on gambling products can be considered a public health intervention that encourages safer gambling while preserving freedom of consumer choice. Statistical risk warnings may be useful to gamblers, given that net gambling losses are the primary driver of harm and that gambling products vary greatly in the degree to which they facilitate losses. However, there is some doubt as to whether statistical risk warnings are, in their current form, effective at reducing gambling harm. Here, we consider current applications and evidence, discuss product-specific issues around a range of gambling products and suggest future directions. Our primary recommendation is that current statistical risk warnings can be improved and also applied to a wider range of gambling products. Such an approach should help consumers to make more informed judgements and potentially encourage gambling operators to compete more directly on the relative ‘price’ of gambling products.

Women in gambling studies: a poststructural analysis

Background Gambling studies literature is a space where discourses call objects such as ‘gambling harm reduction’ and ‘women harmed by gambling’ into being and give them status as namable and describable. Methodology and methods A poststructural feminist analysis of the positioning of women who gamble in gambling studies literature was carried out to explore possibilities and constraints for gambling harm reduction practices. Gambling studies literature was accessed to enable a range of historically emerging framings of women’s gambling practices and harm to be brought to light. Discourse analysis drew on key concepts (discourse, subjectivity, power/knowledge) and principles (reversal, discontinuity, specificity and exteriority) developed by Michel Foucault. Findings Gambling studies have constructed women as: ‘risky gamblers’, ‘vulnerable women’, and as subject to gendered socio-cultural determinants of gambling and harm. Dominant conceptualisations of women in gambling studies tend to bring individual women who gamble into focus, obscuring the social, governmental and commercial determinants of gambling and harm, and often reproducing some unhelpful gender stereotypes in the process. Conclusions Holistic, environmental and Indigenous women’s health discourses have the potential to shift gambling harm reduction from a health services approach to one that is focused on supporting community wellbeing. This includes women’s co-production and ownership of harm reduction strategies. It is concluded that opportunities women’s gambling harm reduction may be found in critical psychology, and/or approaches which emphasize coherent and critical gender analysis, collaborative action, community development and client-led practice.

The Relationship Between In-Play Betting and Gambling Problems in an Australian Context of Prohibited Online In-Play Betting.

Internationally, Internet gambling is increasingly permitted under regulated licensing conditions; however, the specific products that are legal varies between jurisdictions. Online sports and race wagering are now legal in many jurisdictions, but in-play betting (also referred to as “live action” or “in-the-run” betting) is often restricted. In-play betting enables bets to be placed on an event after it has commenced. Prohibitionist policies often cite the potential for this type of betting to increase risk of gambling problems. This study aimed to identify which online bettors are most likely to engage in in-play betting, and to investigate the relationship between in-play betting and gambling problems. Online survey responses were collected from 501 Australian past-month online sports bettors in the context of in-play betting only being available on offshore gambling sites or via telephone betting. Thirty-four percent of participants had placed a bet in-play in the past month. Participants placing in-play bets differed from those who had not in terms of education, employment status, ethnicity, age, and gambling involvement. Those who bet in-play had higher problem gambling severity scores than those who did not bet in-play. Problem gambling severity significantly predicting in-play betting, holding other variables constant. Findings are consistent with previous research indicating that the relationship between in-play gambling and problems holds across jurisdictions which have prohibited and legalized in-play betting. The findings suggest that in-play betting should warrant specific regulatory attention and interventions to minimize gambling harms among individuals that engage with this activity.

Who chooses to enroll in a new national gambling self-exclusion system? A general population survey in Sweden

BackgroundSelf-exclusion from gambling is a common method for prevention and harm reduction in hazardous gambling. However, few national self-exclusion programs, involving a large number of gambling operators and activities in a country, have been assessed scientifically. This study aimed to examine characteristics of individuals who chose to enroll in a recently introduced (January, 2019) national self-exclusion system in Sweden.MethodsAdults and adolescents (from age 16 and above) were addressed with an online survey sent to members of the web panel of a market survey company (1940 respondents). Psychological distress, previous history of addictive disorders, sociodemographic data, and recent history of gambling patterns and over-indebtedness were recorded. Logistic regression tested associations with self-exclusion, with unadjusted analyses conducted for the sub-group of moderate-risk or problem gamblers.ResultsFour percent reported having self-excluded using the new national self-exclusion system. In logistic regression, self-exclusion was significantly associated with younger age (OR 0.65 [0.54–0.79] for increasing age groups) and with the highest level of problem gambling (OR 2.84 [1.10–7.37]). In moderate-risk or problem gamblers, in unadjusted analyses, younger age (p < 0.05) and psychological distress (p = 0.02) were associated with self-exclusion. In none- or low-risk gamblers, 3% had self-excluded, which was significantly associated with younger age (p < 0.001) and self-reported over-indebtedness (p < 0.001).ConclusionsIn a national, multi-venue online and land-based self-exclusion system, aiming to reduce the harm of problem gambling, self-exclusion is expectedly more common in problem gamblers, but also occurs among people without recent gambling problems. Further efforts may be needed in order to increase gambling self-exclusion in problem gamblers, and research in reasons for self-excluding, even in non-problem gamblers, is needed.

Setting Limits: Gambling, Science and Public Policy-summary of results.

The gambling industry has grown into a global business in the 21st century. This has created the need for a new emphasis on problem prevention. This article highlights the core themes of the book Setting Limits: Gambling, Science and Public Policy, taking a broad view of the consequences of gambling for society as a burden on health, well-being and equality. The book covers the extent of gambling and gambling-related problems in different societies and presents a critical review of research on industry practices, policy objectives and preventive approaches, including services to people suffering from gambling and its consequences. It discusses the developments in game characteristics and gambling environments and provides evidence on how regulation can affect those. Effective measures to minimize gambling harm exist and many are well supported by scientific evidence. They include restrictions on general availability as well as selective measures to prevent gamblers from overspending. The revenue generated from gambling for the industry, governments, and providers of public services funded from gambling returns presents an obstacle to developing policies to implement harm-reduction measures. A public interest approach must weigh these interests against the suffering and losses of the victims of gambling.

Gamblers’ beliefs about responsibility for minimizing gambling harm: Associations with problem gambling screening and gambling involvement

Increasingly, gambling stakeholders communicate that minimizing gambling harm is a shared societal responsibility. Individual gamblers’ beliefs about responsibility for minimizing gambling harm are worthy of study because these beliefs might influence gambling behavior. In this study, using a sample of casino loyalty program subscribers (N = 4,795), we observed that respondents who had a positive result on a brief gambling disorder screen were more likely than those who screened negative to hold seven stakeholder groups (i.e., scientists, clinicians, casino employees, government regulators, public health officials, casino industry lobbyists, public safety officials) responsible for helping to minimize gambling harm. The sum of stakeholder groups held responsible for minimizing gambling harm, along with beliefs that casinos share responsibility for encouraging responsible gambling behavior, predicted gambling disorder screening status after controlling for established problem gambling risk factors. These results replicated our previous study using a mostly independent sample. Contrary to our expectations, beliefs about responsibility for mitigating gambling harm were mostly unrelated to measures of gambling involvement. These results provided additional support for the notion that those who are at risk for gambling harm are especially likely to hold others responsible for minimizing such harm. However, they call into question the role of gambling involvement in this relationship.