PREVENTION OF PROBLEM GAMBLING : A COMPREHENSIVE REVIEW OF THE - PowerPoint PPT Presentation

PREVENTION OF PROBLEM GAMBLING : A COMPREHENSIVE REVIEW OF THE EVIDENCE AND IDENTIFIED BEST PRACTICES Dr. Robert Williams Faculty of Health Sciences & Alberta Gambling Research Institute University of Lethbridge Many Ways to Help Conference Victorian Responsible Gambling Foundation Melbourne, Victoria October 22, 2014

Collaborators Ms. Bev West • Former Research Associate, Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta Mr. Rob Simpson • Former CEO, Ontario Problem Gambling Research Centre, Guelph, Ontario

EDUCATIONAL EDUCATIONAL INITIATIVES INITIATIVES

Information/Awareness Campaigns Information/Awareness Campaigns • e.g., ‘know your limits’; ‘gamble responsibly’; true odds; dispelling fallacies; help lines; signs of PG • on gambling product; posters at venue; radio/TV; websites; presentations at schools  Mixed results showing these messages can temporarily improve knowledge and change attitudes  However, a) most people don’t attend to them and b) effect on gambling behaviour fairly minimal (except for helpline calls and presentation to treatment, which reliably increases)  In other prevention fields, behavioural change uncommon, and only occurs if info is personally relevant, behaviour easy to change, and consequences of not changing are significant (e.g., cholesterol, sodium, HIV testing)

On- -Site Information/Counselling Site Information/Counselling On Centres (RGICs) Centres (RGICs) • Info about gambling/PG & referral to, or actual provision of counseling • Since 2002; Australia, Canada, S. Korea, other countries  High patron awareness, but low utilization  61,400 visits in Ontario 2005-2009 vs 200,000,000 customers  8,000 visits for Manitoba 2003-2006 vs 14,600,000 customers  Mostly provide info on PG and make treatment referrals  Information rated as helpful, but very low follow-through on treatment referrals, and no impact on gambling behaviour

School- -Based Statistical Based Statistical School Instruction Instruction • Teaching expected value, odds and mathematical principles underlying gambling (and either directly or indirectly dispelling gambling fallacies)  Several studies, with mixed results  Reliable impacts on knowledge and gambling fallacies, inconsistent impacts on subsequent gambling behaviour

Comprehensive School- - Comprehensive School Based Prevention Programs Based Prevention Programs “ Don’t Bet on It” in Ontario; “Wanna Bet” in Minnesota; “Stacked • Deck” in Alberta, New York, North Carolina • statistical knowledge; gambling fallacies; addictive nature of gambling; building self-esteem, social problem-solving; peer resistance training  Only 4 empirical studies: Reliable impacts on knowledge and gambling fallacies, inconsistent impacts on behaviour (Stacked Deck only program to achieve behavioural change)  School-based prevention programs in other fields (smoking, drug use, etc.) have found similar mixed results

POLICY POLICY INITIATIVES INITIATIVES Restrictions on the General Restrictions on the General Availability of Gambling Availability of Gambling

Restricting # of Gambling Venues Restricting # of Gambling Venues  Good support by virtue of positive correlation between local PG rate and proximity to gambling venues in U.S., N.Z., Australia & Canada  This relationship strongest for casinos: Canadian Provincial PG Prevalence vs. Venues per Capita Casinos r = .75* Bingo Licenses r = .56 Horse Racing Venues r = .40 EGM Locations r = - .01 Lottery Outlets r = - .50  Opening of new venues has also generally been associated with subsequent increases in rates of PG

Restricting More Harmful Types Restricting More Harmful Types of Gambling of Gambling • EGMs, casino table games, Internet gambling  Strong relationship between EGMs per capita and PG rates within countries (r = .66* Canada; r = .60 Australia)  However, no correlation between countries (tau b = - .18)  Modest EGM reductions do not produce much effect on PG rates (e.g., Victoria; S. Australia; Nova Scotia)  However, total EGM elimination in South Dakota (1994) South Carolina (2000), and Norway (2007) did reduce PG.  Prevalence of Internet problem gambling directly related to its legal availability

Restricting the Number of Restricting the Number of Gambling Formats Gambling Formats • One of the strongest associations with PG is number of gambling formats person engages in  Reducing/restricting the number of gambling formats is a theoretically sensible strategy  No empirical evidence

Limiting Gambling to Gambling Limiting Gambling to Gambling Venues Venues  Theoretically sensible, but lacks empirical support  In Canada, no relationship between # EGM locations per capita and provincial PG rates (r = .01).  In U.S. no significant difference in PG prevalence in 5 states with EGM’s outside gambling venues (2.3%) vs states that only have EGM’s within dedicated gambling venues (2.2%)  In Europe, EGMs found outside gambling venues in most countries, yet Europe tends to have lower rates of PG  However, part of the explanation is that jurisdictions with this policy tend to increase number of ‘dedicated gambling venues’ to compensate (e.g., France has 197 ‘casinos’, California has 162 , etc.).

Restricting the Location of Restricting the Location of Gambling Venues Gambling Venues • Individual vulnerability one of the strongest predictors of PG. Historically, casinos were always kept away from major urban centers.  Worldwide, PG and other addictions more often found in poorer neighborhoods  In Canada, provincial PG rates strongly correlated with proportion of the provincial population with Aboriginal ancestry (r = .94*) as well as provincial rates of alcohol dependence (r = .71*).

Limiting Gambling Venue Hours Limiting Gambling Venue Hours • Common policy in some countries  Has good support in the alcohol policy field  Reduction in hours in jurisdictions that have done this (i.e., Nova Scotia, Australia) had modest effects on PG expenditure (probably because the magnitude of the reduction was fairly small)

POLICY POLICY INITIATIVES INITIATIVES Restrictions on Who can Restrictions on Who can Gamble Gamble

Prohibition of Youth Gambling Prohibition of Youth Gambling • Despite almost worldwide underage prohibition: – underage youth may still have significant rates of PG – countries with permissive attitudes toward youth gambling (U.K., Nordic countries), have lower rates of adult PG • Could early exposure have beneficial effects?  Important lessons from the alcohol field (China, southern Europe, Israel vs. France & Aboriginal populations) showing that early exposure counterproductive unless associated with extended modeling of appropriate use

Raising Legal Age for Gambling Raising Legal Age for Gambling • Currently ranges from 16 to 25 depending on the jurisdiction and type of gambling • 18 – 25 year olds have the highest rates of PG  In the alcohol field, it is clear that increasing the legal age significantly decreases use and abuse  Norway found a significant decrease in EGM use when legal age increased from 16 to 18

Restricting Venue Entry to Restricting Venue Entry to Non- -Residents Residents Non • Historically, a common policy • Currently: Bahamas, Malaysia, Vietnam, Nepal, Papua New Guinea, Australia (online casinos), Slovenia (4 times/month), S. Korea (1/16 casinos)  Theoretically sound, but very little evidence  However, casino gambling uncommon in S. Korea (i.e., < 5% of the population), and rates of PG much lower than other Asian jurisdictions (i.e., Singapore, Hong Kong, Macau)

Restricting Venue Entry to Higher Restricting Venue Entry to Higher Socioeconomic Groups Socioeconomic Groups • e.g. dress codes (Europe); income test (Panama, Singapore, Germany); significant entrance fees (Papua New Guinea, Singapore)  Effectiveness unknown, although low income is a good predictor of PG status in western countries

POLICY POLICY INITIATIVES INITIATIVES Restrictions on How Restrictions on How Gambling is Provided Gambling is Provided

Modifying EGM Parameters Modifying EGM Parameters • Speed; Near misses; # play lines; Bill acceptors; Bet size; Maximum win; Interactive features; Pop-up messages; Clock; Mandatory cash out; Payback %; Privacy; $ versus credits; Lights & Sounds; Seating  Research shows some utility for: eliminating early big win, reducing near misses, slower speed, dynamic pop-up messages, lower max bet size, fewer betting lines, eliminating bill acceptors  However, magnitude of effect is small, especially for PGs  Reminiscent of attempts to minimize tobacco harm by adding filters and use of ‘low tar’ cigarettes (i.e., these will always be high risk devices)

Player Pre- -Commitment Commitment Player Pre • Some EGMs and Internet gambling sites allow gamblers to establish time and/or spending limits.  Low utilization when pre-commitment not mandatory  Even when mandatory  Limited effectiveness when limits easily revocable  Limited effectiveness if other opportunities available (i.e., ability to use other EGMs or other Internet sites that do not require pre- commitment)  Limited effectiveness if you can use other people’s ID