Hispanic Gamblers and the CPGTSP Outpatient Program

Michael Campos, Ph.D.UCLA Gambling Studies ProgramPhone: 310.825.6427E-mail: mdcampos@mednet.ucla.edu

2010 Census Data (Ennis et al., 2011)

2006 California Problem Gambling Prevalence Survey Data (Volberg et al., 2006)

2012 Outpatient CPGTSP Program Demographic and Utilization Data (UGSP 2013)

Definition of Hispanic

2010 Census: “Hispanic or Latino” refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Diversity of the Hispanic PopulationCountry of originRacial backgroundReasons for immigrationLength of time in U.S.Generational StatusLanguage PreferenceAcculturation

U.S. Demographic Trends 308.7 million people resided in the U.S. in 2010. 50.5 million (16%) were of Hispanic origin. Increase from 35.3 million (13%) in 2000 Represents the majority of growth in the total

population. Between 2000 and 2010 the Hispanic

population grew by 43% which was 4 times the national growth rate.

U.S. Demographic TrendsThree quarters of Hispanics reported being

of Mexican, Puerto Rican, or Cuban origin.

Mexican origin = 63%Puerto Rican = 9%Cuban = 4%

U.S. Demographic TrendsPopulation Increases among other Hispanic

groups:

Salvadoran = 152%Guatemalan = 180%South Americans = 105%Dominicans = 85%

California DemographicsCA population = 37,253,956CA Hispanic population = 14,013,71937.6% of CA residents were HispanicMajority (81%) were Mexican origin or heritageCA ranks first in population for 4 of 7 Hispanic

groups

Hispanic Population by County

Key PointsHispanics are a large and growing segment of

the population.

The majority of Hispanics in the US are of Mexican origin or heritage, but trends show increasing diversity within the Hispanic population.

In California, Hispanics comprise over 1/3 of the total population, with the large majority being of Mexican origin or heritage.

Culture and Mental HealthA patient’s cultural background may influence

Description of symptoms Meaning imparted to illness Causation and prevalence for some disorders, but not others Coping styles Treatment seeking Stigma

A clinician’s cultural background may influence Communication Diagnosis Conceptions of Mental Illness Assumptions about what a clinician is (and is not) supposed to do

Source: Mental Health: Culture, Race, and Ethnicity, SAMHSA, 2001

Gambling Among U.S. Hispanics

Few nationally representative samplesOthers sampled from Texas, New Mexico, Florida,

MinnesotaAll cross-sectional surveys or interviewsGeneral areas of studies:

EpidemiologyHelp Line UsageCo-morbidities

Prevalence of Gambling Problems

Studies show elevated prevalence rates for problem or pathological gambling among Hispanics relative to Non-Hispanic Caucasians (Stinchfield, 1997; Welte et al., 2001; Westermeyer et al., 2005)

Help Seeking for Gambling Problems

Source: Caudrado, 1999

Key PointsFew studies have examined gambling among

Hispanics and for the most part they have focused on epidemiology.

Most studies show increased prevalence of gambling problems among Hispanics relative to Non-Hispanic Caucasians.

Help seeking for gambling problems among Hispanics is lower than that of Non-Hispanic Caucasians.

CA Prevalence Survey Data

Gambling Problem GroupingAssessed using the NODS (Gerstein et al., 1999).

Used the same four groups as in the CA Problem Gambling Prevalence Survey Final Report:Non-Gambler/Non-Problem GamblerAt-Risk (1 to 2 NODS items endorsed)Problem (3 to 4 NODS items endorsed)Pathological Gambler (5 or more NODS items

endorsed)

Prevalence of Gambling Problems

** p < 0.01

Preferred Games for Past Year Gamblers

* p < 0.05; ** p < 0.01

**

** ***

Key PointsProblem, but not pathological gambling, is higher among

Hispanics relative to Non-Hispanics, particularly among males.

Past year gambling is lower among Hispanic females relative to Non-Hispanic females.

Counter to expectations, we did not see a preference for action oriented games among Hispanic males.

Spanish Speaking Gambling Treatment Providers

Gambling Problem Prevalence by CA Region

Red = 4.5%Yellow = 4.3% to 4.5%Green = 3.7% to 4.3%Blue = 2.0% to 3.7%

Spanish Speaking CPGTSP Providers

CPGTSP Outpatient Data

Sample Used The sample was limited to

English Speaking, US Born, Non-Hispanic Caucasians and Hispanics

62.1% of Hispanics spoke a language other than English at home and 39.8% of Hispanics were born outside the US

All data comes from Intake and In Treatment Forms

53.5%

15.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Ethnicity

Non-Hispanic Caucasian Hispanic

Top Referral SourcesNon-Hispanic

CaucasianHispanic

Helpline (1-800-GAMBLER)

220 (39.1) 102 (63.4)

GA or Gam-Anon 69 (12.3) 8 (5.0)

California Council on Problem Gambling

40 (7.1) 14 (8.7)

Family/Friend 48 (8.5) 7 (4.3)

Healthcare Professional

49 (8.7) 5 (3.1)

Former Client 39 (6.9) 6 (3.7)

Demographics

Key Points

Relative to Non-Hispanic Caucasians, Hispanics wereYoungerMore likely to be maleLess educatedTrended towards being more likely to be married

No statistical differences for income or employment.

Age, Gender, Marital StatusNon-Hispanic

CaucasianHispanic t-value or X2 p-value

Mean (SD) Age 49.5 (13.3) 44.5 (13.4) 4.17 0.000

N (%) Male 341 (56.6) 105 (65.2) 3.84 0.050

N (%) Marital Status

Divorced 150 (24.9) 23 (14.3) 9.79 0.081

Separated 38 (6.3) 15 (9.3)

Widowed 28 (4.7) 7 (4.3)

Cohabitation 33 (5.5) 8 (5.0)

Now Married 207 (34.4) 66 (41.0)

Single/Never Married

146 (24.3) 42 (26.1)

EducationNon-

Hispanic Caucasian

Hispanic X2 p-value

< High School

48 (8.0) 36 (22.4) 44.60 0.000

High School 77 (12.8) 39 (24.2)

Some College

288 (47.8) 63 (39.1)

Bachelor’s Degree

127 (21.1) 16 (9.9)

Grad/Prof Degree

62 (10.3) 7 (4.3)

EmploymentNon-

Hispanic Caucasian

Hispanic X2 p-value

Full Time 295 (49.0) 96 (59.6) 6.08 0.108

Part Time 87 (14.5) 18 (11.2)

Unemployed (SW)

83 (13.8) 20 (12.4)

Unemployed (NSW)

137 (22.8) 27 (16.8)

IncomeNon-Hispanic

CaucasianHispanic X2 p-value

< $9,999 50 (8.3) 13 (8.1) 2.41 0.121

$10,000 to $14,999 37 (6.2) 14 (8.7)

$15,000 to $24,999 75 (12.5) 15 (9.3)

$25,000 to $34,999 74 (12.4) 24 (14.9)

$35,000 to $49,999 74 (12.4) 29 (18.0)

$50,000 to $74,999 132 (22.0) 36 (22.4)

$75,000 to $99,999 56 (9.3) 17 (10.6)

$100,000 to $149,999

64 (10.7) 10 (6.2)

$150,000 to $199,999

17 (2.8) 1 (0.6)

$200,000 and Above

20 (3.3) 2 (1.2)

Gambling Behavior

Gambling Activities

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Poker BlackJack*

VideoPoker**

Craps Slots Roulette Other

Non-Hispanic White Hispanic

Gambling Locations

Most frequently cited location for gambling was at a casino.

Relative to Non-Hispanic Caucasians, HispanicsWere more likely to gamble at a casinoEqually likely to report gambling at other

locations (e.g., track, OTB, Friend’s/Family Home, Internet, etc.)

Gambling Problem Severity

Key PointsRelative to Non-Hispanic Caucasians, Hispanics

Trended towards slightly higher NODS scoresExperienced problems sooner after starting to gambleEntered treatment sooner after experiencing a problemTrended towards being more likely to owe money to family

or friends

Multivariate analysis indicated that ethnicity was not associated with problem severity, rather, current age, age of first gambling experience, time to first problem after initiating gambling, and having an Axis I disorder were.

Duration and NODS scores

Mean (SD) Non-Hispanic

Caucasian

Hispanic t-value p-value

Age First Gambled

25.8 (12.3) 27.1 (12.2) -1.13 0.257

Years to First Problems

17.3 (13.8) 13.6 (12.2) 3.01 0.003

Years to Treatment

12.9 (13.5) 9.5 (11.6) 3.11 0.002

Mean NODS score

8.08 (1.8) 8.38 (1.7) -1.87 0.062

Legal Problems Due to Gambling

7.3

11.8

0

2

4

6

8

10

12

% with Legal Problems

Non-Hispanic Caucasian Hispanic

Gambling DebtNon-

Hispanic Caucasian

Hispanic t-value or X2 p-value

Mean (SD) Log of Total Debt

9.29 (1.9) 9.02 (1.5) 1.46 0.104

Any Casino Debt

62 (10.3) 15 (9.3) 0.13 0.713

Any Credit Card Debt

186 (30.9) 56 (34.8) 0.89 0.347

Any Family/Friend Debt

156 (25.9) 54 (33.5) 3.70 0.054

Any Other Debt

112 (18.6) 39 (24.2) 2.53 0.112

Substance Use

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

Smoking* Alcohol*

Non-Hispanic Caucasian Hispanic

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Mar

ijuan

a*

Coca

ine

Met

h

Stim

ulan

ts

Nar

coti

cs*

Tran

quili

zers

Non-Hispanic Caucasian Hispanic

Psychiatric ComorbidityNon-

Hispanic Caucasian

Hispanic X2 p-value

Mood 181 (33.5) 30 (18.6) 12.97 0.000

Anxiety 105 (19.4) 19 (11.8) 4.94 0.026

ADHD 20 (3.7) 1 (0.6) 4.05 0.044

Psychotic 18 (3.3) 1 (0.6) 3.45 0.063

Personality 6 (1.1) 2 (1.2) 0.02 0.889

Any Axis I Disorder

233 (43.0) 41 (25.5) 16.03 0.000

Significant Predictors of Problem Severity

Variable Beta t-value p-value

Age 0.21 3.10 0.000

Age First Gambled

-0.36 -4.79 0.000

Time to First Problem

-0.12 -2.11 0.036

Any Axis I Disorder

0.131 3.08 0.002

F [16, 540] = 16.75, p < 0.000; R2 = 0.16

Treatment

Key PointsRelative to Non-Hispanic Caucasians,

HispanicsAre more often entering treatment for the first

timeWaited about the same time to enter treatmentSpent a bit more time in treatment, but had

slightly fewer sessions

Multivariate analysis suggested that ethnicity was not related to number of visits, rather, age and intake NODS scores were.

Prior Treatment Experience

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

None One Prior Therapist 2 or More PriorTherapists

Non-Hispanic Caucasian Hispanic

Chi-Square = 12.21, p < 0.01

Wait for Treatment

11.1

8.7

0

2

4

6

8

10

12

Days from First Contact to Intake

Non-Hispanic Caucasian Hispanic

Time in Treatment and Number of Sessions

72.9

84.2*

0102030405060708090

Days from Intake to Discharge

Non-Hispanic Caucasian Hispanic

5.5*5.1

0

1

2

3

4

5

6

Total Number of Visits

Non-Hispanic Caucasian Hispanic

Predictors of Number of Visits

Variable Beta t-value p-value

Age 0.14 2.54 0.011

Intake NODS Score

0.11 2.60 0.010

F [16, 668] = 9.12, p < 0.013; R2 = 0.045