Factors Influencing the Development of Responsible Gambling:

A prospective study

N. el-Guebaly, D. Hodgins, G. Smith, R. Williams, V. Williams

*RA: Ronaye Coulson

PREVENTION: Does it Work?

REALISTIC EXPECTATIONS? From Abolition to Harm Reduction

Experimentation recreation habituation addiction Social problem pathological gambling

Social acceptability: alcohol - targets: driving, FAS … tobacco - overall reduction (young F) gambling ?

Culture of moderation vs impairment (Quebec) Other determinants: poverty, violence …

FINE TUNE! Universal / selective targets - Indicated (2ary) 20-30% or 40-60% reduction

A. Literature Review of Prospective Studies

The domain literature reviews 1999-2000 questioned the relevance & significance of domain variables

Addiction - Mental Health - Sociology Prospective Studies: since 1985 multidisciplinary focus

5 years + sample size 200+ Gambling Studies - K. Winters et al

- G. Barnes et al Youth

- F. Vitaro et al

Unpublished - Abbot et al: 7y adult gamblers

- Cottler & C-Williams: 11y drug users (ECA) Longitudinal Studies are the way to go!

TABLE 1: LONGITUDINAL STUDIES OF GAMBLING BEHAVIORS & PROBLEMS

PROSPECTIVESTUDY/METHOD

Vitaro et al ‘96 Barnes et al ‘99 Winters et al ’93 & ‘02

SAMPLE -631 boys, 1-10 boys/school,throughout QuebecSelf-report: gambling, substanceuse & delinquency imbedded in“adolescent life” questionnaire i.e.,school, dating, healthW 1 at 10-11y: teacher & motherratings of behaviorW 2 at 13 y: boys’ gambling (8items: frequency & amount);delinquency (27 items); substanceuse (38 items)

Study I: adolescent & family6 waves 1989-96; 699 adolescents from13-16 until 18-22 recruited throughrandom-digit-dial sampling. Familiespaid US$50 at W 1 & $75 at W 2-3.Then individuals paid US$25 at W 4-6W 1 completion 71% of all families; 77%among blacksStudy II: delinquency in young men3 waves; 625 males ages 16-19 initially.Retention rates 97% whites & 94%blacks.W 5-6 of study I and Study II, questionabout gambling frequency.

Cohort of 305 young adults, assessedat:T1 – 1990T2 – 1992T3 – 1997-98Mean ages: 16.0, 17.6 & 23.8respectively.49% F, 96% WhiteAt T3: 95% high school degree & 86%in MinnesotaAt T1: telephone list of householdslikely to have adolescent, randomsample, 23% refusal but T1 similar toMinnesota youths.Attrition at T2: 24%At T3: sample of low and high riskgroup; high risk = prior year gambling >weekly; SOGS-RA > 2.

ODDS OFPROBLEMGAMBLING ATYOUNGADULTHOOD

- Gambling linked to delinquency& substance use: moderate butsignificant; stronger relationbetween delinquency &substance use

- Gambling & alcohol consumption co-occur & are linked with other behaviorssuch as cigarette smoking, illicit druguse & delinquency

1. Parental history2. Problem gambling during

adolescence3. Male4. At risk gambling during

adolescence5. Substance abuse6. Poor school performance

Longitudinal Designs

ADVANTAGES Continuities & Discontinuities in behavior

- which problems persist & which do not?

- predictors of resilience & pathology

- necessity & efficacy of prevention & treatment

- reveals causative mechanisms

- validity of diagnostic constructs related to outcome

Variations over time within & between individuals vs C-S

- age of onset & termination as well as course

- identifies causal mechanisms & chain direction

- “escape” from environment & resilience

- predictors of later functioning

First determination of incidence of gambling Cost-effective common data pool for all domains

LIMITATIONS Limited comparability: lack of standard

assessment & operational definitions Confounding age & period effects

- COHORT: group of individuals experiencing same event over same time

COHORT EFFECT: ie. “Baby Boomer”

- PERIOD EFFECT: influence specific to time period, ie. “gambling opportunities”

- AGING EFFECT: change due to age, ie, “age-dependent leisure”

- Cross-section confounds aging & cohort; Longitudinal confounds aging & period

Delay between start of study & first results Sample attrition vs contact planning, ie., subject,

relatives, records, knowledge of who is missing Repeated contacts may influence behavior Funding & personnel across long time span

B. Selecting the Proposed Design

PRINCIPLES - Across the lifecycle & both genders:

1. Study gamut of gambling behaviors

2. Assess impact of a changing gambling culture

3. Identify variables enhancing normative gambling & protective resilience as well as risk variables

4. Identify the potential continuity & discontinuity of gambling behaviors including patterns of recovery.

The “Accelerated Longitudinal” Alternative A multi-cohort sequential strategy reduces F/U period & cumulative effects of testing &

attrition Several cohorts increase confidence in generalizability Disentangles aging from period effects only if there is substantial overlap between FU ages Retrospective data may link up the intercohort intervals

The critical ages selected for a 5 year follow-up are:

13-15 y initiation to gambling + developmental variables

18-20y high risk, frequent gambling

23-25y adult family, job & leisure activities

43-45y mid-adulthood tasks, educate next generation about responsible leisure

58-60y* pre-retirement, fund-raising target due to disposable income

63-65y* understudied with various opinions as to impact of changing culture

Other ChoicesI. Tackling the low prevalence of gambling problems (N=1900)

- 300/age cohort: 150 from unselected general population

150 from select high risk sample [gambling frequency 80th percentile]

- Except; 400/adolescent due to:

II. Age Specific Definitions/Screening of Behavior

III. Survey administration, Objectives & Cost-effectiveness

Ben & Limit A. Telephone B. Face-to-face C. Mixed

Interviews Length 3 hr face-to-face 1/2 day initial

Sampling Random digital RDD + costly travel RDD for Calg & Edm

dialing (RDD) + 4 risk Ft McM/

Edm/Calg/Other P Creek/Cardston/Ft/McL Initial refusal 25%

Attrition rate 13-15%/year ? 15-30% overall

Incentives & tax Less ? $50/ 1/2 day, 30 mid, 75 end

Stress Factor Low Higher RAs & coordinator

Validity Good Better? Best: endorsement/call ID

Flexibility & ownership Less More Best

Family History - Social & problem gambling- Substance use disorders- Psychiatric disorders- Deviance

Biological Risk- Neuropsychological functioning-Frontal lobe- Neurotransmitter-DA (blood DNA)-MAOI activity- Gender- Ethnicity

Temperament/Personality- Impulsivity- Trait anxiety- Moral disengagement

Cognitive- Intelligence- Attentional Ability- Erroneous beliefs/Knowledge- Coping Skills- Problem-solving skills- Ability to delay gratification- Ability to challenge cognitions

Family Environment- Parental behaviour- Marital Status/conflict- Financial strain/SES- Abuse experiences

Extra-familial Environment- Social skills- Friendships/peers- Culture/religion

Stressors- Physical health/ disability- School/work- Familial/peer- Legal

Gambling Involvement- Frequency, duration- Type- Context

Externalizing Problems- Alcohol use- Substance use- Tobacco use- Delinquent activity- Sexual activity

Internalizing Problems- Depression- Anxiety

Gambling Disorders - DSM-IV- Problem gambling- Impaired control

Broader Socio-cultural Factors- Availability of gambling; - public attitudes; prevention programs

Prevention & treatment

Additional Choices Instruments selection

A. Omnibus risk & protection Christchurch Health & Development Stats Can Nat Longit Study US Nat Youth Survey

B. Gambling & Comorbidity focussed Can Problem Gambling Index incl Subst Ab NODS (US Impact Study) SOGS-RA DSM IV TR

C. Specific Blood sample IQ - Personality (NEO) Erroneous Perceptions Social Factors & Attitudes

Exclusion of direct interventions; reporting only Interprovincial = different policies & economics CIHR pillars: biomedical, clinical, health services/systems, population health &

sociocultural determinants Contracted questions

LEGEND1 Chair, AGRI, University of Calgary; 2 Node Coordinator, University of Calgary; 3 Node Coordinator, University of Alberta; 4 Node Coordinator, University of Lethbridge; 5 CEO, AGRI; 6 University of Minnesota; 7 Harvard University

Steering CommitteesOthers

- U of Alberta

- U of Calgary

- U of Lethbridge

- Community

DOMAINS/SITES/AGES

D. HodginsUniversity of Calgary

-

- N. el-Guebaly

- R. Williams

-

BIOPSYCHO-LOGICAL

(Adoles & Adult)

R. Williams+ University of Lethbridge

-

-

-

-

SOCIO-CULTURAL

G. SmithUniversity of Alberta

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POLICY/ECONOMICS

COHORT ORGANIZATIONAL STRUCTURE

EXTERNAL ADVISORY

BOARDK.

Winters 6, H. Schaff

er 7

EXECUTIVE COMMITTEE (Budget, Board relation, Coordination)

N. el-Guebaly 1, D. Hodgins 2, G. Smith 3, R. Williams 4, V. Williams 5

Project Coordinator:Library: Rhys Stevens; Research Assistant: R. Coulson

Anticipated Outcome

First data set on range of gambling behaviors across lifecycle. All domains: biopsychological - sociocultural - policy & economics; CIHR pillars?

First incidence data

Common cost-effective datapool for all domains

Validation of screening instruments across lifecycle

Strong collaborative project across Alberta’s universities

A catalyst for interprovincial collaboration (helps policy/ economic domains) & potential CIHR support - April 2003

The search for truth is like looking for Elvis … on any given day there will be many sightings

--- most will be impersonators!