Michael Campos, PhD UCLA Gambling Studies Program

Terri Sue Canale Deputy Director, CA Office of Problem Gambling

National Council on Problem Gambling Conference

07/19/13

CA Office of Problem Gambling outreach efforts for the Hispanic community

Outpatient data from program inception to the end of FY 2011-12.

Community Outreach TA Contracts

NAPAFASA – Health Care Professionals, Educators, Non-Profit Organizations

CCPG – Law Enforcement Agencies,

Gambling Industry Personnel

Conferences

Latino Behavioral Health Institute (LBHI 2011, 2012)

Spanish Language Media

Radio

Convenience Stores

Cable Television

Newspaper

Billboards

Brochures

First Spanish Language Billboard

New Spanish Language Billboards

Helpline Translated Services Chinese 22 7.0%

Korean 18 5.8%

Laotian 1 0.3%

Mon-Khmer, Cambodian 1 0.3%

Other 8 2.6%

TTY 1 0.3%

Russian 2 0.6%

Spanish 226 72.2%

Vietnamese 34 10.9%

Helpline Caller Ethnicity (4978 Calls)

Caucasian 2239 45.9%

Hispanic 1122 23.0%

African American 560 11.5%

Other Ethnicity 188 3.9%

Vietnamese 171 3.5%

Filipino 163 3.3%

Chinese 112 2.3%

Other Asian 108 2.2%

Korean 105 2.2%

Pacific Islander 38 0.8%

Asian Indian 28 0.5%

Native American 22 0.5%

Japanese 16 0.3%

OPG’s Mandate Treatment efforts shall provide

services that are relevant to the needs of a diverse

multicultural population.

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.

California Demographics CA population = 38,041,430

CA Hispanic population = 14,493,774

38.1% of CA residents were Hispanic

Majority are Mexican origin or heritage

Source: CA Quick Facts; US Census Bureau accessed 06/25/13 at http://www.quickfacts.census.gov/cfd/states/06000.html

Hispanic Population by County

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

Prevalence of Gambling Problems by Hispanic Ethnicity

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Problem Gambling PathologicalGambling

DisorderedGambling

3.0%

1.5%

4.5%

1.8% 1.5%

3.3%

Hispanic All Others

Source: Campos et al., 2012

Gambling Problems in the CA Hispanic Community

Hispanics with Problem Gambling = 434,813

Hispanics with Pathological Gambling = 217,406

CPGTSP Components Telephone-based brief interventions

Outpatient Service Network

Intensive Outpatient Program

Residential Treatment Services

Outpatient Services

8 State-funded sessions with a licensed mental health professional (MFT, LCSW, PhD, MD)

CPGTSP therapists went through a 4-day training on the treatment of gambling problems

About 240 authorized CPGTSP outpatient providers

Provider Survey Results Gender Male 24% (36)

Female 76% (114)

Age Mean (S.D.) 54 (10.1)

Race/Ethnicity

(check all that

apply)

White 77% (116)

African American 6% (9)

Hispanic 7% (10)

Asian 11% (17)

Other 5 % (8)

Degree

(check all that apply)

MFT 73% (110)

MSW 5% (8)

LCSW 15% (22)

PhD 11% (17)

PsyD 7% (11)

Utilized Patient

Workbook

None 7%(11)

1-25% 8% (12)

26-50% 11% (16)

51-75% 5%(8)

76-99% 16% (24)

All the time 53% (79)

Utilized Therapist

Manual

None 11% (16)

1-25% 15% (22)

26-50% 8% (12)

51-75% 8% (12)

76-99% 16% (24)

All the time 43% (64)

Treatment Approaches

Cognitive Behavioral Therapy

Client Centered Therapy

Motivational Interviewing

Supportive Therapy

12-step

Majority used treatment resources provided by the UCLA Gambling Studies Program

Data from February 1, 2011 to June 30, 2012

Race/Ethnicity

815 (59.1%)

107 (7.8%)

149 (10.8%)

215 (15.6%)

94 (6.8%)

Non-Hispanic Caucasian African-American Hispanic API Other

Age by Race/Ethnicity

Mean SD

Non-Hispanic Caucasian 49.0a 13.2

African-American 47.9a 11.2

Hispanic 43.8b 13.3

Asian/Pacific Islander 44.2b 12.6

Other 43.1b 12.4

Note: F[4, 1,351] = 11.4; p < 0.01. Means with different superscripts were significantly

different at p < 0.01 by post-hoc Tukey test.

Male Gender by Race/Ethnicity N %

Non-Hispanic Caucasian 467 57.3a

African-American 65 60.7a,b

Hispanic 86 57.7a

Asian/Pacific Islander 12o 56.1a

Other 61 78.2b

Note: Χ2[4] = 13.7, p < 0.01. Percentages with different superscripts were

significantly different using binomial tests at p < 0.05.

Demographic Differences

Age: Non-Hispanic Caucasians = African-Americans > Hispanic, Asian/Pacific Islanders, Other: About a 5 year difference (49 vs. 44)

% Male Gender: Other > Non-Hispanic Caucasians, Hispanics, Asian/Pacific Islanders, but = African-Americans: About 60% vs. 78% for Other

Demographic Differences Marital Status: No statistical differences (44.9%

Married or Living with Partner).

Children at Home: Non-Hispanic Caucasians < African-Americans, Hispanics, Asian/Pacific Islanders, Other: 24% vs. 34% to 45%

Education: Asian/Pacific Islander > Non-Hispanic Caucasian > African-American > Other > Hispanic: Hispanics had lowest level of education.

Demographic Differences

Employment: Full-time employment statistically equal across groups (About 55%).

Income: Income levels were statistically similar across groups. Most people making 50K to 75K.

Limited English Language Proficiency

1.5%a

0.0%a

8.7%b

7.9%b

1.1%a,b

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

NHC AA H API Other

Gambling Milestones Age First Gambled

Age First Gambling Problem

Years from First

Gambling to First Problem

Years from First Problem

to CPGTSP

Non-Hispanic Caucasian

26.0 (12.3)a 38.8 (14.5)a 13.2 (12.9)a 10.3 (9.5)a

African-American

23.5 (10.4)a 37.7 (12.5)a,b 14.9 (12.9)a 11.2 (9.8)a

Hispanic 27.8 (12.5)a 36.8 (13.3)a,b 9.9 (9.9)b 7.7 (8.0)b

Asian/Pacific Islander

25.1 (10.6)a 35.1 (12.7)b 9.6 (10.6)b 9.2 (7.9)a,b

Other 25.8 (12.1)a 34.1 (13.2)b 8.8 (10.8)b 9.0 (8.6)a,b

Note: Values with different superscripts are significantly different at p < 0.05

by post-hoc Tukey test.

Referral Source

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NHC AA H API Other

Other

Casino Signage

OPG Website

Media

Former Client

California Council on ProblemGamblingHealthcare Professional

GA or Gam-Anon

Family/Friends

Helpline

Intake NODS Scores

8.09 7.97 8.32 8.35 8.28

0

1

2

3

4

5

6

7

8

9

10

NHC AA H API Other

Co-Occurring Psychiatric Disorders

33.8%a

17.1%b 16.4%b 17.5%b

25.8%a,b

18.5%a

9.5%a,b 11.6%a,b

9.5%b

15.1%a,b

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

NHC AA H API Other

MDD Anxiety Psychotic ADHD

Co-Occurring Substance Use

12.3%a

4.7%a,b 4.0%b 7.9%a,b 8.5%a,b

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

NHC AA H API Other

Alcohol Marijuana Other Drugs

Prior Gambling Treatment

29.1%

20.0% 21.2% 22.3% 28.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NHC AA H API Other

Wait for Treatment

10.6

8.2 8.3 9

7.8

0

2

4

6

8

10

12

NHC AA H API Other

Mean Days

Days in Treatment

74.8 79.5

89.6

79.5 73.3

0

10

20

30

40

50

60

70

80

90

100

NHC AA H API Other

Mean Days

Treatment Visits

State funds blocks of 8 treatment visits.

10.8% did not show up for treatment

26.7% attended between 1 and 4 sessions

54.5% attended 5 sessions

8% attended 6 or more sessions

Number of Treatment Visits

4.3a 4.2a,b

3.6b

4.2a,b 4.4a,b

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

NHC AA H API Other

Mean Visits

Any GA Participation while in Treatment

39.5%a

31.4%a,b

24.0%b

32.7%a,b

38.7%a,b

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

NHC AA H API Other

Predictors of Treatment Completion

Completion defined as 5 or more sessions

Aged 56 or older more likely to complete

College grad or professional degree more likely to complete

Those who attended GA more likely to complete

Hispanics less likely to complete.

Odds Ratios for Significant Predictors Variable Odds Ratio 95% CI for OR

Aged 56 or older a 1.8 1.3 – 2.5

College or Professional Degree b

2.9 1.6 – 5.2

Any GA Attendance 1.9 1.4 – 2.4

Hispanic Ethnicity c 0.6 0.4 – 0.8

Logistic Regression (N = 1,357) included gender, age, employment, education,

marital status, GA attendance, Race/Ethnicity.

a Comparison group is 18 to 37 years old.

b Comparison group is Less than High School

c Comparison group is Non-Hispanic Caucasians

Upcoming Work

Focus groups in the Hispanic community on: Gambling behavior

Attitudes towards gambling problems

Attitudes towards gambling treatment

Imperial County has one of the highest rates of gambling problems in the State of California and its population is approximately 70% Hispanic.

Contact Information

Michael Campos, Ph.D.

Phone: 310.825.6427

E-mail: mdcampos@mednet.ucla.edu