The prevention paradox (PP) describes a situation in which a greater number of cases of a disease-state come from low-risk members of a population, because they are more prevalent than high-risk members. Past research has provided only tangential and disputed evidence to support the application of the PP to gambling-related harm.
To assess whether the PP applies to gambling, the prevalence of a large set (72) of diverse harmful consequences from gambling was examined across four risk categories for problem gambling, including no-risk, low-risk, moderate-risk, and problem-gambling.
Respondents who had gambled on non-lottery forms in the past 6 months completed an online survey (N = 1,524, 49.4% male). The data were weighted to the known prevalence of gambling problems in the Victorian community.
The prevalence of gambling harms, including severe harms, was generally higher in the combined categories of lower risk categories compared to the high-risk problem-gambling category. There were some notable exceptions, however, for some severe and rare harms. Nevertheless, the majority of harms in the 72-item list, including serious harms such as needing temporary accommodation, emergency welfare assistance, experiencing separation or end of a relationship, loss of a job, needing to sell personal items, and experiencing domestic violence from gambling, were more commonly associated with lower risk gamblers.
Many significant harms are concentrated outside the ranks of gamblers with a severe mental health condition, which supports a public-health approach to ameliorating gambling-related harm.
In their critical review of the prevention paradox (PP) applied to gambling-related harm, Delfabbro and King (2017) raise a number of concerns regarding specific assumptions, methods, and findings as well as the general conceptual approach. Besides discussing the PP, the review also considers the merits of considering a “continuum of harm,” as opposed to the more traditional categorical approach to classifying problem gamblers. Their critique is carefully modulated and balanced, and starts a useful dialogue in the context of a public health approach to gambling. Unfortunately, some of Delfabbro and King’s (2017) arguments rest on the treatment of gambling harm as a binary state and conflates gambling-related harm with disordered gambling. In this reply, we argue that the application of PP logic to gambling harm has not yet been addressed by us, and is only indirectly related to the more important objective of understanding how gambling can reduce ones’ quality of life.
A diverse class of stimuli, including certain foods, substances, media, and economic behaviours, may be described as ‘reward-oriented’ in that they provide immediate reinforcement with little initial investment. Neurophysiological and personality concepts, including dopaminergic dysfunction, reward sensitivity and rash impulsivity, each predict the existence of a latent behavioural trait that leads to increased consumption of all stimuli in this class. Whilst bivariate relationships (co-morbidities) are often reported in the literature, to our knowledge, a multivariate investigation of this possible trait has not been done. We surveyed 1,194 participants (550 male) on their typical weekly consumption of 11 types of reward-oriented stimuli, including fast food, salt, caffeine, television, gambling products, and illicit drugs. Confirmatory factor analysis was used to compare models in a 3×3 structure, based on the definition of a single latent factor (none, fixed loadings, or estimated loadings), and assumed residual covariance structure (none, a-priori / literature based, or post-hoc / data-driven). The inclusion of a single latent behavioural ‘consumption’ factor significantly improved model fit in all cases. Also confirming theoretical predictions, estimated factor loadings on reward-oriented indicators were uniformly positive, regardless of assumptions regarding residual covariances. Additionally, the latent trait was found to be negatively correlated with the non-reward-oriented indicators of fruit and vegetable consumption. The findings support the notion of a single behavioural trait leading to increased consumption of reward-oriented stimuli across multiple modalities. We discuss implications regarding the concentration of negative lifestyle-related health behaviours.
Legacy gambling harms are negative consequences of gambling that extend past periods of low risk, moderate risk and problem gambling. Gambling harm is typically measured within a 12-month timeframe and is often restricted to examining harm amongst active gamblers. The present research aimed to explore whether people experienced gambling harms 12 months or more after the resolution of at-risk or problem gambling, and how long these legacy harms lasted.
An online survey was conducted in New Zealand with past and current gamblers and concerned significant others (CSOs) of gamblers, N = 1,240 (50.8% female), that asked them about both past and current gambling harms.
A majority of both gamblers and CSOs of gamblers indicated that they still suffered from gambling harm even after most of their behavioural issues with gambling had been resolved, 12+ months ago. Legacy gambling harms reduced over time, with harms diminishing most quickly in the early years, and having an average half-life of 4 years. Harms involving community-relationships, church involvement, and domestic and other violence resolved more quickly than others.
Discussion and conclusions
Legacy harms are common among ex-problem gamblers and should be considered in any full accounting of the impacts of gambling.
Understanding the time course and persistence of legacy harms from gambling can provide gamblers, treatment professionals and public health experts with insights into how to address gambling's long-term consequences.
The Prevention Paradox (PP) suggests that a large proportion of aggregate harm from gambling occurs to people who do not have a gambling disorder. However, it has not yet been tested using a population-representative sample. We aimed to test whether the PP applies to gambling in Finland. The prevalence rates of diverse harmful consequences from gambling were surveyed amongst a population-representative sample of past-year gamblers.
The study used first wave data (N = 7,186) of Finnish Gambling Harms survey, collected via online and postal surveys in 2017. A subset of 3,795 adults (≥18 years), who had gambled at least monthly in 2016, were selected for analysis.
Gambling-related harms were evaluated with the 72-item Harms Checklist. Problem and Pathological Gambling Measure (PPGM) measured respondents’ probable disordered gambling from the subset of items for impaired control (4 questions) and other issues (3 questions).
Consistent with previous findings, the majority of harms were reported by those in the less severe PPGM categories (i.e. scoring <5). However, considering each domain separately, this was true only for financial, emotional/psychological, and work/study harms. The PP was not supported for health, relationship, or social deviance harms.
The population prevalence of the most serious harms (e.g. unsafe living conditions) is concentrated among those with severe impaired control issues. However, even excluding the ∼15% of harms occurring to occasional gamblers, most financial, emotional and work/study impacts occur to those with lower levels of control issues. Efforts at harm reduction should focus on the entire spectrum of issues that people experience from their gambling.
Incentives for wagering products can provide extra value to gamblers. However, there is no financial reason why this added value should lead people to take greater gambling risks. This study aimed to experimentally test if wagering incentives cause gamblers to choose higher-risk (long odds) bets than un-incentivized bets.
An online experiment was conducted with wagering customers (N = 299, female = 12). Participants bet $4 on each of six video game simulations of a sport that they had wagered on in the past 12 months (Australian Football League, Cricket, or Soccer). Each game offered different common wagering incentives: Bonus bet, Better odds/winnings, Reduced risk, Cash rebate, Player’s choice of inducement, or No-inducement. For each game, participants could bet on long, medium, or short odds, and subsequently viewed a highlight reel of the simulated game outcome and bet outcome.
Participants selected significantly longer odds (i.e., riskier) bets on games when an incentive was offered compared to the No-inducement condition. Better odds/winnings was the most attractive incentive, followed by Bonus bet, Cash rebate, Reduced risk, and No-incentive, respectively. No significant differences were observed based on demographics or problem gambling severity.
Discussion and conclusions
The choice of long odds with incentivized bets increases the volatility of player returns. Increased volatility results in more gamblers in a losing position and fewer gamblers with larger wins. Moreover, if long odds bets are priced to provide poorer value to bettors compared to short odds, they would increase gamblers’ losses and equivalently increase operators’ profits.
Impulsivity has consistently been associated with over-consumption and addiction. Recent research has reconceptualized impulsivity as a two-dimensional construct (). This study explores the relationship of the two components of impulsivity, reward drive (RD) and rash impulsivity (RI), on a broad group of 23 hedonic consumption behaviors (e.g., gambling, substance use, eating, and media use). We tentatively grouped the behaviors into three descriptive classes: entertainment, foodstuffs, and illicit activities and substances.
RD and RI positively predicted elevated levels of consumption in a community sample (N=5,391; 51% female), for the vast majority of the behaviors considered. However, the effect sizes for RD and RI varied significantly depending on the behavior; a pattern that appeared to be at least partially attributable to the class of consumption. Results support the view that RD is related more strongly to the consumption of products that provide social engagement or a sense of increased status; whereas RI better reflects an approach toward illicit or restricted products that are intensely rewarding with clear negative consequences.
Discussion and conclusion
Results support the utility of the two-factor model of impulsivity in explaining individual differences in patterns of hedonic consumption in the general population. We discuss findings in terms of strengthening current conceptualizations of RI and RD as having distinct implications with respect to health-related behaviors.
Harmful gambling has been associated with the endorsement of fallacious cognitions that promote excessive consumption. These types of beliefs stem from intuitively derived assumptions about gambling that are fostered by fast-thinking and a lack of objective, critical thought. The current paper details an experiment designed to test whether a four-week online intervention to strengthen contextual analytical thinking in gamblers is effective in changing gamblers cognitions and encouraging safer gambling consumption.
Ninety-four regular gamblers who reported experiencing gambling-related harm were randomly allocated to either an experimental (n = 46) or control condition (n = 48), including 45 males, ranging from 19 to 65 years of age (M = 36.61; SD = 9.76). Following baseline measurement of gambling beliefs and prior week gambling consumption, participants in the experimental condition were required to complete an adaption of the Gamblers Fallacy Questionnaire designed to promote analytical thinking by educating participants on common judgement errors specific to gambling once a week for four weeks. Post-intervention measures of beliefs and gambling consumption were captured in week five.
The experimental condition reported significantly fewer erroneous cognitions, greater endorsement of protective cognitions, and reduced time spent gambling post-intervention compared to baseline. The control group also reported a reduction in cognitions relating to predicting and controlling gambling outcomes.
Cognitive interventions that encourage gamblers to challenge gambling beliefs by reflecting on gambling involvement and promoting critical thinking may be an effective tool for reducing the time people invest in gambling activities.
In the present research, we experimentally investigated whether the experience of winning (i.e., inflated payout rates) in a social casino game influenced social casino gamers’ subsequent decision to gamble for money. Furthermore, we assessed whether facets of dispositional impulsivity – negative and positive urgency in particular – also influenced participants’ subsequent gambling.
Social casino gamers who were also current gamblers (N = 318) were asked to play a social casino game to assess their perceptions of the game in exchange for $3. Unbeknownst to them, players were randomly assigned to one of three experimental conditions: winning (n = 110), break-even (n = 103), or losing (n = 105). After playing, participants were offered a chance to gamble their $3 renumeration in an online roulette game.
A total of 280 participants (88.1%) elected to gamble, but no between-condition variation in the decision to gamble emerged. Furthermore, there were no differences in gambling on the online roulette between condition. However, higher levels of both negative and positive urgency increased the likelihood of gambling. Finally, impulsivity did not moderate the relationship between experience of winning and decision to gamble.
The results suggest that dispositional factors, including impulsive urgency, are implicated in the choice to gamble for social casino gamers following play.
Excessive time and money spent on gambling can result in harms, not only to people experiencing a gambling problem but also to their close family and friends (“concerned significant others”; CSOs). The current study aimed to explore whether, and to what extent, CSOs experience decrements to their wellbeing due to another person’s gambling.
We analysed data from The Household Income and Labour Dynamics in Australia Survey (HILDA; N = 19,064) and the Canadian Quinte Longitudinal Study (QLS; N = 3,904). Participants either self-identified as CSOs (QLS) or were identified by living in a household with a person classified in the problem gambling category by the PGSI (HILDA). Subjective well-being was measured using the Personal Wellbeing Index and single-item questions on happiness and satisfaction with life.
CSOs reported lower subjective wellbeing than non-CSOs across both countries and on all three wellbeing measures. CSO status remained a significant predictor of lower wellbeing after controlling for demographic and socio-economic factors, and own-gambling problems. There were no significant differences across various relationships to the gambler, by gender, or between household and non-household CSOs.
Discussion and Conclusions
Gambling-related harms experienced by CSOs was reliably associated with a decrease in wellbeing. This decrement to CSO’s wellbeing was not as strong as that experienced by the person with the first-order gambling problem. Nevertheless, wellbeing decrements to CSOs are not limited to those living with a person with gambling problems in the household and thus affect many people.