Gambling in Canada During the Pandemic: 6 Months After the National COVID Lockdown

Objective: To investigate the impact of the coronavirus disease (COVID) pandemic on gambling and problem gambling in Canada. Method(s): A stratified national cohort of regular gamblers (n=2790) completed a comprehensive online questionnaire 6 months before the onset of the pandemic (baseline;August-November 2019), during the nation-wide lockdown (May-June 2020), and 6 months after the lockdown (December 2020). Result(s): Significant decreases in gambling frequency, time spent in gambling sessions, money spent, and the number of game types played occurred during lockdown followed by significant increases in all of these same measures postlockdown. However, the level of postlockdown gambling behavior was still significantly lower than prepandemic baseline levels. A significant shift to online gambling was also observed during the lockdown, which persisted postlockdown. Problem gambling scores also declined during the lockdown, with no significant change in these scores postlockdown. Consistent with previous literature, it was found that a higher level of gambling engagement, online gambling participation, and known biopsychosocial factors (family history of problem gambling, gambling fallacies, substance use, male sex, mood disorder) were predictors of problem gambling at postlockdown. COVID-specific factors predictive of problem gambling postlockdown were the presence of negative COVID-related health impacts and increased levels of social interaction and leisure time. Conclusion(s): The COVID-related lockdowns have resulted in lower levels of gambling and problem gambling symptomatology as well as increased online gambling in Canada that have persisted to some extent 6 months postlockdown. Future studies are necessary to ascertain whether these represent permanent or temporary changes. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

Gambling Fallacies, problem gambling, and the role of pandemic specific factors

Gambling Fallacies (GF) are a collection of gambling specific cognitive errors that lead to erroneous beliefs about how gambling works. While previous studies have demonstrated that gambling fallacies are one factor that contributes to the development and maintenance of gambling disorder, longitudinal studies have demonstrated that endorsement of these fallacies can fluctuates across time. The factors that influence changes in level of GF are less understood. The current study examined levels of GF in a national cohort of adults, with two aims: 1) examining the associations between GF levels and type of gambler (non-gambler, non-problem gambler, low-risk gambler, moderate-risk gambler and problem gambler), and 2) identifying the impact of COVID specific variables on GF endorsement. This sample (n = 2,790) was recruited from Leger Opinion's registered online panellists. Respondents completed a survey of gambling involvement and individual difference variables at 6-months intervals: baseline (6-months before the pandemic);during the nation-wide lockdown in Canada;and 6-months after the lockdown. The results of this study indicate that, while somewhat more prevalent among problem gamblers, GF are common among gamblers of all types. However, level of GF endorsement did vary significantly at each 6-month interval in this sample and multivariate analysis indicate that GF endorsement was a significant predictor of increased gambling severity category over time. Also, a bidirectional relationship was evidenced as problem gambling and greater gambling involvement were significant predictors of greater endorsement of GF. COVID specific changes in health and level of social interaction also significantly predicted greater GF endorsement.

The impact of forced abstinence on gambling: A natural ABA design study

The impacts of the COVID-19 pandemic, and responses used to mitigate the spread such as selective closure of non-essential businesses, have been far-reaching. Some of these impacts include changes in health, economic, social and recreation. Included among other non-essential business, in-person gambling venues were closed across Canada. Yet, online gambling opportunities remained available, making this period both a historical first in Canada, and a natural experiment. The current study examined quantifiable ramifications of the sudden forced abstinence from in-person gambling during the nation-wide lockdown in Canada, and what changes occurred six-months later upon reopening. For this cohort study, pre-pandemic base line data was provided six-month before the lockdown by online panel participants (n = 2,790), who were then re-surveyed during the national lockdown and again six-months postlockdown. Nearly one-third of gamblers reported a complete cessation of gambling during the lockdown period. For those who continued gambling, quantitative data indicated signifi-cant decreases on all gambling engagement measures: frequency, time spent in gambling sessions, money spent, and the number of game types played. This was followed by significant increases on each engagement measure six-months post-lockdown. Although these increases did not return to pre-pandemic engagement levels. Problem gambling within the whole sample generally declined during lockdown, however, significant increases in highrisk gambling were evidenced six-months later. In fact, engaging in online gambling and COVID-specific changes in health, employment, and social isolation across the closure and re-opening periods were independent predictors for classification as a problem gambler sixmonths after the lockdown.

Characteristics that predict engagement in instant win games

While gambling problems have long been investigated in association with electronic gambling machines, recent attention has focused on engagement with instant lottery games. Instant win game engagement has been identified as one robust predictor of increased concurrent and subsequent problem gambling (see: Grusser et al., 2007;Short et al., 2015;Stark et al., 2021;Williams, Leonard, et al., 2021;Williams, Leonard, et al., 2021). This emergent finding contrasts with historical perceptions that lottery games are low risk. It is important to understand the individual characteristics of those who engage in instant lottery games, the potential harms associated with engagement, and the biopsychosocial profile of those at greatest risk for experiencing harms. This study sought to identify the characteristics that predict engagement versus non-engagement using a longitudinal data set, namely the AGRI National COVID Project online panel participant data (n = 3449), collected in Fall 2019 (baseline data for this study) and in Spring 2020 (during the nation-wide pandemic lockdown). Results indicate that, pre-pandemic factors including gender, employment status, household financial status, greater involvement in gambling, and elevated problem gambling scores, contributed significantly to the delineation of those who did - versus did not - engage in instant win games during the national lockdown. Additional research is required to understand both, the individual characteristics that lead to susceptibility for problems with instant win games, and the role of environmental factors including social and economic strain experienced during the COVID-19 pandemic in the manifestation of problems related with instant win game engagement.

Implementation of corticosteroids in treatment of COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK: prospective, cohort study

Background Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. Methods We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. Findings Between June 17, 2020, and April 14, 2021, 47 795 (75.2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86.6%] of 12 909 vs 36 415 [72.4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0.79 [95% CI 0.70-0.89], p=0.0001, for 70-79 years;0.52 [0.46-0.58], p<0.0001, for >80 years), independent of patient demographics and illness severity. 84 (54.2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27.5% in the week before June 16, 2020, to 75-80% in January, 2021. Interpretation Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.