Casino accessibility and suicide: A county-level study of 50 US states, 2000 to 2016.

BACKGROUND AND AIMS: Suicide is the tenth leading cause of death in the United States (US). Research over many decades identifies that its etiology is complex, with risk factors operating in multiple domains. One such risk factor is gambling. Over the past three decades, exposure to gambling has increased dramatically in the United States. The aim of this study was to measure the magnitude of the association between casino density and absolute risk of suicide in US counties. DESIGN, SETTING, CASES: This spatial panel analysis used data for 3131 counties from 50 US states from 2000 to 2016, for an overall sample of 53 227 county-year units. Using Bayesian conditional autoregressive Poisson models, we measured incidence rate ratios and credible intervals for the association between the density per population of casinos and other gambling outlets and the incidence of suicide. MEASUREMENTS: The outcome of interest was counts of suicides. The main exposures of interest were casinos and other gambling outlets. FINDINGS: A total of 527 401 suicides occurred during the study period. On average, there was a mean of 1.3 casinos (SD = 9.1) and 1.4 other gambling venues (SD = 5.9) in each county-year. After controlling for confounding, the incidence rate ratio for casinos was 1.016, and the credible interval was between 1.010 and 1.023. CONCLUSIONS: The density of casinos and other gambling venues is positively associated with suicide mortality in the United States.

Community-based social care models for indigenous people with disability: A scoping review of scholarly and policy literature.

Disability is experienced and understood by Indigenous people internationally in distinct ways from other populations, requiring different approaches in disability services. Furthermore, Indigenous populations access disability services at low rates. In response, policymakers, service providers and Indigenous organisations have developed specific models of care for Indigenous people with disability. Social care services, comprising personal care, transport and social activities, can support Indigenous people with disability to live with their families and in their communities. However, little is known about the range of social care models for Indigenous people with disability. To inform policy and practice, we conducted a scoping review of community-based models of social care designed to meet the needs of Indigenous peoples in Australia, Aotearoa New Zealand, Canada and the United States. Our methods were informed by best practice scoping review principles and a collaborative approach that centred Indigenous voices within research appraisal and project governance processes. Literature searches (conducted March-April 2021) yielded 25 results reporting on 10 models of care. We identified two over-arching themes (funding and governance arrangements; service delivery design) that encompass nine key characteristics of the included models. Our analysis shows promising practice in contextually relevant place-based social activity programs, support and remuneration for family carers and workforce strategies that integrate Indigenous staff roles with kinship relationships and social roles. While more research and evaluation are needed, disability funding bodies and service systems that facilitate these areas of promising practice may improve the accessibility of social care for Indigenous peoples.

Towards the decolonisation of disability: A systematic review of disability conceptualisations, practices and experiences of First Nations people of Australia.

In many settler-colonial countries, Indigenous people do not access disability services at rates commensurate with disability prevalence. Existing research suggests that services often do not reflect Indigenous values and social practices, impacting on accessibility. Furthermore, disability services have historically been implicated in processes of colonisation. There is an urgent need to decolonise disability services. Understanding Indigenous knowledge and experience of disability is a necessary step towards achieving this. We systematically reviewed the disability conceptualisations, practices and experiences of First Nations peoples of Australia. Twelve studies met inclusion criteria. There was a consensus among these studies that Western constructs of disability do not resonate with many First Nations people across Australia. The studies reported that many First Nations people conceptualise most disabilities as unremarkable conditions that reflect the normal range of human diversity, although some conditions may be associated with social stigma. Inclusive attitudes and practices of caregiving in First Nations families facilitate the participation of First Nations people with disabilities in family and community life. However, ableism and racism in broader society combine to exclude many First Nations peoples with disabilities from public spaces and from labour markets. Disability services regularly fail to reflect First Nations values and social practices, and can lead to further disempowerment and marginalisation due to diagnostic processes; displacement from country and communities; gendered discrimination; and poor relationships with service providers. We argue that intersectional experiences of colonialism, racism, ableism and sexism, particularly in disability services, can lead to the marginalisation of First Nations participants and families. The decolonisation of disability services requires services to embrace diverse First Nations values and practices associated with human capability, social participation and caregiving. Decolonising disability services also necessitates First Nations control of the governance of disability services and reform across service, organisational, systemic and conceptual levels.

Improving spatial microsimulation estimates of health outcomes by including geographic indicators of health behaviour: The example of problem gambling.

Gambling is an important public health issue, with recent estimates ranking it as the third largest contributor of disability adjusted life years lost to ill-health. However, no studies to date have estimated the spatial distribution of gambling-related harm in small areas on the basis of surveys of problem gambling. This study extends spatial microsimulation approaches to include a spatially-referenced measure of health behaviour as a constraint variable in order to better estimate the spatial distribution of problem gambling. Specifically, this study allocates georeferenced electronic gaming machine expenditure data to small residential areas using a Huff model. This study demonstrates how the incorporation of auxiliary spatial data on health behaviours such as gambling expenditure can improve spatial microsimulation estimates of health outcomes like problem gambling.

A meta-regression analysis of 41 Australian problem gambling prevalence estimates and their relationship to total spending on electronic gaming machines.

BACKGROUND: Many jurisdictions regularly conduct surveys to estimate the prevalence of problem gambling in their adult populations. However, the comparison of such estimates is problematic due to methodological variations between studies. Total consumption theory suggests that an association between mean electronic gaming machine (EGM) and casino gambling losses and problem gambling prevalence estimates may exist. If this is the case, then changes in EGM losses may be used as a proxy indicator for changes in problem gambling prevalence. To test for this association this study examines the relationship between aggregated losses on electronic gaming machines (EGMs) and problem gambling prevalence estimates for Australian states and territories between 1994 and 2016. METHODS: A Bayesian meta-regression analysis of 41 cross-sectional problem gambling prevalence estimates was undertaken using EGM gambling losses, year of survey and methodological variations as predictor variables. General population studies of adults in Australian states and territory published before 1 July 2016 were considered in scope. 41 studies were identified, with a total of 267,367 participants. Problem gambling prevalence, moderate-risk problem gambling prevalence, problem gambling screen, administration mode and frequency threshold were extracted from surveys. Administrative data on EGM and casino gambling loss data were extracted from government reports and expressed as the proportion of household disposable income lost. RESULTS: Money lost on EGMs is correlated with problem gambling prevalence. An increase of 1% of household disposable income lost on EGMs and in casinos was associated with problem gambling prevalence estimates that were 1.33 times higher [95% credible interval 1.04, 1.71]. There was no clear association between EGM losses and moderate-risk problem gambling prevalence estimates. Moderate-risk problem gambling prevalence estimates were not explained by the models (I 2 ≥ 0.97; R 2 ≤ 0.01). CONCLUSIONS: The present study adds to the weight of evidence that EGM losses are associated with the prevalence of problem gambling. No patterns were evident among moderate-risk problem gambling prevalence estimates, suggesting that this measure is either subject to pronounced measurement error or lacks construct validity. The high degree of residual heterogeneity raises questions about the validity of comparing problem gambling prevalence estimates, even after adjusting for methodological variations between studies.

The relationship between electronic gaming machine accessibility and police-recorded domestic violence: A spatio-temporal analysis of 654 postcodes in Victoria, Australia, 2005-2014.

An emerging body of research has documented an association between problem gambling and domestic violence in a range of study populations and locations. Yet little research has analysed this relationship at ecological scales. This study investigates the proposition that gambling accessibility and the incidence of domestic violence might be linked. The association between police-recorded domestic violence and electronic gaming machine accessibility is described at the postcode level. Police recorded family incidents per 10,000 and domestic-violence related physical assault offenses per 10,000 were used as outcome variables. Electronic gaming machine accessibility was measured as electronic gaming machines per 10,000 and gambling venues per 100,000. Bayesian spatio-temporal mixed-effects models were used to estimate the associations between gambling accessibility and domestic violence, using annual postcode-level data in Victoria, Australia between 2005 and 2014, adjusting for a range of covariates. Significant associations of policy-relevant magnitudes were found between all domestic violence and EGM accessibility variables. Postcodes with no electronic gaming machines were associated with 20% (95% credibility interval [C.I.]: 15%, 24%) fewer family incidents per 10,000 and 30% (95% C.I.: 24%, 35%) fewer domestic-violence assaults per 10,000, when compared with postcodes with 75 electronic gaming machine per 10,000. The causal relations underlying these associations are unclear. Quasi-experimental research is required to determine if reducing gambling accessibility is likely to reduce the incidence of domestic violence.

The relationship between player losses and gambling-related harm: evidence from nationally representative cross-sectional surveys in four countries.

BACKGROUND AND AIMS: Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity. DESIGN: Four cross-sectional surveys. SETTING: Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002). PARTICIPANTS: A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15-74 years in Finland and 5235 people aged 15-74 years in Norway. MEASUREMENTS: Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. FINDINGS: Risk curves for total gambling losses were estimated to be r-shaped in Australia {ß losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], ß losses(2 =) -7.6 (95% CI = -17.5, -4.5)}, Canada [ß losses = 2.0 (95% CI = 1.3, 3.9), ß losses(2 =) -3.9 (95% CI = -15.4, -2.2)] and Finland [ß losses = 3.6 (95% CI = 2.5, 7.5), ß losses(2 =) -4.4 (95% CI = -34.9, -2.4)] and linear in Norway [ß losses = 1.6 (95% CI = 0.6, 3.1), ß losses(2 =) -2.6 (95% CI = -12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. CONCLUSIONS: Player loss-risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm.

Gambling expenditure predicts harm: evidence from a venue-level study.

BACKGROUND AND AIMS: The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling-related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling-related harm at the level of the EGM venue. DESIGN: Cross-sectional analysis of survey and administrative data. SETTING: General urban adult population of the Northern Territory of Australia. PARTICIPANTS: The sample consisted of 7049 respondents to a mail-survey about venue visitation and gambling behaviour across 62 EGM venues. MEASUREMENTS: Gambling-related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue-level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling-related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression. FINDINGS: Aggregated to the venue level (n = 62), per-capita EGM expenditure was correlated significantly with rates of gambling-related harm (r = 0.27, n = 62, P = 0.03). After adjusting for venue type and number of EGMs, an increase in mean per-capita monthly EGM expenditure from $AU10 to $AU150 was associated with a doubling in the prevalence of gambling-related harm from 9% (95% CI = 6-12%) to 18% (95% CI = 13-23%). CONCLUSIONS: As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling-related harm at the venue level.

The relationship between alcohol consumption, gambling behaviour and problem gambling during a single visit to a gambling venue.

INTRODUCTION AND AIMS: Despite the well-documented comorbidity between disordered alcohol use and problem gambling, little is known about the co-occurrence of drinking and gambling in gambling venues. This paper appears to be the first to investigate the association between drinking and gambling behaviour among a large sample of gamblers during a specific, non-laboratory gambling episode. DESIGN AND METHODS: We conducted a mail survey of all available households in the Northern Territory of Australia, including questions on drinking and gambling behaviour on the last visit to a gambling venue. We estimate the effect of moderate (1-4 standard drinks) and risky (>4 standard drinks) alcohol consumption on gambling participation and gambling duration for both problem and non-problem gamblers using regression analysis of 7044 survey responses. RESULTS: The probability of participating in electronic gaming machine (EGM) gambling decreased with alcohol consumption for non-problem gamblers, while the probability of participating in TAB (Totalisator Agency Board, off-course totalisator) gambling increased with risky alcohol consumption for all gamblers. Alcohol consumption was not associated with EGM gambling participation for problem gamblers. Moderate alcohol consumption was negatively associated with EGM gambling duration, with a stronger effect observed for problem gamblers. DISCUSSION AND CONCLUSIONS: Moderate alcohol consumption is inversely correlated with both the duration of play and probability of participation for EGM gambling. Current laboratory studies do not predict the drinking-gambling behaviour of the general population in non-laboratory settings. Future research on alcohol and gambling co-occurrence must explicitly consider the drinking and gambling environment in order to produce policy-relevant findings.