The changing epidemiology of gambling disorder and gambling-related harm: public health implications.

OBJECTIVES: Gambling availability, participation and expenditure have increased markedly in many parts of the world. This is expected to continue and have significant public health impacts. The purpose of this study is to examine the changing epidemiology of gambling and gambling-related harm and its implications for public health policy and practice. STUDY DESIGN: This is a narrative review. METHODS: Relevant literature, with an emphasis on recent studies and reviews, was examined to identify major epidemiological findings and trends. RESULTS: Greater gambling availability was associated with an increase in participation and expenditure and a rise in at-risk and problem gambling prevalence rates. While problem gamblers experience considerable harm, most harm arises from non-problem gamblers. These harms are substantial and impact disproportionately marginalised populations. The burden of harm is mainly due to financial problems, damage to relationships and health, psychological distress and adverse effects on work and education. Although at-risk and problem gambling rates initially increased in many jurisdictions, they subsequently declined. More recently, in some jurisdictions, while gambling participation has declined, at-risk and problem gambling rates have plateaued. This at least partly is due to an accumulating 'pool' of past problem gamblers who are highly prone to relapse and other vulnerable groups continuing to experience heavy gambling exposure. CONCLUSION: Public health policies need to focus strongly on reducing exposure to more 'toxic' gambling forms as well as increasing the availability of interventions to assist at-risk and problem gamblers and prevent relapse. Policies and programmes are likely to be more effective if population heterogeneity is considered, and they also address the wide range of modifiable risk and protective factors at individual, community and societal levels. Many of these are shared with other health and social morbidities.

Gambling and gambling-related harm: recent World Health Organization initiatives.

OBJECTIVES: There has been unprecedented growth in commercial gambling. Increasingly gambling has migrated to the Internet and become readily accessible via mobile devices. Gambling disorder and gambling-related harm present a significant global public health challenge. To date, few jurisdictions have included gambling in health policies and addressed gambling-related harm within a comprehensive public health framework. The purpose of this study is to examine recent developments at the global level that may change this. STUDY DESIGN: This is a narrative review and examination of meeting content and outcomes. METHODS: Relevant literature was reviewed, and the content and outcomes of recent International Think Tank on Gambling Research, Policy and Practice and World Health Organization (WHO) meetings were identified, summarised and discussed. RESULTS: Although gambling disorder was included in the International Statistical Classification of Diseases in 1975, relatively little attention has been given to assessing wider gambling-related harms and addressing them within a public health framework. In recent years, this has changed with the first gambling studies to use burden of disease methodologies and the development of harm classifications and conceptual frameworks. This research has strengthened calls for gambling to be included in public health agendas. While few member states have done this, in the past few years gambling has received increased attention from the WHO. This includes its placement alongside alcohol and drugs in 2017 and 2019 WHO global forums and annual WHO meetings on public health implications of addictive behaviours. These and planned WHO meetings and activities are laying the groundwork for a WHO international gambling programme and work plan. CONCLUSION: A significant start has been made to address gambling disorder and gambling-related harm as an important global health issue. This has potential to encourage member states to explicitly include gambling in national and subnational public health plans. However, this progress may be precarious and is likely to require concerted advocacy and support from academic and other civil society organisations to sustain.

Prevalence and risks of pathological gambling in Sweden.

OBJECTIVE: This paper presents results from the first national survey of problem gambling completed in Sweden. METHOD: The Swedish survey is unique in its quality and representativeness, due to the use of multiple modes of data collection, recruitment of respondents from national registers rather than from households, and high response rate. RESULTS: In spite of high rates of gambling participation in Sweden, the combined prevalence of problem and pathological gambling in Sweden is relatively low (3.9% lifetime and 2.0% current). Multivariate analysis shows that being male, under the age of 25 and born abroad are significant risk factors for lifetime gambling problems in Sweden. Additional risk factors are being single, living in big cities, and receiving social welfare payments. CONCLUSION: The groups most at risk for gambling problems in Sweden are people disadvantaged and marginalized by international economic changes as well as the dismantling of the Swedish welfare system.

Recent Chinese migrants' health, adjustment to life in New Zealand and primary health care utilization.

A community survey of 271 Chinese migrants aged 15 years and older living in Auckland was conducted to assess self-rated adjustment and health. The majority of respondents came from Hong Kong and Taiwan. Despite significant changes in their lives, including the absence of family members, unemployment and underemployment, most did not report major adjustment problems or regret having come to New Zealand. Few considered their health to be poor. Forty-two per cent reported having consulted a doctor within the past 12 weeks. Factors significantly associated with having experienced major problems included being aged 26-35 years, rejection from locals and having low English proficiency. Factors associated with poor adjustment included expectations not having been met, regretting coming, low proficiency in English, recent arrival in New Zealand, unemployment, younger age and lower levels of education. Self-rated fair or poor health was found to be associated with Chinese-only reading knowledge, residency of more than 5 years and regretting having come to New Zealand.

Chinese migrants' mental health and adjustment to life in New Zealand.

OBJECTIVE: The purpose of this study was to identify and assess the relative importance of predictors of the self-rated adjustment and psychiatric morbidity of recent Chinese migrants. METHOD: Chinese migrants (n = 271) living in Auckland and aged 15 years or older completed a postal questionnaire that included the Chinese Health Questionnaire (CHQ). The majority of respondents came from Hong Kong and Taiwan. RESULTS: Most respondents did not report major adjustment problems. The psychiatric morbidity rate was 19%. Major predictors of experiencing problems included rejection by locals, being aged 26-35 years or over 45 years and low English proficiency. Major predictors of poor adjustment included unemployment, low English proficiency, lack of university education, younger age, shorter residency, expectations not met and regrets about coming to New Zealand. Predictors of minor mental disorder included regretting coming, female gender and younger age. For migrants resident 2 years or less, unemployment and underemployment were additional risk factors. Mothers with absent husbands and young people with absent parents also had elevated rates of mental disorder. CONCLUSIONS: Although the overall prevalence of mental disorder for this sample of recent migrants appears to be similar to that of the general population, significant risk factors were identified. The findings extend knowledge of the adjustment and the mental health of migrants and provide potential focal points for primary and secondary prevention interventions.

Gambling and problem gambling among indigenous peoples.

This paper compares results from studies of gambling and problem gambling among indigenous groups in New Zealand and in North Dakota. The samples for each of these studies included substantial numbers of indigenous respondents, and the methods used in these studies were similar enough to allow comparisons of Caucasian and indigenous groups from these two distinct cultures. Analysis shows that gambling involvement, gambling expenditures, and gambling-related problems are far higher among indigenous respondents than among Caucasian respondents in both New Zealand and North Dakota. These comparisons suggest that differences between indigenous peoples and Caucasians in gambling behaviors may be due to factors distinct from culture or milieu.

The New Zealand national survey of problem and pathological gambling.

In New Zealand, awareness of gambling-related problems has increased in association with the legalization of new forms of gambling. This paper presents the methods and selected results from a national survey of gambling and problem gambling completed in New Zealand in 1991. While the primary aim of the study was to determine the extent of problem gambling in New Zealand, the study included a second phase intended to assess the validity and reliability of the widely-used South Oaks Gambling Screen as well as to examine other aspects of problematic involvement in gambling. The results of the two-phase study in New Zealand show that problem gamblers in different countries are remarkably similar in demographic terms as well as with regard to other risk factors associated with problematic gambling involvement. The New Zealand study of problem gambling points the way toward important research topics that will require further exploration in the future.

Prevalence studies and the development of services for problem gamblers and their families.

Where funded by government, prevalence studies have typically led to the development of services for problem gamblers and their families. Such assessments of the need for services have been seen as the appropriate political response to growing expressions of concern about problem gambling that often follow moves to legislate for an increasing range of gambling products. This theme is apparent for Australia, Canada, New Zealand and the United States. In this paper, initiatives in these different jurisdictions are briefly summarized and tabulated.

Lifetime prevalence estimates of pathological gambling in New Zealand.

BACKGROUND: Legalized gambling has proliferated recently in many countries and is a public health issue because of the association between gambling participation and the prevalence of pathological gambling. Relatively little is known about the epidemiology of this disorder or the characteristics of pathological gamblers living in the community. This paper summarizes the major findings of a national prevalence survey of pathological gambling conducted in New Zealand; the first national survey to have been conducted to date, and compares them with the results of studies undertaken in the US and Canada. METHODS: A national adult sample of 4053 people was interviewed by telephone to determine involvement in gambling activities. The interview included the South Oaks Gambling Screen (SOGS) for pathological gambling. RESULTS: Of the sample, 2.7% (+/- 0.5%) scored as probable pathological gamblers and a further 4.2% (+/- 0.6%) scored as problem gamblers. These prevalence rates are higher than those reported in previous studies using the SOGS. Ethnicity, age, gender, employment status, having a parent who had gambling problems and regular participation in continuous forms of gambling were major risk factors. CONCLUSIONS: In New Zealand pathological gambling appears to have a lifetime prevalence approximately half that of drug abuse/dependence. The findings suggest that prevalence has increased in recent years and provide a baseline for further study. The risk factors identified give a focus for future research into aetiology, prevention and treatment.

Housing stressors, social support and psychological distress.

This paper explores the links between housing stressors, social supports and psychological distress. It was hypothesised that exposure to housing stressors would be significantly related to psychological distress, but that the adverse effects of housing stressors would be moderated by perceptions of social support resources. In other words, the stress/symptom relationship would be attenuated for individuals who believe that they have active and supportive social relationships. The results of a study conducted in the two New Zealand cities of Auckland and Christchurch partially confirmed this hypothesis, indicating that social support plays a role in mitigating the adverse effects of housing stressors. However, this relationship depends on the severity of the housing stressors. Among our respondents, the presence of social support was indeed associated with reduced symptom levels for those exposed to moderate housing stressors. However, among respondents subjected to high levels of housing stressors, social support was not associated with reduced psychological distress, indicating the need for a more specific policy response to the issue of seriously deficient housing.

Another day in paradise? Life on the margins in urban New Zealand.

This paper examines the relationships between housing and health with respect to a sample of New Zealand public housing applicants. In the first part of the paper, the notion of incipient homelessness is reviewed, the production of this population in advanced capitalist societies is considered and the social geography of the inadequately housed in New Zealand is surveyed. The second part of the paper presents some of the data collected in a survey of the inadequately housed in Auckland and Christchurch (n = 213 households). The results suggest that housing is an important determinant of the health and well-being of this population, but that rehousing the poor should be seen as only one step in addressing inequalities in contemporary urban New Zealand.

Who gets committed: demographic and diagnostic data.

The study compares the sociodemographic and diagnostic characteristics of patients committed to psychiatric care in New Zealand in 1984 with total admissions and with the general population. Committed patients were significantly more likely to be aged 20-39 years, male, of Maori or Pacific Island ethnicity, and have a diagnosis of schizophrenia or affective disorder. These findings provide a baseline from which we may assess changes in the committed patient population following reform of the Mental Health Act.

Locus of control and treatment outcome in alcoholics.

Alcoholism is no longer regarded as a unitary disorder, but conventional measures of cognition and personality have yet to be shown capable of consistently predicting clinical outcomes. The present study evaluated the ability of two measures of locus of control--a generalized measure (IE) and a drinking-related one (DRIE)--to predict therapy involvement during, and treatment outcome following, an abstinence-oriented inpatient program for alcoholics. Both measures were administered to 106 patients (32 women) once near the beginning and once near the end of treatment. A range of other sociodemographic and psychological data was also recorded. Significant and independent shifts in the internal direction were found on both measures from the first to second testing. Relationship between locus of control and treatment participation was weak. DRIE fared better than IE in predicting treatment outcome. Ability to predict outcome was enhanced when interactions between locus of control and cognitive dysfunction were considered and when analyses included nonlinear relationships between these measures and treatment outcome.

Olfaction in Korsakoffs, alcoholics and normals.

Samples of 12 hospitalized Korsakoffs, 12 hospitalized non-Korsakoff alcoholics, and 12 controls, all groups being of comparable age range, were tested using a set of seven visual and olfactory measures which involved memory. By stepwise multiple discriminant analysis it was shown that strong separation could be effected between the three groups, solely on the basis of the olfactory recognition and recall tests, which included the Campbell-Gregson (1972) procedure. The use of of anosmia as a diagnostic indicator for Korsakoff's syndrome is discussed.