PREVENTION OF PROBLEM GAMBLING : A COMPREHENSIVE REVIEW OF THE - - PowerPoint PPT Presentation

PREVENTION OF PROBLEM GAMBLING:

A COMPREHENSIVE REVIEW OF THE EVIDENCE AND IDENTIFIED BEST PRACTICES

• Dr. Robert Williams

Faculty of Health Sciences & Alberta Gambling Research Institute University of Lethbridge Many Ways to Help Conference Victorian Responsible Gambling Foundation Melbourne, Victoria October 22, 2014

Collaborators

• Ms. Bev West
• Former Research Associate, Faculty of Health

Sciences, University of Lethbridge, Lethbridge, Alberta

• Mr. Rob Simpson
• Former CEO, Ontario Problem Gambling

Research Centre, Guelph, Ontario

EDUCATIONAL EDUCATIONAL INITIATIVES INITIATIVES

Information/Awareness Campaigns Information/Awareness Campaigns

• e.g., ‘know your limits’; ‘gamble responsibly’; true odds;

dispelling fallacies; help lines; signs of PG

• n gambling product; posters at venue; radio/TV; websites;

presentations at schools

• Mixed results showing these messages can temporarily

improve knowledge and change attitudes

• However, a) most people don’t attend to them and b) effect
• n gambling behaviour fairly minimal (except for helpline

calls and presentation to treatment, which reliably increases)

• In other prevention fields, behavioural change uncommon,

and only occurs if info is personally relevant, behaviour easy to change, and consequences of not changing are significant (e.g., cholesterol, sodium, HIV testing)

On On-

• Site Information/Counselling

Site Information/Counselling Centres (RGICs) Centres (RGICs)

• Info about gambling/PG & referral to, or actual provision
• f counseling
• Since 2002; Australia, Canada, S. Korea, other countries
• High patron awareness, but low utilization
• 61,400 visits in Ontario 2005-2009 vs 200,000,000 customers
• 8,000 visits for Manitoba 2003-2006 vs 14,600,000 customers
• Mostly provide info on PG and make treatment referrals
• Information rated as helpful, but very low follow-through on

treatment referrals, and no impact on gambling behaviour

School School-

• Based Statistical

Based Statistical Instruction Instruction

• Teaching expected value, odds and mathematical

principles underlying gambling (and either directly or indirectly dispelling gambling fallacies)

• Several studies, with mixed results
• Reliable impacts on knowledge and gambling fallacies,

inconsistent impacts on subsequent gambling behaviour

Comprehensive School Comprehensive School-

• Based Prevention Programs

Based Prevention Programs

• “Don’t Bet on It” in Ontario; “Wanna Bet” in Minnesota; “Stacked

Deck” in Alberta, New York, North Carolina

• statistical knowledge; gambling fallacies; addictive nature of

gambling; building self-esteem, social problem-solving; peer resistance training

• Only 4 empirical studies: Reliable impacts on knowledge and

gambling fallacies, inconsistent impacts on behaviour (Stacked Deck only program to achieve behavioural change)

• School-based prevention programs in other fields (smoking,

drug use, etc.) have found similar mixed results

POLICY POLICY INITIATIVES INITIATIVES

Restrictions on the General Restrictions on the General Availability of Gambling Availability of Gambling

Restricting # of Gambling Venues Restricting # of Gambling Venues

• Good support by virtue of positive correlation between local PG rate and

proximity to gambling venues in U.S., N.Z., Australia & Canada

• This relationship strongest for casinos:

Canadian Provincial PG Prevalence vs. Venues per Capita

• Opening of new venues has also generally been associated with

subsequent increases in rates of PG

Casinos r = .75* Bingo Licenses r = .56 Horse Racing Venues r = .40 EGM Locations r = -.01 Lottery Outlets r = -.50

Restricting More Harmful Types Restricting More Harmful Types

• f Gambling
• f Gambling
• EGMs, casino table games, Internet gambling
• Strong relationship between EGMs per capita and PG rates

within countries (r = .66* Canada; r = .60 Australia)

• However, no correlation between countries (tau b = -.18)
• Modest EGM reductions do not produce much effect on PG

rates (e.g., Victoria; S. Australia; Nova Scotia)

• However, total EGM elimination in South Dakota (1994) South

Carolina (2000), and Norway (2007) did reduce PG.

• Prevalence of Internet problem gambling directly related to its

legal availability

• One of the strongest associations with PG is

number of gambling formats person engages in

• Reducing/restricting the number of gambling

formats is a theoretically sensible strategy

• No empirical evidence

Restricting the Number of Restricting the Number of Gambling Formats Gambling Formats

Limiting Gambling to Gambling Limiting Gambling to Gambling Venues Venues

• Theoretically sensible, but lacks empirical support
• In Canada, no relationship between # EGM locations per capita and

provincial PG rates (r = .01).

• In U.S. no significant difference in PG prevalence in 5 states with

EGM’s outside gambling venues (2.3%) vs states that only have EGM’s within dedicated gambling venues (2.2%)

• In Europe, EGMs found outside gambling venues in most countries,

yet Europe tends to have lower rates of PG

• However, part of the explanation is that jurisdictions with this policy

tend to increase number of ‘dedicated gambling venues’ to compensate (e.g., France has 197 ‘casinos’, California has 162 , etc.).

Restricting the Location of Restricting the Location of Gambling Venues Gambling Venues

• Individual vulnerability one of the strongest predictors of PG.

Historically, casinos were always kept away from major urban centers.

• Worldwide, PG and other addictions more often found in

poorer neighborhoods

• In Canada, provincial PG rates strongly correlated with

proportion of the provincial population with Aboriginal ancestry (r = .94*) as well as provincial rates of alcohol dependence (r = .71*).

Limiting Gambling Venue Hours Limiting Gambling Venue Hours

• Common policy in some countries
• Has good support in the alcohol policy field
• Reduction in hours in jurisdictions that have done this

(i.e., Nova Scotia, Australia) had modest effects on PG expenditure (probably because the magnitude of the reduction was fairly small)

POLICY POLICY INITIATIVES INITIATIVES

Restrictions on Who can Restrictions on Who can Gamble Gamble

Prohibition of Youth Gambling Prohibition of Youth Gambling

• Despite almost worldwide underage prohibition:

– underage youth may still have significant rates of PG – countries with permissive attitudes toward youth gambling (U.K., Nordic countries), have lower rates of adult PG

• Could early exposure have beneficial effects?
• Important lessons from the alcohol field (China, southern

Europe, Israel vs. France & Aboriginal populations) showing that early exposure counterproductive unless associated with extended modeling of appropriate use

Raising Legal Age for Gambling Raising Legal Age for Gambling

• Currently ranges from 16 to 25 depending on the

jurisdiction and type of gambling

• 18 – 25 year olds have the highest rates of PG
• In the alcohol field, it is clear that increasing the legal

age significantly decreases use and abuse

• Norway found a significant decrease in EGM use when

legal age increased from 16 to 18

Restricting Venue Entry to Restricting Venue Entry to Non Non-

• Residents

Residents

• Historically, a common policy
• Currently: Bahamas, Malaysia, Vietnam, Nepal,

Papua New Guinea, Australia (online casinos), Slovenia (4 times/month), S. Korea (1/16 casinos)

• Theoretically sound, but very little evidence
• However, casino gambling uncommon in S. Korea (i.e., < 5% of

the population), and rates of PG much lower than other Asian jurisdictions (i.e., Singapore, Hong Kong, Macau)

Restricting Venue Entry to Higher Restricting Venue Entry to Higher Socioeconomic Groups Socioeconomic Groups

• e.g. dress codes (Europe); income test

(Panama, Singapore, Germany); significant entrance fees (Papua New Guinea, Singapore)

• Effectiveness unknown, although low income is

a good predictor of PG status in western countries

POLICY POLICY INITIATIVES INITIATIVES

Restrictions on How Restrictions on How Gambling is Provided Gambling is Provided

Modifying EGM Parameters Modifying EGM Parameters

• Speed; Near misses; # play lines; Bill acceptors; Bet size;

Maximum win; Interactive features; Pop-up messages; Clock; Mandatory cash out; Payback %; Privacy; $ versus credits; Lights & Sounds; Seating

• Research shows some utility for: eliminating early big win,

reducing near misses, slower speed, dynamic pop-up messages, lower max bet size, fewer betting lines, eliminating bill acceptors

• However, magnitude of effect is small, especially for PGs
• Reminiscent of attempts to minimize tobacco harm by

adding filters and use of ‘low tar’ cigarettes (i.e., these will always be high risk devices)

Player Pre Player Pre-

• Commitment

Commitment

• Some EGMs and Internet gambling sites allow gamblers to

establish time and/or spending limits.

• Low utilization when pre-commitment not mandatory
• Even when mandatory
• Limited effectiveness when limits easily revocable
• Limited effectiveness if other opportunities available (i.e., ability to

use other EGMs or other Internet sites that do not require pre- commitment)

• Limited effectiveness if you can use other people’s ID

• Heavy gamblers are most likely to have these
• Anecdotally, appears to encourage excessive

expenditure

• Unclear why these exist at all
• Most countries do not allow incentivization of increased

alcohol, tobacco, or prescription drug use consumption

• Reward ‘responsible gambling’

Elimination of Player Elimination of Player Reward/Loyalty Programs Reward/Loyalty Programs

Operator Imposed Maximum Operator Imposed Maximum Loss Limits Loss Limits

• Exists on some govt-operated online sites; NZ lottery;

and in Norway (EGMs, sports betting, & online site)

• In Norway, implementation associated with:
• Lower gambling revenue (especially toward end of month)
• Dramatically lower help-line calls for slot machines (n = 42 from

2009 – 2011)

• No overall decrease in PG, which was quite low to begin with

(~1.0%)

Employee PG Awareness Employee PG Awareness Training Training

• Began in Holland in late 80s, now common
• The few ‘satisfaction’ or ‘knowledge’ evaluations have

been positive

• However, in alcohol field, training of alcohol servers has

had mixed behavioural effects due to conflict with profits, lack of enforcement, and personal drinking habits which are inconsistent with the policy

• High level of casino visitation leads to automatic

intervention in Netherlands and Austria

• Risky gambling patterns in Player Card data used to alert

staff (Saskatchewan; SkyCity casino NZ) or player (Sweden)

• Positive behavioural results, more so for direct player alerts
• Theoretically sensible, as much easier to treat emerging

rather than existing problems

Automated Intervention for Automated Intervention for ‘ ‘At At-

• Risk

Risk’ ’ Gamblers Gamblers

Restricting Access to Money Restricting Access to Money

• House credit banned throughout Europe, Australia,

Canada (except ONT); U.S. only country where common

• ATMs typically permitted at gambling venues (not South

Africa, Singapore); withdrawal limits in some places

• Theoretically sensible, as ATM use much higher for PGs,

and PGs often report that restricting ATM availability would be very helpful

• Only one empirical study in Australia, which showed

clear beneficial behavioral effects

Restrictions on Concurrent use Restrictions on Concurrent use

• f Alcohol & Tobacco
• f Alcohol & Tobacco
• Free and/or low cost alcohol common in U.S., eastern

Europe, some Australian states, Macau

• Smoking now only common in Aboriginal casinos and some

non-western countries

• Very strong association with PG, thus, restrictions may serve

strong preventative measure

• Evidence indirectly seen in significant reduction in gambling

revenue occurring in jurisdictions that instituted smoking bans

• Puzzle concerns mechanism by which this revenue has

recovered

Restricting Advertising Restricting Advertising

• Most European countries limit publicity and require

informing public about dangers. Increasingly common in

• ther countries.
• Small to negligible impact on most people, with two

important exceptions:

• PGs report that advertising is a common trigger to gamble
• In the field of alcohol and tobacco, advertising is known to

promote youth involvement

Gambling Venue Design Gambling Venue Design

• ‘Vegas-style’ design believed to encourage gambling

both by venue developers and by gamblers

• However, very little evidence on whether it impacts

actual gambling behaviour

• Unlikely to be strong effect, as EGM revenue per

machine similar regardless of location (convenience stores, casinos, restaurants, bars, hotels, ships)

Increasing Cost of Gambling Increasing Cost of Gambling

• Effective policy for reducing harm associated with

alcohol & tobacco

• Does this apply to gambling when highest

patronization occurs for forms with lowest payback % (i.e., lotteries, instant win tickets)?

• For gambling, ‘perception of cost’ more important than actual

cost (i.e., people attentive to cost of playing relative to possible reward)

• preference for ‘penny slots’, cheap lottery tickets & large jackpots
• Thus, probably utility in legislating a minimum bet size and

maximum win size

Government vs. Private Provision Government vs. Private Provision

• Conflict of interest exists when provider and regulator

part of same organization (government)

• Theoretically, this conflict more likely to impede

implementation of policies that interfere with revenue.

• However, in practice, responsible gambling measures

more common in jurisdictions with this conflict (e.g., Canada vs U.S.).

• Furthermore, in alcohol field, monopolistic &/or govt

provision is associated with less harm to public

SUMMARY SUMMARY

• Large array of initiatives exist, most with

relatively little direct empirical evidence about effectiveness.

• However:

– Some evidence on most of these initiatives – Vast literature in other prevention fields to guide PG efforts

SUMMARY SUMMARY

 Most commonly implemented measures tend to be least effective ones (e.g., awareness campaigns, employee training, EGM modifications)  Furthermore, when potentially more effective measures are implemented (e.g., reduced EGMs, reduced hours), reductions usually too minor to have major effect  Unrealistic desire to implement effective prevention policies that do not inconvenience non-problem gamblers or reduce revenues

BEST PRACTICE #1: BEST PRACTICE #1: Recognize that Recognize that Effective Effective PG PG Prevention will Likely Require Prevention will Likely Require Some Inconvenience to Some Inconvenience to Nonproblem Gamblers and Some Nonproblem Gamblers and Some Loss of Revenue Loss of Revenue

• Goal of harm minimization has to be given equal

priority to revenue generation

BEST PRACTICE #2: BEST PRACTICE #2: Use a Large Array of Educational Use a Large Array of Educational and Policy Initiatives and Policy Initiatives

• Almost nothing that is not helpful to some extent.
• Conversely, no single measure has great ability to prevent

problems.

• Recognize that policy measures are equally, if not

more important than educational initiatives

BEST PRACTICE #3: BEST PRACTICE #3: Coordinate these Multiple Initiatives Coordinate these Multiple Initiatives

• Offer these initiatives simultaneously, rather than

sequentially, and make sure the messages do not conflict.

• A ‘shotgun’ blast only effective if every pellet directed at

same target at the same time.

• Each overlapping initiative reinforces the others, creating a

synergy beyond what occurs with individual efforts.

BEST PRACTICE #4: BEST PRACTICE #4: Decrease the General Availability Decrease the General Availability

• f Gambling
• f Gambling
• Limit or reduce the number of Casinos/EGM venues.
• Limit number of gambling formats.
• Keep gambling venues away from vulnerable populations.
• Restrict gambling opportunities to dedicated gambling

venues.

• Reduce hours of operation.

BEST PRACTICE #5: BEST PRACTICE #5: Eliminate or Constrain High Eliminate or Constrain High-

• Risk

Risk Forms of Gambling Forms of Gambling

• i.e., EGMs, Casino Table Games, Internet

Gambling

• Constrain EGM speed, min & max bet, max win

size, near misses, # play lines

• Require pre-commitment

BEST PRACTICE #6: BEST PRACTICE #6: Eliminate Reward Cards or Use them Eliminate Reward Cards or Use them to Foster Responsible Gambling to Foster Responsible Gambling

• No reward points after certain level of

expenditure

• Use the data to proactively alert players to risky

behaviour

BEST PRACTICE #7: BEST PRACTICE #7: Restrict who is Eligible to Gamble Restrict who is Eligible to Gamble

• Introduce graduated ability to gamble

independently.

• Raise legal age.

BEST PRACTICE #8: BEST PRACTICE #8: Restrict the Use of Tobacco and Restrict the Use of Tobacco and Alcohol While Gambling Alcohol While Gambling

• Deters PGs from gambling in the first place.
• Encourages them to take breaks.
• Allows them to gamble without disinhibiting

effects of alcohol.

BEST PRACTICE #9: BEST PRACTICE #9: Restrict Access to Money While Restrict Access to Money While Gambling Gambling

• Gambling venues should not offer credit.
• ATMs should not be conveniently close.

BEST PRACTICE #10: BEST PRACTICE #10: Impart Knowledge, Attitudes, and Impart Knowledge, Attitudes, and Skills to Inhibit the Progression to Skills to Inhibit the Progression to Problem Gambling Problem Gambling

• Best done with comprehensive school-based

programs (e.g., Stacked Deck).

• However, adult interventions also necessary

(RGICs; Information/Awareness Campaigns; Low Risk Guidelines; etc.)

BEST PRACTICE #12: BEST PRACTICE #12: Keep these Initiatives in Place Keep these Initiatives in Place for Many Years, Because for Many Years, Because Population Population-

• Wide Behavioural

Wide Behavioural Change Takes a Long Time Change Takes a Long Time

For more information For more information

• Williams, R.J., West, B., and

Simpson, R. (2012). Prevention

• f Problem Gambling: A

Comprehensive Review of the Evidence and Identified Best

• Practices. Report prepared for

the Ontario Problem Gambling Research Centre and the Ontario Ministry of Health and Long Term

• Care. Oct 1, 2012.

http://hdl.handle.net/10133/3121