Allyson J. Peller

Real Limits in the Virtual World: Self-Limiting Behavior of Internet Gamblers

The recent expansion of Internet gambling has stimulated debate, policy, and research on this relatively new phenomenon and its potential consequences. The current study focuses on bettors experiencing problems by sampling Internet gamblers who imposed limits on the amount they were allowed to deposit to a betting site. We analyzed the betting transactions over 18xa0months of all gamblers who subscribed to an online betting site in February, 2005 (Nxa0=xa047,134), 567 of whom utilized the site’s self-limit feature. Self-limiting gamblers played a wider variety of games and placed more bets than others prior to imposing limits. After imposing limits, self-limiters reduced their activity, but did not reduce the amount they wagered per bet. Time spent gambling, not just money spent, appears to be an important indicator of gambling problems. Self-limit programs appear to be promising options for Internet gamblers at-risk for gambling problems.

Association of rheumatologic disease with preeclampsia.

OBJECTIVE: To determine whether maternal rheumatologic disease is associated with an increased risk of adverse obstetric or neonatal outcomes. METHODS: Using an institutional database, we identified all women with diagnosed rheumatologic disease (n = 114) who delivered a baby at our institution during a 33-month period. We compared the incidence of adverse obstetric and neonatal outcomes among these women with the incidence among women without rheumatologic diseases (n = 18,534). RESULTS: Women with rheumatologic diseases were more likely to have preeclampsia than women without rheumatologic disease (8.8% versus 2.3%, P < .001) Women with rheumatologic diseases were also at increased risk of preterm delivery (15.2% versus 7.8%, P = .002) and small-for-gestational-age infants (8.0% versus 3.1%, P = .001) compared with women without rheumatologic disease. CONCLUSION: The finding that women with rheumatologic diseases are at increased risk of adverse obstetric outcomes suggests a need for heightened clinical vigilance and further research into the common pathophysiologic correlates. LEVEL OF EVIDENCE: II-2

Trends in congenital malformations, 1974-1999: Effect of prenatal diagnosis and elective termination

OBJECTIVE: To examine trends in congenital malformations, elective terminations for malformations and correlates for the decision to terminate a pregnancy with a malformation. METHODS: All malformed liveborn and stillborn infants and elective terminations for malformations were identified in a large urban tertiary center and general hospital for the years 1974, 1979, 1984, 1989, 1994, and 1999. Nine hundred and fifty-four women with malformed infants, who had always planned to deliver at the hospital, were identified. Prenatal screening by ultrasonography or amniocentesis before 24 weeks of gestation, severity rating of the malformation, parity, marital status, race, level of education, insurance status, and pregnancy history were determined RESULTS: In each of these 6 years, about 2% of newborn infants had a major malformation. The rate of prenatal screening by ultrasonography and amniocentesis before 24 weeks increased from 7% in the years 1974 and 1979 to 61% in the years 1984 and 1989 to 89% in the years 1994 and 1999. Elective termination increased from less than 1% in the years 1974 and 1979 to 18% to 20% in the years 1984, 1989, 1994, and 1999. Pregnancies with fatal and severe conditions were much more likely to be terminated electively than pregnancies with moderate or mild conditions (odds ratio 53.3; 95% confidence interval 22.7–124.7) CONCLUSION: The introduction of routine prenatal screening and the subsequent increase in elective termination for malformed fetuses means that the inclusion of terminated pregnancies in malformation surveillance programs is necessary to study prevalence and risk factors in the epidemiology of malformations.

Toward a paradigm shift in Internet gambling research: From opinion and self-report to actual behavior

Internet gambling is one of the fastest growing gambling-related industries (Christian Capital Advisers 2006). As the Internet gambling industry expands, many stakeholders have created, or are in the process of creating, gambling-related policy. Policy makers promulgating these regulations rely on professional opinions and/or conventional wisdoms related to Internet gambling to guide them because of the lack of sufficient scientific research. There is an ongoing need for quality empirical research to guide the development of public policies that surround Internet gambling. This article summarizes the current state of scientific research about Internet gambling by identifying, describing, and critiquing the available peer-reviewed literature. To identify the peer-reviewed literature related to Internet gambling published between January 1, 1967 and March 7, 2008, we used the search term “Internet [AND] gambling” in the PubMed and PsychINFO search engines. Of the 111 articles identified by our systematic search, only 30 included Internet gambling as a focus. The study methods presented in the abstracts of these 30 articles indicate that none included actual gambling behavior: 10 provided self-reports of gambling behavior using samples not representative of the general population, and 20 of the 30 articles were commentaries. In response to the clarion call to improve the state of psychological research (Baumeister et al. ), we have conducted research utilizing actual Internet gambling behavior. In contrast to prior self-report and case study research, our investigations using actual Internet gambling behavior suggest an overall pattern of moderate Internet gambling behavior (LaBrie et al. ).

Obstetric and neonatal outcomes associated with maternal hypothyroid disease.

Objective: We sought to determine whether women with treated hypothyroid disease were more likely than women without thyroid disease to suffer adverse obstetric or neonatal outcomes or to deliver a child with a congenital anomaly. Methods: Using an institutional database, we identified women with treated hypothyroid disease (nu200a=u200a482) who delivered a baby at our institution during a 33-month period. We compared the occurrence of adverse obstetric or neonatal outcomes among these women to the occurrence among women without thyroid disease (nu200a=u200a19,487). Results: Women with treated hypothyroid disease were not at increased risk for delivering a baby with low birth- weight, fetal demise, or congenital anomaly compared to the control group. Women with treated hypothyroid disease were more likely to have chronic hypertension (2.3% vs. 1.2%, pu200a=u200a0.03) and had an increased risk of pre-eclampsia (4.3% vs. 2.6%, pu200a=u200a0.03) compared to women without thyroid disease. Conclusion: Women with treated hypothyroid disease are not at higher risk than the general population for adverse neonatal outcomes, but may be at increased risk for pre-eclampsia.

Parameters for Safer Gambling Behavior: Examining the Empirical Research

There have been claims that new gambling technology is hazardous to player health, and that technological interventions can alleviate gambling-related harm. In this paper, we systematically review the empirical research about the nexus between gambling and technology to evaluate the veracity of these claims. We use a public health perspective (i.e., the Epidemiologic Triangle) to organize and present study results (i.e., agent, host, and environment). This review intends to offer insight about emerging technology and identify areas that indicate a need for additional research. Forty-seven studies met our inclusion and exclusion criteria; a review of this body of work shows that attempts to develop and implement safety features for new gambling technology are promising, but methodologically are rudimentary and limited in scope. Increased attention to the dynamic interaction among host, agent, and environment factors hold potential to advance the field. In addition, improved study methods (e.g., longitudinal analyses of actual betting behavior), and collaboration among policymakers, manufacturers, and researchers can increase understanding of how new gambling technology affects the public health and stimulate new strategies for implementing effective public health interventions.

Missouri Casino Self-Excluders: Distributions Across Time and Space

According to public health research, exposure to casinos is a risk factor for disordered gambling. Consequently, casino self-exclusion programs, which provide gamblers with the opportunity to voluntarily seek limits on their access to gambling venues, can serve as a barometer of the concentration of disordered gambling in an area. This study reports on the distribution, both temporally and geographically, of 6,599 people who applied to exclude themselves from Missouri casinos between November, 1996 and February, 2004. Analyses used Microsoft MapPoint to plot the location of casinos and self-excluders (SEs) across Missouri and its constituent counties. These regional exposure analyses showed that the Western region around Kansas City is an epicenter of disordered gambling as, to a lesser extent, is the Eastern region around St. Louis. The annual number of SE enrollments increased during the first few years of the Missouri self-exclusion program and then leveled off during the later years. These findings have important implications for public health and the development of public health interventions for disordered gamblers.

A Brief Self-Help Toolkit Intervention for Gambling Problems: A Randomized Multisite Trial

Two studies conducted in Massachusetts and Nevada evaluated the efficacy of a self-help toolkit for problem gambling. Individuals concerned about gambling-related problems, in response to public notices and newspaper advertisements, volunteered for a randomized trial of the self-help toolkit, Your First Step to Change: Gambling. Participants were randomly assigned to 1 of 3 conditions: (a) a printed toolkit, (b) the toolkit and a brief guide to the toolkits content, or (c) assignment to a wait-list condition. Participants, 145 in Massachusetts and 170 in Nevada, reported their gambling behavior, beliefs and attitudes about chance, and recent and planned help seeking at baseline, 88% at 1 month later, and 79% at 3 months later. Findings for the complete and intent-to-treat analyses at both sites indicated that participants significantly improved. At the end of the study period, significantly more toolkit recipients than control group participants reported recently abstaining from gambling. Minimally invasive, self-directed resources like this self-help toolkit can assist remediating gambling-related problems among gamblers who do not engage in formal treatment.

Bipolar disorder as a risk factor for repeat DUI behavior.

BACKGROUNDnBipolar disorder (BD) is more prevalent among people with substance use disorders (SUD) than the general population. SUD among recidivist driving under the influence (DUI) populations are extremely prevalent; not surprisingly, recent evidence suggests that rates of BD also are elevated among DUI offenders. Studies of BD patients with SUD have found high prevalence of other psychiatric disorders and relatively low rate of treatment engagement. This study examines both the prevalence of other mental disorders and treatment status among a cohort of DUI offenders with BD and SUD.nnnMETHODSnA consecutively selected cohort (N=729) of repeat DUI offenders attending a two-week inpatient treatment program completed a standardized diagnostic interview (the Composite International Diagnostic Interview: CIDI). The CIDI generated DSM-IV diagnoses.nnnRESULTSnThis study yielded three main results for this repeat DUI offender sample: (1) BD is associated with significantly higher lifetime prevalence of alcohol, drug, and non-substance psychiatric disorders (e.g., PTSD); (2) approximately one quarter of BD participants have not discussed their mania with a professional; and (3) only half of the BD participants in this cohort have had mania treatment they consider effective and even fewer have had any treatment during the past twelve months.nnnLIMITATIONSnParticipants were predominantly Caucasian males attending treatment as a sentencing option in a single Massachusetts DUI program.nnnCONCLUSIONnThese findings suggest that clinicians in DUI treatment settings should consider both evaluating for BD and initiating therapy.

PTSD Among a Treatment Sample of Repeat DUI Offenders

Recent studies indicate that posttraumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among driving-under-the-influence (DUI) offenders in treatment. Investigation of DUI offenders PTSD and clinical characteristics could have important implications for prevention and treatment. This prospective study examined the demographic and clinical characteristics of repeat DUI offenders with PTSD symptoms at baseline and 1-year follow-up. Seven hundred twenty-nine DUI offenders admitted to a 2-week inpatient program participated in the study. Participants with PTSD evidenced more severe psychiatric comorbidity and reported a higher DUI recidivism rate at 1-year than those without PTSD. This study suggests a need to address PTSD among DUI offenders, as well as to further develop methodologies for accurately reporting DUI recidivism.