Erika Langham

Understanding gambling related harm: a proposed definition, conceptual framework, and taxonomy of harms

BackgroundHarm from gambling is known to impact individuals, families, and communities; and these harms are not restricted to people with a gambling disorder. Currently, there is no robust and inclusive internationally agreed upon definition of gambling harm. In addition, the current landscape of gambling policy and research uses inadequate proxy measures of harm, such as problem gambling symptomology, that contribute to a limited understanding of gambling harms. These issues impede efforts to address gambling from a public health perspective.MethodsData regarding harms from gambling was gathered using four separate methodologies, a literature review, focus groups and interviews with professionals involved in the support and treatment of gambling problems, interviews with people who gamble and their affected others, and an analysis of public forum posts for people experiencing problems with gambling and their affected others. The experience of harm related to gambling was examined to generate a conceptual framework. The catalogue of harms experienced were organised as a taxonomy.ResultsThe current paper proposes a definition and conceptual framework of gambling related harm that captures the full breadth of harms that gambling can contribute to; as well as a taxonomy of harms to facilitate the development of more appropriate measures of harm.ConclusionsOur aim is to create a dialogue that will lead to a more coherent interpretation of gambling harm across treatment providers, policy makers and researchers.

Breaking Bad: Comparing Gambling Harms Among Gamblers and Affected Others

This article examines gambling harms from both gamblers and affected others’ perspectives. Participants (3076 gamblers and 2129 affected others) completed a retrospective survey that elicited information on harms they experienced from gambling across their lifetime. Their responses were analyzed through testing measurement invariance, estimating item-response theoretic parameters, calculating percentages, confidence intervals, and correlations, as well as regressions. The results indicated large commonalities in the experience of harms reported by gamblers and affected others. Further, gamblers appeared to ‘export’ about half of the harms they experienced to those around them. The findings also provided detailed profiles of evolving harms as problem gambling severity varies.

Hierarchy of Gambling Choices: A Framework for Examining EGM Gambling Environment Preferences

This paper presents the Hierarchy of Gambling Choices (HGC), which is a consumer-oriented framework for understanding the key environmental and contextual features that influence peoples’ selections of online and venue-based electronic gaming machines (EGMs). The HGC framework proposes that EGM gamblers make choices in selection of EGM gambling experiences utilising Tversky’s (Psychol Rev 79(4):281–299, 1972). Elimination-by-Aspects model, and organise their choice in a hierarchical manner by virtue of EGMs being an “experience good” (Nelson in J Polit Econ 78(2):311–329, 1970). EGM features are divided into three levels: the platform—including, online, mobile or land-based; the provider or specific venue in which the gambling occurs; and the game or machine characteristics, such as graphical themes and bonus features. This framework will contribute to the gambling field by providing a manner in which to systematically explore the environment surrounding EGM gambling and how it affects behaviour.

Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?

Background Social and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS. Methods Cross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening. Results The largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases. Conclusion Our findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.

A tale of two countries: comparing disability weights for gambling problems in New Zealand and Australia

PurposeThis study aimed to assess the impact of gambling problems on quality of life. Specifically, we generated disability weight estimates for gambling problems in New Zealand, and compared these results with (i) Australian figures (J Gambl Issues, 10.4309/jgi.v0i36.3978, 2017) and (ii) other health states (Lancet, 10.1016/S0140-6736(12)61680-8, 2013); such as anxiety and alcohol use disorders.MethodThe 324 participants (48 experts and 276 general population members) evaluated a series of gambling harm vignettes. The participants rated the decrement to one’s quality of life using Visual Analogue Scale and Time Trade-Off protocols (Br Med Bull, 10.1093/bmb/ldq033, 2010). These evaluations enabled the calculation of disability weights for three categories of gamblers (low-risk, moderate-risk, and problem gamblers).ResultsDisability weight estimates for low-risk, moderate-risk, and problem gamblers in NZ were consistently higher than the Australian weights: low (0.18 vs. 0.13), moderate (0.37 vs. 0.29), and problem (0.54 vs. 0.44). The quality of life impact for problem gambling in NZ (0.54) was comparable to that experienced in severe alcohol use disorder (0.55) (Lancet, 10.1016/S0140-6736(12)61680-8, 2013).ConclusionsThis study represents one of the first attempts to assess gambling-related harm through a public health perspective. The results of this study are informative for policy-making, resource allocation, and service planning. These estimates now allow for the population-level impact of gambling in NZ to be calculated and tracked over time, which is essential for informing harm-minimisation initiatives.

Planning to Practice: Developing Partnership-Building Skills Across the Curriculum

The ability to work in effective collaborations has long been a foundation of health promotion and environmental health practice and, more recently, has been explicitly identified in international accreditation competencies. While limited evidence is available on strategies to teach these skills within single courses, there are no guidelines on best practice, or how to develop the skills across a curriculum. In this article, we demonstrate the scaffolding of partnership building knowledge and skills across an undergraduate public health curriculum through the application of the cognitive apprenticeship model. Using a fading concept, students move from staff-directed to independent practitioners in the development and demonstration of partnership building skills. The model offers an example of cross-program scaffolding for skills that could be adapted to other competencies, disciplines, and contexts.

Validation and Factor Analysis of the Child and Youth Resilience Measure for Indigenous Australian Boarding School Students

Introduction: Resilience is a strengths-based construct that is useful for understanding differences in health and wellbeing among youth. There are a range of validated survey instruments available to measure resilience for Aboriginal and Torres Strait Islander (hereafter respectfully Indigenous1) youth. However, standard international instruments should only be used if they have been subjected to a rigorous cross-cultural adaptation process and psychometric evaluation in the target population to ensure their validity. The aim of the study was to validate an adapted Child and Youth Resilience Measure (CYRM-28) within a sample of Indigenous Australian boarding school students. Method: The CYRM-28, augmented with an additional 11 site specific items was administered to a purposive sample of Australian Indigenous boarding school students (n = 233) as part of the broader T4S survey instrument that captures demographic information and measures resilience, psychological distress and risk, and service usage. Confirmatory factor analysis was undertaken to verify the relationship between the observed variables with the theoretical constructs of the CYRM-28 and previous findings on the factor structure. Cronbach alpha was also calculated to assess the internal consistency of the CYRM-28 within this sample. Results: Survey data were not a good fit for any previously identified models of the CYRM-28, although the inclusion of a site-specific variable improved the overall fit statistics. Two separate scales were confirmed that capture the sources and expressions of resilience for Indigenous Australian boarding school students. This structure is different to previous findings in relation to the CYRM-28, but consistent with conceptualizations of resilience as a dynamic process. Conclusions: The findings are useful in guiding the future use of the CYRM-28 instrument, explorations of Indigenous youth resilience, and for services working with Indigenous youth in out of home care situations. They highlight contextual differences in the measurement of resilience and the importance of validating standard instruments that have been subjected to rigorous cross-cultural adaptation processes. The two scales offer practical guidance to human services working with Indigenous youth on strategies to build and monitor resilience in Indigenous Australian youth and contribute to the emergent understanding of their resilience.

Traditional and innovated gambling products: an exploration of player preferences

Abstract There is concern that recent innovations of traditional face-to-face gambling products may lead to increased harm because of the tendency for innovated products to share certain structural features with electronic gaming machines (EGMs). The VICES framework focusses on several mechanisms known to influence gambling behaviour: visual and auditory enhancements, illusions of control, cognitive complexity, expedited play and social customization. The current study applied the VICES framework to an investigation of player experiences with both traditional and innovated gambling products. Through a series of six focus groups (N = 40) with regular bingo, poker and casino table game players and sports bettors, we examined the characteristics of innovated gambling products and their influences on player experience and the risk of gambling harm. Findings suggest that traditional games are perceived as more social, more enjoyable and less harmful. This was largely attributed to the low social interaction, expedited play and increased potential for consumption that is associated with EGM-type gambling activity. Further, we suggest that VICES, pending some revision, is a valid and applicable framework by which to identify characteristics of innovated products that influence player experience and behaviour.

Could EGM player-tracking systems help link gamblers to treatment services in Australia: a thematic analysis of counsellor and community educators’ perspectives

Abstract There are a number of different pathways to care that people experiencing problems with gambling may pursue. The current research examined the potential of player-tracking systems, such as pre-commitment technology or loyalty cards, to improve the delivery of links to treatment. Thirty-three key informants from gambling treatment and community education in Australia were interviewed about the potential contributions of these technologies to helping link gamblers with problems to treatment services. Thematic analysis revealed three broad considerations for effective links to treatment using these technologies. First, links need to be appropriate in terms of the multitude of problems (other than gambling) that people might face with customized links appropriate to a gambler’s circumstances. Second, the presentation of the links should make them easy to notice and appropriately timed. Third, links should be provided as part of a broader strategy of harm minimization; by recognizing where people are in terms of behavioural change; providing positively framed guidance; and maintaining consistency with public health approaches. This research provides guidance based on informed expert opinion on what features of technology-driven links-to-treatment are likely to meet with greatest success.

How gambling harms experienced by Pacific people in New Zealand amplify when they are culture-related

Pacific people in New Zealand are a minority ethnic population identified in national prevalence studies as having the highest risk of developing gambling problems. As earlier studies identified some links between culture and gambling for this population, our study aimed to deepen understanding of these links and their role in explaining the disproportionate gambling harms experienced by Pacific people. To achieve this aim we employed intersectionality as a theoretical framework to explore the culture-gambling intersection for this population group. We analysed data from a subset of focus groups conducted for a broad study of gambling harms in New Zealand. The subset was selected based on the presence of individuals knowledgeable about Pacific people’s gambling behaviours, including staff from Pacific problem gambling treatment services who provided examples from a cultural perspective. We identified themes at a latent level via an interpretive process to identify underlying cultural contexts of gambling harms. Findings indicated that whilst harms experienced by Pacific people were similar to those identified amongst the general population, the cultural contexts in which some harms manifested were complex. This paper contributes to the existing knowledge base about gambling harms for Pacific people in relation to six culture-gambling intersecting themes that emerged from the data: collectivism, gift-giving, gambling-based fundraising, patriarchy, beliefs about blessings, and sports celebrities. Findings are discussed in relation to the current knowledge of gambling and conceptualisations of gambling harm within Pacific communities. Implications for culturally appropriate harm minimisation strategies and prevention interventions for this population are suggested.