Mark van der Maas

Problem gambling, anxiety and poverty: an examination of the relationship between poor mental health and gambling problems across socio-economic status

AbstractSocio-economic status has been shown to be significantly related to both problem gambling and mental health problems. Additionally, forms of psychopathology such as mood and anxiety disorders have been shown to correlate with problem gambling across a variety of settings. However, relatively little research has been conducted examining whether the connection between mood and anxiety disorders and problem gambling is consistent across different levels of socio-economic status. This study examines gambling-related problems among a representative sample of Canadian adults using the 2008 Canadian Community Health Survey (N = 28,271). Generalized linear modelling is used to analyze the data. A moderation effect is found that shows the relationship between anxiety disorders and problem gambling severity varies significantly across socio-economic status. This study shows that social setting has an important influence on the assumed relationship between psychopathology and gambling problems that is downpl...Abstract Socio-economic status has been shown to be significantly related to both problem gambling and mental health problems. Additionally, forms of psychopathology such as mood and anxiety disorders have been shown to correlate with problem gambling across a variety of settings. However, relatively little research has been conducted examining whether the connection between mood and anxiety disorders and problem gambling is consistent across different levels of socio-economic status. This study examines gambling-related problems among a representative sample of Canadian adults using the 2008 Canadian Community Health Survey (N = 28,271). Generalized linear modelling is used to analyze the data. A moderation effect is found that shows the relationship between anxiety disorders and problem gambling severity varies significantly across socio-economic status. This study shows that social setting has an important influence on the assumed relationship between psychopathology and gambling problems that is downplayed in current problem gambling research. A discussion of the need for greater inclusion of socio-economic context when making assumptions about the connections between problem gambling and psychiatric disorders is made in light of the responsibilities of gambling providers and regulators.

Problem Gambling in a Sample of Older Adult Casino Gamblers: Associations With Gambling Participation and Motivations

As older adults continue to make up a greater proportion of the Canadian population, it becomes more important to understand the implications that their leisure activities have for their physical and mental health. Gambling, in particular, is a form of leisure that is becoming more widely available and has important implications for the mental health and financial well-being of older adults. This study examines a large sample (2103) of casino-going Ontarian adults over the age of 55 and identifies those features of their gambling participation that are associated with problem gambling. Logistic regression analysis is used to analyze the data. Focusing on types of gambling participated in and motivations for visiting the casino, this study finds that several forms of gambling and motivations to gamble are associated with greater risk of problem gambling. It also finds that some motivations are associated with lower risk of problem gambling. The findings of this study have implications related to gambling availability within an aging population.

Protocol: a cluster randomised control trial study exploring stigmatisation and recovery-based perspectives regarding mental illness and substance use problems among primary healthcare providers across Toronto, Ontario

Introduction Primary care settings are often the first and only point of contact for persons with mental health and/or substance use problems. However, staff experience and training in this area are often limited. These factors as well as a multitude of other components such as structural and systemic stigma experienced by staff can lead to clients being stigmatised, leading to poorer outcomes. By developing a comprehensive intervention for primary care staff working at community health centres (CHCs) aimed at reducing stigma towards people with mental health and substance use problems (MHSUP), we sought to test an innovative and contact-based intervention consisting of staff training, raising awareness, a recovery-focused art programme and an analysis of internal policies and procedures. All of these components can inform and support staff so they can provide better care for people who are experiencing MHSUP. CHC staff members and clients will be included in this project as active participants. Methods and analysis This mixed-methods project will consist of repeated surveys of staff and clients, as well as in-depth, semistructured interviews with a sample of clients and staff. A cluster randomised control trial design will test the effectiveness of an antistigma intervention for CHCs in Toronto, Canada. Six CHCs—three receiving the intervention and three controls—will be included in the study. Using a variety of measures, including the Opening Minds Scale for Health Care Providers (OMS-HC), Mental Illness: Clinicians Attitudes (MICA) Scale, Modified Bogardus Social Distance Scale, Perceived Devaluation-Discrimination Scale, Discrimination Experience subscale of the Internalized Stigma of Mental Illness (ISMI) Scale and the Recovery Assessment Scale (RAS), we hope to gain a thorough understanding of staff members’ attitudes and beliefs and clients’ perceptions of staff beliefs and behaviours. In-depth interviews will reveal important themes related to clients’ experiences of stigma both within and outside the healthcare setting. Ethics and dissemination If demonstrated to be successful, this intervention can be used as a model for future initiatives aimed at reducing MHSUP-related stigma among healthcare providers in an organisational context. Adapting this work in other settings is a key strategic goal of this project. The project will also advance knowledge about stigma reduction and the experience of encountering stigma within a healthcare setting. Trial registration NCT03043417; Post-results.

A free ride? An analysis of the association of casino bus tours and problem gambling among older adults: Older adults, bus tours and problem gambling

Abstract Background and aims Little research has examined the relationship between incentives used by gambling venues to attract customers and the experience of gambling‐related harm. Organized and subsidized bus tours are a common example of such incentives. The aim of this study was to examine whether bus‐tour patronage was associated with increased odds of problem gambling among older adults. This study also compared rates of bus‐tour use by socio‐demographic characteristics and gambling behaviours. Design Pearsons χ2 tests and Mann–Whitney U‐tests were applied for bivariate analyses. Multivariate generalized mixed‐effects regression modelling was used to examine the relationship between bus‐tour patronage and problem gambling while controlling for possible confounding factors. Setting Seven gambling venues located in Central and Southwestern Ontario, Canada. Participants A total of 1978 gambling venue patrons over the age of 55 years. Measurements Problem gambling as indicated by the Problem Gambling Severity Index, bus‐tour patronage in the 12 months prior to the survey, spending per gambling visit and past‐month slot machine participation. Findings Regression analyses showed that bus‐tour patronage was associated with higher odds of problem gambling [odds ratio (OR) = 1.71, confidence interval (CI) = 1.06, 2.76] after controlling for several demographic characteristics, type of gambling and gambling expenditures. Bivariate analyses showed past‐year bus‐tour patronage was associated with more frequent slot machine play (χ2 = 48.16, P < 0.001), more past‐year gambling venue visits (P < 0.001) and lower spending on gambling per casino visit (P < 0.001). Compared with non‐patrons, bus tour patrons were more likely to be female (χ2 = 21.92, P < 0.001), born outside Canada (χ2 = 113.18, P < 0.001), above the age of 75 (χ2 = 24.02, P < 0.001) and retired (χ2 = 16.60, P < 0.001). Conclusions When adjusting for potential confounders among older adults, using bus tours to access Canadian gambling venues is associated with increased risk of problem gambling. Bus‐tour patrons are more likely to be female, born outside Canada and above the age of 75 years.

An exploration of gender differences in the relationship between work family conflict and gambling problems

AbstractThe current study is an examination of gender differences in the experience of problems as a result of gambling. Using the framework of work–family conflict, this study compares men and women in terms of how their participation in work and family life relates to gambling problems as measured by the Problem Gambling Severity Index. Data from the 2008 Canadian Community Health Survey, a large representative sample of 28,687 participants in three Canadian provinces, is analysed with generalized linear modeling. The findings of this study show that simultaneously occupying the roles of married spouse and working spouse is associated with more gambling-related problems for women, but fewer for men. The study concludes with a discussion of how the intersection of problem gambling and important aspects of social life presents different problems for men and women due to gendered expectations surrounding work and family life. Implications for the findings in relation to trends of increased use of electroni...Abstract The current study is an examination of gender differences in the experience of problems as a result of gambling. Using the framework of work–family conflict, this study compares men and women in terms of how their participation in work and family life relates to gambling problems as measured by the Problem Gambling Severity Index. Data from the 2008 Canadian Community Health Survey, a large representative sample of 28,687 participants in three Canadian provinces, is analysed with generalized linear modeling. The findings of this study show that simultaneously occupying the roles of married spouse and working spouse is associated with more gambling-related problems for women, but fewer for men. The study concludes with a discussion of how the intersection of problem gambling and important aspects of social life presents different problems for men and women due to gendered expectations surrounding work and family life. Implications for the findings in relation to trends of increased use of electronic gaming machines by gambling providers are also discussed.

Examining the Application of the Opening Minds Survey in the Community Health Centre Setting

Objective: Stigma has been identified as a complex and problematic issue. It acts as a major barrier to accessing care and can exacerbate the experience of a health condition, particularly for clients with mental illness and substance use issues. Scales designed to assess stigmatising attitudes towards those with mental illness and substance use problems among health care providers are necessary to evaluate programs designed to reduce that stigma. The goal of this study was to evaluate the internal reliability and external validity of the Opening Minds Survey for Health Care Providers (OMS-HC). Methods: The current study examined the use of the OMS-HC in assessing stigma held by Community Health Centre (CHC) staff towards clients with mental and/or substance use problems. Participants represented staff from 6 CHCs in the Greater Toronto Area (n = 190). Results: The OMS-HC was found to have acceptable internal reliability for the 15-item version of the scale (α = 0.766) and mixed reliability for its subscales (α = 0.792-0.673). Confirmatory factor analysis showed good absolute (root mean square error of approximation = 0.013) and relative fit (Tucker-Lewis index = 0.996) for the current data. The OMS-HC was also shown to correlate with a series of scales commonly used in stigma research. Conclusions: After testing for internal validity and comparing the OMS-HC to other commonly used scales for assessing stigma and attitudes concerning recovery, the scale was found to be appropriate for the CHC setting and may be advantageous over the use of multiple scales.

The Impact of Remedial Programme Participation on Convicted Drinking Drivers’ Alcohol and Other Drug Use 6 Months Following Programme Completion

Back on Track (BOT) is Ontario’s remedial measures programme for convicted drinking drivers. Based on a pre-workshop assessment, individuals are assigned to complete either an 8-h Education workshop or a 16-h Treatment workshop. Six months later, participants are required to complete a 30-min follow-up interview by telephone. This report presents an outcome evaluation of the BOT programme, examining levels of substance use and related problems assessed during the follow-up interview. This evaluation is based on data from 9202 participants who completed the programme between October 1, 2008 and June 1, 2010. Results indicate that completion of BOT is associated with significant reductions in frequency of alcohol and other drug use, negative consequences as a result of drug use, number of drinks consumed per drinking occasion, and total number of substance users (alcohol and otherwise). There were also significantly more participants who changed substance-using status from ‘users’ at assessment to ‘non-user’ at follow-up than those from non-user at assessment to user at follow-up. These beneficial changes were seen in both the Education and Treatment workshop groups. Recommendations are presented to guide future efforts to improve the effectiveness of BOT and similar programmes in reducing alcohol- and drug-related problems, including impaired driving.

Attention deficit hyperactivity disorder and arrest history: Differential association of clinical characteristics by sex

Attention deficit hyperactivity disorder (ADHD) is often cited as a risk factor for criminality. However, many studies do not take other criminogenic variables into account when reporting on this relationship. It is even less clear whether models that include ADHD as a potential risk factor for criminality consider the importance of sex differences. To answer this question, we collected data from a telephone population survey sampling adults over the age of 18 years in the province of Ontario, Canada (final sample size = 5196). Respondents were screened for ADHD using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four extra items. Problematic drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT), while cannabis misuse was evaluated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The Antisocial Personality Disorder Scale from the Mini-International Neuropsychiatric Interview provided a measure of previous conduct disorder symptoms and the 12-item General Health Questionnaire screening procedure was used to gauge general distress. History of arrest was self-reported. Three separate logistic regression analyses (entire sample, male only, and female only) were applied to estimate the association of the foregoing variables with arrest history. In the combined sample, conduct disorder symptoms, problem alcohol use, and problem cannabis use all predicted history of arrest. With regard to the male sample, conduct disorder symptoms, elevated AUDIT and ASSIST scores, and general distress were associated with an arrest history. For the female subsample, only conduct disorder symptoms and problematic cannabis use showed a relationship with criminality. To summarize, ADHD did not predict history of arrest for either subsample or the combined sample. When comparing males and females, conduct disorder symptoms and cannabis misuse exerted stronger effects on history of arrest for females than males. These results suggest that the relative importance and type of clinical risk factors for arrest may differ according to sex. Such information could be useful for crime prevention policies and correctional programs that take into account differences in experience by sex.

A generational comparison of problem gambling and gambling attitudes among older adult gambling venue patrons

ABSTRACT Gambling is a popular leisure activity for older adults (55+), and existing research suggests that overall older adults are less prone to problem gambling compared to younger cohorts. People born after World War II are now beginning to reach retirement age. The purpose of this article was to explore age-related cohort differences between people born from 1943 to 1960 compared to those born from 1925 to 1942 in their attitudes and behaviours related to gambling. This study employs a large sample (2103) of older adults collected at gambling locations across Southern Ontario, Canada in 2013. Comparisons were made using Pearson’s chi-squared tests for categorical variables and independent samples t-tests for continuous variables with logarithmic transformations for highly-skewed variables. Those of the 1943 to 1960 cohort showed significantly higher problem gambling scores and per visit spending, but lower numbers of visits per year. There was no discernible pattern between cohorts in terms of attitudes toward gambling. Assumptions of lower risk of problem gambling among older adults will have to be re-evaluated as the post-war generation becomes an ever greater proportion of older adults.

Examining the effect of social bonds on the relationship between ADHD and past arrest in a representative sample of adults: ADHD, arrest and social bonds

BACKGROUND Several studies have found a connection between attentional deficit hyperactivity disorder (ADHD) and criminal behaviour in clinical and prison samples of adults, but there is a lack of representative general population data on this. AIM To test relationships between histories of ADHD and arrest. Our main research question was whether any such relationship is direct or best explained by co-occurring variables, especially indicators of social bonds. METHOD Data were from a sample of 5,376 adults (18+) representative of the general population of Ontario, Canada. Logistic regression analysis was used to explore the relationship between self-reported arrest on criminal charges and ADHD as measured by the Adult Self Report Scale (ASRS-v1.1). Indicators of strong social bonds (post secondary education, household size) and weak bonds (drug use, antisocial behaviours, alcohol dependence) were also obtained at interview and included in the statistical models. RESULTS In a main effects model, screening positive for ADHD was twice as likely (OR 2.05 CI 1.30, 3.14) and past use of medications for ADHD three times as likely (OR 3.94 CI 2.46, 6.22) to be associated with ever having been arrested. These associations were no longer significant after controls for weak and strong social bonds were added to the models. In the best fitting statistical model, ever having been arrested was not associated with ADHD, but it was significantly associated with indicators of strong and weak social bonds. CONCLUSIONS The observed connection between ADHD and criminality may be better understood through their shared relationships with indicators of poor social bonds. These include antisocial behaviour more generally, but also drug use and failure to progress to any form of tertiary education, including vocational training. Copyright