Behavior Change Techniques and Delivery Modes in Interventions Targeting Adolescent Gambling: A Systematic Review

Clinical consensus statements on change techniques for gambling treatment: A Delphi study with clinicians

Background and aims

The active ingredients of psychological gambling treatments remain unclear, with research identifying effective change techniques only emerging. This study aimed to identify clinical consensus statements on effective change techniques for gambling treatment according to Australian and New Zealand gambling clinicians. Identification of promising change techniques can inform the development of optimised interventions.

Methods

A panel of 68 clinicians participated in a two-round Modified Delphi study. Panellists rated the effectiveness of 19 change techniques for reducing gambling severity, expenditure and frequency. Consensus criteria for effectiveness and ineffectiveness were defined a priori. Panellists were also asked to provide culturally relevant considerations and adaptations when using change techniques with culturally diverse, linguistically diverse and Indigenous populations. Responses were analysed through a thematic analysis.

Results

Clinical consensus was reached on the effectiveness of 10 change techniques: relapse prevention, goal setting, motivational enhancement, information provision, cognitive restructuring, financial regulation, information gathering, plan social support, problem solving, and decisional balance. There was no consensus that any technique was ineffective, however social comparison received the lowest ratings. Panellists also identified four key themes of considerations when working with culturally diverse, linguistically diverse and Indigenous populations.

Discussion and Conclusions

This is the first Delphi study to explore clinician perspectives on change technique effectiveness. Ten change techniques were identified as likely to be effective. Findings can inform the selection of promising change techniques for inclusion in gambling treatment programs and expedite optimised intervention development by focussing research efforts on change techniques most likely to be effective.

A Structural Equation Model to Explain Gambling Problem Severity in Adolescents with an Integrated Perspective

To be effective in the prevention of adolescent problem gambling, it is fundamental to enhance knowledge about the antecedents of gambling problem severity and the mechanisms through which these dimensions are related to problematic gambling behavior. This study aimed at testing how selected cognitive (correct knowledge of gambling and gambling-related cognitive distortions) and affective (positive economic perception of gambling and expectation and enjoyment and arousal towards gambling) variables are related to gambling frequency and gambling problem severity. Problem gambling was conceptualized as Gambling Disorder symptoms according to the last edition of the DSM. Participants were 447 Italian high school students (68% males, mean age = 16.8, SD = 0.84). Structural Equation Models (SEMs) conducted with adolescent gamblers attested two indirect effects from knowledge to problem gambling: One through gambling-related cognitive distortions and one through gambling frequency. Overall, results confirmed that adolescent problem gambling is a complex phenomenon explained by multiple and different factors. Practical implications for preventive efforts are discussed.

'Getting addicted to it and losing a lot of money… it's just like a hole.' A grounded theory model of how social determinants shape adolescents' choices to not gamble

BACKGROUND

Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble.

METHODS

Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods.

RESULTS

The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests.

CONCLUSIONS

Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

A data extraction template for the behaviour change intervention ontology

Background

The Behaviour Change Intervention Ontology (BCIO) aims to improve the clarity, completeness and consistency of reporting within intervention descriptions and evidence synthesis. However, a recommended method for transparently annotating intervention evaluation reports using the BCIO does not currently exist. This study aimed to develop a data extraction template for annotating using the BCIO.

Methods

The BCIO data extraction template was developed in four stages: i) scoping review of papers citing component ontologies within the BCIO, ii) development of a draft template, iii) piloting and revising the template, and iv) dissemination and maintenance of the template.

Results

A prototype data extraction template using Microsoft Excel was developed based on BCIO annotations from 14 papers. The 'BCIO data extraction template v1' was produced following piloting and revision, incorporating a facility for user feedback.

Discussion

This data extraction template provides a single, accessible resource to extract all necessary characteristics of behaviour change intervention scenarios. It can be used to annotate the presence of BCIO entities for evidence synthesis, including systematic reviews. In the future, we will update this template based on feedback from the community, additions of newly published ontologies within the BCIO, and revisions to existing ontologies.

How can implementation intentions be used to modify gambling behavior?

Problem gambling can cause significant harm, yet rates of gambling continue to increase. Many individuals have the motivation to stop gambling but are unable to transfer these positive intentions into successful behavior change. Implementation intentions, which are goal-directed plans linking cues to behavioral responses, can help bridge the gap between intention and many health behaviors. However, despite the strategy demonstrating popularity in the field of health psychology, its use in the area of gambling research has been limited. This mini review illustrates how implementation intentions can be used to facilitate change in gambling behavior. Adopting the strategy could help reduce the number of people with gambling problems.