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Jonsson J, Lakew N, Lindner P. Mandatory verses voluntary self-tests for new online casino customers: effect on engagement, quality, gambling behavior and use of responsible gambling measures. Harm Reduct J 2025; 22:22. [PMID: 39979952 PMCID: PMC11843787 DOI: 10.1186/s12954-025-01173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 02/10/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND To combat the public health concern that is problem gambling, gambling operators are increasingly being required by legislation to exercise a duty of care obligation, including the provision of Responsible Gambling (RG) tools. Self-test assessments have long been a popular RG tool implemented by many operators, yet there has been scant empirical research on self-tests, including on how the method of delivery impacts engagement, quality, and subsequent gambling behavior. The main objective of the current study was to examine if the level of voluntariness to perform a self-test moderated these key outcomes. METHOD Participants in the study, 1800 new online customers at a leading Swedish gambling company, were randomized to one of three arms: No message (control), up to four messages inviting them to do a self-test, and one message with a mandatory (but technically possible to circumvent) self-test. The interventions were presented when the customer logged in. RESULTS The results showed that 38.9% in the mandatory group and 4.8% in the voluntary group completed the self-test, with indications of a somewhat lower quality of the test by the mandatory group. There was no difference in customer churn or gambling behavior, and only minor differences in use of RG-measures post intervention. CONCLUSIONS We conclude that presentation format matters and can affect the use and quality of tests: gambling operators should exercise caution when interpreting non-risk assessment results derived solely from self-test tools, particularly mandatory ones, as it can result in inaccurate risk assessments that may mislead duty of care obligations. The balance between achieving high participation and maintaining quality (and thereby meaningfulness) is discussed.
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Affiliation(s)
- Jakob Jonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Nathan Lakew
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
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2
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Wood RTA, Wohl MJA, Tabri N, Philander K. Responsible Gambling as an Evolving Concept and the Benefits of a Positive Play Approach: A Reply to Shaffer et al. J Gambl Stud 2024; 40:1779-1786. [PMID: 37537311 DOI: 10.1007/s10899-023-10245-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Affiliation(s)
| | - Michael J A Wohl
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Nassim Tabri
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Kahlil Philander
- Carson College of Business, School of Hospitality Business Management, Washington State University, Everett, WA, USA
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
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3
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Moreira D, Dias P, Azeredo A, Rodrigues A, Leite Â. A Systematic Review on Intervention Treatment in Pathological Gambling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:346. [PMID: 38541345 PMCID: PMC10970379 DOI: 10.3390/ijerph21030346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 07/23/2024]
Abstract
Over the last century, there has been a growing interest in researching pathological gambling, particularly in industrialized nations. Historically, gambling was widely perceived as morally questionable, condemned by religious groups. However, contemporary concerns have shifted towards the health repercussions of gambling disorders and broader societal impacts like increased crime and money laundering. Governments, aiming to mitigate social harm, often regulate or directly oversee gambling activities. The global surge in legal gambling has resulted in a substantial rise in its prevalence, popularity, and accessibility in the last two decades. This paper provides a comprehensive overview of global research on interventions for pathological gambling. Through a systematic search on platforms such as EBSCO, PubMed, and Web of Science, 13 relevant records were identified. The revised findings indicate a heightened occurrence of behavioral addictions, linking them to the early onset of gambling issues and their severe consequences. The research emphasizes the active role that clients play in the process of self-directed change and therapy. Therapists recognizing clients as both catalysts for change and potential obstacles can enhance their effectiveness. A common source of resistance arises when clients and therapists are in different stages of the change process, underlining the importance of therapists aligning with clients' readiness for change. Recognizing the urgent need for a better understanding of this problem in adolescents, this study emphasizes the necessity to tailor prevention and treatment plans based on gender and age-specific requirements.
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Affiliation(s)
- Diana Moreira
- Centro de Solidariedade de Braga/Projecto Homem, 4700-024 Braga, Portugal; (D.M.); (P.D.); (A.A.)
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-362 Braga, Portugal;
- CPUP—Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, 4099-002 Porto, Portugal
- Institute of Psychology and Neuropsychology of Porto—IPNP Health, 4000-055 Porto, Portugal
- Observatory Permanent Violence and Crime (OPVC), FP-I3ID, 4249-004 Porto, Portugal
| | - Paulo Dias
- Centro de Solidariedade de Braga/Projecto Homem, 4700-024 Braga, Portugal; (D.M.); (P.D.); (A.A.)
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-362 Braga, Portugal;
| | - Andreia Azeredo
- Centro de Solidariedade de Braga/Projecto Homem, 4700-024 Braga, Portugal; (D.M.); (P.D.); (A.A.)
- CPUP—Center for Psychology at University of Porto, Faculty of Psychology and Educational Sciences, University of Porto, 4099-002 Porto, Portugal
| | - Anabela Rodrigues
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-362 Braga, Portugal;
| | - Ângela Leite
- Centre for Philosophical and Humanistic Studies, Faculty of Philosophy and Social Sciences, Universidade Católica Portuguesa, 4710-362 Braga, Portugal;
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4
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He M, Chen JH, Wu AMS, Tong KK. Fast or slow: applying life history strategies to responsible gambling adherence. INTERNATIONAL GAMBLING STUDIES 2022. [DOI: 10.1080/14459795.2022.2035422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mu He
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
| | - Juliet Honglei Chen
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
| | - Anise M. S. Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
| | - Kwok Kit Tong
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
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5
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Forsström D, Rozental A, Wiklund E, Carlbring P, Lindner P. Gamblers' Perception of the Playscan Risk Assessment: A Mixed-Methods Study. J Gambl Stud 2022; 38:591-606. [PMID: 34091781 PMCID: PMC9119887 DOI: 10.1007/s10899-021-10043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
Responsible gambling (RG) tools are globally widespread; they aim to prevent or decrease the harm caused by gambling. However, existing research suggests that several included features do not decrease gambling or significantly reduce the subsequent harm. Most of the previous studies have used gambling data to understand the changes in gambling behavior. However, the literature lacks research regarding gamblers' experience and perception of RG tools, which may provide insight into increasing the usage and effectiveness of RG tools. This mixed-methods study aimed to explore gamblers' perception of their risk assessment in the RG tool Playscan regarding developing harmful gambling problems. Overall, 757 participants rated the perceived accuracy of their risk assessment and their perception of the overall RG tool that conducted the assessment. Participants were also allowed to leave a comment providing feedback, which was analyzed using thematic analysis. Quantitative data was analyzed using logistic regression and structural equation modeling. Qualitative analyses revealed that most of the participants were pleased with the risk assessment and found it helpful. Moderated mediation analysis showed that participants' assessment agreement partially mediated the association between expressing a negative view and their general view of Playscan. These results highlight the need to decrease the level of disagreement for promoting a better general view of RG tools to potentially increase their usage and effectiveness.
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Affiliation(s)
- David Forsström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. .,Department of Psychology, Stockholm University, Stockholm, Sweden. .,The Centre for Psychotherapy, Education and Research, Liljeholmstorget 7, SE-117 63, Stockholm, Sweden.
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden ,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Emma Wiklund
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden ,Centre for Dependency Disorders, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Forsström D, Rozental A, Kottorp A, Lindner P, Jansson-Fröjmark M, Hesser H. Further Exploration of the Psychometric Properties of GamTest: A Rasch Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094824. [PMID: 33946511 PMCID: PMC8124206 DOI: 10.3390/ijerph18094824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 11/18/2022]
Abstract
GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population.
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Affiliation(s)
- David Forsström
- Department of Psychology, Stockholm University, Frescati Hagväg 8, 105 90 Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden; (A.R.); (P.L.); (M.J.-F.)
- Correspondence:
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden; (A.R.); (P.L.); (M.J.-F.)
- UCL, Great Ormond Street, Institute of Child Health, London WC1N 1EH, UK
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 214 28 Malmö, Sweden;
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden; (A.R.); (P.L.); (M.J.-F.)
- Centre for Dependency Disorders, Stockholm Health Care Services, 104 31 Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64 Stockholm, Sweden; (A.R.); (P.L.); (M.J.-F.)
| | - Hugo Hesser
- School of Law, Psychology and Social Work, Örebro University, 701 82 Örebro, Sweden;
- Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden
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"Show Me the Money": Preliminary Lessons from an Implementation of Intervention Tools at the Payment Gateway Level. J Gambl Stud 2021; 38:297-317. [PMID: 33761066 DOI: 10.1007/s10899-021-10023-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Traditional approaches that seek to study Responsible Gambling (RG) mainly focus on evaluating platform-based intervention tools applied on gambling operator sites. This paper reports on the implementation, at the payment-solution level, of an intervention tool that gambling customers used to deposit their bets. The approach pre-commits customers to set a single-point spending limit on their payment gateway account, effectively enabling them to apply their budget setting on all gambling platforms on which they choose to play. Ten users who have used the provision for at least six months and on two different gambling platforms were selected for an in-depth interview. Based on the findings from content analysis, the article argues that payment-level intervention approach can potentially (1) provide the overall gambling population with better financial literacy regarding their gambling habits, which promotes responsible spending behaviour, (2) elevate the strain on users to set up intervention tools on every individual platform, and (3) serve as a preventive measure regardless of the existence or absence of intervention tools at gambling sites. Furthermore, the results affirm a gap in existing research and a need for comprehensive guidelines and strategies for financial institutions to positively contribute towards the agenda of RG. The findings of this study highlight the need for revisiting theoretical and philosophical foundations of intervention tool studies and gambling policymaking as well as calls for reassessing how we problematised harmful gambling. The paper contributes to the research on gambling intervention tools.
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8
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Håkansson A, Franklin K, Dahlström M, Lyckberg A. Responsible Gambling Telephone Intervention to High-Risk Gamblers by a State-Owned Gambling Operator in Sweden: Study Protocol for a Study on Effectiveness, User Satisfaction, and Acceptability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239069. [PMID: 33561040 PMCID: PMC7730336 DOI: 10.3390/ijerph17239069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/08/2023]
Abstract
Gambling disorder is associated with severe financial, social, and psychological consequences, but treatment-seeking rates have been described to be low. Apart from formal treatment, motivational interventions in nontreatment-seeking high-risk gamblers have been shown to be promising. However, little is known about the effectiveness and acceptability of such motivational interventions carried out by a gambling operator as part of the company’s responsible gambling policies. Early experiences of such interventions are limited by the risk that gambling in individuals reached with the intervention may continue with a different gambling operator. The present study aims to evaluate effectiveness and user acceptability of a responsible gambling intervention continuously carried out by the Swedish state-owned gambling operator Svenska Spel Sport & Casino. This intervention for high-risk gamblers, identified either through substantial monetary losses or through a voluntary self-test by the gambler, includes a motivational telephone intervention aiming to encourage the gambler to set deposit limits, practice self-exclusion, or seek help. This protocol paper describes the two-tailed evaluation of this intervention: (1) A retrospective, register-based study of the effectiveness of the motivational intervention on gambling expenditures, deposit limits, and self-exclusions in comparison to control individuals not reached by the intervention, including all clients reached or attempted to be reached during September 2019–April 2020 (total n = 3626), as well as a one-to-one matched comparison of clients reached (n = 1404) and not reached; and (2) a prospective web survey study in individuals reached by the same ongoing telephone intervention practice from November 2020 (target n = 200), measuring clients’ attitudes to the intervention, perceived effects of the intervention on gambling, and their self-reported gambling on all operators after the intervention.
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Affiliation(s)
- Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
- Region Skåne, Malmö Addiction Center, 205 02 Malmö, Sweden
- Correspondence: ; Tel.: +46-46-175-596
| | - Katja Franklin
- AB Svenska Spel, 621 80 Visby, Sweden; (K.F.); (M.D.); (A.L.)
| | - Maria Dahlström
- AB Svenska Spel, 621 80 Visby, Sweden; (K.F.); (M.D.); (A.L.)
| | - Axel Lyckberg
- AB Svenska Spel, 621 80 Visby, Sweden; (K.F.); (M.D.); (A.L.)
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Gainsbury SM, Angus DJ, Procter L, Blaszczynski A. Use of Consumer Protection Tools on Internet Gambling Sites: Customer Perceptions, Motivators, and Barriers to Use. J Gambl Stud 2020; 36:259-276. [PMID: 31119509 DOI: 10.1007/s10899-019-09859-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Internet gambling has been widely legalised in recognition of its capacity to, and the importance of, providing consumer protection tools to prevent and minimise gambling-related harms. Most licensed Internet gambling sites are required to provide consumer protection tools, including activity statements, deposit limits, and time-outs (temporary self-exclusion). However, few Internet gambling customers engage with the tools. An online survey of 564 customers of Australian Internet gambling sites aimed to understand the extent to which consumer protection tools are used, characteristics of those using these tools, and the perceptions and attitudes towards tool use, including barriers to use. Most participants were aware of the tools and had accessed activity statements; few had used deposit limits (24.5%) or time-outs (8.1%) but use of these restrictive tools was higher among those at-risk of gambling problems. Satisfaction with tools was generally high among users and tools were mostly used as intended; however, only moderate changes in behaviour were reported. Participants predominately did not use the restrictive tools as they did not see these as relevant for them, and they were perceived to be intended for people with gambling problems. The findings are important to drive necessary improvements to consumer protection efforts including efforts to encourage perception that tools are relevant for all customers. Changes to current practice, including terminology and promotion of tools, are needed by Internet gambling operators and policy makers to improve the utilisation and effectiveness of consumer protection tools to enable sustainable gambling among the broader cohort of Internet gamblers.
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Affiliation(s)
- Sally M Gainsbury
- Gambling Treatment and Research Clinic, Science Faculty, Brain and Mind Centre, School of Psychology, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia.
| | - Douglas J Angus
- Gambling Treatment and Research Clinic, Science Faculty, Brain and Mind Centre, School of Psychology, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia
| | - Lindsey Procter
- Gambling Treatment and Research Clinic, Science Faculty, Brain and Mind Centre, School of Psychology, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia
| | - Alex Blaszczynski
- Gambling Treatment and Research Clinic, Science Faculty, Brain and Mind Centre, School of Psychology, University of Sydney, 94 Mallett St, Camperdown, NSW, 2050, Australia
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10
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The use of personalized messages on wagering behavior of Swedish online gamblers: An empirical study. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2020.106402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Challet-Bouju G, Hardouin JB, Thiabaud E, Saillard A, Donnio Y, Grall-Bronnec M, Perrot B. Modeling Early Gambling Behavior Using Indicators from Online Lottery Gambling Tracking Data: Longitudinal Analysis. J Med Internet Res 2020; 22:e17675. [PMID: 32254041 PMCID: PMC7450385 DOI: 10.2196/17675] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/26/2020] [Accepted: 02/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Individuals who gamble online may be at risk of gambling excessively, but internet gambling also provides a unique opportunity to monitor gambling behavior in real environments which may allow intervention for those who encounter difficulties. OBJECTIVE The objective of this study was to model the early gambling trajectories of individuals who play online lottery. METHODS Anonymized gambling-related records of the initial 6 months of 1152 clients of the French national lottery who created their internet gambling accounts between September 2015 and February 2016 were analyzed using a two-step approach that combined growth mixture modeling and latent class analysis. The analysis was based upon behavior indicators of gambling activity (money wagered and number of gambling days) and indicators of gambling problems (breadth of involvement and chasing). Profiles were described based upon the probabilities of following the trajectories that were identified for the four indicators, and upon several covariates (age, gender, deposits, type of play, net losses, voluntary self-exclusion, and Playscan classification-a responsible gambling tool that provides each player with a risk assessment: green for low risk, orange for medium risk and red for high risk). Net losses, voluntary self-exclusion, and Playscan classification were used as external verification of problem gambling. RESULTS We identified 5 distinct profiles of online lottery gambling. Classes 1 (56.8%), 2 (14.8%) and 3 (13.9%) were characterized by low to medium gambling activity and low values for markers of problem gambling. They displayed low net losses, did not use the voluntary self-exclusion measure, and were classified predominantly with green Playscan tags (range 90%-98%). Class 4 (9.7%) was characterized by medium to high gambling activity, played a higher breadth of game types (range 1-6), and had zero to few chasing episodes. They had high net losses but were classified with green (66%) or orange (25%) Playscan tags and did not use the voluntary self-exclusion measure. Class 5 (4.8%) was characterized by medium to very high gambling activity, played a higher breadth of game types (range 1-17), and had a high number of chasing episodes (range 0-5). They experienced the highest net losses, the highest proportion of orange (32%) and red (39%) tags within the Playscan classification system and represented the only class in which voluntary self-exclusion was present. CONCLUSIONS Classes 1, 2, 3 may be considered to represent recreational gambling. Class 4 had higher gambling activity and higher breadth of involvement and may be representative of players at risk for future gambling problems. Class 5 stood out in terms of much higher gambling activity and breadth of involvement, and the presence of chasing behavior. Individuals in classes 4 and 5 may benefit from early preventive measures.
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Affiliation(s)
- Gaëlle Challet-Bouju
- Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
- SPHERE, INSERM UMR1246, University of Nantes, University of Tours, Nantes, France
| | - Jean-Benoit Hardouin
- SPHERE, INSERM UMR1246, University of Nantes, University of Tours, Nantes, France
- Biostatistics and Methodology Unit,, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Elsa Thiabaud
- Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Anaïs Saillard
- Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Yann Donnio
- Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
- SPHERE, INSERM UMR1246, University of Nantes, University of Tours, Nantes, France
| | - Bastien Perrot
- SPHERE, INSERM UMR1246, University of Nantes, University of Tours, Nantes, France
- Biostatistics and Methodology Unit,, Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nantes, Nantes, France
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12
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Jonsson J, Hodgins DC, Munck I, Carlbring P. Reaching out to big losers leads to sustained reductions in gambling over 1 year: a randomized controlled trial of brief motivational contact. Addiction 2020; 115:1522-1531. [PMID: 31977104 DOI: 10.1111/add.14982] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/14/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS A previous randomized controlled trial demonstrated that telephone- and letter-based motivational interventions with high-expenditure gamblers had significant short-term positive effects on gambling and use of responsible gambling tools. This post-trial follow-up examined outcomes in gambling expenditure over 12 months. DESIGN Observational study following a three-arm randomized controlled trial. SETTING Customers of Norsk Tipping (NT) gambling platforms, Norway. PARTICIPANTS A total of 1003 statistical triplets from the top 0.5% of customers based upon annual expenditure, matched on sex, age and net losses. Mean age was 53.4 years; 19% were women, mean yearly loss for 2016 was 88 197 NoK. Interventions and comparator Feedback intervention by telephone, letter or a no-contact control condition. MEASUREMENTS Primary outcome measure was gambling theoretical loss, derived from the NT customer database. Secondary outcomes were responsible gambling customer actions and whether or not the participant was retained as an NT customer. FINDINGS Per-protocol analyses of triplets who received the telephone call or letter as randomly assigned (n = 596) showed a positive and sustained effect over 12 months: the telephone group showed a 30% reduction in theoretical loss (d = 0.44) and the letter group 13% (d = 0.18), both outperforming the control group with a 7% reduction (d = 0.11). The telephone condition was superior to both the letter and control conditions in per-protocol (P < 0.001) and to control condition in intention-to-treat analyses (ITT) (P < 0.001). Individuals in the telephone condition took more responsible gambling actions. The letter condition had better outcomes than the control in the ITT-only analysis (P < 0.001). More than 93% were still customers a year after the intervention. CONCLUSIONS Personal contact with high-expenditure gambling customers in Norway that provided individualized feedback on expenditures was associated with reduced theoretical losses and greater use of responsible gambling tools over a 12-month period, compared with no contact. Telephone intervention with customers had a larger impact than a mailed letter.
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Affiliation(s)
- Jakob Jonsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - David C Hodgins
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Ingrid Munck
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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13
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Predictors of Strategy Engagement for the Prevention and Reduction of Gambling Harm: a Prospective Application of the Theory of Planned Behaviour. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00265-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Forsström D, Rafi J, Carlbring P. Dropouts’ usage of a responsible gambling tool and subsequent gambling patterns. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1715535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- David Forsström
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Jonas Rafi
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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15
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Lindner P, Ramnerö J, Ivanova E, Carlbring P. Studying Gambling Behaviors and Responsible Gambling Tools in a Simulated Online Casino Integrated With Amazon Mechanical Turk: Development and Initial Validation of Survey Data and Platform Mechanics of the Frescati Online Research Casino. Front Psychiatry 2020; 11:571954. [PMID: 33613331 PMCID: PMC7892621 DOI: 10.3389/fpsyt.2020.571954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Online gambling, popular among both problem and recreational gamblers, simultaneously entails both heightened addiction risks as well as unique opportunities for prevention and intervention. There is a need to bridge the growing literature on learning and extinction mechanisms of gambling behavior, with account tracking studies using real-life gambling data. In this study, we describe the development and validation of the Frescati Online Research Casino (FORC): a simulated online casino where games, visual themes, outcome sizes, probabilities, and other variables of interest can be experimentally manipulated to conduct behavioral analytic studies and evaluate the efficacy of responsible gambling tools. Methods: FORC features an initial survey for self-reporting of gambling and gambling problems, along with several games resembling regular real-life casino games, designed to allow Pavlovian and instrumental learning. FORC was developed with maximum flexibility in mind, allowing detailed experiment specification by setting parameters using an online interface, including the display of messages. To allow convenient and rapid data collection from diverse samples, FORC is independently hosted yet integrated with the popular crowdsourcing platform Amazon Mechanical Turk through a reimbursement key mechanism. To validate the survey data quality and game mechanics of FORC, n = 101 participants were recruited, who answered an questionnaire on gambling habits and problems, then played both slot machine and card-draw type games. Questionnaire and trial-by-trial behavioral data were analyzed using standard psychometric tests, and outcome distribution modeling. Results: The expected associations among variables in the introductory questionnaire were found along with good psychometric properties, suggestive of good quality data. Only 6% of participants provided seemingly poor behavioral data. Game mechanics worked as intended: gambling outcomes showed the expected pattern of random sampling with replacement and were normally distributed around the set percentages, while balances developed according to the set return to player rate. Conclusions: FORC appears to be a valid paradigm for simulating online gambling and for collecting survey and behavioral data, offering a valuable compromise between stringent experimental paradigms with lower external validity, and real-world gambling account tracking data with lower internal validity.
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Affiliation(s)
- Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Jonas Ramnerö
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ekaterina Ivanova
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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16
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Procter L, Angus DJ, Blaszczynski A, Gainsbury SM. Understanding use of consumer protection tools among Internet gambling customers: Utility of the Theory of Planned Behavior and Theory of Reasoned Action. Addict Behav 2019; 99:106050. [PMID: 31522130 DOI: 10.1016/j.addbeh.2019.106050] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/19/2019] [Accepted: 07/13/2019] [Indexed: 11/16/2022]
Abstract
Consumer protection tools such as activity statements, deposit limits, and temporary self-exclusion are provided by most Internet gambling websites to minimise gambling related harms through the prevention of problems and enhancement of controls for those at risk of disordered gambling. However, customer engagement with these tools is very low. Developing a theoretical framework to understand the reasons individuals use consumer protection tools is important to design strategies to increase uptake. Customers of Australian online wagering sites (N = 564) completed an online survey with a follow-up (N = 193) to assess whether the Theory of Planned Behaviour explained intention to use tools and actual behaviour with additional consideration of past tool use. Results showed that past tool use, attitudes and subjective norms, but not perceived behavioural control, were positively correlated with intention to use consumer protection tools. Intention to use the tools prospectively predicted actual tool use. The study validates past behaviour as a predictor of intention, and intention representing a significant predictor of future behaviour. The Theory of Reasoned Action (without the inclusion of perceived behavioural control), rather than Theory of Planned Behaviour, appears to be a suitable conceptual model to understand consumer protection tool use for Internet wagering websites. Use and application of consumer protection tools on gambling websites is not perceived as effortful, but under volitional control and straightforward. Positively influencing individual attitudes, perceived views of others and past tool use could increase online wagering customers' use of consumer protection tools.
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Affiliation(s)
- Lindsey Procter
- University of Sydney, Science Faculty, Brain and Mind Centre, School of Psychology, Gambling Treatment and Research Clinic, 94 Mallet St, Camperdown, NSW 2050, Australia.
| | - Douglas J Angus
- University of Sydney, Science Faculty, Brain and Mind Centre, School of Psychology, Gambling Treatment and Research Clinic, 94 Mallet St, Camperdown, NSW 2050, Australia.
| | - Alex Blaszczynski
- University of Sydney, Science Faculty, Brain and Mind Centre, School of Psychology, Gambling Treatment and Research Clinic, 94 Mallet St, Camperdown, NSW 2050, Australia.
| | - Sally M Gainsbury
- University of Sydney, Science Faculty, Brain and Mind Centre, School of Psychology, Gambling Treatment and Research Clinic, 94 Mallet St, Camperdown, NSW 2050, Australia.
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17
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Broussard JD, Wulfert E. Debiasing Strategies for Problem Gambling: Using Decision Science to Inform Clinical Interventions. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00263-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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18
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19
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Ivanova E, Rafi J, Lindner P, Carlbring P. Experiences of responsible gambling tools among non-problem gamblers: A survey of active customers of an online gambling platform. Addict Behav Rep 2019; 9:100161. [PMID: 31193727 PMCID: PMC6542737 DOI: 10.1016/j.abrep.2019.100161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools. METHODS A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed. RESULTS Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95% CI] = 7.17 [3.61-14.23], p < .001). CONCLUSIONS Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.
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Affiliation(s)
- Ekaterina Ivanova
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Jonas Rafi
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Philip Lindner
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Friskvårdsvägen 4, floor 2, S:t Göran, 112 81 Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
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20
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Matheson FI, Hamilton-Wright S, Kryszajtys DT, Wiese JL, Cadel L, Ziegler C, Hwang SW, Guilcher SJT. The use of self-management strategies for problem gambling: a scoping review. BMC Public Health 2019; 19:445. [PMID: 31035978 PMCID: PMC6489359 DOI: 10.1186/s12889-019-6755-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern. METHODS We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool. RESULTS We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness. CONCLUSIONS Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment.
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Affiliation(s)
- Flora I. Matheson
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - David T. Kryszajtys
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Jessica L. Wiese
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Carolyn Ziegler
- Health Information Sciences Library, University of Toronto, Toronto, ON Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Sara J. T. Guilcher
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
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21
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Tabri N, Hollingshead SJ, Wohl MJA. A limit approaching pop-up message reduces gambling expenditures, except among players with a financially focused self-concept. INTERNATIONAL GAMBLING STUDIES 2019. [DOI: 10.1080/14459795.2019.1567806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nassim Tabri
- Department of Psychology, Carleton University, Ottawa, Canada
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22
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Gainsbury SM, Abarbanel BLL, Philander KS, Butler JV. Strategies to customize responsible gambling messages: a review and focus group study. BMC Public Health 2018; 18:1381. [PMID: 30558568 PMCID: PMC6297977 DOI: 10.1186/s12889-018-6281-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsible gambling messages are widely used as a tool to enable informed choice and encourage appropriate gambling behavior. It is generally accepted that gamblers have different levels of risk of developing gambling problems and require various harm minimization tools and resources. Therefore, it is reasonable to expect that responsible gambling messages should be customized and target specific groups of gamblers. This project aimed to understand hypothesized differences between cohorts of gamblers and receive qualitative feedback on archetypal targeted messages used to increase use of responsible gambling tools. METHODS Focus groups were held to test messages for specific cohorts: young adults (18-24 years), seniors (60+ years), frequent gamblers (weekly), and gamblers of skill-based games (poker, sports betting). RESULTS Cohorts exhibited different preferences and responses to message archetypes. Seniors preferred messages about limit setting, whilst young adults and frequent gamblers responded to messages about their own play and expertise. Skill game gamblers were interested in the odds of winning and their own outcomes over time. However, all groups agreed that using positive, non-judgmental language in messaging is important. CONCLUSIONS This research makes an important contribution to the field by demonstrating that the wording of message content will likely influence the effectiveness of such messages differentially across various groups of gamblers for engaging gamblers in harm reduction tools. Guidance is provided on themes that can be used by public health marketers.
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Affiliation(s)
- Sally M. Gainsbury
- Brain and Mind Centre, School of Psychology, University of Sydney, Camperdown, NSW Australia
| | - Brett L. L. Abarbanel
- International Gaming Institute, University of Nevada, Las Vegas, Box 456037, 4505 S. Maryland Pkwy, Las Vegas, NV 89154-6037 USA
- UCLA Gambling Studies Program, University of California, Los Angeles, USA
| | - Kahlil S. Philander
- Brain and Mind Centre, School of Psychology, University of Sydney, Camperdown, NSW Australia
- School of Hospitality Business Management, Carson College of Business, Washington State University, Everett, WA USA
| | - Jeffrey V. Butler
- Department of Economics, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA USA
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Forsström D, Cisneros Örnberg J. Responsible gambling in practice: A case study of views and practices of Swedish oriented gambling companies. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 36:91-107. [PMID: 32934553 PMCID: PMC7434122 DOI: 10.1177/1455072518802492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/22/2018] [Indexed: 11/15/2022] Open
Abstract
The Swedish gambling market faces a major change in legislation that will
allow foreign-based companies to apply for a gambling licence in
Sweden. A key element in the new legislation are consumer protection
measures. The Swedish gambling market is currently divided between
licensed companies and non-Swedish-based companies providing online
gambling services without a licence in Sweden. How these companies
view their responsibility for preventing gambling-related harm and how
prepared they are for the new regulations are important questions
regarding the new Swedish gambling market.
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24
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Wohl MJA. Loyalty programmes in the gambling industry: potentials for harm and possibilities for harm-minimization. INTERNATIONAL GAMBLING STUDIES 2018. [DOI: 10.1080/14459795.2018.1480649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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Gainsbury SM, Jakob L, Aro D. Understanding end-user perspectives to enhance perceived value uptake of harm-minimization tools: considering gambler’s views of a pre-commitment system. INTERNATIONAL GAMBLING STUDIES 2017. [DOI: 10.1080/14459795.2017.1370723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sally M. Gainsbury
- School of Psychology, University of Sydney, Camperdown, NSW, Australia
- School of Business and Tourism, Southern Cross University, Lismore, NSW, Australia
| | | | - David Aro
- Communio Pty, North Sydney, NSW, Australia
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