An interrupted time series analysis of gambling behavior based on gambling operator revenue-based taxation during the COVID-19 pandemic in Sweden

Risk Factors of At-Risk/Problem Gambling Among Young Adult Spanish Students

The gambling industry in Spain has experienced sustained growth in recent years. This has raised concerns about its potential impact, particularly during emerging adulthood, which is a high-risk period for the development of problematic gambling behaviors. The aim of this study was to estimate the prevalence of problem gambling in young Spanish adults and to examine individual factors associated with at-risk or problem gambling. The participants were 2762 young adults studying at university and vocational schools (64.16% women, Mage = 19.47; SD = 1.64) recruited in three Spanish autonomous communities. Individuals completed an e-assessment including sociodemographic variables, gambling-related characteristics, and the Problematic Gambling Severity Index. A total of 3.51%, 2.14%, and 0.51% were low risk, moderate risk, and problem gamblers, respectively. Predictors of at-risk/problem gambling were early gambling onset (OR 0.790; 95% CI 0.672, .929), mixed versus offline modality gambling access (OR 2.216; 95% CI 1.396, 3.516), and having gambled in the previous year in a casino (OR 1.910; 95% CI 1.194, 3.056), sports betting (OR 1.597; 95% CI 1.003, 2.542), or electronic gaming machines (OR 2.111; 95% CI 1.064, 4.189). Gambling is ubiquitous in the general population and a high proportion of young adults present low and moderate risk of problem gambling. Addressing gambling is a public health challenge and policies to regulate it should be targeted at delaying the age of onset and restricting access to online gambling.

Brief Report: The Rise of Online Betting in Ontario

In this paper we examine the nature of calls for the Ontario Problem Gambling Helpline from June 2021 to Jan 2023 to determine if the increased marketing of online and sports gambling has changed the nature of calls to the helpline. An interrupted time series model comparing the monthly calls before and after the expansion of online gambling and advertising (April 2023), found a significant effect. Calls related to the other games examined did not have a significant interrupted time series effect of from the expansion and advertising of online gambling. The results of this analysis clearly indicate an association between the expansion of legalized gambling and gambling advertising with the number of people who call the helpline for problem related to online gambling.

Harmful types of gambling: changes and emerging trends in longitudinal helpline data

BACKGROUND

Gambling products differ in terms of their harm potential. Products are also constantly developing and changing. However, little research has addressed changes and trends in the types of gambling that are associated with harms. The current study explores trends in the gambling product categories identified as harmful in longitudinal helpline data from three Nordic countries.

METHODS

We use data collected by national helplines in Denmark (StopSpillet), Finland (Peluuri) and Sweden (Stödlinjen) in their daily operations (N = 46 646). The data consist of information collected on gamblers and concerned significant others who have contacted these helplines between January 2019 and December 2022. We analyse which gambling products are mentioned as harmful by clients. The analysis uses linear regression with the interaction term (country) times time regressed over the outcome variable (proportion per month).

RESULTS

The results show that an increased share of contacts concern online gambling. Online casino products have become the most harmful category across contexts. The share of reported harms from online betting and new emerging online forms is also increasing. The share of land-based products as a reported source of harms has decreased across 2019-22.

CONCLUSIONS

The results suggest that online gamlbing environments, and particularly online casino products, are associated with increasing harms to help-seekers. The harmfulness of different gambling products may not be stable, but change over time. Further harm prevention efforts are needed to address the online gambling field, including emerging formats.

Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation

Background

Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities.

Methods

Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender.

Results

The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change.

Conclusion

After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.

Availability restrictions and mandatory precommitment in land-based gambling: effects on online substitutes and total consumption in longitudinal sales data

BACKGROUND

Gambling causes important harms in societies. According to the public health approach, the most effective policies to reduce harms target full populations. Availability restrictions and mandatory precommitment are among the most effective measures. However, restrictions on the availability of some gambling products or channels may also be offset by increased consumption in other products. Substitution effects can have negative public health impacts due to differing harm potential across different gambling products. This paper uses longitudinal sales data (2019-2022) from the Finnish gambling monopoly Veikkaus. During the observation period, the availability of gambling was restricted in Finland due to subsequent waves of Covid-19-related restrictions. In addition, the gambling monopoly introduced mandatory precommitment to land-based EGMs. We focus on how these restrictive policy changes impacted the total consumption of gambling and possible substitution effects.

METHODS

The Finnish gambling monopoly provided weekly theoretical loss data per gambling product category and gambling channel (online, land-based) for the period of January 2019 - July 2022 based on a statutory obligation. We analysed the effects of availability restrictions and other public health measures on the consumption of different products using descriptive time series and regression analyses. We compared the sale of land-based products to online equivalents at product category level and included main policy change periods in the models.

RESULTS

Total consumption of gambling declined during 2019-2022 mainly due to reduced land-based electronic gambling machine (EGM) consumption. Declines in land-based EGM sales were not offset by online alternatives or other close substitutes in the long term. However, during the first wave of Covid-19, there was an observable substitution of land-based table games by online alternatives and land-based horse betting and possibly sports betting by online horse betting. Overall, the results also show that Covid-19 functioned as a boost to an already existing trend of increasing digitalisation of gambling.

CONCLUSIONS

The study provides empirical support for the effectiveness of public health-oriented policies in reducing the total consumption of gambling. Availability restrictions and mandatory precommitment are therefore likely to also reduce the burden of harms of gambling to individuals and societies.

Nationwide, Multioperator Self-Exclusion and Psychiatric Comorbidity in Patients with Gambling Disorder: A Retrospective Chart Review Study from a Regional Treatment Unit

Gambling disorder is an addictive disorder that has been shown to have a detrimental effect on an individual's health, social, and financial situations. Voluntary self-exclusion is one way for patients to reduce harm in gambling disorder, but breaching one's self-exclusion appears to be common. In January 2019, Sweden launched a nationwide, multioperator self-exclusion instrument called Spelpaus (literally "game break"). Spelpaus is unique to Sweden, and there is limited research on the use of this type of nationwide, multioperator self-exclusion services, also in relation to gambling disorder and mental health. There is a reason to follow the clinical picture of treatment seeking for gambling disorder over time, and this study aims to explore clinical characteristics of patients seeking clinical gambling disorder treatment, including sex distribution and mental health comorbidity, as well as the use of Spelpaus amongst patients with gambling disorder and how frequently users gambled despite ongoing self-exclusion, in relation to sex and psychiatric comorbidities. A retrospective chart study was carried out on patients presenting to a regional gambling disorder treatment unit. Information regarding self-exclusions using Spelpaus, gambling despite self-exclusion, and the method of gambling despite self-exclusion as well as psychiatric comorbidities were extracted from medical records. Females were markedly more likely to report overall psychiatric comorbidities (48% vs. 25% among males, p < 0.001), affective, neurotic/anxiety-related (p < 0.001), and behavioral/emotional (p = 0.028) diagnoses and more likely to have two or more diagnoses excluding gambling disorder (p = 0.001). From 120 patients from whom information regarding self-exclusion was present, 114 (95%) had chosen to self-exclude. From the 114 self-excluders, 67 reported to have gambled despite self-exclusion, with unregistered websites being the most common method. Self-exclusion was not significantly related to sex (p = 0.146) or to psychiatric comorbidities (p = 0.178). In conclusion, psychiatric comorbidity was particularly common in female gambling disorder patients and gambling despite self-exclusion was common. Gambling regulations should be improved to help self-excluders avoid being able to gamble on unlicensed gambling operators. Further research should focus on sex differences and the association with psychiatric comorbidities.

Gamblers' Perceptions of the Impact of the COVID-19 Pandemic on Their Gambling Behaviours: Analysis of Free-Text Responses Collected through a Cross-Sectional Online Survey

The COVID-19 pandemic has brought drastic changes to the lives of a substantial portion of the world's population. Many stakeholders have expressed concern about the impact of the pandemic on gambling practices, which have historically increased during times of crisis. The purpose of this study was to provide a snapshot of the impact of the pandemic on gambling practices, focusing on the lived experiences of people who gamble. An online cross-sectional survey was conducted between 16 February and 15 March 2021. An open-ended question allowed the participants to describe in their own words the impact of the COVID-19 pandemic on their gambling practices. A qualitative analysis was conducted based on 724 responses to this question. Among the participants, 57% were problem gamblers, according to their Problem Gambling Severity Index score. Three themes were identified: (1) changes in gambling practices perceived by the respondents during the pandemic, (2) the impacts of these changes, and (3) the factors that influenced the changes in their gambling practices. A meaningful proportion of the sample of gamblers felt that their gambling practices had increased during the pandemic. Many of them did not report the deleterious effects of this increase, whereas others were devastated. Thus, variations in gambling practices during the pandemic must be interpreted with caution, as they may reflect a variety of realities.