Young people who purchase loot boxes are more likely to have gambling problems: An online survey of adolescents and young adults living in NSW Australia

Are Today's Gamers Tomorrow's Gamblers? The Relationship Between Problem Gaming and Online Problem Gambling, and the Indirect Effect of Purchasing Loot Boxes' Risk

The present study aims to bridge the gap regarding the potential influence of problem gaming on problem gambling (PG) by examining the potential indirect effect of risky loot box use in this relationship. We also aim to examine these relationships in an understudied cultural context, that is, Eastern European, thus enlarging the current geographical scope of the research on problematic gaming and gambling. The research was conducted on a sample of 703 Romanians (56.5 percent male, 43.5 percent female), aged between 18 and 46 (M = 23.07; SD = 5.24), who play video games frequently. They completed instruments measuring problem gaming, online PG, and purchasing loot boxes risk. Our findings also indicate that risky engagement with loot box mechanism had a significant indirect effect on the association between the two types of problematic behavior (i.e., gaming and gambling). This suggests that excessive involvement in online gaming is linked with an increased propensity for problematic use of loot boxes, and further with a higher risk of PG. Our results indicate that higher involvement in video gaming may be associated with higher levels of risky engagement, which could plausibly lead to a greater likelihood of purchasing them and this more problematic relationship with loot boxes further increases the risk of PG. Our study contributes to advancing knowledge about these constructs while suggesting the negative impact of loot boxes in that their acquisition is related to higher involvement in online gambling.

Scrutinizing the Gateway Relationship Between Gaming and Gambling Disorder: Scoping Review With a Focus on the Southeast Asian Region

Background

The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries.

Objective

This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area.

Methods

We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison.

Results

The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling.

Conclusions

Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia.

Do problematic gamblers and loot boxers share similar fallacies of thought? A comparative analysis of cognitive biases

Cognitive biases are associated with the beginning and maintenance of addictive behaviours. While these biases have been studied in gambling, they have yet to be thoroughly investigated in the context of loot boxes (LBs), largely because of the relatively recent emergence of this phenomenon. This study compared cognitive biases in problematic gamblers, non-problematic gamblers, LB purchasers, and free-LB openers. For this aim, 279 participants (63.1% males) with a mean age of 23.65 years (SD = 8.66) completed a self-report. The results showed no differences between problematic gamblers, LB purchasers and LB openers on illusion of control and predictive control. In contrast to LB openers, problematic gamblers and LB purchasers obtained statistically similar scores on interpretative biases, gambling-related expectancies and the total score of the Gambling Related Cognitions Scale (GRCS). Only problematic gamblers experienced a higher perceived inability to stop gambling. Moreover, problematic gamblers, LB purchasers and LB openers scored higher on all biases compared to non-problematic gamblers. Eighty-six participants simultaneously gambled and used LBs. When this overlap was controlled, problematic gamblers and loot boxers shared all cognitive biases but the perceived inability to stop gambling; and scored statistically higher than non-problematic gamblers in all cognitive biases except for the illusion of control. The study provides additional evidence of the relationship between gambling and LBs.

Current approaches to the identification and management of gambling disorder: a narrative review to inform clinical practice in Australia and New Zealand

Gambling disorder is a recognised psychiatric disorder in the Diagnostic and statistical manual of mental disorders (DSM-5) and is classified as an addiction alongside alcohol and substance use disorders. The DSM-5 describes a past-year timeframe, episodic or persistent specifiers, early or sustained remission specifiers, and three gambling disorder severity specifiers (mild, moderate and severe). Although anyone can develop gambling disorder, there are known risk factors. In studies involving general adult populations, the likelihood of developing the disorder varies with the type of gambling, and is particularly high for internet gambling, casino table games and poker machines. Australia and New Zealand have shifted the focus of gambling disorder to the identification of gambling harm, in recognition that efforts targeting the prevention of harm may be more effective as they potentially influence a larger segment of the population. Temporal categories of gambling harm (crisis harms versus legacy harms) affect help-seeking and need for treatment. Crisis harms often motivate people to change their behaviour or seek help, whereas treatment addresses legacy harms, which emerge or continue to occur after gambling behaviour ceases. The evidence base and clinical guidelines recommend cognitive behavioural therapy and motivational interviewing but there are many gaps in our understanding of treatment for gambling disorder, including an absence of high quality evaluations that assess treatment effectiveness over the longer term, especially for treatment delivered in community settings. There is also an urgent need to understand how, why and for whom treatment works so that interventions can be optimised to individual needs, thereby facilitating client engagement. Because of limited access to health care and poor retention in treatment, in recent years there has been an increase in treatment choices in the form of internet therapies and smartphone applications.

Two for the GOES: Exploring Gambling Outcome Expectancies Scores Across Mixed and Offline-Only Gamblers in Relation to Problem Gambling Risk Status

As online gambling becomes more prevalent, understanding the motives of online gamblers has become a key focus for research and practice. The aim of this study was to understand differences in gambling-related outcome expectancies between mixed (both online and offline) gamblers and offline-only gamblers, by incorporating gambling harm risk categories from the problem gambling severity index (PGSI). This study comprised a secondary data analysis of the 2015 Northern Territory Gambling Prevalence and Wellbeing Survey. A sample of 1207 individuals in the Northern Territory who had reported gambling at least once in the previous 12 months were used in the analyses. General linear and structural equation modelling were used to ascertain differences in gambling outcome expectancies, in relation to gambling modality (i.e., mixed, offline-only) and PGSI scores. Mixed gamblers tended to score higher on all outcome expectancies than their offline-only counterparts. Outcome expectancy scores were higher in individuals in higher-risk PGSI categories. The escape outcome expectancy was dependent on both modality and risk category. Invariance testing of a low and problem gambling risk subsample revealed differential relationships for both the escape and excitement outcome expectancies for mixed and offline-only gamblers. The results provide an important contribution to the existing literature regarding motivation and outcome expectancies in relation to gambling modality and problem gambling severity. The findings highlight the importance of considering both gambling outcome expectancies and modality when considering problem gambling.

Loot boxes, gambling-related risk factors, and mental health in Mainland China: A large-scale survey

Loot boxes can be bought with real-world money to obtain random content inside video games. Loot boxes are viewed by many as gambling-like and are prevalently implemented globally. Previous Western and international studies have consistently found loot box spending to be positively correlated with problem gambling. Previous Western studies presented mixed results as to the correlations between loot box purchasing and gambling-related risk factors, mental wellbeing, and psychological distress. A large-scale survey of adult video game players from the People's Republic of China (PRC) (N = 2601) was conducted through Tencent Survey. The positive correlations between loot box spending and problem gambling, and between loot box spending and problem videogaming, were successfully replicated. However, other potential risk factors (i.e., impulsivity/impulsiveness; binary past-year gambling participation status; and sensation-seeking tendencies) either did not positively correlate with loot box spending or only did so weakly. Contrary to expectations, high impulsivity was negatively associated with loot box engagement. The Risky Loot Box Index (RLI) most strongly positively correlated with, and was the best predictor in multiple linear regression models for, loot box spending. The RLI may be effective at measuring loot box harms cross-culturally. A surprising weak positive correlation was found between loot box engagement and PRC players' mental wellbeing, and high psychological distress unexpectedly negatively predicted loot box purchasing. Although gambling-like, the risk and protective factors of loot boxes are seemingly different, meaning they should rightfully be treated as novel products. Cross-cultural research can contribute to a better understanding of loot box harms.

Order of first-play in simulated versus monetary gambling

Background and aims

Simulated gambling products, like loot boxes and social casino games, contain gambling elements, but are not classified as gambling. They are available to minors, raising concerns about a "gateway effect" into gambling. This study examined the time course of young people's engagement in simulated and monetary gambling, and associations between simulated gambling and gambling problems and harm. A necessary, although not sufficient, condition for simulated games leading to real money gambling is that simulated play must come first.

Method

Participants were 1,026 young adults (aged 18-25 years) who played video games in the last year. They reported the age at which they first took part in seven simulated and twelve monetary gambling products, and current gambling problems and harm.

Results

First use of loot boxes and video games with gambling content tended to precede monetary gambling. Forms where gambling is a core gameplay element, such as social casino and demonstration games, tended to follow some monetary gambling forms. Engagement in most simulated gambling products was associated with greater harm from monetary gambling.

Discussion

The findings leave open the possibility of a catalyst pathway from youth engagement in loot boxes and games with gambling content to later monetary gambling, but causal psychosocial mechanisms remain unclear. However, a pathway from social casino and demonstration games to monetary gambling appears less likely, which may instead reflect containment or substitution effects. Simulated gambling disproportionately attracts youth who are vulnerable to gambling problems and harm, indicating the need for consumer protection measures.

A scoping review of the association between loot boxes, esports, skin betting, and token wagering with gambling and video gaming behaviors

Background and aims

Many new digital gambling-like activities such as loot boxes, esports betting, skin betting, and token wagering have recently emerged and grown in popularity. This scoping review aimed to: (a) synthesize the existing empirical research literature on gambling-like activities and their associations with gambling and video gaming behaviors, including problem gambling and video gaming; (b) identify sociodemographic, psychological, and motivational factors associated with engagement in gambling-like activities; and (c) identify research gaps and areas for further research.

Methods

A systematic search of Ovid, Embsco, and ProQuest databases and Google Scholar was conducted in May 2021 and last updated in February 2022. The search yielded a total of 2,437 articles. Articles were included in the review if they were empirical studies that contained quantitative or qualitative results regarding the relationship between gambling-like activities and gambling or gaming.

Results

Thirty-eight articles met inclusion criteria and were included in the review. Overall, the review results suggest that all forms of gambling-like activities were positively associated with gambling and gaming with small to medium effects. Gambling-like activity participation was also positively associated with mental distress and impulsivity. Gaps identified included a lack of inquiry into skin betting and token wagering, a lack of diversity in the research methods (i.e., mainly cross-sectional surveys), and a paucity of research that includes more ethnically, culturally, and geographically diverse populations.

Discussion

Longitudinal studies with more representative samples are needed to examine the causal link between gambling-like activities and gambling and video gaming.

Opening Pandora's Loot Box: Weak Links Between Gambling and Loot Box Expenditure in China, and Player Opinions on Probability Disclosures and Pity-Timers

Loot boxes are quasi-gambling virtual products in video games that provide randomised rewards of varying value. Previous studies in Western contexts have identified a positive correlation between loot box purchasing and problem gambling severity. A preregistered survey of People's Republic of China (PRC) video game players (N = 879) failed to replicate this correlation. We observed statistically significant but weak positive correlations between loot box expenditure and past-year gambling participation, and between loot box expenditure and impulsiveness. This study cannot prove that loot boxes are not disproportionately purchased by people with problem gambling symptomatology in the PRC or that PRC players are not potentially at risk of loot box-related harms. Instead, the evidence suggests that the relationship between loot boxes and gambling might be weaker in the PRC than in Western countries. We identified multiple unique factors about the PRC that might be affecting this relationship. For example, the lotteries are the only legally permitted form of gambling. More gamified electronic gambling products are unavailable. The limited availability of gambling meant that a low level of gambling participation (n = 87) was observed, which is a limitation of this study. Additionally, the PRC is presently the only country to legally require loot box probability disclosures as a consumer protection measure. Most loot box purchasers (84.6%) reported seeing loot box probability disclosures, but only 19.3% of this group reported consequently spending less money. Most loot box purchasers (86.9%) thought that pity-timers, which increase the winning probabilities of obtaining rarer rewards, are appropriate for implementation. Future loot box research should give greater consideration to differing cultural contexts and novel consumer protection measures.

Gaming disorder: A summary of its characteristics and aetiology

The emergence, development, and maintenance of gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. None of these alone are sufficient to cause a disordered state, but it is the interactive co-occurrence of all these factors, which in some cases leads to GD. The goal of the present paper is to discuss in detail these three factors based on relevant and recent findings of the literature. Among gaming-related factors, we discuss online vs. offline videogames, the role of game genres, structural characteristics, game design elements, as well as some important monetization techniques. Among individual factors demographic risk factors, personality traits, motivational factors, comorbid psychopathology, genetic predisposition, and neurobiological processes are considered. Finally, among environmental factors we discuss family factors, early life experiences, the role of peers and school-related factors, as well as the broader context of culture including the popularity of esports.

Annual Research Review: Emergence of problem gambling from childhood to emerging adulthood: a systematic review

BACKGROUND

The risk for problematic gambling and associated high-risk behaviors is elevated during adolescence and emerging adulthood. Activities with gambling-like features and novel forms of gambling may place youth at an increased risk for problem gambling.

AIM AND METHOD

The aim of this review is to provide an overview of the association between both activities with gambling-like features and novel gambling activities and problem gambling among youth while examining the role of psychopathology and cognitive processes. Six databases (PsychINFO, MEDLINE, PubMed, Social Work Abstracts, Technology Collection, and Scopus) were searched in November 2021 for peer-reviewed articles investigating the association between the aforementioned variables among youth up to the age of 25 years. Risk of bias was assessed using the Observational Study Quality Evaluation.

FINDINGS

Forty-five articles were included in the review. Positive associations were observed between engagement in activities with gambling-like features (e.g., video games, social casino games, loot boxes) and problem gambling. Increased involvement with novel forms of gambling (e.g., online sports betting, fantasy sports, and esports betting) were also associated with a greater risk for problematic gambling. Males reported higher rates of engagement in these activities and a greater risk of problem gambling than females. Impulsivity, risk taking, cognitive distortions, and specific emotional vulnerabilities were associated with an increased risk of problem gambling.

CONCLUSIONS

Despite the need for additional longitudinal research controlling for relevant confounders, these findings underline how engagement in activities with gambling-like features are relevant in the developmental trajectory toward problem gambling.

Skin Gambling Contributes to Gambling Problems and Harm After Controlling for Other Forms of Traditional Gambling

Esports betting and skin gambling involve betting on the outcomes of video game competitions and/or using virtual currencies for betting. The present study evaluated a conceptual model linking video game involvement, video-game related gambling, traditional gambling, and gambling problems and harm. Data were collected via a cross-sectional online survey with 737 participants aged 18 + who engaged in esports cash betting (n = 576), esports skin betting (n = 184), or skin gambling on games of chance (n = 330). The findings highlighted the distinctly different relationships esports cash betting versus skin gambling had with traditional gambling involvement and harmful gambling. Gambling with skins on games of chance was predictive of gambling problems and gambling harm after controlling for participation in traditional gambling (OR = 1.32 and 1.17 respectively). Whereas betting on esports with cash was associated with betting on a variety of other forms of gambling, and there was no unique contribution to problems and harm over and above participation on these other forms (e.g., EGMs, sports betting). Skin gambling is directly implicated in gambling problems and harm, whereas cash betting on esports is only indicative of interest in many forms of potentially harmful gambling. Greater research attention to skin gambling is warranted, and particularly with respect to its role as a virtual currency more easily accessible for gambling.

Not all games are created equal: Adolescents who play and spend money on simulated gambling games show greater risk for gaming disorder

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail.

The relationship between problematic gambling severity and engagement with gambling products: Longitudinal analysis of the Emerging Adults Gambling Survey

AIMS

To measure the association between problem gambling severity and 19 different gambling activities among emerging adults (aged 16-26).

DESIGN

An online non-probability longitudinal survey collecting data in two waves: wave 1, July/August 2019; wave 2, July/October 2020.

SETTING

Great Britain PARTICIPANTS: A total of 2080 young adults participating in both waves.

MEASUREMENTS

Problem gambling scores were collected using the Problem Gambling Severity Index (PGSI). Binary variables recorded past year participation in 19 different gambling forms, ranging from lotteries to online casino and gambling-like practices within digital games (e.g. loot box purchase, skin betting). Controls included socio-demographic/economic characteristics, the Eysenck Impulsivity Scale and the number of gambling activities undertaken.

FINDINGS

Zero inflated negative binomial model lacked evidence of an effect between past year participation in any individual activities and subsequent PGSI scores. However, negative binomial random effects models for current gamblers (n = 497) showed that skin betting (incidence-rate ratio [IRR] = 2.32; 95% CI = 1.69-3.19), fixed odd betting terminals (IRR = 2.21, 95% CI = 1.61-3.05), slot/fruit machines (IRR = 1.43, 95% CI = 1.07-1.91), online betting on horse/dog races (IRR = 1.53, 95% CI = 1.17-2.00) and online betting on non-sports events (IRR = 1.44, 95% CI = 1.11-1.89) were associated with increased PGSI scores. Online casino gambling had a significant interaction by wave; the impact of online casino betting in wave 2 on PGSI scores increased by a factor of 1.61.

CONCLUSIONS

Past year participation of young adults (aged 16-26) in certain forms of gambling does not appear to be associated with future Problem Gambling Severity Index scores. Among young adults who are current gamblers, past year participation in certain land-based (e.g. electronic gaming machines) and online forms (e.g. skin betting) of gambling appears to be strongly associated with elevated Problem Gambling Severity Index scores.

Loot box consumption by adolescents pre- and post- pandemic lockdown

Loot boxes are virtual items that can be redeemed to receive randomly selected other virtual items, and have been criticized for being similar to gambling. The presence of loot boxes in video games has dramatically increased since 2010, with little evidence available for the current prevalence rate of loot box purchasing in the general population, particularly during and following the COVID-19 pandemic lockdowns. This study uses data from representative samples of American youth to estimate prevalence rates for video game play and loot box consumption before the pandemic (2019) and after the pandemic lockdowns (2022) to examine whether the pandemic has affected loot box usage in the general population and among gamers. The results suggest that youth loot box consumption has increased, rising from 24.9% in 2019 to 31.6% in 2022 among 8th grade (age 13-14) youth. The increase over this time period was larger for girls, though boys are still more likely to purchase loot boxes overall.

Loot boxes use, video gaming, and gambling in adolescents: Results from a path analysis before and during COVID-19-pandemic-related lockdown in Italy

Loot Boxes (LBs), i.e., virtual items embedded within video games with numerous features reminiscent of gambling, are increasingly widespread among adolescents. LB use is associated with problem gambling in youth, but few studies have been conducted on the association between LB use and gambling behavior considering adolescents. Thus, the mechanisms underlying this relationship are not clear. As LB use is a significant and positive risk factor for video gaming severity, and video gaming is associated with problem gambling, we hypothesized that LB use would be related to gambling frequency and problem gambling through the intermediary role of video gaming frequency and problem video gaming. We tested our hypothesis before COVID-19-pandemic-related lockdown and during COVID-19-pandemic-related lockdown, in Italy. Study 1 was conducted with 1,078 high school students (39% boys, mean age = 16.46, SD = 1.28) before COVID-19-pandemic-related lockdown, and Study 2 was conducted with 1,204 high school students (57% boys, mean age = 15.62, SD = 0.64) during COVID-19-pandemic-related lockdown. A path analysis was carried out to analyze the significance of indirect effects from LB use to gambling behavior and problem gambling through video gaming and problem video gaming. In both the studies, results showed that LB use exerted significant and positive direct effects on video gaming frequency, problem video gaming, and gambling frequency. Moreover, LB use had indirect significant and positive effects on problem gambling through video gaming frequency, problem video gaming, and gambling frequency. Findings attest that LB use can be related to problem gambling through a greater involvement in videogames. Thus, a specific subtype of young gamblers can develop Gambling Disorder symptoms from the use of LBs and through an intense use of video games. Practical implications for prevention and treatment are discussed.

Blind box over-engagement and suicide risk among adolescents and young adults: Results of a large-scale survey

BACKGROUND

Gambling appears to be an independent risk factor for suicide among the young population worldwide. Blind boxes are collectable toys packed randomly in the box, which share certain similarities with gambling and are popular among the young population. This is the first study that examined the association between blind box engagement and suicide risk in the young population, the leading consumption group of blind boxes.

METHODS

This study is part of a large-scale, cross-sectional study using convenience sampling conducted Oct 26 to Nov 18, 2021, which covered all the university and college students in the Jilin province, China. A total of 73,206 participants completed the survey with valid data for the current study (male: N = 28,762; female: N = 44,444; Mean age = 19·59). Participants' blind box engagement, suicide risk, depression, anxiety, alcohol use, smoking habit, and sociodemographic characteristics were assessed. First, we used univariate and multivariable binary logistic regression models to examine the relationship between blind box engagement and suicide risk in all participants. Second, we tested whether depression and anxiety would mediate the association between blind box engagement and suicide risk. Third, we analysed the association between "Frequency (i.e., frequency of blind box engagement)," "Bet (i.e., expenditure on the blind box that exceeds affordability)," "Tolerance (i.e., level of addiction)," "Borrowed (i.e., the amount of money borrowed for blind box engagement)," and suicide risk in the group with blind box engagement history.

FINDINGS

4,195 participants (5·73%) have engaged in blind boxes, with 3,255 females (77·59%) and 940 males (22·41%). In the univariate models, binary logistic regression showed that blind box engagement was associated with suicide risk in both male and female participants (male: OR = 2·21, 95% CI = 1·86-2·63; female: OR = 1·64, 95% CI = 1·50-1·78). In the multivariable models, after controlling age, subjective socioeconomic status, per capita disposable income, alcohol use, and smoking habit, blind box engagement still was associated with suicide risk across genders (male: OR = 2·25, 95% CI = 1·89-2·68; female: OR = 1·58, 95% CI = 1·45-1·73). Depression (male: indirect effect = 0·31, SE = 0·04, p < 0·001; female: indirect effect = 0·20, SE = 0·02, p < 0·001) and anxiety (male: indirect effect = 0·26, SE = 0·03, p < 0·001; female: indirect effect = 0·13, SE = 0·02, p < 0·001) mediate the association between blind box engagement and suicide risk. Within the blind box engagement group, forward binary logistic regression revealed that "Tolerance" was associated with participants' suicide risk in both males (p = 0·001) and females (p < 0·001); "Borrowed" (p = 0·019) alone was associated with the male participants' suicide risk.

INTERPRETATION

Our findings showed that blind box over-engagement is positively associated with suicide risk in both young males and females, and this association persisted after adjusting for influencing factors. In spite of the limitations in this study (e.g., cross-sectional, convenience sampling), current findings can assist policymakers in developing regulations for such a prosperous youth-dominant consumption industry while protecting youth's mental health worldwide.

FUNDING

None.

Adolescents Who Play and Spend Money in Simulated Gambling Games Are at Heightened Risk of Gambling Problems

Simulated gambling, such as playing a virtual slot machine for points rather than money, is increasingly part of the online gaming experience for youth. This study aimed to examine (1) if youth participation in simulated gambling games is associated with participation in monetary gambling; (2) if youth participation in simulated gambling games is associated with increased risk of problematic gambling when controlling for breadth of monetary gambling (i.e., number of gambling forms); and (3) if monetary expenditure and time spent playing simulated gambling games increase the risk of problematic gambling. Two samples of Australians aged 12-17 years were recruited-826 respondents through an online panel aggregator (mean age 14.1 years) and 843 respondents through advertising (mean age 14.6 years). Aim 1 was addressed using chi-square and correlation analyses. Linear multiple regression analyses were conducted to address Aims 2 and 3. The findings in both samples supported the study's hypotheses-that (1) youth who play simulated gambling games are more likely to participate in monetary gambling, and that (2) participation and (3) time and money expenditure on simulated gambling are positively and independently associated with risk of problematic gambling when controlling for the number of monetary gambling forms, impulsivity, age and gender. To better protect young people, simulated gambling should, at minimum, emulate the consumer protection measures required for online gambling.

Loot box purchasing is linked to problem gambling in adolescents when controlling for monetary gambling participation

Background and aims

Purchasing loot boxes in digital games is akin to gambling as it involves risking money for a chance-based reward of uncertain value. Research has linked buying loot boxes to problem gambling amongst adolescents, but has not examined co-occurring gambling participation. This study examined links between loot box purchasing and problem gambling amongst adolescents while controlling for monetary gambling participation.

Methods

Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 843) and online panels (n = 826). They included n = 421 and n = 128 adolescents, respectively, who met criteria for problem gambling.

Results

Past-month loot box purchasing was significantly related to gambling problems in bivariate analyses. When including age, gender and past-month monetary gambling, loot box purchases were still associated with at-risk and problem gambling in both samples. As expected, these other predictors attenuated the predictive value of recent loot box purchases in relation to gambling problems. The odds-ratios, nevertheless, were still in the predicted direction and remained significant. When controlling for monetary gambling, age and gender, recent loot box purchasing increased the odds of problem gambling 3.7 to 6.0 times, and at-risk gambling 2.8 to 4.3 times.

Discussion and conclusions

While causal relationships between loot box purchasing and problem gambling remain unclear, the results indicate that loot boxes disproportionately attract adolescents experiencing gambling problems, adding to the financial stress already caused by gambling. Consumer protection measures, youth and parental education, and age restrictions on loot box games are needed to protect young people.

Development and Internal Validation of a Model for Predicting Internet Gaming Disorder Risk in Adolescents and Children

BACKGROUND

The high prevalence of Internet gaming disorder among children and adolescents and its severe psychological, health, and social consequences have become a public emergency. A high efficiency and cost-effective early recognition method are urgently needed.

OBJECTIVE

We aim to develop and internally validate a nomogram model for predicting Internet gaming disorder (IGD) risk in Chinese adolescents and children.

METHODS

Through an online survey, 780 children and adolescents aged 7-18 years who participated in the survey from June to August 2021 were selected. The least absolute shrinkage and selection operator regression model was used to filter the factors. Multivariate logistic regression analysis was used to establish the prediction model and generate nomograms and a website calculator. The area under the receiver operating characteristic curve, calibration plot, and decision curve analysis were used to evaluate the model's discrimination, calibration, and clinical utility. Bootstrapping validation was used to verify the model internally.

RESULTS

Male sex and experience of game consumption were the two most important predictors. Both models exhibited good discrimination, with an area under the curve >0.80. The calibration plots were both close to the diagonal line (45°). Decision curve analyses revealed that two nomograms were clinically useful when the threshold probability for the intervention was set to 5-75%.

CONCLUSION

Two prediction models appear to be reliable tools for Internet gaming disorder screening in children and adolescents, which can also help clinicians to personalize treatment plans. Moreover, from the standpoint of simplification and cost, Model 2 appears to be a better alternative.

Money used in gaming is associated with problem gambling: Results of the ESPAD 2019 Finland

BACKGROUND AND AIMS

The convergence of gaming and gambling may pose a risk for adolescents. Thus, it is important to find out how these behaviours are associated with other addictive behaviours in order to develop efficient preventive measures for youth. The aim of this study was to examine 1) whether problematic gaming and money used for gaming activities are risk factors for gambling, and 2) what kind of impact adolescents' substance use along with other factors related to friends and parents have on this association.

METHODS

The European School Survey Project on Alcohol and Other Drugs data, 2019 of Finnish adolescents aged 15 to 16 (N = 4595). Cross-tabulations with Rao-Scott's chisquare tests were applied to study the associations of the background factors with gambling in the past 12 months. A multinomial logistic regression model was fitted for the outcome variable (gambling in the past 12 months) adjusted for all independent and background variables.

RESULTS

Problematic gaming alone was not associated with gambling participation, whereas using money for digital games increased the risk of gambling. Boys gamble more than girls. The use of alcohol and drugs increased the risk of gambling. Parental monitoring reduced the risk of gambling, whereas hanging around weekly with friends increased the risk.

DISCUSSION AND CONCLUSIONS

Using money on gaming sites may put some adolescents at risk of developing problems with either gaming or gambling. The link between using money in digital games and gambling participation calls for preventive measures, intervention and regulatory acts.

Skin gambling predicts problematic gambling amongst adolescents when controlling for monetary gambling

BACKGROUND AND AIMS

Skin gambling uses in-game items (skins) acquired in video games, to gamble on esports, games of chance, other competitive events and privately with friends. This study examined characteristics of adolescent skin gamblers, their engagement in monetary gambling, and relationships between skin gambling and at risk/problem gambling.

METHODS

Two samples of Australian adolescents aged 12-17 years were recruited to an online survey through advertisements (n = 843) and an online panel provider (n = 826).

RESULTS

In both samples, past-month skin gamblers (n = 466 advertisements sample; n = 185 online panel sample) were more likely to have lower wellbeing, score as having an internet gaming disorder on the IGD, engage in more types of monetary gambling, and meet criteria for problem gambling on the DSM-IV-MR-J. Past-month skin gambling uniquely predicted problem gambling when controlling for past-month gambling on 11 monetary forms and the total number of monetary gambling forms.

DISCUSSION AND CONCLUSIONS

Underage participation in skin gambling is a growing concern. The strong convergence between engagement in skin gambling and monetary gambling suggests common risk factors may increase the propensity of some adolescents to gamble on these multiple forms. Nonetheless, past-month skin gambling predicted problem gambling even when controlling for past-month monetary gambling, indicating its unique contribution to gambling problems and harm. While the study was based on non-probability samples, its results strengthen the case for regulatory reforms, age restrictions and public health education to prevent underage skin gambling and its potentially harmful consequences for children and young people.

Characteristics of Gamers who Purchase Loot Box: a Systematic Literature Review

Purpose of Review

Research has indicated that loot boxes are risky gaming components that could exacerbate Internet gaming disorder due to a link between loot box purchasing and gambling. We conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between loot boxes and gambling, and (c) between loot boxes and other variables.

Recent Findings

Of the 201 studies examined for eligibility, we reviewed 20 studies that met the predefined criteria, which were extracted by searching electronic databases (PsycINFO, PubMed, Ovid, EBSCO, and Web of Science) and the reference lists of included studies, and that were published up to March 27, 2021. Overall, this review identified positive relationships among Internet gaming disorder–related symptoms, disordered gambling symptoms, and engagement with, or investment in, loot boxes. In addition to gaming and gambling, the relationships among some variables, such as mood, gender, physiological state, motivation, and loot box engagement, were examined.

Summary

The present review clarified relationships between loot box engagement, gaming, gambling, and other variables, such as mood, gender, physiological state, and motivation, and partially identified the characteristics of people who purchase loot boxes using real money. Specifically, those who spend more money in-game on loot boxes exhibit Internet gaming–related and/or disordered gambling symptoms and behaviors. Finally, we discussed future directions for clinical psychological studies on loot boxes.