There is strong consensus across current theories and models that education alone will not reduce the prevalence of problem gambling or reduce the harms associated with problem gambling. The core components identified in the different frameworks described above include a variety of preventative activities, particularly focusing on supply and demand reduction measures, the role of gambling as a leisure option, and a range of policy measures. All refer to the importance of conducting or participating in research to build more evidence, noting that there is a general lack of evidence about the effectiveness of many interventions.
This Review does not seek to provide a comprehensive overview of the literature potentially relevant to activities and strategies that address the determinants of problem gambling. In commissioning the current Review of the Local CE&P Model, the VRGF indicated a particular interest in evidence about practices that foster a culture of responsible gambling in communities and responsible gambling environments; and strategies that provide alternative recreational activities to gambling.
5.3.1 Influencing access and opportunity
There is evidence about the impact different characteristics of gambling settings may have on gambling behaviour, including problem gambling. The complexity of the interaction between types of gambling, settings in which they occur, and individual factors adds to the difficulty of building an evidence base about prevention; however, some interventions have been adopted and evaluated in different jurisdictions, including some of the measures described above (Roberts & Hildebrandt, 2008).
Access to gambling products via the sale of tickets for lottery draws, scratch cards and sports lotteries to under‐age customers has been identified as a problem in some countries, and interventions to address the problem have been developed (St‐Pierre, Derevensky, Gupta, & Martin, 2011). St‐Pierre et al.
demonstrated that ‘the request for age‐identification’ by point of sale vendors was the strongest predictor of a sale being refused to younger looking customers. Providing quality, free‐of‐charge education and training programs improved compliance by all point of sale vendors about youth access legislation and policies. The study also showed that the cultural and/or social background of vendors influenced their behaviour, highlighting the need to adapt universal messages and education programs to address the needs of different target audiences.
Other interventions have been embedded in the gambling setting or linked to particular gambling types.
For example, research examining the relative effectiveness of pop‐up messages (i.e., that ask gambling players to set monetary limits) has demonstrated moderate success in supporting EGM players to adhere to pre‐set monetary limits. Pop‐up messages allow gamblers to set limits before playing a machine, so that the machine then displays reminder messages at different time intervals about the amount spent.
The pop‐up messages also remind the gambler when their limit has been reached (Stewart & Wohl, 2012).
Other strategies that have been suggested as components of a comprehensive problem gambling
program are based on evidence that factors associated with gambling settings may contribute to gambling exposure, gambling participation, and harmful gambling. Strategies proposed include: modifications to alcohol availability at venues; changes to venue layout (including natural light); prohibiting credit or cash
advances; training venue staff; pre‐commitment to specified loss and/or time limits; controls on
advertising and promotions; self‐exclusion programs; venue shut‐down periods; limiting the number and location of gambling outlets in a region; enforcing age restrictions; and lowering prize levels. As noted by Abbott et al. (2013), “the evidence base for the effectiveness of such harm reduction approaches is often inconsistent or non‐existent”, which they attribute to the lack of prospective/longitudinal studies, or counteractive measures that may be introduced by the industry that mask potential positive impacts of some interventions. It is important to note, however, the comments of the Australian Productivity Commission (2010):
Evidence is essential to good public policy. However, an excessively high standard of proof about what would reduce consumer detriment from gambling would cause policy paralysis in an area where there are demonstrably large community costs from inaction. Policy needs to take account not only of the costs of mistakenly introducing ineffective policies, but also the costs of failing to act when a policy option may in fact be effective. There are good precedents for precautionary policy action in areas involving people’s safety.13
Areas relevant to the CE&P Model in which the Productivity Commission reported findings and made recommendations included: gambling information and advertising; school‐based education (where they recommended against further programs without first assessing the impacts of existing programs); pre‐
commitment strategies; game features and machine design; venue activities; access to cash and credit;
and accessibility of gaming machines. The Commission also recommended a national centre for gaming policy research and evaluation.
5.3.2 Target groups
Targeted approaches are based on the identification of groups believed to have a higher than average risk for problem gambling. The identification of “at‐risk” groups is generally based on prevalence data that identifies the socio‐demographic and other characteristics of those who are identified as having a gambling problem according to screening tools and/or are experiencing harms from their gambling. It is important to note that the co‐occurrence of factors does not necessarily imply causation. Interpreting the observation that there are more older women among EGM problem gamblers, without further breaking down the co‐occurring factors and experiences, does not provide sufficient guidance for targeting potential preventative activities. There is evidence that gambling behaviour and the rate of harmful gambling varies across ethnic groups, and with gender, age and socio‐economic status (Delfabbro & King, 2012), with differences observed in how these factors are present in different jurisdictions (Williams, Volberg & Stevens, 2012). The mechanisms by which an individual within any of these broadly categorised groups is at greater risk of experiencing personal harm associated with gambling are hypothesised in the literature, but there is no consensus and general agreement that mechanisms will vary for any individual according to a range of characteristics. This complexity makes the targeting of interventions difficult, and the development of an evidence base about effectiveness of interventions challenging.
Young people
Young people (18–35 years) who have been identified in the literature as “at risk” of developing harmful gambling behaviour include:
Young people with family members who gamble
Young people from families with positive attitudes towards gambling
Young people with family members with drug and/or alcohol problems
Young people with friends or classmates who are drug and/ or alcohol users
13 Productivity Commission (2010). Gambling. Report No 50. p21
Young people with few or no close confidantes with whom to discuss problems
Young people with limited educational success
Young people with social, behavioural, or emotional problems
Young people with familial problems
Young people with increasing problems with drug and/or alcohol use.
(Hardoon, Derevensky, & Gupta, 2002)
It is notable that it is not “young people” as a whole who are identified as one “at‐risk” group. The circumstances that occur for young people that make them at risk are similar to those that contribute to the degree of risk for an older person, including social isolation, co‐morbid mental health and substance use issues, and socio‐economic disadvantage.
Primarily because of the convenience and ease of reach, school‐based education is seen as an important first line of response for young people. This is despite the fact that empirical research is yet to show longitudinal evidence that educational messages delivered to young people and children have an effect on the incidence of problem gambling in subsequent years (Ariyabuddhiphongs, 2013). There has been some evidence in the broader study of addictions to suggest that education programs may be successful with young people via a mechanism described as ‘inoculation’ (i.e., an ‘immunising dose’ of information) (Lemarié & Chebat, 2013); however, in general there is a lack of evidence about the behavioural
consequences of school‐based programs. Despite this, there are good theoretical reasons to propose that young people in schools understand gambling‐specific fact‐based information as a foundation for future decision‐making.
The gambling literature indicates that topics addressed through educational interventions vary, but common themes include information about: (1) the difference between games of chance and games of skill; (2) probabilities and notions related to gambling (independence of events, randomness, myths); (3) erroneous beliefs and illusions of control; (4) signs of problem gambling; and (5) resources available to help problem gamblers.
A recent review of evidence identified two categories of education programs: those delivering gambling‐
specific knowledge and gambling‐related general skills workshops (Ladouceur et al., 2012). Gambling‐
specific programs are implemented in educational environments and are designed to provide information about gambling and problem gambling that imparts realistic views and helps develop adaptive attitudes toward gambling (Gaboury & Ladouceur, 1993; Todirita & Lupu, 2013). Gambling‐related general skills workshops are also delivered in educational settings but focus on how to deal with participants’ risk‐
taking behaviour, and how best to reflect on decision‐making and/ or problem solving in the context of risk‐taking activities (Ferland, Ladouceur, & Vitaro, 2005; Turner, Macdonald, & Somerset, 2008; Williams, 2002; Williams, Wood, & Currie, 2010). Evidence on the efficacy of these two kinds of programs is limited, especially their impact on personal and interpersonal skills; however, there is evidence that they increase participants’ knowledge about gambling and may support changes to some behaviours, although their impact in preventing problem gambling over time remains inconclusive.
Culture and language
Evidence suggests that membership of a specified CALD subgroup can be either protective or increase risk for problem gambling (Stevens & Golebiowska, 2013). Risk may increase where cultural group
identification exposes individuals to unique cultural variables influential in the uptake and maintenance of gambling (Oei & Raylu, 2009; Raylu & Oei, 2004). Aboriginal communities have also been identified as having a higher risk for problem gambling (Delfabbro & King, 2012). There is little in the literature about preventative activities that address different cultural groups specifically, although targeting education and information has been described and could be adopted and further evaluated.
The internet gambler
Internet gambling has become very popular amongst young people and it has been identified by some as an activity that attracts other particularly vulnerable populations (Tryggvesson, 2009). Two separate studies have highlighted important features of problem gambling that are relevant to the online
environment. In the first, a study of longitudinal data, the findings demonstrated that the best indicator of a problem gambler in the internet environment is the amount of time spent gambling, rather than the amount wagered or lost (LaBrie, Kaplan, LaPlante, Nelson, & Shaffer, 2008). The second study examined a cohort of young people over ten years and found that the natural history of problem gambling is not like a chronic illness, in that it progresses in a linear fashion; rather, they demonstrated that problem gambling in young people especially is episodic (Slutske, Jackson, & Sher, 2003). In the context of internet gambling, this may infer that any high level of activity (i.e., measured as ‘time’) is directly indicative of problem gambling. Subgroups of young people have been identified as being particularly susceptible to problem gambling in the internet context (Floros, Siomos, Fisoun, & Geroukalis, 2013). Factors that increase susceptibility in young people have been noted above.
Older adults
Problem gambling is not any more common among older adults than other subgroups (in fact, younger people are more likely to gamble and have gambling‐related problems overall), but the literature underlines that gambling can have an indirect, albeit serious affect on the physical and psychosocial health of older adults (Ariyabuddhiphongs, 2012). For example, where inexpensive or free pleasure trips to gambling venues increase access and opportunity to gambling settings for older people, individuals who may have smaller or less satisfying social networks, significant transport barriers and /or other personal characteristics that make the vulnerable may also be more likely to experience harmful effects (Lichtenberg, Martin, & Anderson, 2009). For this reason, leisure substation interventions are popularly proposed as an approach to this particular target group. The challenge for such interventions is to attempt to target those individuals who are most at risk, not just general sub‐groups of the population that may be very unlikely to develop a gambling problem. Considering age along with other risk factors (such as Hardoon et al. [2002] did for young people) can help to better target these kinds of activities.
5.3.3 Promoting social isolation and leisure substitution
While social isolation is a general risk factor for a range of mental health problems, in the case of gambling, the relationship between social connectedness and risk is not clear. Previous research has suggested thatproblem gamblers are connected socially and generally see themselves as members of effective social contexts that class gambling as normal recreation activity (Trevorrow & Moore, 1998).
Shifting one’s leisure pursuits away from gambling to another is thus likely to disengage people with good social connections and leave them with unstructured time and inadequate social skills (Jackson, Francis, Byrne, & Christensen, 2013). The amount of time spent gambling nevertheless is an important indicator for problem gambling and as noted above, has been singled out as a central feature of problem gambling in online environments over and above the amount of money wagered (LaBrie et al., 2008).
It is known that problem gamblers engage in few social activities other than gambling (Jackson et al., 2013). Leisure substitution opportunities organised at a local or community level thus have the potential to shift the amount of time spent in gambling activities and redress some of the negative consequences of stopping gambling activities. Leisure substitution has the potential to provide opportunities through which individuals can rebalance the amount of time they spend gambling and, in optimal circumstances, provide situations where gamblers identify for themselves an emergent, unmet need involving the experience of positive mood when engaging in social activities other than gambling (Jackson et al., 2013).
This focus of time is a viable option as both a universal and targeted program as it has been demonstrated that involvement in conventional social activities is one of the protective factors buffering young people at risk of gambling problems (Dickson, Derevensky, & Gupta, 2008).
Perhaps one of the gaps in knowledge in undertaking more leisure substitution in the community is related to the absence of descriptive information on demographic, social, cultural and emotional and social well‐being, stratified for local needs. The General Social Survey (Australian Bureau of Statistics, 2010) collects this kind of data and it has been applied to develop a picture of social activity, gambling activity and CALD community life (Stevens & Golebiowska, 2013). This kind of data is important for targeting leisure substitution interventions, particularly for the VRGF. While all kinds of social engagement are valid interventions for integrated health promotion in a local catchment, for the VRGF to fund this kind of activity there needs to be a clear demonstration that the targeting is reaching reasonable numbers of people who are most likely to be at risk of developing problem gambling behaviours and experiencing harm from gambling.
5.4 Conclusion
The importance of education is recognised in a public health approach to problem gambling, but primarily on the basis of theories about behaviour change that assume knowledge and attitudes will influence behavioural intentions and behaviour. The lack of evidence for this assumption is acknowledged by most strategies, and it is widely agreed that a multifaceted approach to implementation of a responsible gambling program is required to ensure the greatest impact.
A localised approach to community education is necessary for the implementation of an effective responsible gambling strategy. Discussion of the importance of localised education and awareness strategies highlights the value of continuing efforts in community education and prevention for the promotion of responsible gambling. Principles of effective practice may be useful in guiding the
development of localised activities and developing the links between actions at the state‐wide, regional and local levels.
Recommended guidelines and “best advice” propose the inclusion of media‐based initiatives and school programs, developing a strong “health literacy” about the harms associated with problem gambling, and employing and coordinating a “wide array of educational (and policy) initiatives”.
• The value of involving local community in implementation is supported by evidence. Localised information provision allows tailoring of information for a specific community or target group, increasing the likelihood that people will be cognisant of the responsible gambling messages being conveyed. Community consultation and collaboration is needed in order to empower local communities to develop locally appropriate strategies for overcoming gambling‐related problems.
It increases “buy‐in” and involves more people at deeper level to process information, supports more appropriate operationalisation, and identifies other relevant issues early. This requires efforts to ensure active and equitable participation of local communities in the full spectrum of planning and implementation activities. In doing so, local knowledge and expertise can be utilised, particularly via existing formal and informal community networks.
• Localised information provision, community engagement and education activities and programs, and community consultation, collaboration and development approaches are important
components of community education and awareness‐raising. Assuming messages about gambling are consistent at both the local and central levels, such activities can support activities in public information dissemination on a population‐wide basis.
• Community engagement and education activities and programs targeted to the needs of specific populations groups who are less likely to be engaged by mainstream media and messages, including Aboriginal and culturally and linguistically diverse communities and vulnerable groups, are a valid component of a community education program. Effectively engaging with these individuals and communities can best be achieved on a local level.
• There is little evaluation/evidence about the impacts of broad‐based educational and/or information‐based activities. Where evidence exists, it generally demonstrates knowledge and
awareness change, but there is no evidence of change in gambling behaviours. This is consistent with evidence from other “difficult to change” behaviour.
The components recommended by Williams et al. (2012) and Blaszcynski et al. (2011) include a range of strategies and activities for which there is limited evidence, and there is consequently an emphasis on research and evaluation to test the validity of many of the proposed strategies. The general areas of activity they propose are focussed on decreasing availability of gambling, particularly high‐risk forms of gambling. Specific suggestions included restricting eligibility to gamble, restricting use of tobacco and alcohol in gambling venues, and restricting access to money. Blaszczynski et al. (2011) include many education and awareness‐raising strategies among their essential components as well as some strategies that address supply: restricting under‐age gambling, restricting sale of alcohol, making self‐exclusion options available, and modifying structure features of gambling modes and the environments in which they take place. Roberts and Hildebrandt (2008) suggest a number of non‐education‐related preventative activities, stressing the need for further study and testing of each, including supply reduction measures implemented at a local level, venue or machine‐based warning messages, player‐held electronic gaming machine cards (called Video Lottery Terminal or VLT cards in Canada) that allow players to use various responsible gambling features of machines, and removal of the sale of these cards from gambling locations.
There is consensus that coordinated problem gambling prevention programs should be multidimensional, including where possible the domains of education, training, policy/advocacy and research. Some of the activities that arise from adopting this approach are not explicitly referenced in the current CE&P model and, in some cases, may be considered by some to be outside the scope of the VRGF14. Many of the
There is consensus that coordinated problem gambling prevention programs should be multidimensional, including where possible the domains of education, training, policy/advocacy and research. Some of the activities that arise from adopting this approach are not explicitly referenced in the current CE&P model and, in some cases, may be considered by some to be outside the scope of the VRGF14. Many of the