Factors Influencing the Development of Responsible Gambling: A prospective study

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Factors Influencing the Development of
Responsible GamblingA prospective study

• N. el-Guebaly, D. Hodgins, G. Smith, R. Williams,
  V. Williams
• RA Ronaye Coulson

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PREVENTION Does it Work?

• REALISTIC EXPECTATIONS? From Abolition to Harm
  Reduction
• Experimentation ? recreation ? habituation ?
  addiction Social ? problem ? pathological
  gambling
• Social acceptability alcohol - targets
  driving, FAS tobacco - overall reduction
  (young F) gambling ?
• Culture of moderation vs impairment (Quebec)
• Other determinants poverty, violence
• FINE TUNE! Universal / selective targets -
  Indicated (2ary) 20-30 or 40-60
  reduction

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A. Literature Review of Prospective Studies

• The domain literature reviews 1999-2000
  questioned the relevance significance of domain
  variables
• Addiction - Mental Health - Sociology
• Prospective Studies since 1985 multidisciplinary
  focus
• 5 years sample size 200
• Gambling Studies - K. Winters et al
• - G. Barnes et al Youth
• - F. Vitaro et al
• Unpublished - Abbot et al 7y adult gamblers
• - Cottler C-Williams 11y drug users (ECA)
• Longitudinal Studies are the way to go!

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TABLE 1 LONGITUDINAL STUDIES OF GAMBLING
BEHAVIORS PROBLEMS
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Longitudinal Designs

• ADVANTAGES
• Continuities Discontinuities in behavior
• - which problems persist which do not?
• - predictors of resilience pathology
• - necessity efficacy of prevention
  treatment
• - reveals causative mechanisms
• - validity of diagnostic constructs related to
  outcome
• Variations over time within between individuals
  vs C-S
• - age of onset termination as well as course
  
• - identifies causal mechanisms chain
  direction
• - escape from environment resilience
• - predictors of later functioning
• First determination of incidence of gambling
• Cost-effective common data pool for all domains

• LIMITATIONS
• Limited comparability lack of standard
  assessment operational definitions
• Confounding age period effects
• - COHORT group of individuals experiencing
  same event over same time
• COHORT EFFECT ie. Baby Boomer
• - PERIOD EFFECT influence specific to time
  period, ie. gambling opportunities
• - AGING EFFECT change due to age, ie,
  age- dependent leisure
• - Cross-section confounds aging cohort
  Longitudinal confounds aging period
• Delay between start of study first results
• Sample attrition vs contact planning, ie.,
  subject, relatives, records, knowledge of who is
  missing
• Repeated contacts may influence behavior
• Funding personnel across long time span

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B. Selecting the Proposed Design

• PRINCIPLES - Across the lifecycle both genders
• 1. Study gamut of gambling behaviors
• 2. Assess impact of a changing gambling culture
• 3. Identify variables enhancing normative
  gambling protective resilience as well as risk
  variables
• 4. Identify the potential continuity
  discontinuity of gambling behaviors including
  patterns of recovery.

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The Accelerated Longitudinal Alternative

• A multi-cohort sequential strategy reduces F/U
  period cumulative effects of testing
  attrition
• Several cohorts increase confidence in
  generalizability
• Disentangles aging from period effects only if
  there is substantial overlap between FU ages
• Retrospective data may link up the intercohort
  intervals
• The critical ages selected for a 5 year follow-up
  are
• 13-15 y initiation to gambling developmental
  variables
• 18-20y high risk, frequent gambling
• 23-25y adult family, job leisure activities
• 43-45y mid-adulthood tasks, educate next
  generation about responsible leisure
• 58-60y pre-retirement, fund-raising target due
  to disposable income
• 63-65y understudied with various opinions as to
  impact of changing culture

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Other Choices

• I. Tackling the low prevalence of gambling
  problems (N1900)
• - 300/age cohort 150 from unselected general
  population
• 150 from select high risk sample gambling
  frequency 80th percentile
• - Except 400/adolescent due to
• II. Age Specific Definitions/Screening of
  Behavior
• III. Survey administration, Objectives
  Cost-effectiveness
• Ben Limit A. Telephone B.
  Face-to-face C. Mixed
• Interviews Length 3 hr face-to-face 1/2
  day initial
• Sampling Random digital RDD costly travel RDD
  for Calg Edm
• dialing (RDD) 4 ? risk Ft McM/
• Edm/Calg/Other P Creek/Cardston/Ft/McL Initial
  refusal 25
• Attrition rate 13-15/year ? 15-30
  overall
• Incentives tax Less ? 50/ 1/2
  day, 30 mid, 75 end
• Stress Factor Low Higher RAs
  coordinator
• Validity Good Better? Best
  endorsement/call ID
• Flexibility ownership Less More Best

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Additional Choices

• Instruments selection
• A. Omnibus risk protection
• Christchurch Health Development
• Stats Can Nat Longit Study
• US Nat Youth Survey
• B. Gambling Comorbidity focussed
• Can Problem Gambling Index incl Subst Ab
• NODS (US Impact Study)
• SOGS-RA
• DSM IV TR
• C. Specific
• Blood sample
• IQ - Personality (NEO)
• Erroneous Perceptions
• Social Factors Attitudes
• Exclusion of direct interventions reporting only
• Interprovincial different policies economics
• CIHR pillars biomedical, clinical, health
  services/systems, population health
  sociocultural determinants
• Contracted questions

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COHORT ORGANIZATIONAL STRUCTURE
EXECUTIVE COMMITTEE (Budget, Board relation,
Coordination) N. el-Guebaly 1, D. Hodgins 2, G.
Smith 3, R. Williams 4, V. Williams 5
Project Coordinator Library Rhys Stevens
Research Assistant R. Coulson
EXTERNAL ADVISORY BOARD K. Winters 6, H. Schaffer
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DOMAINS/ SITES/AGES
BIOPSYCHO-LOGICAL (Adoles Adult)
SOCIO- CULTURAL
POLICY/ ECONOMICS
Steering Committees Others - U of Alberta - U
of Calgary - U of Lethbridge - Community
D. Hodgins University of Calgary - - N.
el-Guebaly - R. Williams -
R. Williams University of Lethbridge - - - -
G. Smith University of Alberta - - - -
LEGEND 1 Chair, AGRI, University of Calgary 2
Node Coordinator, University of Calgary 3 Node
Coordinator, University of Alberta 4 Node
Coordinator, University of Lethbridge 5 CEO,
AGRI 6 University of Minnesota 7 Harvard
University
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Anticipated Outcome

• First data set on range of gambling behaviors
  across lifecycle. All domains biopsychological -
  sociocultural - policy economics CIHR pillars?
• First incidence data
• Common cost-effective datapool for all domains
• Validation of screening instruments across
  lifecycle
• Strong collaborative project across Albertas
  universities
• A catalyst for interprovincial collaboration
  (helps policy/ economic domains) potential CIHR
  support - April 2003

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The search for truth is like looking for Elvis
on any given day there will be many sightings ---
most will be impersonators!