Adolescence is a developmental period during which risky behaviors—such as gambling and alcohol use—tend to emerge. In Finland, gambling and alcohol use among underage adolescents is common. Advising adolescents on the potential harms of risky behaviors is important because gambling at an early age is associated with a greater risk of developing addictive behaviors such as problem gambling and alcohol dependence later in life. This week, the WAGER reviews a study by Tiina Latvala and colleagues that examined trends in the relationship between adolescent gambling and alcohol use between genders over time.
What were the research questions?
(1) What trends are there in the relationships between gambling, alcohol use, and drunkenness among Finnish adolescents? and (2) How have these trends changed from 2009 to 2019?
What did the researchers do?
The researchers used data collected biannually from 2009 to 2019 from the School Health Promotion Study (SHPS). The SHPS is a national cross-sectional study that asks 14-16 year olds in Finland about their health behaviors and school experiences. The researchers measured the frequency of gambling and alcohol use by asking the questions, “How often do you gamble?” and, “How often do you use alcohol altogether, e.g., half a bottle of beer or more?” They measured the frequency of drunkenness by asking, “How often do you use alcohol until you are really drunk?”. Among those who used alcohol or got drunk at least once a month, the researchers classified respondents as regular gamblers (gambled at least once a week), occasional gamblers (gambled 2-3 times a week), or non-gamblers, and studied how many respondents fell into these categories each year.
What did they find?
Among boys who reported using alcohol at least once a month, regular gambling became less prevalent over time while occasional gambling and non-gambling became more prevalent. In the first year of data collection, 58.3% of boys who drank at least once a month were regular gamblers, but this number dropped to 20.6% by 2019 (see Figure). Girls who reported using alcohol at least once a month gambled less overall across the study period. Trends were similar for boys and girls who got drunk at least once a month (not shown). Overall, gambling, alcohol use, and drunkenness were more common among boys compared to girls. Gambling was also more common among adolescents who used alcohol or who had gotten drunk compared to those who were not using alcohol or had not gotten drunk.
Figure. This figure displays the proportions of regular gambling, occasional gambling, and no gambling among boys and girls in Finland who reported using alcohol at least once a month from 2009 to 2019. Click image to enlarge.
Why do these findings matter?
Although the prevalence of adolescent gambling decreased over time between 2009 and 2019, there was still a significant proportion of underage adolescents who reported gambling. Additionally, those who used alcohol were also more likely to gamble, which suggests that there is a potential clustering of problems among adolescents. To decrease risky behaviors among adolescents, it is important to address social determinants of health through preventive interventions at the individual, community, and societal levels. Potential interventions include stricter enforcement of gambling policies, increasing education about potential harms resulting from risky behaviors among youth, and more.
Every study has limitations. What are the limitations in this study?
This study was conducted in Finland, so the findings about adolescent gambling and alcohol use might not be generalizable to other countries with different gambling regulations and attitudes. Additionally, because this study used self-report measures, the responses might be impacted by social desirability bias.
Many countries, such as the United Kingdom (UK), have created powerful regulatory bodies which are meant to protect consumers and mitigate risks that come with gambling. These regulatory bodies are not perfect, however. They can be slow to adapt to changes in the gambling landscape such as the rise of online gambling. Further complicating these issues is the presence of cryptocurrency-based1 online gambling operators. While online gambling carries its own risks, crypto gambling might be especially risky for consumers due to the lack of regulatory oversight. Research on the association between crypto-trading and gambling problems also suggests that individuals who engage crypto-gambling may be especially at-risk for gambling problems. This week, The WAGER reviews a study by Maira Andrade and colleagues that reviewed the responsible gambling (RG) features offered by crypto-based online gambling operators.
What was the research question?
What kinds of RG features do cryptocurrency-based online casinos employ?
What did the researchers do?
The researchers collected data from 40 cryptocurrency-based online casinos that were accessible from the UK. Of these, 22 were accessible directly from within the UK, while 18 required a VPN connection to access. The researchers then searched for the presence of seven features intended to promote RG on each of these sites. These included: (1) thorough account registration requirements, (2) a dedicated RG page, (3) separation of promotional material from the RG page, (4) availability of RG tools, such as deposit limits, (5) accessibility of gambling history, (6) RG material promoted via email, and (7) having RG-oriented customer service. (The researchers coded other crypto-based features, but we are not reviewing them here.)
What did they find?
The majority of operators required only minimal information to register. Fourteen sites required an email address (or less), and none required proof of age. The presence of responsible gambling material was also limited; though 31 out of the 40 sites offered an RG page, many contained either promotional material, suggested that gambling was a way to make money, or were otherwise insufficient in educating consumers about gambling-related harms. Slightly over half of the sample (62.5%) provided at least one RG tool, though these were also often limited or not user friendly. Notably, however, 39 of the websites offered gamblers access to their gambling history. Email communication was especially problematic among these sites. Only five sent emails containing RG information, and an additional five either didn’t respond or sent potentially harmful information after a hypothetical request for help from a consumer2 (see Figure).
Figure: Number of crypto-based online casinos with each of the seven RG features.
*One operator was not rated because they did not require an email at registration.
**Two operators were not rated on this criteria.
Why do these findings matter?
These findings could help regulators, researchers, and policymakers understand the current landscape of crypto-based gambling. For example, it’s possible that youth might be engaging with these sites, leading to potential current and future gambling-harm. Other findings suggest that these operators’ RG practices often involve harmful or incorrect information regarding gambling safety, which might increase gambling-related harm instead of reducing or preventing it.
Every study has limitations. What are the limitations in this study?
The researchers did not make deposits or otherwise gamble on any of the crypto-based gambling sites, so they did not get the full customer experience. As such, it is possible that the researchers missed some of the sites’ features or that their records of the sites’ features contain inaccuracies. For example, though the study found that 39 sites offered access to an accounts gambling history, it is unknown whether these were accurate reports or how frequently they were updated. Additionally, despite reviewing 40 sites, this sample is relatively small compared to the overall number of crypto-based gambling sites.
1. Cryptocurrency refers to a digital asset that is worth money and can be used to buy goods and services. The most popular and well-known type of cryptocurrency is Bitcoin, which was released publicly in 2009.
2. To examine potential responses to someone experiencing gambling problems, the researchers sent requests to all 40 websites with the following text: “I want to control my gambling. Can you give me any information on how I can do that? I feel a bit addicted and sometimes I can’t control the money I’m spending.”
Gambling is a common activity among adolescents. Most adolescents gamble without consequences but some experience gambling-related problems and associated harms, including disrupted social relationships, academic challenges, delinquency, and criminal behavior. Their gambling behavior might be influenced by the gambling attitudes and behaviors of their family and friends. This week, The WAGER reviews a study by Megan Freund and colleagues that investigated whether exposure to other people’s gambling is associated with the gambling behavior of Australian secondary students.
What was the research question?
Is exposure to other people’s gambling associated with past-month gambling, types of gambling activities, and at-risk or problem gambling among a sample of Australian adolescents?
What did the researchers do?
Students (n = 6,377) from 93 secondary schools in the Australian states of Victoria and Queensland participated in the Australian Secondary Students’ Alcohol and Drug Survey. Participants reported whether they had ever gambled and their past-month gambling behaviors, including the types of gambling activities they engaged in (i.e., hard or soft1). Students who reported ever gambling were screened for problem gambling. Participants were also asked whether their parent/caregiver, brother/sister, best friend, or other relative had gambled in the past month. The researchers assessed the associations between other people’s gambling and students’ past-month gambling, types of gambling activities, and at-risk or problem gambling.
What did they find?
Thirty-one percent of students in the sample reported ever gambling and six percent had gambled in the past month. Ten percent of students who ever gambled were classified as either experiencing at-risk (8%) or problem gambling (2%). One in five students reported that someone in their household gambled in the past month. Most frequently, students reported past-month gambling among fathers (16%), followed by other relatives (14%). Students were more likely to have gambled in the past month, played any hard gambling activity, and be classified as an at-risk or problem gambler if they had a parent/caregiver, brother/sister, best friend, or other relative who had gambled in the past month. Past-month gambling and at-risk/problem gambling were most likely among students whose parent/caregiver or best friend had gambled (see Figure).
Figure. Odds ratios of the association between other people’s gambling (parent/caregiver, brother/sister, best friend, other relative/someone else) and past-month gambling and at-risk/problem gambling among a sample of Australian secondary students (n = 6,377). Click image to enlarge.
Why do these findings matter?
These findings confirm the association between exposure to gambling in family and friends and gambling behaviors among adolescents. Young people with a parent/caregiver or close friend who gambled were most likely to have gambled recently, engaged in hard gambling activities, and to have experienced at-risk or problem gambling. These findings should inform future problem gambling prevention and education initiatives for young people, such as family-focused initiatives. Successful initiatives might also include skill development for young people, such as how to resist peer pressure to gamble.
Every study has limitations. What are the limitations of this study?
Data were self-reported, so the results might be subject to recall bias and social desirability bias. Because the study was based on a sample of adolescents and was conducted in Australia, the findings might not be generalizable to people in other places with different gambling landscapes.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For additional resources, including gambling and self-help tools, visit our Addiction Resources page.
— Kira Landauer, MPH
1. Hard gambling activities are generally defined as having higher stakes or a more rapid pace of play (e.g., poker, casino games, sports betting) compared to soft gambling activities (e.g., lottery tickets, scratch cards).
For the past three years, since the start of the pandemic, NCPG has offered virtual workshops prior to its regularly scheduled annual conference. This year NCPG presented a range of speakers and topics over the course of two afternoons. One advantage of online workshops is the ability to host international speakers, who might not ordinarily be able to travel. It’s also helpful for those who cannot travel to the NCPG annual conference, providing access to excellent resources from the comfort of their computers.
Several of the presenters were from the United Kingdom, where they have been dealing with the backlash from the 2005 policies that blew the door open on gambling accessibility and are now feverishly working to increase treatment services, prevention and research.Attendees benefited from listening to the lessons learned and hopefully can apply those lessons in their own backyards.
Several researchers presented on their most recent studies looking at the effectiveness of self-exclusion programs, the links between gambling and problem debt, the ever-evolving changes in gambling and responsible gambling language, and the value of providing peer support groups for women. We heard from clinicians and their experiences treating gambling as a co-occurring disorder and about a fairly new integrative treatment model called Congruence Couple Therapy (CCT), which has been shown to have a relative advantage over individual treatment for reducing addictive and mental health symptoms and improving emotional regulation among couples. There was also a panel discussion advocating for gambling policies to move into the national spotlight. With no federal funding, and the increased opportunities to gamble, the field of gambling disorder is behind in workforce development, research and programs regulating gambling harm.
Video games have drawn the attention of activists and public health advocates since as early as the 1970’s. Many of these activists have focused on the intense depictions of violence in video games and suggest that these depictions may lead to real-life violence. One area that is often neglected, however, are depictions of substance use and gambling in video games. Although regulators have begun to investigate loot boxes and their relationship with problem gambling, other forms of gambling in video games have received less attention. For example, skin betting (i.e., exchanging virtual goods for digital gambling currency) — which was first popularized by the game Counter-Strike: Global Offensive — has evolved from betting on in-game matches to skins being used as currency in other games of chance such as roulette. Many of those involved in these underground gambling networks are adolescents who are unable to engage in traditional gambling. This week, the WAGER reviews a study by Nancy Greer and colleagues that examined links between esports, skin betting, and problem gambling.
What was the research question?
How does esports and skin betting relate to other forms of gambling and gambling harms?
What did the researchers do?
The researchers recruited participants through Amazon Mechanical Turk and social media posts in online gaming communities to participate in an online survey. All participants reported either esports cash or skin betting, or gambling skins on games of chance in the past 6 months. In total, 737 participants completed the survey. The survey itself focused on four broad categories: (1) video game involvement, (2) video game-related gambling (including betting on esports), (3) traditional gambling, and (4) problem gambling and gambling-related harms. The researchers used ordinal logistic regression to test the hypothesis that video game involvement increases the likelihood of engaging in video game-related gambling, which in turn increases the likelihood of engaging in traditional gambling and experiencing gambling harms.
What did they find?
Though video game involvement related to video game-related gambling, video game-related gambling was only slightly related to traditional gambling. Consider three different video game-related types of gambling: esports cash betting, esports skin betting, and skin betting on other games of chance. Of these, only esports cash betting frequency significantly predicted involvement in traditional gambling activities. Interestingly, although the sample overall reported high rates of problem gambling and gambling harms, neither esports cash betting nor esports skin betting significantly predicted problem gambling or gambling harms. When controlling for other forms of traditional gambling, only skin gambling on games of chance was predictive of problem gambling and gambling harms (see Figure).
Figure. This figure displays the odds of experiencing problem gambling and gambling harms based on video game-related gambling behaviors. Odds ratios above 1.00 indicate that for every one unit increase in the predictor variable (video game-related gambling behaviors) the odds of being one category higher in the outcome variable (problem gambling or gambling harms) increases by X times. An odds ratio below 1.00 indicates that the odds decrease by X times. For example, a one unit increase in esports cash betting frequency would mean a participant is 1.033 times as likely to experience a one unit increase in their problem gambling severity. Only skin betting on games of chance was significantly associated with either outcome variable. Click image to enlarge.
Why do these findings matter?
These findings suggest that buying skins and esports gambling are not risk factors for problem gambling in and of themselves. Rather, skin gambling on games of chance appears to increase the risk of gambling harms. It remains unclear whether individuals who gamble skins on games of chance do so because they have exhausted other financial resources, or if skin gambling on games of chance directly increases the risk of problem gambling and other gambling harms. Regardless, these findings suggest that regulatory bodies should consider focusing on gambling operators who facilitate skin gambling on games of chance, rather than other more traditional esports focused operators.
Every study has limitations. What are the limitations in this study?
This study has significant limitations in terms of its generalizability. Participants were required to have gambled either on esports or via using skins in the past six months, so the results likely do not represent video game players as a whole. The study also failed to include anyone under the age of 18 despite the fact that many people who gamble using skins are adolescents. Additionally, due to the study’s limited sample size, the researchers were unable to conduct path analysis, an analytical technique that allows for estimating causal effects instead of only statistical associations.
For more information:
Individuals who are concerned about their gambling behaviors or simply want to know more about problem gambling may benefit from visiting the National Council on Problem Gambling. Others who want to learn more about video game addiction can find information via the Cleveland Clinic. Additional resources can be found at the BASIS Addiction Resources page.
Editor’s Note: Today’s review is part of our month-long Special Series on Asian American/Pacific Islander (AAPI) Addiction Research. Throughout May, The BASIS is examining forms of addiction among AAPI communities.
Emerging research indicates that the Asian American community is at greater risk for problem gambling than the general population. However, research often fails to include or accurately capture the realities of gambling and problem gambling within this community, particularly the experiences of Asian American working-class immigrant communities. This week, as part of our Special Series on Asian American/Pacific Islander Addiction Research, The WAGER reviews a study by Mia Han Colby and colleagues that investigated the systemic issues that contribute to gambling in the Greater Boston Asian American community.
What was the research question?
What are the systemic issues that contribute to gambling in the Asian American community of the Greater Boston area?
What did the researchers do?
The authors conducted forty semi-structured interviews with adult members of Asian1 immigrant communities in the Greater Boston area who had a family member, friend, neighbor, or coworker who gambled. Using a community-based participatory research approach, bilingual/bicultural community fieldworkers who had experience working in their respective communities interviewed participants. Participants were asked about their perceptions of gambling in their community, as well as impacts of gambling on families and the community more generally. The researchers analyzed the interviews for common themes pertaining to systemic issues related to gambling and problem gambling in the Asian community in the Greater Boston area.
What did they find?
The interviews revealed how the underlying issues of poverty and social and cultural loss due to immigration contribute to gambling in this community (see Figure). Many participants spoke about the challenges of making a decent living as an immigrant while working low-wage and stressful jobs. Gambling was viewed as a way to make money and improve a family’s financial situation. For example, one participant expressed that gambling gave them “hope that they can have freedom of money.” It was also seen as a way to relieve work-related stress.
Participants also spoke about the challenges of integrating into American society due to cultural and linguistic barriers. Many discussed the lack of appropriate and accessible social and recreational activities, which contributed to experiences of social isolation, loneliness, and boredom. Gambling—especially within casinos—was viewed as a means of socializing and connecting with other Asian community members. Many participants spoke about the ways that casinos targeted Asian clientele, including busing directly to casinos from Asian communities (e.g., from Boston’s Chinatown neighborhood), creating an Asian-friendly casino environment (e.g., employees speak Asian languages, concerts and events featuring Asian artists), and incentives (e.g., free food and discounts).
Figure. Reasons for gambling in Asian communities in the Greater Boston area, by percentage of respondents who identified each reason for gambling (n = 40). Click image to enlarge.
Why do these findings matter?
These findings illustrate the complex and systemic issues that contribute to gambling in Asian communities in the United States, including social and cultural isolation due to challenges integrating into American society, and struggles working low-wage and stressful jobs. Asian CARES (Center for Addressing Research, Education, and Services) of Boston created actionable recommendations for change based on these findings. They recommend investing in neighborhoods where Asian immigrants live and work to create inclusive spaces that facilitate social and recreational activities other than gambling. Additionally, Asian CARES recommended increasing funding to trusted community-based organizations (e.g., Boston Chinatown Neighborhood Center) that provide culturally and linguistically responsive problem gambling, mental health, and social services (e.g., services that help individuals find and maintain employment).
Every study has limitations. What are the limitations of this study?
Data were self-reported and based on past experiences, so the results might be subject to recall bias. Findings from this study might not be generalizable to other geographic areas or to other immigrant populations.
For more information:
Do you think you or someone you know has a gambling problem? Visit the National Council on Problem Gambling for screening tools and resources. For individuals in Massachusetts looking for culturally and linguistically relevant problem gambling services, call the Massachusetts Problem Gambling Helpline (800-327-5050) or visit the Boston Chinatown Neighborhood Center website.
1. Interviews were conducted with members of the Khmer, Chinese, Korean, and Vietnamese immigrant communities in the Greater Boston area.
