Recommendations for Optimizing xaʔtus (First Face) for Mental Health Training: Insights from Key Informants.

Native adolescents experiencing mental health challenges, including substance misuse, often prefer to seek support from their peers and other informal sources, which may be due to lack of access to, and cultural fit with, professional behavioral health services. xaʔtus (First Face) for Mental Health is a Tribal community-based intervention designed to strengthen networks of informal mental health support and open pathways to more formal support. We sought insights from key informants to optimize the planning, promotion, and delivery of First Face trainings to seven Tribal communities in the Northwest United States. We conducted three focus groups with (1) teens completing a residential chemical dependency program at the Healing Lodge of the Seven Nations (n = 10), (2) clinical staff representing the Healing Lodge's Behavioral Health Department (n = 9), and (3) community members representing educators and social service professionals at five of the Tribal nations that support the Healing Lodge (n = 6). Discussion generated planning, promotion, and training recommendations. Planning recommendations focused on showing respect for trainees' time by holding the training during convenient times and factoring in trainees' commitments to work and family, integrating the training into high school science or health education classes, and taking steps to protect trainees' physical safety in the age of COVID while avoiding "Zoom fatigue." Promotion recommendations highlighted community members' possible reluctance to become a First Face due to fear about the responsibilities associated with taking on this role and the need to emphasize the personal relevance of First Face training. In terms of training delivery, participants emphasized the importance of including engaging, interactive activities; instructing future First Faces in self-care; and acknowledging the impact of traumatic contemporary experiences on mental health, while at the same time preventing heated and distressing political debates. We describe our response to participants' recommendations and the rationale for those responses.

A meta-analytic investigation of problem gambling and self-harm: A causal inference perspective.

OBJECTIVE: Problem gambling may be an underappreciated treatment target for reducing self-harm. Multivariate studies examining the relationship between problem gambling and self-harm have returned inconsistent results, perhaps due to insufficient power or differences in study quality. METHOD: We conducted a series of meta-analyses examining the effect of problem gambling on self-harm outcomes of varying severity. We assessed the sensitivity of results to study characteristics, publication bias, and influential cases. To highlight threats to causal inference, we evaluated each study for residual confounding bias. RESULTS: In total, two types of meta-analyses were adequately powered: those assessing (a) the effect of problem gambling (binary) on suicide ideation and (b) problem gambling (binary) on suicide attempt (k = 14 unique studies between the two meta-analyses). For both meta-analyses, we found a positive, statistically significant average effect of problem gambling on the respective self-harm outcome. We did not detect any influential studies among these two meta-analyses, nor residual confounding. However, these findings are limited by the overall quality of included literature. PET-PEESE analysis detected substantial potential publication bias in the main results, with both meta-analytic effects being reduced to statistical nonsignificance. All included studies also used a cross-sectional design for their analysis of interest, thus simultaneity bias cannot be ruled out. CONCLUSION: While these findings suggest there is an appreciable relationship between problem gambling and at least two forms of self-harm (suicide ideation and attempts), well-designed longitudinal research is needed to make more firm conclusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining Responsible Gambling Program Awareness and Engagement Trends and Relationships with Gambling Beliefs and Behaviors: A Three-Wave Study of Customers from a Major Gambling Operator.

A considerable body of literature has examined elements of responsible gambling (RG) programs in land-based gambling venues. The present pre-registered study examines GameSense RG program awareness and engagement trends and relationships with gambling beliefs and behaviors, at MGM's U.S.-based casino properties using three samples of MGM's loyalty program members. We used a repeated cross-sectional approach including observational data collected from one sample (N = 3748) shortly before the rollout of GameSense in 2017-2018, and from two samples collected 1 year (N = 4795) and 2 years (N = 3927) after the program's implementation. We found that awareness of the GameSense program increased between pre- and 1-year post-implementation, yet did not increase further at 2-years post-implementation. Bivariate analyses showed that respondents who were aware of more GameSense components had a better understanding of gambling concepts and used more RG strategies, whereas respondents who engaged with GameSense used more RG strategies than those who did not, but did not display a better understanding of gambling concepts. The relationship between GameSense awareness and self-reported use of RG strategies remained significant in multivariate analyses with covariates. Moderation analyses indicated that a positive effect of overall GameSense engagement on gambling literacy was only found for respondents who had attended a regional property, as compared to respondents who attended Las Vegas or metropolitan properties. All effect sizes were weak, which suggests that practical impacts of the program currently are limited. Our findings have implications for research on land-based RG programs and we provide recommendations for enhancing such programs.

Time out: Prediction of self-exclusion from daily fantasy sports.

OBJECTIVE: Responsible gambling (RG) tools that include play management software, self-limit features, and self-exclusion are relatively common offerings on major online gambling platforms. However, how online gaming and daily fantasy sports (DFS) players use such tools is less clear. The goals of this article were to understand how players use self-exclusion at a major DFS platform and to identify DFS activity-related predictors of self-exclusion. METHOD: During November 2015, DraftKings, a major DFS provider, rolled out a self-exclusion feature that allows players to self-exclude from the platform for a specified amount of time, up to 5 years. We used player records from DraftKings, examining play patterns and self-exclusion across 3 + years of data. RESULTS: We found that less than 0.5% of subscribers in our sample self-excluded during the study period and almost one third of those who self-excluded did so more than once. In general, self-excluders engaged with a greater variety of contests and sports and entered contests with higher entry fees than those who did not self-exclude. Repeat self-excluders selected shorter initial self-exclusion terms and also engaged with a greater variety of game types and sports than one-time self-excluders. However, self-excluders did not engage in riskier contests or experience higher percent losses. CONCLUSION: Our findings have implications for our understanding of RG feature use among DFS subscribers and markers of risk for experiencing problems with DFS and gambling more generally. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Comparison of Two GameSense Implementation Approaches: How Program Awareness and Engagement Relate to Gambling Beliefs and Behaviors.

Despite the size and scope of responsible gambling (RG) programs in the U.S., relatively few studies have evaluated these programs. Using survey data from 4795 subscribers to a casino loyalty program, we examined respondents' awareness of and engagement with the GameSense RG program, and gambling beliefs and behaviors. We compared how differences in the implementation structure and visibility of the GameSense program (i.e., state-regulated with a standalone, branded GameSense center vs. corporate-integrated as part of loyalty program desks) was associated with GameSense awareness and engagement, perceptions of gambling operator RG practices, three Positive Play subscales (i.e., behavior, personal responsibility, and gambling literacy), understanding of gambling concepts, and use of RG strategies. More respondents who had visited the property with a state-regulated, branded center were aware of GameSense (36.5%), compared to respondents who visited other properties (7.4%). Perceptions of the operator's RG practices were generally high for all respondents. Multivariate analyses revealed no relationship between GameSense awareness and gambling belief or behavior outcomes, yet showed that respondents who picked up a GameSense brochure used slightly more RG strategies. Our findings suggest that the visibility of an RG program might influence program awareness and engagement but not certain RG-related behavioral outcomes.

Who holds a shared responsibility view of minimizing gambling harm? Results from a multiwave survey of casino gamblers.

Objective: Academics, gambling regulators, and the gambling industry increasingly espouse a shared responsibility view of preventing gambling harm, considering individual gamblers and external stakeholders (e.g., gambling industry employees, government regulators, and public health workers) to be jointly responsible for this task. This study is the third in a series exploring gamblers' beliefs about responsibility for preventing gambling harm. Method: A sample of 4,336 subscribers to MGM Resorts International (MGM)'s loyalty card program as of January 2020 completed a web-based survey. Results: We observed that 58.1% of participants only held individual gamblers responsible for helping prevent gambling harm. However, two factors increased the likelihood of holding a shared responsibility viewpoint and assigning responsibility to casinos for reducing gambling harm: (a) scoring positive on the Brief Biosocial Gambling Screen (BBGS) or an Expanded Problem Gambling Screen (EPGS) and (b) being aware of GameSense, an onsite responsible gambling education program. Those who screened positive on the BBGS or EPGS also were more likely than their counterparts to deny personal responsibility for minimizing gambling harm to individual gamblers; that is, they were more likely to hold a purely external responsibility viewpoint. A meta-analytic year-over-year comparison revealed that compared to being aware of GameSense, screening positive for problem gambling was more strongly associated with assigning responsibility to casinos for minimizing gambling harm. Conclusions: We discuss these findings in the context of self-determination theory and suggest implications for health promotion and best practices for message design in responsible gambling programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recommendations for improving adolescent addiction recovery support in six northwest tribal communities.

American Indian and Alaska Native (AI/AN) communities offer tangible and intangible resources, including centuries of indigenous wisdom and resiliency, to support their young people in recovery from substance use disorders. At the same time, tribal youth returning home from residential or inpatient treatment are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study endeavored to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest. Using a Tribal Participatory Research approach, we conducted Group Level Assessments with key stakeholders representing educators/coaches, medical and behavioral health providers, social service providers, cultural leaders/elders, and legal professionals among each participating tribe (N = 166). We used content analysis to identify emergent themes among participants' recommendations for improving recovery support. The five emergent themes were (1) Communication, Collaboration, and Accountability among Tribal Departments and Agencies; (2) Community-wide Education; (3) The Importance of Providing Wraparound/Supportive Services; (4) Youth-focused Education, Services, and Events; and (5) Recovery Coaching Model. AI/AN culture was infused within nearly all recommendations for improving recovery support that composed these themes. We discuss specific ways to implement these recommendations, including the forthcoming development of a culturally-grounded community-wide mental health training program developed specifically for, and with, these tribes.

Understanding American Indian Youth in Residential Recovery from Substance Use Disorder: Risk and Protective Experiences and Perceived Recovery Support.

Historical trauma has contributed to the reality that addiction disproportionately affects tribal communities, including American Indian youth. We sought to understand American Indian youths' own experiences and perceptions of the environments to which they return after completing residential treatment for substance use disorder. We recruited three cohorts of American Indian residents of a substance use disorder treatment facility (N = 40). These residents completed a survey that measured risk and protective factors, as well as actual risk behaviors, including drug use, gambling, and violence. Participants were at risk not only for substance use disorders, but for other negative outcomes, and had elevated scores on several community, family, and school risk factors, including perceived availability of drugs, community disorganization, family history of antisocial behavior, favorable parental attitudes toward drug use, academic failure, and low school commitment. At the same time, they were exposed to community-level and family protective factors, and they engaged in many tribal cultural activities. When compared to a national sample of American Indian students of similar age, youth in our sample scored similarly on protective factors, including indicators of community, family, and school opportunities and rewards for prosocial involvement, as well as family attachment, suggesting potential resources and strengths for supporting recovery.

A Scoping Review of "Responsible Drinking" Interventions.

Public health groups, researchers, the beverage alcohol industry, and other stakeholders have promoted and applied the concept of "responsible drinking" for the past 50 years. However, little is known about the state of the existing responsible drinking evaluation research and its application to policy and practice. This project provides a scoping review of studies evaluating responsible drinking interventions. Two primary research questions guided this investigation: (1) To what extent have authors attempted to define the concept of responsible drinking while evaluating responsible drinking interventions? and (2) What is the state of the responsible drinking intervention evaluation literature? We retrieved 49 peer-reviewed articles that evaluated interventions designed to promote "responsible drinking." Four articles provided, or attempted to provide, an explicit definition of responsible drinking; these four definitions lacked consensus. The existing responsible drinking interventions varied considerably in terms of the messages they attempted to convey (e.g., avoid binge drinking, use protective behavioral strategies, stick to relatively safe drinking limits), again suggesting lack of consensus. We observed greater consensus concerning the approach to evaluating responsible drinking interventions: studies typically recruited college students to complete brief, well-controlled experiments and measured potential predictors of drinking behavior (e.g., attitudes, expectancies, intentions) rather than actual drinking behavior. We discuss limitations of this methodological approach and the need for greater consensus regarding the concept of responsible drinking.

Gambling Industry Employees' Experiences with an Onsite Responsible Gambling Program.

We examined gambling venue employees' experiences with GameSense, an onsite responsible gambling information center designed to be a resource for casino employees as well as patrons. Participants included 492 employees who reported on their engagement with, and opinions and knowledge of, the GameSense information center and its staff (i.e., GameSense Advisors), as well as their own employment department and gambling involvement. A minority of participants (33.5%) reported having spoken with a GameSense Advisor about responsible gambling or problem gambling; the remaining 66.5% either did not ever speak to a GameSense Advisor or only had a casual conversation with one. Most participants (88.9%) indicated that casino patrons could use the GameSense program, but less than half (37.9%) believed that casino staff/employees could do the same. Participants generally had positive opinions about the program, endorsing positive potential impacts (e.g., "It helps people avoid gambling beyond their limits") more often than negative potential impacts (e.g., "It encourages people to gamble beyond their limits"). However, gambling venue employees with more extensive gambling histories were less likely to endorse positive potential impacts. Participants' department also was associated with GameSense experiences: those in security/surveillance were the most likely to report having interacted with GameSense Advisors (83.3%) and those in food/beverage/retail were least likely to have done so (28.6%). Some of these findings have implications for improving casino employees' experiences with the GameSense program.

Gamblers' beliefs about responsibility for minimizing gambling harm: Associations with problem gambling screening and gambling involvement.

Increasingly, gambling stakeholders communicate that minimizing gambling harm is a shared societal responsibility. Individual gamblers' beliefs about responsibility for minimizing gambling harm are worthy of study because these beliefs might influence gambling behavior. In this study, using a sample of casino loyalty program subscribers (N = 4,795), we observed that respondents who had a positive result on a brief gambling disorder screen were more likely than those who screened negative to hold seven stakeholder groups (i.e., scientists, clinicians, casino employees, government regulators, public health officials, casino industry lobbyists, public safety officials) responsible for helping to minimize gambling harm. The sum of stakeholder groups held responsible for minimizing gambling harm, along with beliefs that casinos share responsibility for encouraging responsible gambling behavior, predicted gambling disorder screening status after controlling for established problem gambling risk factors. These results replicated our previous study using a mostly independent sample. Contrary to our expectations, beliefs about responsibility for mitigating gambling harm were mostly unrelated to measures of gambling involvement. These results provided additional support for the notion that those who are at risk for gambling harm are especially likely to hold others responsible for minimizing such harm. However, they call into question the role of gambling involvement in this relationship.

Patterns of Daily Fantasy Sport Play: Tackling the Issues.

Daily fantasy sports (DFS), a rapidly growing industry, allows players to create fantasy teams of real-life players and potentially win cash prizes, derived from entry fees. Some stakeholders have expressed concern that DFS's accelerated nature and other features might promote excessive play and related harm. We conducted the first descriptive summary of actual DFS play using records from a cohort of subscribers to a dominant operator, DraftKings. Participants (N = 10,385) initially entered paid National Football League (NFL) contests. Across all participants, players entered a median of two contests per entry day and typically submitted a single entry for each contest they entered. Players paid a median of $87 in entry fees throughout the 2014 NFL season and experienced an overall median net loss of $30.7. However, we identified heavily involved sub-groups of players based on number of contests entered, total entry fees, and net loss. These top 1% groups were less likely to restrict themselves to NFL games, exhibited greater time involvement, but also won a greater percentage of the contests they entered than typical players. Our observations of typical and heavily involved players tend to mirror those generated in previous Internet sports gambling research.

Already at the Table: Patterns of Play and Gambling Involvement Prior to Gambling Expansion.

During 2011, the Governor of Massachusetts signed a bill to allow casino gambling in the state (Commonwealth of Massachusetts 2011). As a result, two resort casinos will begin operations during 2018 and 2019; a smaller slots parlor began operations during June 2015. Prior to this expansion, gambling was widely available in Massachusetts, through the state lottery, off-track betting, and gambling opportunities available in neighboring states. Within this context, it is important to understand the patterns of gambling involvement in the population prior to gambling expansion. The current study examined gambling involvement, patterns of play, and gambling-related problems prior to gambling expansion among a sample of 511 Massachusetts residents who were members of a statewide Internet panel. To measure patterns of play, we asked questions about past-year games played and frequency of play. To measure breadth of involvement, we assessed the number of different games played. To measure depth of involvement, we measured time spent gambling, amount wagered, and amount won or lost. Principal component analysis revealed four play pattern components accounting for more than 50% of the variance in game play frequency. Multiple regression analyses revealed that component scores composed of casino gambling and skill-based gambling (e.g., poker, sports) variables uniquely contributed to the prediction of gambling-related problems, even when depth of involvement was controlled. However, the addition of breadth of involvement to the model resulted in a model where no set of variables contributed significantly, suggesting a complex relationship among play patterns, depth, and breadth of involvement. The study established discrete and distinguishable gambling play patterns associated with gambling-related problems and identified groups of individuals potentially vulnerable to the effects of gambling expansion.

How do homeless adults change their lives after completing an intensive job-skills program? A prospective study.

Among people experiencing homelessness, difficulty securing housing is often compounded by concurrent challenges including unemployment, chronic illness, criminal justice involvement, and victimization. The Moving Ahead Program (MAP) is a vocational rehabilitation program that seeks to help adults facing these challenges to secure competitive employment. We prospectively studied how MAP graduates (N = 97) changed from the beginning of MAP to about six months after graduation. We observed a variety of positive outcomes not just in employment and housing but also in health, substance use, and criminal justice involvement. However, these gains were not universal; for instance, participants were less likely to report positive outcomes at follow-up if they started MAP with a serious mental illness, made relatively small gains in work skills, or did not seek mental health treatment during the six months after they completed MAP. These findings might encourage program staff to devote additional resources toward supporting at-risk students.

Changing Social Networks Among Homeless Individuals: A Prospective Evaluation of a Job- and Life-Skills Training Program.

Social networks play important roles in mental and physical health among the general population. Building healthier social networks might contribute to the development of self-sufficiency among people struggling to overcome homelessness and substance use disorders. In this study of homeless adults completing a job- and life-skills program (i.e., the Moving Ahead Program at St. Francis House, Boston), we prospectively examined changes in social network quality, size, and composition. Among the sample of participants (n = 150), we observed positive changes in social network quality over time. However, social network size and composition did not change among the full sample. The subset of participants who reported abstaining from alcohol during the months before starting the program reported healthy changes in their social networks; specifically, while completing the program, they re-structured their social networks such that fewer members of their network used alcohol to intoxication. We discuss practical implications of these findings.

Using Opinions and Knowledge to Identify Natural Groups of Gambling Employees.

Gaming industry employees are at higher risk than the general population for health conditions including gambling disorder. Responsible gambling training programs, which train employees about gambling and gambling-related problems, might be a point of intervention. However, such programs tend to use a "one-size-fits-all" approach rather than multiple tiers of instruction. We surveyed employees of one Las Vegas casino (n = 217) and one online gambling operator (n = 178) regarding their gambling-related knowledge and opinions prior to responsible gambling training, to examine the presence of natural knowledge groups among recently hired employees. Using k-means cluster analysis, we observed four natural groups within the Las Vegas casino sample and two natural groups within the online operator sample. We describe these natural groups in terms of opinion/knowledge differences as well as distributions of demographic/occupational characteristics. Gender and language spoken at home were correlates of cluster group membership among the sample of Las Vegas casino employees, but we did not identify demographic or occupational correlates of cluster group membership among the online gambling operator employees. Gambling operators should develop more sophisticated training programs that include instruction that targets different natural knowledge groups.

Expanding the study of internet gambling behavior: trends within the Icelandic lottery and sportsbetting platform.

As rates of Internet gambling participation increase worldwide, so too does the need to understand how people engage in this form of gambling. This study represents the first examination of actual Internet gambling records within Iceland, a Nordic country with an active Internet lottery market that imposes strict regulations on gambling operator licenses. We summarized electronic betting records of a cohort of subscribers to the Internet betting service provider Íslensk Getspá. We observed that the typical subscriber bet approximately 3 days per month and made fewer than two bets per gambling day, each worth approximately the equivalent of $4 US. Subscribers lost the bulk (96%) of the amount they wagered, for a total loss of approximately $40 across the 2-year window of observation. Although these observations do not support the view of Internet gambling as an activity that is inherently risky for the typical subscriber, we did observe discontinuity across the distributions of gambling behavior, with the top 1% of subscribers making more than three bets per day.

Associations between national gambling policies and disordered gambling prevalence rates within Europe.

Policymakers and other interested stakeholders currently are seeking information about the comparative effectiveness of different regulatory approaches to minimising gambling-related harm. This study responds to this research gap by exploring associations between gambling policies and disordered gambling prevalence rates. We gathered information about gambling policies for thirty European jurisdictions and past-year prevalence rates for disordered gambling for twelve of these jurisdictions. We present policy trends and prevalence rates and then describe the level of association between policy and prevalence. We observe one statistically significant association between policy and prevalence: rates of sub-clinical (i.e., Level 2) disordered gambling were higher within environments that mandated less strict regulation of advertising for online gambling. Finally, we discuss the implications of our research in the context of the current process regarding the pan-European regulation of gambling. Our findings do not offer evidence for certain assumptions made in the past by the European judiciary.

Breadth and depth involvement: Understanding Internet gambling involvement and its relationship to gambling problems.

The "involvement effect" refers to the finding that controlling for gambling involvement often reduces or eliminates frequently observed game-specific associations with problem gambling. In other words, broader patterns of gambling behavior, particularly the number of types of games played over a defined period, contribute more to problem gambling than playing specific games (e.g., lottery, casino, Internet gambling). This study extends this burgeoning area of inquiry in three primary ways. First, it tests independently and simultaneously the predictive power of two gambling patterns: breadth involvement (i.e., the number of games an individual plays) and depth involvement (i.e., the number of days an individual plays). Second, it includes the first involvement analyses of actual betting activity records that are associated with clinical screening information. Third, it evaluates and compares the linearity of breadth and depth effects. We conducted analyses of the actual gambling activity of 1,440 subscribers to the bwin.party gambling service who completed an online gambling disorder screen. In all, 11 of the 16 games we examined had a significant univariate association with a positive screen for gambling disorder. However, after controlling for breadth involvement, only Live Action Internet sports betting retained a significant relationship with potential gambling-related problems. Depth involvement, though significantly related to potential problems, did not impact game-based gambling disorder associations as much as breadth involvement. Finally, breadth effects appeared steeply linear, with a slight quadratic component manifesting beyond four games played, but depth effects appeared to have a strong linear component and a slight cubic component.