The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews.

BACKGROUND: The WHO highlight alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition as gambling as a public health problem, we also included gambling. METHODS: The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000-2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool. RESULTS: We identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs). We did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy. CONCLUSIONS: Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities.

The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Evaluating for Differences by Race/Ethnicity in the Association Between Income and Gambling Disorder.

Multiple studies show an increased prevalence of gambling disorder among African Americans compared to whites. However, few studies take an analytic approach to understanding differences in risk factors by race/ethnicity. Income is inversely associated with gambling disorder; we hypothesized that this association would vary by race/ethnicity. The main objective was to evaluate whether the association between income and gambling disorder varies by race/ethnicity. With data from the baseline visit of a prospective cohort study, Prevention and Etiology of Gambling Addiction Study in the United States, we used multivariable logistic regression analysis to determine whether the association between income and gambling disorder varies by race/ethnicity. 1164 participants were included in the final analyses. Measures included: demographics (age, sex, race/ethnicity, education, employment, annual household income), veteran status, marital status, homelessness, smoking, substance abuse, alcohol abuse, marijuana use, and lifetime gambling disorder diagnosis as derived from Alcohol Use Disorder and Associated Disabilities Interview Schedule. There was no evidence of effect modification by race/ethnicity in the association between income and gambling disorder (global p value = 0.17). Income was associated with increased odds of gambling disorder, but only for those with low income (< $15,000; OR 2.27, 95% CI 1.46, 3.53). There was no evidence that the effect of income on gambling disorder varies by race/ethnicity. For all race/ethnicities combined, low income was associated with significantly increased odds of gambling disorder (OR 2.27, 95% CI 1.46, 3.53). Further research is needed to better understand racial/ethnic differences in gambling disorder.

Evaluating changes in electronic gambling machine policy on user losses in an Australian jurisdiction.

BACKGROUND: Electronic gambling machines (EGMs) are in casinos and community venues (hotels and clubs) in all jurisdictions in Australia, except Western Australia (only in casino). EGMs have a range of features that can affect how people gamble, which can influence losses incurred by users. The Northern Territory Government recently changed two EGM policies - the introduction of note acceptors on EGMs in community venues, and an increase in the cap from 10 to 20 EGMs in hotels and 45 to 55 in clubs. This study evaluates two changes in EGM policy on user losses in community venues, and tracks changes in user losses per adult, EGM gambler, and EGM problem/moderate risk gambler between 2005 and 2015. METHODS: Trends in venue numbers, EGM numbers, user losses and user losses per EGM by venue type and size are presented to determine if EGM policy changes affected user losses. Data from the 2005 and 2015 NT gambling surveys are used to determine EGM user losses per adult, per EGM gambler, and per EGM problem and/or moderate risk gambler, with several assumptions applied. RESULTS: From 2010 (post smoking ban) to 2013 real user losses were stagnant, but from 2013 to 2017, real user losses in community venues increased 19, 9, 8 and 5% per annum, with increases higher in clubs and hotels with the maximum allowable number of EGMs. Over the same period user losses in the two casinos declined by 13%. Between 2005 and 2015, estimated user losses per EGM problem/moderate risk and problem gambler increased by 5 and 34% respectively. CONCLUSIONS: The analysis demonstrates that reductions in how much money gamblers can insert into an EGM (load-up limit), and/or the abolition of note acceptors, and reductions in the number of EGMs in venues is likely to reduce harm from EGM use. Given the demonstrated inability for Australian jurisdictions to identify and implement effective harm prevention and minimisation interventions, a national approach to gambling regulation in Australia may be desirable. Similarly, national co-ordination of research, particularly on EGMs and online betting is required to better understand changes in gambling policy on related harms.

'If someone donates $1000, they support you. If they donate $100 000, they have bought you'. Mixed methods study of tobacco, alcohol and gambling industry donations to Australian political parties.

BACKGROUND AND AIMS: Business corporations' use of political donations to garner political influence is especially troubling in relation to products that damage human health. We sought to investigate patterns of donations to Australian political parties from tobacco, alcohol and gambling industry actors and the experiences of key informants. DESIGN AND METHODS: We analysed public data on federal and state donations for 10 years to June 2015. We conducted 28 semi-structured interviews with current and former politicians, ex-political staffers and other key informants, concerning the role played by political donations of tobacco, alcohol and gambling companies in Australian politics. We examined temporal associations in donations data, and thematically analysed interviews. RESULTS: Australian political parties declared donations of A$14 million (US$11 M) from tobacco ($1.9 M), alcohol ($7.7 M), gambling ($2.9 M) and supermarket ($1.7 M) entities, excluding donations below the $12 800 reporting threshold. Donations to the governing party increased substantially during debates about an alcohol tax and gambling law reform. Alcohol industry donations to major parties spiked ahead of elections. Interviewees identified the function of donations in terms of: (i) buying immediate influence; (ii) building long-term relationships; (iii) exploiting a flawed political system; and (iv) the need to look beyond donations, for example, to favour exchange; and the public's right to know about corporate influence on policy-makers. DISCUSSION AND CONCLUSIONS: The alcohol and gambling industries make substantial donations to influence particular decisions in the short term and build relationships over the long term. Banning corporate donations and publicly funding political parties warrant consideration to safeguard the integrity of public policy-making.

Effect of the Smoke-Free Illinois Act on casino admissions and revenue.

OBJECTIVE: As part of the Smoke-Free Illinois Act, smoking on the gambling floors of all commercial casinos in Illinois became prohibited. This study examined the effects of the Smoke-Free Illinois Act on casino admissions per-capita and real per-capita adjusted gross receipts using 18 years of data (10 years before and 8 years after the Illinois law went into effect). METHODS: We employed a difference-in-difference regression technique using monthly data for the states of Illinois, Indiana, Iowa and Missouri and control for numerous determinants expected to affect casino admissions and revenue. RESULTS: The Smoke-free Illinois Act was found not to be a statistically significant determinant of per-capita casino admissions and of real per-capita gross adjusted receipts in all the models we estimated. CONCLUSIONS: The estimates from this study clearly indicated that the Illinois law that banned smoking in casinos has had no significant negative economic consequences for casinos in terms of per-capita admissions or revenues.

The relationship between gambling expenditure, socio-demographics, health-related correlates and gambling behaviour-a cross-sectional population-based survey in Finland.

AIMS: To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour. DESIGN: Cross-sectional population survey. SETTING: Population-based survey in Finland. PARTICIPANTS: Finnish people aged 15-74 years drawn randomly from the Population Information System. The participants in this study were past-year gamblers with gambling expenditure data available (n = 3251, 1418 women and 1833 men). MEASUREMENTS: Expenditure shares, means of weekly gambling expenditure (WGE, €) and monthly gambling expenditure as a percentage of net income (MGE/NI, %) were calculated. The correlates used were perceived health, smoking, mental health [Mental Health Inventory (MHI)-5], alcohol use [Alcohol Use Disorders Identification Test (AUDIT)-C], game types, gambling frequency, gambling mode and gambling severity [South Oaks Gambling Screen (SOGS)]. FINDINGS: Gender (men versus women) was found to be associated significantly with gambling expenditure, with exp(ß) = 1.40, 95% confidence interval (CI) = 1.29, 1.52 and P < 0.005 for WGE, and exp(ß) = 1.39, 95% CI = 1.27, 1.51 and P < 0.005 for MGE/NI. All gambling behaviour correlates were associated significantly with WGE and MGE/NI: gambling frequency (several times a week versus once a month/less than monthly, exp(ß) = 30.75, 95% CI = 26.89, 35.17 and P < 0.005 for WGE, and exp(ß) = 31.43, 95% CI = 27.41, 36.03 and P < 0.005 for MGE/NI), gambling severity (probable pathological gamblers versus non-problem gamblers, exp(ß) = 2.83, 95% CI = 2.12, 3.77 and P < 0.005 for WGE, and exp(ß) = 2.67, 95% CI = 2.00, 3.57 and P < 0.005 for MGE/NI) and on-line gambling (on-line and land-based versus land-based only, exp(ß) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for WGE, and exp(ß) = 1.35, 95% CI = 1.24, 1.47 and P < 0.005 for MGE/NI). CONCLUSIONS: In Finland, male gender is associated significantly with both weekly gambling expenditure and monthly gambling expenditure related to net income. People in Finland with lower incomes contribute proportionally more of their income to gambling compared with middle- and high-income groups.

Consequences and associated factors of youth gambling.

OBJECTIVE: To examine gambling behaviors, consequences and its associated factors among Thai youths. MATERIAL AND METHOD: A cross-sectional survey of 1,694 students from Matthayom 1 (grade 7) to university undergraduate level was conducted using a self-administered questionnaire. Questionnaire items consisted of socio-economic characteristics, health behaviors, attitudes towards gambling and consequences of gambling. Factors associated with gambling experience were identified by multivariate logistic regression. RESULTS: Approximately 20% of youth gambling was reported. Gamblers had higher proportion of males, studying in vocational schools and lower GPA and history of smoking and alcohol consumption. Card games were the most common type of gambling, followed by football-betting. Approximately 10% of the gamblers potentially had pathological gambling. Factors positively associated with gambling included having friends (adjusted OR = 4.82) and relatives (adjusted OR = 2.48) who gambled. Having a GPA > or = 3.0 was negatively associated with gambling (adjusted OR = 0.58). The present study reported negative consequences of gambling including feeling of guilt, perception of poorer health and depression or insomnia after losing. CONCLUSION: Gambling prevention program should be developed and focused on student with poor study performance and wrecked relationships in family. Also, a surveillance system for health risk behaviors among youth in school and community should be established by the participation of multiple organizations.

Young adults' gambling and its association with mental health and substance use problems.

OBJECTIVE: To examine the socio-demographic characteristics of young adults' gambling and its association with mental health and substance use behaviour. METHODS: The study is based on 3,512 young adults (1648 males) for whom data from the Mater-University of Queensland Study of Pregnancy (MUSP) were available on self-report gambling, gambling expenditure, Achenbach's Young Adult Self Report and substance use at the 21-year follow-up of the MUSP. The participants' age ranged between 18.2 and 23.6 (mean = 20.6, standard deviation = 0.8) years. RESULTS: Two-fifths of the young adults reported gambling. Males reported more money spent on gambling and were significantly more likely to be at risk of problem gambling. Gambling and problem gambling were significantly more common in less-educated individuals, those who had higher income or those who had a paid job. Individuals who reported gambling were more likely to smoke cigarettes, drink more than a glass of alcohol per day, use illicit drugs, or exhibit high levels of externalising behaviour than non-gamblers. CONCLUSIONS: The findings confirm the high prevalence of gambling and gambling expenditure in young adults. Individuals who are involved in gambling are more likely to report cigarette smoking, alcohol consumption, and use of illicit drugs. There is a need for further research to explore the mechanisms of association between gambling behaviour and individuals' mental health and substance use. IMPLICATIONS: Substance abuse and mental health services are recommended to consider co-morbid gambling problems in treatment-seeking patients.

The impact of a local smoke-free air law on wagering at an off-track betting facility in Indiana.

OBJECTIVE: This study measured the impact of a local smoke-free air law on wagering at an off-track betting (OTB) facility in Indiana. METHODS: Regression analysis was used to compare the trend in per capita amount wagered at an OTB location that went smoke-free to the trend in per capita amount wagered at two comparison OTB locations that continued to permit smoking. Unemployment rate was included as a covariate. RESULTS: During the study period, there was a decreasing trend in the per capita amount wagered at each of the three OTB locations. There was no significant change in the trend for the location that went smoke free or for the locations where smoking has continued. CONCLUSIONS: There is no economic reason to exclude OTB facilities from smoke-free legislation.