The Conceptual Framework of Harmful Gambling: A revised framework for understanding gambling harm.

BACKGROUND AND AIMS: The Conceptual Framework of Harmful Gambling moves beyond a symptoms-based view of harm and addresses a broad set of factors related to the risks and effects of gambling harmfully at the individual, family, and community levels. Coauthored by international research experts and informed by multiple stakeholders, Gambling Research Exchange (GREO) facilitated the framework development in 2013 and retains responsibility for regular updates and mobilization. This review article presents information about the revised version of the Conceptual Framework of Harmful Gambling completed in late 2018. METHODS: We describe eight interrelated factors depicted in the framework that represent major themes in gambling ranging from the specific (gambling environment, exposure, gambling types, and treatment resources) to the general (cultural, social, psychological, and biological influences). After outlining the framework development and collaborative process, we highlight new topics for the recent update that reflect changes in the gambling landscape and prominent discourses in the scientific community. Some of these topics include social and economic impacts of gambling, and a new model of understanding gambling related harm. DISCUSSION AND CONCLUSIONS: We address the relevance of the CFHG to the gambling and behavioral addictions research community. Harm-based frameworks have been undertaken in other areas of addiction that can both inform and be informed by a model dedicated to harmful gambling. Further, the framework brings a multi-disciplinary perspective to bear on antecedents and factors that co-occur with harmful gambling.

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

BACKGROUND: In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. METHODS: Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. RESULTS: Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. CONCLUSIONS: The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

Gambling Participation, Expenditure and Risk of Harm in Australia, 1997-1998 and 2010-2011.

Gambling-related harm results primarily from financial losses. Internationally Australia continues to rank as the largest spending nation per capita on gambling products. This would suggest that Australian gamblers are at disproportionately high risk of harm despite almost two decades of industry scrutiny and regulation, and investment in research, treatment and education programs. However, declines in participation rates, per capita expenditure, household expenditure, national disposable income spent on gambling and problem gambling rates have been cited as evidence that fewer people are gambling, that gamblers are spending less, and that gambling safety in Australia has improved. The current study investigated these propositions using national population and accounts data, and statistics from Australia's two population-representative gambling surveys conducted in 1997-1998 and 2010-2011. Despite a falling participation rate the study found no real change in the number of people gambling overall, and increasing numbers consuming casino table games, race wagering and sports betting. Further found were increases rather than decreases in average gambler expenditure, overall, and across most products, particularly electronic gaming machines (EGMs). Potentially risky levels of average expenditure were observed in both periods, overall and for race wagering, casino table gaming, and EGMs. Changes in the proportion of income spent on gambling suggest risks declined overall and for race wagering and casino table gaming, but increased for EGMs. Finally, while problem gambling statistics were not comparable between periods, the study found double the number of moderate risk gamblers previously estimated for 2010-2011 amongst the 2 million Australians found to have experienced one or more gambling-related problems. The findings have implications for public health policy and resourcing, and the way in which prevalence and expenditure statistics have been interpreted by researchers, government and industry in Australia and elsewhere.

Gender Differences Among Helpline Callers: Prospective Study of Gambling and Psychosocial Outcomes.

Despite the increasing amount of empirical research on gambling helplines (e.g., characteristics, effectiveness), little is known about gender differences on treatment outcomes following contact. The present research addresses this gap in the literature via secondary analysis of an uncontrolled outcome study of New Zealand's gambling helpline (N = 150). To this end, the present research had three aims; (a) explore gender differences (e.g., demographics, co-morbidities, gambling variables) among helpline callers using psychometrically robust measures, (b) assess whether gender predicts treatment utilization following contact and (c) assess whether systematic gender differences exist on gambling and psychosocial outcomes at 3-, 6- and 12-month follow-ups. The results revealed that at baseline, women compared to men, described greater problem severity and shorter problem duration, and were more likely to report electronic gaming machines as their most problematic form of gambling. Women also reported greater distress and lower quality of life. Men, despite less problem severity and distress, were more likely to access treatment following helpline contact. Importantly, both men and women reported significant and equivalent improvements in both gambling and psychosocial outcomes following helpline contact. The improved outcomes remained significant after controlling for treatment attendance. Although different approaches for women may be required by helplines if the goal is to refer callers to treatment, the results suggest that after calling the helpline, women reduced their problematic gambling and improved psychosocial functioning without further treatment.

Why People Gamble: A Qualitative Study of Four New Zealand Ethnic Groups.

In multicultural countries such as New Zealand, it is particularly important that gambling research take into account possible cultural differences. Many New Zealanders come from cultures that do not have a history of gambling, including the Mäori (New Zealand indigenous people), Pacific Islanders, and recent migrants. Little research has examined the reasons why people start and continue to gamble, especially among different ethnic groups. This research project thus aimed to develop a framework to explain how environmental, cultural, and social factors interact with personal attributes to determine gambling behaviors. In a qualitative study, 131 people broadly representative of Mäori, Pacific, Asian, and Päkehä/New Zealand European groups residing in New Zealand were interviewed individually or in focus groups. They included social and problem gamblers, families of problem gamblers, and professionals. Different personal, socioeconomic, environmental, and cultural factors were identified, summarized in a developmental framework, and compared to factors found for ethnic groups in other countries. Public health policy issues were raised, including greater control of gambling promotion.

Knowledge, views and experiences of gambling and gambling-related harms in different ethnic and socio-economic groups in New Zealand.

OBJECTIVE: To describe survey findings which measure broader gambling harms and provide benchmark data to evaluate an awareness and education program to minimise harm; part of NZ's public health approach to problem gambling. To assess whether previously reported ethnic and socio-economic disparities are evident when researching broader gambling harms. METHODS: An in-home, nationwide survey captured data from a multi-stage, random probability sample of 1,774 adults and 199 15-17-year-olds. Oversampling Maori (NZ's indigenous people), Pacific and Asian peoples, and people in areas of deprivation, allowed analysis by ethnicity and socio-economic status. RESULTS: Data show high participation levels; around 8 out of 10 people took part in at least one gambling activity in the previous 12 months. Type and frequency of activities was used to define four groups: infrequent gamblers (60.9%); frequent, non-continuous gamblers (17.6%); frequent, continuous gamblers (4%); and non-gamblers (17.5%). Self-reported knowledge of the signs of gambling harm was high. Arguments about gambling and people going without/unpaid bills provided two indicators of broader gambling harm. Around one-sixth of New Zealanders experienced each of these harms. Impacts were greatest for low-income groups, Maori, and Pacific peoples. CONCLUSIONS: The proportion of New Zealander's experiencing broader gambling harms is much higher than the prevalence for problem gambling. Consistent with other research, results show the flow-on impacts of problem gambling - on family, friends and communities. IMPLICATIONS: Measures can be developed to benchmark the wider harms of gambling and evaluate public health programs addressing harm at population and sub-population levels.

Pacific Islands Families: First Two Years of Life Study--design and methodology.

AIMS: Knowledge about the health, psychosocial, and behavioural characteristics of Pacific peoples with young children resident in New Zealand is limited. The Pacific Islands Families: First Two Years of Life (PIF) Study was designed to redress this knowledge gap. This paper describes the design and methodology of the PIF Study. METHODS: Mothers of Pacific infants born at Middlemore Hospital between 15 March and 17 December 2000 were recruited. Maternal home interviews covering sociodemographic, cultural, environmental, child development, family and household dynamics, childcare, lifestyle, and health issues were undertaken at approximately 6-weeks, 12-months, and 24-months postpartum. Paternal home interviews and child development assessments were conducted at approximately 12-months and 24-months postpartum. Information from Middlemore's Hospital Discharge Summary records and Plunket's 6-week and 6-month assessments was also captured. RESULTS: 1708 mothers were identified, 1657 were invited to participate, 1590 (96%) consented to a home visit; and, of these, 1,477 (93%) were eligible for the PIF study. Of those eligible, 1,376 (93%) participated at 6-weeks, 1224 (83%) participated at 12-months, and 1144 (77%) participated at 24-months. No important differential attrition was observed. Paternal interviews and child assessments were conducted on 825 fathers and 1241 infants at 12-months and on 757 fathers and 1064 children at 24-months. CONCLUSIONS: The PIF study is a large, scientifically and culturally robust longitudinal study that has achieved respectable participation rates in a historically hard-to-reach population. We believe that results from this study will inform future policy development within New Zealand.

Cuidadores informales de las personas mayores dependientes: ¿quienes son?, ¿qué hacen?, ¿qué les sucede? / Informal caregivers of the dependent elderly: who are?, what do they do?, what happen with them?

Las poblaciones están envejeciendo en todo el mundo y esta tendencia se acelerará durante las primeras 2 décadas del siglo XXI. El crecimiento ha sido más rápido en el segmento de mayor edad del grupo etáreo sobre 60 años. Las personas en esta categoría son más susceptibles que otras para requerir cuidados especiales de profesionales y cuidadores informales. Esta transición demográfica, única e histórica, tiene implicancias significativas para la sociedad en general y para el sector salud en particular. La necesidad y demanda de cuidado y apoyo para la comunidad está aumentando, al mismo tiempo que la cantidad de cuidadores informales está disminuyendo y se están aplicando restricciones al gasto en bienestar y salud. Esto pone un gran desafío a la entrega de cuidado de salud o de atención en salud y exige nuevas y más estrechas relaciones de trabajo entre los cuidadores informales, las organizaciones de la comunidad y los profesionales de salud. Este trabajo se basa en los hallazgos de una encuesta nacional acerca de los neozelandeses que proporcionan cuidado informal a la gente mayor. Describe qué formas de cuidado se entregan, por quién y para quién. Estima el valor financiero de esta actividad y examina cómo los cuidadores enfrentan su estrés y su salud mental. Discute la importancia de los cuidadores informales para el cuidado de la salud primaria, incluyendo lo que ellos desean de los profesionales para que los ayuden en su trabajo