Implementation, Maintenance, and Outcomes of an Electronic Referral to a Tobacco Quitline Across Five Health Systems.

INTRODUCTION: Electronic referral (e-referral) to quitlines helps connect tobacco-using patients to free, evidence-based cessation counseling. Little has been published about the real-world implementation of e-referrals across U.S. health systems, their maintenance over time, and the outcomes of e-referred patients. AIMS AND METHODS: Beginning in 2014, the University of California (UC)-wide project called UC Quits scaled up quitline e-referrals and related modifications to clinical workflows from one to five UC health systems. Implementation strategies were used to increase site readiness. Maintenance was supported through ongoing monitoring and quality improvement programs. Data on e-referred patients (n = 20 709) and quitline callers (n = 197 377) were collected from April 2014 to March 2021. Analyses of referral trends and cessation outcomes were conducted in 2021-2022. RESULTS: Of 20 709 patients referred, the quitline contacted 47.1%, 20.6% completed intake, 15.2% requested counseling, and 10.9% received it. In the 1.5-year implementation phase, 1813 patients were referred. In the 5.5-year maintenance phase, volume was sustained, with 3436 referrals annually on average. Among referred patients completing intake (n = 4264), 46.2% were nonwhite, 58.8% had Medicaid, 58.7% had a chronic disease, and 48.8% had a behavioral health condition. In a sample randomly selected for follow-up, e-referred patients were as likely as general quitline callers to attempt quitting (68.5% vs. 71.4%; p = .23), quit for 30 days (28.3% vs. 26.9%; p = .52), and quit for 6 months (13.6% vs. 13.9%; p = .88). CONCLUSIONS: With a whole-systems approach, quitline e-referrals can be established and sustained across inpatient and outpatient settings with diverse patient populations. Cessation outcomes were similar to those of general quitline callers. IMPLICATIONS: This study supports the broad implementation of tobacco quitline e-referrals in health care. To the best of our knowledge, no other paper has described the implementation of e-referrals across multiple U.S. health systems or how they were sustained over time. Modifying electronic health records systems and clinical workflows to enable and encourage e-referrals, if implemented and maintained appropriately, can be expected to improve patient care, make it easier for clinicians to support patients in quitting, increase the proportion of patients using evidence-based treatment, provide data to assess progress on quality goals, and help meet reporting requirements for tobacco screening and prevention.

Gambling, tobacco use, and health among individuals in substance use disorder treatment.

BACKGROUND AND OBJECTIVES: Gambling is highly comorbid with disordered use of tobacco and other drugs, and may increase relapse risk among substance use disorder (SUD) patients. We investigated associations between gambling and tobacco use behaviors among SUD patients to inform clinical care. METHODS: Patients (N = 651, 170 female) from 25 residential SUD treatment programs in California completed surveys about tobacco use, health, and gambling. Using multivariate regression, we examined associations between gambling, tobacco use behaviors, and mental and physical health. RESULTS: Past-year gamblers were more likely than non-gamblers to be current smokers (adjusted odds ratio [AOR] = 1.44, 95% confidence interval [CI] = 1.03, 2.01). Smokers who gambled had higher mean Heaviness of Smoking Index (HSI) scores (mean difference = +0.32, 95% CI = 0.04, 0.60), and more often reported smokeless tobacco use (AOR = 1.73, 95% CI = 1.16, 2.58), compared to non-gambling smokers. Past-year problem gamblers were more likely than all others (non-gamblers and non-problem gamblers) to be current smokers (AOR = 1.44, 95% CI = 1.08, 1.90) and to report high psychosocial stress (AOR = 1.87, 95% CI = 1.34, 2.61). Smokers with problem gambling also had higher HSI scores (mean difference = +0.54, 95% CI = 0.14, 0.95) compared to smokers without problem gambling. DISCUSSION AND CONCLUSIONS: Gambling and problem gambling were associated with tobacco use and heavier smoking. SUD patients with gambling comorbidity may be heavier smokers and may need concurrent treatment for tobacco use and problem gambling. SCIENTIFIC SIGNIFICANCE: This study provides novel data regarding gambling and tobacco use behaviors among SUD patients.

Soluble expression of recombinant midgut zymogen (native propeptide) proteases from the Aedes aegypti Mosquito Utilizing E. coli as a host.

BACKGROUND: Studying proteins and enzymes involved in important biological processes in the Aedes aegypti mosquito is limited by the quantity that can be directly isolated from the mosquito. Adding to this difficulty, digestive enzymes (midgut proteases) involved in metabolizing blood meal proteins require a more oxidizing environment to allow proper folding of disulfide bonds. Therefore, recombinant techniques to express foreign proteins in Escherichia coli prove to be effective in producing milligram quantities of the expressed product. However, with the most commonly used strains having a reducing cytoplasm, soluble expression of recombinant proteases is hampered. Fortunately, new E. coli strains with a more oxidizing cytoplasm are now available to ensure proper folding of disulfide bonds. RESULTS: Utilizing an E. coli strain with a more oxidizing cytoplasm (SHuffle® T7, New England Biolabs) and changes in bacterial growth temperature has resulted in the soluble expression of the four most abundantly expressed Ae. aegypti midgut proteases (AaET, AaSPVI, AaSPVII, and AaLT). A previous attempt of solubly expressing the full-length zymogen forms of these proteases with the leader (signal) sequence and a modified pseudo propeptide with a heterologous enterokinase cleavage site led to insoluble recombinant protein expression. In combination with the more oxidizing cytoplasm, and changes in growth temperature, helped improve the solubility of the zymogen (no leader) native propeptide proteases in E. coli. Furthermore, the approach led to autocatalytic activation of the proteases during bacterial expression and observable BApNA activity. Different time-points after bacterial growth induction were tested to determine the time at which the inactive (zymogen) species is observed to transition to the active form. This helped with the purification and isolation of only the inactive zymogen forms using Nickel affinity. CONCLUSIONS: The difficulty in solubly expressing recombinant proteases in E. coli is caused by the native reducing cytoplasm. However, with bacterial strains with a more oxidizing cytoplasm, recombinant soluble expression can be achieved, but only in concert with changes in bacterial growth temperature. The method described herein should provide a facile starting point to recombinantly expressing Ae. aegypti mosquito proteases or proteins dependent on disulfide bonds utilizing E. coli as a host.

Attitudes Towards Gambling, Gambling Problems, and Treatment Among Hispanics in Imperial County, CA.

Gambling problems are associated with a wide range of serious negative personal, social, health, and mental health consequences and are an important public health concern. Some data suggest that gambling problems may be more prevalent among Hispanics, but few studies have been conducted in this community. The aim of the current study was to gather community-based, gambling-related data in order to increase understanding of gambling problems and their treatment in the Hispanic community. We conducted a mixed-methods study of gambling behavior and attitudes towards gambling, those with gambling problems, and professional treatment for gambling problems in a publicly funded health center serving a primarily Hispanic clientele. Study participants included clinic staff and clinic patients. All participants completed a brief, self-report survey; however, staff participated in a focus group on gambling issues and patients were interviewed individually about gambling issues. Nearly 80 % of patients had gambled in the past month, as compared to about 36 % of clinic staff. Survey data showed that patients had many risk factors for gambling problems. Focus group and interview information indicated that most viewed gambling problems as a form of addiction, the elderly were seen as being at increased risk for gambling problems, and gambling outings represented one of the few recreational opportunities in the region. The majority of both staff and patients believed that there was a need for gambling-related treatment services in the county; however, a notable minority of patients said that they would first seek help from a trusted relative or family member. Possible avenues to increase awareness of, screening for, and treatment for gambling problems may include collaborations with publicly funded health care centers and the training of promotoras to serve as an interface between health services and the community.

Sexual desire, not hypersexuality, predicts self-regulation of sexual arousal.

A person's ability to control their own sexual arousal is important both to reduce the risks associated with some sexual behaviours and to respond sexually with intimate partners. A lack of control over sexual urges is a proposed feature of "hypersexual disorder", though some evidence suggests that sexual desire predicts the self-regulation of sexual arousal better than hypersexuality. In the current study, a sample (N = 116) of men and women recruited from community ads viewed a series of 20-second neutral and sexual films. Before each sexual film, participants were instructed to increase their sexual arousal, decrease their sexual arousal or respond as usual. Higher levels of desire for sex with a partner consistently predicted failures to downregulate sexual arousal. Hypersexuality was unrelated. These findings replicate Winters et al.'s study and extend their findings by including upregulation, women, a new measure of hypersexuality and a higher-trial design.

Differential Gambling Motivations and Recreational Activity Preferences Among Casino Gamblers.

This study investigated three different types of gamblers (recreational, problem, and pathological gamblers) to determine differences in gambling motivations and recreational activity preferences among casino gamblers. We collected data from 600 gamblers recruited in an actual gambling environment inside a major casino in South Korea. Findings indicate that motivational factors of escape, sightseeing, and winning were significantly different among these three types of gamblers. When looking at motivations to visit the casino, pathological gamblers were more likely to be motivated by winning, whereas recreational gamblers were more likely to be motivated by scenery and culture in the surrounding casino area. Meanwhile, the problem gamblers fell between these two groups, indicating higher preferences for non-gambling activities than the pathological gamblers. As this study builds upon a foundational previous study by Lee et al. (Psychiatry Investig 6(3):141-149, 2009), the results of this new study were compared with those of the previous study to see if new developments within a resort-style casino contribute to changes in motivations and recreational activity preferences.

A Longitudinal Examination of Depression Among Gambling Inpatients.

Problem and pathological gamblers demonstrate high levels of depression, which may be related to coping styles, reactive emotional states, and/or genetics (Potenza et al., Arch Gen Psychiat 62(9):1015-1021, 2005; Getty et al., J Gambl Stud 16(4):377-391, 2000). Although depression impacts treatment outcomes (Morefield et al., Int J Men Healt Addict 12(3):367-379, 2013), research regarding depression among gamblers in residential treatment is particularly limited. This study attempts to address this deficit by examining the course of depressive symptoms among clients at a residential gambling program in the Western United States. Forty-four adults were administered a weekly measure of depression (Beck Depression Inventory-II, BDI-II) for eight consecutive weeks. Levels of depression were classified into three groups based on standard scoring criteria for the BDI-II: no/minimal, mild/moderate, and severe depression. Results from a mixed-model analysis indicated a main effect for group and time, as well as an interaction between group and time. Examination of the slopes for the rate of change for the three depression groups indicated no change in the non-depressed group and a decrease in depression scores over time for both the mild/moderate and severely depressed groups. The slopes for the two symptomatic depression groups were not significantly different, indicating a similar rate of change. We speculate that reductions in depression symptoms may be related to feelings of self-efficacy, environmental containment/stabilization, and therapeutic effects of treatment. These results help to illuminate the role of significant processes in residential treatment, including initial stabilization, insight, self-efficacy, and termination.

Crystalizing the role of traditional healing in an urban Native American health center.

A needs assessment surveying American Indians and Alaska Natives (AIs/ANs) at an AI/AN health center in the Midwestern United States was conducted, with an emphasis on traditional Native healing. Data from this study included qualitative material from interviews of community members (N = 27; age 12-82) and service providers (N = 11; age 26-70). Respondents emphasized the path to wellness includes physical, spiritual and mental health and that traditional healing can restore various imbalances. Furthermore, traditional healing was considered a complement to Western medicine. Third, traditional medicine as a tool in healthcare settings was conceptualized on a continuum.

A single-blind study of 'as-needed' ecopipam for gambling disorder.

BACKGROUND: Gambling disorder is a disabling illness experienced by 1% to 3% of adults. Pharmacologic management of gambling disorder has produced mixed results, with some but not all studies showing medication to be more effective than placebo. Ecopipam may offer promise for treating gambling disorder because of its antagonism of dopamine-1 receptors. METHODS: Twenty-eight individuals with gambling disorder were enrolled and received ≥1 dose of oral ecopipam in an 8-week trial (1 week placebo lead-in, 6 weeks of medication (50 to 100 mg/d as needed), and 1 week follow-up. Participants were enrolled between September 2010 and June 2011 at 3 sites in the United States. Change from baseline to study endpoint on the Yale-Brown Obsessive Compulsive Scale Modified for Pathological Gambling (PG-YBOCS) was the primary outcome measure. RESULTS: Treatment was associated with statistically significant reductions in the PG-YBOCS total score (baseline score of 25.6 reduced to 14.0 at study endpoint; P>.001) and PG-YBOCS subscales (Thought-Urge and Behavior, P>.001). CONCLUSIONS: These findings suggest that pharmacologic targeting of the dopamine-1 receptor may be beneficial in gambling behavior. Placebo-controlled, double-blind studies are warranted to confirm these preliminary findings.

Potency assay development for cellular therapy products: an ISCT review of the requirements and experiences in the industry.

The evaluation of potency plays a key role in defining the quality of cellular therapy products (CTPs). Potency can be defined as a quantitative measure of relevant biologic function based on the attributes that are linked to relevant biologic properties. To achieve an adequate assessment of CTP potency, appropriate in vitro or in vivo laboratory assays and properly controlled clinical data need to be created. The primary objective of a potency assay is to provide a mechanism by which the manufacturing process and the final product for batch release are scrutinized for quality, consistency and stability. A potency assay also provides the basis for comparability assessment after process changes, such as scale-up, site transfer and new starting materials (e.g., a new donor). Potency assays should be in place for early clinical development, and validated assays are required for pivotal clinical trials. Potency is based on the individual characteristics of each individual CTP, and the adequacy of potency assays will be evaluated on a case-by-case basis by regulatory agencies. We provide an overview of the expectations and challenges in development of potency assays specific for CTPs; several real-life experiences from the cellular therapy industry are presented as illustrations. The key observation and message is that aggressive early investment in a solid potency evaluation strategy can greatly enhance eventual CTP deployment because it can mitigate the risk of costly product failure in late-stage development.

Regulatory T cells and human myeloid dendritic cells promote tolerance via programmed death ligand-1.

Immunotherapy using regulatory T cells (Treg) has been proposed, yet cellular and molecular mechanisms of human Tregs remain incompletely characterized. Here, we demonstrate that human Tregs promote the generation of myeloid dendritic cells (DC) with reduced capacity to stimulate effector T cell responses. In a model of xenogeneic graft-versus-host disease (GVHD), allogeneic human DC conditioned with Tregs suppressed human T cell activation and completely abrogated posttransplant lethality. Tregs induced programmed death ligand-1 (PD-L1) expression on Treg-conditioned DC; subsequently, Treg-conditioned DC induced PD-L1 expression in vivo on effector T cells. PD-L1 blockade reversed Treg-conditioned DC function in vitro and in vivo, thereby demonstrating that human Tregs can promote immune suppression via DC modulation through PD-L1 up-regulation. This identification of a human Treg downstream cellular effector (DC) and molecular mechanism (PD-L1) will facilitate the rational design of clinical trials to modulate alloreactivity.

Documentation of psychiatric disorders and related factors in a large sample population of HIV-positive patients in California.

This retrospective cohort study examined electronic medical records of HIV-positive patients in California (N = 7,834) to find the prevalence of any psychiatric condition and the associations between several factors and the likelihood of these disorders. Approximately 53 % of the patients in this study had a documented psychiatric condition, including 23 % who had a mood disorder, 19 % who had a substance-related disorder, and 16 % who had an anxiety disorder. After controlling for potential confounders, significant positive associations (p < 0.001) were found between female gender and the presence of any mood disorder (adjusted odds ratio [95 % confidence interval, 95 %CI] = 1.58 [1.26-1.99]) or anxiety disorder (AOR = 1.54 [1.18-2.02]) and between homosexual orientation and the presence of any psychiatric condition (AOR = 1.33 [1.15-1.55]), mood disorder (AOR = 1.71 [1.42-2.07]), or anxiety disorder (AOR = 1.41 [1.22-1.88]). There were also significant negative associations between African-American race and the presence of any psychiatric condition (AOR = 0.68 [0.60-0.77]), mood disorder (AOR = 0.74 [0.64-0.86]), anxiety disorder (AOR = 0.43 [0.36-0.52]), or substance-related disorder (AOR = 0.78 [0.67-0.91]) and between state/federal insurance and the presence of any psychiatric condition (AOR = 0.70 [0.62-0.79]), mood disorder (AOR = 0.71 [0.62-0.80]), or anxiety disorder (AOR = 0.77 [0.66-0.89]).

Discrimination and participation in traditional healing for American Indians and Alaska Natives.

Contemporary American Indians and Alaska Natives (AIs/ANs) who live in urban areas today face the daunting task of navigating an urban landscape while maintaining the facets of their respective Native cultures. While AIs/ANs continue to grapple with the intergenerational trauma associated with forced assimilation, relocation movements, and boarding schools, these traumas have manifested themselves in elevated rates of psychopathology. AIs/ANs have elevated rates of domestic abuse, poverty, suicide, and substance misuse. Furthermore, AIs/ANs, like many other minority cultures often face discrimination in their everyday lives. In light of the aversive experiences they face, AI/AN people have followed the tenets of ritual and traditional healing to address imbalances in the body, mind, and spirit. For providers working with AI/AN clients, it is important to understand who is using traditional healing and why they are using alternative services. Secondary data analyses of survey data from 389 urban AIs/ANs were utilized in order to determine the relationship between experiences of discrimination and traditional healing use. Analyses indicated that experiences of discrimination in healthcare settings were significantly associated with participation in traditional healing. Analyses also indicated that nearly a quarter of the sample reported discrimination in a healthcare setting, roughly half of the sample had used traditional healing, and that the majority of those who had used traditional healing were women, and ages 35-44 (27%). This study calls attention to the socio-demographic factors implicated in traditional healing use by urban AI/AN people, in addition to the clinical and demographic characteristics of this sample.

Pathological gambling, problem gambling and sleep complaints: an analysis of the National Comorbidity Survey: Replication (NCS-R).

The purpose of this study is to investigate the relationship between sleep disturbances and gambling behavior. Data from the National Comorbidity Survey-Replication (NCS-R) was used to examine the relationship between three specific sleep complaints (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]) and gambling behavior. Bivariate logistic regression models were used to control for potentially confounding psychiatric disorders and age. Almost half of respondents with problem gambling behavior (45.9%) and two thirds (67.7%) of respondents with pathological gambling behavior reported at least one sleep compliant. Compared to respondents with no gambling pathology, respondents with pathological gambling were significantly more likely to report at least one sleep complaint (Adjusted Odds Ratio [AOR] = 3.444, 95% CI = 1.538-7.713), to report all sleep complaints (AOR = 3.449, 95% CI = 1.503-7.914), and to report any individual complaint (DIS: OR = 2.300, 95% CI = 1.069-4.946; DMS: AOR = 4.604, 95% CI = 2.093-10.129; EMA: AOR = 3.968, 95% CI = 1.856-8.481). The relationship between problem gambling and sleep complaints were more modest (any sleep complaint: AOR = 1.794, 95% CI = 1.142-2.818; all three sleep complaints: AOR = 2.144, 95% CI = 1.169-3.931; DIS: AOR = 1.961, 95% CI = 1.204-3.194; DMS: AOR = 1.551, 95% CI = 0.951-2.529; EMA: AOR = 1.796, 95% CI = 1.099-2.935). Given the individual and societal ramifications linked with the presence of sleep problems, this study presents another health-related repercussion associated with gambling pathology rarely discussed in the literature.

Report of findings in a DSM-5 field trial for hypersexual disorder.

INTRODUCTION: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial. AIM: This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder. METHOD: Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria. MAIN OUTCOME MEASURES: HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory-Revised. RESULTS: Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. CONCLUSIONS: The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.

Facets of perfectionism in a sample of hypersexual patients.

This study investigated the role of perfectionism in a treatment-seeking sample (N = 136) of adult men and women using the Perfectionism Inventory (PI) and the Hypersexual Behavior Inventory (HBI). Several facets of perfectionism were positively correlated with hypersexuality, with the concern over mistakes scale from the PI accounting for most of the predictive variance in patterns of hypersexual behavior measured by the HBI. Items associated with concern over mistakes closely parallel the construct of shame noted in other studies of hypersexual patients. To a lesser degree, the PI scale planfulness also showed a negative relationship with hypersexuality, suggesting tendencies of impulsivity in the current patients. These data reinforce the findings in other studies that patterns of harsh self-criticism and impulsivity seem to strongly influence hypersexual behavior.

Self-reported differences on measures of executive function in a patient sample of pathological gamblers.

Patients seeking help for pathological gambling often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with gambling. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive deficits. Evidence of executive deficits have been confirmed in pathological gamblers using objective neurocognitive tests, however, it remains to be seen if such findings will emerge in self-report measures of executive control. These observations led to the current investigation of differences between a group of pathological gamblers (n = 62) and a comparison group (n = 64) using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Significant differences between the groups emerged over all nine subscales of executive functioning with the most dramatic differences on BRIEF-A subscales Inhibit, Plan/Organize, Shift, Emotion Control, Self-Monitor, and Initiate among the pathological gamblers. These results provide evidence that support findings among pathological gamblers using objective neuropsychological measures and suggest that the BRIEF-A may be an appropriate instrument to assess possible problems with executive control in this population.

Screening for addictive disorders within a workers' compensation clinic: an exploratory study.

We conducted a cross-sectional study investigating the extent of addictive disorders within a workers' compensation (WC) clinic. We also examined the feasibility of substance abuse screening within the same clinic. In 2009 , 100 patients were asked to complete the World Health Organization's Alcohol, Smoking, Substance Involvement Screening Test (WHO-ASSIST) and the Current Opioid Misuse Measure (COMM). According to the WHO-ASSIST, we found that 46% of WC patients required intervention for at least one substance-related disorder (25% tobacco, 23% sedatives, 8% opioids), and according to the COMM, 46% screened positive for prescription opioid misuse. Importantly, the addition of this screening was brief, economical, and well accepted by patients. Further research should analyze the costs and benefits of detection and intervention of substance-related disorders in this setting.

Reliability, validity, and psychometric development of the pornography consumption inventory in a sample of hypersexual men.

This article reports the psychometric evaluation of the Pornography Consumption Inventory (PCI), which was developed to assess motivations for pornography use among hypersexual men. Initial factor structure and item analysis were conducted in a sample of men (N = 105) seeking to reduce their pornography consumption (Study 1), yielding a 4-factor solution. In a second sample of treatment-seeking hypersexual men (N = 107), the authors further investigated the properties of the PCI using confirmatory factor analytic procedures, reliability indices, and explored PCI associations with several other constructs to establish convergent and discriminant validity. These studies demonstrate psychometric evidence for the PCI items that measure tendencies of hypersexual men to use pornography (a) for sexual pleasure; (b) to escape, cope, or avoid uncomfortable emotional experiences or stress; (c) to satisfy sexual curiosity; and (d) to satisfy desires for excitement, novelty, and variety.

Problem and pathological gambling in a sample of casino patrons.

Relatively few studies have examined gambling problems among individuals in a casino setting. The current study sought to examine the prevalence of gambling problems among a sample of casino patrons and examine alcohol and tobacco use, health status, and quality of life by gambling problem status. To these ends, 176 casino patrons were recruited by going to a Southern California casino and requesting that they complete an anonymous survey. Results indicated the following lifetime rates for at-risk, problem, and pathological gambling: 29.2, 10.7, and 29.8%. Differences were found with regards to gambling behavior, and results indicated higher rates of smoking among individuals with gambling problems, but not higher rates of alcohol use. Self-rated quality of life was lower among pathological gamblers relative to non-problem gamblers, but did not differ from at-risk or problem gamblers. Although subject to some limitations, our data support the notion of higher frequency of gambling problems among casino patrons and may suggest the need for increased interventions for gambling problems on-site at casinos.