Gambling and Migration - The Role of Culture and Family.

Problem gambling (PG) is a public health concern with severe repercussions for the individual, concerned significant others and the society. Foreign borns generally gamble less but are overrepresented among those with PG. Previous research has suggested that other factors, such as socio-economic status, might explain this, but also that cultural factors might play a role in the relationship to gambling and the development of PG. This qualitative study using content analysis investigates the experiences of and opinions about gambling and PG among 12 males living in Sweden with a migrant background in Afghanistan, the Middle East and North Africa. The results were show that the acculturation process could be a factor in developing PG, as well as a cultural values regarding money and wealth. PG was seen as more stigmatized in the origin country, and the family played a more important role in the rehabilitation of PG compared to the general population. The results of this study could be used to inform preventive and clinical programs to better reach people with a migrant background.

Racial-ethnic differences in impulsivity and compulsivity in recreational gambling.

BACKGROUND: Prior data indicate high rates of problematic gambling in some racial-ethnic minority groups, yet research into mechanisms contributing to these associations is scant. The aim of the present study was to examine whether impulsivity and compulsivity differ across racial-ethnic groups in recreational gamblers. METHODS: Young adult non-treatment seeking recreational gamblers were recruited from the general community. Presence of mental health diagnoses (including gambling disorder) was exclusionary. Participants completed clinical interviews, questionnaires, and cognitive tasks germane to impulsivity and compulsivity. RESULTS: 202 recreational gamblers (63.5% males) had mean (standard deviation) age 23.8 (2.7) years and identified using the following racial-ethnic identities: Caucasian (N = 145), African-American (N = 41), and Asian (N = 16). Groups did not differ on age, gender, education, or impulsivity measures. Compared to the Caucasian group, the African-American group reported significantly higher endorsement of sub-syndromal disordered gambling, higher compulsivity scores, and exhibited decision-making decrements on the Gambling Task. The Asian and Caucasian groups did not differ on any measure. CONCLUSIONS: This study suggests that young adult African-American recreational gamblers may experience greater levels of subsyndromal gambling compared to other racial-ethnic groups, and this appears linked with aspects of compulsivity. Future work should evaluate gambling longitudinally to better understand nuanced presentations across different groups, including in other age groups.

Gambling problems, risk factors, community knowledge, and impact in a US Lao immigrant and refugee community sample.

OBJECTIVES: The objectives of this study were to examine gambling-related problems, risk factors, help-seeking attitudes, community perceptions, and correlates of problem gambling in a Lao sample of Southeast Asian refugees and immigrants and to discuss cultural implications for the treatment and prevention of gambling problems in Southeast Asian refugee and immigrant populations. STUDY DESIGN: This was a cross-sectional, community-based interview study. METHODS: Participants (N = 200, males = 51%, females = 49%) were recruited from a Lao community center in a major US metropolitan area (convenience sample; community center recruitment and peer nomination). Structured interviews on gambling and substance use were conducted by Lao center staff members in both English and Lao languages. RESULTS: Gambling-related problems were measured using the South Oaks Gambling Screen (SOGS), gambling frequency, and quantity measures. In a previous study, we reported a substantial number of participants from the sample endorsed gambling-related harms and problems (SOGS score of five or more = 24%) and common methods of play were slots, house betting, cards at a casino, and sports betting. Among those endorsing five or more gambling problems, reasons for gambling included making money (68%), social life (31.3%), entertainment (58.3%), and reducing boredom (35.4%). Less commonly endorsed reasons were depression or stress (14.6%) and escape (10.4%). Many participants reported a family history of gambling problems. Those with problem gambling had twice the level of sibling problem gambling histories relative to those without problem gambling (35.4% vs. 11.1%). There were substantially more participants in the problem gambling group who had started gambling before the age of 13 years than in non-problem gamblers (P < .05). Many recognized gambling as a significant issue in the community and reported knowing several individuals affected by gambling-related problems. CONCLUSIONS: Many participants recognized gambling as a significant issue in the Lao community. We include insights gleaned from a research partnership with a community organization. Although data cannot be generalized to the Lao community because of limitations in sampling methodology, participants viewed gambling as a culturally common social practice. Cultural norms affected where community members gamble, types of games, and betting practices. In this context, community members may view gambling-related harms as both a community-level and individual-level concern. These data suggest a significant need for rigorous research to inform policies and a culturally sensitive approach to public health prevention, intervention, and education. We discuss the challenges and cultural barriers to research and community engagement and offer suggestions for prevention and intervention ideas efforts.

Australia's Gambling Epidemic: The Role of Neighbourhood Ethnic Diversity.

Gambling is a popular leisure activity but also a significant public health issue in Australia. The severity of gambling in Australia is characterised by unprecedented gambling expenditures and losses representing the highest gambling rates in the world, which has led to renewed interests in understanding the factors influencing gambling behaviours. We contribute to the debate on the determinants of gambling by providing the first study that examines the impact of ethnic diversity on gambling. Using data from the Household, Income and Labour Dynamics in Australia survey, we find that ethnic diversity is positively associated with gambling. This result is robust to alternative estimation approaches, alternative ways of measuring ethnic diversity and irrespective of whether gambling is measured using the Problem Gambling Severity Index, gambling expenditures or number of gambling activities. Our results also suggest stronger effects of ethnic diversity for problem gamblers compared to gamblers in other risk categories. These results support the need for policies that promote social capital in diverse communities to reduce the risks of social isolation, which is an important motivator of gambling behaviour.

Does establishing local treatment institutions lead to different populations seeking treatment among Greenlandic Inuit?

Introduction: In 2016, a new addiction treatment service was established in Greenland to tackle the addiction problems with alcohol, cannabis and gambling among the population. The new service has established a treatment center in each of the five municipalities and works in partnership with a central private provider of treatment for those who reside in areas without a local treatment center.Methods: The national addiction database provided us with data from the Alcohol Use Disorder Identification Test, Alcohol Severity Index and questions on cannabis use and gambling behavior received at referral to, and at initiation of treatment. The data were analyzed for differences between the population in local or central treatment using SPSS version 25 (SPSS Inc., Chicago, IL).Results: Significant differences between the individuals in local and central treatment were revealed. Individuals in local treatment are more often women with minor children and a job, and their alcohol use is concentrated on weekends/holidays. Individuals in central treatment are more equal in both genders, few have minor children living at home, heavy drinking is more pronounced, and cannabis is used more frequently as well.Discussion: The findings support our expectations of local treatment being more attractive to individuals with obligations at home. The differences in the populations are worth considering when planning the treatment service, as the needs of the populations might differ. The findings are limited by many missing in the analyses, which we believe is caused by the establishing process of the new service.

Anti-racism and substance use treatment: Addiction does not discriminate, but do we?

Contemporary racism in the United States contributes to health, mental health, and substance use disorder (SUD) disparities among People of Color (POC) compared with White individuals. Despite entering into substance use treatment with a greater severity of SUD and related consequences, POC experience more barriers to treatment engagement, completion, and satisfaction than their White counterparts. As substance use treatment counselors are socialized within institutions of systemic racism, it is important to examine their positioning on racism in relation to their capacity for culturally competent care. This article articulates a need to implement an antiracist framework for substance use treatment.

Additive Effect of Physical Activity and Sedentary Time on Depressive Symptoms in Rural Japanese Adults: A Cross-Sectional Study.

BACKGROUND: Previous studies have reported an additive effect of moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) on depressive symptoms. However, no studies have been conducted in rural community settings. This cross-sectional study investigated whether the additive effect of MVPA and ST was associated with depressive symptoms in rural Japanese adults. METHODS: We identified 2,814 participants from health examinations conducted in Shimane, rural Japan, in 2012 and analyzed data from 1,958 participants. We assessed depressive symptoms using the Zung Self-Rating Depression Scale and measured the total time spent on MVPA and ST using a Japanese short version of the International Physical Activity Questionnaire. Poisson regression analysis examined the prevalence ratios (PR) of depressive symptoms in nine category combinations of MVPA level (no, insufficient, or sufficient MVPA) and ST level (high, moderate, or low ST). RESULTS: A total of 117 (6.0%) participants had depressive symptoms. Compared with the reference category (no MVPA/high ST), multivariate analysis showed that the likelihood of depressive symptoms was significantly lower in the sufficient MVPA/low ST category (PR 0.23; 95% confidence intervals [CI], 0.08-0.66), insufficient MVPA/low ST category (PR 0.37; 95% CI, 0.16-0.86), and insufficient MVPA/moderate ST category (PR 0.39; 95% CI, 0.17-0.90). CONCLUSION: Analysis of the additive effect of MVPA and ST showed that the combinational category of sufficient MVPA and low ST had the lowest prevalence of depressive symptoms in rural Japanese adults. Moderate ST and low ST showed significantly lower likelihoods of depressive symptoms, regardless of insufficient MVPA.

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China.

We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.

Human identity versus gender identity: The perception of sexual addiction among Iranian women.

This qualitative study was conducted to explore the images of personal identity from the perspective of women with sexual addiction. The data required for the study were collected through 31 in-depth interviews. Sensing a threat to personal identity, dissatisfaction with gender identity, dissociation with the continuum of identity, and identity reconstruction in response to threat were four of the experiences that were common among women with sexual addiction. Painful emotional experiences appear to have created a sense of gender and sexual conflict or weakness in these women and thus threatened their personal identity and led to their sexual addiction.

[Gender differences in cluster pattern of health-risk behaviors among rural middle school students in Tujia-Miao Autonomous Prefecture of Xiangxi].

OBJECTIVE: To investigate the gender differences in cluster pattern of health risk behaviors among rural middle school students in Tujia-Miao Autonomous Prefecture of Xiangxi. METHODS: By the method of layered, random and total sampling, questionnaire survey about dietary bias, smoking, alcohol drinking, suicidal ideation, internet addiction and non-secure swimming was taken to 1974 students of eight middle schools from rural areas in four counties of Tujia-Miao Autonomous Prefecture of Xiangxi, Hunan Province in 2014. In 11 kinds of health risk behaviors as the clustering index, first by using the hierarchical clusteringmethod for male and female students were clusteranalysis, determine the optimal cluster number of male and female students were 4 class, then the two step cluster analysis, get the male and female students in 4 types of dangerous behavior clustering patterns of group characteristics. RESULTS: Among the survey of 896 boys and 1078 girls, the boys in the low risk group were composed of 262 people, the ratio was 29. 2%, the girls were composed of 215 people, the ratio was 19. 9%; the boys in the lower risk group were composed of 268 people, the ratio was 29. 9%, the girls were composed of 365 people, the ratio was 33. 9%; the boys with highest incidence of drinking in the moderate risk group were composed of 217 people, the ratio was 24. 2%, the girls with highest incidence of lonely were composed of 264 people, the ratio was24. 5%; the boys in the highest risk group were composed of 149 people, the ratio was16. 6%, the girls were composed of 234 people, the ratio was 21. 7%. In the moderate risk group, boys with highest incidence of drinking( 97. 7%) were always accompanied with behaviors like smoking( 67. 3%), fighting( 63. 6%), non-secure swimming( 66. 4%); girls with highest incidence of lonely( 45. 1%) in the moderate risk group also had behaviors like partial eclipse( 65. 2%), pedestrian violation( 50. 4%) and the like. The total boys and 92. 7% of girls have more than 4 kinds of health-risk behaviors in highest risk group. CONCLUSION: There were gender differences in risk behaviors among middle school students in rural areas of Xiangxi Autonomous Perfecture. Among them, the boys in moderate risk group were marked by drinking, the girls were marked by lonely. The highest risk group had a high rate of risky behaviors, showing a high degree of aggregation of "explicit problem behaviors and implicit behaviors".

The Social and Psychological Impacts of Gambling in the Cree Communities of Northern Québec.

A detailed survey of gambling, addiction and mental health was conducted with randomly selected respondents (n = 506) from four Cree communities of Northern Quebec. The study examined the current patterns of gambling in relation to demographic, social, and psychological factors. Instruments included the Canadian Problem Gambling Index, Addiction Severity Index, Beck Depression Inventory and the computerized Diagnostic Interview Schedule for psychiatric diagnoses. Overall, 69.2 % of the total sample participated in any gambling/gaming activities over the past year; 20.6 % of this group were classified as moderate/high risk gamblers, and 3.2 % were classified in the highest "problem gambling" category. Considering the entire sample, the overall prevalence of problem gambling was 2.2 %. Women were significantly more likely to play bingo (56.6 %) compared to men (35.1 %) and they played more frequently; 20.8 % of women versus 3.8 % of men played once/week or more often. Compared to the no/low risk gamblers, a greater proportion of moderate/high risk gamblers were cigarette smokers (44.8 vs. 56.3 %), they were more likely to meet DSM-IV diagnostic criteria for alcohol dependence (21.2 vs. 46.2 %), and they were more likely to report moderate to severe depressive symptoms in the past month. Risk factors for problem gambling included traumatic life events (physical and emotional abuse), anxiety and depression, as well as drug/alcohol abuse. The high rates of comorbidity between problem gambling, tobacco dependence, substance abuse and other psychological problems demonstrate that gambling among some Cree adults is part of a pattern of high-risk factors for negative long-term health consequences. The results also have implications for treatment, suggesting that interventions for gambling disorders should not focus on gambling alone but rather the constellation of high-risk behaviours that pose a risk to recovery and well-being.

Body Image, Food Addiction, Depression, and Body Mass Index in University Students.

The relationship between body image, depression, food addiction and body mass index (BMI) and differences in these variables due to gender and field of education have not been studied extensively. This study was conducted on a total of 793 university students (20.19 ± 1.90 years). The Beck Depression Inventory, Yale Food Addiction, and Body Image Scale were used. It was determined that body image scores of females and individuals enrolled in health sciences programs were lower compared to those of males and those enrolled in the social sciences. There was a negative relationship between body image and depression and food addiction scores. There was a positive relationship between food addiction and depression scores, in addition to a positive relationship between food addiction and BMI.

Transgression as addiction: religiosity and moral disapproval as predictors of perceived addiction to pornography.

Perceived addiction to Internet pornography is increasingly a focus of empirical attention. The present study examined the role that religious belief and moral disapproval of pornography use play in the experience of perceived addiction to Internet pornography. Results from two studies in undergraduate samples (Study 1, N = 331; Study 2, N = 97) indicated that there was a robust positive relationship between religiosity and perceived addiction to pornography and that this relationship was mediated by moral disapproval of pornography use. These results persisted even when actual use of pornography was controlled. Furthermore, although religiosity was negatively predictive of acknowledging any pornography use, among pornography users, religiosity was unrelated to actual levels of use. A structural equation model from a web-based sample of adults (Study 3, N = 208) revealed similar results. Specifically, religiosity was robustly predictive of perceived addiction, even when relevant covariates (e.g., trait self-control, socially desirable responding, neuroticism, use of pornography) were held constant. In sum, the present study indicated that religiosity and moral disapproval of pornography use were robust predictors of perceived addiction to Internet pornography while being unrelated to actual levels of use among pornography consumers.

Personal gambling expectancies among Asian American and White American college students.

Many college students are involved in gambling behavior as a recreational activity. Their involvement could potentially develop into problem gambling, an issue of increasing concern to student health. At the same time, evidence suggests that Asian Americans are overrepresented amongst problem gamblers in this age period. Research on factors related to initiation and development of problem gambling in college students is necessary to inform the development of effective and culturally-sensitive prevention efforts against gambling. The relationships between personal gambling expectancies at two levels of specificity (two general and six specific types of expectancies) and college student gambling at two levels of behavior (initiation and problems) were examined in a sample of 813 Asian American and White American college students. The study aimed to address (a) whether expectancies explained ethnic differences in gambling, (b) ethnic similarities and differences in the pattern of relationships between expectancies and gambling, and (c) whether expectancies that emerged in both ethnic groups have a greater risk or protective effect for one group than another. Results showed that Asian American students reported more problem gambling than White American students, but expectancies did not account for this group difference. Risk and protective factors for initiation were relatively similar between groups, but different patterns of risk emerged for each group for problem gambling. Implications for college primary prevention and harm reduction programs are discussed.

[Health and Prevention Behaviour of Persons with and without Migration Background]. / Gesundheits- und Präventionsverhalten von Personen mit und ohne Migrationshintergrund.

Based on a sample of the Hannover registration office this project analyses the health and prevention behaviour of Russian- and Turkish-language migrants compared to natives. The project analysis revealed considerable differences, particularly concerning addiction behaviour and physical activities.

Substance Use among a National Sample of Asian/Pacific Islander Men Who Have Sex with Men in the U.S.

The objectives of this study were to describe drug use among Asian/Pacific Islander (API) men who have sex with men (MSM) and to examine how nativity (and acculturation as a secondary correlate) predicted such use. A total of 445 self-identified API MSM from seven metropolitan cities participated in a national HIV serological testing and psychosocial and behavioral assessment study. Results indicate clubbing was significantly associated with higher levels of substance use. Additionally, participants who were U.S.-born were more likely to have reported marijuana use and those with higher levels of acculturation reported less marijuana use. Our bivariate findings suggest that foreign-born status and acculturation experience may provide a protective effect against marijuana use among API MSM. These associations largely did not hold in our multivariate models. Future research should more fully examine the role of acculturation and nativity in substance use behaviors.

[Analysis on influence factors of health risk behaviors of Tujia and Miao adolescents in Xiangxi Area].

OBJECTIVE: To understand the health risk behaviors status and influence factors of Tujia and Miao adolescents in Xiangxi Area. METHODS: By the method of layered, random and total sampling, questionnaire survey about dietary bias, current smoking, current drinking, suicidal ideation, internet addiction and lack of physical exercise was taken to 2094 Tujia and Miao adolescents. Logistic regression analysis was used to analyze the risk factors of health risk behaviors. Results The report rates of dietary bias, current smoking, current drinking, suicidal ideation, internet addiction and lack of physical exercise were 27. 84%, 18. 29%, 28. 03%, 21. 68%, 5. 25% and 52. 82%, respectively. Logistic regression analysis result showed that the risk factor of dietary bias was depression(OR = 1. 352, P =0. 026), the protective factor were schoolboy (OR =0.765, P=0.008) and in residence(OR =0.743, P =0.004). The risk factor of current smoking were schoolboy (OR =6. 782, P =0. 000), insomnia(seldom or sometimes OR = 1. 516, P = 0. 013, often or always OR = 2. 738, P = 0. 000), internet addiction (OR =2.389, P =0. 000), fight(OR = 2. 481, P = 0. 000) and current drinking(OR = 4. 060, P = 0. 000), the protective factor was school record (average OR = 0. 699, P = 0. 026, above average or good OR = 0. 437, P = 0. 000). The risk factor of current drinking were schoolboy (OR = 1. 829, P = 0. 000), insomnia (seldom or sometimes OR = 1. 550, P = 0. 002, often or always OR = 1. 754, P = 0. 004), internet addiction (OR = 1. 901, P =0. 004), fight (OR = l.785, P = 0. 000)and current smoking (OR = 4. 016, P = 0. 000). The risk factor of suicidal ideation were lonely(seldom or sometimes OR = 1. 823, P =0. 010, often or always OR = 4. 445, P =0. 000), depression (OR = 3. 226, P = 0. 000) and only child (OR = 1. 612, P = 0. 003), the protective factor was schoolboy (OR =0. 648, P = 0. 000). The risk factor of internet addiction were schoolboy (OR = 2. 480, P = 0. 000) depression (OR = 2. 650, P = 0. 000) and mainly to play games(OR = 4. 631, P = 0. 000). The risk factor of lack of physical exercise were high school student (OR = 1. 536, P =0. 000) and depression(OR = 1. 410, P = 0. 003), the protective factor were schoolboy (OR ='0. 581, P = 0. 000) and school record (average OR = 0. 798, P = 0. 036, above average or good OR = 0. 609, P = 0. 000. CONCLUSION: Tujia and Miao boys were more prone to smoking and drinking behavior, while girls were likely to happen dietary bias, suicidal ideation and lack of physical exercise behavior. Miao students were high-risk population of smoking and drinking behavior. Insomnia and depression became risk factors of multiple health risk behaviors.

Psychometric properties of the Hebrew version of the Dutch Work Addiction Scale (DUWAS-10).

The present study examined the psychometric properties of the Hebrew version of the Dutch Work Addiction Scale (DUWAS-10), developed by Schaufeli, Shimazu, and Taris (2009). Three hundred fifty-one employees completed a questionnaire measuring workaholism; of these, 251 employees completed questionnaires measuring work engagement, job satisfaction, overcommitment, and burnout. The results confirmed the expected two-factor structure of workaholism: working excessively and working compulsively. Strong correlations were obtained between self-reports and peer-reports, and satisfactory correlations were obtained between the first and second administrations of the DUWAS-10. Furthermore, DUWAS-10 scores showed predictable relations with actual number of hours worked per week, work engagement, job satisfaction, overcommitment, and burnout. Interestingly, despite working fewer hours per week, women reported higher levels of workaholism in comparison to men, and managers reported higher levels of workaholism in comparison to nonmanagerial employees.

Racial discrimination, post traumatic stress, and gambling problems among urban Aboriginal adults in Canada.

Little is known about risk factors for problem gambling (PG) within the rapidly growing urban Aboriginal population in North America. Racial discrimination may be an important risk factor for PG given documented associations between racism and other forms of addictive behaviour. This study examined associations between racial discrimination and problem gambling among urban Aboriginal adults, and the extent to which this link was mediated by post traumatic stress. Data were collected via in-person surveys with a community-based sample of Aboriginal adults living in a mid-sized city in western Canada (N = 381) in 2010. Results indicate more than 80 % of respondents experienced discrimination due to Aboriginal race in the past year, with the majority reporting high levels of racism in that time period. Past year racial discrimination was a risk factor for 12-month problem gambling, gambling to escape, and post traumatic stress disorder (PTSD) symptoms in bootstrapped regression models adjusted for confounders and other forms of social trauma. Elevated PTSD symptoms among those experiencing high levels of racism partially explained the association between racism and the use of gambling to escape in statistical models. These findings are the first to suggest racial discrimination may be an important social determinant of problem gambling for Aboriginal peoples. Gambling may be a coping response that some Aboriginal adults use to escape the negative emotions associated with racist experiences. Results support the development of policies to reduce racism directed at Aboriginal peoples in urban areas, and enhanced services to help Aboriginal peoples cope with racist events.

Gambling behavior and problem gambling reflecting social transition and traumatic childhood events among Greenland Inuit: a cross-sectional study in a large indigenous population undergoing rapid change.

An increase in social pathologies is a key feature in indigenous populations undergoing transition. The Greenland Inuit are a large indigenous population constituting a majority in their own country, which makes it possible to investigate differences within the population. This led us to study gambling behavior and problem gambling among Greenland Inuit in relation to the ongoing social transition and traumatic events during childhood. A large representative cross-sectional study was conducted among Greenland Inuit (n = 2,189). Data was collected among adults (18+) in 9 towns and 13 villages in Greenland from 2005 to 2010. Problem gambling, gambling behavior and traumatic childhood events were measured through a self-administered questionnaire. The lie/bet screen was used to identify past year and lifetime problem gambling. Social transition was measured as place of residence and a combination of residence, education and occupation. The lifetime prevalence of problem gambling was 16 % among men and 10 % among women (p < 0.0001); and higher in towns (19 %) compared to the capital of Nuuk (11 %) and in villages (12 %) (men only, p = 0.020). Lifetime problem gambling was associated with social transition (p = 0.023), alcohol problems in childhood home (p = 0.001/p = 0.002) and sexual abuse in childhood (women only, p = 0.030). A comparably high prevalence of lifetime problem gambling among Greenland Inuit adds problem gambling to the list of social pathologies in Greenland. A significant association between lifetime problem gambling, social transition and traumatic childhood events suggests people caught between tradition and modern ways of life are more vulnerable to gambling problems.