Is there a health inequality in gambling related harms? A systematic review.

BACKGROUND: Here we present a systematic review of the existing research into gambling harms, in order to determine whether there are differences in the presentation of these across demographic groups such as age, gender, culture, and socioeconomic status, or gambling behaviour categories such as risk severity and participation frequency. PRIMARY AND SECONDARY OUTCOME MEASURES: Inclusion criteria were: 1) focus on gambling harms; 2) focus on harms to the gambler rather than affected others; 3) discussion of specific listed harms and not just harms in general terms. Exclusion criteria were: 1) research of non-human subjects; 2) not written in English; 3) not an empirical study; 4) not available as a full article. METHODS: We conducted a systematic search using the Web of Science and Scopus databases in August 2020. Assessment of quality took place using Standard Quality Assessment Criteria. RESULTS: A total of 59 studies published between 1994 and 2020 met the inclusion criteria. These were categorised into thematic groups for comparison and discussion. There were replicated differences found in groups defined by age, socioeconomic status, education level, ethnicity and culture, risk severity, and gambling behaviours. CONCLUSION: Harms appear to be dependent on specific social, demographic and environmental conditions that suggests there is a health inequality in gambling related harms. Further investigation is required to develop standardised measurement tools and to understand confounding variables and co-morbidities. With a robust understanding of harms distribution in the population, Primary Care Workers will be better equipped to identify those who are at risk, or who are showing signs of Gambling Disorder, and to target prevention and intervention programmes appropriately.

A mixed methods investigation of end-of-life surrogate decisions among older adults.

BACKGROUND: A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions. METHODS: We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis. RESULTS: 24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors. CONCLUSIONS: Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision.

Gambling on Smartphones: A Study of a Potentially Addictive Behaviour in a Naturalistic Setting.

Smartphone users engage extensively with their devices, on an intermittent basis for short periods of time. These patterns of behaviour have the potential to make mobile gambling especially perseverative. This paper reports the first empirical study of mobile gambling in which a simulated gambling app was used to measure gambling behaviour in phases of acquisition and extinction. We found that participants showed considerable perseverance in the face of continued losses that were linearly related to their prior engagement with the app. Latencies between gambles were associated with the magnitude of reinforcement; more positive outcomes were associated with longer breaks between play and a greater propensity to end a gambling session. Greater latencies were associated with measurements of problem gambling, and perseverance with gambling-related cognitions and sensation-seeking behaviour.

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity.

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most 'difficult' items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.

Value representations by rank order in a distributed network of varying context dependency.

We report the results of a human fMRI experiment investigating the influence of context upon value judgement. Trials were separated into high and low value blocks such that it is possible to investigate the effect of a change in surrounding trials upon the encoding of financial value. The ventral striatum was dependent upon "local context", with its activity representing the current stimulus' relative value compared only to items in the current block. Conversely the ventral medial Pre-Frontal Cortex and Anterior Cingulate Cortex respond independently of block but also do not represent the absolute values of stimuli. Our use of stimuli values with a non-linear distribution allow us to identify the pattern as representing rank order. This has wide reaching implications for research on neuroeconomics, decision making and reward representation, showing that financial value is not explicitly represented within the brain.

BIS impulsivity and acute nicotine exposure are associated with discounting global consequences in the Harvard game.

OBJECTIVE: The Barratt Impulsivity Scale (BIS) provides a transdiagnostic marker for a number of psychiatric conditions and drug abuse, but the precise psychological trait(s) tapped by this questionnaire remain obscure. METHOD: To address this, 51 smokers completed in counterbalanced order the BIS, a delay discounting task and a Harvard game that measured choice between a response that yielded a high immediate monetary payoff but decreased opportunity to earn money overall (local choice) versus a response that yielded a lower immediate payoff but afforded a greater opportunity to earn overall (global choice). RESULTS: Individual level of BIS impulsivity and self-elected smoking prior to the study were independently associated with increased preference for the local over the global choice in the Harvard game, but not delay discounting. CONCLUSIONS: BIS impulsivity and acute nicotine exposure reflect a bias in the governance of choice by immediate reward contingencies over global consequences, consistent with contemporary dual-process instrumental learning theories.

Thinking about neither death nor poverty affects delay discounting, but episodic foresight does: Three replications of the effects of priming on time preferences.

We outline three attempts to replicate experiments that reported priming effects on time preferences measured by delay discounting. Experiment 1 tested the claim that images of poverty prime impulsive choice in people from less affluent backgrounds compared with people from more affluent backgrounds. Experiment 2 tested the claim that mortality salience-thinking about death-primes people to place more value on the future than people who thought about dental surgery. Experiment 3 tested the claim that an episodic foresight manipulation primes greater discounting than no episodic foresight. Experiments 1 and 2 failed to replicate the effects of priming on discount rates. Experiment 3 was a successful and very close replication of the effect of episodic foresight on discount rates.

Episodic and prototype models of category learning.

The question of what processes are involved in the acquisition and representation of categories remains unresolved despite several decades of research. Studies using the well-known prototype distortion task (Posner and Keele in J Exp Psychol 77:353-363, 1968) delineate three candidate models. According to exemplar-based models, we memorize each instance of a category and when asked to decide whether novel items are category members or not, the decision is explicitly based on a similarity comparison with each stored instance. By contrast, prototype models assume that categorization is based on the similarity of the target item to an implicit abstraction of the central tendency or average of previously encountered instances. A third model suggests that the categorization of prototype distortions does not depend on pre-exposure to study exemplars at all and instead reflects properties of the stimuli that are easily learned during the test. The four experiments reported here found evidence that categorization in this task is predicated on the first and third of these models, namely transfer at test and the exemplar-based model. But we found no evidence for the second candidate model that assumed that categorization is based on implicit prototype abstraction.

Economic and social deprivation predicts impulsive choice in children.

Impulsivity is an individual difference in decision-making that is a risk factor for a number of health concerns including addiction and obesity. Although impulsivity has a large heritable component, the health concerns associated with impulsivity are not uniformly distributed across society. For example, people from poorer backgrounds are more likely to be overweight, and be dependent on tobacco or alcohol. This suggests that the environmental component of impulsivity might be related to economic circumstances and the availability of resources. This paper provides evidence that children aged 4 to 12 from the most deprived areas in England show greater impulsivity in the form of delay discounting than do children from the least deprived areas. The data are discussed with reference to scarcity-based models of decision-making and to public health inequalities.

Individual differences in decision-making: evidence for the scarcity hypothesis from the English Longitudinal Study of Ageing.

We report the results of a pre-registered analysis of data from the English Longitudinal Study of Ageing that was designed to test the hypothesis that economic scarcity is associated with individual differences in decision-making. We tested this hypothesis by comparing time preferences for different socio-economic groups and in geographical areas ranging from the most deprived to the least deprived in England using the English indices of multiple deprivation. The data supported this hypothesis: people in the most deprived areas were more likely to prefer smaller-sooner rewards than people from the least deprived areas. Similarly, people in technical or routine occupations tended to prefer smaller-sooner rewards than people in professional or intermediate occupations. In addition, we found that gender, cognitive function and subjective social status also predicted time preferences. We discuss these results in the context of theoretical models of scarcity-based models of choice behaviour and decision-making.

Do We Become More Cautious for Others When Large Amounts of Money Are at Stake?

A considerable proportion of financial decisions are made by agents acting on behalf of other people. Although people are more cautious for others when making medical decisions, this does not seem to be the case for economic decisions. However, studies with large amounts of money are particularly absent from the literature, which precludes a clear comparison to studies in the medical domain. To address this gap, we investigated the effect of outcome magnitude in two experiments where participants made choices between safe and risky options. Decision-makers were not more cautious for others over large amounts. In fact, risk-taking was accentuated for large amounts in the gain domain. We did not find self-other differences in the loss domain for either outcome magnitude. This suggests that the caution observed in medical decisions does not replicate in financial decisions with large amounts, or at least not in the same way. These results echo the concerns that have been raised about excessive risk-taking by financial agents.

Do changes in the subjective experience of recognition over time suggest independent processes?

Two experiments examined the nature of recognition memory by asking how subjective reports of remembering change over time. In Experiment 1, participants were asked to report their experience of remembering using the well-known remember-know-guess procedure. Estimates of recollection declined over a 14-day period, but estimates of familiarity remained constant, suggesting that the processes are independent. In Experiment 2, participants were asked to report their confidence in their recognition decisions. Subjective reports of confidence were analysed via receiver operating characteristics and also indicated different rates of decline for recollection and familiarity. Superficially, the data appear to support a dual-process account of recognition, but close inspection shows the data to be consistent with a simple signal detection model. The conclusion is that although the phenomenal experience of remembering changes over time this is most likely to be predicated on a single process.

Probability Matching on a Simple Simulated Foraging Task: The Effects of Reward Persistence and Accumulation on Choice Behavior.

Over a series of decisions between two or more probabilistically rewarded options, humans have a tendency to diversify their choices, even when this will lead to diminished overall reward. In the extreme case of probability matching, this tendency is expressed through allocation of choices in proportion to their likelihood of reward. Research suggests that this behaviour is an instinctive response, driven by heuristics, and that it may be overruled through the application of sufficient deliberation and self-control. However, if this is the case, then how and why did this response become established? The present study explores the hypothesis that diversification of choices, and potentially probability matching, represents an overextension of a historically normative foraging strategy. This is done through examining choice behaviour on a simple simulated foraging task, designed to model the natural process of accumulation of unharvested resources over time. Behaviour was then directly compared with that observed on a standard fixed probability task (cf. Ellerby & Tunney, 2017). Results indicated a convergence of choice patterns on the simulated foraging task, between participants who acted intuitively and those who took a more strategic approach. These findings are also compared with those of another similarly motivated study (Schulze, van Ravenzwaaij, & Newell, 2017).

On the Likelihood of Surrogates Conforming to the Substituted Judgment Standard When Making End-of-Life Decisions for Their Partner.

A considerable proportion of end-of-life decisions are made by the patient's next-of-kin, who can be asked to follow the substituted judgment standard and decide based on the patient's wishes. The question of whether these surrogate decision makers are actually able to do so has become an important issue. In this study, we examined how the likelihood of surrogates conforming to the substituted judgment standard varies with individual differences in mortality acceptance and confidence in their decision making. We recruited 153 participants in romantic relationships between 18 and 80 years old from the general population. We asked them to make hypothetical end-of-life decisions for themselves and on behalf of their partner, as well as predict what their partner would do, and complete a series of questionnaires. Participants predicted that their partner would make similar decisions to their own but were more likely to accept a life-saving treatment that could result in reduced quality of life on their partner's behalf than for themselves. Decisions made by older adults were more likely to conform to the substituted judgment standard, which is encouraging given that they are more likely to be confronted with these decisions in real life, although this was not due to differences in mortality acceptance. Older adults were also more likely to have had previous discussions with their partner and thereby know that person's wishes and feel confident that they made the right decision, but these factors did not affect their likelihood of conforming to the substituted judgment standard. This shows that encouraging discussions about end of life among families would ease the decision process, but more work is needed to ensure that surrogates can adhere to the substituted judgment standard.

Do our risk preferences change when we make decisions for others? A meta-analysis of self-other differences in decisions involving risk.

BACKGROUND: Are we more risk-averse or risk-seeking when we make decisions on behalf of other people as opposed to ourselves? So far, findings have not been able to provide a clear and consistent answer. METHOD: We propose a meta-analysis to assess whether self-other differences vary according to particular features of the decision. We reviewed 78 effect sizes from 49 studies (7,576 participants). RESULTS: There was no overall self-other difference, but there were moderating effects of domain and frame. Decisions in the interpersonal domain were more risk-averse for self than for other. Decisions in the medical domain were more risk-seeking for self than for other. There were no overall self-other differences in the financial domain, however there was a moderating effect of frame: decisions in a gain frame were more risk-averse for self than other whereas decisions in a loss frame were more risk-seeking for self than other. This effect of frame was slightly different overall and in the medical domain, where self-other differences occurred in a loss frame but not in a gain frame. CONCLUSION: Future work should continue to investigate how the specific content and context of the decision impacts self-other differences in order to understand the effects of domain and frame we report.

Exploring How Accountability Affects the Medical Decisions We Make for Other People.

In the event that a patient has lost their decision-making capacity due to illness or injury, a surrogate is often appointed to do so on their behalf. Research has shown that people take less risk when making treatment decisions for other people than they do for themselves. This has been discussed as surrogates employing greater caution for others given the accountability they are faced with. We tested the prediction that making accountability salient reduces risk-taking for others relative to the self by manipulating the information shown to participants while they made treatment choices. One group was asked to focus on the consequences for the recipient's family, another on the legal implications of their decisions, and another was not given additional information. Participants reduced their risk-taking for others compared to themselves, irrespective of the condition they were in. Although participants in each condition reported thinking about these factors to different extents, there were no clear differences in risk-taking between groups. However, we did find that, across all participants, thinking about legal consequences reduces risk-taking. We suggest that future research investigates how the effect of thinking about accountability on surrogate choices is mediated by feelings of accountability, in order to further examine the explanations suggested in the literature.

Repetition priming affects guessing not familiarity.

BACKGROUND: The claim that recollection and familiarity based memory processes have distinct retrieval mechanisms is based partly on the observation that masked repetition and semantic priming influence estimates of familiarity derived from know responses but have no effect on estimates of recollection derived from remember responses. Close inspection of the experiments on which this claim is based reveal the effect size to be small, potentially the result of a type-2 error, and/or inflated due to participants not having the opportunity to report guesses. This paper re-evaluates these claims by attempting a partial replication of two such Experiments. METHODS: In Experiment 1 participants made remember, know, and guess responses following primed and unprimed target words. In Experiment 2 participants made sure, unsure, and guess following primed and unprimed target words. RESULTS: In Experiment 1 the repetition priming effect occurred only for guess responses and only for unstudied items. In Experiment 2 the priming effect occurred for both unsure and guess responses, but again only for unstudied items. CONCLUSION: The data are consistent with the view that remembering and knowing do not correspond to confidence ratings; and suggest that contrary to earlier findings, recollection and familiarity do not differ in retrieval mechanisms. As such the effects of repetition priming on subjective reports of remembering should not be cited as evidence for the distinction between recollection and familiarity based memory processes.

Effects of retention intervals on receiver operating characteristics in artificial grammar learning.

Current theories of memory suggest that recognition is composed of separate processes of familiarity and recollection (e.g. [Yonelinas, A. P. (2002). The nature of recollection and familiarity: a review of 30 years of research. Journal of Memory and Language, 46, 441-517]). A key feature of these two processes is that they decay, or are forgotten at different rates. The dual-process model has also been useful in understanding artificial grammar learning. We obtained evidence for recollection and familiarity in artificial grammar learning by analyses of receiver operating characteristics (ROC). Furthermore we found that these were dissociated by retention intervals of 14 days. The slope of the zROC curves deviated reliably from 1 immediately after study and increased towards 1 suggesting that recollection contributed to recognition decisions but declined over the 14-day period leaving familiarity as the only basis for recognition. These data show similar patterns to those observed in word-recognition [Gardiner, J. M., & Java, R. I. (1991). Forgetting in recognition memory with and without recollective experience. Memory &Cognition, 19, 617-623; Tunney, R. J. (submitted for publication). Changes in the subjective experience of recognition over time suggest independent processes] and confirm the view that recollection and familiarity are implicated in artificial grammar learning. Moreover, the data confirm the finding that recollection and familiarity-based memory show different patterns of forgetting.

Kinship and altruism: a cross-cultural experimental study.

Humans are characterized by an unusual level of prosociality. Despite this, considerable indirect evidence suggests that biological kinship plays an important role in altruistic behaviour. All previous reports of the influence of kin selection on human altruism have, however, used correlational (rather than experimental) designs, or imposed only a hypothetical or negligible time cost on participants. Since these research designs fail either to control for confounding variables or to meet the criteria required as a test of Hamilton's rule for kin selection (that the altruist pays a true cost), they fail to establish unequivocally whether kin selection plays a role. We show that individuals from two different cultures behave in accordance with Hamilton's rule by acting more altruistically (imposing a higher physical cost upon themselves) towards more closely related individuals. Three possible sources of confound were ruled out: generational effects, sexual attraction and reciprocity. Performance on the task however did not exhibit a perfect linear relationship with relatedness, which might reflect either the intrusion of other variables (e.g. cultural differences in the way kinship is costed) or that our behavioural measure is insufficiently sensitive to fine-tuned differences in the way individuals view their social world. These findings provide the first unequivocal experimental evidence that kinship plays a role in moderating altruistic behaviour. Kinship thus represents a baseline against which individuals pitch other criteria (including reciprocity, prosociality, obligation and a moral sense) when deciding how to behave towards others.