Skill-Based Electronic Gaming Machines: Features that Mimic Video Gaming, Features that could Contribute to Harm, and Their Potential Attraction to Different Groups.

New gambling products have been developed over time as technology permits. For example, early mechanical slot machines were later replaced by electronic gaming machines (EGMs), which enabled a faster speed of play and more immersive experience. EGMs have in the decades since their invention become one of the main drivers of gambling expenditure worldwide and are one of the gambling products most strongly associated with harm. This literature review considers research relevant to a new subcategory of EGM, 'skill-based' EGMs, termed 'SGMs' here. SGMs can be highly varied in content, with some representing a minimal departure from EGMs, where the typical bonus round is replaced by some skill-based activity, such as a simple video game, which could increase the machine's appeal. Other SGMs feature more radical departures from conventional EGMs, such as multiplayer games using intellectual property from popular TV shows or video games. These skill-based elements could tap into common gambling fallacies such as the illusion of control, and therefore facilitate harmful engagement. SGMs could also be less harmful than current EGMs, if skill-based elements break the dissociative states associated with EGM gambling. The intellectual property used in SGMs may increase their appeal among people who generally do not gamble, and the skill-based elements could increase their interest among gamblers who predominately prefer skill-based gambling formats such as sports betting. The novelty and varied content of SGMs present many open questions, which research should aim to address in future.

The COVID-19 lockdown experience suggests that restricting the supply of gambling can reduce gambling problems: An Australian prospective study.

Background and aims: COVID-19 lockdowns limited access to gambling but simultaneously elevated psychosocial stressors. This study assessed the relative effects of these changes on gambling risk status during and after the Australian COVID-19 lockdown from late-March to late-May 2020. Methods: The study administered three surveys to people who had gambled within the past year at T1. Wave 1 asked about before (T1, N = 2,125) and during lockdown (T2, N = 2,125). Subsequent surveys focused on one year (T3; N = 649) and two years after lockdown (T4, N = 458). The dependent variable was changes in reporting any problem gambling symptoms (PGSI 0 vs 1+). Bivariate analyses and multinomial logistic regression tested for significant associations with: demographics, psychosocial stressors (perceived stress, psychological distress, loneliness, health anxiety about COVID, financial hardship, stressful life events), gambling participation and gambling frequency. Results: Gambling participation and at-risk gambling decreased between T1 and T2, increased at T3, with little further change at T4. When gambling availability was curtailed, decreased gambling frequency on EGMs, casino games, sports betting or race betting, and lower psychosocial stress, were associated with transitions from at-risk to non-problem gambling. When gambling availability resumed, increased EGM gambling frequency, decreased online gambling frequency, and higher psychosocial stress were associated with transitions from non-problem to at-risk gambling. Discussion and conclusions: Gambling availability appears a stronger influence on gambling problems, at the population level, than psychosocial risk factors. Reducing the supply of high-risk gambling products, particularly EGMs, is likely to reduce gambling harm.

Feature preferences of sports betting platforms: A discrete choice experiment shows why young bettors prefer smartphones.

Background and aims: Smartphone, computer and land-based betting platforms each have distinctive features. This study examined 1) preferred features of sports betting platforms amongst young adults and 2) whether feature preferences vary with gambling severity. Methods: The study surveyed 616 Australians aged 18-29 years who bet at-least monthly on sports, esports and/or daily fantasy sports. Participants provided a simple rating of the importance of 24 features of betting platforms and then completed a discrete choice experiment to indicate their preferences amongst different groups of features. Results: Smartphones were the only platform providing all preferred features. The most important feature was ability to bet instantly 24/7 from any location, followed by electronic financial transactions. Less important features were ability to access betting information online and to bet with multiple operators. Social and privacy features, and access to promotions, did not significantly predict platform choice. The experiment found no significant differences in preferred features by gambling severity group or by gender. The non-experimental descriptive data, however, indicated that participants in the moderate risk/problem gambling categories placed significantly more importance on privacy, ability to place in-play bets, bet with cash, bet with a credit card, see frequent promotions, and bet with multiple operators. Discussion and conclusions: Most features that bettors prefer can intensify betting. Curtailment of betting promotions, in-play betting, and credit card betting are measures that can assist higher-risk gamblers without unduly affecting other gamblers. Consumer protection tools, including mandatory pre-commitment, need strengthening to help counter the unique risks of smartphone betting.

The effects of binge drinking on attention in young adults.

Introduction: Alcohol binge drinking is highly prevalent among young adults. While research has established the neurotoxic effects of general alcohol consumption, binge drinking presents unique deleterious effects on the brain through the acute intoxication and withdrawal cycle. The detrimental impacts of binge drinking have been reported across a broad range of cognitive abilities in young adults, however, the research regarding its relationship to attention is mixed. This study investigates the relationship between binge drinking and attention performance in young adults. Moreover, there is evidence to suggest that males and females are uniquely impacted by the neurotoxic effects of binge drinking, so the present study tests the moderating role of sex, as well as the influence of earlier age of binge drinking onset. Methods: One-hundred and five university students were recruited for the study. After collecting socio-demographic, and alcohol use information, participants completed four cognitive tasks designed to measure the three attention networks according to the Attention Network Theory; alerting, orienting, and executive control. Linear hierarchical regressions were used to predict performance with binge drinking score, sex and age of first binge drinking session as predictors. Results: Binge drinking, sex, and age of first binge drinking session did not predict attention impairment, nor did sex moderate the relationship, at least in the selected cognitive tasks. The tasks used to measure attention did not relate in the expected manner. Discussion: While there were no differences in attention performance between those who binge drink and controls in this study, the relationship between binge drinking and attention impairments in young adults may be more nuanced and future research directions are suggested. Theoretical and practical implications of these findings are discussed.

Social Media, Public Health Research, and Vulnerability: Considerations to Advance Ethical Guidelines and Strengthen Future Research.

The purpose of this article is to build upon prior work in social media research and ethics by highlighting an important and as yet underdeveloped research consideration: how should we consider vulnerability when conducting public health research in the social media environment? The use of social media in public health, both platforms and their data, has advanced the field dramatically over the past 2 decades. Applied public health research in the social media space has led to more robust surveillance tools and analytic strategies, more targeted recruitment activities, and more tailored health education. Ethical guidelines when using social media for public health research must also expand alongside these increasing capabilities and uses. Privacy, consent, and confidentiality have been hallmarks for ethical frameworks both in public health and social media research. To date, public health ethics scholarship has focused largely on practical guidelines and considerations for writing and reviewing social media research protocols. Such ethical guidelines have included collecting public data, reporting anonymized or aggregate results, and obtaining informed consent virtually. Our pursuit of the question related to vulnerability and public health research in the social media environment extends this foundational work in ethical guidelines and seeks to advance research in this field and to provide a solid ethical footing on which future research can thrive.

Order of first-play in simulated versus monetary gambling.

Background and aims: Simulated gambling products, like loot boxes and social casino games, contain gambling elements, but are not classified as gambling. They are available to minors, raising concerns about a "gateway effect" into gambling. This study examined the time course of young people's engagement in simulated and monetary gambling, and associations between simulated gambling and gambling problems and harm. A necessary, although not sufficient, condition for simulated games leading to real money gambling is that simulated play must come first. Method: Participants were 1,026 young adults (aged 18-25 years) who played video games in the last year. They reported the age at which they first took part in seven simulated and twelve monetary gambling products, and current gambling problems and harm. Results: First use of loot boxes and video games with gambling content tended to precede monetary gambling. Forms where gambling is a core gameplay element, such as social casino and demonstration games, tended to follow some monetary gambling forms. Engagement in most simulated gambling products was associated with greater harm from monetary gambling. Discussion: The findings leave open the possibility of a catalyst pathway from youth engagement in loot boxes and games with gambling content to later monetary gambling, but causal psychosocial mechanisms remain unclear. However, a pathway from social casino and demonstration games to monetary gambling appears less likely, which may instead reflect containment or substitution effects. Simulated gambling disproportionately attracts youth who are vulnerable to gambling problems and harm, indicating the need for consumer protection measures.

Situational features of smartphone betting are linked to sports betting harm: An ecological momentary assessment study.

Background and aims: Smartphones extend the situational characteristics of sports betting beyond those available with land-based and computer platforms. This study examined 1) the role of situational features and betting platforms in harmful betting behaviours and short-term betting harm, and 2) whether people with more gambling problems have preferred situational features, engage more in harmful betting behaviours, and experience more severe short-term betting harm. Methods: An ecological momentary assessment analysed 1,378 betting sessions on sports, esports or daily fantasy sports, reported by 267 respondents (18-29 years; 50.9% male) over 10 weeks. Results: Factor analysis revealed five situational features of betting sessions: 1) quick, easy access from home, 2) ability to bet anywhere anytime, 3) privacy while betting, 4) greater access to promotions and betting options, and 5) ability to use electronic financial transactions. Regression models underpinned the analyses. Greater short-term betting harm was significantly associated with the ability to bet anywhere anytime, privacy when betting, and greater access to promotions and betting options. Betting sessions when these features were prioritised were more likely to involve impulsive betting, use of betting inducements, and betting with more operators. Respondents with more gambling problems were more likely to prioritise privacy and the ability to bet anywhere anytime; and to bet on in-game events, use promotional inducements, bet with more operators, and report greater betting harm. Discussion and conclusions: Certain situational features of sports betting are empirically associated with engagement and subsequent harm. Only smartphone betting combines all three features associated with betting harm.

Childhood Use of Coin Pusher and Crane Grab Machines, and Adult Gambling: Robustness to Subjective Confidence in a Young Adult USA Sample.

Gambling as a youth is a risk factor for experiencing gambling-related harm as an adult. Most youth gambling research focuses on illegal engagement with age-restricted products, but youth can also gamble legally, by for example betting with friends, or via coin pusher and crane grab machines. Research has associated recollected rates of usage of these machines as a child with adult gambling participation and problems, but only in the UK and Australia, and has not tested for robustness to subjective confidence. The present study conceptually replicated these prior studies by investigating the association between recollected childhood use of coin push and crane grab machines, and adult gambling behavior, in a young adult USA sample. Participants rated their subjective confidence to test if individual differences in recollection biases provided a better account for any observed associations. Results found high recollected engagement rates for both coin pusher (87.2%) and crane grab machines (97.0%), and 5 of the 6 tested associations between youth machine usage and adult gambling engagement and problems were significant and in the hypothesized direction. Rates of subjective confidence were on average high (83.3 and 89.2 on a 0 to 100 scale), and generally did not interact with participants' recollected rates of machine use. These findings extend prior research on potential public health concerns around children's legal engagement with coin pusher and crane grab machines to a new country, the USA.

Characterizing Twitter chatter about temporary alcohol abstinence during "Dry January".

With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020-2). A random subsample stratified by year (n = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits.

Electronic gaming machine accessibility and gambling problems: A natural policy experiment.

Background: Electronic gaming machines (EGMs) are one of the most harmful forms of gambling at an individual level. It is unclear whether restriction of EGM functions and accessibility results in meaningful reductions in population-level gambling harm. Methods: A natural policy experiment using a large (N = 15,000) national dataset weighted to standard population variables was employed to compare estimates of gambling problems between Australian residents in Western Australia (WA), where EGMs are restricted to one venue and have different structural features, to residents in other Australian jurisdictions where EGMs are widely accessible in casinos, hotels and clubs. Accessibility of other gambling forms is similar across jurisdictions. Results: Gambling participation was higher in WA, but EGM participation was approximately half that of the rest of Australia. Aggregate gambling problems and harm were about one-third lower in WA, and self-reported attribution of harm from EGMs by gamblers and affected others was 2.7× and 4× lower, respectively. Mediation analyses found that less frequent EGM use in WA accounted for the vast majority of the discrepancy in gambling problems (indirect path = -0.055, 95% CI -0.071; -0.038). Moderation analyses found that EGMs are the form most strongly associated with problems, and the strength of this relationship did not differ significantly across jurisdictions. Discussion: Lower harm from gambling in WA is attributable to restricted accessibility of EGMs, rather than different structural features. There appears to be little transfer of problems to other gambling forms. These results suggest that restricting the accessibility of EGMs substantially reduces gambling harm.

Social associations and alcohol consumption in an Australian community sample: An egocentric social network analysis.

OBJECTIVE: This study examined how social associations from a person's social network may be associated with their own alcohol consumption. METHOD: Alcohol consumption behavior was examined among the social networks of 784 survey respondents (54% female, Mage = 35.3 years), using egocentric social network analysis. Participants (egos) were recruited via a panel aggregator and completed an online survey about the frequency of their alcohol consumption and that of the 20 most influential people in their lives (alters). The survey also explored who these alters were (family, friends, work colleagues) and the interrelationships among these alters. RESULTS: Egos who consumed alcohol, or consumed alcohol more frequently, were surrounded by more alters who also drank alcohol and felt closer (had stronger ties) to these alters. These relationships remained statistically significant when controlling for demographic and other variables. The social networks of those who consumed alcohol more frequently were more densely intertwined. CONCLUSIONS: Alcohol may serve to initiate social connections and be a "social glue" that reinforces relationships. These strong social associations present a potential barrier to individuals who wish to reduce their alcohol consumption because they have few close social connections who do not drink alcohol (or who do so infrequently), and their highly interconnected social networks make it difficult to socialize only with those who do not drink frequently. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gambling advertising on Twitter before, during and after the initial Australian COVID-19 lockdown.

Background and aims: COVID-19 resulted in the shutdown of almost all sporting competitions and most venue-based gambling opportunities. This study examines how wagering operators in Australia responded, by examining their advertising. Methods: The study compared Twitter activity during lockdown (March-May 2020) to the previous year for four major wagering operators. Results: Wagering operators continued to advertise in earnest, changing their marketing mix to include more race betting content, as races continued to operate. Most also promoted the only sports available, such as table tennis or esports. When sports resumed, sports betting advertising quickly returned to normal, or exceeded previous levels. Despite more content being available in the case of two operators, engagement from the public during lockdown was similar to or lower than previously. Discussion and conclusion: These results indicate that gambling operators can adjust quickly to major changes. These shifts appear to have been successful, with the increase in race betting during this period almost completely offsetting the decreases in sports betting. This is likely due in part to changes in advertising, which have been associated with increased betting activity, particularly amongst vulnerable people. Responsible gambling messages were virtually non-existent on Twitter, which contrasts with mandatory requirements in other media. The study highlights that regulatory changes to advertising, e.g., banning some content, are likely to be met with substitution of content, rather than reduction, unless advertising volume is also capped. The study also highlights the adaptive capacity of the gambling industry in the face of major disruption to supply.

Designing Improved Safer Gambling Messages for Race and Sports Betting: What can be Learned from Other Gambling Formats and the Broader Public Health Literature?

Safer gambling messages are one potential input to a public health approach toward reducing gambling-related harm, and yet there is no strong evidence supporting current messages such as "gamble responsibly" or "keep the fun in the game". Furthermore, sports betting is increasing in popularity in multiple jurisdictions, such as Australia and the US, increasing the need to design effective messaging campaigns for race and sports betting. Compared to other gambling formats, such as electronic gambling machines, the level of potential skill involved in race and sports betting may raise unique issues regarding the design of effective messages. This review first highlights research from the related public health domains of alcohol and tobacco. Then, five potential areas for further messaging-based research in race and sports betting are discussed: teaching safer gambling practices, correcting gambling misperceptions, boosting conscious decision making, norm-based messages, and emotional messages. A broad approach to message design is encouraged, given the potential for individual differences in message receptivity, and for frequently-repeated messages to be ignored or cause negative psychological reactance.

Sleep hygiene in paramedics: What do they know, and what do they do?

OBJECTIVES: Shift workers routinely obtain inadequate sleep, which has major health and well-being consequences. Sleep hygiene describes a range of behaviors, lifestyle and environmental factors that can support optimal sleep. To date, limited research has examined sleep hygiene in shift workers. This study aimed to 1) assess the knowledge and understanding of sleep hygiene amongst shift working paramedics, as well as the perceived impact on sleep, and 2) investigate paramedics engagement with sleep hygiene practices. STUDY DESIGN: Participants completed an online, cross-sectional survey. PARTICIPANTS: Queensland Ambulance Service paramedics (n = 184) who work shift work. MEASURES: The online survey included questions from the Standard Shiftwork Index and Sleep Hygiene Index. RESULTS: Most participants reported little or no understanding or knowledge of "sleep hygiene" as a concept. Participants reported that sleep scheduling and bedroom environment (temperature, light, and noise) were the most impactful on sleep. Few participants reported nicotine and alcohol consumption, or daytime napping, whereas caffeine consumption and mentally-stimulating bedtime activities were more common. Participants who were young, single, and worked all shift types (day, afternoon, and night) as part of their regular rosters, demonstrated less knowledge regarding sleep hygiene, and were more likely to be exhibiting poor sleep hygiene engagement. CONCLUSIONS: Paramedics demonstrated a limited level of understanding of sleep hygiene as a concept, and varied knowledge about the impacts of individual sleep hygiene factors. Further, paramedics demonstrated varied engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions to optimize sleep in paramedics.

Strategies for measuring peer alcohol use within egocentric network analysis.

OBJECTIVE: Compare different strategies for measuring perceived peer alcohol use within network research. PARTICIPANTS: College students (N = 309). METHODS: Collected demographic, personal alcohol use, and egocentric network data. Hierarchical linear regression analyses predicted egos' drinking behavior (AUDIT-C scores). RESULTS: Egos' perceptions of nominated peers' binge-drinking frequency explained a significant portion of variance in egos' AUDIT-C scores, over and above perceptions of nominated peers' frequency/typical quantity of alcohol consumption and important demographic covariates. Using more than three items to assess perceived peer alcohol use did not offer statistically significant improvements and may add unnecessary response burden. CONCLUSIONS: Utilizing the three-item approach (i.e., frequency, quantity, binge-drinking frequency) to assess perceived peer drinking explained more variance in egos' AUDIT-C scores, as opposed to one- and two-item assessments. Implementing this three-item assessment in egocentric network research can enhance programming efforts targeting reductions in binge drinking among college students within social contexts.

Stealth vaping and associated attitudes, perceptions, and control beliefs among US college students across four tobacco-free campuses.

OBJECTIVES: Stealth vaping gained popularity among college students in recent years. It may undermine the benefits introduced by tobacco-free policies. Yet, no studies have investigated attitude and belief factors associated with stealth vaping. The objective of the study was to explore the relationship between attitudes toward on-campus tobacco regulations, normative perceptions of stealth vaping behaviors, and control beliefs with on-campus stealth vaping among U.S. college students. METHODS: Participants from four large, public universities with policies prohibiting use of all forms of tobacco (including e-cigarettes) on campus (N = 863) completed an online survey in Fall 2020. On-campus stealth vaping behavior was captured by past 30-day stealth vaping status and frequency. Hurdle models with logistic and negative binomial regressions were conducted, where stealth vaping status was treated as a binary variable based on the non-zero and zero frequency, and stealth vaping frequency was treated as a count variable. Multiple imputation by chained equations was employed to handle the missing data. RESULTS: Participants with more positive attitudes toward regulating on-campus tobacco use were less likely to practice stealth vaping on campus (OR = 1.16, p < 0.01 [predicting zero]). Those with higher perceptions of stealth vaping among other students were more likely to stealth vape more frequently (IRR = 1.03, p < 0.01). CONCLUSION: Our results highlight the need for interventions to address students' attitudes and normative beliefs about stealth vaping. Efforts are needed to educate college students about the risk of e-cigarettes and to enhance enforcement of campus tobacco-free policies.

Not all games are created equal: Adolescents who play and spend money on simulated gambling games show greater risk for gaming disorder.

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail.

Alcohol Use Disorder Narratives in U.S. Digital News Coverage and Engagement on Social Media.

Social media regularly serves as a source of news and health-related information subsequently shaping public opinion and behavior. We examined mainstream digital news narratives about alcohol use disorder (AUD), including coverage of solutions to AUD, and associations between narratives and engagement on social media. AUD-related articles (N = 339) published in top U.S. newspapers and digital native news sources in 2019 were analyzed by trained coders with a structured codebook (κ = 0.75), examining characteristics of stories highlighting specific individuals affected by AUD and solution-framing of AUD. Facebook shares were used as a proxy measure for an article's potential "reach" on social media. Of articles focused on individuals (72.0%), most (62.7%) depicted individuals affected by AUD as criminals, as opposed to engaging with alcohol treatment or being in recovery (31.1%). These criminal depictions received over eight times as many FB shares, compared to alcohol use treatment or recovery depictions. Law enforcement solutions (63.9%) were depicted most often, followed by AUD-treatment oriented solutions (40.1%), and prevention-oriented solutions (15.8%). Law enforcement solutions received more than five times as much social media engagement than AUD-treatment oriented solutions and over twenty-nine times more engagement than prevention-oriented solutions. There is a need to increase news coverage featuring depictions of individuals who have successfully engaged with alcohol treatment and recovery, reflecting the millions of Americans who have resolved a significant past alcohol problem. News coverage of AUD should also incorporate more depictions of evidence-based prevention-oriented and treatment-oriented solutions to AUD.