'Getting addicted to it and losing a lot of money it's just like a hole.' A grounded theory model of how social determinants shape adolescents' choices to not gamble.

BACKGROUND: Gambling abstinence when underage lowers the risk of harmful gambling in later life. However, little research has examined why many young people refrain from gambling, even though this knowledge can inform protective strategies and lower risk factors to reduce underage gambling and subsequent harm. This study draws on the lived experience of adolescent non-gamblers to explore how social determinants while growing up have shaped their reasons and choices to not gamble. METHODS: Fourteen Australian non-gamblers, aged 12-17 years, participated in an in-depth individual interview (4 girls, 3 boys) or online community (4 girls, 3 boys). Questions in each condition differed, but both explored participants' gambling-related experiences while growing up, including exposure, attitudes and behaviours of parents and peers, advertising, simulated gambling and motivations for not gambling. The analysis used adaptive grounded theory methods. RESULTS: The grounded theory model identifies several reasons for not gambling, including not being interested, being below the legal gambling age, discouragement from parent and peers, concern about gambling addiction and harm, not wanting to risk money on a low chance of winning, and moral objections. These reasons were underpinned by several social determinants, including individual, parental, peer and environmental factors that can interact to deter young people from underage gambling. Key protective factors were parental role modelling and guidance, friendship groups who avoided gambling, critical thinking, rational gambling beliefs, financial literacy and having other hobbies and interests. CONCLUSIONS: Choices to not gamble emanated from multiple layers of influence, implying that multi-layered interventions, aligned with a public health response, are needed to deter underage gambling. At the environmental level, better age-gating for monetary and simulated gambling, countering cultural pressures, and less exposure to promotional gambling messages, may assist young people to resist these influences. Interventions that support parents to provide appropriate role modelling and guidance for their children are also important. Youth education could include cautionary tales from people with lived experience of gambling harm, and education to increase young people's financial literacy, ability to recognise marketing tactics, awareness of the risks and harms of gambling, and how to resist peer and other normalising gambling influences.

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.

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.

Living with dementia in regional Australia: The experience of acute care hospital management from the carer's perspective.

INTRODUCTION: Family carers play a crucial role in dementia care. As the condition progresses, people with dementia become increasingly dependent on their carers for all areas of daily living. The risk of carer burnout is significant. One of the more stressful events for family carers is when hospital admission is required for the person they care for. Living in regional Australia adds complexity to the experience. Hospital and health services in regional Australia could use a greater understanding of the issues associated with hospital care to inform patient and carer management, improve outcomes for this population and support the goal of 'ageing in place'. OBJECTIVE: To explore the experience of carers of people with dementia in regional Australia when hospital care or treatment was required for the person they provide care for. DESIGN: Six family carers living in regional Australia participated in this interpretative phenological study. Individual, semistructured interviews were held and transcribed verbatim shortly after. Data analysis occurred via three key processes: reading and highlighting, coding and grouping, which yielded the major themes and subthemes of the study. FINDINGS: Three major themes and nine subthemes emerged from data analysis. The major themes were: (i) support and supply of specialist care; (ii) travel needs and negotiations; and (iii) empathy and experience make a difference. DISCUSSION: Findings from this study highlight aspects of care that healthcare providers can address to improve outcomes for patients with dementia and their carers. Carers need opportunities to seek clarification and provide input on care plans. Good communication, involvement and relationship building between healthcare staff and carers are vital to achieving optimal patient outcomes. Staff training supporting understanding of appropriate dementia care is essential for improved patient and carer outcomes. CONCLUSION: Factors related to regional location, including lack of specialist care and support, compound carers' challenges. Healthcare provider education on dementia care and dementia-friendly processes in hospitals will support optimal patient and carers outcomes.

Collecting data on the experiences and perspectives of people with dementia in the acute care hospital setting: A systematic scoping review.

BACKGROUND: People with dementia frequently experience poor health outcomes that require hospitalisation; however, the hospital setting is generally unsuitable for these patients. While it is well-recognised that understanding patient perspectives is crucial to providing person-centred care, current clinical care guidelines do not describe how to effectively collect feedback from people with dementia. Historically, people with dementia have generally been neglected from data collection exercises among practitioners and academic researchers, alike. OBJECTIVE: The objective of this review is to describe the data collection processes from peer-reviewed evidence sources that include direct consultation with, and elicit feedback from, patients with dementia about their care experience in the hospital setting. METHODS: The protocol for this systematic scoping review was pre-registered (https://doi.org/10.6084/m9.figshare.16614667.v1). The review considered primary quantitative and qualitative research involving people with dementia as research participants, regarding the quality of hospital care from the patient's perspective. Four databases were searched (MEDLINE, CINAHL Complete, APA PsycINFO and Embase), with 14 studies meeting the eligibility criteria. RESULTS: There has been an increased interest in gaining the perspectives of people with dementia on their health care over the past 5 years. Sundry methodologies were employed by these studies, but most used informal qualitative interviews to support and enable participants with diverse symptoms and functional abilities to take part. Procedures concerning recruitment, ethics and consent, and data collection processes were, likewise, varied and not reported consistently across this body of evidence. CONCLUSIONS: People with dementia can be meaningfully consulted as research participants in the hospital setting. Increased rigour when reporting the methodologies and strategies used during data collection is needed to provide guidance for health services and researchers to further enable the inclusion of people with dementia. IMPLICATIONS FOR PRACTICE: Including people with dementia in data collection endeavours in the hospital setting is essential to improving health outcomes, increasing equity and providing better hospital service delivery to this vulnerable cohort.

The role of day-respite centres in supporting people with dementia to age in place: An interpretive phenomenological study.

ISSUE ADDRESSED: Day-respite care opportunities for people with dementia help prevent informal carer burnout and enable ageing in place. Care workers in these settings are an under-researched workforce who play a pivotal role in providing an engaging and supportive environment for clients with dementia. This study aimed to understand their experiences of providing care for people with dementia. METHODS: An interpretive phenomenological analysis explored the factors that challenge and enable day-respite centre workers of the sole facility in one regional Australian town to provide, what they perceive to be high-quality, person-centred care for people with dementia. Thematic analysis revealed four themes relating to the experience of providing care to people with dementia in this day-respite centre. RESULTS: Care challenges associated with the symptoms of dementia were recognised by participants; however, these issues were mitigated by the powerful enabling factors, including a strong focus on dementia-friendly care, operating within the centre. Thematic analysis yielded four themes of a person-centred workplace culture and strategy, embedded communication practices, provision of a safe and engaging environment and positive staff attributes. These themes were perceived to make participants' jobs more enjoyable, as well as improve their clients' and carers' quality of life. CONCLUSIONS: Day-respite centres offer a valuable resource for people with dementia and their carers, and their success depends on several key environmental and workforce factors. Accordingly, other facilities targeted at caring for this population should assess the feasibility of adopting similar strategies, including selecting and training specialised care staff, adapting the care environment to suit clients' physical and behavioural needs. and establishing routine multi-channel communication methods that effectively connect staff with other care providers, their clients, and their clients' carers. SO WHAT?: The lessons learned in this research could be implemented throughout the wider web of dementia care. Strategies might include the careful selection and training of staff; the provision of dedicated, safe dementia-friendly wards; and routine communication key stakeholders to ensure met-needs care. While there would be a need to scale such care to suit different individual care providers, even seemingly simple strategies would likely have positive effects in optimising care for people diagnosed with this debilitating neurocognitive disease.

Adolescent betting on esports using cash and skins: Links with gaming, monetary gambling, and problematic gambling.

Adolescents can easily access esports betting sites and place bets using cash or skins. This descriptive cross-sectional study examined the characteristics of adolescent esports bettors and relationships between their esports betting, video gaming activities, monetary gambling participation, and at-risk/problem gambling. Two survey samples of Australians aged 12-17 years were recruited through advertisements (n = 841) and online panel providers (n = 826). In both samples, gender and parents' living situation did not differ by past-month esports cash and skin betting, but recent esports betting was associated with engaging in esports gaming activities such as playing and watching esports, and in monetary gambling activities. Past-month esports betting using cash and skins was significantly associated with at-risk/problem gambling. After controlling for recent monetary gambling, recent esports skin bettors were over 3 times more likely to meet criteria for at-risk/problem gambling. Esports betting using skins appears to pose risks for young people and is easily accessible through unlicensed operators.

Are esports bettors a new generation of harmed gamblers? A comparison with sports bettors on gambling involvement, problems, and harm.

BACKGROUND AND AIMS: Esports betting is expanding in popularity, yet little is known about who participates in this niche gambling activity. This study aimed to determine whether esports bettors are more vulnerable to harms and problems than gamblers engaged in traditional sports betting. METHODS: Data were collected from 298 regular esports bettors and 300 sports bettors (who regularly bet on traditional sports, but not esports). These groups were compared on demographics, gambling involvement, problem gambling, and gambling-related harms. RESULTS: Compared to sports bettors, esports bettors were more likely to be younger, university-educated, employed (lower income earners), and speak a non-English language at home. Esports bettors gambled on fewer traditional gambling activities in the last 12 months, but compared to sports bettors, gambled more frequently on some activities, were more likely to meet problem gambler criteria (64.8.% vs 17.3%), and experience at least one gambling-related harm (81.9% vs 45.3%). Being an esports bettor significantly predicted greater problem gambling severity and gambling-related harms. More frequent esports skin betting and skin gambling (on games of chance) were significant predictors of gambling problems amongst esports bettors. DISCUSSION AND CONCLUSION: The results provide preliminary evidence that esports bettors are more likely to experience gambling problems compared to their sports betting counterparts, potentially stemming from their involvement in emerging video-game related gambling products.

Young people who purchase loot boxes are more likely to have gambling problems: An online survey of adolescents and young adults living in NSW Australia.

BACKGROUND AND AIMS: Loot boxes are a common feature in video games where players win, buy or are gifted a virtual box or other container that is unwrapped to reveal virtual items of value, such as skins, weapons, in-game currency or special abilities. The current study aimed to relate the use of loot boxes to gambling problems and harm. METHODS: An online survey was conducted with 1,954 adolescents and young adults from NSW Australia, 59.9% female (aged 12-24), recruited by online panel aggregator, Qualtrics. RESULTS: Buying and selling loot boxes was associated with higher 12-month gambling frequency and gambling problems in young adults, aged 18-24 (Problem Gambling Severity Index). Young adults who bought loot boxes additionally had more gambling-related harms (Short Gambling Harms Screen). Young women, aged 18-24, who opened, bought and/or sold loot boxes spent more money in the last 12 months on gambling. In adolescents, aged 12-17, buying loot boxes was similarly associated with gambling problems (DSM-IV-MR-J). Furthermore, adolescent girls who bought and/or sold loot boxes viewed gambling more positively than other girls (Attitudes Towards Gambling Scale). There was no evidence, however, that longer-term experience in opening or purchasing loot boxes, a differentiating feature of the survey, is associated with current gambling problems. DISCUSSION AND CONCLUSIONS: This study suggests that loot boxes may be attractive to people who are already predisposed to engage in other gambling, and females who use loot boxes may have unique vulnerabilities to gambling problems that could be explored in future research.

"It's about getting the best bang for your buck": Exploring local councils' perceptions about providing exercise infrastructure in public parks.

ISSUE ADDRESSED: Growing evidence suggests that public parks enable physically active communities; however, little is known of the impact of council-provided exercise facilities in outdoor green spaces, and the challenges of providing this infrastructure at a local level. This paper sought to describe some of the factors, as perceived by local government area (LGA) council representatives within Queensland, Australia, that influence community use of, as well as council provision for, weight-bearing outdoor fitness station infrastructure in public parks. METHODS: A nested mixed-methods study was employed, comprised of a survey sent to council representatives for all 78 Queensland LGAs (Stage 1), and follow-up interviews to elicit further insights into the provision of infrastructure in public parks (Stage 2; n = 7). Perceptions around participants' corporate role in the provision of outdoor fitness stations were the focus of analyses. FINDINGS: A thematic analysis described themes of: Moderating public attitudes and motivation; The flow of information; Supporting an active community; Return on investment; and Safety, complianceand climate. Provision of equipment was influenced by the perception that it represented poor value for money, in terms of the desired outcome of increased physical activity, especially when compared with other types of infrastructure (particularly, walking trails); however, opinions about this lack of use outdoor exercise equipment were most often based on anecdotal evidence. CONCLUSIONS: Councils are motivated to support active communities. They would benefit from better access to information about park usage, strategies for marketing healthy living initiatives and data about the economic benefits of parks. SO WHAT?: The current study explores the perspectives of LGA professional "gatekeepers," who develop and maintain public physical activity facilities. Their insights are essential to better understand the practicalities of delivering desirable urban green spaces for physically active communities.

Interest in inducements: A psychophysiological study on sports betting advertising.

Recent research has shown an association between the viewing of wagering advertising, which often presents inducements to gamble, and maladaptive sports-betting behaviours; however, the mechanism/s underlying the development of the intention to gamble remains relatively understudied. Eye-tracking and tonic electrodermal activity was recorded from 59 participants (including 49 regular gamblers and 10 non-gamblers), while they watched a series of advertisements. Following each advertisement, participants were asked to rate how likely they would be to take up the offer presented, therein. The number of fixations placed on each offer differed according to the type of inducement shown (p < .001), with reduced risk and cash back inducements being looked at more often than better odds and bonus bet inducements by all groups. Increased electrodermal activity while viewing the advertisements was associated with greater severity of gambling-related harm (p < .001), as well as greater ratings of desire for most advertisements. Rating of desire was, likewise, positively associated with gambling-related harm (p < .001). These results may suggest that, while the offers in gambling advertisements may be looked at by most viewers, unless there an attendant increase in arousal, it is quite unlikely that these inducements will elicit a desire to gamble. For individuals already at risk of gambling problems, exposure to these advertisements, especially those offering what is perceived to be safer betting options that minimise financial losses, may exacerbate existing harms. Such information may prove useful in guiding industry practice, government regulations, therapeutic interventions, and future research on this topic.

Are sports bettors looking at responsible gambling messages? An eye-tracking study on wagering advertisements.

BACKGROUND AND AIMS: The broadcast of wagering advertisements during televised sports matches has been associated with various adverse outcomes. In order to counter these effects, legislative bodies require wagering operators to include responsible gambling messages in their advertisements; however, the effectiveness of these messages is unclear. This study sought to examine the extent to which responsible gambling messages are looked at, in the wider context of gambling advertisements. METHODS: Forty-nine regular sports bettors and 10 non-gamblers viewed a series of sports betting advertisements, while an eye-tracker recorded the number of fixations placed on responsible gambling messages, as well as other text-based wagering content. RESULTS: Responsible gambling messages were, generally, presented in a non-conspicuous manner. Eye-tracking data revealed that significantly fewer fixations were placed on responsible gambling messages, compared to wagering information (p < .001); however, this effect did not differ according to level of gambling risk (p = .169). The number of fixations placed on the different types of responsible gambling messages was found to vary, based on gambling risk (p = .006), as well as, what appears to be, the physical characteristics of these messages. DISCUSSION: Very few fixations were placed on, or near, responsible gambling messages, compared to other wagering information, meaning that, in their current form, they are unlikely to be effective in protecting against gambling harm. Preliminary evidence shows that presenting messages on a high-contrast/block-color background increases the number of fixations on these. CONCLUSION: Further research is needed to identify ways of increasing the effectiveness of responsible gambling initiatives in the sports betting context.

Does size matter? An examination of problem gamblers' skin conductance responses to large and small magnitude rewards.

Previous research has shown that individuals with substance use disorder equally value small and large magnitude rewards. This has led some researchers to conceptualize the problematic behaviors associated with this disorder as being, at least in part, caused by a deficiency in processing reward stimuli. Considering the documented similarities between substance use disorder and disordered gambling, the current study sought to investigate whether problem gamblers also display such an aberrant pattern of incentive processing. Skin conductance responses (SCRs) to small and large magnitude wins were recorded from 16 problem gamblers (PGs) and 16 healthy controls (HCs) while they completed a computer-simulated electronic gaming machine task. The results show that, while large wins elicited greater SCRs compared to small wins for the HC group, no difference in SCR amplitude was found following large and small wins in the PG group. These findings suggest that problem gamblers may be less effective at evaluating the value of incentives, and are discussed in terms of relevant theoretical frameworks.

Reward and punishment hyposensitivity in problem gamblers: A study of event-related potentials using a principal components analysis.

OBJECTIVE: To investigate whether the latent neural correlates of incentive processing differ between problem gamblers (PGs) and healthy controls (HCs). METHODS: Event-related potential (ERP) data were derived while 16 PGs and 20 HCs played a computer electronic gaming machine (EGM) task. Psychophysiological responses to outcomes commonly encountered during EGM gambling, including Large wins, Small wins, Near-wins, and Losses, were examined using a spatiotemporal principal components analysis (PCA). Subjects also completed questionnaires that assessed their levels of impulsivity, attraction to appetitive stimuli, and avoidance of aversive stimuli. RESULTS: Losses elicited a feedback-related negativity (FRN), whereas wins elicited a feedback-related positivity (FRP) at the same latency and topography. PGs exhibited both attenuated FRN amplitudes following Losses and FRP amplitudes following Wins. Greater P3b amplitudes were found following Wins compared to Losses. FRN amplitudes following Near-wins were significantly reduced compared to Losses for both PGs and HCs. Trends for reduced P3b amplitudes following all outcome types, and for similar P3b amplitudes following Large and Small wins, were found for the PG group. CONCLUSIONS: We provide evidence that PGs are hyposensitive to both positive and negative outcomes. SIGNIFICANCE: The finding that PGs are hyposensitive to reward and punishment provides valuable insight into the nature of deficit in this disorder, and provides a foundation for future research and clinical interventions.

Problem gamblers are hyposensitive to wins: an analysis of skin conductance responses during actual gambling on electronic gaming machines.

Physiological arousal is purportedly a key determinant in the development and maintenance of gambling behaviors, with problem gambling conceptualized in terms of abnormal autonomic responses. Theoretical conceptualizations of problem gambling are discordant regarding the nature of deficit in this disorder; some accounts posit that problem gamblers are hypersensitive to reward, and others that they are hyposensitive to reward and/or punishment. Previous research examining phasic electrodermal responses in gamblers has been limited to laboratory settings, and reactions to real gaming situations need to be examined. Skin conductance responses (SCRs) to losses, wins, and losses disguised as wins (LDWs) were recorded from 15 problem gamblers (PGs) and 15 nonproblem gamblers (NPGs) while they wagered their own money during electronic gaming machine play. PGs demonstrated significantly reduced SCRs to reward. SCRs to losses and LDWs did not differ for either PGs or NPGs. This hyposensitivity to wins may reflect abnormalities in incentive processing, and may represent a potential biological marker for problem gambling.

Can event-related potentials serve as neural markers for wins, losses, and near-wins in a gambling task? A principal components analysis.

Originally, the feedback related negativity (FRN) event-related potential (ERP) component was considered to be a robust neural correlate of non-reward/punishment processing, with greater negative deflections observed following unfavourable outcomes. More recently, it has been suggested that this component is better conceptualised as a positive deflection following rewarding outcomes. The current study sought to elucidate the nature of the FRN, as well as another component associated with incentive-value processing, the P3b, through application of a spatiotemporal principal components analysis (PCA). Seventeen healthy controls played a computer electronic gaming machine (EGM) task and received feedback on credits won or lost on each trial, and ERPs were recorded. The distribution of reward/non-reward outcomes closely matched that of a real EGM, with frequent losses, and infrequent wins and near-wins. The PCA revealed that feedback elicited both a frontally maximal negative deflection to losses, and a positive deflection to wins (which was also sensitive to reward magnitude), implying that the neural generator/s of the FRN are differentially activated following these outcomes. As expected, greater P3b amplitudes were found for wins compared to losses. Interestingly, near-wins elicited significantly smaller FRN amplitudes than losses (with no differences in P3b amplitude), and may contribute to the maintenance of gambling behaviours on EGMs. The results of the current study are integrated into a response profile of healthy controls to outcomes of varying incentive value. This may provide a foundation for the future examination of individuals who exhibit abnormalities in reward/punishment processing, such as problem gamblers.

Electrodermal activity reliably captures physiological differences between wins and losses during gambling on electronic machines.

Differential patterns of physiological arousal to win and loss events during gambling is central to psychological conceptualizations of gambling behaviors but is poorly researched. We recorded heart rate (HR) and skin conductance responses (SCRs) to wins and losses while 23 healthy participants played for small incentives on a simulated electronic gambling task. Wins produced large SCRs whereas losses did not, and large wins produced larger SCRs than small wins. Electrodermal measures also correlated with reward responsiveness on a personality measure and with ratings of excitement during gambling. HR evidenced a slight deceleration before event outcomes, and the rebound HR was larger after wins than after losses. The study demonstrates that physiological changes to gambling events can be reliably captured, and that these changes are sensitive to differential outcomes. These findings establish a foundation for future research in field settings.