Much Ado About Nothing? The Role of Land-Based Gambling Venue Employees in Facilitating Problem Gambling Harm Reduction and Help-Seeking.

Over the past decade, greater emphasis has been placed on the role of the land-based gambling industry to respond to problem gambling behaviour in their venues. Despite this, there is a lack of clear information advising best practice responses by gambling venue employees. This article reviews strategies, practices, and policies employed by land-based gambling venues concerning their employees' role in preventing gambling-related harm and responding to problem gambling behaviours. A systematic search strategy was applied to source peer-reviewed literature which identified 49 articles. The synthesised results were arranged and presented across five categories: (1) the identification of gamblers with potential problems in the venue; (2) gambling venue staff responses to gamblers with potential problems; (3) gamblers' perspectives around venue responsibilities and interactions with gamblers with potential problems; (4) corporate social responsibility programs and the identification of gamblers with problems in the venue; and (5) gambling venue staff needs. The results suggest that most activity performed by venue staff concerning their response to problem gambling is limited to observing and documenting risky behaviours and then discussing this internally with other venue staff. Action which moves beyond this, such as approaching and interacting with identified gamblers of concern, rarely occurs. The results of this review suggest that a focus on the identification and intervention specifically with identified gamblers of concern is a particularly unhelpful aspect of the role of venue staff. The results also indicate that a re-thinking of the role frontline staff play in addressing problem gambling is necessary.

Betting on Australian Rules Football: Can Expert Tipsters beat Randomness?

Betting on the various codes of football in Australia accounts for the majority of sports betting, with Australian rules football (AFL) by far the most popular sport in Australia. Several studies have revealed the heavy presence of gambling advertising during AFL broadcasts, and a frequently used advertising strategy involves the use of well-known AFL commentators outlining their tips and betting suggestions. To date, no research has examined the hypotheses that skill may help in predicting AFL matches and monetary outcomes from AFL betting. Rather than merely discounting such ideas, it is important to test them empirically. The aims of this study were therefore, to examine if (1) expert AFL tipsters made better predictions than random picks, (2) expert AFL tipsters gained greater monetary reward than random selection, and (3) expert tipsters' prediction accuracy improved with betting experience. To this end, six seasons of AFL matches, odds data, and expert tipster data were analysed retrospectively, totalling 1141 matches. Random selections were calculated for each match using an inbuilt random number generator within Microsoft Excel and a $2 simulated wager was applied for each AFL match. The results of mixed-effects modelling showed that experts picked more correct outcomes than random selection; experts' correct predictions were partially mediated by home-game selections; no difference in monetary outcome was observed for experts compared to random selection; experts' predictions did not improve over time. The results of this study may be used to inform both psychological interventions that target gamblers' illusions of control, and public health gambling harm prevention messaging.

Attitudes, Risk Factors, and Behaviours of Gambling among Adolescents and Young People: A Literature Review and Gap Analysis.

Gambling is occurring in a rapidly changing landscape, with new trends and technologies affecting gambling behaviour and problem gambling across a range of populations. Gambling activity among adolescents and young people has received considerable research attention due to a high prevalence of gambling reported among these groups in recent years. Despite legislation worldwide to constrain gambling among adolescents and young people, modern technology, such as online gaming apps and online gambling venues, has significantly increased their exposure to the risks of problem gambling. It is important, therefore, to have up to date information about what is currently known about gambling and to explore gaps in our knowledge. This gap analysis presents the results of a systematic approach to reviewing the current literature on gambling behaviour, attitudes, and associated risk factors for gambling and problem gambling among adolescents and young adults (aged 10-25 years). The review included studies published between January 2015 and August 2020 and included 85 studies for final synthesis. Findings reveal further research is needed on the implications for young people of emerging technologies and new trends in gambling in the digital age. The current gap analysis reveals that this should include more research on the development and impact of both treatment and intervention strategies, and policy and regulatory frameworks from a public health perspective.

Graded Exposure Therapy for Online Mobile Smartphone Sports Betting Addiction: A Case Series Report.

Advances in technology and increased usage of electronic mobile devices over the past decade have changed the way gamblers engage with online gambling. The convenience of mobile electronic devices is understood to be a major contributor to the increase of online gambling, which in turn has been implicated in the growth of sports betting. Emerging evidence suggests several sources of differentiation between mobile and other online gambling, which have important psychological implications. Given the inherent differences, we cannot conclude that evidence for the effectiveness of treatment for non-smartphone problem gambling (PG) automatically translates to online smartphone sports betting PG. The aim of this study, therefore, was to describe the feasibility and preliminary effectiveness of cue exposure therapy (CET) to treat individuals presenting to a community-based PG therapy service with an online smartphone sports betting addiction, using a case series design. Six men (21-42 years old) received up to 10 weekly 60-min manualised CET sessions. Outcome measures were gambling harm, gambling urge, gambling cognitions, psychological distress, and functional impairment. All six participants completed a course of CET averaging 8.33 sessions (SD = 1.75) and reported improvement across each of the outcome measures. Psychological distress scores had reduced to the non-clinical range for all six participants and five participants scored below the cut offs for PG and functional impairment at 1 month follow up. The findings provide preliminary proof of concept evidence for the feasibility and efficacy of CET for online smartphone sports betting addiction.

A Literature Review and Gap Analysis of Emerging Technologies and New Trends in Gambling.

There have been significant changes in the gambling landscape particularly relating to gambling in the digital age. As the gambling landscape changes, regulation of gambling also needs to change. In 2018, the Office of Responsible Gambling in New South Wales, Australia, commissioned a gap analysis to inform their research objectives and priority focus areas. This included an identification of gaps in our understanding of emerging technologies and new trends in gambling. A gap analysis of the peer-reviewed literature published since 2015 was undertaken, identifying 116 articles. The main area of focus was Internet gambling, followed by articles exploring the relationship between video gaming and gambling, the expansion of the sports betting market, Electronic Gambling Machines characteristics and articles exploring new technologies and trends in advertising and inducements. Key gaps related to the need for more research in general, as well as research focusing on subpopulations such as those using different gambling formats, those with varying levels of problem gambling, and vulnerable populations. From a methods perspective, researchers saw the need for longitudinal studies, more qualitative research and improved outcome measures. The development and testing of a public health approach to addressing the harms associated with gambling in these areas is needed.

A single-arm, non-randomized investigation into the short-term effects and follow-up of a 4-week lower limb exercise programme on kinesiophobia in individuals with knee osteoarthritis.

OBJECTIVE: To investigate the short-term effects and follow-up of a 4-week lower limb exercise programme on kinesiophobia in individuals with knee osteoarthritis (OA). DESIGN: Participants diagnosed with knee OA clinically against the American College of Rheumatology criteria were recruited. Participants completed a 4-week lower limb exercise programme. Each participant completed two questionnaires, the Tampa Scale of Kinesiophobia and the Knee Injury and OA Outcome Score. Each measurement was completed at the baseline assessment, at Session 4 of the programme, at Session 8 of the programme, and 6 weeks after the exercise programme. Perceived levels of exertion rate of perceived exertion were measured after each exercise session using the modified Borg scale. RESULTS: Fifty-four participants took part in the study. Kinesiophobia decreased from the baseline assessment to 6 weeks after the exercise programme. KOOS pain, symptoms, sports and recreation, quality of life and activities of daily living score increased, therefore showed improvement. Correlational analysis highlighted a moderate negative correlation between the KOOS pain and kinesiophobia at baseline and 6 weeks after the exercise programme (0.44 and 0.48 respectively). CONCLUSIONS: Understanding baseline kinesiophobia scores could provide an important resource for health professionals who manage individuals with knee OA to improve the quality of care due to the correlation with pain changes and may improve exercise-related outcomes for a longer duration. HIGHLIGHTS: Kinesiophobia is prevalent in individuals diagnosed with knee osteoarthritis (OA). Kinesiophobia decreased in 75% of individuals with knee OA after a 4-week exercise programme. Correlation between pain and kinesiophobia at baseline and 6 weeks after an exercise programme. An understanding of an individual's kinesiophobia level before an exercise programme is important for future prognosis of changes in pain. CLINICAL TRIAL NUMBER: NCT02734342.

Mindfulness and Acceptance-Based Group Therapy: An Uncontrolled Pragmatic Pre-Post Pilot Study in a Heterogeneous Population of Female Prisoners.

The rate of females imprisoned worldwide has increased by more than 50% during the last two decades, with recent figures suggesting that, worldwide, the female prison population may still be increasing at a faster rate than males. Despite prevalence rates for psychiatric conditions among female prisoners being significantly higher than males, there is a particular lack of programs specifically designed for women. This preliminary study evaluates the initial effectiveness of a mindfulness and acceptance-based group program in an uncontrolled pragmatic pilot study of a heterogeneous group of incarcerated women with a range of mental health issues. Participants were 59 incarcerated women who engaged in a 10-session group program. Outcome measures comprised the Acceptance and Action Questionnaire-II, Depression Anxiety and Stress Scale, Mindfulness Attention Awareness Scale, and three screening tools derived from the full version of the Patient Health Questionnaire (PHQ-9), to measure depression, binge eating (Patient Health Questionnaire-Binge Eating Disorder [PHQ-ED]), and somatoform disorders (PHQ-15). Results of linear mixed modelling showed improvements in mindfulness and acceptance, and reductions in depression, anxiety, and somatoform symptoms. Furthermore, acceptance and commitment therapy (ACT) was shown to be an acceptable and feasible intervention for female Indigenous Australian prisoners. A mindfulness and acceptance-based group approach appears to be feasible and acceptable in a prison environment for a female prisoners with a range of mental health symptomatology.

Understanding the business versus care paradox in gambling venues: a qualitative study of the perspectives from gamblers, venue staff and counsellors.

BACKGROUND: In recent years, greater emphasis has been placed on gambling venues to identify potential problem gamblers, respond appropriately and refer to treatment. In seeking the perspectives of problem gamblers, venue staff and treatment providers, this qualitative study investigates how problem gamblers experience being identified and referred for treatment by venue staff. METHODS: A semi-structured interview guide focusing on experiences and perceptions of problem gambling identification and referral for treatment in gaming venues was used to conduct 4 focus groups and 9 semi-structured in-depth interviews. Participants comprised 22 problem gamblers, 10 gambling venue staff and 8 problem gambling counsellors. Audio recordings were transcribed verbatim, and an interpretive phenomenological analysis was conducted. RESULTS: 'Role conflict' was identified as a considerable source of stress for venue staff who described conflicting priorities in responding to problem gamblers whilst maintaining employer profit margins. Problem gamblers described offers of help from venue staff as hypocritical and disingenuous. Venue staff also described reluctance to make moral judgements through the identification of and engagement with problem gamblers, and gamblers described resentment in being singled out and targeted as a problem gambler. Being approached and offered referral to a counselling service was a rare occurrence among problem gamblers. This corresponded with reports by gambling counsellors. CONCLUSIONS: Role conflict experienced by gambling venue staff and patrons alike inhibits effective referral of potential problem gamblers into treatment. Reducing the need for gambling venue staff to make a perceived moral judgement about the gambling behaviours of specific patrons may improve the reception of responsible gambling information and promote help-seeking.

Do Males and Females Conceptualise Work and Social Impairment Differently Following Treatment for Different Mental Health Problems?

The Work and Social Adjustment Scale (WSAS) is used by psychiatric nurses for screening and evaluating patients' treatment outcomes for a variety of mental health problems. This study investigated longitudinal and gender measurement invariance of WSAS using structural equation modeling within a help-seeking problem gambling sample (n=445), and an intervention program for depression and anxiety sample (n=444). The concept of functional impairment was defined by all WSAS items in males and females at pre- and post-treatment assessments. These findings confirm that the WSAS is a robust and efficacious instrument for evaluating treatment outcomes in two differing populations.

Gender differences in temporal relationships between gambling urge and cognitions in treatment-seeking adults.

Many gambling-specific CBT programs seek to target either gambling-related urge or cognitions or both. However, little is known of the influence of one symptom type on another across time and whether these differ for men and women help-seeking problem gamblers. The aim of this study was threefold: to determine presence of measurement invariance for urge and cognition measures over time; to investigate the effect of baseline urge on end-of-treatment gambling-related cognitions - and the reciprocal relationship; and, identify whether these pathways differ across gender. Self-reported gambling urge (GUS), and gambling-related cognitions (GRCS) data from treatment-seeking problem gamblers prior to and post treatment (N = 223; 62% men) were analyzed with cross-lagged panel models, moderated by gender. Conceptualization of urge and cognitions were found to be temporally stable. There was no significant association between baseline GUS scores and post-treatment GRCS scores, nor the reverse relationship. Putatively, this infers that coexisting urge and gambling-related cognition components of problem gambling operate independently over time. Analyses revealed gambling urge had a significantly stronger tracking correlation across time for men than women when adjusting for cognition paths. This investigation provides early evidence for tailoring CBT in response to sub-population gambling-related characteristics, demonstrated across men and women.

Problem Gambling Among Australian Male Prisoners: Lifetime Prevalence, Help-Seeking, and Association With Incarceration and Aboriginality.

Prisoners represent a group containing the highest problem gambling (PG) rate found in any population. PG is of particular concern among Indigenous Australians. Little data exist concerning PG rates among Indigenous Australian prisoners. The present study aimed to address this gap in the literature by examining the lifetime prevalence of PG among male prisoners, whilst identifying prisoners of Aboriginal background. The EIGHT Gambling Screen (Early Intervention Gambling Health Test) was administered to 296 prisoners across three male prisons in South Australia. Previous help-seeking behaviour and forms of gambling were also examined. Sixty percent of prisoners indicated a lifetime prevalence of PG with 18% reporting they were incarcerated due to offending relating to their gambling problem. Indigenous Australian prisoners indicated a significantly higher prevalence of PG (75%) than non-Indigenous prisoners (57%) and reported less than half the rate of help-seeking. Given the high levels of PG and overall low rates of help-seeking among prisoners, prisons may provide an important opportunity to engage this high-risk population with effective treatment programs, in particular culturally appropriate targeted interventions for Australian Indigenous prisoners.

"They Shouldn't Be Coming to the ED, Should They?": A Descriptive Service Evaluation of Why Patients With Palliative Care Needs Present to the Emergency Department.

BACKGROUND: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. METHODS: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period. Demographic and clinical data were collected from electronic health records. RESULTS: A total of 105 patients made 112 presentations to the ED. The 2 most common presenting complaints were shortness of breath (35%) and pain (28%). Eighty-three percent of presentations required care in the ED according to a priori defined criteria. They either underwent urgent investigation or received immediate interventions that could not be delivered in another setting, were referred by a health-care professional, or were admitted. CONCLUSIONS: Findings challenge the misconception that patients known to a palliative care team should be cared for outside the ED. The importance and necessity of the ED for patients in their last years of life has been highlighted, specifically in terms of managing acute, unpredictable crises. Future service provision should not be based solely on a patient's presenting complaint. Further qualitative research exploring patient perspective is required in order to explore the decision-making process that leads patients with palliative care needs to the ED.

Experiential avoidance mediates the association between thought suppression and mindfulness with problem gambling.

Experiential avoidance (EA) has been shown to be an important etiological and maintenance factor in a wide range psychopathology that includes addictive, anxiety, depressive and impulse control disorders. One common form of EA is thought suppression. Problem gambling causes enormous problems for afflicted individuals and has major social costs for their families and the community. Despite increasing interest in the contribution of EA to a broad range of psychological problems, its association with problem gambling has not previously been empirically investigated. The purpose of this cross-sectional study was to investigate the relationship between EA, thought suppression, and mindfulness among a group of 103 treatment seeking problem gamblers. Of particular interest was the extent to which EA accounted for the relationships between problem gambling and the two theoretically opposing constructs: thought suppression and mindfulness. Results showed EA was predictive of problem gambling. Thought suppression was positively associated and mindfulness negatively associated with problem gambling, and these relationships were mediated by EA. Directions for future research are suggested which include the application of treatments for problem gambling that undermine EA, such as acceptance and mindfulness based therapies.

Exposure therapy for problem gambling in rural communities: a program model and early outcomes.

OBJECTIVE: Rural South Australia contains a higher share of electronic gaming machines and gambling expenditure per capita than metropolitan areas, raising concerns about the risk of problem gambling in these communities. This paper describes the implementation and outcomes of an outreach behavioural psychotherapy (exposure therapy) program for problem gambling in rural South Australia. METHODS: A retrospective cohort study design was used for 551 adult treatment-seeking problem gamblers who presented to the Statewide Gambling Therapy Service in South Australia. Fifty-one gamblers were from rural areas and participated in the outreach program. Outcomes were compared between gamblers who participated in either the metropolitan-based or rural outreach program. Outcome measures used: South Oaks Gambling Screen, Kessler Psychological Distress Scale, Work and Social Adjustment Scale, and hours gambled the previous month. RESULTS: Sixty-one per cent of clients (n = 551) completed treatment. There was no significant association between service location and number of treatment completers. Significant improvements were recorded across all outcome measures for both groups with small to large effect sizes, and there were no significant differences in outcomes at post-treatment between the groups while controlling for baseline scores. CONCLUSIONS: Both metropolitan and rural clients reported significant clinical improvement. Given the risk of problem gambling in rural communities, these early outcomes are encouraging. These findings will inform future treatment planning and service delivery for rural clients, and guide further research into the effectiveness of exposure therapy for problem gambling.