The impact of legal cannabis availability on cannabis use and health outcomes: A systematic review.

BACKGROUND: For alcohol, regulating availability is an effective way to reduce consumption and harm. Similarly, the higher availability of medical cannabis dispensaries has been linked to increased cannabis consumption and harm. For recreational cannabis markets, such a link is suspected but still poorly understood. METHODS: A systematic literature review (PROSPERO registration number 342357) was conducted on 1 July 2022 in common libraries (Medline, Web of Science, PsycInfo, Psyndex, CINAHL, Embase, SCOPUS, Cochrane) for publications since 2012. Studies linking variations in the availability of legal cannabis products to behavioral outcomes (cannabis use or related health indicators) were included, while studies focusing solely on the legalization of medical cannabis were excluded. The risk of bias was assessed using an adapted version of the Newcastle-Ottawa-Scale. RESULTS: After screening n = 6,253 studies, n = 136 were selected for full-text review, out of which n = 13 met the inclusion criteria, reporting on n = 333,550 study participants and n = 855,630 presentations to emergency departments. All studies were conducted in North America, with the majority from Western US states. Using longitudinal (n = 1), cross-sectional (n = 4), or repeated cross-sectional (n = 8) study designs, an increased availability of legal cannabis was linked to increased current cannabis use and health-related outcomes (vomiting, psychosis, or cannabis-involved pregnancies), regardless of the indicator employed to measure availability (proximity or density) among both adults and adolescents. The positive correlation between cannabis availability and consumption is most pronounced among those groups who have been less exposed to cannabis before legalization. The association between the availability of legal cannabis and risky use indicators was less consistent. CONCLUSIONS: Groups who have been least exposed to cannabis before legalization may be most susceptible to increased availability. In jurisdictions with legal cannabis markets, restrictions on the number of legal cannabis retailers, especially in densely populated areas, appear warranted.

The Gambling Consumption Mediation Model (GCMM): A Multiple Mediation Approach to Estimate the Association of Particular Game Types with Problem Gambling.

Bivariate associations of problem gambling with participation in particular game types often decrease when adjusting for demographics or consumption behavior (e.g., number of game types played). A summary of 14 peer-reviewed studies showed inconsistencies as well as conceptual and methodological challenges. The aim of this study was to expand previous research by a combination of (1) sophisticated feature-engineering, which disaggregates gambling intensity into facets within and beyond a game type of interest, and (2) the application of mediation models. Data comprised last year gamblers of three merged cross sectional Icelandic gambling surveys of 2007, 2011, and 2017 (N = 4422). For each of 15 game types (12-month time frame), a parallel multiple mediation model was applied to disaggregate bivariate associations of last year game type participation and problem gambling (Problem Gambling Severity Index) by six mediating mechanisms: (1) demographic problem gambling propensity, (2) number of game types played, (3) gambling frequency within the type, (4) maximum gambling frequency across all types beyond, (5) usual spending within the type, (6) maximum usual spending across all types beyond. Games showed two distinct profiles via which mediator they mostly impacted problem gambling: Electronic gaming machines offline, scratch cards offline, live betting online, and poker offline as well as online impacted problem gambling mostly via gambling frequency within, whereas all other types mostly impacted via the number of game types played. The applied mediation models answer the question by which mechanism game types impact problem gambling in a more exhaustive way than previous research.

A nurse-driven analgesia and sedation protocol reduces length of PICU stay and cumulative dose of benzodiazepines after corrective surgery for tetralogy of Fallot.

PURPOSE: Analgesia and sedation protocols are reported to reduce the requirement of sedative and analgesic agents, duration of mechanical ventilation, and length of pediatric intensive care unit (PICU) stay. However, these studies often were conducted based on inhomogeneous cohorts. The aim of this study was the evaluation of a nurse-driven analgesia and sedation protocol in a homogenous population of infants following corrective surgery for tetralogy of Fallot (TOF). DESIGN AND METHODS: This retrospective analysis was conducted in a cardiac PICU of a tertiary referral center. Two cohorts of patients who underwent corrective surgery for TOF below the age of 7 months, were retrospectively evaluated before and after implementation of a nurse-driven analgesia and sedation protocol. We compared peak and cumulative doses of midazolam, morphine, and clonidine, length of PICU stay and time on mechanical ventilation. RESULTS: A total of 33 patients were included in the preimplementation period and 32 during the postimplementation period. Implementation of the nurse-driven analgesia and sedation protocol had no effect on time on mechanical ventilation (72 hr [24-141] vs. 49 hr [24-98]), but significantly on length of PICU stay (7 days [5-14] vs. 5 days [4-7]). Cumulative doses of midazolam (7.37 mg/kg [4.70-17.65] vs. 5.0 mg/kg [2.70-9.12]) as well as peak doses of midazolam (0.22 mg·kg-1 ·hr-1 [0.20-0.33] vs. 0.15 mg·kg-1 ·hr-1 [0.13-0.20]) and morphine (50.0 µg·kg-1 ·hr-1 [39.7-79.9] vs. 42.5 µg·kg-1 ·hr-1 [29.7-51.8]) were significantly reduced. The postimplemantation group showed no increase in postoperative complications and adverse events. PRACTICE IMPLICATIONS: The implementation of a nurse-driven analgesia and sedation protocol is safe in infants following corrective surgery for TOF. It reduces significantly the length of PICU stay, cumulative and peak doses of midazolam and peak doses of morphine.

Do Simulated Gambling Activities Predict Gambling with Real Money During Adolescence? Empirical Findings from a Longitudinal Study.

As technology has developed, the international gambling market has changed markedly in recent years. The supply of internet-based gambling opportunities has become ever more significant. At the same time, the introduction of new gambling opportunities always brings a demand for evidence-based scientific evaluation, with regard to the associated risks of addiction. Simulated internet gambling, which is the focus of this study, represents a relatively new product group located at the interface between gambling and computer gaming. Concerns have been raised in scientific literature, especially with regard to the adolescent age group, as to whether participation in simulated internet gambling directly promotes recruitment to the world of monetary gambling, as defined in the gateway hypothesis. The research design was based on a standardized, representative longitudinal survey (over a 1-year period) with a total of 1178 school pupils from Northern Germany (M = 13.6 years; 47.5% male). It must be borne in mind that 12% of the adolescents belonged to the subgroup of "onset gamblers" and first reported experience with monetary gambling at the second stage of surveying. Logistic regression analysis demonstrates that this migration process is fostered by (1) participation from home in simulated gambling on social networks and (2) significant exposure to advertising (relating to both simulated and monetary gambling). Within the subgroup of simulated internet gamblers, variables such as particular patterns of use (including breadth and depth of involvement with simulated internet gambling, certain motives for participation, and microtransactions) do not serve as significant predictors. Despite this, important needs for action for the purposes of prevention and research can be identified.

Economic Recession Affects Gambling Participation But Not Problematic Gambling: Results from a Population-Based Follow-up Study.

In October 2008, Iceland experienced the fastest and deepest financial crisis recorded in modern times when all three major banks went bankrupt in less than 2 weeks. The purpose of this follow-up study is to examine potential changes in participation in 12 different gambling types and in problem gambling before (time 1; year 2007) and after (time 2; year 2011) the economic collapse in 2008. The time between the first and second wave of data collection was 3.5 years. In total, 1,531 participants took part in the study, 688 males and 843 females. There was a considerable increase in past year gambling behavior from 2007 to 2011, mostly due to increased participation in lotto (National lotto and Viking lotto) but also in bingo, monthly lotteries (class lotteries with at least monthly draw) and scratch tickets. Only EGMs (electronic gaming machines) participation declined significantly between the two timepoints. Examining past year problematic gambling figures revealed that there were no changes in the prevalence figures between the year 2007 (1.2%) and 2011 (1.1%). Further examination revealed that those who reported financial difficulties due to the recession were more likely to buy lotto- or scratch tickets during the recession than those who were not financially affected by the crisis. These findings remained after controlling for background variables and baseline gambling activity (gambling in 2007). Overall, the findings of the follow-up study suggest that when people are experiencing financial difficulties during economic recessions, the possibility to improve their financial situation by winning large jackpots with low initial stakes becomes more enticing.

Thresholds of probable problematic gambling involvement for the German population: Results of the Pathological Gambling and Epidemiology (PAGE) Study.

Consumption measures in gambling research may help to establish thresholds of low-risk gambling as 1 part of evidence-based responsible gambling strategies. The aim of this study is to replicate existing Canadian thresholds of probable low-risk gambling (Currie et al., 2006) in a representative dataset of German gambling behavior (Pathological Gambling and Epidemiology [PAGE]; N = 15,023). Receiver-operating characteristic curves applied in a training dataset (60%) extracted robust thresholds of low-risk gambling across 4 nonexclusive definitions of gambling problems (1 + to 4 + Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition [DSM-5] Composite International Diagnostic Interview [CIDI] symptoms), different indicators of gambling involvement (across all game types; form-specific) and different timeframes (lifetime; last year). Logistic regressions applied in a test dataset (40%) to cross-validate the heuristics of probable low-risk gambling incorporated confounding covariates (age, gender, education, migration, and unemployment) and confirmed the strong concurrent validity of the thresholds. Moreover, it was possible to establish robust form-specific thresholds of low-risk gambling (only for gaming machines and poker). Possible implications for early detection of problem gamblers in offline or online environments are discussed. Results substantiate international knowledge about problem gambling prevention and contribute to a German discussion about empirically based guidelines of low-risk gambling.

Gambling in the Mist of Economic Crisis: Results From Three National Prevalence Studies From Iceland.

In October 2008 all three major banks in Iceland went bankrupt with serious consequences for Icelandic society. The national currency lost more than half of its value and there was a sharp increase in household debts and prices for domestic goods. Very little is known about the potential effects of economic recessions on gambling participation and problem gambling. This study reports on the results of three national prevalence studies conducted before and after the economic collapse in Iceland. The same methodology and measures were used in all three studies to ensure their comparability and the studies included in total N = 8.249 participants. There was an increase in past year gambling participation which extended across most gambling types. Only participation on EGMs declined significantly after the economic collapse. Past year prevalence of problematic gambling increased but further examination revealed that this increase is most probably explained by an increase in card and internet gambling among young men. Moreover, those who experienced financial difficulties due to the economic recession were 52% more likely to have bought a lottery ticket during the recession compared to those who were not affected financially. Overall, the results indicate that serious national economic recessions have differential effects on gambling behavior.

The "Pathological Gambling and Epidemiology" (PAGE) study program: design and fieldwork.

The German federal states initiated the "Pathological Gambling and Epidemiology" (PAGE) program to evaluate the public health relevance of pathological gambling. The aim of PAGE was to estimate the prevalence of pathological gambling and cover the heterogenic presentation in the population with respect to comorbid substance use and mental disorders, risk and protective factors, course aspects, treatment utilization, triggering and maintenance factors of remission, and biological markers. This paper describes the methodological details of the study and reports basic prevalence data. Two sampling frames (landline and mobile telephone numbers) were used to generate a random sample from the general population consisting of 15,023 individuals (ages 14 to 64) completing a telephone interview. Additionally, high-risk populations have been approached in gambling locations, via media announcements, outpatient addiction services, debt counselors, probation assistants, self-help groups and specialized inpatient treatment facilities. The assessment included two steps: (1) a diagnostic interview comprising the gambling section of the Composite International Diagnostic Interview (CIDI) for case finding; (2) an in-depth clinical interview with participants reporting gambling problems. The in-depth clinical interview was completed by 594 participants, who were recruited from the general or high-risk populations. The program provides a rich epidemiological database which is available as a scientific use file.

Is poker a game of skill or chance? A quasi-experimental study.

Due to intensive marketing and the rapid growth of online gambling, poker currently enjoys great popularity among large sections of the population. Although poker is legally a game of chance in most countries, some (particularly operators of private poker web sites) argue that it should be regarded as a game of skill or sport because the outcome of the game primarily depends on individual aptitude and skill. The available findings indicate that skill plays a meaningful role; however, serious methodological weaknesses and the absence of reliable information regarding the relative importance of chance and skill considerably limit the validity of extant research. Adopting a quasi-experimental approach, the present study examined the extent to which the influence of poker playing skill was more important than card distribution. Three average players and three experts sat down at a six-player table and played 60 computer-based hands of the poker variant "Texas Hold'em" for money. In each hand, one of the average players and one expert received (a) better-than-average cards (winner's box), (b) average cards (neutral box) and (c) worse-than-average cards (loser's box). The standardized manipulation of the card distribution controlled the factor of chance to determine differences in performance between the average and expert groups. Overall, 150 individuals participated in a "fixed-limit" game variant, and 150 individuals participated in a "no-limit" game variant. ANOVA results showed that experts did not outperform average players in terms of final cash balance. Rather, card distribution was the decisive factor for successful poker playing. However, expert players were better able to minimize losses when confronted with disadvantageous conditions (i.e., worse-than-average cards). No significant differences were observed between the game variants. Furthermore, supplementary analyses confirm differential game-related actions dependent on the card distribution, player status, and game variant. In conclusion, the study findings indicate that poker should be regarded as a game of chance, at least under certain basic conditions, and suggest new directions for further research.

Self-exclusion as a harm minimization strategy: evidence for the casino sector from selected European countries.

As the international gambling market continues to expand, determining effective approaches to prevent gambling-related problems becomes increasingly important. Despite a lack of in-depth research into its benefits, self-exclusion is one such measure already in use around the world in various sectors of the gambling industry. The present study is the first of its kind to examine the effectiveness of self-exclusion schemes in the casino sector in selected European countries. A written survey yielded a sample of N = 152 (self)-excluded gamblers. In addition to this cross-section analysis, a small sub-group (n = 31) was monitored over time by means of follow-up surveys carried out 1, 6, and 12 month(s) after the exclusion agreement came into force. The results reveal that the self-excluded individuals are typically under a great deal of strain and show a relatively pronounced willingness to change. However, this largely reaches its peak at the time the decision to self-exclude is made. From a longitudinal perspective, various parameters indicate a clear improvement in psychosocial functioning; a favorable effect that also starts directly after the exclusion agreement was signed. Finally, considering theoretical and empirical findings, possibilities for optimizing (self-)exclusion schemes will be discussed.

[Coping, adjustment, and bullying among male children and adolescents]. / Stressverarbeitung, psychische Auffäilligkeiten und Bullying bei Jungen.

This study aimes to investigate if bully-victim status types differ in coping with interpersonal stressors, psychological adjustment, and strain state among male pupils. In total, N=207 sixth to ninth graders (aged 10 to 16 years) were asked to complete self-report measures, which assessed experiences with bullying and victimization, coping strategies, externalizing and internalizing problems, and strain. Overall, bully/victims showed the worst psychosocial functioning. Victims were characterized by a mixed pattern of maladaptive coping as well as anger control and internalizing problems. In contrast, bullies scored low on maladaptive coping and high on externalizing problems. Results suggest preventive interventions, which must be tailored to special needs of the groups regularly involved in bullying and victimization.