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1.
J Gambl Stud ; 39(3): 1059-1076, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35704251

RESUMO

Internationally, the prevalence of gambling disorder has been reported to be higher among homeless people than the general population; however, little is known about the factors associated with gambling disorder in this population. The present study aimed to investigate the prevalence of gambling disorder and its associated factors among homeless men using shelters in Osaka City. A cross-sectional survey was conducted from 30 to 2018 to 4 January 2019, using the 2017 Japanese National Survey of Gambling (JNSG) questionnaire, supplemented with questions about homeless experiences, drinking, and smoking. Using the South Oaks Gambling Screen, the presence of gambling disorder was determined by a score ≥ 5 out of 20. Multivariate logistic regression was conducted to explore factors associated with lifetime gambling disorder. Lifetime and past-year prevalence of gambling disorder among 103 participants was 43.7% (95% confidence interval [CI]: 34.5-53.3) and 3.9% (95% CI: 1.5-9.6), respectively, which are higher than the 6.7% and 1.5% found among men in the 2017 JNSG. Reasons reported for currently gambling less were primarily financial. Factors associated with lifetime GD included "more than 20 years since the first incidence of homelessness" (adjusted odds ratio [AOR]: 4.97, 95% CI: 1.50-16.45) and "more than five incidences of homelessness" (AOR: 4.51, 95% CI: 1.06-19.26). When homeless individuals with gambling disorder try to rebuild and stabilize their lives, the presence or resurgence of gambling disorder may hinder the process and pose a risk of recurring homelessness. Comprehensive support services for homeless individuals with gambling disorder are required. (250 words).


Assuntos
Jogo de Azar , Pessoas Mal Alojadas , Masculino , Humanos , Jogo de Azar/psicologia , Estudos Transversais , Prevalência , Japão/epidemiologia
2.
BMC Public Health ; 20(1): 1022, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600398

RESUMO

BACKGROUND: Despite increasing attention to the social determinants of health in recent decades, globally there is an unprecedented burden from non-communicable diseases (NCDs). Recently, the corporate and commercial conditions associated with these, commercial determinants of health (CDoH), have also begun to receive attention. This research aims to articulate the CDoH as described in the literature, summarize substantive findings, and assess strengths and limitations of current literature. METHODS: Systematic review of formal (Medline, EMBASE, Scopus, Global Health) and grey literature (database, Google Advanced, targeted website, citation searching). Searching identified 125 texts for full-text review, with 33 included for final review. Data extracted were analyzed thematically. RESULTS: The dynamics constituting CDoH include broad facilitators such as globalization of trade, corporate structures, and regulatory systems, articulation of social and economic power, neoliberal and capitalist ideologies; additional elements include corporate activities such as marketing, corporate political activities, corporate social responsibility, extensive supply chains, harmful products and production, and issues of accessibility. These contribute significantly to worsened global health outcomes. CONCLUSIONS: Literature describing effects of macro conditions and corporate activities on health could usefully utilize CDoH terminology. Facilitation via revised, consistent and operational definition of CDoH would assist. Social, political, commercial and economic structures and relations of CDoH are under-theorized. Systematic approaches to identifying, describing, and disrupting these are required to improve global health.


Assuntos
Comércio , Saúde Global/tendências , Doenças não Transmissíveis/epidemiologia , Humanos , Internacionalidade , Política , Determinantes Sociais da Saúde , Responsabilidade Social
3.
Health Promot Int ; 35(4): 671-681, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31257421

RESUMO

Complexity and systems science are increasingly used to devise interventions to address health and social problems. Boundaries are important in systems thinking, as they bring attention to the power dynamics that guide decision-making around the framing of a situation, and how it is subsequently tackled. Using complexity theory as an analytical frame, this qualitative exploratory study examined boundary interactions between local government and community health organizations during the operationalization of a systems-based initiative to prevent obesity and chronic diseases (Healthy Together Communities-HTCs) in Victoria, Australia. Across two HTC sites, data was generated through semi-structured interviews with 20 key informants, in mid-2015. Template analysis based on properties of complex systems was applied to the data. The dynamics of boundary work are explored using three case illustrations: alignment, boundary spanning and boundary permeability. Alignment was both a process and an outcome of boundary work, and occurred at strategic, operational and individual levels. Boundary spanning was an important mechanism to develop a unified collaborative approach, and ensure that mainstream initiatives reached disadvantaged groups. Finally, some boundaries exhibited different levels of permeability for local government and community health organizations. This influenced how each organization could contribute to HTC interventions in unique, yet complementary ways. The study of boundary work offers potential for understanding the mechanisms that contribute to the nonlinear behaviour of complex systems. The complementarity of partnering organizations, and boundary dynamics should be considered when designing and operationalizing multilevel, complex systems-informed prevention initiatives.


Assuntos
Doença Crônica/prevenção & controle , Promoção da Saúde/organização & administração , Obesidade/prevenção & controle , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/métodos , Humanos , Governo Local , Pesquisa Qualitativa , Vitória
4.
Health Promot Int ; 35(5): 1015-1025, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31550349

RESUMO

Time-limited prevention initiatives are frequently used to address complex and persisting public health issues, such as non-communicable diseases. This often creates issues in terms of achieving sustainable change. In this study, we use a system dynamic perspective to explore the effects of stop-start funding over system behaviour in two community-based initiatives designed to prevent chronic diseases and obesity. We conducted a qualitative exploratory study using complexity theory as an analytical lens of two Healthy Together Communities (HTCs) initiatives in Victoria, Australia. Data were generated from 20 semi-structured interviews with health promotion practitioners and managers, from community health and local government organizations. Template analysis based on properties of complex systems informed the inductive identification of system behaviour narratives across the stop-start life-course of HTCs. A central narrative of system behaviour emerged around relationships. Within it, we identified pre-existing contextual conditions and intervention design elements that influenced non-linearity of system self-organization and adaptation, and emergence of outcomes. Examples include cynicism, personal relationships and trust, and history of collaboration. Feedback loops operated between HTCs and these conditions, in a way that could influence long-term system behaviour. Taking a dynamic life-course view of system behaviour helps understand the pre-existing contextual factors, design and implementation influences, and feedback loops which shape the long-term legacy of short-lived interventions aimed at solving complex issues. In turn, greater awareness of such interactions can inform better design and implementation of community-based interventions.


Assuntos
Promoção da Saúde , Governo Local , Doença Crônica , Humanos , Obesidade , Vitória
5.
Health Promot J Austr ; 31(2): 298-308, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31353685

RESUMO

ISSUE ADDRESSED: Globally and locally, environmental degradation (including climate change) and inequity pose major risks to health. While health promoters recognise the importance of both issues, they may be seen as separate agendas. This study investigated health promotion addressing both issues together. METHODS: The study was an investigation of health promotion practice addressing environmental sustainability and equity, conducted in 2013, as part of a community-based participatory action research project with three Primary Care Partnerships (PCPs) in Victoria, Australia, during 2009-2016. RESULTS: Thirty-two local health promotion projects addressing both environmental sustainability and equity were identified. Analysis showed clusters of environmental, equity and health themes, particularly around: (a) caring for local environment, food, access to nature and Indigenous participation; (b) sustainability of housing, thermal comfort and reducing energy costs; and (c) sustainable and active transport. The study also found a marked decline in the number of PCPs in Victoria identifying environmental sustainability as a priority in 2013, compared to 2009. Analysis of helpful factors and challenges to practice identified by research participants, suggests interrelated political, organisational and discursive factors contributed to this decline. CONCLUSIONS: The study suggests local health promotion can contribute to the development of societies that are more ecologically sustainable and more equitable. However, the challenges suggest broader advocacy is required to support local action. SO WHAT?: Environmental degradation and inequity are major threats to human and ecosystem health. This study shows local health promotion can address both issues concurrently, and provides important information about challenges to this work.


Assuntos
Conservação dos Recursos Naturais/métodos , Equidade em Saúde/organização & administração , Promoção da Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Pesquisa Participativa Baseada na Comunidade , Humanos , Vitória
6.
BMC Public Health ; 19(1): 517, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060524

RESUMO

BACKGROUND: Electronic gambling machines (EGMs) are in casinos and community venues (hotels and clubs) in all jurisdictions in Australia, except Western Australia (only in casino). EGMs have a range of features that can affect how people gamble, which can influence losses incurred by users. The Northern Territory Government recently changed two EGM policies - the introduction of note acceptors on EGMs in community venues, and an increase in the cap from 10 to 20 EGMs in hotels and 45 to 55 in clubs. This study evaluates two changes in EGM policy on user losses in community venues, and tracks changes in user losses per adult, EGM gambler, and EGM problem/moderate risk gambler between 2005 and 2015. METHODS: Trends in venue numbers, EGM numbers, user losses and user losses per EGM by venue type and size are presented to determine if EGM policy changes affected user losses. Data from the 2005 and 2015 NT gambling surveys are used to determine EGM user losses per adult, per EGM gambler, and per EGM problem and/or moderate risk gambler, with several assumptions applied. RESULTS: From 2010 (post smoking ban) to 2013 real user losses were stagnant, but from 2013 to 2017, real user losses in community venues increased 19, 9, 8 and 5% per annum, with increases higher in clubs and hotels with the maximum allowable number of EGMs. Over the same period user losses in the two casinos declined by 13%. Between 2005 and 2015, estimated user losses per EGM problem/moderate risk and problem gambler increased by 5 and 34% respectively. CONCLUSIONS: The analysis demonstrates that reductions in how much money gamblers can insert into an EGM (load-up limit), and/or the abolition of note acceptors, and reductions in the number of EGMs in venues is likely to reduce harm from EGM use. Given the demonstrated inability for Australian jurisdictions to identify and implement effective harm prevention and minimisation interventions, a national approach to gambling regulation in Australia may be desirable. Similarly, national co-ordination of research, particularly on EGMs and online betting is required to better understand changes in gambling policy on related harms.


Assuntos
Eletrônica , Jogo de Azar , Políticas , Adolescente , Adulto , Idoso , Austrália , Feminino , Jogo de Azar/economia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
7.
BMC Public Health ; 19(1): 989, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337366

RESUMO

It was highlighted that in the original article [1] Fig. 3 and Fig. 4 legends were incorrect. This Correction article shows Fig. 3 and Fig. 4 with their correct legend.

8.
Int J Health Plann Manage ; 33(2): e636-e647, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29573281

RESUMO

PURPOSE: Independent, not-for-profit community health services in the state of Victoria, Australia, provide one of that country's few models of comprehensive primary health care (PHC). Recent amalgamations among some such agencies created regional-sized community health organisations, in a departure from this sector's traditionally small local structure. This study explored the motivations, desired outcomes, and decision-making process behind these mergers. METHODOLOGY: Qualitative exploratory study was based on 26 semistructured interviews with key informants associated with 2 community health mergers, which took place in 2014 in Victoria, Australia. Thematic data analysis was influenced by concepts derived from institutional theory. FINDINGS: Becoming bigger by merging was viewed as the best way to respond to mounting external pressures, such as increasingly neoliberal funding mechanisms, perceived as threatening survival. Desired outcomes were driven by comprehensive PHC values, and related to creating organisational capacity to continue providing quality services to disadvantaged communities. ORIGINALITY/VALUE: This study offers insights into decision-making processes geared towards protecting the comprehensiveness of PHC service delivery for disadvantaged communities, ensuring financial viability, and surviving neoliberal economic policy whilst preserving communitarian values. These are relevant to an international audience, within a global context of rising health inequities, increasingly tight fiscal environments, and growing neoliberal influences on health policymaking and funding.


Assuntos
Serviços de Saúde Comunitária , Instituições Associadas de Saúde/organização & administração , Política , Tomada de Decisões Gerenciais , Entrevistas como Assunto , Motivação , Atenção Primária à Saúde , Pesquisa Qualitativa , Vitória
9.
Qual Health Res ; 28(12): 1897-1909, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29671375

RESUMO

Comprehensive theories of health justice can supplement rights-based approaches like primary health care, by conceptualizing key terms, and systematizing knowledge about structural factors that influence health. Our aim was to use "health capability" as a theoretical lens for understanding how primary health care approaches might address structural factors impeding health in a rural Swazi community. We conducted abductive, interpretive, analysis of a mixed-method (QUAL+quan) data set about "health capability deprivations," generated through participatory action research. Four themes are discussed: illness and disease, unhealthy daily living environments, inability to move freely, and gendered expectations and norms. The analysis demonstrates that there were complex interrelationships between health capability deprivations, material and ideological deprivation prevented community members from aspiring to or securing their right to health, health capability theory can augment primary health care approaches and vice versa, and qualitatively driven, mixed-method research can generate unique insights about structural factors that influence health.


Assuntos
População Negra/psicologia , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Pesquisa Participativa Baseada na Comunidade , Culinária , Meio Ambiente , Essuatíni/epidemiologia , Feminino , Abastecimento de Alimentos , Identidade de Gênero , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Abastecimento de Água , Adulto Jovem
10.
Aust J Prim Health ; 21(3): 268-72, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25194398

RESUMO

Until now, comprehensive service planning has been uncommon in the Victorian community health sector. Where it has occurred, it has primarily been undertaken by community health services embedded within larger, hospital-based health services. Reflections on the utility and efficacy of community health service planning are largely absent from the Australian peer-reviewed literature. Using a case study focussed on a specific centre in Melbourne's outer suburbs, this paper explores how community health service planning is shaped by the current policy context, the legal status of registered community health services, and the data and methodologies available to inform planning. It argues that regular and systematic service planning could support registered community health centres to better understand their unique position within the primary health-care landscape, having regard to their inherent opportunities and vulnerabilities. Furthermore, consistent and effective service planning is proposed to benefit agencies in establishing themselves as critical players in promoting local population health initiatives and driving improved health outcomes.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Humanos , Estudos de Casos Organizacionais , População Suburbana , Vitória
11.
Aust Health Rev ; 37(5): 574-8, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23632204

RESUMO

OBJECTIVES: To determine what types of supply-side change underpinned the recent decline in longer (Level C and D) consultation provision and to evaluate the impact of the May 2010 reforms in realigning Medicare with long-term health policy objectives. METHODS: Retrospective analysis of Level C and D consultation provision by general practitioners (GPs) across Australia. Outcome measures were extent (number of consultations per providing GP) and participation (proportion of GPs providing these consultations). RESULTS: The proportion of GPs participating in Level C consultation provision is substantial (96%) and constant; however, extent of provision per GP decreased by 21% between 2006 and 2010. Level D participation decreased from 72% during 2006 to a nadir of 62% in 2009, and extent of provision decreased by 26% between 2006 and 2010. CONCLUSION: Two distinct types of change underpinned the overall decline in Level C and D consultation provision. GPs appear to be providing Level C consultations less often, but the overwhelming majority still provide these consultations to some extent. The extent of provision of Level D consultations and the proportion of GPs providing them has decreased; an appreciable number of GPs simply stopped providing Level D consultations. Medicare reforms appear ineffective in realigning Medicare with long-term policy objectives.


Assuntos
Clínicos Gerais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Austrália , Humanos , Estudos Retrospectivos
12.
Int J Health Policy Manag ; 12: 7723, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37579379

RESUMO

BACKGROUND: Commercial determinants of health (CDoH) represent a critical frame for exploring undue corporate and commercial influence over health. Power lenses are integral to understanding CDoH. Impacts of food, alcohol, and gambling industries are observable CDoH outcomes. This study aims to inform understanding of the systems and institutions of commercial and/or corporate forces working within the Australian food, alcohol, and gambling industries that influence health and well-being, including broader discourses materialised via these systems and institutions. METHODS: Twenty semi-structured interviews were conducted with key-informants on Australian public policy processes. Interviewees were current and former politicians, political staff members, regulators and other public servants, industry representatives, lobbyists, journalists, and researchers with expertise and experience of the Australian food, alcohol, and/ or gambling industries. Interviews sought participants' perceptions of Australian food, alcohol, and gambling industries' similarities and differences, power and influence, relationships, and intervention opportunities and needs. RESULTS: Strategies and tactics used by Australian food, alcohol and gambling industries are similar, and similar to those of the tobacco industry. They wield considerable soft (eg, persuasive, preference-shaping) and hard (eg, coercive, political, and legal/economic) power. Perceptions of this power differed considerably according to participants' backgrounds. Participants framed their understanding of necessary interventions using orthodox neoliberal discourses, including limiting the role of government, emphasising education, consumer freedom, and personal choice. CONCLUSION: Food, alcohol, and gambling industries exercise powerful influences in Australian public policy processes, affecting population health and well-being. Per Wood and colleagues' framework, these manifest corporate, social, and ecological outcomes, and represent considerable instrumental, structural, and discursive power. We identify power as arising from discourse and material resources alike, along with relationships and complex industry networks. Addressing power is essential for reducing CDoH harms. Disrupting orthodox discourses and ideologies underpinning this should be a core focus of public health (PH) advocates and researchers alike.


Assuntos
Jogo de Azar , Indústria do Tabaco , Humanos , Austrália , Política , Política Pública , Saúde Pública
13.
Asia Pac J Public Health ; 35(8): 479-485, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37727956

RESUMO

The National Health Protection (NHP) of Indonesia is a pro-poor social health insurance as the government pays the monthly premium for the poor. A waste picker is classified as an urban poor group needing affordable or free access to health care. This study explores the extent to which the NHP protects the health of waste pickers and provides them with quality health care. For this mixed-method study, 342 waste pickers completed the survey, 40 engaged in interviews, and 15 participated in Natural Group Discussions. The study found that 20% of waste pickers were not enrolled in NHP due to issues such as incorrect validation of poverty, discrimination, illegal fees, nepotism, unaffordable premiums, and lack of interest in purchasing the health plan. Among those who were enrolled, waste pickers expressed satisfaction with the health care they received and the behavior of the staff. However, they did criticize certain aspects such as waiting times, service gaps between full-paying and subsidized patients, suspicion of the quality of medicines, complicated medical administration procedures, and inflexibility of the capitation system. The study concludes that despite the NHP, poor groups remain vulnerable to accessing free health care.


Assuntos
Eliminação de Resíduos , Humanos , Reciclagem , Indonésia , Seguro Saúde , Previdência Social
14.
Addict Behav Rep ; 18: 100500, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38169673

RESUMO

Introduction: Losses disguised as wins (LDWs) are a salient type of losing outcome common to electronic gambling machines (EGMs). These events occur when a gambling payout is less than the amount wagered (i.e., a net loss) but is nonetheless accompanied by the sounds and animations that accompany genuine wins. Previous lab-based studies have reported that participants tend to overestimate genuine wins when LDWs are present. This study reports an independent replication of these findings in a large online sample that included a substantial number of individuals reporting high-risk gambling and frequent EGM users. Methods: This online study recruited a sample of 940 participants who were randomly assigned to view one of two brief videos. Each video displayed a short period of simulated online slot machine gambling and included 2 genuine wins and either 3 or 0 LDWs. Participants were asked to estimate the number of times a win occurred that was more than the amount bet. Participants also completed the Problem Gambling Severity Index. Results: The mean estimated number of genuine wins was significantly larger for the condition displaying LDWs, 3.02 [95% CI = 2.82, 3.21] than the control condition, 2.14 [1.98, 2.30], t(887.66) = 6.78, d = 0.44, p <.001. Conclusions: We replicated the LDW-triggered win overestimation effect previously reported in lab-based experiments that have recruited smaller samples. This effect was robust in both low-risk and high-risk groups, indicating that even experienced gamblers remain susceptible. Exploratory modelling suggested only a minority of individuals were uninfluenced by LDWs.

15.
Drug Alcohol Rev ; 42(5): 1235-1245, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37071591

RESUMO

INTRODUCTION: Excessive alcohol use is associated with non-communicable diseases and social problems, such as work absence, financial problems and family violence. Expenditure and expenditure shares on alcohol are valuable measures to monitor financial activities on this risk behaviour. The aim of this paper is to report trends in alcohol expenditure in Australia over the last two decades. METHODS: Data are from six waves of Australian Household Expenditure Surveys from 1984 to 2015-2016. We explored trends of alcohol expenditure among Australians and in different socio-demographic groups in the last 30 years. We further examined changes of expenditure on different on- and off-premises beverages over time. RESULTS: Absolute alcohol expenditure has remained the same between the 1980s and 2016, after accounting for inflation. However, a declining trend in relative alcohol expenditure as a proportion of total household expenditure was found across nearly all demographic groups (e.g., sex, age, employment, household income), except for women aged 45-54, who showed an increasing trend of alcohol expenditure after 1998-1999. DISCUSSION AND CONCLUSIONS: The current study shows declines in relative alcohol expenditure, which may reflect declines in alcohol's relative importance within the elements of the person's lifestyle they need to pay for and/or increased awareness of alcohol's health and social harms. Further longitudinal analysis should explore additional predictors of household expenditure on alcohol. Results suggest that current bi-annual indexation increases in alcohol tax should account for increases in income to ensure the effectiveness of pricing. Moreover, attention is needed to address drinking among middle-aged females.


Assuntos
Consumo de Bebidas Alcoólicas , Gastos em Saúde , Pessoa de Meia-Idade , Humanos , Feminino , Austrália/epidemiologia , Bebidas Alcoólicas , Etanol
16.
J Immigr Minor Health ; 25(6): 1402-1425, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36976449

RESUMO

Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.


Assuntos
Etnicidade , Migrantes , Humanos , Grupos Minoritários , Minorias Étnicas e Raciais , Pesquisa Qualitativa
17.
Addict Behav ; 125: 107151, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34700154

RESUMO

INTRODUCTION: There is growing concern internationally about co-occurring gambling and homelessness. We systematically review prevalence estimates in help-seeking and community samples. METHODS: Adopting PRISMA guidelines, we searched CINAHL Plus, Cochrane Library, Embase, Ovid MEDLINE, PsychINFO, Proquest Central, PubMed, Scopus, Web of Science, and Google Scholar for relevant peer-reviewed articles in English. Primary outcomes examined in narrative and quantitative syntheses included prevalence of: (i) gambling in persons experiencing homelessness; (ii) harmful gambling in persons experiencing homelessness; and, (iii) homelessness in persons experiencing harmful gambling. RESULTS: Searches identified 917 records after removing duplicates. After screening, 45 articles providing 54 prevalence estimates across 12 countries were included, with help-seeking (k = 37) and community based sample (k = 8) estimates pooled separately. Gambling prevalence (all timeframes) in help-seeking samples of persons experiencing homelessness is low (28.7%, 95% CI: 17.3-41.7, k = 14) compared to the general population (approximately 60-80%). However, harmful gambling prevalence (including problem, pathological, and disordered gambling) in help-seeking samples of persons experiencing homelessness is high (16.5%, 95% CI: 10.2-24.2, k = 20) compared to the general population (approximately 1-7%). Additionally, homelessness prevalence is high in help-seeking samples of persons experiencing harmful gambling (23.6%, 95% CI: 18.4-29.2, k = 4) compared to the general population (<1%). Meta-analysis found high between-study heterogeneity and risk of bias from small samples sizes. CONCLUSIONS: There are high rates of harmful gambling in persons experiencing homelessness and, concurrently, high rates of homelessness in persons experiencing harmful gambling. Improvements in sampling and measurement are needed to strengthen robustness and generalizability of prevalence estimates, which can potentially inform the scale and targeting of clinical interventions, support services, and policy responses.


Assuntos
Jogo de Azar , Pessoas Mal Alojadas , Jogo de Azar/epidemiologia , Humanos , Prevalência
18.
Addiction ; 117(6): 1702-1712, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34817109

RESUMO

BACKGROUND AND AIMS: Homelessness is one of the most significant harms associated with gambling and appears to affect older adults disproportionately, but the relationship has received little research attention. This exploratory study investigated how gambling and homelessness is linked in older adults. METHODS: Using qualitative research methods, we undertook in-depth semi structured face-to-face individual and group interviews to gather data from a purposive sample (n = 48) of key informants working in service provision for older adults (aged 50+ years) experiencing gambling-related harm and/or homelessness in Victoria, Australia. Thematic analysis of data focused on evaluating mechanisms and identifying contextual conditions that activate pathways between gambling and homelessness. RESULTS: The relationship between gambling and homelessness in older adults is often indirect and non-linear, and can represent a reflexive cycle. Experiencing periods of homelessness into older age can contribute to gambling, often because the adverse impacts of homelessness on older adults' mental and material wellbeing increase the appeal of gambling. Additionally, comorbidities (e.g. substance use, mental illness, past trauma) and structural conditions (e.g. gambling accessibility, poverty, housing insecurity) can activate gambling. Furthermore, because gambling in the older homeless adult population is frequently hidden and regularly overlooked by service providers, it often continues unabated. Gambling in older adults can also contribute to the onset of first-time homelessness. Large and rapid losses from high-intensity gambling frequently characterize this route to homelessness. Such gambling is often triggered by major life events and changes (e.g. bereavement, job loss, relationship difficulties), and the outcomes are often worsened by the conduct of gambling operators and creditors. CONCLUSIONS: The link between gambling and homelessness in older adults is complex, with connecting mechanisms often contingent upon individual, interpersonal and structural conditions and contexts. There is potential for preventative and ameliorative action given many of the underlying conditions appear modifiable through policy intervention.


Assuntos
Jogo de Azar , Pessoas Mal Alojadas , Idoso , Jogo de Azar/epidemiologia , Habitação , Humanos , Pesquisa Qualitativa , Problemas Sociais , Vitória/epidemiologia
19.
Syst Rev ; 11(1): 12, 2022 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-35042545

RESUMO

BACKGROUND: Stigma is a social process that impedes access to support for mental health conditions and alcohol and other drug (AOD) use, particularly for people from migrant and ethnic minority backgrounds. There is limited understanding, however, of people's experiences of stigma, the underlying drivers, intersections with ethnicity, gender, and citizenship status, and how powerful discourses and social institutions create and perpetuate systems of stigma. This review aims to synthesise and critically analyse qualitative evidence to understand how stigma associated with mental health conditions and AOD use operates among people from migrant and ethnic minority groups. METHODS: Qualitative evidence will be identified using MEDLINE, Embase, PsycINFO, CINAHL, Applied Social Sciences Index and Sociological Abstracts. Two reviewers will screen the titles, abstracts and full-text articles. Eligible studies will include original, empirical, peer-reviewed qualitative evidence, published in English since 1990. Studies must examine stigma in relation to mental health conditions, illicit drug use or alcohol consumption among participants who are from migrant and ethnic minority backgrounds. Studies will be critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the level of confidence in the findings will be assessed using Confidence in the Evidence from Reviews of Qualitative research. Data will be analysed using the 'best fit' framework synthesis approach, drawing on the Health Stigma and Discrimination Framework. DISCUSSION: This review will provide an in-depth understanding of the stigma associated with mental health conditions and AOD use among people from migrant and ethnic minority backgrounds. The findings will inform culturally responsive interventions that aim to reduce the negative impact of stigma on individuals, families and communities. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021204057.


Assuntos
Preparações Farmacêuticas , Migrantes , Minorias Étnicas e Raciais , Etnicidade , Humanos , Saúde Mental , Grupos Minoritários , Pesquisa Qualitativa , Revisões Sistemáticas como Assunto
20.
BMC Public Health ; 11: 58, 2011 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-21272368

RESUMO

BACKGROUND: Increasing concern about the negative impact of alcohol on the Australian community has renewed calls for tighter regulatory controls. This paper reviews levels of and trends in public support for liquor control regulations, regulation of alcohol promotions, and alcohol pricing and taxation reforms in Australia between 1998 and 2009. METHODS: Six electronic databases and twenty public health and alcohol organisation websites were searched for research literature, reports and media releases describing levels of public support for alcohol controls. Only studies which randomly selected participants were included. RESULTS: Twenty-one studies were included in the review. The majority of the Australian public support most proposed alcohol controls. Levels of support are divided between targeted and universal controls. CONCLUSIONS: Implementation of targeted alcohol policies is likely to be strongly supported by the Australian public, but universal controls are liable to be unpopular. Policy makers are provided with insights into factors likely to be associated with higher public support.


Assuntos
Alcoolismo/prevenção & controle , Regulamentação Governamental , Opinião Pública , Austrália , Bases de Dados como Assunto , Humanos
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