Benchmarking gambling screens to health-state utility: the PGSI and the SGHS estimate similar levels of population gambling-harm.

BACKGROUND: Both the Problem Gambling Severity Index (PGSI) and the Short Gambling Harms Screen (SGHS) purport to identify individuals harmed by gambling. However, there is dispute as to how much individuals are harmed, conditional on their scores from these instruments. We used an experienced utility framework to estimate the magnitude of implied impacts on health and wellbeing. METHODS: We measured health utility using the Short Form Six-Dimension (SF-6D), and used this as a benchmark. All 2603 cases were propensity score weighted, to balance the affected group (i.e., SGHS 1+ or PGSI 1+ vs 0) with a reference group of gamblers with respect to risk factors for gambling harm. Weighted regression models estimated decrements to health utility scores attributable to gambling, whilst controlling for key comorbidities. RESULTS: We found significant attributable decrements to health utility for all non-zero SGHS scores, as well as moderate-risk and problem gamblers, but not for PGSI low-risk gamblers. Applying these coefficients to population data, we find a similar total burden for both instruments, although the SGHS more specifically identified the subpopulation of harmed individuals. For both screens, outcomes on the SF-6D implies that about two-thirds of the 'burden of harm' is attributable to gamblers outside of the most severe categories. CONCLUSIONS: Gambling screens have hitherto provided nominal category membership, it has been unclear whether moderate or 'at-risk' scores imply meaningful impact, and accordingly, population surveys have typically focused on problem gambling prevalence. These results quantify the health utility decrement for each category, allowing for tracking of the aggregate population impact based on all affected gamblers.

Measuring Behavioural Dependence in Gambling: A Case for Removing Harmful Consequences from the Assessment of Problem Gambling Pathology.

Behavioural dependence (BD) for gambling has traditionally been subsumed under the concept of 'problems': a hybrid construct that includes both indicators of BD, and adverse consequences (harm) arising from excessive time and money expenditure. Although progress has been made towards specific measurement of harm, dedicated measures of BD do not exist. Theory led us to expect that (1) dependence and harm are measurably distinct constructs, (2) harm mediates the relationship between dependence and wellbeing, and finally, that (3) separate measures should be more effective than a unidimensional problems measure in predicting wellbeing. Candidate BD items from six existing measures of gambling problems were extracted and evaluated with respect to DSM-5 criteria and content overlap, leading to 17 candidate items. This was further reduced to 8 items based on both item content and psychometric criteria, using data from an online panel of 1524 regular gamblers, with demographic characteristics similar to Australian population norms. Participants also completed measures of harm, problems, and subjective wellbeing. All three hypotheses were confirmed. BD was shown to be highly reliable and unidimensional, and measurably distinct from gambling harms. Harm mediated the negative relationship between BD and wellbeing. The harm + BD model yielded better predictions of personal wellbeing that a unidimensional, continuous problems measure-and explained about twice the variance of a simple contrast between problem and non-problem gamblers. We conclude that is psychometrically justified to specifically measure gambling BD, and this may be of particular use in theoretically-driven applications.

A Quantification of the Net Consumer Surplus from Gambling Participation.

Gambling exposes people to risk for harm, but also has recreational benefits. The present study aimed to measure gambling harm and gambling benefits on similar scales using two novel methods adapted from the Burden of Disease approach (McCormack et al. in Psychol Med 18(4):1007-1019, 1988; Torrance et al. in Health Serv Res 7(2):118-133, 1972) to find whether gambling either adds or subtracts from quality of life. A Tasmanian population-representative survey of 5000 adults (2534 female) from random digit dialling (RDD) of landline telephones in Tasmania (50%), as well as pre-screened Tasmanian RDD mobiles (17%) and listed mobile numbers (33%), measured gambling benefits and harms amongst gamblers (59.2%) and a non-exclusive set of people who were "affected" by someone else's gambling (4.5%). The majority of gamblers indicated no change to their quality of life from gambling (82.5% or 72.6% based on direct elicitation or time trade off methods, respectively). Nevertheless, a weighted average of all the positive and negative influences on quality of life, inclusive of gamblers and affected others, revealed that the quality of life change from gambling is either a very modest + 0.05% or a more concerning - 1.9% per capita. Gambling generates only small or negative net consumer surpluses for Tasmanians.

Validation of the Short Gambling Harm Screen (SGHS): A Tool for Assessment of Harms from Gambling.

It is common for jurisdictions tasked with minimising gambling-related harm to conduct problem gambling prevalence studies for the purpose of monitoring the impact of gambling on the community. However, given that both public health theory and empirical findings suggest that harms can occur without individuals satisfying clinical criteria of addiction, there is a recognized conceptual disconnect between the prevalence of clinical problem gamblers, and aggregate harm to the community. Starting with an initial item pool of 72 specific harms caused by problematic gambling, our aim was to develop a short gambling harms scale (SGHS) to screen for the presence and degree of harm caused by gambling. An Internet panel of 1524 individuals who had gambled in the last year completed a 72-item checklist, along with the Personal Wellbeing Index, the PGSI, and other measures. We selected 10 items for the SGHS, with the goals of maximising sensitivity and construct coverage. Psychometric analysis suggests very strong reliability, homogeneity and unidimensionality. Non-zero responses on the SGHS were associated with a large decrease in personal wellbeing, with wellbeing decreasing linearly with the number of harms indicated. We conclude that weighted SGHS scores can be aggregated at the population level to yield a sensitive and valid measure of gambling harm.

Environmental Factors in the Choice of EGMs: A Discrete Choice Experiment.

EGMs are a form of entertainment, and the gambling environment is an important contributor to the overall experience. Logically, to select a play-environment, EGM gamblers must choose the platform through which to access the EGM (e.g., internet, mobile application or land-based venue), a particular provider (e.g., specific website, app vendor or branded casino), and the game itself (e.g., based on graphical theme or bonus features; Thorne et al. in J Gambl Stud, 2016. doi: 10.1007/s10899-016-9601-2 ). A discrete choice experiment was conducted to identify the features of the platform, provider and game that are most strongly preferred by EGM gamblers. Participants were 245 EGM gamblers from clubs in Victoria, Australia and 7516 EGM gamblers from an Australian online panel. Results indicate that the ideal environment for the average gambler consists of: gambling at a club that is close to home; with a group of friends; in a relatively quiet place that has air conditioning, cheap food and a large space to play in; on a classic game with quality animations and small bet sizes; where you feel safe and secure; and where there is a wide variety of other games to play when you are done. Segmenting these results by problem-gambler status highlights important differences in preferences between problem and non-problem gamblers. Problem gamblers are less likely to give weight to the company they share and have a preference for larger venues. Using a powerful paradigm from marketing research, the present study was able to determine the relative value of different features of the EGM gambling environment, and also contributes important insight towards what constitutes a safer environment for recreational play.

Veiled EGM Jackpots: The Effects of Hidden and Mystery Jackpots on Gambling Intensity.

Understanding the impact of EGM Jackpots on gambling intensity may allow targeted strategies to be implemented that facilitate harm minimisation by acting to reduce losses of gamblers who play frequently, while maintaining the enjoyment and excitement of potential jackpots. The current study investigated the influences of Hidden and Mystery Jackpots on EGM gambling intensity. In a Hidden Jackpot, the prize value is not shown to the player, although the existence of a jackpot prize is advertised. In a Mystery Jackpot, the jackpot triggering state of the machine is unknown to players. One hundred and seven volunteers (males = 49, females = 58) played a laptop-simulated EGM with a starting $20 real-money stake and a chance to win a Jackpot ($500). Participants played for either a Hidden or Known Jackpot Value, with either a Mystery or Known winning symbol combination in a crossed design. Lastly, a control condition with no jackpot was included. Gambling intensity (speed of bets, persistence) was greater when the Jackpot value was unknown, especially when a winning-symbol combination suggested that a win was possible. While there is no evidence in the present investigation to suggest that Hidden or Mystery jackpots contribute to greater player enjoyment, there is some evidence to suggest a marginal positive contribution of hidden jackpots to risky playing behaviour.

Jackpot Structural Features: Rollover Effect and Goal-Gradient Effect in EGM Gambling.

Relatively little research has been undertaken on the influence of jackpot structural features on electronic gaming machine (EGM) gambling behavior. This study considered two common features of EGM jackpots: progressive (i.e., the jackpot incrementally growing in value as players make additional bets), and deterministic (i.e., a guaranteed jackpot after a fixed number of bets, which is determined in advance and at random). Their joint influences on player betting behavior and the moderating role of jackpot size were investigated in a crossed-design experiment. Using real money, players gambled on a computer simulated EGM with real jackpot prizes of either $500 (i.e., small jackpot) or $25,000 (i.e., large jackpot). The results revealed three important findings. Firstly, players placed the largest bets (20.3 % higher than the average) on large jackpot EGMs that were represented to be deterministic and non-progressive. This finding was supportive of a hypothesized 'goal-gradient effect', whereby players might have felt subjectively close to an inevitable payoff for a high-value prize. Secondly, large jackpots that were non-deterministic and progressive also promoted high bet sizes (17.8 % higher than the average), resembling the 'rollover effect' demonstrated in lottery betting, whereby players might imagine that their large bets could be later recouped through a big win. Lastly, neither the hypothesized goal-gradient effect nor the rollover effect was evident among players betting on small jackpot machines. These findings suggest that certain high-value jackpot configurations may have intensifying effects on player behavior.

Attitudes Towards Gambling and Gambling Reform in Australia.

The Attitudes Towards Gambling Scale (ATGS) is a 14-item survey instrument examining general attitudes towards gambling (Orford et al. in Int Gambl Stud 9(1):39-54, 2009). The current study examined the validity of this scale in an Australian community sample of 1794 adults (52.8 % female). As well as considering measures of internal consistency and factor loadings, we examined the functional utility of the scale as a mediator of gambling activity, problem gambling status, and consequent opinions on national gambling-reform legislation. We found internal consistency and factor loadings of the ATGS within the Australian sample to be comparable with those observed in the original UK study. Additionally, ATGS scores were found to be a relatively robust predictor of attitudes towards gambling reform and harm minimisation. Further, the ATGS mediated the relationships between experiences with gambling and attitudes towards harm reduction. The findings suggest that the ATGS is a useful tool for examining general attitudes towards gambling within an Australian context.

Jackpot Expiry: An Experimental Investigation of a New EGM Player-Protection Feature.

Given the evidence for the motivating influence of electronic gaming machines (EGM) jackpots on intensifying player behaviour (Rockloff and Hing in J Gambl Stud 1-7, 2013), there is good reason to explore consumer-protection features. Jackpot Expiry is a potential feature of a mandatory pre-commitment system or player identification system (e.g., loyalty program) whereby the availability of jackpots expires after a fixed interval of play. One hundred and thirty volunteers (males = 56, females = 74) played a laptop-simulated EGM with a starting $20 real-money stake. In the test condition, players were shown a "relevant" message stating that the promised jackpot had expired and could no longer be won by the participant (after the 20th trial). In the irrelevant message condition a similar pop-up message simply said to push the button to continue. Lastly, a control condition had no pop-up message about the jackpot expiring. The results showed that betting speeds (one indicator of gambling intensity) were significantly slowed by the relevant 'expiry' message. Most importantly, all wagers past the 20th trial were programmed as losses. Player receiving the 'expiry' message for a cash jackpot quit with significantly more money remaining on the machine. Therefore, jackpot expiry was effective in limiting player losses, while there was no evidence that jackpot expiry reduced self-rated player enjoyment of the simulated EGM experience.

EGM Jackpots and Player Behaviour: An In-venue Shadowing Study.

Although electronic gaming machine (EGM) jackpots are widespread, little research has yet considered the impact of this feature on gamblers' behaviour. We present the results of an in-venue shadowing study, which provided measures of player investment and persistence (e.g. number of spins, time-on-machine) from participants undertaking one or more EGM sessions on their choice of machines. 234 participants (162 female) were recruited in-venue, with half (stratified by age and gender) primed by answering questions encouraging 'big-win' oriented ideation. Primed participants were more likely to select jackpot-oriented EGMs, and primed at-risk [Problem Gambling Severity Index (PGSI) > 4] gamblers tended to select machines with a higher median jackpot prize amount than others ([Formula: see text]). Neither PGSI nor priming was associated with the rate at which participants switched machines. EGM jackpots were associated with great spend overall, and PGSI score was associated with a greater spend per play. Positive interactions were found between jackpots and PGSI, and PGSI and priming in terms of predicting greater persistence. Finally a structural model of session level variables is presented, that incorporates positive feedback between money won and number of plays in an EGM session.

Delusions of expertise: the high standard of proof needed to demonstrate skills at horserace handicapping.

Gamblers who participate in skill-oriented games (such as poker and sports-betting) are motivated to win over the long-term, and some monitor their betting outcomes to evaluate their performance and proficiency. In this study of Australian off-track horserace betting, we investigated which levels of sustained returns would be required to establish evidence of skill/expertise. We modelled a random strategy to simulate 'naïve' play, in which equal bets were placed on randomly selected horses using a representative sample of 211 weekend races. Results from a Monte Carlo simulation yielded a distribution of return-on-investments for varying number of bets (N), showing surprising volatility, even after a large number of repeated bets. After adjusting for the house advantage, a gambler would have to place over 10,000 bets in individual races with net returns exceeding 9 % to be reasonably considered an expert punter (α = .05). Moreover, a record of fewer bets would require even greater returns for demonstrating expertise. As such, validated expertise is likely to be rare among race bettors. We argue that the counter-intuitively high threshold for demonstrating expertise by tracking historical performance is likely to exacerbate known cognitive biases in self-evaluation of expertise.

The impact of jackpots on EGM gambling behavior: a review.

This paper reviews literature on how jackpots influence Electronic Gaming Machine (EGM) gambling behaviour. Most of the available evidence addresses the motivational effect of the mere presence of EGM jackpots on play, as actual wins are relatively rare for individual gamblers. The review identifies a distinction between rational, biased and irrational motivations that attract people to EGM jackpots. The evidence suggests that EGM jackpots should generate additional consumption on EGMs above machines that do not have such lottery-like features. Rational motivations are likely to lead to consumer surplus, whereas biased and irrational motivations are likely to contribute to excessive consumption. Moreover, there is evidence that excessive gambling consumption is strongly associated with gambling-related harm. Future research should identify how the structural features of different types of jackpots; such as progressive, deterministic, hidden, mystery, linked and wide-area jackpots; may differentially appeal to rational, biased and irrational gambling motivations. Jackpots are common feature of EGM games, and therefore it is important to have a better understanding of how jackpot features influence play on the machines.

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

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

Unambiguous evidence that over half of gambling problems in Australia are caused by electronic gambling machines: Results from a large-scale composite population study.

Background and aims: It is well understood that engagement with some forms of gambling, like EGMs, is riskier than other forms. However, while reports of associations are common, few studies have attempted to evaluate and compare the relative risk of all available forms, and none have estimated the relative contribution of each form to the total burden of gambling problems (GP) in a population. Methods: Using an aggregated dataset of national and state-based prevalence studies in Australia (N = 71,103), we estimated prevalence and unique effects of frequency of engagement on each form on GP. Two alternative numerical methods were then applied to infer the relative contribution of each form to the total amount of GP. Results: EGMs are responsible for 51%-57% of gambling problems in Australia, and 90% of gambling problems are attributable to EGMs, casino, race, and sports betting. Casino table games and EGMs are equally risky at the individual level, but the former contribute far less to problems due to low participation. Bingo and lottery play show no statistically detectable risk for GP. Discussion and conclusion: The results illustrate which forms present the greatest population burden and illuminate the reasons why. EGMs have an outsized impact. EGM uniquely combines high risk conditional on play, with a high participation rate and a high frequency of play among participants. This is in contrast to risky but less commonly played casino games, and prevalent but non-risky forms like lotteries. We conclude that EGM regulation should be a primary focus of policy action in Australia. More innovative policy ideas relating to EGMs should be tested due to the disproportionate impact of this product type.

Validation of the Consumption Screen for Problem Gambling (CSPG).

A 3 item screen for problem gambling was developed based on a conceptual analogue of the Alcohol Use Disorders Identification Test--Consumption (Bush et al. in Arch Intern Med 158:1789-1795, 1998); a brief screen that measures consumption rather than harm. Data were collected from an email panel survey of 588 men and 810 women (n = 1,398) across all states in Australia. Respondents indicated their consumption of gambling products using the 3 items of the new Consumption Screen for Problem Gambling (CSPG). Receiver Operating Characteristics curve analysis was used to analyze the performance of the new items relative to the Problem Gambling Severity Index (Ferris and Wynne in The Canadian problem gambling index: Final report, 2001). Results show a 98% probability that the CSPG score for a randomly chosen positive case of problem gambling will exceed the score for a randomly chosen negative case. In addition, a score of 4+ on the CSPG identified all 14 cases of Problem Gambling correctly, while only 7.3% of non-problem gamblers had scores of 4+ (sensitivity = 100%; specificity = 92.7%). Lastly, only 3.0% of respondents without any gambling problems had CSPG scores of 4+. The current study suggests that the CSPG, a brief consumption-based measure for gambling products, can quickly and accurately identify people who are likely to be experiencing gambling problems.

Validating the short gambling harm screen against external benchmarks.

Background and aims: The Short Gambling Harm Screen (SGHS) is currently the most frequently applied dedicated measure of gambling-related harm (GRH), though concerns relating to scale validity have been expressed. The current study aimed to address criticisms that several SGHS items do not depict genuine harms that may occur as a result of gambling, causing the scale to overestimate harm. Specifically, we aimed to test convergence between the SGHS and its constituent items with: (1) wellbeing, and (2) psychological distress. Methods: To test criterion validity of both the scale and the items, retrospective analyses of survey data from 2,704 Australian adults (36% non-gamblers; 64% gamblers) were conducted. Subjective wellbeing and psychological distress scores, captured using the Personal Wellbeing Index (PWI) and the Kessler-6 Psychological Distress Scale (K6), respectively, were used as external (non-gambling) benchmarks. A total of 428 (16%) respondents scored at least 1 on the SGHS. Results: Monotonic decreases and increases, corresponding to poorer personal wellbeing and higher psychological distress, were found with each additional SGHS score increase. Gamblers endorsing a single SGHS item reported lower wellbeing and higher psychological distress than both non-gamblers and gamblers who scored zero on the SGHS. Discussion and conclusion: These results show that the SGHS is a valid measure of GRH and contradict suggestions that low scores on the SGHS do not indicate true harm. The SGHS represents a valid and innovative short screening tool to measure GRH in population prevalence studies.

House-edge information and a volatility warning lead to reduced gambling expenditure: Potential improvements to return-to-player percentages.

Cost-of-play information is one public health intervention recommended to help reduce gambling-related harm. In the UK, this information is given on electronic gambling machines in a format known as the "return-to-player", e.g., "This game has an average percentage payout of 90%." However, previous evidence suggests that this information could be improved by equivalently restating it in terms of the "house-edge", e.g., "This game keeps 10% of all money bet on average." A "volatility warning," stating that this information applies only in the statistical long-run, has also been recommended to help gamblers understand cost-of-play information. However, there is no evidence comparing these information provisions' effect on gamblers' behavior. An experiment tested US gamblers'(N = 2433) incentivized behavior in an online slot machine, where this information was manipulated between-participants along with a counter showing the total amount bet. Preregistered analyses showed that participants gambled significantly less when house-edge information or a volatility warning were shown compared to standard return-to-player information, with no effect of the total amount bet counter, and no significant interaction effects. However, these significant findings had small effect sizes, suggesting that a public health approach to gambling should not rely on informational provisions only. Subject to supportive evidence from more ecologically-valid designs such as field studies, these results suggest that improved cost-of-play information could lead to reduced rates of gambling expenditure and therefore benefit a public health approach to gambling.

A speed-of-play limit reduces gambling expenditure in an online roulette game: Results of an online experiment.

UK online casino games are presently not subject to any limitations on speed-of-play or stakes. One recent policy proposal is to ensure that no online casino game can be played faster than its in-person equivalent. Another policy proposal is to limit the maximum stakes on online casino games to £2, to match the current stake limit on electronic gambling machines. This research experimentally investigated the speed-of-play proposal subject to a £2 stake limit, in an online experiment using incentivized payouts based on £4 endowments and a commercial online roulette game, which was slowed-down in one condition to enforce a speed-of-play limit of one spin every 60 seconds. UK residents, aged 18 years and over and with experience in playing online roulette (N = 1,002), were recruited from an online crowdsourcing panel. In the slowed-down condition there was a credible reduction in the amount gambled. This effect occurred via a credible reduction in the mean number of spins which outweighed any potential increases in bet sizes. Speed-of-play limits may be effective in reducing gambling expenditure for online roulette.

Audience influence on EGM gambling: the protective effects of having others watch you play.

One component of social facilitation on gambling is the potential for an audience of people to observe the play of Electronic Gaming Machine (EGM) gamblers and influence their behaviour without participating directly in gambling themselves. An experiment was conducted with an audience of onlookers, purported to be students of research methods, taking notes while watching the participants play an EGM. Forty-three male and 82 female participants (N = 125), aged 18-79 (M = 49.2, SD = 15.6), played a laptop simulated 3-reel EGM using a $20 stake in three conditions: (1) alone, (2) watched by a simulated audience of six persons, or (3) watched by an audience of 26. Outcomes on the poker machine were rigged with a fixed sequence of five wins in the first 20 spins and indefinite losses thereafter. The results found smaller bet-sizes associated with larger audiences of onlookers, and this outcome is consistent with a hypothesized motivation to display more wins to the audience. Moreover, final payouts were greater in the audience conditions compared to the control, further suggesting that an audience may be a protective factor limiting player losses.

The social contagion of gambling: how venue size contributes to player losses.

The Social Facilitation Effect shows performance on many simple tasks is enhanced by crowds of onlookers or co-actors (others performing the same activity). Previous experimental research has shown that Electronic Gaming Machine (EGM) betting behavior is intensified by the belief that others are gambling along with the subject (Rockloff and Dyer, J Gambl Stud 23(1):1-12, 2007). The present study extends these findings by simulating crowds of differing sizes using a fake video-conference along with a live confederate who gambles concurrently with the subjects. Fifty-four male and 81 female subjects aged 18-82 (M = 46.9, SD = 16.7) played a laptop simulated 3-reel EGM using a $20 stake in 3 conditions: (1) alone, (2) in a simulated group of 5 persons plus 1 live confederate, or (3) in a simulated group of 25 persons plus 1 live confederate. The EGM outcomes were rigged with a fixed 20 trial winning sequence followed by an indefinite losing sequence. As hypothesised, gambling intensity, as measured by trials played, speed of betting and final payouts, was progressively greater with larger crowd sizes (P < .05). In contrast, bet-size was slightly lower with larger crowds. The results suggest that gambling venues with more players tend to increase gambling persistence and contribute to greater long term monetary losses.