Country- and individual-level determinants of probable problematic gambling in adolescence: a multi-level cross-national comparison.

AIMS: To estimate the role of family and socio-economic indicators of welfare state in accounting for probable problem gambling during adolescence in a representative sample of students living in nine European countries. DESIGN: Data from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) Study were used for cross-sectional analyses of adolescent probable problem gambling. SETTING: Representative surveys in nine European countries. PARTICIPANTS: A total of 31 236 16-year-old students. MEASUREMENTS: Respondents' probable problem gambling, socio-demographic characteristics and parenting (regulation, monitoring and caring) were measured individually. Indicators of wealth (gross domestic product per capita, GDP), expenditure on public health (% GDP) and benefit in kind for families/children (% GDP) were obtained from national public databases. FINDINGS: Students who perceived more parental caring [odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.85-0.98] and monitoring (OR = 0.57, 95% CI = 0.53-0.62) reported less involvement in probable problem gambling. Moreover, students who perceived stronger parental regulation (OR = 1.16, 95% CI = 1.09-1.23) were more likely to be possible problematic gamblers. At the country level, expenditure on public health was associated negatively with probable problem gambling (OR = 0.87, 95% CI = 0.78-0.97), whereas GDP per capita (OR = 1, 95% CI = 1.00-1.00) and the benefits in kind for families/children (OR = 1.16, 95% CI = 0.89-1.51) showed no association with probable problem gambling. CONCLUSIONS: Family characteristics and expenditure on public health may play a key role in explaining probable problem gambling among adolescents in Europe.