Transcript el-Guebaly - PRISM: University of Calgary Digital Repository

Factors Influencing the Development of
Responsible Gambling:
A prospective study
N. el-Guebaly, D. Hodgins, G. Smith, R. Williams, V. Williams
*RA: Ronaye Coulson
PREVENTION: Does it Work?
REALISTIC EXPECTATIONS? From Abolition to Harm Reduction
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Experimentation  recreation  habituation  addiction
Social  problem  pathological gambling
Social acceptability: alcohol - targets: driving, FAS …
tobacco - overall reduction (young F)
gambling ?
Culture of moderation vs impairment (Quebec)
Other determinants: poverty, violence …
FINE TUNE! Universal / selective targets - Indicated (2ary)
20-30% or 40-60% reduction
A. Literature Review of Prospective Studies
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The domain literature reviews 1999-2000 questioned the
relevance & significance of domain variables
Addiction - Mental Health - Sociology
Prospective Studies: since 1985 multidisciplinary focus
5 years +
sample size 200+
Gambling Studies - K. Winters et al
- G. Barnes et al Youth
- F. Vitaro et al
Unpublished
- Abbot et al: 7y adult gamblers
- Cottler & C-Williams: 11y drug users (ECA)
Longitudinal Studies are the way to go!
TABLE 1: LONGITUDINAL STUDIES OF GAMBLING BEHAVIORS & PROBLEMS
PROSPECTIVE
STUDY/METHOD
SAMPLE
ODDS OF
PROBLEM
GAMBLING AT
YOUNG
ADULTHOOD
Vitaro et al ‘96
Barnes et al ‘99
-631 boys, 1-10 boys/school,
throughout Quebec
Self-report: gambling, substance
use & delinquency imbedded in
“adolescent life” questionnaire i.e.,
school, dating, health
W 1 at 10-11y: teacher & mother
ratings of behavior
W 2 at 13 y: boys’ gambling (8
items: frequency & amount);
delinquency (27 items); substance
use (38 items)
Study I: adolescent & family
6 waves 1989-96; 699 adolescents from
13-16 until 18-22 recruited through
random-digit-dial sampling. Families
paid US$50 at W 1 & $75 at W 2-3.
Then individuals paid US$25 at W 4-6
W 1 completion 71% of all families; 77%
among blacks
Study II: delinquency in young men
3 waves; 625 males ages 16-19 initially.
Retention rates 97% whites & 94%
blacks.
W 5-6 of study I and Study II, question
about gambling frequency.
Winters et al ’93 & ‘02
Cohort of 305 young adults, assessed
at:
T1 – 1990
T2 – 1992
T3 – 1997-98
Mean ages: 16.0, 17.6 & 23.8
respectively.
49% F, 96% White
At T3: 95% high school degree & 86%
in Minnesota
At T1: telephone list of households
likely to have adolescent, random
sample, 23% refusal but T1 similar to
Minnesota youths.
Attrition at T2: 24%
At T3: sample of low and high risk
group; high risk = prior year gambling >
weekly; SOGS-RA > 2.
1. Parental history
- Gambling linked to delinquency - Gambling & alcohol consumption co& substance use: moderate but
occur & are linked with other behaviors 2. Problem gambling during
significant; stronger relation
such as cigarette smoking, illicit drug
adolescence
between delinquency &
use & delinquency
3. Male
substance use
4. At risk gambling during
adolescence
5. Substance abuse
6. Poor school performance
Longitudinal Designs
ADVANTAGES
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Continuities & Discontinuities in behavior
- which problems persist & which do not?
- predictors of resilience & pathology
- necessity & efficacy of prevention & treatment
- reveals causative mechanisms
- validity of diagnostic constructs related to
outcome
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Variations over time within & between individuals
vs C-S
- age of onset & termination as well as course
- identifies causal mechanisms & chain direction
- “escape” from environment & resilience
- predictors of later functioning
First determination of incidence of gambling
Cost-effective common data pool for all domains
LIMITATIONS
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Limited comparability: lack of standard
assessment & operational definitions
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Confounding age & period effects
- COHORT: group of individuals experiencing
same event over same time
COHORT EFFECT: ie. “Baby Boomer”
- PERIOD EFFECT: influence specific to time
period, ie. “gambling opportunities”
- AGING EFFECT: change due to age, ie, “agedependent leisure”
- Cross-section confounds aging & cohort;
Longitudinal confounds aging & period
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Delay between start of study & first results
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Sample attrition vs contact planning, ie.,
subject, relatives, records, knowledge of who
is missing
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Repeated contacts may influence behavior
Funding & personnel across long time span
B. Selecting the Proposed Design
PRINCIPLES - Across the lifecycle & both genders:
1.
Study gamut of gambling behaviors
2. Assess impact of a changing gambling culture
3. Identify variables enhancing normative gambling &
protective resilience as well as risk variables
4. Identify the potential continuity & discontinuity of
gambling behaviors including patterns of recovery.
The “Accelerated Longitudinal” Alternative
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A multi-cohort sequential strategy reduces F/U period & cumulative effects
of testing & attrition
Several cohorts increase confidence in generalizability
Disentangles aging from period effects only if there is substantial overlap
between FU ages
Retrospective data may link up the intercohort intervals
The critical ages selected for a 5 year follow-up are:
13-15 y initiation to gambling + developmental variables
18-20y high risk, frequent gambling
23-25y adult family, job & leisure activities
43-45y mid-adulthood tasks, educate next generation about responsible
leisure
58-60y* pre-retirement, fund-raising target due to disposable income
63-65y* understudied with various opinions as to impact of changing culture
Other Choices
I.
II.
III.
Tackling the low prevalence of gambling problems (N=1900)
- 300/age cohort: 150 from unselected general population
150 from select high risk sample [gambling frequency 80th percentile]
- Except; 400/adolescent due to:
Age Specific Definitions/Screening of Behavior
Survey administration, Objectives & Cost-effectiveness
Ben & Limit
Interviews Length
Sampling
A. Telephone
Random digital
dialing (RDD)
Edm/Calg/Other
Initial refusal 25%
Attrition rate
13-15%/year
Incentives & tax
Less
Stress Factor
Low
Validity
Good
Flexibility & ownership Less
B. Face-to-face
3 hr
RDD + costly travel
?
?
Higher
Better?
More
C. Mixed
face-to-face 1/2 day initial
RDD for Calg & Edm
+ 4  risk Ft McM/
P Creek/Cardston/Ft/McL
15-30% overall
$50/ 1/2 day, 30 mid, 75 end
RAs & coordinator
Best: endorsement/call ID
Best
Biological Risk
- Neuropsychological functioning
-Frontal lobe
- Neurotransmitter
-DA (blood DNA)
-MAOI activity
- Gender
- Ethnicity
Externalizing Problems
- Alcohol use
- Substance use
- Tobacco use
- Delinquent activity
- Sexual activity
Temperament/Personality
- Impulsivity
- Trait anxiety
- Moral disengagement
Family History
- Social & problem
gambling
- Substance use disorders
- Psychiatric disorders
- Deviance
Cognitive
- Intelligence
- Attentional Ability
- Erroneous beliefs/Knowledge
- Coping Skills
- Problem-solving skills
- Ability to delay gratification
- Ability to challenge cognitions
Family Environment
- Parental behaviour
- Marital Status/conflict
- Financial strain/SES
- Abuse experiences
Stressors
- Physical health/
disability
- School/work
- Familial/peer
- Legal
Extra-familial Environment
- Social skills
- Friendships/peers
- Culture/religion
Broader Socio-cultural Factors
- Availability of gambling; - public attitudes; prevention programs
Gambling Involvement
- Frequency, duration
- Type
- Context
Internalizing
Problems
- Depression
- Anxiety
Gambling Disorders
- DSM-IV
- Problem gambling
- Impaired control
Prevention &
treatment
Additional Choices
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Instruments selection
A. Omnibus risk & protection
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Christchurch Health & Development
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Stats Can Nat Longit Study
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US Nat Youth Survey
B. Gambling & Comorbidity focussed
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Can Problem Gambling Index incl Subst Ab
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NODS (US Impact Study)
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SOGS-RA
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DSM IV TR
C. Specific
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Blood sample
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IQ - Personality (NEO)
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Erroneous Perceptions
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Social Factors & Attitudes
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Exclusion of direct interventions; reporting only
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Interprovincial = different policies & economics
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CIHR pillars:
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Contracted questions
biomedical, clinical, health services/systems,
population health & sociocultural determinants
COHORT ORGANIZATIONAL STRUCTURE
EXECUTIVE COMMITTEE
N. el-Guebaly 1, D. Hodgins 2, G. Smith 3, R. Williams 4, V. Williams 5
DOMAINS/
SITES/AGES
BIOPSYCHOLOGICAL
(Adoles & Adult)
SOCIOCULTURAL
POLICY/
ECONOMICS
Steering Committees
Others
D. Hodgins
University of Calgary
R. Williams+
University of Lethbridge
G. Smith
University of Alberta
- U of Alberta
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- U of Calgary
- N. el-Guebaly
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- R. Williams
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- U of Lethbridge
- Community
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LEGEND
1 Chair, AGRI, University of Calgary; 2 Node Coordinator, University of Calgary; 3 Node Coordinator, University of Alberta; 4
Node Coordinator, University of Lethbridge; 5 CEO, AGRI; 6 University of Minnesota; 7 Harvard University
K. Winters 6, H. Schaffer 7
Project Coordinator:
Library: Rhys Stevens; Research Assistant: R. Coulson
EXTERNAL ADVISORY BOARD
(Budget, Board relation, Coordination)
Anticipated Outcome
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First data set on range of gambling behaviors across lifecycle.
All domains: biopsychological - sociocultural - policy &
economics; CIHR pillars?
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First incidence data
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Common cost-effective datapool for all domains
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Validation of screening instruments across lifecycle
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Strong collaborative project across Alberta’s universities
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A catalyst for interprovincial collaboration (helps policy/
economic domains) & potential CIHR support - April 2003
The search for truth is like looking for Elvis …
on any given day there will be many sightings -- most will be impersonators!